Creating a Fall Risk?
Working in a skilled nursing setting definitely has its benefits and drawbacks, as I am constantly discovering. There is a huge advantage to working with the same patient every day of the week. Watching him make gains and meet goals, sometimes daily, is extremely rewarding. On the other end of the spectrum, working with many who have end-stage dementia or are at the end-of-life can take its toll on morale at times.
One interesting dynamic a therapist can find herself in is when the patient becomes strong enough to be a danger to himself. Over the past few months I've been working with a CVA patient who began therapy unable to communicate or even stand. With daily intensive therapy, this same patient can now ambulate 50 feet with a hemi-walker and minimal assistance.
Our rehab team was thrilled with the patient's success. This was what physical therapy was all about -- returning functional independence back to a patient through hours of facilitation and hard work. I have to admit, the rush of excitement I felt when the patient took his first few steps with the walker outside of the parallel bars is one I'll never forget.
Unfortunately, with his newfound ability to walk, combined with poor judgment, this patient became a major fall risk overnight. The patient, though verbalizing more, still struggles with communication and insists on trying to stand up from his wheelchair every hour of the day. Nursing becomes exasperated too, as their quiet sedentary patient who used to stare out the window for hours is now pulling himself out of his wheelchair with help from the hallway rails.
The joy of the patient's gait progression becomes less exciting with the threat of a possible devastating fall with each passing day. One therapist described the irony of the situation as "making the patients just strong enough to hurt themselves." Which is depressing but true in some cases. We certainly will not withhold treatment to patients just because their cognitive judgment is compromised. So we continue to treat and progress gait along with safety awareness in the hope that the patient will be safe. I try to keep in mind the big picture of therapy -- "return to prior level of function" -- which in some cases can be synonymous with "fall risk."