Thursday, May 31, 2007
Wednesday, May 30, 2007
Tuesday, May 29, 2007
Monday, May 28, 2007
Sunday, May 27, 2007
Saturday, May 26, 2007
Blue and Mellow (too)
| Your Brain is Blue |
 Of all the brain types, yours is the most mellow. You tend to be in a meditative state most of the time. You don't try to think away your troubles. Your thoughts are realistic, fresh, and honest. You truly see things as how they are. You tend to spend a lot of time thinking about your friends, your surroundings, and your life. |
the "too" part in my title refers to my friend Cathy's results... again, I say we ARE sisters seperated at birth!
Body Worlds
Well, yesterday I went to see Body Worlds at the Old Port with my bio class. It was amazing to see. Sometimes I forgot that I was looking at real people, and not statues. The method of plastination is neat and really conserves the body well. I especially liked the one with the nervous system, you can see all the nerves (CNS and PNS), they were thicker than we thought. I've included a few pics I got off the website (as we are not allowed cameras in the exhibit) and one of me and my bio teacher afterwards (we went to Pub St-Paul). Great day!
Take a look at thisvideo it's neat!
Friday, May 25, 2007
Thursday, May 24, 2007
Wednesday, May 23, 2007
Upwards and Onwards!
Well, I passed Med-Surg II and A&P IV! So I am moving on up to my 3rd and final year of nursing school come next August! WOW! What a long and intense year this has been. Both school-wise and personal-wise... But I survived it all and even enjoyed most of it.
Now I can relax and not freak out over exams and grades anymore! Woohoo... party-time!
Am going to Body Worlds on Friday. Will post more about that soon.
Now I can relax and not freak out over exams and grades anymore! Woohoo... party-time!
Am going to Body Worlds on Friday. Will post more about that soon.
Summary of the 6th Annual Evidence-Based Practice Conference at UCLA
Victoria Morrison, RN, BSN, Nurse Research Assistant at St. Joseph Hospital in Orange, Calfiornia, recently attended the 6th Annual Evidence-Based Practice Conference at UCLA. Here is her summary :
On April 26, 2007, I went to the 6th Annual Evidence-Based Practice Conference at UCLA, “Empowering Patients and Nurses As Partners in Evidence-Based Care.” I thought I would share some of the keynote speaker’s ideas on evidence-based practice. The keynote speaker, Bernadette Mazurek Melnyk, PhD, RN, CPNP/NPP, FAAN, FNAP, is the Dean and Distinguished Foundation Professor in Nursing at Arizona State University. She kindly emailed me and gave me permission to use excerpts from her lecture to put on our blog.
According to Dr. Melnyk, evidence-based practice (EBP) is a problem-solving approach to clinical practice that integrates the conscientious use of best evidence in combination with a clinician’s expertise as well as patient preferences and values. The aim of EBP is to make decisions about types of care . Resources available also must be considered in decision-making.
As nurses, we must accelerate EBP because despite an aggressive research movement, the majority of findings from research often are not integrated into practice. Dr. Melnyk poignantly noted that it takes approximately 17 years to make a change, so we as health providers need to get a move on to make things happen. Often practices within nursing are routed in tradition and are often outdated; they do not lead to the best patient outcomes. Even traditional continuing education conferences do not significantly improve clinical performance and as nurses we need to improve clinical outcomes and performance. Also EBP must be implemented to advance our profession and enhance life-long learning and keep our practices up to date. In the future, it is quite possible that 3rd party payers will only provide reimbursement for healthcare practices that are supported with evidence. Therefore we need to be practicing EBP.
EBP affects patient’s physiological, psychosocial, and functional status. As pointed out by Melnyk, EBP improves outcomes and outcomes reflect IMPACT! This then leads to a positive effect on the health system.
A study by Pravikoff, Tanner, and Pierce (2005) looked at registered nurses in the U.S. The researchers found that 34.5% of the sample only needed information infrequently, almost half were not familiar with the term “evidence-based practice,” and more than half believed that their colleagues use research findings in their practice. This study also showed that most nurses do not search information resources to gather practice information and only 27% had any instruction in using electronic databases.
Barriers to evidence-based practice in the Pravikoff et al. study included “lack of value for research.” Organizational barriers for using information in practice included “presence of other goals with a higher priority.” Researchers concluded that “RNs in the United States aren’t ready for evidence-based practice because of the gaps in their information literacy and computer skills, their limited access to high quality information resources, and above all, the attitudes toward research” (Pravikoff et al., 2005 p. 50).
Knowing this information, how do we get EBP into practice? This is the burning question when there are such visible barriers. According to Melnyk, we must become key facilitators of EBP or champions. This roles involves obtaining knowledge and skills of EBP, understanding that EBP improves care and outcomes, believing in the ability to implement EBP, developing mentor(s)/teachers who are skilled in EBP, and gaining administrational/organizational support. In making patient care decisions, we must use our clinical judgment and expertise, access up-to-date evidence, and consider patient’s preferences and values to make a decision.
