Signs of the end of summer

It was too good to last. Yes, summer is trying to escape here in RehabLand. It didn't even get to 90 degrees today, and for August, that's cool. The pools are still open (mostly on the weekends) but many are getting ready for the last weekend: Labor Day.

I escaped today as I usually do. I have to go on rounds at Washington, so if I'm not feeling adventurous, I just hop on a shuttle bus. The trip is short, so I don't see much. Standing outside is the part I like if the weather is nice: seeing the sun and soaking up some rays (even if I'm wearing heavy-duty sunscreen to avoid both cancer and wrinkles). Today was glorious. The potted plants aren't wilted and the flowers are blooming again as if it's spring.

The patients like this weather too. When you can convince your therapist to take you outside for a game, or to go wheeling around campus, you've won. We call it community integration and on days like today, it's a good thing.

Why? Because you learn how to get up and down curbs (and how to gauge where the water will be when it rains) and despite whatever illness or injury put you in a wheelchair, for the moment, you're free to hang out and be a lounge lizard. Don't worry, our patients get sunscreen too. Orders for sunscreen are harbingers of spring around the Hotel, just like the swallows coming back to Capistrano.

However, the shuttle trips never last. I'm always dropped off at the door to reality. And today, someone is waiting. Waiting for me, the resident expert, to help them solve one more problem, before they go off into the summery, yet cool sunshine.

I'll take it any day! Hope you enjoy every minute of gorgeous whenever it comes your way.

More later...

Dear Boss

I know you are stressed. I'm sure you're kind of on autopilot, but I notice things.

I notice that you said, "You learn this in therapy" in way too many places recently. Yes, people learn things in therapy, but when you have a RN in the room and a therapy student with patients in a education class, you have to make sure the patients understand one thing.

They should learn EVERYWHERE at any time. Yes, everywhere. If they don't, they may not survive.

Nurses work 24/7, and frankly, we should be teaching patients that amount of time, too. It's not just during therapy, or by nurses on breaks from therapy, it's whenever they can. I view saying "hi" to someone in the hall as an education opportunity. Like the fellow who wandered into the clinic at Washington while I was talking to my nurse friend T. He learned something, because I took five minutes to teach him (thank goodness for those brochures in my bag!).

Our therapists might be good, but they are not here 24/7. Our nurses are. Please don't discount them. Empower them. Encourage them to do their best, to learn more, to get certified, to be the best they can be.

Sincerely (because I really do care),

RehabRN

Clueless

Dear Therapist:

I understand your job is to do therapeutic crafts with patients in your clinic.

I don't appreciate it when you leave said patients unsupervised in the area I'm supposed to work and they make such a mess that it will take another two days of housekeeping to clear the air enough so I can breathe again.

Yes, it is a pain that I'm in this space you claim as your own but it's temporary. You only have 4000 square feet elsewhere plus another 3000 of storage. There's only about 400 square feet here free that I can use due to the junk, er, craft supplies.

Remember nurses take care of the health part of health and wellness in rehab, and if the air's contaminated where I'm supposed to work, I won't be healthy enough to take care of patients.

I'm going to take the high road on this one, but if it gets ugly, I assure you, I'll make sure you don't forget it.

Wishing you many clues,

Sincerely,

RehabRN

Preaching to the choir

Most people don't think about death happening in rehab, but it does. Probably more often than you know. Right now, we're rehabbing a patient who has been seeing palliative care.

It may not happen immediately on a unit, but we prepare as if it might.

I read this recent article on death from author Suzanne Gordon with more than a passing interest. It hits home to me. Sometimes I wonder why we let people get set up for false hope. Is it so we have a rehab goal for therapy? Is it so we might record a FIM gain?

Or is it because, we're just like everyone else. We don't want to be the "bad guy". If we tell the truth, we could be the bad guy and make the patient and/or his her family upset.

But if we perpetuate the illusion of hope, aren't we stealing the shred of truth the patient relies on us to give him or her?

It makes me wonder...more later.

Do we know...

In honor of psychology week, do you know the difference between a psychologist and a social worker?

How to use a Hoyer lift?



If not, maybe you need to view this one this one, which should be called What really happens in therapy.



Enjoy the adventures!

One day

When I retire, I may have to write a book entitled, "The Poop Chronicles". Some days are so FOS, as the radiologists say.

Recently, WildDog, who is getting pretty old, now only relieves himself on our front porch (next to the bushes) or in the driveway. He's gotten pretty adept at surrounding the RehabRN family truckster with feces. Most of the time, Dahey cleans up after him quickly. 

