Posies and Posturing Topics of Debate for Nurses and Doctors

No flowers and no sitting --- on anything!

That’s the mandate to visitors in many British hospitals and has been for some time, but at least one doctor thinks it’s time to loosen up.

Dr. Iona Heath wrote a letter to the British medical journal BMJ recently and argued that this recommendation is unjustified and denies patients the chance to be close to their loved ones, according to an Associated Press story.

"I was shocked when I heard about it," Heath is quoted as saying, and she added that she would “definitely sit on a patient's bed” if she were making a house call or hospital visit.

"Doctors should never be discouraged from sitting, because patients consistently estimate that they have been given more time when the doctor sits down," Heath wrote in the commentary. "Such interactions are precious and should be made easier rather than more difficult."

Britain's department of health, which supports the no-flowers, no-sit policies, said each hospital can decide whether or not to adopt them.

“…patients with MRSA… may shed contaminated skin onto the bed and this could be picked up and transmitted to someone else," officials maintain.

Opponents say there is no proof that bringing flowers and sitting spread infection.

I have a couple of comments, both as a nurse and former patient:

It seems to me that most visitors would hesitate sitting on patients' beds because most patients have numerous tubes and wires that visitors would just as soon avoid. And it's a bit annoying to have to work around visitors sitting on a bed and a tiny nuissane to ask visitors to move.

As a former patient, I definitely don’t want visitors sitting on my bed. It’s a small piece of real estate that I need to call my own when I’m feeling really lousy. I say that when patients are conscious, they need their space.

Being forbidden to sit on a nearby chair seems over-the-top, though, and could really discourage visitors from coming, and that’s generally not good for patients.

As for flowers: As long as they don’t cause a problem for a roommate or the patient, they can be a welcomed source of solace. Colorful blooms can remind patients that someone is thinking of them and that can be a comfort at a stressful time.

What do you think?

Sitting or no sitting?

Flowers or no flowers?

Much ado about nothing?

Tell us about it.

Wanted: Ideas for Increasing Compliance Among Patients With Diabetes

All nurses know that diabetes is a huge problem in this country. At least 24 million people suffer from the disease – close to 8 percent of the population or nearly one in 12 people, according to the Centers for Disease Control and Prevention.

The vast majority of diabetics are of the type-2 variety and we know the tremendous costs associated with that. So if we’re looking for ways to cut health care expenditures, reducing the number of people with type 2 diabetes would be right at the top of the list.

The $64,000 question is how to do it.

In the conversations I’ve had with nurses who are diabetes specialists, motivating their patients to make positive changes in their lifestyles is a major problem and no one seems to have figured out what really works.

Apparently these nurses are not alone. A study published online recently by the Journal of the American Board of Family Medicine found that physicians also are pretty frustrated when it comes to caring for diabetics.

Researchers at University of Medicine and Dentistry New Jersey-Robert Wood Johnson Medical School, the University of Hawaii and the University of Michigan interviewed 34 primary care physicians in diverse practices in California, Indiana, Michigan and New Jersey. They all provide outpatient care to adult diabetic patients and talked specifically about the barriers that put patients with uncontrolled diabetes at risk for cardiovascular disease, which is two to four times higher than in adults without diabetes, according to the American Diabetes Association.

The doctors identified the barriers to be in two categories: “patient-related” and “system-related.”

Patient-related barriers include financial problems, lack of support from other family members, patients putting themselves last, depression and pain.

System-related barriers for doctors include difficulties with delivering care and making referrals, and the failure to utilize technology to make a patient’s health record readily accessible at the point of care.

System-related barriers for patients include inconvenient appointments, lack of transportation and its cost, and poor coordination of care among multiple providers.

“Ideally, a multidisciplinary team of nurses, diabetes educators, pharmacists and endocrinologists would greatly improve a primary care doctor’s ability to assist patients…” said lead study author Jesse Crosson, PhD, assistant professor of family medicine and director of the New Jersey Primary Care Research Network at UMDNJ-Robert Wood Johnson Medical School. “Physicians inherently want to help their patients get better, but diabetes is a chronic disorder that becomes more difficult to manage over time, even when treated properly.”

Researchers said that responses and the frustration factor were consistent for doctors in all four areas of the country where the survey was conducted. And all respondents felt they lacked the ability to motivate patients, to address their resistance to lifestyle changes and to eliminate barriers to good care.

I believe you could substitute the words “nurse diabetes educators” for “doctors” because from what I hear, nurses are constantly trying to devise ways to increase patient compliance. As yet, they haven’t had huge successes either, but there must be some examples out there.

Do you know of or have any?