Dr. Melnyk lists five steps as the process of EBP:
1. Ask the burning clinical question in PICO format
Patient population
Intervention of interest
Comparison intervention or group
Outcome
2. Collect the best evidence. Search first for systematic reviews (e.g., the Cochrane Database of Systematic Reviews) and evidence-based clinical practice guidelines (http://www.guideline.gov/).
3. Critically appraise the evidence.
4. Integrate evidence, clinical expertise, and patient factors/preferences to implement a decision.
5. Evaluate the outcome.
So remember, evidence-based practice improves outcomes for patients, and nursing is all about the patients! This conference again renewed my own enthusiasm for EBP. I would again like to thank Bernadette Melnyk and Arizona State University for sharing her power-point presentation.
References
Melnyk, B. (April 2007). Empowering patients and nurses as partners in evidence-based practice. Power-point presentation given at UCLA Conference.
Pravikoff, D., Tanner, A., & Pierce, S. (2005). Readiness of U.S. nurses for evidence-based practice. American Journal of Nursing, 105(9), 40-50.
On April 26, 2007, I went to the 6th Annual Evidence-Based Practice Conference at UCLA, “Empowering Patients and Nurses As Partners in Evidence-Based Care.” I thought I would share some of the keynote speaker’s ideas on evidence-based practice. The keynote speaker, Bernadette Mazurek Melnyk, PhD, RN, CPNP/NPP, FAAN, FNAP, is the Dean and Distinguished Foundation Professor in Nursing at Arizona State University. She kindly emailed me and gave me permission to use excerpts from her lecture to put on our blog.
According to Dr. Melnyk, evidence-based practice (EBP) is a problem-solving approach to clinical practice that integrates the conscientious use of best evidence in combination with a clinician’s expertise as well as patient preferences and values. The aim of EBP is to make decisions about types of care . Resources available also must be considered in decision-making.
As nurses, we must accelerate EBP because despite an aggressive research movement, the majority of findings from research often are not integrated into practice. Dr. Melnyk poignantly noted that it takes approximately 17 years to make a change, so we as health providers need to get a move on to make things happen. Often practices within nursing are routed in tradition and are often outdated; they do not lead to the best patient outcomes. Even traditional continuing education conferences do not significantly improve clinical performance and as nurses we need to improve clinical outcomes and performance. Also EBP must be implemented to advance our profession and enhance life-long learning and keep our practices up to date. In the future, it is quite possible that 3rd party payers will only provide reimbursement for healthcare practices that are supported with evidence. Therefore we need to be practicing EBP.
EBP affects patient’s physiological, psychosocial, and functional status. As pointed out by Melnyk, EBP improves outcomes and outcomes reflect IMPACT! This then leads to a positive effect on the health system.
A study by Pravikoff, Tanner, and Pierce (2005) looked at registered nurses in the U.S. The researchers found that 34.5% of the sample only needed information infrequently, almost half were not familiar with the term “evidence-based practice,” and more than half believed that their colleagues use research findings in their practice. This study also showed that most nurses do not search information resources to gather practice information and only 27% had any instruction in using electronic databases.
Barriers to evidence-based practice in the Pravikoff et al. study included “lack of value for research.” Organizational barriers for using information in practice included “presence of other goals with a higher priority.” Researchers concluded that “RNs in the United States aren’t ready for evidence-based practice because of the gaps in their information literacy and computer skills, their limited access to high quality information resources, and above all, the attitudes toward research” (Pravikoff et al., 2005 p. 50).
Knowing this information, how do we get EBP into practice? This is the burning question when there are such visible barriers. According to Melnyk, we must become key facilitators of EBP or champions. This roles involves obtaining knowledge and skills of EBP, understanding that EBP improves care and outcomes, believing in the ability to implement EBP, developing mentor(s)/teachers who are skilled in EBP, and gaining administrational/organizational support. In making patient care decisions, we must use our clinical judgment and expertise, access up-to-date evidence, and consider patient’s preferences and values to make a decision.
Dr. Melnyk lists five steps as the process of EBP:
1. Ask the burning clinical question in PICO format
Patient population
Intervention of interest
Comparison intervention or group
Outcome
2. Collect the best evidence. Search first for systematic reviews (e.g., the Cochrane Database of Systematic Reviews) and evidence-based clinical practice guidelines (http://www.guideline.gov/).
3. Critically appraise the evidence.
4. Integrate evidence, clinical expertise, and patient factors/preferences to implement a decision.
5. Evaluate the outcome.
So remember, evidence-based practice improves outcomes for patients, and nursing is all about the patients! This conference again renewed my own enthusiasm for EBP. I would again like to thank Bernadette Melnyk and Arizona State University for sharing her power-point presentation.
