DiversityNursing Blog

BY ISSIE LAPOWSKY

When you’re deaf, finding a job isn’t easy.

The trickiest part, explains Ryan Hait Campbell, is the interview. “You’re not required to tell an employer you’re deaf until the interview, but sometimes, they’re a little shocked,” says Campbell, who has been deaf since birth. “They don’t know how to handle it.”

Because of things like this, he says, unemployment rates are staggeringly high among the deaf. Hard numbers are tough to come by, but some figures estimate that around half of people with hearing disabilities are unemployed.

But Campbell wants to change this. He’s the co-founder and CEO of MotionSavvy, an Alameda, California-based startup that’s developing a case for tablet computers that can serve as a virtual interpreter for the deaf. Known as UNI, the case uses gesture recognition technology developed by Leap Motion to translate sign language into audible speech. It then merges this with voice recognition technology to convert spoken word to text. Because there are a variety of signs for any given word, users can upload new signs using a feature called Sign Builder. The system learns how individual users sign, while also distributing each new sign to every UNI device.

On Tuesday, MotionSavvy launched an IndieGoGo campaign for UNI to raise money and recruit beta testers to help build its dictionary of signs. For $499, a discounted rate, 200 selected backers will get a tablet and UNI case to try at home. “This could really give deaf people the power to live the lifestyle they want to live,” Campbell says, “and we think that is very powerful.”

Such technology would have seemed a distant dream not long ago. But the past decade has brought a wave of investment and interest in both gesture recognition technology and voice recognition technology, driven by companies like Apple and Microsoft, as well as smaller players like Nuance and Leap Motion. That hasn’t gone unnoticed by those who want to improve the lives of the deaf community. MotionSavvy is one of several players trying to capitalize on the convergence of these trends.

Just last week, Transcense, launched an IndieGoGo campaign for an app that provides real-time voice recognition so deaf people can follow a conversation. But unlike UNI, it doesn’t give deaf people who haven’t mastered speech a clear way to talk back. For MotionSavvy, that is the final—and most important—puzzle piece.

“It’s kind of like solving a quadratic equation at this point. It’s figuring out the right variables and stacking things together in such a way that they’ll all perform efficiently,” says Stephen Jacobs, associate director of Rochester Institute of Technology’s Center for Media Arts, Games Interaction, and Creativity.

Jacobs introduced Campbell to MotionSavvy CTO Alexandr Opalka when both were studying at RIT. Opalka, who also is deaf, had been working on similar technology as a student in RIT’s National Technical Institute for the Deaf. They teamed up with four other deaf students, and in 2012, launched MotionSavvy.

The technology is in its earliest stages. UNI recognizes only 300 signs, and its voice recognition component remains unreliable, though Opalka says UNI will come equipped with new and improved voice recognition for beta testers. And yet, during a demo of UNI at WIRED’s New York City office, it wasn’t hard to see just how transformative a technology like this could be. Campbell used it to sign a few common phrases to Opalka, such as “What’s your name?” and “Where are you from?” Yes, it was wonky, but still it struck me as sort of magical.

Campbell says that reaction’s not entirely unique. “I brought this to a table of older deaf people, and they all freaked out,” he says.

But it’s not just the deaf and hard of hearing who are excited about UNI. Campbell says the FCC has gotten in touch. For many low-income deaf people, translators, video relay services, and other communication tools are prohibitively expensive. So the National Deaf-Blind Equipment Distribution Program picks up the tab. When the commercial version of UNI launches in 2015, it’ll cost $799, plus a $20 monthly subscription for Sign Builder. It’s not cheap, but it’s better than the alternative.

Campbell acknowledges the product is a “moonshot,” and admits it may never replace human interpreters. In fact, he and Opalka hope that it does the opposite. If UNI can achieve its intended purpose—facilitating one-on-one communication— then it could become easier for deaf people to get decent jobs. And who typically pays for interpreters? Employers. “If you can’t communicate during an interview, you’re not getting the job,” Opalka says. “With UNI, we predict more people who are deaf will be able to get jobs and stay working, and that’s how we’ll get more people to hire interpreters. There will be more people in the workforce.”

