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Brenda F. Johnson MSN

Gastrointestinal Nursing
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Brenda F. Johnson has 29 years experience as a MSN and specializes in Gastrointestinal Nursing.

After three years on a Med/Surg floor, I transferred to an outpatient setting. I was interested in a normal schedule, but little did I know I would find my niche in GI nursing. I love GI nursing because every day is a learning experience. My passion for writing led me back to school to get my degree in creative writing. Most of my writing prior to allnurses was creative non-fiction and poetry. Writing for the online magazine is great, allowing me to combine my love of nursing and writing. It is a dream come true!

Brenda F. Johnson's Latest Activity

  1. The evolution of nurses day or nurses week took many years to become official. The first official attempt was in 1953 when Dorothy Sutherland of the U.S. Department of Health, Education and Welfare proposed a “Nurses Day” to President Eisenhower. She wanted it to reflect the 100th Anniversary of Florence Nightingale's mission to Crimea, but it did not get done. However, the following year in 1954, a National Nurses Week was celebrated from October 11-16 (Gillies, 2003). In 1955, a bill was introduced to declare a National Nurses Week, but it did not pass. Ten years later, the International Council of Nurses started celebrating “International Nurses Day”. President Nixon is asked in 1972 to acknowledge a “National Registered Nurse Day”, but it did not happen. However, two years later, Nixon proclaims “National Nurses Week”. The same year, the International Council of Nurses proclaims May 12 as “International Nurse Day” (Gillies, 2003). There are several milestones in the years that followed, and in 1982 the ANA recognized May 6 as “National Recognition Day for Nurses”. That same year, Congress also made a resolution for May 6 to be “National Recognition Day for Nurses”, and then President Ronald Reagan signed a proclamation on March 25 declaring the same (Gillies, 2003). The ANA made nurses week (May 6-12) official in 1990 (Gillies). May 12 is Florence Nightingale's birthday, so it is fitting that we end the week of celebration - celebrating her. After attending nursing school in Germany, Florence went back to London and became superintendent of a hospital for “gentlewomen” (The History, 2016). Her work in public health and during the Crimean War set new standards for healthcare. She decreased mortality by improving sanitary conditions. Not only that, she kept records of the people who died, and how they died. This allowed her to make the connection between sanitation and disease. Florence actually had some of the first evidence-based research in healthcare. Looking back at how many changes (or not) have taken place in nursing and the medical field, it seems overwhelming. Even so, the nurse's mission has remained steady throughout this medical metamorphosis. This is evidenced in a book published in 1930, , F.A.C.P. In the preface, he tells us what his perspective of what a nurse is. “The function of the nurse in medical diseases is to observe symptoms accurately, to recognize early signs of complications and to carry out the physician’s orders intelligently” (1930). This description applies today just as much as it did in 1930. Although we have made great strides in Chemistry, biology, and electronics, our basic purpose remains as it always has been - to provide care to our patients to the best of our ability without doing any harm. I love my old medical and nursing books. I enjoy reading them and seeing the nursing students’ signatures written crookedly inside the front cover and maybe some scribbled notes of something they thought was important. These books are precious, connecting the past with the present. One of the books in my collection was written in 1917 by George M. Price, M.D. called, Hygiene and Sanitation A Text-Book for Nurses. When I flipped to the dedication page, it read, “To Lillian D. Wald - The pioneer of Public Health Nursing in the United States and the foremost advocate for the extension of the scope of the nurses’ work. This book is dedicated in appreciation and respect” (Price, 1917). Wow. Makes me wonder if he knew her or just knew of her. This is the perfect segue into talking about Lillian D. Wald and her contributions to the world of sanitation, education, and the improvement of conditions for children in that day and time. Lillian Wald is known for her work in reforming public health. Not only did she open a “settlement house” (opened in poor urban areas in an attempt to bring the rich and the poor together in proximity and socially) in 1893 called the Henry Street Settlement, she moved into the house along with her friend and fellow nurse Mary Brewster (Lillian, n.d.). There in the house, she provided nursing care for the poor. Eventually, there were many nurses who would come and volunteer their time. Soon, the settlement was able to open playgrounds, afterschool programs, kindergarten, mother’s groups and more. Lillian was able to discern what the community needed and then make sure it happened. Together, she and other well-known women’s rights activist such as Lavinia Dock and Florence Kelley helped to write textbooks, aiding to the progression of the professional nurse. New York City school children benefited from the many people living in that settlement who helped to improve conditions in the schools. Special educations classes were created, and a program for school nurses was started, along with a lunch program for the students. Lillian’s activism and hard work in her community were boundless, including her work in the political arena to end child labor. Her story is a good example of how one nurse changed a country (Lillian, n.d). Getting back to the book, I thought you would enjoy what Dr. Price had to say in his preface. “The last decade has seen a wonderful expansion of the function of the trained nurse and a great broadening of the scope of her usefulness. No longer are her duties limited to the simple care of the sick. The nurse has become a priestess of prophylaxis. Her work in preventative medicine has become invaluable. She has become an important factor in social, in municipal, and in public health work” (Lillian, n.d). **To all the wonderful male nurses out there, know that we appreciate you and you are the “princes of prophylaxis”. ** While documenting in charts has become obsolete, we now see our faces in the reflections of all of the electronic devices we use. We get lab, and other results in real time and can treat patients sooner. Communication has become easier and faster, decreasing the incidents of delay of care and improving patient outcomes. While all of this is great, let’s not forget to look up and make eye contact with our patients; they need it, and so do we. Just from looking at them we can tell so much. We can see if they are pale, in pain, or nervous, and most of all, it begins the process of building a rapport. Nurses Week is to celebrate you. All the times you ignore your back pain and keep going, or brush off the bladder that is about to burst in order to care for your patient. As you bring them their lunch while yours is getting cold, this week is for you. When a doctor yells at you for something that is no fault of yours, this week is for you. As you walk to your car on feet that are so tired they can’t take any more steps, we celebrate you. The connection we have as nurses over the past decades to now binds us in our journey of serving. The best things about the healthcare system have been created by nurses just like you. Do some creating of your own and don’t forget to get a massage to reward yourself. You never know, decades from now, nurses may be reading about you and all the wonderful things that you were able to accomplish. Tell us about some things you would like to pioneer. References Blumgarten, A. (1930). A Textbook of Medicine for Students in Schools of Nursing. New York: The MacMillan Company. Filiacia, A. Lillian Wald - Public Health Progressive. (n.d.). Wordpress. Retrieved from www.lillianwald.com Gillies, H. Florence Nightingale The History of Nurses Week. (2003). CountryJoe. Retrieved from www.countryjoe.com/nightengale/nursesweek.htm. Price, G. (1917). Hygiene and Sanitation A Textbook for Nurses. Philadelphia and New York: Lea & Febiger. The History of Nurses Week. (2016). Ashford University. Retrieved from https://www.ashford.edu/online-degrees/health-care/the-history-of-nurses-week
  2. Brenda F. Johnson

