20140207 Current Events

http://www.medscape.com/viewarticle/820234?src=rss#3 Mandatory Flu Vaccinations for Nurses

This article on medscape tells about a pregnant nurse who was fired for refusing the flu vaccine.  I find this situation to be very interesting.  I really want to side with the nurse.  I want to be able to say that I believe that should have been her option.  I want to say this because, in other cases, I myself would like the right to refuse a vaccination if I feel that it is not safe.

However, this is the flu vaccine.  I myself have never received it, but I do get it for my children every year, and when I begin nursing school, I will begin taking the shot.  I simply do not take it because I have never had the flu and I do not currently work with an at-risk population.  Since my children's immune systems are immature, I feel incumbent to vaccinate them.  Because the flu is so contagious, I do believe that anyone working in a hospital, long term care facility, or, really, anywhere where there is a concentration of people (such as a school) should receive the vaccination if they do not have a solid reason not to.

This nurse was pregnant, and she feared that the vaccination could put her baby at risk.  Her anxiety over this was so great that she was able to get a physician's note saying that the stress from worrying about this was putting her baby at risk.  However, this just is not fact-based.  While no group of pregnant women is assembled as part of a study of effects on pregnancies before the vaccine is released, data from after the vaccine is released shows that receiving the vaccine may actually lead to lower incidence of pre-term birth.

In an age of evidence-based practice, do we want a nurse who won't use the evidence?

And then, I do see her side.  How do we know what is true?  But anecdotal stories of things going awry are hard to critically examine, since they don't really give us enough information to prove causality.  In some cases, it is less clear. With a disease so easily spread as the flu, I just don't think there is enough evidence against the vaccine. Could her employer have given her some tasks away from patients until after she had the baby, or after flu season? It is possible, but would that be her job? I am all for being flexible, and I think employers should be flexible. But I can also see how they wouldn't want her in the building, and also that there might not be another job suited to her with minimum patient contact. It could truly be a dangerous precedent.

http://www.recorder.com/news/townbytown/shelburne/10549654-95/letter-nursing-shifts

letter to the editor regarding nurse demands in a strike; nurses being overworked; quality of care

This is a letter to a paper editor, spurred by a patient's observations about nurse scheduling and overtime, as well as an impending strike. The patient appreciates the competence demonstrated by her nurses and expresses dismay at the focus on profit rather than patient outcomes. 

The Trophy is not to Blame

I have seen several articles making participation trophies the scapegoat to basically all that is wrong with our generation, and it irks me every single time.  

Don't get me wrong, the practice of handing out participation trophies should end. It is wasteful, for one thing. I had a lot of softball and basketball trophies. Most of them were participation trophies, but there were a few good ones in there: a couple of second places, a first place, and even a first place all-stars trophy. Guess what? They were all ugly, all useless, and all got in the way of toy storage. I felt obligated to keep them, until one day I didn't. I have no clue whether they are still in my parents' basement. My t-shirts from the team got far more use.  I do still remember end-of-season pizza and swim parties, and those were good times. I don't know a kid who, if asked, would choose a (really ugly) trophy over a party, but I am sure they might be out there, and I am sure they might have more reasons to choose that than that they think they are entitled to a trophy.

So, you say that there are no participation trophies in the real world of adult life. Really? Are you sure you've never, ever received an adult participation trophy? Let's look at this real world.  Did you ever have an off day at work? Did you blow a presentation, make a mistake, or spend time chatting with a coworker while on the clock? Did you still get paid for that day? You probably even aren't at 100% for 100% of the hours you work per week. In that case, you may not have actually worked enough hours to qualify for benefits. Bet you got them anyway.  Maybe you give your best, but maybe you're not the best in the field. You may be passed over for a promotion, but you get paid because you work and you do a pretty good job. Not a great job, but you work hard. 

That doesn't apply to you? I bet you work 60 hour weeks, right? Lots of people do. Has your family ever suffered because you weren't with them?  I bet you still get to claim tax benefits, either from being married, even though you may sometimes not be the best spouse or from having kids, even if you barely see them. Not to mention the true benefits of having them.  You know, love, and stuff. 

I could go on with other examples, but let's just get to the heart of why this tendency to blame the supposed faults of a generation on participation trophies bothers me.  Who decided that our generation would receive participation trophies? Maybe it was inspired by children who threw fits when other children got trophies for winning, and maybe not. In any case, an adult, who would not him or herself receive the trophy, started this practice. 

So, it's not our fault. We were victim to a misguided set of beliefs. Poor us.  But we shall overcome, and we certainly will not inflict this horrendous practice upon our children.  That would teach them that if they are not particularly good at something, they can still expect to be rewarded with cheap pieces of plastic, and that would in turn symbolize to them (not us, mind you; it's children who care about the outcomes of t-ball games) that mediocrity is to be celebrated. 

