Wednesday, January 24, 2007

Customer service

As evidenced by our latest P-G surveys, patients' families are not altogether pleased with our services.
Besides the usual "pillows were hard/flat/lumpy", "unit was too cold/hot/dreary", and "food could be better", we did get some valued feedback that pointed to actual issues that needed addressed. And that is another post for another day. Let us focus on my bellyache for now, 'k?
As with any business, a well-timed smile and weighted sincerity can go a long, long way.
It is not enough to display clinical competence and take the very best care of the patient - our number one priority.
We must appease the sons and daughters and sisters-in-law in a way that makes them feel valued and justified.
Seeing as how the family members are most often the ones to complete and return these surveys, one must pander to the offspring and siblings as though they are every bit your responsibility as well.
Staying well over an hour past posted visiting hours? Offer them a beverage.
Alerting you the very moment mom's foley drained 100cc into an empty bag? Give her a complete bed bath.
Complaining that dad's parkinsonian tremors are due, in fact, to the temperature on the unit? Put mittens on him. This is helpful to staff as well, when he digs in his diaper and then claws at you when you try to change him.
It says on the activity board that there was a group for coping skills earlier. Why didn't mom attend?
Wrong answer: Your mother is confused, disoriented, and spells the colors of the numbers that are floating by. That group was not appropriate for her needs.
Right answer: Oh my goodness! That was an oversight on my part, and I'm deeply sorry for the inconvenience. We will be having another session on self-care activities starting very soon. Would you like be the first in, to find a good seat? I could assist you if you'd like. (insert warm smile here)
There are the family members who are an obvious asset to have around. These are the ones who have a clue. Perhaps their loved one has battled bipolar for decades. They are used to the behavioral issues and abilities the patient can, will, or did possess. They are patient, kind, and understanding. They applaud your efforts, steel will, and patience. They are often grateful to have this bit of respite.
The ones that are red-flagged are the supposed "new onset dementia" patients' families. New onset dementia is a bit of an oxymoron. This patient has been exhibiting a steady decline, and the family has been in denial. Push comes to shove, and they just can't deal with it any more. Possibly the physical demands have become too much. There is also the factor of incidental depression and anxiety for the family member. This tends to weigh heavily on their own behavior. The son or daughter tends to expect or demand results far beyond their own capabilities, and transfer their guilt and frustrations onto the staff. Sometimes, we are left with the feeling that if you think you can do it any better, then please, take her back home. Instead, we grin and bear it.
I think, because we are often frustrated, we tend to avoid the family. This is w-r-o-n-g. The family wants - needs - to be involved, to know we're there for them. Sure, this burdens us with another patient, if you look at, but if we don't tend to the family's needs, we appear to be unavailable, uncaring, and possibly even incompetent. That nurse never stopped in to check on mom the whole time I was here. What if she needed something? I bet she is ignored all day long.
Currently we have a patient whose daughter is perplexed beyond all reasonable doubt about her mom's abrupt change in mental status. We received the patient after a lengthy stay on the medical floor. This woman was put through every diagnostic test one could think of, without a cause found. She does not exhibit the typical symptoms of dementia of any type. Depression, maybe. Psychosis, maybe. Basically she just sits there, mute, no eye contact, no response except to neuro stimuli. According to the daughter, she was driving her car, shopping, playing pinochle, and cleaning her house up to a week before she ended up like this. No CVA, no seizure activity on the EEG, no indication to what might be wrong. Unfortunately, the daughter is a wee bit on the manic side at this time. This poses a challenge to us, because she is more needy than the patient. She has submitted bulleted memos to the physician and social worker about what her mother needs, what she wants, and how these feats are to be accomplished.
A couple of days ago, she rushed up to me to ask what was going on with mom. She had heard the doctor prescribed her THREE new medications! Does that mean he has a diagnosis?? Because I was involved in about a gazillion other more important tasks, I told her I wasn't sure without reading her progress note, but I would do that soon, and get back to her. I never did. She left without further inquiry, and I forgot about it. During a rare moment of solitude, whilst enjoying a cup of very bad coffee, it dawned on me that I had neglected to complete a task. I hate loose ends. And I felt a little guilty. As aggravating as these family members can be, I really do try to put myself into their shoes and pretend it was myself worrying about my loved one. And, as every good nurse does, you visualize your own parent/spouse/sibling in that bed, and treat the patient accordingly.
So, I called her. The doctor had placed her mother on aricept, haldol, and celexa. She wanted to know what each pill was for, and what the diagnoses meant. I summarized the information she requested. I explained that sometimes medications are started not because of an assumed diagnosis, per se, but to treat specific symptoms. In short, her mood should brighten and her thoughts become more clear. Since the daughter displays a strong inclination for research, I offered to print her out the med-teach sheets on each drug, and told her they would be attached to the front of her mother's chart for her when she comes in. And then I did just that. Mission accomplished. Took less than 10 minutes start to finish. The bad coffee got colder but the warm feel-goodliness of my attempt gave me a boost.
She mentioned me during treatment team, stating I was an asset to this unit, because I offered her information and hope. And a moment of my time.

