Nursing Notes

April 17, 2012

Mental illness means higher risk of physical problems

Filed under: Nursing — Shirley @ 1:08 pm
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Here’s an article from Nurse.com that talks about a study showing a correlation between mental health and physical health.  As a psychiatric nurse, I have always know that my patients have a higher risk of certain physical diseases.  It’s amazing to me that it has taken so long for others to notice and try to figure it out.

Asthama, diabetes, hypertension, and even strokes are common Axis III diagnoses for inpatient mental health patients of all ages.  There has to be a reason for this correlation.  Maybe now there will be more studies to try to figure out the connections.  I can only hope so.

Please read this excerpt of the article and click over to Nurse.com to read the rest.  It’s worth your time and effort to do so.  While there, check out some of the other articles they have about current nursing issues.

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Adults who had a mental illness in the past year have higher rates of certain physical illnesses than those not
experiencing mental illness, according to a report by the Substance Abuse and Mental Health Services
Administration.
For example, 21.9% of adults in a SAMHSA national survey who experienced any mental illness (based on
diagnostic criteria specified in DSM-iv) in the past year had hypertension. Meanwhile, 18.3% of those without any
mental illness had hypertension.
And 15.7% of adults who had any mental illness in the past year also had asthma, while 10.6% of those without
mental illness had the condition.
Adults who had a serious mental illness (a mental illness causing serious functional impairment that
substantially interferes with one or more major life activities) in the past year also showed higher rates of
hypertension, asthma, diabetes, heart disease and stroke than did people who did not experience serious mental
illnesses.
Adults experiencing major depressive episodes (periods of depression lasting two weeks or more including
significant problems with every-day aspects of life such as sleep, eating, feelings of self-worth, etc.) had higher
rates of the following physical illnesses than those without major depressive episodes in the past year:
hypertension (24.1% vs. 19.8%), asthma (17% vs. 11.4%), diabetes (8.9% vs. 7.1%), heart disease (6.5% vs.
4.6%) and stroke (2.5% vs. 1.1%).
The report also shows significant differences in ED use and hospitalization rates in the past year between adults
with mental illness in the past year and those without. For example, 47.6% of adults with serious mental illness
in the past year used EDs, as opposed to 30.5% of those without past-year serious mental illness. Adults with
past-year serious mental illness were more likely to have been hospitalized than those without (20.4% versus
11.6% respectively).
“Behavioral health is essential to health. This is a key SAMHSA message…[read more]

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August 24, 2011

Seventeen Percent of Cancer Nurses Unintentionally Exposed to Chemotherapy, Study Finds

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Here is an interesting article from Science Daily about nurses’ exposure to chemotherapeutic agents.  What I love about the articles I find at Science Daily is the exposure you get to new and exciting scientific data.  The information is usually the early results of formal investigations, but it is interesting to get this glimpse into the workings of the medical, environmental, psychological, biological, and anthropological scientist’s minds.

With that in mind, I present this article about the cost to nurses who are routinely exposed to chemotherapy.  This is probably going to turn into the next big push for safety in the nursing field, so it is pertinent to discuss here.  Please read this article and visit the original site for others similar; then come back here and let’s discuss.

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ScienceDaily (Aug. 23, 2011) — Nearly 17 percent of nurses who work in outpatient chemotherapy infusion centers reported being exposed on their skin or eyes to the toxic drugs they deliver, according to a new study from the University of Michigan Comprehensive Cancer Center.

The study surveyed 1,339 oncology nurses from one state who did not work in inpatient hospital units. About 84 percent of chemotherapy is delivered in outpatient settings, largely by nurses. Results appear online in the journal BMJ Quality and Safety.

“Any unintentional exposure to the skin or eyes could be just as dangerous as a needle stick,” says lead study author Christopher Friese, R.N., Ph.D., assistant professor at the U-M School of Nursing.

“We have minimized needle stick incidents so that they are rare events that elicit a robust response from administrators. Nurses go immediately for evaluation and prophylactic treatment. But we don’t have that with chemotherapy exposure,” Friese says.

Safety guidelines for chemotherapy drug administration have been issued by organizations such as the National Institute for Occupational Safety and Health. But these guidelines are not mandatory. Guidelines include recommendations for using gowns, gloves and other protective gear when handling chemotherapy drugs.

