Hospital-savvy people, please spill

Parent Cafe
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<p>My spouse is having open-heart surgery next week. I’ll be in a big city research hospital, sleeping each night with relatives a few blocks from the hospital. </p>

<p>The medical team wants me nearby but said that in CCU the first 2 days, nursing staff is plentiful (ratio to patients 1:2). Then he’ll spend another 4 days in the more general recovery ward and they want me to help him bedside.</p>

<p>I’m not sure what “help” means but it’s due to a nurse-patient ratio of 1:20 or somesuch. If it’s too much they can bring in paid aides on 4 hours’ notice. </p>

<p>What do I do here? Bring a book, a chair-pad, knitting, cellphone? I’ve had experience doing serious bedside care in peoples’ homes – but not in a big complicated institution such as a hospital. </p>

<p>Also, how do I get in good with the nursing staff?</p>

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<p>I think that you will have to play this by ear; it will all depend how much care your spouse will need on that second leg and how often you plan on being by the bedside…</p>

<p>I’m not sure it’s a question of “getting in good” with the nursing staff, but rather a question of numbers…if you think that you can be there 16 hours a day (or that your spouse will be fairly self-sufficient and patient), an aide won’t be necessary…otherwise, you can reconsider at that point…</p>

<p>yes, bring all the things you mentioned…and you can adjust as you proceed…plus if this is not in an area that you are familiar with, you may want to familiarize yourself with eating establishments closeby; hospital food gets old really quick (for both you and your spouse)…</p>

<p>thoughts are with you and yours…</p>

3

<p>I spent a lot of time in a big teaching hospital when my mother was in her last years. The nurses were, for the most part, very good, but they were stretched thin and not available quickly unless it was a true emergency.</p>

<p>Once your husband is able to get out of bed, you’ll probably be expected to help him to the bathroom, take him for short walks up and down the hallway, etc. Bring lip balm and moisturizer for both of you - hospital air is very dry and chilly. If you have a portable DVD player (or a laptop) you could bring it to watch movies. And I second rodney’s recommendation of finding places to get decent food - once your husband is ready to eat he’ll really appreciate something tasty. </p>

<p>One of the main reasons you’re there is as an advocate for your husband. If something isn’t right, don’t be afraid to make a fuss until you get someone to pay attention.</p>

<p>As for getting in good with the nurses, keep a bowl of M&M’s or other candy in the room, and let the nurses know they’re free to help themselves. You’ll be one of the most popular rooms on the floor. </p>

<p>Best wishes to you both.</p>

4

<p>Sorry to hear of husband’s surgery.</p>

<p>Books, magazines, knitting, all helpful. You’ll probably need to leave the hall to use cell phone, but you can answer the landline in room. Helping husband to eat & drink can be very helpful. You may also help him comb hair and wash face, brush teeth. You can ask for assistance when he needs to use bathroom/potty/jug.</p>

<p>when husband in CCU, the nurse will often care for your spouse and person next door. Its when he moves to medical recovery floor that you will be frustrated with the time delays. Think about hiring someone for night time. </p>

<p>MDs often do their rounds early AM, so I would be there if I wanted an update. Make sure you let them know of any dietary restrictions. I would bring in jar of Kosher chicken soup and ask nurses if I could leave in their frig, and then heat a cup in their microwave (after checking if he is on low sodium diet). Be sure you take care of yourself and eat well. </p>

<p>Again, my best wishes to you and husband.</p>

5

<p>Wow, I find this incredible. The hospital I work at the patient care ratio once out of ICU is 8 to 1 at MOST. The ratio of 20 to 1 sounds dangerous to me.
I am a nurse and have also spent alot of time with my dad in ICUs and general units.
If the ratios are indeed 20 to 1, I would not leave my husband alone there. I would stay overnight in the hospital.
What might they expect you to do?
Help get washed up/personal cares
Help to the bathroom
Help with turning/moving in bed.
Help with eating</p>

