Introduce Yourself – It Makes A Difference To A Patient

The importance of introductions – Staff > Patients

Hello, my name is Chris and I have been blogging about the journey my dad has been on since he suffered a heart attack back in April 2015 and, had a diagnosis of Parkinson’s disease in October 2015.

Today, dad stepped onto another path after being referred to the eye clinic at his local hospital, this was the result of a visit to his opticians for a routine eye test.  The optician suspected he could have the beginning of a cataract and a possible risk of early onset of glaucoma.  Another worry, but something that was suspected and had to be investigated.

My dad is one of the most friendly, respectful and accommodating people you could meet, never complains, and always sees the best in people.  The reason I am highlighting this fact, is due to the way my dad was treated today, which left me quite surprised and a little upset.

We arrived at the clinic reception, dads appointment letter was taken from him and he was told to take a seat, no details were checked, no explanation was given as to what would happen next.  We took a seat and waited to be called into clinic.

When dad was called into the clinic about half an hour later, he was given a routine eye test and asked to take a seat back in the waiting room again, no introductions or an explanation as to what would happen next was given.

We followed the health care assistant into the next waiting room and took a seat, not knowing what we were waiting for, but guessing it was to see the specialist.

After about an hour of waiting, one of the nursing assistants turned on a TV screen showing the waiting times/delays for each specialist, having identified my dads specialists name, I asked if the hour wait was from the time we arrived, or, the time the screen was activated for all patients in the waiting room to see (which was then 11am) I was told it was from the time of dads appointment, which was 10am. . .

The reason I was asking, I was aware that dad had been sitting for an hour therefore, he would be a little off-balanced when he stood up, and I was worried if I left him to get a coffee, as was suggested, he may get called into clinic without me being there to assist him.  After speaking to a member of staff, I was informed that if he got called into clinic the nursing assistant would make sure he was ok if I hadn’t returned by this time.

After this discussion and a chat with my dad I decided to go and get him a coffee from the coffee shop on the next floor (reluctant to leave him, but aware he needed some refreshments) Thankfully I returned just in time, as I passed the coffe to my dad, his name was called and we had to go into see the specialist.

Dad had no time to have his drink, but at least he was not waiting any longer to see the specialist.  I was trying to explain to the nursing assistant that dad needed this drink, but we were ushered into the consulting room without any further discussion and dad was directed to the examination chair.

The reason I was a little upset and I must say surprised, was at no point did anyone introduce themselves, not one member of staff said “Hello George, my name is . . .” something as simple as a name, how difficult is that?  I thought it was really disrespectful to the patient, but also showed lack continuity on behalf of the NHS.

If you have been reading my blog, you will know that I have 28yrs NHS experience, having worked in a number of non-clinical roles in two NHS Trusts, in front-line services and most recently corporate services.  I am aware of the importance of introducing yourself and being respectful of the patient, especially when they are feeling vulnerable.

I have been following a very important campaign for the last year, that has been widespread across the NHS, promoted across the social network platform which is called:

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This was started by Dr Kate Granger (Twitter – @GrangerKate) and has NHS Trusts across the country joining in and taking up this challenge.

More details can be found on the following link:

http://nhsemployers.org/campaigns/hello-my-name-is

Introducing yourself to a patient is a personal and respectful act of acknowledgement, putting the patient at ease, it is so easy to say, hello my name is. . and should be the first thing any member of staff interacting with a patient should say!

The test itself involved putting drops into dads eyes, and as anyone knows, the first thing you do when anything goes into your eyes, you blink continuously! While this was happening my dad was being told to keep his eyes open so the specialist could look into his eyes, but this was impossible for dad to do as the drops were irritating his eyes therefore, making him blink.

With the disappearance of the nursing assistant, I was ‘told’ to help, which I found very disturbing as I could see my dad struggling.  I asked if he could have a minute to relax, but was told he had to continue while the drops were in and the test was done.  It was at this point the nursing assistant came back into the room and I was directed out of the way as she took over, I watched as she tried to hold dads head against the eye machine to get the test done.

I found the whole experience a little traumatic to watch as I could see dad was struggling, and I didn’t feel that either of them were being considerate to his condition, or putting him at ease.  I was so relieved once it was over for my dad.

Once the test was over, the specialist discussed the results, but directed them to me and not my dad.  I then tried to bring my dad into the discussion asking him if he understood what was being said, and if there was anything he wanted explaining again.

The good news was that there was no glaucoma at present, but the test would have to be repeated in another 2/3 months.  Nothing was mentioned about possible cataracts, as stated on the referral by the opticians therefore, I’m hoping this is not an issue to be identified at a later date.

