Wednesday, March 31, 2010

AdsenseCamp.com

Bingung dengan Google Adsense yang tidak tampil di Blog
karena Blog Anda berbahasa Indonesia !
Kenapa tidak coba AdsenseCamp.com aja !











Adsensecamp.com | Adsensenya Indonesia, disini kita bisa sign up dengan 2 kategori. Advertisers dan Web owner. Kalo mau pasang iklan tentang toko, usaha jasa, website atau perusahaan kita dengan sistem bayar per unit klik, anda bisa memilih kategori Advertisers. Tapi kalo mau dapat tambahan penghasilan, seperti di google adsense, tidak ada ruginya mencoba sign up di kategori Web Owner. Jadi setiap kali ada yang melakukan klik terhadap iklan di situs kita, kita akan mendapatkan bayaran.

Setelah sign up, kita akan mendapatkan email konfirmasi yang dikirimkan melalui email kita yang berisi account untuk mengaktifkan keanggotaan kita di Adsensecamp.com. Dengan mengklik link yang ada di email konfirmasi tersebut, secara otomatis keanggotaan kita diaktifkan.

Setelah kita login di situs AdsenseCamp.com, baiknya kita mengisi form rekening dan lain-lain, setelah itu kita bisa mencopy script html adsensecamp.com, yang akan menampilkan iklan-iklan di situs kita. Ada beberapa pilihan yang bisa dipilih sesuai selera.

Bagaimana pembayarannya

Setiap klik yang dilakukan oleh pengunjung terhadap iklan AdsenseCamp.com yang ada di situs kita, kita mendapatkan bayaran sebesar Rp. 300,- – 400,-. Dan jumlah itu akan selalu bertambah setiap hari. Bila jumlah nominal yang kita dapatkan sudah mencapai Rp. 10.000,- nominal itu akan ditambahkan ke rekening bank kita.

Apakah hanya itu ?

Tidak, dengan mereferalkan situs adsensecamp.com ke temen-temen kita, kita akan mendapatkan Rp. 25,- dari setiap klik yang dilakukan terhadap iklan adsensecamp.com yang ditampilkan di situs referral kita.

Coba yuk!

Adsense Indonesia

Browser tercepat untuk PC Windows


Jakarta - Browser yang diklaim paling cepat untuk berlari di komputer bersistem operasi Windows rupanya bukan Internet Explorer, yang sama-sama besutan Microsoft. Melainkan browser Opera 10.50.

Opera begitu percaya diri dengan klaimnya tersebut. Bahkan dikatakan Chief Executlahive Opera, Lars Boilesen, Opera 10.50 menjadi browser tercepat dalam semua tes yang dilakukan.

"Apa artinya untuk Anda: Tak akan ada lagi waktu menunggu untuk situs yang sedang didownload," lanjutnya, dikutip detikINET dari PC Magazine, Rabu (3/3/2010).

Meski demikian, Boilesen juga mengakui bahwa yang terpenting bukanlah pada hasil uji coba. Namun bagaimana kenyataannya di lapangan, apakah juga dapat berlari dengan sangat cepat atau hanya hasil mentereng di atas kertas.

Opera 10.50 sendiri saat ini sudah dapat diunduh oleh pengguna. Untuk pengguna Windows sudah disediakan dalam pilihan 42 bahasa. Sementara bagi pengguna Mac dan Linux sepertinya masih harus bersabar menunggu kedatangannya.

Tuesday, March 30, 2010

So you think Britain is a Nanny State? Random thoughts on Obamacare.

Well Britain is a nanny state.  And it's pathetic.  And it looks like America is heading down that road as well. 

http://www.mcall.com/news/local/all-a1-5nosmoke.7222732mar30,0,6728342.story

Seems unrelated but I you'll see a lot more of this real soon. I wonder how much worse this is going to get when young healthy people who don't want to buy insurance are forced to buy into Obama's corporate/government co-op or under the threat of IRS bullying and fines if they don't comply.   The system will swell with expensive bureaucrats and lawyers (the only people who can even make an attempt to understand all the ins and outs of the new legislation) and the common people will be punished with restriction after restriction to "keep costs down".

The poorer states are already freaking out now that they are realising the cost of Obamacare, which is being  imposed on them by the feds in a very unconstitutional manner. Some of the states supported leftist reform.  But now that they are seeing just how high the costs are going to be, and realising that state funded services such as foster care, education etc are going to have to take major cuts they are trying to back pedal a little bit.   The country is already broke.  Americans are in for a shock if they don't think that Obamacare is going to restrict individual freedom.  The fat cats will line up at the government trough and manage to get richer as always.  But I think more than anything they should blame the republicans for all of this.  US healthcare needed reform but it was ignored completely for too long and the democrats saw their chance to expand the federal government and gain more control over people's lives using the guise of "protecting people from corporate evil" to achieve their goals..  In my opinion "reform" should have gone in a different direction entirely.  The left (like most groups) hates a monopoly where the rich get richer unless it's their own monoploy.  Now they have theirs.

Damn it!

Neurology has lab. Will I never escape touching dead human body parts bathed in formaldehyde?

Reflection on Flaws

For my FIM class we had to write an essay on one of our flaws. Here's mine... for all the googlers. This is how I got in trouble last time. Lets see how it works this time...


Oh to choose just one flaw, when there are so many to pick from. Should I select the flaw that I believe is most hazardous to my physician health, I would say my largest and most important flaw is that I am different. Now, upon first glance one may paradoxically think that being different is an asset… and indeed in many cases it is. But not in this case. Not in the land of doctors.

For me, being different means that I rarely seem to be on the same page as my peers. My ideas are usually out in left field compared to everyone else (who oddly always seem to agree with each other). I am bored by routine. I think outside the box. Not just on the other side of the line… but really really far away from the box. I have millions of ideas. Every day. Every moment. I’m a big picture person and often fail to understand the importance of details. I often choose ethics and humanity over what makes “business sense”, and I hug my patients and chit-chat about their grandchildren when it is not a convenient time. I have no patience for pettiness and jealousy and turf wars. I’m never aware of class gossip because I don’t gossip, and I usually prefer to be alone. Although I am constantly told that I am understanding, non-judgmental, and easy to confide in, I myself feel misunderstood. While everyone else panics about exams, I only aspire to pass. Usually because my head is filled with other ideas. My classmates have planned out their residencies, and I believe that destiny leads you to where you are going. I don’t take notes in class. Frankly I can barely pay attention in class. My mind is busy thinking of new ways to recruit donors for a self-sustaining hospital that I want to build in rural Colombia. Or something the professor has given me a new idea for a way to get my pancreatic cancer cell line to develop drug resistance. Or maybe I could develop a research project on the predictive factor of a patient’s ability to correctly define their own disease state. Or…. See? It’s endless. I could go on forever.

One of the consequences of being a misfit is that I am usually thought to be overstepping my role in whatever I’m doing, often my benevolent intentions interpreted as just the opposite by my colleagues. My friends would describe me as willful and passionate and a creative problem solver, but I doubt my classmates would say the same. Just last week I noticed that one of my classmates was displeased because I asked a patient additional questions not on our “list”, which were technically the responsibility of other student team. To me, I was being empathic and human and searching for pieces of a very large puzzle thus far not found. In the end, I was able to locate a huge missing piece of that patient’s diagnosis. Unfortunately, I’m certain my classmate felt that his territory was infringed upon and that I was being overly aggressive.

I have seen other physicians with similar personalities experience severe difficulty fitting in, and difficulty maintaining their position in the physician world. I believe the key to solving this problem is to be as quiet as possible, and as unobtrusive as possible while training to be a physician. Hopefully someday when I’m older, wiser, and more secure in my medical career I can be more forthcoming with my quirkiness.

I can honestly say I have tried and tried to stifle the parts of my personality that cause me ask millions of questions, to say what no one else is thinking, to challenge authority, and to question the legitimacy of nearly everything I am presented with. I understand how detrimental these qualities can be to a physician-in-training. I’m working on it. It’s just so darn difficult! The excitement I feel when I have a new idea or find a solution to a problem is overwhelming!

Now that I’m older, I’ve come to embrace the fact that I am different. Although it has been a hard road. I’ve never been friends with the masses, but instead have a small but precious collection of friends who are also quite quirky and out-of-the-box thinkers. Many of them older, many of them physicians. They’ve told me that I’ll do well in my chosen career, and that I’m an “old soul” We shall see. Hopefully they are correct.

