Ask a Nurse

From Home Remedies to Hospital Care

Amer Assoc of Colleges of Nurs

• Editorial: Free Press
• Año: 2001
• ISBN:
  9780743213554
• Categoría: Medicina
• Categoría: Teoria, pratica e riferimenti medici

In the hospital or at the doctor's office, it's the nurses whom patients trust to answer their questions simply, directly, and understandably. So who better to provide inside information about how to manage common health conditions, apply simple home treatments, and make the most of the health care system?
Compiling the expertise of 550 nursing schools and 100 nurses nationwide, Ask a Nurse is a one-of-a-kind quick-reference book of invaluable hands-on treatment and healing tips. Every word in it has been written by nurses: nurses who practice nursing, nurses who teach it, nurses who spend all their days working with and caring for patients. They know what works and what doesn't; they can tell you when you need a doctor's care and what you can do yourself.
Ask a Nurse focuses on the everyday complaints -- acne, allergies, cuts and scrapes, diarrhea, flu, hemorrhoids, insomnia, stress, and more -- that you can most easily treat yourself, at home in most cases. Arranged alphabetically, the entries explain common conditions, list detailed symptoms, and offer top-to-bottom treatment "menus, " featuring everything from effective over-the-counter medications to tried-and-true home remedies and self-care. Alternative and herbal therapies are included: readers will learn, for instance, that devil's claw can ease arthritis pain, tea tree oil can relieve athlete's foot, and a tea bag can reduce swelling.
The nurses address men's, women's, and children's unique health issues separately, with special attention paid to identifying and treating addictions and eating disorders; showing what type of contraception to use and how to avoid sexually transmitted diseases; and highlighting when infertility and sexual dysfunction can be handled at home. The nurses also present a complete guide to consumer rights, dispensing tips on how to make a hospital stay more comfortable, choose a reliable pharmacist, put together a home medical kit, and finally, decide when a living will or do-not-resuscitate order is appropriate.
With easy-to-find reader-friendly boxes and charts supplementing the A-Z directory of everyday ailments, Ask a Nurse offers readers all the comfort, care, and reassuring practical advice for which nurses have always been known. With 100 nurses putting their names to their personal tricks of the trade, this book provides the insider information that you can use to make wise decisions regarding your health.

Part 1
Understanding Healthand Well-Being

CHAPTER 1
The Special Expertise of Nurses

The Changing Health Scene

Medical care and health care delivery have changed radically over the past two decades. On the medical front, for example, new and revolutionary drugs have dramatically improved the lives of people with depression. Heart attack and stroke victims are twice as likely to survive and recover because of new pharmaceutical products and clinical interventions. Combinations of several unique drugs have lifted the once-guaranteed death sentence from many individuals with AIDS. In addition, people of all ages are enjoying improved lifestyles thanks to artificial joints, organ transplants, and a never ending stream of durable new medical equipment. But with these new medications and procedures comes a new demand—the ability to manage chronic conditions, an area of expertise nurses have always claimed for their own.

Medical advances are not the only changes in health care. The way we receive our care, from whom we receive it, and where it is delivered have also changed. In fact, the delivery of care has changed more in the last 15 years than it did in the preceding hundred years. In 1986 the average hospital had 83 percent of its beds occupied. Today, that same hospital (if it remains open) has a less than 50 percent occupancy rate. The average time a person spends in the hospital has dropped by more than half in the last decade. More than 2,000 different surgical procedures are now performed exclusively on an outpatient basis that in 1985 were done only if a person was a hospital inpatient. These changes require more attention to at-home care—a traditional area of nurse expertise.

Even more dramatic have been the changes in the way we pay for health care. In 1987 less than 3 percent of the insured population were enrolled in any form of managed care. Today, more than 70 percent receive their care in a managed program, especially HMOs. In the Medicare population alone, more than 100,000 people a month are enrolling in medicare HMOs. More than 9 million elderly people are now in these programs. By the year 2006, almost 20 million senior citizens will have enrolled. The increasing number of elderly patients also requires the management of chronic conditions in a home environment.

The new and emerging technologies of medicine and the reengineering of health insurance, with its emphasis on managed care, have changed the identity of the people who provide health care. Under the traditional fee-for-service health insurance model, individual physicians controlled the system and the patient flow. A doctor had to admit a person to a hospital. Physicians freely determined what procedures they wanted to provide and did so without oversight or intervention. Hospitals granted doctors privileges based on their competence and their ability to admit patients and generate business. Under this system, the level of unnecessary procedures reached an all-time high. For example, the cesarean section rate soared from 5 percent in 1970 to more than 20 percent today. Yet experts have suggested that the rate should not exceed 12 percent. Nine out of ten hysterectomies performed today do not meet any clinical consensus, meaning that many, if not most, are probably unnecessary. The federal government has noted that by 1994, more than half of all cataract extractions were being done too early. Many studies have shown that at least one third of all coronary bypass operations are being performed too soon, thus creating a high likelihood of reclogging and, further, of more risky surgery.

