Click here for a yummy recipe for Chocolate Chip Pumpkin Bread.
Click here to read a Great article online from the Los Angeles Times on Midwifery care in America. It sums up the state of birth in the US quite well, highlighting the disparity between the amount of money being spent on obstetrical care in the US and the sad results seen in our rank of 41st among industrialized countries.
Click here to read about President Bush's "Healthcare Conscience Rule." This is a sticky subject. One that I'm not totally set on my stance about. I do think direct care providers like physicians should have the ability to decide for themselves and their practice what services they will perform. However, where do you draw the line? What services and what providers does this cover? Only abortions? Only for religious reasons? The wording of this rule seems to allow for any procedure, any service worker, and because of any "moral" persuasion.
What would the repercussions be if a secretary refused to bill for a patient's IUD placement? What about when the person who cleans instruments refuses to clean circumcision trays and instruments? Do you see how this can snowball into one huge, subjective license to refuse services?
And, if a provider can refuse to perform services, can they also refuse to offer them and refuse to provide full informed consent to their patients... Can they refuse to tell the potential patient all of their choices - whether or not they would personally choose them - Can they refuse to tell them the risks, benefits and alternatives of all possible procedures applicable.
As a healthcare provider, myself, there are certainly parts of my job I would love to refuse to participate in. But, is that my choice? I am employed by the hospital I work at. I agreed to provide the services of a registered nurse on a maternity floor. So, that entails many things I would not personally choose for myself, but that others do choose for themselves (elective cesarean sections to name only one).
I am ok with that as long as there is full informed consent. Who am I to make decisions for others? Who am I to say that I know what is better for them? And who am I to practice selective nursing. If I agree with your choices, I will provide you care? No. That is not what I signed up for. I agreed to help those in need of medical services, no matter why - no matter if their "Good" or "Bad" choices put them in need of this medical care.
There just seems to be a whiff of judgementalism to this "healthcare conscience rule." A wiff that makes my stomach turn. I've lived through my share of legalism and judgementalism... People thinking they had superiority over me and authority to judge me because of what they would label as "wrong" or "bad" choices.
Unless you are walking in someone's shoes, you cannot know all of their reasons for their choices.... There is a lifetime of history behind each person's current situation. You must meet them where they are... accept them as they are... and help them no matter why they need your help.
Rant over. Off my soap box. "I'm just saying (As sis would say)."
Showing posts with label health. Show all posts
Showing posts with label health. Show all posts
Tuesday, January 6, 2009
Sunday, December 14, 2008
MRSA in Nurseries
Tomorrow is the last day of classes for the semester. I only took 2 classes this semester. Nurs 390 during the 1st 7 weeks; Nurs 457 during the last seven. Currently, I'm procrastinating - I have to finish up my last project of the semester: a power point presentation on "Electronic Health Records and Their Impact on Nursing Informatics." BORING. But necessary, I suppose.
As an nod to Nurs 390 and in an effort to procrastinate even more, I'll share one of the papers I wrote this semester here..... Enjoy.
The presence of Methicillin-resistant Staphylococcus aureus (MRSA) in the hospital setting and medical research has increased dramatically and is steadily growing from less than 5% in 1976 to 40% in 1999 (Chambers, 2001). Additionally, 25% to 50% of the general population is a carrier of MRSA. And, young children, who can become colonized shortly after birth, have a higher rate of colonization than do adults (Chambers, 2001). These facts, along with recent outbreaks of MRSA in well-baby neonatal nurseries across the country, make the strictly enforced use of standard precautions imperative as a mainstay for the successful prevention of new cases in the vulnerable infant population.
Standard precautions are used as a minimal acceptable practice on all patients in the healthcare environment. These are basic precautions used to safeguard healthcare providers and their patients alike from infections and cross-contamination. Along with other protective measures such as wearing gloves and gowns when indicated, standard precautions include the practice of performing hand hygiene before and after patient contact, and disinfecting shared patient equipment between each use (CDC, 2006). These measures have been established by the Center for Disease Control and Prevention and are universally accepted as good and safe practices that are effective at limiting the spread of pathogens (CDC, 2006).
