patient centered care

Episode 10: Patient Centered Care

June 07, 2019

Current news

Healthcare is a huge industry with a large piece of market share. Many times we do not see how much we actually get charged per visitor per procedure, we just pay what the bill says to pay but eh costs are never broken down.

To give you a look at one side of healthcare, in 2018 the medical device industry, the industry that creates pacemakers, surgery tools, LVADs, etc.., brought in a revenue of 180 Billion dollars.

The united states are the largest medical device market in the world. We innovate, create, and use more medical devices than any other country in the world. The FDA approves medical devices.

There are different ways the FDA approves medical devices. The most common way a device is approved is with the 510(k) clearance, it accounts for about 83% of all medical device approvals.

The crazy thing about that is the devices that go through that approval process do not need clinical human trials. So what are the requirements to get your device approved through this process? You are required to show that your device is as or more effective than the current device in the market. You can compare animal trials with the same efficacy and it can get cleared for market use without ever getting tested on humans.

In the past decade deaths associated with medical devices are 80,000 and over 1.5 million injuries totaling 8 billion dollars in settlements alone. Most of those products have never gone through human trials. This is one loophole that can be easily exploited.

Patient-Centered Care

Patient-centered care is the practice of caring for patients, and their families, in a way that brings meaning and values the individual patient. Patient-centered care includes listening to, informing and involving patients in their care. Patient-centered care models correlate with better patient outcomes and increased satisfaction¹.

  • Respect patient values and preferences².

    • The way we do certain things and the way we go about our day is not how everyone goes through the motions. Just because we like something a certain way does not mean everyone else does. As nurses, we have to abide by the patient's cultural values and preferences. We have many lifestyles.
    • Dietary preferences are their main one you’ll see in the hospital. Some people are vegetarian or cannot eat certain foods like pork or beef. The simplest way to make a patient appreciate you more is when you put in a dietary order or notify the dietician about what foods they can or cannot eat.
    • Some religious patients like to devote time to prayer. Another easy way to show respect to the patient's values is to allow them time alone to prayer or meditation.
    • There are many different end of life rituals. End of life care also has different variations. Some families like to sing over the body or wash them.
  • Coordinate care

    • As nurses we are, many times, the middle person. We are the ones that notify the consulted physician and explain what is going on. Proper consults should be addressed. Is the patient have blood sugar issues? It would be a good idea to let the primary know to put endocrine on. If the patient is concerned about the cost of care or psychosocial issues, homelessness, depression, etc.. Even though we cannot directly help the patient with the cost of healthcare or homelessness we should at least notifying social services to address these issues.
    • It’s never a good idea to minimize the amount of time to spend with the patient but you want to bundle care, especially on the night shift. A patient does not want to be disturbed every couple of hours from 12 to 6 am. Bundling care promotes patient to rest and allows you to more efficiently get tasks done. If you get your tasks done quicker and more efficiently it allows for more time to be spent with conversing with the patient.
  • Information and education²

    • Keep the patient informed on what’s going on. What is the plan for today, is there a schedule. It’s always good to let the patient and family know what's in store ahead and if they know what time you are coming back they will hit the call lightless.
      • I personally like to ballpark a schedule. I’ll be back to do your assessment, shoot numbers, and give meds at 9, do your dressing at 11, and I'll try not to wake you too much after midnight. I will be checking up on throughout the night to make sure your ok and that your medications are running. At around 5 I will be drawing your blood and giving your morning medication.
    • When you are giving meds or changing dressing explain what you are doing and what the medications are for. It shows that you know what you are doing. Its also good to show and explain it to the family member because they are going to be the ones to assist the patient when they go home.
    • Remind the patient that physicians will be rounding in the morning and can also answer any questions that the patient has because they are the ones dictating care. If the patient is going for a procedure make sure they understand it, if they don't the physician has to come and educate the patient, your education is used as reinforcement as reinforced teaching.
  • Comfort and empathy³

    • Physical comfort is very important. I’ve never heard a patient say that the mattress they are on is comfortable and how many times have you talked in and the patient has slid down in bed?
    • Pain is another key thing that needs to get addressed. Is your intubated patient’s blood pressure high because of pain? Maybe you’re better of giving pain meds than pushing that hydralazine. There’s nothing worse than being in pain and cooped up in a hospital room all day and night.
    • Fear and anxiety are often accompanied by illness. Empathize with the patient understand where they are coming from. Have a conversation, ask about their family, how long they’ve lived in the area, crack a joke, and get a little personal. Don’t always treat them like they are broken, make them feel a bit more human.

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References
  1. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1745-7599.2008.00336.x
  2. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2702.2004.00817.x
  3. https://link.springer.com/chapter/10.1007/978-3-319-27625-0_11
  4. https://www.oneviewhealthcare.com/the-eight-principles-of-patient-centered-care/
  5. https://www.fda.gov/medical-devices/device-approvals-denials-and-clearances/510k-clearances


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