Thomas Eakins' The Gross Clinic

Dr. Wes has an art-related post today, so I thought I would take this opportunity to draw your attention to an article I enjoyed from American Arts Quarterly on Thomas Eakins' The Gross Clinic (seen above).

From 2007, James F. Cooper makes an interesting analysis of the painting...

Eakins’s monumental effort, eight by seven feet, portrays the celebrated surgeon Dr. Samuel D. Gross removing a piece of infected bone from the thigh of a patient suffering from osteomyelitis. Five doctors are assisting him in this delicate operation. The surgery is being observed by almost thirty medical students in the amphitheater at Jefferson Medical College. Gross is depicted deep in thought, pausing momentarily with scalpel in hand. A strong light from above illuminates the dome of Gross’s head and the heads of the doctors working on the patient. William Innes Homer, author of Thomas Eakins: His Life and Art(Abbeville Press, 1992), compares The Gross Clinic to Rembrandt’s masterpieces The Night Watch (1642) and the Anatomy Lesson of Dr. Tulip (1632). Homer praises the American artist, but the comparison immediately draws attention to what is wrong with Eakins’s painting. The darkness surrounding the figures in both Rembrandt works is rich, and the deep velvet blacks add greatly to the atmosphere. The black background which covers almost two-thirds of The Gross Clinic is essentially a dark wash tinted with red. All of the doctors and several of the students are dressed in black, including the patient’s mother, shown directly right and below Dr. Gross’s right hand. The perspective of the painting is askew because Eakins has used white in the background behind Dr. Gross to frame his own self-portrait (the figure seated in the first row of the auditorium sketching the scene). The chalky white of the table he is drawing on sits visually on the surface of the canvas, refusing to recede into the background. To make matters worse, Gross’s shirt is almost the same tone and chroma as the tabletop behind him. Eakins takes no advantage of the painting’s apparent “flatness.” He makes little attempt to organize the figures and the negative or “empty” spaces between figures into formal, cohesive elements of color and line, which communicate visually with each other and the entire composition. Indeed, his preparatory oil sketches for the final work reveal the same confusion and murkiness.

Nurse on swine flu on BoingBoing

Swine flu explanation/update on BoingBoing written by a nurse. Also, track new cases with VeraTect. This is the first time I have used Twitter...

Would you like fries with that, comrade?

At KevinMD, you can see what the future means for American society--being gamed by "choice". This poll asks you to choose between three options:

1. the government should control diet
2. there isn't enough scientific consensus to control diet
3. people can outfox the government

What the fuck? Where is the "I don't want to live in a totalitarian society" option? And I'm not raising the red scare--having the state control the minutiae of life like what you eat is, literally, the definition of totalitarianism.

I don't know what's wrong with people...

Hey, people, what's wrong with you??!!

Drug errors and learning

There's a good story from drug pusher on her first serious med error. I don't know meds nearly well enough. I have a foggy idea of which IV push meds should go over time and which not, but don't know the appropriate times. At least I know this is a weakness, though.

Swine flu

This article says the WHO is convening to decide is the swine flu was weaponized. However, it's a dubious-looking publication as far as I can tell...

Lost my watch...

I don't know how, but I lost my watch. I always knew this is how it would end. I was constantly taking it on and off to wash my hands and do patient care. Plus, I don't wear a watch in civilian life, so I don't miss it when it's not on. I'm pretty sure I left it in ICU on Nur464 clinical day 7, but I just called there, and the ICU doesn't have a lost and found.

My watch was the Timex Expedition, as shown below. Considering that I don't where jewelry or accoutrements and generally dislike possessions, it was a pretty good companion. It was modest without appearing cheap (from a distance) and masculine without being overwhelming. According to my color chart, I should choose gold but I like silver instead (owing to nerdy inclinations), so the body worked for me, and the brown leather band matched my school uniform and shoes well (looking good--a key component of nursing school, as every scared student knows). A watch is not as cool as a stethoscope, but a stethoscope has a pretty low functionality-to-cumbersomeness ratio, so the watch ranked right up there.

