Patient Education Class Research Articles

145-LB: Improving Continuous Glucose Monitoring (CGM) Use across Ten National Centers: Results from the T1D Exchange Quality Improvement Collaborative (T1DX-QI)

Many studies have demonstrated the clinical benefit of continuous glucose monitoring (CGM) in type 1 diabetes (T1D). Although favorable insurance policy changes have gradually increased the access of CGM nationally, widespread uptake has been slow. The T1DX-QI is a national type 1 diabetes learning collaborative coordinated by the T1D Exchange in Boston, MA. This work describes how 10 diabetes centers in the T1DX-QI used QI principles including the Plan - Do - Study - Act (PDSA) cycles to test and expand different interventions to increase CGM use in their respective centers. Successful efforts include the redesign of relevant workflows, assessing and removing barriers to adoption, developing CGM patient education classes, and advocating for state Medicaid coverage of CGM. The centers piloted these changes in 12 - 26 year olds with T1D. The coordinating center used statistical process control charts to evaluate the effectiveness of the interventions (Figure 1). Eight of 10 participating centers improved CGM use significantly. There was a 12% improvement from over 20 months across the entire cohort of centers (range 7-34%). This demonstrates that by using QI principles to test interventions and cross-learning, the T1D community can increase use of CGM devices. Figure 1. Disclosure O. Ebekozien: None. N. Rioles: None. D. DeSalvo: Consultant; Self; Dexcom, Inc., Insulet Corporation. K. Gallagher: None. J.M. Lee: Advisory Panel; Self; Goodrx. Consultant; Self; T1D Exchange. Research Support; Self; Lenovo. R. McDonough: None. K. Obrynba: None. P. Prahalad: None. S. Thomas: None. R.S. Weinstock: Board Member; Self; JDRF. Consultant; Self; Insulogic LLC. Research Support; Self; Boehringer Ingelheim International GmbH, Diasome Pharmaceuticals, Inc., Eli Lilly and Company, Insulet Corporation, Jaeb Center for Health Research, Kowa Research Institute, Inc., Medtronic, Tolerion, Inc. S. Corathers: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust

Preoperative Patient Education Class During an Orthopedic Mission Trip: Effects on Knowledge, Anxiety, and Informed Consent

BackgroundPatient knowledge about arthritis and risks, benefits, and outcomes of joint arthroplasty in developing countries is unknown. We evaluated the effectiveness of a preoperative class on improving knowledge and decreasing anxiety during a surgical mission trip offering total joint arthroplasty. MethodsA team of US health care providers taught a preoperative class to 41 patients selected for total joint arthroplasty during a surgical mission trip to Guyana. Participants completed a 32-point survey about arthritis; indications, risks, and benefits of joint arthroplasty; and postoperative, in-patient rehabilitation expectations. The State-Trait Anxiety Inventory was used to measure participant anxiety. Participants completed identical surveys before and after class. Matched-pairs Student t tests were used to compare means between preclass and postclass surveys. Significance was accepted at P < .05. ResultsSeventy-eight percent of patients (31 of 41) scored less than 12 of 32 possible points (40%) on the preclass knowledge questionnaire. Mean ± standard deviation knowledge scores improved from 14.0 ± 4.5 before the class to 16.5 ± 6.5 after the class (P = .008). Anxiety scores (n = 33) improved from 35 ± 13 before the class to 33 ± 12 after the class (P = .047). ConclusionOn this surgical mission trip, underserved patients' knowledge about total joint arthroplasty increased only modestly after taking a preoperative class. Greater understanding of how to educate patients and reduce their anxiety on medical missions is needed.

