1. Avoid putting off seeing a MD because of money. Having annual physical exams, physicals can help address problems and also compare and look at trends in regard to the patients vital signs. Also labs and certain test that need to be ordered can be addressed at physicians visit.
2. Avoid Too much salt and saturated fats I your diet. Mexican foods taste great but this could be the reason why you are in the hospital, in the first place. Salty foods make your body to retain water, thus increasing your heart work load. Saturated fats causes plaque formation that can lead to heart attack or strokes
3. Avoid smoking at all cost. Smoking predisposes you to many types of cancers and also causes hardening of arteries. This hardening of arteries makes them to narrow, causing hypertension. Avoid second hand smoking, which is worse than primary smoking. Never smoke in the same room with infants or kids, if you must smoke.
4. Avoid looking up things up on the internet and basing your treatment based on this information. Not all sites are reputable. If Internet was all that great, there would be no reason for doctors to spend 7 years PLUS in medical school.
5. AVOID letting the small children visiting and crawl on the hospital floor. Hospitals are some of the dirtiest places on earth riddled with drug resistant bacteria, viruses and fungi. Wash your hands before you eat

1. We are so dedicated to our profession that we don’t always leave our cares for you at the door; we take you home with us. Just when you thought no one else cares we care for you and the whole family and many times put our families on the back burner.
2. From a nurse, “how are you doing?” Isn’t a polite greeting…and “OK ” isn’t a complete answer. Telling me the truth, that you are nauseated/scared/in pain …doesn’t make you a wimp or a burden. It enables me to properly care for you.
3. We give up our own families to care for you and your family and wouldn’t change that fact for anything
4. That we sacrifice sleep, eating, and time at home with our families to ensure that YOU’RE comfortable, nurtured, fed and back home with YOUR family, and that YOUR quality of life is at its peak.
5. That we have feelings too and what happens at work, don’t always stay at work! Just because we may not show our emotions such as sadness at the time of a tragedy doesn’t mean we don’t cry or care about you and your family feelings. Respect us and stop being abusive.
6. We get upset when we see you come back with the same problem over and over again, that could have been prevented. You make us think that there was something more we could have done to convince you to make better decisions.
7. When I’m not in your room I’m not just sitting around eating bon bons. I am running around trying to make sure the 100 things that have to be sorted out behind the scenes don’t affect you. I’m tracking down meds from pharmacy, trying to find the RT, the phlebotomist, the CNA, the doctor, the paperwork that should have been in your chart, the orders that should have been written to prep you for surgery, supplies that we suddenly run out of and are needed etc. And I do this for multiple patients (no you aren’t my only patient) all shift long.
8. We are human beings too. I’m somebody’s son or daughter, somebody’s mother and somebody’s wife. So before talking consider all those aspect. You get exactly what you plant.
9. That we have to somehow make our hearts, brains, and hands all work together in difficult and emotional situations. Sometimes we are the cooks, waitress, maintenance, housekeeping, laundry and everything else at once and still manage to function.
10. We are NOT personal servants.

Lateral violence refers to acts that occur between colleagues, where bullying is described as acts perpetrated by one in a higher level of authority and occur over time. The acts can be covert or overt acts of verbal or non-verbal aggression. Relational aggression is a type of bullying typified by psychological abuse. Behaviors include gossiping, withholding information and ostracism. Behaviors can extend outside the workplace and can occur in person or in cyberspace. (Dellasega, C.2009).

Have you ever been bullied, harassed or experienced lateral violence as a nurse or as a healthcare professional? The following are some of the comments we received from our facebook page.

Sue Savasta-Crabtree I have not personally been a victim of bullying but many of my new nurses tell me that the reason they leave a hospital environment is due to bullying.

Fact: Most victims of bullying do not recognize the fact that they are being bullied. Some nurses don’t realize facial expressions, rudeness, practical jokes are forms of bullying.

Fancy Griffith Yes! Especially when my nurse manager complements me… Then it’s really bad! I never knew how petty grown women can be until I became a nurse… Sad!

Jenny Broberg Yes, as a new nurse…had a nurse literally say she would be on my case until I quit. I reported this to management & their advice was to just ignore her. Needless to say, I got out of that toxic environment. That is the only time I have run into a nurse bully.

Such behaviors should be reported to nurse managers. Nurse managers ought to listen and investigate such claims without any bias.

Daniel Linder Yep, harassment. Wasn’t “accepted” by a small knit group of icu nurses and heard snickering, horrible comments about me…because I came from a Level 1 Neuro ICU and needed a little help getting used to medical icu patients.

“Cliques” reinforce bullying making it seem like it is an acceptable behavior. Such Cliques often gang together against the victim.

