Friday, October 12, 2007

Nursing histories for better patient care

The article about patients not recalling their medications brought back many memories from when I was working in the hospital. When patients are admitted, nurses do a nursing history that is quite similar to the medical history, but with a different goal. Although the patients have already been asked many questions, our questions were geared towards helping us understand our patients to be able to give good patient care. The more we learned about our patients, the better we could care for them.

One question that would get a lot of confused answers would be “what medications are you on?” So many patients, especially the older ones, would say, “the white one for diabetes, the blue one for high blood pressure…” Trying to track down which medication and which dosage wasn’t always easy. Challenging would be a good word. :-)

Other questions we asked were sometimes met with suspicion. We would ask what the bowel and sleeping habits were normally. I remember some families members getting really upset over these questions. The stress of their loved one being ill, the stress of the admission and all that went into it, and now they were being asked questions that seemed useless to them. I would explain knowing what is usual at home helps us a lot in the hospital. For example, if we have admitted someone who only has a bowel movement every three days, we’re not going to start pushing laxatives after 24 hours. If a patient usually stays up until 2 a.m., we’re not going to worry if they’re still awake at midnight.

Even questions such as if someone lived alone, if there were stairs in the home, and about living arrangements. These are all important issues. Nurses need to know what people are like at home in order to judge if they are having problems in the hospital. Equally important, nurses need to know what type of living situation the patient is going to be discharged to.

Most of us are aware that by the time we are doing the nursing assessment and nursing history, the patients have been poked and prodded more than they thought was humanly possible, and they have been asked questions until they can’t think straight any more. But, it’s also important to remember that nurses have a different take on patient care and the answers patients give nurses are for different goals than the answers patients give doctors.

News for Today:

Infants' cough and cold meds pulled from shelves
MS that Runs in Families Appears More Severe than Non-Familial MS
A little tipple might topple food-borne microbes
Statins cut risk of heart attack, but lifestyle changes still needed: scientist
Patients can't recall their medications to tell doctors
Anticlotting drug found to be safe in sickle cell patients
Prostate cancer increases hip fracture risk by eight times in 50 to 65 year-olds
COPD rates, higher than expected in China, will continue to grow
Statins reduce loss of function, keeping old lungs young - even in smokers
Even occasional use of spray cleaners may cause asthma in adults

2 comments:

Terrie Farley Moran said...

Hi Marijke,

Another problem with meds (at least for me ) is that the generics show up in a different form every time the prescriptions are filled. I presently have two blood pressure generics and one statin that are the same shape and color. Without wearing my eyeglasses and using a magnifying glass I cannot tell them apart so I often wonder which one I take twice a day and which two I take once.

Can't wait until I get really old. I'll probably poison myself and every one but the drug companies will be saying, "What a shame. She was so young!."

Terrie

Marijke Durning said...

that is a huge problem Terrie. It's something that has caused problems for some people and is scary from a safety point of view. Thanks for mentioning this.