Archive for the ‘Uncategorized’ Category
Posted on November 8, 2011 - by Nurse Virginia
END OF LIFE DECISIONS – WHEN MEDICINE JUST DOSEN’T KNOW TO STOP
When continuing treatment is pointless, who determines it is time to stop? Arlene was 87 years old and had suffered significant decline in the past year cognitively as well as functionally. But the last four months had been nothing short of a nightmare. Arlene was in a house fire and sustained burns over 50% of her body. Now, in the emergency department of a large hospital, where Arlene was now going to be a patient for some time, the team swung into action to save her.
The hospital did numerous skin grafts that were really difficult on the elderly Arlene. But during the last four months she had also suffered a stroke, pneumonia, multiple infections, heart failure, respiratory distress and now after all she had been through she was unconscious and on a ventilator for the last month.
Before the fire Arlene had often spoke of her readiness to die. All of her contemporaries had already passed away and she was ready when her time came. But even though she had a Do Not Resuscitate form signed, the fact that she was in the fire changed everyone’s expectations of Arlene’s “end of life.”
When Arlene’s daughter tried to bring up the subject of “letting her go,” to the hospital staff, they only spoke of the immediate issue; a stubborn graft that just wasn’t healing, increasing her nutrition via the tube in her stomach, etc. The fact that she was 87 years old and unconscious didn’t seem to be of significance and no one even suggested that a decision should be made.
Arlene’s daughter had to become very assertive. She went to the Medical Director who reviewed Arlene’s chart since admission and could clearly see how the staff had become caught up in the many facets of this case and no longer saw Arlene. Once someone could see Arlene, the staff could move on to support her daughter.
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on November 7, 2011 - by Nurse Virginia
THE FUTURE OF HEALTHCARE – COMMUNITY BASED CARE AND CAREER OPPORTUNITIES
Healthcare is rapidly moving out of the hospital setting and into the community. Only the most difficult and complicated cases are remaining behind in the hospital. This shift in practice in not only in the U.S. but around the world and will be responsible for many changes.
If you are hospitalized in the U.S., they better get it right while you are there because re-admission will be frowned upon. There will now be a monetary penalty against a hospital of 1% in 2013 for re-admissions, according to the Hospital Readmission Reduction Program. From there it will increase to 2% penalty in 2014 and 3% penalty in 2015.
The point being, that when a patient is discharged from a hospital the facility must provide education on the disease process before discharge, and will be held accountable. Making mistakes in self-care including miss-medication will be regarded as poor teaching and a patient that was not ready for discharge.
I well remember a member of my family who was caught up in the hospital revolving door situation about 10 years ago. George had congestive heart failure and needed frequent monitoring of weight gains, diet and medication usage. After many re-admissions his wife literally threw up her hands and said – “you take care of George.”
From that day on, over the next six years George was never re- admitted to the hospital again. When he died, it was in his apartment, with his caregiver at his side and not hooked up to any machines.
What it took was constant vigilance to watch for symptoms and adjust accordingly. Eventually his caregiver was able to monitor his well-being with little additional input.
This change in healthcare opens up many new opportunities for nurses as well as other healthcare professionals. A need for what will be referred to as “Transitional Care” and “Transitional Coaches” will be needed to assist in accomplishing the goal of reducing hospital re-admissions. The Georges of the future will be getting much more help and support.
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on October 24, 2011 - by Nurse Virginia
THE FAT OF LIPEDEMA IS VERY DIFFICULT TO HEAL
Carol said she had, had a “little accident,” someone had spilled scalding hot water on her leg. This would be a serious situation for anyone but for Carol, those words held special significance. You see, Carol has Lipedema a rare fat disorder that causes fat to be stored in her lower extremities, never to be released from her legs. Since her teen years the lower half of her body had just grown larger and larger. Until now, at close to 300 pounds Carol is pretty much immobile and home bound.
Although an accident with scalding hot water would be terrible for anyone, for Carol this event could be potentially life threatening. Fat is very difficult to heal and the fat associated with Lipedema even more so. The potential for infection to set into the wound is very high indeed, due to the limited circulation in fatty tissue.
