Brenda F. Johnson

I’ve been a GI nurse for about 25 of my 27 years of nursing and I have seen a multitude of changes take place. The proficiency of a colonoscopy has improved as scopes have become more flexible with high definition cameras that lead to an increased adenoma detection rate. Now that screening colonoscopy is paid for by insurance, more people are getting one and lives are being saved. But there still remains a societal imputation around the test that hopefully over time will disappear with education and awareness. March 24 - 28 is GI nurses week this year, so if you know a GI nurse, please celebrate with them. SGNA is the national organization for GI nurses that sets the guidelines for standards of practice and provides many services with the most important being education about gastroenterology. There are many opportunities in your community to serve as a volunteer or participant at a colon cancer awareness event. Here in Chattanooga, we have the Rump Run on March 9th. It is a run or walk event with a bouncy house and face painting for the kids, and a large colon to walk through that exhibits different types of colon polyps and cancers. Colon cancer survivors are the highlighted guests of the day as they share their stories to help spread awareness. It is a fun way to spend a Saturday morning. The reason a colon screening is so important is that very often there are no symptoms when a person has colon cancer. There may not be any visible bleeding or pain and therefore some cases of colon cancer are not detected until there is an occluding tumor or metastasis. Educate your circle of friends and family to talk to their doctor about when they should get a colonoscopy. The first time screening is at age 50 except for African Americans who should get one at 45, and of course those with a family history. Some of you may have read or heard that colon cancer is on the increase in younger people. The highest increase has been seen in the age group of 20s. Although the exact cause is not known, genetics and environmental factors are thought to play a role. These younger patients are more likely to die from the diagnosis than older patients (Priedt, 2018). Some signs and symptoms that we can tell our patients to watch for is blood in the stool, diarrhea and constipation, abdominal cramps, and the feeling that aren’t empty after a bowel movement. If one of your patients, friends or family has unexplained weight loss, fatigue, and jaundice, make sure they make an appointment to see their doctor right away. These are signs of advanced colon cancer and they need to be addressed. Most of us have known someone affected by colon cancer, and the fright that diagnosis can bring. We lift up those going through the trenches of surgery, chemo and radiation in our prayers. Also, we celebrate the survivors, those who have been in the pit and are now on the other side. Many survivors give back by telling their story and educating their community. March is the month to highlight these wonderful people and one by one, save a life. I am proud to be a GI nurse and I learn something all the time. I have come to respect the GI system and how important it is to our bodies. Research is continually realizing all that the GI system does for us and how we treat it is so important. What we eat and drink really does matter. Celebrate Colon Cancer awareness month in your unit or office this year and make it an annual event. Participate or volunteer in a local event, it is rewarding and not to mention a lot of fun! Are you a colon cancer survivor? If so, please share your story with us. Reference Preidt, R. Colon Cancer Hits Younger Adults Especially Hard, 1 Oct, 2108. Healthday Reporter. Retrieved from https://www.webmd.com/colorectal-cancer/news/20131001/colon-cancer-hits-younger-adults-especially-hard-study-finds#1

The hemocult card is in no way good enough. It may not detect blood in that particular sample. You need a colonoscopy, there is no substitute for a visual inspection. Once you get past the prep for the test, the rest is a piece of cake (so to speak). The standard of practice is a colonoscopy at 50, find a good Gastroenterologist and get it done.

In our country, and specifically in healthcare, we are leadership deprived. It is difficult to lure good leaders into management positions due to the increased stress that they will have to deal with. Adding to that, younger nurses don’t want it either. There are other fields of nursing that they can invest education and experience in that will yield them more money. Some nurse managers are promoted out of convenience or because they are great nurses. However, Good clinicians don’t always make effective managers because they may not have any leadership skills. Over 70% of nurse staff turnover is because of bad managers (Roussal, 2016). When a nurse leaves a position, it can cost around $75,000 to replace that person (Roussal, 2016). This includes the recruitment of the new staff person, replacement, and possibly temporary staff until the position is filled. Included in that number is the overtime paid to the present staff and the orientation of the new person. When there is a high turnover, the core staff become burned out and unhappy leading to the potential of additional turnover. Personally, I have had some fantastic nurse managers, and some not so fantastic. But my recent experience tops the not so fantastic scale by epic proportions. I kept waiting for the lies to catch up to this person, or the emotional bullying to escalate until someone finally reported the problem. For years, I had begged for help from the manager’s superior, but to no avail. Nothing happened. I felt trapped, frustrated, and angry. Was there no one who cared that the whole department was stressed and unhappy? A part of my frustration was that my co-workers would not stand up for themselves and report the manager. A culture of co-dependency and toxic circumstances had festered for so many years, that I guess they accepted it as status quo. Recently, my manager did something that was so egregious that this person is now forced to step down from their position. What I have realized from this experience is that some of my co-workers who would not have reported this incident. The manager would have gotten by with it, and gone on to commit other intentional errors. Now that there is some exposure to the bad management, my co-workers are more willing to speak up. The people who were brave enough to speak up in the first place did so with much consideration and purpose. There are incidents that are reportable, that must be reported by those with knowledge of what happened. Of course, there are incidents that aren’t harmful but still need to be reported. This allows for a review of the system and root cause analysis that improves how we do things and prevent future incidents. There are a few leadership qualities that lead to failure; lack of vision is one of them. Leaders must be able to articulate their vision so that the staff can relate and understand. This will help staff know that they are a vital part of fulfilling that vision. If a leader has no connection to the larger picture, the staff feel disconnected and unimportant. When a manager has no empathy, the staff don’t feel cared for. Part of having empathy is being able to listen and hear them when they have concerns. No motivation can kill a department’s ability to thrive. Having an environment that helps to create energy and purpose will allow the staff to enjoy their workplace. Also, when a leader has no eye on the future, the staff feel stifled and are unable to learn and grow. Good leaders create trust between themselves and the staff. If the staff has trust, then they will feel comfortable bringing to you issues that they have. They will also know that the manager has their back in difficult situations. A nurturing environment will grow empowerment amongst the staff. A good leader accepts responsibility for things that are their responsibility. They don’t deflect blame onto the staff, or elsewhere but instead are mature enough to self evaluate and use situations to improve their leadership skills. Being an advocate and liaison between the staff and upper management, other departments, and ancillary is an important part of being a good manager. Being open and approachable will go a long way in human relationships. Having a good emotional IQ helps as well. Communication is extremely vital in maintaining any relationship, and especially important with management. Being able to effectively communicate and have crucial conversations will make all the difference in how staff respond to changes. Not every good leader can be excellent in all aspects, but they can continue to try and learn. As for those bad leaders. . . I have no idea! Tell us about your good leader, or bad one. Give us the reasons they are either good or bad. Reference Roussal, L., Harris, J., Thomas, T. (2016). Management and Leadership for Nurse Administrators, 7th Edition. (Western Governors University). Retrieved from: https://wgu.vitalsource..com/#/books/undefined/