What can you share with other nurses about care for diabetics that might improve compliance?

What are the biggest barriers to improving health for your patients?

Tell us about it.

New Toothbrush: A Metaphor for a Healthy Life

For some reason, teeth are always left out of any discussion about health.

We all know how important good dental health is to overall health, but I’ll bet most of us in primary care forget to mention it when we’re encouraging patients to make lifestyle changes. Dental health affects nutrition, pregnancy, cardiovascular health and overall well being. People with rotten teeth don’t feel good or feel good about themselves.

Maintaining good dental health used to be a suggestion with low-cost consequences, but like everything associated with health care these days, the cost of maintaining those pearly whites is ever-increasing.

This was brought home to me the other night when my husband bought a new toothbrush –the electric kind. The one we had finally died after I-don’t-know-how-many years. I think we paid $30 for it.

This new one cost $80 and came with a sleek silver and blue body that had the usual on/off button and charger. It also included a 30-page instruction booklet (two languages); an instructional CD; protective cover; handle display; brushing-mode button; wall mount; adhesive tape; and “SmartGuide” display unit and timer that works remotely. It sits on the counter and knows when you pick up the toothbrush, then tells you just how long to brush each quadrant of your teeth. And it doubles as a clock.

I blanched at the price, but later found the same model for up to $200 on the Internet, so I’m going to consider myself lucky. And the 30-page instruction booklet, the instructional CD, and the multiple brushing modes (daily clean, sensitive, massage, whitening and deep clean) and this SmartGuide also made me feel as though I got my money’s worth.

This electric toothbrush also comes with four types of brush heads which I haven’t figured out yet.

So you can appreciate the complexity of this hi-tech toothbrush, take a gander at a portion of the directions for one of the timers (remember, it comes with two).

“Your toothbrush comes with the Professional Timer and the Count Up Timer activated. If you wish to change these settings, proceed as follows:
• Press and hold the mode button [c] until the SmartGuide display unit shows “30” and “timer”.
• By briefly pressing the on/off button [b], switch the 2-Minute Timer. Confirm your choice by pushing the mode button.
• This will lead you directly to the Count Up Timer display (“up” and “timer” will be shown). Switch to the Count Down Timer by pressing the on/off button and confirm it with the mode button.

“Please note: It is normal that the handle display shows two flashing bars when operating in the timer setting mode”.

I don’t know about you, but when I hear the word “mode,” I know I’m in trouble. That’s when I begin to panic and alternately yearn for analog watches and televisions with only three channels.

The final test, though, is how the darn thing works.

I completely ignored all of the instructions it came with, waited for my husband to put it together, pressed the “on” button and …wow. Using this new toothbrush versus the old one is like the difference between watching analog TV and digital/high-definition. I hadn’t realized how old and sickly our former toothbrush had become.

And maybe that’s a metaphor we can pass on to our patients.

Tell them that they have no idea how great they’ll feel until they get that new toothbrush/lifestyle. Forget the complicated, extraneous home gyms, expensive gym memberships and costly diet plans. Eat less, move more and learn how to handle stress. That should be instructions they’ll understand.

What extra health advice or tips do you find yourself providing to your patients?

What tools do you use to get the message across?

Do you have any evidence that the message is getting through?

Tanning Salons: Nurses Weigh In

Years ago when I lived in the Midwest in a state that had real winter, we used to rush outdoors at the first sign of sunshine and being baking. A golden brown physique was highly desirable, and as prom neared, girls spent increasing time on their tanning mission to assure they’d look dazzling on The Big Night.

And then the sunlamp became available at local pharmacies and every high school girl bought one. (Prior to that, only dermatologists had them and they were used liberally to treat acne.)

I was among the true believers who thought that the sunlamp was not only good for giving you that rosy glow (or second-degree burn if you fell asleep under the lamp), but that it was actually good for your health.

Well, now we know differently, and dermatologists tell me that many of these girls-turned-middle-aged-women are currently paying the price. They may have changed their bad habits, are staying out of the sun and liberally applying sunscreen now, but the damage has been done and the skin cancers are blossoming because of past transgressions.

You’d have to be living in a cave not to know that prolonged sun exposure is the chief reason for the development of skin cancers, including deadly melanoma. Nonetheless, browning via tanning beds or the real thing seems to be more popular than ever. Some women – and men, too —actually schedule their lives around bake-time on the beach or balcony and/or sessions at the salon.

I equate tanning equipment to cigarettes; there is no upside to using them – no health benefits at all. The International Agency on Cancer recently classified indoor tanning devices as cancer-causing agents, and the World Health Organization and the American Academy of Dermatology recommend banning those under 18 from being exposed.

