You are
Joined: 14 Jun 2003
Posts: 1
Posted: Sat Jun 14, 2003 3:48 pm Post subject: The Bomb, Joyce
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What an example of what a nursing professional should be! I'm so glad you're on our team!!!
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patient
Joined: 29 Oct 2002
Posts: 137
Posted: Sun Jun 15, 2003 5:17 am Post subject: Why no education?
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aprnjam,<
>I agree with everything you said, but one thing caught my eye. We had a patient support group and we asked the doctor and staff to take part as guest speakers to teach us about dialysis. The SW told us she wasn't taking her Sundays to come to the meetings and its doubtful anyone else would either ( I know, great SW ). But as it turned out, she wasn't far off. We got minimal help.<
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>The times the doctor or staff turned up it did help patients greatly, but although we invited them continually they didn't take the effort seriously. <
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>Some staff would go on and on about the number of patients who came to the meetings. It wasn't many and they took that to mean that the meetings weren't working. In actuality, the meetings were working very well for the few who attended.<
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>I told the doctor that if he would spend some of his doctor round time teaching the patients something and if other staff would teach and answer questions IN the unit then patients would care more about their txs. The doctor laughed and said most patients don't want to learn. <
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>My question to you is, is this the attitude medical people are taught to have in medical school? Are they taught to have the patients rely on them for everything or are they taught to withold info from patients? Do they think that only medical people like you with a teaching ability should teach patients anything? Because without education patients are being put in their graves sooner..much sooner.<
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>I've heard that in the best units, education is very big. Some units use little fun quizzes and any method they can to get education to the patients.<
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>I feel very concerned when I observe things like a nurse giving a patient the total wrong info on his diet like telling him not to ever eat certain foods, when the truth is he has to be very careful with certain foods, but he may eat in moderation. Or I heard a patient recently say to the nurse, "Am I bad because my phosphorous is too high? <
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>Patients are very impressionable and if they are told the wrong thing they become very confused. That's why there should be accurate education and not false info circulated around. <
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>And I just wonder why you think doctors and staff don't think it's their responsibility to educate or that only certain staff can teach? <
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>The time our doctor taught at our group he did an amazing job. We all marvelled at what a good teacher he was, but he had the attitude like no one could really understand him. It wasn't true -we understood him very well and enjoyed learning about our bodies and condition. <
>After about a year, our group came to an end. Some of the most faithful attenders died. Others just gave up on it as they found it difficult to maintain an attiude of continually learning about their disease, because the medical people would not support us.<
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>When the group folded, the doctor then came out of the woodwork and told me the group had been a good thing and he wished that I would continue it. But I felt that the group would not go forward, because the doctor and staff would not take their responsibility to educate. I never could get this across to them and decided to end my work with the group as a statement to them that dialysis has to include education in the unit at the teachable moment or patients will not thrive.Trying to elicit change in that unit was like trying to beat a dead horse and wake him up..it just wasn't going to happen.
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aprnjam
Joined: 28 Apr 2003
Posts: 85
Posted: Sun Jun 15, 2003 4:02 pm Post subject: There is no excuse
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for a physician not to educate a patient on any subject. The younger doctors have been taught that this is to be part of their practice. However, once they get into actual practice, many of them tend to forget this vital portion of their practice because their practices dictate that the more patients they see in a day, the more money they make. Physicians do not make as much money as many people think. I know physicians who only make 80-90K/year, where others are making much, much, more. The ones making less money, are the ones who are taking the time to educate their patients.<
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>Most physicians and professional staff will not give up their day off too come to a meeting where they are not paid. Sorry, but this is just the plain old truth. Unless the organization that they work for requires that they do some sort of public service, it won't happen. They will not give up time with their families to attend a meeting of this sort.<
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>The statement that the doctor made about most patients not wanting to learn, is sad, but very true. I can not even tell you the number of patients I have tried to educate about their disease processes and they tell me that they have either "heard it all and don't care anymore" or that "you will handle it and I don't need to know." It's very rare that you find patients that really want to be educated.<
