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View Poll Results: Do we do too much?
Yes, we do too much. We should stick to health issues. 7 35.00%
No, we don't do enough. A person's health is affected by their lifestyle. 8 40.00%
I think what we do is just right. 5 25.00%
Multiple Choice Poll. Voters: 20. You may not vote on this poll

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  #1  
Old 11-09-2007, 03:14 PM
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Default Do we do too much?

Thinking back on when Kaiser dumped a patient on skid row, I started wondering if hospitals had too much responsibility to take on with patients. Is it really up to a healthcare establishment to fix everything wrong with a patient's life? If a patient comes in with a broken foot but is also homeless, is it up to the hospital to find a place for that person to go in addition to treating the broken foot?

When a patient is discharged and has a home but no one can come and pick them up, why is it our job to get them cab fare or a bus token?

I actually discharged a patient once in this situation. He said he had no one to pick him up, so if I could just take him out to the bus stop he'd take it from there. I felt really weird doing that. I've had other patients demand cab fare to get home.

Am I making sense? I don't mean to sound insensitive, but I don't see how we can fix everything.

If the patient has nowhere to live, and there's nowhere to take them - what are we supposed to do? I feel like the way things are going, we're going to have to start feeding patient's cats while they're in the hospital.

Of course it would be nice if we could fix everyone's problems, but our resources are already stretched thin.

What's your opinion?
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Old 11-09-2007, 04:25 PM
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Ok, A persons lifestyle and home environment influence their health and may be detrimental to their recovery BUT we cannot fix everything, we must not assume even that people always want everything fixed. As a district nurse I was often shocked by the way in which people chose to live (lack of cleanliness, smoking even though they could barely breath etc) but it was not my job to either judge the way people lived or to set about completely changing everything for them.
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Old 11-09-2007, 06:59 PM
BrianRN
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No need to try to change everything but an attempt to fix is better than nothing. As for taking them to the bus stop, I work at a hospital that the bus stop is between the emergency room parking lot and the visitor's parking lot. Nursing has a role in case management to try to fix the environmental factors but there's a limit to what you are able to do. Financial limitations as well as the behaviors of patients cannot be controlled by nurses sometimes. I think humanity in general is obligated to help out others and if nurses are in a position to do something to change a patient's environmental situation for the better then they should.
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Old 11-09-2007, 08:23 PM
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Geena........your question for the poll was way too hard! I can give you instances where I feel that each one of the responses are right; and I can give you instances when each one of the responses are wrong. My answer varies on the actual situation. For instance: 18 year old IDDM (just turned 18). Used to be on mom's insurance and now, since he turned 18 and was out of school, he did not have insurance. He was not on public assistance. He worked at McDonald's for minimum wage. His Mother told him that since he is 18, his diabetes is now "his" responsibility. Up until that time his diabetes had been well controlled. He came into the ER because he was running out of insulin (Lantus) and his blood sugar was elevating. He started taking half doses of insulin each day in attempts to make his insulin last longer and keep his blood sugar under control while still being able to give himself "some," insulin. He was at a loss and didn't know what to do. He said he was going to get paid from McDonald's the following week and was going to try to get his insulin then. (I sincerely doubt that he makes enough money at Mickey D's to buy insulin) He came into the ER, to quote him, "in the hopes we could help him not go into DKA."

I called every hospital coordinator, administrator, supervisor I could think of to ask for some assistance for him but in the end I was told there was nothing we could do; that "We can't dispense medication here and besides, insulin is NOT a life saving medication." (Yes, not life saving, but that's another story for another day.) I was freaking stunned; so in my "shy" manner I said, "You're right, it's not life saving, why don't we just wait until he goes into DKA then we can admit him to the ICU and give the hospital a huge bill instead of giving him a bottle of insulin now." Of course I had to add, "He's probably just going to go out and get high with the insulin anyway and share it with his friends."

