I am currently on my neuro prac on a stroke/rehab ward. On my first day I was writing notes at the nurses desk when a nurse hurried past calling for a doctor and some assistance. One of the patients on the small ward had tried to end his life by jumping off the balcony before the nurse had managed to get him back inside. The patient who had suffered a stroke was hemiplegic and had communication problems and was clearly frustrated and angry at the attempts made to prevent him hurting himself. The patient continued to scream on the ward, swearing and saying that the staff should of just let him die before a doctor calmed him down by sedating him.
This is not the first time this year that I have dealt with patients who have attempted to end their life however I have never been experienced to the situation actually taking place. I cannot even begin to imagine the emotional turmoil that some of these patients are going through, having to depend on others for all their basic needs when previously they were completely independent. Today I had one of my patients tell me that he wanted to die. He has been an inpatient for over 10 weeks and his progress has started to stagnate in terms of functional gain. What do you say to someone who shares that with you? Encouragement throughout treatment sessions is crucial but as Andrew said it is so important to be careful of what you say, so that you don't give people false hope.
I think it is important to be aware and very conscious of the fact that people who have had an acute neurological insult are more prone to having negative thoughts and feelings of hopelessness. This can carry over to you and be quite a burden yet you can't pretend to know how the person feels. At the end of the day, referral to psychologists may be required but patients are still going to reveal their darkest feelings on occasion and it is necessary to know how to handle these situations with tact and not disregard them.
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2 comments:
Scary post,
I've done a prac on a neurosurgery ward and talked to pt's who do not seem to happy that they are still alive. I havent had an experience as direct as yours and I would find it quite difficult. We are going to be professional's and as such need to maintain professional relationships (and somewhat distant) with our pt's, but in these situations it's kind of hard.
Important for the PT to chat to other members of the team- in this case the senior PT and the clinical psychologist- in order to get ideas as to what may be helpful to say to the pt, and in order for the pt to be supported to get through the difficult phase. Re not offering false hope- these 2 clinicians will also be in a better postion that you to have an idea of prognosis. Also important to set small achievable goals that have some meaning to pt - often involving time with other family members. Also important for PT to consider own mental health and consider what resources are available to PT- sometimes the carer also needs care.
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