Monday, April 30, 2007

it's dreadfully cold
come under the covers here
and let me warm you

Sunday, April 29, 2007

her eyes are blue ponds
wild neglect and overgrowth
where children have died

Saturday, April 28, 2007

I like big muscles
genetic advantages
and daily bench press

Friday, April 27, 2007

American Journal of Critical Care has a new look and adds some "evidence based" features

Michael Muscat, Managing Editor of American Journal of Critical Care, has provided me with this description of the newly redesigned AJCC. Burlew Medical Library users can access via the library's web site the full text of this journal, including the current May 2007 issue featuring the new features and redesign.

"Score another point for evidence-based nursing care and practice. The American Journal of Critical Care (AJCC), the peer-reviewed scientific journal published by the American Association of Critical-Care Nurses (AACN), has just been revised with a new reader-friendly format and more attention paid to everyday clinical challenges. New features include the Clinical Pearls page, which summarizes bedside applications from select articles in the issue, and the AJCC Patient Care Page, which offers AACN best practices following related content in select articles. The May 2007 issue, for example, includes an AJCC Patient Care Page advising readers to seek protocols to address the issue of family presence during CPR and invasive procedures in the ICU. AJCC journal club articles are now accompanied by the EBR or Evidence-Based Review section, which spotlights the primary investigator of the chosen research study and discusses the methodology and implications of that article for clinical practice. The journal is geared toward clinicians in high acuity and critical care and is coedited by a nurse and a physician: Kathy Dracup, dean of the UCSF School of Nursing, and Peter Morris, an associate professor of medicine at Wake Forest University. Those interested should visit the journal's Web site at The first redesigned issue appeared May 1. "

there is no sense in love
proverbial thorns and blooms
are for idiots

Thursday, April 26, 2007

Hero is secret
he no longer wants to win
bad luck for Princess

Tuesday, April 24, 2007

Travel Nurse: Checklist (Work Facility Follow-Up )

As I come to the conclusion of another travel nurse assignment I feel I need to write a follow up to my Work Facility Checklist. This follow up was prompted by a number of aggravating experiences I have had while working at my current facility. One such aggravating experience deals with the facility removing the cap on the number of patients facility nurses were required to tend.

Here is my revised checklist with questions you will want to ask about your travel nurse assignment before you sign with your travel nurse agency. You may also want to look at my travel nurse housing stipend checklist and my travel nurse salary, insurance and benefits checklist.

Questions for the agency:
1) Has the Agency previously provided travel nurses to the facility?
2) Has the Agency received any negative reports or feedback about the facility from travel nurses who have previously worked at the facility?
3) What is the nurse/patient ratio and is there a cap on the number of patients you will be required to handle? You will definitely want to have a cap included in your contract with the Agency. If the facility subsequently removes the cap you will at least have your Agency contract cap to fall back on.
4) If there is a conflict in your Agency contract and facility policies which takes precedent?
5) What type of scheduling is done (weekly, monthly, quarterly)?
6) Will I work in 4, 8, or 12 your shifts and am I required to work weekends and holidays?
7) What are the facility's orientation procedures?
8) Do I need any special licensing to work at the facility?
9) What type of charting system is used?
10)Will I be required to be "on call"?
11)Will I be able to or required to work overtime?
12)Who do I contact (the facility, my recruiter, my employer, other) if I have a problem or an important issue to discuss?
13)Is there an agency representative available 24 hours a day, 7 days a week?

Most Travel Nurse Agency representatives I have worked with can answer these questions over the telephone, but you will want to make sure the answer you get is included in your contract. I have heard other travel nurses say "If it isn't in writing the conversation never happened."


Well, the day has come. This Friday I will get Botox for my spasticity/clonus in my left leg. I am nervous, scared and excited! I am nervous because this is new for me, scared because I think it'll hurt and excited because the thought of being less spastic and less clonus is, well, amamzing. It's been 3 years of this and I need a break.

The Botox lasts for for up to 3 months, so this means that if it works for me and I think it's worth it, I will have to do it again... and again.

Wish me luck! And yes, i will blog about it... I may even bring a camera and get my friend to take pics.