Over the last 12 hours...

I've become an entrepreneur. Just got my first babysitting gig. Well, first "new" gig. 4 hours for $100. Yay!

Thank You. That's All.

I have never experienced the kindness of strangers as I have today. I don't want to elaborate, other than to say thank you. Thank you RGFEWYL.

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A Win for the Little People

by Heather Bradford, CNM, ARNPChair, ACNM Government Affairs CommitteeTuesday, March 23, was a big day for many Americans when the President signed major health care reform legislation into law. But Tuesday was an even BIGGER day for midwives. Under this new law, after 19 years of hard work, certified nurse-midwives (CNMs) will be equitably reimbursed for their services under Medicare beginning

The Medical Ward Sisters Song

To the tune of 99 bottles of beer.

5 little stressed out Sisters on the wards, 5 little stressed out Sisters , when one of those Sisters has a nervous breakdown and falls there will be 4 stressed out Sisters left on the wards.

4  little stressed out Sisters on the wards, 4 little stressed out Sisters , when one of those Sisters has a nervous breakdown and falls there will be 3  stressed out Sisters left on the wards.


3 little stressed out Sisters on the wards,3 little stressed out Sisters , when one of those Sisters has a nervous breakdown and falls there will be 2 stressed out Sisters left on the wards.


2 little stressed out Sisters on the wards, 2 little stressed out Sisters , when one of those Sisters has a nervous breakdown and falls there will be 1 stressed out  Sister freaking out on the wards.


1 little stressed out Sister on the wards,1 little stressed out Sister , when that one sister has a nervous breakdown and falls there will be 0  stressed out Sisters left on the wards.

And management loves it because they want to hire more purchasing officers and patient journey champions rather than pay for any form of qualified nurses.

What do you think of my attempt at songwriting?  I know, I know I should have a job at Sony. ; )

Monday, March 29, 2010

In Deep %$#&

Holy crap. I'm in deep, well, crap. Financially, that is. Lets just say that every other academic year of my life I have been able to take summer school classes in order to qualify for financial aid to well, SURVIVE, until the next semester starts. I just assumed that I could do that now. Um, just tried to do so and was DENIED. The financial aid guy said unequivocally med students are not allowed to take summer school unless they are MD/MPH (a degree I already have, and therefore cannot get again).

So lets do a little math. I have money for April and about 1/2 of May (I'm short bc my car broke down on me TWICE this month totaling about $1000 to fix. YIKES!). I need approximately $1500 per month for rent ($895), utilities (+/-$200), a couple of old student loan payments ($200) and my cell phone ($70). Plus another $250 per month for food, gas, parking at school, and anything expendable I might need. So say $1750 per month for June, July, August, and 1/2 of May. That's um....$6,125

Where the EFF am I going to get that from?????

In between telling me the "good" news, the financial aid counselor suggested that I do what most students do.... get money from their parents. After telling him that that was no way plausible and hey, I'm 31 years old now... he hinted that I should ask anyway... he's sure that my parents "care" about me and would be willing to help out. After all, I AM a med student. Guess he's never heard of parents that can't just dole out $10k on a whim.

Now, silly me... I thought he was going to suggest I get a J-O-B... an old fashioned method of supporting oneself. The same method I've used for years... which until now has always solved my financial woes. Maybe I could write a book on these elusive so-called "jobs" and their usefulness, sell a million books and be rich! That would solve everything.

OTHER SOLUTIONS I'VE THOUGHT OF

1) Summer School - denied (see above)

2) Job - tricky
-Problem here is that school ENDS May 30 and STARTS July 15 (only 6 weeks off)... yet financial aid doesn't come in until the beginning of September. So if I work FULL time every day that I have off, I will likely only make about half the money I need.
-Not to mention, I have to take 4 (count 'em) physiology exams during those 6 weeks.
-PLUS who's going to hire me full-time for 6 weeks?

3) Wealthy Relatives - HAHAHAHAHA... wait... laughing... so much.. I ...hahhahhaah... can't ...type

4)Begging for change - I've heard the average pan-handler makes like $70 per day in metropolitan areas. That's TAX FREE baby. But it's also HARD GODDAMN WORK. Plus, the only place to pan-handle in the city is by the urban hospital complex... and my fellow classmates would see me. Maybe since this health-care bill passed I could wear my white coat while begging and I would be more believable. My sign could say "$300k in debt, unemployed, and working towards an MD. Why lie? I need groceries"

5) Robbing a bank - plausible, requires more thought and planning. Best solution thus far.



Me=so screwed it's laughable.

SIDENOTE: Out of REAL and SERIOUS concern, I went grocery shopping last night and bought a crap load of groceries and brought them home and FROZE them. Bread, milk, fruit, pot pies (hey, they're like 69 cents), etc. It's like planning for hurricane season. With electricity. Hopefully....

Lucked Out

While the rest of my class is cramming like crazy for our physio shelf exam tomorrow, I am instead taking jacuzzi tubs and drinking wine. That's right, folks... I managed to get out of the exam and get 4 days off of uninterrupted relaxation. Why, you may ask? Well, since I screwed up and missed Block II and III of physio, I couldn't very well take the shelf exam. So this summer after my make-up exams I'll take a make-up shelf. So I'm not totally out of the woods. Especially since everyone else will be enjoying this thing called SUMMER and I will be studying physio. Oh well, living the moment right now!

Even More Fun at Mealtimes and Productive Ward

At 6 PM they send a food trolley up to the ward.  At 6:30 they take it away.

On this particular shift we had 2 RN's and 2 care assistants for the shift.  That was the entirety of the ward staff. No ward clerk to answer the phone.

There were 15 patients that needed to be fed.  The entire ward consisted of 30 patients.

Between 6 PM and 6:30 PM thirteen people rang for commodes.  This takes at least 20 minutes for each patient as you have  to find a commode, get two staff to transfer the patient onto it, transfer the patient back to bed and then wash the commode for 11 minutes between patients as specified by the infection control bitches.  They should do it themselves.  It might help them lose some weight.

Between 6 and 6:30 five people needed analgesia.

Between 6  and 6:30 two new admissions were sent up.

Between 6 and 6:30 four IV pumps beeped and alarmed because of empty bags, pulled out lines, occlusions, and air in the lines. Time consuming to fix.

Between 6 and 6:30 one confused patient fell.  She thought she was late for her bus.

Between 6 and 6:30 seven phone calls came in from family members who tried to talk my ear off and refused to get off the fucking line so I could get all the way back down the ward to my patients.

Between 6 and 6:30 one hundred and seventy drugs were due to be given.  170.  Most were not on the ward.  Many needed careful and time consuming preparation.

Between 6 and 6:30 one man had chest pain.  It looked pretty classic.  I had to page a medic (when I could actually manage to get a line out between relatives phoning).  Get observations, GTN spray, an ECG, bloods and 02.  I had to ignore the food trolley, and the call bells to do this and run past frail patients who were left with a tray of food that they couldn't manage to feed themselves.  When the medic came I had to give a load of other stuff to the patient, and organise a transfer to CCU as well as hand him over to CCU and ring his family and answer all of their questions.  I was quickly losing the ability to feed any patients.  I found myself wishing that these poor bastards would let me get off the phone as it was mealtime.

Between 6 and 6:30 recovery demanded that either myself or the other RN working with me escort a patient back to the ward from theatre.

Between 6 and 6:30 a consultant showed up to do rounds and his junior doctor snapped his fingers at me to let me know they wanted me to follow them around as they reviewed each of their 11 patients.

By 6:25 one care assistant managed to get all the trays handed out.  Then she started on the first feed. And it was then that kitchen started demanding all the trays etc back so that they could get them washed, sorted and get home on time.

I am not exaggerating.  If anything, I am being conservative with all this.

The productive ward fuckos have given us some new ideas to try in order to help is avoid malnutrition in our patients.  I wish I could scan the letter onto this blog.  They gave us 5 orders suggestions to facilitate meal delivery.

