Each year more than 15,000 women under the age of 55 die of heart disease in the United States. And younger women are twice as likely to die after being hospitalized for a heart attack as men in the same age group.
It doesn't help that women tend to delay seeking emergency care for symptoms of a heart attack such as pain and dizziness, says Judith Lichtman, an associate professor of epidemiology at the Yale School of Public Health. "We've known that for a while," she says.
In a small study published Tuesday in Circulation: Cardiovascular Quality and Outcomes, Lichtman and her colleagues looked into why women delay getting help. The researchers conducted in-depth interviews with 30 women, ages 30 to 55, who had been hospitalized after a heart attack.
It turned out that many had trouble recognizing that they were having symptoms of a heart attack. "A lot of them talk about not really experiencing the Hollywood heart attack," Lichtman tells Shots.
A heart attack doesn't necessarily feel like a sudden painful episode that ends in collapse, she notes. And women are more likely than men to experience vague symptoms like nausea or pain down their arms.
"Women may experience a combination of things they don't always associate with a heart attack," Lichtman says. "Maybe we need to do a better job of explaining and describing to the public what a heart attack looks and feels like."
But even when women suspected that they were having a heart attack, many said they were hesitant to bring it up because they didn't want to look like hypochondriacs.
"We need to do a better job of empowering women to share their concerns and symptoms," Lichtman says.
And medical professionals may need to do a better job of listening, she adds. Several women reported that their doctors initially misdiagnosed the pain, assuming that the women were suffering from acid reflux or gas.
Doctors should pay special attention to women who have high blood pressure or cholesterol, as well as those with a family history of heart disease, Lichtman says.
This is just a preliminary study. Lichtman has already started working on a much larger study investigating why women have a higher risk of dying from heart disease than men.
But the findings aren't too surprising, says Dr. Nisha Parikh, a cardiologist at the University of California, San Francisco who wasn't involved in the research.
"I take care of young women who have heart disease, and this story is very common," she says.
Part of the issue is that most of the research on heart disease has focused on men, since the condition is more common among men. As a result, the diagnostic tools that doctors use to identify heart disease aren't always well suited for female patients.
Cardiologists are just beginning to rethink how to best recognize and treat heart attacks in women, Parikh notes.
Heart disease is the third leading cause of death for women ages 35 to 44, and it's the second leading cause of death for women 45 to 54, according to the Centers for Disease Control and Prevention. (Cancer is the No. 1 cause.)
"Historically we thought of heart disease as sort of a man's disease," Parikh says. "But that's not the case."
This study also highlights the importance of empowering women to speak up about their worries, says. Dr. Jennifer Tremmel, a cardiologist at Stanford University.
"It's interesting because the whole idea of female hysteria dates back to ancient times," Tremmel says. "This is an ongoing issue in the medical field, and we all have to empower women patients, so they know that they need to not be so worried about going to the hospital if they're afraid there's something wrong."
Days before he's scheduled to leave the hospital, he's already gone viral on social media because he was born 'en caul.'
Silas was completely encased in his amniotic sac, said Los Angeles' Cedars-Sinai Medical Center in a Facebook post. That's so rare, that even doctors delivering babies hardly see it. So Silas' doctor snapped a photo with his cell phone.
It looked like the baby was trapped in a big water bubble.
"Even though it's a cliche -- we caught our breath," neonatologist William Binder told CNN affiliate KCAL. "It really felt like a moment of awe."
Then Binder got to work helping Silas to breathe - and giving him special care, because Silas was born three months before his due date via Caesarean section.
Later, Silas' grandmother showed the cell phone photo to his mother, Chelsea Philips.
"It was definitely like a clear film, where you could definitely make out his head and his hair," Philips told the affiliate. Silas was curled up in fetal position inside.
What is 'en caul'
The amniotic sac is an opaque bubble that covers all babies in the womb from right after conception. As the baby grows, it fills with fluid, including the baby's urine.
The sac cushions the baby from bumps and jostles during mom's daily ups and downs.
Normally, during a birth, it breaks, and the fluid rushes out, which is where the term 'breaking water' comes from.
But sometimes, the sac can get stuck around part of the baby, according to Dr. Amos Grunebaum, an obstetrician and gynecologist, who publishes a website on birth and baby care.
It can, for example, get stuck on the baby's head, which makes it look like its wearing a glass space helmet. That's also where the term caul comes from -- it derives from Latin words that refer to a helmet.
Such amniotic sac helmet births are rare enough, but to have the entire baby inside the sac, or 'en caul,' occurs in less than one in 80,000 births, Cedars-Sinai said.
When Philips heard how rare her Baby's birth was, she was flabbergasted. "I was like, oh my gosh, Silas, you're a little special baby," she told KCAL.
