Nursing Career a Predictor of Depression?

What does current research tell us about depression, nursing work performance, and occupational health conditions? That the indicators are present of workplace burnout, PTSD, common mental disorders,  and weight gain from occupational nursing stress. Studies conducted by Weller, et. all., (2008), Peterson et all, (2008), Jolivet et al., (2010),  HS Lin, (2010), Greiger, (2007), Dillman, (1987), Welsh, (2009) , and more have contributed specific research to the body of knowledge surrounding nursing careers, job stress,  and depression. Colleagues of  Yohai, (1987) , Gartner, (2010), and Langleib (2008), also have conducted research that indicated higher instances of wellness problems from the negative impact of nursing work. The research underscores the key premise of evaluating nursing occupations as a predictor of depression.

Does nursing as a career function as a predictor of depression? This above body of research and its combinant conclusions supports increased review of depression as an occupation covariable of nursing as a work choice. The response of nursing employers, hospital wellness initiators, and occupational nursing consultants should be impacted accordingly.

Nursing requires long hours, pain and suffering, complex pharmaceutical regimens and physician-ordered therapeutic treatments. And that’s just what the patients have to go through! Nurses as occupational workers must study and internalize a great deal of empirical knowledge to perform their jobs. Then they must absorb dozens of personality types, workplace idiosyncracies, and patient preferences. This must be done working long hours with little structured rest and relief.

But as studies show, nurses on the whole pay a price for the stress of their workday responsibilities. Burnout is common.  And employers should pay attention to where their training investment is going. Because almost 80% of the respondents report at least one health problem that impacts work productivity.  More muscular support and improved employer and healthcare schemes for treatment of a signally underreported problem such as this should be immediately complemented by companies via employee outreach.

Participants in the depression studies also reported other signifiers of unhappiness, burnout, and workplace difficulty. Anxiety, sleep problems, medication interventions, errors involving safety and medication indicate a workplace disaster waiting to happen. Wellness, it seems, is a professional responsibility for nurses. But it should be an ethical responsibility from employers toward their nursing workforce.  A large portion of the depressive-skewing group showed problems with obesity, lack of mental well-being, and a marked loss of productivity. These factors directly relate to lessened ability to manage workplace tasks and nursing duties. This is not the “Dark Ages” of pink collar employment anymore. Nursing retention spells better quality of care for patients in every scenario.  But as the research shows, wellness institutions, hospital medical-surgical wards, and global nursing workplaces all show a heightened coefficient of depression, as a nurse’s career lengthens.  And for nurses and nursing employers to (still) sponsor a working environment that promotes medication errors and unnecessary instigation of poor nursing performance is of grievous concern. For the corpus of the population looking to nurses for healthcare, having a depressed nurse doing nursing tasks and performing services for you is an alarming possibility, and yet now a statistical probability.

Nursing institutions themselves can most concretely change the elements causing some of the depressive orientation in nursing occupational experiences. Lessening workplace impairment should be a cooperative goal between all parties. Workers suffering from Depression, reporting health and coping issues, and committing errors are a risk. Nurses at risk for impaired work performance do not make positive role models.The validity of depressive indicators across all samples illustrates a higher demand for employer assistance programs.

High rates of depression can occur in every profession from stockbrokers to firemen. But nurses are the kind of specialized workers that should know enough to recognise stress and intervene before formal depression takes hold. And healthcare managers are far from immune to depression either. According to Welsh’s study of 150 nurses, the estimated prevalence rate for major depression is above 20%. Job satisfaction and burnout are also reported, but experts theorize that much more internalized stress is simmering under the surface.  The etiology of depression and the implications of depressive symptom incidence in nursing employees transcends mere lifestyle and cultural backgrounds.

   Total Depression Score (TDS) is the factor that rates the individual as a participant in the depression-growth dynamic sketched in research literature. Nursing associations throughout the United States actively participate in these studies to prevent growth of occupational difficulty and regression. The gender factor remains somewhat skewed, as an overwhelming share of aging nurses are female. In the North Carolina study, 91%, of the respondents were female. As male populations in nursing occupations changes, more data will be available with more updated research. 