1. They will be buying red trays and red tops for water jugs to help the nurses identifty who needs to be fed.

2.  We are getting this giant laminated flow chart/ map of the ward that we have to fill in every mealtime identifying who needs to be fed in red marker.  If someone doesn't get fed we have to colour in their block with a green marker and if they are able then we colour in that block with blue pen. If they are NBM for whatever reason we use a purple marker.

3. All staff have to drop what they are doing and participate in meal delivery.  This is a dig at RN's who often leave meal delivery to the assistants because we have unavoidable ill patients, orders, and drugs due at mealtime.  The assistants cannot help us with orders, drugs, and ill patients.  ( I really don't think that they ladies crying for commodes and the man with chest pain would have appreciated being ditched at mealtime.)

4. We are to complete a nutritional care plan and audit.  A "nutrition score" must be calculated for every patient over the age of 60.

5.  Doctors will be told NOT to do rounds at mealtime.  (They have never complied with this rule on any other occasion so why the hell would they start now?).

Management thinks that they have covered their assess with these 5 objectives.  They can turn around and say "we have done this and that to help our nurses stay on top of malnutrition and be more efficient at mealtimes."

How completely dumbass is all of this?

Sunday, March 28, 2010

Nursing Jobs New York Style

Quick, name the city in the United States that offers nurses the most career opportunities. If you guessed New York City, you hit the nail on the head. In 2005, there were nearly 70,000 jobs for skilled nurses in New York City. But there’s more to the demographic than just numbers. When it comes to nursing jobs, New York is number one in more ways than one.


Salaries


According to the Bureau of Labor Statistics, the mean salary for a registered nurse nationally is $52,810. In New York, 72% of all registered nurses are earning more than $55,000 annually. The average salary for a registered nurse in New York is $64,000 as compared to the national average of $49,840. (all statistics from BLS). A licensed practical nurse can count on a salary in the $30,000-$45,000 range. New York is the single top market for nursing jobs across the country.

Read More

Shelf Exam Rules from the Physio Prof...

"NBME rules state that only two students can be out of the room for bathroom breaks at a time and that students must be escorted to and from the restroom by a proctor (don't be nervous, they wait outside). Additionally, bathroom breaks take precious time away from an already fast-paced exam. I recommend that both caffeine consumption and consumption of beverages be kept to a minimum, if possible, the morning of the exam."

Saturday, March 27, 2010

Nursing University in Indonesia

There are several university that provided nursing major in Indonesia whether state or private university. Here are state university :
  1. Airlangga university (www.ners.fk.unair.ac.id)

  2. Indonesia university (www.fik.ui.ac.id)

  3. Syah Kuala University (www.unsyah.ac.id)

  4. Andalas University (www.unand.ac.id)

  5. Padjajaran University (www.unpad.ac.id)

  6. Gadjah Mada University (www.ugm.ac.id)

  7. Diponegoro University (www.undip.ac.id)

  8. Udayana University (www.unud.ac.id)
Before you decided to study at nursing major, make sure that the university accredited by Indonesian Higher Education (DIKTI) and Indonesian Nurses National Association (INNA). You can find more information about accredited institution at www.dikti.go.id.

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Friday, March 26, 2010

Definitely

Just rocked the histo exam. Yay!

UPDATE: Ouch. Let me clarify. Rocked the practical. Written, not so much. But its over none-the-less!!!!

NCP - Nursing Care Plan for Appendicitis

NCP - Nursing Care Plan for Appendicitis

Nursing Diagnosis

1. Pain associated with incision wounds to the abdomen mesial area post surgery

Purpose
Pain decreased / lost with

Results Criteria
Rilek looked and can sleep properly.

Intervention
  • Review the location of the pain scale, characteristics and reported pain relief with appropriate changes.
  • Maintain a break with a semi powler position.
  • Encourage early ambulation.
  • Give your entertainment activities.
  • Kolborasi team of doctors in the provision of analgesics.
Rational
  • Useful in the supervision and efficient drugs, the healing progress, changes and characteristics of pain.
  • Eliminate stress increased abdominal supine position.
  • Improve organ function.
  • enhance relaxation.
  • The relief of pain.

2. Activity intolerance associated with the limitation of motion secondary to pain

Purpose
Activity tolerance

Results Criteria
-client can move without restriction
-are not careful in moving

Intervention
  • Note the emotional response to mobility.
  • Provide activities in accordance with the client state.
  • Give clients to exercise passive and active motion.
  • Help clients in conducting activities that burdensome.
Rational
  • Immobilisasi forced to increase anxiety.
  • Increasing organ kormolitas as expected.
  • Improving body mechanics.
  • Avoiding things that can aggravate the situation.

Staff Nurse Jobs for Filipino Nurses

The POEA recently approved a job order offering employment opportunities in Staff Nurse Jobs for Filipino Nurses. The job order for the said staff nurse jobs for Filipino nurses was approved by the POEA last March 12 for a recruitment agency located in Ermita, Manila. For the said staff nurse jobs for Filipino nurses, a job order balance of 26 staff nurse jobs applicants will be selected for recruitment in Nursing Jobs Abroad for Singapore.

If you think you are qualified and interested to apply for the said staff nurse jobs for Filipino nurses, you can visit their website and fill up their online resume. Or, you can visit their office and fill up an application form. For more details on the qualifications and requirements, you can dial their landline numbers indicated below.


Emerald International Manpower Services Corp.
Rm. 303-304 Merchant Building
509 Padre Faura Street, Ermita
Manila
Tel. Nos.: 521-0222 / 521-6418 / 521-6209
Fax No.: 523-4938
Email: eimsc@tri-isys.com / eimsc_sg@tri-isys.com
Website: www.emeraldinternational.com.ph

Thursday, March 25, 2010

Nurse Staff Jobs Egypt

A healthcare institution in the beautiful country of Egypt is looking for Filipinos who are qualified for Nurse Staff Jobs Egypt. These nurse staff jobs Egypt has a POEA job order that was approved last March 12 for a recruitment agency based in Quezon City. For the said nurse staff jobs, the recruiting agency is allowed by the POEA to recruit up to 13 nurse staff jobs applicants.

To start your application for the said nurse staff jobs Egypt, proceed to the office of the recruiting agency and fill up their application form and submit the following documents:
  1. Resume
  2. Diploma
  3. Transcript of Records
  4. Related Learning Experience (R.L.E.)
  5. Board Certificate
  6. PRC Card
  7. Board Rating
  8. Employment Certificate
  9. Seminars & Training Certificates
  10. Passport
  11. Birth Certificate
  12. Marriage Certificate
  13. 6 pcs. of 2x 2 pictures
For more details on the said nurse staff jobs, you can contact the recruiting agency in their contact details specified below.


Kirsten Recruitment, Inc.
99 Jasmin St. corner Scout Reyes
Roxas District, Quezon City
Fax: (632) 413-0211
Telephone No.: (632) 372-0270
Email Add: info@kirstenrecruit.com
Website: www.kirstenrecruit.com

After Tomorrow

I'm done with Histology! Just got to make it through one month of Neurology and a couple weeks of Inflammation and I am DONE with 1st year! Well, minus those make-up exams I have to take during the summer.

Nursing Care Plan for Benign Postatic Hyperplasia

NCP for BPH


Assessment
  1. Subjective data :
    • The patient complained pain in the wound incision.
    • The patient says can not have intercourse.
    • Patients are always asking action taken.
    • The patient said that urinating is not felt.

  2. Objective Data :
    • There incision wound
    • Tachycardia
    • Restless
    • Blood pressure increases
    • Facial expressions of fear
    • Installed catheter


Nursing Diagnosis

Disruption of comfort : pain associated with muscle spasm spincter

Purpose
After 3-5 days of treatment for patients unable to maintain adequate degree of comfort.

Results Criteria
  • The verbal pain patients say reduced or lost.
  • Patients can rest.

Intervention
  • Note the location of pain, intensity (scale 0 - 10)
  • Monitor and record the pain, the location, duration and trigger factors and pain relief.
  • Observe the signs of non-verbal pain (anxiety, forehead wrinkle, increased blood pressure and pulse)
  • Give a warm ompres in the abdomen, especially the lower abdomen.
  • Instruct patient to avoid stimulants (coffee, tea, smoking, abdominal strain)
  • Set the position of the patient as comfortable as possible, teach relaxation techniques.
  • Perform therapeutic treatment of aseptic.
  • Report to your doctor if the pain increases.

