PARADIGM BYTES Newsletter for Paradigm 97 September 18, 2012 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. ***~~~***~~~***~~~*** SNIPPET Are your knuckles white? May 25, 2012 -- Today National Public Radio's Morning Edition ran a generally helpful 5-minute report by Patti Neighmond about widespread nurse understaffing in U.S. hospitals, as part of the radio network's "Sick in America" series. Following a poll showing that one third of U.S. hospital patients reported that nurses were "unavailable" when needed, NPR placed a "call out" on Facebook for nurses themselves to explain what was going on. Nurses responded with stories of being compelled to care for patients non-stop for their 12-hour shifts, with few or no breaks, and worrying that understaffing made it impossible to provide safe care. The Morning Edition piece consults University of Pennsylvania nursing scholar Linda Aiken, who argues that the U.S. now faces not so much a shortage of nurses as a shortage of nursing care at the bedside, which matters because nurses are the "surveillance system" in health care. And commendably, the piece explains, partly through an audio clip from a direct care nurse, how under-staffing can endanger patients, for example if a nurse is too busy to note subtle condition changes or respond to an alarm. An American Hospital Association representative stresses that hospitals today face financial constraints as well as sicker patients and a proliferation of care technologies. But NPR presents no advocate on the other side, like a union leader, to respond with the argument that it is conscious policy choices, not something totally beyond the control of hospitals or government, that result in nursing being severely underfunded. . No direct care nurse featured on the segment is identified, because almost all who responded were "worried about retaliation" from employers. And sadly, it seems that whoever wrote the piece could not resist having Morning Edition host Renee Montaigne lead off with the inane cliché that nurses are the "backbone" of the health care system, which suggests that nurses are tough but unthinking pieces of hardware, like beds. Still, we appreciate the report's basic points that the current understaffing means nurses are working on the edge and that this can threaten patient health. We thank NPR and Patti Neighmond. Montaigne begins by asserting that "nurses are the backbone of hospitals; pretty much any patient or doctor will tell you that." Maybe they will, especially if influential media figures continue to repeat it as if it were some great compliment. We understand that the backbone is important, and the one good aspect of the metaphor is that it suggests nurses are strong and important; the hospital could not work without them. But the image also implies that, like the backbone, nurses have no brains or education. They just work hard, hang tough, go the extra mile, pick your own companion clichés. But what people need to know about nurses is that, like physicians but unlike bones, they are university-educated professionals who save lives. Montaigne says that a new poll by NPR, the Robert Wood Johnson Foundation, and the Harvard School of Public Health has found that "one-third of hospitalized patients say nurses weren't available when needed, or didn't respond quickly to requests for help." Montaigne introduces NPR health reporter Patti Neighmond, who notes that nurses provide "most of the hands-on patient care," so NPR was "surprised" that its polls showed they were often unavailable. NPR put a call out on Facebook, and in response "hundreds" of nurses reported that "they get no breaks, no lunches, barely time for the bathroom." And even when these nurses do get a break, they're not relaxing, as the first audio quote from an "unidentified nurse" makes clear: We're always afraid that something will happen to our patients during the time that we're off the floor. And I, personally, don't feel comfortable leaving my patients unless I know that a co-worker is actually looking after them during the time that I'm off the floor. Neighmond says that nurse works in a busy urban emergency department, and "like nearly all we talked to, . . . didn't want her name used because she's worried about retaliation from her employer." The nurse told NPR that she "rarely stops - not for 12 hours," and that although one nurse for three patients would be ideal in her ER, she "typically" has five or more patients, "often eight, if she's covering for a colleague taking a lunch break." The nurse also gives a good example of the perils of understaffing: We're always afraid that something will happen to our patients during the time that we're off the floor. And I, personally, don't feel comfortable leaving my patients unless I know that a co-worker is actually looking after them during the time that I'm off the floor. There are times that I've been with a patient where I, literally, could not leave their bedside because maybe I was injecting a medication that you have to push slowly over five to 10 minutes so that it doesn't harm them. And I can see a call bell going off down the hallway, and there's no way I can go and respond to that. Neighmond notes that the only option there is to yell for another nurse to help. Of course, this scenario would be a problem even if the nurse had only two patients, but a colleague is far more likely to be available to help if she has three patients, rather than five, or eight. The report goes on to quote the "unidentified nurse" about how these shifts affect her: There have been shifts where I've driven home at the end of 12 hours, and I'm gripping the steering wheel, and all I can think of is, what happened during my shift? Did I miss anything? I've run ragged; I didn't get a break; my knuckles are white. … I've thought, before, that the day that I come home and look back, and realize that I made a mistake because the demands exceeded any reasonable capacity on the part of a nurse, that's the day that I never want to be a nurse again. The report offers no comment about whether we should be concerned about the nurses who are going through this, or whether anyone else is concerned, but maybe the audio clips are enough. And the report does go on to offer some helpful information about why understaffing happens and how it might affect patients. Neighmond observes that these stories make it sound like there is a shortage of nurses, but according to Linda Aiken, "a researcher and professor of nursing at the University of Pennsylvania," that is not the case now. Aiken notes that we "have a shortage of nursing care, but not a shortage of nurses." According to the report, Aiken says there was a shortage "about a decade ago," but "that's changed," and many new nursing graduates now can't find jobs. While the last part is correct, the U.S. shortage continued long after 2002. And the improved supply of U.S. nurses today has been driven to a large extent by the return of veteran nurses to the