Auckland Hospital, New Zealand
Scientific Tracks Abstracts: J Nurs Care
A 53 year old, severe spina bifida client was unable to complete a below knee amputation at Auckland hospital in 2015. The patient was admitted to a critical care unit with septic shock secondary to bilateral lower limb ulcers, infected with Methycillin Resistant Staphylococcus Aureus (MRSA) and Pseudomonas. Lower limb amputation was the obvious choice of treatment and this was discussed very cautiously with patient and family. The prospect of amputation was calmly but adamantly denied by the patient for over a month, despite extensive discussions with the intensive care specialists, orthopaedic surgeons and family. Multiple cardiac and respiratory arrests while in the critical care unit and lack of consent to proceed with further treatment, prompted a palliative care approach and the patient was moved to the wards. Surprisingly, the palliative patient decided to undergo the amputation. However, the patient had another cardiac arrest on the operating table and so the leg was amputated, but the wound was unable to be closed. What made the patient change his decision? Many health professionals encounter stages of grief like shock, denial, anger until the patient consents for an amputation. What did the health professionals miss while they were looking at this patient? What did the patient observe of the hospital system while undergoing complex wound care? The video also looks at a novel way of closing an amputation wound without any suturing and provides a learning point that even a neolithic procedure like amputation can be ever evolving, in terms of its approach towards the wound and the amputee.
Sowmia Thomas is the orthopaedic clinical nurse specialist at Auckland Hospital, New Zealand. She has completed her Post Graduate studies from University of Auckland and Bachelor of Nursing from Manipal University, India. Her primary role is complex wound care for trauma and also sarcoma surveillance.
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