It's particularly surprising in a C-section, because the scalpel usually pierces the amniotic sac.
The doctors must have missed Silas's.
For Tabitha Waugh, it was another typical day of chaos on the sixth-floor cancer ward.
The fire alarm was blaring for the second time that afternoon, prompting patients to stumble out of their rooms. One confused elderly man approached Ms. Waugh, a registered nurse at St. Mary’s Medical Center here, but she had no time to console him. An aide was shouting from another room, where a patient sat dazed on the edge of his bed, blood pooling on the floor from the IV he had yanked from his vein.
“Hey, big guy, can you lay back in bed?” she asked, as she cleaned the patient before inserting a new line. He winced. “Hold my hand, O.K.?” she said.
Ms. Waugh, who is 30 and the main breadwinner in her family of four, still had three hours to go before the end of a 12-hour shift. But despite the stresses and constant demands, all the hard work was paying off.
Her wage of nearly $27 an hour provides for a comfortable life that includes a three-bedroom home, a pickup truck and a new sport utility vehicle, tumbling classes for her 3-year-old, Piper, and dozens of brightly colored Thomas the Tank Engine cars heaped under the double bed of her 6-year-old, Collin.
The daughter of a teacher’s aide and a gas station manager, Ms. Waugh, like many other hard-working and often overlooked Americans, has secured a spot in a profoundly transformed middle class. While the group continues to include large numbers of people sitting at desks, far fewer middle-income workers of the 21st century are donning overalls. Instead, reflecting the biggest change in recent years, millions more are in scrubs.
“We used to think about the men going out with their lunch bucket to their factory, and those were good jobs,” said Jane Waldfogel, a professor at Columbia University who studies work and family issues. “What’s the corresponding job today? It’s in the health care sector.”
In 1980, 1.4 million jobs in health care paid a middle-class wage: $40,000 to $80,000 a year in today’s money. Now, the figure is 4.5 million.
The pay of registered nurses — now the third-largest middle-income occupation and one that continues to be overwhelmingly female — has risen strongly along with the increasing demands of the job. The median salary of $61,000 a year in 2012 was 55 percent greater, adjusted for inflation, than it was three decades earlier.
And it was about $9,000 more than the shriveled wages of, say, a phone company repairman, who would have been more likely to head a middle-class family in the 1980s. Back then, more than a quarter of middle-income jobs were in manufacturing, a sector long dominated by men. Today, it is just 13 percent.
As the job market has shifted, women, in general, have more skillfully negotiated the twists and turns of the new economy, rushing to secure jobs in health care and other industries that demand more education and training. Men, by contrast, have been less successful at keeping up.
In many working- and middle-class households, women now earn the bigger paycheck, work longer hours and have greater opportunities for career advancement. As a result, millions of American families are being reconfigured along with the economy.
“The culture still has traditional attitudes about who does what, who brings home the bacon and who scrambles the eggs,” said Isabel Sawhill, co-director of the Center on Children and Families at the Brookings Institution. “The economy is now out of sync with the culture, and I think that’s creating tensions within marriage.”
A New Springboard
At the Waughs’ house, it is T.J. Waugh, 33, who picks up the couple’s two children from the babysitter when he leaves his afternoon shift at a small plant in Huntington.
By the time Ms. Waugh arrives home in rural Salt Rock from her shift, often far later than her 7 p.m. quitting time, the children have been bathed and fed.
The house is usually messy. The bathroom walls are covered with scribbles from bath crayons; dirty clothes pile up. Ms. Waugh often jams six 12-hour shifts into one week, leaving little time for cleaning and laundry. Mr. Waugh mows the lawn and will run the vacuum cleaner now and then, and if there are no clean towels, Ms. Waugh will do a load of laundry. Otherwise, housework waits until she has a stretch of days off.
“I’m just really tired when I get home,” Ms. Waugh said.
Ms. Waugh is the keeper of the family’s books. That she out-earns her husband — a pipe fitter who hunts deer and plays men’s softball on the weekends — is an unspoken given.
“She doesn’t rub that in,” he said.
Without missing a beat, Ms. Waugh adds, “It doesn’t matter where it comes from.”
Most of the new jobs produced by America’s sprawling economy — especially since the turn of the century — are either in highly paid occupations that often require an advanced degree, or, more predominantly, in lower-paid positions providing direct services that cannot be sent overseas and, at least for now, are difficult to automate.
But even with a hollowing out of the job market and a broad stagnation in wages, an analysis by The New York Times has found, a set of occupations has emerged that holds promise as the base of a more robust middle class.
Many are in health care, which has grown sharply over the last few decades.