Knocking on the door, I paused a second before opening it. Inside were two people, the young man who was the patient, and his mother. I introduced myself and began asking the usual questions for esophagogastroduodenoscopy/ colonoscopy patients. Did you finish your prep? Did you eat any solid food yesterday? He passed my test, so then after checking his armband, he hopped on the stretcher and off we went. As I pushed the stretcher to my department, he had a few questions of his own. How long will this take? Will I feel anything? During our conversation both to the department and back to his room, I noticed some unusual words, and some not so unusual such as hot showers, how many drugs he had done and when, and pot smoking. Some of the conversation seemed cryptic between mother and son. I didn't participate in that part of the exchange, but listened. Both exams showed normal results, and when I got report from my fellow GI nurse, she mentioned pot smoking, and in a whisper insinuated that there was more to the story than the mother knew. Once he was settled back in his room, I went to the nurses station to give report and that is when I found out about his diagnosis, "Cannabinoid Hyperemesis Syndrome". The other nurse was just as interested as I, and she told me that it was basically when too much pot was smoked that they got severe abdominal cramps and vomiting,and then took long hot showers to relieve the cramping. That's when I decided I needed more information about this. According to the article, "Cannabinoid Hyperemesis Syndrome", it is a rare situation that advances to repeated and very severe spells of vomiting. It is seen only in patients who use cannabis daily on a long term basis. The marijuana in these cases works paradoxical of what it usually does. Normally, it decreases nausea and vomiting, however in these cases, the opposite is true. Marijuana is harvested from the dried leaves, seeds, and flowers of the Cannabis sativa plant. The chemicals in the plant bind to the brain and cause the "high" felt by the users. But not only does it bind to the brain, but also to the digestive tract. Long term users feel the effects of the drug because it affects the length of time it takes to empty the stomach as well as decreasing the pressure of the lower esophageal sphincter, leading to the emesis. Certain receptors in the brain stop responding to the drug which leads to hyperemesis. Researchers are not sure why some patients get the syndrome while other do not. During these bouts of hyperemesis, patients can see blood from a tear in their esophagus called a Mallory Weiss tear. Whenever we see blood, it is scary and further investigation is needed to make sure there isn't something more serious wrong. There are three stages of CHS, the prodromal stage, the hyperemetic phase, and the recovery phase. Below it is explained further: Prodromal phase - early morning nausea and abdominal pain, most keep a normal eating habit during this phase, and use more marijuana to help the nausea. This phase can last from months to years. Hyperemetic phase - ongoing nausea, repeated vomiting, abdominal pain, symptoms of dehydration, and decreased food intake, weight loss. Vomiting is intense and the patient is overwhelmed. They take multiple hot showers during the day and it eases the nausea. Most seek medical attention during this phase. Recovery phase - the symptoms go away only if the patient stops using the drug. Normal eating is resumed and this phase can last days to months. The symptoms usually return if the patient smokes marijuana again. The symptoms of CHS are very similar to other issues, and because of it's relatively new diagnosis, it can often be misdiagnosed. The treatment for CHS is IV fluids for dehydration, antiemetic medications, pain medication, PPIs, and ironically frequent hot showers. To recover completely, the patient must stop the use of marijuana. Some of the complications that can occur with CHS are: Muscle spasm/weakness Brain swelling Seizures Kidney failure Heart rhythm abnormalities shock If you see patients with repeated admissions due to severe vomiting, consider CHS. Patients often do not admit they smoke pot to their doctor, however, it can save them possibly years of misdiagnosis and prevent further health problems. Have you had any patients with CHS? Please share your story. Reference "Cannabinoid Hyperemesis Syndrome". N.d. Saint Lukes Health System. 17 May, 2018. Web.

On the NSFC website, they list goals for November to raise awareness for Stomach cancer. Education is always top in the list because it encourages us to tell people about the risks factors, detection, and prevention. As with any type of cancer, funding is needed to continue research and improve treatments. They have educational events and a worldwide annual walk to help improve early detection rates and save lives. While we are focusing on our Thanksgiving menu, lets look at what can cause stomach cancer. While the exact cause is unknown, there are identified foods that correlate to stomach cancer such as foods that are prepared by salting, pickled, or smoked. There is a lot of information on the Moffitt website regarding stomach cancer. Some things that can be a precursor for stomach cancer are atrophic gastritis and intestinal metaplasia. Either of these conditions would be diagnosed with an EGD, and these procedures are not approved for screening. Therefore, at this point, symptoms must be present in order to get an EGD. Some symptoms to look for according to Moffitt are: pain in the stomach area, swallowing difficulties, heartburn, jaundice, decreased appetite, and feeling full with little food. Some advances symptoms may include: fatigue, vomiting up blood, blood in stool, and weight loss. Moffitt's cancer center phone number is 1-888-663-3488 If you have patients, friends or family with any of the above symptoms, encourage them to see their primary physician or Gastrointestinal doctor. Nurses are often in the teaching role, and there are risk factors that patients can be aware of. Some of the risk factors we can be on the lookout for are: pickled and smoked foods (as mentioned before), previous surgery, obesity, smoking, excess alcohol, exposure to fumes and dust, and a history of stomach polyps, or long term stomach inflammation. There are hereditary genetic disorders that need to be surveyed such as non-polyposis colorectal cancer, hereditary diffuse gastric cancer, and familial polyposis. We have heard of H pylori and its effect on the stomach, but it is also one of the largest risk factors for gastric cancer. Because of H pylori propensity to cause ulcers and inflammation, it increases a person's chance of stomach cancer by six according to Moffitt. For those with a history of H pylori, the above genetic factors, or previous gastrectomies, there are tests that can be done to screen for stomach cancer. The EGD is the most effective because the doctor is able to take a biopsy of the stomach lining, a serum pepsinogen measurement, and a barium-meal gastric photofluorography. Depending on the type of stomach cancer a patient has and the stage will dictate the type of treatment. Whether it is Lymphoma, carcinoid, squamous cell, small cell, GIST, or Leiomyosarcoma, the oncologist will know best how to treat the cancer. A patient can undergo chemo, radiation, surgery, and molecularly targeted therapy for their cancer. There are several types of surgeries as well. The surgeries performed for stomach cancer can be as minimally invasive as a an endoscopic mucosal resection, to a partial gastrectomy, or a total gastrectomy. If you have taken care of patients or have family members who have undergone a total or partial gastrectomy, you have seen the difficulty they have just being able to eat. This subject is personal to me not only because I am a GI nurse, but because my precious Uncle had gastric/esophageal cancer. He is no longer with us, and the cancer isn't the only problem that he suffered with, but it changed his life. He had a partial gastrectomy and part of his esophagus removed. The recovery was horrible, but the part that bothered me the most was his inability to eat. He was never able to eat normally after his surgery and lost a tremendous amount of weight. To be able to sit with him and enjoy a meal, only to see him stop after a couple of bites and even be in pain was difficult to see. He had a long history of smoking and drinking which probably played a part in his cancer. Love and miss you Uncle Ed. Share your stories about gastric cancer and keep educating!

