Treating the whole patient?

  1. 0
    What is your definition of this? Does your facility do something different to make this possible?

    Our scores (yes, those!) came back a few days ago. We scored in the high 90's for teaching and discharge information (thank you very much. That is my job!) timely with answering lights. Pain was down in the 70's. We need more eduation to certain nurses who are paranoid and stingy with pain meds.
    What got my attention (and nurse manager) was this score.
    "Treating the patient as a whole", the score was in the 60's. Of course we want that higher. There will be a staff meeting on this next month. This is the third month in a row it has been low.

    Our staffing is good. 3-5 pt's on any shift. We have CNA's, so nurses aren't exactly completely overwhelmed.

    I want input.
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  3. 22 Comments so far...

  4. 5
    Whole patient... My definition is even though the patient is in with a RTKR, we shouldn't neglect any other needs they have. Are they having BMs regularly. Did you walk in and find them crying, if so, why? Do they need a Chaplin or a psych consult.

    They are scratching their face a lot, don't just assume they have allergies... could it be Rosacea or something else not related to medications they are on...

    That is how *I* look at it. I do a focused assessment on the "problem," but then I do a complete head to toe assessment. Not just when they are admitted, but the beginning of every single shift.

    Pain... don't get me started on pain. I don't understand why nurses feel the need to judge a patient's pain and think they know better than the patient the kind and rating of the pain he is having... And why oh why do nurses police pain meds. Grr..
    brandy1017, leslie :-D, Debilpn23, and 2 others like this.
  5. 0
    Quote from tokmom
    What is your definition of this? Does your facility do something different to make this possible?

    ....

    What got my attention (and nurse manager) was this score.
    "Treating the patient as a whole", the score was in the 60's. Of course we want that higher. There will be a staff meeting on this next month. This is the third month in a row it has been low.

    Our staffing is good. 3-5 pt's on any shift. We have CNA's, so nurses aren't exactly completely overwhelmed.

    I want input.
    That particular measure is so very broad. The definition the facility has may not be the definition the patient is responding with.

    If the patients are the source of those scores, what do they feel isn't being done? Have you had a chance to review the verbatims from the patients who were surveyed? Are there less subjective questions you can share that roll up into the overall score?
  6. 1
    Quote from dudette10
    That particular measure is so very broad. The definition the facility has may not be the definition the patient is responding with.

    If the patients are the source of those scores, what do they feel isn't being done? Have you had a chance to review the verbatims from the patients who were surveyed? Are there less subjective questions you can share that roll up into the overall score?
    I asked my manager that specific question. What does that mean? What were the former patients asked? He doesn't know either, but I think we need to find out.

    I do wonder if it is tied to pain scores...somewhere. I don't know. That is why I asked what that terminology meant to everyone here. We do have some nurses that are pretty task oriented and focus pretty much on just that. Our hospital is also small, so it doesn't take a lot of lower scores to really pull them down.
    dudette10 likes this.
  7. 1
    Back in the day.....treating the "whole" patient meant treating them as a biopsychosocial being with biological, psychological and social needs.

    Not sure how that translates into today's acute care setting. With good reason, most nurses I know consider it a pretty successful shift if the patient's "biological" needs have been met.

    Something tells me this will end up being a good thread.
    leslie :-D likes this.
  8. 1
    Honestly, treating the "whole" patient score may be more a reflection of the doctors. I think pain and such could be playing a role with the scores, but how many patients feel like their doctor focuses on them as a whole patient? Mentally, emotionally, talked to on their level, financially, asking about the little things, ect. I know we had a meeting about these scores and it was actually discussed that, even though the patient was supposed to be rating the nursing staff, often times they would write in the comments about the way their physician treated them.

    I'm not sure if I'm on track, but its food for thought.
    tokmom likes this.
  9. 9
    Quote from tokmom
    What is your definition of this? Does your facility do something different to make this possible?

    Our scores (yes, those!) came back a few days ago. We scored in the high 90's for teaching and discharge information (thank you very much. That is my job!) timely with answering lights. Pain was down in the 70's. We need more eduation to certain nurses who are paranoid and stingy with pain meds.
    What got my attention (and nurse manager) was this score.
    "Treating the patient as a whole", the score was in the 60's. Of course we want that higher. There will be a staff meeting on this next month. This is the third month in a row it has been low.

    Our staffing is good. 3-5 pt's on any shift. We have CNA's, so nurses aren't exactly completely overwhelmed.

    I want input.
    Perhaps the powers that be will institute a new catch-phrase: "Hi, I'm Wise Woman RN, and I will be your nurse today. I want to treat you as a whole, so please let me know if you feel you are only being treated as a part... "
  10. 0
    Quote from Wise Woman RN
    Perhaps the powers that be will institute a new catch-phrase: "Hi, I'm Wise Woman RN, and I will be your nurse today. I want to treat you as a whole, so please let me know if you feel you are only being treated as a part... "
  11. 5
    When I treat a patient as a "whole" I look beyond the dx. I know most nurses do but do they actually implement. I look at their baseline before surgery/dx and what they are currently. I try hard to make sure the pt's routine is the same at home if possible. (of course only if it is safe and realistic)
    Do they stay up late/go to bed early? Simple yes, but valid. I try and figure their idiosyncrasies and try to conform to fit them. You got your ocd pt's, nervous nellies, controlling, needy, PTSD, you name it. Unless it is caused by the admission/dx itself I want the pt to be themselves. Included in this is how self care are they. There is a huge spectrum. Some nurses fit them in either self care/ambulatory or fallrisk/unable to care for self. I find many nurses not tolerating pt's for who they are either. Some nurses I work with try so hard to put the pt within their own standards that the pt is ignored in sense. In turn I can see why pt's may feel they are not being treated as a whole.
    A simple example: Pt comes in for abd pain, she is in her 80's but alert and oriented. When I recieved her as a pt she was 2 days post op lap choli, with one week since admission. She had her SCD's on, she was being turned every two hours, she was eating well and she had good pain control. But the one thing that was overlooked was she was independent living and walked into the ER. All she had was a simple lap choli. I pulled the pillow out from behind her unhooked the SCD's and assessed her ability to get up with/without help. She could not even get herself up to sit on the side of the bed. Everyone made the assumption that she came from a facility (even though independent they had assisted living as this facility too) and that she was in her 80's that she was not stable enough to be mobile. May appear that way after surgery due to meds but no one took the time to check for baseline. Obviously the md missed this one too.
    Another example: I reported off to a nurse (good nurse too) that my man in 31 was A/O3, up with assist and continent with urinal at bedside. Well I guess he spilled it and caused his bed to be wet. She realized he was soaked after report. As I was walking out the door I almost stopped to assist her But I noticed she was giving him a bed bath and making him roll to change his linens. It upset me. I advised her that with one assist she can get him to the bedside chair and he can clean himself. She ignored me. Not that she thought he could not do it but felt this was easier. I felt like she was taking what self care he had away from him.
    I had him again and got him up to a bedside chair with toiletries for him to do it himself before she came back on. I did not want to see that happen to him again.
    canoehead, GrnTea, leslie :-D, and 2 others like this.
  12. 0
    Very interesting. Thanks.


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