Motivation: Excellence
Monday November 23, 2009
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Sometimes it’s going that extra step to make sure patients understand not only which exercises they need to do in the hospital, clinic, or home, but specifically why they’re doing them and how the exercises will help the patients achieve their personal goals.
Each therapist has his or her own idea of what excellence means, from pursuing an advanced degree in the field while practicing full time, to beating the odds of a patient’s grim diagnosis. But the best PTs and PTAs are partners, not just teachers.
Tina Zitzka, PTA, at Central DuPage Hospital in Winfield, Ill., and Janene Reeves, PT, DPT, at Barnes-Jewish Hospital in St. Louis, say educating patients, actively listening, practicing patience, and creatively finding fresh ways to motivate patients are a few of the key factors in being an excellent therapist.
Meaningful Motivation
“I can tell someone who’s just had a knee replacement to do a quad set, but they don’t know why they’re doing it,” Zitzka says. “If I teach them that the quadricep is the muscle that guides the knee and you have to strengthen that muscle to move the knee in the right direction, it makes more sense to them.”
Explaining how the body works is often just the first step. “I often see [patients] right after surgery and they still have the nerve block ... they may not be able to feel what I’m talking about, so I have them use their other knee to feel the movement,” Zitzka says.
Whether demonstrating an exercise or describing an activity, it’s important to show the patients how a movement looks from every angle, she says. “Some people are very visual. So, for instance, if the patient needs crutches I will get us both crutches and we’ll walk around the gym together.”
Zitzka says she often helps patients overcome their fears, such as worrying their surgeons won’t be happy with their progress, or that they may not be able to play sports or continue activities that are important to them.
But finding a way to get through to patients who wants to ease up or give up can be a personal challenge. The trick, she says, is making them understand how far they’ve come. Clinical range-of-motion measurements and other objective markers tell a story, she says, but not in the same way as functional milestones. It’s important to point out each patient’s achievements, such as being able to ambulate to the mailbox today when last week they couldn’t. “When they see how far they’ve come, they can see why they need to keep going,” she says.
Zitzka plans to keep going as well. She is finishing prerequisites so she can pursue her doctorate in physical therapy next year while continuing to practice full time. She plans to become a PT.
“I like to be a leader,” she says. “When you’re a PTA, you have to rely on the PT to do the evaluation and make the plan of care. … I want to be able to say this is what’s wrong and this is what you need to do.”
Victory Over Adversity
Physical therapist Janene Reeves works with patients at Barnes-Jewish Hospital who need, among other services, joint mobilization and strength and endurance training. Among her pursuits of excellence was getting her doctorate while continuing to see patients full time.
But one patient in particular, who recently detailed her thanks in a letter to Reeves’ supervisor, helped remind her that practicing excellence in physical therapy is more than obtaining another degree, but means reaching for goals that even a patient’s own physicians may think is too high.
The patient, a woman near the age of 70 with cancer, first came to Reeves when she was undergoing chemotherapy and was hospitalized with pneumonia. At that point, the patient could barely sit up in bed, Reeves recalls. They had a long way to go to reach their number one goal — to convince the patient’s physicians that she was strong enough to receive a bone marrow transplant that could save her life. Because of her age and condition, her physicians said the odds were against her.
In her letter to Reeves’s supervisor, the patient wrote: “My doctors didn’t have much faith that I would ever leave. Janene didn’t give up on me and she always believed I would do it. She is the reason I was able to walk out of here. I remember that she would encourage me to try walking. We would walk along the bed and to the door.
Then we would walk to the exit sign — we always had a goal. … I remember the first time I was able to make a full circle in the hall. That was quite an accomplishment. I will never forget Janene.”
Part of what Reeves loves about her job, she says, is getting to see what people are capable of when someone works with them one-on-one. “I think a lot of times doctors will look at a patient’s age and count them out for a lot of things.” she says. “But I think that’s one of the beautiful things about physical therapy — instead of looking at age and demographics, we actually look at what you are able to do now and what your potential is for getting back to the point before you got sick.”
Reeves helped her patient master the typical progression of mobility with compassion and encouragement, starting with bed mobility and lower-body strengthening exercises, then moving on to sitting and standing balance, transfers, gait training, and endurance activities.
The greatest satisfaction came when Reeves read the end of the patient’s letter, which was written upon her return to Barnes-Jewish Hospital in the spring: “I am here today to get the bone marrow transplant.”
Reeves’ formerly bedbound patient triumphantly returned to Barnes-Jewish ambulating without a walker, and was able to do many of the things at home she had done before becoming so ill, Reeves says.
Most therapists gain satisfaction from their patients’ victories, but being acknowledged for excellence in a letter was particularly exciting. “Most of the time people don’t tend to write-and I don’t blame them,” Reeves says. “They expect to be treated well and fairly. So it’s nice to get a letter like this.” •
Marcia Frellick is a contributing writer for Today in PT.
To comment, e-mail pteditor@gannetthg.com.