Finding out more about what causes nursing career stress can illuminate the changes necessary to minimize wear and tear on the ‘ candy-striped collar ‘ industry. In a cross -sectional survey performed across 2500 random North Carolina nurse samples, only 47% bothered responding despite a dollar bill being provided! ( The Dillman strategy.) This shows a discomfort present when half of all nurses have to come to grips with how depression is affecting them.

For those considering the nursing profession, statistics and studies exploring depression as a coefficient of occupational nursing have something to say. There is no ” free-ride” in any career. In a nursing career, as studies and depression literature indicate, the cost of interaction and wear and tear of being a nurterer and a caregiver may have hidden social costs. Workplace characteristics play into this trend. The occupational risk of depression in the nursing field co-varies with employment type, age, level of nursing education attained, and communication elements between other nurses at the place of work.

Many of the above research authorities noted obesity as a depressive co-factor, and a synthesis of high BMI and other depressive indicators in stressed out  nurse candidates suffering burnout. . While the stigma of being overweight and the concept of career dissatisfaction is not unique to nursing professionals, the clusters of other signifiers attending incidence of career longevity in nursing, as well as the obesity factor, are. But other factors such as overcrowding of the patients in the healthcare environment,  and a lessened ability to communicate with other staff can also exacerbate depressive trends. Communication operates to solve many problems, and its absence in a nursing envirinment is a sure sign of workplace dysfunction. And the communication breakdown does not only limit profession nursing performance.  In cultures where many individuals are cued to conceal concerns about their own mental wellness, nurses are not as reliable for self-reporting symptoms of depression.

The current research offers new treatment options for depressed nurses and those experiencing job stress. Computers can offer Lcd-enabled counseling interventions and Internet–based cognitive  therapy technologies. Nursing assistance strategies for support should quantifiably emphasize more robust participation in these programs. Healthcare employers should introduce employees to their mobile and smartphone pathways to wellness.  Brands such as Mind street, E-couch, and Moodgym are examples.

Incidence of depression, depressive tendencies, and behaviors associated with depressive symptoms have been tracked in nursing sample groups of varying occupational nurses around the world. From field hospitals in theaters of war to metropolitan hospital wards, the research compiles statistics and observations that hint at a need for organized proactive response. One study of German nurses reflected the combination of lowered mental health rating, health problems, and lowered workplace productivity. Registrations of continuous and consistent depressive problems in nursing professionals should be resonant enough, by now, to incite employer-side support.

Studies and literature from varying institutions and scholars have been actively researching the extent to which depression correlates with nursing.  Medical-surgical nurses and intensive care nurses show a stronger inclination to self-reporting depression or depressive symptoms. These symptoms are correlations of somatic complaints (trouble sleeping), major life events, addictive habits, and signifiers of occupational stress.

The burden on nurses is to support the healthcare mission of physicians in hospitals, clinics, nursing homes, and field hospitals. Any type of nurse, it seems, may be subject to depression as his or her age rises and their career longevity extends. Yet nurses receive education and training about the downside of depression and its impact on well-being. The research begs the question ‘Why can’t nurses actively discount depression in their own lives, let alone offer impactful interventions to their patients?” Employers and wellness institutions should answer this query with a set of nursing occupational supports that reinforce the investment nurses have made not only for their own careers, but for optimum patient-side medical care experiences as well.

 

Nurses and Depression: An Essay

Nursing and depression are a strange pair of entities that intersect at various points of the compass. Yet the nursing profession continues to walk an uneasy line between comprending depression as a patient symptom and experiencing depression  as a career side effect. Today nursing stands at a pivotal place in history, with academia, the origins of medicine, and progress pulling the threads of nursing theory every which way.

Nursing is a time-honored institution whose origins claims famous feminist icons such as Clara Barton, Margaret Sanger, Mary Breckenridge, and Florence Nightingale. But the feminist mystique itself has oudistanced the treatment and conventional wisdom surrounding depression as a medical concern. Depression, and the treatment of depression, for many people, can be a difficult concept to grasp. Depression is a psychiatric disorder of the mind and psyche which affects persons undergoing medical treatment, but can also originate as a harbinger of other diseases. Depression has almost become a slang term in the pop culture vocabulary used casually to descrive feeling “down”. Yet as a medical denominator, the presence of depression  is serious business.

