Treating the whole patient?

demylenated, BSN, RN · Aug 13, 2011

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..

dudette10, MSN, RN · Aug 13, 2011

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?

tokmom, BSN, RN · Aug 13, 2011

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.

Old.Timer · Aug 13, 2011

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.:)

A&OxNone, MSN, RN · Aug 13, 2011

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.

Wise Woman RN · Aug 13, 2011

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... "

tokmom, BSN, RN · Aug 13, 2011

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... "

:lol2:

StrwbryblndRN · Aug 13, 2011

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.

tokmom, BSN, RN · Aug 13, 2011

Very interesting. Thanks.:)

SweetseRN · Aug 13, 2011

My example...My own daddy broke his leg, not crazy serious but still a nasty fracture. The ortho doc came in, showed him a model of the bones, ligaments and tendons of the leg and had hand on the door knob in less than 5 minutes. I am glad I was there because I had to ask...How much risk is there for DVT with this injury? What can I do for PT to help him heal and minimize loss of function? What about pain, ummm, can you give him some meds? Oh and by the way he tends to be constipated as it is, how can we prevent that while mobility is limited and narcotics are on board? (I actually gave up at that point because I knew the answers and was just asking questions because I was annoyed with the lack of care)....What about depression r/t immobility...Will there be atrophy from the immobilization? How much weight can the broken leg bear if any at all? What do we watch for as far as complications? How can we prevent arthritis from setting in? So...Sorry for the rant but all of those should have been answered if you are taking care of a whole patient. This doc just saw a cracked bone and not a person. It made me sad.

Anna Flaxis, BSN, RN · Aug 13, 2011

The problem with this measure is that it is completely subjective, and so not objectively measurable, which makes the results less meaningful, IMO. Since "treating the patient as a whole" means something different to everyone, an actual definition that includes specific, objectively measurable behaviors should be adopted. Otherwise, it's a set-up to have low scores and have staff feel demoralized because of it.

So, to adopt a definition, you need to find out from patients what specific behaviors contribute to feeling as if they are being treated as a whole, and those specific behaviors are what should be asked about on the surveys.