However, healthcare providers, including nurses and physicians, frequently fail to adhere to these guidelines when performing patient care activities. Reasons given by delinquent providers for non-adherence include a heavy workload leading to time limitations, forgetfulness, unavailable equipment and false beliefs such as the belief that the patient did not pose a risk or the belief that their co-workers also were not following standard precautions (Ferguson, Waitzkin, Beekman, & Doebbeling, 2004).
These excuses given by healthcare providers for not following standard precautions represent flawed logic and contribute to cross-contamination and subsequent increasing rates of MRSA and other infectious diseases in our hospital settings. If a healthcare provider is non-adherent and fails to sanitize their hand or their equipment between patients for any reason they are increasing the chance of cross-contamination which could lead to susceptible patients becoming infected with MRSA. Consequently the patients’ hospital stay, costs and mortality are accordingly increased as well (CDC, 2006).
The infant patient population is uniquely susceptible to MRSA infections because of their immature immune systems, close contact with other patients in the night nursery and routine skin integrity breaks from circumcision, as addressed below. Therefore, I believe there needs to be 100% compliance by neonatal nurses with the guidelines set forth by the CDC to prevent the spread of MRSA, regardless of convenience to the healthcare provider or patient. Additionally, I believe there are other unique interventions that are outlined that neonatal nurses need to implement in order to protect their unique patient population.
According to research it is of importance to note that the solution used during newborn baths and hand-washing influences the effectiveness of the disinfection obtained. Bacti-stat (0.3% triclosan) has been proven to eradicate MRSA outbreaks in well-baby nurseries (Zafer, Reese & Mennonna, 1995). Therefore, some hospitals are in the routine, prophylactic practice of giving a baby a bath with bacti-stat on two occasions: at birth and before discharge in order to reduce the likelihood that the infant will contract and take home any infectious disease like MRSA.
Another unique contributing factor to newborn MRSA infections is the circumcision procedure which occurs during this period of hospitalization. Any break in skin integrity along with recent surgical procedures, which circumcision is, increases a patient’s likelihood of contracting MRSA (CDC, 2006). Accordingly, as Van Howe points out, when there is an outbreak of neonatal MRSA, male infants are disproportionately infected (2007). In fact, one study directly linked circumcision and the related lidocaine injections with neonatal MRSA. Additionally, the same study stated that the moist post-circumcision site is particularly susceptible to microorganism growth (Nguyen, Bancroft, Guevara & Yasuda, 2007).
With this knowledge a neonatal nurse can intervene in practical ways to decrease a circumcised male’s incident of contracting MRSA. Initially, good hand hygiene should be preformed prior to, during and after circumcision while providing circumcision care. Next, all surgical circumcision equipment should be kept covered until time for it to be used (Nguyen, et al, 2007). Finally, multiple use lidocaine vials should be eliminated as they have been linked to contamination and subsequent MRSA infections (Nguyen, et al, 2007).
In conclusion, because in most cases well women come to the hospital and deliver well infants, it is especially urgent for the obstetrical staff to do everything possible to limit iatrogenic infections such as MRSA. This can be accomplished with strict adherence to standard precautions, especially in the common well-nursery, initiation of bacti-stat solution for newborn baths, and sanitary circumcision procedures including the elimination of multi-dose lidocaine vials. The implications of these prophylactic procedures would be providing the best evidenced-based practice currently available in order to achieve exceptional quality, safety and service.
References:
Center of Disease Control and Prevention. (2006). Management of multidrug resistant organisms in healthcare settings, 2006. Retrieved September 14, 2008, from
http://www.cdc.gov/ncidod/dhqp/pdf/ar/MDROGuideline2006.pdf
Chambers HF. (2001). The Changing Epidemiology of Staphylococcus aureus? Emerging Infectious Disease, Mar-Apr; 7(2). Retrieved September 14, 2008, from
http://www.cdc.gov/ncidod/eid/vol7no2/chambers.htm
Ferguson KJ, Waitzkin H, Beekman SE, Doebbeling BN. (2004). Critical Incidence of non-adherence with standard precautions: Guidelines among community hospital-based healthcare workers. Journal of General Internal Medicine, July; 19(7): 726-731. Retrieved September 14, 2008, from
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1492480
Nguyen DM, Bancroft E, Mascola L, Guevara R, Yasuda L. (2007). Risk factors for neonatal methicillin-resistant Staphylococcus aureus infection in a well-infant nursery. Infection Control and Hospital Epidemeology, 28(4):406-411.