Michele Byrne I’ll never forget how I felt when I was put on a hall where there was a burn patient who needed a dressing change… I needed explanation of the treatment and I was told to “figure it out!” … I would never do that to anyone!

Being given a task that does not fit your skill level is a form of nursing bullying and harassment.

Emman Domingcil when I was still at my undergraduate years, I experienced being humiliated by a staff nurse in front of a patient. I really felt so down that time. However, this incident served as an inspiration for me to strive harder. As I am now a professional nurse, I keep telling myself not to do the same thing which the staff nurse did to me when I was still learning.

Zero bullying tolerance is one of the best ways to eradicate nurse bullying. Whether the behavior resulted in a positive inspiration does not justify the behavior.

Angie Kostelnik Been there! Frequent attempts to drag me down when I was a student. I learned to kill them with kindness.

Retaliating a bullying behavior causes work place violence. Reporting to the chain of command is the way

Tiffany Ryan Recently graduated nursing school and the phrase, “Nurses eat their young” was definitely experienced. I found it was more frequent in older nurses – they were in our shoes once before, why do they feel the need to put us down?

Old “nursing culture” is not a justification for bullying either.

Allison Waters Thomason My very first day off of orientation I sobbed all the way home and wondered why I ever wanted to be a nurse after the way I was treated by this one “old” nurse whom I had formerly respected. Happy to say that, 3 years later, I am still a nurse, in the same position, and I nurture and respect and help our new grads and students. Bullying is wrong and some nurses do “eat their young.” This is unacceptable behavior and just because it may have been done to you doesn’t mean that you have to do it to others

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April Monetti I was told in nursing school that in the field, “nurses eat their young”- I found out how true it was sad to say. But on the brighter side, I have chosen to not fall into that stereotype & welcome students with open arms & a friendly environment to learn & urge them to do the same when they are out in practice. We must remember- we were ALL students @ one time!!

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Cathy Parks Brody Nurses can be some of the cruelest people I know. I love being a nurse but hate that it is full of people who back stab, gossip, make false accusations, etc… We need to be a team! Maybe they should bring back team nursing but only if you can pick your team.
My preceptor was awesome though. It was when I changed shifts that the bad stuff happened. They loved dumping on me as a new nurse. I would have twice the work load of my older peers. I cried many days on my way home.

What is the Impact of Lateral Violence and Bullying in Nursing?

• 40% of clinicians “kept quiet” or “ignored” an improper medication due to an intimidating colleague (Institute for Safe Medication Practices, 2004).

• Unmanaged anger contributes to hypertension, coronary artery disease, depression, psychological problems or other health problems (Meyers, 2006).

• Low staff morale, increased absenteeism, attrition of staff, deterioration in the quality of patient care. (Hughes 2008).

• Nurses leave the profession due to lateral violence and bullying contributing to the nursing shortage.

Sources:

http://www.nursingworld.org/LinkLibrary/Nurse-Manager-Tools/Lateral-Violence-and-Bullying-in-Nursing-Factsheet.pdf

What’s your take?

But nursing staff have different opinions about using these measures as indicators of quality of nursing care. The following are a few comments from facebook users: -

Karen Randall Bumgardner I don’t think there is any way to prevent falls, some patients are determined not to stay in bed no matter what we do. That being said, I think that the current staff rations are VERY poor! One nurse can’t be responsible for 50 patients at night with only two CNA’s to help. It’s not fair to the residents or the staff, who do everything they can to prevent these things and never succeed. Also, those CNA’s are the heart and soul of nursing. Without them, a nurse is merely a nurse. It takes great TEAMWORK to pull together and make a great nurse. Pay the CNA’s more, they deserve it and will work harder!

Regina Barner I am neutral. Can certainly be both. Try working long term care with nursing hours minimum requirement in Pa is 2.7 hrs/day!!! That being said there are some pts who can fall rite in front of you and I can always tell when my residents are entering the end of their lives. They develop open areas. The key is to have preventative measures in place from the get go. Have your aides’ vigilant with reporting etc.

Kevin LuAllen Ohhh NO. Tell the damn nurses managers to hire more Nursing Help. ” CNA” help so we nurses can Nurse, instead of doing it all. Having as many pt’s as we have with barley enough help to run a hot dog stand. Patient care starts suffering from higher up. Not at the bedside. We can only so much in 12 hrs.

Linda Bell Poor staffing. And we should not be held accountable for pre-admit health. Poor nutrition and mobility causes decubitus and poor skin integrity. Doesn’t happen overnight government and insurance companies have found ways not to pay their bills.

Larry L Smith I agree! I do think a key to prevent both is both instruction and proper staffing levels. Pressure ulcers are totally preventable, but unfortunately, not all falls can be prevented, as some patients tend to be compulsive and try to rise suddenly.

