Archive for August, 2010

In Which I Bore You with Pictures of More Roses

My ISP was down again today. Took some rose pictures instead, with my Canon and my brand-new-to-me garage-sale tripod. The sun was a little high and a little bright, but still a reasonable effort. [Click on the pics for clearer, better images.]

Rosa ‘Leander’ (Austin)

Rosa ‘Tropicana’ (HT)

(Incidentally, I don’t usually have Hybrid Teas in my rose garden — too much muss, too much fuss — but ‘Tropicana’ looked so tempting in the Loblaws Garden Centre this spring.  I haven’t  been disappointed: it’s bloomed nearly continuously all summer. It was probably worth the 12.99 I paid for it, even if I kill it with benign neglect over the winter.)

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When Hospitals Block Facebook, Laziness Is The Real Issue

Phil Baumann argues that hospitals should seize the Twenty-First Century by the sub-epididymal masses and set free Twitter and Facebook. “Should hospitals block Facebook?” he asks,

That’s not really the question. Here’s the question:

Should hospitals block the 21st Century?

If they can, then that means they have access to technologies which can also probably cure all disease from the face of the earth.

Then they’d be out of business, and we wouldn’t have to fret about their policies over staples of mainstream communication like Facebook and Twitter. :)

And here’s the fiduciary responsibility part: the more comfortable a business is using social media internally, you know what happens? It becomes more proficient in marketing and public relations in our time.

Management is morally obligated to ensure the best care for patients. It’s also legally obligated to do what’s right for Investors.

I don’t disagree with Phil Baumann much about the supposed reasons hospitals block social networking sites: risk management, security and patient privacy are common excuses, and are mostly founded (as Baumann says) on fear and ignorance. But I think the real purpose of hospitals blocking Twitter and Facebook has more to do with control and productivity than risk reduction and confidentiality. Plainly speaking, social networking sites make people lazy.

Let me illustrate. My employer, Acme Regional Health Centre unblocked Facebook  and Twitter from hospital computers for a short time. I won’t exaggerate and say it was an unmitigated disaster, but when you sit down at a nursing station and see every computer terminal opened to Farmville, and the nurses in Resus are tweeting the nurses in Exams, there’s a problem.

The experiment lasted about a month. It failed because it ignored a fundamental fact of human nature: if people are given the choice of doing something amusing and fun, like playing on Facebook, and doing something tedious and boring, like filling in MARs*, amusing and fun will win every time.

And yes, it looks extremely poor if patients and their families catch you fooling with your Facebook photo albums, when you should be getting the bedpan for the 98 year-old in Obs Six.

In the end, health care professionals — I include physicians as well as nurses in this categorization — can’t act, well, professionally with social networking sites. The ideals suggested by Phil Baumann are exciting and visionary. The reality is somewhat more drab and prosaic.

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*Medical Administration Record

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Back in Business; Some New Links

Tachycardia, dizziness, headache, nausea, diaphoresis, that was me  — and yes, the cause was the loss of my connection to the Interwebs, felled by a Jovian bolt of lightning striking my local wireless tower.

Or so they say.

Hmmm.

Anyway, in the interim, in lieu of a real post, I want to draw your attention got some cool new links obtained via Twitter, some (all) of which will end up on the sidebar.

  • New (to me) physician blogger The Examining Room of Dr. Charles, who writes “. . . about medical news, clinical studies, and curious bits of knowledge [and] hope[s] to post a few reflective vignettes and poems.” He’s also holding a poetry competition for all you would-be health care poets. (Thanks to GAMaleRN for pointing me to this link.)

It's shellfish, really

  • Lyall is a somewhat idiosyncratic nurse-photographer/blogger from western Australia, who says “For the most part this tumblelog isn’t a beacon of eruditionhowever occasionally I post serious entries about healthcare and the image of nursing.” The image on the right is from his blog; in case you’re wondering where the urethral meatus is to stick in the catheter, look elsewhere, because it’s an abalone.
  • Way down south (from here, anyway) is a nurse who describes himself a “raging liberal in Southeastern Kentucky, waiting for the day this nation comes to it’s senses” and yes,  EKYProgressive writes some about politics — and nursing, and then more politics. We need more politically conscious nurses, don’t you think?

