Navigating HealthCare

 

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I am going to give you some basic tips for getting through your next hospital visit.

1.    Carry your insurance card as well as some form of identification with you.
2.    Have a list of your medications and maybe even several copies. Have the list up to date.
3.    Write down past medical history on that list.
4.    Write down your allergies and tell them to everyone that you see.
5.    Show up early for your appointments. Registration takes time.
6.    Have a list of your vaccinations. Know what you have had and when.
7.    Ask, ask, ask questions. Don’t be a bystander in your healthcare, be an active participant.
8.    When someone gives you a drug, ask what it is for.
9.     If someone orders a test, ask why.
10.    Ask for your test results.
11.    Ask for explanations. It is your right.
12.    If you feel uncomfortable, tell someone.
13.    Carry a notebook and pen with you during a hospitalization to write down any questions that you have.
14.    If you have a healthcare proxy form or any advanced directive form, bring that with you.

This is just a small list, but by asking questions, having the appropriate documentation and lists with you- you can make your journey through the healthcare system much more manageable.

~SarahLee, RN

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So You Want to Be a Nurse?

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Are you thinking of changing careers? Are you thinking of finding a career? Have you thought about being a nurse?

Being a nurse can be great work, but it can be hard. A nurse often works 8-12 hour shifts, sometimes without breaks. A nurse sees people at their worst and at their most vulnerable, when they are sick. Being a nurse can be very rewarding, but to become a nurse should not be taken lightly.

I thought that I would offer a little bit of advice to you about what to consider if you are considering nursing.

First, why are you thinking about being a nurse? Do you care about people? How are you when someone is hurt? Are you sympathetic? These are all good qualities to have if you want to be a nurse. If you don’t have the foundation of caring for others, you may burn out very quickly.

Do you know what a nurse does? A nurse does much more than hand out band-aids and water. A nurse assesses patients, formulates a nursing diagnosis, implements a plan of care and then evaluates that plan of care. Each of those steps involve more than you might think. Have you ever followed around a nurse for a day? If you haven’t I suggest that you find someone to follow to get your feet wet and see if this is something that you want to do.

What kind of nurse do you want to be? There are (in the United States) LPNs, or Licensed Practical Nurses. There are RNs, or Registered Nurses. Each of these nurses have different job descriptions and responsibilities. A person can become a LPN generally by completing a 1-2 year course. A person can become a RN by several different routes. To be a RN you have to have an Associates degree or a Bachelor’s Degree. The interesting thing to keep in mind is that whether you have a 2 or 4 year degree, everyone has to take the same board test for nursing, the NCLEX. Many nurses obtain their 2 year degree, pass the NCLEX and then move towards their 4 year degree while working as a nurse. Other nurses go and get the 4 year degree and then take the NCLEX. Of course, following the ADN or the BSN, a Master’s Degree can be obtained in several areas including nurse education and nurse practitioner.

The great thing about being a nurse is that there are so many different areas to be a nurse! You could work in a hospital, in a home care setting, in a Dr.’s office, on ships, on planes and in other countries. Generally after a nurse graduates he or she works on a general Medical-Surgical floor for at least a year to gain experience. Many nurses then specialize in certain areas such as pediatrics, intensive care, emergency care and operating rooms.

There are many great resources out there for those who are learning about this profession. One great resource is the Johnson and Johnson Discover Nursing Campaign. This site provides information regarding the different areas of the nursing career path. The site also provides information about scholarships and schools for aspiring nurses.

This little article has only scratched the surface of what it involves to become a nurse. I encourage anyone who is seriously considering this amazing and at times stressful career to carefully do research.  Make sure that you would be a good fit for the profession, and that the profession would be a good fit for you.

I wish you well!

~SarahLee RN

Doctors and Nurses

Doctors and Nurses

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Linked are two articles, from which all in healthcare can learn and reflect. The original article is On Breaking One’s Neck: by Dr. Arnold Relman, with a complimentary article :A Patient’s-Eye-View of Nurses by Dr. Lawrence Altman.

