Help please! Cerebral Palsy PhysTherapy

dishes, BSN, RN · Jul 28, 2016

She needs to be assessed by a physiotherapist and the PT can demonstrate the proper way to stretch her. Do NOT try to stretch her without professional training.

Kitiger, RN · Jul 28, 2016

What are her Mom's thoughts? What has worked in the past? Before the doctor appointment, can you talk to her Mom?

Does she see an ortho doctor regularly?

When were her last X-rays taken?

Baclofen is normally given 3 times/day. Is she only getting it twice a day? ???

Her doctor can order PT as a consult.

BabyFood26 · Jul 28, 2016

She needs to be assessed by a physiotherapist and the PT can demonstrate the proper way to stretch her. Do NOT try to stretch her without professional training.

I understand your concern. She did have only one PT consult done in which I was involved in and was able to gain the hands on training from the PT to do those 2 exercises. Ok, So then I should not try anything new until she gets another one. I'm just so frustrated :down:

BabyFood26 · Jul 28, 2016

What are her Mom's thoughts? What has worked in the past? Before the doctor appointment, can you talk to her Mom?
Does she see an ortho doctor regularly?
When were her last X-rays taken?
Baclofen is normally given 3 times/day. Is she only getting it twice a day? ???
Her doctor can order PT as a consult.

Her mom is very wishy washy, very avoidful of new situations, close minded to any new advice, had a PT consult done once, I was on duty at the time at which time the PT instructed me on the proper techniques to use on her.

She only sees a primary care provider once every 4-6 months.

Her baclofen is actually only twice a day. With the exception of a seperately ordered PRN dose that mom is allowed to give at her discretion. Which is not often.

I should note that she has 3 other nurses, she has 24hr care. I honestly with all my heart do,not believe that they take the time to do these exercises with her though.

As far as any diagnostics like XRAYS, no the mom refuses just about everything. It's extremely frustrating. I'm at my wits end. I don't want to throw the mother under the bus, but her fear of trying anything new is totally crippling any chance my pt has of a better quality of life.

dishes, BSN, RN · Jul 29, 2016

Your over-protective comments about 'my patient' and 'love her to death' and undermining of the patient's mom and nursing colleagues are warning flags that you may be at risk of crossing therapeutic boundaries, if you are too emotionally invested in her care, you will not be an effective advocate for her.

sallyrnrrt, ADN, RN · Jul 29, 2016

Op, I agree with dishes

Kitiger, RN · Jul 29, 2016

Question for doctor: Is the pain from increasing scoliosis putting pressure on internal organs or is it from muscle spasms?

TheCommuter, BSN, RN · Jul 29, 2016

Thread has been moved to the Rehabilitation Nursing forum for more replies.

BabyFood26 · Aug 13, 2016

Your over-protective comments about 'my patient' and 'love her to death' and undermining of the patient's mom and nursing colleagues are warning flags that you may be at risk of crossing therapeutic boundaries, if you are too emotionally invested in her care, you will not be an effective advocate for her.

I was actually very surprised when I read your comment. It never crossed my mind that I might be compromising her care by acting too emotionally attached, almost as if she were my own daughter. My comments pertaining to the mother and other nurses were just my general observations, and genuine concerns. But I'm very curious now, if all of these things that I have "concerned " myself with have actually hurt me instead. I really appreciate your honest opinion and I do agree with you that I have entered that danger zone of exiting the therapeutic range and entering un-professionalism. I felt lost and this really helps me to see that there's much more that needs to be addressed in my own professional development. It has been difficult for me doing in home care. I have a daughter, i see alot of her in the patient and I have become attached to this family and the patient like they are my own. Do you think it is wise to find employment in a different field? Or is it possible to retrain myself? I'd appreciate your feedback. You seem very informed. By the way, when u are doing one on one care, and in home care, is it technically wrong to refer to the patient as "my patient?" I'm asking bcz it simply flows out of my mouth on a regular basis. What is the professional way to say it?

JustBeachyNurse, LPN · Aug 13, 2016

I was actually very surprised when I read your comment. It never crossed my mind that I might be compromising her care by acting too emotionally attached, almost as if she were my own daughter. My comments pertaining to the mother and other nurses were just my general observations, and genuine concerns. But I'm very curious now, if all of these things that I have "concerned " myself with have actually hurt me instead. I really appreciate your honest opinion and I do agree with you that I have entered that danger zone of exiting the therapeutic range and entering un-professionalism. I felt lost and this really helps me to see that there's much more that needs to be addressed in my own professional development. It has been difficult for me doing in home care. I have a daughter, i see alot of her in the patient and I have become attached to this family and the patient like they are my own. Do you think it is wise to find employment in a different field? Or is it possible to retrain myself? I'd appreciate your feedback. You seem very informed. By the way, when u are doing one on one care, and in home care, is it technically wrong to refer to the patient as "my patient?" I'm asking bcz it simply flows out of my mouth on a regular basis. What is the professional way to say it?

you crossed the line. You see your daughter in her. You need to be reassigned to another client. You are too emotionally involved clearly resentful of the mother and other nurses. You are now risking your job. YOU CANNOT BECOME ATTACHED TO THR FAMILY AND (patient) CLIENT AS IF YOU WERE A RELATIVE.

