Sunbelt Staffing » Nursing

Disclosing Medical Errors: A Nurse’s Role

Howard Gerber — Thu, 26 Jan 2012 11:16:33 +0000

Everyone makes mistakes in their personal life and in their professional life. This is true for all people in all professions. However, it is more important when a mistake is made in the field of medicine because it can result in the death of a patient. It can be scary to admit to someone that you have made a mistake, and terrifying if that mistake may have negatively affected their health. However, it is one of the most important parts of a nurse’s job.

Follow Procedure

If you have never made a mistake on the job, you have been very lucky. As with any run of luck, it won’t last. When it does happen, it is important to follow the procedures put in place by your facility. They are in place to help patients, staff, and the facility. Each facility has different protocols, so be sure to learn what you are supposed to do as soon as possible. While it can be overwhelming to keep up with all of the administrative tasks and procedure policies, it is important to keep this information where it is easily accessible. This will help protect all concerned parties. If you are unsure of current policy, ask your immediate supervisor. If you find it difficult to obtain exact information on what you should do, consider talking to you safety board or human resources contact and suggesting a review on procedures for the entire staff.

Learning from Mistakes

Aside from the importance of correcting any errors as soon as possible to minimize the negative impact on patient health, medical professionals can learn from each other’s mistakes. When errors are reported they are monitored, and when the same mistake is seen repeatedly, standard procedures may change to prevent that mistake from happening in the future. If nurses fail to report these mistakes it is almost certain they will continue to happen.

Legal Concerns

You may be worried that you will lose your job or face legal consequences if you disclose an error. While it is certainly possible, following the procedures outlined by your medical facility will minimize this. You must be empathetic to the patients but before speaking to the patient or family about an error, be sure you know what you are and are not allowed to say. Even if you do face legal consequences or the loss of the job, it is still your duty to report the error.

Have you ever had to disclose a medical error? Did you see changes put into place because of your report?

Disclosing Medical Errors: A Nurse’s Role is a post from: Sunbelt Staffing

Postpartum Depression

Howard Gerber — Thu, 05 Jan 2012 13:00:53 +0000

Postpartum depression (PPD) is not just a little bit of sadness after a baby is born that is the result of hormone levels returning to normal, although that can certainly be the case for some women. For some women, though, it is a debilitating depression that can last for months or years after the birth of the baby, putting both mother and baby in danger. There are three different levels, all of which are related to postpartum depression: baby blues, postpartum depression, and postpartum psychosis.

Symptoms

The symptoms of postpartum depression vary in intensity and severity. Often, postpartum depression will first present with symptoms similar to a milder form of depression known as “the baby blues.” Baby blues may resolve on its own and is more common than the other forms. Postpartum depression is more intense and can last for years, if left untreated. Postpartum psychosis is the most debilitating form of mental illness found after the birth of a child, and usually develops within the first few weeks after giving birth.

Baby Blues/ Early Postpartum Depression

Anxious
Crying
Difficulty concentrating
Irritable
Mood swings
Sad
Trouble falling asleep

Postpartum Depression

Anger
Decreased appetite
Decreased sex drive
Excessive fatigue
Extreme mood swings
Feelings of guilt, shame, inadequacy
Hopelessness
Inability to bond with the baby
Insomnia
Irritability
Thoughts of harming the baby or self
Withdrawal from family and friends

Postpartum Psychosis

Attempting to hurt self
Attempting to hurt the baby
Confusion
Delusions
Disorientation
Hallucinations
Paranoia

Treatments

Baby blues do not usually need treatment, as the issues will resolve naturally over the course of several weeks. Sleep, assistance caring for the baby, social interaction, and avoiding alcohol can all help reduce symptoms. Postpartum depression usually requires counseling and medication to resolve issues. Medications may include antidepressants or hormone therapy. With treatment, symptoms may resolve within a few months, but it is possible they could linger for more than a year. It is important that treatment not end too soon, as it could lead to a relapse.

