Identifying patients at risk for Ebola

Ebola is knocking at our door…will you open it?

How to identify patients at risk

Knock knock.

Whose there?

Ebola.

Ebola who?

No, I’ve got Ebola you idiot, let me in.

Is it just too soon for joking about this topic? The headlines are horrifying, telling us things like “Ebola is here”, “Burn the bodies” and of course “Fear of Ebola breeds a terror in physicians”.   This is what we are talking about at the water cooler right now. People are afraid of Ebola.   People need answers. Let’s find answers…

What to look for (Symptoms)

The incubation period for this virus is from 2 to 21 days, with humans becoming infectious during the onset of the first symptoms. These first symptoms include:

• Sudden onset fever
• Fatigue
• Muscle pain
• Headache and sore throat
• Vomiting
• Diarrhea
• Rash

As this virus continues:

• Kidney and Liver function
• Both internal and external bleeding (oozing from gums, stools)

Other things to look at include laboratory findings such as a low white blood cell count and elevated liver enzymes.

It can be difficult to differentiate Ebola from other viruses even with all of these symptoms present, so the following test are also completed before a diagnosis can be made:

• * antibody-capture enzyme-linked immunosorbent assay (ELISA)
• * antigen-capture detection tests
• * serum neutralization test
• * reverse transcriptase polymerase chain reaction (RT-PCR) assay
• * electron microscopy

* virus isolation by cell culture.

Again, most of the early symptoms are very ambiguous, and they will present very much like any other virus such as the flu. The key is really going to be two fold: 1.) ask questions. 2.) remain calm.

When we triage patients; that’s where the questions need to be very direct. Try questions such as:

1. When did your symptoms begin?
2. How high has your temperature been?
3. Did you have a Flu shot this year?
4. Have you been outside of the country in the last month?
5. If so, where did you go?
6. Have any of your friends and family been out of the country in the last thirty days? Where did they go?

Be careful with these questions, we know that people tend to be less than forthcoming when they feel threatened. Our patient’s are not on trial here, we simply want to protect them as well everyone else.

Ebola is extremely frightening for any patient to even consider, especially since it is still thought of as a death sentence. It’s for that reason that the healthcare professionals, although completely “freaked out” themselves, must remain calm and offer hope to the patient.

So, they have the diagnosis…what now?

First of all, the patient will be placed on droplet isolation as per the CDC recommendations (2). Then supportive care will be the key. Although there are two potential vaccines on the horizon, neither one has been approved as of yet (3). So, we will focus on rehydration and treatment of specific symptoms as they arise.

Yes, Ebola is a scary virus. Yes, it will most likely make its way to the U.S. Yes, we will open the door to these patients just like we have for every other patient group.

For more information:

1. http://www.cdc.gov/vhf/ebola/pdf/ems-checklist-ebola-preparedness.pdf

2. http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html

3. http://www.who.int/mediacentre/factsheets/fs103/en/

Drowning in Depression

The last thing I remembered was my brother telling his buddies that he would teach me to swim in one easy step, next thing I remember was flying through the air and landing in the lake. I tried to scream, but as I sank into the water, no sound seemed to come out. I remember my brother yelling at me, “swim!” Swim? I had never been to the lake on my own before, and I did not know how to swim, and he wanted me to just start swimming? Really?

Obviously the best time to teach someone to swim is NOT while they are drowning. The same thing can be said for someone going through depression. During a “bout” of depression it’s not necessarily the best time to teach someone about ways to avoid drowning in depression. Drowning is exactly how it feels during depression for most people.

Preparation for swimming may entail things like swim lessons, floatation devices and practice. We typically teach people learning to swim the importance of never going swimming alone. Now for people who struggle with depression, preparation is a bit different…they get medication. Really though, couldn’t we say to those who are preparing themselves…never go into depression alone?

However, there are practical ways to prepare for depression before it comes back, here are a few ideas:

 

1. Learn to do life with others. Join a small group of some sort, and make yourself accountable to it and to those in the group. Having people in your life that will hold you accountable, no matter what, is so very important. Build genuine relationships, let people in, and open up.

2. Reach out to serve in your community. Now, serving in your community can be anything that you are comfortable with. If you have a chronic medical condition, perhaps something that has physical labor involved may not be the best option but there are other options.

