“Adaptable” Beds: Good or Bad Idea?

I don’t think I’ve ever seen “nursing plan” in a headline before, but there it was on the front page of our Sunday morning newspaper. The story is of interest to every nurse because what might happen at this San Diego-area hospital could be a harbinger of things to come.

A hospital north of the city is building a new $925 million, 228-bed facility that is set to open in 2012. This hospital promises to have the latest of everything in technology, as well as a novel concept in patient care known as “adaptable beds.”

The idea calls for keeping patients in the same beds throughout their hospital stay, even as their condition improves or worsens. The reason, say administrators, is because “studies have shown that errors decrease and satisfaction increases when patients stay put.”

This hospital wants to designate 120 of its 280 beds as adaptable.

The problem, say the nurses, is that the adaptable-bed concept bumps heads with California law, which requires that certified nurse specialists care for patients in units or clusters. The state also mandates nurse-to-patient ratios, which nurses say will be difficult to meet with an adaptable-bed policy. The California Nurses Association, which represents this hospital’s nurses, says such changes will not work with the nurse-to-ratio mandates.

The hospital’s answer to these stumbling blocks is to change the law. To that end, it has introduced a bill in the state assembly that would create a pilot program calling for five hospitals to try this “hospital-of-the-future” concept and see if it flies. If results are favorable, the law should be changed, the hospital counters.

A group of nurses from the hospital in question will testify against the adaptable-bed policy when they meet with state legislators in Sacramento in mid-April. What they will tell lawmakers is that keeping a patient in the same bed during a hospital stay compromises patient safety. A change will mean that nurses of the same specialty will no longer be able to work together – Ia bad idea, they say, because currently, when one nurse needs backup, he or she gets help from another nurse with like skills.

The current system also allows for a solid nurse-mentoring system, say foes of adaptable beds.

Do you think the adaptable bed system is a good idea?

If so, why?

If not, why not?

What problems do you foresee?

Are nurse-to-patient ratios a good idea, and should the laws be change?.

New Health Care Legislation: What's In It For Nurses

Well, we finally have it: new health care legislation, formally known as the Patient Protection and Affordable Care Act (HR 3590).

You can’t exactly call it health care reform because there are, as yet, so many changes still needed to improve the delivery of health care in this country -- but we can call it insurance reform.

As with any legislation, there are winners and losers, depending on your views, and I don’t know all the details, but I’m trying to learn. The experts are telling us that this act will make it possible for millions to obtain health care coverage that was once unobtainable. Other major points of the bill, as I understand them, include the ability for kids to remain on parents’ policies until they are 26 years old; and the elimination of the pre-existing condition clauses, caps on benefits, the denial of coverage to families who have children with congenital problems, and the practice of rescission.

What's in this new legislation for nurses?

Quite a bit, as it turns out.

Thanks to the American Organization of Nurse Executives, here is a summary of provisions affecting nurses:

• The reauthorization of Title VIII Nursing Workforce Development Programs (under the Public Health Service Act), which includes provisions for the Nursing Student Loan Program; Loan Repayment and Scholarship Program; Nurse Faculty Loan Program; and grants for basic and advanced nursing education, practice and retention.
• Provisions for the expansion of nurse-managed clinics and primary care, prevention, health promotion and emergency health services.
• Under the banner of improving patient outcomes, care coordination and health care cost reduction: pilot programs to establish Medicare community-based care transitions, and maternal, infant and early childhood home visitation.
• Under school health: the establishment of school-based health centers.
• Other critical nursing-related provisions: funding for research and treatment for pain care management; improved access for certified nurse-midwife services; and independence-at-home demonstration projects which will show that using nurse pracatitioner- and doctor-directed primary care teams are cost-effective.

I can’t address the needs of other states, but in California where I live, it appears there is going to be a great need for nurses for all of the reasons above and because there are going to be a lot more patients. Community clinics and doctors’ offices are expecting a deluge of patients in the near future. All of those previously uninsured people will be seeking care, and there is speculation as to whether our current resources will be able to handle the flood.

According to local newspapers, there are more than three million people who may be seeking basic care that didn’t pr couldn't before the passage of this bill, and that means a greater demand for primary care nurses and doctors.