Source: www.wired.com

The UCLA Health Interpreter/Translation and Deaf Services program provides services to all UCLA Health inpatients, outpatients, and their relatives at no cost. Every attempt is made to provide services in any language. The service will be provided by an in-person interpreter, video conference or by telephone.

Source: Youtube

By MIKE STOBBE

For more than two months, health officials have been struggling to understand the size of a national wave of severe respiratory illnesses caused by an unusual virus. This week, they expect the wave to start looking a whole lot bigger.

But that's because a new test will be speeding through a backlog of cases. Starting Tuesday, the Centers for Disease Control and Prevention is using a new test to help the agency process four or five times more specimens per day that it has been.

The test is a yes/no check for enterovirus 68, which since August has been fingered as the cause of hundreds of asthma-like respiratory illnesses in children — some so severe the patients needed a breathing machine. The virus is being investigated as a cause of at least 6 deaths.

It will largely replace a test which can distinguish a number of viruses, but has a much longer turnaround.

The result? Instead of national case counts growing by around 30 a day, they're expected to jump to 90 or more.

But for at least a week or two, the anticipated flood of new numbers will reflect what was seen in the backlog of about 1,000 specimens from September. The numbers will not show what's been happening more recently, noted Mark Pallansch, director of the CDC's division of viral diseases.

Enterovirus 68 is one of a pack of viruses that spread around the country every year around the start of school, generally causing cold-like illnesses. Those viruses tend to wane after September, and some experts think that's what's been happening.

One of the places hardest hit by the enterovirus 68 wave was Children's Mercy Hospital in Kansas City, Missouri. The specialized pediatric hospital was flooded with cases of wheezing, very sick children in August, hitting a peak of nearly 300 in the last week of the month.

But that kind of patient traffic has steadily declined since mid-September, said Dr. Jason Newland, a pediatric infectious diseases physician there.

"Now it's settled down" to near-normal levels, Newland said. Given the seasonality of the virus, "it makes sense it would kind of be going away," he added.

The germ was first identified in the U.S. in 1962, and small numbers of cases have been regularly reported since 1987. Because it's not routinely tested for, it may have spread widely in previous years without being identified in people who just seemed to have a cold, health officials have said.

But some viruses seem to surge in multi-year cycles, and it's possible that enterovirus surged this year for the first time in quite a while. If that's true, it may have had an unusually harsh impact because there were a large number of children who had never been infected with it before and never acquired immunity, Newland said.

Whatever the reason, the virus gained national attention in August when hospitals in Kansas City and Chicago saw severe breathing illnesses in kids in numbers they never see at that time of year.

Health officials began finding enterovirus 68. The CDC, in Atlanta, has been receiving specimens from severely ill children all over the country and doing about 80 percent of the testing for the virus. The test has been used for disease surveillance, but not treatment. Doctors give over-the-counter medicines for milder cases, and provide oxygen or other supportive care for more severe ones.

The CDC has been diagnosing enterovirus 68 in roughly half of the specimens sent in, Pallansch said. Others have been diagnosed with an assortment of other respiratory germs.

As of Friday, lab tests by the CDC have confirmed illness caused by the germ in 691 people in 46 states and the District of Columbia. The CDC is expected to post new numbers Tuesday and Wednesday.

Aside from the CDC, labs in California, Indiana, Minnesota and New York also have been doing enterovirus testing and contributing to the national count. It hasn't been determined if or when the states will begin using the new test, which was developed by a CDC team led by Allan Nix.

Meanwhile, the virus also is being eyed as possible factor in muscle weakness and paralysis in at least 27 children and adults in a dozen states. That includes at least 10 in the Denver area, and a cluster of three seen at Children's Mercy, Newland said.

Source: http://news.yahoo.com

By Debra Wood

One out of every six newly licensed nurses (more than 17 percent) leave their first nursing job within the first year and one out of every three (33.5 percent) leave within two years. But not all nurse turnover is bad, according to a new study from the RN Work Project, funded by the Robert Wood Johnson Foundation.

“It seemed high,” said Carol S. Brewer, PhD, RN, FAAN, professor at the University at Buffalo School of Nursing and co-director of the RN Work Project, the only longitudinal study of registered nurses conducted in the United States. “Most of them take a new job in a hospital. We’ve emphasized who left their first job, but it doesn’t mean they have left hospital work necessarily.”