    Medical Research: How Valid Is It?

    What is Valid Research? We use peer-reviewed research articles to base our nursing practice on, and it’s called Evidence-Based Practice (EBP). Peer-reviewed means that scholarly experts in the subject have analyzed the information for validity. For example, the protocol for sepsis is based on EBP. Over time, as more research is conducted, the protocol may be updated as new treatments emerge. However, there are several issues within the medical research community that should give us pause when we are looking at information. In other words, we should not take it for granted that everything we read is completely accurate and unbiased. Concerns There are several concerns about medical research, such as wasted money, quality vs. quantity, reporting bias, and cultural issues. Wasted Funding There is a lot of waste in the research field according to the article, “Reducing Bias and Improving Transparency in Medical Research: A Critical Overview of the Problems, Progress, and Suggested Next Steps” (2020, Bradley, et al). In fact, they claim that 85% of the money used for research is not spent on something that the medical community needs, but rather on what individual medical researchers are given incentives for (2020, Bradley, et al). Because of this bias, studies are not conducted properly, and a lot of the research cannot be replicated (2020, Bradley, et al). And if you remember from science class, an experiment is not valid unless it can be duplicated. Take for example the research that has come out the past year about Covid-19. There were many publications that published non-peer-reviewed studies (2020, Dobler). When this happens, inaccurate information can be contained in the article, which is then spread over every media outlet like it’s the gospel truth (2020, Dobler). Unfortunately, there are low medical literacy viewers that believe everything that they see and hear on television. This is not their fault, it is the publishers of the misinformation. Often these studies have very small sample sizes and poor study designs (2020, Dobler). Other faults in rushed research are that they have no group to compare results with, and no protocol that is publicly available (2020, Dobler). When no protocols are available, there is no accountability. Some of the research done on Covid-19 was performed by people who had no experience with respiratory infections, let alone any associates that could help produce authentic work (2020, Dobler). As a result, many gross misunderstandings were accepted by the public. To help us understand the disproportionate accurate versus inaccurate research trials we will look at the trials that took place last year. Out of 1528 studies registered in 2020 with using NIPPV (Noninvasive Positive Pressure Ventilation) for Covid patients, only 3 were randomized. (2020, Dobler). Randomization in medical research using human subjects is a must in order for the results to be unbiased and accurate. Quality Vs Quantity Academics are pressured to publish regardless if there is interest or not (2020, Bradley, et al). As you may already know, what is published, studied, and the conclusions are widely based on financial incentives (2020, Bradley, et al). This creates a culture within research to conduct studies that are not objective. For example, the pharmaceutical companies (that we know are rolling in money) often have an institution do a study for them, creating a conflict of interest (2020, Bradley, et al). Pharmaceutical companies evidently can opt-out of proclaiming conflicts of interest, Bias Every day that we look at a news article, or watch it on television, information is cherry-picked according to the message that they want to convey. The same thing happens with research published by journals or scholarly publications (2020, Bradley, et al). In many cases, if the results of a study have a negative result, then that study is not published (2020. Bradley, et al). What may happen, is that a spin is applied to the information so that it comes across in a more positive, or different manner. When a study goes through peer review, and the scholars report a bias or that the study does not state the limitations of the study, the report can be ignored (Bradley). And even worse, some researchers are developing their hypothesis after the study is conducted in order to match the results of the study (2020, Bradley, et al). Cultural Issues Some of you may remember when cardiac research was done, it only included men in the study. How then can the results be applied to women? It doesn’t make any sense. Just as doing research without including minorities creates health disparities (2021, Heath). According to the article by Sara Heath, “Why Poor Diversity in Medical Research Threatens Health Equity”, an oncology study in 2019 was broken down as follows: 76% White 18% Asian 6% Hispanic 3% Black Due to this process, the complete awareness of a disease process is not being learned. Ways to Improve As stated before, in order for the study to be taken seriously, it has to be reproducible. Bradley writes that transparency and positive guidance will improve honesty (2020). He also thinks that there should be a limit on how many studies can be submitted for institutional assessment (2020, Bradley, et al). Also, they need to register their hypothesis, methods, and analysis before a conclusion is found (2020, Bradley, et al). There is a problem, however, with producing individual patient information, so sometimes the data is private and cannot be revealed. Conclusion As nurses, we must recognize that there are flaws in the research process that can cause misunderstandings in the patient community. Hopefully, in the future, there will be more regulation of studies performed as well as what is published as unbiased facts. References Bradley, S.H., Devito, N.J., Lloyd, K.E., et al (2020). Reducing Bias and Improving Transparency in Medical Research: A Critical Overview of the Problems, Progress, and Suggested Next Steps. Journal of the Royal Society of Medicine, 113(11). Dobler, C., (2020). Poor Quality Research and Clinical Practice During Covid-19. Breathe: Practice-Focused Education for Respiratory Professionals, 16(2). Heath, S., (2021). Why Poor Diversity in Medical Research Threatens Health Equity PatientEngagementHit.
  3. Brenda F. Johnson

