Patient Profile:
Mr X (pseudonym – not patient’s real name) is a 20-Year-old single man who lives in greater London with his mother and father. He is a non – smoker and a non – alcoholic. He was accompanied by his mother who took care of him throughout his perioperative experience. He is a self – employed Photographer.
Previous Medical History:
The patient suffered from a very mild asthma since his childhood and is taking Ventolin to relieve his airways. He also experienced hearing loss due to impacted ear wax in his left ear in 20015 and a tympanic membrane perforation in his left ear in 2007 also a tympanoplasty on the Right ear in 2011 and an enlarged vestibular Aquedut (EVA) in his right ear in 2012. Perianal abscess and a drainage of the perianal abscess over five years ago.
Presenting Complaint:
Mr X had been working late one day and was exhausted when he got home, whilst he was in the shower (having a hot shower) the steam made him feel light headed. Mr X then collapsed and landed face first in the bathtub fracturing his nose. Since, then he’s been experiencing a blocked nose. The patient was scheduled for a functional endoscopic sinus surgery also known as a (FESS).
Anaesthetic Management:
The anaesthetist induced the patient by administrating Propofol – Lipuro 1% (10 mg/ml) into Mr x’s cannular and Liodcaine Hydrochloride 5% w/v and phenylephrine hydrochloride 0.5% w/v topical solution in his throat. The patient also had a laryngeal mask airway (LMS) inserted to his mouth. The patient was positions supine/Bilateral on the operating table when given the anaesthetics He was also given the general anaesthetic remiphentanol during the surgery to be kept asleep whilst being operated on.
The patient also mentioned to the anaesthetist that during one of his previous operations he felt sick after he woke up in recovery due to the drugs given.
Surgical Management:
Mr X was positioned the same way he was in the anaesthetic room – supine on the operating table. A head ring covered in Inco pad was placed under the patient’s head, to prevent pressure damage during the surgery. The skin was prepped using Chlorohexidine without alcohol also known as savlon.
Drapes were used to put onto the patient before the incision was made to Mr X. The surgeon used a range of different instruments during procedure such as the and used a naso gauze to close the wound.
Discussion:
The Health care assistant (HCA) went to collect the patient from the ward. Before the patient changed into his hospital gown, the HCA compared the patients name band to his consent form, whilst asking the patient to confirm his name and date of birth. She also asked the patient to confirm his signature that he has given consent for the procedure (a FESS) to be done. This confirmation from patience of their signature reflects the rights of patients to control what happens to their own bodies (Abbott and booth (2014).
The ward nurse was called over also checking the patient’s wristband, care plan and consent form. According to Hughes and Mardell (2009) the ward nurse must make sure that the patient is fully prepared to go to the theatre and patients should be assessed to make sure they’ve received adequate information, about their procedure. They also need to make sure patients understand how the procedure will take place and potential outcomes of the surgery. The ward nurse should have spoken with the patient whilst doing her checks asking the patient if he knows which procedure he’s having, if he’s been told how the procedure will happen and, if he understands the consequences with having the surgery. Making sure that the patient is prepared for surgery increases their safety and improves their surgical outcomes. Practitioners will therefore, become more involved in the patients care because they’re able to assess the individual needs of a patient and prepare them for surgery (Wicker and Dalby 2017).
McCabe (2004) also commented on how nurses were more concerned with completing their tasks as they were compulsory to be completed rather than speak to patients. This was seen with Mr X where the nurse did not communicate with him as she was going through his care plan to make sure he was given the information needed before surgery. McCabe also mentioned in her research that some patients can feel annoyed because they aren’t being spoken to and also feel that they are not being cared for as individuals. However, there were other patients in her research who accepted this as normal that nurses are more concerned with their work /tasks.
Mr X’s individualised care plan was then signed by the nurse, and the patient was taken to theatre. Once the patient had arrived in the anaesthetic room he had asked where to leave his phone during the operation and he didn’t know if he was meant to ask before leaving the ward. The HCA and the ward nurse should have double checked and asked the patient if he had any of his belongings with him before leaving the ward because they had already locked his valuables away in the ward.
