Monday, October 30, 2006

85 million Americans CAN be wrong

A recent PEW Internet survey demonstrates that of the 80% of American Internet users who ahe searched for health information, only 25% check the source and date of the information all of most of the time. That translates to approximatel 85 million Americans whoa re "gathering health advice onlnie without consistently examining the quality indicators of the information they find. View the full PEW report here

To make sure YOU know how to evaluate health information sources on the WWW, check out some of these tools:

National Library of Medicine's Evaluating HealthInformation: a tutorial

Health on the Net (HON) Code of Conduct for medical and health Web sites

Sunday, October 29, 2006

The Children's

Well, I started my peds rotation this past Friday. I am at the Montreal Children's Hospital. Nice place, large though... long halls and I tend to get lost easily, but not as badly as when I was at the Royal Victoria last year. I was really hoping to be at the Shriner's Hospital, but hey, I am finally in peds and that is what I wanted!

The floor we are on is a real mix of cases, a medical floor. We even have one long term patient there, nice kid, lives there as he is on a vent. His room is decked out in posters/desk/computer... He goes to school in the mornings usually then comes back around 12:30-1ish. I've actually known him for nearly 18 months, as we used to take transport at the same time.

We had fun the first day on the ward. We started the day by touring the hospital and then on the ward we went on a "treasure" hunt of sorts. We were each given a scenario and had to then seek out the material and procedure info we needed in order to do it. It's fun riffling through drawers/cabinets. We then got to play with an IV pump and tubing. Everwhere we go the pump are all different so it was nice to be able to learn how to program one and trouble shoot BEFORE you actually encounter the problem on a patient.

My teacher is a doll. I love her, she is cool and fun and nice and very approachable! And she has a neat scottish accent.

My one bad aspect of this first day was that we spent from 7:30AM to 2PM walking/standing with very little break time where I could actually sit, so at the end of our conference I very nearly passed out! I felt my BP drop and I nearly dropped too. Sat down and my teacher stayed with me. I was slightly embarassed and really didn't want my teacher to see that the first day, but it gave us a chance to talk and for her to get to know me and my "needs" (ie: sit down a bit more often!).

All in all it was a good first day, I may even end up working in peds!

Thursday, October 26, 2006

Thursday, October 19, 2006

Critical Care Sedation Team

At St. Joseph Hospital, our mission is to deliver safe care and use best practices based on research and the best evidence. Implementation of a practice change is not easy, but will be successful with a dedicated and enthusiastic multidisciplinary team.

The sedation team has been meeting as a group for over one year now. We have added members and some members have left. But the goal remains clear: to develop an approach to patient centerd care of the Critical Care patient who is on the ventilator and in need of sedation. The goal of this plan was to reduce the amount of time the patient spent on the ventilator. We would accomplish this by giving the patient the best sedation at the correct levels for their individual needs. The plan included a daily awakening to assess for readiness to com off the ventilator rather than leave the patient sedated longer than necessary.

Victoria Randazzo, who is the champion of this issue as well as the chairperson of the committee, has brought together a multidisciplinary team to improve the care of this group of patients. Her team consists of Intensivist, Pharmacists, Nursing Clinical Educator, Critical Care unit management and 10 members of the nursing staff, Respiratory Department management and staff as well as Dana Rutledge, the Nurse Research Facilitator.

The team has worked together to develop a set of physician orders that adhere to the policy and procedure that Victoria authored. An education module for the critical care nursing staff was developed with input from everyone. The entire critical care staff attended the in-service which was taught completely by the nurses on the sedation team.

Following this education process, the physician orders were distributed and our plans then went into effect. In addition to this core education, one of the Intensivists provided an education seminar for the critical care staff on agitation and sedation in general. He and a sub group are working on developing a set of physician orders for the non-ventilated critical care patient.

We have just started to proceed with chart review, but we've discovered a decrease in need for patient restraints already. We expect to find fewer self-extubations and a shorter time on the ventilator with subsequent decreases in VAP as well as decreased of LOS.

We have increased patient comfort and our family survey revealed improved satisfaction when receiving care from a kind, loving nurse who is now able to efficiently reduce the agitation and maintain comfort for their loved ones while on the ventilator. The long term team effort - where all disciplines were working toward enhanced patient outcomes - increased the collegial relationship between physicians, staff nurses, respiratory therapy and pharmacy.

Wednesday, October 18, 2006


I passed my Obs rotation so now it is official, I never have to do it again!!! (knock on wood, I have to pass this term!)
I am now waiting to get my biology test grade...

I start pediatrics tomorrow, we have 2 labs then we are in the hospital/community.


Friday, October 13, 2006


It's over! No more OBS! YAY!

New/updated reviews on Cochrane of interest to nurses

The following new or updated reviews from issue 3, 2006 Cochrane Library may be of special interest to nurses. To read the complete review you will need to access the subscription to the Cochrane Library. Nurses at St. Joseph Hospital,Orange and CHOC may access the Cochrane library through the library's web site.

