See no Ebola, Hear no Ebola, Speak no Ebola

016“The Nurse Killer Disease” is Ebola’s nickname in Liberia. And its coming to a hospital near you. Will your hospital be ready?

According to National Nurses United conference call today, and reports all over the country, and abroad, hospitals are NOT prepared for Ebola – not at all.

Why is there no political support? Talking heads just keep talking.

Why do hospitals have no mandated training, no consistent guidelines or policies, no protocols, no adequate PPE or  hands-on training with practice?

Why are potentially adequate hospital isolation rooms not being reserved for Ebola cases – in favor of totally inappropriate rooms?

Why is a nurse being fired, for calling CDC to get advice on how to handle a potential Ebola case, in the name of a HIPPA violation?

How can hospitals get housekeeping to clean Ebola rooms adequately and dispose of used PPE and other waste from those rooms?

How many nurses will die and transfer EVD to others because of hospitals denying adequate training and appropriate PPE?

Per one of the expert speakers – whether or not EVD is classified as being transmitted by aerosol, the EV is now known to demonstrate an affinity to macrophages in the respiratory system where it replicates itself. Tiny particles become airborne as copious sprays of emesis and stool are broadcast. So whether or not the affected person develops respiratory symptoms, inhalation still could have been the mode of transmission.

Donning and removing PPE is, of course, the most vulnerable time. PPE needs to be impermeable. Rooms need to be negative pressure.

Caregivers need to wear respirators – not surgical masks. Preparadigm N-95 respirator is recommended underneath impermeable PPE that covers all. Massive supplies will be sorely needed.

Don’t let your hospital get away with saying that traditional contact isolation gear will protect you. Band together and insist.

If a member of the management team had to enter the room of an Ebola patient, you can bet your bottom-dollar that they would put on the best quality hazmat suit known to man.

Well-known, retired pediatric brain surgeon, Dr. Ben Carson, said: “I have no desire to induce panic, but we must realize that some viruses are known to undergo mutations, which make them even more virulent. If the Ebola virus becomes even more pathologic, the ensuing panic and destruction of human life could go far beyond what is currently being acknowledged…”

Fear, fear, fear, fear, fear. It can paralyze us, or it can push us to action.

Where will help come from? It may need to come from you. Here is your time to shine. Be passionate. Be heard. This is life or death – seriously.

More is being learned daily about Ebola. Know and practice at least the currently accepted CDC protocols found at www.cdc.gov .

The National Nurses United website has created a marvelous “toolkit” that is a must-see for all nurses: http://www.nationalnursesunited.org/pages/nnu-nurses-toolkit . It is a great place to start as you arm yourself with critical information.

If you see a breach of safety, call NNU at: 1-888-381-4585. They promise to keep your call as confidential as possible.

When given a chance to use more – or less – PPE, choose MORE. Cover it ALL up, baby!

L’Chaim! (To LIFE!)

What Kind of Ebola Isolation Breach Occurred in Dallas?

CNN reports a “breach in protocol”. Besides that, I wonder – is existing protocol is appropriate and sufficient?

Apparently, the first US Ebola victim, Duncan, had contact with at least 48 people before being put on isolation. And the nurse who contracted the virus was not among these 48.

At this time, reports say that no breach in protocol has been identified – but they also say that there was a breach. What???

In addition to that conflict, there is still another big question hanging in the air – Are the current protocols adequate for this type of virus? Oh, and are supplies sufficient?

Add to the mix – many of us have worked at hospitals that insisted staff answer their companion phone every time it rings – even if staff is in full isolation gear inside of an isolation room.

This pr028actice is infuriating – to say the least – not to mention that it is dangerous and unnecessary. And I can’t help but wonder if one of these types of practices is what led to the nurse catching the deadly Ebola Virus Disease.

Removing isolation garb is the most critical step in staying protected from the Ebola virus. And the nurse in Spain who caught Ebola said she may have touched her face when removing her mask.

So, in Dallas, was it really a breach in protocol? If so, was the breach noticed – reported – addressed? Is the protocol insufficient?

And the million-dollar question: Have CDC and hospital management teams taken into account all of the other processes that currently interfere with a nurse protecting him/herself and others when working in an isolation room?