In the past few years, there have been great strides in improved medication and insulin for the treatment of diabetes. November is the month that diabetes is highlighted to bring awareness to the chronic disease that affects so many Americans. Sometimes, the actions that need to take place are in the political arena. On the American Diabetes Association website, they ask people in states with issues to support legislation that will help people with diabetes. One plea comes from California where low-income families cannot get their monitors covered; Medicaid does not cover this item in California. There are victories noted regarding diabetes research such as Congress renewing federal funding. There are opportunities to get involved at all levels: local, state, and federal, which is what the ADA is hoping for by increasing awareness. American Diabetes Association - Take Action As nurses, we see patients who have been ravaged by diabetes. Those who have lost limbs, eyesight, and have serious heart and kidney issues and suffer on a daily basis. We see the struggle that these patients deal with in trying to control their daily sugar levels. Young children and their parents who deal with insulin control have a whole other set of worries. Keeping young children compliant can be difficult and can result in anger or depression in the child. Diabetes is one of the leading diseases in America, and the fight for these patients never stops. The ADA website talks about some myths associated with diabetes. The first myth is the common belief that overweight people will get diabetes. Being overweight is certainly a risk factor, but there are other factors involved. Genetics play a role in who will most likely get diabetes. Those with a strong family history are at risk for developing diabetes and should get tested regularly as well as practice healthy behaviors that will decrease their risk. Ethnicity also will determine who will get diabetes. Those who are African American, American Indians, American Mexicans, and Asians are at a higher risk. And let's not forget age, as we get older, our risk gets higher. Can eating too much sugar cause you to develop diabetes? Actually, no. Eating a lot of sugar can make you gain weight, which puts you at higher risk, but genetics and the other factors listed previously predispose one to diabetes. Another misconception is that when the doctor puts a patient on insulin, that means that the patient is not doing a good job at controlling their disease. Over time, a person's body produces less insulin and that requires them to be put on insulin. The insulin will help them keep their sugars at a good level and therefore decrease complications, making insulin a good option for these patients. There is an advocacy group called "Beyond Type 1" that is supported by people who have diabetes, (some are famous) to help educate and support those with type 1 diabetes. They offer suggestions for this month to spread awareness. Their goal is to educate people about diabetes and eradicate ignorance and misconceptions. They encourage the use of social media and taking diabetes awareness into the classroom to help support children with diabetes, giving them encouragement and positiveness in their day. Some of us have encountered the patient who is okay with having a 300 fasting blood sugar. As nurses, we must keep educating these patients and their families. Being truthful in the reality of their situation is showing that we care about them and their future. For others, the cost of insulin or supplies can be a barrier to compliance. That is where our involvement in our local government can help these patients. We as nurses are the largest body of educators, and we have the power to change our communities. Encourage your patients to exercise, eat healthy, and check their sugars often. They are empowered, as are we, when they take control of their own bodies. There are many nurses out there with diabetes, and we are the ones who really can put reality into practice for our patients. Each time we teach, we are putting another brick in the foundation of their knowledge and understanding of their disease. Celebrate Diabetes Awareness this month and share your stories with your community here in allnurses!

Licensed Practical Nurses across the country are commemorated during the month of October. If you work with an LPN, make sure to recognize them with a banner, food and gifts during the week of October 7 to 13th. Let them know how much we appreciate them and all the hard work that they do. LPNs supervise unlicensed assistant personnel, provide direct patient care, and education. Working under the supervision of a doctor or RN, LPNs can also insert catheters and IVs. Over the years, LPNs have been able to work in a variety of settings. They work in doctors offices, hospitals, nursing homes, and long-term care facilities (National LPN/LVN, 2015). We celebrate their dedication and hard work over the weekends, holidays and nights. Americans are living longer which increases the need for long-term care. The U.S. Department of Labor Bureau of Labor Statistics tell us that the need for LPNs will expand by 25% during the years of 2012 and 2022 (National LPN/LVN, 2015). The evolution of the LPN is an interesting story and often unacknowledged. Originally, the nurses would work in family homes taking care of sick people and also doing housework and watching children. That was in the 1800s, and in 1897, in New York City, a school named Ballard School began giving classes to these healthcare workers (History of LPN, 2014). Disease was widespread in the city, so the practical nurses went into the slums to educate and treat the people hands on. This is the essence of community health care. They realized that better sanitation was the key to improving New York's life from the inside out according to the article, History of LPN Field (2014). Eventually, in 1914, Mississippi was the only state that passed laws regarding LPNs. Then in 1917, the National League of Nursing Education started the process of establishing standards for the practical nurse. When World War I rocked the United States, nurses were needed, however, after the war, many didn't return to the field due to the trauma that they had endured during the war. This added to the nursing shortage throughout the United States (History of LPN, 2014). History of LPN Field (2014) tells us that during the period of 1920 to 1940, most LPNs were found in the public health field. But then World War II came and once again the number of LPNs grew tremendously. At this point, they worked mostly in the hospital. By 1952, the nursing field was 60% LPNs, and licensure became required. During the 1980s, the different levels of the nurse role went through professional scrutiny and as a result, many LPN roles transitioned from the hospital back into the community. Presently, LPNs practice in all roles across the healthcare spectrum (History of LPN, 2014). LPNs have had a varied past of experience and service. This week is your opportunity to be acknowledged for all of the hard work that you do. My husband is an LPN and has been one for many years, so I realize what you go through. Long-term caretakers have a special heart that endures long shifts with aching backs. The care you give makes the patient's life better, and we thank you for that. Healthcare wouldn't be the same without you! Are you an LPN? Tell us about your journey, where you work and what you value. Also, celebrate each other as we recognize you! References: History of LPN Field. (2014). LPNJobsHelp.comNational LPN/LVN Recognition week/ Dorsey Schools. (2015). Dorsey Campuses (Michigan Events).

