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Little things making a big impact - new tool aides personalised care for non-communicative patients

Photo: Health Times
Graduate nurse Veronique Murphy has been recognised for developing an innovative tool, designed to help nurses provide more personalised care to patients experiencing delirium or dementia.

Ms Murphy, who was named Outstanding Graduate in the HESTA Australian Nursing and Midwifery Awards, designed the tool as part of her graduate project at Alfred Health.

“I first got the idea when I was looking after a patient who had recently been diagnosed with brain cancer which was affecting his ability to communicate as well as his mood,” says Ms Murphy.

“He was often visibly upset and frustrated. When his family visited, they showed the nurses photos of the patient at the gym – he had been a personal trainer and loved the gym.

“If spoken to about the gym while the patient was being assisted with medication or other cares, he was calmer, seemed to be in a better mood, and smiled more.
“I’d only been a nurse for 2 weeks and it just moved me how significant knowing some small details about a person’s life can be to their experience of hospitalisation.”

Called, ‘my preferences’, the tool is basically a patient preferences prompt sheet, which includes four areas where information can be added about the patient, for example likes, dislikes, food preferences, important people in their life, and important things about their past, present and future.
“Ideally, the sheet can be placed in the bedside folder of any patient who may have difficulty communicating their preferences to staff, and so can be added to whenever new information is learned about the patient through patient or family interactions,” says Ms Murphy.

“The aim was to try to facilitate improvements to patient centred care and emphasise the importance of non-clinical information to promoting a patients’ comfort and sense of personhood.”

Working in acute care, nurses are often time-poor and patients move around quickly, leaving nurses with little time to focus on the person, but rather the patient’s condition.

“The idea was that instead of having to go through the progress notes for details, the sheet could be handy and available to all clinical staff for quick notes or relevant information.”
Before becoming a reality, ‘my preferences’ began as a list of journal entries Ms Murphy had recorded, outlining positive and negative experiences at work.

“I felt like I could provide better care when I knew the ‘little things’ about patients which I had learned because I had met their families the day before, or because I’d looked after them a few days in a row.

“And I noticed that other nurses could help me with my patients when they also knew small details – the names of sons and daughters, their favourite hobby, how they spent their days – which helped to redirect or support a patient who might be confused or distressed.”

With the effects of delirium and dementia quite fluid, the ability to quickly note down preferences can have a big impact.

“Hospital is so overwhelming.

“You’ve got people who are essentially strangers asking you to swallow tablets and in many ways restricting your freedom to do what you want to do, people wheeling you into machines and asking you to eat or drink things you may not usually eat.

“Delirium is such a common hospital complication, at least when  we know some of the person’s preferences, we can work with the resources that we do have to provide an environment that feels safer and more familiar, or perhaps guide them a little away from the fear, distress or confusion they may be experiencing.”

The idea is that the prompt sheet can be placed in the bedside chart of any patient who might not be able to consistently communicate their preferences.

It’s designed so that staff can  quickly note down information that might help make the patient feel safer in an unfamiliar environment or in a time of distress, as well as a quick reference for the acute care environment, that doesn’t add too much extra paperwork.

“Simple examples might include that the person likes hot milk with breakfast and so providing this will encourage them to eat.

“Or that they worked as a shoe maker and so tend to stress if they can’t see their own shoes, or that their cat is being looked after by their granddaughter so the patient can be reassured if they forget and start to worry about their cat.”

Ms Murphy says the impact of knowing and acknowledging these ‘little things’ was tremendous, and could dramatically change the hospital experience of patients unable to properly communicate.

“I guess simply put, I just can’t fathom the idea of someone feeling invalidated, scared, confused or unheard in hospital, or families worrying that their loved one will be seen as just a patient and not a person.”

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Nicole Madigan

Nicole Madigan is a widely published journalist with more than 15 years experience in the media and communications industries.

Specialising in health, business, property and finance, Nicole writes regularly for numerous high-profile newspapers, magazines and online publications.

Before moving into freelance writing almost a decade ago, Nicole was an on-air reporter with Channel Nine and a newspaper journalist with News Limited.

Nicole is also the Director of content and communications agency Stella Communications (www.stellacomms.com) and a children's author.