Nurses and Depression: An Essay

Nursing and depression are a strange pair of entities that intersect at various points of the compass. Yet the nursing profession continues to walk an uneasy line between comprending depression as a patient symptom and experiencing depression  as a career side effect. Today nursing stands at a pivotal place in history, with academia, the origins of medicine, and progress pulling the threads of nursing theory every which way.

Nursing is a time-honored institution whose origins claims famous feminist icons such as Clara Barton, Margaret Sanger, Mary Breckenridge, and Florence Nightingale. But the feminist mystique itself has oudistanced the treatment and conventional wisdom surrounding depression as a medical concern. Depression, and the treatment of depression, for many people, can be a difficult concept to grasp. Depression is a psychiatric disorder of the mind and psyche which affects persons undergoing medical treatment, but can also originate as a harbinger of other diseases. Depression has almost become a slang term in the pop culture vocabulary used casually to descrive feeling “down”. Yet as a medical denominator, the presence of depression  is serious business.

Depression can be a symptom as well as a diagnosis. Yet the physical side of the medical and nursing fields can often override the psychological of many wellness crises. Conventional wisdom usually trumps academic progress. Commercial pharmaceutical treatment usually beats out long-term alternatives, and little endorsment is given to nontherapeutic analysis. The medical institution as a whole functions mostly to heal the body, and the psycho-analytic milestones in healing don’t keep pace with the limitation of treatment access options for the afflicted. Dabbling in depression doagnosis is seen as specialist referral stuff. Medical professionals are all too familiar with these “rules of the road”.

Both doctors and nurses are more comfortable in general discussing medical symptoms according to a pathology of pure anatomy and disordered functions of the body. This is their clinical training taking over. This is understandable, as many facets of the psychological applications of depression treatment color between the lines of many disciplines. And ad hoc experimentation in the world of treatment for depression is uually not rewarded from a multiple of perspectives.

Too often, physicians skip over depression as a treatable illness and focus on the more concrete diagnoses of the body. In many cultures, psychological illness still carries a stigma from periods of civilization where too little was known about the causes and origins of depression. The onus of depressive symptoms as ‘”madness” still  remains.

Early man used drugs, societal separation, and medicinal forms of witchcraft to “treat” early forms of depression. Later cultures shipped mad people offf to sea, in groups, on a Ship of Fools”., Relying on God to guide their destiny. Sigmund Freud and Carl Jung introduced a standardized form of psychological vocabulary to the medical world, and contemporary man has distinguished himself by pursuing depression in its various guides as a clinical and scientific study for decades.

Today, studies connect depression and everything to sleep deprivation, opiate addiction, anorexia nervosa, Post-Traumatic Stress Disorder, and more. Prevention of depression and observing symptoms of depression, are now a key element of physician treatment advice. The dynamic of career choice has affected medical workers, doctors, and nurses as the practices began to take on occupational definition since the late 1600’s. Medicine  as a discipline has undergone radical reforms from it’s early days. The “physicking’ of another person began to take shape not just as a career for learned man, but as an occupation for educated men and individuals in search of a paying career. While the first doctors of this type were from the most elite classes of scholar and the most wealthy set of people in every culture, religion as  a passport to medical practice admitted religious elders to the treatment of others in more than one tribal civilization around the globe.

Many early teaching institutions centered around the scholastic training of doctors, priests, and teachers. The estimation of a physician was often ruled by his breadth of knowledge of medical studies and material of a religious nature. The indoctrination of a scholar in religion was thought to cement the ethics required to operate a medical practice and found the personal ethos necessary for treatment of other persons, conscious or unconscious. The access to the metaphysical world that many cultures connect with physical wellness allowed this transmutation of disciplines to coexist for many centuries.

The ethics associated with physicianship caused male scholars in the early 1700’s to pledge their scholastic faith in religion, as a going rates of “dues” cementing Christian ethics to the science of treating the bodies of other people. But as Calvinism, the teaching s of Martin Luther, and other religious doctrines took shape, the emergence of a new class of doctor purely to treat the physical malady emerged. The doctor as pure scientists emerged. Marie Curie and her husband were examples of this kind of doctor, who practiced their science without allowing religious culture to dominate their thinking. Doctors were thought of as esteemed members of the community, the equal of all but the highest echelons of the social order. Doctors are respected in every type and section of population where high level of education, practice of any differentiated culture, and necessary acknowledgement of the body of knowledge required and the commitment necessary confers a certain prestige.