For us in the medical field, handwashing is second nature. We wash our hands before assessing a patient, and then again after. We understand how vital it is not to pass germs from patient to patient or surface to surface. Most Americans also share our understanding about the importance of handwashing. However, there is a large part of the population that does not share our understanding. The Global Handwashing Partnership has put out some information and goals for worldwide education regarding handwashing. The global advocacy group has created some simple reminders for families across the world to help them remember when is the most important times to wash their hands with soap. Their logo for this year is, "Clean hands - A recipe for health". Their goal is to link food preparation and eating with washing hands with soap. Preventing the spread of disease and improving how people prepare food will prevent the spread of disease and improve their children's health, even save their lives. In low income homes, food preparation has shown to be one of the largest problem with almost 70 percent of diarrhea resulting from inadequate food preparation. This is especially the case in children under the age of five. However, pregnant women, those who have compromised immune systems and even the unborn are also at risk.The Global Handwashing Partnership has defined critical times to wash hands in their initiative in relation to food: Before cooking/preparing food Before eating and feeding someone /includes breastfeeding Those who fall into a caregiver role are to be the responsible example. By washing our hands at the most critical times, we will create habits for ourselves and those around us. By washing hands and our food better, diarrhea will be decreased especially in the very young. Diarrhea as we know can not only cause malabsorption, but death. When children do not get proper nutrition, in their first few years of life, they can have issues with growing. Their brain growth could be stunted and their immune system compromised, which they cannot make up for, the damage is permanent. If these children can be taught to wash their hands with soap and water, then their diarrhea can be greatly decreased and then as a result their risk for underdevelopment will be too. Chronic environmental enteric dysfunction is caused by fecal contaminated food. The body can't absorb nutrients because it is too busy fighting off disease. Plus, these kids don't eat when they feel so sick which makes them more susceptible to future disease and recurrent diarrhea. Here's more information on this organization and what resources they offer. They have tools and materials that you can use. Taken from their website, here are some ways that you can make a difference today. *wash your hands with soap at critical times -before eating, cooking, or feeding others *model good handwashing behavior *make handwashing part of family meals *establish places to wash your hands in the house, community, school, and health facility *promote effective handwashing behavior change in research, programs, and advocacy When you are busy at work and are tempted to skip washing your hands, remember how important it is and take the time to do it for you and your patient's. We often forget how many surfaces we come in contact with and who made contact with that surface before you. Just because we can't see them, bacteria and viruses can live on surfaces for a very long time. If you are part of an advocacy group that educates on handwashing, tell us what you do and what a difference it has made in your world.

My husband is an LPN and had no idea that there was an LPN week.

Thank you for working in mental health, it is a difficult area. I understand what you are saying because I see it in my own family. We can hope that with more awareness, the younger generation will get treatment earlier and be more open to it.

Whether it is a family member, friend, or you, mental illness can be devastating, especially when it goes untreated. When a person with mental illness reaches out to someone they feel safe with and then receive negative feedback, they can be devastated. People who don't understand, will often say something that hurts the person reaching out. As a result, that person may not tell another person, ever. People who are suffering with a disease need help, support and treatment. Mental illness is no different than any other disease but it is one that often gets hidden until something tragic happens. Sometimes all a person needs is for someone to listen. Caring enough to actively listen can mean a lot. We know as healthcare workers how much listening can change a situation. The National Alliance on Mental Illness is an organization here to help change America's perception of mental illness. They advance their cause through education, support, and patient advocacy. Their website tells us that eating disorders are the most harmful. Eating disorders can start young, so being able to detect a child with one could save their lives. The National Institute for Mental Health reported a study from 2015 that tells us that one in five people (43.8 million) adults have a mental illness. America's young people age 13-18 have a high number of those affected as well. In fact 21.4% will deal with some form of mental illness in their life. These numbers are high, and that isn't including those who do not discuss their problems with their doctors and go undiagnosed. Whenever we have a problem, no matter what it is, having someone who understands, helps us to feel better about the situation. We share our stories because we know that the other person relates on a gut level. As a person with a mental illness, finding a support group, or someone they can talk to, can make a huge difference in their treatment. Knowing that they are not alone can be the difference between life and death. Having family members who have mental illnesses, I see how ignoring the issue can make it so much worse. These people often mask their feelings with alcohol or drugs, leading to other physical illness. Many people refuse treatment while others take medication and once they feel better, they stop taking it. This cycle can be dangerous for the patient. Talking to our loved ones can be tricky. Staying nonjudgemental and open to what they say is essential. Having real conversations helps everyone involved. *The helpline for the National Eating Disorders Association is 800-931-2237 *Text NEDA to 741741 to get connected to a volunteer National Suicide Prevention Lifeline 800-273-TALK (8255) The more we share information and talk about mental illness, the more the stigma will dissolve. We can be part of the movement to educate ourselves and others about mental illness. As nurses, we can talk to our patients openly and honestly helping them to get the correct treatment. Involving their families will also decrease the stigma that surrounds mental illness. Allowing both the patient and the family to ask questions of us and the doctors will help one by one getting past learned prejudices about mental illness. We as nurses can also be the voice of reason among our peers. A person who is mentally ill can cause their caretaker to fear them due to not knowing how to properly approach their care. When we coach our co-workers and lead by example we will improve the patient's experience along with educating each other. Understanding the dynamics of their illness will help us in treating them. Speak to the patient about their illness as you would their other physical issues. They will appreciate the openness and honesty. I know there are a lot of nurses out there that work in the field of mental illness. Share with us your experience to help us educate each other and the patient.

I know, it is so frustrating. But often this is the case.

