Thought & Action: multitasking, the civil class, and the scholarly voice

2008 is drawing to a close, but not before I could read the autumn'08 issue of Thought & Action, the National Education Association's journal of higher education. This issue contains three articles related to technology (or at least modern life) and education. Although they're not presented as such, all three seem related to me.

You Say Multitasking Like It's a Good Thing

In the first article¹, Professor Charles J. Abaté reviews with a skeptical eye the issue of "multitasking." He identifies three myths related to multitasking that he refutes with evidence from psychology: (1) multitasking saves time, (2) learning while multitasking is as good as learning while single tasking, and (3) the young have an advantage at multitasking. At least the first two clearly have something to say to nursing and nursing education.

Sources that I don't have time to re-find and cite here have suggested that multitasking is a skill at which women excel (or at least are better at than men) and is a professional characteristic of nursing. As Abaté suggests, this is likely not true. What's more, the suggestion that multitasking is a skill rather than a necessary evil of nursing changes the terms of the issue in a way that is likely not good for patients. The necessity for mutlitasking is something that should be reduced or rooted out systemically at the health institution level, not something that students should be indoctrinated with at the educational level. For example, at my hospital, those on the 7pm-7am shift have to do shift assessments at 7pm and again at 11pm. Charting is something that is necessarily done in snatches of time here and there. Since multitasking nurses are not actually saving time, it's an efficiency reducer and administrators should seek to reduce its incidence.

Multitasking indoctrination occurs in nursing school mostly in relation to clinicals. I have often thought that the idea of learning medications by researching patients is a bad idea, and Abaté seems to agree with me. My personal thoughts on patient research and learning medications (and lab values, pathophys, etc) have had more to do with the half-life of information and repeated sustained study, but the multitasking issue adds its own dimension--learning while multitasking does not support analytical thinking. Abaté's evidence here is a study from the 2006 Proceedings of the National Academy of Sciences. It's an interesting study with regard to the clinical learning design of nursing school and something I'll return to in a future post.

The Civil Classroom in the Age of the 'Net

In the second article², Professor P.M. Forni addresses the problems educators face with kids these days. Just at the end of this last semester, one of the faculty at my school was describing to me how the graduating class below mine complains that all the requirements imposed on them are too stringent and should be reduced. While I have a lot of complaints of my own about nursing school, I have simpathy with things like the required 73 test average for passing and penalties for absence and tardiness. The way students act these days is preposterous, although to try to be fair, I often also feel the anxiety and anger that they seem to feel free to express. Forni makes several suggestions with, in my opinion, mixed usefulness:

Establish a climate of relaxed formality. Control in nursing education is a problem, but formality is not control. Nursing is quite different from other undergraduate programs in the degree of time spent together, whether students all taking the same courses or faculty spending hours at a time with students multiple days per week. The authority gap can disappear, and establishing formalized boundaries can help with this. Also, as an instructor, informality leaves you open to manipulation. If you need to be called by your first name to feel younger, a little bastard can start calling you Mrs. X to tear you down a little. I did that.

Train students to distinguish the trivial from the valuable. Forni suggests that the web-based equality of valuable and trivial material means each course should start from the philosophical perspective of why we are engaged in this study and, having established value, show students how to differentiate good and bad web sources.

Sell your product and yourself. Forni distinguishes the cultures of knowledge retention and knowledge retrieval. This is actually a really big deal, and I confess to being one of the "bad" students in this regard. I depend on lab values and medication information being available at my fingertips. Forni makes the point that knowledge retention is necessary for future learning. In order to make analytical connections, you have to actually remember. I agree.

However, Forni fails to note that this point does not solve the problem of why the student has to sit in a class. Retained knowledge can be tested remotely and gleaned from books and the web without classroom attendance. What is the professor's role? Forni doesn't say exactly.

Let's face it. The modern education system was designed in a time when knowledge was passed from person to person. That time is passed. Either professors bring something extra to the classroom or they are obsolete. Bad professors bring props and humor. Good professors bring illustrative anecdotes and try to identify the areas where these specific students are having trouble.

Stipulate a fair covenant. I think this suggestion is rather poor. I had a nursing professor who did this and then felt she couldn't make a change in the syllabus that both she and the class wanted--duh!

A mixed bag for the road. Here, Forni implies that instructors should seek to diminish the digital divide between themselves and students. I have mixed feelings about this. It's all right as long as two things are kept in mind: (a) making things fancy won't cut it and (b) web-based material still needs to be structured. Filling up PowerPoints with nice backgrounds and ClipArt is not learning how to use PowerPoint effectively. Putting up an extranet site for a course that's full of broken links and files too large to view quickly is taking a step back, not forward.

More on civility from Forni at Johns Hopkins website.

Scholarly Voice and Professional Identity in the Internet Age

Professor Douglas Harrison [LinkedIn] teaches English and also blogs on Southern gospel music. In the third article³, he addresses working in "mixed modes" on his blog (posting things with an academic, critical voice and also trivial and personal things) and suggests that academic blogging should no longer be seen as something to undermine a professional academic career. The points here about niche audiences, forming new intellectual communities, and personal enrichment will be familiar to those who have used the Interwebs since about 2000. The one thing that really strikes me, though, is the reference to an academic who says blogging takes up more of the time he used to spend watching TV and reading mystery novels. Spending all one's time thinking about one's academic field does not strike me as a good thing.

1. Charles Abaté (2008). You say multitasking like it's a good thing. Thought & Action, 24, 7-15


2. P.M. Forni (2008). The civil classroom in the age of the Net. Thought & Action, 24, 15-22


3. D. Harrison (2008). Scholarly oice and professional identity in the Internet age. Thought & Action, 24, 23-34

Home Health: water your Christmas tree

Greetings loyal readers. I've taken some days off here for Christmas, but now I'm back! Tonight, December 28th, we enter the 4th day of Christmas. For those of you who don't know, the "12 days of Christmas" song refers to an actual calendar period stretching from December 25th (Christmas) to January 6th (Epiphany, which commemorates the visitation by the three wise men). Epiphany, it seems to me, actually adds an eschatological dimension to Christmas, but let's not drift into theology here...

What I really want to mention is the importance of watering your Christmas tree. In this age of iron, many people have moved over to fake trees, but some still purchase the real thing (and a select few cut it down themselves). If you are one of these, please note the videos below which demonstrate the utility of keeping your tree watered.

As you may have heard in your hospital before, you're not supposed to try to put out fires larger than a television set (or old-style computer monitor). The first video shows a Christmas tree fire enlarging beyond that point in about 3 seconds. The second video shows, I believe, the difference in burning between a dry and a moist Christmas tree.

You wouldn't let your patients get dehydrated, don't let it happen to their Christmas trees, either!