While many nursing leaders have voiced concern that high turnover among new nurses may result in a loss of those nurses to the profession, that’s not what the RN Work Project team has found. Most of those leaving move on to another job in health care.

“Not only are they staying in health care, they are staying in health care as nurses,” said Christine T. Kovner, PhD, RN, FAAN, professor at the New York University College of Nursing and co-director of the RN Work Project. “Very few leave. A tiny percent become a case manager or work for an insurance company, verifying people had the right treatment.”

Such outside jobs tend to offer better hours, with no nights or weekends. The nurses are still using their knowledge and skills but they are not providing hands-on care.

The RN Work Project looks at nurse turnover from the first job, and the majority of first jobs are in the hospital setting, Brewer explained. However, in the sample, nurses working in other settings had higher turnover rates than those working in acute care.

Kovner hypothesized that since new nurses are having a harder time finding first jobs in hospitals, they may begin their careers in a nursing home and leave when a hospital position opens up. On the other hand, those who succeed in landing a hospital job may feel the need to stay at least a year, because that’s what many nursing professors recommend. Hospitals also tend to offer better benefits, such as tuition reimbursement and child care, and hold an attraction for new nurses.

“Our students, if they could get a job in an ICU, they’d be happy, and the other place they want to work is the emergency room,” Kovner said. “They want to save lives, every day.”

The RN Work Project data excludes nurses who have left their first position at a hospital for another in the same facility, which is disruptive to the unit but may be a positive for the organization overall, since the nurse knows the culture and policies. The nurse may change to come off the night shift or to obtain a position in a specialty unit, such as pediatrics.

“That’s an example of the type of turnover an organization likes,” Kovner said. “You have an experienced nurse going to the ICU [or another unit].”

While nurse turnover represents a high cost for health care employers, as much as $6.4 million for a large acute care hospital, some departures of RNs is good for the workplace. Brewer, Kovner and colleagues describe the difference between dysfunctional and functional turnover in the paper, published in the journal Policy, Politics & Nursing Practice.

“Dysfunctional is when the good people leave,” Brewer said.

The RN Work Project has not differentiated between voluntary and involuntary departures, the latter of which may be due to poor performance or downsizing. And some nurse turnover is beneficial.

“If you never had turnover, the organization would become stagnant,” Kovner added. “It’s useful to have some people leave, particularly the people you want to leave. It offers the opportunity to have new blood come in.”

New nursing graduates might bring with them the latest knowledge, and more seasoned nurses may bring ideas proven successful at other organizations.

Once again, Brewer and Kovner report managers or direct supervisors play a big role in nurses leaving their jobs. Organizations hoping to reduce turnover could consider more management training for people in those roles.

“Leadership seems a big issue,” Brewer said. “The supervisor support piece has been consistent.”

Both nurse researchers cited the challenge of measuring nurse turnover accurately. Organizations and researchers often describe it differently, Brewer said. And hospitals often do not want to release information about their turnover rates, since nurses would most likely apply to those with lower rates, Kovner added. When assessing nurse turnover data, she advises looking at the response rate and the methodology used.

“There are huge inconsistencies in reports about turnover,” Kovner said. “It’s extremely important managers and policy makers understand where the data came from.”

Source: www.nursezone.com

By Brittany Maynard

Editor's note: Brittany Maynard is a volunteer advocate for the nation's leading end-of-life choice organization, Compassion and Choices. She lives in Portland, Oregon, with her husband, Dan Diaz, and mother, Debbie Ziegler. Watch Brittany and her family tell her story at www.thebrittanyfund.org. The opinions expressed in this commentary are solely those of the author.

(CNN) -- On New Year's Day, after months of suffering from debilitating headaches, I learned that I had brain cancer.

I was 29 years old. I'd been married for just over a year. My husband and I were trying for a family.

Our lives devolved into hospital stays, doctor consultations and medical research. Nine days after my initial diagnoses, I had a partial craniotomy and a partial resection of my temporal lobe. Both surgeries were an effort to stop the growth of my tumor.

In April, I learned that not only had my tumor come back, but it was more aggressive. Doctors gave me a prognosis of six months to live.

