Today I was inspired once again by another Consultant on the ward round and when shadowing the nurses carrying out routine checks in the wards.
On the morning ward round, there were two new doctors to the ward as 1st August every year is the change over date for placements. They got to straight to work learning how the Orthogeriatrics ward paperwork is filled in and what tests are necessary for every patient on certain numbers of days after their operation, following the Trust’s policy. I learned a lot about how to make myself more approachable and how to gain more rapport with the patients. The Consultant taught me that eye contact is very important to reassure the patient, as well as touching the patient’s hand or arm where appropriate to make them feel at ease. In terms of body language it is ideal if you are able to approach them side-on as this makes the situation less daunting and if there is an opportunity to get to the same physical level as the patient by sitting on a bed or a chair it should be taken to make them feel comfortable to open up to you. An introduction of who you are and listening to the patient talk about some of their non-medical history is a good way to let them feel free from awkwardness. The best doctors are good listeners as they let the patient explain what they think is going on then correct them when they are going a little off track. Doctors check that the patient is okay with what they are doing to them before they do it, for example listening to someone’s heart or prescribing new medicines.
It is surprising how important social services are to the NHS in finding places for patients to go after they have recovered in the ward. It was shocking to hear that some people had been in hospital beds for over a month, though medically fit, waiting for a place to live at a care or residential home. (Due to the serious nature of a broken neck of femur, it is common for elderly people to lose all independence and have to move into care homes.) This is inappropriate use of finite NHS resources as hospital is a place for medical recovery and not for bed rest. These hospital beds could be used for other patients in areas where the number of patients exceeds the number of beds. The members of the healthcare team have to treat the patients as well as sometimes having to organise housing needs. The type of housing the person lived in before admission correlates with recommended time spent in hospital before discharge. This is because if the patient is living alone it could be very dangerous and painful to have to rely on themselves for everything whilst recovering, whereas if living in a nursing home there would be plenty of support available to help with recovery. This is why every orthogeriatric patient that has come from a care home is aimed for discharge after five days on a ward, whilst those striving for their independence again may take a lot longer.
Furthermore I learned that everyone comes from a different stage in their lives and has different personalities, and this means that the ‘level’ that the healthcare team want the patient to be at for discharge is very variable. Not every patient is perfectly healthy before they break their hip and come into hospital, so it would be wrong to prevent discharge of patients if other medical issues that are being monitored by their GP are under control. It is important to remember that difficult communication may not be solely due to delirium after the operation, but could be due to underlying medical issues. This is why it is very important to find out as much as you can about the patient when they enter the hospital through A&E before they have the operation and are admitted to the ward.
Taking bloods is not always easy, especially if the patient has lost a lot of blood during surgery. This is a common problem that nurses come up against when doing observations. I learned today that nurses are the ‘doing’ of the ward in that they change the sheets, serve the dinners and water, put in cannulas and do observations, as well as giving out medication and collecting data about the patients that is reported and analysed by doctors to come up with a plan. This plan is discussed with other members of the healthcare team including Physiotherapists and Occupational Therapists in regular ward round meetings. MDT meetings are held to discuss which patients are ready to be discharged and what needs to be done for the safest possible discharge.
Learning the difference between osteoblasts and osteoclasts is important to understand the condition osteoporosis, which causes the weakening of bones and is a common reason for fracturing bones during a fall. Osteoblasts are cells that synthesise bone, whilst osteoclasts break down bone tissue for repair of the bone. If osteoclasts work at a higher rate than osteoblasts, bone is broken down faster than it is synthesised, causing weakening and osteoporosis.