Heart bypass as hypothermia treatment

We received a "cool" admission the other day in the Step-Down unit at CVPH. Normally, I wouldn't be able to mention this because of HIPAA laws, but it was written up in our local newspaper, so let me simply repeat what's already out there:

PLATTSBURGH -- On Christmas Eve, Merrill Sartwell will turn 84 years old.

He almost didn't make it.

"I guess I'm a miracle baby," Sartwell said from his comfortable bed in the Intensive Care Unit at CVPH Medical Center.

Sartwell went from his Peru home into the woods in Clintonville to check on a few things at a tool shed Sunday.

His vehicle got stuck, and he started walking out of the woods. But he got tired and sat down for a moment to catch his breath and fell asleep.

He wasn't found until the next day, when a logger driving by noticed something and went to check it out.

Sartwell's body temperature had dropped to a dangerous low of about 80 degrees Fahrenheit.

He was brought to the CVPH Emergency Room where Dr. Russell Hartung began treatment. Hartung consulted with cardiovascular surgeon Dr. Albert Abbott.

After a CAT scan to determine if Sartwell had fallen and hit his head, Abbott put Sartwell on a heart-lung bypass machine.

The machine, hooked up to a main artery in Sartwell's neck, actually warmed his blood up to a safe level in just under an hour.

"This procedure works very well for severe cases of hypothermia," Abbott said.

"It helps to have the right patient."

A few days later, Sartwell was resting comfortably and giving his nurses a hard time -- with a smile, of course.

"They've been treating me very well here," Sartwell said Thursday.

"But that's why I pay my taxes."

Sartwell doesn't remember exactly what happened to him, but he is grateful for the help he received.

"I guess I went a little brain dead," he said.

"That was quite an experience, but I wouldn't want to go through it again."

Sartwell was dressed in cotton pants, boots and a regular jacket.

"If I had known I was going to stay overnight I would have dressed better," he joked.

Dr. Abbott was pleased to see his patient doing so well.

"I'm glad to see it turn out this way," he said.

"It's important for people to know that we have this technology. This is the North Country, and a lot of people are outside in the cold, and this sort of thing does happen."

'Rod's mom, RIP

This photo is from my Flickr stream and is one of my great co-workers (as opposed to my not-so-great co-workers, of which there are enough). His mother died recently. Because our local paper wasn't on top of things, the online obituary notice for Linda Lamica wasn't available at the time of the funeral, but it is now:

TUPPER LAKE — Linda Mary Lamica, 59, of Plattsburgh and formerly of Tupper Lake, died peacefully with family at her side Wednesday, Nov. 19, 2008, at CVPH in Plattsburgh after a brief battle with cancer. Linda was born May 23, 1949, in Tupper Lake, the daughter of Irvin and Rita (Grenier) Lamica.

She attended Holy Ghost Academy until her junior year and with the school closure, transferred to Pius in Saranac Lake, graduating in 1967. She then went on to attend CCBI in Syracuse. She worked mainly in Social Security benefits and lived in the Syracuse area the majority of her career. She had a variety of interests, including traveling, skiing, snowmobiling, crocheting and other crafts.

She is survived by one son, Jared Lancor and his wife Erin of Plattsburgh; two sisters, Anne Marie Bedore and her husband Glenn of Tupper Lake, Jeanne Lamica of Plainfield, Vt.; two brothers, the Rev. Alan Lamica of Saranac Lake and John Lamica and his wife Dina of Tupper Lake; nieces and nephews who include Emily Churco of Buffalo, Jesse Bedore of Tupper Lake, Kaley Cook and Kyle Cook.

She was predeceased by her parents in 2007.

Calling hours will be held from 10 to 11:45 a.m. Saturday, Nov. 22, at the Stuart-Fortune-Keough Funeral Home in Tupper Lake. A Mass of Christian burial will be celebrated at noon at St. Alphonsus Church with Father Alan Lamica officiating. Burial will be in the parish cemetery.

Those wishing to make memorial contributions are asked to consider the American Cancer Society or High Peaks Hospice.

Online condolences may be made at www.stuartfortunekeoughfuneralhome.com

Virology presentation: chlamydiaphage chp2

For my final presentation in Bio416, I presented all the research I could find on Chlamydiaphage Chp2. Hopefully, I'll be writing more on this in the next week or two as another installment of ResearchBlogging...

Gokushovirus

Vogue Paris 2009 calendar: sexy or dumb?

I've never understood the attraction for some men in the sexy nurse image. I've never thought nurses were sexy. The sexy women I've met who were nurses either wanted to get out of nursing or weren't very good nurses. Anyhow, Vogue Paris has released their 2009 calendar with the following (dumb) image. Via


I mean, honestly, if you were going to have a nurse fantasy, wouldn't it be one where the nurse was actually acting like a nurse?

Finals (semester?) over: we take this opportunity...

Monday morning was the final exam in Nur435 Psychiatric Nursing. Monday afternoon was a presentation on my Nur427 Nursing Research project. Monday evening and all day yesterday, I worked on the term paper and "journey paper" for Nur428 Management/Leadership.

Hopefully, all my nursing is over for the semester. I only needed to get about 25% of the points on my research project, so I should be okay, although the literature review and ethical/legal components that I left to my partner ended up being weighted most in the grade. There's also the possibility that I could fall on my face in Management/Leadership. The class was very disorganized, and I'm not sure what the instructions for the term paper were even after asking the instructor to clarify three different times (I ended up just using the grading rubric as an outline, which makes a piss-poor paper).

Now all I have left is a presentation for Bio416 Virology. It could go well except that we've had about a month to work on it and I have to do it all today and tomorrow morning. As the NA's would say at work, "oh shit balls..."

Anyhow, I take this opportunity to provide a little "Bach break" from finals by way of David Post's son. Via Volokh Conspiracy...

Nursing at Pearl Harbor

In a panic for a paper due tomorrow in Nur428 Management, I almost forgot that today is Pearl Harbor Day--commemoration of the attack on the US Navy base at Pearl Harbor, Hawaii, on December 7, 1941. Over at The Corner, Stephen Spruiell has visited a gathering of Pearl Harbor veterans in Texas...

...85-year-old Frank Curre Jr., agrees to talk to me. His story is harrowing. He was only 18 when his ship, the U.S.S. Tennessee, was bombed in the attack. He saw the U.S.S. Arizona explode when a bomb ignited its ammunition magazine. He describes the resulting carnage as “like someone threw up a box of popcorn into the air, the popcorn was the men coming off her.”

Of course, nurses were at Pearl Harbor, too. Lieutenant Ruth Erickson remembers...

The first patient came into our dressing room at 8:25 a.m. with a large opening in his abdomen and bleeding profusely. They started an intravenous and transfusion. I can still see the tremor of Dr. Brunson's hand as he picked up the needle. Everyone was terrified. The patient died within the hour.

