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Watching the work of medical professionals contributes to the better education of students. It must be taken into account that in such cases, students not only expand their knowledge of medicine but also develop their observational skills. Such competencies are necessary for understanding staff’s actions, analyzing compliance with established standards, and improving practice in case of identified shortcomings. The current paper presents an observation report on two units at Hampton VA Medical Center, Community Living Center (CLC) – rehabilitation and hospice. Even though it is a big institution, several problems have been identified that require practice improvement.
The Rehabilitation Unit at CLC accepts patients who do not need a long-term hospital stay. The observation concerned the doctor’s work with the patient requiring wound care. The process was analyzed following the steps proposed by Hansen (2020): phasing, observation from several directions, comparison with standards, identifying right and wrong, and offering improvement. The same scheme was applied to analyze the work of the hospice. Here, observation was carried out on the care about dying patients and process of body donation for science.
Wound care in rehabilitation had several difficulties and problems requiring attention. Considering the stage before the procedure, the specialist was late due to a lack of staff and ineffective communication with the assistant since there was no warning about the delay. During the doctor’s work, he took all the necessary actions – he removed the bandage, assessed the wound and healing progress, anesthetized, cleaned, made a new bandage, and provided instructions for follow-up care. It is worth noting that the doctor brought the necessary tools, and his bag was quite old, suggesting that the hospital does not provide enough material for work.
The information shared by the wound specialist revealed the violation – although the doctor indicated the need for a daily dressing change, the nurse does wound care only once a week. However, following the standards of care, it is crucial to follow the guidelines for dressing for better recovery (Encompass Health, 2020). Considering the situation from the nurse’s point of view, one can assume a lack of time for duties. The improvement of practice is possible through the revision of the schedule, the involvement of additional employees, and the establishment of effective communication in the team.
Observing the work of specialists in the hospice also raised several questions and concerns. In particular, by examining the environment, one can note the small room size to accommodate two patients simultaneously. Remarkably, it is essential to ensure the patient’s dignity to maintain their quality of life in end-of-life care (“Palliative care,” n.d.). In addition to the potential room inconvenience, there was a delay in admission to the system due to a ward secretary’s absence, which violated the requirement for care. Nevertheless, later, the staff provided the patient with the necessary comfort and pain medication.
Moreover, the dying patient and his wife notified that they had donated their bodies to science. However, as it revealed later during communication with a nurse, the couple had little information about the process. The Department of Health regulates body donation in Virginia and requires compliance with many conditions that patients should know (“How donation,” n.d.). As a result, improvements are needed in the unit through additional employee education about supporting the patients’ dignity, effective team communication, and informing patients.
Thus, the surveillance of the two CLC departments demonstrates that the institute requires changes. An analysis of the situations and their comparison with existing standards showed directions for improvement. In particular, due to personnel’s lack of time, wound care can be ineffective and slow recovery. The staff’s work with a patient requiring end-of-life care in hospice also raised concerns, as there were delays, and the patient and his family were not sufficiently aware of some issues.
References
Encompass Health. (2020). Wound care. Clinical practice guidelines. Encompass Health – Home Health & Hospice. Web.
Hansen, C. (2020). Improving observation skills.Hansen. Web.
How donation works. (n.d.). Virginia Department of Health. Web.
Palliative care. (n.d.). Virginia Department of Health. Web.
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