Monday, June 26, 2017

Do Nurses Have a Role in Complementary Therapies?


Last year during the Olympics, the practice of cupping was brought to the forefront. Many athletes were spotted sporting large round welts on their their back, shoulders, and upper chest that were caused by cupping. This caught the attention of the sports analysts and reporters, and the Western world quickly became interested in this new-to-them practice.

Cupping is an old traditional form of Chinese medicine, often used in conjunction with acupuncture. I went for acupuncture last week to help deal with a headache I had since January. It was a sinus-type headache but tests and scans showed that there was no infection, allergies, inflammation, nothing. So, I returned to an acupuncturist I'd visited a few years before. I forgot that she did cupping after the acupuncture session:

Cupping mark on my shoulder

It doesn't hurt while cupping is done and while it looks like a nasty bruise, it's only tender if you press hard on it. It looks awful but - my headache is virtually gone. It's down to about 10% of what it was before. I'll be going for another session later this week. So was it the acupuncture? The cupping? Both?

Practitioners claim that cupping can treat many disorders, including asthma, arthritis, GI upsets, and chronic pain, among others. Generally, the practitioner heats the air in a cup, usually with a flame, and the cup is placed on the skin. This produces suction. It’s believed that this suction promotes blood flow to the area, resulting in better health. When the cup is removed, a red or bruising mark may be left behind.

Regardless of what we may personally believe about complementary and alternative medicines, patients are using them. An article I wrote for Oncology Nursing News in 2015 stated that, “53% of American adults used CIT [complementary and integrated therapies] at some point in their lifetime, and 42% said they used it within the past year. People with cancer reported even higher use: 65% of cancer survivors used CIT at some point, and 43% used it within the past year.”

As nurses in North America, we generally work in facilities that focus on evidence-based medicine. Some facilities have developed integrative therapy departments, where patients can benefit from complementary medicines, such as acupuncture or massage therapy, along with Western medicines. These include facilities such as Johns Hopkins, Cleveland Clinic, and Mayo Clinic. I wasn’t able to find any similar departments associated with Canadian hospitals, although many major cities do have integrative medical clinics. So what do we say if patients ask us our opinions on complementary medicine?

The College of Registered Nurses of Nova Scotia published guidelines for nurse practitioners and registered nurses on the topic. The document reviews the nurses’ role in therapies, the nurses’ ethical and professional responsibilities, and how nurses might have a role in practicing complementary therapies. The college concluded: “Registered nurses and nurse practitioners can be actively involved in the delivery of CAHC therapies or simply help clients access appropriate information and make treatment decisions. Regardless of their role, RNs and NPs must be well informed and possess the appropriate knowledge and skills to provide safe care. Having evidence informed knowledge of potential benefits and risks of particular therapies is crucial. As RNs and NPs strive to provide comprehensive care for their clients, they must always ensure that they practise CAHC within the context of a nursing framework and within their standards of practice and code of ethics.”

Personally, I believe in some types of complementary medicine, but not necessarily alternative medicine. I have used acupuncture and massage therapy with good results. Complementary means that the treatment is in conjunction with evidence-based medicine practices. Alternative implies that the treatment is instead of. However, regardless of our own beliefs, it is vital that our patients trust us enough that they tell us if they are undergoing other forms of treatments or therapies. They may be more willing and open to telling their nurses than their doctors, for fear that their doctors will insist that they stop their treatments. As nurses, we can help them understand why it’s important that they be open with their treating physicians.

Do you see a role for nurses in complementary health practices?


Thursday, June 1, 2017

Sepsis – So Deadly, So Under Recognized


I work with a US-based group, Sepsis Alliance (SA). It’s a patient advocacy group with a mission to raise sepsis awareness and save lives. While it’s an American organization, the situation in the US parallels that of Canada when it comes to sepsis recognition and management. According to a report issued by Stats Canada in 2011, one in every 18 deaths in Canada is due to sepsis—one out of every 18. In the US, it kills over a quarter of a million people every year. That is a lot of deaths. Why is this happening?