The U-M Comprehensive Cancer Center adheres to these safety guidelines and has procedures in place to implement and enforce them for all staff who administer chemotherapy drugs. U-M nurses did not participate in this study.

The study authors found that practices that had more staffing and resources reported fewer exposures. Also, practices in which two or more nurses were required to verify chemotherapy orders — part of the suggested guidelines — had fewer exposures.

“This research shows that paying attention to the workload, the health of an organization, and the quality of working conditions pays off. It’s not just about job satisfaction — it’s likely to lower the risk of these occupational hazards,” Friese says.

Unlike needle sticks where a specific virus is involved and preventive treatments can be given, it’s more difficult to link chemotherapy exposure to a direct health effect. That makes it more difficult for health care systems to respond to these incidents. Unintentional chemotherapy exposure can affect the nervous system, impair the reproductive system and confer a future risk of blood cancers.

Friese collaborated in this study with the U-M School of Nursing’s Occupational Health Nursing Program, which focuses on training nurses to promote injury prevention and protect against work-related injuries and environmental hazards on the job. By combining this practical occupational health perspective with the expertise of quality and safety researchers, the team hopes to better understand what happens during chemotherapy exposure and what can be done in the work place to prevent it.

“If we ensure patient safety, we should also ensure employee safety by strictly adhering to the national safety guidelines…[read more]

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August 11, 2011

5 Reasons Nurses Want to Leave Your Hospital

Here is a really good article from HealthLeaders Media.  I frequently find great articles on this site, so I do encourage you to visit there and look for yourself.  After reading this article, I felt that my thoughts had been broadcasted out into the internet.  This article discusses the comments and thoughts of all the nurses I have ever worked with as well as my own thoughts.  I would like to add a 6th reason for a nurse to be looking to leave a hospital and that is personal safety.  If the facility does not think enough of its nurses to protect them from random attacks, it is definitely time to leave.

Please read this article and come back here to let me know what you think.  I love a good discussion, don’t you?

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Rebecca Hendren, for HealthLeaders Media, August 9, 2011

Your nurses have one eye on the door if you do any of the following.

Although economic woes abound, nurses are planning their exit strategies and will make a move when things improve. A recent survey from healthcare recruiters AMN Healthcare found that one-quarter of the 1,002 registered nurses surveyed say they will look for a new place to work as the economy recovers.

Are your nurses engaged, committed employees? Or are they biding their time until they can go somewhere better? To predict whether you face an exodus, take a look at the following five reasons why your nurses want out.

1. Mandatory overtime

Nurses work 12-hour shifts that always end up longer than 12 hours due to paperwork and proper handoffs. At the end, they are physically, mentally, and emotionally exhausted. Forcing them to stay longer is as bad for morale as it is for patient safety.

Some overtime is acceptable. People get sick, take vacations, or have unexpected car trouble and holes in the shift must be filled to ensure safe staffing. Nurses are used to picking up the slack, taking overtime, and pitching in. In fact, overtime is an expected and appreciated part of being a nurse. Many use it to help make ends meet. Mandatory overtime, however, is a different matter. Routinely understaffed units that rely on mandatory overtime as the only way to provide safe patient care destroy motivation and morale.

Take a look at the last couple of years’ news stories about RN picket lines. Most include complaints about mandatory overtime.

2. Floating nurses to other units

One nurse is not the same as another. Plugging a hole in a geriatric med-surg unit by bringing in a nurse from the pediatric floor results in an experienced, competent nurse suddenly becoming an unskilled newbie. A quick orientation won’t solve those problems. Forced floating is usually indicative of larger staffing problems, but even so, its routine use is dissatisfying and compromises patient safety.

Instead, create a dedicated float pool staffed by nurses who volunteer and who can be prepared and cross-trained. Institute float pool guidelines that nurses float to like units. For example, critical care nurses find a step-down unit an easier transition than pediatrics.

Float pool shifts open up options for nurses who need more flexibility and offering a higher rate means you’ll never be short of volunteers.

3. Non-nursing tasks

Nurses are already understaffed and overworked. Hospitals with too few assistants rub salt on the wounds. RNs shouldn’t have to take time from critical patient care activities to clean a room or collect supplies. Gary Sculli, RN, MSN, ATP, patient safety expert and crew resource management author, offers a vivid analogy. Imagine if half way through a flight you saw the pilot come down the aisle handing out drinks because the plane was short staffed. It just wouldn’t happen.

