New Year’s Resolutions

Hey Everyone (that reads this) J :

These last couple of months of 2009, particularly the last month (December) has been pretty much rockbottom so far of my life. Nothing has gone right…I am in a constant state of looking for something that is out of reach. I don't even know what I'm looking for, which makes it harder to find. But this subject will be in a next blog. I'll get to that later.

First I want to talk about my resolutions. (Not in any order..just how they come to mind)

1. I want to Learn Chinese!! I actually want to learn every language (at least 10) and Chinese has always fascinated me, so good place to start. I know a lot of Spanish and a tid bit of French, but I'm ready to take on China. And Sign Language is a very close second.
   
2. I need to continue my weight loss regimen, so I guess this is and isn't a "resolution". Its been a rocky road in terms of losing weight but at least it's a road at all and best I can do with the new year is to keep trying. I need to be 20 pounds less by next year!
   
3. I need to keep better control of my finances…big time. Its not that I spend a lot of money, but the money I do spend I spend without keeping track of and then I get my bills…and I just feel out of control. I don't know where any of it possibly went. But I guess that's a typical part of life…but I have to try. It will never be perfect, but I need some sort of system…any ideas?
   
4. I need to stop biting my stupid fingernails!!!!! Enough said.
   
5. I need to do a heck of a lot better in my studies. I haven't been good enough. Have to keep trying. Med surg is coming this spring, and it will be the hardest class yet. I have to put every ounce of effort I possibly have into this course.
   
6. I need to focus on being happier with living in my skin. I have been very on edge lately and I can't place why. But that's another blog, like I said.
   
7. I want to read more!! And paint more!! (Summer activities).
   
8. I need to keep my room clean as I can.
   
9. I need to keep my car as clean as I can!! It makes me sad to drive it.
   
10. I need to focus on de-stressing more, because this has been ridiculous! J
    

Wish me luck J <3

~ A Writer in a Nurse's Body

Have ‘Mercy’!

This week I would like to discuss the T.V. Show on NBC, "Mercy". First off, I give it a high thumbs up. I have watched every episode to date and have been very impressed with each episode overall. However, I know where differing viewpoints are coming from, and they make me angry sometimes too. For instance, the biggest upset about the show for many people is that sometimes the characters do things that would never be expected in a hospital. A lot of people are picking on the fact that character Sonia was walking down the hall in her gown and got attacked by a patient. I agree, that is a little (OK, maybe a lot), far fetched. But the point the writers of the show were trying to make was that although she was dressed in this beautiful gown and late for her date, she made the decision to help a patient that was calling for help when no one else was around, and she was off duty. The whole point of this show is to show nurses in a brighter light and that even though it may be far fetched, nurses might actually do something for a patient such as that. Which most of us would…just not in an evening gown! Many of the viewpoints brought up in my presenting article circulate around the very valid point that NO show on TV is ever going to accurately portray nurses 100%. If you wanted even 90% accuracy, you have to turn on Discovery Health channel. This is primetime TV we are talking about, in order for the show to remain on the air, they need viewers. They need to entice viewers that aren't nurses, otherwise they wouldn't have enough viewers. The general public does not care what is accurate nursing and what is not. They want drama! The public wants love triangles and sexy scenes in supply closets. Its T.V. drama, get over it. The show would never survive if there was no drama. However, I think in order to "save" themselves, in fear of intense criticism from real nurses, the show really does an accurate portrayal of something I haven't seen at all in any other show thus far: Nursing advocacy! In each episode, one or more of the three leading nurses (Chloe, Sonia and Veronica) have had a patient that needed the nurse to fight for their rights. A couple episodes ago, Chloe "stepped over her boundaries" by fighting with the Dr. to get him to realize what she was saying about the drug abuser. She believed he had ringing in his ears and went through a lot to prove it. Just this past week, Character Sonia went through a lot of thinking to come up with a solution on how to help the trouble-making nude sleepwalker (again with the drama). A couple episodes ago Veronica went through the trouble of finding her patients amputated leg in the biohazard room to help her patient achieve closure. Just last week she stayed with a patient that wasn't technically "hers" to make her feel comfortable throughout her hospital stay. As you can see, in each episode the nurses go out of their way to fight for their patient or find a solution. This is accurate, this is what we are supposed to do for all of our patients. Also, I think the medical information is very accurate on the show. I think Veronica displays a very good portrayal of a nurse. She performed a very good physical assessment, and asks all the right questions. She even used the pain scale (1-10) even after the patient said she wasn't in "that much pain". I am also continuously impressed with her good therapeutic communication skills. She has a soothing voice, and always knows what to say (lets put aside the fact that the show has writers that spend all day figuring out the "perfect thing to say").

