Case study 1

Sarah, a 34-year-old business manager, was admitted to hospital with severe joint pain, mild chest pain and a fever. She was discharged after 3 days, even though she was still experiencing pain, and the doctors told her that the pain was associated with arthritis. She was discharged with anti-inflammatories, a mild analgesic medication and reassurance that the pain that she still experienced would improve with rest and the medication. One week later she felt exceedingly unwell and in severe pain so again attended the local A&E where it was found that her joints were very inflamed and that she had a lobar pneumonia but no fever. The medical team diagnosed her with pneumococcal septicaemia and septic arthritis. During a 3-week stay in hospital further tests were undertaken and she was diagnosed as having systemic lupus erythematosus (an autoimmune disease where the body mistakenly attacks healthy tissue including the skin, joints, brains etc.).

The question is whether the nurse could have done anything to stop the initial discharge from hospital. However, once the medical team have identified that discharge is appropriate and discharge is prepared the patient is unlikely to challenge this decision. Therefore, it is essential that the nurse advocates for the patient and ensures that appropriate preparation is undertaken. The nurse on the ward could enhance their advocacy for the patient and speak for her, explaining the pain assessment results and the impact, on the patient, to the doctor. They could also encourage the patient to be more vocal regarding what she is experiencing identifying that she could ask for an independent advocate to ensure that her view is put to the doctors and that she is listened to.

Case study 2

Theresa had just had a total abdominal hysterectomy (surgical removal of the uterus (womb) and ovaries). Within the 4 days after the operation she had not been moving around due to the post-operative pain but had refused analgesics as she said she didn’t want to become addicted. Following this she developed acute chest pain and a diagnosis of a pulmonary embolism (a blood clot in the lungs) was made, which required further treatment meaning that she stayed in hospital for a further week. Encouraging mobility and deep breathing exercises after surgery is essential to reduce the risk of post-operative complications. Therefore, if a patient refuses to take analgesic medication then it is essential that the nurse explains the benefits of the analgesia and that the likelihood of addiction will be avoided due to the short-term use of the medication. The nurse can also ensure that the patient is referred for physiotherapy to support mobility, deep breathing and coughing. The effective use of post-operative analgesics can enhance patient recovery and reduce the risk of further complications.