Monday, April 23, 2007

E-Journal Club #2

Deep Vein Thrombosis in Hospitalized Patients: A Review of Evidence-based Guidelines for Prevention

Kehl-Pruett, Wendy ARNP, MSN, CCRN

Dimensions of Critical Care Nursing, Volume 25(2), March/April 2006, pp 53-59

Author’s Abstract

“Deep vein thrombosis affects many hospitalized patients because of decreased activity and therapeutic equipment. This article reviews known risk factors for developing deep vein thrombosis, current prevention methods, and current evidence-based guidelines in order to raise nurses' awareness of early prevention methods in all hospitalized patients. Early prophylaxis can reduce patient risk of deep vein thrombosis and its complications.”

I originally found this article too simplistic, since at our hospital we utilize the “vent bundle” concept in which anticoagulation therapy and compression teds are highlighted at our unit rounds which take place each day, usually day shift and night shift. Does your unit utilize “unit rounds”?

The “unit rounds” we have for both night shift and day shift seem to be the best way we have to disseminate evidence based practice, from all participants of the healthcare team. It is also the best way to educate and remind staff of a process, old or new, that we intend to focus on until it is accepted practice. Some of our physicians order both the stocking TEDS as well as the compression teds. Is this overkill?

Wednesday, April 18, 2007

CC, Psych, Students, and Looking Forward

Hm, seems I haven't posted at all this semester. That's probably because this semester was insane. I'm in the last leg of the race, so I'll have to gloss over a great part of my experience. But to bring you up to speed, here's the digest version:

Psychiatric Nursing

I had the same teacher for psych clinicals as I did for First Level. I really like her, so that was nice.

Despite this, I have decided psych is not my thing. While meeting really crazy people is interesting, I feel like I'm not busy enough up there. Sitting around and watching people... talking about feelings... ugh. For one, I am naturally pretty empathetic. When we study communication techniques, all I can think is "Duh, this is so obvious", and become quite bored. For another thing, psychiatric medicine isn't going to change any time soon. And if you go into it, you stay there. Your skill set is totally different from every other part of the hospital. The longer you're on the psych unit, the more outdated your general knowledge becomes.

I've learned some interesting things though. Did you know 1 in 100 people is schizophrenic or has schizoid characteristics? That's a devastating statistic. All those homeless dudes, the freaky people wandering the streets with shopping carts and talking to their demons. I've met a lot of those people. I am thankful for that... not many people have the chance in our society. It's really amazing to talk to someone who used to be well-adjusted, then sank into a paranoid, hallucinatory mental illness. What happened to them to make them that way? Sure, genetics is some of it, but we all have the potential to go nuts inside of us. It really makes me aware of my own coping mechanisms. I think I am, if nothing else, more self-aware after being around the mentally ill.

Just shows that everyone has something to teach us. Even people who are 100% positive that they are Jesus Christ.

Critical Care

I have absolutely loved Critical Care. I relish the challenges; everything about it is awesome. I can definitely see myself doing it, and listed all the ICUs as my first choice for preceptor placement.

That said, most of the class is failing Critical Care lecture. (I'm talking consistent class averages of 70%, where 80% is the lowest passing score). It's so bad that they've actually had to provide some additional opportunities for people to bring up their grades. Not bonus points, no, nothing like that. But they've adjusted test scores to omit "bad" questions more than once. That NEVER happens in nursing courses. It's shocking. I'm glad they're adjusting scores, but damn. I hope my friends pass.
Luckily, I was passing before the scores were adjusted. But then, when they gave multiple answers to some questions, my grade shot up to like a 90% (Which is fine by me. Most everyone I talk to is failing with a 78% or so).

My clinical instructor for Critical Care is like a younger and less experienced version of Instructor Fantastic. This is only her second semester of teaching, so she still has some things to learn. She tends to take on too much work and take some things too personally. But overall I think she's going to be a really great asset for that college; smart, passionate, but really dedicated to helping students learn.

I have a lot of respect for teachers who manage to prove they have all three of those characteristics. It's a rare combination, and is the reason I look up to Instructor Fantastic so much. One day I hope to go back to grad school. I hope to have my own chance to make those quiet affirmations about why we nurses must be ethical, excellent, and compassionate. How can we call ourselves moral human beings if we don't carry out our professional honorably? How can we expect anyone to treat us better than we have treated others?
(Of course I wouldn't say it in so many words. No one likes to toss around words like "honor" in casual conversation. But I'd hint at it in the way it has been hinted to me.)


