MedWorm: Nurses

Css in blogger - part two

St Vincent's Hospital Darlinghurst - Male Nurses — Sat, 05 Jul 2008 04:00:00 +0100

This is the my second attempt at creating an image gallery within a Blogger Blog using Cascading Style Sheets (CSS). The code that I have used will allow for a larger image to appear when the cursor is passed over them.In my previous post, I created a similar CSS image gallery effect that I found at Dynamic Drive. All went according to plan if you were using Internet Explorer. But for those using other Internet browsers, the larger image was cut off at my sidebar. In my endeavour to learn more about CSS and CSS image galleries, I was lucky enough to come across a new acquaintance who goes by the name of, "Narrowband". I am attempting to partly replicate his example which is based on Dynamic Drive's CSS and his invaluable assistance has enabled me to put this one up on the blogosphere.NOTE: Within my template I have placed Cascading Style Sheets (CSS) into two sidebar widgets. The codes are similar but each CSS was given a unique gallerycontainer and thumbnail reference name.Settings within each CSS were customized in order for the larger images to appear above and below the thumbnails that you see here.Enjoy the images! If you encounter any problems please let me know what they are, including the details of your Internet browser. This has taken a long time to do and even though I'm knackered, I loved doing it. Thank you again, Dynamic Drive and Narrowband and as we say Downunder, "Your blood's worth bottling."To be continued... (Source: St Vincent's Hospital Darlinghurst - Male Nurses)

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Saving lives quickly.

impactEDnurse — Fri, 04 Jul 2008 22:56:15 +0100

Its always interesting to see how other cultures manage emergencies. You know, you are watching the news and there has been a disaster, or an act of terrorism, or an accident and its all noisy and crowded with thirty or forty people all loudly trying to help out in different directions at the same time. An ambulance careens into shot, the doors slap open and out charge the ambulance people, scooping up the patient and crowd surfing their way back into the truck, as the poor dude bounces around on the stretcher limbs all akimbo. The ambulance screeches off through dust or debris, and out of shot around a tight corner barely missing a chicken or a dog or a cliff as one door flies open. Cut to the hospital where the ambulance has already slid into the burnt rubber emergency entrance, and the patient is pushed through the doors at some sweaty, unwieldy, adrenergic velocity; trolley over on two wheels dodging those sitting or laying on the tiles, it skids into a sliver of space amongst the clatter of metal gurneys propping up sunken eyed survivors of frag or fire or fear. Everyone is shouting, or running, or running and shouting, as the dude lays limply in his own pool of silence, wide eyes rolled down at his wet fleshy fate. You know the scenes Im talking about? Lots of people in stained flapping lab coats rushing around so fast that is seems what the patient needs most must be momentum. Its different where I work. Not to say that the compassion of those trying to save a life with so much haste and so little resources is any less than the more metered care of the doctors and nurses I work with. Quite possibly it is greater. I just find it uncomfortably difficult to imagine turning up for work each day in an atmosphere of desperate amok. ShareThis (Source: impactEDnurse)

Hearty, healthy, red, white and blue cake for 4th of july

A Hearty Life — Fri, 04 Jul 2008 19:39:04 +0100

A red white and blue hearty dessert recipe… You will need: 1 store bought angel food cake 2 cups of strawberries 2 cups of blueberries 1 tub of Sugar Free Cool Whip Sugar free strawberry Jello Cut angel food cake in half, prepare Jello as directed and when set scoop out of container and mix so Jello becomes ‘chopped’ up. Place Jello on top of bottom piece of Angel food cake and place upper piece of cake on top- think of Jello as your filler layer. Use SF Cool Whip as icing and spread over the top and down the sides of Cake with Jello filler. Cut up berries and sprinkle on top of cake- hold out half to sprinkle on top of individual servings when served. When all assembled place cake in fridge for at least an hour before cutting to serve. Tags: cardiac disease, dessert healthy and diabetic, diabetes, heart-disease, recipe cakeShare This (Source: A Hearty Life)

A hearty and happy 4th of july

A Hearty Life — Fri, 04 Jul 2008 19:27:52 +0100

For all of those in the great USA- Happy 4th of July! Image details: American flag against blue sky served by picapp.com Share This (Source: A Hearty Life)

Green tea is good for your heart- again!

A Hearty Life — Fri, 04 Jul 2008 17:18:26 +0100

There is indeed a beneficial effect of green tea on risk factors for heart disease. A new study found that the consumption of green tea rapidly improves the function of endothelial cells lining the circulatory system which is big news in the progression of atherosclerosis. Results showed that endothelium-dependent brachial artery dilatation increased significantly after drinking green tea, with a peak increase of 3.9 per cent 30 minutes after consumption. This is too cool in that it is something you can due for your heart health right in your own home! I think green tea is an acquired taste but it is definitely worth a go based on the above test results. to read more on this… Tags: blood-pressure, cardiac disease, food, green tea, heart-disease, nutritionShare This (Source: A Hearty Life)

Psycho paperwork

Nurse Ratched's Place — Fri, 04 Jul 2008 16:46:00 +0100

Tired of paperwork? Check out White Coat Rants to see the best post ever about medical forms that need a facelift. Sponsored by allnurses.com - Where Nurses Come Together (Source: Nurse Ratched's Place)

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Provigil: as american as apple pie

Nurse Ratched's Place — Fri, 04 Jul 2008 15:18:00 +0100

Wow, I want whatever she’s on. She looks so Yankee Doodle PERKY! Maybe she’s standing like that because her leotards are too tight, or maybe it’s because she’s been taking a bit too much Provigil for her ES. That’s the new marketing term for “Excessive Sleepiness.” No, I’m not kidding. The makers of Provigil have found a new way of marketing trucker speed. Can’t stay awake? Take Provigil and wave your stars and stripes all day long! Check out this “non-biased” website about Provigil. The website also claims that Provigil cures apathy and Nurse K’s favorite ailment, fibromyalgia. Have a happy and safe 4th of July holiday weekend. Sponsored by allnurses.com - Where Nurses Come Together (Source: Nurse Ratched's Place)

Know your limits or your blood pressure

A Hearty Life — Fri, 04 Jul 2008 14:17:35 +0100

When you are fatigued, you increase your effort to make up for their diminished capability due to fatigue. When this happens blood pressure tends to rise and remain elevated until the task is completed or individuals stop trying because they think success is impossible or too difficult to be justified. So there you have it…. We feel that we will get a big ol’ pat on the back and a hooray, but really we are just harming ourselves. You need to know your limits and give yourself a break. Do not be a hero! What do you think about this? via Science Daily Tags: blood-pressure, cardiac disease, heart-diseaseShare This (Source: A Hearty Life)

Nurse a bit, dance a lot.

impactEDnurse — Fri, 04 Jul 2008 09:24:49 +0100

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Partying like it’s 1999 through the eyes of nursing diagnoses

Emergiblog — Fri, 04 Jul 2008 04:50:18 +0100

Oh man, did I have a good time last weekend or what? Two concerts in 24 hours - 345.62 miles apart, two flights and virtually no sleep for 36 hours. I had a blast. This is me with Mr. Jeff Scott Soto himself. What a thrill ! This was after the San Francisco concert last Friday. By the same time Saturday, we were all hanging out in the parking lot of the Reseda venue. “We” meaning the band and about 40 fans. Quite a let down to come back to work, let me tell you. My mind is still in LA, my body is obeying Joint Commission standards. Well, at least I got to play “groupie” for a weekend, hung out with friends and got to meet the nicest gentleman in rock again this year. Jeff doesn’t have to tour. He plays one venue and we all fly out to see him! ****************************** Rock groupies connoisseurs encounter certain health issues as they travel to keep up with the artist (s) with whom they share a musical bond. Let’s look at some of these issues using nursing diagnoses. Any resemblance to me a particular person is coincidental. ***** 1. Pain, acute, due to prolonged shaking of the booty resulting in bilateral hip discomfort, exacerbated by the fact that the only exercise the patient has had in 2 years is running to the bathroom. 2. Pain, acute, secondary to prolonged repetitive movement in stiletto heels resulting in metacarpal spasms. (Very) recent in-depth research has shown that this also occurs in people born in 1957 who wear old-lady-orthopedic Reeboks instead. The etiology of this age based phenomenon is not known. 3. Pain, acute, secondary to vibration of wooden bench upon which patient sits as the bass guitarists in the three (lousy) opening bands crank their amps to eleven. ***** 4. Affect, giggly, due to Caipiroska intake x 2 followed by two margaritas that would have knocked Jimmy Buffett on his ass. 5. Coordination, impaired, manifested by urge to walk 20 feet to the ladies’ room in a straight line despite the ladies’ room being 10 feet away and around a corner. Co-dependent associates will assure the patient she looks “totally normal”. 6. Hearing, impaired, due to prolonged exposure to decibels that would deafen a 747, exacerbated by unwillingness to look like Herman Munster with fluorescent orange ear plugs sticking out sides of head. ***** 7. Vertigo, exacerbated by two plane flights and two concerts in 24 hours, less than four hours of sleep and five hours of dancing. 8. Mental status, altered, due to getting a hug from favorite singer and manifested by inability to focus on mundane tasks 5 days post-exposure. Finally, what advice to you give someone with Rockstar Syndrome? Suck it up. Take your NSAID of choice, drink plenty of fluids and for pete’s sake don’t come into my ER! I’m feeling just as lousy as you are! Trust me. Sponsored by allnurses.com - Where Nurses Come Together (Source: Emergiblog)

--i never promised you a rose garden...

Milliner's Dream — Thu, 03 Jul 2008 23:22:00 +0100

My landlords built their house about 20 years ago (in their 60's) themselves. She designed the home, (as well as several others in the "neighborhood.") My apartment, above the garage, was originally her design/art studio. When her sister needed a place to stay, they converted the studio to an apartment. Eventually, her sister had trouble climbing the stairs, so they built another apartment on the back of the house and rented the space where I now live. At some point her sister went to assisted living, and both apartments became income for them.My landlady is also a rose expert, specifically climbing roses. I wandered the property and snapped photo after photo of the gorgeous flora gracing the several acres.Watch for many of the (accidentally) beautiful photos of these roses in upcoming posts. (Source: Milliner's Dream)

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Hr is leading the way. oh dear.