Not so much this weekend. Dog poop turned into smashed dog poop in the driveway. Now, we have to get out the scraper or maybe even the dreaded hose.

And while most of you may go to boring old staff meetings where certain members of the "interdisciplinary team" only show up if there is food available and a show, we are different. The game of choice for our team: complain about the nursing staff BEFORE the manager gets to the meeting. Don't wait, don't give a recap, leave the recap to the office manager to do that.

I wonder what those industrial psychologists would say about our "team dynamics".  Poopy, was my first thought, and it wasn't because incontinence in therapy was mentioned, either.

Lots of fertile ideas, and they aren't all poopy.

That is all. Enjoy your day!

Sunday stealing

Ah, yes, the crazy meme blog. I've missed ye not because I didn't want to visit, but I've been busy.

Here are some good ones for this weekend here and my abbreviated version below.

What if you came across a backpack stuffed with one hundred thousand dollars. Would you keep it?

Heck no! I know exactly where they send you if you do, and it's not worth the sentence frankly. I would be trotting it to whomever owned it or the nearest police station--with a witness and I'd get a receipt.
 
What if you were the most powerful person in the world. How would you use that power?

Gee, so many things you could do. I'd probably start small and see what happens. World peace and ending starvation are pretty big tasks. I've always wanted to grow up to be a full-time philanthropist!
I have a list of people I'd like to meet and a list of people who I'd like to ask for advice. They're not the same for a reason.
 
What if you found a magic lamp?

Ask these questions my mother taught me: Does it go with the current decor? How much would it take to redo the decor so the lamp would fit?  What does the genie look like and what is his/her offer?

So many darned decisions. :)

What if the internet didn't exist? 

Ack! I'd still be in my very first job if it didn't. Or I'd spend lots of money on phone calls and expedited mail! And I would not be in the job I am in today. I did a lot of research on the internet before I became a nurse.
 
What if you never started blogging?

I would have never encountered some of the interesting people I've met online. Or I'd be in jail for killing some of the idiots I've worked with. Blogging is cheap therapy, kids.

Write out your frustrations, let go, keep growing and look back later. Evaluating yourself later is not a bad thing. It prompts something called growth.

What are your November 22 Thanksgiving plans?

Eat, drink and be merry (and I'll be cooking!) There is so much to be thankful for this year in spite of the craziness of the past year.

Not passive, but definitely agressive

Oh, it was such a delight to read an e-mail with lovely things like this:

"Don't we already do this?"
Yes, but not the way the main office says we will do it.

"Does it make our staff look incompetent?"
Not if you aren't already, and with e-mail like this, I wonder.

"..prime therapy time stolen"
FYI this is for aquatherapy...for which only certain Hotel patients qualify. Yes, I'm asking for that time (around an hour) so I'm that time thief.

So being a good team member, I bounced this to a couple of nurses at another two hospitals in the system.
Their answers when I gently mentioned the time conflicts were similar:

"Yes, we had the same thing until the chief medical officer had a chat..."
"Once they knew we were really going to do it and not back down..."

And after I recovered from the shock, I asked whether it would be okay with these folks to bring along two of the people who helped me write the bulk of the process documentation at the request of the boss.

I loved the response to that. My reason: share and share alike (if there going to try to take me down, I'm bringing my own backup...)


"Not sure what that has to do with explaining the reason for the change."

It will be interesting to see what happens at our meeting. Stay tuned. TGIF!

It could have been worse...

I could have had a whole lot of meetings today. Two big ones were cancelled, so I HAD to do my required education at my desk and close the door to keep the rabble out all afternoon

But, never fear, friends, I still had lots of other entertainment at the meetings I did attend.

I got to hear about Dr. R's trip to the Big Ditch and the ride on the mule. In some spots, you can't see the bottom. Good thing for that sure footed creature!

We got to discuss our patients in our weekly meeting (that's what rehab centers have to do on a regular basis). I got to discuss my interventions from my office to keep some patients out of trouble. (Always fun.)
I couldn't do anything about the character offering to "help" another patient with his stash of marijuana.
No matter what we do, some of these folks just don't get it that we are not in a state that allows Mary Jane for medicinal purposes (keep driving west, please!)

