A great article ...can't wait for April's Newsletter

This Medscape article was brought to my attention by Sandy Summer's "Truth About Nursing.org. She wrote: March 12, 2010 -- Today Medscape ran a long, powerful article by Laura Stokowski headlined "A Letter to Hollywood: Nurses Are Not Handmaidens." The article features very good explanations of the common myths about nursing that Hollywood promotes, as well as information about what nurses really do to help patients.

Dear Hollywood,

We, the nurses of the world, have something to say to you. Nurses are not what you think. Nurses are independent, highly educated, and skilled healthcare experts who save lives every single day. We work hard and are dedicated to making differences in people's lives.

And we are really sick of going home after a 12-hour shift, turning on the television, and seeing ourselves depicted as brainless bimbos. This has been going on far too long, and it has to stop.

The Clown Took a Job as a Nurse
I remember a time when I was in nursing school, watching TV with my roommate, Liz. A skit came on, in which a famous comedienne of the day was dressed up like a clown. For some reason the clown had to leave the circus. "So," said the narrator, "the clown took a job as a nurse." We laughed at the absurdity of this, but I never forgot it. We were in the middle of a demanding 4-year nursing program, and the suggestion that anyone, even a clown, could be a nurse, just like that, was wounding. I think it was then that I began to take notice of how Hollywood represents nurses.

The answer is...badly. But it isn't just disrespect that comes through in Hollywood portrayals -- it's contempt, and it's not at all subtle. You scorn us in the way you pigeonhole nurses on the small screen -- it seems that we're either half-wits, nymphomaniacs, or latter-day Nurse Ratcheds. Obviously, you have no concept of nurses as autonomous, knowledgeable professionals. We work alongside physicians, but we are their colleagues, not their subordinates. Yet in every hospital drama, physician characters are ordering nurses around, treating them like uneducated servants, or performing nursing care themselves and getting the credit for it, while the nurse characters just fade from view.

I can almost hear your reaction to my complaints. There, there, dear, don't take it personally, it's harmless, it's funny. Is it, really? Will it still be harmless or funny one day in the future when you are in the hospital and you press your nurse-call button and no one responds? Or it is answered -- eventually -- by a minimally trained hospital "technician"? The nursing shortage will have reduced our ranks considerably, and driven many of us into early retirement. It doesn't help the situation when schoolchildren and teens already discount the notion of becoming nurses because of the way nurses are portrayed on Grey's Anatomy. Becoming a nurse, they believe, is a waste of their talents.[1]

Maybe You're Misinformed
I'm going to give those in Hollywood the benefit of the doubt, and assume that they just have the wrong impression of nurses, and have no idea what nurses really do. But for the non-nurse readers, we'll pretend that you are in the hospital, and you've just had emergency heart surgery.

Who do you suppose will be at your side, watching your blood pressure, making sure you don't go into shock?
Who will be alert for the slightest hint of life-threatening hemorrhage?
Who will respond in mere seconds if your heart begins to beat irregularly?
Who will make sure that your chest tube doesn't get blocked and cause you to go into cardiac arrest?
Who will keep the circulation moving in your lower legs so you a clot doesn't develop and you don't die from a pulmonary embolism?
Who will be constantly watching to make sure that you don't stop breathing, that you are getting enough oxygen, that postoperative pneumonia is not developing?
Who will relieve your pain before you even have to ask?
Who will explain everything that is happening to you and teach you how to take care of yourself after you go home?
I'll give you a hint -- it's not your physician. It is your nurses. They will see you safely through one of the most dangerous times of your life, doing all these things and more.

And just so we're clear, I'll tell you what your nurses won't be doing. They won't be clustered around the nurses' station as though at a cocktail party, flirting with physicians. They won't be in the broom closet or the stairwell or behind the patient's curtain giving sexual favors. They won't be trailing after the physician as he marches down the hall, in case he needs a cup of coffee or someone to dump on. Nor will they be in the receptionist's chair, moaning about not being able to get into medical school. If these scenes sound a little familiar -- I'm not surprised. This is how nurses are regularly portrayed on television dramas.

No Angels of Mercy, Please
Hollywood, we're not asking you to glorify nurses. Don't turn us into heroes or martyrs. We just want to be accorded the respect, the esteem that our education, status, and profession warrant. We want our dignity back. We don't want the entire world to think of us as sleazy, dim-witted underlings. We want to erase the image of the "naughty nurse" -- this is your bizarre fantasy, not ours.

We want young, impressionable children to view nursing as a viable, respected, and even admired profession, one they would be proud to call their own. But most of all, we want our patients to trust us and value our knowledge, so that when we teach them how to become healthier people and live longer, healthier lives, they will listen. This, our most treasured ability -- the core of nursing -- is what you threaten with your cheap attempts to increase ratings by ridiculing the nursing profession.

So my question to you is, is it worth it? Is the money you make from entertaining viewers with mentally unbalanced, sexually promiscuous, or idiotically subservient nurse characters worth influencing potentially hundreds of thousands of young men and women to shun a career in nursing? Will you feel content, even proud, the next time you encounter a nurse, in the thought that you regularly chip away at her self-respect and her ability to be effective in her job?

Or will you infuse some realism into your tired stereotypes? You can start by discarding the following myths -- their demise is long overdue.

Myths About Nurses Perpetuated by Hollywood and Other Uninformed Media
1. Physicians are nurses' superiors in the hospital hierarchy- nurses "work for" physicians.

Not true. Nursing is a separate, autonomous profession. We work with, not for physicians. We have our own leaders, and we regulate, license, and manage ourselves. Nurses decide what nurses do, not physicians.

2. Nursing doesn't require much education.

Nursing education is highly specialized, intense, and rigorous, because nursing itself is a profession grounded in science. Many people, if they believe nurses go to college at all, think that most nurses attend a brief 1- or 2-year program. In fact, 58% of nurses presently have a bachelor's degree or higher, a number that is growing every year. The "2year" nursing program doesn't really exist - the associate's degree in nursing requires prerequisites even before entering the nursing program, making it essentially a 3-year program. And in many areas, new graduate nurses undergo extended fellowships in the clinical setting that greatly increase their education and skill in nursing as they enter the profession.

3. Nurses mainly "fetch things" for physicians.

Nursing is a practice that is unique and distinct from medicine. Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.[2] Nursing's focus, and what sets it apart from medicine, is the whole person, not just the specific, presenting health problem, and nursing encompasses both actual and potential health problems. Nursing's scope of practice has been shown in numerous studies to save lives and improve health outcomes.

4. Nurses are those who aren't smart enough to get into medical school.

This might be the most irritating myth of all. It presupposes that nursing is just a tiny subset of medicine, a fallback for people who can't quite make it up the ladder. However, nursing is a different profession, not the same profession watered or dumbed down. Many nurses go on to earn advanced degrees at the master's or doctoral level, but they are still practicing nursing (note that nurse practitioners and other advanced practice nurses may share some of the same functions as physicians in their specialties, but they are philosophically nursing-oriented in their approach to patients). And research shows that care provided by these advanced practice nurses is equal to or better than that provided by physicians.[3-6]

Spotlight on the Best and Worst Media Portrayals of Nurses
It's award season in Hollywood, so it's timely that the Truth About Nursing organization ("the Truth") has just released both its end-of-decade (Tables 1 and 2) and annual (Table 3) awards for images of nurses in the media. From their press release:

The Truth About Nursing announces its list of the best and worst media portrayals of nurses it saw between 2000 and 2009. The Truth's Decade Awards highlight media from a decade in which the world has faced a deadly nursing shortage fueled in significant part by poor public understanding of the profession.[7]
In a promising turn of events, several nurse-focused television dramas (a rarity in Hollywood) premiered in 2009, and these shows made the "Best List." The smart and skilled nurses on Showtime's Nurse Jackie, TNT's HawthoRNe, and NBC's Mercy, rather than retreating into the background, are front and center, fighting for patients, not for attention.