But we certainly did not learn that ourselves.  No, just our peers with less critical thinking abilities than us, says Matt Walsh. 

It's all about something that we had no control over at the time it was happening and that we can easily discontinue. 

Except that it's not. 

I used to see adult participation trophies on a daily basis. Did you get dressed this morning and do you own a mirror and/or do you ride in a car? Do you have a latte with pretty swirls? Oh, did you cook dinner today, or can you afford to go out for a treat?  Do you have an opinion about something, founded or unfounded? Do you agree with something someone has said that may be controversial? Do you have legs and feet?  Well, you deserve to be on the front page of a newspaper with a circulation including your friends and their friends. A circulation you more or less choose, and can shape to reinforce you for performing everyday acts of mediocrity, beginning with being self-obsessed. And you deserve to know that people like what you're putting out there. You're entitled to that attention, at whatever cost. It's adult interaction. 

I am a parent. I was a stay at home mom to two toddlers for a year, and I wasn't very good at it. (Luckily, they still love me.) You know what I observed about my attachment to my smartphone?  

It did not relieve stress. It did not help me stay connected with grown-ups. The real connections I have know where to find me outside of the Facebook. 

That is just me and if you tell me that your smartphone use does help you de-stress or stay connected, it is possible that you may be using yours better than I used mine.  I still completely and wholly believe that if you are worried about participation trophies and you are actively participating in social media, you might be looking for an easy way out. You may have accepted a scapegoat because it is far easier than examining your need for constant reinforcement. The trophies are already gone and you had no part in it. The boomers did that to us, the buncha dumbasses. 

Is it a problem? That's for you to decide. I think at this point, some of us might agree that participation trophies may not be the issue. It may not be Facebook, either. It could be some need you as a parent feel to break the bank at Christmas. Or something. There are just a lot more likely causes than rewarding kids for trying. 

Let's go back to the fact that our families still love us. This makes me think about the parable of the prodigal son. So, the responsible son worked every day of his life for his father. His brother, on the other hand, took his inheritance and left to enjoy everything he could find to enjoy. So, dude comes back, and now their dad is throwing the irresponsible son a party.  Not the one who works hard every day of his life. Not the one who has stood by his father thick and thin. Nope.  

So forgive the colloquialism, but I just can't see this conversation playing out any other way. The responsible son says, "WTF, dad?"

And does his father say, "you know, son, you're right.  I shouldn't be celebrating this failure of a son, this person who abandoned us?"  

You know, he didn't. 

He said, "come on and enjoy this party. Have a glass of wine. Here's some fatted calf.  You're going to get your reward. But come celebrate your brother's return with us."

Mom-bloggers like to tell me that we all feel like failures as parents sometimes. I guess it may be true. But I still feel like I may be a pretty mediocre mom. I don't craft. I tried to home preschool my son, and failed so miserably that I couldn't even get up and try again. I gave up on being a stay at home mom. I said I wouldn't spank; I do. I said I wouldn't scream; I do. I try my best, but that is so, so often not enough. I break my own heart almost daily. 

Love is not a trophy. But damn if I'm not thankful for the grace that means that I don't have to be the best to be worthwhile. The rewards I get for doing my best, even when it's not the best, inspire me to try harder. If I could use that, how much more could a child?

Current and Future Reading, post 1

I think I will make weekly posts regarding what I've been reading, with summaries, for articles that don't inspire more through research. Hopefully, I will be able to use labels to help catalog and easily find them, should I need them later. 

Without further ado...

Kokomo, IN woman volunteers a meal and feeds 600.  

Melody Kegel in IN was asked by her pastor to see if the Red Cross needed meals. He thought that his church would be happy to provide a meal. But, as the need grew, so did Melody's willingness to serve.  She ended up feeding people all week.  

http://feedly.com/k/1b1aAMo

Researchers Block Replication of HIV Virus

At universidat Catolica de Valencia, they have created synthetic molecules called terphenyls, block traction between protein and the HIV virus's RNA receptor by binding to the virus's receptors. Amazing! So exciting! 

http://www.sciencedaily.com/releases/2013/11/131128103951.htm?

In future reading, I have come across quite a few articles and podcasts about fluids in sepsis care in the last 24 hours, so I will probably write a larger post once I have read, listened, and digested those. 

http://emcrit.org/blogpost/best-fluids-comment-ever/

Cancer and Heredity

This does not exemplify what I expect my future posts regarding research into medical sciences and nursing to be.  This is actually an extra-credit assignment for microbiology.  I had to write to a prompt that I didn't feel fit the information given in the presentation, so please don't judge.

