Hello guys!
This week’s entry relates to my current CP placement. It’s interesting what you can get to experience in the inpatient setting! Especially when it comes to surgical patients with PAIN! Therefore, I have learned it is extremely important to ensure optimal pain control. To help me understand better, my Curtin Tutor has taught me to imagine having my own chest split apart – nasty pain indeed! Do remember to look at the meds chart (what pain meds have been given and what time) / acute pain service form, perform a subjective ax and then liaise accordingly with the nurses regarding additional administration if necessary before mobilization :)
Now, you must be wondering what’s with this ‘bashing’? Recently, I saw this chap on POD 1 after thoracotomy. HPC was assault. Two ICCs inserted, together with the ‘usual’ attachments nasal prongs, PCA and IDC. High priority for Chest PT and I was glad to be given this case! But the picture turned ugly and real challenging when I went in to see him. He was obviously uncomfortable and every response was accompanied by aggressive, nasty swearing. His answer to my pain question - “Two tubes stuck into me, what you think? Nurses kept asking this stupid question!” He was on PCA but I guessed it still wasn’t sufficient for him. He went on to talk about how he has gone through a lot in his life. Somehow, I thought I could empathize with him and the pain he was going through. So I put up with all the F*** off!!! (Would you have done the same?) All that was going through me was that he needs to get up and I will try. I did not take what he said personally. I could finally calm the storm a little when he expectorated some thick brownish sputum which was unusual for him – that got him concerned when I told him if these were to accumulate, he would get a chest infection. The PT then came along to give me a hand (thank god!). She was assertive which I thought was essential to deal with this patient but that got him nasty (again!), saying he would get his sister to bash us up and that he did not need our help. We had to then put up with him, walked 20m and eventually popped him on the edge of the bed as he refused to SOOB.
I thought the treatment was incomplete as I hadn’t done my SMIs, supported coughs and evaluation. I was also worried about him sitting on the edge. It didn’t occur to me that I had absolutely no sense of danger till the PT signaled to me repeatedly to maintain a distance from him She also told me that in fact, I need not have put up with him; it could be documented that treatment was not provided or modified as patient was verbally aggressive and has a violent tendency. We informed the nurses (who had the same –ve experiences) and the nursing manager who said she would contact security to speak to him.
I was abit disoriented after that session as I never knew before that this was regarded as one of those circumstances we would not treat our patients. I had this conflict / dilemma in me as I believe he does need our help… in the end, I quickly popped into his room again (a safe distance away!) and told him to perform hourly SMIs and supported coughs. He nodded his head :)
What I learned from this is that patients are going through a lot in addition to their pain...; they can have some social issues going on too and that they may not necessarily appreciate our interventions initially... But at no time should we compromise our own safety. We need to learn to judge the situation and modify interventions accordingly. Hopefully, that will still enable us to achieve our main goal of getting them well again asap! :)
Peiying ~
This week’s entry relates to my current CP placement. It’s interesting what you can get to experience in the inpatient setting! Especially when it comes to surgical patients with PAIN! Therefore, I have learned it is extremely important to ensure optimal pain control. To help me understand better, my Curtin Tutor has taught me to imagine having my own chest split apart – nasty pain indeed! Do remember to look at the meds chart (what pain meds have been given and what time) / acute pain service form, perform a subjective ax and then liaise accordingly with the nurses regarding additional administration if necessary before mobilization :)
Now, you must be wondering what’s with this ‘bashing’? Recently, I saw this chap on POD 1 after thoracotomy. HPC was assault. Two ICCs inserted, together with the ‘usual’ attachments nasal prongs, PCA and IDC. High priority for Chest PT and I was glad to be given this case! But the picture turned ugly and real challenging when I went in to see him. He was obviously uncomfortable and every response was accompanied by aggressive, nasty swearing. His answer to my pain question - “Two tubes stuck into me, what you think? Nurses kept asking this stupid question!” He was on PCA but I guessed it still wasn’t sufficient for him. He went on to talk about how he has gone through a lot in his life. Somehow, I thought I could empathize with him and the pain he was going through. So I put up with all the F*** off!!! (Would you have done the same?) All that was going through me was that he needs to get up and I will try. I did not take what he said personally. I could finally calm the storm a little when he expectorated some thick brownish sputum which was unusual for him – that got him concerned when I told him if these were to accumulate, he would get a chest infection. The PT then came along to give me a hand (thank god!). She was assertive which I thought was essential to deal with this patient but that got him nasty (again!), saying he would get his sister to bash us up and that he did not need our help. We had to then put up with him, walked 20m and eventually popped him on the edge of the bed as he refused to SOOB.
I thought the treatment was incomplete as I hadn’t done my SMIs, supported coughs and evaluation. I was also worried about him sitting on the edge. It didn’t occur to me that I had absolutely no sense of danger till the PT signaled to me repeatedly to maintain a distance from him She also told me that in fact, I need not have put up with him; it could be documented that treatment was not provided or modified as patient was verbally aggressive and has a violent tendency. We informed the nurses (who had the same –ve experiences) and the nursing manager who said she would contact security to speak to him.
I was abit disoriented after that session as I never knew before that this was regarded as one of those circumstances we would not treat our patients. I had this conflict / dilemma in me as I believe he does need our help… in the end, I quickly popped into his room again (a safe distance away!) and told him to perform hourly SMIs and supported coughs. He nodded his head :)
What I learned from this is that patients are going through a lot in addition to their pain...; they can have some social issues going on too and that they may not necessarily appreciate our interventions initially... But at no time should we compromise our own safety. We need to learn to judge the situation and modify interventions accordingly. Hopefully, that will still enable us to achieve our main goal of getting them well again asap! :)
Peiying ~
1 comment:
Hi Peiying,
It sounds to me like you handled the situation very professionally, insisting on giving him treatment when many people wouldn't have.
I think when people are acting like that then they should be prepared to not receive optimal treatment. It's just plain rude and no normal human being acts like that.
I know we're told to look at it from the patients perspective, try to understand what they're going through, but i think the patient has to look at it from our perspective too, understand that we're going to work and trying to do our job, that by seeing him we'll be helping him, and shouldn't have to put up with that.
I can't say that if i was in the same situation as you that i would have handled it the same way. I probably would have told him that he was acting inappropriately and if he doesn't want treatment to just say so. After outlining the risks of not receiving treatment and being sure he wanted to refuse, I'd leave him be. If after being explained the risks he decided to have treatment, then he should have alot less to complain about during the session.
That being said, i think you handled the situation very well, just in a different way to how i personally would have. Your patient received treatment, and in the end you got out of there in one piece.
Thanks for the post, it's interesting to hear about this situation, and i hope the rest of your placement goes well :-)
James
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