Ideas about health vary. What seems like a healthy lifestyle choice to one may not to another.
Usually when we think about health, we think of the things we've been told to stay away from, things we're told not to do. Cigarette smoking, fatty foods, toxic waste dumps, chain saws, lead paint, heroin. We think of the risks we take when we don't heed the warnings of experts: objects are closer than they appear; do not operate while under the influence of narcotics or alcohol; unsafe at any speed; an apple a day...
But what about the things we should do to maintain our health? These axioms do not seem debatable to me: eat right, exercise, be careful. It really is this simple, and the common denominator is moderation.
We are incessantly bombarded by the media, our friends and family, with all the latest health scares and all the newest health fads. Mad cow disease, E. coli, leaded toys, Suzuki roll overs, weight loss diets, Adkins, abdomenizers, gastric by-pass. With all of this, who has time to remember the essentials?
In the ER, many patients come in with problems with which they subsequently leave only to return again at a later time with the same problem. Chronic problems like back pain, migraines, respiratory difficulties. It is discouraging because (1) it seems that we are not helping them maintain their health at all, and (2) the quick fix they receive in the ER often allows them to ignore the underlying issues that cause the symptoms for which they return again and again. Not only is this inefficient, it is dangerous to their health!
The solution, of course, is education, but often the ER is not the most appropriate place to educate patients about the causes of chronic problems. It is easy (and becoming more culturally appropriate) to tell people to stop smoking cigarettes; it is less easy to teach them how or to follow up with an effective health care plan.
And some chronic problems are caused by conditions which are almost taboo to even mention. Obesity is one. Telling a person to take their asthma medication on a regular basis is astute and may be considered good, prudent nursing education. Suggesting that they eat less and exercise more in order to shed the extra 80 pound sack of concrete they tax their diseased lungs with everyday might be considered offensive.
But shouldn't they hear this? Shouldn't someone educate them about the connection between obesity and respiratory problems, how mass affects the function of systems, how the increased size of anatomy may have deleterious effects on physiology?
A recent book by a prominent sociologist questions statistically the obesity epidemic. As an ER nurse, I do not know whether or not obesity is on the rise (although I suspect it is), but I do know that obese patients have problems others don't, and I see a lot of them. For the individual, it doesn't matter whether statistically there is an epidemic or not; one is either over-weight or not, relatively speaking, and morbidity is influenced by this fact.
I think the health education ER nurses should attempt should be simple, albeit remedial: eat right, exercise, and be careful.
Does anyone doubt it?
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4 comments:
ARGGGGG!!!!
I have been truggling with google blogger.
I had a post, and it was chopped off in the middle. I can't seem to get it to re-post properly.
The gist of that posts was this:
Obesity IS on the rise in the United States, particularly in childhood populations. There have been efforts to question the statistical analysis used to produce exact figures for the so-called "obesity epidemic," but to date the bulk of the evidence suggests our average poundage per person is indeed on the rise. I linked abstracts for three studies which supported these claims, but they were lost. It's getting late to pull them up again.
The question to you, or at least my question to you, is this: what privilege does the ER have to public health education that is not shared by primary care providers? Why should we expect the ER to succeed where primary care seems to be failing? As you point out elsewhere, the primary mission of the ER is not to promote health awareness or provide basic family care. Rather, the ER's mission is to provide immediate intervention to critical and life-threatening medical conditions. Is it really reasonable to expect public health education could be be added to the ER agenda in such a way that it simultaneously (1) gets the attention required to be more effective than what is already delivered in primary care settings, while (2) not distracting resources from the proper mission of the ER? Aren't you already overworked and understaffed?
If the ER were in fact one of the most appropriate places for public health awareness, it seems to me it would be for one of the following reasons:
1. Certain vulnerable patients do not have access to primary care, but do have access to emergent care
2. Given the context in which the advice would be given, some patients would believe ER staff more than they would believe primary care staff
3. The ER simply gives better, more factual advice than primary care providers
None of those three possibilities, with the possible exception of the first, seem like a very accurate description of the way things work. Did I miss something important?
My two cents, in case you want it, is the following. There should be more distinction between primary care and emergent care, not less. Patients with non threatening medical conditions (the kind of condition you classify as mainly "inconvenient") should be diverted to a more appropriate venue for treatment, and not granted access to the ER.
If the patient flow through our healthcare system were more properly balanced, I think we would see a much greater demand for cheaper family practice type services, and a reduced demand for more expensive emergency type services. How do we achieve that restructuring? I guess I have my opinion, and it involves a single entity picking up the bulk of America's healthcare tab, but there may be other ways. Expanding the scope of practice for nurses with advanced degrees in order to flood the general practice market, increasing per-visit Medicaid co-pays and expansion of valid government heath insurance for the poor and indigent (instead of the passive private health insurance we have now, via "dine and dash" at the ER) are examples. But I do not see how encouraging ER nurses to spend more of their time dispensing advice on diet, exercise, and good decision-making could produce very much difference.
Well,
I found the nurses I worked with, when dealing with obesity needed NOT to give advice, but abstain from judgement. I was amazed how many office charts had weight listed as "refused".
'Cmon, you can get them to get on the scale.' I said to my slightly overweight excellent nurse that I loved working with until she fired ME after 15 years.
She whined and blushed. I realized SHE was uncomfortable with the process.
So we did some short therapy on her discomfort, emphasizing the patient vs our own needs, pointing out that it is a DATA POINT (278#), not an insult, and the only way WE(as helpers) can help is to abstain from judgement. NOW, lets talk about nutrition.....
And after a few sessions of the nuts and bolts it comes down to the frightful truth of "How does this 6-12 inches of fat help this person?" because it does...
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