Recently, as part of an ongoing collaborative initiative on supporting family caregivers with AARP (see the comprehensive, and free, AJN supplement called State of the Science: Professional Partners Supporting Family Caregivers), I listened to a group of family caregivers talk about what it’s like to care for sick parents and relatives at home.
What they said they needed most to ready them for caregiving was what nurses used to do to prepare patients for discharge: teaching patients and family members about dressing changes, medications and diet, etc.; helping them arrange for follow-up like home health care; and making sure they had prescriptions and knew when to make a follow-up appointment (or, sometimes, just making the appointment and sending caregivers home with a day or two of medications).
How did we lose these things? How did it come to be that these discharge preparation activities became dispensable? What next might we give away because there’s no time? Is there a “line in the sand” that we won’t cross?
I know in my own practice and practice setting (charge nurse in a busy Toronto-area ED) the discharge piece is essential to completing the circle when providing patient care. We routinely make referrals to social work or home care, give out information and do health teaching about diet, scripts, dressing changes, signs and symptoms of infection, when the sutures need to come out, when to return, OTC medications (we’re permitted to do this in Ontario) and so on. It’s all well within our scope of practice, and indeed I would think it’s a professional expectation. It’s a chance to appropriately end the therapeutic relationship and, of course, there’s a liability issue attached to not prepping well for discharge.
But I know all is not well in other places. The questions posed by the post are good ones, and the answer, has to do more with the attempted (and ongoing) deskilling of nurses over the past few decades — the idea that hospital administrations essentially view nursing as task-driven and routinized; nursing roles in this model are severely circumscribed and reduced to a set list of tasks to increase productivity and lower costs for the hospitals. The predictable result: nurses who are emotionally and intellectually disinterested and disengaged in their practice. Sound familiar? I guess the larger question this begs is to what degree are nurses themselves (and, it must be said, self-described nursing leaders) complicit in the deterioration of our profession; indeed, it’s hard to imagine another profession that would undermine itself and give up valuable roles so cheerfully.
Or maybe we should just give up the pretence that nursing is a profession altogether?