Depression can be a symptom as well as a diagnosis. Yet the physical side of the medical and nursing fields can often override the psychological of many wellness crises. Conventional wisdom usually trumps academic progress. Commercial pharmaceutical treatment usually beats out long-term alternatives, and little endorsment is given to nontherapeutic analysis. The medical institution as a whole functions mostly to heal the body, and the psycho-analytic milestones in healing don’t keep pace with the limitation of treatment access options for the afflicted. Dabbling in depression doagnosis is seen as specialist referral stuff. Medical professionals are all too familiar with these “rules of the road”.

Both doctors and nurses are more comfortable in general discussing medical symptoms according to a pathology of pure anatomy and disordered functions of the body. This is their clinical training taking over. This is understandable, as many facets of the psychological applications of depression treatment color between the lines of many disciplines. And ad hoc experimentation in the world of treatment for depression is uually not rewarded from a multiple of perspectives.

Too often, physicians skip over depression as a treatable illness and focus on the more concrete diagnoses of the body. In many cultures, psychological illness still carries a stigma from periods of civilization where too little was known about the causes and origins of depression. The onus of depressive symptoms as ‘”madness” still  remains.

Early man used drugs, societal separation, and medicinal forms of witchcraft to “treat” early forms of depression. Later cultures shipped mad people offf to sea, in groups, on a Ship of Fools”., Relying on God to guide their destiny. Sigmund Freud and Carl Jung introduced a standardized form of psychological vocabulary to the medical world, and contemporary man has distinguished himself by pursuing depression in its various guides as a clinical and scientific study for decades.

Today, studies connect depression and everything to sleep deprivation, opiate addiction, anorexia nervosa, Post-Traumatic Stress Disorder, and more. Prevention of depression and observing symptoms of depression, are now a key element of physician treatment advice. The dynamic of career choice has affected medical workers, doctors, and nurses as the practices began to take on occupational definition since the late 1600’s. Medicine  as a discipline has undergone radical reforms from it’s early days. The “physicking’ of another person began to take shape not just as a career for learned man, but as an occupation for educated men and individuals in search of a paying career. While the first doctors of this type were from the most elite classes of scholar and the most wealthy set of people in every culture, religion as  a passport to medical practice admitted religious elders to the treatment of others in more than one tribal civilization around the globe.

Many early teaching institutions centered around the scholastic training of doctors, priests, and teachers. The estimation of a physician was often ruled by his breadth of knowledge of medical studies and material of a religious nature. The indoctrination of a scholar in religion was thought to cement the ethics required to operate a medical practice and found the personal ethos necessary for treatment of other persons, conscious or unconscious. The access to the metaphysical world that many cultures connect with physical wellness allowed this transmutation of disciplines to coexist for many centuries.

The ethics associated with physicianship caused male scholars in the early 1700’s to pledge their scholastic faith in religion, as a going rates of “dues” cementing Christian ethics to the science of treating the bodies of other people. But as Calvinism, the teaching s of Martin Luther, and other religious doctrines took shape, the emergence of a new class of doctor purely to treat the physical malady emerged. The doctor as pure scientists emerged. Marie Curie and her husband were examples of this kind of doctor, who practiced their science without allowing religious culture to dominate their thinking. Doctors were thought of as esteemed members of the community, the equal of all but the highest echelons of the social order. Doctors are respected in every type and section of population where high level of education, practice of any differentiated culture, and necessary acknowledgement of the body of knowledge required and the commitment necessary confers a certain prestige.

In the succeeding centuries, academic studies have dominated the world of organized medicine. Then the business world took over mass medicine, and the world now has become a globalized client of large scale medical insurance companies. The patient is not always the client, as doctors usually are the ones that pharmaceutical companies look to for sponsorship of their treatment of new type of medications. It is the nursing profession, and nurses in particular, who deliver the front line of medical care and therapeutic attention to patients. It is the nurses in the medical world who are the ones that patients interact with the most.

