Everyone who has been reading in this blog site knows that I hate to be floated to other units coz I have written a post about being floated earlier. Last night was another “nightmare in nursing street.”

After reporting  for work in my own unit, I was told that I need to be floated to E.R. I felt so bad hearing that but I had no choice coz everybody was being rotated to be floated where there was lack of staff, and so it was my turn last night. I hurriedly went down to ER to catch up the endorsement there.  The nurses there were quite nice  to welcome me though and that eased my discomfort a bit.

I was assigned two beds at the treatment area. I thought, hey this is going to be okay. Two patients is better than six to seven patients back in my home unit. But then in a few minutes, I suddenly felt the fast-paced atmosphere in ER. My patients stayed in the bed for like 1-2 hours only and was replaced by another patient as soon as the other one left.  I haven’t even finished documenting and discharging the previous ones, I was forced to take another one coz the patient was placed already on the bed waiting for a nurse to attend to him/her. I wasn’t able to count how many patients I had the whole night but it was just too many.

I was used to taking care of male adult surgery patients and this has been my work for the last eight years (seven years in another country). Last night, I had to take female patients – one was even a case of vaginal bleeding! I told the charge nurse about this issue but I was told that patient sex is not a concern in ER and that male ER nurses take female patients with no problems. Ah okay, I forgot that I was an ER nurse-in-an-instant now. I had to pull a female nurse’s arm to help me attend to that patient who was about to have a vaginal exam. In this country where culture is a great concern, I had to be careful with nursing female patients. And I had several of them last night.

And there was a baby patient too! Pediatric nursing was never my cup of tea, and I can’t even cannulate a small baby’s arm! And yes, I had to take care of the poor baby whose parents had to settle with a nurse who has no experience with babies, except his own. My very first unit since I started my nursing career in the Philippines was pediatric ward. I thought that it would be fun dealing with babies and children. But then, realizing that it was sick babies and children I was taking care of, I just couldn’t cope up, that I had to resign and transfer to another hospital (I couldn’t transfer to another unit soon enough). Now, I had to face a sick baby again, and worst – in an emergency setting. How safe can I be to him was a question in my mind while taking care of him.

Add to my frustrations was my inadequate orientation to the work area. The first and last time I was floated in ER, I was in the Resuscitation Area. Now I was in the Treatment area with about 15 beds.  I was given a quick orientation of the outgoing nurse, but of course, that would never be enough. For a short period of time I had to know what the routines of the unit were, figure out where the supplies were, orient myself to the new surrounding, and deal with a different patient load. Not to mention the unfamiliar faces I had to work with.

I had to mention that the nurses who were in the Treatment Area were quite helpful to me. I asked too many questions and requested so many help and they tried to assist me in anyhow. I knew they were so busy themselves but I had no choice but to force somebody to face me and answer my queries. It was a big night last night for ER and there were several major road accidents that the department was dealing with. Getting somebody to teach me how to operate pieces of medical equipment, and how to work with their computer system was a tough thing to do.

It was too frustrating and stressful being floated. Last night was too exhausting – physically, mentally and emotionally. I am still having a major headache while writing this post. I felt writing what my head wants to say could somehow ease my stressed brain cells.

 Although floating is sometimes justified to keep a safe staffing level to the area where the nurse is being floated, I sometimes feel that it could be better if the nurse from the same unit is called in (as overtime or return time). He would know what to do in emergency situations,and the people in the unit would know his capacity as a nurse. Also, I would like to acknowledge that floating gives nurses the opportunity to widen nursing knowledge. But then, it isn’t training, when you get your own live patients, and that people who will be training you will be busy taking care of their own patients. We don’t risk patient safety and satisfaction with the intent of training a nurse.

Although I know that nurse floatation is an issue in most hospitals in many countries, not just here, I feel it is an issue that needs to be looked at. I know that I am not alone who gets this feeling whenever a nurse is floated. Being floated is just too stressful for the nurse. I am just not being negative. I am just thinking out loud.

People who have narrowings (plaque) in kidney blood vessels sometimes are referred for angioplasty and stenting to open up the blood vessels and improve blood flow to the kidneys. The kidneys help regulate blood pressure and when the kidney arteries get narrowed people can develop high blood pressure and kidney failure. I actually worked in an angiography lab for years where we performed balloon and stent procedures on renal arteries and had very good results. But does opening up the kidney blood vessels translate into health benefits? What do research studies say about renal artery procedures?