I just hope that dad will be treated a little more compassionately at his next appointment, and he won’t be left bruised as he has been by this procedure.

I have always found it hard to listen to criticism about the NHS having worked in the organisation for so long, and also experiencing the other side, as a patient and a relative of a number of patients that have been treated by the NHS.  However, there are times, like today, when I can understand the criticism. . .

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Embrace The Knowledge Of Our Aging Relatives

If only everyone took the time to listen:

Browsing through Twitter this evening, I came across a tweet posted by @IAmJohnSparks

I couldn’t resist sharing, as it made me think of all the times I have regarded my dad as the most influential person in my life, the one who I go to foe advice, the source of knowledge that was second to none in my eyes.

Please read the tweet, take it in, think about the words, and if possible respond to let me know who, in your eyes is that person and what is it that you have learned from them.

I can recall a conversation I had with my son’s teacher at one of his parents evenings, we were discussing the usual, work, attitude, progress etc. . Then, the teacher asked me about my dad, which I thought was a bit of a strange question, considering I hadn’t even mentioned him.  However, it was then that I found out that anything that was discussed in certain lessons such as ‘History’ Geography’ that my son had doubts about, or found hard to believe, apparently he would inform the teacher that he would go and ask his granddad!

This, I believe happened a number of times with different teachers, and my son would go back to those teachers to let them know they were right, as his granddad had verified the information.  I found this to be really funny at the time, but I also felt proud that my son had such a respect for his granddad and the knowledge he held.

He still seeks him  out now for clarification on certain things.

I would love to hear some feedback, and maybe we could build on this to promote the knowledge and learning we should be gaining from our elderly relatives and the aging population.

Positive Steps – Looking Forward

Positive Steps:

I am very happy to report that my dad has definately turned a corner on his journey of recovery.

At the end of April 2015 when my dad had his heart attack, it really knocked him sideways and changed him from an independent, outgoing, confident, happy go lucky man, into a frail and dependent individual.

As a daughter I found this sudden change very worrying and I was left thinking about the possibility that my dad may not recover.   Along with the diagnosis of Parkinson’s disease 6 months later, this has been a very worrying and exhausting year.

What a difference a year makes:

One year on things are finally looking up, we are still on a continuing journey of recovery with every day that passes, but I am finally starting to see my dad slowly recovering, he is showing more of an interest in the simple things he always enjoyed, such as his garden.  It may be the lovely warm and sunny weather we have been enjoying lately which has given my dad some inspiration to get out there and start doing little bits in his garden, but whatever it is I am so happy to see my old dad in there somewhere. . .

He is taking more of an interest in his wellbeing, he is not suffering from the breathlessness that stopped him in his tracks this time last year. His appetite has increased, his weight has been maintained, he is smiling more and making conversation so much more than he has done in the last year.  His mischievous side is rearing its head again, much to the amusement of his grandchildren and great granddaughters.

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It is so nice to see his confidence and energy coming back and seeing him doing more than he was, although he still suffers with dizziness and balance issues due to the Parkinson’s, this is something that may become easier with an increase in his medication. Time will tell!

Taking the timeout from my career to look after my dad was not an easy decision, becoming his carer was never a role I would have envisaged at all, but at the time I couldn’t really see an alternative.

I am happy to have been there for my dad, I know I have helped him in so many ways and he has felt secure in the knowledge that I’m there for him always.  I’ve been pointing him in the right direction to assist in his recovery, from his cardiac therapy group to his follow up hospital appointments, advising him on the services that were available for him, and advising him of the potential benefits each of these services will provide for him.  All provided by the NHS, in particular Community Health Services.

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I would certainly advise anyone in this position to take advantage of the services provided by the community health teams.  They have been influential in the rehabilitation process my dad has been through, and is still involved in today.

Therapy Sessions – Speech & Language

Dad is now working with the speech & language therapist, and fter his initial assessment he is now following a plan of action which is assisting him in his efforts to regain his vocal range, which has been affected by the heart attack and Parkinson’s.  He looks forward to these sessions, as they have given him a goal to aim for and that is to regain his singing voice (prior to his illness he was a member of the Irish Guards Choir for over 10 years)

It would be wonderful to see my dad singing again one day, and now I can see his efforts are starting to pay off. .

Just the other day, without any prompting, my dad broke out into song, which was a lovely surprise, it’s just that we were walking into a department store at the time! Very entertaining 🙂

 

 

Speech and Language Therapy

Aside

Speech and Language Therapy Services:

Speech and language therapists (SLTs) are allied health professionals. They work closely with parents, carers and other professionals, such as teachers, nurses, occupational therapists and doctors. There are around 14,000 practising SLTs in the UK working in a wide variety of settings.

