Friday, April 29, 2005

Get the "GYST" of things

I have just finished the first semester of Nurse Practitioner school by the skin of my teeth. I am so glad to be finished with Statistics (until Research class). I don't do well with mathematics, which is one reason why I never became a doctor.

Recently, I attended a meeting at our hospital and one of the discussions was "preparing yourself to call a doctor on the telephone.." (A dreaded thing to most nurses.) I have had varying successes in this endeavor. The obvious problem is calling unprepared with all of the important information in front of you. Nothing is worse than being called from a patient's room in the office to try and give orders to an unprepared nurse. So, I decided to try and come up with a plan for new nurses and some veterans in order to ease this tension...

Ask a veteran nurse (after explaining the details of the problem) whether or not it's worth a call to the doctor. Use other's expertise!!! Often, we have already seen this problem many times before and can tell you what to do first.

Try my new acrynoym.. GYST (pronounced jist... which stands for "Get Your Shit Together... this of course means... a current set of vitals, the chart, a list of current medications, exact symptoms, etc... Nothing is more irritating to a health professional than getting called out of a room to try and answer a question about a patient with little or no pertinent information. Being called out multiple times is some of what increases your wait time in the waiting room.

According the studies, they say you have about 7 seconds to hold a person's attention, which means about 5 for medical professionals. We have very short attention spans and rarely tolerate wasted time. This is due to having to juggle several physical and mental tasks at one time.

I have been hung up on numerous times as a nurse. This is extremely rude by the doctor. My solution is to call them right back and say "I know we must have been disconnected because I know that you didn't deliberately hang up on me.." This often jolts some professionalism back into play.. If not, I let it roll off my back. I don’t take things personally unless a doctor deliberately makes a personal attack.

To sum things up; please make sure that you are prepared when calling health professionals. It makes things easier all around. It also helps keep our standards of professionalism higher in the doctor’s eyes. It’s hard enough out here to care for patients with the workload without the battles between the caregivers..

Carry on troops!!!

Tuesday, April 26, 2005

Nursing Philosophy (A work in progress)

.Nursing Philosophy (A work in progress)

I believe that people truly want to be healthy. They will attempt to adhere to treatment suggestions as long as they feel in control of their healthcare decisions. Through our sphere of influence, we have many opportunities to enhance the health of our patients. This can be used for the good of our profession or for the detriment of it. Polls have placed nursing in one of the highest levels of trust. Our actions can help influence others to be healthy or can make them doubt our knowledge base. This includes physicians and others in our field that we come into contact with. We must act in a professional manner and conduct ourselves accordingly in order to maintain this high level of influence. We must not abuse these levels of trust. In order to do this, practitioners must gain the respect of their patients by treating them as individuals and not just a disease process. Nursing involves taking care of the whole person. A competent nurse understands that individuals are made up of several different components. These physical, spiritual, environmental, social and economic factors are what make the entire patient. Nurses cannot treat one part of the patient without affecting the rest of the balance. In order to be effective practitioners, we must be proficient in all domains of nursing.

According to Stanley (2005), in Benner’s theory there are seven domains of nursing practice that must be utilized between the novice to expert transition of nursing:

1. The helping role

2. The teaching-coaching function

3. The diagnostic and patient-monitoring function

4. The effective management of rapidly changing situations

5. The administration and monitoring of therapeutic interventions and

regimens

6. The monitoring and assuring of quality of health care practices

7. The implementation of organizational and work-role competencies

These core domains are critical in maintaining the health of our patients. Nurses must understand that these different functions are used in several ways throughout the patient/caregiver interaction. We need to use every opportunity to educate ourselves and stay up to date regarding practice techniques and modalities. By doing so, we monitor the quality of healthcare practices and can effect what works in our fields of practice. Through collaboration with others in the healthcare field, we can optimize patient outcomes. Nurses often must juggle the ability to mix the helping, caring and teaching components with the diagnostic and therapeutic interventions involved with medical practice effectively, while monitoring situations in an acute setting. Nurses must have an innate ability to multitask or they will not be effective in patient care.

Nurses must also treat each other with respect and dignity. We are often accused of “eating our young”. New nurses are very impressionable and will choose role models from the first few areas of practice that they are in. They practice what they see. Nurses must be aware of the appearance they project to others. If they are obviously in the profession for the money, patients and other nurses can tell. We must value each other’s knowledge and learn from each other. Nurses are also known to attempt to “block progression” of other nurses in response to their own feelings of jealousy, inadequacy and stagnation. If a nurse feels comfortable in whatever level he or she is in, that is fine. We should be able to continue to enlarge our knowledge base and continue forward if we choose. Nursing is a valued profession that should have high goals and expectations. We must encourage advanced education in order to maintain the legitimacy of the profession. My priority is to continue to enlarge my own knowledge base and continue my education toward becoming an advanced practice nurse. I will continue to be a good role model to other nurses and will present myself as a professional nurse.

