9.16.2008

Musings over an issue of AJN

Ever since I graduated from nursing school, I've been getting copies of the American Journal of Nursing in the mail. I generally don't have much use for print media nowadays, the content-to-advertising ratio never seems very good, the printed materials themselves take up space, and then of course there's subscription fees.

After 3 or 4 monthly issues piled up in my mail "inbox" area I decided to grab a couple on my way to the coffee shop. I have to admit, it's not that bad. Most of my typical gripes with the magazine format still apply, but there were things about it that I enjoyed. There was a good mixture of scholarly articles (it was refreshing to read something a little closer to my reading level after all of the dumbed-down reading that was foisted on me in nursing school) and interesting musings, interspersed with cut-out charts and assessment tools and the occasional ad that I actually found interesting. It dawned on me, thumbing through an issue...I've become a target market! Weird.

There was an insert with this month's issue that focused on the role of the family caregiver, a person who, with or without a license or medical training, is in the position of providing direct care for a family member at home. There were a lot of articles about how Registered Nurses can assess and support families' home-care efforts, issues surrounding Nurse Practitioners' current inability to initiate home health services, and some interesting accounts of how insurance considers "skilled nursing" as something focused more on machines rather than hands-on skilled nursing care (pulmonary toileting isn't covered, but suctioning is, for example).

Anyway, the reason I'm rambling on about all of this was that thumbing through the issue gave me an idea, and it's this:

When someone takes on the responsibility for caring for a family member at home, there's a lot of information that needs to get across. Medications. Wound and ostomy care. Injections. Skin care. Pharmacological and non-pharmacological pain management. I've seen the overwhelmed looks on patients faces when they're receiving discharge instructions. Pamphlets written well above their reading ability. Dense discharge forms with scrawled addendums. It's a nursing responsibility to make sure the teaching is effective, but not all family caregiver roles are initiated in the hospital.

To support new family caregivers, I think it would be a good idea to set up a sort of distance learning system that can be accessed from home or a public computer. Take an individual patient's diagnoses and home care needs and customize a distance learning syllabus to provide a reference and learning aid for any family member who wants to get involved in care. This could be automated pretty easily, I've seen resources on hospital intranets that generate printable pamphlets for patient education, but I think this process could be improved upon by connecting family caregivers directly to resources like this.

Although my first impulse is to suggest that this should be some sort of freely available national resource (and I still think that's a good idea), it might be more realistic and workable to have this be a service of a particular hospital or system of hospitals. That way the learning aids served to the family caregiver can be customized not only with information pertinent to the patient's condition but also information specific to the patient's primary physician, like doctor's orders, dates of exams and appointments, etc.

Hell, you could even make it interactive, the module being served to the family caregiver could even allow for uploading pictures of wound healing, questions could be posted and answered, why not?

It seems to me that the more we support family caregivers, the more efficiently we'll be able to use our scarce health care resources. There's other issues in play, of course, like the availability of "attendant hours" and RNs for tasks family members can't provide, but it seems like there's definately room for improvement in how family caregivers are supported by the health care delivery system.

What I perceive to be the overarching problem, as I've mentioned before, is the quality of information technology resources employed by both educational and health care delivery systems. Maybe this is a job for Google, they're already getting their fingers in this particular pie anyway.

3 comments:

Geri said...
This comment has been removed by a blog administrator.
PM, RN said...

Sure, there's still always the old-style print material, but you'd be suprised how many "elderly" people are proficient with computers. My grandmother has a website and uses email and all that. Computer use is increasing rapidly in this country at least, i think the percentage that hasn't sent an email is down to 5% or so.

It's also an idea that doesn't have to be the -only- way to do things, but a service you can offer to make people's lives easier. I'll bet it's the kind of service that someone will finally get around to learning how to turn a computer on for.

As long as it wasn't designed by the same people who made our idiotic courseware, it should be pretty easy to navigate.

PM, RN said...

Sorry GB, had to delete your comment because it had my name in it. The comment that I deleted above read (without my name):

Good idea PM, but there are so many elderly caregivers who don't want to or can't use the computer you would have to incorporate some other means for them to obtain the info..which I am sure you have already considered, but I like the idea. Hope all is well post-nursing school.