Forcemaster

Ive worked in the ED for 3 1/2 years now, and before that i used to work on a trauma ward so ive seen both sides of it... Ive gotten round it mostly by 'making friends' with as many ward staff as possible. If im friendly and positive and all the initial care tasks for the patient are complete then when i arrive on the ward... no problems... still have problems getting some wards to answer the phone when trying to call them to see if the bed is ready, let them know they need air matresses or IV pumps etc... its like they see the extension im calling from and think NOOOoooo...

ah... thats the uk/usa difference showing up. in the us you probably had to do a thesis for your undergrad degree right? at universities in the uk, the term thesis is usually associated with phd/engd (doctoral) and research masters, whilst dissertation is the more common term for a substantial project submitted as part of a taught masters or an undergrad degree (e.g. ba, bsc, bmus, bed, beng etc).

Thanks for reading... I am currently writing a dissertation for a BSc and am looking for some supplimentary information. What i need to know is what Nursing students and qualified nurses across the world are taught about respiratory assessment... Specifically :redbeathe Have you been taught to auscultate the chest with a stethoscope? :redbeathe Were you taught this as a student or once you qualified? :redbeathe How often do you use this skill in your day-to day practise? :redbeathe If you have not been taught this skill, would you find it helpful to be taught? :redbeathe How important do you think it is to listen to someones breathing as part of your initial assessment? Any and all information would be greathly appreciated! Regards Matthew

I think you might find a year long stint in any acute unit setting will be of benefit as it helps you get used to the idea of being 'the nurse' rather than 'the nurse student'. I started in trauma ortho and ended up doing it for 3 years before switiching to trauma plastic surgery, then moving to the ED in the last month. I now have an extensive background in traumatic injuries assessment and treatment, and as many of my ortho patients were older people, with concurrent medical problems (i.e a bout of fast af caused them to have a postural hypotension and made them black out, fall and break their hip) i have a fiar experience in dealing with medical problems. At the end of the day, if you want to do the ED, do the ED. You will learn the specialist skills and knowledge you need while on the job. Whatever you decide, make sure it is right for you. Good luck!

Are they making personal calls or are they talking to other members of the health care team??? I would have to say that any nurse making personal calls near patients while at work is acting in an unprofessional manner. It is one thing to use your mobile to talk to other members of the health care team about a patient because it gives you access to the rest of the team at the bedside, an invaluable source of information, but to discuss with your fiends the plans for the weekend...

I totally agree that the question is badly phrased and does not allow for much latitude. Yes monitoring their peripheral neuro-vascular state should be the first port of call, as well as securing additional analgesia a close second.... Though I would like to hope that the patient received some analgesia before the cast was applied as some plaster techs can be a little rough when applying the cast to get the alignment correct. At the end of the day though, the first 5 signs of compartment syndrome are PAIN PAIN PAIN PAIN and PAIN If you have an altered neuro-vasc state, it is actually getting quite late in the game and you are already sustaining tissue damage. Therefore I would get the plaster saw and bi-valve the cast (cut in along one line from proximal to distal end. This splits the cast just enough to provide additional room for swelling. If your patient gets pain relief from cutting the cast then consider yourself as having done the right thing. Many of the nurses i work with are reluctant to cut a cast... but i always say to them "a cast can be replaced... an arm cannot"

Get ready for a looooooooong list... Litman 4100 stethoscope HP IPAQ Pocket PC & Medical software (Lexicomplete, Epocrates and several Skyscape programes) Aestehsiometer set Otoscope and Opthalmascope set Manual BP Finger Sats probe Arterial non-toothed clamp Venoscope Tendon Hammer Percussion hammer Goniometer Pocket ECG reading card Pocket Echo reading card Presteige Medical Nursing Clipboard EMT scissors Tuff-cut bandage scissors Straight cut scissors Large and small Bandage scissors & Disecting scissors Various sizes and shapes of tweezers Eye protection Electric razor (for trimming hair pre-cannulation, ECG etc) Turtle-skin needle resistant gloves (go under normal nitrile gloves) Tourniquet Maglite AA and Maglite AAA Fobwatch tape measure Name & contact details stamp Oh... and i also have a small tool kit that contains an adjustable wrench, scredrivers and pliers that stays in my locker untill needed. While at work i also have gauze and several pairs non-sterile gloves in my pocket as well... For a lot of this stuff i have 2 or more copies as i often sterilise them between uses. I am such a nerd