References
Melnyk, B. (April 2007). Empowering patients and nurses as partners in evidence-based practice. Power-point presentation given at UCLA Conference.
Pravikoff, D., Tanner, A., & Pierce, S. (2005). Readiness of U.S. nurses for evidence-based practice. American Journal of Nursing, 105(9), 40-50.
Tuesday, May 22, 2007
Monday, May 21, 2007
E-Journal Club #4
Selling, Kathleem, M.D., Theodore E. Warhentin, M.D., Andreas Greinacher, M.D., “Heparin-induced Thromocytopenia in Intensive Care Patients”, Critical Care Medicine, April 2007: vol.35:4 pp.1165-1176.
Abstract
“Objective: To summarize new information on frequency of heparin-induced thrombocytopenia (HIT) in patients treated in intensive care units (ICU), developments in the interpretation of assays for detecting anti-PF4/heparin antibodies, and treatment of HIT patients.
Study Selection: All data on the frequency of laboratory-confirmed HIT in ICU patients were included; for laboratory testing of HIT and treatment of patients, this review focuses on recent data that became available in 2005 and 2006.
Data Extraction and Synthesis: HIT is a potentially life-threatening adverse effect of heparin treatment caused by platelet-activating antibodies of immunoglobulin G class usually recognizing complexes of platelet factor 4 and heparin. HIT is more often caused by unfractionated heparin than low-molecular-weight heparin and is more common in postsurgical than in medical patients. In the ICU setting, HIT is uncommon (0.3-0.5%), whereas thrombocytopenia from other causes is very common (30-50%). For laboratory diagnosis of HIT antibodies, both antigen assays and functional (platelet activation) assays are available. Both tests are very sensitive (high negative predictive value) but specificity is problematic, especially for the antigen assays, which also detect nonpathogenic immunoglobulin M and immunoglobulin A class antibodies. Detection of immunoglobulin M or immunoglobulin A antibodies could potentially lead to adverse events such as bleeding if a false diagnosis of HIT prompts replacement of heparin by an alternative anticoagulant. For treatment of HIT, three alternative anticoagulants are approved: the direct thrombin inhibitors, lepirudin and argatroban, and the heparinoid, danaparoid (not approved in the
Conclusions: HIT affects <1%>
Have you experienced any episodes of HIT in your unit?
Sunday, May 20, 2007
Saturday, May 19, 2007
Friday, May 18, 2007
Thursday, May 17, 2007
Wednesday, May 16, 2007
Travel Nurse: Summer Agency Assignments
The summer is almost here which means I am receiving numerous e-mails from several travel nurse agencies with their summer assignments and positions. I thought I would attach one of the e-mails I received today with a list of the available assignments. Enjoy!
AN E-MAIL FROM ONE OF MY AGENCIES:
Hello Everyone
My needs are finally here for spring and into summer for OR Techs, LPN's and
RN's nationwide. I have listed the top money positions, a couple with bonuses,
and some that are accepting one year contracts.
In addition to these I have a ton of positions in TN, IL, FL, CO, AZ , TX and
WA opening up. And as usual we have needs in all areas of California for summer.
Come work per diem for 4 weeks and stay by the beach. Let me know if you are
interested ASAP, as these jobs are going fast . Where do YOU want to go?
Hospital: Tucson Medical Center Tucson, AZ
Location: Tucson, AZ
ICU
Days and Nights
Pay: 30's
other areas include completion bonuses up to $6000
Hospital: St. Francis
Location: Lynwood, CA
ER & Labor and Delivery
Night
Pay: High $30's
Hospital: Mendocino Coast Dist Hospital
Location: Mendocino
L&D
Night
Pay: High $30's
Hospital: Eisenhower Memorial
Location: Indio, CA
1. OR RN
Evening/Day shift
Pay: 35 hour
2. CCU/ICU RN
Days and Nights available
Pay: 35/hour (1-2 year contracts also available)
Surg Tech positions $20-23/hour
Englewood, CO
Bristol, CT
Albuquerque, NM
Fort Pierce, FL
Kingman, AZ
San Fran, CA
LPN positions $20-24/hour
Easton, MD Med Surg
Sincerely,
[NAME REDACTED]
AN E-MAIL FROM ONE OF MY AGENCIES:
Hello Everyone
My needs are finally here for spring and into summer for OR Techs, LPN's and
RN's nationwide. I have listed the top money positions, a couple with bonuses,
and some that are accepting one year contracts.
In addition to these I have a ton of positions in TN, IL, FL, CO, AZ , TX and
WA opening up. And as usual we have needs in all areas of California for summer.
Come work per diem for 4 weeks and stay by the beach. Let me know if you are
interested ASAP, as these jobs are going fast . Where do YOU want to go?
