Motivating factors

I was recently invited to post a pointer in a blog post titled, "25 Ways to Stay Motivated as a Nurse". Until I was asked, I can honestly say I never gave much thought to how I stay motivated as a nurse. As I reflected back on my career, I realized the one thing that kept me motivated through these 30+ years was the many career options.

I began my career as a staff nurse on a surgical floor in the healthcare facility where I attended nursing school. I was thrilled to get a position in one of the most respected teaching hospitals in the Philadelphia area. Working on a surgical floor was okay, but I knew from the start it wasn't quite the right fit. Within 5 months, the critical care unit was short-staffed; when they reached out for volunteers to transfer to critical care, I immediately volunteered. The transition was anxiety-provoking, stressful, exciting, and everything I hoped for. I loved working in a high-tech, fast-paced environment with a talented multidisciplinary team, where I could actually help people who needed it the most. This care environment motivated me to work my way up the ranks, first as a preceptor, then as clinical leader, and finally as nurse manager.

But life happens, and suddenly my motivation transitioned to family. With the birth of my first child, I resigned my position as nurse manager, assumed a relief night nurse position, and spent days caring for my daughter. As my family grew, it was the perfect situation. I was able to continue the career I loved, avoid the daycare shuffle, and launch a side job as a freelance clinical editor...perfect career options!  

But as anyone who has worked nights knows, years of missing out on much needed sleep to volunteer at school during the day, attending sporting events and concerts in the evening, and scrambling home to catch a nap before work takes it's toll. So, as my children grew older I explored my options, applied for employment with a freelance client, and landed a position as a part-time clinical editor.  It was a unique opportunity to express my creative side while applying my nursing skills. But as the cliche goes, all good things must come to an end...our company was sold to a major corporation, part time positions were eliminated, and hi ho, hi ho, it's back to the hospital I go...More opportunities in critical care, and then eventually, in infection control and prevention. As you can see, nursing is a career filled with endless, exciting opportunities; opportunities that can fit every stage of life.

What career options have you explored to keep you motivated as a nurse? I'd love to hear your story.

Warmth for a fall day

Well, it's been quite awhile since I've written...but as I sit here on this cold, rainy, blustery fall day I couldn't resist sharing a favorite recipe. I know, it isn't my usual health-related post. It isn't even a healthy recipe, but it's a family favorite that tastes great and warms the soul. Perfect for a fall rainy day!

The original recipe was published in the March 1988 edition of Bon Appetit, but as with nearly every recipe I use I've modified it.

Fall sausage and beef stew

3 tablespoons extra virgin olive oil

1 pound kielbasa sausage

2 pounds beef cubes

1/4 cup almond flour (or unbleached flour)

2 medium or 1 extra large onion

4 cloves of garlic minced

3 cups dry red wine

2 beef bullion cubes

2 cups water

3 sprigs of fresh parsley

2 bay leaves

1 1/2 teaspoons dried thyme

5 large carrots

1 pound of parsnips

Food prep

• Cut the kielbasa sausage on an angle in 1/2 inch-wide slices. 
• Trim the beef cubes and cut into 1-inch cubes, if needed.
• Slice the onions.
• Peel and mince the garlic cloves.
• Chop the parsley sprigs.
• Peel and cut the carrots on an angle in 1/2 inch-wide slices.
• Peel and cut the parsnips on an angle in 1/2 inch-wide slices.

Putting it together

Add enough extra virgin olive oil to coat the bottom of a Dutch oven. Heat the oil over medium-high heat. Add the kielbasa sausage and cook it until it's lightly browned. Remove the kielbasa sausage from the Dutch oven with a slotted spoon and allow the sausage to drain on a paper towel. Add half of the beef cubes to the Dutch oven and cook until it's lightly browned. Add extra virgin olive oil to the Dutch oven, as needed. Remove the browned beef cubes and place them on the paper towel. Repeat with the remaining beef. 

Add a tablespoon of extra virgin olive oil to the Dutch oven and saute the onions until lightly browned. Add the garlic and lightly brown. Next, add the flour and mix well. Add the beef and sausage. 

Finally add the wine, bullion cubes, water, parsley, thyme, bay leaves, carrots, and parsnips. When the mixture begins to come to a boil, reduce the heat to low and cook until the beef is tender. Alternatively, place the Dutch oven in the oven at 325 degrees and bake for 2 to 2 1/2 hours.

Enjoy! or, I guess I should say Bon Appetit!

The scope about CRE

The USA Today headline read, "Deadly bacteria on medical scopes trigger infection". CNN reported, "What is CRE? Nightmare bacteria have killed again". The news was alarming, especially if you had a recent endoscopy.

So, what are these superbugs? 

Carbapenem-resistant Enterobacteriaeceae (CRE) are so-called superbugs; bacteria that have become resistant to common antibiotics known as carbapenems. Carbapenem antibiotics include, doripenem, meropenem, ertapenem, and cilastatin/imipenem. These antibiotics are commonly prescribed to treat severe infections, such as bloodstream infection, urinary tract infections, pneumonia, and wound infections that are resistant to other antibiotics.

