My Strong Medicine

8 crazy things nurses do during flu season | Scrubs – The Leading Lifestyle Nursing Magazine Featuring Inspirational and Informational Nursing Articles

Anyone disagree??

The flu season can make a nurse act crazy

2011-11-30T11:07:00.001-05:00

8 crazy things nurses do during flu season

As nurses, we get very comfortable with our obsessive compulsive behaviors.

During the flu season our OCD-like nature gets ramped up simply because of the obvious – more people are sick.

Whether it’s from a new strain of the influenza virus or maybe the idea of people refusing (or plain neglecting) to get the vaccine, here are ways to take some extra precautions to ensure we don’t get the flu….

1. Pay with credit or debit

Can you imagine the filth and germs hanging out on that paper money… or those coins? We all took microbiology. We know what can hang on!

2. Avoid mass transit transportation

Everything from the subway, bus transit, planes, etc. (Please refer to “taking the stairs”) Who wants to be huddled up next to someone with a snotty, runny nose? You have nowhere to go!

3. Take the stairs

Elevators are a no-no. What if someone sneezes!! Seriously?!

4. Personal stash of disinfectant wipes

Who knows when you may need to use a public telephone, a public computer, or worse yet… have to pull open the door to exit a public bathroom instead of pushing the door!

5. Wear long sleeves everywhere

For that one time you use a public bathroom and you have to pull the door instead of push the door to exit. Need I remind you that not everyone washes their hands after they’re finished? (Oh, you know I’m right.)

6. Avoid salad bars and buffet meals (including family ones)

Some people forget how the food is actually made and prepared. Yes, those employed by a business establishment wears gloves. They are required by law, but what about your family? Or your friend’s football party??

7. Refuse and/or deny any requests to borrow your cell phone

I’m pretty sure you can figure out why.

8. And of course, this is a given: We wash our hands. And then we wash them again. And again. And again.

What do you do to avoid the flu?!

Another post from over at Scrubs. Crazy is as crazy does…. right? LOL

Did you over do it?

2011-11-25T11:25:00.001-05:00

I came close yesterday!

Thank You Thanksgiving Thursday

2011-11-24T08:16:00.000-05:00

I can proudly say I’ve kept up with the Thank you Thursday concept for 2.5 months. It’s been very ‘weak’ at times, but I’ve kept up with making sure I make at least 5 thank you’s or I am thankful for at least 5 things each week.

It’s definitely kept me grounded and humble. I continue to be thankful for some of the most simplest things, but then again nothing is ever really that ‘simple’ is it?

Be sure to be as ‘thankful’ as possible this week during our ‘yearly’ time for thanks.

I’d like to thank the last week for:

warm weather still! Yes, the warmer temps here in Western PA have been nice. Remember warm for us this time of year IS 60 degrees.

my crazy cats. For not being the all around terrors that other cats display. They’re crazy alright, but they could always be worse.

a certain professor of mine for taking the time to listen to my (and other classmates) concerns about our school’s program. While they probably can’t fix any of our concerns, they at least made us feel heard.

for good co-workers. last week one shift in particular could have been just an all out miserable time. Instead it was survivable and even fun.

the kindness of strangers.

Be sure to thank those who make the sacrifice during the holidays. Be it the retail worker, the health care worker and of course our men and women in uniform. While you’re all feeding your faces take a moment to thank those that make it possible.

Happy Thanksgiving everyone.

Happy Thanksgiving to all my fellow Nurses out there

2011-11-24T06:19:00.001-05:00

I'm sure you can relate to this in some small way.

The NEW breakast on the go!

2011-11-23T10:05:00.001-05:00

Eating on the go: Product review for nurses | Scrubs – The Leading Lifestyle Nursing Magazine Featuring Inspirational and Informational Nursing Articles

I think this could apply to any and all students (traditional & non-traditional).

Heh heh.

What group projects realllly taught you

2011-11-17T21:00:00.001-05:00

via thedailywh.at

Is there a nurse out there who didn't laugh at this?
Heh heh

A lunch bag on steroids for nurses

2011-11-17T11:48:00.001-05:00

Do you pack your lunch? Check out this lunch bag that is THE ticket for those long shifts. A recent post from over at Scrubs Magazine.

Eating on the go: Product review for nurses

*Disclaimer: This product and containers were provided free of charge. The blogger is in no way affiliated with balanceddaylunchkit.com. All opinions are of his own, and is under no obligation to promote or defend the product in question.*

As everyone knows, I’m a commuter student with lunch-packing challenges. (Read my previous post here on ‘Packing my bags‘) I noticed in the Scrubs Magazine fall 2011 print edition a page on getting organized (page 16 if you’re interested). We also have a page dedicated on our website to ‘The Organized Nurse‘.

I read about the product ‘Three Squares in One’. They have a ‘lunch bag’ of sorts they call the ’12-Hour Shift Bag’. I found it so intriguing I contacted the company to see if I could try it out. The were nice enough to provide me with the bag as well as the food containers that fit inside! Needless to say I was acting like a kid in a candy store.

I have always promoted healthy eating. Bring a lunch and leave the money at home. So I’ve been trying to find a lunch bag that can do that very thing, but can provide me with meals over the course of the day. So the 12-Hour Shift Bag seemed like the answer to all my woes.

After using (and abusing) it for work and school over the past couple weeks I’m ready to share my findings. It definitely touts a large capacity for storing any and everything. It has two main compartments that are individually insulated. So you could potentially have one ‘hot’ and one ‘cold’ meal. It actually has the two sides labeled ‘One’ and ‘Two’. I initially found that entertaining, but then I utilized the labeling more than I ever thought I would whenever I would go hunting for my food.

The containers they provided fit perfectly (as they should I guess). They had a nice seal-locking mechanism on them that ensured your food’s freshness. Something I really liked. Especially with the wear and tear I gave it. My food never spilled.

I loved the little zippered ‘compartments provided on each ‘flap’. You could store napkins, utensils or even pre-packaged snacks in those nifty pockets. And once again they were still insulated. Within each ‘side’ there were small elastic Velcro straps provided. I later realized these could be utilized to secure containers as well as secure and cooling device you may utilize (like the blue ice cooling blocks). In addition there was also an additional compartment with a magnetized flap for additional storage space.

It definitely held up to the rugged wear and tear. I swung that thing over my shoulder and across my back numerous times throughout a single day. The adjustable strap was key! And the straps were attached to the main unit by metal clasps, which was nice. This way the strap doesn’t tether away from the main unit.

Space was not an issue. There was plenty of room to bring just about anything. The two main compartments, the zippered pockets in the flaps, and then the additional zippered outside pockets on both sides made for easy portability.

While it was a large bag, it seems that you could compress or collapse one side of the bag if you wanted to, if you were only needing one side for those shorter days (or shifts).

Here are my bulleted highlights of this product:

PROS:

Ample storage space with deep pockets

Well compartmentalized

Zippered flap for utensil storage

Individual insulation is great for bringing hot & cold meals

Ability to secure items within the compartments

Option to collapse one side to only utilize half the bag

Strong and sturdy adjustable carrying strap

Aesthetically pleasing for both men and women

Labeling of each side compartment

CONS:

Very bulky at times to carry

When fully pack – can be quite heavy

Overall grade: A

I don’t think there is a ‘perfect’ lunch bag out there, but this comes about as close as you can get. It has enough options available to suit just about any and every need for those nurses looking to pack their meals for the long shift. The name of the product says it all. I highly recommend this product.

I would like to extend a special thank you to Kathi Blackwell from Balanced Day Bags Inc. for her generosity in providing this product.

*Disclaimer: This product and containers were provided free of charge. The blogger is in no way affiliated with balanceddaylunchkit.com. All opinions are of his own, and is under no obligation to promote or defend the product in question.*

Thank You Thursday

2011-11-17T10:30:00.001-05:00

I’m keeping the faith that recognizing the positive things in my life will keep my life positive. So I will continue to be thankful.

I would like to thank the past 7 days for:

Breakfast with my in-laws

Conversations with my Dad

The subtle but hilarious humor my wife and I share together

Old friends

My military brothers and sisters for keeping me and my loved ones safe.

I always try to find 5 things that were positive. No matter how simple or complex they may be, they still make my life that much better.

What are you thankful for this week?

A NEW strain of seasonal rhinitis?

2011-11-16T09:05:00.001-05:00

Ohhhhh c'mon.

You know you laughed.

Fear of MRI's??

2011-11-16T08:49:00.001-05:00

Is nursing school built to “break us down” rather than “build us up?” | Scrubs – The Leading Lifestyle Nursing Magazine Featuring Inspirational and Informational Nursing Articles

What if Healthcare was like the Food Service Industry??

2011-11-14T08:42:00.001-05:00

via scrubsmag.com

What if....

Nurse cartoons – What’s the tip? | Scrubs

11/11/11: 'Ones' in a lifetime

2011-11-11T09:20:00.001-05:00

In the middle of cake and presents last year, Lynsie Schuman had a revelation about her twins. They were destined to celebrate their golden birthday on a special day -- "ones" in a lifetime, so to speak.

Kyra and Tyler are turning 11 on 11/11/11.

"It's pretty cool," said Kyra, who will be leaving her native Wisconsin for Cancun, Mexico, with her family for a special celebration. Not just because she will probably not see another 11/11/11 in her lifetime, but because of her grandpa, Philip Schuman, who served in Vietnam.

"It's Veterans Day," Kyra said.

People around the world have made special plans for Friday. Think of when the clock strikes 11:11:11 on 11/11/11. A perfect palindrome -- the time and date reading the same backwards and forwards -- and the only double-figure palindromic date.

And 11/11/11 won't come around again for another 100 years.

via cnn.com

What will you be doing at 11:11:11 today??

It only happens 'ones' in a lifetime.

Veteran's Day

2011-11-11T08:50:00.001-05:00

What nursing education can learn from medical education

2011-11-05T20:01:00.001-04:00

Is nursing school built to “break us down” rather than “build us up?”

This past week was my first week with our physician preceptors. As a nurse practitioner student we log many clinical hours with our physician preceptors. This week was learning about the ‘patient presentation’.

It may sound odd, but nurses are quite familiar with the concept. The patient presentation is when a provider ‘reports’ or ‘presents’ their patient to the physician. This could be for a consult, a new admission, or for the coverage hand-off between colleagues. While we nurses are familiar with this concept, it’s a whole different ball game when you are the one presenting.

It was another ‘pressure cooker’ situation. Something we are all too familiar with. We build up the scenario in our minds to be the end-all-to-be-all. We picture ourselves making every mistake in the book and of course we envision the physician as this mad-hatter like tyrant who will bark at your every word.

It of course was the complete opposite.

Throughout the entire process the physician was receptive, pleasant, and absolutely empathetic to our newness. She was an active listener and gave great feedback in such a positive manner. At no time during this experience did I feel ‘put-down’, inferior, or guilt-ridden. I could sense that our physician preceptor was making every attempt to level the playing field and teach us, not torture us.

My clinical preceptor brought up a very valid realization after this experience. He asked us if we noticed how much our physician preceptor tried to ‘build us up’, not ‘break us down’. He wanted to know if we have had similar experiences in our previous nursing education and training..

I honestly can say 90% of my nursing education and experience has been about ‘breaking us down’. Sad, but true. I can remember many times nursing preceptors ridiculing students for not performing well or making simple mistakes.

Our physician made it well known she expects us to make mistakes, and that the mistake made now will help save lives later. “It’s not about being wrong, it’s about not being prepared”. Being afraid to make a mistake is not the same as carelessness.

I think nursing education as a whole could learn a thing or two from physicians.

I find the professional relationship and their respective professional curriculum between nurses and physicians to be polar opposites, and I can’t understand why? Barring from the obvious difference between a nurse and a physician, how do two professions with the same goals arrive at their destination in two very different ways?

As a side note, to all my fellow nurses out there. Physicians are misinformed about our educational system and standards. I guess I automatically assumed physicians understood the requirements and curriculum progression of our profession. We took a great deal of time to explain how a nurse ‘becomes’ a nurse (RN, BSN, LPN, CNA), and how a nurse is trained for specific specialties (critical care, emergency, oncology, etc.)

I’m still amazed at how much I learn every day.

Another post from over at Scrubs.

Thank You Thursday

2011-11-03T21:29:00.001-04:00

The late edition…

I would like to thank the last week for the following:

Being home with my wife every night (last week’s conference reminded me of how much I like being home)

Unseasonably warm weather. Thaaaaank you. I miss the summer

The high-tech gadgetry in my car. It alarms me when I need air in my tire. Very important info being a commuter.

Cool classmates. It’s always nice to get a helping hand when needed.

Everything Crossfit. I’m having more fun than I thought I’d ever have!

What are you thankful for this week?

Tattoos & Pain…

2011-10-27T12:28:00.001-04:00

Another nursing urban legend: tattoos and pain

So the other day I got my flu shot. Yep, I get it every year. Regardless of the folklore out there I’ll take every little bit of help I can get when it comes to fighting off any bout of the flu.

I was in line waiting my turn. I could hear the nurse give the ‘warning message’ each time she administered the injection, “A pinch and a burn…”. I honestly didn’t think anything of it.

My turn. I sit down, fill out the proper documentation and roll up my sleeve. Subconsciously I’m waiting to hear the warning message, but instead she pauses. She leans towards me and says, “Oh. I don’t have to warn you do I?”

Now I immediately thought she meant, oh you’re a nurse. So you know what I’m about to do.

No.

Instead she goes on to say with a sarcastic chuckle, “This shouldn’t hurt a bit with all the artwork there. Right?”

She was referring to my tattoo. I have one on each of my upper arms.

I politely responded, “No, I’ll be fine. Thanks though!”

I walked away chuckling.

You’re probably wondering why I was chuckling? I walked out of the room thinking of a very popular urban legend in the nursing world:

There is an inverse relationship between the number of tattoos a patient has and their tolerance for pain.

So, the more tattoos a person has, the less tolerant they are of pain. Any pain. Or, put it another way, the more tattoos the more they whine (sorry for being so blunt).

Like you, I used to scoff at the mere thought of this. But then I worked in the PACU. I took care of many patients post operatively. I then continued to take care of surgical post-op patients during my time in the ICU, something I still do to this day. Let’s just say I’ve taken care of my fair share of patients who have had surgical procedures. As time progressed I noticed there was a sliver of truth to this urban legend. Maybe even more than just sliver.

I’m not here to dispute the definition of pain. I know that a patient’s pain is what they say it is, where they say it, when the say it is. All I’m saying is when we nurses see tattoos, we can’t help but wonder.

What do you think?

Another one of my posts over at Scrubs. Any thoughts on this urban legend?

Another nursing urban legend: tattoos and pain | Scrubs – The Leading Lifestyle Nursing Magazine Featuring Inspirational and Informational Nursing Articles

Thank You Thursday

2011-10-27T09:08:00.001-04:00

I would like to thank last week for the following. Thank you for:

Traffic and the lack-there-of when I arrived at my conference this week

My in-laws. I cannot begin to imagine what my life would be like without them.

