My first true ward experience has been on a neuro ward, and I must say it’s adds a whole new dimension to the word challenging. It’s not only your’s and your patient’s timetable you have to work around, but all the medical and other AH staff as well. One particular day comes to mind as particularly ‘dynamic’. After arranging our day in the morning, around patients appointments, each other’s timetables (as we worked in pairs for some patients), as well as clearing times with nursing staff, it seemed that none of our plans were going to work out. Even after helping nursing staff to get our patients ready, we were all running behind, and eventually were unable to see many of our patients that morning. The afternoon seemed to run a little smoother, except when I got to one of my patients who had been up and took a few steps in her room (but still remained a hoist transfer on the ward) the day before. I started to assess her more formally – including going through the Stroke Assessment form, and realized she had deteriorated quite a lot. Before I was able to test ‘muscle strength’ her nurse came in and asked if she could be taken to the toilet. I did not want to get the patient up again before doing some sort of muscle and voluntary control assessment, and so proceeded to do this. The nurse came in again two minutes later and told me that it was rather urgent that the patient went to the toilet, and told me to walk her. Eventually I did get the patient up (with 2 by min assistance), however found her gait was VERY slow. It took us 15 mins to walk about a meter. Eventually another nurse came in to help us, but left shortly after stating she would be back soon.
To cut a long story short, the other physio student helping me had to go, and I was left with the patient to take her and stay with her in the toilet, and get her back to bed again. It was an awkward situation, one which I believe I was unable to effectively do on my own – or even with the help of another physio student. By the time I got her back to bed, my session was over and the patient missed out on effective treatment for the whole day. The next day, the same nurse came in at the beginning of my session again and requested I do the same thing – despite me having written her as a definite hoist transfer on the ward. This time I asked for her help, however she said I only needed two people (myself and the other physio student), so I merely asked her to watch while I demonstrated the patients complete inability to carry out the task. She then requested that we hoist the patient to the commode and take her to the toilet. I did not know how to use it, nor feel safe operating it, so she said she’d show us and leave us to it….
To cut an even longer story short, the nurse helped us to carry out the hoist transfer and stayed with the patient this time, however begrudgingly. Soon after I informed my supervisor as it was more than a one off occurrence, and my patient was missing out on treatment time due to the situation. My question: Is it right to say no when a nurse asks you to toilet a patient in the above outlined situation?
1 comment:
Its never an easy situation, but at some point your treatment has to be made a priority. No one minds helping out in this situation occasionally but when you have deliberately organised the time around nursing staff for 'physio treatment' then thats what it should be (within reason). I was in a similar position and all I could do was try and re-negotiate a time with the nursing staff to find something that would be more appropriate so that you could conduct a full Assessment and treatment (very diplomatically of course!)
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