Outcomes

I was asked to write a few paragraphs on the subject of nursing sensitive patient outcomes. In other words, I am to demonstrate that what I do makes a difference to the patient, affecting in some way the outcome of their treatment. So this may seem a bit pedantic, expecially as related to what you usually get here, but here I go.

Nursing sensitive patient outcomes are different from medically clinical outcomes. The amount of radiation someone gets or the number of years they take Tamoxifen may make a difference to how long the patient remains free of disease, but those outcomes are measured and celebrated by medicine much more so than nursing. Nursing outcomes tend to be more a result of the marriage of art and science that is the substance of nursing interventions at their most basic level. And while they may indeed make a difference to how long a patient remains free of disease, the measurements of the success of nursing interventions tend to be more anecdotal and less statistical.

A nursing intervention typical of our practice is providing information. Nurses do this each day, as they book consults, do chemo education, teach people how to self-inject; nearly everything and anything that a nurse does provides information in some form. As a simple and specific example, I remember the time I was giving a person first-time chemo for newly diagnosed lung cancer.

I called the patient in, got her comfortable in a chair, and gathered the supplies for starting her IV. I checked her bloodwork and called pharmacy for her chemo. I sat down and started her IV, chatting with her as I worked. When I had the IV established, I looked up and tears were streaming down her face. "Oh," I said, "you should have told me you didn't like needles."

"It isn't the needle," she said. "It's everything."

I pulled the curtain and sat down with her. I talked her through everything that would happen that day. I gave her teaching sheets on the drugs she was about to receive and went through them, so she would know what to look for in terms of side effects. I started from the bare basics, like how long it would take that day, that her husband could stay as long as he liked, where he could park the car, and that they could bring their own sandwiches in to the treatment room if they wanted. I told her the next cycle would be exactly the same, and not as scary, because she would know exactly what to expect, where the treatment room was, what the nurses' names were, how long it would take, and what the drugs would do to her. By the time I left to get her chemo and hook it up, she was much calmer. Another patient, a second-timer, sort of took her under his wing and reassured her that the first time was the worst, just because of the not knowing. It seemed to help that there was someone there to corroborate my story.

The next time I saw her for a treatment, she looked like a different person. She was relaxed and smiling. She said to me, "You know, you were right. It was so much easier coming this time. I knew exactly what to expect and it made all the difference." It felt good to know that my intervention contributed to someone's positive experience, just by telling them what to expect.

This experience taught me that the amount of information a patient has is related very closely to their comfort level (and it can be a bit of a balancing act between too much and too little, depending on what the patient needs). Now, whenever I book consults, I make sure I tell the patient exactly where to come, where to park, how long it will take, and what the doctors will do. When they have seen the doctor, I recap what was said and what they can expect next. I always give them my contact information, and encourage them to call with any little question. It is important for them to know they have access to information.

Nursing interventions, like providing information, compliment and support medical interventions. By telling patients what they need to know, they can focus less on things like how to get to their appointment, and more on what the treatment recommendations are. If a patient is more relaxed and less anxious, they will understand more, and their energy can be spent on healing, rather than worrying. While nurses don't prescribe chemo or radiation doses, they have as much power to affect outcomes, and in different but equally important ways.