A 5-year study called the ASTRAL Study (published in the New England Journal of Medicine, Nov 2009) followed over 800 patients in the United Kingdom. Patients with renal artery stenosis (narrowings) were randomized to medications only or medications plus balloon angioplasty/stenting. Patients who received balloon angioplasty and medication therapy were found to have a slower progression of narrowings but no significant differences were observed in blood pressure or kidney blood work. Patients with severe narrowings leading to flash pulmonary edema (fluid in the lungs) or rapidly progressing kidney disease were not included in this study. So the health benefits in these patients are not known. But this study suggests that the routine use of balloon angioplasty and stenting for kidney artery narrowings is not recommended. Individual risks and benefits should be discussed with you physician to determine whether this procedure should be performed in addition to taking medications.

Sometimes patients surprise you. Sometimes you really need to talk to them about their expectations, desires, wishes, and hopes. Sometimes their assumptions don’t quite match up with your own. And sometimes this has unexpected consequences. Today the surprise is in the Resus Room. Here, there are five beds, two nurses. It’s where the sickest come, CTAS 1 and 2, and this morning is no different.

Contestant 1 is a 74-year old male, right-sided failure, no blood pressure to speak of, junctional bradycardia, a medical history that’s a tale of woe, full code, and Altzheimer’s, so he calls out and tries to climb out of bed. Contestant 2 is a 54-year old male, in acute renal failure, who’s blown his only good kidney, anuric, taching along at 140, BP in his boots, maxed on Levophed, whacked out chemistry, including a creatinine of 868; he’s pale to the point of waxiness, and diaphoretic. He’s been sick for a long time, and he has the wary eyes of someone who knows the jig is up.

He needs dialysis now, therein being the problem: Acme Regional doesn’t have facilities for dialysis.  Renal patients are supposed to be sent to Superior Hills Health down the road, which is our regional dialysis centre — except getting SHH to accept transfers is at all times problematic. It’s always some damn thing: no beds, no staff, can’t be bothered, whatever.

But there is a light. The patient, JK, has actually been accepted by the hospitalist and the nephrologist at Superior Hills. It’s just a matter of making the arrangements and sending him off. Maria, my partner for the day, flip a coin — I get JK. I do my initial assessment, which confirms my first thought eyeballing the patient from the nurse’s desk: this guy is circling, and what’s worse, knows it. Fear is clearly in his black eyes, peering out from under knots of unkempt hair, but he says little. And there is little I can offer him, except comfort and a fast transfer out.

But he has some imminent problems: he’s third-spacing all the fluid he can’t pee out, his lungs are filling up like a bathtub, and his respirations are starting to get a little laboured. I’m having a psychic vision of an intubation in my near future, which giving this patient’s condition is clearly a bad plan.

I finish charting and start on the usual telephone trek to get this patient transferred. I page both the hospitalist and the nephrologist who accepted the patient. Neither is on-call, and Locating at Superior won’t get them either. I call the floor at Superior Hills where’s he’s supposed to be going. Nope, haven’t heard of him. I call the Patient Flow Management at SHH.  Same answer — and the bed manager there is a little concerned my patient is obviously an ICU patient, and neither the hospitalist nor the nephrologist have ICU admitting privileges. Finally, after an hour of telephone hide-and-seek it becomes apparent that neither accepting doc has bothered to tell anyone at Superior Hills about this patient.

I sigh, and glance over at JK. Let the games begin. This patient, as critically ill as he is, is going nowhere.

I page the internist, and together we plot a two-pronged strategy: I will continue to hound Superior Hills for a renal bed, while he’ll try to Criticall the patient out. The phone calls continue. Vast amounts of time are wasted, as the patient continues to circle, trying to find a bed somewhere, anywhere, that can do dialysis. The internist speaks to docs in hospitals between between Windsor and Ottawa, looking for a bed. A moment of humour: a nasty phone call from the bed manager at Superior Hills. Criticall called her, looking for a bed. She isn’t impressed. Oops. Finally, at last, we manage to contrive a bed at Holy Somolians Hospital downtown, where he will finally get his much needed dialysis.

At 1700, ten hours after start of shift, the ORNGE team finally collects JK and flies off to Holy Somolians. Good luck, I breathe, so long, and have a good life. Despite hours and hours of bullshit and nearly insurmountable institutional and systemic barriers, you’re going to live.

Next morning. I’m exhausted. I can deal with a sick patient, and I can deal with health care stupid, but doing both at once leaves me wiped. Diane’s in charge.  She takes off her funky pink reading glasses and peers at me over the Desk. “That patient of yours, JK, the one transferred downtown? He died.”

