tag:blogger.com,1999:blog-70285534868217500042024-02-20T10:32:13.705-08:00NYLegalNurseNYNurseAdvocatehttp://www.blogger.com/profile/11874483846438325547noreply@blogger.comBlogger17125tag:blogger.com,1999:blog-7028553486821750004.post-36686468795210546402014-11-01T12:03:00.001-07:002014-11-01T12:03:16.850-07:00Do nurses really understand Advanced Health Care Directives?<a href="http://rnjournal.com/journal-of-nursing/do-nurses-really-understand-advanced-health-care-directives#.VFUucDc9OqQ.blogger">Do nurses really understand Advanced Health Care Directives?</a>NYNurseAdvocatehttp://www.blogger.com/profile/11874483846438325547noreply@blogger.com0tag:blogger.com,1999:blog-7028553486821750004.post-44332617369960399302014-10-15T10:57:00.003-07:002014-10-15T10:57:06.286-07:00Ebola:
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?”
NYNurseAdvocatehttp://www.blogger.com/profile/11874483846438325547noreply@blogger.com0tag:blogger.com,1999:blog-7028553486821750004.post-34158713581458982922013-07-07T09:18:00.000-07:002014-01-08T07:47:52.099-08:00My experience on the other side of the GurneyI 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.
NYNurseAdvocatehttp://www.blogger.com/profile/11874483846438325547noreply@blogger.com0tag:blogger.com,1999:blog-7028553486821750004.post-56452909932848071272012-06-28T14:16:00.002-07:002012-06-28T14:16:56.512-07:00http://www.eprognosis.org/p/calculators.htmlNYNurseAdvocatehttp://www.blogger.com/profile/11874483846438325547noreply@blogger.com0tag:blogger.com,1999:blog-7028553486821750004.post-71587189898932905632012-06-28T14:12:00.002-07:002012-06-28T14:12:24.902-07:00http://www.geripal.org/2012/06/what-is-meaningful-interaction.htmlNYNurseAdvocatehttp://www.blogger.com/profile/11874483846438325547noreply@blogger.com0tag:blogger.com,1999:blog-7028553486821750004.post-49695051197503978322011-02-12T13:31:00.000-08:002011-02-12T13:31:39.541-08:00You're sick It's dementia<iframe width="480" height="295" src="http://www.youtube.com/embed/blAHFRSBdNA?fs=1" frameborder="0" allowFullScreen=""></iframe>NYNurseAdvocatehttp://www.blogger.com/profile/11874483846438325547noreply@blogger.com1tag:blogger.com,1999:blog-7028553486821750004.post-51382405614584327332010-06-04T07:39:00.000-07:002010-06-04T07:39:19.516-07:00Exploring New Horizons In Nursing Practice<a href="http://rndegrees.net/blog/career-development/exploring-new-horizons-in-nursing-practice.html">Exploring New Horizons In Nursing Practice</a>NYNurseAdvocatehttp://www.blogger.com/profile/11874483846438325547noreply@blogger.com0tag:blogger.com,1999:blog-7028553486821750004.post-17688134430190357432010-05-22T06:56:00.000-07:002010-05-22T06:56:38.553-07:00The Opposite of Love | GeriPal - A Geriatrics and Palliative Care Blog<a href="http://www.geripal.org/2010/05/opposite-of-love.html">The Opposite of Love | GeriPal - A Geriatrics and Palliative Care Blog</a>NYNurseAdvocatehttp://www.blogger.com/profile/11874483846438325547noreply@blogger.com0tag:blogger.com,1999:blog-7028553486821750004.post-16981232513560472532010-05-22T06:48:00.001-07:002010-05-22T06:48:41.084-07:00Heroic Measures and the Elderly<a href=http://www.ecarediary.com/ViewBlog.aspx?BlogID=222>Heroic Measures and the Elderly</a><br /><br />Posted using <a href="http://sharethis.com">ShareThis</a>NYNurseAdvocatehttp://www.blogger.com/profile/11874483846438325547noreply@blogger.com0tag:blogger.com,1999:blog-7028553486821750004.post-29410266028894033092010-05-22T06:19:00.000-07:002010-05-22T06:19:26.228-07:00Nurses are the best! | GeriPal - A Geriatrics and Palliative Care Blog<a href="http://www.geripal.org/2010/05/nurses-are-best.html?utm_source=feedburner&utm_medium=twitter&utm_campaign=Feed%3A+Geripal+%28GeriPal%29">Nurses are the best! | GeriPal - A Geriatrics and Palliative Care