Omani nursing students volunteer at local church




The members of St. Matthew's United Methodist church of Valley Forge, Pa. are more knowledgeable about their health thanks to four Villanova University College of Nursing students. The four women, who are nurses from the Sultanate of Oman and are completing their bachelor of science in nursing degree at Villanova, volunteered to assist with the congregation’s health fair on March 21st. “We learned more about volunteering and community service,” explains Wadha Al Mamari.

The students checked blood pressures, shared general cardiac health tips and follow up advice on any abnormal results. Their faculty, Joyce Willens, PhD, RN, assistant professor and a member of the church, taught CPR to the lay public gathered at the church, while the students offered the blood pressure screening. “They were very excited about the opportunity to serve the community and with the notion of seeing a different worship place,” says Dr. Willens. Villanova enjoys a 16-year relationship with Oman, providing BSN-completion, MSN, PhD and continuing education to its nurses and is enriched by having Omani students on its campus.


In these photos, Samiha Al Habsi checks the blood pressure of Pastor Dawn Taylor of St. Matthew’s Church. The health fair volunteers included (l to r) Raiya Al Hajri, Samiha Al Habsi, Dr. Joyce Willens, assistant professor, Mirfat Al Barwani and Wadha Al Mamari.

Dr. Dowdell to serve on American Nurses Foundation committee


Elizabeth Burgess Dowdell, Ph.D., R.N., CRNP has been invited to serve on the Nursing Research Grant Reviewer Committee of the American Nurses Foundation (ANF), the philanthropic arm of the American Nurses Association. The associate professor from Villanova University College of Nursing will serve a three year term. The invitation was extended on the recommendation of the ANF’s Board of Trustees because of her research prowess. An expert in parent-child nursing, Dr. Dowdell’s scholarly work focuses on health risk behaviors and vulnerability across the lifespan, victimology and issues of violence, and nursing care of children.

Wednesday, March 24, 2010

Irritating

There is something about smelling marijuana in class that really irks the shit out of me. I'm not sure why, really... cause I really don't give a crap if people smoke pot or not. It's not particularly my cup of tea... but I'm not against it either. But for whatever reason, when I smell it on people in class I get really pissed off. Maybe I feel it is disrespectful to our learning environment, or maybe I'm jealous that other students are so ahead of the game that they can come to class totally gorked, or maybe I just can't stand the smell.

I mean, is it really not possible to take a shower or at least roll the windows down in the car instead of coming to school smelling like bud? I guess that may, indeed, be too much to ask. I mean some of these guys wore eau de dead body for all of first semester. Whats a little MJ compared to that?

Tuesday, March 23, 2010

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Monday, March 22, 2010

So Where is Anne?

I am job hunting.

And working a lot.  I was hoping that working double shifts would get me some extra cash but they are back to not paying overtime and we are getting extra time off instead.  Which, of course, leaves the wards even more short staffed.

I had the fright of my life yesterday.  Have to change details to protect confidentiality and all that.

I was on duty with one other RN and an an inexperienced auxilliary who did not know how to make a bed.  For the whole floor.

One of my patients was having a procedure downstairs and the department demanded, DEMANDED that the patient get transported back to my ward with an RN escort.  That means I had to go down there and bring him back. They are, of course, better staffed with less patients but for whatever reason the department staff always refuses to bring patients back.  We went back and forth for some time.  I told them that there was no way I could leave the ward to dick around down there waiting for porters and such.  But I got sick of them ringing me constantly and accusing me of messing up their list thus delaying patient procedures in their department.  I knew I wasn't going to win.  I know they don't understand nor do they want to hear about the short staffing on the wards.

Against my better judgement I went. And I got stuck down there waiting for them to get it together and then waiting for the porter.  I harassed them and reminded them that I really really needed to get back to the ward.

When I got upstairs I was wheeling this patient who immediately needed post procedure observations taken into his bay.  I peered into the bay across from his to see a young patient of mine looking very funny.  I ran to this person and it was obvious that this patient was in respiratory arrest. Was not breathing.  Still had a pulse though.  I dumped the post procedure patient (distressed that I was leaving him on a trolley in the middle of the bay--he didn't understand what was happening) and put the resus call out.

Holy shit.  This person has a history and was probably in the throes of a seizure while I was getting dicked about by recovery who couldn't be bothered to bring the patient back to the ward.  Following the fit, he stopped breathing.  And a I suppose it was several minutes later that I saw him.  I have no doubt if I had been on the ward, or if there was 1 RN per bay it would have been dealt with immediately.  The auxilliary didn't even understand that the patient wasn't breathing.

We have more patients going for diagnostics and procedures every hour that require nurse escorts than we have nurses to escort them.  The ward is almost always increasingly short staffed as a result.  So basically if we have 2 nurses and 2 auxillaries on shifts we are often left with two staff on the ward because of escorting.

I really fucking hate the people I work for.

I went to this study day/ meeting where we had our (old fashioned trained not been on a ward in 30 years) leaders telling us to read the reports on Staffordshire and cry for the suffering that was dished out by our colleagues.   They wanted suggestions about how to "improve" care and efficiency.  They want more with less but patient care will not be harmed and we will not be a staffordshire. They told us over and over that 20 billion is getting cut out of the NHS budget and that the current system is unsustainable.  They shut down and refused to discuss RN staffing when we mentioned it.  The even chortled. Sadly, they don't understand that it is cost effective to have more RN's at the bedside. 

Other head managers were at this thing saying things like "we are listening to our nurses".  He shocked me when he said it. Then I saw a journo and a photographer from our local paper  at the back of the room.   As soon as the journos split so did the chiefs. But they had a nice little photo in the paper with a "We are listening to our Nurses" headline.

Dicks.

Um, guys...

I love that you all read my blog... for which I am eternally grateful and in return I will try my best to entertain and motivate you towards med school.

But I have just one request.

Please don't send me your homework problems. As a first year, I have tons of my own homework... and my medicine/science knowledge level is somewhere between a grasshopper and a dandelion. I'll probably just mess you up. My best advice, go find someone smarter to ask :)

Larger than life


When I jumped off the elevator on the third floor today, there was, staring me right in the face... a research poster (the Urology Dept. was obviously proud of this one) with a very large photo of something similar to what is shown below. Only the one on the wall at school had a (very) real penis in it. The poster was on Peyronie's Disease, which is a disorder of the fibrous tissue in the penis. Ok, fair enough. But really? A big penis picture as a welcome to the 3rd floor? I'm not normally a person who laughs when I hear the word "vagina" or snickers when the professor says "clitoris".... but this made me laugh. Good for a giggle and a double take.

Mammogram Advice a Health Threat

The recent announcement by the U.S. Preventive Services Task Force, a national panel of medical officials tasked with reviewing clinical data and making recommendations about preventive care, has generated considerable confusion about the role of mammography and threatens to undo years of beneficial public and physician education and behavior adaptation.

Since the news broke about the recommendation last month, our team of breast cancer specialists has been inundated by questions, concerns and comments from women.
Until 1990, the breast cancer death rate in the United States had remained unchanged for 50 years. With the introduction of screening mammography, there was an abrupt and sustained decrease in the breast cancer death rate by 30 percent over the past 20years. The new USPSTF guidelines threaten to reverse the significant progress that has been made over the past two decades.

The task force recommends against routine screening mammography for women ages 40-49. However, there is ample scientific evidence that women in their forties can expect an equivalent decrease in breast cancer mortality due to screening mammography as compared to women 50 and older. Population studies in Sweden have shown a 40 percent decrease in breast cancer mortality in women ages 40-49 who underwent screening.

The incidence of breast cancer rises steadily with age, but there is no dramatic increase at age 50. The probability of being diagnosed with breast cancer among women in their forties is 1.44 percent as compared with 2.63 percent among women in their fifties. Meanwhile it has been estimated that 40 percent of the years of life saved by screening can be attributed to women diagnosed under the age of 50.

The task force advises only those women in their forties who are at high risk to undergo screening. However, it should be emphasized that only 10 percent to 25 percent of breast cancers occur in women at high risk. The majority of breast cancers arise in women with no special risk factors.

