Flowers, Tomatos, Worms and Men

Those who know me well will certainly tell you that it is dangerous to ask me about my garden, children or chickens. You will receive much more information that you ever really wanted!

Today, I will try to edit myself.

My favorite flower to grow is the Hydrangea. They are tremendous amounts of fun because you can manipulate the color of the flower just by what you add to the soil to change its acidity. I have tried for years to do the same thing with a man that I have given my life to- but unfortunately, the man you marry is the man you get.  No matter what you add to a man his true colors stay true. There is no manipulating the man to change.

Here is my favorite blue.

I also have a love of growing vegetables, especially tomatoes. Every type of  tomato modern and heirloom and ranging in size from the tiny cherry tomatoes to the huge Beefsteak varieties. They are perfectly easy for anyone to grow because they thrive on abuse. If you water or fertilize too much, you will only get a big, beautiful, green plant. The tomato plants must believe that it is going to die before it will produce lots of fruit.

The proper care of the tomato plant can  easily be compared to successful care of  a husband. Men also thrive on abuse and will flourish if treated harshly and made to tow the line. If the gardener-wife pays too much attention and applies too much fertilizer to her man, he will grow to be huge and produce very little fruit.

The tomato plant has very few predators but, there is one which can prove deadly to the tomato plant if left unchecked. The Tomato Hornworm. This worm and I are mortal enemies. The evil worm is green and fat and has faux eyes running down both sides of  the length of their bodies. If the gardener attempts to pull them from the plant, they spit green liquid all over you. I personally enjoy pulling them from the plants (with gloves on of course) and throwing them to my laying hens while muttering, “Spit on me will ya”!, followed, of course by evil laughter!

A wife can also compare these pests to the predators of men who might prey on your husbands. While the shiny green Japanese Beetle females prefer to dine on more exotic fare, The tomato horn-worm woman with her fake eyeballs and suction cup feet will be happy to dine on your man no matter how large or how little he produces! She will not hesitate to spit green juice on you in a second! So, heed my warning all of you garden loving wives and  inspect your big, green, lush man just as often as you would the spindly well producing man, often and throw any of the suspected  parasites found to the chickens.

The evil devil woman worm

Like I said, ask me about my garden and you will receive way too much information!

Adventures in Nursing, the Good, Bad, and Ugly.

I made the decision to become a nurse to satisfy a deep need to benefit mankind, to do God’s work and quite honestly, to satisfy a deep desire to be needed. My children were of the age that they did not want to be “mothered” anymore so, I took myself to nursing school and studied like a fiend. I was determined to be the best nurse possible and show all those little 20 somethings in the desks next to me that an old dog of almost 40 years of age could still learn new tricks. I was driven to prove to the world that giving birth to my sons may have ruined my body but not my brain!

I loved immersing myself in the scientific nurse information  that was being shoved in my face continuously by my dedicated instructors. (I purposely chose not to use the phrase “spoon fed” because it would be terribly misleading). Nursing school is the place to use the phrase Get in, sit down, fasten your seat belt and try to enjoy the ride without throwing up. (I think that I only threw up once).

I made it though school and passed the dreaded NCLEX test and was full of hope and excitement to begin my new job as a staff nurse. I had my white nurse shoes and my halo and my angel’s wings, and my nursing license and I was ready to heal the world.  I did not mind at all emptying urinals, getting those warm blankets, making sure the family got a hug when they cried.  I loved leaving my shift each night feeling as though I made the world a better place in some tiny little way.

BUT then, reality set in. It began with my first student loan statement. I think that I said out loud, “They want me to pay what? Do they realize what a new nurse makes?”

Then came the realization that nurses are expected to document EVERYTHING that we do. I had an ah ha moment when it dawned on me that my nursing instructors really meant it when they said…over and over again….”if it is not charted then it wasn’t done”.  Patients will never understand the panic that nurses feel when you tell us that you  peed in the toilet and not in the container provided! It is as if you never peed! Now you will have to drink before the end of my shift, you MUST pee before the end of my shift and I have to see it! I cannot leave here until you have peed and I can prove it in millilitres on your chart!

Another goal of a good nurse is to make each patient feel as if they are the only one. That is, until you get the patient who really believes this and calls you into the room repeatedly to “fluff their pillow”. (I am NOT exaggerating! This really happens!) The good nurse fluffs, smiles, asks if there is anything else that is needed and goes back to the patient who is vomiting or is in pain and really needs help.

