Archive for category Some Days You Just Gotta Post Links

Observations and Assessments


Nursing Related:

New  (to me)Blog Shoutouts  —

This blog hopes to present a different perspective on the Vancouver 2011 Stanley Cup Riot. Here, we’ll try to post letters of those that were working on the front lines: police officers, fire fighters, paramedics, doctors, nurses, hospital staff, transit staff, volunteers, and many more.”

The Boerewors Emergency Medicine Chronicles: “A bad day at work yesterday….it was tripping along quite nicely…we were well staffed…I’d even beaten my own best score at ‘Zombie Gunship’

…and then at about 17h50,just before my evening meal break, ShufflingBob called me to the resus room to look at a baby…
…a 13 month old baby who had a number of serious congenital health problems…
…necessitating a colostomy…
…who had been vomiting more than 15 times a day, every day,since Wednesday…
…who had seen the GP on Wednesday (and got given Amoxil) and on Friday (and got given Erythromycin)…
…and who was pale…grey coloured…with an oxygen saturation of 72%…
…a respiratory rate of 84…
…and a pulse of 180…”
…the baby was in a peri-arrest situation..”

Ordinary Citizen by Day:

“Patient: They’re gonna go an exam on me?!

Me: Well, you did come in with a complaint that usually necessitates one to determine the problem.>

Patient: Well you can tell them that I don’t want ANYONE getting all up in my cupcake! No. Way.”

What to Do When Docs Go Wild. Call them out. “A physician who threatened to use an AK-47, a sexually harassing doctor who looked at porn on work computers and a specialist who used to cause nurses to draw straws with the loser having to interact with her. These were some of the horror stories. . . .”

Sweating the Small Stuff. Important. Do it. Really. “But it is also uber important not to let the small stuff slip past. Often the small things are in actuality, big things a long way off. Sometimes this tyranny of distance hides a mass and velocity that are completely underestimated. Until impact.”

Outcomes of Nurse-Inserted Central Venous Catheters. “It adds to a growing body of evidence that nurses can and must provide services for which they are capable and trained and that allowing nurses to function within the full scope of their licensure and education will only increase the efficiency of the healthcare system and improve patient satisfaction and outcomes.”

Stop Calling Them Dear, Dear. It’s nasty and dehumanizing: “But once you’ve decided that “old dear” is fine, you’ve already depersonalised and infantilised the elderly. Why would you care what the old dears think? They’re just a bunch of old dears.”

Update on the Brian Sinclair Case. According to the Winnipeg Free Press:  “Sinclair, a 45-year-old double amputee, died in 2008 of a treatable bladder infection at the Health Sciences Centre after waiting 34 hours for treatment. The Winnipeg Regional Health Authority recently paid Sinclair’s family $110,000 on a portion of their lawsuit dealing with Brian Sinclair’s wrongful death.Berthaudin said in a written decision that Zbogar and Trachtenberg did not provide any evidence to back up their public nuisance allegation.”How Home Care Workers are Treated Like Dirt. “For millions of aging households, a home care worker is the only person who provides the day-to-day assistance and emotional interaction they need to function. Yet, typically, that worker is neglected herself–by the government.”


Did My Post Suck Today?  “God, I would love it if the Westboro Baptist Church protested this blog.”

One Reason Why Wealthy People Tend to Self-Perpetuate. “I think that one of the reasons that the children of wealthy parents tend to become wealthy too – aside from the obvious – is that they comprehend more career options.”

Irony Alert. Homophobes may be acting out . . . wait for it . . . on their own same-sex attraction: “Individuals who identify as straight but in psychological tests show a strong attraction to the same sex may be threatened by gays and lesbians because homosexuals remind them of similar tendencies within themselves.”

Antibiotic Resistant Bacteria. On meat. Yum.

[UPDATE (17/04/12): after much moaning and whinging, fixed the formatting.Which I tend to fuss over — don’t want to obscure the message.]