Economists at the Labor Department project that by 2022, as baby boomers age, health care and social assistance will absorb nearly 20 percent of consumer spending, double the share of manufactured goods. The sector is expected to support over 21 million jobs, five million more than today. This includes half a million more registered nurses.
A Rare Green Shoot
The reordering of the economic landscape can be seen all over West Virginia’s old coal country, where billboards along the highways that run through the region advertise a new cardiac center and an orthopedic clinic; and where a strip mall houses Scrubs Unlimited, a medical outfitter, its retail floor crammed with nursing uniforms in 38 colors and Peter Pan prints.
Hugging the Ohio River as it bends around the Appalachian foothills, Cabell County, which includes Huntington, has often found itself on the wrong side of economic change. The population — about 97,000 today — has shrunk 10 percent over the last three decades, as the old have died and many of the young have left.
The railroad that helps shuttle coal to Huntington, one of the nation’s busiest inland ports, is still a source of jobs. But manufacturing employment — once clustered at the long-gone glassmaking plants and furniture makers — has dwindled to fewer than 5,000 jobs. Recently, a 1920s-era nickel alloy plant laid off dozens of workers after a bankruptcy, a corporate acquisition and weak sales.
In real terms, wages in Cabell County now are lower than in the 1970s, stumbling along well below the national average. One in five residents lives in poverty.
The health care industry — which added 3,000 jobs here over the last 10 years — is one of the few green shoots in a struggling economy.
West Virginia has been battered by the same forces that have reshaped the nation since the late 1970s, when global competition, an overvalued dollar, declining unions and advanced technology began to undercut the jobs created during America’s industrial heyday, deepening income inequality. And since 2000, the share of middle-income workers has been squeezed and wages have stagnated.
Yet many of the jobs added in medical services here and across the nation have turned out to be surprisingly good ones.
That was what motivated the only male registered nurse colleague of Ms. Waugh’s on the sixth-floor cancer unit, Johnny Dial, a former highway construction worker and heavy equipment mechanic. More men are joining nursing, but they still make up only 10 percent of the ranks, compared with 4 percent in 1980.
As Mr. Dial contemplated supporting a family, it came down to health care or the railroad if he wanted job security and benefits. He chose what he thought would be a more fulfilling career, and the same one as his wife, who is also a nurse.
“You get to help people,” Mr. Dial said.
Women Stepped Up
Similar thinking was behind the career choices of Ms. Waugh’s fellow female R.N.s. They include a former waitress, a former journalist, an ex-administrator in a metals factory and a former store clerk at Bath & Body Works. In addition to the satisfaction of the work, they all said, the wages are generally better in health care than they could find in other fields.
Ms. Waugh has urged her husband to try to move up at his company, where he earns about $40,000 in regular wages, plus pay for occasional extra shifts, or to switch to a more lucrative career, maybe even in health care as a radiology technician.
But for Mr. Waugh, the only way up at the plant is to go into sales, a promotion he already turned down because he said he did not want to “deal with people.” He could earn more in the coal mines, but that work is dirty and dangerous.
Mr. Waugh has talked about trying college again; he dropped out twice in the past. At one point, his wife even filled out application papers for him to jump-start his re-enrollment, but he did not pursue class work.
“My philosophy is he is lazy,” Ms. Waugh said, standing in the hospital’s white hallway. “That’s what makes me so mad.”
For all the troubles associated with traditionally male jobs, women have not had an easy ride through the economic turmoil, either.
“The occupational structure has not somehow become more women-friendly,” said David Autor, an economist at M.I.T. who has studied the changing American job market. In fact, he added, “the hollowing out of middle-skill jobs was larger for women than for men.” The process intensified sharply during the financial crisis and the ensuing economic downturn.
But in general women have reacted much better, climbing the educational ladder to capture more of the better jobs. Today, 38 percent of women in their late 20s and early 30s have a college degree, compared with 15 percent 40 years ago. The completion rate for young men is now 7 percentage points lower than for women — back then it was 7 points higher.
This has given women an edge in the new job market: Today, almost 58 percent of registered nurses have a bachelor’s degree or more, compared with about a third in 1980.
This is true across the range of occupations capable of supporting a middle-class life. In 1980, 55 percent of workers who earned the equivalent of $40,000 to $80,000 in today’s dollars had at most a high school diploma, according to the analysis by The Times, which reviewed census returns for employed people ages 25 to 64. Only a quarter had a college degree. Today, the share of college graduates has risen to about 41 percent, while just under 31 percent have completed no more than high school.
“The days when a very, very substantial share of the work force would be able to make good middle-class incomes from jobs that did not require post-high school training are just not the case anymore,” said Francine D. Blau, an economics professor at Cornell University.