NPAC Conference 2018 - Barkley & Associates Earn up to 48 contact hours at the National Conference for Nurse Practitioners in Acute Care (NPAC) 2018. If you are a Nurse Practitioner who rounds in a hospital, works in the emergency room, or see acutely ill patients, then this is the conference for you. Join colleagues from all over the country in celebrating this year's theme, "Expanding Our Horizons." Learn while you network with experts in your field, you never know what opportunities you will happen upon. Bring back to your work and place of practice new evidence-based knowledge that you can incorporate into patient care. But don't forget to take advantage of some fun activities Las Vegas has to offer. When and Where The conference will be at the Westgate Las Vegas Resort and Casino on November 7-11, 2018. Westgate Las Vegas Resort & Casino 3000 Paradise Rd. Las Vegas, NV 89109 $109 per night plus $25 resort fee and tax For online reservations CLICK HERE For phone reservations to the Westgate, call 1-800-732-7117 and use passcode SBA8R. Sessions There are over 30 opportunities for pre-conference advanced procedure workshops sessions with the opportunity of receiving 3 CEUs. From "Difficult Airway Management" to "Managing Extremity Issues", you can choose the time that is best for your schedule. Also available during the preconference are special courses: ENLS Course, Emergency Neurological Life Support" 12 Lead ECG Workshop" Advanced Imaging and Radiology Workshop: CTs, MRIs, PET, and More. A Post Conference is available - "Procedural Workshop: Advanced Suturing". The full brochure is available at the following link: Brochure: http://www.npcourses.com/NPAC/Las.Vegas.2018/Brochures/AB.8.30.18.pdf Provider approved by the California Board of Registered Nursing, Provider Number CEP 15436. All NP state regulatory agencies (i.e., State Boards of Nursing) and all national certifying bodies (e.g., ANCC, AANP, AACN, PNCB, and NCC) recognize and accept AANP CE credit for recertification! Conference Faculty The Keynote speaker is Ruth Kleinpell Phd, ACNP-BC, FAANP, FCCM, FAAN and she will talk about the Advancing NP Practice: Setting the Future Agenda. Special Events Join your peers and see all the exhibits at the Welcome Reception on Thursday, November 8, 2018 from 5:30 to 7:30. Make sure to take the time to participate in the Poster Sessions. There will be a peer-reviewed session on both Friday and Saturday Registration Information Early Bird is n longer available at this time. The conference registration is $689 until 10/23/18 and then it will be $719. Nursing students receive a lower price at $449 but you must provide ID. Conference cancellations must be done by mail to Barkley & Associates. After September 25th there will be no refunds. Prices are subject to change without notice. Preconference Prices With the main conference, the pre-conferences cost $89, without it is $139. The special workshops are $129 to $199 with the conference and $179 to $249. There are daily and combination fees available on the website. Hurry and Register for the NPAC Conference! Come and learn with hundreds of other nurse practitioners, take part in the hands-on workshops and sit in on the sessions to hear from the best in the field. You will find a rich and diverse program that offers a max of 48.75 CEUs, 14.25 in pharmacology and 1.25 in advanced procedures. Full conference registration is available all day on Thursday. Let it all soak in while you learn, network, and recharge in Las Vegas. Bring a best friend or family member to enjoy the city and all it has to offer!

Your story is much like the woman's I wrote about. She is still on workman's comp though. She actually just came back to work after another surgery. It's a shame that this is common. It shouldn't be.

Susan stepped up to the next available person and handed her the flu shot questionnaire filled out and signed. The tiny room was full of activity. There were piles of syringes and alcohol pads next to papers on the wood table. Office chairs were pushed back against the wall as people lined up to get their annual flu shot. The woman took Susan's paper, glanced at it, then placed it on the table next to her. Picking up a syringe and an alcohol pad, she turned to Susan and tore open the alcohol package. Susan turned her head away as she pushed up her sleeve on her left arm so she could get the shot. After all the years of giving shots, Susan still hated receiving one. She got a whiff of rubbing alcohol just before her knees buckled. The pain in her left shoulder took her breath away as heat rushed over her body from the top of her head to her toes. It took Susan a second to gather herself, leaning on the table for a second. As she walked out of the room, she rubbed her left shoulder. Susan was sure the needle had hit the bone and the pain was unbearable. As she entered the elevator, a wave of nausea surged up her gut. Overwhelmed, Susan inhaled deeply, as she concentrated on keeping her breakfast in her stomach. Beads of cold sweat glistened on her pale forehead, her brown bangs absorbed the sweat and clung to her skin. Her hand shook as she wiped her forehead with the back of her hand. What was happening? She asked herself as she stepped off the elevator. Entering the break room, Susan declared rubbing her shoulder, "Man, they sure did give my flu shot high on my shoulder. It really hurts! And I'm sure they hit bone!" She sat down in one of the chairs in the crowded break room. "Yeah. they gave me mine high too! But I have more fat on me, you are so small. Eat a hamburger girl!" one of the co-workers joked. Throughout the rest of the morning, more people declared how high their flu shot was given too. Some complained of soreness, but Susan was sure no one felt like she did. The charge nurse herself had received a shot too high on her arm and after hearing everyone else talk about it, she reassured everyone that she would report the issue. Susan took some ibuprofen and applied some ice to her shoulder and made it through the day. Over the next couple of weeks, the pain persisted. Changing clothes, especially her shirt, was difficult, she often had to ask her family for help. Susan tried to lift her arm to her shoulder, but the pain was so bad it brought tears to her eyes. It took a lot of extra time to get ready for work in the morning. Favoring her left arm, she tried to use her right arm for everything. One morning while she tried to brush her hair, frustration, pain, and anger engulfed her. She threw the brush against the wall and collapsed on the bathroom floor in tears. Able to do most of her job, she continued to work. Every day she took OTC medication along with heating pad or ice packs to try and dull the pain, hoping that it would go away. She hated to complain. She questioned herself on how a flu shot could change her life so much. Finally, after two weeks, Susan timidly sent her department manager an email, explaining what had been happening. Embarrassed, she felt silly, but she could not take it anymore. Within the next day or two, she received calls from the Occupational Health departments and Workmen's Compensation. Walking into the Occupational Health department Susan felt hopeful. This was a step towards fixing what was wrong, getting rid of the pain. After she signed in and filled out the questionnaire, she sat down in one of the cold chairs. She pulled her lab jacket around her small frame in an effort to ward off the chill. She cringed as her left shoulder sent a sharp pain down her arm. "Hello Susan, how are you? Please come this way," she walked ahead of Susan to the room. On the way to the exam room, Susan noticed another employee in the room next to hers. "He is here for the same reason you are," she said. Taken aback, Susan didn't know how to feel. Several emotions passed through her body as she hopped up on the exam table. The woman standing before her was the one who had organized the flu shot event this year, and here she was telling her that more than just herself had had a problem. "Yes, I started getting a lot of phone calls the same day you got your shot," she told Susan. "Many people were complaining of pain in the arm they got their shot in and that the shot was given too high. We went over and educated those people as soon as we could. At the end of the day, we told them not to come back. Their services were no longer needed." Susan's blue-green eyes widened, and her pulse increased. A flush came to her cheeks as she processed what was being told to her. She gripped the arms of the chair she was now sitting in until her knuckles went white. Forcing herself to relax, she put her hands in her lap and inhaled deeply. The nurse manager continued to tell her that she had looked at Susan's consent and found out who had given her the shot and now was contacting all the other people who they had given shots to. Susan's mind raced with questions. Why was the education taken place after the damage was done? Who were these people, and what was their credentials? How could she trust the woman standing in front of her now, knowing that she had not taken proper precautions before subjecting the entire hospital staff to someone obviously not qualified? To find out the rest of the story, stay tuned!! Here's the rest of the story... Injection Gone Wrong: Part 2 Injection Gone Wrong: Part 3

