Patient Advocacy

One of the key roles of nurses is being patients' advocate. I don't know how many of us take this role seriously. I personally give it the gravity it deserves, having learnt the hard way.

At this point in time I was working in ICU. Yes, I have tried my hand at many things. As usual I report for my shift with enthusiasm. According to the allocation I would be receiving the next patient who is admitted.

This can be a good thing or a bad thing. A good thing because you can get a stable patient and a bad thing because you can admit a very sick patient who will keep you on your feet for the remaining time of the shift.

On this day I was lucky, or I thought I was. This patient had come as a referral. His major presenting symptom was angina that had resolved after some analgesia. His ECG had shown NSTEMI. On the surface he seemed very stable. In fact he was quite chatty, a jolly good fellow.

I do the usual admission procedure, settle him in bed, attach him to the cardiac monitor, take his vitals and do my documentation. All through this, he his cracking my ribs. The doctor comes to review and all is well. I bid his wife and son goodbye, telling them that they will be called if something happens, a routine declaration.

Now I'm settled. At about 0100 hours, my patient starts complaining of chest pain. In seconds he is flat on the bed. No chest rise. After some rounds of CPR we manage to revive and intubate him. An hour later, another asystole. This time our efforts came to nothing. I had to make that phone call. Can I just say, those are the worst phone calls you can ever make.

In hindsight, what this patient needed was Percutaneous Coronary Intervention (PCI), a procedure that wasn't done in the facility. Myocardial Infarction (Heart Attack) is like the iceberg that sank Titanic. On the surface everything seem calm but underneath, fatal reactions are happening. Prognosis is dependent on how fast interventions are made.

As this patient's advocate, I should have insisted the patient be referred for PCI or at least set the ball rolling. The problem was that I didn't know what PCI was. Or let me put it this way, I didn't know what the proper management for a heart attack was.

The burden of being a patients' advocate is that we have to be knowledgeable in our area of practice. We have to know what alternative therapies are available. While the best of this knowledge comes with experience, doing extra reading and short courses goes a long way.

What I'm trying to say in so many words is; there is no advocacy without knowledge.