Saturday, November 1, 2014

Do nurses really understand Advanced Health Care Directives?

Do nurses really understand Advanced Health Care Directives?

Wednesday, October 15, 2014

Ebola: As a patient advocate and as a nurse I have to make a stateement about this poor nurse in Texas who contracted Ebola. Spreading of an infectious disease When health care professionals put on those special isolation gowns and gloves this is part of “INFECTION CONTROL”, not infection eradication. Of course the goal is to eradicate but the point is to control the spread of the infection while caring for the ill patient. Part of controlling the spread of infection is educating the people visiting about the immediate risk to themselves and others and what protective gear they should be wearing. This is not about being politically correct it is about safety. With the shift in health care to be more “patient centered”. We have gotten away from the ultimate goal patient safety and infection control. We now have rugs in waiting rooms. Can you really clean a rug. Children are permitted on the nursing units. When I was at the hospital recently, young children were crawling all over said rugs? How can that be sanitary? The treatment of the nurse who contracted Ebola by the media The initial response from the media was that the nurse broke protocol? The problem is the guidelines set forth and provided were standard infection control protocols. I am glad the local nursing union stood up and said give us specific protocols to address this infectious disease and permit us to ask questions to the experts. Permit being the operative word. You can write up a protocol and no matter how clear it seems, there is room for interpretation. This is why dialogue needs to occur. The difference between Ebola and other infectious diseases that we may see in the hospital is the virulence and the risk to life. Logically, would this nurse break protocol knowing the risks? I find that highly unlikely. Nurses are at higher risk for contracting infectious diseases due to the proximity to the patient and the time spent with the patient. In the critical care setting the nurse to patient ratio is, generally one to two patients. Based strictly on these numbers, the day is spent with the patient. The longer you are in contact the higher the risk of contracting the disease. This is a logical deduction. No other health care worker spends this much time in close contact with a patient with an infectious disease. The doctor examines the patient and leaves. The nurse has more contact with the immediate area of the patient. The immediate area includes surfaces that may have inadvertently become contaminated Nurses are taught about infection control practices during our training. Nurses are also taught about the consequences of breaching policy and procedure as well as the consequences to our health as well as the health of our family and loved ones if we fail to follow proper infection control practices. Other health care workers come in contact with the patient and may touch surfaces after they have come in contact with the patient. Is it possible that someone other than the nurse did not follow proper procedure, proper hand washing, proper decontamination, absolutely. Previous blogs of mine discuss dirty hands doctors, a pastoral care professional that touched my skin wearing gown and gloves. All health care workers must be trained to effectively provide infection control. I wonder had the health care professional that contracted Ebola in Texas been a doctor would the media have treated him or her differently? When the story broke o 10/13/14 on CNN consistently reporters stated that the nurse broke protocol? Yet the following day CNN and other news networks stated quietly, that the nurse states she did not break protocol and now they are saying they are unsure what occurred. The physician consultants for the news networks explain about general infection control practices and Dr. Sanjay Gupta makes a good point that the key here is that this infection is virulent and less forgiving. All health care workers must be trained and retrained in proper infection control and the specifics of the disease they are working with. It is a shame that the first statements from the media was, “what did the nurse do wrong?”