And for a finale to my day, I heard rain outside my window. It was only S, the rec therapist with the patients watering the garden below. Everything was fine and dandy, and S. went back to her office and brought patients inside. Well, we thought they all came in...Mr. G., a particular character decided he was going to move the sprinkler. When he did that and started rolling in the front door, he started dragging the hose inside underneath his electric wheelchair.

A man in the lobby saw Mr. G. coming in and helped him get the hose out from under the chair, just as he was dragging the sprinkler inside. Thankfully, only Mr. G. got wet. A Good Samaritan turned off the hose, so Mr. G. wouldn't flood the whole front entrance.

All in all, it was a pretty good day. One (or even two) less meetings in life is a very good thing.

More later...

A day in the life...

Here was my day:

1. Show up and get report from the NPs. This is my favorite part of the day. One of them (we call her mom) is getting ready for her child's wedding. We get an update every day on child, the dogs and the new house.

2. Check e-mail and respond. Realize I'd better get going to my assignment on the other side of campus.

3. As a member of a quality team, I am responsible for visits to certain departments quarterly, thanks to former big boss volunteering my services. It was a stupid move, but since no one will take my place, I'm making the best of it. It gets me out of the office for a morning each quarter.

4. I finished the quality visit, then walked back (outside) to the office slowly to enjoy the glorious weather.

5. When I got back, the therapy staff had lunch for all the nurses (they don't want to intrude on nurses' week, so they always wait one week). It was nice.

6. The rest of my day was playing fix-it. Fix this, fix that, find this, find that.

7. At the end. I set up a meeting with the boss, including a conference call for the nurses on nights to attend. We actually got some callers. I told them how to mute the lines, but somehow, we still heard Stacy getting her hair done (water, etc.)

The boss finally asked, "Are you in a bar or in the bathroom? If it's a bar, tell me which one?"



Happily, the meeting was brief and to the point. People left happy...reasonably speaking. We need more of that on the floor.

Stay tuned...

Heard on the unit

"Here's something for your office." Mr. G.

One of our patients made a ceramic planter in an art therapy class (part of our OT department) and put a small houseplant in it. He gave it to me because I told him my artwork in the office (made by another patient and Bubba) had flowers and plants in them.

It made my day.

You know it's Monday when...

"It's a cruel, crazy, beautiful world./Every day you wake up/I hope it's a blue, blue sky." --Johnny Clegg

1. Your patient is the heaviest one on the floor.
2. The first thing you have to do when you walk into the room and say hi, is suction said patient.
3. After that, you have to change the patient's external catheter, since the last shift somehow managed to pull it off. Said patient has a wet pad beneath him.
4. Clean up patient and change pad.
5. Wait for docs to round. Hold bowel routine, 'cause heaven forbid a doctor see a patient who poops whilst they're in the room!
6. Once Dr. HarvardMedSchool gives you crazy orders (like attach dressings without attaching them and you're not using one of these), start bowel routine.
7. Bowel routine over, so bathe patient. Suction again, and again, and again, before shave, after shave, after turning, etc.
8. Feed patient lunch. Suction patient.
9. Be so happy you follow the rules re: isolation gowns in rooms because as you dress patient, patient has a lot of gas, which is accompanied by a moderate amount of loose stool, which sprays bed rail, bed, and some gets on you.
10. Take off gown, wash hands, put on new isolation gown and other assorted PPE, then suction patient again.
11. Get patient dressed, into wheelchair and adjusted. (This takes 30 minutes including cleanup after explosion).
12. Get patient out door.
13. Patient returns in two minutes frothing. Suction again.
14. This time it works, get patient to therapy for evaluation for new wheelchair.
15. Patient is gone for not quite an hour. Lo and behold, the PT inadvertently pulls off external catheter during transfer. Put patient back to bed and clean up.
16. Suction patient again once in bed. Finish cleanup.
17. Dress patient in new clothes. Get patient adjusted then resupply room for next nurse.
18. Give report.
19. Wash wet cushion cover.
20. Go home.

And in between all that, I had 1) other patients and 2) lots of documentation to do.

So glad I eat fast and early! And I'm thrilled my work Monday is over, over, over!

Stay tuned...

My least favorite thing

As a nurse, revolves around a body product. Yes, I deal with pee, poop, blood and sputum all the time, but my Achilles heel (in the right context) is emesis.

That regular ol' vomit will send yours truly to sick bay in the right circumstances. Alas, sometimes those rascally patients will do it once in a while.

So at work the other day, at the nurses' station, I was talking to the charge nurse and a few others about these Achilles heel issues we have.