“What?”

“He got there and refused dialysis. Said he never wanted it. Then up and died.”

“What?“

Surprise.

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Howdy friends!

It’s been 13 days since i stopped schooling.. It’s like I was walking away from my dream and I’m heading in a place where man’s worst nightmare appears. I thought that nothing can go wrong and I will be soon having my diploma. The thing is, my sponsor had a very serious illness where she became bedridden and sick. I know from that time that something bad will happen. Then come one day that a very horrible news screamed all over the house.  I will not be able to continue my studies because the sponsor might have been in a near-to-death phase and their family don’t want to continue to help us anymore. Well from that time, I know that my time left to be with my friends is very limited. Stopping in second year second semester wasn’t exactly my plan. But having financial crisis and everything, I guess my time came to an end. I realized that God has something planned for me that’s why this is happening. So from the day I heard the news, I mae up my mind to have the best week with my bestfriends in school. LOL! I just remembered the quotations from the movie Life or something like it by Angelina Jolie, ” What will you do if you have only seven days to live?”, in my case, what should I do if I only have seven days to be with my friends?.. haha..

It was seven days before the official start of my class. I went to school with my other classmates just to have a meeting with other students from other year. The meeting was about the make-up class for those students who accomodate a number of absences in their RLE duties. My other classmates was wondering why I’m not doing the enrollment form. Then I suddenly told the whole truth, that I’m just finishing my make-up class so I can stop shooling. They felt flushed when I told them that. My bestfriends and I have a lot of plans in the future like swimming together in Rizal Memorial Coliseum, watching cinemas together, going to Star City, helping each other in every cases, finishing our course, passing the board exam. And me being a drop-out student is not one of those plans. Well we didn’t waste a single minute, we enjoy the Tree Planting at Caliraya Laguna, which was supposed to be the replacement for the make-up duty. It was one of the best bonding moments with my friends. How glad I am to be with them, and I even experienced to have a tree planting program before I say goodbye to my school.

Tree Planting (Composting) at Caliraya Laguna

Well the memories won’t be forgotten. I want to thank God for giving me such wonderful friends. I’ll always remember the the times that we always go to cinemas to watch movies. In case you’re wondering who they are..

The best bonding moments with my friends.

If you put the cursor over the picture, you will see their names. I’m the one in pink. This was taken last November 16. This was my last and the best bonding moments with bestfriends. That day was very memorable because that was the same day I told them my secret that I’ve been hiding ever since I went to college. They accept me for who I am and they accept all my flaws. I’m glad to be their friends. I guess I will be able to see them someday again in their scrub suit and I will be in my future job.. “Psychologist”. Right now, I’m looking for a job to be more productive. I think I’ll try to be a call center representative for the mean time so that i will be able to help my parents in the recent finances and to have my own pocket money that will be saved for the next school year.

Someday I’m going to be like them, wearing the scrub suit or simply the nursing uniform. But for now, I’m going to finish my studies next year in a different university. I’m goin to take up BS Psychology next year and I’m going to save money after I graduated so that I can go back to finish nursing. Somehow from the first two years of being a nursing student, I enjoyed my course and I enjoyed what I’m doing. But I know this is not the right time for me. I know there will a time that I will be able to finish nursing and only god can tell when. I’m just here going with the flow and doing my best to reach that dream.

This picture is captured from the mirror ceiling at SM Manila.

I will never forget everyone that touched my life in different ways especially my friends, classmates, clinical instructors, and the faculty of College of Nursing at Lyceum of the Philippines University.

This song chorus  from Splender should end my blog..

It’s alright, I’m ok
I think God can explain
I believe I’m the same
I get carried away
It’s alright, I’m ok
I think God can explain
I’m relieved, I’m relaxed
I’ll get off of your back

Goodbye and until next time! I’ll update you guys what’s goin on in my life.. Don’t forget to pray and strive to what you think is better. Always remember what Candice Michelle always says..”If you don’t go for your dreams, someone else will!”. Love what you do and do what you love! Always reach for your goals. Sometimes God give us problems and difficulties so that we can be stronger and better person.

Dream on!

Always on the brighter side of life,

MJ Vicera

I walked into the station this morning, and the night’s charge nurse asked, “You know you’re charging, right?”  Ummm…no.  I ran through the list of senior nurses who are always there.  Not today.

The day was okay.  Not too much went on as far as charging duties, but it was my first day to charge alone. The nurses working with me were all fairly new except for the ICU nurse who was pulled to our station, though she was unfamiliar with our routine and discharge procedures.

