Thunderwolf

No person has the right to abuse another. Not even a patient.

Truly sad.

Don't feel bad RNinIN, I'll probably be flamed also. Regarding inpatient hospital nursing, for the most part, this has improved or greatly improved, at least from my experience. Talk about bullying, it was "power for the course" and almost routine on inpatient floors 20-30 years ago. As a nurse, it was called, developing your "tough skin", which was on the job training. Bullying came from ALL directions...other nurses, nurse managers, and especially (OMG) the physicians. If you survived and developed that protective emotional skin, you were half way home to be considered being a "seasoned" nurse. Nurses, especially new nurses, crying at the nurses station or in the hallways was not uncommon. I would imagine now that that kind of bullying or some measure of it would probably be more common in smaller community hospitals and at ECF/SNFs than at large inpatient hospitals. From my experience, bullying is a climate that is either permitted or NOT permitted by hospital administration. Bullying starts and ends there. And with the proverbial "**** runs downhill," so does bullying...from admin on high to the physicians, from the physicians to the nurses and patients, from nurses to other nurses and also to patients. Do you see who ultimately looses in this whole process chain?....it is the patient, because they get it from all directions as well. Bullying is detrimental to patient health and well being. So, a bullying climate in any hospital or at any outside facility is a measure (in my opinion) of management or administration. So, not meaning to minimalize bullying found today....but, you should have seen it 20-30 years ago. It was bad. Real bad. Not as much any more, but if it is bad for you today, this may be more facility specific. If so...look at administration in being somewhat responsible for it. Administration directs and structures the climate. Then ask yourself, is it really worth it to stay there and not look elsewhere if that is an option? More medical institutions are "modernizing" themselves away from it.

After reading many posts on this thread, this seems relevant to the discussion. Medical goal of eliminating pain can lead to over-prescribing pills, accidental dependence | The Columbus Dispatch "Americans have been told that we can and should be pain-free," said Constance Scharff, director of addiction research at the Cliffside Malibu Treatment Center in Los Angeles. "And doctors have been told that there are medications that will make that happen. That's the root of the whole drug epidemic." And in part with this, if we have ongoing chronic pain issues ourselves as nurses, does this lend ourselves as nurses to medicate/overmedicate a patient more often because we refer back to what made us feel better? In a small nutshell, co-dependency. That needs brought up. Can't neglect that issue altogether. And lastly, there are medical conditions like sickle cell, acute post op, cancer, et cetera that do benefit from ATC (Around The Clock) medications. That is a separate issue altogether. Not talking about that....just for the record.

Found an excellent news report on the epidemic of Heroin in West Virginia. But, I am sure, it pandemic across our nation. EMT Wears A Body Cam To Show What Heroin Does To People | 97.5 WAMZ

The BSN will become, and already is in many cities, THE entry point into acute care/hospital nursing. Many, if not most, hospitals in my city will only hire BSN nurses. Also, many of our own non-BSN nurses are going back to school for their BSN. The writing is on the wall. Get your BSN sooner, than later, if all possible.

Totally agree with twozer0 on most of his rationale. To put it in even more simpler terms, would you wake up a patient to give him/her a sleeping pill? No. The same logic applies here with pain medication. Wakefulness and pain are both conscious experiences, for the most part. If unconscious/asleep, what are you truly medicating? Now in saying that, does that mean pain is not present? It depends. We all experience some discomfort when we sleep to one degree or another. One example of this is when we change positions off and on during our time of sleep. Lying too long in one position often becomes uncomfortable, so we turn and reposition ourselves while sleeping. We tend to do this unconsciously. Does that mean we need to medicate it? No. Does that mean pain will not wake us up? No. If a level of threshold discomfort is achieved due to injury/surgery/disease, we may awaken and then may/will become conscious to our level of comfort/discomfort. At that time, yes, it may become appropriate to medicate for pain then. Will I automatically wake up a patient to medicate them with a prn pain medication if he/she earlier requests that I do? No, 99% of the time. I will medicate for pain only if the patient awakens on his/her own and then becomes aware of pain and requests it. So, what may contribute to discomfort while one sleeps other than injury/surgery/disease? What are some non-verbals that may indicate discomfort/pain in a sleeping patient? How about a full bladder? And...do you medicate that? No. You toilet. Is the room too cold or too hot? Do you medicate that? No. You adjust the room temperature. There are many things that can contribute to unrestful sleep. That is where sleep hygiene comes into play. Good job, twozer0, in your explanations on this thread. You are most correct regarding a patient who is unconsciously sedated. It does, however, become a tad different with a patient who sleeps that is non-sedated chemically. This is where nursing becomes more an art mixed with science than vice versa.

