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Archive for December, 2010
Patient praises Nurses
Posted by Sean on December 29, 2010
This was awesome. So heart warming to hear the appreciation of our work from the one person’s opinion that matters the most.
The patient.
Amplify’d from well.blogs.nytimes.com
In Praise of Nurses
I love and admire nurses.
Oncology nurses and ostomy nurses. Radiation nurses and post-op nurses. And those essential, always-there-when-you-need-them, round-the-clock nurses. (And though most of my experience is with female nurses, I admire male nurses, too.)
Now this isn’t some abstract infatuation, based on seeing “South Pacific” one too many times. I’ve been hospitalized six times in my life, and the medical personnel I came to know best — and like best — were the nurses.
To generalize: Nurses are warm, whereas doctors are cool. Nurses act like real people; doctors often act like aristocrats. Nurses look you in the eye; doctors stare slightly above and to the right of your shoulder. (Maybe they’re taught to do that in medical school?)
My most recent dependence on nurses came in 2008 and early 2009 as I was treated for an aggressive Stage 3 prostate cancer. But more about that later.
My first vivid nurse memory comes from the summer of 1970 at Exeter Hospital in New Hampshire. I was 12 years old — almost 13 — and a benign tumor in my right knee needed to be cut out.
The night before surgery, a no-nonsense nurse in starchy whites strode into my room like a drill sergeant. She carried a basin of warm water, shaving cream and a razor, and I soon found out that she was a real baseball fan, a Boston Red Sox fan.
“The Sox need to trade Carl Yastrzemski,” she said as she began shaving my right leg. “They need to start dangling him … dangling him, trade him for someone like Roberto Clemente or Dick Allen.” I never even noticed the razor had planed my leg to a hairless sheen.
When I spent six weeks in the hospital in 1984 — first at Englewood Hospital in New Jersey, then at Mount Sinai Hospital in New York — some of the nurses started feeling almost like family. And, like family, nurses can sometimes be a bit too frank.
I was admitted to Englewood because of heavy bleeding from my ulcerative colitis. My hemoglobin level was 5.6 — the normal number for men (as all nurses know) is between 13 and 17 — and the admitting nurse offhandedly said, “I’ve never seen anyone alive with a hemoglobin that low.”
I thought my wife, Deb, was going to faint.
A week later I was bundled into an ambulance and packed off to Mount Sinai, where the days passed in a “Matrix”-like blur. I remember the nurses calling, “Keys!!!” and the big fist of keys zipping and zooming up and down the hall floor … the old man with a thick Yiddish accent chanting, “Noice, noice, noice!” … the nurses wrapping my arms, sore and swollen from all the IV needles, in hot towels.
Finally I had surgery to remove my ravaged colon. Post-op there are always those disorienting moments as you shake off the anesthesia. Angelic visions flutter about the bed, swabbing your forehead, slipping ice chips between parched lips, and you wonder: Heaven? Or recovery room?
“How’re you feeling, Mr. Jennings?” Recovery room – whew!
And most recently, for my prostate cancer, I was treated at Robert Wood Johnson University Hospital in New Jersey. Except for a flip-flopping energy level, I’m doing well. Every three months, I get my PSA tested — so far, so good.
It made me smile that the nurses there called the two round, plastic drains that dangled from my side ”grenades.” And it was one of my grenades that made one young doctor understand that I was more than just another ”prostate cancer, post-op.”
I can’t recall her name, but the doctor had been told to remove my drain, my last grenade. She needed to grab it firmly, then tug. Instead, she held it tentatively, as if it were a surly garter snake, and waggled it inside my body.
It hurt. I got dizzy, nearly threw up and broke out in a cold sweat. When I told her I was going to pass out, she sheepishly went and got help.
Real help. She went and got a nurse.
Dana Jennings, an editor at The New York Times, is the author, most recently, of “What a Difference a Dog Makes: Big Lessons on Life, Love and Healing From a Small Pooch” (Doubleday, 2010).
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Posted in random | Tagged: nurses | 1 Comment »
Patient education – lost in translation
Posted by Sean on December 28, 2010
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The one constant thing I keep encountering is the lack of education given to the (our) patients and their families. Patients and their loved ones are scared and confused the majority of the time. It’s always our job to lessen those fears and eliminate their confusion, yet we as nurses (heck most health care professionals) miss the bus on this one.
Maybe it’s not enough time? Maybe it’s not enough effort? Resources? Information? I really don’t know.