    What Can We Do About a Negligent Doctor?

    Respect For Doctors I’m afraid there may be more questions than answers regarding reporting physician malpractice. Things are certainly better than they were when I first started my nursing career in 1992 in relation to physician behavior. I remember doctors frequently being inappropriate, especially in a sexual manner. Newer nurses have raised the bar with improved expectations, which has helped to change the physician/nurse dynamic. Programs have been developed that protect nurses and techs from being bullied. However, there remains the troubling issue of bringing concerns about physician practice to light. I have the greatest respect for doctors. The training and long hard years of school that they spent sacrificing to learn. Their hard work doesn’t end with graduation, but begins. Healthcare is a fulfilling career, one that becomes a way of life. But just like in any other profession, there are some that don’t hold themselves to higher standards. There are many stories available in several forms such as podcasts, that can spin the stories of patients who have suffered greatly at the hands of incompetent doctors. These stories are easier to bring to light because of the terrible tragedies that ensued, such as death or severe maiming. Most of the doctors in the latter stories are mentally ill and purposely hurt people or prescribe treatments that will kill them, not only costing their lives but money. Concerns My heart lies with the stories concerning patients that do not get a complete exam. For example, during a colonoscopy, a doctor is required to go to the cecum, the very end of the colon. They must go up to the ileocecal valve and go into it so they can examine the entire area. They should also attempt to go into the small bowel. This is not always possible, but it should be a priority if the patient is having diarrhea or any colitis symptoms. A larger percentage of cancer is found on the right side of the colon, which is why standards dictate that the cecal area be examined thoroughly. Once the cecum is reached, the requirement is to examine the colon for six minutes on the way out. This is standard practice across the United States, it is the time needed to completely visualize the colon. When a person completes the wretched prep, pays a co-pay, and comes into the hospital or clinic to have a screening or diagnostic colonoscopy, they expect that the exam will be done properly. I have seen polyps left, masses that should have been taken out just minimally biopsied, and cecal times the same as the end times. That means, the doctor exited the colon within a minute or less of reaching the cecum. These are just a few examples, but they are some of the most worrisome. I speak to colonoscopies because that is what I know, but this concern applies to any treatment, surgery, exam, or office visit. If all of the data is not looked at, or all of the anatomy isn’t examined, then it can lead to a disastrous future for the patient. Reporting a Doctor Reporting a physician is a difficult thing, both emotionally, and professionally. As I write this, my stomach feels sick. Questions roll around in my head about the “what if’s”. But if we don’t say something as the patient advocate, then who will? I have filled out incident reports each time that I’ve been a part of negligence or malpractice. Sometimes I am told that it’s my word against the doctors. When are doctors going to be held to the same standards as the rest of healthcare? They are not above lying, cheating, fraud, or malpractice. There is an ethics hotline that is available to anonymously report something or someone at our facility, and there are the good old incident reports for reporting untoward events at my facility. But is that enough? How do we know that it goes beyond the risk manager, or the person reading the report or listening to the phone call? There is a way to report doctors through the State Medical Boards ( a simple Google search finds each state). These government agencies file complaints according to the potential for harm. The issues that are considered high priority are: sexual misconduct, practicing medicine while under the influence, and providing substandard care (Docinfo, n.d.). The report is then studied and if they have the authority to look further into the complaint they then begin investigating. The doctor and parties involved are notified, expert witnesses give their opinion, and action is taken or not taken. It can go to a court trial and if the physician is found guilty, a public notice is given and disciplinary actions are taken. Reports aren’t taken very seriously on their own, it’s when there becomes a trend. I do understand that they need protection from false claims, but there must be a middle ground. In part two of this article, I will look more in-depth at the reporting system and its effectiveness. Have you ever reported a physician for malpractice? What was the outcome? Reference Reporting a Doctor for Unprofessional Conduct. (n.d.). Docinfo. Retrieved from https://www.docinfo.org/report-a-doctor/
  4. Brenda F. Johnson

