Visiting Brooklyn During the Pandemic

Last Friday, my son got married in Brooklyn. It was a beautiful wedding, but as Arlo Guthrie might say, that is not what I came here to talk about. Being in Brooklyn from Thursday afternoon until Friday afternoon was very unnerving, because of COVID-19.

We drove down on Thursday. It was the longest car ride we have taken since some time in February. We parked the car in a garage about three blocks away from our hotel. Walking on the streets of Williamsburg, Brooklyn, we saw everything. There were a lot of people, many more than we have seen during the five months of the pandemic. Some were wearing masks, but some were not. It wasn’t very easy to keep six feet of social distance on city sidewalks.

The hotel, itself, felt safe; we didn’t really see many people. Thursday, we met my two sons and my daughter-in-law for dinner. Again, we had to walk on sidewalks with lots of people, masked and unmasked. We ate outside and tried to keep on our masks when we weren’t eating.

Friday morning, we walked toa bakery to get something to eat for breakfast. The store did have social distancing measures in place. Only one patron was allowed in at a time and the line outside was spaced six feet apart.

These experiences of the pandemic in a big city made me realize how fortunate I have been to sit out the pandemic in Western Massachusetts. We have not eaten at a restaurant at home; we have just gotten takeout. We can walk at home not wearing masks and often we don’t see anyone else.

Being in Brooklyn made me realize the enormity of COVID-19 and the fear and anxiety I have lived with for over five months. I do not want to get sick and I do not want anyone I love to get the virus either. I wish no one else would ever get sick from Corona. My heart goes out to anyone who has gotten the virus and all the families affected by the disease.

Florence Nightingale, Part 3

This is part three of my three part post of a paper I wrote in 1994 about Florence Nightingale. You can read part one here and part two here. I had a good time revisiting this paper from almost thirty years ago.

Amy Mittelman ©2020, Professional Nursing I,                                                           Fall 1994

FLORENCE NIGHTINGALE

Lauren Smith used the Nightingale concept of management to frame her discussion of clinical nurse specialist (CNS) managed care for the chronically ill child.  In myelomeningocele clinics in Ohio, clinical nurse specialists provide case management.  Smith argues that this case management has provided early identification and intervention, continuity of care, increased parental advocacy skills, improved social and development skills for the children as well as professional growth and interdisciplinary collegiality for the nurses. She feels this work has carried out Nightingale’s directive of knowing that “what you do when you are there shall be done when you are not there.”[1]

Smith’s article was part of two in a recent issue of Clinical Nurse Specialist presented under the heading “Florence Nightingale: A CNS Role Model.”[2] The other article, “CNS Roles in Implementation of a Differentiated Case Management Model,” did not mention Nightingale.[3]

In doing research for this paper, I found many references to Nightingale, particularly in Japanese nursing literature. I disagree with the opinion expressed a few weeks ago that modern nursing views Nightingale as outdated. She remains a starting point for many nurse scholars and many nurses are eager to link their work with hers.  This may explain why that article appeared under the rubric “Florence Nightingale: A CNS Role Model” even though it did not mention Nightingale. Other examples of this are an article in Nurse Educator that is a letter by a nursing student to Nightingale and a response written by a Nightingale scholar, an article by Elise Gropper that claims Nightingale as “Nursing’s First Environmental Theorist,” and the work by Giger, Davidhizar and Miller that links Roy and Nightingale.[4]

Smith is an example of clinical use of an aspect of Nightingale’s theory. However, there are not that many explicit clinical examples because many of her themes – particularly asepsis – are an integral and unquestioned part of nursing today.  A Nightingale nurse caring for an ill hospitalized patient would not focus on the medical aspects of the patient’s condition. Nightingale did not consider that part of the nurse’s domain. As a Nightingale nurse you would assess the environment of the patient, paying particular attention to sanitary issues. You would draw your diagnoses from those functional health patterns that are environmentally oriented including Activity-Exercise, Sleep-Rest, Role-Relationship and Nutritional. Decreased Cardiac Output would not be an appropriate Nightingale diagnosis, but Impaired Physical Mobility or Impaired Skin Integrity would be. Your goals for the patient would focus on preventing illness from environmental conditions. Thus, your interventions would involve repositioning if the patient was bedridden, providing a restful, clean atmosphere and keeping the patient’s skin clean and dry to prevent skin breakdown.

