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Occupational challenges in nursing never end. End of shift reports, patient handoffs, and access to ...read more
Posted by nurse on October 2, 2011 under Critical Care, Nursing Careers, patient health | 
Patients may not know how much nurses are doing for them. In fact, beyond the clinical and bed side setting, nurses are using their energy and intelligence to promote and support patient health care on their own time. Even nurses caring enough to aid with transitional assistance and prescription pickup know their is room in the administrative plan for patient care to expand its reach to close the circle of healthcare visits and community wellness in a positive manner.
But the impact from nurses does not end on the hospitals steps or past the elevator line. Nurse are winning crucial gains in nursing right and patient care victories across the nation. The agenda for professional nursing organizations to improve patent care and hospital care has been under reported n the news, perhaps due to the overwhelming lack of press attention to nurse community support versus hospital clinic and HMO facility support.
But nurses can benefit from a wider scope of attention to their independent community support not only f nursing contracts and patient wellness rights, but institutional changes toward patient care for the impact of all nurses, healthcare technical staff, physicians, and patients. Nurses at the local Manhattan VA hospital recently acted against workplace violence, returning their facility yo t abetter atmospheric environment for patients and nurses.
Do patients know how much nurses fight for them even when they aren’t in the hospital? Do patients know how much nurses are their advocate even before they get to the hospital? Nurses are in a position to assess the need for facilities for public healthcare and how they match patient and family access to services. Nurses who know the insurance firewall many patients have to face to afford services support the means by which patient can access care in multiple community and facility scenarios.
Nurses who stand up for their rights provide an arena where they can support patients with adequate return and compensation. The collective bargaining and contract negotiations they pursue with their respective employment groups can affect the standard of nursing care any patent receives in future. The good news is that nursing right s and wages have been strongly supported recently in wage and professional demonstrations and labor agreements.
A San Leandro California acute care facility was kept open by widespread support in person by masses of healthcare staff to demonstrate the need for its operations to continue. The facility was facing closure. In May, the national Nursing United association supported senators Sanders and Rep. Jim McDermott introducing the American Health Security Act of 2011, which would bring to patients everywhere a single-payer bill for healthcare services.
Children’s Hospital nurses struck recently in Oakland, California to defend the healthcare rights of children in that facility for expanded hours and technical staffing. The University of California body of nurses administration won a new contract for 26 months. That’s 12,000 nurses who will be committed to quality healthcare in an extended scenario of skilled patient care planning and execution of bedside and operation and procedural skilled nursing.
University nurses nationwide met at a convention held in Chicago in March to share policies, advise wisdom and experiences. This level of concentrated nursing power, together with the monetary and community gains in healthcare access due to nurses, show that nurses have more than just a commitment to a paycheck. Whether the workplace is skilled nursing, home care, clinical assistance or surgical nursing, nurses today at all levels are showing they have a commitment to the well being and healing of all their patients.
Posted by nurse on October 1, 2011 under Critical Care, Nursing Careers |
Novice nurses can be scheduled as part of a care plan for experienced staff, but investing in their training improves the nursing establishment as a whole and returns the past favor. The novice nurse development period is crucial to career goal formation and advancement along administrative and biomedical career pathways.
Every nurse now in circulation learned medical skills and caregiving techniques from other nurses, and every nurse in any level of administration was once a novice nurse. The pressure to move appointments along and complete a full course of inquiry to a care plan may create a conflicts with the novice nurse’s training.
Novice nurses can start a shift experienced and knowledgeable and be downturn by the end of the shift, confronted with a vast array of situations they didn’t see coming. The press of visitors, the beeping of machines, the traffic back and forth to the patient rooms and the trek between departments, pharmacy, and floors can wear down the novice nurse.
Novice nurse leave behind the impressions they received about the nursing profession from school and begin to form a knowledge base from their own experience. The academic setting where the knowledge was borne in fades before the immediacy of the nursing experience in the real. How nurses relate their academic learning to their on-the-job challenges creates an occupational expertise they can draw on for a lifetime.
The nurturing and caregiving professions demand a lot of their best personnel. Novice burnout can occur when peer counseling and supervisor encouragement is not available. This is a particularly challenging time to enter the nursing field as so many hospital clinics and healthcare facilities face community growth in patient demand with diminishing resources and funding for patient care. Novices may not also understand how staff hours and patient ratios affect the operating budget of the hospital going forward.
