Saturday, January 28, 2006

ah-HAH! Nursing blogs review part two

Well, I have been reading lots of blogs lately. See, I put links to some over there on the left hand side?

There are lots of blogs by nurses out there in the blogosphere (remember when we used to call it cyberspace? I digress). Lots of mediocore ones, some really pathetically bad ones, and some wonderful ones. I put three of the best I've found so far in the "Interesting blogs-health related" links on the left (don't worry, those of you not featured, I can't possibly have read but a miniscule number of the total available yet...).

Digital Doorway is written by a nurse who describes himself as "work[ing] with the Latino community in a medium-sized New England city, caring for individuals with HIV/AIDS, diabetes, addiction, and sundry illnesses related to lives rife with trauma and the intergenerational effects of poverty". He also teaches nursing at a Community College. I surmise by reading the story of his day at work that somewhere in his job description are the words "case management". His post of January 27th. perfectly describes what it is like to be invited into a family's life by way of your job. Every nurse engaged in community care which includes home visiting, can relate to sitting on the dirty floor in a bedroom in a house defined (in many ways) by poverty.

Emergiblog is "the life and times" of an "Emergency Department RN"; well-written, interesting, and managing to simultaneously explain it just like it is with humor while maintaining compassion for those whose situations are described. Wow. Of course, the wonderful graphics and pictures of Cherry Ames don't hurt. You have no idea how great it was to find another nurse who confesses to the world that she started on her nursing journey thanks to Cherry. Me too!

Here is a Cherry Ames' page, BTW, for the rest of you fans.

Finally, stop by Coffee and Conversation in a Smoky Room, which describes the trauma experience of student nursing pretty well. It seems only yesterday I was in the lobby on the first day of clinical, wearing my beautiful starched white cap and apron and thinking "I must be crazy, what have I done? Good God, why did I ever think I could be a nurse, for Heaven's sake?".

30 years ago.



Friday, January 27, 2006

"The public is always rightfully enraged when one of these awful deaths occurs"

Sometimes sentences just make such cogent statements that it's impossible not to quote them as titles.

This sentence just screams to me that we, "the public", fully expect these deaths to recur, since we are "always rightfully enraged when one" does occur.


Wednesday, January 25, 2006

Childhood heart repairs may not last

Open-heart surgery for babies and young children didn't become common until the 1970s. Before then, only a quarter of "blue babies" and other infants born with complex heart defects lived beyond a year. Now, more than 95 percent of these "miracle babies" will grow up, living near-normal lives for many years.

Only recently have enough of the early survivors reached adulthood for doctors to notice a disturbing trend: Starting about 20 years after childhood surgery, the risk for some serious problems -- irregular heartbeats, enlarged hearts, heart failure, occasionally even sudden death -- begins to rise among people who had complex defects repaired.

There is a problem in general with young adults transferring from pediatric specialty care to adult specialty care. It's particularly acute for those with complex disorders that are more frequently treated by pediatric specialists than by their adult counterparts, but it extends to primary care as well.

Any hints from your institutions or neighborhoods?


Monday, January 23, 2006

Why we like cute

"...Scientists who study the evolution of visual signaling have identified a wide and still expanding assortment of features and behaviors that make something look cute: bright forward-facing eyes set low on a big round face, a pair of big round ears, floppy limbs and a side-to-side, teeter-totter gait, among many others..."

This article in the NY Times, reporting on recent research into what makes things cute and why we like it so much also reveals:

"...New studies suggest that cute images stimulate the same pleasure centers of the brain aroused by sex, a good meal or psychoactive drugs like cocaine..."

Which explains a lot. Surely.

Now seriously. Think about babies.

"...Human babies have unusually large heads because humans have unusually large brains. Their heads are round because their brains continue to grow throughout the first months of life, and the plates of the skull stay flexible and unfused to accommodate the development. Baby eyes and ears are situated comparatively far down the face and skull, and only later migrate upward in proportion to the development of bones in the cheek and jaw areas...."


"... On starting to walk, toddlers struggle continuously to balance themselves between left foot and right, and so the toddler gait consists as much of lateral movement as of any forward momentum..."

C'mon, aren't you thinking "awww" to yourself right now?

I was going to put a damper on things by musing about the implications for those babies who don't meet standard "cuteness" definitions, but I think I'll just drop that hint and depart.


Saturday, January 21, 2006

woo-wee! Nursing blogs review part one

I've just spent several hours reviewing nursing blogs with the help of Google (hopefully, without government supervision of same, as some of the blogs are a trifle, um, explicit). Things I've learned so far:

1) lots of nurses don't like nursing much.
2) new nurses think old nurses suck and await the day we all retire with profound hopeful glee.
3) old nurses think new nurses suck and lament the wave of the future when they retire and the new crew takes over the ship.
4) some nurses use baby words to describe excreta. It's interesting, but unnerving.
5) excreta of all kinds and body fluids in general figure prominently on many nursing blogs. Leading one to wonder which came first: the attraction to nursing of people interested in excreta and body fluids, or the frequent exposure to same resulting in profound preoccupation in off-duty hours with writing about it all?

I have not yet come to any conclusions. I actually went looking at nursing blogs to find some to put in a permanent link section here, such as seen on many medical blogs (and parenthetically: how come all health-related blogs regardless of content or authorship are lumped under the category "medical"?). Sadly, although there are several nurses blogging with whom I would be proud to share a night-shift cup of coffee, there are many more who are, well, embarrassing. This need to describe in graphic detail the horrible incident of the body-fluid-of-the-day and the play-by-play details of how you made it through the shift seem so much wasted space to me.

