Leadership qualities are needed to produce good outcomes for physical therapy patients in home care. As a physical therapist (PT) in Staten Island, NY, I often find that it takes ingenuity to work with individual patients, each with their own life story, personal circumstances, dreams, fears, and personal goals. I strive for the best outcomes by approaching each patient with respect and enthusiasm, regardless of their medical, social, or psychological issues. One thing I love about being a PT in home healthcare is the ability to get to know each patient as an individual. This allows me to craft a realistic plan of care that encompasses the patient's goals and recognizes their personal circumstances.
We clinicians frequently encounter situations that require us to devise "out of the box" solutions. Drawing on our leadership skills, we make change happen and deliver results while coping with the unexpected. It's all in a day's work. As PTs, we routinely find ourselves doing comprehensive assessments for patients and establishing realistic goals focused on improved functioning and mobility, while also meeting that patient's personal goals. We then take fast, appropriate action to achieve the best possible outcomes.
Thinking back on challenging situations makes me recall a patient named Theresa. She lived with her supportive family who were involved in her care, but she was angry, as stubborn as a mule, and alienated nearly everyone who tried to help her. She suffered from end-stage renal failure and required dialysis thrice weekly. My biggest concern was that she frequently fell. She fought my safety suggestions tooth and nail. A Visiting Nurse Service of New York social worker provided Theresa with supportive counseling and community resources, including Meals on Wheels-which of course, she absolutely hated.
On my first visit, I recommended that Theresa use assistive devices, including a "grab bar" in the bathroom. In her words, a grab bar would look "hideous." I also encouraged Theresa to avoid falls by getting rid of her throw rugs. I carefully folded them and put them on a closet shelf, but when I returned for my next visit I found them all back in the exact same spots. Finally, while Theresa was out of the home, her family and I orchestrated some safety installations. One grandchild had the idea to decorate her grab bar, which we were pleasantly surprised to find, made it acceptable to her.
One day I noticed Theresa staring out the window at her car. She yelled: "I would love to go out and warm up my car. But if I move, everyone hollers, 'Don't do that! Sit here! Don't get up! You will fall!'" Theresa was letting us know that she'd lost confidence and felt frustrated at what she perceived as lack of control over her life. With time, patience, encouragement, and hand-holding, we were able to help Theresa regain self-confidence and control over her life. Although she could not do some of the things she had done earlier in her life, she was able to regain some of the control over her life, at least to a point that was acceptable to her.
Theresa died last year, but I clearly remember how she taught me to understand each patient's goals, feelings, and desires. She helped me to remember that sometimes, angry behavior on the part of patients is understandable. When patients see us sincerely wanting to help them, our leadership can be contagious. With a lot of support and understanding, many times, patients like Theresa become leaders in their own care. And this is the best outcome we can ask for.