Patients may often be less than pleased by what the hospital and staff can do for them under their existing coverage or as a result of care plan staging. This may be a drain on psychological energy for novice nurses who expect grateful and happy patients. Learning to rely on fellow nurses for emotional assistance, encouragement and tips and support is key to the survival of a novice nurse. Methods for communicating feedback and channeling energy from initial shifts in nursing can be the start of a beautiful working relationship with the nursing occupation for any novice nurse.
Novi nurse must bear down under stress to meet their performance requirements, both from patient assessments, note taking, reporting to other nurses and physicians, and executing new and changing orders from other healthcare personnel as well as communicating and acceding to patient demands where possible. Nurses stretched to the breaking point and crowded wards may be all they can handle, and new customer service problems and peer correction issues may be more than novice nurses can handle.
Novice nurses looking for a variegated assortment of patients across disease and condition boundaries may be surprised to find the bulk of their outpatient population in recovery from gastric bypass, or the multitude of inpatient care plans based around obesity and diabetes. Despite what the nursing textbooks say, these conditions are vastly saturated into the healthcare patient population and create a draw on nursing resources, surgical staff, and beds. And the real world practice of selecting patients according to their ability to pay is often not what nursing brochures on ethics policy stated when novice nurses were in school.
Economic downturn, a glut of midlevel and superior nurses in top tiers of employment, and aging population centering medical care around certain disciplines are taking novice nurses by surprise these days. Nurses prone t a certain specialty may find their career orientation shifting more to where the bulk of the patient population is geared, which today is toward seniors and aging in place communities as well as homecare nursing situations and disorders of the general medicine front.
Novice nursing can be the freshman year of a nurse’s career, or the turnaround phase that make an individual shift their occupational expertise in nursing to a more paraprofessional career like counseling, nutrition, technical equipment operator, or EMT. Lateral changes in the career of a novice nurse, or the decision to further their nursing education in occupational research, counseling, or advanced nursing education is often the fruit of the bulk of reflections made after a novice nurse completes their season caring for patients hospital wide.
Tags: career, clinic, hiring, job, medical, novice, nurses, occupational, on-the-job, physican, prescription, ptient, wrk
Posted by nurse on September 28, 2011 under Critical Care, patient health |
Nurses study the processes and techniques of medical treatment of the body, but some of the biggest challenges in a nursing job or nursing occupation over a career lifetime span are dealing with patient trends and responses to physical behavior. The patient undergoes many situations which change their attitude to the medical process as a whole and their place in it. Anger, frustration, pain, ignorance, habit, and even religion and cultural attitudes may change what the patient is willing to do under doctor’s orders.
Patient interaction with the medical system is one of many dynamics studied by occupational nurses and nursing science researchers. One of the most important dynamics of these is the concordance to physician orders and medical advice by the patience. But the system goes through countless documentation, clinical sessions, direct medication advice, treatment care plan repetition, and verbal reminding of exactly the same pharmaceutical cautions and instructions given by the doctor. This should result in a faithful concordance to doctor’s orders.
But the pharmaceutical sciences are rife with abuse. Patients try to alter or extend prescriptions. Even when they don’t need additional medication they may want it. They may try to obtain additional medication or stronger dosages to achieve an average for resale to others online or on the street. On the lighter side, some patients merely forget the intended dosages or make a change once and unwittingly change their medication habits against doctor’s orders by accident.
Why do patients act or react against their own self interest when their health is at stake? What makes a patient who knows they haven’t gone to medical school decide they know best concerning a given pharmaceutical substance or medication? Nurses strive in vain to understand the willful ignorance or slight attention paid to circumstances serious enough to warrant pharmaceutical intervention with the body, but not attention to the law. It is against the law to take medication not intended for you or to give medication to others it was not prescribed for.
Nurses, doctors and physicians must observe and report irregularities about patient use of medications at once. There are standard and practices that underscore this need for medication vigilance. The doctors and medical staff must responsibly monitor medications among all their other duties, but the public may often misunderstand why nurses, doctor’s patients and medical staff are evaluating the patient on an ongoing basis. The incarnation of the watchful, evil nurse who sees all evil is a comic but altogether inexact one.
The laws concerning patient practice and pharmaceutical medications for nurses to give to patients have been through several decades of streamlining and change. The process by which papers and documentation goes through to the patient from a hospital, clinic, dispensary and/or nursing facility is conducted after thorough overviews and training. Entire wards and surgery staffs must be on the same page regarding the flow of information, medication, approval and dispensation of medications to patients. These are safeguards for the public good.
The patient population as a whole can be counted on for a good faith follow up to doctors advice and medical consultation results. But medications, prescription alteration, medication abuse, and suspected suppression of treatment via pharmaceutical interaction must be monitored on a daily basis, sometimes hourly in some cases. patients may hear contrary advice from friend relatives, and other patients and change their use of the treatment accordingly, without the doctor’s knowledge.