In the succeeding centuries, academic studies have dominated the world of organized medicine. Then the business world took over mass medicine, and the world now has become a globalized client of large scale medical insurance companies. The patient is not always the client, as doctors usually are the ones that pharmaceutical companies look to for sponsorship of their treatment of new type of medications. It is the nursing profession, and nurses in particular, who deliver the front line of medical care and therapeutic attention to patients. It is the nurses in the medical world who are the ones that patients interact with the most.

But as the nursing career as a lifetime occupation has developed as a paying gig, the culture of acceptance and respect may not have been as evolved. The participation in medical profit for nurses has not followed along with that enjoyed by physicians working half the amount of time per week.  While nurses do the “heavy lifting” of patient care, their compensation is not commensurate with the time spent and sacrifices required of someone who has embarked on a nursing career. Nurses may work unpaid overtime, stay late, and do extra work, but nursing pay generally doesn’t always reflect this contribution. Ensuing generations of nurses will decide if more reform is in order.

 

 

 

 

 

 

What Nurses Need to Know About Cutting

Chronic consitions anf acute care crises are not the only area in which nurses serve their patients. Nurses must be vigilant to observe compulsive and dissociative disorders beginning among their patients in care. When a patient is at risk for harming themselves, the situation becomes a health care crisis.

Patients under monitoring will exhibit patterns of normal behavior. Then changes in a patient’s habits will stand out.  One aberrant behavior that signals the need for attention is cutting. Cutting may sound odd, even absurd to most people when first encountering the medical disorder. But cutting is no laughing matter. It can affect housewives, adolescents, students, and profession people of all ethnicities  and at every education level.

Yet the  problem of cutting is more widespread than thought at first, although experts cite early underreporting as a major factor. Many caregivers may not wish to risk their position on an intervention. Irregular nursing staffing can result in turnover that prevents consisted reliability between caregivers with an opportunity to see cutting symptoms.

Cutting is a problem that has become a recognized part of the vocabulary of disorders and psychological signs of emotional distress in people. Striking mainly juveniles and adolescents, cutting is a practice where the physical mutilation of the skin serves no purpose but abuse. Cutting flourishes in environments where body checks and inconsistent observation is the norm.

Both women and men suffer from cutting. The inclination will start small, and the disorder will build as the victim of cutting behavior learns to harm themselves routinely. Cutting may be hidden by hobbies such as carpentry, fishing, sports, and crafts where cuts and abrasions can be shrugged off as casual. Where cold weather can conceal skin condition, nurses should urge patients to change into a gown for evaluation. Many doctors who skip the full-body evaluation can miss the signs and symptoms of cutting right under their nose.

Cutters are trying to treat their emotional pain. The individual will start to experiment and transfer feelings of emotional pain to a physically concrete manifestation of cuts, bruises, lesions, in areas not regularly seen by others. This is regularly in the lower arms and forearms, which can be hidden by long sleeved clothing. The individual will withdraw from normal social activity if it reveals their cutting scars or lesions.

Therapy for cutting involves multiple disciplines. Treatment involves  confronting the cutter in a safe space and  from their caregivong usually takes the form of two tiers of treatment. Skin cuts are treated for infection and bandaged, and mild painkiller is prescribed. Psychiatric examination and counseling make up the other part of treating cutters.

It would seem that those in metaphorical pain would avoid seeking actual pain. Yet for many this is bringing their pain into the open. Wound care nurses should be wary of patients who pick at scabs or worsen wounds and lesions between dressings.   Yet the exhilaration and catharsis of the cutting ritual allows the individual to achieve emotional release from psychological pressure. Cutters can form bonds with website friends online part of the cutting world.

Cutting is usually done by persons who feel helpless to control important aspects of their lives. Cutting is generally a shameful secret they hide. Cutters should not be condemned, but take in recommending the case for treatment. Friends should report this to a doctor or physician for further investigation.

Signs and symptoms of self-injury may include dermal scars that can be seen in those who have been practicing the self-abuse of cutting for some time. Referrals to the appropriate speciaist are encouraged.

Cutters may distinguish themselves by having sharp objects like pins, knives, switchblades, or razors on hand. They may be seen to wear long sleeves on their arms  and long pants unseasonably in hot weather. Cutters often exhibit difficulties in having close friends near, or holding long-term friendships or have difficulties in interpersonal relationships. The intimacy and familiarity required in these relationships make it difficult for the cutter to hide the cutting habit.

The habit of cutting may become a compulsion for some , one they wish to hide. Conditions in the cutter’s life may lead them to question their existence and voice thoughts of hopelessness or confusion. Stressful life events such as loss of a loved one, decline in social contacts,and new changes in negative life experience may signal a potential for cutting.

