What do you know about cyanosis of the hands and feet of the normal newborn?
Monday, December 31, 2012
Monday, August 6, 2012
Another great episode of Insights in Nursing!
Great discussion on the future of nursing, how staffing patterns impact patient outcomes and mobile technology in patient care!
http://insightsinnursing.com/
Enjoy!
http://insightsinnursing.com/
Enjoy!
Monday, July 9, 2012
History taking getting too personal?
Whether or not you support the constitutional right to bear arms and what you believe the right to free speech covers, there is a definitely a controversy brewing in Florida over the "Gag Law." A recent ruling states that Florida "cannot enforce a law that prohibits physicians from asking patients whether they own a gun because it infringes on their First Amendment right to free speech." The National Rifle
Association (NRA) helped lobby for the law believing the second amendment was at risk and stating that the information obtained by healthcare providers would go into individuals' permanent health records. Physician groups argue they are trying to protect children and that assessing whether there is a gun in the home is necessary to provide education on gun safety, similar to bike and car safety. Other groups disagree. But what about adult patients?
The question then becomes what information is necessary for healthcare providers? How is some of this and other social information used in relation to patients' overall health care? Some argue that some information should not be kept in their permanent medical record and do not understand the relevance.
Would it be appropriate to assess a person with profound depression risk for suicide? Part of that assessment would include assessing for a plan, access to methods and ability to carry it out. How about a patient that has substance abuse issues - is it appropriate to ask about the use of drugs and alcohol? Sexual orientation, partners? You get the point...
As an ACNP I understand the concept of history taking but I also understand the need for being respectful of sensitive information. Of course many patient's do not share everything with healthcare providers out of fear, or stereotyping or some sort of recourse. Will this situation in Florida have the effect they are looking for - preventing unintentional firearm accidents? I'm not sure. But I do know that constitutional rights are polarizing topics and it seems that most sit on one side or the other. Regardless of your personal beliefs on firearms or free speech, when it comes to caring for patients, the patient must remain central in order to be a true advocate.
Tuesday, July 3, 2012
Taking care of everyone but ourselves
Nurses, physicians, respiratory therapists, paramedics and others, on the other hand are all aware of the consequences of poor health such as obesity and chronic hypertension. Yet, there are many healthcare providers and workers that are in extremely poor health, smoke, are very obese. How many of us work with colleagues that can not respond to code situations quickly and you find you are the only that can actually run to the bedside? Everyday tasks are fraught with shortness of breath, fatigue, painful joints and other ailments during the long 12-hour shifts or longer. Add to that lack of sleep and stress of the shift (see Burning Out: Combating compassion fatigue & moral distress) and nurses and other care providers are set up for health problems. Unfortunately, nurses are not necessarily good at caring for themselves on daily basis. I am talking daily renewal and refreshing your body and mind - taking time to clear your head and let go of the stress of the shift. Celebrate the saves and mourn the losses. When it comes to preventive health and wellness, we tend to care for those around us and put ourselves last; waiting to the last minute or too long to seek care. But I regress....
If you walked into my old unit almost any day of the week, you would find some sort of processed, junk food in the lounge. I myself have an insatiable sweet-tooth and am known for always having a chocolate stash! But I am also not obese, not even overweight - not even close. I am a vegetarian and I rarely sit still and I drive my family crazy about being healthy because I don't want any of us to suffer from the diseases I treat patients for. My point is this...you never see a plate of veggies and fruit in the nursing unit lounges. When was the last time you saw a big bowl of hummus and cucumbers? You may see salsa, but with corn chips and out of jar! Cookies, brownies, candy, chips and more. Even the cafeterias struggle to cook healthy options. And firehouses...they definitely like their bacon and sausage in the morning and meat and potatoes in the evening! (No disrespect to all my paramedic and firefighter friends!)
On a serious note, it disturbs me that we as educated professionals are teaching and preaching to patients and their families how to stay healthy and prevent further admissions by "reducing dietary sodium," "smoking cessation," "cutting back on alcohol consumption," "increasing fruits and vegetables while reducing sweets and fats," yet the collective we is just as unhealthy as they are. What message are we sending our patients? One news media article cited that 55% of nurses are obese. It is clear we are not following our own advice. Again, what does that do to our credibility? How can we take better care of ourselves and be better role models for our patients?
With healthcare at the forefront of discussion in the media and a focus on prevention and reducing costs, it is important that we are do our part to care for ourselves and each other.
I encourage you go to the Nurses Health Study link. The partners have been studying the health of nurses since 1976 and currently recruiting nurses for their third study.
The Nurses Health Study
Sunday, June 10, 2012
Burning out: Combating compassion fatigue & moral distress
Compassion fatigue is defined as a loss of compassion and caring over time. It is a condition that is hallmarked by emotional, physical and spiritual exhaustion that occurs from caring for and internalizing the suffering of others. Compassion fatigue is also referred to as secondary post-traumatic stress disorder. Nurses have a propensity to carry on the burdens and problems of others - their patients, coworkers, families, and friends which may leave them exhausted and feeling empty. (I recommend reading Bertice Berry's Blog, especially Day 145: Seeing Miracles)
Moral distress is another term often used related to burn out, however often there is an ethical component or dilemma associated. Nurses frequently find themselves in the middle of conflicts involving patient care issues, especially related to end-of-life or futility of care. This produces a great deal of stress for the nurse whom often has no outlet.