The Truth gave honorable mention to newspaper columns written by Ronnie Polaneczky, reporting by Integrated Regional Information Networks, the documentary Nurses on the Discovery Health Channel, and the HBO film Wit starring Emma Thompson. "Most Improved" awards were given to the television drama ER for better depictions of nurses during the show's final 4 years, and the "Take a Loved One for a Checkup Day" campaign for changing its name from "Take a Loved One to the Doctor Day," which ignored the significant role of nurse practitioners in providing primary care to the campaign's target population.

Table 1. Ten Best Media Portrayals of Nurses of the Decade, 2000-2009

1 Nurse Jackie New York ED nurse Jackie Peyton is tough but talented, and finds creative ways to help patients lead better lives or find lasting peace
2 Mercy Veronica Callahan is an Iraq war veteran with PTSD who leads a crew of smart and committed nurses.
3 Critical Care: The Making of an ICU Nurse Boston Globe article chronicled the 8-month training of a new ICU nurse showing the high level of skill required to care for these complex patients
4 The Rookies Episode 1 of Lifeline: the Nursing Diaries shows nurses engaged in routine nursing functions, such as life-saving interventions and patient education
5 Angels in America Nurses at the center of AIDS care, balancing skill, determination, humor, and caring
6 Media by Diana Mason Weekly radio show Healthstyles with nurse experts; garnered mainstream press for nursing research
7 HawthoRNe Chief nursing officer Christina Hawthorne is a strong and skilled expert nurse in Richmond, Virginia.
8 Media by Theresa Brown Blog for New York Times about nurses, giving nursing perspective on key policy issues
9 Media by Suzanne Gordon Wrote the book Nursing Against the Odds: How Health Care Cost-Cutting, Media Stereotypes, and Medical Hubris Undermine Nursing and Patient Care (2005)
10 California and Massachusetts Nursing Associations. Advocated for nursing through mass media campaigns explaining the value of nursing and presenting nurses as articulate, holistic advocates of public health


Adapted from The Truth About Nursing Decade Awards[7]

Table 2. Ten Worst Media Portrayals of Nurses of the Decade 2000-2009

1 Grey's Anatomy Nurses are insignificant, as physicians perform real-life nursing work. Nurses are portrayed as bitter or fawning losers.
2 House Ignores nurses completely or treats them as annoying fools who are there to clean up the mess.
3 Private Practice Mocks clueless nurse character who works as a receptionist.
4 The Naughty Nurse Many appearances throughout the decade, including ads by Virgin Mobile, Gzhelka Vodka, the Lung Cancer Alliance, the Heart Attack Grill; and in degrading comments made by Kelly Ripa and "Dr. Phil" McGraw on TV.
5 The Today Show For attacks on advanced practice nurses, including nurse midwives and nurse practitioners.
6 ER (2000-2005) Portrayed nurses as physician handmaidens whose highest aspirations are to go to medical school.
7 Passions An orangutan named Precious serves as a private-duty nurse, suggesting that apes can do nurses' jobs.
8 Hopkins 24/7 & Hopkins Repeatedly suggested that physicians perform all important care; virtually ignored the thousands of highly skilled nurses who work there.
9 Media by the American Medical Association Comments in major news media questioning the competence and qualifications of nurse practitioners, in spite of evidence of their effectiveness.
10 The robot nurse Doesn't exist, but makes appearances in the media as "robo-nurse," "virtual nurse," "nurse robot," electronic nurse," etc., reinforcing the view that a "nurse" is anyone or anything that acts as an assistive caregiver.


Adapted from The Truth About Nursing Decade Awards

Annual awards for the year 2009 are found in Table 3.

Table 3. Best and Worst Portrayals of Nurses in the Media, 2009

Best Worst
1 Nurse Jackie 1 Grey's Anatomy
2 Mercy 2 House
3 HawthoRNe 3 Private Practice
4 Theresa Brown 4 The Today Show
5 Pauline Chen, New York Times 5 Minette Marrin, Sunday Times (UK)
6 Nurses advocating in the media 6 New York Times damaging portrayals
7 Reports on nurse innovators 7 "Naughty nurse" advertisements
8 Zara Nicholson, Cape Argus (S. Africa) 8 Three Rivers
9 Erin Thompson, USA Today 9 Mental
10 Reports on school nurses 10 The robot nurse


Adapted from The Truth About Nursing Annual Awards, 2009.
Available at: http://truthaboutnursing.org/press/awards/2009/awd.html.
Used with permission

For some perspective on this, I contacted Truth About Nursing's Executive Director, Sandy Summers. The Truth is an organization that seeks to increase public understanding of the central, front-line role that nurses play in modern healthcare. I asked Ms. Summers how the Truth comes up with the "best" and "worst" awards.

"We analyze depictions of nurses in the news, the lay media, television, radio, music, films, billboards, plays, magazine articles - all sorts of media - and tell readers how good a job they are doing in portraying nurses," responded Summers. "Sometimes, it's good; sometimes it's bad. When a show is doing something right, we ask our readers to send letters to thank the media for doing a good job. When we find a negative or stereotypical depiction of nursing, we encourage our readers to send letters asking the media to improve its product. We set up form letters to help facilitate this and clearly, the more letters the media receives, the more likely they are to respond favorably (though the AMA appears to be an exception.)"

And the Truth has made some headway. When the Lung Cancer Alliance (LCA) used a rap-style video called "Waitin' Room Service" that included nurses dancing suggestively and making sexual overtures to "Dr. Lunglove," the Truth started a letter writing campaign to ask the LCA to remove the video from its Website. "They were admirably trying to educate people about lung cancer," explained Summers, "but they didn't need to use a naughty nurse to do that. The LCA did finally listen to all our letters and phone calls, and took the offensive video off its Website -- but with much resistance."

I asked Summers if stereotypical depiction of nurses was a global problem, to which she gave an unqualified "yes," and continued, "The whole world has this problem, not just the United States. It's even worse in some areas where nurses are viewed as the equivalent of prostitutes, and have trouble finding husbands because their jobs bring them such disrepute. But the media stereotypes are the same, largely propagated by Hollywood shows which are spread throughout the world. The US is the world's biggest purveyor of negative images of nursing.

"Trying to get messages about the value of nursing across to the media is a monumental task," explained Summers. "The media don't actually speak to nurses -- they don't think they need to. They 'learn' about nursing by watching other media depictions so they think they know what nurses do without asking about it themselves. They think, 'nurses just get stuff for physicians.' That's what goes on inside their heads, so we have to change that, shake them up with the truth about what nurses really do. It's very difficult when nurses themselves are reluctant to speak with the media -- these are 2 groups of people who need to communicate, but neither one wants to talk to the other."

Nurses will have to be stronger, louder, and more direct in their messages to all media -- not just Hollywood dramas but television and radio news programs, newspapers, and others who degrade the image of nursing -- but how? The Truth has answers. On their "Take Action" Web page, they describe "what you can do to shape a better image of nursing." You will find hundreds of ideas, such as writing letters to television programs such as Grey's Anatomy, House, or Private Practice (addresses provided), submitting your own nurse story ideas, using nurse-friendly language, or learning how to interact more effectively with the media. If you are interested in finding out more about how media portrayals of nursing affect the nursing profession, read Saving Lives: Why the Media's Portrayal of Nursing Puts Us All at Risk, by Sandy Summers and Harry Jacobs Summers (2009).