Florence Nightingale had a tremendous impact on the history and development of nursing as a profession. I found it interesting and informative to read her work.  Many of her practical suggestions are still applicable today. Perhaps her claim that “observation, ingenuity and perseverance … really constitute the nurse” says it all.[5]

[1] Smith, Lauren D. 1994. Continuity of care through nursing: Case management of the chronically ill child. Clinical Nurse Specialist 8 (2), p. 68.

[2] Sparacino, Patricia S.A. 1994. Florence Nightingale: A CNS role model. Clinical Nurse Specialist 8 (2): 64.

[3] Brubakken, Karen, Wendy R. Janssen, and Diane L. Ruppel. 1994. CNS roles in implementation of a differentiated case management model. Clinical Nurse Specialist 8 (2): 69-73.

[4] Decker, Bernita, and Joanne K. Farley. 1991. What would Nightingale say? Nurse Educator 16 (May/June): 12-13; Gropper, Elise I. 1990. Florence Nightingale: Nursing’s first environmental theorist. Nursing Forum 25: 30-33; Giger, Joyce N., Ruth Davidhizar, and Scott Wilson Miller. 1990. Nightingale and Roy: A comparison of nursing models. Today’s OR Nurse (April): 25-30.

[5] Nightingale, Florence. 1860. Notes on nursing. New York: D. Appleton and Company, p. 65.

 

 

 

Florence Nightingale, Part 2

This is part two of my three part post of a paper I wrote in 1994 while in nursing school. You can read part one here. Nightingale’s advice on sanitary practices, especially frequent hand washing, seems very relevant.

Amy Mittelman ©2020,                                                                                   Professional Nursing I, Fall 1994

FLORENCE NIGHTINGALE

In Nightingale’s view the environment was also nature centered and physically based; it was the nurse’s responsibility to manipulate it to provide sanitary conditions. Her emphasis was one of prevention. “True nursing ignores infection, except to prevent it.  Cleanliness and fresh air from open windows, with unremitting attentions to the patient, are the only defense a true nurse either asks or needs”[1] Giger, Davidhizar and Miller have found Nightingale’s focus on the environment to be similar to Sister Callista Roy’s adaptation nursing theory.[2]

In 1860 the germ theory of disease was not a part of scientific discourse.  As it became prevalent, Nightingale refused to believe it.[3] Because Nightingale believed that disease was a reparative process, external forces such as dirt, odors, and poor diet had to cause it. She would not accept that a person could get sick in sanitary conditions.  Nightingale did not believe that medicine was a “curative process . . . nature alone cures.”[4] Health was a state of nature; illness was a response to a disruption in that state.

Although Nightingale rejected the germ theory of disease which is a cornerstone of modern medicine and nursing, many of her opinions on sanitary practices are still appropriate. She emphasized frequent hand washing, the value of fresh air, the evils of dirty carpets, the importance of modulating the stimulus a patient receives, and the importance of maintaining a patient’s spirits. These all remain critical aspects of caring for a patient and effecting recovery.

Nightingale believed that the same guidelines of sanitation applied to the healthy as well as the sick. The person was a subject of nature and had the responsibility to observe nature’s law in such a manner (sanitary) as to avoid infection and illness.  Again, the emphasis was prevention.[5]

To Nightingale, the nurse’s role in the reparative process was “to put the patient in the best condition for nature to act upon him” She felt that nursing should “signify the proper use of fresh air, light, warmth, cleanliness, quiet and the proper administration of diet – all at the least expense of vital power to the patient.”[6]

Nightingale advocated a patient centered nursing. She stressed the importance of “sound observation” for “the sake of saving life and increasing health and comfort.” Although Nightingale emphasized the high level of attention that the nurse must undertake, she also pointed out the importance of delegating responsibility as a way of knowing that “what you do when you are there, shall be done when you are not there.”[7]

 

[1] Nightingale, Florence. 1860. Notes on nursing. New York: D. Appleton and Company, p. 34.

