I would like to share an experience from my rural placement. It is in regards to a palliative patient who was on the ward list. The patient was extremely emaciated, was nearly completely blind, and had severe respiratory disease. He had threatened nursing staff, and was clearly losing his will to live.
On this particular day, my overseeing Supervisor was up on the ward with me. We went in to see this patient, who was clearly distressed and absolutely did not want to get out of bed. I initially introduced myself and attempted to persuade him to do some chest exercises, however he was completely disinterested. When I mentioned getting up, just to sit on the edge of the bed, he swore at me, and as much as I wanted to get this patient to move, I knew I had to respect his wish for me to go, and leave him be.
However, my Supervisor was not at all happy with my performance. He had his turn to get this patient out of bed. He used his bellowing voice to tell the patient that the Doctor’s had requested he get up. After much distress from the patient, he angrily got up out of bed to the toilet. He was clearly very distressed with having to do this, and I felt a little upset for the patient as well as he was not happy.
The point I am trying to make is at what point with a palliative patient do you leave your professional hat at the door, and respect the patients wish to be left alone? Is our role more to improve their quality of life in these later stages, rather than attempt to 'treat'. Has anybody encountered this instance over their clinical practice?
I was told by my Supervisor that I was too soft, and needed to work harder to get these patients out of bed. I have to say I disagree when it comes to palliative care. I did learn through this experience that there are different approaches to treating the same patient, and we all have to respect the different ways in which we practice.
I would be interested to hear how others would have dealt with this situation, and what approach others would have undertaken.
Thankyou!
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