New Reviews of special interest to nurses:

Ad libitum or demand/semi-demand feeding versus scheduled interval feeding for preterm infants

Breastfeeding or breast milk for procedural pain in neonates

Dressings for healing venous leg ulcers

Drugs for preventing postoperative nausea and vomiting

Exercise for type 2 diabetes mellitus

Routine prophylactic drugs in normal labor for reducing gastric aspiration and its effects

Updated review of special interest to nurses:

Aerobic exercise for women during pregnancy

Double gloving to reduce surgical cross infection

Fetal electrocardiogram (ECG) for fetal monitoring during labor

Mechanical devices for urinary incontinence in women

Preoperative hair removal to reduce surgical site infection

School-based programmes for preventing smoking

Telephone counseling for smoking cessation

Cochrane provides free evidence summaries to support decision making during disasters

The Evidence Aid project: Resources for natural disasters and other healthcare emergencies

The following information is taken directly from the Cochrane website.

"This website highlights evidence relevant to the effects of interventions. Its aim is to help people making decisions about health care in natural disasters and other healthcare emergencies. The topics were originally identified as priorities by people in the regions affected by the 2004 tsunami, and relate to interventions that might be used or available. Where possible, a structured summary ('Evidence Update') or another summary has been prepared, based on one or more Cochrane reviews. If a summary is not available but a relevant Cochrane review exists, a link is given to the review in The Cochrane Library. If a suitable Cochrane review is not available, there are links to other sources of evidence, in particular to topics in the BMJ's Clinical Evidence. (The inclusion of links to material from outside The Cochrane Collaboration does not imply endorsement of that material by the Collaboration.) More information on Evidence Aid is available here. If you would like to comment or ask questions, please email "

Infectious diseases
Injuries and wounds
Rebuilding of communities and infrastructure
Mental health

Thursday, October 12, 2006

Finally Over

YAY, postpartum/Obs rotation is finally over this week. 2 clinicals left and I am done with it (today and tomorrow)...

Monday, October 9, 2006

National Institute of Nursing Research celebrates 20th Anniversary

Happy 20th anniversary National Institute of Nursing Research!! Read about the anniversary celebration.

NIH awards $700M to speed translational research at centers nationwide

The NIH this week announced the first 12 participants in a new national consortium charged with speeding the translation of cutting-edge research into clinical practice. The grants will award 12 universities approximately $700 million over the next five years, with plans to distribute an additional $500 million to as many as 60 academic medical centers by 2012. As part of the network, centers will act as “discovery engines” that pool research data to identify scientific discoveries and apply them to real-world patient care, emphasizing improvements among underserved populations, interdisciplinary collaboration among scientists and providers, and the development of clinical informatics tools. For example, the University of California-Davis plans to use its $24.8 million grant to study chronic disease management and establish a new center for clinical and translational research, while the University of Pittsburgh will launch a patient registry program that can be tapped to identify candidates for clinical trials. The director of the NIH notes that the program marks the “first systematic change in our approach to clinical research in 50 years” (NIH release, 10/3; Neergard, AP/Yahoo! News, 10/3; Portland Business Journal, 10/3).

Thursday, October 5, 2006

Travel Nurse: Checklist (Insurance and Benefits)

We need to make sure we find out all we can before we're on the road. Before we sign that contract, pack our bags, and wave good-bye to friends and co-workers, we need to ask a lot of questions. I mean, who wants to put their license in jeopardy, or get stuck in a crappy situation with incompetent or no help?

My next three posts will include a series of checklists that some of you might find helpful to utilize before taking on a new assignment. I recommend printing this and the next two posts (about checklists) out so you can have them in hand before you call or interview with your potential agencies and facilities. Here are some questions or FAQ's every travel nurse needs to ask :


Ask the agency:
* Will I have insurance coverage (malpractice, life, medical, dental)?
* What are the cost and coverage for each type of insurance (maximum out-of-pocket expense, date of eligibility, premiums, and deductibles)?
* When does coverage begin for each? Who's covered? What's covered? Are existing conditions covered? If not, when will they be covered?
* Will I have a choice of health care providers and hospitals?
Can I use the insurance when I travel to other states or countries?
* Will I lose the coverage if I take a break between travel nursing contracts?


Ask the agency:
* Are there other benefits and bonuses? 401(k)? Loyalty program? Continuing-education or travel reimbursement? Sign-on bonus? Completion bonus? Larger bonus for longer stay or for hard-to-fill position? Bonus for referrals?
* Does the agency offer meal allowances? Travel awards? Vacations? Special payment arrangements for items or conveniences important to me?
* If the agency pays bonuses, when would I qualify for one? What conditions must I meet to qualify for it? When would my bonus be paid? Would it be taxed?
* If the agency offers a retirement plan, when would I become eligible to contribute to it? Does the agency match my contribution? If so, when would that begin and what would the contribution consist of? When would I become vested? Into what investments would my funds be placed? Would I have control of my investments? Is there a penalty for withdrawing my money if I stop traveling?
* Will I have typical mileage reimbursement when I travel for the agency or hospital? Will the reimbursement cover a portion for transportation to the assignment and then reimbursement for return to my home (or to my next assignment)?
* Can travel reimbursement be arranged to meet my individual needs?
* How long has the travel agency been in business?
* Does the agency provide support and assistance with license processing, licensing fees, and other credentialing needs?

