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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
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