Crystal Scheiferstein I disagree. There are some patients no matter how many times you turn them and no matter what measures you take, develop pressure sores. And there are patients that you can sit and watch for hours on end and as soon as you step away to take care of other patients will fall. I think that pressure sores and falls are an indicator of lack of staffing.

Nicole Ferris Keefe I believe it indicates that nurses are overwhelmed by the patient to nurse ratio; and documentation; and numerous phone calls to doctors that they can’t possibly do quality patient care! Leading to patient safety issues! Let us do our job, not everyone else’s to!!!

Alyson Hope pressure sores can be avoided easily enough but like others say, you need good staffing levels to deliver decent nursing care and no matter how many nurses you have on duty, if a patient is determined to walk/mobilize when they are unable to do so independently then you’re gonna get falls that is no one’s ‘fault’.

May Jane Carinal I agree that these may indicate poor nursing care but at some point, these kinds of incidents were not avoided because of the fact that there are no enough ratio of NURSES to a certain ward… and not all the time nurses are with the patients. Significant others of the patients also play an important role in giving care..They should work hand-in-hand with the health team especially with the nurses and doctors…So that good nursing care will be rendered to the patients…

Angélica Maria Zeledón Baca You have to look at the whole picture. Is it a sudden jump in falls per month, or is there suddenly more pts with pressure ulcers ? Also, falls can be prevented to some degree with medication, altering of the environment, providing the resident with something to keep them occupied, often even some education. Nursing interventions are designed to bring the rates down. This applies especially if it is one particular resident/patient with a sudden increase in falls per month, or a new pressure ulcer.
Pressure ulcers can be prevented with 2/24 turning, but also an air/water mattress with the appropriate pressure setting, and also some tweaks with meds.
Regardless of what anyone says, the people we look after should be looked at as unique individuals, not a number nor a percentage on a report.

What is your take about falls and pressure ulcers as indicators of nursing quality of care? Leave a comment please

1. Severe work related injuries especially back ones: Always ask for help. Use ergonomics like you were taught and never underestimate patient weight. Light patients are the ones that can hurt easily.
2. Hospitals eliminating LVN/LPN positions: Get yourself a nursing degree, preferably a bachelor’s degree and get a specialty certification. You will always impress nurse recruiters.
3. Lack of Nursing Experience: If you are a new graduate, enroll into an internship or a residency program. If possible, start as a student nurse (externship) in the hospital that you plan to apply for a job.
4. Hospitals closing doors and going out of business. Keep yourselves competitive and sought after by everyone.  These are tough times
5. Medication errors: Many nurses are dismissed from work and sometimes barred from practicing due to medication errors. From simple to fatal medication errors, any can make one ineligible to get a nursing job.
6. Immigration and work authorization laws. Nurses no longer get guaranteed green card in America. Many foreign qualified nurses are finding themselves jobless due to lack of work authorization

1. I am here to make you as comfortable as I can, not to knock you out/keep you out with pain meds.
2. That we worry about you, think about you, and care about you long after we clock out. We continue thinking about you even when we are at home.
3. Our patients come before ourselves, our family, friends or social life. And sometimes… our own health.
4. Although we do care about you and want to do anything we can for you, we do need at least a short lunch break to give us more energy to get through the day and to give our brains a short break from constantly thinking.
5. That Nursing is a way of life and it comes from our hearts- not because it is a great way to make $$!!! And yes- we DO cry…
6. Thank you ever once in a while!!! We could use some positive attitudes and a genuine thank you can go a long way.
7. That we have feelings too and what happens at work, don’t always stay at work! Just because we may not show our emotions such as sadness at the time of a tragedy doesn’t mean we don’t cry our eyes out when we leave! We were taught that we have to separate ourselves from emotions just so we can serve you.  And yes, that includes patients being rude to us!
8. That there are many of us who debate whether to continue nursing daily, disheartened by administrative politics and poor behavior on the part of MDs and patients ! However we are STILL there in your time of need!
9. We are not maids, slaves or personal messengers. We are highly educated professionals with a heart. We are nurses, AND MAY SEEM LIKE WE ARE engineers, social workers, advocates, listeners, translators, food finders at 3am. We work short staffed, poorly stocked…and at the end of the day its always the nurses fault.
10. We are the ones at your side 24/7, not the doctors. So don’t hold back information from us that you think we don’t need to know!

