Tag Archives: health

Keeping Toddlers Safe in an Adult Only Home

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Scarletti Confetti pencil and markers on paper 2011 by J.Paradisi

With the onset of late summer hot weather many local children are falling through the screens of open windows. (Another frequent danger to children during hot weather is drowning.  AJN editor-in-chief, Shawn Kennedy posted an excellent article on that subject for Off The Charts).

When I was a Pediatric nurse, the falling diagnosis was nicknamed failure to fly, but only if the child was admitted for nothing more serious than observation and a few bruises. Often the injuries are life threatening or worse, and in truth such an accident is no laughing matter. Perhaps this is why Sesame Street has never featured an episode titled Things That Don’t Fly, in which I imagine Elmo singing a list of things that don’t fly: rocks, books, and YOU!

Okay, that’s not funny either; it’s a poor attempt at humor stemming from recent anxiety while babysitting my favorite toddler, the sister of my favorite twelve year old. A decade has passed since I’ve babysat a toddler, and I worried over her potential for injury while in my care. I’m a nurse, and a former Pediatric Intensive Care nurse at that. It’s a lot of pressure. Of all the people in the world, she should be safe with me, but from the moment she entered my home I realized how dangerous the adult environment David and I share is for an active toddler, even after efforts of childproofing, which included taking all of our CDs out of their towering storage rack and laying it on its side so she couldn’t pull it down on herself, locking under the sink cabinets, installing socket covers, and removing from reach all small, swallowable objects. The balcony door was fastened the entire visit, and she was not allowed on the balcony, even with adult supervision. All windows were closed and locked. There would be no failure to fly on my shift.

Here’s some other tips gleaned from over fifteen years in pediatrics, the news, and personal experience. In no way is this list complete or infallible:

Grandma, What’s in Your Purse? I have no idea how many accidental poisonings occur because a small child finds prescription pills in an unattended handbag. It’s so common that I have removed my little bottle of ibuprofen, used for headaches at work, from my purse. It’s inconvenient; sometimes I have to mooch from my coworkers or walk over to the hospital pharmacy and purchase ibuprofen when a headache comes on at work, but that’s how it is.

 ABSOLUTELY KNOW WHERE THE CHILD IS BEFORE STARTING THE CAR’S ENGINE. This applies when there is more than one adult with the child. Too many children are run over by a car while it’s backed out of a garage or driveway. The driver of the car and the adult in the house each assumed the child was with the other. When I was fifteen years old in Drivers’ Ed, the instructor taught us to walk behind the car to see what might lurk there before getting into the driver’s seat. This is an especially good idea when small children are near.

Never Leave The Child Unattended With The Family Dog. Dogs that are not accustomed to children are unpredictable around them. Dogs that are accustomed to small children are unpredictable around them. I once heard a story of a loyal dog uncharacteristically attacking the family’s toddler. The family was so shocked that after the dog was put down, they had an autopsy performed and found the dog had a painful ear infection. When the toddler touched her ear, the dog attacked him in pain. A very sad story. Protect both the child and the pet by never leaving them together unattended.

Secure That Big Ass TV. Towers of CDs aren’t the only things children old enough to crawl can pull down on themselves. TV’s that are not secure on their bases or bases that are the least bit wobbly put children into ICU’s with crushing injuries every year.

Do Not Assume Any Device Installed For The Child’s Protection Will Work. I’ve seen children who got under impossibly heavy hot tub covers and drowned. Baby gates fail and lead to falls. Years ago, I put my daughter’s baby acetaminophen on top of our refrigerator, safely out of reach when she was small. When she became a teenager, she informed me that as a child, she had climbed the kitchen drawers onto the counter and ate one or two orange flavored acetaminophen at a time while I took a shower, demoralizing me the way only a teenager can demoralize a parent.

The Best Protection for Children is Your Presence. Let the housework and phone calls wait. You are not the kid’s parent, so you’ll have time to clean up after they leave. Getting to know these little people is one of life’s most satisfying experiences. This is your opportunity to influence a developing new life in a positive way. There is nothing in the world more important than their safety and your peace of mind. Enjoy it while it lasts. They grow up so fast.