Mental Nurse — Thu, 03 Jul 2008 16:38:03 +0100

I’ve been following the John Spencer/Virgin Healthcare saga as raised by Doc C. However, during my surfing I also stumbled across this Personnel Today HR website and was [expletives deleted] to read this insightful article. I make no apologies for posting in full - it has to be read to be believed. Incidentally, the site welcomes comments so feel free. Mental health: Off message - No trace of nuts 22 May 2008 10:03 Warning: any member of the kneejerk brigade should have their hammers at the ready, and should begin tapping their patellas furiously in preparation for getting really, leg-twitchingly annoyed, for we are about to enter into dangerous territory. Into the mouth of madness, as it were. How many workplaces across the UK display the cheery sign ‘You don’t have to be mad to work here but it helps’? Yet when it comes to talking about mental ill health, people find the subject too difficult to tackle - either preferring to ignore the subject for as long as possible, or taking the moral high ground and pontificating furiously about the need to confront the issue in a caring and sharing kind of way. Taboo Mental ill health is undoubtedly something that most people will have some experience of at one time or another - either personally, or as a witness - and is, therefore, one of the few things that most people would be qualified to discuss. But, by and large, we choose not to. And employers seem more reticent than the average person, with only 5% of them acknowledging that members of the workforce have any such problems. However, the Shaw Trust rightly argues that employers need to wake up to the fact that many people in their workforce will have some form of mental breakdown at some time. And the recent House of Lords ruling that an employer has to pay compensation for failing to spot an employee’s suicidal tendencies suggests that employers should take the matter seriously. But the TUC’s recent call for employers to encourage job applications from people with mental health difficulties and to urge individuals to disclose any mental health problems they may have (PersonnelToday.com, 16 May) shows that it has only the most tenuous grip on reality. No clues It suggests that organisations should abandon their fears about employing people with known mental health conditions, yet apart from some generalised information about how to spot symptoms of mental distress, gives few clues to help managers actually deal with the problem. According to the TUC work-related stress accounts for over a third of all new incidences of ill health, and each case of stress-related ill health leads to an average of 30.9 working days lost. It says this equates to 12.8 million working days being lost to stress, depression and anxiety every year. Stress, it must be stressed - unlike ‘pressure’, which can be a positive motivating force - leads to mental ill health. Costly failure According to Tim Cooper, managing director of the Shaw Trust the failure to manage mental health in the workplace costs the UK economy as much as £9bn in salaries alone, not including the impact on productivity (Personnel Today ITALS, 22 April). And figures form the Office for National Statistics show that at least one in four employees experiences stress, anxiety, and other forms of mental ill health (Personneltoday.com, 1 February). Ok.. so far it’s not so bad….. however… it continues…. The workplace is full of delusional individuals getting by and going up the ladder despite their obvious shortcomings. And as people have a tendency to employ people who are like themselves, that already provides an open door to a fresh supply of people with depression, anxiety and the like. Sit up and take notice So just getting employers to be aware of the problem in their midst would be a good start. For instance, it is arguable that anyone who chooses to work more than 40 hours a week clearly has a disorder of the frontal cortex. The Health and Safety Executive helpfully provides a list of mental health symptoms for managers to spot impending trouble. The most common signs of of anxiety are palpitations, headache, back ache, breathing difficulties, feeling on edge, worrying excessively and panic attacks. And when it comes to out-and-out depression, symptoms include inability to concentrate, impaired sleep, bouts of crying, poor appetite and general fatigue. Typically stereotypical uneducated stupidity… yet, there’s more…. emphasis added… A role for OH Clearly, investing in an occupational health service would be a good starting point. And if so many of us are suffering with mental health problems, surely it would be a dereliction of duty for any organisation anywhere to knowingly court even more mentally distressed individuals who might pose a danger to existing members of staff - not to mention members of the public or other people being served by the organisation? That way madness lies. And better still…. emphasis still added Any discriminating employer would aim to give jobs to the people best qualified to do them. Sadly, but correctly, that would rule out people who would struggle to cope due to some mental frailty. And unfortunately, there really is no business case for employing someone with mental health difficulties. Unless, of course, you know differently. If you’d care to let him know differently… Tony Pettengell (About this Author) (Source: Mental Nurse)

A prime time

Mental Nurse — Thu, 03 Jul 2008 12:44:42 +0100

I was called upon to escort a patient that had presented in A&E to a hospital out of area recently. The patient who I will call Ted was a mathematician and at the start of our journey which was to take about an hour I asked him what branch of mathematics he studied. Number theory he replied and then proceeded to tell me all about it…. Number theory for those of you who don’t know (most of you I would imagine) is a branch of mathematics concerned with the properties of numbers in general and integers (whole numbers no decimal point or fractions) in particular. It what we used to call arithmetic when we were at school and number theory is a higher form of arithmetic The 3rd century Greeks studied arithmetic as did the Indians and Arabs from the 9th century onwards but it was not until the 16th and 17th century that number theory was studied in Europe. Fermat posed his last theorem in 1657 which states that If an integer n is greater than 2, then the equation a^n + b^n = c^n has no solutions in non-zero integers a, b, and c. This little gem kept mathematicians guessing all over the world until it was finally proven in 1994. A recurring topic in number theory and one of particular interest to my friend Ted is prime number theory. Prime numbers are positive integers that are only divisible by two other numbers one and the number itself. All other numbers can be factored into two or more prime numbers (numbers that cannot be factored themselves). So Ten, which is not prime can be factored into: 10= 5 x 2 And 100 100= 2 x 50 =2 x 2 x 25 = 2 x 2 x 5 x 5 And 23244 23244 = 2 x 2 x 13 x 149 where 149 is prime (trust me) The first 34 prime numbers are 2, 3, 5, 7, 11, 13, 17, 19, 23, 29, 31, 37, 41, 43, 47, 53, 59, 61, 67, 71, 73, 79, 83, 89, 97, 101, 103, 107, 109, 113, 127, 131, 137, 139. The largest known prime as of June 2008 is 2↑ (32,582,657) -1 a number which is 9, 808,358 digits long (impressed? I was). Other odd things about prime numbers is that there are apparently an infinite number of them (Euclid 300 BC) and while they appear to be randomly distributed they have some rather surprising properties and there are laws governing their behaviour. The above picture shows the distribution of Gaussian prime numbers when espressed grahically. Prime numbers were thought to be of interest only to mathematicians until 1970 when it was publicly announced that prime numbers form the basis of public key cryptography algorithms. So next time you pay by credit card over the internet or enter your pin number in a cash machine, remember that it is thanks to prime numbers that your details are kept secret. Prime numbers occur in nature, for example most star fish have five arms and prime numbers are apparently used as an evolutionary strategy by Cicadas. Cicadas of the genus Magicicadas spend most of their life underground as grubs only emerging once every 13 or 17 years at which point they fly about and breed, dying after a few weeks at most. Emerging once every 13 or 17 years in this fashion means that it is difficult for a predator to evolve as a specialist predator on the Cicada unless it had the same breeding cycle. If Magicicadas emerged every 12 years instead then predators with breeding cycles of 2, 3, 4, 6,and 12 years would be sure to encounter cicadas and would probably evolve to predate on them. Finally string theory the much heralded theory of everything that might unlock the secret of interstellar and time travel appears to have prime numbers at its heart. Quantum theory posits four dimensions, three in space one in time (3 & 1, prime numbers) but later theories suggest another dimension to allow for the action of gravity (5 Dimensions, prime number) String theory resolves some of the anomalies between these five dimensions by suggesting a duality between them and then suggest an eleventh just for good measure. Hence according to M theory which incorporates string theory the universe can be fully explained in terms of eleven dimensions (11, prime number, see what I mean spooky). Ted explained the significance of prime numbers to me in this way. Prime numbers he said are like the elements in Mendeleev’s periodic table they are the irreducible building blocks of mathematics. Understanding primes would, said Ted, lead to an understanding of space and time itself and lies at the heart of the physical universe. Ted referred to Prime numbers in the sort of hushed reverential tones usually reserved for God or artistic beauty. Lets hope he gets better soon. Other interesting facts about primes One is not really a prime number, (it’s not really a number at all it is just is apparently) Two is the only even prime number (Well D’oh even I managed to work that one out) All prime numbers except 2 and 5 end in 1, 3, 7, or 9 Any even number greater than two can be expressed as the sum, or difference of two prime numbers (Goldbach’s conjecture) 2+2= 4 = 7-3 3+3 = 6 = 17-11 5+3 = 8 = 13-5 7+3 = 10 = 17 - 7 Prime numbers make you irresistible to members of the opposite sex and improve your performance in bed. (I think Ted may have been lying about this last one) (Source: Mental Nurse)

Much ado about nada

Time for Your Meds — Thu, 03 Jul 2008 04:00:00 +0100

So, it keeps getting hotter and hotter and it comes closer and closer to my nervous breakdown, which usually happens during the summer months...and I just don't see it happening. While LTD still has to occasionally force the meds down, I take them on my own as much as humanly possible. I hate taking them. I hate it too much for mere words to describe, but I take them anyway. And they are keeping me sane. I tried to barter away a few of them at my appointment with the shrink, but that was a no-go. He always has to remind me that the better I feel, the less I feel the need for meds--but indeed, it is medication that is making me feel better. It's a viscious cycle. Feeling the need to get political for a second...John McCain scares the living shit out of me. And I'm talking like anti-Christ scary. He's like Bush with Brains. He's BWB. *shakes it off* These days there is more laughter than tears, more feeling safe than being afraid, more exposure and less hiding. The fact that I'm exposing my breasts shouldn't matter. I'm getting out there, people! And I'm in love. This is gooey, mushy, heels-over-head love...all day, every night, non-stop bliss. We used to wonder why we never fought, but we seldom do that anymore. Strangely, this safe, sane, vanilla love has been the most passionate experience of my life. If love is all you need, then why do I still need medication? Hmmmm? Anyone? Bueller? Bueller? (Source: Time for Your Meds)

