Treating the whole patient?

~Mi Vida Loca~RN, ASN, RN · Aug 13, 2011

We do pretty well with our scores. Something we do, every patient admitted, on their white board, we ask them "What is the most important thing to you during your stay, what equals excellent patient care for you" We get a variety of answers. "Staying comfortable" "staying pain free" "Allowing me rest periods" "limit my visitors" and so on. That way we know exactly what is important to that patient.

For me, treating the patient as a whole is recognizing each person has a story and is an individual. Not treating them as the liver in room 4 or the lap appy in room 6.

xtxrn, ASN, RN · Aug 13, 2011

My first thought is looking at how the person's medical situation is going to effect his social, spiritual, emotional, and employment balance. JME. It's not just the ex lap- if it's a big tough guy who won't ask for pain meds, and gets pneumonia because it hurts to move, the emotional need for control has to be addressed...a mom and dad who have a stillborn, allowing them to grieve not only the loss of the baby, but possible spiritual distress w/the "why" questions that can never be answered. The kid who was in a car accident and because of the injuries now has to completely rethink his future career....

Making the proper referrals to the departments that handle those concerns could be something to look at....:)

handyrn · Aug 13, 2011

Yes, to xtxrn's answer. I recently read an article about pain and sufferring. They are two different things, but is it being differetiated? Physical pain is just that-physical pain. But sufferring is referring to the emotional turmoil that might be going on due to various reasons such as the ones xtxrn brought up. Most people lump pain and sufferring together. Does your questionnaire/survey specifically ask if the patient had adequate physical pain control and then give a definition of what physical pain is versus sufferring? Maybe the patients aren't able to differentiate between the two and are giving low scores because they feel crummy, and are calling it pain, when in actuality, it is really emotional sufferring.

tewdles, RN · Aug 13, 2011

I think stargazer made this point...this is not measurable in it's current form.

You CAN treat the whole patient (this is a huge part of what we do in hospice). We look at some of the individual pieces of that pie; What are the emotional needs of the patient and family? What are the spiritual needs, the psychosocial needs, the sexual needs.

We consider how their illnesses affect all of these things and include interventions to improve the status in the POC.

So my recommendation would be to sit as a group and consider one aspect of caring for the "whole" patient that is not clearly identified already, and make that the focus of your process improvement. You will want to consider how you need to interact with the patients so that you positively impact the patient/outcomes...but, you will also want to consider how you speak to the patients ABOUT your actions and interventions so that when they encounter that question on the survey they understand and know HOW to answer in the way you are hoping they will.

tokmom, BSN, RN · Aug 13, 2011

Yes, to xtxrn's answer. I recently read an article about pain and sufferring. They are two different things, but is it being differetiated? Physical pain is just that-physical pain. But sufferring is referring to the emotional turmoil that might be going on due to various reasons such as the ones xtxrn brought up. Most people lump pain and sufferring together. Does your questionnaire/survey specifically ask if the patient had adequate physical pain control and then give a definition of what physical pain is versus sufferring? Maybe the patients aren't able to differentiate between the two and are giving low scores because they feel crummy, and are calling it pain, when in actuality, it is really emotional sufferring.

I have no idea, because an independent survey company does the survey over the phone. I have no idea what they even ask! I guess that is the first step. Finding out the questions

This has been an interesting thread. Everyone has a general idea what treating the whole patient means but then the edges get murky.

Ruby Vee, BSN · 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.

ditch press-gainey.

tokmom, BSN, RN · Aug 13, 2011

ditch press-gainey.

that would be nice. however, we do know that won't happen.

xtxrn, ASN, RN · Aug 13, 2011

Also, these are patient perceptions- which aren't always something that can be 'fixed' - LOL :) They may be lumping things together in their own heads that have absolutely no bearing on things normally provided by nursing care....??? Just thinking out loud

Isabelle49 · Aug 14, 2011

Are you talking about Holistic Nursing? That doesn't exist anymore.

linearthinker, DNP, RN · Aug 14, 2011

If patients are the ones doing the scoring, you will never meet all their expectations. Sure you may save their life or something equally dramatic, but dam.nit, they still have psoriasis so you failed.

leslie :-D · Aug 14, 2011

Are you talking about Holistic Nursing? That doesn't exist anymore.

gawd, i understand your frustration.

let me assure you though, there's a good handful of us left.

leslie