The Nurse-Patient ratio five years later

The Nurse-Patient ratio: Five years Later In the late ’90s, the California Nurses Association sponsored a bill that would ensure safe staffing for patients in California. Known as AB394, the bill was the third attempt made to obtain mandated ratios in the state. The first was in 1993, but the bill died in committee. A second bill came around in 1997 and was passed through the legislature, but eventually vetoed by Gov. Pete Wilson. Things changed in the fall of 1999, however, and then-Gov. Gray Davis signed AB394 into law, the nation’s first directive mandating nurse staffing ratios for acute-care hospitals.

The California Department of Health Services (DHS) was given the task of determining and implementing the staffing ratios over a period of several years. During that time, nurses, legislators, media and the public at large were bombarded by a variety of messages from both proponents and opponents of the law. Some said hospitals will close; other said patients should be afraid to go to the hospitals where it wasn’t yet implemented; many hoped nurse satisfaction would increase, thus keeping more nurses at the bedside.

The Ratio Effect

To date only two studies have been conducted that specifically focused on the outcomes and/or results of this law, and both were published in the nursing journal Policy, Politics & Nursing Practice. The first was in 2005 and its primary focus was on the impact of the nurse-patient ratio on incidence of patient falls and prevalence of pressure ulcers. The results revealed no significant changes and they were not able to find compliance with the ratio per shift or unit, but they seemed to show an overall compliance with the law.

The second study was published earlier this year and focused more specifically on nurse satisfaction, which was revealed to have improved between 2004 and 2006. The authors stipulated that the improvements were not associated with the degree to which the hospitals were expected to increase staffing.

Massachusetts and the Nurse-Patient Ratio

Even though the studies concluded that more studies are needed to fully determine the effect of mandating staff ratios, both sides of the nurse-patient ratio debate have latched onto them. Each side has used the effect and efficacy of nurse-patient ratios to argue the case for and against legislation brought before state houses throughout the country.

Earlier this summer, the Massachusetts House of Representatives passed a bill very similar to California’s law. Meanwhile the Massachusetts Senate proposed and passed a bill that would allow individual hospitals, in conjunction with nurse input, to develop a nurse-patient staffing plan specific to that hospital. The customized plan would then be publicly posted and would allow the state’s Department of Health (DPH) to monitor and audit and, where appropriate, penalize hospitals for failure to comply with their own staffing plan.

Both plans have a deep attachment to either the passage or defeat of their legislation. They each built coalitions to help them press their cause and argument.

Ultimately neither bill passed since both houses failed to agree upon a compromise prior July 31, 2008, the end of the legislative session. As with California, emotions and rhetoric surrounding the Massachusetts legislation ran high, and dire predictions were announced should either bill pass.

Acuity-Based vs. “Cookie Cutter” Systems

As a nurse who is very outspoken (imagine that) on all things nursing, my readers may remember my earlier column on the nurse-patient ratio that was published in 2004. [Editor's Note: This article can be found below.] My position on the mandated ratio law hasn’t changed. I am a firm believer in the acuity-based patient assignment system. Though many nurses and their supporters seem to prefer the more cookie-cutter approach of the ratio, my experience has taught me that it can and is subject to manipulation. I use the term “cookie cutter” to describe the mandate because even though it has been based on outcomes from nursing research, in my opinion, it ultimately removes the individual nursing judgment from the patient assessment system.

Advocates of the nurse-patient ratio laws will often argue that the law is simply a “floor,” not a “ceiling,” and that the ratio can be adjusted based on patient acuity. However, I have rarely seen this put into practice. Perhaps it is believed that the “law is being met” even when the patient acuity might demand a different assignment.

For example, not that long ago a RN working in ICU at a hospital in the Los Angeles area shared how she had started her shift with one patient and, as the shift progressed, the charge nurse assigned her an additional newly admitted patient. The RN, who had many years of experience under her belt, informed the charge nurse that the patient assignment was inappropriate since both patients were highly unstable and a 1:1 ratio was more appropriate for each. The charge nurse disagreed with the RN’s assessment and said that the law’s requirements had been met. So the RN had to assume the care of the two patients and, sadly, one died on her watch.

I later learned that she was fired, and when asked if she had filed an incident report about the unsafe patient assignment, she replied, “Why bother?” The charge nurse who made the initial assignment had defended her decision; therefore she felt her complaint would fall on deaf ears.

I was somewhat surprised by her response since I know that there had been an extensive educational campaign to educate nurses on the nurse-patient ratio laws, and several hospitals had even developed a reporting mechanism for their nurses to report violations of the law.

Then again, this could be another example of the “human factor” — just as one can easily point the finger at the healthcare industry for ignoring reasonable patient assignments, one can never underestimate the impact that one nurse can have on another — people sometimes just do unwise things, regardless of what common sense, training or laws suggest they should do.

Between the Battle Lines

Presently, the movement to regulate patient assignment is making its way across our country. My research revealed 12 states that have or are considering legislation that would mandate a minimum nurse-patient ratio in hospitals. 14 states are considering legislation that attempts to address nurses’ concerns about staffing. Oregon (the only state so far) has enacted legislation that requires an acuity-based staffing plan, and I look forward to reading the research on the state’s experience.

I foresee a heated battle in the states with a mandated nurse-patient ratio, especially in light of the two studies that have been published on the subject matter. I read a letter to the editor of the Salem News (a local paper in Massachusetts) claiming that the 2002 had been “academically discredited,” and when I learned of this accusation I asked another University of California at San Francisco (UCSF) professor to shed light on this accusation.

The person I chose to contact, since I know her, was Joanne Spetz, the author of the 2008 study mentioned earlier in this column. She expressed a common conundrum often faced by researchers. She said the study had not been “academically discredited,” but questions had been raised about its methodology.

Just because an organization disagrees with the results of a study, the funding source, or even the researchers themselves does not mean that the results of said research should be discarded. It is imperative that we — especially those of us who advocate so passionately for nursing, don’t engage in such destructive behavior. That’s for the spin doctors, lobbyists and politicians. Labeling research done by hospitals, clinics or fellow nurses with whom we may not agree as being tainted or discredited does not move the nursing profession forward.

Fact or Fiction?

That said, we still must consider the bias of sponsored research, which is why researchers often make a habit of disclosing both their affiliations, possible conflicts of interests, and the sources of funding. So long as this information is clearly disclosed, we should be cautious about making accusations and assumptions.

For example, when I read the 2008 study authored by Ms. Spetz, I thought it odd that Bay Area RNs had been oversampled (this was disclosed in the study) since the Bay Area has a more unionized RN workforce than elsewhere in our state. So I emailed her and asked about it, to which she explained that it had been done at the request of and with funding from a specific foundation.

No doubt the oversampling was weighted statistically to not have an effect on the overall outcome, and it’s not uncommon for studies to use such a process to balance studies when such “side tracks” are taken. This serves as a good example of the slippery slope we can go down if we choose to accept such practices.

It is critical as the nurse-patient ratio debate continues that we seek out all research related to the effects of California’s law and separate fact from fiction. However, to do so we must be willing to allow both sides to present their concerns and their studies. For example, one of the big selling points currently being promoted by supporters of mandated ratio laws is that nurses have flocked back to the bedside.

If truth be told, there has been a documented 90,000 new RN licenses issued since AB394 was signed into law. However, a nearly equal number of RNs have left the state during this same period. Of even greater concern is a recent revelation that a large number of RNs have not renewed their license at the first renewal opportunity.

I learned of this unsettling statistic from Ms. Spetz, who led me to understand that California’s Board of Registered Nursing (BRN) has asked her to study this development. I, for one, look forward to learning the results of this study because our state can ill-afford nurses flocking into California to get their licenses if an equal number are going to flock out.

It is equally important that we study the assertion made by the hospital industry (which occurred early in the implementation) that the law would cause hospital closures. Proponents of the nurse-patient ratio law have dismissed such claims as alarmist talk, but I know that in the Los Angeles County area we’ve had 11 hospitals close during this period. Some have claimed they closed because they could not meet the mandated ratios while others intimated that the ratios were a contributing factor.

I’m no naïf when it comes to healthcare and its politics, so I know that there are many reasons why hospitals face closure. Though I’m not sure how much AB394 impacted these decisions, I for one would like to know whether AB394 was a contributing factor or not. This could have wide-ranging impacts if similar models are adopted nationwide.

The Future of Nursing

Why nurses stay or leave the bedside is not a simple answer and goes beyond a mandated nurse-patient ratio. It is easy for nurses to latch onto this as the answer to all our woes, just as we often hear the phrase, “If nurses were only compensated more fairly there would be no nursing shortage.”

The nursing shortage is a spectrum of challenges that need to be addressed if we ever hope to solve it. Some feel that the cookie-cutter approach is part of the answer. I’m convinced that such decisions are best left to the bedside nurse and not legislators and bean counters. We are taught the skills needed to do patient assessments and we should be in a position to put our education, training and skills into action.

Geneviève M. Clavreul, RN, Ph.D, is a healthcare management consultant who has experience as a director of nursing and as a teacher of nursing management. gmc@solutionsoutsidethebox.net

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The Nurse/Patient Ratio, originally published January 26, 2004, Working Nurse issue 2
by Genevieve M. Clavruel, RN, PhD

The New Year heralds many things, and this year brings legislation mandating a nurse/patient ratio in California. But after the confetti stops falling, did we get what we want? We now have a panacea for thousands of nurses in California, however the ratio really can’t be enforced. (At the writing of this article the companion bill for enforcement is stalled in the legislature, having been defeated at least once already)

As my children are fond of saying, “Why am I not surprised?” Having been a nurse for almost 30 years, most of those years spent in the NICU/PICU, I am used to working with a strict nurse/patient ratio. ICUs and a few other areas of nursing have always been under the control of an “acuity” system. Actually, all nursing is supposed to be, but we know this isn’t always the case. For this reason, I knew in my heart that legislating a nurse/patient ratio was probably an exercise in futility.