Wednesday, April 20, 2005

Fibromyalgia information

Fibromyalgia is a condition characterized by aching and pain in muscles, tendons and joints all over the body, but especially along the spine. The body also is tender to touch in specific areas-called tender or trigger points.
Fibromyalgia is not associated with muscle, nerve or joint injury; inadequate muscle repair; or any serious bodily damage or disease. Also, people who have fibromyalgia are not at greater risk for any other musculoskeletal disease.
Q
What causes fibromyalgia?
A
Researchers have not been able to pinpoint one identifiable cause for fibromyalgia, but there are many theories. One theory suggests that stress contributes to the onset of fibromyalgia. Other possible causes are:
  • Disordered sleep patterns, which can lead to fatigue and a lower pain tolerance
  • Abnormal production of pain-related chemicals in the nervous system
  • Low levels of growth hormone in the body
Q
What are the symptoms of fibromyalgia?

Bodily pain is the primary symptom of fibromyalgia. Although the pain of fibromyalgia can be felt all over the body, there usually are certain areas of the body that are tender even to light touch. In addition, the pain is usually worse when a person is trying to relax and is less noticeable during busy activities or exercise.

Other symptoms often are associated with the pain, including:
  • Sleep disturbance
  • Depression
  • Daytime tiredness
  • Headaches
  • Alternating diarrhea and constipation
  • Numbness and tingling in the hands and feet
  • Feelings of weakness
  • Memory difficulties
  • Dizziness
Stress often makes the symptoms of fibromyalgia worse.

Q
Who gets fibromyalgia?
A
Women are affected by fibromyalgia much more commonly than are men. People typically first develop symptoms in their 20s or 30s. In the U.S., about 5 million people, or 2% of the population, have fibromyalgia.
Q
How is fibromyalgia diagnosed?
A
The diagnosis of fibromyalgia is based on the results of a combination of tests and symptoms, including:
Complete medical history and physical exam (to exclude other illnesses that may have similar symptoms such as rheumatoid arthritis, muscle inflammation, bursitis or tendonitis )
  • Presence of widespread pain together with some of the other symptoms of fibromyalgia
  • Presence of very tender areas ("tender/trigger points") at specific locations (People who have fibromyalgia experience abnormal sensitivity when light pressure is applied to 18 specific areas on the body.)
Q
How is fibromyalgia treated?
A
People with fibromyalgia receive individual treatment based on several factors, including their overall health, medical history, number of tender points, severity of pain and presence of other symptoms. Treatment for fibromyalgia includes:
  • Medications that decrease pain and improve sleep (see below)
  • Lifestyle changes, including stress reduction
  • Exercise to improve heart and lung health, flexibility, and strength
  • Relaxation techniques to relieve muscle tension
Q
What medications are used to treat fibromyalgia?

A
Medications that increase restful sleep may help. These include low doses of antidepressant medication taken before bedtime. Other kinds of sleeping pills are not very helpful for people who have fibromyalgia.

Nonsteroidal anti-inflammatory drugs (NSAIDs) -- including ibuprofen and naproxen -- may help decrease pain, but should be used long-term only under the care of a doctor. These drugs have many side effects, such as stomach upset and fluid retention. They also may interact unfavorably with other drugs, such as medications for high blood pressure. Tylenol (acetaminophen) may be helpful, and it is easier on the stomach and less likely to cause drug interactions.

Steroids (such as prednisone) used to treat other rheumatic conditions have been tested in people with fibromyalgia and did not appear to improve symptoms. However, a steroid injection directly into a muscle spasm may sometimes be used when other treatments have failed.

Q
What exercises should people with fibromyalgia consider?
A
Participating in aerobic exercise for 30 minutes three times each week is an important step to improve fibromyalgia symptoms. Exercise increases heart and lung function and stretches tight, sore muscles. Brisk walking, biking, swimming and water aerobics are good activities to choose when starting your exercise program. Your doctor can help you choose an exercise program that is right for you.

Q
What are some techniques I can use to reduce stress and relax?
A
Evaluating the causes of stress and learning new ways to handle or cope with stress should help improve fibromyalgia. Relaxation exercises can help you cope with stress.
Q
What is the long-term outlook for people with fibromyalgia?
A
Although fibromyalgia is not caused by stress, stress can make symptoms much worse. Occasionally, if the situations that caused the initial stress are resolved, fibromyalgia may spontaneously improve and medications may not be necessary.

