# 77 July 2006

"Be who you are and say what you want, because those who mind don't
matter and those who matter don't mind."

Dr. Seuss

(continues below)

mental health professional trainings
primary care professional trainings
psychological assessment supervision and consultations
Shawn Christopher Shea
links and recommended readings


# 77 July 2006

"Helping a Patient with Organic Brain Damage to Take Their Meds"

TISA Description of the Problem: I personally find few misfortunes more painful to watch than a patient who has been brain damaged, whose life is massively changed for the worse by the few seconds involved in an accident or the aftermath of a bacterial invasion such as meningitis. The confusion and fears of these patients sometimes complicate their ability to take the very medications that can help them the most. In the following compelling interviewing tip and strategy, Katherine Cherrington, RN provides some true wisdom. I hope that you enjoy it.

Tip: Sometimes patients with brain damage cannot even remember why they are taking their meds, and consequently may become appropriately frightened or agitated when asked to take them. In such situations, staff sometimes choose to follow the patient around with the medication in tow, often perceived by the confused patient as an attempt to be "forced" to take something they do not even remember they need. Such actions neglect the patient's sense of personal space, while making it more difficult to allow the patient to have the needed time to re-process why they need the med and what might be the damaging results for the rest of the day if the med is missed or the patient becomes upset about the issue of taking the meds.

This approach often results in the outright refusal of medications, an increase in agitation and even violence (occasionally resulting in a patient being placed in seclusion until the patient settles). This scenario is often followed by a breakdown in trust and feelings of being wrongfully accused by the staff of noncooperation.

In contrast I have found the following strategy to be frequently useful. After discussion with the treatment team and the patient we agree upon a simply stated set of goals for the patient such as:

1. He/she will take medications.
2. He/she must remain calm.
3. He/she will talk to the assigned staff about any concerns.

Because of memory impairment the patient will be gently reminded of these shared goals at least daily (and often times multiply throughout the day), thus there are no surprises for the patient when medications are offered, for the patient is expecting them.

If for some reason the patient refuses the medications, my approach is simply to remind the patient of our shared goals (which have been written down on paper for just such moments of sharing). I gently remind the patient that this is solely his choice and what the consequences might be depending upon his choice. I will then let him know that I will be at the medication room in 15 minutes, and that I hope that he makes the right decision that will help him to make the best gains for the rest of the day.

If he has started to feel a bit agitated, I remind him that it is not too late to turn things around and make sure the rest of the day goes great, and I'll see him in 15 minutes at the med room. Done with a reassuring calmness and lack of "forcefully pushing the meds," I find that this approach has often been very successful.

TISA Follow-up: This is a great tip and emphasizes the power of forming a collaborative relationship over medications in which the patient feels we are working with each other against the problems caused by their illness. Katherine's tip would fit in wonderfully with the approach called "the Medication Interest Philosophy" that forms the basis of my upcoming book "Improving Medication Adherence: How to Talk with Patients About Their Medications." The book has over forty interviewing tips for helping patients to feel more comfortable and interested in taking their medications. It's the first book of its kind. Please keep your eye out for it this upcoming August or September when it will hit the bookstores and amazon.com (Published by Lippincott Williams & Wilkins).

Tip provided by:

Katherine Cherrington RN
(who also provided the quote of the month!)
Whitby Mental Health Centre Corporation
Whitby, Ontario, Canada