RE: Pt. disch. No teaching, No instructions, No nothing!!!

[celeste7767]

My husband was recently hospitalized for 11 days for placement of urostomy via ileal conduit for bladder cancer with bone mets. Although I may sound like supernurse, in 32 yrs of nursing I have never had any experience with stomas. I do remember that in 1975, my first job on a surgical floor had patients who got colostomies, ileostomies, etc. and that when they were emotionally and physically able, they and a family caregiver attended classes where an ostomy nurse gave classes to these people whose lives had taken a sudden hairpin turn into no man's land and they were depressed and frightened. But there were always several other experienced nurses in the classes to help them learn about the various appliances and what would fit and work best for their body type, etc. When they went home, they had the name and phone number of one of the ostomy nurses to contact in case of emergencies or just questions or help walking one through their first pouch change.

I know this sounds like a fairytale, but there were more things good about the 60's and 70's than just the 60's and 70's. We were enabled to give the best patient care we could devise. No idea was turned away if it helped prevent complications, promoted well-being and optimum health.

21st century health care is more like medical care was before Semmelweiss discovered that bacteria was the cause for puerperal fever in new mothers. Only the poor delivered their babies in hospitals; the wealthy delivered theirs at home with a midwife because upwards of 89% of newborns delivered in hospitals died within 5 days of unknown causes.

It seems we have come full circle today. My husband's surgeon said that the nurses were all experienced in stoma care and would teach him all about it. No one on that unit knew anything about them and even admitted they did not get many there. On his last day before discharge, an ostomy nurse on her way to a "conference" dropped in to give my husband's nurse "the basics" on ostomy care and changing the appliance. She never told my husband her name, never addressed him by name and never addressed any of the instructions to him or allowed him time for questions or concerns. She never returned. The next day we were sent home with minimal supplies, no information with the exception of a 4 page ostomy care sheet that was incomplete and ended in mid sentence. It gave no practical advice or explanations or discussions of the various devices, how to place them, what is some kind of powder for, would we need it. It must be what this NEW KIND OF NURSE TEACHING IS ALL ABOUT. (NANDA) Tell the patient how it will affect his life; don't eat cheese, it will make the urine smell; what kind of clothes to wear. But no step by step instructions and illustrations to help with the practical side of such a radical change to ones body image. And discharge instructions!!

WHAT A JOKE!!!! We were supposed to have a Home Health nurse out within a week after d/c. Still don't have one. She is supposed to come out Friday, 8 days late and the skin is breaking down and weeping because we don't have the supplies or instructions we need. Also, 30-40 years ago, there was a name and phone number of a contact person if the patient had any problems when he got home.No one, no where.

ALL THE COMPUTERS, TECHNOLOGY, AND EVIDENCED BASED PRACTICE IS NOT GOING TO IMPROVE NURSING CARE AND MEDICAL PRACTICE WHEN NO ONE IS PRACTICING IT! AND NONE OF THE NURSES WITH THE EXCEPTION OF THE ONES IN THE STEPDOWN UNIT SEEMED TO CARE WHETHER THEIR PATIENTS WERE LYING IN FECES OR SCREAMING IN PAIN. THEY WERE ALWAYS GATHERED AROUND THE DESK AND THEIR COMPUTERS.

It really is time to go back to the good old days.....and the well known old adage that went like this:

"STAY AWAY AND OUT OF HOSPITALS NO MATTER WHAT HAPPENS TO YOU. EVERYONE KNOWS PEOPLE ONLY GO THERE TO DIE!!

Celeste7767:madface:

[TazziRN, RN]

my daughter had surgery on her foot a few years ago, and when she was discharged the pacu nurse asked her how tall she was, set the crutches at that number, and sent her home without any crutch fitting or training. when i checked it out the hand grips were so high her arms were bent, and they were set so long that she was placing the feet way far apart to make them fit under her arms.

as for the home care nurse, several things could have happened: did the hospital or doctor refer out right away? if your husband has private insurance versus medicare, did the visits get authorized by the insruance company? the last one is a biggie. those are the only two reasons i can think of that would cause home health to delay going in.

[Dolce, RN]

That is really sad. I would be calling the surgeon's office to complain. It is completely unacceptable to have poor patient teaching on such an important subject. Colostomy care is a big deal! I cannot believe you had such poor patient education.

Sorry about your bad experience.

[woody62, RN]

I am truly sorry for what happen to your husband. There is no excuse for what his surgeon failed to do, what the ostemy nurse failed to do, what the home health agency has failed to do. I would be on the telephone to the hospital administrator, the Board of Medicine, the Board of Nursing, my state and federal Congressperson. And I would follow up with written complaints to all the agencies and people I had spoken to. I am assuming your husband is on Medicare, given the number of years you have practiced. Contact them as well and inform them of your husband's lack of treatment because he has been failed miserably.

Woody:balloons:

[mianders, RN]

It must be very hard to deal with these problems along with your husbands cancer diagnosis. This is a very good website with all kinds of information and support groups. I wish there was more i could do.:icon_hug:

www.uoaa.org

[jessiern, BSN, RN]

That really is a diaster in my opinion. I work in a small hospital, and we see patients very often that have been in large hospitals and not gotten the instruction they need. We advise patients in that situation to contact the hospital admin. or the DON at least. Policy are usually instate regarding patient teaching, they just aren't inforced. The only way it will change is if patients and nurses that care bring it to management attention.

We had a woman a few months ago call and ambulance for her daughter. She had recently been a larger hospital, one notorious for not providing education. She had a MVA, and as a result was paralized. I can't remember the details of her injuries, but she also now had a colostomy and a peg tube (She had brain damage) with tube feeding.

