Polio Eradication, or lack therof

http://abcnews.go.com/Health/wireStory/spread-polio-now-world-health-emergency-23586786?page=2

Reading this story is somewhat perplexing.  I understand the spread of Polio in places that the virus exists, and how the social and political climate affects the level of protected individuals.  When they bring up Ukraine, however, I am a bit confused.  Has Polio been reported there, in the drinking water? 

A quick google search turns up this helpful article: http://www.reuters.com/article/2013/11/15/us-ukraine-polio-idUSBRE9AE0LJ20131115

In this article, it is spelled out more clearly: low vaccination rates in the middle east contribute to the rising rates.  With lower levels of trust in the government, Ukraine's citizens are vaccinated on a lower level, and so are vulnerable to travelers from the mideast. 

Interesting.

Nursing Shortage

Granted, it is a USAToday article.  Okay, but I will read more later when I can.

http://www.usatoday.com/story/money/business/2014/05/07/ozy-nursing-shortage/8807937/

What I am paying attention to here is the nursing shortage abroad.  Don't get me wrong - I want to also serve in the USA - probably the majority of my career.  But I want to live abroad as well and am wondering if there are places in Sub-Saharan Africa and/or India that could work while raising a family.

What can I learn here today?

A big shocker: I hate my job.

I work with awesome people.  These people are good at what they do and they love it.  They have personality, and are funny, and I get the sense that they are just good people.  My work environment is safe, and I am fully aware that there are many people who would love to sit at a desk all day.  I even have grown accustomed to that part and can't say that it's the worst thing anymore.

The problem is that I am absolutely passionate about everything to do with nursing and medicine and surgery and public health and disaster relief, and feel almost exactly the opposite about business cases and risk assessments and board reports. 


A fun little fact: some nurses have to make business cases and board reports.  Assessing a patient is a type of risk assessment.  (I must point out that it's actually not the process of risk assessment that I hate - it's the fact that I am assessing risk on things that are not living beings.  I understand the importance on a mental level, but it does not resonate with me.)

So, I have chosen to be miserable until such a time that I can go to nursing school.  But today I am reversing that decision.  I am going to choose to be as much a learner here as I am when I dig into chemistry videos or articles about nursing as a career.  Every day, I will ask myself: What can I learn here today?  It may be something that only helps me until I leave.  Then again, it might be something that helps me in communicating with doctors, in organizing my thoughts, prioritizing, focusing.  And it could very well be that one day I will need to present to a hospital board of directors. 

Can I give some credit where credit is due?  A dear friend points this out.  Where life is unfair (and this is hardly unfair; I am being paid), there is always a reason -- there is always something we are meant to learn. 

Why am I here today?  What is it I'm supposed to be learning from this?  How can I better live today?

Happy Nurses' Week!!

I have to admit that I did not know that it was nurses week but I'm glad to know now!  I loved this piece in TIME: http://life.time.com/culture/national-nurses-week-time-to-say-thank-you/#1.

What should I do? 
Ideas:
* As I failed to get the name of the extraordinary nurse who cared for me after the birth of Maggie, maybe I should send the nurses of the mother/baby unit something - a fruit basket? Candy? What else do you give as such gifts?  Definitely with a note saying how wonderful they were. Maybe it would be better to send a note now and treats later, as I hope they are covered up in treats this week. 
* Also something for Bev, who has encouraged me to shadow where she is director of nursing.  I still have not followed up with her and need to do so. 

Daydream Exploration: Travel Nursing

Well, my research into this daydream -- working as a nurse in Spain -- is quite disappointing.  Spain has an overabundance of nurses and there are not enough jobs.  They are not in need and not giving out work permits or visas.  Sheesh.

There are quite a few places I would like to live in Spain.  I speak South American Spanish but do understand (and am understood by) Spanish speakers from Spain.
Mallorca is one, and there is an english-language agency there that provides in-home care.  This is not really my area of interest, but one possibility.

Midwifery is another area in which there is a need.  Again, not what I hope to specialize in, but ...

Antibiotic Resistance

http://www.scientificamerican.com/article/antibiotic-resistance-is-now-rife-across-the-globe/?&WT.mc_id=SA_BS_20140502

Dire straits, y'all.