Product reviews: shit that works like it's supposed to edition

Head Nurse — Thu, 03 Jul 2008 04:00:00 +0100

It's been a while since I've done one of these. Therefore, without further ado, Shit That Works Like It's Supposed To:1. Cline Vineyards Viognier, 2007I've only ever tasted Becker Vineyards' (just down the road! Try the lamb!) viognier before, and found it a little on the sweet side. Cline Vineyards is a California establishment that produces a semi-dry viognier with a nice, peachy aftertaste that also includes a little oak and some citrus. It's good for drinking when the temperature is, say, 102* for the fifth stinkin' day in a row.2. MyChelle Fruit Fiesta Facial PeelThe blog on which I read the first review of this product mentioned "vat of acid" and "having my face used as a pinata at a school for wayward children". I didn't find it all that difficult to endure, but then, late-thirties acne has me inured to almost anything. My face, when I washed it off, was clean and smooth and well-moisturized, with nary a hint of redness. This is a keeper. It didn't even fade my freckles!3. Sara Lee 45 Calories & Delightful 100% Multi-grain breadDon't kill me. Friend Heather, who is a successful yoga teacher and Weight Watchers' devotee, swears by this stuff. I had been eating the Pepperidge Farms 15-Grain Shred Utility What The Hell Is This? Gristle? Bread for years in order to get my full RDA of grains. It made me sleepy. The Sara Lee stuff, though it's probably made with black magic, tastes just as good with peanut butter and fills me up without making me nap afterwards. 4. M.A.C. Loud Lash mascaraI have one complaint with Loud Lash: It's not manufactured any more. If you can find some on eBay in an unopened package, grab it. This shit stays put through a twelve-hour day during which both the water and power go out, meaning no electricity, and it will. Not. Come. Off. You'll have to use straight oil to dissolve it. Which means you'll have to buy either an oil cleanser or plain olive or coconut oil, but it's worth it. 5. Parachute (or any brand, really) Pure Coconut OilSpeaking of oil, did you know that coconut oil is molecularly quite close to sebum?That means that you can rub it on your face and leave it there for a couple seconds and it'll dissolve not only makeup, but blackheads. It'll condition your hair beautifully if you put it on said hair when said hair is dry and shampoo it out afterwards. It'll take care of nasty dry-skin rashes with no fuss. Best of all, a huge bottle of it is $1.67 at Mida's All Indian All Asian Bazaar, Your One-Stop Shop For All Asian Needs, which means you'll have bank left over for some stick-on bindis for when you're feelin' fly.6. And, last but not least, Le Vent Du Nord.Just go buy a couple of albums, already. It's the best toe-tapping, dance-inciting, nasal-projected-singing music Quebec has to offer. And the guy on guitar is cute. (Source: Head Nurse)

Shift change

code blog: tales of a nurse — Thu, 03 Jul 2008 04:00:00 +0100

Not to be confused with "Change of Shift," for which you should head over to Emergiblog to get info on how to submit your entry for the next edition! It's quite easy - all Kim wants is your very first post! We were recently on vacation and on our way to returning the rental car, we stopped to fill it with gas. I thought I'd go in and get the boy some pretzels to munch on until we could get him some real food. I picked out a bag and went up to the counter to pay for them. The clerk informed me that they were doing "shift change" and that I'd have to wait if I planned on buying that bag of pretzels. Seriously? I have never been in that situation before. I was quite surprised. My face must have shown it, because she said that she'd allow me to have the bag if I provided exact change. In the hospital, we have shift change at least every 8 hours. Our shifts are so varied, though, that it's possible to have nurses coming and going every 4 hours. We even had shift change at 3am at times until that shift was eliminated. The biggest shift change is undoubtedly at 7am, the next at 3pm and the next at 11pm. We have a rule that there is to be no family in the unit while shift change is occuring, and we aren't too keen on taking phone calls from family members either. For the former, patient privacy is the main concern. We talk to each other at the desk, but the desk is really out there in the open and anyone standing around can hear private information. For the latter, it is a courtesy to the nurses. The off-going nurse wants to give report and go home. The oncoming nurse wants to get report and start her shift. Constant phone calls that interrupt this just prolongs report and so we encourage people not to call for updates during these times. I don't find this unreasonable. Most other people don't either. There's rarely anyone around or calling at 7am, but the 3pm shift change is another story. There are usually lots of visitors and phone calls during that time. Most people understand, but there are a few that get angry at being told they have to wait until report is over. I gotta tell you though. Shift change at a gas station was a new one for me. (Source: code blog: tales of a nurse)

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Why have nurses?

Mental Nurse — Wed, 02 Jul 2008 20:49:47 +0100

Everything’s far too affable and agreeable here. So, cat, meet pigeons : Why have nurses in mental health? Really, stop and think for a moment. Maybe on in-patient units, where arguably nursing may still have a role for some patients some of the time (but is it RMN stuff?), some nurses may be needed some of the time. But not necessarily. In the community, shouldn’t they all be banned? If you need psychological work, the expert is the psychologist. If you need to optomise function, the expert is the occupational therapist. If you need diagnosis or drugs, the expert is the psychiatrist. If you need social and practical support, the expert is the social worker. Informal support from friends and family. Peer support from group work facilitated by a STR worker. Support workers could care coordinate and advocate, too. Non-statutory input from MIND, AGE Concern etc. Depot medication, like insulin or injected vitamin B12, would be given by a district nurse. Motion for the house : I propose that in mental health, nurses are no longer necessary. Discuss. (Source: Mental Nurse)

I hate you so much right now

Mental Nurse — Wed, 02 Jul 2008 16:35:43 +0100

I recently did a post on my site about a bipolar guy who, while drunk and detained in a psychiatric hospital in the USA, threatened to kill the president. The staff reported this to the secret service and the guy was subsequently sentenced to almost five years in jail. Timothy Pinkston was detained in a psychiatric hospital at the time and therefore I would presume “clinically insane” or whatever the term is. I can’t understand how they could send him to jail for something he said while he was officially mad and safely locked up in a psychiatric hospital. I wondered if you guys could enlighten me how things would pan out if there were a similar incident in a UK psychiatric hospital. The case raises lots of issues but there are four main areas that concern me. 1) Personal responsibility while under the influence of alcohol Up here in Smalltown, Scotland it is fairly common for people to threaten to kill each other when drunk. The usual scenario is two guys arguing in a pub and as one is ejected, he shouts, ”This isn’t over mate. I’m gonna get you. YOU’RE DEAD!”. Occasionally it’s all forgotten about the next day, sometimes there is a permanent rift between them and at worst a punch-up at a later date. The thing is, drunken threats are rarely taken seriously here, but I accept that may not be the case in all cultures. Anyway, what is the situation in a psychiatric unit when someone is drunk, are they considered responsible for their actions? If I am admitted totally pissed and I get stroppy and start threatening people, am I likely to be charged? What if, as an inpatient, I become violent and punch a nurse, will I be charged? 2) Personal responsibility while under section Can patients be held responsible for their actions whilst detained in hospital against their will? If I am violent whilst detained in hospital would you ever call the police? Similarly, if I am detained in hospital and during a restraint I threaten to kill you when I get out, can I be charged? How do you judge the seriousness and potential consequences of each threat and avoid reporting thousands of people to the police? 3) Nurses responsibility and breaching confidentiality At what point is it OK to disclose something a patient has said to you while under your care? If I tell you I smoke hash, I don’t expect you to call the police. If I tell you I plan to send hate mail to my neighbour, do you inform any external agencies? If I say that I plan to murder someone what would you do? Do you pass the buck to a colleague? What do you do if your manager poo poos your concerns and tells you to drop it? How do you actually respond? 4) Terrorist threat What if I am not violent or threatening but whilst under your care, disclose extreme personal views on politics which lead you to suspect I may be a threat to national security, how do you respond? Do have any set protocols or guidelines for these situations or is it left to your discretion? I appreciate I have asked loads of questions but I’m guessing there may be an all encompassing statement that covers most of the issues here. (P.S. You may have may guessed that I’m a bit paranoid at the moment.) (Source: Mental Nurse)

My next 30 years

thoughts from the night shift — Wed, 02 Jul 2008 13:12:00 +0100

"I think I’ll take a moment, celebrate my age The ending of an era and the turning of a page Now it’s time to focus in on where I go from here Lord have mercy on my next thirty years " My goal when I graduated nursing school was to be a flight nurse by the time I turned 30. I started as a new grad in a Level 1 ED, the first new grad they hired in over 20 years. I switched to the ICU when I really didn't want to, just because I knew I HAD to. Our base sits on the water, so last night I sat on the skids, looked over at the water and thought about just how lucky I am that I achieved my goal. Its hard to know where to go from here (as the song says), but I know I'm happy. So today I am doing a spa day.... seaweed, mud, massage... the works. We're doing dinner at my favorite restaurant and then a movie. It looks like a good day to me!!! (Source: thoughts from the night shift)

Smoking bans: the global picture

Mental Nurse — Wed, 02 Jul 2008 13:10:56 +0100

As the UK prepares to ban smoking in all public places including behind the bike sheds at the Mayfair club in London as well as euphemistically named “smoking rooms” on psychiatric admission wards up and down the country. Backrooms everywhere prepare to be no longer smoke filled and Mental Nurse takes a look at what other countries are doing to curb this perfectly legal occupation filthy and disgusting habit which is even worse than badger baiting or feeding small children feet first into the business end of a garden waste shredder. Australia Smokers are no longer able to light up on Manly, one of Australia’s most famous and picturesque stretches of surfing beach. Mr Ian, our Antipodean correspondent reports: “Strewth it’s no longer considered manly to light up on Manly! What is this *@## ing country coming to? Once we were a proud nation unafraid to spark up when ever and where ever we wanted now we are a bunch of limp wrested wooses. No wonder we can’t come up with a decent national anthem the only thing that rhymes with Australia these days is dahlia and failure.” Buhtan The remote Himalayan Kingdom of Bhutan is thought to be the only country to introduce a total ban on tobacco and tobacco related products probably because they don’t know what they are. In line with its policy of putting happiness at the heart of government policy Bhutan’s recently elected interior minister for chuckles his holiness Rim Tim Thunder Bolt kid Ken Dodd said: “Well fancy that Missus, fancy that, oh yes here we are in lovely Notty Ash, but any one caught with a fag in their mush is going to get my tickling stick inserted right up ‘em where the sun don’t shine then we will see who’s laughing.”. Canada Smoking levels in Canada are some of the lowest in the world, 21% of Canadians over the age of 15 reported smoking in 2002, according to government statistics. When asked why a government official replied “Because for much of the year it’s too fucking cold to nip out for a fag, you try it when it’s -30º below, even the bears are giving up”. France France attempted to cut smoking levels by raising the price of cigarettes by 200% but were forced into a humiliating climb down when Paris tobacconist, Roger de Bruillard strategically placved a carton of 200 Gitannes in the centre of the Champ de Elysees in Paris, bringing the entire French road network to a complete standstill. M. de Bruillard said a firm “Non” to French President Jacque Chirac before claiming 3000 Euros compensation for having to work a 30 hour week during the dispute which lasted precisely 37 minutes in October 2007 India India has banned smoking in public places in recent months in an attempt to curb high levels of tobacco addiction but no one has really noticed. Afghanistan Afghanistan banned smoking in public buildings and tobacco advertising in general in December 2007 but the ban was only effective when Mullah Mustafa Fajj, minister for religious prayers and fun times put 36 lashes on a pack of twenty and threatened to amputate the smoking arm of any one found with more than an ounce of rolling tobacco. Ireland Following their rejection of the Lisbon treaty The Republic of Ireland has continued to buck the European trend by repealing the smoking ban introduced in March 2004. Finnan O’ Flaherty chief of the little people brought about the change in policy by placing the strongest leprechaun curse on the EU in over a decade. The Irish are now the only European nation able to enjoy a fag and a pint in their local boozer. Bertie Ahern Irish Taoiseach criticised Finnan for endangering the countries seemingly bottomless pot of European gold by his actions and described the diminutive Irish pixie as. “Ya great feckin eejit” The Netherlands A tough crack down on smoking from January this year saw cigarettes banned from many public places including railway stations, trains, toilets and offices with tough penalties for bars and restaurants not complying with the new measures. Judiciary Hetebrij van Grootepunt-Borsten (most learned and very relaxed) of the Dutch High Court said: “Hey ish kool, yah” But in a surprise move the smoking of cannabis in Amsterdam’s coffee shops was unaffected as long as tobacco is not being smoked at the same time. Zimbawe President for life Robert Mugabe in another act of defiance aimed at the countries former colonial oppressors has declared the 12th March to be National Zimbabwean Smoking day. International observers however doubt if the country will be able to scrape together the estimated 10 Trillion Zimbabwian dollars needed to buy a packet of ten Marboros in time for the celebrations. United States America has some of the strictest laws on smoking in public. In New York smoking has been banned in clubs, bars and restaurants since March 2003 while in Washington the Federal government is considering using the Patriot act in what some have seen as a heavy handed attempt to crack down on smoking in the Capitals public spaces. California has banned smoking from death row prisoners awaiting death by lethal injection, citing prisoner safety, comfort and welfare as the main reasons for the measure that many have described as pointless and a bit of a waste of time really.. (Source: Mental Nurse)