Why this attitude, you may ask? First, hospitals and The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) already require the development of an acuity tool to assess the patient and assign nurse/patient ratios. Second, I hate to see laws passed for the sake of passing laws. Do California nurses need reliable nurse/patient ratios? Yes. Do these ratios need to be enforceable? Yes. Do we need legislation? Probably not.

Let’s dissect the problem. How is the nurse/patient ratio determined? In theory, each hospital has in place an acuity procedure. It can be as simple as if the patient has x, they are a 1; if the patient has x and y, they are a 2; and so forth. The more complicated the care required for the patient, usually the higher the number assigned. Then, depending on the number, the nurse has an allotment of patients. For example, a nurse can have a total of two, three, four or even 10 patients that are ranked 1, but a nurse can only have a total of one patient if that patient is ranked 6 or 7.

The system is simple, until the human factor is taken into account. That factor is the charge nurse, who usually makes the assignments. In most cases, a floor nurse is assigned the duty of being charge nurse during a shift. She is usually not trained as a manager and is often unwilling to take the risk of rocking the boat. Tomorrow she will be a floor nurse again and someone else will be the charge nurse.

Any management expert will tell you that this is a formula for disaster. A recent incident at a local area hospital serves as a good example of this problem.

I showed up for work one night at a “Not Quite Out in the Sticks” hospital (which was listed as one of the top 100 hospitals in the nation). As usual, the NICU was short-staffed—nothing new there, especially since this unit suffers from nurses consistently calling in sick. A recent survey found that nurses were as likely to call in sick because they were just “plain sick and tired” as they were due to actual illness.

The charge nurse for the night gave me my assignment. Three neonates, one is ranked a 5 and two are ranked at 4. By visually assessing the number of IVs they each had, the order for lipids and TPN, and the nasal cannulas, I knew that I was being assigned three patients that were all 5’s. This was before I discovered that two of the neonates ranked 4 were also having severe Brady’s and apnea. This was an unsafe patient assignment. So much so that one of the infant’s IVs infiltrated and he was burned from the medication being delivered.

The nurse assigned his care, who I had relieved, was not only devastated, but frustrated as well. The injury under normal circumstances was probably avoidable, but with the patient load assigned, it was an accident waiting to happen.

As I stated earlier, I have been a nurse for 30 years. It was my RN license that kept a roof over the heads of my four children, mother and dog when my husband and I divorced — so I place a high value on it. Unwilling to risk my license, I alerted the charge nurse of the unsafe patient load. Her response to me was, “Well this is the ranking that has been in place for several days.” My response to her was, “Just because it was ranked wrong in the first place doesn’t mean we have to perpetuate the error.”

A charge nurse who had been trained in management, and who was assigned solely as a charge nurse, would have been better prepared to deal with the problem, or may have had at her disposal a wider array of “management tools” to help solve the problem. For example, she may have prefaced the unusually heavy assignment with words of encouragement and support, such as, “We are really short-staffed this evening, and with your many years of experience I thought that you would be up to this challenge,” or “I know that this is a heavy assignment, but I am here to help when you need it.”

She did, however, send the transport RN to change the ranking of one of my patients from a 5 to a 4. The nurse in the bay next to me leaned over, winked and whispered, “Now don’t you feel better?”

The above is a good example of how, even with an acuity system in place, the nurse/patient ratio is ignored. To believe it could be legislated was a pipe dream. Nurses, hospital administration and unions would better serve the patients and nurses if we took different, more effective action.

Here is a quick and dirty solution to part of the problem:

Step One: Make charge nurse a middle management position. This is a good way to reward competent and interested nurses who are ready to begin moving from the bedside, but who might not be ready to tackle the head nurse position.

Step Two: The charge nurse does not get assigned a patient load. Instead, like the head nurse, she would take on the care of patients when and where necessary. Her primary focus, however, would be to come to the aid of the nurses on the floor and do admitting when necessary. With this method a floor nurse on occasion could be assigned a slightly higher than normal patient load. For example, caring for three patients ranked 5, because the charge nurse would be there to help when needed.

Step Three: Train the charge nurse in management techniques. The charge nurse position needs to be a stable position, not a position that is rotated among floor nurses. By assigning the charge nurse position a stable “rank” it is more likely there will be a constant continuum of care and fairness of assignment.

Step Four: Compensate the charge nurse, not necessarily with money, although a pay increase is always appreciated. Compensation could also come as a benefit package, designated parking, extra paid time off, paid CEU classes or additional university-level classes.

Is this the solution to the nursing shortage? No. However, I feel it is one step in the direction of mitigating the problem. One of the biggest reasons why nurses leave the field is that they feel poorly treated, such as when they are asked to work an unfair assignment.

Geneviève M. Clavreul is a healthcare management consultant. She is an RN and has experience as a director of nursing and as a teacher of nursing management.

PARADIGM BYTES
Newsletter for Paradigm 97
June 10, 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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SNIPPETS
(As a preface to the following from Wendie. She is answering a student nurse who wrote saying that she didn't see any difference between and AA or BSN. What was all the argument about)She writes: "This is one of the most contentious issues in nursing: the level of education needed for a profession. As many of the NN'rs know, I come down squarely on the side of a BS in Nursing or BSN (not a BA or "BAS," whatever that is) as entry-level educational preparation. When I had smaller kids and they asked me a question, I always asked them, "Do you want the short answer or the long one?" Since I can count on the fingers of one hand the number of times they ever said, "Short" and still have enough left over for the Boy Scout salute, here it is again. ::note to self: copy this for cutting and pasting later:: (Disclaimer: Have worked as a staff nurse, inservice/staff development, instructor, NCLEX prep course instructor, case manager in multiple settings, and other stuff too numerous to mention. In short, been around, seen that, done that. Have also been a patient with different levels of caregivers.)

What's a profession? Is nursing a profession? What's the basic educational prep for people you think of as professionals? Would you want your chemistry research done by someone with an associate degree? Your child taught high school math or English? Your income tax advising? Sure, there are good people with lower level education who succeed in life, but don't let that "we all have the same license and sit for the same exam" fool you. Better education makes you better at what you do. There are any number of people who can give you examples of BSNs or MNs who don't know how to take a rectal temp (why does everyone focus on that and bedpans when they think of nursing, anyway?) and marvelous crusty old LPNs who saved the resident's butt one dark and stormy night, but for every single one of those I will see your anecdote and raise you half a dozen godawful errors made by nurses who didn't take the coursework and didn't get exposed to the idea of autonomy in school.

Time: The bachelor's degree takes four years. The associate's degree (AS or ASN) takes ... three and a half, once you count all the prerequisites you're going to have to take before they admit you into the nursing program. And those who say you can work on your BSN while you are working as an RN with an AS don't tell you (and maybe don't know, to be charitable) that many of your course hours from the AS program are not transferrable, so it won't just be a matter of a semester or two or three. AND working as a nurse is HARD, almost as hard as nursing school ... think you'll have the mental, physical, social, and financial energy for more education at the same time? Oh, and in most jurisdictions you can't sit for the LPN exam and work as one while partway thru a AS or BSN program anymore, either.

Job opportunities: Although the old a-nurse-is-a-nurse-is-a-nurse attitude is fortunately fading away, I realize that people who are just starting out have a very incomplete idea of what it means to be a nurse. However, look around the place and see who's working. Are you planning to be older some day? Do you see older nurses working in those entry-level staff or charge positions? If not, where did they all go? Why do you care? Well, suppose you work on a general medical floor and get entranced by cardiac rehabilitation after following a patient who did it. A job comes up in the department, hooray! Oops, BSN only. Or you find your heart drawn to helping underserved women in a public health clinic for high-risk pregnancy. Sorry, BSN only in public health. After five or six years as a staff nurse you have become a resource to new hires and your peers and you realize you have a gift for teaching. You see that a position in staff development has come open, and you are first in line at HR to apply. You got it.... BSN is the minimum. School nursing? BSN. Hurt your back and want to go for a job in case management? BSN. You discover you have a gift for asking, "Why do we do it this way?" and are amazed to find you want to look into jobs in management or nursing research.....BSN minimum. You are starting to get the picture now. Also, many, many practice settings give you a differential for BSN. No, I know, not all, but hey. One more factor.

Growth: The questions in the licensure exams (NCLEX) are developed from errors made in the first year of practice by new grads, and regardless of pass rates from different level programs, anyone in practice can confirm the research: In the first year of work all new grads perform at about the same level as they get their feet under them and get used to the idea of working as an RN. But after that year, the BSNs pull ahead in ways that are related to their higher level of education. Why? Because what we call in the ed biz "psychomotor skills," the things you do with your hands, can be done by anyone with enough practice. Hell, we teach lay people how to do peritoneal dialysis at home or suction tracheostomies. But the understanding of WHY some things are as they are is something you get in better education: more science, more sociology, more psychology, more history, a basic statistics class, exposure to more clinical settings (I doubt if you'll get a full semester in peds, psych, OB, or any public health at all in any AS program) give you the insight to ask better questions and make better decisions".
best
Wendie

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MEDICAL NEWS
Hep C drug achieves 75 percent cure rate: study (Reuters 5/25) The results from the first late-stage Phase III study of telaprevir came in at the high end of expectations for a cure rate of 70 to 75 percent, with slightly lower discontinuation rates due to side effects than previously seen.
Investors cheered the data, sending Vertex shares, which have slumped recently, up 12 percent in after-hours trading. Telaprevir is expected to become a multibillion-dollar drug for Vertex if approved by the U.S. Food and Drug Administration.