Sunday, July 7, 2013

My experience on the other side of the Gurney

I am starting this blog with my experience which has now become my mission. As I write this I think to myself if this is my experience I know what to do. What would happen if I didn't? What would happen if I just"listened to the doctor". My name is Fern. I am a Registered Nurse, 19 years as of May. I have had the opportunity recently to be at the other end of the examining table for more than a check up. Doctors really do say the darndest things. I think I would have lost my job 5 times over for the experiences that I will share today that really happened to me. Experience 1-The emergency- I called the doctors hotline at 5 am as I was in the worst pain I had ever been in, in my life. I explained to the doctor on call (this was not my attending physician) that I was a Nurse Practitioner and I thought it was X, Y, a and Z. Given my history and my symptoms logically this was a life threatening issue. I contacted the doctor and did not go straight to the Emergency room as this was also not my primary area of expertise and felt I should defer to the doctor. "He who has herself for a doctor, has a fool for a patient", I thought to myself. As I entrusted my care to the physician on the under end of the phone. She assured me that it was probably not what I was thinking and she sent me to the office which opened at 8 am. I arrived at the office was examined and was sent to the emergency room. I should have gone to the Emergency Room I was right. I went to the Emergency room was rushed to emergency surgery and was sent to recovery. I was in the care of two wonderful angels. The two nurses that cared for me after this surgery. I don't know how many hours had elapsed since the surgery but I know from experience It takes me a long time to wake up from anesthesia. When the resident assessed me or rather came over and attempted to coerce me into leaving the hospital, I could barely stay awake. I had not gotten up from the stretcher yet as my legs still felt like they didn't work. My eyes were heavy with sleep. I was nauseas. My head was swimming. I didn't want to do anything except sleep. The pain was excruciating and the nausea was barely tolerable. I was refusing pain medication because I didn't want to become more nauseas. The doctor informed, "okay we can discharge you now." I muttered something about not having gone to the bathroom yet and not being able to walk to her in a barely audible slurred drug induced slur. She looked me square in the eyes and asked me, "well, what do you want to do sleep." I turned over and went back to sleep. After the doctor left in a huff, (she stomped off). My husband shook me a little to wake me up and make me focus. He said to me, "Fern, I don't think I can take care of you like this." The nurses assured my husband that I would not be leaving there care anytime to soon and they would not discharge me like this!! Well yes of course I would like to sleep that is what you do when anesthesia is wearing off? I guess this doctor never had anesthesia before. I spoke with my attending physician who was little more than sympathetic. When I explained what had happened she asked me if I realized that the doctor that was on call was taking care of another patient. I guess that other patients care which was not emergent was more important than my life. My issue was life threatening. Incident 2: Dirty hands doctor I go in to a doctors office for a consult. He is very polite, compassionate and provides all the necessary information required for me to make a decision. He walks into the room examines me and then picks up an instrument he used on the previous patient with his bare hands which he had left in the sink to demonstrate to me the procedure that he will be performing on me. This goes completely against CDC regulations on infection control. I am sure he violated OSHA and JCAHO infection control standards as well. I was appalled. I never went back to him again. I contacted the doctor that referred me and informed her about his infection control practices. I felt like I was violated. If he didn't follow these simple procedures what else is he doing incorrectly. Did he even washes hands before he touched me? Incident 3: Refusal to treat for a reasonable request This one happened today. So perhaps lately I am becoming a bit of a germaphobe. I ask all practitioners who are going to do anything invasive to kindly wash their hands with soap. I don't like Purell. There have been studies noting that Purell loses efficacy over time. I know some practitioners swear by it. I don't and respectfully request if you are going to be doing a procedure on me anything from drawing blood on that you please wash your hands. I don't care if you just did it and walked in the room. I request that you wash your hands. This is a nominal request. Can you blame me? Believe me there are more stories I can tell you but I think I have become this way because of dirty hands doctor and what had happened to my father (I hope he does not read this blog). Thank g-d he doesn't understand how to google my name yet or really how to use the internet as well as he thinks he does. At any rate my dad went in for a procedure and got more than he bargained for. After his procedure he developed a hospital acquired urinary tract infection followed by a bacteremia. Proper hand washing could have helped prevent such an infection from occurring. So this doctor comes in sits down explains the procedure he will be performing on me. I asked politely, "Can you please do me a favor and wash your hands". He informed me, "I will use purell, like I did before I walked in here." I said, "no I would like you to use soap." He replied, "I will get another physician to care for you." As the physician was walking out, he replied. "Purell is better than soap." I fired back, "No it isn't." Five minutes later the nurse came in and informed me that I should get dressed and that I need to come back tomorrow to have the procedure. NO PHYSICIAN SHOULD REFUSE TO TREAT YOU BECAUSE YOU ASK THEM TO WASH THEIR HANDS WITH SOAP! PHYSICIANS ARE NOT GODS AND THEIR HANDS ARE NOT STERILE. IT IS ESSENTIAL THAT They practice GOOD HAND WASHING. This is part of INFECTION CONTROL PROCEDURES. Hand sanitizer is not always the best option and nothing beats good handwashing.