Nursefriendly.com: patient care

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Saturday, August 20, 2011

A Nurse's Wish, Nursing Poems, Caregiver Stories

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To be a nurse requires dedication,
with years of study and preparation.
I pray for guidance and humbly ask
that I will do well at this chosen task.
When illness strikes or pain demands,
and a life is placed within my hands,
give me compassion, knowledge and skill
to do the things that comfort and heal
Suffering makes patients' fears grow worse
and they seek reassurance from their nurse.
Help me see things from their point of view
and always know what is best to do.
May I have a part in some small way,
in restoring good health to someone today.
Let my work be all that I want it to be
I ask the Great Healer to work through me.
Helen Bush

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Friday, July 8, 2011

When Nurse Make Mistakes (Theresa Brown, RN) - NYTimes.com

By THERESA BROWN, R.N.
This year, a Seattle nurse named Kim Hiatt committed suicide. Ms. Hiatt’s death came nearly seven months after she had given an unintended overdose to an infant heart patient, a medical error that was said to have contributed to the child’s death days later.
Ms. Hiatt had been a nurse for 27 years and had often cared for the 8-month-old girl during the child’s stay in the pediatric intensive care unit of her hospital. She had probably drawn up the right dose of the drug hundreds of times in her career. But once, she made a life-changing error. A baby died, and she was suspended, then fired from a profession she loved. And now she’s dead.

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Thursday, May 5, 2011

Notes of a Student Nurse: A Dose of Reality « Off the Charts

It’s been said before that we are our own worst enemies, our own worst critics. I can’t imagine a time when these phrases are truer than during nursing school. Little more than a year ago, when I was starting my prerequisites for admission to the BSN nursing program, I was giddy with excitement. Images of what life would be like played in my head like episodes of Grey’s Anatomy, or, on a day I was feeling a bit more goofy, reruns of Scrubs.

I took any opportunity I had to share with friends, family—even new apartment neighbors—that I was well on my way to nursing school with the confident smile of a person destined to save the world, one patient at a time. I scoured discussion boards and nursing student forums late into the night, anticipating the day that I, too, would have something profound to contribute.

I laughed off those who warned me that the path was difficult and ridden with challenges. There was no bridge I couldn’t cross, no task I couldn’t do, and no test I couldn’t pass with flying colors. The world was mine. Now, I’m living those moments as a first semester nursing student—but a funny thing happened on the way to the present, a thing I will lovingly refer to as reality.

via ajnoffthecharts.com

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Sunday, May 1, 2011

What Nurses Wish You Knew - Philadelphia Magazine - phillymag.com

No matter what health-care reform winds up looking like, one thing’s certain: Nurses will play a bigger role than ever, taking over duties from doctors, moving out of hospitals and into the community, looking after frail aging boomers, leading the push to keep costs down and improve outcomes. So this seemed the perfect time for a consult with the people who really run health care in Philadelphia. As one nurse told us, “Doctors only think they’re the quarterbacks.” Here’s what nurses had to say about their work, their patients, life and death, and those little white caps they used to wear.
1 // It’s okay to buzz // Really. Go ahead. Room too cold? Need a pillow? Got a question about your meds? Use the buzzer; that’s why they put it there. “My 82-year-old mother was just in the hospital for a stroke,” says Presbyterian Hospital’s Michael Becker, “and she said, ‘I can only hit the buzzer two times a day.’ I asked, ‘Why is that?’ and she said, ‘Because they’re going to get tired of seeing me.’ I said, “No, no, Mom, it doesn’t work that way.’” If somebody’s pushing the buzzer all the time, nurses know there’s a deeper issue and work to address it.
2 // You don’t have to be afraid // Nurses understand that patients often don’t speak up because they feel vulnerable. But when we don’t voice our thoughts, they have no way of knowing what needs improvement—until the patient-satisfaction survey arrives after the fact. And they hate finding out there was something they could have fixed if they’d known about it. “It’s natural to be fearful,” says Pennsylvania Hospital’s Mary Del Guidice, “because you’re lying in bed with all these faces looking down at you. But don’t be afraid of us.”

