Once again I assumed the default setting for this group was "reply to all" so I accidentally sent my reply to an individual. That message is being forwarded to the group.


Nerissa


--- On Wed, 11/19/08, Nerissa Belcher <[log in to unmask]> wrote:

> From: Nerissa Belcher <[log in to unmask]>
> Subject: Re: dignity -- say what?
> To: "Chris Hanks" <[log in to unmask]>
> Date: Wednesday, November 19, 2008, 4:10 AM
> Hi everyone,
> 
> It appears my position has been mis-interpreted. What
> I'm trying to say is we need to provide quality medical
> care while respecting our patients. As for protecting
> ourselves with documentation if only it were not necessary.
> In the USA, however, nursing is much more about
> documentation than patient care. I'm a new nurse but was
> a podiatrist for twenty years. The same rules applied to me
> as a foot doctor. Documentation requirements in the USA (UK
> too?) are out of control. But, like it or not if we wish to
> retain our employment we do what we're paid to do. Which
> is to document. A major reason I got out of podiatry is I
> wasn't paid to document. Each and every ridiculous new
> documentation requirement to come down the pike did not come
> with any funding for it. As advantage of nursing is as
> ridiculous as the requirements are if someone wants to pay
> me good money to write for the 10,000th time my nursing
> focus about pain control and preventing falls (hint to the
>  administrators - I got the ideas well before writing them
> down for the 100th time) then so be it. I can cash my checks
> in good faith.
> 
> Getting back to patient care the ethical issue is when
> quality care conflicts with patient desires. I disagree with
> Stephen Padgett who seems to think that since medical
> standards change over time we should assume patients are as
> likely to be accurate in their medical assessments as nurses
> and other trained medical professionals. Fact is the
> patients are likely to know less about what works than we
> do. If they decide not to follow our advice then we should
> support them in doing so but not put our jobs at risk by
> failing to document the discussion.
> 
> Additionally I wish to point out that patients will more
> likely follow our advice if we show confidence in ourselves.
> I.E. if we really believe we don't have a clue, since
> things are always changing, patients will be prone to not
> following our advice. IMO part of being a professional is in
> keeping up with our studies so our advice is as current as
> research allows.
> 
> Nerissa
> 
> --- On Wed, 11/19/08, Chris Hanks
> <[log in to unmask]> wrote:
> 
> > From: Chris Hanks <[log in to unmask]>
> > Subject: Re: dignity -- say what?
> > To: [log in to unmask]
> > Date: Wednesday, November 19, 2008, 3:26 AM
> > Dear all
> > Thank you Olga for the reference, I will read this.
> > I have to say that I fully agree with Stephen's
> > eloquent outburst.  And there is no reason not to be
> > passionate in decrying a situation which is commonly
> > encountered (though there are delightful exceptions).
> > As I read Stephen's contribution I did feel for
> > Nerissa, as I think that I recognise the anxiety of
> the new
> > nurse placed in a stressful environment, however, I
> feel it
> > crucial that the points Stephen makes are carried into
> > practice.  I have been having discussions with senior
> > undergraduate student nurses regarding these ethical
> issues
> > for many years; the students express positive patient
> > centred ideals.  When I visit practice areas or teach
> some
> > post qualifying classes, it saddens me that often the
> ideals
> > appear lost.  In particular it worries me how often
> nurses
> > think that they know best, sometimes blessed with only
> > scanty second hand knowledge, and no inclination to
> > question.
> > 
> > Thanks Stephen
> > 
> > From Chris Hanks
> > Senior Lecturer
> > University of Plymouth
> > England
> > 
> > ________________________________________
> > From: A list to promote discussion of philosophical
> issues
> > in nursing [[log in to unmask]] On Behalf
> Of
> > Olga Jarrin [[log in to unmask]]
> > Sent: 19 November 2008 01:31
> > To: [log in to unmask]
> > Subject: Re: dignity -- say what?
> > 
> > Medical facisim, lol... and after days of dialogue on
> how
> > we ought to disagree and present our arguments!
> Stephen,
> > Nerissa is an ex-podiatrist and new nursing grad (oh
> the
> > wonders of google). I'm going to take a different
> tack
> > and reference the latest issue of ANS 31(4), 283-295.
> > Gweneth Hartrick Doane & Colleen Varcoe's
> article
> > Knowledge Translation in Everyday Nursing: From
> > evidence-based to inquiry-based practice addresses
> their
> > "deeply felt concern with the profound disparity
> that
> > often exists between what nurses know and what nurses
> > do." They go on to give an example of a nurse who
> > provided care to one of the authors in a way
> inconsistent
> > with her education. The authors wonder briefly if
> workplace
> > stress or culture might explain the incongruence
> between the
> > nurse's perception of her nursing practice and the
> > author's perception of her nursing care.
> > 
> > Here is another side of Nerissa, something she wrote
> just a
> > year ago:
> > 
> > I'm in nursing school with one semester to go.
> Student
> > nurses are taught to be supportive of all their
> patients.
> > This includes Christians, atheists, minorities, gays,
> etc.
> > 
> > I agree strongly with this approach. Nurses should