Blog</a>NYNurseAdvocatehttp://www.blogger.com/profile/11874483846438325547noreply@blogger.com0tag:blogger.com,1999:blog-7028553486821750004.post-56672290995887364322010-05-21T19:18:00.001-07:002010-05-21T19:18:47.732-07:00NY Legal Nurse Consultants Inc - Resources<a href=http://www.newyorklegalnurseconsultants.com/c-6-resources.aspx>NY Legal Nurse Consultants Inc - Resources</a><br /><br />Posted using <a href="http://sharethis.com">ShareThis</a>NYNurseAdvocatehttp://www.blogger.com/profile/11874483846438325547noreply@blogger.com0tag:blogger.com,1999:blog-7028553486821750004.post-64499246313467104662010-05-20T08:52:00.001-07:002010-05-20T08:52:37.883-07:00Heroic Measures and the Elderly<a href=http://www.ecarediary.com/ViewBlog.aspx?BlogID=222>Heroic Measures and the Elderly</a><br /><br />Posted using <a href="http://sharethis.com">ShareThis</a>NYNurseAdvocatehttp://www.blogger.com/profile/11874483846438325547noreply@blogger.com0tag:blogger.com,1999:blog-7028553486821750004.post-26763920578593386132010-04-26T19:14:00.000-07:002010-05-07T18:07:19.112-07:00Whose job is it to discuss advance directives?Whose job is it to discuss Advance Directives?<br /><br />When I think about this subject and obviously I think about it a lot. I equate it with it is every ones job but no one knows how to do it.<br /><br />In nursing school it is brushed upon. In medical school it is not talked about. In Law school they often have internships on it? But as much as I feel my attorney colleagues have their place I don't feel explaining medical procedures should be done by someone who is not medical. <br /><br />So Who Should be discussing Advance Directives?<br /><br />The Attorney: Often attorneys draft health care proxies and living wills along with a Last Will and Testament. These health care proxies and living wills often get locked in the safe with the Last Will and Testament and don't get looked at again. I have heard rumor of 30 page documents in legal terminology. In speaking with one attorney who is sympathetic to my cause he mentions as the only legal document that an attorney drafts and unleashes on the general population.<br /><br />The Doctor: Recently laws have been enacted to assist physicians in having these conversations. Health care costs are increasing, overhead is increasing. This is not often on the physician's radar as a high priority. Many times these discussions happen with family members of the patient not the patient in an emergent time.<br />The U.S. Agency for Healthcare Research and Quality (www.ahrq.gov), in a 2003 article, “Advance Care Planning: Preferences for Care at the End of Life,” found:<br /><br /> * Only 12 percent of the patients with an advance directive received input from the physician in the development<br /> * Between 65 and 75 percent of physicians whose patients had advance directives were not aware they existed.<br /><br />The physician is suppose to follow this but doesn't even know the patient has this document in place and the physician did not have any input on it.<br /><br />The Nurse: This group of health care professionals are an ideal group to assist the community in making educated health care decisions. Nurses are educators and advocates,<br /><br />More Americans Discussing – and Planning – End-of-Life Treatment. The Pew Research Center, January 2006. http://people-press.org/reports/pdf/266.pdf.<br /><br /> *42% of Americans have had a friend or relative suffer from a terminal illness or coma in the last five years and for a majority of these people and 23% of the general public, the issue of withholding life sustaining treatment came up.<br /> *One of the most striking changes between 1990 and 2005 is the growth in the number of people who say they have a living will – up 17 points, from 12% in 1990 to 29% now<br /><br />29% is not enough.<br /><br />I have read other reports that say the percentage of advance directives has increased.