I always get so irritated listening to students complaining after an exam.

I'm lucky in that I've never had a problem with test anxiety. If anything, I have test apathy. I always go into exams cold and leave equally unruffled, even if the test was ridiculously hard. Perhaps I'd worry more if I actually failed exams? But I digress; my point is that I don't feel any particular reason to become unhappy with my instructors after I take a test.

All around me I hear such negativism. Everyone talking about how the teachers are unfair, how they should be teaching differently, how they should mention what would be on the test more specifically. How the teachers should "give them" more points. I usually smile amiably to this and nod, but inside I'm always thinking "Wtf? Give? Your grade is nobody's responsibility except your own. You aren't a victim of fate."

This mentality is even more astounding since we have discussed it explicitly in psych class. Viewing oneself as a victim is an unhealthy way of coping with life. It only makes you depressed and prevents you from fixing your problems. I'm not saying I never get pissed off when I miss a question. But the person I get pissed at is myself for not studying more. Everyone can study more. Everyone can always do something more for a class and making a higher grade. If you think you can't, you're fooling yourself. (Especially if someone else in the class makes a 98%. You at least know it's possible then.)

Anxious to Stay, Anxious to Go

Summer semester starts May 14th and ends in the first week of August. And then that will be it. I will graduate Aaahhh! I have no idea what I'll be doing after that. My boyfriend graduates from UT in December, and I can't figure out what I'll be doing between August and the time he settles into a job. We've been apart for a couple years now, and frankly I'm eager to move to Texas and get on with my life.

At the same time, I don't want to build my life around another person. I want to begin my career and stay in a place long enough to become a strong member of the team. I want to save my money. I want to buy a car that doesn't scream like a dying cat as it wheels down the street. I want to learn and grow and be good at my job. I do not want to start work somewhere and suddenly pack up a few months later to go live in whatever city in which my boyfriend finds employment.

But I also don't want to be apart from the person I love any longer than I have to. I've been waiting such a long time... such a very long time.

I am introspective by nature, so I often question what it means to live a good life and be a worthwhile human being. It is difficult to weigh things like careers, money, love, family, and time while gazing out into my future. I can't say which takes priority right now, which pathway is the wisest.

I can only hope it becomes clearer in the next several months. I have found that having too many possibilities can be just as paralyzing as having none.

Nursing Scholarships

Nursing Scholarships. In recognition of the valuable role nurses have in the health workforce, the nursing scholarship program has been established.

Nursing scholarship is an award of access to an institution or a financial aid for students pursuing undergraduate or graduate education in nursing to help and pay for their education, which are offered by governments, colleges and private, outside sources that based on any number of arbitrary criteria.

Many scholarships are available for nursing students (LPN-to-RN, RN-to-BSN, RN-to-MSN, BSN-to-MSN or MSN-to-doctorate programs), but not everyone eligible for scholarship awards. Does student who qualifies only can get scholarsip program.

Scholarship's program it was helpful for the nurses to continue their career path in nursing, Types of nursing scholarships are :

  • Undergraduate Nursing Scholarships
  • Programs that designed to offer coursework that allows migration from one level to the next level such as an LPN to RN; or an RN to BSN, or Bachelor of Science in Nursing - the four-year RN degree.

  • Graduate Nursing Scholarships
  • Program that designed to offer the nurses student which choose to study in such specialties as Oncology, Gerontology, Anesthesia, Critical Care or Trauma, among a variety of others.

    There are more scholarships categorized by a specific nursing specialty, such as Acute/Critical, Advanced Practice, Anesthetist, Emergency, ect.

    Tuesday, April 17, 2007

    Travel Nurse: My Heartfelt Condolences to Family and Friends

    Like most of the people I know, I have been struck with horror since first hearing about the shootings at Virginia Tech yesterday. To those who may have been in some degree directly impacted by the tragedy I offer my heartfelt condolences. You are in my prayers.

