Challenging situation - A fall Flashcards
The Scenario where a patient has experienced a fall
As a Healthcare Provider: “I noticed you’ve had a fall. Can you tell me where you’re feeling pain? Let’s make sure we address any injuries you might have. It’s important to understand what caused the fall to prevent future incidents. Can we talk about what happened?
As a Family Member/Bystander: “I see that you’ve fallen and seem quite shaken. Let’s make sure you are not injured. Would you like me to call for medical assistance? It’s okay to feel upset after a fall; I’m here to help you through this.”
1) Ensure Immediate Safety: First, ensure that the environment is safe for both you and the patient. If the patient is still on the ground, assess if it is safe to help them up or if they should remain in place until further assessment
2) Calm and Reassuring Demeanour: Approach the patient calmly and with a reassuring demeanour. Falls can be traumatic, and the patient may be experiencing fear, pain or embarrassment
3) Initial Assessment: Conduct an initial assessment by asking if they are in pain, where they are hurting, and if they hit their head during the fall. Check for any visible injuries like cuts, bruises, or deformities
4) Vital Signs Check: Depending on the severity of the fall and the patient’s response, check vital signs - pulse, blood pressure, respiratory rate, and oxygen saturation
5) Detailed Medical Assessment: After addressing immediate concerns, perform a more thorough medical evaluation. This may include a neurological assessment, checking for potential fractures, and evaluating for underlying causes of the fall, such as dizziness, syncope, or balance issues
6) Empathy and Support: Throughout the interaction, show empathy. Acknowledge the patient’s experience and provide reassurance. For instance, you might say, “I understand that fall can be quite frightening but you are in safe hands now”
7) Gather Information: Ask questions about the fall - where it happened, how it happened, and if the patient experienced any dizziness or other symptoms before hand. This can help identify risk factors or causes of the fall. “I just want to know more about your fall and how we can prevent it from happening again.”
8) Plan of Care: Based on your assessment, develop a plan of care. This might include ordering imaging studies, providing wound care, administering pain relief, or referral to a specialist if needed. Document thoroughly so the wider medical team can provide tailored care
9) Prevention Advice: Discuss fall prevention strategies with the patient. This might include home safety modifications, physical therapy for balance and strength, or reviewing their medications for any that might contribute to falls
10) Follow-Up: Arrange for follow-up care as necessary. This could be a follow-up appointment, referral to physical therapy, or additional diagnostic tests
11) Family/Caregiver Involvement: If appropriate and with the patient’s consent, involve their family or caregivers in the discussion, especially regarding fall prevention and follow-up care
SOCRATES pain assessment
S - Site: refers to the location of the pain. Asking the patient to describe where they are experiencing the pain helps in identifying the affected area or areas
O - Onset: when the pain started and whether it was a gradual or sudden onset. Understanding the onset can give clues about the underlying cause of the pain
C - Character: the nature or quality of the pain. Terms patients might use include sharp, dull, aching, burning, stabbing, or throbbing. Different types of pain can be indicative of different conditions
R - Radiation: asks if the pain moves or radiates to other areas of the body. For example, pain from a heart attack might radiate to the left arm, neck, or jaw
A - Associations: any symptoms associated with the pain, such as nausea, vomiting, sweating, dizziness, or shortness of breath. Associated symptoms can be important in diagnosing the cause of the pain
T - Time Course: timing of the pain, including whether it is constant or intermittent, and if there are any patterns. For example, pain that is worse at night or after certain activities can provide important diagnostic information
E - Exacerbating or Relieving Factors: understanding what makes the pain worse or better. Certain activities, positions, medications, or other interventions might influence the intensity of the pain
S - Severity: the intensity of the pain. It’s often assessed using a scale (like 0 to 10, where 0 is no pain and 10 is the worst pain imaginable) or through descriptive terms. Severity helps gauge the impact of the pain on the patient’s life and guides treatment decisions
How to approach
1) Immediate Response and Assessment:
- Approach the patient calmly and confidently. Show concern and establish a connection. For instance, say, “Hello, I’m [Your Name], a [Your role]. I see that you’ve had a fall. How are you feeling right now?”
- Quickly assess the situation for any immediate dangers to the patient or yourself
- Check for responsiveness and injuries. If the patient is conscious, ask about pain, dizziness, or any other symptoms in open questions.
2) Empathy and Reassurance:
- Acknowledge the patient’s emotions. They might be scared, embarrassed or in pain, Say something like, “I understand this can be very unsettling. You are in safe hands and we’re here to take care of you.” “It is very natural to feel upset”
- Maintain eye contact and use open body language to convey your attention and concern
3) Gathering Information:
- Ask about the circumstances of the fall if they are open. Understanding the context can help in assessing risk factors and underlying causes
- Inquire about past medical history or any previous falls, if relevant and appropriate
4) Communication and Explanation:
- Explain what you are doing and why. For instance, “I’m going to check your blood pressure and pulse to make sure everything is okay” or “I might have to check your blood pressure once my team arrives to check”
- Use simple, clear language and avoid medical jargon
5) Making the Patient Comfortable:
- Ensure the patient is in a safe and comfortable position while waiting for further assessment or assistance
- Offer assistance. For example, if they need to sit up or need a glass of water, nmake
Angry patient & family
it’s important to demonstrate empathy, effective communication, problem-solving skills, and professionalism
1) Acknowledge and Validate Their Feelings: Begin by acknowledging the emotions of both the patient and their family. Recognize their anger and frustration, validating their feelings as understandable reactions to a distressing situation. For example, you might say, “I can see that this situation has upset you and your family, and I understand why you feel this way.”
2) Ensure Immediate Safety and Care: Ensure that the patient is receiving the necessary medical attention. Address any immediate health concerns resulting from the fall, such as pain or potential injuries
3) Listen Actively: Give the patient and their family an opportunity to express their concerns and feelings about the fall. Active listening involves paying full attention, not interrupting, and showing that you are engaged in understanding their perspective
4) Empathy and Understanding: Show empathy towards both the patient and their family. Express your concern for the patient’s well-being and the emotional impact the fall has had on the family
5) Provide Clear Information: Once you have a complete understanding of their concerns, provide clear and concise information about what led to the fall, if known, and what steps are being taken to address the patient’s immediate health needs and prevent future incidents
6) Explain Protocols and Procedures: Inform them about the protocols and procedures in place for dealing with falls, including any investigations to understand the cause and prevent future occurrences
7) Involve Them in the Care Plan: Involve the patient and their family in developing a care plan moving forward. This includes discussing any changes to treatment or care to address factors contributing to the fall
8) Address Concerns and Offer Solutions: Respond to any specific concerns raised by the patient or family. Offer solutions or alternatives where possible, and discuss how similar situations might be avoided in the future
9) Follow Up: Ensure that there is a plan for follow-up care. This might include additional medical evaluations, rehabilitation, or meetings to discuss the incident further
10) Documentation: Document the incident and the interaction with the patient and their family in their medical records, including their concerns, the information provided, and the agreed-upon plan
11) Reflect and Seek Feedback: After the interaction, reflect on the situation to learn from it. Consider seeking feedback from colleagues or supervisors on how the situation was handled and what could be improved
12) Provide Support and Resources: If the patient or family continues to be distressed, consider referring them to support services, such as counselling or patient advocacy group