Taking your personal stethoscope into an isolation room is prohibited. The same rule should be applied to companion phones, personal cell phones, and all other items in pockets for which a nurse might be tempted to reach.

In addition, nurses in isolation rooms should be left undisturbed by overhead communications (often used in lieu of the companion phone.) Nurses should be permitted to focus on the duties at hand so as to finish and get out of the room quicker.

After all – would it really be that much trouble for the ward clerk or the charge nurse take the call and handle the issue while the nurse is detained in the isolation room trying to save a life?

Yes – a little frustration just popped out there. But you must admit – that is a genuine issue. And it contributes to problems in maintaining proper isolation – whether for Ebola, MRSA, VRE, C-Diff, or other conditions.

So what can the bedside nurse do? Be assertive. Decide to work by-the-book (the CDC book) to save your life and the lives of others. And do not let authorities bully you into breaching accepted protocols.

All you can do is the best you can do. Chances are – your assertiveness will inspire your coworkers to do a better job too.

Cheers!

Ebola – What You Always Wanted to Know

You know those public restrooms with blow-dryers for your hands? Aren’t they great? That is until you want to open the door to get out.

Do you use your shirt tail, toilet paper, or ???

Enter Ebola.

According to WashingtonPost.com Ebola virus can easily live on the door handle for hours and infect you with no problem. Oh – and don’t forget about the toilet flush handle and the sink handle.

And I don’t want to ever shake hands again. Maybe we can just bump elbows!

This virus is transmitted a lot easier than HIV. We are talking about blood, saliva, mucus, vomit, feces, semen, urine, breast milk, and even sweat and tears.

Except for the semen, nurses can come into contact with all of these bodily fluids on a daily basis. And – oh, lovely – the virus stays alive for several hours to several days on surfaces. But simple household bleach kills it.

And if an Ebola-infected person coughs or sneezes into your face, and their saliva gets into your eyes, nose, or mouth, you could become infected.

What are traditional ways to catch Ebola? Initially, it comes from contact with bodily fluids of bats, monkeys, and apes, as well as forest antelopes and porcupines. Once a person contracts the disease, it can be transmitted human to human.

According to CDC, CDC.gov an infected person can transmit the virus only after they become symptomatic. Symptoms include: fever, headache, diarrhea, vomiting, stomach pain, muscle pain, and unexplained bleeding or bruising.

Symptoms usually begin 8-10 days after exposure – but can begin as soon as 2 days.

How long does it take to recover? MD-health.com says that if you survive the first few weeks of illness, you are considered to be on the road to recovery.

After that, weeks of rehab are required to repair muscle damage and restore wellness. The virus remains alive in semen for up to 3 months after recovery, so males can still be a threat for that length of time. EVD can remain in breast milk for a prolonged period as well.

Fatality rate is 25-90% according to who.int .

NPR.org says that the most likely time to die from EVD is in the first 10 days. But if the person survives through the initial crisis, their body will begin to create antibodies against the virus.

Once the person has recovered from the infection, it is believed that they will have a life-long immunization against it. Treat EVD with rehydration and supportive care. There is no approved medication or vaccination as of yet.

Unapproved meds en.wikpedia.org says that ZMapp works a lot like immunoglobulin by producing passive immunity. However, the body itself naturally produces antibodies to EVD in response to the illness. So who knows whether it was the ZMapp that helped the two survivors who have been all over the news lately or if they would have done just as well with just supportive care?

Also, en.wikipedia.org/TKM says TKM-Ebola is the second drug used but is not getting as much attention due to possible side effects.

So, there you have it – On surfaces, use bleach. On your skin, use soap and water or alcohol-based hand cleanMoringa tree in the sunser. Don’t play with wild animals in West Africa. If you get infected anyway, seek medical attention immediately and say your prayers.

And that’s about all I have to say about that.

Cheers!

Resources in links.

When the Confused Patient is Your Parent

Nursing can be pretty task-oriented sometimes. It is natural to consider how much more time some patients will take than others – but what if somebody’s patient is your parent?

Whether the patient is fall risk, flight risk, combative, or all of the above, they require more frequent rounding and re-orientation – which sometimes does not even last long enough for you to leave the room.159

But what about when the patient is your very own parent? That changes everything, doesn’t it? When your own mom or dad is in the hospital, their coping difficulties touch you in a different way.

