MunoRN 59,924 Views
Joined: Nov 18, '10;
Posts: 8,946 (71% Liked)
; Likes: 24,131
Critical Care; from
10 year(s) of experience
Parents don't have "full decision making capabilities in the US", it actually works the same exact way here. Hospitals and their ethics committees can determine that futile care is not appropriate and make the decision to withdraw care against the parents wishes, parents can appeal that decision in court just as the parents of Alfie Owens did. This is not particularly rare in the US, it's been about a month since my hospital had to take legal steps to bring futile and tortuous treatment to end in a child.
There were no "experimental treatments" offered, no additional treatments were proposed by the Vatican hospital, doctors from the Vatican hospital who travelled to Liverpool to evaluate Alfie agreed that his condition was not curable and other than palliative care they did not suggest different treatments would be available to him in Italy.
Denial and bargaining are well established steps in the grieving process. Appropriate care does involve helping ensure that the grieving process doesn't result in abuse of the child.
I would call this Sinus Arrhythmia (probably respiratory related) in the setting of sinus bradycardia. There is no "dropped beat" as there is no "p" wave. There is also no AV block as there is no "p" wave to be blocked.
I see this a lot in PACU. People are just waking up and taking slow breaths with a HR in the 40s and 50s. As they get more awake their rate picks up and the slight variation between beats is not so pronounced. You really need a longer strip with concurrent clinical assessment. (i.e. the thing happens with every inspiration)
No zebras here, move along.
Who actually read the ANA's position on this? Where do you disagree?
"To explore the clinical case for the effect of nurse staffing models, we collaborated with health care insight leaders Avalere and a panel of top nurse researchers, thought leaders and managers. The white paper concludes that staffing levels in a value-based health care system should not be fixed, as day-to-day hospital requirements are constantly in flux. "
I think they were short a CNA and needed the help for 4 hours.
This is exactly what happens when the pharmacy sends a pre-filled medication syringe or bag to an inpatient unit. You didn't see the pharmacist draw up the medication either, but do you go to the nurse manager and refuse to give the medications sent from pharmacy? No. You check the label on the syringe with your order and give the med and sign it out. It's not a violation in practice to give a medication that another trained and licensed professional prepared.
Is the family member to whom you're referring a POA or a guardian? There's a big difference. And is there actual paperwork documenting the legal status, or are we just talking about next of kin? In the case of someone who holds legal power of attorney for healthcare, the POA only becomes effective when the individual is unable to make decisions for her/himself. Is the client considered sufficiently impaired to lack the mental capacity to make her/his own decisions about eating/drinking?
Who said we are the "only" group that doesn't accept gifts? None of the professionals I know, from a wide variety of healthcare disciplines, would accept gifts from clients. That's a basic professional boundary, in any number of disciplines.
As I said in previous post, it's certainly reasonable to avoid these products all together out of worry for one's job, but it's also not as though it's not possible to make a reasoned decision on this based on measurable data rather than the more hysteria based rationale that seems to dominate this topic.
I just changed job and work in a small office part of the time. My cubicle-mate (we are within 3 feet of each other) has a radio on the entire day. I find it very difficult to concentrate let alone talk on the phone (which is part of my job).
I'm truly ready to quit over the issue.
When i worked my entire day in the ED, we ran around way too much to listen to music plus there was always something else going on....
Why call them chucks? Because Charles is too formal.
Well.... How do we know the pt didn't sign a POLST under duress? How do we know it wasn't forged or altered in some way? How do we know the pt didn't change his mind ten seconds before arresting -- even with a proper POLST?
Generally tattoo artists limit their inking to what a client requests. Considering the Ockham's razor principle, that tattoo's presence is more simply explained by "this man commissioned this tattoo," vs "the tattoo artist drugged the man and acted without consent, having been paid off by a murderous wife who wants to collect his life insurance and move to Fiji with her young Latin lover."
One acting in a feduciary capacity is supposed to make the decisions that to the best of their knowledge is what the PATIENT would want.