--summertime fun (and food)

Milliner's Dream — Wed, 02 Jul 2008 07:58:00 +0100

On our first 90 degree day I enjoyed a day in the sun with a friend on Sunday. This included being introduced to sushi, a baseball game, blues music, Chinese food, among other things. For my inaugural sushi tasting we went to Sushi Revolution. Check out the pictures, but it's a trip! There is a conveyor belt that brings colored-coded-for-price plates of sushi around for you to choose. It's like Japanese dim sum. Next was taking in the Tacoma Rainiers game at Cheney stadium. Our timing was perfect, because just as we walked up to the ticket booth pre-game a gentleman was waving to reserved seat gold club member tickets he couldn't use and was giving away for free. Next was the Taste of Tacoma, just down the road. This was following by a brief stop for blues music at The Spar, but we decided quickly that we wanted Chinese food and went elsewhere for that, at a dive called Yen Ching, with delicious food, but no web site!What a wonderful break from work. A full day off --and my first weekend day off since February. Whew. (Source: Milliner's Dream)

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Meet allnurses.com

Nurse Ratched's Place — Wed, 02 Jul 2008 04:01:00 +0100

This is Patricia. She graduated from nursing school in 1961. I found her picture in one of my old nursing school yearbooks. Check out those crazy cat eye glasses. I love her glasses as much as I love her cap. Patricia and I want to welcome my newest sponsor to Nurse Ratched's Place. Allnurses.com is a popular online meeting place for nurses. Learn about the latest trends in nursing by visiting allnurses.com, or have a conversation with over 287,671 nurses just by clicking on the widget located in my sidebar. Come join us at allnurses.com. Patricia and I will be looking for you. Sponsored by allnurses.com - Where Nurses Come Together (Source: Nurse Ratched's Place)

Meet allnurse.com

Nurse Ratched's Place — Wed, 02 Jul 2008 04:01:00 +0100

This is Patricia. She graduated from nursing school in 1961. I found her picture in one of my old nursing school yearbook. Check out those crazy cat eye glasses. I love her glasses as much as I love her cap. Patricia and I want to welcome my newest sponsor to Nurse Ratched's Place. Allnurse.com is a popular online meeting place for nurses. Learn about the latest trends in nursing by visiting allnurse.com, or have a conversation with over 287,671 nurses just by clicking on the widget located in my sidebar. Come join us at allnurse.com. Patricia and I will be looking for you. Sponsored by allnurses.com - Where Nurses Come Together (Source: Nurse Ratched's Place)

Grand rounds salutes independence!

Emergiblog — Tue, 01 Jul 2008 22:41:23 +0100

Independence Day draws near and Dr. Rich over at The Covert Rationing Blog has dedicated this edition of Grand Rounds to anything that addresses issues pertaining to the Revolution! Many thanks to Dr. Rich for including Emergiblog’s submission as I had spent the weekend attending Jeff Scott Soto concerts on business in LA and was just a wee bit late! I did not realize this, but Dr. Rich has written a book entitled Fixing American Healthcare and you can purchase it on amazon.com or through the “Publish or Perish” site here. I’ve ordered it - I couldn’t resist the “Grand Unification Theory of Healthcare” subtitle! Should be an interesting read! (Is it just me or has George Washington always had a pot belly?) ****************************** Keep those “Change of Shift” submissions coming in! Remember, as CoS starts its third year, I’d like all nurse bloggers to send me their very first posts, along with a bit of info on why they started blogging. This is an easy one because you don’t have to write anything new! Just did up the old post and let’s take a walk down memory lane. I will actually begin my 4th year of blogging on August 1st, and I know there are nurses out there who were blogging way before that! If you’ll pardon the Matchbox Twenty quote: let’s see how far we’ve come! Blog Carnival or Contact button, as usual for the submissions. Sponsored by allnurses.com - Where Nurses Come Together (Source: Emergiblog)

Jed’s home set to get a diy sos ….

Mental Nurse — Tue, 01 Jul 2008 07:41:51 +0100

And for those who haven’t met Jed.. he’s here. He is the Patron(ised) Saint of Madness and mascot of the Acute Mental Health Unit, apparently. And on who’s authority is he getting a DIY SOS makeover? Well for a start, I think Nick Knowles might be happy to be involved. He’s just condemned Reality TV shows for mocking the mentally ill… but that’s a whole other thread. However, more illustriously, none less then the incumbent president of the Royal College of Psychiatrists, Professor Dinesh Bhugra had this to say: Britain’s most eminent psychiatrist has launched a powerful attack on the state of Britain’s acute psychiatric care system, saying many inpatient units are unsafe, overcrowded and uninhabitable, adding: ‘I would not use them, and neither would I let any of my relatives do so.’ <ref> So what does the great Bhugra have to say? With the advent of the Darzi reform specifically highlighting Mental Health as the Cinderella service we’ve always know, I’m pretty sure he’s about to take the goverment to task. Isn’t he? ‘Some acute psychiatric inpatient ward conditions are absolutely unacceptable,’ he told The Observer. ‘They are uninhabitable. The system often leaves patients feeling lost and abandoned. I predict the situation will become worse in coming years.’ Ooops.. sounds like he’s predicting he’ll ruin it even more? I’m sure he meant to add… “..unless we do something“? “But what?” I hear you both cry…. Bhugra is calling on the government to introduce a compulsory kitemark system of accreditation for all acute, inpatient psychiatric wards: ‘Until there is a compulsory kitemarking scheme, my prediction is that, as overcrowding increases, funding becomes more stretched and morale of patients and staff fall, overall conditions are likely to continue to deteriorate.’ Bloody great idea! Lets have some standards and accredit wards that reach those standards. Why didn’t anyone think of that before? Probably because we already have standards; be they generally unwritten ones, and having written ones doesn’t make better managers or produce extra funds. Tho it does help to train the managers on where to put the money and what to address…. just think of a Tesco’s shelf-stacker filling holes in shelves with tins - how would they know where to fill if they didn’t have a manager saying “there’s a hole in tinned tomatoes on aisle 3″; and if they didn’t tell the stock room workers to tell him when they were running out of tinned tomatoes then surely we’d have a huge tinned tomato crisis. What the shelf-stackers don’t realise is in his office, the shop manager has a list that goes… - check tomato tins are filled - check there are spares out back - check sweetcorn tins are filled - check there are spares out back The Darzi reform says change comes from bottom up - not top down. But when government determine that the last lot of extra funding it afforded mental health should be spent on community services it kinda ties your hands to improving in-patient services. But is it acceptable to allow this sort of thing to continue? ‘I arrived at the mixed ward one evening with a letter from my GP which explained that because I was a survivor of rape and sexual abuse, I was very scared of being in a unit with men. Despite this, the nurses said it was too late to show me around or even indicate where the bathroom was or where to get breakfast in the morning. ‘I found it hard to even persuade them to give me fresh bandages to cover the wounds I’d given myself from self-harming. There was very little individual interaction. Nurses communicated in one-word screams: ‘breakfast!’, ‘dinner!’, ‘medication!’ ‘The male patients walked around with their genitals hanging out of their ill-fitting pyjamas and, when one man deliberately exposed himself to me in the dining room and I complained to a nurse, he replied: ‘What do you expect? This is a psychiatric ward.’ When I told one of the female staff members that the ward scared me, she admitted it scared her too. Modern matrons (did they ever really happen in the AMHUs?) can certainly make a difference, given the authority, to the functional and professional practices of a unit. As Darzi said: Nurses play a vital role in the NHS: they will always be at the heart of shaping patient experience and delivering care. I’d love to see substantial funds injected for a one off overhaul of in-patient services but rather than waste huge amounts of money on business consultations and steering committees to lead audit and monitoring to set government kitemarks standards or accreditations processes - why can’t we just let sensible non-governmental organisations such as the Bright Charity take their Star Wards ideas forward? It’s not bloody brain science and they’re likely to do more good for the dollar than some suit with a clipboard. (Source: Mental Nurse)

She may not get twitter, but it doesn’t mean she’s not brilliant.

