I know that a few of my posts have been about communicating with patients with expressive dysphasia, but as it turns out I have come across quite a few obstacles in this area and consequently have learnt a few lessons. One patient I am currently seeing on my neuro placement is a 54 yo female with a RMCA, left hemiplegia, left hemisensory loss and expressive dysphasia. In the morning when I came to take her to physio and stood her up I noticed she had been incontinent of her bowels on the chair she was sitting in. I found her nurse and assisted her to transfer the patient to the shower. The patient didn't appear too phased by it, and after she'd been cleaned up we were able to complete a solid hour of rehab as she seemed in relatively good spirits.
In the afternoon when I went back to see her she was lying in bed and unresponsive to my requests to go down to the gym, her body language telling me the answer was no. There was nothing extraordinary about this as I had often found she was lethargic and uncooperative in the afternoons. However, I persevered setting the wheelchair up next to the bed to see if she would at cooperate with me. Once she was sitting on the edge of the bed I could see she had been incontinent of urine in the bed and was quite wet. I told the patient I would get a nurse to clean her up and she burst into tears. I have been working with this patient for 4 weeks and haven't once seen her cry so I was quite astonished. I reassured her it wasn't her fault and was able to cheer her up to the extent she was laughing and smiling in the gym. Later I asked her if the reason she didn't want to come down was because she had wet the bed and she nodded, becoming very upset once more.
This incident made me realise that I have become almost immune to incontinence as I have seen so many patients wet the bed or a chair, and so it's not really a big deal to me. This has perhaps caused me to not be aware of the impact it has on the patient. Even though the patient I saw was incontinent maybe once every day or second day, that didn't stop it from being an embarrassing and distressing experience. This lack of awareness is possibly shared by a lot of staff, as evident by the fact that most people neglect to show the patient any reassurance or comfort when they need it. While it is obviously important to clean the patient up, it's easy to forget how you would feel yourself if you had just wet the bed. So in future I will endeavour to see things from the patient's perspective and remember that even if it isn't a big deal for me, it is probably a big deal for the patient.
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1 comment:
It's almost a lesser of two evils approach that we can take with regards to a situation that is embarresing for some one else. Most people probably treat it like an everyday experience even if it isn't, just so as not to make the situation more humiliating. You raised a good point. No matter how often it can happen, it is still a really humiliating experience for the individual. Good on you for noting the impact your response could have and being sensitive to it. We can be walking into an emotional minefield with patients, at times, so that kind of awareness goes a long way.
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