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!!
Specializes in icu, er, transplant, case management, ps.
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
How insulting. I am a graduate from a program, in which I graduated in 1971. Yes, we had more time to teach patients and family members. As the years passed, patients spent less and less time in the hospital and received less and less teaching and education. Teaching and education they both desperately need.
In 1998, my eighty-six year old father was hospitalized and underwent surgery. Four days later, I came in, with my seventy-six year old mother, to see him and was informed he was discharged. Discharged with his original surgical dressing, no medications,no home health referral. I refused to take him home until I met with the chief administrator of this community hospital. There was no reason nor no excuse for the actions of the nursing staff and the surgeon. My father's discharge was delayed twenty-four hours while proper plans were made for home health assistance, obtaining of pain medication for me to administer and obtaining of necessary equipment for my father to be bath, ambulated and care for. If I had not been a licensed R.N., even though a disable one, my father would have been pushed out the door. And I would have hired the best attorney I knew to sue the heck out of the hospital, the nurses and the surgeon. And I would have won.
Some of the attitudes expressed here is as if the patient and his family should be responsible for the care once the patient has been discharged. I hate to tell some of you this, education ebgins the minute the patient is admitted. Get the order from the attending. Involve the necessary departments, involve the necessary staff. Don't drop your responsiblility because 'the patient only spent two days on my floor'.
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:
i didn't see her presenting her story this way. i had taken what she said with the understanding that the times before the 60's and 70's was when it was unsafe to be in a hospital.
op said:
"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."
i understood the op trying to explain how paperwork has gotten out of control to the point that there is no time to engage in patient teaching. that the way things are run, nowdays it is just as dangerous to be a paient in the hospital as it was "...before semmelweiss discovered that bacteria was the cause for puerperal fever in new mothers."
Specializes in OB, Telephone Triage, Chart Review/Code.
I often wish we could have nurses that would just do discharges...someone who could spend more time with discharge instructions, office visits sched before pt leaves the hosp., etc.
I have seen hospitals that rely on pt eduction through the television!
This is why whenever I have a patient who's parents will need to be doing any kind of "nursing" care at home, I take the time to teach. It can be as simple as talking through the steps as a procedure is being performed. When parents start to feel comfortable, then I'll have them start doing procedures. I'm talking about things like stoma care, giving meds through g-tube, maybe a scheduled straight cath. Of course I don't just hand them supplies and say here you go, and yes it takes more time to watch them do it than to just do it myself, but I could not in good faith send them home without knowing what to do. I also report off to the oncoming shift what teaching has been done and what needs to be done or touched up. I have the luxury of working Peds with a 1:4 ratio, I cannot imagine having to find time to teach and care for more patients.
Specializes in Vents, Telemetry, Home Care, Home infusion.
i can understand your frustration and see it every day as a homecare agency central intake manager who's department processes 75+ referrals a day, 135+ on friday.
it has gotten to the point that were lucky if we receive more than name, address + phone, prescribing doctor and insurance info. hey we need a diagnosis along with skilled services idicated/requested as many patients don't know actual reason they were admitted/diagnois and only about 40% have discharge instructions with them.
homecare industry standard has always been to see the patient within 48 hrs of hospital/snf/rehab discharge ---happens to be medicare requirement too. daily we receive calls from patient telling us they just got back out of the hospital and when my nurse coming??----sleuting reveals insurance company gave auth but discharging facility never called referral into agency, or my favorite: facility upon admission notified patient on homecare, but not referred back to homecare "cause doctor never wrote an order for homecare". :angryfire:angryfire:angryfire
due to advances in endoscopy and laproscopic surgery, they is definately less patients with ostomy's today compaired to when i started in homecare 20 years ago to the point that most medical equipment companies in philadelphia area do not carry ostomy supplies, it has become a niche market ---partially driven by insurance reimbursement rates.
actions i'd take to address inadequate care/teaching:
1. contact home health agency: ask to speak with supervisor why
took 8 days for visit to be scheduled. (not referred, insurance
authorization, patient volume or misplaced referral, etc).
follow-up with hospital case managment/discharge planning
department if indicated.
2. homecare rn should be able to give advice on care. if concerned about their advice/care, ask agency for cetn/wocn expert eval.
3. follow maryloufu advice writing letters to hospital mangagment.
state that you are "filing a grievence". start by looking at
hospital pamphlet: should tell you if facility has grievence procedure
or patient ombudsman to report care concerns. then cc your letter
to director/vp nursing, unit manger, case managment, surgeon and
pcp. include deadline in getting back to you for follow-up.
4. visit cetn and wocn nursing organizations regarding care standards. include in your letter how your husbands "instruction" deviated from these standards.
wocn + surgeon group now recommends preop visit by wocn:
woody62, RN
928 Posts
How insulting. I am a graduate from a program, in which I graduated in 1971. Yes, we had more time to teach patients and family members. As the years passed, patients spent less and less time in the hospital and received less and less teaching and education. Teaching and education they both desperately need.
In 1998, my eighty-six year old father was hospitalized and underwent surgery. Four days later, I came in, with my seventy-six year old mother, to see him and was informed he was discharged. Discharged with his original surgical dressing, no medications,no home health referral. I refused to take him home until I met with the chief administrator of this community hospital. There was no reason nor no excuse for the actions of the nursing staff and the surgeon. My father's discharge was delayed twenty-four hours while proper plans were made for home health assistance, obtaining of pain medication for me to administer and obtaining of necessary equipment for my father to be bath, ambulated and care for. If I had not been a licensed R.N., even though a disable one, my father would have been pushed out the door. And I would have hired the best attorney I knew to sue the heck out of the hospital, the nurses and the surgeon. And I would have won.
Some of the attitudes expressed here is as if the patient and his family should be responsible for the care once the patient has been discharged. I hate to tell some of you this, education ebgins the minute the patient is admitted. Get the order from the attending. Involve the necessary departments, involve the necessary staff. Don't drop your responsiblility because 'the patient only spent two days on my floor'.
Woody:angryfire