MERS and Contagion?

This makes me think of Contagion, althuogh it is only one of an unfathomable number of diseases that are dangerously spreading from animals, and then slowly around the world, due to increased crowding and travel. 

http://www.cdc.gov/media/releases/2014/p0502-US-MERS.html

The following paragraph was interesting to me:
While experts do not yet know exactly how this virus is spread, CDC advises Americans to help protect themselves from respiratory illnesses by washing hands often, avoiding close contact with people who are sick, avoid touching their eyes, nose and/or mouth with unwashed hands, and disinfecting frequently touched surfaces.

Aren't all respiratory illnesses basically spread through the virus making its way to your hands through coughing or sneezing, or someone else coughing or sneezing, on a surface?  And we touch our faces and eventually infect ourselves by touching a mucus membrane?  How would this vary?

Vital Signs

AJN, American Journal of Nursing:

May 2010 - Volume 110 - Issue 5 - p 11

doi: 10.1097/01.NAJ.0000372049.58200.da

In a short article in the American Journal of Nursing, Louise Rose, PhD, RN reminds us of the importance of monitoring vital signs.  "Abundant research," she says,  "indicates that vital signs aren't consistently assessed, recorded, or interpreted."  This is despite the fact that they are the best indicators of many complications or conditions, and offer clues to the reasons for deterioration of patients.  

Rose offers suggestions as to why vital signs may be pushed off as a menial task.  It is, after all, repetitive and time consuming.  In some cases, machines perform the task automatically; perhaps a nurse is not reviewing these reports.  On the other hand, less experienced medical professionals may deliver inaccurate results.  And, likely as any explanation (probably moreso) is that the nurse workload prevents them from taking and/or recording accurate vital signs.

So, how can and should this be addressed?  Isn't this fundamental?

I won't pretend to have the answer to this problem, but I do think it helps to be aware of the situation.  This is probably very indicative of the environment I will be entering.  If something this fundamental is being overlooked, what does that say about nurse morale and workload?  Or is it something else?

Medical Spanish - Entry 5

ligadura de trompas - tubal ligation

"tenia usted ligadura de trompas?" - Did you have a tubal ligation?

Medical Spanish - Entry 4

parpadear - to blink

or

pestañar- to blink (this is what is used in Argentina.)

pestaña, por favor.
blink, please.

Feelin' Flighty

I have some research to do.  I have some studying to do.  I could learn some more medical Spanish. I could find a journal article or current even to read and reflect upon. But, my mind is so restless tonight, so, I'm gonna go with it.  What's bugging me?

Costa Rica is bugging me.
Last time this happened, it was some nonspecific European country. 

While I think it is absolutely important to serve my community here, and while I feel a calling to help in poorer areas, both domestically and abroad, I also think a year or two abroad in an interesting place would not only be fun, would not only be great for the children, but would also expose me to other ways of thinking that can help me think outside the box here. 

So, I'm starting to think about it.  My destination would necessarily be English- or Spanish-speaking.  And, I would need to be able to take my family.  How would Santi come along?  How would we find a place that worked for both of us? 

I read this, about teachers who "life swapped," and this about the feasibility and logistics of travel nursing with a family. 

What I'm Reading Today

How Public Health Advocates are Trying to reach Non-Vaccinators

The approaches described in the article are interesting, because the situation was actually the opposite for me.  While pregnant with my first son, I was unsure whether to vaccinate.  One of the factors in arranging a meeting with his pediatrician was whether the practice would allow us to skip vaccinations or modify the schedule.  This practice allows that, and is the only one in our area that I found that did.  When I went to meet with the pediatrician, I asked him about vaccinations.  He calmly explained with facts, and offered articles as support, why vaccinations are safe and why the risk from not vaccinating is much greater than from vaccinating.  His approach made sense to us, and we choose to vaccinate our children.  When we go to our check-up appointments, the vaccinations are a part of the appointment.  That is, if we were non-vaccinators, we would have to actively deny the vaccination. 

