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Experience: The best teacher
LETTERS MEDICATION REVIEW IN ONE LTC FACILITY I was very much interested in your " N e w s W a t c h " item regarding the improper monitoring of drug therapy in nursing homes, as alleged by the General Accounting Office (Sept e m b e r / O c t o b e r , p. 152). I am an R N / s h i f t coordinator in a prestigious, religious-affiliated, 300bed nursing home, 200 of which are skilled care beds. One of my functions is to supervise the changing oi~ the computer-produced " M e d i c a t i o n S h e e t / P h y s i c i a n Order Sheet," used for the daily dispensation of drugs. I am extremely upset with the lack of concern on the part of some attending physicians. It is my belief, backed up by professional experience,.that m a n y of our residents are overmedicated and also receiving medications that are definitely contraindicated for concomitant use. I can state from first hand knowledge that the review by most of our attending physicians given to the monthly continuance of orders is a perfunctory signature at the bottom of the page. Also, our " p h a r m a c e u t i cal reviewer" is the pharmacist with whom we contract for this computer service. On the numerous occasions when I brought this to the attention of our I . . . . director of nursing and administrator, the response was a shrug of the ~houlders a n d / o r a " w h a t do you exp e c t - i t ' s a business." I would sincerely appreciate a reply and any suggestions about possible further steps I as a nurse can take. I a m sending a copy of this letter to Rep. Claude Pepper, chairman, House Select C o m m i t t e e on Aging. Secondarily, I appreciate the " m e a ty" information in your publication. R.N., Pa.
WHY NO MENTION OF DELLUMS BILL? [ was quite concerned that Dr. Mauksch's C o m m e n t a r y , " W h e r e Do W e Stand with National Health Insurance?" (September/October 1980, p. 203) did not mention Ron-
aid Dellums's bill, Health Service Act (H.R. 2969), that is the only health insurance bill supported by the G r a y Panthers. This proposal would ensure comprehensive health care for all and would provide for radical changes in the health care s y s t e m , primarily t h r o u g h creation of a governmentsponsored national health service. Because of this latter fact in particular, Dellums's bill is not likely to gain the support of the current health care establishment and thus its chances of passage are remote. This m a y be why Dr. Mauksch overlooked it. But how can nurses give thoughtful and thorough consideration to an issue as important as national health insurance if commentaries such as Dr. Mauksch's do not even refer to other, albeit more politically unpopular, alternatives? DIANA J. MASON, R.N., N.Y. Space limitations forced Dr. Mauksch to discuss only the two national health proposals that are receiving the most Congressional attention. Rep. Ron Dellums's bill (H.R. 2969) is summarized in the May/June issue, page 8 2 . - - T h e editor.
EXPERIENCE: THE BEST TEACHER T h a n k you for your insightful editorial, " L e t ' s turn the Tables" (Sept e m b e r / O c t o b e r , p. 169). Having just attended an inservice program conducted and instructed by a 76year-old retired social worker, I can attest to the concept of experience being the best teacher. I have been involved in geriatric nursing care of the total individual for the past five years, and I have found that the personal growth and self-esteem that can be nurtured in our patients becomes a lifeline for self-improvement and motivation. M y personal philosophy is taken from the Book of Proverbs: " L e t the wise listen and add to their learning, a n d let the discerning get guidance." BONNIE PARSONS, R.N., N.J.
NO SUPPORT SERVICES IN NEW YORK CITY? I am writing in response to the article/interview "Ombudsman for All," in your S e p t e m b e r / O c t o b e r issue. I really believe "'Nursing H o m e Placement for All" would have been a much more appropriate title for this article. Have they no Visiting N u r s e Associations/home nursing programs in N e w York? Are there no homemaker programs there? Are Meals on Wheels ever a consideration? Is it not possible for people in N e w York to receive physical, occupational, speech, or enterostomal therapy at home? Is there no such thing as Respite or Hospice set up in N e w York to help families keep their loved ones at home? I truly hope that failure to mention the vast amount of community services that could be utilized to keep the patient in his home following hospitalization is simply an overoversight and that the patients there are made aware of the m a n y options open to them aside from nursing home placement or a grisly existence in their own home environment! -PATRICIA NELSON, R.N., Wise.