<br /><br />It does not matter how much the research says that advance directives have increased. The problem is if your loved one has not discussed these issues and you are charged with making their wishes known to the health care practitioners that are charged with caring for someone you love.<br /><br />How can you make these complicated health care decisions if you don't know what your loved ones would want?NYNurseAdvocatehttp://www.blogger.com/profile/11874483846438325547noreply@blogger.com0tag:blogger.com,1999:blog-7028553486821750004.post-10359730364482982602010-04-25T13:08:00.001-07:002010-04-27T19:35:45.045-07:00For My Friend. This ones for you. <meta name="Keywords" content=""> <meta equiv="Content-Type" content="text/html; charset=utf-8"> <meta name="ProgId" content="Word.Document"> <meta name="Generator" content="Microsoft Word 2008"> <meta name="Originator" content="Microsoft Word 2008"> <link rel="File-List" href="file://localhost/Users/NYLegalNurse/Library/Caches/TemporaryItems/msoclip/0clip_filelist.xml"> <!--[if gte mso 9]><xml> <o:documentproperties> <o:template>Normal.dotm</o:Template> <o:revision>0</o:Revision> <o:totaltime>0</o:TotalTime> <o:pages>1</o:Pages> <o:words>414</o:Words> <o:characters>2364</o:Characters> <o:company>New York Legal Nurse Consultants Inc</o:Company> <o:lines>19</o:Lines> <o:paragraphs>4</o:Paragraphs> <o:characterswithspaces>2903</o:CharactersWithSpaces> <o:version>12.0</o:Version> </o:DocumentProperties> <o:officedocumentsettings> <o:allowpng/> </o:OfficeDocumentSettings> </xml><![endif]--><!--[if gte mso 9]><xml> <w:worddocument> <w:zoom>0</w:Zoom> <w:trackmoves>false</w:TrackMoves> <w:trackformatting/> <w:punctuationkerning/> <w:drawinggridhorizontalspacing>18 pt</w:DrawingGridHorizontalSpacing> <w:drawinggridverticalspacing>18 pt</w:DrawingGridVerticalSpacing> <w:displayhorizontaldrawinggridevery>0</w:DisplayHorizontalDrawingGridEvery> <w:displayverticaldrawinggridevery>0</w:DisplayVerticalDrawingGridEvery> <w:validateagainstschemas/> <w:saveifxmlinvalid>false</w:SaveIfXMLInvalid> <w:ignoremixedcontent>false</w:IgnoreMixedContent> <w:alwaysshowplaceholdertext>false</w:AlwaysShowPlaceholderText> <w:compatibility> <w:breakwrappedtables/> <w:dontgrowautofit/> <w:dontautofitconstrainedtables/> <w:dontvertalignintxbx/> </w:Compatibility> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:latentstyles deflockedstate="false" latentstylecount="276"> </w:LatentStyles> </xml><![endif]--> <style> <!-- /* Font Definitions */ @font-face {font-family:Times; panose-1:2 0 5 0 0 0 0 0 0 0; mso-font-charset:0; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:3 0 0 0 1 0;} @font-face {font-family:Cambria; panose-1:2 4 5 3 5 4 6 3 2 4; mso-font-charset:0; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:3 0 0 0 1 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-ascii-font-family:Cambria; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:Cambria; mso-fareast-theme-font:minor-latin; mso-hansi-font-family:Cambria; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} p.MsoListParagraph, li.MsoListParagraph, div.MsoListParagraph {margin-top:0in; margin-right:0in; margin-bottom:0in; margin-left:.5in; margin-bottom:.0001pt; mso-add-space:auto; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-ascii-font-family:Cambria; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:Cambria; mso-fareast-theme-font:minor-latin; mso-hansi-font-family:Cambria; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} p.MsoListParagraphCxSpFirst, li.MsoListParagraphCxSpFirst, div.MsoListParagraphCxSpFirst {mso-style-type:export-only; margin-top:0in; margin-right:0in; margin-bottom:0in; margin-left:.5in; margin-bottom:.0001pt; mso-add-space:auto; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-ascii-font-family:Cambria; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:Cambria; mso-fareast-theme-font:minor-latin; mso-hansi-font-family:Cambria; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} p.MsoListParagraphCxSpMiddle, li.MsoListParagraphCxSpMiddle, div.MsoListParagraphCxSpMiddle {mso-style-type:export-only; margin-top:0in; margin-right:0in; margin-bottom:0in; margin-left:.5in; margin-bottom:.0001pt; mso-add-space:auto; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-ascii-font-family:Cambria; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:Cambria; mso-fareast-theme-font:minor-latin; mso-hansi-font-family:Cambria; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} p.MsoListParagraphCxSpLast, li.MsoListParagraphCxSpLast, div.MsoListParagraphCxSpLast {mso-style-type:export-only; margin-top:0in; margin-right:0in; margin-bottom:0in; margin-left:.5in; margin-bottom:.0001pt; mso-add-space:auto; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-ascii-font-family:Cambria; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:Cambria; mso-fareast-theme-font:minor-latin; mso-hansi-font-family:Cambria; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} /* List Definitions */ @list l0 {mso-list-id:1447114035; mso-list-template-ids:2074250358;} @list l0:level1 {mso-level-number-format:roman-upper; mso-level-tab-stop:40.5pt; mso-level-number-position:left; margin-left:40.5pt; text-indent:-.25in; mso-ansi-font-size:10.0pt; mso-ansi-font-weight:normal;} @list l0:level2 {mso-level-number-format:alpha-lower; mso-level-tab-stop:1.0in; mso-level-number-position:left; text-indent:-.25in; mso-ansi-font-size:10.0pt; font-family:Times; mso-ansi-font-weight:normal;} @list l0:level3 {mso-level-tab-stop:1.5in; mso-level-number-position:left; text-indent:-.25in; mso-ansi-font-size:10.0pt; font-family:Times;} ol {margin-bottom:0in;} ul {margin-bottom:0in;} --> </style> <!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-ascii-font-family:Cambria; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Cambria; mso-hansi-theme-font:minor-latin;} </style> <![endif]--> <!--StartFragment--> <p class="MsoNormal" style="margin-bottom: 12pt;"><span style=";font-family:Times;font-size:10pt;" >The other night I was at a friends 40<sup>th</sup> birthday party and I was discussing my new business with some friends. <o:p></o:p></span></p> <p class="MsoNormal" style="margin-bottom: 12pt;"><span style=";font-family:Times;font-size:10pt;" >
<br />One of my girlfriends shared with me that her mother is going through the advance directives issues with her grandmother.<span style="">
<br /></span></span></p><p class="MsoNormal" style="margin-bottom: 12pt;"><span style=";font-family:Times;font-size:10pt;" ><span style="">
<br /></span></span></p><p class="MsoNormal" style="margin-bottom: 12pt;"><span style=";font-family:Times;font-size:10pt;" ><span style=""> </span>My friend explained that her grandmother never wanted to be in the nursing home. She said she does not want to be resuscitated and she did not want any “heroic measures.”<span style=""> </span>She mentioned to me that the nursing home called her mother about administering intravenous antibiotics and her mother was not sure what to do.
<br />
<br />When I speak with my clients I go over just this.
<br />
<br />The perception of heroic Measures run the gambit. Some think of them as only medication to facilitate blood pressure and cardiopulmonary resuscitation. Others think about heroic measures including artificial respiration, artificial nutrition and hydration, intravenous medication, antibiotics. Their is no hard fast rule to this as of yet.
<br />
<br />Ultimately it depends on what you believe and your goals of care. You, being the patient if you are able to make these decisions for yourself or you as the person charged with making these decisions for another (you, being the surrogate).