    I Did It! I Earned My Master’s in Nursing Informatics

    I have been in contact with the Director of the Informatics dept. at my company. She knows that I'm interested and will let me know when a job opens. So that will involve Meditech and working with that to improve data gathering. I want to stay at the same company because of the good 41K match they do. So until I retire.....After that, I would like to work from home in some capacity. Your job sounds so cool!
  5. About a year into getting my Master’s Degree, I wrote Getting My Graduate Degree: Is It Worth It? the article mentioned above about my experience up until that point. It wasn’t long after that, that my life turned upside down and inside out. School was both a welcome distraction and a pain in the ***. The work itself during the first three semesters was very similar to the management track. It wasn’t until about the fourth semester that the focus was on informatics. I did miss the in-class experience in the beginning. I thought that not having face-to-face interaction would somehow decrease the amount that I could learn. But in this day of technology, all things are possible. Face-to-face doesn’t have to mean that the person is in the room with you. And of course, with the emergence of Covid, the entire nation has learned to Zoom. We have become creative in the ways that we communicate, teach, and learn. The online WGU program utilized several approaches to teach, such as monitored - multiple-choice testing, research papers, and self recordings. I was expected to master all forms of media, which stretched my knowledge base (and my patience) of what I’m capable of. These skills have already helped me in my present job as Clinical Coordinator of a GI lab, and of course, prepared me for a future in informatics. Much of what I learned was based on Evidence-Based Practice (EBP). Nursing practice bases its principles on what has gone before us, and what is the most effective method that improves patient care. The proven best method becomes our standard of care. I learned how to choose peer-reviewed research as well as interpret the information that was given in the articles. Learning the APA method was a change for me, because I had used MLA in creative writing. At this point, I am confident in my ability to do technical and research writing. When I started studying coding, creating flow charts, dashboards, ERD, and much more, it stretched my brain. At the beginning of constructing my flowchart, I had a complete meltdown. I think I even cried in frustration, but my course instructor gently talked me off the ceiling and walked me through it. The instructors did not tell me exactly what to do, but guided me to the right information. Now, I actually enjoy making a flowchart. I understand the purpose and have learned how to do the shapes and arrows in order for the flowchart to make sense. I feel that I learned a lot, so that made it worth it. My hospital reimbursed a lot of the tuition which was a huge help, and as far as my age - we are never too old. Why do we put limitations on ourselves? I do know one thing, I’ve never had a more stressful year in my personal life. I am getting a divorce after 37 years of marriage. I found out earlier last year that there was cheating, along with other ugly things. That will take me a long time to work through and because of Covid, the court date keeps getting delayed. Also, my oldest daughter relocated here from Michigan with her husband and five children. Three of those are under five. I love reconnecting with her and getting to know her husband. They helped me in my worst moments by protecting me from my ex., and basically saved my life. However, there is a noise level with the small children that made it very difficult to work on homework. Work proved to be added stress due to low staffing. I had a difficult time getting my work done because I often have to work on the floor. I love working on the floor, but I also have a large responsibility as the clinical coordinator to keep the place running. Also, we are doing a whole new build-out, which is absolutely amazing! There has been a lot of work and time that goes into that as well. My staff is fantastic, and I couldn’t do it without them. For me, going back to school was worth it. I don’t regret any of it, because knowledge is power. What the future holds, only God knows. He has carried me through so many hardships, and I trust my future to Him. For now, I will rest in that. As for my immediate future, I plan to continue redecorating my house and write creatively as well as for allnurses. I want to find myself, explore new things, and treasure my freedom. When Spring comes, I am going to grow as many herbs and vegetables that my property will hold. Gardening soothes my soul and makes me happy. Going back to school is a very personal decision, one that takes commitment, money, and time. No one can tell you how to live your life, just do what’s in your heart and follow your gut.
  6. Brenda F. Johnson

    Nurse Severely Beaten Injured By Patient

    Just a question, what stopped you from filing an incident report? I am on your side, and I think what happened to you is criminal - from the pt and the facility. But doing a report that day would start a paper trail.
  7. Brenda F. Johnson

    Gastrointestinal (GI) Nursing

    One idea may be to train a couple of the GI nurses to do an admission, start the IV, etc. That way there would be consistency of care, and the admitting nurse would get some support in the beginning of the day. I hope this helps
  8. Brenda F. Johnson