    With Love,

    Monday, April 16, 2007

    Shooting.. again

    After the Dawson shooting there were 3 more school shootings in the US. And now there is another, this time over 30 dead and another 30 injured. I had hoped that I would not be writing about another school shooting, but here I am. This one is being called the worst school shooting ever in the US. I believe it. It's sad, it angers me. I saw it when I got home from school and just sat there and cried. Memories of my own school shooting and the aftermath still very much in my thoughts. Many of us at school are still going through some form of post-traumatic stress disorder. These memories may fade eventually, but not yet.

    My thoughts are with those at Virginia Tech. The pictures bring back many scary memories, and those living through it now will not soon forget or get over it.

    Friday, April 13, 2007

    Julie's picks from the nursing literature: March 2007

    These articles especially captured my attention from the recent nursing literature dealing with research or EBN
    1. Welk DS. How to read, interpret, and understand evidence-based literature statistics. Nurse Educator. 2007 Jan-Feb; 32(1): 16-20. (10 ref) Burlew carries this journal AN: 2009505151 NLM Unique Identifier: 17220762.
    3. Fineout-Overholt E. Johnston L. Teaching EBP: implementation of evidence: moving from evidence to action. Worldviews on Evidence-Based Nursing. 2006 4th Quarter; 3(4): 194-200. (21 ref) AN: 2009481523.
    4. Abbott CA. Dremsa T. Stewart DW. Mark DD. Swift CC. Adoption of a ventilator-associated pneumonia clinical practice guideline. Worldviews on Evidence-Based Nursing. 2006 4th Quarter; 3(4): 139-52. (43 ref) AN: 2009481519
    5. Felber SH. Sylvanus TL. Wilson C. Kapoor R. Library and nursing research collaboration. Journal of Hospital Librarianship. 2006; 6(3): 19-30. (13 ref) AN: 2009383611.
    6. Johansson P. Dahlstrom U. Brostrom A. Consequences and predictors of depression in patients with chronic heart failure: implications for nursing care and future research. Progress in Cardiovascular Nursing. 2006 Fall; 21(4): 202-11. (52 ref) Burlew has some online access, no print issues. AN: 2009373963 NLM Unique Identifier: 17170596.
    7. Vollman KM. Ventilator-associated pneumonia and pressure ulcer prevention as targets for quality improvement in the ICU. Critical Care Nursing Clinics of North America. 2006 Dec; 18(4): 453-67. (135 ref) Burlew carries this journal AN: 2009350169 NLM Unique Identifier:
    8. Fonteyn M. Polinski K. Lynch K. McKenna C. Gorman D. Saint-Eloi S. An evidence-based policy to guide nurses in using a power injector to instill contrast media. Oncology Nursing Forum. 2007 Jan; 34(1): 199. Burlew carries this journal AN: 2009484138.
    9. Bradshaw A. Price L. Rectal suppository insertion: the reliability of the evidence as a basis for nursing practice. Journal of Clinical Nursing. 2007 Jan; 16(1): 98-103. (35 ref) Burlew has some online access, no print issues. AN: 2009481114 NLM Unique Identifier: 17181671.
    10. Hoogerduijn JG. Schuurmans MJ. Duijnstee MSh. de Rooij SE. Grypdonck MF. A systematic review of predictors and screening instruments to identify older hospitalized patients at risk for functional decline. Journal of Clinical Nursing. 2007 Jan; 16(1): 46-57. (39 ref) Burlew has some online access, no print issues. AN: 2009481109 NLM Unique Identifier: 17181666.

    Thursday, April 12, 2007

    Travel Nurse: Long Time No Blog

    It has been awhile since my last serious post...and for good reason. Work has been hectic. You may recall me posting about the conflict between my travel nurse contract provision limiting the number of patients I am required to handle and my assignment hospital's new policy of an unlimited patient load. Since that post I have had several run-ins with hospital administration. Anyone who has had a similar run-in knows that you never really win. It is a constant battle. Every other shift the issue comes up and every other shift I am required to look like the bad nurse who doesn't care about the other nurses on the floor. All I can say is "I didn't sign on to be worked to death. I signed on for the fun of travel."

