Author: Kendra Simpson

I hope this writing piece evokes a new way of thinking/ tackling a similar situation in the clinical setting, whether or not you agree with how I handled it. This has been an enjoyable journey and the people who have been reading and following my post, I thank you thoroughly for that, this is my final piece for my ethics module.

I would like to tackle human rights, with particular emphasis on key human rights which I thought were neglected in this scenario. It is, however, difficult not to link with the patient’s rights charter and other ethical topics (e.g. abuse) when dealing with human rights and you may see the link yourself.

I was in my third clinical placement of this year (2018). My patient had just undergone a laparotomy and subsequently, he could not use his abdominal muscles during tasks for the next +/- 6 weeks due to them being severed, making his life rather difficult. I had spent several days with him but as most of us know, everyone reacts differently to their pain and take varied amounts of time to reach their milestones (log rolling, SOEB, sit to stand, transferring to a chair, walking, etc). This particular patient was making slow but steady progress and was definitely trying his outmost to comply with the physiotherapist. The nursing staff, however, decided that this patient should bridge, sit at a 90 degree angle in bed, roll and get out of bed on command only 2 days post-laparotomy, I did not agree with this in the slightest. This, to say the least, caused some tension and ended in a debate of 8 nurses (all with the same/ similar mindset) and one student physiotherapist (myself). During the whole debate, the patient went on to tell me the horrors he was experiencing when I was not there. He reported that the nursing staff had popped his soma bag from mishandling him/ handling him with unnecessary force (on observation, it was confirmed that the soma bag had popped and that they had re-sealed it). On top of it all, the patient was from Angola and reported that they often did not speak to him in English and rather spoke to each other, over him, in a native language; this patient was not treated with respect nor dignity which he is entitled to (South African Constitution and Bill of Rights , n.d.).

This was a difficult predicament for me to be in as I had never witnessed any of the alleged wrongdoing and the nurses denied everything, reporting that he was lying and talking nonsense to me.

However, this particular scenario, I was present for. I was treating another patient, in the same ward but I was hidden from the patient’s sight. I heard screaming and my name being called (he had seen me come into the ward that morning and we had exchanged some words prior to me seeing another patient). When I went over, the nurses were shouting at the patient, instructing him to get out of bed. They had elevated his bed to +/- 60 degrees, placing pressure onto the abdomen and telling him to come up into a crunch (engaging the abdominal muscles), swivel/ twist (engaging the obliques and could possibly pull at the sutures) to get into SOEB (sitting on the edge of the bed) and stand up so they could make his bed. When he said he needed to first defecate, they simply told him to bridge for a bed pan or get up and walk to the toilet himself. I think it is important to note that the previous day I had told and demonstrated to the nurses how to have the patient active roll himself (utilizing the logroll technique) onto a bed pan to avoid use of the bedpan. Additionally, the patient had been SOEB the previous day with the physiotherapist utilizing the logroll technique over a flat surface (the bed was placed in a neutral plane – no inclination).

I quickly stepped into the now noisy, busy cubicle and got the story of what was happening. I then re-educated the nursing staff who told me that he is day 2 post-op and has to be walking, they are right to an extent, we do try to mobilize patients as quickly as possible but within their pain and willingness. A patient has the right to deny treatment (HPCSA , 2008). The patient had just recently started accomplishing bed mobility – this was his second laparotomy in a matter of 5 months – his previous one, he recovered very quickly but this one was taking longer to heal (this could be due to the previously severed skin being re-severed). The nurses did not hear my reason and instead stood in a large group and questioned my knowledge; it felt that this was amplified due to me being a student. I stood my ground, I went through the protocol taught at University and the hospital’s protocol regarding laparotomies but the head nurse simply stated that she had never seen a patient in his situation which was not walking the first day post-op. In this moment, my clinician walked into the ward and diffused the situation. She confirmed my methods but she was diplomatic about the situation and did praise the nurses for trying to ‘encourage’ the patient to mobilize as if we wait for a patient to be ready, they may never be.

I admired her diplomacy but I did not agree with praising an individual/ individuals for placing a patient in pain and possibly in danger.

The patient was not in a healthy and safe environment which he is entitled to as written in the patient’s rights charter of South Africa as his physical and emotional well-being was being compromised (HPCSA , 2008). He did not feel safe being alone with the nursing staff and requested I be around during the day as much as I possibly could and he was distressed as he was being put into unnecessary pain and was constantly being pressurized by the nursing staff.

In the future, as a qualified physiotherapist, I do believe I would be even more assertive as I was that particular day and I would take it a step further and report them if it were to happen again. I do believe in diplomacy and communication, therefore, I would not have discussed the situation in front of the patient as we did that particular day and rather have taken it to a more private setting. Additionally I would hear each and every nurse out before rushing in to protect my patient and come across as accusing them of wrongdoing as I might have done in that situation. However, as great as diplomacy is, I will not accept my patient’s rights to be neglected and if necessary, I would report the nursing staff to the hospital and the HPCSA if the behaviour continued. I did document thoroughly about the occurrence which took place on the day and would continue to do so to ensure protection for myself if they were to accuse me of wrongful doing.

I look forward to your feedback, learning is continuous.

REFERENCES 

HPCSA . (2008, May). Health Professionals Council of South Africa . Retrieved October 6, 2018, from Guidelines for good practice in the health care professions : http://www.hpcsa.co.za/downloads/conduct_ethics/rules/generic_ethical_rules/booklet_3_patients_rights_charter.pdf

South African Constitution and Bill of Rights . (n.d.). Chapter 2: Bill of Rights. Retrieved October 6, 2018, from South African Constitution and Bill of Rights : http://www.justice.gov.za/legislation/constitution/SAConstitution-web-eng-02.pdf