Latest Likes For MunoRN

Latest Likes For MunoRN

MunoRN 26,150 Views

Joined Nov 18, '10. Posts: 7,253 (68% Liked) Likes: 17,228

Sorted By Last Like Received (Max 500)
  • May 23

    I've dealt with a number of coding patients who are responsive during part or all of resuscitation. Good quality CPR can produce systolic blood pressures in the 80's or even 90's by art line, and a Lucas Device can sustain greater than 100 torr for an extended period of time. I've only seen this in patients where CPR is started immediately at the time of arrest, or where CPR is actually started before pulses are completely lost. It's basically the same thing that happens with a syncopal episode; the brain looses effective perfusion for a short time, in which case it's not unheard of for the patient to regain consciousness with the return of effective perfusion.

  • May 23

    The term "client" had been around in some settings for a while, then around the year 2000 a work group with the ANA recommended that we use the term "client" as a general replacement for "patient". It was only after this switch that they actually studied the effects of this terminology and as a result they quickly reversed their recommendation, although by that point it had already made it into textbooks and general academia and there was no turning back.

    The term we use to refer to someone indicates how we view that person and our relationship with that person. "Client" refers to a participant in a financial transaction or business relationship, while "patient" refers to someone in a therapeutic relationship. As it turns out, patients don't generally like to be seen as a source of revenue, they prefer to know that we see them as someone in need of nursing care.

  • May 23

    Quote from Pangea Reunited
    I would imagine those percentages vary greatly by hospital/region/unit, etc. I would bet my life that nowhere near 83% of the patients I work with are paying for anything.
    Quote from OldDude
    Haha...take another drink of the koolaid...our local pedi hospital get 96% of it's income from medicaid...
    I'm not sure how being on medicaid is equated with not paying anything at all towards healthcare. The vast majority of those on healthcare have at least paid into medicaid in the past and the majority are currently paying into medicaid since the majority of medicaid recipients work.

  • May 23

    Quote from mushyrn
    My feelings about the BSN as entry haven nothing to do with someone who is already a nurse and working. I am talking about the FUTURE. Where do we want our profession to go?

    If we want to legitimately be considered as a "profession", we CANNOT continue to degrade further nursing education and courses. We cannot degrade those wanting a higher education level. A bachelors degree is the MINIMUM, repeat, MINIMUM entry to practice in any other profession that is respected and in high esteem. This is the present and the future.

    Again, I AM talking about the first time college students who are entering the nursing profession. It should be a BSN entry only going forward. It shouldn't be some trade job that requires 15 months of training. We may as well be plumbers (not that anything is wrong with plumbers, but we should aspire for more). I don't see why people are so against this.
    An ADN isn't 15 months or a vocational degree, thus the term "LVN" (V=vocational). Things were different 20 or so years ago, but currently ADN programs, either through competitive necessity or state mandate, use a curriculum that is comparable to BSN curriculum, and both include about a year of pre-reqs and 2 years of program. What ADN's lack compared to BSN's is about a year's worth of general electives (art history, etc), and it's doubtful this translates into measurable differences in patient outcomes.

    The ADN program in my area has used previous bachelor's degrees as an admission criteria, and has had so many applicants with previous degrees that now it's a requirement for application. In my BSN program not a single student had a previous degree, so if more education should always be the requirement then why are we allowing BSN's with no previous degrees to practice on a level equal to multi-degree ADN grads.

    I think there's broad agreement that what quality education for nurses, and this is the main reason why BSN-as-entry to practice hasn't become the established standard, it would degrade the quality of nursing education. We know one of the most important determinants of quality nursing education is clinical availability, moving our nursing student capacity to BSN programs would only move us backwards in terms of quality of educational experience. What makes more sense is to spread out clinical demands to broader areas that can better support those demands, and move BSN curriculum to those programs, which is what is already happening, so what else should change?

  • May 22

    I've dealt with a number of coding patients who are responsive during part or all of resuscitation. Good quality CPR can produce systolic blood pressures in the 80's or even 90's by art line, and a Lucas Device can sustain greater than 100 torr for an extended period of time. I've only seen this in patients where CPR is started immediately at the time of arrest, or where CPR is actually started before pulses are completely lost. It's basically the same thing that happens with a syncopal episode; the brain looses effective perfusion for a short time, in which case it's not unheard of for the patient to regain consciousness with the return of effective perfusion.

  • May 22

    If there was some evidence that chair alarms reduce the risk of falls then there might be some argument that the nurse allowed an overtly unsafe situation to occur but the evidence doesn't appear to support that. Either way, the nurse has to weigh the benefits of the patient getting up out of bed and spending a worthwhile amount of time in the chair with the risks of doing so, and generally there's too much harm in limiting activity more than necessary to outweigh the risks of leaving a patient in a chair.