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>No one, in any medical program, nurse practitioner program, or physician assistant program is taught to withhold information from a patient. We are all taught to teach them about their diseases processes. It is very difficult to teach the patient when the majority do not want the education and assume that the healthcare care provider will take care of everything. So many patients still feel that the the healthcare provider will "take care of everything and tell me what I need to know." This is the old fashioned paternalistic view of medicine, and it is very difficult to change in so many patients.<
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>The problem with the nurses is the level of education that they receive. The majority of registered nurses are Associates Degree nurses. I am not trying to be disrespectful to these nurses, but they often do not receive the intensive microbiology, pathophysiology, nutrition, nursing theory, nursing education classes that the Bachelors or Master's prepared nurse receives. While there are many excellent Associates Degree nurses, this has been a debate among nurses for many years. The Associates Degree was created in the 1960's to meet a severe nursing shortage, and many areas that are critical to nursing where cut short, and continue to remain short in the programs. In the Bachelor's programs, nurses are required to complete one year of pathophysiology, one year of microbiology, one year of chemistry, one year of psychology, one to two semesters in nutrition, all the core courses that lay all the necessary groundwork for a good solid knowledgeable background in nursing. The upper nursing courses contain classes on nursing theory, nursing research, nursing concepts, where we are taught to apply the principles of patient education, and we are have the background in the sciences to teach the classes without making errors. In a Masters programs, you have even more in-depth classes in pathophysiology, patient education, etc. All the extra education, gives the BSN or MSN prepared nurse the educational background to provide the proper information as well as the resources to be able to find the information if unable to answer the questions. I teach in a AA to BSN program, and I have 3rd and 4th year students who are unable to research a problem and use critical thinking skills and determine and answer, and they have been nurses for as long as 20 years. When they fail their exams, they are angry and challenge me, and it all boils down to they think they have enough pathophysiology, so they don't bother to read the book or my lecture notes, so they fail the exam. A sad, but true fact. I fail at least 1/2 of each of my classes.<
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>Nursing has made a move to have only certain nurses as nurse educators in an effort to help decrease the confusion that is caused by the multiple people giving multiple information, some of incorrect to patients. Many facilities are now hiring nurse educators in specific fields to do all of their patient education. These are usually BSN or MSN prepared nurses whose speciality is the topic they are teaching, and the patient spends time with this nurse until all questions are answered and the patient understands. It's a wonderful service, if only all facilities would use them. Many facilities (I'm not speaking
about dialysis units in this case) have found that by using the nurse educators that the patient gets more consistent information instead of misinformation from several people. Often the doctor is unable to discuss the issues with the patient and
ing it down to the patient's level, sad but true fact, and they often leave the patient education piece to nurses. Again, this is my personal opinion, but the dialysis units would be in a lot better shape if they would hire a nurse educator who is a specialist in dialysis to educate each and every patient there and answer your questions when needed. Hopefully, someday, that will be a reality.<
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>When physicians speak to the lay public, they often feel that they are not making themselves clear, and that they are using language that the general public will understand. They feel that if they explain it to you once, then you should have it. Most physicians are very intelligent, and they feel that the members of their audience should be able to get what they are telling them in one lecture and that they should not have to repeat it. They "forget" that they are not talking to a group of their peers who are well versed in the pathophysiology of a disease process, but to lay people who are trying to learn, and their frustration level is very low. I once had an argument with a physician about changing the verbiage in a letter that was being sent to the patients explaining changes that were being made in the clinic. I stated that a sentence needed to be restructured, because our patient population was poor, undereducated and would not understand the verbiage he had contained in one sentence. I wanted him to simplify it. He refused, and sure enough, as soon as the letter was sent to the patients, the switchboard was inundated with phone calls asking what did he mean by that sentence. This is a place where BSN or MSN prepared nurses can fill in the gap and make the patient education piece effective for the patient. Nurses are trained to be able to teach patients at all educational levels, and to develop methods to teach the patient, where physicians are not routinely taught this skill. Hopefully, this will be something that we can change someday and have good patient educators in all dialysis units. Let's keep our fingers crossed!!!!