I mean, other nurses already know all about it. So does the general public, who are the providers of the body-fluids you clean up and then run home to blog about. This public show of sardonic, jaded, burnt-out, "let's see who can be the most graphic and use the most vulgarity" rather petty storytelling doesn't show us to our best advantage, does it?

But of course, what do I know, old-timer that I am. :-)

Stay tuned for part two, I know there are good blogs out there to link to!!! Any suggestions welcome, by the way.


Friday, January 20, 2006

Children Born in 2001: First Statistics

Very interesting, the changing face of America.

These stats are from the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B), a nationally representative sample of the nearly 4 million children born in the United States in the year 2001 being conducted by the National Center for Education Statistics. To quote: "During the first wave of the study, 10,688 parents provided information and 10,221 children were directly assessed."

Randomly (well, not true, selected by me!) stats include:

51 percent were boys and 49 percent were girls;

54 percent were White, non-Hispanic; 14 percent were Black, non-Hispanic; 26 percent were Hispanic; 3 percent were Asian/Pacific Islander, non-Hispanic; 1 percent were American Indian, non-Hispanic; and 4 percent were multiracial, non-Hispanic;

23 percent were living in families whose household income was below the poverty threshold;

Forty-five percent of children living below the poverty threshold lived in households with no father present, while 12 percent of children living at or above the poverty threshold lived in households without a father;

Black children (58 percent) were more likely than White children (10 percent), Hispanic children (20 percent), or Asian children (6 percent) to live in a household with no father present.

These kids will be in charge in America in 2040---or in jail. We can watch it happen, or we can try to intervene.

Isn't that the decision society faces, brought down to simplest level: who is the mote, who is the light?


Thursday, January 19, 2006

"Bringing Vincent Home"

This article perfectly describes the everyday frustrations of trying to navigate systems purportedly there to "help" individuals with significant cognitive impairment.

As both a mom and a "case manager", I could underline all the salient points: it's too scattered, too confusing (if these two caregivers-a pediatric nurse specialist and a tenured professor of health policy can't do it, who can?), and too subject to error.

Medicaid obviously remains the life-sustaining key to most services for people like Vincent.

Do you wonder why some of us moms-and case managers-are wondering how much more Congress will cut Medicaid under the belief that it is too lavish?

There are lots of Vincents out there. They are living substandard lives under the radar of your health care and disability "services", and when their elderly parents die, someone somewhere is going to be trying to figure out how to bring Vincent home.

Read this article.


Wednesday, January 18, 2006

The baby is better and this and that

I've been sick with the flu or something. People always say they have had "the flu" when they are sick with some unknown thing, and hey! who am I to knock tradition? My unknown "flu" was a headache-sleepy-low fever-general malaise thing, actually. Of course, being a nurse I truly felt my headache for twenty four hours indicated I probably had either some rare disease or perhaps a tumor (nurses rarely have simple headaches), and was all set to call my doctor and get an MRI ordered when miraculously it stopped.

So, must have been "the flu" after all. Or a miracle. Maybe both; I don't suppose they are mutually exclusive.

Anyway, I have been feeling blah and old and somewhat discouraged and wondering if I really make any difference to any living soul, which I suppose is typical post-New Year's Resolution Blues (you know, when it occurs to you that all those resolutions you make each year are just so much malarkey, even if you truly believed for even one second you would attempt to stick to them).

And Congress is messing with Medicaid. And one of my little clients was removed to foster care today. And my Spanish-speaking mom wants to know if the police pull her over and she can't produce a driver's license will they call Immigration and if so, who will take her multi-disabled child if she is deported? And it takes five months to get a wheelchair for a child...did you know that? That is the average time in our wheelchair clinic for new wheelchairs, because first you get the doctor's order, then you make an appointment to get a fitting, then they try to get it authorized by the insurance company, then the insurance company denies it, then they have to get a letter of "medical necessity" from the very same doctor who ordered it in the first place (i.e. said it was medically necessary and so I am ordering it), then it gets approved, then it goes to the medical equipment company who orders the stuff from a vendor, and then FINALLY it comes in. Meantime mom walks around with the baby in a stroller which causes every doctor, nurse, and therapist who sees her to say, "you know, mom, you really need to think about getting a wheelchair for your child"...

And why do we call all our client's mothers "mom"? And is it patronizing? And why can't I stop?

Anyway, the baby I wrote about below, the little trooper in PICU, is getting better. She is extubated, and tolerating a bit of po feeding. Her g-tube is shot for some reason, and they have quit replacing it for right now and are NG feeding her. But I saw her sitting up in a little swing at bedside and she had a big smile for me.

That's enough for today. I think there's meaning in here somewhere-in my life, I mean, not this rambling post.



Wednesday, January 04, 2006

How to tell friends your new baby has a disability

Interesting discussion on Red State M-word about a couple whose baby was born with Down syndrome, and the struggle they had over how to announce this. It's good to see physicians and other medical professionals talking about this issue, which is generally only a conversation that parents have with one another later on! "How did you tell?" is a common topic at gatherings of parents whose kids have Down syndrome, anyway.

I'd be interested in how people view this on both sides of the announcements, by the way.

If you were once a new parent of a baby who was diagnosed at birth with a disabling condition, how did you (or did you) announce this?

If you are not such a parent, what do you think? Would it be helpful to you to know this about a friend or family member's new baby? Is it necessary?