Showing posts with label hospitals. Show all posts
Showing posts with label hospitals. Show all posts
Monday, December 30, 2019
Nurse Practitioners and Physicians Behind the 8-Ball
On June 8, 2019, an excellent article was published in the New York Times that clearly stated something I've been thinking about for quite some time. The article was titled, "The Business of Health Care Depends on Exploiting Doctors and Nurses", and the subtitle was "One resource seems infinite and free: the professionalism of caregivers". It was written by Dr. Danielle Ofri, a physician at Bellevue Hospital in New York City.
Monday, August 21, 2017
In the ER.......
The following story was published here on Digital Doorway in July of 2010. The issues of nurse burnout and compassion fatigue have not changed in the last seven years, and this anecdote from the ER is as salient today as ever.
Wednesday, March 06, 2013
Nurses Rising
Nurses are legion. We populate almost every corner of the healthcare industry, and we are the largest segment of the global healthcare workforce. In terms of hands-on care, we're at the bedside, in the home, caring for residents of long-term care facilities, taking care of schoolchildren, ministering to the dying, and tending the wounded on the battlefield. Like I said, we are legion, and our importance to society cannot be underestimated.
Wednesday, October 31, 2012
Magnet Hospital Study Says So Much
A recent study conducted by the University of Pennsylvania School of Nursing shows a dramatically lower mortality rate and better patient outcomes at Magnet hospitals. The authors concluded that these results are largely due to "measured nursing characteristics". It's yet another feather in nurses' (non-existent) caps.
Wednesday, September 19, 2012
Patients and Self-Advocacy
Several recent studies have brought to light some disturbing issues regarding patients, medical providers, and the relationships between them. These studies underscore the importance of positive relationships between patients and providers, and how important it is that healthcare consumers feel empowered to advocate for themselves.
Wednesday, July 18, 2012
Nurses' Occupational Health
This week, Laura Wenger of Practice Greenhealth and The Healthier Hospitals Initiative stated on RN.FM Radio that nurses have the highest rate of occupational asthma in the United States. I was taken aback by this simple statement, and have been thinking about this statistic ever since.
Tuesday, May 29, 2012
Book Review: "The Craft of Compassion at the Bedside of the Ill"
Disclaimer: As always, I received no payment for this book review, only a copy of the book from the author in order to facilitate the writing of this post.
"The Craft of Compassion at the Bedside of the Ill" is a poetic and moving discourse on compassion by nurse, author and medicine man Michael Ortiz Hill. In this stirring book, Mr. Hill presents his view of compassion as a craft that can be learned, honed and developed, a notion that many in the nursing and medical fields would be wise to heed.
"The Craft of Compassion at the Bedside of the Ill" is a poetic and moving discourse on compassion by nurse, author and medicine man Michael Ortiz Hill. In this stirring book, Mr. Hill presents his view of compassion as a craft that can be learned, honed and developed, a notion that many in the nursing and medical fields would be wise to heed.
Friday, May 25, 2012
Nursing, NPR, and Where to Go From Here
Nurses and nursing are consistently in the news these days, and with issues surrounding health care continuing to come to a boil in the U.S. and elsewhere, we can expect more stories that include nurses to bubble to the top.
Friday, April 27, 2012
"Googling" Our Workplaces?
It seems to be common knowledge these days that employees at places like Google, Apple and other Silicon Valley success stories enjoy perks that many of us in the healthcare industry can only dream of. Even other companies---like biotechs and others---have learned that small perks can go a long way toward employee well-being and morale. Why don't we healthcare workers---who save lives every day---enjoy even a fraction of these sorts of benefits?
Tuesday, March 20, 2012
Nurses Need Support
The more nurses I talk to, whether in my clinical nursing work or as a coach for nurses, it's increasingly obvious to me that nurses simply need support. While "Nurses Day" and the accompanying flowers, buttons and pens may be nice gestures, Nurses Day and other such celebrations would mean a whole lot more if meaningful support---not platitudes---were offered to nurses who so desperately need it.
Sunday, December 05, 2010
Cold Comfort
Recently visiting my father in the hospital and participating in his transfer to an acute rehab facility, it brought home the ironic fact that hospitals and other inpatient facilities are often the last places where one would want to be in order to recuperate from illness.