Then the burned patients streamed in. The USS Nevada (BB-36) had managed some steam and attempted to get out of the channel. They were unable to make it and went aground on Hospital Point right near the hospital. There was heavy oil on the water and the men dived off the ship and swam through these waters to Hospital Point, not too great a distance, but when one is burned... How they ever managed, I'll never know.

The tropical dress at the time was white t-shirts and shorts. The burns began where the pants ended. Bared arms and faces were plentiful. Personnel retrieved a supply of flit guns from stock. We filled these with tannic acid to spray burned bodies. Then we gave these gravely injured patients sedatives for their intense pain.

Orthopedic patients were eased out of their beds with no time for linen changes as an unending stream of burn patients continued until mid afternoon. A doctor, who several days before had renal surgery and was still convalescing, got out of his bed and began to assist the other doctors.

Video of neutrophil chasing bacterium

UPDATE 12/7 : looking at this again, I realize I accepted uncritically the fact that this was a neutrophil. Look at the tail. Perhaps it isn't. I don't really know...

This is really amazing...


via Greg Laden's blog

Discover article on men's health dx

Discover has an interesting article that recounts the diagnosis of a man with diffuse neurological symptoms. From 29, Male, and Dangerously Ill:

The signs were not good. Photophobia —light bothering the eyes—is a classic symptom of infection or inflammation of the meninges, the lining of the brain. Ataxic gait—inability to walk a straight line—suggests damage to the cerebellum, the brain’s coordination center. Most odd and worrisome was the difficulty urinating. That suggested a tumor or infection in the spinal cord.

The symptoms were all over the neurological map. I got off the phone and found the charge nurse. “Jeannie, Dr. Giron is sending a patient down. Possible meningitis. We need an isolation room.”

Nursing research final, part 2

And here is the second essay from the final...

Discuss the distinction between research utilization and evidence-based practice. What do you see as your role in applying research to practice? How will you recognize the need for further research related to a patient-care scenario and how will you know when any given research is ready for utilization? What are some barriers to RU and EBP you may encounter and strategies for overcoming those barriers? (10 possible points)

Research utilization (RU) and evidence-based practice (EBP) may be presented as the same thing in some sources, but they are not. One way to think of the difference between RU and EBP is to consider RU as a technical process and EBP as a paradigm of the clinical environment. RU refers to the process of applying the results of studies to problems in real-world circumstances. The definition of "problem" here can be quite flexible, and RU has been described as existing in a continuum from narrow approaches such as changing protocols to broad approaches such as changing staff attitudes to problems-solving (Polit & Beck, 2006). EBP refers to a way of conducting oneself or one's staff in a setting of continuous patient care such as a hospital or public health venue. It means making patient care decisions in light of the best possible empirical knowledge, and it is essentially a way of defining the relationship between health care and the social and natural sciences.

One way to conceive of the difference between RU and EBP is to consider what types of questions are asked under these two approaches. Strictly speaking, RU might not be a type of questioning, but could be something that could be used in the process of answering questions. However, RU could also represent an approach to questions that starts from the science: "Here is some research. What does it mean for us?" EBP represents an approach to questions that starts from clinical problem-solving: "Here is a problem. What research exists for us?"

Between the two approaches of RU and EBP, nurses do not actually have to choose. Besides titled positions (such as CNS) dedicated to performance review, the role of a nurse applying research to practice is mutlifaceted and can be conceptualized by looking at the two types of questions above. The EBP question starts from a clinical situation, so it implies that the nurse is in a practice situation already. The RU question starts from research, which would be found in perusing journals or databases, so it implies that the nurse is engaged with the research outside the clinical situation. EBP is a theoretical approach to patient care, but RU is part of the professional aspect of nursing--continuing self-education and keeping up with the latest knowledge in the profession by reading journals. The role of the nurse who subscribes to EBP is to define problems during practice and approach the literature in off hours to define solutions to those problems. The role of the nurse as professional is to read broadly and maintain education related to the latest science.

In order to succeed with either EBP or RU, the nurse must be familiar with the specific jargon and methodologies used in research studies. For nurses engaged in EBP, it is necessary to know when the research that has been found is adequate to solve the clinical problems and when further research is needed. For nurses engaged in RU, it is necessary to know when specific studies are appropriate for being brought to the practice setting. Together, these are the skills necessary to evaluate evidence. Questions must be asked: Was the sample representative? Was the questionnaire valid and reliable? Did the interviewer adequately control for her own preconceptions? Were the results significant enough (p) to be meaningful?

One would hope that the hard work of reading the methodology closely would be done by journal editors and peer reviewers, but that is not always the case as some research might not be adequate to change practice but might be publishable for its value in suggesting new directions for research. To make things easier for those using research, systematic strategies have been devised such as Cochrane-based evidence hierarchies and multiple practical models (e.g., Stetler and Ottawa). These provide guidance to the reader on the quality of studies and the method for decision-making about studies. In the end, however, the nurse is left to contend in her own local health-care setting with her education and wits.

And wits the nurse may need aplenty if she is to overcome some of the barriers to RU and EBP. Polit and Beck (2006), describe a number of these in the eighteenth chapter of their text. The barriers described there run the gamut from individuals to organizations and inertia to intention. Examples include a lack of education for research skills on the part of nurses, lack of financial incentives on the part of hospitals, and the perceived threat of those whose practice must change in the face of evidence. But one possible barrier is not addressed in this chapter. Does the profession of nursing, by its nature, appeal to people who are resistant to research review?

In talking with ICU and PCU nurses at a local hospital, themes emerged of impatience with and disinterest in research, as well as social marginalization of nurses who were interested in such "intellectual" pursuits. Comments were made such as "I'm a hands-on learner" and "I wanted to be a nurse so I would be doing something." EBP has definite advantages for patients and RU is a clearly important component of patient care, but the skills and psychology of administering bedside care and pursuing research represent a type of task-switching that other professions are not asked to do.

This barrier is a difficult one to overcome since it relates not only to nurses' conceptions of the profession of nursing but also to their own identities. It is a shame to say that the most consistently successful and implementable idea would probably be a transactional solution related to nurses' job responsibilities. Providing more personal time or breaks in exchange for participation in journal clubs or study participation would force nurses to describe their responsibilities differently. A more deeply successful idea would be a transformational solution. Unfortunately, this is less implementable since transformational leadership so often requires inspiration itself.

References

Polit, D.F., & Beck, C.T. (2006). Essentials of nursing research: Methods, appraisal, and utilization (6th ed.). New York: Lippincott Williams & Wilkins.

