Grand Rounds from a surgical suite

Another excellent edition of Grand Rounds. I've been waiting all weekend for this. With this oppressive heat at its height in MI today, it will be the perfect way to spend down time inside the A/C. Grab an iced tea and enjoy!

Nursing in Israel

To say the proverbial deck is stacked against this male, Arab nurse in Israel would be a grievous understatement. Given the current events in the Middle East, specifically between Lebanon and its neighbor, Israel, I found this recent AJN article most interesting.

In the article, written by an Arab nurse who was assigned to the direct care of Ariel Sharon during his first CVA in 2005, he writes about how he came to be a nurse. Believe it or not, it was racism that funneled him towards this profession. Nursing, he says, is a profession that is not considered a "security risk" to the Nation of Israel. Arabs in a Jewish state, he claims, are not allowed to enter into high-tech or military vocations for the very reason they are Arabs and could pose a security risk to the nation.

The irony is inescapable. As an Arab nurse, he ended up caring for the Jewish Prime Minister of the very country that has deemed his ethnicity a "security-risk."

The well written article ends with this quote:

I don't see Sharon as my enemy, although Israel does not always see Arabs as friends. Fighting stereotypes is what I do almost every day, whether it is prejudice aimed at me as a man in a traditionally woman's profession or as an Arab living and working in Israel. I am helped in this by the principles of nursing, which emphasize patience and tolerance toward others, without regard to race, religion, sex, or nationality.

Whatever your feelings about the current situation between Israel and Lebanon and who may be at fault, this article reminds me that I have chosen a profession that proudly alienates itself from racism and prejudices of any sort.

I am reminded of my colleagues in Iraq who daily provide superb nursing care to both Americans and Iraqis (friendly and the enemy alike.) But when they put their stethoscope on a patients chest to auscultate lung sounds, they do not hear ethnicity or even political affiliation. They hear a universal sound, the movement of air through human lungs.

Another great edition of Change of Shift

I am honored to be included this week. If you have ever considered submitting a post-Just Do It! Its the broad spectrum of opinions and viewpoints, stories, and experiences that make it such a great medical web log carnival.

Grand Rounds is Up

This weeks Grand Rounds is up and a Medical Humanities blog is hosting. Very interesting to look at healthcare as an art aiken to gardening vs. always looking at it through the lens of warfare. Enjoy!

Warm and Fuzzy aka Bedside Manner

During my weekly perusal of some of my favorite blogs, I came across an interesting post from GruntDoc. He discusses a particular experience as a patient himself that gave him pause to consider bedside manner, including his own. Its worth the full read, but I wanted to quote him on one item in particular, "However, Derm's lack of any appreciable bedside manner has me reevaluating one of my longest-held beliefs, that people don't really care if their doctor has a great bedside manner, but only really want a doctor who is very competent and does the job right." excerpt from gruntdoc.com July 19, 2006 post.

It struck me as interesting that in my recent meetings with docs, my warm fuzzy side does need a bit of hand holding. When it doesn't happen and I begin to introspectively wonder if its me, my intellect steps in. I remind myself I am, in fact, only there looking for this particular physicians wisdom, skill and knowledge. I am not looking for interpersonal relationship pointers or positive affirmations.

It is interesting to me that patients will let it slide when a doc doesn't demonstrate the warm and fuzzy, but when a nurse won't give it up...look out! It has been my observation that patients demand both from a nurse. They look for, if not require, skill and good bedside manner. Patients are much more apt to complain about their nurses when they don't get a balanced mix of both. Most nurses I know sense this need from their patients and oblige this unspoken request. On a final note, think of the "bad nursing" stories you've read or heard. How many of those situations could have been made better or eliminated altogether with a change in the nurses disposition?

Its just an MRI

I've determined I am not a good patient and that is probably what seasons my compassion as a nurse. I can honestly empathize with patients who have anxiety about the medical setting and procedures, because I do too.

I am scheduled for an MRI tomorrow morning, at 0720 (way too early). My options were 0730 or 1930. I chose the morning because I didn't want the whole day to think about the impending test.

This is silliness. Its an MRI not a spinal tap! Its painless, a little noisy, and only 60min. in length. As I was lying in the tanning bed this morning (I know I shouldn't fake bake but Im scary pale if I don't) I tried pretending I was on an MRI table, I think I made it less than a minute w/o moving...this is gonna be tough for me. Amazingly, its not the small space, its not being able to move....

They called to pre-register me yesterday. The receptionist informed me I can't bring a CD because their CD player is broken...nice. She also told me there is a "button" I can push to stop the test if I get claustrophobic. "Claustrophobic?", I question, "Is that a common reaction?" Her hesitation at how to frame her response was all I needed to realize if I don't have claustrophobia I may feel like I do for this test. Oh man...I can do this, its pain free. I just have to keep telling myself its an hour of kid-free. No phones, no housework calling to me. Its just an MRI.