With more understanding, I know why it is so important that my children, and all children who are able to be vaccinated, are.  I still agree with the practice's approach of allowing non-vaccinated children, because those children, whose parents are making a bad decision, should also have a right to health care.  I wish our provider didn't have to be the one to provide it, because I did worry before my children were vaccinated, but I felt the quality of care we receive there was excellent, so I did not change providers.

Medical Spanish - Entry #3

malpartos - miscarriages

mal = bad
el parto = birth

TEAS Study Notes

Questions I am still finding answers to for studying TEAS - ongoing list compiled from various sources.  I delete them as I feel comfortable with them, and am adding more based on practice tests.  The original compilation is from a post on allnurses.com.  Just google that site plus "how I studied for the TEAS V"

Reading - the first section

•Know which primary sources make sense for a given type of story

•Summarizing sentences...be able to choose which is the best fit for a given story. [I can do this but want more practice]

•Understand what you can logically conclude from a story [I can do this but want more practice]

•Inference and what can be concluded from a given example [I can do this but want more practice]

•Decipher the meaning of a word based on its context in the sentence (mine were not as easy as the examples, so really think about this style of question.) [I can do this but want more practice]

•Choosing an appropriate title for a given paragraph (again, sounds easy, but I had to really think about this one because the answers are similar)

Math - the second section

(1) calculating percent increase/decrease

 (2) Work rate problem formula.

•Be able to list four numbers in the order requested. These numbers may include whole numbers, fractions, and decimals in any combination. Be VERY careful to order them as requested. (ex: greatest to least, least to greatest) [In the practice tests I keep doing it in opposite order!]

•Roman numerals.

•Familiarize yourself with interpreting information based on charts. (seems easy, but be sure you read headings and info on the charts, as there may be very important information)

•Know when you would use a bar chart/circle graph/histogram/scatter plot/line plot. Ex: if you want to show a change in something over time, you would use a line plot.

•Know the FOIL method

•Be very, very, very familiar with absolute value and how to solve equations that include absolute value.

Science - the third section

•Scientific reasoning

•The scientific method (know the steps, in order, and know examples of each step)

•Understand why an experiment is repeated

•Know the fundamentals of electronegativity

•Understand the various physical states of matter (gas, liquid, solid) and how a change in state might change pressure/volume/etc.

•Get a feel for the chemical properties of water, along with the specific values for it (such as specific heat/temp at which it freezes/boils/etc.)

•Understand what happens during serial dilution and what values result from it (these are very easy)

•Know the general concepts of natural selection and adaptation. Make sure you are able to distinguish between the two given an example.

•Know all of the factors that influence birth/fertility rates. Be able to decipher if the population will increase or decrease given an example.

•understand population growth/decline based on rates of emigration immigration/birth/death.

•Know your biological classifications from general to specific: Domain, Kingdom, Phylum...etc. Watch these questions, paying attention to whether they are asking for more specific or more general in the order.

•Know as much as you can possibly learn about Nucleic Acids/DNA/RNA. Know their make up, how they bond, the nitrogenous bases and how they pair, which are unique to DNA or RNA, and which are shared by both DNA/RNA, know which are purines and which are pyrimidines.

•Know what it happening in all of different stages of translation and transcription. Know where it happens.

•Know the parts of a cells in both eukaryotes and prokaryotes, and what those parts do. Know if they produce anything or if they are involved in an immune response...etc.

•Understand the makeup of the cell wall in both plant and animal cells.

•Always, always, always equate protein with amino acids (the building block of proteins)

•Understand what chloroplasts do and how they do it.

•Chromosomes, genes, and alleles...know what they are, how they relate to each other, and how they affect organisms.

•Cell differentiation - know what the meso/endo/ectoderm become.

•Mitosis/Meiosis - understand all phases (ex: G1, S, G2...)of each and what is happening in each. (I found videos useful in this...especially those from Khan Academy) Know what types of cells these happen to.

•Be sure you understand what a heterotroph and autotroph is and how they relate to each other in the life cycle.

•Review photosynthesis - review it again - then review it again. (the entire process) Know what it produces and how that product is used.

•Be very familiar with cellular respiration, why it happens and what is happening.

