My Personal Encounter With Patient Neglect
“No mockery in the world is so hollow as the advice showered upon the sick. It is of no use for the sick to say anything, for what the adviser wants is, not to know the truth about the state of the patient, but to turn whatever the sick may say to the support of his own argument, set forth, it must be repeated, without any inquiry whatever into the patient’s condition. ‘But it would be impertinent or indecent in me to make such an inquiry,’ says the adviser. True; and how much more impertinent is it to give your advice when you can know nothing about the truth, and admit you could not inquire into it (Florence Nightingale, p. 101).”
INTRODUCTION: THE POWER OF THE PATIENT-CENTERED CLINICAL METHOD
Patient-centered care is the pillar of clinical relationships. It dictates how health care professionals and other clinical staff operationalize the interests, care plans, satisfaction, and safety of their community of patients. Patient-centeredness tends to bridge the professional, clinical, and institutional gulf between patients and healthcare professionals as it provides a dialoguing platform on which patients willingly participate in the protocols of their own care strategies.
Patient-centered care therefore looks at the patient within a holistic framework of clinical assessment, and of the strategies of care execution. This involves considerations of spirituality, political correctness, respect for cultural differences, effective clinical communication strategies, and proper application of clinical hygiene, where health care professionals do not impose their opinionated professionalism on patients to the virtual exclusion of patients’ participating voices in the execution of their protocols of care. Nightingale concurs that inquiries about the protocols of patient care should be based on sufficient data (Nightingale, 1969, p. vii).
Yet patient-centered care does not exist in a vacuum. It thrives on mutual respectability, beneficence, justice, non-maleficence, respect for life and for autonomy, compassion, fidelity, kindness, love, family relationships, and trust. As a team of scholars describes it, patient-centered care: “Emphasizes respect for patient values in individual care decisions as well as the role of patients and families as advisors and essential partners in improving care practices...It is characterized by a two-way partnership” (Millensen, Shapiro, Greenhouse, & DiGiola lll, 2016, para. 2).
These ethical values overlap with my core personal beliefs and professional philosophy about the patient-centered clinical method. These values also underscore my zero-tolerance approach to patient neglect. Also, I strongly believe family relationships are important facets of patient-centered care that healthcare professionals should not ignore.
As a nursing student during one of my recent clinical rotations, I witnessed patient neglect and a measure of disregard for the input of family members in the care of their family member. I am writing about them in hopes of not repeating them in my future professional practice.
AN INTERESTING CASE STUDY
A patient who had undergone hip surgery self-reported a pain score between 7 and 9 on a medical pain scale of 0-10, 0 being no pain and 10 being worst pain imaginable. The nurse I shadowed responded accordingly to the pain as she saw to it that I correctly administered the recommended pain medications to this patient.
Under her supervision, I retrieved the pain medications from the pyxis and administered them using the six rights for safe medical administration. Before then, I had performed a head-to-toe assessment of the patient, asked subjective questions, took vital signs, and conducted a focused pain assessment in the hip area using the PQRSTU acronym, where P stands for palliation/provocation, Q for quality of pain, R for region/location of pain (or radiation of pain), S for severity of pain, T for time/onset/duration of pain, and U for understanding patient’s perception of pain.
The nurse and I then checked up on the patient every hour to assess her pain level, to find out from her whether she needed assistance with anything, to inspect her IV lines and surgical site, and to dress the surgical site. Patient self-reported a pain score of 4 on a medical pain scale of 0-10, a significant improvement over a period of about five hours since the nurse and I assumed our shifts at 7am. Her condition seemed to look up for the most part. She thanked us profusely.
The patient’s two children, a man and a woman, showed up. The two, especially her daughter, nagged about everything from the bed sheets, why her mother had been kept in bed rather than in the couch next to her bed, why the hospital still continued administering her provider’s recommended pain medications to why the physical and occupational therapists were not there with their mother. In addition, she wanted stronger pain medications for her mother rather than the ones her mother was already taking. She turned the room’s relative quietude into a disruptive storm of psychosocial disarray.
The daughter would not take the nurse’s clinical position—and even her own mother’s claim—that the pain medications were working. Filial insistence convinced the mother otherwise, namely of the rightness of her daughter’s opinionated demands, and she instantly changed her initial story, succumbing to her daughter’s insistence that she be given a new regimen of pain medications. The nurse and I found ourselves in a state of cognitive paralysis—shocked.
Our genuine efforts appeared to amount to nothing in the reckoning of the patient’s daughter. The nurse and I became jittery, sweating profusely and trembling at the mere sight of the nagging lady. The lady’s demanding and commanding tone, unwelcoming body language, and intimidating affect forced me out of the room almost immediately.