<br />
<br />I suggest asking the following questions when speaking with anyone from a facility requesting consent for a procedure of any kind.<o:p></o:p></span></p> <p class="MsoListParagraphCxSpFirst" style="margin: 0.1pt 0in 0.1pt 40.5pt; text-indent: -0.25in;"><!--[if !supportLists]--><span style=";font-family:Times;font-size:10pt;" ><span style="">I.<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style=";font-family:Times;font-size:10pt;" >Find out the name, the title, how long has this person been working with your loved one? <o:p></o:p></span></p> <p class="MsoListParagraphCxSpMiddle" style="margin: 0.1pt 0in 0.1pt 1in; text-indent: -0.25in;"><!--[if !supportLists]--><span style=";font-family:Times;font-size:10pt;" ><span style="">a.<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style=";font-family:Times;font-size:10pt;" >Who you are talking to is important. <o:p></o:p></span></p> <p class="MsoListParagraphCxSpMiddle" style="margin: 0.1pt 0in 0.1pt 1in; text-indent: -0.25in;"><!--[if !supportLists]--><span style=";font-family:Times;font-size:10pt;" ><span style="">b.<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style=";font-family:Times;font-size:10pt;" >The explanation will be different based on their level of education and if they are just a consultant on the case.<span style=""> </span><span style=""> </span><o:p></o:p></span></p> <p class="MsoListParagraphCxSpMiddle" style="margin: 0.1pt 0in 0.1pt 1in; text-indent: -0.25in;"><!--[if !supportLists]--><span style=";font-family:Times;font-size:10pt;" ><span style="">c.<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style=";font-family:Times;font-size:10pt;" >If need be request to speak with the physician or the charge nurse if a satisfactory explanation was not given.<o:p></o:p></span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-left: 40.5pt; text-indent: -0.25in;"><!--[if !supportLists]--><span style=";font-family:Times;font-size:10pt;" ><span style="">II.<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style=";font-family:Times;font-size:10pt;" >Ask, what do you expect to accomplish with this measure (ie.Antibiotics, hospitalization, Medications)?</span><span style="font-family:Times;"><o:p></o:p></span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-left: 1in; text-indent: -0.25in;"><!--[if !supportLists]--><span style=";font-family:Times;font-size:10pt;" ><span style="">a.<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style=";font-family:Times;font-size:10pt;" >Restore present state of health or provide comfort.</span><span style="font-family:Times;"><o:p></o:p></span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-left: 1.5in; text-indent: -0.25in;"><!--[if !supportLists]--><span style=";font-family:Times;font-size:10pt;" ><span style="">1.<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style=";font-family:Times;font-size:10pt;" >This will allow you to decide if this is inline with your family member's personal goals?</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-left: 40.5pt; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-size:10pt;"><span style="">III.<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style=";font-family:Times;font-size:10pt;" >What are the overall goals of care? </span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-left: 1in; text-indent: -0.25in;"><!--[if !supportLists]--><span style=";font-family:Times;font-size:10pt;" ><span style="">a.<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style=";font-family:Times;font-size:10pt;" >Sometimes the treatment that they are seeking to administer may not be in line with the overall goals of care.</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-left: 1in; text-indent: -0.25in;"><!--[if !supportLists]--><span style=";font-family:Times;font-size:10pt;" ><span style="">b.<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style=";font-family:Times;font-size:10pt;" >Asking this question assists everyone in clarifying the overall goal</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-left: 40.5pt; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-size:10pt;"><span style="">IV.<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style=";font-family:Times;font-size:10pt;" >Summarize and repeat what this person has said to you.</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-left: 1in; text-indent: -0.25in;"><!--[if !supportLists]--><span style=";font-family:Times;font-size:10pt;" ><span style="">a.<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style=";font-family:Times;font-size:10pt;" >Perception is everything. </span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-left: 1in; text-indent: -0.25in;"><!--[if !supportLists]--><span style=";font-family:Times;font-size:10pt;" ><span style="">b.<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style=";font-family:Times;font-size:10pt;" >Paraphrasing and reviewing ensures you received the information the sender was intending to deliver.</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-left: 40.5pt; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-size:10pt;"><span style="">V.<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style=";font-family:Times;font-size:10pt;" >Ask yourself are these in line with the goals that your loved one has shared with you or what you think she/he would want if she/he was able to make this decision right now with the facts you have in front of you based on his/her present state of health?</span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-left: 1in; text-indent: -0.25in;"><!--[if !supportLists]--><span style=";font-family:Times;font-size:10pt;" ><span style="">a.<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style=";font-family:Times;font-size:10pt;" >Make the decision a factual decision not an emotional decision.<span style=""> </span></span></p> <p class="MsoListParagraphCxSpLast" style="margin-left: 1in; text-indent: -0.25in;"><!--[if !supportLists]--><span style=";font-family:Times;font-size:10pt;" ><span style="">b.<span style="font: 7pt "Times New Roman";"> </span></span></span><!--[endif]--><span style=";font-family:Times;font-size:10pt;" >It is a decision you are making based on the wishes of another.