Seventy-five percent of patients who received 12 weeks of telaprevir in combination with current standard treatment of pegylated interferon and ribavirin, followed by either 12 or 36 weeks of standard treatment achieved a sustained virologic response, or SVR, which is tantamount to a cure. ... http://www.reuters.com/article/idUSTRE64O6IQ20100525?feedType=nl&feedName=ushealth1100

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Since Johnson & Johnson have done extensive advertising about nursing (for which I have been very grateful), what does that do for us when their reputation is damaged ? Any opinions ?

FDA finds grime at J&J plant, urges use of generics (Reuters 5/5/10) A Food and Drug Administration report released on Tuesday said its inspectors found thick dust and grime covering certain equipment, a hole in the ceiling and duct tape-covered pipes at the Fort Washington, Pennsylvania, facility that made 40 products recalled last Friday.

Inspectors also found raw ingredients contaminated by an unspecified bacteria, a lack of quality control procedures and poor handling of complaints, according to the report dated April 30.

The findings were a further blow to J&J's reputation, as the FDA later on Tuesday urged parents to choose private label alternatives for the over-the-counter medications and said it was weighing possible further regulatory action. A full list of more than 40 affected products made by McNeil Consumer Healthcare can be found at www.mcneilproductrecall.com. ... http://www.reuters.com/article/idUSTRE64367Z20100505?feedType=nl&feedName=ushealth1100

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AACN's Review of the New Healthcare Reform Law (15-page pdf) The American Association of Colleges Nursing’s overview of supported provisions and sections requiring attention. Patient Protection and Affordable Care Act Public Law No: 111-148 Nursing Education and Practice Provisions http://www.aacn.nche.edu/Government/pdf/HCRreview.pdf

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The Evidence is In - California RN-to-Patient Ratios Save Lives With CA Ratios, NJ would have 14%, PA 11% Fewer Deaths Ratios also Boost RN Retention, Increase Time for Patient Care

A major new study led by one of the nation's most eminent nurse researchers provides compelling new evidence that California's landmark RN-to-patient staffing law reduces patient mortality, assures nurses more time to spend with patients, and substantially promotes retention of experienced RNs.... http://www.calnurses.org/media-center/press-releases/2010/april/the-evidence-is-in-california-rn-to-patient-ratios-save-lives.html

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A new Joint Commission Sentinel Event Alert warns that health care facilities today are being confronted with steadily increasing rates of crime, including assault, rape and murder.

The Alert urges greater attention to the issue of violence and to controlling access to facilities to protect patients, staff and visitors, noting that assault, rape and homicide are consistently in the top 10 types of serious events reported to The Joint Commission.

Caron Wong, Publications and Special Projects Manager, (630) 792-5178 cwong@jointcommission.org

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On Saturday April 24th, 2010, a group of students from the University of New Mexico Physician Assistant program were volunteering at the Indian Pueblo Cultural Center in Albuquerque during the Center’s American Indian Week “Pueblo Days” to offer free voluntary blood sugar tests. The device used to prick the finger to get the blood sample required for testing was meant for single patient use and not for multiple patients. Those who volunteered for testing that day may have been put at risk of contracting infections due to potential exposure to diseases spread by blood contact.

Despite direct faculty supervision, three mistakes were made: They used the wrong device; they were not all properly trained on the device; no records of those tested were kept. (and they didn't change the lancet)

We estimate that 51 to 55 individuals were tested, potentially exposing these people to other's blood. The diseases of greatest concern are Hepatitis B and C although theoretically HIV is also possible. Our best current assessment of the risk of infection is less than a 0.5% risk. Even though the risk is small it is something we are very concerned about it and are taking it seriously. http://contact.health.unm.edu/ ~~**~~**~~**~~**~~**~~
INTERESTING READING

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

The Nurse's Role as a Patient Advocate Whether calling attention to a potential medication error, helping the rest of the health care team hear a patient’s voice or shaping policy by speaking from first-hand experience, advocating for patients comes naturally to today’s nurses.
“Advocacy is the heart and soul of nursing practice,” said Cindy Zolnierek, RN, MSN, director of practice at the Texas Nurses Association in Austin. “Nurses believe they hold the patients’ safety and care in their hands.” Many nurses give this advocate role little thought, considering looking out for their patients’ well-being part of the job—for instance, reminding a surgeon that he needs to order a different pre-op antibiotic to avoid an allergic reaction or calling attention to the fact a patient lives alone and is not ready for discharge. http://www.nursezone.com/default.aspx *********************** Helicobacter pylori's helical shape helps it colonize the stomach The bacterium Helicobacter pylori, which lives in the human stomach and is associated with ulcers and gastric cancer, is shaped like a corkscrew, or helix. For years researchers have hypothesized that the bacterium's twisty shape is what enables it to survive - and thrive - within the stomach's acid-drenched environment, but until now they have had no proof.... http://www.news-medical.net/news/20100528/Helicobacter-pyloris-helical-shape-helps-it-colonize-the-stomach.aspx

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RANDOM FACT: A giraffe can clean its ears with its 21-inch tongue!
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KCI receives 510(k) clearance to market V.A.C. Therapy System for treatment of VLUs (venous leg ulcers) Kinetic Concepts, Inc. announced today that it has received 510(k) clearance from the Food and Drug Administration to market its proprietary Vacuum Assisted Closure, or V.A.C. Therapy System, for the treatment of venous insufficiency ulcers, also known as venous leg ulcers....
http://www.news-medical.net/news/20100528/KCI-receives-510(k)-clearance-to-market-VAC-Therapy-System-for-treatment-of-VLUs.aspx
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Questions to consider for a solo NP practice Serious thought and planning are required for nurse practitioners who are considering launching their own private practice. It is important to define the practice mission, prepare to take responsibility for more than just patients and figure out how running a business may affect personal relationships. ADVANCE for Nurse Practitioners http://nurse-practitioners.advanceweb.com/Features/Top-Story/Are-You-Ready-for-Ownership.aspx
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Drink This, Not That! features “20 Worst Drinks In America” New York Times bestselling authors David Zinczenko and Matt Goulding are out with the definitive list of the "20 Worst Drinks in America" as featured in the new book Drink This, Not That!—in stores now. The list highlights the country's most calorie-and sugar-laden drinks, everything from flavored waters and juice imposters to beers and margaritas. http://www.news-medical.net/news/20100528/Drink-This-Not-That!-features-e2809c20-Worst-Drinks-In-Americae2809 d.aspx **********************
Cancer care and oncology nursing are headed in a new direction, guided by multiple intertwined factors, including the aging of baby boomers and the longer-term needs of patients with cancer. These factors, coupled with general concerns about the nursing profession and healthcare, including the shortage and costs for care, are creating a challenge for oncology nurses. The challenges evolve their roles as educators, case managers and agents of societal change. ...
http://news.nurse.com/article/20100524/NATIONAL01/105240001/-1/frontpage
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RANDOM FACT: A Boeing 747 airliner holds 57,285 gallons of fuel.
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A whole body MRI scan accurately detected breast tumors that had spread to the bone, even when there were no symptoms, offering a safe way to check patients, Indian researchers said on Thursday. They said whole body magnetic resonance imaging or MRI -- should be the method of choice for checking to see if breast cancer has spread. ... http://www.reuters.com/article/idUSTRE6456N420100506?feedType=nl&feedName=ushealth1100
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Croup--Assessment and management Rajapaksa S et al. – This article discusses the key aspects of diagnosing croup and the evidence supporting the different treatment strategies. The assessment of airway, breathing and circulation, focusing on airway, is paramount in treating croup. However, it is important to take care not to cause the child undue distress. In mild to moderate croup, give prednisolone 1.0 mg/kg and review in 1 hour. In severe or life threatening croup, give 4 mL of adrenaline 1:1000 (undiluted) via nebuliser and send immediately to hospital via ambulance. http://www.racgp.org.au/afp/201005/37124
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The Nanotech Gamble: Promise vs Risk Written by Andrew Schneider
Nanotechnology, touted for potential to cure diseases, ease energy woes, and more, is big business. But evidence shows the engineered particles could pose huge rishks. with little being done to enzxure public safety, one expert asks, "Must the bodies stack up first?" First in a 3-part investigative series
http://www.aolnews.com/nanotech/article/amid-nanotechs-dazzling-promise-health-risks-grow/19401235?icid=main|htmlws-main-n|dl1|link1|http%3A%2F%2Fwww.aolnews.com%2Fnanotech%2Farticle%2Famid-nanotechs-dazzling-promise-health-risks-grow%2F19401235
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With two-thirds of adult Americans and a third of children overweight or obese, the need for more activity is dire, health experts said in launching the plan. The plan calls for changes in medical school curricula, local regulations to encourage construction of sidewalks, playgrounds and parks, guidelines for doctors on counseling patients, and a return of organized exercise to school days. ... http://www.reuters.com/article/idUSTRE6424AT20100503?feedType=nl&feedName=ushealth1100
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RANDOM FACT: The tongue is the fastest healing part of the body. (what about the eye?) *****************
Bypass, stents equally safe five years on: study WASHINGTON (Reuters 5/5) - Patients who got heart bypass surgery and those who got their blocked arteries propped open with stents fared equally well five years after their procedures, South Korean doctors reported on Wednesday. The study of more than 2,200 patients showed no difference in death, heart attack or stroke between the two groups, Dr. Duk-Woo Park of Ulsan College of Medicine in Seoul and colleagues reported. The patients all had a serious heart blockage called unprotected left main coronary artery stenosis, which doctors agree needs treatment. But heart surgeons have disagreed about whether stretching the artery open and inserting a wire mesh tube called a stent is as effective as more traditional bypass surgery. ... http://www.reuters.com/article/idUSTRE6445R020100505?feedType=nl&feedName=ushealth1100
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RANDOM FACT: A camel's hump stores fat that the camel uses for energy when food is scarce not water !