Van Howe, RS. (2007). The possible role of circumcision in newborn outbreaks of community-associated methicillin-resistant Staphylococcus aureus. Clinical Pediatrics, 46(4): 356-358.
Zafer AB, Butler RC, Reese DJ, Gaydos LA, & Mennonna PA. (1995). Use of 0.3% triclosan (Bacti-Stat) to eradicate an outbreak of methicillin-resistant Staphylococcus aureus in a neonatal nursery. American Journal of Infection Control, Jun; 23(3):200-8.
As an nod to Nurs 390 and in an effort to procrastinate even more, I'll share one of the papers I wrote this semester here..... Enjoy.
Prevention of Methicillin-resistant Staphylococcus aureus (MRSA) in Neonatal Nurseries
The presence of Methicillin-resistant Staphylococcus aureus (MRSA) in the hospital setting and medical research has increased dramatically and is steadily growing from less than 5% in 1976 to 40% in 1999 (Chambers, 2001). Additionally, 25% to 50% of the general population is a carrier of MRSA. And, young children, who can become colonized shortly after birth, have a higher rate of colonization than do adults (Chambers, 2001). These facts, along with recent outbreaks of MRSA in well-baby neonatal nurseries across the country, make the strictly enforced use of standard precautions imperative as a mainstay for the successful prevention of new cases in the vulnerable infant population.
Standard precautions are used as a minimal acceptable practice on all patients in the healthcare environment. These are basic precautions used to safeguard healthcare providers and their patients alike from infections and cross-contamination. Along with other protective measures such as wearing gloves and gowns when indicated, standard precautions include the practice of performing hand hygiene before and after patient contact, and disinfecting shared patient equipment between each use (CDC, 2006). These measures have been established by the Center for Disease Control and Prevention and are universally accepted as good and safe practices that are effective at limiting the spread of pathogens (CDC, 2006).
However, healthcare providers, including nurses and physicians, frequently fail to adhere to these guidelines when performing patient care activities. Reasons given by delinquent providers for non-adherence include a heavy workload leading to time limitations, forgetfulness, unavailable equipment and false beliefs such as the belief that the patient did not pose a risk or the belief that their co-workers also were not following standard precautions (Ferguson, Waitzkin, Beekman, & Doebbeling, 2004).
These excuses given by healthcare providers for not following standard precautions represent flawed logic and contribute to cross-contamination and subsequent increasing rates of MRSA and other infectious diseases in our hospital settings. If a healthcare provider is non-adherent and fails to sanitize their hand or their equipment between patients for any reason they are increasing the chance of cross-contamination which could lead to susceptible patients becoming infected with MRSA. Consequently the patients’ hospital stay, costs and mortality are accordingly increased as well (CDC, 2006).
The infant patient population is uniquely susceptible to MRSA infections because of their immature immune systems, close contact with other patients in the night nursery and routine skin integrity breaks from circumcision, as addressed below. Therefore, I believe there needs to be 100% compliance by neonatal nurses with the guidelines set forth by the CDC to prevent the spread of MRSA, regardless of convenience to the healthcare provider or patient. Additionally, I believe there are other unique interventions that are outlined that neonatal nurses need to implement in order to protect their unique patient population.
According to research it is of importance to note that the solution used during newborn baths and hand-washing influences the effectiveness of the disinfection obtained. Bacti-stat (0.3% triclosan) has been proven to eradicate MRSA outbreaks in well-baby nurseries (Zafer, Reese & Mennonna, 1995). Therefore, some hospitals are in the routine, prophylactic practice of giving a baby a bath with bacti-stat on two occasions: at birth and before discharge in order to reduce the likelihood that the infant will contract and take home any infectious disease like MRSA.
Another unique contributing factor to newborn MRSA infections is the circumcision procedure which occurs during this period of hospitalization. Any break in skin integrity along with recent surgical procedures, which circumcision is, increases a patient’s likelihood of contracting MRSA (CDC, 2006). Accordingly, as Van Howe points out, when there is an outbreak of neonatal MRSA, male infants are disproportionately infected (2007). In fact, one study directly linked circumcision and the related lidocaine injections with neonatal MRSA. Additionally, the same study stated that the moist post-circumcision site is particularly susceptible to microorganism growth (Nguyen, Bancroft, Guevara & Yasuda, 2007).