Summer Weekend Guests Part I

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Salt bowl, chocolate, and spurtle photo: jparadisi 2010

This weekend David and I happily entertained out of town guests. Besides the opportunity to spend time with people we love, we get to see our city, Portland, Oregon, through the eyes of visitors. Here are a few of the fun places we visited:

Bob’s Red Mill: 5000 SE International Way, Milwaukie, Oregon, uses antique millstones to grind whole grain products, which they package and sell. On weekdays you can tour the mill, then head over to the grain store and restaurant to buy products or have a hearty meal. I had the eggs and grits for breakfast, but could have had French toast, waffles, or one of many other choices from the bakery or espresso bar. Family friendly, Bob’s Red Mill has a vast selection of gluten-free products too. Bob’s steel-cut oats are an international award winner (also available gluten-free). If you buy some to take home, be sure to buy a hand-carved spurtle (Scottish porridge stirring stick) made by artisan Tim Cebulla from native Oregon myrtle wood.

The Meadow: 3731 N. Mississippi Ave., Portland, Oregon. Okay, I know about sodium and high blood pressure, but it’s worth learning the discipline of moderation to shop at The Meadow. This unique establishment sells salt from all over the world. I think of it as geology for my kitchen. As a return customer, I already own one of their salt starter sets, and a bowl carved from pink Himalayan rock salt. So, I bought a bar of imported dark chocolate to melt directly in the salt bowl for dipping fresh strawberries and bananas into. The knowledgeable salesperson provided complete instructions on how to do it. Besides salts of the earth, The Meadow also sells a large assortment of fine chocolates, wines, and fresh flowers.

Pistils Nursery: 3811 N. Mississippi Ave., Portland, Oregon, is down the street from The Meadows.  A marvel of design in a very small space, Pistils is a nursery and chicken habitat in a converted old house. Nestled in a largely residential neighborhood, my husband wondered how they keep their free-roaming, exotic chickens within the fenced yard. I’m curious how they keep the neighborhood cats out. At any rate, this homey version of a full-fledge nursery is a delight for the senses. I am kicking myself that this was one of the rare times I was without a camera. You’ll have to go see for yourself.

If Lousia May Alcott Were a Nurse: Oh Wait, She Was.

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Peds Ward by JParadisi Acrylic,charcoal, flash & pencil on vellum 2008

     Nurses’ Week is over, but we left out one of my favorite nurses. She did not advance nursing science. Instead, she gave the profession a human face. I love Louisa May Alcott.

     She wrote Little Women. Do girls still read Little Women? I am grateful my mother considered reading the classic a rite of passage into womanhood (along with Gift from the Sea, and The Good Earth). She gave me a hardbound, illustrated copy of the novel for Christmas when I was in the fifth or sixth grade. To this day I do not know if I love Jo or Amy more. Beth scares me. Meg…she never really materialized for me.

     Okay, Little Women, blah, blah blah, yeah, you read it. You like Jo too. Amy was a bimbo. Too bad for Elizabeth. Meg went on to play the sister on Family Guy, who cares? Well, darling, do you know that Alcott borrowed books from Ralph Waldo Emerson’s private library? That neighbor Henry David Thoreau was her mentor. That she was an Abolitionist and Women’s Rights activist.  Do you know that before she became famous for penning Little Women in 1869, she was a nurse in the Civil War? The experience changed the course of her life, and likely shortened it. In 1863, she published her nursing experiences in the slender volume Hospital Sketches. The book has the tagline:  “An Army Nurse’s True Account of her Experiences during the Civil War.”  

     An aspiring actor and playwright, Alcott grew up in poverty.  Her father, Amos Bronson Alcott was a respected educator and philosopher lacking both business sense and money management skills. Louisa took jobs teaching and in domestic service to support her family. When war broke out among the United States, she wrote, “I want something to do.” Encouraged to write, young Alcott felt she lacked necessary life experiences. At a neighbor’s suggestion, she decided to ”go nurse soldiers. So far, very good.”

     I won’t post a synopsis of the book, other than to say it contains a disturbing account of the death of a soldier whom Alcott befriended.  Her description illustrates that in the days before anesthesia, a soldier’s death was the male counterpart of a woman’s sufferings in childbirth.  