I updated the doctor to the situation and he told me to just give him the bottle and he wrote the order for me to do so. Again, I was told by the powers that be that I was not permitted to give him the whole bottle.

How did the story end? I ended up giving him his normal dose of insulin for the day and....well....I don't know for sure, but I must have left the bottle of insulin on the bed and thrown it away accidentally when I changed the sheets. Opppsss.

His story, and his story alone is what made me choose the answer that "we don't do enough." Of course, I could give you examples of the other two answers to the poll that may want to make me answer differently. I guess in the end, all of us just want to help; and sometimes that means we do too much, too little, and not enough.
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Old 11-09-2007, 10:56 PM
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MyOwnWoman, your answer was so awesome, but this part made me really laugh:


Quote:
Originally Posted by MyOwnWoman View Post
"He's probably just going to go out and get high with the insulin anyway and share it with his friends."
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Old 11-10-2007, 04:23 AM
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And people don't think social medicine is a good thing?

I must say I find your story quite shocking myownwoman, because of course in the UK any young person (or indeed anyone) will get as much insulin as they can possibly use and what is more because of its life saving necessity they will get if for nothing, free el zippo.
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Old 11-10-2007, 08:10 AM
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It's a tough call sometimes. As for MyOwnWoman's post, yes there are some cases when "we", (management, too), don't do enough. But we had a case a few years ago when a young paraplegic from a BIG city took a bus up here to the very rural north country. He was paralized from a gunshot wound during a gang fight, and had a colostomy, but no pouches for it. He went to one of the few homeless shelters here, but they wouldn't take him because of his "medical issues". They sent him to our ER. Although very stable, medically, the ER doc admitted him for social reasons. He thought he was in a hotel, and that the call bell was room service. "I want a chocolate bar, change my ostomy pouch, bath me." He was able to do all this himself, he did have a w/c, but because he was a "patient", we did for him. Sure, we tried the teaching route for his ostomy, but he already could do it, just chose not to. For 4 months, this man lived at hour hospital, because case management had no where to send him. Finally, he mentioned he wanted to go to Colorado. So case management gave this man a bus ticket, (from Northern New England!) took him to the bus station, 40 miles from here, and helped him onto the bus. He also left with several hundred dollars of ostomy supplies, $100 in cash, and some new clothes. He got all this, plus 4 months of free room and board, as he wouldn't supply the information to apply for medicaid. In my opinion, this was too much. (BTW, nursing had a party after he left!!

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Old 11-10-2007, 08:04 PM
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Stella....that is going above and beyond the call of duty and it is just that type of scenario that would make me want to say "you need to learn how to help yourself. and that we already do too much." What is really worse is that the cost of the ticket to Colorado, the ostomy supplies, the hotel room, etc was probably well worth it to get the "monkey" off of the back of the hospital; but unfortunately, that "monkey" will be back one day only because he knows "if you did it once, you'll do it again."

I'm almost sure that is not what is meant by "The Circle of Life."
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Old 11-16-2007, 11:16 AM
jojodow
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I worked with a lot of Homeless patients at the hospital. We were actually surprised to be assigned to a patient with insurance.
Some would take advantage of the system, some just wanted to get better to go back to their freedom of the streets.
I've always taken the "leading the horse to water" philosphy. Do what you can, if they won't help themselves, then there's nothing left to do.

Yes I do think we do too much, I think we wouldn't have to if there was a govt. program in place. I think everyone needs to take responsibility for themselves if they can. There's only a problem when too many people don't.
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  #10  
Old 11-21-2007, 08:13 AM
Petro Heller
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Question Do we do too much?

I don't really understand what is meant by that question. I am a RN specialising in the OR and as Theatre sisters we are often expected to assist in operations in cases of emergency e.g. Cesarean sections. I honestly think I do as much as I must,and sometimes I go the extra mile if needed. When is it too much? When is it not enough? Surely we must all judge matters for ourselves against our own conscience
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