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Observations and Assessments


Further to my post “Sleepy Sleepy Nurse”: Sleep or Die. Really.

My jobRegistered Nurse.

We don’t know as much about infection control as we think we do. “Less than a quarter of the Clostridium difficile cases in a hospital could be traced to patients in the same ward, challenging a common assumption about how the infection spreads.” Medscape summary. Original article here.

And we’re not as smart at Triage as we think we are. Analyzing the records of 519 patients aged 65 years or older who were triaged using the Emergency Severity Index, from University Hospital Basel in Switzerland, found that 117 patients were undertriaged and 15 were overtriaged.” Anecdotally, I think this is true. My only quibble is why the small sample size? I mean, 519 patients is two days of volume in a busy ED, which means only a few poorly trained triage nurses could skew the results.

Nurses’ Presenteeism and Its Effects on Self-Reported Quality of Care and Costs. I read the article and went “Meh.” Rather evades the real issues around presenteeism, i.e. workplaces penalizing nurses for taking sick time.

Oh, dear.

On the menu: Pink Slime! I swear I will never, ever buy ground beef ever again.

And they didn’t live happily ever afterReal life Disney princesses, fallen. A photo exhibit by Dina Goldstein. My favourite: Cinderella knocking back shots in a bar on Hastings Street in Vancouver’s Downtown Eastside.

Younger than the Happy Meal. An important reminder from Fred Clark the supposedly “eternal” truths about abortion maintained by evangelical Christians are of much more recent vintage than you think.

Great music in the cause of crap content. Dissecting the cultural significance of country music. Quote:

The conservative movement has been cannibalizing conservative art for years now, to the point where I’d say country music is far from a victory of conservative cultural or artistic success and is instead a mirror image of what conservative politics have become: easy and unthinking. No depth, all surface. Superficial and insular. Maybe I’m wrong, but building an entire genre on the back of the idea that regurgitating the same sound on top of the same basic premise over and over again hardly strikes me as a triumph of cultural conservatism.

What language do deaf people think in?

Ayn Rand is the Karl Marx of the Right. Mostly because she tells people with incredible amounts of privilege they are the real victims in life’s lottery. Quote: “She offers them something that is crucial to every successful political movement: a sense of victimhood. She tells them that they are parasitised by the ungrateful poor and oppressed by intrusive, controlling governments.”

The Reformed Whores respond to Rush Limbaugh: “I’m a slut.” Hugely funny and right on the money.

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Observations and Assessments

Notions to small for a blog post, all in one place, a.k.a. the periodic link dump.

Giving all aid short of actual help. First, some words from the American Nurses Association on Amanda Trujillo. The ANA finallyissued a news release, in which they absolutely avoided, like nervous grannies dithering over an icy stretch of sidewalk, any position at all. However, they are watching the case “closely.” They advise “nurses and the public not to rush to judgments about complex cases based on social media postings or other media coverage.” They tell nurses in trouble to avail  themselves of the “many resources available on its website”. That’s pretty well it.  Three Tweets and they could have saved themselves 323 words and a news release. Would have been a more honest display of actual content, too.

That’s gonna leave a mark. Meanwhile Kim McAllister over at Emergiblog administers a very judicious flogging to the ANA over said news release above. Jennifer Olin does more dissection here.

Big and growing. More resources on Amanda Trujillo, including media contacts and how to contribute to her cause at NurseFriendly’s site.

Funky, interesting and fabulous New Blogs! New to me, anyway.

  • Medical Ethics and Me has some great, relevant material on its collective blog. Deserves to have a much wider audience.
  • Greg Mercer: a very new blog, and a strong advocate for nurses

So what about Pinterest, anyway? Got my account, and am still puzzled by what exactly to do with it. (Though got a recipe for Olive Garden Alfredo Sauce.) HealthisSocial has some answers, but may also be mocking you.