Non-union hospitals in my experience tend to globally run under the dictum of "Don't like it, then leave." Union hospitals tend to globally run under the dictum of "Don't like it, then change it." For most of my 30 years of nursing, it has been in non-union hospitals. I now work in a union hospital. I am going on my 9th year. You couldn't have me return to a non-union hospital again. Believe me, unions DO...STILL...have their place.

This physician reminds me of OLD School medicine. Hostile Work Environment is often, in my mind, from my 30 years of nursing, a code phrase of bullying physicians in the work place. In my first 15 years of nursing, it was more common than not to witness physicians being totally disrespectful and unprofessional towards nurses. Sexist, rude, profane, aggressive, immature, you name it, you saw it. Physicians cursing ten times worse than sailors in front of or at patients and nurses. Physicians picking up charts and throwing them at nurses and clerks. Physicians having very loud temper tantrums in the hallways. Yes...this was common...back then. Administration did nothing and tended to look the other way. Whistle blowers were often retaliated against by Admin. Later on...thanks, I'm sure, to lawsuits and patient satisfaction scores impacting the administrative dollar, administration began to step in and intervene. Nowadays, that same physician would get hospital security called upon him/her in many hospital facilities. In fact, for myself, if a physician did become hostile and I felt unsafe, I would not hesitate to call security...even if just to begin a paper trail on that physician. If he/she becomes hostile towards you, it may very well occur again with another staff member. In the past, many nurses had to put up with a lot of poor physician behavior...because THAT was the norm and you were expected to suck it up or leave according to most Admin back then. Nowadays, such behavior is totally unacceptable by anyone, including a physician. In saying all of this, I truly believe from being a nurse for so long and by working in different hospital settings, much of physician behavior in the hospital is directly related to what the work philosophy is in Admin. It all starts and ends in Admin on high. If they permit it or turn the blind eye to it, then poor physician behavior would certainly return. If a physician threatens you harm, that is assault. If he/she actually lays hands on you, that is battery. In either case, security needs called and the paper work needs to begin....before even contacting your manager. Next, you begin looking at your options.

Good job. "Safety First" often becomes our top principle that directs everything that we do. Is the patient safe? In regard to self injurious behavior, the need for setting limits on behavior directly/indirectly and for implementing interventions to reduce such risks are certainly within our realm. Oftentimes, this may be simply being that we step in as a patient liaison that pulls in other resources for that patient. In this case, parents, psych, social worker, the E.D. Never take something like this upon yourself alone as a nurse. When it comes to unsafe behavior, we need to take this seriously, assessed and intervened. Regardless of the reason why a person cuts, it is not your issue. Your issue is to answer that question...Is the patient safe? If the answer is no, then assess and intervene upon the immediate risk at hand and then liaison out for the patient as their advocate. Good job. Good job.

An individual with strong clinical skills who can be equally competent as an independent clinician as well as a team player.

Excellent advice.

I find it interesting that the prescription overdose trend also tends to show some parallels to JCAHO's goal in improving a patients alleviation of pain. I would really like to see some studies that may demonstrate or not a correlation between the two...JCAHO and rising prescription drug overdoses. I wouldn't be surprised that a correlation exists, proving some iatrogenesis.

