What part of pt care gets overlooked most often - page 5
Ive noticed oral care. Last night I went in to check on a patient I heard moaning (not my patient, but was concerned). She was half in bed/half out, O2 off her face (sat 72), slumped in bed, leg... Read More
Jan 18, '07Occupation: RN Specialty: * Cardiology * Oncology * Medsurge RN ; Joined: Dec '06; Posts: 1,220; Likes: 855I agree with the oral care business; too many things to do and oral care is last on the list of priorities lol
Last time i worked my female obese patient had not had a BM in 7 days!
She was on Vicodin 5/300 q 4hours so this didn't help matters any...
I suggested a soap suds enema with warm water and she took me up on it, however after getting the order approved from the Doc it took 6 hours for myself and my CNA to coordinate our efforts to give this lady her enema.
So often we treat people with pain but forget to assess the causes!
:caduceus:Last edit by CaLLaCoDe on Jan 18, '07
Jan 21, '07Specialty: OB, HH, ADMIN, IC, ED, QI ; From: US ; Joined: Jun '06; Posts: 2,340; Likes: 2,045Consideration of all bodily systems (not just the errant one(s) being treated), emotional well being, and need to know. How many times have we been told to "explain the process to the patient"? How many times have we neglected that, or assumed someone else did that?
I think an easy to use daily list needs to be placed at the patient's bedside where it is in plain view and not likely to be thrown out or spilled upon, like they have to maintain cleanliness in public restrooms at restaurants, etc. with a writing utensil attached to it, to initial basic needs.
Those facilities with handheld computer data must be conscientiously used. That means, don't chart something as accomplished, if it wasn't done!
Now that all charts are not on the foot of patients' beds, or outside their doors or taken away in the mistaken belief that information therein is the purview of professional staff only and not for patients' review, something
needs to be at the bedside as a reminder, but not where vistors can access it. It could be in a waterproof closed folder, to maintain privacy, and if visitors show an interest in reading it, labelling it "Private and Confidential would absolve the Nurse from breaking HIPPAA..
Patients used to be made to feel like naughty children whose hands were caught in the cookie jar if they looked at information originated by others about them. I feel strongly that rounds need to be made again by charge Nurses with the chart each shift. reviewing with the conscious patient the lab results and vitals, and procedures they had or will have soon, and to treat them as a member of the healthcare team, to ascertain that they did receive the care that was noted, even if that means looking in their mouths if it is thought they may not remember having oral care. or are not fully conscious. Remember to act interested in each person/patient, as if they were a favorite relative pr friend.
This will impress patients with your concern about them, and can be done quickly by explaining that you will come back if they have questions that can't be answered during rounds, and WRITE DOWN the patient's "need to know", so the charge Nurse (not the caregiver about whom the patient may have a complaint) WILL COME BACK LATER!
This really will save time (if misunderstandings occur) and increase confidence of patients in the care they receive. Make time to save time.
Feb 18, '07Joined: Sep '05; Posts: 937; Likes: 136Quote from MarySunshineahh the illussive teaching - yeah id have to say that isbiggie for me - had a daughter come in to our dementia unit freaking out - had had dad in several NH where they handed her a pamphlet and said nothing - then coming to a unit with a LOT of dementias in onee place spooked her- thank god it was a half quiet ( if ya can ever have that hahah) night and i was able to spend over half hour showing her around and explaining things she might see and calming her - reassuring her and basically explaining what i could abot dementia. she was so upset that dad said things that were not like him- i felt good by the end of talking woith her that i di dgood but it is a very very rare chance to get to do so.I'm in an ICU so we have more time for hygiene stuff. I would say we aren't able to give enough time to patient/family education. We're always just running in and out of rooms in a rush as we go over our "to do list."
Feb 18, '07Occupation: Diabetes Educator Specialty: 15 year(s) of experience in Diabetes ED, (CDE), CCU, Pulmonary/HIV ; Joined: Jan '07; Posts: 528; Likes: 76I agree with oral care on total care pts. However, this is getting better in ICU/CCU setting because of the push to reduce Ventilator Associated Pneumonia (VAP)
Feb 18, '07Occupation: Staff Nurse Specialty: 18 year(s) of experience in Rehab, LTC, Peds, Hospice ; From: US ; Joined: Jan '06; Posts: 593; Likes: 562Oral care big time. I'm responsible if the CNA's don't do it. If I"m made aware I make sure they do. My NPO patients I usually do try to do even though the CNA's are supposed to. The other day of course I didn't get to it with a patient that of course is the families big concern (focusing on that lets them forget how sick he is, I think). It was just a hellish day. I gave him lots of attention that day, just not mouth care yet. (Breathing treatments etc) I was totally honest with them about it, luckily they know me and know I try very hard to make sure my patients get good care. It's so frustrating though! I have 26 patients and 2 cnas (LTC and rehab) theres just sometimes a limit to what can get accomplished in 12 hours with that many people. As far as quality care goes, incentives are not going to magically give me more time to do the things I"m already committed to provide to my patients, more staff is!
Feb 18, '07Specialty: OB, HH, ADMIN, IC, ED, QI ; From: US ; Joined: Jun '06; Posts: 2,340; Likes: 2,045Only in the UK and British Commonwealth are there times when visitors aren't allowed, still. In the US, we value their participation in patient care. They feed their friends and kin, and I'll bet if we handed them a toothbrush or mouth swabs and demonstrated it, they'd help with oral care (with patient permission, of course). There are times when procedures are done, that they are asked to wait outside - and won't leave if given an approximate time for re-entry.
I like the signal buffet restaurants have to indicate the time for the dirty dishes to be removed - a sign that says so.
Range of motion is also a big issue, as is the need to avoid "foot fall" by positioning correctly. How many times does a patient on qh turning, actually get turned?
Feb 18, '07Occupation: RN-i (RETIRED) Specialty: ORTHOPAEDICS-CERTIFIED SINCE 89 ; From: US ; Joined: May '00; Posts: 14,479; Likes: 2,298I confess I didn't read all pages. I have an eye floater that's driving me batty.
But I'll vote for tooths and hoofs, ears and rears.
I can't tell you how many patients tell me their feet had never been soaked in the bath basin.
I also can't tell you how many tell me they have never been given a hot wash cloth before meals and another after they use the bed pan.
Feb 18, '07Occupation: psychiatric nurse Specialty: 9 year(s) of experience in Psychiatric ; From: US ; Joined: Apr '03; Posts: 668; Likes: 374I think the patient's feelings get overlooked more often than not. We go about our business and hurry to get things done, charted, passed out, etc., but I think sometimes we fail to notice how the patient FEELS.