PixelRN — Tue, 01 Jul 2008 04:00:00 +0100

So my Mom did watch Hopkins last week, even though she didn’t read my smartass remarks on Twitter. She did, however, end up making a very astute observation about one of the docs. Dr. Quinones, that God-like neurosurgeon, was actually at Bayview Medical Center, not Johns Hopkins Hospital. (For those of you not familiar with the Hopkins system, Bayview is a little hospital down the road that falls under the Hopkins umbrella. Many doctors practice at both facilities.) I thought that when they were wheeling one of his patients out it looked like the Bayview lobby, but I wasn’t completely sure. My mom, however, was absolutely sure, as she noticed that in one of the shots you could see a computer screen with “Bayview Medical Center” on it. Go Mom! As my husband said, “Your mom doesn’t let anything get by her, does she?” (PixelRN trivia tidbit: Bayview was where I was giving all of those flu shots last fall.) ShareThis (Source: PixelRN)

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In which my mother bursts my twitter balloon

PixelRN — Tue, 01 Jul 2008 04:00:00 +0100

ME: Did you read all my smartass comments on Twitter when you watched Hopkins the other night? MOM: No, I don’t want to do Twitter. ME: C’mon, it’s not that hard… MOM: It’s just that… if you’re supposed to type in whatever you’re doing at any given moment, then wouldn’t you just say, ‘I’m sitting at my computer, typing into Twitter’ all the time? Twitter just hasn’t been the same for me ever since. Thanks, Mom. ShareThis (Source: PixelRN)

Happiness: discuss.

Mental Nurse — Mon, 30 Jun 2008 12:30:21 +0100

This is a post about being happy. Actually, it’s more a post about how you can become happy. Well, really it’s a post about how Professor Layard (of the ‘bring on the 40,000 CBT psychologists‘ fame) knows we can all become happy. Quite simply: “Happiness is inversely related to income at higher levels of income because of the declining marginal utility of getting richer,” See? He continues to demonstrate: “Let me show you.” He draws a graph: on the X axis is income per head, on the Y axis is average happiness. A curve ascends boldly and then tails off ignominiously. At the bottom of the curve, you will find countries such as Zimbabwe or Russia, where increases in national income per head will increase levels of happiness. “Think of economic growth in India - it has been associated with rises in average happiness.” On the ignominious bit you will find a cluster of western countries, including our own, where such rises in income per head don’t cheer us up one bit. Ok, do you have a simpler explanation Prof? What is happiness, Layard asked in his 2003 lecture series Happiness: Has Social Science a Clue? His answer was simple: “By happiness I mean feeling good - enjoying life and feeling it is wonderful. And by unhappiness I mean feeling bad and wishing things were different.” To his satisfaction, he had cut through a philosophical Gordian knot. Yes, many philosophers didn’t think the matter was so simple Allllllrighty…. So happiness is “feeling good” and unhappiness is “feeling bad”. The whole nonsense report goes on a little about economy and happiness Last year, Layard visited Bhutan, the Himalayan kingdom where government pursues the goal of gross national happiness (GNH). “Bhutan seems much happier than countries that have a materialist rather than moral ethos. Relationships are rather equal, there’s very little status anxiety.” He was impressed by the four pillars of Bhutan’s GNH: the promotion of equitable and sustainable socioeconomic development; preservation and promotion of cultural values; conservation of the natural environment; and establishment of good governance. “What really struck me is that as a matter of policy, there is very little extreme poverty. Bhutan realises that a redistribution of wealth that favours the poor most is better for producing happiness.” Layard’s mission now is to make Britain a bit more like Bhuta At the risk of ruining such an otherwise fantastic and deeply thought through notion… 1. Layard is starting to sound a little too happy with himself. 2. Bhutan is one of the most isolated and least developed nations in the world. I think the lack of being interfered with will be a big contributor to Bhutan being “happy” More considered opinion in this 2006 report assures us: Feeling sad? Researchers at Britain’s University of Leicester reckon you might just be in the wrong country. According to Adrian White, an analytic social psychologist at Leicester who developed the first “World Map of Happiness,” Denmark is the happiest nation in the world It furthers: Not surprisingly, the countries that are happiest are those that are healthy, wealthy, and wise. “The most significant factors were health, the level of poverty, and access to basic education,” White says. Population size also plays a role. Smaller countries with greater social cohesion and a stronger sense of national identity tended to score better, while those with the largest populations fared worse. Hmm… are they suggesting that unhappiness might actually be a product of poor national governance? Personally, I’ve not been happy since Beckham’s 1986 red card. Happiness is simply the absence of anything to feel bad about. (Source: Mental Nurse)

Vacation!

Digital Doorway — Mon, 30 Jun 2008 11:17:00 +0100

Dear Readers,We will be on vacation from July 1st to July 6th. Thus, Digital Doorway will also have a rest.Be well, and please stop back next week for the continuing saga..... (Source: Digital Doorway)

“hello, is this the emergency department?”

impactEDnurse — Mon, 30 Jun 2008 11:08:02 +0100

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Quote of the week #5

~ Dust in the Wind ~ — Mon, 30 Jun 2008 11:04:00 +0100

Man who has been waiting 30 minutes to have the cut on his thumb assessed: "You call this the emergency ward?! You should call it the death ward - you move so slowly that we'll all be dead before you get to us!" (Source: ~ Dust in the Wind ~)

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Do we speak good english in our emergency departments?

impactEDnurse — Mon, 30 Jun 2008 10:50:26 +0100

A delicate topic. How many times have you seen this scenario in your hospital ? A doctor from a non-English speaking background with very a limited English vocabulary trying to take a medical history and perform a complex assessment on a patient from a different non-English speaking background who also has a very limited English vocabulary. Exactly what sort of linguistoliptic therapeutic relationship is taking place here? Many times I have seen doctors who have managed to progress through the medical system despite an exasperatingly poor ability to effectively communicate with their patients in English. So, what sort of level of English vocabulary is needed to practice safe and effective medicine? With the deepening staffing shortages in many public hospitals necessitating increasing recruitment drives from overseas, are we screening for adequate English communication skills in our doctors? Or is good medicine more than just words? What are your thoughts? ShareThis (Source: impactEDnurse)

T’was the night before christmas..

Mental Nurse — Mon, 30 Jun 2008 08:25:42 +0100

Monday 30th June is the date for Darzi’s final report on proposed NHS reforms; the eve of the NHS 60th anniversary. My Gosh! The ann…… tii….. cciiiiiiiiiii …………………………. ……… pation! Personally, I’m so excited I was awake hours ago while everyone was still sleeping … but then it’s GMT +9hours in Oz and I had a lie-in. Then I got bored waiting and read some comments on the Telegraph online page… like this one… Sir - You report (January 30) that the University of California, Berkeley, has discovered that the male Anna’s hummingbird produces various noises with its tail and that a student suggests that this is “a new mechanism for sound production in birds”. It is not. Any naturalist will tell you that the common snipe, Gallinago gallinago, is long known for making a sound resembling the bleating of a lamb through the vibration of its tail feathers. In Gaelic the snipe is known as “the goat of the air”. Anyhow…. I’m most intrigued to see the Rant and Crippen duo’s responses, if only just for their predictable highly expressed emotional reactions (to the Darzi review - not the “goat of the air”). For more info on the Darzi review go here: Lord Darzi will release the Next Stage Review final report on Monday. The report will set a new foundation for a health service that empowers staff and gives patients information and choice, and ensures health care that is personalised, safe and high quality for all. You will be able to see the final report launch event live on this website from 2.15 on Monday afternoon, the final report and supporting documents will be available here from 3.30. The draft NHS constitution and a further document around workforce, planning, education and training (WPETS) will also be launched on Monday. These too will be on the website. Bloggers…. Start your engines…. (Source: Mental Nurse)

Dla should not be given to people with disabilities

Mental Nurse — Mon, 30 Jun 2008 06:53:21 +0100

That’s the latest cry of the MoS: That giant sucking sound you hear is the noise of money being vacuumed from the wages of productive workers into the pockets of dubious welfare claimants. ..writes a MoS journalist, who, by definition of his chosen career, is also a dubious claimant to being a productive member of society. It continues… How can it be right for taxes to be used to subsidise alcoholics and drug abusers, in the guise of a questionable, inadequately monitored payment called ‘Disability Living Allowance’, which can be obtained without a doctor’s letter? The same way a smoker can get access to a mobility allowance when they can’t walk more than 10 steps; or a fast food junkie can apply for home renovations because they can’t fit through the door anymore. Why is this article picking on alcoholics and drug users? Information obtained by The Mail on Sunday under freedom of information laws shows amazing increases in the numbers claiming DLA for ‘drug and alcohol abuse’ and among those claiming for ‘learning difficulties’. Ahh.. ok they’re not. They’re having a go at the intellectually impaired too. That makes it more equitable. Sufferers of unspecified back pain and ‘psychosis’ - in many cases, the result of illegal cannabis smoking - also lined up in growing thousands to collect our cash. Back pain sufferers and self-induced mentally ill. Cool. But why so angry of Tunbridge Wells? We do not know how much of Britain’s enormous £169billion annual welfare bill is well or badly spent. We do know that it is almost a quarter of the national budget, and consumes every penny of the £160billion paid in income tax by the working population. Ahh… money. But s/he’s just spouting at one particular area of those who access DLA - and not very well as they assume all drug and alcohol (and back pain and intellectually impaired) issues are simply malingerers. I’m not suggesting all alcoholism and drug use that leads to DLA claims is excusable or acceptable, but neither would I suggest that this is an area that can easily be arbitrated. The article does recognise the need for some individuals to receive support: All of us are happy to help look after the victims of genuine misfortune. But we expect the authorities to make sure that such assistance is given only to those who need it. So how do we do that? The article doesn’t say. Perhaps the forms could be more specific and people can tick boxes marked: Systematically sexually abused from the age of 4 Beaten regularly until left home at 15 Made redundant; lost wife and kids - not coping very well with life adjustment But then we all cope differently. And just who are the “victims of genuine misfortune”? Alcoholism and drug use is a condition that generally requires treatment to effect a remedy. It is a contentious debate - much like the chicken and egg - as to whether individual behaviours that lead to compromised functioning should attract support of a welfare state. It’s no different tho to the aforementioned smokers, junk food eaters and can be extended to many other risk-taking people - such as extreme sports enthusiasts and NuLabour voters. Certainly we in health care can see the initial demise and perpetual cyclical failures of recovery. What we should be concerned with is not how we make it harder for all to access welfare but how we can better provide services for those so debilitated. I’m not sure on the current trends but I certainly advocate innovative ideas like attending recovery groups earns you an extra 5 quid a week. To promote this issue under the heading of drug abusers and alcoholics is merely relying on the low-public imagery such attributes elicit. I object strongly to tarring all users and alcoholics in this way as malingerers. If I were to guess a random figure I know it wouldn’t be 100% as is being suggested. Unfortunately, this sort of press backs the current convoluted and frustrating welfare system that sets out a series of tests and hoops and forms that only those who were not genuinely messed up would be able to complete. I think it’s a sort of witch-hunt test that hails the old adage “If she doesn’t drown - then she’s a witch!” (Source: Mental Nurse)

