NURSES CODE OF ETHICS

 

 REMEMBER WHEN IN NURSING

WT LOSS TIPS

WT LOSS TIPS
#1-Keep a diet diary. Write everything down that you put in your mouth, yep that means mints/gum, drinks, everything. Note Net Carbs with ea meal. #2-Wt in Once a Month #3-Keep total daily carbs <20g #4-Walk, Swim or Bike then Do It Again

Nurse’s Report: Observations and Evaluation from a Nurse and Family Member’s View:

Many changes have occurred in my profession over the past 40+ years.  Many have been positive changes resulting in an improved quality of care in various aspects of nursing.  Sadly, however, some changes leave a negative impact not only for patients’ safety and outcomes but for our profession in general.  Nurses stuck to computers and cell phones have become a situation that is out of control and must be changed.  Nurses using diagnostic templates and care guides without incorporating individual patient goals and outcomes has become common place and is completely contradictory to the overall concept and core of nursing: The Nursing Care Plan.   Our profession has essentially removed itself from the bedside and chained the nurse to the desk.

This note comes after observing and caring for multiple family members and friends over the past year while they received care at a local hospital in Broward County, FL.   Since the majority of the observations occurred repetitively and during various admissions it would appear that the nursing culture in this hospital group has changed significantly and sadly, not for the better.  I worked at the facility in question when they first opened and over the past 40 years many friends and family have received care at this hospital. Never have I felt the need to express concern as to the care or lack thereof.   In fact, I constantly boasted to all I knew how wonderful this hospital is and how very much I would recommend it and its sister hospitals.  Now, sadly I hesitate to do so.

First and foremost let me say the nursing staff and most of the physicians in the ER and ICU were superb and the quality of care in these units was without a doubt excellent.   Overall the staff was pleasant and personable however, all the staff we encountered in the last year stated how they hated their jobs, were eager to leave and hated what nursing as a profession has become.  One doctor even stated more than once, "Nursing has gone to hell; they don't do much of anything anymore.  Hospitals will kill you, get out now!"    In all my years I NEVER heard a doctor speak about nursing like this. In all my experiences I have NEVER heard nursing as a profession so disrespected and ridiculed.

Here is but an example of what I have observed more than once based on just three people I know and cared for while in the hospital over the last year with the most recent just this month. 

While in the ER:

The PA and Paramedic both made no effort to clarify to the patient their title and role when the patient called them doctor.  (Lay people need this explained slowly and clearly).

When the RN treating said relative asked the Case Manger for help to find a doctor the reply was “he does not have insurance and I can’t be bothered” (There’s no excuse for this)

On discharge with a large umbilical hernia the patient was referred to a surgeon who only takes private insurance or cash.  When the patient asked for help finding a doctor who would take Medicaid he was told they (the nursing staff) are not allowed to help.  (This is completely contradictory as to how to discharge a patient)

While on Telemetry at IPMC: The following occurred at least twice with both people having the diagnosis of DVT and Bilateral PE:

A RN arrived to the room within 15 minutes of arrival to enter demographic data into a bedside computer.  NO ASSESSMENT WAS DONE

A second RN arrived about 30 later minutes later stating she would be the nurse tending to the patient.  She put on the halter monitor and yet again NO ASSESSMENT WAS DONE.

Neither of the two nurses looked at the affected extremity, evaluated respiratory status, palpated for pulses, assessed hep lock site, took vitals, etc.  (This is beyond comprehension that nurses do not do assessments anymore)

Nurse and PCA's were constantly interrupted by cell phones while at the bedside, which they answered immediately and often abruptly left the bedside to return 30 minutes to hours later.   (This facility uses cell phones to communicate among staff; these should be turned off while at the bedside. This is probably one of the worse practices I have ever seen)

 O2 was knocked off while the patient slept.  The next day it was still off, this went unnoticed.  It was well over 8 hours later when I finally pointed it out to the nurse.  O2 Sat was not checked, the oxygen was stopped.

Not one PCA/NA offered assist with hygiene yet patients were on complete bed rest.   

One nurse came into the room around 2 am and woke the patient to try and discuss doctor assigned to the case! (You don’t wake people at that hour to discuss such things)

Although patients were permitted to use the BSC (without a doctor’s orders mind you) no one bothered to leave toilet tissue and no one came to clean it out. 

