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Answers to Your Nursing Career Questions

It’s Patient Safety Awareness Week from March 6 to 11, 2011

March 4th, 2011 by – Marijke Durning

Did you know that next week is Patient Safety Awareness Week? It’s an annual observance led by the National Patient Safety Foundation. According to the website, the foundation’s mission is to improve the safety of patients by:

- Identifying and creating knowledge associated with patient safety

- Identifying how to spread the knowledge

- Developing the culture of patient safety and

- Raising public awareness of the issue

So, what exactly is the week for?

The week is to help health care personnel from nurses to lab technicians and doctors to pharmacists to remember, identify, and/or learn about issues in patient safety. The foundation encourages initiation of conversations and programs, and assessment of patient safety in various facilities.

While it may be too late to do any official planning for your facility this year, it’s never too late to discuss patient safety with  your colleagues. A few  minutes during shift change or a staff meeting, if one is planned, are good times to review basics and perhaps ask if there are issues that your colleagues would like to discuss.

Why is this needed?

Patient safety involves many different things. Patients can be harmed by falling, by medication errors and by other mix ups in procedures. Although many of these incidents are labeled as accidents, most are not truly accidents but occurred because someone skipped a step or failed to identify a danger.

Constant reminders in the form of programs, posters, meetings, workshops, and reviews of incident reports can help nurses understand and remember where the accidents may occur and how they should be avoided.

Nurses don’t voluntarily go in to work saying they’re going to harm a patient, of course not! But, reminders, such as this awareness week do help us remember that mistakes and accidents happen – and many are preventable.

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When I’m a nurse, I’m never going to….

February 17th, 2011 by – Marijke Durning

When you were a nursing student – or perhaps you are studying nursing right now – did you ever say, “When I’m a nurse, I’m never going to ____”? Chances are that you did.

Of course, there are things that we say we’ll never do and we won’t do them – that includes illegal and unethical behavior. But most of us, at one time or another, have observed a nurse’s behavior and declared that we would never be like that. We would never be short with a patient. We would never be abrupt with a colleague. We would never forget to do something and – the biggest of all – we would never make a nursing mistake.

In a perfect world, we would keep our vows to never do anything that could be perceived as less than perfect. But sometime was we see and interpret as “wrong,” may not actually be that way. Don’t forget, we are getting mere glimpses of behavior and we are imposing our own judgment on that behavior.

Imagine a nurse coming out of a patient’s room and you hear him saying to someone in the room, “I told you I would be right back,” in what you deem to be an exasperated tone. You may decide that this nurse is being impatient and should be speaking with more respect. And, you may be right. However, we don’t know what happened in the room, we don’t know what he said to the patient before that – in fact we don’t know anything other than the sentence we heard and the tone in which we perceived the message was said.

It’s not just in nursing jobs that these types of scenes occur. We may be in a grocery store and hear a child having a temper tantrum and the parent may be at her wit’s end. It’s not unusual for people to think thoughts like:

- That’s what you get for taking your child to the store late in the evening.

- Geez, all she has to do is tell the kid “no!”

- If that was my child, she wouldn’t be screaming like that.

- Can’t she just take the kid and leave?

- When I have children, they’re never going to be allowed to behave like that.

These are all judgments that people are making without knowing any of the background. And many of us make those judgments every day.

What “nevers” do you remember thinking when you were studying nursing?

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Preventing concussions

February 15th, 2011 by – Sue Barton

  I work in a rehab facility and take care of patients with traumatic brain injuries. This is not really a question, but I just want to get the word out to other nurses about prevention.  Can you help? 

There has been more information and interest in this topic over recent years, both in professional  publications and in those for the general public.  Of particular concern has been the topic of repeated concussions in both professional and student athletes.  As nurses we can all help get the word out to our patients and our communities about the preventive value of helmets and the importance of seat belts,car seats and booster seats.  While helmets are required for football players for example, they are also important for recreational use for bike riding, in-line skating and skateboarding, skiing, snowboarding and even sledding.  Many communities have organizations that sponsor free bike helmets and fitting sessions.  Make sure that helmets fit properly; a bike helmet should sit flat across the head rather than tilted back and should fit snugly.

The CDC has helpful information on concussion prevention and treatment for both the health care providers and for the public, including parents and coaches.  The person who sustains a concussion should avoid activities that could lead to re-injury for at least 2 weeks. 

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Nurses: Tomorrow is Darwin Day, Feb. 12

February 11th, 2011 by – Marijke Durning

We’ve all read the jokes about Darwin, his theory of evolution and the reasons behind the “Darwin Awards.” And sometimes, the nurses, especially in the country’s emergency rooms, think they are meeting many of the Darwin Award contestants.

While some of the events may seem a bit on the questionable side, we nurses can often nod our head and say “Yup, I had a patient who was just like that.”

