Monday, October 22, 2007

It's not just about the tasks

Babs said something in a comment thread the other day that I'm going to steal and comment on.

"The majority of my career has been all about what makes people tick. The tasks are only a small part of the real job, no matter how much the current healthcare environment tries to swing the pendulum into the "nurse robot" direction. We have to determine that in order to determine the best way to educate and motivate them, as well as to simply make sense of what we see of people (for our own psychological health) so that we can all keep a handle on it and maintain some semblance of normalcy in everyday life.

Every experienced nurse I know is well-versed in and well-experienced with contact with most anything appearing in the DSM-IV and that sort of psychological assessment of those we come into contact with is just part of the job. You can't effectively and definitively address behavioral and compliance issues, self-destructiveness, and family support issues unless you know what motivates the individual and his/her network as well as what their challenges are. As such, I've got 20 years of behavioral science under my belt.

It's the only way to effect change and bring about results when people are destroying themselves and/or those around them - which often has everything to do with why they're utilizing the system. It's not a detailed diagnostic assessment, but the more familiarity one has with hallmark signs and causative factors, the easier it is to pinpoint behavior patterns that are witnessed and then implement basic therapeutic communication - just little seeds here and there with each contact - in order to gradually bring about that change. The only way we can beat the current crisis is through behavior modification. It's also best for the patient as well as for the system for that to happen."

When I read this, (which I actually had to do two or three times, because it was originally all in one paragraph and my attention span is such that I have to have lots of line breaks or I get confused and start thinking about puppies or some such nonsense), I thought to myself, "Self, this is a woman who actually gives a shit."

Not only does she give a shit, but she actually understands that there are multiple issues at play in our current healthcare crisis. In the political arena, everyone seems to be focused on how to get affordable (or free) healthcare for everyone.

It irritates the hell out of me sometimes to read the opinions of non-medical people that are pro-Universal Healthcare, because the issue isn't simply the availability of said healthcare, it's also the behavior of people who are wasting valuable resources, and the fact that they will continue to do so regardless of which plan is implemented.

But in our current state of burnout and apathy, we go to work every day (at least in my ER we do) and not only expect people to act in a self-destructive manner, but we've actually begun to enable it. After all, it's easier to give the whiny fibromyalgia patient on disability their narcotics 3 times a week than it is to listen to them complain, or better yet, than to get the complaint in writing from administration for not providing "good customer service".

Granted, there seems to be a vast majority of people that are not interested in changing. But like Babs said, we should be more interested in what motivates the individual, as well as find out what their challenges are. It shouldn't just be about giving them their Dilaudid and kicking their whiny asses out the revolving door. There should be a way for us to effect a change, or at least attempt to.

Is that easy with our current staffing issues and patient loads? Hell, no. Sometimes it's not even feasible to get more than a basic assessment done, forget the bells and whistles of "what makes you tick?" But sometimes, we have the time to sit down for a second and learn something about the person we're treating, and possibly educate them and alter their perceptions (and ours).

And it might not make a damn bit of difference to 9 out of the 10 drug seekers you talk to that day. But for that one, you might have, as Babs puts it, "planted a seed". And eventually it might matter.

I don't have any solutions to the healthcare crisis. I don't think that we should be every patient's friend. I don't think that you can care about everyone, or you'll explode. And I don't think that it's worth it to try to "make a difference" all the time, because, well, again with the exploding.

But every once in a while, I think we need to put down the Dilaudid for a second and see if there's something beyond basic skills that we can do for our hardest patients. You know the ones I mean. Not the sick ones. The ones we don't like.

Because even if we accomplish nothing, we're not any worse off than when we started. And we may have actually done something that will make a difference in the long run.


NocturnalRN said...

I agree. Now if I could just find the time....

Nurse K said...
This comment has been removed by a blog administrator.
MonkeyGirl said...
This comment has been removed by the author.
Nurse K said...

Fine. I do have more to say on this topic in general though and--pfeh--I don't have my own blog anymore:

I do think it's important to address the reasons why frequent flyers especially visit the ER over and over, whether it's for drugs or for seemingly inane medical complaints. Oftentimes, the patient has under or unaddressed depression or anxiety, for instance. Other times, they are uninsured and are just using the ER as primary care/convenience clinics for asthma or arthritis or endometriosis or whatever and don't know that there are reasonably-priced primary care clinics you can go to and simply need a 1-minute pep talk on the importance of primary care.

I don't feel like looking for citations, but I remember hearing that when a doctor or nurse counsels a patient to quit smoking (even if it's just saying that, "Smoking has been shown to increase heart disease, and since you are having chest pain, we recommend that you quit smoking to reduce this risk") that it oftentimes has an effect on the patient's decision to quit, especially if the patient is in the ER or hospital for a smoking-related problem or a problem that could be affected by smoking (such as wound or surgical healing).

Also, relatedly, it has been shown that patients/people in general are more likely to heed your advice if you use the word "because" in your advice. Once you say "because", the chances of that advice being heeded goes way up. "Take this prednisone with food because it will keep your stomach from getting upset." "One you pass your kidney stone take it to your clinic to be analyzed because finding out what the stone is made of is important in figuring out how to prevent them from happening again."

Babs RN said...

Actually, Monkeygirl (now that I have a replacement modem for the one that blew up the other night, I'm just catching up)- I thank you for your comments here, and you do "get it." I've always tried to plant seeds here and there when people come through and it's not something that takes a whole lot of time to do. It's just part of the communication we have with these folks - particularly the one we see over, and over, and over, again.

Apparently several people have assumed that other referenced post was about a specific blogger whose stuff I barely even bother to read, I guess because I went off at her in the comment thread; not taking into account the fact that I might encounter such people on a regular basis through my work, that they drive me absolutely nuts, and that I might occasionally need to rant. I just shrug my shoulders at those people. Small minds live in small worlds. If the comment thread is read in its entirety, it's easy to note that quite a few people have recognized their own relatives and bosses in that same rant. It's universal.

Nurse K, I don't think you're right there next to Satan. I just choose not to engage in discussion with you if I can help it. As to comments, I take no issue with respectful dissention - I oo, however, take issue with people out there just trying to start stuff for their own amusement.

mom said...

Reminds me of the little girl on the beach throwing back starfish..."it made a difference to that one!" Hope you know the story or it won't mean anything to you. I am proud you are my are good people!

RealisticRN said...

One acronym...WTF?
Love ya,