On two admissions the nurse tried to state that the patient’s primary care doctor did not go to that hospital and tried to assign a house doctor.  Both patients’ doctors most certainly do go to the hospital in question, I intervened to rectify that issue.   

Tests were ordered which the patient did not understand and subsequently did not want

On the day of discharge, after I mentioned that not one RN did an assessment nor did one Aide offer assistance with hygiene during the entire stay did someone come in to help. 

Again, let me reiterate that the staff was amazingly pleasant and kind however, they did not provide quality nursing care.

In summary, It is obvious nurses need to get back to the basics.  Fundamental care should not be overlooked and pushed aside.

HOUSEHOLD CHORES-ORGANIZED & MADE EASY

HOUSEHOLD CHORES-ORGANIZED & MADE EASY:

The advantages of a clean home are numerous.  No, I don’t mean spotless, Homes & Gardens picturesque clean.  I am talking about one where there are not too many crumbs on the kitchen floor for the baby to eat, where you have clean laundry and bed linens, clean dishes to eat off of, and can take a bath without fear of touching something gross and contagious.  Of course the biggest advantages of a clean home are comfort and safety.   Clean bathrooms and kitchens are actually very important because you don't want to spread germs around the house which cause illness.  Tidy and clean living rooms can help avoid accidents.  Another advantage of following a list or guide is everything that is important gets cleaned on a consistent basis therefore you don't forget something or neglect something too long, generally, to the point where it gets really out of control.

So, let’s begin with the daily clean-up routine.

 

Every morning we get up, put on clean clothes, eat breakfast, dirty a few dishes, etc.  You know the drill.  However, what if one morning we wake up to put on our clean clothes, or eat our bowl of cereal, and there are no clean clothes or dishes?   Our life has been disrupted and we could have avoided this.

How can we avoid disrupting our life?  Simply by making sure that our household cleaning schedule reflects and complements our daily routines and habits.  Actions such as cleaning our dirty dishes  or washing laundry as a load appears or putting things away right immediately, when done as consistently as we use them, will keep our life going in an easy and organized manner.  In other words clean the dishes or rinse and put them in the dishwasher right after you use them.  Don’t wait and let the dirty clothes pile up; it is easy to knock out one load while watching TV.   

When I talk about daily household chores I am not talking about cleaning your house for hours on end each day.  In fact, you will find that using a daily clean up schedule you will not need to clean that long at all and it certainly makes the weekly cleaning a great deal easier and quicker.

The following two lists (daily cleanup and weekly chores list) are only guides, but generally I think these are pretty universal.   Using these list should certainly help keep your home tidy and easier for you to keep clean.

Daily Household Cleanup:

Take out Trash

Make beds

Dirty Clothes Control:  Place dirty clothes in laundry baskets, not tossed around the house and wash a load when you can.

Tidy as You Go:  Make sure to put things where they belong, don’t let things pile up in one spot. It is harder to clean up a huge pile later on.  Toss out anything you no longer want rather than let it pile up for later. In other words, tidy up as you go.

Bathrooms:  Daily bathroom cleaning beats weekly scrubbing of scum and old pee any day.  Bathrooms are one of the dirtiest places in the house.  They should be done at the very least once a week if not more often.  Here's an easy way to keep the bathrooms manageable and always clean.  Be sure to keep Clorox wipes under the sink or next to the toilet on the floor.  Once you and your partner both get into this habit you will see how easy it really is. It takes all of a few minutes and poof, the only thing left weekly in the bathrooms will be the floors.

General Bathroom Area:   The idea here is that each person in the home chips in and does this at least once a day so let’s say after a BM.  Put those Clorox wipes left in the bathroom to good use.  Wipe down the toilet well making sure to lift the toilet seat, wipe well around all parts of the seat and around the base of the toilet too.  Wipe down counter and fixtures with a new wipe.

Shower & Tubs:  Use shower to shower or similar item with each shower.  Assuming you sprayed the shower after your last visit and left the product on all surfaces.  Keep a toilet brush in the corner of the shower and while standing in there scrub the walls and tub well.  Use the handheld shower head to rinse all surfaces then spray with shower to shower on exiting.   If all parties do this daily it takes just a couple minutes and no scum will build up.