I purchased the watch a while back just for nursing clinicals. It's timed patient's pulses in the post-ortho-surgery unit, kept me on time for taking newborn vitals in the nursery, and made sure my lunch break didn't run over in adult mental health. I can always get another one. Exactly alike. But it won't be the same. I hope this isn't an ill omen...

Bum sugar, or why bad ideas persist

A few weeks ago, one of my instructors was telling us about the treatments they used to perform in hospitals for ulcers, which included applying sugar and placing the ulcerated part of the patient under a heat lamp. (For those non-nursing types, current treatment is re-positioning patients to relieve the pressure that causes ulcers and prevents them from healing...)

I don't know where the idea that putting sugar on an ulcerated rump would make it get better, but really that's not such an interesting question. Even today, there are all kinds of crazy ideas for therapy that crop up. Most of them simply die before reaching the trial stage. A much more interesting question is why nurses and doctors persisted in the idea that a sugary bum was health-promoting long after it must have been obvious to anyone and everyone that it didn't work.

In large part, this is the same question that one would ask about traditional medicine in tribal or third-world societies. And Tanaka, Kendal, and Laland determined to answer that question.

Writing in PLoS ONE, the researchers have created a mathematical model that seeks to demonstrate the primary factors that contribute to persistence of ineffective treatments throughout the world. Using what seems to be a Bandura-style social cognitive model, the researchers assume that learning is based on observation. Keeping this in mind, it stands to reason that treatments that are performed (or demonstrated) more often will create more learning. Since effective treatments end the conditions for their use, ineffective treatments will be performed more often, resulting in increased learning and greater persistance.

The researchers have created a mathematical model that takes into account the factors that contribute to social learning. I'm not qualified to critique their model, but to the extent that I understand it, it makes sense. If you enjoy wading through math, you can read the Methods section of this article yourself.

What's the relationship to nursing? If I understand this article properly, it is implying that the way to identify and end ineffective practices is simply to end practices that aren't supported by Evidence-Based research. As nurses, this is difficult to do in the face of medical staff who operate without evidentiary basis for their prescriptions. What IV fluid protocol is best for burn victims? No real consensus, but lots of definitive opinions. The role for hospital practice councils here would be to continue to push for reviews of the literature. On an individual basis, questioning protocols and calling for transparency in publishing the evidentiary basis for protocol adoption would be appropriate.

1. Tanaka, M., Kendal, J., & Laland, K. (2009). From Traditional Medicine to Witchcraft: Why Medical Treatments Are Not Always Efficacious PLoS ONE, 4 (4) DOI: 10.1371/journal.pone.0005192

Saturday night at the dive-in

Last night, the college hosted a Saturday night "dive-in" movie. They showed the classic horror flick Creature from the Black Lagoon, and showed it in the university pool so students could swim and watch the movie at the same time. It sounds like a crazy idea, but it was actually a lot of fun. I'd never seen Creature before, which was the draw for me, but I couldn't have enjoyed it any more than I did. It made me sentimental for days of hanging out with other nerdy kids at Swarthmore. It was there I was first introduced to kung fu movies by Carl Heiberg, who encouraged me to see The Legend of Fong Sai Yuk, which was being shown on campus by Justin Hall, in his film series called "Two-Fisted Films" or something. This was before Jet Li was known in the U.S., and I was pretty blown away. Ahhh... great times.

Congratulations, Lauren Caniano!

A word is in order about our Nur464 clinical instructor, Lauren Caniano (?,?,?). Lauren has been a PCU and ICU nurse, a coach for the local USS swim team, and a clinical instructor among other things. She graduates this spring from nurse practitioner school and, as you can see, will have her first child (a son) not long after. Not everything about her life has gone ideally, but she has always been an excellent co-worker who sets the bar high and expects and encourages those around her to meet it. All the best to her, even she isn't able to see our clinicals out to the end...

