On a recent women’s health placement I was seeing a patient following hysterectomy, who also suffered from Parkinson’s disease, which had been poorly managed (medically) since admission. The patient was previously coping at home with support from her husband, but it had been documented in the notes that nursing staff were struggling to mobilise her for personal care with 2 x max assist and were requiring the assistance of a hoist.
My supervisor and I assessed the mobility of the patient and were able to mobilise approximately 10 steps on the spot with a WZF and 2 x minimal assistance, with lots of verbal encouragement/ reassurance. As we were performing this assessment a member of nursing staff entered the room. She had previously submitted a form/ report stating it was an occupational risk to attempt to mobilise the patient without the use of a hoist. She felt we had undermined her ability/ decision making by not taking into account what she been documented in the medical notes. She became very emotional, raised her voice and used coarse language, stating “what makes you Physio's think you can do it, when we couldn't” and that our input would not mean the patient would return home but rather would still end up in a high care facility – in front of the patient and her family!
My initial reaction was shock. I felt very uncomfortable and slightly embarrassed to be part of a team of health “professionals” when this act was clearly unprofessional. I couldn’t help but feel sympathy for the patient as her feelings and goals had been completely discounted by this nurse. I was also concerned that we had not communicated effectively with other members of staff before beginning assessment/ treatment.
My supervisor took the nurse out of the patients room to calm her down whilst I was left in the room with the patient and her family (on my first day at this facility!). I attempted to apologise to the family who were also shocked, but very understanding, and re-assured them that we were doing everything we could to improve her mobility and discharge her home, rather than to a care facility.
This event highlighted the importance of professional behaviour and not letting “work politics” and personal feelings affect the care of clients.
However, we were also in the wrong. The situation could have been avoided if we had been wise enough to discuss plans/ reasoning for treatment plans with relevant nursing staff and members of the allied health team before executing the treatment rather than “going behind their backs”.
Note: It was later discovered that her Parkinson’s medication had been charted incorrectly, once this was corrected her functional abilities improved enormously. In light of this I think it’s really important to never give up, or sell a patient short and deny them of a fair chance of independence. All patients deserve a chance to reach their most optimal physical state, and it’s our job to explore every possible avenue to help them achieve this.
Subscribe to:
Post Comments (Atom)
1 comment:
Personally I think you handled the situation in a very professional manner. Sometimes a day can become so hectic that we don’t have the time to liaise with every allied health member in the event of a confliction of belief in the management of a particular patient. I have been in a similar situation myself with a nursing staff member who went against my professional judgement. I think to respond the way you did professionally and rationalise why you are doing what you are doing without trying to “prove a point” is the best way to reach any common ground and encourage the nursing staff member that you have every confidence in her clinical decision making but have chosen to do things differently. Also as you did, it is very important to explain to the client why there was a difference of opinion so the client can still be confident in their own abilities and not lose sight of their goals.
Post a Comment