Substantial Preoperative Work Is Unaccounted for in Total Hip and Knee Arthroplasty

BackgroundThe Centers for Medicare and Medicaid Services has recently designated the codes for total hip and knee arthroplasty as misvalued and has asked the Relative Value Scale Update Committee (RUC) to review the work required to perform these procedures. Although other studies have reported time spent on perioperative and postoperative care, time spent on coordinating and performing preoperative care is not included in current RUC methodology and has yet to be addressed in literature. MethodsWe prospectively tracked a consecutive series of 438 primary total hip arthroplasty and total knee arthroplasty patients by one of the 5 surgeons over a 3-month period. Each clinical staff member tracked the amount of time to perform each preoperative care task from the last clinic visit until day of surgery. Data were analyzed separately between providers and ancillary medical staff. ResultsAlthough the current RUC review includes 40 minutes of preservice time on the day of surgery, surgeons spent an average of an additional 43.2 minutes while physician assistants and nurse practitioners spent an additional 97.9 minutes per patient on preoperative care prior to that time. Ancillary medical staff spent a mean of 110.2 minutes per patient. The most common tasks include preoperative phone calls, templating and surgical planning, and preoperative patient education classes. ConclusionSurgeons and advanced practice providers spend nearly 2 hours per arthroplasty patient on preoperative care not accounted for in current RUC methodology. As readmissions, hospital stay, and complication rates continue to decline, Centers for Medicare and Medicaid Services should consider the substantial work required during the preoperative phase to allow for these improved outcomes.

Abstract 20: A Standardized Education Class To Increase Efficiency And Access To Breast Reconstruction

Purpose: Shared decision-making is a key component of patient-centered care and has been shown to improve patient satisfaction and quality of life. Strategies to improve access to breast reconstruction while maintaining high quality standards of patient education, fostering shared decision-making, have not been established in Plastic Surgery so far. Methods: Since January 2019 a 1-hour standardized patient education class was offered to all new patients in addition to standard consultations in the breast reconstruction clinic of the senior author. The number of new patient consultations per clinic day over a period of 6 months and the average consultation time after introduction of the patient education class were compared to the number of new consultations and the consultation time before introduction of the class. To evaluate the patients’ perception of shared decision-making, the 9-item Shared Decision Making Questionnaire(SDM-Q9) and the Satisfaction with Informationscale of the BREAST-Q Reconstruction Module were electronically distributed among the patients and compared between the two groups (n=30 for class participants, n = 20 for non-participants). Results: After introduction of the patient education class, the average duration of new patient encounters was significantly shorter compared to the period before the class was introduced (31.8 min vs. 53.5 min, p < 0.01). Accordingly, the rate of new patient consultations increased by 43.5% from 4.6 to 6.6/clinic day after introduction of the class. No significant differences were seen between class participants and non-participants in the SDM-Q9 scores (average sum score: 96 vs. 91, p = 0.58) and BREAST-Q scores (74 vs. 85, p = 0.14), indicating a non-inferiority of the education class in terms of patient education and autonomy compared to traditional consultations. Conclusion: By introducing a standardized patient education class to our breast reconstruction clinic, we were able to significantly shorten the average duration of new patient encounters, thereby increasing access for patients to breast reconstruction, while at the same time maintaining a high standard of patient education and perceived shared decision-making among patients.

A standardized patient education class as a vehicle to improving shared decision-making and increasing access to breast reconstruction

Shared decision-making is a key component of patient-centered care and has been shown to improve patient satisfaction and quality of life. Herein, we study the impact of a standardized patient education class for prospective breast reconstruction patients on clinic efficiency, access to care, and perception on shared decision-making. The number of new patient consultations per clinic, as well as average duration of the first individual clinic encounter, was compared before and after the introduction of a standardized education class given by the senior author to all new breast reconstruction patients. To evaluate patients' perception of shared decision-making, the 9-item Shared Decision-Making Questionnaire (SDM-Q9) and the Satisfaction with Information scale of the BREAST-Q Reconstruction Module were electronically distributed among the patients and compared between the two groups. Introduction of the patient education class was associated with a significant reduction in the duration of new patient encounters compared to historic controls (31.8 min vs. 53.5 min, p<0.01) along with permitting a 43% increase in new patient visits. No differences in self-perceived patient education and autonomy were seen between class participants and historic controls in the SDM-Q9 scores (p = 0.58) and BREAST-Q scores (p = 0.14). The introducing a standardized patient education class translated into a significant reduction in the duration of individual new patient encounters, thereby increasing patient access to care, while maintaining high-quality standards of self-perceived patient education and shared decision-making.