Kitchen:  Clean up kitchen after meals including using Clorox wipes on all counter surfaces and cabinets handles.  Sweep up crumbs on the floor.  Run and empty dishwasher as needed.  Every time you go into the refrigerator get in the habit of looking for outdated items and toss them, keep it tidy and wipe any spills right away.  Every time you go into the pantry, put things back where they belong and keep it tidy.  These quick steps will go a long way to help avoid huge, hour upon hour cleaning later on.  Quick tip to help keep cabinets doors clean--as you stand there waiting for something to boil or bake, wipe down the cabinet doors. 

Garage, Patio & Grill:  Between each monthly maintenance of these areas just keep them tidy and cleaned up with each use.  

Brush Pets: This may need to be done daily with long haired pets and it may suffice to do it biweekly. Adjust your schedule accordingly.

Keep a Shopping List:  Check paper products and cleaning supplies as you go and keep a list. Each time you go into the pantry or refrigerator note items you will need.  It is much easier and quicker to keep a list going than to try to see everything you need right before you want to go shopping. This also helps to keep the spending under control as you will shop according to what you need rather than impulse shop.

WEEKLY HOUSEHOLD CHORES:

Side Note on Pets: The number of times each week the floors will need to be done is dependent upon the number of pets in the home and if they shed a lot or a little.  Some homes will need to be vacuumed and mopped daily while others can easily be done biweekly. It is highly recommended that floors in homes with pets be swept at least twice a week and mopped at least weekly. 

Monday –

Wash bed sheets.  

Dust upstairs.  Sweep, vacuum and/or mop upstairs and steps-Pet hair loves to congregate in the corners of steps so be sure to vacuum stairs well. 

Tuesday –

Laundry as needed (don’t forget those nice hand towels in the guest bathroom). 

Pay bills as needed. 

File as needed, etc.

Dust downstairs.

Sweep, vacuum and/or mop downstairs floors.   

Groom pets as needed.

Wednesday –

Clean bathrooms-If you follow the daily suggestion the bathrooms will be pretty much clean, just wipe up as needed and mop the floors.

Clean Kitchen- If you follow the daily suggestions the kitchen will be in order and pretty much clean, just mop and scrub floor and flush disposal drain with vinegar.

Thursday –

Laundry as needed

Friday-

If you have a pet/s, repeat floor cleaning in the area the pet/s reside the most.  

Saturday –

Sunday –

Grocery shop

Cook and portion meals for the week

   Laundry as needed

   Lawn and yard work as needed

See monthly and annual maintenance schedule too

YES-VACCINATE: Importance of Vaccinations

YES! VACCINATE!

Most parents want to do what is best for their children.  They understand the importance of car seats, baby gates and other ways to keep children safe. But, one of the best ways to protect children is to make sure they have all of their vaccinations.  When people place the majority of the public at risk because of their own personal misinformed beliefs rather than proceed according to expert recommendations then they should be held accountable for endangering the lives of our kids and the public in general.

Vaccinations have reduced the number of infections from vaccine-preventable diseases by more than 90% yet many parents still question the safety of immunizations because of misinformation they received. (See below for further details on misinformation.)   

Immunizations have helped children stay healthy for more than 50 years. They are safe and they work.

Immunizations can save your child’s life. Because of advances in medical science, your child can be protected against more diseases than ever before. Some diseases that once injured or killed thousands of children, have been eliminated completely and others are close to extinction– primarily due to safe and effective vaccines.

Immunization protects others you care about. Children in the U.S. still get vaccine-preventable diseases. In fact, we have seen resurgences of measles and whooping cough (pertussis) over the past few years. In 2010 the U.S. had over 21,000 cases of whooping cough reported and 26 deaths, most in children younger than 6 months. Unfortunately, some babies are too young to be completely vaccinated and some people may not be able to receive certain vaccinations due to severe allergies, weakened immune systems from conditions like leukemia, or other reasons. To help keep them safe, it is important that you and your children who are able to get vaccinated are fully immunized.  This not only protects your family, but also helps prevent the spread of these diseases to your friends and loved ones.

Immunization protects future generations. Vaccines have reduced and, in some cases, eliminated many diseases that killed or severely disabled people just a few generations ago. For example, smallpox vaccination eradicated that disease worldwide. Your children don’t have to get smallpox shots anymore because the disease no longer exists. By vaccinating children against rubella (German measles), the risk that pregnant women will pass this virus on to their fetus or newborn has been dramatically decreased, and birth defects associated with that virus no longer are seen in the United States. If we continue vaccinating now, and vaccinating completely, parents in the future may be able to trust that some diseases of today will no longer be around to harm their children in the future.