Nur464 clinicals day 8 - ICU

I take back everything I said yesterday implying that the ICU is boring.

Our modus operandi in the ICU part of Nur464 clinical rotation is--rather than get a patient assignment a day ahead and do research--to meet our clinical instructor on the cardiac unit and then go down with her to the ICU, where she finds for us a suitable nurse to shadow.

Well, when we went down today, there was a lot of chatting and networking that left me gazing into the distance absentmindedly. So when I noted a doctor preparing to intubate a patient, I took it upon myself to choose that assignment. And I don't regret it. The nurse I was with had just started her shift and just received the patient when I went in the room, so I got to see things from the ground floor, so to speak. She didn't stop the entire day and barely had time to assess her other patient.

I can't relay much of what happened, but suffice it to say that without working with a crashing patient requiring a code or rapid response, this was about as challenging and interesting a day as I could hope to have in our local hospital. It made me understand the appeal of ICU, as opposed even to my beloved current workplace. Moreover, between yesterday and today, I feel that my impression of ICU nurses as generally more intense and more capable people has been confirmed. I do think it's possible that some of them wouldn't be able to function on a med-surg floor as effectively. I think I would underperform on a med-surg floor as well. But this is like noting that Einstein might underperform as a ditch-digger. I exaggerate, but you get my point.

Crank opens tonight

Did you ever imagine a cheesy action film based in cardiology?

How the state will tax your ice cream...

Furious Seasons is justly horrified over a new chip that, when swallowed, can detect a patient's compliance with medicine regimen. As he points out, a chip with this ability could also be used to monitor your intakes and send you a "counselor". Or tax your ass off. This is something I hadn't foreseen, despite the borderline paranoia.

UK nurse whistle-blower

This BBC article is about a nurse who went beyond whistle-blowing reporting to whistle-blowing filming, and got the job boot. I can see both sides in this issue, although I think the nurse acted within ethical bounds.

What to do after graduation

Well, I don't think I can avoid any longer the choices that will have to be made when I graduate. There's a good possibility I may not graduate as I am scheduled to in May due to the fact that I have outstanding work due in Nur425 Community Health, but I probably will.

I'm looking forward to finally never having to consider b.s. college work again; to being able to make some money; to reading whatever I like; to getting back to karate and kendo; to working out and losing weight; to listening to more Bach; to starting on my conversion reading list; and mostly to the summer.

It's unfortunate that my grades haven't been maintained at the level they were at in pre-nursing cognate courses (4.0), or I could consider going on for a PhD in physiology, which I think is where my real heart lies--in academia, not the hospital. However, it's not a possibility for me, so I have to consider my options for graduation:

1. work in my local PCU--this would be my #1 choice, but based on certain factors I have written about here before, I don't think it's a real option for me;
2. try to get a job in a local med-surg unit for a year to build up enough hours to take the CCRN exam, then move on to a PCU or ICU in another locale;
3. try to get a job in a telemetry or coronary care unit in another locale;
4. join the navy;
5. try to get a job overseas with a cool organization like the Global Viral Forecasting Initiative;
6. not get a nursing job and work in some other field while writing a book on men's health.

Five would be a real change in life direction for me. GVFI has stations in Malaysia and other parts of SE Asia, and it would be great to live there for a while.
Four has a lot of appeal to me, although I am still skeptical about working as a male nurse in the military.
Three is professionally appealing, but the lifestyle, involving having to find a car (for the first time) as well as housing, etc., while fending off depression (again) is not appealing.

Some combination of two and six is the most likely option, I think, although I don't know that it would be a good idea to try to work on a book and the CCRN exam at the same time.

Nur464 clinicals day 7 - ICU

Clinical rotation today was in ICU. Not much to report, other than that I didn't do much. Although I've worked in the hospital for a while, I had the impression--as I suspect many people do--that ICU care is all about running codes, with CPR, defibrillators, and complex IV drips being used in the midst of doctors and nurses running around in a panic. Actually, that describes the step-down unit I was in the last few weeks more than ICU. From what I can tell, ICU is mostly about waiting and watching and getting patients over a few dangerous humps so that their bodies don't derail their own healing processes.