EXAMINING THE LEARNING NEEDS OF PATIENTS WITH REDUCED EJECTION FRACTION POST MYOCARDIAL INFARCTION

Patients with a reduced left ventricular Ejection Fraction (LVEF) post Myocardial Infarction (MI) are at risk of adverse outcomes such as the development of symptomatic Heart Failure (HF) (Shah et al., 2017). Although improvement of LVEF may occur early after initial event, due to the structural damage and remodeling of the myocardium, up to 50% of patients do not demonstrate improvement in LVEF several months after their initial MI (Chew et al., 2018). These patients are predisposed to the development of HF, making it essential that they are aware of possible symptoms post discharge and understand when to notify their physician. Most patients in this ‘grey zone’ would not necessarily receive any in-hospital education related to HF as they would not meet criteria for HF Clinical Pathways or Guideline related standards as they don’t have clinical HF. A quality improvement project was initiated at our tertiary cardiac care institution to examine the learning needs of patients with a reduced LVEF post MI to improve standard education practices and improve patient outcomes. The project used a qualitative, descriptive approach in which ten patients (post MI with reduced LVEF ≤ 40%) and six healthcare professionals (HF Nurse Specialists, Cardiologist) participated in telephone or face-to-face, semi-structured interviews. Data was analyzed for key patterns and themes. Four main themes were identified in the analysis: EF Knowledge, Heart Failure Signs and Symptoms, Understanding and Teaching, and Cardiac Rehabilitation Programs. Most participants perceived there were no explicit standards on the education surrounding EF and the signs and symptoms of heart failure. Furthermore, although cardiac rehabilitation programs have become an integral part of the standard of care, poor patient adherence remains high due to a lack of understanding surrounding the benefits of this program. The complexity of cardiac patients with reduced EF post MI is a primary theme learned in that patients may oftentimes find themselves facing sudden or unexpected symptom changes after hospital discharge. Findings in this quality review have concluded that these individuals should have an understanding of individualized ejection fraction and possible HF symptoms prior to leaving hospital in order to ensure patient safety and improve clinical outcomes. Recommendations include changes to current patient education materials and classes, individualized, targeted follow up systems of care and patient-health care provider dialogue that speaks to the specific learning needs of this at-risk patient group.

Effectiveness of a Patient Education Class to Enhance Knowledge about Lung Cancer Screening: a Quality Improvement Evaluation.

Best practices to facilitate high-quality shared decision-making for lung cancer screening (LCS) are not well established. In our LCS program, patients are first referred to attend a free group education class on LCS, taught by designated clinician specialists, before a personal shared decision-making visit is scheduled. We conductedan evaluation on the effectivenessof this class to enhance patient knowledge and shared decision-making about LCS. For quality improvement purposes, participants were asked to complete one-page surveys immediately before and after class to assess knowledge and decision-making capacity regarding LCS. To evaluate knowledge gained, we tabulated the distributions of correct, incorrect, unsure, and missing responses to eight true-false statements included on both pre- and post-class surveys and assessed pre-post differences in the number of correct responses. To evaluate decision-making capacity, we tabulated the distributions of post-class responses to items on decision uncertainty. From June 2017 to August 2018, 680 participants completed both pre- and post-class surveys. Participants had generally poor baseline knowledge about LCS. The proportion who responded correctly to each knowledge-related statement increased pre- to post-class, with a mean difference of 0.9 (paired t test, p < 0.0001) in the total number of correct responses between surveys. About 70% reported having all the information needed to make a screening decision. Our results suggest that a well-designed group education class is an effective system-level approach for initially educating and equipping patients with appropriate knowledge to make informed decisions about LCS.

Benefits of a membership in a psoriasis patient organisation: a quasi-experimental longitudinal study.

