I am currently completing my cardiopulmonary placement at ICU. I was seeing a multiple trauma extubated patient who was due to go to the ward that afternoon. I approached the nurse and asked what time it would suit to treat this patient. The nurse brushed me off and said he had to wash the patient and transfer him to a ward bed. I said I’d come back in a half hour and see how everything was going. When I returned to the patient the social worker was seeing the patient. As soon as the social worker left I approached the nurse. This time I was more assertive. I told the nurse that I needed to see this patient this morning before lunch and asked if now was a good time. He finally agreed.
When I auscultated the patient I heard decreased breath sounds in the lower zones. Following auscultation the patient asked what I’d heard. I explained that air wasn’t getting right down to the bottom of the lungs so we needed to do some breathing exercises. As I was explaining this to the patient the nurse was shaking his head at me and telling me to stop. The nurse then took me aside and told me that I shouldn’t be telling the patient my findings because he was very anxious following the accident. The nurse was very rude and treated me in a condescending way. I was extremely embarrassed as the patient was close by and probably realised what was going on. I went and chatted to my peers and supervisor and decided to treat him after lunch. The general consensus was that the patient had the right to know what I’d heard. I couldn’t rationalise to the patient why I was doing breathing exercises if everything was fine. There was no point in lying to the patient to limit his anxiety.
This experience taught me to be more assertive with the multidisciplinary team. I needed to see that patient in the morning and even though the nurse didn’t think the patient had to be treated I needed to be more confident when communicating with him. When the nurse questioned me about telling the patient breath sounds I should have been surer of myself and said that the patient had the right to know. Confidence is a huge part of being a physiotherapy student and is a quality I am hoping to further develop during these placements.
2 comments:
Confidence is a really important part of being a professional. I'm also learning the importance of being assertive in various teamwork situations. In hospitals you have the nurse, the consult, the ot, the social worker, the family, the SDN and anybody else really. So picking you're time to be extra assertive is also key. I was treating a patient when the doctor came in. He was nice in the way he approached the patient and acknowledged me briefly, but took over physically with the patient so I felt to leave. When I checked with my supervisor, she commented that the doctor will often take virtually 3 minutes, and listening to what they say is often helpful for discharge planning. Even though it is often a heirachy on which we can seem some where further down, we do have an important role to play - but so do the rest of the health team. Each team member needs to be approached with respect. Some nurses and OT's really seem to have a gift with negotiating treatment combinations, schedules and various roles in the health team. I'm learning a lot from how they approach professionals. It's all in the communication and knowing where you stand!
I totally agree that confidence plays a huge role in being a physio and this is one of my challenges. I have had experiences where the patient detected that I was not very confident with what I was saying and that affected their compliance with the exercises negatively. Also, during multidisciplinary team meetings, it is very usual that the patient is ready for discharge as far as the other health professionals are concerned but not on a physio perspective. This certainly affects the patient's safety at home (or hostel, etc) should the discharge push through. I commend you for being assertive. I agree that it is best to tell the patient the truth as they deserve it. If we conceal information from them, it can only cause confusion especially when they realize that what we explained to them doesn't quite match with what they are feeling. Confusion leads to anxiety and this can make the patient's condition worse.
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