Yes, cleaning a room is important, but don’t force nurses’ attention away from their patients. Distractions are dangerous and compromise patient safety…[read the rest]

 

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July 1, 2011

Patient Classification Systems Address Nurse Staffing Balance

Here is an interesting article from Health Leaders Media that I found.  I have read this article several times, because I am impressed with the information it contains.  It is not often that you come across an article that actually gives nurses and nursing in general any credit for lowering bottom line costs and increasing productivity, while improving customer satisfaction.

As a nurse who has worked in the Sharp system as a travel nurse, I can say that their use of electronic staffing equipment far and away leads the nation.  The nurses working for this system really are satisfied and relatively happy with their current employment.  There is the ordinary stress-related bickering, but if asked, these nurses will mostly tell you that they like where they work.  That is a far cry from the responses I have gotten at other hospitals.

Please read this article and then let me know what you think.  Visit the original site, too, because there are many wonderful nursing articles available there.

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Susan Stone, PhD, RN, and Ruth Plumb, MSN, RN, for HealthLeaders Media , May 24, 2011
Determined to achieve meaningful use of electronic health records (EHR), hospitals and health systems will increasingly adopt clinical information technology between now and 2015. This is certainly a welcome development for our economy and patient health. However, because providers are putting larger investments into EHR systems, they are overlooking other strategies to quickly enhance clinical and financial performance and support their pending transformation to accountable care.

While EHR technology is key to reducing costs and improving care quality, safety, and outcomes, providers also can achieve these goals by leveraging patient classification software and managing nursing staff more effectively. When used in parallel or integrated with an EHR, these combined resources give organizations extra tools to realize even greater clinical and financial benefits. This is a lesson that San Diego-based Sharp HealthCare has learned and benefited from over the past two decades.

Since 1990, Sharp HealthCare has used a nursing staff management solution to assign nursing staff and resources appropriately, improve care, and manage RN labor costs and department budgets. Every hospital faces these common challenges, but addressing them successfully is especially difficult for California-based providers struggling to survive the Golden State’s unique and pervasive capitated environment.

Though health systems in other states have not been exposed to capitation, this will change soon with the Patient Protection and Affordable Care Act allowing the Centers for Medicare & Medicaid Services (CMS) in early 2012 to use payment models such as partial capitation. Under this particular model, providers and accountable care organizations will bear some but not all of the financial risk.

In addition to helping organizations better manage their bottom line in a risk-based reimbursement environment, a patient classification system makes it easier for hospitals to comply with nurse-to-patient ratio regulations. Fifteen states and the District of Columbia have passed nurse staffing legislation, according to the American Nurses Association. But with hospitals admitting a higher volume of sicker patients and cutting nursing budgets across the country, RNs and others are increasingly urging lawmakers in other states to pass laws to ensure sufficient staffing to meet patients’ needs.

Having the right skill mix and nurses with the necessary skills readily available to take care of the right patient at the right time is essential to quality of care, patient safety and financial health. Still, it is common for nurses, unions, and state regulators to question hospitals’ staffing level decisions. An intensive care unit RN, for instance, may contend that a patient’s acuity demands his or her sole attention or the services of an additional nurse. This questioning or complaint about inadequate staffing, which tends to increase when facilities institute layoffs in poor economic times, is often emotional.

A patient classification system enables hospitals to remove emotion from the equation by demonstrating through hard data that its decisions are valid, not arbitrary. The tool applies an evidence-based approach to assign, match, and schedule nurses where they are needed the most based on patient acuity level.

Institutions that use the technology to assess acuity on every shift across all patient care units are able to provide objective documentation showing they are not understaffed, which of course places patients at risk. This proactive assessment of patient acuity helps ensure business continuity when regular charge nurses are out sick or on vacation. Replacements typically are less familiar with a unit’s policies and procedures, which can result in poor patient outcomes and higher costs.

A patient classification system promotes operational consistency by offering data on fill-ins that can be used to run a department efficiently in the absence of the regular charge nurse. More importantly, the process of assessing acuity on every shift gives health systems the ability to act immediately to prevent understaffing and overstaffing, both of which result in higher costs from potential malpractice lawsuits, disputes with employees, lost productivity and overtime.

Lack of awareness among many nurses about the budget process, healthcare financial management principles and how assignments are determined is a major reason for those costs. When bedside RNs are unaware of the financial role they play in managing and determining the fiscal health of their employer, nurses and administrators are pitted against each other.