Charge nurse:  "Oh, I just can't do sputum. Coughing, spitting...yuck!" To Mr. J., one of our characters with a trach who hangs out at the nurses' station to catch up on gossip between therapies, "J., I know I've known you for years, but you'd better not cough anything over here or else." J. just rolled his eyes and went somewhere else, since we started grossing him out. Obviously, no gossip was going to be discussed.

Newbie nurse: "I worry about someone having an arterial bleed. That much blood is scary. What if I pass out and can't hold pressure anymore?"


Our most experienced rehab NP: "RehabRN, did I ever tell you about when I worked at the kids camp one summer before cell phones? (this automatically piques the interest of the junior nurses, who can't imagine life without one.)"

"I had a kid with a high temp that wouldn't go down whatever I did. I was really worried about him, so I called the parents at camp and told them what ER I was taking Johnny to. On my way out of camp, my husband Bob was driving in, per usual. I rolled down the window, told him what was going on and that he could stay or follow me."


"I thought Bob elected to stay back at camp, so I kept going to the ER. All of a sudden, Johnny says, 'My stomach really hurts, I think I'm going to be sick.' So I pull over to the side of the road, and he opens door."


"What I didn't know, was that Bob decided to follow me, stop once he saw me pull over, then approach the passenger's side of the car. Kid then proceeded to vomit all over Bob once he opened the door."

"Needless to say, Bob doesn't approach the car from the passenger's side of the car anymore."

Lessons learned: Listen to your experienced NP wife, get a cell phone, and never assume anything with kids.


(BTW this post was inspired by NurseXY's comment about his sick kid. Hope you have a great vacation, dude, with little to no more vomit in store!)

Nothing like a little rehab...

I love being a rehab nurse, but I'm starting to think people think I'm a drug rehab nurse, not a rehabilitation nursing professional. I leave the heavy-duty counseling to the professional counselors, and licensed therapists.

It is interesting, though, in the rehab clinic, since we deal with lots of issues, especially pain management. One of Madison's finest pharmacists, Mike, came over today to talk to some of the patients in afternoon therapy groups.

Not sure if anything will change, but you have to start somewhere...stay tuned!

Ahh...take a breath...

It's been busy the last few days with my class finishing up. The paper has finally been turned in, I'm officially registered for next semester and my exam is over and I passed! Hooray!

Now the fun of the holidays begins. The halls of ye old snowflaked and hollied Hotel Rehab are full of people going hither and yon to therapy and the reservation agents just keep filling the rooms (since they don't work holidays, anyway!). The holidays are usually a slow period for us, but this year will not be the case. Lots of people are eagerly anticipating the annual holiday party, so we'll see what happens. Last year I missed it, because I got the pleasure of working. This year is different.

Since I'm off today, I'm maintaining the fleet, otherwise known as making sure my car is ready for winter and I'm jamming in my favorite coffeehouse with A Very Special Christmas. With all this global warming, we'll probably end up with several feet of snow or 60 degrees for Christmas. Nevertheless, I'll be ready in my trusty old car, which turns double digits next year.

More to come...stay tuned!

Happy Rehab Week!

Yes, indeed, it's time to give a shout out to all my fellow rehab nurses and all of our friends in other rehab-related specialties, especially the therapy folks.

Want more info? Check out The National Rehabilitation Awareness Foundation for more information.

Nuggets for March 11

Since I'm a rehab nurse, we do a lot of work with other disciplines (the vaunted "interdisciplinary team"). Here are a few resources I've found about some of the other areas we work with on a regular basis. Enjoy!

The OTs (Occupational Therapists)

The OTs work with patients on ADLs, or Activities of Daily Living, such as dressing, bathing and transferring, among other things. They also work with cool technology such as ECU (Environmental Control Units) units, which help patients turn on lights, answer phones and do other tasks.

Wanna be an OT? The American Occupational Therapy Association has lots of information, for potential students, current therapists, and the general public.

RESNA is an organization of interest to OTs (and lots of other rehab folks) since they deal with adaptive technology.

OTResources at tripod is run by an OT with links to various sites and definitions. It's an oldie, but goodie.

VCU (Virginia Commonwealth University) Library also has a great general links page about occupational therapy items.

The PTs (Physical Therapists)

The PTs work with patients on ambulation, stretching and strength training, among other things, including getting you a wheelchair or cane if you need it. In other words, they work you out. If after all that work you need something else for that balky shoulder, the PTs are the folks to talk to first for a heat pack or some ROM.