Because my tumor is so large, doctors prescribed full brain radiation. I read about the side effects: The hair on my scalp would have been singed off. My scalp would be left covered with first-degree burns. My quality of life, as I knew it, would be gone.

After months of research, my family and I reached a heartbreaking conclusion: There is no treatment that would save my life, and the recommended treatments would have destroyed the time I had left.

I considered passing away in hospice care at my San Francisco Bay-area home. But even with palliative medication, I could develop potentially morphine-resistant pain and suffer personality changes and verbal, cognitive and motor loss of virtually any kind.

Because the rest of my body is young and healthy, I am likely to physically hang on for a long time even though cancer is eating my mind. I probably would have suffered in hospice care for weeks or even months. And my family would have had to watch that.

I did not want this nightmare scenario for my family, so I started researching death with dignity. It is an end-of-life option for mentally competent, terminally ill patients with a prognosis of six months or less to live. It would enable me to use the medical practice of aid in dying: I could request and receive a prescription from a physician for medication that I could self-ingest to end my dying process if it becomes unbearable.

I quickly decided that death with dignity was the best option for me and my family.

We had to uproot from California to Oregon, because Oregon is one of only five states where death with dignity is authorized.

I met the criteria for death with dignity in Oregon, but establishing residency in the state to make use of the law required a monumental number of changes. I had to find new physicians, establish residency in Portland, search for a new home, obtain a new driver's license, change my voter registration and enlist people to take care of our animals, and my husband, Dan, had to take a leave of absence from his job. The vast majority of families do not have the flexibility, resources and time to make all these changes.

I've had the medication for weeks. I am not suicidal. If I were, I would have consumed that medication long ago. I do not want to die. But I am dying. And I want to die on my own terms.

I would not tell anyone else that he or she should choose death with dignity. My question is: Who has the right to tell me that I don't deserve this choice? That I deserve to suffer for weeks or months in tremendous amounts of physical and emotional pain? Why should anyone have the right to make that choice for me?

Now that I've had the prescription filled and it's in my possession, I have experienced a tremendous sense of relief. And if I decide to change my mind about taking the medication, I will not take it.

Having this choice at the end of my life has become incredibly important. It has given me a sense of peace during a tumultuous time that otherwise would be dominated by fear, uncertainty and pain.

Now, I'm able to move forward in my remaining days or weeks I have on this beautiful Earth, to seek joy and love and to spend time traveling to outdoor wonders of nature with those I love. And I know that I have a safety net.

I hope for the sake of my fellow American citizens that I'll never meet that this option is available to you. If you ever find yourself walking a mile in my shoes, I hope that you would at least be given the same choice and that no one tries to take it from you.

When my suffering becomes too great, I can say to all those I love, "I love you; come be by my side, and come say goodbye as I pass into whatever's next." I will die upstairs in my bedroom with my husband, mother, stepfather and best friend by my side and pass peacefully. I can't imagine trying to rob anyone else of that choice.

What are your thoughts about "death with dignity"?

Source: CNN

By Ian Lee

 Far from the sea, a man-made coral reef is taking shape -- and it could change medical operations forever.

Step inside the OkCoral lab in Israel's Negev Desert and you'll find row after row of quietly bubbling fish tanks, each containing a precious substance.

It is hoped the coral grown in this surreal "farm," could one day be used in bone operations -- encompassing everything from dental implants to spinal procedures.

Unlike animal and human bones, coral can't be rejected by the body, say medical experts at the company CoreBone, which manufactures bone replacements from coral.

Grown in the lab, this coral is also free from the diseases you might find in the oceanic variety.

Start-up science

Assaf Shaham founded the unusual laboratory six years ago at a cost of $2.5 million, with an ambitious vision of tapping into the billion dollar worldwide bone grafting industry.

But first he'll need the approval of authorities in the European Union and U.S., with a decision expected next year.

The father-of-two's dedication to the business is astounding -- if not a little disconcerting.

"In six years of growing corals, I haven't left these four walls for more than 12 hours -- not even once," he said.

"For me, it's 100% learning as I go. I take the mother colony, and I cut off a branch of the coral with a diamond saw. Then I glue it to another base made out of cement."

The delicate ecosystem needs constant care to ensure the water's salinity, temperature, and chemical make-up is perfect -- any variations and the coral could die.