We have all seen it - burned out coworkers call out more, are late to work, have no interest in most of what they do, chronic fatigue, decreased productivity, high turnover, workplace injuries, reduced satisfaction in work and home, and even more patient complaints. Not to mention patient safety events; if our head is not in the game so to speak how can we be sure we are not going to make a serious error or failure to rescue or prevent harm to a patient.
There are many reasons that nurses become burned out with their jobs. High patient acuity, staffing issues, conflicting values and expectations for time between work and other life responsibilities and difficult or devastating patient situations.We talk about it. We say, "Oh, I'm so burned out, I just don't care anymore." Yet we do little to nothing about it. At work we barely support each other; often because we are so busy ourselves and consumed with our own tasks and crises. Helping and supporting each other through difficult situations and even the everyday ones has to be a priority. It is wearing us out and creating an undercurrent of distress and hostility and resentment. Having formal systems in place to help us deal with difficult emotions is important not only for the staff member involved but all other staff, and more importantly for the patient.
At home we do even less. We set no priorities of care for ourselves. Do not allow ourselves to grieve a loss at work or at home. We do not give ourselves permission to really care for ourselves in a healthy way - sleep and eat well, exercise, rest and relax, read a good book, play and so on.
I have posted some very good resources on moral distress, compassion fatigue and burn out. I strongly encourage you to read them and develop resources in your workplace to combat this insidious foe to our job satisfaction and personal happiness.
Addressing Moral Distress: An Important Step toward a Healthy Work Environment
Six Ways to Deal With Compassion Fatigue and Burnout, Kendra Mims, ENA Connection (Mar 2012)
Monday, May 28, 2012
Safe Practices: Preventing Needlestick Injuries
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| Dr Mary Foley |
I recently had the privilege to learn more about the Safe in Common campaign, an exciting healthcare initiative that is promoting safe work environments free from needlestick injuries from one of the leading health worker safety advocates, Dr. Mary Foley. Below is our interview. Please read and consider taking the pledge for preventing needlestick injuries and creating safe work environments.
(Kelly) What has been your experience with the general "culture" or perception by nurses and other healthcare professionals regarding needlestick safety?
(Dr Foley) In my experience, healthcare workers are focused on patient care. They are aware of needlestick risks, but they keep their worries about occupational injury in the background, so they can focus on giving the best care they can. That presents some danger to healthcare workers. Doctors, nurses, aids, lab technicians, housekeeping, and maintenance personnel are all at risk when sharps devices and delivery systems are not designed for maximum protection.
(Kelly) Can you estimate the cost in lost wages or medical care annually related to needlestick injuries? What is the emotional cost?
(Dr Foley) There is an emotional cost to the ever-present threat of an injury, which is there even if a healthcare worker manages to keep the concerns "controlled", so they can focus on patient care.
When a worker is exposed to a contaminated device, there is an immediate sense of panic, since this could be an infected device. In spite of that fear, or maybe because of it, almost half of all injured workers fail to report their injury—which puts them at risk for no coverage if they become ill.
Injured workers talk about the tension in their personal and family lives as they wait for test results which are conducted over 6 or more months to determine if the worker is infected. Some healthcare personnel are encouraged to take prophylactic medications, some of which are difficult to tolerate.
The preferred future: reduce accidental injuries with better devices, proper training, and a culture of safety.
(Kelly) Can individual nurses make a difference?
(Dr Foley) Individuals can make a difference. Care for the caregivers begins with self care—being as knowledgeable as possible about protecting patients and oneself. But many of the improvements in health care settings will require collective action by policy makers, device makers, occupational health specialists, managers, and staff.
(Kelly) What can we all do to offer our support?
(Dr Foley) The Safe in Common campaign was launched in May, and we already have thousands of pledges of support. Just as importantly, the subject of sharp injury prevention is active again, over 10 years after the passage of the Needlestick Safety and Prevention Act. There have been some improvements in some rates of injuries, but there are still too many occupational injuries from sharps, and now, many of those occur when staff uses "safety" devices. Clearly, the devices in use are not adequately protecting staff, and more work must be done.
Spread the word (thank you for writing about this), share the pledge, advocate for educational content and conference programming that informs and advocates for better protection.
(Kelly) Can you provide any statistics / facts about the frequency and gravity of needlestick injuries?
(Dr Foley) Virtually all healthcare personnel are at risk of harm from occupational exposures such as needlestick injuries. The Center for Disease Control notes that nurses sustain approximately half of all needlestick injuries, while physicians, housekeeping and maintenance staff, technicians, and administrators are also harmed.
