Do You Know Your Hospital Rights?
(BlackDoctor.org) — As a former Nurse Care Manager for people with chronic illness, I’ve done my share of advocating while my patients were in the hospital. A large part of that work entailed teaching patients how to advocate for themselves, feel empowered within the health care system, and learn how to take charge when it was appropriate to do so.
Just recently, my wife was hospitalized for a very aggressive bacterial respiratory infection, and we were very grateful for the care and attention that she received during her 48-hour stay. Luckily, the infection was caught early enough and timely intervention prevented any serious complications.
In my wife’s case, it was not appropriate for her to make sound decisions when her blood oxygen saturation plummeted and she couldn’t think straight. But once she stabilized, she took the bull by the horns and made her needs known to the staff whenever necessary. As her husband (and private nurse!), it was then my job to sit back, observe, and chime in at opportune times, making sure that t’s were crossed, i’s were dotted, and promised care delivered.
The first thing to be learned about hospitalization is that you have a right to question everything that is done to you—or suggested to be done to you. When in the Emergency Department, we have to understand that, when under duress and slammed with patients, ED docs cast a wide net, ordering tests and procedures faster than you can say “Code Blue”. To some extent, this is prudent and conservative medicine that can save your life. On the other hand, many unnecessary tests are ordered in haste by physicians who simply need to cover their bases (and their posteriors!) in an efficient manner.
This is all well and good, but if you’re uninsured and come to the ED for care, you certainly don’t want to pay for a clinically unnecessary CT scan simply because your doctor was worried she might have overlooked something. Question the relative need for certain tests and procedures, and be on the look out for lazy ordering that is simply making up for a lack of time for a thorough exam and history.
Too Many Cooks in the Kitchen
Hospitalized patients are usually under the charge of an “attending physician” who may or may not be the patient’s primary doctor as an outpatient. This can matter a great deal to you, because once you are “handed off” from the ED to the hospital floor, a hospitalist will take over your care, orchestrating the game plan with the rest of the team, which can consist of multiple nurses, various specialized physicians, advanced practice nurses (nurse practitioners), anesthesiologists, radiologists, therapists and others. Chances are, this hospitalist has never seen you before and knows nothing about you, and he or she has dozens of other patients for whom he or she is responsible. Although they are busy people, you have a right to demand their attention and ascertain that they are treating you as an individual, not simply as just another body with a problem.
If you are a patient in what is known as a “teaching hospital”, medical students, interns and “residents” (senior medical students almost complete with their studies) may also be part of the team, and it can be confusing trying to sort out just who’s who.
Remember, if you don’t know who someone is or what they’re doing in regards to your care, ask to see their identification and have them explain their role to you clearly. If you are uncomfortable being examined or treated by a medical intern or student, you also have a right to refuse their care, although this is truly how they learn.
Ask your nurses (and your family) to help you keep notes and understand who is doing what and who is taking responsibility for each aspect of your care. With this information, your knowledge then becomes a tool for asking the right people the right questions at the right time.
You Have the Right to Refuse
At any time during your hospital stay, you have a right to question, refuse or accept any suggested test or procedure. Your body is still your temple even when you’re in the hospital, and you have a right to know what’s being done to you, why it’s important (or not), and what the consequences might be if you refuse. As I mentioned earlier, uninsured patients must be vigilant in making sure only necessary tests and procedures are ordered, but even fully insured patients don’t want tests that seem to be ordered as an afterthought. Understand the care that you’re receiving, and feel empowered to say no (it if feels safe and prudent to do so).
Navigating the Nurses
While doctors may be important to your hospital stay, nurses are crucial, and they will deliver the lion’s share of your care throughout your hospitalization. Nurses are the largest portion of the health care workforce and are one of the most trusted professions in the country in poll after poll. That said, a good nurse can make your day and a bad nurse can make it hell. Therefore, it’s a good idea to establish a good rapport with your nurses and understand their role.
Nurses do indeed carry out orders given by physicians or nurse practitioners (advanced practice nurses), but nurses also have their own science that they bring to the table. On many hospital units, nurses have dozens of “standing orders” which allow them to make independent decisions regarding your care, and they also report their findings to the attending physician or specialist. Nursing science has its own set of non-medical diagnoses and research-based protocols that impact how your care is delivered, and nurses use critical thinking to assess, plan, implement and evaluate patient care. If you’re confused about anything, a nurse is often a good person to turn to for clear information and advocacy on your behalf.