Patient organisations play an important role in supporting patients with chronic diseases and allow information transfer beyond professional care structures. Until now, only few studies have investigated the benefits of a dermatological patient organisation. In this study, potential benefits of joining the German Psoriasis Association (Deutscher Psoriasis Bund e. V., DPB) were surveyed. The quasi-experimental longitudinal design included four groups of individuals suffering from psoriasis: those (1) with DPB membership of 5 years, (2) with voluntary new membership, (3) with randomly awarded membership, and (4) without membership. Participants were interviewed two times in 12 months, about quality of life, depression, participation in patient education classes, health status, and treatment benefits. 295 individuals participated (mean age 54 years; 50.3% females). At the outset of the study, participants with voluntary new membership rated their health status worse and showed higher depression scores than those with awarded membership. The proportion of participants who joined patient education classes only increased in the group of long-term members. Health status worsened in the group of non-members, and it improved in the group of those with awarded and voluntary new membership. Treatment benefit only increased in the voluntary new members group. DPB membership seems to be associated with some relief from psoriasis-related strains, particularly in the group of those who joined voluntarily. This could be due to the fact that individuals who become members out of their own volition are more likely to seek information and, therefore, benefit from their active engagement.

Providing patient information and education in practice: the role of the health librarian.

In this article, guest writer Ivana Truccolo presents an overview of her work at the Scientific and Patient Library of a Cancer Comprehensive Centre in Italy coordinating the patient education process. She discusses the historical evolution of the concept of patient education and how this has run alongside the role of the health librarian in the provision of consumer health information. Details are provided about various patient education programmes in place at the Centre. In particular, various activities are discussed including patient education classes, the development of patient education handouts and a narrative medicine programme which includes a literary competition. The article concludes with a specific outline of the role the health librarian can play in the provision of consumer health information and patient education. H.S.

In Lumbar Fusion Patients, How Does Establishing a Comfort Function Goal Preoperatively Impact Postoperative Pain Scores?

The purpose of this feasibility study was to determine the impact of establishing a comfort function goal preoperatively on postoperative pain scores and opiate requirements in lumbar fusion patients. A comfort function goal is defined as the pain score identified by the patient describing the level of pain tolerance to participate in healing activities such as deep breathing, ambulation and participation in activities of daily living. The design was prospective, nonrandomized, intervention group (n = 30) compared with retrospective chart review as control group (n = 30). Sample included patients scheduled for routine lumbar fusion in an urban southeastern hospital. The study intervention established a comfort function goal during a routine preoperative patient education class. No significant difference in pain score or opiate requirement was found for these data. However, a fundamental clinical question arose surrounding opiate requirements and dosing management. In our hospital, the norm for postoperative pain management is to categorize pain scores as mild (1-3), moderate (4-6), and severe (7-10) pain. Physician orders commonly use this differential to order opiate dose ranges. In this sample, the mean pain score for the intervention group at home is 5.8 and the mean comfort function goal is 4.9. Based on normative categories of pain scores, if a patient's baseline of tolerable pain is 4.9, this has potential impact on clinician responses to managing pain, as 4.9-5.8 is, for this patient, perhaps a mild range of pain, not moderate. If a patient reports a pain score of 7, and their norm is 5.8, the delta is only 1.2. Does this imply that the patient is experiencing mild or severe pain? Does the nurse deliver a dose of pain medication that is in the mild or severe dose range?

The Effects of Pre-Surgical Education on Patient Expectations in Total Knee Arthroplasties

As patients prepare for total-knee arthroplasty surgery, they have many expectations related to their long-term recovery and function. This research examined whether the use of a pre-surgical patient education class with an additional long-term expectation module addressing recovery during the first 12 months after surgery was more effective in modifying participant’s pre-surgical expectations than participants receiving the standard pre-surgical education class alone. Prior to the class each participant completed one disease-specific instrument, a general-health survey, and a total-knee replacement expectation survey. After the class, each participant once again completed the total-knee replacement survey. Included in the study were 42 participants who were enrolled in a pre-surgical education course that was randomized. The participants in the control group received the standard pre-surgical education addressing pre-surgical topics. The participants in the intervention group received the standard pre-surgical education plus an additional module that specifically addressed long-term recovery and function up to 12 months post surgery. The primary outcome of the data revealed that participants’ who received the standard pre-surgical education with the additional module and who had an educational level higher than highschool, had expectations that were able to be modified to coincide with the surgeons’ expectations.

