Clinical placements

The importance of advocating for your patients

When a patient in distress refused medical treatment, nursing student Charlotte Callow acted as her advocate to ensure she received holistic care
Advocacy-tile.jpg

When a patient in distress refused medical treatment, nursing student Charlotte Callow acted as her advocate to ensure she received holistic care

While on placement in a busy emergency department, a woman was admitted with heavy vaginal bleeding.

She had undergone a scan when she was six weeks pregnant, and was told she was miscarrying. She was informed by medical staff to go home and wait, as she wanted the process to occur naturally. But this was five weeks later, and she still had no signs or symptoms that she had fully miscarried.

She was assessed by an emergency department doctor and referred to the gynaecology department with a high temperature and fluctuating observations. The stability of her condition was questionable and none of the

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When a patient in distress refused medical treatment, nursing student Charlotte Callow acted as her advocate to ensure she received holistic care 


When communication between doctor and patient breaks down, nurses
can be instrumental in achieving the best care outcome.

While on placement in a busy emergency department, a woman was admitted with heavy vaginal bleeding. 

She had undergone a scan when she was six weeks pregnant, and was told she was miscarrying. She was informed by medical staff to go home and wait, as she wanted the process to occur naturally. But this was five weeks later, and she still had no signs or symptoms that she had fully miscarried. 

She was assessed by an emergency department doctor and referred to the gynaecology department with a high temperature and fluctuating observations. The stability of her condition was questionable and none of the emergency department doctors had seen a case like it. 

In distress

Doctors from the gynaecology department visited the patient and started examining her. During the examination, I noticed that the patient's body language and facial expressions were indicating that she was in distress and discomfort.

After a few more moments of pain, she calmly requested that the doctor stop, but the doctor did not make eye contact with her and continued to remove tissue.

This caused the patient to become frustrated, further heightening her anxiety. Pushing the doctor away, she shouted that she didn't want to be touched and removed the speculum herself. She then asked that everybody except me leave the room. 

The registrar looked puzzled, but I told her the patient just needed a minute, and that I would come and find her soon.  

Lack of understanding 

After calming the patient down, I realised she did not understand the reasoning behind the doctor's actions, which hadn't been explained to her. 

This meant that the basic principles of consent had not been met; the right of every patient to decline treatment and withdraw consent must be respected.

I then spoke to the doctor to ensure I had all the details to answer any questions from the patient, and made sure the patient had time to ask anything she needed to. 

Seeing the patient from only a biomedical viewpoint meant the registrar failed to consider her mental well-being, and the result was not patient-centred care. 

Standing up for patients

I had built up a therapeutic relationship with the patient based on trust and respect, and it was my role to advocate for her in this situation. To achieve the best outcome, I also had to effectively manage communication with the doctor. 

The situation had a positive outcome: everyone involved was satisfied with the care and experience in the end, but this situation reinforced how important it is for nurses to stand up for their patients and advocate for them when necessary. 

I understood my limitations as a nursing student and acted only within my competency. I attempted to work ethically and maintain integrity, openness and honesty, and practice in a holistic, non-judgmental and sensitive manner as stated in the Nursing and Midwifery Council standards of pre-registration education. 

Reflecting on this experience increased my knowledge of holistic care. I always ensure my practice is evidence-based and in accordance with the NMC Code and the NHS constitution.


About the author 

 

 

 

 

Charlotte Callow graduated from the University of Essex in September 2016 and now works in acute care in London 

 

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