bedside in the recent recession. If entry into nursing remains at current levels, the U.S. is still predicted to be short 15% of needed nurses by the year 2030. And the global shortage of nurses remains a public health crisis that kills millions of people every year. In any case, rather than asking a nursing advocate to explain why understaffing occurs, NPR consults only Nancy Foster, a vice president with the American Hospital Association. Foster reportedly says hospitals "are facing big financial challenges." Foster: In part, it's because our patients are sicker. They are coming to us with many more intense diseases and disorders than they would have 25 years ago. In part, that's because there are so many more medications and devices and other interventions at our fingertips, we can help many more people than we could have 25 years ago - and restore them to health. Neighmond goes on report that Foster says nurses "aren't alone in feeling the crunch," but does not explain who else is feeling it. Are AHA executives also gripping the steering wheel white-knuckled on their way home every night, wondering if they killed anyone today? The report does at least go back to Aiken for more on how nurse short-staffing affects patient outcomes. Aiken says (in the report's words) that "any reductions in nurse staffing, at a time of increasing patient demand, jeopardizes care," and in a direct quote, she states: "Nurses are the surveillance system in hospitals for the early detection and intervention, to save a patient." Neighmond focuses on the not-enough-time-for-early-detection point, using another audio quote: Unidentified nurse: You know, you might walk into a room, and they're breathing and they look OK and they answer your questions. But if you look at their neck and their jugular vein is just slightly distended, or you check their nail beds and they're a little bit dusky - you know, taking the time to pick up on the small details like that, those are the early warning signs that somebody is getting sicker fast. Fantastic. That is exactly the kind of information the public needs about the importance of nursing skill to patient outcomes--and the nature of nursing as, in part, a critical exercise in preventing bad things from happening, perhaps not something most of us are conditioned to appreciate. Just as offensive players in team sports tend to get more attention than defensive ones, care givers associated with dramatic interventions tend to get more attention--and funding--than those associated with prevention. This might have been a good place to mention the growing body of research by Aiken and others in the last decade showing that lower nurse staffing means worse patient outcomes and a significantly increased risk of death. pull out quote 3Instead, Neighmond returns to the poll, which showed that half of "Americans" hospitalized overnight in the past year were "very satisfied" with their care, a third were "somewhat satisfied," and 16 percent were "dissatisfied," "so it's not all bad news." But "with a rapidly aging population, the fear is that the nursing staff will be stretched even more thinly." So--we're not that concerned with the current situation, it just bears watching? Anyway, Neighmond says that the Facebook call-out was not scientific, so many nurses may disagree with "this overworked nurse," but the poll is "scientific," and "it does point to significant problems when it comes to the availability of nurses at the bedside." There is very helpful information here, particularly about the effects of nurse understaffing on patients, and the distressing prevalence of the problem. The audio clips from the "unidentified nurses" are compelling. And the fact that the nurses must hide from their hospital employers' potential retaliation only makes their accounts more persuasive. However, neither the ground-level reports of the direct care nurses nor Aiken's quotes about the effects of understaffing are adequate to counter the AHA's unchallenged account of what is causing it, with its implication that there really isn't much to be done. NPR should have consulted a strong advocate for better nurse staffing, and should have been more explicit that understaffing doesn't just happen because of changes in financial structures, demographics, and care technologies, but it is also the result of policy decisions, made by humans, who do not think that nursing is important enough to merit adequate reimbursement. When more patients and care technologies appear, more nurses are required, and decision-makers know how to find them, if they are willing and able to pay. Those policy decisions should be identified and questioned, at least through input from advocates, not merely alluded to with timid mainstream media phrases like "significant problems when it comes to the availability of nurses at the bedside." Still, the report has some very good elements, and we thank Patti Neighmond and NPR. Listen to and / or read the piece "Need A Nurse? You May Have To Wait" by Patti Neighmond. You can contact Patti Neighmond at Morning Edition through NPR's contact us form. If you do send her a letter, please send us a copy too, at letters@truthaboutnursing.org. Thank you! http://www.truthaboutnursing.org/news/2012/may/25_npr.html ~~**~~**~~**~~**~~**~~ FROM A MEMBER The following was sent in by Rozalfaro. Sounds interesting and I wanted to share with you all: After many comments from colleagues, I'm starting a campaign to have "Be on Your Patients' S.I.D.E" (summarized below; applies to all settings) posted on every unit and at every school of nursing. You can download an eye-catching handout free from http://www.alfaroteachsmart.com/handouts.html (Choose Handout #16, S.I.D.E Care Principles). Please download, copy, and share! Be On Your Patients' S.I.D.E.* Use S.I.D.E to remember overarching care principles: S- Safety and comfort. Make safety and comfort top priority. I- Infection prevention. Be alert to infection risks; wash your hands; teach patients to do the same D- Dignity. Help patients maintain self-respect; ensure privacy. E- Engage and educate. Involve patients and families in making decisions; teach them what they need to know to be independent. For more information S.I.D.E. or coaching on teaching critical thinking (on-site, on the phone, or electonic coaching) simply reply to this email. Rosalinda (Roz) Alfaro-LeFevre teachsmartalfaro@aol.com ~~**~~**~~**~~**~~**~~ INTERESTING READING Please remember that the REUTERS articles usually good for only 30 days CDC Warns Of Flu Risk For Kids With Disabilities Children with intellectual disability, cerebral palsy and other neurologic disorders are at much greater risk of complications from the flu, federal health officials said Wednesday. In a study looking at the 2009 H1N1 flu outbreak, the U.S. Centers for Disease Control and Prevention found that a disproportionately high number of kids with neurologic disorders died as compared to other children. What’s more, of those