Thursday, November 30, 2017

Hospital Signage - Yesterday and Today

Visits to contemporary hospitals always throw me for a loop. The hodge-podge assemblage of signage is indeed mind boggling, at least for me. Practically every vertical surface or door has a sign of one sort or another dutifully posted. Guide signs, financial responsibility notices, warning signs, nursing award plaques (none of those back in my day, that's for sure,) and mystery signs that my foolish mind simply could not decipher.
Signs were few and far between in vintage hospitals.

I found myself asking myself, how in the world did old school hospitals function without the copious ( that "c" word is one of the all time  favorite words of my generation of nurses) use of signs? The hospital building itself was without an identifying sign. It was completely unnecessary because everyone intuitively knew it was a hospital. A hospital was a hospital and everyone knew where it was. Does God sign the sky?

Walking through a modern hospital corridor with all those solid, opaque doors with confusing (at least to me) signage does cultivate a sense of mystery. When one of these  modern, occlusive, door  contraptions swing or magically whoosh open, I scramble to peak inside. I could have read the ever present, omniscient signage, but I like the feeling of being an explorer on an adventure. It's like a series of hidden little worlds where computers and electronic doo-dads seem to dominate.

Old hospitals were not like this. No signs necessary. You could sense where you were by the various olfactory, auditory, or visual  cues. The radiology department was defined by the scent of photographic fixer and all those lead aprons hanging outside the mostly open doors. No mysteries here. Morgues and central supply were always in the basement and the ORs were always on the top. I rambled on about this in a previous post.

Emergency rooms were always on the same level as the street and there was  a memorable sign nearby. Old school  emergency triage began at street level and an actual sign began the process by a stern warning: AMBULANCE CASES ONLY. There was always an assemblage of police cars at the ER and I suspect hospital emergency rooms were one of the safest places in all of Chicago.

Hospital labs were easy to navigate. Everything was out in the open. Hematology was defined by the click-clck-click of manual tabulator gizmos used by the technicians to count the various lymphocytes and eosinophils in a sample. I used to love that sound because it reminded me of crickets. A bit of nature  in the midst of an urban jungle. The microbiology department was easy to spot with banks of incubators and rows of microscopes. The chemistry lab division smelled, well chemical. You couldn't miss it. The hospital laundry was easy to find, just follow that lovely clean linen smell and as you got closer, little flecks of lint falling like snow clearly defined the locus.

Old hospitals had very few people just strolling through as outpatients because there were no outpatients. Any nurse would be all to happy to direct any lost soul moving about the halls so there was little need for signs. The loud, ubiquitous hospital paging system clearly announced visiting hours and instructions for hospital visitors. One of the greatest advances in modern hospitals is the absence of verbal loud speaker pages. They could really jangle your nerves.

Occasionally, a modern hospital sign will cause my foolish, old brain to crash in a state of persistent befuddlement. What the heck is an outpatient ICU?? I was completely  bamboozled by a sign pointing the way to "Ambulatory Surgery."  How in the world, I wondered, can you perform surgery on someone while they are walking around? I suspect it is a great way to prevent post op complications like atelectasis and clots, but do the benefits outweigh the risks of surgery in motion?

I' getting carried away here so I'll leave you with some contemporary hospital signage that got my attention and made my blood boil. The sign below serves to provide the patient with all the respect and dignity of a visit to Wal Mart. The remuneration request is for something that is an abstract concept concocted by an office sitting bean counter which  contrasts with the mission of healthcare to provide tangible care for a person in need. Money and associated big business  is what robbed both doctors and nurses of their status as caring professional care givers and relegated them to nothing more than dollar sign driven minions. It's a sin and a shame.

Thursday, November 23, 2017

Giving Thanks

Thanks, Nancy

 I have lots to be grateful for and often think of those who helped me as a young nurse. Thanks to you Nancy Swabeck RN for your patience in sharing your skills as one of the most elite and skilled scrub nurses I have ever known. It sounds paradoxical, but as the pressure and anxiety came to a boil with unexpected problems your relaxed peacefulness and calm demeanor flourished. A life lesson to be sure.

