I have been working with a patient who is palliative. His main goal was to return home and look after himself, and he was determined not to have MOW.
When i was first referred to this patient he was pretty imobile and the team was having trouble getting him to do things independantly. He wouldnt walk for the physio and the nurses were being asked by the patient do do most ADL's for him.
I completed an intitial interview with the patient and discovered that he really wanted to go home but was requiring assistance (from his perpective) with all ADL's.
When i did a shower assessment with the patient i encouraged him to do things by himself if he could and ask for assistance if he really needed it. The patient asked for assistance but it was hard to determine if this was due to pain, motivation or tiredness. From this assessment i talked to the team in regards to discharge planning. They were NOT aware that the patient was requiring so much assistance and at this stage i had concerns re: discharge home. The discharge was therefore delayed and the patient was assessed for rehab - as he was previously fully independant. However this was not feasable and the patient had the options of going home with a package of support or going into care. The medical team were thinking RH would be more appropraite but slowely they came round to the idea of going home! YAY
So i then worked with the patient to see what tasks he had to be able to do to return home. These were mobility around the top level of his home, preparing simple meals and transfering from bed and chair. So next the patient and I did a kitchen/breakfast preparation assessment - and i set the environment up to be as similar as it would be at home. I organised a perching stool as i had thought this may be helpful at home to conserve energy and increase his safety when preparing meals. As it turned out the patient sat to prepare all of the meal and sequenced everything appropriately. It became obvious that the patient had set routines he follows and had great insight into his abilities and symptoms if he was not feeling well. Therefore i was convinced that he would be safe to prepare simple meals at home, and he movilised 30m to get to the assessment and back with rests at each end.
We had a family mtg with the patient, Nurse Maude, RN's, Doctors, Myself, and the patients Son. It was great that everyone worked together with the primary aim of getting the patient home. I was organising a perching stool and bedside commode as the patient really wanted to try removal of his cathetor. Also it was my "field" to organise the bed. The nursing staff thought a hospital bed as on his bad days he sits up in bed and spends most of the time in bed. However i had assessed the patient to have Independant bed mobility and transfers. This is something i need to talk with my supervisor about as i need help justifying which selection is the best. Preferably the patient should have a hospital bed as he is likely to need it within the next few months anyway. He is also on an air mattress and he is very thin/deconditioned so i would recommend he has this at home also - especially for the bad days when he spends alot of time in bed.
One mistake i made today was ordering a mattress through supplies when they dont have them - opps - oh well i learnt from that - should have checked with another staff member tho! Just as well when i canncelled the order they hadnt processed it anyway.
So going to learn more about hospital beds and pressure care tomorrow - a learning need i do have.
I also have another patient who has a sacrum pressure area and i am going to be doing a Waterloo pressure area scale tommorrow with - which will be good learning that - so we can determine what mattress is required. Have to also find out what Grade the pressure area is though..
All for tonight