Wednesday, April 14, 2010

Respecting the rights of my patient

I have had a patient who i have talked about in the previous posting. Also repeated below..

Patient C: A lady who has been verbally agressive and non compliant since admission has finaly agreed to participating in OT asessments. As this was identified to me on Friday, I de-prioritised after discussing the case with the medical team who agreed.

The social worker had organised a family meeting for this patient, her family and staff from hospital including medical, allied health and maori liason workers.
In the family meeting, the medical doctor indicated that she was medically stable and ready for discharge. Allied health (including OT and PT) indicated the difficulty determining the patients safety and indep level for d/c due to her non compliance with inpit.
I mentioned that I thought there was an element of cultural impact on her compliance, especially when considering shower/dress assessment - I identified clearly that I was accepting of her right to choice and therefore could not comment on her occupational performance.
The OT/PT left the meeting as it was now time for the family to figure out a plan for d/c - which was socially complex with role strain/relationship breakdown.
As a result i discontinued any further input.

However, I was approached by the CNM of the ward. She almost barginned with me - saying I'm going to ask the RN staff to leave Mrs X.. tomorrow morning so that you can go and do an assessment with her. If she doesnt do it, come and get me and "shel do it if I'm there"...

I was almost disgusted in that comment, but didnt say so. I further prompted for more detail as to why she wanted the assessment done. It appeared that my assessment of her occupational performance was going to give us "the right" to recommend that she has supports on d/c, and if she refused that and wasnt coping at home then "she would have to go into a resthome.
Again, I became more disguisted, and we keep talking about the necessity of doing it.
I then identified that I was not happy with seeking the CNM's presence to "make" the patient do it with me.
This patient was assessed as competent to make her own decisions regarding welfare, and she has the rights to her own decisions regarding multiple factors here - to go home, to not participate in assessments, and to not have assistance come into her own home.
This is basic rights!
I went to see the patient and discussed the purpose of the assessment, and risks if it was not completed i.e. may not cope at home. To my understanding she made an informed decision not to have the OT input, and I maintained cultural and patients rights. Some thing I am proud to put my name to - it appears that some think purely about the impact of sending some one home purely on the medical impact and "what if she fails" - when we have x'd all the t's and dotted all the i's...


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