African Caribbean Abdominal circumfrence Acceleration capacity Acetate Acromioclavicular Acute Air conduction Anchored catheter antecubital anticoagulant anticonvulsnat assist control autologous cell alert & cooperative Astler-coller anterior chamber (of the eye)

TGA Theraputic Goods Administration TGV Thunder god vine (the short name for Tripterygium wilfordii) How about this one? LuesI

and every year when i start sharing clinical evidence related to hospital acquired infections (hais) i get inundated with contradictory responses... but hey...i'm a nurse and as such a glutton for punishment so here goes again... it has been suggested that approximately one in ten patients admitted to hospital suffer from one or more hais at any one time (department of health/public health laboratory service, 1988). the potential for cross-contamination and spread of organisms such as methicillinresistant staphylococcus aureus (mrsa) and clostridium difficille (c-diff), among others, within healthcare facilities, the homes of staff and the community is clear. despite the mounting evidence there seems to be a large number of health care providers, not just nurses, that don't see the risks for whatever reason. now i will agree the the current situation does not support healthcare staff in following best practice. minimum standards for uniform provision, changing facilities and laundering need to be agreed and introduced as a matter of urgency, to support current initiatives in the prevention of health-care-associated-infections. the most important aspect though is to educate all those who insist on continuing with practices that put their patients and the wider community at risk... now before i get that backlash of uproar many think i may deserve for apparently questioning various members of this site's clinical practices, i will attempt to re-address some of the points made... visitors are just as resonsbile for hygine in hospitals as staff... -i agree that visitors should shoulder some of the responsibility for ensuring that hospitals are a safe environment, but in order to do that they need education and support from health care staff. they should be educated in standard isolation practices (handwashing and use of ppc) when necessary, and these practices should be enforced by the nurses rigidly. it may mean we look like the bad-guys if we dont explain it properly and at a level our patients and their relatives can understand... but i'd rather spend time doing that than have to tell my patient they have contracted mrsa or c-diff it is not just nurses who are responsible for this issue... -again i totally agree... doctors, physios, ots, radiographers, domestics... everyone in employed by a health care organisation is responsible... but nurses are the visible face of healthcare and as such an easy target... but change has to start somewhere and we should be leading by example... at the moment we seem to be saying "hey its not just us you should be blaming"... instead we should be able to say "i know my practice is safe, we are just waiting for everyone else to catch up with nurses!" there are not enough changing facilities or uniforms/scrubs are not provided -i agree again... but if enough of us get it together, we can force change on the system. it wont be easy... but is is necessary. the evidence is here... all we have to do now is act on it! and speaking of evidence, plowman et al (2001), estimated that hais cost the national health service (nhs) and the uk taxpayer £986.36 million a year... most of this cost, £930.62 million was borne by in-patient services, and £55.74 million by non-acute services, of which general practitioners costs were valued at £8.49 million, hospital out-patients departments £26.83 million and district nursing services £20.51 million. now i don't have the figures for the usa, but if hais cost the uk this much, and providing adequate changes of clothing and washing facilities should reduce this figure, you could find yourself saving money... i stress the could part here because there is no research into how much it would cost the nhs to provide adequate changing facilities (presumably more of a one off cost to convert existing facilities and rooms with maybe the odd layout to keep them clean and servicable) and adequate uniform provision (presumably a regular expenditure), so i can't perform a cost-benifit analysis... still... the potential is intriguing. this is an extract taken from the 'nursing standard' one of the major weekly uk nursing publications... "... healthcare staff uniforms are frequently contaminated by disease-causing bacteria, including staphylococcus