Im planning to go shopping afterwards as a reward. This is crazy, really, its just an MRI.

UPDATE: MRI went fine. I took 1mg of xanex (Gods gift to the nervous) and it seemed to fly by. The techs and nurse were super nice. It made all the difference! I may have to wait a few hours before I head of to the mall though, Im still feelin pretty "chilled out" : )

A World Without Nurses

"Imagine a world without nurses. Think of a world without persons who know what nurses know; who believe as nurses believe; who do what nurses do: who have the effect that nurses have on the health of individuals, families, and the nation; who enjoy the trust that nurses enjoy from the American people. Imagine a world like that, a world without nurses".
Margretta Madden Styles, past president of ANA and ICN

My favorite professional publication to date is The American Journal of Nursing. It is well worth every penny of its subscription price. I enjoy almost everything about it, from the wide range of editorial views of nurses with all types of experience to the articles that always expand my knowledge. I am working on a post about the publication, but in my research, I came across this quote and had to share it. My favorite thought within the quote is ..."imagine a world without nurses...who believe as nurses believe."

The eyes have it

I thought to myself, "Have her eyebrows always been that short?" Then my God-given gift of mothers intuition kicked in and I remembered asking 11 yr old to give 2yr old a bath yesterday.

The fact I have misjudged 11yr old's capabilities in giving 2 yr old a bath is now a foregone conclusion, as her explanation leaves much in question...

In a desperate attempt to explain her actions, 11yr old said, "Mom, don't get mad. I was actually helping. 2yr old took the razor and shaved off a chunk of her L eyebrow, so I had to fix it...Don't get mad." Again, mothers intuition would translate that defense as, "I saw the razor and was curious what she would look like with only half of her eyebrows."

She must have felt the need to repeat the direction not to get mad because smoke, Im quite certain, began to pour from my ears and my voice dropped several octaves.

So tell me, how do you discipline the 11 yr old? I've already reluctantly ruled out shaving half of 11yr olds eyebrows off. (the heck of it is that I rely on her for relatively cheap, dependable childcare for my quick errands) Not Anymore. :(

Um, excuse me

I finally had the courage to comment on one of my favorite med blogs by a doctor. Check her out. And it occurred to me that this confidence thing is an emerging issue I need to get a handle on if Im going to be a successful nurse.

In clinicals, the few times I needed to talk to a doctor one would have thought I was facing George W. himself. I have never been "quick on my toes" and I've always known I would never be an ED nurse for that very reason. However, I really must learn to muster some confidence to speak with physicians. My patients and their physicians rely on me to effectively communicate information. I, however, am frozen in fear about not having the info they need or not having the info fast enough for them. (Afterall, it still takes me 15 minutes to do a simple assessment that takes experienced nurses all of 5 minutes to perform.)

My Fundamentals nursing instructor went so far as to suggest that if we are going to refer to physicians as "Dr. so and so" then we as nurses should insist on being referred to as "Nurse so and so." Im not sure I would go that far with my confidence (Imagine how House would react to that request...lol) but at the very least, I do need to muster some confidence.

Mistakes

I just read an awesome post from a nurse. Read it. In it, she mentions making a mistake and it made me remember my first "big mistake" as a nursing student...the memory still makes me squirm.

I thought I was educating a daughter about the "farting noises" (dtr's words) coming from her moms stomach. I was explaining that her mom's stoma from her colostomy will allow gas to pass through it and it will sound louder that normal passing of gas. Originally, her mom went in for a suprapubic catheter placed because she had lost bladder control because of a neurogenic bladder. (nerve damage to nerves inneravting the bladder). Needless to say, the bowels sort of got in the way and the surgeon punctured a hole right through them while he was piercing the bladder for the catheter. Normally, a surgeon would simply explain to the pt/family what happened and what had to be done as a result. This guy neglected to tell the pt or her dtr what happened, so no one but the nurses and surgeon even knew about the colostomy.

Enter student nurse...and all the sudden Ive opened a can of worms. When I told my clinical instructor about it, she treated me like I was a moron. I think she even said something like, "why are you teaching?" I felt so degraded. I thought that was part of our job, to teach. This dtr needed to know what the noise was (at the very least.)
I hated that feeling.

Clinical Instructors/Nurse Mentors: please do not portray a nurses duties as ones that should and will always be performed w/o error. Please be honest and real with your nursing students and new nurses; mistakes are real, they happen and it does not necessarily mean you are a bad nurse.

Nursing Students: Mistakes will happen. Do not allow them to rob you of a very important skill, your confidence.