Anyway, that’s it for me. Off to sit on the porch and formulate more conspiracy theories about my loss of Internet access.

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A Nurse on Dying

A dying nurse’s thoughts on palliative care:

“Dying isn’t just about the physical stuff, it’s about the heart, the spirit. Most patients will tell you that nobody talks to them about the dying process and what to expect. They’re in a place where they feel so alone.

“I go to those dark places with them. I can’t understand what they’re going through — nobody can die for you — but being able to listen to them means somebody cares.”

Chris Sherwood RN is dying from a rapidly advancing form of Parkinson’s. His attitude exemplifies the best of nursing. Go read the article in the Toronto Star.

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Would You Like to Supersize Your Lipitor for 99 Cents?

Tongue firmly in cheek (I think) an article in the American Journal of Cardiology suggests handing out statins* with your favourite megameal: [via Nursing Times]

A team from Imperial College London said that cardiovascular risk associated with the fat content in a 7oz cheeseburger and small sugary milkshake could be cut by giving customers statin pills at the same time.

At less than 5p [8 cents] per pill – the same as a portion of ketchup – the researchers said the plan would be a cheap way of combating the negative health effects of junk food in the same way that smokers are offered filters and drivers must wear seatbelts.

They said: “Routine accessibility of statins in establishments providing unhealthy food might be a rational modern means to offset the cardiovascular risk.

“Fast food outlets already offer free condiments to supplement meals. A free statin-containing accompaniment would offer cardiovascular benefits, opposite to the effects of equally available salt, sugar, and high-fat condiments.”

But that would be the same as, um, admitting that Big Mac combo is actually really bad for you and, what’s more, the synergistically evil combination of Big Pharm and Big Fast Food might be enough to bring about the Apocalypse.

But the marketing possibilities would be endless. . .
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*I.e. drugs which lower cholersterol. Lipitor and Crestor are two examples.

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Florence Nightingale: Images and Words

It may seem a strange principle to enunciate as the very first requirement in a hospital that it should do the sick no harm.

Notes on Nursing 3rd Edition (1863)

How very little can be done under the spirit of fear.

As quoted in The Book of Positive Quotations (2007) by John Cook

Read the rest of this entry »

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What Do Nurses Do, Anyway?

If you’re a nurse, this is probably not going to come as a shock:

Students are in the dark about what a nursing career actually involves, according to a new poll to mark 100 years since the death of Florence Nightingale.

Many 18-year-olds are unaware that a nurse has the authority to give medicines to patients and can have prescribing powers.

The survey of 1,000 students from all academic backgrounds was carried out for the Florence Nightingale School of Nursing and Midwifery at King’s College London.

[snip]

Professor Anne Marie Rafferty, head of the school, said: “It is a worry that many students do not fully understand what a career as a nurse involves. We need to challenge and update the image of nursing to tell it as it is – one of the greatest and most rewarding professions providing one of the most precious services to society – compassionate, high-calibre care delivered by outstanding people.”

It’s a good question, and on the 100th anniversary of Nightingale’s death, probably one worthwhile asking ourselves: what exactly do we nurses do, anyway? What’s the point of nursing? Is it something that can be summarized in 25-words-or-less? How are we different in practice or in theory from the myriad of other health care professionals?

In short, what makes us unique? Or is our uniqueness a myth?

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“Miss Nightingale Dies, Aged Ninety”

An account of the life of Florence Nightingale, published the day after her death on 13 August 1910, one hundred years ago today.

Miss Nightingale Dies, Aged Ninety

By THE NEW YORK TIMES

LONDON, Aug. 14.–Florence Nightingale, the famous nurse of the Crimean war, and the only woman who ever received the Order of Merit, died yesterday afternoon at her London home. Although she had been an invalid for a long time, rarely leaving her room, where she passed the time in a half-recumbent position, and was under the constant care of a physician, her death was somewhat unexpected. A week ago she was quite sick, but then improved, and on Friday was cheerful. During that night alarming symptoms developed, and she gradually sank until 2 o’clock Saturday afternoon, when the end came.

During recent years, owning to her feebleness and advanced age, Miss Nightingale had received but few visitors. On May 12 last she celebrated her ninetieth birthday, and was the recipient of a congratulatory message from King George.

