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A patient’s-eye-view of nurses

Lynn Babington, Ph.D., RN, professor and dean of Fairfield’s School of Nursing, posted a comment on this intriguing article by Lawrence K. Altman, M.D., about Dr. Arnold S. Relman, the eminent former medical educator and editor. In it, Dr. Altman wrote, ‘Despite decades as a medical educator, researcher, author and editor of The New England Journal of Medicine, Dr. Relman confesses that he “had never before understood how much good nursing care contributes to patients’ safety and comfort, especially when they are very sick or disabled.” Dr. Babington responded: Dr. Relman, a national leader in medical education, in a recent article about his experience as a patient, writes about his recent discovery of the importance of nursing care to the safety and recovery of patients. He specifically states, he “had never before understood how much good nursing care contributes to patients’ safety and comfort, especially when they are very sick or disabled.” He also noted, “What personal care hospitalized patients now get is mostly from nurses. When nursing is not optimal, patient care is never good.” In fact, nurses go beyond making suggestions to physicians in the care of patients. Nurses, especially in the acute care setting, are in the best position to observe changes in patient’s conditions, make decisions and provide interventions to not only prevent physical decline, but to augment healing and recovery. In nursing education today, students study physical assessment, pathophysiology and pharmacology, along with the basic sciences, so that they can recognize changing patient conditions and either implement immediate interventions to respond to those conditions or call in the patient care team, including the physician, to change the course of treatment for patients. Many patients and families do not recognize the importance of those very specialized assessment skills that nurses use every day. For example, a post operative patient may be progressing as planned, but when the nurse is speaking with the patient, she (and most nurses are women) may recognize that the patient has begun sweating and displaying agitation. The nurse will take the patient’s blood pressure, check the heart rate and respiratory rate and note any changes from the last time these were recorded. She will check the wound site for redness, tenderness and any changes. Based on her assessments, she will contact the patient care team, including the physician, to discuss these findings (a potential infection or drug reaction) and seek appropriate interventions to prevent the patient from deteriorating. Nursing knowledge and assessment skills, along with communication skills, are essential to the safe recovery of patients. Nurses are at the bedside 24 hours a day, while physicians typically “check in” on a patient once or twice a day. The collaboration of the entire team has never been more important.

Published in The New York Times on 2/10/14

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