Think of heroin withdrawal symptoms like the worst flu symptoms...muscle/abd cramping, joint aches, anxiety, some dehydration as a result of nausea/vomiting, diaphoresis, lacrimation, rhinorhea, diarrhea...very unpleasant, but not at all fatal. They feel like dying, but it is nothing like alcohol or benzo withdrawal, which can be fatal. Pretty much, heroin/opiate withdrawal only requires supportive care till it runs its course. Some meds can be helpful. Bentyl for abd cramping, Neurontin at a fairly moderate to high dosing schedule for anxiety and aches (only if kidney functioning is adequate though...check the BUN/Creatinine levels), Motrin for joint aches, Trazodone or Seroquel as a sleeper, Benadryl or Vistaril for itch/pruritis, Haldol or another antipsychotic for psychotic symptoms, Zofran or Tigan for nausea....please notice, no PRN meds with an addictive quality (ie Benzos)...this is very very important with this population. If they shoot up, be mindful that Hep C may be present, which can jack up those liver enzymes. Also, if shooting up, most fatalities from IV heroin occur from endocarditis from using dirty needles. If there is this concern, an echocardiogram may be warranted to rule it out. These folks are also well known to be very theatrical in their presentation of symptoms. Be mindful of this. Manipulation and lying are their names of the game. It comes with the turf in this drug category of dependence, much worse than in alcohol. Observing them/behaviors/reported symptoms when they are not aware of being observed by you is best, if possible (ie TV monitor). You will often observe huge inconsistencies in what they report and in what you observe. Also, have strict guidelines that your patients are only medicated by their assigned nurse...do not permit staff splitting or going behind your back to another nurse for medication of symptoms. The games, the games...watch for it. Now is not the time to be working on depression issues with you...while going thru active withdrawal. That is for the CD/MH Counselor. That is for outpatient or followup after detox. Many have used heroin/opiates as a means to numb out...physically, spiritually, and emotionally. Numb is what most heroin addicts call "feeling normal"...and they actively seek it by any means. Normal to them is numb. When they actually are off the drug after detox, they will begin experiencing feelings once again...that is good, very good...but they may not want to...much easier in their minds to be numb and soulless. Outpatient counseling after detox will then be helpful as they begin experiencing feelings previously denied or numbed. As a detox nurse, it is your role to help them from the physical aspect...the physical withdrawal. Counseling comes after you or in conjunction with you if your facility has CD counselors on site. But, you are not the one to be really delving into their issues or business. If you do, it tends to reflect more about yourself than the patient in front of you. As a nurse, it is best to be objective in your approach, assessment, and intervention. If you have issues with codependency yourself, this makes this all the more important. If not, you may allow yourself to become totally ineffective as a nurse. Side and last note, nurses are to be very mindful of their professional boundaries with this population....that means...no giving out your personal info like your cell or home phone number, your address, giving money, going out together after detox on a personal level, and god forbid, dating your ex patient. If you cross these boundaries, it says much more about yourself than the patient....you have issues. Your patients are not your friends, your buddies, or to be your potential future mate. If a nurse treads these sort of waters, that nurse needs counseling. As you can tell, I am very passionate about this topic. I saw alot when I worked in detox...excellent experiences. I learned greatly from the literature, from this population while in the field, and from the nurses themselves. Some of the nurses were excellent role models, very learned and experienced. Some, well, going back to the boundary topic, really needed some professional help. Hope this answered many of your questions (asked and unasked). Peace to yah. Good luck in your clinicals.

addiction in america has a new face: prescription drugs. last year, prescription drugs replaced heroin and cocaine as the leading cause of deadly overdoses. and celebrities are showing us that mixing prescription pills -- the pills you may have in your home right now -- could be just as deadly as shooting up heroin or snorting cocaine. according to [color=#004276]statistics from the office of national drug control policy, there are some 20,000 drug-related deaths a year in the united states. even more shocking than the deaths of all of our mothers, fathers, brothers, sisters and children is that drugs prescribed by a doctor -- not bought off the streets -- were the leading cause of fatal overdoses. http://www.cnn.com/2009/health/09/14/velez.mitchell.pill.addiction/index.html

More professional....I agree.

Ditto

Interesting, you are correct. That was the link then...but since from then to now, it links elsewhere to that other site. How odd. Any way, the info on the original post remains informative and relevant. Thanks for the update.

