NUR1201 The Patient Experience: Partnering In Care

Case Study:

Welcome.  Mr William Taylor is it?

Yes.

What can I call you?

Ah, you can call me Bill.

Call you Bill? Ok, well, my name’s Natasha Reedy and I’m the examiner for this course, The Patient Experience and Partnering in Care.  So, thank you for joining me today to talk about a recent experience for you, and you’re going to share with us that experience and some advice on how nurses could improve their care.  So, before we start that, how’s your day been today? 

My day’s been up and down, but enjoyable.

Yeah, and did you do anything specifically today?

I bowled with the Golden Oldies and had equal high game, so I did alright.

Ok, excellent, alright.  And are you married?

Yes I’m married.

And have you got, do you have children that are grown up?

I have all middle aged children these days.

Alright, and any that live in your local city, or rural city?

Yes, we have 2 daughters in this city.

Ok, alright.  It’s a regional city isn’t it?  That’s good for you, and do you see them much?

Oh, when we’re needed to mind the children.

Alright, well that’s always helpful. Ok good, and are you minding any children, grandchildren, today?

Yes, we’ve had our youngest granddaughter today.  She’s on school holidays. 

Ok, well that’s really good.  That’s a really valuable thing that you do to help out your children.  That’s great.  Alright, well let’s get back onto why you’re here today.  And, I understand, is it about 6 years ago you had a couple of falls that impacted you then, and they still impact you now.  So, can you tell us what happened the day you first fell?

Well, what happened was, that I was out doing the prescribed exercise routine.  I’d gone down to the shop, walked down to the shop, and walking back I didn’t stop to blow my nose, and I tripped over a piece of concrete and I just belly flopped into the gutter which took skin off my nose and my chin, wrecked my right shoulder, and took skin off my left elbow. 

Wow, that’s some really bad injuries there.

I was motoring along at the time.

Yeah. And sorry, you didn’t experience a fracture though? 

No, there was no fracture, but there was certainly a major injury because I immediately lost use of my right arm.

Ok, alright.  That’s significant isn’t it? 

Yes it is.

So tell me then what happened?  So you’re lying half on the gutter, half on the footpath, and were you fairly close to home at this point or not?

I was about 20 metres from home.

So what happened? Was anyone around that saw the accident?

Absolutely nobody.

Nobody?

I was on my own by myself.

So how did you feel at that time? Did you go into shock?  Were you kind of like, ‘oh, what’s happened?  And I wonder how I’m going to get up off the ground’ or…

Well, that was my major thought, was how in the heck am I gonna get out of this mess.

Yeah

Because I couldn’t put any weight on any part, on any limb. So I rolled over and swivelled onto my backside and managed to get up from there.

Yeah, and do you remember when you got up did you feel pain anywhere, or did you feel dizzy, or what were your feelings at the time?

I was in absolute agony with my right shoulder. 

Ok. Intense pain?

Intense pain yes.

Ok, so you struggled home all by yourself?

Yes.  I saved the shopping.

Yes?  You saved the shopping?  So you still struggled home with a really painful right arm was it?

Yes.

That you couldn’t move, and so you had to put all your groceries on the other arm?

That’s true.

And then you got home, and was there anyone home when you got there?

Yes, my wife was there and we had visitors as well.

Ok, alright, and so what happened then?

They all wanted to rush me off to hospital, but I declined.  I decided I’d wait till the following morning to see my GP who sent me for an xray.  And I waited for results of the xray and I took them back to my GP and I was sent to a surgeon.

Ok, so just going back to that day that you had the accident.  So you had the opportunity to go to the hospital, but you declined.  Was there a reason why you wanted to wait to see your own doctor rather than go to the hospital?  Were they tending to send you to the public hospital?

Well, the down side of going to the public hospital is the time you spend there waiting to be seen.

Have you had a bad experience before at a public hospital?

I have had a bad experience at the hospital yes.

What happened there?

I had a kidney stone being passed and I waited 11 hours to get relief.

In the waiting room? Were you in the waiting area?

Waiting room – yes.

And you were in intense agony for 11 hours in the waiting room?  And so what care were the staff giving you during this time in the waiting room?

Every 3 or 4 hours I’d go and ask for more pills.

Right.  So no one was coming and checking on you?

No one was coming to talk to me at all.

Did anyone update you on why you had to wait so long and you were in intense pain?

Bout half way through the period I was told I was next in line, but meantime there was 5 or 6 ambulances arrive and they had priority.