Give me empathy or give me…another nurse

Emergiblog — Mon, 30 Jun 2008 05:13:25 +0100

Did you know there was actually a call for nurses in the Revolutionary War? I found this blurb on the Women in the U.S. Army website, which is also where I found this poster. I’ll reproduce it here, I have no actual author to credit, but the reference is the link above: “Shortly after establishment of the Continental Army on 14 June 1775, Major General Horatio Gates reported to Commander-in-Chief George Washington that “the sick suffered much for want of good female Nurses.” General Washington then asked Congress for “a matron to supervise the nurses, bedding, etc.,” and for nurses “to attend the sick and obey the matron’s orders.” In July 1775, a plan was submitted to the Second Continental Congress that provided one nurse for every ten patients and provided “that a matron be allotted to every hundred sick or wounded.’ “ Hey - they actually had patient ratios back then (”one nurse for every ten…”)! I guess we don’t “obey the Matron” anymore. Now the “Matron” is called Joint Commission! ****************************** The title of this post is in keeping with Dr. Rich’s Grand Rounds theme of “Independence Day”. Of course the first thing I wanted to do was put up a pic of Jeff Goldblum, but he meant the actual holiday! So, a paraphrase of Patrick Henry’s famous statement inspired the following post. It doesn’t take a bit of government intervention to implement. That alone is amazing. *************** Empathy: the ability to understand and share the feelings of another. ******* She’s in her mid thirties. First pregnancy, just found out she was expecting earlier in the week. Home pregnancy test; hasn’t even had time to make an appointment with her doctor. Tonight she began spotting. Nothing major, but she knows something isn’t right. She is cramping. And she is shaking. Tearful. Her husband is at her side. He doesn’t know what to say, but he is worried. Asking a lot of questions. What does she need? She needs a nurse who can empathize with what she is going through. You see, we know that many, many pregnancies end in a miscarriage. We also know that you can have spotting early in pregnancy and still have a perfectly healthy pregnancy/baby. We know that if you are having a miscarriage, there is nothing in the world that will stop it. But she doesn’t. She’s scared, she is bleeding, and will probably be grieving the loss of her baby within a few hours. She doesn’t need a nurse who rolls their eyes because she is “over-reacting”. She needs empathy. ******* He is in his mid-twenties. He vomited once (or twice) and has abdominal pain. Feels like hell, is pale and pretty sure is he is about to vomit again. He called his mom to drive him into the ER. Pretty dramatic presentation. Dizzy when upright, mom wheeled him in via wheelchair. He’s scared. He’s uncomfortable and honestly thinks he may be dying, or at least on the verge of dehydration. All he wants is to stop vomiting and feel better. We know that vomiting is self-limiting. We know this is most likely a viral gastroenteritis. We know he’s in no danger. We know his symptoms can easily be allieviated with medication. But he doesn’t. He doesn’t even know the term “gastroenteritis”. He just knows that it feels like something is horribly wrong. He doesn’t need a nurse who rolls their eyes and silently calls him a “wimp”. He needs empathy. ******* She’s in her mid-forties. She arrives in the middle of the night in sunglasses, holding her plastic garbage can in front of her face. Migraine. Three days. Vomiting. 24 hours. Photosensitive. Extreme. She’s tired. Tired of being in pain. Tired of not being able to get on with life. She tried every one of her medications, more than once. Keeping them down is another story. We know this is probably a typical migraine. We know that many people come in to the ER with the same complaint and are discharged after receiving some pretty heavy-duty drugs. We often see them many times in one month. We know the drill. And so does she. She knows there will be some suspicion. She can hear it in the tone, she can see it in the face of the nurse who takes down her triage information. What she doesn’t need is someone who doesn’t believe her pain is a 10/10 and rolls their eyes because she is allergic to Toradol and Phenergan. She needs empathy. ******* Empathy is at the heart of our profession. As in synonymous with “caring”. It’s what we do. It’s what we have to offer as nurses. We give of ourselves so that others can feel better. In the ER specifically, we work quickly to get them as comfortable as possible. But we absolutely must have empathy. The opposite? Apathy. And apathy is just another word for nothing left to feel. God help us if we get to that point in our practice. God help our patients when we get to that point in our practice. They expect medical care from their doctors. They need empathy and caring from their nurse. It’s what we do. Sponsored by allnurses.com - Where Nurses Come Together (Source: Emergiblog)

Medical assistant online training special report: extreme caution!

Medical Assistant Net Blog — Mon, 30 Jun 2008 04:00:00 +0100

Special Report: Extreme Caution!... "The world is a book and those who do not travel read only one page." Saint Augustine Those looking for a medical assistant school must first understand the meaning AND purpose of a good medical assistant program. Don't become one of those horror stories where students wind up with certificates, or diplomas that are completely worthless, and with (Source: Medical Assistant Net Blog)

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Reflections....

Digital Doorway — Mon, 30 Jun 2008 02:06:00 +0100

Life moves along a trajectory and it often seems that one is simply along for the ride. However, as powerless as we may sometimes feel vis-a-vis our life's development, I feel certain that I must take full responsibility for how my life has grown and changed. Whether there are unseen forces at play or not, taking responsibility for my life is one way that I empower myself to reflect on the choices that I have made, not to mention the choices before me as I press forward.Nursing as a career was a conscious choice to work in a field that would provide me with a reliable income while also allowing me to serve others in a soulful way. That ability to serve and give from the heart is, for me, truly at the center of nursing. Even as I begin a process of decreasing the amount of time I spend providing hands-on care (at least temporarily), I remain conscious of the notion that it is the face to face contact that makes my "nurseness" real.Developing a career as a writer, so far my identity as a nurse is absolutely central to my writing----here on Digital Doorway, on Nurse LinkUp, and in other online venues where I may soon be providing content, articles and blog posts. My life-long desire to be a writer is now manifesting itself through the "filter" of nursing, and my life as a nurse is feeding and abetting my work as a writer. This symbiosis (and may I also say synthesis?) is gratifying and exciting, and while writing becomes more and more central to my life and career, I plan to never lose sight of my very deep-seated need for contact, intimate interaction, and the gifts of the nurse-patient relationship.This newest manifestation along my career trajectory is keeping me on my toes, and I look forward to watching the progression as things develop and change. Thank you for staying tuned, and thank you for being the eyes and heart on the other side of the computer screen. (Source: Digital Doorway)

How to get 300,000 quid for not doing your job

Mental Nurse — Sun, 29 Jun 2008 15:21:42 +0100

This is the sort of egocentric selfish inane inequity that gets on my tits. A psychiatrist who released a mental patient who then stabbed a retired banker to death is suing for compensation. Consultant Gill Mezey wants more than £300,000 from her employer for damage to her career. Why did they suspend her? Dr Mezey, 50, decided to let paranoid schizophrenic John Barrett out of hospital for an hour’s leave without even seeing him, in September 2004. Barrett, then 43, immediately absconded, armed himself with kitchen knives and the following day attacked Denis Finnegan, 50, as he cycled through Richmond Park in South West London. Of course, I don’t know the full story of what came to pass, but it does seem that Dr Gill authorised this patient to leave hospital the same day he was compulsorily admitted. Trying to be analytically just; it would be reasonable to suggest a junior doctor or even a nurse practitioner called the consultant, rather than the patient, to request this authority. However, if doctors, and moreover Consultants, wish to retain this authorative control, they must be prepared to accept the responsibility that comes with it. Legal documents issued by her lawyers allege she has been humiliated by being banned from clinical work and the trust has breached her employment contract. She also claims she will be unable to apply for clinical excellence awards and will lose money from her private practice. I would suspect that investigations were carried out and, in the gravity of such an erroneous decision, it was right to suspend her from clinical duties during this time. This is no different treatment than I would expect towards any clinician undergoing critical investigation. In fairness to Dr Gill’s compensation claim tho; Mr Finnegan’s family did not seek or receive a penny in compensation for his death. They are outraged at Dr Mezey’s decision to sue South West London and St George’s Mental Health NHS Trust. [Dr Gill] claims she has lost out financially and been ‘humiliated’ by her bosses, who suspended her on full pay. Well why should Denis’s family get any compensation - it’s not like he’s got to live with anything? (Source: Mental Nurse)

This week in mentalists… week 35 (i think)

