We can forget about patients...even if they are non-responsive

This is now my last week on my neuro prac. I have mentioned this patient previously but I want to post another blog to update you all. I have been seeing this patient since day 1 at prac. This patient is an 88yo man who was admitted to ED 4weeks ago and was diagnosed with having a (L) CVA. His past medical history included 2 previous CVA ( TIA and R MCA ischaemic stroke) aswell as AF, emphysema, HTN and much more.

I have treated him every day for 4 weeks. His GCS is still only 10/15, he spontaneously opens his eyes, makes incomprehensible sounds, and localises to pain. He does not follow verbal commands (which may be due to many factors such as ideomotor/ideational dyspraxia, global dysphasia, decreased cognition etc etc). Functionally - he is 2x max assist to move up/down bed (with slide sheet), rolling L and R, and Supine to SOEOB. He does not have static or dynamic sitting balance and req a full hoist to transfer from bed to reclined bucket chair. Treatment so far has included passive movements and muscle stretches esp of (R) pect mj, lat dorsi, wrist and long finger flexors, hamstrings and plantarflexors (he has an artificial R elbow and his range pre-admission was 60-90 degrees flexion, thats all so it has been difficult to stretch biceps but I maintain that limited range by passive mvt). Also rolling L and R and position in long sitting for chest management and supine to SOEOB x 2A. I have also been lucky enough to find a physio to help me put him on a tilt table which he tolerated well.

Three weeks ago I assisted the physio to hoist this pt out into a reclined chair which he also tolerated well. We put in the nursing sheet that the patient is able to be hoisted out into the reclined chair and should be hoisted out each day and placed in the chair for at least 30 min. Every day I asked the nursing staff if the pt had been hoisted and I was told they did not have time. So I told the physio and she said it is part of the nursing care plan and that they should be doing it. I checked each day and this poor patient was being left in bed each day. Last week I had had enough so I asked a nurse if she could help me hoist this pt OOB. Her response if that I am a student and not capable of doing such a thing. Politely I reassured her that I was more than capable and that I had hoisted the pt out with the PT the prev week. It took me half and hour to convince 3 nurses! Finally we hoisted him OOB and he was in the reclined chair for 30 min. I politely said to the nurses that would it be possible to check the nursing care plan and see if this was in there for this patient. They said they would check.

The next day I asked if the pt had been hoisted and I was given the same response - We havent had time! I feel like I have failed this patient. Even though he is non responsive he is still a human being! Hopefully next time i am in this situation I will be the physio on the ward and hopefully what I recomment will have more impact then being just a student.