A Right to Your Records

Posted by nurse on September 2, 2011 under Critical Care, patient health | Be the First to Comment

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.

Nursing Home Feeding Controversies

Posted by nurse on September 1, 2011 under Critical Care, patient health | Be the First to Comment

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.

The Changing Face of E. R. Medicine

Posted by nurse on August 28, 2011 under Critical Care, Nursing Careers, patient health | Be the First to Comment

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.

7 Dirty Secrets of Hospital Stays

Posted by nurse on August 25, 2011 under Critical Care, patient health | Be the First to Comment

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.

What Patients Expect

Posted by nurse on August 13, 2011 under Uncategorized | Be the First to Comment

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.

Nursing & Wound Care

Posted by nurse on August 5, 2011 under Critical Care, patient health | Be the First to Comment

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.

Managing Managed Care

Posted by nurse on under Critical Care, Nursing Careers | Be the First to Comment

Nurses learn a lot about business working in hospitals. They learn a lot watching doctors manage patients, and they learn a lot seeing the decisions hospital administrators make. The best exposure to real world business ideas may come from everyday observation of how administrators run health care facilities. The coming together of business practices with a mission to heal people can have some significant obstacles.

Clinical care decisions and care plan modifications should be the result, in every case, for every patient, for the best case scenario and horizon of medical status for that individual patient. Unfortunately, more and more HMO and clinical management decisions are taking the initiative to place less staff, more patients, and fewer resources in the facility to do the same job. Any health company can act to reduce staff hours and practical resources for certain types of cases.

Clinics spend more money on the computer system, which is meant to give more time to physicians and patients. But the computer system is really used for shaving time off medical consultations because doctors and nurses use it to skim every patient’s background history. But often they miss a lot because the computer interactions makes it easy to skip critical details and items of note. This can cause time consuming errors. But mavericks at computers aren’t necessarily nurses.

Do medical staff invest more time in being trained to operate support systems than treat patients? Sometimes it can feel that way. The processes should always enable better care, not discourage. Putting systems between patients and staff can reduce the overall effectiveness of the health process. Nurses can tell when when patients are confused and angry. Patients should know more about their care plan than the clinic’s computer capabilities or the hospital’s referral system.

Some nurses encourage going back to an organic model of dealing with patients that lets them inform doctors and nurses about specific condition histories and unusual or ongoing problems associated with their treatment. When a physician assumes the medical “chart” on the screen in front of them will take care of their concerns, the error can introduced into the patient’s care loop. And the system rolls on and, regardless of the outcome of individual cases.

Imagine a hospital or clinic where the computer systems have failed, and staff and physicians have to work with paper and pencil. Does the standard of care drop? Why does it and why should it? The fact is that many hospital and clinic staff rely on systems and forms and computer keyboards when pure medicine re-creates a focus on healthcare at its most basic level. The business side of healthcare benefits from the lion’s share of the paperwork and processes.

Staff now have a secondary distraction of supposedly supplemental service aids which can absorb their attention and provide crutches where actual thought and analysis used to form the consultation whole. These can safeguard costs and reduces losses. But nurses should be able to look past these functionary items and maintain focus on the patient. Nurses should become wary of any system or process that distracts staff focus from patient care.

Nurses should ask questions that eliminate such errors, and reduce the amount of omissions in a weekly care table or care plan update. Is the condition better the same, worse, than the last visit? Are living conditions, medical site treatment (for flesh wounds and skin conditions) and consultations interfering with successful recovery?

Health Literacy and Nursing

Posted by nurse on August 4, 2011 under Critical Care, patient health | Be the First to Comment

Nurse and medical staff Physicians and administrators are becoming part of the debate concerning health literacy in the mainstream. Can every member to which a communication is addressed understand the message? Are the words at the level the patient can understand? Do elderly and children require different health literacy approaches? Is a teenager capable of understanding a document meant for a licensed nurse? What replacement material can be distributed to achieve the same message being communicated?

These are important questions that healthcare administrator across the globe are being challenged with handling. This is an education process and many key players who interact with the public will need guidance.

Our culture is not as health literate as it might be and far from as literate concerning health issues as it needs to be. the fact is, most individuals that become patients have little or none of the knowledge required for the most basic understanding of their own biology, healthcare norms, patient best practices, and hospital and medical equipment terminology. The United States Surgeon General is part of the project.

