Hats Off to Student Nurses Who Chose Service Over Self

Kudos to the nursing students at the Johns Hopkins University School of Nursing (JHUSNO) who volunteered their time to provide health care and education to people in impoverished areas of Haiti, New Orleans and Baltimore.

I’m sure there were other nursing students from various schools across the country who did the same, but I happened to read about those at JHUSNO. When break time rolls around, it can’t be easy to forego some down time away from intense studies and other scholastic obligations, but three groups of JHUSNO students did just that. Here’s where they went and what they did:

One group headed for Haiti. This was one of many trips for Assistant Professor Elizabeth Sloand, PhD RN, CRNP, who each year takes undergrads to the island for a lesson in global health. The students worked with the Haitian Health Foundation to teach positive health practices to the children and youth of Haiti. They also did some screenings and care.

The 10-day experience benefited the students, too, according to Sloand. They learned to rely on basic nursing skills, and exercised their critical thinking and problem solving skills in a low-tech/ no-tech environment.

The destination of a second group of student nurses was New Orleans, where 11 members of the National Student Nurses Association’s Hopkins Student Nurse Relief Corps took on two projects. The first was in the Lower Ninth Ward, one of the most seriously damaged areas during Hurricane Katrina. They hammered and painted, and laid shingles and tiles, helping to reconstruct damaged and demolished homes. Then they turned their energies toward the Touro Infirmary emergency department at the Lower Ninth Ward Health Clinic, and to St. Anna’s Medical Mission Mobile Clinic, where they used their nursing skills.

The third group of student nurses had only to travel a few miles within Baltimore. Each day for a week, nursing students worked to complete civic, social and environmental services, such as working in programs that focus on problems in urban restoration, domestic violence and homelessness.

It is good to see that nurses understand they have places in both their local and global community, and that fostering good health takes many forms. A tip of my extinct nursing cap to all of these students and any others who demonstrate a selflessness so needed in today’s world.

How are you or nurses in your community making a difference?

Do you think nurses should be expected to give of their time outside of their work, even though it already is a giving profession?

Tell us what you think.

Health Care in the United States and Canada: Neither is Perfect; Both Need Help

Canada’s health system is often held as a shining example of what a health care system can be.

Some have the notion that everyone north of the border gets everything for free. If that sounds like it’s too good to be true – well, it is.There are a lot of good things about Canadian health care delivery, for sure. Every citizen, by virtue of being born, automatically is covered by whatever system the province has in place. (Each province – Canada’s version of a state – has its own plan.)

An American friend of mine who moved to Canada during the 1960s and married a Canadian woman decided not to return to the states because benefits for his autistic son were so much better in Canada. This same friend happened to be the guy picked by the Ontario government to redesign the province’s system for long-term care.

Just like in the United States, Canadians are living longer and costing the health care system more each year. In Toronto, the problem was particularly acute. The city is one with high diversity, and each ethnic group has nursing homes “just for their people.” This had advantages; caregivers in these institutions are familiar with the ethnic traditions, customs, foods etc., and can provide comfortable, nurturing environments. The disadvantages: This makes for duplication of services and inefficiency, and with an ever-increasing aging population, Ontario’s health system is running out of money.

My friend's mission was to streamline services without raising the ire of any group – a nearly impossible task – but he's a smart man. He told the groups to come together and develop solutions they all could live with.

So I learned that Canada’s “perfect health care system” is not so perfect, and some Canadian journalists agree. Here is what five of them had to say in interviews in HealthBeat, published by the Association of Health Care Journalists , based in Columbia, MO.:

“Despite health care coverage for everyone, many people in Canada don’t have a family doctor. Health care coverage here includes psychiatric care, but it doesn’t include psychotherapy because therapists cannot bill the provincial health insurance plans. It also doesn’t include medication, and many people in Canada cannot afford their meds.“(The United States has) a terrific system in many ways if you can access it. It’s cutting edge, it’s competitive and consumer oriented – but as a physician, the patients I cared for weren’t able to access it.” – Miriam Shuchman, a physician-reporter for 20 years and medical school instructor who writes for the Canadian Medical Association Journal and formerly for the New England Journal of Medicine.

“Despite our universal Medicare system, there are some two-tiered aspects to the system, especially as each province controls their own health care system. Different drugs are covered in the provincial formularies for different folks, seniors, those on social assistance, but mostly prescription drugs are not covered. You need insurance for that.

“The head of the Canadian Medical Association runs a private hip and knee replacement clinic in Vancouver which gets you in and out faster than the hospital, although that often depends on the region you live in. (We also have) a scarcity of family practitioners, especially in smaller cities and rural areas.

“(The U.S. health system is) good in some ways – new treatments, interdisciplinary health teams – but abysmal in others. Hard to fathom 40 million people with no health insurance.” – Kathryn O’Hara, a faculty member at Carleton University’s School of Journalism and Communication in Ottawa and vice president of the Canadian Science Writers Association.

