Grids

When you're in nursing school, part of your clinical training is to fill out all the paperwork that is required in the care and keeping of a patient under your. There are admission forms, daily flow sheets, physicians' orders, incident reports, medication forms, transfer forms, consultation forms, discharge forms...I'm sure other nurses could list more forms. These are just the ones that I use almost daily. The one I find most disturbing are what we affectionately call “The Skin Sheet”.

When you are admitted to our facility, we strip you naked and inspect your skin from head to toe. Any bruises, moles, scars or potential for skin injury is documented on a form. But if you have an injury that moves into the realm of “wound” (think bedsores), we fill out the Skin Sheet. The Skin Sheet is a grid on which we record the date we found the wound, stage of the wound, the size of the wound, if it's draining, if it is tunneling, if it smells, and if it hurts. It's meant to be an objective tool that tells us how to treat the wound and allows us to monitor the progression of the wound. What the Skin Sheet doesn't explain is how the wound got there, what kind of neglect this patient experienced before admission to our facility, or how anyone who claims they are in health care could allow this to happen?

I often disagree with much of what goes on where I work but there are some things I think we do particularly well and that is prevent and heal wounds. If a patient comes in with a clean bottom, it stays that way while they are with us. If they come in with a wound, we do everything we can to improve it or heal it. But when a patient comes into the facility with wounds that are so large and so invasive, it becomes clear that somewhere down the line, the patient was the victim of neglect.

The Skin Sheet I fill out every week on this patient only tells me if these wounds are getting bigger or smaller. They don't explain why this person sat in his own filth for so long that his skin started dissolving to the bone. The boxes on the Skin Sheet only allow me to what kind of drainage is coming out of the wound. There is nowhere on the grid where I can document how fast the room was spinning the first time I stripped off the old, soiled dressing and saw what was there. I can document on the Skin Sheet if I think the wound causes pain for the patient. But there is nowhere on the Skin Sheet where I can document my rage that whoever was responsible for what happened to this man (who cannot speak or move of his own volition). There is no place on the grid for me to document how useless my emotional reaction is to this man. Every time I initial the sheet, I bear witness to what I believe is neglect that has caused harm.

Into the fray...

It is a universally accepted notion that any person in possession of an opinion will wish to share it... mostly. So here I am, many years late, diving into the fray. This diary of sorts is meant primarily for friends and family, however anyone is welcome to join the conversation. The opinions expressed here are mine alone and may range from evaluations of local restaurants to essays on health care.

It was dismaying to me that our local Olive Garden won “Best Italian Restaurant” when there are so many locally owned Italian restaurants that serve delicious meals and where there is no danger of running out of pre-fabricated chicken parmesan. Don't get me wrong, I like a good bread stick as well as the next person. But food is a way of getting to know other cultures...everyone eats. So why not try that local French-Thai place by the train station?

It is alarming to me when I hear that health care reform will mean health care rationing. If you think there is no rationing in our current system, talk to a patient with low hemoglobin whose insurance will not cover a simple weekly injection of darbepoetin alfa, but will cover a blood transfusion . I currently work in the health care industry, but I have worked in pharmaceuticals, IT and education. I have stories to share about all of them.

It is gratifying to know that the Internet allows us to connect with people from all over the world and stay in contact with the people who mean the most to us. That is the hope and purpose of this blog. Welcome to it.