Clinical placements

Improving the patient experience through person-centred care

When one of her patients refused to eat, nursing student Georgiana John used her nursing skills to work out what was wrong and find a solution to the problem

When one of her patients refused to eat, nursing student Georgiana John used her nursing skills to work out what was wrong and find a solution to the problem.

If a patient is acting out of character and seems distressed, use your
skills to determine what is wrong. Picture: Alamy

I was working on an orthopaedic ward in my first year of training when I helped to care for an older patient, who I will call Jean. 

Jean had recently undergone a total hip replacement after having a fall and fracturing her hip. She was also living with dementia. 

During breakfast, I noticed that Jean was not eating much, even with the assistance of a red tray system. I thought she may still be tired, and made a note to myself to make sure she ate at lunchtime. 

Unusual behaviour 

I was assisting my mentor with medication administration and carrying out other nursing duties when I noticed that Jean seemed agitated and distressed. I tried talking to her but she wasn't very responsive. 

When lunch came, I asked Jean if she wanted me to help her eat, but she didn't seem hungry and refused her food. 

I was starting to become concerned by Jean's behaviour, so I informed the doctor on the ward that she was distressed, which was unlike her. 

Jean had been prescribed paracetamol for pain relief, so the doctor asked my mentor to administer this and to keep an eye on her to see if her condition improved. 

First-time procedure 

When Jean still seemed distressed after having pain relief, I decided to check her pad. I thought she might be uncomfortable because her pad needed changing. 

When I did this, I noticed some smears of faeces on her pad. I could see that this was stuck, and that Jean appeared unable to have a natural bowel movement. 

I called my mentor for help, and after we had positioned Jean on her side, my mentor manually evacuated the faeces. 

This was the first time I had seen this procedure performed, and I was a bit shocked initially. But my mentor was helpful and kind, explaining what she was doing and why as she went along. The manual evacuation was such an obvious relief for Jean, and that was all that mattered. 

New skill

After we had finished the procedure and freshened her up, Jean fell asleep. I couldn't believe what a difference it had made. Jean’s refusal to eat and her agitation made so much more sense now that we knew what was wrong with her.

She slept for a few hours and when she woke up she was back to her normal self, like nothing had happened. 

This was a great learning experience for me. It started by identifying that Jean was not her usual self, and then using my nursing skills to determine what was wrong so we could find a solution to her problem. If I had not checked Jean’s pad to try and work out what was wrong, we would not have known how constipated she was.

As well as learning a new nursing skill, this experience helped me to truly understand the importance of patient-centred care. 

About the author




Georgiana John is a second-year nursing student at Greenwich University  

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