Although hospitals offer an essential service, they can often be comfortless, cold and unwelcoming places that are polluted with noise, unnecessarily bright lights, the constant interruption of patients' desire to rest, and a dizzying array of providers with whom patients sometimes have little or no personal connection as they are poked, prodded and otherwise examined.
Observing my father in his room in the rehab facility, the first thing I noticed was the fact that he was being constantly barraged by noise that intruded on his well-being and his ability to rest. Staying in a two-person room, a patient is always subject to the vicissitudes of having a roommate, and my father was unlucky enough to be at the mercy of his roommate's intermittent groans of pain and complaint, and also the high volume of his television that was on from the moment he woke up in the morning until he turned out the light at bedtime.
To add insult to injury, nurses and aides laughed and talked loudly in the hallway, carts with squeaky wheels were pushed down the hallways at all hours, and intercoms and buzzers continuously added to the nauseating medical din.
My father, sitting with his head in his hands, accepted the offer of foam earplugs procured from the nurses station, but they sadly did little to block out the constant noise that infiltrated his world and rattled his already troubled brain. The poor guy just wanted to rest, and the very facility promising him "healing" offered an environment completely unsuited to that end.
In my mind, most hospitals, nursing homes and health facilities are built with the convenience and ease of its employees in mind. While the physical layout does indeed need to take the efficiency of health care delivery into consideration, the lack of consciousness around patient comfort is nothing short of appalling.
When it comes to noise pollution, every patient bed should be equipped with wireless (or wired) headphones connected to the television, eliminating the cacophony of two televisions tuned to different channels blaring simultaneously in every room.
Next, every cart and wheeled conveyance used in a health care facility should have the most state-of-the-art solid rubber wheels that provide the most silent movement possible. From mop buckets to gurneys, wheels should be as silent as a whisper.
Regarding nurses and other staff, voices should be as quiet as possible, and while laughter and joviality provide for a more lighthearted work environment, I have observed that many staff frequently seem oblivious to the fact that their place of work is also a place where patients come for rest and healing. Staff do not need to take a vow of silence, but conversational voices can convey information more readily and efficiently than raised voices loud enough to wake the dead.
And then there are the lights and the environment. Where are the full-spectrum bulbs, skylights, picture windows, fountains, options for soothing music, and views of the outdoors that are conducive to healing? Why are rooms not designed in a manner wherein each looks in upon a central courtyard of beauty? Where is the research on the use of color and light to induce a feeling of calm? So many hospital walls are adorned with awful colors reminiscent of the dull and uninspiring hues of vomitus and stale urine. Hospitals are not meant to be prisons.
Watching my father react to the noise, interruptions, bright lights and cheerlessness of the hospital and rehab facility, I was struck by the readily visible fact that many facilities simply ignore the creature comforts of patients, creating environments that neither inspire nor engender restful recovery. Feeling powerless to help him to be more comfortable, my visit came to an end, and it was little comfort leaving my poor sick father at the mercy of an environment ill-suited to his overall well-being.
While there are indeed some superlative hospitals out there that embody the very heart of the nature of the healing environment, most mainstream hospitals offer a pedestrian and uninspiring atmosphere that does little to assist the sick in their process of recovery. Those hospitals that do provide optimal care and a healing environment should be held up as an example to those who simply take the path of least resistance.
Leaving my father sitting alone in that rehab was one of the hardest things I have ever done, and I hope to never again be in the position to leave someone behind who is receiving care in a facility in which I do not have the utmost confidence. While there was one nurse who took a special interest in my dad, that was cold comfort in light of the suffering that he was experiencing, and I'll sleep better when he is safe and sound in his own home once again.
Although hospitals offer an essential service, they can often be comfortless, cold and unwelcoming places that are polluted with noise, unnecessarily bright lights, the constant interruption of patients' desire to rest, and a dizzying array of providers with whom patients sometimes have little or no personal connection as they are poked, prodded and otherwise examined.
Observing my father in his room in the rehab facility, the first thing I noticed was the fact that he was being constantly barraged by noise that intruded on his well-being and his ability to rest. Staying in a two-person room, a patient is always subject to the vicissitudes of having a roommate, and my father was unlucky enough to be at the mercy of his roommate's intermittent groans of pain and complaint, and also the high volume of his television that was on from the moment he woke up in the morning until he turned out the light at bedtime.