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Mon Jun 16, 2003 12:38 am Post subject: Education
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The education that dialysis staff gets is "one size fits all" education! They are taught for instance that if a pt. has high bp when they come in for tx. it MUST be because the pt. needs fluid removal. They tell pts. "you can't drink oj", "you can't eat chocolate at all, ever" ect.. The other day I overheard a tech. tell a pt. that she wouldn't
ing the pt. a second cup of ice because "I'm taking fluid off of you,and you can't have anything to drink". I had to fight to have them not take off prime and rinseback; I was told "everyone has to have it taken off if they're a dialysis pt.", never mind that I didn't need any fluid removal and have no fluid restrictions. There is no thinking behind what is taught, they are just told "this is the way it is". They learn to believe what they are told, and don't do any reasoning, therefore trying to apply the same rules to every pt. <
>In regards to infections, MRSA is scarey! My mother was a diabetic receiving wound care in both the nursing home and hospital, and the things I saw were downright frightening! Supplies were left on a cart exposed, or as in the case of the hospital tape and dressing materials were left in a window sill, or on bedside table. In the nursing home supplies were on the med. cart, and the nurse didn't wash her hands or put on gloves. When I was present I said something, but I wasn't there to keep watch every day. My mom ended up with MRSA, and she also had amputations. I've seen more MRSA infections, and wound care gone bad than I ever thought I would, but know that it doesn't have to be that way; it's not hard to wash hands and wear gloves, and anyone who is that lazy that they won't do it should find another profession where cleanliness is not a problem! Lin.
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aprnjam
Joined: 28 Apr 2003
Posts: 85
Posted: Mon Jun 16, 2003 3:33 am Post subject: I couldn't
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agree with you more. Education MUST be tailored to the individual patient. Again this falls into the category of the level of education of the people caring for you. If you have someone who is run through a program in a short period of time, then it stands to reason they are not going to the base of knowledge that they need to provide the best care possible. You CAN NOT learn something as intricate as dialysis or wound care in a few weeks without having a solid background in the sciences. When I say sciences, I mean all the microbiology, chemistry, pathophysiology and all the other things that the BSN or MSN prepared nurse must take to obtain their degrees.<
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>I also agree with you that MRSA infections are some of the worst out there and they are scary. I have walked in and seen nurses not wash their hands or put on gloves to do wound care, and I have been known to throw charts across the nurses station, call the Director of Nurses down, turn the facility in, and have the nurse fired. I DO NOT stand for that kind of care. There is no excuse for someone NOT washing their hands or wearing gloves. Wound care supplies should NOT be left in the room, but on the wound care cart, where they can not become containimnated. This is why there is such an issue in nursing homes today. A lot of this decreased when they finally put full-time geriatric nurse practitioners in nursing homes, but since Medicare decreased reimbursement for geriatric nurse practitioners, many of us are looking for jobs and a vital service is now missing in many nursing homes. When the nursing homes knew that they either had a GNP on staff, or that the physician had hired a GNP to work for him to visit the facility 2-3 times a week, a lot of this behavior stopped. We made a big difference. With the cuts, now a lot of this behavior may resurface. Lin, I'm sorry, but evidently your mother was not in a facility where a GNP was present. There are ways a person can investigate a long-term facility prior to placing a loved one there. If anyone would like to know more about this, contact Arlene and she can give you my e-mail address and I can give you some tips on how to find a good nursing home for a loved one.
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Wed Jun 18, 2003 12:28 am Post subject: Thankyou!
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My point was that lack of infection control happens everywhere; it doesn't take a complete lack of it, but rather small
eaks to infect pts.. I've seen it myself while working in healthcare many years, and have again seen it in the nursing homes, hospitals, and now see and hear of it in dialysis units. An institution can have in place rules on such, and most people can even follow them, but if one doesn't just one day a person can become infected! It's not just education, but enforcement too. It's a shame that educated professionals must be policed for infection control, but it's neccessary!<
>The nursing home and hospital my mom was in was rated top notch, and there were infection control regs. in place, and posted everywhere. There was antibacterial lotion and soap everywhere, and instructions posted on the importance of using them. What does it take? Closed circuit cameras documenting whether or not staff does what they are supposed to? I've seen both good staff, and bad staff. Unfortunately all it takes is one
each of infection control standards, and the pt. pays the price! Lin.
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aprnjam
Joined: 28 Apr 2003
Posts: 85
Posted: Wed Jun 18, 2003 7:49 am Post subject: What it takes
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is people who care about their job and their patients. If we had more that REALLY cared we wouldn't have these problems.
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Thu Jun 19, 2003 12:26 am Post subject: Need more like you!!!
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aprnjam
Joined: 28 Apr 2003
Posts: 85
Posted: Thu Jun 19,
2003 1:19 am Post subject: Thanks
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There are alot of us out there, but unfortunately, we're scattered in different places across the US. A lot of the MSN prepared nurses that care are nursing instructors and we are doing are best to instill these values in the nurses that we teach. I can tell you that the drop rate in my classes is high, almost 50% because "my expectations are too high." If they think my expectations are too high, then I don't want them in my class or in nursing!