Postpartum psychosis must be treated immediately and may require the mother be hospitalized. A combination of therapy and medications are used to treat postpartum psychosis. Medications may include antidepressants, as well as mood stabilizers and antipsychotics.

All forms of postpartum depression are difficult for most women to talk about – or even think about. It is the time in their lives when they feel they are supposed to be happiest. Likely, their family and friends will be expecting them to be joyful, and the mother may not know how to share how she is feeling for fear of disappointing them or seeming like a bad mother. It is especially important that the healthcare providers who are around the mother during this time take the time to find out if she is experiencing any of the postpartum depression symptoms so she can receive the care she needs.

How have you helped educate new mothers about the various forms of postpartum depression? Do you find that some mothers are relieved to know what is happening to them or are the majority offended that you’ve questioned the joy their child has brought?

Postpartum Depression is a post from: Sunbelt Staffing

Motivating Physical Therapy Patients

Howard Gerber — Tue, 03 Jan 2012 13:00:28 +0000

Physical therapists are heroes and villains in the story of recovery. At first, they are the villains of the story because they make the patient hurt more. The patient has dutifully been “taking it easy” for a bit after their surgery or accident and they have begun to feel a smidge better. Then they are suddenly being asked to bend, stretch, and move in ways that make the pain come back tenfold. This is, of course, a necessary component in healing and regaining full motion – but it still hurts. Usually it isn’t too terribly hard to motivate a patient to come back for their therapy appointments during this initial stage because it is all too obvious that they desperately need help to get back to their pre-injury state. However, motivating the patient to complete their exercises at home can be quite the challenge. The task of motivation becomes even more challenging once the initial phase of therapy is over and the time for maintenance begins.

At Home

While the patient is in your office, you can use a mixture of the good cop/bad cop routine. But what about once they walk out of your office and need to do their exercises at home to get ready for the next appointment? Many patients think they don’t really need to complete all of those exercises, or that you won’t notice if they don’t, or that they don’t have enough time, or any other number of reasons that prevent them from doing what they need to do at home to get better. How do you make sure they follow through?

First, make it as easy to do as possible. Give them cues that will jog their memory and remind them it is time to exercise. Suggest they do their exercises with part of their daily routine such as brushing their teeth, taking a shower, eating a meal, or even going to the bathroom. If they do several small exercises at each of these daily activities, they will have worked in their physical therapy exercises without having to “find time” each day to do them.

Next, make sure they know how to do each of their home exercises completely before letting them leave the first day. If you wait until the end of their session to hand them a flyer and quickly review it, they may say they understand even if they are mostly unclear. Consider yourself a teacher and the patient your student. How many students really ask questions if they don’t understand and want to get out of the classroom? By showing them their “homework” at the beginning of the session and walking them through each exercise, they are more likely to remember the correct method and follow through during the week.

Maintenance

By the end of your therapy relationship, you will know that your patient understands the importance of his or her therapy and how to complete the exercises you have prescribed. What you will not know is if the patient has the motivation to do so. Have you ever heard someone say a picture is worth a thousand words? Find a picture, video, or patient with a similar injury who did not complete their maintenance to show or introduce to your patients. It will likely take years of practice to accumulate samples for a variety of injuries, but you can enlist the help of fellow therapists and doctors to create a database. Show your patients just how badly their recovery can go if they don’t follow through. It is much easier to believe what you are shown than what you are told.

How do you motivate your physical therapy patients?

Motivating Physical Therapy Patients is a post from: Sunbelt Staffing

Seasonal Affective Disorder

Howard Gerber — Thu, 29 Dec 2011 13:00:14 +0000

Seasonal affective disorder is aptly referred to as SAD, because the people suffering from the disorder often diagnose themselves as being simply sad at first. While there are variations of seasonal affective disorder that affect people during the spring and summer, most cases begin sometime in the fall and last throughout the winter with symptoms finally subsiding in the spring.