The amazing learning opportunity this week during the conference I attended.

For me not vomiting out of fear and anxiety in front of the audience during our group’s presentation.

My wife for being there for me, and always supporting me.

What happened this week that you are thankful for?

Describe yourself in four words...

2011-10-22T11:07:00.001-04:00

via bitsandpieces.us

This was fun..

A healthy rotating shift? Is there such a thing?

2011-10-19T14:26:00.001-04:00

The ideal rotating shift?

I just read a new study that claims that ‘working rotating shifts is not as potentially unhealthy as it used to be’. What? Is there such a thing?

I wonder if those who conducted the research have ever worked a rotating shift in their life??! It seems that there is now a more ‘ideal’ formula for rotating your day and NOC shifts. Instead of working 2 weeks of days and then 2 weeks of nights this article ‘claims’ there is now a trend to work day-day-night-night then five days off in a row. I like the adjective they used in the article I read though. They called this trend of rotating shifts more ‘humane’.

I must admit, I’m glad to see research is being conducted on ways to minimize the detrimental effects of shift work. I don’t think they will ever eliminate the health risks involved with ‘flipping’ your circadian rhythm.

When I read the word ‘humane’ I immediately blurted out ‘Darn right!’. Working a NOC shift has got to be a warped zombie-apocalypse training scheme in my book. I don’t know about you, but working ANY type of NOC shift turned my brain into much and pretty much guaranteed all my autonomic bodily functions would short-circuit. I couldn’t see straight, I could stand without swaying and stringing more than two words together to form a comprehensible sentence just wasn’t possible. I remember feeling like I had the ‘flu’ every month when I had to do the shift ‘flip’. My hats off to those that can ‘flip’ with minimal damage.

It probably didn’t help that I have chronic insomnia and I am such a light sleeper. So much of light sleeper than a kitten walking on a newly installed carpet woke me from my sleep (true story). When I would work nights every trick in the book to help you sleep would not work for me, since the wind blowing outside would wake me up.

*sigh*

This would explain why I don’t work nights anymore.

…

I’m still chuckling at the word ‘humane’.

Article of interest:

Modern Shift Work Patterns May Be Less Harmful to Health

My sarcastic post over at Scrubs. Am I alone on this one?

The ideal rotating shift? | Scrubs – The Leading Lifestyle Nursing Magazine Featuring Inspirational and Informational Nursing Articles

Personal trainer becoming obese on purpose?

2011-10-18T19:05:00.001-04:00

via shine.yahoo.com

Since May, Drew Manning has gained about 70 pounds on purpose. And he’s not done yet.
Drew is a personal trainer and has always been the “fit guy.” He’s now on a journey he calls Fit 2 Fat 2 Fit where he spends six months (he has about 4 weeks left) eating unhealthy food and not exercising, then he will take six more months to get fit again. Why? To experience for himself what it’s like to be overweight, how tough it is to lose weight, and ultimately show others how to get fit.

Wow. Amazing. Really. I'll be curious to see how his experiment pans out.

Entitlement of the ‘Doctor’ title

2011-10-16T11:47:00.001-04:00

Doctoring the ‘Doctor’ title?

There has been much scuttlebutt throughout the online health care community. The divisive ‘physician versus advance practice nurse’ debate has gained quite a bit of steam thanks to a recent article by the New York Times titled: When the Nurse Wants to Be Called ‘Doctor’. A great big thank you and ‘shout out’ to the NY Times. I think this conversation needed to continue.

Over the course of the past several days I have been keeping a log of responsive articles (please see the end of this blog post for articles of interest). I have taken an interest to this particular debate, since I am a current Nurse Practitioner student who will eventually hold a Doctorate of Nursing Practice (some years down the road).

I for one do not have a solution (sorry). However, I do feel this debate is based on valid rationale that has gone awry.

Yes, I firmly believe we as practitioners should not mislead our patients. The social stigma and public knowledge that follows the title of ‘Doctor’ can lead one to believe they are in fact a medical doctor, ergo a physician. The reality is that not all ‘Doctors’ are ‘Physicians’. We need to remind ourselves that the PhD has been around for quite a long time, and that there are doctorate degrees in many other health care related disciplines.

To quote Dr. Kevin Pho over at Kevin MD:

“Those who earn a doctorate degree, whether it be in nursing, pharmacy, or psychology, deserve to be called “doctor.” Period.”

So in defense of Nurse Practitioners with their DNP, they are not misrepresenting themselves. They’ve earned the title. But it’s the intention in which the title is used that makes all the difference, in my humble opinion.

Proudly conveying your earned title without proper clarification and intention can easily be mistaken for deception and misdirection. In the original NY Time article the NP introduced herself as ‘doctor’ and followed up with “I’ll be your nurse”. No misdirection there.

I think this is the source of the physician community’s angst, and disapproval. If the NP is making an empty attempt at representing themselves as a physician with their numerous years of education and rigorous training, then yes, I too would be on the defense. Even though I am not a practicing NP (a mere student), I don’t believe there are NP’s out there that would outright misdirect or misrepresent themselves as someone they are not. If they are, then shame on them. They are not only damaging their professional credit and earned title, but they are potentially placing their patients in harms way.

I know in the end, both physicians and advanced practice nurses share the same goal of optimal patient outcomes. Splitting hairs over entitlement and attempting to ‘strip’ someone of a title that have rightfully earned is just a waste of energy and a misuse of vital resources.

Articles of interest:

When the Nurse Wants to be Called ‘Doctor’

Should medical students be introduced as Doctor?

Calling yourself Doctor and what that now means

Turf Wars

Universal board certification can solve the Doctor Nurse controversy

A post over at Scrubs that continues the conversation about the newly controversial title.

Doctoring the ‘Doctor’ title? | Scrubs – The Leading Lifestyle Nursing Magazine Featuring Inspirational and Informational Nursing Articles

So This Just Happen

2011-10-14T17:48:00.001-04:00

iPhone 4S

iOS 5

Siri

Notification banner

This new phone rocks!

The AHA : BMI Is Clinically Insufficient To Measure Adiposity (Obesity)

2011-10-13T09:27:00.001-04:00

Clinical Context

According to 2 articles in the January 20, 2010, issue of the Journal of the American Medical Association, the prevalence of overweight or obesity in the United States is 68.0% in adults (Flegal and colleagues) and 31.7% in children 2 to 19 years old (Ogden and colleagues). The risks for overweight or obesity are generally the result of excess adiposity. Body fat distribution and body composition are also important. The severity of metabolic abnormalities is linked more with visceral adipose tissue than subcutaneous adipose tissue, as reported by Fox and colleagues in the July 3, 2007, issue of Circulation.

This scientific statement from the American Heart Association (AHA) addresses methods to assess total body fat, distribution of body fat, body composition, and ectopic fat.

Study Synopsis and Perspective

Body-mass index (BMI) and waist-circumference measurements should remain the primary tools for assessing adiposity in the population, according to a new scientific statement from the American Heart Association (AHA) [1]. Individuals with a high BMI or those with a disproportionately high waist circumference for any given BMI should be examined by clinicians for further risk stratification and targeted with lifestyle interventions, including weight loss, according to experts.

Dr Marc-Andre Cornier (University of Colorado, Denver), the lead author of the AHA statement, which is published online September 26, 2011 in Circulation, told heartwire that it remains important to continue to advance the mindset among clinicians that obesity is a clinical problem. In deciding it is a problem and that it is something to be treated, clinicians next have to assess these patients.

The new AHA statement stresses the importance of using existing tools for the assessment of overweight and obesity, including BMI and waist circumference. While most patients are weighed when visiting their physician, waist circumference is used far less frequently.

BMI is also not without its problems, given the heterogeneity in individual body fatness and the associated risk for comorbidities at a given BMI. The heterogeneity in BMI is related to age, sex, and ethnicity, as well as differences in body composition and body-fat distribution. For this reason, the AHA statement notes that the assessment of total fat mass with a BMI is a "good and realistic start," but it is not clinically sufficient.

Waist-circumference measurements, according to Cornier, are a helpful tool to identify individuals with excess visceral and liver fat, as data suggest that for any BMI level, increased waist circumference is predictive of an increased risk of comorbidities. "Specifically, for a given BMI, individuals with an elevated waist circumference will likely have more abdominal fat and thus more visceral, liver, and ectopic fat and more risk for obesity-related metabolic disorders," according to Cornier and colleagues.

The AHA scientific statement also provides an assessment of other methods to assess body composition, including anthropometry, skinfold thickness, and hydrostatic weighing, among others, but Cornier told heartwire there is not enough scientific evidence to recommend their general use in clinical practice at present.

References

Cornier MA, Deprés JP, Davis N, et al. Assessing adiposity: a scientific statement from the American Heart Association. Circulation 2011; DOI: 10.1161/CIR0b013e318233bc6a. Available at: http://circ.ahajournals.org.

Related Link
The National Guideline Clearinghouse has developed a Guideline Synthesis: Assessment and Management of Obesity and Overweight in Adults, which is available online.

Study Highlights

Assessment of total body adiposity

The primary tool to assess body fatness in clinical practice is BMI, which has a sensitivity of 50% and a specificity of 90% to identify excess adiposity.

BMI might not correlate well with body fat resulting from age, sex, and ethnic factors.

Body weight measurement alone is insufficient.

Assessment of distribution of body fat

Measurement of waist circumference at the iliac crest is recommended to complement BMI measurement in the clinical setting.

Waist circumference is a simple and inexpensive method to assess body fat distribution. It correlates with abdominal obesity and with morbidity and mortality related to adiposity.

Hip circumference does not significantly predict all-cause mortality.

Thigh and calf circumferences are linked with mortality risk in men.

Waist-to-hip ratio, waist-to-height ratio, and waist-to-thigh ratio are not routinely recommended, but waist-to-height ratio and waist-to-hip ratio might be useful in adjusting for body differences in ethnic groups.

Sagittal abdominal diameter, measured with computed tomography or magnetic resonance imaging (MRI) or directly on the patient, is a better adiposity marker than waist-to-hip ratio. However, standardized, validated, and normal thresholds of measurement are needed.

For research, computed tomography at the L4-L5 intervertebral space and MRI assess subcutaneous adipose tissue and visceral adipose tissue, but limitations include an unclear ideal site for MRI imaging, cost, availability, time, technical skill needs, and difficulty with performing an MRI on very obese persons.

Assessment of body composition

The only current clinically accepted method is measurement of the midupper arm and midthigh circumferences, but accuracy and reliability vary.

3-skinfold thickness measurement (of the chest, abdomen, and thigh) is low cost and simple but can underestimate percent body fat, varies by race, and is more difficult to perform in older or obese persons.

Near-infrared interactance measures optical density at various sites but has unacceptable prediction errors.

Hydrodensitometry or hydrostatic weighing was the previous gold standard and can be performed in very obese persons, but it does not account for individual variation in fat-free mass and requires active participation.

Air displacement plethysmography might be useful, but data on risk stratification are needed.

Dual-energy x-ray absorptiometry, one of the gold standards in research, can be used to measure composition and abdominal fat, but it does not differentiate between subcutaneous and visceral fat and requires more data on risk prediction and cost.

Computed tomography and MRI are gold standards in research for assessment of adipose and lean body mass.

Bioelectric impedance analysis is limited by unreliable body fat distribution estimates and the influence of sex, age, disease state, ethnicity, fatness level, environment, and menstrual cycle.

Methods of fat composition should be adapted or validated for the elderly population and for ethnicity.

Assessment of ectopic fat

Localized proton MR spectroscopy is a reliable measure of intracellular triglyceride content.

Ultrasound, computed tomography, and MRI can detect liver fat, but these methods cannot quantify intrahepatic triglyceride levels.

Serum levels of alanine aminotransferase can be normal in cases of increased intrahepatic triglyceride content.

Assessment of changes in adiposity

Body weight measurement alone is insufficient.

Reduced weight and BMI are linked with reduced morbidity, but not mortality, risks.

Reduced waist circumference has an uncertain role in predicting cardiometabolic risk factors and abdominal visceral fat.

Change in body fat content is linked to changes in body weight and is reliably assessed by air displacement plethysmography, dual-energy x-ray absorptiometry, and bioelectric impedance analysis, but no longitudinal data exist on clinical events or survival duration.

Clinical Implications

The recommended primary tool to assess adiposity is BMI, which is easy to determine, but has a poor sensitivity in identifying excess adiposity and might not accurately reflect body fat resulting from age, sex, and ethnic groups.

The recommended adjunct tool to assess body fat distribution is waist circumference at the iliac crest, which is simple to perform, is inexpensive, and correlates well with abdominal obesity. A higher waist circumference is linked with increased risks for adiposity-related morbidity and mortality.

via medscape.org

It's about damn time someone is addressing the efficacy and usefullness of the darn BMI. I still hate that we health care professionals use the BMI as a measuring tool to grade a person's 'obesity' or risk for it.

BMI is also not without its problems, given the heterogeneity in individual body fatness and the associated risk for comorbidities at a given BMI. The heterogeneity in BMI is related to age, sex, and ethnicity, as well as differences in body composition and body-fat distribution. For this reason, the AHA statement notes that the assessment of total fat mass with a BMI is a "good and realistic start," but it is not clinically sufficient.

Nurses? Catty?

2011-10-12T22:36:00.001-04:00

Nurses go clique-ety clique

Heard at the lunch table on campus the other day, “I sometimes miss working in the mill”.

This spawned quite the conversation, I must tell you. The conversation topic involved the ‘pulse’ of the nursing profession and its sometimes palpable cut-throat atmosphere. I think you’ve heard it before. Nurses can be ‘catty’, and cliques seem to be a very common occurrence on nursing units.

“We need more men in nursing”

(I must say I wasn’t expecting this statement). When I inquired as to why we need more men in nursing, the response was not what I expected (or hoped).

“Most men confront you when there is conflict. They tell you how they feel right to your face. They speak their business and move on.” “Women do just the opposite”

Catty: Subtly cruel or malicious; spiteful (Free Dictionary)

As you can tell this was quite the venting session amongst a small group of nurses. It seems that a lot of nurses feel that the majority of nurses are following a horrible stereotype. Apparently most women can be quite mean?

As you can see I’m writing this blog post with a lot of question marks. I’m wondering just how true these opinions really are. Or should I say, how common are these feelings outside of my lil’ world of nursing?

I have to bashfully admit something though. I found great humor in this conversation. Mostly because I’ve heard this before. But more specifically, I found it highly entertaining that I was the only man in this conversation.

I for one think that there is a shred of truth to these thoughts, but I’m not so convinced that they are gender specific. I’ve met a lot of cruel men and women in my professional career thus far. I don’t think the ‘meanness’ trait has some strange exclusivity to the X chromosome. But it sure makes you wonder.

So folks, what do you think?

Are most nurses catty?

If they are, why? And what the heck can we do about it?