Sepsis isn’t always preventable, this is true, but early detection and treatment often prevents it from progressing to severe sepsis and septic shock. A couple of years ago, I saw how effective a sepsis protocol can be. A family member who had a stroke was diagnosed with endocarditis while in the ICU. He showed the classic signs of sepsis onset and the staff was all over it, preventing more complications. Research has shown that for every hour patients with severe sepsis aren’t treated, their chance of survival drops by 8%. Like stroke and myocardial infarctions, there is a “golden hour,” during which immediate treatment can mean the difference between life and death.

I’ve learned a lot about sepsis and its impact over the past seven years, working with SA. One of my tasks is to respond to emails from people who want to share their stories of sepsis, hoping to spread the word to spare someone else the same pain. The stories, which are published on the site, are heartbreaking: parents who lost children, children who lost parents or siblings, survivors who live with life-changing effects caused by sepsis. So many of these victims may not have been in that situation if they or someone else had recognized the signs and symptoms of the condition.

Jim O’Brien, MD, former medical director of SA, often says that we could—right now—cut the sepsis death rate in half even without new technology, new tests, or new medications, simply with early recognition and immediate treatment with antibiotics and fluids. But there lies the rub –sepsis has to be recognized in time for successful treatment. People need to know about it and how to recognize it.

According to annual surveys commissioned by SA, most people have never heard the word “sepsis,” and many of those who have, don’t know what it means. The medical community is partly responsible for this. We talk about people dying of complications of pneumonia, of urinary tract infections, or meningitis. But that’s not that they died of; they died from sepsis. If someone has cancer, develops an infection and dies, it’s not the cancer that killed, them, it’s sepsis. But we don’t say that.

In three months it will be September, Sepsis Awareness Month. Let's find ways to spread awareness, to educate people about this often fatal illness that no one knows about. If you'd like to learn how, SA has developed tool kits for the public, professionals, and the media: Sepsis Awareness Month.



Wednesday, April 12, 2017

Whistle Blower Nurse Fined by Her Own Professional Body

I have two questions for you:

If you see something wrong and this something is hurting or having a negative impact on people, is it not your duty to speak out about it?

Does it matter what your profession is if you do call it out?

The answer to the first question should be - in my opinion - yes, it is your duty. The answer to the second question seems to be a bit more complicated if you are a nurse and you live in Saskatchewan, Canada.

I remember reading about Carolyn Strom last year and I didn't think too much about the story because I figured that the story didn't have legs and that everything would work out. I was wrong.

Two years ago, Carolyn, an RN, wrote a post on her Facebook page about the quality of care her grandfather received in a long-term care facility, particularly at the end of his life when he was in palliative care. She criticized the care, but according to reports, she also offered solutions - being a nurse herself, she understood the issues associated with caring for patients in a long-term care environment. However, her professional body, the Saskatchewan Registered Nurses Association, charged her with professional misconduct and Carolyn was fined $26,000.

What is worrisome about this is that Carolyn was not acting as a nurse at the time, she was acting as a private citizen who was concerned about the lack of quality care not just for her grandfather, but other patients at this facility and similar ones. She was expressing her frustration and disappointment as anyone might. Except, she has an RN behind her name, which apparently means she's not allowed to express those thoughts.

According to the Globe and Mail, this is what Carolyn wrote:

“My grandfather spent a week in palliative care before he died and after hearing about his and my family’s experience there, it is evident that not everyone is ‘up to speed’ on how to approach end of life care or how to help maintain an aging senior’s dignity. 
“I challenge the people involved in decision making with that facility to please get all your staff a refresher on this topic and more. Don’t get me wrong, ‘some’ people have provided excellent care so I thank you so very much for your efforts, but to those who made Grandpa’s last years less than desirable, please do better next time.”
So, Carolyn was charge by the body's disciplinary committee with five breaches:

1- Not respecting patient confidentiality
2- Failure to follow proper channels in making a complaint
3- Making comments that have a negative impact on the reputation of staff and a facility
4- Failure to first obtain all the facts
5- Using her status of registered nurse for personal purposes

Here are my arguments:

1- When it is your family member, patient confidentiality doesn't work here. When my mother was dying last year, I could have written about it all I wanted as long as she had never expressly forbidden it. (This charge was dropped).