I do know that when I spend those dedicated few minutes with my patient and their family talking about their care, our plan of attack, my goals for my shift, what I’ll be doing, not doing, the ‘why’s’ for the interventions I’m performing, explaining those ‘numbers’ on the monitor, and trying to lay out their overall plan of care – they sit their like it’s their first school lesson.
“Deer in headlight” look.
Sitting still in their seat.
Watching my every move.
They ask questions, I answer them to the best of my knowledge. If I can’t answer the questions I investigate and give them direction. We have a dialogue about the do’s and don’ts of their care. Why this.. Why not that.
It’s an enriching and engaging interaction.
Everybody wins.
They get to feel more comfortable about all that happens in the room. They aren’t startled when alarms go off, or ancillary staff comes in to draw blood (this patient was on a heparin drip).
I get to understand and better appreciate their view point as well as get a ‘feel’ for their willingness to contribute to their care. Will they comply, will they be uncooperative, will they be engaging, etc.
A certain level of trust is established in those few and finite minutes that we as nurses rarely get to spend with our patients.
I wonder if that’s part of the overall problem? Those few minutes make all the difference when determining success and/or failure. I think that interaction helps and hinders their overall experience, their state of health AND ultimately their length of stay!
In a world of health care fraught with ‘adding more to the to-do laundry list’, we spend less and less time at the bedside.
How can we get those few minutes back?
How can we prevent this loss in translation?
…
Hmm…
Posted in health, opinion | Tagged: health | 3 Comments »
Yet another reason to fight obesity
Posted by Sean on December 28, 2010
This one is a lil far reaching, but it does make a point. I can’t say this is based on sound evidence other than common knowledge.
Just another reason to keep that waist size down.
Amplify’d from www.medpagetoday.com
Obesity Can Be Fatal in Auto Accidents
“The increased mortality among moderately to morbidly obese drivers is probably due to closer proximity to the steering column and comorbidities,” they speculated in the paper.
Obese drivers may be able to reduce their risk by choosing larger vehicles and moving their seat back sufficiently so that no part of their body touches the steering wheel, which can lessen the force of impact in an accident, Gemme suggested in an interview.
“Often morbidly obese people are stuck, though, because the seats don’t go back far enough,” he told MedPage Today. “They’re limited by what the manufacturer produces.”
Obesity significantly increased the likelihood of death to the driver for both men and women, although the risk was slightly higher for men.
But overweight — a BMI of 25 to less than 30 kg/m2 — actually appeared somewhat protective, with an odds ratio of 0.952 compared with normal weight (P=0.0293), and the “slightly obese” with a BMI of 30 to less than 35 kg/m2 weren’t at elevated risk (OR 0.996, P=0.7758).
The researchers cautioned that waist circumference may have been a more accurate determinant of obesity, since large muscle mass can throw off BMI, but wasn’t reported in the database.
Also, the study couldn’t account for safety features of the vehicles involved in the crashes studied, they noted.
If more obese individuals are already buying bigger, safer cars, “then it is possible that our results underestimate the increased mortality risk of the severely obese,” Gemme’s group warned in the paper.
Their elevated mortality in car crashes may be a contributor to the overall population risk, but comorbidities could be a confounding factor as diabetes, cardiac disease, and other conditions may boost risk of dying from injuries sustained in an accident, the researchers noted.
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Posted in random | Tagged: obesity | 4 Comments »
Male Nurse Humor
Posted by Sean on December 21, 2010
This one actually caught me off guard.
I’m still chuckling about this one.
Some times the best laughter is when laughing at yourself.
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Making the Grade in Nursing
Posted by Sean on December 16, 2010
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During my entrance into this wonderful profession I can still remember the stress over grades. Most ‘students’ in general want to excel at their studies. So as nursing students we fought for every point on our exams. From the first semester all the way to our senior semester there were certain students that just HAD to get that ‘A’.
I was one of them ‘in the beginning’. As the semesters rolled on I realized that being a competent practitioner was not about the ‘grades’ you got in school. Excelling as a nurse was not about the ‘exams’. What mattered most was how you put it all together for the ‘bigger picture’. That bigger picture was and still is all about your patients.
Does an A student equate to a ‘strong’ nurse?
Does a C student equate to a ‘weak’ nurse?
Nope.
In fact in my experience your ‘grades’ as a student have absolutely no bearing on how you perform your duties as a nurse.
That’s the rub.
You can be a rock star-like student nurse. You can kick @ss and take names on all your exams, your clinical performances and even ‘knock them dead’ when checking off a new ‘skill session’. But none of it will matter once you get out there and practice the art of nursing.