Asking these questions probably won’t make you the most-liked, but it will certainly help you become well-informed and better prepared. So, get out your pad and paper, and get to asking. If you conduct these simple interviews, it will assist you in deciding which agency and facility you should choose, and give you some peace of mind knowing you will be going into an assignment as a well-informed nurse.

Wednesday, October 4, 2006

Travel Nurse: My Roots In Travel

Some of my fondest memories of my youth are of family vacations. My Dad was (and still is) really into owning real estate. I think he felt like he needed to own a home in every state in the southeastern United States (and he just about did). He and my mom love to travel. When I was growing up, we had a mountain house in Tennessee. I am the one on the rock getting splashed by my sister. I love those cold mountain whitewater rivers, climbing on the slippery rocks.

Tennessee is on my list of places to spend a few months as a travel nurse. I have a looong list.

Monday, October 2, 2006

and Again...?

Yet another school shooting in the US. The 3rd in a week for the US... it's just too much. When will this type of thing stop?
This time at an Amish school.

and possibly another near school shooting.

one word: "WHY?"

Julie's picks from the Nursing Literature September

These articles caught my eye from our September 2006 current awareness search on nursing research/evidence based nursing. Staff at St. Joseph Hospital of Orange and Children's Hospital of Orange County can request copies from Burlew Medical Library or, in many cases, can obtain the full text online through the library's web site. Other individuals should contact the libraries at their institutions.

Accession Number 2009257259 NLM Unique Identifier: 16931921.Author Chulay M.Title Good research ideas for clinicians.Source AACN Advanced Critical Care. 2006 Jul-Sep; 17(3): 253-65. (20 ref)

Accession Number 2009232221 NLM Unique Identifier: 16684165.Author Ng WQ. Neill J.Title Evidence for early oral feeding of patients after elective open colorectal surgery: a literature review.Source Journal of Clinical Nursing. 2006 Jun; 15(6): 696-709. (34 ref)

Accession Number 2009172164 NLM Unique Identifier: 16620252.Author Crenshaw JT. Winslow EH.Title Actual versus instructed fasting times and associated discomforts in women having scheduled cesarean birth.Source JOGNN: Journal of Obstetric, Gynecologic, and Neonatal Nursing. 2006 Mar-Apr; 35(2): 257-64. (40 ref)

2009230807 NLM Unique Identifier: 16801357.Author Gray-Miceli DL. Strumpf NE. Johnson J. Draganescu M. Ratcliffe SJ.Title Psychometric properties of the post-fall index.Source Clinical Nursing Research. 2006 Aug; 15(3): 157-76. (30 ref)

Nursing Research. 2006 Jul; 55(4S): Supplement note: the entire supplement is on smoking cessation

2009210546 NLM Unique Identifier: 16707539.Author Dew PL.Title Is tympanic membrane thermometry the best method for recording temperature in children?Source Journal of Child Health Care. 2006 Jun; 10(2): 96-110. (56 ref)

2009237092 NLM Unique Identifier: 16825921.Author Vitale A.Title The use of selected energy touch modalities as supportive nursing interventions: are we there yet?Source Holistic Nursing Practice. 2006 Jul-Aug; 20(4): 191-6. (36 ref)

Cedars Sinai in Los Angeles: novel approach to increase handwashing

As reported in the Sept 27, 2005 Daily Briefing from the Advisory Council"

"Cedars-Sinai (Calif.): Takes novel approach to promoting hand hygiene
Having exhausted traditional avenues for achieving widespread compliance with hand hygiene guidelines, Los Angeles-based
Cedars-Sinai Medical Center adopted an unconventional approach to raising physician awareness and effecting behavioral change, according to a column in the New York Times Magazine. The hospital’s former chief of staff launched a widespread hand hygiene compliance effort after returning from a cruise, during which he noticed that crewmembers—who dispensed hand sanitizer during the re-boarding process and in the buffet line—were more vigilant than hospital-based providers about proper hand hygiene. Initially, Cedars-Sinai “gently cajole[d] the doctors” with faxes, e-mails, and posters advertising hand hygiene guidelines. Recognizing the need for more proactive intervention, the facility enlisted nurses to police physicians’ compliance, distributed bottles of hand sanitizer in the physician parking lot, and deployed a “Hand Hygiene Safety Posse” to award $10 Starbucks gift cards to physicians who were “caught” washing their hands. Administrators note that although these efforts raised compliance from 65% to 80%, the facility still fell short of the JCAHO-mandated 90% threshold. To take the facility’s performance to the next level, a hospital epidemiologist cultured the hands of providers involved in the hand hygiene effort and created a screensaver to be displayed on every hospital computer featuring images of the “disgusting and striking” bacteria revealed by the cultures. According to administrators, the screensavers helped push compliance to nearly 100%, a level that the facility has sustained ever since (Dubner/Levitt, 9/24). "