In Our Own Words: Medscape Nurses

Same blog, but we are in the process of moving to a new site. You can find new posts at:

http://blogs.medscape.com/nurses

 

Please check it out today.

I have been having interesting online conversations with fellow patients diagnosed with dystonia about the use and effect of spirituality and faith on chronic disease and illness. Most of us with dystonia realize that a cure is a long way off, especially with NIH funding cuts. Personally, I don’t expect a cure for my dystonia during my lifetime. I expect only the reality of dealing with a complicated, complex, disorder marked by misfiring neurons of unknown origin!

I believe that healing prayer can be effective for physical issues, mental/emotional issues, and spiritual issues. Too often, people are looking for only the instantaneous and complete healings that Jesus performed. To be sure, those kinds of healings still occur today. But they seem to be just as rare now as then. It’s more common to see gradual healing, often in conjunction with traditional healing methods like medicine, surgery, and counseling. Just keep in mind that healing is the work of God, done by his will. No one can control it. We can only position ourselves -- or others -- to receive it, and then ask. And we should not be surprised if we ask for one type of healing, such as physical, and receive another, such as spiritual.

_However, I have never been asked by a patient or their family to pray with them in the ICU setting. Have you?_ This shouldn’t be a surprise for a simple reason. Western medicine in particular has been relatively single-minded in its approach to healing, focusing primarily on the body -- and even just parts of the body -- for physical healing. But as healthcare advances, a more holistic approach to healing is emerging. The relationship among body, mind, and spirit is becoming clearer.

_As the acuity of patients rises, will the use and power of prayer increase? Should we, as nurses, encourage the role of prayer in healing and comfort? What about our own beliefs? Do miracles occur in medicine today? I’d love to hear your thoughts on this topic._

Quote: _"Find out about prayer. Someone must find out about prayer." (_Albert Einstein)

RELATED RESOURCES Primum non nocere (First, Do No Harm): Prayer, Culture, and Evidence-Based Practice

Intercessory Prayer for the Alleviation of Ill Health

I just read some interesting articles about hourly nurse rounding. Hourly rounding was described as the nursing practice of regularly checking on patients needs using the 4 Ps — positioning, personal needs, pain, and proximity of personal items such as the call light — with the promise to return in 1 hour. I recall performing hourly rounding on the night shift over 20 years ago when I was just beginning my career as a new, young, inexperienced graduate. It worked! At the time team nursing was also in vogue. _I wonder if we need to return to this practice?_

How many times have we found an unresponsive patient at 4 am, when we last saw them joking to us at 12 midnight? Our time now seems to be preoccupied with individualized care plans, transfers and admissions, bed shortages, and electronic documentation rather than actually visibly seeing our patients on an hourly basis.

Of course, a major difficulty is how to establish a work-day design that actually makes hourly rounding possible. This might be a particular problem with the nursing shortage today.

_What are your thoughts on hourly rounding? Has your facility implemented this practice and how is it working? Should we return to this practice?_

ARTICLES Collaboration Helps Hospitals Fine-Tune Hourly Rounding Ring for the Nurse! Improving Call Light Management

A Canadian newspaper, the _Globe and Mail,_ released a news story on the infrastructure of aging, crumbling medical centers. They described several scenarios that sound all too familiar to us:

_"Susan Hales hospital bed in Joseph Brant Memorial Hospitals orthopedic wing is pushed against a corridor wall, squeezed between linen carts and orphaned equipment. Cleaning staff maneuver a wheeled garbage bin around Ms. Hales IV pole. Visitors smile awkwardly as they pass, stepping sideway to avoid bumping the family members perched on the edge of her mattress.”_

Sound familiar? One of my best friends used to work in a large medical center in upstate NY, a Magnet-designated facility, and she told me that when their ER was too full, the staff would create patient rooms out of cleaning closets. _Can you imagine being stuck in a closet for a 6-hour ER wait?_ The gist of the _Globe and Mail_ story was the increased outcome of deadly infections among patients within these crumbling walls. Almost all of the medical facilities within the immediate New York City area are aging. Paint peeling, mice scrambling, flies a-flying, tiles disintegrating, and garbage falling out of bins. Infections may very well be on the rise as we encounter more and more crumbing, aging infrastructures. Frightening, isnt it ?

