Nurses and Therapists working together to achieve a common goal: a healthy, independent patient
As a physical therapist who practices in the acute care setting I have had a lot of interaction with nurses throughout my career. One thing I have consistently seen when working along side a nurse in a patient’s room is the difference in the amount of physical assistance I initially offer a patient versus how much a nurse provides. When it comes to assisting a patient I tend to abide by the policy “let’s see what you are able to do for yourself” before I provide any physical assist. Whereas my nursing colleagues often do not allow the patient the hassle of struggling to get themselves situated when prepping for a transfer or performing bed mobility. I strongly encourage all nurses reading this right now to NOT do this and be patient. It is okay to let the patient struggle. Do not feel obligated or feel bad if they are having difficulties; as learning to do for themselves will be to their health benefit while under our care and services.
Providing this level of assistance to patients automatically can cause them to become reliant and may increase their debility through learned helplessness. Once this occurs the soliloquy that follows only makes the patient less and less independent and thus increase their burden of care in the future. Allowing a patient time to problem solve, initiate, and attempt to complete tasks such as repositioning themselves in bed or transferring from supine to sit empowers the them to be able to participate in their care and in turn causes them to build strength and even improves cognitive awareness. If a patient were to remain passive in their care, inhibition of both mind and body would be the result which directly interferes with our goals for the patient as clinicians.
So when I am in the patient’s room and I see nurses providing this level of assistance, I tend to ask them to try and hold back a little to allow the patient a chance to perform the task independently. When I do this I realize that more often than not nurses find this strange or even cruel that I am willing to stand there and watch a patient struggle to move around or sit up. Judging by that nurse’s body language I can see their urge to want to reach out to assist the patient when they see the increased time it takes for them to complete their task and the patient expresses discomfort or exertion. Am I wrong to do this? As I mentioned above my reasoning is just, so are nurses wrong to want to assist? I would argue that they are not wrong either.
Assisting the patient to complete tasks is a part of their training. So why the different mentalities between our two disciplines while caring for a patient? Maybe because we both come from two different schools of thought. In nursing, though I have never been educated formally in nursing school, their training includes a lot of goals for patient satisfaction while in the acute care setting. The idea is to tend to the patient to satisfy any needs they may have including that of mobility. With this in mind a patient struggling to complete a task may seem like you are not satisfying their needs and causing unnecessary burden on their behalf. So assisting them to eliminate this burden makes the patient more satisfied with the level of care they are being provided while in the hospital. So the nurse has treated the patient within this school of thought, which differs from that of a therapist.
So what is a therapists school of thought? Oddly the goal of physical therapy is often to make ourselves obsolete. Does not do much for our job security does it? However, our goal for a patient is for them to return to their prior level of function with their mobility and often that is independent. As the saying goes practice makes perfect. The more opportunities a patient has to practice independence with their mobility the more they are able to correct and perfect the movement to return it to its normal efficiency. A lot of what therapist do during treatment is verbally cue and facilitate re positioning to improve efficiency of the task to allow the patient a greater chance at completing it successfully on their own.
The differences in time management between the disciplines may play a role in this as well. Therapist in the acute care setting often can delegate as much time as needed with a patient, however nurses may not have that luxury. Often nurses have several patients on their caseload at one time and they may all be requiring that nurse’s attention at that time. So allowing a patient to struggle and slowly complete a task could be inefficient for both the patient and the nurse. So providing total assistance completes the task faster and the patient is happy and the nurse is able to move on to his/her next task. If you are guilty of this as a nurse or a therapist I strongly urge you to consider not to allow yourself to do this. In therapy we treat the patient’s needs by educating them on what they can do for themselves and facilitating their practice in doing so. If we can continue to carry this over consistently throughout the patient’s day, then soon they won’t even need your assistance at all! That is one less patient you will have to worry about tending to for mobility to meet their satisfaction.
So nurses reading this lets work together. Let’s take the extra time to see how much of a mobility task a patient is able to accomplish on their own. Obviously certain emergent situations would warrant total assistance however if we can consistently allow a patient to practice a certain task between disciplines we can increase carry over and decrease the burden of care for that patient at a faster rate. Communicate with the therapist to see how each particular patient is transferring and more often than not the therapist will give you tips on how to assist that patient with their transfers. This effort to perform interdisciplinary care in the long run benefits the patients that we are here to serve and will also build cohesiveness between disciplines building a stronger healthcare team.
Read part 2: LET’S GET PATIENTS UP AND OUT OF BED (part 2)
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