Medical investigations and medical day care

11 Medical investigations and medical day care

• To understand the role of medical investigations and day care in the care of the medical patient

• To follow the journey through admission, procedure, recovery and home

• To understand the role of the nurse and other professionals within medical investigations

• To identify learning opportunities within medical day care/investigation units

Introduction

For your medical nursing learning experience you may find yourself placed in a medical day care unit or investigations unit. This may be for the whole of your placement or for a short period of time as an insight learning day or a longer ‘spoke’ placement. However long you will spending in the day care/investigation unit, it will be a great opportunity to care for a wide variety of patients with differing medical problems and experience the many roles of the nurse within the unit.

This chapter will start by explaining what medical investigations and medical day care are and will then take you through the journey of two patients attending a medical day unit – one to undergo a medical investigation and the other to receive medical treatment – and how you can meet your learning outcomes and identify learning opportunities with such patients.

What are medical investigations?

Many patients will be attending the unit to undergo investigations. The aim of these investigations will be to diagnose patients’ problems so that they can receive appropriate treatment and care. In some ways, a medical investigation is similar to day surgery in that the patient will be admitted on the day of the procedure, usually be sedated or anaesthetised to undergo the procedure and then, after a period of recovery, discharged, again usually on the same day. The difference between medical investigations and day surgery is that medical investigations are usually diagnostic procedures compared to day surgery which is usually a treatment or a surgical intervention for an already diagnosed problem.

What is medical day care?

Patients attending medical day care will be receiving medical treatment for an ongoing medical problem. They may just attend on one occasion for treatment or may attend on a number of occasions over the course of a few days, weeks or months.

Where does medical day care take place?

Medical day care/investigation units are usually based within a hospital as they require access to theatres, radiology and pharmacy, among other departments that are generally hospital based. They can be found within both NHS and independent health services. The units usually operate on a 5-day, Monday to Friday basis and their hours will usually be from 7 or 8 a.m. to 8 or 9 p.m. Patients attending the unit can be out-patients or in-patients from other areas of the hospital. The out-patients will be admitted from their place of residence, for example home, intermediate care or nursing home, on the day of their investigation or treatment and then be discharged back to their place of residence from the unit on the same day once everything is completed. Some of the investigations carried out in the unit will be necessary investigations for in-patients on the wards as well. So patients will be brought from the ward at a specific time to have their investigation in the unit. Their preparation and recovery will take place on the ward they are staying on. If your placement is on a medical ward, intermediate care or a nursing home, then see if it is possible to arrange to accompany a patient who is going to the day care unit for an investigation.

Find the operational policy for the unit you are placed in. This will give you information on the types of patients seen, how they are referred to the unit and how the unit operates on a day-to-day basis. From this, you will be able to begin to plan some of your learning outcomes for your placement. The text by Howatson-Jones and Ellis (2008) provides good information on the range of settings medical day care may take place in along with the role of the nurse in these settings.

The journey through the medical day care and investigation unit

This section will take you through the journey of a patient attending a medical investigation unit using a case history approach. You will be encouraged to consider what the patient’s needs may be and the role of the nurse in meeting these needs at each stage of their journey.

Medical investigations

Mr Murray is a 42-year-old bank manager who has been suffering from severe heartburn for the last month. He has tried over-the-counter indigestion remedies and they have had no effect. He recently had a shoulder injury from playing tennis and has been taking anti-inflammatory medication for pain relief. Over the last couple of days he has noticed that his stools have been black.

Before admission

Mr Murray makes an appointment to see his GP regarding the severe heartburn (epigastric pain) he has been experiencing. After taking a full history, his GP is concerned that Mr Murray may be suffering from a peptic ulcer which may be bleeding, resulting in the black-coloured stool. To ensure Mr Murray receives the appropriate treatment, he will require a diagnostic gastroscopy. His GP writes to the gastroenterologist at his local hospital explaining the history of Mr Murray’s problems and requesting a gastroscopy as an out-patient. He also arranges for Mr Murray to have a series of blood tests and commences him on a medicine called a proton pump inhibitor to begin treatment for a suspected peptic ulcer.

A few days later Mr Murray receives an appointment to attend the medical investigations unit at his local hospital for a gastroscopy in 3 weeks’ time. He is required to be at the unit for 8 a.m. and he has been instructed not to eat or drink anything for 6 hours prior to this. He will also need to stop taking the medication prescribed to him by the GP 2 weeks before his appointment. He has a leaflet explaining more about a diagnostic gastroscopy to read. He is also asked to attend a pre-admission assessment appointment in 1 week’s time. He has never been admitted to hospital or needed to attend hospital as an out-patient before.

What do you know about diagnostic gastroscopy? If you were Mr Murray, what questions might you have about the procedure?

Look at the following Website regarding diagnostic gastroscopy to learn more about what it is and why it is carried out:

http://www.nhs.uk/Conditions/Diagnosticendoscopyofthestomach/Pages/Introduction.aspx (accessed July 2011).