Bioweapon attack in five years

From the AP, here:

WASHINGTON (AP) — A bipartisan commission is asserting the country should expect a terrorist attack using nuclear or biological weapons sometime in the next five years.

The report, which is scheduled to be publicly released on Wednesday, suggests that the incoming administration of President-elect Barack Obama should improve the capability of the United States to counter such an attack and to prepare if necessary for germ warfare.

The report was written by the Commission on the Prevention of WMD Proliferation and Terrorism. Among other things, it concluded: "Our margin of safety is shrinking, not growing."

The commission also is encouraging the new White House to appoint a National Security Council official to exclusively coordinate U.S. intelligence and foreign policy on combating the spread of nuclear and biological weapons.

Nursing research final, part 1

I'm not sure why anyone would want to read this, but here is the first essay from my Nur427 Nursing Research take-home (mentioned in the last post)...

One of the identified essentials of baccalaureate nursing education is "scholarship for evidence based practice" with a goal of promoting "professional nursing practice grounded in the translation of current evidence into one's practice". In what ways has your nursing education at Plattsburgh prepared you to consider and utilize research in your future practice? (5 possible points)

The advantages of employing baccalaureate-prepared nurses in the hospital care setting has been demonstrated through lower rates of patient mortality. This is not simply a matter of extra training since the baccalaureate program uses a different emphasis in the preparation of nurses. Specifically, baccalaureate programs like Plattsburgh State's focus on a broader, scholarly approach to education that emphasizes participation in nursing scholarship post-graduation. Scholarship should facilitate the integration of evidence and patient care practices. To help examine how Plattsburgh has prepared students to integrate evidence into practice, a rubric is proposed based on distinguishing, within the educational context, ubiquitous integration from transparent analysis and intellectual exploration from practical application.

This proposal could be represented by a table in which integration and analysis on one axis would each intersect with exploration and application on another. Integration in this context refers to bringing principles of research and scholarship into the pursuit of knowledge aimed at non-scholarly activity. Analysis refers to the investigation of research and scholarship on its own terms. Exploration refers to the mental, abstract activities normally associated with classroom learning, while application here refers to learning through the experiences outside the classroom that require problem-solving in a non-academic environment.

At the intersection of analysis and exploration is the most straight-forward type of learning associated with research. The primary item in this field is the Nur427 Nursing Research course. The content of this course is designed to provide an introduction to tools--if not for the purpose of performing research, at least for the purpose of reading and understanding research. However, readings in the course have gone beyond research tools and touched on the history and theory of using research in nursing practice. In this way, the course has given structure and direction for the baccalaureate-level practice of nursing.

Nur427 would not be the only item in the field of analysis-exploration, however. General education courses such as statistics and introduction to sociology also belong. Like Nur427, statistics focused on some of the tools of research. Sociology provided an introduction to some of the theoretical underpinnings of research, which in turn provides direction for identifying research problems.

The integration and exploration field is represented by the type of work that was done in Nursing Fundamentals and Care of the Adult I. In those courses, research papers were assigned for which students were asked to summate the state of science on a nursing topic. Like Nur427, the work in these courses was aimed at an understanding of the research utilization process--especially, in these cases, the processes associated with reviewing literature. Unlike Nur427, the intellectualization of the assignments' purposes was integrated into the process of carrying out the assignments rather than being the assignments' content.

Toward the end of Care of the Adult I and moving on into Care of the Adult II, the course assignments became focused on Nursing Care Plans and the focus shifted to real patients. This work belongs in the field of integration and application. Evidence and nursing research was a key component of the creation of Nursing Care Plans, but its use never became the point of planning. It remained in the background, and the focus remained on solving the real problems that were presented to students by real patients in clinical rotations.

The final field in this table would be analysis and application. Should it be populated with anything? If it is like the other analysis field, it should include courses or assignments that are transparently and reflectively based on learning about research. And if it is like the other application field, it should be based on something like a clinical or field experience. The model would be a course about research usage that used real patients or real practice situations as a basis for exploring the process of research utilization. At PSU, the closest course to this model would be the Management/Leadership course.

One issue that, it seems, should be addressed in the transition of all nursing education to four-year programs is the place of a Management course in the curriculum. Educating all nurses for management, which is what would happen if the BSN/ADN distinction disappeared, is not resource-efficient. It would make more sense to substitute a Practice Review/Research Utilization course that would have a clinical component that would focus on how, as a floor nurse or specialist such as a WOCN or CNS, an individual uses research.

Anyhow, this table format does a good job of introducing formal aspects of the way PSU has prepared students to integrate evidence into practice. However, it does not capture the experience of the total liberal arts education. Extra-curricular events such as the Nomadicare presentation on nursing in Mongolia give salience to features of nursing research such as bracketing. And the experience of being in the university setting with professors who have or are engaged in their own production of evidenciary knowledge is exposure to leadership in this area.

Using GoogleBooks to assist with take-home exam

For Nur427 Nursing Research, we were given a take-home exam (vignettes and short-answer, thank God!) to be completed over Thanksgiving break. There were a few terms I wasn't really sure how to interpret in the context of the questions: in particular, "operationalize"--not a hard concept in research, but one we hadn't discussed and I wasn't familiar with. The index wasn't helpful as it only pointed to the glossary, which was inadequate. What to do?

Well, I got the idea of looking in GoogleBooks to see if the Index was an inadequate index. Sure enough, Essentials of Nursing Research (6th ed.) is available on GoogleBooks. And if you type in the term "operationalize" or "operationalized" in the upper-right-side search box, it turns out that the term shows up in many more places than the Index indexes.

I think this demonstrates another great (free) educational use of Google. Can't find something in your textbook? Use GoogleBooks.

The Patient Nurse by Diana Palmer

As you know, we live in a world where female nurses are often portrayed as objectified sex symbols. As a male nurse (student), I can live with this. In fact, to tell the truth, I, personally, am ready to live in the world of the objectified male nurse sex symbol.

The other day at work, I was waiting for a ride near the Fast Track entrance, where someone had dropped off a box of romance novels. Bored, I started to rummage through it. Then I noticed this book cover. Wow, I thought, this must be a book that presents a male nurse as an objectified sex symbol--this must be a first!! After all, you can see clearly that "the patient nurse" is the unfortunate (but patient) man who has to wait (patiently) for the heroine to figure out that it is really the male nurse she loves...
Ho, ho, hold on there!! You didn't read the back cover, did you? That's no male nurse, that's Dr. Ramon Cortero, and his "patient" is Noreen Kensington, "a nurse with a serious condition of heartache..." Remedy? Why nothing other than "A dose of old-fashioned loving!"

Yeah, baby, yeah!!

