Throughout my clinical rotations, I have learned how I will portray myself in the clinical setting, what type of nurse I would like to be and to always show compassion. My first ever patient in my clinical rotations gave me this realization, and I will forever be thankful that this patient allowed me to be a part of their care. This patient had a cervical fracture as well as a recent diagnosis of clostridium difficile. Due to this he was incontinent of his bowels and was unaware when he passed any stool. Upon assessment of my patient, I had realized the patient had been soiled for many hours, and thus, cleaned and bathed the patient. There were other instances on this specific day that also did not sit well with me, for instance, when I had cleaned the patient with a nurse after he was incontinent another time the nurse was sighing and expressing frustration with their incontinence. The patient was unable to control their bowels and was unable to recognize when they had passed stool due to a cervical fracture. The patient clearly expressed embarrassment due to an inability to care for themself, by avoiding eye contact and no longer being sociable when they once were. After they had been bathed, the nurse informed me that physical therapy is on their way and to replace the pillows. The patient had been in a brief thus, I grabbed a clean gown and dressed the patient prior to placing the pillows. This was to ensure the patient was dressed if physical therapy had walked in that exact instance.
For this patient, the inability to care for themself was rather difficult for them to come to terms with. That they once were able to dress, bathe, and complete activities of daily living independently were now no longer true. This may correlate to their previous occupation, gender, etc. However, with further discussion, the patient was able to identify support at home which could assist him as well as assistance through occupational and physical therapy to hopefully regain some sense of independence. That day I feel as though I helped the patient preserve dignity and reevaluate their support system which thus, from there gave the patient some hope.
On my second rotation, one patient had a history of drug abuse, and unfortunately, I had never seen the patient’s nurse that day minus for report. The patient required some assistance due to a spinal fracture thus, resulting in mobility issues. However, the patient on that day attempted to be more of an active participant in their care compared to notes of previous days in the hospital. The patient and I completed all activities of daily living, and the patient partook in physical therapy. That day had been physically demanding on the patient, however, with support, the patient was able to complete these tasks with moderate assistance.
The patient came from low socioeconomic status, had subsidized housing, and was receiving assistance for their history of drug abuse. The patient had a lack of a support system, and thus, it was essential for the patient to identify someone in their life as well as know that the health care professionals were there to support him through his recovery as well. The patient was able to identify one member of their support system that day and was able to contact them. This patient required more attention than various other patients due to the fact that they lacked the support that some other patients may have from their support system.
In my final clinical rotation, my patient had been admitted due to a suicide attempt, this was another patient who unfortunately would require more attention. Due to suicidal ideation, depression, and a previous suicide attempt the patient remained in the hospital for a long period of time. The patient as a result suffered issues with mobility due to long periods of immobility. On that day the patient had also begun to become more of an active participant in their care. The most exciting aspect was with the assistance of physical therapy, their nurse, and myself we were able to encourage the patient to mobilize to the commode. That was the first time the patient had mobilized out of bed in their stay at the hospital.
This patient also lacked a support system, they were in the process of reconnecting with a past coworker and had a caregiver who visited the patient’s home. However, the patient and the past coworker communicated often during their stay at the hospital. This patient did require more attention due to the fact that the patient lacked a support system. The patient wanted an advocate for their care, for instance, the patient identified a walker which would specifically help assist them due to recent surgery to their rotator cuff, as they needed an item that would be helpful to lean weight onto one side. Thus, assisting with mobility to the commode. The patient also wanted someone to listen to their stories, to feel heard, and to be recognized.
When I first started my clinical rotations, I neglected to realize how important a support system is for a patient. Now I know that a support system is crucial for a patient’s care, that this is what encourages a client to mobilize out of bed, to partake in their care, etc. When the patient does not have a support system, you become that support to that patient. That you should never “assume” that a patient has a support system. As well as the fact, that your patient who requires more attention, is rather “talkative”, or “ties you up” should not be avoided and may be experiencing anxiety or is lacking a support system. A patient requires care of all realms of health psychosocial, physical, mental, spiritual, environmental, etc. Thus, the patient should be assessed in all areas.
For two out of three of the patients listed above, I was acknowledged that case management had been working with the patients to receive the care which they required. However, with one of the patients, I am unaware of this situation that is the patient who was admitted due to a suicide attempt. I am unaware if there were counseling services referred to the patient. This is an instance where I could have advocated for the patient. That this patient although, occupational and physical therapy were working with the patient and thus, the patient was regaining hope within themselves. The patient required services for their mental health as well. I recognize now that mental health is just as crucial as physical health, and this should have been investigated as well as addressed if need be. The patient had a psych evaluation however, I am unsure if this went much further.