2- Should Carolyn have written a letter to the facility or gone higher? Yes, she should have. However, she could have done so and still posted on social media as a private citizen. Many of us have stories of letters of complaint we've written that were never addressed.

3- So, does this mean we can't bash United Airlines for the horrible video of a man being forcibly removed from his seat a few days ago? Because it would have a bad reputation on the staff and organization?

4- Can anyone ever obtain all the facts?

5- We all use our background, education, and "status" for personal purposes. It's who we are. Does this mean that I can never comment on anything health or medical related - because I'm a nurse? Why is her call out of her grandfather's care any different than a sibling who isn't a nurse might have been?

So, what is the message here? If you're a nurse and you see bad care, shut up. Don't tell anyone. Don't vent on social media. Don't criticize. If you do, you're guilty of professional misconduct.


You can read more about her story here on the CBC website.

And there is a GoFundMe page raising money to help Carolyn pay those ridiculous fines, if you feel so inclined to help her.

Tuesday, February 28, 2017

Your Failure to Plan Doesn’t Constitute an Emergency On My Part: Mandatory Overtime

 When we think of mandatory – or forced – overtime, our minds might go back to the day before labor unions, when people in factories were steadily working hour after hour, day after day, in unsafe and unpleasant conditions. But mandatory overtime is not a thing of the past for some nurses in Canada. It’s a reality.
No one argues that units must be staffed – there must be a certain number of nurses to maintain a safe level of patient care. But what happens when there is no staff to cover the next shift?
At first, supervisors usually ask for volunteers who would like to work overtime. But what does the hospital do when no nurse steps forward? If they can’t call for outside help (private agencies), their only option may be to pressure nurses into working another shift or, to bluntly tell nurses that they must stay. This is mandatory overtime, although they may not use those words.
While the administrators are solving their staffing problems, they are causing a whole host of problems for their nurses who need or want to go home – they may have daycare issues, classes to attend, senior relatives to care for, important appointments to keep, or they may need to get some much needed sleep.
If nurses refuse to work overtime, they may be threatened with “abandoning their patients.” However, according to the Canadian Federation of Nurses in their position statement on mandatory overtime, this is not true. The union says, ”It is important [to know] that refusing duty to care is not [to be] confused with client abandonment, which occurs when a nurse leaves before the end of a scheduled shift, or being unavailable during a scheduled shift for a period of time that compromises patient/resident/client care.” So, by saying that you can’t/won’t work an extra shift, you cannot be told you are abandoning your patients. But that is on paper. Our conscience may say otherwise.
Research has shown that tired workers make more mistakes. Tired workers have more accidents going home. They are unhappier overall, and their health may suffer over the long-term. In fact, a 2015 review study, published in the Lancet, looked at people who consistently worked more than the usual 40-hour workweek. The researchers found several studies that concluded that these workers are at a higher risk of stroke.
This problem must be addressed, particularly as patients who are in the hospital are sicker than they ever were before. They need more eyes on them, more procedures done with them, and more split second decisions made. Their nurses must be on the ball and refreshed, not tired and frustrated because they are at work against their will.
The union’s position paper goes on to say, “With the exception of disaster situations, or emergency circumstances (where the Code of Ethics outlines the duty to provide care), nurses unions feel that there are no circumstances whereby employers should mandate employees to work overtime. Mismanagement of human resources and chronic unfilled vacancies do not constitute emergency conditions or grounds for ordering mandatory overtime. Additionally, the right to refuse duty to care may also be applied during an emergency situation when ability to provide safe care is compromised by unreasonable expectations, lack of resources or ongoing threats to personal well-being.”
In other words, your failure to plan ahead of time doesn’t constitute an emergency on my part.

What do you think hospitals should do if there is no one available when a nurse’s shift is over?

Friday, February 24, 2017

Do You Take Your New Prescriptions Right Away?

I came across an interesting, but not unsurprising press release this morning. It seems that a study done in Spain found that over 15% of patients who received a new prescription did not get it filled. The study, which was published in the British Journal of Clinical Pharmacology, found that initial medication non-adherence, or non-compliance, was 17.6%.