No one provided information to the mother. Our DON contacted theirs DON, sure this most not be true. Their DON admitted education had not been provided. Per the DON, they had to discharge her quickly because her bed was needed. And a home health nurse was supposed to come out, who never did because as it turns out they neglected to contact the agency.

The woman suffered aspiration pna because her mother didn't know to keep the HOB elevated, and had a pressure ulcer because she didnt' know to turn her. We spent 3 weeks caring for her, and having her mother assist, and eventually she cared for her soley be herself, and did a great job. The home health nurses report she is doing "Great". A little education goes a long way.

[maryloufu]

Write a letter to the head of the facility and the manager of the floor and the chief nursing officer. This is a terrible incident that must be addressed.

It is a terrible shame. So sorry that this happened to you.

[banditrn]

That is really sad. I would be calling the surgeon's office to complain. It is completely unacceptable to have poor patient teaching on such an important subject. Colostomy care is a big deal! I cannot believe you had such poor patient education.

Sorry about your bad experience.

I can believe that they had poor education - I've seen it in the hospital that I left. I observed several nurses whipping thru the educational and discharge instructions so fast that people didn't understand what was going on, then whipping them out the door.

Myself and a few others took our job seriously and tried to truly educate our patients - but we were harranged for being 'too slow' and 'taking to much time in a patient's room'.

[ChocoholicRN]

I happen to work in one of those large hospitals, a very well known hospital as a matter of fact. I defintately feel the pressure from higher level nursing staff to get patients out because we need the bed. Just yesterday, I had discharge orders for a patient who definately needed some sort of visiting nurse or home health aide for a few hours a day. This woman came in with confusion (she was much better by the time she left) and was borderline incontinent-she could hold her urine just long enough to get to the bathroom, but not always. She also had an unsteady gait and needed some sort of walker or cane. I couldn't discharge this woman without knowing she had some sort of home care set-up. Although the patient's son was getting frustrated with how long the social worker was taking (she had an emergency case before them to deal with), I didn't care because I knew he would be even more unhappy if his mother went home with no future care planned. By the time they left, her son had all the discharge instructions, all meds explained to him, a walker for his mother, an appointment already made with a doctor, and an appointment with a VN the next day for a full work-up. I wish I had the time to be this aggressive with every patient discharge, but in these big hospitals it often feels like our only job is to get patients out as fast as possible. In fact, if the ER is busy and needs beds, as soon as one of our patients has a discharge order, could be 10AM before their care is even arranged, we are allowed to take a "hallway" patient for that room the will be empty 5 hours later. Talk about feeling rushed! I really wish these big name hospitals, mine included, would just take a step back and look at the kind of care we often provide to these patients. We could learn a lot from smaller hospitals.

[luv2luvlife]

Time to do a little creativity here:innerconf

I'm going to respond to you ,,,,,,,using yr very own words

"I know this sounds like a fairytale, but there were more things good about the 60's and 70's than just the 60's and 70's. We were enabled to give the best patient care we could devise. No idea was turned away if it helped prevent complications, promoted well-being and optimum health."

Here is your answer to the above with your own words;

"It really is time to go back to the good old days.....and the well known old adage that went like this:

"STAY AWAY AND OUT OF HOSPITALS NO MATTER WHAT HAPPENS TO YOU. EVERYONE KNOWS PEOPLE ONLY GO THERE TO DIE!!

My Response; I guess the old days were not so good after all, if this saying became common knowledge:bugeyes:

My Response; I remember having a patient and his wife was an 'old' nurse. She kept talking about how this was done,,,that was done,,,how it was much better,,,,,,on and on she would rant. She and her husband didn't want anyone telling/educating them about anything. THe way they used to do it was best,,,,,,,,,,, We sent her and hubby home with educational booklet/pamphlets and an information sheet with community resources/nurses etc. God help the poor wee nurses and Doc's that come across these types.:redpinkhe

[FireStarterRN, BSN, RN]

I totally agree with the opening post. I think the reason is that everything is extremely rush rush today, and patient teaching at discharge is mainly aimed at documenting enough to keep the doctor and hospital from getting sued.

Our hospital went to having a computer generated program spit out discharge instructions that are too lengthy to review at time of discharge. I'll go over a few things with the patient specific to them, but tell them to please read the instructions, which go into ridiculous detail.

The best we can do is provide teaching while they are still hospitalized, but often the buck is passed on this, plus hospital stays are very short. It's really a scandal and a shame.

P.S. Good luck to your husband, I'm sorry you're going through this, God Bless you both!

[oldiebutgoodie, RN]

I'm so sorry this happened to you. I am an ostomy/wound care nurse, and I like to spend time with my patients before they are discharged. However, often the surgeon discharges them too soon, or never tell us about the patient until they are out the door, or discharge them on the weekend and expect the home health nurse to do all the teaching! It is really shameful.

Hope things are going better for you. Not sure what the situation is with his stoma, but I really like Hollister's Premier Urostomy pouches. They are flexible, one piece, and come is both regular or convex versions. You would use a convex one if his stoma doesn't protrude very much.

You can go to Hollister's web site and ask for free samples. I'm not sure if you have to call them or fill something out online, but they seem to be good about sending samples. They are at http://www.hollister.com

Another good resource is the urostomy guide at http://www.uoaa.org/ostomy_info/pubs/uoa_urostomy_en.pdf

This is from the United Ostomy association of America.

Good luck to you!

Oldiebutgoodie