•Be able to read a codon chart and decipher the outcome from a given example (this question was more difficult than the basic charts I studies. make sure you study both basic and more advanced examples)

•Mutation vs. adaption

•Phenotype/Genotype - what are they and how are they related?

•Punnet squares and calculating probability given an example. You will need to make sure you can set these up properly, which includes knowing the difference between heterozygous/homozygous/recessive/dominant and how they fit into the equation)

•Kinetic and potential energy. Make sure you can recognize an example of each. I suggest googling several examples so you can solidify the difference in your mind. My question was more difficult than the basic, but easy to understand because I had the concept down pat.

•The dreaded earth science question - is there one? Yes. And as covered in the manual, mine was about the sun. It was a concept not covered in the manual, but was easy nonetheless. There were no other earth science questions on my test. No rocks, clouds, water cycle...etc.

•Understand the purpose of a catalyst

•Know everything there is to know about the periodic table and the information you can get from it. Atomic number, atomic mass, how many protons/electrons/neutrons are in a given element. Know how the numbers relate to each other and how to decipher how many of each is in an element if given a specific number. (again, Khan Academy was a great resource on this). Also know the physical and chemical patters withing the table (what the rows mean, what the columns mean, which elements are more likely to have ionic/covalent bonds). Lastly, make sure you understand electron configuration.

•Be very familiar with valence electrons and why they are important

•Enzymes and vitamins - what do they do, where do they come from, why are they important.

•Understand pH balance/acid/base. Know what a given pH means (acidic or basic?) and understand what adding something to it may to to the pH (think about things that may raise or lower the pH of blood, for example)

•Understand bonds - ionic/covalent

•Understand hydrocarbons - saturated/unsaturated

•Make sure you remember how to balance a basic chemical equation (Khan Academy has an excellent video on this.

•Anatomy/Physiology as follows:

•Know the path of blood through the heart, including valves and whether the blood is oxygenated)

•Know the make up of the lungs and where oxygen exchange occurs

•Know the sections of the brain and what each is responsible for

•Tissue types, where you would find them, and what they do. Know several examples of each type of tissue.

•Digestive: follow bollus through the digestive system in its entirety. Know about peristalsis. Know about the digestive enzymes. Know where protein/carbs/fats are broken down. Know where the bulk of nutrients are absorbed. Know which division of the nervous system controls it.

•Know the functions of the liver, spleen and pancreas. Know which systems they belong to (and they may belong to more than one....hint)

•Know what the lymph system does and how it accomplishes it. Be mindful, also, of what it doesn't do. Just a suggestion.

•Be very familiar with the nervous system and its divisions. Know what each controls and the branches that make them up.

•Make sure you understand the structure/function of the kidney...well.

•Anatomical directions (super/inferior, proximal/distal...etc.) apply to an example.

•Know how the thyroid and parathyroid work together and what they do separately.

•Immune system - natural vs. artificial/active vs. passive. Recognize examples of each type. Also know the different cells involved and what they do.

English - the fourth and final section

•Recognize common possessive nouns.

•Pronoun/Antecedent agreement.

•Dialogue - correct punctuation and usage

•First/second/third person voice and recognizing which from a sentence or short story.

•Grammar usage for style/clarity

•Using sentence context to decipher the meaning of a word.

•Recognizing a simple vs. complex sentence

•Be able to identify a top and supporting sentence. Know the difference.

•Know the meaning of common prefixes/suffixes/roots (ex: uni, ous, endo...etc.)

•Rules of capitalization.

•Correct usage of commas, ellipses, semicolons, colons, hyphens, and parentheses.

•Correct usage of quotation marks and apostrophes.

•Go over a list of commonly misspelled words. You will have one on your test. if you get confused, look away from the word and write it down. If that doesn't help, write it in a sentence.

TEAS Study Notes: Electronegativity, Covalent Bonds, Ionic Bonds

Electronegativity - the measure of attraction of an atom for the electrons in a chemical bond.

Note - electronegativity/ionization energy increases as we move up and to the right on the table.

