Friday, August 22, 2008

Patient Care 101

RT's Job description: evaluate, treat, coach patients with respiratory disorders, monitor and set equipment controls, read and evaluate physicians orders, and be a motivational speaker...wait a minute...motivational speaker??

Something that they might not teach in school, that has everything to do with patient care, is how to have a positive, motivational, and uplifting attitude, in a serious if not life threatening situation. For example, if you show the patient that you are scared or afraid then, of course, they will be too. If you are calm yet genuinely concerned for the patient, the patient will develop a trust and remain more calm then they otherwise would.

I can only attest to this type of situation because I know what it feels like to be in the patients shoes. I was right by my wife side when we had our first daughter. On the sunny morning of march 25th 2006, around 7 o'clock in the morning, my wife's water broke. We got up, got ready, drove to the hospital, and a couple hours later she was dilated to a 4 or 5. All fairly normal. After, that it all started to go down hill. We started to watch the monitor, and the heart rate of the baby drop. It was a somewhat slow process, 80...70...60 beats per minute, this caused us some concern. At the time, there wasn't anybody in the room. So, being a normal, worried soon to be father, I quickly went to go get the nurse. As the nurse entered the room the babies heart beat remained constant around 60 bpm, of course! The nurse was almost annoyed that I brought her in. She checked to monitor and said "it's fine" and walked out the room. In deed, my feelings about this was not all that reassuring, nor was my wife's. Soon after, we watched the stats of the baby continue to fall...50...40... "Okay! I am going to go get the nurse again!" I blurted to my wife as I was already half way out the door. This time as the nurse came in, there was a different feeling, a feeling of panic. The nurse quickly checked the connections to the monitor and the connections to my wife... they were all in place. The nurse called quickly for the doctor and the anesthesiologist. As the situation got worse, the panic of this particular nurse steadily grew; as she did, so did I. They decided to wheel my wife quickly into the O.R. to prep to do a Cesarean. As soon as we got in to the O.R. the babies stats shot right back up. "The baby is just playing with us," I thought to myself. So we went back into our room without continuing with the c-section. Of course to our surprise, the babies heart rate plummeted again once we got back into the room. The nurse quickly ran in, freaking out and scaring the crap out of us at the same time. We quickly went back to the O.R. and the doctor, being calm and steady said "don't worry mom and dad, we will have this baby out in less then 5 minutes." I think at that point, my wife and I both felt better knowing that we were in good hands from here on out. And sure enough, our daughter was out breathing and crying within 5 minutes. It was a great experience.

I am glad that the end results turned out the way they did. The only thing that really bothered us was that nurse. She revealed to much of what she was feeling. She showed her disinterest in our situation at the beginning, and then she realized how serious the situation was and started to worry. Whether she was worried more about her job because she had taken light a serious situation or she worried about the baby, I don't know.

By having this experience I can seen how important it is to stay calm through these types of situations. That is why RT's have a much larger role then one might think. I read an interesting blog about RT's being motivational speakers that peaked my interest. I recommend reading it. He mentions that "sometimes we come across patients that don't understand the severity of their condition, patients who are lazy or unfortunately, patients who have given up all together. This is when it is essential that we, as therapists, motivate the patient."
Most of this may be common sense to you RT's that have been in the field for a while. Those that are just getting started may have seen RT's react different to different scenarios. We have to motivate and encourage each patient because that could make all the difference in their survival. Can you imagine how a 8 year old asthmatic, suffering from an asthma attack, would react if he had an RT that was frantic? Of course, it would only make matters worse.

RT's please share any experiences that you might have in this area. What do you think? Do you think this is important while treating a patient? Any tips on how to motivate the patient would be great.


browniesunday said...

An RT can really set the mood in any emergent situation. Generally if the RT stays calm, the RN stays calm, the patient stays calm, and things get accomplished quickly and efficiently. If the RT is freaking out - general bedlam ensues.
Patients often get worse in general panic - heart rates go up, hypertension ensues, an asthmatics airways can really clamp down.
Staying calm also helps you think.
I remember getting called in near hysterics to a patients room because the pulse ox read 56. I walk in the room. Pt is sitting up looking scared spitless - but otherwise pretty normal- not even cyanotic or anything, staff is freaking out, running around, paging the doc and the house supervisor. I take out my Nonin pulse ox, slip it on the other hand - normal SPO2 of 93. Turns out blood pressure cuff was on the arm and didn't deflate.
Nothing makes you look like a bigger idiot than freaking out over nothing.

Rick Frea said...

Great post. I agree 100%. I think I even wrote about this on my blog a while ago. When I was first starting out, a sr. RT told me that it was my job to stay calm in stressful situations, because the nurses will be stressed out enough for everyone. It turned out to be very good advice. And I do agree, an RT CAN set the pace. I like the phrase, "Motivational speakers," because that IS what we really are. In my post, I wrote that RTs are the PR department for the hospital. Great post.