let's start with the patient

Wolters Kluwer Health, Inc.

Let's Start with the PatientAuthor(s): Crescentia J. TroySource: The American Journal of Nursing, Vol. 51, No. 12 (Dec., 1951), pp. 699-700Published by: Lippincott Williams & WilkinsStable URL: http://www.jstor.org/stable/3468048 .

Accessed: 15/12/2014 23:09

Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at .http://www.jstor.org/page/info/about/policies/terms.jsp

.JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range ofcontent in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new formsof scholarship. For more information about JSTOR, please contact [email protected].

.

Lippincott Williams & Wilkins and Wolters Kluwer Health, Inc. are collaborating with JSTOR to digitize,preserve and extend access to The American Journal of Nursing.

http://www.jstor.org

This content downloaded from 128.235.251.160 on Mon, 15 Dec 2014 23:09:20 PMAll use subject to JSTOR Terms and Conditions

http://www.jstor.org/action/showPublisher?publisherCode=lww

http://www.jstor.org/stable/3468048?origin=JSTOR-pdf

http://www.jstor.org/page/info/about/policies/terms.jsp


care. Under the guidance of the graduate nurse and the clinical instructor, the student might even make out the nursing care card!

This card serves a threefold purpose: each nurse may use it, it helps to provide consistency and continuity of care, and it saves time. To be of value, the card must be used. The person who gives nursing care should refer to it, daily, before giving the care, and someone should be responsible for keeping it up to date. The head nurse and general duty nurses may do this as new information is obtained. Any member of the hospital staff who subsequently cares for the patient can make valuable con- tr;butions. An interchange of information between a professional nurse and the aides might bring out such questions as: "What did you observe about Mrs. Cohen today? . . . Is she eating her food? ... It is a good idea to ask patients why they do not eat .... What can we add to Mrs. Cohen's nursing care card today to help others give her good care?"

In situations where' the professional nurse's contact with patients must be limited chiefly to giving medications and treatments, the occasions for giving bedside care can become quite precious- and fruitful beyond expectation if the nurse can still look upon each patient as an individual. For example, even though a professional nurse may give complete care to Mrs. Cohen only once, this patient's needs are known to her, and Mrs. Cohen still is one of "her patients." This nurse is interested in Mrs. Cohen's progress and continues to make suggestions-for instance, that perhaps she could have an early consul- tation with a social service worker, or that occupational therapy might be help- ful, both as therapy and as diversion. As ,the librarian visits the ward, the nurse remembers to request books in the patient's native language.

In integrating this concept of the patient as a person not only in theory but also in our nursing practice, the "patient" predominates our every activity. Instead of thinking in terms of "baths" or "A.M. cares" for Mrs. Jones, Mrs. Bennett, and others, our planning would revolve around individual problems, like this:

Mrs. Jones is a new patient, "up and about," but her care needs to be evaluated.

Mrs. Bennett is over her acute illness but needs to be encouraged to get up and move about.

Mrs. Costello is worried about her son, , who is in military service.

Mrs. Tendello is scheduled for a retro-

TODAY, despite all the responsibili- ties thrust upon us, if we are to

function as nurses and render care to the patient, we must take our patients off the assembly line of hospital routines and ask: "What care should this patient receive to get well and wdhat should be done to keep him well ?"

The Assignment In both the functional and case meth-

ods of ,assignment, we are apt to regard the patient as someone who requires a bath, food, medications, and treatments rather than, say, as Mrs. Cohen, a person with a cardiac ailment who lives by herself on the fourth floor of a walk-up apartment and who waited until her legs were so edematous that she devel- oped a cellulitis before coming to the hospital. Many ward activities are of necessity streamlined to get the work done. Although this may result in excellent scientific treatment it does not provide for individual care.

Our Mrs. Cohen, and indeed every patient, whether on a private service or on a ward, whether acutely ill or chroni- cally ill, requires more than a bath, medications, and treatments. They need someone to evaluate their needs.

Since Mrs. Cohen is not acutely ill, she might be cared for by an auxiliary worker under the guidance of the head nurse or a staff nurse. However, if pos- sible, each new patient regardless of the nature or degree of illness should receive initial care from a professional nurse. She is the only one of the nursing team whose training has been based on a recognition of the physical, mental. emotional, psychological, social, and re- ligious components that make up an individual.

For example, the doctor's order sheet on Mrs. Cohen's chart says: "Bed rest- may bathe self." However, as the professional nurse gets Mrs. Cohen ready for the bath, she may see that this patient appears to be fatigued and de- pressed, and the nurse will bathe this

moderately ill woman who has been sick and lonely for a long time. She knows many little things which would comfort Mrs. Cohen, such as an oil ap- plication rather than soap and water on legs that are red and edematous. A foot cradle would alleviate the discomfort of weighty bed clothes. The experienced nurse will note dyspnea that may occur after the bed has been lowered to change the draw sheet, or she may keep the patient in an upright position if that is indicated. In that case, she will try to assist the student or auxiliary worker who may be assigned the care of this patient tomorrow by passing this infor-

Miss Troy (Cornell-New York; B.S., New York University), who is on the staff of Bellevue Hospital in New York, is no stranger to Journal readers. She is the author of "Tender, Loving Care" and "I Like Working with Private Duty Nurses."

mation on to them. This detailed care need not be given in the morning but could be given at any time during the day.