Mental Nurse — Sun, 29 Jun 2008 14:51:11 +0100

So Z is sunning it up in Bognor; and I have no idea how to do this having not undertaken a double degree and … as Doc C might put it… this is dumbing down of “This week in Mentalists”…. but somebody had to do it. Apologies in advance for omissions, misquotes, forgetting your names, bad representations and wrongly attributing excerpts to someone who didn’t actually write it (a specialty of mine)…. Otherwise, please enjoy. [All complaints in writing please to SWGAS@mentalnurse.org.uk.] Pole to polar has another guide to living with mental illness: So! The Psychiatrist has decided that you’re mental. Well done! By now you’ve probably been told what flavour of mental you have. The flavour favoured by most is bipolar disorder but you may have been told you have schizophrenia, depression, anxiety, a personality disorder, obsessive compulsive disorder or an eating disorder. Or even more than one of those things! That’s good, it means you’re extra special. What will happen now is that they’ll hold a little conference behind your back to determine whether you’re going to be prescribed medication, going to be referred for therapy or whether you’re going to be kicked out of their office. There’s a few other interesting posts since that one too.. so just keep reading. In a carer’s journal, Sam’s dad Mike has doubts about the sudden presence and purpose of an Advocate… This is clearly political. The advocate was wheeled out at the last CPA meeting and sat between the consultant and Sam’s named nurse. Her only contribution was to ask if Sam was “compliant” with medication - and when told “yes” said that he clearly liked it then. Afterwards she told Jane that she had only met Sam a couple of times and found him difficult to engage with. Mental patient about town is having some Success! Yesterday I managed to go to the launderette for the first time in over two months. I’m now wearing clean clothes and my duvet and sheets smell fresh. It may be a small thing but this has lifted my spirits. Keen to build on this success I’ve just got a haircut and as well as paying my bills at the paypoint shop on the Earls Court Road. Being a poor person means I have metres for the gas and electric, so I pay a higher tariff. Something’s not quite right there, I keep thinking. But I mustn’t grumble. I have gone a few days now without major problems with paranoia or believing people can hear my thoughts. The dysphoric mania has returned but it’s not too bad. I wasn’t able to update this site Monday or do much of any use but today I’m able to sit at the computer and I haven’t head butted it so far. Shrink reminds everyone that nurses are bloody wonderful.. well actually he was talking about Wibble and non-pharmocological treatment successes in Dementia.. but I can quote whichever bits I like… I’m blessed to be working with nursing staff who are exceptionally good at what they do. Which isn’t diagnosis or medical stuff, it’s nursing care. I’ve a lady in permanent care, through progression of her dementia. She has become increasingly vocal (shouting out) and wandersome. We have no antishouting pill. We have no antimoving pill. There’s also a little discussion in the comments about doll therapy which is an interesting read. Dumped by a hallucination gives some “reality” therapy to Rhiannon after a tiff between them.. “Oh my, Rhiannon! You’re not self-harming again, are you? Naughty naughty!” “I fell into a tree,” she says, with utmost dignity, turning her arms so we can see all the better while trying to look like it was a natural action. Uh-huh? She just fell into one of the only two trees in the whole field, did she? The ones that are about a million miles away? And let’s see how loud me and Gwyn can yell attention-seeker! Quite loud, as it turned out. DBAH also posts candidly on considering violence tendencies.. I’ve heard that inveterate self-harmers, trying to get over it, will sometimes turn everything they see into an instrument for self-harm without even trying, without necessarily any intention to use it that way – it’s a subconscious action. So, y’know – look at a bed and see the bedpost, a blunt object against which your poor tender skull could be thumped; look out a window and see not the view but the sharp-edged shards it would make when shattered; and a lunchroom? Knives for wrists, forks for eyes, plates for more shards, burning food, chairs with narrow legs to impale, heavy tables that could crush feet. That kind of cheerful thing. Well, OK, let’s reverse it – I see a bed and it’s not my head being smashed on the bedpost; it’s not me who’s being cut on that window; and the lunchroom? It’s best not to even go there, if you ever want to walk into a canteen free of paranoia again in your life. Aethelread the unread was pleasantly surprised at actually how read his post had been.. This blog had it’s biggest ever daily total of hits on Tuesday, the day after I posted, and the post has rocketed (or, at least, gently strolled) into the exact centre of my “most viewed over all time” list, even though it’s only been up for a few days. Now, I wonder, was it the topic, or the rather provocative title, that produced the extra interest? So what provocative title? “Curing” homosexuality: religion, psychiatry & the limits of free speech Blimey, that’s a title and a half for you… Experimental Chimp responds to this Times Online article about patients being “jollied along” rather than treated, with this: So this pretty accurately describes how I feel about the system. It’s working for me now, but it sure took a while and I’m only getting the right treatment because I continually pushed for it over the course of a pretty horrible year. Finally, Mr Man’s Wife explains her relative absence over the last few months on the blogosphere… As you no doubt know, I was suffering from depression during the winter months. I have a history of depression and this time round I have been taking antidepressants since 2002. I’m usually fine as long as I “keep taking the tablets” as they say, but sometimes I get a bit “wobbly” and need my tablets increasing for a while. This doesn’t usually last long, but this time the increase in tablets made little or no difference, and my depression only really started to lift around mid-March. Since then I have struggled on and off, and I have found that the only thing that has really kept it at bay is total avoidance of stress and pressure – hence the lack of posts. Good to see you back MMW. If it helps, I’ll cancel winter. (Source: Mental Nurse)

Cannabis worse than the nazis

Mental Nurse — Sun, 29 Jun 2008 09:45:56 +0100

Professor Tom Booker, head of drug research at Glasgow’s Clyde University and the man who conducted the latest lengthy study into the drug, said: “Yeah, whatever.” A spokesman for the University said: “The Nazi’s were very bad people but even they could not make a middle class white boy adopt dreadlocks for a hairstyle, or make a highly intelligent middle aged man crawl around the floor of his laboratory in his underpants weeping with laughter about nothing at all, and then eat his own weight in marshmallows.” Following the promotion of cannabis to the top spot in the evilness rankings the top ten most evil things in the world are: 1. (-) Cannabis 2. (2) Tobacco 3. (4) Debt consolidation ads featuring Carol Vorderman = 5. (1) Richard and Judy = 5. (3) The Nazis 6. (-) Heathrow Airport 7. (5) Prince Phillip 8. (7) Joseph Stalin 9. (-) Noel Edmonds 10. (10) The Devil and all his minions (Previous position in brackets) It’s official read all about it here. (Source: Mental Nurse)

Css in blogger

St Vincent's Hospital Darlinghurst - Male Nurses — Sun, 29 Jun 2008 04:00:00 +0100

This is the my first attempt using Cascading Style Sheets (CSS) in a post. All credit goes to Dynamic Drive, and from what I can gather this post should display correctly in most browsers.When you pass your mouse over a thumbnail, a larger image will be displayed. I first started off creating this within Windows Live Writer and after pulling out half my hair attempting to get this right, I then published the post to my Blogger Blog. Unfortunately I hit a FEW hurdles as I hadn't used CSS in Live Writer before, but after some copying, pasting and deleting between the two, I put a few problems to sleep, permanently .To make this all work in the end, I placed CSS code within a sidebar widget to get another piece of code within the post itself to work. There was supposed to be text below each large image but I wasn't able to do it, due to a hitch with blogger or was it my. I'm not quite sure but it appears to work without the text.If you have any problems could you please let me know what they are and what browser your using, in order to further educate myself and perhaps others as well.Just to finish off, I would like to thank Dynamic Drive and the Windows Live Writer Team. You guys rock!To be continued... (Source: St Vincent's Hospital Darlinghurst - Male Nurses)

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How the nurse practitioner's place was born

The Nurse Practitioner's Place — Sun, 29 Jun 2008 04:00:00 +0100

Kim at Emergiblog has put out a request for our very first blog post for Change of Shift. I have been blogging since Feb. 2005 (has it been that long?) I started blogging after I was googling some nurse practitioner information and stumbled upon a few NP blogs and noticed that there weren't very many of them out there on the net. My first posts consisted of answering questions like "What is a Nurse Practitioner?" etc. but further posting also included my aggravations of schooling and pictures of family life. I also tried to include some funnies on occasion. Imagine my surprise when I started to have regular readers (Lisa,Teresa, Azygous, Kim,Geena just to name a few. I felt so honored that some of my fellow nurses in the blogosphere would take the time to leave a comment and encourage me through the harrowing experiences of the times. Some of my readers have come and gone. Some don't blog anymore. I miss popping in and seeing what they've been up to. Soon, I started to pick up traffic and decided to add yet another reason to blog. Cold hard cash. Sounds rather materialistic, but when your student loans start stacking up (83,000), you start to look for ways to offset them. I added Adsense (which has been very good to me so far!) Then I got my very first paid advertiser Scrubs Gallery and now I am proud to be an affiliate of NP Business Owner. School finished and it's been over a year now since I graduated as a FNP and am loving every minute of it. I really encourage anyone who is thinking of becoming a nurse or already is and is thinking of continuing your education, do it! And don't forget to blog about your experiences so we can all enjoy and learn from them! (Source: The Nurse Practitioner's Place)

Impermanence

Digital Doorway — Sun, 29 Jun 2008 02:38:00 +0100

Reflect on this: The realization of impermanence is paradoxically the only thing we can hold on to, perhaps our only lasting possession. It is like the sky, or the earth. No matter how much everything around us may change or collapse, they endure. Say we go through a shattering emotional crisis . . . our whole life seems to be disintegrating . . . our husband or wife suddenly leaves us without warning. The earth is still there; the sky is still there. Of course, even the earth trembles now and again, just to remind us that we cannot take anything for granted. . . .---Sogyal Rinpoche (Source: Digital Doorway)

The patience of patients.

