Case study of patient care in radiography

This investigation will consider the needs of a 24-year-old female patient who has been referred for an abdominal X-ray. The patient arrived from the emergency department on a trolley with suspected perforation. She appears to be in a lot of pain, is on oxygen and has been vomiting. She speaks Bengali with little English. She is accompanied by a nurse and her older brother who speaks English. This report aims to identify needs and requirements to form the most suitable plan of care for the patient, whilst in the radiography department. The following objectives will be taken into consideration; the needs of the patient, legal requirements and the role as a healthcare professional. Areas that will be considered in this investigation are communication, consent, patient dignity, health and safety, patient management and inter-professional collaboration. Patients beliefs, ethical issues and confidentiality need to be taken into account when planning patient care, as care needs to be tailored for each individual person who uses hospital services. In this investigation all the issues mentioned will be addressed and a care plan will be made for this patient.

Communication:

Communication is vital with patients as the procedure needs to be explained and understood before the patient gives consent. The 3-point-check, checking the patients name, date of birth and address could help show how much English the patient understands as well as identifying the patient. Last menstrual period also needs to be checked before an x-ray as it could damage the growth of a foetus. The nurse may have already performed a pregnancy test or made arrangements for communication as the patient speaks little English. Communication with the patient’s brother could also be beneficial as he speaks English and could be used as an interpreter if no professional interpreter is available. Interpreters can also be used to convey non-verbal communication such as body movements and gestures. It is normally preferred that relatives are not used as interpreters due the unknown reliability of translation (Fraser and Cooper, 2009). Consent from the patient is required for anyone to be present in the room. In 2004 the British Red Cross and Department of Health issued multilingual phrasebooks to every UK hospital, which covers 36 languages, including Bengali. The intention was to provide translations of common medical terms and questions that can be used for basic communication with patients. Another issue, which could effect communication, is that the patient is nervous, in pain, on oxygen and is vomiting. This could make it difficult for the patient to talk and cause misunderstanding about what is being said. To ease this the patient will need to be kept calm and comfortable by using simple language to explain the procedure and respecting the patient’s individual beliefs and needs (Department of Health, 2003).

Patient Dignity:

Patient dignity is an important part of health care. This includes patient privacy and patients religious, social and ethical beliefs. Privacy can be maintained by providing private areas the patient to undress and discuss treatment. This may not be necessary for this patient as she may already be in a gown or could be unable to undress herself. Once communication with the patient has been organised, her beliefs need to be made clear as it may make a difference to the way that care is provided. The main religious beliefs that may have an effect in a radiography department are a requirement to be treated by a radiographer of the same sex and prohibition to undress in company of others (Department of Health, 2009). For an abdominal X-ray, any material, like metal, which may affect the image, will need to be removed from the area. This may not be appropriate for the patient. Issues with the sex of radiographers can be overcome if other staffs are available. In circumstances where an image cannot be taken due to patients’ needs and requirements, the patient must be informed of the risks involved and be offered other forms of treatment. As researched by Field and Smith (2008) it may not be appropriate for the brother to be with the patient. The patient’s dignity may be lost if information about delicate issues, such as last menstrual period (LMP), is known by family members.

Consent:

Before the abdomen x-ray can be taken the patients consent is needed. Consent is also needed for the patient’s brother or an interpreter to be in the room and for the radiographer to touch the patient for positioning. For consent to be valid the patient has to be correctly informed and must have the capacity to give consent for the procedure in question (Department of Health, 2009). The patient must not be influenced or pressured into either giving consent or not giving consent. Being pressured or influenced can come from healthcare professionals, family members or friends. This is why the patient’s brother is an unreliable source for translation as he could give false translations if he doesn’t agree with the female patient’s decision. In this case it will be vitally important that good communication is made, as the patient may not understand what is said because she speaks little English. The level of understanding may be impaired due to the patient being nervous, vomiting and on oxygen. Due to this it may not be possible to gain written consent so other forms of consent can be used. Consent can be written or verbal. Written consent is normally preferred as it can be used as evidence if necessary. Informed consent is signalled by the actions and behaviour of an informed patient (Department of Health, 2009). For example if the patient positively responds to requests then it can count as consent. The nurse who has accompanied the patient to the radiography department could be a witness to verbal or informed consent.