To eliminate damaging infighting and wasteful spending, Sharp HealthCare, which serves 1.3 million residents of San Diego County in southwest California, has made it a priority to educate nurses how to use the patient classification system to analyze, track, and monitor staffing, productivity, and nursing budgets. Its leaders discuss the critical role that technology, patient acuity, and appropriate nurse assignments play. Every Sharp HealthCare facility shares annual financial targets and justifies its department budget. Hospital executives and RN leadership emphasize that their budget development is comparable to how RNs manage their household finances. In other words, the health system deploys the funds it has to provide care in the most efficient and cost effective manner possible. Like nurses—or anyone else—Sharp HealthCare cannot spend money it does not have.

Today, RNs understand staffing decisions are based on patients’ best interests as opposed to driven by an effort to save money at the expense of quality care. The results are fewer misunderstandings, misconceptions, and conflicts that distract Sharp HealthCare hospitals and nurses from their core clinical mission.

Sharp HealthCare sets goals for facilities partly based on the location and the size of an institution’s nursing staff. As a not for profit healthcare system, the organization’s long-term viability is dependent on its financial health and well being.

Increased nurse awareness and the nurse staffing management system have helped Sharp HealthCare not only weather a weak economy for the past three years, but also post impressive financial results during the same period.

The outreach also gives nurses a clearer view of the economic picture at the facility and enterprise levels, and how their institution compares to local and national peers. Whenever a financial variance occurs in their unit, RNs now can easily pinpoint it and determine the reason why. The software enables Sharp Healthcare to:

  • Deliver accurate patient acuity, skill mix, and census data in real time, ensuring charge nurses and nursing managers have the information necessary to optimize clinical and financial outcomes
  •  Analyze retrospectively whether nursing assignments were a factor in near misses that harmed or placed patients at risk
  • Aggregate information to enhance clinical, financial, and operational decision-making
  • Benchmark internal evidence-based data against national standards for acuity
  • Develop and successfully manage nursing budgets

To further increase time savings for nurses and validity and reliability of data, Sharp HealthCare now is working to integrate the software with its EHR.

With health reform altering reimbursement models and the first of 78 million baby boomers beginning to turn 65 years of age in 2011, staffing, clinical, and financial pressures on providers will only intensify. Since RN labor costs represent providers’ single largest controllable expense and a significant percentage of their operating budget, it is critical to use nursing resources more efficiently and enlist RNs as strategic assets and financially oriented managers. Providers following this path will find it easier to navigate the rapidly changing healthcare ecosystem and meet their goals.


Susan Stone, PhD, RN, is chief nursing officer and Ruth Plumb, MSN, RN, is an acuity nurse specialist at Sharp HealthCare, which comprises four acute care and three specialty hospitals in southwest California.

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June 7, 2011

Public Health Nursing, Anyone?

Filed under: Nursing — Shirley @ 2:16 pm
Tags: , , , , ,
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Have you ever thought about becoming a Public health nurse?  I never had even given it a single moment.  Then I had a friend email me about going to Alaska to do public health nursing and I had to see what it was all about.

I found this video on YouTube and thought it would be interesting for other nurses to see, so will post it here.  I’m too far along in my career to consider this, but for you younger nurses, this looks like real nursing at its best!

Please watch the video and leave me a comment on your thoughts about this type of nursing, won’t you?

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May 17, 2011

Health Coaching

Here is a wonderful article that showcases Health Coaching in a very positive light and show the benefit our patients get from such a great program, when it is available.  Health Coaching goes hand-in-hand with the work that nurses at the bedside do.  We do education and review of behaviors, the health coach makes a game plan with our patients and follows up with them to encourage participation.

With all the focus on healthcare changes right now, it is very uplifting to find such a wonderful article about this new profession.  I firmly believe that health coaching is here to stay and we need to figure out how to integrate this activity into our patient care.

This article is from Hospital and Health Networks Magazine.  This magazine is full of timely and useful information about all the changes taking place in the healthcare field today.  I recommend you visit the site and spend some time reading there.

Let me know what you think about this article and about health coaching, won’t you?

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By Tracy Granzyk Wetzel

Hospitals update their playbooks to make patients active members of the care team

Clint Coon is a computer network manager for the Iowa Department of Safety, still working full time at 66 years of age while managing health conditions affecting his heart, kidneys, vasculature and sleep—in addition to cancer.