The patient or individual will mull over questions about his or her personal identity, such as “Who am I?”, “Where am I going?,  “What am I doing here?” They may exhibit panic and confusion when confronted with obstacles.  Nurses should be alerted to patients with pronounced skin conditions and the above mentioned problems.

Patients involved in cutting behaviors will experience behavioral and emotional instability, such as uncontrolled crying or mood extremes.  Cuters may ecperience problems with impulse control, and be subject to violence aggressiveness or other taboo behaviors. Cutters form a new routine, replacing the chaotic unpredictability of their problems with the “control” of the cutting instigation.

There may be a detectable change in patients, from an external viewpoint. . A patient who usually goes out for a walk or shops with friends and suddenly elects to stay in or avoid phone calls may be a patient considering cutting or performing the cutting practice as a way of coping. The cutter’s disorder is marked acute when the individual finds solace or relief in cutting.

Nurses should discuss with the charge nurse, roommate, staff nurses and social if they have overheard the patient make statements of helplessness, hopelessness or worthlessness. Futility and despair are the emotional hallmarks of a cutter. Intervention is only possible if the caregiver or nurse steps in and speak up.

Slackers: The Ethical Divide of Nursing

The ethical divide between professional nurses with morals and accountability, and the others, becomes clear just as soon as a newly qualified student nurse becomes a professional. As in many occupations, nursing has its share of sour apples. And, as in many professions, some employees work to find a way around the system. Some nurses commit timekeeping violations. Others goof off and text on the job. Some chat too much with other workers, ignoring monitoring and auditing tasks. Slackers send a message that nursing is not serious business.
Sooner or later many nurses developed a career path. Many nurses begin with small slips, like writing inaccurate representations of events to favor their colleagues. And some others gang up on certain patients, to teach them a lesson. it’s human nature in some people to become predators against others and take advantage, but better nurses withstand the temptation to abuse those vulnerable and in their care.
Many times advisors and instructors will stress the importance of contacts within the industry and joining new network of friends. But this can backfire. Nurses cherish the bonds of friendship between each other, and sometimes too much. Would a friend ask you to risk your license putting false paperwork into a patient’s chart? Would you report a friend who removed records from the chart and shredded them? Would you realize if a future supervisor didn’t hire you because they remembered the deeds of a nurse clique or “posse’ you used to be with in the past? Being able to choose the company you keep may be the last true luxury nurses have. You may pay a price in the future for fun times today.
Nurses starting their first job take their license as proof they have studied hard, mastered all materials, and learned the necessary techniques and skills to provide positive and meaningful care to benefit all patients. Yet after a while, newly licensed nurses will start to notice something. Not all nurses share their same commitment. Some are lazy, some never finish the job right, and some just find ways to do things that are sloppy and incomplete. Every nurse must find the way they choose to deal with this.
Some nurses view a nursing job as a part time paycheck an avenue to another career. They want to be an actor, or an artists, or even have another job. Maybe they found their way to nursing through family connections and it didn’t seem all that hard to do. But they really don’t like the work, and they don’t mind if it shows. These nurses use their phone a lot when they are supposed to be working, and spend a lot of work time goofing around, looking at take-out menus or chatting with vendors and providers who come by to visit. But the medical world does not smile on this kind of slacking.
This kind of nonchalance leads to many nursing errors, such as too much or missing medication, skipped insulin doses, erratic chart-keeping, and missed shifts due to inability to copy the schedule. These type of employees perhaps showed more promise once upon a time. And many facilities can‘t afford to let such nurses go because a shortage of qualified and experienced nurses keeps them reliant on current staff. They arrive at work and hang out, looking for ways to skip the work and get coffee, hide in closets and rooms to talk to others, and just hang around.
Usually for nurses like these, the big attraction to coming to work is to socialize with the people working there. This can be a problem, because the bonds between nursing co-workers should not be more important than the professional commitment as a provider. Often, many nurses can prey upon the weaknesses of others. They can use peer pressure to cause one nurse to treat a certain patient or even a co-worker nurse badly or with disrespect. This is slacker peer pressure.
Yet so many nurses convince themselves that coming to work late doesn’t matter, that calling in sick for entertainment and social reasons doesn’t help co-workers, and that unclocked breaks just don’t really count as infringements. These types of nurses can contribute to an entire downturn in morale, because nurses working hard observe their peers slipping by with doing much less. Why should work hard, a nurse might say to themselves, when if ‘so and so” was here, they would just watch the clock until the small hand clicked at the top?
Sadly, many types of people use nursing to abuse the system. The steal medications, overcharge insurance companies, send false bills, and sign invoices for amounts of supplies much larger than what was actually used. Nurses may not realize that when they are asked to sign a bunch of audits, or when other staff convince them to sign many orders the did not witness or to even file papers in the chart that are not legitimate, they are risking their license. And showing new nurses whom to trust on the job is not something you can teach in a textbook.
Insurance fraud usually starts in small to medium sized businesses where slacking off and discovery of errors puts some people at a disadvantage. A nurse who has noticed a serious error made by one of their co-workers can choose to report it, or instead leverage this information for better shifts, a raise, or even a promotion. Nurses should be vigilant to review their state nursing board website and keep updated on the regulations governing their license. Maybe some employees notice that an employee takes off work an hour early every day their manager is not in the office. A new nurse trainee observes that not every staff member has t clock in and out per timekeeping regulations. Maybe they notice that the physical therapy staff bill for more sessions with their patient clients that actually occurred. Any omission of reporting such things can build a situation where nobody has ethics and finally some incident brings the whole situation to light. And at that point, nobody is a winner.
Many slacker nurses or people who are just too burned out to care adopt a philosophy of “say nothing, do nothing” at work. They think this keeps them free from blame when situations arise on the job for nurses to commit dishonest acts or abuse patients. When the nursing employees have this many compromising issues on the job, the patient care comes second. Soon, going to work in really a tripwire into unethical behavior that could lose them their job, let alone their license. And many nurses later confess to horrible infringements of patient rights simply because they got strong-armed on the job from the director of nursing or the administrator.
It is so much easier, in nursing, just to keep a clean slate and make sure that the nurses you choose to associate with are the one most admired and emulated by all. The nurses with authority are the ones who should provide a leadership example for everyone. As a new nurse, any nurse who questions why a felow employee is performing a certain action or declaring certain statements or giving orders, should be vocal to their superiors about just what is going on. Just the knowledge that one person had noticed this might be enough to form a correction plan and sever “bad apples” from a healthy tree.