As for hospitals, many have been temporarily down-sized because of the loss of income from the now-unemployed – people who lost their health insurance with their jobs. A certain portion of those did make their way into hospital beds but it was because, unable to pay for primary care, they put off seeking help until they required hospitalization.

So the health care landscape is going to undergo some transformation in the next few months and years, and nurses are going to have a ring-side seat at the action.

Do you think the new health care legislation will change your professional and/or personal life?

What changes would you like to see in health care delivery?

Do you think this health care bill will encourage more people to join the nursing profession?

Will it encourage more to enter the field of primary care?

Tell us about it.

Posies and Posturing Topics of Debate for Nurses and Doctors

No flowers and no sitting --- on anything!

That’s the mandate to visitors in many British hospitals and has been for some time, but at least one doctor thinks it’s time to loosen up.

Dr. Iona Heath wrote a letter to the British medical journal BMJ recently and argued that this recommendation is unjustified and denies patients the chance to be close to their loved ones, according to an Associated Press story.

"I was shocked when I heard about it," Heath is quoted as saying, and she added that she would “definitely sit on a patient's bed” if she were making a house call or hospital visit.

"Doctors should never be discouraged from sitting, because patients consistently estimate that they have been given more time when the doctor sits down," Heath wrote in the commentary. "Such interactions are precious and should be made easier rather than more difficult."

Britain's department of health, which supports the no-flowers, no-sit policies, said each hospital can decide whether or not to adopt them.

“…patients with MRSA… may shed contaminated skin onto the bed and this could be picked up and transmitted to someone else," officials maintain.

Opponents say there is no proof that bringing flowers and sitting spread infection.

I have a couple of comments, both as a nurse and former patient:

It seems to me that most visitors would hesitate sitting on patients' beds because most patients have numerous tubes and wires that visitors would just as soon avoid. And it's a bit annoying to have to work around visitors sitting on a bed and a tiny nuissane to ask visitors to move.

As a former patient, I definitely don’t want visitors sitting on my bed. It’s a small piece of real estate that I need to call my own when I’m feeling really lousy. I say that when patients are conscious, they need their space.

Being forbidden to sit on a nearby chair seems over-the-top, though, and could really discourage visitors from coming, and that’s generally not good for patients.

As for flowers: As long as they don’t cause a problem for a roommate or the patient, they can be a welcomed source of solace. Colorful blooms can remind patients that someone is thinking of them and that can be a comfort at a stressful time.

What do you think?

Sitting or no sitting?

Flowers or no flowers?

Much ado about nothing?

Tell us about it.

Wanted: Ideas for Increasing Compliance Among Patients With Diabetes

All nurses know that diabetes is a huge problem in this country. At least 24 million people suffer from the disease – close to 8 percent of the population or nearly one in 12 people, according to the Centers for Disease Control and Prevention.

The vast majority of diabetics are of the type-2 variety and we know the tremendous costs associated with that. So if we’re looking for ways to cut health care expenditures, reducing the number of people with type 2 diabetes would be right at the top of the list.

The $64,000 question is how to do it.

In the conversations I’ve had with nurses who are diabetes specialists, motivating their patients to make positive changes in their lifestyles is a major problem and no one seems to have figured out what really works.

Apparently these nurses are not alone. A study published online recently by the Journal of the American Board of Family Medicine found that physicians also are pretty frustrated when it comes to caring for diabetics.

Researchers at University of Medicine and Dentistry New Jersey-Robert Wood Johnson Medical School, the University of Hawaii and the University of Michigan interviewed 34 primary care physicians in diverse practices in California, Indiana, Michigan and New Jersey. They all provide outpatient care to adult diabetic patients and talked specifically about the barriers that put patients with uncontrolled diabetes at risk for cardiovascular disease, which is two to four times higher than in adults without diabetes, according to the American Diabetes Association.

The doctors identified the barriers to be in two categories: “patient-related” and “system-related.”

Patient-related barriers include financial problems, lack of support from other family members, patients putting themselves last, depression and pain.

System-related barriers for doctors include difficulties with delivering care and making referrals, and the failure to utilize technology to make a patient’s health record readily accessible at the point of care.

System-related barriers for patients include inconvenient appointments, lack of transportation and its cost, and poor coordination of care among multiple providers.