But as the nursing career as a lifetime occupation has developed as a paying gig, the culture of acceptance and respect may not have been as evolved. The participation in medical profit for nurses has not followed along with that enjoyed by physicians working half the amount of time per week.  While nurses do the “heavy lifting” of patient care, their compensation is not commensurate with the time spent and sacrifices required of someone who has embarked on a nursing career. Nurses may work unpaid overtime, stay late, and do extra work, but nursing pay generally doesn’t always reflect this contribution. Ensuing generations of nurses will decide if more reform is in order.

 

 

 

 

 

 

Recognizing Medication Side Effects

Today a hot topic in nursing efficiency and best standards in healthcare is maintaining corporeal integrity and patient health despite heavy medication orders.  Nurses administering medication therapy to patients need to be watchful for side effects. Harmful side effects can be fatal. Any nursing performing 24 hour triple checks should converse with charge nurses and consult communication logs to verify any symptoms of a problem with a new medication that may have appeared.

Nurses should not wait to be directed by other staff or pharmacy advisors but verify from administrators,  Internet resources or the drug literature what the potential side effects are. Patients have a right to know what these side effects are before the medication is administered for the first time. If there is a potential drug-to-drug interaction, a delay may be in order while the physician is notified. Another drug may be substituted to eliminate potential problems, side effects, and patient discomfort.

The obvious benefits of nurses maintaining a rapport with their charges become evident here. A caring treatment nurse or observant and communicative med nurse can know what condition the patient’s skin normally is, what skin products the patients use, and under what circumstances irritation or rash incidents arise. Is the patient a complainer or do they hold back complaints?  Do they follow the same bathing and skin cleansing regimen daily? Does the patient use water that is hard, too hot, or for too long a period? Nurses should work closely with nurse’s aides to make sure unknown skin problems do not arise in conjunction with new medication administration. Both problems happening at once muddle the waters.

Patients in hospitals and long-term care  facilities usually do not handle their medications and thus cannot read the warning advice. They may not have Internet access or know how to spell the name of the medication. It is irresponsible and unprofessional for a nurse to force, trick, or dispense new medication to a patient without advising them of these risks and getting their permission. Violation of these rights can result in oversight agency scrutiny,  facility citation, and/or a nursing  license revocation.

For these reasons, any nurse should be mindful of the potential side effects of new medications. And over time, patients may develop allergies or new unpleasant and painful drug reactions. Before nurses sign off on pharmacy memoranda detailing potential interactions with the medication, they should review the nurse assistant’s body check documentation as well as the licensed nurse progress notes from every shift since the inception of the drug’s administration.

While some people have faith in homeopathic medicine, medical science is predicated on conservative and well-tested treatment advice. Unless the patient is utilizing off-label benefits of the drug for conditions other than those initiating the drugs’ order, nurses should follow the exact dosages and administration schedules the physician recommends.

Patient healthcare involves ongoing maintenance of functioning body systems. This includes circulation and muscle support to the dermis, musculature, and epidermis.  These systems undergo changes when systemic alteration occurs. Drug administration via the vein, orally, or topically is encountered by the body as a systemic alteration. Patients receiving therapeutic care require new and additional surveys to maintain the integrity of the skin.

The skin is the largest organ in the human body. The color, texture, febrile nature, friable veins, diffusion of capillary circulation, and moisture content of the skin tells the story. Changes can be tracked and documented to show the progress of a treatment for a condition or illness.

Nurses learn anatomy to understand how the heart and muscles drive the circulatory system. These functions are involuntary. They also stimulate immune system responses that are designed to protect the body’s regular functions.  The response of the immune system and the hypothalamus is governed by genetic  rules which are predetermined at birth. Generally these operate for everyone the same way.

But due to the infinite variation between one human body to another, individuals will differ when a foreign substance, such as a toxin or strain of bacteria is inserted into the bloodstream. The body’s response should be reviewed for the things the patient can communicate, and the things that can be observed.

Thus,  Person A may have no response to ingesting plant spores. But Person B may have no tolerance for plant spores. This intolerance is not a cognitive communication. It is expressed by changes in body functions exclusive of other medical problems.

