What are some former and current sacred cows in nursing?
By sacred cows, I mean facts, protocols, standards of practice etc. that were once bedrock but have been debunked over time through overwhelming evidence. This could either be stuff in the past that now seem so ridiculous, or stuff you still see nowadays that really should be stopped. Things like diethylstilbestrol for pregnant women, lidocaine and liberal doses of bicarb "just because" in codes, relying on auscultation only to check NG tube placement etc.
One of my big research articles for school was about the routine use of normal saline during endotracheal suctioning. Turns out its bunk. I, for one, was scared by my nursing school teachers into using it all the time. Otherwise, I will always scrape the trachea or leave the patient drowning in his own secretions. Really? Now, I have had chronic trach/vent-dependent patients who ask for NS for their own comfort and preference. I happily oblige but I no longer feel obligated to lavage every intubated and trached patient I have.
I'd have to call the CO2 retainer/excessive oxygen issue a double sacred cow, maybe a siamese twin sacred cow.
For some reason many thought that you could never give a CO2 retainer large amounts of oxygen, which of course wasn't true (sacred cow #1), but in debunking that another sacred cow was created which is the idea that excessive oxygenation couldn't cause hypercapnia, which has never actually been true. The part that's debated is what the specific mechanism is, it's now thought that inhibiting respiratory drive isn't the main mechanism, but that a ventilation/perfusion mismatch related to excessive oxygen levels is the primary cause, but regardless of the cause expert guidelines still advise a goal range of 88-92%.
I spend some of my time as a RR nurse, and it's not all that unusual to get a call from a nurse who says they CO2-retaining-COPD'r has been getting progressively more lethargic, ABG's show worsening hypercapnia and the nurse has been pushing their sats to 98% all day, I explain the problem and typically get the response that this is a myth. I'll often refer them to this: AHRQ WebM&M: Morbidity and Mortality Rounds on the Web
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Oh no. That is terrifying! Gloves are my bubble of protection -- I can do anything if I have gloves. Anything.
My practice is not that old but I was taught to Trendelenberg (sp?). I was also introduced to Swanz-Ganz as the top of the line monitoring possible. And now I haven't seen one used in at least 5 years.
Swanz are still used but are usually very specific to shock and cardiac especially those waiting for or have had transplant.
I don't remember it personally, but my older co-workers told me they were taught not to use gloves when cleaning a patient after a code brown because it would shame and embarrass the patient.
As a nursing assistant working on floors back in the day yes, was told off by more than one nurse who spied one hand on gloves when cleaning up a patient. "You are giving the patient the impression something is *wrong* with them...." it was explained to me. I was like "uh Yeah, there is something wrong with them that is why they are in the hospital... *LOL*). "You don't wear gloves when you go to the bathroom do you?...." . Well no I don't as a matter of fact but I'm not lying in a hospital bed and I know where I've been...."
This attitude persisted until AIDS/HIV exploded onto the healthcare scene. It seemed almost overnight you couldn't keep latex gloves on the floors. A box that may have lasted days was now empty in hours.
Once things settled down and it became known how HIV was spread some places began to try and clamp down on "glove madness". That is unless you were dealing with bodily fluids or the potential you didn't need to "suit up" just to examine a patient. These persons were suffering already (HIV/AIDS patients) and didn't need their condition reinforced by someone putting on gloves just to say make their bed.
YW, yes Saint Vincent's had one of the most distinctive caps in NYC! *LOL* Many grads and student's weren't all that thrilled with the thing as it was hard to keep on the front of your head. If it wasn't sliding off (into a freshly filled bed pan for instance...) you were whacking the "wings" into drapes, IV lines/bottles/bags and so forth. *LOL* In peds one friend of mine swore her St. Vincent's cap whispered to babies and small children "pull here"! *LOL*
Personally weep a little bit each time one sees any pictures of anything to do with Saint Vincent's Manhattan now that the place is gone and replaced by uber-luxury housing. The site is now called "Greenwich Lane" and is set to make the Rudin family a bundle. West Village Condos, Lofts & Townhouses in Manhattan | The Greenwich Lane
To DoGood - Was your St. Vinnie's an LPN or RN program? Worked with a top-notch LPN who attended a ST. Vinnie's that also closed, but I thought it was North Jersey.
To DoGood - Was your St. Vinnie's an LPN or RN program? Worked with a top-notch LPN who attended a ST. Vinnie's that also closed, but I thought it was North Jersey.
Didn't go to Saint Vincent's but worked at the Manhattan and other Catholic hospitals in NYC.
At least in NYC there were three Saint Vincent's schools of nursing, Manhattan, Staten Island/Richmond, and Queens. All were RN and began as hospital based diploma programs but switched to offering ADN by the 1980's. The Manhattan school on Christopher Street closed in 1997 IIRC, with the Staten Island and Queens schools closing in 2004 when the system went bankrupt. These two were purchased by a for profit education company and are now called Saint Paul's school of nursing.
The order still owns the former nursing school in Manhattan property IIRC. It is leased to a City agency or some such I *think*. The building is gorgeous and landmarked so it cannot be torn down unlike the hospital several blocks away. The Sisters of Charity still operate a nursing program as part of The College of Mount Saint Vincent. Don't think they have an LPN program in NYS though.
To be fair Saint Vincent's is a name connected to healthcare around the world and not all places are run by the same order. So it very well may be there is a Saint Vincent's LPN program in New Jersey or elsewhere.
I remember not allowing new MI patients couldn't have anything too hot or too cold. They felt it caused coronary spasm
Also bedrest/very limited activity. Bedpan or BSC since shouldn't walk alllll that way to the bathroom.
Strict bedrest for hepatitis. My Merck in the 80's made a point of "strict bedrest is no longer considered necessary"; which I had to show to a physician treating me in a little village clinic half way around the world. She wanted me to use a bedpan, when there was a toilet not 30 feet from my bed.
amoLucia
7,736 Posts
Way back when - when someone came in with GI ulcerative disorders, automatically a strict SIPPY diet.
Don't know if they do that kind of stuff anymore in hospitals anymore. I mean I can understand avoiding spicy chili but those SIPPYs...