NUR1201 | The Patient | Preventing Falls And Harms From Partnering

Well, the down side of going to the public hospital is the time you spend there waiting to be seen.

Have you had a bad experience before at a public hospital?

I have had a bad experience at the hospital yes.

What happened there?

I had a kidney stone being passed and I waited 11 hours to get relief.

In the waiting room? Were you in the waiting area?

Waiting room – yes.

And you were in intense agony for 11 hours in the waiting room?  And so what care were the staff giving you during this time in the waiting room?

Every 3 or 4 hours I’d go and ask for more pills.

Right.  So no one was coming and checking on you?

No one was coming to talk to me at all.

Did anyone update you on why you had to wait so long and you were in intense pain?

Bout half way through the period I was told I was next in line, but meantime there was 5 or 6 ambulances arrive and they had priority.

Right, so for 11 hours you stuck it out in the waiting room in intense pain.  And the waiting room, was it full of other people?

Yes it was.

And they were watching you?  How did you feel being in such terrible pain in front of all those people and not being attended to by the staff? How’d you feel?

My feelings in that situation was very uncomfortable but I wasn’t worried about what anyone else thought.

No.  And do you remember feeling angry, do you remember getting angry about why the staff weren’t coming and telling you what was going on, why they weren’t caring for you?  Were you feeling upset and frustrated?

No, I didn’t get angry, because I knew that there was a priority system and my priority was number 4.

When you think back to the pain.  If I said to you 10/10 is the worst pain you’ve ever or would ever experience and 0 was no pain, what was that pain sitting at in the waiting area?

Well, that pain was about an 8.

An 8? Ok, and so they gave you some medication did they?

Yes they did.

Do you remember what they gave you?

Codiene.

Some codeine.  Right, and did that relieve the pain at all for you?

It dulled it for a little while, that’s about it.

It dulled it for a little while, but it came back and peaked.  And when it peaked, you had to go back to the counter and ask for it.

And ask for it.  That’s exactly right, yeah.

So that wasn’t a very good experience for yourself.

It certainly wasn’t one to encourage you to attend public hospitals.

Right.  Did you ever get to be seen?  Was it after 11 hours, or, did you leave and go…?

I did get to be seen but it was amazing.  I was called in to a waiting room and on the way in I said to the nurse ‘I need to go to the toilet’, and I passed the stone.

Right. Ok.  And then you had immediate relief?

I had immediate relief, yes.

Ok, but it took 11 hours.

11 hours to get seen to.

Ok, so that’s very disappointing.

It was yes.

So this time when you had the fall, you were not going to go and go through that same experience again.

That’s exactly right yes.

So you decided to stick it out at home where you were more comfortable rather than get ignored at the hospital, is that right?

Yes.  With pain killers, yes.

Right, ok, so you had some pain killers at home?

I did yes.

Right, ok.  So you stuck it out during the night, and in the morning, did you find that pain a lot more severe?  Were you able to move it or not?

No, I couldn’t use it.  I couldn’t use it from the moment I fell and…

So did your wife have to help you get dressed and get showered?

I had to be up and dressed and showered, and everything else, and if you’re right handed and not ambidextrous, doing things with your left hand is very unco.

And so did your wife drive you to the doctors clinic?

Yes she did.

And how does your wife feel about driving?

She was extremely nervous because we were new in town.

So new in town, and would she get a chance to drive much normally though as well or…?

She normally doesn’t want to drive, but basically after the fall, she drove for about 6 or 7 months, because I disqualified myself from driving. 

Yeah, cause you couldn’t.  And so, the impact on your wife then, did she find that high stress?

Very stressful yes.

Because she didn’t know her way around and didn’t have confidence.  So then that would have impacted on you too, you would have…

I had to be a navigator as well.

You had to be a navigator, you couldn’t take control like you would normally, you know, take control of those situations.  Ok.  So you presented yourself to the GP clinic the next day having to struggle through the morning, manage your wife, navigating while you were in pain, get to the GP clinic, and then how was the care you received there at the GP clinic?

I have no complaints about the care and the response to my situation. Absolutely none.

Ok, right.  So they assessed you?

They did yes.

And you said you got an xray.  Did you get blood tests done or anything like that?

Blood tests weren’t called for. But the xray, I waited for it and brought it straight back.  I had an open appointment to come back with the xray. 

Ok, that’s good.  Alright, and so you went to see the surgeon and what was the outcome there?