Fibers in the skin, but still no Morgellons explanation

Morgellons disease is characterized by skin lesions that contain fibers of unknown origin. Morgellons is often dismissed as delusional parasitosis or Munchausen's syndrome by proxy (now boringly re-named FII, fabricated or induced illness), although the fibers represent an objective finding and their origin is contested if not unknown. Critics insist the fibers are placed or at least synthetic in origin (fabric-induced illness?), while proponents of the disease point to a number possible origins such as production by the Argobacterium or some fungus.

In a provisionally-published paper by Almarestani, Longo, and Ribeiro-da-Silva, chronic inflammation was shown to induce the growth of sympathetic nervous system fibers in the dermis. The researchers injected complete Freund's adjuvant into the paws of rats and subsequently stained tissues after several weeks. Nerves were shown to change typical innervation of the lower dermis to innervation of the upper dermis as well.

Of course, nerve fibers don't really correspond to the fibers present in Morgellons as the images in the PDF demonstrate. My best guess is that Morgellons represents a few legitimate unrelated cases of pathology of unknown origin combined with a lot of DP and FII. It would be interesting, though, to discover a real pathological process at work in Morgellons.

1. Lina Almarestani, Geraldine Longo, Alfredo Ribeiro-da-Silva (2008). Autonomic fiber sprouting in the skin in chronic inflammation Molecular Pain, 4 (1) DOI: 10.1186/1744-8069-4-56

November

It's November. Actually, it's well into November and Thanksgiving is drawing close. Here's a photo of the street outside my house at about 5 o'clock the other day. Kind of depressing isn't it?

I hope I pass all my classes this semester...

Ebola Bundibugyo - new virus confirmed

Aetiology posts on the newly confirmed filovirus Ebola Bundibugyo. You can read about the virus on her blog or in PLoS Pathogens. What I'd like to mention is that I know nothing about any possible role of nurses in infectious disease work outside the role of "Infection Control Nurse" at a hospital. Does anyone out there? You can e-mail me if you do. (My e-mail address is in my blogger profile.) Thanks.

What causes 10% of seizures presenting in emergency rooms of the SouthWest?

Parasites in the brain.

Read more at Neurophilosophy. I won't recount the details here...

Carl Zimmer's tattoos moved

I think I posted on Carl Zimmer's science tattoos before, but now they've moved. This one is from a nurse...

Vital organs stitchery

Found here, via BoingBoing

Ilaria Capua

Seed magazine's "Revolutionary Minds" currently features people who are changing the way science is communicated. One of them is Ilaria Capua of the Global Initiative on Sharing Avian Influenza Data:

In 2006 virologist Ilaria Capua was studying samples of avian influenza from Africa. The World Health Organization asked Capua to deposit the genetic sequence of one of her samples into a database to which only a select few laboratories had access. She balked. "I said, 'Wait a minute, we're talking about a serious potential threat to human health. We know very little about how this virus is moving. Not enough scientists have had the opportunity to look at this virus.'" So Capua opted to put the sequence in GenBank, an open-access database, where it was downloaded 1,000 times in a single week. Capua's small act of rebellion was just the spark for a much larger challenge to the system...

Photoshare - international health photography

I just came across this interesting project:

Photoshare is a service of The INFO Project helping international non-profits communicate health and development issues through photography. We welcome you to browse the Photoshare collection, request images for non-profit educational use, and learn more about development photography. Our online photo database currently contains more than 15,000 cataloged images shared by colleagues around the world for documentary use.

Photoshare is supported by USAID and The INFO Project is a Johns Hopkins School of Public Health initiative. The photo above is the 1st place winner from the (2007) 5th annual photoshare photo contest.

Do not call Child Abuse Hotline

--UPDATED @ 22:03 -- After further consideration, my psych instructor has elected to give credit for answers (a) and (b) below. I suspect that means a large proportion of the class gave answer (b). In the spirit of giving credit where credit is due, I applaud her (unexpected) decision in this case. However, I still think my critical comments below are generally applicable.

I just had a quiz in psychiatric nursing. We were told it would be on the reading assigned for today, so I spent last evening going over the readings. On a ten-question quiz, at least 3 of the questions were not on material from the readings, including this one:

"You are at a soup kitchen and see a known pedophile coming out of the bathroom with a child. What is the priority nursing intervention?
(a) to call the child abuse hotline.
(b) to protect the child without intervening the self with the perpetrator
(c) to blah, blah, obviously wrong
(d) to blah, blah, obviously wrong"

So what would you do? In this situation, there is no information about things like, for example, where the telephone is or how many people are in the building. It's possible that the telephone is in an office down the hallway, and the building is filled with people. Would you leave the pedophile and child together to go call the Child Abuse Hotline? Or would you do something to secure the child and then call? The instructor's answer was (a), although I would do (b).

Do you agree with the instructor? If you reasoned that you would ask someone else to keep an eye on the child while you called the hotline, you would, first, be making an assumption about the availability of other people that is not stated in the question and, second, be giving (b) as the de facto answer by justifying your choice by first intervening to have someone else protect the child.

My instructor said that calling the hotline would result in having authorities arrive immediately to protect the child. Is that true? According to the New York State Office of Child and Family Services, calling the Child Abuse Hotline results in an "investigation of each report within 24 hours," not an immediate response. Moreover, according to NYS OCFS, if "you believe that a child is in immediate danger, call 911 or your local police department."

If you see a situation where a child could reasonably be in danger of abuse in the immediate future, your priority should be to protect the child, not to nab the offender. The fact that the situation is a known abuser in a transient public location indicates that the situation is an immediate one, not like seeing bruises on a child who is going home with her parents.

The rationale behind NCLEX questions is that they are "hard" because they demand "critical thinking skills." In my experience, "critical thinking" for NCLEX means correctly guessing what the instructor wants or the correct set of assumptions that the instructor has made about the situation. Note to all those who have not been educated outside the nursing profession: guessing what's the in the questioner's head is not "critical thinking."

The other day in nursing, we were told that those on high have determined that nurses need intern-like immersion experiences in order to be adequately prepared. We also know that there is a lot of shock amongst new grads and a high turnover rate in the profession. Maybe these are all indicators that nursing school does a crappy job of vetting/educating nurses?

Hump day video

In the MTV archive, I was looking for an '80s song I can never remember--something about "physical touches" and "then it tears you apart" or some such, and I found this video of an Olivia Newton-John song "Physical" that I've never heard before. Humorous video.

PSU nursing on TV

Recently, our Fox network affiliate did a report on the nursing shortage and featured PSU nursing. I don't know how long this link to the video will work, however.

Attention

I scored a 57 on their quiz...

House is Massive Attack's Teardrop...

(...also, soylent green is people!) I was reading BoingBoing's post on the new MTV video archive, when I noticed that one of the videos they had posted (of a song I had never heard of before), sounded and looked like the opening sequence of Fox's "House, MD." I looked it up, and, sure enough, everybody except me knows already! House uses the song "Teardrop" by the British band Massive Attack as its opening theme.