conditions, the most frequently cited were intellectual disability, cerebral palsy and other neurodevelopmental disorders, researchers reported in the journal Pediatrics. The 2009 flu season was significant because the number of children who perished during the pandemic that year was more than five times higher than the median for the previous five flu seasons. ... http://www.disabilityscoop.com/2012/08/29/cdc-warns-flu-risk/16347/ ************************************* No risks seen with flu shot in early pregnancy (Reuters Health) - Adding to evidence that the flu shot is safe for pregnant women, a new study finds no link between the vaccine and the risk of serious birth defects.The study, of nearly 9,000 pregnant women who got the flu shot, found that about 2 percent had a baby with a major birth defect, such as a malformation in the heart or a cleft lip. That was identical to the rate among almost 77,000 pregnant women who did not get the vaccine. ... http://www.reuters.com/article/2012/08/28/us-flu-early-pregnancy-idUSBRE87R0QB20120828 *************************************** NASA's Mars rover Curiosity is one of the most ambitious and delicate space missions we have ever tried. So far it has achieved incredible success. Here is a quick look at what makes Curiosity's work so amazing: RANDOM FACTS: Talk about accuracy. After 36 weeks in space (and 350,000,000 miles), Curiosity touched down within one minute of schedule and hit a target 4 & 1/2 by 12 miles. NASA puts the cost of the Curiosity mission at $2.5 billion, which includes spacecraft development, science investigations, and the cost of launch and operations. ****************************** Anti-Epileptic Seen to Quiet Chronic Cough The seizure and pain drug gabapentin may ease a persistent cough unresponsive to other treatments, researchers found. The drug boosted cough-specific quality of life (QOL) and cut cough frequency and severity, compared with placebo in the small randomized trial by Nicole M. Ryan, PhD, of the University of Newcastle in Australia, and colleagues. The number needed to treat to improve QOL related to chronic coughing was only 3.58, the group reported online in The Lancet. Given the minimal side effect profile, gabapentin could be a viable alternative in treating chronic cough, Ryan and colleagues wrote. ... http://www.medpagetoday.com/Pulmonology/GeneralPulmonary/34477 **************************** Missed Diagnoses in ICU Often Have Deadly Results: Review TUESDAY, Aug. 28 (HealthDay News) -- Misdiagnosis causes or contributes to as many as 40,500 patient deaths in intensive care units in U.S. hospitals each year, which is about the same number of deaths caused each year by breast cancer. That's the finding of a team of researchers who reviewed 31 studies that provided details about more than 5,800 autopsies conducted to detect diagnostic errors in adult intensive care unit (ICU) patients. The investigators found that 28 percent of those ICU patients -- more than one in four -- had at least one missed diagnosis at death. In 8 percent of the patients, the diagnostic error was serious enough that it may have caused or directly contributed to the patients' deaths and, if known, would have led to changes in their treatment. Infections and vascular conditions, such as heart attack and stroke, accounted for more than three-quarters of the fatal diagnostic errors, according to the researchers at the Johns Hopkins Armstrong Institute for Patient Safety and Quality. ... http://consumer.healthday.com/Article.asp?AID=668084 ******************************* Real-life "Contagion" uses DNA to halt outbreak (Reuters) - If Hollywood needs a plot for a medical thriller, scientists at the National Institutes of Health have one: Doctors, using cutting-edge technology called whole-genome sequencing, trace an outbreak of a deadly bacterial infection, identify precisely how it's spreading - and in the final minutes sic poison-spewing robots on the rampaging microbes. That's essentially what scientists did when Klebsiella pneumoniae, an often-lethal bacterium, spread through NIH's research hospital in Bethesda, Maryland last year, as described in a study published on Wednesday in the journal Science Translational Medicine. "With whole-genome sequencing," said microbial geneticist Julie Segre of NIH's National Human Genome Research Institute, who led the study, "we were able to understand how the outbreak was moving through the hospital and identify weaknesses" in infection-control practices, finally halting the outbreak. ... http://www.reuters.com/article/2012/08/22/us-usa-genomics-outbreak-idUSBRE87L0UP20120822?feedType=RSS&feedName=healthNews ************************************** Scientists ID Cancer-Causing Agent in Smokeless Tobacco WEDNESDAY, Aug. 22 (HealthDay News) -- Scientists have linked a specific ingredient in smokeless tobacco products to an increased risk for oral cancer, in research using rodents. The culprit, found in such products as chewing tobacco and snuff, is a nitrosamine compound called (S)-NNN. Nitrosamines in tobacco are considered to be cancer-causing, according to the U.S. National Cancer Institute. Authors of the new study acknowledge that such compounds are found in many foods, including beer and bacon. But they say that levels are much higher in smokeless tobacco products, leading them to suggest that the U.S. government should therefore ban or regulate (S)-NNN. The researchers are scheduled to present their findings Wednesday at the American Chemical Society annual meeting, in Philadelphia. "This is the first example of a strong oral-cavity carcinogen that's in smokeless tobacco," study author Stephen Hecht, from the University of Minnesota, said in a society news release. "Our results are very important in regard to the growing use of smokeless tobacco in the world, especially among younger people who think it is a safer form of tobacco than cigarettes. We now have the identity of the only known strong oral carcinogen in these products." ... http://www.nlm.nih.gov/medlineplus/news/fullstory_128503.html *************************** A pill that treats and tells (Reuters) - If you have trouble remembering whether you took your pills on time, your medicine may soon have the answer for you. Pills for anything from the common cold to diabetes or cancer can be embedded with tiny ingestible chips that keep track of whether a patient is taking their medicine on time. The digital feedback technology, devised by Redwood City, California-based Proteus Digital Health Inc, can also prompt patients to take their medicine and even ask them to take a walk if they have been inactive for too long. "Overall, people only take their medications half of the time ... adherence is a really big issue across all treatments," Eric Topol, chief academic officer of Scripps Health, a non-profit medical service provider, told Reuters. ... http://www.reuters.com/article/2012/08/27/us-proteus-ingestiblesensor-idUSBRE87Q0D520120827?feedType=RSS&feedName=healthNews ************************** Benefits of circumcision outweigh risks, U. S. pediatrics group says (Reuters) - The American Academy of Pediatrics has issued new guidelines saying the health benefits of infant circumcision outweigh the risks of the surgery, but the influential physician's group has fallen short of a universal recommendation of the procedure for all infants, saying that parents should make the final call. The change was prompted by scientific evidence that suggests circumcision can reduce the risk of urinary tract infections in infants and cut the risk of penile cancer and sexually transmitted diseases, including HIV and the human papillomavirus or HPV, which causes cervical and other cancers. Although the AAP's 1999 statement was fairly neutral, the new statement, published on Monday in the journal Pediatrics, comes down in favor of the procedure, saying the health benefits of newborn male circumcision "justify access to this procedure for families who choose it." ... http://www.reuters.com/article/2012/08/27/us-usa-circumcision-idUSBRE87Q02720120827 *********************** Selection and Serving Strategies of TV dinners... So how do you make the best choice, faced with hundreds of frozen dinners and entrees that are readily available? Frozen meals have gotten tastier over the years, but you still must buy and try before you find your favorites. Beware of potpies with crust, Hungry Man dinners, and stuffed-crust or extra-cheese pizzas. Select dinners that are balanced and contain a lean source of protein, such as Lean Cuisine, Healthy Choice, and Weight Watchers brands. Choose dinners or entrees with no more than 300-400 calories. Choose meals with no more than 30% of the calories coming from fat. This would be about 10-14 grams of total fat if the meal contains 300-400 calories. Select meals with no more than 6 grams of saturated fat. Aim for a sodium content no higher than 600 milligrams. Add on a side salad with low calorie dressing, a serving of fruit, and a glass of low-fat milk to round out the meal. This will help you boost the fiber, calcium and nutrient contents of your meal. http://www.sparkpeople.com/resource/nutrition_articles.asp?id=585 ************************ U.S. cases of West Nile virus set record, deaths rise: CDC NEW YORK (Reuters) - A total of 1,590 cases of West Nile virus, including 66 deaths, were reported through late August this year in the United States, the highest human toll by that point in the calendar since the mosquito-borne disease was first detected in the country in 1999, health officials said on Wednesday. The toll is increasing quickly. "We think the numbers will continue to rise," said Dr. Lyle Petersen, director of the U.S. Centers for Disease Control and Prevention's Division of Vector-Borne Infectious Diseases. Through last week, 1,118 cases and 41 deaths had been reported. The updated figures represent a 40 percent increase in the number of cases and a 61 percent spike in the number of deaths, but are short of the all-time record for a full year: 9,862 cases and 264 deaths in 2003. In hard-hit Texas, the number of confirmed cases soared to 894, with 34 people dead, this year as of Wednesday, according to the Texas Department of State Health Services. Over half of the deaths occurred in the north of the state. ... http://www.reuters.com/article/2012/08/29/us-usa-health-westnile-idUSBRE87S0WC20120829?feedType=RSS&feedName=healthNews *********************** UC Berkeley SETI survey focuses on Kepler’s top Earth-like planets By Robert Sanders, Media Relations | May 13, 2011 BERKELEY — Now that NASA’s Kepler space telescope has identified 1,235 possible planets around stars in our galaxy, astronomers at the University of California, Berkeley, are aiming a radio telescope at the most Earth-like of these worlds to see if they can detect signals from an advanced civilization. The search began on Saturday, May 8, when the Robert C. Byrd Green Bank Telescope – the largest steerable radio telescope in the world – dedicated an hour to eight stars with possible planets. Once UC Berkeley astronomers acquire 24 hours of data on a total of 86 Earth-like planets, they’ll initiate a coarse analysis and then, in about two months, ask an estimated 1 million SETI@home users to conduct a more detailed analysis on their home computers. “It’s not absolutely certain that all of these stars have habitable planetary systems, but they’re very good places to look for ET,” said UC Berkeley graduate student Andrew Siemion. ... http://newscenter.berkeley.edu/2011/05/13/uc-berkeley-seti-survey-focuses-on-kepler%E2%80%99s-top-earth-like-planets/ ******************************** Quiz Time Which statement about breast-feeding and obesity is correct? a. Breast-feeding has no effect on the risk of obesity in children. b . Breast-feeding is associated with a higher risk of children becoming overweight. c . The beneficial effects of breast-feeding on weight may last into the late teen years. d . The beneficial effects of breast-feeding on weight end in the early teen years. (Answers at end of newsletter) Reprinted with permission from: Production/Electronic Channels Coordinator HealthCom Media 259 Veterans Lane Doylestown, PA 18901 ****************************** Pelvic floor muscle exercises effective for urinary incontinence in women A comparative effectiveness report from the Agency for Healthcare Research and Quality states that pelvic floor muscle exercises (similar to Kegel exercises) are effective in increasing the ability of women with urinary incontinence to hold their urine. The report also states that drug-based treatments can be effective, but the degree of benefit is low and side effects are common. ... http://www.ahrq.gov/news/press/pr2012/muscleuipr.htm ************************* Top 20 Common Interview Questions and Answers 1- Tell me about yourself. This is probably the most asked question in an interview. It breaks the ice and gets you to talk about something you should be fairly comfortable with. Have something prepared that doesn’t sound rehearsed. It’s not about you telling your life story and quite frankly the interviewer just isn’t interested. Unless asked to do so, stick to your education, career and current situation. Work through it chronologically from the furthest back to the present. 2- Why are you looking for another job (or why did you leave your previous job)? On the surface this appears to be a simple question, yet it is easy to slip. I would suggest not mentioning money at this stage as you may come across as totally mercenary. If you are currently in employment you can say it’s about developing your career and yourself as an individual. If you are in the unfortunate position of having been downsized stay positive and keep it brief. If you were fired you should have a solid explanation. Whatever your circumstances do not go into the drama and detail and stay positive. 