I had to get the right people to come down and fix our copier.  It had an error message (F-77-o2 something or other) and a sad-faced man wearing a tie and carrying a suitcase.  Seriously weird, never seen it before, and it took all day to get it fixed.

I took care of assignment changes at 3pm.  I checked our crash cart.  I helped my nurses with whatever they needed.  My patients were great.

It really was a good day, and yet I left with a headache over the additional stress of responsibility.  Nothing happened, but the idea that something could happen kept me on edge.

Finally, I have started to find articles on business postings and hospital finance postings that address the shortage and ways to deal with it.  I have always felt that retention would be a key point for hospitals who frequently find themselves unable to  fill the vacant positions they already have, let alone any new ones from nurses who are leaving their positions.

This article is from Healthcare Finance News and to me, seems like a light at the very distant end of the tunnel.  Read  this article and let me know if you feel like I do-hopeful!

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The Sainsbury Centre for Mental Health has published ‘The chance of a lifetime: preventing early conduct problems and reducing crime’. A very high proportion of those who have the most serious conduct problems during childhood go on to become involved in criminal activity. This paper argues the case for greatly increased investment in evidence-based programmes to reduce the prevalence and severity of conduct problems in childhood.

Download the report here: http://www.scmh.org.uk/news/2009_preventing_conduct_disorder.aspx

The Department of Health has published ‘Swine flu: updated guidance for mental health services’. This is updated guidance for Mental Health services and partners on planning and responding to the Swine Flu H1N1 pandemic.

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_109172

So today I decided, instead of going out and shrieking in horror at the irrepressible hordes of inconsiderate Black Friday folks starting my Christmas shopping, I would sit inside and get some stuff done that I’ve been meaning to get done (ie, putting little twinkly lights in my fake ficus tree; dusting the tops of the cable box and DVD player; watering the plants; watching the concerts I’ve DVR-ed lately [KT Tunstall is amazing]).  W and E2 are coming over in a few minutes, and we have very lofty plans to … play video games.  E2 is indefatigable and kicks our butts up and down the street in Star Wars: Episode III.  She plays a terrifying Lord Vader.

In other news, had a good day with the Mother and the G-parents yesterday (Hi, Grandma and Grandpa!  Thanks again for dinner!).  Train ride back into the city was much better than the train ride home on Wednesday (where your friendly blogger had to stand from Market East all the way to Ambler before a seat opened up).

Have to give a presentation on what a genetic counselor does for our Intro to Nursing course tomorrow — we have a little something fun cooked up for the class; I’ll let you know how it goes.  So now the big decision for the afternoon is:

1. Should I play General Grievous or Obi-Wan?
2. Pizza or Royal Tavern for dinner tonight with W and E2?

Hope you all are having a great Thanksgiving weekend!

Yesterday, we had our first retdem…and,men, it was sooooooo nerve-wrecking!. our retdem is about taking the vital signs (pulse, temperature, respiration & blood pressure). eh, I am currently taking up bachelor of science in nursing kasi, so we need to study health assesment, viatl signs, etc.. anyway, so that was what we ought to do for that day.

I was feeling so unprepared, though I have all the equipments I need, still I feel mentally unprepared! The first batch left, most came back frowning, and one came back crying. oh men! i got more nervous!

and finally, after two hours, eleven minutes and 40 seconds of waiting, it was our turn to perform our return demonstration(retdem). I kinda nervous…not to mention having heard of all their comments about what happened to them earlier…this is it! I entered the lab with a smile. and then…answered few questions with my partner regarding the step by step procedure before you go inside the patient’s room and when you are inside and when you’re going out…assess, diagnose, plan, implement, evaluate…after which we performed the task.

first stop, temperature, pulse and respiration:

o0ps, I almost got a minus two, when I forgot to wash my hands

*note: if you are to the room of your patient, the most important thing you should do is to clean your hands,disinfect with alcohol or water and soap.

also, in cleaning the thermometer, if it’s mercurial thermometer…before using, clean it from the bulb to the stem; and after using,clean it from the stem to the bulb…cleanest to the dirtiest.

so,I was done taking those things.the last thing left is taking the patient’s blood pressure.

ohhh,this one…i practiced this thing over and over and over again, until I make it right.

and because, I kinda practice real hard…I got less mistakes in taking the BP.