Why does the general public need a better understanding of how healthcare terms and medical terminology work? A better literacy concerning health initiatives, public health concerns, growing outbreaks and health conditions for the public at large is of benefit to all. This can save time clear understanding and keep the public better educated about the myriad ways they can help themselves, a public health literacy movement is taking form nationally and globally.

Health literacy has fallen in areas where literacy and information channels have been delimited by media , language differences, or complexity of information dissemination. Literacy in healthcare facilities can be as simple as the rewording of signage to accommodate th understanding of the majority of patients. Outdated or regional terms applied to distant campuses with different demographics makeups can be problematic for visitors and time consuming for staff to address.

The simple fact is that health outcomes are the result of whatever health literacy the patient or the populace at large has. An action plan or call to action can be formulated for every clinic public health institution or hospital to improve communication for facility resources wherever possible.

Nursing Workplace Violence Quiz

Posted by nurse on August 1, 2011 under Critical Care, Nursing Careers | Be the First to Comment

Emergency Room and hospital nurses face the danger of a a violent assault every day from patients. This quiz is designed to be printed, distributed, and collected. The results can be used to start a dialogue with nursing administration at your place of work, or prompt a decision from management about how to go forward dealing with the imminent threat of violence from patients upon staff.

If necessary, collect the forms from other nurses and log results and deliver the forms to your supervisor or the hospital administrator. In the case of a lawsuit between a nurse and the hospital, these documents can be used as proof that the hospital had formal notice that nurses were aware of the threat to their personal safety and that this had been communicated to hospital managers and administrators.

One a scale from one to ten, mark the appropriate indicator of how much you agree that this statement reflect circumstances and occupational nursing conditions at the clinic, healthcare facility, hospital or medical learning institution you are a member of.

1. I feel that hospital/clinic security adequate screens potential risks to my emergency ward, consultation area, patient base, department, and public access working zone of the facility.

1. Completely agree „„ ___ 2. Agree mostly ___ 3. Agree somewhat ___ 4. Agree except for exceptions ___ 5. Disagree due to a personal experience and/or recent incident ___ 6. Disagree due to personal incidents and reported incidents of other patients on staff , and even patient on patient violence. ___ 7. Disagree due to more than one reported incident/personal experience. ___ 8. Disagree and feel hospital/management staff know about this problem. 9. Disagree and feel threatened on the job. ___ 10. Disagree and demand hospital/facility supported training exercises meant to improve staffs safety procedures in case of emergency assault by a patient.

2. I have never observed an incident of patient-on-staff violence involving a knife, sharp, weapon or gun.

1. Completely agree ___ 2. Agree mostly ___ 3. Agree somewhat ___ 4. Agree except for exceptions ___ 5. Disagree due to a personal experience and/or recent incident ___ 6. Disagree due to personal incidents and reported incidents of other patients on staff , and even patient on patient violence. ___ 7. Disagree due to more than one reported incident/personal experience. ___ 8. Disagree and feel hospital/management staff know about this problem. 9. Disagree and feel threatened on the job. ___ 10. Disagree and demand hospital/facility supported training exercises meant to improve staffs safety procedures in case of emergency assault by a patient.

3. I have never filed at least any formal complaint with the union about this problem.

1. Completely agree ___ 2. Agree mostly ___ 3. Agree somewhat ___ 4. Agree except for exceptions ___ 5. Disagree due to a personal experience and/or recent incident ___ 6. Disagree due to personal incidents and reported incidents of other patients on staff , and even patient on patient violence. ___ 7. Disagree due to more than one reported incident/personal experience. ___ 8. Disagree and feel hospital/management staff know about this problem. 9. Disagree and feel threatened on the job. ___ 10. Disagree and demand hospital/facility supported training exercises meant to improve staffs safety procedures in case of emergency assault by a patient.

4. I feel other nurses/staff do not know about this issue, and do not discuss it.

1. Completely agree ___ 2. Agree mostly ___ 3. Agree somewhat ___ 4. Agree except for exceptions ___ 5. Disagree due to a personal experience and/or recent incident ___ 6. Disagree due to personal incidents and reported incidents of other patients on staff , and even patient on patient violence. ___ 7. Disagree due to more than one reported incident/personal experience. ___ 8. Disagree and feel hospital/management staff know about this problem. 9. Disagree and feel threatened on the job. ___ 10. Disagree and demand hospital/facility supported training exercises meant to improve staff safety procedures in case of emergency assault by a patient.