The most common medication prescriptions not filled were for a certain type of pain reliever (22.6%) and the least common was for ACE inhibitors, usually used to manage high blood pressure, hypertension (7.4%).

Understanding why someone doesn't fill or take a new prescription is important and it can have a substantial impact on a person's health. Do they not fill the prescription because they don't agree with the diagnosis? Can they not afford the medication? Do they plan to do so later but then get too busy or forget? Did someone talk them out of it?

The researchers did find that the patients who were most likely not to fill their prescriptions were:

  • Younger adults, 
  • Americans (the study was done in Spain), 
  • Having a psychological or psychiatric disorder, 
  • Having a pain disorder, or
  • Receiving treatment by a substitute/resident GP in a teaching center.


"We are especially concerned about the high rates of initial medication non-adherence in chronic treatments such as insulins, statins, or antidepressants and suspect that it is also related to an increase in costs, so we are designing an intervention targeting high risk patients," said Dr. Maria Rubio-Valera, senior author of the British Journal of Clinical Pharmacology study.

So what can we do to about this? Patients must take control of the conversation, no matter how hard
it might be. Patients need to ask their doctors why they are prescribing medications. If they don't understand the responses, the patients need to push for clarity. And if the patients feel they won't or don't want to take their medications, they have to relay this to their doctors so alternative treatments can be discussed. It's not a good idea to let the doctor believe you are going to be compliant if you don't plan on it.

And how can healthcare professionals help? Nurses, for example, are often in a good position to question why patients aren't taking their medications and to explain why the medications are necessary. Many times patients will tell nurses things that they would never discuss with their doctor. And doctors need to be aware, or more aware, of why their patients may be reluctant to fill that prescription. Taking a few minutes to explain why it's important and to actually ask if there are any concerns regarding the medication, the treatment overall, or even the cost, could make a big difference.

Monday, February 13, 2017

Facebook, Instagram, and Twitter – Nurses Beware?

Should nurses be using social media? Of course, there’s nothing to stop nurses from having social media accounts. These accounts allow them to chat with friends and family members, share photos, and learn about what’s new in the cyberworld. But when social media crosses over into the work and professional world, things can start to get murky.

© Gajus | Dreamstime.com - woman surfing internet

It’s reality – nurses share stories with each other. I don’t know many nurses who don’t swap some at-work tales about particularly memorable patients or situations. We usually are very mindful of not providing details or enough information that someone could be identified, but part of this peer-to-peer sharing can be helpful in allowing us to blow off steam, to get support, or even to learn things about how other nurses may have handled a particular situation. But speaking to one nurse in a social situation and telling a story online where hundreds of people could see it – or more if the story is spread by others – is a different situation. What may not be recognizable to a person in a one-on-one conversation, may be identifiable to someone in a much bigger crowd.

Some nurses have taken this storytelling a step further by taking photos at work and sharing them online. Taking photos and sharing them without the subject’s permission is almost always a no-no, but to do so in a healthcare environment? It seems surprising that any nurse would think that is ok to do. But it has happened. According to a Medscape article, a nurse in a trauma unit did just that.

We also have to think about ourselves, our privacy, and our safety. Unfortunately, not all the people we deal with at work are nice. While most of our patients, clients, and families are good people and wouldn’t want to harm us, there are always a few who are either very unhappy with the care they’ve received (or didn’t, depending on the situation) or are generally unhappy people overall. With it being so easy to track people down using the Internet, the risk of being found through social media by people who may want to cause problems is there.

It’s also possible for patients or families to investigate nurses by looking at their online profiles. If they find photos or comments that could be seen as unprofessional, this could cause conflict at work, and employers may see this as a breech of ethics.

We could argue that what we do on our own time, professional-looking or not, is our own business, but not everyone sees it that way. The Medscape article says: "We violate our patients' trust if there are pictures of us on Facebook behaving unprofessionally, making off-color remarks, or expressing certain opinions online. Patients do see these things, and some are actively looking for them. It's our professional obligation to behave in a certain manner."