Smooth and easy flowing movement of instruments with that last little burst of energy on approach to the surgeon's hand was her trademark, but it was anything but when I tried to replicate her ease of movement. Herkey, jerkey and uncertainty marked my initial efforts. "Keep at it. When you are gong through a surgical shit (Nancy didn't cuss) storm - keep on going," were typical words of encouragement from her.

Nancy was a cool headed natural problem solver when it came to instrument handling. I was always flummoxed by trauma cases that engaged two  teams working simultaneously. My usual modus operandi involved setting up two separate Mayo stands and designating one as self service. Sometimes this worked when dealing with ortho, but always left one of the teams disgruntled with my lame efforts.

Nancy taught me how to mentally divide a single Mayo stand in two sections so as to serve double duty. Half for this service and the other half for that service. It worked but usually made my head spin. Later when we received brand new elevated neuro tables with just one huge work area, she taught me how to create an imaginary Mayo stand work area. I'm a slow learner so she went to the trouble of outlining a pretend Mayo stand with methylene blue. It worked like a charm.  She always had an answer for everything.

The events of a long ago Thanksgiving are also on my mind when we had that brainstorm of a notion to cook a turkey in an autoclave. The tale of the autoclaved Thanksgiving turkey is on this blog somewhere and some day I will mater links.

I am also grateful to all of you who read my incessant foolishness. There are so many well written nursing blogs out there by bright, young, whippersnapperns that I hate to waste your time. At least I provide some cognitive diversity to the nursing world. Oops that sounds a bit grandiose so I better cease while I can. Thanks for your readership and a festive Thanksgiving to you and yours.

Sunday, November 19, 2017

Vintage Magnetic Therapy for Ocular Foreign Bodies

I just love gadgets and gizmos from the days of old school healthcare. Now this handy dandy device is something that I could have put to use this past summer. I'm a self-taught, self maiming, lumberjack of sorts and as I was happily sharpening one of my dull chains, a fragment of metal was hurled into my eyeball by the grinder. I dimwittedly  thought my eyeglasses would provide ample protection, but that shiny shard found an indirect  path to my eye. Metal shavings have tiny little barbs on them that can make removal difficult. I tried to irrigate that little devil, but it would not budge.

After a $600+ emergency room visit,  the metal shaving was successfully removed. I tossed the antibiotic prescription into the circular file along with an opthamology consult and lived happily ever after.

Now if I had  access to that device pictured above, the ER visit would have been unnecessary. When the American industrial age was in full swing it was commonplace for workers to experience problems with metal shavings impacting their eyes.  An enterprising opthamologist devised the above piece of medical equipment. The foreign body victim positioned their eyeball over the cone shaped proboscis like business end of this machine and the doc activated the electromagnet. PRESTO.. the metal shaving was liberated from the eyeball. I don't even want to think about the end result if the metal shaving was retro-ocular. Would the entire eyeball be pulled out? Hmm..I guess discretion is the better part of valor when using devices like this.

I've been attempting to figure out if the illustration on the right is just for demonstration or is this the outcome of treating a platoon of steelworkers after a blast furnace mishap?

Tuesday, November 14, 2017

Nursing Diagnosis - An Aimless Pursuit

Your patient suddenly loses consciousness, blows his pupils with a narrowing pulse pressure and
has the beginnings of decerebrate posturing.   What's your diagnosis nurse?

"This patient is experiencing hypovigilance secondary to disruption in the flow of energy resulting in a disharmony of the mind, body, and/or spirit." Say what nurse? Old time diploma students never dabbled in this high minded, academic  activity of  the modern  nurse diagnosticians, quite the contrary, we were sternly advised, "Nurses do not diagnose."  This resulted in many deferrals to "Ask your doctor."

We were well versed in acute clinical contingencies (Ha..Ha...I can talk just like you smarty pants nurse diagnosers) and knew exactly what to do if the patients under our care had problems.
Verigo on arising-back to bed...A hemorrhaging arm laceration-slap a blood cuff on while the resident scrambles for hemostats...Hypoglycemic..Have some orange juice...A sluggish chest tube-milk it.  It's really just plain old common sense.

A bona fide diagnosis is based on objective and measurable data, not the whim of a nurse wordsmith spouting off gobbledegook. The evidence supporting the diagnosis would enable different practitioners to come to the same conclusion. I think that those folks a lot smarter than I call it inter- rater reliability.