Medical Spanish - entry 2

I had to go looking for new vocab today because the word of the day site didn't have anything new for this entire week.  Today I have two ways to say jaundice:

ictercia

piel amarillenta

I will ask my in-laws about these terms tonight.  My thoughts are:

ictercia - probably pronounced ick-ter-CI-uh

piel amarillenta - piel means skin, and amarillo means yellow, so I'm wondering if amarillenta is yellowed. 

Medical Spanish - Entry 1

Medical Spanish's word of the day is "el conocimiento," meaning consciousness.  To ask, "did you lose consciousness," one would ask, "Perdio usted el conocimiento?" [sic] (I left out the accents.)

I've never heard that used.  It's the first time I've come across a phrase on medical Spanish's page that I did not previously know and will have use for. 

It makes sense.  I think of conocimiento as meaning knowing - not knowledge, really - but being familiar with.  So if I think of it in terms of if you've lost the ability to know - that makes sense.

Public Health Concern: Conspiracy Theories

A survey getting some press today indicated that half of all Americans believe in health-related consipiracy theories.  This survey was conducted by political science professor Eric Oliver at the University of Chicago, and published in JAMA. 

Some of the conspiracy theories include:

• Vaccines cause autism
• Cell phones cause cancer
• The FDA is deliberately preventing access to natural cancer cures
• The use of GMOs in food is a program designed to shrink the world population

This, to me, represents a very difficult challenge in public health. I believe that, in buying into these myths, people believe they are being responsible and thinking critically.  It is hard, though, to refute the "evidence" that people have access to: they saw it on the internet, and therefore it must be true.  This is tough to refute not because it is true, but because what people believe is true often has little to do with what actually is. 

To give examples of concrete issues with these views, if a patient believes that there is a natural food out there that will cure him of cancer, and meanwhile refuses to accept chemotherapy, there will be a real consequence to that person and his family. Unfortunately, that consequence could come too late for it to be useful as a learning experience to that patient.  I have not heard of a situation in which this is happening en masse, however.  The anti-vaccine mamas, however, are, as a group, taking a path that not only puts their own babies at risk, but those children and adults who are not able to be vaccinated.
In a more abstract sense, would trying to change these views by any means lead your patient to distrust you, and do more damage to the situation than good?  I feel this is extremely likely, and this secondary danger may be even more dangerous than the first situation.  It certainly depends on the patient. 

Nursing Jobs for New Grads

Kurtz, Annalyn.  "For Nursing Jobs, New Grads Need Not Apply." CNNMoney.  January 23, 2013.  http://money.cnn.com/2013/01/14/news/economy/nursing-jobs-new-grads/

Another article with some age.  But, it's not as if this is changing quickly, as noted in the article itself.

See also: http://www.georgiahealthnews.com/2013/05/nurses-jobs-sign-times/, http://www.healthecareers.com/article/top-reasons-why-new-nurses-cant-find-jobs/172234, and
http://www.workingnurse.com/articles/why-nursing-school-grads-have-trouble-finding-jobs

It's a truth that I do not want to accept. Despite it being shouted from the mountaintops that there is a dire shortage of nurses, nurses, and new grads in particular, are having a hard time finding work. 

I do have a few things working for me.  When I finally finish this degree (ha! start!), I will be getting a BSN.  So, I do feel more likely to find employment than ADNs, especially with the push for BSNs over ADNs that I've heard about happening at more and more hospitals.  My first choice program has a 100% employment rate 6 months after graduation, as well.

I don't even pretend that means I will get my choice of jobs. I am pretty sure that I do want to work in the hospital setting, but a nurse I spoke to yesterday (one whom will actually be helping me to find some shadowing opportunities) reminded me that there are scores of other options for working as an RN.  Allow me to go off on a reflection tangent.

While most of my excitement regarding nursing comes from fantasies of working as a scrub nurse, nurse anesthetist, or ER nurse, public health is another interest of mine.  Before our vacation, I did some research into the public health situations of the countries we would be visiting.  My most basic motivation behind becoming a nurse was a desire to help people.  Perhaps working at the health department is not as exciting as I wish it to be, but working with HIV/AIDS patients is of interest to me.  Helping low-income pregnant mothers-to-be take care of themselves and their babies is very important.  I do fantasize about later being able to take part in my church's medical mission trips, and the assessment skills I would sharpen in those environments would be so helpful there.