Nurses go clique-ety clique | Scrubs – The Leading Lifestyle Nursing Magazine Featuring Inspirational and Informational Nursing Articles

Be Inspired. Period

2011-10-11T20:25:00.001-04:00

via facebook.com

I'll say it again - what was your excuse (or excuses) for not exercising? For not bettering yourself?

Epic toughness. Epic

Dear Printer Gods

2011-10-11T13:12:00.001-04:00

You suck.

Why does my printer run out of the only colored ink cartridge that I DON'T have?

Seriously.
Excuse me while I run to the store now.

*hmph*.

Telling it like it is

2011-10-09T17:07:00.001-04:00

When nurses need to give a “straight” answer

How long am I going to be here? How long does the surgery take? How long do I have to take this medication? How long do I have to wear this thing?

I often get these type of questions asked quite a bit from patients and their families. I get questions asking for ‘time frame’ specifics regarding any and everything about their care. Unfortunately, there really is no recipe for success in health care is there?

If I can, I always answer these questions with a bit of humor. A quick witted, “whenever the doctor says so”, seems to bring a smile to most faces. Yes, it may very well be a sarcastic smile, but a smile nonetheless.

(Oh, c’mon you know you’ve used that one before)

Isn’t it ironic that we constantly require our patients to adhere to a time schedule, yet we never can give them a straight answer about ‘how long’.

After my quick rebuttal to most of these questions, I give the long drawn out speech about how there is no recipe for success in healthcare. A + B does not always equal C. While we always have the best intentions, time is not something we can ‘predict’. Not even in the most ideal conditions.

The ‘real’ answers:

A perfectly performed surgery without any complications can still have scheduling delays. There are always emergent cases that take priority in the echelon of care. You can’t preventing the unforeseen.

Being in the hospital can be as short as 1 day and as long as 3 months (or more). There are a myriad of factors that determine whether or not the issues that brought you into the hospital can be resolved. Most of which we have no control over.

Some medication can be a lifelong venture, some can be taken for a specific time frame, while others are taken until your supply runs out.

What you are required to ‘wear’ is serving a purpose to help aid in the healing process or to probably prevent further damage. So it will be worn until it is no longer needed.

Oh, and don’t think for one second that just because you have a friend or family member that was treated for the same thing means that you’ll get the same treatment in the same frame of time. Uh-uh. No-siree-bob.

I wish I could make up a recipe book, I really do. It might make our jobs a lil easier, and I’ll bet the patients would love it!

Am I the only nurse that does this??

When nurses need to give a “straight” answer | Scrubs – The Leading Lifestyle Nursing Magazine Featuring Inspirational and Informational Nursing Articles

Sometimes I Really Don't Like Twitter and Its Bots

2011-10-09T07:47:00.001-04:00

I post this on Twitter last night:

And then I get a notification from this account this AM that it is now following me:

Any flaming idiot can figure out that this ridiculous account has some sort of bot that searches for the key word (or words) ‘furniture’ and/or ‘patio’ and/or ‘outdoor’.

Grr…

Darn Twitter.

Embarrassingly realizations later in life?

2011-10-07T10:44:00.001-04:00

I didn’t realize that water towers were for water pressure. I thought that they were an emergency supply of water.

I finally realized that soft drinks are called soft drinks because there’s no alcohol in them and alcohol makes something a “hard drink”

Familiar with MJ’s song “I saw mommy kissing Santa Clause?” For 26 years I thought to myself, what a cheating, unfaithful bitch. Then it dawned on me that the Santa was the dad.

I thought magnesium was a miracle drug since it was always listed on my medication. Then I realized mg stands for milligrams.

I learned what marital status was when I about 18. For some reason I always read it as martial status, as in martial arts. I took karate when I was younger so on my first few job applications I wrote “yellow belt” instead of single.

Worcestershire sauce isn’t pronounced “wister-shister”. Thanks Dad.

Eeyore is the sound a donkey makes

I was well into my 20′s when someone told me that the only reason my mom had me buy shoes with two finger lengths worth of room in the toes was so I wouldn’t grow out of them so fast. I had been wearing shoes a half size too big ever since my feet stopped growing.

I learned that “blowjob” didn’t mean “hair styling”, two years after a girl offered me one, and I said I liked my hair the way it was. I was fourteen when she inquired.

That the words to La Bamba are NOT “La la la la bamba”. I speak spanish and i didn’t know this until i was singing along to it in my car with my latina girlfriend this last spring and she said, “You know those aren’t the words, right?” The proper words for that part: Para bailar La Bamba…

It’s Espresso. Not Expresso.

I always heard the term prima donna but never saw it spelled out until I was about 25. Yes, 25. Until then, I thought it was Pre-Madonna, as if there was also a Post-Madonna. Biggest facepalm ever.

When i was young i tried to be cool and say i wanted a “Roman Coke”. I was told it’s actually a “rum and coke.”

“For he’s a jolly good fellow, that nobody can deny!” I thought it was the fellow himself that nobody could deny, not the fact the he is jolly good.

Girls probably would have dated me if I had just asked some of them.

Pickles are made from cucumbers. I was 20. That was a turning point in my life.

I always thought the slogan was, “Nobody does it like Sara Lee.” I figured out surprisingly recently that it’s, “Nobody doesn’t like Sara Lee.”

via bitsandpieces.us

This was too funny not to share.
And uhh.. noooo.. err.. uhh.. I've never had any of these realizations.

The most powerful healing tool we use

2011-10-07T09:17:00.001-04:00

The power of touch

The most powerful healing tool gets lost in the background to the buzzing, beeping, clicking and shuffling. The rhythms of a nursing unit set the pace of the day. An alarm sounding, a timer beeping, and a monitor blipping. Rush, rush, rush to the next task at hand, all the while treating our patients like another piece of equipment. I too am guilty of this sin. I get caught up in the moment. I worry about time. I am mindful of the roar.

Thankfully, I had the pleasure of getting back to the basics the other day at work. Due to staffing needs / wants and census changes at the drop of a hat I was floated to a neighboring unit to function as a nurse aide.

It’s no secret how I feel about that job and the angels that perform their duties on a daily basis (here and here) , so stepping into their shoes was a great opportunity to maintain my perspective.

I was reminded how powerful the art of ‘touch’ can be. During my shift, I lost count on how many bed baths I gave. Most of the bed baths were done at light speed by the end of the morning, but the first few of bed baths I was able to take my time.

During the bed bath I was able to chat with my patients, learn about them, talk with them about any and everything that was on their mind. I was also able to help alleviate many fears and concerns they were having about their hospital stay.

I can’t say I give the greatest bed baths. Heck, I’d be willing to admit I’m actually quite horrible at it (to this day I can never hold the darn hand towel correctly!). What I AM good at is having a soft hand and light touch. It’s a dying art in the present fast-paced world. But, having the ability to move a patient correctly, safely and gently holds more value to the patient than we care to admit.

One of the greatest compliments I got that day at work was from an elderly gentlemen who was making a slow recovery from a life-changing surgery recently. As I was cleaning up my ‘mess’ of dirty linens and tidying up his room he reached out his hand gesturing me to come closer. He took hold of my forearm ever so gently with his frail but firm hand and said, “Thank you. You did a good job”.

I gotta tell ya. I don’t think I’ve ever smiled longer.

I’m not sure he realized how powerful his touch was for me.

Another post from over at Scrubs. I sometimes forget how important the simplest gesture can be.

The power of touch | Scrubs – The Leading Lifestyle Nursing Magazine Featuring Inspirational and Informational Nursing Articles

A nursing student again…

2011-10-06T17:14:00.001-04:00

Clinical rotation jitters

So, it’s official. This week I became a nursing student doing clinicals (again). This week was my first week walking the halls of a hospital system as a ‘Nurse Practitioner Student’. I must say it was a very eerie feeling (to say the least). I felt like I was back in my diploma program! Here I was (again) sweating bullets over every little detail concerning my participation in nursing ‘clinicals’. The really scary part is the NP program I am in is nice enough to slowly introduce us into this new role by taking baby-steps. This week I simply started an observational experience. So it wasn’t like I was actually required to ‘perform’ any role-specific duties… although it sure felt like it!!!

We are told to wear business casual and our lab coat – what do I wear??

Shoes – I need comfortable business casual shoes! I can’t spend all day on the floors in my tennis shoes or my crocs!

Holy crap! My lab coat. I have to wear a lab coat. Call me crazy, but it was quite surreal to wear the long lab coat.

My name badge – what should it say? What shouldn’t it say? Credentials? No credentials?

These are just some of the ridiculous things I think about. Like I said, it’s only going to get more stressful (readers beware -this is my preemptive warning).

It was also quite surreal to rub shoulders with the physicians, surgeons, physician assistants and nurse practitioners. I honestly had to train my brain to step away from the rigors and responsibilities of bedside care (while rounding on patients) to focus on the decision-making and thought processes of my preceptor (a physician). I need to learn how to start thinking beyond the bedside and develop my advanced assessment and diagnostic skills. I probably expect way too much out of myself this early on, but I feel so overwhelmed with fear it’s honestly indescribable.

How in the world do these advanced health care providers do what they do, in such split-second timing is just awe-inspiring to witness first hand. I never really ‘got it’ when I would round as the bedside nurse. I was focused on my responsibilities and my duties as the bedside nurse (not that there is anything wrong with that!). I didn’t have a real appreciation for the bazillion-and-one things that they have to process in order to make the decisions that need to be made.

Did I mention how terrified I am?

My hope is this fear will turn into gnarling dedication to improvement -otherwise I’m going to fail and fall flat on my face (cynically joking) .

I definitely have to not only step up my ‘game’, but I need to bring my ‘A game’ at all times.

This is going to be a fun semester!

Another post from over at Scrubs.

Clinical rotation jitters | Scrubs – The Leading Lifestyle Nursing Magazine Featuring Inspirational and Informational Nursing Articles

iRemember: Steve Jobs

2011-10-06T17:04:00.001-04:00

Crazy rituals | Scrubs – The Leading Lifestyle Nursing Magazine Featuring Inspirational and Informational Nursing Articles

This is one of the better videos in memory of the great man.

Thank you Thursday

2011-10-06T10:00:00.000-04:00

The past 7 days, Thank You for:

Gainful employment – our economy is not easy.

Life truly is shorter than we can ever imagine, thank you for mine and my loved ones life.

Your coworkers truly do make the difference sometimes – heck all the time.

Death cannot be avoided, life shouldn't be either.

Being stuck in traffic, not part of the auto accident that created it.

What are you thankful for this week?

Crazy nursing student habits

2011-10-03T19:01:00.001-04:00

Crazy rituals

Maybe it’s just a nursing school / nursing student thing? Or maybe it’s just for us crazy people pursing Master’s degrees? Or maybe it’s just the school I’m attending? Who knows.

What I do know is that we love to torture ourselves.

Immediately after an exam, why do all of the students congregate and huddle into packs to dissect and discuss the questions on the exam? Yeah, the exam you literally just took.

Now, let me clarify something. In this particular program we take exams and then we always have a scheduled lecture after class (yeah – torture, I know.). Most of our classes meet once a week, so I’m just assuming that the thinking behind the lecture after an exam is just to monopolize and utilize the time allotted and scheduled. Most of my classes are scheduled and average of 2 – 4 hrs., so the exams last an hour-ish. We have a shortened lecture immediately after the exam.

So, here we are. Completely spent and drained from taking the exam. And somehow we always end up huddling to ruminate over what we just survived. We bounce our ideas and our thoughts on what the correct answer was on just about any and every question we were asked.

I think in a weird sort of way we seem to initiate these conversations to validate our performance. We think we did OK, or we try to create a pseudo-grade in our head. So we talk about the test to see if we in fact are right about our performance on the exam.

I don’t know if it’s just me. But half-way through these conversations I get panic-stricken and start losing a grip. All the answers that I thought were right, were not the answers that the majority of my classmates chose!

Oh-oh.

Maybe I failed the exam? Here I thought the whole time I did OK, heck even thought I did well, and now after the ‘huddle’ I’m paranoid I failed! What the heck! What gives here!

Ever since this ritual was discovered, I keep telling myself after every exam – “Nope. Not gonna do it this time around. I’m not gonna say a peep about the exam”.

And just like clock-work I end up with the paranoia I said I wasn’t going to participate in!

Grr.

Am I all alone here on this one?

Another post from over at Scrubs.

How are you? Are you fine?

2011-10-02T15:03:00.001-04:00

Freaked out
Insecure
Neurotic
Emotional

Are you fine?

Distance Caring?

2011-10-02T11:38:00.001-04:00

Tele-what?

You’ve heard of distance learning, but what about distance caring?

That’s the newest concept in the world of health care these days. Telemedicine, telehealth and of course telenursing. They all seem to fall under the same umbrella definition of delivering care from a remote distance.

We nurses are no strangers to this type of care. There are nurses out there who used to deliver their care to their patients over the phone (and some still do). What has changed over the years is the avenue by which this care is delivered…for example, via this lil invention called the internet (have you heard of it?). The ‘net brought enormous technological advancements in health care delivery and health care monitoring.

Everything from Holter monitors to 24-hour pharmacies to the Electronic Medical Health Record has catapulted the way in which we provide care to patients.

We’ve leapfrogged from downloading patient data ‘after-the-fact, to real-time monitoring of an event as it happens. This real-time monitoring has now been taken to the ‘next level’.

Traditionally, patients who are being monitored by ‘telemetry’ (bare-minimum continuous ECG ) are monitored by nursing staff (as well as physicians) who are with the patient on the same unit, the same floor, heck – the same building!

Well, not anymore.

The amazing advancements in our technology have opened new doors (literally). Patients are being ‘monitored’ remotely. The nurse (or physician) is now monitoring patients and their dynamic vital signs from a distance. That distance can be as close as the next floor or as far as the next building. I read somewhere that monitoring was performed across state lines and even across coast lines! The distance threshold seems to hold no boundaries lately.

As a critical care nurse this equally excites and scares the bejeezus outta me. How awesome that would be to have the ability to possibly stop an emergent event from happening from a distance?! But, on the other hand, how horrifically scary would it be to make an error in judgment!

The possibilities are endless if you think about it. There are of course numerous adjustments and accommodations that would have to be made for every instance. Patient safety would be the priority.

I’m not sure how comfortable I would be performing those duties? As a critical care nurse we are always, always, always taught to never trust a monitor and to always, always, always (did I emphasize always enough?) check the patient first. No matter how great the technology may be, I just don’t think anything can replace your 5 senses.

Another post from over at Scrubs. Have you had any experience with this yet?

Tele-what? | Scrubs – The Leading Lifestyle Nursing Magazine Featuring Inspirational and Informational Nursing Articles

Thank You Thursday

2011-09-29T10:00:00.000-04:00

Well, this is the first week of the official 'Thank you Thursday' weekly post. Thanks again Joni for such an awesome idea.

So, this week. Thank you for:

Dry weather during my commute to school

Dry weather while walking around campus!

