Models of Reflection


I was asked by a family to assess their mother who they wanted to come into our home for palliative care.

The information I was given by the family was she had a pressure sore that wouldn’t heel and the only option was to amputate which the family had refused. There was urgency for her to leave the hospital as she had been in 13 weeks and prior to her stay had been living independently at home and now dying due to lack of care at the hospital, their catalogue of events were horrendous, all dated and timed.

I visited the mother in hospital who seemed bright and answered my questions appropriately; she was keen to come to my home. I then went to speak to the nurse in charge and look at her hospital notes the conversation we had in which I was told the pressure sore was a grade four and what I read in the notes led me to the conclusion that we could meet this ladies needs so I agreed to take her. The lady arrived much to my surprise the following morning.

As this lady had a pressure sore I informed the District Nurses that I had a new resident that would need their attention. They decided to come on the day she arrived and do their assessment. Normally the nurses go about their work and report to me afterwards, on this occasion I was asked to go to the lady’s room and look at the sore. I was horrified to see tendons and bone visible, this was an ungradable sore, I had never seen anything so bad even the nurses were emotional.

On reflection there were clues dotted all along that this was not an ordinary transfer from hospital to a care home. I had allowed my knowledge of the hospital to cloud my judgement and perhaps had ignored the big red warning sign of “palliative care for a pressure sore” and the speed at which the lady arrived.

As a result I have put in place that if we are asked to take someone with a pressure sore, then we need to see a recent picture of the wound, furthermore if there is any doubt it has been agreed that...