     Alcott was dedicated to the men in her charge. Her brief nursing career ended when she contracted typhoid fever. She survived, but suffered life-long chronic pain; a side effect of the mercury-based medication used to treat her. She obsessively turned to writing, becoming the main financial support of her entire family.  Little Women made her rich, but it was her nursing experiences that made her a writer. I will close this post with Alcott’s own words about Hospital Sketches:

These sketches, taken from letters hastily written in the few leisure moments of a very busy life, make no pretension to literary merit, but are simply a brief record of one person’s hospital experience. As such, they are republished, with their many faults but partially amended, lest in retouching they should lose whatever force or freshness the inspiration of the time may have given them.

To those who have objected to a “tone of levity” in some portions of the sketches, I desire to say that the wish to make the best of every thing, and send home cheerful reports even from that saddest of scenes, an army hospital, probably produced the impression of levity upon those who have never known the sharp contrasts of the tragic and comic in such a life.

The unexpected favor with which the little book was greeted, and the desire for a new edition, increase the author’s regret that is not more worthy such a kind reception.

Louisa May Alcott

Concord, March 1869

Hospital Sketches by Louisa May Alcott is available from Applewood Books.

Interruptions Increase Errors. Really?

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Nurse's Note artist: JParadisi. pencil and ink on paper

     I am writing this post while my husband pumps air into his bicycle tires in our living room (ka-chunka chunka-chunka), muttering about how much work cycling is. Finding uninterrupted time to write or paint is sometimes challenging. In nursing, where the safety of patients depends on accuracy, it is impossible. It is the biggest absurdity of my two careers.    

      This morning I read a Medscape article about interruptions exponentially increasing nursing medication and procedure errors. Researchers collected data for the study by observing nurses at two hospitals. Although the conclusion seems obvious, I appreciate hard numbers applied to a reality all nurses recognize. Collecting data is the first step towards change. Shockingly, according to the study a single interruption during medication administration increases frequency of errors to 25%.    

     In all my years of nursing, I have never completed a single task from start to finish without an interruption. A coworker asks a question, a patient or family member needs something, a phone call from a physician or another department and I am distracted. Once, on pediatric unit, I entered my first patient’s room to find him vomiting violently in the bathroom. While holding his small head out of the toilet, calming him down, and keeping his IV in place, my pager beeped. I had to ignore it, but as soon as the patient was safely in bed, I went to the nurses’ station to see why I was paged. There, a unit secretary lectured me about her expectation for an immediate call back to a page (although doctors have an unwritten, twenty-minute grace period to answer pages for non-urgent matters). Why was I paged? A doctor had a question. I did not need to explain myself to the secretary; when I did, her expectation remained unchanged. Whatever. I called the doctor back, and there wasn’t a problem. My point is interruptions can wait until a patient is safe. The problem is most nursing units have expectations that everything be done now. STAT is the most over-used word in health care. Is there really such a thing as STAT Colace? There is an unrealistic pressure on nurses to do everything at once. It is impossible, and patient safety suffers. It’s a no brainer. How sad studies are necessary to prove the obvious.    

        Creating a safe zone where nurses can draw up medications without interruption is a reasonable idea; however, it does not address the interruptions occurring in the patient’s room, like the pager going off in my pocket.  I am often interrupted while double-checking blood, accessing a port, or hanging chemo by the patient asking for a blanket “when you get a chance” or answering their cell phone. They do not realize how much concentration it takes to give safe care. More than once, I have explained to patients or family members “I need to focus on what I’m doing to keep you safe, and I will be glad to answer your question as soon as I finish.”  I’ve never had a patient or family member complain about it. They appreciate dedication to their safety.   

     Interruptions are a daily part of everyone’s life. Reducing nonessential ones is crucial to safe nursing practice, and adjusting expectations (including staffing ratios) is critical.     

     You can find the article   

Interruptions Linked to Medication Errors by Nurses    

At  medscape.com

Oncology and Hospice Nurses Should Read this Article

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       Okay, this isn’t the happiest subject to post on a beautiful Friday morning before a weekend, but the topic is important and it’s part of my job to know this stuff. Warning: it’s about end of life treatment for patients with terminal cancer.

      Oncology and Hospice nurses, please read this article in today’s Health section of the New York Times. Whether to turn off pacemakers in the face of terminal illness is a consideration in end of life discussions with patients and their families. Read the article:

Life Saving Devices can Cause Havoc at Life’s End

     Have any reader’s had experiences related to this? 