Sure getting the good grades and mastering the material is going to assist you and even make your ‘job’ easier in the beginning (and in the long run some times), but if you can’t apply your knowledge, generate some sharp critical thinking skills and develop a compassion for the people you take care of, you will not succeed as a nurse.
In fact it’s my believe you will fail as a nurse (but that’s another story).
I only bring this to light since I’m back in the saddle again. My first semester as an acute care nurse practitioner student and I’m already caught up in the world of ‘grades’. I’m feeling like a failure if I don’t get the ‘A’, and I really need to stop it.
I need to center myself and be sure to keep my focus on the big picture. I will grasp and master the concepts, but I will not let the ‘grade’ dictate my success.
For all the ‘students’ out there – don’t lose sight of the big picture. In the end, your patient won’t give a damn what your grades were as a student. They will however give a damn about how you care for them.
Posted in health | Tagged: nurse practitioner, student | 8 Comments »
Lake Effect Rooftop
Posted by Sean on December 14, 2010
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The Ultimate Probiotic: Fecal Transplant
Posted by Sean on December 14, 2010
And a ‘last ditch effort’. Fecal transplanting folks. I heard about this procedure two years ago, and thought it was just a joke or scam.
There is no concrete evidence to support the therapy, but it’s provided some compelling results for treating C-diff.
I’m on the fence about the whole issue. Maybe it IS the ‘yuck’ factor. Who knows.
What I do know is that C-diff can be a deadly illness, and anything that can stop the progress of this illness in its tract has promise.
I’ll be interested to see how this develops.
Amplify’d from news.yahoo.com
Last-ditch method at fighting intestinal superbug
WASHINGTON – A superbug named C-diff is on the rise, a germ that so ravages some people’s intestines that repeated tries of the strongest, most expensive antibiotic can’t conquer their disabling diarrhea.
Now a small but growing number of doctors are trying a last-ditch treatment: Using good bacteria to fight off the bad by transplanting stool from a healthy person into the sick person’s colon.
Yes, there’s a yuck factor. But reports of several dozen cases in a medical journal and at a meeting of the nation’s gastroenterologists this fall suggest that with no more inconvenience than a colonoscopy, people who have suffered C-diff for months, or longer, can rapidly improve.
Yet it’s much more complex: An entire bacterial neighborhood is transplanted, almost like an organ transplant minus the anti-rejection drugs, says Dr. Alexander Khoruts of the University of Minnesota. He took a genetic fingerprint of the gut bacteria in a woman left emaciated after eight months of severe C-diff. Not only did the diarrhea disappear after a fecal transplant, but that normal bacteria mirroring her husband’s — the donor — quickly took root in her recovering intestine.
Here’s the caution: Fecal transplants haven’t been studied in the way that science requires to prove they work — by comparing similar patients given either a transplant or more intense antibiotics. History is full of failed treatments that doctors thought promising until they were put to a real test.
“There’s very good reason to think this fecal transplantation, or bacteriotherapy, might work, but it needs to be proven before everybody starts to do it,” stresses Dr. Lawrence Schiller, a gastroenterologist with the Baylor Health Care system in Dallas. He followed reports on the treatment at the American College of Gastroenterology’s recent meeting, but hasn’t joined the fledgling trend.
“They’re caught in this cycle of treatment and re-treatment,” says Minnesota’s Khoruts, who has performed 21 fecal transplants since discovering how normal bacteria took over in his first patient in 2008. He’s now begun more detailed before-and-after mapping of patients to try to identify whether particular good bacteria are key.
Fecal transplants aren’t new — the first was reported in 1958, and they’ve been performed occasionally ever since. But of 170 cases described in medical journals since then, about a third were published this year, suggesting increased interest as the C-diff problem grows, says Montefiore’s Brandt.
Doctors who perform fecal transplants agree that more rigorous research is needed — without it, there’s no way to know if only the supposed successes, and not the failures are being written up. Brandt is planning a pilot study.
How are they done? There’s no one method. Brandt insists on a list of tests to make sure the donor doesn’t have diseases such as hepatitis or HIV, or intestinal parasites. Then the donor, usually a close relative, brings in a fresh stool sample that Brandt liquefies and essentially drips into the patient’s colon during a routine colonoscopy.
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An open letter from a 'sexy' nurse to Dr. Oz
Posted by Sean on December 10, 2010
I had to share this. I posted this over at Scrubs Magazine and thought my readers around my social media ‘circle’ might like this one.
I’d love to hear your thoughts.