_Do you work in an old and disintegrating or over-crowded building? Have you noticed a rise in infections in your patients? If so, tell us about them._

“There is snow outside the kitchen door. It covers the deck in white sheets, unbroken except for the occasional paw print, and it cascades off the steps in thick, soft layers onto the pine trees in our backyard.” So begins the plight of a first year medical resident in upstate New York. Right away, I was reminded of my own backyard in upstate NY -- the massive snow in the winter and the pine trees that are next to our own house. Shoveling snow often preoccupies our time during long winters!

The journey described by the author took me through his first day as an intern with the help of nurses during an on-call shift. He never would have made it without the assistance and knowledge of nurses. Ahhh -- how these young interns depend on us so much. Some realize it immediately, others don’t realize it until their first medical error arises, and still others never realize the value of nurses during their entire residency_ (or their entire medical careers!)._

_Do you remember your first interaction with green, wide-eyed interns? Share your story with us! (Please alter any names and other identifying characteristics.)_

I just finished reading the book by Sara Bongiorni titled “A Year Without "Made in China": One Familys True Life Adventure in the Global Economy.” The 227-page book describes how a family survived without buying “Made in China “labeled imports for an entire year -- 365 days. The author and her family decided to forgo Chinese factory made sneakers, sunglasses, nails, sheets, household goods, and more. The memoir is wildly humorous, but got me thinking about our economy, especially since watching the Beijing Olympic Games.

How much of the healthcare supplies we use – IV bags, supplies etc, are “Made in China” today?? Anyone ever wonder if they have seen "Made in China" labels on health equipment that we use on a daily basis? I never thought that a global issue like this would hit home. I began scrounging around within my own apartment for items that held the label “Made in China.” My forks did. My flower pots did. My towels held the same label. All "Made in China."

What next? Healthcare systems owned by China?

I am in total surprise that the Joint Commission has decided to focus on nurse harassment and bullying, along with lateral violence in the workplace. We all know that it exists. But, is it the role of a national agency that accredits hospitals and care standards to address this ongoing, worsening problem? Is the Joint Commission going to create a standard of some sort? Will it really be effective in stopping lateral nurse violence? I don’t think so.

I do think practicing nurses need to reassess behavior towards our colleagues. We each are responsible for ourselves. If we can’t act compassionately to ourselves and colleagues, how can we be compassionate to our patients? And what about the role of nursing administrators in enforcing policies against discrimination, harassment, and lateral violence within staffs and units?

_Should punitive disciplinary actions be taken against those nurses participating in lateral nurse harassment or violence? Should they be allowed to continue working as nurses? What are your thoughts?_

The Joint Commission Sentinal Event Alert Behaviors That Undermine a Culture of Safety

Reading the latest news (360 Degree Care) about Sloan-Kettering’s newly developed ICU, I have one key question to ask -- how high tech must we go to give efficient care to patients today? Is rubberized flooring necessary? Do Web cams interfere in patient privacy? (Would you want to be seen weeping on a Web cam with your dying family member?) The article on Nurse.com describes how “Rooms have Web cams to let nurses monitor patients and beds that turn 360 degrees, perform respiratory percussion and vibration, turn and weigh patients, and elevate them to a chair position.” What happened to an aide and a nurse physically getting a patient out of bed, letting them dangle by the bedside, and then stand and walk to a chair? I have not seen this new ICU although there are constant advertisements, "Come Join Us," in nursing magazines for job positions in the unit. But I do like the idea of more room space; there never seems to be enough in any ICU. And I certainly like the concept that nurses had input in designing the unit architecturally. New beds, no manual chest percussion. My arms can get a rest now!

_HAS YOUR CRITICAL UNIT BEEN UPDATED RECENTLY? WHAT WOULD YOUR OPTIMAL ICU LOOK LIKE?_