<p>What I like to be there for is watching for a change in condition that might be missed by too busy nurses. In our hospital we have something called a rapid response team that anyone can call if you are concerned about a patient’s condition. Find out if they have something like that.
I like to be there when the MDs come around. I get what the plan is, whether there are any new meds or orders, things they are concerned about. And then if the nurses don’t seem to be following through with those things I question them.
Never be afraid to voice a concern…the worst that can happen is someone will get ****ed off. The worst that can happen if you don’t voice a concern could be catastrophic.
Make sure the nurses and MDs and all caregivers are washing hands upon entering and leaving the room. Don’t be afraid to tactfully remind them.
Make sure your husband is identified by name/birthdate when given meds or any procedures. This might be done verbally or by scanning a wristband.</p>

<p>As far as getting in good with the nurses… I think you just need to be pleasant and courteous. When you have concerns voice them in a non-threatening/aggressive manner.
Don’t treat them like the hired help (but don’t be afraid to ask for things) Thank yous are appreciated. </p>

<p>If you ever have serious concerns about any caregiver, don’t hesitate to go to the nurse manager.</p>

<p>Prayers to you and your husband.</p>

6

<p>Went through something similar when DH had thoracic cancer surgery 6 years ago. Surgery lasted 10+ hours. DH spent 8 days in CCU–5 of those on a respirator before being moved to a chest surgery recovery floor in another wing of the hospital.</p>

<p>I was allowed in his CCU room during visiting hours (basically 8 am 'til 8 pm daily), Nurse-patient ratio there was 1:2. I knitted scarves (some of which I gave to various of DH’s nurses. Great convo starter, btw.), did some reading, but mostly I found reading took too much concentration. Cellphones will not be allowed in CCU. If this were to happen today, I might take my iTouch since it has both books and some fairly mindless games on it.</p>

<p>In CCU I helped by having Dh’s medical info instantly available in my mind. We also had a crisis in CCU and I was able to give written permission for procedure DH needed, but which he was refusing. (long story… but make sure you have medical power of attorney before you go and have a copy for the hospital to keep on file. It’s a life saver. Literally.)</p>

<p>When he had been moved to the recovery ward, I helped by talking with his various therapists (respiratory) and then arranging for he delivery of necessary equipment to the hostel where we were staying (the hospital where he had surgery was 2200 miles from home) and when we arrived home. I also helped by making sure he complied with his respiratory therapy exercises in the hospital, walking with him in the halls (which was both respiratory and physical therapy), making sure he didn’t fall when he was in the bathroom. Lots more stuff.</p>

<p>When DH was in recovery ward, I knitted some more–my scarfs were popular among the nursing staff by then… I also read some, but mostly DH and I talked.</p>

<p>Some nurses are friendlier than others. In CCU, the nurses worked either 10 or 12 hours shifts so there was plenty of time to chat and get friendly. (LOL! By the end of his 3 day shift, one of the nurses knew all about both my kids, my pets, our camping & cycling trips–he even knew all my kids’ nicknames. He told me about his wife, his dogs, his stint in the army in southern NM…One another one told me about his brush with cancer and about how it felt to be living in remission.)</p>

<p>Same was true for the nursing staff in the recovery ward. Be friendly. Don’t be rude or pushy (you can be insistent about wanting X done without being rude). Thank them when they go out of their way to do something for you. Don’t yell at them for stuff that’s beyond their control. Don’t bother them about minor or inconsequential stuff, but don’t be afraid to draw their attention to things that concern you. </p>

<p>DH had 4 rounds of major chest surgery with his cancer treatment. I spent alot of time in CCU and recovery wards over the course of 2 years. Only twice did I have negative interaction with his nurses. (One was a nursing student with a superiority complex; the other was a ward nurse who was p<em>ssy because a surgical patient–DH–had been put in her neuro CCU. She tossed me out and I went to get DH’s surgeon who informed the nurse I was allowed to stay and she really *did</em> need to get respiratory therapy down to DH stat.)</p>

