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For the patient with limited mobility, the clinician’s choices and actions play an especially important role. Even the seemingly small aspects of the clinician’s behaviors can have large effects on the patient’s experience and potential for future mobility during draping, positioning, assessing vital signs, or performing a dependent transfer. The clinician’s abilities to establish rapport with the patient and engage the patient in the task, to create an environment conducive to mobility, and to establish baselines and monitor responses to activities can be powerful influences on the patient’s capacity for mobility.
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ATTENDING TO THE PERSON: ESTABLISHING RAPPORT
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A patient’s behaviors are a function of both the person and the surroundings.1–4 As a clinician, you become part of the patient’s environment, and the nature of your interactions has a strong influence on the patient’s behaviors and thus the clinical outcome. Consider this: A cold, uncomfortable, or otherwise unpleasant environment is much easier to tolerate if you feel safe and are in the company of kind and respectful people. A beautiful setting, on the other hand, can seem intolerable if you are surrounded by overpowering people you feel you cannot trust.
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It is the clinician’s obligation to create an optimal psychosocial environment for the patient. In doing so, clinicians must guard against biases and the natural tendency to make assumptions about a patient based on age, education level, or other factors.
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Being attentive to and respectful of a patient helps reduce the patient’s anxiety and allows the patient to focus more fully on the mobility task. When interacting with a patient:
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Obtain the patient’s consent before initiating treatment.
Listen to the patient’s information, questions, and concerns. Take time to respond, and respond genuinely.
Be clear about the patient’s goals and how your planned activities fit into those goals.
Maintain patient confidentiality. Speak about patients respectfully in their presence and absence.
Be aware of power differentials, intended or otherwise, between you and your patient. Minimize the perceived power differences when possible. Move to be at eye level with your patient, use language that is familiar to your patient, avoid patronizing comments or gestures, and so on.
Implement a caring touch while respecting the patient’s cultural preferences and personal boundaries.
Explain all procedures to patients before initiating them, even if you think your patient is not able to understand.
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When the clinician makes physical contact—to position the patient or to assist in a dependent lift, for example—the rapport that has been established can determine whether that contact is effective or is resisted by the patient.
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Matching your expectations to your patient’s true capabilities also tends to yield better mobility outcomes.5–8 When your expectations are too high, the patient can become frustrated and give up. Inappropriately low expectations, on the other hand, are associated with overprotective behaviors, which foster continued ...