Let's take a closer look at a couple of examples:

VACCINE PREVENTABLE DISEASE: PERTUSSIS (Whooping Cough)

Infants too young to be fully immunized remain most vulnerable to severe and fatal cases of pertussis.

What is pertussis?
Pertussis, also called “whooping cough,” is a very contagious disease caused by bacteria (germs). Pertussis is usually mild in older children and adults, but it often causes serious problems in very young children (i.e., infants less than one year of age).

How is pertussis spread?
The germs that cause pertussis live in the nose, mouth and throat, and are sprayed into the air when an infected person sneezes, coughs or talks. Other people nearby can then inhale the germs. Touching a tissue or sharing a cup used by someone with pertussis can also spread the disease. The first symptoms usually appear about 7 to 10 days after a person is exposed. Infants often get pertussis from older children or adults.

Who gets pertussis?
Pertussis is most common among infants less than a year old, but anyone can get it. Pertussis can be hard to diagnose in very young infants, teens and adults because their symptoms often look like a cold with a nagging cough.

Is pertussis dangerous?
It can be, especially for infants. Pertussis can cause breathing problems (apnea), pneumonia, and swelling of the brain (encephalopathy), which can lead to seizures and brain damage. Pertussis can also cause death (rarely), especially in very young infants.

Can pertussis be prevented?
Yes, there is a vaccine to prevent pertussis. It is given along with diphtheria and tetanus vaccines in the same shot (called DTaP or Tdap). Five doses of vaccine, given in a series starting at 2 months of age, are needed to protect a child from pertussis. An adolescent and adult booster vaccine is recommended for persons 11-12 years and older. The vaccine works for most children, but it wears off after a number of years.

In CA. Sixty-six of the hospitalized cases to date this year (June 2014) have been in children 4 months old or younger. Two infants have died so far. Health officials point to a lack in immunizations, waning immunity and more aggressive detection as reasons behind the spike in whooping cough cases. There's 313 documented cases thus far this year in Fl. which is up 112 for the same time period last year.

POLIO
A resurgence of polio in the Middle East and Africa has sparked a dire warning from public health officials, including U.S. experts who fear the deadly virus is just a plane ride away.

Childhood vaccines eliminated polio from the U.S. in 1979, and are still used today to prevent new infections. But more and more parents are delaying vaccines or skipping them altogether, leaving their children vulnerable to deadly diseases.

MEASLES, MUMPS

Just this year (2014) the U.S. has seen a spike in measles cases, even though the virus was wiped out more than a decade ago. Mumps is also on the rise, and the first U.S. cases of MERS emerged recently.

CDC (2014): Measles cases in USA hit 20-year high

Ninety percent have been among people who have not been vaccinated or have unknown vaccination status.

MISINFORMATION and CONTROVERSY 

The MMR vaccine controversy centered around the 1998 publication of a fraudulent research paper in the medical journal The Lancet that lent support to the subsequently discredited claim that colitis and autism spectrum disorders could be caused by the combined measles, mumps and rubella (MMR) vaccine.  

FURTHER READING:

Study Linking Vaccines to Autism Is “Fraudulent”                   http://healthland.time.com/2011/01/06/study-linking-vaccines-to-autism-is-fraudulent/

The Dangerous History of Anti-Vaccine Conspiracies

  http://www.weather.com/health/just-prick-origin-and-evolution-anti-vaccine-movement-20140228

RESOURCES: 
CDC 
AAP
Healthy Children
USA TODAY MAY 29, 2014

NURSING HISTORY: THE NURSE’S CAP

NURSING HISTORY: THE NURSE’S CAP

When people think of the history of nurses, many still visualize a white uniform, white stockings, thick white shoes and of course the often heavily starched white cap.  History buffs may remember pictures of nursing caps while many older nurses may very well still own theirs.

Being capped symbolized accruing the knowledge and ability needed to truly serve as a nurse. Capping ceremonies were often emotional affairs with guest speakers testifying to the value of nurses within their communities. As one speaker at a 1938 graduation powerfully expressed, “the nurse’s cap means to you what the soldier’s uniform means to him. When this cap is pinned on your head, it means you have become a member of one of the noblest professions and have subscribed to its ideals of service. You are no longer merely an individual responsible for her own acts; you are part of the nursing profession.”

