Smith & Nephew Introduces Pressure Ulcer Management Program

To help facilities manage the risk and high cost of pressure ulcers and infected wounds, Smith & Nephew, Largo, FL, has developed an approach called BRIDGES. The program is designed to improve assessment of high-risk patients, standardize practice protocols, develop customized core formularies, drive proper product selection and utilization, improve protocol compliance, and track sustainable, repeatable results.

As of October 2008, the Centers for Medicare and Medicaid Services will no longer reimburse hospitals for the treatment of 8 hospital-acquired conditions, including pressure ulcers and various types of infection. This action makes implementing a pressure ulcer prevention program especially important at many facilities where nonwound care experts are managing the prevention and treatment of wounds. This can lead to significant variations in treatment, product use, and outcomes.

The BRIDGES program was implemented at the University Medical Center in Lubbock, TX, to reduce the incidence of pressure ulcers. After 1 year, the hospital-wide (excluding the intensive care unit) incidence of pressure ulcers was reduced from 15% to 0%. Wound care product costs were reduced by $63,713. The number of days requiring negative pressure wound therapy was also reduced, resulting in a savings of $17,068. The company’s goal through this program is to help customers reduce risk, improve utilization, and maximize clinical and economic outcomes.

Medline Unveils New Packaging for Silvasorb

Medline Industries, Inc, Mundelein, IL, introduces innovative packaging for its line of SilvaSorb wound care dressings, designed to increase user safety. The new packaging, including an outer box and inner pouch, provides clear, concise instructions on the proper use of the product, along with a pamphlet that offers a 2-minute tutorial on important wound care guidelines. Packaging for each family of wound care products is color-coded and the inner pouch includes a crack-and-peel sticker for dressing change and charting.

Midwest Once Again Prepares for Winter Weather

Power has been restored to homes and businesses throughout most of the nation’s midsection as winter weather is once again in the forecast for the weekend.

By Katie Lawson, Staff Writer, RedCross.org

Thursday, December 20, 2007 —

Red Cross volunteers delivered warm meals to Adna High School and allowed families to visit with friends, learn about services available in the community and take a break from cleaning up their homes and property. (Photo courtesy: Daphne Mathew/American Red Cross)

Many residents in the Midwest are finally out of the dark and cold today following winter weather last week that left more than 500,000 homes and businesses in Oklahoma without power for days.

For a fourth consecutive weekend, a storm system threatens to bring a mixture of rain and snow to the region as early as Friday.

A cold front that began nearly two weeks ago swept through the Midwest, bringing sub-freezing temperatures and a combination of rain, freezing rain, sleet and snow. In Oklahoma, ice accumulation ranged between a glaze and one inch across most of the state, causing widespread power outages and treacherous travel conditions. The storms caused the biggest power outage in state history and utility workers continue their efforts to restore power to the region.

American Red Cross disaster workers were among the first on the ground in Kansas, Oklahoma and Missouri, delivering relief in the form of temporary shelters, warming centers, hot meals and snacks and other emergency assistance. Members of the Red Cross Annual Disaster Giving Program helped provide the funding to rush relief to the affected residents, but the need for additional donations is still great due to the vast devastation the storms caused throughout Kansas and Oklahoma.

The Red Cross opened more than 130 shelters in the region and worked with the Southern Baptist Convention to provide meals for the more than 18,000 people who needed safe shelter overnight. To date, the Red Cross has served more than 100,000 meals and snacks to those affected by the storms.

As custodians of nearly half of the nation’s blood supply, the Red Cross also took steps to prevent the ice storms from affecting blood collections. The Renaissance Hotel in Tulsa agreed to host a blood drive in the hotel to give stranded guests the opportunity to help out.

Elsewhere, schools in Iowa and Wisconsin were closed last week and Des Moines International Airport was also forced to close for a period of time due to ice. Media reports state that the storm predicted for the weekend will bring ice and snow along with wind gusts of between 25 and 35 mph.

Although the majority shelters have since closed their doors, the Red Cross remains on alert to provide shelter, food and comfort to residents in the nation’s midsection and elsewhere.

Global Partners Get Jump on Measles

Measles deaths drop by 91 percent in Africa and 68 percent globally

By Jennifer Lubrani, Staff Writer, RedCross.org

Thursday, November 29, 2007 — Measles is a leading killer of children in many developing countries where prevention, treatment and health care can be difficult to access. But with strong global support from governments, health workers and dedicated volunteers, significant progress is being made in the fight against measles.