Surviving clinicals this week at school

For my wife always thinking one step ahead of me - she takes such good care of me

Having some amazing co-workers who are going through some tough times

New clothes

time with my family during their birthday

time with my cousin - I missed hanging out with him

What are you thankful for this week?

All you hot heads out there

2011-09-28T21:10:00.001-04:00

Yawning is typically linked to tiredness, but a group of researchers from Princeton and the University of Arizona have found it may simply be a means to regulate brain temperature.

The researchers found yawning frequency correlates with the season and yawning is more likely when the temperature outside is less than the temperature of the brain. Their argument is that keeping your mouth agape helps regulate the temperature of the brain by exposing the roof to cooler air. In the author's previous studies, cooler brains have been linked to alertness, which might help explain why we yawn when we're tired.

via lifehacker.com

This explains it!
OK. It might explain why I yawn, but now I wanna know why my brain is too warm?

You see.. I've over-worked my brain. Yeah... that's it.

Why do we always reach for medication?

2011-09-28T17:05:00.001-04:00

Instead of allowing our bodies to strengthen, instead of nurturing our health, instead of improving the ‘fight’ of our immune system we seem to find more ways to find a shortcut to a healthier you. We debilitate our immune system and we coddle our bodies by reaching for the next best thing.

Maybe it’s the era in which I was raised?

Maybe it was the household where I was lucky enough to spend my youth?

Maybe it’s just me being stubborn and bull headed? (most likely)

I just feel that we should allow our bodies to take the hit. We don’t grow stronger by living in a bubble. We grow stronger by learning to defend ourselves. I’m talking about our immunity to illness and disease. This conversation brushes shoulders with the ‘Antibiotic resistance’ debate. No I don’t believe every child should be place on an antibiotic every time the get the sniffles.

I also don’t think we need to start prescribing a medication that is intended to alleviate symptoms of COPD and Asthma exacerbation for the common cold ^**

It’s a runny nose people! C’mon.

Intranasal ipratropium bromide for the common cold.

Cochrane Database Syst Rev. 2011; (7):CD008231 (ISSN: 1469-493X)

Albalawi ZH; Othman SS; Alfaleh K
Sheikh Abdullah S. Bahamdan Research Chair for Evidence-Based Health Care and Knowledge Translation, College of Medicine, King Saud University, P.O. Box 68639, Riyadh, Central, Saudi Arabia, 11537.

BACKGROUND: The common cold is one of the most common illnesses in humans and constitutes an economic burden both in terms of productivity and expenditure for treatment. There is no proven cure for the common cold and symptomatic relief is the mainstay of treatment. The use of intranasal ipratropium bromide (IB) has been addressed in several studies and might prove an effective treatment for the common cold.

OBJECTIVES: To determine the effect of IB versus placebo or no treatment on severity of rhinorrhoea and nasal congestion in children and adults with the common cold. Subjective overall improvement was another primary outcome and side effects were reported as a secondary outcome.

SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2011, Issue 1) which contains the Acute Respiratory Infections Group's Specialised Register, MEDLINE (1950 to January week 4, 2011), MEDLINE in-process and other non-indexed citations (February 2011), EMBASE (1974 to February 2011), AMED (1985 to February 2011), Biosis (1974 to February 2011) and LILACS (1985 to February 2011).

SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing IB to placebo or no treatment in children and adults with the common cold.

DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed trial quality. We used a standardised form to extract relevant data and we contacted trial authors for additional information.

MAIN RESULTS: Seven trials with a total of 2144 participants were included. Four studies (1959 participants) addressed subjective change in severity of rhinorrhoea. All studies were consistent in reporting statistically significant changes in favour of IB. Nasal congestion was reported in four studies and was found to have no significant change between the two groups. Two studies found a positive response in the IB group for the global assessment of overall improvement. Side effects were more frequent in the IB group, odds ratio (OR) 2.09 (95% confidence interval (CI) 1.40 to 3.11). Commonly encountered side effects included nasal dryness, blood tinged mucus and epistaxis.

AUTHORS' CONCLUSIONS: For people with the common cold, the existing evidence, which has some limitations, suggests that IB is likely to be effective in ameliorating rhinorrhoea. IB had no effect on nasal congestion and its use was associated with more side effects compared to placebo or no treatment although these appeared to be well-tolerated and self-limiting. There is a need for larger, high-quality trials to determine the effectiveness of IB in relieving common cold symptoms.

Intranasal ipratropium bromide for the common cold| Medscape Reference Online

** = Sorry folks, if you want to read the full article you have to sign up for the free account on Medscape (I would highly recommend it)

Saving time at work

2011-09-28T11:26:00.001-04:00

Tick-tock, tick-tock. I don’t know about you but my entire day at work is ruled by the clock. Everything from the medication I give to the procedures my patients have to every ‘timed’ care event that we perform.

Everything in some way shape or form is on a ‘timer’.

Lately, my timing has been ‘off’. I can’t seem to get a leg up and stay ahead of the 8-ball. The other day I clamped an NG from wall suction after giving a med, and lets just say the tube remained clamped for the better part of my shift (thankfully it was only a couple of hours). I realized that looking up at the clock to see the time and calculating my next ‘event’ was just not cutting it. So here are 3 tips that I think are going to help me, and I thought I’d share them:

A Watch

Now, before you go poking fun. I’m not just talking about a standard time piece. I’m talking about a watch that has a timer, an alarm and possible a stop watch (if needed). I own one of the traditional ‘Ironman’ triathlon watches that has all the above. I’m starting to used the ‘timer’ more frequently, especially after the NG episode recently. Set your timer to whatever interval you need to remind you of your next ‘event’ (a timed med, unclamping a tube, your next blood sugar, etc.)

The IV Pump

Most IV pumps these days are quite advanced. I sometimes think they are a lil’ too much, but the advancement has definitely increased safety and decreased the likelihood of simple human error. This suggestion really doesn’t utilize those ‘advancements’. The next time you have a med to give, or a blood sugar to check (Q 1 hr. on Insulin gtts) set the volume of your infusion for one hour or whatever time you need. That way, in 1 hr., your IV pump will (annoyingly) alarm ‘low volume’ which will require your attention. You can reset the volume to the next desired interval to keep you on schedule.

A Smartphone

This last suggestion is only if you already own a smartphone. No need to go buying one just for this purpose. My iPhone and most smartphones have a pre-installed timer, alarm clock and stopwatch. If yours does not, there are million and one ‘apps’ you can download for free, or for a small fee. My iPhone is always on my hip now since I utilize it more for medication references as well as medication calculations (and just about everything else), so if I forget to wear my watch I utilize my phone. Heck, there are times when I use both my watch and my phone to help keep me ‘on time’.

Care to add any suggestions to this list? What do you use at work to keep you ‘on time’?

Another post over at Scrubs. I really gotta get in front of that 8-ball.

Three on-the-job time saving tips | Scrubs – The Leading Lifestyle Nursing Magazine Featuring Inspirational and Informational Nursing Articles

Coffee preventing depression?

2011-09-28T11:16:00.001-04:00

It is not clear why it might have this effect, but the authors believe caffeine in coffee may alter the brain's chemistry. Decaffeinated coffee did not have the same effect.

The findings, published in Archives of Internal Medicine, come from a study of more than 50,000 US female nurses.

The experts are now recommending more work to better understand the link.

And they say it is certainly too soon to start recommending that women should drink more coffee to boost mood.

via bbc.co.uk

I'm thinking they're stretching this one pretty far, but being a coffee drinker.. heck I'll go with it.

Back to school checklist

2011-09-24T12:44:00.001-04:00

Nursing school checklist

The beginning of the school year is when I do a mental checklist to make sure I have what I need to start this semester and last through the entire school year.

Interested to hear: Do you have anything to add to my list, or recommendations on certain brands?

Book bag : Check their condition. Yes, I said their. I have multiple bags I use depending on the day and depending on the class. I’m a ‘backpack’ kind of student, but I also have a messenger bag. I need to make sure the bags are gonna make it through the semester. Have you ever had the strap of a bag just ‘fail’ on you in the middle of transport? Yep, my books and supplies went everywhere. It was not a pretty sight.

Planner : This is almost a moot point these days with the popularity of smartphones and tablets, but I still carry around the traditional calendar planner. I think these days I use it for carrying papers and documents, but I still utilize the calendar in addition to my trusty iPhone.

Printer & Accessories : Ever run out of ink mid-print? I always take stock in what I have, and what I need prior to the start of the semester. I’ve noticed I print a couple ‘forests’ worth of paper in the beginning. Everything from course syllabus, outlines, assignments, course schedule, book list, etc., gets printed out for each class. I need to determine what I have and what I need. This includes printer cartridges & paper!

Supplies : I try to envision what I do and what I need on hand while I’m in class as well as what I utilize when I am studying (at home and on campus). Everything from pens, pencils, erasers, white-out, sticky-notes, highlighters, bookmark tabs, scissors, stapler (and staples), paperclips, etc. This list is usually pretty long, and I almost always forget something.

Storage : How do you store your documents? Where do you store them? Do you use or utilize jump drives? It’s a crazy thought, but some of us still use discs to store data. Do you utilize online storage (in the cloud as they like to say)? Is your online storage maxed out? Is it a paid membership? Is it free? Do you need to clear the clutter out of your storage device to make room for the new data?

Study : How do you study? What do you utilize? Do you record lectures? Is the device you use to record operational? Do you need extra batteries? Is it digital – if so do you need to clear the memory for the new data?

Notes : How do you organize your class? Are you a spiral notebook kind of person? Or a loose-leaf paper and binder kind of student? Do you utilize folders or tabbed organizers? Make sure you have ample supply of whatever it is you utilize. I have my binders and paper ready to go.

This is a randomly small list of things I inventory each semester. I find it helps make the transition a little less hectic, because we all know how ‘stress-free’ those first two weeks of class are right? Right? (Yes, insert heavy dose of sarcasm now)

What crazy things to you check when your school year starts? Another post from over at Scrubs.

Nursing school checklist | Scrubs – The Leading Lifestyle Nursing Magazine Featuring Inspirational and Informational Nursing Articles

Earning It

2011-09-24T09:31:00.001-04:00

I stole this from a friend over on Facebook. I had to share this.

Back in September of 2005, on the first day of school, Martha Cothren, a social studies school teacher at Robinson High School in Little Rock , did something not to be forgotten. On the first day of school, with the permission of the school superintendent, the principal and the building supervisor, she removed all of the desks out of her classroom. When the first period kids entered the room they discovered that there were no desks. 'Ms. Cothren, where are our desks?' She replied, 'You can't have a desk until you tell me how you earn the right to sit at a desk.' They thought, 'Well, maybe it's our grades.' ... ... 'No,' she said. 'Maybe it's our behavior.' She told them, 'No, it's not even your behavior.' And so, they came and went, the first period, second period, third period. Still no desks in the classroom. By early afternoon television news crews had started gathering in Ms.Cothren’s classroom to report about this crazy teacher who had taken all the desks out of her room. The final period of the day came and as the puzzled students found seats on the floor of the deskless classroom, Martha Cothren said, 'Throughout the day no one has been able to tell me just what he/ she has done to earn the right to sit at the desks that are ordinarily found in this classroom. Now I am going to tell you.' At this point, Martha Cothren went over to the door of her classroom and opened it. Twenty-seven (27) U.S. Veterans, all in uniforms, walked into that classroom, each one carrying a school desk. The Vets began placing the school desks in rows, and then they would walk over and stand alongside the wall. By the time the last soldier had set the final desk in place those kids started to understand, perhaps for the first time in their lives, just how the right to sit at those desks had been earned.. Martha said, 'You didn't earn the right to sit at these desks. These heroes did it for you. They placed the desks here for you. Now, it's up to you to sit in them. It is your responsibility to learn, to be good students, to be good citizens. They paid the price so that you could have the freedom to get an education. Don't ever forget it.' By the way, this is a true story. Please consider passing this along so others won't forget that the freedoms we have in this great country were earned by U. S. Veterans.

I then did a quick search and discovered that this story seems to be true via Snopes.

This and many other stories always seem to circulate during those ‘military holidays’. And then during the 9/11 anniversary there was a small surge in what I like to call ‘convenience patriotism’. The problem I have is how we so easily forget and have forgotten about the tremendous sacrifice our veterans and our current military personnel have made. They are the reason for almost all your comforts in life, yet we still continue to ignore them.

I’m doing my miniscule part by passing on such a heart-tugging story.

The best bumper sticker evah!

2011-09-24T09:07:00.001-04:00

via twitter.com

Found this on twitter from an NP I follow. This. Is. Full. Of. Awesome.

The social media check-in app wars

2011-09-23T22:11:00.001-04:00

Me thinks I see a copycat?

I’m a TV junkie. I was perusing the internets reading up on the fall season premieres when I stumbled across a new SoMe^* app that promotes “"Connect with your friends around the shows you love". It’s called IntoNow:

Now, anyone that follows me around the SoMe circles knows I’m a big GetGlue fan:

After I read more about this IntoNow app, I’m getting an oh-so familiar feeling. As if I’ve seen or used something verrrrrrrry similar.

Here is the IntoNow description from iTunes:

Get more from TV! IntoNow is the best way to connect with your friends around the shows you love.
"I was amazed to the point where I was dumbfounded" — MG Siegler at TechCrunch
Great reviews from TechCrunch, Mashable, Reuters, All Things D, VentureBeat and many more...
IntoNow makes engaging with your favorite TV shows easy, social, and fun. Just tap the green button when your favorite show is on and IntoNow will identify the show and episode; provide all data and links associated with it; and help you share on Facebook and Twitter. IntoNow also helps you see which shows you have in common with your friends — including whether they’ve seen the latest episode — and alerts you whenever you and a friend are watching the same show at the same time. Use it to discover new shows, discuss your favorites with your friends, and learn more about whatever you’re into now!
Features:
- Identify live TV, or anything that’s run on TV in the last five years, from your television, computer or mobile device.
- Get full episode and cast information, as well as info on future airings.
- Receive notifications when your friends are watching the same episode or show.
- Comment on what your friends are watching in the app, or on Facebook and Twitter.
- One-click access to IMDb, Netflix, and iTunes so you can learn more or start watching right away.
- Add new friends using Facebook, Twitter, your address book, or “search by name.”

Aaaaaaand.. now check out the description of GetGlue on iTunes: (by the way GetGlue has been around since 2009)

GetGlue is a fun social network for entertainment. Check-in to what you are watching, reading and listening to. Connect with friends, discover new favorites, and unlock FREE stickers and discounts.
“The single most useful social networking tool I’ve encountered” - Wired
Positively reviewed by top press, including: L.A. Times, NY Post, Mashable, Gizmodo, and many more!
Features:
* Check-in to your favorite TV shows, movies, music, and more
* Earn rewards from over 40 major media companies
* See what your friends are currently watching, reading, or listening to
* Rate things to get awesome recommendations based on things you like
* Get filtered new releases and old favorites picked just for you
* Share the TV shows, movies, and music you like
Join more than 1.5 million other users who are sharing 9 million check-ins per month.
Watch a 60-second overview: http://www.youtube.com/watch?v=-P0tkjkSO20
Earn rewards from our current partners, including: 20th Century FOX, A&E, AMC, Animal Planet, CNN, Comedy Central, Discovery, Disney, Dreamworks, ESPN, FOX, Food Network, HBO, HGTV, MSNBC, MTV, NBC, PBS, Science Channel, Showtime, Sony Pictures, SPEED, Starz, SyFy, TBS, TLC, TNT, Travel Channel, truTV, USA, Universal Pictures, and other major entertainment companies.