Unfortunately, it is the family of the nurse who suffers the frustration of the over utilized nurse. Families, please understand when we act as though we could care less that you have a bellyache and please understand when we tell you to go sit on the toilet and it will go away. We really truly do care and will spring into action if you begin to bleed from any orifice.

It has been a few years now and my diploma is dusty, my nurses wings tattered and halo is askew but I am still in love with the nursing profession. I am, and always will be a healer and as long as we nurses remember to care for each other as well as for ourselves, we will be able to continue to cherish the thank you s, and the hugs from our patients and continue to smile as we fluff those pillows.

The Future of Nursing Education

Every nurse, new and old alike will tell you that graduation from a school of nursing does not a nurse make. In fact, the education is only the beginning of the development of a phenomenal nurse.

The first day that the graduate nurse starts work on the floor and is finally able to practice their newly acquired skills is when the nurse really learns. Only when those learned skills are practiced over and over again will the nurse become adept, comfortable and have the dexterity of a seasoned professional.
The future of nursing education will become a partnership with technology just as it has become in all health care settings.  An example of the marriage between nursing and technology is already evident in the number of nursing programs who have implemented online courses into the curriculum enabling students to further their education without sacrificing family and work to obtain advanced degrees in nursing.

The emerging technology that will, in my opinion, drastically change the way that nurses learn and perfect their practical skills without having to find a willing human patient is Virtual Medical Training.

Second Life, NESIM (Nursing Education Simulator) is a simulation training program created recently  by John Miller, a nursing instructor in Washington. The students assess the patient, use critical thinking skills and  learn to use defibrillators, IV pumps, and other “hands on” skills to treat their computer-generated patient who is experiencing a variety of medical problems.

This education method is gaining population among the entire medical community and is being used to train medical students too.  Discover magazine has an interesting article showcasing the virtual operating room where medical students can observe and participate in simulated surgery.

http://discovermagazine.com/2009/jul-aug/15-can-medical-students-learn-to-save-real-lives-in-second-life

There is a simulator that teaches how to perform a tracheotomy (not for nurses or other non-physician people please).

http://simcen.org/VME%20Lab/projects/cric/images/cric_web_animation.gif

This kind of “hands-on” training without using a real human will create a more confident nurse who is skilled in their craft the very first day that the nurse works on  the floor.  This will be better for the new nurse, the nurse preceptor, and it will greatly reduce the anxiety level for the new nurse and for the patient.

When is the Best Time to Talk About End of Life Issues?

Nothing is certain in life except death and taxes. We make sure that our taxes are finished and mailed  by April 15th each year to avoid penalty but many of us put off  dealing with a decision equally if not more important.  Death is inevitable so discussing and drafting an advanced directive should be as important as filing those tax returns and the advanced directive for healthcare only needs to be done once. We all know that the time to make decisions about what we want to happen to us if we cannot speak for ourselves needs to be made while we are of sound mind and body. However,  not many of us wants to face the reality that we all will eventually die. This decision needs to be made not by people who are ill or aged. The human body begins to age and advance toward death the day that we are born. The best time to make the decisions about what we want to happen in case of illness or debilitating accident is when you are healthy and well.
It is always a surprise  to me to be admitting someone to the hospital who has been battling some type of cancer for months or years and hear them tell me that they have no advance directive. They leave the issue to the doctor and the doctor is leaving the issue to the patient. No one wants to talk about death so often times the member of the health team who is inevitably left with the issue is the nurse who is then placed directly in the middle of a family filled with grief, denial, guilt, and fear.

I am of the opinion that the family practitioner is the one who should be introducing the issue to the patient at some point during a yearly physical when the patient is healthy and has time to make thoughtful decisions about how they want to be cared for and what will happen to them if they become unable to make decisions for themselves.  I chose to discuss this topic to inform and educate people about how to go about putting together an advance directive and the importance of discussing those wishes with your loved ones.

There was a bill introduced to Congress in 2007 that did not pass but was sent to committee and is still sitting there.  The bill  intended to mandate that as part of Medicare reimbursement that  patients would need to have advanced directives in place. The passage of this type of bill would force healthcare to address this issue with patients resulting in savings of  Medicare payments to provide medical care to patients who cannot speak for themselves but are receiving medical treatment that they would never have wanted if the patient had been able to speak. The bill can be found at Govtrack.org http://www.govtrack.us/congress/bill.xpd?bill=s110-466 .