impactEDnurse — Sat, 28 Jun 2008 12:24:59 +0100

Photo Credit: Mark Cummins Patients in the waiting room just dont get it. And neither do we. Lets explore this a little deeper. But first, here is a great letter from Deana about something that every nurse who works in an ED experiences: I would like to get your input on something that is troubling me about being in the hospital with patients. I currently am a senior in a bachelor of science nursing program in the States. I worked for two semesters as a care partner/patient care technician on a med/surg floor and then about 2 months ago, started working 1-2 shifts per week in an emergency dept. in a small community hospital in town. It has been an education in ways that I didn’t foresee. I am astonished at the selfishness of people and their complete lack of understanding on how an ED works. Example: last night, the ED was dead (we actually had a couple of empty beds!) and only two patients in the waiting room. I was holding down the fort in triage for a moment while the triage nurse went to do something. At that moment, a young mom with a limp toddler came rushing up to the window and quietly said her baby had just been seizing from fever. I turned around, the triage nurse had just come back, and she whisked the mom and baby immediately back into a room where nurses materialized out of nowhere and started working on the kid. I went back to triage to make sure someone was there until the triage nurse could get back. Suddenly, this woman was in my face and blessing me out for the fact that we took a patient who had just arrived back into the ER before her boyfriend who had been there for 5 whole minutes and was suffering from back pain. I explained to her that she was in triage and that sometimes we need to take patients back first, even though they arrive later, because of their condition. She did not care. In her mind, it was a first come, first serve issue. And, I’m sorry to say, I strongly suspect that she thought racism was part of the reason we didn’t take them back first. Well, within 2 minutes, the triage nurse was back and we got the boyfriend checked in. Total wait time in the waiting room? Less than 10 minutes. Boyfriend could walk, talk, the whole bit. No wincing, no apparent restriction in movement, just some back pain. I had to start an IV on him. Normally, nurses in that ED choose an 18 gauge but I always choose a 20 gauge unless otherwise indicated because I just don’t want to cause unnecessary pain. Well, I was so furious that they actually thought they should be seen before a seizing 20 month old that I chose an 18 gauge. And this man, this grown man who had tattoos, actually told me he was afraid of needles. Seriously. I thought to myself, gee, that’s too bad. Ya hear that screaming in the background? That’s the feverish 20 month old you thought should have to wait so you could be seen first. He’s getting an IV with a pretty big gauge right now AND he’s about to get a lumbar puncture. Ian, I know in the big scheme of things, what I did was no big deal. What is scaring me is that I am just a student - I haven’t even started to practice yet, but I had malice in my heart. Lord knows it was wrong of me to feel that way and do what I did. In which Ian looses his cool, and carries on like a wanker in his own ED. Deana, let me tell you a story. Not that long ago I got a needle stick injury just before I was about to go off duty. It was a very low risk exposure, but following our occupational exposure protocol, I registered myself to be seen and have some blood taken etc. Anyways, it was a very busy shift so I settled down to fill out the lumber-yard of paperwork I had generated for myself. An hour later I popped over to see where I was in the queue. I had moved backwards! Bugger. This was eating into my own time now and I very quickly became impatient. Come on…Ive got stuff to do. Another hour passed and I was still waiting to get sorted out. Come on..I have to be back here in six hours. My patience was evaporating exponentially. Ten minutes later: This is ridiculous! I watched two people register with chest pain….. just great. COME ON PEOPLE!! How much longer have I got to waste my time hanging around here? I just wanted to shake the spinal fluid out of someone. AAAAAGHHHHHHHrrhhhh!!!!! Now, this is from a nurse with 25 long years of ED experience. An experienced triage nurse who knew exactly what sort of workload was unraveling in the department that evening. A nurse who quickly found he probably has much more in common with all those other scared and frustrated patients in the waiting room than to that persona of cool, capable, objective, professional emergency nurse he imagines himself to inhabit. So be it. The one finger lesson. Here is a little experiential experiment. You could just read about it, but to actually reflect and gain some understanding, to actually grok it, I recommend you follow through the instructions. Part one: It is a very busy Friday night in your ED. A forty year old man presents two your department with a small rubber washer stuck on his fingertip. He is complaining of a lot of pain. He has good capillary refill to his fingertip and no other injuries. How long do you think he can safely wait to see a doctor? Do you think an emergency department is an appropriate place for this man to present? What would your advice be to this man? Part two: Now. Take a small elastic band and wrap it around and around the tip of your finger at the base of your fingernail. It should be tight but not painfully so. Leave it in place for as long as you judged the man could wait to see a doctor ( or as long as you can bear…which ever occurs first). Notice how your perception of everything changes as the pain in your finger increases. Notice as time goes on how hard it is to think about anything except you, your finger, and your pain. Try to carry on with your daily activities as normal. As the throbbing pain escalates….notice how you start to get this creeping catastrophization. Do you worry about whether there is enough blood getting to the tip of your finger. Could it fall off. Perhaps it might get infected and you could get a sepsis. You just might die! Shit. What exactly do you feel now? What are you thinking? Eventually, the whole universe tends to contract into this single narrative of pain and suffering and fear. Intellectually, this might seem like a ridiculous thing to say about such a minor thing as an elastic band on your finger…but try it and see if I’m wrong. And when you can bear the pain no longer (which is in my experience often what it takes before your typical male patient will seek medical help), imagine you come into the emergency department and are Triaged by the nurse (you) who answered the first part of the exercise. How would the you in part one interact with the you in part two? And how would the you in part two feel about that? And how would you behave whilst you waited? [ Read on: The patient I just wanted to slap. The power of reflective practice. ] ShareThis (Source: impactEDnurse)

Watching the scales...again

Time for Your Meds — Sat, 28 Jun 2008 04:00:00 +0100

My doctor has put me on yet another medication--this one for my cholesterol, which is dangerously high. Adding that to the diabetes and the kidney damage, my weight must come down. He wants me on a low-fat, high fiber diet, which sounds like such fun, but which is totally necessary to keep from having a fucking heart attack or stroke. So, I joined Weight Watchers (again) because it's the only thing that has ever worked for me in terms of real weight loss. The thing with diabetes (Type 2) is, you can totally eradicate the disease by eating right, losing weight and exercising. I wouldn't have to swallow those enormous pills every morning and night, I wouldn't have to stick my finger to check my blood several times a day and I'd get healthy in the process. Everyone with diabetes knows this, so why doesn't everyone do it? Because it's fucking hard, that's why. Well, it's also hard to have heart disease, kidney damage, high cholesterol and to be so fat and out of shape that climbing a simple flight of stairs is to be avoided at all costs. This is not fun. Quitting smoking would also be a good idea, yes? How many times have I tried that? At least ten. What will be the lucky number? When will I quit for good? When will I get off my ass and stop making excuses? (Source: Time for Your Meds)

Does mental illness exists ? (3)

Mental Nurse — Fri, 27 Jun 2008 11:54:38 +0100

Take a look at the following two articles both from the USA. The first is about three mentally ill people who were all involved in serious incidents after stopping their medication. David Tarloff a schizophrenic hacked to death a psychologist, Lee Coleman slashed two while on a rampage and Khiel Coppin a “disturbed” teenager confronted Police and was shot dead, The article suggests tracking mentally ill patients and ensuring their compliance with medication regimes by monitoring Medicaid payments. The second article suggests using the database to track people with serious mental illness and alerting Health care professionals and Police when psychiatric patients stop their medication but before they fall through the cracks in the system and turn violent. The article also advocates greater communication between the criminal justice and the mental health system to identify potentially dangerous mentally ill people in the first place. Also mentioned is Kendra’s law, a statute empowering psychiatrists to obtain a court order compelling the most dangerous mentally ill patients to take medication as a condition of their release into the community. It is also advocated equipping the emergency 911 system to notify Police when they are called to the address of someone with a history of serious mental illness. Setting aside the inflammatory nature of the reporting, (psychiatric patients always hack at their victims usually while on a rampage they are then confronted by cops who end up shooting them) you don’t have to be in complete agreement with Ted [1] [2] to see that these proposals have profound implications for civil liberties and some of the above proposals are to be adopted in this country. But when are people with mental illness responsible for their behaviour? There are some philosophical positions which maintain that people are never responsible for their behaviour because behaviour is always determined by previous events. Jean Paul Sartre took a diametrically opposed view when he stated that humans have “absolute freedom” the only limits to our freedom being freedom itself. For Sartre to be is to choose oneself and freedom is the essence of what it is to be human. However there remains considerable support for the notion that people with mental illness are not fully responsible for actions which are symptomatic of their illness. To what extent psychiatric patients are responsible for their actions depends on which mental illnesses, if any, provide a valid excuse for an individual’s behaviour. Schizophrenia for instance causes cognitive as well as emotional distortions on such a scale that most people are comfortable regarding it as a bona fide illness. But it is the distortions in belief and reasoning that provide the clearest justification for excusing the bizarre and sometimes violent behaviour that results from this condition and forms the basis for the insanity defence in law. Psychopathic personality disorder is a more contentious diagnosis as it often includes symptoms that are destructive and criminal in nature. There is understandably great suspicion of any attempt to excuse the behaviour of psychopaths but it is an open question to what extent psychopaths can comprehend the morality of their actions when their moral understanding is extremely limited. Another way of describing psychopaths is as people with deeply flawed personalities who have no use for morality, to blame such a person for their behaviour would be like blaming a cat for playing with its prey before killing it. How can we blame someone for doing what is in his or her nature? Alcoholism faces us with a different dilemma. Should alcoholism count as a disease at all? Certainly those thought to be alcoholics can not be detained under the MH Act purely for their alcoholism but a key issue in deciding if alcoholism is a mental illness is in deciding to what degree an alcoholic is responsible for his or her continued drinking. It is only plausible that alcoholism is an illness if alcoholics are in some meaningful way not responsible for their drinking. Evidence to support this view is supplied by the presence of withdrawal symptoms when a chronic alcoholic stops drinking. Brain damage that can occurs through excessive drinking and studies that show alcoholism runs in families is also taken as evidence that alcoholism is an illness and should be treated as such. But this evidence is contestable, withdrawal symptoms merely shows that it is difficult to stop drinking while brain damage is suggestive of a disorder not necessarily an illness. Laziness and cowardice could also turn out to have a genetic component but this would not make them a disease. The problem for alcoholics is that they are often described in highly pejorative terms, weak, self deceiving, selfish, self-destructive, short-sighted, uncaring and even pathetic. Describing alcoholism in terms of personality traits renders the “alcoholism as illness” argument at best secondary and at worst irrelevant. However it is hard to describe alcoholism as a matter of rational choice, problem drinking often presents as a self perpetuating way of life and while it is difficult to pin point a specific cause for excessive drinking the drinker often has a role in perpetuating his or her problem. Testimonials from addicts provide evidence for the difficulty of giving up addictive substances and sometimes no amount of willpower or resolution to give up is sufficient to deal with the problem. Heavy drinkers will often fail to cut back or moderate their alcohol consumption despite the knowledge that their actions will have dire and potentially fatal consequences. This argument suggests that the issue of personal responsibility is logically “a priori” to the issue of free will and addiction is therefore a disease because addicts are unable to control their addiction. Self control in any form of mental illness is a matter of degree and the ability for an individual to exercise free will is central to deciding an individuals competence and if it is justified to deprive them of their liberty on the basis of what they might do to themselves or others. Some people generally have more control over their behaviour than others, some are better at resisting temptation than others and it is rare for anyone to have complete control over their actions and behaviour. It would seem to follow therefore that there must be a limit to which anyone suffering from a mental illness is or is not responsible for their actions. To put it another way the disease status of mental illness is not an all or nothing thing state of affairs. Unfortunately for the purposes of public policy there is little room for a concept of mental illness as a semi disease. (Source: Mental Nurse)

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Back in an old saddle

Digital Doorway — Fri, 27 Jun 2008 04:16:00 +0100

Today I began a four-week intensive of covering for vacationing Nurse Practitioners at my old office for 16 to 20 hours each week. While I've been spending a half-day there most weeks---filling med boxes, doing simple home visits, filling insulin syringes---I am now back in the position of Care Manager, albeit temporarily. My anxiety vis-a-vis this little sojourn has been high, and today was no exception. However, once I was ensconced in that old familiar milieu, surrounded by caring colleagues who I've known for many years, my anxiety melted away and I just got down to the task(s) at hand. Still, I can safely say that being back in this capacity causes me to feel immense gratitude for the opportunity to no longer work full time, and to have left the job of Care Manager behind. My nursing career is at a new place, with a learning curve at my new hospice position, many writing opportunities (mostly over at Nurse LinkUp), and the ability to pick and choose what I do and when I do it. So, I'm watching the wheels, and I think I like how they're turning. (Source: Digital Doorway)

20 out of 10: change of shift

The Nurse Practitioner's Place — Fri, 27 Jun 2008 04:00:00 +0100

20 Out Of 10: Change of Shift A great compilation of the different types of nursing in the profession. A must read for those considering joining our ranks! (Source: The Nurse Practitioner's Place)