3. Trust God with everything. This one really trumps the other ways to prepare as it provides you with Hope. Most people who are struggling with depression and perhaps even suicidal thoughts have lost all hope that anything can ever get better. Oh sure, I can tell people things like “cheer up” or “it will be better tomorrow”, but those are just words when you are IN depression…there does not seem to BE a tomorrow at those moments. But there is one who overcame the world for us, one who will not change and one who will love us for all time no matter the situation. Develop a relationship with your creator BEFORE the times of complete despair come, before you hit the bottom….He will catch you if you just allow Him to.

Depression is awful and the number of people who are struggling with it is just astronomical; as a matter of fact most people will have a time in their lives that they will struggle with depression, even if just a situational depression. Why not prepare before you get there? Take time today to begin building your preparation skills to avoid drowning in depression.

 

 

 

Mentored or Marinated (Nurse Bullying)

“Oh hell no! I am NOT going to take an orientee with me tonight; can’t they figure this stuff out? I really don’t have time for this, they always just drag me down”. These very harsh words were said directly in front of the new nurse as she sat awkwardly at the nurses station with the “senior nurses” arguing around her about who would “have to” take on the burden of orienting a new nurse.

The new nurse on the unit, inexperienced, unsure, and very dependent on others for direction during those first fragile new years into nursing. We have all been there at some point or another; or maybe you are there right now. How is that going for you? What is your experience like so far? Are you being mentored or are you being marinated for the next feast?

The new nurse in the above situation had an awful first experience into a profession that she had dreamt about for years upon years. I know her story very well, as it’s my story. It’s been over twenty years since I took those first steps into the health care field, but those very first impressions, the bullying I experienced, could have very easily changed my direction forever.

According to one study, 38 percent of working adults have experienced bullying at work and 42 percent have witnessed bullying behavior. And while most workplace bullies are men, women can be bullies, too: 40 percent of all workplace bullies are female, according to the “Workplace Bullying Institute.”

One source describes bullying as: “any vexatious behavior in the form of repeated and hostile or unwanted conduct, verbal comments, actions or gestures that affect an employee’s dignity or psychological or physical integrity and that result in a harmful work environment for the employee” (Canada Safety Council, 2005).

Okay, so what can we do to rid our profession of the cancer of bullying? Well, it seems straight forward enough, but we can go directly to the person who is bullying and confront the behavior in a non-confrontational way. Be very careful not to escalate the situation, rather just communicate that this is not acceptable.

If the direct approach is not effective the next step would be to report the behavior to our managers. For some reason we still seem to live by the old adage, “snitches get stitches”; but that is just not truth. Actually this simple action can sometimes be enough to extinguish the behavior. When we approach management with this situation try to have the bullying events well documented, if possible have witness statements available as well. Having all of our “ducks in a row” before we approach management will help management to deal with the situation in an effective manner. Your managers need to know what is happening in their units!

Bullying is hurtful and can give new grads a terrible first impression of nursing. Bullying in healthcare is nothing new, and it takes many forms, but does it really have to be something that we just accept as part of nursing? I say no. Let’s get out there and demonstrate the same compassion we give our patients to each other. We need to be supportive of each other…we are in this together.
Long hours, lack of breaks for food or bathroom and mandatory overtime does not give us reason to marinate each other for the feast; it is rather a reason to band together.

What is your experience?

Hands

Hands:

There is a man holding out his hands like the extended branches of a grand oak tree

He has worn and weathered hands

Wise hands

The kind of hands you can trust

Hands that were meant for holding

Although there is power in his fingers as they spread like the wings of an eagle

And I can tell these hands were meant for giving, not for taking

In the sunlight his hands become paper- thin leaves, revealing the roots of a family tree

This is a man who had mastered the art of reckless love

Carefree hands, hands that were meant to run wild

Someone who gave his heart away before it was acceptable

Hands that were before their time

This is a man who had proven his unyielding love everyday of his life

Nurturing hands that raised a family

He was a man who took great pride in his family but his wife was the real light of his life

Hands that had found the answer to every question they were searching for

Hands that didn’t have enough time

**

This man now sits in an assisted living community

Dementia has robbed him of his last memories of having a family

Whenever questions of his life are asked, the man has no answers now

Except to hold his hands out and whisper,

“I know I did great things with these hands. I can just tell.”