A Malagasy Red Cross volunteer marks a child’s finger indicating she received a measles vaccine. (Photo: Gene Dailey/American Red Cross)

That’s the message from today’s announcement that the Measles Initiative has helped to reduce measles deaths in Africa by 91 percent—between 2000 and 2006— thereby reaching the goal to cut measles death by 90 percent four years ahead of the United Nations’ goal. Globally, measles deaths have dropped by 68 percent during this same time.

In 2001, a global health initiative—led by the American Red Cross, UNICEF, the United Nations Foundation, the U.S. Centers for Disease Control and Prevention, and the World Health Organization— was launched to reduce measles deaths in Africa. Since 2005, the Initiative has expanded to Asia and other parts of the world where children are at risk.

Since 2001, the Measles Initiative has supported the vaccination of more than 400 million children in over 50 countries. The vaccination campaign includes additional life-saving health interventions, including Vitamin A, de-worming medicine and insecticide-treated bed nets for malaria prevention.

A key to this success are volunteers at Red Cross and Red Crescent societies around the world. The American Red Cross provided financial and technical support to national societies, where volunteers work in advance to spread the word about upcoming campaigns.

“We literally go door-to-door informing, educating and motivating mothers and caregivers about the critical need to vaccinate their children,” said Bonnie McElveen-Hunter, chairman of the American Red Cross. “These mobilization efforts are essential for our success, helping us consistently reach more than 95 percent of the vulnerable population and saving countless lives.”

Still measles continues to take the lives of nearly 600 children under 5 years each day – approximately 242,000 children each year.

Although the fight against this deadly disease is not over, measles deaths are being dramatically reduced, ensuring that children around the world have a safer and healthier future.

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Pediatric Burn Case

As a student nurse, I was assigned an 18 month old burned boy. My instructor thought that the extra care and attention might be helpful to getting fluids and the like into him. This was in the 60’s and non-flammable clothing was not yet mandatory for children. Well, this little fellow was in a sleeper, playing in the back yard while his dad burned yard rubbish. Somehow, he fell in or got close enough for the sleeper to catch fire. It was nylon, and sort of melted into the baby. He had third degree burns on his belly, second degree on chest face and arms.

He was in isolation, so we had to “suit-up” each time we entered the room. Every time someone entered, they were met with terrified screams from what looked like the Pillbury Doughboy with leprosy. As a student, at most I would be allowed to watch some proceedure, but I was not able to do anything, like start an IV or debried a site. But after about 10 minutes of listening to him scream, I realized that we all looked alike, blue monsters, with only the skin around our eyes to distinguish us. Our hair was covered with a white cap, our face with a blue mask, and our clothing with a blue gown that tied in the back. One blue monster would come in, gently tell him that he was going to get a shot, or scrub his leg, and then offer him OJ or tea. No wonder his intake PO was zero. I left the room, frustrated and distressed.

How could I communicate with someone who could barely speak, and who would not be quiet long enough to listen to the few words he did know. How did I get hime to know that I was a Good Nurse, not one of the ones who would hurt him?
I went in search of my instructor. Knowing that she had two students rotating through Recovery (post-op), I wandered in that direction. One of the nurses from surgery passed me, then another, pushing a Guerney in the same direction that I was heading in, and faster. I caught up with the second nurse and asked who was the charge nurse that day, and she replied that she was, and asked what I needed. “I know that look. What do you want?” When I explained, she laughed and said that that was easy. I returned to the surgical suit with her, got a cart from the hallway, and filled it with gowns, draped it and returned to Pediatric Services.

Calling on the Unit Clerk assistance, I wrote a couple of signs and pasted them to the wall above the carts. The first one said: These blue gowns are for painful and distressing procedures. When dressed in them, keep speech to a MINIMUM, Just tell him what you will do, do it and leave. These are the Bad Blue Nurses. The second one read: These green gowns are to be worn when providing food, or play. They never come into the room when painful procedures are being done, but can enter later, and comfort the child. These are the Good Green Nurses.

Then I went into the room dressed in green and cavorted around, singing a silly song about good green nurses serving candy, cookies and ice cream. Then I served him some ice cream, making appropriate train choo-choo noises or airplane sounds. He settled down, and I spent the rest of the shift playing with him, and leaving the room when Bad Blue Nurses come in. The following day I was rounding the corner when I saw one of the Peds nurses strip the blues, don the greens and rush back to comfort him. “Did that Bad Blue Nurse hurt you? I’m so sorry. I brought you a popcicle. A grape one. Isn’t that tasty?” I gowned up in greens, and spent another day entertaining him. The floor nurse said that he had it all figured out, and would start screaming as soon as a Bad Blue came in, and never when a Good Green entered the room.