Physicians may check up on patients to make sure they are not mixing up their current treatment plan and care with a previous systems or pharmaceutical therapy schedule. Since similar medication and painkiller,s topical antibiotics and medications in differing combinations would be use to treat any given ailment it is not surprising that long term care patients of any ailment may elect to become a “higher authority” on what the medications can do for them. But absent from these “independent” decisions by the patient regarding their medications.
Pharmaceutical therapy is only part of a balanced diet and exercise, rest and mobility that physicians have in mind when they admit or discharge a patient. Surgical intervention and other processes or procedures applied to the body set up the scenario for pharmaceutical follow-up. Drug taking can affect the way a patient sees the medical process and they can feel they are taking stand for themselves asserting an independence over the control of medical substances ingested.
Patients may become so familiar with their medications and with the running of a long term course of treatment they may unwittingly alter their completion of a physician’s instructions.
The dosage of the medication of a patient must be of concern to their nurses at all times. Do sufficient dosages exist of each medication and are they readily available at the proper time? Querying patients can determine their level of awareness of what drugs they are taking and when.
Typically patients may receive the initial notification of a pill medication from their physician but they may not realize that they want to change it or make changes later when the bulk of the problem may be over, in their own estimation. Their state of mind and medical condition may change such that they are no longer able to recall the exact information. They my reach in the dark, fuzzy and sleepy, or excited and in pain, for the wrong medication in the wrong amount.
One patient may independently decide the benefit of a medication has run its course, without the benefit of a doctor’ input a nurse advise or consultation. The patient may need money and want to change their dosage to make up for another one they will sell or trade for goods, cash or other drugs. relatives may steal their drugs or they may accidentally pour them down the sink or spill them. And a very small rate of patients will report low or null absorption due to extremely rare factors such as mineral presences, menstrual activity, or neural chemicals interfering with drug adhesion.
As a solution, physicians will order specimen testing to ensure patient concordance to prescription advice. Verbal counseling and reminder follow ups, and well as constant checking of available medications and the condition of these medications and their quantities, can be very impactful, especially for outpatients. Blood tests and urine tests will reflect this and should be collected and reported to the patient’s file as accurately as possible.
The reasons why a patient may change their use of a medication are varied. But a nurse or physician, attending nurse or technician must report and consult with a physician for any patient suspected of altering or changing their intake of prescription medication for any reason. Regardless of the rational employed by the patient for such a change, patient fidelity to pharmaceutical therapy plans must be safeguarded as much as possible.
Tags: advice, clinical, doctors, hospital, law, medical, medication, nurses, nursing, occupational, Patient, pharmaceuticals, physicians, prescriptions
Posted by nurse on September 15, 2011 under Critical Care, Nursing Careers, patient health |
Nurses must respect pain complaints and responds to them appropriately. Whether this means summoning another doctor or referring the patient to another nurse, they should let the patient know the next step. Pain complaints must be promptly treated. Physicians must be able and willing to discuss side effects, cost issues, and complications of home care versus hospital care when outlining a care pan for patients.
Patients don’t like to feel like prisoners. Feel free to remind them they can refuse any care, feeding, test or snack before discussing it with the physician. Nurses should make sure patients understand they have treatment options even if they don’t know to ask for them. Patients have options that busy nurses may not feel obliged to advise them of. Nurses should exercise the utmost care in administering and counseling patients regarding pain management and pain therapies.
Nurses should know the data that pain specialists need to know to assess and consult with the patients when pain management becomes the primary topic of concern in a care plan or actively applied treatment. No treatment should require a split-second decision by the patient. If the Internet is not available in an urgent care setting, hospital room, or clinic visit, patients are completely dependent on the communications the nurse makes.
Posted by nurse on September 2, 2011 under Critical Care, patient health |
Ever wonder what is on those charts? Patients have a right to their records and copies of their records, and also have a right to see what summarized information makes up the bulk of their history. A patient should be able to view and comment upon their chart in conversation with their doctor. Are current health assessments correct, were they in the past, and were details as communicated to the patient about what choices were available really shared? When all the principals are in the room the answers to these questions can be surprising.
Any patient being treated today could end up in court. Medical malpractice lawsuits are real. The decisions to pursue legal action occurs when attorneys and the patient have the best information possible about the course of treatment. Supporting signatures or emails can be added to the patient’s own records regarding these matters. A patient should begin keeping a diary of every hospital or clinic visit as soon as possible after diagnosis, or even before.