In November, the Howard County Board of Health in Maryland became the first state to ban those under 18 years old from using any type of tanning equipment.

Board members voted after hearing testimony from both sides of the argument, and I hope there were some nurses testifying in support of the ban. We can do our small part by appearing where the topic is under debate and countering those arguments that UV rays from tanning beds really aren’t that harmful; that everyone needs to supplement the sun to make enough vitamin D; and that businesspersons have a right to make a living.

I don’t know if there are other jurisdictions contemplating this ban. In my opinion, we should just say no to tanning salons.

Is your city or county discussing the issue?

What do you tell your patients?

Share your thoughts with the nursing community.

The Health Insurance Debate: It Affects Real People

The Health Insurance Debate: It Affects Real People

The nurses who take care of my dear friend, Lynn, now have a real example of the shortcomings of our health care system – or lack thereof.

Lynn, who lives in the Dallas/Fort Worth area, has worked for 30 years as a journalist, some of that time as a health care specialist. She is not a nurse, but because of her work, she knows more about medicine and health care than many civilians. Lynn and I worked together for a while for a dot.com company from which we were both laid off. That was the end of our group health insurance. I’ve had various policies ever since; she has purchased insurance on her own for about the last 10 years.

After Lynn discovered by accident that she had kidney cancer in 2008, her insurance was cancelled. She managed to undergo surgery the day before the policy expired and so far, no signs of new cancer. The insurance company wouldn’t allow her to purchase further coverage and so there are big bills for post-op care.

In 2009, Lynn also developed a rare, congenital heart/lung defect that has exacerbated her chronic obstructive pulmonary disease and weakened her heart. I won’t go into the details, but there were several misdiagnoses along the way which made her condition even worse than it might have been otherwise, and now she needs a lung transplant.

Lynn has been hospitalized several times in recent weeks and each time the bill is thousands, but she has no means to pay anything because she can no longer work. Because her disability payments are more than $674 a month, she doesn’t qualify for Medicaid.

It’s a nightmare; I can’t imagine how it could be worse. My heart goes out to her and it’s frustrating because, as a nurse, I feel I should be able to help. The only things I have to offer are supportive words and phone calls.

Even sadder is that there are many stories like Lynn’s. Through no fault of their own, or because they have lost jobs, or because their incomes are a few dollars too high, they have no health insurance and no prospects of getting any unless Congress comes up with some program that will provide coverage.

I’ve witnessed in my own family the divisions that exist over the health care/insurance reform debate. I just hope that those who are responsible for coming up with some plan do it soon enough to help people like Lynn. She has worked all her life, followed the rules and contributed her fair share of taxes. She did the responsible thing and purchased health care coverage so she wouldn’t be a burden to anyone.

I hope the members of Congress, who hold her fate and that of others like her, remember that it is these citizens who are paying their health insurance premiums. They can rest easy at night knowing that if catastrophe strikes, they’re covered.

Do you have friends or family who have no health insurance?

If so, how has it affected their lives?

In your area or specialty, do you encounter chronically ill people who have no health insurance?

If so, how does it affect your life?

What would you tell your congressperson was the greatest problem with the current health care system?

Tell us what you think.

Woman Seeking Advice: Why Should I Be A Nurse?

The email came a couple of weeks ago and I’ve been thinking about it ever since.

A woman who reads this blog -- Kate from the Philadelphia area – asked my advice about becoming a nurse. She is currently taking prerequisites to get into nursing school and has been accepted to an accelerated program because she already has a bachelor’s degree in music therapy.

“Nursing will be a second career for me,” she wrote. “I currently work with special needs children. I love it, but I have always been interested in the medical field as well. For the first time in 13 years, all my own children are in school full time and I have some free time on my hands.”

So Kate decided to return to school and pursue a career in nursing, but she is having second thoughts.

“I am worried about a few things,” she confessed.

“First of all, nursing jobs are in short supply in my area… It would be disappointing to spend money on a second degree and then not be able to find a job. Another thing that worries me is that I have talked to many nurses over the last year, asking them about their jobs. Most nurses I talk to are not happy in their work and discouraged me from going into the field. They felt underpaid, overworked etc. While I did find some that enjoyed it, the majority didn't. Any advice/opinions you could give me would be great.”

I was flattered that she asked, but I’m no expert on the job market.

I do know, I told her, that there are geographical pockets of nurse-unemployment as well as pockets of nurse shortages. I recently read that, despite all the jobs that are disappearing in this country, 22,000 health care jobs were created in the last quarter of 2009. Now all of those are not nurses, but certainly some of them have to be.