Do you use social media? If you do, do you have rules about what you will post and what you won’t?





Wednesday, February 8, 2017

No Time to Exercise - Short Bursts of Activity Work Too

We hear it all the time when it comes to getting exercise: "Just get moving," or "take the stairs instead of the elevator or escalator," but do those short bursts of energy really make a difference in our overall fitness levels? For those who are used to seeing friends and colleagues going to the gym for hours on end or running long distances, a shorter time for exercise done at home (or at work) may seem too good to be true. But it's not, say many exercise gurus, including the author of the book One-Minute Workout and a new study published in the journal Medicine & Science in Sports & Exercise.

According to a press release issued today:

"Interval training offers a convenient way to fit exercise into your life, rather than having to structure your life around exercise," says Martin Gibala, a professor of kinesiology at McMaster and lead author on the study. "Stair climbing is a form of exercise anyone can do in their own home, after work or during the lunch hour," says "This research takes interval training out of the lab and makes it accessible to everyone."

The researchers performed a small 6-week study (31women) that evaluated two protocols. The women were sedentary before beginning the study. Sessions took place three times a week and took about 30 minutes total over the course of a week, 10 minutes per session for warm up, cool down, and recovery.

© Dirima | Dreamstime.com - Sporty woman running and climbing stairs
The first experiment had subjects performing three 20-second sessions of continuous stair climbing at maximum ability ("all-out") compared with subjects who exercised with the same intensity but on exercise bikes. In the second experiment, the participants vigorously climbed up and down one single flight of stairs for 60 seconds. According to the press release, both protocols increased the participants' cardiorespiratory fitness.  (Note: I was unable to find the study online so I can't be more specific with these findings). Considering how tiring it can be to climb stairs, this doesn't seem to be a stretch.

But not everyone has stairs at home, so if doing stairs isn't your thing, there are other options that may prove equally effective. A new iBook called How to Watch TV and Get Fit, 3 Minutes at a Time, by Debbie Rahman, presents you with a 12-week program that works on helping your cardio, strength, and balance. The book's website has a few sample 3 minute exercise videos (Disclosure: I recently met the art director of this project). Again, this approach may seem too good to be true, but if you're trying to squeeze some exercise into your life but something more structured isn't going to work, a program like this could be the answer.

So whichever approach you use, it's good to know that if you don't have the time or the desire to commit to joining a gym or taking part in lengthy time consuming exercise programs, there is still hope.

Friday, February 3, 2017

What Do Crocheted Octopuses and Preemies Have in Common?

As much as people like to trash Facebook, I have to say it is a great way to learn about ideas and issues around the world - unique things that you may never have heard about otherwise. Take this story for instance.


Researchers from Denmark discovered that premature babies in neonatal intensive care units (NICUs) respond positively when they have a crocheted octopus at their side. The crocheted tentacles of the octopuses* remind the tiny babies of their umbilical cord. While babies are in utero, they often
grab hold of their cord as they float around in their cocoon-like home, but once they're born, there's nothing for them to grab on to, other than their life-saving tubes that may be pulled out or dislocated. But babies who were each given a crocheted octopus seemed less stressed. Nurses have observed the babies' heart and respiration breathing rates drop when they are able to hold on to the tentacles. Another important benefit: if the babies are holding and pulling on the tentacles, they are less likely to pull on those tubes.

A hospital in the UK decided to give their premature babies their own octopus to see if it would make a difference, according to an online article in Prima. The nurses in the hospital did find that the octopuses helped their little charges.

First kangaroo care (holding baby to the skin), now octopuses, what next will we find will help those fragile babies?


*This is the correct plural form of octopus :-) 

Tuesday, January 31, 2017

Snow-Related Heart Attacks May Show Up Two Days Later

Every winter we hear stories about people who have heart attacks after a heavy snowfall. It's not hard to imagine. People who are usually sedentary or moderately active take to shovelling out their driveways or to rescue their cars from mountains of snow pushed to the side of the road. A new study suggests that while the heart attack/snow shovelling connection is valid, it's the moderate snowfalls that seem to have the most effect. In addition, the heart attacks often present two days after the snowfall.