Her wishes were that her funeral should be as quiet as possible, and though there is a strong feeling among the general public and among military men in favor of a public funeral, there is little doubt that her expressed desire in this connection will be taken into consideration.

Not even the death of a royal personage could have called forth more universal expressions of regret and tributes of love and affection than appear in the English papers.

Miss Nightingale’s Career

“The Queen of Nurses” and “The Soldier’s Friend” are titles which have stuck to Florence Nightingale since her memorable service in behalf of the wounded and dying in the Crimean war. Though Miss Nightingale was 90 years old last May, and although she had been an invalid ever since she returned from the Levant in the stirring times following the heroic struggle of the British in the Russian Empire, she retained her mental faculties to the last. The last honor to be conferred upon her by a grateful country was in 1908, when the freedom of the City of London was bestowed upon her. The ceremony took place in the Guildhall, in the presence of thousands of people, including many nurses and doctors. Miss Nightingale, then in her eighty-eighth year, was too infirm to attend, and was represented by her nephew.

Before that, in December, 1907, she received from King Edward the English Order of Merit. The statutes had to be modified by the King in order to admit of her appointment and Queen Alexandra’s own birthday was selected as the most suitable date for the bestowal of the honor.

Florence Nightingale, the daughter of William Shore Nightingale, a wealthy English landowner in Florence, Italy, was born in that city in 1820 and from that city she took her given name. When a mere child she returned with her parents to England where she lived on her father’s estate of Lea Hurst, Derbyshire. She was highly educated, being thoroughly at home in the French, German, and Italian languages. Her inclination toward philanthropy manifested itself early in life and she did much for the poor neighbors around her English home.

She began her life work by entering as a pupil in the Lutheran Hospital of Pastor Fliedner at Kaiserwerth, near Dusseldorf-on-the-Rhine. Here she acquitted herself in such a manner as to draw the highest praise from her teacher. In the early fifties she returned to London and devoted herself to labor in a hospital for sick governesses, where her health succumbed to the severity of her tasks. She had hardly recovered from the strain of this work when the greatest undertaking of her life was thrust upon her.

The Crimean war had opened. England was engaged in the formidable task of trying to clip the claws of the Russian bear. Thousands of Englishmen were sent away to the Black Sea, where the rigors of Winter on that iron coast were such that, although the army never penetrated the country more than a day’s march from the sea, the campaign almost failed through the breakdown of the chain of commissariat supplies, while in 1854 there were 18,000 men in the military hospitals.

Her Work in the Crimea

In the first stage of the Crimean not a woman nurse was employed in any of the military hospitals, for the class of women who had in the past been employed was so notoriously bad that the War Office decided not to send out any women nurses to the Crimea. After the battle of the Alma, however, the country rang with indignation at the neglected condition of the sick and wounded soldiers. Stirred into action, Sir Sydney Herbert, Secretary of War, wrote to Miss Nightingale saying that she was the one woman to take charge of the organization of a corps of nurses. He offered her absolute authority in this department. Strangely enough, on the same day Miss Nightingale wrote offering her services. A few days later she sailed for the Crimea with thirty-four nurses, and the Government congratulated the country on having obtained her services.

The women arrived just after the battle of Inkerman had been fought. There were 4,000 men in the hospitals, some wounded, but most of them sick.

There are, of course, very few veterans of the war of the Crimea still alive, yet there have been in late years some who remembered the sweet and sympathetic face of Florence Nightingale, and who were never tired of telling about her noble work in the hospitals. It was not only in the details of nursing, but in the gentle and watchful care for his comfort that Miss Nightingale made herself a beautiful memory to the soldier. She lent her aid to the surgeons when strong men turned away in horror, and sustained the courage of the wounded by her appeals to the ties which bound them to home.

Nor was it in the hospitals alone that her unselfish energy and untiring devotion were felt. There was an invalids’ kitchen, where appetizing food for the sick who could not eat ordinary fare was provided under Miss Nightingale’s eye. She provided also laundries, where clean linen could be obtained. In company with the army Chaplains she established a library and a school room, where she had evening lectures to amuse the convalescents. She personally attended to the correspondence of the wounded, and in many ways fully earned the title conferred upon her by the soldiers–“The Angels of the Crimea.”

