A Very Confused Patient

Hi Guys,

I am on my ortho placement. This particular patient was from the #NOF ward and as you can imagine these patients tend to be quite elderly.

This patient was an elderly Aboriginal male from the Gascoyne region with a # NOF (L). We were asked to teach this man how to climb stairs so he could get up into the plane in a few days time. In comparison to many patients on the #NOF ward this man, at first appearance, seemed quite good. So we wheeled him to the therapy area to get him started on the stairs.

We first demonstrated the process and then assisted him to the steps. Ascending the stairs he required much prompting but completed them successfully. However, when we reached the top he seemed to get stuck. We asked him to turn around but it was like he was frozen. We tried explaining that once he got down he could sit and have a rest...no response. And then (i'm assuming he was quite tired at this stage) he began to sit down. Both of us screamed to get him to stop and i jammed my leg behind him to stop him from sitting. We eventually got him back down.

It's horrible watching your patient slowly descend to the floor because you know once they're on the floor they won't have enough muscle strength to get up. The only option would be to get a hoist because the set of stairs are quite narrow and it would be near impossible to get a person either side of the patient to help get him up. I think the reason it happened was because we talk to much. I thought we actually simplified many of our instructions but on further consideration i think we continue to talk to fill the empty silence. It takes a long time for patient's to do simple things like take a step and so we fill the silence by explaining why we're doing it, what we're going to do after this task etc. But they can't focus on more than one thing at once and are easily distracted. So, unconsciously, we might have said the word 'sit' in the preceding sentence and before you know it that's what he was doing =p

Next time the instructions have to be less wordy and very simple. I think even a sentence might be too much. And commands will have to be one or 2 words. I would stop talking in between and just allow him to take his time and complete the task. I would consciously try to avoid using the word sit (especially when the patient is at the top of the stairs). Using hands to guide the movement more than we actually did may have been useful for this patient as words seemed to confuse him.

After the initial scare on the stairs this patient progressed quite well and is noew able to manage stairs with much less prompting and assistance. He should be getting on the plane some time this week.