Patients can often spot where one doctor might make an assessment about patient care needs working from assumptions about patient wishes gleaned from concise chart notes. But a history can me made up of hundreds of informational exchanges with and where subsequent doctors might ask if at a specific point in time information was lacking about other therapies, treatments,and procedures. When an evaluation requested, at which point in the medical treatment course, and by whom?
Since the patient is the one most familiar with all the details of the treatment history, they are the most likely ones to post errors and elisions of fact. But when a patient passes from one doctor to another, one staff of nurses to another group, and one department of a hospital or another, the facts supporting certain recommendations and treatments can get mangled or deleted. The patient can annotate their own files with the rationale and supplemental information need to make sense of it.
One small detail can be hugely significant. The details should be recorded when staff are handing off critical portions of recovery to other departments can be crucial to understanding a physician’s planned path to patient wellness. Multiple rehabilitation strategies might be viable, for example. But setting forth in writing what the reasons are for the order in which the patient will undergo the therapies required. These include occupational therapy, physical therapy, woundcare, and speech therapy.
Much is made by nurses and administrators about the need for accurate completion of paperwork. The nurse should not be afraid to review her notation on the procedures orders with patients or make these comments known to the doctor. Patients will not welcome medical coverage from a provider which shields it medical files from the patients themselves. And by the time a patient undergoes a treatment or application of a pharmaceutical remedy that is not right, it is already too late.
Many patients will want to look for an application online that tracks and charts patient history. The patient will want an information rich timeline showing the progress as well as records rages and readings from various tests and checkups. Many specialists want to review the case later and see which therapies answered the condition well after related former therapies and courses of medication have been tested and found wanting.
Patents who move from a local doctor to doctor’s offices in another state, or patients who see a doctor while traveling should not have wait for the consulting physician to search for past records.
At some future point in time, past blood test results and tox screens, as well as other types of tests will be relevant in a discussion of other conditions or medical health problems. And being able to plot out the treatment in hindsight may hep a patient handle their upcoming medical challenges as well.
Interested patients should be able to track and forecast medical costs, commuting and wellness diets using a file including their medical journals of treatment and the outcome of each visit. Medicine is a revisionist science at times. In later phases of diagnostics, a new pair of eyes may review the past treatment history and intercede with questions that break the case wide open.
Posted by nurse on September 1, 2011 under Critical Care, patient health |
Over five million people currently have dementia as a clinical problem or side effect of a similar degenerative disease. These patients will either be cared for in a nursing home environment or caregivers will give them nursing support at home. But challenges to traditional nursing roles in the face of today’s healthcare issues and treatment conventions make for conflicted caregivers, patients and patient families n the context of nursing home care.
Many people with relatives in a nursing home complain of uncaring nurses, patients who are mistreated, and even missed or stolen pharmaceuticals. These challenges are what staff must face even while expending daily effort on patient care 24 hours a day. And issues regarding feeding patients and administering meals and nutrition are not the least of these concerns.
Many caregivers argue the patient is not aware n late stages of dementia of anything other than basic sensation. But can healthcare providers skip a step that is cost intensive, hard to manage, and rife with staffing problems and complexity to administrate?
Dementia is not curable and 70% of the patients currently suffering from this medical problem will never recover. But can intravenuous nutrients replace the role of oral meals, and will the replacement of a social construct like mealtimes restrict the patient from other benefits of community events like mealtimes and conversational exchange? And what burden does this expectation place on nursing homes and nurses, and managerial staff who must address the issue daily?
An examination of the institution’s goals is important. Does the nursing home intend to provide a home-like setting? Does the staff promote a hospital type facility environment? Does family visitation assist or distract patients from eating properly? While ideally nurses would give each patient all the time they need to eat the full meal apportioned to the, few nurses can command such time periods without answering questions from critical staff. Many family and friends of patients with dementia mistakenly place blame on nurse, who are not making the decisions.
Nursing staff must manage a ward of patients with a variety of challenge for daily interaction and sociability in nursing homes. But end-stage dementia patients must be fed efficiently in order for a staff to service other clients in a timely manner. Nurse must ignore requests from interactively sound patients with communications facultys in order to literally spoon-feed patients who may not know any better. While often challenged as a heartless solution, IV nutrition can solve both time efficiency issues and overcome difficulty with a patient who is averse to feeding.
To make matters more difficult, weight loss and sedentary bed rest can obfuscate weight gain or loss doctors need to know about. The significance of a mealtime may matter to a patient with dementia one day, yet the next they may be completely unaware of appetite, satiety, or nutrition intake as a anything other than a curiosity. How are nurses to cope? Models of behavioral response in patients wit dementia are being developed to more adequately rate the ability of the patient to benefit from spoon feeding versus IV course of nutrition therapy.
