Matters of Note: Lack of Patient Education and Increased Suffering by the Patient
According to the American journal of infection control, lack of knowledge about infection rates and its prevention causes wound infection to the patient undergone caesarean section [AJIC], 2010). According to (Riley & Suda, 2012) the rates of caesarean section are increasing with the passage of time. Apart from its increased medical costs, it is the substantial cause of postoperative morbidity which further more increases health care costs because of readmission of women.
During clinical rotation at Aga Khan Hospital Karimabad, I came across with the case of a women who was 23 years old admitted since 3 days. She was admitted with surgical wound infection after C-Section which took plays 5 days ago. When I interviewed her further she told me that she was not told or taught about how to clean and take proper care of her surgical site at the time of discharge and she also did not ask. When she went home she thought water may infect the wound so she neither took bath nor cleaned the stitches which led to severe infection.
Upon her assessment I found out that she was in severe pain, scoring 7/10, sharp, continuous, exacerbates with sitting or changing position, relieved with medications, associated with headache. Pussy discharge was coming out of it. She was really depressed because of her medical condition as well as she could not meet her child due to child’s immature immune system, doctor also told her to not to feed her infant who was days older to prevent the transmission of infection care. This ultimately resulted decrease in infant’s weight.
She verbalized that “ just because of these health care providers for not giving me teaching I am bearing intense pain, unable to take care of my child even feeding the child, I am totally isolated form my family especially my child”. By seeing her suffering, I was feeling very bad and disappointed that why I did not take initiative to provide her proper wound care teaching, through which she might not suffered. I did dishonesty with my profession because as being a healthcare provider this is my primary responsibility to educate the client, assess their knowledge and clearly making them understand about the care at home at the time of discharge from hospital. Actually I was a novice at that platform so I thought that other staff nurses will told her about proper wound care.
Another important drawback was that I considered patient health education as unimportant which resulted in severe consequences experienced by patient. Because of just missing one but major component of health care, I physically, socially, emotionally and psychologically distressed the patient as well as her newborn who got deprived of adequate nutrition, love and care from his mother at his most critical period of life. Along with endangered two lives at the same time. If I was confident enough at that time and stepped ahead to provide her teaching then she might not be in this state.
During previous clinical rotations many times I encountered that nurses, doctors, and other healthcare providers neglect either the component of patient education or the evaluation of the teaching given to patient, therefore they cannot find out the level of information the patient has got or sometimes because of hectic shifts, caring a critical patient or heavy work load they keep patient teaching as the least priority subject. From this scenario I clearly understood the importance of patient education, its benefits and as a source of reduction in patient suffering. In addition it plays a significant role in patient’s holistic care. In my point of view the incident happened primarily because of the lack of postoperative wound care teaching to the patient as well as lack of evidence based nursing interventions.
I did not assessed the knowledge of the client regarding wound infection and neglected the fact that she is highly susceptible to the infections, as the patients gone through Caesarean section are four times more vulnerable to infection as compared to those who have gone through vaginal delivery (Johnson & Young, 2006). Secondly, I was not confident enough to take the step in providing education to the client. The reason behind it was that as a student nurse it was my first clinical exposure to antenatal clinic, we never visited such areas before I found myself impulsive at that stage and relied to the staff nurses. According to the work place advocacy proposal, postpartum women are not provided with adequate information during their in-hospital stay regarding adjustment to physical as well as psychological changes, taking care of themselves and their newborns and alarming signs to which they have to respond immediately which results in threat to women’s life and their newborns (Springer & Parkham, 2007) .
Thirdly because I perceived patient education as less important component which other staff members do so.probably because new registered nurses do not what strategies must be used and how to evaluate the knowledge status of postpartum moms (Springer & Parkham, 2007). This scenario could be undertaken differently if I assessed her in detail including her knowledge status regarding mode of delivery and precautions that must be taken at home to prevent complications. Health care providers must work collaboratively to ensure the women’s physiologic safety and her newborn, and it should emphasis women to take her as well as her newborn care (Springer & parkham, 2007). Faculties must provident sufficient clinical exposure to the student nurses at these areas, where they can build up their confidence and competence; seek for the opportunities of patient education and advocacy.
There must be criteria to assess, judge, evaluate & document mother’s knowledge, ability and confidence of caring the newborn efficiently (Workplace Advocacy Proposal, 2007). Through my personal experience I observed that student nurses rely on staff nurses to provide teaching because they feel lack of knowledge and inexperienced so they must consult to their faculty tackle the situation so that we can get the information about authentic resources for gaining information and their utilization in patient teaching. In future, I may encounter the same incident so at that time I will consult for the expert advice (faculty), work on it and will not neglect the patient’s need of education. Whenever I get the opportunity to provide health education I never step down to it, because it will enhance my knowledge as well as cause patient’s beneficence and may improve my competence level. According to the journal of hospital infection, (2006) feedback and evaluation of the teaching catalyst the review of practice determined to reduce postpartum surgical site infection rates.
1. Johnson, A. (2006). Caesarean section surgical site infection serveillance.Journal of Hospital Infection, 64, 30-35.
2. Monte, M. (2010). Postdischarge surveillance following cesarean section The incidence of surgical site infection and associated factors. American Journal of Infection Control, 38, 467-472.
3. M.M.-S. Riley et al. (2012). Reduction of surgical site infections in low transverse cesarean section at a university hospital. American Journal of Infection Control, 40, 820-825.
4. Springer, K. (2007). Importance of Postpartum Teaching in Women’s Healthcare. Work Place Advocacy Proposal, 1-10.
About the Author: Naureen Rehman is a student of Bachelors of Science in Nursing at Aga Khan University School of Nursing And Midwifery, Pakistan. She can be reached at [email protected]
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