Nurses’ caps had both practical purposes and symbolic significance. Though it’s difficult to pin down an exact time period when wearing caps became standard practice, there is a consensus that they became prevalent in the mid-1800s.  The nurse’s cap originated from a group of women in the early Christian era, called Deaconesses, an order of nuns. These women were separated from other women during this time by their white covering worn on their head. This particular head covering was worn to show that this group of women worked in the service of caring for the sick. Originally, the head covering was more of a veil, but it later evolved into a white cap during the Victorian era. It was during this era that “proper” women were required to keep their heads covered. The cap worn was hood-shaped with a ruffle around the face and tied under the chin. Long hair was fashionable during the Victorian era, so the cap kept the nurse’s hair up and out of their face.

The nurse's cap was derived from the nun's habit and developed over time into two types: A long cap, that covers much of the nurse's hair, and a short cap, that sits atop the nurse's hair.  Different styles of caps were used to depict the seniority of the nurse, the frillier and longer the more senior the nurse.

Since nuns were among the first women to be trained as nurses, and to train nurses in turn, the original caps were akin to habits. Social mores of the time also necessitated the caps, since women were expected to keep their heads covered, yes even indoors. These longer caps served more than just the dictates of fashion; they also helped to keep a nurse’s hair out of her face as she worked, which facilitated more sanitary conditions.

For Florence Nightingale the cap was inextricable from the profession itself. When she organized a mission of mercy to Scutari during the Crimean War, Nightingale required her nurses to wear a special uniform and nurse’s cap. After the war,she set up the Nightingale Training School at St. Thomas’ Hospital; there, the longer, more bonnet-like caps were shunned, and students wore shorter caps with their uniforms.

In many ways, the history of the nursing cap correlates to the history of women’s social advances. As time passed and long hair was no longer required by fashion, etiquette, or custom, the caps served as signifiers for a particular nurse’s educational background and level of expertise. Different nursing programs and hospitals offered their own caps: some caps were ruffled and frilled, others were starched stiff and box-like; some were Dutch-styled,winged caps, others looked like knotted kerchiefs. For instance, if you were a patient in the early 1900s, and the woman checking your pulse was wearing a cap delicately fluted with lace, you knew that you were in the capable hands of a graduate from the University of Maryland School of Nursing. This cap was called “the Flossie” in honor of Florence Nightingale.

Though caps were beautiful to behold, they were cumbersome to care for.  Great care was taken in washing, starching of some and maintaining its original appearance.  Some caps had to be continually replaced, at expense to the nurse herself. Still, the cap was symbolic, a sign of great achievement and status and eagerly desired by generations of nurses to come.  Caps also provided a sense of community and belonging. No matter where a nurse worked, seeing a cap from ones’ own school provided a sense of familiarity and ease.

Caps were bestowed in various rituals.  Student nurses were usually expected to wear a simple cap, no stripe or pin, as part of their uniform.  It was not until the student achieved post-probationary status or senior level status or graduated (dependent upon the school) that they earned the rite of passage known as a capping ceremony. Capping ceremonies were often held in churches, where, before the students’ friends, peers and families, they’d be “capped” by an instructor or by a mentor usually referred to as a “big sister.”

But as women in general become more enfranchised and empowered in the workplace, the nursing profession expanded into administrative areas and caps became relics .  Caps, once thought of as the epitome of nursing achievement, quality and sanitary care gradually disappeared, now seen as harbingers for bacteria and other harmful contaminants.

Although the nursing cap is no longer required as a part of a nurse’s uniform, it still holds the same significance that it did during the time of Florence Nightingale. The nursing cap symbolizes the goal of nurse, which is to provide “service to those in need.”  Furthermore, the cap is a sign of the industry’s ageless values of dedication, honesty, wisdom, and faith. (Catalano, Joseph T).

"Today one is more likely to find nursing caps in hospital and nursing historical societies but, one should remember that for many it is still a powerful reminder of hard work and achievements as well as dedication to our patients and our chosen profession and although I may no longer wear my cap I most certainly earned it and am proud to have done so." (dcs)

References:
Image, Function, and Style:A history of the nursing uniform. AJN, 104(4):40-48, April 2004.

Catalano, Joseph T. NursingNow: Today's Issues, Tomorrow's Trends. 6th ed. Philadelphia, PA: F.A. Davis,2012.