Dummers welcome dancers for Feast Day at Ohkay Owingeh Pueblo, New Mexico, 2008. Photo by Julien McRoberts. The drum is a powerful instrument. Indigenous people throughout Turtle Island refer to it as the heartbeat of Mother Earth. It is used in many spiritual and sacred ceremonial practices. Some say the beat of the drum has the power to change natural elements, including the weather. It is believed to have the power to heal sickness, and some believe it has the power to send messages both to the animal world and to the spirit world. The drum is broadly considered to be the first musical instrument used by humans. Historians and music ethnologists alike point out that the drum has been utilized by virtually every culture known to mankind for a multitude of purposes. In ancient times, the earliest drums were used for religious rituals, social dances, sporting events, feasts, special ceremonies, in preparation for hunting, and as a prelude to war. However, it is virtually a universally held belief that the original purpose of the drum was to communicate, many times over long distances as a warning or signal. In the Americas, the drum has a history that dates back to pre-Columbian times. Remnants of wooden cylinder drums and small pottery drums found in Central Mexico, Costa Rica, Peru, the Guatemala highlands and other parts of Mesoamerica have been dated back to A.D. 700; older examples most likely existed but succumbed to the elements. From the Inuit people of the Arctic region, the salmon and whaling cultures of the Pacific Northwest, and the Northern and Southern Plains tribes, to the Eastern Woodlands, the Rio Grande Valley and elsewhere, Indigenous people of North America continue to use drums for dances, ceremonies, games and sacred practices. Power Over Illness and Weather The drumbeat evokes many powerful forms of energy and is an aid in helping to focus one’s attention and to see clear intentions. Certain types of beats are said to carry special healing powers into the human body. A sick person’s psychological and physiological states are believed to be altered by the rhythmic drumbeats and accompanying song, and the illness becomes more attuned to other medicinal remedies. Stories about drummers being able to influence weather conditions, such as inducing or dissuading thunder, rain and other elements through the vibrations sent into the atmosphere, are common among Indigenous people. In the springtime, the Menominee of Wisconsin celebrate the return of the sturgeon to Keshena Falls, the fish’s original spawning waters, and summon the sturgeon’s return home with the beat of the drum. Black Elk, an Oglala Sioux holy man made famous by John Neihardt’s book Black Elk Speaks, offers this perspective: “Since the drum is often the only instrument used in our sacred rites, I should perhaps tell you here why it is especially sacred and important to us. It is because the round form of the drum represents the whole universe, and its steady strong beat is the pulse, the heart, throbbing at the center of the universe. It is the voice of Wakan Tanka (Great Spirit), and this sound stirs us and helps us to understand the mystery and power of all things.” Thomas Evans is a citizen of the Pawnee Tribe who works in the curatorial lab with the National Museum of the American Indian’s artifact collections. Although he cannot say so definitively, he believes the oldest drum in the museum’s collection may be an old Delaware drum that was originally collected prior to 1850. He points out that there are other Eastern drums in the collection that are made of whiskey/nail kegs that were also collected at about the same time. Evans believes research shows that many of the Missouri River tribes, as well as Eastern tribes, traditionally used gourd rattles and rawhide bundles for their ceremonial practices and singing, rather than drums, until perhaps the 1880s when the hiduska (powwow) was introduced. In his upcoming book Moving History: The Evolution of the Powwow, Dennis Zotigh, a citizen of the Kiowa Tribe who also works for NMAI in Washington D.C., describes how, in pre-reservation days, Plains singers would unroll a big rawhide, sit on the ground and use ceremonial sticks to drum out a cadence. “With the introduction of the military base drum around the turn of the 19th century, most Plains tribes adopted it, replacing their rolled-out hides. In some cases, it was modified to fit tribal constraints. Rawhides were stretched and tied over the drum to create drumheads. The base is made from a hollowed-out tree trunk or by bending wood panels into a circle or eight-sided frame,” Zotigh writes. http://www.nativepeoples.com/article/articles/326/1/Drums%3A-Heartbeat-of-Mother-Earth

