My confused patient

I am currently on an orthopaedic inpatient placement where I have been treating an elderly man with a NOF fracture who has communication difficulties. He is from a remote community therefore to be discharged he must be able to climb up and down several stairs in order to board a plane. One nurse will be on the flight with him to assist with climbing the stairs.

I have seen this patient on 3 occasions where he has been taken to the physio gym to practice climbing stairs. Initially although I adjusted my communication, I treated this patient the same way I would any other elderly NOF fracture patient not taking into account the fact that he had never been in a situation like this before. Mr X appeared to be ignoring instructions and did not seem to be interested in the treatment at all. He required x2 mod-max assist to complete the task along with constant prompting during the first 2 treatment sessions.

I began the third treatment session by practicing his ambulation with a WZF around the gym during which I explained that he must be able to climb stairs to board the plane to return home. Even though we had already mentioned this to him he had not previously seemed to understand the relevance of the task. In this treatment session, Mr X’s performance improved significantly and he climbed the stairs with 1 person minimal assistance. I feel this improvement was due to this patient being more familiar with the whole situation therefore not feeling anxious or confused.

I am worried that he will become confused when faced with another unfamiliar situation (the plane). During the next therapy session the nurse that will be accompanying Mr X on the flight will join us to practice assisting him to climb the stairs so that when he does return home there will be one familiar element.

Looking back at the initial 2 sessions where I became frustrated with his performance and what appeared to be lack of interest in the task I realise that his behaviour reflects somebody who is confused and uncomfortable. I will be taking this experience on board when treating similar patients in the future and try to recognise when a patient is confused and not to assume they do not want to learn.