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Study Reveals Widespread Fatigue, Risk for Errors with 12-Hour Nursing Shifts
Newswise (press release) — A common practice of successive 12-hour shifts for US hospital nurses leaves many with serious sleep deprivation, higher risk of health problems ...
http://www.newswise.com/articles/study-reveals-widespread-fatigue-risk-for-errors-with-12-hour-nursing-shifts
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Management of beharioral problems in Alzheimer's disease Gauthier S et al. – Alzheimer's disease (AD) is a complex progressive brain degenerative disorder that has effects on multiple cerebral systems. In addition to cognitive and functional decline, diverse behavioral changes manifest with increasing severity over time, presenting significant management challenges for caregivers and health care professionals. Almost all patients with AD are affected by neuropsychiatric symptoms at some point during their illness; in some cases, symptoms occur prior to diagnosis of the dementia syndrome. (required to join) http://www.mdlinx.com/NurseLinx/newsl-article.cfm/3103937/ZZ5603146585149290157159/?news_id=1188&subspec_id=51
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May 25, 2010 -- The latest list of terrible-for-you restaurant food is out, with consumer groups accusing big national chains of packing huge amounts of calories onto unsuspecting diners. “Compared to some of the foods we’re seeing in restaurants now, the Big Mac seems downright dainty,” says Michael Jacobson, executive director of the consumer group Center for Science in the Public Interest (CSPI). The group took aim at nine meals served at popular restaurant chains, noting that many contain far more calories, fat, trans fat, sodium, or sugar in one serving that most adults are supposed to get in a single day. While the recently signed health reform law requires chain restaurants with 20 or more locations to post calorie counts in their menus and on menu boards starting in 2011, Jacobson says restaurants should improve labeling now. ... http://www.webmd.com/food-recipes/news/20100525/group-warns-extreme-restaurant-meals *********************

This was sent in by MJSolon (Melva) Thank you Dr. Nurse? 28 States seek to extend Nurse's powers A nurse may soon be your doctor. With a looming shortage of primary care doctors, 28 states are considering expanding the authority of nurse practitioners. These nurses with advanced degrees want the right to practice without a doctor's watchful eye and to prescribe narcotics. And if they hold a doctorate, they want to be called "Doctor." For years, nurse practitioners have been playing a bigger role in the nation's health care, especially in regions with few doctors. With 32 million more Americans gaining health insurance within a few years, the health care overhaul is putting more money into nurse-managed clinics. (Doctors are fighting it with AMA backing) http://www.aolhealth.com/2010/04/14/dr-nurse-28-states-seek-to-extend-nurses-powers/?icid=main|htmlws-main-n|dl3|link7|http%3A%2F%2Fwww.aolhealth.com%2F2010%2F04%2F14%2Fdr-nurse-28-states-seek-to-extend-nurses-powers%2F

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WASHINGTON (Reuters 5/26) - Sellers of ginseng, echinacea and other herbal and dietary supplements often cross the line in marketing their products, going as far as telling consumers the pills can cure cancer or replace prescription medications, a U.S. government probe found.... http://www.reuters.com/article/idUSTRE64P5MY20100526?feedType=nl&feedName=ushealth1100
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Type 3 Diabetes: Brain Diabetes? Wood L et al. – A relationship between diabetes mellitus (DM) and dementia is undeniable, with numerous studies concluding that DM increases the risk of cognitive decline and dementia, including Alzheimer’s disease (AD). The apparent overlap between DM and dementia has led to the suggestion that AD is not solely a neurologic disorder, but rather a neuroendocrine disorder, with Steen et al coining the term type 3 diabetes to describe this hybrid disease...To date, there are no specific treatments with proven efficacy in the prevention of cognitive decline or AD in patients with DM. ... http://www.uspharmacist.com/content/d/feature/i/1102/c/20754/
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RANDOM FACT: Snickers is the best selling chocolate worldwide, raking in over $2 billion annually.
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A Randomized Study of the Effects of T'ai Chi on Muscle Strength, Bone Mineral Density, and Fear of Falling in Women with Osteoarthritis Rhayun Song, Beverly L. Roberts, Eun-Ok Lee, Paul Lam, Sang-Cheol Bae. The Journal of Alternative and Complementary Medicine. March 2010, 16(3): 227-233. doi:10.1089/acm.2009.0165.
– T'ai chi increased knee extensor muscle endurance and bone mineral density in older women with osteoarthritis, and decreased their fear of falling during daily activities. Further study with long–term follow–up is needed to substantiate the role of t'ai chi exercise in the prevention of fall and its related fracture.... http://www.liebertonline.com/doi/abs/10.1089/acm.2009.0165
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CHICAGO (Reuters 4/14) - A test run of an "artificial pancreas" that monitors blood sugar and delivers both insulin and regulatory hormone called glucagon helped patients achieve near-normal blood sugar levels for more than 24 hours, U.S. researchers said on Wednesday.... http://www.reuters.com/article/idUSTRE63D47V20100414?feedType=nl&feedName=ushealth1100
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RANDOM FACT: Orcas (killer whales), when traveling in groups (AKA pods), breathe in unison.
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All About Osteoporosis: A comprehensive analysis Davis S et al. – Osteoporosis affects more than half of persons older than 50 years. Earlier practice guidelines represented the standard of care but did not adequately address some populations. In 2008, revised guidelines addressed previous concerns. The fracture risk assessment tool (FRAX) helps physicians and patients gain a better understanding of a specific patient’s risk, and clinical experience has highlighted several other risk factors. ...
http://www.musculoskeletalnetwork.com/osteoarthritis/content/article/1145622/1551345
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Eat this bread for a Healthier Smile What you pick from the bread basket might have an impact on your pearly whites. You're probably (hopefully) already grabbing the whole-grain goodies for their fiber and nutrition content. But now here's another reason to be choosy: Whole grains may also help defend against gum disease.... http://www.realage.com/tips/eat-this-bread-for-a-healthier-smile

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Top 10 Qualities of a Great Nurse... Those who succeed in nursing and who gain the most personal fulfillment from it start their careers with certain unique qualities. Do you have what it takes to be a great nurse ? http://nursinglink.monster.com/careers/articles/5019-top-10-qualities-of-a-great-nurse?
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HUMOR SECTION

An 80-year-old West Virginian hillbilly goes to the doctor for a check-up. The doctor is amazed at what good shape the guy is in and asks, “How do you stay in such great physical condition?”

“I’m from WV and I am a hunter,” says the old guy, “and that’s why I’m in such good shape. I’m up well before daylight and out hunting all day .. I have a beer, and all is well.”

“Well,” says the doctor, “I’m sure that helps, but there’s got to be more to it. How old was your Father when he died?”

“Who said my Father’s dead?”

The doctor is amazed. “You mean you’re 80 years old and your Father’s still alive. How old is he?”

“He’s 100 years old,” says the old Hillbilly “In fact he hunted with me this morning, and then we went to the topless bar for a while and had a little beer and that’s why he’s still alive. He’s A WV man and he’s a hunter, too.”

“Well,” the doctor says, “that’s great, but I’m sure there’s more to it than that. How about your Father’s Father? How old was he when he died?”

“Who said my Granpappy’s dead?”

Stunned, the doctor asks, “You mean you’re 80 years old and your grandfather’s still alive?”

“He’s 118 years old,” says the old Hillbilly

The doctor is getting frustrated at this point, “So, I guess he went hunting with you this morning too?”

“No, Papa couldn’t go this morning because he’s getting married today.”

At this point the doctor is close to losing it.

“Getting married!! Why would a 118 year-old guy want to get married?”

“Who said he wanted to?"


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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

https://nursing.advanceweb.com/CE/TestCenter/Main.aspx

Nursing Knowledge International has the leadership resources to advance your nursing career. Take 15% off the online purchase of all leadership products from the Honor Society of Nursing, Sigma Theta Tau International now through 30 June 2010 Use code NURSELEAD at checkout.

All the following CE courses are at: http://www.nurse.com/

Sexually Transmitted Diseases: Women Face M… CE594
http://ce.nurse.com/CE594/Sexually-Transmitted-Diseases/

Scleroderma: More Than Skin Deep CE588
http://ce.nurse.com/CE588/Scleroderma:-More-Than-Skin-Deep/

What Infectious Diseases Can Providers Expe… CE590
http://ce.nurse.com/CE590/What-Infectious-Diseases-Can-Providers-Expect-in-Haiti?/

The Crushing Blow of Crush Injuries CE473
http://ce.nurse.com/CE473/The-Crushing-Blow-of-Crush-Injuries/

Activating a Stroke Alert: A Neurological E… CE591
http://ce.nurse.com/CE591/Activating-a-Stroke-Alert:-A-Neurological-Emergency/

Safety First: The Joint Commission’s Nation… CE583
http://ce.nurse.com/CE583/Safety-First/

Teaching Tomorrow’s Nurses: What’s Happenin… CE595
http://ce.nurse.com/CE595/Teaching-Tomorrow’s-Nurses/

Weight Management: Facts Not Fads CE585
http://news.nurse.com/article/20100430/ALL01/105030015/-1/frontpage

Documentation: Getting it right Conflicting priorities often derail comprehensive chart entries.
http://nursing.advanceweb.com/Continuing-Education/CE-Articles/Documentation-Getting-It-Right.aspx?prg=15 Learning Scope #332 1 contact hour


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

Back issues of the newsletter are available at: http://www.ismp.org/Newsletters/nursing/backissues.asp.
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/

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

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

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/

Find an address via aerial ! When you enter an address you will see a picture of that place.
There's a little map with a little man on it - you can move the little man up and down the block if you need to. http://www.vpike.com/