The body dysfunction  evinces itself in a set of symptoms visible to the eye. It might be a rash, bumps, and/or itchy patches of skin . Sometimes the condition will irritate the patient to comment. For nonverbal or inert patients, symptoms such as swelling, striations, “weeping”, bumps or other dermal eruptions may occur.

Patients may not be able to see what is going on. A full body check is in order at least daily, before and after treatment. These data items should kept well documented in the patients chart for physician review. Symptoms such as nausea, inflamed throat, vomiting, loss of appetite, rash, hives, unusual numbness of extremities and more should be noted carefully. Nurses suspicious of side effectsvof medications should chart an intervention in the patient’s care plan. Wellness should  be achieved without the above mentioned side effects. It is for the doctor to determine whether or not the benefit of such medication outweighs the irritation and discomfort the patient undergoes.

Symptoms of side effects should be evaluated with reference to the patient’s normal condition and status. Failure to chart regular full body checks and regular medical examinations can cloud the issue. And only the facillty being alerted to signs of anaphylactic shock, observed by a nurse,  can save a patient when extreme side effects (akin to allergies) are present. Immediate medical attention is triggered by the predictive and denoted set of side effects described on the warning labels required by law to accompany all medications.

Patients receiving new orders for ongoing conditions or diseases with new symptoms must be protected from the natural occurrence of allergies and untenable side effects. Signs of side effects of given medications is nature’s way of making sure the body does not ingest any more harmful material.

Patient medication forms part of therapeutic intervention for serious conditions. Antibiotics are an accepted and highly recommended response by physicians to lab tests, clinical consultant, and referrals to a specialist. Antibiotics are adminiatered to the human body three ways, internally, orally, and topically. Creams, gels, sprays and powders can be applied directly to the skin or affected area. Oral antibiotics are administered  by mouth and sometimes by other means.

Infusion Vein therapy (Intra Venous therapy)  is administered by access to the vein. The needles’s access to a skin based channel allows direct systemic delivery of antibiotic material. Yet an etiquette prevails to ensure patient safety, operator efficiency, and an optimum outcome.

Dosages of antibiotics in the above mentioned methods are governed by strict standards. The I.V. medication is calculated by laboratory tests, “peak and trough” reports, creatinine levels and patient weight. Maintenance of kidney function is imperative.

Nurses who follow the signs of allergy, medication symptomatology of side effects and problems of specific medication types can offer their patients a wholly beneficial skill set that will enhance treatments and drug administration. Patients can enjoy greater quality of life,  without dosing errors, unnecessary discomfort,  or negative drug interaction.

 

Hospital at Home

A new model of nursing involves providing hospital level care for patients transitioning to living at home. This model can improve the efficiency of hospitals and other facilities by lengthening the time between hospital stays and facilitating better medical outcomes. The recovery of any patient in the context of their own home will always feel better. The care plan can thus be carried out with minimum discomfort of the patient. And lack of malaise will always trump pharmaceuticals, or so many psychologists believe. Patients can therefore meet the demands of their illnesses and meet their healthcare challenges without having to encounter a fearful hospital experience and culture shock.
The patient eligible for Hospital at Home must have sufficient oxygen flow and non-ischemic chest pain or absence of chest pain. After meeting clinical criteria for eligibility, the Hospital at Home patient will part of a new and progressive service model for acute-care candidates. The resources such as oxygenation and infusion are mobilized, the service performed at the patient’s home, and the nurse provided for “outpatient” aftercare. Thus the patient receives the best in skilled postprocedural nursing, without the awkward and often uncomfortable (and frequently painful) transportation hiccups, to and fro.
The patients feel they have more control over their lives while in their homes, while a hospital is a sterile and unwelcoming environment that maximizes the unknown element of any serious medical procedure. The room in a hospital may have to be shared with another person the patient find threatening. Occupying a hospital bed in a room with a stranger can be overwhelming for a patient already uncertain about their outcome. The noise and intrusions of people such as nurses. physicians, housekeeping, technicians, phlebotomists, administrators, case managers, and records clerks, can be annoying. The coming and going of such people in their space can keep patients awake, disturb their slumber patterns, and fan anxiety.