With this knowledge a neonatal nurse can intervene in practical ways to decrease a circumcised male’s incident of contracting MRSA. Initially, good hand hygiene should be preformed prior to, during and after circumcision while providing circumcision care. Next, all surgical circumcision equipment should be kept covered until time for it to be used (Nguyen, et al, 2007). Finally, multiple use lidocaine vials should be eliminated as they have been linked to contamination and subsequent MRSA infections (Nguyen, et al, 2007).
In conclusion, because in most cases well women come to the hospital and deliver well infants, it is especially urgent for the obstetrical staff to do everything possible to limit iatrogenic infections such as MRSA. This can be accomplished with strict adherence to standard precautions, especially in the common well-nursery, initiation of bacti-stat solution for newborn baths, and sanitary circumcision procedures including the elimination of multi-dose lidocaine vials. The implications of these prophylactic procedures would be providing the best evidenced-based practice currently available in order to achieve exceptional quality, safety and service.
References:
Center of Disease Control and Prevention. (2006). Management of multidrug resistant organisms in healthcare settings, 2006. Retrieved September 14, 2008, from
http://www.cdc.gov/ncidod/dhqp/pdf/ar/MDROGuideline2006.pdf
Chambers HF. (2001). The Changing Epidemiology of Staphylococcus aureus? Emerging Infectious Disease, Mar-Apr; 7(2). Retrieved September 14, 2008, from
http://www.cdc.gov/ncidod/eid/vol7no2/chambers.htm
Ferguson KJ, Waitzkin H, Beekman SE, Doebbeling BN. (2004). Critical Incidence of non-adherence with standard precautions: Guidelines among community hospital-based healthcare workers. Journal of General Internal Medicine, July; 19(7): 726-731. Retrieved September 14, 2008, from
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1492480
Nguyen DM, Bancroft E, Mascola L, Guevara R, Yasuda L. (2007). Risk factors for neonatal methicillin-resistant Staphylococcus aureus infection in a well-infant nursery. Infection Control and Hospital Epidemeology, 28(4):406-411.
Van Howe, RS. (2007). The possible role of circumcision in newborn outbreaks of community-associated methicillin-resistant Staphylococcus aureus. Clinical Pediatrics, 46(4): 356-358.
Zafer AB, Butler RC, Reese DJ, Gaydos LA, & Mennonna PA. (1995). Use of 0.3% triclosan (Bacti-Stat) to eradicate an outbreak of methicillin-resistant Staphylococcus aureus in a neonatal nursery. American Journal of Infection Control, Jun; 23(3):200-8.
Monday, October 6, 2008
Awareness
October is Breast Cancer Awareness month.
Go to this site to view some touching short films (10 min or less) made by people who have been affected by breast cancer. I thought the one made by little Maxwell titled, "My Mommy has Cancer" was truly touching.
Somehow my kids and I got onto the topic of cancer last night. It was difficult to explain to them why there is not a cure for cancer. Let's hold onto the hope that one day there will be and until then pray for peace for those who are living through cancer right now.
Go to this site to view some touching short films (10 min or less) made by people who have been affected by breast cancer. I thought the one made by little Maxwell titled, "My Mommy has Cancer" was truly touching.
Somehow my kids and I got onto the topic of cancer last night. It was difficult to explain to them why there is not a cure for cancer. Let's hold onto the hope that one day there will be and until then pray for peace for those who are living through cancer right now.
Monday, May 26, 2008
Little Lance's Heart
Caressa alluded to Lance's heart problems in her comment on the last post. I've not written about it here. But, there are a lot of aspects of life I haven't written about. Not because they are not important. Just because.
Lance was born with a congenital heart defect. He had a coarctation of the aorta, which is a narrowing of the major vessel that leaves the heart and carries all of the newly oxygenated blood to the body. This creates hypertension in the upper extremities and hypotension in the lower extremities. It can lead to congestive heart failure and sudden death if undetected and uncorrected.
Lance's defect was discovered when he was 10 months old. He had corrective surgery immediately upon discovery (he had a subclavian flap procedure). We were told at the time that he would recover fully, but there was a chance that his aorta could re-narrow.