The man in the poem turned out to gain the family he always wanted, only to have it snatched away from him in the midst of his disease. You would never have know by looking at this seemingly crazed man the love he shared in his lifetime. Therefore, you can never really understand the depths of someones pain dealing with a disease like dementia. In the end all we have is perspective. Katherine Garcia.

http://abovethelaughingtree.wordpress.com/2014/06/06/new-perspectives/

When things DON’T get better

 I remember telling my mother, who had Multiple Sclerosis,  over and over again “it’ll be okay”.  She never argued the point with me, but it was definitely NOT okay.  As a matter of fact, she suffered with physical pain more days than not.

Mr. Smith found out that the pain he was experiencing in his back and legs for the last few months was caused by cancer that had already metastasized to the bones.  When we entered his hospital room that evening to do our change of shift report, he was emotionally distraught, the nurse grabbed his hand and said in a very confident voice, “it’ll be alright Mr. Smith”.

One report states that in 2005, 133 million Americans were living with at least one chronic condition, It goes on to say that this number is expected to grow by 2020 to 157 million (Bodenheimer, Chen & Bennett, 2009).

So, what do we say when things just aren’t going to get better?  The most comfortable thing to say for most of us is a quick “It will be okay”.  But is that really what’s best for the patient, or just what’s best for us?

Actually what happens to these patients more times than not, is they get put into one of three nice neat little boxes: the “frequent flyer” box, or perhaps the “drug seeking” box or a super easy box  the “hypochondriac” box.

Of course these labels are both false and extremely hurtful to the patients, but they take some of the self-imposed responsibility off of ourselves.  It’s ironic that a profession known to be compassionate and trustworthy would be so cold and dishonest with our patients whom we serve.

I do not believe that any nurse or medical professional truly chooses healthcare for a paycheck, but rather because we have made a conscious decision to put the needs of others above our own…we do this everyday that we see patients.  So, what can we do to reach out in compassion to this increasing patient population?

Listen to the patients needs.  People who suffer from chronic pain will typically speak of their pain in different ways than an acute pain sufferer.  They have learned to adapt coping skills that will down play the “look” of pain.  These patients may have family or friends at the bedside and be laughing and behaving like “all is well”, but verbalize to the nurse a pain level of 6, 7, or higher.  IF these patients say that they have pain…THEY HAVE PAIN. Listen to them properly, use your listening skills to decode what they’re hiding or minimizing.

Observe the signs of pain.  It’s not enough to just ask our patients to rate their pain on a scale of one to ten, we need to go farther and actually look for the signs that the patient may not tell us about.  We already know to look for facial grimacing, moaning and teeth grinding, but what about those that are irritated, moody, and angry?  They may very well be attempting to deal with their pain the only way they can.  Chronic pain sufferers will struggle with depression, decreased activity, poor concentration and many entertain suicidal thoughts or language.

Make sure they know they have Value.  While we may agree that every person has value, when we use platitudes with these patients we tend to devalue them and their feelings.  Things like “you just need things to get this off your mind”, or “you walked yesterday, you can do it today”.  An especially difficult one is, “you just need to work harder or try harder”.  Pep talks are great for the gym, but don’t translate well at the bedside.  Rather, allow the patient to tell their story and just listen.

Evaluate your own patients.  How do you feel about the patients who can’t be “fixed”, the ones who will be on the call light every four hours on the hour for their pain medications, the ones who verbally lash out at you when you forget to bring the medicine because you were so busy?  It’s frustrating to try and please these patients sometimes, and nobody enjoys being yelled at or berated because we didn’t do something in a timely manner.  Keep in mind that they are trying very hard to be “normal”, but they are going through a lot.  Chronic pain is just one of those things in life that’s hard to understand unless you’ve gone through it.  It tends to wreak havoc on the body and the mind, not to mention that it’s physically and emotionally exhausting.  All we can do is be patient and allow the patients to deal with their pain in the best way that they can.  We cannot fix them.

When we Listen, Observe, Value and Evaluate we show love to our patients who are suffering.  This does not come naturally to most of us, but our patients are worth our little bit of discomfort as we attempt to find the right words to say.

 Bodenheimer, T., Chen, E. & Bennett, H. (2009, February). Confronting the growing burden of chronic disease: Can the u.s. health care workforce do the job?.Health Issues, 33(2), Retrieved from http://content.healthaffairs.org/content/28/1/64.full

 

“I am a patient and I need to be heard.” A 15-year-old Explains Patient Experience in Human Terms

“I am a patient and I need to be heard.” A 15-year-old Explains Patient Experience in Human Terms.