And there’s that onslaught of aging boomers that are going to need care, and all the boomer nurses that will be retiring, so all the experts are predicting that overall, there will probably be a nurse shortage in the coming years.

As for pay: on the whole, nurses are paid pretty well. One recent report said that the average pay for nurses is $62,000, but it didn’t specify whether that’s for hospital staff nurses or otherwise, or whether that figure reflects nurses with degrees or without. But in general, nursing is a fairly well paid profession, especially for those with degrees.

Of course, any nurse will tell you that no matter how well or how poorly you’re paid, you have to like the work. I cautioned Kate that nursing is not for wimps – especially hospital nursing – but there are so many other well paying fields open to nurses now that didn’t exist a few decades ago. The possibilities really are endless, and I told her that she has a leg up on other nurses for a particular job because she already has a degree and 13 years experience working with special-needs kids.

I’ve interviewed tons of nurses all over the country and there are plenty who absolutely love where they work – mostly because of the terrific camaraderie among co-workers. I told Kate that there can be great variances in work environments and that co-worker support can make all the difference in the world.

Lastly, I told Kate to figure out why she wants – or thinks she wants – to be a nurse. Is she just looking for something to fill her free time or does she feel the call?

What would you say to Kate if she asked you whether she should pursue a career in nursing?

Please share your thoughts.

Message from the Nurses in Haiti: Don’t Forget!

It’s been about five weeks since Haiti’s capital, Port au Prince, was leveled by a 7.0 earthquake. News of the city, its survivors and those who went to help has predictably faded from front-page headlines. In my local paper today, there were a couple of items in the News Briefs section, despite the fact that even more misery is likely to come.

The weather is quickly moving into the rainy season and health care experts in the area are predicting rampant disease because of the lack of shelter and sanitary conditions. I can’t even imagine…

I’m not surprised that we hear so little about the plight of the Haitians these days. Earthquakes and their immediate aftermath offer a lot of photo ops (“If it bleeds, it leads” television reporters like to say). I guess fever and diarrhea and just plain misery are not exciting enough to warrant hour-to-hour coverage. Once the media swarm has ceased, we’re left with a slow, infrequent hum of news coming from disaster areas.

But that’s always the way with cataclysmic events.

As the aftermaths age, the story and experience almost become non-existent for those who aren’t living it. I can’t help thinking, however, of all the nurses who volunteered their time, money and expertise to charitable organizations that either rushed into Haiti with aid or were already there helping the Western Hemisphere’s poorest country. How are they managing? How are they processing all the pain and sadness they are seeing? How are they dealing with stress of caring for orphans and misplaced children who are dirty, hungry and hurting? The parents who have lost their children? The people who have lost friends, home, everything?

It seems way too much to handle, and yet, nurses usually come through. And at least they’ll eventually return home to warmth and cleanliness. As one nurse said to me, “It’s not about us.”

I had the privilege of talking to some of the nurses who were either in Haiti post-earthquake or who had gone to Haiti and already had returned home. (Some referred to the Jan. 12 disaster as “the event,” as if saying “earthquake” was just too painful or would cause another one.) What surprised me, though, was the number of nurses and organizations that were in the country pre-earthquake. Two American university nursing school programs in this country had established sister nursing school programs in Haiti. For some time they have been sending nurses as teachers as well as economic aid.

Other American nurses were working regularly in clinics for women and children and were trying to raise the bar on the standard of care. As one nurse put it, practicing medicine in Haiti, even on the best day, is learning to do without. “That’s just normal operating procedure here,” she said. “Sometimes you have water and electricity; sometimes you don’t, but you learn to give care without those things.”

The other message, which ended most interviews, was a plea to keep reminding Americans and other economically well off nations that Haiti’s post-earthquake plight is going to last a long, long time. “The need is great and it will continue to be great,” the nurses told me. “Don’t let people forget Haiti.”

One additional comment: I’ve had to opportunity to read emails from an engineer and a building contractor who went to Haiti to provide advice and aid. They noted that in some areas, there are just too many volunteers of this type. “People are just standing around…” one wrote. “There just isn’t enough for them to do yet.”

That is definitely not the case when it comes to nurses.

In some instances, the only limiting factor for caring for the injured was the lack of ORs and other medical facilities, but there was never a shortage of things for nurses to do. Those who weren’t schooled in trauma care learned quickly and there were always people who, at the very least, needed consolation.

What have you or your colleagues done to get involved in helping Haiti, whether on the scene or from afar?

Is it possible to get “catastrophe fatigue?”

Do you think there has been enough media coverage on what nurses are doing in Haiti?

Has there been too much or too little overall coverage?

Tell us what you think.