On my second placement, I had a patient who sustained a head injury who was then in the high dependency unit after cranial surgery. I was going to start assessing her but the nurse came by and said that she needs to be taken downstairs in 10 minutes to undergo x-ray for her lungs secondary to the presence of sputum post surgery. There were many patients to be seen that day so I had to maximise my time with her by prioritising the most important things. However, still intent on being thorough, I started conducting a full assessment of the ROM and strength of the UL and LL.
After the session my supervisor talked to me and said that it is fine to do a thorough assessment of the ROM and strength but I should have prioritised assessing the most important things that would verify whether or not she can stand up and do transfers from bed to chair and back, since I did not have enough time. That is, just the strength of the muscles she would need to stand up. I was planning to assess these along with many other things but I realised that I failed to see these as the priority in that particular situation. Also I somehow panicked a bit when I was told by the nurse that the patient will be taken somewhere in several minutes.
That experience made me realise how things can change quite quickly in such settings and that more often than not, they require a great degree of adaptability on my part and everyone else concerned. I have learned that circumstances like that are inevitable, especially in hospitals. It is important to be always ready for changes in circumstances and be calm enough to be able to make good decisions that optimise the time of everyone concerned. Another thing that I have learned is to constantly liaise with other health professionals concerned (ie, doctors, nurses, OTs, SPs, social workers) to use my time more efficiently. When I face the same situation next time, I will ascertain and analyse the immediate and most relevant needs of the patient very carefully and base my assessment and treatment on that. As with making myself calm in any situation, that comes with practice.
2 comments:
That's a really good point - the circumstances regarding a patient can change so quickly and we have to be flexible. And not just in hospitals! On my last placement in outpatients, there was a clinic day where each new patient came into the clinic and saw a doctor, a speech therapist, the OT, the physiotherapist and the nurse in the space of 2-3 hours. And we had several patients. The order they saw us and the type of documentation regarding their history kept changing. We had to be prepared to see a patient whose notes we didn't have and who was not the person we had been reading up on. So you adapt your assessment and prioritize. Yes, I learned it the hard way too. It is a skill you don't think about until you are in the practical setting.
I completely agree with you. No matter how perfectly you plan out your day, it always seems to change! It is also really difficult to determine priorities, especially with the limited clinical experience of a student. However, from all my hospital based pracs thus far, mobility assessment always seems to be the initial priority. It’s also important to make sure that these mobility charts are constantly updated and transferred with a patient. For example, I had a patient transfer rooms just recently, and the wrong mobility chart was transferred. Instead of reading x2 assist for bed mobility, transfers and ambulation, she was given another patients chart which read independent with all mobility! I guess it always pays to check these things!
Also, as you said, it is really important to liaise with other health professionals. One thing which helped me to liaise better with team members was to sit in during a treatment session (e.g. attend OT/SP session, listen to a doctors ward round, go to family planning meetings with social workers). I found by doing this, it helped me to get more of an insight into what other members of the allied health team do, and how closely we work together to achieve patient goals.
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