Balancing
act
August 11, 2016 --
You�d think that everybody in health care would want the same thing:
health. More formally, we call that outcomes; the goal of
doctors, nurses, and of course, patients should be the achievement
of the best possible outcome in the situation, even if that is, say,
a death with pain minimized, or a chronic disease managed. But it�s
not so.
However, the wants of each player are surprisingly different. Here
I�ll discuss the situation that is most familiar to me, the acute
care hospital. When he is there, the patient wants meals, to be
warm, to receive timely responses to his call bell, and to be helped
to the bathroom ASAP.
The nurse, on the other hand, has quite a different list of wants.
She wants to know clinical data such as WBC (white blood cell count,
a measure of response to infection) as part of her mental model of
her patient�s health status, to be able to deliver meds on time
because that is an important measure of her performance, to prevent
falls and bedsores because these are indicators of quality of
nursing care, to be confident of the appropriateness of meds orders
since she, ultimately, is the one administering them, and that pain
meds are adequate because she is the one witnessing suffering and
managing it within parameters determined by others.
Sometimes these differing goals are in conflict. For example, going
to the bathroom might risk a fall. Letting a patient sleep
undisturbed might risk a pressure ulcer (bedsore). In summary,
health care processes are complex and the motivations of its
participants are surprisingly divergent. Managing all this so that
all needs are met is a remarkable balancing act that nurses do every
day.
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