Question: Your patient has fallen in the shower unwitnessed. You are the first on the scene. He is bleeding from the head. What issues might you need to consider and what actions would you take?
A seemingly straight forward question, but with lots of tricky elements! For many experienced nurses and midwives, much of this may come across as second-nature. However, the panellists are looking for your critical thinking and problem solving skills, detail orientation, and ability to think of the full gamut of issues that can arise from a situation such as this. In the end, they want to know that you can practice safely, for both yourself and your patients.
Here’s some of what we think you should address when answering a question such as this.
It’s important to address your personal safety. Taking standard precautions such as PPE, seeking assistance, and safe manual handling need all be considered, and should be part of your answer.
What steps do you then need to take to provide care to the patient in question, and in what order should this occur? First and foremost, you need to be using the processes of DRSABCD, controlling the bleeding, and calling a Rapid Response or MET call.
You will also have to consider what assessments may be required for this patient. This could include vital signs, a neuro assessment, GCS, AVPU and blood glucose levels (BGL).
You should also make sure that you remain with the patient, and what reassessment will need to be made. Future planning such as care planning and questioning why the patient fell should also possible be addressed.
What policies are involved with an incident like this? For example, does the Falls Policy and Post-Falls Management kick in? Does the Falls Risk Assessment and Management Plan (FRAMP) need to be addressed?
What documents need to be addressed? For example, an Incident Information Management System (IIMS) report should be filled out, as well as a management plan.
Finally,what ethical issues does this raise? For example, are there privacy issues that need to be addressed? There is also the question as to who needs to be informed. Address the issue using the line of escalation, and note that the family should always be informed.