8 Final Assignment

Emily, who was working her second day on an Orthopaedic unit, was assigned to a patient, Kathy, who had been admitted from the operating room late the previous evening. Kathy, who was in her sixties, had tripped on a rough tile in a Convenience store and when her boot caught on the edge she fell and fractured her patella. Kathy was new to the area and hadn’t made many friends. When she fell, two days earlier, rather than have the workers in the Convenience store call an ambulance, she called a woman who had been doing some painting for her, and this woman and her partner took Kathy to the community hospital emergency department. Kathy was sent home with crutches and told to return the next afternoon for surgery. The same friend brought her to the hospital the next day, where Kathy presented at the pre-operative assessment area.  She was told she would be discharged home that evening, right after her surgery. She was not asked about her living situation. (Note Kathy lived alone in a home with outdoor and indoor stairs. She had two small dogs and as noted since she was new to the area, she did not have a strong social network yet.)As it turned out, Kathy’s surgery was delayed, therefore the surgery was not completed until after midnight so she was admitted to the Orthopaedic unit. Since Emily, Kathy’s nurse was new to the unit, she had just completed her orientation where she had been taught about the protocols for patients with knee replacements. The protocol included a referral to physio and community care prior to discharge. Emily followed this protocol and arranged for Kathy to go to the physio department for assessment.  She was taught how to use crutches and a walker to assist in ambulation since she had to be non-weight bearing for 6 weeks.  She was also taught how to use stairs safely and provided with recommendations for assistive devices.  The physio told Emily that it was important that this referral was made as they usually do not see patients with fractures, only with planned knee replacements. When the nurse in charge saw that Emily had also made a referral to Community Care she canceled this, telling Emily that this was only part of the protocol for patients with knee replacements. Kathy was discharged with a prescription for pain medication, and an appointment at the fracture clinic a week later. The same friend picked her up and took her home. Emily was concerned that patients such as Kathy were at risk and wondered what she should do.