© Luckydoor | Dreamstime.com - Snow Shovel

This large study took place from 2010 to 2015 and looked at over 400,000 adults who had been hospitalized at two hospitals in Boston. The researchers assessed patients who had been admitted with cardiovascular conditions and cold-weather conditions (frostbite and falls/injuries). Interestingly, the researchers found that admissions to hospital for patients with heart disease occurred most often (increased by 23%) after moderate snowfalls, defined as 5 to 10 inches, rather than high snowfalls. Cardiovascular disease admissions actually dropped by 32% on high snowfall days, the authors wrote.

One theory that might explain why moderate snowfalls have more of an effect is that people may stay inside more during heavier snowfalls and that moderate falls seem easier to manage.

So be careful, even if the snowfall isn't drastic and beware of the signs and symptoms of a heart attack for a few days after your time shovelling snow:

  • Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw or back.
  • Nausea, indigestion, heartburn or abdominal pain.
  • Shortness of breath.
  • Cold sweat.
  • Fatigue.
  • Lightheadedness or sudden dizziness.

Friday, January 27, 2017

My Professional Website Update

I've been writing and editing health and medical information since the late 90s, going full-time in 2009. I love my work, even if that means having to do something I'm not thrilled about: marketing. Being a freelance writer means you have to constantly market yourself to ensure a steady flow of clients and work.

Much of my work comes from repeat clients and I get a good bit through referrals from colleagues or other editors who have passed on my information. But I also have to make sure that I'm out there so people who are looking for health writers - or nurse writers - can know that I'm available. So, as a freelance writer, my website (along with this blog) allows potential clients to find me and see if I might be a good fit for their needs.

Before I began doing this on a full-time basis, I designed my own website and it worked well. I received many queries, some that resulted in paying work. But as the years passed, my site began to scream out "I designed this myself," and it was no longer a look I wanted. I bit the bullet and hired a web designer. I wanted a site that showed potential clients that I am a professional, but I wanted it clean and something that reflected my niche of health writing. And I got it:



The designer nailed it. It's clean, the colors are what I would have picked, and it presents really well.

There is some debate as to whether writers need their own site now. There are many sites that allow writers to post their CVs or writing samples. I am registered with some, but I think it's important for writers to also have their own space that they're in charge of. The other sites may be helpful, but we're at their mercy, whether it's updated, how it looks, and more. So I think that my website is a good investment.

So, here is my new website. Here's to a new year of work and discovery!



Thursday, January 26, 2017

Are Menopause Symptoms Made Worse by Anxiety?

The symptoms of menopause can be distressing for many women. From the hot flashes to insomnia, the severity of the symptoms can affect their quality of life. If we already know that anxiety can make symptoms of any condition worse, does that mean if a woman is anxious, will she experience more drastic menopause symptoms? According to a study published in the journal Menopause, yes, it does.


The study looked at data from 3,503 women who were post menopausal. The researchers found that 61.9% were depressed and that 13.7% of the women reported a severe impairment in their quality of life; 25.5% mentioned severe urogenital symptoms (vaginal dryness and urinary incontinence) and 18.5% said they had severe psychological symptoms.

So what does that mean practically? The researchers concluded that screening of women undergoing menopause is important, but it's also important for women themselves to be aware of this possibility. If you do have anxiety or you have started to feel symptoms that make you believe that you're getting increasingly anxious, there are some steps you can take on your own to try to reduce the anxiety. These include things like meditation, mindfulness, exercising regularly, and keeping a journal, for example. Of course, professional help and guidance from a counsellor or therapist may be more appropriate.

Whichever steps you take, it's important to understand that you're not alone. According to a press release discussing the study:

"Although anxiety is a common symptom during menopause, panic attacks are not," says Dr. JoAnn Pinkerton, NAMS executive director. "This study documents the importance of screening patients for anxiety. If women are having significant anxiety, they should discuss viable treatment options with their healthcare providers. These can include relaxation techniques, caffeine reduction, and exercise. Estrogen therapy or other mood medications might also prove helpful.

Have you gone through menopause? How have you found the process?