Hospital Duty -- Part 5 Dealing with Nurses
The nurses serving your loved one can be you ally or enemy. They can work with you or keep you in the dark. It’s always my aim to work with them, to support them in any way I can, and to be as friendly and gracious as I can be. When I arrive I the morning, I check the white board in the room and find out who is staffing my loved one. There is always an RN and one or two other staff. These others vary by facility, but are always lower levels of licensing. In California, you will find Licensed Vocational Nurses (LVNs) and Certified Nursing Assistants (CNAs). As soon as possible, I make contact with each of these people and introduce myself if they don’t know me. I check on what’s happened through the night and any scheduled procedures for that day. I always try to be positive and upbeat. It will pay off when I need something.
It’s important to know who does what in your hospital. For example, only an RN can give medications, start an IV, or do certain other procedures like complex dressing changes. If you ask one of the other staff for this, all they can do is give the message to the nurse. Generally bed changes, grooming, and toileting are done by the other staff. Don’t ask the RN.
Nurses these days are overworked and under-appreciated. Many work 12 hour shifts. They may or may not have time to review the patient's full record, especially if things are changing quickly with the patient. This is where my notebook and I shine. I'm often the only person in the room who knows the what’s been done and what the history is. I assume that they know what they’re doing until I see something that concerns me. Then I'll ask a question. Either, “what” or “why,” or if I'm sure something is not right, “Are you aware…?” The what’s and why’s educate me. For example, one nurse mentioned that my sister should not have an IV because the antibiotic she was on was hard on the veins. There were two IV nurses checking her arms for a good IV site. After a bit I said, “By the way, are you aware she’s on vancomycin?” They obviously hadn’t checked her chart. “Oh, that changes everything!” they said and proceeded to order a picc line. Incidents like this happened several times per hospitalization.
I always try to check out with the nurses when I'm ready to leave. And I always try you be upbeat and gracious. It usually pays off with both information and suggestions, and better care for the one who often doesn’t feel well enough or alert enough to be gracious. So work with your nurses. Be their asset, not a nuisance. You’ll be glad you did.
Photo Courtesy of Flickr Creative Commons/Christiana Care
Labels: advocate, hospital, nurse
Tuesday, May 08, 2012
Hospital Duty -- Part 4 Dealing with Doctors
My goal is to talk to every doctor on the case at least one a day. In the hospital system Sis and Mom are in, a hospitalist has primary responsibility for inpatients, with specialists being called in as needed. I’m usually able to get the hospitalists to agree to come while I'm there since they are in the hospital all day. Specialists, on the other hand, are coming from their practices and they come when they come. However, I would tell each one when I expected to be there and many have accommodated me. I keep a list of questions for each provider so I can use their time efficiently. By being the constant voice for the patient, I find that most physicians not only work with me, but even appreciate my participation as long as I don't try to do their jobs for them. Again, the patient is usually too sick to ask good questions or remember what’s said. They need an advocate who is tracking for them.
Photo Courtesy of Flickr Creative Commons/Yuya Tamai
Labels: advocate, doctor, hospital, physician
Monday, May 07, 2012
Hospital Duty -- Part 3 Take Good Notes
One of the keys to my effectiveness as a patient advocate is the spiral notebook I maintain for each patient. This is simply a chronological record of everything I learn and questions I have. On the inside front cover, I list the names and telephone numbers of each physician. This is particularly important as in my sister’s case where she’s seen at least a dozen docs over the past year and a half. I also keep track of the names of office staff I've talked to. They appreciate being called by name the next time I call back.
Each day I'm at the hospital I note the date and anything of importance that happens that day -- tests, physician consults, med changes, allergies, answers to questions, problems, names of helpful staff, ... anything ... I also log telephone calls both during and between hospitalizations. This binder has been invaluable over time. I'm usually the only person in the room with an accessible record of care, especially over multiple hospitalizations. I can't tell you how many times my notes have prevented duplicate tests or treatments or even treatment errors. This not only protects the patient, but also helps the staff do their job better. So as soon as you know you’re in for hospital duty, grab a notebook!