Many a nurse will look at themselves in the mirror after a feeding session with a particularly difficult patient, and wonder, “Did I go to nursing school for this?”Likewise, many patients are simply not in possession of their faculties and nurses who know better may refuse to spend time getting a patient with little or no motor skills, recognition, or interactivity responses to participate in feeding. Yet nurses are blamed when they label a patient with dementia difficult or uncooperative.
Nurses have had conventional healthcare problems with patients with dementia spitting out food, refusing to eat it, chew or swallow, resenting myriad difficulties for healthcare providers. Feeding patients comes under the auspices of the certified nursing assistant or “orderly” in most nursing homes. End stage dementia patients often are fed through tubes as a matter of convenience, which can often shock family and visitors to end stage patients with dementia conditions in nursing homes. Sights like these give rise to a nursing home culture and negative perception.
For reasons such as those listed above, home are nursing has become much more popular. In part this is due to the family’s wish to monitor caregiving on a one to one basis with the nurse practitioner of certified nursing assistant. In this way a dedicated nursing resource can be scaled to the total care plan for one patient with dementia.
Posted by nurse on August 28, 2011 under Critical Care, Nursing Careers, patient health |
The popular Hollywood television show “E.R.” is what springs to mind when people discuss ER medicine. But the reality of most hospitals, including the one you go to, is very different. A broken leg, burn, or bleeding wound is no longer a ticket to enter a hospital for immediate medical attention. Today’s Emergency Room medicine is lost in a mishmash of buzzwords that disguise both the changes in conventional medicine planning and public healthcare facilities, but confuse the pathway of modern medicine in varying stages across the healthcare divide.
And healthcare is divided. Those who can afford to pay premiums and get coverage have a safety net in case of emergency. They are assumed to approach their healthcare provider offices first and use general emergency care for high-risk medical traumas such as critical infections, contagious disease outbreaks, flesh wounds caused by violence or gunshots. Unfortunately the incidence of household accidents, car accidents, and physical injury is so common now that this category is overflowing. But joining these persons waiting for Emergency Room care are those with dermatological ailments, chest colds, staph infections, influenza, and chicken pox (just to name a few).
Those who cannot afford coverage, cannot find HMO companies to accept their application, or who somehow are left between active coverage from regular insurance policies get caught in a trap. Any service they need now falls under the banner of “Emergency Room” care. In case of an illness their immediacy of physical illness advances their jockeying for treatment while their ability to pay (or meet the demand to get to a hospital or healthcare facility) is diminished. By doing so, the lack of coverage creates a slippery slope for at-risk medical populations. The inability of the hospital to treat anything bit the worst condition encourages patients to let their problems get worse to ‘earn them first priority when they do show up at the hospital.
The system in fact encourages people to get worse first, to qualify for quicker attention in the Emergency Room, rather than wait for days to see a doctor for preventative diagnoses and pharmaceutical treatment. Picture the average television drama where the patient rushed in on the gurney instead waits in the general ‘Urgent Care” lobby, filling out form and navigating a series of red tape and service desks to get to the word “Go”. In some cases twelve hours can pass from initial recording of vital signs to actual physician consultation.
What can hospitals do? Only long-term solutions are available. The improvement in health literacy would limit the damage done by ignorance of healthcare norms, personal hygiene, or contagious disease prevention lacking many regional and ethnic populations. Persons who may have never seen a doctor before or never been tested for general health problems appear in emergency rooms with little knowledge of their own personal history. This complicates the problem for doctors, who must chart an compete health profile for each such person. This takes a much longer time to deliver an adequate consultation
These individuals now number in the millions in each metropolitan area. In the at-risk population and the suburbs, individuals refuse to attend health clinics, pop-up health clinics, get blood taken or tested, or participate in basic healthcare unless they suffer a medical emergency such as a car accident or lose consciousness. But threats to general population health, such as hepatitis, staph infections, HIV, and chlamydia exist everyday, until long term symptoms present themselves and patients stumble to the “Emergency Room”, expecting a quick fix.
