Posts Tagged ‘nurses’

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On Cats Sucking the Breath Out of Babies, and Other Health Superstitions

February 15, 2012

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Soul on the Head of a Pin,” was published in the May 2010 issue of AJN.

I recently babysat a friend’s busy toddlers, and was happy to share the long (but lovely) day with a good friend who happens to also be a nurse. We’d just gotten the babies tucked into their cribs and were stepping out of the nursery with a sigh when I noticed the family’s cat lounging in a padded rocking chair, blinking lazily at us.

“Wait!” I said, scooping up the cat. “We can’t leave the cat here. Cats suck the breath out of babies!”

My friend looked at me like I’d lost my mind, and I instantly wished that I hadn’t said it.  The absurdity of the statement was clear to me. And yet it felt like a truth I’d known forever, even if I couldn’t remember why.

As it turns out, it was something I was told as a child—by my grandmother. Knowing this makes my statement make sense, at least to me, as I adored my grandma and would have accepted anything she told me as undisputed truth. Even so, I’m surprised (and a little embarrassed) that in spite of higher education and years of nursing experience, despite the obvious physiologic impossibility of a cat sucking the breath from a baby, and despite the fact that I’ve had my own children, and cats, such a notion was lying dormant in my consciousness and escaped unexpectedly and unbidden.

In my curiosity about the idea of cats sucking breath from babies, I came across a 1930 book, Shattering Health Superstitions, by Morris Fishbein, MD. It’s subtitled “An Explosion of False Theories and Notions in the Field of Health and Popular Medicine.” Dr. Fishbein discusses 57 medical claims, asserting their fallacy only after explaining their origin.

Here are some of the chapter titles, verbatim:

  • Some people think that fish is a brain food and that a lot of mackerel in the diet will convert a moron into an Einstein.
  • Some people believe that warts can be removed by tying knots in a string and burying the string at a crossroads in the moonlight.
  • Some people think appendicitis is just an old-fashioned stomach ache and that the doctors developed the disease for their own satisfaction.
  • An apple a day keeps the doctors away.
  • When the oldest inhabitant begins to feel pain in his joints, there is going to be a change in the weather.
  • It takes whiskey to kill a cold.
  • A favorite Midwestern cure for rheumatism is to carry a buckeye in the trousers pocket.
  • Kissing can cause trouble, but it doesn’t cause cold sores.
  • Most people believe that a big head is sure evidence of a massive intellect.

While there may be a shred of truth in a couple of the beliefs alluded to in these chapter titles (many people with arthritis certainly do report worsening symptoms with changes in the weather; many claims have been made for the benefits of fish oil of late; etc.), most have as much basis as certain more recent widely held beliefs regarding the various evils of vaccinations. Read the rest of this entry ?

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When Lawmakers and Physicians Hold Nurses Back

February 13, 2012

Editor’s Note: Toni Inglis, MSN, RN, CNS, FAAN, writes opinion for the Austin (TX) American-Statesman. She works at the Seton Healthcare Family in Austin as a neonatal ICU staff nurse and also writes a nursing blog for Seton and edits its monthly NursingNews. This article is a reprint of an April 22nd commentary in the Statesman. Toni was inspired to write the column after a particularly disappointing legislative session, in which Texas advanced practice nurses made fewer gains than in past sessions—despite Texas ranking last in access to health care and having the most restrictive laws in the country regarding APRN scope of practice and prescriptive authority. She believes the poor access and barriers to practice are related.

AJN finds the article particularly relevant as legislatures across the country deliberate on APRN barriers to practice. You can read her commentaries at ingliscommentary.com.

Here’s an idea that wouldn’t cost Texas a dime but would save millions of dollars every year: Remove all barriers restraining nurses from practicing to the full extent of their education and training.

by Brian Romig/via Flickr

No state needs primary care providers more than Texas, which has a severe shortage. Texas ranks last in access to health care and in the percentage of residents without health insurance. Of Texas’ 254 counties, 188 are designated by the federal government as having acute shortages of primary care physicians. Of that number, 16 counties have one and 23 have zero.

If every nurse practitioner and family doctor were deployed, we still couldn’t meet the need. Texans are desperate for health care.

Doing the math and to help meet the need, the Legislative Budget Board recommended autonomous practice of advanced practice nurses after a preceptorship.

In Texas, our legislature — session after session — keeps the most restrictive laws in the country. Nurse practitioners don’t want to perform brain surgery. They just want to provide primary care and are quick to refer cases to a doctor when necessary.