    Gastrointestinal (GI) Nursing

    Gastrointestinal (GI) Nurses specialize in issues and diseases of the stomach, esophagus, and bowel. This specialty area is a job that continually evolves as equipment improves, new procedures are developed, and science learns more about how the GI tract functions. Being a Gastrointestinal Nurse is a complex, but interesting job. Knowing the intestinal tract landmarks and disease processes are an important part of the job. Infection control issues are also a huge part of GI nursing. Not all GI labs have nurses wash the scopes, but even so, they must be educated on the cleaning process and storage aspects of the scopes. Most Common Procedures in a GI Lab (not all-inclusive) Esophagogastroduodenoscopy Colonoscopy Endoscopic Retrograde Cholangiopancreatography Small Bowel Enteroscopy Other Procedures (not all-inclusive) Endoscopic ultrasound Bravo Ph study Esophageal and/or Anorectal Manometry Radiofrequency Ablation Percutaneous Endoscopic Gastrostomy Fecal Transplant GI Procedure Personnel There are two personnel in the room in addition to the physician. One must be an RN; the other one can be an RN or a Tech. The majority of facilities use anesthesia, Certified Registered Nurse Anesthetists (CRNA), to administer propofol intravenously, and in others, the RN provides conscious sedation through the IV such as versed, sublimaze, benadryl, and valium. Role of the RN in the GI Lab The RN can function as the Circulator in the room or as the tech. The exact duties will be different depending on the layout of the facility. Circulator RN Chart all of the information: Patient name, doctor name, staff, scope used, start/stop/cecal time, findings, procedure, etc. Label specimens and enter them into the computer for processing Use closed-loop communication with post-op diagnosis and specimens Be available to help the tech, such as getting the equipment that is not closely available Provide pressure on the abdomen as needed to assist the doctor Be available to help the CRNA if needed for airway management, emergency equipment, and medication Be the third eye watching the screen for abnormal findings, such as polyps Tech Directly assist the GI physician with obtaining specimens with biopsy forceps, snares, etc. Set up the room before the procedure with everything needed for the procedure: scope, cleaning material such as enzymatic soap, towels, 4x4s, etc. Clean the scopes after the procedures are finished, called bedside cleaning which is an important step in infection prevention. It includes sucking 500cc of enzymatic soap/water through the scope after blowing air through it, then wiping it down with a soapy lint-free cloth. Knowing the scope anatomy and handling procedures is vital to keeping the scope working properly and prevent damage Know infection control standards and how to maintain clean/dirty surfaces as well as possibly sterile ones. Perform closed-loop communication Desired Qualities The GI nurse must be focused in order to process all the information/activity that happens in a procedure. Good communication is an asset not only with each other, but with the physician. Willingness to learn - every day can be a teaching experience in the GI lab. Organization is an important skill to have while working in the GI lab. The fast pace and turnover requires the nurse to work in a coordinated fashion with the rest of the personnel in the room. Critical thinking is an asset in the GI lab, there are often emergencies that require the nurse to be forward-thinking, Education is a large part of being a GI nurse, so having the knowledge and skill to convey disease processes, their treatment, and long-term management is important for the patients Work Areas (not all-inclusive) GI lab in freestanding ambulatory units Hospital GI lab (often require the nurses to be on-call which means covering 24 hours for emergencies) Physician clinic/office GI lab Job Requirements Graduate from accredited RN nursing program Degree: Diploma, ADN, BSN or higher Successfully pass NCLEX-RN Current, unencumbered RN license in U.S. state of practice Professional Organizations / Certification Society of Gastroenterology Nurses and Associates (SGNA) - SGNA's goal is to educate, use evidence-based practice, safe practice. They provide guidelines for scope cleaning, procedures, and all things GI. American Board of Certification for Gastroenterology Nurses (ABCGN) - The ABCGN is the accrediting body that sets the rigorous standards for certification. Average Salary (2020) According to ZipRecruiter, the average annual pay for a GI Lab Nurse in the U.S. is $92,319 with salaries as high as $150,500 and as low as $24,000. According to Glassdoor, the average annual salary in the U.S. for a certified gastroenterology Registered Nurse (RN) is $65,870.
  9. Future Trends - BirthsAs stated in the introduction, future trends related to the Covid-19 virus are pure speculation. What we can look at to give us an idea of how America will respond, is to look at what has happened in the past. But first, let’s look at what the Census Bureau said about projected births in the United States in their article, “Demographic Turning Points for the United States: Population Projections for 2020 to 2060”, by Vespa, Armstrong, and Medina. Fewer BirthsVespa states that the American population is aging, and by 2030, all baby boomers will be over 65 years of age (2020). That means that one in five Americans will have reached retirement age. Going a step further, he projects that for the first time in history, older adults will outnumber children (Vespa, 2020). So without the virus factor, America was already looking at lowered birth rates. Increase in Divorce, Domestic Abuse, SuicideMany of my friends and I have joked about there being a baby boom because of the quarantine. However, we hear about an increase in divorce, domestic abuse, and suicide. Considering these tragedies, it leads one to deduce that there will not be an increase in births. There are several articles about divorce rates being increased since the pandemic, but not a lot of data. However, in China, there have been record filings, which makes sense due to the fact that they have had a longer period of time in quarantine with Covid (Wall, 2020). Xi’an, the capital of the Shaanxi Province has “seen an unprecedented number of divorce filings (Wells, 2020). Unstable Economy In the article, “Half a Million Fewer Children? The Coming COVID Baby Bust”, by Kearney and Levine, tells us that the economic condition that has been caused by COVID will drastically decrease birth rates (2020). Kearney speculates that there will be up to 500,000 fewer births in the year 2021 (2020). What they are basing their number on, is America’s history. In the past, when the country has experienced a recession, the birth rate falls. When families experience unemployment and reduced wages, their security is threatened. Looking back at the Great Recession, just a few years ago in 2007 to 2009, the birth rate dropped by 9% over the five years after the recession (Kearney, 2020). Unemployment rates directly correlate with lower births. With a one percentage point increase in unemployment, a parallel of a 0.9 percent decrease in births (Kearney, 2020). Looking even further back into history at the Spanish Flu, we see the correlation of mortality rates and birth rates being inverse (Kearney, 2020). However, the years of the Spanish Flu did not involve an economic recession, and women did not have access to birth control as they do now. Unlike during the Spanish Flu when all ages died from it, COVID related deaths are significantly higher in people 45 and over (CDC, 2020). The age group 34 and below have a very low number of deaths (CDC, 2020). So the death rate and birth rate should not be parallel involving COVID as in other epidemics It has been shown that families who are more financially stable have more children (Kearney, 2020). Anxiety and uncertainty is a huge deterrent for families wanting to start or expand their family. People do not know how impacted they will be financially in the future, leading to putting off having children or deciding not to have any. We do not know what our country will look like in six months, or how our birth rate will be. Only in the future will we be able to answer the multitude of questions that plague us presently. Drug and Alcohol AbuseAnother aspect of humanity is that drug abuse and binge alcohol use escalates during financial crises as shown in the article, “Binge Alcohol and Substance use Across Birth Cohorts and the Global Financial Crises in the United States” (Yang, Roman-Urrestarazu, and Brayne, 2018). Drug and alcohol use leads to unemployment, and poor health (Yang, 2018). This slippery slope is associated with economic instability, poor relationships, isolation, and many more debilitating issues. Being that there is an uptick of drug and alcohol abuse since the quarantine, common sense tells us that this leads to higher rates of mortality and divorce which leads to fewer babies. There are many reasons that Americans may be having fewer babies in the next few years. COVID will be blamed for many of them due to the devastating effect it has had on our country. What will happen remains to be seen, and we can learn from what we see. Will there be a boom or a bust? You tell me.References Kearney & Levine. 2020. Half a Million Fewer Children? The Coming COVID Baby Bust. Brookings Vespa, Armstrong & Medina. 2020. Demographic Turning Points for the United States: Population Projections for 2020 to 2060. United States Census Bureau. Wall. 2020. Divorce Rates and COVID 19. States Attorney. Yang, Roman-Urrestarazu, & Brayne. 2018. Binge Alcohol and Substance Use Across Birth Cohorts and the Global Financial Crises in the United States. PLOS
  10. Brenda F. Johnson