If that wasn’t strangely odd enough check out the screenshots of the two apps:

Me thinks there is a copycat?

^*SoMe = Social Media

One ‘Sick’ Uniform

2011-09-23T10:01:00.001-04:00

How clean is your uniform?

Isn’t it amazing how our uniform defines our profession? I guess you could say all of health care to some degree. We as nurses love to wear our scrubs. We love to be able to say we wear our ‘pajamas’ to work every day (OK, maybe I’m the only one that says that). But what if the uniform we are wearing is causing harm? Or could potentially cause harm in the form of infection?

It’s not a new concept, but I recently read an article (Dangerous Bacteria Hide Out in Nurses’, Doctors’ Uniforms) on how our scrubs and our lab coats (all types of care providers) can and do harbor harmful bacteria. When I saw the title of this article it immediately brought back memories of the cleanliness of physician’s ties (How Clean Is Your Doctor’s Tie?).

It is no secret that we deal with a boat load of serious disease-causing germs on a daily basis while on the job. It doesn’t matter where we work, it’s what I would call assumed risk for us. This is health care, and we are caring for the unwell.

I guess I’m wondering how often we think about the ‘sterility’ of our uniforms (all of them). I mean, I don’t think I’m alone when I say I wear my scrubs from my home, to work, at work, and then back home. In fact I’m pretty sure we have all run errands before and after work while still wearing our scrubs. What’s that say about our cleanliness? Or our infection prevention? We ALL know how easy bacterial transmission can be (those darn vectors!).

When I worked in the PACU, we had to wear OR scrubs. We could not wear scrubs from outside the hospital. We had to change into our uniform that was provided for us by the hospital. And then at the end of the day we changed and tossed the dirty uniform in the dirty linens to be washed by the hospital cleaning service.

I used to think that was such a pain.

Then I remembered my pediatric rotation in nursing school. All the germs we encountered there. I specifically remember MANY of my classmates getting the sniffles, head colds and full-blown flu during that time frame. We were told to rigorously clean our equipment (pens, markers, clipboards, BP cuffs, stethoscopes, etc.) to make sure we didn’t transport any of the ‘germs’ home. RSV was not our friend. I remember wiping down my shoes with Clorox wipes after each clinical day!!!

I’m still pretty ‘Type-A’ about most of the aforementioned, but somehow I’ve gotten away from including my uniform.

Maybe I’m being too ‘Type-A’, but I wonder how many times we nurses have gotten sick, or we have passed on the ‘germs’ to someone else who eventually became sick, simply by the uniform we were wearing. (See this article about germs on your scrubs, as well).

Things that make you go hmm…

How ‘sick’ are the scrubs you are wearing? Another post from over at Scrubs.

How clean is your uniform? | Scrubs – The Leading Lifestyle Nursing Magazine Featuring Inspirational and Informational Nursing Articles

Getting older means getting smarter

2011-09-22T10:08:00.001-04:00

When you notice that first gray hair rearing its ugly head, there are more important things to do than rush to the store for a bottle of Just For Men. Hard-training fitness enthusiasts over the age of 40 need to make some pretty serious adjustments to their workouts if they want to continue to make progress and remain injury free.

In your 20s and early 30s you can lift heavy weights much more frequently, loading the spine and joints with reckless abandon. As long as you don't do anything too crazy, you'll usually be okay. But once you start creeping north of 35 and getting closer to the big four-oh, you might not be so lucky. Below is a list of important changes you need to make to your training program.

1) Reduce frequency of spinal loading. I often have younger lifters squat two to three times per week or squat one day and deadlift another. However, this is not such a good idea for the older lifter. The lower back takes longer to recover than any other part of your body, and as you get older this becomes even more noticeable. Therefore, it's best to put all your lower back intensive exercises like squats, deadlifts, good mornings, etc., all on one training day so that you have a week to recover.

2) Cut lower body sessions to once per week. As you get older, it becomes more important to do some extra conditioning work like jumping rope, running hills or pushing a sled. This is both for your cardiovascular health and for keeping body fat gains at bay. Because of this, you'll want to cut your lower body strength workouts down to just one day per week (in most cases). That will allow you to still get out and run or play without running into any recovery issues or over-stressing your knees.

3) Limit heavy pressing to one day per week. Heavy pressing is great for building up the chest, shoulders and triceps, but it also takes a toll on your rotator cuff muscles and all the tendons and ligaments surrounding your shoulder joint if you do it too often. The over-40 crew is better off limiting their heavy press work to once a week and substituting in more joint friendly variations like suspended pushups and higher rep dumbbell presses on their other upper body workout of the week.

4) Eliminate (or drastically reduce) low-rep training. Working up to heavy sets in the one to five rep range is awesome for building strength. But these sets can also beat you up pretty good. Older lifters will have a much harder time recovering from excessively heavy weights and thus would be well served to keep the majority of their sets in the eight to 12 rep range. As long as you train smart and keep a log book you can still make tremendous strength gains in this rep range while sparing your joints. The other great thing about training with higher reps overall is that it will help you preserve muscle mass. Guys in their late 30s will naturally start to lose muscle mass as they age. By training with moderately heavy weights in the range of eight to 12 reps, you can reverse this and will actually be able to build some more muscle.

5) Do longer and smarter warm-ups. When I was in my 20s, I used to walk into the gym and immediately put 50 percent of my first working set on the bar. That was my warm-up. Nowadays, having learned my lessons the hard way, I take a full 10-15 minutes to warm up properly by doing mobility drills for the shoulders, hips and other injury prone areas. Guys in their late 30s and 40s absolutely have to make time for this. Other important parts of the warm-up include some light calisthenics, foam rolling to improve soft tissue quality, muscle activation drills for the upper back and glutes as well as some dynamic stretching. Whenever you're pressed for time, it's better to cut out some of your workout than it is to skimp on your warm-up.

With those five minor adjustments you can continue to train safely and make progress well into your golden years.

Good luck.

Get Jason's free muscle-building e-book and learn more about hardcore training at JasonFerruggia.com

via huffingtonpost.com

I was happy after reading this. I do all of the above suggestions.

‘Thank You’ Thursday

2011-09-22T09:41:00.001-04:00

This is an idea I literally just came up with ‘Thanks’ to Joni (@joniwatson) over at Nursetopia. Her post today was motivated by none other than Jimmy Fallon. I guess he does a thank you note segment (never watched the show, sorry) that more than likely has a twisted-humor spin to it. She thought it a great idea, so she decided to thank those who made a difference for her (minus the twisted-humor part I think?.

I’m taking it a step further and attempting to spread the positivity through a weekly blog post called : Thank you Thursday. I’m inviting anyone and everyone to join in! Lets make being thankful as infectious as complaining.

I enjoy writing thank you notes to people who make a difference in my life. Jimmy Fallon cracks me up with his thank you note segments, and sometimes I want to join in on the thank you note hilarity.

This week, though, I am seriously thankful for Outlook calendar reminders, gas stations selling travel-size fingernail polish remover, instructions printed directly on equipment (rather than paper that gets lost), and items – both at work and at home – with off switches. Each has come in quite handy in a pinch this week.

So, thank you. You made my life easier this week, and I’ll take all the easy I can get.

What are you thankful for this week?

My Thank You Thursday:

I want to thank the receptionist and employee at my optometrists office for fixing my glasses and replacing parts for no charge. I’m thankful to my family for going the extra mile to keep the peace. I’m thankful for the ‘Remember the Milk’ application. Oh, I’m thankful I read my schedule wrong at school this week: getting on campus super-duper early ended up being a blessing in disguise.

Thanks again Joni.

Thank You for Making My Work and Life Easier « Nursetopia

GetGlue for iPhone: Go Get It

2011-09-22T09:29:00.001-04:00

If you follow our blog, you know that GetGlue had a very exciting summer. We are now 1.5M users strong, up from 1M in April. Check-ins grew 130% in just 3 months - from 5M check-ins in May to 11.5M check-ins in August.

But today is the day the GetGlue crew has been really looking forward to. Just in time for the Fall TV season, we are announcing a major update to GetGlue.com and GetGlue for iPhone. We have re-imagined the entire user experience and have made check-ins more delightful and rewarding and focused on interesting conversations with friends and other fans. Watch this video to find out what is new:

1. Interesting Conversations

Everyone is talking about the conversation around TV, but really, if you look at all the check-ins and tweets combined what you get is a lot of noise. Where is the actual conversation? How can we reveal the actual real-time, fun, witty, interesting, and engaging conversations around tv and entertainment at large?

With this release, we are happy to announce a new feature called Interesting Conversations - a real-time stream of GetGlue check-ins and tweets, available inside the GetGlue iPhone app, GetGlue.com and also via GetGlue API.

GetGlue developed a filtering methodology, which significantly reduces noise and increases the relevance of check-ins and tweets in real-time. The combined stream is much more compact, but is also way more interesting and engaging - a real-time social conversation around TV.

The conversation theme runs through the entire app update. After you check-in you land on the new conversation screen. The screen shows recent check-ins from friends as well as interesting check-ins and tweets from everyone who is watching the same show. This new screen is real-time, relevant and engaging. It combines what your friends are saying and what everyone is talking about right now.

2. Friend Leaderboards

Another cool feature in this release is Friend Leaderboard. GetGlue is the first check-in app to have Friend Leaderboards around every show, movie, artist, book or topic. With the Friend Leaderboard you can see a list of top 10 friends around any object ranked by the number of check-ins.

The Leaderboards are both fun and useful. For shows you love, you can’t help but compete with friends for the status of the biggest fan. For new shows, the Leaderboard facilitates discovery because you can instantly see which friends are the experts and can provide insight on whether you’ll like the show or not.

You can access the leaderboard from each check-in response screen, and also from each show, movie, etc. details page on the app. On GetGlue.com the leaderboard is displayed prominently in the sidebar for each show, movie or recording artist.

And a whole lot more!

In addition to these three new features, we went through a complete re-design of the app. Everything is more optimized, more useful, and more fun. The check-in flow in particular is richer and more rewarding. We are now surfacing your personal stats, stickers unlocked, specials, and trending information on every check-in.

Download the app now!

We hope you enjoy the new features as much as we enjoyed working on them and can’t wait to hear your feedback.
-->
Tagged as: fall tv, GetGlue, iphone, real-time conversations

Tags: fall tv | GetGlue | iphone | real-time conversations

via blog.getglue.com

Anyone that follows me around SoMe (Social Media) circles knows I've been using GetGlue since its inception.
I love it! And the updated iPhone app is the bomb.

Be sure to check out the video:

Fall TV Frenzy

2011-09-22T08:10:00.001-04:00

via whoknew.news.yahoo.com

This time of the year, I always get a bit excited for 'my' TV shows to come back for their 'fall premiere', as well as keep an eagle eye out new ones.

I do find it interesting that as of lately - all the (new/newer) shows that I find an interest in seem to get pulled and cancelled.
I think it's a conspiracy.

Flu Vaccine Supply Ample this year

2011-09-22T08:06:00.001-04:00

WASHINGTON -- There's plenty of influenza vaccine to go around this year, and one more type of vaccine has been added to the mix, making it easier than ever to be immunized against the flu, according to the CDC.

There are nearly 90 million doses already available at doctors' offices, walk-in clinics, and drug stores, and the CDC expects about 170 million doses to be available in total, CDC Director Thomas Frieden, MD, MPH, announced Wednesday.

Last year, about 123 million people in the U.S. received flu shots -- a 16% increase from the previous flu season -- and federal officials are hoping the numbers increase this year.

People still resist getting a flu vaccine because of misconceptions about the vaccine -- such as that it gives you the flu, or that handwashing is just as effective, said William Schaffner, MD, president of the National Foundation for Infectious Diseases (NFID), adding that federal officials are working to encourage more people than ever to get flu shots this year.

"Our goal is to make annual influenza vaccination a no-brainer for Americans across all age groups," he said during a press conference at the National Press Club.

Echoing its recommendation from last year, the CDC is urging a flu shot for every person over the age of six months, including pregnant women, who can pass some immunity onto their newborns if they themselves are vaccinated.

In addition to the traditional intramuscular influenza injection, the nasal spray, and a high-dose injection for people age 65 and older, there is a new vaccine that is injected just under the skin using a smaller needle, making it less painful than an intramuscular shot. That smaller needle isn't an option for children, however; it's approved only for adults between the ages of 18 and 55.

While children aren't eligible for the thinner-needle shot, there is some good news for them: children between the ages of six months to 8 years who received a vaccine last year only have to get one vaccination this year, as opposed to the normal two-shot series. However, if such a child did not receive a flu shot last year, he or she must receive two doses, at least four weeks apart, the CDC is recommending.

Federal health officials predict the strains of flu that will sicken people during this year's flu season will be the same strains observed during last year's flu season, so this year's vaccine is the same as the 2010 vaccine. It will protect against H3N2, influenza B, as well as H1N1 virus responsible for the 2009 outbreak.

"This year is unusual because the strains in this year's vaccine are identical to last year's vaccine," said Schaffner.

However, that doesn't mean that people who got vaccinated in 2010 can skip their shot this year, Frieden said. Effectiveness of the vaccine wanes, so another shot is necessary this year, and the sooner the better, said Frieden, who received his flu shot in front of the crowd and cameras at Wednesday's press conference.

Overall, 63% of healthcare workers received a vaccination during the last flu season, according to the CDC, which is better than a study last year from the American Academy of Pediatrics that pegged that number at just 40%.

Even if not all healthcare workers are practicing what they preach, they need to keep preaching, said Richard Beigi, MD, an assistant professor of obstetrics, gynecology and reproductive sciences at the University of Pittsburgh. In order to improve vaccination rates, doctors should encourage patients -- especially pregnant women who are at higher risk of complication and death from influenza -- to get vaccinated in order to protect themselves against the virus.

Beigi said pregnant women are five times more likely to receive a flu shot if a doctor makes a direct recommendation.

More effective communicator | Scrubs – The Leading Lifestyle Nursing Magazine Featuring Inspirational and Informational Nursing Articles

Just the other day I was told by a patient's family member that they don't get the flu vaccine, because they got the flu the last time they got 'the shot'

*sigh*

Are you getting vaccinated? I do.
I get my flu shot every year.
I can't remember the last time I had the flu, honestly.

Therapeutically effective communication

2011-09-21T19:11:00.001-04:00

More effective communicator

As nurses we all learn about therapeutic communication. I’m not here to review that. But, does being a therapeutic communicator make you an effective communicator?