With nurses delivering care around the clock, remember that three shifts generally make up most hospital floor schedules, those shifts being 7am-3pm, 3pm-11pm, and 11pm-7am (except for units that use 12-hour shifts from 7am-7pm and 7pm-7am). This means that in the course of 24 hours, you may have up to three different nurses responsible for you along with their shift colleagues, so you will have to negotiate relationships with three sets of caregivers during the course of each day. “Change of shift” involves the incoming nurses receiving “report” from the outgoing nurses, and these periods of the day are times when nurses will generally be less available to you, so plan accordingly.
The “Charge Nurse” is the nurse “in charge” of the particular floor or unit where you are staying. If you have an issue with a particular nurse, have a question or concern, or want to speak with a nurse with the most authority, ask for the “charge nurse” during any given shift and communicate your concerns to him or her.
Nurses are people too, and they understand—or should understand—that you are an individual with individual needs and desires. For instance, my wife found that being woken up every three hours for vital signs and assessments was exhausting, so she negotiated with the nighttime charge nurse to only be awoken once during the entire night. She also negotiated for the door to her room to be kept closed, and she asked for earplugs and a sleeping pill to assist her in getting needed rest. Since my wife has chemical sensitivity, she requested that the floors not be waxed during her stay, and she requested that housekeeping clean the room only with water mixed with vinegar in order to minimize the effects of chemical cleaners on her respiratory status and health. She also refused care from any nurses or personnel wearing perfume or cologne. These requests were honored by the nursing staff, thus my wife’s stay was more restful than it may have been otherwise.
Being hospitalized is no fun, and when we are in the hospital, we are in a vulnerable state, and are often frightened, anxious and not at out best. Use common sense, the assistance of friends and family, and the development of positive relationships with your health care team in order to get the most out of your hospitalization while remaining an empowered and informed patient.
Also remember that the only dumb questions are the ones that are not asked, so be inquisitive, curious, and unafraid to question anything that you don’t understand. You’ll be healthier and more informed in the process.
Easy Tricks To Boost Your Health
(BlackDoctor.org) — Want to boost your health, your memory, your mood, your energy, all of it! Too lazy to put very much effort into accomplishing any of that? Well, the below health tricks may be perfect for you. Yes, just about all of them do sound a bit odd, but trust us, they work!
Yawn. Yawns are one of the best-kept secrets for flexing your mental muscles, says Andrew Newberg, M.D., associate professor of radiology at the University of Pennsylvania in Philadelphia. Brain scans reveal that yawning activates areas responsible for social awareness and feelings of empathy—which may explain why yawns are so contagious: even reading this may cause you to yawn! “They might also strengthen the precuneus, a part of the brain that plays a central role in memory retrieval and self-reflection,” Dr. Newberg says. The quick hit of oxygen wards off sleepiness and helps you stay focused by regulating metabolism and cooling the brain.
Even better. “Yawn as often as possible—in the morning, at work, before a big test,” Dr. Newberg suggests. It will give your brain an instant pick-me-up. Can’t yawn on cue? Fake it a few times and you won’t be able to help yourself.
Blink. You may consider it a cute come-hither flirtation device, but batting your eyelashes is also essential for healthy eyes. The action coats the eye with tear film, a liquid layer that washes away debris and delivers nutrients to the cornea to promote good vision.
Even better. Avoid a staring contest with your laptop, cell phone or e-reader—it can make for fewer blinks. In fact, looking at a computer made the average gal blink half as often as usual, experts at The Ohio State University at Columbus noted. “We get so absorbed in the screen that our blinking reflex goes down, causing vision to get strained and blurry,” says James Salz, M.D., clinical professor of ophthalmology at the University of Southern California in Los Angeles. Try the 20/20/20 rule: Enjoy a tech break every 20 minutes and gaze at least 20 feet into the distance for 20 seconds to relax your eyes and encourage blinking.
Breathe. Taking slow, deep breaths can help lower blood pressure and alleviate anxiety, pain and asthma symptoms. It can even prevent painful cramps during exercise. “When we’re stressed, angry or intently focused, we breathe more shallowly or hold our breath without realizing it, which can reduce the flow of oxygen and intensify our emotional and physical distress,” says Mark Gregory, M.D., an internist at Washington University in St. Louis. “Deep breathing allows airways to fully expand for an improved exchange of oxygen and carbon dioxide, releasing tension and creating a calming effect throughout the entire body,” he adds.