Hospital: Tucson Medical Center Tucson, AZ
Location: Tucson, AZ
ICU
Days and Nights
Pay: 30's
other areas include completion bonuses up to $6000
Hospital: St. Francis
Location: Lynwood, CA
ER & Labor and Delivery
Night
Pay: High $30's
Hospital: Mendocino Coast Dist Hospital
Location: Mendocino
L&D
Night
Pay: High $30's
Hospital: Eisenhower Memorial
Location: Indio, CA
1. OR RN
Evening/Day shift
Pay: 35 hour
2. CCU/ICU RN
Days and Nights available
Pay: 35/hour (1-2 year contracts also available)
Surg Tech positions $20-23/hour
Englewood, CO
Bristol, CT
Albuquerque, NM
Fort Pierce, FL
Kingman, AZ
San Fran, CA
LPN positions $20-24/hour
Easton, MD Med Surg
Sincerely,
[NAME REDACTED]
Nurses Job in Oil Company
Some of oil company in Kuwait on the last month ago they offer an opportunity for the nurses to work in their company. The number of interested nurses works in oil company generally because of facilities and the profit that were received, such as health insurance and the school for them who chose to bring their family (child and wife) and more salary.
Qatar oil company also recently held recruitment for the Nurses to work in their company, and until now job opportunity for the medical's profession still open such as Dental Nurse, Supervisor Nurse, senior Pharmacist and Physiotherapist. The Nurses or other Medical Staff they can submit their application direct to the Qatar Oil Company through their website on internet.
Other Job vacancy also available for the Nurses in Saudi Aramco, one of Oil Company in Saudi Arabia. Work in Saudi Aramco Oil Company you’ll get the recognition and reward you deserve. They looking for experienced nursing personnel to work on hospitals and clinical facilities in Dhahran, Al-Hasa, Ras Tanura and Abqaiq.
Qatar oil company also recently held recruitment for the Nurses to work in their company, and until now job opportunity for the medical's profession still open such as Dental Nurse, Supervisor Nurse, senior Pharmacist and Physiotherapist. The Nurses or other Medical Staff they can submit their application direct to the Qatar Oil Company through their website on internet.
Other Job vacancy also available for the Nurses in Saudi Aramco, one of Oil Company in Saudi Arabia. Work in Saudi Aramco Oil Company you’ll get the recognition and reward you deserve. They looking for experienced nursing personnel to work on hospitals and clinical facilities in Dhahran, Al-Hasa, Ras Tanura and Abqaiq.
PowerPoint presentation on EBP at St. Joseph Hospital, Orange
Dana Rutledge, PhD, RN and Victoria Morrison, BSN, RN recently showcased a PowerPoint presentation on evidence-based practice at our recent National Nurse's Week festivities. This presentation summarizes EBP as it relates to nursing and shows a decision flow chart describing the Iowa Model on which our EBP is based. Check it out!!
Tuesday, May 15, 2007
Monday, May 14, 2007
Great article on implementing evidence based practice with Nursing CE units
There is a terrific overview by Susan W. Salmond EdD entitled "Advancing Evidence-Based Practice: a primer" in Orthopaedic Nursing 26(2):114-125 March-April 2007. Reading this article and completing the accompanying post test earns the reader 2 nursing contact hours. The fee is $10 for NAON members and $20 for nonmembers. Even if you're not interested in the CE units, the article is definately worth the read. It covers the paradigm shift that has led to a focus on evidence based practice, barriers to and strategies to overcome barriers to evidence based practice, asking PICO questions, levels of evidence and critically appraising evidence. This article is one of the most cogent and concise summaries of a complicated topic that I have seen. For SJH and CHOC patrons, Burlew Medical Library carries this journal in print but not online. Contact the medical library if you would like a copy.
Sunday, May 13, 2007
Saturday, May 12, 2007
Friday, May 11, 2007
Julie's picks from the literature April 2007
These current EBN or nursing research articles especially piqued my interest:
1. Pellico LH. Chinn PL. Narrative criticism: a systematic approach to the analysis of story. Journal of Holistic Nursing. 2007 Mar; 25(1): 58-65, 66-8. (54 ref) AN: 2009523418 NLM Unique Identifier: 17325316.
2. O'Malley P. Order no harm: evidence-based methods to reduce prescribing errors for the clinical nurse specialist. Clinical Nurse Specialist. 2007 Mar-Apr; 21(2): 68-70. (17 ref) Burlew carries this journal AN: 2009522842 NLM Unique Identifier: 17308440.
3. Couchman BA. Wetzig SM. Coyer FM. Wheeler MK. Nursing care of the mechanically ventilated patient: What does the evidence say? Part one. Intensive & Critical Care Nursing. 2007 Feb; 23(1): 4-14. (69 ref) AN: 2009510989 NLM Unique Identifier: 17046259.
4. Rattray J. Jones MC. Essential elements of questionnaire design and development. Journal of Clinical Nursing. 2007 Feb; 16(2): 234-43. (41 ref) Burlew has some online access, no print issues. AN: 2009505889 NLM Unique Identifier: 17239058.