    Have you had your Colonoscopy? March is Colon Cancer Awareness Month

    The nurse charts, helps with abdominal pressure, labeling specimens, etc. The Tech assists the doc. The nurse runs the room, makes sure the time out is done, and consents are signed.They stand right beside them and assist them with biopsies, snares, etc. They obtain the specimen and communicate with the nurse and doc to make sure they label it according to what the doc wants. Does that help? I think that is wise, the cologaurd has it's place, but you can't beat a direct visual. Good Luck!!
  11. Brenda F. Johnson

    Have you had your Colonoscopy? March is Colon Cancer Awareness Month

    To get the pt ready, we hook them up to monitors, turn them on their left side and they have oxygen too. Yes, a pad or towel goes under the bottom. Basically that is it.
  12. Medical AdvancesWhether we like it or not, the future has caught up with us. Old school nurses like me who have been practicing for thirty years or more have witnessed many changes. Just a couple of examples are needleless methods of administering medications and the multitude of other safety measures initiated that decrease medical and medication errors. Electronics have improved surgical, endoscopy, and X-Ray equipment by increasing accuracy. Oh, and let’s not forget electronic charting. When electronic charting first came, we nurses often complained. The common complaint was that we felt the computer took us away from the patient. Paper charting allowed us to chart at a later time and was much less complicated. However, computer charting has decreased mistakes with hard stops and standardization of the nursing language. Each step of medical advancement has increased the quality of patient care and decreased complications. And here we are on the cusp of improving the world in medicine even more. Telehealth has been around for a bit actually, but it is getting ready to be a large part of the healthcare system. What is Telehealth?What is Telehealth? It is the use of electronic information to transmit patient information and providing healthcare services. As mentioned earlier, this method of care has been used in the United States since 1964 when they used closed-circuit television (Nelson & Staggers, 2017). It has been used in medical teaching for a long time as well, beginning with live video. BenefitsThere are many benefits to using telehealth, such as decreasing or removing travel barriers for the poor, rural, and disabled. Telehealth will provide more immediate care which can lead to earlier detection of disease or health issues. By putting the power back into the patient’s hands, they become empowered, more independent, and therefore more compliant. Telenursing allows nursing and technology to combine in order to give care to those who may have trouble accessing medical care for a myriad of reasons. As we know, rural patients have difficulty with transportation due to geographic conditions, and less access to practitioners. Medical compliance is lower in rural patients, making chronic conditions harder to manage. Veterans are another group of patients that need assistance to connect with providers. Veterans with disabilities may have trouble traveling to appointments for services that are not offered locally. There are several successful programs that use telehealth in order to better provide care. The one we will focus on is The Department of Defense. Real-time appointments are conducted via video between the patient and the provider. The patients may include active service members, retirees, or dependents. Some of the services that are provided include mental health, dermatology, pulmonary disease, and cardiology care through telehealth. For more information, here is their website. Technology allows doctors to monitor vital signs, blood sugar levels, temperature, bi-pap readings, and much more. This eliminates the need to go to the doctor's office so often in the case of chronic conditions, homebound patients, and handicapped patients. Biometric data can help to not only monitor conditions but also to diagnose issues. Loop recorders are a good example. When patients have short periods of heart arrhythmias, it is often hard to record, and therefore diagnose and treat. Loop recorders are small devices implanted in the upper chest that record heart activity. They activate and begin recording when the heart rhythm becomes abnormal. This information helps the cardiologist to diagnose the patient. The question may arise asking if telehealth is equal to a face-to-face visit. Studies have shown that telehealth is just as effective (Nelson & Staggers, 2017). Another concern when using telehealth is privacy. The same rules and laws apply to these situations that apply to any other HIPAA related issue. Another consideration is the patient’s media/computer and health literacy. These factors must be considered as medicine moves forward using telehealth. Telehealth is becoming more sophisticated and applicable with each passing year. There is much to contemplate as we move forward using telehealth in the United States. What are your thoughts on the future of healthcare using telehealth? Share your thoughts and experiences with the allnurses community. https://youtu.be/cC88besDEDc
  13. Brenda F. Johnson

