The Board of Directors of the American Association of Colleges of Nursing (AACN) has moved to establish the Commission on Nurse Certification (CNC), a new credentialing body to oversee the certification of Clinical Nurse Leaders (CNLs). Composed of representatives from practice and academia, this new authority will lead the effort to certify graduates of master's level nursing programs that prepare advanced generalists for practice across a variety of health care settings. [click link for full article]
Gerald was a young man in the seventies in Texas. In his early twenties, he was studying at the police academy to become a police officer. His psychiatrist speculates that this was when he had his first psychotic break. He began to develop paranoid delusions that his boss was out to kill him. Gerald is an example of paranoid schizophrenia that is refractory (resistant to) to treatment. As you watch the video remember the positive symptoms of schizophrenia which are thought broadcasting, hearing voices, seeing visions, and a tendency to communicate in concrete, non abstract language.
Be aware also that Gerald is, in the later part of the video, going through a placement conference. This is a meeting with his doctors, his mother, and his conservator about his placement. He clearly wants his mother to be around to visit him and he clearly refuses to recognize the reality of the fact that she needs to move to where she can make a better living.
"Struck by lightning" is exactly right. People who have schizophrenia are not bad people. They are afflicted with an illness that unravels the distinction between logic and illogic, between dreams and waking life.
In the next video, Gerald is moved to his new living quarters. He meets up with his father. Throughout his move, you can see the distress his delusional thinking causes him. He is afraid the people that are closest to him are going to kill him. He knows that something is not right. His life should have turned out better. This is the torment that mental illness causes. It is the regret of a life gone completely wrong.
EXCLUSIVE: THREE people have resigned from a nursing home near Geelong after photos of residents' body parts were used in a sickening "guess who" game at a private party.
Pictures taken at Ann Nichol House, in Portarlington, were used in a game played at a farewell party for a member of staff attended by about a dozen people at a local golf club earlier this month.
Sources told the Herald Sun about 30 hostel residents had agreed to let staff photograph their colostomy bags and body parts such as arms, legs, toes and knees for what they were told was a "scientific project".
Appalled staff who heard about the party game complained to hostel management who counselled those involved but decided against telling residents and their families what had occurred.
The Federal Department of Health and Ageing, which regulates the aged care industry, will today launch an investigation into the incident.
"We take these allegations very seriously and an investigator will be sent to the home tomorrow," spokeswoman Kay McNiece said yesterday.
The 60-bed Ann Nichol hostel, which has a 20-bed dementia wing, is run by Bellarine Community Health.
Bellarine Community Health CEO John Fendyk yesterday said management had decided not to inform residents that the photos had been misused because it did not want to upset them.
"We wanted to deal with the issue internally," he said.
Mr Fendyk said the staff involved had been counselled about their responsibilities to residents and several had chosen to resign.
He said the vast majority of staff at the facility were highly professional and described the incident as a one-off.
"We don't believe there was any excuse for what occurred," he said.
"This was a silly issue that a number of staff didn't appreciate."
Lynda Saltarelli, who runs agedcarecrisis.com website, said the misuse of the photos was a shocking breach of the dignity and privacy of Ann Nichol House residents.
"To treat the residents like this is absolutely disgusting," she said.
Ms Saltarelli said the incident was the "tip of the iceberg" of problems in the aged care industry, including a shortage of nurses.
An Ann Nichol House staff member, who did not wish to be named, said morale at the facility was low and personal care workers, who did not have the same level of training as nurses, were being given too much responsibility for looking after residents.
In September 2006, the Aged Care Standards Accreditation Agency found the Anne Nichols Hostel complied with all 44 expected outcomes for aged care facilities and accredited it to November 2009.
I was wandering the aisles of Safeway this morning when my pager went off. It was a patient from another clinic. I answered her questions, directed her to go to the ER, and then asked her why she called my clinic's pager. She said she had called information and ours was the only number available. Okaaaay, was there not someone on call for her clinic and why couldn't she reach them?
Her reply: "My cell phone is dead and I don't have a charger and their number is in my phone."
Does anyone but me think this is scary? Is there something wrong with using pen and paper to record information these days? Batteries die, computers have viruses, software has bugs. I'm sure this young lady was given a training manual when she became a patient at that clinic and the manual has contact information in it. Why did she not think to look for what she needed there? What would she have done if my clinic number had not been available? She has symptoms of an infection that could be serious if she does not take care of it quickly.
I have met young people who do not know how to make change unless a computerized cash register does it for them, who cannot tell time on a clock that is not digital, and cannot do simple math without a calculator. Electronic technology is useful and entertaining and there is nothing inherently wrong in using it but not at the expense of our intellect and independence. It is not necessarily better or faster or more efficient just because it glows and is computerized.