Redesigning Services in a Patient Education Resource Center Setting: A DMAIC Quality Improvement Project

This article describes a quality improvement project using the Six Sigma DMAIC framework in a health care setting. The project goal was to increase efficiency and decrease instructor time spent teaching patient education classes by grouping together patients with similar learning needs.

A pharmacist-managed telemedicine clinic for hepatitis C care: a descriptive analysis

Summary We established a pharmacist-led telemedicine clinic to manage patients with chronic hepatitis C infection. The clinic used individual pharmacist-to-patient consultations. There was also a group hepatitis C patient education class. The hepatitis C telemedicine service began in February 2011 and was available at three remote sites (Santa Maria, Bakersfield and East Los Angeles) from the main site in West Los Angeles. A total of 96 patients were seen through telemedicine in the first nine months. A patient satisfaction survey was conducted at the end of 2011 and 18 questionnaires were returned. In comparison with visits to the clinic in West Los Angeles, all patients were at least equally satisfied with telemedicine and there were no patients who were less satisfied with telemedicine. Telemedicine reduced the travelling distance and time it took for patients to attend their clinic appointment. 82% of patients preferred their future hepatitis C clinic visits to be conducted via telemedicine and 78% would prefer any future clinic visit for any disease state management to be conducted via telemedicine. The use of telemedicine increased the opportunities for patients living in remote areas to receive care for hepatitis C management.

The Implementation of the Discharge Nurse on a Mother–Baby Unit: A Conduit to Increased Patient Satisfaction

Paper Presentation Purpose for the Program The discharge nurse (DN) position was presented to hospital administration in 2011 for permission to grant a trial as a strategy to improve patient satisfaction with the mother–baby unit (MBU) discharge process. We hoped to improve consistency of parent education before discharge and improve patient satisfaction with the process. We also felt this position would affect throughput between the labor and delivery unit and the MBU simply through facilitation of timely discharges. We projected an increase in our Press Ganey and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores as a result of this innovative program. Proposed Change A DN would work five 8‐hour shifts Monday through Friday. The DN would meet patients on their first day admitted to the MBU and begin their plan for discharge. Furthermore, the DN would review all prescriptions on the day of discharge, including the effects of medication and potential adverse effects, review and prepare necessary paperwork, review discharge instructions for the mom and infant, review all screening tests and results, and review follow‐up appointments for the mom and infant. Patients discharged in the coming day or days would attend a daily parent education class taught by the DN. The final car seat check would also be executed by the DN. After the mom and infant were discharged, the DN would document the discharge and complete the process. Implementation, Outcomes, and Evaluation The position was trialed for 3 months and made permanent late spring 2012 after evaluation of outcomes were realized. Press Ganey as well as HCAHP scores validated an increase in patient satisfaction with the discharge process and patient education class time. The hospital administration recognized the positive outcomes and is presently using this best practice on another unit. Implications for Nursing Practice This innovative program can be used on any unit struggling with discharge‐related patient satisfaction scores. The efficiency gained as a result of this process can be extrapolated for admission as well, and an admission and discharge team can be used to generate improved satisfaction in addition to improved throughput between units. Standardization ensures that the education surrounding discharge of mothers and newborns is consistent from one patient to the next. Nurse satisfaction was improved from this process and left more time for the staff nurse to monitor, care for, and teach patients with less fragmentation.