The only thing I can add to our collective knowledge is that the visual design of the opening sequence appears to be strongly influenced by the music video. Check it out for yourself:

And then there's the question of the lyrics: do they mean anything about the show House?; and what are they? Is it "Feathers on my breath" or "Fearless on my breath"? Is it "Nine night of matter", "In the night of matter", or "Night, night of the dead"? There doesn't seem to be a lot of agreement on the lyrics, and none of them make sense to me, but here's my best guess, as seen on LyricWiki:

Love, love is a verb
Love is a doing word
Fearless on my breath
Gentle impulsion
Shakes me makes me lighter
Fearless on my breath

Teardrop on the fire
Fearless on my breath

Night, night of the dead
Black flowers blossom
Fearless on my breath
Black flowers blossom
Fearless on my breath

Teardrop on the fire
Fearless on my......

Water is my eye
Most faithful mirror
Fearless on my breath
Teardrop on the fire of a confession
Fearless on my breath
Most faithful mirror
Fearless on my breath

Teardrop on the fire
Fearless on my breath

You're stumbling a little
You're stumbling a little

The Atlantic on trans-gender issues

The blog Mindhacks has a link to a long article in The Atlantic on the current trend in transgender issues. According the article, in just the last few years, psychiatrists have a seen a huge increase in the number and extremely young age of children being referred for gender-identity issues. The article chronicles the struggles of some of the children and their families:

School had always complicated Brandon’s life. When teachers divided the class into boys’ and girls’ teams, Brandon would stand with the girls. In all of his kindergarten and first-grade self-portraits—“I have a pet,” “I love my cat,” “I love to play outside”—the “I” was a girl, often with big red lips, high heels, and a princess dress. Just as often, he drew himself as a mermaid with a sparkly purple tail, or a tail cut out from black velvet. Late in second grade, his older stepbrother, Travis, told his fourth-grade friends about Brandon’s “secret”—that he dressed up at home and wanted to be a girl. After school, the boys cornered and bullied him. Brandon went home crying and begged Tina to let him skip the last week.

For another perspective, you can also read the First Things article by Johns Hopkins University Distinguished Service Professor of Psychiatry Paul McHugh. His article is mostly about adult men looking for sex change surgery, however, rather than children:

First, I wanted to test the claim that men who had undergone sex-change surgery found resolution for their many general psychological problems...psychoanalyst Jon Meyer was already developing a means of following up with adults who received sex-change operations at Hopkins in order to see how much the surgery had helped them. He found that most of the patients he tracked down some years after their surgery were contented with what they had done and that only a few regretted it. But in every other respect, they were little changed in their psychological condition. They had much the same problems with relationships, work, and emotions as before. The hope that they would emerge now from their emotional difficulties to flourish psychologically had not been fulfilled.

Sad all around, no? This world is truly a veil of tears.

Express Scripts extorted with patient prescriptions

WIRED news is reporting that prescription manager Express Scripts has contacted the FBI about a letter it received threatening to disclose the identities and prescriptions of millions of patients if it does not pay big bucks.

Patient advocate on open access

Michael Crichton, RIP

I just learned from CNN that Michael Crichton, the author of Jurassic Park, died on November 4th from cancer. He was 66, but check out his photo on the CNN site from 2005 when he was 63. That's one of the most youthful 63's I've ever seen. It makes you wonder if his cancer was induced by some experimental anti-aging self-treatment like HGH. I don't mean that as a slur, though. I think any experiment like that by someone like Crichton would come intellectual curiosity and an exploratory spirit rather simple vanity.

I will remember Crichton fondly. A good friend from high school named Matt Patrick who I have lost contact with started reading Crichton and convinced me to try. (I don't generally read "best-sellers.") The first book I read was Congo. I went on to read Eaters of the Dead, Jurassic Park, Sphere, and Rising Sun. I will always remember my high school days immersed in these novels, riding in cars or buses, and feeling connected to my friend. He was so enthusiastic about these books, it was infectious! I wish I had followed his plan rather than my own and gone into science. Perhaps I would be a virologist now. Anyhow, my dad also read a number of his books, including State of Fear. Crichton may have been on the wrong side of science in the long run, but he was on the right side of the argument. I don't think most people get the point of State of Fear, which is that truth is obscured by propaganda and scare-mongering, even when it is true propaganda.

Crichton should be remembered by health care professionals for at least two reasons. First, in our current world of mega-selling celebrity authors like John Grisham, Crichton was an authentic physician and wrote from that perspective. Second, he popularized a lot of themes relevant to medicine and health such as genetic manipulation and pandemic infections.

I intend to go back and read some of his earlier work, which is oriented at the medical field. I wonder what would have happened if I had read that material as a high school student...

Local woman goes to Washington: Supreme Court's Wyeth pre-emption case

As you may have seen in the news, pharmaceutical company Wyeth was sued by Vermont resident Diana Levine over the labeling of Phenergan (now what drug class is that, nursing students?), and the case is now going to the Supremes (and I mean the ones headed by John Roberts, not the ones headed by Diana Ross).

If you check out the links at right, you will notice that just about any place in Vermont is local for me. Plus, it just so happens that one of the largest employers in the local area is... Wyeth. (Kind of ironic, no?) When I was growing up, Wyeth was called Wyeth-Ayerst Labs, and they had a research facility in nearby Chazy, NY, that employed smart people. (My coolest Boy Scout leader was an avid rock climber named Steve Bailey who was also a statistician in animal research.) The facility produced papers like this one, which was published the year I graduated from high school:

Spontaneous lymphosarcoma, likely of renal origin, was diagnosed in a naive, juvenile, male cynomolgus monkey (Macaca fascicularis). Histologically, renal architecture was effaced by dense infiltrating sheets of plump cells... Serological tests were negative for infection with Simian Immunodeficiency Virus (SIV)...

Now, Wyeth has closed most of the facility and just maintains a manufacturing plant that they are planning to shut down in the near future. That will mean one more blow to the area economy and culture, which has been going downhill since the closure of Plattsburgh Air Force Base. In line with the rest of the area, the local newspaper printed an article about the case on the front page today, but had to use an AP article rather than their own reporter... stop me if I'm boring you...

Anyhow, the case went up to the higher court because Wyeth argued that federal approval of drugs and drug labeling protected pharmaceutical companies from responsibility at the state level for inadequate warnings on drug labels. I'm not a lawyer, but this seems like a pretty decent argument. Certainly not a slam-dunk case of pharmaceutical evil, like other recently uncovered nefariousness (and, by the way, the blog after the link is excellent and a great example of the usefulness of ResearchBlogging).