I attended the Science Friday presentation on the 22^nd of November about cancer, genetics, and heredity.  The flyers for the presentation themselves were informative and thought-provoking: Cancer is always genetic, but when is it inherited?  I would wager that many people, like me, have never thought about this important differentiation.  The speaker, Kerry Crandall, gave an informative presentation regarding the causes of cancer and genetic testing.  I learned quite a few things, some of which actually had a surprising impact on some things I once thought. 

One of Ms. Crandall’s first statements was that when she started working in the field [in 1988], nobody was talking about hereditary cancer.  She went on to say that this came up seven years later [in 1995].  This was surprising to me, but it makes sense in light of the percentage of cancers that are actually hereditary.  One thing that I learned about cancer and heredity that was quite central to the presentation was that only about 5 – 10% of cancers are hereditary.  If I had been asked to guess prior to this experience, I may have guessed that about 75% of cancers were hereditary.  Conversely, it is about 70% of cancer that is believed to develop due to acquired changes, which include exposure to carcinogens, the aging process, and chance.

Secondly, I learned about the characteristics of hereditary cancer.  These characteristics are that multiple individuals on the same side of the family are affected with the same or related cancers, over multiple generations, with the cancer occurring at a younger age than usual, and no known environmental risk factors.  The other types of causes are acquired changes (which are sporadic) and familial.  Ms. Crandall stated that family history is that best tool for differentiating between sporadic, familial, and hereditary cancers. 

Finally, I learned that testing of multiple gene mutations is sometimes done in a sort of “panel” test.  This testing looks for sequencing differences, deletions, and duplications of various genes, and can take anywhere between a few days and a few months to return results.

Ms. Crandall stated that federal and state laws protect against discrimination based on results of genetic testing when it comes to searching for health insurance.  She also said that laws are not so helpful when it comes to life insurance. 

Relating these facts to microbiology in three different ways is a bit more difficult.  Obviously, information about mutations in genes relates to microbiology as we look at the processes through which cells divide and acknowledge that mistakes sometimes happen in that process. The fact that there are 1000 or more mutations of BRCA-1, some of which are “just mutations” that have no dangerous implications that we know of, is just a point of interest.  Secondly, when we think about some of the environmental factors that might make up some of the 70% of cancers created by acquired changes, some of those causes in the category of “chance” might include microorganisms like viruses (for example, human papillomavirus and its link to cervical cancer).  Finally, a question from the audience about Factor V Leiden clotting disorder piqued my interest.  This condition is caused by a gene mutation that causes the clotting protein to deactivate more slowly than it should. 

So, how does this affect the way I think?  As previously stated, I was completely surprised by the low number of cancers that could be considered genetic.  Without having done any research, I thought that my grandmother’s bout with breast cancer automatically meant that I was at a higher risk for breast cancer.  However, being that she is the only member of my mother’s family who has had breast cancer, and the only member of my mother’s immediate family to have had any cancer at all, that her cancer occurred at age 72, and the fact that my grandmother was exposed to carcinogens for decades in the form of heavy secondhand smoke while my grandfather smoked cartons of cigarettes per day, it is unlikely that my risk of breast cancer is elevated due to any genetic factors.  So, this has had an important impact on my thought. 

Secondly, because Ms. Crandall indicated that genetic testing is not indicated for people with no elevated risk, and because I could face discrimination if I was found to carry some gene mutations, I have come to the conclusion that I am very unlikely to ever seek genetic testing to rule out possible inherited cancers.  (I might be interested in having testing to determine my genetic origins, however, as my paternal grandmother was an orphan and I’m very curious to know her background.  It would be awesome to find some relatives to visit in some faraway land…)

Finally, the 30% instance of familial cancer that is not necessarily related to genetics, but more linked to commonalities in habits and environment, inspires me to pay careful attention to what may be working well in my environment and upbringing.  We are a very healthy family – low instances of cancer, obesity, diabetes, heart disease, etc.  It seems to me that we may be doing some things right, worth continuing as tradition.

In conclusion, I am happy that I attended this presentation, and found it informative.  While I did have trouble linking it solidly to microbiology in three different ways, I do think that there is a very solid link between this information and microbiology as we remember the processes of cell division and the ways that that can be impacted. 

Routine

This is supposed to be a rough routine.  It won't be followed to the letter, but its purpose is to provide a general framework for our days.  I will have to work up to the 5am wake-up call - both because of my own habits and because of Maggie's desire for extended morning nursing sessions.  It looks like there is almost no play time for the kids, but for right now, that happens where things are not scheduled - where I am doing chores.  I mean, it is their work, so I think it should be on the schedule, but it becomes redundant.  I think when we move into warmer weather and can go outside, it would make sense to put things on the schedule since we would be moving locations.