Men still hold most of the top jobs in the economy, including seven out of 10 jobs that pay over $80,000 a year. But women are rapidly moving up the ranks. Women hold 44 percent of middle-income jobs, compared with about a quarter 30 years ago.
These trends may not hold forever. Though educational attainment continues to rise for women, their progress in the workplace — in terms of both wages and jobs — has slowed significantly. Tighter controls on the cost of health care could weaken the job growth and pay raises helping support the new American middle. And while the industry is largely immune to foreign competition, it may be affected by advances in labor-saving technology.
Even as more women get ahead, many men are struggling to grab a handhold into higher-paying jobs. After her husband was laid off from a string of auto mechanic jobs, Donna Colbey, 53, urged him to switch careers and become a radiology technician.
It was a job Ms. Colbey knew would offer a good salary and require only two years of training. She had taken the same route, which eventually led her to a nursing career at a Washington hospital.
He enrolled in the courses but dropped out after a few months.
“He got tripped up over the math and didn’t go back,” said Ms. Colbey, who regularly picks up extra shifts to support her family.
A Relentless Pursuit
Far more is expected of nurses now than even two decades ago. Medical advances have kept patients alive longer, meaning many are sicker with more complex illnesses than in the past. Nurses must master technology that helps both treat and track patients, and they are called on to coordinate not just with doctors but also social workers and physical therapists.
At St. Mary’s Medical Center, Ms. Waugh, in her navy scrubs, fed potassium on a recent day into the vein of one woman with a broken hip who was on the cancer floor because of a lack of beds. She gave anti-nausea medicine to a moaning young man with liver cancer in the midst of chemotherapy and prepared pills for a half-dozen other patients, documenting it all on a computer.
An outpatient arrived for his regular blood-drawing and, squatting alongside him in a waiting room, Ms. Waugh unbuttoned his shirt and collected blood from an access port in his chest.
Ms. Waugh’s pursuit of learning to advance her career has been relentless. By her own count, she has been out of school for no longer than two years since kindergarten.
All that education has come with a cost. The couple has amassed about $50,000 in student debt. Ms. Waugh would like to send her children to a better school, but the $10,000 annual tuition that would require is out of reach. “I can’t save for their college and send them to private school,” she said.
To her husband’s co-workers who are raising families on pipe fitters’ salaries, the Waugh family is rich. Ms. Waugh’s purchase of a new Toyota S.U.V. raised eyebrows around the plant.
“We’re not wealthy,” Mr. Waugh said, “but we’re not poor.”
It hasn’t been easy getting to this point. As she made the rounds at the hospital, Ms. Waugh explained how her family was set back in 2008 after Collin was born. She stayed home for one year with the boy, who had digestive problems and required expensive formula. Living on just Mr. Waugh’s salary, they ran through their savings and they accumulated credit card debt that they are still paying off.
“That was a horrible financial situation,” Ms. Waugh said.
But later this year, when her classes and other course work are finished, Ms. Waugh will qualify as a nurse practitioner, a job that she expects will allow her to earn at least 50 percent more than her current salary. And she will be prepared, she believes, for almost anything to come.
“I knew if I was a nurse I could be self-sufficient,” she said, “and wouldn’t have to rely on anyone to take care of me.”
It’s something each of the nation’s 3.1 million RNs understands intimately: Being a nurse is intense. The hospitals and clinics where they work are often stressful. And patient care and healthcare systems have never been more complex.
Nationally, nurse turnover stands at 20 percent, but nearly 40 percent of nurses are ready to leave their job after a single year. About 14 percent leave the field altogether, and the ‘working wounded’ that remain are at best demoralized and at worst error-prone. And dealing with RN turnover is among the biggest, costliest burdens in healthcare today.
It’s why University of Virginia School of Nursing’s Compassionate Care Initiative has sponsored a new Public Radio documentary series – Resilient Nurses, now available online – which will be heard on many public radio stations starting this month and also on Sunday Feb. 22 on the NPR Channel (#122) of SiriusXM satellite radio at 4pm ET / 1pm PT.
Hosted by award-winning documentary producer David Freudberg of Humankind, the program takes a no-holds-barred look at what ails American RNs: the stress, the exhaustion, and the pressured environments that often lead to their burnout.
But beyond sourcing RNs’ biggest challenges, Freudberg offers a promising glimpse into the growing number of nurses hoping to improve their lot by harnessing well-being through resilience. Freudberg also chronicles the growing movement of resilience at a handful of American clinics and hospitals where administrators realize the very real financial and personal stake they have in helping their nurses effectively handle stress.
And the stories are inspiring. Sharing the voices of these powerful, real nurses may be an important step in healing the profession’s broken hearts, strengthening American RNs’ care and practice through a practitioner-centered approach to well-being.