5. Rheingans JI. A systematic review of nonpharmacologic adjunctive therapies for symptom management in children with cancer. Journal of Pediatric Oncology Nursing. 2007 Mar-Apr; 24(2): 81-94. (49 ref) Burlew carries this journal AN: 2009523593 NLM Unique Identifier: 17332422.
6. Gerrish K. Ashworth P. Lacey A. Bailey J. Cooke J. Kendall S. McNeilly E. Factors influencing the development of evidence-based practice: a research tool. Journal of Advanced Nursing. 2007 Feb; 57(3): 328-38. (44 ref)
7. Smirnoff M. Ramirez M. Kooplimae L. Gibney M. McEvoy MD. Nurses' attitudes toward nursing research at a metropolitan medical center. Applied Nursing Research. 2007 Feb; 20(1): 24-31. (38 ref) AN: 2009506615 NLM Unique Identifier: 17259040.
NLM Serial ID Number
NLM Serial ID Number
8. Mitchell SA. Beck SL. Hood LE. Moore K. Tanner ER. Putting evidence into practice: evidence-based interventions for fatigue during and following cancer and its treatment. Clinical Journal of Oncology Nursing. 2007 Feb; 11(1): 99-113, 130-4. (118 ref) Burlew has some years.
9. Tipton JM. McDaniel RW. Barbour L. Johnston MP. Kayne M. LeRoy P. Ripple ML. Putting evidence into practice: evidence-based interventions to prevent, manage, and treat chemotherapy-induced nausea and vomiting. Clinical Journal of Oncology Nursing. 2007 Feb; 11(1): 69-78, 130-4. (75 ref) Burlew has some years. AN: 2009499475.
10. Logan DM. Culturally and linguistically appropriate services: an overview of policy and safe acute care nursing practice in the United States. Gastroenterology Nursing. 2007 Jan-Feb; 30(1): 29-35. (37 ref) Burlew has some online access, no print issues. AN: 2009517704 NLM Unique Identifier: 17312422
Thursday, May 10, 2007
Wednesday, May 9, 2007
Tuesday, May 8, 2007
Monday, May 7, 2007
E-Journal Club #3
Newhouse, Robin P., RN, PhD, CNA, CNOR
“Creating Infrastructure Supportive of Evidence-Based Nursing Practice: Leadership Strategies” Worldviews on Evidence-Based Nursing 4 (1), 21–29.
Author’s Abstract:
“Nursing leadership is the cornerstone of successful evidence-based practice (EBP) programs within health care organizations. The key to success is a strategic approach to building an EBP infrastructure, with allocation of appropriate human and material resources.
This article indicates the organizational infrastructure that enables evidence-based nursing practice and strategies for leaders to enhance evidence-based practice using "the conceptual model for considering the determinants of diffusion, dissemination, and implementation of innovations in health service delivery and organization."
Enabling EBP within organizations is important for promoting positive outcomes for nurses and patients. Fostering EBP is not a static or immediate outcome, but a long-term developmental process within organizations. Implementation requires multiple strategies to cultivate a culture of inquiry where nurses generate and answer important questions to guide practice.
Organizations that can enable the culture and build infrastructure to help nurses develop EBP competencies will produce a professional environment that will result in both personal growth for their staff and improvements in quality that would not otherwise be possible.”
Commentary
We were just discussion promotion of evidence-based “thinking” in the research council this week. Even though putting research into practice is clear, using this evidence in practice is not always easy, especially when your physician says “I don’t like to use Versed.” I think we as nurses are used to looking toward the physician as the absolute leader. It is a shift in our way of practice to realize we must now, perhaps, remind the physician that that is “not what the literature supports” or that "our new policy" now asks us to do things another way. But if everyone thought and acted this way, it would become part of the work culture.
I like the way this article talks about resources. We have generated a lot of good ideas in our critical care unit. How does the manager decide how much time and money to allocate to each idea?
I would like to thank the Burlew’s librarian, Julie Smith, for her EBN articles in “picks from the literature.” See April 13, 2007, in this blog.
Sunday, May 6, 2007
More silliness
| Your Birthdate: October 14 |
 You work well with others. That is, you're good at getting them to do work for you. It's true that you get by on your charm. But so what? You make people happy! You're dynamic, clever, and funny. And people like to have you around. But you're so restless, they better not expect you to stay around for long. Your strength: Your superstar charisma Your weakness: Commitment means nothing to you Your power color: Fuchsia Your power symbol: Diamond Your power month: May |
Saturday, May 5, 2007
Friday, May 4, 2007
Update on X-rays, blood tests...
Ok, so the hip/pelvis X-rays came back as normal, no bone problems/calcifications... good in one way, bad in another. Good because that would mean more problems and possibly a future career issue, bad because it means I have to re-learn how to walk without compensation (or at least not too much compensation). The pain is still there, though less since I got a new shoe orthotic for my "good" side.