  • May 22

    I think once the argument is focused on who's "fault" it is and what counts and doesn't count a fall to blame someone for then the process has failed. What the focus should be is to how best care for the patient, and just leaving them in bed because there's no chair alarm isn't what's best for a recovering ICU patient. It may not seem like it, but chair time is essentially a work-out for a patient recovering from a critical illness, and research shows improved outcomes for patients who get two periods of chair time per day. All efforts should be made to avoid preventable falls, but you still have to take into account what's best for the patient overall.

  • May 22

    If there was some evidence that chair alarms reduce the risk of falls then there might be some argument that the nurse allowed an overtly unsafe situation to occur but the evidence doesn't appear to support that. Either way, the nurse has to weigh the benefits of the patient getting up out of bed and spending a worthwhile amount of time in the chair with the risks of doing so, and generally there's too much harm in limiting activity more than necessary to outweigh the risks of leaving a patient in a chair.

  • May 21

    I've dealt with a number of coding patients who are responsive during part or all of resuscitation. Good quality CPR can produce systolic blood pressures in the 80's or even 90's by art line, and a Lucas Device can sustain greater than 100 torr for an extended period of time. I've only seen this in patients where CPR is started immediately at the time of arrest, or where CPR is actually started before pulses are completely lost. It's basically the same thing that happens with a syncopal episode; the brain looses effective perfusion for a short time, in which case it's not unheard of for the patient to regain consciousness with the return of effective perfusion.

  • May 21

    I've dealt with a number of coding patients who are responsive during part or all of resuscitation. Good quality CPR can produce systolic blood pressures in the 80's or even 90's by art line, and a Lucas Device can sustain greater than 100 torr for an extended period of time. I've only seen this in patients where CPR is started immediately at the time of arrest, or where CPR is actually started before pulses are completely lost. It's basically the same thing that happens with a syncopal episode; the brain looses effective perfusion for a short time, in which case it's not unheard of for the patient to regain consciousness with the return of effective perfusion.

  • May 21

    If there was some evidence that chair alarms reduce the risk of falls then there might be some argument that the nurse allowed an overtly unsafe situation to occur but the evidence doesn't appear to support that. Either way, the nurse has to weigh the benefits of the patient getting up out of bed and spending a worthwhile amount of time in the chair with the risks of doing so, and generally there's too much harm in limiting activity more than necessary to outweigh the risks of leaving a patient in a chair.

  • May 21

    If there was some evidence that chair alarms reduce the risk of falls then there might be some argument that the nurse allowed an overtly unsafe situation to occur but the evidence doesn't appear to support that. Either way, the nurse has to weigh the benefits of the patient getting up out of bed and spending a worthwhile amount of time in the chair with the risks of doing so, and generally there's too much harm in limiting activity more than necessary to outweigh the risks of leaving a patient in a chair.

  • May 21

    I've dealt with a number of coding patients who are responsive during part or all of resuscitation. Good quality CPR can produce systolic blood pressures in the 80's or even 90's by art line, and a Lucas Device can sustain greater than 100 torr for an extended period of time. I've only seen this in patients where CPR is started immediately at the time of arrest, or where CPR is actually started before pulses are completely lost. It's basically the same thing that happens with a syncopal episode; the brain looses effective perfusion for a short time, in which case it's not unheard of for the patient to regain consciousness with the return of effective perfusion.

  • May 20

    I've dealt with a number of coding patients who are responsive during part or all of resuscitation. Good quality CPR can produce systolic blood pressures in the 80's or even 90's by art line, and a Lucas Device can sustain greater than 100 torr for an extended period of time. I've only seen this in patients where CPR is started immediately at the time of arrest, or where CPR is actually started before pulses are completely lost. It's basically the same thing that happens with a syncopal episode; the brain looses effective perfusion for a short time, in which case it's not unheard of for the patient to regain consciousness with the return of effective perfusion.

  • May 20

    I've dealt with a number of coding patients who are responsive during part or all of resuscitation. Good quality CPR can produce systolic blood pressures in the 80's or even 90's by art line, and a Lucas Device can sustain greater than 100 torr for an extended period of time. I've only seen this in patients where CPR is started immediately at the time of arrest, or where CPR is actually started before pulses are completely lost. It's basically the same thing that happens with a syncopal episode; the brain looses effective perfusion for a short time, in which case it's not unheard of for the patient to regain consciousness with the return of effective perfusion.


close
close