Americans thrive on being able to access things quickly. Drive-thrus give us our coffee, hamburger, or prescription through our car window. We are busy people, and this allows us to multitask without dragging the kids or dog out of the car. We can't see a doctor or nurse practitioner through our car window, but we can stop at our convenience at a clinic on the corner or in the grocery store for our UTI. That is retail healthcare. As Jeannette Y. Wick RPh, MBA tells us in the article, "Retail Health Care: Where It's Been, Where It's Going", there has been a shift in the recent years away from the emergency room for those non-emergency healthcare problems such as bronchitis or that rash on your belly. The cost is less for the patient, and valuable resources are not held up when an urgent care clinic is visited instead of a hospital emergency room that is trying to help a person in a real crisis. Retail healthcare is attractive to the consumer, but for the investor, it is even more so. "What's Behind the Surge in Retail Healthcare Deals?" written by Nirad Jain, Jeremy Martin and Kara Murphy explain that, "From 2012 to 2017, the number of deals involving retail health companies-those that operate freestanding health-related outlets like dental clinics or urgent care facilities-has soared, increasing at a compound annual rate of 34%" That is a large number, and for investors it means a good return. The owners examine it from the patient's side as well as a business side to find the best solution for both parties, their competition is the patient's (consumer's) reward. The investing companies are dependent on the consumer and the consumer has a choice whether to use them or not. This makes the company look at patient proximity, specialization of care, cost, and last but not least customer satisfaction. Patients are becoming self-advocates. One out of three patients look online for a diagnosis and 41% say that a medical professional confirm their diagnosis according to the article by Gary Druckermiller, "What Can the healthcare Industry Borrow From Retail Marketing?". We've already seen the upside to this form of healthcare: a variety of health care services, close proximity to patients, less cost to the patient, less wait times, profit for the owners, and standardized protocols. There are some issues that have to be taken into consideration regarding retail healthcare. No company can provide everything to everyone, so they have to cater to the "most valuable" according to Jain. Knowing the patient's needs coupled with the business side of knowing the regional market is a must for their success. Another issue for the corner clinics is keeping doctors and nurse practitioners. Recruitment for this type of job is not easy and not having the proper number of clinicians can back up the patient load and eventually, the consumer will go somewhere else. There is a fine balancing act by the investing companies that goes into these clinics. Reimbursement looms as an ever-changing factor for these clinics, making the owners concerned. As reimbursement changes, especially if it increases, will roll down to the customer and possibly increase the rates. Continuity of care for the patient is very important. Guiding a patient over time and making sure they receive the proper care can get lost if the primary physician is not informed. For example, it a patient visits a clinic for a UTI, the primary doctor doesn't necessarily get notified. One time is fine, but if the patient is having frequent UTIs and goes to more than one clinic, a diagnosis could get missed. The patient could potentially have other issues going on that require more intense studies. A breakdown in the patient to primary relationship will happen if the patient solely relies on the clinics therefore, the continuity of care will be fractured. In a study cited by Jeannette Y. Wick in her article, "Retail Healthcare: Where It's Been, Where It's Going," she tells us that between 2008 and 2015, 21 million uninsured people made 52 million visits to urgent care clinics. The use of urgent care has increased greatly and will continue to do so. In fact, they have increased by 93% With the multiple advantages of retail healthcare, there can be a downside. With all the conveniences, patients may go long periods of time not seeing the primary and miss doing essential exams, or fall through the cracks on a diagnosis. Have you seen it effect your patients? References Druckenmiller,Gary. "What Can the Healthcare Industry Borrow From the Retail Marketing?" Evariant. 14 January, 2016. 29 August, 2018. Web. Jain, Nirad., Martin, Jeremy., and Murphy, Kara. "What's Behind the Surge in Retail Healthcare Deals? Bain & Company. 9 May, 2018. 28 August, 2018. Web. Wade, Evan. "Investigating the Rise of Retail Clinics." HealthCare News. 11 April, 2018. 28 August, 2018. Web. Wick, Jeannette Y RPh, MBA. "Retail Health Care: Where It's Been, Where It's Going". Contemporary Clinic Pharmacy Times. N.d. 29 August, 2018. Web.

Thank you for your insight. I think what worries me most is what you talked about in 1 and 2, lack of follow up and missing an important diagnosis because they are not looking at the whole patient like the primary caregivers.