The bloods came back as normal too. YAY! Even my cholesterol levels were great, odd since I have lived of fries and salt and vinegar chips and other junk food since September (2nr yr nsg school makes me crave junk food.. must be the stress or something!).
My neuro ordered more bloods this past week (cause I haven't had enough poking already!). She wants to see if my fatigue, and lack of eating (or not much eating, I do eat after all, just not much) has anything to do with my thyroid and my poor eating has affected my B12 levels and such. So I did that on Tuesday and now I wait to find out if anything comes back as LOW or HIGH or WEIRD!
The bloods came back as normal too. YAY! Even my cholesterol levels were great, odd since I have lived of fries and salt and vinegar chips and other junk food since September (2nr yr nsg school makes me crave junk food.. must be the stress or something!).
My neuro ordered more bloods this past week (cause I haven't had enough poking already!). She wants to see if my fatigue, and lack of eating (or not much eating, I do eat after all, just not much) has anything to do with my thyroid and my poor eating has affected my B12 levels and such. So I did that on Tuesday and now I wait to find out if anything comes back as LOW or HIGH or WEIRD!
Botox me cont...
Well it's been a week since I got the Botox. 4 injections in all in my left calf muscle, 2 of which really really hurt (I have hypersensitivity in some parts of my leg). It seems to be working, not completely yet, I was told it could take up to 2 weeks to be able to see the effects. Already I have less spasticity and much les clonus.
The problem is my quad... either it is MORE spastic or i am just noticing it more as the lower leg is "quieter". I have to see my doctor in another week and a half so will discuss it then.
I had some side effects, mainly fatigue and headache, but being a nursing student also does that, so who knows!
I'll post more updates as they come...
This is not a pic of me, but it's what it looks like when they do it..
The problem is my quad... either it is MORE spastic or i am just noticing it more as the lower leg is "quieter". I have to see my doctor in another week and a half so will discuss it then.
I had some side effects, mainly fatigue and headache, but being a nursing student also does that, so who knows!
I'll post more updates as they come...
This is not a pic of me, but it's what it looks like when they do it..
New Pics
Here are a few new pictures taken recently... some at the RVH where I did my med-surg II rotation, one at home with me and the cats!
One more week of class followed by a week of exams (Nursing final, Bio {A&P IV} final and Nursing OSCE) and I AM DONE until August! Wish me luck for exams!!!
Sillyness
| You Are a Boston Creme Donut |
 You have a tough exterior. No one wants to mess with you. But on the inside, you're a total pushover and completely soft. You're a traditionalist, and you don't change easily. You're likely to eat the same doughnut every morning, and pout if it's sold out. |
Thursday, May 3, 2007
Wednesday, May 2, 2007
Abstract and Commentary
Callen, B. L., Mahoney, J.E., Grieves, C.B., Wells, T.J., & Enloe, M. (2004). Frequency of hallway ambulation by hospitalized older adults on medical units of an academic hospital. Geriatric Nursing, 25, 212-217.
Authors’ Abstract
Lack of activity during hospitalization may contribute to functional decline. The purpose of this study was to determine the frequency of hallway walking by older adults hospitalized for medical illness. The study was an observational time-sampled study, which was conducted in the hallways of 3 medical units of a 485-bed academic health care center. Each unit was observed weekdays for eight 3-hour intervals covering 8 AM to 8 PM. Before each observation, nursing staff were questioned about walking abilities of patients aged > 55 years. During observation, frequency and minutes of patients’ hallway ambulation were recorded. Of 118 patients considered by nurses as able to walk in the hallways, 18.6% walked once, 5.1% twice, 3.4% more than twice, and 2.9% did not walk at all per 3-hour period. The median minutes for ambulation was 5.5. Frequency of ambulation was as low for patients independent in walking as for those dependent (28% vs. 26%, P=.507). Of the 32 patients who walked in the hallways, most did so alone (46.8%, n=15) or with therapy staff (41%, n=13); few walked with nursing staff (9.4%, n=3) or family (18.8%, n=6). In this setting, hallway walking was very low for hospitalized older patients. If this trend of limited walking is found to be prevalent across other settings, then both independent and dependent patients will require additional interventions to improve ambulation during hospitalization.
Commentary by Dana Rutledge, RN, PhD, Nursing Research Facilitator
This is one of few studies that document anything about ambulation in hospitalized patients. Its limitations include the fact that it was an observational study, that determination of patients’ ability to ambulate and need for assistance was based upon nursing judgment, that no data were collected on motivation to walk, and that the study only occurred on weekdays. Despite these limitations, study results point out that medical/surgical patients do not ambulate a lot, and that much ambulation may be driven by “therapy” goals rather than optimizing patient physical function (normal conditioning). This implies that patients who do not have ambulation “ordered” may lose function even if they entered the hospital fully functional. We are all aware of the “hazards of immobility” (Olson, 1967): pathology including cardiovascular, respiratory, gastrointestinal, musculoskeletal, urinary, metabolic, and psychosocial health changes.
