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Doing it their way
LETTERS this annual travail can appreciate the unconscionable amount of time, effort, and energy required before, during, and after the survey, and understand that almost immediately upon closure, preparations begin for the next survey by other groups. Today, chief among the department supervisor's duties is the achievement of a Superior Rating. All else must be secondary, and to this end all plans are made. ROWENA ROGERS, RN,C, BS, Clermont. FL
HANG IN THERE
Yes, I do believe a nurse can realize her full potential as a professional in the nursing home, but frustrations concerning federal and state rules and regulations seem doomed to remain. Professional growth comes from the positive input of grateful patients and family members, who appreciate what we do and the obstacles we are up against. Every day those of us delivering health services in the longterm care field meet opposition and negative criticism from varied sources. However, to those housed within the SNF we provide a valuable, much-needed service. We have not forgotten the elderly. We do bring the necessary combination of love and skill to the growing population of older adults who are unable to live independently. To Alice Quinn Walter and other nurses in long-term care I say, "hang in there!" Don't lose enthusiasm and commitment to our purpose. We are needed and we do make sound nursing judgments based on sound assessments of the sick. I have looked into many aging eyes that reflect thanks for a job well done. ELIZABETH MILTON, RN, CA
DOING IT THEIR WAY
Recently I read a newspaper article by an activities director who described the exciting activities she had planned for the elderly residents in a long-term care facility. She explained, "We had them do this," "we told them to do that," "we gave them instructions." Such statements suitaest that aged
people in institutions cannot plan or decide for themselves. Not one line of the article said, "the patients planned" or "they chose." In our endeavor to help elders remain active, are we forgetting they are people who can be self-directing? Four years as nursing director in LTC have taught me that some elderly residents have lost interest, but this does not mean that we should force them to take part in planned activities. Granted there is a need to stimulate movement, but why must it be done in our way? The elderly are more likely to respond to one another than to staff. Would it not be more logical to have the elderly plan activities that interest them, with us as facilitators? Instead of the standard weekly bingo and crafts, could we not let them make some choices? I'm sure that many elderly residents, if asked, would be willing to speak for their group and gather suggestions. At the nursing home where I worked we did just this; the resident response was heart warming. These residents held cooed wine and cheese parties, dances, and monthly birthday and holiday parties for which they did the planning, decorating, and invitations. Before their first dance, everyone was hoping for a big turnout. The music was playing as I watched a few residents walk past my desk to the dance area. Soon the laughter and music grew louder as more and more residents arrived, in wheelchairs or using canes and a few pushing friends in wheelchairs. I left my paper work and went to see what was going on ... Nurses' aides and nurses who were free or off duty were dancing with residents. Residents were dancing with each other, and those who couldn't dance were clapping and tapping their feet. The greatest thrill was to see a resident with double leg prostheses dancing and laughing. I saw smiles and heard laughter from residents I had never seen smile before. It was the total resident involvement that made this a total success.
JOAN DIPASQUALE, RN, MSN, Columbia. SC
TWU PIONEERED GNP EDUCATION
In "Gerontological Nurse Practitioners: Past and Present" (July/ Aug., p. 219), Priscilla Ebersole identified the first GNP educational programs but left out a crucial oneTexas Woman's University. TWU admitted its first GNP class in 1973. In fact, TWU trained a faculty member and gave its curriculum plan to the University of Colorado to start its program. TWU also provided consultation and gave its curriculum design to New York University and has encouraged many other universities to develop their own programs. TWU has always been known to be one of the very first-if not the. first-pioneers in the training of GNPs. DOLORES M. ALFORD, RN, MSN, Dallas. TX
ANGER OVER DRGs
I read the article on DRGs ("Patient-Family Responses to the DRG System," Sept.jOct., p. 271) with great understanding and frustration. I have been an RN for 25 years, the last 16 in a 150-bed community (Catholic) hospital, with experience in ICU. Three years ago I got a BSN and now work in the home care department of the same hospital. In the last eight months with DRGs' influence I see patients sent home too soon by previous standards. However, 50 to 75 percent of these people do fairly well. The experience of the other 25 percent is the reason I'm writing-and to vent my anger at the Medicare regulations. I do agree with more aggressive discharge guidelines, but just when they came about, Medicare cut back the allowances for home visits. For example, a fractured hip patient goes home within 5 days of surgery having had some physical therapy for use of walker. The public health nurse can average 2 to 3 visits for a maximum of 2 to 3 weeks. Catch to this is: patients often need more help from aide with bathing and personal care, but aide can only help patients as long as PHN can keep case open. If patients don't Continued on page 55