To add insult to injury, nurses and aides laughed and talked loudly in the hallway, carts with squeaky wheels were pushed down the hallways at all hours, and intercoms and buzzers continuously added to the nauseating medical din.
My father, sitting with his head in his hands, accepted the offer of foam earplugs procured from the nurses station, but they sadly did little to block out the constant noise that infiltrated his world and rattled his already troubled brain. The poor guy just wanted to rest, and the very facility promising him "healing" offered an environment completely unsuited to that end.
In my mind, most hospitals, nursing homes and health facilities are built with the convenience and ease of its employees in mind. While the physical layout does indeed need to take the efficiency of health care delivery into consideration, the lack of consciousness around patient comfort is nothing short of appalling.
When it comes to noise pollution, every patient bed should be equipped with wireless (or wired) headphones connected to the television, eliminating the cacophony of two televisions tuned to different channels blaring simultaneously in every room.
Next, every cart and wheeled conveyance used in a health care facility should have the most state-of-the-art solid rubber wheels that provide the most silent movement possible. From mop buckets to gurneys, wheels should be as silent as a whisper.
Regarding nurses and other staff, voices should be as quiet as possible, and while laughter and joviality provide for a more lighthearted work environment, I have observed that many staff frequently seem oblivious to the fact that their place of work is also a place where patients come for rest and healing. Staff do not need to take a vow of silence, but conversational voices can convey information more readily and efficiently than raised voices loud enough to wake the dead.
And then there are the lights and the environment. Where are the full-spectrum bulbs, skylights, picture windows, fountains, options for soothing music, and views of the outdoors that are conducive to healing? Why are rooms not designed in a manner wherein each looks in upon a central courtyard of beauty? Where is the research on the use of color and light to induce a feeling of calm? So many hospital walls are adorned with awful colors reminiscent of the dull and uninspiring hues of vomitus and stale urine. Hospitals are not meant to be prisons.
Watching my father react to the noise, interruptions, bright lights and cheerlessness of the hospital and rehab facility, I was struck by the readily visible fact that many facilities simply ignore the creature comforts of patients, creating environments that neither inspire nor engender restful recovery. Feeling powerless to help him to be more comfortable, my visit came to an end, and it was little comfort leaving my poor sick father at the mercy of an environment ill-suited to his overall well-being.
While there are indeed some superlative hospitals out there that embody the very heart of the nature of the healing environment, most mainstream hospitals offer a pedestrian and uninspiring atmosphere that does little to assist the sick in their process of recovery. Those hospitals that do provide optimal care and a healing environment should be held up as an example to those who simply take the path of least resistance.
Leaving my father sitting alone in that rehab was one of the hardest things I have ever done, and I hope to never again be in the position to leave someone behind who is receiving care in a facility in which I do not have the utmost confidence. While there was one nurse who took a special interest in my dad, that was cold comfort in light of the suffering that he was experiencing, and I'll sleep better when he is safe and sound in his own home once again.
Sunday, September 14, 2008
I Did It
Well, I did it. After twelve years of eschewing taking a job in a hospital, I have applied for a part-time position in a local inpatient psychiatric unit. Things have been very slow at all of my per diem jobs, and while I'm very hesitant at this juncture to commit to a solid position, finances are telling me that it may be time to at least have 16 or 20 hours of assured work each week. So, this 24-hour per week position consisting of two 12-hour shifts may fit the bill.
Although I swore off the dreaded "two years of Medical-Surgical nursing after graduation" (something I was told at the time was professional suicide), I just recently decided to apply for this position as a stop-gap measure at a time when I am need of more regular work. Granted, I have been quite determined in my anti-hospital stance, but working in a psychiatric milieu is a far cry from the rigors of Med-Surg, and since I've done such a great deal of outpatient psychiatric nursing, perhaps it's high time I take a peek "on the inside".
Anyway, I haven't even had a call back for an interview yet, so please stay tuned for the developments vis-a-vis this interesting turn of events.
Although I swore off the dreaded "two years of Medical-Surgical nursing after graduation" (something I was told at the time was professional suicide), I just recently decided to apply for this position as a stop-gap measure at a time when I am need of more regular work. Granted, I have been quite determined in my anti-hospital stance, but working in a psychiatric milieu is a far cry from the rigors of Med-Surg, and since I've done such a great deal of outpatient psychiatric nursing, perhaps it's high time I take a peek "on the inside".
