1
LETTERS this annual travail can appreciate the unconscionable amount of time, effort, and energy required before, during, and after the survey, and un- derstand that almost immediately upon closure, preparations begin for the next survey by other groups. Today, chief among the depart- ment supervisor's duties is the achievement of a Superior Rating. All else must be secondary, and to this end all plans are made. ROWENA ROGERS, RN,C, BS, Clermont. FL HANG IN THERE Yes, I do believe a nurse can realize her full potential as a professional in the nursing home, but frustrations concerning federal and state rules and regulations seem doomed to re- main. Professional growth comes from the positive input of grateful patients and family members, who appreciate what we do and the obstacles we are up against. Every day those of us de- livering health services in the long- term care field meet opposition and negative criticism from varied sources. However, to those housed within the SNF we provide a valu- able, much-needed service. We have not forgotten the elderly. We do bring the necessary combination of love and skill to the growing popula- tion of older adults who are unable to live independently. To Alice Quinn Walter and other nurses in long-term care I say, "hang in there!" Don't lose enthusiasm and commitment to our purpose. We are needed and we do make sound nurs- ing judgments based on sound as- sessments of the sick. I have looked into many aging eyes that reflect thanks for a job well done. ELIZABETH MILTON, RN, CA DOING IT THEIR WAY Recently I read a newspaper article by an activities director who de- scribed the exciting activities she had planned for the elderly residents in a long-term care facility. She ex- plained, "We had them do this," "we told them to do that," "we gave them instructions." Such statements suitaest that aged people in institutions cannot plan or decide for themselves. Not one line of the article said, "the patients planned" or "they chose." In our en- deavor to help elders remain active, are we forgetting they are people who can be self-directing? Four years as nursing director in LTC have taught me that some el- derly residents have lost interest, but this does not mean that we should force them to take part in planned activities. Granted there is a need to stimulate movement, but why must it be done in our way? The elderly are more likely to respond to one an- other than to staff. Would it not be more logical to have the elderly plan activities that interest them, with us as facilitators? Instead of the standard weekly bingo and crafts, could we not let them make some choices? I'm sure that many elderly residents, if asked, would be willing to speak for their group and gather suggestions. At the nursing home where I worked we did just this; the resident response was heart warming. These residents held cooed wine and cheese parties, dances, and monthly birthday and holiday par- ties for which they did the planning, decorating, and invitations. Before their first dance, everyone was hoping for a big turnout. The music was playing as I watched a few residents walk past my desk to the dance area. Soon the laughter and music grew louder as more and more residents arrived, in wheel- chairs or using canes and a few push- ing friends in wheelchairs. I left my paper work and went to see what was going on ... Nurses' aides and nurses who were free or off duty were dancing with residents. Residents were dancing with each other, and those who couldn't dance were clapping and tapping their feet. The greatest thrill was to see a resi- dent with double leg prostheses dancing and laughing. I saw smiles and heard laughter from residents I had never seen smile before. It was the total resident in- volvement that made this a total suc- cess. JOAN DIPASQUALE, RN, MSN, Columbia. SC TWU PIONEERED GNP EDUCATION In "Gerontological Nurse Practi- tioners: Past and Present" (July/ Aug., p. 219), Priscilla Ebersole identified the first GNP educational programs but left out a crucial one- Texas Woman's University. TWU admitted its first GNP class in 1973. In fact, TWU trained a fac- ulty member and gave its curriculum plan to the University of Colorado to start its program. TWU also pro- vided consultation and gave its cur- riculum design to New York Univer- sity and has encouraged many other universities to develop their own pro- grams. TWU has always been known to be one of the very first-if not the. first-pioneers in the train- ing of GNPs. DOLORES M. ALFORD, RN, MSN, Dallas. TX ANGER OVER DRGs I read the article on DRGs ("Pa- tient-Family Responses to the DRG System," Sept.jOct., p. 271) with great understanding and frustration. I have been an RN for 25 years, the last 16 in a 150-bed community (Ca- tholic) hospital, with experience in ICU. Three years ago I got a BSN and now work in the home care de- partment of the same hospital. In the last eight months with DRGs' influence I see patients sent home too soon by previous stan- dards. However, 50 to 75 percent of these people do fairly well. The expe- rience of the other 25 percent is the reason I'm writing-and to vent my anger at the Medicare regulations. I do agree with more aggressive dis- charge guidelines, but just when they came about, Medicare cut back the allowances for home visits. For example, a fractured hip pa- tient goes home within 5 days of sur- gery having had some physical ther- apy for use of walker. The public health nurse can average 2 to 3 visits for a maximum of 2 to 3 weeks. Catch to this is: patients often need more help from aide with bathing and personal care, but aide can only help patients as long as PHN can keep case open. If patients don't Continued on page 55

Doing it their way

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LETTERS

this annual travail can appreciatethe unconscionable amount of time,effort, and energy required before,during, and after the survey, and un­derstand that almost immediatelyupon closure, preparations begin forthe next survey by other groups.