Many people with fibromyalgia will continue to have symptoms despite treatment, especially when life is stressful. However, medications that can alter the balance of pain-producing chemicals, such as anti-depressant drugs, should improve symptoms.

When other forms of treatment, such as acetaminophen (Tylenol) and aerobic exercise, are combined to treat fibromyalgia, even more improvement can be expected.

Those who are able to continue working and fulfilling their social obligations, despite their pain, end up doing best.


For a complete guide to fibromyalgia for your patient visit WebMD Health Reviewed by the doctors at The Cleveland Clinic Department of Rheumatic and Immunologic Diseases. Edited by Michael W. Smith, MD, Sept. 2003. Copyright © 2004, The Cleveland Clinic.

Monday, April 18, 2005

Just The Nurse (spankysplace.blog-city.com)

When I saw this post at spankysplace, I just had to post it on my site so that everyone possible could read it.. Thanks for letting me pass on your work!!

Just The Nurse (spankysplace.blog-city.com): "Just the nurse.

An oft used term mimicked, pronounced with derision and scorn, mockingly sounded by patients, doctors, allied staff and nurses themselves. Just the nurse. I hear it echoing in hallways, elevators, offices, and hospital cafeterias. Just the nurse. But I also hear it in other situations and know that nurses repeat it to themselves many times in the course of their career.

Will you adjust my pillow the patient asks? Sure, the nurse responds as he adjusts the pillow, because I am "just the nurse."

Will you get me some pain pills the patient asks? Sure the nurse responds, and then proceeds to examine the patient’s condition for signs of stress and pain. He asks many questions to make sure he understands what is hurting and if something new has gone wrong. Vital signs are taken to further evaluate what might be wrong. Satisfied that the patient’s pain is with in normal considerations for the condition the nurse gets the pain pill. He checks the names and expiration date of the medication. He checks the order to make sure it really has been ordered for this patient. He checks the dose and route of the medication. He goes back and checks the patients name against the ID band. He asks again if the patient is allergic to anything. He helps the patient sit up to take the pills and settles the patient back into a comfortable position. He returns in twenty minutes to check for adverse reactions because he knows every medication can cause adverse reactions. With over eight thousand medications he tries to learn the major classes of medications and the major adverse reactions of each class. Satisfied the patient is ok he leaves to let the patient rest. Forty minutes later he again checks on the patient to see if the patient’s pain is diminished and to again check for allergic reactions. Finally he leaves the patient to rest, because he is, "just the nurse."

He holds a cool cloth to the head of a patient while they vomit into a basin. He adjusts the weights of a patient in traction to allow for better treatment. He cleans the pins protruding from the patient’s legs where the traction is attached. He brings meals to the patient and removes soiled waste pans from the bedside. He assesses his patients for blood clots, fevers, coughs. He changes bandages and cleanses wounds. He checks IV sites, catheters for urine and heart monitors, arterial blood pressures, cardiac output, and even brain pressure. He does this because he is, "just the nurse."

He monitors the patients breathing tube and ventilator settings, skin for pressure sores, feet for foot drop or blood clots or loss of circulation, urine for infection, chest for pneumonia, surgical wounds for infection, chest tubes for air leaks, lungs for collapse, heart for fatal rhythms, wound vacs for proper seal and wound healing, ABG’ for proper oxygenation of the blood, abdomen for pain or loss of motility. He does this because he is, "just the nurse."

He explains to family how all the machines work. He translates doctoreze into plain language the family can understand. He helps them fill out forms, find the bathrooms, find the cafeteria, the lounge, a hotel, a restaurant, a phone to make long distance calls, a pastor. He holds them in his arms and allows them to cry on his shoulder during the worst moments of their lives. He does this because he is, "just the nurse."

She holds neonate babies in her arms while they fight to survive after being born half formed. She monitors the jet oscillators, the IV, the catheters for heart and kidneys. She wraps them in saran wrap to protect them from hypothermia. She calculates and measures infinitesimal amounts of life saving drugs and administers them to her tiny charges. She places her hands on the baby to impart a human touch to another living soul, knowing that mom will never return and and that baby will never survive because of the abuse suffered under mother’s management. She does this because she is,"just the nurse."

She pumps on the chest of a patient needing cardiopulmonary resuscitation, changes with another nurse so she can administer life saving drugs, monitors the patient’s heartbeat, draws arterial blood gases and then bags the patient while the respiratory tech runs the ABG machine. Lets the RT bag again while she draws blood to check patient chemistries. Monitors the patient’s heart, ventilator, life while transporting the patient to another hospital for life saving surgery. Gives blood and medication in route to the other hospital to keep the patient alive. She does this because she is, "just the nurse."

