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.

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.

Kaylee Expected To Be Sent Home

In a surprise twist from yesterday’s post, the Toronto Star reports today that 2-month-old Kaylee may be sent home.

Yesterday, they took the child off life support to allow her to pass away. There was hope that her heart would be viable for transplant for another child at Sick Kids.

When they took her off life support she began to breathe on her own.

Kaylee has rare brain disease called Joubert Syndrome. The disease affects the cerebellar vermis causing hyperpnea, hypotonia,  oculomotor apraxia, mental retardation, and ataxia. The disease prognosis ranges from mild to severe depending on how developed the cerebellar vermis is. However, the bottom line is that children can survive with the disease.

In Kaylee’s case, she normally stopped breathing when she fell asleep, but when the health team took her off her ventilator she began to breathe on her own.

“How long would she live? It’s a hard question,” her mother said in a Toronto Star interviw outside the hospital tonight. “It could be months to a couple of years. Doctors said she has such a severe case (of Joubert Syndrome) that she won’t be able to see, walk or talk.”

To me, the strength of life in this little child is truly amazing.

Child Close to Death

A heart wrenching story coming out of Toronto Sick Kids today as a two month old Kaylee will be taken off life support tonight.

The little girl suffers from a rare brain disease called Joubert Syndrome and is unable to breathe without life support.

There is hope that Kaylee’s heart will be a match for another very ill child in the hospital but in order for that to happen Kaylee must pass away soon enough for the organs to be viable.

Kaylee’s father,  Jason Wallace, said, in a Toronto Star interview that he and his wife, Crystal Vitelli, are comforted by “the knowledge that a child will get another chance at life and that we are doing what is the right thing to do.”

It is a difficult story because one child’s death must occur in such a way as to allow another to live.

The nurse’s on the floor must be struggling along side the families. As a student, I often wonder how the nurses manage. I know there are the tough ones. The ones who have seen it all before. But they’re still human.

I was once told by a fellow nurse not to care about every patient that comes in.

As I start my career, I hope I never get like that. I’m not sure shutting out the human side of nursing is at all good. I think it’s good let ourselves be human.

Never Underestimate a Head Injury

Video: Coverage of Natasha Richardson Saves Little Girl

It was not the fact that they refused treatment that was the caused of death…it was the fact that the local area didn’t have a helicopter.  Anyway…

The story about the child’s head injury should bring home the message: go to your ER if you or a family member have experienced a blow to the head. Get a CT and ideally a neurology or TBI (traumatic brain injury) specialist consult.

However, bleeds to the brain aren’t the only risk from TBI. I recall a male doc. who fell and lightly bumped the back of his head. By the time we saw him, his entire life had changed. He was having problems at work,  he had difficulty socially and his family and social life had decayed. The curious part was there was no clear area of damage on his MRI.

I believe he is doing well now after he got the help and resources he needed.

Still, it’s terrifying to think that even a small bump on the head can lead to life long or life threatening issues.

Learn more about TBI:

1. NINDS Traumatic Brain Injury Information Page
2. “Signs and Symptoms”. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control
3. TBI

Ontario Spends $2.1 Million on eHealth

Today, the Ontario goverment announced that it would spent $2.1 million to provide every diabetic patient with an electronic health record by 2012.

The program, called eHealth Ontario, will connect health care professionals, pharmacists and patients to better manage the efficiency and safety of prescriptions and medications as well as reduce wait times.

“eHealth Ontario is a new organization that will play the leading role in harnessing information technology and innovation to improve patient care, safety and access in support of the government’s health strategy,” states the agency on its web site. “We will provide a single, harmonized, coherent province-wide eHealth Strategy and align it through a single point of accountability.”

The overall goal of the program is to have 65 per cent of doctors and their patients using e-health by 2012.

Elizabeth Witmer, Ontario’s conservative health critic, said that Ontario hasn’t been doing a very good job when it comes to eHealth.

However, leaders of the new program are optimistic that they can successfully improve Ontario’s eHealth initiative.

One of the key areas of the plan is to involve diabetic patients in a close electronic monitoring system that will allow health care workers to follow patients’ health status and alert them to any concerns, ideally reducing hospital visits.

The program also hopes to reduce wait times by making access to health easier and increasingly preventative.