5. I never have wanted to leave work due to to feeling threatened from an incident at this hospital that made me fear accident, injury or assault.

1. Completely agree ___ 2. Agree mostly ___ 3. Agree somewhat ___ 4. Agree except for exceptions ___ 5. Disagree due to a personal experience and/or recent incident ___ 6. Disagree due to personal incidents and reported incidents of other patients on staff , and even patient on patient violence. ___ 7. Disagree due to more than one reported incident/personal experience. ___ 8. Disagree and feel hospital/management staff know about this problem. 9. Disagree and feel threatened on the job. ___ 10. Disagree and demand hospital/facility supported training exercises meant to improve staffs safety procedures in case of emergency assault by a patient.

6. More security/improved security staff response time is a reasonable way to deal with this issue.

1. Completely agree ___ 2. Agree mostly ___ 3. Agree somewhat ___ 4. Agree except for exceptions ___ 5. Disagree due to a personal experience and/or recent incident ___ 6. Disagree due to personal incidents and reported incidents of other patients on staff , and even patient on patient violence. ___ 7. Disagree due to more than one reported incident/personal experience. ___ 8. Disagree and feel hospital/management staff know about this problem. 9. Disagree and feel threatened on the job. ___ 10. Disagree and demand hospital/facility supported training exercises meant to improve a staffwide safety procedure in case of emergency assault by a patient.

7. I am unaware of recent incidents involving patient-on-staff assault or attack

1. Completely agree ___ 2. Agree mostly ___ 3. Agree somewhat ___ 4. Agree except for exceptions ___ 5. Disagree due to a personal experience and/or recent incident ___ 6. Disagree due to personal incidents and reported incidents of other patients on staff , and even patient on patient violence. ___ 7. Disagree due to more than one reported incident/personal experience. ___ 8. Disagree and feel hospital/management staff know about this problem. 9. Disagree and feel threatened on the job. ___ 10. Disagree and demand hospital/facility supported training exercises meant to improve the staff’s safety procedures in case of emergency assault by a patient.

8. I believe the union organization guards my rights and defends my actions in these cases.

1. Completely agree „ ___ 2. Agree mostly ___ 3. Agree somewhat ___ 4. Agree except for exceptions ___ 5. Disagree due to a personal experience and/or recent incident ___ 6. Disagree due to personal incidents and reported incidents of other patients on staff , and even patient on patient violence. ___ 7. Disagree due to more than one reported incident/personal experience. ___ 8. Disagree and feel hospital/management staff know about this problem. 9. Disagree and feel threatened on the job. ___ 10. Disagree and demand hospital/facility supported training exercises meant to improve staff safety procedures in case of emergency assault by a patient.

9. I feel I can detect a likely violent patient and protect myself in time.

1. Completely agree „ ___ 2. Agree mostly ___ 3. Agree somewhat ___ 4. Agree except for exceptions ___ 5. Disagree due to a personal experience and/or recent incident ___ 6. Disagree due to personal incidents and reported incidents of other patients on staff , and even patient on patient violence. ___ 7. Disagree due to more than one reported incident/personal experience. ___ 8. Disagree and feel hospital/management staff know about this problem. 9. Disagree and feel threatened on the job. ___ 10. Disagree and demand hospital/facility supported training exercises meant to improve staff safety procedures in case of emergency assault by a patient.

10. I think such patient violent attacks on nursing staff and physicians are extremely rare cases and should not be used for an SOP in everyday practice.

1. Completely agree ___ 2. Agree mostly ___ 3. Agree somewhat ___ 4. Agree except for exceptions ___ 5. Disagree due to a personal experience and/or recent incident ___ 6. Disagree due to personal incidents and reported incidents of other patients on staff , and even patient on patient violence. ___ 7. Disagree due to more than one reported incident/personal experience. ___ 8. Disagree and feel hospital/management staff know about this problem. 9. Disagree and feel threatened on the job. ___ 10. Disagree and demand hospital/facility supported training exercises meant to improve staffs’ well being and knowledge of safety procedures in case of emergency assault by a patient.

