“What’s Wrong With Our Bodies, Anyway?”

Um, nothing. Just that runway models — and expectations — are getting skinnier. From Plus Model Magazine. On the left is a “straight-size” runway model, on the right, “plus” size model Katya Zharkova (size 12-14). A stunning contrast between the near-anorexic “norm” and healthy reality, wouldn’t you say?

According to the magazine:

–Twenty years ago the average fashion model weighed 8% less than the average woman. Today, she weighs 23% less.

– Ten years ago plus-size models averaged between size 12 and 18. Today the need for size diversity within the plus-size modeling industry continues to be questioned. The majority of plus-size models on agency boards are between a size 6 and 14, while the customers continue to express their dissatisfaction.

– Most runway models meet the Body Mass Index physical criteria for Anorexia.

– 50% of women wear a size 14 or larger, but most standard clothing outlets cater to sizes 14 or smaller.

More images here.

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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.

• RNAcademy.com: New grad on the ED offers a fresh perspective.

• Greg Mercer: a very new blog, and a strong advocate for nurses

• Comma to the Top declares war on those who would redesign grammar.

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
.

A Small Rant from Your Friendly X-ray Tech

A note sent to me from my favourite MRT (Medical Radiation Technologist). A reminder too, that nurses aren’t the centre of the universe, even if we think we are.

Some thoughts from an MRT. . .

Now I know we aren’t perfect but I feel like a rant about portable examinations.

If a portable examination is requested it’s because the patient is too ill to come to the department, not because they are in the bed nearest the window and it’s a hassle to get them out of the room. Portable exams give less information than a department film so why chose inferior diagnostics?

So the patient is too sick to leave the floor might there be a need for a nurse to help the MRT with the patient? Just saying, just wondering. Now this help isn’t for the MRT’s benefit – though lifting and maneuvering people one handed is tricky – it’s for the patient.. Even if your patient is sitting bolt upright and square on do you think it’s a kindness to have them pulled forward by one arm as the heavy cassette is placed behind them? Because this is what the MRT has to do if the patient can’t lean forwards.

Oh and please don’t all run the minute the portable machine comes trundling down the corridor. It isn’t radioactive. And if you don’t have time to move 2 chairs, a commode, a walker,  and a couple of tables out of the room what makes you think the MRT does??

You know if you help with the exam then I’ll help put everything back in it’s place.

In Emerg, when you call the tech for a stat film then do acknowlede ge them when they arrive, and maybe even stay to help, (see above re too sick to go to the department.) If you don’t hang around then do answer the tech when they ask if the patient can be sat up for the film, or have any other questions about your patient.

Points well taken. Remember it’s about the patients, right? I’m pretty sure too other health care professionals have similar valid gripes about us. Ladies and gents, we need to pull up our socks.

On Allegations of Patient Abuse at St. Joseph’s

This story concerning alleged abuse of a senior at St. Joseph’s Health Care Centre (and yes, I know “alleged” is a weasel word) has been making the rounds in the Toronto media, including some blaring front pages in the Toronto Sun:

Ron Meredith claims two burly security guards at a west-end hospital manhandled him, dragged him to an empty room and shackled him to a bed like an animal.

The frail 79-year-old alleges he lay there unattended at St. Joseph’s — forced to wear a diaper — for seven hours until he was discovered by cleaning staff.

His only crime, he claims, is that he was sitting in a chair waiting patiently to be discharged.

“What they did to me was unbelievable,” Meredith said Monday, still in shock and covered in bruises two days after his ordeal.

Woken up by a noisy patient in the next bed, Meredith got dressed, went for coffee, and believing his discharge was imiment, sat down by the nurses station to wait. Unfortunately, the situation escalated.

He claims two security guards, “big guys,” approached shortly before 7 a.m.

“They accused me of trying to escape and told me to go back to my room,” Meredith recalled.

The senior explained he was waiting to be discharged but the guards again ordered him back to his room.

“I told them I was already dressed and I didn’t feel it was necessary to go back.”

After a third warning, he says the situation turned ugly.