The Indian Health Service (IHS) Public Health Professions (PHP) are responsible for addressing the health needs of over 1.8 million American Indians and Alaska Natives in a network of 48 hospitals, more than 230 clinics, and a system of Tribal and Urban programs. As part of the US Department of Health and Human Services, our mission is to raise the physical, mental, social and spiritual health of this diverse population to the highest level. Learn more about the Opportunity, Adventure, and Purpose offered by IHS Public Health Professions. Learn more about the men and women, and services of IHS Public Health Professions. More about Disciplines Starting your career? Looking for new challenges? IHS has openings for full-time and part-time positions, as well as residency and externship opportunities. More about Positions Commissioned Corps, Civil Service or Direct Tribal Hire - match your professional and personal priorities to the right career path. More about Career Paths & Benefits Information you need to know to apply for an IHS Loan Repayment Program Award. More about Loan Repayment IHS hospitals and clinics are located in 35 states throughout the US - find an IHS Service Area. More about IHS Service Areas IHS has temporary duty (TDY) opportunities available for volunteers interested in serving. More about Volunteers IHS hospitals and clinics are located in 35 states throughout the US - find an IHS Service Area. More about Events Find the IHS recruiter for your profession. More about Contact Us Go to the site: http://www.ihs.gov/JobsCareerDevelop/careers/

A Collaborative Approach to Specialty Patient Care in Cardiology University Medical Center, Indian Health Services, University of Arizona The Native American Cardiology Program was established by Dr. James Galloway in 1994, in recognition of the changing health problems and needs of Native Americans in the Southwest. Prior to the 1960s, coronary artery disease was relatively uncommon among Native Americans. Over the past decades, changes in diet, economics, and lifestyle have resulted in marked increases in the rates of obesity, diabetes, high blood pressure and kidney failure, all of which increase rates of coronary disease, heart attacks, and cardiac deaths. Rates of diabetes and the metabolic syndrome are twice as high among Native Americans compared to the general US population. The most common cause of death for people with diabetes is cardiovascular disease. Unfortunately, these changes in risk factors have resulted in Native American death rates from heart disease that surpass those of the general U.S. population. Cardiovascular disease is the number one cause of death for Native Americans in the Southwest and around the nation. Rheumatic heart disease is another unique problem that affects Native Americans much more commonly than the general US population. High rates of rheumatic fever have resulted in a significant amount of valvular heart disease that has become rare among other populations in the country. The valve disease associated with this childhood illness may present 20 to 40 years after the episode of rheumatic fever and only half of the patients with rheumatic disease remember ever having had rheumatic fever. As a consequence, high rates of mitral stenosis, often accompanied by other valve disorders are seen that require surgical intervention. Diagnosis and management of these difficult cases are worked closely with cardiac surgeons at University Medical Center when surgical intervention is required. This collaborative group understands the unique living conditions and economic limitations that many of their patients face and incorporate these factors into their decisions regarding valve surgery and anticoagulation needs. The circumstances and history of each patient are considered individually in making recommendations regarding surgical or percutaneous interventions. 24/7 Provider Consultation and Patient Transfers: All Health Care Providers who care for Native Peoples 1-800-777-7552 http://www.ihs.gov/Cardiology/

Injuries are the leading cause of death for American Indians and Alaska Natives from ages 1-44 years, and the third leading cause of death overall. Unintentional injury mortality rates for Indian people are approximately three times higher than the combined all-U.S. races rate (IHS, Trends in Indian Health 2000-2001). However, this disparity varies by IHS regional Area and by cause of injury (CDC, Atlas of Injury Mortality Among American Indian and Alaska Native Children and Youth, 2005). The IHS has established a widely-recognized injury prevention program that works with tribes and other partners to reduce the disproportionate impact of injuries on Indian people. http://www.ihs.gov/MedicalPrograms/InjuryPrevention/