The person with Lipedema needs to take very good care of the skin on their legs and do a daily inspection. Many times the individual with Lipedema is unaware of an injury.
Barb wanted to try a new cream on her legs that offered some comfort measures for the aching that accompanies Lipedema. While applying the cream, Barb was surprised to see an open bleeding wound on her thigh, that she wasn’t even aware that she had. She had felt no pain and was unaware when she might have injured herself.
Carol’s burned area was the size of a dinner plate. She needed to go immediately to an emergency treatment center to begin the three step program of preventing infection, healing the injury and receiving pain relief. Carol reported a week later that she did have a nasty looking green area on her leg that was draining, but on the whole the area does look like it is healing.
When you are dealing with a disorder like Lipedema, there is no such thing as a “little accident.”
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on October 17, 2011 - by Nurse Virginia
BEING WITH SOMEONE WHO IS SERIOUSLY ILL
Book excerpt:
Sometimes the thing people need from you the most is the hardest of all….to just be with them. It’s easier to run around doing things, keeping busy and solving specific problems, than it is to just be there with their pain, their fear, their anger, their guilt.
Listening, without interruption, can be difficult for those of us who are “talkers.” But listening has its rewards. You may truly learn what it is like to be in someone else’s place. You may gain remarkable insights from people facing their mortality. Only one thing is certain. If you allow the seriously ill individual to fully express himself, it will bring you closer. There are many things you may never have to do as a caregiver but listening is not one of them.
Learn to listen. Try to be patient when people tell you the same thing over and over. Remember, the information they’re dealing with may be so shocking to them that it may require a lot of processing for it to sink in. No matter how understanding their doctors are, no one in the medical establishment can give them what you can …..time. Listening can be a form of healing because it lets them know someone cares.
For the dying person, their reality is shifting rapidly. Sometimes they go through psychological changes in a matter of months that would normally take years. If you don’t listen, you won’t know what’s appropriate at any given time.
Pay attention to what they say. If they say they can’t breathe, listen. If they say they don’t want to go to the hospital, listen. Also listen to the little requests. If they want a certain new music selection to make them feel better, listen. They’re already feeling like they’re losing control. If you don’t listen they will feel this even more.
Book except: Share the Care by Cappy Capossels and Sheila Warnock publisher, Simon & Schuster
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
www.pleasegettoknowme.com
Posted on October 6, 2011 - by Nurse Virginia
CELLULITE – THE SCOURGE OF EVERY WOMAN, CONNECTED TO FOOD INTOLERANCE
(Book Excerpt)
Fat storage in the body is controlled by special receptors in each fat cell. These receptors are called alpha2 receptors. Various hormones may stimulate alpha2 receptors and open the door into the fat cell to allow the deposit of more fat into the cell. The most prominent of these hormones is insulin. Insulin in the blood encourages more fat to be deposited into storage.
On the other hand, beta-receptors open the figurative back door of the fat cells to allow fat out into the bloodstream. Hormones that stimulate the beta-receptors are thyroxin and adrenaline.
As Dr. Dancy poignantly points out in her book “not all fat is created equal.” In women the fat cells around the hips, thighs, and buttocks have six times as many alpha2 receptors as beta-receptors. This implies that fat can be stored six times as fast as it can be released from these areas. Many women will attest to this truth. Elsewhere in the body there are six times as many beta-receptors. This means fat will be lost six times as fast from these areas. Therefore, physiologically, if fat is to be gained, it will most likely show in the hips, thighs, and buttocks. And when fat is lost, it will come from the upper body in most women. This is truly the worst of both worlds and explains a lot. No matter the reason for the weight gain, the overweight will appear on the hips, thighs, and buttocks of most women and on the upper body on men.
Book excerpt from: Your Hidden Food Allergies Are Making You Fat by Rudy Rivera M.D. and Roger Davis Deutsch – Three Rivers Press, New York
I highly recommend buying this book and passing it on to your nearest and dearest. Not only for cellulites, obesity, and Lipedema but also for all the many disease processes that are linked to inflammation.