Today, chief among the depart­ment supervisor's duties is theachievement of a Superior Rating.All else must be secondary, and tothis end all plans are made.

ROWENA ROGERS, RN,C, BS,Clermont. FL

HANG IN THEREYes, I do believe a nurse can realizeher full potential as a professional inthe nursing home, but frustrationsconcerning federal and state rulesand regulations seem doomed to re­main.

Professional growth comes fromthe positive input of grateful patientsand family members, who appreciatewhat we do and the obstacles we areup against. Every day those of us de­livering health services in the long­term care field meet opposition andnegative criticism from variedsources. However, to those housedwithin the SNF we provide a valu­able, much-needed service. We havenot forgotten the elderly. We dobring the necessary combination oflove and skill to the growing popula­tion of older adults who are unable tolive independently.

To Alice Quinn Walter and othernurses in long-term care I say, "hangin there!" Don't lose enthusiasm andcommitment to our purpose. We areneeded and we do make sound nurs­ing judgments based on sound as­sessments of the sick. I have lookedinto many aging eyes that reflectthanks for a job well done.

ELIZABETH MILTON, RN, CA

DOING IT THEIR WAYRecently I read a newspaper articleby an activities director who de­scribed the exciting activities shehad planned for the elderly residentsin a long-term care facility. She ex­plained, "We had them do this," "wetold them to do that," "we gave theminstructions."

Such statements suitaest that aged

people in institutions cannot plan ordecide for themselves. Not one lineof the article said, "the patientsplanned" or "they chose." In our en­deavor to help elders remain active,are we forgetting they are peoplewho can be self-directing?

Four years as nursing director inLTC have taught me that some el­derly residents have lost interest, butthis does not mean that we shouldforce them to take part in plannedactivities. Granted there is a need tostimulate movement, but why mustit be done in our way? The elderlyare more likely to respond to one an­other than to staff.

Would it not be more logical tohave the elderly plan activities thatinterest them, with us as facilitators?Instead of the standard weekly bingoand crafts, could we not let themmake some choices? I'm sure thatmany elderly residents, if asked,would be willing to speak for theirgroup and gather suggestions. At thenursing home where I worked we didjust this; the resident response washeart warming.

These residents held cooed wineand cheese parties, dances, andmonthly birthday and holiday par­ties for which they did the planning,decorating, and invitations.

Before their first dance, everyonewas hoping for a big turnout. Themusic was playing as I watched afew residents walk past my desk tothe dance area. Soon the laughterand music grew louder as more andmore residents arrived, in wheel­chairs or using canes and a few push­ing friends in wheelchairs.

I left my paper work and went tosee what was going on ... Nurses'aides and nurses who were free or offduty were dancing with residents.Residents were dancing with eachother, and those who couldn't dancewere clapping and tapping their feet.The greatest thrill was to see a resi­dent with double leg prosthesesdancing and laughing.

I saw smiles and heard laughterfrom residents I had never seen smilebefore. It was the total resident in­volvement that made this a total suc­cess.

JOAN DIPASQUALE, RN, MSN,Columbia. SC

TWU PIONEEREDGNP EDUCATIONIn "Gerontological Nurse Practi­tioners: Past and Present" (July/Aug., p. 219), Priscilla Ebersoleidentified the first GNP educationalprograms but left out a crucial one­Texas Woman's University.

TWU admitted its first GNP classin 1973. In fact, TWU trained a fac­ulty member and gave its curriculumplan to the University of Colorado tostart its program. TWU also pro­vided consultation and gave its cur­riculum design to New York Univer­sity and has encouraged many otheruniversities to develop their own pro­grams. TWU has always beenknown to be one of the very first-ifnot the. first-pioneers in the train­ing of GNPs.DOLORES M. ALFORD, RN, MSN,

Dallas. TX

ANGER OVER DRGsI read the article on DRGs ("Pa­tient-Family Responses to the DRGSystem," Sept.jOct., p. 271) withgreat understanding and frustration.I have been an RN for 25 years, thelast 16 in a 150-bed community (Ca­tholic) hospital, with experience inICU. Three years ago I got a BSNand now work in the home care de­partment of the same hospital.

In the last eight months withDRGs' influence I see patients senthome too soon by previous stan­dards. However, 50 to 75 percent ofthese people do fairly well. The expe­rience of the other 25 percent is thereason I'm writing-and to vent myanger at the Medicare regulations. Ido agree with more aggressive dis­charge guidelines, but just whenthey came about, Medicare cut backthe allowances for home visits.

For example, a fractured hip pa­tient goes home within 5 days of sur­gery having had some physical ther­apy for use of walker. The publichealth nurse can average 2 to 3 visitsfor a maximum of 2 to 3 weeks.Catch to this is: patients often needmore help from aide with bathingand personal care, but aide can onlyhelp patients as long as PHN cankeep case open. If patients don't

Continued on page 55