aureus, clostridium difficile and glycopeptide-resistant enterococci (gre), presenting a potential source of crossinfection in the clinical setting (babb et al 1983, perry et al 2001, speers et al 1969). maximum contamination occurs in areas of greatest hand contact, that is, pockets, cuffs and aprons (babb et al 1983, loh et al 2000, wong et al 1991), allowing re-contamination of washed hands..." while hand hygiene is now well recognised as the single most important factor in the prevention of cross-infection, contact transfer of bacteria from uniforms leading to infection has also been described (hambraeus 1973, hambraeus and ransjo 1977), yet seems to be an issue that so many are resitant to... and i have no idea why when there is a rapidly growing mountain of evidence around clothing contamination. in a study which demonstrated that contamination of uniforms might be a significant contributory factor to the spread of nosocomial infection, callaghan (1998) highlighted the widespread problem of inadequate provision of uniforms and laundering facilities in hospitals. this resulted in many staff travelling to and from work in uniforms which they laundered themselves in a domestic washing machine. following a major outbreak of salmonella infection at the victoria infirmary, glasgow, in december 2001 and january 2002, the watt group report (scottish executive 2002) raised concerns about the trust's uniform policy, and recommended that: 'every trust should have a staff uniform policy that ensures: -all staff uniforms are laundered by, or under the auspices of, the nhs. -the widespread practice of staff travelling to and from work in (potentially contaminated) uniforms ceases. -adequate staff changing and decontamination facilities are provided.' as an aside, public concerns about the role of staff uniforms in the spread of infection have been voiced by a number of speakers in a recent parliamentary debate on hospital-acquired infection (house of commons 2004). where an employer requires staff to wear uniform, callaghan (1998) recommended that the number provided should be sufficient to allow a change of uniform per shift, taking into account turnaround times for laundering and delivery. for nurses, she suggests that not less than nine uniforms be provided. the responses received from trusts that required uniforms to be worn show that 43 per cent provide only three or four uniforms per nurse, making it difficult to change daily or if the uniform becomes grossly contaminated. however, 86 per cent of trusts expect nurses to change uniforms on a daily basis. only 26 per cent of trusts had adequate onsite changing facilities; the rest being insufficient or absent. in both the watt group report (scottish executive 2002) and callaghan's (1998) study, lack of changing facilities meant that staff were obliged to travel to and from work in potentially contaminated uniforms or change in unsuitable places, for example, toilets. this is despite the fact that the workplace (health, safety and welfare) regulations (1992) require that changing facilities, including lockers and showers, be provided for staff and that current nhs estates (2003) guidance on infection control in the built environment states that: -"changing facilities should be provided for all staff, to encourage them to change out of their uniforms in the workplace..." few trusts provided on-site laundry services and turnaround times, regardless of site, were inadequate. however, it was a surprise to find that almost two-thirds provided no laundry facilities for nursing staff. when combined with the finding that, in a further 26 per cent of trusts, nurses did not feel able to use a service they perceived as inadequate, it appears that around 90 per cent of healthcare staff have to take responsibility for the cleanliness of their uniforms. this implies that it is usual for staff to travel to and from work either wearing or carrying potentially contaminated clothing. the fact that more than half of the trusts questioned did not condone off-site wearing of uniform can make little difference to practice, as most staff have no suitable place to change. despite publication of the nhs executive (1995) guidance for the laundering of healthcare linen and callaghan's (1998) more specific guidance, few trusts provided appropriate guidance for staff on handling and home washing of uniforms. some instructions were spurious, unhelpful or wrong. it is worth noting, however, that even if home laundering guidance followed that favoured by callaghan (1998a), it would be impossible to assure the quality of the processes undertaken by staff in their own homes.