More details can be found on the following link:

http://www.rcslt.org/governments/docs/what_is_slt_factsheet

After successfully completing a programme of exercise provided by the Physiotherapy/Occupational Therapy Team, my dad has now been referred to the Speech and Language Therapy Team.

Since my dads heart attack and diagnosis of Parkinson’s, he noticed a marked deterioration in his voice and speech, which has been worrying.  At first I thought it was just part of his recovery from the heart attack, which left him very weak and fragile, but as his health improved with medication and therapy, his speech was still noticeably impaired.

Having found out more about Parkinson’s I now understand this is a symptom of the disease, as is the difficulties with swallowing and can be helped with therapy.

The Speech and Language Therapy Team assess, diagnose and treat communication, voice and swallowing impairments enabling patients to achieve their maximum potential.

The team provide a service to patients in hospital and in the community, visiting patients in their own homes (as in my dads case)

Further details of this service can be found on the following link:

http://www.5boroughspartnership.nhs.uk/speech-therapy-knowsley/

The Initial Assessment:

Dad’s first assessment took place in his own home with the speech and language therapist and consisted of a number of tasks for him to take part in.  First of all he was asked to do some deep breathing tasks to relax him before he was instructed to shout as loud as he could (dad found this a bit strange as it had been so long since he even had a reason to shout and, to be honest, I can’t remember the last time I heard my dad shout) but I believe this gave him some reassurance that his voice was in there somewhere 🙂

The therapist will continue to do some one to one work with him over the next few weeks before referring him to a therapy group which will continue with his rehabilitation.

My dad has been a member of the Irish Guards Choir for over 10 years and loved taking part in the fundraising events, concerts, weddings etc. . .

But after his heart attack he has only managed to attend a few practice nights, partly due to his slow recovery and trying to rebuild his confidence, but mostly due to his worry on the change in his voice and speech.

The choir has been a big part of his life since he lost my mum 10 years ago and I hope one day to see him join them once again. . .

 

Older People’s Health Needs – No Response!

Are community services meeting older people’s health needs? Live discussion As featured by Guardian Healthcare

http://www.theguardian.com/healthcare-network/2016/apr/14/are-community-services-meeting-older-peoples-health-needs-live-discussion

I would have liked to comment but didn’t get a response. . .I tried with my tweet!

Taking That Step Forward – Reablement

A Step Forward Makes All The Difference:

Knowsley Assessment and Reablement Service

I cannot thank the Knowsley Reablement Team enough, for the dedicated support they have given my dad over the last 4/5 weeks.

Every day they have visited my dad at home to take him through a programme of exercises to help build up his core muscle strength, this programme has given him back his confidence and enabled him to take some steps towards becoming independent again.

The main aim of ‘Reablement’ is to provide therapy based support which is designed to help people re-learn the skills they need to live independently. The service is aimed at people who have been in hospital and need support to progress with their recovery. This service prioritises people who have the potential to improve their independent living skills and mobility.

There is so much support for elderly people from the Community Health Services if the right referral is made to the right services.

However, I also understand that if I didn’t have some form of knowledge of the services available and hadn’t followed up these services through my own determination, I wonder who would have signposted my dad to this excellent programme. . .

Would this be the responsibility of the GP? I am not so sure!

Having taken on the responsibility for my dads care and recovery I have found myself following up so much.  One regular follow up is a blood pressure check, this has been advised by the Neurologist since my dad started on his Parkinson medication, due to a possible side effect of the medication which could result in a drop in blood pressure.

Every month I make an appointment with the nurse at the GP surgery for dads blood pressure check, so far so good, although dads blood pressure is slightly on the low side anyway, it has stayed stable, which is reassuring.

Looking back over the last 5 months though, I can not recall any appointment being made for my dad to see his GP for a review or update on his condition since he was diagnosed with Parkinson’s in October 2015.  The last appointment was in November 2015 which I made for my dads medication to be prescribed.

This month dad had a review of his condition with the neurologist and his medication was increased, but as of 3 weeks later no appointment has been sent out from his GP surgery to increase his medication, and I am sure the neurologist report would be with the GP by now!  Therefore I will have to follow this up and make an appointment with dads GP so his medication can be increased. . .

Should this be my responsibility or should GPs follow up these reports?

As my dad has his medication delivered in ‘Blister Packs’ from the local chemist, I waited to see if his prescription had been updated for this month, but no new prescription had been sent to the chemist for the increased Parkinson medication, so we are another month without this increase.