Yearly screening may be especially important for younger women because they tend to have faster growing cancers. Lengthening the screening interval to two years will diminish the survival benefit for all women and ultimately contribute to more treatment related toxicity because more cancers will be diagnosed at a later stage.
Physical exam, whether practiced by a woman herself or her doctor, will always be complementary to any breast-imaging technique.

Women should remember to bring any changes to their doctor's attention regardless of how soon after a negative mammogram they occur. We can each cite many personal instances where a woman's self exam led her to a doctor for follow up, sometimes with life-saving consequences.

In conclusion, the breast specialists at the Center for Cancer Prevention and Treatment at St. Joseph Hospital do not support the revised screening mammography guidelines recently issued by the Task Force and strongly urge women 40 and older to continue annual screening mammography. Better yet, talk to your own doctor about your risk factors and make a decision together about your breast health. It could save your life.

This is your brain on physio...


Physio test in an hour... and my brain is totally fried. Literally, I CAN NOT study for even one more second. Yet I feel as though I know nothing. We'll see how this plays out.

Saturday, March 20, 2010

Oh. My. God. I knew it!

I just took this assessment tonight. Awesome!! All except for the Ortho part. No way in hell is there a 5% chance I'm doing that. So sad about radiology, family medicine and derm. Oh well, I'm over it.

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Out of Curiosity...

I'd like to know how many people have read my entire blog, versus people who are just occasional readers. If you've read the whole thing... will you please

EITHER (just one)

Comment and let me know

OR

Check the "this makes me want to be a doctor" box.

Thanks, Ella

Putting the "H" in

Ok. Confession time.

I've known for a long time that I'm ADD. That's no secret. Well, maybe it is... as it seems obvious to me (as I'm the one inside my own crazy head)... but people who I tell say "really, I wouldn't have guessed that". I've taken meds a couple of times in the past... which actually work well for me... but they tend to make me sick, they're expensive, and since I'm ADD I often forget to take them. So I don't bother.

Recently, however, when describing some muscle pains to my physician, she asked me what I thought the problem was. I told her my convoluted theory that I was dopamine depleted... yada yada... muscle pains... yada yada and by the way, I think I'm ADD. So she suggested I get tested... since there just happens to be an ADD expert around. So I agreed.

The test (which, may I say, was on the top 10 most annoying experiences of my life) came back with a recommended diagnosis of ADHD. Hyperactive type. Say what?

When I asked her why on earth I was hyperactive type, this conversation ensued.

DOC: "well, since childhood you've described having trouble sitting still and paying attention... and even now you have trouble going to class and staying all day. You skip out on conferences, skip office meetings, and when you do attend you get up and walk around, sort M and M's by color, and draw elaborate designs on your notepad to keep your attention"

ME: "So??? Doesn't everyone do that? I mean, most conferences and office meetings are, in fact, useless and boring. And they could just tell me the info in 15 minutes instead of 3 days. It's stupidity. And by the way, that computer ADHD test was totally bogus. Clicking stupid X's for an hour? Who can do that? No one! That was so annoying"

DOC: "No Ella, everyone is NOT like that. I promise you. And by the way, that test was only 14 minutes. And most people can do it easily."

ME: "Well, everyone I know would find that highly annoying. And I've had millions of discussions with friends and family about how boring and difficult it is to sit through class and meetings."

DOC: "It is well known that people with ADD and ADHD associate with other people who have ADD or ADHD. So maybe in YOUR world everyone does that, but I assure you, most people can pay attention and sit through class and are not bored."

ME: (silently) "touche"

In the end we agreed that I have ADHD... but not to "do" anything about it. Me and meds don't get along too well, so she was like "well, you've come this far... you may as well keep doing what you're doing"

True dat. Although, this may have been useful information when I was struggling to get through the MCAT. Four times.

Friday, March 19, 2010

Nurse Anesthetist faculty to serve on State Board of Nursing


Bette M. Wildgust, MSN, MS, CRNA, is the newest member of the State Board of Nursing of the Commonwealth of Pennsylvania. Wildgust was nominated by Governor Edward G. Rendell and approved by the Senate on March 16th. She is a certified nurse anesthetist and clinical associate professor who is program director for the Villanova University College of Nursing-Crozer Chester Medical Center School of Nurse Anesthesia. This is Wildgust’s first six-year term on the Board.

Wildgust has over 30 years experience in teaching nurse anesthesia students and the administration of anesthesia programs. She started her career as a program director 1979 when she began the first nurse anesthesia program at Our Lady of Lourdes Hospital in Camden, N.J. Her commitment to the profession of nurse anesthesia and to the advancement of educational standards that further the art and science of anesthesiology and result in better patient care has been recognized with the Pennsylvania Association of Nurse Anesthetists (PANA) Didactic Instructor of the Year Award and the PANA Program Director of the Year Award.

The State Board of Nursing, based in Harrisburg, establishes rules and regulations for the licensure and practice of professional and practical nursing in the Commonwealth and provides for the examination of all applicants. The College of Nursing is approved by the State Board of Nursing of the Commonwealth of Pennsylvania.

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Thursday, March 18, 2010

A Question for the Masses


Is it possible to love a future not-yet met nor owned dog as much as you love your first and beloved dog? Or will I never love again? Can you tell I miss my dog more than life?

I'm considering offering my landlord my firstborn child in exchange for allowing my dog to live here....

Oh, and to explain the socks.... I bought him baby socks for my new place so he wouldn't scratch the floors...

Stepping Up My Game

Today was Match Day Part II. On Monday all the 4th years found out IF they matched. Today they found out WHERE. I went to the ceremony... and I've decided I better step up my game. From the 4th year class there were at least 7 going to Harvard, 2 to Brown, 5 to Yale, 3 to UCSF, other schools I saw were Duke, Dartmouth, Mayo, UCLA, UCSD, Mt. Sinai, etc. Lots of orthopedics, surgery, emergency, anesthesiology, plastic surgery, radiology, PMnR... holy smokes. I better get on it. And quick!

Top 10 Reasons to Attend Lobby Day

by Heather Bradford, CNM, ARNP, Chair, ACNM Government Affairs CommitteeOnce about every four years, ACNM hosts its Annual Meeting in DC. Why DC? We need your voice. On Tuesday, June 15, we hope hundreds of midwives will storm Capitol Hill to meet with their legislators (two senators and one US representative) and discuss issues vital to the sustainability and growth of midwifery. This is one

Wednesday, March 17, 2010

My New Superhero...

So I've found a new person to idolize. You all know I'm obsessed with Dr. Kenton Hadley... (that's still in effect of course)... but she's internal medicine. Yes... I know... I like her despite the fact that she's IM. Admittedly, this new cool doctor chick isn't as totally accomplished as Dr. KH, but she's younger.... a resident, and she's EM. I've worked with her twice now in the emergency department.... and she is just pretty bad-ass all around. I've seen her run 2 full traumas at the head of the bed, plus I think she is incredibly smart.

I don't know anything about her personally.... (clearly I haven't been stalking her well enough)... but in my mind she's a superhero. I imagine that she and her husband and their dog save the world on weekends, maybe she collects Chihuly glass, is a trained wine connoisseur, goes to art openings on weekdays, and she has a closet full of Christian Louboutins that she wears after her ED shifts. I'm sure she only cooks occasionally, but fabulously, for friends... probably because she is too busy traveling the world in her time off... as she is also simultaneously the medical director for the WHO's Latvian health project. She has a plethora of job offers after graduation with ungodly attached salaries, of which she has declined all of them in favor of spending the next year with Doctors Without Borders.

Ok, back to reality... she's an awesome EM doc and she has pretty hair. That's the extent of what I know about her. Which is WAYY more than I can say for most of the women around here that I am supposed to consider mentors. Yech.

Research Abstract and Commentary: Aromatherapy Massage

Effectiveness of Aromatherapy Massage in the Management of Anxiety and Depression in Patients with Cancer: A Multicenter Randomized Controlled Trial

Wilkinson SM, Love SB, Westcombe AM, Gambles MA, Burgess CC, Cargill A, Young T, Maher EJ, Ramirez AJ. Journal of Clinical Oncology, 25, 532-538.