What Is at Stake
For a long time I just turned off the television when anything offensive came on. I avoided hospital or medical shows entirely, knowing that I would be disgusted by them. Lately I've realized that not much has changed since I was in nursing school, and there is much more at stake here than hurt feelings. As Summers said, "We cannot solve the global nursing shortage without resources for nursing clinical practice, education, research and residencies. And we cannot get this needed funding if decision-makers think we are unskilled losers. If you were in charge of a billion dollars and had to decide how to divide it, would you give it to the lifesavers or their flunkies? This is why nurses get half of 1% of the National Institute of Health budget and nursing residencies get $1 for every $375 that physician residencies receive. If nurses are not valued by the public, we will not be funded, and the global nursing shortage will continue to further spiral out of control."

The fact that nurses are often excluded from healthcare policy decisions reflects the general belief that nurses' opinions don't matter, a belief that is reinforced by media depictions of nurses. This is what we must change. The image of nursing would benefit from having a visible, highly respected nurse leader, such as the proposed Office of the National Nurse.[8]

If all 3 million of us (15 million worldwide) were to join forces and attack this issue head-on by speaking back to the media, and advocating for the nursing profession, I am convinced we could fix the image of nursing and nurses, and the snowball effect could change the direction of the nursing shortage and the future of healthcare

http://www.medscape.com/viewarticle/718032 (free registration is required. But this is the entire article).

PARADIGM BYTES for March 2010

PARADIGM BYTES
Newsletter for Paradigm 97
March 13, 2010

PARADIGM DEFINED:1) an outstandingly clear or typical example or archetype.2) a philosophical and theoretical framework of a scientific school or discipline within which theories, laws, and generalizations, and the experiments performed in support of them, are formulated.Our website...... http://paradigm97.blogspot.com/ Please copy, paste, and bookmark it.
MISSION STATEMENT

We believe that nurses need each other for support during the "lean and mean" days to help survive them. We offer research results and other ideas to enrich the nursing experience.

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SNIPPET

Gallstones are hardened deposits of digestive fluid that can form in your gallbladder. Your gallbladder is a small, pear-shaped organ on the right side of your abdomen, just beneath your liver. The gallbladder holds a digestive fluid called bile that's released into your small intestine.
Gallstones range in size from as small as a grain of sand to as large as a golf ball. Some people develop just one gallstone, while others develop many gallstones at the same time.
Gallstones are common in the United States. People who experience symptoms from their gallstones usually require gallbladder removal surgery. Gallstones that don't cause any signs and symptoms typically don't need treatment.
Gallstones may cause no signs or symptoms. If a gallstone lodges in a duct and causes a blockage, signs and symptoms may result, such as:
Sudden and rapidly intensifying pain in the upper right portion of your abdomen
Sudden and rapidly intensifying pain in the center of your abdomen, just below your breastbone
Back pain between your shoulder blades
Pain in your right shoulder
Gallstone pain may last several minutes to a few hours.
Tests and diagnosis
Bilirubin test Bilirubin test — Overview covers definition, results of this test for liver disease.
HIDA scan HIDA scan — Overview covers definition, risks, results of hepatobiliary iminodiacetic acid (HIDA) scan.
Treatment and Drugs:
Cholecystectomy (gallbladder removal) Cholecystectomy — Overview covers definitions, risks of open and laparoscopic gallbladder surgery for gallbladder removal.

Complications:

Obesity Obesity — Comprehensive overview covers causes, treatment and prevention of this serious health risk.
Gallbladder cancer Gallbladder cancer — Comprehensive overview covers symptoms, treatment of cancer of the gallbladder.
Cholecystitis Cholecystitis — Comprehensive overview covers causes, symptoms, complications and treatment of gallbladder inflammation.

References:
Understanding gallstones. American Gastroenterological Association. http://www.gastro.org/wmspage.cfm?parm1=5680. Accessed May 28, 2009.
Choi Y, et al. Biliary tract disorders, gallbladder disorders and gallstone pancreatitis. American College of Gastroenterology. http://www.acg.gi.org/patients/gihealth/biliary.asp?mode=print&. Accessed May 28, 2009.
Browning JD, et al. Gallstone diseases. In: Feldman M, et al. Sleisenger & Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2006. http://www.mdconsult.com/das/book/body/140200591-2/0/1389/0.html. Accessed May 28, 2009.
What are the risk factors for gallbladder cancer? American Cancer Society. Accessed June 8, 2009.
Rakel D. Cholelithiasis. In: Rakel D. Integrative Medicine. 2nd ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/142209696-2/0/1494/0.html. Accessed June 8, 2009.
Venneman NG, et al. Gallstone disease: Primary and secondary prevention. Best Practice & Research Clinical Gastroenterology. 2006;20:1063. http://www.mayoclinic.com/health/gallstones/DS00165
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FROM THE MEMBERS

The following question was sent in by JANNARN@AOL.com (Janna) "Q:...Do you understand all the aspects of Long Term Care Insurance and if so, do you think it's worth the cost ?"
(Please, members, respond to her question ; I will print the response in the April Newsletter)
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The following was sent in by a member, Robert Hess, announcing that the Forum for Shared Governance just started an online community. Please visit the site to support his endeavor.

He writes: " The Forum for Shared Governance just started an online community, Shared Governance Bedside Boardroom, at http://netstation.us/sg/

Robert Hess, RN, PhD, FAAN Founder, Forum for Shared Governance (856) 424-4270 (610) 805-8635 (cell) info@sharedgovernance.org www.sharedgovernance.org
^^^^^^^^^^^^^^^^^^^^^^^^^^^
Sandy Summers wrote: You can watch Mercy Wednesdays at 8pm/7c on NBC or watch episodes online at http://www.nbc.com/mercy (If you haven't seen this nursing one.....it is much better that the others).
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Just an afterward.....from Linda (Jenxl@AOL.com ) who responded to the following: " Just supposed to thaw it at room temp or in frig and not in microwave to avoid losing any nutrients. Did the article mention that possibility? "
she wrote:
"Re the above: the main reason one should Not use a microwave to heat breast milk is that fat particles can heat up more than some of the milk and burn the baby.....much like a jelly filled doughnut can do to an adult. If one doesn't believe it try heating the jelly filled doughnut first! (You can call it a research study so you don't have to feel guilty about eating a doughnut.)."
^^^^^^^^^^^^^^^^^^^^^
This was sent in by Roz (roz@alfaroteachsmart.com) UBI in the Knife and Gun Club: The secret language of doctors and nurses
http://www.smithsonianmag.com/arts-culture/The-Last-Page-UBI-in-the-Knife-and-Gun-Club.html
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MEDICAL NEWS

NP remains committed to women's health Kingston, Pa., nurse practitioner Cheryl Fuller says she prefers to meet patients where they are, which may be a prison or juvenile detention center, or at her Women to Women clinic that specializes in women's health. "I know her dedication and I know her experience, not only in the health care field, but also her passion for helping people. I know that for her it's a labor of love," says Rev. Ann Marie Acacio, who nominated Fuller for The Times Leader's Health Care Heroes awards.... http://www.timesleader.com/features/Nurse_practitioner_remains_committed_to_women_rsquo_s_health_01-12-2010.html
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Medical journal retracts autism paper 12 years old The Lancet medical journal formally retracted a paper on Tuesday that caused a 12-year international battle over links between the three-in-one childhood MMR vaccine and autism.
The paper, published in 1998 and written by British doctor Andrew Wakefield, suggested the combined measles, mumps and rubella (MMR) shot might be linked to autism and bowel disease.
His assertion, since widely discredited, caused one of the biggest medical rows in a generation and led to a steep drop in the number of vaccinations in the United States, Britain and other parts of Europe, prompting a rise in cases of measles.
"It has become clear that several elements of the 1998 paper by Wakefield ... are incorrect," the internationally renowned scientific journal said in a statement.... http://www.reuters.com/article/idUSTRE61132920100202?feedType=nl&feedName=ushealth1100
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The Orb of Life December 1, 2009 -- Today the Democrat and Chronicle (Rochester, NY) ran a very good article by Patti Singer about the work of University of Rochester nursing scholar Martin Schiavenato to develop an "orb" that uses artificial intelligence to measure pain in premature infants. Schiavenato and his team are developing ways to measure vital signs and movements, then translate them into colors so clinicians can determine and treat the conditions of vulnerable infants, for whom pain may have life-long developmental effects. ... http://www.truthaboutnursing.org/news/2009/dec/01_dem_chron.html

