Nurses Acknowledged: A Different Type of Nursing Management

As an advocate for patient well-being and general comfort, how do you, as a nurse, provide extra care beyond the expected medical intervention?

You know of the typical daily activities assistance, medication giving, cardiac/respiratory monitoring, injury protection, but how much time do you really spend to alleviate the untold burdens or ease the long-felt tensions of your patients?

The Doctors TV Show announced their favorite type of Nurse for the year 2012. And the best part, this nurse is a 'he'. Hospital Nurse Jared Axen is known as the 'singing nurse' in Henry Mayo Newhall Memorial Hospital, Los Angeles. He visits his patients and brings a smile to their faces with his talent in music.

courtesy of cbsla.com, Jared during his rounds

But how can the gift of song actually benefit ill patients?

Let's dig into the following effects of music therapy to the body...

Heart and Lungs: 
The right kind of music actually lowers blood pressure, puts the heart rate to a relaxed beat, and slows breathing cycles. This causes a calming sensation throughout the body. Notice the ambiance of spas and coffee shops? Where else can you find instrumental and country music?

Mind: 
The brain also benefits to these sounds. Mood can be improved and even sleep is induced. For those experiencing migraines or regular headaches, music can actually be the relief. Also, during moments of tension, this kind of therapy can alleviate stress and some studies suggest it can lessen the feelings of burden during a depressive episode.. And since music is known to stimulate brain cells to both hemispheres of the brain, a person gets to experience better data retention and a boost in learning performance. Try playing a tune when studying or memorizing for an exam.

Others: 
Now aside from the above triad, effect of rhythm can involve the rest of the body too. Researches have revealed that listening to music allows the release of immunity-enhancing hormones while decreasing the stress hormone cortisol.
When a person also gets to hear inspiring songs, bodily movements are easier performed - just like how you would like to listen to your favorite tune to start your morning and even assist you in house chores or office tasks. Somehow music creates a movement response when this kind of psychological stimuli is induced.
Lastly, and for me the most profound, is that music therapy eases chronic pain conditions.  This is so because the act of listening usually leads to visual imagery, thus spawning creativity. And since imagination is bred, divertion, emotional stimulation, and a sense of control also tend to be the result.

What I have noticed in the study and application of nursing is that communication is very essential. Yes we've heard about therapeutic communication for the nurse-client relationship, but sometimes in the actual circumstance, going beyond what the books have taught us might just actually work. That's where our talents come into place. Singing, storytelling, drawing, or simply being there for the client as a worthwhile presence can make a difference. We don't actually have to be as talented as Jared in the field of music to please a patient. We sometimes just have to shed our passive scales and reach out more often, with or without public acknowledgement...because the right way of nursing always involves the matters of the heart.

'God has blessed me with so much, it's the reason why I do what I do.' as Jared puts it.

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(Jared Axen currently resides in Santa Clarita Valley. He took up an associate degree majoring in Music, before he decided to juggle it with the nursing course. He was also nominated a Service Excellence Award by a family who have deemed him an essential figure in the remaining days of their ill-stricken member. He later received the Southern California Hospital Hero Award during November of last year.Throughout his staff nursing years, Jared has used his golden voice to cheer up patients and make them feel not just taken care of, but at home.
The Doctors TV Show is an American talk show airing in the US, Australia, Canada, and other parts of the world, lasting an hour long.The show was originated by Dr. Phil McGraw and is starred by a cast of physicians who discuss about medical and health issues.)


For a glimpse of Jared's performance to and with the patients, check out this video from CBSLA News:
http://losangeles.cbslocal.com/2012/12/01/nurse-finds-intriguing-way-to-comfort-his-patients/

7 Things to Consider in Looking for a Nursing Home

None of us wish to see our senior citizen loved one separated from us, but there will come a time when our energy and even skills can no longer be enough to handle the care these kinds of patients need and deserve.

Being apart can already be unbearable enough for both parties. That is why choosing the right nursing home for them should be planned and researched ahead of time, as well as performed with utmost scrutiny. So use your senses wisely and start your investigation with the following tips in mind:

Cleanliness

It should be a basic criterion for scouters such as you to assess for the neatness of your loved ones’ home-to-be. Checking if the nursing home is generally clean, is also gauging the staffs’ attention to residents’ daily spills, dirt, and clutter - simply with your first sight.

Aside from using your eyes in determining cleanliness, don’t fret to use your nose and hands as well. Check for unusual odors. Whether these could be scary spoiled food or human waste and vomitus, odor can indicate how much time and seriousness is spent by the staff to eliminate these discomforts.

For dust and grime, don’t be afraid to touch-check countertops, desks, and other furniture.

Cleanliness though is not merely the absence of dirt nor the presence of spotlessness. What we tend to forget is that organization also contributes to making an area look clean.  So aside from magnifying corners and surfaces, look at the residence in general. Are the furniture situated in proper place and order?