She makes a game of changing the child’s sheets while smiling and providing comfort care to a child with cancer. She buys the kids funny hats to help ease the pain of loosing all their hair. She sedates her patients and monitors their breathing and vital signs while the doctors perform painful tests on her small helpless patients. She holds them when they become scared and frightened as people come at them with needles. She finds their favorite foods, provides game cubes and play stations to ease the boredom all between administrating toxic concoctions to stave off cancers deadly march. She explains to mothers and fathers the intricacies of the disease process. She repeats this to aunts, uncles, and grandparents. She sits with brothers and sisters and explains in children’s language what is happening, without trying to frighten them. She provides literature to the parents in Spanish, English, Romanian, German, Japanese and a host of other languages. She does this because she is, "just the nurse."

"She makes sure the patient is who he says he is and makes sure which surgery he is there for. She helps him fill out the papers, mark the correct extremity for the procedure, start the IV, explain the procedure, transfer the patient to and from the surgery table. Monitors the doctor to make sure he has everything he needs, runs to get drugs, instruments, blood, suture, sponges, other doctors to assist. She keeps count of every thing that enters or leaves the operating room. She sends surgical samples to the lab, holds the phone to the doctor’s ear so the pathologist can tell the doctor if the tissue is cancerous or not. She recovers the patient, gets them through waking up, shaking, vomiting, breathing treatments, heart monitors, and teaching for going home or admission. She sits with the family while the doctor explains that nothing can be done. She stays with the family to answer questions after the doctor leaves. She holds hands, hugs, gives hope and sometimes cries with her patients. She does this because she is, "just the nurse."

He speaks to the young wife of the 26 year old male nurse who is unresponsive and has a flat EEG after a medical error. The young wife, also a nurse, has to make the decision to remove life support after a massive medical error has left him brain dead. He helps the young wife fill out the papers for organ donation and leads the young wife to the bedside. He watches as she says good-bye to her young husband. After a time the young wife says she is ready. He turns off the ventilator, removes the tube from the endotracheal tube, and holds the young wife in his arms as she watches her husband. He does not breathe, he is dead. He turns the ventilator back on and leads her back to the lounge. He feels crushed inside. He does this because he is,"just the nurse."

He speaks quietly to his 96 year old patient whose every friend and family member she ever knew has already died. Whose home is gone and whose life is coming to an end. He shuts out the din and chaos of the ER and asks the patient if she is ready to die. He holds her hand and prays with her as the spirit of the Lord carries her to eternal rest. He does this because he is, "just the nurse."

If this is what being "just a nurse" is all about, then I want to be "just a nurse" my whole life!!
Keep up the great works out there!!!

Monday, April 11, 2005

Many Patients Prefer Nurses to Doctors

Many Patients Prefer Nurses to Doctors: "Many Patients Prefer Nurses to Doctors

By Daniel DeNoon
WebMD Feature Reviewed By Gary Vogin, MD

April 4, 2002 -- If you see a nurse practitioner instead of a doctor, will you get proper care? Yes, a British study says -- and odds are you'll like it better.

Since the days of Florence Nightingale, there's been a debate over what a nurse should be. Trained nurse practitioners offer primary care. And that care appears to be just as good as what doctors can provide, according to an article in the April 6 issue of the British Medical Journal.

University of Bristol researchers reviewed all published studies comparing the primary care offered by nurse practitioners to that of doctors. The findings are remarkably consistent. Nurses spent more time with patients. Nurses conducted more tests. Patients did no better or worse when they saw a nurse instead of a doctor -- but they were more satisfied with their care.

'For those kinds of patients in the study -- those wishing same-day medical care -- nurse practitioners provide a very good standard of care,' study leader Chris Salisbury, MD, tells WebMD. 'I wouldn't want people to read too much into that and think they can completely replace doctors with nurses. Complicated psychological problems, longstanding illnesses, multiple drug treatments -- there are many things that require a doctor's training.'

Jan Towers, PhD, isn't surprised by the findings. A certified nurse practitioner and director of health policy for the American Academy of Nurse Practitioners, Towers notes that certification as a nurse practitioner requires six years of medical training.

'Nurses are taught to take good, complete patient histories,' Towers tells WebMD. 'Eighty-five percent of any diagnosis is getting a good history. Nurses are taught to do that comprehensively. And as for patients liking nurses better -- well, we do a lot of patient education and spend a lot of time ex"

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