Labels: advocate, hospital, notes
Friday, May 04, 2012
Hospital Duty -- Part 2 -- Your Presence is Required
I know this isn't always possible for GenSandwichers, but if a loved one is in the hospital, it's important for them to have an advocate on site at least during the day. It would be ideal to have someone in the room 24/7 but I know that's almost impossible for most of us. But try to be present as much as possible during the day.
When Sis and Mom were in the hospital, I would arrive as early as possible, which for this night-person was usually 9:30 or 10:00 am, and would stay at least until after dinner. The exact times depended on what was being done that day, how important my presence was, and how far I had to drive. If a procedure was scheduled early, I would be there for that. Otherwise, I would arrive by 10:00.
Why is this important? These days you don't get to stay in the hospital unless you're very ill. This usually involves pain meds, painful tests, and even surgery. The result is that the patient is usually in no condition to advocate for herself or understand what is being done for what reason. She's often sleeping, groggy, in pain, and disoriented. And some, like both Mom and Sis, are afraid to advocate for themselves. They take on even more of a passive victim spirit than usual. They don't want to offend or inconvenience the staff, so they let things go.
So my job is to advocate for them. My job is to not be afraid. Of course I try my best to be polite, innocent, even humorous so as not to offend, but I'm awake and alert and the patient isn't.
Of course, it helps if you know something about medicine, but that isn't a requirement. My rule of thumb is to ask questions until I understand. If I can't get an answer from one person, I ask the next one. I keep asking until I learn the terminology and understand the concept. Then I can explain it to the patient. I find that most staff is willing to answer questions if I'm sensitive to the timing. And since I relieve them of some of their more mundane responsibilities, they quickly learn to value my presence and work with me.
So if possible, be present as much as you possibly can.
When Sis and Mom were in the hospital, I would arrive as early as possible, which for this night-person was usually 9:30 or 10:00 am, and would stay at least until after dinner. The exact times depended on what was being done that day, how important my presence was, and how far I had to drive. If a procedure was scheduled early, I would be there for that. Otherwise, I would arrive by 10:00.
Why is this important? These days you don't get to stay in the hospital unless you're very ill. This usually involves pain meds, painful tests, and even surgery. The result is that the patient is usually in no condition to advocate for herself or understand what is being done for what reason. She's often sleeping, groggy, in pain, and disoriented. And some, like both Mom and Sis, are afraid to advocate for themselves. They take on even more of a passive victim spirit than usual. They don't want to offend or inconvenience the staff, so they let things go.
So my job is to advocate for them. My job is to not be afraid. Of course I try my best to be polite, innocent, even humorous so as not to offend, but I'm awake and alert and the patient isn't.
Of course, it helps if you know something about medicine, but that isn't a requirement. My rule of thumb is to ask questions until I understand. If I can't get an answer from one person, I ask the next one. I keep asking until I learn the terminology and understand the concept. Then I can explain it to the patient. I find that most staff is willing to answer questions if I'm sensitive to the timing. And since I relieve them of some of their more mundane responsibilities, they quickly learn to value my presence and work with me.
So if possible, be present as much as you possibly can.
Tuesday, December 04, 2007
Health Care Advocates for Mom and Dad
The Milwaukee Business Journal writes than an increasing number of adult children are becoming advocates for their aging parents’ health care needs. This is having an impact on employers as these advocates are present at work, but preoccupied.I’ve found that I need to be increasingly involved with Mom’s health care needs. She doesn’t hear well, nor does she understand much about the complexities of her medical needs. She nods like she understands, but if I challenge her, she really doesn’t know what the doctor said or what it means. To top it off, she’s what we used to call the “worried well”—people with minor health issues who are convinced they have cancer, heart problems, or something equally serious.
I’ve taken to having her make as many appointments as possible in a two-day period when I can plan to be there. It tires her, but we sure get a lot done. Recently we saw the podiatrist, the hearing aid specialist, and the neurologist. In each case, the problem was less serious than she had been telling me it was, based on her understanding of what they had told her last time. We got a lot done in a little time and I was so glad I was able to go. And this time, we even had time to take her for a drive!
Labels: advocate, aging parents, health care, medical care