I helped with a ventilated patient today. Most of the day was spent collecting vital signs off the bedside monitor or watching the nurse chart, chat, etc. She was an excellent nurse from what I could tell, and is a nationally-certified paramedic, to boot. For myself and the patient's family, she was good at explaining the monitors and physiological concepts in layman's terms, which I think is a mark of real understanding and intelligence.

Although my medium-to-long-term goal has been to work in an ICU, based on today's experience, it might be too boring.

A Final Arc of Sky

Via my Nur464 instructor's Smartbrief report, a new book, a memoir written by a critical care nurse. I haven't read this book, but it's in my queue now. I'm happy to see something that might be better written than a textbook (although our Nur464 textbook is quite good, actually).

Eat corpse-bread for breakfast

Wow. I've been to Thailand, and I took day tours out of Bangkok, but not this one... This 28-year-old baker/sculptor, makes models of human cadaver parts out of bread. Models you can eat. For inspiration, he relies on "anatomy books and his vivid memories of visiting a forensics museum." Actually, very good memory and good sculpting ability as well. I don't know if I would eat one of these, though. More photos on the original page...







via ImpactEDnurse

Is an NP a physician?

Following on the last post... The Happy Hospitalist takes up this question, as it was posed at allnurses.com. Health care needs to get its terms straight. Patients can't have everybody under the sun going around calling themselves everything under the sun. Sure, NPs can provide some primary care, but doctorate-level NPs calling themselves "Dr. Nina Practica" isn't doing anybody any good, except it's stroking the ego of the NP.

Top 10 reasons for advanced practice

via Dr. Wes, the Top Ten Reasons to be a doctor also seem to me to apply to advanced practice nursing (read this the first time cause you get blocked by a firewall after that...)

Nur464 clinicals day 6

Things went much better today. Kept same patients from yesterday, so no extra research last night or on site at the hospital today. It was a little hectic getting the assessments and med passes done quickly in the morning, but then all of a sudden I had a lot of free time to help others out. Helped with an open heart patient who was a youngster when WWII ended--open heart surgeries hadn't even been invented yet. How cool is that!!

But now to do all the clinical paperwork this weekend, plus write a paper for Community Health, a paper for Professional Issues, study for an exam in Care of the Adult III, and work 16 hours at the hospital... woohoo!!

Nur464 clinicals day 5

Today was a real bummer in clinicals. I feel like I did pretty badly with documentation and made a stupid medication error--I interpreted an order for 2 Lorcet as an order for 1-2 Lorcet. Actually, I didn't misinterpret. I thought (as I always have--I don't where I got this idea) that, as a nursing measure, an order like this for analgesic tabs could be given in partial doses. Of course, that doesn't really make sense on reflection. I wouldn't have considered giving 0.5mg morphine IV push when the order is for 1mg... or maybe I would have, I don't know. Anyhow, obviously the reason Lorcet is ordered in tabs has to do with the manufacturing and not so nurses can administer partial doses. I don't know why I never thought about this before, although I do think this was the first time I've had an opioid/APAP combo ordered as a straight number of tabs rather than a range of tabs.

As we use a computerized medication administration record, I caught my error when I went to give a second tab of the Lorcet after the patient requested it (I had offered one now, another if ineffective). The computer told me I couldn't give Lorcet again for another 3.5 hours. Doh! I over-rode the computer so the patient could get the med, but...

I fessed up to my clinical instructor, who didn't make a big deal out of it because I wasn't overdosing the patient or making a mistake that would have put the patient in danger. However, she did say she was going to follow up with the attending nurse. It will be interesting to see what happens, as I've never made an outright medication error in clinicals before, and I don't know what the consequences to a clinical error might be.

Again, as I've mentioned before, we don't get enough clinical hours in this Bachelor's program. Although I take responsibility for this error, it also represents a systemic failure as more hours under the closer supervision that we receive in the earlier med-surg courses might have caught this mistake in my thinking.