via phillymag.com

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Monday, April 11, 2011

Patient complaints do not fit the primary care office visit

by Kevin Pho, MD
Primary care physicians often have to see patients with a litany of issues. Often within a span of a 15-minute office visit.
This places the doctor in the middle of a tension — spend more time with the patient to address all of the concerns, but risk the wrath of patients scheduled afterwards, who are then forced to wait.
And, in some cases, it’s simply impossible to adequately address every patient question during a given visit.
It’s a situation that internist Danielle Ofri wrote recently about in the New York Times.
In her essay, she describes a patient, who she initially classified as the “worried well”:

via kevinmd.com

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Wednesday, February 9, 2011

Nurses’ Widespread Job Dissatisfaction, Burnout, And Frustration With Health Benefits Signal Problems For Patient Care — Health Aff

Job dissatisfaction among nurses contributes to costly labor disputes, turnover, and risk to patients. Examining survey data from 95,499 nurses, we found much higher job dissatisfaction and burnout among nurses who were directly caring for patients in hospitals and nursing homes than among nurses working in other jobs or settings, such as the pharmaceutical industry. Strikingly, nurses are particularly dissatisfied with their health benefits, which highlights the need for a benefits review to make nurses’ benefits more comparable to those of other white-collar employees. Patient satisfaction levels are lower in hospitals with more nurses who are dissatisfied or burned out—a finding that signals problems with quality of care. Improving nurses’ working conditions may improve both nurses’ and patients’ satisfaction as well as the quality of care.

via content.healthaffairs.org

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Tuesday, December 14, 2010

Integrating New Nursing Grads, Nursetogether.com

Do you remember what it was like to be a new nursing graduate? One day you were a student, and ‘poof,’ one day you were a nurse. Expectations ran high and responsibilities ran even higher. The cushion of ‘just being a student’ and having your instructor ultimately be responsible is gone in an instant. Do you remember the anxiety, fear and unsure feelings of those first few months?

When you are well into your own career and overloaded with your own patients, it is easy to forget what it was like in the beginning. But wait, we need your active participation to help us integrate our new staff, now more than ever! In a profession that is one of the most trusted and respected in the world, it is embarrassing that we have a phenomenon known as ‘nurses eating their young’ - the well known, but little talked about, epidemic of senior nurses making work life even more challenging for their young counterparts. I am hopeful that the general public is unaware of this, as it would be rather embarrassing for us!

Why do you think this exists? Do we feel that new grads must ‘pay their dues,' that because no one supported us, we don’t need to support them? Is it our own insecurities? Are we worried they have newer, fresher knowledge, and that they will want our jobs?

Whatever our reasons, whether conscious or not, many of us are hurting, rather than helping, our new nurses integrate into our institutions. With the shortage of nurses so prevalent, wouldn’t it be in OUR best interest to help these ladies and gentlemen through their first, and possibly most challenging, year in the profession?

Dr. Judy Boychuk Duchscher, RN, PhD, has made her life’s work helping new nurses transition into the workplace. Beyond this article, her compelling research and tools for integration can be found on www.nursingthefuture.ca.

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Monday, December 13, 2010

Doctors, nurses often contribute to patients' weight problems - FierceHealthcare

Although some doctors and nurses seems to think stigma and shame can help motivate patients to lose weight, the opposite seems to be true, according to a doctor's commentary published today in the Los Angeles Times.

"People who are exposed to stigmatizing situations are more likely to engage in unhealthy eating behaviors and less likely to be physically active," said Rebecca Puhl, director of research at the Rudd Center for Food Policy and Obesity at Yale University, who was interviewed for the piece.

Indeed, most women in one study coped with stigma over their weight by eating more food or refusing to diet.

What's more, humiliating interactions may make overweight patients unwilling to seek out medical care, which means their other medical problems likely will go untreated, as well. Puhl says that healthcare providers need to adjust their expectations, pointing out that losing weight isn't just about having patients go on diets. An inability to diet down to a healthy weight isn't due to just lack of motivation, according to Puhl.

She also calls on healthcare providers to recognize that even relatively small changes in weight count as progress toward better health. Most people can't lose more than 10 percent of their body weight and keep the weight off over time, she says.

Dr. Valerie Ulene, the commentary's author and a preventive medicine specialist whose siblings tortured her when she was an overweight child, says that patients who are overweight deserve to be treated compassionately and effectively. "It's not just the right thing to do, it's the best approach for successful treatment," she writes.