The fish swimming around each tank are essentially the "worker bees" of the artificial reef. They eat the algae growing on the coral, their feces helps feed the coral, and finally, their movements in the water keep the coral strong.

And much like the traditional canary in the coalmine, if the fish die, you know something's not quite right in the water.

Clever company?

Happily for Shaham, his ambitious experiment appears to be thriving, with coral in the lab growing at ten times the normal rate.

Just a small container of the coral costs roughly $5 to $10 to produce, and sells for around $250.

One of the biggest benefits of the business is its environmental sustainability.

"We have a constant supply," says Ohad Schwartz of company CoreBone.

"We don't have to worry that in several years, harvesting from the sea could be forbidden."

It's a concern they'll never have to think about, when harvesting these remarkable fruits of the desert.

Source: http://www.cnn.com

By Jeroen Tas

Imagine a time when a device alerts you to the onset of a disease in your body long before it’s a problem. Or when your disease is diagnosed in Shanghai, based on the medical scan you did in Kenya. This future is far closer that you might think due to rapid advances in connected devices and sensors, big data and the integration of health services. Combined, these innovations are introducing a new era in healthcare and personal well-being.

In only a few years, mobile technologies have spawned tremendous innovation of consumer-level health tools. The emerging solutions are focusing on health conditions over a person’s lifetime and on holistic care. They generate constant insights through analytics and algorithms that identify patterns and behaviours. Social technologies enable better collaboration and interconnected digital propositions that reach out to communities of people with similar conditions, engaging them in ways which were never before possible.

We are starting to get a taste of what the consumerization of healthcare will mean in the future. In two to three years, analysing your personal health data will become commonplace for large parts of the population in many countries. Also, it is very likely that for the first time it will not be the chronically ill but the healthy people who will invest the most in managing their health.

Digitization and consumerization will rattle the healthcare industry. It is already tearing at the very fabric of the traditional healthcare companies and providers. Innovation is not only about just adding a new channel or connecting a product. It is also a complete redesign of business models, adjustment of systems and processes and, most importantly, it calls for changing the culture in companies to reflect the new opportunities – and challenges – presented by the digital world.

To drive true industry transformation, companies need to collaborate and continue to learn from each other. Great strides will be made in alliances, which, for example, will deliver open, cloud-based healthcare platforms that combine customer engagement with leading medical technology, and clinical applications and informatics.

The game will not only be played by the traditional healthcare providers. With consumerization, even companies without healthcare expertise, but with strong consumer engagement and trust, could potentially become healthcare companies. Big multinationals invest incremental budgets in developing new propositions and count on their global user bases or professional networks to gain a foothold in the market.

And in parallel, a raft of start-ups are attempting to transform the worlds of preventive or curative healthcare – in many cases, limited only by their imaginations. For example, we may see virtual reality technology moving from gaming industry to healthcare for improving patients’ rehabilitation after a stroke. Or we may see facial recognition software become common in monitoring and guiding patients’ daily medical routines.

While these new propositions tackle a number of healthcare industry’s core concerns and provide solutions to completely new areas, these propositions still need to mature. They need to become scalable, reliable, open, and the user experience needs to be harmonized.

But perhaps one of the most important challenges is related to people’s behaviour and preferences. Regardless of whether these new and existing companies are analysing health data, using virtual reality or reading people’s vital signs, they all need ample time to become trusted and accepted in the emerging digital health care space. Especially for the new entrants, obtaining the right level of credibility will be one of the key success factors.

Consumers, patients and professionals alike, will need the right motivation, reassurance and mindsets to adopt these new solutions. The companies that know how to offer us tailored, cutting-edge solutions, combined with meaningful advice and trustworthiness, will be the winners and become our trusted advisers in health.

Source: World Economic Forum

By ERIC WHITNEY

When a fire department gets a call for medical help, most of them scramble both an ambulance and a fully staffed fire truck. But that's way more than most people need, according to Rick Lewis, chief of emergency medical services at South Metro Fire Rescue Authority in the Denver suburbs.

"It's not the prairie and the Old West anymore, where you have to be missing a limb to go to the hospital," Lewis says, "Now it's a sore throat or one day of cold or flu season sometimes, and that can be frustrating for people, I know it is."