For those unfamiliar, the nine Supreme Court Justices are very smart and well-informed and read ahead of their cases. Probably their opinions are pretty well made up by the time the lawyers for the two opposing sides get their day in court, which is called the "oral arguments." Nevertheless, the oral argument is the sexy part, so that's when people start paying attention for realz. In Wyeth vs. Levine, the oral arguments started Monday, and you can follow them at the FDA law blog or at the Wall Street Journal law blog. Also, there is coverage the Drug and Device Law blog, including an on-the-scene report of the oral argument, which should be informative for you if you never pay attention to that stuff. In fact, here's a small sample:

JUSTICE SCALIA: Well then, gee, then all of the qualifications you were making earlier about whether it's new information or a new assessment, that's irrelevant. MR. FREDERICK: No, it's -- JUSTICE SCALIA: You're saying whenever it's unsafe, whatever the FDA has approved, you have a lawsuit. MR. FREDERICK: No. What I'm saying is that the information developed after the original label is approved, and it is not a floor and a ceiling -- JUSTICE SCALIA: There -- there was nothing about new information in what you just said. You said it's misbranded if it's not safe, new information or not. MR. FREDERICK: And that's -- JUSTICE SCALIA: Is that -- is that -- is that your position? MR. FREDERICK: Our position is that the duty is on the manufacturer to make a safe label, and if the label is -- JUSTICE SOUTER: But getting to Justice Scalia's point, as I understand your answer to an earlier question, on the day that the FDA approves the label, if there is no further information indicating danger, then any liability that is based upon what the -- the kind of information that the FDA knew would be pre-empted. The only time -- you're saying pre-emption does not occur when there is -- forget the word "new" for a moment -- when there is further information, information in addition to what the FDA was told, whether it's 1,000 years old or discovered yesterday; and if there is liability predicated on further information beyond what the FDA was told, then there is not pre-emption. Is that a fair statement of your position? MR. FREDERICK: That's fair, but let me just make clear that our test would require the FDA to consider and reject the specific basis on which the State law -- JUSTICE SCALIA: If that's a fair statement then you have to retract your -- your earlier assertion that whenever it's not safe it's misbranded. I mean -- MR. FREDERICK: I'm not going to retract that, Justice Scalia. JUSTICE SCALIA: -- which is it? Whenever it's not safe, it's misbranded, or what you just responded to Justice Souter? MR. FREDERICK: The basis -- the basis of the FDA's approval is on the basis of limitedinformation, which Congress has said for public safety reasons -- we are not doing a balancing here; we are doing this for public safety -- And if the label is not adequate for public safety it is a misbranded drug. JUSTICE SOUTER: Okay, but if -- if the so-called misbranding is determined to be misbranding, based upon information which was given to the FDA, as I understand your position, you would admit that there was pre-emption. MR. FREDERICK: I -- I think there is pre-emption, but that does not mean -- JUSTICE SOUTER: Okay. So there -- MR. FREDERICK: Maybe there is no -- JUSTICE SOUTER: In other words, there is that one exception at least to the broad statement that you gave in answer to Justice Scalia? MR. FREDERICK: Let me try to untangle it this way. The fact that there is pre-emption and you cannot bring as State law failure-to-warn claim doesn't mean that the drug isn't misbranded under the Federal standard the FDA -- JUSTICE SOUTER: But the -- but the misbranding is of no consequence to liability. MR. FREDERICK: Well, if -- JUSTICE SOUTER: In other words, I think you're saying if there -- if there would be pre-emption it may be misbranded, but there cannot be any recovery in a State tort suit. MR. FREDERICK: That's correct. The -- the point -- JUSTICE SOUTER: Okay. So misbranding under those circumstances is a purely theoretical concept. MR. FREDERICK: In that very hypothetical, yes. JUSTICE SOUTER: Okay.

Scientific American points out that this case is interesting because it wouldn't normally reach the Supreme Court:

However, the court has granted review in a series of pre-emption cases, and it seems to me that the Court might be attempting to articulate a clear pre-emption doctrine. What we have, at least in the implied pre-emption context, is a lot of ambiguity.

What they're saying is that the Supreme Court has agreed to make decisions on some cases it wouldn't normally hear, probably in order to set precedents.

Anyone in health care should be interested in this situation because the pre-emption issue might have big repercussions in terms of health care costs. You might think the evil conservatives on the Supreme Court are just protecting big pharma from helpless victims, but honestly, if drug labeling can't protect pharmaceutical companies from being sued, they're going to have the bejeezus sued out of them. And do you know who's going to pay for that? All of us, in the form of higher drug prices. And do you know what might happen to drug research if drugs become a huge liability? It might (a) stop or (b) move overseas. Either way, it would mean less pills for you and me. As a nurse, where do you think the greater good for patients is?

Also, you might be interested to know that the physician assistant who administered the Phenergan gave it through IV push into an artery instead of a vein. This case is separate from the settlement that Ms. Levine made with the health clinic where the PA worked.

Election 2008 round-up : run for the hills!!

Well, it looks like Obama won the election, and it'll probably turn out to be by a bigger margin than a lot of recent elections. Right now, I'm in the computing center in Feinberg Library not paying attention to the time, and I found out Obama was projected to win because of the hooting and yelling that started down the hallway, where there is one of those ubiquitous cable televisions mounted on the wall. It carried on for a long time. Then there was a loud bash on the other side of the emergency exit door behind me (I jumped), and an alarm started that has been going off for about 20 minutes now.

A short time ago, a guy came in and said there was nude streaking and all manner of chaos going on outside, so his friend got up and they left to ogle. Now it's just me and a girl, working on a paper, who called her boyfriend at the gym and made smoochy sounds over the fact that Obama won.

I have tried very hard not to pay attention to the election this year. I have cultivated the following feline sensibility:

Nevertheless, I cannot be happy that Obama won. McCain was not a good choice, but the irrational pleasure over Obama's victory is very scary. Obama is not like Hitler or Mussolini, but his electorate is quite a bit like the one's that sent those fellows to their destiny. "Heal America and change the world..."? Are you really that dumb? Or is it neediness?

Well, anyhow, Obama's lifetime of campaigning without much legislative experience is about to come to an end. I think he's going to find it much harder to get things done than he anticipates, and he can't keep talking about change in the future when he's in office. My guess is that the media is going to sour on him, too. People have short memories, and once Bush is out of office, all the animosity against him that fueled Obama's election is going to be forgotten.

So, we'll see how things go. Mostly, they won't change, I think.