<br /><!--[if !supportLineBreakNewLine]-->
<br /><!--[endif]--></span></p> <p class="MsoNormal"><span style=";font-family:Times;font-size:10pt;" >Don’t perpetuate this situation.<span style=""> </span>This process causes emotional stress <span style=""> </span>and guilt that lasts a life time.<o:p></o:p></span></p> <p class="MsoNormal"><span style=";font-family:Times;font-size:10pt;" ><o:p> </o:p></span></p> <p class="MsoNormal"><span style=";font-family:Times;font-size:10pt;" >Make your wishes known to your family and loved ones and memorialize it in a Health Care Proxy Form.<o:p></o:p></span></p> <!--EndFragment--> NYNurseAdvocatehttp://www.blogger.com/profile/11874483846438325547noreply@blogger.com2tag:blogger.com,1999:blog-7028553486821750004.post-86081832941549106342010-04-25T11:10:00.000-07:002010-04-27T19:41:52.929-07:00Health Care ProxyYou want to do the right thing for your family. You made sure you took care of life insurance. You had an attorney draft a Last Will and Testament. <br /><br />Advance Directives, who wants to think about them?<br /><br />In my fifteen years of nursing, I can’t tell you how many times I heard the words from a teary-eyed wife or sister, son, husband or brother. <br /><br /><span style="font-weight: bold; color: rgb(153, 0, 0);">"Gee we never discussed that." </span><br /><br />What do you say to someone who is guilt ridden? Someone who never discussed their health care wishes with his or her loved one and now the surrogates don’t know what the right answer is. <br /><br />The right answer is to make your health care wishes known. Learn from the people you care about. Make your wishes known, now while you have the ability to share these wishes with friends and family. <br /><br />Identify a health care agent. One person who you trust with your life to make medical decisions for you in the event you are not able to make them for yourself. A person who will; above all do what you want them to do, because it is your wish. <br /><br />Appoint a second in command. An alternative health care agent. In the event that the health care agent is unable to or unwilling to make medical decisions for you the alternative agent will step in.<br /><br /><span style="font-size:130%;"><span style="font-weight: bold;">Don’t just sign on the dotted line.</span></span><br /><br />You need to let your loved ones know your wishes. <br /><br />Give your health care agent and your alternative agent copies of your health care proxy form. Give a copy to your doctor. Give a copy to the hospital anytime you go to the hospital. If you go back to the same hospital they may have a copy of it on file BUT assume they don't in an emergency it is best to have a little packet of important papers to grab and go with. <br /><br />Have a thoughtful discussion about this. Have this discussion with your health care provider and get the facts about measures that you may undergo if you were critically ill. Understand the ramifications of your choices. Sometimes health care providers are not ready to have this conversation with you. <br /><br />Health care providers are human. We have feelings too. We don't want to lose you as much as you don't want to go. Sometimes we are uncomfortable speaking about these measures as well. If you find your health care provider is uncomfortable with this subject you can ask your health care provider who they would recommend to speak with you about this. Don't let them dismiss the issue. <br /><br /><span style="font-size:130%;"><span style="font-weight: bold;">Everyone over 18 should have a heath care proxy. </span></span><br /><br />My name is Fern Wasserman.<br />I am a nurse and I assist people in facilitating these conversations. <br /><br />If you would prefer a self service approach their are many books that may assist you. The one I feel gives a great explanation is by Hank Dunn: Hard Choices for Loving People. <br /><br /><span style="color: rgb(153, 0, 0); font-weight: bold;">Life is uncertain. </span><br /><br />You can give your family and loved ones the greatest gift. <br /><br />Sharing your wishes and directing your health care in the event you are unable to make decisions is the gift that keeps on giving. <br /><br />Allow the people you love to go to sleep assured that they honored your wishes.NYNurseAdvocatehttp://www.blogger.com/profile/11874483846438325547noreply@blogger.com0tag:blogger.com,1999:blog-7028553486821750004.post-10526432846751270322010-04-03T12:05:00.000-07:002010-04-26T19:32:01.662-07:00Advance Directives Defined<span class="Apple-style-span" style="font-family:'times new roman';"><b>What is an Advance Directive?</b></span><div><span class="Apple-style-span" style="font-family:'times new roman';">
<br /></span></div><div><span class="Apple-style-span" style="font-family:'times new roman';">Advance Directives give a person the choice to make medical decisions in advance. </span><span class="Apple-style-span" style="font-family:'times new roman';"> They empower one to make health care decisions prior to a devastating situation. </span><span class="Apple-style-span" style="font-family:'times new roman';"> They allow one to direct another person to make medical decisions in the event of the inability to make health care decisions.
