Stemming A Future of Workplace Violence

Chances are that most of us heading into the workforce as new nurses will experience violence.

The National Survey of the Work and Health of Nurses reported in 2005 that more than 34% of nurses said they had been physically abused in the last year.

ONA president Haslam-Stroud said that the number has most likely risen and will rise in the future if nothing is done to stop violence.

The ONA has lobbied the Ontario government over the past few years to amend the Occupational Health and Safety Act to better protect nurses.

Recently the government announced amendments to the act that it says will do more to protect health workers.

Physical abuse  is only one form of violence nurses face as problems such as verbal attacks and sexual harassment continue to be an issue.

There should be a zero tolerance policy for any type of violence, backed up by the organization a nurse works for and not just legislation.

Since workplace violence continues to be an issue, it makes me wonder why organizations don’t seem to take more accountability and ensure safety for their employees.

Media, the Flu and a Missing Cat

The cat found her way outside tonight. So I spent the last half hour roaming around the outside of the house making that sound one makes when trying to attract cat’s attention. Cat was having none of it until, for some reason, she squawked at me from the darkness. Probably had enough entertainment watching me stumble about and was ready for a bit of food.

Cat is to blame for me writing this at 1:19am.

School is full of whispers about the swine flu today.  The media has picked up the pace in the last week with the flu leading the news. I get the feeling the news people are always a bit deflated when no one outside Mexico has been reported dead or hospitalized. Still, since hearing about the first cases, I can’t shake a feeling that the situation will get much worse before it gets better. Then, I wonder how much of my perception is being influenced by overzealous media reports.

Incidentally, the WHO are going to attempt to re-brand swine flu since the current term is threatening the pork industry.

Google Maps Track Swine Flu Pandemic

Click HERE to go to map of swine flu pandemic.

Swine Flu Confirmed in Canada

Just watching the news this evening. Canada has had its first confirmed cases of swine flu that really was just a matter of time. The cases are all from travelers returning from Mexico and are being reported primarily as mild cases.

Meanwhile, the Toronto Star reported today that over 100 people in Mexico have died from the current flu outbreak.

There is a general feeling that Canada can handle an outbreak, and current flu drugs apparently work against the strain.

Since flu symptoms are the same as regular seasonal flu, without specific tests, there is no way to tell the difference.

Putting things in perspective, 4,000 people die yearly from the regular seasonal flu in Canada.

The standard list of precautions are being circulated:

• If you are sick stay home
• Wash your hands frequently
• See a health professional if you experience severe flu-like symptoms

Swine Flu and the Cytokine Storm

With the Swine flu threatening pandemic status the real danger is its unusual veracity among younger populations.

Normal seasonal flu will often be of greatest threat to children and the elderly; those with weaker immune systems.

It is theorized that certain strains of the influenza such as the swine flu cause a cytokine storm triggering an extreme immune reaction in healthy people between 18 and 40 years old.

A cytokine storm creates a potentially fatal feedback loop between cytokines and immune cells (Osterholm, 2005).

Cytokines are a diverse group of signaling molecules that, among other functions, are secreted in response to pathogens such as the influenza virus thereby activating and recruiting an increasing number of immune cells.

In normal situations this is a healthy response, however, for unknown reasons, a cytokine storm occurs when in the presence of a highly pathogenic invader (Osterholm, 2005).

If a cytokine storm occurs in the lungs, for example, there is a potential that the lungs will become filled with fluid and immune cells with the possibility of blocking of the airway leading to eventual death.

It is believed that the cytokine storm reaction caused the high number of fatalities during the 1918 pandemic flu epidemic (Osterholm, 2005).

In 1918, “more than half the deaths occurred among largely healthy people between 18 and 40 years of age and were caused by a virus-induced cytokine storm that led to the acute respiratory distress syndrome (ARDS)” (Osterholm, 2005).

• Proposed Method of Cytokine Storm (New England Journal of Medicine).

The Blunted Expression of Text

An interesting story in the Star this week explores how texting can often come across as rather blunt.

It seems that some of the texting generation have put aside sensitivity of how their message may be received by others.

Their priority is to create a short and compact message, but it can often come across to the recipient as blunt to borderline abusive.

“They [students] sound like they’re going to burn your door down,” says Professor Tim Blackmore in a Star interview.

“They send messages that are both lazy and in the imperative – “Hey, u didn’t tell me what was wrong with my paper.”

“You think, that’s some crust. But then they come into your office and they are crying. They are nice people. But their messages are surface, not about depth. They need to step back and get some context.”

In the early days of email, I remember paying little attention to how my emails sounded. And often I received a terse response.

I also received emails myself that could be read as terse and insensitive. When I questioned the sender, they seemed mystified by my interpretation.

I often thought the mood of the reader could also add to the misinterpretation of the emotional intent behind the message.

If I were in a bad mood, I may read a friend’s email as negative.

These days, I’m often careful to word emails neutrally, especially when emailing work or professionally related contacts. I may even occasionally revert to a letter writing style using dear and sincerely.

And God forbid you use sarcasm since it is almost always misinterpreted in text based messages.

