Tuesday, February 28, 2017

Nurse Sara? Nurse Turpel?

In their book, From Silence to Voice: What Nurses Know and Must Communicate, Bernice Buresh and Suzanne Gordon propose that the title “Nurse” be resurrected as a means of identifying nurses to patients, families, and other health care providers.  We should identify ourselves with the title Nurse before our last name.  These authors say that nurses identifying self and other nurses to patients, families, and physicians by the title Nurse (as in Nurse Turpel) displays professional courtesy to each other and indicates that professional recognition is expected.  

Buresh and Gordon list the same reasons that I’ve heard from nurses regarding not presenting their last names to patients.  They address all of these reasons – being more approachable, invasion of privacy, last names are not necessary to garner respect, and potential dangers to health care providers – and provide arguments against them.  Good arguments, but I’m not completely convinced.  

There is something to be said for using titles when addressing someone.  It’s the reason we teach our children to use Mr. and Mrs. when addressing adults instead of first names.  Even when I remind students in my online classes that I prefer to be called by my first name, they continue to use “professor” or “Mrs. Turpel”.  For the physicians I know well and call by first name, I still use the title Dr. when talking to them or about them in front of patients.   

Buresh and Gordon’s entire book is about how nurses can present themselves so that the public and other health care professionals understand our role.  Definitely, this is important.  People still have no idea what nurses do.  And, I do think there is plenty we can do to advance the nursing profession and communicate better about our profession with the public.  

I’m still not sure about using the title Nurse, though.  How about you?

Saturday, February 25, 2017

Is There an Excuse for Poor Nursing Care?

My friend’s mother is in the hospital and is receiving poor nursing care.  When my friend first started telling me about some of the things that were happening, I tried to convey empathy, but, honestly, in the back of my mind I was thinking that maybe my friend’s view was distorted.  As the days have gone by, though, I realize that her mother is getting, plain and simple, poor nursing care.

It’s heartbreaking.  This profession is important to me and to hear that a fragile, older adult patient is not moved, not cleaned, and not offered hydration and nutrition is horrible.  Maybe, possibly, perhaps, if, at least there was some continuity of care, if nurses caring for her knew what the plan of care is on a daily basis, if nurses even knew what the basic equipment being used on this patient is, if they knew when her conditioned worsened and notified a provider, it would be possible to overlook some of the lack of solid basic nursing care.  Maybe.  

Unfortunately, that’s not even the case.  

What has been offered to my friend as a defense for the poor care? 

“I got busy.” “She’s a new nurse.” And, though these are bad enough, even more excuses.

Is there an excuse for bad nursing care?  Why does it happen?  

There is a big focus right now in healthcare on avoiding medical errors.  Huge efforts are made to put in place processes that stop errors from occurring because, we know, healthcare processes are complex and most errors occur because of system failure.  “Nobody goes to work and wants to hurt a patient”, we often hear.

Then why is my friend’s mother not receiving even the most basic nursing interventions?

Nursing school is not easy.  The nurses caring for her had to graduate from a reputable program and pass the licensing exam; then they had to get hired by this hospital system, which has a good reputation in the area.  Presumably, these nurses are not going to work every day with the intent of providing poor nursing care. 

Still, they are. 

Even when nursing leadership became aware of this poor care, things haven’t changed.  

Roberts and Ion (2015) propose that participation in poor nursing care is from a thoughtlessness that comes from habituation, or conditioning, to the health care environment.  

I wonder if the excuses that have been presented to my friend are indicative of this habituation or conditioning.  

Is busyness an excuse for poor care?  I know that good staffing is linked to good outcomes for patients, but nurses’ busyness is not necessarily from poor staffing.  Is the fact that the nurse is new an excuse for poor care? If Roberts and Ion are correct, then it should be just the opposite.  The novice nurse should be providing excellent care, having not yet been conditioned or habituated to the environment. 

So, I have to ask, is there an excuse for poor nursing care?  

Roberts, M., & Ion, R. (2015). Thinking critically about the occurrence of widespread participation in poor nursing care. Journal Of Advanced Nursing, 71(4), 768-776. doi:10.1111/jan.12586

Friday, February 24, 2017

I Told You!

More evidence that the gut is the most important organ in the body…as I’ve been saying for years now.

There is a link between constipation and chronic kidney disease.

Researchers* found that chronic kidney disease occurred more often in people with constipation AND end-stage renal disease was more prevalent in those with constipation.

Yep, it’s all about the gut

*Sumida K. et al. (2016). Constipation and incident CKD. JASN, 11.10.2016.