Again, I am left wondering what would happen if I didn’t follow this up?

 

The Importance Of Therapy Services

The Reablement Team – Programme of Exercises:

In my last post, I discussed my frustrations at the lack of information shared throughout services within the NHS, in particular GP referrals into the support and therapy services available for people with Parkinson’s.

However, I am pleased to say, after a number of weeks and a GP referral to the ‘Reablement Team’ within ‘Community Health Services’, my dad has finally stepped onto the right pathway of care for his Parkinson’s.

This is proving to be an excellent programme for my dad and we are already seeing positive results.

The first initial assessment was carried out in his own home by a Physiotherapist and a specialist Parkinson’s practitioner.  I was able to observe the assessment which was very thorough and clearly defined throughout.  The assessment consisted of a number of information gathering tasks.

Physiotherapist – Introduced herself to my dad, giving her name and the reason she was in attendance.  She created a relaxed atmosphere taking time to explain what the assessment was about.  She explained about the information she required on his medical history, medication, current wellbeing, general health and ability around the home.  Once the discussion was completed, the physiotherapist asked my dad to perform a number exercises, in order for her to assess the strength in his legs and arms, balance and stance.

Parkinson’s Practitioner – Introduced herself to my dad, giving her name and the reason she was accompanying the Physiotherapist.  During the physiotherapists assessment, the Practioner was constantly    assessing each movement my dad made, identifying areas of concern that were showing through his movements, balance and eye movements due to his Parkinson’s.  I found this very interesting, as I was not aware of these areas of concern, due to my lack of knowledge on Parkinson’s, but the information was incredibly useful to me and my dad.

This is one of the reasons you need the experts to support you when caring for someone with Parkinson’s disease, as they have the skills and knowledge to deal with these concerns.

Assessment included the following:

  • Dad walking up and down the stairs
  • Getting on and off his bed
  • Using the bathroom (was the toilet too low, did he require a higher seat)
  • Using the bath/shower (if he had a chair or bath board)
  • Access into and out of his home
  • Assessing his kitchen, cooking, preparing food (did he require a trolley)

Incidentally it was while they assessed his bathroom, that they identified that the battery operated rise and fall bath chair, which had been fitted months earlier, was much too big for the type of bath he had.  They explained how a bath board would be safer and easier to use, and that they would arrange for this to be replaced.

I cannot praise the two specialists enough, they took this time to assess my dad, they were excellent with him, and treated him and myself with so much respect during the assessment.

The Outcome – The Physiotherapist arranged to visit my dad the following week to go through a programme of exercises with him.  This would involve muscle building exercises and retraining his brain to engage with different movements, while trying to break some initial habits, such as standing on his heels instead of his full foot, this creating the possible balance issues he had been experiencing.  Although some of the balance issues could also be due to his condition and medication, the exercises would help.

Occupational Therapy Team – Once the initial physiotherapy sessions had been established, it was decided to call in the Occupational Therapy Team, due to my dad having some problems with the programme of exercise.  This was nothing to do with the exercises, it was due to the slight memory lapses my dad was suffering from (another symptom of his Parkinson’s, and one that is being assessed through another service – The Memory Clinic) and the Physiotherapist wanted to make sure the exercise programme continued.

The Occupational Therapists arranged to visit my dad each day to go through the programme with him, and establish some continuity for him, this would enable him to get into a routine, as well as having someone supporting him through the exercises.  This really helped him, and I think he even started to look forward to it.

Dad has now been on the programme for 3 weeks, and has taken to the exercises very well.  He understands the importance of the exercises, and how they are helping him to regain some of his muscle strength, as well as helping his balance and walking.

My Questions:

  • If this programme is so important to the wellbeing of patients with Parkinson’s, why is it, that I had to research and discuss this with a number of people before my dad gained the right support and was placed on the right pathway of care?
  • Should all Parkinson’s patients go through this programme?
  • Should this programme be established as soon as a diagnosis of Parkinson’s is made?

I guess I have been lucky, due to working in the NHS and having an understanding of the services available, I was able to speak to the right people, in the right places and push forward to gain the right referral from the right service (GP) for my dad.

Although this took time, 5 months to be exact! I didn’t give up. . .

However, I do still wonder if there are other people just like my dad, with newly diagnosed Parkinsons, who have nobody to push for them and are not getting the right support from these excellent services just for the want of the right referral. . . . 

The Importance Of Signposting For Parkinson’s Disease

Parkinson’s – Why ‘Signposting’ is so important

In recent posts I have discussed the importance of ‘Signposting’ and here I am bringing the subject up again.