Yet as managed care has taken control, doctors have lost much of their autonomy. Today, an individual doctor cannot make major procedural decisions alone. Groups of doctors, expert in their fields, have designed protocols and treatment regimens that are being used by the federal government and private insurance companies in deciding what is, or is not, appropriate treatment for an individual patient. With these new protocols, nonspecialist physicians are often doing what only specialists did a few years ago, and, even more significant, highly trained nurses and technicians are now able and authorized to provide what used to be “doctor only” care. From primary care practitioners, whose duties are being replaced by advanced-practice nurses, to specialists, such as heart surgeons, whose skills are being replaced by medications that can be administered by a trained nurse, the individuals who perform medical services and deliver medical care to the typical consumer are changing.

Why a Nurse?

Today, more than ever before, a wide range of trained, licensed, and respected practitioners is available to meet health care needs. The old castes are no longer relevant. The modern medical office has a host of different, yet qualified, professionals working in it. It is rare that we see an office with just a physician, nurse, and receptionist. Today, we are more likely to encounter a group of physicians and a range of nurses (with different levels of training), along with physician’s assistants, several technicians, and maybe even a practitioner of some form of alternative medicine.

Yet today’s nurse is becoming more and more the key to the consumer health experience. And there is probably no profession that has changed more in the last hundred years than nursing. In fact, today’s advanced-practice nurse—a nurse with training well beyond a bachelor’s degree—is very similar to the primary care physician in both training and ability to deliver care. It is now quite common to find independent offices of nurse-practitioners. (Nurse practitioners are registered nurses who have taken additional training and are certified to handle many of the primary care functions of physicians.)

The nursing profession has made great strides since the early days of the century, when nurses were often viewed as little more than handmaidens to doctors. Today, nurses are well-educated and well-qualified clinicians who provide a wide range of health care services in a variety of settings.

The nursing profession has developed both baccalaureate and graduate programs (master’s and doctoral) in primary care, pediatrics, women’s health, gerontology, and midwifery, to name a few. In addition, many nurses complete continuing education programs to keep current on advances made in their fields. Nurses fulfill a very important role in being the first contact for many consumers entering the health care system, and their impact is immense.

In today’s hurried health care environment, physicians have precious little time to attend to every aspect of care. Nurse-practitioners are well skilled at taking a health history, performing a complete physical checkup, reviewing a medical record, listening to the main complaint of a consumer, and even providing or prescribing treatment. In fact, many health care educators suggest that nurse-practitioners are often more adept at collecting patient information than physicians are. Nurses are also the sole health care professionals who have been trained in providing patient education.

Studies conducted during the past decade have found that 75 to 80 percent of adult primary care cases and upwards of 90 percent of pediatric primary care services can be competently handled by nurse-practitioners.

Several successful demonstration projects, held in conjunction with prestigious schools of nursing, illustrate this point. So successful are these nurse-practitioners that they are now integral to the primary care teams of most managed health care plans. In fact, as managed care plans develop new disease management programs—programs that provide a team approach to managing specific conditions such as asthma, diabetes, and heart disease—nurses are being called on to serve as team leaders.

In other words, today’s nurse is a well-educated, highly skilled health care professional. And he or she is very probably the most consumer-oriented and experienced health care provider the patient is likely to encounter. Consider these facts:

• Nurses are the only licensed health care professionals trained in health education.
• Nurses deliver 95 percent of all health care, making them the most reliable source of information about treatment issues and problems.
• Managed care companies have made nurses the centerpiece of care, recognizing that nurses are the most skilled at directing patients to appropriate care.
• Public opinion polls show that nurses are the most trusted and respected health care professionals, outdistancing physicians.
• Nurses provide more hands-on patient care to consumers than any other professionals.

Specialty Certification

Not only have nurses improved their educational programs, they have also established a credentialing system that is overseen by the profession. Today, there are more than 20 clinical areas in which nurses can earn specialty certification. Each specialty board sets its own standards for certification, which may include years of experience on the job, advanced degree credits, and continuing education credits. Nurses who earn specialty certification are identified by additional letters after their names; for example, CNM is the abbreviation for certified nurse-midwife.

You don’t have to look any further than the certified nurse-midwife program to see the contributions of advanced-practice nurses. Nurse-midwives provide women with an option when choosing obstetric care, as well as a birthing setting other than a hospital. Working independently, except for certain collaborative or backup arrangements with physicians, certified nurse-midwives clearly demonstrate the competency, skill, and value of advanced-practice nursing.

Midwifery isn’t the only area in which nurses have developed specialty certification programs. Other specialties include critical care nursing (CCRN), childbirth education (ACCE), emergency nursing (CEN), infection control (CIC), pediatrics (PNP), anesthesia (CRNA), diabetes education (CDE), nephrology (CHN), and women’s health (WHNP), to name a few. When a consumer sees those initials after a nurse’s name, the person can be assured that a significant amount of advanced specialty training has been undertaken.

Skills and Expertise

Based on their education and experience, nurse-practitioners and other advanced-practice nurses are well qualified to manage patient care. Nurse-practitioners assess the needs of their patients, make clinical diagnoses, develop and implement treatment plans, monitor the status of their patients, participate in patient education, and, when necessary, refer patients to other health professionals within the health care delivery system.

While the level of training and education of nurses has been steadily increasing, one aspect of their experience has become more and more important—the day-to-day management of illness at home. As hospital stays get shorter, and more and more procedures are done out of the hospital, the need for home health care has increased enormously. As the population ages, as more people live longer with the help of new medications, therapies, and procedures, the more need there is for the kind of hands-on home management of chronic conditions that has always been the unique terrain of ...