The Resilient Nurses audio podcast is now available online. Editors and bloggers may download and publish graphics and a brief program description from http://www.humanmedia.org/nurse/resources.php.
We hope the program will inspire nurses, nursing professors, nursing students and others in healthcare to begin their own resilient practices.
Christine Phelan Kueter, writer
Source: U.Va. School of Nursing
Have you ever wondered what happens during a heart transplant operation? The surgical team at Baylor University Medical Center (@BaylorHealth) in Dallas understands the curiosity. On Monday night, the hospital offered the public an intimate look at the process of one patient's heart transplant journey using the hashtag #HeartTXLive and also #heartTX.
While hospitals have tweeted about organ transplant surgeries before, this is believed to be the first one to be tweeted in real time. The hospital says they chose to tell the story from the patient's point of view, and also documented the surgery with photos and video.
Dr. Gonzo Gonzalez (@HRTTRNSPLNTMD), chief of cardiac surgery and heart transplant and mechanical circulatory support at Baylor University Medical Center assisted with the live tweets, while Dr. Juan MacHannaford performed the surgery.
To protect the patient's identity, the hospital used pseudonyms for the patient and her husband, referring to them as Jane and John in the tweets. Jane was born with cardiomyopathy, which causes an enlargement of the heart muscle and structural problems. In Jane's case, she was born with an abnormal left ventricle, and had a bacterial infection at 3 months old that caused her to go into cardiac arrest.
The live tweets paint a picture of the stress that comes with performing such a high-profile and high-risk surgery -- from waiting for the donor organ's arrival to the complex process of removing the patient's heart, implanting the new one and ensuring it's beating and circulating the patient's blood inside her body. Here are some highlights:
Scientists have discovered a highly aggressive new strain of HIV in Cuba that develops into full-blown AIDS three times faster than more common strains of the virus. This finding could have serious public health implications for efforts to contain and reduce incidences of the virus worldwide.
Researchers at the University of Leuven in Belgium say the HIV strain CRF19 can progress to full blown AIDS within two to three years of exposure to virus. Typically, HIV takes approximately 10 years to develop into AIDS. Patients with CRF19 may start getting sick before they even know they've been infected, which ultimately means there's a significantly shorter time span to stop the disease's progression.
The scientists began studying the cases in Cuba when reports began coming in that a growing number of HIV-infected patients were developing AIDS just three years after diagnosis with the virus. The findings of their study were published in the journal EBioMedicine.
Having unprotected sex with multiple partners can expose a person to numerous strains of the HIV virus. Research has found that when this occurs, the different strains can combine and form a new variant of the virus.
When HIV first enters the human body it latches on to anchor points of a certain protein, known as CCR5 on the cell membranes, which then allows it to enter human cells. Eventually the virus then latches onto another protein of the cell membrane, known as CXCR4. This marks the point when asymptomatic HIV becomes AIDS. In CRF19, the virus makes this move much sooner.
For the study, the researchers analyzed blood samples of 73 recently infected patients. Among the group, 52 already had full-blown AIDS, while the remaining 21 were HIV-positive but the virus had not yet progressed. The researchers compared their findings to blood samples of 22 AIDS patients who had more common strains of the virus.
The researchers found that patients with CRF19 had higher levels of the virus in their blood compared with those who had more common strains.
They also had higher levels of the immune response molecules known as RANTES, which bond to CCR5 proteins in early stages of the virus. The abnormally high level of RANTES in patients infected with the new strain indicates that the virus runs out of CCR5 anchor points much earlier and moves directly to CXCR4 anchor points.
Thanks to advances in medical treatment and the development of highly effective antiretroviral drugs, HIV/AIDS is no longer a death sentence. But the researchers caution that patients with the new strain of the virus are more likely to be diagnosed when they already have full-blown AIDS and when damage from the disease has taken a toll.
The researchers suspect that this aggressive form of HIV occurs when fragments of other subsets of the virus cling to each other through an enzyme that makes the virus more powerful and easily replicated in the body.
There are currently 35 million people worldwide living with HIV/AIDS, according to the most recent data from the World Health Organization. Scientists have identified more than 60 different strains of the HIV 1 virus, with each type typically found predominantly in a specific region of the world.
1. First of all, “Why didn’t you just become a doctor? You’re too smart to be a nurse” is a rude thing to say.
Wall Street Journal Live
Submitted by SadiaK.
2. And no, people can’t just apply for nursing licenses before being educated and rigorously trained.
20th Century Fox
Submitted by jennah4377addc7.
