25 Nov 2016 | Partners in Care
Rose Russell was about to head off to Malaysia to deliver an academic writing course when she had a fall that drastically changed her plans.
Rose tripped on an unsecured bollard (vertical road marker) and fell, landing on her leg and hip – on the bollard. She was taken to the local emergency department and then admitted to hospital where an x-ray showed she had broken her femur. That night she had a hip replacement.
And so began her patient journey, spanning three wards and two hospitals in different district health boards (DHBs). It’s an experience that has left her with strong views about the importance of good communication between patients and health professionals.
Up to that point Rose, who is in her 60s, had only been in hospital twice, so it was an unfamiliar environment to her. Her overwhelming impression of the first hospital she was in was of isolation, confusion, and to some extent, of ‘being a nuisance’. She felt vulnerable and unsure how physically incapacitated she would remain in the future but no-one was able to answer her questions.
'People came and went all the time, staff, visitors and patients, enormous numbers of them. Some of the doctors and nurses introduced themselves, some didn’t. I was medicated and confused and felt really cut off. My cell phone wasn’t working and there was no internet access.'
While Rose had a daughter in the region, she lived some distance from the hospital and was working.
'She was a great support, but there was a limit to the amount of time she could spend with me.'
Rose says because many of the staff didn’t introduce themselves, say what their role was, or appeared in teams, she was unsure who her main doctor was.
'Being medicated made it even harder to remember these things, so being reminded would have been very helpful.'
She remembers the unbroken sleep in spite of being on sleeping pills.
'In my first ward there was a woman who was really aggressive and made a lot of negative comments about her three roommates including me. And another woman arrived back in the room after medical treatment and immediately started packing and rustling plastic bags at about 4am, believing she could go home at that hour. In the second ward, a fellow patient was allowed to have her hired TV on loudly at any time.'
She says almost all the nurses appeared quite stressed. Apart from one, there was no small talk, only attention to medical matters like giving medication and ticking charts.
'That was all they seemed to think was important as treatment.
'You had to fit in around them. You didn’t know when any of the medical staff might come – there appeared to be no pattern. One nurse didn’t want to help me put my shoes on even though I couldn’t do it myself at that stage. She spent some time trying to find a hospital aide to do it, couldn’t, so then made a big deal about putting gloves on before she helped me.
'There was only one nurse who seemed to have any rapport with patients. She called me by my first name, unlike the others and made small talk – like what she’d be doing on her days off and when she’d next see me. In my position, over a nine-night stay in hospital and in the absence of friends, these little exchanges were very important. They made me feel I was a real person – more than just a set of medical problems.'
About half way through, I was moved to a second ward where most of the medical staff were new to me.
'The physiotherapist reported that I was very anxious – not focused and not aware of reality. This prompted a visit from someone else. I felt so confronted.
'I tried to explain that if I was anxious, my new state was due to my new situation – my ‘acute trauma’ hip replacement was the result of an accident, not an elective surgery. This meant I had no prior time to prepare, either physically or mentally.
'Everything had changed very suddenly. When the accident happened I immediately lost my job, salary, overseas trip, independence, access to social contact and confidence. I was used to being able to access information and get answers to important questions when needed.
'I said I thought a certain level of anxiety might be the normal outcome in response to all these sudden changes plus high levels of medication.'
Rose was given a test about her mental abilities. A score of nearly 100 percent was reassuring.
'It went some way to restoring my confidence.'
She was told, unofficially, over three days that she would be discharged either later the same day or the following day.
'I was keen to leave after what seemed a very long time. I packed up and arranged for my daughter to come and get me, but each time was then told I was not being discharged "just yet", with no explanation.'
Rose and her daughter found this very frustrating. In hindsight, Rose thought she was being kept in because of the physiotherapist’s report.
After nine days Rose was discharged and went at stay with her daughter for a few days while arranging a flight home, to another region of New Zealand. She checked several times before leaving the hospital that the physiotherapist was arranging on-going support and needed equipment for when she returned home.
However, she arrived home to find nothing had been organised and had to contact her local hospital to ask them to urgently arrange the necessary support.
But her journey wasn’t over. Rose started feeling unwell and went to see her GP. He was so alarmed he drove her to the emergency department himself.
'I had developed two infections. At least one was an ESBL – probably from my catheter in the first hospital, and there was an additional infection in my hip.' (An ESBL is a bacterial infection resistant to most antibiotics.)
Rose was in the second hospital in isolation for five nights while the hip wound was re-opened, cultures taken so the infection could be identified, then drained and treated.
She says her experience in this hospital couldn’t have been more different.
'The two surgeons expressed sympathy for what had happened to me, and reassured me before re-opening my hip. They visited me afterwards and gave continuity by being the surgeons I saw at my on-going outpatient check-ups.
'The ward staff lent me a phone after admission so I could call friends and family. They helped me get internet service, checked and changed my meal plan and reassured my visitors who were concerned to find me in an isolation room.
'I felt they genuinely cared about all aspects of my recovery, not just the medical needs. There was easy, relaxed conversation, a sense of humour and shared jokes – a completely different atmosphere. They all knew my name and I knew theirs.'
Rose says that towards the end of her stay, she was feeling a bit weepy.
'The night nurse saw this and sat down with me and said "come on and let it all out". I told her about all the questions I had – like could I do yoga again, how much was this going to intrude on my life?
'She told me to write it all down and then organised for someone from the infectious diseases area and orthopaedics to come and see me. They answered my questions, reassured me and kept me informed about progress towards identifying my infection and its treatment.'
Rose was so impressed that, before she was discharged, she asked to speak to the person in charge of nursing so she could tell them what an amazing experience it had been.
'It’s just communication really,' she says.
'Keeping people informed, having respect. Treat the person and the illness, not just the illness.
'It’s not hard to do and it makes all the difference.'