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INTERESTING READING

Please remember that the REUTERS articles usually good for only 30 days

Compliance versus adherence in serious and persistent mental illness Nursing Ethics, 02/02/10 Vuckovich PK – The ideal goal is adherence, which requires the patient to be an active participant in the team. This goal is consistent with nurses’ ethical values, but for such patients this is frequently unrealistic. If the person is severely psychotic, treatment may be involuntary and the goal compliance. Psychiatric nurses participate in involuntary treatment and thus should acknowledge the ethical implications of compliance as a goal and not obscure the issue by calling compliance adherence. ... http://nej.sagepub.com/cgi/content/abstract/17/1/77
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What is this ? Autism increased exponentially and now bi-polar?? BOSTON (Reuters 1/15) - The number of children aged 2 to 5 who have been diagnosed with bipolar disorder and prescribed powerful antipsychotic drugs has doubled over the past decade, according to research released on Friday.The data, compiled from 2000 to 2007, and published in the Journal of the American Academy of Child & Adolescent Psychiatry, could inform testimony at the upcoming Boston-area murder trials of the parents of 4-year-old Rebecca Riley. The girl died of an overdose of mood-stabilizing medication in 2006.
A Boston child psychiatrist, Kayoko Kifuji, diagnosed Riley with bipolar disorder and attention deficit hyperactivity disorder when she was 30 months old, and placed her on several powerful drugs: Depakote, an antiseizure medication also used for bipolar disorder, and clonidine, a blood pressure medication.... http://www.reuters.com/article/idUSTRE60E0NC20100115?feedType=nl&feedName=ushealth1100
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RANDOM FACT: The blue whale’s heart is the size of a small car.
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The role of community health advisors in community-based participatory research Story L et al. – This article provides ethical insights from one such 'insider–outsider', community–based participatory research project implemented via community health advisors in the Mississippi Delta. Both community–based participatory research and community health advisors provide opportunities to address the ethical issues of trust, non–maleficence, and justice in minority communities. ... http://nej.sagepub.com/cgi/content/abstract/17/1/117
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Coronary heart disease knowledge tool for women Journal of the American Academy of Nurse Practitioners, 02/01/10 Thanavaro JL et al. – Women continue to have low CHD knowledge, and nurse practitioners should provide education to improve women's CHD knowledge as a strategy to promote healthy lifestyle practices and CHD risk prevention. The new tool can be utilized in future research to measure women's CHD knowledge....
http://www3.interscience.wiley.com/journal/123266810/abstract?CRETRY=1&SRETRY=0
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Comparison of Temporal Artery to Rectal Temperature Measurements in Children Up to 24 Months Journal of Pediatric Nursing, 02/01/10 Carr EA et al. – This descriptive study compared temporal artery (TA) and rectal temperature measurements, patient comfort during temperature measurements, and nursing time required to obtain temperature measurements. Study participants (n = 40) included children 0–24 months old with fever higher than 38°C, admitted to a freestanding children's hospital in the Midwest. .... http://www.pediatricnursing.org/article/PIIS0882596309004126/abstract?rss=yes
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RANDOM FACT: There are 18 different animal shapes in the Animal Crackers cookie zoo! *******************