Disappointing.  Very disappointing.  He was overly honest and …

What did he say?

And, what’d he say? Well, I had a 30cm tear in the muscle that goes over the shoulder.

That’s a really huge tear, isn’t it?

It is yes.  And he said to me, he said can sew you up, repair it, he said, but repairing it would be like sewing an old rag into a new pair of jeans.

Oh.  And hearing that news would be kind of, were you shocked?  To have your body described like that?

Well, I thought, you know, am I that old, and is my flesh that…

Fragile.

… tattered?  Cause I immediately thought of these people that have hip operations and all that sort of thing who are in their 80s.  And so what was different?

That’s right.  So, did you think at that time, so he offered, did he offer you a choice of physiotherapy?

He didn’t offer me a choice, he sent me to the best one in town.  In his opinion.

Ok, alright. In his opinion? Ok, and did you think at the time, being in this regional city, would it be worthwhile, or did your GP suggest maybe, visiting another surgeon for another opinion maybe in the metropolitan city, as a, just to have a second opinion?

No.  I was quite satisfied with his diagnosis.

You were satisfied?  Right, and so you went to the best physio…

Yeah, according to him.

And so what did you think then of the physio? What was the care there?

The physio was very good.

Ok.  And what made you think that the care from the physio was ‘very good’?

Well, the physio taught me how to use my arm, with the assistance of the other arm, and with the assistance of other aids, such as sticks and you know, you get it to lift and so forth, you know, resistance exercises.

And how often did you have to do these exercises? Did you go to see, ah, was it a male physio, or female?

Female.

Female. And did you have to see her weekly, once a week, what was the regime there, or did you do it at home?

Well, according to my entitlement I had 4 visits with her.

Ok, what’s this entitlement.  Can you talk to me a bit about that?

The entitlements were through medicare and also through my private health fund, who limit a certain number of visits, but if I wanted more I had to pay full price.

So you had 4 visits. Ok, and do you remember what the cost might have been or not?

At the time each visit cost me, with the subsidy, $35. 

Ok, alright.  So then, you’re travelling along and then, I hear that you end up having another fall inside the house 4 weeks after that.  A really nasty fall.

Yeah, I had a dizzy spell and hit the deck.  I was standing up and when I spoke to my GP about it, a blood test was ordered and we found out that I was anaemic and …

Were you surprised to hear that you were anaemic?

Well, I was relieved in a sense because I’d initially gone to my GP and told him that I feel like I’m breathing *rarified* air.

Right.

And I’m not getting enough oxygen through my system.

When was that?  Quite a while before these falls?

Yeah. Quite a while.

Ok.

And a blood test revealed that I had a double whammy with anaemia.  I was iron deficient and my haemoglobin count was down considerably.

Right, so this then contributed to your dizzy spell, and then the fall.  So what’s the, do you mind talking about what the treatment’s been since finding out that you’ve been anaemic? 

Well, initially I was put on iron tablets, which seemed to keep me balanced.  But 10, 12 weeks ago, I had a colonoscopy and an endoscopy to find out why I’m anaemic, which we failed to do.  So…

So, you had those tests but didn’t find out why you’re anaemic?

So, next week I swallow the pill cam.

You’re going for a pill cam?

Check out the lower bowel, the small intestine.

Ok, so this is pretty advanced technology isn’t it?

It is yes.

So, what’s required when you swallow this camera?  Do you know?  What did they say you needed?

I’ve got to have a liquid diet the day before, and no food the day I swallow the cam, until well after lunch time. So, the cam’s got basically a clean gut to go through.

Ok, alright.  And so, then you’ve got to catch the camera is that right?

No, the camera is disposed of, but I wear an apparatus around my body which captures the photos, the images, and this camera takes 2 photos every second.

That’s fabulous.  So, can you talk to me about this camera?  What have they said?  How is it going to be positioned on you to get the images?

Just sat on the tummy area here, strapped to the body.

Right.  And so, who’s going to do that for you?

Specialist gastro… gastrol… gaston…

Gastroenterologist? Yeah, ok.  This sounds pretty fabulous.

Yeah, it is.

So, they’re following up.  They haven’t found the reason for the anaemia with the colonoscopy and endoscopy, so now they’re going to go a bit further using advanced technology – a camera that takes a photo of you every 2 seconds?

2 photos every second.

Ok, that’s pretty good.  And then it dissolves, you don’t have to worry about the afterwards.  That sounds pretty good. So, it sounds like you’ve got a lot of trust in the specialists doctors and that system, the system outside of the main hospitals.