3. Because nursing is not about wiping butts all day.
Shironosov / Getty Images/iStockphoto
Submitted by MariliseB
4. And nurses are not just there for their ability to “nurture” and “mother” patients; they’re there to use science and critical thinking to save lives.
Submitted by hellokitty914 and edwyer94.
5. Which is why it’s annoying when people think you’re always just following a doctor’s orders.
Getty Images/iStockphoto Dana Bartekoske
Submitted by oneloveyogi.
6. But you’d never know that from TV and movies, which almost never portray nurses accurately.
NBC / Getty Images
Submitted by angry penguin.
7. The reality is that doctors rely heavily on the knowledge and observations of nurses to make decisions about patient care.
Submitted by lexia49c9c42e3.
8. And it is often the nurses who make life and death decisions.
Submitted by andreae41060b2b6.
9. Nurses are actually more like a doctor-social worker-respiratory therapist-pharmacist-phlebotomist-physiotherapist-receptionist-X-ray technician-transporter-housekeeper-caregiver hybrid.
Submitted by oneloveyogi.
10. Which is probably why they’re not actually wearing sexy nurse outfits over lingerie with stilettos on their feet.
Submitted by sandrafromparis.
11. That might also be because a huge number of nurses are men.
Submitted by preciouskittenn.
12. Who, by the way, are not all gay.
Submitted by richardd31.
So now that all that’s cleared up, there are a few more things that nurses don’t want or need to hear.
13. When nurses are “just taking blood pressure” they are simultaneously assessing a dozen things about a patient’s condition.
Submitted by shannooney.
14. It doesn’t help anyone to say that all nurses do is put on Band-Aids when they’re actually catching potentially fatal mistakes made by doctors who don’t know the patient as well.
Submitted by betty.swiecka.
15. And when people assume a home health care nurse is there to give sponge baths and clean the house, it makes it harder for them to provide care.
Submitted by kimberly.riggs.18.
16. Saying nurses are so lucky to work three days a week ignores how much recovery time and rest is needed after long shifts and demanding work.
Submitted by lydia.maria.94.
17. Patients with the “I write your check” mentality that feel justified using nurses as servants make it harder for nurses to do their jobs.
Submitted by kelly.hilker.
18. That job is not being a personal drug dealer who is totally OK with going to jail just so a patient can get some OxyContin.
Submitted by nic0lie0lie and cheries4218b4a82.
19. So if you come in and say you’re allergic to every drug except Dilaudid and that you needs lots and lotsof Dilaudid, the nurse is onto you, buddy.
Submitted by cheries4218b4a82.
20. And when a nurse clearly knows the answer to your question and you say, “Can you ask the doctor?” you’re undermining their expertise and their profession.
Submitted by lalroma.
21. But the great thing about nurses is that they don’t actually care all that much about all these misconceptions.
Submitted by jonathanr49e5c50fe.
22. Because the thing they care more about than anything is saving your life.
Submitted by jonathanr49e5c50fe.
23. But for those of us who are annoyed on their behalves, we are just going to leave this here.
Submitted by ashleym45a8b720b.
Nurses’ Health Study recruits “next generation”
Boston, MA - From the dangers of tobacco and trans fats to the benefits of physical activity and whole grains, much of what we know about health today is thanks to the .
Researchers are recruiting 100,000 and to join the long-running Nurses’ Health Study and expand its landmark research on health and well-being. And for the very first time, male nurses and students are being invited to join.
RNs, LPNs, and nursing students between the ages of 19 and 46 who live in the US or Canada are eligible to join the study. More than 38,000 have signed up already, and recruitment will stay open until the goal of 100,000 participants is reached.
Researchers hope to engage a highly diverse group of nurses in the “next generation” of the study. For the first time, nursing students are eligible to enroll.
In order to make participation as convenient as possible for busy nurses, participants can join online and complete the study’s surveys through a secure website, .
More than 250,000 nurses have participated in the study since the 1970s. By completing confidential lifestyle surveys, they have helped advance medical knowledge about nutrition, exercise, cancer, heart disease, and many other conditions.
“Nurses were originally recruited for their expertise in accurately reporting health data,” explains , the study’s lead researcher and Chair of the Nutrition Department at in Boston, Mass. “Their involvement has been invaluable, and their dedication is remarkable—an astounding 90% of them are still enrolled, decades later! The new group, NHS3, will allow us understand how today’s lifestyle and environment affect a person’s health in the future.”
Nurses enrolled in the earlier studies are encouraging their children and younger colleagues to join. “My mom started filling out surveys when the study began,” one nurse recently commented on the NHS3 Facebook page (). “I am so proud to be part of this study and see what it has done.”