I found out this week that it does not. Taking that initial history can be challenging to say the least.

You can listen with the most empathetic ear, but if you cannot effectively communicate AND therapeutically communicate, the conversation you have with your patient will be short and ineffective.

Here are some key concepts that may look vaguely familiar to those who know therapeutic communication skills:

Level the playing field

We all know to always maintain direct eye contact, but also make it a point to maintain the patients eye level. Meaning, unless you can’t prevent it, don’t interview your patient standing over them. Everyone remembers how to communicate with pediatric patients right? Well it equally applies to adults. Be on their level – literally and physically!

Two ears & one mouth

This means you should listen twice as much as you talk. The best communicators are the greatest listeners.

Wide open spaces

I would hope you are within close proximity of your patient. Trying to elicit a meaningful dialogue from across the room is not very effective. Although there can be such a thing as ‘too close’ and invading personal space. Please respect someone’s wishes and be culturally sensitive to their needs and wants, regardless of how you feel about them.

The Doppler effect

Be very aware of the tone of your voice. While we always want to use our ‘inside’ voice, I think we can all admit to raising our voice to speak above the ambient sound of the hustle & bustle of the nursing unit. I honestly would suggest starting with a whispered voice. I haven’t met anyone who gets offended by a whisper, but many will be offended by a boisterous megaphone-like shriek.

Be a N.U.R.S.E.

(Sorry, I learned this new acronym and had to share)

N – notice

Listen, listen, and then listen some more

U – understand

Developing a plan of care

R – respond (& reflect)

Clarify yours and their understanding

S – sympathize

Validate how they are feeling

E – empathize

Be objectively aware and non-judgmental

A lot of these suggestions are not new. In fact I think all nurses possess these skills, or they learn them as they travel through their career. It never hurts to remind ourselves.

Another post from over at Scrubs.

Being a Nurse

2011-09-20T20:39:00.001-04:00

Kim McAllister just keeps flexing her nursing skills. Here is a recent video interview she did on ‘what it takes to be a nurse’.

What It Takes To Be A Nurse

If you’re wondering “should I become a nurse,” you’re going to want to make sure you like science, have good communication skills, are detail-oriented and can problem solve, multitask and handle stressful situations. In today’s episode, Kim McAllister, an emergency room nurse with over 30 years of experience, tells us that it takes a lot more than caring about people to be a good nurse. Kim shares great career advice and all kinds of information about nursing careers.

…Kim tells us what schooling is required to become a nurse. She advises taking lots of science classes in high school and then, because so many nursing jobs are looking for a Bachelor’s of Science in Nursing, Kim suggests going for the 4-year degree today. Kim spent most of her nursing career with a 2-year Associate’s Degree in Nursing and from her experience believes another great route is to get the ADN to start your nursing career and then, while getting real life work experience, keep going to school on the side to earn your BSN. In addition to this great advice, Kim walks us through a typical day and provides an ER nurse job description.

Way to go Kim! Be sure to check out the original post in its entirety!

What It Takes To Be A Nurse | Careers Out There

The Bo Jackson phenomena of nursing

2011-09-19T20:33:00.001-04:00

Do “new nurses” scare you, too?

Lately I find myself becoming quite the cynic. I’m not a cynical nurse, I’m just discovering things throughout my ‘world’ that are cause for cynicism. Well, not everything in my world. Mostly the new nurses.

Now remember, I haven’t even been a nurse a decade yet! And here I am remembering the “good old days” of nursing. Scary. I know.

I guess what gets under my skin is I’m finding more and more ‘newer’ nurses who think they know everything. OR they think they’ve experienced everything simply because they’ve been a nurse ‘long enough’, to see the ‘same thing’ more than once. Complacency can infect all of us at one time or another. We get so comfortable with repetition that we find safety in it, and then we find braggadocio. I’ve been doing this for a mere seven years, and to this very day, I still learn something new, or appreciate a new concept every day.

I cannot shake the feeling that the ‘newer’ nurses scare me just a little. This hollow, yet inflated, ego is going to get them in trouble. So much trouble that I often wonder if their patients will suffer.

It was handed down to me in a very profound way that it’s our job, as nurses, to expect the unexpected. To think in terms of the ‘worst case scenario’. To prepare for the worst, but expect the best. To always have our ‘game’ face on, and to always play our ‘A’ game. I just don’t see that with these ‘newer’ nurses. Now, don’t get me wrong. I’ve seen plenty of awe-inspiring new nurses, that can and have put me and other experienced nurses to shame. I am humbled by their skills, I really am. But, I can’t remember the last time I felt humbled by a new nurse.

I’m not just talking about whom I’ve worked with shoulder-to-shoulder. I’m talking all facets of interaction (in-person & on-line). So it’s not just my small circle of the world.

Maybe I need a breather?

Maybe I need a change of scenery?

Maybe it’s not me at all?

I don’t know. What I do know is that it’s my responsibility to myself and my profession to continually challenge this new attitude. I’m not saying we need to ‘put’ anyone ‘in there place’, but we definitely need to educate and enlighten those that need it.

Am I alone on this, or have others come across this ‘Bo Jackson’ phenomena of ‘knowing everything’?

I’d love to hear your thoughts.

This was a post over at Scrubs. I was trying to figure out why I have come across so many new nurses who have this trait.

Do “new nurses” scare you, too? | Scrubs – The Leading Lifestyle Nursing Magazine Featuring Inspirational and Informational Nursing Articles

Naked at work

2011-09-19T15:12:00.001-04:00

No. Not what you think.

Ever show up for your shift and realize you forgot your watch?!

I don't know about you- but my whole shift is off kilter. I constantly look at my bare wrist checking the time on a watch that isn't there!

It definitely puts a damper on my time management. Lol.

Am I alone on this one?

Behind the doors of a nurses’ mind

2011-09-17T22:03:00.001-04:00

Here was a post over at Scrubs Magazine taking a comical look at how my mind as a nurse works sometimes. Am I alone?

A nurse’s subconscious mind

There are just some things non-nursing folks will never understand. It’s not a ‘knock’ against those who are not a nurse, really it’s not. What I’m talking about is how your brain gets ‘re-wired’ once you become a nurse. I don’t know if it happened over night? Maybe it happened gradually over the past half a decade? What I do know is my mind thinks and processes things SO differently than it did prior to being a nurse. I wonder… am I brain-washed??

Here’s what being a nurse can do to the mind:

At the restaurant, we silently hope that the person choking at the table next to us doesn’t need assistance – yet if they do we’ll be the first to run to their side.

Walking through the fog of a public ‘smokers break area’ – we all want to reach out and smack you. Do you want to die breathing through a tube?

While phlegm doesn’t normally bother (most) us at work – the sight or sound of you hacking up a ‘lung’ in public really does bother us. Especially when you don’t cover your mouth!!!

Public restrooms. Yes – there is nothing sanitary about them most of the time. What we can’t stand is witnessing someone use these facilities and then walk out without washing their hands!!! (How am I supposed to pull the door open and exit the bathroom without contaminating my hand??)

For some strange reason – we can never look at another persons arms the same ever again. Every time we see a good vein – yep, you guessed it, we think to ourselves, “wow! I could start an #16 gauge needle there!” Sorry.

We continue to micro-analyze anything on TV or in the theater that has a shred of health care related activities. “Oh yeah, THAT would happen” has echoed through our minds one too many times.

To this very day, I think we all have been cursed with measurements. We subconsciously measure how much we have urinated, how many CC’s of fluid we have drank and of course how many carbs were in our meals.

While on vacation – no matter the geographic location. We somehow ‘notate’ and remember where the closest emergency room and hospital are located.

I’m not sure if it’s just a nursing thing, I think paramedics share this curse. We still to this day have a spare set of scrubs stored in our vehicles, along with old ‘not in use’ equipment like stethoscopes, pen lights and scissors.

We still shake our heads at those wonderful ‘blood pressure screening stations’ located throughout the supermarkets and discount stores. I think we are more troubled by the fact that the public believe these measurements to be accurate.

We still (often) forget that it’s not common practice to talk about blood, bodily functions, and bodily fluids as a discussion topic during a meal. Again, sorry.

Yes, we find humor in the most disgusting and disturbing things sometimes (OK, all the time). I’d like to think it’s our defense mechanism for making sure we don’t drive ourselves crazy and burn out.

This just scrapes the surface of what goes on behind the doors of our minds. I continue to convince myself that I’m not brain washed, but that I have been trained and educated to always ‘be prepared’, but sometimes you have to wonder.

(That was a joke folks)

A nurse’s subconscious mind | Scrubs – The Leading Lifestyle Nursing Magazine Featuring Inspirational and Informational Nursing Articles

The real reason we nurses get bitter

2011-09-17T21:56:00.001-04:00

Shrtstormtrooper shares a story over at New Nurse Insanity (link below) that encapsulates why we nurses develop short fuses. Fuses that lead to burnout, angst, anger and all kinds of negativity. Sometimes (some) nurses really need to check themselves before ‘reporting’ a fellow ‘fighter’ to their supervisor. Walk just a few steps in another co-workers shoes.. you might think twice about reporting someone for something you yourself probably forget or miss just as much, if not more than most nurses!

A high five to Shrtstormtrooper.

Priorities, seriously

So I got called into the Boss Man's office this morning, because the floor wrote me up and he wanted to address the issue.
At this point, my feet hurt, I haven't peed yet tonight, I didn't get to eat anything, I have blood on my scrub pants…..

I have poop on my scrub pants…

I haven't finished charting on that last arterial bleeder that came in….

and my coffee from 7pm is still sitting full on the counter next to my computer. It's been a rough night.

I got written up because, in all the madness, I missed a skin tear on this patient. One skin tear, out of many. And actually, it wasn't my patient to begin with,

New Nurse Insanity: The Adolescent Years | Priorities, seriously

Follow the link above to read the whole story. Be sure to leave a comment for her, let her know she’s not alone!

Dr. Oz doesn't have the juice

2011-09-16T08:42:00.001-04:00

Mehmet Oz, MD, the Columbia University thoracic surgeon who gained fame first in books and more recently with his syndicated television show, has run afoul of the Food and Drug Administration with his report about levels of arsenic in popular brands of apple juice.
The FDA called the report "irresponsible and misleading" and another TV doc, ABC's Richard Besser, MD, accused Oz of fear-mongering.
In a recent episode of The Dr. Oz Show, Oz reported that five brands of apple juice -- Minute Maid, Apple & Eve, Mott's, Juicy Juice, and Gerber -- all contained some level of arsenic and suggested that this was a cause for concern.

The show used an independent laboratory, EMSL Analytical, to test dozens of samples from three U.S. cities to compare the level of arsenic in the juices to the Environmental Protection Agency's safe standard for drinking water, less than 10 parts per billion.

At least one sample for four of the five brands -- excluding Minute Maid -- came in above that threshold. The highest level measured was in Gerber apple juice, at 36 ppb.

The segment earned a stiff rebuke from representatives of government, industry, and academia for causing unnecessary alarm, even before it aired.

The criticism centered primarily on Oz's testing methods, which provided a level of total arsenic in the juices. The results do not provide a breakdown of the levels of the two forms of arsenic -- organic and inorganic.

In heated confrontation aired on ABC's Good Morning America, Besser not only blasted reporting of only the total arsenic numbers but also charged that relying on a single lab to test for arsenic fell far short of scientific standards. Oz, however, refused to back down and maintained that he acted responsibly.

According to the FDA, arsenic is found in the environment in both forms, either as a result of natural processes or the result of contamination from human activities. In the U.S., some pesticides used up until 1970 contained arsenic.

The organic form of arsenic is "essentially harmless," according to the FDA. The inorganic form can cause problems at high levels or with a long period of exposure.

In a letter sent to The Dr. Oz Show before the segment aired, Don Zink, PhD, senior science adviser in the FDA's Center for Food Safety and Applied Nutrition, wrote, "The FDA believes that it would be irresponsible and misleading for The Dr. Oz Show to suggest that apple juice contains unsafe amounts of arsenic based solely on tests for total arsenic."

The FDA said it has been testing for arsenic in apple juice for several years. The juice is first screened with a test for total arsenic because it is rapid, accurate, and cost-effective, according to Zink. Only when the total level of arsenic is greater than 23 ppb does the agency employ the more complex inorganic arsenic test.

"The vast majority of samples we have tested for total arsenic have less than 23 ppb," Zink noted.

In a second letter to the show, Zink informed the producers that the FDA had performed its own testing on samples of apple juice from the same lot that yielded the highest level of arsenic in Dr. Oz's investigation. All of the results ranged from 2 ppb to 6 ppb.

"In short," Zink wrote, "the results of the tests cited above do not indicate that apple juice contains unsafe amounts of arsenic."

In an email to ABC News and MedPage Today, Aaron Barchowsky, PhD, a professor in the department of environmental and occupational health at the University of Pittsburgh, said that he agrees with the FDA's conclusion.

"It is the inorganic form of arsenic in the environment that is toxic, and measuring total arsenic is not informative," he wrote. "I support the comments by the FDA and agree that the Oz show analysis is incomplete and probably misleading."

On its website, the FDA said that it has a standard for an unsafe level of arsenic in water but not in apple juice for two main reasons -- the consumption of water is much greater and most of the arsenic in water is the unsafe inorganic form, whereas in fruit juice, most of the arsenic is the organic form.

Henry Miller, MD, a fellow at the Hoover Institution at Stanford University and formerly the founding director of the FDA's Office of Biotechnology, criticized Oz for failing to provide evidence that the levels of arsenic found in the apple juice were dangerous.

"Unless there is evidence that a substance is present at sufficient exposures and levels to cause harm, warnings about its presence in food (or in our bodies, for that matter) is irresponsible alarmism," he wrote in an email. "This is the same sort of rubbish peddled by radical environmental activist organizations about pesticides."

This article was developed in collaboration with ABC News.

It's about time someone put this sensationalist in his place and knocked him off his media-drive pedestal.

*hmph*

As you can tell I have never been a fan of him. Not on the infamous 'O' show and not with his own TV show. I cannot agree with his 'fear-mongering' (great definition by the way) either. I have a hard time understanding how a thoracic surgeon can portray such a transparently misleading TV show medical 'expert'.

He is doing everyone in the health care community a disservice by making it our jobs now to support or defend all of his notions to our patients.
I cannot tell you how much I tire of the repeated response of, "Well... Dr. Oz says....."

*grr*

Just a Little Heart Attack

2011-09-15T21:29:00.001-04:00

I think this is awesome. While it of course is using humor as the medium, it pinpoints the very REAL problem of most women not fully understanding what the signs of a heart attack are.
And even when they do (and this goes for men & women), they continue to deny their symptoms or write them off as 'not happening' or 'not important'.

Take care of yourselves out there, and do you part to help take care of the ones you love by spreading the word.

Oh - and it having Elizabeth Banks in the video was sooo not a bad thing.

Appreciate the gifts you are given. Life IS tougher for others.

