Monday, 31 March 2014

Power dynamics and patient feedback

This morning I was working with one of the health sciences schools at a Melbourne university. I happened to be working with the same student I had a couple of weeks ago when my character was one day post-operative. I remembered the student, but I think he became confused as he wondered whether he was supposed to remember me (even though I was playing the same character). Sometimes what happens within a simulation takes on a life of its own.

The student who was working with me was professionally polite, but a little cold and formal. He needed to relax a little to build better rapport with my character who was gung-ho and very motivated to get on with her rehabilitation. In the feedback afterwards, I gave him a quick refresher on rapport building and he looked like he'd heard it all before.

The main thing I talked to him about though, was quite personal and is an example of why feedback from simulated patients is so powerful. The student had a cold and was sniffling and fighting nasal congestion throughout our consultation. On several occasions he apologised for his cold, which I noted as a sign that he was aware of what I might be noticing. Great. What wasn't so great was when he wiped his nose with his hand and then moved in to touch me as part of my treatment. I considered saying something during the consultation, but it didn't really fit with my character, so I suffered through the hand-to-nose-to-knee sequence several times, silently giving thanks that he wasn't my dentist.

When I gave the feedback he looked shocked and was very apologetic. He told me he wasn't aware that he'd been doing that. I know that hand hygiene receives heavy attention throughout health education and continues into the workplace, so I was surprised to see this behaviour. I suppose it highlights why there are signs everywhere with instructions about how to wash your hands or use hand sanitiser properly. (Don't forget to do the back of the hands too!)

I know that it would be rare for a real patient to tell their allied health professional to wash their hands after they wiped their nose. This is because of the power dynamics and powerful protocols in play, as we align to playing our designated roles.

How's your hand hygiene? Would you stop someone from treating you if they had wiped their nose just before touching you? 

No comments:

Post a Comment