• Low saturated fats
• Limit sugar intake
• Limit salt intake
• Encourages 4-9 servings fruits/veg. per day
• Encourages 6-8 servings of whole grains per day, legumes, nuts
• Less than 6 oz. Fish, meats and lean poultry daily

DASH Diet

• Low-fat, low salt diet
• Encourages fruits, vegetables, whole grains, fish poultry and nuts
• Lowers BP, LDL cholesterol
• Promotes weight loss
• May lower risk of heart attack and stroke in women

Atkin’s Diet

• Low carbohydrate
• High protein and fat intake (good and bad fats)
• Promotes weight loss
• Lowers triglycerides.
• Increases HDL
• Lowers BP
• Questionable long term physical effects

South Beach Diet

• Low carbohydrate (but allows for “good” carbohydrates with low glycemic index
• Includes good fats
• Encourages fruits, vegetables, whole grains and lean protein
• Promotes weight loss
• May help decrease risk for the Metabolic Syndrome

Ornish Diet

• Vegetarian diet
• Extremely low fat, high fiber diet
• Encourages complex carbohydrates
• Incorporates exercise and stress management
• Decreases LDL
• Promotes weight loss
• May decrease angina and plaque development in blood vessels

Mediterranean Diet

• Low fat
• Small portions of high quality foods
• Encourages 7-10 servings of fruits and vegetables/day, olive oil, nuts, red wine, and fish
• Incorporates exercise and healthy lifestyle changes
• Decreases LDL, BP, and blood sugar
• Promotes weight loss
• May help prevent repeat heart attacks/angina

Low saturated fats:

These are foods such as lean meats and meat alternatives like beans or tofu. White meats are better than red meats. If possible, stay away completely from organ meats although liver is rich in iron and other important macro-nutrients. Other foods includes fish, vegetables, beans, and nuts nonfat and low-fat dairy products polyunsaturated or monounsaturated fats, like canola and olive oils, to replace saturated fats, such as land.

Eat a variety of whole grain products such as oats, whole wheat bread, and brown rice.

Eat fish twice a week. Oily fish, which contain omega-3 fatty acids, are best for your heart. These fish include tuna, salmon, mackerel, lake trout, herring, and sardines.

 Limit sugar intake.

If you must use sweeteners, use bee honey or brown sugar.

Limit salt intake to 2,300mg/day

Encourages 4-9 servings fruits/veg. per day.
Eat a wide variety of fruit and vegetable servings every day. Notice that vegetables have almost no calories and can help in weight loss. It is advisable to eat fruits and vegetables of all colors like dark green, deep orange, yellow etc. Each color variety is rich in different micronutrients.

Limit meat intake to less than 6 oz. Fish, meats and lean poultry daily

Evidence-based practice is ”a process, which encompasses the use of best available evidence alongside clinical expertise and the patients’ perspective, to plan care as well as evaluating the performance through a process of self-reflection or peer assessment” (Scott & McSherry, 2009, p.1090). Evidence-based practice is “A core body of nursing knowledge is derived from the process in which research is incorporated into practice; this process has been called best practice, quality of care, and evidence-based practice” (Boswell & Cannon, 2011, p. 23).

Melnyk & Fineout-Overholt (2005) suggested five key elements of evidence-based practice. These are : -

• Asking the important clinical question.
• Collecting the most relevant and best evidence.
• Critically appraising the evidence.
• Integrating the evidence with one’s ownclinical expertise and patient preferences tomake a practice decision.
• Evaluating the outcomes of that decision.

References:

Boswell, C. and Cannon, S. (2007). Introduction to nursing research: Incorporating evidence-based practice. Sudbury, MA: Jones and Bartlett

Scott, K., & McSherry, R. (2009). Evidence-based nursing: clarifying the concepts for nurses in practice. Journal of Clinical Nursing, 18(8), 1085-1095. Retrieved from CINAHL Plus with Full Text database.

The following is a fascinating list of 10 facts about oral contraceptives: -

1. Birth control pills won’t make you gain weight. While maternal hormones like progesterone is associated with weight gain during pregnancy, progesterone based OCs does not cause weight gain.
2. Combination OCs (estrogen/progestin) can prevent ectopic (tubal)
pregnancy.
3. Oral contraceptives can help prevent ovarian cysts, endometrial cancer and
colon cancer. They cannot prevent sexually transmitted infections.
4. Using OCs in your 30s could help prevent hip fracture later in life.
5. Oral contraceptives can prevent heavy bleeding during your period and
reduce the risk of iron-deficiency anemia.
6. Oral contraceptives can reduce the risk of ovarian cancer, including some
hereditary forms associated with mutations in the BRCA1 and BRCA2 genes.
7. There are no serious medical consequences to skipping periods by using
birth control pills as continuous contraception.
8. There is a chewable birth control pill, Femcon Fe, that includes seven days of
pills that contain iron.
9. Today, more than 40 different OC brands are available to U.S. women.
10. Oral contraceptives may not be for you if you are over 35 and smoke, are
overweight or obese, have diabetes or hypertension or a personal or family
history of clotting disorders.