On one hand, it can be a big advantage to be “just” the family member. You might be appreciated by the staff.  You will probably get to spend more quality time with your parent that would have often been uninterrupted by normal household activities.

But, on the other hand, you could easily come to feel like an abused slave when you find yourself the only one performing the ADL’s for your parent. At the same time, you might even find it difficult to have linens brought to you in order for you to provide the shower and bed changes.

Some Med-Surg floors can often be so short-staffed that family member/sitters are actually criticized for not doing most of the work for their parent.

I haven’t told you anything new so far. But what about the advocate piece? Who could possibly be a better patient advocate for your confused elderly parent than you? And who better than you could preserve and promote your parent’s dignity?

As a nurse, you know what care is reasonable. As a son or daughter, you care more about their fair treatment than anybody else on the planet.

Doctors want to see the patient’s numbers improve. Case managers want to assure a fast, safe discharge and good insurance coverage. Nurses want to provide a fair and equal amount of care to all of their patients.

But 158you – you have had those critical conversations with your parent. You know their feelings about life-improving vs heroic treatments. You have had the DNR conversation with them. You know how your parent, and the rest of the family, feels about all of these big issues.

As hard as this is to think about, it is truly a huge honor to be the one who cares for your parent in the hospital.

It is also one of the biggest ways you can honor your parents at this time in their lives. They possibly can no longer communicate effectively, and they need you to do it for them.

To all the friends, family members, caregivers, and loved ones – you may have got only a little while longer with them – and too soon they will fly away. So, thank you for being there for them. Even if hospital staff takes advantage of you and expects too much of you, thank you for being there for your parents. Thank you for being their hero.

Cheers!

Never Have a CVA in Another Country – the Canadian Tourist

ER called report. My next admission was a stable middle-aged male with TIA. OK, another TIA – I knew the protocol. No big deal on my M/S unit.

He was a Canadian tourist who was in town with a tour group composed of his fellow church members.

He arrived alert. But when we asked him to stand and transfer from the wheelchair to his bed, he could not bear weight on his left leg or use his left arm effectively. His speech was a little slurred as well.

The transporter read my furious expression and went into defense mode. She swore, with a vow, that he was not like that when she put him into the wheelchair just minutes prior.

I was livid! This was no TIA, and putting an evolving CVA into a regular hospital room was not OK. I told the charge nurse and called the doctor.

The charge nurse, and several other nurses, verified my claims. But still – we could get no orders for an ICU transfer – no orders to consent him for TPA – and no explanation of why!

The next day, the doctor told the patient that he had, indeed, had a stroke. He said that our hospital would work with his Canadian insurance and provide him with the best treatment options that his policy would allow.

And the doctor added that it was wise of him to have taken out a traveler’s health insurance policy to cover him on his trip. I was thinking, “Then why didn’t you do more for him yesterday?!”

With the news of his diagnosis, he was shocked and called his daughter, with help, and she said she would fly down to see him immediately. He cried – and I felt like crying too.

Soon the therapy began. He was given PT, OT, ST, and every kind of TLC we could think of for him. What a kind person! We all liked him so much!

His tour group visited him. His daughter came and brought him mementos from home. He was a well-loved mRed Maple Tree Canadaan.

Meanwhile, our hospital case managers worked with the Canadian insurance people to try to get him home as soon as it was safe for him to fly.

I could not help but wonder, since his CVA was not hemorrhagic, was the lack of aggressive treatment that first day political or insurance-related? Doctors would not answer.

Did his traveler’s insurance contain exclusions? Did our hospital really provide this patient with the best that his country allowed? Were our hands really tied?

I guess I’ll never know about his particular case. But the patient stayed with us a good two or three weeks -receiving his therapies until such time that he could return home.

What a remarkable and kind gentleman! He went home with deficits. But at least I know that the nurses, therapists, and case managers provided him with the very best that we could give, and it was a pleasure to do so.

For more information about traveler’s insurance: Prepare, Travel, Return: A Beginner’s Guide to Globetrotting and
Healthy Travel: Don’t Travel Without It!

I’ll Bet You Do it Unconsciously

What is it that comes so automatically to nurses that we don’t even realize we’re doing it? You do it when you trainIMG_0194 your dog, select your produce, buy a new outfit, create a new budget, teach your children – and even when you fight with your SO.

