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Mater Hospital
5
Communication and information in medical and surgical wards
Transfer
to medical or surgical wards
Again, many of the patients knew what to
expect during their stay on the medical or surgical wards
because they had been admitted to the hospital on prior
occasions:
| MS01: I've been in before for the
same thing, so I know what way it was going to be, do
you know. FS14: I was in a couple of times recently
and I've been in this ward before, so I knew what to
expect. FM19: Ach sure, I've been in this ward more
times than enough love.I live in here. |
However, the nursing staff had not explained
to MM12 that a key nurse had been designated to his care,
so when he read a notice which said 'named nurse', he thought
it had been placed there to test his memory:
| .Tell us this. How come sometimes
you are in a ward and it says on that thing there -
the wee locker beside you - it says it belongs to a
nurse?.Well, it said 'named nurse'. I was wondering
what it was? I thought someone put it up for - what
do you call it - for my memory? |
Adequacy
of explanations given of tests or procedures carried out
In general, the patients seemed to have
been adequately informed as to why tests or procedures were
being carried out:
MM17: .she's (the doctor) definitely
going to send me for this test, this dye test. I'm all
for it. I said, 'I'm all for it'.That'll tell about
my arteries - what's maybe blocked.
MM06: (he would be undergoing) a sort of a scan of the
lungs.They (the doctors) think the lungs, you see -
with the heart not pumping right - the lungs are not
functioning proper. They sometimes scan it and see if
they can fix that. |
However, a medical patient (MM18) was
very unclear about a particular procedure which he had undergone
- both the name of the procedure and the specific purpose
for which it was being carried out:
| I went for that 'electrocardiograph'.
They put me out for that, so they did.Well, they were
just investigating everything, you know. They said this
double pneumonia thing was serious enough and they wanted
to check that everything is working okay.Yes, Dr. -----,
I think it was, said that they give you electric shocks
but you don't feel anything because they knock you out
for it. |
As regards whether the medical staff asked
for the patients' views about having procedures done, the
patients often responded that this was irrelevant as they
were admitted to hospital in order to undergo such treatment.
Consequently, the patients often automatically deferred
to the doctors' judgement:
| He may have done, I can't remember.
But sure why else would you be in here except to have
the treatment done? You wouldn't be coming in here and
then saying: 'no, it's alright then. I won't have the
treatment'. They do whatever's best for you. I wouldn't
know what that was - I'm not a doctor. |
On the other hand, a surgical patient
had been informed that he needed a procedure carried out
on an infected wound and the medical staff waited for him
to decide whether he wanted the procedure carried out or
not:
| MS01: Oh, they'll not do anything
until I decide, you know. I'll give them that, you know.
But it's trying to get your head around it.Well, sure
I have to have it, but they (doctors) do tell you as
much as they can so that you understand what is happening. |
Adequacy
of explanations given of new medications provided
The majority of the patients were not given
any new medications. The reason for commencing patients
on new medications was sometimes explained to the patients
at the time:
| MM17: The doctor came up to me there
and told me she's going to put me on warfarin because
my heart is not pumping enough. |
However, sometimes the purpose of each
new medication was not explained to patients until they
were being discharged home:
| MM05: .I know the steroids is to strengthen
up your muscles and all, like that in your cavity of
your chest and your lungs and all like that, but they
do explain what the tablets are when you are going out
(going home). They just say you're going on a new tablet,
that's all. But they don't really tell you what it's
for until you're going out.Then he'll explain before
I leave what they're for - the new ones - and he'll
say why they're important to keep taking them. |
Similarly, a medical patient (MM06) only
realised that he was taking medication to control his blood
pressure when he was given a list of his medications prior
to being discharged:
| .I'm on tablets there for blood pressure,
yet they haven't told me I've got high blood pressure. |
In addition, the staff did not usually
explain the potential side-effects of medications to the
patients. However, a few of the patients were aware of some
of the side-effects through reading the proprietary information
provided with medications:
| MM13: The information in it (the medication
container) - it gives you an information leaflet, you
know. One of the side effects is cold feet. |
One patient said it was not necessary
to know the side-effects, because the staff monitor the
patients for these while they are in hospital:
| FS14: Sure they monitor you in here
to see if you have any reaction to the tablets. |
On the other hand, if the possible side-effects
of new iron tablets had been explained to FM07 in advance,
she might have been able to tell the staff that she had
experienced some unpleasant side-effects when she was previously
prescribed the same tablets by her GP. Instead, she developed
gastro-enteric symptoms when she took the new tablets and
it was a day or two later before she realised that the medications
had caused her upset stomach. The patient subsequently asked
her husband to bring in her original tablets and she was
permitted to take these instead.
Adequacy
of information given to surgical patients
The surgical patients seemed to have been
well-informed by the staff prior to their operations:
FS14: .she (the consultant) came to
see how I was and talk to me before I went for the operation.Yes,
I'm happy enough. I know what (was) involved.
MS03: They told me I'd be confined to bed for a while
and I'd have to learn to walk again and all of that,
after it, you know. They told me all that.They told
me about the soreness of it - like you can't expect
anything else, it just has to be, you know what I mean?
You can't expect to be all right when they're taking
a bit out of inside of you. |
Similarly, the three surgical patients
were seen by anaesthetists prior to their operations and
were satisfied that they had a good understanding of what
the operations would involve. In addition, in the third
interview conducted after his discharge from hospital, MS01
said that the surgeon had been very patient and had explained
the operation more than once to his wife, as she had found
it very hard to grasp the information in initially. In addition,
the consultant explained to the patient how the operation
would affect him:
| He explained the aftermath: how I
would feel, the side effects, the rest of it, you know. |
However, in relation to the issue of privacy,
when the same patient's wife asked to speak to the consultant
about a delay in a scan, the consultant began discussing
the case in a corridor outside a ward, where people walking
past could hear what was being said. When the patient's
wife asked if there was anywhere more private that they
could talk, the discussion took place instead in a vacant
room near the admissions ward.
As regards the information provided post-operatively,
MS03 was unsure whether the medical staff had identified
that he had cancer. In addition, a hearing impairment further
contributed to his uncertainty about the information which
he had been given:
| MS03: ..I think it was a cancer growth,
you know. They (the doctors) said that there was an
obstruction in the bowel, you see. And then I think
they said after that, that it was like a cancer thing.
I don't know, to be honest with you.If they did (say
whether it was cancer) I mustn't have heard them, love.
You see, I've a hearing aid now. I don't wear it all
the time, but I should be wearing it. That's him (the
doctor) who said to me, 'I done the thing - the operation
- on you', but he says, 'we think we've removed it all'.
So, all they have to do is check it out, you know? |
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