"Trauma awareness amongst different staff"

About: Royal Infirmary of Edinburgh at Little France

(as a service user),

I was sent for a routine pre-op ECG in the out patient department 3 (OPD3) as part of my assessment for Day Surgery.

Relevant background: I have had previous experiences as a patient in NHS Lothian which have left me with PTSD and has left me struggling to feel safe anywhere in the organisation. Since that incident I had had a number of ECGs without any problem so wasn't worried about the procedure.

Due to PTSD I had been accompanied by various friends/carers to every scan/appointment. There was no queue when we arrived at ECG desk and 3 staff available. Nurse 1 immediately sent friend to sit elsewhere giving us no choice. My friend did check with me before went, and I admit I said it would be ok (due to past ok ECGs) although it meant I entered room and lay waiting with anxiety levels already going up.

Nurse 1 entered room and told me to pull my top up, whilst they got machine ready. I had deliberately worn a V-neck top so that 1st chest leads would sit in the V, and only needed to pull T-shirt to bra line. She turned round put some of leads on, and told me to take top further off. I responded by telling them about what had happened to me previously in that hospital and that the T-shirt was up far enough (& didn't say, but it is a fact that gave access whilst maintaining dignity, which ECG technicians/staff in A&E seem to have sussed, always leaving you decent).Nurse 1 showed zero understanding/empathy re what I had told them. They just said I'm not doing that, came straight across to me and grabbed my T-shirt/bra trying to pull them off. Unsurprisingly I went into flashback/trauma mode which includes losing my speech.Nurse 1 left room to call Nurse 2.

Nurse 2 came in, sent Nurse 1 to get a glass of water and, having asked me if it would help, my friend. They asked me something else and I mimed pen/paper which they gave me, and wrote about what had happened to me previously. They said something showing me they  had 'heard' and understood the impact of what I had written about and were sorry saying that must have been so difficult. They said they'd take their time, not to worry re getting upset, and that I should feel really proud of myself after I'd had it done. Nurse 2 proceeded to place remaining leads without removing any clothing, did the ECG with dignity/clothing preserved, and offered to let me take the ECG dots off myself (which I did).

I left with procedure done, but washed out by the flashbacks and suffered consequences for next 24hrs or so. I believe nurse 1 needs training re communication, empathy/humanity, and revalidation of their practical skills.

Nurse 2 demonstrated that managing trauma/trauma-awareness doesn't need to involve specialist training - treating someone as a human rather than an object, communication and the compassion (in NHS Lothian values) have equal effect. Led by my consultant surgeon (the thoughtfulness they put into things and took on board immediately when 1st met re PTSD without questioning/fed on to others), the consultant gastro/consultant anaesthetist, radiographer and DSU nurses were exemplars of this. I have no reason to think any of them, nor Nurse 2, have had trauma training, but by meeting me as human-to-human they enabled me to feel safe for the 1st 24hrs ever as a patient. This is even though I had to spend some of the time anaesthetised where wouldn't have known if anything untoward done to me, when I know what staff have been allowed to do to me when I was awake to witness.

As I removed my own ECG dots, I am aware Nurse 1 misplaced chest leads III + IV, despite this being a regular clinical skill for them; or does 'familiarity breed contempt'/lack of care over procedure.

In anaesthetic room immediately pre-surgery, consultant anaesthetist explained before putting on ECG saying I hear you have problems with ECGs. If that has been written in my notes, could it please be changed from the non-factual information to the factual information that I have a problem with people removing/going inside my underwear without prior explanation/consent.

Responses

Response from Jeannette Morrison, Head of Patient Experience, NHS Lothian

Dear patient99

Thank you very much for sharing your feedback with us following your ECG appointment which was part of your assessment for day-surgery at the Royal Infirmary of Edinburgh.

I am so sorry to hear that the first nurse you met was not as sympathetic or understanding to your situation and the impact that this caused you. I can only imagine how anxious you must have been preparing for this ECG and how important it was to you that your friend was able to support you during this.

I was really pleased to read that when the second nurse arrived she was able to offer the support and encouragement for you to proceed with the ECG and to bring your friend back into the room to be with you.

I have shared your feedback with clinical team and have asked them to reflect on your feedback.

I do hope that you are recovering well from your procedure and thank you again for sharing your feedback with us.

Kind regards

Jeannette

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