…first, I positioned the patient, in a sitting position, place the cuff on the patient’s arm (the left arm is usually used, because it’s near to the heart).
what was hard was finding the brachial pulse of my pateint…brachial pulse is the pulse near the anticubittal area.
after finding it, I pumped the sphygmomanometer up to the point where the brachial pulse is not felt anymore. after that you pump an additional 30 mm Hg, above the point where the brachial pulse is no longer felt.

after which you place the stethoscope on the place where the brachial pulse is,then slow release the pump…slowly!.

the first beat you’ll hear would be the systolic pressure and the last beat is the diastolic. and there you got your blood pressure.
usually, for adults, the normal BP is 120/80 mmHg
*and never forget to double check the BP after 2 minutes.

ahhh..and on the last part, while my prof is eating his breakfast…he asked me last thing we should remember when we’re done taking the vital signs…it’s to wash your hands, clean the mess and say “byebye”…

ohhh….first retdem pa lang…it wasn’t that easy, but at least I really learned that we should always be prepared on the unexpected!.

hay,I can’t wait to become a nurse!!
excited >.<

Nursing jobs are the top most career in the world which gives peace of mind and more cash to bank account. Nursing jobs are considered the most sought-after career the world over. People choose nursing career path to get more advance in profession and finance.

There are lot of changes over the last few decades in nursing profession. Due to rapid changes  in  environment, there is a high importance been given for nursing jobs. It is also vital to learn the changing trends in nursing field for gaining a successful career path same as in other fields

There are various options in the nursing career. One can select any specialization in nursing and can gather more skills, knowledge along with experience, that will result a strong his/her career in nursing industry in the near future. There are many categories under nursing jobs, on which a person can specialized, Such as nurse practitioner jobs, Occupational therapy jobs, RN Jobs, Travel nursing jobs and etc As well as nursing job is well revered and acclaimed professions in the world. When the nurses are climbing in the Career ladder with advancement, they advance financially too.

As far as there more options in nursing jobs, if a person who cannot get good skills on one area, he/she can choose another expertise area in the nursing jobs itself. The wide variety of options also does not make the people feel like they are forced to take up the nursing profession because it is the career of the future. The chance to choose their own specialization will give them a chance to still make a decision of what they want in life.

Due to good demand for nursing jobs in developing nations, the availability of nursing jobs are pretty high too. This is one of the important point on getting desire of more people towards nursing career. When a large crowd is moving towards one direction, the rest too will easily follow the steps, as it is already so easy to find nursing jobs online. Specially, there the demand for RN (Registered Nurses) is increased due to there are more elderly people as a result of health care systems. As well as, the shortage of trained nurses too makes more demands for RN jobs.

Some agencies have started to work with nurses to cater temporary shortfalls in some areas, as a result of this, demand for travel nurses too starts to grow up.

Nursing jobs offer many opportunities for career advancement. The nursing hierarchy has many levels, all of which offer and advance in nurses’ careers along with the finance. So, as same as in other careers, there are chances for further advancement in nursing career too. This is one of the plus point of nursing jobs.

When a person decided to move with nursing career, not only him/her, but also the society too get benefits from his/her service, due to this we can call nursing jobs as a  noble profession. As you noticed there is a sudden rise in the number of nursing jobs, it indicates that there is a higher chance to increase the quality of medical field.

As far as the demands of nursing jobs increase, there are degree programs for nursing education too get more popular. So, the world is going to see more young nurses in future and more quality service which leads to a revolution in medical industry.

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This is an interesting article that discusses the way a hospital system decided to change the way it provided care and establish a goal for the future by addressing patient care and patient perceptions.  That is unique in this field, but what really caught my eye was the fact that the model was developed mainly on the input from nurses who were actually giving that care.  That is unheard of!

It is very nice to see an article that gives credit to the nursing staff and actually has nice things to say about their collective abilities to facilitate changes that make things better.  In this instance, the patients themselves gave the model a good response.

Anyway, read the article here or visit the original and read some of the other articles found there.  It is worth your time, I think, to read and think about this process.  Maybe you can initiate something similar in your own system?  It’s not impossible, but I agree change is always hard.

________________________________________________________________________________________

ThedaCare, a four hospital community health system based in Appleton, Wisc., is a leading healthcare delivery system and is nationally recognized for its continual process improvement efforts. The hospital recently implemented one of its widest-ranging improvement efforts — a truly integrated, collaborative model to guide all inpatient care. The collaborative model has been widely successful in improving the quality of patient care and making that care more efficient, according to Kathryn Correia, senior vice president of ThedaCare and president of Appleton Medical Center and ThedaClark Medical Center in Neenah, Wisc.