3- What do you know about this organisation? Do your homework prior to the interview. Doing the background work will help you stand out. Find out who the main players are, have they been in the news recently? You’re not expected to know every date and individual yet you need to have a solid understanding of the company as a whole. 4- Why do you want this job? This questions typically follows on from the previous one. Here is where your research will come in handy. You may want to say that you want to work for a company that is x, y, z, (market leader, innovator, provides a vital service, whatever it may be). Put some thought into this beforehand, be specific and link the company’s values and mission statement to your own goals and career plans. 5- Who are our main competitors? This shows you really understand the industry and the main players. Think about a few and say how you think they compare; similarities, differences. This is a good opportunity to highlight what you think are the company’s key strengths. 6- What would your previous co-workers say about you? This is not the arena for full disclosure. You want to stay positive and add a few specific statements or paraphrase. Something like “Joe Blogs always mentioned how reliable and hard working I was” is enough. 7- How do you handle stressful situations and working under pressure? There are several ways of addressing this one. You may be the sort of person that works well under pressure; you may even thrive under pressure. Whatever the case may be just make sure you don’t say you panic. You want to give specific examples of stressful situations and how well you dealt with them. You may also want to list a few tools you use to help you, such as to do lists etc. It is alright to say that if you feel you are way over your head you will ask for assistance. It is equally acceptable to say that you work best under pressure if this is indeed the case and relevant to the particular role. 8- Are you applying for other jobs? If you are serious about changing jobs then it is likely that you are applying to other positions. It is also a way of showing that you are in demand. Be honest but don’t go into too much detail, you don’t want to spend a great deal of time on this. If asked about names of who you have spoken to it is absolutely legitimate to say you prefer not to disclose that information at this stage. 9- What are you like working in a team? Your answer is of course that you are an excellent team player; there really is no other valid answer here as you will not function in an organisation as a loner. You may want to mention what type of role you tend to adopt in a team, especially if you want to emphasis key skills such as leadership. Be prepared to give specific examples in a very matter of fact sort of way. 10- What sort of person do you not like to work with? This is not an easy one as you have no idea whom you would be working with. Even if you can immediately think of a long list of people you don’t like to work with, you could take some time to think and say that it’s a difficult question as you have always gotten on fine with your colleagues. 11- What is your greatest strength? This is your time to shine. Just remember the interviewer is looking for work related strengths. Mention a number of them such as being a good motivator, problem solver, performing well under pressure, loyal, positive attitude, eager to learn, taking the initiative, attention to detail. Whichever you go for, be prepared to give examples that illustrate this particular skill. 12- What is your biggest weakness? A challenging one, as if you so you have no weaknesses you are obviously lying! Be realistic and mention a small work related flaw. Many people will suggest answering this using a positive trait disguised as a flaw such as “I’m a perfectionist” or “I expect others to be as committed as I am”. I would advocate a certain degree of honesty and list a true weakness. Emphasize what you’ve done to overcome it and improve. This question is all about how you perceive and evaluate yourself. 13- What has been your biggest professional disappointment/achievement so far? If asked about disappointments mention something that was beyond your control. Stay positive by showing how you accepted the situation and have no lingering negative feelings. If asked about your greatest achievement chose an example that was important to you as well as the company. Specify what you did, how you did it and what the results were. Ideally pick an example that can relate to the positions you are applying for. 14- What kind of decisions do you find most difficult to take? There is no right or wrong here. The logic behind this type of question is that your past behaviour is likely to predict what you will do in the future. What the interviewer is looking for is to understand what you find difficult. 15- Tell me about a suggestion that you have made that has been successfully implemented. Here the emphasis is on the implemented. You may have had many brilliant ideas, but what the interview is looking for is something that has actually materialised. Be prepared to briefly describe how it went from an idea to implementation stage. 16- Have you ever had to bend the rules in order to achieve a goal? Beware of this type of question! Under no circumstances is it necessary to break company policy to achieve something. Resist the temptation to answer and give examples, as what the interviewer is looking for is to determine how ethical you are and if you will remain true to company policy. 17- Are you willing to travel or relocate if necessary? This is something you need to have very clear in your mind prior to the meeting, if you think there is any chance this may come up. There is no point in saying yes just to get the job if the real answer is actually no. Just be honest as this can save you problems arising in the future. 18- Why should we hire you? This is an important question that you will need to answer carefully. It is your chance to stand out and draw attention to your skills, especially those that haven’t already been addressed. Saying “because I need a job” or “I’m really good” just won’t cut it. Don’t speculate about other candidates and their possible strengths or flaws. Make sure you focus on you. Explain why you make a good employee, why you are a good fit for the job and the company and what you can offer. Keep it succinct and highlight your achievements. 