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.

 

 

 

Methylated Spirits Revisited

On Sunday my site got 155 views. On Monday  121. That is a lot more views than I usually get. Most of them were to read my post on methylated spirits which is almost seven years old. I don’t really get it since when you google “methylated spirits” my post doesn’t come up.

I was going to tweet about this, but since Twitter still won’t let me tweet my URL, I decided to write a short post about it instead. The problem with Twitter is over 2 years old. I don’t think it will ever get fixed.

I am little afraid that the sudden increase in views  was some kind of hack, but everything seems okay. If anyone knows why there would suddenly be so much interest in methylated spirits, please let me know.

Denatured alcohol

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.

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.

 

 

 

Cirrhosis

Cirrhosis of the liver is on the rise, according to the New York Times. From 1999 to 2016, deaths increased 65%. The largest increase in deaths was in the population group aged 25 to 34. From 199 to 2008, in some groups including Native Americans and African Americans cirrhosis rates stayed steady or decreased. After 2008 both groups saw increase in  cirrhosis deaths.

The author of the study cited in the newspaper article hypothesizes that the increase can be attributed to the Great Recession and economic despair among young men.  He does acknowledge, however, that “almost every one of these deaths, particularly in the young, is completely preventable.”

Cirrhosis deaths are usually preventable because alcoholic abuse is the major cause of the illness. I have written about this in a previous post which you can read here.

This is the picture from that post.

Opioid Epidemic

In January, Blue Cross Blue Shield of Massachusetts surveyed 601 Massachusetts adults about the opioid crisis. A majority know someone who has been addicted to opioids and three in ten know someone who has died from drug addiction.

The respondents felt that this was the most important issue to then and that it wasn’t getting better. A clear majority think it is a public health issue rather than one of law enforcement. There is large support for increased treatment. However a majority also think the addicted person shares some of the blame.

Over half of the respondents think that prescription drugs are too easy to get and legal drugs are seen as more of a problem than illegal.  22 % of the people had themselves taken a prescription pain killer in the past two years.

Rural areas appear to be the most affected by the problem. 16 percent of the sample came from rural areas  and 77 percent of them thought opioids was a very serious problem.

81 percent of the same was white while 7 percent was black.  As the opioid crisis has become more pronounced it is clear that people are paying attention because it is affecting white rural or suburban areas. Heroin has been a problem in urban minority neighborhoods for a long time but has not received the same focus.

The fact that most of the respondents saw prescription drugs as the problem is also a change. Although President Trump thinks that gangs are the major source of drugs the current crisis has been fueled by d0ctors with prescription pads.

The other major culprit in the current crisis is the pharmaceutical industry which aggressively marketed opioids as a appropriate response to pain. In nursing school I learned that pain was the fifth vital sign and had to be adequately addressed.

Of course chronic pain sufferers are the other side of the coin. In clamping down on misuse of prescription drugs we may inadvertently be limiting access to pain relief for this population.