Right, so for 11 hours you stuck it out in the waiting room in intense pain.  And the waiting room, was it full of other people?

Yes it was.

And they were watching you?  How did you feel being in such terrible pain in front of all those people and not being attended to by the staff? How’d you feel?

My feelings in that situation was very uncomfortable but I wasn’t worried about what anyone else thought.

No.  And do you remember feeling angry, do you remember getting angry about why the staff weren’t coming and telling you what was going on, why they weren’t caring for you?  Were you feeling upset and frustrated?

No, I didn’t get angry, because I knew that there was a priority system and my priority was number 4.

When you think back to the pain.  If I said to you 10/10 is the worst pain you’ve ever or would ever experience and 0 was no pain, what was that pain sitting at in the waiting area?

Well, that pain was about an 8.

An 8? Ok, and so they gave you some medication did they?

Yes they did.

Do you remember what they gave you?

Codiene.

Some codeine.  Right, and did that relieve the pain at all for you?

It dulled it for a little while, that’s about it.

It dulled it for a little while, but it came back and peaked.  And when it peaked, you had to go back to the counter and ask for it.

And ask for it.  That’s exactly right, yeah.

So that wasn’t a very good experience for yourself.

It certainly wasn’t one to encourage you to attend public hospitals.

Right.  Did you ever get to be seen?  Was it after 11 hours, or, did you leave and go…?

I did get to be seen but it was amazing.  I was called in to a waiting room and on the way in I said to the nurse ‘I need to go to the toilet’, and I passed the stone.

Right. Ok.  And then you had immediate relief?

I had immediate relief, yes.

Ok, but it took 11 hours.

11 hours to get seen to.

Ok, so that’s very disappointing.

It was yes.

So this time when you had the fall, you were not going to go and go through that same experience again.

That’s exactly right yes.

So you decided to stick it out at home where you were more comfortable rather than get ignored at the hospital, is that right?

Yes.  With pain killers, yes.

Right, ok, so you had some pain killers at home?

I did yes.

Right, ok.  So you stuck it out during the night, and in the morning, did you find that pain a lot more severe?  Were you able to move it or not?

No, I couldn’t use it.  I couldn’t use it from the moment I fell and…

So did your wife have to help you get dressed and get showered?

I had to be up and dressed and showered, and everything else, and if you’re right handed and not ambidextrous, doing things with your left hand is very unco.

And so did your wife drive you to the doctors clinic?

Yes she did.

And how does your wife feel about driving?

She was extremely nervous because we were new in town.

So new in town, and would she get a chance to drive much normally though as well or…?

She normally doesn’t want to drive, but basically after the fall, she drove for about 6 or 7 months, because I disqualified myself from driving. 

Yeah, cause you couldn’t.  And so, the impact on your wife then, did she find that high stress?

Very stressful yes.

Because she didn’t know her way around and didn’t have confidence.  So then that would have impacted on you too, you would have…

I had to be a navigator as well.

You had to be a navigator, you couldn’t take control like you would normally, you know, take control of those situations.  Ok.  So you presented yourself to the GP clinic the next day having to struggle through the morning, manage your wife, navigating while you were in pain, get to the GP clinic, and then how was the care you received there at the GP clinic?

I have no complaints about the care and the response to my situation. Absolutely none.

Ok, right.  So they assessed you?

They did yes.

And you said you got an xray.  Did you get blood tests done or anything like that?

Blood tests weren’t called for. But the xray, I waited for it and brought it straight back.  I had an open appointment to come back with the xray. 

Ok, that’s good.  Alright, and so you went to see the surgeon and what was the outcome there?

Disappointing.  Very disappointing.  He was overly honest and …

What did he say?

And, what’d he say? Well, I had a 30cm tear in the muscle that goes over the shoulder.

That’s a really huge tear, isn’t it?

It is yes.  And he said to me, he said can sew you up, repair it, he said, but repairing it would be like sewing an old rag into a new pair of jeans.

Oh.  And hearing that news would be kind of, were you shocked?  To have your body described like that?

Well, I thought, you know, am I that old, and is my flesh that…

Fragile.

… tattered?  Cause I immediately thought of these people that have hip operations and all that sort of thing who are in their 80s.  And so what was different?

That’s right.  So, did you think at that time, so he offered, did he offer you a choice of physiotherapy?

He didn’t offer me a choice, he sent me to the best one in town.  In his opinion.

