Monday, July 9, 2012

History taking getting too personal?

Whether or not you support the constitutional right to bear arms and what you believe the right to free speech covers, there is a definitely a controversy brewing in Florida over the "Gag Law."  A recent ruling states that Florida "cannot enforce a law that prohibits physicians from asking patients whether they own a gun because it infringes on their First Amendment right to free speech." The National Rifle 
Association (NRA) helped lobby for the law believing the second amendment was at risk and stating that the information obtained by healthcare providers would go into individuals' permanent health records. Physician groups argue they are trying to protect children and that assessing whether there is a gun in the home is necessary to provide education on gun safety, similar to bike and car safety. Other groups disagree. But what about adult patients? 

The question then becomes what information is necessary for healthcare providers? How is some of this and other social information used in relation to patients' overall health care? Some argue that some information should not be kept in their permanent medical record and do not understand the relevance. 

Would it be appropriate to assess a person with profound depression risk for suicide? Part of that assessment would include assessing for a plan, access to methods and ability to carry it out.  How about a patient that has substance abuse issues - is it appropriate to ask about the use of drugs and alcohol? Sexual orientation, partners? You get the point...

As an ACNP I understand the concept of history taking but I also understand the need for being respectful of sensitive information. Of course many patient's do not share everything with healthcare providers out of fear, or stereotyping or some sort of recourse. Will this situation in Florida have the effect they are looking for - preventing unintentional firearm accidents? I'm not sure. But I do know that constitutional rights are polarizing topics and it seems that most sit on one side or the other. Regardless of your personal beliefs on firearms or free speech, when it comes to caring for patients, the patient must remain central in order to be a true advocate.

Tuesday, July 3, 2012

Taking care of everyone but ourselves

It is no secret that a majority of Americans are overweight. Some studies predict that 42% of Americans will be obese by 2030; with obesity defined as weight greater than over 20 - 25% of normal body weight. The most common health consequences of obesity are also well know - hypertension and diabetes. What many lay-persons may not be aware of are the myriad of other health issues that result from obesity: cardiovascular diseases (risk of cardioembolic events such as stroke and myocardial infarction) renal dysfunction, infertility, erectile dysfunction, obstructive sleep apnea, risk of developing various cancers, not to mention decreased quality of life (this list is by no means exhaustive).

Nurses, physicians, respiratory therapists, paramedics and others, on the other hand are all aware of the consequences of poor health such as obesity and chronic hypertension. Yet, there are many healthcare providers and workers that are in extremely poor health, smoke, are very obese. How many of us work with colleagues that can not respond to code situations quickly and you find you are the only that can actually run to the bedside? Everyday tasks are fraught with shortness of breath, fatigue, painful joints and other ailments during the long 12-hour shifts or longer. Add to that lack of sleep and stress of the shift (see Burning Out: Combating compassion fatigue & moral distress) and nurses and other care providers are set up for health problems. Unfortunately, nurses are not necessarily good at caring for themselves on daily basis. I am talking daily renewal and refreshing your body and mind - taking time to clear your head and let go of the stress of the shift. Celebrate the saves and mourn the losses. When it comes to preventive health and wellness, we tend to care for those around us and put ourselves last; waiting to the last minute or too long to seek care. But I regress....

If you walked into my old unit almost any day of the week, you would find some sort of processed, junk food in the lounge. I myself have an insatiable sweet-tooth and am known for always having a chocolate stash! But I am also not obese, not even overweight - not even close. I am a vegetarian and I rarely sit still and I drive my family crazy about being healthy because I don't want any of us to suffer from the diseases I treat patients for. My point is never see a plate of veggies and fruit in the nursing unit lounges. When was the last time you saw a big bowl of hummus and cucumbers? You may see salsa, but with corn chips and out of jar! Cookies, brownies, candy, chips and more. Even the cafeterias struggle to cook healthy options. And firehouses...they definitely like their bacon and sausage in the morning and meat and potatoes in the evening! (No disrespect to all my paramedic and firefighter friends!)

On a serious note, it disturbs me that we as educated professionals are teaching and preaching to patients and their families how to stay healthy and prevent further admissions by "reducing dietary sodium," "smoking cessation," "cutting back on alcohol consumption," "increasing fruits and vegetables while reducing sweets and fats," yet the collective we is just as unhealthy as they are. What message are we sending our patients? One news media article cited that 55% of nurses are obese. It is clear we are not following our own advice. Again, what does that do to our credibility? How can we take better care of ourselves and be better role models for our patients?

With healthcare at the forefront of discussion in the media and a focus on prevention and reducing costs, it is important that we are do our part to care for ourselves and each other.

I encourage you go to the Nurses Health Study link. The partners have been studying the health of nurses since 1976 and currently recruiting nurses for their third study.

The Nurses Health Study