South Metro receives more than 12,000 emergency medical calls a year, and takes about 7,000 patients to area hospitals. Somebody who's been running a fever for a couple of days may need help — just not necessarily a ride to the ER. That disconnect can be frustrating for both ambulance crews and patients.

Crews aren't required to transport everyone who calls, but Lewis says they fear lawsuits if they were to leave and a patient got worse. Also, ambulance companies typically don't get paid unless they take somebody to the hospital. So Lewis teamed up with Mark Prather, an emergency room doctor, to try and come up with a better way.

"We created a mobile care unit that can go to a given patient, if we think they're safe to treat on scene, and provide definitive on-scene treatment," says Prather.

The mobile care unit is, basically, a station wagon. Advance practice paramedic Eric Bleeker shows off some of the gear. "This one is a suture set, so it has everything for wound closure, from staples to regular sutures," he says.

Ambulances don't have that kind of equipment, so even someone who just needs a few stitches gets a ride to the emergency department.

Several cities across the country are using paramedics as physician extenders, sending ambulance crews to do routine things like hospital follow-up visits in places where basic health care is hard to get. South Metro's model focuses on responding to calls. The team always includes at least one nurse practitioner, who can prescribe basic medicines that they stock in the mobile unit.

"A lot of what we do is sort of that mid-level between the acute care you receive in an emergency department and what the paramedics can currently do," says Bleeker.

It's kind of like an urgent care clinic on wheels.

There's also a miniature medical lab. "We can run full blood chemistry, we can do complete blood counts, we can check for strep throat, we can check for influenza," he says. Those are capabilities that even many doctors' offices don't have on site.

South Metro Fire also relies heavily on Colorado's new electronic medical records network. The nurse or EMT can call up patient records on the scene to provide care that's more like an office visit, and dispatchers can check recent medical histories to make sure they send ambulances to people who might really need one.

That person who called 911 because they were running a fever could end up being diagnosed and treated in their living room by South Metro's station wagon for about $500, instead of spending a lot more for similar care at an emergency room.

Insurance companies don't yet pay for this, though, says Prather.

"That's maybe why nobody has done it yet," he says, laughing.

For the last nine months South Metro has been running the service basically for free, to prove that it saves money. But Prather thinks that's about to change because of Obamacare. The law aims to get insurance companies, Medicare and Medicaid to stop paying for too much medical care. And it can penalize health care providers who contribute to overuse of emergency rooms.

"It allowed us to think about payment differently, and basically switch from a volume situation to a quality situation," he says.

But it's not like the law just flips a switch and starts paying for appropriate care instead of rewarding providers who see a high number of patients and do lots of procedures. The change to reward efficient, appropriate health care is just starting to happen. Slowly. But Prather is now in talks with insurers and hopes to be getting paid soon.

Source: http://www.npr.org

By Susan Donaldson James

Raymond and Mazie Huggins, a devoted West Virginia couple with the same failing heart condition, didn’t think they would make it to their upcoming 74th wedding anniversary on Oct. 10.

But in August, Raymond or “Huggie Bear,” 96, and Mazie Leota, 93, received newly FDA-approved heart valves in a life-saving procedure on the same day.

“We went to the supper table one night and Raymond said, ‘If you have it done, then I will have it done and that’s how we will do it — together,'” Mazie said. “We went in together, had it done together and came home together.”

The couple went to the Cleveland Clinic for transcatheter aortic valve replacement or TAVR, a procedure designed for those who typically can’t withstand the risk of open-heart surgery. A catheter is wound through an artery in the groin and into the heart muscle.

This non-invasive surgery has been used on patients for some time, but the smaller valve required for the Huggins’ surgery was just approved in June after successful clinical trials.

“I’m very glad we had it and I am feeling fine,” said Mazie, a great-grandmother and former dental secretary. “I can’t get over there not being any pain afterwards.”

Now, the couple, both “with it” intellectually and otherwise healthy, can celebrate their long marriage at home in Moundsville, where they continue to live independently. They have every reason to expect to live an even longer life: Mazie’s maternal grandmother lived to be 108. 