Ok, alright. In his opinion? Ok, and did you think at the time, being in this regional city, would it be worthwhile, or did your GP suggest maybe, visiting another surgeon for another opinion maybe in the metropolitan city, as a, just to have a second opinion?

No.  I was quite satisfied with his diagnosis.

You were satisfied?  Right, and so you went to the best physio…

Yeah, according to him.

And so what did you think then of the physio? What was the care there?

The physio was very good.

Ok.  And what made you think that the care from the physio was ‘very good’?

Well, the physio taught me how to use my arm, with the assistance of the other arm, and with the assistance of other aids, such as sticks and you know, you get it to lift and so forth, you know, resistance exercises.

And how often did you have to do these exercises? Did you go to see, ah, was it a male physio, or female?

Female.

Female. And did you have to see her weekly, once a week, what was the regime there, or did you do it at home?

Well, according to my entitlement I had 4 visits with her.

Ok, what’s this entitlement.  Can you talk to me a bit about that?

The entitlements were through medicare and also through my private health fund, who limit a certain number of visits, but if I wanted more I had to pay full price.

So you had 4 visits. Ok, and do you remember what the cost might have been or not?

At the time each visit cost me, with the subsidy, $35. 

Ok, alright.  So then, you’re travelling along and then, I hear that you end up having another fall inside the house 4 weeks after that.  A really nasty fall.

Yeah, I had a dizzy spell and hit the deck.  I was standing up and when I spoke to my GP about it, a blood test was ordered and we found out that I was anaemic and …

Were you surprised to hear that you were anaemic?

Well, I was relieved in a sense because I’d initially gone to my GP and told him that I feel like I’m breathing *rarified* air.

Right.

And I’m not getting enough oxygen through my system.

When was that?  Quite a while before these falls?

Yeah. Quite a while.

Ok.

And a blood test revealed that I had a double whammy with anaemia.  I was iron deficient and my haemoglobin count was down considerably.

Right, so this then contributed to your dizzy spell, and then the fall.  So what’s the, do you mind talking about what the treatment’s been since finding out that you’ve been anaemic? 

Well, initially I was put on iron tablets, which seemed to keep me balanced.  But 10, 12 weeks ago, I had a colonoscopy and an endoscopy to find out why I’m anaemic, which we failed to do.  So…

So, you had those tests but didn’t find out why you’re anaemic?

So, next week I swallow the pill cam.

You’re going for a pill cam?

Check out the lower bowel, the small intestine.

Ok, so this is pretty advanced technology isn’t it?

It is yes.

So, what’s required when you swallow this camera?  Do you know?  What did they say you needed?

I’ve got to have a liquid diet the day before, and no food the day I swallow the cam, until well after lunch time. So, the cam’s got basically a clean gut to go through.

Ok, alright.  And so, then you’ve got to catch the camera is that right?

No, the camera is disposed of, but I wear an apparatus around my body which captures the photos, the images, and this camera takes 2 photos every second.

That’s fabulous.  So, can you talk to me about this camera?  What have they said?  How is it going to be positioned on you to get the images?

Just sat on the tummy area here, strapped to the body.

Right.  And so, who’s going to do that for you?

Specialist gastro… gastrol… gaston…

Gastroenterologist? Yeah, ok.  This sounds pretty fabulous.

Yeah, it is.

So, they’re following up.  They haven’t found the reason for the anaemia with the colonoscopy and endoscopy, so now they’re going to go a bit further using advanced technology – a camera that takes a photo of you every 2 seconds?

2 photos every second.

Ok, that’s pretty good.  And then it dissolves, you don’t have to worry about the afterwards.  That sounds pretty good. So, it sounds like you’ve got a lot of trust in the specialists doctors and that system, the system outside of the main hospitals.

Well, being a type 2 diabetic, I have a, what I consider to be, a very good health professional team on my side.

Ok. So that’s good that you mentioned you’ve got type 2 diabetes.  The nursing students listening to you actually would be interested in if you could share your other medical conditions and if you have any surgical conditions.  What are they?

Last September I had my inferior tubernates reduced.

Right.

That’s my nose – a nose job. To aid breathing and to make my breathing a little bit more efficient.

Alright, do you suffer with hay fever with that or…?

I suffer with an allergic rhinitis, which is hay fever …*indiscernible*.

Ok, so you’ve got that, and you’ve got type 2 diabetes, and you’ve got anaemia.  Do you have any other conditions? Do you have high blood pressure?

Hypertension yeah.