Additionally, the Oncology Times featured an article about this very issue. It is a part of the Health Reform plan and is an attempt to avoid starting treatment or prolonging life when the patient did not desire it. People often forget that if you have no health care directive, your physician has to consider you an full code and continue to treat you until you die regardless of your prognosis. http://journals.lww.com/oncology-times/Fulltext/2010/02100/Health_Reform_May_Push_End_of_Life_Discussion.1.aspx

An advance directive does not have to be complicated and does not require the advise of an attorney. All that is needed, depending on your state, is a few forms and a notary. There are some wonderful internet resources to help guide the layperson put together  an advance directive. The following resources were chosen to provide the most detailed information to assist and educate the layperson in compiling an advanced directive. The web sites offer suggestions about how to  make your wishes known to your family so that everyone involved understands what medical treatment that you want or do not want.

The Caring Info web site contains hyperlinks for each state so that you can find a form which is in compliance with each state’s particular regulations. There is an excellent article about how to choose a healthcare agent and how to make your wishes clear to them if you become incapacitated.         http://www.caringinfo.org/stateaddownload

American Bar Association website at  http://www.abanet.org/aging/toolkit/home.html provides a toolkit for working through the process of deciding what you want, how to talk with family and a guide to assist you in deciding what you consider to be quality of life.

US Living Will Registry http://liv-will1.uslivingwillregistry.com/forms.html

This site contains forms for all 50 states, assistance and advice about how to put it all  together and then stores them in a central database instead of a safe deposit box or in a drawer somewhere.

The American Hospital Association has a site called Put it in Writing it contains key resources and also includes a wallet ID card to alert health care workers that you have a Health Care Directive and lists family contacts in case of emergency. The site focuses on educating people and  raising awareness around this important issue. http://www.putitinwriting.org/putitinwriting_app/index.jsp

Georgetown University-Kennedy Institute of Ethics-Library and Information Services sponsors a database. The National Reference Center for Bioethics Literature http://bioethics.georgetown.edu/nrc/resources/AdvanceDirectives.htm contains informational links and available resources for everyone for the layperson to the healthcare provider.

If there are complicated issues or the above web sites do not address all of your questions, there are attorneys who specialize in living wills and advance directives who can assist. Don’t leave this important task undone. In a time of grief, allow the family that you love to reminisce and to grieve and then begin to heal. Save them the stress of trying to figure out what you would want. Decide for yourself talk to your family and then file your papers. Unlike the IRS, the penalty will go to your family if you file late.

Health Care Informatics

When I enrolled as a Health Care Informatics student, I was terrified at what I had gotten myself into. I had visions of math and statistics. Since I didn’t know what health care informatics was all about; it was scary. Math and statistics are scary to me since I have difficulty understanding them and since I didn’t understand what Health Care Informatics was: this course was scary too and must surely be filled with lots of math and statistics. That is the connection that my brain makes with the unknown.
I was pleasantly surprised to learn during this first week of class that Health Care Informatics is simply the storage and organization of health information and the sharing of that information. I became downright excited when I found out that I was going to get to Twitter and blog and call it homework! In only one short week I have become quite enthralled with Twitter and I am tweeting with the big boys!

There is so much more to Health Care Informatics than my simplistic description above.  The most important example is the Electronic Health Record. The EHR is a wonderful tool since it compiles all of a patient’s health information in one system that can be viewed by the patient’s health care providers. Some positives are that the health care team has instant access to all of the patient’s medical history, tests, treatments, surgeries, medications and this allows the health care team to provide faster, more accurate and efficient care for the patient. The question is: Who owns and who should have access to this information? The information is about the patient and is personal so my first thought is that it should belong to the patient. But, the hospital pays for the program so does the hospital own the information?

HIPPA dictates that the information contained in the EHR belongs to the patient and the patient has the right to access the information and to determine who sees the information. The physician is being paid to use the information and the hospital may own the software and hardware but not the actual information contained within the system. The insurance company could potentially use the information to try to dictate care that the physician provides in an attempt to cut costs or they could even deny coverage based on past medical history. So, the obvious solution would cause some to simply say, “Don’t allow the insurance companies access to the records”. However, this is not a realistic statement since we all know that the insurance companies will simply refuse to pay the patient claims unless the patient signs a form giving them access to the EHR. Should there be government regulations? I say the more governmental interference that you have the worse the situation will become.

There seems to be no question in my mind that the patient is the owner and controller of their personal health record.  The involvement of the government and the insurance companies scares me almost as much as math and statistics.

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