Most states with far less need do not legislate practice barriers to nurse practitioners. Given the severity of our problem, shouldn’t we at least bring ourselves in line with those other states? Read the rest of this entry ?

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Remembering the Big Picture, Hypothermia, Nursing Books of the Year

January 20, 2012

From its earliest beginnings, nursing has embraced a holistic view of health. What we eat, the environments in which we work and live, our social relationships—all these influence health. Yet, as nurses, many of us shy away from looking at the big picture; instead we narrow our focus, addressing only the immediate problems of this patient, this family. It’s true that many patients treated in hospitals or outpatient clinics are there only for a short time. But how will such patients and their families fare in the long run if they lack access to public transportation to get to their follow-up appointments? How can patients recover from illness when they must choose between paying the mortgage and filling prescriptions?

That’s an excerpt from “Voices Rising,” the editorial in the January issue of AJN by Shawn Kennedy, editor-in-chief. We hope you’ll take a moment to read the whole thing and give it some thought.

Also in the January issue, you’ll find plenty of reading suggestions in the AJN 2011 Book of the Year Awards; a CE on the causes, diagnosis, and management of hypothermia; and a great deal more, including a feature, “Cardiac Catheterization Through the Radial Artery,” that advocates the use of the transradial artery rather than the femoral artery for cardiac catheterization in certain situations.—JM, senior editor

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Poll: What Can We Actually Do About Hospital Room Noise?

January 17, 2012
By ArtsieApsie, via Flickr

Fierce Healthcare reports this week on the latest findings about hospital room noise: ”hospital rooms can be as noisy as chainsaws, according to a new study [subscription required] published this week in the Archives of Internal Medicine….The average noise level in patient rooms was close to 50 decibels….The noise disruptions mostly come from staff conversation, roommates, alarms, intercoms and pagers….Loud hospital rooms are associated with clinically significant sleep loss among patients and even may hinder recovery.”

So, nurses (and patients, MDs, others): can anything be done about this? Does your hospital do anything? Take our poll, and also of course feel free to leave a comment on this post.—JM, senior editor


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Diabetes Plus Marijuana Plus Medical Errors Minus Nursing Blogs

January 12, 2012

What’s new in health care news this week?

Diabetes everywhere. There’s an entire Health Affairs issue devoted to the topic of “Confronting the Growing Diabetes Crisis.” It looks at many interrelated issues, such as the personal financial burden of having diabetes over the course of a lifetime, whether it’s best to put scarce health care resources into focusing on prevention or treatment, models for community-based lifestyle programs for those with type 2 diabetes, the positive effects of the Affordable Care Act on giving those with diabetes access to affordable health insurance and crucial care, genetic factors related to type 2 diabetes, and a great deal more. Inevitably, many of the articles focus on type 2 diabetes, which is so closely linked to America’s obesity epidemic.

by Jorge Barrios, via Wikimedia

Joint studies. The New York Times reported this week on a large government study showing that, whatever one believes about marijuana’s psychological effects or the efficacy of its various medical uses, long-term marijuana smoking—at least one joint per day, every day of the year—does not impair lung function or contribute to the development of COPD. Will this change anyone’s mind about whether this drug is evil, a panacea for all ills, or somewhere in between? Probably not.

Unreported harm. The Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services issued a report last week stating that only 14% of medical errors and other events that harm Medicare patients were reported by hospital employees. The report calls for improving reporting systems and the creation of a list of ”potentially reportable events.” According to the New York Times story on the topic, adverse events that have gone unreported include ”medication errors, severe bedsores, infections that patients acquire in hospitals, delirium resulting from overuse of painkillers and excessive bleeding linked to improper use of blood thinners.”

Which leads us (or does it?) into nursing blogs. Many of the ones in our blogroll have been pretty silent in the past few months, or longer, and it’s not clear why. Some bloggers are taking a break, some have burned out or decided to use their time for other things (like going back to school), some have simply decided to spend more time on Facebook or sharing their thoughts by ’microblogging’ on Twitter (or are simply playing lots of Words With Friends on their smartphones). There are almost certainly many interesting new nursing blogs we don’t yet know about that are taking their places. If you know about them, please let us know. We need to take some time and do some digging. And we plan on doing a serious revision of the blogroll in the next few weeks.—JM, senior editor  

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Health Technology Hazards: Top 10 for 2012

January 5, 2012

Photo by Jasleen Kaur, via Flickr

Advances in health technology can save patients’ lives, but can also cause harm, as the recent Ecri Institute report, Top 10 Technology Hazards for 2012, reminds us. Here’s a snapshot of the hazards nurses should be focusing on, and some suggestions they give on how to prevent them.