2011-09-15T20:29:00.001-04:00

Happy Re-Birthday To Me « My Strong Medicine

I think I need to say this over and over again. Appreciate the gifts you are given.

10 years later–I Still Don't Have Bad Days Anymore : Happy Re-Birthday To Me

2011-09-15T16:51:00.001-04:00

For those of you who have been around me for the past couple years have already heard this story, but I re-post it every year for cathartic reasons. So I apologize if you’re reading this again.
It’s now been an entire decade my life changed (for the better).
The scar (on my skin) has healed well, it’s almost barely visible. The emotional ‘scar’ is ever-present and continues to be the defining gift of my life. I no longer have bad days – only bad moments that are temporary. I only need to touch my neck to be reminded what a bad day REALLY is.
I want to thank everyone for being a part of my world. Life truly is fleeting.

And I want to especially thank my beautiful wife for being my angel every single day of my life. She truly makes my life full and complete. Without her I would not be the person I am today, and without her I would not be nearly as happy.

She understands how important this day is to me, and each year she still makes it special in her own unique way. I want everyone to know how luck I am, and truly special she is to me. Thank you Angel.

Happy Re-Birthday To Me

Originally posted by Sean on September 19, 2008

This time of the year always has a special place in most of America’s hearts. September 11, 2001 is a date none of us will soon forget. It changed the face of our nation and impacted our world in a way none of us could have ever imagined. Emily (crzegrl) shared here views of how it impacted her.

At the risk of diminishing or making that day any less than it really was. This time of the year has a very different meaning for me. I do remember September 11th. I do remember what I was doing that day. I do remember how I felt and how the world around me changed. But it’s not what is in the forefront of my mind.

September 15, 2001

My Re-Birthday.

It’s been 7 years.

It was a Saturday. (Yes I remember it that well)

There was a time in my life when I was not active in healthcare (It was a short time). I had stepped away from the healthcare setting and returned to my career in retail. Retail had helped pay my way through college, and then it was the way to put food on the table after college was over. My career in healthcare wasn’t paying the bills, and retail was a better option (at the time).

It was a typical Saturday night. I was one of the midnight managers on duty. Part of my responsibility as a manager was to hold the night-shift meeting with the over-night employees.

This particular night we decided to have an open forum concerning the difficulties people may or may not be having with the current state of affairs. The terrorists attacks were affecting everyone, and we wanted to let our employees know we cared.

I can’t say I remember how it happened.

I can’t say I was prepared for it.

It happened in time ‘slices’.

I was talking with the over-night group of employees. It was me in front of approximately 20 others. Half-way through the meeting and in mid-sentence I can vaguely remember an ‘itching’ or ‘biting’ feeling on my neck.

….??

It wasn’t anything out the ordinary. I chalked it up to one of the bodily aches or pains I have no explanation for. (Like when I get a shooting pain in my finger that comes a goes in a matter of 7 seconds)

It got more quiet. It was like I could only hear the fans of the air conditioning running. I guess the only way to explain it… is things seemed to slow down.. immensely. Like the slo-mo option on a VCR/DVD player.

I don’t know what happened next. Or should I say I don’t know which came first. The banshee-like shrieking screams or the shadow of a person coming out of my left peripheral vision. All I know is that it was a startling moment.

The Scream.

The Shadow.

And I reflexively look to my left.

I remember saying to my self, "Hmm, why is Jane (we’ll call her Jane for identity purposes) standing so close to me. She should be sitting out in the crowd with the rest of the group."

She’s now advancing towards me. "What is she doing?"

Her left arm is raised in the air. I think she’s going to take a swing at me. So out of reflex, I block her left arm. I block her arm with my R arm and grab her swinging arm with my L hand. Then I grasp her swinging arm with both hands.

I can’t quite figure out why she’s trying to hit me?

Another handful of screams.

Through the tussle and wrestling of her arm I realize my hand is full of blood??? In fact I have blood on both my hands?

"OK. Who’s blood is this?", I blurt out with a sense of sarcasm.

… ??

More screams.

… ??

Wait a minute.

What’s that in Jane’s hand?

Is that..?

No way.

Wholly SH#T. Jane has a knife in her hand.

"The blood is YOURS! She cut your throat. Your bleeding from your neck!!!!!!", a voice from the crowd cries out hysterically.

Now, I’m no idiot. I know the inner workings of the human body. I’m pretty well versed in what anatomical structures are located in the neck.

I know I’m still breathing. I’m not chocking. Not having any trouble moving air.

???

At the same time Jane is tackled by a single employee from behind. Then another, then another. And then more. It takes close to 5 people to get her down.

I put my hand on my neck.. and sure enough … nothing but blood.

Yep. It’s a true story. I was attacked from behind with a swiss army knife by an employee of mine, in front of approximately 20 people. She sliced my neck almost from ear to ear.
Here are the finer points of the story:

- she used a very dull and old swiss army knife

- she did not use the blade side of the knife and drag it across my neck to cut me. She used the knife in a stabbing motion and scraped the tip of the knife across the length of my neck

- she never spent a night in jail. She had a psychiatric evaluation. Her medications were adjusted. And that’s the last thing I was told (Please don’t ask.. I don’t know what the heck happen concerning her lawful conviction)

- Yes, I have a Keloid scar that has taken 7 yrs to slowly diminish on my neck. (The intent of the ED physician was to use the smallest/thinnest suture possible so to NOT leave a scar, and it did the exact opposite)

-The only entertaining piece of all this was that when the 911 call was made. All the EMS arrived expecting to see a decapitated man. And I mean ALL of the EMS. For the small town I was in, I think I counted 4 Ambulances and 6 marked Police and 2 unmarked Police cars.

There isn’t a day that goes by that I don’t think about that day. It changed my life. We always whine and complain about some of the most ridiculous things in life that seem so very important at the time. Everything from being late for work, being stuck in traffic, having to wait in line in the grocery store, having a poor wait staff wait on you at the restaurant, or having to sit in coach for a 4hr flight… the list is endless. Everyone hates having a bad day.
I touched on my theory about life and how bad your day really was here.

I’m not perfect. I do have stress in my life. I do have those ‘Pull out your hair’ moments and those "all i wanna do is scream" moments. But I’m always grounded and reminded by my profession and by my past that maybe you and/or I not having THAT bad of a day.

September 15th is my Re-Birthday. I was given a second chance at life. For some strange reason, I survived that incident. I will never know why. I questioned it for a long time, and never got the answer I wanted until I realized there was no answer. I’m here. I’m staying here. I’m not going anywhere. And while I’m here, I’m making the most of my stay.

Here’s what scares me sometimes when I think about my attack.

As an employee for the retail store I worked for, each employee is issued a box cutter. The only reason I’m still here is because Jane had bad aim, and a dull swiss army knife.

What if she would have used the box cutter instead of her swiss army knife?

…

…

Nope.

I don’t have bad days anymore.

Carpe Diem

The G.O.D. Complex

2011-09-15T09:07:00.001-04:00

Medal of Honor recipient highlights Marine’s valor as well as risks US troops faced under controversial rules of engagement | The Envoy - Yahoo! News#

I'm chuckling, but please keep in mind this is not isolated to just the physicians.

A Marine is awarded the Medal of Honor

2011-09-15T08:16:00.001-04:00

As a former Marine I often wonder how many of us realize how very few Medal of Honor awards have been bestowed upon a Marine? I like to think it’s because all Marine’s carry a high level of duty to others, and while Sgt. Meyer’s actions are honorable are far from unique to those band of brothers.

Thank you Sergeant, and a humble congratulations. I am sure your fellow brothers are equally thankful and proud.

Medal of Honor recipient highlights Marine’s valor as well as risks US troops faced under controversial rules of engagement
On Thursday, President Obama will award the Medal of Honor to Marine Sgt. Dakota Meyer.
Meyer will become the third living recipient--and first Marine--to be awarded the Medal of Honor for actions in Iraq or Afghanistan, the White House said. He is also the first living former Marine to receive the highest U.S. military honor since the Vietnam war, a Marine Corps press officer told The Envoy Wednesday.

The heroic conduct Meyer displayed in retrieving the bodies of four fellow Marines killed in battle occurred during a September 2009 battle in Kunar Province, Afghanistan. The rules of engagement for the conflict have caused controversy and some bitterness.

Meyer was serving as a member of a Marine Corps training team embedded with Afghan National Army forces in Gangjal, Afghanistan on September 8, 2009.

"A full moon was drenching the mountains in ghostly light as some 60 Afghan soldiers, 20 border police officers, 13 Marine and U.S. Army trainers and I set out for Ganjgal at 3 a.m. from the U.S. base in the Shakani District," McClatchy national security reporter Jonathan Landay, who was embedded with the unit at the time, reported in September 2009.

As the team came under insurgent fire and rocket attack, however, U.S. commanders repeatedly denied the request to provide air cover, under new rules of engagement designed to reduce civilian casualties.

"U.S. commanders, citing new rules to avoid civilian casualties, rejected repeated calls to unleash artillery rounds at attackers dug into the slopes and tree lines — despite being told repeatedly that they weren't near the village," Landay reported. "We waited more than an hour for U.S. helicopters to arrive, despite earlier assurances that air cover would be five minutes away."

By the time helicopters arrived, four U.S. Marines had been killed, as well as eight Afghan troops and the US Marine commander's Afghan interpreter.

"The Marines were cut down as they sought cover in a trench at the base of the village's first layer cake-style stone house," Landay reported. "One Marine was bending over a second, tending his wounds, when both were killed, said Marine Cpl. Dakota Meyer, 21, of Greensburg, Ky., who retrieved their bodies."

Meyer, born in 1986, retired from the Marines in June 2010, and now lives in Kentucky.

The last living former Marine to receive the Medal of Honor was in 1973: "Now-retired [Marine] Sgt. Maj. Allan Kellogg . . . received the Medal from President Nixon at the White House on Oct 15, 1973," Military Times' Dan Lamothe reported.

An App for THAT?!

2011-09-14T19:33:00.001-04:00

In this day and age... ya nevah know.

How was your summer?

2011-09-13T05:42:00.001-04:00

Isn't sad how true this comic really is?

*WARNING - PARENTAL FLASHBACK*

I remember when we were growing up. We actually DID a written report at the first of the school year. "My summer vacation", "What I did this summer" were some of the titles for my report.

Boy, I'm getting old.

Going to see 'Somebody'

2011-09-12T19:41:00.001-04:00

via cirquedusoleil.com

Cirque du Soleil | Quidam *

This will be our second 'Cirque' show we've attended. We are expecting to be equally amazed again!

If you want to know what my definition of 'absolute strength' is, just watch these performers.
Absolutely amazing body strength, with such grace and poise.

* - Quidam = translated "Somebody; one unknown".

The causes of the obesity epidemic?

2011-09-12T17:28:00.001-04:00

Yes, we kids had our milk and cookies after school, but then we went out to run around and play until dark. Television watching (through my father’s business, my family acquired an early TV with a seven-inch screen) was mostly a weekend family affair, not a nightly ritual with constant noshing.
Most meals were prepared and eaten at home, even when both parents worked (as mine did). Eating out was a special event. “Convenience” foods were canned fruits and vegetables, not frozen lasagna or Tater Tots. A typical breakfast was hot or cold cereal sweetened with raisins or fresh fruit, not a Pop-Tart, jelly doughnut or 500-calorie bagel with 200 calories of cream cheese.

via nytimes.com

Has anyone heard of Occam's Razor?

A Father with no regrets

2011-09-12T09:42:00.001-04:00

A simple, yet elegant and touching story concerning the death of two brothers who served during the 9/11 attacks as told by their father.

Some scars cut deep

2011-09-11T09:45:00.001-04:00

Serious Ink of the Day |The Daily What

Never forget.
Always thank.

Always.

Begin CPR…

2011-09-08T19:39:00.001-04:00

Then you see this:

Serious Ink of the Day: 81-year-old Joy Tomkins of Downham Market, Norfolk, wanted to make sure no one tried to bring her back from the dead, so she did what any normal grandmother of six would do: She had “Do Not Resuscitate” tattooed on her chest.

“I do not want to be half dead, I want to be fully dead,” said Tomkins, who suffers from arthritis, Reynard’s disease, and diabetes. “I’m afraid the medical profession will, with the best of intentions, keep me alive when I don’t want to be alive.”

Despite her wishes, a General Medical Council spokesman said Tomkins’ ink will likely be ignored. “Mrs Tomkins’ tattoo would not be enough information by itself for a doctor to make this decision on in an emergency.”

The tattoo, of course, is just a backup: Tomkins has a living will that says the exact same thing.

Of course this is all speculation, but what if you went to start CPR. You exposed the sternum to find that tattoo. What exactly would you do? Yeah, I know. It’s not a binding legal document. But, how would you feel if you were proceeding with life-saving measures to discover that when this patient was of ‘sound mind’ she did not want to be resuscitated?

Of course I’m over-simplifying things!

But it sure does make you pause doesn’t it?

How safe is your hotel safe?

2011-09-08T16:38:00.001-04:00

My first job fair | Scrubs – The Leading Lifestyle Nursing Magazine Featuring Inspirational and Informational Nursing Articles

This was rather disturbing since we just got back from a weekend trip where we used the safe for the very reason this video suggests.

We stored our passports as well as credit cards and money while we were out and away.

We are taking another trip, and I will be sure to check the safe for this default password.

Things that make you go hmm..

I was never a 'Barbie Girl' fan in the 90's

2011-09-07T08:35:00.001-04:00

via new.music.yahoo.com

Apparently neither was/is Rolling Stone magazine. Heh heh.
Although I have to admit I found a couple of the songs entertaining in their day (#5 and #8)

Wading in the job fair ‘pool’

2011-09-05T21:08:00.001-04:00

Over at Scrubs I share my experience at my first job fair as an ACNP student! Exciting times lie ahead!

My first job fair

In all my years of professional employment, I’ve never attended a job fair. Not that I wasn’t interested, I’ve just been lucky enough to have a job lined up each time they were appropriate. I already had a job in an ICU 2 months prior to graduating nursing school. I was into my 4th year as an employee when I graduated with my BSN. So up until now they really didn’t make much sense for me.

Fast forward to the present. I’m just completing my first year in my ACNP program with 4 more semesters to go (yes, there is a faint light at the end of the tunnel). While I’m a little bit ahead of slope, I thought I’d attend the job fair that was offered recently just to see what to make of it. I must say, prior to making my way there, I was actually quite nervous?? Not sure why, since I’m not even close to that stage in my new role!

In my current ACNP program we had the unique opportunity to attend a job fair geared for physicians. It seems to be the new trend in health care since the allied health care professionals, sometimes called physician extenders are being utilized more and more in a wide variety of settings (PA’s & NP’s)

It was surreal to be walking amongst the ranks of physicians. Once again I’m still getting used to this new advanced role (not that I’ve even got my hands dirty yet!).

This particular fair you could pre-register and upload your CV and/or resume via their website. They also had the option of bringing them with you.