“My father’s goal was to live long enough to get on the Smuckers jar,” said their son, Roger Huggins, 67. “Last year, even with his heart problems, he made apple butter and applesauce out of the tree in the backyard.”

Roger said his father, a former glass factory shipper and retired prison guard, is “very strong and a tremendously hard worker.” He calls his mother an “angelic” woman who worries about others and is beloved by all who know her.

“My mother protects my father to the fullest,” said Roger. “He might make her madder than the dickens, but she protects him to the fullest.”

Two years ago, his parents had stents put in their hearts on the same day.

“I was in pre-op with them,” said Roger, a retired food company sales rep. “Their tables passed in the hallways and they were awake enough to make [the medical staff] stop their beds. They held hands and kissed each other and had the whole hospital crying.”

Roger, who drives three hours each way from his home in Erie, Pennsylvania, to check in on his parents and organize their medications, persuaded them to have the TAVR procedure after doing his own research.

Raymond insisted his wife go first, then his surgery followed.

“They both were prepared to pass away on the table,” said their son. “But it very well could have been much worse if my mother had woken up and my dad had died beside her. Or harder if my father had woken up.”

“The first thing my father said when he came out of the anesthesia was, ‘Am I alive?’” said Roger. “The second thing he said was, ‘Is my wife alive?’ The third thing he said is, ‘I’ve got to go out and fix the yard.’ He’s a workaholic.”

The Hugginses may not be the oldest patients ever to undergo TAVR surgery (some patients have been 98 and 100), but they were the first couple, according to their surgeon, interventional cardiologist Dr. Samir Kapadia.

“The data suggest that 50 to 60 percent would not make it until the end of the year with their condition,” he said. “They were declining fairly fast. … When they came to us they were very short of breath and had medical problems that were unbelievably complex.”

The aortic valve is the “door” to the heart, according to Kapadia. A normal opening is about 2.5 cm. But theirs were closed down to .3 and .4 — “about 10 times less.”

“Five or 10 years ago, nothing could have been done for them,” he said. “We would have had to stop the heart and open up the chest, and at that age the recovery would be up to two months, with significant risk,” he said.

Mazie was prepped for surgery first at 5:30 a.m. and Raymond followed at 9:30 a.m.

“The kissed each other and were in recovery opposite each other and wanted to be together holding hands in the same room,” said Kapadia.

By the evening after surgery, they were out of bed, and the next day, they were walking. Mazie’s release was delayed because of fluid in her lungs, so Raymond insisted on staying at the hospital with her for several more days.

The couple is now back at home with a part-time caregiver, looking forward to their anniversary next month.

Mazie attributes their 74-year happy marriage to good communication.

“There have been a few ups and downs,” she said. “If you don’t agree, get it out and say it and get it over with.”

Kapadia said the family’s closeness was an important factor in the surgery’s success.

“They are wonderful people,” he said. “Their son fought for them to be treated together as the only best option. Who would take care of the other one? It would have been a disaster for their family life.”

“But more than anything else, they wanted to live and celebrate and enjoy the last part of their life together.”

Source: http://www.today.com

By Marijke Durning

THE BASICS

Higher education is a key requirement for nurses as the U.S. healthcare environment grows ever-more reliant on technology and specialized skills. There are three common academic pathways toward becoming a registered nurse (RN): the nursing diploma, associate degree (ADN) and bachelor’s degree (BSN).

Following completion of one of these programs, graduates must pass the National Council Licensure Examination for Registered Nurses (NCLEX-RN) and satisfy state licensing requirements to begin work as an RN. Bridge programs, such as LPN-to-RN and ADN-to-BSN, allow nurses to move ahead in their nursing careers.

Each choice of training program is distinct and offers levels of education to qualify graduates for increasingly responsible roles in nursing practice. This guide is designed to break down the step-by-step process for becoming an RN, including the various routes possible on this career roadmap. Included is an overview of potential specializations and certifications for those interested in moving beyond basic nursing duties. Below are estimates for RN salaries and job growth as well as tools to help prospective nurses search for online and traditional educational programs.

WHAT DOES A REGISTERED NURSE DO?

More than 2.7 million registered nurses are employed in the United States, and nearly 30 percent work in hospitals, according to the Bureau of Labor Statistics (BLS). Other RNs work in clinics, physicians’ offices, home health care settings, critical and long-term care facilities, governmental organizations, the military, schools and rehabilitation agencies.