PURPOSE: To test the effectiveness of supplementing usual supportive care with aromatherapy massage in the management of anxiety and depression in cancer patients through a pragmatic two-arm randomized controlled trial in four United Kingdom cancer centers and a hospice.
PATIENTS AND METHODS: 288 cancer patients, referred to complementary therapy services with clinical anxiety and/or depression, were allocated randomly to a course of aromatherapy massage or usual supportive care alone.
RESULTS: Patients who received aromatherapy massage had no significant improvement in clinical anxiety and/or depression compared with those receiving usual care at 10 weeks postrandomization (odds ratio [OR], 1.3; 95% CI, 0.9 to 1.7; P = .1), but did at 6 weeks postrandomization (OR, 1.4; 95% CI, 1.1 to 1.9; P = .01). Patients receiving aromatherapy massage also described greater improvement in self-reported anxiety at both 6 and 10 weeks postrandomization (OR, 3.4; 95% CI, 0.2 to 6.7; P = .04 and OR, 3.4; 95% CI, 0.2 to 6.6; P = .04), respectively.
CONCLUSION: Aromatherapy massage does not appear to confer benefit on cancer patients' anxiety and/or depression in the long-term, but is associated with clinically important benefit up to 2 weeks after the intervention.


Commentary by Dana N. Rutledge, RN, PhD, Nursing Research Facilitator

This randomized controlled trial contributes to the body of evidence about the effectiveness of complementary therapies in cancer, specifically the use of aromatherapy massage (AM). There have been complaints that the “evidence” about complementary therapies is weak or nonexistent. This gives little credence to providers who wish to use these therapies. This study gives strong evidence that in the short-term (two weeks after AM was completed) cancer patients who received AM had less anxiety than patients who did not receive AM. They did not have less depression or other symptoms (e.g., pain, fatigue, nausea and vomiting, global quality of life).

The study intervention was massage with essential oils delivered by massage therapists over 1 hour weekly for 4 weeks. Patients in the treatment group received at least one treatment. Patients in the control group received access to psychological support as part of their cancer care. Patients recruited to the study had been referred to complementary therapy services by a cancer health professional.

Of interest to hospital nurses is that in a pilot study of 57 patients receiving AM, patients showed significantly decreased average anxiety levels immediately after the treatment. This endpoint was not of interest to the researchers, but would be to hospital nurses. This means that immediately following a 1-hour massage with essential oils, patients had less anxiety – on average. No adverse effects from the AM were reported.

Cadaver what?

Cadaver memorial. That's what I attended yesterday. A little memorial for the families of those who donated their bodies to anatomy lab... and an annual event at my school. However, this year it was sans families... because none of them showed up. But alas, it was nice to say a prayer and have a little commemorative ceremony.... even though (gasp) I hate funerals and memorials and refuse to go under normal circumstances. I don't even go to my family memorials. I only went to this one on accident because I was under the impression that it was mandatory. Damn.

Anyway, the point of why I am telling you this is because some of my classmates wrote reflections about their anatomy experience that they read during the service. And every one (save for one, maybe), was a story (albeit lovely) about how they were uncomfortable in the beginning yet came to peace with chopping up an already dead person over the course of 14 weeks. Really???? How about it sucked more and more every day, directly proportional to the increasing stench of the body and decreasing ability of my sanity and rational thinking to overcome stress and panic? I can't believe it. How come no one stood up there and said (in an ever so tactful way) how horrible it was?

Do I have to do EVERYTHING????? Just a joke, classmates. I think you did a lovely job. And be glad I'm not in charge of med school, or we'd start making the Whoopies and the Jane Fondas look conservative and proper.

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REGISTERED NURSE NEEDED IN UNITED STATES

A reputable home health agency serving patients in Northern Virginia, Suburban Maryland, and the District of Columbia USA, is looking for qualified nurses to fill both part-time and full time positions for its Virginia location. Interested applicants must have at least two years' experience in the field of nursing as well as basic IV training; knowledge of home care is preferred but not required for the position. To receive more information about this position, please contact Mary Tatum or Shaneta Martelli at 703-912-2080. You may also email resumes to shaneta@ameri-nurse.com or fax them to 703-912-2090.

Looking forward to work with you.

Thanks....

Tuesday, March 16, 2010

Midwifery Advocates Protest Seemingly Illogical Hospital Decision

by Candace Curlee, CNM, MS, ACNM Region VI RepresentativeA curious thing happened last month in Ventura County, CA. St. John’s Pleasant Valley Hospital in Camarillo decided that midwives can no longer practice at their facility. Midwives have been practicing at St. John’s for the past 30 years. Evidently, the pediatrics and obstetrics committees along with the board of directors made the decision

Monday, March 15, 2010

Dorothea Orems Theory of Self Care (YouTube)

Dorothea Orems Theory of Self Care (YouTube)

A good day...

Match day turned out to be a pretty good day for everyone I know who was trying to match. Especially for a friend of a friend of mine. Her name is Lucia, and she is a foreign medical graduate (FMG) from South America who graduated medical school in 2000.

Now, in case you aren't aware, it is damn near impossible for FMG's to become physicians in the US for a plethora of reasons. First and foremost is probably because of stigma and bias. Second, they must successfully pass their USMLE's in ENGLISH... which is a tough task for native speaking physicians, and third, they have to beat out the 1,000's of FMG's that apply every year.

So Lucia wanted to go into psychiatry, but after she moved to the US she couldn't get a residency spot. She failed Step 1 the first time, but subsequently passed all three steps. She applied to hundreds of programs.... every po-dunk program she could... but never got even 1 interview. She worked in clinical research, did research at the NIH, and kept up her studies. She reapplied year after year.... and still never got even 1 interview.

Finally, this year, after being out of medical school for 10 years, she matched. All because a friend helped her get an interview and a week of shadowing. And the school she's at ain't too shabby, folks.

Congrats Lucia! She definitely gets the prize for tenacity. Oh yeah, and her 2nd baby is due the week before residency starts in July.

T-E-N-A-C-I-T-Y.

PREGNANT!

That really doesn't have that much to do with this post... but it's one of those words I like to throw around in a crowd. It's a hot word. When you say it, everyone can't help but stop what they're doing and look over to see who the hot word refers to. "Herpes" is also a hot word. Say that at a party and see how much attention you get.

Anyway, the point of the post is actually a memory I had today. A great pre-med moment. So I had to share.

When I was at Harvard doing my PBPM program I also worked at Beth Israel Deaconess Emergency Department doing clinical research. I was 23. And there was a hot (I mean HOT) emergency medicine doctor there that I could barely stand to be around out of complete fear that I would do or say something stupid. He was actually beautiful... and I don't say that about many men. And tall. Anyway.... I was reading an article today and his name was on it.... and it made me remember one specific day in the ED.

The cool thing about Beth Israel is that they love to teach... so if you say you're a "pre-med" you automatically get to see/do/watch tons of stuff. So on this particular day Mr. Stupidly Gorgeous was about to do a spinal tap... and so sure enough he hunts me down and asks if I'd like to help. If it were anyone else, I totally would have wanted to... but I really wanted to be as far away from him as possible. But in the name of not being a jackass, I of course said yes.

So we go into this woman's curtain cubicle and prep for the tap. She's naked doing the side snail curl on the bed, Mr. Stupidly Gorgeous is trying to get the tap, and I'm supposed to be holding some tubing up so it doesn't get contaminated. But 20 minutes later he still hasn't gotten the tap. At 30 minutes I am getting dizzy from standing so long, being excited about the tap, and being nervous about being next to Mr. Stupidly Gorgeous. Around this time I remember that I also haven't eaten for over 8 hours... and several minutes later I start feeling pins and needles on the top of my head. Then I start seeing black spots. I try to shake them off by breathing deeply and moving my head. But then my sight is almost gone and I know I'm going to pass out. I don't want to pass out on the patient while Mr. Stupidly Gorgeous is trying to tap her... but I'm too embarrassed to actually tell him that I'm going to pass out. So I lay the tube on the bed, put my back to the wall, and slid down to my butt as I passed out silently.

The next thing I hear is a faint conversation between a couple of doctors about the probability that I am pregnant.... one of those "matter of fact" ED conversations. I remember being HIGHLY insulted that everyone would automatically assume that I was pregnant (especially being a 23 year old pre-med). Anyway, I wasn't pregnant... just dehydrated and hypoglycemic... and totally nervous about being around the greek god. Eventually I had to face him and apologize for ditching him in the middle of a procedure... but he was pretty cool about it. Which just made him all the more stupidly gorgeous to me.