Before the FDA gained control of how networks can air medication commercials, several doctors did some research and wrote if their findings in, "Television Advertising and Drug Use", by Barry Peterson, Ph.D., et al. They take the stance that advertisements of over the counter drugs contributes to public misconceptions and encourage drug use. "In promoting OTC drugs for the relief of everyday symptoms such as pain, nervousness, or lethargy, drug companies may deceive the public into thinking that drugs are an easy way out of everyday discomfort". That was 42 years ago, but the same concern is echoed by doctors in 2001. In the article, "Ban TV ads For Prescription Drugs?" it tells us that the American Medical Association would advocate for banning prescription drugs ads from television, newspapers, and magazines. They feel that the misinformation is causing problems with the patient population. They also say that these ads undermine their credibility. Doctors find themselves in a quandary when patients demand a medication they saw advertised, but the doctor feels another medication would better fit the patient's problem. Dr. Angelo Agro, an ear, nose, and throat doctor says this about medication ads, "Ads by their nature are biased and compressed and are driven more by drug companies' financial concern than by concern for the patients' best interest". Although there were doctors meeting to lobby against the drug companies advertising, there were also doctors who felt that a ban would violate free speech. The latter group of doctors that felt the ban was unnecessary and made it known to the committee that they saw medication advertisements as a positive because they may encourage patients to see their doctor, even those who wouldn't normally seek medical treatment. They also felt that these ads help to take the stigma out of certain conditions such as depression. Present day research is related in the article written in 2018, "Coverage By The Media Of The Benefits And Risks Of Medications", by Roy Moynihan B.A. et. al. They discuss how news stories need to cover adverse effects as well as benefits, and often research is focused on the results to favor the company. They found that out of the 207 newspapers and television stories they looked at exhibited shortcomings in their reporting. Moynihan reported that only 15 percent of the media outlets presented relative and absolute benefits; 83 percent gave information in relative terms only which can be misleading. Declaring only absolute or relative benefits does not tell the full story. 53 percent did not talk about potential harms, and 70 percent did not mention cost. Cost can be a deciding factor for many patients in whether they will choose a particular medication. Disclosure was an issue also. Scientific literature underreports the ties between research results and industry. They conclude that the news media should "focus" more. They suggest an educational program for journalists that would help them to focus on the reporting and interpretation of clinical findings. The FDA states on their website under the title "Background on Drug Advertising", the following: The FDA oversees the approval and marketing of prescription drugs through the law, "Federal Food, Drug, and Cosmetic Act". We have a lot of regulation in regards to getting medications on the market compared to other countries. The mid-80s saw more involvement of the media in direct to consumer advertising instead of only to doctors and pharmacists. You have probably noticed that there are some commercials that are really vague, and others that go into great detail. There are several classifications of drug ads: Product Claim Advertisements - These are the only ads that state the benefits and risks of a drug Reminder Advertisements - These ads give the name of the drug, but not the drug's uses. Help-Seeking Advertisements - These describe a disease or condition but do not suggest a specific drug. Ex. are ads for allergies, asthma, or erectile dysfunction. I have noticed an increase in advertisements for medications, especially on television and in magazines. Ever since the FDA approved advertising for medications years ago, the number per commercial break has skyrocketed. According to the article, "Think You're Seeing More Drug Ads on TV? You Are, and Here's Why" by Joanne Kaufman, 771,368 medication ads were shown in 2016. She states that it is "an increase of almost 65 percent over 2012". Not only has the number increased for medical advertising, but the class of drugs as well. Years ago, we saw ads for allergy medication or reflux, but now we see chemo drugs, cardiology drugs, and insulin. The marketing is towards those who are older (and still watching TV), rather than the younger generations. The professional opinions are varied in regards to advertising of drugs, some have reasons they are for them, and those opposed have their thoughts. Research shows that the average consumer can be misled by these advertisements. This misinformation can cause issues between the caregiver and the patient. The doctor may have several reasons why a particular medication may not be right for their patient but the patient feels that it is the best choice for them. Cost is another factor, especially with new medications. Insurance may not pay for a new drug, and the patient is left with a large bill or having to go back and ask the doctor for another alternative. Some patients are more pill driven than life-changing driven in regards to treatment and end up on a long list of medications. Should drug companies be allowed to advertise at all? Should the government be involved? It's difficult to turn back federal regulation, and advertising is money driven. What would you like to see happen regarding the advertising of medications? References "Background on Drug Advertising". www.fda.gov/Drugs/ResourcesForYou/Consumers/PrescriptionDrugAdvertising. 20 July, 2018. Web. "Ban TV Ads For Prescription Drugs?". CBS News. 18 June, 2001. 20 July, 2018. Web. "Basics of Drug Ads". www.fda.gov/Drugs/ResourcesForYou/Consumers/PrescriptionDrugAdvertising. 20 July, 2018. Web. Bell, Robert A. Phd, Kravitz, Richard L. MD MSPH, Wilkes, Michael S. MD PHD. "Direct to Consumer Prescription Drug Advertising and the Public". 14(11)651-657. Journal of General Internal Medicine. 14 Nov, 1999. 20 July, 2018. Web. Kaufman, Joanne. "Think You Seeing More Drug Ads on TV? You Are, and Here's Why." The New York Times. 24 Dec. 2017. 20 July, 2018. Web. Moynihan, Ray B.A. et al. "Coverage By The News Media Of The Benefits And Risks Of Medication". The New England Journal Of Medicine. Vol. 342 Nu. 22, 11 July, 2018. 20 July, 2018. Web.

Haha, I will have to pay attention to that!

Preparing a patient for a test involves instructing them with specific teaching points plus not just listening, but hearing the patient's questions in order to ensure the best results. There are many steps leading up to a colonoscopy that can prevent a repeat test due to an inadequate prep. These steps can get confusing, so this is where nurses can guide patients in navigating the do's and don'ts. Because it's not a simple, "stay NPO after midnight" instructions, we will go over tips for the days preceding the colonoscopy, the different preps, special indications for diabetics and renal patients, and some important things to remember post colonoscopy. Tips Having a clean colon can literally save a person's life because if there is stool left, it can adhere to the wall of the colon or pool in a puddle, covering a sessile polyp, or other disease process. Sessile polyps are flat and are more likely to become cancerous than polyps on a stalk. Usually the doctor will repeat the colonoscopy soon enough to catch it, but some patients put it off not realizing the dangers. Dr. Robert Bresalier is quoted in the article, " Ensure success with colonoscopy prep," " If the prep isn't done right, and your colon isn't completely clean, the danger is we won't see important, potentially cancer-causing polyps." It seems like everyone has advice about how best to get ready for a colonoscopy, but there are some diet suggestions that are proven to help. According to the article, "Preparing for a colonoscopy" by The Family Health Guide, begin several days before the test date to eat low fiber foods. Stay away from whole grains, seeds, dried fruit, nuts, and vegetables. Good things to eat are; soup, chicken, fish, white rice, pasta, eggs, with plenty of fluids. More specifically, one week prior have patients stop fiber supplements like Citrucel or Metamucil. If they take iron pills, they need to be stopped as well as NSAID's such as Aleve, naprosyn, and ibuprofen. Most doctors will allow continued use of aspirin, especially if patients have a history of a stroke or heart attack, but anticoagulants such as plavix and coumadin and over the counter herbs and vitamins like vitamin E, should be discontinued. Patients need to check with their cardiologists regarding their anticoagulant therapy before scheduling a colonoscopy. Depending on the doctor's request, some patients are told to be on clear liquids the day before the prep, which is two days before the actual test, or just the day of the prep. It is important to reinforce what clear liquids are, such as broth, sprite, coffee (no milk), jello, and frozen popsicles. Follow Your Instructions Instruct patients to read over all instructions several days before their colonoscopy, and again the day before the prep to make sure nothing is forgotten. A must for patient's comfort is wet wipes and butt balm. Their bottom will be sore, so using these items from the beginning will decrease irritation. The previous articles, “To Colonoscopy or Not to Colonoscopy” and “Diseases of the Colon: A Case for Getting a Colonoscopy” explained the importance of getting a colonoscopy and diseases of the colon. This article will complete the thread, tying it up by talking about how important it is to follow the doctor’s instructions in colon cleansing and how nurses can be patient advocates to ensure their success. According to "The Gourmet Colon Prep" by Carol Rees Parish, R.D., M.S., the following colon preps are the most common. NuLytely (GoLytely) - powder miralax (PEG-3350) in 3-4 liters with flavors available. This prep requires clear liquid diet the day before the procedure. Half-Lytely - Miralax (in 2 liters) along with bisacodyl delayed release (4 tablets) with clear liquids the day of the prep. Colyte - Miralax in 3-4 liters with flavors available. No solid food allowed after light lunch then prep begins between 4 and 6 pm. Moviprep - Miralax in 2 liters with 1 liter of additional clear liquid. A small dinner of yogurt or clear soup one hour before the prep begins the night before the test. Fleet Phospho-soda - Monobasic sodium phosphate monohydrate, comes in a 45ml bottle or 75ml prep kit. A total of 72 oz prep after a low residue lunch followed by prep and clear liquids starting at 2pm the day before procedure. Extra fluids strongly encouraged. Lo-So Prep - Magnesium carbonate, citric acid, potassium citrate, and bisacodyl tablets. The powder is mixed in 8 oz of water along with 4 tablets, and one suppository. Not much is available about further recommendations such as diet and fluids. OsmoPrep - Sodium Phosphate monobasic - 32 (thirty-two) tablets with 64 oz. clear liquids minimum. Suprep - Sodium sulfate, potassium sulfate, and magnesium sulfate. Some doctors will have patients on a clear liquid diet two days before, then depending on the doctor's order, one dose of 6 oz mixed with water to make 16oz. The second dose is the same day or the next morning both doses followed by 2 16 oz. water. Tips to Make the Prep More Palatable No red or purple colored drinks or frozen items! The reason for this is that the red/purple dye will look like blood because the dye remains in the colonic fluids. Chilling the prep is recommended along with drinking it quickly through a straw. Rinsing the mouth helps to remove the taste of the prep and/or suck on hard candy. Remember nothing after midnight, even gum or hard candy will generate bile production and increase the chance of aspiration or cancellation of the procedure. Special Considerations Diabetic patients should check their sugar levels frequently, and choose sugar free clear liquids. Kidney patients must take special precautions, avoiding preps with sodium phosphate. Sodium phosphate crystals can deposit in the kidneys, causing damage, impairing tissue along with electrolyte imbalances. NuLytely or GoLytely are safe alternatives for renal impaired patients. Post Colonoscopy Most patients go back to normal diet and medications post procedure. If there were biopsies taken, the doctor will call the results to them, or discuss the pathology on the follow up visit in the office. Patients usually receive written discharge instructions and pictures along with a verbal result from the doctor immediately post procedure. The patient should not drive, operate any machinery, or make any legal decisions for about 24 hours, and it is recommended to have someone stay with them during this recovery period. Conclusion It has been established that a screening colonoscopy can save a person's life. Making up your mind to go ahead and schedule one is the first hurdle. We as nurses should be an example and get ours when appropriate, plus it gives us insight into what the patient goes through. Educating the patient on the benefits of a colonoscopy and the importance of following the prep instructions can make a huge difference in their success. **If you are a floor nurse and the patient is not taking the prep as prescribed or they are not having the expected results - call the doctor. There are steps that can be taken to "move" things along or delay the procedure until the patient is compliant in finishing the prep. This saves everyone a lot of phone calls and an incomplete colonoscopy due to inadequate prep. Helping one patient at a time get through the rough days of colon cleansing is how to make the largest impact. You will learn from them and they will learn from you, taking that knowledge to the next patient and friend or family member. This concludes the articles regarding colonoscopies, thank you for reading all three of them and happy prepping! References Espat, Adelina, & Cordeiro, Brittany. "Ensure success with colonoscopy prep." Focused on Health, March 2014. MDAnderson Cancer Center. 6 June, 2015. Web. Parrish, Carol Rees, R.D., M.S. "The Gourmet Colon Prep." Nutrition Issues in Gastroenterology, Series #56. Practical Gastroenterology, Nov. 2007. 6 June, 2015. Web. White, Martin R., M.D. "Gatorade/Miralax Prep For Colonoscopy." Medical Clinic of Houston, L.L.P. 6 June, 2015. Web. To read the other articles in this series go to: To Colonoscopy or Not to Colonoscopy Diseases of the Colon: A Case for Getting a Colonoscopy