Update @ 12:51 - Shocked!! I mentioned above "all manner of chaos," but I thought that fellow was talking about a little bit of cheer and hi-jinx. But as soon as I opened the library door, I could hear the almost-deafening howl of a crowd of people and see red flashers reflecting off the buildings around the Angell Center's courtyard. Of course, I had to see. The street was filled with students!! The dorms must have all emptied out into the streets, and they were out there yelling, clapping, holding signs, and, from the sounds of it, pushing things over. I decided to leave as it was a scary scene, and as I left, they started to march down the street with cops looking on. What is the matter with people?

Election Day 2008

"Many forms of Government have been tried and will be tried in this world of sin and woe. No one pretends that democracy is perfect or all-wise. Indeed, it has been said that democracy is the worst form of government except all those other forms that have been tried from time to time."
-Sir Winston Churchill, Speech in the House of Commons, 1947

Eighty-one-year-old uncovers government deceit

I was reading a little election coverage over at Volokh Conspiracy when I noticed their post about an elderly woman who was denied a gun purchase until after an investigation. Of course, an elderly woman buying a gun for the first time would make you think of a suicide attempt, which I'm sure is why the purchase was delayed. Is this right? I don't think it is. I see two ways for nursing to intervene in health:

1. on a personal level, which would mean being directly involved with this woman in this case;
2. or, possibly, on a systemic level, which would mean interacting with communities with regard to re-payment schemes, pollution, etc., and would be excluded in this case since purchasing a gun is an inherently health-neutral act.

For nurses to approve what actually happened is stepping outside what should be clearly defined professional boundaries. There's a lot of talk in my nursing program about professionalism, but in, for example, law there's no way for lawyers ethically to push themselves into the practice of medicine or nursing. Part of being a profession is drawing a line that both absolves you of responsibility for saving the world and limits you from saving it.

Of importance to note is the fact that if the records had been kept according to the law, the woman would probably have not been prevented. Ah, the intertwining of ethics, letters, and enforcement!

I must confess that I lapsed into "health"-oriented "nurse think" when I first read about this--yeah, the law was broken and someone's rights were probably violated but maybe we saved a life. Luckily, there is the ever vigilant Nurse with a Gun who helped me get my thinking grounded again. Thanks, Xavier.

Churchill on Romans

"I have no doubt that the Romans planned the time-table of their days far better than we do. They rose before the sun at all seasons. Except in wartime we never see the dawn. Sometimes we see sunset. The message of sunset is sadness; the message of dawn is hope. The rest and the spell of sleep in the middle of the day refresh the human frame far more than a long night. We were not made by Nature to work, or even play, from eight o’clock in the morning till midnight. We throw a strain upon our system which is unfair and improvident. For every purpose of business or pleasure, mental or physical, we ought to break our days and our marches into two."
-Sir Winston Churchill, Roving Commission: My Early Life, 1930

Nurses, do not spread urban legends, please

My mother recently received an e-mail forward from a friend who is a nurse practitioner. The content of the e-mail was that you can get necrotizing fasciitits from wearing bras that haven't been washed after purchase. The e-mail contained a number of photos of real breast conditions that were claimed to be n.f. of the breast. My mother was pretty upset and started to research this more on the Internet to get more information. Then she stumbled across the About.com Urban Legends section refuting this hoax e-mail. That made her even more upset.

Nurses can't really do anything about hoax e-mails. However, you as a nurse can stop spreading fear about health by researching information before you pass it on. Any nurse should be able to investigate infection control issues enough to debunk this bra hoax, and a nurse practitioner should be able to debunk it by diagnosing the photos as whatever they are--cancer, furuncles...

Halloween special: melon brains

Instructions for this low-GI fruity Halloween food are at Instructables.



via BoingBoing

Mozart, nursing school & what you're missing

Over last weekend, I found some CD's in my house that I hadn't listened to in probably over a decade. Today, I'm in the computer lab at Feinberg Library, and I brought along this CD of Mozart opera arias. It is wonderful. I haven't listened to Mozart at least since I started nursing, I think. I feel so happy right now.

Students are depressing. People who are stuck in the world of popular music, TV, and new fads are depressing. Being shut up in nursing school with them is awfully depressing, but I didn't realize how much until just now.

If you're in nursing school, try getting out of it, mentally, for a little while. It might do wonders. I forgot that life goes on.

Note to angry people: TV for fantasy, not education

I just came across the Center for Nursing Advocacy, which in part monitors the portrayal of nurses on TV shows and, I note, has a particular problem with Fox's "House." First, I must confess that I love "House," or at least I used to. Recently, it has become really trashy with transparent attempts to lure viewers with gross-out cadaver scenes and depictions of bisexual woman-on-woman sex. Give me a break. The show was really excellent in its first season and quite good in the second and third, though, and it can still be enjoyed occasionally for the interactions between House, Wilson, and Cuddy.

I have noted myself the poor portrayal of nurses on "House." Nurses usually just clean up the messes and answer the call bells. The doctors give injections and meds, perform entire codes on their own, and interact with the family and patients. It's not just the nurses who get short-shrift, though. Lab and diagnostic techs are never portrayed and neither are transporters, engineers, housekeepers, volunteers, social workers, etc. I understand the criticisms of this show, but I think the Center for Nursing Advocacy needs to get a grip. Television shows are for fantasy and entertainment, not education. Lots of people fantasize about being powerful doctors. Nobody fantasizes about being nurses or lab techs. People who do just become them. Anyhow, consider just the logistics:

• The show needs get the actual characters on-screen. "House" is not about a hospital, it's about House and the other doctors. If the MDs were absent whenever the show was in the lab, they wouldn't be on the show. And if the MDs were always portrayed in the dictating rooms or the staff conferences room, it would be a pretty boring show! Having the MDs do all the work is just a dramatic device, not a slight to nursing and allied health care.
• The show can't afford to pay all those people. Can you imagine if the cast of "House" included all the staff of a hospital--you couldn't afford to make it!
• The show is a comedy. This gets overlooked a lot because it is a dark comedy, but all the business about having nurses clean up is supposed to be funny, not realistic.
• The show is based on Sherlock Holmes. In the Holmes books, he and Watson and a few other supporting characters perform all the law-enforcement functions. "House" follows the same model.

I watch "House" with my dad, and I get embarassed whenever they have interactions with nurses on the show, but really it's not all about me. If my dad ever goes in the hospital, he'll see what nurses actually do. Another point of interest is that my mother had cancer and surgery, and she talks about the doctors still but never the nurses. I think the nursing professional just has to accept the fact that, by its very nature, it's going to fade into the background of people's minds. When people are sick, what's salient is what's wrong with them and what has to be done for them to get better--doctors' work.

I'd also like to point out to the Center that nurses do "do secret naughty things with big powerful male physicians." In fact, that seems to be a pretty big part of nursing as far as I can tell. Don't like it? Try passing some judgement on these people when the rumors go around instead of complaining when the public points out what everyone knows.