Educating the public about nursing, how do we do it?Register Today!
- by rncountry Jun 14, '01I have a question that I am sure many can help with. Many hands make light work. It is clear that the public and legislators both need to understand what it is that professional nurses do. What they understand it that we pass meds, we do procedures, we deal with physicians and so on. What they do not understand is the why of what we do. Much like we had to learn in nursing school, the why is the most important part of what you are doing. I am asking that each of you that respond to this post take just one thing that you do in a daily routine and describe it as if you were teaching someone, and that someone has absolutely no idea as to what it is that nurses actually do. Most of Joe Public would fit that description. The subject to choose from is many. Let me start though with the easiest, I pass meds. It is up to me to look over the med list of every one of my patients, understand what they do and why my patient is taking it. Depending on the type of medication I may need to check blood pressure and heart rate before giving my patient those meds. And if the blood pressure or heart rate is outside of the range of where they should be for those medications then I must decide if I should hold those meds or not. I must look for drug interactions. I need to access if a patient is on the appropriate dose and type of pain medication based on my assessment of the patient. If my patient is on antibiotics with little result, then I need to see if a culture and sensitivity has been done on the offending bacteria, to assess whether the appropriate antibiotic is being used. If my patient has been on long term antibiotic use I need to look in their mouths and see if any thrush has developed. With very long term use of antibiotics a yeast infection of the blood may occur. I need to be aware of that and on the lookout for symptoms. I need to look for drug interactions and appropriate dosages. I need to be aware of my patients allergies to any medications. I need to know if my patient is able to swallow their meds, if they need to be crushed and put down a tube in either their nose or their stomach, do they need their meds in applesauce or something like that. Any medications that my patient is on that I am not familiar with I must look it up so I am fully aware what it is that I am giving to my patient and why. If I see anything that gives me pause I need to go back into the chart and check the original order, and depending on what I find I may need to discuss my patients meds with the pharmacist and the physician. I know many drugs by heart, with normal dosages and uses, however new drugs come out all the time and I must never take for granted the knowledge that I have. I must also know that what is "normal" dosages may not be appropriate for the patient whose liver or kidneys are compromised. I must know the side effects of the drugs my patient is on so I know to look for those side effects just in case. When I go into a patients room I need to explain to the patient what it is they are taking and why. If the patient is unable to understand what I am teaching, then it is up to me to make sure that responsible family understand what their loved one is taking and why. I must also chart any education that I give to patient or family. All medications must be signed off as given right after the patient takes their meds. Failure on my part to do so may result in a patient getting an additional dose if for any reason I need to leave the floor and another nurse watches over my group of patients. I must do this for each and every one of my patients. Legally I have a half an hour before and a half an hour after the times set for medications to make sure all of my patients receive their meds. The first med pass of the day is usually the heaviest, if I find any problems and need to clarify anything with the physician it takes precious time to do so given my legal window of time to work with. Some physicians I page will call back in a timely fashion, some will need to be paged several times before I get a response, some will get nasty with me for questioning an order, some will hang up if I do not get to the phone quickly enough, and some but by no means the majority will call back in a timely fashion, will wait for me to get to the phone and be pleasant and educational when I speak to them. While I am doing all my med pass I am likely going to be interrupted by aides who are requesting my assistance to toilet someone or turn someone. I may be interrupted by a physician doing early rounds with questions as to how their patient is doing, I may be interrupted by a family member calling to see how their loved one is, I may need to attend to a patient who needs a nurse NOW. I need to know who needs a blood sugar taken before breakfast so I get an appropriate reading and make sure I am there to take the blood sugar before they eat. I must give insulin based on the reading that the glucose monitor gives me. I may have a patient that is combative, and who will swing at me when I attempt to give medications. I may have a patient that refuses medications only to have a family member demand why mother is not getting her meds, accusing the nursing staff of being neglectful. The family member does not understand patient rights, nor do they believe that mom is refusing her medications. A family member may become angry and verbally abusive with me because of medications that the physician has ordered because" I told him I didn't want my dad taking a sleeping pill" not understanding the effects of sleep deprivation. For each of these problems I must have a ready intervention. Behavior management for the combative patient, as well as the ability to duck and dive quickly and in the right direction. For the family members I must do education so they understand what is going on with their loved ones and why. I need to do this in such a way that they understand, and without giving any offense to an already angry person. I am never to get angry back with a nasty family member or a patient, even if they are alert and understand what it is that they are doing. When communicating with any patient or family members I also have to remember that they do not understand medical terminology, and yet ensure they understand what I am explaining to them. Sometimes that is difficult. I need to do everything that I do during a med pass in about an hour to keep to my legal time frame. Please understand if I seem a little rushed and do not have any time to chat with you. I will try to fit that in later, if I can.
So who else is game here? We do alot of complaining that the public does not understand what we do. Take the time please, to pick just one thing out of your day and do what I have done. We need to learn how to educate the public. Only when we do so, maybe using what others post, will the public have even a glimmer of what it is that we do, why we are so important to the healthcare system, and why it is not appropriate for unlicensed personnel to be doing our jobs.
I thank anyone in advance who will do this.