“Canadians are very attached to their universal health care system and usually agree that it is superior to that in the U.S., but most admit there are many challenges. Health care is eating up a larger share of provincial budgets and it’s difficult to keep spending in check when everyone expects cutting-edge treatment and care. Canada does not have a national drug plan and many people are not covered for drugs by their employer.

“Most provinces cover drugs for seniors and the poor. Some private type of services are beginning to crop up in some provinces, for example, MRI and orthopedic clinics. Only the very wealthy would be able to take advantage of these services and many say this is a slippery slope to two-tier health care.

“(The U.S. has) no system at all. Huge numbers of citizens are uninsured and go without treatment for a variety of chronic diseases. The wealthy are over-treated, over-tested, over-medicated and there’s no evidence they live healthier or longer than Canadians, who all have access to health care regardless of income.” – Maureen Taylor, Canadian Broadcasting Corporation.“(In the U.S., there are) great doctors, great facilities and a shocking disregard for patient care by major insurers.” – Terry Reith, Canadian Broadcasting Corporation.

“…Canada’s health system is not utopian or…not a socialist evil incarnate. What Canada has is a decent publically funded health insurance system, one with many benefits and many flaws. “I don’t think the U.S. has a health system. Rather, it has many disparate elements of care that range from among the best in the world to the shamefully mediocre for a country of such wealth. …U.S. health care is expensive, bureaucratic and often inequitable.” – Andre Picard, public health reporter for The Globe and Mail.

Having read these comments, what can you say about American health care versus the Canadian health care system?

Tell us what you think.

Nurses, Do You Have a Daily Plan?

It’s satisfying to see nurses taking the lead in making hospitals better places for patients, families and the nurses who care for them. Nurses are no longer relegated to just taking orders without questions; we’re in the forefront of change.

For example, take Beth King, MA, BSN, RN, CCM, a nurse working at the VA National Center for Patient Safety in Ann Arbor, Mich. A couple of years ago, she was bothered by the way that patients often aren’t informed about what’s going to happen during their hospital stay. We all know, of course, that unpredictable things occur with the course of any illness, but there is a plan of care and treatment. Many times, though, patients and their families are not informed and are in no condition to provide input anyway.

King saw the need for patient input, as well as the need for better care and improved patient safety, so she set out to fill them. She developed The Daily Plan, a single document created each day that helps patients and families understand what to expect during hospitalization. They are informed, when possible, about their nutrition plans and upcoming tests and procedures. This document is created by importing data and information from patients’ electronic medical records – a really great idea because nurses caring for the patients don’t have to create another document from scratch.

This seems like a smart idea -- not only for patients and their families, but for nurses as well.

When they sit with the patient and/or family to discuss the day’s plan, it provides an opportunity for teaching and questions. Nurses who have used The Daily Plan say it allows them to identify possible adverse events and errors of omission, mostly discovered while talking to the patient or family. Add it up and it means safer environments for patients, as well as peace of mind for families and nurses.

What do you think of this idea?

Do you have ideas that might improve patient safety and care?

Have you developed such tools or programs that are in use now?

Tell us about it.

The Economy Takes Its Toll on Diabetics

I was talking with a friend of mine who is a nurse practitioner and diabetic educator. She told me that there are a lot of patients these days not keeping their appointments at her diabetes clinic. Many of the no-shows have lost their jobs and with them, their health insurance plans. Oh sure, these folks are offered the COBRA option, but they can’t afford it.

One husband and wife who come to the clinic are both diabetics and are sharing their insulin. They can only afford enough for one, they say. Other patients say they can’t afford to buy good food and certainly can’t afford the expensive supplies required for monitoring their blood sugar.

My NP friend feels powerless. She gives out what samples she has, but she must ration them.“I feel like I’m playing God,” she says. “I go into work dreading it every day.”

You and I know what’s going to happen down the line. These diabetics are going to meet with disaster—expensive disaster. Maybe their crises will be small ones at first, but eventually they’ll find the nearest emergency room because the little crises have turned into big, serious ones. We’d like to think that the economy will pick up soon and that these people will return to work, but by the time that happens, the damage to their vessels will be done.

My friend’s clinic is a microcosm of what’s happening everywhere; diabetics are skimping on supplies and drugs. Experts don’t have to guess about this. The Centers for Disease Control and Prevention tracks the sales of diabetic supplies and drugs, and despite this growing number of diabetics—1.6 million Americans were diagnosed in 2007—sales are down.

It’s not hard to figure out why. According to what I‘ve read, the monthly cash costs for drugs and supplies of a diabetic with no insurance run between $350 and $900. The sad thing is that there are almost 18 million people with diabetes in the United States (and who knows how many undiagnosed cases). Most are Type 2, which means their diseases are probably preventable.