1. Alarm hazards
The risk: With nurses being constantly bombarded by bells, it’s easy to see how alarm fatigue can set in, leading to desensitization, nurses being unable to distinguish the urgency level of alarms, and improper alarm adjusting.

Some suggestions: According to the report, a facility should look at the big picture, examining the entire alarm environment when setting up an alarm-management system. Alarm notification and response protocols should be developed to ensure that each alarm will be recognized, that the appropriate caregiver will be notified, and that the alarm will be promptly addressed. Policies should also be established to control alarm silencing, modification, and disabling.

2. Radiation exposure
The risk: High levels of radiation used during radiation therapy can cause serious harm if errors occur, including damage to normal tissue and organs. And despite radiation levels being lower in diagnostic settings, the increasing number of patients undergoing diagnostic radiography may reveal more risks in the future.

Some suggestions
: The report suggests that adequate staffing levels may be a place to start. For radiation therapy, standard checklists should be developed for each step of patient treatment, and standard patient treatment procedures should be documented and followed. For CT scanning, radiation doses used should be as low as reasonably achievable while maintaining acceptable image quality.

3. Medication errors using infusion pumps
The risk: Mistakes such as mistyping data or entering it into the wrong field can have major adverse effects, including death. The use of “smart” pumps has helped, but preventable errors—such as misprogramming—can still occur.

Some suggestions: The report suggests hospitals should develop appropriate drug libraries for clinical areas that use infusion pumps, with standardized concentrations of drugs and solutions. Facilities should also get “buy-in” from staff members who will be using the system before and during purchasing of the system. Infusion pump technology safeguards should be emphasized, and noncompliance with safety systems should be addressed immediately. For more on smart pumps, read the CE feature “Increasing the Use of ‘Smart’ Pump Drug Libraries by Nurses: A Continuous Quality Improvement Project,” in AJN’s January issue (link pending in next day).

4. Needlestick and other sharps injuries
The risk: Exposure to bloodborne pathogens such as hepatitis B virus, hepatitis C virus, and HIV.

Some suggestions: Facilities are recommended to assess injuries and current practices to determine where and when these injuries occur most often. Using the data, an action plan should be developed and implemented. Some aspects of the plan could be ensuring adequate training of personnel and obtaining supplier support for in-service training on the use of protective devices. Read the rest of this entry ?

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On Protocols, Shortcuts, and the Unforgettable Smell of Ether

November 9, 2011

By Linda Johanson, EdD, RN, associate professor of nursing at Appalachian State University, Boone, NC

In nursing school my professors warned us of the dangers of taking shortcuts when performing procedures. They cautioned that deviations from protocols could lead to serious error. I had to learn this lesson the hard way, and although it’s been about 30 years since I made this mistake, I still remember the occasion like it happened yesterday.

The patient was in ICU bed #10, a glassed-in isolation room across from the nursing station. He was in his mid-60s, but he was mentally handicapped, so he appeared and acted younger. He was in the unit recovering from a respiratory arrest, and on the day I was caring for him he was still intubated, but breathing spontaneously.

by james bowe, via flickr

I was completing an assessment on him when the charge nurse called to me from the nursing station, and I stuck my head out the door to see what she wanted. She told me there was a new order to remove the patient’s indwelling urinary catheter. I checked my pockets for a 10 mL syringe to perform the procedure but didn’t find one.

When I complained about having to go all the way to the supply room to collect one, the charge nurse queried, “Well, you have scissors, don’t you? You can just cut the catheter with them. The balloon will deflate, and it will pull right out. I’ve done it a hundred times.”

Cut the catheter? I had never heard of that before, but I was a relatively new nurse, so I hadn’t been exposed to a lot of things yet. Of course I had scissors right in my pocket, and I got them out. Was this an example of one of those unacceptable shortcuts we’d been warned about in nursing school? It would sure be quicker and easier than running all the way to the supply room.

I approached the patient, who although unable to comprehend what was happening, seemed to regard me with a trusting expression. I exposed the catheter and opened my scissors to a spot about one inch from its point of entry. I hesitated for one brief second, then snipped the tube. I gave the catheter a little tug, and the patient winced. The tube stayed firmly in place, the balloon obviously fully inflated. Read the rest of this entry ?