I Might Be A Redneck...

I think I might be a redneck. My uncle brought a $600 bottle of red wine to a dinner party at my home. He needed a decanter, all I had to offer was a tupperware pitcher. He asked for cheesecloth to strain the sediment from the wine, all I had was coffee filters. So there we all are, seated around a semi-formally set dinner table drinking very expensive grape juice from a plastic tupperware pitcher...I wonder if he felt like he should have brought the $7 bottle instead?

It was good wine. I would have never paid more than $50 for it though. My hubby and I actually love wine. We are not wine snobs. We just enjoy Napa Valley in the fall, know what wines we like, and enjoy watching The Wine Guy, Mark Phillips,whenever he is on PBS.

Cheers~

Yadda Yadda Yadda

Maybe this is the place to get this off my chest. I happen to strongly dislike the people in nursing school who turn a routine _____ (insert topic here) lecture into a therapy session as they rehash the stories of their childbirths, family deaths, ED visits with kamikaze kids..yadda yadda yadda.

But, I have one of those stories (actually two, ok three). So in an attempt not to tick off fellow classmates this fall, and in an attempt for penance for recounting one story during first sem, here are my stories.

He Has What?
my mom was diagnosed w/ multiple myeloma. she was sent to karmanos for a stem cell transplant, 2 days after the transplant, my dad is sitting at her bedside and complains of chest pain. the nurse sends him down to the ED, they draw his blood and "what the fu$%" was almost audible when the doc read the labs...leukemia...serious leukemia...gonna die in a few days leukemia. that was a thursday night. On monday night at 11, he died. My brother and I were frequent flyers on the hospital elevators as we spent an hour at one bedside and another hour at the other bedside. At one point, they wheeled in my dad in his hospital bed, parked it next to my moms bed and all they had the strength for was to hold each others hand. God, what a pitiful picture seared in my head for eternity. Cancer sucks, I want to defeat it, I want to kill it and stomp on it and mash it into the ground like you do with a nasty looking bug on the sidewalk. I want to be an oncology nurse...I think. I want the nurses who cared for my dad to know they were awesome, they made a difference, they cared for him technically and with a human love that exceeds technology.

Don't Push!
I have four kids, how can I not share a birthing experience...
I weaseld my way into getting induced 2 weeks early. I was geeked, a planned birth w/ an epidural in place even before the first contraction...BONUS! The doc says, well, why dont you walk over to l/d, we'll get the epidural placed, Ill break your water and you'll be nursing by Jeopardy. BONUS! I walk over to l/d...pain free so far BONUS! oh, wait, I think this is a contrac....oh shit this hurts....the nurse (goddess) says sit on the edge of the bed, curl your back like a cat and we'll get the epidural placed. I sit...GUSH...water all over the floor (its so warm...did I just pee my pants?) The nurse (not so goddess like anymore) says..."that was your water, you're not getting an epidural, lets check you, swing your legs up on the bed...(this is where I wish I could insert the noise a pinball machine makes when you loose your last ball)
I open my legs and out comes a head...Im now screaming (sorry, I cant help it) the nurse closes my knees and says DO NOT PUSH. (where is the doc? the instrument table isn't even set up...)
Dont Push? Are you freaking kidding me?? You may be a seasoned l/d nurse, but have you ever had a kid? I have to push, its a little beyond my control at this point. So the baby's out, the doc makes it in to "catch" and the nurse hands the baby to me and says "here, hold her until I can get the warmer turned on" Needless to say, I was nursing my baby during Guiding Light, not Jeopardy.
I think I want to be an l/d nurse.

Good Grip
last one and I will be done...(remember I have four kids)
Same scenario, I conned my way into an early delivery, although they were a bit more cautious this time given the speediness of baby #3.
Epidural is in this time, but it only took on one side (this should feel interesting). This nurse checks often, Im progressing quickly-big surprise, they broke my water, doc checks and Im at 7, and "oh" she says, "he has a good little grip." WHAT THE F%^$? what do you mean he has a good little grip? He was presenting with his hand, I was at a seven, ready to deliver in short order. I've never seen nurses and a doctor move so fast in my life (no, I haven't rotated in ED yet) I was on my way to OR for a c-section. BUT WAIT I say...DO NOT CUT...I can feel half of my body (and not the half from waist up) After it was all said and done, I could barely feel my chest...and my b/p was 40 over something...uh, Im feeling a tich liquidated over here....
I learned I could never be a nurse anesthetist, but again I think I would enjoy labor and delivery

Ok, so my stories have been broadcast, I promise not to be the one in class who monopolizes the lecture with my war stories. We all have them, and we will all collect them as we ride this crazy coaster called nursing.