Real Nursing - page 3

It's one of the most satisfying activities that my job entails. Last night, I noticed that an A-Fibber had refused Coumadin. That's bad, because A-Fibbers are at a very high risk for stroke and... Read More

  1. by   Orca
    I've left hospitals too sick to have absorbed any information, with a stack of papers in my hand. Most of them were about who to call if I wasn't satisfied with the hospital "service."
    Excellent point. Hospitals are very concerned about what patients think of what happened while they were lying in the bed. I don't know of any who ask questions about how well they prepared the patient to go home, or to maximize their chances for a successful recovery. About all they tell patients is to come back if something goes wrong. What about preventing the return visit altogether?

    Love the name, BTW. Very clever!
    Last edit by Orca on May 29, '09
  2. by   imelling
    Angie I don't think you could have said this any better and what a perfect example. If you didn't save that patients life in the very near future, you most certainly gave her much more time and quality of life. Hey, are you supervisors reading and listening?

    I think what also could be touched on here is that pts are being d/c home much sooner and sicker these days, and quite often connected to "scary medical equipment" they have little or no understanding of. If the pt is caring for themselves they should demonstrate that they can properly use the equipment, know when and how to take their meds, learn the proper name and dosage of their medication, how each medication works and benefits them, what it looks like, or if the pt is unable then the caregiver must learn this and demostrate the same. Preferably not all on day of d/c. This must be taught!
    Also, it shouldn't surprise anyone that the less time a nurse spends educating her pt or pt's family before d/c the % of readmissions go up proportionately often with more serious problems then when initially admitted (or worse). It's such a shame when this is so completely avoidable.
    If we don't or can't find the time to do this, you can be certain it won't be done, and patients will suffer for it.
    Something I always recommend when pt's are going home on new meds or many different ones is keeping a notebook and pen right with their meds and keep a log, with medication, dosage, time and date noted as each pill comes out of it's bottle (this also gets them reading the actual prescription on the bottle too). For pt caregivers especially if more than one this is an absolute must. When the pt keeps their next appt. all should be brought to their doctors office. This shows medication compliance, that the patient cares and is involved in their healthcare, and opens an intelligent dialog between the pt/caregiver and doctor or nurse regarding how they've done since d/c. Almost always another teaching opportunity comes next!
  3. by   lpnstudentin2010
    while it is not a story of nurses but docs this story shows how educations is a very important thing:

    plastic surgeon said he would do 1 of 3 procedures. One of which was suturing my eye closed. I told him I did not mind which one was done, I just dont want the one where you sew my eye closed. He says fine and we start the process of choosing which one to do.

    about a month later my opthalmologist says he wanted to suture the eye closed. I told him No i did not want that. His response.......why. I explained that i would look wierd walking around with my eye stitched closed. He said no no no the stitches are not on the outside but on the inside.

    him taking the time to ASK why I did not want the procedure made it so he could understand that I had a misconseption of the procedure and he was able to clear it up and make me feel better, and fine with having it. had my plastic surgeon asked he would have known but since he did not ask why I did not share it with him and so I had thoguht he was crazy for wanting me to walk around with black stitches on the outside holding my eye closed.

    after that appointment with my eye doc, I agreed to the procedure and it made a diference to my quality of life for a little bit of time
  4. by   Gesundheit
    Absolutely agree. Take care of yourself first, (take your breaks, drink water, PEE! and take a minute to breathe and laugh). Then comes your patients (cause when you are maxed out and frazzled you are much more likely to kill them) and then worry about overtime and the evals. Document document document. Keep your own notes and detailed accounts of super busy nights or nights you felt overloaded. Bring that with you to you eval and ask how management can help keep that from happening again.

    Stand up for yourselves and your patients. We are skilled, valuable, smart and passionate people, there is no reason to compromise care for fear of being docked for doing your job right.
  5. by   rkitty198
    So very true!
    A patient had a Foley removed outpatient. Came back in with terrible "bladder pain." Patient went 15 hours without urinating, verbalized he did not know he was supposed to "pee" within 8 hours. Patient handed all literature to staff and nothing was within the instructions to let provider know if he/she was unable to void. He/she was scared out of their mind!

    I stayed late one night giving discharge instructions to a family, I had been with them all day so why not finish up with them. Good thing I stayed late, as when I was about to clock out there was a patient who coded and I was able to help when each Nurse had just got on shift and had 8 patients each.

    I had always wanted to be a teacher and a nurse. I am so blessed that I get to do both!
  6. by   WhyattMorgansMom
    I can appreciate the nurses that take the time to explain the simple things. After my first surgery, I didn't now (was out of it mostly) about the incentive spiro, man did my nurse show me how to use it and the best part was when I went to cough, she showed me a simple "trick" with the pillow that saved me a lot of pain. Taking those 5-15 minutes to explain something simple can help the pt in so many ways.
  7. by   Valerie Salva
    Great writing and vitally important points. Thanks.
  8. by   Multicollinearity
    Angie O, you are an allnurses gem. I learn so much from you and enjoy reading your posts.
  9. by   Desert Man
    Hi Angie, I hear you and identify with you, like just about everyone else here. However, the reality is that large corporations are not ultimately interested in the sincerity of your work. They are only concerned with you clocking out on time. Ironically, they become interested when there is a patient complaint, or patient care incident that may damage their image, or have some legal implication for them.
    To be an effective nurse and patient advocate, do not figure on your employer. They are concerned with tangible evidence they can read. Don't expect them to understand how good you have been at your job and conscientious in preventive medicine. If you leave late they will eventually 'can' you and depending on the employer, that could come sooner rather than later.
    We are working in a health care system that does not put the patient first, but rather the needs of the health insurance companies, JCAHO etc, etc. (Incidentally, you figure last in the equation). You don't think our endless charting is for the sake of the patient do you?
    The problem is that corporations want it all. They want all their written and computerized charting done and then whatever else occurs to them! If there is a suggestion that you can complete your charting and still do health education, while you're maxed out with a heavy patient load, possibly taking admissions and doing discharges, they'll add that to your job too.
    As nurses, we have always been dumped on. We are seen as people that are willing to attend to all the needs of the patient. Our own "profession" encourages this. Hence, we are easily manipulated by the corporations that employ us. Nothing is too much, since it is always presented to be in the interests of the patient. The role of the nurse continues to become ever more complex. With often competing interests - needs of the corporation vs the needs of the patient. Eventually, if we aren't already there, the job will be so conflicted that we will find it too difficult to do. It isn't that young people don't want to come into the job, it's just that they are discouraged from doing so.
  10. by   Successfully123
    Thanks for a GREAT article!!! Teaching in any setting not only improves patient compliance; it promotes independance and self reliance. This is what quality care delivery is all about. Kudos!!!!
  11. by   nursenow
    Hmm. Real nursing. Last night I was walking down the hall and noticed an elderly gent drooling on himself as he wandered past the nursing station; i wiped his chin and kept on going. I didn't save his life and I don't know that I taught him anything. I wonder if that is considered real nursing?
  12. by   Suninmyheart
    Thanks Angie for such wonderful inspiration. Well said.
  13. by   UM Review RN
    Quote from nursenow
    Hmm. Real nursing. Last night I was walking down the hall and noticed an elderly gent drooling on himself as he wandered past the nursing station; i wiped his chin and kept on going. I didn't save his life and I don't know that I taught him anything. I wonder if that is considered real nursing?
    My opinion is that what you did was an act of kindness. No special skill or knowledge is really required for the task of helping someone stay clean. However, specialized skill and professional knowledge are required to discover whether the source of the drooling is a stroke, loose dentures, or dementia, and then intervene appropriately.