    A Shift in Perspective

    Yes, one thing is for sure. . . change is constant. Medicine's evolution over the years has built on previous knowledge and has expanded on it. EPB is used in everything now, from charting to dispensing medications. It improves the quality of patient care, which is what we all want!
  14. I have not personally been fired for being sick, but I have witnessed other nurses suffering that fate. I felt bad for them and I can’t imagine what they must have gone through. We want things to be fair and just, and to be able to trust the company that we work for to do the right thing. However, employers aren’t always fair. I’m sure many of you reading this will be able to relate to the story highlighted in this article. A nurse from Nolensville, Tennessee, Chrissy Ballard was fired this summer after being off from work to begin treatment for her stage 2 hormone-receptor negative (can’t be treated with hormones because it doesn’t have hormone receptors), and HER2+ breast cancer (tests positive for the protein human epidermal growth factor receptor 2 which encourages the growth of cancer cells). Chrissy worked with dying patients in Hospice care for a company called Caris Healthcare. This past March, Chrissy was diagnosed with the terrifying diagnosis of breast cancer. She must now face her own truth of mortality, after helping patients do the very same thing. Caris Healthcare fired her in the middle of her cancer treatment. Her termination letter states that the reason for her firing was due to “health reasons”, but that she was eligible for rehire. Caris Healthcare’s mission statement is to “Hospice with Compassion and Hospice with Grace”. Their actions towards Chrissy does not line up with their mission statement. Not one person on earth is immune to being diagnosed with cancer, or some other diagnosis that threatens our life and well being. If the day comes that we need to take time off from work for an illness, we hope to be able to take the needed time off to have surgery and other treatments without retribution from our employer. The Family and Medical Leave Act of 1993 (FMLA) that was initiated by President Bill Clinton, allows employees to take 12 unpaid weeks off from work for qualified reasons while their jobs remain secure. The employee must have been at the institution for 12 months in order to qualify and have worked 1250 hours during that time. Chrissy was fired just before the 12-month deadline. While Chrissy’s case is being fought in the legal arena, Chrissy and her husband say that they regret not putting her request in writing. Lawyers suggest that when you are going to be out for qualified reasons, put it in writing as to why you are asking for time off. After reading about Chrissy’s situation, I pulled up the policy for attendance at my facility. The policy stated that an “Absence”, in which the employee must take an unscheduled absence over 4 days be referred to FMLA with a written note from a physician. Under the “organizational rights” in the policy, it tells us that the business has the right to authorize or refuse the request to be off, and are able to investigate absences to determine whether the reason is justifiable. In the employee handbook at my place of employment, it gives the following reasons an employee can use FMLA for pregnancy-related issues such as complications, birth, and care after birth or adoption, care of a family member with a serious illness, and a serious health condition that inhibits the employee from doing their job. FMLA is also granted for military reasons including allowing the employee to take off 26 weeks for a special leave related to care for a covered service member. FMLA allows the employee to come back to work to an original or equivalent position, same pay and benefits. In a perfect world, we would be able to take off the amount of time that we need and be able to keep the same job. However, employers have to protect themselves as well. Some employers engage in shady practices that put their employees in jeopardy. It is our job to know the law and our employers’ policies regarding time away from work. We should never assume anything. When applying for a job, make sure to check into whether they provide short term disability, long term disability, insurance, and that they fit the qualifiers to provide FMLA. Chrissy’s surgery was successful, and now she is in the middle of her radiation treatments. The Equal Employment Opportunity Commission is investigating her case for improper firing. Her case can and will set a precedent for nurses in the United States. Like I stated earlier, I’m sure there are nurses reading this who have experienced good and bad issues regarding their employer when faced with a life-changing event. Share your experience if you wish, or give advice to those who may be facing this in their lives right now. Below is the link to the article about Chrissy Ballard if you would like to read more about her. A Hospice Nurse Started Chemo. Then Her Employer Fired Her.
  15. Brenda F. Johnson

    Workplace Violence in Healthcare: Nurses, What is Being Done to Protect Us?

