STARES Entry Two: Professional Behaviour

Situation

73 yo male patient presents with partial lower limb paralysis following emergency T9/T10 laminectomy. English is not the patients first language but can communicate clearly. Patient having difficult time after multiple hospital transfers and incontinence as a result of the surgery. He was extremely upset about his condition as he had been in near perfect health prior to the disease in his spine, and had received some poor care from some medical personal prior to arriving at this ward.

Task

Conduct an initial assessment of patient’s lower limb muscle capabilities using the oxford scale attached to official hospital assessment form. Supervisor in attendance.

Action

I reviewed the patient’s file and noted his social and medical history, but the real extent of his condition and his distress was not realized until we introduced ourselves. Having felt prepared to do the assessment prior to entering the room, I was flustered and needed prompting and guidance to remain objective and conduct the assessment. We tested isometric contractions of the gluteal muscles, hip flexors, hip abductors and adductors, knee flexors, knee extensors, ankle dorsiflexors and ankle plantar flexors, and toe flexors and extensors.

Result

All the key muscle groups that the surgery had affected were tested and we made the patient as comfortable as possible during the test, as well as expressing empathy and ensuring his emotions were cared for and concerns addressed.

Evaluation

I felt my ability to conduct an initial assessment lacked confidence at a time when the patient really needed to be shown he was in good hands. My supervisor guided me through and had to help me to prioritise the assessment. As the patient could not be rotated (surgical precaution), some muscles could not be tested against gravity. An estimate was made by the supervisor whether the patient would be able to do this based on resistance with gravity. This was a very worthwhile experience as it showed me how important it was to remain objective and adapt procedures to fit with patient’s specific impairments/limitations.

Strategies

Although our task was to get a baseline assessment of the patients muscle strength, there were many other factors that needed to be addressed to care for this patient in a holistic manner, specifically his emotional state. In any field of professional medical care there will be people in great distress that need your professional medical knowledge, but very importantly need to be treated like human beings and reassured and given the time to express their concerns. In future I will try to be prepared for the flood of emotions that can come from initial meetings with patients, give that patient enough time to fully express themselves and conduct a professional, objective assessment. I feel that in that particular circumstance I should have excused myself (like I needed to get something) and taken a moment to compose myself. Having watched my supervisor handle the situation so well has given me confidence that I would be able to at least duplicate this performance in the future.