Sadly, Americans like to eat a lot and move too little, so nurses have a two-fold, uphill battle. We must motivate people to prevent diabetes by maintaining healthy lifestyles, and we have to help patients with diabetes to figure out how to take care of themselves so that they avoid heart attacks and strokes, and keep their kidneys, sight and legs.

Here in San Diego, the director of a large diabetic free clinic told the Associated Press that a third to half of their formerly middle class patients who have lost their jobs are not taking any medications. He added that the number of people seeking samples has recently grown by a third, and he used the word “rationing,” too.

Got ideas for solutions to this dilemma?

Please share them.

Regulation Versus Price Hike: Which is More Lethal to Big Tobacco

My mom always told us never to use the word “hate,” but when it comes to the Big Tobacco, well, I can’t help myself.

How many nurses have watched how many people die—slowly and painfully—as a result of smoking or using other tobacco products? I can answer the second question; it’s about 438,000 people every year.

Several of my relatives have been among these. Most started smoking in the 1950s or earlier when the tobacco companies told us that it was cool to smoke, that smoking made us sexier, that it was a good way to keep off weight, and—this seems unbelievable now—that certain brands were actually recommended by doctors. So sadly, these people were soundly addicted by the time the surgeon general officially and belatedly pronounced that smoking was dangerous to health.

And what do smoking-related illnesses cost us?

About $75 billion a year.

Imagine what we could do with that money if we didn’t have to spend it taking care of people with lung cancer, mouth cancer, esophageal cancer, cancer of the larynx, emphysema and a whole bunch of other health problems to which the use of tobacco contributes.

I almost cheered and kicked up my heels last week when I read that the tobacco industry will finally come under the control of the Food and Drug Administration. At first, I couldn’t believe my eyes; this move was unimaginable just a decade ago. The idea that the FDA would regulate the production of tobacco products used to be Big Tobacco’s worst nightmare. Unthinkable, they argued.

I’m not sure how the FDA will regulate a product that is designed to kill you or make you an addict. At the least, the agency should be able to assure us that cigarettes contain no asbestos, as some once did, and that the levels of nicotine in cigarettes are not surreptitiously increased.

Still, I’m a little nervous because FDA regulation is supported by the biggest tobacco company, Philip Morris USA, which is responsible for 50 percent of cigarette sales in this country. Big Tobacco never does anything that isn't to its benefit. For instance, they were more than happy to put warning labels on cigarette packages because that took them off the hook for liability.

I’m thinking that the recent hike in federal tax (62 cents), which makes the price of the cheapest pack about $5.50, may do more than anything else to snuff out the sale of cigarettes. Quite a few smokers who were interviewed by television reporters after the tax went into effect threw up their hands and said, “I can’t take it anymore. I’m quitting!”

We can only hope.

Insurance Company Blacklists - No Surprise

I read a story in the newspaper yesterday that made me choke on my hot chocolate, even though it was about something that I have suspected existed anyway.

Insurance companies have blacklists—confidential information that contains all the conditions for which you are automatically denied coverage.

But in our hearts, we knew that.

We’ve all heard stories of people who have been denied health insurance—maybe more than once—because of various health problems like a history of kidney stones, or because the applicant is taking a drug for diabetes, high blood pressure or depression.

I have a friend in his late 50s who hikes miles at high altitudes, cycles about 100 miles a week and does heavy yard work, but he takes a drug for high lipids. His family has those genetics. He’s probably 10 times healthier that most men his age, but he’s been denied insurance coverage several times. He finally found a policy for $700 a month. He’s not anxious to grow older, but paying this much for health insurance has him counting the days until he qualifies for Medicare.

Even scarier are the “data-mining companies” that store “information about your health, including detailed usage of prescription drugs.” These companies then sell this information to insurance companies. Is this legal? And how do they get this information?

Directives to agents and salespersons on withholding coverage are often available on insurance company Web sites. People more clever than I have broken through the computer system barriers and discovered the blacklist manuals, usually called something like “Guide to Medical Underwriting.”

One company executive, when pressed, refused to talk to the reporter (John Dorschner of the MCT News Service). Instead, the company produced a statement that, paraphrased, says that “we follow industry standards, don’t break any laws and won’t talk to you about this subject.”

The bottom line is that health insurance companies are in business to make money. That means their goal is to pay out as little as possible, and that’s in direct opposition to subscribers’/patients' needs.

I know I’ve posed these questions before, but they bear repeated consideration:
Should such enterprise exist at all?
Should anyone make a profit by denying needed health care?
Should 10 cents to 30 cents of every dollar spent on health insurance go for overhead and profit of the company that sells it?
Should CEOs be making millions while 47 million people (and counting) have no health insurance?

If we were to have some sort of universal health care system, it wouldn’t mean that everyone could have everything. We might not want to pay for heart transplants and experimental surgeries, but everyone should be able to receive a certain level of health care, with an emphasis on prevention, and health coverage shouldn’t be connected with employment.

Tell us what you think.