Safety

Dealing with geriatric patients should always involve the analysis of safety. Since aging can affect memory, judgment, and balance to name a few, nursing homes should have these elderly-safety measures.
One simple requirement is proper lighting all throughout the house. If there are rugs and carpets, they should be fastened and slip-free. Hallways should be wheelchair accessible with easy handrails on the walls. Facilities should not be faulty but functional, which can include faucets, door knobs, heating and cooling systems, and basic appliances. Their alarm systems should also be present and working. These can be call bells/buttons, smoke detectors, and sprinklers.

It is also essential to know the nursing homes’ protocols in case of emergencies. Let them show you their first aid kits, fire exits, extinguishers, list of telephone numbers to call, and if possible, the nearest route to the nearby hospital. Are they knowledgeable enough of the guidelines to follow in case accidents happen?

Food

Another aspect that you should take into account is the food the residents are sufficed with. They should be able to eat varied, clean, nutritious, and appealing meals served in the right temperature at the right time. Snacks should also be available at some hours and special diets should also be considered. Furthermore, eating time must not be pressured. This should serve as a comfortable session for socializing. How about asking one of the residents about their view of the food?

Activities

Be informed as well of the nursing home’s activities. Know more about their choices for the resident’s leisure time, social situations, and religious participation. Inquire if residents can choose their daily routine too, such as bed time, bath time, and entertainment. Take a peek at their outdoor area if such is safe for your loved ones. Are the activities and areas appropriate and stimulating?

Personnel and Nursing Care

Now that you’ve probably taken the tour, assess the staff available. It would be best if you know someone from the facility whom you can refer to right away for updates and someone you can trust for the truths of the nursing home. But if there is none, perform a quick holistic investigation of the employees. Ask if their staff underwent a background check before being hired. Know about trainings and seminars they have attended with regards to geriatric care, or if the staff have previous reliable experience with such patients. Make a mental calculation or confirm the nurse-patient ratio data.
Get to know about their care plan, as this is their guide for nursing care. Consider a kind of care plan where both you and your patient can decide together with the health workers the management your loved one receives. You may also inquire if there are residents similar to the case of your patient. So you would know if they have experience in that specific management, and to what state they have maintained if not improved optimum wellbeing. Ask about medications as well; how these are stored, given, and recorded.

Now by the time you’ve spent enough dialogue with your key person, evaluate to which depth she has answered your queries and whether these are clear, precise, and unassuming. Also get to check other staff if they appeared to be interested and accommodating with guests such as your arrival. Notice the expressions and appearance of the residents they handle if they are clean-looking, well-dressed, and comfortable.

Special Services

Some more things to consider are the overall and special services the nursing home offers. These therapeutic services can include, physical, occupational, speech, dietary, Alzheimer’s, etc. and may sum up to additional fees, so make sure you are informed of such, if ever you wish to avail. Speaking of fees, ask to be oriented about their billing process.

Another info you should be aware of is physician access. Know the flow on medical assistance and if the patient can have an easy communication with his or her personal doctor.

Most nursing homes have affiliated community organizations which are usually composed of volunteers; check this aspect as well.

Then move on to the allowable visiting hours and means of checking your loved one’s condition in the nursing home.

Legal Matters

Lastly, and most importantly, you must be aware that nursing homes are surveyed each year and must comply with State standards. Let them show you their certificate and business permit. A nursing home can have it all, but if they aren’t allowed to engage in business legally, then your visit can be rather a waste of time. Ask about Medicare and Medicaid too.

So when you’ve found the appropriate nursing home for your loved one, get into even more minute details and go for a comprehensive checklist. Visit the links below for printable materials.

http://www.medicare.gov/nursing/checklist.asp

http://www.caregiver.com/channels/ltc/articles/nursing_home_checklist.htm

Then let me know how it goes. Happy scouting!

Nursing in the Philippines: Why so caring?

Do you remember the time when a Filipino nurse was hailed by US President Obama because of her unconditional act of saving helpless babies during super storm Sandy?

To quote, this is what the president said, “We should follow the example of a New York City nurse named Menchu Sanchez. When Hurricane Sandy plunged her hospital into darkness, she wasn’t thinking about how her own home was faring,” Obama stated during his address before a joint session with the Congress. “Her mind was on the 20 precious newborns in her care and the rescue plan she devised that kept them all safe.”

But President Obama is not the only one who gets to notice Filipino nurses. These “angels in the sickroom” are positively acknowledged elsewhere in the world. But why is that so?

What makes Filipino nurses who they are? What kind of training do they undergo in the Philippines?

And what makes them master the art of caring above every other native nurse?

Few of the answers are found in this English-translated article from the popular and well-loved Bob Ong Quotes. You may tend to giggle and LOL at the scenarios, but the following reality is actually the pitiful truth of the state of the Philippine nation.

Healthcare in Philippine Public Hospitals

“You are a nurse in the Philippines if you can relate to this:

A nursing student once asked me, ‘Sir, where can we get a URINAL?’

