Tuesday, 18 March 2008


Since this blog is sort of reflective practice, does it count as work on a day after work?

I've decided the answer is a resounding yes! But I would say that, wouldn't I?

I finish placement at the end of next week, which will give me a week or two to write to essays and read for them, too. Piece of piss, compared to the stunts I pulled on my first degree.

Anyway, the aforementioned difficulties.

We have a long term patient on ward currently. The patient has a lot wrong with them, and has been bed bound for an extended period of time (+3 months). Due to a stroke, the patient is in dire need of neuro-rehab, but our ward won't take the patient due to the fact they are out of catchment area, and the closer to home ward won't take the patient with a wound*. So they are with us until a deep sacral wound heals.

Which is annoying, as it's not a gastrointestinal problem. Anyway.

Up until recently, there was another patient on ward who was also long term. This patient had neurotic problems, and it is suspected they were tampering with their drugs, treatment and documentation in order to stay in hospital. This had something to do with psychology, and something more to do with the fact that BUPA were paying them 250 squid every day they stayed in hospital. However, the psychological issues meant this patient would stir up trouble with the others. Rumours which turned into Chinese whispers.

It appears, even though the latter patient is gone, the patient in question is still being effected. This patient thinks the ward is talking about them, behind their backs. Stuff like that.

Onto of that, this patient is also suffering the effects of being looked after for so long. Noone is really innocent of being nice to the patient, and it is very hard to not do so. Being cruel to be kind is easier said than done, but that is what happened today.

Yesterday, the patient was in severe pain localised to the groin. Bed-bound, the patient had been catheterised for months. Now, it had begun to hurt. Usually, laying the patient on their side could take the pain away, but it didn't work this time. Neither did a hefty concoction of pain killers. Re-siting the catheter led to more pain when we tried to inflate the balloon. My mentor took a clinical decision, which I agreed with, to remove the catheter and use absorbent pads while we thought of something.

In the middle of this, the medical team were made aware of the problem. They said they'd come back to examine the area, but never did. Can you believe that? Doctors not doing what they say they will? Well, I never... < /sarcasm >

The only problem with removing a catheter after such a long time is that the muscles have sort of forgot what they're supposed to do. Quite promisingly, the patient began to urinate every hour. They insisted they didn't know when it was coming, and so couldn't call for a bedpan and assistance. Which essentially meant they were sitting in their own piss for a while, which is NOT good for the two wounds down there.

However, our hunch, mixed with clinical judgement, tells us this might be a cry for increased attention from the already high level the patient gets. And it doesn't stop there.

The patient should be competent when it comes to transferring from bed to a wheelchair using a funky piece of wood called a banana board**. Now, don't get wrong. The patient got a shit deal. They had originally been out of bed to go for an appointment in the hospital proper. I went with. We weren't seen as quickly as promised and we're screwed around before being told we couldn't be helped. So the patient had a right to be irritated, being stuck out of bed for a long time when it's not very pleasant and having nothing to show.

So, when we got back and tried to transfer, the something was wrong. The patient was not putting any effort in, and I - secretly, at the time - got the impression that they were trying to make it hard for us. Eventually, the move broke down and they cried for us to save them. However, my mentor is no weight lifter and neither am I. Even if we were, ad hoc moving and handling is dangerous, so my mentor took the quick and excellent clinical decision to guide the patient to the floor. The patient was now in tears, and stayed thus until we could hoist them back in.

Patients acting out for nurse attention is not a new problem, but it is a tough one. In this case, the patient needs more specialist care. We can't replace this need for specialist rehabilitation by being overly nice to her and possibly neglecting others. But the specialist care is nowhere on the horizon. In reality, to paraphrase Amy 'the Dickhead' Winehouse, this patient should go to re-hab. But the bosses, for now, have said 'No, no, no'.

* Apparently the nurses there can't dress a wound with gauze.

** I personally think it looks like a giant boomerang, but whatever.

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