**
Additional questions:

1. Homecare nurses are safe from violent attacks as well as healthcare facility/HMO nurses.

1. Completely agree ___ 2. Agree mostly ___ 3. Agree somewhat ___ 4. Agree except for exceptions ___ 5. Disagree due to a personal experience and/or recent incident ___ 6. Disagree due to personal incidents and reported incidents of other patients on staff , and even patient on patient violence. ___ 7. Disagree due to more than one reported incident/personal experience. ___ 8. Disagree and feel hospital/management staff know about this problem. 9. Disagree and feel threatened on the job. ___ 10. Disagree and demand hospital/facility supported training exercises meant to improve staffs’ well being and knowledge of safety procedures in case of emergency assault by a patient.

2. I would never sue my employer if due to a patient attack I lost the ability to work/motor skills.

1. Completely agree ___ 2. Agree mostly ___ 3. Agree somewhat ___ 4. Agree except for exceptions ___ 5. Disagree due to a personal experience and/or recent incident ___ 6. Disagree due to personal incidents and reported incidents of other patients on staff , and even patient on patient violence. ___ 7. Disagree due to more than one reported incident/personal experience. ___ 8. Disagree and feel hospital/management staff know about this problem. 9. Disagree and feel threatened on the job. ___ 10. Disagree and demand hospital/facility supported training exercises meant to improve staffs’ well being and knowledge of safety procedures in case of emergency assault by a patient.

3. I have a support network of training, staff and security at work capable of preventing injuries from patients.

1. Completely agree ___ 2. Agree mostly ___ 3. Agree somewhat ___ 4. Agree except for exceptions ___ 5. Disagree due to a personal experience and/or recent incident ___ 6. Disagree due to personal incidents and reported incidents of other patients on staff , and even patient on patient violence. ___ 7. Disagree due to more than one reported incident/personal experience. ___ 8. Disagree and feel hospital/management staff know about this problem. 9. Disagree and feel threatened on the job. ___ 10. Disagree and demand hospital/facility supported training exercises meant to improve staffs’ well being and knowledge of safety procedures in case of emergency assault by a patient.

4. Reporting an attack by a patient will not harm my employment relationship of affect my employment duration.

1. Completely agree „ ___ 2. Agree mostly „ ___ 3. Agree somewhat „ ___ 4. Agree except for exceptions ___ „ 5. Disagree due to a personal experience and/or recent incident „ ___ 6. Disagree due to personal incidents and reported incidents of other patients on staff , and even patient on patient violence. „ ___ 7. Disagree due to more than one reported incident/personal experience. „ ___ 8. Disagree and feel hospital/management staff know about this problem. „ 9. Disagree and feel threatened on the job. „ ___ 10. Disagree and demand hospital/facility supported training exercises meant to improve staffs’ well being and knowledge of safety procedures in case of emergency assault by a patient. ___

5. I have never been kicked, hit, struck, scratched, shot, knifed, or attacked by a patient.

1. True ___
2. False ___

***

1. Completely agree ___
2. Agree mostly ___
3. Agree somewhat ___
4. Agree except for exceptions ___
5. Disagree due to a personal experience and/or recent incident ___
6. Disagree due to personal incidents and reported incidents of other patients on staff , and even patient on patient violence. ___
7. Disagree due to more than one reported incident/personal experience. ___
8. Disagree and feel hospital/management staff know about this problem.
9. Disagree and feel threatened on the job. ___
10. Disagree and demand hospital/facility supported training exercises meant to improve staffs’ well being and knowledge of safety procedures in case of emergency assault by a patient. ___

Nursing and Super-Obesity

Posted by nurse on July 29, 2011 under Critical Care, patient health | Be the First to Comment

Nurses see a lot the general public rarely gets to see. They see people at their best and worst, their most faithful and most hopeless, and their most courageous and most desperate. But one observation universally true among nurses at all levels is the increase in obese and morbidly obese patients of any kind and caliber. While genetics, diet and a sedentary lifestyle can be determiners, super obese patients pose a threat to their own health by arresting their horizon for recovery from anything from a heart attack to a stroke, from a freak car accident to a serious fall.