When I read this abstract, I was surprised at the low proportion of walks where the patient was with nursing staff or family. So, in the article, I searched for how they measured this. Walking was observed by a non-staff observer who “sat in a corner of the middle section of the unit;” walking in the rooms was not observed. Each of 3 medical/surgical units were sampled during 3-hour intervals between 8 a.m. and 8 p.m. Each unit was observed for 24 hours. For patients who would be observed (> 55 years), the observer first gathered information about patient activity from the nursing staff. Per observation period and per patient, the observer noted time and duration, route taken, apparent purpose, and presence of human assistance or assistive device. The definition of the walk’s purpose was confusing to me:
· For therapy – patient walking with a nurse or off-unit health professional
· For a purpose other than therapy – walking with a definite goal (e.g., walking to elevator)
· For exercise – walking along or with family with no observable goal
I was unable to reconcile how the researchers differentiated walking with therapy staff or with nursing staff.
So, the actual percentages of walks per category may not make sense, but overall, patients did not walk much. I wonder how much patients at St. Joseph are walking.
Olson, E.V. (1967). The hazards of immobility. American Journal of Nursing, 67, 779–97.
Callen, B. L., Mahoney, J.E., Grieves, C.B., Wells, T.J., & Enloe, M. (2004). Frequency of hallway ambulation by hospitalized older adults on medical units of an academic hospital. Geriatric Nursing, 25, 212-217.
Authors’ Abstract
Lack of activity during hospitalization may contribute to functional decline. The purpose of this study was to determine the frequency of hallway walking by older adults hospitalized for medical illness. The study was an observational time-sampled study, which was conducted in the hallways of 3 medical units of a 485-bed academic health care center. Each unit was observed weekdays for eight 3-hour intervals covering 8 AM to 8 PM. Before each observation, nursing staff were questioned about walking abilities of patients aged > 55 years. During observation, frequency and minutes of patients’ hallway ambulation were recorded. Of 118 patients considered by nurses as able to walk in the hallways, 18.6% walked once, 5.1% twice, 3.4% more than twice, and 2.9% did not walk at all per 3-hour period. The median minutes for ambulation was 5.5. Frequency of ambulation was as low for patients independent in walking as for those dependent (28% vs. 26%, P=.507). Of the 32 patients who walked in the hallways, most did so alone (46.8%, n=15) or with therapy staff (41%, n=13); few walked with nursing staff (9.4%, n=3) or family (18.8%, n=6). In this setting, hallway walking was very low for hospitalized older patients. If this trend of limited walking is found to be prevalent across other settings, then both independent and dependent patients will require additional interventions to improve ambulation during hospitalization.
Commentary by Dana Rutledge, RN, PhD, Nursing Research Facilitator
This is one of few studies that document anything about ambulation in hospitalized patients. Its limitations include the fact that it was an observational study, that determination of patients’ ability to ambulate and need for assistance was based upon nursing judgment, that no data were collected on motivation to walk, and that the study only occurred on weekdays. Despite these limitations, study results point out that medical/surgical patients do not ambulate a lot, and that much ambulation may be driven by “therapy” goals rather than optimizing patient physical function (normal conditioning). This implies that patients who do not have ambulation “ordered” may lose function even if they entered the hospital fully functional. We are all aware of the “hazards of immobility” (Olson, 1967): pathology including cardiovascular, respiratory, gastrointestinal, musculoskeletal, urinary, metabolic, and psychosocial health changes.
When I read this abstract, I was surprised at the low proportion of walks where the patient was with nursing staff or family. So, in the article, I searched for how they measured this. Walking was observed by a non-staff observer who “sat in a corner of the middle section of the unit;” walking in the rooms was not observed. Each of 3 medical/surgical units were sampled during 3-hour intervals between 8 a.m. and 8 p.m. Each unit was observed for 24 hours. For patients who would be observed (> 55 years), the observer first gathered information about patient activity from the nursing staff. Per observation period and per patient, the observer noted time and duration, route taken, apparent purpose, and presence of human assistance or assistive device. The definition of the walk’s purpose was confusing to me:
· For therapy – patient walking with a nurse or off-unit health professional
· For a purpose other than therapy – walking with a definite goal (e.g., walking to elevator)
· For exercise – walking along or with family with no observable goal
I was unable to reconcile how the researchers differentiated walking with therapy staff or with nursing staff.
So, the actual percentages of walks per category may not make sense, but overall, patients did not walk much. I wonder how much patients at St. Joseph are walking.
Olson, E.V. (1967). The hazards of immobility. American Journal of Nursing, 67, 779–97.