19- Regarding salary, what are your expectations? Always a tricky one and a dangerous game to play in an interview. It is a common mistake to discuss salary before you have sold yourself and like in any negotiation knowledge is power. Do your homework and make sure you have an idea of what this job is offering. You can try asking them what the salary range. If you want to avoid the question altogether you could say that at the moment you are looking to advance in your career and money isn’t your main motivator. If you do have a specific figure in mind and you are confident you can get it, then it may be worth going for it. 20- Do you have any questions for us? This one tends to come up every time. Have some questions prepared. This will show you have done some research and are eager to know and learn as much as possible. You probably don’t want to ask more than 3 or 4 questions. Try and use questions that focus on you becoming an asset to the company. A generic one might be “how soon can I start if I were to get the job”. Another idea is to ask what you would be working on and how quickly they expect you to be able to be productive. Remember to ask about next steps and when you can expect to hear back. http://www.careerinsider.org/top-20-common-interview-questions-and-answers/?goback=.gde_2816581_member_152091551 ************************* Nursing Shortage Rearing Its Head Again The nursing shortage was never resolved. It was sort of put on hold when the economy tanked. Nurses of the Baby Boom generation were poised to retire, but the majority of them were forced to continue working for financial survival. Others had to return to work in order to make it through some of the toughest economic times ever. The impact has been that new grad nurses have had an impossible time finding work; something that has been unheard of for several decades. Now that the economy is in a recovery mode, Baby Boomers are retiring and the shortage of nurses is becoming a nightmare. The severity of the situation is predicted to be catastrophic as hospitals and health care facilities struggle to find nurses to fill these voids. And the shortage of nurse educators is going to affect the number of new nurse who can be trained to take over. ( From The Nursing Site Group Blog Kathy Quan, RN, BSN.) http://www.thenursingsiteblog.com/2012/08/nursing-shortage-rearing-its-head-again.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+thenursingsiteblog%2FVKMA+%28The+Nursing+Site+Blog%29&utm_content=FaceBook *********************** 3D Movies Linked to Increased Vision Symptoms Philadelphia, PA (July 2, 2012) - Watching 3D movies can "immerse" you in the experience—but can also lead to visual symptoms and even motion sickness, reports a study – “Stereoscopic Viewing and Reported Perceived Immersion and Symptoms”, in the July issue of Optometry and Vision Science, official journal of the American Academy of Optometry. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health. Symptoms related to 3D viewing are affected by where you sit while watching, and even how old you are. "Younger viewers incurred higher immersion but also greater visual and motion sickness symptoms in 3D viewing," according to the authors, led by Shun-nan Yang, PhD, of Pacific University College of Optometry, Forest Grove, Ore. "Both [problems] will be reduced if a farther distance and a wider viewing angle are adopted." Greater 'Immersion' in 3D Also Associated With Increased Symptoms The researchers performed experiments in which adults, from young adult to middle-aged, were invited to watch a movie (Cloudy with a Chance of Meatballs) in 2D or 3D while sitting at different angles and distances. Visual and other symptoms were assessed—including the role of factors including age, seating position, and level of "immersion" in the movie. Twenty-one percent of participants reported symptoms while watching the movie in 3D, compared to twelve percent with 2D viewing. For younger study participants, blurred vision, double vision, dizziness, disorientation, and nausea were all more frequent and severe when watching the movie in 3D.... http://www.wolterskluwerhealth.com/News/Pages/3D-Movies-Linked-to-Increased-Vision-Symptoms.aspx?WT.mc_id=EMxj00x20120817xL3 ********************* UK to review cosmetic surgery industry (Reuters) - Britain has launched a review of the cosmetic surgery industry, which could lead to tighter restrictions on the way companies operate and market their services in the wake of the PIP breast implant scandal. The Department of Health said on Wednesday that Bruce Keogh, medical director of the National Health Service, would lead a team that will gather evidence and make recommendations to the government by March. The PIP scandal exposed deficiencies in the cosmetic surgery sector, with more than 40,000 British women given substandard silicone breast implants made by French firm Poly Implant Prothese (PIP), among hundreds of thousands worldwide. The review will also consider wider cosmetic procedures such as facelifts, liposuction and injections using Botox, the popular anti-wrinkle treatment made by Allergan. "The recent problems with PIP breast implants have shone a light on the cosmetic surgery industry," Keogh said. ... http://www.reuters.com/article/2012/08/15/us-britain-cosmeticsurgery-idUSBRE87E07N20120815?feedType=RSS&feedName=healthNews ****************************** FTC says drug patent settlements used to delay generics n"(Reuters) - The Federal Trade Commission said makers of branded drugs that settle patent challenges by promising not to launch their own generic alternatives are using such agreements to delay generic competition. In a friend-of-the-court brief, the regulatory agency said such patent settlements in which drug companies agree not to launch their own authorized generic versions are a way of paying a generic rival to delay their entry into the market. The assessment came as a federal court in New Jersey that oversees many lawsuits against drug companies weighs a private antitrust challenge to such an agreement between Pfizer Inc's Wyeth unit and Teva Pharmaceutical Industries Ltd, the world's largest generic drug maker. "Empirical evidence confirms what the pharmaceutical industry has long understood: that a no-(authorized generic) commitment provides a convenient method for branded drug firms to pay generic patent challengers for agreeing to delay entry," the agency said in the proposed friend-of-the-court brief filed on Friday. ... http://www.reuters.com/article/2012/08/14/us-ftc-generics-idUSBRE87C10A20120814?feedType=RSS&feedName=healthNews ************************** RANDOM FACTS: A tree can absorb as much as 48 pounds of carbon dioxide per year and can sequester 1 ton of carbon dioxide by the time it reaches 40 years old. Bonus Fact: One large tree can lift up to 100 gallons of water out of the ground and discharge it into the air in a day. ************************* On August 24, the Department of Health and Human Services (HHS) announced a one-year delay to the deadline for healthcare providers to become compliant with ICD-10 coding standards. Providers now have until Oct. 1, 2014 to implement the new system. Currently, providers use ICD-9 to code diagnoses and procedures. The current system utilizes 13,000 codes, while ICD-10 will include 68,000 codes. The proposed rule was initiated when many provider groups expressed serious concerns about their ability to meet the Oct. 1, 2013 compliance date. The change in the compliance date for ICD-10 will “give providers and other covered entities more time to prepare and fully test their