Achieving effective communication between two specialty groups is an accomplishment; managing five at once is nearly miraculous. But Coon has a partner on the inside—Dave Swieskowski, M.D., CEO of Mercy Clinics in Des Moines. Swieskowski is a data hound who believes that systems must be redesigned to better harness technology developed over the last 50 years. And he strongly believes patients must be more involved in their own care.

Engaging patients at Mercy Clinics is now part of daily operating procedure. At the forefront is their physician office-based health coach program, which allows Mercy to proactively manage the blood pressure, glucose levels and immunization rates of more than 25,000 patients.

“Any clinical goal we set, we can hit pretty easily,” Swieskowski says. “Cholesterol, cancer screening—it’s all the same process. Any type of follow-up that needs to be done, we think we can get 95 to 97 percent of patients to do so.”

Mercy has been tracking patient outcomes for about 15 years, and success is equal parts patient and provider effort. Through the health coach and shared decision-making programs, patients are trained to become active participants in their care. Health coaches ask patients to set health behavior goals versus outcome goals, and together, coach and patient develop a behavior-change plan with one- to two-week follow-up compared with the typical three months.

“You have to know your patients, track them and measure what is going on with them,” Swieskowski says.

The majority of Coon’s health care takes place at Family Medicine in Urbandale, Iowa. After discharge from a recent hospital stay, Coon’s first stop was the clinic. He walked in without an appointment, and within minutes was in his coach’s office, filling in gaps of information not yet received from the hospital.

“This kind of relationship is greatly appreciated—this go-between, or breaking down of the extended time you can’t reach a doctor,” he says. “I think patients are more comfortable because they get a fairly rapid response.”

Health & Human Services has made patient engagement a priority. In March, Secretary Kathleen Sebelius released the National Strategy for Quality Improvement in Health Care. The strategy, mandated by the Affordable Care Act, defines three broad aims and six national priorities, including “Ensuring that each person and family are engaged partners in their care.”

The pressure to reduce avoidable readmissions underscores the need to engage patients better. In an April 2, 2009, New England Journal of Medicine article, Stephen Jencks, M.D., reported that 50.2 percent of Medicare beneficiaries readmitted within 30 days had not seen a physician between discharge and readmission.

Though many readmissions are planned, experts say some could be avoided partly by helping patients understand their conditions and what they need to do once they’re out of the hospital, and then to stay in contact with them to make sure they are following through.

“The best organizations will thrive in new ways when thinking differently about engaging patients,” Institute for Healthcare Improvement President and CEO Maureen Bisognano said at the American College of Healthcare Executives national conference in March. “We need to understand the entire journey of our patients.”

‘Not Just the Medical Stuff’

Health systems in search of excellence, like Mercy Clinics, are leading the way in coordinating care for their patients and engaging them in the process.

Steven Counsell, professor of medicine at Indiana University and a scientist at the Center for Aging Research, designed the Geriatric Resources for Assessment and Care of Elders program, first implemented at Wishard Health Services in Indianapolis. The GRACE program uses a team approach combining transitional and primary care via home visits, and engaging patients in a care plan individualized to their needs. A social worker and nurse practitioner perform an in-home assessment of patients; collaborate with the GRACE team, which includes a geriatrician, pharmacist and mental-health case manager; and remain the link between patient and primary care physician. Weekly team conferences keep everyone on target.

“It’s not just the medical stuff,” Counsell says. “You can have a great plan for heart failure, correct…[read more]

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April 29, 2011

Confessions of a Psych Nurse

Here is an article I found on NurseTogether that absolutely blew me away.  As a psych nurse for over 20 years, I can empathize and sympathize with this author.  She speaks my thoughts.  It is amazing.  I immediately emailed her for permission to repost this article here for you to read and enjoy.  Won’t you let me know how you feel about the things she has to say?  Please click over to her website and read some of her other posts and maybe leave her a comment while you are there.

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A Nurse Confesses:  There is no way to work on a psych ward of a mental hospital and not learn something about life; I have met some of the strangest and most original individuals.  When people find out where I work, and have worked for almost 22 years, their mouths hangs open in awe.  Most of the time the phrase, “I don’t know how you do it” is mentioned, as they shake their heads.

 I confess there are things about working in a mental health institution that I do not like, and there are times when I have to bite my tongue and keep my lips glued together because I become so agitated.  I thought I would list for you my dislikes and explain later what I have learned.  Deep breath…here I go.