Well, being a type 2 diabetic, I have a, what I consider to be, a very good health professional team on my side.

Ok. So that’s good that you mentioned you’ve got type 2 diabetes.  The nursing students listening to you actually would be interested in if you could share your other medical conditions and if you have any surgical conditions.  What are they?

Last September I had my inferior tubernates reduced.

Right.

That’s my nose – a nose job. To aid breathing and to make my breathing a little bit more efficient.

Alright, do you suffer with hay fever with that or…?

I suffer with an allergic rhinitis, which is hay fever …*indiscernible*.

Ok, so you’ve got that, and you’ve got type 2 diabetes, and you’ve got anaemia.  Do you have any other conditions? Do you have high blood pressure?

Hypertension yeah.

Yeah?  Hypertension? Ok, and don’t have glaucoma or anything regards your eyes?

No, my eyes are pretty good.

Do you wear glasses for reading and driving?

Just for reading.

Just for reading? Ok, and what about your hearing?  How’s your hearing?

I’ve been industrial deaf for a number of years.

Ok, do you wear a hearing aid at all?

I’m supposed to yes.

You’re supposed to?  And are, which ear?  Is it both ears?

Both ears yeah.

Both ears, and you don’t.  Are you wearing a hearing aid today?

No, I’m not. 

Ok, and hows the hearing going with me?

Very well. It’s the high range that I am deaf.

Ok.  Alright, so, why don’t you wear your hearing aids?

I find them extremely uncomfortable, and background noises annoy me.

Alright, so if a nurse was to come care for you, it would be really important that you would tell them that, and then get your care in a quiet room so that, so you could hear them.

Yeah, I find that if I’m going into a situation where I have to be attentive and need to hear what’s going on I wear them.

Ok, alright, good.  What about, do you mind sharing what medication you’re on?

I’m supposed to bring a list wasn’t I? I’m on..

Well, to your best ability, what do you take?

Ok.  I take cetirizine for the rhinitis, which is Zyrtec.  I take amlodipine and indocin for blood pressure.  I take diabex or metformin or … hmmm, I’ll come to it in a minute.  And I also take a tablet called flomax because my prostate is on the enlarged side.

Ok, alright, that’s good to know.  Now, we probably need to sort of finish off, but I just wanted to check… 

Diamicron

Diamicron?  Ok, good.  Do you take aspirin or anything like that?

No.

No, alright.  So, just before we sort of finish off and you can give the student nurses some tips on how to give good care to someone like you, just wanted to go back to during your childhood, if you can remember, and as you were growing up, was there any experience with the health care system that has impacted you in any way? Did anything significant happen to you as you grew up?

Well, I have no recollection of anything impacting myself personally, but family wise, we had, my father was an amputee and the doctor who operated on him removed his lower limb when he could have had a second opinion and it was found that others believed it was unnecessary amputation. And the thing about this doctor was that he was inebriated at the time, because there was a big thing happening in the local town and …

Was it a rural town was it?

It was a rural town yes, in outback Queensland.  And the thing is when he amputated the leg he sewed the flap the wrong way.  Instead of tucking it behind, he tucked it forward, and…

This is why people felt that he didn’t make the right decision?

... and the wooden legs, and other aids and that in those days were very primitive.

Right, and so do you remember how that impacted your dad?

It changed his total life style. He was very active and an expert horseman and stock man, and he became a, well he became a station cook after that, which mean he was continually working in the heat, and this prosthesis was continually aggrevating his leg.

So you’ve experienced the health care system in a rural town, and in a time, era, would that have been around the 1960s or …?

He lost his leg in 1939.

Ok, so it was quite back in time then, 1939.  And so, and that, and the rural experience, one doctor in that area.

One doctor, in the local hospital, and foreigner.  Not that we should be down on foreigners, but he was and he was later interned during the second world war, so he was obvioiusly of the wrong nation.

Ok.  Alright, well thank you for sharing that.  So we need to just finish off now, and so, basically you know, having patients share their experience with the future nurses is really important because it’s like you’re a partner in the care. Or you should, you need to be a partner in this care cause you’ve got knowledge of the experiences because you’re at that ground zero experiencing it, so what are some tips for these future nurses about how to give good care?  What care do you need personally for you to rate care to be good? What do you look for?