There are compliments in both articles for nurses, as well as warnings that should be considered.

. As quoted from the original article :On Breaking One’s Neck:

“What personal care hospitalized patients now get is mostly from nurses. In the MGHICU the nursing care was superb; at Spaulding it was inconsistent. I had never before understood how much good nursing care contributes to patients’ safety and comfort, especially when they are very sick or disabled. This is a lesson all physicians and hospital administrators should learn. When nursing is not optimal, patient care is never good.”

The review article in the New York Times, written by Dr. Altman,  brings to light the thought provoking differences between physicians and the nursing staff. Dr. Atman expresses concern at the movement towards technology, citing technology as objects that can “Deflect the doctor’s attention.”

I think that nursing as a profession should also heed this concern-does our bedside report become just a huddle in the hallway? Are we including the patient? Are we prioritizing our time between the computer and the patient?

Hopefully we are not, as nurses, using as our starting point of care the review of notes-or as Dr. Relman so memorably states:

“Lengthy notes in the computerized record, full of repetitious boilerplate language and lab data, but lacking in coherent descriptions of my medical progress, or my complaints and state of mind.”

This is referring to the MD notes-but what about our nurses’ notes? Do they adequately reflect the patient? Do they just present the data, or the whole person? I have a tendency as a nurse to at times subconsciously rely on previous documentation-but our starting point needs to be the patient, not the notes. How are we doing? Do we clarify what we saw in the record with the living person in front of us?

Another nice quote, by Dr. Altman, complimenting nurses is as follows:

“Nurses’ observations and suggestions have saved many doctors from making fatal mistakes in caring for patients. Though most physicians are grateful for such aid, a few dismiss it — out of arrogance and a mistaken belief that a nurse cannot know more than a doctor.”

I think that nurses everywhere should read these two articles and be thankful for the recognition. But we should also realize that what is wise for the doctors is wise for the nurses.

We should never forget, in this healthcare system that is changing faster and becoming more difficult every day, the patient is first-and someday the person in the bed could be me or my family.

I had a nursing instructor once that said:

When you enter a room, and you see lines, and IVs, and ‘stuff’, don’t worry about all of those lines, start at the patient, and work your way out.”

Will our patients, will we, our families, be reduced to hallway huddles and medical note jargon and technical terminology? Or will our care be about the individual, the person, with a cautious inclusion of technology as needed?

These articles provide warning signs about our healthcare and we will do well to heed them, whether doctor or nurse.

Glimmers of Winter

My “glimmers” as brought about by the weekly writing challenge

It was odd, I thought, that the church on the corner, built of dark red brick, was light tonight. Stained glass windows, lining the sides of the church had gold beams streaming out of them, into the darkness of the street next to them. Always I had seen this church dark, like the night and the city around it, I had never seen it with light.

I had seen it in the early morning, with its chipped white steeple standing upright like a sentry. Its windows were stark in their darkness, even if the sun was shining.

I had seen it at night, with its wooden front doors, with the  stoop full of shadows, where the homeless sat, flicking their ash on the stone steps.

Tonight I saw, for the first time, the gold and red tints in the windows, the outline of a tree through the first window, with the leaves golden yellow and the trunk golden brown and I wondered why did they design a tree in the glass?

The light shown out onto the sidewalk, catching the back of a man walking away wearing a dark hat, winter coat and red snow boots. His hands were in both of his pockets and his head was bent, and I still don’t know if it was because he was cold or because he was just not used to the light.

Earlier in the week I sat on a bench in the mall, and watched a girl walk by in a short black skirt and red, high, high heels. Her long bare legs were striding with purpose as she talked rapidly on her pink sequined cell phone. I sat, with my winter coat and hat and scarf still on, and warm boots firmly in place still trying to get warm after having to park two miles away from the mall and then hike in through the cold. I wondered-how did she get through the slushy parking lot and the chilly wind to the mall without dying of hypothermia? And I really wanted to ask her but she was gone and I wouldn’t have, anyway.

