Although as students we are generally given a fairly low case load in order to develop our clinical skills in as pressure free environment as possible, this placement has challenged my ability to effectively manage the number of patients I have been allocated. Currently on my neuro inpatient placement, we are given an average of three patients to see in the am and pm, which doesn’t sound like a lot but as a developing student with only basic clinical skills in this area, I am quickly learning the value of preparation and organisation.
This week I learned the value of time management and organisation at the expense of one of the patients I am currently treating. The patient is a 51 y.o L MCA with right sided weakness and expressive aphasia who has been quite emotional since her admission, with regular episodes of crying and swearing out of frustration at her current functional level. Another student and I notified her we were coming to see her for a gym session at 10 am, then went to treat another stroke patient from 9 am. With the first patient, I was fortunate enough to experience the gratification of walking a patient for the first time post stroke who cried with happiness. Unfortunately this achievement took longer then the estimated hour we had allocated and when the other student and I showed up to our second patients room 20 mins late, we found her crying out of frustration.
We apologised for our lateness and attempted to explain why we weren’t there on time, yet she refused to attend physio that morning saying she was too distraught. The other student and I decided not to persist and came back later that afternoon. When we came back she explained the reason she was so upset was because she has difficulty communicating and non of the nursing staff understood what she was waiting for. She also expressed frustration at waiting and not being told what was happening, making her feel useless and confused. After this explanation I felt terrible and realised either the other student or I should have taken two minutes to let her know we would be running late.
From this experience I learned the importance of communication and preparing myself for situations like these which may occur in the future. I understand that in the future my case load will increase and I have to develop strategies to manage that increase with the patients bet interests. If any one has any suggestions on how the situation could have been handled better I would be very appreciative. Thanks.
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I have not done my neuro placement yet, and this really highlights to me how importnant it is to consider a patient's feelings, particularlt an emotional patient. This patient(as I am sure many other neuro, and non neuro patients)must feel like she has no control of anything in her life right now so sticking to an apointment, and establishing a routine with her could help her to feel that bit more in control.
Your comment of ensuring that next time you are running late you will let your next patient know is spot on. Perhaps also mention to your patients that sometimes you may be held up with another patient, and that you could be up to 20-30 min late. That way they have the 'heads up', and won't think you have forgotten them.
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