Hospital at home involves skilled-nursing level care and aftercare attributes without high hospital costs. Hospital at home allows a patient to receive nursing facility level care, specialty treatments, and adjunct technical nursing services in the comfort of familiar surroundings. Often just the proximity to friends and family can assist patients in recovery and recuperation. Hospital-at-Home is rated highly by caregivers, nurses, patients, and family members. This factor alone should become a consideration when reviewing scenarios for medical procedures.

Medical centers across the country favor Hospital at Home (Hah!)as a way to ease the burden on limited-bed hospitals and medical costs the patients at the same time. Hospital-at-Home is a care model that can be adapted for metropolitan or suburban community recommendations. Usually these costs factor into the overall cost of any hospital stay. By shaving the expense of hospital level services with adjunct mobile providers, health management organizations can more feasibly recommend in-patient stays and facility admissions without the likelihood the procedures will be rejected on a basis of cost.

Not every patient adapts to services in a hospital environment. Privacy, communication, access to the physician and a case manager can complicate the overall scenario. Reducing the cost by up to one-third is one advantage of Hospital at Home. But in addition to cost concerns, a patient can regain the rights of residency and all the benefits it confers. Patients can use their home phone, computer, receive mail, host pets, and receive visitors any time of the day or night. Patients can enjoy all the benefits of their home surroundings while getting optimum care. These can be important advantages when a patient envisions a planned and necessary medical procedure.

    Many people are not comfortable in hospitals and grow nervous at the thought of staying in one

. The may have negligible confidence in the “system”. Distance, cost, and awkward transportation issues may make the whole idea of a hospital procedure, no matter how needed, become a horror. And many seniors are homebound and have limited access to hospitals and other needed. Given these problems, a decline may be envisioned by the physician recommending the procedure. But Hospital-At Home is likely to be sponsored by the HMO the patient belongs to, on a cost basis alone.

The complete package of services and the organization necessary may be beyond their grasp. But Hospital at Home allows for these vulnerabilities and assists many seniors and homebound others to gain their medical services without negative outcomes. And many patients rightly fear the contagion and infection that many medical professionals know is present. Hospital admission and continued skilled nursing can present many more problems than a patient is willing to deal with. But pre-treatment in a clinical setting and follow-up services after the performed medical service enables patients to receive vital and necessary treatment, and then recover in the comfort of their own home.
The modern world allows technical mobile access to treatment and lab services like phlebotomy, radiography, dialysis, and skilled nursing bedside care. Acute medical problems grow scary for the individual patient uncomfortable alone in a hospital bed, surrounded by strange noises, equipment, and people. Just the sound of their home and natural surroundings and resuming regular living patterns can ease patients back to recovery. The outcome of any hospital procedure or service will be improved for every patient. Additional follow up testing, such as EKG, PICC line placement or removal, X-rays, ultrasound or others, can be dealt with at home.

Evaluation of HaH candidacy starts with the Emergency Room staff. They will be trained to identify the patients that require inpatient services but may benefit better by being treated at home. The clinical eligibility criteria will be part of an attribute list developed by the Hospital at Home model. A team will be assigned to prepare the patient for Hospital at Home services and scheduled in conjunction with their medical procedure or treatment. The quality of the ultimate outcome can be radically improved on a per-patient basis. Less stress, fewer complications, reduction in the mortality rate, and more value for each element of care should contribute to the Hospital at Home model being used more and more. Satisfaction from use of the Hospital at Home model is had by the patient, by the caregivers, and by the HMO, and ideal result.

Nursing and the Wound Care Dilemma

Wound Care in recent years has become big business. As a medical specialty group wound care has grown into a competitive market of the larger medical services provider industry. Wound care has also made a name for itself by providing mobile services. For many at-home patients and institutional clients without in-house debridement doctors, this is a winning solution.

