anon456

A 36-year-old man has been arrested on suspicion of impregnating woman in a vegetative state who gave birth last month at a Phoenix health care facility, Phoenix Police Chief Jeri Williams said Wednesday. Nathan Sutherland, a licensed practical nurse who was caring for the woman at the Hacienda HealthCare facility, has been arrested and is being booked on preliminary charges of sexual assault and vulnerable-adult abuse, Williams said. https://www.cnn.com/2019/01/23/health/arizona-woman-birth-vegetative-state/index.html

Wonderful!

I'm not able to complete the survey-- the format is messed up on both Google Chrome and Firefox

FLK- funny looking kid, one who looks "syndromy" but hasn't been diagnosed with that (yet). Often time if I say SCD's too fast the parents look at me funny, so I have to spell it out "Sequential Compression Devices" not STDs!

This is good, basic info! Very useful! You are so right about the challenge of that pulse-ox staying on! Here are some things I've learned- I work mostly pulm/stepdown When an infant stays above 60 for too long, they can "poop out" and just get tired and need emergency intubation. Especially if they are also needing a lot of effort to breathe with bronchiolitis or other airway issues. Don't be afraid to suction infants if they seem to have a lot of mucous in the way of breathing. Deep suction as necessary. Sometimes we get a baby who looks awful, transferred from another unit. I do some deep suction and nasal lavage and oftentimes they improve significantly and immediately. Also reposition with neck rolls to the CPR position- it helps open airways on the little ones. But if you have to do that to keep an open airway, call the doc right away, too. When assessing a peds patient for respiratory issues, always pull the shirt up enough to see the belly and chest. You can better see retractions and chest movement. A couple weeks ago I had a patient with severe pleural effusion come in. Patient had a history of asthma so at first they assumed it was that-- but then xrays showed fluid. I could see that one side of her chest was not moving very well when I lifted the shirt.

Because we live in a culture of advanced medicine. We no longer lose half our children to disease, because we now have vaccinations. Grandpa won't die of a heart attack; he is given bypass surgery. Women don't die in childbirth that often anymore, they get emergency c-sections. I was suctioning a sick baby a few nights ago after yet another coughing fit, adjusting its oxygen as needed, and coordinating with the respiratory therapist on its treatments, tube-feeding it, and thinking to myself that 50 years ago this baby would have certainly died. Instead this illness was just a small bump in what will probably be a long, healthy life for this baby. Death is no longer something the average person sees every day. When it happens it's shocking. We expect medicine to fix everything.

I have only encountered DNR in my practice. I have heard that some facilities use AND instead: Allow Natural Death. This change in terms would make it a lot easier, I think, for some families to choose natural death rather than DNR, which sounds scary and harsh.

I love your article, and I love doing the things for these patients that they need help with. I have spent time talking to worried parents, sitting while a constipated patient tries his best on the toilet and cannot be left alone, helped a child who dropped the back of her gown into the toilet water, and lots of bed-wetters who needed total linen changes and improptu baths in the middle of the night. I love being of service and helping these people and giving them dignity in the process. I'm being paid by the hour, and that's part of how I am paid to spend those hours. On the other hand . . . I feel frustrated that nurses are stretched so thin they cannot spend that time with the patients. They have a set of busy, busy patients with lots of meds due, or someone who is unstable and needs constant support at the bedside for an hour before going to ICU, or all the hours of charting that need to be done. This is where I feel the conflict arise. As I'm helping the patient in the room or listening to a parent tell me their worries, in the back of my head I'm being pulled by the knowledge that I have an IV med about to finish next door, or that I'd better finish that huge pile of admission paperwork before the new patient goes to sleep. I would like to not feel rushed when I do those time-consuming things that can often make a real difference in the long run.

This made me laugh! My strategy is to keep a hand between me and the trach so it gets on my hand instead. And to wear protective eyewear. Always.

Thanks! This is very timely as I have just started this program.

I belong to the school of thought that it's all about the patients. However I do think that some more difficult or needy patients/families need to have that boundary defined for them so everyone knows the exact role of the nurse-patient relationship and no one crosses that line. As far as nursing being therapeutic-- my job satisfaction does play into that and I wonder if the poster who said that meant that it should be a satisfying job (most days of course!) and if it's not, things should be examined further. As for myself, I am becoming a firm believer in mental health services for *all* people who work in the caring-type jobs such as nurses, firefighters, police officers, social workers and such. Seeking those services and learning ways to cope and take care of ourselves after seeing what we see at work will make us better people to live with to our family/friends and also help us to do a better job with our patients and their families.

I had to examine this when working with a patient who was on the floor for a long time. Complex needs both emotional and psychological. Family was extremely controlling and manipulative. They had the entire hospital hopping to meet their demands and it was honestly ridiculous. I struggled nightly to firmly but tactfully balance between family demands and patient safety. Sometimes I left the shift knowing the patient was safe, but feeling very emotionally beaten down trying to also keep family happy in small ways that did not have anything to do with patient safety. Also the family used me as a sounding board a lot of times. I had to really examine my own boundaries and sought out education and advice from more experienced nurses. One night I had to stick to my guns and refuse to give a PRN to the patient because it was not safe to do so. This judgement was backed up by docs who the family demanded that I call to bedside. I felt good about my decision but why did the family not respect my role more? It's a shame that the family behaved like that because their behavior directly impacted the care of the child-- making nurses not want to work with that patient, and the ones who did were stressed out and had to be extra extra careful not to make a mistake because of distraction or feeling pressure or feeling judged.

I like this part of the article the best: Many nurses wonder how some hospital administrators, chief nursing officers, and unit managers are able to look the other way while understaffing, a lack of supplies, and poor working conditions negatively affect patient care. Some nurses are puzzled by the current trend of placing customer service on the highest pedestal while patient care gets placed on the back burner. There are times when I have to choose between what is best for the patient, safe for me, etc. and pleasing management or obnoxious families. I have become more assertive to safety and figure if they have a problem with me refusing an unsafe assignment or putting family demands at the bottom of my priorities, they can fire me or put a bad mark next to my name. But if a patient is harmed because I compromised safety to please higher-ups, I could not live with that.

As a fellow peds nurse who works ICU and step-down, I have had the sad experience of nursing many pertussis babies and toddlers through the course of that awful illness. I couldn't agree more with your article! I have also cared for a child who "visits" us often who was the victim of meningitis and is now brain damaged. Many years ago when I was pregnant I had my titres drawn and learned I was not immune to rubella, even though I had been fully vaccinated throughout my childhood. Thanks to herd immunity I did not get sick and my baby was born healthy. I was vaccinated before I left the hospital with her. I fear that there will be less and less of this herd immunity as time goes on, and my most vulnerable patients will suffer greatly for it.

I work peds and I love how they personalize a lot of the medical care for the kids. :-) I have started many IV's on stuffed animals. A couple of years ago my grandma had to stay in the hospital for several days. When visiting her I was struck by how drab the unit was, and how de-personalized it was. I mean they were nice and the hospital was the best in the area and her care was great. But there were no colors, no pretty pictures on the walls, no "Welcome Grandma!" on the white board, no heart-shaped bandages or comfort food ready to order from the menu. They did, however, have a nice "Sundowner's Club" volunteer. I think a hospital would be a lot less depressing and scary for adult patients if we applied similar ideas for them. After all, hospitals can bring out a lot of the same phobias in adults as in children.