I absconded to the staff restroom and locked myself in, contemplating the lady’s behavior and its implications for the professional practice of nursing. My disabling preoccupation with the lady’s behavior put me beyond the immediate acknowledgement that my abscondence could potentially translate into patient neglect. I did not however give any serious thought to this line of thinking and legal, clinical interpretation, and absconded in my helpless moment of thoughtless confusion.
I should also stress that raw fear gave wings to my unplanned abscondence, having momentarily lost my presence of mind in the heat of my thoughtless confusion. Fear factor therefore drained the strategic, professional and clinical contents of my presence of mind, a difficult situation that partly led to my divorce from the actualities of my clinical and psychosocial expectations.
What’s more, rather than seeing fear as a tactical psychophysiological response to a difficult situation, and taking full advantage of it to realign and redefine my clinical, professional and psychosocial focus, I deferred to the disorganized wisdom of my innermost insecurities instead. And then from nowhere I suddenly remembered the following lines from Bob Marley’s “Running Away”:
“Ya must have done something wrong
“Why you can't find the place where you belong?...
“Every man thinketh his burden is the heaviest
“…Who feels it knows it…
“But ya can't run away from yourself.
“Could ya run away from yourself?
“Can you run away from yourself?
“Can't run away from yourself!
I was stuck with my questioning shadows which I could not run from! I needed a moment of catharsis. I needed a moment of decompression. I needed a moment of self-reflection. I needed a moment of self-assessment. I needed a savior. I needed to salvage my drowning self from the dire situation, from my cognitive suicide, and this powerful song provided that long-sought psychological and emotional relief. The end result was self-resurrection given that the song jolted me out of my dead-coffin of strategic cluelessness into an ideational, professional oasis of Joseph Schumpeter’s creative destruction. Creative destruction then threw a lifeline to my sinking self in the form of diplomatic reincarnation. I soon recalled my human relations skills and sociality from my subconscious den, by which time it was too late to put them into practice.
I instantly became a thoughtful mutant, fully conscious of my psychosocial and emotional limitations in the specific arena of human relations. I then run to myself, I returned to myself, I became myself, thus merging with the silent yet eloquent dictates of my spiritual, intellectual, and emotional capital, although my nagging conscience consistently denied me respite from my daring constellation of shortcomings. I no longer saw myself as a “saint.” George Orwell made the following critical observations in his 1949 essay, titled “Reflections on Gandhi,” after reading Gandhi's autobiography The Story of My Experiments with Truth (Kwarteng, 2015):
“Saints should always be judged guilty until they are proved innocent…Sainthood is also a thing that human beings must avoid…the average human being is a failed saint.”
I was a nagging dead "saint" secretly hidden in a sarcophagus of cogntive paralysis, confused as ever! Regardless, I thought to myself that we needed to do right by our patients no matter what! Yet I was not the only one who walked out of the room. Other nurses did same. These nurses crowded around the nurses’ station to criticize the lady in hushed tones. I didn’t partake in the criticism because I felt it amounted to unprofessionalism. Here, I came to the stark realization that my near-death experience with the protocols of human relations was a disappointing sham, a false dream, and that I could even always do better in spite of my crippling shyness and selective mutism.
Looking back however, either the nurse or I should have rushed out for the physical and occupational therapists, resettled the patient in the couch, replaced the bed sheets, and reported the matter to the charge nurse. The nurse should have reported the lady’s concerns to the patient’s provider. I think the word nagged was inappropriate, perhaps even too harsh, as the lady had a say in her mother’s care. I regret it now. I also think I should not have absconded. In the future I will make good use of therapeutic communication, empathy, professionalism, and respect for and acknowledgement of family in patient-centered care to address difficult psychosocial and clinical expectations. This is important for improving patient outcomes. I also think what a patient says about pain is final. This goes to the heart of Bob Marley’s:
“Every man thinketh his burden is the heaviest…who feels it knows it.”
That innocuous sense of physiological, phenomenological, physical, and intellectual relativity represents the definining professional anthem and strategic logic of the patient-centered clinical method.
That said, everything else about my clinical experience remains the same!
Kwarteng, F. (2015, March 20). Dr. Kofi Dompere On Kwame Nkrumah’s Scientific Thinking 10. Retrieved from https://www.modernghana.com/news/605944/1/dr-kofi-dompere-on-kwame-nkrumahs.html
Millensen, M.L., Shapiro, E., Greenhouse, P.K., & DiGiola, A.M. (2016). Patient- and family-centered care: A systematic approach to better ethics and care. AMA Journal of Ethics, 18(1), 49-55. http://doi: 10.1001/journalofethics.2016.18.01.stas1-1601.
Nightingale, F. (1969). Notes on nursing: What it is, and what it is not. Mineola, NY: Dover Publications, Inc.
Disclaimer: "The views/contents expressed in this article are the sole responsibility of Francis Kwarteng and do not neccessarily reflect those of Modern Ghana.