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MEDICAL RECALLS
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More than 1 million Infantino baby slings recalled — More than 1 million baby slings made by Infantino were recalled Wednesday after claims linking them to three infant deaths. The Consumer Product Safety Commission said babies could suffocate in the soft fabric slings. The agency urged parents to immediately stop using the slings for babies under 4 months. The recall involves 1 million Infantino "SlingRider" and "Wendy Bellissimo" slings in the United States and 15,000 in Canada. http://www.usatoday.com/news/health/2010-03-24-infantino-baby-sling recall_N.htm
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Ultram (tramadol hydrochloride), Ultracet (tramadol hydrochloride/acetaminophen: Label change Ortho-McNeil-Janssen and FDA notified healthcare professionals of changes to the Warnings section of the prescribing information for tramadol, a centrally acting synthetic opioid analgesic indicated for the management of moderate to moderately severe chronic pain. The strengthened Warnings information emphasizes the risk of suicide for patients who are addiction-prone, taking tranquilizers or antidepressant drugs and also warns of the risk of overdosage. ...
http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts
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Metronidazole injection 500 mg / 100 ml: Voluntary recall due to non-sterility Pharmaceuticals, Inc. announced the voluntary nationwide recall of all lots of metronidazole injection, USP 500mg / 100mL manufactured by Claris Lifesciences and distributed by Sagent due to the discovery of non-sterility in two lots of metronidazole injection. The lot numbers being recalled are: A090742, A090743, A090744, A090745, A090746, A090769, A090770, A090771, A090772, A090773, A090774, A090775, A090776, A090968, A091014, A000013, A000016 and A000019, which were distributed to hospitals, wholesalers and distributors nationwide from February through May 2010. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts/ucm212311.htm
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Teleflex Medical AQUA+FLEX Hygroscopic Condenser Humidifier (Catalog Number 1570): Recall FDA and Teleflex Medical notified healthcare professionals of a worldwide voluntary recall affecting certain lot numbers of the Teleflex Medical AQUA+FLEX Hygroscopic Condenser Humidifier (HCH) (catalog number 1570), a passive humidifier indicated for use to effectively warm and humidify inspired gas during mechanical ventilation. The 22cm connector on the flex tube may not fit securely within the endotracheal tube (ET) connector. This may result in the product becoming disconnected from the patient ET tube. Device failure is recognizable by the user as an alarm from the ventilator, oxygen sensor or other compatible device to which the AQUA+FLEX tubing is connected. No injuries have been reported to date. (for lot #s) http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts/ucm211153.htm

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Baxter International Inc. announced a voluntary recall of all manufactured lots of Hylenex recombinant (hyaluronidase human injection) has been initiated as a precautionary measure due to instances of particulate matter observed in a limited number of vials during routine stability testing. To date, no medical events or customer complaints associated with this issue have been reported. As part of this stability testing for Hylenex recombinant, a limited number of vials were observed to contain small, flake-like particles, identified as glass. The company estimates that there are approximately 3,500 vials in the marketplace.
Baxter is working with the product's NDA-holder, Halozyme Therapeutics, to investigate the root cause of the issue and appropriately address the situation. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts

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FDA and Gyrus ACMI notified healthcare professionals of a Class I recall of Gyrus ACMI Micron Bobbin Vent Tube T, 1.27 mm. This device is implanted for ventilation or drainage of the middle ear. Units of the product in lot number MH136952 have been shipped without being sterilized. This product was manufactured only on December 17, 2009 and distributed only on December 22, 2009. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts

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NURSING HINTS CORNER

ISMP Nurse Advise-ERR May 2010 Distribute instructions for oral dispenser. Take a look at the oral dispenser that accompanies morphine sulfate oral solution 100 mg/5 mL. The dispensing end of the plunger is pointed rather than flat—a specialty design not typically employed by key US hospital suppliers of oral syringes (e.g., Baxa, BD, B. Braun). It accompanies some liquid products for the purpose of providing a low residual syringe volume after drug delivery. The pointy tip fits into the hub area, pushing out liquid and leaving little behind in the dead space. However, confusion has been reported regarding how to measure liquids—from the end of the pointed tip of the plunger, or from the widest part of the plunger above the pointed tip. Some nurses have been using the tip of the plunger to read the volume against the syringe scale, which is incorrect. All doses should be measured by aligning the widest part of the syringe plunger with the calibrated markings. By measuring from the tip, nurses will administer more than the intended dose. A long-term care consultant pharmacist brought this issue to light when narcotic counts at three different facilities showed remaining volumes different than expected. Residents may have been given higher doses than prescribed if nurses measured the dose by aligning the plunger tip with the calibrated markings on the barrel. The error happened with a generic product, which is no longer on the market; however, Roxane distributes a morphine sulfate oral solution that uses the same syringe. The FDA-approved Medication Guide for the Roxane product has a section under “Patient Instructions for Use” that explains exactly how to use the syringe, and it has a detailed illustration showing how to accurately measure the product (Figure 2, on page 1). Education of nurses, pharmacists, and other healthcare professionals may be necessary if the “Patient Instructions for Use” information is not reaching them. Please pass this information along to nurses who work in areas where morphine 100 mg/5 mL or any other product packaged with this type of syringe is used. The reporter suggested that the company include the syringe diagram on the box flap of the product’s carton; however, the carton may not always reach the nurse. If possible, patient-specific doses should be dispensed from the pharmacy in labeled oral syringes. (hopefully these directions are sufficient; If you need the picture, let me know).
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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





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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


Nurses often have difficulty articulating the essence of what they do. It is so difficult to put into words the often subtle yet profound way that nurses impact lives. It is something that must be experienced, mastered, and emblazoned upon the soul to be truly and deeply understood.

— Donna Wilk Cardillo, RN
A Daybook for Beginning Nurses

Hope to see you online or write me..... Frankie
RNFrankie@AOL.com

May 2010

PARADIGM BYTES
Newsletter for Paradigm 97
May 16, 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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SNIPPETS
(This is from Kurt Ullman-- thanks)
Eating and Drinking During Labour: Let Women Decide

Women should be allowed to eat and drink what they want during labour, say Cochrane Researchers. The researchers carried out a systematic review of studies examining the traditional practice of restricting food and fluid intake during labour and found no evidence for any risk or benefit for women at low risk of complications.

Throughout much of the last century, eating and drinking during labour was considered dangerous and many maternity units operated “nil by mouth” policies or restricted what women in labour were allowed to eat and drink, regardless of women’s preferences. This was largely due to concerns about possibly fatal damage to the lungs caused by “Mendelson’s syndrome”, where particles of regurgitated food are inhaled under general anaesthetic during Caesarean sections. Recently, however, attitudes have begun to change and in many maternity wards, particularly in the UK, women are now allowed to eat and drink what they want during labour.

The Cochrane Systematic Review, which included five studies and a total of 3130 women, looked at the evidence for restricting food and drink in women who were considered unlikely to need anaesthesia. They found no evidence of any risk or benefit associated with eating or drinking, whether in studies comparing eating and drinking at will or just water with complete restriction, or in studies comparing specific foods, fluids, or carbohydrate drinks with water.

“Since the evidence shows no benefits or harms, there is no justification for nil by mouth policies during labour, provided women are at low risk of complications,” said lead researcher Mandisa Singata, who is based at the East London Hospital Complex in East London, South Africa. “Women should be able to make their own decisions about whether they want to eat or drink during labour, or not.”

The researchers did not find any studies that assessed the risks of eating and drinking for women with a higher risk of needing anaesthesia. Therefore, further research is need before specific recommendations can be made for this group.

However, Singata concludes that there may be better ways to approach studies of eating and drinking during labour. “While it is important to try to prevent Mendelson’s syndrome, it is very rare and not the best way to assess whether eating and drinking during labour is beneficial for the majority of patients. It might be better to look at ways of preventing regurgitation during anaesthesia for those patients who do require it,” she said.

Work on this review was supported by a grant from the National Institute for Health Research (NIHR), UK.

Full citation: Singata M, Tranmer J, Gyte GML. Restricting oral fluid and food intake during labour. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD003930. DOI: 10.1002/14651858.CD003930.pub2.

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MEDICAL NEWS

Top Story in Medscape Nurses is Stokowski's Article, "Will We Have a National Nurse?" Nurses around the country are weighing in and overwhelmingly agree that the time has come for the United States to have a National Nurse. Of the dozens of emails the NNNO received, only three were of a negative nature (one nurse thought this was a left/liberal idea; one nurse felt we should be putting the fire that was already in the hospital out before we moved to prevention; and another nurse thought this would cost too much, not realizing that HR 4601 asks that a position already funded through taxpayer dollars be known as the National Nurse).
The National Nursing Network Organization (NNNO) agenda is to have a National Nurse to promote prevention. The NNNO is not a union and is not affiliated with the CNA/NNOC of AFL-CIO. The NNNO is a 501(c)4 non-profit legislative advocacy organization. Read the bill: HR 4601: The National Nurse Act of 2010 http://www.nationalnurse.org

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INTERESTING READING

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

The Calcium Side Your Bones Crave Keep your skeleton strong and fracture-free by serving that calcium supplement with a salad on the side.

Salad? Yep, salad. A 4-year study found that older adults with the highest intakes of carotenoids -- think tomatoes, carrots, and leafy greens for major sources -- retained more bone mineral density than folks eating fewer fruits and veggies.... http://www.realage.com/tips/the-calcium-side-your-bones-crave

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People get hungrier when they're starved for sleep (Reuters 4/9) - People who are trying to stay trim may want to make sure they get plenty of sleep. In a study, researchers found that normal-weight young men ate a Big Mac's-worth of extra calories when they'd gotten four hours of sleep the night before compared to when they slept for eight hours.
Given the findings, and the fact that people have been sleeping less and getting fatter over the past few decades, "sleep restriction could be one of the environmental factors that contribute to the obesity epidemic," they write in the American Journal of Clinical Nutrition.... http://www.reuters.com/article/idUSTRE63854120100409

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April 10 (HealthDay News) -- Severe peripheral vascular disease may be much more common in younger American adults and women than previously suspected, according to a new study.

