Cul2

When you're stumped, when you have nothing to say, when you can develop no argument -- produce the ad hominem attack. That the best you can do?

Stargazer: Glad to see you're sticking to the topic of this thread. I presented a point of view relative to the topic. You don't have to agree with it. We can just agree, civilly, to disagree. But don't claim the moral high ground by digressing and running away from a debate.

Gee, Stargazer. You so sure that you know who and what I am or am not. Dodging your question? I have absolutely no obligation to share any personal information with you. And because I don't, you jump to conclusions. Really logical reasoning. You've come to so many conclusions based on so little evidence. Tell you what -- I'll reveal all that personal information about me when everyone else on this blog is required to do the same. Then we'll really find out who is writing what. Sound fair? All we have on the web are words. That's all. Words. All we can do is read those words, put them into sentences, and see if they make sense. You refuse to do that. You refuse to look at an argument and debate it. Apparently, it's because you have all the answers. You just assume, assume and assume, ask personal questions -- and if you don't get any answers, assume some more. You sound proud that you're not willing to read an intellectual book relative to the profession. Okay. Enjoy your other book. I've read that series and it is great.

"i read your post. i know what it said. the original post, and the topic of this thread, was an observation of human behavior that we nurses encounter frequently. sometimes we can make stereotypes from these observations. that's the interesting thing about stereotyping, is that it has such a negative connotation, but yet there are studies that suggest that stereotyping is typically quite accurate. i agree that there are a lot of comments on an that do seem to be a bit lacking in areas such as psychological insight and emotional intelligence, but that phenomenon is not limited to an. which brings me to a side note, i understand you are not a nurse. may i ask what your occupation is, and what you expect to gain by participating on a discussion forum for nurses?" stargazer: i agree that the lack of psychological insight isn't limited to allnurses, but my expectation (perhaps it's misguided) is that nurses should have a good handle on human psychology. although, i must say, i read a significant number of posts on allnurses as condescending also. some are unintentional as are mine. some are consciously condescending and use "venting" as an excuse. a few points in response to your last post: i'd like to see the studies you refer to regarding stereotyping. i'll refer you to the work of dr. jerome groopman, esp. his book "how doctor's think," and several of his essays. also, atu gwande. groopman has focused on cognitive traps, or thinking errors that doctors (and nurses) fall into that sometimes result in fatal errors. these involve the use and misuse of heuristics. i don't deny the value of heuristics and stereotypes. but they also present dangers. frankly, i see too much generalization and stereotyping on allnurses, esp. regarding patient behavior. you find my comment is indicative of a sense of superiority on my part? perhaps. we all have our egos. perhaps i have a background in psychology. you say you "understand" that i am not a nurse, and if that is true, what my background is and what i expect to gain from participating in this discussion. i'm not quite sure how you can know what anybody is or isn't on this blog. just because one says one's a nurse, that doesn't necessarily mean anything. this is the web, remember? what i hope to gain from participating, whether i'm a nurse or not, is to present some different perspectives on issues under discussion. i'm not saying i'm always right, but enjoy playing the devil's advocate, especially when i seen discourse moving in only one direction and everybody agreeing with everybody else with little objection. my occupation is not relevant. the strength and validity of my arguments are relevant. they should stand or fall on reason and logic. but do remember this -- the verb "to nurse" is a transitive verb. that means it takes an object (not that patients are objects). but one doesn't "nurse" in a vacum. for the action to be complete, one needs a patient. the patient is the other half of the action. without the patient, there is no action. the patient's perspective is as valuable as the nurses or doctor's. i won't say more valuable. as valuable in its own way. having said all that, i'll work on my occasional tendency to appear condescending and superior. that's not my intent. i just enjoy a robust debate, and i think that's important in any profession.

you said: " i don't buy this. if this was true, then all patients would assume helplessness upon admission to the hospital. but not all patients do. so, there *must* be a component of the *individual's* makeup that comes to bear." i had said: " [color=#333333]i don't deny that there are people who are helpless before they arrive at the hospital and then continue the behavior there..." why would this have to be true for all patients? this isn't an all or nothing world. people are different. and whether you're interested in this topic or not -- i think it comes to the heart of this discussion, which too often is stereotyping patients. i realize it would be easier if everyone were the same, but, that's not the case. i am sometimes astounded at the lack of psychological insight i find on some of these threads.