Just An Observation

Fifteen years ago I interned in a mother/baby unit while I was in nursing school. Back then most of the mothers I attended were married (or at least had a significant other who wasn't a one night stand) and most of the mothers were adults. But things seem to have changed over the years.

I am once again working in a mother/baby unit for the first time since nursing school. The hospital I work in has the same or similar demographics to the one I worked in in nursing school. But now married mothers seem to be the exception and not the rule. For that matter, mothers with a significant other who even shows up for a baby's birth are not as common as I would have thought. I am startled at the number of teenage girls having babies. Babies having babies.

Is this an irreversible trend? Does anyone besides me even think this trend should be reversed?

Dr. Barbara Ott in Haiti


Dr. Barbara Ott, associate professor and volunteer with Operation Smile, cares for a young Haitian woman who has just had surgery on her leg for an orthopedic trauma. Beds were low cots and floors were dry dirt in the post-operative care tent, making for a dusty and physically challenging care environment.

Transforming horror into hope in Haiti


Barbara Ott, Ph.D., R.N. is no stranger to challenging nursing environments. She has shared her critical care nursing skills in some of the most harsh places the world has to offer, caring for children through Norfolk, Virginia’s Operation Smile in such countries as Thailand, the Philippines, Honduras, China, Russia, Morocco and Brazil. She was compelled to volunteer for one of the organization’s recent teams sent to Haiti.


In late February, the associate professor at Villanova University College of Nursing joined about a dozen other health care professionals, including nurses, orthopedic surgeons, and nurse anesthetists, for the 10-day effort in Fond Parisien, just outside the capital Port-au-Prince where the January 12th catastrophic earthquake occurred. Some team members moved in and out so the number varied over time. Staff ate beans and rice twice a day, slept in tents and worked long hours in a physically demanding environment. Not trusting the safety of the buildings on the property of an orphanage and school, her team set up its operations in a small tent city next to a refugee camp run by the Harvard Humanitarian Initiative. It is a place where the “walking wounded”—people of all ages with recent amputations—are the new norm. Challenged by the scarcity of crutches, they are either immobile or lucky to find help.


Moving outside of its usual pediatric facial deformity repair surgery, the Operation Smile team handled at least 60 adult and pediatric orthopedic cases, including amputation revisions (removing more of an affected limb due to tissue death or infection), rod placement to stabilize bones, and removal of external fixation devices in bones that healed. The two operating rooms were sterile environments in tents. The triage and post-operative recovery areas were not, with 130 degree temperatures, dirt floors and an invasive, persistent layer of dust that settled over skin, sterile packaging and other equipment. Yet, the nurses provided high quality care, somehow managing to have zero infections at pin sites (pins are the small metal pieces inserted through the skin to keep a healing bone in place)—a fact duly noted by the naval commander of the USNS Comfort hospital ship that transported patients to and from the Operation Smile makeshift hospital.


Each pair of nurses shared a translator who spoke the native Kreyol. Among the 259 patients, Dr. Ott saw severe wounds, recalling one woman whose wound occurred when she was pulled out of a building, causing her skin and muscle to shear off her foot, exposing bone. Her options were to “become septic and die or to be a 79 year old amputee in Haiti,” notes Dr. Ott. The patients lived two in each tent, along with their family caregivers. There were also 47 unaccompanied minors who had lost their parents in the destructive force of 7.0 magnitude earthquake.


Despite the tragedy, Dr. Ott explains the future-oriented Haitians, “I was very taken with their attitude. I didn’t expect that. They were anticipating a better time in the near future.” How does she summarize her nursing experience in Haiti? “It was amazing work,” explains Dr. Ott, “We were dirty and tired but felt we were doing something important.”

Today...

Is Match Day!

The highly anticipated yet much dreaded day. Every 4th year med student's fate is determined today when they find out a simple "Yes" or "No" as to WHETHER or not they matched into a residency program. If "yes", they wait until Thursday to find out where they are going (they ranked their "favorites" weeks ago) at a huge ceremony hosted by the medical school. If "no"... they slunk away into a cave and begin contemplating suicide. No, really....(really). Actually if they didn't match, they participate in "Scramble" which starts tomorrow at noon. Every program that didn't fill up is listed... and they start calling and faxing like ninnies to try to get a spot. Any spot. Anywhere. Hopefully in their desired field... but possibly not. And definitely not in the location they expected. Unfortunately.

Match is basically one giant fraternity/sorority... where you and the program rush (interviewing)... and then there's preference day (second look)... and then match day (bid day). Exhilarating. Probably joyous. Potentially fatal... well, at least temporarily until the said 4th year regains his or her bearings, begins to breathe and realizes the world is, indeed, not over.

I just found out that at my school the Dean's office closes down completely and the Deans clear their schedules during Scramble so that the students who are scrambling can come in and use the phones, private offices, faxes, computers, etc... AND have the Deans call other programs on their behalf. Nice.

Anyway, congrats to all my friends who matched today. And if you didn't... don't stay in your cave too long, ok? We all still love you.

Saturday, March 13, 2010

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Friday, March 12, 2010

Singapore Nurse Work

A Quezon City based recruitment agency that’s been operating since 2004 is currently looking for Filipino nurses who are qualified for Singapore Nurse Work. The said Singapore nurse work are for Staff Nurses and have a job order that was approved for recruitment by the POEA last February 26. For the said Singapore nurse work, a job order balance of 15 nurse work applicants will chosen for recruitment for nursing jobs abroad.

To apply for the said Singapore Nurse Work, applicants must submit their application directly to the office of the recruiting agency or they can fill up their online application form. For further details on the said Singapore nurse work, you can dial their landline numbers indicated below.


SaviourMed International Placement, Inc.
2nd Floor MIP BLdg.,
28 GSIS Avenue, GSIS Village,
Project 8, Quezon City
Philippines
Tel Nos.: (632) 920-6808 / 928-0249
Telefax: (632) 920-6807
Mobile Phone: 0917 8232309
E-mail Address: saviour_med@pldtdsl.net
Website: www.saviourmed.com

Nurse Hiring for Singapore

The POEA or Philippine Overseas Employment Administration recently approved a job order that will provide employment opportunities to Filipino nurses who are qualified for Nurse Hiring for Singapore. The job order for the said nurse hiring are for Registered Nurses and was approved last March 2 for a recruitment agency located in Ermita, Manila. For the said nurse hiring, a job order balance of 11 nurse hiring applicants will be chosen for the said Filipino nursing jobs abroad.

If you are interested in applying for the said nurse hiring for Singapore, submit your application to the office of the recruiting agency or you can visit their website and fill up their online application form. For more details on the qualifications and requirements for the said nurse hiring for Singapore, you can visit their website or dial their landline numbers specified below.


FSL Int'l Manpower & Promotion Services Inc.
Rm. 302 & 303 LBH Building
1431 A. Mabini Street, Ermita
Manila
Tel Nos: 5245551
Telefax: 5246337
Mobile Nos: 0918-9416579 / 0917-3263537
Email Add: fsl_international@pldtdsl.net
Website: fslinternational.com

Tomorrow...

I'm going camping with my class... and bringing my dog. Yay! Did I mention I'm a ridiculously good dutch oven camp cooker? Yay again!

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Thursday, March 11, 2010

Cultural Incompetency

Where to start? For my FIM class... you know the stupid class I hate... we have a section called "cultural competency". Which is the new bane of my existence. Not because I don't think the topic is important... because I do. But rather because in all my years in academia I have never once seen anyone worth respecting teach it in a respectable nor interesting way.

For instance, today we were required to watch a stream of staged videos which were supposed to demonstrate how culturally insensitive situations can occur. I shit you not, the patients were all black and the docs all white. Every scenario was ridiculously staged... and then we were required to answer a series of questions which were insane.

Here's an example of what happened today:

Video: White doc, black patient. Patient has uncontrolled hypertension, previous MI, etc. Doc is speaking a little overly scientific and parental and patient is being a little too apathetic about his unhealthy lifestyle and a little too defiant about physician knowledge. Not to mention, the video contained every stereotype you could ever come up with... about the doc as well as the patient. Patient uses wrong verb tenses, says he's unemployed, and brags about using the ED for his primary care doc. Doc rolls his eyes every time the patient uses sub-literary journal level language, suggests buying organic foods and joining an expensive gym to work out.