    Yes, she was known by her attacker. I didn't put much about him. He worked as a parking valet at the garage and had recently been fired.
  16. I don’t remember hearing anything about Carlie’s murder last January, but her community of nurses did. On January 25, 2019, in the parking garage of a Wisconsin hospital, Carlie was kicked in the head over 40 times and then left to die under a car in the early hours of the morning on January 25, 2019 (O’Reilly, 2019). It was so cold that her skin froze to the concrete (Harris, 2019). She left work at 1:00am, was found at 3:43am by a snow plow driver, and tragically died at 4:21am. Carlie died a slow, torturous death - Alone (O’Reilly, 2019). As I read Carlie’s story, and how she died, it weighed heavy on my heart. I pictured someone I know falling victim to such a brutal death and my stomach squeezed so hard that it hurt. Was Carlie conscience, did she lie there thinking about her husband and family. How much pain did she suffer while her tears went unheard. With any act of violence, we try to rationalize it - we try to make sense of it. But the circle of thoughts that we continually play in our minds about something irrational cannot be rationalized. Nurses often are on the receiving end of abuse, and those feelings and memories stick with us forever. Not to mention our individual histories and personal experiences with abuse that we bring with us everyday. The ones that have shaped us and have developed how we respond to abuse. Any abuse - verbal, sexual, physical, or mental is immensely personal, it touches and shapes our souls. The abuser tries to steal our joy and our sense of safety, but it’s time we as nurses stop putting up with workplace violence. According to Bankole K. Fasanya and Emmanuel A. Dada, in their article, “Workplace Violence and Safety Issues in Long-Term Medical Care Facilities: Nurses’ Perspectives”, that on a daily basis, two people are killed as a result of workplace violence, and 87 are injured (2016). This statistic covers any field of work, however, the healthcare field takes credit for a large majority of those numbers. In fact, in the article, “Educational and Managerial Policy Making to Reduce Workplace Violence Against Nurses: An Action Research Study”, it tells that we as healthcare workers are victim of almost 74% of the abuse inflicted in the workplace (Hemati-Esmaeili, Heshmati-Nabavi, Pouresmail, Mazlom, & Reihani, 2018). Workplace violence can be verbal, emotional, sexual, or physical and most nurses have experienced one or more forms in the span of their career. Abuse can come from a peer, superior, doctor, patient, or family. Certain fields of nursing suffer higher incidents of abuse such as the Emergency Department, Long Term Care, and the Psychiatric wards. A large percentage of these events are not reported. The reason may be that there is a feeling that nothing can or will be done, or that there will be retribution for reporting. How can we, as nurses advocate for ourselves? We need to empower ourselves and our fellow nurses and learn what our choices are and what is being done about workplace violence. A bill was introduced February 19 this year by Representative Joe Courtney. He represents Connecticut in the House of Representatives since 2007. This bill - H.R. 1309 will require the Department of Labor to look into violence in the healthcare field. It is asking that requirements be set to educate healthcare workers on how to de-escalate violent situations, and recognize the signs of impending violence. Also, it asks that each incident be investigated as soon as possible in order to get the most accurate information. Nurses often do not feel comfortable or safe reporting incidents of workplace violence. They fear retribution, prejudice, or even losing their jobs. This bill will allow them to report concerns and events privately and without punishment. What can we do? Contact your state Representatives and Congressmen/women and ask them to support this bill. Tell them that is is essential that something be done to protect us. If this becomes mandatory, turnover will decrease, morale will increase, and the culture of the healthcare field will greatly improve. The perception that nurses are expected to endure a certain amount of violence needs to be eliminated (Fasanya, 2016). Thank goodness the majority of workplace violence cases are nonfatal. But one fatal incident is too many. Share your stories with the allnurses community. References Fasanya, B., & Dada, E. (2016). Workplace Violence and Safety Issues in Long Term Medical Care Facilities: Nurses’ Perspectives. Safety and Health at Work, 7(2), 97-101. doi: 10.1016/j.shaw.2015.11.002 Harris, C. (2019). Dying Wisconsin Nurse Found Frozen to Ground was Allegedly Targeted by Former Parking Valet. People. Retrieved from https://people.com/crime/slain-wisconsin-nurse-was-allegedly-targeted-by-valet/ Hemati-Esmaeili, F., Heshmati-Nabavi, F., Pouresmail, Z., Mazlom, S., & Reihani, H. (2018). Educational ad Managerial Policy Making to Reduce Workplace Violence Against Nurses: An Action Research Study. Iranian Journal of Nursing and Midwifery Research, 23(6), 478-485. doi: 10.4103/ijnmr.IJMNR_77_17 O’Reilly, M. (2019). Murder and Me. Medscape Nurses. Retrieved from https://www.medscape.com/viewarticle/917203