As key worker how do you manage this situation?

Q. Alice’s main goal is to walk, however the team agree this is unlikely. What should you do now? Select true or false for each of the options listed below.

Following your discussion with Alice she tells you exactly what she sees are the difficulties she experiences in relation to her walking and how she feels she can overcome them

Alice: ‘Okay, I know I struggle to get up from a chair and I need help, so I suppose I need to be able to do that to walk, and when walking in the gym the physios move my leg and stop me from falling. So that makes the physio’s think I can’t walk by myself. But I really think if I had a higher chair I could get up by myself and if they let me try a frame or a stick I would be able to walk without any help’

You now need to start writing her next set of goals with her, what are you going to set and how do you write them?

Q. Alice’s main goal is to walk, however the team agree this is unlikely. What should you do now? Select true or false for each of the options listed below.

Ignore it – she hasn’t achieved her walking goal for the last four weeks, she’s not likely to achieve it now, she’s not listening and it’s a complete waste of time – False – Alice may need more time to come to terms with her disability. By ignoring it you may make Alice feel that she is not being listened to. This may impact on her mood and motivation.

Stop doing patient centred goal setting as Alice is too unrealistic – False – Alice has successfully identified realistic goals previously. Patient centred goal setting ensures that Alice’s views have been listened to and encompassed in her rehabilitation and potentially can be used to help her come to terms with her current abilities.

Discuss walking fully and encourage her to identify what the issues are and what she needs to do to walk. – True – This identifies what Alice thinks are the issues and lets the key worker know what she is thinking. It makes her identify what she requires to do to walk and therefore she knows exactly what she needs to do to achieve that goal. This should make the next review process easier.

Tell her she will never walk again, she must use a wheelchair and walking should be removed as a goal. – False – These goals are Alice’s and it is important that she comes to terms with the fact that she isn’t going to walk. Removal of a goal should only occur if the patient has achieved it or that they accept that it is beyond them. By presenting a wheelchair negatively without explanation and as a last and final resort she may feel that she has failed and be reluctant to use it.

Ensure that as the key worker you know what the team feel Alice needs to be able to do to walk and that you have set aside enough time to do goal setting with her. – True – You need to be fully aware of the patient’s ability when reviewing and setting goals so that you can have an informed discussion with the patient and that clear goals can then be set. Dedicated time for goal setting is important so that the patient feels listened to and can actively engage with the process.

Discuss with her what would be the alternative if walking remains difficult and how does she feel about using a wheelchair? – True – You are not dismissing her walking goal but letting her know there are alternative ways of getting around and what the possible advantages of that might be (using one in the ward may allow her to go to the TV room or the toilet by herself).

Tell her she will walk it’s just a matter of time. – False – It is important to remain positive but not to give false hope.

You encourage Alice to express her understanding of her current ability. Alice states “I can’t stand up by myself, and in physio I need help with my walking”. You realise the next step is to set some goals with Alice.

 

Page last reviewed: 01 May 2020