It has been about 7 & 1/2 years since then. Each check up with the cardiologist has been very good, overall. The last time we saw them, they did an echocardiogram and discovered he also had another congenital heart defect that hadn't been detected to that point called a bicuspid aortic valve. Normally, the aortic valve has 3 flaps; Lance's has only 2. At the time it was discovered, they told us it was nothing to worry about at the time and they would just keep watching him. In fact, they told us he was doing so well that we should not come back for 2 years.
Then I took him back last week (it had been 2 years). And, the appointment was less than reassuring. While the cardiologist still thinks there is nothing that needs to be done immediately, he was noticeably concerned about a couple aspects of the exam. He encouraged us to keep Lance away from certain activities and shortened our follow up time to 1 year again.
They are worried about two things, I gather. One is the re-narrowing of the original aortic defect. The second is the decrease in diameter of the bicuspid valve - this could result in a dilated aorta distal to the valve, possibly leading to rupture of the aorta.
While I am trying to trust the doctor - he is from one of the most respected pediatric cardiologist groups in the country - it was hard to leave the office and agree to "act normally" for a whole year without another checkup. I have yet been able to go a day since without thinking about little Lance's heart.
My prayer is that we will go back in a year and all of the tests at that time will show that both the repaired site of the aorta and the aortic valve are holding up wonderfully. In the long term, I pray for no more heart surgeries for little Lance - ever. That's a big prayer; but God is a big God.
Lance was born with a congenital heart defect. He had a coarctation of the aorta, which is a narrowing of the major vessel that leaves the heart and carries all of the newly oxygenated blood to the body. This creates hypertension in the upper extremities and hypotension in the lower extremities. It can lead to congestive heart failure and sudden death if undetected and uncorrected.Lance's defect was discovered when he was 10 months old. He had corrective surgery immediately upon discovery (he had a subclavian flap procedure). We were told at the time that he would recover fully, but there was a chance that his aorta could re-narrow.
It has been about 7 & 1/2 years since then. Each check up with the cardiologist has been very good, overall. The last time we saw them, they did an echocardiogram and discovered he also had another congenital heart defect that hadn't been detected to that point called a bicuspid aortic valve. Normally, the aortic valve has 3 flaps; Lance's has only 2. At the time it was discovered, they told us it was nothing to worry about at the time and they would just keep watching him. In fact, they told us he was doing so well that we should not come back for 2 years.
Then I took him back last week (it had been 2 years). And, the appointment was less than reassuring. While the cardiologist still thinks there is nothing that needs to be done immediately, he was noticeably concerned about a couple aspects of the exam. He encouraged us to keep Lance away from certain activities and shortened our follow up time to 1 year again.
They are worried about two things, I gather. One is the re-narrowing of the original aortic defect. The second is the decrease in diameter of the bicuspid valve - this could result in a dilated aorta distal to the valve, possibly leading to rupture of the aorta.
While I am trying to trust the doctor - he is from one of the most respected pediatric cardiologist groups in the country - it was hard to leave the office and agree to "act normally" for a whole year without another checkup. I have yet been able to go a day since without thinking about little Lance's heart.
My prayer is that we will go back in a year and all of the tests at that time will show that both the repaired site of the aorta and the aortic valve are holding up wonderfully. In the long term, I pray for no more heart surgeries for little Lance - ever. That's a big prayer; but God is a big God.
Tuesday, May 20, 2008
On the Book Shelf
I've been doing a ton of reading. My list consists of mostly NCLEX study books. In fact here is a picture of all of my study books - These are strictly for review and practice questions... these are not text books I used in class.But, aside from that, I've been reading a couple books about teaching myself how to crochet! That was one of my goals for myself this year. I'm still really clumsy with the hook and the stitches leave a lot to be desired...but it's a start!
I came across a a report I am going to read. It is called, "The Falling Age of Puberty in U.S. Girls."
It is available to down load free at this site.
Looks intriguing. I am fascinated with all things woman: menarche, pregnancy, birth & menopause. I just can't learn enough about these topics!
Ok, today's procrastination over. Off to study.
