During my first practice placement, as the placement was in the early stages, I was mainly assisting the radiographers and had just started operating the treatment couch controls to get patients off the couch after treatment.
The incident occurred on a day when the machine was delayed and the department was very busy. I had been in the treatment room observing the radiographers as they set up Patient X who was a non-English speaker and was usually anxious about treatment. To help with translation the patient’s daughter was always brought into the treatment room before and after every treatment.
On this day, I sensed that Patient X was particularly very anxious as the radiographers set her up in the treatment position and after we had left the treatment room, I saw via the CCTV in the control room that she could barely keep still and was breathing very heavy during treatment.
Prompted by this, after treatment was delivered I ran into the treatment room without getting her daughter from the waiting area and attempted to get her off the couch. In the process of lowering the couch and turning the gantry around Patient X leaped from the couch despite my loud warnings that the couch was still quite high up and not low enough for her to safely get up.
Patient X did not understand my warnings in English.
FEELINGS (WHAT WERE YOU THINKING AND FEELING?)
As I sensed her discomfort and anxiety, I felt very empathetic because I was aware of how daunting the experience must have been for the patient especially being in a room with so much going on and not understanding what is going on or what is being said. Upon noticing how uncomfortable the patient felt, I was compelled to ease her of her discomfort as quickly as I could.
I thought about expressing my observation about the patient and also expressing my intentions to the radiographers on the scene but since they did not seem to notice or be concerned about it I dismissed the thought of telling them because I did not want to be told off or even come off as insensible if I was wrong about the observation.
As it was my first placement I tried to prove myself to the patient and radiographers as efficient, competent and sensitive to the needs of patients.
Despite not expressing my feelings to any qualified radiographer, I still felt I had to take action about the situation and safely remove her from the treatment position and off the couch as quickly as I could.
I felt very remorseful after the incident.
After the incident, I clearly expressed my remorse to the patient’s daughter who then relayed it to the patient who was in turn very kind and gracious. I felt relieved after the patient assured me that she was alright and not in any way hurt.
I also told the radiographers what I had noticed about the patient and what had prompted my actions. Expressing myself to them made me realise that I was in fact not the only one that had sensed and noticed the patients discomfort and anxiety.
I felt a lot more at ease when the radiographers listened to me and reassured and encouraged me about my practice.
EVALUATION (WHAT WAS GOOD AND BAD ABOUT THE EXPERIENCE?)
After the incident, I very deliberately asked for a break. I used the short time off to gather my thoughts and reflect upon the situation. I replayed the incident in my head and tried to understand why and how it happened. I found that reflecting right after the incident occurred was important for me to rejuvenate and come to terms with my feelings.
Looking back, I commend that I paid enough attention to my patient to notice her discomfort. I also commend that my actions were driven by compassion for my patient as we must ensure that compassion is central to the care we provide (The NHS Constitution for England – GOV.UK . 2018. The NHS Constitution for England – GOV.UK.) As compassion is one of the NHS values that guide our practice, this encourages me going forward.
In addition to this, I commend that empathy for my patient fuelled my actions.
I also appreciate manner in which the qualified radiographers at the scene handled the situation. I feel that they resolved the situation very properly without scolding me or telling me off in front of the patient. They made sure to tell me that they recognized the intentions which drove my actions and were very supportive and encouraging afterwards.
I think I mishandled the situation by making a conclusive decision on my own about the state of my patient without asking more qualified staff around me how they felt. I had no previous experience of dealing with any similar situation and so I was unqualified to judge and act upon the situation on my own. I think it was also dissatisfactory that I acted haphazardly in the face of what I thought was a dire situation. I should have been calm and composed in dealing with the situation. I recognise that I acted impulsively and as a result I put the patient as risk.
ANALYSIS (WHAT CAN YOU MAKE OF THE SITUATION?)
My discernment of the patient’s anxiety and discomfort were right and valid but my succeeding actions to assist the patient could have been executed better. I understand that my inexperience played a role in the cause of my actions and hence my impulsive reaction. I also see now that because of how I ran and rushed into the treatment room I could have scared the patient; a patient that was already quite anxious. The situation could have been quite daunting for the patient, not understanding what was being said, she could have easily interpreted my hastiness as something to worry about rather than me just trying to get her off quickly.
CONCLUSION (WHAT ELSE COULD YOU HAVE DONE?)
I could have shown good communication and teamwork by expressing to the radiographers at the scene what I had noticed about the patient and how I felt about the patient’s obvious discomfort. I could have asked if my observations were valid and then further asked for advice on my how to handle the situation.
I could have also involved the patient’s daughter in my dealings with the patient as doing this would have further put the patient at ease. (The NHS Constitution for England – GOV.UK. 2018. The NHS Constitution for England – GOV.UK.)
I have also learned the importance of maintaining professionalism, composure and confidence in front of patients. Recognising this, I realise now that I could have walked and not ran into the room and carefully rather than hastily brought the patient off the couch safely.
I could have also communicated effectively with the patient by using appropriate gestures since language posed as a communication barrier.
ACTION PLAN (IF IT AROSE AGAIN WHAT WOULD YOU DO?)
“It is not sufficient to have an experience in order to learn. Without reflection upon this experience it may quickly be forgotten, or its learning potential lost”.
I acknowledge that the purpose of the practice placement is to provide a practical experience. However, without reflecting upon this experience and undergoing a self-evaluation process, the learning opportunity would have been lost.
If this situation arose again, I would search for the things I can do, however small, to give her comfort and relieve her suffering.
(The NHS Constitution for England – GOV.UK. 2018. The NHS Constitution for England – GOV.UK.)
I would ensure that the comfort of my patient comes before all else. I would note to the radiographers the patients discomfort so that they would be put at ease before carrying on with treatment. Furthermore, if I still noticed their anxiety during treatment via the CCTV cameras in the control room, I would quickly inform a radiographer so that the appropriate measure is taken.
If I had to get the patient down from the treatment couch after treatment, I would ensure that the patients daughter is invited into the treatment room in order to put the patient at ease. I would quickly but carefully get my patient out of the treatment position and off the couch. In this way, I would correctly express my compassion towards the patient.