As for what I (and many other people) don't like about the show, I dislike the fact that these nurses are getting punished for the nursing advocacy. Again, I know its for ratings, its for drama between the doctors and the nurses. I get it. But here is Veronica trying to get her patient into a rehab program and despite the doctor saying no (only because the patient stole his sandwich), Veronica still goes behind his back to get him in the program because she believes it is the right thing to do for her patient. I hate that there is a disciplinary trial held against her for this. Also, why is Veronica the only one wearing scrubs? Why does Sonia get to wear gorgeous clothes that help her figure every week, while Veronica has to wear typical scrubs that do nothing for what I'm sure is a gorgeous figure underneath? Also, why does Sonia always have her hair down, in gorgeous locks, whereas Chloe and Veronica (more Veronica than Chloe) portray an accurate version of a nurse with her hair pulled back in a perfect yet very messy bun? Is this done on purpose? The last thing that I disapprove of in this show is how much Patient confidentiality is compromised. Just this past week, (and this isn't the only time it has happened), Sonia and her friend (a nurse?) are loudly talking about her nude sleepwalking patient in the hallway. Not only are they talking about him, but making fun of him, even referring to him as a "gargoyle". Meanwhile, if you notice, this takes place right outside where all the patient rooms are! It's a TV set, they only use so many different patient rooms, and they are all seemingly right outside this nursing station that we always see. Out of all the things that I (and others) should get upset about in terms of show accuracy, this is what gets me the most. We learn so much about how to maintain proper patient confidentiality rights and here are these characters throwing information out to anyone.

Learning a New Language

This was my last week working with the Pediatric Clinicals. I'm actually sad. OK, maybe I'm happy to not have to drive to St. Peters weekly anymore, but I am actually sad to not have any more pediatric patients until my future job…I was finally getting used to the aspect of taking care of kids instead of adults. Med/Surg this spring is really going to through me for another loop. I actually had a rather metaphoric dream last night after clinical that I was walking down a hospital hallway and was headed towards the pediatric playroom. When my fellow classmates and I got there, we found many adult "typical" med/ surge patients there in this colorful and playful playroom. I was frantically looking for the kids, I missed them. But I knew I had to take care of these adults too. But enough with the dreams…

I wanted to take time this week to discuss my recent metaphoric epiphany I realized this week when I was in the PICU. We are learning a language, the language of nursing. In a metaphorical sense, I'll break it down. When you learn a new language, most adults learn in three stages. First, you can understand the basics. You know the general idea of the language. You can maybe say a couple choppy words you just learned but people can tell immediately you aren't fluent. Well, that's how I felt last spring after interventions. I felt so overwhelmed with the realm of nursing, I knew the basics but that's about it. But, importantly, I was ready to learn more. The second step in learning a language is being able to read it and listen to it and understand it. Well, that's how I felt this week after the PICU. I was instructed to read a child's chart (a long history) and then follow the pediatrician around as well as the nurse. Not only did I understand what I could make out from the handwriting in the chart, but I could understand 90% if what the doctors and nurses were saying about the patients. That was rewarding. The third step is being able to speak the language fluently. Well, I'm certainly not at all fluent yet. I feel right now I can squeak out sentences, but I don't sound confident behind them. At least I certainly dot feel confident. I'm hoping for that last stage to fully develop this spring or next year. That way by the time I enter the workforce, I am ready to talk in "their" language (as if you were moving to France- It'd be beneficial to pass all these stages before you moved in). Granted, just because I am fluent in the language does not mean I am a great nurse. Knowing French doesn't make you a great citizen right away. You have to learn the culture, the customs, how things are done, the dialects, the slang, the people, etc. Well, in my future job it will take at least 5 years to learn all the nursing ways, the nursing instincts, etc. But once you can speak the language, that will all fall in a lot faster.