As for the documentation--again with the I+Os. The patient is drinking from a pitcher I'm not monitoring and up to the bathroom ad lib. How am I supposed to do these I+Os? I don't know. Also, a patient has an IV drip but the "clear totals" function on our Symbiq Hospira pumps doesn't work, so we record hourly totals by calculating the rate x time? In my book, that's tantamount to lying--we don't have a record that the pump pumped the whole time. I haven't had the courage to ask these documentation questions, and after the mistake today, I'm in a worse spot. I will have to see the clinical instructor's disposition tomorrow.

Patient gets urinated on by other patient

A patient in a nearby hospital wrote the following letter to the editor, eliciting the following response from the hospital. Although patients have a lot of valid complaints, hospitals aren't perfect. In this case, I think this was an unfortunate accident for which the hospital staff is not at fault. Funny comment overheard at work today: "Being urinated on by another patient is almost as bad as waking up to find another patient in your bed." Given a choice, I think I would not choose being urinated on!

Security lost
TO THE EDITOR: Most people believe that when you are in the hospital, when visiting hours are over, you're secure and safe. Or that if you leave a sick loved one there under the care of nurses, that they will be cared for while you go home to rest. Little do you know what is wandering the halls of CVPH.

What happened to me the early morning hours of Monday, March 23, on the seventh floor of CVPH left me humiliated and frightened. I have never felt so violated in all of my life. I was ill and unable to breathe, and had just gone to sleep. The lights were out and my door was ajar like it always was. I was sound asleep, but opened my eyes when I heard a noise. My door was open and a man was standing next to me. He was holding onto my IV pole and he was urinating on me, on the floor, in the air — everywhere.. I screamed and tried to get out of the room.

I found a nurse at the nurse's station and told the personnel what was happening. The nurse immediately identified the man by his name without even needing to check to see who it was. After cleaning my room, the nurses said "well, you can go back to bed now." I couldn't sleep after that. Would you be able to? I came home as soon as I told my doctor what had happened and why I needed to be discharged. They pushed this incident under the rug, but I am so totally disturbed by it.

The hospital is supposed to be a place where patients are safe to rest and recover, but I will never feel safe at CVPH again.

Susan

Hospital responds
TO THE EDITOR: We at CVPH Medical Center are extremely sorry and apologetic that the incident of March 23 described in the above letter did occur. It was an indignity that no one should experience, and we apologize profusely. Patient safety and security are at the top of our list of priorities.

We believe that staff on the nursing unit where the incident took place did everything correctly, including having an alarm on the patient who caused the problem. Staffing was appropriate. All regulations and procedures were followed. The truth is that many patients who are hospitalized become confused, particularly elderly patients who may suffer from stages of dementia as well as other clinical health problems. It only takes a few seconds to get out of a hospital bed and walk into the room next door without anyone noticing. That is a fact in any acute-care hospital in the country.

We apologize that such an unfortunate event took place and will try our best to prevent it from happening again. Patient safety is of extreme importance at CVPH.

Stephens Mundy
President and chief executive officer
Cynthia Gardner, RN
Vice president, Patient Care Services

The Sexy Nurse Report

Check it out: http://the-sexy-nurse-report.blogspot.com

Bringing EBN to obstetrics

I don't normally post on maternity issues, but I thought this article at Suite101 on changing practices in obstetrics was great. A lot of Suite101 articles are suspicious, and this one didn't have citations for the research it claims, but as it is written by a certified doula who is a childbirth educator, I think it's safe. It's nice to see a doula who isn't primarily about importing native birthing techniques from South America or something. The article covers eating during labor, amniotomy, and episiotomy.