Impact of Patient Education Class for Inpatients Admitted for Heart Failure on Rates of 30 Day Readmission

Impact of Patient Education Class for Inpatients Admitted for Heart Failure on Rates of 30 Day Readmission

Interventions for enhancing consumers' online health literacy

Access to health information is critical to enable consumers to participate in decisions on health. Increasingly, such information is accessed via the internet, but a number of barriers prevent consumers making effective use of it. These barriers include inadequate skills to search, evaluate and use the information. It has not yet been demonstrated whether training consumers to use the internet for health information can result in positive health outcomes. To assess the effects of interventions for enhancing consumers' online health literacy (skills to search, evaluate and use online health information). We searched: the Cochrane Consumers and Communication Review Group Specialised Register; Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1 2008); MEDLINE (Ovid); EMBASE (Ovid); CINAHL (Dialog); ERIC (CSA Illumina); LISA (CSA Illumina); PsycINFO (Ovid); Index to scientific and technical proceedings; SIGLE; ASLIB Index to Theses; ProQuest Dissertation Abstracts; National Research Register/UK CRN Portfolio database; Current Controlled Trials - MetaRegister of Controlled Trials. We searched all databases for the period January 1990 to March 2008. Randomised controlled trials (RCTs), cluster RCTs and associated economic evaluations, quasi-RCTs, interrupted time series analyses, and controlled before and after (CBA) studies assessing interventions to enhance consumers' online health literacy, in any language. Two review authors independently selected studies for inclusion, assessed their quality and extracted data. We contacted study authors for clarification and to seek missing data. We presented results as a narrative and tabular summary, and calculated mean differences where appropriate. We included two studies: one randomised controlled trial (RCT) and one controlled before and after (CBA) study with a combined total of 470 participants. The RCT compared internet health information classes with patient education classes for participants with HIV infection. Only the RCT, which we rated as having a moderate risk of bias, reported statistically significant positive effects for primary outcomes related to online health literacy in the intervention group, for the following outcomes: 'Self-efficacy for health information seeking', 'health information evaluation skills' and the 'number of times the patient discussed online information with a health provider'. The CBA, which we rated as having a high risk of bias, compared internet health information classes with a control group receiving no intervention among healthy adults aged 50+. It showed significant positive changes only in a secondary (behavioural) outcome in the intervention group, regarding the readiness to adopt the internet as a tool for preventive health information. No adverse effects were reported.There is low quality evidence that such interventions may improve some outcomes relevant to online health literacy in certain populations. Due to the small number of studies and their variable methodological quality, the evidence is too weak to draw any conclusions about implications for the design and delivery of interventions for online health literacy. There is a need for well-designed RCTs to investigate the effects of such interventions. These should involve different participants (in terms of disease status, age, socio-economic group and gender) to analyse the extent to which online health literacy reduces a barrier to using the internet for health information. Trials should be conducted in different settings and should examine interventions to enhance consumers' online health literacy (search, appraisal and use of online health information) like internet training courses, measuring outcomes up to at least one year after the intervention to estimate the sustainability of the intervention effects.

Impact of a Structured Group Patient Education Class on Compliance Rates for Screening Colonoscopy (SC)

Impact of a Structured Group Patient Education Class on Compliance Rates for Screening Colonoscopy (SC)

Outreach to Improve Patient Education at South Carolina Free Medical Clinics

The University of South Carolina (USC) School of Medicine (SOM) librarians have partnered with eight free medical clinics in South Carolina to enhance patient education efforts. During these outreach projects, project librarians purchased and installed computers, projectors, screens, LCD monitors, and touch-screen information kiosk equipment in each clinic, conducted MedlinePlus® training sessions with clinic staff, and added links to MedlinePlus on the patient education area of the clinics' websites. As a result, the free medical clinics incorporated MedlinePlus into their patient education classes or used the self-playing tutorials in patient waiting rooms.