Well, I just had an experience with the iron infusion, where I had the nurses 100% attention.  She never left my side, which I believe she was required to do, to stay with me, and all the time that process was happening, she was there, she kept my mind off what was happening, she talked to me about all sorts of trivial things, and we got through the situation quite well.  But my advice to the nurses coming on and just starting their careers would be simply: stay current, stay in your books – there’s nothing worse than somebody who has a profession and gets left behind; and when you come across an old guy like me – get past the nonsense, and give him the attention he needs.

Ok, that’s great.  So, yeah basically building up a relationship, and getting that communication happening, show their interest in you, and finding out what care you need, and whether or not you need any other care as well. Like not just what you’ve come in for but maybe there could be something else they could help you with and advocate.  Well thank you.  Thank you Mr William Taylor for coming and sharing your story today, it’s been lovely to meet you.  Thank you.

Pleasure.

Write a report on preventing falls and harms from falls and partnering.

Answer:

Understanding patient experience and partnering with him in his own care such as asking questions and participates in decision making has clinical benefits (Epstein & Street, 2011). The chosen scenario here is about an old man 75ears old who was doing prescribed exercise as he was walking to the shop, he fell and got injured at his left. He also has other medical conditions; anaemia, type 2 diabetes and hypertension, has industrial deafness and has allergic rhinitis. He has an experience of his father being amputated wrongly by a foreign doctor and being delayed or waiting for long in public hospital when he had kidney stone. The essay will focus on the topic preventing falls and harms from falls and partnering. Gibbs reflective cycle will be used and it consist of description of the scenario, feelings and thoughts, values and beliefs and the conclusion.

Mr. William Taylor was out 20 meters away from home doing prescribed routine exercise he had gone down to the shop and when he was walking back he didn't stop to blow his nose he tripped over a piece of concrete and he just belly flopped into a gutter which peeled his skin off his nose and his left elbow and wrecked his right shoulder. The major injury was that he lost immediately the use of his right shoulder and he was in pain, nobody was there to help him out. The risk of falls and harm from falls is increased for people whose vision is impaired, have poor balance, weak muscles, low bone density and those under some medications (Dionyssiotis, 2012). Another experience is the patient being kept in the waiting room in public hospital for 11 hours without being attended yet he was in a pain of grade 8, he had to ask for codeine pills every 3 or 4 hours, no one came to talk to him until half way period he was told he was next in the line but meantime 5 or 6 ambulances came and they had priority and at 11th hour he was called but luckily he felt the urge to go to the toilet and passed the stone

I feel empathy for the patient when he fell and nobody was there to save him he had to crawl and perseverance the pain. I feel uncomfortable as a nurse about the issue of the patient waiting for 11 hours without being attended to and being given codeine pills every 3 or 4 hours. I feel discouraged as a nurse when the patient does not want to be treated in public hospitals where more nurses work. I think it was unethical for the doctor to amputate patient's father leg and never sutured correctly the muscle. I think also its good for the patient to understand his conditions, drugs he is using and what they treat because this reduces anxiety and hastens recovery (Carman et.al, 2013)

Mr. William believed that public hospitals don't offer immediate services because of waiting for 11 hours it made the patient become uncomfortable and suffer in pain. This belief originated from how public hospital personnel offer the services. He also has the belief that his father was amputated wrongly because of the view of other people that it was unnecessary amputation. and also the doctor being from another nation and it was a local hospital. He also believed also the physiotherapist was good because he helped him in arm assistance and he never wanted second option because he trusted in his surgeon

Care was inadequate various situation. This includes the patient being kept waiting for 11hours without any intervention and being given pills codeine which is a morphine which can cause dependence and overdosing. Blood tests was not taken for further investigation which lead to him feeling dizzy after sometimes and he felt. His surgeon did not also offer him choice of physiotherapist. He just gave an opinion. He was tested but they never found out why he was anaemic. His father also had not been amputated correctly and he never had a chance to do his work like being a stock and horseman.

Care was adequate in many situations like he was being given painkillers while waiting. He was also helped by being taken to his personal doctor and was taken x ray and was brought back immediately and he was explained to. He was given an opinion of the best physiotherapist and he helped him in assistance of his arm. He got adequate care by a nurse who was with him during iron infusion and he was able to be strong through the process, he was able to understand his drugs he was talking and why he is taking them.