Five holes in your organization's IT security structure A 2009 report by the Ponemon Institute showed that 80% of the health information technology teams surveyed had experienced security breaches. Among the five most common gaps in an organization's IT security infrastructure were solutions that have no integrated or privileged-based accessibility and a lack of log-in tracking systems, the report noted. Healthcare IT News http://www.healthcareitnews.com/news/five-holes-your-organizations-it-security-structure
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Drink This at Breakfast and You'll Eat Less Later The key to not overeating at lunch is to choose carefully at breakfast. And here's a beverage choice that may help: skim milk. The Skinny on Skim Milk The group of overweight men and women had a couple of slices of toast with margarine and jam along with their milk or juice. And even though both breakfasts supplied an equal number of calories, the milk drinkers still ate less at lunch. They simply felt more satisfied. ... http://www.realage.com/tips/drink-this-at-breakfast-and-you-will-eat-less-later
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The Nurse-Crusader December 8, 2009 -- Today the New York Observer published a generally good profile of "controversial" Columbia nursing dean Mary Mundinger, who is retiring after a quarter century at the forefront of the fight to help advanced practice nurses (APRNs) win the respect and resources they need to provide high-quality, cost-effective care. Dana Rubinstein's piece even cites the research, too often missing from press reports on APRNs, demonstrating that APRN care is at least as effective as physician care. The article also provides a short but relatively insightful look at the lack of respect nurses have historically suffered, and suggests that the nurse-focused television shows that appeared in 2009 represent a step forward for public understanding of the profession. The piece does at times paint a bit too rosy of a picture--some advances for APRNs and the appearance of the new nurse shows do not necessarily mean the public has grasped that nurses generally deserve more authority and respect. And there are a few unfortunate elements, like the reporter's apparent belief that "doctor nurse" is an appropriate term to describe APRNs. But on the whole the article is a helpful look at a nursing leader and the advanced practice nursing she has championed. We thank Ms. Rubinstein and the Observer. http://www.truthaboutnursing.org/news/2009/dec/08_observer.html
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RANDOM FACT: The Capitol building in Washington, D.C. has 365 steps to represent every day of the year.
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Simple Rule for Controlling a Sweet Tooth How much of the sweet stuff can you have without blowing a healthful eating plan? Sugar Overload If you want to ward off excess pounds and heart disease, heart experts recommend you use this simple cap: 100 calories. That's about how many calories' worth of added sugar you should limit yourself to each day.Actually, it's 100 calories for women, 150 for men (lucky fellas). And an "added sugar" would be any sugar that's been added to foods or beverages during processing or preparation, be it sweetened yogurts, cereals, or candies. Unfortunately, most Americans get about 430 calories of added sugars daily -- enough extra to easily contribute to the growing pandemic of obesity and cardiovascular disease.... http://www.realage.com/tips/simple-rule-for-controlling-a-sweet-tooth
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Study links hormone to addiction, risk-raking (Reuters 2/1) People with high levels of the hormone dopamine in the brain, and low sensitivity to it, tend to be greater risk takers and may be more prone to addictive behavior, drug abuse and gambling, a study has found. ... http://www.reuters.com/article/idUSTRE6105RE20100201?feedType=nl&feedName=ushealth1100
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(Reuters 1/29) Cutting down on saturated fats and eating more fish and omega-3 fatty acids can help older people reduce bad cholesterol and increase good cholesterol levels, study data showed. Changes in diet helped even if people already were taking cholesterol-lowering statin medications, researchers said.... http://www.reuters.com/article/idUSTRE60S63920100130
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RANDOM FACT: Pennsylvania is misspelled on the Liberty Bell.
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HANDY HINTS: If you have crayon marks on your walls get a damp cloth and dip it into some baking soda. Rub the cloth on the crayon marks, be sure to put some elbow grease into it. hmmmm
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Please someone try this and then let me know ! Mustard makes an excellent soak for tired, overworked feet. Combine one tablespoon mustard in a pan of warm to hot water.Stir the water well to completely dissolve the mustard. Soak your feet for approximately twenty minutes.
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National Nurse Nominated For Third Time As A Top Nursing Blog Thank you to Nursing Programs Online for choosing the National Nurse News Link/ blog as one of the "Top Rated Nursing Blog" winners. This is especially thrilling news as this is the third award the National Nurse News Link has received in less than 3 months! We also owe a special gratitude to those who have sent in their own writings about the Office of the National Nurse initiative; you can find many of these posts in the archived months and years posted as links on the lower right side of this web page.
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THRIFTY TIP: Paying one additional mortgage payment each year, whether in a lump sum or monthly increments, can lower a 30-year loan down to 18 years. If you pay more than one extra payment, the number of years will decrease even more. Since this additional payment will be applied only to the principal and not the interest, you end up saving thousands and thousands of dollars once the home is paid off!And it also lowers the total amount of interest the borrower will pay, because it lowers the principal and length of time it will take to pay off the loan.
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FDA warnings cut antipsychotic use 19% Studies have shown that using antipsychotic drugs shortens the lives of elderly patients with dementia. The U.S. Food and Drug Administration issued a warning about the drugs in 2005.
"We concluded that it resulted in a modest reduction," said Dr. Ray Dorsey of the University of Rochester Medical Center in New York, who conducted a six-year study along with colleagues, said of the warning.
Dorsey said the group does not have enough data to say how many people benefited from the warning, and he did not cast the results as a sign of its success or failure.... http://www.reuters.com/article/idUSTRE60A5DB20100111?feedType=nl&feedName=ushealth1100
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RANDOM FACT: Frowning burns more calories than smiling (we all know why that is)
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New guidelines cover catheter-associated UTIs New guidelines on catheter-associated urinary tract infections are aimed at prevention and treatment in hospital and long-term care patients. The authors said one way to prevent infections is nurse-based or electronic physician reminder systems or automatic stop-orders that ensure catheters are only used when needed. Medscape (free registration) http://www.medscape.com/viewarticle/716906
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This definitely is an OMG kind of situation ! I am sure you are aware of this , but here it is in a nutshell... Houston Chronicle Medical emergency In reporting a doctor's mistakes, a West Texas nurse risked ... ... small thing in tiny Kermit, Texas. But they saw it as their professional duty to report what they believed was shoddy work by Dr.Rolando G. Arafiles. ... Texas, it turns out, has laws that protect whistle-blowers — but only from civil suits. Criminal prosecution is another matter entirely. After the medical board received the nurses' anonymous complaint, its investigators gave a copy to Dr. Arafiles. That complaint alleged that he'd given patients inappropriate care, including sewing a rubber tip not intended to be attached to humans onto a patient's crushed finger (a case that the Texas Department of State Health Services had red-flagged). Too, the complaint noted, Arafiles urged patients to buy Zrii, a questionable nutrition supplement sold via a pyramid-marketing structure. http://www.chron.com/disp/story.mpl/editorial/6863280.html
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Drop Fat Forever with this Creamy Food Several studies suggest that extra calcium in the diet (and yogurt's got lots) may inhibit fat absorption in the small intestine. And that means having less of it to store around your hips, thighs, and belly....
http://www.realage.com/tips/drop-fat-forever-with-this-creamy-food
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(Reuters 1/24) (This is still available)- An abnormality in two genes can make a common class of chemotherapy drugs used to fight breast cancer less effective, U.S. researchers said on Sunday in a finding that could help doctors better tailor treatments.
They said changes in two genes on a small region of chromosome 8q made tumors resist the effects of drugs called anthracyclines, but not other types of chemotherapy drugs.
"This is useful because it helps select who might be resistant to anthracyclines," said Dr. Andrea Richardson of the Dana-Farber Cancer Institute in Boston, whose study appears in the journal Nature Medicine.... http://www.reuters.com/article/idUSTRE60N1KD20100124?feedType=nl&feedName=ushealth1100
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RANDOM FACT: A quarter of the bones in your body are in your feet.
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Messing with Texas September 11, 2009 -- Recently veteran Texas nurses have published powerful op-eds advocating legislative changes to improve nurses' practice environments--and public health. On August 22, the Houston Chronicle ran an op-ed by Linda Record Srungaram arguing that the recent indictment of two West Texas nurses after they filed a complaint about a physician with the state medical board showed the need for better whistle-blower protections for nurses, who must be able to engage in such advocacy to protect patients. And today, the Austin Statesman published Toni Inglis's piece arguing that primary care shortages require the removal of legislative barriers that still inhibit the work of advanced practice nurses. These op-eds show the importance of nurses speaking up to protect patients and to show the public that nurses are critical thinkers with thoughtful perspectives on health policy. We thank those responsible for the op-eds. http://www.truthaboutnursing.org/news/2009/sep/11_texas.html
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Vegatative Patient "talks" using brain waves (Reuters 2/3 ) - A man in a deeply unconscious state for five years has been able to communicate with doctors using just his thoughts in a study scientists say is a "game changer" for care of vegetative state patients.
British and Belgian researchers used a brain scanner called functional magnetic resonance imaging to show the man, who suffered a severe traumatic brain injury in a road accident in 2003, was able to think "yes" or "no" answers to questions by wilfully changing his brain activity.
Experts say the result means all patients in coma-like states should be reassessed and it may change the way they are cared for in future. http://www.reuters.com/article/idUSTRE61261J20100203?feedType=nl&feedName=ushealth1100
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ZURICH (Reuters 2/25) - Roche's Avastin helps women with advanced ovarian cancer live longer without their disease getting worse, a late-stage study showed, boosting its prospects after a recent setback in stomach cancer. Roche, the world's largest maker of cancer drugs, said on Thursday it was the first positive Phase III study of an anti-angiogenic therapy, which uses drugs to stop tumors from making new blood vessels, in advanced ovarian cancer. ... http://www.reuters.com/article/idUSTRE61O2AZ20100225?feedType=nl&feedName=ushealth1100

