Archive for category Social Media Ain’t Just About What You Had For Breakfast

More on When Labelling Patients Causes Patients to Die

In the comments WhiteCoat (of WhiteCoat’s Call Room fame) strenuously objects to my take on the Anna Brown case:

Wow.

Someone on my blog suggested that I check out this post after I just posted about this story yesterday.

To all of you who think “something more should have been done,” what should that “something” have been? She had multiple tests and exams performed for the same complaint – including sonograms which showed no blood clots the day before she died. She was having the same pain in her legs since she was hospitalized the week before. Gold standard test for DVTs is ultrasound. Do we repeat the ultrasound every day? Every hour? What other testing was “necessary”?

TorontoEmerg – think of all the patients you see with back pain requesting narcotic pain medications. Do you order serial MRIs on them to rule out the possibility of cauda equina? Or tumor? If so, what is the medical basis for the testing? If not, why? I’m assuming you don’t. When you miss the one patient who has a tumor and becomes paralyzed, you’ll be harangued because “obviously” the patient had something wrong and you neglected to address it. Yet once you tell the patients that they won’t be receiving any narcotic pain medications, many of the patients in severe pain stand up, curse at you, and storm out of the emergency department.

You say that Ms. Brown was “unable to walk.” The article showed that a nurse saw her standing the same day that she couldn’t walk. How many patients do you see who come to the emergency department and can’t get out of their car when they arrive? That’s a “red flag” that something is wrong. Do you order a million dollar workup on all of them? How many patients do you see who have had dozens of normal CT scans for their chronic abdominal pain? Is that proper medical care? I could go on and on, but you get the point.

The problem is that your post suffers from horrible hindsight bias. You knew the outcome and now you’re bashing the people who treated Ms. Brown because they didn’t have the ability to look into the future to see what would happen.

Yes, the outcome was horrible. Yes, there were miscues and miscommunication. I’m sure that Ms. Brown was “labeled” as someone trying to game the system. Society “labels” every aspect of our lives every day. President Obama is “liberal.” Ron Paul is “crazy.” Pit bulls are “dangerous.” Doctors are “rich.” Baby pandas are “cute.” Doing so doesn’t make us bad, it makes us human. Someone who was articulate and polite to the providers and to the police may have been treated differently. One of my readers said this was the “perfect storm” of events leading up to Ms. Brown’s death.

To say that Ms. Brown didn’t receive proper care or that her complaints were ignored is just wrong. I’m betting if you ordered all the testing you think Ms. Brown should have received on all of the patients who walked through the doors at your emergency department, *you’d* be the one being ridiculed.

I appreciate WhiteCoat taking the time to post such a lengthy reply. He fully explicates many of his points on his blog. I won’t editorialize much here, because I think his perspective is important to how we discuss cases like Anna Brown. I don’t share his point of view for a number of reasons, but I do agree with him that labelling people makes us human. The trouble starts, for me at least,  when we allow our interior — and often unrealized — biases to influence our care.

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Hacked and/or Phished

My Twitter account was hacked yesterday evening. Apparently a very good imitation of me sent out a mass direct message. It read “lmao…omg i am laughing so hard at this pic u i just found” followed by a link to a page which asked you to “sign in” to your Twitter account — obviously a plot to collect usernames and passwords. (Actually, a not-so-good imitation of me: I’m about the last person on earth not to uncapitalize “i” or use “lmao” or “omg” or “u.”)

Of course I fell for it — the page looks just like Twitter login page — and I had just tapped “Enter” when I realized I was being phished.

Damn it all to hell. Password reset hell, that is.

I apologize for any inconvenience to anyone affected. If you’re a trusting soul like me, and was taken in, unfortunately you will need to reset your passwords.

Some tips on securing your Twitter account here.

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I’ve Been Selected for a Not-So-Clever Marketing Scheme

This blog has been named as one of the  “20 Best Blog for Nurses” by that august institution, Jacksonville University School of Nursing. My jaded, cynical, shrivelled heart tells me it’s a trojan horse marketing scheme, since the button they emailed me links to information on their MScN program, and there doesn’t seem to a “20 Best Blogs for Nurses” page on their site.

I’m curious. How many other nurse bloggers got a note saying they were one of the 20 Best?

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Time for the Talk

A tried and true (if tedious) bait and switch routine to draw attention to a serious issue.