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- Jun 14, '01 by rncountryp.s. please also note what specialty you work in. I am in longterm acute care.
- Jun 16, '01 by MijourneyHi. As a home health nurse, I wish the public would stop viewing nurses as surrogate mothers and sisters. As you pointed out in the example in your post rncountry, there is alot more that goes into administering a drug then simply following the doctor's orders and giving it. Not only does the public need to know this, but people within the health and medical field need to be willing to acknowledge this fact, including nurses. This being the case, the public needs to understand that nurses should be entitled to livable wages just as doctors and therapists are.
- Jun 16, '01 by Chellyse66Ok Helen I am game. Let me tackle for example "Meals".
Most might say, "what about meals all you have to do is pass out a tray"
To the contrary:
Lets take a typical Nurse on a 12 hour shift in a Nursing Home (I also work Long Term Care) with 30 patients (this is average)
There are 3 meal times, that is 90 prepared meals to deal with in a given shift.
First the Nurse must ensure that the correct diet is being followed, for example Low sodium, diabetic,clear liquid, puree, puree meats only, mechanical soft these are a few choices.
In Long Term Care a Licensed Nurse is required to oversee any meal activities taking place both on and off the unit (many residents go to a dining room setting)
Let's say 10 of the thirty patients require complete and total assistance (many times there are only 3-4 Cna's available to help feed these patients so the Nurse generally takes 1-2)Not only does she ensure the correct diet and feed the patient but also watch for risks of choking and aspiration, this is 3 times during the shift.
Lets say that 5 of the 30 are tube feeders,
- requiring the nutrition to be delivered via a gastro tube directly into the stomach. these patients may have bolus feedings (one time dosages calculated for thier bodies given all at one time at designated times during the shift).
Or Continuous feedings (a bag of solution continuously infused)
In both cases the patient must be assessed for placement of the tube, to ensure that it is infusing into the stomach not the lungs.
Checked for excessive residual feeding solution remaining in the stomach, which could incrase the risk of aspiration (inhaling the solution into the lungs), this is done via a piston syringe.
Once assessed the solutions have to be monitored if they are continually replacing the bag as necessary, also ensuring the correct type of feeding is in place. Some patients are diabetic, others with nutritional imbalances requiring specific replacement nutrition therapies.
Another 5 of the 30 patients are what is known as restorative diners, these patients are participants of a dining program specific to thier individual needs to restore thier optimal functioning level at mealtime. Sometimes there are specific restorative dining aides to assist these patients, other times it is the Nurses responsibility. The patients use special assistive and adaptive devices to eat thier meals, which have to be placed on thier hands and plates at meal times.
Five 5 more patients are categorized as assitive feeders, meaning they need help in setting up the meal, Ie opening the milk container, sprinkling the salt ,cutting the meat, buttering the bread, once this is complete they eat without help in handling the utensils but generally require attention throughout the meal.
Lastly, the last 10 are self feeders either eating in the dining room or at the bedside. These individuals generally need minimal assistance but the Nurse needs to be aware that they have recieved the correct meal and are following dietary protocols specific to the ordered diet.
With all that said the Nurse is also responsible for documenting the consumption of the meal, any problems with that consumption (ie choking ,vomiting,dislikes ect)and what percentage was consumed.
Now if that were not enough, the Nurse also has to be aware of those ambulatory, dementia residences, making sure they made it to each meal, or the patients that may have been out on pass and missed a meal. We order replacement meals from dietary, when the wrong meal is delivered or the patient was dissatisfied with the meal.We also have to be keenly aware in LTC of the portion,content and presentation of the meal. Was it delivered timely and hot?
Between each of these meals there are designated times for supplemental snacks and hydration, the Nurse is responsible for ensuring these are given to the residents and required to also document the percentage taken on the Medication Administration Record.
Now if all that were not enough I can tell you in LTC we also have a very small supply of dietary workers, and Nurses not only wait the tables in the dining halls but buss them too.Before each meal Nurses are additionally responsible to help transport residents to and from the dining area as most are wheelchair bound.
All of this three times a shift for twelve hour shifts. How long do you suppose it takes the average Nurse, doing only the minimal to achieve these directives?
Ok Helen I did my part. LOL
- Jun 16, '01 by Chellyse66P.S. Forgive my grammatic errors above and let me add to my statement, I forgot to mention the multiple arguments from combative diners, the behavioral interventions, this is routine every meal there is always one incident. In light of allowing the residents autonomy and dignity by law we have to allow them to dine as they choose.
Also, according to Law we must wash our hands between each and every patient encounter (I am not saying this is unnecessary just impossible when you have more than 90 diners and maybe 5 staff members)
They do have alcohol gel in bottles or on the wall, but see the time consuming steps?
Mind you medication times and the federal law of one hour before and after designated med times comes into paly because generally meals and meds are on virtually the same time schedule.
Lastly by law in LTC Nurses can not dispense any medications while the patient is actively engaging in a meal or activity.
Now figure that one out.....!!!!
Meals 7-8am, 12-1pm, 5-6 pm
Meds 7-9am, 12-1p, 5p and 9p
- Jun 16, '01 by mustangshebaThis is an excellent idea, and you two have done a great job. I'll have to think on this a bit. But what a great tool this could be!