    On a more pleasant note, our family took another mini-vacation. This time to Navarre Beach, Florida. You may recall that Navarre was wiped out by multiple hurricanes the year before Katrina hit Nawlins. Even though several years have passed there is still a lot of work left to do. The most popular beach in Navarre is on an island. You have to travel over a half mile long bridge to get to the island. On one side of the island the waves were about 2 to 3 feet high. Our boys had a great time swimming in the surf. My husband went to Wal-Mart and bought one of those blow up sleeping beds for the boys to play on. We have found that those beds are larger and much tougher than your average kids raft and cost the same in most cases.

    We were in Navarre for three days. Each day we would spend half of the day on the side of the island with the waves and the other half on the side facing the Navarre coastline. On the Navarre coastline side the water is as flat as if it were in a lake. The girls are younger and enjoyed swimming without being turned upside down by waves. The flat side was also much clearer than the other side. We caught minnows with a net, hermit crabs and some tiny blue crabs. There were also black birds with long necks diving under the water. Every now and then we would see one of the birds come up with a fish in its mouth.

    You could also see huge chunks of asphalt in the water. The asphalt had apparently been a part of a huge parking lot that is now sunk underwater due to the hurricane. I would insert pictures here, but we forgot the camera for this trip.

    I will try to do a better job of posting and keep sending the e-mails.

    Travel Nurse Aim

    Tuesday, April 10, 2007

    Making a Poster Presentation

    The difference between poster and oral presentations is that with a poster presentation, the poster does most of the 'talking' about your project. That is, the material presented conveys the essence of your message. However, that does not mean that you can abandon the poster during the designated time. You have to 'stand-by-your-poster'! Your task as the presenter is to answer questions and provide further details; to bask in praise or suffer difficult questions; and to convince others that what you have done is excellent and worthwhile. A poster presentation should guide each viewer through the basics of the study or project, freeing the presenter to focus on discussion of essential elements of the work. Decisions about poster format and design contribute to efficient and accurate transfer of information using this medium.

    A scientific poster is a communication tool that combines a verbal presentation with a visual aid. They are given to a small group of people, are limited in time and range of view, and are informal and interactive. Posters should look as professional as your professional research or project. Poster size specifications will differ for each presentation venue; always plan to use the space well. Incorporating good basic graphic design principles, using good quality art materials and papers, and the use of color as an organizing tool will contribute to the professional approach of this scientific communication. The average interaction time for a poster presentation is 10-15 minutes. You must use visual short-cuts and plan your verbal presentation carefully to do posters well.

    Important characteristics for posters to have:
    clear scientific value;
    viewer-friendly lay-out, i.e., it has a hierarchical organization (“easy to follow sequence”), contains minimal text, has conveniently arranged and understandable graphs, and avoids (where possible) mathematical formulations.
    “It takes intelligence, even brilliance, to condense and focus information into a clear, simple presentation that will be read and remembered. Ignorance and arrogance are shown in a crowded, complicated, hard-to-read poster." Mary Helen Briscoe

    Poster Guidelines

    Succinct title
    Background (review of literature, need for project)
    Project description/methodology and context (sample, setting, etc.)
    Implications for nursing

    Here are two templates I have shared with nurses in the Orange County region over the past several years. I found the first template (for a rectangular poster made on Powerpoint for professional reproduction) on the internet several years ago, and did not gain permission to publish it. This template allows someone to make a poster for use on a bulletin board surface (attached with tacks or velcro) or for reproduction on foamcore board. The trifold template (you need MS PowerPoint to view) is a modification of the first template that allows someone to reproduce a poster and tack it on a 3x5' tri-fold poster board (for table top display).

    Monday, April 9, 2007

    New Pics of Makena

    As many of you know by my previous post, I have a foster baby elephant that I sponsor in Africa. She is rather cute and gets into all sorts of trouble (funny, good trouble) and is a real mischief maker! I recently got an update with a few new pictures so thought I would include them here!

    One of Makena alone and one with her and her stockade mate, Sian. She loves Sian and really loves sucking on Sian's ear which drives Sian absolutley nuts... but she eventually gives up and lets Makena do as she pleases. (Makena loves being the baby!)

    And if any of you wish to foster an elephant, look at the link I have on the right I named elephant rescue. It's $50 USD a year, and they are a reputable organization. Please check them out, it's well worth it.