Victoria's Research Corner
As evidence based projects (EBP) and research studies are being done, I wanted to let you know about projects as they are happening. Every newsletter, I will be interviewing someone who is doing either an EBP or a research study. For this newsletter I had the wonderful opportunity of interviewing Terry Zeilinger, Manager of the Mother-Baby Unit, regarding her research study, “Determination of whether 36-hour screening transcutaneous bilirubin adds to knowledge gained from 24-hour screening”.
Q. What is your study about?
A. “We are looking at transcutaneous bilirubins at 36 hours in babies who are born here at St. Joseph’s Hospital during a 3-month period who are not discharged before 36 hours post delivery. The standard of care has been 24-hour bilirubins and then on a PRN (as needed) basis if a baby looks jaundiced. Most babies’ average length of stay is 2 days for a vaginal delivery and three days for a C-section. We are trying to catch babies who are in trouble with abnormal (high) bilirubins to try to avoid complications such as increased dehydration, poor feeding, and ultimately kernicterus.”
Q. Is it an EBP/Research Study?
A. “This is a quantitative research study.”
Q. What made you interested in this project?
A. “We had a baby whose bilirubin was normal at 24 hours. At 40 hours the nurse noticed the baby looked jaundice and took a transcutaneous bilirubin, the level was high. The baby went home and was then readmitted to CHOC for still increased bilirubin. A few other babies were also readmitted post discharge from the Mother/Baby Outpatient Center due to high bilirubins.”
Q. How did you go about doing your research?
A. “I decided to look into the research already available and realized there weren’t any other studies that looked at bilirubins greater than 24 hours. After discussing with a colleague, she suggested I make this a research study. I then went to Dana Rutledge, the Nurse Research Facilitator, and we organized the information. I then had to go the Institutional Review Board (IRB) for approval of my study. Now I am doing chart reviews looking at trending in 24 and 36-hour bilirubins of babies.”
Q. What are your expected outcomes?
A. “We have already started the practice change and the study in the units looking at 36-hour bilirubins and so far, empirically, there are more babies already requiring phototherapy. Hopefully, we will be able to find these “high risk” babies and give intervention, supplementation, and closer follow-up.”
Q. Have you done research before? If so what did you learn?
A. “I did a small project for my Master’s, which looked at finger feeding preterm infants versus bottle-feeding. I learned that although research is interesting there is some frustration with the amount of time it takes. There can be a lot of limitations. You must review policy and procedures, look at articles, go to councils for approval, and possibly change a practice.”
Q. Will you do an EBP/research project again?
A. “I would like to. I definitely have an interest. The mother baby unit based council and myself are looking at alcohol application versus natural cord drying in infants, this may lead to another study.”
Q. What is your study about?
A. “We are looking at transcutaneous bilirubins at 36 hours in babies who are born here at St. Joseph’s Hospital during a 3-month period who are not discharged before 36 hours post delivery. The standard of care has been 24-hour bilirubins and then on a PRN (as needed) basis if a baby looks jaundiced. Most babies’ average length of stay is 2 days for a vaginal delivery and three days for a C-section. We are trying to catch babies who are in trouble with abnormal (high) bilirubins to try to avoid complications such as increased dehydration, poor feeding, and ultimately kernicterus.”
Q. Is it an EBP/Research Study?
A. “This is a quantitative research study.”
Q. What made you interested in this project?
A. “We had a baby whose bilirubin was normal at 24 hours. At 40 hours the nurse noticed the baby looked jaundice and took a transcutaneous bilirubin, the level was high. The baby went home and was then readmitted to CHOC for still increased bilirubin. A few other babies were also readmitted post discharge from the Mother/Baby Outpatient Center due to high bilirubins.”
Q. How did you go about doing your research?
A. “I decided to look into the research already available and realized there weren’t any other studies that looked at bilirubins greater than 24 hours. After discussing with a colleague, she suggested I make this a research study. I then went to Dana Rutledge, the Nurse Research Facilitator, and we organized the information. I then had to go the Institutional Review Board (IRB) for approval of my study. Now I am doing chart reviews looking at trending in 24 and 36-hour bilirubins of babies.”
Q. What are your expected outcomes?
A. “We have already started the practice change and the study in the units looking at 36-hour bilirubins and so far, empirically, there are more babies already requiring phototherapy. Hopefully, we will be able to find these “high risk” babies and give intervention, supplementation, and closer follow-up.”
Q. Have you done research before? If so what did you learn?
A. “I did a small project for my Master’s, which looked at finger feeding preterm infants versus bottle-feeding. I learned that although research is interesting there is some frustration with the amount of time it takes. There can be a lot of limitations. You must review policy and procedures, look at articles, go to councils for approval, and possibly change a practice.”
Q. Will you do an EBP/research project again?
A. “I would like to. I definitely have an interest. The mother baby unit based council and myself are looking at alcohol application versus natural cord drying in infants, this may lead to another study.”
Tuesday, May 1, 2007
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