Symptoms

Symptoms of fall and winter seasonal affective disorder include:

Anxiety
Changes in appetite, particularly cravings for carbohydrates
Decrease of energy
Depression
Difficulty focusing
Excessive sleeping
Feelings of hopelessness
Heavy feeling of the legs or arms
Loss of enthusiasm in previously enjoyable activities
Weight increase
Withdrawal

Causes

No specific cause has been discovered for seasonal affective disorder, however, as with other mental health issues it is likely that age, genetics, and chemical makeup all play a part. There are some indications that melatonin and serotonin levels may play a role as well as the individual’s circadian rhythm.

Tests

Seasonal affective disorder can be quite difficult to diagnose as it closely mimics other forms of depression. While there is no medical test for SAD, tests and exams can be used to rule out other causes for the depression. Certain criteria do have to be met for a diagnosis of seasonal affective disorder to be made which include:

Symptoms are followed by periods that are symptom free.
Symptoms cannot be explained by other means.
Symptoms occur during the same season for a minimum of two consecutive years.

Treatments

Light therapy, medications, and psychotherapy are the most common treatments. Light therapy is usually the first treatment, because there are virtually no side effects. Some antidepressants have been used to successfully treat seasonal affective disorder. Psychotherapy can help make people more aware of what is happening to them and help them learn to deal with the symptoms, although it is unlikely to actually alleviate the symptoms. In extreme cases, people have been known to move from areas that experience drastic changes in the winter to areas that have much milder winters. Although it is possible for people to suffer with seasonal affective disorder in sunnier areas, such as Florida, it is much less common.

How to Help

Many people will suffer in silence thinking they simply have the holiday blues or that they are having a few bad weeks. Be sure to advertise the symptoms associated with the disorder to bring awareness to a larger group of people. Many people may be relieved to know that there is something wrong with them that can be treated and that other people feel the same way.

Have you treated a patient with seasonal affective disorder? What treatments have you found to be most effective?

Seasonal Affective Disorder is a post from: Sunbelt Staffing

Pulmonary Nursing

Howard Gerber — Thu, 01 Dec 2011 13:00:17 +0000

Pulmonary nursing, also known as respiratory nursing, is one of the many specialties available to nurses. Choosing a specialty is a great choice for those who really love a specific field. It can also be a good way to find higher paying positions.

Job Expectations

A pulmonary nursing specialist will work with individuals undergoing pulmonary care. Patients with any sort of problem with the respiratory system or lungs may enter into their care. Diseases that affect these areas of the body include asthma, tuberculosis, cystic fibrosis, emphysema, and pneumonia.

Experience and Education

The only way to become a pulmonary care nurse is to first be a registered nurse. For those still in nursing school, focus on the classes that center around respiratory care. Once degree work has been completed students will need to pass the NCLEX-RN. Look for positions that offer experience in the respiratory field to help move into the field permanently.

Outlook

In the next decade the need for registered nurses is projected to increase. As the population ages, the need for pulmonary care specialists will grow as well making this an excellent specialty to consider.

Environments

There a number of areas a nurse specializing in pulmonary care can work such as doctor’s offices, hospitals, rehabilitation centers, and nursing homes. Allergy and asthma specialists have a special need for pulmonary nurses to help as they diagnose and treat their patients. Nursing homes are filled with patients who have difficulty breathing for a variety of reasons and nurses in this field must be well versed in respiratory treatments. There are also positions overseeing transplants and clinical trials.

Associations and Social Media

The primary association for pulmonary nurses within the United States is the Respiratory Nursing Society. They offer a wide range of professional development opportunities and a chance for colleagues to network. The counterpart in the United Kingdom is the Association of Respiratory Nurse Specialists who provides continuing education opportunities, host conferences, and make networking within the profession easier.

Twitter has several accounts worth following if you are interested in pulmonary care.

@PulmonaryReview This account is maintained by the Pulmonary Reviews publication, an invaluable resource for physicians and those who specialize in pulmonary care. The account is updated several times a week.

@RTmagazine This account is maintained by RT, a respiratory care publication. The account is updated several times a day.

@ADVANCERespCare This account is maintained by the free trade publication, ADVANCE for Respiratory Care & Sleep Medicine.

