Patient Dignity:

Once communication with the patient has been planned,
patient B’s beliefs need to be made evident to the radiographers on site, as
this can change how the care to patient B is delivered. According to the
society of radiographers, an equality of care to all service users must be
implemented with no discrimination from gender to sexual orientation (Freeman, 2008). In relation to the
abdominal x-ray, any metal artefacts will need to be removed prior to the
x-ray, however, patient B may object to this. Issues with the sex of
radiographers on site can be overcome if other operators are available. In circumstances
where an image cannot be taken due to patient B’s needs and requirements, then she
must be informed of the risks involved and be offered other forms of treatment.
When asking for the LMP of patient B, it would be decent to ask the male
relative to leave the x-ray room while she is informing the radiographer who
needs to know. This retains the dignity of patient B, as she may not want
family members to know of her last LMP. With patient B vomiting as soon as she
comes into the x-ray room, radiographers on site will need to help calm her
nerves and clean up the vomit before carrying out the examination.

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Communication:

The 3-point-check, patient B’s name, date of birth and
address is not only useful to gauge how much English she understands, but it
identifies her too. Getting the LMP of patient B is an absolute necessity, due
to the procedure’s risk of mutating the baby’s rapidly growing cells,
especially an abdomen x-ray. This causes changes could slightly increase a
baby’s risk of birth defects or certain cancers, such as leukaemia, later in
life (Roger W. Harms, 2015). Conversing with the
patient’s relative would be beneficial, as he speaks English and could be used
to interpret patient B if a translator isn’t on site. (Itri, 2015) However, a member of
staff is preferred to interpret as relatives could be unreliable or may lie. Communication
can be affected by the patient being nervous, in pain or any number of things. This
can lead to a breakdown in communication that causes confusion about what is
being said. By keeping the patient calm and comfortable by using simple
language to explain the procedure and respecting the patient’s individual
beliefs and needs, this should relieve confusion and any negative feelings that
she may be experiencing. (Linda Hafskjold, 2015)

Consent:

Before the abdomen x-ray can be taken the patient’s consent
is needed. Consent is also needed for the patient’s brother or an interpreter
to be in the room and for the radiographer to touch the patient for
positioning. For consent to be valid the patient has to be correctly informed
and must have the capacity to give consent for the procedure in question
(Department of Health, 2009). The patient must not be influenced or pressured
into either giving consent or not giving consent. Being pressured or influenced
can come from healthcare professionals, family members or friends. This is why
the patient’s brother is an unreliable source of translation as he could give
false translations if he doesn’t agree with the female patient’s decision. In
this case, it will be vitally important that good communication is made, as the
patient may not understand what is said because she speaks little English. The
level of understanding may be impaired due to the patient being nervous,
vomiting and on oxygen. Due to this, it may not be possible to gain written
consent so other forms of consent can be used. Consent can be written or
verbal. Written consent is normally preferred as it can be used as evidence if
necessary. Informed consent is signalled by the actions and behaviour of an
informed patient (Department of Health, 2009). For example, if the patient positively
responds to requests then it can count as consent. The nurse who has escorted
the patient to the radiography department could be a witness to verbal or
informed consent.

 

 

Patient
Management:

The patient will need to be monitored at all times through
the x-ray procedure as any changes in her condition could be life-threatening.
She has a suspect perforation. As defined by Oxford (2010), perforation is the
creation of a hole in an organ, a tissue or a tube inside the body. A disease,
allowing the contents of the intestine to penetrate the peritoneal cavity, can
cause this. Basic observation that needs to be made while in an x-ray
department are pulse, respiration and temperature, as these are easy
observations which can be the first signs of changing conditions. The patient
is also in a lot of pain. Pain can be assessed by talking to the patient and by
watching the way the patient behaves. (Field and Smith, 2008). As the patient
has come with a nurse from another hospital department she may have been given
pain management such as morphine or paracetamol, and the radiographer should
ask the nurse this when the patient first arrives. Other methods of pain
management, which include no drugs and can be easily implemented in an x-ray
department, include keeping the patient calm, relaxed and distracting the
patient from the pain. This can be done by talking to the patient, either with
or without the use of an interpreter depending on the needs. If the patient’s
condition worsened when in the radiography department the scan may not be
possible and emergency action may be necessary. This would involve calling in
emergency nurses and doctors to help. The patient would need to be transferred
to the relevant part of the hospital for care.

Health and Safety:

Health and safety are essential in the NHS. This includes
health and safety of workers, patients, visitors and anyone who enters the
hospital. As the female patient has suspected perforation, is on oxygen and has
been vomiting, it is likely that she is a trauma patient. Anger or aggression
is a common way to react to trauma. The communication barriers could worsen
this. Anger is a reaction to fear and uncertainty and if not controlled can
cause danger to workers and carers in the hospital (Easton, 2009). Control methods
include talking to the patient, making sure that she understands what is
happening and considering body language, as this could worry the patient or the
patient’s brother. Also as the patient is on oxygen and has been vomiting its
necessary to ensure that the oxygen tank is functional throughout the procedure
and that backup supplies are available if needed. The patient has been
transferred on a trolley so will need to be moved to the table for the abdomen
x-ray. As the patient may not be able to move, a team of trained staff will be
required for manual handling to move the patient. The movement can be done in
many ways including log rolling and the use of a slip mat. The team should
include about 6 members of staff to ensure that no injury is caused to the
staff; i.e. back injury, and to ensure that the patient is supported well.
Health and safety standards should be maintained at all times.

Inter-professional
Collaboration:

Inter-professional collaboration is an essential component
of healthcare. The College of Nurses of Ontario (2008) believes it means
working together with other members of the healthcare team who each make an
individual contribution to achieving a common goal or purpose. A number of
professions have already been included in the care of the female patient; the
nurse who is accompanying her, the doctor who referred her to the x-ray
department, porters and possibly much more such as paramedics and triage
nurses. The radiographer will need to work with the nurse and the brother to
help the patient and possibly with an interpreter to help with translations and
communicating with the patient. The referral card will have a doctor’s name and
signature, which needs to be checked before the x-ray can be taken. This
requires inter-professional collaboration as only certain qualified staff can
refer patients to the x-ray department. As the patient is on a trolley and in
pain she may not be able to move onto the x-ray table. Extra staff will then be
required to help with manual handling when moving the patient from the trolley
to the table. Porters will be needed to transport the patient after the x-ray
has been taken. The x-ray image will need to be sent to colleagues who can then
plan the care. If surgery is needed then information will need to be supplied
to them. Inter-professional collaboration makes healthcare efficient and as
radiographers work with every department in a hospital, it is vital that
inter-professional collaboration is enforced.

Conclusion:

In summary, it is not only a radiographer’s duty to take
x-ray images of every patient who walks into the department but also to ensure
that their experience is beneficial and satisfactory to their needs. This can
take many forms as with the female patient, who speaks little English, her
needs required special measurements for communication with possible use of an
interpreter, pain control, other forms of consent and precautions about giving
details to the patient’s brother. She also requires care as she is wearing an
oxygen mask. For this patient, all of her needs and beliefs have to be taken
into account, but still whilst working within the law. The radiographer is also
obliged to make sure that each patient will receive the correct care after
their visit to the radiography department. For example, information needs to be
passed on to relevant professions after the female patient’s abdomen scan is
taken. The patient should be able to leave the radiography department feeling
that she was welcome in the department and knowing that the hospital staff all
cared about her well-being. This type of care, which has been tailored to suit
the patient’s needs, is not just for patients who cannot speak English or
patients who are in pain.