 I dislike when someone comes into the hospital just so they can get a check (aka crazy check) when they are clearly healthy but truly too damn lazy to work.

 I dislike when someone is purely and simply mean spirited and uses their diagnosis of being mentally ill as an excuse to cling to.

 I dislike when prisoners come in and break furniture, hurt the staff, share their rude and unintelligent slurs to the staff and demean them, because they have nothing to lose and will be going back to jail.

 I dislike an addicted individual who tries to use their mental illness to be prescribed Benzo to feed their habit, and then becomes demanding when they are told no.

 I dislike restraining someone in the bed.  It makes my heart hurt to see someone, or have to place someone, in that situation.  Even though I know at the time it has to be done – everything else has been exhausted – sometimes it is necessary to protect the staff and the patient. 

 I truly dislike calling a doctor who blows off the fact that the nursing staff have already tried many measures before calling him in the middle of the night for more help, and he refuses it because he doesn’t think it is needed.  I also dislike that he feels he shouldn’t have to come to the unit to observe what is going on, leaving the staff in harm’s way.

 I dislike a doctor who comes to the unit during a high risk situation and hides behind the female staff for protection.  I am not a shield; I am a nurse with a family, just like he has.

 I dislike staff who forget how blessed they are and that they have a home to go home to, when a patient is crying because they are homesick and cannot return to their home.

 I dislike not being able to help a patient understand what he/she is seeing – climbing the walls is part of their illness and not real – but they can clearly can see something there.

 I dislike looking into someone’s eyes and seeing pain, hurt, and loneliness – lost souls that I cannot help.  I really dislike that feeling.

 When a new patient comes onto the unit, I like to learn about who they are, not who the chart says they are.  I want to know where they used to work, where they went to school, how many brothers and sisters they have, and whether they are married and/or have children.  I have found that when I approach a patient as a person, rather than as a patient, they open up and let down the walls that they come in with.  I get to peep inside of their lives for just a moment.  I dislike when staff forget that the people we serve had a life before they arrived on our unit.  They attended school, had some kind of home, they have a mother, father, wife, husband, and/or children.  We have all made some really crappy choices in life – we may not have landed in jail or in a mental hospital, but there were choices made along our path.

 I confess – my psych patients have taught me a lot about life.  I have not always liked working in chaos and in hazardous and dangerous situations, but I have always liked talking to the ones I meet.  They have showed me that we are all one step away from the admission office when life hands us more than we can bear.  They have taught me that just because I cannot see delusions and hallucinations doesn’t mean they are not real.  They have taught me the feelings of real compassion for another human when they cannot help themselves.  They have taught me that being with family is not always the safest place to be.  At times, families hurt family members deeper than a stranger does.

I confess – my life has been changed by a mentally insane person.  Just think…yours could be too.

About the Author: For the first 5 years online, Angela Brooks spent her time in network marketing e-commerce with health products. In the last year, she has followed her passion where she has worked for over 21 years in the same state funded psychiatric hospital, working in a dangerous acute psychiatric ward.

Angela also runs her own company on the side and supports other nurses in how to bring passion into their role at work. Visit www.AngelaBrook.com.

Click here for more information on Angela Brooks.

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April 28, 2011

Residential Health’s med monitoring pilot slashes readmissions

HELP Telemedicine clinic 1

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Here is an article that describes another way that telemedicine can be utilized to prevent readmission.  In reading this article, I was confused by the physicians who did not want to participate in this study.  Why?  If this is a way to maintain a patient’s health while out of the hospital, what is the problem?

Please read the entire article and come back here to tell me what you think, okay?  I really would like to hear from you on this topic.  It seems that telemedicine is the wave of the future and we need to be prepared to use it as nurses.  I think it is a great tool for health.  That’s just my opinion.  What’s yours?

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By Jay Greene

Crain’s Detroit Business

A pilot project by Madison Heights-based Residential Home Health LLC that uses remote medical monitoring held hospital readmissions to 3 percent last year for 239 patients with congestive heart failure and chronic obstructive pulmonary disease.

National data show that 20 percent of all Medicare patients are readmitted to hospitals within 30 days, and 33 percent are readmitted within 90 days, costing Medicare more than $17 billion annually, according to a 2009 study in the New England Journal of Medicine.

