A Moment to Shine
Sometimes I'll be the one to initially assess a patient who requires increased intervention by nursing. In a SNF, patients can fluctuate in ability, cognition and activity level, which is often first seen by the therapy department. Typically one of us will see something unusual and discuss the patient among ourselves after we've notified nursing of the potential change in the patient. I've worked with brilliant therapists who have been so concerned about the patient's well-being, they'll call the MD rather than wait for nursing to make the call.
Whether it's me or some other therapy person who first notices a change, we seldom stand up on a pedestal and proclaim our Mensa membership. The assessment of a patient is a group effort based on the skill and experience of the whole department. Many times I've notified the PT with a concern about a patient's joint-replacement healing wound and redness associated with it. After a look by the PT, we then determine the next course of action and treatment. Both my and the PT's assessment have value and will directly benefit the patient involved.
While I was working per diem at one place, I assessed a patient in regard to increased pain and swelling in her knee. I may have been the first therapist to actually touch her leg since the evaluation. The patient often wore pants so her leg was not immediately accessible when watching her move through the range. I like to see surgery sites on patients so I can make note of them in the chart. I asked her to remove her pants and yes, it took time and effort but was well worth it.
I might have saved the patient's leg with that extra time. What surprised me most was that nursing didn't see what her knee looked like first. Then I realized the full-time therapist should have caught this as well. The patient knew it did not look right and may have kept it hidden from nursing and other therapists in the hope it would clear up by itself. I'm glad I was there to help her. But it wasn't only my assessment that noticed her knee, it was the combination of being educated and instructed by all the brilliant therapists I've had the pleasure of working with all these years.