Synchronicity is a weird and wonderful thing. Here I was talking about the my own promiscuous use of the F-bomb this week, and now a non-profit uses it as part of an advertising campaign in order to be relevant to the Gen Y demographic:

Fuck Cancer [according to the non-profit’s website] saves lives by teaching people how to look for cancer, instead of just find it. We change the way cancer society perceives cancer by challenging the stigma and the victim mentality. We shift the balance of power from the cancer to the patient, and turn “patients” into “cancer Fuckers”, fighters, and survivors.

I’m not very convinced, though, that “Fuck Cancer” as an advertising slogan — in the hope, it seems, that the concept will be go viral over social media — will be very effective. Attention getting, maybe, but in the end it feels too much like slacktivism: just point and click to a warm fuzzy. What do you think?

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The Nurse’s Social Media Advantage

Congratulations and multiple woots to Rob Fraser, who’s published his book, The Nurse’s Social Media Advantage. The publisher’s blurb:

Social media has reached into every profession – and nursing is no exception. Almost daily, new research and publishing methods emerge. This fast-paced, ever-changing way of disseminating information will continue to evolve, whether nurses participate or not. With the vital role that nursing plays in the health care community, nurses cannot afford to fall behind. Social media provides exciting possibilities for networking, creating content, finding and sharing information and collaborating to create a global nursing network.

These changes can be challenging, but STTI’s new book The Nurse’s Social Media Advantage: How Making Connections and Sharing Ideas Can Enhance Your Nursing Practice will provide you with the tools you need for success.

The book is available from Amazon here.

Rob mugging with his book. Pic from his personal blog.

You get the feeling Rob is going places. Anyway, well done.

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The Eternal Flame

Scenes from a dissipated childhood, courtesy of 15 and Falling, an anti-smoking campaign aimed at adolescents brought out by the Nova Scotia Department of Health and Wellness.

I have to admit, I laughed my ass off when I saw this. Who doesn’t like a good flatus joke, after all?

[Via.]

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How To Be Arbitrarily Kicked Out of Nursing School

In some states, public display of a placenta by a nurse is punishable by death

Want to get kicked out of nursing school? Display a placenta on Facebook.

The shorter version of this story tells of a director of nursing named Jeanne Walsh arbitrarily booting a student named Doyle Byrnes (right) from the from the nursing program at Johnson County Community College in Overland Park, Kansas only a few months short of graduation. Her heinous offence? She published on Facebook (with her instructor’s permission, mind you) a photograph of herself beside an anonymous placenta. In the letter of expulsion Walsh was brutal, yet undoubtedly fair — at least in her own mind. She wrote Byrnes: “Your demeanor and lack of professional behavior surrounding this event was considered a disruption to the learning environment and did not exemplify the professional behavior that we expect in the nursing program.”

I am mystified and not only by the Walsh’s evasive, accountability-shifting use of the passive voice. All I see here is an obviously excited, eager student with the “shiny shultz” side of the placenta showing in a tray.* Bad taste? Debatable. It’s certainly no worse than reality television. It’s not as though she’s swinging the thing around by the umbilical cord. Maybe instead of the contagious grin, she should be frowning at it slightly. Is there some gross violation of nurse-placenta confidentiality I’m missing?  What, did the placenta call to complain about its treatment?

Not Nurse Ratched had the best comment:

JCCC says it’s “a lesson hard learned.” Indeed, but not the one the school probably thinks it’s sending: the lesson is that nursing is filled with inexplicable decisions and finding out after the fact you did something Bad. This student can carry that lesson with her, but is it really one our nursing schools should be teaching? Can they not teach something more like “here’s an opportunity for education regarding healthcare and social media”?

Yep, indeedy, that pretty well sums up this school’s competency. No warning letter, no chance at remediation, just straight out the door. Nothing like grabbing the figurative axe for fixing a problem —  and incidentally demonstrating the nasty underbelly of nursing. Makes you wonder how this school reacts when a student actually does something serious.

So a few conclusions: first, Johnson County Community College’s nursing program is probably — well, let’s be kind and damn with faint praise: they do their very best, despite having no sense of proportionality — or humour. Second, higher degrees in nursing are evidently not guarantees of effective skills in either nursing education and administration. Third, we often talk about nurses eating their young. After seeing this story and hearing about others like it —  and it truly pains me to say this — I’m beginning to wonder if the source lies in nursing educators inculcating those old-fashioned nursing “values.” You know, the ones that say arbitrary and unjust behaviour, back-stabbing and treating nurses as expendable are acceptable. After all, isn’t this a classic example of how colleagues and superiors knee-cap young nurses and students?

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*Note to AtYourCervix: I was not sleeping all the time during my Obs/Gyne rotation.