I remember the bright midnight that I saw, that same night coming home when the moon was shining so bright it was like the sun in Hawaii, except it was winter and the moon. The shadows that it caused, reflecting the trees on the hard white snow and hearing in my mind the song ” I go out walking after midnight.” The crunch of my boots on the snow walking to the house because it was so cold and realizing, that if it wasn’t eleven degrees I would go out walking, but instead I curled up under my blankets and slept, at peace because of the amazing moonlight that bathed my world in a silent glow.

Please-Just Let Me Go Home Part II

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~Continued~

When I called the Dr.-he again prescribed an even higher dose of the same medication. I gave it, hoping that this time, it would be enough.

My shift was almost over, and as I was giving report to the oncoming nurse, Virginia was again trying to climb out of bed. Together, we both put her in a chair and brought her to the nurses’ station, attempting to calm her down as well as put her in a safe area where they could keep an eye on her throughout the night.

She was getting increasingly more agitated, and kept saying “Why is this happening? Why can’t I go home?”

I left feeling devastated that she had to be in such an emotional state.

The next day I heard what had happened after I left for the night.

Virginia did not get better. She continued to get more and more agitated throughout the night.  Even ANOTHER dose of the medication was given to her without any results whatsoever.

Finally, sometime before morning, one of the nurses was going through Virginia’ chart and realized that a medication she had been on at home had not been prescribed to her. A medication that a person could experience withdrawal from.

Surprised at finding this, the nurse notified the physician, who ordered the medication.

And by around noon the next day, Virginia was completely back to her normal mental state.

And she told me later that the night before had been “The worst night of her life, and she had lived a nightmare.”

I tell this story because I think of how I assumed. I assumed that Virginia, because she was elderly, was demented. How that once the night was over with some medication, she would be fine. That she was ‘sun downing’ and probably just had some ‘memory issues.’

I assumed that how I have treated dementia patients in the past was how I could treat Virginia.

When in fact, she did not have dementia at all, but was suffering from medication withdrawal!

Just because someone is elderly does not mean that they must or will be confused.

Just because one medication works in one situation, does not always mean it will work in another.

When giving care, never assume.

You could change a person’s life for the better.

Or for the worse.

You never know.

 

 

 

 

 

Please- Just Let Me Go Home

 

 

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She sat in her chair by her bed and talked to me about her life. She was busy, her house was a mess, and she didn’t know if she would be well enough to make Thanksgiving dinner for her family next week. This was her second night here at the hospital “Just because I fell” and she wanted to be home. She was “Sure my heart is fine, they haven’t found anything by now anyway.”

As I took her vital signs I encouraged her to eat her dinner and to “Worry about you. You can’t worry about what you are going to do until you feel better.”

She smiled and relaxed a little at the reminder. She started to eat her dinner and I continued on my rounds.

As I start my shift by assessing my patients, when I go in and out of rooms I continue to engage in ‘small talk.’ By this I let my patients know that I care, that I want to talk to them, they can talk to me and it also gives me a chance to assess their cognitive abilities.

As I left Virginia’s room I was encouraged to have met an elderly (80 something year old) woman without any evidence of confusion or an altered mental state.

The evening continued on and suddenly, around eight-o-clock, Virginia began to seem a bit more confused. She began to insist (kindly but firmly) that she was going home tonight, that her husband would be back to get her. Attempts by me to remind her of our conversation earlier that she would at least be staying in the hospital one more night did no good. She was very insistent but at times re-directable.

Several times over the next few hours we would find Virginia almost out of bed. She needed the help of a walker normally, although she could move quite well all things considered.

We had to put a call bell on her bed that alarmed every time she tried to get out.

She was getting angry, and trying to hit the staff.

She also seemed to have developed a bit of a body tic that could be noticed when she was laying in bed.

