Clinical placements

Patient's death made me determined to be more assertive

The death of a patient made student Lydia Nganga determined to be a more assertive advocate.

A placement experience made Lydia Nganga realise the importance of communicating concerns.

During my last placement in my first year of training, I was working on a cardiothoracic ward where the patients were mostly pre and post-surgery.

A 50-year-old man, admitted for surgery, had a history of high blood pressure and diabetes.

He had blocked arteries, which had reduced his ability to carry out his daily tasks without becoming extremely short of breath. This had also resulted in his mobility being very compromised resulting in him spending most of his time in bed.

Due to his unstable cardiac status, the patient had been admitted for continuous monitoring until he was stable enough for surgery.

Vital surgery approval

At the start of a night shift, I was told that he had been approved for surgery and was first on the list for the following morning. At this point, he had been in hospital for more than two weeks and the news was celebrated. He was removed from the telemonitoring equipment so that he could have a bath.

While preparing the patient for surgery, he mentioned how out of breath he was. I had also observed this so relayed this information to my mentor. I was told that the procedure for a coronary artery bypass graft was for the patient to have a shower and shave due to the high infection risk.

After escorting him to the bathroom, he mentioned that he was short of breath but indicated that he would be fine as he had his oxygen with him. I left him on his own but made sure to check on him often.

I also showed him where the emergency bell was located.

Acting fast

Unfortunately, he had a cardiac arrest 30 minutes later in the bathroom and died. As he was alone, he must have collapsed just after the last time I saw him. Although the response was quick when he was found, efforts made to resuscitate him were unsuccessful.

I was aware of the dangers of being short of breath but I was not able to relay my concerns. I checked on the patient every 5 to 10 minutes as instructed, which was against my clinical judgement.

I had previously spoken to the patient and was aware of the seriousness of his condition. I had hoped that he would be allowed to have a bedside bath or maybe have assistance in the bathroom to be monitored effectively.

Effective communication

As a student, I followed the instructions I was given. The next day the practice of removing patients with unstable cardiac status from their monitor was stopped, and they now receive a bedside wash while being monitored constantly.

This experience made me realise that to be an effective advocate for my patients, I have to be more assertive and communicate my concerns to other members of staff. I now make sure I use my clinical knowledge to be an effective patient advocate and relay information to other members of the team – and make sure I am taken seriously.

I have found that offering solutions to problems that arise makes it easier to be listened to, which has facilitated my learning as a nurse.

About the author

Lydia Nganga

Lydia Nganga is a second-year nursing student

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