For a year and a half she labored in this field until her work there was no longer necessary. In August, 1856, she returned to Lea Hurst. A grateful country would have welcomed her royally, but she had no desire for public praise and shrank from his every manifestation. She arrived when she was least expected and eluded those who would have honored her.

The Queen, however, was not to be denied. She sent for Miss Nightingale to visit her at Balmoral and decorated her with her own hand. The Sultan of Turkey made her a valuable present. The English Government on behalf of the people was very practical in its expression of appreciation, and presented her with $250,000.

Endows St. Thomas’s Hospital

She made herself still more popular by refusing to keep the money for her own needs, turning it over for the establishment of St. Thomas’s Hospital. In this is the Nightingale Training School for Nurses. In recent years Miss Nightingale has been unable to give her personal attention to the school, but it was and still is conducted on the plan she devised. Ms. Nightingale at this time was the heroine of the hour. Poems were written in her honor, songs and pianoforte pieces were dedicated to the “good angel of Derbyshire,” playbills displayed her name beside that of Hamlet, grocers put her portrait on their bags as an advertisement, street minstrels found a Nightingale ditty a remunerative attraction, broadsheet ballads on “The Nightingale” were the fashion on Seven Dials, and young ladies in ringlets and spencers played the “Nightingale Varsoviana” in drawing-room circles.

Some of the young women who entered the training school which Miss Nightingale founded were of the best social standing, moved to emulate Miss Nightingale’s example. The probationers, or nurse pupils, are required to remain three years before they can become Protestant sisters. After this term of probation they usually know whether they have found their proper vocation.

Although Miss Nightingale’s health was never robust after her Crimean experience, nevertheless she contrived to write much that was of value. Her “Hospital Notes” have been remarkably successful, and her “Notes on Nursing” have had a circulation reaching into the hundreds of thousands. She has written many more papers and reports, some for publication, some for the information of her Government. During the American civil war she was constantly consulted as to the management of field hospitals and great good came of her advice.

In recent years Miss Nightingale has led a quiet life, the condition of her health not permitting activity. Hundreds of persons have constantly expressed a desire to visit her, but she was able to receive only a few. She had, however, as distinguished a company of sympathetic correspondents as any woman in Europe. She was a personal friend of Lord Napier, of the Duke of Cambridge, and of Lord Wolseley. Both Queen Victoria and Queen Alexandra were in the habit of sending regularly to her home to inquire about her health.

In her youth Miss Nightingale had a great desire to study medicine, but then the profession was closed to women. The injustice of the exclusion ranged her on the side of those who later started the propaganda for opening the professions to women. She has also been a lifelong exponent of woman’s suffrage.

In 1890 England formally celebrated the great nurse’s birthday. There were meetings and speeches at various towns, and the Prince of Wales presided at the ceremonies at the Training School for Nurses. The chorus of praise which reached her ears as she sat in her invalid’s chair at the completion of threescore years and ten was such as few women have enjoyed in the history of the world. Perhaps the greatest good that has resulted from her noble life has been the setting in motion of a force which has led thousands of women to devote themselves to systematic care of the sick and wounded.

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There’s Something Wrong With My Pot!

Overheard at Triage:

Youngish Woman: (overly distraught) The room started spinning, and I started feeling all weird ‘n’ stuff, and lightheaded, and I don’t know what’s wrong with me! Also, I got really really hungry!

Boyfriend: We were smoking marijuana.

Triage Nurse: Isn’t that the desired effect, guys?

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Raking in the Bucks

My jaw dropped to the floor and narrowly missed striking the cat on the head when I saw this:

The highest-paid nurse in the Regina Qu’Appelle Health Region earned close to a quarter of a million dollars last year.

The top five salaries paid to registered nurses in the RQHR ranged from $180,530 to $243,540.

The nurse earning $243,540 was employed on a nursing unit at Regina Pioneer Village, while the second highest wage earner was an emergency room nurse who received $186,562.

Now, the top base salary for nurses in Saskatchewan is around $84,000 per year. Which means, roughly, the nurse making over 240K a year was working, approximately, 80-some hours a week, each and every week of the year.

My first question: is he or she freaking nuts?

My second question: how can this nurse provide safe and competent when she or he  is working, literally, every day of the week for a year?

My third question: why would his/her manager permit it?

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