"Failure to communicate clearly or empathetically"

About: Leicester Royal Infirmary

What I liked

(What follows is the beginning of my comments suggesting improvement.) I was brought into one of the treatment areas by a medical student, who had taken my information. He was joined by two women, one of whom was the nurse practitioner, though she did not identify herself as such, and who as I recall, did not introduce herself. I have no idea who the third woman was. They did not close the curtain.

The nurse practitioner did very little to try to establish a connection with me, to show that she was now centered on me and my problem. She seemed, rather, to be kind of passing through, just there to do the minimum and then to move on. She remained standing the entire time, with the other two looking on. Halfway through the interaction, the medical student asked if it was okay if he looked on (when my wound was being closed), but the issue of his and the other woman's presence should have been addressed from the beginning.

The nurse practitioner asked to see my wound. The previous day, I had had five stitches in my forearm removed, and during the night, the wound had completely reopened. She told me that she would not re-stitch it. When I asked why, she said, “Well you can see that the skin is already curled.” I could not see what she was talking about, nor did I understand its significance. She told me that the wound could be left open and that it would heal that way, only with a much bigger scar. I got the impression she was saying that closing the wound was pointless. But then she told me that she was going to close it with steri-strips and that I would need to go back to my GP in five days, though she did not explain what for, or why. When I asked if she felt that the wound would heal closed, she said that it probably would but that the “worst-case scenario” was that it would heal open. She put on the steri-strips and the bandage, told me to keep it dry, and repeated that I should see my GP in five days.

What could be improved

I left in a state of confusion, not really understanding why she did not re-stitch it, nor what the real prognosis was for the wound healing properly. Later in the day, I called emergency to see if I could speak to the nurse practitioner to get more information, but she was gone. They put me on the line with another nurse practitioner. (I asked who I was speaking with, but she didn't want to tell me, seeming suspicious.) I asked her to explain why the other nurse had done what she had done, and what was the significance of the comment about “curled edges”. She said that she had not seen the wound, and that these kinds of decisions depend on the opinion of the person giving the treatment. I asked repeatedly for her to explain what are the criteria that are used in such a situation, but she would only repeat that it was dependent on the person making the decision. At one point she also asked me if the other nurse had given me a care leaflet, to which I had to answer no.

I decided to go to a walk-in center in Oadby to see if I could get some clear information from a doctor. When I asked the doctor why they would not have re-stitched it, she said, “because of the risk of infection”. The wound is already partially healed, so it doesn't make sense to invade it again. Okay––that makes sense. Why could the nurse practitioner not have told me that simple fact?

In short, there didn't seem to be a sufficient awareness at the hospital that they were treating not only a wound but also a human being who arrives with fears and uncertainties. First, I want to know that the person treating me is fully focused on me and my condition. I also want them to tell me who they are and what they are going to do. Second, I need a clear explanation for the chosen mode of treatment. Third, I need clear instructions about what to expect and how to care for my condition. I did not receive any of these in an adequate way.

Anything else?

There are a few of other minor issues that I can comment about. First, when I arrived at the entrance, there was a group of women chattering behind the desk. They looked at me but said nothing (though at least they had smiles on their faces). This kind of thing always makes me feel that the staff, who I think should be focused on serving me, are more concerned with socialising. Second, when I arrived I was also quite thirsty. I went to the water cooler in the waiting area, but it was broken. And third, though this may seem petty, the drab, outdated blue uniforms do not inspire confidence.

Finally, having been treated by one nurse practitioner and spoken to another, I am not at all convinced that they are sufficiently trained to be working in an emergency ward.

Story from NHS Choices

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Responses

Response from Leicester Royal Infirmary

We are sorry for the poor communication and lack of explanation this patient clearly received, if we had the nurse practitioners name we would speak to them direct as this is clearly not a level of service that our Emergency Department aspires to.

In the Emergency Department we realise that communication is a fundamental aspect of the care we provide as patients are often anxious and worried when they attend unexpectedly. All of the practitioners have received extended training and skills to be able to function at this level. The treatment the patient received is what I would of expected as standard for a wound that has reopened, as explained by the GP this was due to an increased risk of infection.

If you have any further queries, please contact our PILS team who will be able to investigate and respond to you. They can be contacted on 08081 788 337.

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