high care patients

This blog concerns dealing with patients in hospital who are for palliative care or high care nursing homes. I came across such a patient on my neuro placement. He was an elderly man who had a dense hemiplegia and had been on the ward for about two and a half months and still had no sitting balance, no upper limb movement or no lower limb movement even with facilitation. Our supervisor wanted us to treat him aggressively on our four weeks there. So everyday for two hours two of us would treat this patient and we would literally be sweating afterwards and he would be exhausted. But after about the second week, we noticed such an improvement in him that it motivated us to keep on going. He was able to sit for about two minutes, although with very poor alignment, and his head control was dramatically improving.

We attended a number of team meetings for this patient and strongly recommended him for rehab along with the support of our supervisor, as we really believed that with intensive therapy he would be able to achieve a level of functioning that would enable him to return home to the care of his wife. Initially the decision was made that he was awaiting a place in rehab, and we were all very pleased with this outcome. Then on our last week we found out that they had changed their minds and thought that a high care aged facility would be more appropriate. The other student and I were really disappointed with this news, as we felt that all our hard work, including the patients, had all been for nothing. We knew that in a high care facility he would not get any rehab to the level that he needed, and the thought of him lying around all day really saddened me.

I spoke with my supervisor about this and she said that it happens a lot, and that at the end of the day the decisions are made in conjunction with the family for the welfare of everyone involved. I realised that his wife probably would have really struggled to care for him, and it would have put undue stress on her. I think it just highlights the importance of not becoming attached to patients, and to try separate yourself from the emotional aspects, to an extent, so that it doesn’t affect your treatment. The supervisor also said that it is just our job to keep on working really hard with the patient until their discharge because every gain we make will make a huge difference to them. I will always take this approach from now on.