Kimberly Teehee is senior policy adviser for Native American affairs at the White House Domestic Policy Council. This is what Kimberly Teehee has written regarding the myths. ___________________________________________ I wanted to record this and write this post to debunk the myth that the Indian Health Service (IHS) is a government health plan gone wrong. It is truly unfortunate that recent press stories seek to scare Americans about health insurance reform by highlighting the IHS system. First, the IHS system is not an insurance plan. And comparing the two is like comparing apples to oranges. IHS provides comprehensive health care services to approximately 1.9 million American Indians and Alaska Natives living on or near reservations in 35 states. Some of these health services include doctor visits and check-ups, dental and vision care, diabetes prevention and treatment, mental health and substance abuse treatment, and home health care. IHS also helps construct hospitals and clinics and provides safe drinking water and sanitation facilities to American Indians and Alaska Natives. Health insurance, by contrast, provides individuals a guarantee to a defined set of benefits for a price. While the IHS accepts insurance payments for care it provides, it is not an insurance plan. Second, national health reform will not dismantle IHS. American Indians and Alaska Natives will continue to have access to their Indian health service facilities. And third, while Indian health has been historically underfunded, several tribes have developed innovative and award-winning approaches to provide health care to their communities. These sites serve as successful models for other rural and public health programs. President Obama supports IHS which is why he proposed a 13 percent increase in the FY 2010 budget, and invested $590 million in the American Recovery and Reinvestment Act of 2009. http://www.reznetnews.org/blogs/tribalog/clearing-myths-health-insurance-reform-and-ihs-38200

Alone. This is how Notah Begay III describes his journey as a youth with golf aspirations to a Division I athlete and now a professional golfer. Begay, a Navajo, Isleta and San Felipe Pueblo, is one of the few Native professional athletes in the world. The 36-year-old is a Stanford graduate and the lone full-blooded Native golfer on the PGA Tour, where he is a four-time winner. "I always felt alone," he said in a media conference call Monday. "Through my entire career because I was the only Indian on the whole golf course. What really kept me together was knowing that Native American people were always supportive of me, always behind me. That's what kept me going and it keeps me going to this day." Today Begay is doing his part to help Native youth on and off the golf course. Four years ago, he created the Notah Begay III Foundation to provide health and wellness education to Native youngsters in form of golf and soccer. This year Begay has the help of his Stanford roommate and friend, Tiger Woods. http://www.reznetnews.org/article/tiger-woods-joins-notah-begay-help-native-youth-38110

Deputy Attorney General David Ogden: "We're really at kind of a crisis point." On just a single day this year on the Red Lake reservation in northern Minnesota, police and investigators received emergency calls about a suicide, a murder, three stabbings, two shootings and multiple incidents of domestic violence. Federal statistics have shown American Indians are the victims of violent crime at more than twice the national rate, with incidence of homicide and domestic violence much higher than the national average. The Obama administration announced Thursday a new effort to try and combat some of this crime on reservations, where shortages of law enforcement personnel and federal dollars have led to lawless environments. The top three Justice Department officials — Attorney General Eric Holder, Deputy Attorney General David Ogden and Associate Attorney General Thomas Perrelli — will travel to states with high Indian populations over the next two months to talk to tribal members and crime experts about what can be done. 'Suffering in People's Lives That Is Just Unacceptable' "It translates into suffering in people's lives that just is unacceptable in this country," Ogden said in an interview with The Associated Press. "We're really at kind of a crisis point." The problems are not new. In the 1990s, Holder, Ogden and Perrelli all worked on Indian crime for then-Attorney General Janet Reno in the Clinton administration. Many of the same issues still exist, including limited resources, a lack of coordination among agencies and little focus on the issue. "We have to look at whether we're doing enough and I think it's clear we're not," Ogden said. "I think we can devote more law enforcement agents, I think we can help in the training of law enforcement agents, we can have more prosecutors and I think we can provide more support to tribal institutions." Increased federal dollars will probably also be part of the equation, Ogden said. Gang Activity Part of the Problem Reports of violence on reservations — especially the poorest and most remote — are constant. Red Lake has certainly known its share of crimes. In 2005, a 16-year-old there killed seven people at his school and two people on the reservation. Gang activity has risen in tribes across the country as drug traffickers have taken advantage of gaps in law enforcement. Still, little is known about what exactly is happening on reservations or how the incidents are handled. Data has been sporifice for decades and crime surveys rarely separate out tribal statistics. Ogden says better data collection is one of the department's priorities. One of the main problems in reducing crime has been a lack of officers; often a handful of patrol cars will police a reservation the size of a small state. http://www.reznetnews.org/article/justice-boost-fight-against-tribal-crime-38250