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Making time for person-centred care

Human contact and reassurance can help older patients in the emergency department just as much as relieving their pain, writes Justin Walford.

The ambulance crew tell me you have been admitted to the emergency department with a suspected femoral shaft fracture. I see a scared, frail older person, but when I look into your eyes theres a sparkle. This must be how you made it to 101 years old.

Part of me wants to sit with you, hold your hand and tell you everything will be all right and whats going to happen and when. To provide you with the psychological support and reassurance that you need. But I cant give you this time. The emergency nurse in me knows that if I do not complete a full set of vital signs and a top-to-toe survey looking for other injuries, this might prove fatal.

So I listen to the handover, the minute

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The ambulance crew tell me you have been admitted to the emergency department with a suspected femoral shaft fracture. I see a scared, frail older person, but when I look into your eyes there’s a sparkle. This must be how you made it to 101 years old.


Human contact and reassurance should be a priority when nursing older people
Picture: John Houlihan

Part of me wants to sit with you, hold your hand and tell you everything will be all right and what’s going to happen and when. To provide you with the psychological support and reassurance that you need. But I can’t give you this time. The emergency nurse in me knows that if I do not complete a full set of vital signs and a top-to-toe survey looking for other injuries, this might prove fatal.

So I listen to the handover, the minute synopsis of the preceding couple of hours, but I know there is more to you than these 60 seconds. What was your job? Are you married, widowed or single? Are you a mother, grandmother or great grandmother? Who is your next of kin?

Once confirmed that your injury is a femoral shaft fracture we apply a splint and give you intravenous (IV) paracetamol. Later, despite the femoral splint and the IV paracetamol, you are still in pain and a small aliquot of morphine is administered. A femoral nerve block is inserted to reduce the amount of systemic analgesia you require.

Now you are comfortable I’m finally able to spend time with you, albeit a couple of minutes, to provide some psychological care. It feels good.

‘Silver trauma’ is on the rise, which means I will see more older patients with traumatic injuries such as fractures. Of course I must focus on providing them with excellent clinical care. But the person-centred aspects – human contact and reassurance – deserve to be as much of a priority. Having the time to find out more about older patients and their lives is as important as relieving their pain.    


About the author

Justin Walford is charge nurse in the emergency department at the Royal Sussex County Hospital in Brighton

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