As said before the ward nurse must insure that the patient is fully prepared for theatre Hughes, S. and Mardell, A (2009). The ward nurse should have made sure to ask the patient if all his belongings was securely locked away before the patient left the ward. This shows that miscommunication with patience can lead them to not be confident to speak up as they haven’t been specifically asked about their concerns. Whilst Mr X was in the ward, he could have felt his presence wasn’t acknowledged so he didn’t have the right to speak up about his concerns at that moment, so he thought he could ask someone else later on. For the reason that the nurse was focused on having to sign the patients care plan before they leave to go to theatre.
McCabe (2004) suggested that it could be because some nurses do not understand the meaning and significance of patient and nurse relationship for the benefit of the patient. This lack of awareness from nurses’ causes them to make assumptions about what kind of care a patient needs from the nurses that will benefit the patient because they do not ask patients question. This was shown when the ward nurse did not speak to the patient before leaving for theatres, she may have assumed the patients do not want to talk before going into theatre or may just be distracted with her work. The HCA put his phone in a disposable cardboard kidney dish and into a bag placing it underneath his trolley.
The anaesthetic nurse in training told the patient he needs to remove his gown and lie onto the bed. The nurse started to help the patient remove his gown, but she should have asked the patient first if he’d like any help removing his gown rather than just going ahead to help the patient because he was slow. Mr X may have felt he was being a nuisance to the nurse because he was slow because the nurse didn’t ask him if he needed any help, this way the patient would think the nurse is genuinely trying to help the him. If the anaesthetic nurse asked Mr there wouldn’t be a mis understanding and asking him may have made him feel reassured, safe and for as an individual. When patient are asked they get a patient centred approach which allows them to have the authority to make decisions about what happens to their bodies rather than nurses making assumptions about what they think a patient needs McCabe (2004).
As soon as the patient was positioned on to the bed, the anaesthetist came in and introduced himself to the patient. The anaesthetist then turned to the medical student and asked if she’d like to try putting in a cannula for the patient. They did not ask the patient if it was ok that they put a cannula in, instead anaesthetist went straight to teaching the student how to put a cannula into a patient. Whilst this was happening there was many other things happening at the same time and what they were doing wasn’t told to the patient.
The anaesthetist was teaching the medical student to put the cannula in and setting up the drip, the anaesthetic nurse in training was trying to place the ECG dots onto the patient without asking permission from Mr X instead telling him to move his hand, and the ODP was filling out the WHO checklist before preparing the drugs for the anaesthetist. The nurse in training, the medical student and the odp didn’t introduce the patient before they carried on with their duties, assuming the patient would be ok with all the chaos happening around him. According to Wicker and Dalby (2017) patients may be anxious when they enter the anaesthetic room. Which is why its useful to inform patients and reassure them about what is being done to them. It would have also bee useful to have someone talk to Mr X whilst the anaesthetist, odp/ anaesthetic nurse prepares the equipment than the room being silent, and the patient is feeling anxious. This could have allowed Mr X to feel less anxious and assured whilst he was in the anaesthetic room.
They should have also tried to reduce the number of things that was going on at the same time. It may have seemed as a normal thing for them to do, however this may have been overwhelming for the Mr X due to the number of people leaning over him to connect things to him and the machines. They could have started with the ECG dots then the cannula and so on, to make the patient feel more comfortable. Mahoney (2014) stated that patients should not be treated as you wish to be treated but, as they would wish to be treated. They may have thought the patient was alright with everything going on and was fine not speaking to anyone but, they should have tried to put themselves into his shoes and thought maybe he would’ve wanted less things going on at the same time and someone communicating with him.
They could have had the ODP talk to the patient after she had set up the drugs for the anaesthetist rather than waiting for the patient to be anaesthetised as Mr X is aware of what’s going on around him and he may feel more anxious due to the number of people crowding around him. They could have also asked the patient if he felt comfortable with all this happening or ask the patient before attaching things to him.