To learn more:
- here's the Los Angeles Times commentary
Related Articles:
Too often, MDs blame obese patients' ills on fat
To help patients lose weight, don't call them fat
Health-conscious docs more likely to offer lifestyle advice
Conquering chronic disease with lifestyle medicine
Guest Commentary: Brad Wilson on fighting obesity

via fiercehealthcare.com

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Monday, November 29, 2010

The New, Well-informed Patient - NurseZone

The New, Well-informed Patient

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Annette Moore-Mitchell, MSN, RN, CMSRN, suggests removing distractions and assessing to be sure patients are ready to listen before beginning any teaching session related to their condition and care.
“When patients are fully informed, it helps relieve anxiety and uncertainty,” said Annette Moore-Mitchell, MSN, RN, CMSRN, clinical instructor of nursing at Oklahoma City University in Oklahoma.

Children require special attention to decrease stress levels. Not only must parents understand the plan of care, the patient and siblings also want to know what is happening. Child life specialists at Children’s Medical Center Dallas provide supportive care by using developmentally appropriate education, preparation and therapeutic activities to improve patients’ emotional well-being.

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Tuesday, November 16, 2010

Hospital care fatal for some Medicare patients - USATODAY.com

An estimated 15,000 Medicare patients die each month in part because of care they receive in the hospital, says a government study released today.

The study is the first of its kind aimed at understanding "adverse events" in hospitals — essentially, any medical care that causes harm to a patient, according to the Department of Health and Human Services' Office of Inspector General.

Patients in the study, a nationally representative sample that focused on 780 Medicare patients discharged from hospitals in October 2008, suffered such problems as bed sores, infections and excessive bleeding from blood-thinning drugs, the report found. The federal Agency for Healthcare Research and Quality called the results "alarming."

"Reducing the incidence of adverse events in hospitals is a critical component of efforts to improve patient safety and quality care" in the U.S., the inspector general wrote.

The findings "tell us exactly what some of us have been afraid of, that we have not made much progress," said Arthur Levin, director of the independent Center for Medical Consumers and a member of an Institute of Medicine committee that wrote a landmark 1999 report on medical errors. "What more do we have to do to make sure that sick people can rest assured that they're not going to be harmed by the care they're getting?"

Among the findings in the report obtained by USA TODAY:

•Of the 780 cases, 12 patients died as a result of hospital care. Five were related to blood-thinning medication.

Two other medication-related deaths involved inadequate insulin management resulting in hypoglycemic coma and respiratory failure resulting from oversedation.

•About one in seven Medicare hospital patients — or about 134,000 of the estimated 1 million discharged in October 2008 — were harmed from medical care.

•Another one in seven experienced temporary harm because the problem was caught in time and reversed.

About 47 million Americans are enrolled in Medicare, a government health insurance program for people 65 and older and those of any age with kidney failure.

The adverse events found in the study weren't necessarily due to medical mistakes, said Lee Adler, a University of Central Florida medical professor who was involved in the study. For example, he said, an allergic reaction to a penicillin injection is an adverse event, but it's a medical error only if the patient's allergy was known prior to the shot.

Among the problems identified in the report were Medicare patients who had excessive bleeding following surgery or a procedure. For example, one patient had excessive bleeding after his kidney dialysis needle was inadvertently removed, which resulted in circulatory shock and an emergency insertion of a tube to allow breathing.

When the tube was removed the next day, the patient inhaled foreign material into his lungs and needed lifesaving medical help, the report said.

Peter Pronovost of Johns Hopkins University, co-author of the book Safe Patients, Smart Hospitals, said medical mistakes are "an enormous public- health problem."

"We spend two pennies trying to deliver safe health care for every dollar we spent trying to develop new genes and new drugs," Pronovost said. "We have to invest in the science of health care delivery."

via usatoday.com

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Monday, November 15, 2010

Top 10 Pocket-Essentials for Nursing and Clinicals - Nursing Link

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Top 10 Pocket-Essentials for Nursing and Clinicals

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Scrubs Magazine

Scrubs Magazine is the lifestyle website for and about nurses. Here you’ll find weekly giveaways, “best of” lists, and both the lighter side and the serious side of nursing with cartoons, scrubs style DOs and DON’Ts, beauty, health and wellness. Scrubsmag.com also features revealing stories from nurse bloggers ranging from a newly minted nurse to a seasoned RN to a misunderstood male nurse. Follow us on Twitter and join our conversation on Facebook.