    SJH Critical Care E-journal Club

    Once again, I am starting the e-journal club here at St. Joseph’s. I will post a journal review article every two weeks or so to those people that have requested to be on my mailing list. I will post a summary or the author’s abstract on this blog site so that people can comment here. Judy Rousch, RN, BSN

    Kalisch, Beatrice J., PhD, RN, FAAN. “Missed Nursing Care: a Qualitative Study”, Journal of Nursing Care Quality, Vol.21, No. 4, pp. 306-313.

    Author’s Abstract:

    “The purpose of this study was to determine nursing care regularly missed on medical-surgical units and reasons for missed care. Nine elements of regularly missed nursing care (ambulation, turning, delayed or missed feedings, patient teaching, discharge planning, emotional support, hygiene, intake and output documentation and surveillance) and 7 themes relative to the reasons for missing this care were reported by nursing staff.”

    I found this study simple and yet profound at the same time. Through an e-mail, the author confided that as a consultant to hospitals, these same themes kept coming up over and over again.

    I was amazed at the honesty of the replies from the staff interviewed. Would we have the kind of insight this article lets us see if the unit manager asked the staff the same questions? Do some units have an authentic ability to see and handle these issues? How do you feel these time constraint issues are handled on your unit?

    Sunday, April 8, 2007

    Happy Easter!

    Happy Easter! Hope the Easter bunny was good to you... this little guy is pooped after all the egg hidding he had to do!

    And this is just funny, had to add it in!

    Wednesday, April 4, 2007

    Cochrane Database of Systematic Reviews-- news

    All documents in the Cochrane Database of Systematic Reviews are now in PDF format. That means no more tweaking the document to make sure that all the tables print and a document that is shorter in its final print version.

    Other Cochrane News

    "Two Cochrane Reviews to be published in January The Cochrane Library 2007,
    Issue 1, report on smoking cessation:

    • A recently licensed nicotine receptor stimulant trebles the odds of
    stopping smoking. The new anti-smoking drug varenicline was first licensed for use in the UK on 5th December 2006. An early Cochrane Review of its effectiveness shows that it can
    give a three-fold increase in the odds of a person quitting smoking. Varenicline is
    the first new anti-smoking drug in the last ten years, and only the third, after NRT
    and bupropion, to be licensed in the USA for smoking cessation.

    • New evidence boosts the conclusion that some antidepressants can
    double a smoker’s chance of quitting. The most recent Cochrane review concluded antidepressants bupropion (Zyban) and nortriptyline double a person’s chances of giving up smoking and have few side-effects, but selective serotonin reuptake inhibitors (SSRIs) such as
    fluoxetine (Prozac) are not effective. A recently licensed nicotine receptor stimulant trebles the odds of stopping smoking. The new anti-smoking drug varenicline was first licensed for use in the UK on 5th December 2006. An early Cochrane Review' of its effectiveness shows that it can
    give a three-fold increase in the odds of a person quitting smoking. Varenicline is the
    first new anti-smoking drug in the last ten years, and only the third, after NRT and
    bupropion, to be licensed in the USA for smoking cessation.

    Monday, April 2, 2007

    Study Study Study!

    I am slowly going bonkers. I have a class test (#2) for nursing on Wednesday and am slowly losing it. I am having a hell of a time focusing on studying. I am so distracted at home, that I have to get out of the house to study, even the noisy (and I do mean LOUD) school cafeteria or upper atrium is better than home! Doesn't help that it is now "warmer" out and lately sunny! I finished clinical last week and walked out of the Vic to a bright sunny day, only I was too damned tired to enjoy it! But I chose this profession (why? oh ya right, I LIKE it... can't wait to graduate!).

    As you can tell I decided to take a break, so am writing this blog entry... or I am procrastinating, AGAIN! I will get through this semester and PASS because the thought of doing it all again makes me want to cry, so, that being said it's back to the books (medical-surgical nursing... blah) and class notes, and there are a ton of them!

    Oh ya, and my camera and/or software for the camera is messed up and I cannot download (upload?) any of my pics onto the computer!!! Grrrr!

    Ok, back to it...