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Changes in Latitude: Comparing Health Care Systems with Nurses Down Under

October 26, 2011

By Peggy McDaniel, BSN, RN, who writes the occasional post for this blog and currently works as a clinical liaison support manager of infusion in Australia, New Zealand, and Asia Pacific.

latitude lines/ wikimedia commons

I recently found myself sitting on a boat, enjoying a “sausage sizzle,” dressed as a pirate no less. In Australia, a party that includes barbecued meat usually includes sausage; thus the name. The pirate theme was an added bonus. As an American and a nurse, I was pleasantly surprised to find myself seated at the same table as two Australian nurses. What were the chances of that? The conversation that evening gave me some insight into the Australian health care system, which I am just getting familiar with.

Comparing health care systems. Once we all realized we were experienced nurses and shared the belief that quality patient care should always be the primary focus of health care, the conversation turned to cost. In Australia, there is a public health option that all Australians can access. It is paid for by taxes. If you choose to do so, you can also purchase a private plan to supplement this public option. I have yet to determine what part, if any, employers play in paying for health care or private insurance. However, a sick Australian will always get care and not incur a lifetime of debt for that care within their public health care system.

My fellow nurses were amazed to hear that in the U.S., you may not have health insurance for a variety of reasons. One of the nurses purchases private insurance as a “backup” to public care. She used this coverage for an elective procedure, chose her own surgeon and private hospital, and was able to schedule the procedure in a timely manner. This same nurse admitted that if you need a new hip or knee and you only have public coverage, you may have to wait for up to a year. However, if you have cancer and need treatment, it will start promptly after diagnosis, whether or not you have private insurance or not.

Both nurses asserted that the care for acute and emergent issues is of high quality in the public hospitals. They were able to give me examples of how the system works, from a personal and work perspective.

As in the U.S., hospitals here in Australia are struggling with the rising costs of health care. The public hospitals in each state utilize their group buying power to purchase supplies and equipment, which helps keep costs down. The private hospitals often have a bit more polish and shine, but all the hospitals strive to give Australians high quality care and the nurses I’ve met are passionate about that goal.

Imitate the American system? One of the nurses I chatted with exclaimed, “Our politicians keep telling us that we should be more like the American system, but I think that’s a mistake. What do you think?” Admittedly, I have much to learn about Australian health care, but so far I have to agree with her. As an American who has gone without health insurance because I was rejected due to preexisting conditions and was not employed full-time, I thought this system sounded pretty reasonable. The Australian nurses certainly felt that anything less would be unacceptable. Read the rest of this entry ?

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Domestic Violence Screening Matters

October 12, 2011

By Karen Roush, MS, RN, FNP-C, clinical managing editor

I am a nurse. I am a doctoral candidate and a writer. I am a domestic violence survivor. I lived for years with fear and uncertainty—will this be a good day, a day of laughter and affection? Or a brutal day of fists and humiliation? Like many women experiencing domestic violence, I hid it from my family and friends. In fact, I even hid it from myself. I couldn’t see myself as a battered woman, wouldn’t accept that I was that kind of person. But domestic violence doesn’t happen to a certain kind of woman—it happens to anyone, rich or poor, college educated or high school dropout, urban and rural, of every ethnicity. We—you and I—all are the faces of domestic violence.

Just ask. October is National Domestic Violence Awareness Month. How many of your patients have you asked about domestic violence this month? Or any month? Twenty? Ten? None? Screening matters. One of every four women you see has experienced domestic violence. Research tells us that women will talk about it when asked by a provider that they feel cares and can be trusted. They will leave an abusive situation when they feel supported and resources are available to them. Read the rest of this entry ?

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What One Thing Will Make Today Better for You?

September 12, 2011

As I entered Mr. Ricker’s room, I remembered that the night nurse had mentioned that his wife had been with him overnight. I knocked very lightly and opened the door a crack. The two of them were cuddled up closely in the bed.

“What One Thing Will Make Today Better for You?” That’s the title of the Reflections essay in the September issue of AJN, in case you thought a genie had materialized out of the steam from your afternoon coffee mug. A simple question, but one that author Susan Goff has used since the 1970s with her patients. Sometimes the answer is surprising—that is, sometimes we shouldn’t assume we know what patients want . . . or need. Sometimes, in the case of the patient she describes in this essay, there’s something that should trump NPO. We hope you’ll read the essay and let Susan know your thoughts in our comments section below.—JM, senior editor


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