We live in a world where we expect our hospitals, doctor offices, etc to be clean. But imagine a time when that wasn't the case. Standards haven't always been in place to make sure institutions kept themselves as clean as possible. The book I am using for this article is titled New World Health Series, New Primer of Sanitation & Physiology which was written in 1919. The cover has become separated from the pages and each students' signature is written on the blank pages along with the city in which they lived - Greeneville and Newport, TN. are the two that I can make out. Imagine the hands that held this book and what did each student grow up to accomplish? What a cool treasure. What struck me was that the author, John W, Ritchie (Professor of Biology, College of William and Mary) used his book to educate young people about the importance of the public getting involved in healthcare. In the chapter titled, "Preventing Contact Infection" it reads: "Every city and every county should have a hospital to which cases of typhoid, pneumonia, scarlet fever, diphtheria and other like diseases can be be taken. Then the spread of the germs to other members of the families of the sick persons will be stopped; the interference with the business and work of the other members of the families by quarantine will to an extent be avoided; and the patients will be able to have the care of the physicians and trained nurses at all times. This service ought to be paid for by the public; for it is the fault of the public when any one is attacked by a communicable disease. Smooth running automobile ambulances now make it possible to move patients safely for long distances, and we should no longer attempt to take care of cases of infectious diseases on farms or in private houses." This excerpt tells us a lot of information. At the time this book was written, hospitals were still being developed. 1860 to the 1930s saw the emergence of the first hospitals, spurred by the Civil War. The idea of a place to take people when they are sick not only to treat them, but keep them from spreading their disease was beginning to catch on. The request that there should be a hospital in every city seems foreign to us, most of us have not only several hospitals, but now urgent care centers are everywhere. Not only do we have multiple methods of getting health care, but we have a myriad of cleaning products. From simple soap to enzymatic cleaners, there is something for everything in all forms. One of the products discussed in the book was Biniodid of mercury (corrosive sublimate). The book describes it as, "twice as powerful as bichlorid of mercury" and is useful in disinfecting hands because it doesn't injure the skin. This product and those like it (such as the one used for treating syphilis) are not used anymore because of mercury toxicity. Carbolic acid is also discussed. It is made in a 2 ½ % solution = 3 ½ ounces of liquid carbolic acid to a gallon of water. Ritchie states that it is a good disinfectant in regards to sputum and "other discharges from the body." But the best disinfectant for sputum is Lysol. It is stronger than carbolic acid but it "destroys the colors in clothing." Chlorid of lime is a cheap and powerful disinfectant according to the book. It could be purchased under the name "bleaching powder". It is recommended being used in diseases of the intestine, for the cleaning of wastes. However, one of the cheapest and most effective disinfectant is sunlight. Sunlight and fresh air are mentioned in all of the old medical books that I have. God gave us a disinfectant built into our daily world, one that cleanses and refreshes. It is fun to look at the progression of how healthcare became what it is today. When I read these old medical books that I write the "Era Gone By" series from, I realize what a privilege it is to have that window to pick up, with the torn pages and worn covers and look into what it was like a long time ago. If you have enjoyed this article, see my blog for more "Era Gone By" pieces.

Yes! I was just in a public bathroom the other day and someone walked out without washing their hands. I want to holler at them, hey! You forgot to wash! Thank you from another vintage book lover.

A fellow vintage book lover!! I wrote an article on masturbation and the old way of thinking about it. You should read it. What crazy stuff we can learn from the past. Thank you for sharing!

The reference is at the end of the article

Wow, thanks for sharing. I know this has to have an extreme effect on the family.