The disease causes a narrowing in blood vessels that carry blood to the arms, legs, kidney and stomach and leads to symptoms that include pain and cramping in the legs during exercise.

Researchers analyzed data on 994 men and women, age 55 and younger, treated in the Wake Forest University School of Medicine Vascular Center between 1998 and 2009. They found that most of them had premature atherosclerosis (hardening of the arteries). Severe premature arterial disease of the legs (64 percent) was the most common finding.... http://healthday.com/Article.asp?AID=637753

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RANDOM FACT: What is called a "French kiss" in the English speaking world is known as an "English kiss" in France.
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Spanish for You: Bridging the Language Gap in Healthcare With more than 32 million Hispanics in the United States, half of whom speak only Spanish, healthcare professionals today are faced with a number of challenges on the job. The biggest obstacle many U.S. healthcare providers face is the obvious language barrier that exists with patients who don’t speak English. It’s a problem of particular relevance, as the US has the third-largest Hispanic population anywhere in the world! Hispanics make up 15% (2007 U.S. Census Bureau) of our population and that number is projected to grow exponentially. One of every eight American is of Hispanic descent and the number is projected to steadily increase to 98 million. ... http://w3.rn.com/News/news_features_details.aspx?Id=33600

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Progress Toward Ovarian Cancer Early Detection: Strategies, Guidelines, and Clinical Trials Drescher CW et al. – Women at high risk for ovarian cancer based on gene mutations or a significant family history are candidates for ovarian cancer screening using CA–125 and TVS and/or risk reduction surgery. Routine population–based screening is not currently recommended. Early results from randomized trials demonstrate that screening detects many ovarian cancers prior to clinical diagnosis. The impact of screening on ovarian cancer mortality requires additional study. ... http://www.femalepatient.com/html/arc/sig/Gyn/articles/035_04_022.asp
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(Reuters 4/21) - Shutting off a single gene can help stop the cascade of damage that can paralyze people with spinal cord injuries, U.S. researchers reported on Wednesday. They propose using a common, generic diabetes drug in combination with a gene-silencing technique to stop spine injuries from getting any worse, and believe the approach may also work in people with stroke and traumatic brain injuries. Their experiment, published in the journal Science Translational Medicine, shows it is possible to stop the bleeding that can cause the damage from an injured spinal cord to spread and worsen.... http://www.reuters.com/article/idUSTRE63K4VB20100421?feedType=nl&feedName=ushealth1100
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April 14, 2010 -- Today, Voice of America ran "Nurse, I Need a Reality Check: Hollywood shapes many perceptions of medical professionals but that's a problem for real-life nurses," a helpful, in-depth piece about Hollywood's portrayal of nursing by Faiza Elmasry. The piece featured extensive quotes from Truth executive director Sandy Summers and nurses at Johns Hopkins Hospital. see the article and hear the radio report... http://www1.voanews.com/english/news/american-life/Nurse-I-Need-a-Reality-Check-90822599.html

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FDA turns attention to radiation therapy devices The U.S. Food and Drug Administration said on Thursday it has received nearly 1,200 complaints in the last decade about devices that deliver radiation treatments to cancer patients and has called on manufacturers to help improve safety.
The FDA sent letters to 93 makers of radiation treatment devices, urging them to attend a workshop to address concerns about patient exposure to excess radiation from medical treatments and procedures.

Companies sent letters include Varian Medical Systems, Siemens, Philips, GE Healthcare, Hitachi Ltd and several private firms.

Radiation exposure became a major concern in October after the FDA said it was investigating 206 cases of patients being exposed to toxic doses of radiation during CT scans of the brain at Cedars-Sinai Medical Center in Los Angeles.... http://www.reuters.com/article/idUSTRE6374IP20100408?feedType=nl&feedName=ushealth1100

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RANDOM FACT: Forest fires move faster uphill than downhill.
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Factors associated with safe patient handling behaviors among critical care nurses Lee S–J et al. – More than half of participants had no lifting equipment on their unit, and 74% reported that they performed all patient lift or transfer tasks manually. Significant factors for safer work behavior included better safety climate, higher effort–reward imbalance, less overcommitment, greater social support, and day shift work. Physical workload, personal risk perception, or MS symptom experiences were not associated with safe work behavior. Safe work behaviors are best understood as socio–cultural phenomena influenced by organizational, psychosocial, and job factors but, counter to extant theories of health behaviors, do not appear to be related to personal risk perception. Management efforts to improve working conditions and enhance safety culture in hospitals could prove to be crucial in promoting nurses' safe work behavior and reducing risk of MS injury. http://www3.interscience.wiley.com/journal/123362984/abstract

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A once-a-day pill helped completely rebuild bone in rodents with severe osteoporosis, a finding that could lead to a new class of drugs to treat the brittle-bone disease in humans, U.S. researchers said. The team tested a compound that blocks the production of serotonin produced in the gut in mice and rats with a severe form of the disease and found they completely recovered their bone density.
"If you break the bone, it looks like a normal bone," said Dr. Gerard Karsenty of Columbia University Medical Center in New York, whose study appears in the journal Nature Medicine.

Using the findings, he said the team is working to develop this type of treatment for human patients with osteoporosis, in which bones become fragile and porous, increasing the risk of fracture.

"There is an urgent need to identify new, safe therapies that can increase bone formation on a long-term basis," Karsenty said.... http://www.reuters.com/article/idUSTRE6170QN20100208?feedType=nl&feedName=ushealth1100

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Fruit, veggies, exercise -- they all make the heart-healthy list. And now, according to a new study, so does this breakfast staple: cereal.

But we're not talking about Cocoa Puffs. We're talking about whole-grain cereals -- like steel-cut oats, shredded wheat, or muesli. Men in a study who noshed at least once a week on whole-grain cereals were significantly less likely to experience heart failure.... http://www.realage.com/tips/a-breakfast-staple-that-blocks-heart-failure

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WASHINGTON (Reuters) - People who drink two or more sweetened soft drinks a week have a much higher risk of pancreatic cancer, an unusual but deadly cancer, researchers reported on Monday.
People who drank mostly fruit juice instead of sodas did not have the same risk, the study of 60,000 people in Singapore found. Sugar may be to blame but people who drink sweetened sodas regularly often have other poor health habits, said Mark Pereira of the University of Minnesota, who led the study.

"The high levels of sugar in soft drinks may be increasing the level of insulin in the body, which we think contributes to pancreatic cancer cell growth," Pereira said in a statement. Insulin, which helps the body metabolize sugar, is made in the pancreas.

Writing in the journal Cancer Epidemiology, Biomarkers & Prevention, Pereira and colleagues said they followed 60,524 men and women in the Singapore Chinese Health Study for 14 years.... http://www.reuters.com/article/idUSTRE6170NY20100208?feedType=nl&feedName=ushealth1100

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The total antioxidant content of more than 3100 foods, beverages, spices, herbs and supplements used world wide. A plant-based diet protects against chronic oxidative stress-related diseases. Dietary plants contain variable chemical families and amounts of antioxidants. It has been hypothesized that plant antioxidants may contribute to the beneficial health effects of dietary plants. Our objective was to develop a comprehensive food database consisting of the total antioxidant content of typical foods as well as other dietary items such as traditional medicine plants, herbs and spices and dietary supplements. This database is intended for use in a wide range of nutritional research, from in vitro and cell and animal studies, to clinical trials and nutritional epidemiological studies.... http://www.nutritionj.com/content/9/1/3
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What’s In The Health Care Reform For Nurse Practitioners And Their Patients?
A preliminary analysis of the final Health Care Reform legislation includes: a nondiscrimination provision that includes nurse practitioners, recognition of nurse practitioners as primary care providers and leaders in public and home care medical home pilots and demonstrations, funding for nurse managed clinics; funding for graduate nurse education and post graduate experience demonstrations, inclusion in primary care Medicare payment increases, and inclusion in ACOs (Accountable care organizations). The bill language is replete with provider neutral language that will facilitate the utilization of nurse practitioners in many venues.... http://www.aanp.org/AANPCMS2/LegislationPractice/What%92s%2BIn%2BThe%2BHCR%2BFor%2BNurse%2BPractitioners%2BAnd%2BTheir%2BPatients.htm


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NEW YORK (Reuters April 26) - U.S. Department of Health and Human Services Secretary Kathleen Sebelius has called on health insurer WellPoint to stop dropping coverage for patients recently diagnosed with breast cancer, calling the practice "deplorable."
http://www.reuters.com/article/idUSTRE63M2YM20100423?loomia_ow=t0:s0:a49:g43:r2:c0.093023:b33334166:z0
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Care model strives for efficiency As a nurse practitioner at the CareMore Health Plan center in Modesto, Calif., Heather Del Villar is trying to keep Medicare patients with chronic diseases from going back to hospitals by remotely monitoring their health and providing immediate treatment. "We prevent their conditions from getting worse. It makes sense from the patient's standpoint, the medical standpoint and the business standpoint," Del Villar said. The Modesto Bee (Calif.) http://www.modbee.com/2010/04/26/1142432/care-model-strives-for-efficiency.html
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RANDOM TIDBIT: REM sleep may help developing brains mature. Premature babies have 75 per cent REM sleep, 10 per cent more than full-term babies. Similarly, a newborn kitten puppy rat or hampster experiences only REM sleep, while a newborn guinea pig (which is much more developed at birth) has almost no REM sleep at all.
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Child abuse drops sharply in U.S. Study: Incidents declined by 26% from 1993 to 2006 NEW YORK - A massive new federal study documents an unprecedented and dramatic decrease in incidents of serious child abuse, especially sexual abuse. Experts hailed the findings as proof that crackdowns and public awareness campaigns had made headway.
An estimated 553,000 children suffered physical, sexual or emotional abuse in 2005-06, down 26 percent from the estimated 743,200 abuse victims in 1993, the study found... http://www.msnbc.msn.com/id/35205114/ns/health-kids_and_parenting/ (personally, I believe that child abuse is now hidden better)

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Now here is something we all need to know......hmmm

RANDOM FACT: After eating, a housefly regurgitates its food and then eats it again.
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NEW YORK (Reuters 4/28) - Sticking to a strict diet of mom's milk during the first 4 months of life may reduce a child's risk of developing asthma by their eighth birthday, according to a new study.