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RANDOM FACT: One acre of peanuts will make 30,000 peanut butter sandwiches.
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ENRs facilitate the application of current evidence into every day emergency nursing practice. ENA anticipates that ENRs will make a positive impact on patient care and emergency nursing practice by bridging the gap between practice and currently available evidence. The ENRs were created based on a thorough review and critical analysis of the literature following ENA’s Guidelines for the Development of Evidence-Based Emergency Nursing Resources (Guidelines).
Guidelines for the Development of Evidence-Based Emergency Nursing Resources
The Guidelines outline the approach used to develop ENA’s Emergency Nursing Resources. The Guidelines serve as the foundation for the development of ENRs by ensuring consistency of the evidence-appraisal process and incorporation of current, best available evidence for practice. Offering a systematic approach to the review of literature and making recommendation for emergency nursing practices, the Guidelines may also serve as a resource for others engaged in implementing evidence-based practice in emergency nursing. http://www.ena.org/Research/ENR/Pages/Default.aspx
Current ENRs : ENR: The Use of Capnography During Procedural Sedation / Analgesia in the Emergency Department
ENR: Family Presence During Invasive Procedures and Resuscitation in the Emergency Department
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NEW YORK (Reuters 2/4) - The saturated fat found mainly in meat and dairy products has a bad reputation, but a new analysis of published studies finds no clear link between people's intake of saturated fat and their risk of developing heart disease.
Research has shown that saturated fat can raise blood levels of "bad" LDL cholesterol, and elevated LDL is a risk factor for heart disease and stroke. Because of this, experts generally advise people to limit their intake of fatty meat, butter and full-fat dairy.
The American Heart Association (AHA) suggests that adults get no more than 7 percent of their daily calories from the fat; for someone who eats 2,000 calories a day, that translates into fewer than 16 grams of saturated fat per day.... http://www.reuters.com/article/idUSTRE61341020100204?feedType=nl&feedName=ushealth1100
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RANDOM FACT: On the east face of the aluminum apex of the Washington Monument are the words "LAUS DEO" which is Latin for praise be to God. ***************
Dolder C et al. – Adequate treatment of behavioral disturbances in Alzheimer's disease is both important and difficult. This report describes a case series that examined the effectiveness and safety of low-dose divalproex in the treatment of agitated patients with Alzheimer's disease who were admitted to an inpatient geriatric psychiatry unit over a 1-year period. The case series suggests that low–dose divalproex may offer behavioral improvement and a reduced risk of side effects for some patients with agitation in Alzheimer's disease. ... (need to register)
http://journals.lww.com/practicalpsychiatry/Abstract/2010/01000/Low_Dose_Divalproex_in_Agitated_ Patients_with. 10.aspx
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What Makes a Nurse Great, Skill or Compassion? While education and knowledge are important for one to be a nurse, assets including compassion, leadership, and a desire to learn make for a 'great' nurse. If I were a patient, I would certainly expect my care provider to be competent in nursing skills, knowledge, and have a degree. However, on the other hand, if I were acutely ill and feeling hopeless, I would want a nurse that showed genuine empathy and concern for me .... http://www.associatedcontent.com/article/113659/what_makes_a_nurse_great_skill_or_ compassion.html?cat=4
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(Reuters 1/22) - One in five American teens has unhealthy cholesterol levels, a major risk factor for heart disease in adults, the U.S. Centers for Disease Control and Prevention said on Thursday.
The heavier teens were, the more likely they were to have high cholesterol but even 14 percent of teens with normal body weight were found to have unhealthy cholesterol levels, the CDC said.
CDC researchers studied data on 3,125 teens collected from the National Health and Nutrition Examination Survey for 1999 through 2006. ... http://www.reuters.com/article/idUSTRE60K54I20100122?feedType=nl&feedName=ushealth1100
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(Reuters 1/22) - Shaving 3 grams off the daily salt intake of Americans could prevent up to 66,000 strokes, 99,000 heart attacks and 92,000 deaths in the United States, while saving $24 billion in health costs per year, researchers reported on Wednesday. The benefit to the U.S. population would be comparable to cutting smoking by 50 percent, significantly lowering obesity rates and giving cholesterol drugs to virtually everyone to prevent heart attacks, said Dr. Kirsten Bibbins-Domingo of the University of California, San Francisco and colleagues.... http://www.reuters.com/article/idUSTRE60K0VP20100121?feedType=nl&feedName=ushealth1100
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(Reuters 2/2) Boost in Bacterial count refines UTI Diagnosis Revising the definition of a urinary tract infection to raise the minimum amount of bacteria that must be present would improve diagnostic accuracy, according to a study. British researchers said raising the universal threshold would reduce the number of false-positive tests but also would require changes in lab techniques.... Medscape (free registration http://www.medscape.com/viewarticle/716362
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RANDOM FACT: The word pound is often abbreviated as lb. This comes from the Latin word libra which literally means "balance" as in a scale.
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Q from a nurse and A from Wendie: The nurse writes: If you have an order to give electrolyte-replacement meds PO but you found out that their K and their Mag were WNL, would you hold the meds and clarify orders with MD or give them? What if you work nights, would you call the MD at 10PM to clarify or wait until the AM shift RN to clarify? I have 2 senior nurses fighting over this.

Wendie answers:
Is this a one-time order or has this patient been getting this all along and that's WHY s/he is at normal levels? Are there other meds or conditions that would tend to lower these levels if supplements aren't maintained? Is this a REPLACEMENT med (with the order that says, ”If level is less than X, give Y dose,“ or a MAINTENANCE med?The order should also include a ”hold for XXX“ and you can get the MD to add this at rounds in the morning. Make that part of your protocol c pharmacy support and you'll never have this argument again.

Best, Wendie
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A Surprising Cause of Pain..... Uncontrolled blood sugar can be a source of chronic pain If has diabetes and chronic pain, diabetic neuropathy may be to blame. ... http://yourtotalhealth.ivillage.com/diabetes-women.html?nlcid=pa03-03-2010
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HINT: To refresh tired or puffy eyes, place used tea bags in the refrigerator for fifteen minutes. Place on closed eyes for a few minutes. ***********************

Census Bureau Estimates May Undercount Medicaid Recipients, Overcount Uninsured
Bethesda MD - Widely cited estimates from the Census Bureau likely overstate the number of uninsured people and understate the number of people with Medicaid coverage because of an inability of people to recall their insurance status accurately from the previous year, according to a study published today on the Health Affairs Web site.

The CPS, administered in February, March, and April, asks respondents whether they had health insurance coverage (including Medicaid) at any point in the previous calendar year. However, the CPS's long recall period (fourteen to sixteen months) can lead to inaccurate responses, report lead author Jacob Klerman, a principal associate at Abt Associates in Cambridge, Massachusetts, and coauthors.

According to Klerman and his colleagues, CPS responses are most inaccurate for those whose periods of Medicaid coverage in the previous year were relatively short and relatively early in the year, as those are hardest to recall. The researchers say that similar recall problems may affect CPS estimates of those covered by other types of health insurance in addition to Medicaid, and they call for research into whether other surveys, such as Census's American Community Survey, could provide better estimates of the uninsured. You can read the article by Klerman and coauthors at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.6.w991
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Little Evidence Exists Regarding eICU Impact On Intensive Care Cost/Quality Bethesda MD - While nearly 10 percent of U.S. hospital intensive care unit (ICU) beds use advanced telemonitoring-known as eICUs- there has never been a systematic evaluation of how the innovative approach to caring for critically ill patients affects quality and costs, according to a study by the Center for Studying Health System Change (HSC) published today as a Health Affairs Web Exclusive.

The study makes the case that comparative effectiveness studies should examine delivery-system and work-process innovations, not just drugs, devices, and services. Hospitals clinical leaders have "strong views" about ICU telemedicine-trademarked as eICU by the dominant vendor VISICU Inc. -- but have "little objective information on which to judge the worthiness of this innovation," observes HSC Senior Consulting Researcher Robert A. Berenson, also an institute fellow at the Urban Institute, and co- authors. You can read the article by Berenson and coauthors at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.5.w937
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* Failure to Plan for Inevitable Expenses e.g. BUDGET BLUNDERS If you pay property, auto, health and life insurance on a monthly basis you are paying additional fees. Budget for lump sum payments and save the fees!
* Clothing This is often considered an incidental expense which means it usually goes on the credit card. Set aside a monthly clothing budget. If you don't use it, roll it over and you will have twice as much to spend next month, etc...
* School Supplies This is another one you just can't omit if you have kids.
* Pet Care If you have a pet, you have expenses that come with it. Vaccinations, flea control, veterinarian, and food are just a few. Consider the monthly and yearly cost of owning a pet when buying.
* No Emergency Fund In addition to insurance, clothing, pet care and other incidentals, everyone should have an emergency fund some-where. This is in addition to your 401ks IRAs and any other long-term investments. If the transmission suddenly falls out of the bottom of your vehicle you don't want to have to liquidate your retirement account to replace or fix it!
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Evidence-Based Management and Treatment of Outpatient Community-Associated MRSA Guilbeau JR et al. – Recently, the incidence of community–associated methicillin–resistant Staphylococcus aureus has increased, which requires urgent attention to safe practice and prevention. Because this is a relatively new public health problem, the evidence to support management is evolving. NPs are positioned to examine the evidence and incorporate findings into practice. http://www.npjournal.org/article/PIIS1555415509004036/abstract?rss=yes
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Questions are raised about long-term care hospitals The growth of long-term acute care hospitals in the U.S. is troubling some who say the businesses are not well regulated and offer patients inadequate care. An analysis of Medicare records found the hospitals were cited for serious violations of rules at twice the rate of ordinary facilities, with patients suffering more often from bedsores and infections.
The New York Times http://www.nytimes.com/2010/02/10/health/policy/10care.html?ref=policy
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BOSTON (Reuters 2/10) - A single large infusion of the Gilead Sciences drug AmBisome cured nearly every case of the deadly parasitic infection visceral leishmaniasis (the natural infection of phlebotomine sand flies by leishmania parasites), researchers reported on Wednesday in a study from India. The researchers said using a single dose of the drug, known generically as liposomal amphotericin B, would make it possible to treat many more patients, whose initial symptoms often are fever, fatigue, and weight loss as the parasites infect cells.
The disease can be found in Europe, Asia and Africa, but it is concentrated in India. http://www.reuters.com/article/idUSTRE6195OP20100210?feedType=nl&feedName=ushealth1100
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HANDY HINT: Are your feet tired and tender? Well, you know there are more than 1,000 nerve endings on your soles. Place a handful of marbles in a basin and fill with warm water. Soak your feet for 10-15 minutes, rolling your soles over the marbles to stimulate the pressure points that turn on the calm all over! (or just roll a soda bottle/beer bottle with your instep if you don't have the time to do the above)