Nursing diagnoses grant objective status to subjective information. When subjectivity is confused with fact and treatments based on unfounded assumptions are implemented, bad things can happen such as that infamous 1-10 pain scale.

When nursing transitioned from a diploma based hands on education training to an academic setting, office sitter, nurse big shots had to come up with entities to differentiate themselves. They came up with three humdingers that are indeed, unique to nursing. Nursing research, which, more accurately should be called clinical research if the purpose is to improve clinical care. We don't have doctor research. Nursing theory of which I have written jabbered about in a previous post and finally nursing diagnosis.

These discursive disciplines have one thing in common. They are unique to nursing and difficult for other healthcare entities to understand. If the end game is to be a valuable, contributing member of a collaborative, team effort they fall short. Lots of nurses, especially old fools like me cannot comprehend them so maybe we should drop the nursing from nursing diagnosis and work toward a common goal. Diagnosis that is based on objective fact and guides healthcare workers toward effective treatment.

Nursing is all about common sense and using what you know to directly and appropriately helping patients. Having a nursing life that involves only intellectual and down right incomprehensible material is not a good way to live. Some folks think that mastering complex linguistic feats  and fancy talk is going to make them look smart and sophisticated. Truly smart nurses have a high sense of humility and plain talk that really does help patients overcome illness or mishaps.  .

Thursday, November 9, 2017

Poetic Artistry at it's Finest

Pretty please check out Underside of Nursing Blog (It's on my blogroll.) A poem dedicated to all the OldfoolRNs of the nursing world.

Thursday, November 2, 2017

Downey VA Introduces the Shoe Shine Nurse

 Downey VA Hospital, the agencies largest psychiatric facility, had an aloof contingent of highly
educated,  office-sitting nurses dedicated  to grinding  out an assortment of directives, memos, and program notes to lowly staff nurses for implementation.. These administrative hot shots even had their own building complete with plush Karastan carpeting, air conditioning and fancy  pictures on the walls. A far cry from the dingy, smoke filled  wards with cyclone fencing and bars on all  the windows where staff nurses practiced. These office bound nurses never ventured far from their comfortable habitats, but their word became law out on the wards.

Here is a real gem of a memorandum  from one of those office sitters with ample, well padded backsides that I recently  discovered in my basement junk pile  archives of old nursing paraphernalia, "Adjunctive therapy is utilized for phenomenologically promoting a patient's  self actualization when neutrality and anomia of traditional therapy are compromised. An  additional tool to augment the psychotherapeutic milieu." That one's a real head scratcher, but I guess, the general idea is to engage the patient in an activity program so he can find something to do.

Examples of adjunctive therapy include: psychodrama where the patient acts out a scripted scenario under  staff direction, token economy where the patient earns rewards and privliges as outlined by the staff, exercise group involving that old 1..2..bend and grunt routine, and work details such as the "spoon factory" where listless patients dutifully inserted plastic spoons in plastic bags for 8 hours at a stretch.

These adjunctive therapy all share a common thread and that's top/down delivery. A group leader instructed patients in a rigid, authoritarian manner.This did little to establish trust or facilitate communication.

Something different was needed here to demonstrate trust and caring. As I surveyed the ward, I noticed most of the patients were wearing scuffed and dull leather shoes. The ubiquitous athletic shoe was decades in the future. Low and behold, off in a distant corner, a little used and neglected  shoe shine bench sat gathering dust.

Suddenly an epiphany popped into my head. The next day on the way to work, I stopped by the local Ben Franklin store (remember those?) and purchased a few tins of Florshiem paste shoe polish. After gathering  a few worn out T-shirts, I was in the shoe shine business.  That evening after the head nurse departed I initiated my shoe shine therapy program. I pulled that old relic of a shoe shine bench away from the wall, dusted it off  and barked out, "OK fellas step right up. Let Nurse Fool shine your shoes. Let me buff them up to a brilliant shine in nothing flat."

Patients were reluctant at first, but after encouragement from the attendants,  a few disheveled  patients stepped forward and propped their lusterless shoes on the bench for an enthusiastic shine by my deft hands. At first I chatted with them about the condition of their shoes to get them talking. The role reversal and lateral delivery of care was off putting at first, but the shoe shine did help to build trust.

Caring and trust were in short supply at Downey VA, but at least I tried.