Amplify’d from scrubsmag.com
An open letter from a ‘sexy nurse’ to Dr. Oz
For anyone who watches day time TV, surfs the internet or frequents this wonderful website for nurses you probably have heard about the Dr. Oz debacle and the nursing profession. One of our fellow bloggers posted some thoughts on it here (jump on over and read it here of you’re not familiar with the scene).
So a month later Dr. Oz (or should I say Dr. Oz’s ‘people’) releases a formal and public apology with some politically correct and publicly sound words.
As a nurse I wonder why some think this is enough? So I thought I’d write my own ‘letter’ to Dr. Oz (or his people) expressing my and hopefully many other nurses concerns.
Dear Dr. Oz (or his ‘people’)
I’m a registered nurse of 5 years young. I’m a health care professional and a fellow ‘healer’. You’re November 4th episode that lauded the efforts of a weight loss success story was initially inspiring, but eventually quite damaging.
I myself did not watch it. I’m not a fan of day time TV (sorry). I do however support any activities that promote and attempt to improve our overall health and wellness. So for those efforts I thank you. But, the show took a turn for the worse and got quite out of hand in the eyes of your fellow professionals.
Were you aware of the guests’ actions prior to the taping (I’m assuming it’s a live studio audience)? Or were you actually caught off guard? Was this whole routine rehearsed, or was it spontaneous?
Regardless of it’s origin the whole process has angered many of your fellow ‘healers’ including myself. Did you notice I referred to myself as a ‘healer’ and not a subordinate? Did you notice there was no reference of ‘sexy’ anywhere in my description?
As a physician partner I can only assume you have worked with ‘our kind’ prior to your fame. Yes, our kind. We are called nurses. We are trained health care professionals, not a colloquial fantasy, nor a subservient helper.
Somehow during the taping of your TV show you forgot that.
Oh, wait did I mention I’m a male nurse? So the whole ‘sexy’ reference truly hits a chord with me.
You are being chastised by our profession because of what profession you represent. As a physician partner we hold you to a higher standard. We assumed you held these same standards.
During that show, regardless of when you were made aware of the guests actions, you should have stopped it. Stopped it in its tracks before it progressed. You as the heralded professional’s professional should have had the common decency and forth right professionalism to put the brakes on that charade. I’m all about fun, but when it mocking a profession fun?
Our profession continues to battle stereotypes of all kinds. We continue to lose the battle against warped public knowledge, internet fantasy, misguided beliefs, historical falsehoods, and just simple ignorance. But, when we have to wage that battle with a physician it’s both angering and disheartening. Is this how you show the ‘respect’ you speak of?
We expected more from you dear doctor.
Shame on you for not ‘knowing’ the difference.
And the battle continues.
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Posted in random | Tagged: nurses | 6 Comments »
The Unsolved Mysteries Of Obesity Continue
Posted by Sean on December 10, 2010
This is a compelling and plausible hypothesis. We truly still don’t know why America continues to get heavier and heavier.
We sure have some great theories.. but then how do we explain the over weight animals??
Amplify’d from www.newsweek.com
Fat Canaries in a Coal Mine
If it were just kids, we could blame obesity on the cutbacks in phys-ed classes, school vending machines that sell high-calorie junk, and the substitution of videogames for kickball. If it were just adults, we could blame obesity on supersizing, fast-food meals, and pedestrian-unfriendly towns that force everyone into a car. But while 68 percent of American adults qualify as overweight or obese, and 17 percent of children do (compared with 5 percent in 1971), there are other increasingly pudgy populations. Meet some overweight pets, lab animals, and even urban rats.
David Allison, an obesity researcher at the University of Alabama at Birmingham, has long criticized the Big Two explanation for America’s thundering thighs: dwindling physical activity as a result of social changes like fewer sidewalks, and increasing calorie intake as a result of nefarious food-industry marketing. By chance, he came upon a record of marmosets in a Wisconsin research colony: the little primates’ weight had soared over the previous 15 or so years, even though they had not been bred for larger size, switched chow supplier, or undergone any other change that would obviously explain their extra heft. That set Allison looking for weight records of other animals.
With colleagues, he scrutinized the weight histories of 24 populations, from alley rats in Baltimore to lab macaques in California and even control groups of mice in federal toxicology studies.
In a paper to be published in
Proceedings of the Royal Society B (for biology), they report that in 23 of the 24—eight species, 20,000-plus animals—the percentage of obese individuals has risen since the 1940s (or since the oldest records they found). The odds of that happening by chance are 8 million to 1. And since neither feral rats nor lab chimps nor any of the others have cut back on phys ed or patronized vending machines more, says Allison, we need to look for explanations beyond the Big Two.
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Posted in random | Tagged: obesity | 5 Comments »