Um, no? Does the World Really Need a 5-Inch Phone With a Stylus? (I would lose the stylus in about 10 minutes.)

Another float in the Parade of the Blindingly Obvious. Nurses need breaks! say health care leaders. (You think?)

The complaints are even more surprising given the culture of nursing. Rarely having time for rest and meal breaks is part of the nursing folklore. New graduate initiation practically stipulates that a requirement of successful floor nurses is a gargantuan bladder.

This culture is entrenched. A 2004 study published in the Journal of Nursing Administration revealed that hospital staff nurses were completely free of patient care responsibilities during a break or meal period less than half the shifts they worked. In 10%

of their shifts, nurses reported having no opportunity to sit down for a break or meal period. The rest of the time, nurses said they had time for a break, but no one was available to take over patient care

Next thing they’ll be telling us is nurses shouldn’t be punished for taking sick time.

“Weeds are the tithe we get for breaking the earth.” Too true. An elegy on the humble weed

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Observations and Assessments

Notions to small for a blog post, all in one place.

You need to take your pain medication. Once upon a time, TorontoEmerg had some fairly significant surgery on a major joint. It was (theoretically) exceeding painful, but fortunately TorontoEmerg’s orthopod was very generous in supplying TorontoEmerg with Percocets and Tylenol 3s, and thusly TorontoEmerge experienced very little pain. Even when going to (really) painful physio, TorontoEmerg was kept more-or-less comfortable and at the end had a full recovery —- all because of adequate pain control.

TorontoEmerg was an RN, and knew how to take pain medication effectively.

So when five patients show up at Triage in one with poor pain control post operatively, even with adequate analgesia prescribed, TorontoEmerg begins to think some surgical nurses know squat about pain control and/or failing to teach adequately about analgesia when discharging patients. It isn’t about throwing a script for some opioid at patients and telling them to take the med “when the pain is really bad.” Is there is some deficit in our training which makes us reluctant to counsel patients on pain control?

You need to take your stool softener. Same topic. Different angle. I had several patients come to Triage yesterday for constipation related to opiate use post-operatively. None of them had any instructions about preventing or addressing what to do about the (inevitable) constipation. Again, why are we screwing up our discharge instructions?

Myth of the Queen Bee. Some research probably pertinent to nurses aspiring to leadership positions.

Drop Me a Postcard. This is kind of cool: internet postcards you can drag and drop to email, Facebook/Twitter messages, which pose some pertinent, challenging, difficult questions. From

How to deal with difficult colleagues. It seems too simple.

“Please do not let them breed.” Yep.

Size does matter. I thought this story was interesting because it exemplifies the anti-science, anti-intellectual climate we seem to be labouring under. Shorter version: right-wing web sites excoriate supposedly taxpayer-funded study of penis size and gay men’s health as trivial and frivolous, except, as it turns out, the study was not directly funded by the U.S. government and there is in fact an important correlation between sexual health and penis size, which in turn has implications for reducing HIV transmission.

Speaking of bad foodDeep fried butter. Really. Move over cheeseburger-on-a-glazed-doughnut. As Sean says, I’m speechless.

Dumb road signs



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Observations and Assessments

Notions to small for a blog post, all in one place.

Pomodoro is not just Italian for tomato. It’s actually an effective time-management technique. Like (for example) in clearing up unanswered emails. I find it actually keeps me focussed on writing, and helps me avoid the ever-present temptation of the evil Twitter.

The best thing about basic nursing is that it reminds you of why you became a nurse. An elemental truth. Susan Eller explains:

This patient in the hallway, waiting for a bed and needing some pain medications just needed some routine nursing care: comfort measures, information, and compassion.

Yet, the wife took my hand before they left the ED and thanked me for taking the time.  She appreciated that even though he wasn’t my patient, and she could see that I was busy, that I took the time to make sure that he was informed and comfortable.