[2] Giger, Joyce N., Ruth Davidhizar, and Scott Wilson Miller. 1990. Nightingale and Roy: A comparison of nursing models. Today’s OR Nurse (April): 25-30.

[3] Vicinus, Martha, and Bea Nergaard. 1990. Ever yours, Florence Nightingale. Cambridge, Massachusetts: Harvard University Press.

[4] Nightingale, Notes, p.133.

[5] Ibid.

[6] Nightingale, Notes, p. 133, 8.

[7] Nightingale, Notes, p. 125, 35

The Liquor Industry and COVID-19

At the beginning of the year, thing were looking pretty good for all segments of the brewing industry. Local and state municipalities see craft beer as an important economic driver, That’s why a tax cut was part of Trump’s disastrous tax bill and why this year the industry got an one year extension for that tax reduction. Then COVID-19 happened.

Most states have closed bars and prevented restaurants from providing in house service. They are allowed to provide grab and go service. How has this affected brewers and distillers?

Here is a roundup of articles about how the liquor industry is faring during the pandemic. Like everything else in our society, regulations surrounding certain practices are being  loosened or abandoned. When this is over, many thing will be different.

Deschutes Brewery has laid off  over 300 workers and is not presently offering any to-go services.

The governor of Rhode Island  issued an executive order  that allows limited sale of beer and wine when people are getting takeout from restaurants.

Last Saturday, some Milwaukee brewers had a pop-up  brewery drive-through in a parking lot.

Before the virus, only  twelve states allowed  delivery of all  kinds of liquor while thirty-one states allowed  delivery of beer and wine. This article is arguing for a permanent change in these regulations.

Reminiscent of Prohibition, distilleries are producing hand sanitizer. The relief bill passed last week allows distilleries to do this without having to pay the excise tax.

I hope everyone is safe and stays well.

Life Lessons

As you may have noticed, last week I didn’t post anything. On Tuesday I was getting ready to go to New York City on Wednesday for a legal matter pertaining to a relative. Once again, as has been happening all year, life intervened to prevent my blogging.

My relative is a single person and has not designated anyone to be their power of attorney. They also do not have a will. A health care proxy is in place. This legal matter has made me realize how important it is to proactively plan for your old age and eventual demise.

People in sound mind and body may be reluctant to grant authority over either their financial or health concerns to someone else. However enunciating your wishes when you can will save both time and money later. A lawyer told me that she tells clients “spend $700 now to avoid $10,000 later.”

It is also prudent to plan for your funeral and burial. Buying a plot or deciding to be cremated as well as stating where you would like your funeral to be held will make everything easier for your grieving relatives. Everyone should designate a power of attorney and execute both a health care proxy and will.

 

Sleep Hypnosis

As I have mentioned before, I often have insomnia. Recently I have been a sleep therapist who has taught me self hypnosis. I wanted to try hypnosis for my sleeping problems since I felt I had tried everything else.

Before the first visit, I thought that she would put me under, give me a command and then I would automatically go to bed and  fall asleep. It doesn’t really work like that.

The therapist gave me tools to use to focus sufficiently so I could fall asleep. The idea is to put yourself in a trance through counting down, visualizing going downstairs while counting from ten to one, using a mantra with deep breathing and other techniques.

The cognitive behavior aspects of insomnia also comes into play. Being on a set sleep schedule is key as is avoiding devices for a period of time before you go to bed. To me, the hypnosis feels close to guided meditation with the purpose being a successful night of sleep.

Stop The Bans

Yesterday I attended a  Stop the Bans rally in Northampton. Similar demonstrations  were held all over the country in response to the draconian anti-abortion laws that Alabama and other states have passed. It is very depressing to me that  reproductive rights are so threatened in 2019 when I can remember marching for the right to have an abortion in New York City in  the late 1960’s.  Abortion became legal in New York State in 1970.