The population of these individuals lackadaisically showing up in the hundreds every hour to Emergency Rooms now outnumbers actual emergency room patients as qualified by the scenario seen on television. This is because the national healthcare services do not penalize individuals for refusing to seek medical attention (until they are dropping dead), or answer to a doctor for any medical condition. In a nation teeming with drug addicts, smoking addicts, alcohol addicts and cancer victims,
Imagine a person rushed to the hospital by EMT’s due to a 911 call and ushered into the hospital on a gurney. Then picture those same EMT’s wheeling that patient around all day from floor to floor, hall to hallway, department to department, because anything short of actual death, bleeding or gunshots merely earns the patient a place in a long line. The suggested instructions to call 911, found on the back of medication bottles or given by advice columns, assume a healthcare provider is available on less than an 18 hour wait.
Seventy years ago, only persons living in wilderness areas or on remote ranches or farms needed to address extreme situations of health consultations and inadequate care due to inability to gain access to adequate medical staff and health services. Home healthcare nursing used to be an exotic professional sideline for nurses whose clientele were independently wealthy or otherwise unable to get transported to a proper medical facility. Now many patients prefer this type of care because they find hospitals and clinics overcrowded, their questions shut out, and the quality of care too significantly diminished.
But today an entire layer of ill or ailing persons exists in a gray area. These individuals cannot afford insurance, have pre-existing conditions, and delay or avoid medical consultations, examinations or qualified advice until an “emergency” arises. Emergency Room care used to be specifically for accidents, cardiac events, respiratory emergencies, or skin and wound trauma that was likely only remedied by surgery and/or a hospital admittance scenario. The framework of “Urgent Care” patients now includes physical conditions years old and ailments impossible to treat in a surgical setting or benefit from a trauma team treatment window or 24- hour care plan.
But nurses and physicians know that these emergency situations arise out of lack of addressing current health problems as well as accidents, and an emergency room visit is far more likely to be the result of a long standing medical problem, physical ailment, or ongoing disease, rather than something having occurred in the last few days. The lack of healthcare literacy amongst the general population, as well as the mental and psychological fears associated with hospitals visits, also keep patients from coming promptly to the hospital when they should.
When they do come to the hospital, they get an ugly surprise. Persons with sniffles and headaches now stand in line side by side with persons with split skin, fever, chills, infection and contagious diseases. People wearing surgical masks now dot the emergency rooms, because they know the likelihood for casual contact with chairs, instruments, and bathroom surfaces occupied by ery sick people waiting 8 hours or more can commence another medical problem. But closure of healthcare facilities and the number of persons dropped from insurance due to occupational severance makes these “emergency room” care situations worsen.
Horror stories abound from people whose condition grows worse because they have to stand in line behind thirty people with minor symptoms and wait for them to thread their way through the initial stages of emergency room care screening. The bar for actual Emergency Room care has risen so high, due the population pressuring it upward, that for every person admitted to an actual treatment room, over five hundred are turned away. The creates a snowball effect, because each one of those patients may worsen and become tomorrow’s emergency.
The lofty aims of nursing and physician education can leave a gap between the reality of everyday medical practices and the abstruse discussion of methods in practice. The nature of the healthcare animal as a service is that the treatment will be performed long before the payment scenario is ironed out. To limit their exposure, hospitals now dump all their incoming medical patients in one group and have them sit in “cattle call” waiting rooms. This puts pressure on nursing staff and creates a negative atmosphere for patients.
The ability of most people to simply afford the treatment they need creates layers of new problems that burden systems already bulging at the seams. The inelasticity of hospital billing, the hourly surge of hundreds of new patients per dozen beds, and the concrete limitations of admittance patterns was not designed to accommodate the portion of uninsured individuals that now flood emergency rooms. The problem is that hospitals have changed their inpatient routines to classify emergency room situations for consultation and examination.
Nurses in large part must shoulder the burden of the pressure of increased application of individuals to Emergency Room care. Nurses must act when they see a worsening condition in a candidate for a Emergency Room consultation. Physicians must take into account arresting a medical condition with the proper application of resources when the patient does arrive, and gage risk of re-infection and recovery in their everyday environment. History will show if the standard techniques applied today in Emergency Room will benefit the public at a large, or create an underclass of extended ailment patients untreated at large.
Tags: care, clinics, condition, doctors, e.r. emergency room, healthcare, medical, nurse, nursing, patients, physicians, sick, ucla olive view
Posted by nurse on August 25, 2011 under Critical Care, patient health |
In the advertising dreamworld most healthcare companies project in the media, sick patients get wonderful care with full focus on them as individuals. Health is a concept everyone strives for. Hospitals on television look like wonderful clean places where healing takes place with pretty nurses, big smiles, and witty humor. But in reality, patients can share a room with a marijuana smoking person covered in tattoos who treats the room like a Holiday Inn to be trashed.