“Ideally, a multidisciplinary team of nurses, diabetes educators, pharmacists and endocrinologists would greatly improve a primary care doctor’s ability to assist patients…” said lead study author Jesse Crosson, PhD, assistant professor of family medicine and director of the New Jersey Primary Care Research Network at UMDNJ-Robert Wood Johnson Medical School. “Physicians inherently want to help their patients get better, but diabetes is a chronic disorder that becomes more difficult to manage over time, even when treated properly.”

Researchers said that responses and the frustration factor were consistent for doctors in all four areas of the country where the survey was conducted. And all respondents felt they lacked the ability to motivate patients, to address their resistance to lifestyle changes and to eliminate barriers to good care.

I believe you could substitute the words “nurse diabetes educators” for “doctors” because from what I hear, nurses are constantly trying to devise ways to increase patient compliance. As yet, they haven’t had huge successes either, but there must be some examples out there.

Do you know of or have any?

What can you share with other nurses about care for diabetics that might improve compliance?

What are the biggest barriers to improving health for your patients?

Tell us about it.

New Toothbrush: A Metaphor for a Healthy Life

For some reason, teeth are always left out of any discussion about health.

We all know how important good dental health is to overall health, but I’ll bet most of us in primary care forget to mention it when we’re encouraging patients to make lifestyle changes. Dental health affects nutrition, pregnancy, cardiovascular health and overall well being. People with rotten teeth don’t feel good or feel good about themselves.

Maintaining good dental health used to be a suggestion with low-cost consequences, but like everything associated with health care these days, the cost of maintaining those pearly whites is ever-increasing.

This was brought home to me the other night when my husband bought a new toothbrush –the electric kind. The one we had finally died after I-don’t-know-how-many years. I think we paid $30 for it.

This new one cost $80 and came with a sleek silver and blue body that had the usual on/off button and charger. It also included a 30-page instruction booklet (two languages); an instructional CD; protective cover; handle display; brushing-mode button; wall mount; adhesive tape; and “SmartGuide” display unit and timer that works remotely. It sits on the counter and knows when you pick up the toothbrush, then tells you just how long to brush each quadrant of your teeth. And it doubles as a clock.

I blanched at the price, but later found the same model for up to $200 on the Internet, so I’m going to consider myself lucky. And the 30-page instruction booklet, the instructional CD, and the multiple brushing modes (daily clean, sensitive, massage, whitening and deep clean) and this SmartGuide also made me feel as though I got my money’s worth.

This electric toothbrush also comes with four types of brush heads which I haven’t figured out yet.

So you can appreciate the complexity of this hi-tech toothbrush, take a gander at a portion of the directions for one of the timers (remember, it comes with two).

“Your toothbrush comes with the Professional Timer and the Count Up Timer activated. If you wish to change these settings, proceed as follows:
• Press and hold the mode button [c] until the SmartGuide display unit shows “30” and “timer”.
• By briefly pressing the on/off button [b], switch the 2-Minute Timer. Confirm your choice by pushing the mode button.
• This will lead you directly to the Count Up Timer display (“up” and “timer” will be shown). Switch to the Count Down Timer by pressing the on/off button and confirm it with the mode button.

“Please note: It is normal that the handle display shows two flashing bars when operating in the timer setting mode”.

I don’t know about you, but when I hear the word “mode,” I know I’m in trouble. That’s when I begin to panic and alternately yearn for analog watches and televisions with only three channels.

The final test, though, is how the darn thing works.

I completely ignored all of the instructions it came with, waited for my husband to put it together, pressed the “on” button and …wow. Using this new toothbrush versus the old one is like the difference between watching analog TV and digital/high-definition. I hadn’t realized how old and sickly our former toothbrush had become.

And maybe that’s a metaphor we can pass on to our patients.

Tell them that they have no idea how great they’ll feel until they get that new toothbrush/lifestyle. Forget the complicated, extraneous home gyms, expensive gym memberships and costly diet plans. Eat less, move more and learn how to handle stress. That should be instructions they’ll understand.

What extra health advice or tips do you find yourself providing to your patients?

What tools do you use to get the message across?

Do you have any evidence that the message is getting through?

Tanning Salons: Nurses Weigh In

Years ago when I lived in the Midwest in a state that had real winter, we used to rush outdoors at the first sign of sunshine and being baking. A golden brown physique was highly desirable, and as prom neared, girls spent increasing time on their tanning mission to assure they’d look dazzling on The Big Night.