The fair was a smörgåsbord of gifts, sales pitches, shoulder rubbing and networking! Everything and anything was on the plate. It was a pleasant surprise to see so many recruiters excited and interested in potential Nurse Practitioner hirees! I was overwhelmed by the positive feedback and encouragement all the recruiters showed, not to mention all the cool gadgets and free pens (you know how we nurses like our pens)!

The purpose of me attending a job fair an entire 18 months too early was just to learn what to expect from one of these shindigs, get a sense of what employers are looking for, get my name out there, and ultimately start the career ball rolling as soon as possible.

Mission accomplished.

I learned a couple things about job fairs:

Come prepared with a sense of what you are looking for. ( I honestly wasn’t)

Ask and answer as many questions as possible. (ask specifically about the job and all it entails)

Sign up for any and all lists that are offered – can you say networking?

Don’t be shy – enjoy the free stuff while it lasts!

Be careful – some recruiters can be like used-car salesmen/saleswomen (need I explain that one?)

I must say, after this experience I am even more excited to get my hands dirty and jump head first into my advanced practice career. The sky being the limit isn’t just a saying anymore!

How Sports Medicine and Nursing are similar

2011-09-05T06:22:00.001-04:00

via nytimes.com

“They watch ‘Grey’s Anatomy’ and think we can do anything,” said Dr. Raymond Monto, a sports medicine orthopedist in West Tisbury, Mass. “And to a certain extent, we allow that.”
Added to that is the effect of sports stars and their doctors. Patients “see a high-profile athlete and say, ‘I want you to do it exactly the same way their doctor did it,’ ” said Dr. Edward McDevitt, an orthopedist in Arnold, Md., who specializes in sports medicine.
The result is therapies that are unproven, possibly worthless or even harmful. There is surgery, like a popular operation that shaves the hip bone to prevent arthritis, that may not work. There are treatments, like steroid injections for injured tendons or taping a sprained ankle, that can slow the healing process. And there are fads, like one of Ms. Basle’s treatments, P.R.P., that soar in popularity while experts debate whether they help.
All this leads Dr. Andrew Green, a shoulder orthopedist at Brown University, to ask, “Is sports medicine a science, something that really pays attention to evidence? Or is it a boutique industry where you have a product and sell it?”
“For a lot of people it is a boutique business,” he said. “But are you still a doctor if you do that?”

Odd that this field of study is still trying to prove itself and fight the ridiculous preconceived myths of their chosen specialty.
This was an interesting article. Especially since my pre-nursing career was in sports medicine!

Things that make you go hmm.

Back to school essentials

2011-09-05T06:07:00.001-04:00

Any questions?

What is so important about 10 lbs?

2011-09-03T17:16:00.001-04:00

I’m knee-deep into studying. I’m reviewing some differential diagnostic literature.
Here’s the concept:

“Unintentional weight loss > than 10 lbs can signal an underlying (pathologic) condition”

I’m not here to squabble over what this ‘red flag’ can or cannot indicate. This is not a new ‘concept’ for me. Whether it was ‘Nursing 101’ or not… I’ve understood this ‘standard’ red flag for quite some time. What I’m curious about now is – why 10 lbs?
Who decided that 10 lbs was enough? Why isn’t it 5 lbs? Or maybe 15 lbs?
Heck, we could discard the 5 lb incremental system and shoot for 8lbs? or say 12 lbs?
I guess I’m curious about the ‘why’. Why 10 lbs? (I mean X does mark the spot – doesn’t it? Heh heh)
Just some food for thought. Heck, maybe someone out there has the answer?

Everytime I hear the word Dentist...

2011-09-01T19:58:00.001-04:00

http://www.gregfrewintheatre.com/

This is what I think of. A big thanks to Bill Cosby for making my childhood extremely entertaining.
After watching this video, I realized that the younger generation would not really appreciate this skit, since the Dentist doesn't even use the spit bowl anymore.
This stand up performance is still one of my all-time favorites.

Oh. By the way, I've been to the Dentist recently.

Cravin' my coffee

2011-09-01T15:11:00.001-04:00

This whole 'decrease your coffee' intake adventure is not going well. I've made the vain attempt to drink Green Tea in the afternoon when I'm 'JONESIN' for a cup'o Joe. Up until now, it's been OK. I mean Green Tea just doesn't taste the same.

-*humpf*-

Now that I spend my afternoons doing some studying or some form of schoolwork – I associate the scholarly activities with …… COFFEE!

I don’t know if it’s the taste I miss?

Maybe it’s just the smell?

I mean I do ‘doctor up’ my coffee with flavored creamer (French Vanilla).

(Insert loud & child-like moan and groan)

Help.

☺

A horrificly vengeful naughty nurse - is still a naughty nurse.

2011-09-01T06:16:00.001-04:00

Such imagery, which we call the "naughty-axe," unites the profession's naughty and battle-axe images into one unsavory package of sex and violence, and so it suggests that nursing is all about mindless feminine extremes, rather than life-saving work for skilled professionals of both genders.

via truthaboutnursing.org

It truly is a shame that the public still doesn't grasp the concept or understand the frustration we nurses have every single time this ridiculous stereotype is used - in no matter what context.
Sorry folks, having the 'naughty nurse' as a vengeful murderer sure doesn't help the overall image of our career.

Ahh, the battle continues.

What does it take to be successful?

2011-08-31T22:09:00.001-04:00

via vimeo.com

Very hard for me to add anything to this video, that isn't already expressed.

Desire to breath = desire to succeed

Go get it.

Smoke-free colleges

2011-08-31T21:21:00.001-04:00

via cnn.com

Another awesome step towards a healthier U (as in University).

It may only be a baby step, but it's still a step forward and not backward. Or better yet standing still watching.

Our weekend awa(y)cation to Niagara

2011-08-28T19:32:00.001-04:00

We wanted one last 'hurrah' for the summer before the fall semester started up for me. So we decided on a weekend to Niagara Falls. Since we actually possessed passports (from our Saint Thomas trip) we decided to hop on over the border to Canada.

Wow!

It was awesome.

We drove up Friday. Checked in to our (ridiculously large) hotel room.

We booked some seats at a local magic show, so we didn't get too comfortable.

The magician was Greg Frewin:

Now, I'm no stranger to magic and the illusionist - but this was my first time seeing any of that live!

It. Was. Awesome…. To say the very least!

He had a handful of acts that included different sizes of tigers (woah). He was quite the entertainer. We were both very happy we decided to add that to our itinerary.

Saturday was all about our bus tour. A bus picked us up at our hotel and took us around town to all the main attractions:

Whirlpool Rapids and Journey Behind the Falls

Butterfly Conservatory

Maid of the Mist

Niagara's Fury (this was a 3D ride on the creation of the falls)

Floral Clock

It was all pretty darn awesome to say the very least.

No one told me that Niagara Falls, CA was a mini-vegas type atmosphere?!

Oh yeah, we finished the weekend off by visiting the Ripley’s Believe it or Not museum.

Very cool.

So close - yet so far away...

2011-08-28T13:39:00.001-04:00

Hard to believe that next school year I will get to check that lil’ box!!!

Prosthetic Athleticism - Fairness and Equality?

2011-08-28T11:21:00.001-04:00

Editor's note: Dr. Ford Vox is a medical writer and neuro-rehabilitation physician. He is the medical director of Brain Injury Rehabilitation at New England Rehabilitation Hospital and clinical assistant professor of Physical Medicine and Rehabilitation at Tufts University School of Medicine.

Boston (CNN) -- A man born without functioning legs ran the 400 meters in 45.07 seconds on July 19, 2011, the fastest time recorded by an amputee. The ripple effects of this historic achievement may initiate a paradigm shift in how we view our bodies.

That's because any time under 45.25 seconds is good enough to earn a spot in the London Olympics next summer, and the July race qualified 24-year-old Oscar Pistorius to represent the South African track team in the World Championships in Athletics starting Sunday with the 400 meter heats in Daegu, South Korea.

Pistorius will need to run one more time under 45.25 seconds in the first half of 2012 before finally earning his spot in the Olympics, and at this point most observers believe he will make it.
...

via cnn.com

This was a great conversation about society's views of prosthetic athleticism. Interesting and thought provoking to say the least.

Apixaban: The anticoagulation debate continues

2011-08-28T10:40:00.001-04:00

PARIS -- Compared with warfarin treatment, atrial fibrillation patients treated with the investigational factor Xa inhibitor apixaban had fewer strokes or embolic events, fewer major bleeding events, and were less likely to die during an average of almost two years of treatment, researchers said.
Those results emerged from the 18,201-patient ARISTOTLE study, which was published online today by the New England Journal of Medicine.

It seems promising, but the adherence monitoring is still an issue. And of course the $.

Ergo why Warfarin is still the 'standard'.

Swing and a miss..

2011-08-28T09:54:00.001-04:00

Irene’s path and strength luckily was not enough. It did not make it too far inland. Hope all my east coast folks are doing well.

Terrain picture brought to you by Wunderground.

Half of Americans Obese by 2030

2011-08-26T06:18:00.001-04:00

If the current "obesity epidemic" continues unchecked, 50% of the U.S. adult population will be obese -- with body mass index values of 30 or higher -- by 2030, researchers said.
Drawing on data from the National Health and Nutrition Examination Survey (NHANES) series from 1988 to 2008, Y. Claire Wang, MD, of Columbia University's Mailman School of Public Health, and colleagues projected that, compared with 2010, there will be "as many as 65 million more obese adults" in the U.S. by that year. ...
An important finding was the rising burden of obesity among people 60 and older, the researchers emphasized. Of the 65 million additional obese people projected in the U.S. in 2030, 24 million would be in this age range. This population -- already the sickest and most expensive in terms of medical costs -- is the fastest-growing in the U.S. and Britain. Therefore, the overall disease burden and economic effects of obesity may be magnified. In addition to their caveat about extrapolating trends into the future, Wang and colleagues cited other limitations to the study: methodological issues related to the NHANES and HSE surveys; uncertainties in the relationships between obesity, other diseases, and economic impacts; and the study's 20-year timeframe, which may underestimate future impacts of pediatric obesity.

So you want to advance your career? | Scrubs Magazine

While thee actual definition of 'obese' is still under scrutiny, the alarming relationship between our overall health and our weight is not something we can simply keep ignoring.

We are getting more sick. What is disheartening is that it is almost all preventable.

OH-KAY. Is someone trying to tell us something?

2011-08-24T21:17:00.001-04:00

Here are the headlines over the past couple days:

Dangerous hurricane Irene threatens Northeast

East Coast quake cracks Washington Monument stone

7.0-magnitude earthquake strikes northern Peru

And finally....

Steve Jobs Resigns as CEO of Apple, Tim Cook Named as Successor

Jus' sayin' folks. Jus' sayin'.

Advancing your nursing career

2011-08-24T17:14:00.001-04:00

An article I posted over at Scrubs Magazine. While the choices may seem endless and confusing, which path you choose can be a very simple decision.

So you want to advance your career?

I think I’ve said this before. One of the greatest things about our career is the unlimited supply of choices and opportunity. The path our career takes is only limited by ourselves and our desire to move forward.

So would you be the least bit surprised by the unlimited number of choices a nurse has when it comes to picking a direction for an advanced degree? No, of course not. Advancing your nursing education is not as simple as “I’m going on to get my Masters degree in Nursing.” You have to pick a path as an advanced degree nurse.

Here are just a few of those options:

Advanced Practice Nursing

Nurse Practitioner (Adult, Acute Care, Neonatal, Family)

Nurse Midwife

Nurse Anesthetist

Nurse Educator

Clinical Nurse Specialist

Nurse Manager (Nurse Leader)

Nursing Informatics

Masters in Nursing specialty in:

Acute care

Adult

Family

Geriatric

Neonatal

Palliative care

Pediatric

Psychiatric

Obstetrics and Gynecological

Now throw all that into a bowl and add a dash of PhD and/ or DNP (Doctorate of Nursing Practice) and you got yourself a confusing swirl of opportunities just waiting for the picking!

Yes. It seems overwhelming enough to cause a slight headache, but when you break it down into it’s most simple forms, you can see the light at the end of the tunnel.

When I finished my BSN (I did an RN -to-BSN program) I knew I wanted to continue on and advance my degree. I just wasn’t quite sure which direction to choose? What if I choose wrong? What if I change my mind? What’s the best decision? What’s the most profitable? Which path takes the longest amount of time? Which path takes the shortest amount of time?

These questions and many others all have their relevance. They really do. The problem is, none of them are as important as this question:

Where do you see yourself practicing (in 5 years), where it would NOT be considered a job?

…

That’s really what ultimately guides you onto your next adventure. Of all those choices, which one could you do on a daily basis and not consider it your ‘job’? Where do you feel you make the most impact?

Let’s put it another way. In your current practice as a nurse – where are you most happy? And does that happiness elicit the most ‘effect’ to the patient’s you care for? For me, it’s always been Critical Care. I’ve felt the care I give at the bedside makes the most impact on my patients. I’m not meant to work in an office. I’m not meant to care for the ‘not well’. I’m meant to care for the critically ill. It’s where I am most happy. I love making the difference we make. I want to take that feeling and extend it. I want to expand my skills and knowledge. I want to advance my care where I know I’ll be happy, and where I know I believe I’m needed.

One final thought on those myriad of choices you can make when considering an advanced degree. I would HIGHLY recommend you ‘shadow’ someone already doing the job. I remember shadowing a CRNA when I was trying to make my decision on advancing my career. I small part of me wondered if being a Nurse Anesthetist is something I want to do. After shadowing the CRNA I realized that it wasn’t something for me.

In the end, the choice to advance your career is all about you. Don’t let the naysayers or the recruiters try and sway your choices. As a nurse, we tend to deliver our care from our hearts. Let your heart help you make this decision.

Body Health Quakery - Nausea Prevention?

2011-08-24T10:52:00.001-04:00

If you're prone to motion sickness, need some morning sickness relief, or are dealing with nausea for another reason, try this quick acupressure technique.

Preventions writes that this health trick has been shown in 40 studies to effectively reduce nausea from motion sickness. The technique is to:

Press between the two tendons on the inside of your wrist, about three finger breadths below the base of your palm

Healthy and sustainable living blog WakoWa Salon advises you relax your arms and shoulders while doing this. Try it for about 30 seconds and you may feel immediately better, but some people may need several minutes. This technique may also help relieve anxiety.

You could buy a wrist band with a button designed to apply pressure to this point, but this is a quick trick you can apply whenever nausea strikes.

via lifehacker.com

I'm not one to discredit any intervention that could help relieve discomfort - especially nausea! But, I'm not one to believe this technique would actually work, or be the least bit effective.

This is also coming from a health care professional who takes care of those who experience nausea for specific reasons (most of the time). Maybe it works in other instances.

I'm open for the possibility since, up until recently, I thought that taking (or drinking) 'Ginger' would stop motion sickness. I witnessed first hand that Ginger was the end-all-to-be-all cure for motion sickness on a boat.

Crazier things have happened.

Walking & gaining weight?

2011-08-19T09:42:00.001-04:00