Death Can Only Be Prolonged So Long

This week I chose to write about an article published in "Newsweek", written by Evan Thomas. The article is titled "The Case for Killing Granny", and it is about exactly what it sounds like. The premise for the article is whether or not we are over treating and spending too much money (mostly from Medicare) on people either on hospice or just old age in general? In this day and age when diseases are becoming more and more apparent in old age, when do we draw the line to stop treatment and to live and let die? Everyone knows that the Baby Boomers alone are causing a major tidal wave that is starting to wash upon the shore as we speak. Give it ten years and we will have an overwhelming amount of elders in our nation, and most likely a lack of resources to treat them properly. But what is properly? Speaking about his mother who was diagnosed with lung cancer after smoking her whole life, Thomas quotes, "She seemed puzzled and a bit frustrated that she had to be so insistent on her own demise". Doctors are pushing for her to get this and that test done, and to prolong her life as much as possible. Now this ties in with my article last week as well. At what point do we cross the big "Euthanasia" line? At what point in time will it be not only acceptable, but encouraged, that we stop spending as much money on unnecessary treatment and prolonged life supplies on the elderly? "The need to spend less money on the elderly at the end of life is the elephant in the room in the health care debate. Everyone seems it but no one wants to talk about it. At a more basic level, Americans are not just afraid of dying, but about talking and thinking of dying. Until Americans learn to contemplate death as more than a scientific challenge to be overcome, our health care system will remain unfixable."

As of right now, almost a third of the money spent by Medicare- approximately $66.8 billion a year- goes to the end of life patients in their last two years of life, when patients are the sickest. Studies show that about 70% of people want to die at home but that about half die in hospitals. How are we looking right past this? Why aren't we doing a better job of taking these specific elders that insist on not getting the tests and treatments and just want to die in peace at home? Doctor's face two challenges: First, they want to be heroes. They want to be heroes for themselves, for their patients, for their friends, for their reputations. Doctors have grown to be used to the fact that "Americans want the best, they want the latest, and they want it now." Doctors want to do all they can to cure these ailments and build a reputation. Also, most doctors nowadays are paid by Medicare based on procedures. Essentially, the more procedures they order, the more they get paid; which ties into their second challenge. Americans nowadays have also gotten brainwashed into the same idea. The more treatments and tests the doctor orders, the better he must be for it. He must be smarter, a better doctor. People feel like they have been "jipped" for their money if tests aren't run to see what's wrong…even if nothing is wrong at all. We are a society of hypochondriacs, and test results make us feel better.

Thomas brings up a very obvious topic that I think us nursing students are all aware of, but no one really ever sits down to think about. Most elders, whether or not they are actually sick or just afraid, go to the doctors because it makes them feel better just going. They are essentially seeking a cure for loneliness and assurance, even if they are unaware of it. If we could focus our Medicare money and attention on money that could possibly go to organizations that are purely dedicated to spending time with the elders for a low cost, we could potentially save millions. If we spend more manpower, (not necessarily nurses or doctors) but even volunteers to sit with elders in their last years of life, to combat loneliness. What if that could work? We could create jobs to stimulate the economy by employing people to run or work for these organizations. "Death can be delayed for only so long, and sometimes the wait is grim and degrading". It Is unethical for doctors and medical professionals to prolong life on an unnecessary basis, when it is not wanted. For each case, they need a nurse's attention, they need a hospital bed, they need medicine, they need supplies, and they need manpower to help with whatever procedures need to be done.

We could save all that if we just thought about why we were doing it.