Not All Days are Magically Delicious

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Wound Vac ink & pastel on paper 2010 by JParadisi

        When I was a pediatric critical care nurse working in busy trauma centers, my duties included wound care. I have salved and wrapped burns, and limbs ravaged by meningococcemia. I’ve dressed the fingers of a child whose surgeon successfully used leeches to regain their circulation.  As an adult oncology nurse, I occasionally float to the wound care area and change dressings. 

       A few weeks ago, I changed a wound vac dressing. A wound vac is a small mechanical device in a fanny bag, worn by the patient 24/7.  Black sponge is packed into the wound and covered with an adhesive, transparent film. A suction tube connects the dressing to a canister attached to the wound vac. When the wound vac is turned on, it sucks all the air out, compressing the sponge tightly into the wound. There is barely any sound as the machine ”vacuums” the wound’s drainage into the canister. The suction stimulates healthy tissue, often reducing healing time dramatically. If an air leak is present, there is a loud sucking noise when the machine powers on, and the sponge will not compress. This means it needs more transparent covering to seal it. If that fails, the entire dressing comes off and redone, which is not very comfortable for the patient. 

     The patient I was seeing dreaded the dressing changes. I sat on a rolly stool, listening to him express his feelings about the progress he was making. I used my best communication skills. We connected, and he trusted me with the dressing change. 

     His wound was shaped like one of the marshmallows in a box of Lucky Charms cereal. Its complex shape made cutting the bulky, black sponge to fit difficult. Nope, there wasn’t a template from the previous dressing changes, but that would have been nice. The wound’s location made keeping the sponge in place challenging. Using tricks, I managed to get everything in place. The patient tolerated the procedure well. I turned on the wound vac. 

     The machine made a loud sucking noise and the sponge did not compress. I looked at my patient and the disappointment in his eyes matched my own. I was unable to make an airtight seal by reinforcing suspicious areas with more transparent film. My patient said, “You’re not going to redo the dressing, are you?” It sounded more like a statement than a question. I knew he had reached his limit of tolerance, and I felt terrible.  ”Let me try one more thing first,” I said. I stepped into the hallway and looked for help. Fortuitously, one of my WCON friends was out there, holding her lunch sack.  Also a nurse, she has advanced certification in wound and ostomy care.  ”I need help, I can’t get a seal on a wound vac,” I pleaded. She put away her lunch and in five minutes she found the leak, fixed it, and the wound vac powered on in silence. The black sponge fully compressed. My patient went home. 

     I was not the hero I wanted to be that day. Someone else stepped in for me. That’s why I like being part of a team, because not all days are magically delicious.

What You Focus on Expands

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    Yesterday morning, I attended an awards breakfast at the hospital I work for, honoring 105 nurses with Certificates of Nursing Excellence. My colleagues were recognized for developing patient safety and education programs, precepting, and academic or certification achievements. I received recognition because the American Journal of Nursing published my painting Love You to Death on its October 2009 cover. I was scheduled to work during the breakfast, but two days earlier, our manager arranged patient scheduling so I could attend, without burdening my coworkers with extra work.

     The usual hospital administrators, with the addition of a Chief Nursing Officer, presented the awards. This executive nurse sits on our hospital’s Board. To my knowledge, she is the first nurse to sit on the Board. She makes significant contributions to nursing management.

     Home from work, I checked my email and found that senior art editor Sylvia Foley mentioned both of my blogs, JParadisi RN’s Blog and Die Krankenschwester in a post on the AJN blog Off the Charts.

     Recognition for hard work feels good.

     There are more than 105 excellent nurses working at our hospital. Many simply did not fill out the form required to receive recognition. They choose to work hard without it. We are all wired a little differently, in that respect.  I used to prefer staying under the radar too. But part of taking care of me is taking time to celebrate accomplishments, instead of keeping track of failures. What you focus on expands.

     Happy Nurses Day.

I Wish I’d Said It

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For attractive lips, speak words of kindness.

For lovely eyes, seek out the good in people.

For a slim figure, share your food with the hungry.

For beautiful hair, let a child run their fingers through it once a day.

For poise, walk with the knowlege that you never walk alone.

As you grow older, you will discover that you have two hands,

one for helping yourself, and the other for helping others

    Audrey Hepburn