From her mumblings, I could tell she was suffering from confusion.
When I mentioned the poor condition of this lady, the SHO said, within earshot of the patient's family, ''well, at her age, we can't force her to drink, can we If she doesn't want to drink that's up to her''.
I thought how insensitive this comment was and later on (in a private area, away from prying eyes and ears), I told him about how unnecessary and unprofessional he had been. The SHO then tried to defend his actions/words in a combative manner and became quite aggressive towards me. I stated that hydration could be given intravenously, avoiding actual 'drinking' anyway.
It is well documented that critical incidents are stressful, possibly traumatic, for all involved: Health care professionals, patients, the patient's loved ones and casual observers. When a critical incident occurs it is necessary to engage in immediate action in a professional manner. What is more desired is the prevention of critical incidents in hospitals through better assessment and diagnostics, care, communication and support.
The purpose of this essay is to examine the mentioned critical incident from a more holistic standpoint rather than strictly technical. The resources I have used are from various medical and psychological works from the UK, Canada, Australia and the U.S.
In the case of 'Norma,' I was quite distressed when I examined her mouth and saw the telltale signs of dysphagia, then noted the status of her mental condition as protocol dictates in such cases, i.e., 'General factors such as body habitus, drooling, and mental status should be noted' (UTMB, Dept. of Otolaryngology 2001). I found it very disturbing that she was in such a dehydrated condition and that nothing had been done to alleviate it. Dehydration does occur, but it can be prevented, especially when one is hospital.
Dehydration has a potentially dangerous effect on elderly people; when I saw the dried tongue, confusion and dark urine with Norma I was alarmed that no fluid had been administered. Upon alerting the SHO of her condition and his callous and unprofessional comment of, 'well, at her age, we can't force her to drink, can we If she doesn't want to drink that's up to her,'' I had several reactions at once:
1. I had no support in my evaluation and request for treatment.
2. The family was within earshot and heard the comments.
3. I feared for Norma's well being.
This essay will be divided into several sections, discussing several factors of this incident from different perspectives.
Stressor 1: Initial Dismissal of Request
According to Jeanette Wick (1999), 'Once dehydration becomes a problem, the entire health care team must be involved in its resolution, and specific dehydration management strategies must be included on the resident's care plan.' Dysphagia being the condition of being unable to swallow, it should have been obvious to the SHO that in Norma's case, not wanting to drink was not the issue. She could not drink and another method of rehydration was in order. I feel that my recommendation was sound.
Not only was I distressed that Norma was