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Crossing That Mysterious Line on Facebook

The other day EMS brought in a 58-year-old man to a certain Toronto-area hospital. His chief complaint? He had broken a toe nail. Left great toe, to be exact.

Seriously.

Now, I have a ten-dollar bill that says you think you know where I’m going with this: stupid ambulance-calling patient abusing the system, har-har, look at the dummy. Right?

Wrong.

One of my spies tells me there is a nurse at this hospital who posts tales of triage on her public Facebook page. She nailed — she thought — this particular patient just after Christmas, and didn’t bother to change the details of the chief complaint much to protect confidentiality.* Nor did she much conceal her contempt for this particular patient.

The detail the nurse neglected to mention on Facebook was this patient’s early-onset Alzheimer’s. He was just beginning to have some very serious cognitive problems; he called EMS when his toe began to bleed, then became quite agitated. His wife thought there was something seriously wrong.

Maybe not so funny now, right? Maybe more a case for social work and home care intervention than public ridicule?

I know there is a veritable cottage industry out there devoted to silly emergency department stories. Patients, in truth, do some very strange and funny things, and sometimes their appearance at the triage desk are for reasons less than credible. Hell, I’ve spun more than a few stories on this blog myself. I hope at the end of it I’ve respected both the patients and their confidentiality. But clearly the nurse above crossed a line. To me it feels abusive and frankly, rotten.  There’s a huge confidentiality issue. The context was deliberately left out: it’s not funny at all if you know the circumstances. The patient and family are in a particularly vulnerable situation.

But the question I have to ask is, where exactly is that line, and how do we know when we’ve crossed it?

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*I have, however.

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Students Using Social Media to Inform: Webliography Creation

[When I saw this post on Terri Schmitt’s blog, Nurse Story, I was so impressed by her students’ work I immediately tweeted her to ask permission to repost it here, which she was kind enough to grant. Very cool, guys, and well done.  As Terri would say, GO NURSING!]

by Terri Schmitt Nurse Story

These students have done amazing things and have compiled legitimate sources of internet health information on a good variety of topics. This is what nursing does, we educate, and we can use social media to do that well. These nurses,  in an RN to BSN program, bring their personal interest, knowledge, and skills of internet website evaluation to benefit to their patients on the world-wide-web. I have included a table below with their twitter names and the links to their webliographies. ENJOY!

@MidwestRN – Coronary Artery Disease:http://midwestrn.wordpress.com/2010/10/24/coronary-artery-diseas/

@RnRey – Nursing and Genetics: http://rnnursejourney.blogspot.com/2010/10/nurses-and-genetics

@CampusNurse – Oral Mucositis: http://campusnurse.wordpress.com/2010/10/24/oral-mucositis/

@ahopkinsrn – Obesity: http://ahopkinsrn.wordpress.com/2010/10/20/obesity/

@clynn_rn  – Glomerulonephritis: http://clynnrn.wordpress.com/2010/10/24/webliography/

@nrodrockrn – Diabetes: http://bsnhereicome.wordpress.com/2010/10/24/diabetes-webliography/

@sandypark82 – Gastroparesis:http://sandypark82.wordpress.com/2010/10/24/gastroparesis/

@JessicaMRN – Epilepsy: http://nursejessi.wordpress.com/2010/10/24/epilepsy-webliography/

@NurseNaters – CVA Recovery:http://adventuresinmursing.blogspot.com/2010/10/recovery-from-cva.html

@thetoddrn – COPD: http://thetoddsblahg.wordpress.com/2010/10/19/copd-webliography

@Jales_RN – Preeclampsia: http://jalesknowsbabiesrock.blogspot.com/2010/10/annotated-webliography-of-preeclampsia.html

@SusanInman – To Stick or Not to Stick: http://apediatricnursesperceptions.blogspot.com

@sburntina – Interstitial Cystitis: http://sburntina.wordpress.com/2010/10/22/webliograph-interstitial-cystitis/

@RNkcummings  – Diabetes: http://kcummi.wordpress.com/2010/10/25/everything-you-could-want-to-learn-about-diabetes/

@Julia1219 – Femeroacetabular Impingement:https://nkwagala.wordpress.com/2010/10/20/femoroacetabular-impingement/

@punkerkas – Schizophrenia: http://krankenschwester-punkerkas.blogspot.com/2010/10/dealing-with-schizophrenia.html

@rjbreigRN – Chronic Fatigue Syndrome: http://anursetale.blogspot.com/2010/10/chronic-fatigue-syndrome.html

@megRN4356 – Total Knee Replacements:http://megrn4356.wordpress.com/2010/10/24/total-knee-replacements/

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