World Records no Barrier to This Centenarian

Canadian Jaring Timmerman broke world swimming records earlier this week in Winnipeg. But this wasn’t his only accomplishment.

Mr. Timmerman just recently turned 100.

Competing in the 100-104 year old category (there is also a 105-110 year old category), Mr. Timmerman shattered the 50-metre and 100-metre freestyle records on Saturday at Pan Am Pool during the 2009 Manitoba Masters Swimming Championship.

“Oddly enough, they’re world records,” Mr. Timmerman told the Winnipeg Free Press Monday. “So that’s something, isn’t it? I don’t know whether I was spry or not — I was nervous as a kitten. But I’m glad that I accomplished something. It was good.”

Anyway, quite an amazing story. Thought I’d share.

We are truly never as old as we think.

Reading Between The Lines: High-fructose Corn Syrup Study

A recent CBC news story headline reports that “Fructose is worse than glucose when it comes to sweetened drinks: study”

When I read that headline my first instinct was that I should be keeping an eye out for fructose. Reading on.

“The findings suggest that fructose-sweetened beverages can interfere with how the body handles fat, leading to medical conditions that increase susceptibility to heart attacks and strokes.” says the news report.

OK. I really have to watch out for fructose.

Then the report tells us that it is actually North America’s over consumption of things like high-fructose corn syrup that is the real problem (that stuff’s in everything…seriously).

So they didn’t really mean good old fructose (found in fruit juices, honey etc.) they meant high-fructose corn syrup. OK. Got it.

Reading a little further the report says “In the 10-week study, 17 subjects consumed a quarter of their calories from fructose-sweetened beverages and another 15 subjects drank the equivalent amount in glucose-sweetened beverages”

So lets say an average 30-year-old adult male consumes about 2,900 calories daily. They had these poor souls drinking 725 calories a day from fructose-sweetened beverages.  Not too surprising then that their insulin control was out of whack.

But seriously, high amounts of high-fructose corn syrup really isn’t good for your sugar control.

So the moral to the story is, don’t drink 1/4 of your daily calories in soda pop with high-fructose corn syrup.

Science, unlike media, is an ongoing process of theory and argument. One theory is proposed and evidence, through research, is given. Another scientist may come along and say, “no that isn’t right” and try to disprove the original research. Theory is never absolute. Media interpretation of scientific evidence, however, always seems a lot more definite. Especially with a good attention grabbing headline.

Gallows Humor

One Last Cookie

This elderly man was at home, dying in bed.

He smelled the aroma of his favorite chocolate chip cookies baking.

He wanted one last cookie before he died.

He fell out of bed, crawled to the landing, rolled down the stairs, and crawled into the kitchen where his wife was busily baking cookies.

With waning strength he crawled to the table and was just barely able to lift his withered arm to the cookie sheet.

As he grasped a warm, moist, chocolate chip cookie-his favorite kind-his wife suddenly whacked his hand with a spatula.

“Why?” he whispered. “Why’d you do that?”

“They’re for the funeral,” she replied.

——

“Don’t be surprised if you hear someone crack a joke or two down there (the ED)”, my teacher had told me just before I went down for my placement day. “It’s just how they get by.”

Now in my last year, I’ve had some experience with dark humor and health care. If you want a job where you see people daily in some of the worst conditions imaginable (gun shots, head trauma, car accident, heart attack, stroke, stabbings etc.) and you don’t mind the light banter of dark comedy then the ER is for you! Odd? Horrific? Not really, just very human.

Nurse P and Nurse M, just back from dinner, enter the ER just as a man vomits gray, green stuff all over the floor.  Nurse P says off offhandedly as they move to help the man, “I wonder if that cafeteria meatloaf will crawl in here soon and ask for an IV?”

Put human beings in awful situations on a daily basis and, in order to walk through those doors every day, people will find ways to cope.

Also known as gallows humor, it is “a dark or morbid sense of humor unique to people who deal with suffering and tragedy—for example, patients who are terminally ill joking about their illness or death as a means of coping with the illness” (source).

The term comes from “Freud’s (1905) description of prisoner’s making light hearted jokes on the way to the gallows” (Martin, 2007, p 48).

It is used as a method of maintaining one’s sanity in rather dark situations (Martin).

Maggot Therapy has Similar Outcome to Wound Debridement, Studies Say

Recent studies from bmj.com (2009) state that maggot therapy has a similar outcome and cost to standard leg ulcer treatment.

I’ve participated in standard leg ulcer treatment. It generally involves unpacking the wound, debridement (removal of dead tissue) from the wound, cleaning and repacking.

The studies suggest that our friend the maggot also debrides the wound quickly, reduces infection and triggers healing.

The randomized controlled trial focused on clinical outcome and cost of maggot therapy compared to traditional ulcer treatment. Generally no difference was found between the two treatments.

Another commonly used method, Hydrogel debridement, was found to take longer than both maggot therapy or standard care.

On the other hand, Nigam et al. (2006) write that maggot therapy is considered a successful therapy for old, chronic wounds, that have not responded to standard treatment.

So now I wonder if anyone has seen maggot therapy recently in practice.

I just can’t imagine explaining it to my patient….”You’re going to do what with WHAT to my leg ?!?”