It startled me that she was so grateful. In my perspective, I was just doing my job the way I always do it.  In the scope of my busy day with critically ill patients who needed so much more, this tiny little thing that I did made an impact on her.

Coal Cares. Really, they do.

And the high and mighty this campaign managed to piss off. Given the thousands that air pollution kills every year by exacerbating various respiratory illnesses, you’d think the coal industry — whose contribution to poor air quality is remarkable — would be a little less, um, shameless.

Parakeet madness in Britain. Hitchcock would have a field day.

A good source of nursing blogs (via @DrDeanBurke). Oh, yeah. There I am. Sweet.

More on bullying. The Nursing Ethics Blog:

The hardest questions I’ve ever been asked by med students and nursing students have to do with bullying, and with the difficulties inherent in being at the bottom of their respective professional hierarchies. Students understandably find it difficult — and a source of moral distress — to be not only subject to bullying, but to sometimes be involved in courses of action that they see as unethical and yet powerless to do anything about it.

In discussions I’ve seen around the Interwebs this past week, the consensus seems to be the risk of bullying decreases with experience and growth of confidence. Which begs the question: why do we subject the most valuable and vulnerable members of our profession to this behaviour?

And still more. From a med student who gets it:

As a medical student, I’ve witnessed and experienced my share of bullying by a handful of doctors (though to be fair, by nurses as well). In one instance, I watched a surgeon mock a new nurse in the operating room, teaching her with absurd faux-patience how to properly hand him his instruments.

And silence still kills. “Research and regulatory bodies have long confirmed that poor communication in healthcare is harmful at best and deadly at worst.”

Dept. of It Was Too Good To be True. Magnet hospitals are just as sucky for nurses as normal hospitals. Except they’re better at self-promotion.

Housekeeping. The spam filter has been acting up again. I gave it a good swift kick, and restored some comments that were placed in the spam file.

Also if you have emailed in past while and I haven’t gotten back to you, I will. A friend of mine declared email bankruptcy and deleted a whack of messages in one fell swoop, on the theory she was never going to asnwerthem, and they were just sitting there, making her worried and a little neurotic. Not quite there, but I can see the premise.

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Some Days You Just Gotta Post Links Vol. 8

That sort of day. Cold and feeling like snow. Enjoy!

Carter: Worldwide, we only have 1,700 cases left, and we know where every single one is located. About 98 percent are in Sudan. But those last few cases are very difficult. If they were not so challenging, they would have been eradicated 15 years ago.

Clinical competence, willingness to educate, and calm and empathic reassurance are critical to helping patients and families during a loved one’s last hours of living. Clinical issues that commonly arise in the last hours of living include the management of feeding and hydration, changes in consciousness, delirium, pain, breathlessness, and secretions. Management principles are the same whether the patient is at home or in a healthcare institution. However, death in an institution requires accommodations that may not be customary to assure privacy, cultural observances, and communication. In anticipation of the event, inform the family and other professionals about what to do and what to expect. Care does not end until the family has been supported with their grief reactions and those with complicated grief have been helped to get care.

Brazilian police are investigating the case of an elderly woman who was declared dead — only to wake up hours later inside a coffin in a funeral home.

The 88-year-old woman died two days after the incident and police in Minas Gerais state want to know if poor medical care and the misdiagnosis contributed to her death. [Or rather, undeath — ed.]

  • Grey’s Anatomy — created by Shonda Rhimes, ABC.
  • Despite a couple fleeting portrayals in which nurse characters displayed health knowledge, this popular hospital drama generally ignored nursing except for the occasional insult–and the fact that the show’s heroic physician characters regularly performed critical tasks that nurses do in real life.

  • Housecreated by David Shore, Fox.
  • This year included a few appearances from the snarky nurse Jeffrey, who appeared to have no real clinical role, but overall the show continued to present its nurses as anonymous physician lackeys and to have the brilliant Greg House and his physician team perform important nursing tasks.