You need to call your manager to transition off this case if not get fully reassigned to other cases.

While it's nice to have primary nurses I think it at times creates a mutual dependency and barriers are readily crossed

My agency uses client to remind us that this is not family or a friendship but a professional relationship. Several nurses have crossed the line and a few now have their jobs in jeopardy for assuming all families are their new BFF and the client is "like their own", lied about an error assuming a new client would back them up and got way too comfy in a new client home. The struggling parents arriving home with a critical child already overwhelmed with grim prognosis were not so forgiving. The nurses were shocked that parents complained when parents "always love them". In fact both have been caught badmouthing coworkers to gain favor with a family. This time it backfired

Nurses who feel the need to form personal bonds with clients need to stay far away from 1:1 PDN/hone are especially with pediatrics. This is not family, not your new BFF

BabyFood26 · Aug 13, 2016

you crossed the line. You see your daughter in her. You need to be reassigned to another client. You are too emotionally involved clearly resentful of the mother and other nurses. You are now risking your job. YOU CANNOT BECOME ATTACHED TO THR FAMILY AND (patient) CLIENT AS IF YOU WERE A RELATIVE.
You need to call your manager to transition off this case if not get fully reassigned to other cases.
While it's nice to have primary nurses I think it at times creates a mutual dependency and barriers are readily crossed
My agency uses client to remind us that this is not family or a friendship but a professional relationship. Several nurses have crossed the line and a few now have their jobs in jeopardy for assuming all families are their new BFF and the client is "like their own", lied about an error assuming a new client would back them up and got way too comfy in a new client home. The struggling parents arriving home with a critical child already overwhelmed with grim prognosis were not so forgiving. The nurses were shocked that parents complained when parents "always love them". In fact both have been caught badmouthing coworkers to gain favor with a family. This time it backfired
Nurses who feel the need to form personal bonds with clients need to stay far away from 1:1 PDN/hone are especially with pediatrics. This is not family, not your new BFF

Thanks for your input. I appreciate insight from more seasoned nurses and experienced individuals. However, I do feel as though your starting comments were a bit judgmental and belittling towards me as a professional. It is not that black and white. I would appreciate if the entire context of my comments were taken into full consideration. In this I mean that

In fact, I already stated that I could see that there was a shift in my therapuetic technique into emotional attachment. Now that I've seen this, I simply asked if I could retrain myself or I should search for a new career path as an lpn. The other stuff in your reply was a bit excessive and unnecessary. That is just my opinion.

The way I expressed my opinion of the mother might have seemed harsh, but I do not resent her. I am not sure what you mean by nurses being concerned with being BFFs with the family. When you spend 5 to 6 days a week with a family for over a year and have accompanied them to special occasions such as birthdays, etc. as the pts caregiver of course. I guess then this brings up another question.

How do i act like i care, but not get attached?

What makes a good 1:1 caregiver?

I understand now going back and reading my comments about the pts mother were unprofessional. I regret that. I have gotten to know very well and that might be true about the resentment.

A few things i need to address is that I DO NOT use the pts family approval and love for me as validation for being a qualified professional. In any case. Perhaps you've had some experiences yourself with 1:1 care that have tainted your view on home health nurses? That is a genuine question, not a snotty remark.

I would also like to put it out there that i readily communicate and enjoy problem solving with my fellow coworkers and have never thrown a nurse under the bus to gain brownie points or lied to cover up an error, etc. I strongly believe in there existing an entire team to care for a complex home care case such as this. I am not comfortable with being the "sole" caregiver, and have never witnessed any patient benefit from it. Hence my feelings of concern and reason for reaching out.

I accept constructive criticism. My only concern here is that the point of us all being here is to listen with open hearts and minds, and use our experience and education to help those in need of guidance. I think that there are times when all of us jump to the conclusion that it needs to be assumed as the person in need of guidance is the worst case scenario and there is a need to come hard right out of the gate.

I hope all individuals involved in this thread understand that their replies are all appreciated and taken into consideration. But I am not comfortable with certain assumptions.