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<p>20:1 is really amazing! Former critical care nurse here. Above advice is all good.
I would suggest that you make sure H has pain meds pretty much around the clock those first few days. Try to plan those walks in the hall for about 1/2 hour after medicating.<br>
Don’t go crazy with the food - small amounts of tasty stuff is best.
Check frequency of BMs - you don’t want a cardiac patient who is constipated from pain med to strain on the toilet. (It’s a delicate balance…)
I know it sounds horrible but do something to at least acknowledge the aides - they’re the ones who know where everything is but are often overlooked. (But you’re p3t, I know you’ll do that anyway.)
As far as getting what you want/need from the nurses…I have turned into an absolute tiger in the past few years when family members have been hospitalized. Nurses have a reputation for eating their young (other nurses…) I was relentless - literally standing next to the med nurse in the hall as she made her rounds…making the charge nurse put me through to the surgeon who was scrubbing up… I don’t think you should follow my advice there!!
Good luck to your husband and please keep us up to date on his recovery.</p>

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<p>I am kind in shock about a 1:20 nurse to patient ratio and that the medical team has asked that you be available to do bedside care! What if you were disabled or ill yourself?! I have never heard of that before, and quite frankly, I’m appalled.</p>

<p>That said, you’ve gotten some good advice. Be aware that pain medicine, once on the general floors, is often given by mouth and the orders will be written along the lines of “give every x hours as needed for pain.” That means that they will not automatically bring him his pain meds every x hours, only if he asks. Stay on top of his pain. With a 1:20 nurse to patient ratio, if he waits until he is in a great deal of pain before he asks for his medicine, you will not be able to manage his pain. By the time his overworked nurse gets a chance to give him the medicine (possibly 30 minutes to an hour after you ask for it, if she doesn’t forget about it), he may be really, really uncomfortable. </p>

<p>Good luck and best wishes for a speedy recovery for your husband.</p>

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<p>The OP stated

  • not 20:1.</p>

<p>P3T - I sent you a PM but it echos much of what other posters stated here - be an advocate, help where you can with logistics like getting the patient up, etc., ask questions, push for something to get done when necessary, but know when to stay out of the way. Prepare for long boring stretches with a laptop if allowed, books, knitting, etc., know where the food/drinks are for yourself, etc.</p>

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<p>1:2 in acute care; 1:20 in the step-down unit.</p>

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<p>I don’t have any info on the nurse:patient ratio, but nurses are stretched thin and in spite of job re-engineering efforts there seems to be lots of time needed for paperwork and issues not involving direct patient care. I had surgery a couple of years ago and required 3 days for recover in a general ward. My wife stayed around the clock. She helped track down nurses when needed, did some of the tasks you might expect would be done by nursing and she did things like forage for food and help me to take short walks around the ward. I work in the medical field and am pretty cynical. Even so, I did not expect the care to be that poor especially at a well known major tertiary care center. I don’t mean to raise undue concerns but a family member can be a big, big help for a patient recovering from surgery.</p>

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<p>Add my good wishes and prayers for your husband. I’ve spent a lot of time at the bedsides of hospitals. Too much time. I always bring a book, even bills, something for me to do because initially, after a surgery or intense treatment, patients tend to want to sleep. I also take a notebook and pen to keep a patient journal, so that I have a good record of what is happening, including getting the names of all of the nurses, doctors and other medical personel who will be caring for him. That can be particularly valuable if there are issues. It also seems to get a lot more attention and care from the staff as well when they can see that you are taking notes. </p>

<p>You are there to keep an eye on him, advocate for him, make things a bit easier for him. I do not recommend physically caring for him unless you know what you are doing. I have seen people hurt themselves trying to physically assist someone. My MIL was hospitalized 3 times for replacement surgeries and she is one big woman. It would have been foolish for me to have attempted to support her. Also if something does go wrong, if you hands were in the pot, it’s complicates who dirtied it. </p>