"Breast milk is the optimal food for infants during the first months of life," lead researcher Dr. Inger Kull of the Karolinska Institute in Stockholm, Sweden, told Reuters Health in an email. "But whether or not breastfeeding reduces the risk of asthma has been debated."

Through her milk, a mother transfers "good" bacteria, antibodies and proteins that can help thwart infection. But the evidence for how breastfeeding might influence the later development of asthma remains confusing, with various studies suggesting protective, neutral and even detrimental effects.... http://www.reuters.com/article/idUSTRE63R4TL20100428?feedType=nl&feedName=ushealth1100

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FDA probes risks of HIV, prostate, other (Reuters 5.3) The Food and Drug Administration said on Monday it was probing reports of liver toxicity with patients who used Kaletra to prevent HIV infection after exposure to the AIDS virus.

The agency also said it was investigating cases of male breast cancer in patients treated with Avodart as well as Merck & Co's prostate drug Proscar and baldness treatment Propecia.

The FDA releases a quarterly list of safety probes to inform the public about early investigations of potential side effects that have been reported. The list released on Monday covered issues identified between October and December 2009.

Being on the list does not mean the FDA has concluded the drug causes the specific risk, the agency said. http://www.reuters.com/article/idUSTRE6424DA20100503

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BMI is not an accurate measure of obesity Obesity may be far more of a problem than experts realize because body mass index is an insensitive measure of excess body fat, researchers said. A study of more than 1,200 patients found 66% of those deemed obese based on dual-energy X-ray absorptiometry scans had BMI values in the non-obese range. ... http://abcnews.go.com/Health/Wellness/bmi-underestimates-prevalence-obesity/story?id=10521712
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43 OTC drugs for infants, children are recalled Johnson & Johnson's McNeil Consumer Health care unit voluntarily recalled batches of 43 nonprescription drugs for children and babies, including liquid formulations of Tylenol and Benadryl, because of manufacturing problems at the company's facility in Fort Washington, Pa., that were cited by the FDA. ... http://www.washingtonpost.com/wp-dyn/content/article/2010/05/01/AR2010050103051.html
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Issue Date: October 2006 Vol. 1 No. 1 Author: Ira Gene Reynolds, BSN, RN, PCCN-CMC Calculating I.V. drip rates with confidence While you're working your shift on the progressive care unit, the physician phones in an order to start a patient's I.V. dopamine infusion at 5 mcg/kg/minute. As you hang up the phone, your mind starts to race: How fast should I set the infusion pump to deliver 5 mcg/kg/minute? Will I be able to remember the complex drip rate equation I learned in nursing school? Will I have to mix the solution or will it come premixed? Will I have to titrate the drug myself, or will I get a regular physician's order? If I need to titrate it myself, can I do this on my unit?
Many nurses are expected to deliver and titrate I.V. drugs regularly. Such factors as unit protocols, titration policies, and the specific drug ordered determine exactly how you'll deliver and titrate an I.V. drug.

Today, with an emphasis on patient safety, the pharmacy staff customarily mixes the majority of drug solutions and also may calculate infusion pump rates. Many pharmaceutical companies have gotten in on the act, too, providing a drip rate matrix.

Although many I.V. infusion pumps calculate drip rates automatically, these rates must be double-checked to ensure patient safety. So chances are you'll need to calculate I.V. drip rates and titration scales yourself.

If you feel uneasy when performing these critical tasks, you're not alone. To boost your confidence, this article presents simplified equations to help you breeze through selected I.V. drip rate calculations.

NOTE TO READER: For the sake of accuracy, the rest of this article is available in PDF format only: http://www.americannursetoday.com/assets/0/434/436/440/6182/6184/6190/6208/0d39b2a0e79043daa 93d29d73cf4681a.pdf

http://www.americannursetoday.com/Article.aspx?id=6208&fid=6182
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Your heart disease risk could probably be lower with a little more of this nutrient on board: vitamin D. Older adults who had the highest blood levels of vitamin D enjoyed a 33 percent lower risk of developing heart disease in a recent study. And supplements are a fine source. You can also look to sunshine and fortified dairy products to get your fill of D.

Beyond Bone Health Vitamin D has long been touted for its benefits to bone health. But more and more research is showing a bigger role in health. In a study, adults who had the highest levels of D had the lowest level of "cardiometabolic disorders" -- the family of conditions that includes heart disease, diabetes, and metabolic syndrome. ... http://www.realage.com/tips/take-this-supplement-for-heart-health

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Get more nutrition with every bite when you choose chickpeas that are dark in color. Black, red, purple -- chickpeas come in more colors than basic beige. And a recent study indicates that dark-hued chickpeas may have as much as 13 times more polyphenols in each serving.

Your True Colors With 6 grams of protein, 5 grams of fiber, and a scant 140 calories per half-cup serving, chickpeas are a dieter's dream. And not only will you get more polyphenols in the darker varieties, but those extra polyphenols pack 31 times more antioxidant power compared to the lighter colored legumes, research shows. In fact, the antioxidant powers of dark chickpeas power right past those of dried fruit, most nuts, and many other legumes.... http://www.realage.com/tips/choose-this-color-chickpea

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RANDOM FACT: Almonds are part of the peach family.
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Study Shows RN Ratios Save Lives A new study provides evidence that California’s RN-to-patient staffing law reduces patient mortality, assures nurses spend more time with patients and promotes retention of experienced RNs. The study, published by Health Services Research, was conducted by University of Pennsylvania researchers led by Linda Aiken, RN, PhD, director of the Center for Health Outcomes and Policy Research at the school of nursing.

Surveying more than 22,000 RNs in California and two comparable states, Pennsylvania and New Jersey, the researchers found New Jersey hospitals would have 14% fewer patient deaths and Pennsylvania 11% fewer deaths if they matched California’s 1:5 ratios in surgical units.

Fewer California RNs miss changes in patient conditions because of their workload than New Jersey or Pennsylvania RNs, the researchers said.... (My daughter, a Florida nurse on a step-down cardiac unit, has a minimum of 7 patients !) http://news.nurse.com/article/20100423/NATIONAL02/105030017/-1/frontpage

(I think this article is "preaching to the choir"........the hospital administrations need to digest these facts).
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Trepp R et al. –Knowledge of diabetes is mediocre among medical and nursing house staff. For physicians, the knowledge level depends on the speciality (internal medicine better than surgery and gynaecology) and correlates with the comfort level in dealing with diabetes, but is not higher in attending physicians than in residents. Nurses have a high comfort level, which, however, does not correlate with knowledge, which is similar in medicine, surgery and student nurses, but low in gynaecology.... Free full text pdf http://www.smw.ch/docs/PdfContent/smw-12974.pdf
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Popular Diet Plans Can Unclog Arteries Low-fat, low-carbohydrate and Mediterranean diets ( http://www.healthday.com/Article.asp?AID=636488) all can help to reverse thickening of the artery walls that can lead to heart attack and stroke, Israeli researchers said. They found that even if weight loss is only moderate, sticking to the diets long-term can reverse atherosclerosis. HealthDay News http://www.healthday.com/Article.asp?AID=636488
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Your body might be able to break down fat better if you do this one simple thing: stand more. A small study suggests that when people sit around too much, enzymes that help break down fat are practically turned off. Bad news not just for your waist but also for your heart and artery health. The solution? Fidget, pace, get up, get down. Do whatever you have to do to move those legs of yours. Often.... http://www.realage.com/tips/lose-fat-just-by-standing

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Fundamental Patterns of Knowing in Nursing: the Challenge of Evidence-Based Practice Porter et al. – This article reconsiders the fundamental patterns of knowing in nursing in light of the challenge of narrow empirics in the form of evidence–based practice. Objections to the dominance of evidence–based practice are reviewed, and the reasons for it are examined. This ineffability can be countered only by introducing a wider form of empirics than countenanced by evidence–based practice into all patterns of knowing, to demonstrate their salience and to make their use in practice transparent. ... http://journals.lww.com/advancesinnursingscience/Abstract/2010/01000/ Fundamental_Patterns_of_Knowing_in_Nursing__The.3.aspx
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RANDOM FACT: Antarctica has as much ice as the Atlantic Ocean has water.
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Inkjet'like device 'prints' cells right over burns WINSTON-SALEM, North Carolina (Reuters 4/8) - Inspired by a standard office inkjet printer, U.S. researchers have rigged up a device that can spray skin cells directly onto burn victims, quickly protecting and healing their wounds as an alternative to skin grafts....
http://www.reuters.com/article/idUSTRE63657520100408?feedType=nl&feedName=ushealth1100
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RANDOM FACT: Your body is creating and killing 15 million red blood cells per second!
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New Drug Shows Promise for Curing Hepatitis C Antiviral telaprevir works when previous treatments failed, trial results show WEDNESDAY, April 7 (HealthDay News) -- Adding the antiviral drug telaprevir to a second-round treatment for hepatitis cures about half the people who were not helped in the first round, new research shows.