<br />
<br />This is not solely an end of life issue. One may be under anesthesia and lack decision making capacity.
<br /></span></div><div><span class="Apple-style-span" style="font-family:'times new roman';">
<br /></span></div><div><span class="Apple-style-span" style="font-family:'times new roman';">Advance directives go into effect only in the event decision making capacity is lost.
<br />
<br />Anyone over 18 can be a health care agent. Not everyone should be though.
<br />
<br />Advance Directives are memorialized in a health care proxy form.
<br />
<br />For state specific documents please see http://www.caringinfo.org/stateaddownload
<br /></span></div><div><span class="Apple-style-span" style="font-family:'times new roman';">
<br /></span></div><div><span class="Apple-style-span" style="font-family:'times new roman';"><b>Who Should have an Advance Directive?</b></span></div><div><span class="Apple-style-span" style="font-family:'times new roman';"><b>
<br /></b></span></div><div><span class="Apple-style-span" style="font-family:'times new roman';">Everyone over the age of 18 should consider writing up a health care proxy. In New York State two signatures are required to make the document legal.
<br />
<br />The information on the health care proxy document can be changed at anytime. <span class="Apple-style-span" style=";font-family:Georgia,serif;font-size:15.9722px;" ><span style="text-decoration: underline;">
<br /><span style="font-size:85%;">
<br /></span></span><span class="Apple-style-span" style=";font-family:'times new roman';font-size:100%;" >In New York we have an excellent resource for completing your advance directives. <span class="Apple-style-span" style="font-family:Georgia,serif;"><a href="http://doyourproxy.org/">http://doyourproxy.org/</a>
<br /></span></span></span></span></div><meta charset="utf-8"><meta charset="utf-8"><div><span class="Apple-style-span" style="font-family:'times new roman';">
<br /></span></div><div><div><span class="Apple-style-span" style="color: rgb(51, 51, 51);font-size:small;" ><span class="Apple-style-span" style="font-family:'times new roman';">New York Legal Nurse Consultants Inc. is here to assist in facilitating this difficult discussion.</span></span></div><div><span class="Apple-style-span" style="color: rgb(51, 51, 51);font-size:small;" ><span class="Apple-style-span" style="font-family:'times new roman';">
<br /></span></span></div><div><span class="Apple-style-span" style="color: rgb(51, 51, 51);font-size:small;" ><span class="Apple-style-span" style="font-family:'times new roman';">Contact Fern Wasserman at New York Legal Nurse Consultants Today.</span></span></div><div><span class="Apple-style-span" style="color: rgb(51, 51, 51);font-size:small;" ><span class="Apple-style-span" style="font-family:'times new roman';">
<br /></span></span></div><div><span class="Apple-style-span" style="color: rgb(51, 51, 51);font-size:small;" ><span class="Apple-style-span" style="font-family:'times new roman';">www.NewYorkLegalNurseConsultants.com</span></span></div><div><span class="Apple-style-span" style="color: rgb(51, 51, 51);font-size:small;" ><span class="Apple-style-span" style="font-family:'times new roman';">Fern@NewYorkLegalNurseConsultants.com</span></span></div></div>NYNurseAdvocatehttp://www.blogger.com/profile/11874483846438325547noreply@blogger.com0tag:blogger.com,1999:blog-7028553486821750004.post-39948048119595067332009-10-25T08:09:00.000-07:002009-11-08T14:46:21.000-08:00This is just the Beginning..I started this Blog as Legal Nurse NY. I wanted to be consistent to avoid confusion.<br /><br /><br /><br /><br /><br />I am now NYLegalNurse. Here is a recap of my previous blogs which I hope are helpful.<br /><br /><br /><br /><br /><br />In my attempt to gain a client base and web presence I have found some time savers and time wasters. I found the following were excellent ways to get your name out there...