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Sunday, May 19, 2013
Have you ever been hospitalized and found yourself "in the dark" about what was happening to you? Many patients do not know what to ask their doctors or nurses, but they want autonomy or self-determination. You may come across these two terms. They simply mean the patient has the right to participate in, ask questions, and make the final decision involving their care.
This article will help you make appropriate decisions about your health care.
When you are admitted to the hospital, you must first be registered in the admitting department. It is here that you start your quest for self-determination. For example, you will be asked in the admitting department about advance directives. The Patient Self-Determination Act of 1991 mandated that all health care facilities obtain either a living will or durable power from patients being admitted into their hospital. Before you come to the hospital, it is helpful to have these ready for your admission.
A living will directs your health care per your wishes and does not need a lawyer. These are your wishes about your medical care in writing.
A durable medical power of attorney allows you to choose someone to carry out your health care wishes if you are no longer able to act for yourself.
Nurses and doctors have a commitment to make relevant information available to you, the patient, and to protect you from misinformation. They will discuss with you the nature of your condition, treatment options, and the risks involved. When you have been given and understand all of the information related to your care, you will be asked to sign an Informed Consent form. It is then that you can be truly autonomous in your decision making.
Many times the patient does not understand what is being said to them in the hospital or they did not hear what was being said due to a sensory deficit (loss of hearing). Patients must make their questions heard. Nurses and doctors rely on the patient and family for cues that they either understand or do not understand what is being discussed. If the patient states "Yes, I understand," this is what is understood by the hospital nurses and doctors. As partners with patients, they want to fill in the knowledge gaps when misunderstanding occurs related to your health care.
When the nurses and doctors are rounding in your room, have family present. Most hospitals round early in the morning (before surgery starts in the operating room) and then after surgery in the evening. Ask your doctor approximately what time he/she will be rounding on you so that your family can be there. If you are in the hospital for a second or third opinion about your diagnosis, nurses and doctors will inform and guide you to appropriate resources if needed.
Have a list of questions ready for morning and evening rounds. Having a list will help you and your family to ask important questions. To eliminate anxiety, practice asking your questions. When there are many people in your room, it is hard to ask your questions exactly the way you wanted to.
Using your list to ask questions while the doctors are rounding helps you get the answers to your questions right away. Keep a pencil and extra paper on your bedside table so that you will be able to write down what is being said to you during doctor rounds.
When you ask your nurse questions like, "What test will the doctor be ordering?" or "When will I be discharged?", they will not get answered right away if the nurse cannot find the information in the progress notes section of your chart. Progress notes are a section in every patient's main chart that allow doctors and other departments (physical, occupational, and speech therapy, social workers, nutrition, and pastoral services) to write down what they have found after each visit with you. Progress notes are a very important part of your personal chart because it is here that your plan is written out by your doctor.
You may request that your nurse check your progress notes for clarification. When you are not clear what was last discussed between you and your doctor, your nurse can check your progress notes and discuss what you and your doctor have just discussed. It is better to review what was said while the information is still fresh in your thoughts.
There may have been times when you were in the hospital and did not understand what was being said to you even though the nurse, doctor, or other hospital staff had already explained it to you. Patient education materials can be helpful when you still have questions. These are written for the non-medical reader, use many illustrations, include frequently asked questions, are available in large print, and are also written in many languages.
Every hospital has patient education materials developed just for you, the patient! Many large teaching hospitals have education materials downloaded on their computer at the nurse's station. This makes it easy to print out copies for you and your family. Written material is useful for a patient when they are lying in bed the night before a test and cannot remember what the test involves. They may not sleep well and may be anxious on test day.
Why do some patients not ask their questions again? Some patients do not ask again because they do not want to bother the nursing staff or they are embarrassed that they have forgotten. Never feel that you should not ask again. However, having a written copy of your test procedure at your bedside for reviewing is helpful to control your anxiety and also provide patient autonomy.
Educational materials available to you range from topics like diabetic teaching, medication information, test and surgical procedures to pastoral services, cafeteria menus, and parking information. When you want an answer, just ask! Unanswered questions will only leave you unsettled in your hospital bed. Nurses and doctors have a commitment to make relevant information available to their patients.
Discharge can be a time of high stress and anxiety for the patient and the hospital staff. How do most hospitals plan for your discharge? Did you know that your discharge begins when you are admitted to the hospital? Your doctor initiates your plan for discharge when he/she examines you upon admission. As you move through your hospital stay, many consults, tests, and medications may be ordered for you. Discharge planning is preliminary until the day of your discharge. At this time, your discharge instructions become final and are then formally shared with you.
Every patient will receive a copy of their discharge instructions and another copy is placed on the patient's chart. Discharge plans and instructions are discussed with the patient at the bedside by the doctors and nurses. Your doctor usually discusses follow up appointments and medication prescription questions. Your nurse will discuss all other pieces of your discharge instructions and get clarification for any part of your discharge plan that you do not understand.
Many patients have questions about their health care benefits at the time of discharge. Every hospital has a department that is staffed with health care benefits experts. These experts have a degree in social work, but you may also see a trend in teaching hospitals using registered nurses to staff this department. They are sometimes referred to as Patient Care Resource Managers (PCRM). Questions about insurance, work release forms, home health set up and payment, and even vouchers for taxi rides home from the hospital can be answered in most hospital settings by this group of experts.
Nurses and doctors work closely with your PCRM so that you can go home and not have to worry about gaps in your health plan. Hospital systems strive for optimal health of their patients.
As the United States admits patients that are sicker and older than previous decades, nurses and doctors are being taught how to guide patients through their busy hospital stay. Providing patient autonomy during health care decision-making and encouraging the patient to ask questions provides open communication between the patient, doctor, and nurse.
Communicating with your hospital staff will send you home with optimal health, both emotionally and physically.
Advance Directives (Medline Plus)
Consumer's Tool Kit for Health Care Advance Planning (American Bar Association)
How to Get a Second Opinion
Patient's Bill of Rights (American Cancer Society)
Talk With Your Doctor
U.S. Living Will Registry
What to Expect During Your Hospital Stay (American Hospital Association)
This article is a NetWellness exclusive.
Last Reviewed: Jun 09, 2010
Jayne L Rose-March, PhD, MSN, CNS, RN
College of Nursing
The Ohio State University