Anyway, I haven't even had a call back for an interview yet, so please stay tuned for the developments vis-a-vis this interesting turn of events.
Sunday, December 09, 2007
Psychiatric Units: The Next Extreme Makeover?
Making a visit to a friend in a psychiatric ward reminds me of everything a psych unit should be and generally is not. Ostensibly places where individuals in need of respite and psychological support are sent for “healing”, all of the units which I have visited generally lack every amenity which I would consider necessary for the creation of a truly healing environment. From the institutional colors of the walls to the utter lack of homey touches denoting any notion of soul, most psychiatric units still seem to lack the humanistic qualities that readily foster recovery, wellness, and normalcy. Hospitals---whether they be psychiatric or otherwise---sorely lack the amenities and cutting edge philosophies which could actually create truly healing environments.
In the unit which I recently visited, there is the poorly named “Relaxation Room”. Here, I was not surprised to find institutional furniture (what else could there be?), one bright fluorescent light fixture in the ceiling, and a maddeningly lame collection of plastic bins desultorily littered with colored beads, dry white rice (for “tactile stimulation”), an empty bottle of bubbles, and other detritus perhaps thought to have therapeutic and “crafty” benefits. In said relaxation room, there was no source of music. In an effort to create a sense of relaxation, one entire wall was covered with an enormous piece of wallpaper showing a life-size beach scene in a useless attempt to give the individual “relaxing” in the room a sense of being at the seaside. Two deflated bean-bag chairs sat lazily collapsed against the wall. The room is anything but relaxing. It feels more like a glorified closet, a dubious afterthought of pretend holism.
What might there be in a true “Relaxation Room”? A fountain. A selection of ambient, classical, and other calming music. A video monitor on the wall from which the patient can choose various nature scenes to watch and meditate on. Full-spectrum lighting and/or therapeutic lighting. Inspirational books written by spiritual leaders and others who offer words of comfort, solace, and empowerment. Meditation cushions. Clean and soft carpeting for doing yoga or stretching.
On a psychiatric unit, where can patients spend time? In the tiny “Relaxation Room”? A non-descript and highly uncomfortable “dining room” with hard wooden chairs and tables? Where is the exercise room, complete with yoga mats, exercise balls, and other non-threatening materials without sharp edges or other risk factors. Where can a patient really work off some steam? Where does one go to run, or to roll on the floor and stretch? How can physical health and fitness be so utterly overlooked when restoration of health is so paramount?
As for food, why can’t it be served “family style” at a long table, where patients sit together and pass food back and forth from serving dishes, fostering community, interaction, and socialization? Why must everyone receive their individualized institutional tray and sit---isolated and disconnected---as they “nourish” themselves?
Where is the garden? Where are the full-spectrum lights which studies have shown can counteract the ravages of Seasonal Affective Disorder? Where are the inspiring books, DVDs, and magazines? Where are the “healing clowns”, visiting musicians, poets and artists? Where are the plants and the stuffed animals? Where, dammit, is the comfort?
The “kitchen”, open for “nourishment” and snacks, sports Salada tea, tepid water, coffee, and crackers. Where is the fresh fruit? What nutritional choices are there other than sugar, caffeine and white flour? Where are the foods that truly nourish the soul, appease the appetite, and provide some modicum of sensual stimulation and satisfaction?
The most notable evolution vis-a-vis providing radically different environments within a hospital setting is the birthing room. Expecting parents have demanded that birthing suites and maternity wards within hospitals be designed in a way which provides the comforts of home within a hospital setting. This vocal and relatively affluent group has brought about enormous and revolutionary change vis-a-vis the nature of the birthing environment. Families in labor now ensconce themselves in wood-paneled suites with king-size, four-poster beds, birthing tubs, and numerous amenities meant to provide the laboring mother and her spouse and family a comfortable and home-like environment in which to undergo the process of birth. This is revolutionary, yet this revolution has not moved beyond the walls of maternity centers, and perhaps the psychiatric units are the next frontier in need of an “extreme makeover”.
I am sure that somewhere in this country (but more likely in Europe), there exist psychiatric institutions wherein humanism and holism are paid more than just lip service. For now, the majority of psychiatric institutions in this country are most likely similarly sterile and devoid of simple yet effective changes which could lend themselves to providing a much more pleasant, healing, and effective therapeutic environment.
