Its bright early spring afternoon, the sun is shining, and a lady called Audrey who 87 years old has just finished planting primulas in her garden, earlier in the day she drove to the supermarket to do her weekly shop and went down to the local pharmacy to drop off her repeat prescription.
The next morning, she receives a phone call from her neighbour Maureen who is in her middle seventies, she has an appointment at the hospital, but her feet have swollen, and she asks if Audrey might have a pair of shoes that have Velcro fastening that she can loan. Yes of course says Audrey who goes off to the wardrobe to the find the new pair she has never worn. Ten minutes later Audrey finds herself on the ground, she has bashed her forehead, smashed her left shoulder against the low wall and has a huge gaping wound on her right knee, the wound gushes with blood because she takes blood thinning medication.
Luckily the postman is in the cul-de-sac and he calls an ambulance and Audrey’s grandson and they are both taken to A and E.
Audrey is treated at and A and E and spends a day and half in the clinical decision’s unit, they tell here she will be transferred to either a ward, the community hospital or a respite nursing home for some occupational therapy. They don’t think she has broken her shoulder but assume from the scan that arthritis along with the fall have combined to create uncertainty, so they will check again next week, she has 12 stitches in her knee, a black eye and a bruised forehead.
At A and E, a nurse has told her to make sure she takes good care of her hearing aids, as they don’t want them to get lost, her grandson brings in white box with a big label “Audrey’s hearing aids” to put them in “so they won’t get lost”. By now Audrey is so concerned about her hearing aids, that she insists her grandson takes them home with him as she doesn’t want to lose them, she insists she can manage without them.
By the Sunday she has been transferred to an elderly ward in the hospital and Audrey is worried about the “old” ladies in the ward, most of which are probably younger than her. She simply doesn’t see herself as old. The lack of hearing aids is causing her to mis hear what the staff are saying to her and she is creating her own narrative about the communication that is taking place. The staff insist that she needs a continence pad “just to help her whilst she recovers”, she says no, she can get the toilet if staff just take the time to support her in taking the few short steps. It’s her grandson’s intervention that finally puts the issue to rest and they all agree that its support not continence aids that are vital to help her maintain her independence and support her recovery.
For two days in the ward she struggles to hear what is being said to her, but she still insists that won’t have her hearing aids, as they will get lost and she spent too long going to and fro to Specsavers to get the more reliable digital ones.
By the Wednesday she has been transferred to the local community hospital for physio and occupational therapy. She arrives at 6.30pm in the evening just before she gets a visit from her niece Lorraine, when Lorraine arrives she unpacks her Aunts bags, takes off her aunt’s coat and makes Audrey comfortable.
A nurse arrives and asks if Audrey has had a MRSA swab, Audrey can’t hear properly (she doesn’t have her hearing aids) and creates her own narrative and answers a question that hasn’t been asked. The nurse asks Lorraine if the patient has Alzheimer’s? Lorraine says no, her Aunt Audrey is probably a bit tired from the ambulance journey, a bit disorientated by the move, that she can’t hear well because she hasn’t got her hearing aids.
At this point the nurse doesn’t know the patients name, hasn’t read her notes, has not introduced herself and has made several assumptions about this old lady who has just arrived.
During three short days after hospital admission we saw Audrey transform from an active 87-year-old living alone, taking care of herself, with plans for her summer holidays to an old lady, who is offered continence pads, is deaf and whose deafness is assumed to be Alzheimer’s because she appears confused when she answers questions that haven’t been asked.
Audrey is now happily at home with some carers support morning and evening, and If it had not been for the advocacy of her grandson and niece then maybe the outcome might have been different.
In experience of care week, we talk about person centred care and personalisation being important, but it seemed like for Audrey they were both a million miles away. So, the next time you get an elderly patient admitted to your ward, don’t make a fuss about their hearing aids because they might get lost, just ensure that the person has a safe box in which to store them and make sure when they transfer they have all their belongings as well as their hearing aids with them. The same is also true of glasses.
Audrey went back to the wards at the acute and community hospital to take in a thank you card and a treat for the nurses who looked after her so well.
But did they look after her well? did they deserve a thank you? would things have been different if anyone caring for Audrey would have asked her what matters to her? Would things have been different if she didn’t have family advocating for her? If they had asked her four short questions and acted upon them?
- What do you know about your condition?
- What’s important to you?
- What scares you?
- What would you trade to achieve your goals?
What mattered to Audrey was independence and getting back to her own home, it seemed like lots of the care removed her independence and did little to build on the assets that Audrey already had.
So, the next time you look at the thank you cards on your ward, think about Audrey and really think about what are your patients thanking you for?
Are they thanking you for asking “What Matters to Me?” and delivering care that sees the person not the injury or illness, that treats each person as individual, with individual needs and wishes. Or are they saying thank you for care that ignores the assets and gifts that are already there, for care that inadvertently takes away from someone’s goals, because we are focused on process and procedures.
We must focus on true shared decision making and we must deliver person centred care, but we also must recognise our own conscious biases and be aware of those unconscious biases that make us less inclusive. Just because someone is 87 doesn’t mean that they think of themselves as an old lady.
Make sure your next thank you card recognises your contribution to truly personalised care.