NURSES’ HEALTH STUDIES
Started in 1976 and expanded in 1989, the Nurses’ Health Studies have led to many important insights on health and well-being, including cancer prevention, cardiovascular disease, and diabetes. Most importantly, these studies showed that diet, physical activity, and other lifestyle factors can powerfully promote better health.
Contact: Michael Keating
SOURCE Nurses Health Study 3 www.nhs3.org
ATHENS — Fotini Katsigianni wears a white nurse’s hat that protrudes prominently from the top of her head. She is head nurse at Evangelismos Hospital, one of the city’s most prominent.
So she was surprised last month when she was approached by a man in the hospital’s hallway. At the time, Ms. Katsigianni’s husband was a patient there. The strange man extended an arm with a business card and averted his face, so she could not identify him. He offered to rent her a cut-rate nurse.
“He told me for 30 euros I could have whatever I want!” Ms. Katsigianni said, laughing at the idea of the head nurse being solicited to buy illegal nursing care.
First the men come to the hospitals of Greece during visiting hours, leaving business cards with pictures of nurses under pillows and in waiting rooms. Then the women come at night, mostly foreigners from countries like Georgia, Romania and Bulgaria. They are the nurses of Greece who aren’t really nurses.
Greece’s dire finances have gutted its health care system. Universal coverage effectively ended under the austerity measures imposed under the terms of the country’s bailout. Budget cuts have also thinned the ranks of hospital staff nurses, who are supposed to handle medical tasks like changing IVs.
Now, when patients come to a hospital in Greece, they increasingly have to hire their own nurses just to receive basic care. While private nurses have long been a feature of Greek health care, the country’s wrenching economic crisis has left many patients with neither the money nor the insurance coverage to hire licensed caregivers.
Instead, patients are turning to illegal nurses, often immigrants with little or no training. One top official said he believed that half of the nursing care came from 18,000 illegal providers.
The situation reflects the grip of the black-market economy on Greece, where even paying skilled workers like mechanics and plumbers under the table to avoid taxes is commonplace. Frustrations among Greeks over the deterioration of living standards helped feed the left-wing Syriza Party, which came to power last month vowing to reject austerity policies.
Illegal nurses typically pose as family members or say they are longtime personal employees of a patient. In reality, temp agencies employing these women send men into the hospitals to distribute business cards advertising 12 hours of nursing care for less than $60. By contrast, a contract nurse at another hospital, Sotiria, costs nearly $70 for 6 hours and 40 minutes, though those who still have insurance can be reimbursed for about a third of the cost.
Thanos Maroukis, a professor at the University of Bath, England, who has studied the problem, said temporary agencies are taking “over control of the hospital’s workplace,” adding, “It’s incredible what’s happening, but it’s true.”
Nurses are just the beginning. Almost anything can be rented.
“We have the same thing with TVs, with ambulances, I would say with bedding,” said Anastasios Grigoropoulos, the chief executive of Evangelismos Hospital. “Or chairs.”
Chairs are carried in by strangers who rent them to groups of visiting relatives. Or they bring televisions.
In many other developed countries, hospital security would simply expel unauthorized visitors. But administrators face staff shortages and impoverished patients. They also say they lack the legal jurisdiction to act without police intervention.
“Because of the crisis, the last three years, we see more and more illegal nurses,” said Mr. Grigoropoulos. “You can’t do anything.”
He has called the police, and a few days earlier, Evangelismos was raided. Several illegal nurses were arrested, but that is a fairly rare event, because the police have had their own cutbacks.
Government agencies, too, have been overwhelmed. An influx of immigrants since the 1990s swelled a pool of cheap labor.
These immigrants “filled the space and found themselves in every clinic and every hospital,” said Dimitrios Papachristou, a senior official at the Social Insurance Institute, a state agency known by its Greek acronym, IKA, which provides insurance and pensions to 2.2 million Greek workers, including nurses. “Why is that? There was a great demand by the patients” for cheaper care, Mr. Papachristou said.
Part of the problem, he said, was that his agency had been given the task of conducting inspections of nursing credentials, a task beyond its typical expertise.
“Let me give you an example,” he said. “I’ll send an inspector to a hospital to inspect contract nurses who work there. So I find at that hospital 15 people who are working there do not have an IKA permit.”
But often he does not have the authority even to issue fines. Instead, his agency reports such incidents to hospital directors, and they decide whether to call the police.
“It’s an extremely illogical thing,” he said.
Because most illegal nurses are immigrants, Golden Dawn, the far-right extremist party, has attempted some of its own “raids” on hospitals, advancing its xenophobic agenda.
But some of the real nurses having trouble getting work are themselves immigrants, like Eleni Souli, a 41-year-old Albanian who married a Greek man and works as a contract nurse. She was sitting among a group of eight other nurses at a cafe outside another Athens hospital recently. All had studied for two to four years to become nurses, and they poured out their frustration over coffee and cigarettes.