One winner in 2001 was from Pennsylvania:

“Phil, a curious Philadelphia resident, wondered what it felt like to be hit by a bullet… so he took a gun and shot himself in the shoulder. This sent the ambulance racing to Phil’s residence for the second time to treat another gunshot wound. Why did he do it, not once but twice? In Phil’s own words, “I wanted to see if it hurt as much as it did the first time.”

In 2003, this story came out of India – if it wasn’t tragic, it would be funny:

“Regarding accidental deaths during the construction of a subway in New Delhi, the New York Times wrote, “One of those killed was an unlucky thief who tried to steal braces holding up a concrete slab; it fell and killed him.””

And also from 2003, from the state of California, comes John’s story:

“John, a Los Angeles real estate attorney, was skimming leaves from his pool when he noticed a palm frond caught in the power lines. His education had equipped him with sufficient acumen to become a successful litigator. Yet he was not shrewd enough to avoid becoming a toasty critter, when he reached up with the long metal pole and poked at the palm frond. Did I mention the power lines?

John was, for once, the path of least resistance.

Perhaps as an homage to his litigation skills, his family sued both the utility company and the pool supply store, for failure to disclose the danger of poking a metal rod into the power lines.”

Do you have any great Darwin Awards stories to share?

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Home care for aging patients

January 15th, 2011 by – Sue Barton

  I’m a student making home visits to an elderly couple where the husband has mobility problems due to vertigo, as well as progressive dementia.  Where do I start to help them?

This is such a good experience for you as a student because it reflects the future direction of health care in two important ways.  The first is the aging population, which will mean more needs in the area of geriatric care.  Secondly the trend will be toward providing more care in home and community settings.   From your description, it seems clear that safety is a priority in the area of fall risk.  Also,  there will likely need to be assistance for the wife if she is increasingly in the role of caregiver for her husband.

Be sure that you have complete information about any complicating disease issues such as diabetes or heart conditions, and review medications.  Are medications being given appropriately, and are side effects a problem?  You can arrange for PT and OT evaluations and adaptations of the home from a safety perspective.  Home care aides can visit to assist with bathing, meals and daily activities.  Adult day care programs may be an option to provide a therapeutic setting for the elderly man and respite for his wife.

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Measuring OTC medications

January 11th, 2011 by – Sue Barton

  I’m on my pediatric rotation now, and I want to be sure that parents are giving the right dose of over the counter medicines like acetaminophen.  What is the best teaching plan?

Medication for children is dosed by weight, usually in mg/kg doses.  Many over the counter (OTC) meds have doses by weight and age on the label, but often the label advises parents to check with their health care provider.  You can determine correct dosage by consulting your pharmacology references and doing the math, or you can refer to dosing charts for commonly used medications provided by the manufacturer.  For commonly used OTCs such as acetaminophen and ibuprofen, it’s helpful to give parents a dosing chart for reference as the child grows.  Show them how to use the current weight, the product form (drops, elixirs, chew-ables, junior tablets), and the correct time interval between doses to give the medication in a safe and effective form.

It’s helpful to demonstrate drawing up the correct dose in a marked dropper or oral syringe, and have the parent return the demonstration.  Using terms such as teaspoon (5 ml) can be confusing if a kitchen spoon is used rather than a calibrated measuring device.   While overdosing can cause toxicity, under-dosing can mean the child does not receive adequate symptom relief.

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Posted in Common Nursing Procedures, Patient Interaction

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Characteristics for Psychiatric Nursing

December 8th, 2010 by – Derek Brocklehurst

What are the personal characteristics needed to be a good psychiatric nurse?

Being a good psychiatric nurse means providing excellent and safe care to all of your patients. The psychiatric and mental health field can be extremely taxing on your own mental health, as the patient population can be challenging. From schizophrenic patients who hear voices to patients with 2 conflicting personalities, the patients you will encounter on a mental health ward require big-hearted nurses with their wits about them.

As far as characteristics go, you want to be a great listener. Many of these patients will have stories to tell and it is important for you to pick apart the irrelevant statements from the cues or hints that might point to better patient care. For instance, if a schizophrenic patient is telling you a story and they mention they “hear voices”, you might inquire as to what those voices are saying, specifically asking if they are telling the patient to harm themselves or others. Providing safe care, emotionally, physically, and mentally, to all psychiatric patients in your #1 priority.

Please visit the American Psychiatric Nurses Association webpage for more information about mental health nursing.

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Posted in On-the-Job Fears, Patient Interaction

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Hospice and Palliative Care Coping Mechanisms

December 6th, 2010 by – Derek Brocklehurst

What are some coping mechanisms for both the hospice nurse as well as the hospice patient in end-of-life care?

Hospice and palliative care nursing can be very fragile and emotional work environments. If a patient has a debilitating or terminal illness, it can be extremely trying for all parties involved. Remember, your #1 job as the nurse is to safely deliver care to the patient. It is also good to know that taking care of yourself and your emotional needs will in turn help you care for your terminal patient.