But many patients receiving wound care by such onsite providers have to wrestle with a whole new set of problems. Because of the frequency and the proximity of the new surgeon’s provider visits, this brand-new physician now rules over the patient’s care plan. This random new doctor now is the most influential surgeon in the patient’s orbit.
In the medical world, certain conventions of eminence and integrity are assumed. A physician is generally esteemed by the level of education attained, the prestige of their academic credentials and their source, and the work history performed after graduation. The prestige of the places a physician works after graduation and the relative importance of their work experience determines the opportunities in the medical industry. This also predicates their authority in future patient care giving advice.
The occupational issues the physicians will come up against in the medical community will be a reflection of their formal training. But a position in wound care is due to years spent practicing in the field of wound care medicine. This standing
comes after years, sometimes decades working in professional medical care. Patients receiving wound care services almost never choose the doctor or know anything about them, unlike other types of doctors.
Mobile wound care surgeons analyze the condition of the skin. They measure and record the size depth and breadth of wounds and infected areas. The debridement surgeon can advise new courses of treatment. The wound care surgeon can also discontinue applications if treatments he or she finds detrimental or causeless. They may dismiss effective regimens without a second thought.
Soon the orders for the wound care may bear no similarity at all to the most successful and most impactful wound care regimens the patient has known. No other services can be authorized anymore. The patient is cornered. Then in addition to the discomfort and trauma of heavy infections, the wound care patient is twice over a victim. He or she will be left scratching their head, wondering ‘How did I get here?’

Medical provider services are part of an industry that makes money not doing its job. The more disorders, wounds, lesions, and infection that occur, the more money the hospitals, clinics, and services providers make. Of the gargantuan corporate behemoths that run modern medicine, all of them run on a modern theme: Sickness is an income opportunity.

Wound Care is a segment of an industry that nevertheless subscribes to business drivers that try to curry relationships with their business-to-business clients. In this particular, the patron is the long term care facility or Home Health corporation the patient belongs to. This means that a side contract is attached to the agreement between the physician and the patient. In the B2B world, this means that the interests of the facility and their case management prerogatives come before the wishes of the patient. While the patient may be under the impression that they are in partnership trying to improve their wound care ailments, the real boss of the situation is the facility or Home Health provider management.

This is a dilatory arrangement, as the patient will take consideration of other providers’ advice, including that of the PCP, assuming ongoing wound care success. They may discuss and develop the care plan with a projection of straightforward cooperation from the wound care service. But this assumption may be unwarranted. After making communications with other physicians regarding treatment, medication, and new therapies, the patient may find that the care plan is the victim of a hostile takeover.
Now the patient has heard so many different opinions about her case she feels seasick. After years of listening to persuasive opinions about treatments, the pendulum never rests. There is an endless cycle of wound care referral, the provider’s care initiation, the physician’s kindly bedside manner and befriendment. Then comes the sales pitch, the heavy sell, the isolation from other treatment doctors, and then the coup de gras. The wound care physician announces “It’s my way or the highway”, and the patient wonders how they got into this mess.
Now, all the documentation sets up the wound care provider as the decision-maker of the care plan. Nurses would do well to assist patients in coping and dealing with their doctors double-crossing them. Nurses and counselors should update case managers and family members if the observe patients feeling upset and confused by unsuccessful efforts to make their wishes understood. The concept of respecting resident rights is one that nurses should apply very seriously to all their charges.

The wound care physician now holds the upper hand and if the patient does not obey orders, the doctor can fault the patient for not being compliant. This can discredit the patient with the medical insurer. Documentation like this can risk the patient losing their medical coverage.
All of the assurances and advice that the patients received when other physicians were following the along the case somehow now gets lost. And it is surely a sheer coincidence that the recommendations of the most recent wound care visits dovetail with the least cost scenario for wound care treatment.
Nurses should recognize when patients feel distressed about any treatment they are receiving. But the impetus of hospitals and long term care facilities is to allow the business drivers of any medical care instituion have the last word.
Nurses today must decide whether to honor patient wishes or put the fiscal gains of their employer first.
This is the wound care dilemma for nurses. To step forward, and help, or do nothing, and hinder the situation. Nurses must acknowledge when the transparency and quality of patient care is compromised by the absence of patient consideration. Nurses must also operate with loyalty toward their employer. For nurses experiencing the above referenced type of scenario, serious reflection should ensue. These issues should make nurses everywhere advocate for patients who are getting manipulated by the ‘system.’
And professional nurses will serve their ethics best by obeying traditional standards of nursing handed down by generations. Namely, to put patient health, welfare, and recovery above all other considerations. Monetary and otherwise.

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