systems to ensure a smooth and coordinated transition to these new code sets,” according to an April 9 press release. Another part of the final rule establishes a health plan identifier (HPID). Authorized by the Affordable Care Act, HPIDs will help simplify the existing process for determining a patient’s eligibility for care and coverage, according to HHS. ... http://tinyurl.com/8k2k3um To read the final rule, which was published in the Federal Register on Sept. 5, click here. http://www.ofr.gov/OFRUpload/OFRData/2012-21238_PI.pdf ~~**~~**~~**~~**~~**~~ HUMOR SECTION We all fail sometimes. But there's something about failing with style. Here are some of the best test paper blunders from the most clueless - and inventive - of students. * Classical Studies * Question: Name one of the early Romans' greatest achievements. Answer: Learning to speak Latin * Biology * Question: What is a fibula? Answer: A little lie * Classical Studies * Question: What were the circumstances of Julius Caesar's death? Answer: Suspicious ones * Biology * Question: Give an example of a smoking-related disease Answer: Early death * Biology * Question: What is a plasmid? Answer: A high definition television * Religious Studies * Question: Christians only have one spouse, what is this called? Answer: Monotony * Physics * Question: Name an environmental side effect of burning fossil fuels. Answer: Fire * Geography * Question: What does the term "lava" mean? Answer: A pre-pubescent caterpillar * Geography * Question: The race of people known as Malays come from which country? Answer: Malaria * Geography * Question: Name one famous Greek landmark Answer: The most famous Greek landmark is the Apocalypse * History * Question: Where was the American Declaration of Independence signed? Answer: At the bottom. ~~**~~**~~**~~**~~**~~ CEU SITES---(CME and CNE) Those that are-----Free and Otherwise.......... Go to www.sharedgovernance.org for access to a just released, free continuing education module about shared governance, written by Robert Hess, Forum’s founder, and Diana Swihart, Forum advisory board member. Please follow me on Twitter as Dr Robert Hess. Pay Only $34.99 for a full year of CONTACT HOURS www.nurse.com for CNE offerings. 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/ ! ~~**~~**~~**~~**~~**~~ WEBSITES/ LINKS Always on the lookout for interesting websites / links. Please send them to:RNFrankie@AOL.com. This is an excellent nursing site, check it out: http://nursingpub.com/ Robert Hess, RN, PhD, FAAN (856) 424-4270 (610) 805-8635 (cell) Founder, Forum for Shared Governance info@sharedgovernance.org www.sharedgovernance.org Decubqueen's website: www.accu-ruler.com http://www.thebreastcancersite.com/clickToGive/home.faces?siteId=2 http://www.nationalnurse3.blogspot.com/ RNs launch a national safe staffing campaign http://www.1199seiu.org/media/magazine/sept_2007/safe_staffing.cfm H.R. 2123, The Nurse Staffing Standards for Patient Safety and Quality Care Act of 2007 http://www.washingtonwatch.com/bills/show/110_HR_2123.html Board Supports Your Right to Refuse An Unsafe Assignment: Nurse Practice Act cites three conditions for patient abandonment http://findarticles.com/p/articles/mi_qa4102/is_200408/ai_n9450263 The Nursing Site http://thenursingsite.com . http://www.thebreastcancersite.com/clickToGive/home.faces?siteId=2 http://www.snopes.com http://www.solutionsoutsidethebox.net/ Raconte's website http://www.theanimalrescuesite.com/clickToGive/home.faces?siteId=3 National Do Not Call Registry If you're buying a used car, it is recommended having a mechanic inspect it first. And screen the car's VIN through the free database at carfax.com/flood This is a sampling of the offers on : Rozalfaro's website: http://www.alfaroteachsmart.com/articles.htm Metric conversion calculators and tables for metric conversions http://www.metric-conversions.org/ ******************************************************* ******************************************** * MEDICAL RECALLS * ******************************************* ****************************************************** J&J unit recalls bone putty (Reuters) - The health regulator said certain lots of bone putty made by Johnson & Johnson unit Synthes were recalled as there was potential for the putty to catch fire if it came in contact with electrosurgical cautery systems during surgery. The Hemostatic Bone Putty is used to stop bone bleeding by creating a physical barrier along the edges of bones damaged by trauma or cut during a surgical procedure. The recall, which has been classified as Class I, or the most serious type of recall, was initiated on July 5. ... http://www.reuters.com/article/2012/08/21/us-jnj-fda-recall-idUSBRE87K0WE20120821?feedType=RSS&feedName=healthNews *************************** I-Flow ON-Q Pump with ON DEMAND Bolus Button (If you use these pump models, or know where they are being used, please read the Class I Recall) At: http://www.fda.gov/MedicalDevices/Safety/ListofRecalls/ucm317826.htm *************************** Revatio (sildenafil): Drug Safety Communication - Recommendation Against Use in Children FDA notified healthcare professionals and their medical care organizations that Revatio (sildenafil) should not be prescribed to children (ages 1 through 17) for pulmonary arterial hypertension (PAH).This recommendation against use is based on a recent long-term clinical pediatric trial showing that: (1) children taking a high dose of Revatio had a higher risk of death than children taking a low dose and (2) the low doses of Revatio are not effective in improving exercise ability. Treatment of PAH in children with this drug is an off-label use (not approved by FDA) and a new warning, stating the use of Revatio is not recommended in pediatric patients has been added to the Revatio labeling. BACKGROUND: Revatio is a phosphodiesterase-5 inhibitor used to treat pulmonary arterial hypertension by relaxing the blood vessels in the lungs to reduce blood pressure and is approved to improve exercise ability and delay clinical worsening of PAH in adult patients (WHO Group I). ... http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm317743.htm ****************************** Covidien Shiley Adult Tracheostomy Tubes: Class I Recall - Reports Of Volume Leakage And/or Disconnection Between The Inner And Outer Cannulae FDA notified healthcare professionals that Covidien is recalling certain cuffed Shiley tracheostomy tubes due to consumer complaints related to reports of volume leakage and/or disconnection between the inner and outer cannulae, which were observed during mechanical ventilation of patients. Certain lots of Shiley size 8 adult, reusable, cuffed tracheostomy tubes are included in this product recall. All other sizes and styles of Shiley tracheostomy tubes are unaffected by this action. Affected tracheostomy tubes were manufactured and distributed from October 1, 2009, to June 26, 2012. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm315634.htm ********************************* Codeine Use in Certain Children After Tonsillectomy and/or Adenoidectomy: Drug Safety Communication - Risk of Rare, But Life-Threatening Adverse Events or Death The FDA is reviewing reports of children who developed serious adverse effects or died after taking codeine for pain relief after tonsillectomy and/or adenoidectomy for obstructive sleep apnea syndrome. Recently, three pediatric deaths and one non-fatal but life-threatening case of respiratory depression were documented in the medical literature. These children (ages two to five) had evidence of an inherited (genetic) ability to convert codeine into life-threatening or fatal amounts of morphine in the body. All children had received doses of codeine that were within the typical dose range. BACKGROUND: When codeine is ingested, it is converted to morphine in the liver by an enzyme called cytochrome P450 2D6 (CYP2D6). Some people have DNA variations that make this enzyme more active, causing codeine to be converted to morphine faster and more completely than in other people. These “ultra-rapid metabolizers” are more likely to have higher than normal amounts of morphine in their blood after taking codeine. High levels of morphine can result in breathing difficulty, which may be fatal. Taking codeine after tonsillectomy and/or adenoidectomy may increase the risk for breathing problems and death in children who are “ultra-rapid metabolizers.” http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm315627.htm *********************** Hospira Hydromorphone Hydrochloride Injection 2MG/ML 1mLfill in2.5mL Carpuject:Recall-May Contain More Than The Intended Fill Volume Hospira and FDA notified healthcare professional of a nationwide voluntarily recall of one lot of Hydromorphone Injection, USP, 2 mg/mL, (C-II), 1 mL fill in 2.5 mL Carpuject, NDC 0409-1312-30, due to a reported complaint of a single Carpuject containing more than the 1 mL labeled fill volume. Opioid pain medications such as Hydromorphone have life-threatening consequences if overdosed. Those consequences can include respiratory depression (slowed breathing or suspension of breathing), low blood pressure and reduced heart rate including circulatory collapse. The affected product is a prefilled glass cartridge for use with the Carpuject Syringe system. The affected lot number is 12720LL. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm315685.htm *********************************** Synthes Hemostatic Bone Putty: Class I Recall - Potential for Putty to Ignite There is the potential for Hemostatic Bone Putty to ignite if contacted with electrosurgical cautery systems under certain conditions during surgery. BACKGROUND: Hemostatic Bone Putty stops bone bleeding by establishing a physical barrier along the edges of bones that have been damaged by trauma or cut during a surgical procedure. The affected models and lot numbers can be found in the FDA Recall Notice. ... http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm316472.htm ************************************** CareFusion Alaris Pump Module Model 8100: Class I Recall - Motor Stalls During Infusion FDA notified healthcare professionals and their medical care organizations of the Class 1 recall of this product due to reports of motor stalls during infusion with the Alaris Pump Module, model 8100. Most of the motor stalls reported have occurred at high infusion rates (typically over 900 ml/hr). The firm cannot rule out the possibility of motor stall occurrence at lower infusion rates. When a motor stall occurs, the Alaris PC unit and the Alaris Pump Module display the visual error code 242.4030 with an audible alarm that is followed by a termination of infusion. Termination of infusion, especially in high risk patients, could result in serious injury or death. ... http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm316827.htm ********************************** Reumofan Plus: Recall - Undeclared Drug Ingredient FDA is warning consumers that Reumofan Plus, marketed as a natural dietary supplement for pain relief and other serious conditions, contains several active pharmaceutical ingredients not listed on the label that could be harmful. An FDA laboratory analysis of Reumofan Plus found that it contains Diclofenac Sodium, a prescription non-steroidal anti-inflammatory drug (NSAID) that may cause increased risk of cardiovascular events such as heart attack and stroke, as well as serious gastrointestinal (GI) adverse events including bleeding, ulceration, and fatal perforation of the stomach and intestines, and Methocarbamol, a prescription muscle relaxant that can cause sedation, dizziness, low blood pressure, and impair mental or physical abilities to perform tasks such as driving a motor vehicle or operating machinery. The Mexican Ministry of Health discovered that at least one lot of the product contains the corticosteroid dexamethasone, a drug that acts as an anti-inflammatory and immune system suppressant. FDA has received multiple reports of adverse events associated with the use of Reumofan Plus, including liver injury, sudden worsening of glucose control, weight gain, swelling, leg cramps, and adrenal suppression. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm306360.htm ~~**~~**~~**~~**~~**~~ 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/. ~~**~~**~~**~~**~~**~~ NEW MEMBERS Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com WELCOME TO: glrxroland@yahoo.com (Gina) August 15, 2012 mamalynne3@yahoo.com (Lynne) September 15, 2012 ~~**~~**~~**~~**~~**~~ 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.... So, please send me your new name/address, okay? RNFrankie@AOL.com ~~**~~**~~**~~**~~**~~ 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) ~~**~~**~~**~~**~~**~~ PARADIGM 97 CO-FOUNDERS: MarGerlach @AOL.com (Marlene) and RNFrankie @AOL.com (Frankie) ~~**~~**~~**~~**~~**~~ 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. ************* ANSWERS: Which statement about breast-feeding and obesity is correct? a. Breast-feeding has no effect on the risk of obesity in children. b. Breast-feeding is associated with a higher risk of children becoming overweight. c. The beneficial effects of breast-feeding on weight may last into the late teen years. d. The beneficial effects of breast-feeding on weight end in the early teen years. Correct answer: c. Studies show that breast-feeding is associated with a lower risk of children becoming overweight. The benefits of breast-feeding may extend into the late teen years and even adulthood. ~~**~~**~~**~~**~~**~~ THOUGHTS FOR THE DAY When we are children we seldom think of the future. This innocence leaves us free to enjoy ourselves as few adults can. The day we fret about the future is the day we leave our childhood behind. --Patrick Rothfuss, The Name of the Wind ^^^^^ Maturity is when your world opens up and you realize that you are not the center of it. --M.J. Croan Would really like to hear from you..... Frankie RNFrankie@AOL.com