I can see "DNR" might be problematic, since it could mean "Daffodils 'N Roses" or "Dine Nightly on Ribs" or could be a loved one's initials strategically placed near the heart. But "do not resuscitate" with a signature? In the absence of other information, that sounds pretty clear.
This is not exactly a 12 hour shift issue. The issue is really.. working nights. You are forced to try to change your circadian rhythm throughout the week.
I myself.. cannot do it. I bow to anyone that can work nights, period.
Get on 12 hours, day shift and THAT is a nice gig.
The anti-vaxxers get upset because there is a question of whether or not we ought to force them to comply. Forcing people to do things they don't want to do, especially with regards to what goes in their bodies absolutely sucks for us morally and we should avoid it whenever we can.
Force takes many forms. Threatening to cut off a person's employment or income counts as force. As does prohibiting school.
Using force is justified only when you are very certain that it will benefit the community and also very certain that it will not cause harm to the individual. Then you have moral grounds with which to use force.
My problem with using force on the flu shot is that we don't know what getting it 80 times over the course of a lifetime will do to people and we do know that flu doesn't usually kill healthy people. It does kill sick people, so maybe it is justifiable to use force for healthcare workers-- as in take your shot or don't come to work, don't get paid.
But for folks not working in healthcare I don't think force is justified with regards to the flu shot. It's a vaccine people are expected to get every year. We don't know what effect, if any that has over a lifetime yet.
In 100 years when we have evidence that giving flu shots to a person every year from ages 3 to 100 did not cause undue harm to that person, then we will have moral grounds to use force.
I think gardasil is also one where using force is not justified for similar reasons. It hasn't been around long enough. Gardasil is a weaker case against force then the flu shot, because we aren't expected to get it every year.
With proven, older vaccines that prevent devastating illness like polio, I think we are justified in straight up forcing people to comply. Not like, hold a person down and put a needle in him, but definitely keeping kids out of school, and maybe even cutting off income.
And I say that as a quasi-anarchist who vaccinates her children and gets her required annual flu shot. And also as a psych nurse, who sometimes really does have to hold people down and give them a needle. It breaks my heart every time and I don't do it unless it is really, really necessary.
As of 2009, just over half of ADN students were second career students, often with previous degrees, this comes from research put together for a 2009 committee on making BSN the entry to practice, it says I'm not supposed to "re-publish" any of it, I'll see if that is still the case.
I agree that the research has shown different levels of education in programs a couple of decades ago resulted in differing outcomes. There was no delineation of what exactly these outcomes resulted from, but the best guess seems to be that it was the differing content and curriculum, it could be due to other factors are less obvious but seem unlikely, for instance it could be because BSN students are more likely to live in a dorm, I tend to doubt that having ASN students live in a dorm for a year would necessarily improve the outcomes of their patients down the road.
Well, it was a bit tongue in cheek. The statement I was challenging was "Minimum wage increase benefits everyone." I think that is naive, and is probably not shared by all those actually paying minimum wage.
Hypothetical ice cream shop that pays minimum wage to high school students. They have no particularly unique or difficult skills. The owner works his tail off and is not wealthy. The kids who work there don't need a living wage, they need some pocket money. Any more that he pays them is money out of his pocket that won't be helping his kids pay for college.
I don't think he benefits from minimum wage increases. If he did, he would simply raise wages. I am quite sure that there will be some businesses right on the edge of survival that will fold if minimum wage goes up.
That being said, I agree that minimum wage should be raised. Effectively, minimum wage has gone down hugely.
It's just that I accept the fact that economic decisions are complex, and very few benefit everybody. They need to be seen in balance.
This is very much on my mind as a new tax code is being developed. There are people who have made it their life mission to make rich people richer. They are telling me that that with certain changes, everyone, including me, will benefit. While I think it is awesome that they have taken a sudden interest in my well being, I am a bit skeptical.
Advertise With Us