Abortion was not legal in Massachusetts until Roe v. Wade in 1973. Massachusetts was also one of the last states to legalize birth control. However, last year, Gov. Baker, a Republican signed  the Nasty Women Act which repealed several old laws regarding abortion and birth control.  Nasty stands for Negating Archaic Statutes Targeting Young Women; legislators felt  the bill was necessary in the wake of Brett Kavanaugh ‘s appointment to the Supreme Court.

Several of the speakers at yesterday’s rally spoke about pending legislation in Massachusetts, the Roe Act.  This legislation would remove the requirement of parental consent for  an abortion for people under the age of 18.  The Roe Act also provides health care coverage for abortions for people who don’t have Mass Health.

Current Massachusetts law does not provide abortion coverage after 24 weeks. The Roe Act would extend that time period in cases of fatal fetal anomalies. Other provisions of the bill include ending the currently required 24-hour waiting period, and codifying the principles of reproductive freedom into state law. You can get more information about the Roe Act here.

Notable Nurses Part Two

This is the second part of the list from Regis College. The information about Margaret Sanger is somewhat problematic. As the birth control movement progressed it moved further and further away from its’ radical roots and  often embraced eugenics and population control rhetoric.

Susie King Taylor (1848-1912): First African-American Union Army Nurse in the American Civil War

Lillian D. Wald (1867-1940): Public Health Advocate

  • Shortly after beginning classes at the Women’s Medical College in New York, during a trip to coordinate classes for immigrants in New York’s Lower East Side, Wald was so shocked by the poor state of health of those living in tenement houses there that she felt she needed to do something. She left school and founded the Nurses’ Settlement at Henry Street to help those most in need of medical care.
  • At the Nurses’ Settlement, Wald and a small number of other nurses pioneered the field of public health nursing. The group charged for medical care on a sliding scale. They hoped that by adjusting how much they charged based on the means of their clients, they could make health care affordable to everyone.
  • Wald’s bold decision to leave the medical establishment and prioritize the general health of the community was a success. Her efforts at improving the health of her community, as well as educating future medical practitioners on the need for this service, contributed to the founding of the National Federation of Settlements. Much like Wald’s Nurses’ Settlement, this organization aimed to provide desperately needed medical aid and public services to the communities that needed them the most. The field of public health nursing would eventually become its own profession.
  • Wald became the first chairperson of the National Organization for Public Health Nursing, which worked to develop this new field.

Margaret Sanger (1879-1966): Founder of Planned Parenthood

Mabel Keaton Staupers (1890-1989): Advocate for Racial Equality in Nursing

Notable Nurses Part One

A reader sent me something her sister sent her. Both are considering  careers in health care. It is from the Regis College website and is a list of prominent nurses from the nineteenth century on.

I will confess that I hadn’t heard of few of them, however, it seems  like good information to pass on so I am posting it here. The list is long so I have divided it in two. The links are from the Regis site. As always comments as well as additional names are welcome.

Dorothea Dix (1802-87): Mental Health Advocate

  • Dix discovered her passion for teaching when she opened her first school at 15 years old, but it wasn’t until she was 39 that she discovered her second passion. While teaching classes in a women’s prison, Dix found that mentally ill and developmentally disabled women were imprisoned there under inhumane conditions. Horrified by what she had seen, Dix decided she had to do something to end the practice of confining these groups of people in prisons rather than caring for them.
  • This new calling inspired Dix to travel across the United States and Europe visiting prisons to advocate for better treatment of those within. She eventually brought her arguments to Congress and convinced legislators to support the opening of the Government Hospital for the Insane. This facility still exists and is now known as St. Elizabeth’s Hospital.
  • When the Civil War broke out in 1861, Dix traveled to Washington, D.C., where she became a nurse attached to the War Department. She was soon made superintendent of Army nurses. She stayed in that position until the end of the war.