Wednesday, May 14, 2008
Worth Watching
I just watched a very touching documentary online. It is called "A Walk to Beautiful" and is aired at various times on PBS depending on where you live; however, it is on line HERE in "6 chapters." It is definitely worth watching.
It is about women in Ethiopia who suffered with obstetric fistulas. There is a hospital there dedicated to treating these women. It follows one woman through her journey. Very memorable.
It is about women in Ethiopia who suffered with obstetric fistulas. There is a hospital there dedicated to treating these women. It follows one woman through her journey. Very memorable.
Monday, April 14, 2008
The New Report Card
My children brought home their report cards last week. All made the honor roll. All were outstanding. But my daughter had a defeated look on her face as she handed hers over. She had several high 90's and no grade lower than a 90. So, what was the issue?
Tucked inside her report card, very attainable to her, was her "BMI report" stating that she was "overweight."
That's outrageous on many levels.
To begin, there are many false positives and false negatives with BMI measurement. The BMI is the currently acceptable mode of determining if a child is growing normally. You can plug your height and weight into online BMI models easily. However, even though it is a widely acceptable method, it is only a rough estimate and is influenced by many other factors including muscle mass and a child's stage of puberty.
In females, girls experiencing puberty lay down fat pads and grow "out" before they grow "up." This stage of puberty is very common for the 6th grade girls who are carrying home their own "BMI report cards" labeling them as "overweight." The girls are also at a very vulnerable and impressionable stage that could easily influence them to create a negative self-body image.
Disturbed thought disorders such as anorexia occur most frequently in adolescents going through puberty and the rates of anorexia are only increasing. With this in mind, wouldn't one want to guard defensively any negative influence exerted on the young impressionable minds of prepubescent girls?
One has to question the overall goals of the school in doing this. Is it to bring awareness to parents about the obesity epidemic in our country. If this were the case, wouldn't it make sense that along with the "BMI Report Card" the parents would also receive recommendations such as following up with their family doctor or tips on providing adequate exercise and sound nutrition.
And, if the schools were so concerned about the obesity epidemic, to what extent are they willing to back up their deep concern by implementing healthy changes in the school environment? Does a 40 minute gym class once every 6 school days count as adequate exercise? Are school lunches consisting of cheeseburgers, fries and milk cutting it as sound nutrition?
I take personal responsibility for the health and well-being of my children. They are involved in activities, their TV time is limited, and we eat responsibly. If the school system has concerns about my children's health, let them voice it to me, personally or by mail at least. Do not put this outrageous claim inside my honor roll daughters report card, making her feel inadequate.
Tucked inside her report card, very attainable to her, was her "BMI report" stating that she was "overweight."
That's outrageous on many levels.
To begin, there are many false positives and false negatives with BMI measurement. The BMI is the currently acceptable mode of determining if a child is growing normally. You can plug your height and weight into online BMI models easily. However, even though it is a widely acceptable method, it is only a rough estimate and is influenced by many other factors including muscle mass and a child's stage of puberty.
In females, girls experiencing puberty lay down fat pads and grow "out" before they grow "up." This stage of puberty is very common for the 6th grade girls who are carrying home their own "BMI report cards" labeling them as "overweight." The girls are also at a very vulnerable and impressionable stage that could easily influence them to create a negative self-body image.
Disturbed thought disorders such as anorexia occur most frequently in adolescents going through puberty and the rates of anorexia are only increasing. With this in mind, wouldn't one want to guard defensively any negative influence exerted on the young impressionable minds of prepubescent girls?
One has to question the overall goals of the school in doing this. Is it to bring awareness to parents about the obesity epidemic in our country. If this were the case, wouldn't it make sense that along with the "BMI Report Card" the parents would also receive recommendations such as following up with their family doctor or tips on providing adequate exercise and sound nutrition.
And, if the schools were so concerned about the obesity epidemic, to what extent are they willing to back up their deep concern by implementing healthy changes in the school environment? Does a 40 minute gym class once every 6 school days count as adequate exercise? Are school lunches consisting of cheeseburgers, fries and milk cutting it as sound nutrition?
I take personal responsibility for the health and well-being of my children. They are involved in activities, their TV time is limited, and we eat responsibly. If the school system has concerns about my children's health, let them voice it to me, personally or by mail at least. Do not put this outrageous claim inside my honor roll daughters report card, making her feel inadequate.
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