5 am - wake up. stretch. shower. make up. get dressed. put in load of laundry. eat high-protein breakfast. make coffee. read inspirational materials. plan day.
6 am - tidy downstairs. work on chore of the week if it takes place downstairs. listen to podcasts, read news, read journal articles, or blog.
7 am - make breakfast for everyone else. help get everyone up. stretch.  sing songs. feed. get kiddos dressed. put laundry in dryer. wash breakfast dishes.
8 am - get kids headed toward school if a school day.  if not a school day, extended time-in with both kids/kindness activity.
9 am - time in, then put laundry away, then start dinner (possible start of playdate)
10 am - mwf - time in, then chore of the month. t - extended time in, which could include fun lessons th - Pack storytime - or playdate
11 am - mwf - little lesson, then go pick up Nico, t - long lesson, or several lessons (fun ones), th - Pack storytime and library - or playdate continued
12 pm - lunch, time in. kids help clean up. dishes.
1 pm - nap or quiet for kids, quiet time for me, nap if needed, planning time if not
2 pm - nap or quiet, quiet time for me, chore of the week if not completed before
3 pm - time in. little lesson, cleanup.
4 pm - time in, finish dinner prep, clean kitchen, time in.
5 pm - time in, little lesson, cleanup.
6 pm - kids set table for dinner. dinner. time in.
7 pm - kids help clean up after dinner, then can watch TV or play.  we do dishes.
8 pm - clean up toys in all rooms, baths, storytime (time in)
9 pm - storytime, cont, bed
10 pm - Read, bed

Small Things

"Be faithful in the small things, because it is in them that your strength lies." - Mother Teresa

Now this blog will become my record of my journey.  I have been dealing with the feeling of being discouraged.  Setting goals and working towards those goals, and, just as importantly, having records of my progress, is my self-prescribed way out.

How do you eat an elephant?  One bite at a time, of course.  But when it seems like the elephant is some sort of cancerous tumor that just keeps on growing, well, you get tired of eating.  You get full.  I can't help it.  Right now, my elephant is growing beyond the rate at which I can chomp.  But not taking bites is not making it stop growing.

And, really, it's not helpful to view your life as a cancerous elephant, even if it doesn't fit nicely into boxes.  To be clear, I do not really see my life that way.

Because I like for things to fit nicely into boxes, I have a few tools to help me try to do that.

- For goals - which I'm thinking of as medium-to-long-term goals - I'm going to use 43 Things.  I do not have 43 goals.  http://www.43things.com/person/julialedesma

- For disciplines - by which I mean daily or weekly habits that I want to integrate - I'm using Joe's Goals:


So, this blog will be used as a gratitude journal, somewhere to chronicle my journey, as well as a place to file reports about the things I am learning as I go.  I might add our lesson plans, I might talk about applying to nursing school, and I might tell you about Mother Teresa or Jewish customs.

It's really for me, and I doubt anyone else will read it, but I hope someone else who might be a little discouraged finds it helpful.

Yum

I needed to use the greens that we picked in the fall that have since been in my deep freeze.  I love Central American food, and the summer sun inspired this dish.

I don't have any pix right now, but next time I make the dish, I will come back and add some.  It is only pretty for a minute after serving.  There's so many colors in it, but then they kind of ... fade.

This is the first recipe I am posting.  My recipes will almost always make a bunch.  I always cook enough to serve for two dinners and two lunches when I cook.  The sides listed below are to serve for only one dinner and one lunch.

Sweet Potato and Turnip Greens
Main dish:
2 tbsp coconut oil (or olive oil if not available)
3 Sweet Potatoes, in chunks
4 Carrots, Chopped
1 tsp cumin
1 tsp chile powder
1 tbsp diced garlic
1 small package fresh portabello mushrooms, diced
2 green bananas, chopped
1 large can diced tomatoes
1 small can mild diced green chiles
1 lb turnip greens
2 green onions
10 ounces frozen mango
1 can coconut milk
1 tbsp sugar
salt to taste

Sides:
2 cups rice
4 red potatoes
1 green onion
1/2 tsp diced garlic
1/4 cup chopped cilantro
2 roma tomatoes
1 avocado, chopped


1.  Cook rice as directed.  Set aside.
2.  Bake potatoes and cut into large chunks. Set aside.
3.  Toss garlic, sweet potatoes, and carrots in oil and saute over medium heat (if using coconut oil) or high heat (if using olive oil) for about 2 minutes.  Coconut oil will cause a lot of smoke, so if there is too much smoke, reduce heat and stir.
4.  Add spices and stir.
5.  Add all remaining ingredients except for greens, stir, and bring to boil.
6. Add greens, do not stir, cover.  Do not reduce heat until mixture has returned to boil.
7.  Simmer over low heat for at least 20 minutes.
8.  In a small bowl, mix diced green onion, garlic, cilantro, and tomato.

To serve, plate rice, then red potatoes, then the main dish, topped with the cilantro salad and avocado.

Enjoy!