Mr. P. is an 89-year-old with a left hip fracture and has been admitted to the rehabilitation unit to regain complete function. Mr. P. requires minimal assistance to walk to the bathroom with a walker. He needs assistance with hygiene, getting dressed, feeding, toileting, and needs supervision for mouth care. His vital signs are T-36.5 ?, P-64, R-22, BP- 128/62, O2 sat- 94%. The vital signs were reported to my clinical instructor and no concerns were raised. Mr. P. is alert but confused about his location and thinks he is in his home and he needs to be reminded that he is in the hospital constantly. He reported no pain. Mr. P is on a regular diet with assisted feeding and other activities of daily living (ADLs). The following reflection is focused on the importance of reducing fall risks and helping a patient regain their ability to perform ADLs.
According to the Mayo Clinic staff (2015), older people are at higher risk of hip fractures due to osteoporosis which is the weakening of bones with age. Mayo Clinic (2015) reported that taking several medications, having impaired vision and issues with balance also contributes to older adults being vulnerable to falling and tripping, which is the most common cause of hip fractures in the older population. Mcgilton, Chu, Naglie, Wyk, Stewart, & Davis (2016) found that about 50% of the older adult population who get a hip fracture face declining functional ability and it becomes harder to perform ADLs. The World Health Organization (2017) states that rehabilitation is “… a process aimed at enabling per0sons to reach and maintain their optimal physical, sensory, intellectual, psychological and social functional levels. Rehabilitation provides disabled people with the tools they need to attain independence and self-determination”. When Mr. P. had to void, I made sure his path to the bathroom was clear to prevent tripping. Before Mr. P. stood up, I put non-slip socks on both his feet and placed his walker in front of him. I also lowered the bed until his feet touched the ground and assessed if he felt dizzy or nauseous before he began to walk. I supervised him while he went to and back from the bathroom. I gave him privacy while he voided and then helped him pull up his pants because he was unable to bend down completely to pull them up himself. As a nursing student, I was influenced to put my skills that I learned to use by providing complete care for the patient such as putting on his shoes or giving him a shower. I realized that I had to allow Mr. P. to do as much as much as he can by himself with minimal assistance because he was in rehabilitation and his goal is to be able to do everything by himself. By offering to do everything for him, I am extending his discharge date and doing a disservice for Mr. P.’s recovery.
After I reflected on my mistakes, I became more conscious of allowing Mr. P. to be as independent as possible and I would only step in and help if he cannot do a task and can potentially hurt himself. After discussing ways to help Mr. P. become independent and under which circumstances I should step in with the personal support worker (PSW) that I was assigned to, I implemented her suggestions into my practice. She suggested that I encourage Mr. P. to put on his own shoes and if he needs help, then I can use my feet to hold the shoes in place or push them closer to him. The PSW also suggested that I let Mr. P. hold the shower head and wash and I can aid in applying the shampoo on his head while he massaged it in his hair. I need to work on controlling my need to want to help as much as I can and allowing the patients to work on regaining their functional ability by themselves.
Do you feel that you are not getting the complete nursing experience? Do you have any suggestions for me on how I could help patients do ADLs on their on?