And then the sunlamp became available at local pharmacies and every high school girl bought one. (Prior to that, only dermatologists had them and they were used liberally to treat acne.)

I was among the true believers who thought that the sunlamp was not only good for giving you that rosy glow (or second-degree burn if you fell asleep under the lamp), but that it was actually good for your health.

Well, now we know differently, and dermatologists tell me that many of these girls-turned-middle-aged-women are currently paying the price. They may have changed their bad habits, are staying out of the sun and liberally applying sunscreen now, but the damage has been done and the skin cancers are blossoming because of past transgressions.

You’d have to be living in a cave not to know that prolonged sun exposure is the chief reason for the development of skin cancers, including deadly melanoma. Nonetheless, browning via tanning beds or the real thing seems to be more popular than ever. Some women – and men, too —actually schedule their lives around bake-time on the beach or balcony and/or sessions at the salon.

I equate tanning equipment to cigarettes; there is no upside to using them – no health benefits at all. The International Agency on Cancer recently classified indoor tanning devices as cancer-causing agents, and the World Health Organization and the American Academy of Dermatology recommend banning those under 18 from being exposed.

In November, the Howard County Board of Health in Maryland became the first state to ban those under 18 years old from using any type of tanning equipment.

Board members voted after hearing testimony from both sides of the argument, and I hope there were some nurses testifying in support of the ban. We can do our small part by appearing where the topic is under debate and countering those arguments that UV rays from tanning beds really aren’t that harmful; that everyone needs to supplement the sun to make enough vitamin D; and that businesspersons have a right to make a living.

I don’t know if there are other jurisdictions contemplating this ban. In my opinion, we should just say no to tanning salons.

Is your city or county discussing the issue?

What do you tell your patients?

Share your thoughts with the nursing community.

The Health Insurance Debate: It Affects Real People

The nurses who take care of my dear friend, Lynn, now have a real example of the shortcomings of our health care system – or lack thereof.

Lynn, who lives in the Dallas/Fort Worth area, has worked for 30 years as a journalist, some of that time as a health care specialist. She is not a nurse, but because of her work, she knows more about medicine and health care than many civilians. Lynn and I worked together for a while for a dot.com company from which we were both laid off. That was the end of our group health insurance. I’ve had various policies ever since; she has purchased insurance on her own for about the last 10 years.

After Lynn discovered by accident that she had kidney cancer in 2008, her insurance was cancelled. She managed to undergo surgery the day before the policy expired and so far, no signs of new cancer. The insurance company wouldn’t allow her to purchase further coverage and so there are big bills for post-op care.

In 2009, Lynn also developed a rare, congenital heart/lung defect that has exacerbated her chronic obstructive pulmonary disease and weakened her heart. I won’t go into the details, but there were several misdiagnoses along the way which made her condition even worse than it might have been otherwise, and now she needs a lung transplant.

Lynn has been hospitalized several times in recent weeks and each time the bill is thousands, but she has no means to pay anything because she can no longer work. Because her disability payments are more than $674 a month, she doesn’t qualify for Medicaid.

It’s a nightmare; I can’t imagine how it could be worse. My heart goes out to her and it’s frustrating because, as a nurse, I feel I should be able to help. The only things I have to offer are supportive words and phone calls.

Even sadder is that there are many stories like Lynn’s. Through no fault of their own, or because they have lost jobs, or because their incomes are a few dollars too high, they have no health insurance and no prospects of getting any unless Congress comes up with some program that will provide coverage.

I’ve witnessed in my own family the divisions that exist over the health care/insurance reform debate. I just hope that those who are responsible for coming up with some plan do it soon enough to help people like Lynn. She has worked all her life, followed the rules and contributed her fair share of taxes. She did the responsible thing and purchased health care coverage so she wouldn’t be a burden to anyone.

I hope the members of Congress, who hold her fate and that of others like her, remember that it is these citizens who are paying their health insurance premiums. They can rest easy at night knowing that if catastrophe strikes, they’re covered.

Do you have friends or family who have no health insurance?

If so, how has it affected their lives?

In your area or specialty, do you encounter chronically ill people who have no health insurance?

If so, how does it affect your life?

What would you tell your congressperson was the greatest problem with the current health care system?

Tell us what you think.