Are you a pulmonary nurse or are you interested in specializing in this field? If so, what made you decide on this field?

Pulmonary Nursing is a post from: Sunbelt Staffing

World Mental Health Day

Howard Gerber — Thu, 27 Oct 2011 13:00:35 +0000

World Mental Health Day is celebrated annually on October 10. The holiday is supported by the World Health Organization and the United Nations, and is designed to increase the public’s awareness and understanding of mental health issues around the world.

School

It can be very hard to discuss mental health in a school setting. Teachers often feel there is a stigma associated with mental health issues such as depression or anxiety and choose not to share any personal struggles for fear of professional disciplinary consequences. Students will often self-medicate with drugs or alcohol in order to deal with depression, anxiety, bullying, or social awkwardness. School therapists can utilize this day as an opportunity to bring in speakers to discuss depression, anxiety, drug and alcohol abuse, and healthy ways to improve one’s mental health. Be sure to offer faculty members workshops and speakers during planning periods, lunch, and before and after school so they have a chance to meet with speakers as well. Partner with local mental health professionals that accept the school’s medical insurance and create a brochure listing them and their specialties to place in the teacher’s mail boxes.

Pharmacy

Unfortunately, mental illness is still seen as taboo. People suffering from depression, anxiety disorders, and even chemical imbalances often do not seek help because they feel they should be able to “figure it out on their own.” One way pharmacists can raise awareness of the importance of mental health is to discuss the various medications and the conditions they are intended to treat. By creating a public dialogue about mental health, pharmacists may be able to encourage individuals to be more conscious of their own mental health status and become aware of options designed to improve their mental health. Contact manufacturers of antidepressants and anti-anxiety medications for displays about their product and the conditions they treat. Include a display with contact information for local therapists, psychiatrists, psychologists, and support groups. Put the display up on the 10^th and leave it up for the entire week to reach a greater audience.

Health Professionals

If you are a nurse of a physical therapist you too can help raise awareness about mental health issues. Both professions often work with people who are suffering from chronic pain or who have had a severe trauma or accident. While these clients may be receiving the medical care they need to treat their physical injuries they may not even be aware that their mental health needs to be addressed as well. Put a display in the waiting room that proclaims the importance of mental health as well as physical health and the warning signs that chronic pain may be negatively affecting their mental health. Include the names and phone numbers of pain management groups, support groups, and mental health professionals in the area.

World Mental Health Day is a post from: Sunbelt Staffing

So you Want to be a Perioperative Nurse

Howard Gerber — Wed, 05 Oct 2011 13:00:35 +0000

How many people have watched hospital dramas on television like ER or Grey’s Anatomy and wondered what it would be like to work in a high energy hospital setting? Probably most of the people watching the shows, but they are probably thinking about being the doctor or surgeon. The background cast of nurses and orderlies are hardy a blip on the radar. This can even be true when patients are in the operating room or emergency room. Everyone is focused on the physician, but without the nurses just how much would get done?

A perioperative nurse is one who has been specifically trained to work with surgeons and the medical team within the operating room environment. They are an integral part of the surgical team. It is a demanding and rewarding career in a high energy environment. There are several perioperative nursing positions including circulator, scrub, patient educator, and RNFA.

Circulator Nurse

A circulator nurse manages the patient’s care while in the operating room, as well as the needs of the attending surgical team. The circulator nurse maintains overall perspective of the environment and does not usually assist directly with the surgery.

Scrub Nurse

The reason most people call a perioperative nurse a scrub nurse is because they scrub in. He or she uses the same soap and sterile garments as the physicians so they are able to work within the operative field and assist in the surgery. They hand the sterile instruments to the physician as they are called for and may assist in monitoring the condition of the patient.

Patient Educator

A patient educator works with the patient and the family to provide information prior to the surgery to allow them to make informed decisions. This role is filled by a registered nurse with experience in surgical cases.