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on October 4, 2011 - by Nurse Virginia
INFLAMMATION – THE LINK TO MANY DISEASES
Every disease process seems to be tied to inflammation. Whether it is arthritis, diabetes, Alzheimer’s disease or even cancer, the health care community agrees that the common link when it comes to disease is inflammation.
The definition for “inflammation” is literally – to set on fire. Many people would agree with that definition because inflammation involves redness, heat, and always pain in a part of the body. Well not “always” – internal inflammation will most likely not be painful as there are few pain receptor sites on internal organs.
It is much easier to avoid something that causes an immediate reaction (say an itchy sweater) and can be seen then something that is causing inflammation inside the body. This is the difficulty with food intolerances, they can’t be seen. These foods are causing inflammation in you the individual who has sensitivity to it and not in others.
I found out years ago that I was allergic to oranges. By the process of elimination I found that citrus especially oranges gave me eczema. Up until that time I had horrendous eczema on arms and neck. When I gave up citrus the eczema was much better but not gone until I realized I also had a severe reaction to furniture polish. My answer was to not eat oranges and stay away from furniture polish and my eczema was gone.
What if there was something as simple as a blood test that could tell you all the foods causing inflammation – inside your body. A test that could tell you which of the 211 foods tested you are sensitive to, and which foods are making you sick.(the test I took required a prescription from a licensed physician – call for info at 847 640 1377)
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
www.pleasegettoknowme.com
Posted on September 26, 2011 - by Nurse Virginia
WE NEED TO ENCOURAGE OUR YOUTH TO CHOSE THE NURSING PROFESSION
Future Nurses of America – was an afterschool club when I was in high school. It was common then for kids to stay after school and participate in future Nurses of America or Future Teachers of America. I don’t remember a shortage of nurses in those days. Maybe those clubs were effective in motivating students into joining the nursing or teaching professions.
How did the United States come to a time when so many of our nurses have been imported from other countries? It is far too frequent now to go to a hospital or nursing home and find all foreign born nurses.
The problems that come along with this situation only begin with a decline in accurate communication due to a difference in language. Even someone who has been using English for several years can easily have a misunderstanding related to translation problems. Health care is not an area where you can tolerate a miscommunication.
There is also a difference in the way nursing schools teach in other countries. In the US nurses are pretty much taught how to be safe and then where to find information and to think for yourself. Many foreign nurses on the other hand are taught to practice in a more dependent role. Patient teaching doesn’t usually come into play for these nurses as well.
I still am of the opinion that every family needs to have a nurse somewhere in their ranks. Someone to go to when you just didn’t understand what the doctor or lab tests were telling you. Someone who really cares about the family’s health issues, and can talk to the physician in a professional to professional manner.
I just found a very informative site to locate nursing schools at: Nursing-Degree-Online.org (find at http:www.nursing-degree-online.org)
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on September 19, 2011 - by Nurse Virginia
WILD FIRES ALL OVER TEXAS – WHY IT IS NO SURPRISE
In his book Mad Cowboy Howard F. Lyman explains in a clear easy to read way how the livestock industry in America is causing damage to the environment. Mad Cowboy is a must read for anyone concerned about the increase in obesity, heart disease, cancer and yes even diabetes as well as the world wide destruction of the environment.
Book Excerpt:
By introducing cattle in unnatural numbers onto marginal land where they do not belong in the first place, we are tampering dangerously with complex ecosystems. An insidious spiral develops: overgrazing leads to more dust and drier air (as less water transpires from vegetation), leading to less rain, resulting in still less plant life. Also, topsoil bared to the elements tends to experience greater extremes in temperature, destroying root systems and soil organisms. In the short run of a century or so, the damage to overgrazed land could result in the kind of desertification currently afflicting the American West, about 10 percent of which has reached the state at which it can barely support life. In the long run of several centuries, we in America could be creating another Sahara-for the Sahara itself was a region luxuriant with trees eight thousand years ago, before nomadic tribes began burning the trees to provide grazing for their herds.
