It was definitely a different experience coming from the pediatrics rotation to a skilled nursing facility, as the patient population could not be more different.
During this long-term care rotation, majority of the patients had significant past medical histories, which could have been contributing to the decrease of their overall health. Therefore, I had to adjust to a new format of presentation to my preceptor. While many times the patient’s history looked overwhelming, my preceptor helped me to focus on the main points. What happened to the patient prior to them being admitted to a skilled-nursing facility, what was their baseline prior to discharge from the hospital and what are their goals to be achieved during their stay at the Gouverneur Skilled Nursing Facility. I learned to take a step back and evaluate which factors are the most important to the patient’s recovery.
Additionally, during this rotation eliciting history from some of the patients turned out to be challenging. There was a significant language barrier since majority of the patients either spoke Cantonese or Spanish, and I had to use the assistance of professional translators numerous times. Furthermore, some patients were not reliable to elicit the correct history due to their functional deficits at which point I had to fill the gaps by talking with the patient’s family, their social worker, their nutritionist and their physical therapist. For this rotation, I had to use an extensive interdisciplinary approach.
My perspective has definitely changed due to this rotation. Treating and managing geriatric patients with numerous comorbidities requires a different approach than with adults. Aspects that should be considered include patient’s baseline functional status before being admitted to the skilled nursing facility, what kind of support their received and will be able to receive upon discharge, their nutrition status, their emotional status, their goals and wishes, and their advance directives. While certain procedures and surgeries would treat a specific disease or disorder in an adult, in the geriatric population the provider has to weigh the risks and benefits and whether or not the patient is even stable enough to receive said treatment.
One of the most memorable patients that I have encountered was an elderly woman who lived by herself, slipped and fell at home and had broken her hip. She was unable to call EMS herself until two days later her coworkers called because they were concerned about her absence at work. This patient underwent surgery to fix her broken hip, but from all the time she was down on the floor at home waiting for help and the significant immobility after surgery, she developed a stage 4 sacral ulcer. I could not imagine how scared and alone she had felt when she fell and was unable to call for help. From my prior EMS experience, I have arrived to numerous calls where the elderly has fallen down and had to wait a significant amount of time before someone called for help. Not only did my patient underwent a dramatic medical injury, I could not imagine the toll this incident took on her psychologically. She will be staying at the Gouverneur Skilled Nursing Facility for a while and I hope she makes a full recovery and is able to receive assistance after to discharge.
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