In similar patients who did not participate in Residential’s Cardiopulmonary Hospital Admit Management Program, called CHAMP, during the last six months of 2010, the readmission rate was 25 percent, said David Curtis, Residential’s president.

But remote monitoring isn’t universally popular.

“Not every patient wants to use telemonitoring, and some physicians don’t want it,” Curtis said. “In order to drive down readmissions, we need better alignment (with patients and physicians).”

Curtis said the reduction in readmissions comes by focusing on three areas: educating patients within 24 to 48 hours after going home from the hospital, preventing medication errors, and having patients take vital signs with the devices daily.

Residential uses remote medical monitoring devices provided by Philips Telehealth Solutions including wireless weight scales, blood pressure cuffs and blood glucose meters.

Residential nurses and therapists teach patients to use the Philips devices. The data is transmitted daily to Residential, where nurses monitor it and contact physicians if warranted.

But the use of remote medical monitoring devices to reduce readmissions is still in its infancy and studies have shown mixed results.

For example, a study published November in the New England Journal of Medicine showed no reduction in readmissions from use of telemedicine in heart failure patients. However, the study concluded that many of the patients didn’t take daily readings from the instruments.

Curtis is familiar with the studies and says the effectiveness of the remote monitoring devices is only as good as nurses and therapists following up with patients to make sure they are compliant.

“If we don’t hear from our patients by 11 a.m., we are calling to remind them,” Curtis said. “The value of telemedicine is not in the equipment, it is in the process and patient education we use to prevent readmissions.”

Christopher Kim, M.D., a hospitalist at the University of Michigan Hospitals in Ann Arbor and a readmission reduction expert, said some technology vendors are aggressively promoting the use of telemedicine devices to reduce hospital readmissions.

“I am not sure it is completely justified yet,” he said. “The technology can help, but we have to look at our workflow and make sure we coordinate care with post-acute providers to keep patients out of the hospital.”

Besides the program saving Medicare money and improving patient care, Curtis said demonstrating low readmission rates will help bring more patient referrals to Residential from physicians.

“If we have the best outcomes, we can generate new business,” said Curtis, a health care and manufacturing consultant who acquired Residential six years ago with three other partners, including Chairman and CEO Mike Lewis, a lawyer who was a senior partner at Troy-based Dean & Fulkerson.

The company is already one of the state’s largest non-hospital-based agencies with more than 2,200 patients, according to the Michigan Home Health Association.

Annual revenue for 2010 for Residential and its affiliates totaled $48 million, down from $53 million in 2009, Lewis said. The revenue slide came from rising costs and flat Medicare payments, a shortage of nurses and therapists that limited census, and costs associated with expanding into Illinois, he said.

“We had staffing issues last year because of the nursing shortage, but this year we have hired one clinician every other day (more than 50 nurses and therapists),” Lewis said.

Of Residential’s 473 employees in Michigan, 255 are nurses and therapists and 17 employees are part of the company’s marketing and community liaison team, Curtis said.

In Michigan, Residential averages 1,500 patient home care visits per day, a 20 percent increase from last year. The company also has an agency in Illinois that averages about 300 patient visits per day.

Jerry Wilborn, M.D., a pulmonary critical care specialist and hospitalist who refers some patients from Botsford Hospital to Residential, said he uses data collected by Residential to determine…[read the rest here]

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April 15, 2011

Nurse Dies After Assault At Cape Mental Health Center

As a mental health nurse, of course, this article held some significance for me.  But the problem discussed here–death and physical damage done to nurses during normal work hours–really belongs to all of nursing.  I don’t think about the potential for being hurt when I get up each morning, but the truth of the matter is that I deal with a very volatile population and that staffing for this type of patient is never adequate.  99% of the people I care for would never, ever hurt me or any other person; dispite having a mental illness.  It is that 1% that I have to worry about.  My difficulty is in identifying them in time to protect myself.

My heart goes out to this nurse’s family.  My heart goes out to this nurse’s workmates.  There is nothing quite a scary to a mental health team as the death of one of their own while at work.  I hope that hospital provides the staff with some type of counseling to deal with this event.

Here is the article.  Please read the entire article and feel free to visit the original site to leave a comment there.  Please leave me a comment if you have any thoughts about this article.