Yeah?  Hypertension? Ok, and don’t have glaucoma or anything regards your eyes?

No, my eyes are pretty good.

Do you wear glasses for reading and driving?

Just for reading.

Just for reading? Ok, and what about your hearing?  How’s your hearing?

I’ve been industrial deaf for a number of years.

Ok, do you wear a hearing aid at all?

I’m supposed to yes.

You’re supposed to?  And are, which ear?  Is it both ears?

Both ears yeah.

Both ears, and you don’t.  Are you wearing a hearing aid today?

No, I’m not. 

Ok, and hows the hearing going with me?

Very well. It’s the high range that I am deaf.

Ok.  Alright, so, why don’t you wear your hearing aids?

I find them extremely uncomfortable, and background noises annoy me.

Alright, so if a nurse was to come care for you, it would be really important that you would tell them that, and then get your care in a quiet room so that, so you could hear them.

Yeah, I find that if I’m going into a situation where I have to be attentive and need to hear what’s going on I wear them.

Ok, alright, good.  What about, do you mind sharing what medication you’re on?

I’m supposed to bring a list wasn’t I? I’m on..

Well, to your best ability, what do you take?

Ok.  I take cetirizine for the rhinitis, which is Zyrtec.  I take amlodipine and indocin for blood pressure.  I take diabex or metformin or … hmmm, I’ll come to it in a minute.  And I also take a tablet called flomax because my prostate is on the enlarged side.

Ok, alright, that’s good to know.  Now, we probably need to sort of finish off, but I just wanted to check… 

Diamicron

Diamicron?  Ok, good.  Do you take aspirin or anything like that?

No.

No, alright.  So, just before we sort of finish off and you can give the student nurses some tips on how to give good care to someone like you, just wanted to go back to during your childhood, if you can remember, and as you were growing up, was there any experience with the health care system that has impacted you in any way? Did anything significant happen to you as you grew up?

Well, I have no recollection of anything impacting myself personally, but family wise, we had, my father was an amputee and the doctor who operated on him removed his lower limb when he could have had a second opinion and it was found that others believed it was unnecessary amputation. And the thing about this doctor was that he was inebriated at the time, because there was a big thing happening in the local town and …

Was it a rural town was it?

It was a rural town yes, in outback Queensland.  And the thing is when he amputated the leg he sewed the flap the wrong way.  Instead of tucking it behind, he tucked it forward, and…

This is why people felt that he didn’t make the right decision?

… and the wooden legs, and other aids and that in those days were very primitive.

Right, and so do you remember how that impacted your dad?

It changed his total life style. He was very active and an expert horseman and stock man, and he became a, well he became a station cook after that, which mean he was continually working in the heat, and this prosthesis was continually aggrevating his leg.

So you’ve experienced the health care system in a rural town, and in a time, era, would that have been around the 1960s or …?

He lost his leg in 1939.

Ok, so it was quite back in time then, 1939.  And so, and that, and the rural experience, one doctor in that area.

One doctor, in the local hospital, and foreigner.  Not that we should be down on foreigners, but he was and he was later interned during the second world war, so he was obvioiusly of the wrong nation.

Ok.  Alright, well thank you for sharing that.  So we need to just finish off now, and so, basically you know, having patients share their experience with the future nurses is really important because it’s like you’re a partner in the care. Or you should, you need to be a partner in this care cause you’ve got knowledge of the experiences because you’re at that ground zero experiencing it, so what are some tips for these future nurses about how to give good care?  What care do you need personally for you to rate care to be good? What do you look for?

Well, I just had an experience with the iron infusion, where I had the nurses 100% attention.  She never left my side, which I believe she was required to do, to stay with me, and all the time that process was happening, she was there, she kept my mind off what was happening, she talked to me about all sorts of trivial things, and we got through the situation quite well.  But my advice to the nurses coming on and just starting their careers would be simply: stay current, stay in your books – there’s nothing worse than somebody who has a profession and gets left behind; and when you come across an old guy like me – get past the nonsense, and give him the attention he needs.

Ok, that’s great.  So, yeah basically building up a relationship, and getting that communication happening, show their interest in you, and finding out what care you need, and whether or not you need any other care as well. Like not just what you’ve come in for but maybe there could be something else they could help you with and advocate.  Well thank you.  Thank you Mr William Taylor for coming and sharing your story today, it’s been lovely to meet you.  Thank you.

Pleasure.

Write a report on preventing falls and harms from falls and partnering.

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