07 January 2011

This week I was at the Victoria hospital. Whilst there I encountered an elderly patient who was very confused and agitated. The patient was accompanied to the department by a male nurse. Before attending to her I had been told she was in an agitated state in the waiting room and had been crying and calling out to members of staff for help. On entering the room I introduced myself and explained why she was there and what she was required to do. The patient was in a wheel chair, she asked who I was and requested to see my identification badge before proceeding. Once she was satisfied that I was who I claimed to be, she continued to tell me that she had been brought in by ambulance and needed to go to the ward. I explained again that the doctor required an x-ray of her chest and he was up in the ward waiting. I took my time to explain to her we needed her to either stand or sit back in the chair for the examination, but she insisted on seeing every member of staff’s identification badge before proceeding.

It wasn’t long before we established she was not going to co-operate. We asked the male nurse if there was anyone in the ward that she recognised and trusted that could help with the patient so she would co-operate. He explained that he was new to the ward so he didn’t know. We then decided to phone the ward and ask the staff if there was anyone who could help with explaining to the patient what was required. We didn’t want to resort to sending her back without achieving the examination.

After trying everything we decided it wasn’t fair on the patient to keep pursuing the examination. It was difficult to communicate with the patient as she kept talking over the top of me when I was trying to explain why she was there and what she was there for. She demanded to see all the staffs’ identification badges that were in the room, and she would not sit up for an x-ray until she had spoken to her doctor. It was obvious no one would be able to get through to her unless she knew them or trusted them.

I found the situation a little frustrating as she seemed capable of what was required and she also seemed to understand where she was and what she needed to do but just seemed obstructive. However, if the patient is becoming agitated due to new and strange surroundings with unfamiliar faces and is also confused to what is going on, I can only imagine this will increase her fear, confusion and stress level.

Medical dictionaries define confusion as, “a state of disturbed consciousness, with disruption of thought and decision making capacity”. During my training good communication skills has always been highlighted as being essential. Having patience and a good understanding of what is required when dealing with any patient is important, however having good communication skills is vital when dealing with elderly patients especially when they are confused or frightened. According to Shank and Ratchford, confusion can be divided into two categories: acute confusion (also called delirium) and chronic confusion (also called dementia.)

Risk factors which are associated with confusion in the elderly can include normal degenerative age-related changes, as well as physical conditions, as well as emotional and social disruptions in lifestyle. Age is the best studied and the strongest risk factor for dementia. Age-related changes include the diminished ability of the brain to adapt to both internal and external changes. As aging occurs a person’s short-term memory may become less reliable than their long-term memory.

As a radiographer, it can be difficult to establish trust with elderly patients who are experiencing confusion or anxiety. We see patients for such a brief time, perform the examination and then they leave. We only have a short period of time to gain the best diagnostic images while gaining patients trust. This trust can also be difficult to maintain when having to move a patient who is in pain. However throughout my time on placement and through many experiences as an auxiliary nurse I do know how to try and gain trust from patients who are in pain or confused. By coming down to a patients eye level, and speaking slowly while having eye contact eases tension and can calm patients. I do feel if you can calm someone who is frightened it is easier to communicate with them and gain their trust. Although we were unable to gain any images for this particular patient I do feel it was the correct thing to send her back to the ward as we were only adding to her anxiety increasing her fear and confusion. I feel the nursing staff should have pre-warned us regarding the patients condition, I would do exactly the same in the future as I feel trying to force a patient or trying to achieve a diagnostic image in that type of situation could possibly have an detrimental affect. I think as a professional you should try your best to gain an x-ray, however knowing how you maybe increasing someones fear and knowing when to step back is also important.
Attached to this piece of writing are documents on communication with patient and communication with the elderly.

Lacy, K. 1998. Communicating with patients: a quick reference guide for clinicians. [online] New York: Clinical Advisory Committee. [Available at: http://www.arhp.org/uploadDocs/QRGcommunicating.pdf] [Accessed November 20 2010].

Communicating with impaired elderly persons. [Available at: http://www.ec-online.net/knowledge/articles/communication.html] [Accessed November 20 2010].

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