“Lean” process improvement
In 2003, ThedaCare executives searched for a way to accelerate the health system’s process improvement efforts and stumbled upon lean management — a management and process improvement method that is focused on eliminating activities that do not add value to the organization’s end product. Executives from the health system found a company in their own backyard that had successfully implemented lean processes to the manufacturing of outdoor equipment and set forward in implementing these same processes in their hospitals.

“We knew there was a lot we didn’t know, but we decided to get our hands dirty and jump right in,” says Ms. Correia. “We brought in facilitators and held week-long rapid improvement events where groups of employees examined various processes and recommended improvements. We looked at the various results from these events and selected a few areas to work on first.”

The hospitals started with improving administrative aspects of hospital processes, and then moved to examining enterprise value streams. Eventually, hospital leaders began to focus on improving inpatient care in order to differentiate ThedaCare’s inpatient services from its competitors, and put an improvement group to work to figure out a way to meet this goal.

“We decided that our vision for the future was creating a unique inpatient and ER experience, which relates back to the mission of our hospitals, and this became part of our strategic plan,” says Ms. Correia. “What resulted from about 18 months of process improvement events examining this was a total redesign of our inpatient care — a truly breakthrough and innovative model for collaborative care.”

Model of success
After a year of trialing the new, employee-developed collaborative-care model, ThedaCare began implementing it system-wide — a process which is expected to be completed by 2012. The model has proven extremely effective so far, reducing costs associated with inpatient stays by 25 percent, patients’ length of stay by 25 percent and various error margins to nearly zero and significantly increasing patient satisfaction scores.

According to Ms. Correia, the model’s effectiveness is due to the input of front-line employees in developing the model. “Innovation happens synergistically. We knew we had to figure out what our differentiator would be in the future for inpatient care, but we weren’t quite sure what it would be,” she says. “Nurses had a good concept of what they wanted collaborative care to look like, but we needed lean processes to really develop something we could implement.”

ThedaCare’s collaborative care model is truly groundbreaking and will likely serve as a model for many other hospitals as they look to integrate their services and provide more collaborative care. The model is composed of six critical elements, all of which encourage the collaboration of caregivers and the removal of non-value added activity in the provision of inpatient care. The six elements are:

1. Collaborative rounding upon admission. Within 90 minutes of admission, a nurse, physician and pharmacist round on a patient and his or her family and collaboratively develop a care plan specific to the patient. The three-way rounding ensures that all providers understand and agree upon a patient’s course of care, and the presence of the pharmacist additionally reduces the possibility of harmful drug interactions, says Ms. Correia.

2. Evidence-based plans of care. Each patient receives his or her own evidence-based single plan of care, which integrates services from various departments within the hospital. The care plans are developed using care guidelines from Milliman Care Guidelines, a Milliman Company, and all disciplines combine to form a single integrated plan.

3. Nurse as manager of care. In ThedaCare’s collaborative model, the nurse is the navigator of patient care and is supported by ancillary paraprofessionals. The nurse is responsible for guiding the patient from one phase of care to the next and makes sure that all quality criteria are met during each phase of care. Nurses often suggest options to physicians in order to advance care at a more optimum rate, says Ms. Correia.

4. Tollgates. As patients move through their care plans, nurses ensure that the patients do not move forward unless they meet certain requirements of their last phase of care. These “tollgates” are based largely on care guidelines and time, and serve stopping points along the path of care. When a patient reaches a tollgate, the nurse will only allow the patient through to the next phase of care if it is documented that the patient has undergone certain measures of quality required in the previous phase of care.

For example, evidence-based medicine suggests that pneumonia patient should receive an antibiotic within four hours of admission. Thus, a ThedaCare nurse is responsible for ensuring that all pneumonia patients receive an antibiotic in this time frame, and if this doesn’t occur, the nurse must stop the care pathway and fix the issue before advancing the patient.

5. Electronic medical record. Thedacare uses electronic medical records to track the progress of a patient’s care along his or her pathway and share health information among providers from different service areas within the hospitals. The EMRs also include notifications for tollgates, alerting nurses of the need to evaluate a phase of care.

6. Purposeful design of physical space. Finally, ThedaCare redesigned its inpatient floors in order to make care more efficient. Each patient room includes approximately 80 percent of supplies a nurse would need to care for a patient; this reduces the time a nurse would spend traveling from the room to the central supply location, says Ms. Correia. Additionally, the rooms are designed to reduce the steps staff members take to perform various tasks, thereby making care more efficient.