Pre-admission assessment

Two weeks prior to his procedure, Mr Murray attends for his pre-admission assessment appointment. This is held at the out-patient department of his local hospital. A nurse conducts the pre-admission interview. The nurse talks through the history of Mr Murray’s current health problem and asks about any previous medical history or other health problems that he currently has. The nurse also checks his blood pressure, pulse, temperature and respiratory rate. This is to help determine Mr Murray’s suitability to undergo the procedure. The nurse then explains to Mr Murray what will happen on the day of the procedure, including what time he needs to be there and where to report to. She advises him about stopping eating and drinking 6 hours prior to admission and reminds him that he should now stop taking his proton pump inhibitor tablets. There is then an opportunity for Mr Murray to ask any questions he has about the procedure and coming into hospital.

The purpose of the pre-admission appointment is to help determine that the patient is medically stable to undergo the procedure and also to provide information to the patient, which will lessen the chance of them not attending on the day due to anxiety or fear. It also enables the nurses to plan for any particular needs the patient may have on the day of the procedure, such as hospital transport or special dietary requirements. These consultations can be carried out by doctors but are often done by nurses and can also be done over the telephone.

The following link contains a short video of a nurse explaining a pre-operative assessment, which would be similar to the one Mr Murray attended:

http://www.nhs.uk/nhsengland/aboutnhsservices/nhshospitals/pages/going-into-hospital.aspx (accessed July 2011).

On the day of admission

Mr Murray arrives at the medical investigation unit at 8 a.m. on the day of his gastroscopy. He has had nothing to eat or drink since the following evening. On arrival, he is greeted by a nurse and shown to a cubicle area with a trolley and a chair, and the nurse explains that she will return shortly to admit Mr Murray.

Think back to the admission of a patient discussed in Chapter 5. What aspects of the admission process do you think are likely to apply to an admission to a medical investigation unit?

When the nurse returns, she begins by checking Mr Murray’s personal details, name, address, date of birth and the contact details for his next of kin. She then takes a set of observations – blood pressure, pulse, temperature, respirations and oxygen saturations – to establish a baseline and to ensure that Mr Murray is in a fit condition for the investigation. Once these are recorded, she explains what will happen during the day. She explains the procedure to Mr Murray and asks if he has any concerns or questions. The nurse also checks that someone will be able to collect Mr Murray after his procedure as he will not be able to drive following his sedation and should not be alone overnight following the sedation. Mr Murray’s admission may also include him being weighed, as the dose of some sedatives is calculated based on the weight of the patient.

Reflection point

How might a person who has never been in hospital before feel when attending a day unit for a procedure? What anxieties and concerns may they have and how could you, as the nurse caring for them, alleviate some of these anxieties and concerns?

Good communication skills are essential when caring for patients attending for an investigative procedure. Patients need to feel reassured and confident in the skills and knowledge of the health professionals caring for them. You will have learning outcomes or competencies regarding communication as it is one of the Nursing and Midwifery Council (NMC) Domains and an integral part of the NMC (2010a) Essential Skills Clusters – care, compassion and communication. For example, it is expected that you will do the following:

• Respect patients as individuals and strive to help them preserve their dignity at all times.

• Engage with patients in a warm, sensitive and compassionate way.

• Engage therapeutically and actively listen to patients’ needs and concerns, responding using skills that are helpful, providing information that is clear, accurate, meaningful and free from jargon.

• Gain patients’ consent based on sound understanding and informed choice prior to any intervention and that their rights in decision making and consent will be respected and upheld.

The following two articles, although written about day surgery, illustrate the need to develop a therapeutic relationship with your patient even though they are with you for a short length of time:

Rogan Foy C, Timmins F (2004). Improving communication in day surgery settings. Nursing Standard 19(7):37–42.

Mitchell M (2010). A patient-centred approach to day surgery. Nursing Standard 24(44):40–46.

The next person to see Mr Murray is the consultant gastroenterologist who will carry out the gastroscopy. He has come to complete Mr Murray’s consent form with him.

Consent

For all medical or surgical procedures, from a blood test to major surgery, a person must first give consent. Consent must be both voluntary and informed. To be voluntary means that the person must make the decision whether or not to consent by themselves and not do so under pressure from anyone else; their doctor, family or friends. To be informed, the person must be given full information about what they are consenting to and involves the risks, the benefits, possible alternatives and what might happen if the procedure is not done. The person must also be capable or have the capacity to make the decision to consent or not (Department of Health 2009).

The following guidance for health professionals and patients on consent for treatment will be useful for you to read:

Department of Health (2001). Consent – what you have a right to expect. A guide for adults. DH, London.

Department of Health (2009). Reference guide to consent for examination or treatment, 2nd edn. DH London.

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Tags: Placement Learning in Medical Nursing A guide for students

Feb 25, 2017 | Posted by admin in NURSING | Comments Off

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