Nurses know the dirty truth regarding how much patients have to deal with once admitted. They are ironically the lowest ones on the item pole, while being billed the entire time. Hospitals can be dirty, understocked, understaffed, and full of distractions that make patients feel like they are recovering from treatment on third base at Yankee Stadium, only noisier. Privacy is a joke, and sleep is a forgotten memory. And for a lucky few, there is more discomfort ahead.
1. Patients Can’t Read up on Medications
A doctor visiting a patient at bedside has to take their drug recomendation at face value. Without Internet access, they can’t double check medications with even serious side effects. Patients can be in the course of a therapy very harmful to them, or their mental state and not know it. Without full disclosure of side effects (and even allergy tests) no patient should be gulping down new meds on five seconds notice. But patients are often given no choice.
2. Hospitals Fill Beds on Quotas
A patient may wonder why their condition this week merits admission to the hospital, wheras the same condition last week did not. The fact is, most hospitals operate close to a very thin profit margin and look for patients to admit with a high probability of breaking even or profiting. If a few beds are empty, the company can draw from the emergency room for patients too eager to get admitted to read the fine print. Then the discharge orders come when better insured patients apply for treatment.
3. Bed Rest Isn’t Good for You
Two thirds of the American public is overweight. The last thing they need is to be enforced with bed rest and nonstop meals. Hospital food is so bad some nurses and physicians include stool softeners with the checkout forms. With some advance notice a patient might eat lightly, or drink more water, or even bring some fruit or preferred snacks. The diabetic menu at many hospital is not necessarily about calories, just substituting protein and nutrients for sugars and fats. And the noise of the hospital hallways can be compared to an airport runway with machines, beeps, other patients and the turbulence of nurses running in and out every 5 minutes.
4. The Compliance Game
Nurse, physicians and staff play a game concerning the patient’s participation in their care plan. if a patient asks questions, demands to speak to the doctor, questions dosages or asks for basic assistance, nurses may telegraph to each other the patient is “difficult”. This keeps nurses from answering call buttons and physicians from absorbing comments. Once a nurse tags a patient as difficult, most of what they say to administrators or customer service personnel is discounted.
5. You Never See the Bill
The patient’s healthcare bill is coded in a complex set of abbreviations, medical language codes, and unreadable shorthand for hospital procedures. Without keeping track of what tests were performed when, and how many blood samples were taken, a patient has no control over hat they are being billed. Any other business transaction on the planet allows the customer to examine the bill. But the person who suffers is the patient, whose healthcare company may rate them a risk because their care appointments have bloated fees and additional charges.
6. Mistakes Are Invisible
The sheer volume of processes one ward of patients can bring to a hospital creates a logistical nightmare that requires administrative coordination to execute smoothly. But the behind the scenes errors are often smoothed over so all patients see are one more stool sample, and on more hypodermic needle going in. Mistakes are common and mixups are legion, especially in busy hospital departments where too many handoffs are incomplete and information flying too fast for medical personnel to keep up. Just watch how many times nurses try to take a patient to an appointment they don’t have.
Perhaps the dosage orders and treatment advice does not kick in until the next nurses’s rotation, leaving the patient to wonder why the doctor told them something different. The fewer opportunities a patient has to review labels, doctor’s orders, fine print, and notes, the less they know about the wrong thing going on. Mistakes in billing and mismatched codes, incomplete paperwork and confusion between clinic appointments and departmental visits can spell disaster. An these incidents are all too common.
7. Patients Cannot Be Choosers
In almost every vertical business channel in commerce today, customers can vote with their feet or wallets which services are the best and what they want. Except in medical care, where patients are almost always the victim of transportation problems, family disputes, caregiver schedules, and/or limitations in ability to attend appointments, and general inability to deal with their illness going forward. Any complaint made usually makes the client suffer. In this case, the patient has to deal with the likely pointlessness of dealing with an issue with medical staff because they are the likely source of return or follow up care.
Frankly, individuals made to stay in a hospital for three days might take better care of themselves if they learned what kind of punishment they were in for down the line.
Posted by nurse on August 13, 2011 under Uncategorized |
Many patients may be first time visitors to the admittance experience. Asking patients how many hospital stays they have had and how long ago that was can tell them how much information a patient needs to be comfortable with hospital processes and nursing norms. Find out if a patient needs counseling from a pastor, loved one, or next of kin to stabilize their mood.
Admittance puts a patient under complete twenty four care of multiple nurses, physicians, technical staff, even hospitality and housekeeping staff. Many patients are not prepared for this. They may need some time to adjust. Nurses should look at blood pressure, body English, sleep patterns and pulse statistics and read whether patients are entirely ready for the procedures ahead of them.