Diabetes calculator

QDScore is a webtool to calculate your risk of developing DM2, based an a study published in BMJ.

via Happy Hospitalist

Riot police cause heart attack

A man in London was pushed forcefully by riot police, and moments later suffered a heart attack: http://news.bbc.co.uk/2/hi/in_depth/business/2009/g20/7988812.stm

via bOINGbOING

Idiotic Colbert Report and the sexy nurse

Tonight I made the mistake of reading some Salon.com writer named Glenn Greenwald. I followed a link to his article on Obama's worse-than-Bush wire-tapping policy, then got interested in his report on Portuguese drug de-criminalization. But then I made the big mistake of reading some of his shallow mud-slinging partisan whining, and watched a clip from the Colbert Report.

As someone who purposefully avoids filling my head with the group-think crap that passes both for commentary and for comedy these days, I am always disappointed when I make the infrequent venture into TV or pundit land. Colbert's satire of a truly pathetic melt-down by some other pundit named Glen Beck is immature, pointless, and not humorous. Plus, he goes on to provide us with another image of "the sexy nurse," looking like nurses never look anymore (or ever did, actually).



At least by juxtaposing the sexy nurse with Wolverine, we can choose to believe the implication that the sexy nurse is a fictional character, but I know that wasn't the intention. As I asked previously on this blog, wouldn't the sexy nurse be less likely to be a legitimate mascot the closer one gets to a medical organization, and if you're going to have a fantasy about a nurse, wouldn't you want to fantasize about someone who actually looks like a nurse rather than someone wearing lingerie, holding a sharp object, and wearing a stupid-looking infantalizing hat that dates from decades ago?

National Public Health Week

This week, April 6-12: www.nphw.org

Cardiac and catheterization news

In recent news:

• WSJ health blog brings up the topic of whether doctors are using angioplasty too aggressively
• according to the EARLY-ACS study, it doesn't matter whether Integrilin is started in the ER or in the cath lab
• coronary angiography improves outcomes for cardiac arrest patients (not sure why, although this seems to imply it can catch more cases of fixable CAD)
• CT angiography radiation can be reduced effectively
  
• allergic reactions to Plavix can be treated with antihistamines and steriods
  
• pre-loading with statin 24 hours before elective PCI reduced peri-procedural MI by 44%, while statin 12 hours before PCI reduced 30-day MI by 48%
• statins also seem to have benefit in preventing venous thromboembolism and reduce inflammation as a separate protective effect from reducing cholesterol
• omega-3's add nothing to post-MI care when meds are optimized, but infusion of bone marrow stem cells post-MI may assist in recovery
• WSJ also reports on some results of the 2009 annual meeting of the American College of Cardiology
• just a little more exercise does the body good for health failure patients
• Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT), which causes 15% of sudden cardiac deaths in those under 30, can be treated with Felcainide, a sodium channel blocker
• men who were big (fat!) in their 20s are at increased risk for a-fib as they age
  

Nursing as a university subject

I am revisiting this post in 2011. Don't remember what I was going to say, and the link is broken:
http://www.mentalnurse.org.uk/index.php/2009/04/04/nursing-not-a-proper-university-subject/

I have mellowed about college after graduating. Two years ago, I have would have had a lot to say about whether the nursing curriculum properly fit into the liberal arts model.

Today, I would say it definitely does not, but "meh, who cares?"

After two years in the work force, I still fundamentally agree with Charles Murray's assessment that professions requiring board exams should not require school as a pre-requisite for taking the exams. Most of what I did not get out of school and learned on the job, I could never have gotten out of school. What I did get out of school, I could have acquired on my own through self-study. Allowing someone to sit for the board exams with an academic degree would not end nursing schools. The majority of nurses probably could not have gotten by with self-study, and a larger number would not want to. But letting the un-lettered sit for exams would require schools to focus on their value-added, probably improving them.

Sexual orientation vs. wrinkled uniform: non-objective standards in nursing school

Read this story on a nursing student who appears to have been forced out of school for non-objective reasons.

I also had an experience similar. In one clinical, we had a weekly clinical assessment sheet that was a list of characteristics on which we would be graded on a scale of 1-3. You had to get an average of all 2s for the semester to pass clinicals.