I don't deny that there are people who are helpless before they arrive at the hospital and then continue the behavior there, and are often enabled. But there are many people who are not helpless who become so when they enter the hospital. Why is that? It's more a factor of the hospital culture and perhaps the general culture of what hospitals are "supposed" to be than it is the personality of these patients. Human beings pick up quickly and subconsciously the atmosphere and "rules" of their surroundings. They either adapt or fight. For sick people, it's just easier to adapt and go along with the program, even if they don't agree. But hospitals have tremendous potential to influence patients as to how to behave. I recommend the book "Influencer" by Patterson et. al. There's much hospitals can do to lead many patients along the path to self-care, if they utilize recent research about how to influence people.

"hospital induced paralysis. it is a syndrome in which an individual becomes completely helpless upon crossing the hospital threshold." hospitals can "induce" the kind of behavior you describe -- if they have that power -- then they also have the power to induce the opposite. poor hospital "cultures," policies designed merely for efficiency, staff burnout and poor attitudes, (which too often come out on these blogs), lack of any kind of patient-centered care -- these things and others most often cause the kind of behavior you're describing. if patients feel like their being treated like objects, they start behaving like objects. they don't all of a sudden become stupid when they enter hospitals. humans quickly adapt to the atmosphere around them. when they feel powerless, many become powerless in order to survive. unfortunately, the cultures of too many hospitals enable this kind of behavior.

And no one person suggests that you ask the man if he might feel more comfortable if a male nurse did the procedure. Maybe he wouldn't. Maybe he would. How would you know? Ask. I know. I know. There's nothing to be ashamed about. Oh? Well, let the patient decided what there's to be embarrassed or ashamed about and the best way to mitigate that embarrassment. This is the double standard and the entitlement attitude that some people refer to -- "I'm a nurse so I'm just entitled to do this or that to him or her because I'm qualified." Let the patient make some of these decisions based upon their comfort level.

It seems to me that, for some at least, this issue is at heart about trust, honesty, oversight and supervision. Some may just firmly be against having any student nurse or doctor work on them. But most people, I really believe, are open to it if, and I repeat, if they believe people are being honest with them, if they see there there is oversight and supervision, and if they feel safe. Much depends upon the demeanor of the student. If they appear confident, fine. If they're too nervous, not fine. But, frankly, once trust has been lost, it's extremely difficult to get it back. How many have by chance found out a student was working on them without being told? How many felt deceived? Now, you can say all you want about signing consent forms with that fine print written in legalese. That may be a "legal" standard, but it's not a human one. Patients must be asked if students can work on them, and be introduced to the students -- even better, have the student approach the patient and ask permission to work on them. That represents respect. If this doesn't sit well with some, then work on models or standardized patients.

"but i am not such a special snowflake that i really need to worry about what professionals are thinking about my corpus." i don't disagree with that point of view, but it is a point of view. as i see it, it's not about what the professionals are thinking or how they feel. it's about what the patient is thinking and how he/she feels. that's the crux of the issue. frankly, i assume that most professionals are so used to their work that they take it in stride. this is both good and bad. good if they don't ever forget how the patient may be feeling. bad if they become habituated or numb or routinized to such an extent that they just go through the motions without thinking. but the point isn't how the caregiver feels. it's how the patients feel. most patients don't have this done to them every day. indeed, many patients have never had this done to them before. this is were the abyss exists sometimes between the patient and the caregiver point of view.