    Damhof is the nurse navigator at the Willmar Regional Cancer Center.

    Barb Hoeft, director of the cancer center, describes her as “our go-to person.”

    “Every cancer patient needs a nurse navigator to talk to,” she said.

    Damhof does a little of everything: listening, advocating, troubleshooting, organizing appointments and referrals, and connecting patients and families with the resources they need

    • Somewhat related, if you want good news about the world’s oceans, don’t look here:

    Record warm ocean temperatures across much of Earth’s tropical oceans during the summer of 2010 created the second worst year globally for coral-killing bleaching episodes. The warm waters, fueled in part by the El Niño phenomena, caused the most coral bleaching since 1998, when 16 percent of the world’s reefs were killed off. “Clearly, we are on track for this to be the second worst (bleaching) on record,” NOAA coral expert Mark Eakin in an interview last month. “All we’re waiting on now is the body count.”

    Dr. Todd Hanna, emergency services medical director, and Kathy Racela, emergency department nurse manager, brainstormed, read medical literature and consulted colleagues to determine how to speed up triaging patients so that those with lesser complaints could receive care in exam areas in the front end of the department and save the hospital’s 28 emergency beds for more serious cases.

    At the busiest times, between noon and 11 p.m. seven days a week, the hospital has set up “rapid triage.” During these hours, a physician evaluates a patient within 30 minutes in an exam area near the check-in desk.


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    Some Days You Just Gotta Post Links Vol. 7

    A little more than the usual linkage, to carry you through the holiday season.

    • A medical wiki, supposedly written only by real physicians. There ought to be a nursing wiki, don’t you think? How would we start one?

    “Optical illusions mystify and inspire our imagination, but in truth they show us that how we see the world is not necessarily physically accurate, but rather depends a lot on our brains. Illusions such as the ones we used influence how big something looks; that is, they can trick us into believing that two identical objects have different sizes.

    • “Specially trained nurses, known as nurse practitioners, may help speed the diagnosis and management of patients with back pain who would normally wait months to see a surgeon, according to a new study.”

    Although 67% of Canadians and 85% of Australians support legal euthanasia, according to polls conducted by Angus Reid in Canada and by theNorthern Territory News in Australia, Nitschke says support from the medical community is lower than the general population. “Some people think you can either support palliative care or euthanasia. They don’t think you can have both.”

    “Let’s shock him!” Without even batting  an eye, the pads were placed on the patient, “EVERYONE CLEAR?” The familiar sound of charging I hear the daily, when the equipment is tested.  And then a very new and different sound as 200 joules of electricity surge through the machine and into the patient and the patient nearly leaping off the bed, yelling, and grabbing his chest, as his heart is told to beat differently. His eyes bulged in his head. He looked like he might vomit, might punch someone in the face, and then, nearly as soon as it began, he lied peacefully. He converted. Heart rate 130’s, A fib.

    • Hospital stupid, in which player pianos are more important than rape kits.

    Under no circumstances are any healthcare providers, paid or volunteer, to perform CPR on me, including artificial respirations or chest compressions. There are exceedingly few people that survive such therapy and frankly, I’d rather use that slim chance to win the lottery

    Should the preceding request go unheeded and I am on a ventilator, under no circumstances should artificial ventilation continue for more than one week. If I cannot be taken off the ventilator in that time, please remove the endotracheal tube or whatever artificial airway is in my body and turn off the ventilator. I will take my chances.

    Under no circumstances am I to be fed. This includes tube feedings via any port in my body including intravenous, nasogastric, orogastric, percutaneous endogastric or duodenal routes, or even if someone should offer to cut up my food and/or feed it to me. Should the recommendation for such a form of nourishment be mentioned as part of my care, I summarily refuse it.