More articles from this author:

Self-Defense for Nurses

3 Great Nurse Jokes

10 Tips to Fill Your Tummy, and Not Your Scrubs!

Ani Burr | Scrubs Magazine

Every nurse (and student nurse!) carries around the essentials, here’s my “Top Ten” pocket-essentials for nursing and clinicals!
1. Pens – There’s something magical about nursing – nurses can make pens disappear into thin air! Make sure you keep extras near by, but always have a black ink pen on hand. Even if your hospital has gone paper-less, you’ll need it to mark something, sign something, or make a note of something. Highlighters for your own use – marking up your papers, and a dry erase marker for your patient boards.
2. Stethoscope – I guess this one is a given, but you want to make sure you get a stethoscope you can use effectively (i.e. the ear pieces aren’t poking your brain so hard you can’t concentrate on the sound), and also make sure you have a type specific to your patient population (adult, cardio, peds, neonates, etc).
3. Bandage scissors – There’s always a use for these, even when you’re not cutting bandages or tape. No sense wasting time fumbling around trying to open packaging for a pulse ox, keeping a (good) pair of bandage scissors on you will save you time. Just make sure you keep an eye on them, don’t let them wander off with those pens!
4. Penlight – A penlight is an essential for a good neuro check, and to me, this is the part of the nursing assessment that is most often glazed over in non-neuro patients. Having my own pen light in my pocket is a reminder to me that I need to use it, complete my assessment, and make sure that I don’t skip it even if the patient is alert and oriented X4!
5. Alcohol prep pads – I know for clinical I stock my pockets full of these. You need them for IVs, you need them to clean off your pens – you need them. A lot of them. On hand, all the time.
6. Saline flushes – I’ll never forget the instructor who would check meds with us in the morning, and then as we were leaving the med room would grab a hand full of saline flushes and shove them in my pockets saying, “you’re going to need these!” and I always thought there was no way I would need all of these flushes. But sure enough, she was right! You probably don’t need a handful (especially since they’re bulky and their packaging makes a lot of noise in your already-full pockets) but having a spare has never hurt!
7. Tape – Taping and re-taping IV’s, taping a sign on a door, taping around a pulse-ox to keep it secure, tape is essential. Paper, plastic, satin, whatever you prefer, it will always come in handy
8. Chapstick/lotion – I always carry a chapstick, since my lips chap easily, if you need it, keep it on hand so you’re not running back to your locker/bag to grab it. Lotion can be too bulky for your pocket, but if you can find a small tub of it, and your hands dry out (especially with constant sanitizer use and hand washing), it’s important to maintain your own skin integrity.
9. Brain – Not the one in your head, but whatever it is that keeps you organized throughout the day. A change of shift sheet, a hospital-provided “brain” to keep track of everything that goes on is how you’re going to stay on top of it. Students, if you don’t have one, make your own! Check out this blog to find out what to add!
10. Cash – Last but not least, carry a few dollars on you in case you need a mid-morning or mid-afternoon snack or a quick cup of coffee. I know I always need my morning coffee with breakfast, and maybe something sweet in the afternoon!
Every nurse carries their supplies out of experience. These are what I’ve found to be practical and necessary when I am in the clinical setting and at work.

What’s in your pockets?
Next: Top Nursing Gear Must-Haves >>

More on ScrubsMag.com:
• In New Nurse: Oh Organization!
• In Male Nurse: Nursing Gear List
• In Student Nurse: What’s in Your Pockets

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Sunday, November 14, 2010

Consult-A-Nurse - HCA Hospitals, Florida

Consult-a-Nurse is a FREE community service from the HCA hospitals in your area, designed to help you find a physician, obtain health information, or register for an HCA hospital sponsored event in your community.

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Friday, November 12, 2010

Hospitals try high-tech to better inform patients - San Jose Mercury News

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In this photo taken Oct. 29, 2010, Kristen Miller, a colonoscopy... ((AP Photo/Brian Kersey))