The American Physical Therapy Association has lots of information for current and potential physical therapists.

PT Central has a great collection of links on things such as PT programs, news and events.

The University of Maryland Health Sciences library also has a good, brief listing of PT resources.

The RTs (Recreation Therapists)

The fun people! Recreation therapists don't always get their due, because some people think what they do is just fun and games. Yes, recreation is fun, but it's a vital part of a rehab program, especially when your patients stay with you for a long time. It's also another sneaky way to get patients to use those skills from other disciplines, such as OT and PT.

NCTRC is the national certifying body for Recreation Therapists.

Charles Dixon has a great Therapeutic Recreation Directory with lots of links regarding this area.
Another great, quick access site is http://iamarecreationaltherapist.com/ which has great photo montages of recreation therapists in a variety of settings.

Speech!

No, they won't give one, but we call speech therapy whenever we have someone who needs a swallow evaluation. It takes an order most of the time, but the good folks from speech therapy can help you out with patients with not only dysphagia, but other issues such as speaking difficulties.

The American Speech-Language-Hearing Association is one organization dedicated to the issues encountered by speech therapists, including swallow disorders.

This Speech Therapy resources site has lots and lots of links to topics related to speech therapy.

Get up and go Monday

I managed to get up and go, even if I felt a little slow. So did a couple of our patients.

Our first admission was on site when I arrived around 0715. This is highly unusual, but this patient came from home and was not picked up, so this added another element of excitement to my day when I went into report and I found out that I'd be the admitting nurse.

Happily, I got my assessment and some paperwork out of the way before I started getting my other two patients ready. One of the volunteers set up one of my patients and he got ready and I didn't have to do too much.

I got him ready and up in his chair, and away I went to the next patient. The next guy was a little perturbed that he had to wait for the docs, but that's what happens sometimes when they're rounding and talking. Better late than never to therapy!

The rest of the day went reasonably well, and I even got to eat my lunch by 1330. I got my patient to therapy for all of the afternoon session. He went back to bed and watched a movie on his laptop, which thoroughly entranced his roommate, who had never seen a DVD before.

It was all good, even if I escaped a couple of minutes late. More fun tomorrow...we'll see how crazy the weather is! Stay tuned!

And if you don't have enough to worry about..

Check out this article from the UK on the use of "stripper therapy" for some Huntington's disease patients. Thanks MJ from www.nurseratchedsplace.com for that one.

What a can of worms this would open up here in the US....just a few things to consider...

1. What would our other patients think if they wanted to go along, but didn't have the requisite disease...I see trouble on the unit!

2. Would the rec therapy folks get fired, since all we'd have to do is take the folks to our favorite red light district for "therapy"?

3. Would they start hiring "nurses" from said red light district? And as MJ mentioned, could you imagine the care plans?

And now, since I've finished reading From Silence to Voice, I find it incredibly ironic that the "nurses" arranged this trip. Wouldn't the "nurses" need doctor's orders for the patients to leave the unit for said trip? And do you see the word "doctor" anywhere in this story? No, you don't.

Hmm...and we wonder why people think what they do about nurses.

Nuggets for April 22

Since I'm a SCI rehab nurse, I always find some of the techniques the therapists use to be pretty interesting. Many people think the PTs and OTs are using "space age" stuff with all the different equipment and materials that are available now. My favorite techniques are the ones that are incredibly simple.

At 66, he learned to sing so he could learn to talk (from www.nytimes.com)

Pet therapy is a component of many rehabilitation facilities. At Saintarama, the dogs came out on Wednesday nights, so it was always interesting to see how patients would react when they saw 4-6 dogs, big and small on the unit.

While it's not about pet therapy per se, I enjoyed this article about the Pope and cats from this past week. It just goes to prove that pets can make a difference in people's lives, even for the big guy at the Vatican.

Cat lovers appreciate soul mate in Vatican (also from www.nytimes.com)

TBI (Traumatic Brain Injury) is in the news a lot lately, particularly since many members of the military are returning home with this type of injury. For the VA, it is a major research topic.
Here are a couple of links, one linked to a VA research article, and one lay article, from a family's perspective.

Feature Article: Special Journal Issue on Traumatic Brain Injury (info from www.research.va.gov)

The TBI Recovery Network is a 501(c)(3) non-profit in Carlisle, OH, started by the parents of Ashleigh, a TBI patient, and contains information they discovered on the road to her recovery.