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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 > > > >