Klebsiella and Escherichia coli (or E-coli) are enterobacteriaceae that are normally found in the human gut. Occasionally they escape from the gut causing serious infections. Frequently these bacteria produce an enzyme that makes them resistant to carbapenem antibiotics; the enzyme protects the bacteria, preventing them from being killed by the carbapenem antibiotic. What makes matters worse is that sometimes CRE are resistant to all antibiotics, making them extremely dangerous to anyone who becomes infected by them.

Who's at risk for CRE infection?

Typically healthy people don't get CRE infections; they commonly affect patients in hospitals or long-term care facilities. These people are affected because they have weakened immune systems, and invasive tubes and catheters that make it easy for the bacteria to enter the body and cause infection. CRE are usually spread from person to person through contact with wounds or stool of an infected person. Treatment with certain antibiotics may also increase a person's risk for CRE infection.

Recently, however, special endoscopes used during a medical procedure, known as endoscopic retrograde cholangiopancreatography or ERCP, have spread the infection. During this procedure, an endoscope (known as a duodenoscope) is inserted into the patient's mouth and advanced into the intestine where the bile duct attaches. ERCP is used to diagnose and treat gallstones, open bile ducts, and obtain samples to diagnose tumors of the pancreas, bile ducts, or  gallbladder. For patients who require ERCP, it can be a life-saving procedure.

The scoop behind the scope

Researchers estimate that more than 500,000 ERCPs are performed annually in the United States; fewer than 100 cases of ERCP-associated CRE infection have been reported. Investigators believe that the intricate design of this special endoscope may be at fault, because it presents a special challenge for cleaning and disinfecting the device.  The Centers for Disease Control and Prevention, the Food and Drug Administration, and manufacturers recommend that healthcare workers strictly adhere to infection prevention practices and the manufacturer's guidelines for cleaning and disinfecting the device.

ERCP endoscope tip

The good news

Although an infection with CRE is very frightening; the chance of getting a CRE infection from endoscopy is rare. Moreover, there have been no reported cases of CRE infection related to routine endoscopy, such as colonoscopy.

Anger, within the first two hours

I get up early, empty the dishwasher, and people still leave dishes in the sink...I ride the train with a man who invades my personal space, and reeks of last night's party...I get to work with a plan for the day,and it's derailed by the first e-mail...The anger takes control, my teeth and fists clench, my body tenses,
I'm enraged, and ready to...have a heart attack.

According to researchers at the University of Sydney, research shows that heart attack risk increases eight-fold within the two hours following intense anger. During the study, patients admitted with an angiography-confirmed heart attack were questioned about the events within the 48 hours prior to symptom onset.

Nearly 2% of  the patients studied experienced an anger-triggered heart attack. The heart attack didn't typically occur during the anger episode but within the two hours following. Anger was defined as 5 and above on a scale of 1 to 7; patient's reported feeling angry (body tense, fists and teeth clenched, and ready to spiral out of control) to enraged (completely out of control). Extreme anger was triggered by arguments, work anger, and road rage. These triggers are known to increase heart rate and blood pressure, constrict blood vessels, and increase  clotting, which increase the risk for heart attack.

These findings highlight the importance of stress relief and anger management in promoting heart health. Improving overall health by controlling hypertension, quitting smoking, reducing cholesterol, and taking medications, as prescribed, can also reduce the risk...So, be slow to anger...for your heart's sake.

18 particles is all it takes

I've worked as a critical care nurse and then as an Infection Preventionist, taking care of patients with a variety of illnesses and injuries...assisted a neurosurgeon as he drilled burr holes into a patient's skull, a cardiothoracic surgeon as he opened a patient's chest, stuck my hands in countless wounds, gathered leaches as they reduced a neck hematoma...but nothing makes me more squeamish or turns me into a germaphobe like the attack of the dreaded norovirus... especially when it enters my home. Yesterday, the dreaded virus did just that...

Norovirus is a highly contagious virus that spreads quickly; especially in schools, cruise ships, healthcare facilities, and day care centers, where people are in close proximity. Just how contagious is the norovirus? According to the Journal of Medical Virology, as few as 18 norovirus particles  can cause illness. Translated, the number of particles that would fill the head of a pin would have the capability of infecting more than 1,000 people. 

How is the norovirus spread? 

• By touching objects contaminated with the virus and then touching your fingers to your mouth 
• Through consumption of food or liquids contaminated by the virus
• Via contact with an infected person.

When norovirus attacks it causes inflammation of the stomach, intestines, or both causing nausea, vomiting, abdominal pain, and diarrhea. These symptoms may also be accompanied by body aches, headache, and fever. Frequent episodes of vomiting and diarrhea can quickly cause dehydration. 

So, what can you do to prevent the spread of norovirus?

