I have a hard time focusing when I am repeatedly interrupted. How many times have you walked down the hall to get something, met with an unexpected request or encounter, and then found you couldn’t remember where you were going or why?
A few years ago I was working as float nurse in an outpatient facility. One of the specialties I floated to was the pediatric clinic. There were seven or eight nurses (a mix of RNs and LPNs) working at the same time, with half assigned to administering medication, mostly vaccines, and the others performing telephone triage and monitoring patients in the observation room. I can now admit that I used to pray to get assigned to the triage section—not because giving injections was a problem, but because the setup of their system terrified me. Read the rest of this entry ?
What should be done about a person with a chronic medical condition who can’t make it to their primary care provider but isn’t sick enough to call 911?
Recently a case came to my attention of a woman in her 60s with a history of impaired mobility due to primary lymphedema of the legs, obesity, and some other chronic medical problems. One day while getting up out of bed she strained her back. The pain from the injury made it that much harder to tolerate any kind of physical activity. She was no longer able to climb up or down stairs. Since there was no way to leave her house without going down several steps, she couldn’t get the medical care she needed to treat the acute back pain or the wounds on her lower legs associated with the lymphedema. As the months passed, her leg wounds grew worse and her inactivity led to more inactivity. Although her husband and children were able to assist her in some capacity, they had no way to get her out of the home.
Prior to the her back injury, she’d routinely visited her primary care physician as well as a vascular surgeon—but neither felt comfortable ordering home care for her (nor did they offer any solutions). Without an order, a home care service couldn’t take her case. A trip to the emergency room wasn’t really what she needed, but aside from calling 911 there was no other way of getting her seen by someone with the privileges to prescribe either the medications or home care she needed. Read the rest of this entry ?
A small study published in the June issue of Health Education and Behavior found that mindfulness meditation in the workplace lowered stress levels and improved sleep. The findings have made the rounds on the Internet, with several blogs and Web sites reporting the results and giving their own spin on the value of the intervention. I also wrote about it for the AJN eNews, (delivered by e-mail inbox if you sign up), where each month I’m writing a column called “Taking Care of You.”
Evidently, caring for themselves is a foreign idea to some nurses. At the Nursing Times Web site two anonymous nurses posted the following comments about the notion of meditating while at work:
“Morale is at rock bottom. So please don’t make them completely hysterical with the suggestion that meditation during their lunch breaks would be useful in helping them ‘attain a heightened awareness of the factors that cause them stress’.”
“…we don’t get ANY breaks. And I think the notion of being able to sit at the desk in the nursing office is a very bad joke.”
That second commenter goes on to suggest that what’s needed isn’t meditation but rather more staff.
AJN writes a lot about the staffing issue, and it’s a real one. But the question remains: is “mindfulness” a part of your self-care arsenal? And if not, are you more pessimistic than you should be? After all, Tindle and colleagues reported findings in Circulation earlier this month showing that “cynical, hostile women” had higher rates of coronary heart disease than optimistic women did.
In our discussions of how to “brand” AJN, we on staff have sometimes referred to it as “the journal for the career-minded nurse.” I’ve often wondered who those nurses are. Some might think they’re that small percentage of nurses who go on for advanced degrees (only 13% of nurses, according to one source) or those who move into management positions.
But I see them differently. I think there are a lot more career-minded nurses out there than we give credit for. What about nurses in direct-care roles who strive to be the best clinicians they can be—aren’t they “career minded” too? They’re the nurses I looked up to when I was working in the hospital and hoped to be like some day. They keep the basic principles of good nursing in mind, combining compassion and evidence-based practice, behaving professionally, dressing appropriately, staying aware of health care trends, and advancing nursing by participating in unit- and hospital-wide committees and professional organizations.
It’s not always easy. I broke the “dress appropriately” rule once, and will never do that again! (A hospital is no place for snakeskin pants, I learned.) And what would a nurse manager think of my new nose ring? One recent blog post debates that issue.
In my definition, career-minded nurses also take their role as preceptor very seriously, showing patience and understanding to new nurses. We need more of this; as one nurse blogger, Not Nurse Ratched, put it: “I have many assets to bring to this profession and to my patients, and I hope I survive my first year without burning out so that I can keep those assets in this profession.”
Patients need smart, capable nurses at the bedside. Perhaps if those nurses start getting the respect they deserve, we can keep them there.
Charla on horse 2-3 years ago; daughter Briana standing.
I recently had an e-mail exchange with Michael Nash, the twin brother of Charla Nash. Charla was the victim of a chimpanzee mauling in February of this year. I first wrote a post about her in April and then an update on her condition in May. In April, she had just spoken her first words, her daughter’s name and her nurse’s name, upon waking from a medically induced coma.
Michael tells me now that Charla continues to recover. Most of her physical wounds have healed, and she will soon be discharged to a rehab facility. She is blind and has prosthetic eyes. She also has had several facial-reconstructive surgeries, including the placement of a prosthetic hard palate. A large piece of her scalp was torn off in the attack, and that wound is still being treated (it requires wet-to-dry dressing changes three to four times a day).