In the line of Fire

In the line of fire

In healthcare, we all share a few things in common despite our areas of specialty. One of these things is that we each have made a choice to put the needs of others before ourselves.

I tell the story often in class when one morning a wonderfully feisty 71 year old woman who was on the ventilator, and had multiple contact isolations in place as well…as most of our patients do. This young lady decided to decanulate herself and went into respiratory arrest right after. When I heard the code called over head I rush to the room and found one of my co-workers compressing while another was bagging her; neither had on an isolation gown or even gloves. Everyone in that room was at risk for MRSA, VRE and her C-Diff, but the mentality of the room was focused on “not on our shift Mrs. Smith”.

As arrogant as that statement is for us to make, we have all muttered those sentiments about a patient. Although Mrs. Smith’s situation had a great outcome, we are not always guaranteed such results.

We get to come in contact with over 20 blood borne pathogens on any patient at any given time, and the exciting part is…we never know who is infected.

Take time to care for yourselves, remembering that at the end of your shift…you go home. Wear your PPE, wash your hands, and know your risks…. you are very important!

Who will speak

As I sat in the emergency room last week, I became acutely aware that patients need an advocate, someone to stand up and say, “wait that’s just not right”.

  “I am the Lorax.  I speak for the trees.  I speak for the trees for the trees have no tongues” (Dr Seuss, The Lorax).  Now patients have tongues, of this I don’t argue, but people don’t always understand all the lingo.

 Ok, I’m done talking in the Seussical rhyme.  However, it is true.  I sat for over an hour in a room where no one came to check on me, no one came to check my vital signs…no one came at all.  I eventually got up and left that very same hospital that I am employed by and went on to file a complaint.

 “Unless someone like you cares a whole awful lot,  Nothing is going to get better.  It’s not” (Dr. Seuss, The Lorax). 

 Okay, so I wasn’t completely done with Seuss.  There is so much truth there though, if we don’t get involved in the system, it wont ever get better.  

* Nurses, take time to see your patients, listen to them. 

* Doctors, your patients all have something to tell you, please listen to them. 

* Patients, don’t settle for mediocrity, stand up for yourselves and if you can’t hire an advocate.

 So, today I ask this question: Who will speak for the patients?

 

Enjoy the ride

I had a patient the night before last that changed my thinking; this young man had found out that very day that he has terminal cancer.  I went into his room expecting to see a depressed man, but found him instead playing a game of uno with his family.  After his family left I had time to talk to him for a while, so I asked him how he is staying so positive throughout this time?  He said that he wants to make happy memories for his family to hold onto after he’s gone.

I thought about what he said long after I left his room that evening…he’s right.  We have today, we’re not promised tomorrow.  So, what can I do today to make happy memories for those I love?

Here’s a few ideas:

* Be curious.  In a 2007 study, Todd Kashdan and Colorado State psychologist Michael Steger found that when participants monitored their own daily activities, as well as how they felt, over the course of 21 days, those who frequently felt curious on a given day also experienced the most satisfaction with their life—and engaged in the highest number of happiness-inducing activities, such as expressing gratitude to a colleague or volunteering to help others.

* Be Friendly.  In a recent Gallup World Poll, the biggest predictor of happiness at work was whether or not a person had a best friend they could call on for support.  Don’t isolate yourself…reach out.

* Be Flexible.  We can’t hide from the world or the negative things that happen, but we can make the choice to not dwell on it.

* Be creative.  Situations will happen, and there will be times when you don’t feel well enough to go out with the family or there just isn’t enough funds to go out.  When that happens why not stay home and play a board game, a card game  or find things in the house that have meaning like a locket or picture and tell the story.  Don’t isolate though, that punishes both you and your loved ones who want to spend time with you.

* Be Faithful.  Whatever your beliefs are…be faithful.  Over 85 percent of people confronting a major illness pray, according to a University of Rochester study.  One study even found that prayer raises dopamine levels which is associated with a feeling of well being or joy. Sharing this experience with your loved ones is a great way to make positive memories that will last.

Of course, take care of you; eat better foods and exercise.

Enjoy the ride, we never really know how long we have to be on this crazy little journey…so go make memories!