• Wash your hands with soap and water when visibly soiled by rubbing them together vigorously for at least 20 seconds. 

• Wash your hands with soap and water before eating, before preparing or handling food, and after using the toilet or changing diapers.
• Use an alcohol-based hand rub frequently to decontaminate your hands, by rubbing all surfaces of the hands until the agent dries. 

• Thoroughly wash fruits and vegetables before consuming them.
• Discard any foods that might be contaminated with the virus.
• Avoid preparing foods if you become ill.
• Don't provide care for others while you're ill.
• Clean and disinfect contaminated objects and surfaces with a chlorine bleach or other disinfectant that is effective against the norovirus.
• Immediately wash clothing or linens that may be contaminated with the virus.

Keep in mind that even when you feel better, you can still spread the virus to others. In fact, you are most contagious when you are ill and during the first few days after you feel better. You can shed the virus in your stool for 2 weeks or longer after you've recovered; so, make sure you continue to practice good hand hygiene and take the other necessary precautions to prevent the spread of the infection.

Remember, hand hygiene is the single most important thing you can do to prevent the spread of any infection!

Animals improve quality of life for cancer patients

When I work in my home office,  I feel immediate joy when my daughter brings my Grandpuggle to our house for doggy daycare. Lil Bits gets out of the car, runs through the door, and jumps onto my lap as soon as she finds me. As I sit at my desk working, I experience instant stress-relief when she snuggles into my office chair...She definitely has a positive influence on my emotional well-being....Research shows that I'm not alone...

A recent study by Stewart Fleishman, a physician at Beth Israel Medical Center's Continuum Cancer Center in New York,  found that the emotional and social well-being of patients with cancer improved when they interacted with therapy dogs during combined chemotherapy and radiation therapy. During this study, 42 patients receiving treatment for head, neck, and gastrointestinal cancer consented to daily animal visits. A self-assessment tool, known as the FACT-G questionnaire, was administered to gain insight into each patient's baseline emotional, functional, personal, and social well-being. 

Lil Bits

A dog visit was scheduled for each chemotherapy or radiation therapy session. During the visits, each patient spent time in the waiting room petting, talking, and playing with a dog. A FACT-G questionnaire was administered bi-weekly to the patients for the duration of the study. 

During the course of treatment, patients developed adverse effects, such as pain; fatigue; skin lesions; and difficulty swallowing, eating, and speaking. Despite this physical decline, patients reported an increase in emotional and social well-being. In fact, Dr. Fleishman reported that a patient said she would've stopped treatment but continued so she could see the dog.  

Why? Because despite the patients' physical decline, the therapy dogs were excited to see them. The dogs displayed unconditional love not noticing the patients' physical decline. 

Animals clearly provide human health benefits, even for patients undergoing grueling combination cancer regimens with radiation therapy and chemotherapy. As a result, many more cancer centers are offering animal-assisted visits for their patients.

Pain in the...

For more than 20 years I cared for critically ill patients; repositioning, turning, transferring, and transporting them...not once, did I experience back pain or discomfort. Now that I have a desk job that requires sitting more than 8 hours a day, I'm hampered by lower back pain and stiffness. After rising from the office chair, it takes at least 10 steps before I can straighten up completely and get into my normal pace and stride.  Sadly, I'm not alone. 

According to the National Institute of Arthritis and Musculoskeletal and Skin Disease approximately 27 million Americans age 25 and older have osteoarthritis. Osteoarthritis, the most common form of arthritis, is a degenerative disease that affects joint cartilage. Osteoarthritis commonly affects joints in the fingers, thumbs, neck, lower back, knees and hips. 

Signs and symptoms of osteoarthritis

• Joint stiffness; especially after getting out of bed or after prolonged sitting
• Joint swelling
• Crunching feeling with joint movement
• Sound produced by bone rubbing on bone

Diagnoses

A variety of techniques are used to diagnose osteoarthritis including symptom history, physical examination, X-rays, magnetic resonance imaging, joint fluid analysis, and blood tests to eliminate other possible causes.

Treating  osteoarthritis

An individualized treatment plan should take the patient's health, lifestyle, and current needs into consideration. The treatment plan may include a variety of interventions:

• Exercise, such as walking, swimming, water aerobics
• Weight control
• Rest
• Assistive devices 
• Heat or cold application
• Transcutaneous electrical nerve stimulation
• Massage
• Acupuncture
• Over-the-counter pain relief aids, such as acetaminophen
• Nonsteroidal anti-inflammatory drugs 
• Opioids
• Corticosteroids
• Other medications
• Surgical intervention

Key to living success

Self-care is the key to living well with osteoarthritis. People who engage in their care report fewer physician appointments, less pain, and a better quality of life. Self-care success requires:

•  learning about the disease and treatment options
• staying active and engaging in an exercise program
• eating healthy foods 
• controlling weight
• getting plenty of sleep
• enjoying life
• maintaining a positive attitude.