Patients may not be aware of their immediate need for admittance or be surprised by the incidence of it and be unprepared. The swift changes in floors, rooms, wards or departments may dismay or confuse them. The loss of privacy may seem routine to nurses, but shock patients, who find extraneous personnel invading their space on the slightest pretext. In order to chart fluids and collect samples, nurses should take care not to alienate patients and make them refuse to give us the last vestiges of privacy they feel they have.
Admitted hospital patients will have a room and a bed, a phone and a bathroom, an IV line, electrical conduits for other devices, and trash receptacles and movable surgical trays in a limited space. They may be surprised by the constant entry of household staff, nurses, physicians, and even doctors performing rounds if the facility is a teaching hospital.
Nurses should keep communication fluid and constant despite staff turnovers. If nurses can give patients a heads-up concerning their room traffic the hint will be greatly appreciated. Nurses discussing another case or personal business may continue a conversation while both are present in the hospital room of an unrelated patient, for example. Nurses should never repeat gossip, complain about supply shortages, or say anything to alarm a patient about their standard of care.
Posted by nurse on August 5, 2011 under Critical Care, patient health |
Wound care requires the skill of a trained nurse for various reasons. Patients are rarely skilled enough to become full time nurses for themselves on their own. Wound care involves physical cleaning, ongoing assessment, pharmaceutical treatment, topical medication, and bandaging. The patient’s attitude toward treatment and their state of mind regarding ongoing care can massively impact the overall medical problem as a whole. Nurses skilled in wound care will find employment in every major clinic and hospital worldwide n any basis.
Nurses and therapists should be prepared for the physical requirements and emotional components of a wound care consultation. The environment should allow for spillage, drainage, wound changes and nonpermanent staining of bedding, pillows and cushions from treatment medications, drainage, blood and assorted fluids. Nurse should not get angry at patients for spilling treatment medication of topical wounds, or brushing bedding and cushions with wounds due to awkward positioning or strained circumstances.
The physical cleaning of a wound may require the patient be moved and the limb or area of the body affected revolved and angled differently for adequate treatment. Patients of various age, weight, and flexibility may have movement limitations that require additional time and patience on the part of the nurse or physician assistant to clean, unwrap, treat, and rewrap with bandages. Nurse need to be patient and slowly advise patients to stand up, turn, adjust their elbow, arm, leg or ankle to unwrap and wrap bandages, for example.
Wound care should take place in a sterile environment. Sheets and pillows should be clean and free from patient-to-patient contamination. Stained sheets should be put in burn bags or disposed of as soon as possible. Disinfecting sprays should be used all around the treatment area and a suitable amount of time allowed to elapse before subsequent patient consultation in the same area. When time is short between scheduled patient consultations, a revolving theater of beds should be used allowing germination extinction and bacterial clearance between patient habitation.
Nurses will become so used to the wound care consultation routine they may forget that patients are waiting for prompts about what to do and hints as to what is going on. It may be boring nd repetitive for nurses to verbalize, but patients need to be groomed in the medial visit what to to expect and need to be told what to do. Nurses should indicate to a colleague or via notations regarding the improvement, stasis, or alteration of the wound.
A patient may forget, due to pain, time elapsed, and other issues about what to do in the procedure. This is not a sign of inattention. But nurses may presume patients are not “tuned in” because they don’t remember every step of their consultation procedure. The overall consultation has a meaning for every part and individual the patient interacts with. Each staffer can independently determine if the patient is clearheaded, attentive to questions, honest in nature, evasive, hiding other symptoms, or trying to avoid discussing alcohol, smoking and drug abuse.
Taking vitals, weighing in, taking patient history, and updating medication and general condition information should be a a part of every wound care treatment. Changes in weight, normal biological processes, appetite, overall health and substance abuse can alter effectiveness of oral medications and circulation. These factors can change the dynamics of a given course of wound care. Smoking can affect Vitamin C absorption, for example, halting necessary citric acid activity and immune system support. Patients must be reminded they must play their part in wound care processes.
No consultation should be contained within a time period that excludes open and honest communication and information exchange about conditions affecting the wound. physicians and nurses can often miss critical pieces of patient data because the visit was so rushed patients were distracted from mentioning something important.
Nurses should ask questions about the wound condition and get the patient to communicate about the degree of infection, localized pain, copiousness of drainage, and/or redness/swelling. Re-orienting patients to their wound concerns is an occupational charge that reminds the victims that their medical condition is serious and requires ongoing assessment and vigilance. Patients and their wounds will appreciate it.