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HUMOR SECTION

A guy walks into work, and both of his ears are bandaged.
The boss says," What happened to your ears?"
"Yesterday I was ironing a shirt when the phone rang and I accidentally answered the iron, instead."
"Well, that explains one ear, but what happened to the other?"
"Well, I had to call the doctor!"
000000000000
As the family gathered for dinner, the youngest son announced he had just signed up at an Army recruiter's office. There were audible gasps around the table, then laughter, as his older brothers shared their disbelief that he could handle this new situation. "Oh, come on, quit joking," snickered one. "You would never get through basic training, " scoffed another. The new recruit looked to his mother for help, but she just looked at him.
When she finally spoke, she asked, "Do you really plan to make your own bed every morning?"

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CEU SITES---(CME and CNE)
Those that are-----Free and Otherwise..........

Pay Only $34.99 for a full year of CONTACT HOURS http://www.nursingspectrum.com /

Free CEs http://www.myfreece.com/welcome.asp

Free & Discounted CEs!
Need CE credits? We offer CE courses on a variety of topics, and, better yet, a bunch are discounted or free. Just added: Legal Aspects of Restraints (free!) and Calcium Imbalances. For a complete list of CE offerings:

https://nursing.advanceweb.com/CE/TestCenter/Main.aspx
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CE: Post-Stroke Depression Learning Scope #326 1 contact hour Fee: $ 8.00
Expires February 15, 2012
Early assessment and interventions can promote optimal recovery.
http://nursing.advanceweb.com/Continuing-Education/CE-Articles/Post-Stroke-Depression.aspx

This site was sent in by FNPMSN@aol.com (Cindy) http://cmepain.com/ !

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WEBSITES/ LINKS
Always on the lookout for interesting websites / links. Please send them to:RNFrankie@AOL.com.

Robert Hess, RN, PhD, FAAN (856) 424-4270 (610) 805-8635 (cell)
Founder, Forum for Shared Governance info@sharedgovernance.org www.sharedgovernance.org
Decubqueen's website: www.accu-ruler.com

http://www.thebreastcancersite.com/clickToGive/home.faces?siteId=2

http://www.nationalnurse3.blogspot.com/

Website: http://www.infoplease.com/ anything and everything answered.

The Emergency Email & Wireless Network Alerting us to scams/phishing, etc.
http://www.emergencyemail.org/newsemergency/anmviewer.asp?a=489&z=43

RNs launch a national safe staffing campaign http://www.1199seiu.org/media/magazine/sept_2007/safe_staffing.cfm

H.R. 2123, The Nurse Staffing Standards for Patient Safety and Quality Care Act of 2007
http://www.washingtonwatch.com/bills/show/110_HR_2123.html

Board Supports Your Right to Refuse An Unsafe Assignment: Nurse Practice Act cites three conditions for patient abandonment http://findarticles.com/p/articles/mi_qa4102/is_200408/ai_n9450263

The Nursing Site http://thenursingsite.com .

http://www.thebreastcancersite.com/clickToGive/home.faces?siteId=2
http://www.snopes.com

http://www.solutionsoutsidethebox.net/ Raconte's website

http://www.theanimalrescuesite.com/clickToGive/home.faces?siteId=3
National Do Not Call Registry

If you're buying a used car, it is recommended having a mechanic inspect it first. And screen the car's VIN through the free database at carfax.com/flood

This is a sampling of the offers on : Rozalfaro's website: http://www.alfaroteachsmart.com/articles.htm
Critical Thinking is More Than Problem Solving Critical Thinking: Not Usually Rapid Fire
Should Clinical Courses Get a Letter Grade?
Metric conversion calculators and tables for metric conversions
http://www.metric-conversions.org/