My answer went, ‘My dear, you are not in a private hospital. Go and look for an empty Intravenous (IV) plastic bottle, cut it, make sure the edges are not left sharp, and let your patient use that as a container for his urine. That’s also what you have to do when your patient is vomiting and needs an EMESIS BASIN.’

Do you need to give IV medications but do not have an AMPULE BREAKER? It would be difficult to break the glass; but don’t worry, just use your BANDAGE SCISSORS. Use it as a saw to file the neck of the ampule, and surely it will now be easier to open.

Are you performing suctioning but your elderly patient tends to bite the suction catheter? Get a syringe, remove the needle and plunger, wrap it with clean gauze, and allow him to bite that instead. It will now be easier for you to suction. But of course, don’t forget to take it away right after. It is better that way than to purchase a BITE BLOCK, since your patient already has the scarce means to purchase such.

Even More Resourcefulness

You are about to do blood transfusion….and you need a COMPRESSOR because the transfusion won’t flow? DON’T LOOK FOR WHAT ISN’T AROUND! Use a BLOOD PRESSURE CUFF..

Do you need to cover an IV Fluid bottle because its contents are sensitive to light? WRAP THE BOTTLE AND TUBES WITH CARBON PAPER..

No hot water bag nor ice pack? Use RUBBER HAND GLOVES…
…and speaking of gloves…these can also be placed into the autoclave to be reused…gloves are still good to go AS LONG THERE ARE NO HOLES YET!!!

Now, if you need a FACE MASK to ‘nebulize’ a pediatric patient, and because there’s no supply and your patient cannot afford one, JUST TAKE A CLEAN BOND PAPER, SHAPE IT INTO A CONE, AND ATTACH IT TO THE KIT USING TAPE…OTHER NURSES USE STYROFOAM CUPS, these are much durable though!! Hehe..

There’s a lot of hospital admissions and lesser OXYGEN TANKS available…what a head nurse usually does is to split the main tube, then attach the nasal cannulas to the two patients…that way more people can benefit!

No more IV stands?? The common intervention is to… ‘GET AN ALUMINUM WIRE… (So what do I do, hang myself? Hahaha No!) ATTACH IT TO THE CEILING, MAKE SURE IT IS SECURELY DONE, THEN HOOK THE IV BOTTLE TO THAT!!

So that’s what the nurse did, and jokingly prayed… ‘Lord, please don’t make it to the point where even the BEDS need to be improvised…

...hmm there still ARE enough WHEEL CHAIRS though, I think those are better resting places if more sick patients arrive..’

During Code Blue… ‘Where’s the CARDIAC BOARD???!!!’

‘ Alright, wait..here it is, here it is…’

‘ Whoa, PLYWOOD??!! Where did you get that?’

‘got that from the nearby window sill..’

OR if the patient is a child, make use of the wood from the BEDSIDE TABLE!... at least the patient gets to be revived.. (think)

Now, Mr Patient can’t pay for a MECHANICAL VENTILATOR…well, our powers can no longer reach that far!!! So all day long, the watcher must use the AMBU BAG (BVM). He can just do alternate rounds with another of the patient’s watchers… but what if there’s only 1 watcher? Well, what else, SUPER NURSE to the rescue!! ‘Uhm Sir… allow me to do that even for an hour, so you can go rest and have your lunch first’.. 

The difficult part is when the relatives decide to sign the HAMA form because they no longer have the means to pay even if they already belong to Charity Patient Class D….

...oh life is so hard.

A nurse supervisor once said, ‘You’re in a government hospital, if you follow the ideal measures and interventions, you’re never reviving your patient.’”

This is also true in the public ward settings of a private hospital. Many of these patients struggle to survive. That is why getting sick can be the worst thing that could happen to their budget or even their life; because outside the hospital, feeding the right quantities and qualities to their families is even barely attained.

How These Affect Filipino Nurses

Nurses who have never gone to the Philippines nor any other third world country, might simply shake their heads at these scenarios. Some may even find it funny, especially in its original vernacular form, but these circumstances have forced Filipino nursing students and staff nurses alike to harness their analytical abilities. Imagine having to deal with these every day - endless admissions with such pitiful lack of resources in crazy shifting schedules at a meager salary.

So by the time they get to go abroad and experience the ideal settings of patient healthcare using the latest technology from foreigners who have much to pay, they find their duties to be a dip in the tub. And since Filipino nurses have been used to such stressful situations, they tend to go beyond what is assigned to them to make their patients feel extra comfy.

How about you, what do you think nurses from the Philippines have in common which make them that way? Have you had an enlightening experience with a Filipino nurse?

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(Consider me spamming with the excessive exclamation points and caps, but I preferred to retain the punctuation marks and all to get as close as possible to the original vernacular form.)

Photo sources:
carepathways.com
shopmedvet.com
consumer.org.hk
walmart.com
commons.wikipedia.org
surgmed.com
whitemiremedical.com
nwmedicalsolutions.com
shop.gohcl.com
webmd.com
rubbermarketnews.net
medical-supplies-equipment-company.com
cardinalhealth.com
charlestonpulmonology.com