Health and Safety:

Health and safety is essential in the NHS. This includes health and safety of workers, patients, visitors and anyone who enters the hospital. As the female patient has suspected perforation, is on oxygen and has been vomiting, it is likely that she is a trauma patient. Anger or aggression is a common way to react to trauma. The communication barriers could worsen this. Anger is a reaction to fear and uncertainty and if not controlled can cause danger to workers and carers in the hospital (Easton, 2009). Control methods include talking to the patient, making sure that she understands what is happening and considering body language, as this could worry the patient or the patient’s brother. Also as the patient is on oxygen and has been vomiting its necessary to ensure that the oxygen tank is functional throughout the procedure and that back-up supplies are available if needed. The patient has been transferred on a trolley so will need to be moved to the table for the abdomen x-ray. As the patient may not be able to move herself, a team of trained staff will be required for manual handling to move the patient. The movement can be done in many ways including log rolling and the use of a slip mat. The team should include about 6 members of staff to ensure that no injury is caused to the staff; i.e. back injury, and to ensure that the patient is supported well. Health and safety standards should be maintained at all times.

Patient Management:

The patient will need to be monitored at all times through the x-ray procedure as any changes in her condition could be life threatening. She has suspect perforation. As defined by Oxford (2010), perforation is the creation of a hole in an organ, a tissue or a tube inside the body. A disease, allowing the contents of the intestine to penetrate the peritoneal cavity, can cause this. Basic observation that need to be made while in an x-ray department are pulse, respiration and temperature, as these are easy observations which can be the first signs of changing conditions. The patient is also in a lot of pain. Pain can be assessed by talking to the patient and by watching the way the patient behaves. (Field and Smith, 2008). As the patient has come with a nurse from another hospital department she may have been given pain management such as morphine or paracetamol, and the radiographer should ask the nurse this when the patient first arrives. Other methods of pain management, which include no drugs and can be easily implemented in an x-ray department, include keeping the patient calm, relaxed and distracting the patient from the pain. This can be done by talking to the patient, either with or without the use of an interpreter depending on the needs. If the patient’s condition worsened when in the radiography department the scan may not be possible and emergency action may be necessary. This would involve calling in emergency nurses and doctors to help. The patient would need to be transferred to the relevant part of the hospital for care.

Inter-professional Collaboration:

Inter-professional collaboration is an essential component in healthcare. The College of Nurses of Ontario (2008) believe it means working together with other members of the healthcare team who each make an individual contribution to achieving a common goal or purpose. A number of professions have already been included in the care of the female patient; the nurse who is accompanying her, the doctor who referred her to the x-ray department, porters and possibly many more such as paramedics and triage nurses. The radiographer will need to work with the nurse and the brother to help the patient and possibly with an interpreter to help with translations and communicating with the patient. The referral card will have a doctor’s name and signature, which needs to be checked before the x-ray can be taken. This requires inter-professional collaboration as only certain qualified staff can refer patients to the x-ray department. As the patient is on a trolley and in pain she may not be able to move herself onto the x-ray table. Extra staff will then be required to help with manual handling when moving the patient from the trolley to the table. Porters will be needed to transport the patient after the x-ray has been taken. The x-ray image will need to be sent to colleagues who can then make a plan of care. If surgery is needed then information will need to be supplied to them. Inter-professional collaboration makes healthcare efficient and as radiographers work with every department in a hospital, it is vital that inter-professional collaboration is enforced.

Conclusion:

In summary, it is not only a radiographers duty to take x-ray images of every patient who walks into the department, but also to ensure that their experience is beneficial and satisfactory to their needs. This can take many forms as with the female patient, who speaks little English, her needs required special measurements for communication with possible use of an interpreter, pain control, other forms of consent and precautions about giving details to the patient’s brother. She also requires care as she is wearing an oxygen mask. For this patient, all of her needs and beliefs have to be taken into account, but still whilst working within the law. The radiographer is also obliged to make sure that each patient will be receive the correct care after their visit to the radiography department. For example, information needs to be passed on to relevant professions after the female patient’s abdomen scan is taken. The patient should be able to leave the radiography department feeling that she was welcome in the department and knowing that the hospital staff all cared about her well being. This type of care, which has been tailored to suit the patient’s needs, is not just for patients who cannot speak English or patients who are in pain. Each patient that comes in for a scan needs to be treated individually as everyone has preferences and it is the job of the radiographer to guarantee patient satisfaction on both a healthcare and social level. The patient should always be the priority to anyone in healthcare.