    I have been sitting down with the Vice-Presidents and they will shortly begin having meetings with upper-level management who will then be meeting with middle-management, who then will meet with your unit managers to work on the operating budgets for the next fiscal year.  Sacrifices will have to be made at one point.  We’re hoping this doesn’t include layoffs, but instead we will flex and cancel people so that they have a de facto pay cut since they no longer work their scheduled hours.  We’re all doing it.  In fact I am taking off time this month as well, flexing.  Of course, my salary isn’t remotely effected.  We here at the Head Orfice do appreciate your sacrifices, but are asking for more.  We need you to do more with less.  Our new operating budgets will reflect that.  There are going to be hard decisions to make in the next year and I hope that our staff will be willing and able to make the changes needed and if not I’m sure there are plenty that will.

    [But read the whole thing.]

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    Some Days You Just Gotta Post Links Vol. 6

    The ultimate, time-honoured, blogging fake-out, where your faithful blogger shouts, “Look over there!” while going off and doing something else altogether. Enjoy.

    • A nurse ethicist on end of life care: “The fact that families feel that they haven’t felt that they’ve been part of the decision-making processes regarding end-of-life care and wishes, means that something is definitely wrong with how the health care team is functioning, at a very basic level.”
    • Our First World obsession with the never-ending War on Drugs (among other things) harms palliative care patients in developing nations: “This lack of availability is not because morphine is costly or difficult to get hold of. What is to blame is the so-called war on drugs, says Lohman. So concerned are developing nations such as Columbia, Egypt, and India about the potential for addiction, or the illicit use of morphine, that they make it almost impossible for doctors to give morphine to patients.”
    • A takedown of Cash for Work/Food for Work programs in Haiti. Long read, but worth it if you’re interested in development issues. [Via]
    • Trouble is the culture wars, like most wars, are about the money. But still, a good question: “Could we all find a way to take up the Hippocratic Oath to ‘first, do no harm’ regardless of our beliefs on ‘culture wars’ issues? Clearly, it would not be easy – but isn’t it worth trying?”
    • Also, an ECG wiki: ECGpedia! Because I love cardiology and intend to bore you all. [Via]

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    Some Days You Just Gotta Post Links Vol. 5

    When Pumpkins Drink

    Okay, so I posted this photo last year. But most of you weren’t around last year; laziness is the fall-back position today anyway, so what the hell. It’s still funny, if, um, vulgar.

    I also figured it was a day for links: looking back over the past few weeks, there’s been a lot of substantial writing. In short: tired brain. So without further ado:

    • Do dogs enjoy dressing up for Hallowe’en? Short answer, no: “To put raiments on a dog is to blithely ignore his essential dogness.”
    • Findings shared with Nursing Times reveal that members of the public, who were interviewed in 81 research sessions, commonly described nurses as overworked, underpaid, patient, stoic, put upon, unambitious and passive.”

    Per Capita Health Spending And 15-Year Survival For 45-Year-Old Women, United States And 12 Comparison Countries, 1975 And 2005

    • Yet another reason to be cheerful. Why do I think our descendants (if, in fact, we have any) will view our stupidity with the same distaste, shame and smugness (if truth be known) we view the Inquisition, burning at the stake, the Thirty Years War, the slave trade in the 17th, 18th and 19th Centuries, or the Opium War?

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    Some Days You Just Gotta Post Links Vol. 4

    If I win a million dollars, or find a sugar-daddy — real or figurative — I’ll blog full-time. Meanwhile, some links for your viewing pleasure.

    • Ethics of overseas medical work: “Short-term [medical] trips that disregard existing programs and local priorities can divert resources from local providers, disrupt local relationships, and undermine efforts to build sustainable, cohesive primary health systems.”
    • A micro-level problem with large consequences: “A new global partnership is targeting a silent and often overlooked killer in the developing world: harmful smoke from the dirty cookstoves and open fires where women make their family meals.”
    • Moral distress has been shown to lead to anger, guilt, self-blame, and withdrawal from patients, resulting in some cases in nurses leaving their positions or the profession.”

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