It made the rest of his stay much less stressful, both for him, and the staff.

from www.allnurses.com

Nursing Care of Older Adults: How to Try This

Assessments and Best Practices in Care of Older Adults

Caring for older adults is far more complex than the majority of today’s nurses and other healthcare providers ever learned in school, and than the majority of faculty in any schools of nursing are prepared to teach their students. In fact, lack of knowledge about care of older adults among the teachers, students and working graduates of nursing programs results in inadequate assessment skills-skills that are the foundation of good geriatric care—and ultimately in missed or erroneous diagnoses, treatments that can harm rather than heal, and a reduced quality of life among those 65 years of age and older.

In order to provide resources that will help to fill the gap between knowledge and practice in the care of older adults, the John A. Hartford Foundation has funded the Hartford Institute for Geriatric Nursing (HIGN) at New York University’s College of Nursing, and the American Journal of Nursing, for a project called How to Try This. How to Try This is an initiative that will translate the evidence-based geriatric assessment tools in the HIGN Try This assessment series into cost-free, web-based resources including demonstration videos and a corresponding print series featured in the AJN.

Why is assessment of older adults so important? Illnesses in older people often look different than in younger ones. For instance, younger adults with a urinary tract infection will have many or all of these symptoms: frequent urination, pain from bladder spasms, blood in the urine, and fever. Changes that occur with aging often mask these symptoms that provide early clues to a urinary tract infection. The first sign of a urinary tract infection in an older adult might be confusion or a fall. If the nurse does not have the knowledge and skills to further evaluate the older adult who might fall or become confused, the infection can go untreated and result in overwhelming infection, and possibly death.

Age-appropriate assessments: the foundation for good care of older adults

Assessment has long been recognized as the most important step in determining appropriate care. The Scope and Standards of Gerontological Nursing Practice establishes the professional standards, required nursing knowledge, and the specific nursing skills and abilities against which gerontological nurses are held professionally and legally responsible. These standards define assessment as the first step in managing patients and the basis for developing a comprehensive plan of care.

Good assessment leads to all subsequent care and requires that nurses know:

• on whom assessments should be conducted
• when to conduct the assessment
• how to conduct the assessment
• how to interpret the assessment
• how to communicate the findings to the patient, family, and other members of the healthcare team
• how to use the findings to shape the plan of care.

-American Journal of Nursing

The Language of Pain

Years ago in my high school P.E. class, I jumped down off some bleachers and sprained my ankle really bad. I sat there holding my ankle and was face was somewhat contorted into an expression of pain, although there were no tears, no outcry, and no drama. Yet, one of my classmates accused me of acting like a baby. I felt shame over this for years because even my own family had the attitude of “Don’t bother me with your pain”, “Don’t embarrass me by expressing it/what will people think” type of stoicism.

Then I went through CNA training and the first half of LVN school, and read what the textbooks had to say about pain. The first thing I learned was that different people and cultures have different attitudes about pain and express it differently. Even within the same culture, people will express their pain differently. The second thing I learned was people should not be judged on how they express their pain, and that people with chronic pain can look and act normal, and have normal vital signs. The shame I had lifted, when I realized there was nothing wrong with expressing my pain, but I was angered and disgusted at the judgmental attitudes of the people I have known.

A year before the CNA class, I woke up to abdominal pain that gradually grew worse as the day progressed. I went to the doctor to have it checked out, just in case it was appendicitis. It turned out to be a ruptured ovarian cyst. The pain was high, about an 8 on the 10 scale. No one at the doctor’s office had me rate the pain on the pain scale, and the doctor told me to take ibuprofen for the pain, instead of writing a prescription for a painkiller. The ibuprofen didn’t even touch the pain. I didn’t call back and tell them that because, at the time I was uninformed and thought that ibuprofen was all that they would recommend and all I would get, and they wouldn’t prescribe anything stronger. I did know about codeine, since my dentist prescribed it after I had impacted wisdom teeth removed. It really helped the pain. When I took pharmacology, I learned about other types of painkillers, and wondered why didn’t the doctor try something else, even if it was Toradol? Why didn’t I just call back and tell them the ibuprofen is not helping? Would they have told me “That’s all we can suggest? Would they have thought of me as a drug seeker? It kind of makes me wonder what would happen if I had a bone fracture. (Maybe I need to read my chart)

I took care of a resident with dementia when I was a CNA and this resident would swear during care. A few months before I got the job, I had clinicals in the same facility and had the same resident assigned to me, and this resident wasn’t swearing then and I wondered why. I would hear other coworkers telling this resident “You shouldn’t swear” and I think they were thinking it was a behavioral thing. One day I was giving this resident a shower and heard swear words when I touched a knee, so I asked “Is your knee hurting?”. The resident said yes and I told the nurse. After that, the resident didn’t swear so much because the pain was finally adequately treated. I don’t know how long this person had to live with the pain, because the staff thought it was a behavioral issue.