My concerns have nothing to do with whether these young people are competent or caregiving. Of course they could be. But they are minors. Who takes the responsibility for their actions? Who's the deep pocket in a lawsuit? You can have these young adults sign any documents you want regarding HIPAA violations and other ethical issues -- but these documents are meaningless. As minors, they can't be held responsible. That's one issue. The other is patient informed consent. I contend that patients have an absolute right to know their caregiver is a minor, and, thus, the implications of that situation. If patients are fully informed and agree, then so be it. If hospitals want to get involved in these kinds of risky situations, fine. As long as everyone goes into it with their eyes wide open.

Let's do a little philosophy here, okay? Ontology -- no, this isn't about cancer. It's about the essence of what it means to be a "patient." What "is" a patient? And what "is not" a patient. A patient is a human being -- a person, an individual. Not just a body, but a mind and a soul. A patient, in essence, isn't a teaching tool to be "used" by professors and students. Now, many patients will agree to being used as a teaching tool if they are approached with respect and dignity -- if there's a clear understanding that it is the patient's right to refuse. Most patients do understand that doctors and nurses need hands on training in hospitals. But -- Hiding such consents in small print in documents, and putting people "out" quickly before inviting in the spectators -- that's not informed consent. It's a travesty, unworthy of the profession of medicine. It's an entitlement attitude, an us vs. them point of view, a complete disregard for the humanity of the flesh going under the knife. Frankly, it's an ethical violation. But apparently, it's so common these days that professionals have become oblivious to this disrespectful behavior.

It's interesting how the focus here is on just one side of the issue. If patient autonomy has any significance at all, if individual values and differences count, if respect and dignity matter, than the patient perspective is part of any question of this nature. Patients aren't potted plants sitting in the corner of the room; they're not objects to be worked on, turned as needed and bathed. If this mother had asked about her 16-year-old son giving a bed bath to an adult female, there would be no question in anybody's mind. Can you imagine the responses we'd get on this bog? Some of the responses here are just another example of the double standard regarding male and female modesty.

According to the definition of sexual harassment, if you overhear something that you feel is harassment and it bothers you, offends you, then it can be considered sexual harassment. You're the one sexually harassed. Sexual harassment isn't just between the offender and the person who is being addressed. It affects everyone nearby. For example, if the offender says something and the person he/she says it to isn't offended, but a person standing nearby hears it and is offended, that can be considered sexual harassment. I don't know what happened here. I wasn't there. But the OP obvious interprets this as sexual harassment. The OP could be considered the one who was sexual harassed in this case.

Isn't this interesting. All the stories are about men. I guess no females ever come into the ER for any embarrassing conditions. Or is this just an example of why its unhealthy for one gender to dominate a profession. There's an old boys club -- and there's an old girls club as well.

"sweetheart, i'm pretty sure they were kidding. it was in fun. calm down.and be careful going home." pretty sure, huh? yes, and god help a group of male nurses who joke like this about female patients. men don't get medical care as often as women, don't go to the doctor, etc. there are many reasons, and the medical profession in general doesn't seem very interested in those reasons. perhaps one reason don't seek medical care as often as women is the stereotyping and attitudes and double standards expressed on these threads. i know. i know. it's all only in jest. easy way to avoid criticism. just say it's all a joke.

For a perspective on this topic from a great American poet, short story writer, and doctor, read the short story, "The Use of Force" by William Carlos Williams. You'll find it here: The Use of Force--William Carlos Williams (1883-1963)

"you didn't need to get a male attendant to finish up this shower, and you don't need to avoid this patient in the future or be sure he is only showered by a male attendant because that will only make him feel worse." why is everybody afraid to just ask the patient how he or she "feels" about who will bath him or her? how about a little patient autonomy? how do you "know" it will make him feel worse to be bathed by a male nurse? isn't that stereotyping? some people feel comfortable with opposite gender care like that, others don't. for some it some it doesn't matter. i would suggest that if the genders were reversed here, there would be more concern for the female patient's modesty than for the man's. just a suggestion. i would suggest it's more likely the female patient would either be asked her comfort level by a male nurse, or would have been provided a female bather from the beginning. why go around assuming this and assuming that about how patients feel about these things? why just send in an opposite gender caregiver to give the bath? why not ask?