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*
MEDICAL RECALLS
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Nipro GlucoPro Insulin Syringes: Recall Nipro Medical Corporation and FDA notified healthcare professionals of a voluntary nationwide recall of all GlucoPro Insulin Syringes. These syringes may have needles that detach from the syringe. If the needle becomes detached from the syringe during use, it can become stuck in the insulin vial, push back into the syringe, or remain in the skin after injection. This recall includes all product codes and lot numbers with expiration dates before 2011-11 (November 1, 2011). Product was distributed nationwide, including Puerto Rico. Consumers who have GlucoPro Insulin Syringes should stop using and return them to point of sale for reimbursement. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts/ucm198445.htm
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HAPPYTOT Stage 4 and HAPPYBABY Stage 1 & Stage 2 Pouch Meals - Recall FDA notified healthcare professionals that Nurture, Inc., is recalling selected varieties and date codes of HAPPYTOT Stage 4 and HAPPYBABY Stage 1 and Stage 2 pouch meals with date codes expiring between November 2010 and January 2011 due to a packaging defect that could cause a possible bacterial contamination. The meals are packaged in plastic pouches with plastic caps. Recalled varieties and UPC codes are listed in the firm's press release. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts/ucm197570.htm
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Erythropoiesis-Stimulating Agents (ESAs): Procrit, Epogen and Aranesp: Drug Safety Communication FDA and Amgen notified healthcare professionals and patients that all ESAs must be used under a REMS risk management program. As part of the risk management program, a Medication Guide explaining the risks and benefits of ESAs must be provided to all patients receiving an ESA. Under the ESA APPRISE Oncology program, Amgen will ensure that only those hospitals and healthcare professionals who have enrolled and completed training in the program will prescribe and dispense ESAs to patients with cancer. Amgen is also required to oversee and monitor the program to ensure that hospitals and healthcare professionals are fully compliant with all aspects of the program. FDA is requiring a REMS because studies show that ESAs can increase the risk of tumor growth and shorten survival in patients with cancer who use these products. Studies also show that ESAs can increase the risk of heart attack, heart failure, stroke or blood clots in patients who use these drugs for other conditions. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts/ucm200391.htm
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Alli 60 mg capsules (120 count refill kit): Counterfeit Product FDA updated January 18 alert with information on laboratory analysis of sibutramine levels in counterfeit product. Additional FDA laboratory tests on the counterfeit product show that people may be taking 3-times the usual daily dose (or twice the recommended maximum dose) of sibutramine if they are following the dosing directions for Alli. Healthy people who take this much sibutramine can experience anxiety, nausea, heart palpitations, tachycardia (a racing heart), insomnia, and small increases in blood pressure. This excessive amount of sibutramine is dangerous to people who have a history of cardiovascular disease, and can lead to elevated blood pressure, stroke, or heart attack. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts/ucm197862.htm
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Meridia (sibutramine hydrochloride): Follow-Up to an Early Communication about an Ongoing Safety Review FDA notified healthcare professionals that the review of additional data indicates an increased risk of heart attack and stroke in patients with a history of cardiovascular disease using sibutramine. Based on the serious nature of the review findings, FDA requested and the manufacturer agreed to add a new contraindication to the sibutramine drug label stating that sibutramine is not to be used in patients with a history of cardiovascular disease, including:
History of coronary artery disease (e.g., heart attack, angina)
History of stroke or transient ischemic attack (TIA)
History of heart arrhythmias
History of congestive heart failure
History of peripheral arterial disease
Uncontrolled hypertension (e.g., > 145/90 mmHg)
http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts/ucm198221.htm
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McNeil Consumer Healthcare Over-The-Counter Products: Recall McNeil and FDA notified healthcare professionals of an expansion of the December 2009 recall. McNeil Consumer Healthcare has now applied broader criteria to identify and remove all product lots that it believes may have the potential to be affected, even if they have not been the subject of consumer complaints. Consumers who purchased product from the lots included in this recall should stop using the product and contact McNeil Consumer Healthcare for instructions on a refund or replacement. The affected product lot numbers for the recalled products can be found on the side of the bottle label. Any adverse reactions may also be reported to the FDA’s MedWatch Program by fax at 1-800-FDA-0178, by mail at MedWatch, FDA, 5600 Fishers Lane, Rockville, MD 20852-9787, or on the MedWatch website at www.fda.gov/medwatch.
http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts/ucm197740.htm
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MuscleMaster(dot)com Products Sold on Internet as Dietary Supplements: Recall MuscleMaster(dot)com, Inc. and FDA notified consumers and healthcare professionals of the voluntary nationwide recall of all lots and expiration dates of the seventeen dietary supplements listed in the firm press release, sold between June 1, 2009 and November 17, 2009. FDA informed MuscleMaster(dot)com that it believes that the recalled products contain ingredients that are steroids.... http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts/ucm197834.htm
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BD Q-Syte Luer Access Devices Recall BD Nexiva Closed IV Catheter Systems RecallAcacia IV Extension Sets with BD Q-Syte Luer Access Device Recall
BD, Acacia Inc. (known as MPS Acacia), and FDA notified healthcare professionals of the recall of certain lots of these devices. The BD Q-Syte Luer Access Device is a needleless valve manufactured by BD, intended for use with other infusion therapy products in the administration of fluids into the intravenous system. Use of the recalled devices may cause an air embolism or leakage of blood or therapeutic product which may result in serious injury or death. The REF/catalog and lot numbers which were sold in the US are noted in the firm's press release. The affected lots were distributed from November 2008 through November 2009. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts/ucm200137.htm
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Cardiac Science Automated External Defibrillators (Powerheart, Cardiovive, CardioLife models): Recall Cardiac Science Corporation and FDA notified healthcare professionals and consumers of a recall because the automated external defibrillator (AED) may not be able to deliver therapy during a cardiac resuscitation attempt, which may lead to serious adverse events or death. These AEDs were manufactured in a way that makes them potentially susceptible to failure under certain conditions. Each of the approximately 12,200 devices affected in this recall can be confirmed at the Cardiac Science Web site, www.cardiacscience.com/AED195. The affected AEDs were manufactured or serviced between October 19, 2009 and January 15, 2010 and include the following models - Powerheart 9300A, 9300E, 9300P, 9390A, 9390E, CardioVive 92532 and CardioLife 9200G and 9231. Each affected AED should immediately be removed from service since it may not deliver the expected therapy. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts/ucm200138.htm
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OneTouch SureStep Test Strips (LifeScan): Recall LifeScan and FDA notified healthcare professionals of a voluntary recall of eight lots of OneTouch SureStep Test Strips, used by people with diabetes to measure their blood glucose levels at home. The test strips are being recalled because they may provide falsely low glucose results when the glucose level is higher than 400 mg/dL.
The eight lots of consumer OneTouch SureStep Test Strips being recalled are identified in the firm's press release. Lot numbers are located on the outer carton and test strip vial. LifeScan estimates approximately fourteen thousand packages (50- and 100-count) of consumer OneTouch SureStep Test Strips were distributed nationwide between August 1, 2009 and January 28, 2010. ... http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts/ucm202254.htm
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StatSpin Express 4 Centrifuges Model 510: Class 1 Recall FDA notified healthcare professionals of a Class I recall of the StatSpin Express 4 Centrifuges, Model #510, Serial Numbers 00100 through 001679, manufactured and distributed from November, 2007 through January, 2010. The rotor of the centrifuge may break and separate from the motor, striking a safety microswitch so it fails to shut down the centrifuge. The loose rotor may strike the lid of the centrifuge housing which may cause the lid to open and eject pieces of the rotor. These pieces may cause serious physical injury to bystanders and may expose them to blood-borne infectious micro-organisms. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts

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NURSING HINTS CORNER

Small-diameter enteral feeding tubes often get clogged from the feeding formla residue. To prevent this residue buildup, we flush the tubes Q 4 hours (and each time the feeding is interrupted or discontinued) with 5/8 oz of cranberry juice, followed by 3/8 oz of water.
The acidic cranberry juice breaks up the formula's residue, and the water rinses away the juice, preventing sugar from crystallizing in the tube. Dee Adinaro, RN, MSN
Used with permission from 1,001 Nursing Tips & Timesavers, Third Edition, 1997, p.132, Springhouse Corporation/www.springnetcom.
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ADVERTISEMENTS
from the members
This ad is from Decubqueen (Gerry)..........Accu-RulerAccurate wound measurement designed by nurses, for nurses. Now carrying wound care and first-aid supplies at prices you can afford.Visit us at http://www.accu-ruler.com/.
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NEW MEMBERS
Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com

WELCOME TO:

rnpftno_1@bellsouth.net (Marilyn) January 19, 2010

martha.griffis@sgmc.org (Martha) February 26, 2010

nursedt@bellsouth.net (Devonne) February 26, 2010


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NOTICE:
I attempt to send newsletters to your email addresses on file and if the newsletters are rejected THREE consecutive times, I must then delete the email address until you contact me with an updated email address; I have no way to reach you without a correct email address....You could always send me your Home number....lol So please send me your new name/address, ok? RNFrankie@AOL.com
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EDITORIAL STAFF:
GingerMyst @AOL.com (Anne), GALLO RN @AOL.com (Sue), HSears9868 @AOL.com (Bonnie), Laregis @AOL.com (Laura), Mrwrn @AOL.com (Miriam), and Schulthe @AOL.com (Susan)
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PARADIGM 97 CO-FOUNDERS:
MarGerlach @AOL.com (Marlene) and RNFrankie @AOL.com (Frankie)
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DISCLAIMER: The intent of this PARADIGM BYTES Newsletter is to provide communication and information for our members. Please research the hyperlinks and information provided by our members. The articles and web sites are not personally endorsed by the editors, nor do the articles necessarily reflect the staff's views.

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THOUGHT FOR THE DAY

"We make a living by what we get, but we make a life by what we give."
Winston Churchill (1874-1965),

British politician known chiefly for his leadership of the United Kingdom
during World War II. He served as Prime Minister from 1940 to 1945
and again from 1951 to 1955.

Write and/or hope to see you online..... Frankie/Frances
RNFrankie@AOL.com