Anne Cote replies: Indeed New York City has innumerable community agencies, support programs, and probably the country's foremost visiting nurse society. Through New York Hospital's home care office, social service department, and head nurses, the patient representatives work closely with all external support groups. As I said (page 174), " W e track down friends . . . muster social workers and all community agencies, and project Scope visits the person daily, and Meals on Wheels are brought in." The specific group I discussed in relation to institutional placement consists o f elderly patients who are too f rai l to manage at home even with every available community service, too poor to afford a fu ll-tim e companion, and too proud to apply f o r Medicaid so long as they have any money left.
WHY NO MENTION OF DELLUMS BILL? [ was quite concerned that Dr. Mauksch's C o m m e n t a r y , " W h e r e Do W e Stand with National Health Insurance?" (September/October 1980, p. 203) did not mention Ron-
aid Dellums's bill, Health Service Act (H.R. 2969), that is the only health insurance bill supported by the G r a y Panthers. This proposal would ensure comprehensive health care for all and would provide for radical changes in the health care s y s t e m , primarily t h r o u g h creation of a governmentsponsored national health service. Because of this latter fact in particular, Dellums's bill is not likely to gain the support of the current health care establishment and thus its chances of passage are remote. This m a y be why Dr. Mauksch overlooked it. But how can nurses give thoughtful and thorough consideration to an issue as important as national health insurance if commentaries such as Dr. Mauksch's do not even refer to other, albeit more politically unpopular, alternatives? DIANA J. MASON, R.N., N.Y. Space limitations forced Dr. Mauksch to discuss only the two national health proposals that are receiving the most Congressional attention. Rep. Ron Dellums's bill (H.R. 2969) is summarized in the May/June issue, page 8 2 . - - T h e editor.
EXPERIENCE: THE BEST TEACHER T h a n k you for your insightful editorial, " L e t ' s turn the Tables" (Sept e m b e r / O c t o b e r , p. 169). Having just attended an inservice program conducted and instructed by a 76year-old retired social worker, I can attest to the concept of experience being the best teacher. I have been involved in geriatric nursing care of the total individual for the past five years, and I have found that the personal growth and self-esteem that can be nurtured in our patients becomes a lifeline for self-improvement and motivation. M y personal philosophy is taken from the Book of Proverbs: " L e t the wise listen and add to their learning, a n d let the discerning get guidance." BONNIE PARSONS, R.N., N.J.
NO SUPPORT SERVICES IN NEW YORK CITY? I am writing in response to the article/interview "Ombudsman for All," in your S e p t e m b e r / O c t o b e r issue. I really believe "'Nursing H o m e Placement for All" would have been a much more appropriate title for this article. Have they no Visiting N u r s e Associations/home nursing programs in N e w York? Are there no homemaker programs there? Are Meals on Wheels ever a consideration? Is it not possible for people in N e w York to receive physical, occupational, speech, or enterostomal therapy at home? Is there no such thing as Respite or Hospice set up in N e w York to help families keep their loved ones at home? I truly hope that failure to mention the vast amount of community services that could be utilized to keep the patient in his home following hospitalization is simply an overoversight and that the patients there are made aware of the m a n y options open to them aside from nursing home placement or a grisly existence in their own home environment! -PATRICIA NELSON, R.N., Wise.
Anne Cote replies: Indeed New York City has innumerable community agencies, support programs, and probably the country's foremost visiting nurse society. Through New York Hospital's home care office, social service department, and head nurses, the patient representatives work closely with all external support groups. As I said (page 174), " W e track down friends . . . muster social workers and all community agencies, and project Scope visits the person daily, and Meals on Wheels are brought in." The specific group I discussed in relation to institutional placement consists o f elderly patients who are too f rai l to manage at home even with every available community service, too poor to afford a fu ll-tim e companion, and too proud to apply f o r Medicaid so long as they have any money left.