Oh, well . . .*heavy sigh and shake of head*. . . I know I can't resist "progress" and grumbling about it will do me no good. I already annoy people because I am not available by cell phone every minute of the day and I can't make empty social chit-chat about the characters on the latest sit-com but I get by and I am quite content to be "unplugged" unless it suits my purposes. Heck, I even turn off the computer once in a while.
The Scalabrini Nursing Home at Griffith has received funds for 22 high care beds in the latest round of residential aged care places.
There is also funding for 95 high care places at three nursing homes in Albury.
Member for Riverina Kay Hull says she recognises there is a shortage of aged care places in the region, and says another 22 beds is a bonus for the Griffith area.
She has encouraged aged care providers in the region to keep applying.
In the latest round, five of the nine applications for aged care places succeeded and there were two capital works grants, one for the Murray Haven Hostel at Barham.
There's a really cool show on called "." It's a witty, irreverent, brutally honest car show hosted by three dry-witted Brits: (), , and . Last season they road tested the new (). The S-Class is the big, expensive standard example of wretched excess in wealthy parts of the western world. It has long been the chariot of the privileged: for taking the kids to boarding school...their crested blazers neatly folded in the trunk, or ushering African royalty through the impoverished village square behind bulletproof glass. However, it's also the example of automotive innovation. Top Gear host Jeremy Clarkson makes a big deal of this the latest generation S-Class. The new model has active cruise control that adjusts the car's speed according to traffic around it. It also has an infrared camera system that gives the driver "night vision," which increases visibility on poorly lit rural roads. There are dozens of other features that have never before appeared on a car. Many of them sound ridiculous...but the truth is - many of these features will be on every car in 10 years.
The S-Class was the first major production car to have a 3-point seatbelt (1965). It was the first car to offer anti-lock brakes (1978). It was the first car to have an airbag (1981). It was the first car with crumple zones (1959). It was the first car with electronic stability control (1995). It was the first car with satellite navigation. These are all standard equipment on most cars today, and if you note the dates above, it often took nearly a decade for these innovations to flood the mainstream. The S-Class is the laboratory and testing ground for automotive safety innovation. In fact, many of the innovations conceived in the S-Class, once thought ridiculous extras, have become so critical to public safety that they are required by law on all production vehicles. If there hadn't been an S-Class, or, really, an automotive marketplace that encourages competition and innovation, we would be living in a much more dangerous (and expensive) world. I've written about how competition drives innovation before: .
The S-Class is my metaphor for specialty hospitals. After several posts singing the praises of primary care physicians, I'd like to give specialists their due credit. If primary care doctors (internists, family practitioners, general practitioners) are the medical profession's voice of reason and judgment, specialists are the risk takers...the frontier. Without a frontier, the status-quo would never go anywhere. Specialty hospitals are privately-owned (usually by the physicians who run them) hospitals that focus on medical specialties like cardiology or , for example. Because they only treat certain conditions, they devote all of their resources to those conditions, and show they have better patient outcomes for it. Specialty hospitals are our testing ground for prototypical advances that could make their way into the mainstream and save lives. And Congress is killing them.
An article by of the , entitled "," explains how Congress' moratorium on physician referrals of Medicare patients to specialty hospitals could become permanent, effectively killing the hospitals off completely. The reason? Community hospitals have loud voices and those voices are crying "unfair competition." As Professor , Nancy McPherson Professor of Business Administration at the , has observed, this congressional attempt to suppress competition was not advanced in the interest of patient care: "... no one alleged that the specialty hospitals were bad for the consumers' health. No, instead, the general hospitals alleged that the specialty hospitals were bad for their health." (emphasis mine)
In fact, shows that specialty hospitals are helping patients and improving health care. The government's own research committees found:
(1) Specialty hospitals had no significant negative impact on the financial condition of traditional hospitals.
(2) Specialty hospitals could promote innovation in patient care.
(3) Specialty hospitals provide predictable scheduling and patient care.
(4) Specialty hospitals have higher rates of patient satisfaction.
(5) Specialty hospitals have lower mortality rates.
(6) Specialty hospitals have comparable costs to traditional hospitals.
(7) Physician referrals to specialty hospitals are not self-serving.
Yet the community hospital lobby is powerful, and Congress could make some temporary changes permanent...which would amount to a death sentence for current specialty hospitals and contraception for future ones. If competition is stifled permanently, we will have yet another example of interests contrary to improved patient outcomes and economic efficiencies throwing American health care under the proverbial bus.