The U.S. Occupational Safety and Health Administration (OSHA) estimates 5.6 million workers in the U.S. healthcare industry are at risk of occupational exposure to bloodborne pathogens via needlestick injuries and other sharps-related injuries. OSHA further reports that each year 385,000 needlestick injuries and other sharps-related injuries are sustained by hospital-based healthcare personnel. This equates to an average of around 1,000 sharps injuries per day in U.S. hospitals.
Including other non-acute healthcare facilities, it is estimated that between 600,000-800,000 healthcare personnel incur a needlestick injury each year in the U.S.
Forty percent of injuries occur after use and before disposal of sharp devices, 41% of injuries occur during the use of sharp devices on patients, and 15% of injuries occur during or after disposal.
(Kelly) How did you get involved advocating for needlestick safety?
(Dr Foley) As a registered nurse for more than 35 years, I was one of the first healthcare workers to combat the emerging HIV-AIDS epidemic during my work at Saint Francis Memorial Hospital in San Francisco during the 1980s. I played a key role in securing the passage in California of the first state-based laws in the U.S. mandating the use of safety medical devices. Afterwards, I joined other nursing colleagues to campaign for the adoption of the Federal Needlestick Safety and Prevention Act. Elected President of the American Nursing Association (ANA) in 2000, I was in the Oval Office of the White House when President Bill Clinton enacted the Act into law. Since, I have continued to work to improve healthcare policy, including improving the workplace, and promoting safe care for workers and patients nationally and internationally. Given my passion and knowledge of the issues, Safe In Common asked me to lead their Needlestick Safety Advocacy Tour.
(Kelly) What does Safe in Common do to protect healthcare personnel?
(Dr Foley) Safe in Common is a movement of healthcare personnel committed to making their working environment safe from the risk of needlestick injury. With the safest equipment, the best practices and the right culture, we believe all needlestick injuries can be prevented. The non-profit organization was established to enhance and save the lives of U.S. healthcare personnel at risk of harm from needlestick injuries. First established in 2010 as an online community of healthcare professionals and other advocates committed to injection safety, Safe in Common is leading the Needlestick Safety Advocacy Tour across the U.S from March 2012 through March 2013 to engage with healthcare personnel to hear their concerns, raise their hopes and unite them together behind the creation of a workplace environment that is free from the risk of needlestick injury.
The Tour will visit more U.S. hospitals and attend healthcare conferences across the nation during the first stage of the national campaign. At each location, Safe in Common representatives will advocate for needlestick safety, record real stories from healthcare personnel, and provide demonstrations of the latest safety-engineered medical devices that can help to deliver optimal protection to those at risk of harm.
(Kelly) What is the Safe in Common Pledge?
(Dr Foley) The pledge is the cornerstone of the NSAT: http://www.safeincommon.org/needlestick-safety-pledge.
Our goal is to have at least 100,000 healthcare personnel take the pledge as a show of support that more can be done to reduce needlestick injuries. The pledge, which can be taken online or in person wherever SIC is engaging healthcare personnel, says “A safe working environment is essential if I am to effectively serve the needs of my patients. Needlestick and sharps injuries represent one of the most serious threats to occupational safety within my facility.”
The pain and trauma that these injuries inflict upon healthcare personnel, and their loved ones, is unacceptable. The dollars lost each year in the testing and treatment of reported injuries is unacceptable. The continued use of medical equipment that fails to adequately address the safety and functional needs of healthcare workers and their patients is unacceptable.
Thank you Dr Foley for sharing this important topic with my readers. Patient safety causes often take priority over safety initiatives for ourselves. As nurses, other healthcare providers and ancillary services it is imperative to use caution and advocate for safe and healthy work environments.
Please follow the link and take the Safe in Common Pledge!
Please follow the link and take the Safe in Common Pledge!
Saturday, May 26, 2012
NTI 2012: A conference to remember
Not that I could possibly list every detail or even quantify the conference, but some of my personal highlights of the conference include:
- Opening Supersession on Monday - Sticks of Thunder, Mary Stahl, Pioneering Spirit Awards
- Mastery Session on Break the readmission cycle by integrating Pallitiative care with life-saving therapies
- Bertice Berry's Mastery Session - Becoming the highest version yourself
- President-elects new theme - Dare to
- Robin Benincasa Keynote Address
- Interactive lecture utilizing technology and the other amazing sessions
- Networking with AACN board members
- Meeting up with classmates from graduate (CNS) & post-graduate (ACNP) schools
- Nurses Night Out at Sea World
- And so many other incredible moments
Thank you AACN and the numerous sponsors that make NTI possible. Having attended other conferences and professional organizations, NTI is of the highest quality and is very well organized. Not to mention fun!
This conference came for me at a important time as I embark on new path in nursing. Perhaps that is why it resonated so deeply with me. So as the post-conference journey begins how will I take the lessons learned and apply them to my practice, to my self as a leader, a healer, as mother and spouse? I leave you with the challenge Kathryn Roberts did...Dare To
Dare to Dream. Change. Lead. Act.
What do you DARE TO do?
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