When the med student was going to put the cannula into the patient, she didn’t ask the patient or inform the patient before trying to put the cannula in. she was also having difficulties with trying to put it and was assisted by the anaesthetist to re direct the needle. whilst she was struggling to do so the anaesthetist was helping to re direct the needle the patient looked to be in pain and more anxious but the anaesthetist and med student didn’t notice this as they were focused in trying to get the cannula in. patients who are about to go through a surgery experience anxiety even if they’ve had surgery before. Different patients express the anxiety in different ways with some patient being more talkative and other not saying a word like Mr X in this situation. it’s up to the staff members i.e. the anaesthetist and the medical student in this situation to be able to read their body language and act accordingly. Ways in which they could’ve helped Mr X is to explain to Mr X they were going to put a cannula in and that he may feel a small scratch whilst they were doing so Hughes and Mardell (2009)
The anaesthetist then apologised for not being able to put the cannula into his hand and had try again on his forearm. As they tired the second time the patient looked distressed when he heard they were going to try again and once they succeeded Mr X said, “it hurt more than the first time they tried”. They could’ve also talked through what they were doing as they were doing it, rather than explaining after they’ve done it. The ODP also had her hand folded as this was happening. However, she could have told the anaesthetist that the patient is in pain or informed the patient it’s normal to feel a scratch as this is happening. The patients view of their care will be affected by the interpersonal skills how practitioners can communicate effectively with their patients. Therefore, the non – verbal communication the Mr X was showing should have been picked up by the ODP and should have acted appropriately to make Mr X feel more relaxed. The anaesthetist explained to the patient since he hasn’t eaten or drank anything all day, they found it difficult to find a vein to put the needle in on the first try, which he should have said before trying again the second time. The ODP folding her arms may have given Mr X the impression that she isn’t concerned for him Abbott and booth (2014).
Conclusion:
Planning patient care is important within hospitals as its purpose is to help imitate conversations and improve the communication level between the patients and practitioner. It also brings patients and practitioners who are experts in this field to find out all the issue they have and how they can go about making patients feel as comfortable as possible during the perioperative journey. Additionally, care plans are put in place to identify what each patient needs and to support patients during their perioperative experience so that they have a better life after leaving the hospital.
However, in reality implementing care plans for individual patients are not seen to be used the way they’re supposed to be used to help the communication level between the patient and health care professionals, so that patients feel comfortable to ask questions to the health care professionals about their worries. Instead these specific care plans are seen as a requirement that has to be done because its compulsory. For example, when Mr X was in the ward and the ward nurse was performing her checks on his care going through her questions before we left for theatres, it was said in a monotone as if the nurse wasn’t bothered and just wanted to get on with her work. This meant that Mr X couldn’t ask the nurse about his concerns of where he needed to leave his mobile phone before entering the theatre.
If the ward nurse had asked the patient after completing her checks if Mr X had any valuables, he wanted to be kept safe and locked away or if she had more of an open structure and seemed interested in the patients care and making eye contact with Mr X he may have felt more confident to ask the ward nurse in the ward. However, the HCA who was with the patient could have also asked the patient before leaving as she had to bring the patient to the theatre.
Whilst the patient was also in the anaesthetic room they should have also had a one of them talked to the patient whilst trying to hook the patient up one by one rather than all at once overwhelming Mr X for example they could’ve had the ODP talk to the patient whilst the anaesthetist was trying to put the cannula in and when the anaesthetic nurse in training was trying to attach the ECG dots. This may have made Mr X calmer if he had someone explaining to him what was going as it was happening, to make him feel less anxious as they were doing it.
Reflection:
This follow through of a patient has allowed me to see how certain tasks such as performing checks on a patient care plan, communication with patients are done in reality compared to how they should be done/ should always be done for each and every patient. For example, I’ve seen how some health care professionals are focused on accomplishing their task as requirement rather than focusing on the individual needs of the patient which would be more supportive of the patient. I have also learnt that communication is one of the most important aspects in terms of caring for the patient. When communicating with patients this allows them to voice their concerns and feelings in that moment and builds the communication level between the patient and practitioners.
There also times where I’ve noticed some health care professionals don’t use communication effectively to speak with patients where it could have benefitted them. Therefore, patients do not receive/feel that patient focused care. For example, when Mr X was in the anaesthetic room and a number of people were doing different jobs and not communicating with Mr X explaining what they were doing until after they had finished with attaching Mr X to the machine and the drips rather than clarifying what they’re doing before they started.
If I were to come across this type of situations again in the future, I’d want to acknowledge/ recognise the situation and be able to speak and listen to the patient to be able to relieve them of their concerns and have an open structure where they can do so, to allow patients to be able to ask questions. I’d also make sure that if I need to put anything onto the patient, I’d ask the patient first if it’s alright and explain to them what I’m doing it, so that the patient can feel involved in their own care also, making sure that not to many different practitioners are trying to do everything at the same time, by letting know this may overwhelm the patient.