There are few human accomplishments on the planet that are viewable from space. Two of them are the Great Wall of China, and the fires that are burning in the Brazilian rain forest. As many as seven thousand have been detected burning in the Amazon in one day, as ranchers find fire to be the quickest and most expedient way to clear land. More of Brazil is aflame now than ever before. An area about the size of Maine is cleared from the Amazon annually. While most Americans are concerned about rain forest destruction, few realize that cattle ranching stands as its salient cause. An estimated 70 percent of the clearing of the Amazon is for cattle pasture. In fact, “pasture” is perhaps too generous a term for what cattle get. Rain forest topsoil is notoriously poor in nutrients and is fragile. Its mineral base is exhausted after a few short years of producing grass, and luxurious jungle degrades to desert in a wink of history.
I urge you to read Mad Cowboy PLAIN TRUTH FROM THE CATTLE RANCHER WHO WON’T EAT MEAT by Howard F. Lyman with Glen Merzer published by Simon and Schuster, New York.
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on August 24, 2011 - by Nurse Virginia
BEING RUDE IN THE WORKPLACE – ESPECIALLY IN HEALTHCARE WE NEED TO BE CIVIL
What makes healthcare workers cross, rude, and sometimes insensitive to each other? Possibly the same things that make everyone else short, impatient, uncivilized and impolite. Lack of civility to one another has become common. Nurses have always had this saying “We eat our young.” And that is true. So often the nurse to be bullied is the lowest ranking nurse, the new graduate. This has nothing to do with your age, just how long you have been in nursing, what you have done and what you have seen.
Rude, disruptive, and intimidating behavior to others can happen in any setting. I have attended several Women’s Groups in Churches and been greeted with that same stare and “we’re together, your alone’” looks from the “group.” It doesn’t always have to be something spoken or a sarcastic remark. It can be eye-rolling or intimidation by dominating the conversation, and leaving you out.
This type of behavior can be due to over work, over stress, or just rushed and unhappy people. Sometimes it can just be due to the fact that many people don’t like anything or anyone new. In the past when we had a problem keeping new staff because the current staff was so unfriendly to new comers. I would tell the employees, the next person who starts here may become your best friend, think about that.
Stopping this type of unkind behavior may mean becoming more kind and thoughtful yourself. If you are always conscious or aware of others and your approach to them, you may see a difference. You could spend more time focusing on what the other person wants instead of what you want
This doesn’t mean you have to lie down and let everyone walk all over you. Keep in mind that bullying behavior can only work as long as people let the bully get away with it. Speak up – say something. Don’t go into clichés like “Who died and made you boss?” But talk about how you feel, how the thoughtless words affected you.
If you can help the person know how hurtful the words or tone they use are, there just might be something in it for them, to cause change.
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on August 18, 2011 - by Nurse Virginia
HOW TO GET MOTIVATED AND CHASE AWAY THE BLUES
I just got a new car, and no I am not going to suggest a new car will chase away the blues. But what is there about a new car? Is it because it is so clean and shiny that it lifts the spirits? I think some of it might just be kicking you out of your comfort zone. When you change things up abit it makes a person more aware, you need to be on your toes. Where did that book say the trunk release was? That doesn’t look like a trunk release to me, are you sure?
Instead of literally being on automatic when you drive, you have to be more aware because things are in different places. So at the same time you are on high alert to operate the car, you become more aware of the car and in so doing enjoy it all the more.
That same awakening experience can be achieved by just mixing things up a little in your office or home. Move a few things around- this picture in the same place for 10 years would look great and new again on another wall or maybe on a stand. That lamp you inherited from your mother could be better enjoyed on the other end of the living room. (If you have so much stuff on top of the lamp, you can’t even see the lamp, you a have another problem –please search “hoarding” on this blog site)
When you have the blahs, shaking things up abit might be the answer. The definition of “doldrums” is a state of low or no activity. Getting yourself out of the doldrums might just mean waking yourself up by changing things around. Go through your house and try to move about 25 things – small moves – and see if it doesn’t take away the blahs.
A little Feng Shui could chase the blues away.
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
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