Negligence is when one fails to take appropriate steps or care to prevent another person from being injured (James, 2013). Nursing negligence occurs in a situation where a nurse who is fully capable of caring others does not do it in a reasonable manner. This affects patient's perception on the hospital setting. Mr. William was left not being attended for 11 hours and now he has bad experience with public hospital. Being alone during accidents is also a big risk. The patient was alone when he fell down and no one was there to rescue him he rolled himself and endured the pain. Competence is when one is dully qualified with appropriate capacity and authority in practice (Drucker, 2012). Health professional are required to carry out functional test of competence to examine whether they can perform some procedures, such as, surgery. Mr. William father was not treated and operated well due to lack of competence

Quality of care and patient safety is the extent to which healthcare services given to patient’s or the community population leads to improvement in desired health outcomes (Aiken, et.al, 2012). It should be safe, effective, efficient timely and equitable. The government has set up a system that is integrated in order to manage patient safety and quality risks. It has come up with safety and quality policy, protocols and procedures and also give responsibilities, roles and accountabilities for patient safety and quality through the use of my health record (Silow-Carroll, Edwards, & Rodin, 2012). Those offering should be competent and motivated and should have effective communication skills. Nurse who took care of the patient was competent enough to be with him throughout out process of iron infusion. Patient knowledge on drugs and procedures he is supposed to be done on is vital aspect in care of the patient. It reduces anxiety and hasten healing. Mr. William was aware of drugs he was using and the conditions he was struggling with.

Public hospitals medical personnel should be increased to avoid negligence and keeping the patients waiting for long hours. This reduces death rates due to lack of attendance. This can be effected by government employing more medical professor and ensuring there is proper management. Medical schools or institutions that offer training should be well managed and equipped to avoid chances of incompetence in medical field. School administration should ensure every student enrolling to be a doctor should be able to perform surgeries well and can think well before acting to avoid the chances of causing more harm to the patient. Nurses should provide quality are to the patient by being with them and talking to them to avoid anxiety and complications due to being absence (Dougherty, & Lister, 2015). They should have good communication witnessed. Old people should be restricted from exercising long distance away from home. This reduces accidents and ensure immediate action is taken in case an accident occurs before other complications are witnessed. Patients are screened for risk of a fall and the likelihood of getting harm from falls when they present themselves, when being admitted and in cases where there is a clinical indication (Gray-Miceli, & Quigley, 2012). Strategies for prevention are put in place for those clients with risk of falling. Patients and relatives are briefed of the risks from falls noticed and then engaged in the progression (Hills, 2011).

In conclusion understanding patient experience helps the medical professionals to plan how to care for his patient and manage prejudices and beliefs the patient has. According to National safety and quality health service standards partnering with consumers; consumers and care givers get information on health service organization performance and contribute to the ongoing monitoring, measurement and evaluation of performance for progressive quality improvement. This enables cooperation, maintaining transparency, sharing of knowledge and information freely. The clinical benefits include decreased readmission rates and rates of health care acquired infection, it improves adherence of treatment regimens, it reduces risk of the patient experiencing adverse events.

References

Carman, K. L., Dardess, P., Maurer, M., Sofaer, S., Adams, K., Bechtel, C., & Sweeney, J. (2013). Patient and family engagement: a framework for understanding the elements and developing interventions and policies. Health Affairs, 32(2), 223-231.

Dionyssiotis, Y. (2012). Analyzing the problem of falls among older people. International journal of general medicine, 5, 805.

Dougherty, L., & Lister, S. (Eds.). (2015). The Royal Marsden manual of clinical nursing procedures. John Wiley & Sons.

Drucker, P. (2012). The practice of management. Routledge.

Epstein, R. M., & Street, R. L. (2011). The values and value of patient-centered care.

Epstein, R. M., Fiscella, K., Lesser, C. S., & Stange, K. C. (2010). Why the nation needs a policy push on patient-centered health care. Health affairs, 29(8), 1489-1495.

Gray-Miceli, D., & Quigley, P. A. (2012). Fall prevention: assessment, diagnoses, and intervention strategies. Evidence-based geriatric nursing protocols for best practice, 4.

Hill, S. (2011). The knowledgeable patient: communication and participation in health (Vol. 2). John Wiley & Sons.

James, J. T. (2013). A new, evidence-based estimate of patient harms associated with hospital care. Journal of patient safety, 9(3), 122-128.

Silow-Carroll, S., Edwards, J. N., & Rodin, D. (2012). Using electronic health records to improve quality and efficiency: the experiences of leading hospitals. Issue Brief (Commonw Fund), 17(1), 40.