RNFA

An RNFA, or Registered Nurse First Assistant, is a nurse who has gone through additional surgical training. The RNFA assists by controlling bleeding during the procedure, using medical devices, cutting tissue, and suturing. An RNFA may also be instrumental in patient care before or after the procedure.

Environment

Perioperative nurses are not relegated to hospital operating rooms. They may also work in outpatient surgery centers or in the office of a physician who performs procedures on site. Other health care facilities such as health departments and emergency care centers may also employ perioperative nurses.

Many nurses find once they begin working in a hospital setting that they want to delve further into a specialty. Surgical nurses are no different. Have you found a home in the OR? Do you love working in a surgical environment? What advice do you wish someone had given you before you became a perioperative nurse? What would you tell a nurse new to this specialty?

So you Want to be a Perioperative Nurse is a post from: Sunbelt Staffing

Using Vestibular Swings for Your Patients

Howard Gerber — Tue, 27 Sep 2011 13:00:44 +0000

Vestibular swings are therapeutic devices designed to address a variety of vestibular disorders. VRT, or vestibular rehabilitation therapy, is the first line of treatment for most patients with this type of condition. The exercises designed by the therapist help to retrain the brain of the patient to compensate for their condition. Often VRT will make it possible for patients to lead a normal life without requiring surgery. This therapy is usually provided by a physical or occupational therapist.

Vestibular Disorders

The vestibular system controls the processing of sensory information, such as controlling balance. If the area is affected through injury, disease, a genetic condition, or environmental conditions a vestibular disorder may occur. The most common problems cited by patients suffering from a vestibular disorder are vertigo, imbalance, and dizziness. Specific conditions include Meniere’s disease, acoustic neuroma, ototoxicity, cholesteatoma, and autoimmune inner ear disease. According to some studies, about 35% of American adults over the age of 40 will experience a vestibular dysfunction. These conditions are often overlooked and underdiagnosed.

Types of Swings

Vestibular swings can be an important component of VRT. There are a variety of swings that can be utilized for this type of treatment. Each gives a different sensory experience. They may be used together or separately depending on the condition being treated. Indoor swings include the disc swing, spinning top swing, string swing, and the around about swing. Autism patients may also benefit from the sensory input these devices provide.

Children especially seem to enjoy this type of therapy because it seems more like playing than working. Adults may be more resistant to the initial increased feelings of vertigo and dizziness the swings may cause; however, repeated treatments tend to resolve these issues.

Grants

Vestibular swings can be prohibitively expensive for a practice that only treats a small number of vestibular disorders each year. With such a small percentage of patients using the devices it can be difficult to find the funding to invest in one of these therapy options. One way to afford specialty devices is through grant funding. If your therapy establishment is connected to a hospital, inquire with the hospital’s grant writer. If you work at a private practice consider government, state, or foundation grants.

To learn more about vestibular disorders, visit the Vestibular Disorders Association. Have you had experience with a patient suffering from a vestibular disorder? Have you seen improvement with balance exercises or vestibular swings? What is your favorite type of swing?

Using Vestibular Swings for Your Patients is a post from: Sunbelt Staffing

How Much Do You Know about Eating Disorders?

Howard Gerber — Tue, 20 Sep 2011 13:00:09 +0000

An eating disorder is a condition which causes irregularities in the daily diet of the patient. This could include severe limitations of caloric intake or an excessive increase in consumption followed by ritualized purging. These disorders can effect men as well as women and typically develop during the teens or early adulthood. However, any of these disorders could develop at any point. There are several types of eating disorders; however, the most prevalent are anorexia and bulimia.

Symptoms

People with anorexia nervosa are obsessed with the food they eat and their weight. They believe themselves to be overweight even when they are dangerously underweight. They will attempt to achieve and maintain a weight far below what is healthy for their height and age. To lose weight, or prevent gaining weight, they may exercise excessively or starve themselves. Some patients will use both methods to maintain control over their weight.

Patients with bulimia nervosa eat large amounts of food and then attempt to rid their body of the excessive calories through purging. Patients may purge by inducing vomiting or diarrhea or may engage in excessive exercise rituals. As with anorexic patients, bulimics have an altered body image.