One week I had an argument with my instructor. The next week, I received 1s for the neatness of my paperwork even though the paperwork was filled out the same way it always had been. Since I had been receiving 2s on everything throughout the semester, these 1s would have sunk me for the whole class.

I resolved the argument with the instructor and received 3s for neatness on the next assessment list, which gave me an average of 2s for the semester and allowed me to pass. However, the whole thing was a sham.

H.R. 1001 - outsourcing nursing to migrant nurses

Today, the Health Care Blog has posted an Op-Ed called "Let's Pay Nurses Minimum Wage." I think it's in jest, but it brings up a real issue.

Congressional House Representative John Shadegg has introduced a bill to congress to allow foreign nurses--especially from India, China, and the Philippines--to obtain non-immigration visas to work in the United States.

The bill is H.R. 1001, "To create a new nonimmigrant visa category for registered nurses, and for other purposes," also known as the Nursing Relief Act of 2009. Rep. Shadegg introduced the bill February 11, and it was referred to a subcommittee of the House Judiciary Committee on March 16. The bill can be found in the Library of Congress' Thomas database. This link to Thomas should take you to the text of the bill:
http://thomas.loc.gov/cgi-bin/query/z?c111:H.R.1001:

The implications here are not clear to me since I don't know the current laws covering migrant workers and those with foreign nursing educations. Would migrant nurses have to pass the NCLEX boards? Would they have the same scope of practice as American RNs? Could they be forced to join unions as American nurses are?

It seems to me there are some professional issues here. If foreign nurses aren't forced to pass national boards, it will throw into question any professional skill or expertise. If foreign nurses are forced to pass national boards, it will throw into question American nursing education (which might not be a bad thing--I can think of a few changes I'd like to make). If migrant nurses with less education come to America and perform as well as American nurses, will this undercut unions' ability to make the case that nurses deserve higher pay? If migrant nurses aren't forced to join unions, will this drive down nursing pay anyhow?

I'm sure this bill will be in the blogosphere soon. As of right now, after checking about 15 nursing blogs and the ANA and AACN sites, I find no evidence that it's been picked up yet.

Interestingly, the bill parallels some private efforts in the same direction. For example, the New York College of Health Professionals signed an agreement with China's XinXiang Medical University to increase the numbers of Chinese students who may come to the US, as reported by NursingWorld.com:

These Letters follow a formal visit by Marion Spector, Chief Nursing Advisor, and Dr. Ali Song, Dean, People’s Republic of China Affairs, on behalf of New York College to strengthen relationships between the College and Colleges, Universities and Medical Centers in China. Specifically to develop programs for both bringing Chinese nursing students and other health professionals to the United States, as well as having students from New York College of Health Professions take courses at those facilities.

New York College of Health Professions already owns a 35 acre facility in Lou Yang, PRC, and with these additions will begin to create a foundation for more international programs.

But lest you think this is all about health care, don't forget to follow the money:

As part of the larger research project the College is in talks to market and develop the products of the legendary Shaolin Temple, the home of Kung Fu along with the mastery of other holistic health forms, from the Monks in Henan.

I, for one, am opposed to H.R. 1001 for a variety of reasons, some of which go beyond professional issues. It will be interesting to see how things turns out.

Nur464 clinicals day 4

All in all, it was another laid back day in the step-down unit yesterday. I removed a foley for the first time. I helped out here and there. Not a lot for me to do. The nurses kept complaining of how busy they were, but kept denying that they needed help when I offered it.

Following the percutaneous coronary intervention I watched Thursday, I did some research on the patient and discharged 'em mid-morning. The patient had a unique condition that I thought might be affected by the PCI, so I did some research on it and made up a teaching sheet. I had it approved by my clinical instructor, then gave it to the interventionalist's PA, who gave it to the interventionalist. The word I got back was that it was okay to give it to the patient, but the spirit of the approval and the technicality of approval were not in sync.