Is there a particular reason why my posts were removed from this thread?

To the OP -- I think the first thing you need to do is to stop calling these behaviors "no-no's." That diminishes their significance. If they are indeed insignificant, then ignore them. If they concern patient safety, then report them or talk with the individuals involved. Perhaps a tough decision. But when you see something that is wrong, you're not being neutral by not dealing with it. You become part of the problem.

"Hmmm, you seem more upset about how the notification was handled than about the actual death, am I missing something?" Perhaps. You may be missing the elemental significance of communication psychology. It's not surprising that the living may accept death more readily than they accept being (their perception) mistreated about the death. The dead are dead. Nothing can be done about that. But how we treat the living, the survivors, can be of more significance. Why do we have funeral rituals? For the dead? No, for the living. I must believe, I have to, that most medical staff understand this intuitively and professionally. Though these accidents happen and miscommunication occurs, we can never accept it as standard operating procedure and fail to communicate empathically,honestly, authentically with the survivors. Fail to do that at your own peril. The consequences can be severe.

IMO, this isn't about mistakes. Everyone realizes mistakes happen. This is about how, too often, mistakes are handled in medical situations. No explanation, no apology, no empathy, no consideration -- essentially no authentic communicattion. Risk management takes over and it's all about CYA. What results is what you read from the OP. Anger, resentment and often retaliation. It becomes get even time. For the next step it's not uncommon for patient families to consult a lawyer. I'm not saying this is the best path to take. I'm saying that this is what happens when lack of communication is interpreted as lack of caring, empathy, respect, dignity. Studies show that when this happens, patients are more likely to sue and for much more than if honest, open communication had taken place.

"unfortunately its not my place to do that. the family is so heartbroken and distressed that taking legal action against the hospital that may not even do anything is the last thing on their mind.. it wont bring him back right? i just know, if its up to me, i, nor anyone that i care about will not be seeking care at that hospital unless i keel over in their parking lot. -- again i dont know that his fate is in anyway related to the sub par care he received there, but i know it gives me icky memories and i dont wanna go back there." I understand what you're saying and don't question your decision. I'm not suggesting taking legal action. I do want to point out, though, this is an example of where lack of communication contributes to lack of faith in the medical system, in this case, a particular hospital. Perhaps that lack of faith is justified. Perhaps it is not. Until we develop a system where patients feel, if not comfortable, at least perhaps responsible for reporting these kinds of incidents -- not to necessarily punish anybody -- but to make clear what their expectations are while at the same time giving the hospital a chance to debrief and correct problems. Hospitals aren't perfect. As with all of us they have blind spots and sometimes just don't see things. Like all of us, sometimes they see things and just rationalize why they don't need to do anything to correct them. I read on here many complaints about patient satisfaction surveys. As this incident shows, hospitals should be concerned with these survey results but even more concerned with what never gets reported to them because people don't feel comfortable reporting. The hospital culture needs to make it clear that they want to hear the good and the bad and that this is because they always want to get better at what they do. I don't have the answer as to how all this can happen with all the problems facing medicine and hospitals today. But that doesn't mean it doesn't need to happen.

You need to report this in detail -- times, places, names, etc. Let them sort out whether there were mitigating circumstances, reasons that this happened. Let them investigate and find out. If we just let these things happen without reporting them we don't give the system a chance to either kick out/punish/retrain the incompetent or debrief and figure out how to do things better.

"We (Nurses) are being dumb-ed down for the sake of cost-cutting measures. We are too expensive. They would rather hire a CNA than an RN because it's cheaper." This is the essence of it all. What we're seeing is the deprofessionalization of basic bedside care in medicine. I'm not saying nurse assistants don't have a role in the system. They do. But one must look at the motivation for all this -- and it isn't aimed at improved patient care. It's aimed at saving money. It's all about money these days. Follow the money. And this trend will continue, scopes of practice of cna's and pt's and ma's will become wider and wider, just to save money -- all this will continue until the public and the nursing profession stands up and fights it.