Some of the many things that I learned on my Long Term Care rotation at Gouverneur SNF were about palliative care and how interdisciplinary teamwork makes a big difference to patient care. I also learned a lot about cultural competency when interacting with my patients of varying ethnicities.
Dr. Humphrey, my preceptor is a palliative care specialist. She took the time to educate me on the various aspects of palliative care including speaking with families and patients about goals of care. I observed her bedside manner and how she built trust with patients and their families before suggesting their different end of life options and guiding them in making a decision. Since Gouverneur is a SNF and does not have the same resources that a hospital does, families at times need to make the choice for their loved ones to return to the hospital or be made comfortable at the SNF. Majority of the time the patient does not have an advanced directive so this decision must be made by family or other health care proxy. I learned that each person will have different goals of care and that it is our job as providers to respect their wishes and act in their best interests, even if we would not make that decision for ourselves or a loved one.
Before I rotated at Gouverneur I found it really hard to communicate with an interpreter for patients who didn’t speak English. At my rotation, we had patients of various ethnicities and often had to use interpreters in languages such as Cantonese, Mandarin, Toishanese, Spanish, and Polish. I learned how to properly communicate with the interpreter, how to conduct an interview and which questions to prioritize. The more I practiced, the less challenging it felt, and the more proficient I became. I am sure I will use this skill at my other rotations and as a practicing provider in NYC.
I gained a lot of useful knowledge about how nursing homes work and the various disciplines that work together to provide care. I had the opportunity to work alongside a nurse practitioner, Ms. Lising who was a wound care specialist. She taught me all about the various kinds of wounds including pressure wounds, diabetic, arterial and venous wounds and deep tissue injuries. I also got to know the nursing staff, the physical therapists, a dietician and social workers. I gained a lot from observing their teamwork. Knowing what each of them does will be useful to me when coordinating care for my future patients.
One thing that I plan to improve on is becoming proficient at the various dosing of medications and fluid administration. I feel like this is an area that I am familiar with but not yet proficient. When I wrote admission and monthly notes, I tried to pay attention to the dosing of the various medications so that they become more familiar to me. This is knowledge that I plan to build on as I go to my next rotations.
In conclusion, my perspective about patients in long term care facilities has changed. When I started my rotation, I was very focused on the medical aspect of care. As time went on however, I began to be more cognizant that each patient is an individual with a whole life story. I realized that the social aspect of care is just as important for many of these patients as managing their medicines. I know that on other rotations, in more fast paced environments I will likely not be able to give each patient the time and attention that I was able to give in long term care. I do think though that this experience has given me a new understanding of patients and will improve my patient care especially to those patients who seem difficult to care for.