HANG IN THERE
Yes, I do believe a nurse can realize her full potential as a professional in the nursing home, but frustrations concerning federal and state rules and regulations seem doomed to remain. Professional growth comes from the positive input of grateful patients and family members, who appreciate what we do and the obstacles we are up against. Every day those of us delivering health services in the longterm care field meet opposition and negative criticism from varied sources. However, to those housed within the SNF we provide a valuable, much-needed service. We have not forgotten the elderly. We do bring the necessary combination of love and skill to the growing population of older adults who are unable to live independently. To Alice Quinn Walter and other nurses in long-term care I say, "hang in there!" Don't lose enthusiasm and commitment to our purpose. We are needed and we do make sound nursing judgments based on sound assessments of the sick. I have looked into many aging eyes that reflect thanks for a job well done. ELIZABETH MILTON, RN, CA
DOING IT THEIR WAY
Recently I read a newspaper article by an activities director who described the exciting activities she had planned for the elderly residents in a long-term care facility. She explained, "We had them do this," "we told them to do that," "we gave them instructions." Such statements suitaest that aged
people in institutions cannot plan or decide for themselves. Not one line of the article said, "the patients planned" or "they chose." In our endeavor to help elders remain active, are we forgetting they are people who can be self-directing? Four years as nursing director in LTC have taught me that some elderly residents have lost interest, but this does not mean that we should force them to take part in planned activities. Granted there is a need to stimulate movement, but why must it be done in our way? The elderly are more likely to respond to one another than to staff. Would it not be more logical to have the elderly plan activities that interest them, with us as facilitators? Instead of the standard weekly bingo and crafts, could we not let them make some choices? I'm sure that many elderly residents, if asked, would be willing to speak for their group and gather suggestions. At the nursing home where I worked we did just this; the resident response was heart warming. These residents held cooed wine and cheese parties, dances, and monthly birthday and holiday parties for which they did the planning, decorating, and invitations. Before their first dance, everyone was hoping for a big turnout. The music was playing as I watched a few residents walk past my desk to the dance area. Soon the laughter and music grew louder as more and more residents arrived, in wheelchairs or using canes and a few pushing friends in wheelchairs. I left my paper work and went to see what was going on ... Nurses' aides and nurses who were free or off duty were dancing with residents. Residents were dancing with each other, and those who couldn't dance were clapping and tapping their feet. The greatest thrill was to see a resident with double leg prostheses dancing and laughing. I saw smiles and heard laughter from residents I had never seen smile before. It was the total resident involvement that made this a total success.
JOAN DIPASQUALE, RN, MSN, Columbia. SC
TWU PIONEERED GNP EDUCATION
In "Gerontological Nurse Practitioners: Past and Present" (July/ Aug., p. 219), Priscilla Ebersole identified the first GNP educational programs but left out a crucial oneTexas Woman's University. TWU admitted its first GNP class in 1973. In fact, TWU trained a faculty member and gave its curriculum plan to the University of Colorado to start its program. TWU also provided consultation and gave its curriculum design to New York University and has encouraged many other universities to develop their own programs. TWU has always been known to be one of the very first-if not the. first-pioneers in the training of GNPs. DOLORES M. ALFORD, RN, MSN, Dallas. TX
ANGER OVER DRGs
I read the article on DRGs ("Patient-Family Responses to the DRG System," Sept.jOct., p. 271) with great understanding and frustration. I have been an RN for 25 years, the last 16 in a 150-bed community (Catholic) hospital, with experience in ICU. Three years ago I got a BSN and now work in the home care department of the same hospital. In the last eight months with DRGs' influence I see patients sent home too soon by previous standards. However, 50 to 75 percent of these people do fairly well. The experience of the other 25 percent is the reason I'm writing-and to vent my anger at the Medicare regulations. I do agree with more aggressive discharge guidelines, but just when they came about, Medicare cut back the allowances for home visits. For example, a fractured hip patient goes home within 5 days of surgery having had some physical therapy for use of walker. The public health nurse can average 2 to 3 visits for a maximum of 2 to 3 weeks. Catch to this is: patients often need more help from aide with bathing and personal care, but aide can only help patients as long as PHN can keep case open. If patients don't Continued on page 55