Learn more about this model here

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“Now I want you to know, brothers, that what has happened to me has really served to advance the gospel.” (Phillippians 1:12, NIV)

Yesterday at our nursing home service that we hold on Sunday Nights, I asked the people to share what they were thankful for.

Now before I give you the overwhelming answer… let me say that most of these dear people’s quality of life is not the best. They use walkers, wheelchairs, and their ages range from 80’s to 90’s and even two are in their 100’s. What a great group of people. I would like to hear all the history of their lives. WOW!!!

Well the answer was LIFE. Overwhelmingly they all said it almost like it was rehearsed. The thing they are most thankful for was life.

I wondered how many of us who are disabled and suffer daily with pain, walking issues, and many others disabilities could say this same thing? Many times I myself have complained with pain or of some malady in my body. I will now look at life much differently after last night.

Our Bible example is Paul for all he went through. Beatings, shipwrecked, imprisonments, and many other things. He still had the attitude that God allowed these things to happen to him so he could
keep spreading the gospel. Maybe to a different crowd than everyone else, but at least he was still spreading the gospel.

Paul took what God told him, that my strength is made perfect in weakness, seriously. He still trusted in God despite what he was suffering.

How about you? Are you like Paul? Can you thank God for your disability and go on and work for Him?

Father, today may we receive the grace that you gave Paul and others to be able to go out and be thankful even though we are in pain and suffering. I know this is for the furtherance of the Gospel.
Show me to whom you want me to go, Lord. In Jesus name, AMEN.

ABOUT THE AUTHOR
Pastor Pat Dittert lives in a berm home in Central Iowa with his lovely wife Nancy and 5 fur babies. Pat lives with Chronic Pain from a number of surgeries and injuries. Brain Tumor surgery left him disabled and unable to do most physical activities. He is also a survivor of Cancer and now has 4 stints in his heart. Pat has several Internet Ministries, and is a freelance writer with Christian newspapers, books, Internet, etc. rivpat77@msn.com

If you come away from my suggestions with one understanding, you should hope it is this:

In most of the trainings I’ve been through as a Caring Professional, there is almost always a missing key component. Yes, for you too.

After sitting for several hours, taking in good information and understanding the benefits and features of a new perspective or action, we are inevitably left without the key. This missing key is almost always the weakest link in any efforts at growth, healing or change.

We understand who would benefit, why they would benefit, what the benefits are, and when the benefits would occur. We even understand how to implement this understanding or action.

What we don’t understand is how to consistently and ruthlessly remember to implement this new understanding or action until it becomes integrated into our bones.

Ruthlessly remembering to implement = integration

Today, you may want to practice eye contact, touch, working with personal space, using people’s names, and/or praising people around you.

You may wake up today with the intention to practice touch, silence, gratitude, bodily awareness, breathing, and/or shining your radiance.

You may plan to use your workplace to practice presence, tonglen, kindness, dying, acceptance, and/or forgiveness.

But what you want, what you intend to do, and what you plan to do, matter little if you are lacking a method to help you remember to implement.

Ruthlessly remembering to implement = integration

Being Awake is the key to implementation – and implementation is the key to integration.

If you fail at integration, you may as well have stayed in bed and skipped the class.

The first class of Doctor of Nursing Practice (DNP) students at Stony Brook University will graduate in December 2009. Nursing professionals hope that educating more nurses at the doctorate level will increase the amount of faculty to teach undergraduate students, and help mitigate the nursing shortage.

According to a recent report, the NHS is falling behind Europe to implement new technologies that would benefit patients’ recovery time or quality of life. Barbara Harpham, Chairman of the Medical Technology Group and Chairman of Heart Research UK said

Slashing budgets is counterproductive as modern technologies help thousands of people stay in work and out of hospital. We already lag behind much of Europe, with problems like hospitals denying patients NICE-approved technologies because they lack the facilities or staff to support their use.

Conversley, NICE has recently refused to approve two more cancer drugs claiming that they would be too expensive to provide under NHS funding. Ssorafenib (Nexavar) for liver cancer and (so far)  bevacizumab (Avastin) for metastatic colorectal cancer have both been refused.

It’s seems to me that whether NICE refuses to approve a drug or whether the NHS won’t pay out for it, patients in this country will continue to be denied life-prolonging or life-improving treatments.

The Report “Medical Technology – Can We Afford To Miss Out?” indicates that three times more cardioverter-defibrillator (ICDs) were installed in Germany last year compared with the UK, despite the device being approved by NICE.