I have heard of doctors being reluctant to give narcotics for terminal cancer pain. I never understood that, since if someone has terminal cancer, is in a lot of pain, and is going to die anyway, then becoming addicted would be the least of their problems. Or people with chronic pain are under medicated for this reason and their quality of life deteriorates. Also, people with dementia are under medicated because their pain isn’t recognized. I’ve even heard of a few nurses reluctant to give legitimately prescribed narcotics, either trying to avoid giving them altogether, or making people wait for their pain medication, and this is wrong because people needlessly suffer.

In a sense, we are all drug seekers and clock watchers. After my impacted wisdom teeth were pulled, I was prescribed codeine with Tylenol, one tablet every 4 hours. During the night my jaw would hurt; and when I looked at the time, it would be 4 hours after the last dose. I didn’t need to watch the clock, the 7/10 pain in my jaw did it for me. When we have a cold we go down to the store for OTC meds. We look at the directions for how often to take them and we look at the clock to see when the next dose can be taken.

I do believe that pain should be managed adequately for everyone, and no one in legitimate pain should be judged for how they cope with it or how they express it. I have never been in chronic pain—–yet. It could happen though, to any one of us at any time.

by squeakykitty of all nurses.com

Art of Nursing

Nurses are old and young, tall and short, skinny and wide. We come from all walks of life. Some choose to enter the nursing profession for job security, others to help those around them. Throughout our schooling, we are taught and tested on the science of nursing. Our primary focus is the ability to recall important facts, to think ahead of the current situation, and to understand interactions between the patient and the interventions we provide.

Elusive, yet widely recognized, the art of nursing is our ability to connect with those around us. It is only when we begin direct patient care that we become aware of the art of nursing. The word art can be used to describe the results of a particular task as well as the knowledge and skill required to perform that task. Like other more fashionable art forms, nursing can be dramatic, inspirational, comedic, relaxing, comforting, joyful, and even sad. Nursing is also creative, existential, and has a particular rhythm. This intangible connection can create an environment of healing, one that allows patients to fully participate in their own recovery process.

My great-great-aunt Mae was a nurse at the turn of the 19th Century. Seven days a week, she hitched-up her horse and buggy to provide medical care and comfort in her rural community. When the local veterinarian was busy, she would also help care for local horses and cattle. Later, she became a psychiatric nurse, and even later a nurse educator. Nursing allowed her to travel, meet new people, and provide for independence that most women couldn’t attain in that time period. For her, nursing meant freedom and the ability to be her own person.

My great-aunt Marge became a nurse in the late 1930s. She initially worked in a small country hospital. When World War II erupted, she moved to a bigger city to care for veterans on a medical ward. As she provided these brave men with physical care, she also performed assessments and interventions to help relieve their psychological pain. She felt that her calling at that time was to heal their damaged spirits. Though her career spanned many decades and various nursing specialties, it is this work that brought her the most joy and great professional pride.

When I decided on a career in nursing, I knew none of this. I had worked in healthcare settings since I was 15 years old, and always knew I wanted to work in a patient care environment. I readily learned the tasks I needed to perform whatever job I was assigned. But more than that, I could easily connect with my patients on a level deeper than I expected. Patients would open up to me. Even at the tender age of 16, I had elderly patients share their fears of death and dying with me – seeking comfort

Nurses teach, support, communicate, medicate, and coordinate patient-care events. Nurses are patient advocates who provide comfort and hope to our patients and their families. The art of nursing is in play when we just ‘know’ what to do to meet a patient’s emotional needs: when to hold a patient’s hand, stroke their brow, crack a joke or even just sit and listen. Most of this is being accomplished simultaneously during each patient interaction.

The science of nursing allows us to care for our patient’s bodies; but it’s the art of nursing that calls me to the profession and allows each nurse to touch souls.

by NMSANE of allnurses.com

Communication of RNs