Duties include administering direct care to patients, assisting physicians in medical procedures, providing guidance to family members and leading public health educational efforts. Depending on assignment and education, an RN may also operate medical monitoring or treatment equipment and administer medications. With specialized training or certifications, RNs may focus on a medical specialty, such as geriatric, pediatric, neonatal, surgical or emergency care. Registered nurses work in shifts that run around the clock, on rotating or permanent schedules, and overtime and emergency hours can be unpredictable. Registered nurses are required to complete ongoing education to maintain licensing, and they may choose to return to college to complete a bachelor’s degree or master’s degree with the goal of moving into advanced nursing practice roles or health care administration.

THE STEPS: BECOMING A REGISTERED NURSE

Step 1: COMPLETE AN APPROVED NURSING PROGRAM

Anyone who wants to be an RN must finish a nurse training program. Options include programs that award nursing diplomas, associate and bachelor’s degrees. An associate degree in nursing (ADN) typically takes from two to three years to complete. Accelerated nursing degree programs could potentially shorten the time required. A bachelor’s degree in nursing (BSN) takes about four years of full-time study to complete, or two years for those in an ADN-to-BSN program. While the structure and content of these training programs differs, they should feature the opportunity to gain supervised clinical experience.

Students may initially only have the time and money to complete a two-year program, but they might later decide to convert their ADN to a BSN degree. Or, students may leap directly into a four-year BSN program if they plan on moving into roles in administration, advanced nursing, nursing consulting, teaching or research. Nursing students complete courses such as the following:

• Anatomy
• Biochemistry
• Biology
• Chemistry
• Computer literacy
• Health care law and ethics
• Mathematics
• Microbiology
• Nutrition
• Patient care
• Psychology

A bachelor’s degree program may also include courses on specific health populations, leadership, health education and an overview of potential specializations. A four-year bachelor’s degree program could require liberal arts courses and training in critical thinking and communication to complete the curriculum. Bachelor’s programs can broaden nursing experience beyond the hospital setting. According to the BLS, some employers require newly appointed RNs to hold a bachelor’s degree.

Step 2: PASS THE NCLEX-RN

Accredited undergraduate nursing degree or diploma programs alike are designed to prepare students to sit for the NCLEX examination. Upon graduation, aspiring RNs should register with the National Council of State Boards of Nursing to sign up for the National Council Licensure Examination for Registered Nurses. Candidates receive an Authorization to Test notification before the exam. At the exam, rigorous verification of candidates' identity may include biometric scanning.

This computerized exam has an average of 119 test items to be completed within a six-hour time limit. Examinees who do not pass must wait from 45 days to three months to re-take the exam. According to the California Board of Registered Nursing, students who take the exam right after graduation have a higher chance of passing.

Step 3: OBTAIN A STATE LICENSE

Every state and the District of Columbia require that employed registered nurses hold current licenses. However, requirements vary by state, so students should contact their state board of nursing or nurse licensing to determine exact procedures. In some states, RNs need to complete the NCLEX-RN, meet state educational requirements and pass a criminal background check. The National Council of State Boards of Nursing maintains a listing of licensing requirements on its website.

Step 4: PURSUE ADDITIONAL TRAINING AND CERTIFICATION (OPTIONAL)

For professionals who decide to become advanced practice registered nurses (APRNs), a BSN degree provides an academic stepping-stone to master’s degree programs. There are also bridge programs for students who only hold a two-year nursing degree and RN licensure but wish to enroll in graduate programs.

Those with master's degrees may qualify for positions such as certified nurse specialists, nurse anesthetists, nurse practitioners (NPs) and nurse midwives. It's important to research evolving professional requirements. For example, the American Association of Colleges of Nursing proposes that NPs should earn a Doctor of Nursing Practice (DNP) degree. A DNP or a PhD degree may appeal to nursing professionals who seek positions as scientific researchers or university professors in the nursing sciences. RNs may also seek certifications in a medical specialty such as oncology. Certifications are offered by non-governmental organizations attesting to nurses' qualifications in fields such as critical care, acute care, nursing management or other advanced areas.

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Source: www.learnhowtobecome.org