Tag: nursing

Dicephering a stroke patient’s message

I had been working as a nurse practitioner in stroke/neurology for three years when I encountered Mr. B, a 67-year-old patient who came to our hospital with acute onset of right-sided weakness and aphasia following a moderately-sized left-middle cerebral artery stroke.

Mr. B’s course was typical of an acute stroke patient, and we proceeded through our work up and evaluation as usual. Since Mr. B’s language center was in the left side of his brain, he was suffering from language deficiencies that included profound expressive aphasia. During his stay in our hospital, he worked with our skilled therapy team. It was evident to all of his healthcare providers that he was extremely frustrated with his inability to communicate.

The day before we had scheduled to send him to acute rehab, I entered the room for daily rounds with another nurse practitioner on our team. Mr. B again seemed agitated and frustrated as he tried to communicate his wishes to us. I grabbed my notebook and a dry erase marker, which he was able to grip in his right hand.

To our surprise Mr. B was able to write, but the letters were jumbled, and we set the notebook page aside feeling unsuccessful in our attempt to communicate.

An hour later we were called back to Mr. B’s room by his daughter. It turns out that when she was a child, her father had used mirror image writing to communicate with her as a special code. She saw the notebook page from earlier that morning lying on his bedside table and recognized the pattern immediately. We grabbed a mirror and were able to decode the message.

Full story of a stroke patients message at Clinical Advisor

Insurance type tied to dying dementia patients’ care

The chance that nursing home residents with advanced dementia will receive inappropriate care may be related to their insurance coverage, a new study suggests.

Insurance Type Tied to Dying Dementia PatientsFewer dying people with dementia were moved to the hospital for possibly unneeded care when their insurance coverage paid on a per-patient basis, rather than for every test and treatment, researchers found.

NYU School of Medicine’s Keith Goldfeld said so-called managed care organizations are motivated to stop people from receiving unnecessary and costly care.

People with advanced dementia won’t usually benefit from being hospitalized during the last months of life for acute ailments like pneumonia, Goldfeld, the study’s lead researcher, said. The focus should be on making the person comfortable.

“When the focus is on comfort, the idea is to try to limit the type of care that could be burdensome for the patient and costly,” he said.

Nursing homes may want to send very sick residents to hospitals because it shifts the cost of treating them from the homes to the hospitals and Medicare, the government-run health insurance for the elderly and disabled.

Full story of insurance and dementia care at Reuters

Photos courtesy of and copyright PhotoPin, http://photopin.com/

Nurse practitioners play an important role in preventing errors

Nurse Practitioners Play Important Role in Medical Error Prevention“To Err is Human: Building a Safer Health Care System,” was published in 1999 by the U.S. Institute of Medicine (IOM) and brought attention to the need for the reduction of medical errors in the US health-care system.

As a result of this publication, efforts were made at both the macro and micro levels of health care to improve patient safety. Hospitals implemented policies for improved medication administration. Surgeons were encouraged to adhere to “time out” procedures prior to initiating surgical interventions, during which they state the name of the patient and the duties of each clinician present. State licensing boards require continuing education be completed on the prevention of medical errors prior to licensure and again on renewal.

A medical error is defined by the IOM as “the failure to complete a planned action as intended or the use of a wrong plan to achieve an aim.” Awareness of the responsibility to prevent medical errors and improve patient safety is widely discussed and is addressed in the curriculum for registered nurses. Registered nurses are usually encouraged to be the patient’s advocates through this role, and much of the time they are the last line of protection against an error. This background often makes nurse practitioners better at completing the planned action as intended and using the correct plan to accomplish an aim.

Full story of nurse practitioners and error prevention at The Clinical Advisor

Photos courtesy of and copyright PhotoPin, http://photopin.com/

Studies Find Mixed Results for Dementia Units

Mixed Results for Dementia UnitsBy their euphemistic names, ye shall know them: The Memory Care Unit. The Reminiscence Neighborhood. Homestead.

These special units for residents with dementia have spread throughout the American nursing home industry; more than 16 percent of nursing homes now include one.

The laudable idea was to move patients with dementia out of the typically over stimulating and understaffed nursing home into a separate wing, a calm and secure environment where well-trained staffers would offer tailored activities, handle problematic behaviors and provide greater support.

But I’ve always wondered whether these units actually live up to their promises and their higher price tags. In a competitive nursing home market, they may provide an edge in attracting paying customers. But do they provide better care, or mostly a reassuring name and a locked door?

The research provides some intriguing findings but, sadly, no clear thumbs-up for families trying to figure out if this is the solution for someone who wanders, gets frightened or obstreperous, or needs more attention.

Full story on dementia units at The New York Times

Photos courtesy of and copyright PhotoPin, http://photopin.com/