As happens to all of us sooner or later, I recently experienced nursing care as a patient. It was the best of nursing and the worst of nursing. However, it was also so much more. During my hospitalization, I experienced a few treasured moments. And a few weeks later, I had a big aha moment.
Waking up in the postanesthesia care unit (PACU), I clearly recall the pain. I also recall hearing my nurse, who I later learned had been a PACU nurse for more than 10 years, calmly tell me, "You really should stop wiggling around like that-it would help us both." Being a bit confused, it wasn't really what she said but how she said it that made me decide to lay still-and that helped. Then, I overheard her advocating for a small dose of Demerol. And as my brain was trying to recall why we stopped giving Demerol to neurosurgery patients, my pain went away. She was an expert nurse.
On the floor, I had other great nurses-the nurse who found a work-around to get the cooling device to function better, the nurse who responded to my comment about not being hungry with "order something anyway, you'll want it at 2:00 a.m." Later, eating a snack at 1:30 AM, I realized how brilliant she was. Then at discharge, my nurse put aside the 30+ pages of printed educational content-looked right at me-and said, "I'm going to tell you what you really need to know, so listen to this part first." She was right; that information was what I really needed to know. They were all right. They were great nurses, and it made me proud to be a nurse.
A few weeks later, I was reflecting on everything great about that stay and I realized something very important. I have no idea whether those great nurses wrote a nursing care plan individualized to my hospitalization. I have no clue whether they got my vitals exactly 4 hours after surgery. I don't care whether or not they charted that the bedrails were in the right position. Moreover, if the PACU nurse did not document my pain level and goal before she advocated for the Demerol, I'm okay with that.
I am not arguing that documentation is unimportant. However, maybe there is something more important than documentation. We know the right dose for most medications. Maybe there is a right amount of documentation. We have questions. What is really important to chart? What proportion of the variance in outcome (r2) after craniotomy for tumor can be explained by documentation of vitals during the first hour after surgery? Of the billions of bytes of data documented by nurses every day-how many words are ever read by another member of the healthcare team? We need research. We need evidence.
Documentation (charting) might not sound like a research topic, but there are clear hypotheses waiting to be tested, and the Journal of Neuroscience Nursing is eagerly awaiting the opportunity to publish well-conceived studies that improve bedside care for patients with neurological and neurosurgical injury or illness.
Dr Olson declares that he is the editor of the Journal of Neuroscience Nursing.