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CHICAGO—Learning he had prostate cancer floored John Noble. Then came the prospect of surgery and his overpowering fear of being "put under" with anesthesia.
Remarkably, he found comfort in a computer. A soothing woman's voice explained the operation step-by-step, its risks and benefits, and even answered his questions. Noble's phobia vanished. The operation to remove his tumor was uneventful and Noble is doing fine.
The 54-year-old Pennsylvania lawyer was aided by an interactive computer program that is part of a growing trend in health care, helping patients better understand what they are consenting for the doctor to do.
Proponents say this way of getting informed consent makes patients partners in decision-making.
Such a system "sends a message that the decisions are truly owned by the patients," said Dr. Harlan Krumholz, a Yale University heart specialist and advocate of changing informed consent procedures.
Computer-based informed consent programs are also part of a broader push for electronic record-keeping that President Barack Obama's administration has advocated to improve patient safety and curb medical errors.
The Emmi Solutions program that John Noble watched about prostate cancer surgery can be viewed at home, and that's where Noble watched it.
Shortly after his diagnosis last December, while he was still grappling with shock and denial, his doctor e-mailed him the program.
"I put off watching it for a
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while," he said. "Who wants to be filled in on the facts of the surgery? Ultimately I forced myself to review it when I was all alone."
By the time he watched it, he felt better prepared mentally than when his doctor first told him he had cancer.
Noble said his biggest fear "was being knocked out. I was terribly afraid of it."
As the interactive explained the operation, Noble could pause it and ask questions or review the information to make sure he understood it.
"It changed my perspective. It removed my fear," he said.
Traditionally, informed consent has involved a conversation with the doctor and signing medical forms written in tough-to-decipher legalese.
It has a dual purpose: to make sure patients understand risks and benefits, and to protect hospitals from lawsuits in case something goes wrong.
Even for someone with a law degree, like Noble, that process can be dizzying in the emotional aftermath of a scary diagnosis.
Research shows patients often have no clue about what they just signed and may end up totally uninformed about why a procedure is being recommended or how it might help or hurt them.
Chicago-based Emmi Solutions has developed programs used in more than 100 hospitals, including the University of Pittsburgh Medical Center, where Noble had his surgery.
Dialog Medical in Atlanta makes another popular informed consent program, iMedConsent, used by more than 190 U.S. hospitals. It's designed for doctors and patients to go over together. Versions written for patients with a sixth-grade reading level are available.
The Department of Veterans Affairs now requires its doctors to use iMedConsent programs for all procedures needing informed consent. The VA estimates it will receive 2.6 million consent forms this year from patients who used the program.
Dr. Ellen Fox, the VA's chief health care ethics officer, recalls a patient who watched the program with his doctor before having a repeat test to see if his bladder cancer was back. Afterward, the man told his doctor he thought he would be having the same test he had four times before.
It was the same test. "But for the first time, the patient really understood what was going to be done to him," Fox said.
"In order to make informed choices about health care, patients need complete and accurate information," Fox said.
"It is ultimately the patient's choice" whether to have a procedure. It's just that patients may not realize they have a choice. The program helps make that clear, she said.
The University of Chicago Medical Center recently began requiring new patients referred for colonoscopies to watch an Emmi program, with hopes that it will reduce the no-show rate.
Kristen Miller, 29, an online marketer with an intestinal condition called Crohn's disease, watched the Emmi program before she had a recent colonoscopy.
Miller has had previous colon exams and wasn't nervous about the procedure. But for the inexperienced, she believes it would take away "the intimidation factor."
Knowing more about the procedure may make it seem less unpleasant, and better informed patients are more prepared for their treatment, said Dr. Stephen Hanauer, the hospital's gastroenterology chief.
Research has shown that better informing patients about their care also can make them less likely to sue if something goes wrong. Still, it's no guarantee, and computer-based informed consent programs provide an electronic record that gives hospitals extra ammunition against malpractice lawsuits.
When patients watch Emmi programs, stopping and starting them to review information, they create an electronic trail. Hospitals have used that data in court to argue that patients were informed about specific risks because they watched portions of the program where risks were detailed.
Sara Juster, a vice president at Nebraska Methodist Health System, says that feature may have played a role in a patient's recent decision to drop a lawsuit against Methodist Hospital in Omaha.
The patient had sued over a shoulder injury her baby suffered during childbirth, a problem her first child also had encountered. The woman had watched an Emmi program detailing risks for the injury, but claimed she had not been informed, Juster said.
The hospital had electronic documentation, so the woman dropped her suit.
Juster said most of the system's obstetricians give pregnant patients "prescriptions" to watch Emmi programs about labor and delivery. Within the past eight years, obstetrics-related suits against the system's hospitals have dropped by half, from about 12 a year to six.
———
Online:
Emmi Solutions: http://www.emmisolutions.com
Dialog Medical: http://www.dialogmedical.com
Foundation for Informed Medical Decision Making: http://www.informedmedicaldecisions.org/

via mercurynews.com

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A Bit of Wisdom

People are often unreasonable, illogical, and self-centered;
Forgive them anyway.

If you are kind, people may accuse you of selfish, ulterior motives;
Be kind anyway.

If you are successful, you will win some
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Be honest and frank anyway.

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Build anyway.

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The good you do today, people will often forget tomorrow;
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Give the world the best you've got anyway.

You see, in the final analysis, it is between you and God;
It never was between you and them anyway.

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