Clara Barton (1821-1912): Founder of the American Red Cross

  • During the Civil War, Barton saw the desperate need for medical supplies and services on the front lines of battlefields. She took it upon herself to travel to battlefield after battlefield offering care to both armies. This earned her the moniker “The Angel of the Battlefield.”
  • Once the war was over, Barton traveled to Europe, where she again provided nursing services to wounded soldiers, this time in a war between France and Prussia. There, she was inspired by the newly organized Red Cross. Upon her return to America, Barton founded the American Red Cross.
  • Once the American Red Cross was established, Barton turned to expanding the organization’s duties from battlefield aid to disaster relief. Eventually, the organization would begin providing aid internationally. Today, the American Red Cross provides health and disaster relief services around the world.

Linda Richards (1841-1930): First Formally Trained Female Nurse

  • Richards became the first American nurse to complete a formal nursing program in the United States when she graduated from the nurse training program at the New England Hospital for Women and Children in 1873.
  • Her most lasting impact on the history of medicine came when she saw how the lack of medical records in most hospitals caused patients to suffer. There were no reliable records of patients’ previous conditions, chronic illnesses, or treatments that had already been tried. Having these medical records on hand would help doctors determine the best way to help their patients. Richards eventually developed an organized system of note-taking and record-keeping to ensure that this was no longer a problem.
  • Richards never stopped working to improve her profession and became a leading educator in her field. She started nursing schools in the United States and abroad. Richards even traveled to Kyoto to help establish Japan’s first nurse training program in 1885.

Mary Eliza Mahoney (1845-1926): First African-American Registered Nurse

  • Mahoney worked as a private-duty nurse at the New England Hospital for Women and Children for years before she was finally admitted to the hospital’s nursing program in 1878.
  • She was the first African-American woman to complete formal training and become a registered nurse in the United States.
  • When the Nurses Associated Alumnae of the United States and Canada, now known as the American Nurses Association, expressed prejudice against people of color within their organization, Mahoney left the association. She then became a founding member of the National Association of Colored Graduate Nurses to advocate for the dignity and equality of minorities in the nursing profession.
  • In 1936, the National Association of Colored Graduate Nurses began awarding the Mary Mahoney Award to a person or group making strides to integrate the nursing profession. This award continues to be granted to those who carry on Mahoney’s legacy of promoting equality for minorities in the nursing professions.

 

Fitbit

A few months ago, I bought a Fitbit Charge HR2 because I wanted to see how hard I was exercising when I skated. I have had pedometers in the past and they are bad at capturing the stroking you do while skating. I had hoped that the Fitbit would be different but it is a pedometer like every other one I have had. It works best if you are walking.

The heart monitor is also not very accurate. I never get into the peak range when skating even though I know I am really exerting myself by how  out of breath I am. A couple of times when I have done strength training or circuits I have gotten into the peak range.

Fitbit has you set goals. The default is five days of of exercise and 30 minutes daily activity. I don’t really understand why those are two different things. If I do two hours of Tai Chi I don’t get any activity minutes. If I used one of the device’s preset categories like “workout” maybe then I would get both the day of exercise and the activity minutes.

The Fitbit also monitors your sleep. I thought I would hate this feature but I don’t mind it at all. Of course, it is quirky as well. If you are lying down but fully awake it often counts that as sleeping time. It has been interesting to see the different sleep cycles. Sometimes it calculates that you got more sleep than you would have thought based on how much you were tossing and turning. Sometimes it is less than you would have thought.

When I first had the Fitbit, I was motivated to tailor my activity and exercise to its parameters. That has mostly faded. Now I just use it to monitor my goal which is 300 minutes of exercise a week. I try to skate 3 days a week and do Tai Chi one day. Often that is it for the week so I don’t get the five days and Tai Chi doesn’t count as activity so that day I don’t get the thirty minutes of activity.

I got a Fitbit because SuperTracker and the President’s Challenge went out of existence. That and a paper calendar was how I used to track my exercise. I still use a paper calendar to keep track of how many hours I skate so I know when to get my skates sharpened. I really liked SuperTracker better and working on my platinum medal was more motivating.

If you have had experiences with Fibit or other exercise and heart trackers, let me know. If you use something other than a tracker for recording your exercise, I would love to know what that is.