Patient Communication

I recently saw a 66 year old patient who was a day 1 post-op for a Whipple’s procedure. She also had other co-morbidities in that she was completely deaf in her (L) ear, and had only partial hearing in her (R) ear. The patient also subjectively stated that she used a walking stick at home during ambulation as she had poor strength in her (L) LL and would often “loose her feet” and fall to the left. The patient had been nauseous and vomiting earlier in the morning but felt better later in the morning when I saw her.

From reading the patient notes I identified that communication obviously would be an issue in treating this patient. The nursing staff also mentioned that she displayed some minor cognitive deficits. I planned to address this consideration to treatment by making sure that the patient had their hearing aid switched on at an adequate level, and to make sure that when I was speaking to them that I was talking to her good (R) ear with clear simple language. If it was needed, I was also prepared with a small whiteboard and marker for communicating if there were any hearing or language issues.

I had planned to explain the purpose of physiotherapy after her operation, and then what we aimed to do today. I knew that this would be essential to avoid any confusion once actually mobilising the patient. At the time I believed I had adequately explained everything necessary, the patient seemed to understand everything discussed, and I was ready to ambulate the patient. During ambulation I was conscious to stay on the patient’s weak (L) side that she had already explained occasionally gives way. The problem I encountered that I hadn’t planned for was that although I had adequately explained what we were planning to do prior to standing the patient up, once I was on her (L) side she had great difficulty hearing me even when I spoke with a loud clear voice.

I was asking her questions to monitor how she was feeling as we were ambulating, however, she was not replying and began to look very pale. I sat her down at a chair that I had previously set up as a rest spot if the patient needed, however, we had planned to go to the chair set up further down the hall. Once she was sitting I could get to her favoured side for hearing and she had no other distractions, I was able to communicate effectively with her. She had felt a little bit light headed and was in slight pain but didn’t feel as though she needed to be sick or was going to fall while we were ambulating.

At that point I called one of the nurses over to assist me with ambulating the patient slightly further up the hall and then back to her room, once she started to feel better. By doing this the nurse was able to stand on her (R) side and communicate more effectively with her. After this the patient was actively communicating to us, and later stated that she felt safer when she had the nurse telling her she was doing well. The situation has helped me with planning of similar issues by making sure I consider adequately monitoring patients subjectively, even if it means getting the assistance of someone else in a situation where you may think you can otherwise do it yourself.