Hello everyone, this week I would like to share my experience with you for one of my patients in gen surg. He was the patient who has undergone Ivor Lewis, a complex surgical procedure of partial oesophagus removal. He was a day 5 post op patient that was just transferred up to gen surg ward from ICU. Since the complexity of the operation, my supervisor requested me, another student and my supervisor herself to see him together.
Before we saw this patient, we have planned what we will be doing on him and that included SMI, supported cough and ambulation. When we walked into his room, we went through normal assessment with him. Despite he was on moderate pain on his incision site, the pain was well managed by PCA and he was keen to stand up since the operation. During the whole session, I and my partner explained the information in regard to post-op care to the patient comprehensively, so that it slightly ran overtime. Therefore, my supervisor jumped in and told us that we got to be hurried. Then, when we stood the patient up, he started desaturating from 96% 8L HFNP to 90%, during that time we were not very nervous but we did not know what to do so that my supervisor was not so happy about our clinical decision making and she jumped in again and lead the treatment. Eventually, we finished the whole session in a hour time.
After the session, my supervisor criticized our time management and organization. Also she told us we have informed the patient in too much detail that was not necessary to do. On my reflection, I admitted that it was not the good session in terms of the overall flow and time management. However as a student I think that we need to inform the patient in fair amount of detail rather than just ‘do’. In addition, I felt so much pressure when my supervisor watched your performance and asked me question at the same time, it is just very distracting for me and I cannot concentrated in my performance.
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3 comments:
I had some similar issues on a previous prac- knowing how much detail to give the patient about their pathology. My supervisor suggested that on your initial visit you should give them a general overview of their condition in very simple terms, focussing more on safety. If there are pamphlets or information sheets available that go into further detail, you can give the patient this on the first session, tell them to have a read of it and ask you any questions they may have at your next session. It seems to be an effective way to save time- as not all patient's want to know details, depends a lot on personality.
I agree Simon I think that it is often quite hard to determine the right amount of detail to tell a patient so that they are educated enough to manage themselves appropriately. I guess this is something that comes with experience, which is especially hard as a student as we learn all this detail at uni and sometimes try and blurt it all out to the patient again to give them the best care possible.
I also agree that when supervisors are “looking over your shoulder” it can be quite nerve racking and disrupt your flow of the session, especially when they interrupt you and ask you questions. Often a little communication can go a long way.
I actually have a tendency to rush the information/education part!! I'm constantly looking at my watch and making sure that I don't run late because I want to demonstrate good time management to my supervisor. Seems we're all in the wars to figure those issues out! And yes, there's something extremely stressful about having a supervisor standing behind you when you're doing it.
On reflection, I think a good approach would be like Nic said. Concentrate on what's important from a safety point of view. Anything extra may have to come from what the patient says. If they ask questions, seem confused, want more info, I think we have a duty to answer to those. And let your info be guided by that, maybe?
As nerve racking as it is, to have a supervisor behind us during those times, I think it may help to keep in mind that we may hate it more if we DIDN'T have the supervisor to guide us...
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