I had a patient in clinical once, named RE, who had been brought into the emergency department by his sister. RE’s sister was worried because they had increased weakness and confusion. RE lived alone and reported falling ten times within the last month. This patient was admitted to the floor and diagnosed with acute kidney injury on top of their stage three chronic kidney disease. RE was not getting the most out of our healthcare system and suffered many falls that may have been avoided with proper screening and care.
Falling just once is one too many times, as one fall will increases your likelihood to fall again. This patient was to be referred to a rehabilitation center at discharge. I can’t help but think that this should have been done long before now and if so, how many falls could have been avoided. I question whether RE regularly saw a doctor, or if they had the means to get to an appointment or the insurance/funds to afford it. RE was confused and weak upon admission and I wonder how long they were in that state before their sister saw them and got worried. RE lives alone and may not have someone to check in on them regularly to assess their status or help if needed.
I believe there should be systems in place to ensure that everyone has access to healthcare in all capacities. There should be assistance with insurance, transportation, medications, screening, educating, and treating diseases. If RE had access to more support, maybe they would not have had a single fall. It is possible that RE would be in an earlier stage of CKD with more help and they may have avoided AKI all together. It can be easy to assume that RE does not care about their health and that they avoided help for too long. From all the barriers I have learned about, that cannot be an assumption to jump to. RE may not have had the access or ability to receive care even if they wanted it.
Health systems and the policies regarding them could do better. The United States does not have equality or equity when it comes to healthcare. Those that are more educated, those with more money, and those that live in certain areas have better healthcare and better outcomes. Your health should not be based on any of those factors, and everyone should be able to receive proper care regardless of who they are. The healthcare system needs reform, and it can start with healthcare workers all the way to policy makers. If nurses and other healthcare professionals are educated and understand the barriers that their patients face, they can be more apt to help provide care based on needs. There can be biases against patients but learning more about the whole picture and the various barriers can change the mindset and the care that is given.
I want to give the best care and be an advocate for my patients. I want to be a person that they can trust to take good care of them. I only saw this patient for a few hours on one day, but I still tried to give them quality care. I sat with them, got to know them, and discussed their feelings about their care. I find that as a student I can spend more time with patients and comfort them. Nurses and other healthcare professionals have numerous patients and must split their time up. I can use most of my time and efforts on one or two patients. Although I was able to talk and make RE feel comfortable, I was not able to help much beyond that. I wish I could have done more to ensure RE got the proper care especially after discharge. My hopes are that they continued getting the care needed in the hospital with proper referrals to a social worker, rehabilitation, PT/OT, and any other resource needed. RE’s care should not end after they leave the hospital and I hope they receive the proper care to avoid more falls and readmissions.
