Why You Should Get to Know Your Patients

Do you know your patient? More than twenty years ago Dr. Afaf Meleis wrote about the importance of knowing your patient and the unique opportunity for nurses to utilize this knowledge to improve care (Schumacher, Jones, & Meleis, 1999). "Knowing your patient" tin can mean dissimilar things to different nurses depending on how you define knowing and where one practices. In this editorial, nosotros nowadays 1 practical example exemplar and evidence to back up this approach.

A couple of months ago, the authors participated in nursing rounds on Mr. E., a 77-year-old human who was retired with a PhD degree in psychology. He had a diagnosis of dementia and was admitted with a gastrointestinal illness and dehydration. He and his wife had recently moved to the area to be closer to their children. Because the nurses in this infirmary were part of an ongoing study (see http://clinicaltrials.gov, trial NCT01505257), they had access to a tool to detect delirium called the Confusion Assessment Method (CAM, Inouye et al., 1990) embedded in the hospital electronic medical record and were assessing his mental status every shift. They had even reviewed his chart to avoid medications that might cause him to get delirium on peak of his dementia (Fick & Resnick, 2012). However, Mr. E. would oftentimes appear restless and try to get out of bed unassisted, even though he was still quite unsteady due to weakness from his gastrointestinal disease. Similar many hospitals, this infirmary encouraged fall prevention strategies. Although the nursing staff was getting Mr. E. up in a chair every solar day, they as well implemented a pad that would audio an warning every time he stepped on information technology, and so he would be put promptly back into bed.

While doing our rounds, we introduced the "All Most Me Lath" to Mr. E., which helped initiate a conversation with him and his wife and afterwards helped us know him better and implement a nursing intervention to address his care needs. The All About Me Lath, which was adult by the direct care nurses in consultation with the gerontological clinical nurse specialist and nurse practitioner, contains information including what older adults prefer to be called, their favorite music, what makes them feel at-home, their past occupation, hobbies, and the names of family members and pets. Considering the board is in the room and highly visible, staff do non demand to search through the nautical chart for this cardinal information and it is available in the centre of the night if the older adult with dementia or delirium becomes restless or agitated.

Mr. Due east. had a Mini-Mental Land Examination (Folstein, Folstein, & McHugh, 1975) score of 17 of 30 and scored negative for delirium on the CAM. He had some problems with comprehension but was still able to accept a conversation with the nurses about his likes and dislikes. While filling out the board we found out that his favorite matter to do every day was to take a 3-mile walk around his neighborhood with his wife. Nosotros discovered he loved classical music, sports, outdoor activities, and had a true cat. This information, including his prior action level, was placed on the All About Me Board that hung in his room. Subsequently the nurses knew how much he had been walking at home they implemented a schedule where he would take progressively longer walks in the hallway with staff and a family member. The nursing staff reported that his restlessness decreased and the caregiver reported high satisfaction with use of the lath.

The lath (Effigy) is colorful, big, easily designed on the calculator, and is laminated so information technology can be wiped down with disinfectant and reused. The board tin be adapted to the setting and produced for a minimal cost. Although many hospitals have orienting white boards with the appointment and proper noun of the nurse caring for the patient that shift, we found that most older adults cannot fifty-fifty see the boards (sometimes they are behind the patient), and the information is not very helpful to their intendance.

The All About Me Board, which was adult by the authors, contains key information nigh the patient.

This blazon of approach helps us personalize interventions for individuals with dementia and helps u.s. know our patient (Schumacher et al., 1999). This is supported by piece of work that illustrated the importance of individualizing care to increment the bear on of your intervention (Kolanowski, Litaker, & Buettner, 2005; Kolanowski & Whall, 1996; Penrod et al., 2007). In addition, the lath is congruent with Kitwood's (1997) framework of personhood and person-centered nursing intendance. This allowed the nursing staff to know the person beginning, rather than the affliction. By getting to know a piffling bit nearly Mr. Eastward.'southward life story and things he enjoys doing, nursing intendance is personalized and tailored to his needs. Importantly, this intervention helped us address Mr. E.'s restlessness, increased his activity level, and possibly avoided delirium and a subtract in his role.

A recent pocket-size written report from 19 residents found that using a person-centered care approach with nursing assistants improved both resident and nursing banana perceptions of closeness and satisfaction (Penrod et al., 2007; Van Haitsma et al., 2013). Many aspects of hospitalization are not conducive to maintaining office and activity and atomic number 82 to infirmary-acquired functional decline (Creditor, 1993). On the other hand, the benefits of concrete activeness and practise in older adults are well known, and the bear witness for the cognitive benefits of practise is growing (Boltz, Resnick, Capezuti, Shuluk, & Secic, 2012; Gates, Singh, Sachdev, & Valenzuela, 2013; Ruthirakuhan et al., 2012). A number of studies have tested models to promote role in older adults across settings of intendance (Boltz et al., 2012).

Nurses need to consider and plan for the elements of the hospital environment that encourage activeness and those that impede it; including an overly zealous desire to forestall falls and the unintended consequences this can have for older adults. Mr. E. and the use of the All Almost Me Board is merely one example of how to get to know your patients and maintain their function and action level while hospitalized. Can yous recall of others?

Acknowledgments

Dr. Fick acknowledges funding from the National Institute of Nursing Inquiry Early Nurse Detection of Delirium Superimposed on Dementia (END-DSD) (grant 5 R01 NR011042 03), besides as nursing staff and nursing leadership at Mount Nittany Health System for support of this project and delirium rounds.

Footnotes

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Correspondent Information

Donna M. Fick, Journal of Gerontological Nursing, Professor of Nursing, School of Nursing, Professor of Medicine, Department of Psychiatry, The Pennsylvania Land University, University Park, Pennsylvania.

Brittney DiMeglio, Developed/Gerontology Nurse Practitioner Student.

Jane A. McDowell, Project Manager, School of Nursing, The Pennsylvania Country Academy, University Park, Pennsylvania.

Jeanne Mathis-Halpin, Clinical Supervisor, Mount Nittany Wellness System Country Higher, Pennsylvania.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3930328/

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