"This is the first large study in patients who had not responded to standard treatment," said Dr. John G. McHutchison, associate director of the Duke Clinical Research Institute and lead author of a report in the April 8 issue of the New England Journal of Medicine.... http://www.healthday.com/Article.asp?AID=637811

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TODAY'S THRIFTY TIP: After heating and cooling, water heating is typically the largest energy user in the home because it is necessary for so many domestic activities. So it pays to keep your water heater working as efficiently as possible like lowering the water temperature thermostat by ten degrees and wrapping the water tank in an insulating blanket. But there is a simple and very important part of maintenance that many people ignore or don't even know about.

In the course of normal use, minerals and natural sediment in your water condense and settle to the bottom of your water heater. This sediment can seriously impede the efficiency of your water heater and can eventually cause it to malfunction, not to mention the fact that the sediment will eventually start to get into your tap water.

Learning how to clean hot water heater sediment is easy: First turn off the power so you don't risk electrical shock or burn out your element. Then turn off the cold water valve to the tank. Attach a garden hose to the tank drain valve and then drain a few gallons of the hot water in the tank through the hose. Then close the drain valve and open the cold water valve and you're ready to use the tank again.
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RANDOM FACT: The average human head has about 100,000 hairs
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“Over my 20 years in neonatal nursing, I’ve seen an evolution of change to a more baby-driven approach, rather than a nurse-driven or parent-driven one,” said Kim Guglielmo, RN, (at left in photo) a clinical nurse at UNC Health Care’s Newborn Critical Care Center in Chapel Hill, NC.

The trend of cue-based feeding in the NICU has nurses paying more attention than ever to signals young patients provide about their hunger. A recent study links hunger-based feeding with shorter lengths of stay. ... http://nursing.advanceweb.com/Regional-Articles/Features/Promoting-Early-Discharge-in-NICU.aspx?prg=15



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HUMOR SECTION


An elderly man was on the operating table awaiting surgery. He had insisted that his son, a renowned surgeon, perform the operation. As he was about to receive anesthesia, he asked to speak to his son.

"Yes, Dad, what is it?"

" Don't be nervous. Do your best. And just remember, if something happens to me, your mother is going to come to live with you and your wife."


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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

https://nursing.advanceweb.com/CE/TestCenter/Main.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.

Back issues of the newsletter are available at: http://www.ismp.org/Newsletters/nursing/backissues.asp.

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://nursenetworkers.com/ Check this site out....it's new and seems interesting

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

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.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/
** http://www.chegg.com/ Cheap textbook rentals. Best way to rent books for college

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MEDICAL RECALLS
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LIFEPAK 15 Monitor/Defibrillator by Physio-Control Inc. FDA notified healthcare professionals of a Class I recall of LIFEPAK 15 Monitor/Defibrillator manufactured and distributed between Marcy 26, 2009 and December 15, 2009. There is a potential for the device to unexpectedly:
Power Off then On by itself.
Power Off then NOT turn On.
Power Off by itself requiring the operator to turn it back On.
Stay powered On and not allow itself to be turned Off.
Healthcare professionals are encouraged to report adverse events or side effects related to the use of these products to the FDA's MedWatch Safety Information and Adverse Event Reporting Program: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts/ucm209467.htm

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Coviden Initiates Voluntary Recall of Certain Shiley™ Tracheostomy Tubes FDA and Coviden notified healthcare professionals of a recall of certain lots of its cuffed ShileyTM tracheostomy tubes and Custom/Specialty tracheostomy tubes due to the product’s cuff not holding air as a result of leaks in the pilot balloon inflation assembly. With respect to the affected units, if a cuff does not hold air, ventilation will be adversely affected since the ability to generate positive pressure in the airway could be compromised by lack of cuff seal. This could result in a sudden decrease in the amount of oxygen in the blood or a sudden increase in the amount of carbon dioxide in the blood, especially if the patient requires assisted mechanical ventilation. In some instances, this could result in serious injury, including death.
The voluntary recall only affects lot numbers from a specific period of time. Only Shiley tracheostomy tubes from lot numbers listed in the firms' press release are affected by this action. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts

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Cardiac Science Automated External Defibrillators - Powerheart, Cardiovive, NK, Responder models: Class I Recall [UPDATED 04/27/2010] This update alerts users that Nihon Kohden (NK) and GE Responder models are also affected although they were not identified in earlier communications about this recall. In addition, Cardiac Science issued a software upgrade for the devices’ self tests on 02/24/10 for the Powerheart automatic external defibrillators (Models 9390A and 9390E) and is planning on issuing a similar software upgrade for other affected devices. However, FDA’s review of the updated software indicates that it detects some but not all electrical component defects. Updated recommendations and complete list of affected models can be found in the 04/27/2010 Medical Device Update. http://www.fda.gov/Safety/MedWatch/SafetyInformation /SafetyAlertsforHumanMedicalProducts/ucm205165.htm

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McNeil Consumer Healthcare Over-the-Counter Infants’ and Children’s Products: Recall including Tylenol, Motrin, Zyrtec, and Benadryl products McNeil Consumer Healthcare and FDA notified healthcare professionals of a voluntary recall of certain over-the-counter (OTC) Children’s and Infants’ liquid products manufactured in the United States, including Tylenol, Motrin, Zyrtec, and Benadryl products. Some of these products may not meet required quality standards. This recall is not being undertaken on the basis of adverse medical events. However, as a precautionary measure, parents and caregivers should not administer these products to their children. These products were distributed in the United States, Canada, Dominican Republic, Dubai (UAE), Fiji, Guam, Guatemala, Jamaica, Puerto Rico, Panama, Trinidad & Tobago, and Kuwait. See the company Press Release for a list of products affected by this recall. Consumers can contact the company at 1-888-222-6036 and also at www.mcneilproductrecall.com . http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts/ucm210442.htm

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Camolyn eye drops, Fisiolin nasal drops: Voluntary recall due to non-sterility US Oftalmi and FDA notified healthcare professionals of the nationwide recall of all over-the-counter eye drops and nasal drops, initiated due to conditions at the manufacturing facility that cannot assure the sterility of the products. Products that are non-sterile have the potential to cause eye infections, which may be sight threatening. Products are packaged in 15mL plastic bottles and were distributed nationwide to food and drug distributors. The products affected by this recall with lot numbers, expiration dates and UPC codes are noted below. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlerts forHumanMedicalProducts/ucm207794.htm
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Stud Capsule For Men: Product contains Undeclared Drug Ingredient Kanec USA and FDA notified healthcare professionals of a nationwide recall of Stud Capsule For Men [Lot #060607-01/060108-01, Exp 6-2013], after being informed by FDA that laboratory analysis of a sample found the product to be adulterated with sildenafil, an FDA approved drug. The products are sold as a blister pack containing one capsule per unit of use 24-packs in a Box. Lot number and expiration date appears on the seal. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsfor HumanMedicalProducts
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FDA notified healthcare professionals of the Class 1 recall of certain lots of the BD Q-Syte Luer Access Split Septum device and other finished products, including kits and trays, sold by other companies in which the Q-Syte Luer Access device is a component. This device is used with other infusion therapy products to administer therapies, such as chemotherapy, blood and fluids into the intravenous system. The affected BD products were distributed from August 1, 2008 through February 1, 2010.

These lots of the BD Q-Syte Luer Access Split Septum devices are defective, which may result in air bubbles leaking into the infusion system and into the patient’s bloodstream, resulting in an air embolism. In addition, these defective devices may result in leakage of therapy being infused and result in incomplete inadequate administration of therapy. There is also a potential for blood leakage through this defect. These problems may result in serious injuries or death. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlerts forHumanMedicalProducts

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Boston Scientific Implantable Cardioverter Defibrillators: Recall FDA notified healthcare professionals that FDA has been notified by Boston Scientific that it has stopped shipment and started recalling all of its implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy defibrillators (CRT-Ds) that have not yet been implanted.

FDA is advising practitioners that they should not use these devices unless and until the agency reviews and approves the changes the company has made. FDA is not aware of new safety concerns and, therefore, does not recommend that any of the devices subject to the recall be explanted. Product families included in this advisory include Boston Scientific’s Cognis, Confient, Livian, Prizm, Renewal, Teligen and Vitality. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedical Products/ucm205409.htm

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Natural Wellness and FDA notified consumers that MasXtreme, a product sold as a dietary supplement contains aildenafil close in structure to sildenafil and is expected to possess a similar pharmacological and adverse event profile as well as the drug phentolamine which is an alpha-adrenergic blocker. This may pose a threat to consumers because aildenafil may interact with nitrates found in some prescription drugs (such as nitroglycerin) and may lower blood pressure to dangerous levels. Consumers with diabetes, high blood pressure, high cholesterol, or heart disease often take nitrates. Common side effects of phentolamine include arrhythmia (abnormal heart rhythm) and tachycardia (rapid heart beat).

MasXtreme is sold in blister packs containing one (1) capsule. The product is distributed nationwide by Natural Wellness Inc. Consumers who have purchased MasXtreme capsules are urged to immediately discontinue their use. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHuman MedicalProducts/ucm206791.htm

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NURSING HINTS CORNER

(why don't you send in your hints? ...I would appreciate it)

Smooth Move: When I need to transfer an obese patient from one bed to another, I slide the patient and his mattress onto the new bed. Mattress handles make this easy to accomplish. This method reduces strain and discomfort for both the patient and the nurse. It also works well with patients who have difficulty moving. Fay Stout, RN
Used with permission from 1,001 Nursing Tips & Timesavers, Third Edition, 1997, p. 41, 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:

Our newest member: jessicafreeman4@yahoo.com (Jessica) April 28, 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


What a cruel thing is war: to separate & destroy families
and friends, and mar the purest joys and happiness God has
granted us in this world; to fill our hearts with hatred
instead of love for our neighbors, and to devastate the
fair face of this beautiful world.

Robert E. Lee, to his wife, 1864


Hope to see you online..... Frankie
RNFrankie@AOL.com