In the end, money talks. Birthing is big business, and hospitals compete for families and continually try to outdo one another with their “birthing packages”, offering home-like experiences for deserving and demanding (and affluent) families who want a special birthing experience within the safety of a hospital.
As for the psychiatric patients, who will advocate for their experience of improved therapeutic environments? Will the families of those who need in-patient psychiatric treatment band together and flex their economic muscle, demanding change and improvement? Or perhaps there is a Victorian-era austerity or Dickensian horror which we collectively feel is still appropriate for those experiencing “madness”. Do we still negatively label those struggling with mental illness or extreme states of mind? Do we judge those who have attempted suicide as undeserving of a beautiful, calming, and truly healing environment?
Recovery from attempted suicide, mania, major depression, affective disorders, thought disorders or personality disorders can be a life-long process. Some never fully recover and must utilize psychiatric units as if they were equipped with revolving doors. If many of our most vulnerable citizens need to visit such places, why do we hesitate to offer them the most healing and supportive environments that we can? This is not just a medical question. It is moral question. And if this question was part of a pass or fail test, we would long ago have failed quite miserably.
In the unit which I recently visited, there is the poorly named “Relaxation Room”. Here, I was not surprised to find institutional furniture (what else could there be?), one bright fluorescent light fixture in the ceiling, and a maddeningly lame collection of plastic bins desultorily littered with colored beads, dry white rice (for “tactile stimulation”), an empty bottle of bubbles, and other detritus perhaps thought to have therapeutic and “crafty” benefits. In said relaxation room, there was no source of music. In an effort to create a sense of relaxation, one entire wall was covered with an enormous piece of wallpaper showing a life-size beach scene in a useless attempt to give the individual “relaxing” in the room a sense of being at the seaside. Two deflated bean-bag chairs sat lazily collapsed against the wall. The room is anything but relaxing. It feels more like a glorified closet, a dubious afterthought of pretend holism.
What might there be in a true “Relaxation Room”? A fountain. A selection of ambient, classical, and other calming music. A video monitor on the wall from which the patient can choose various nature scenes to watch and meditate on. Full-spectrum lighting and/or therapeutic lighting. Inspirational books written by spiritual leaders and others who offer words of comfort, solace, and empowerment. Meditation cushions. Clean and soft carpeting for doing yoga or stretching.
On a psychiatric unit, where can patients spend time? In the tiny “Relaxation Room”? A non-descript and highly uncomfortable “dining room” with hard wooden chairs and tables? Where is the exercise room, complete with yoga mats, exercise balls, and other non-threatening materials without sharp edges or other risk factors. Where can a patient really work off some steam? Where does one go to run, or to roll on the floor and stretch? How can physical health and fitness be so utterly overlooked when restoration of health is so paramount?
As for food, why can’t it be served “family style” at a long table, where patients sit together and pass food back and forth from serving dishes, fostering community, interaction, and socialization? Why must everyone receive their individualized institutional tray and sit---isolated and disconnected---as they “nourish” themselves?
Where is the garden? Where are the full-spectrum lights which studies have shown can counteract the ravages of Seasonal Affective Disorder? Where are the inspiring books, DVDs, and magazines? Where are the “healing clowns”, visiting musicians, poets and artists? Where are the plants and the stuffed animals? Where, dammit, is the comfort?
The “kitchen”, open for “nourishment” and snacks, sports Salada tea, tepid water, coffee, and crackers. Where is the fresh fruit? What nutritional choices are there other than sugar, caffeine and white flour? Where are the foods that truly nourish the soul, appease the appetite, and provide some modicum of sensual stimulation and satisfaction?
The most notable evolution vis-a-vis providing radically different environments within a hospital setting is the birthing room. Expecting parents have demanded that birthing suites and maternity wards within hospitals be designed in a way which provides the comforts of home within a hospital setting. This vocal and relatively affluent group has brought about enormous and revolutionary change vis-a-vis the nature of the birthing environment. Families in labor now ensconce themselves in wood-paneled suites with king-size, four-poster beds, birthing tubs, and numerous amenities meant to provide the laboring mother and her spouse and family a comfortable and home-like environment in which to undergo the process of birth. This is revolutionary, yet this revolution has not moved beyond the walls of maternity centers, and perhaps the psychiatric units are the next frontier in need of an “extreme makeover”.