“All of a sudden they pounced on me,” Meredith claims.

Both guards allegedly pulled him out of the chair, pinned his arms behind his back in a painful position and dragged him down the hall to an empty room.

“They threw me on the bed and I hurt my back on one of the rails,” Meredith said, adding the guards then cuffed his wrists and ankles to the bed.

“They really did a job on me,” he said. “And when that diaper was put on me I knew I was in for a long haul.”

Ugh. Nasty story. The thing is, as an old RN, I can immediately see suggestions there is much more to this story than meets the eye. The bruises, for example, on this poor patient’s arms are clearly old and related to IV starts or blood draws; they are particularly common in patients taking anticoagulants, which I strongly suspect this patient is on. They weren’t caused, in any case, by undue restraint. Further, one wonders if this patient refused a reasonable request to return to his room and wait for discharge; the patient then became increasingly angry and frustrated, and matters escalated from there.

On the other hand, as an old RN, I can clearly (and distressingly) understand how this story is completely plausible. Poor (or no) communication from the nurses on the inpatient unit to the patient and family on the care plan. Overreaction and assumptions made on the part of the nursing  staff. Stereotyping of the elderly as always confused and/or demented. Overuse of restraints. Underlying view of nurses that patients must be under control at all times. (Hospitals aren’t prisons!) Et cetera.

The point  is that there isn’t enough information to make an informed judgement one way or another, accusations made by the media notwithstanding. The problem is when health care horror stories — a favourite Canadian meme — appear in the press, it’s always a one-sided conversation. When hospital spokespeople say they cannot discuss the issue because of patient confidentiality, they aren’t being obfuscatory. Hospital administrators aren’t perpetuating a cover-up  By law, hospitals absolutely cannot make public patient information. This is to protect patients themselves. I mean, do you want information about you bum boil perianal abscess publicized?

The interesting thing for me is that the story, and how it is being played out in the media, suggests the public has a fundamental lack of trust in hospitals/health care and their ability to address complaints, and especially serious complaints like this one. This is precisely because there is a legislatively mandated lack of transparency. It’s not like hospitals want to treat patients shabbily, or think unethically (and possibly illegally) restraining patients is best practice, or don’t approach patient complaints with the necessary due weight. From experience, I can verify hospitals take all sentinel events extremely seriously, because we are, after all, in the business of making people better. I have no doubt that multiple various administrators at St. Joe’s are addressing the issue as I write. In short, time is needed for the appropriate investigations to be made.

I have to think, whatever the outcome, that this whole business was fundamentally a nursing issue. It could have been avoided. Basic Nursing 101: Avoid power struggles.  The nurses should have just let Mr. Meredith sit in his chair. Maybe that’s the ultimate takeaway.

Related articles

• Toronto man, 78, says he was injured by hospital staff (cbc.ca)

So When Does This Become a Crisis?

I walked into the Emergency Department one hot morning a couple of weeks ago and found every last stretcher — twenty-five beds, including the two we try to reserve for trauma or codes — was filled with admitted patients; furthermore, five additional patients were waiting for consultants and likely admission. We were operating at 120% capacity even before the usual gamut of ED patients would begin flooding in.

Trying to manage an ED under these circumstances is like walking through an open field holding an umbrella during a thunderstorm. You know lightning is going to strike, and you hope like hell it doesn’t strike you. As charge nurse you start re-triaging the patients already under your management. Which admitted patients requiring cardiac monitoring can be safely parked in the hallway (in violation of fire codes) to make room for the syncopal vag bleed at triage? Which chest pain gets the last monitored bed? Is that MVC the paramedics rolling in nothing or a multisystem trauma?

And then, nurses providing care at the front-line begin to get frustrated and angry, because all of them chose to be ED nurses (as opposed to med-surg nurses), and they have lots of expensive education to validate their choice. In the event, they are helpless watching their elderly admits decompensating before their eyes.

Even more seriously, the sudden arrival of a trauma or a patient coding in the waiting room means a scramble to find room; in a scenario when seconds count, delay could be disastrous if there is no available bed to treat them. I don’t actually think the general public understands the fine line emergency department nurses and physicians walk between successful outcomes, where the patient is treated, made well, and discharged, and the morgue. Every health care professional in the ED practices with their heart in their throat and their licences over the fire.