“They are not nurses," Ms. Souli said of the illegal workers.
Maria Skiada, 54, has been a nurse for 23 years. She said she recently saw a woman who did not even use gloves when she cleaned up.
“That is how you get bugs all around the hospital,” she said.
Ms. Souli said doctors would sometimes be surprised at how infections spread.
“When they see that in the blood work of a patient, they’ll see something and say, ‘Where did he get that from?’ ”
She counted eight illegal nurses at the clinic where she worked the previous evening. “At night,” she said, “it’s full of them.”
That was clear in another part of town, at Sotiria Hospital, on a recent chilly night.
A young Georgian woman in a striped blue shirt was caring for a patient. She said she had already been working at the patient’s home and came with him to the hospital, a claim administrators say is frequently used. A second woman peeked out of the room next door, then waved away questions, saying she could not speak Greek.
“They take food out of our mouths. That’s how it is,” said Stavroula Antoniou, 46, a licensed nurse who works on temporary contracts at Sotiria. She emphasized that her bitterness was not tinged with racism and that many legitimate nurses were foreign-born.
“We’ve earned this,” she said of her job. “We’ve studied and we’ve sat in classrooms.”
Dr. Miltiadis Papastamatiou, Sotiria’s chief executive, said retired nurses were often not replaced, “and that’s led to the needs of both patients and staff not being adequately met,” though he downplayed the extent of the problem at Sotiria.
But a staff nurse there, who would not give her name for fear of losing her job, acknowledged the severity of the issue.
“We know what’s going on,” she shrugged. “Everybody knows.”
Written by James McIntosh
While many would rather not think about when someone might die, knowing how much longer a seriously ill person has left to live can be very useful for managing how they spend their final days. Researchers have now revealed eight signs in patients with advanced cancer associated with death within 3 days.
Diagnosis of an impending death can help clinicians, patients and their friends and family to make important decisions. Doctors can spare time and resources by stopping daily bloodwork and medication that will not make a short-term difference. Families will know if they still have time to visit their relatives.
"This study shows that simple bedside observations can potentially help us to recognize if a patient has entered the final days of life," says study author Dr. David Hui.
"Upon further confirmation of the usefulness of these 'tell-tale' signs, we will be able to help doctors, nurses, and families to better recognize the dying process, and in turn, to provide better care for the patients in the final days of life."
The study, published in Cancer, follows on from the Investigating the Process of Dying Study - a longitudinal observational study that documented the clinical signs of patients admitted to an acute palliative care unit (APCU). During the study, the researchers identified five signs that were highly predictive of an impending death within 3 days.
For the new study, the researchers again observed the physical changes in cancer patients admitted to two APCUs - at the MD Anderson Cancer Center in Houston, TX, and the Barretos Cancer Hospital in Brazil.
Eight highly-specific physical signs were identified
A total of 357 cancer patients participated in the study. The researchers observed them and documented 52 physical signs every 12 hours following their admission to the APCUs. The patients were observed until they died or were discharged from the hospitals, with 57% dying during the study.
The researchers found eight highly-specific physical signs identifiable at the bedside that strongly suggested that a patient would die within the following 3 days if they were present. The signs identified were:
- Decreased response to verbal stimuli
- Decreased response to visual stimuli
- Drooping of "smile lines"
- Grunting of vocal cords
- Hyperextension of neck
- Inability to close eyelids
- Non-reactive pupils
- Upper gastrointestinal bleeding.
With the exception of upper gastrointestinal bleeding, all of these signs are related to deterioration in neurocognitive and neuromuscular function.
Neurological decline strongly associated with death
"The high specificity suggests that few patients who did not die within 3 days were observed to have these signs," the authors write. "These signs were commonly observed in the last 3 days of life with a frequency in patients between 38% and 78%. Our findings highlight that the progressive decline in neurological function is associated with the dying process."
As the study is limited by only examining cancer patients admitted to APCUs, it is not known whether these findings will apply to patients with different types of illness. The findings are currently being evaluated in other clinical settings such as inpatient hospices.
On account of the relatively small number of patients observed for this study, the authors also suggest that their findings should be regarded as preliminary until validated by further research.
In the meantime, the authors of the study are working to develop a diagnostic tool to assist clinical decision-making and educational materials for both health care professionals and patients' families.
"Upon further validation, the presence of these telltale signs would suggest that patients [...] are actively dying," they conclude. "Taken together with the five physical signs identified earlier, these objective bedside signs may assist clinicians, family members, and researchers in recognizing when the patient has entered the final days of life."