MunoRN 26,150 Views
Joined Nov 18, '10.
Posts: 7,253 (68% Liked)
I've dealt with a number of coding patients who are responsive during part or all of resuscitation. Good quality CPR can produce systolic blood pressures in the 80's or even 90's by art line, and a Lucas Device can sustain greater than 100 torr for an extended period of time. I've only seen this in patients where CPR is started immediately at the time of arrest, or where CPR is actually started before pulses are completely lost. It's basically the same thing that happens with a syncopal episode; the brain looses effective perfusion for a short time, in which case it's not unheard of for the patient to regain consciousness with the return of effective perfusion.
The term "client" had been around in some settings for a while, then around the year 2000 a work group with the ANA recommended that we use the term "client" as a general replacement for "patient". It was only after this switch that they actually studied the effects of this terminology and as a result they quickly reversed their recommendation, although by that point it had already made it into textbooks and general academia and there was no turning back.
The term we use to refer to someone indicates how we view that person and our relationship with that person. "Client" refers to a participant in a financial transaction or business relationship, while "patient" refers to someone in a therapeutic relationship. As it turns out, patients don't generally like to be seen as a source of revenue, they prefer to know that we see them as someone in need of nursing care.
I would imagine those percentages vary greatly by hospital/region/unit, etc. I would bet my life that nowhere near 83% of the patients I work with are paying for anything.
Haha...take another drink of the koolaid...our local pedi hospital get 96% of it's income from medicaid...
My feelings about the BSN as entry haven nothing to do with someone who is already a nurse and working. I am talking about the FUTURE. Where do we want our profession to go?
If we want to legitimately be considered as a "profession", we CANNOT continue to degrade further nursing education and courses. We cannot degrade those wanting a higher education level. A bachelors degree is the MINIMUM, repeat, MINIMUM entry to practice in any other profession that is respected and in high esteem. This is the present and the future.
Again, I AM talking about the first time college students who are entering the nursing profession. It should be a BSN entry only going forward. It shouldn't be some trade job that requires 15 months of training. We may as well be plumbers (not that anything is wrong with plumbers, but we should aspire for more). I don't see why people are so against this.
If there was some evidence that chair alarms reduce the risk of falls then there might be some argument that the nurse allowed an overtly unsafe situation to occur but the evidence doesn't appear to support that. Either way, the nurse has to weigh the benefits of the patient getting up out of bed and spending a worthwhile amount of time in the chair with the risks of doing so, and generally there's too much harm in limiting activity more than necessary to outweigh the risks of leaving a patient in a chair.
I think once the argument is focused on who's "fault" it is and what counts and doesn't count a fall to blame someone for then the process has failed. What the focus should be is to how best care for the patient, and just leaving them in bed because there's no chair alarm isn't what's best for a recovering ICU patient. It may not seem like it, but chair time is essentially a work-out for a patient recovering from a critical illness, and research shows improved outcomes for patients who get two periods of chair time per day. All efforts should be made to avoid preventable falls, but you still have to take into account what's best for the patient overall.
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