Creating an anticoagulant patient education class

A patient education workgroup was developed on a progressive care medical/vascular surgical unit. The workgroup identified patient education needs regarding discharge education for postsurgical patients and those discharging with oral anticoagulants (OAC). Staff surveys aided the workgroup in identifying a need for additional discharge education for patients and families. After various methods of patient education were explored, it was determined the workgroup could best meet the needs of the patient population through a class format providing group discussion and interaction. Logistical details and class formatting were configured to meet both the needs of the patients and the nursing staff. Current institutional patient education pamphlets were used to develop the content for the class. Physician review and input were obtained during the development of the content. A patient education specialist was also consulted to ensure proper literacy levels were used. To meet the Joint Commission National Patient Safety Goal regarding anticoagulant safety, the content focused on home management, which included the following: knowledge of INR goal range, dietary factors, when to call the provider and safety precautions. Other topics to promote self-efficacy in anticoagulation therapy were also included in the content. Postclass evaluations completed by patients and families provided useful feedback for continuous improvement and patient satisfaction. Preliminary survey results indicate high patient satisfaction with the class. Plans include a quality improvement project to evaluate the effectiveness of the patient education class on OAC.

Task-Oriented Pain Management: A Patient's Perspective

"I'll tell your nurse." The wall speaker beeped off before I could respond to the person at the nurses' station. Frustrated, I yelled out my hospital room door, "You said that 20 minutes ago!" Having just had bilateral knee replacement surgery, my only access to the world beyond my hospital bed was the call button, but I expected this. During the preoperative patient education class that my family and I attended, we were told that the most important thing a postoperative patient could do would be to ask for help. Use a call button for even the slightest need, use ice packs as oft en as possible, and do not under any circumstances get up without help. Only a few days into rehabilitation I learned that if I needed something, it was going to take more than one push of the call button. Desperate for ice packs and a trip to the bathroom, I decided it was time to take matters into my own hands. There was a walker about three feet from my bed, just close enough for me to grab with the reaching stick provided by the occupational therapist. The question at this point wasn't whether or not I could make it to the bathroom. This wasn't the first time I had broken the rules and ventured past the confines of my bed alone, so I knew I could do it. The question was whether or not I'd make it to the bathroom in time. A nurse entered my room-the first response aft er four calls in 40 minutes- and helped me back into bed. "You know, you're not supposed to be walking around by yourself," the nurse advised as though I didn't know. On her way out, she asked if there was anything else I needed. Exhausted from a strenuous exodus to the restroom, I didn't remember until aft er she was gone: ice packs. My recent inpatient experience left me with a sense of inner conflict. As the daughter of a nurse, I had to try to reconcile what my mother taught me about nursing with what I experienced. "Nurses are a patient's number one advocate," Mom always said. "They are your eyes, ears, and voice when you are at your most vulnerable." The staff at the rehabilitation center ran a very tight ship. They had to; with few nurses on the unit and more than 30 patients screaming for pain medication, ice packs, and all the other needs, they were well trained to methodically provide care to the highest standards of a Magnet hospital. What I observed, however, is that when care is provided in the form of a regimented task list, stretching nurses far too thin, the patients suffer from the lack of compassion that comes from being treated like a checklist of responsibilities rather than a human being. Every day I awoke at five to the sound the curtain being drawn around my bed. A nurse had to take my vitals and draw my blood to check my Coumadin level. It was difficult to get back to sleep-the discomfort of two prosthetic joints made sleeping at all nearly impossible. The sound of clean towels and a water-filled basin dropping on my bed table roused me out of a lucid nap 2 hours later. To me, this was the first physical therapy session of the day. Getting myself up, bathing from a basin without spilling onto my sheets and reaching for my clothing was physically strenuous enough that by the time I was done, I needed a nap. My breakfast frequently got cold as it waited for me to finish my morning rituals. I wondered if my age had anything to do with the absence of assistance. I oft en heard the nursing staff comment on how unusually young 746B was, that 746B would probably recover faster than the other patients. They wondered what 746B did to need double knee replacement surgery before age 30. I wanted to scream, "746B has a name and needs help getting dressed!" Two different pain medications were administered every day: a controlledrelease drug given every 12 hours and a fast-acting narcotic given every 3 to 6 hours as needed. …