So when does this become a crisis?

We’re told the principal cause of ED overcrowding is patients waiting for long-term care blocking acute-care beds. Not quite coincidentally the Toronto Star recently published an article about the appalling treatment an elderly woman received at the hands of a nursing home called Upper Canada Lodge in Niagara-on-the-Lake. The woman, named Sylvia Bailey, had a broken tibia which was left by nursing home staff untreated for twenty-three days.* She later died because of complications related to the fracture, and the case is now subject to a coroner’s inquest.

The two issues are not unrelated. Health care for seniors is vastly underfunded, and it’s reflected in both the number and quality of beds available. As a society we tend to give a lot of lip service to the care and support we give to seniors. In reality the frail elderly are at the bottom of the health care food chain. They aren’t glamorous or fashionable or have carefully managed public-relations campaigns associated with them. How many people do you see wearing a bracelet or ribbon for proper health care for seniors?

I tend to be quite cynical about this. The elephant in the room is that care for seniors is expensive, and no politician seems to be willing to state the obvious: provision of even adequate supports for a growing population of senior citizens is going to take a considerable mobilization of financial resources, i.e. increased taxes. Politicians love adopting seniors as a apple-pie issue. But given the current political climate which informs us we’re over-taxed, nurses are over-paid,and  the health car system is bloated, and throw in dodgy financial calculations by every provincial political party, any politician who tells you the case of Sylvia Bailey shall never be repeated, and ED wait times will magically disappear is flat-out lying.

So again, when do we decide this is a crisis?

__________

*College of Nurses of Ontario, are you listening?

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?

How to Eat in the Most Obese County in the United States

Let’s start with an appetizer:

One thing you need to know before going to the Mississippi Delta is what a Kool-Aid pickle is — and how to make it.

1. Pour pickle juice from a jar of pickles into a bowl.
2. Add Kool-Aid to pickle juice.
3. Pour pickle juice back over pickles.
4. Enjoy?

Where can you find Kool-Aid pickles? All over the region, including at the Double Quick, a chain of convenience stores, many of which also sell a smorgasbord of fried foods.

The video, produced by the NPR and Oxford Magazine, documents the difficulties eating well in (putatively) one of the richest agricultural regions on earth, where fresh, unprocessed food is the exception. Not surprisingly, there is a close relationship between poverty and poor diet; the devastating sequellae of diabetes, hypertension, heart disease and stroke, it hardly needs to to be said, ends up afflicting those least able to afford the health care, drugs and lifestyle changes necessary for effective management. Note the interview in the grocery store, and the dearth of fresh vegetables, apart from a few over-processed tomatoes and cucumbers.

Gone Gardening, and Theresa Brown Gets Bullied

Spring has finally made a tentative appearance, so I’m outside communing with nature today.

A couple of thoughts to consider: First, is there a connection between bullying in health care and this?

Also, check out the growing dust up between Theresa Brown (@TheresaBrown), who wrote in the New York Times yesterday decrying the culture of bullying in health care institutions, and the somewhat defensive, hand-wringing reactions of some prominent physician bloggers, whose principal objection seems to be nurses shouldn’t have the temerity to call out physicians who bully them. I’m guessing, incidentally, most nurses will agree with Brown on this.

Shock and Awe Advertising, Part 2

More shock and awe health care advertising, via Thunder Bay Regional Health Sciences Centre’s P.A.R.T.Y. Program. This program, originally developed by Sunnybrook Health Sciences Centre, is aimed at reducing trauma/risk-related injury among youth.

P.A.R.T.Y. Program: Webpage ~ Facebook.

Shock and Awe Advertising, Part 1

This ad is evidently creating some controversy, including the use of a very (medically) graphic image at :24. Don’t say you weren’t warned. Is it worthwhile? From my point of view, yes — but then, I think anything is fine by me that grabs the eye and makes the message in a media saturated world.