The consequences of obesity in patients are increasing. Lost work, custody of children, poor self-image, decreased chance of healthy relationship, and reliance on mood medications are only some of them. And the problems that complicate their new and recurring medical problems are progressively worse conditions such as pulmonary irregularity, hypertension, cancer, sleep apnea, and diabetes.

The problem of obesity in industrialized countries is costing health care companies, nations, and the population dearly. Elderly patients and children and adolescents who are obese carry increased risk from other developng conditions. Super Morbid Obesity is the category of persons with over 225% of their normal body weight. Individuals waiting for a wonder drug are just kidding themselves, and putting a strain on healthcare programs they are a part of.

But even while some patients may feel they are only slightly obese, they may qualify as morbidly obese. And among the morbidly obese patient volume there is now a new subcategory of patient, the super-obese or super-super obese person. These patients may or may not qualify for bariatric surgery or dueodenal switches, longeitudinal gastrestomatic changes via surgery or other perioperative reatments for conditions directly and secondarily related to morbid obesity.

They learn by observing repetition of symptoms in some patients, and individual abnormalities in others. By mentally cataloguing and remembering each case, a nurse can improve their relative and associative knowledge of medical treatments by noting when patient response to treatment is positive or negative. This framework of clinical experience can enrich a nurse’s perspective and qualify them over time to drive patient to better habits and encourage positive changes in daily routine and diet.

If the obese in this country, and around the world, knew what additional medical dangers they were creating for themselves by cultivating a physique with too much extra weight, they might be illuminated by the counseling of the nearest nurse practitioner or nutritionist. Nurses see when patient are too bulky to use certain equipment with, and nurses are the ones challenged when a patient needs treatment but the nurse cannot find a vein or abdominal fat creates a barrier to appropriate examination and surgery.

Nurses have a privileged viewpoint of obesity and the standpoint of modern medicine behind them. Of all the counselors who might lecture to the morbidly obese and motivate them to lose weight, nurses are the primarily best personae. They can immediately tell when an individual is at risk for obesity related disorders, of which diabetes is only one.

When morbidly obese patients visit a clinic or hospital, they might need a special scale the facility does not have or require some special blood pressure mechanisms cannot be used effectively due to their body mass. Statistics show morbid obesity increase the frequency of doctor’s visits and frequency of maladies and disorders of skin, cancer, circulation and the heart. But super obese patient present a logistical and well as acute critical care situation with every visit.

Super obese patients need extra room in the waiting room, restroom, and consultation room as well as operating theater and technology suites. This can cause administrative problems for hospital and clinics as well. Elderly patients become dismayed when a modest clinic cannot treat their condition, when the healthcare facility may already have every bed that can handle their weight filled. Nurses need special motorized beds to raise patients to the proper angle and height for correct treatment. Morbidly obese patients can overload the system.

The entire perspective of a physician who has to deal with the limitations of blood pressure, circulation, physical activity, and diet of the morbidly obese patient is slanted toward a delimited healing horizon the patient themselves has put in their way. The physician is rare who tries not to groan inwardly when an obese patient presents with symptoms, because an elaborate guessing game has just begun. The doctor must analyze how many of the patient’s symptoms are actually specific to their weight problem and how many acute due to a disorder from another cause or from an already present super obesity.

The labeling of a patient as morbidly obese is not an abusive pejorative term, but a medically correct term for people with body mass concentrations over a certain index measurement of their height and weight. These patients have limitations of breathing and blood activity pressure that crosses off the list many effective medications. Since the side effects of some extremely effective medications might be numbness circulation loss or increased heart activity, morbidly obese patients cannot risk this. Nurses see how confused obese patients become when they learn that the regular alternatives afforded to more weight-proportionate patients cannot be applied to them.

Nurses treat the distaff maladies associated with extreme obesity that most people do not understand and never get to see. The patients who are bedridden with pressure sores, diabetic strokes, and numbness do not get observed by the general public. But nurses follow the progress of patients through initial admittance through a care plan, and can advise those bordering on morbid obesity the chasm that lies before them. And nurses can see with their own eyes how many more patients in any hospital are obese, morbidly obese, and super-obese.

The message for continuing healthcare should be clear. Eradication of obesity as a present factor in any condition, even everyday health, is the most positive treatment factor for any potential care plan. Individuals of all ages and ethnic types, of any gender and persuasion should be encouraged actively to reduce their weight. The future of their own healthcare is at stake.