Some coping mechanisms for the nurse in such situations would include communicating and voicing emotions with friends, coworkers, or family about your job and hospice care in general (be careful not to bring up any specific patient information as to not break HIPAA regulations.) If a patient passes during your care, memorializing the patient and reflecting on positive aspects of the patient’s life can help to bring some closure to you. Make sure to check out the Hospice and Palliative Nurses Association website for more information.

Coping mechanisms for the patient during times of sorrow and terminal illness would include scheduling visits with family and friends to help the patient reflect on their life. Even though tears might be present, encouraging the patient to open up and reflect on past accomplishments with loved ones will help them through difficult times.

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Posted in On-the-Job Fears, Patient Interaction

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How HIV & AIDS Changed Nursing

December 2nd, 2010 by – Marijke Durning

Nursing has changed drastically over the past few generations, but not all changes are due to technology and progress.

Nurses who graduated before then 1980s can remember what it was like to give patient care in the pre-HIV/AIDS days. Universal precautions, which are now taken for granted in the United States, were not part of nursing practice before 1981. Patients were placed on isolation if they were known to be or suspected to be infectious, but if there was no reason to suspect, no precautions were taken.

Gloves for nursing care were reserved for isolation patients, intimate care or for cleaning body fluids. To wear gloves to give a backrub or take blood just wasn’t done. It was a waste of resources and considered not necessary.

How things have changed. Now nurses have to consider everyone and anyone as being infectious – not just with HIV, but other blood borne disease as well, such as hepatitis C. By treating everyone as infected, nursing staff decrease their risk of being accidently exposed to contaminated fluid.

While these changes have all been necessary to protect the nurses, how have they affected health care, patients and nurses?

When a patient is approached by a nurse who won’t touch him without gloves, this can be demoralizing, especially if you know you don’t have a contagious disease. While it’s understandable that a nurse will wear gloves if giving a bedpan or starting an intravenous, is it necessary to wear them while helping a patient stand up? To help him put on his hospital gown? The human touch has left nursing – there seems to always be a rubber or latex barrier between the nurse and the patient.

Nurses are more frightened now. We’re afraid of catching diseases from our patients, whether the fear is even realistic. Being pricked by a used needle has gone from concerning to frightening. Patients are assumed to be contagious, so a nurse who may have been exposed to body fluids lives with the fear of infection until tests prove otherwise.

Health care costs increase too. While gloves may seem to be a relatively inexpensive item, we now go through so many boxes now that they have become a large part of supply costs.

Yes, nursing has definitely changed.

December 1 was World AIDS Day – an important day to remember. Millions of people are still becoming infected world wide. The disease has not been beaten, only subdued in some parts of the world.

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Posted in Patient Interaction

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How to Help a Family After a Death

November 12th, 2010 by – Marijke Durning

When a patient dies, the nurse’s immediate physical tasks may be over, unless he must do the after-death care, but his psychosocial care of the family and friends may continue a while longer. Not everyone is comfortable talking about death, but it is a reality and one that most of us deal with every day. So what can nurses say when families ask them questions about what to do after a death?

Here are some examples:

Funeral homes

If the death was expected, the family may already have made arrangements with a funeral home. Or, regardless of how the patient died, the family may have pre-planned funeral arrangements. If this is the case, the family must contact the funeral home to get the process going. If the family does not have arrangements, they must choose a business that they feel is best for their needs. Choices may be made based on location, for the convenience of visitors; the size, if many people are expected; religious beliefs; and family tradition, just to name a few.

The family needs to provide the funeral home with information about the deceased, such as the name, age, where the body is located, and a few other details as requested by the individual funeral directors.

Death notice

Not all families choose to put a notice in the paper (or online now), but those who do may choose to write it themselves or have it done by the funeral home staff. This is usually one of the services they offer.

Telling others about their loved one’s death can be very difficult. Sometimes it is easiest to ask one or two friends or family members to be the point person to give out information to people who ask about the upcoming service if there is to be one.

Burial or cremation

If the family hasn’t discussed this before the death, it could be a touchy subject. Unfortunately, this can also cause rifts in families. There’s not much a nurse can do in the way of suggestions, but maybe just hearing them out can help them make their decision.

Death certificate

Death certificates are valuable documents that must be kept safe. If possible, the family should get more than one copy because many of the needed tasks, such as dealing with the bank to insurance usually requires a death certificate.

Who to notify

After a death, there are many people who should be or need to be notified:
Governmental agencies (governmental assistance,  car registration, licenses, anything official that was in the deceased person’s name)

Insurance companies if there was life insurance

- Banks and financial institutions, to close credit and bank accounts that belonged to the deceased person

Employers, to allow the employer to activate any benefits that may be provided by the company- Companies to whom the deceased paid bills, they will have to be settled, closed, or transferred

- Lawyer who holds the will, if one was written

Death, even when it’s expected, usually throws a family into chaos – some more than others. But if a nurse is able to answer some of their questions, this may make a big difference in how they remember their loved one’s last hours and death.

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The material on this site is for informational purposes only, and is intended as a supplement, not as a substitute for medical advice, diagnosis, or treatment provided by a qualified health care provider.