<br /><br /><br /><br /><br /><br />Legal Nurse NY<br />Saturday, September 26, 2009<br /><a name="2692129759375822761"></a><a href="http://legalnurseny.blogspot.com/2009/09/getting-my-business-to-ride-information.html">Getting my business to ride the information superhighway</a><br />Okay so my journey on the world wide web information superhighway feels like I am riding on the Long Island Expressway from Manhattan to Oceanside in a Yugo at 4 pm with the radiator overheating on a Friday afternoon with my GPS on the fritz.<br /><br /><br /><br /><br /><br />Slow going but eventually I will get there with a few minor detours.<br /><br /><br /><br /><br /><br />This detour was via New Jersey.<br /><br /><br /><br /><br /><br />Anyone who knows my sense of direction will understand this statement.I have chosen the following exits or outlets to market my business name and brand.<br /><br /><br /><br /><br /><br />Linkedin: <a title="View public profile" href="http://www.linkedin.com/in/nylegalnurse" name="webProfileURL">http://www.linkedin.com/in/nylegalnurse</a><br /><br /><br />This form of social media networking is mostly for business and has some great tools to see and be seen.<br /><br /><br />The groups are excellent and provide ways to consult with colleagues in the form of a list serve.<br /><br /><br />Linkedin also gives me an ability to market to potential attorney clients.<br /><br /><br />My potential clients also have the ability to get a brief synopsis of the services my company provides.<br /><br /><br />Linkedin also offers ability to link to my website, my twitter account and my blog or my CV on visual CV.<br /><br /><br /><br /><br /><br />Brownbook.net <a href="http://www.brownbook.net/account/profile/15495">http://www.brownbook.net/account/profile/15495</a><br /><br /><br />Brown book is more of a directory like yellow book. This is another free service which allows your business to obtain a space to be found on the web. You may write a brief bio and note your contact information.<br /><br /><br />Fast pitch <a href="http://www.fastpitchnetworking.com/profile.cfm?ContactID=52368492&Style=3I">http://www.fastpitchnetworking.com/profile.cfm?ContactID=52368492&Style=3I</a><br /><br /><br />is a cross between linked in and facebook. It has more of a facebook feel by design but it appears to have a smaller following. <a href="http://www.fastpitchnetworking.com/buyprofile.cfm?ContactID=52368492"></a><br /><br /><br /><br /><br /><br />Lastly, I am working on a VisualCV. <a href="http://www.visualcv.com/">http://www.visualcv.com/</a><br />I think visual CV bares adding as it appears to be a great site.<br />It offers an excellent format for resume writing.<br />You can attach your resume to an email as a PDF or send a perspective client or employer a link to view your CV.<br />You can add it as a URL to all the social networking sites as well offering more exposure. It can itself be utilized as a webpage. Visual CV gives you the ability to add work product samples and multimedia.<br /><br /><br /><br />Happy driving....<br /><br /><br /><br /><a href="http://legalnurseny.blogspot.com/2009/09/you-are-in-business-do-you-have-website.html">You are in Business, Do you have a Website?</a><br />YES, Yes I do. Thank you Microsoft office live. Microsoft office live offers: free web hosting, templates, e-mail addresses and online support.<br /><br /><br /><br /><br /><br />The greatest part about it is it FREE.<br /><br /><br /><br /><br /><br />No really. It is Free.<br /><br /><br /><br /><br /><br />That is not the greatest part about it.<br /><br /><br /><br /><br /><br />The greatest part about it is you don't need a degree in computer programming to navigate the site. It has templates.<br /><br /><br /><br /><br /><br />You do require an 8 year old.<br /><br /><br /><br /><br /><br />If I used an 8 year old, it probably would have taken me less time to put up my website up.<br /><br /><br /><br /><br /><br />It took me a few days and it was not very difficult at all.<br /><br /><br /><br /><br /><br />Check it out at <a href="http://smallbusiness.officelive.com/">http://smallbusiness.officelive.com/</a><br /><br /><br /><br /><br /><br />Happy Website Building...NY Legal NurseNYNurseAdvocatehttp://www.blogger.com/profile/11874483846438325547noreply@blogger.com0