I posted a short version of the hospital experience this past few days on my home blog but I decided to put more detail for those of you that care.
Sunday I was doing really well. Jeremy and Dad gave me a blessing in the afternoon and it was such a good day. When it started to get late the breathing problems started to get worse. Jeremy and I were watching a movie when I started to get a very mild chest pain. After 30 minutes we decided not to risk it and go into the ER since the pain wasn't going away. About 20 minutes after I was strapped up to everything in the ER the pain went away and I started to feel stupid. I told them the pain was gone but they kept monitoring me anyway. I was still having problems breathing, so I guessed that was why. The chest x-ray they did was fine. About an hour after we got there they came in and put me on oxygen. I started to feel better quite quickly after that. At least another hour passed and mom, Jeremy and I were all ready to go home. We were sure they would be letting me go soon, and I kept telling mom she could leave if she wanted that it was no big deal. I was feeling so sheepish and dumb for going once again to the expensive ER. A few minutes later the doctor comes in and tells me that the Cardiologist wants me admitted. We were all taken back. I've never been hospitalized so I'm going from sheepish to shocked in a matter of seconds. Mom left shortly after that and Jeremy stayed with me while they had Labor and Delivery come down and administer a non-stress test on Uno. He was fine and so next thing I know I'm being wheeled off to a small room and hooked up to more monitors. Finally at 3:00am or so Jeremy was able to go home and rest.
That night every-time I would roll over one of the electrodes on my chest would pop off and they would have to wake me up to fix it. They brought breakfast just after 7am, so ya. Not a lot of time between to sleep. Not to mention the stress of being without anyone alone in the dumb hospital.
Monday morning the doctors came to see me. The cardiologist stopped by and let me know that he was ordering another ECG and starting me on the heart medication (a beta-blocker). Jeremy was able to come quite early so it was nice not to be alone anymore. My OB came in and told me that he wanted me moved up to Labor and Delivery so that they could monitor the baby as well as myself. Not long after two nurses came to take me upstairs. I was shocked at how much nicer and bigger the room was. Jeremy and I started to laugh, and he was thrilled to have somewhere more comfortable to sit with me.
After getting the baby hooked up to all the monitors they started me on a low dose Beta-Blocker (heart med). Within a few hours they were able to take me off the Oxygen and just after lunch they took me down to get my ECG. It was a bit odd being wheeled downstairs in a hospital gown, the whole time I was just praying I wouldn't happen to bump into anyone I knew! The tech that did my ECG said "I'm no Cardiologist but it looks like your EF has improved." I was SO EXCITED. Once they took me back upstairs I told mom and then we waited to hear from the Cardiologist. He came to visit just after 5pm and told me that things were looking a lot better. It was so nice to know that the medication was working that well already. My EF went from 45% to 50%. It's now at the lowest it can be at and still be considered normal function. Thank goodness for modern medications. The Cardiologist let me know that he and my OB decided to keep me one more night to monitor the baby's reaction to the meds but that if the Periantologist gave us the ok I would be able to go home Tuesday.
Tuesday morning they let us know that they were trying to get me into the Periantologist early. I already had an appointment at 1:30pm but they were hoping I would be able to go home before that. No such luck. We didn't even get to see her until it was past 2pm. They did a big ultra sound on Uno and he was measuring even further ahead than before, 2 1/2 weeks ahead. A whopping 4 lbs and 14oz. (could be off 12 oz either way). He was also not shy about his boy parts for the first time since 22 weeks when we found out he was a boy. It's always nice to have that reassurance that he really is a boy. My amniotic fluid was low, so I do have to get that checked again on Friday. The Periantologist told us to continue working with the medication and keep an eye on my blood pressure. They are still watching the Hypertension and they just don't want any complications on top of the heart issue we are already dealing with. She told me to continue to take it easy and that when it comes time for delivery she's made sure to make some special notes about how I shouldn't be hydrated too much for fear the extra fluid would cause my heart to give out. I made sure to tell mom (Jeremy was with me) so that just in case I forget, someone will be there to remind doctors when I'm in labor. After all this time I would really like to live, and hold my baby. We asked the Doctor if it would be ok to be discharged now and she said yes. I was so excited to be done. When we got back up to L&D I was ready to have that IV taken out ASAP! The nurses at the hospital the entire time I was there were wonderful. I would be thrilled if any of them were there to help during the delivery, I can't say enough about them.
I still have followups with all the doctors still, and will probably be seeing a few of them a week till Uno finally makes his big debut into the world. I am just happy that things were able to be caught and treated so well.