I thought that what I had done was exactly what we should be doing in a world of ideal nursing. My recommendations were conservative and covered bases I thought the doctor might not address. They attempted to give the patient information for self-empowerment in case something was forgotten in the course of follow-up office visits. Did the interventionalist feel that my teaching sheet was bordering on medical advice? Did he feel threatened somehow?

It would be nice if someone could have just said, this is okay but I would prefer that you didn't give it to the patient.

Historical nursing equipment

ImpactedNurse has a post on historical nursing equipment. Check out the workmanship on this safety case for a mercury thermometer. Life is just not the same nowadays. I know many people would quote me statistics about the danger I would face in an old hospital, not to mention the lack of care. But overall, in terms of total utility, I'm not sure that modern times have it over the pre-computer age, or even the pre-industrial age. See the post for an image of an old stethoscope.

TEDMED2009 - on my schedule I hope

If I don't get a job out of school, TED's medical conference in October of 2009 may be on my agenda. Looks good...

I don't even know what blueberry buckles are...

A Boston.com article on men in nursing interviews a male paramedic who became an ER nurse. To unwind after his 3p-3a shift, he... bakes? Ah, yes. Cookies, brownies, and blueberry buckles. I don't even know what blueberry buckles are.

Also, he wears a Patriots jersey to work? That's not progress, it's pathetic. I'm sorry for people who have to work in places where their co-workers can wear t-shirts and athletic clothing to work.

Nur464 clinicals day 3

Today was okay. I spent a long time waiting in the cardiology department for a stress test, then I spent a long time watching an IVUS and stenting. Performed a discharge teaching today, and the attending nurse for the patient talked to him for a while after I left. So, I asked what I should have added to my teaching, and she said nothing, which I don't believe. Having someone believe you underperformed but not being willing to tell you is an extremely frustrating experience, you know?

TED: hunting the next killer virus

Finally, some glimmer of hope that there might be a place for nurses in virology...

Self-serve medicine... finally!

Due to the wonders of time zones and the web, ImpactedNurse posted on self-serve medicine tomorrow, and I can read and post on it yesterday!

His hospital has a station next to their ER where patients can have access to supplies and instruction manuals so that they can treat themselves for minor conditions. Bravo!

I have long thought that with the current health & science education that people receive throughout school and the ability to access deep and broad information resources, the usefulness of professional health care providers should be much reduced. We shall see if I am right as the future unfolds...

RealAge is marketing scam

The RealAge website is a marketing scam by pharmaceutical companies, per Furious Seasons. That's unfortunate.

Ebola Reston virus antibodies in people

The WHO released a statement yesterday about antibody testing in Philippine citizens exposed to Ebola pigs...

31 March 2009 -- On 16 February 2009, the Government of Philippines announced that a slaughterhouse worker who has daily contact with pigs tested positive for antibodies against the Ebola Reston virus.

This brings to six, out of a total of 141 people, who have tested positive for Ebola Reston antibodies in the Philippines since testing began in December 2008. All six people who were antibody positive reported occupational exposure to pigs.

The Philippine Department of Health has said that all six people who tested positive appear to be in good health. Pig-to-human transmission is believed to be the most likely source of infection.

To date, since the first human to develop antibodies against Ebola Reston was reported in 1989, no significant human illness has been reported in association with Ebola Reston infection. However only a very small number of humans with Ebola Reston antibodies have ever been detected, and all were healthy adult males. The threat to human health is likely to be low for healthy adults but is unknown for all other population groups, such as immuno-compromised persons, persons with underlying medical conditions, pregnant women and children. More studies are needed to better understand the public health implications of Ebola Reston in humans and efforts should be made to reduce the risk of human infection.

Ebola Reston virus species belongs to the Ebola genus in the Filovirus family, a genus that comprises other Ebola species that are known to be highly pathogenic for humans. All members of the Filovirus family are only handled in laboratories with the highest level of biosecurity.

Recent cases in the Philippines mark the first time that Ebola Reston has been found in pigs, and the first time that suspected transmission from pigs to humans has occurred.