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Please Read Aloud



Please read the following paragraph aloud to yourself or to a coworker.

1 eV is equal to the amount of kinetic energy gained by a single unbound electron when it accelerates through an electric potential difference of one volt. In plain numbers, 1 eV equals 1.602176487(40)×10−19 Joules. In comparison, a single molecule floating in air has the energy of 0.04 eV.

Having completed this little exercise, are you able to work with subatomic particles?  Is your coworker competent in operating large hadron colliders?  Do you have any idea what I am talking about.

If you do know what I am talking about, please explain it to me.  I am clueless.  But, I can verbalize understanding of the amount of kinetic energy 1 eV equals.

Every day I read that patients verbalize understanding of information that is not required to help them improve their overall health status.  Many times the probability the patient actually understands how to apply this useless information to their daily lives is pretty much zip.

We even have an abbreviation for Verbalizing Understanding. It is used with such frequency that the abbreviation V/U shows up daily in visit notes, goals, etc.

Here’s a secret.  I don’ really care what the patient understands.  I only care about the end result of our care.

Ten fingers and a key board is pretty much all it takes to verbalize understanding of pretty much anything.  Changing behavior is a far loftier goal than merely verbalizing understanding.

Consider the following two goals.

  1. Patient will verbalize understanding of diabetes diet by end of episode.
  2. Patient will have blood sugar ranges between 70 and 150 throughout episode.

The design of the second goal shifts the thought process in care planning slightly to the left.  The nurse taking care of the patient is no longer bound and determined to teach the patient all the biochemistry involved in the way the body uses insulin to transport glucose across cell walls how pH and electrolytes are influenced by a lack of insulin. This makes about as much sense to some patients as subatomic particles makes to us.

In order to meet the second goal, the nurse determines why this particular patient has a high sugar and work with the patient to change the behaviors contributing to a poorly managed disease process.  Whether or not the patient can verbalize understanding is not nearly as important as reaching the goal of a healthy blood glucose level.  This may be a simple as getting the patient to trade out his cokes for diet coke or as complicated as involving the entire family for whom eating cake has been a way of celebrating everything from birthdays and holidays to successfully tying one’s shoelace in the morning.

I am quite certain there are patients who will benefit and use a sound understanding of their disease process to improve their health. In these patients, the second goal works just as well.

It all depends on the patient.  Got that?  It depends on the patient.

2 Comments Post a comment
  1. Sherita mays #

    Informative

    Like

    July 6, 2012
    • Thanks, Sherita. For those of you who do not know my friend, Sherita, she works on the South Side of Chicago. Her days are an adventure. One patient didn’t have electricity but a neighbor did allow him to use an extension cord to piggy back enough light to bathe and such. This is the kind of patient who really needs help with contacting family members who will ensure meds are refilled timely, that he knows which meds to take when, that he has a way to get to the MD, etc. He is probably not interested in the biochemical alterations secondary to his disease process but nurses like Sherita do brighten his day and keep him home which is where he wants to be. For many of our elderly, the familiarity and comforts of home – no matter how they seem to us – are preferable to the Ritz any day of the week. (And yes…. she has contacted the social worker and light company for him.)

      Like

      July 6, 2012

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