Patient Centered Care

I step out of my Mrs. Balabusta role for the following post, and speak, for a change, and a nurse and more directly, as a member of the sentient human race.

Having said that, it has come to my attention in the last week of clinics that I have been sadly overestimating the intellectual capacity of many people, mostly patients. In short, Thinking is Very Overrated.

I now move to the realm of nursing theory. My lay readers may follow along at their own Peril:

Nursing, in common with many other professions, loves key catch phrases, especially if you are writing a paper, or a grant, or say, for example, both. Two of my favorite catch phrases are Evidenced Based Practice and Patient Centered Care. I could write an entire post about Evidence Based Practice, or I could sum it up like this: "Let's try this and see if it works - if it does, we'll write a paper!"

But I digress, because this post is about Patient Centered Care. This affects me and my family on a very personal level because the institution in which my grandfather (aka The Man of Steel) resides has become all about Patient Centered Care. If I had to sum of the theory of Patient Centered Care in a nutshell it would go like this - "We should care more about the patient than the institution itself." Radical, I know, but they do have evidence to back up this theory. The evidence runs something like a lot of surveys that say patients like their care providers to, get this, make the patient their first priority, especially in institutions they are likely to reside in for several years and to which they will be leaving their entire life savings.

But I digress again. One example at my grandfather's institution of Patient Centered Care is that they now serve breakfast anytime between 7 and 10 a.m. to accommodate those habitual late risers. My grampa however points out rather succinctly that although he is an early riser and likes to eat breakfast no later than 8, the staff didn't ask him what time he liked to wash or get dressed. The aforementioned Man of Steel, who is by the way classified as the "old old" only requires clean towels, help with his AFO and tying his shoes. Still, he likes to have his shoes tied before breakfast, so his idea for Patient Centered Care would be if they would ask him what time he likes to get dressed and washed instead of offering him breakfast until 10.

Also they offer him a bedtime snack. They take a cart around and bring him graham crackers. Every night, graham crackers. This is exactly what makes institutions institutional and exactly the kind of thing Patient Centered Care was supposed to make extinct. So Grampa, being sick of graham crackers, asked for a banana before bed. He was told that the graham crackers already had his sticker on them, so he had to take them, and anyways the bananas will be served with his breakfast. "Well, I will take the graham crackers if I have to. But if the bananas are handy, could I have my banana now instead of in the morning?" Surprisingly, this request was granted and Grampa considered it a major victory, stroke of unusual luck, or a mere fluke. But if you ask him what's nu - he has a story to tell about how he scored a banana for bedtime snack.

So you would think the above stories mean that if the institution really wants to center their care around the patient, they would logically.....ask the patient what they want? I admit that would be the direct approach - it's almost too easy. In fact, it's just what they'd be expecting us to do. So obviously, that's not what they did.

In fact, the institution mailed a form to my father about my grandfather that was about 8 double sided pages long. It came with a cover letter stating that the more we know about our patients the better care we can offer them, and that is why we are asking you the family members to fill out this questionairre titled "My Life Story". My father decided he didn't have all the information he needed to answer some of the questions so he brought the questionairre to Thanksgiving Dinner so after the Packer game was over (We BEAT the Lions) he would ask Grampa the necessary information.

Now some of the questions were in fact, centered around better care for the patient. Information like religious preference and marital status, number of children and grandchildren (my father attached a spreadsheet here). However, some of the questions were irrelevent, bordering on ridiculous and made for some very humerous exchanges that in retrospect, we should have videotaped. I will however, from memory give you some examples of the questions and Grampa's answers.

Personality inventory: Check the box if you think this adjective applies to you. Grampa, just answer yes or no if you want to check the box.
Active? - Yes.
Passive? - Yes.
Angry? - Why? What did you do?
Depressed? - Every time the social worker meets with me they ask me that. Do I look depressed? Anyway, I just say no.
Cheerful? - Sure, why not?
Insightful? - Okay.
Introspective? - What does that mean?
Hopeful? - Hopeful? I'm 93! What exactly am I supposed to be hoping for?
Athletic? - Sure, I can walk to the bathroom by myself.
Demanding? - Eh, why knock your head against the wall? It would be nice if they could serve the coffee -HOT- with the dessert, otherwise the coffee gets cold while they are passing around the dessert. Is that too much to ask? Is that demanding?
Content? - Content or continent? Okay.

As amusing as that exchange was, it only got better from there.

Where is your favorite place to go on vacation? -Vegas? Why?
What is your favorite book? - I don't like books.
What is your favority movie? - I don't care for the pictures.
What is your favorite movie actor? - They're all bums.
What about actress? - Elizabeth Taylor, she was pretty good.
What's your favorite sport? (This is after the game which we parked at the end of the dining room table for the Thanksgiving Dinner) - Football, I guess.
What do you do to relax? - Relax? I relax when I'm asleep don't I?
Do these things help you to relax:
Prayer? - No, usually he goes pretty fast.
Synagogue? Isn't that the same as prayer?
Temple? Isn't that the same as Synagogue? Who wrote these questions?
Meditation? Never.
Purposeful breathing? Everytime I breath its on purpose.
Sports? You mean watching sports or playing?
Reading? No.
Music? Yes.
Tai Chi? Gezuhntieit.

Then we go to the really obscene stuff. I admit, these next few questions made me lose my patience and go off like... like... like a ...wait a minute, you tell me.

What is your favorite color? - Why you painting the room?
What is your favorite day? - Is today Thursday? That sounds pretty good.
What is your favorite dream? - None of your business.
What is your favorite plant? - Huh? Plant? Like flowers? Elm trees are nice. You know the poem, roses are red, violets are blue -

That's it. Right there. I want someone to tell me for the love of everything holy what instrument these administrators lifted from which study and how knowing your favorite PLANT is going to impact patient care as much as a stupid question like - WHAT DO YOU LIKE TO EAT BEFORE BED, IF ANYTHING?