Try using a Transilluminatior. I use the Venoscope to very good effect on my difficult sticks check it out at https://venoscope.secure.powweb.com/content/index.php

There is actually a very valid scientific reason why some medicines still come in glass ampules. Basically some of the medications interact with plastic, affecting their chemical structure and long term viability... The basis of the science (and you will have to forgive me if this is not quite right but im a nurse, not a chemist ) is that plastic is an organic compound (They are composed of organic condensation or addition polymers) which means they can interact on the chemical level with their environment. This is not a consideration with plastic equipment becuase it can be made of tougher plastics with different additives (like silicone) that are more stable and resistant to environmental factors... but the plastic ampules are, by necesity thiner and easier to break, which means that their molecular structure needs to be less stable... which means it has a greater chance of interacting with the medications it is supposed to hold. You dont get this problem with glass because it is a uniform amorphous solid that is essentially inert and quite strong. If you really have that much trouble with them, try investing in an ampule opener... they take a little practice but on the unscored glass ampules, they really work.

In the case of Brittany, I believe that is how it is spelt in Galic... Dayvod is Welsh... not sure about the others but they too might just be the 'non-english-ised' versions of names.

Dear Doc... Decided not to give that Phosphate enema PO as the Pt is Nill by mouth! Dear Dr. I re-took the Urgent bloods from your patient. Please remember to either take the bloods to the lab, tell a nurse you have taken them or call the specimin porter to collect them because, contrary to the myth that many doctors share, the bloods do not grow legs and walk down to the lab on their own... But of course its not just the doctors that we can send these too... Dear Radiology When we state on a X-ray order form for "hard copy to return with patient to the ward" it is not a code for "please loose the films in the reporting room till the next day's shift come on..." Thanks and have a nice day! Now i know this is not a post-it message and is infact a phone call i had with the overnight radiology staff... but its still worth a mention "A&E Radiology" "Hi its Staff Nurse on $ £ ward. Ive got a patient here by the name of $%^&* who is due an urgent chest x-ray." "Let me see... right ive got the form here." "Well it was ordered over an hour ago and we were told you would call us when we could take her down" "Did we?" "Yes..." [silence] "So when can she go down?" "You want it done tonight?" "Well when we filled out an urgent request we were thinking we could either wait to diagnose a pleural effusion when the fluid overflows from her mouth onto the floor and she drowns... or we could just get an x-ray and put in a drain..." [silence] "Im going to bring the patient down to you now..." "Erm... ok"

I seem to have ended up as 'The Funny Guy' on my ward. Some of the things I get up to have gone down in my hospitals' urban legends... For charity, I surfed a hospital dinner tray down 2 flights of steps at my second job... Ended up on my backside halfway down the second flight... I raised nearly £200 for the hospital to buy a new PS2 for the Paeds day unit. Still... in hind-sight that was not so funny... I had to have an x-ray of my sacrum as I couldn't sit down for 2 days after..., I once went to answer the phone and punched myself in the eye with the receiver. One of our domestics and I have a running joke... it always seems I end up having to walk down the corridor she has just mopped and I keep saying one day i'm going to slip on her floor... well about 7 months ago I was walking round the corner with a producer from the BBC City Hospital programme, towards the film unit, talking about the upcoming live broadcast from the ward I work on when I saw the domestic with her mop and said... "One of these days I'm going to..." I never finished the sentence as I slipped on the floor and ended up smacking into the wall. I later found out that the film unit was actually filming the corridor for potential material to use on the opening credits and caught my gymnastics on film... I made a staring role in the units xmas party Then there was the time that one of the House Officers and I walked onto a ward in the middle of the night carrying an extention ladder... We walked past the nurses station and back out again without saying a word. I once found one of our consultants ties at the nurses desk... He called a little while later saying he was calling around to see if anyone had seen his tie... Now bear in mind that what follows is based on the fact that he was forever flouting infection control policy... I took the tie to a friend of mine in the lab and we swabed and cultured it... After working out what was growing on it, we mounted it on a piece of paper with a label saying "Infection Vectors come in all shapes and sizes", then laminated it and pinned it to the consultants door...