With his back hunched, auxiliary nurse Bruno Blouin moves slowly between the stretchers, leaning on a cane. He is holding a urine collection pot in his free hand. “Where is your toilet?” His vision is blurry and his hearing impaired. ” hey boy, that’s a long way, those toilets! »
Bruno Blouin usually works in the emergency room of the Hôtel-Dieu de Sherbrooke, but this morning he is playing the role of a patient. He is taking part in an unprecedented simulation exercise in Quebec, in which The duty could attend. For nearly an hour, he and five colleagues put themselves in the shoes of an elderly person in the emergency room. They are dressed in a special suit that limits their range of motion and arches their backs, jeopardizing their balance. They also wear glasses that simulate cataracts.
In their ears, plugs that prevent them from hearing the instructions of the caregivers in the hubbub of the emergency room – a soundtrack broadcasts noises from the corridor. Caregivers transformed into sick people struggle to handle their pills because of gloves that interfere with their dexterity.
“We will be able to go to bed, madam,” said nurse Véronic Poulin, who is directing the simulation, raising her voice. “There, we will put you on monitor. The doctor wants to see if your heart is okay. The caregiver connects her patient to a solute and installs a urinary catheter. When her patient tries to get up to sit in an armchair, all the wires that connect her to the appliances and devices get tangled. A classic. “Wires are really cumbersome,” remarks Bruno Blouin.
For five minutes, the six participants must remain lying on their stretcher with a cervical collar. “We know it can’t be comfortable,” says nurse Annie Proteau, her gaze fixed on the ceiling because she is unable to turn her neck. “I know it even more! »
The Hôtel-Dieu de Sherbrooke has been offering this training to emergency personnel since the spring. About twenty doctors and about sixty orderlies, auxiliary nurses and nurses have followed her so far.
Étienne Sabourin took part in the game last Thursday. He felt “rushed” during the simulations. “It just makes you realize that we are contributing to their non-cooperation,” says the nurse who has worked in the emergency room for 30 years. He believes that “slowing down a bit” on interventions could help. “But it’s not easy with the lack of resources,” he says.
The simulation aims to make staff aware of the conditions experienced by the elderly. “It changes people’s glasses a bit, says the DD Audrey-Anne Brousseau, specialist in geriatric emergency medicine at the CIUSSS de l’Estrie. It’s not so much the knowledge that we need to change. It’s really how people see the older person. »
According to the doctor, the scene of the cervical collar marks many participants. Elders are often forced to wear them after a fall. “We make them wait for hours, hours and hours, says the DD Brousseau. During the simulation, we wear it for five minutes and the time seems so long to the participants that it makes them aware of [se dire] : “is it really necessary?”, “should I rather quickly ask the doctor to come and see him?” or “are we going to take action to reduce the time spent immobilized as much as possible?” »
Geriatric SWAT team
The Hôtel-Dieu de Sherbrooke is a leader in geriatric emergencies in Quebec. It is the only Canadian hospital to have achieved silver certification in this area from the American College of Emergency Physicians. The Brome-Missisquoi-Perkins Hospital in Cowansville also received one, the bronze.
In 2017, the Sherbrooke hospital center set up a ” SWAT team geriatric” in the emergency room. The interdisciplinary geriatric team, made up of two nurses, a physiotherapist and a social worker, assesses the needs of elderly patients and ensures that they move if they have no medical contraindications. Professionals also prepare an “exit plan”.
“We are also there to avoid hospitalization as much as possible, says a nurse from the team, Véronic Poulin. We really look to see if the patient is able to return home safely using all available resources. We call the family, living environments and stakeholders in the file. »
A stay in the emergency room can lead to immobilization syndrome. “When you immobilize a frail elderly person for a day, that’s three days of rehabilitation,” says Dr.D Brousseau. After eight hours in the emergency room, delirium can develop in those with cognitive impairment, she adds.
The emergency department of the Hôtel-Dieu tries to adapt to seniors aged 75 and over, who represent 35% of its clientele. She offers non-slip stockings to patients rather than just blue hospital socks. She fixed a digital clock on the wall of each room showing the day, date and time. A small physiotherapy room, with a training staircase, has also been set up in the unit. Staff have access to equipment, such as a baby doll, for people with advanced Alzheimer’s disease.
Despite everything, there is still a long way to go, says Véronic Poulin. It’s hard to change the culture in the emergency room, which she summarizes as follows: “We keep our patients lying on the stretcher, we wait for the doctor to come, then [que] exams [arrivent]…” In his “ideal” world, the sick would be seated in their chairs and not confined to their stretchers all day. Like at home.
This vision contrasts with that of emergency patients, according to Mihret Karahasanovic, physiotherapist in the interdisciplinary team. “People say to themselves: ‘we’re going there because we’re in pain, we stay in bed, we wait to do x-rays, then to have pills to get better and go home'”, he explains. . However, he and his colleagues want to mobilize them. “Patients are not left to rest unless they have to be,” he says. A small revolution in the world of emergencies, for patients and employees alike.