Even better. Place your hands on your abdomen and practice slowly inhaling through your nose and exhaling through your mouth, suggests Dennis Lewis, author of Free Your Breath, Free Your Life (Shambhala Publications). As you take in air, you should feel your belly expand. “When you exhale, do it gently through pursed lips and visualize that you’re blowing on a candle that’s several inches away so the flame is lightly flickering,” Lewis says. Repeat six or seven times and your breathing will naturally deepen. Does it get any easier than that?
Toast. That ice-cold brew at happy hour doesn’t only strengthen your resolve to chat up the cute guy or girl at the bar; it may also make your skeleton stronger. “Beer contains silicon, and diets rich in this element are associated with an increase in bone mineral density among premenopausal women,” says Ravin Jugdaohsingh, Ph.D., senior research scientist at the MRC Collaborative Centre for Human Nutrition Research in Cambridge, England. “The female hormone estrogen may act with silicon to help prevent bone loss in women.”
Even better. Brews derived from malted barley tend to contain more silicon than those that are wheat-based, according to a study from the University of California at Davis. Opt for pale ales such as India pale ales (IPAs), which were found to be the richest in silicon. But stick to one a day or you’ll cancel out any health benefits.
Nap. Our ability to learn drops by about 10 percent between the hours of noon and 6 P.M., but taking a midday snooze helped study participants reverse that decline, according to research from the University of California at Berkeley. “As the day goes on, we’re constantly learning new things,” says study author Bryce Mander, Ph.D., post-doctoral fellow in psychology. “These details are stored in the cortex of the brain and bound together in the hippocampus, a region that may have limited space and be only a temporary storage location.” So how can a siesta prevent information overload? “We believe napping may allow us to consolidate what we’ve learned, improving the hippocampus’s ability to process and store more information,” Mander says.
Even better. Limit naps to 45 minutes and avoid dozing after 4 P.M. so you don’t have trouble drifting off come bedtime and getting the seven to eight hours of nightly zzz’s experts advise. “If we haven’t slept enough at night, it can take us twice as long to do things the next day, particularly when it comes to complex thinking and information processing,” Mander explains.
Stand. This time, Mother does know best. “Good posture can help prevent muscle strain, fatigue and pain,” says Daniel Mazanec, M.D., associate director of the Center for Spine Health at the Cleveland Clinic. “It keeps back muscles long and strong, whereas hunching and slouching can shorten your muscles and lead to chronic aches that may require some formal rehabilitation.”
Even better. While standing, imagine you’re a puppet with a string coming out of the top of your head that’s pulling you upright,” Dr. Mazanec recommends. When you’re walking, focus your gaze directly ahead and pretend you’re balancing a plate on your head. And at the office, avoid leaning forward in your seat while you work by positioning your computer screen so it’s at eye level and sitting with your feet flat on the floor, knees bent at 90 degrees. Placing your keyboard so the bend in your arms is 90 degrees while you type will also encourage proper posture.
Refresh. Turns out, there really is something special in the air near the water: Ocean waves, wind and sunlight break apart air molecules and create negatively charged ions that can improve your mood. “Negative ions cling to dust in the air, making the particles heavier so they drop toward the ground, leaving the air you breathe in more oxygen-rich,” says Namni Goel, Ph.D., assistant professor in psychiatry at the University of Pennsylvania. “The antidepressant mechanism of negative ions remains unknown, although preliminary research suggests they may increase levels of serotonin, chemicals that lift your mood.” High levels of these ions were also found to treat seasonal affective disorder in a study at Columbia University in New York City.
Even better. Levels of negative ions are reliably high by the crashing surf, but sadly, not every day can be a beach day. The happy news: Outdoor air usually contains more negative ions than the stuff we breathe inside, so savor them whenever you can
by going for a walk or jog outside or simply throwing open a window.
Laugh. Feeling guilty for skipping the gym this morning? Laugh it off. “Repetitive mirthful laughter—the type of humor that pertains to the absurdities in life, rather than the demeaning kind—causes a physiological response that’s similar to the effects of moderate exercise,” says Lee S. Berk, Dr.P.H., director of the molecular research laboratory in the School of Allied Health Professions at Loma Linda University in California. Like exercise, laughing lowers the levels of cholesterol and stress hormones that suppress immunity, Berk says. “It also ups levels of dopamine, a chemical that activates your brain’s pleasure center—which is what makes laughter so enjoyable.”
Even better. Whether you’re a quiet chuckler or a raucous knee slapper, the benefits of laughing are the same. So find what tickles your funny bone (say, your favorite YouTube video) and set aside 20 to 30 minutes throughout the day to crack up. Who knows? Maybe you’ll feel so good, you’ll have the energy to do something active after all!