When the confusion began to get past the directable stage and I started to notice the tic I gave the Dr. a call and asked him to come out and look at her.

He very nicely arrived and came into assess Virginia. We both were aware that Virgina did partake of an alcoholic drink in the evenings. It was assumed that perhaps she partook of a bit more than she had revealed. The idea of ‘sun downing’ was also discussed and so he prescribed a small dose of IV Ativan.

The Ativan didn’t work. It didn’t seem to change anything and so I called the Dr. again.

He prescribed another dose of Ativan, again small.

I gave it, and it did nothing. Virginia was still climbing out of bed, her alarm kept going off, and she was insisting very strongly that she “Had to go home and where is my husband?

The problem was, however, that after the Ativan, Virginia was not only staying confused, she was also getting weaker and more unsteady on her feet.

By now it was ten at night and I was getting more and more worried that Virginia was going to fall and break a hip because she was getting more and more confused, agitated and now had strong medication in her system.

I had seen this scenario play out many times with dementia patients.

At one point I was two rooms down from Virginia administering medications. I heard her alarm going off and ran quickly to her room, only to find her already to the door, holding onto the door frame tightly because she was so unsteady.

She looked at me with a glazed and confused look and said “Please, I can’t stay here tonight, I have going home! I need to leave, I’m so sorry, why do I feel this way?”

And I looked at her and wanted to cry, because she could not process why she was here, needed to be here and could not go home. And I didn’t want to give her any more medications, but what could I do? She was too unsteady to walk, too agitated to stay in bed and too mentally distressed to relax.

So I helped her back in bed, persuaded her to stay there for about two minutes, and went back to nurses’ station to call the Dr. yet again.

~To be continued~

The Decision

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They met outside of the café. The sun was warm and the street was quiet.

He held out her chair and she sat. The metal seat felt cool through her summer skirt.

He sat across from her as the waiter came. They both ordered coffee, black.

It was brought to the table almost immediately.

Words were not exchanged as they sat there, sipping their coffee and looking out across the street.

She was watching two children playing in the fountain in the town circle.

He was watching the shop owner up the street wash his window. The window was covered in suds. Fresh Bread Made Daily the window said.

They could both smell the bread from their table.

Finally he spoke.

“We have to make a decision.”

“I know” she replied. She took another sip of coffee.

The children were running now, in circles around the fountain, laughing under the deluge.

Their mothers were sitting on a bench, talking and watching.

“I don’t really want too, you know” she stated.

“I know,” he replied softly, still watching the window washer. “But we don’t have a choice. She can’t…”

“I know she can’t,” she interrupted sharply. Realizing, her tone softened. “I just wish we didn’t have to be making this decision.”

“We have to,” he said again. “We owe this to her. She left the burner on again last night….you know she got lost last week…every since Dad died it’s been getting worse…”

Looking at the creamer on the table she decided that she would have some. Pouring it into her cup it made a cloud as the black coffee turned brown. She mixed it with the spoon just for something to do.

She thought. “Isn’t there a song out, something about clouds in my coffee…?”

She sighed.

“That was us, you know” she said, nodding towards the children and their mothers. “And that was her. When did this change? When did we become the ones having to make the decisions?”

He shook his head.

The window washer was rinsing his window. “Remember when she used to take us there?” he said. “She would let us have one slice of whatever we wanted.”

She smiled. “Only one, because we couldn’t ruin our dinner.”

They both laughed, strain combined with a good memory.

Sober, she said “She won’t like it.”

He set his cup down.

They looked at each other.

“She thought I was Uncle Steve” he said.

She nodded, biting her lip then looking away as tears started to come.

“Ok.” she said. Wiped her eyes with her napkin.

“Let’s start looking…”

“I have a list of places to start” he pulled a folded paper out of his pocket. “We can pick the best ones and then go visit them…”

And they began to compare and to discuss as the children went on playing in the fountain and their mothers continued watching.

And the window washer finished and went back inside his store.