- Jun 16, '01 by CraigB-RNOn one of the other boards it was suggested that we as nurses write to Oprah. Maybe an episode or two on nurses might do some educating of people. At least people who are home during that time.
- Jun 17, '01 by MijourneyHi. Performing wound care in the home can be particularly treacherous. All of the following is not in any particular order. Some things may be left out.
You go in a home infested with people, bugs, pets, and rodents and you have a person who have multiple wounds ranging from stage 2-4 and greater (fist size). As the nurse on this case, you perform a complete assessment of all body systems with emphasis on the comorbities and past history. You do an extensive assessment of the wounds with accurate measuring of the bed, edges and anything beyond the margins, drainage, odors. You look at the how the wounds have been managed including any surgeries that may have been performed on the wound. You look at current treatment. You look at anything that may be impeding wound care including a diabetes, vascular disease, dementia, etc. You assess nutritional status. You assess pain. You assess patient care equipment. You review the medications along with the tube feeding supplement the patient is getting. From my experiences in facility based nursing, you would normally be able to stop at this point because you and your coworkers are the one's doing twenty four hour management of the wound. But, in the home you've got to go further and assess the family's participation and readiness to manage the patient's wounds. You have to make arrangements for transporation back and forth to the doctor's office if the patient is so disabled that they cannot go the traditional route. In some cases, this is not used as an option. The nurse ends up being the total eyes and ears of the doctor. So for the families: Do they know what type of wound the patient has and why he/she has it? Do they know why wound care is necessary? Do they know that they are crucial to the outcome of the patient's wound. Do they understand why it is important for the patient to get a certain amount and type of calories each day? Do they know why it is important to make sure that the patient regularly gets his/her medicines? Do they know why the patient has to be turned frequently? Kept clean and dry? Do they understand that any comorbity such as diabetes that is out of control impedes wound healing? Do they realize how important it is to properly manage the equipment being used in patient care? Manage the supplies? Do they realize that they are the primary caregivers of the patient in the home, and the nurse and CNA are only there to assist them and not the other way around? Do they realize how resource intensive that total patient care will be for them? If there are several capable family members in the home, do they not realize that in order to reduce the burden on one family member and keep momma out of a LTC facility, they all have to be willing to participate? Calling the home health nurse at 3am in the morning to come over because a dressing that we have taught a family member to patch in emergencies came off and the caller does not want to wake that person up. When a person is receiving care in the home, the ultimate responsibility for that patient's care falls on the family. It is up to me as the home health nurse to assess the readiness to learn by the family and get the major players together and instruct and educate them in a clear and pointed way on all aspects of wound care and how they impact the patient's health. If I determine that the family is really not ready to learn, but they are simply avoiding what may be the inevitable, I request the services of our social worker who is in a very good position to review the overall family situation and discuss alternatives with them if they are not ready to accept their responsibilites with keeping a needy loved one in the home.
My ability to try to provide the best care possible with patients who have skin integrity problems and keep current is contingent upon my ability to attend continuing education seminars and regularly read literature on this topic. Also, I have to regularly collaborate with the physician, my supervisor, my peers, and wound care companies. No, I'm not a wound care specialist, but because our agency only employs one wound care nurse, the rest of us are responsible for managing wounds as well as everything else. I do the best I can, and it's hard with the volume of paperwork we have to do on these patients. I enjoy and appreciate those families who are proactive with their loved ones care. Thank you.
- Jun 17, '01 by cjpHi everyone,
I work in a specialty office, Allegy and Immunology. I do procedures in the office that a few short years ago would never have been considered to be done as out patient. I'm talking IV therapy, in particular IV gamma globulin. ( I know this can be done in the home but we feel the risk of reaction is too great to be done in the home. We've had a few that did have reactions)Besides the IV therapy I give allergy shots, do skin testing, as well as asthma care and asthma management classes. This is of course besides answering telephone, having an asthmatic walk in with an acute exacerbation or an anyphylaxis to an allegy shot. Don't get me wrong I love my job but I become very offended when people in the community say that office nursing is a "piece of cake." "You can't do much more than take blood pressures and get people ready for the doctor to see." We office nurses are becoming very specialized. I don't know one that doesn't work her tail off. I would love just one lay person to shadow me for a day and see if their opinion changes by the end of the day. Which by the way is often 6 or 7 PM.
- Jun 17, '01 by nurse110Great Idea I work in a nursing home, where I'm the only nurse on duty at night. We have 118 residents and 6 CNA's on nights to take care of them. People and families need to know the things we do during the night. Like, for example, the ones that are up at night to smoke (you have to watch them so they don't get burned), the ones that are constantly on the call light because they're lonely (you sit and talk with them and try to comfort them), the ones that need to be turned and dried (because they are unable to do it themselves), the one that get out of bed frequently without clothes on (because they do not realize what they are doing), the ones near death (you sit and hold their hand so they don't pass alone). You know there are so many things, that unless you work the field, I don't thing you'll understand it. But you know what IT"S WORTH IT.