<p>As you H recovers, he will want some things to pass the day as well. TV, telephone-making calls to others, something to read, just talk with you, have you get some food or drink, research some issue. One is very helpless stuck in a hospital bed. Completely at the mercy of the staff. I know I had to come up with what I thought were extremely simple solutions to some things that upset MIL and were not addressed. Also, by being there you have a good view of how your H is doing. How is that painkiller affecting him? Does he need a laxative? Is he drinking too much in fluids, not enough? All of these things are what you can observe in the long hours there that are far more relevant than the 5-10 minute lookover that he will get from nurses and doctors. Some patients also get tongue tied and have amnesia when the doctor appears and asks if there are any questions, issues, problems. My MIL would complain, complain, complain, until the doctor or nurse appeared and then she would forget all of those complaints and want to make small talk with them. Very frustrating. I would yank the conversation back to her wants, needs, care many times.</p>

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<p>Sorry my OP wording was ambiguous. The Critical Care Unit has a nurse-patient ratio of 1:2 and they’re implying I’m hardly needed on a medical level then.</p>

<p>But after 2 days or so, the transfer to a more general cardiac recovery ward has a ratio which, as I recall, was quoted to me as 1:20 and confirmed in phone conversation with a head nurse there. The doctor told my spouse quite clearly that I should plan to be bedside or if I couldn’t be there for him and we had “resources” then a nurse’s aide could be arranged on a 4-hour notice. </p>

<p>Thanks for many good pointers above. I’m taking notes. No I didn’t already think of ANY of them. This is helpful guidance.</p>

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<p>Bring a notebook and pen to write down mediations, what they look like, frequency and questions to ask the doc during rounds. Bring in snacks and drinks for yourself, ask the nurses to keep them in their fridge, although some hospital rooms now have fridges. Good luck to your husband</p>

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<p>

Whoops - I missed the 1:20 part. I’ve found that even in an area with a high nurse to patient ratio it’s helpful to have an advocate there - they probably have that high ratio because they need them and they’re kept plenty busy.</p>

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<p>When my husband’s appendix was taken out–a fairly routine procedure–what I noticed is that my husband needed an advocate and a go-for. I got extra blankets, more water, a snack, that kind of thing–all the stuff the hospital staff was just too stretched to take care of, all of which made him more comfortable. </p>

<p>When I had my two knee surgeries, both times I got myself out of the hospital as fast as possible, The second time, I booked a night at a lovely 5-star hotel a block away from the hospital where I had my surgery. My husband stayed there with me, and we used room service for all the meals. The extra day of no-hassle recovery made a huge difference and cost us significantly less than another day in the hospital would have. My doctor thought it was a great idea, especially the part where I could get to the hospital in minutes if I needed to.</p>

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<p>The ratios caused consternation in the thread so far, so I double-checked with my spouse. He said it goes from 1:2 (in acute care) to “something like 1:10 or 1:12…” (in step-down unit). I completely mis-heard.</p>

<p>The principle’s the same – I’m supposed to help and advocate – but I apologize for garbling the statistics above. Same issue, but for good reason the professionals above couldn’t believe that 1:20.</p>

<p>All these practical suggestions - the notepad, noting the SIZE of medications, staying ahead of pain… as well as attitude-set, are all very helpful. I absolutely respect the nurses and nurse’s aides but never would have thought to layer on the M&M candies. I will.</p>

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<p>Even 1:10 or 1:12 is high in my book.
As a nurse one of the nicest things a patient’s family did was to order pizza for the unit. They just ordered pizza hut or something like that but on a busy day we all got to eat and were very grateful.
Be your husband’s eyes and ears!
Is there anyone who can take your place for awhile? Anyone to share the load?
If not make sure you get fresh air when your husband is napping.</p>

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<p>I work in the medical profession. You don’t want a bowl of M&Ms in a patient’s room; too many issues with disease spread, etc.</p>

<p>Nursing staff always appreciates something special for their lounge, though - bagels,chocolate,etc.</p>

<p>Good luck</p>

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<p>The nursing staff love receiving food for their lounge. Love it, love it, love it.</p>