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not bad – Axli A. Malsack – Redding, CA, USA
well he straps are a little uncomfortable at first but after 3 months of nursing, it is nice to have something pretty to wear. The only thing i dont like is that it only offers medium support and as a 40dd, that just isnt quite enough.

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It was a slow Thanksgiving day shift.  The nursery was quiet, and I was counting the hours until I could be home celebrating with my family.  Half way through the shift a call comes in from the Mother/Baby unit.  A nurse is concerned about one of her babies, who is not eating well and is breathing fast.  The pediatrician would like him admitted to the NICU for monitoring.

I received report from the Mother/Baby nurse.  She informs me that mom is a 40 year old gravida 10, para 9–now 10 (she has been pregnant 10 times, and has 10 living children).    She has custody of none of her children due to issues with drug addiction.  She is living in a local community shelter.  She had no prenatal care with this pregnancy.  Her drug screen is negative, and she states she has been clean and sober for over two years now.  She denies knowing who the father is.  She was brought in by ambulance, and had an uneventful, but precipitous delivery about 18 hours ago.  The infant’s drug screen is negative.  Social Work has been notified, and the Department of Children and Family Services is investigating.

The mom accompanies the baby to the NICU.  The mom looks as if she is 60 years old.  She is haggard, and weary, and scared. Her hair is unkempt, and her nails are caked with dirt.   I introduce myself and she gives me a worried smile.  She has not one tooth left in her mouth.  She sits quietly as I proceed to admit her baby to the NICU.

The baby is full term and his size is appropriate for gestational age.  He is markedly tachycapnic with respirations of 80-100 breaths per minute.  He is active to irritable.   He has a soft heart murmur.   I do the routine care of monitors, starting an IV, drawing an arterial blood gas, etc.  The infant’s oxygen saturations are 60% on room air. I place an oxygen cannula on the infant and paged the neonatologist.  I proceed to measure the baby’s oxygen  sats from his upper extremities and obtain a four extremity blood pressure.  His upper extremity saturations are 85%, and there is a positive difference between the upper and lower extremity blood pressures.  His overall oxygen saturations do not improve while on 100% inspired oxygen.

The neonatologist gives the mom the bad news that her baby most likely has a cyanotic heart defect.  He needs to be transported to a Childrens Hospital immediately for surgery.

…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….

This mom, who has more than a lifetime of hurt and pain, this mom who has lost 9 children because of her own drug use and inability to care for her babies, this mom who has been abused and beaten and who has sold her own body to survive, this mom who was homeless, this mom who has turned her life around and is clean and sober and struggling to survive, this mom…….

This mom turns to me, a white, well-educated, upper middle class woman, a nurse…..this mom turns to me……..

This  haggard , tired , no teeth in her head, mom turns to me and kisses me full on the mouth.  This mom cries with tears of pain and joy.  This mom repeats over and over again about how thankful she is that we were there to take care of her son.  How we helped her and how God sent her to us.  I am so very thankful for this day. The day my son’s life was saved.

……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

This nurse is so very thankful that this mom was sent to me.  This mom who showed me what being thankful really means.  Her and he son was sent to us…..we were not sent to her.  And for this…. I am so very thankful.

RR

Jakarta, BNP2TKI (23/11) – Warga negara Malaysia kemungkinan akan bisa kembali mempekerjakan Penata Laksana Rumah Tangga (PLRT) asal Indonesia bulan Desember mentang. Isyarat ini disampaikan Menteri Sumber Daya Manusia Malaysia Datuk Dr S Subramaniam sebagaimana dilannsir harian Malaysia, The Star, Senin (23/11).

Menurut Subramaniam, pembicaraan antara Malaysia dan Indonesia sedang berlangsung untuk menyelesaikan beberapa hal. “Masih ada beberapa hal lagi yang perlu diselesaikan. Begitu ini selesai, para pembantu rumah tangga bisa datang lagi ” ujarnya.

Sebagaimana diketahui, Pemerintah Indonesia telah menghentikan sementara pengiriman TKI ke Malaysia pada Juni 2009 lalu menyusul maraknya kasus kekerasan terhadap PLRT Indonesia di negeri jiran itu.

Ditandaskan Dr Subramaniam, diharapkan semua masalah akan selesai pada bulan Desember 2009. Menurut petinggi Malaysia itu, pemerintah Indonesia telah menyampaikan kesiapannya untuk menyelesaikan permasalahan tersebut secepat mungkin.

Saat ini ada diperkirakan terdapat sekitar 280 ribu PRT Indonesia yang bekerja sebagai Tenaga Kerja Indonesia (TKI) di Malaysia. (hp)