Initially, her physicians were concerned about her mental and cognitive recovery. But it seems she’s doing better than expected. Her family is dedicated to supporting her throughout this ordeal: two brothers take turns staying in Cleveland to be near her at the hospital, and Brianna, her daughter, has been staying there over the summer. Yet still, Michael says, Charla is down at times. Here are Michael’s words about one of his most recent visits to her.
One day she told me I could go home. I told her I could stay a while longer. She said she meant to go home and get on with my life. I said I could not do that. She said that I could and I responded that I couldn’t and you know why I could not. She asked why and I said, because you would not leave me. She said that she would and I responded that you are lying, your nose is growing. Then she got very quiet but I am sure it was a turning point. Since then I feel she is back 100%.
He is planning a big surprise in August for Charla, but hasn’t revealed what it will be. Visit the Charla Nash Trust Website if you’d like to keep updated on Charla’s condition, or make a donation to help cover medical bills.
Sometimes it’s the most basic care that has the greatest impact on health outcomes. A recent article on CNN.com highlights Dr. Alfonso Torress-Cook’s work to reduce the rates of health care–associated infections (HAIs). (Click on the video above to watch a Fox news report about Torress-Cook.) This is a big deal because, according to a 2007 CDC report, there were 1.7 million HAIs in 2002; these were associated with approximately 99,000 deaths in the U.S. That’s a rate of 4.5 infections per 100 admissions, or one in 22 patients.
Torress-Cook’s strategy includes meticulous hand-washing by the staff, head-to-toe cleaning of the patients (including under their nails and oral care), daily cleaning of hospital rooms, giving antibiotics only when cultures prove they are necessary, and feeding yogurt to patients to replenish bacteria in the gut.
When I heard about Michael Jackson’s death I was shocked and saddened, as most music fans were. I prefer to remember him from his Off the Wall days, and it’s a record I listen to fairly regularly. But I wouldn’t have thought I’d be writing about his death on a nursing blog—until I heard the 911 call made from Jackson’s house before he died.
Apparently, Dr. Conrad Murray, a cardiologist trusted by Jackson, was administering chest compressions to Jackson on his bed—that is, on a soft, compliant surface that offers little resistance. This got me thinking. In hospitals, a backboard that’s attached to the crash cart is slid under a patient during cardiopulmonary resuscitation (CPR). The hard surface allows the compressions to be given deeply enough. And when someone collapses due to cardiac arrest in a public place, she or he is usually ends up on a hard surface like the floor. In all of the CPR certification classes I’ve taken, mannequins are on either the floor or a table—but no one has ever mentioned what to do if the victim is on a bed. Should you transfer the patient to the ground? Read the rest of this entry ?
“Take care of your teeth”—it’s something we’re told as soon as we’re old enough to hold a toothbrush. But it’s not so straightforward for the nursing personnel who provide oral care in nursing homes. According to a 2000 Surgeon General report on oral health, “Mouth care is often considered an unpleasant task and is often delegated to nursing auxiliaries, who have even less oral health training than registered nursing staff.”
This month AJN features a case study of a patient that proves this point. A severely disabled man received such poor oral care from nursing home personnel that his oral and nasopharyngeal secretions built up (“inspissated”), and he died from asphyxia. The lead author, Joseph A. Prahlow, was the pathologist in charge of the autopsy; the article features graphic photos of the thickened secretions that blocked his airway. A companion article by two dentists, Pamela S. Stein and Robert G. Henry, gives nurses suggestions Read the rest of this entry ?
Photo by HeavyWeightGeek / Gavin Brogan, via Flickr
By now, most people are aware of the basic formula for maintaining a healthy weight: eating low calorie, nutritious food and exercising regularly. But obesity continues to be a major health issue worldwide, and it seems clear by now that there’s more than a knowledge deficit at the root of the problem. That’s why when I worked in primary care I was always frustrated by orders to give patients a handout on low-fat diets (and two minutes of explanation) and send them on their way. Once, a patient came in with back pain; she’d fallen out of a chair that broke when she sat on it. While her eyes glazed over, I spent a few minutes going over the diet the doctor ordered for her. At the end of this painfully futile exchange I asked her if she had any questions. She responded, “Have you ever thought of cutting your hair short?” Something tells me she didn’t run right out to buy vegetables and join a gym. Read the rest of this entry ?
I was really happy when I saw that a manuscript about pulse oximetry had been submitted to AJN. Pulse oximeters are everywhere in the health care environment, in both inpatient and outpatient settings, but—as a literature review published in the November 1 2006 issue of Australian Critical Care determined (click here for the abstract)—many clinicians don’t understand how they work. For example, a colleague told me that, one night when she was working, a physician wrote orders to replace continuous monitoring with once-per-shift monitoring for a patient whose condition had improved. She removed the probe from the patient and unplugged the machine, but kept it at the patient’s bedside. The patient care technician working that night documented the patient’s oxygen saturation level as 98% every hour from midnight to the end of the shift at 7 a.m., even though the patient was not hooked up to the oximeter. (The technician was terminated because of this). Read the rest of this entry ?
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
