Thursday, November 26, 2009

In came a spanner to the works

Case continued...
Ok so i had thought that the case was all sorted and that he would be discharge home and that would be that...
No that was the ideal.
Reviewing the notes and talking to my colleagues, it appeared that the patient was complaining and communicating his concerns about going home.
He did not agree with my decision that he steps were safe for him to get up and down on his bottom or by using the rail/ledge.
He was concerned about other things as well, and didnt appear to be able to problem solve his way though situations.
I had heard that he had been giving other staff members grief and so i expected that he would give it to me as well.
In hindsight I should have completed more in-depth education with him, and helped him to problem solve, but i new he had told the PT's that he wanted to do it his way.
He was not going to stop arguing with me so i decided to leave the situation and seek support.
The staff and my colleagues were amazing. They talked over the whole case with me, and offered advice of how to deal with his complaints.

Reflecting on the whole thing now...
This case could have been better managed by myself, but i realize that this man was particularly difficult.
How could i have managed the case better?
Perhaps got the PT, RN and or SW to visit the patient with me to coordinate the discharge better and facilitate question and answering sessions with him.
Perhaps think about defining my role with him, so that it was clear from the start e.g.that one of my roles was to assess from a professional opinion about his home environment safety, not to provide him with an alternative house/situation.

Overall, we got it sorted, I double educated him and provided him written advice or recommendations for managing at home.
I had amazing support from the ward staff and OT's - and it really reflects that new graduates do need support with clinical reasoning even when you think its a simple case


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