What is it?

Here is a hint. It starts with assessment. Yep, its the nursing process – so let’s  pick a problem. I want to bond better with my Grandma’s dog and have fun with him by teaching him a new trick.

The trick I want to teach him is to jump through a large, flaming hoop. The dog is a nine-year old, tiny, Toy Poodle. But he can hear well and likes to obey to get treats.

Admittedly, he isn’t really big or agile enough to jump through a ring of fire – but if my catcher on the other side is super-able to catch the carefully tossed furball….

Oh no! That is a problem!

The diagnosis – What do you think? Do you like: “Knowledge Deficit – related to unrealistic and scary dog trainer!” ? Well, maybe you would word it a little differently?

Planning probably uses more brain cells than any other part of the process, and this is the part that pays off the most. You might consider using pamphlets, videos, or live demonstrations. You will obviously encounter objections and questions for which you will want to be prepared beforehand.

By the time you reach implementation, you are thoroughly ready for your well-thought-out teaching tasks. We discuss, cuss, and discuss some more. And then you have me try an easy (substitute) trick with said tiny dog.

IMG_0187Lastly, (and I use that word loosely) how did it work out for you? Your evaluation is where it is the most tempting to fudge or compromise.

For instance, some might say, “That’s good enough.” But it is also a golden opportunity to start over fresh for an even better result. (Or is that my OCD talking?)

That’s the thing about the nursing process. It never ends. Its a cycle – way of life – and can even be a way of putting some of life’s biggest problems into perspective sometimes.

The Nursing Process – putting into words, and steps, the things we already do every single day.

Want to find out more? Applying Nursing Process:: A Tool for Critical Thinking 7TH EDITION
and/or Nursing Process: Concepts and Applications

Cheers!

What Surprising Factor Drives Patient Satisfaction Scores?

Patient satisfaction scores RULE. Nurses are constantly being told to change aspects of their practice, in order to raise “those sacred scores.”

But what is the number one underlying factor influencing the scores that patients give?

Just to validate surveys for a second – most of us appreciate honest feedback. Even in personal friendships, we like to know if what we offer to the relationship is beneficial. Feedback gives us a chance to alter our future behaviors – or not.

Not surprisingly, because of their effectiveness, satisfaction surveys are widespread – not just for hospitals. Most businesses ask customers to participate in their surveys.

Why? Because the results are valuable to competition and business growth. Survey Monkey says its all about patients/customers receiving what they expect.Scan0004

Of course you know patients want to feel that you know them very well. They like for you to speak to them in plain language, and to make sure they really understand the content and how to apply it. They also want to feel your positive attitude and see great teamwork.

Am I saying that its all about YOU? YES! I am saying it is all about YOU.

You are the one they have to trust with their lives and well-being for 12 hours. You are the one they hope will get their medicine right, keep them safe, advocate for them, and promote their healing with knowledge, compassion and honesty.

They are trusting their lives to you. What an honor!

But what makes YOU feel positive and work well with your team? Had you thought about how much your own feelings about your work directly influence your patients’ perception of their own safety?

In other words, do you and your nurse managers realize how closely YOUR satisfaction is linked to your patients’ satisfaction scores?

Not surprisingly, according to Science Direct, a strong correlation was found between poor patient satisfaction surveys and burned out nurses.

Patients who had nurses who were exhausted and ready to quit gave negative scores. Conversely, patients cared for by nurses who found their work meaningful, gave higher scores on their surveys.

The bottom line seems to be that, “IF MAMMA AIN’T HAPPY, THEN AIN’T NOBODY HAPPY!”

In other words, if nurses are not happy, and no longer view their job as meaningful, the patients will sense it and feel less confident that they are getting the best care possible. Studies across the globe have found this true, as you will see in the article in thebmj .

So, for floor nurses and nurse managers alike, “THE SURVEY SAYS”: Patient satisfaction = nurse job satisfaction. Food for thought, eh?

Cheers!

Sources for this article:

Survey Monkey

The Profitable Practice

Science Direct

The bmj

For more information, see:

Love Your Patients! Improving Patient Satisfaction with Essential Behaviors That Enrich the Lives of Patients and Professionals
TIME to CARE: How to love your patients and your job
How to Survive and Maybe Even Love Your Life as a Nurse

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