> provide
> > the best care they can and not attempt to impose their
> > opinions on the people they care for.
> > 
> > Nerissa Belcher
> > September 23, 2007
> > 
> > 
> > 
> > --- On Tue, 11/18/08, Stephen Padgett
> > <[log in to unmask]> wrote:
> > 
> > > From: Stephen Padgett
> > <[log in to unmask]>
> > > Subject: Re: dignity -- say what?
> > > To: [log in to unmask]
> > > Date: Tuesday, November 18, 2008, 7:20 PM
> > > I don't know where to begin to say how much
> this
> > message
> > > disturbs
> > > me. The astonishing arrogance and self-regard of
> it is
> > > matched only by the
> > > wild self-pity. Oh, poor us! Forced to do more
> > > documentation, to protect
> > > ourselves from vengeful patients who had the
> temerity
> > - the
> > > cheek!-- to
> > > refuse our always-excellent advice! But now they
> > regret it,
> > > don't they?
> > > they wish they'd listened to us, they'll
> try
> > to
> > > "re-invent themselves"
> > > (whatever that means) to blame us for their
> lapses,
> > but we
> > > know better,
> > > don't we? don't we always?!
> > >
> > >       and that this should arrive in my inbox
> under
> > the subject
> > > heading
> > > "dignity"!!
> > >
> > >       No, Nerissa, this isn't dignity or
> respect
> > or even
> > > nursing in my
> > > book. This is medical fascism. First off, it
> > conveniently
> > > ignores all
> > > the mistakes *we* make, all the ways our
> > "advice"
> > > changes with the
> > > latest research, the shifting fashions and
> priorities,
> > the
> > > season. It
> > > ignores all the nonsense we say to people...
> > >
> > >       Have you been a patient recently, Nerissa?
> Or a
> > family
> > > member of
> > > one? I don't wish you any ill health, but it
> is an
> > > excellent way to shake
> > > off professional arrogance. To be the recipient,
> as
> > opposed
> > > to the
> > > dispenser, of so much well-intentioned and
> utterly
> > useless
> > > (if not
> > > downright offensive) advice that nurses, doctors,
> and
> > > others dish out
> > > everyday is a profoundly humbling experience. And
> have
> > you
> > > looked
> > > recently at the data on patient lawsuits &
> > malpractice
> > > claims?  Most
> > > clinicians wildly over-estimate their actual risk
> of
> > being
> > > sued.
> > >
> > >       And that's not even the main issue. The
> main
> > issue is
> > > simply that
> > > people do not give up their rights to make
> choices
> > when
> > > they come into the
> > > healthcare system. It's astonishing to me
> that we
> > > continue to have
> > > to debate this in health care. And no, Nerissa,
> > you're
> > > not the only one
> > > who thinks like this -- this attitude is all too
> > common
> > > among the
> > > providers I meet. Not everyone, not by a long
> shot,
> > but far
> > > too many. It's
> > > the seamy side of professionalism - the "we
> know
> > > better" side.
> > >
> > >       Whether you agree with a patient's
> choices -
> > whether
> > > you think
> > > they make the most sense from a medical
> standpoint,
> > whether
> > > they are
> > > congruent with YOUR careplan -- is not the point.
> The
> > point
> > > is, it's
> > > their call. This ethical orientation is
> fundamental to
> > our
> > > system of
> > > professional relationships -- it helps to counter
> that
> > > "we know better"
> > > pull - and it is very disheartening to hear you
> wave
> > that
> > > away because
> > > people making the *wrong* choices might become
> > > "problems" later on -
> > > problems for us, of course. (Poor us!)
> > >
> > >       "Warning" people is fine,
> documenting
> > is always
> > > a good idea, but I
> > > think you need to do more than just "consult
> with
> > the
> > > ethics people." I
> > > think you need to have a long talk with them
> about
> > what
> > > you're in charge
> > > of and what you're not.
> > >
> > >       Stephen Padgett
> > >
> > >
> > > On Tue, 18 Nov 2008, Nerissa Belcher wrote:
> > >
> > > > Hi Ms. Davis,
> > > >
> > > > IMO, if a patient deliberately chooses to
> > increase
> > > their risk despite
> > > > nurses advising them of the danger then they
> are
> > > problems waiting to
> > > > happen. We all know the drill. The
> > > nurse/doctor/therapist, etc. didn't
> > > > warn them firmly enough, or document well
> enough,
> > or
> > > consult the ethics
> > > > people. I support free choice but we need to
> be
> > very
> > > aware that people
> > > > reinvent their pasts to claim ignorance of
> things
> > > later. Sadly, still
> > > > more documentation for nurses needs to be
> > completed in
> > > anticipation of
> > > > problems.
> > > >
> > > > Nerissa
> > > >
> > > >
> > > > --- On Tue, 11/18/08, Davis, Betty
> > > <[log in to unmask]> wrote:
> > > >
> > > >> From: Davis, Betty
> > <[log in to unmask]>
> > > >> Subject: RE: dignity
> > > >> To: "Nerissa Belcher"
> > > <[log in to unmask]>
> > > >> Date: Tuesday, November 18, 2008, 3:10
> PM
> > > >> You stated, "Show them respect
> unless
> > doing
> > > so harms
> > > >> their medical
> > > >> care."  Does that imply that
> > noncompliance or
> > > >> disagreement with the plan
> > > >> of care warrants disrespect?  That
> statement
> > seems
> > > to
> > > >> disallow free
> > > >> choice....  And, please, be gentle....
> > > >>
> > > >> Betty W. Davis, PhD, RN, CNE
> > > >> Assistant Dean, Nursing
> > > >> Program Head, Associate Degree Nursing
> > > >> Meridian Community College
> > > >> 910 Hwy. 19 North
> > > >> Meridian, MS 39307
> > > >