On the other hand, I do not know anyone who has not been affected by cancer in some way.  Research is second nature to me.  I may not love it in and of itself, but I could love it for its outcomes. 

Accepting that the hospital is not the only place of employment for new grads is part of the battle.  Because I have had to wait for the right time for nursing school, I have also made experiences for myself.  I can do more, though.  It is very hard to do so, especially for nurses who have other things going on.  It's not just children, but many second-career nurses also have aging parents to care for.  Sometimes, working one job is all we can do. There are many obstacles that can keep us from taking extra time to gain experience outside the job, but when the market is so competitive, it is really incumbent upon us to prove our interests and skills in as concrete a fashion as possible.

While it is not an option I am currently considering, if I do not find a job in any of my top choice area, geriatrics is a good area to look into.  The population is aging, and we helpers are needed to take care of a population that has taken care of us.  

I have some time before I am on the job market.  I have hope that the job market will improve in that time, but I do not expect it to do so quickly.  I think it is important to remember that experience in any area of nursing can inform other specialties.  Elderly people also have surgery; mental health patients have babies; children visit ERs; HIV patients sometimes require addiction recovery services; diabetic patients may require surgery.  There are so many crossovers, that skills built in one area cannot but serve as experience for another, down the road.  It is important, then, to stay alert to these transferable skills, just as someone attempting over years to transition into nursing might do.

Response to Manton's Emergency Nursing piece in the Imprint (forever ago)

Manton, Ann, PhD, RN, FAAN.  “Emergency Nursing.”  Imprint: The National Student Nurses Association Journal.  January 2004.  23 – 25.

 

Anne Manton is an associate professor at Fairfield University, as well as past president of the Emergency Nurses Association.  Here, she writes about the job of an emergency nurse, and the pros and cons of this specialty.  I would like to reflect on the five factors she presents for preparation for a career in emergency care:

First, Dr. Manton emphasizes that quick thinking, the ability to prioritize quickly, and flexibly restructure ones day are vital to being an ER nurse.  To an extent, I believe these qualities are important to all nurses, but very much enhanced in the fast-paced environment.  In my own life, I have experience with this in caring for a family including two babies, while thinking in two languages.  Additionally, when I served as network administrator, information security officer, and operations coordinator, I learned quickly how to wear various hats in any given situation.  Obviously, this is not the critical environment of nursing, but I do know that I am able to multitask and prioritize on the go.  I also believe that having a very firm knowledge of the subject matter enables one to prioritize and multitask efficiently.

Secondly, Dr. Manton says that assessment skills, as well as the ability to apply those assessments, are key.  Again, I feel that a thorough knowledge, gained through study and experience, are what enable a nurse to assess correctly and to understand the significance of the information gained.

Thirdly, “[e]mergency nurses need a strong knowledge base in every area of nursing.”  This is especially attractive to me.  Along with my desire to work in a fast-paced environment, I am interested in a complete picture of knowledge in nursing.  And, like in number one, I do think that this knowledge is helpful no matter what area of nursing one is in.  However, it is absolutely vital for an emergency nurse.

Next, Manton stresses the importance of critical thinking and notes that, as opposed to other specialties, many ER patients do not yet have a diagnosis.  This, again, is especially attractive to me.  Of course, it could be very stressful to deal with situations in which there are big unknowns.  However, I have always enjoyed putting pieces of information together, as well as working with a team.  It also seems like a test of knowledge, but under higher stakes than usual.

Finally, “good communication skills are imperative,” says Manton.  I think I excel in this area, and in two languages, at that.

 

I think often about my desire to be an emergency surgery nurse, and whether that is a dream that I can make into a reality.  I also think about where I want to work before working in the emergency department.  Manton suggests gaining experience in medical/surgical nursing, which suits me just fine as I am dying to get into an OR.  I also wonder if my path does still involve nurse anesthesiology.  This would guarantee OR work – but would be quite a bit different (as all nursing is) in the ER, as well. 

I’m not sure I’ve drawn any conclusions here.