A half hour at the bedside provides an excellent opportunity to become ac- quainted with the patient as a person. It also enables the professional nurse to contribute to and assist in the planning that is necessary if Mrs. Cohen is to receive nursing care tailored to her spe- cific problems.

This requires teamwork. An informal discussion with the doctor, head nurse, and general duty nurse participating would help the latter when she, subsequently, is recording the individual needs of this patient on a nursing care card.

On a teaching service, a general duty nurse and a student might work together in giving initial care to a new patient, with the student also participating in the informal discussion of the patient's

DECEMBER 1951 * VOL. 51, NO. 12 699

Let's Start with the Patient

How does nursing care become patient centered? Here are some practical suggestions.

By Crescentia J. Troy, R.N.



This cord can be a useful tool for the nurse who plans the patient's care.

grade pyelogram. Would having a student accompany her to the x-ray department make her feel better, and will it be a good teaching opportunity, too?

Mrs. Andrews is going home soon. What are her needs for teaching?

Individualizing Routines Functional nursing can include a great

deal of planning for individual patients. In administering medications we can teach the patient about drugs he should know about, like insulin or digitalis, long before he is ready for discharge. In administering digitalis to Mrs. Cohen, the nurse may ask her if she has ever taken "a pill like this green one" before. After checking with the doctor about probable discharge orders, the nurse can merely mention the fact to Mrs. Cohen that when she goes home the doctor will prescribe this medicine, and "it is important to take it regularly just as you do in the hospital."

If Mrs. Cohen suddenly develops anorexia, she will be reassured by the calm, matter-of-fact, information that medications sometimes cause a loss of appetite and, if this occurs at home, she should come to see the doctor. This would be a good time to stress the value of seeking early treatment rather than waiting until symptoms are far advanced.

When receiving an "injection," the patient who "hurts all over" will feel better if the nurse says softly, "Ah, this is the magic drug which has made you well enough to complain!"

In giving a diuretic the nurse can an- ticipate the bewilderment of a patient who may never have received this type of drug before, by explaining its action in language the patient can understand. If he replies, "But I don't have any trouble voiding," he will nevertheless be grateful to know that it will help reduce the swelling in his ankles!

Weighing patients can be very rou- tine to the nurse-but it is important to the patient. The person who weighs 110 pounds is alarmed at the loss of another two pounds. A few words to explain that "it was because of the injection I gave you yesterday" is reassuring. Of course this may create a new problem when the scales remain stationary-or when the patient decides that 104 pounds is little enough to weigh and he begins to refuse his injections. He will find comfort in the knowledge that the "injection" works only while his ankles

and feet are swollen and. when he has no more excess fluid, the injection will not affect his weight.

Serving meals can be a part of the daily chores-or a challenge. Mr. San- chez may be on a general diet but, if he had a bronchoscopy the preceding day, he will find a soft diet much easier to take. Mrs. Cohen might refuse her salt free diet but she wl~l be more likely to try it if she knows how it will benefit her-and if the hot foods are hot! If Mrs. Cohen still refuses food, the nurse who is aware of the patient's back- ground may tactfully ask the rabbi to talk to Mrs. Cohen about her diet.

Grouping Assignments Around Problems

When there is a perennial shortage of time and personnel, much can be ac- complished by grouping assignments around problems. Patients who are placed together after admission can be oriented and reassured by group discussion, initiated by the nurse, on "why they have to go without breakfast every morning" (as a preparation for diag- nostic tests). Incidentally, a cup of hot coffee for all when the tests are com-

pleted may elicit, "This is the best cup of coffee I ever tasted. Nurse, you are an angel!"

If there is no other opportunity, patients who are presumably ready for discharge can receive instruction as a group. You can test the effectiveness of your teaching by giving them an opportunity to ask questions and by having the ,patients perform return dem- onstrations.

Patients who have physical disabilities are encouraged by observing others who have conquered similar afflictions. The young blind girl who, standing by a window, says, "My what a beautiful day it is" makes everyone feel brave.

Strangely enough, the nurse who has an opportunity to give bedside care to a patient, even though this occurs only once, and has used this contact as the beginning of a continuous, purposeful activity, has an enviable rapport with the patient. He senses her interest and feels her influence. When his visitors come he looks at her when he says proudly, "my nurse." She in turn probably will include all fifty patients on the ward with her twinkle as she smilingly says, "They are all my patients."

Patients and Nurses in Psychiatric Hospitals

Slightly more than 400 psychiatric fa- cilities are included in the American Psychiatric Association's 1951 study, which was reported in their publication Psychiatric Nursing Personnel. Eighty- eight per cent of all patients in these 400 hospitals were being cared for in state or county institutions; their nursing care was being given by only 50 per cent of all the nurses and 77 per cent of the attendants. Private psychiatric hospitals and psy-

chiatric units in general hospitals cared for only 3 per cent of the patients, but employed 19 per cent of the nurses and 6 per cent of the attendants. Twenty- seven per cent of the total group of nurses and 17 per cent of the attendants were employed by the Veterans Administration and other federal hospitals to care for 27 per cent of the total number of psychiatric patients who are housed in the various institutions throughout the country.

700 THE AMERICAN JOURNAL OF NURSING



let's start with the patient

Documents