Kathleen Keenan, Physiotherapist in Rehabilitation, NHS Ayrshire and Arran.
As a physiotherapist working in a rural community hospital, one of the biggest challenges I face each day is managing expectations.
I began my career around 10 years ago: back then, I remember seeing most of my patients each day. Times have changed – an aging population versus a relatively static number in our workforce means increasing demand is placed on our services and we have to look differently at how we provide them to ensure quality and efficiency.
Try explaining this to 80 year old Jessie and her family. Walking into the rehabilitation ward I cover at visiting time can feel like I’m in the wild, being stalked by a predator waiting on its moment to pounce. Jessie’s daughter wants to know why she hasn’t been seen today – Jessie was told she was coming to the rehabilitation ward for “intensive physiotherapy”. Now, where did that phrase come from??
The reality is that Jessie didn’t have any physiotherapy because there’s one of me versus up to 20 ward patients, a day hospital service, outpatients and all of the resultant paperwork. Jessie herself is exhausted – she is battling multi-morbidities and still recovering from her most recent acute event, a fractured hip. If I’d had the time to see her today, would she actually have been fit? I have tremendous sympathy for Jessie’s daughter – she just wants the best for her Mum.
It’s taken me a long time to accept that I can’t see patients every day but I ask you to consider this; if you were in their shoes, would you prefer me to see you every day for 5 minutes or spend longer on a quality session, say 3 times per week, where I actually listen to you and work towards your goals?
Early and honest conversations involving patients and their relatives are a good place to start in managing expectations. When people are informed about a service and know what to expect, they are less likely to be disgruntled. When I chat to Jessie’s daughter, she admits she hadn’t really considered that Jessie’s OA knees and COPD would play a part in how well she recovers from her hip fracture.
Self management is another key solution – a challenging concept for the age group I work with. Their generation typically expect to be given a “treatment”, not to have to invest anything themselves! Showing patients an exercise programme that can be completed independently (or with the help of visitors) out with formal treatment times can encourage them to take some control. No, I tell Jessie, I don’t need to be there watching you for it to count as part of your physio!
Now, none of the above is ground breaking. We are encouraged daily to be innovative and try new ways of working but it’s also important to remember that simple things can go a long way.
Sit Less Move More Feel Good! (Glasgow University, 2019) tells us that the average older adult spends 7 hours per day sitting. Changing position from sitting for a few minutes every 30 minutes can provide a multitude of health benefits.
So I ask this of anyone who has contact with a patient in hospital: use your contact as an opportunity, if it’s safe, to get them moving. Take 5 minutes to go through their exercises, ask them to stand up, take them a walk to the window. All of these things are part of the whole physiotherapy package.
Now back to the ward I go, with my best smile on, to face today’s round of questions from Jessie’s daughter…
Written by: Kathleen Keenan, Physiotherapist in Rehabilitation, NHS Ayrshire and Arran.
Sit Less Move More Feel Good (Glasgow University 2019) – https://sitlessmovemore.uk/sign-up/index.html