Treatment

These disorders must be treated both medically and psychologically. The disorder can cause dehydration, destabilization of electrolytes, muscle loss, low blood pressure, irregular heartbeat and a variety of other problems. Treatment of the disease begins with proper nutrition and hydration, possibly via a feeding tube and intravenous fluids.

Medications may be used to reduce the symptoms of these eating disorders. Antidepressants such as fluoxetine may be used to treat bulimia. Unfortunately, no medications have been specifically proven to help patients suffering with anorexia, although a variety of antidepressants may provide some benefit.

The psychological components of the treatment will be more long lasting. Individual, family, and group therapy are often indicated in patients with anorexia. Individual therapy helps the patient identify the destructive behaviors contributing to the disorder and find healthier ways of dealing with those impulses and behaviors. Family therapy can teach family members how to help the patient care for herself and how to identify symptoms that may indicate a relapse. Group therapy allows the patient to meet with and identify with others who are currently living with the disorders as well as those who are in recovery.

Therapists are arguably the most important component in treating patients with eating disorders. While it is certainly true that the medical damage can be immense, it can be treated in a finite period of time. Patients with eating disorders will often need years, if not lifelong, counseling.

As a therapist, how long do you typically see a patient with an eating disorder? Which form of therapy have you found to be most beneficial for your patients?

How Much Do You Know about Eating Disorders? is a post from: Sunbelt Staffing

National Alcohol and Drug Addiction Recovery Month

Howard Gerber — Tue, 06 Sep 2011 13:00:39 +0000

September is National Alcohol and Drug Addiction Recovery Month. Alcoholics and drug addicts who are no long are actively using or drinking will often tell people they are recovering rather than reformed or cured. This is because addiction is a lifelong condition. Patients who are recovering alcoholics or drug addicts work very hard to refrain from going back to the destructive path they were once on. It is important that people become aware of the difficulties associated with using drugs or consuming excessive amounts of alcohol, to know that there are options available to help with quitting, and that there are support programs to help them stay sober.

Prevention

Prevention must start in early childhood. Schools can use this month to teach students about the dangers of drinking and using drugs. Numerous community outreach programs are willing to come into schools to give presentations. Mothers Against Drunk Driving and Students Against Destructive Decisions are two of the most well-known. Therapists, drug counselors, or sponsors from Alcoholics Anonymous or Narcotics Anonymous may also be willing to present to individual classes or school assemblies. To promote conversation and understanding consider sponsoring contests or competitions among the students to raise awareness of the problems associated with drug and alcohol abuse.

Cessation

Any medical profession regularly in contact with the general population is in the perfect position to discuss cessation methods with their clients. Therapists and nurses can place posters showing the effects of smoking, drug use, or alcohol abuse and provide information to treatment centers. Pharmacies can provide brochures or display posters discussing the dangers of abusing prescription medications and the warning signs that dependency may be evolving.

Recovery

Offer to let support groups place literature in your office or possibly hold meetings after hours in your facility. Physical therapist can offer to teach relaxation techniques to members who need alternative ways to deal with stressful situations. Ask groups such as Alcoholics Anonymous and Narcotics Anonymous what you can do to help reach more of your patients who may be suffering in silence.

Coworkers

Health care professionals have a high instance of substance abuse because of the easy availability at work and high levels of stress associated with having a career in caring for others. If you or someone you work with has developed a dependency on drugs or alcohol, it is important to seek medical assistance. Your coworkers and others in the medical field understand the temptations and will be able to support you, or those you work with. Alcohol and drug addiction happen across income, social, and ethnic groups. Recovery is just as possible and important for healthcare professionals as it is for the patients they serve.

How do you help your patients with their recovery? Do you think drug prevention strategies are important in schools? Do you think it is more difficult for educators and healthcare professionals to seek and receive treatment?

National Alcohol and Drug Addiction Recovery Month is a post from: Sunbelt Staffing