dont get tunnel vision

On my neuro placement, I was in a neurological ward, and I had a few patients on my caseload that had sustained a severe traumatic brain injury. As you would know, in patients with severe traumatic brain injury, often there is little or no voluntary movement present. Some may have even lost the ability to speak, either directly because of the injury, or because they have a tracheostomy in situ. This was the case with a few of my patients. In such cases, obviously the subjective assessment is very limited, with the patients’ inability to communicate being the limiting factor. This often makes it very difficult to identify with the patient, socially, as a person, and to gain a picture of the person they were in your mind. Coupled with this, often upon reading the notes, there is no social backround available beyond the patients name and age, because maybe they have no family to provide this information, or for other reasons. These factors can make it very difficult to understand the person that they were before their injury, and its hard to see beyond the nearly comatose body that lies in the hospital bed.

Added to this, the ward was very fast and demanding, and as it was one of my earlier placements, I was very nervous about my abilities and found that my mind was constantly racing to plan treatments and assessments. With the patients with severe TBI, I apportioned little time to subjective assessments, concentrating on my manual handling and just really trying to remember everything. As such, I became very tunnel-visioned in my assessment and treatments of my patients, partly due to anxiety over this being my neuro placement, and partly because I guess was so focused on what I had to do. I began to see the patient in my mind as “room H: do passive movements, muscles stretches, possibly sit up, remember to keep knees blocked”.

My curtin clinical tutor had a very different perspective. While commending me for my focus on treatment plan and my manual handling, she also gave me constructive feedback regarding my inability to consider the patient as a whole. I noticed that she was very compassionate towards these patients, and thoughtful. She would be very sensitive to the slightest flicker of movement from a patient or the slightest show of will or emotion, and would really try hard to identify with the patient. She would spend a lot of time just speaking to the patient, encouraging them, and trying to get consistent responses from them.

She helped me to see that inside these often comatose looking bodies is a mind that thinks and a person that feels, just like anyone else, and that part of my job was to help these people to break out of the silence and stillness and help them to gain movement again, and be able to express themselves. She taught me to think beyond just the physical impairments and to consider how the patient is feeling, what is going on inside their mind, where they are at emotionally. My tutor helped me to see beyond the condition, to the person.

I realize that from time to time I slip into the frame of seeing the condition rather than the person, and in some patients, maybe this does not matter as much as with others, but since having the neuro prac I am now much more aware that a condition can almost never be separated from a person.