Wednesday, January 10, 2007


Kick back, relax, and be glad you're on night shift this week. That's what I keep telling myself.
It's that time again. State inspection. So much better here than that last place I was at. Yikes.
Are all the "i"s dotted and "t"s crossed? Every form filled out in full? Signatures, initials, dates, times? If it's not documented, it didn't happen!
You gotta love the restraints. Chart the same thing in three different places.
It amuses me how the medical floors (it seems) can tie anyone down for petty little reasons, and we have to jump through hoops backwards for our own protection. Not that I advocate restraints or anything. Nope. Just an observation is all.
Really though, we're not worried. We run a pretty good unit, and do what we're supposed to. It's just the prep work and double-checking that leads up to this visit that makes me a little wrought with exhaustion.
That, and adjusting my schedule to accomodate the shift rotation.
I'm getting too old for this. But I love it; keeps me on my toes and gives me a change of scenery. Some patients actually do have an "off" switch! And my LPN partner this week is just awesome - what a team! She knows the paperwork and routine better than I do. Indispensable, I tell you.
Off to bed now, have a great day everyone (all 4 of you)!

Saturday, January 06, 2007

Puncture resistant. Who'd a thunk it.

Dear Tide -
I'm writing to say what an excellent product you have! I've used it since the beginning of my married life, when my mother told me it was the best. She was so right. Now that I am older and going through menopause, I find it even better! In fact, about a month ago, I spilled some red wine on my new white blouse.
My unfeeling and uncaring husband started to berate me about how clumsy I was and generally started becoming a pain in the neck. One thing led to another and I ended up with a lot of his blood on my white blouse. I tried to get the stains out using a bargain detergent, but it just wouldn't come out.
After a quick trip to the supermarket, I stopped and got a bottle of liquid Tide with bleach alternative, and to my surprise and satisfaction, all of the stains came out! In fact, the stains came out so well, that some detectives who came by yesterday told me that the DNA tests were negative and my attorney said that I would no longer be considered a suspect!
I thank you, once again, for having such a great product. Well, gotta go. I have to write a letter to the Hefty bag people...

Monday, January 01, 2007

A new year, A new me

The Bitter Woman's Guide to Zen

To know Nirvana, you must understand these four noble truths:

  1. Anything that angers me will incur my wrath.
  2. All suffering is caused by my wrath.
  3. You can avoid my wrath by not being stupid.
  4. You can avoid being stupid by following the Four-Fold Path.
  • Do not say anything to contradict me. This is called "Right Views."
  • Strive, at all times, not to anger me. This is called "Right Intentions."
  • Do not say anything you know, or even suspect, will anger me. This is called "Right Speech."
  • Keep a chocolate bar and a twinkie for me on your person at all times. This is called "Right Conduct."

You can find the road to Nirvana by contemplating these ancient koans, or riddles:

What is the sound of my fist slamming against your head?

All beings tremble before violence. All fear death. All love life. Knowing this, would a wise man poke a snake?

Tabibi once asked Baso, "What is Buddah?" Baso answered, "Damned if I know. Where's my twinkie?"

Right Views. Right Intentions. Right Speech. Right Conduct. If a student has the patience to wait until the mud clears, the student will not get his ass kicked.

Peace be with you.