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April 14, 2011 11:13 AM

Cape Cod & the Islands Community Mental Health Center in Pocasset. (photo courtesy: David G. Curran/SatelliteNewsService.com)

Cape Cod & the Islands Community Mental Health Center in Pocasset. (photo courtesy: David G. Curran/SatelliteNewsService.com)

POCASSET (CBS) – The death of a nurse at a Cape Cod mental health center may mean new charges for the patient suspected in the crime.

Back in late March, 60-year old Jason Lew, a nurse at the Cape Cod and islands Community Mental Health Center, was assaulted by a patient. Lew’s injuries were so serious he was brought to several different hospitals before he died last Friday.

“There was some kind of an altercation. The nurse who subsequently died was assaulted during the course of the altercation,” said Cape and Islands District Attorney Michael O’Keefe.

O’Keefe said the suspect was immediately arraigned on assault charges, but depending on what the medical examiner finds, more charges could follow.

“It was a couple days later that the individual was deceased. So, it’s that full sequence of events that is the subject of an investigation to see what, if any, other charges might be appropriate,” said O’Keefe.

If the assault is found to have played a role in Lew’s death, it would make it the third worker in a local mental health center to have been killed by residents in the past four months.

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April 4, 2011

A New Program for Foot Care Nursing is Available Online

Foot care is not the most glamorous  area of nursing care, but I believe it is one of the building blocks to good health.  If feet are not assessed and cared for properly, all types of physical and emotional issues can arise.

I have always been interested in learning how to do proper foot care and used to follow a particular thread on Allnurses.com’s forum that was about foot care as a business idea for nurses.  I got frustrated when I learned that to become trained and certified, I would need to go the west coast to take classes and then I would need to certify with Wound Care certification.  It seemed like quite a bit of effort and money to maybe be able to make a living as an entrepreneur nurse.

Imagine my surprise and delight when I found this PR in my email.  I am really interested in checking this out, and I thought someone out there also might enjoy this information, so I am posting it here.

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Poor or no foot care can cause infections, amputations even death of Diabetics. Professional Education, LLC, is launching a comprehensive Foot Care Program online for nurses.

This program requires no travel, no time away from home or work and no specific dates or hours of attendance. It can be the prep program for the exam for Certified Foot Care Nurse, a new specialty nurses can add to their career resume.
Austin, TX (Vocus/PRWEB) January 29, 2011

Professional Education, LLC, has a Foot Care Program for RNs that is entirely online. The program brings their knowledge-base in diabetic foot care to where it should be. Regular and monitored foot care is essential for diabetics and those with other chronic illnesses, and a deficiency in this care can be deadly. Diabetes Mellitus is said to be diagnosed in over 11.2% of men and 10.2% of women over 20 years old, according to the American Diabetes Association, but few nursing schools include more than a cursory mention of care of the feet in their curriculums. No nursing text reviewed had over 1.5 pages of text on the feet and many less than one.

A new specialty, Foot Care Nurse (CFCN) now provides the information for nurses to perform appropriate foot care to diabetics and other chronically ill patients. Professional Education’s RN Foot Care Program on http://www.continuing-your-education-online.com is a prep class for the Wound, Ostomy and Continence Nursing Certification Board exam (http://www.wocncb.org) to become a Foot Care Nurse (CFCN®) or can be taken just for added information. This specialty is growing rapidly because of the maturing of our population and the rapid increase in diabetics. A Certificate of Attendance to a prep course and an Internship are required for taking the FCN exam. The exam is taken at nearby test centers.

The trend in attaining specialty certifications makes this Program attractive. Nurses with a specialty certification are paid an average of $12.81 more per hour, according to the RN Magazine’s 2009 Nurse Earnings Survey. Though not defined by specialty, this Survey does indicate that a specialty increases the earning power of RNs.

“Foot Care Nurses are valuable in these days of the high rate of diabetes,” says Suzie Fleak, R.N., Centrum Manager, Columbus, OH. “Foot care is important to maintaining health for the diabetic.” Fleak suggests these specially trained nurses can be utilized in nursing homes, wound care facilities, critical and emergency care units; in community and home health nursing, medical and podiatry offices and many other locations where health care is provided.

Professional Education, LLC, launched January 2011, will be offering quality courses within a wide array of professional specialties and strives for excellence in the programs. All courses will be on-line only, though when needed by the specialty, Internships will be designed for that purpose. All courses are written by experts in the specialty. For questions and if you know of courses that would meet our site goals, see http://www.continuing-your-education-online.com or contact us at 512-763-9340.

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