I still don’t feel enough is being done to signpost patients to the services that are available for certain health conditions.

I have experienced the frustration of being passed from one service to another while trying to identify the correct care pathway for my dad.  This has been the case after his recent diagnosis of ‘Parkinson’s’

WHAT IS PARKINSON’S?

Parkinson’s is a progressive neurological condition.

People with Parkinson’s don’t have enough of a chemical called dopamine because some nerve cells in their brain have died. Without dopamine people can find that their movements become slower so it takes longer to do things.

The main symptoms of Parkinson’s are tremor, rigidity and slowness of movement.

Similar symptoms can easily be associated with the onset of ‘old age’ and this may have been one of the reasons my dad had not known he had Parkinson’s, we certainly hadn’t considered this as an option.  It could also be the reason his GP had not discussed this as a possible cause of dads symptoms, despite my dad having regular check-ups for other health issues.

Should more be done to test for this condition when there are a number of obvious symptoms?

The diagnosis of ‘Parkinson’s was unexpected and another stepping stone on the pathway of care.  Initially after diagnosis we were directed back to the GP for medication, it was during this consultation an appointment with a ‘Parkinson’s Nurse Specialist’ was advised, but no other option was discussed at this point.

Working in the NHS I have been able to discuss my dad’s ongoing health issues with some of my colleagues, they have provided support and advice on the services that my dad should have been referred to, such as the Parkinson’s therapy group.  

I was however, quite surprised to hear that the referral would have to come from the GP! 

Why was this not mentioned by the GP?

Therefore armed with this information, I contacted the GP surgery and discussed this with the GP receptionist, who assured me they would pass on the information to the GP.

After a couple of weeks, no word had been received on this referral, so I called the surgery again, this time I was informed that my dad already had an appointment with the Parkinson’s Nurse Specialist and no other referral was required at this time.

I found this quite worrying as I had been informed of the importance of early referral for therapy, once a diagnosis of Parkinson’s had been made.

PATHWAY SO FAR:

Neurologist: Initial diagnosis

GP: Prescribed Medication – Referral to Parkinson’s Nurse Specialist.

Parkinson’s Nurse Specialist: Assessment 

This assessment was not as informative as I expected, it was more of an update on my dad’s condition with an explanation of his previous medical history. The nurse specialist did not have my details on my dad or his recent medical history, no patient notes or information.

The meeting did however, give us reassurance of the support that was available from the nurse specialist, but when I asked about the therapy group and informed her of what I had been told, they didn’t seem to know anything about it.  At this point I gave them the name and contact details of the practitioner who had provided me with this information, and after further discussion I was assured they would complete the report for the GP and send a copy to the practitioner to pursue this further.

I really do feel very frustrated by the lack of information shared throughout services within the NHS, especially when so much emphasis is put on identifying the correct care pathways.  I really feel for the patients who don’t have someone to help and advise them of the support that is available for them. . . 

My next post will report on the positive outcome from further discussions regarding the therapy services, and how things have moved on for my dad.

As one pathway ends, another begins

Cardiology:

I am pleased to report that my dad has been discharged from the cardiology department after his 2nd follow up appointment (Post MI) The cardiologist was pleased with dad’s progress and the medication, which will be continued as prescribed.

A decision was made not to intervene with invasive heart surgery, which at dad’s age would be more of a risk to him than a positive intervention.  So I will continue to support his wellbeing, making sure he takes his medication, regular excercise and healthy eating.

Memory Clinic:

Dads referral to the ‘Memory Clinic’ has resulted in blood tests and a brain scan, he will now be seen by the Consultant Psychiatrist in 2 weeks time to discuss the results.

The referral was made due to my dad suffering from memory lapses over the last few months, these were concerning me and my dad therefore, the test will conclude if the episodes are just part of the aging process, or if there is a possibility that early onset of dementia or Alzheimer’s could be causing this.  I do hope it is not any of the latter, but if it is then at least the diagnosis will be early and treatment can begin.

I cannot stress enough about the importance of early diagnosis of these conditions.

http://www.knowyourcare.co.uk/i-need-help-with/health,-recovery-and-wellbeing/dementia/how-to-get-help.aspx

Parkinson’s Disease:

I recently posted about my dad’s recent diagnosis of ‘Parkinson’s Disease’ and this is another pathway that is now opening up to us.  Having no previous knowledge or information on this disease, I know find myself researching and discussing the care and support that is available.

My next post will report on the pathways that are available through ‘Community Services’ and the difficulties I have experienced with ‘signposting’. . .