Question: What is the main issue in this video?

Answers:

A) The patient should be more concerned about his severely unhealthy habits and should take more responsibility for his own health

B) The patient and the physician are talking past each other instead of communicating well

C) The patient should be re-assigned to a black physician

D) The physician is not being sensitive and is not picking up on cultural cues that would help him to appropriately solve the patients problems.

After a group discussion we settled on the best answer B (heaven forbid the answer is A). However, one of my group members says "Hey guys... I know B is the right answer... but I know how these assignments work. I bet my life that the answer is D. If we want the points for getting the right answer, we should pick D"

He managed to convince us... so we chose D for the points. And freakin-A... he was right.

Now, tell me that this situation doesn't in effect PERPETUATE racism. Instead of both parties taking responsibility for the miscommunication... which would imply equality...it's the "superior", white doc's responsibility to figure out how to solve the black patient's problems.... thus implying that the patient doesn't have the ability to assess and solve his own issues. Right there, in class, we just affirmed the notion that white doctors, in fact, are superior and should take the higher moral road. The whole thing is pure insanity.

I mean... if we're going to address racism... lets do it. But nix those lame-ass videos for god's sake.

A Midwife’s Take on the NIH VBAC Consensus Conference

by William F. McCool, CNM, PhD, CRNP, FACNMThis past week the NIH held a 3-day Consensus Conference examining the current situation in maternity care regarding vaginal births after cesarean (VBACs), which have diminished considerably in number over the past 10 to 15 years. I was able to attend, and urge everyone to read the consensus preliminary report. In addition, many news outlets have picked

Tuesday, March 9, 2010

To the Folks at UMass Med School Dept of Medicine....

I really hope I didn't tick off your whole department... as my IM post made the blog roll on the front page of the Department of Medicine website. I mean... I'm sure you are all really lovely people... nothing personal, Ok?

A Crazy Idea?

As I have mentioned before, I love photography. And while I am no expert in cameras and equipment... I think I have an artistic eye. Well, at least I have been told that. It's one of the few hobbies I have that I think I'm sorta good at. Anyway.... on a whim last year I submitted some of my photos to a few art markets... and I was accepted to a few to sell my work. Which I have never done. Mostly out of fear... and the probably wrong idea that "photography doesn't sell". Plus, I'd need to buy a large format photo printer and some supplies. Which is an investment. Which I really can't afford anyway.

But wouldn't it be so so so nice to be able to make some extra money for med school in a fun way instead of waiting tables or babysitting. Remember that post way back when when I naively said something to the effect of "Holy crap I'm in med school... hopefully I'll never have another bs job again!!" I think I spoke (wrote) too soon!

Anyway... I've survived this long on my own... with wayyyy worse jobs than serving or babysitting. Something will happen. I'll keep you posted.

Will the NIH Panelists read the blogs and Twitter feeds? And should they?

by Amy Romano, CNM (Originally published on Science and Sensibility for Lamaze International on March 8)I spent the good part of today glued to the live webcast of the National Institutes of Health Consensus Develop Conference on Vaginal Birth After Cesarean (VBAC). The agenda was packed with expert testimony on the findings of a systematic review of 35 studies involving over 660,000 women with

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Monday, March 8, 2010

Not adding up

After doing a little math, I realized that I'm not just broke. Im broke broke. Really broke. If I don't spend even 1 extra dollar for the next 4 months I'll barely make it. I need a job. Something part-time and flexible.

Any ideas?

Don't say serving. Been there.

Sunday, March 7, 2010

Nursing Jobs in Saudi Arabia

Saudi Arabia

saudione.jpgSaudi Arabia has intrigued travelers for centuries. Its vast swathes of desert were the swaddling clothes of infant Islam and the birthplace of the Arab race and of Arabic, a language considered holy by Muslims. It's also home to two of Islam's holiest cities - Makkah and Madinah - and to a host of modern, thriving, oil-rich metropolises.

Saudi Arabia is a monarchy in southwestern Asia, occupying most of the Arabian Peninsula

Saudi Arabia
is a land of vast deserts and little rainfall. Huge deposits of oil and natural gas lie beneath the country’s surface. Saudi Arabia was a relatively poor nation before the discovery and exploitation of oil, but since the 1950s income from oil has made the country wealthy. The religion of Islam developed in the 7th century in what is now Saudi Arabia. The Kingdom of Saudi Arabia was founded in 1932 by Abdul Aziz ibn Saud, and it has been ruled by his descendants ever since.

The Country's topography ranges from wide plains to deserts, valleys, mountains and plateaus. The main features are: The Empty Quarter (Al-Rub Al Khali) desert.

  • The Empty Quarter (Al-Rub Al Khali) desert.
  • The Eastern plateaus and plains.
  • The NorthernMountains and plateaus.
  • The "Najd" plateaus of the Central Region.
  • The Western highlands.
  • The "Tihama" plains in the southwest.
  • Widespread Mountain and desert valleys.

Visit Sites : http://www.professionalplacement.co.uk

Saturday, March 6, 2010

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Are They Hiring?

I just had a look at my Trust's current vacancies.

There are jobs for managers and administrators, purchasing officers, and HR.

Lots of them.

No Staff Nurse posts are being advertised.

They are advertising for more "apprentices" and aiming the adverts at teenagers.

It still makes me laugh when people say that the University education of Nursing is what has destroyed Nursing care.

You idiot.

If we actually had university educated nurses staffing the wards I would agree with you.  But the university educated nurses are stacking shelves at Asda while they try to find a job at the bedside.  Even if they only want to do noctoring and managerial stuff they cannot even dream of it, if they do not have years of experience as a bedside nurse first.

The vast majority of staff on the wards at any given time these days are untrained, uneducated but mostly nice if a little dippy carers who have never been to university and do not want to become Nurses.  It is getting to the point where we rarely have more than 1 RN per shift.  The Nurses are an aging workforce.  Most of the time that one nurse per shift is someone who trained back in the "good old days".  The majority of NHS staff who are actually qualified nurses trained pre project 2000.  Carers cannot help with drugs, treatments, orders, information organisation and action etc etc.  The lone nurse carries that on her own.  There are more drugs that need to be prepared and given than you can possibly, physically give.  That's the case even with the threat of getting sacked for a med error and getting struck off as a nurse at the forefront of your thoughts.  Even if your stomach is doing flip flops, due to fear that you are going to kill someone due to medication problesm, you still cannot do it.

In Victoria, Australia and California, USA the hospitals must staff their wards with degree nurses so well that no degree nurse is to have any more than 5 patients at a time. This is law.  The hospitals tried to resist these laws but patients were dying.  The law went into effect around the year 2001.  If one of her 5 patients gets unwell, she gets another real nurse to help out with her other 4. In the UK I start my shift with more patients than I can handle, then I get more and I have so many constant and unrelenting interruptions that I cannot accomplish a thing.  The only way to survive, and ensure my patients survive is to stay focused.  This makes me look hard---as if I am lacking in compassion.
 The  degree RN in California has a small number of patients which allows her to do everything for them.  Care assistants are few and far between. This is what they have over there, rather than untrained kids running around and one real Nurse trying to do it all for 30 patients like we have in the UK.  On a 30 bed ward in California you would have 7 real Nurses  at least (One in Charge), maybe one care assistant who is merely helping out rather than taking charge of the basic care, admin staff to answer the phone, domestics, dietary staff for a shift..   In the UK  you will have one real Nurse and 3 untrained kids on a 30 bed ward per shift and that is all. This is getting to be the norm.

You won't hear of any patients getting starved, neglected, and left in their own filth in Victoria or California.   And their staff nurses are ALL degree nurses. 

You think it costs too much to pay all that well educated staff?  Wrong again, they actually have lowered their costs by improving patient outcomes as a result of having strict, legistlated nurse patient ratios. If hospitals weren't so busy fucking around with government initiatives and interference this stuff would probably be automatic.

http://nurseactioncenter.org/campaign/Staffing_Ratios/explanation

http://www.haponline.org/downloads/HAP_Summary_HB_147_SB_689_Nurse_Staffing_Levels_Sept2009.pdf

The second link is fabulous.  The hospitals would not be able to include care assistants and non direct care providing nurses in their ratio declarations.