I am sure that somewhere in this country (but more likely in Europe), there exist psychiatric institutions wherein humanism and holism are paid more than just lip service. For now, the majority of psychiatric institutions in this country are most likely similarly sterile and devoid of simple yet effective changes which could lend themselves to providing a much more pleasant, healing, and effective therapeutic environment.
In the end, money talks. Birthing is big business, and hospitals compete for families and continually try to outdo one another with their “birthing packages”, offering home-like experiences for deserving and demanding (and affluent) families who want a special birthing experience within the safety of a hospital.
As for the psychiatric patients, who will advocate for their experience of improved therapeutic environments? Will the families of those who need in-patient psychiatric treatment band together and flex their economic muscle, demanding change and improvement? Or perhaps there is a Victorian-era austerity or Dickensian horror which we collectively feel is still appropriate for those experiencing “madness”. Do we still negatively label those struggling with mental illness or extreme states of mind? Do we judge those who have attempted suicide as undeserving of a beautiful, calming, and truly healing environment?
Recovery from attempted suicide, mania, major depression, affective disorders, thought disorders or personality disorders can be a life-long process. Some never fully recover and must utilize psychiatric units as if they were equipped with revolving doors. If many of our most vulnerable citizens need to visit such places, why do we hesitate to offer them the most healing and supportive environments that we can? This is not just a medical question. It is moral question. And if this question was part of a pass or fail test, we would long ago have failed quite miserably.
Sunday, November 04, 2007
Daylight Dawns
Daylight dawns on Sunday morning after spending the night in ICU tending to my mother-in-law. The paradoxes of a hospital stay abound. Throughout the day yesterday, she was encouraged to stay awake all day in order to reprogram her brain to get sleepy at night. So, we did our best to stimulate her during the day and keep her from sleeping too much.
And then arrives the night shift. Settled intermittently in a marginally comfortable lounge chair next to her bed, I observe throughout the night how ICU is anything but restful. Noisy carts are pushed up and down the halls at all hours----shouldn't they have silent rubber wheels? The patients' sleep is interrupted almost hourly: phlebotomy, respiratory therapy, blood pressure, medications, portable chest x-rays. Nurses and therapists come and go, some chatting loudly as they enter the room. A long night is made more exhausting by the irony of turning the clocks back one hour at 2am. A long night made longer.
As for me, I can make myself comfortable enough, but the constant interruptions, beeping monitors, nurses bustling in and out, noisy carts in the hallway---it's enough to drive one 'round the bend.
In one of our chats in the wee hours, my sweet mother-in-law and I joke about how much patience it takes to be a patient, and how little rest one gets in the hospital. I remark about how she was forced to stay awake during the day, only to be tortured throughout the night at the moment she had fallen asleep. She's not amused.
If I wasn't so tired, it would be funny. For now, the irony will have to do. One comes to the hospital for healing, but the nature of the hospital environment denies one the rest one so desires and needs. Oh, the irony of it all!
And then arrives the night shift. Settled intermittently in a marginally comfortable lounge chair next to her bed, I observe throughout the night how ICU is anything but restful. Noisy carts are pushed up and down the halls at all hours----shouldn't they have silent rubber wheels? The patients' sleep is interrupted almost hourly: phlebotomy, respiratory therapy, blood pressure, medications, portable chest x-rays. Nurses and therapists come and go, some chatting loudly as they enter the room. A long night is made more exhausting by the irony of turning the clocks back one hour at 2am. A long night made longer.
As for me, I can make myself comfortable enough, but the constant interruptions, beeping monitors, nurses bustling in and out, noisy carts in the hallway---it's enough to drive one 'round the bend.
In one of our chats in the wee hours, my sweet mother-in-law and I joke about how much patience it takes to be a patient, and how little rest one gets in the hospital. I remark about how she was forced to stay awake during the day, only to be tortured throughout the night at the moment she had fallen asleep. She's not amused.
If I wasn't so tired, it would be funny. For now, the irony will have to do. One comes to the hospital for healing, but the nature of the hospital environment denies one the rest one so desires and needs. Oh, the irony of it all!
Subscribe to:
Posts (Atom)