Whilst on my Gerontology placement, family meetings, involving a representative from all members of the multidisciplinary team and the pt's family would be called sometimes to discuss discharge planning and Rx to date. I found this situation quite daunting the first time i had to deal with it as i wasnt sure what i was meant say or how to put it as i knew that what we had to say was going to be distressing to the pt, as she was adamant that she wanted to return home to continue living independantly whilst myself and the other teams felt she was more suitable for placement in a hostel as she was suffering from severe end stage OA in multiple joints bilaterally which was severley hampering her functional ability, so much so that she could only raise her shoulders about 10 degrees, took five minutes to get into bed on her own, and could only walk 15m i 4ww.
After explaining her current mobility to the family and explaining there wasnt much room for improvement no matter how much Rx we gave her, and with heavy emphasise from the whole team that it would be in her best interests to try and place her now whilst she was borderline low/high level care and there was the chance we could get her into low level where the facilitys are much nicer as we were scared if we waited any longer she would be high level care. Despite our best efforts the pt and family were adamant that she would return home. This upset and frustrated me quite a bit as it was very clear that she was not going to be able to manage on her own, however I understood it was still her decision to make so I just had to do my best in her remaining time there to assist her to do things as easily as possible and prepare her for a return home.
The lesson i learned from this situation is that although you may not agree with the decision the pt makes if they are cognitively in the right state to make it you have to accept it even though you know it is not in their best interests, in these meetings there is no need to feel anxious or nervous as no one is there to bite your head of or respond negatively to what you have to say they just want to hear your proffessional opinion and become informed, and even though you are a student you are still are seen as a proffessional to the family so be confident in your knowledge and dont be afraid to speak up or offer your opinion because they appreciate it very much.
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Yes I agree Rach, in those situations all we can really do is speak up and offer our professional opinion. Even with the best communication, some families/patients will still disagree and insist on leaving. On my gero prac we came across a similar situation whereby the family was really, really caring and were determined to get their mother home and look after her. My supervisor explained to me that sometimes you just have to allow the patient to return home even if you do not believe that they or their family are ready... and hope that after a few days/weeks of experiencing the realities of being out of 24hr care, the patient and family will realise in their own time. These are also the situations where it is important to make sure the patient will receive some ongoing physio from outpatients or a service like rehab in the home, rather than just being left to their own devices.
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