Dengue Fever Study Review

Dengue fever, a one rare tropical disease more prone to be common in Malaysia, South America, or South Sea islanders, is a spreading community health threat in settled countries. Unpoliced immigration from countries with little or no sanitation, poor innoculation records. Vaccination problems and low health standards is infiltrate more vulnerable healthcare environments every day.

These health threats are getting worse. The CDC cited in its July 2010 report that dengue fever is transmitted by mosquito bites, and where surface water cultures and agronomies are present. In time these figures and for other diseases like AIDS have grown worse. In South Africa, transmitted diseases have crossed over into population threats for travelers. Incubation can allow for re-uptake of diseased matter to likely insects, And in some (notorious) cases, rare hospital-based person-to-person transmission. .

For civilized societies, the prevalence of immigrant residents working in unsanitary health conditions near surface water with little or no medical care ensures an epidemic of a once rare tropical disease. Harking back to distant eras when medicine as it is practiced today was in a stone age of ignorance, dengue fever was also called break-bone fever for the level of pain and bone damage the dengue visited on its victims. The more serious phase of dengue fever (DHF) can cause fatal occurences of circulatory failure, shock, and multiple organ failure leading to death.

Evincing symptoms of dengue fever are back-of-the-eyes headache, an ache or pressure in the temples, arthritis flare ups, or “ghosting”, myalgia, contact rash, ecchymoses, and interior oral bleeding or nasal bleeding from mucus tissues. Clinical examination and patient history can indicate dengue fever, as well as dengue fever viral matter in the immunoglobins of IgM and IgG. An assay capture test should be run for patients exhibiting these symptoms without exclusive indications from existing conditions. Re-infection of dengue fever can occur, so patient history with respect to dengue fever is critical.

Brain damage from shock can affect the pathology of the organism as a whole, as well as exacerbate any existing medical condition. Patients in this state exhibit multiple systemic vulnerabilities. The intensity of dengue fever continues to a more serious stage, the DHF. Dengue Hemorrhagic Fever, a potential cause of death, may last two to seven days with fever, abdominal pain and vomiting throughout.

Fever can abate during the DHF phase of dengue fever without the condition being recovered from. Dengue fever wellness plans require patient assistance via nursing and leaves patients bedridden through the course of recovery.

Nursing students and community care professionals can estimate a possible case of dengue fever from lab tests showing hematocrit increase, thrombocytopenia in the blood cell count, and leukopenia. Long term complications for recovered dengue fever patients  include myocarditis, encephalopathy, and liver failure. The dengue fever has no vaccine treatment as of yet. An estimated fifty to a hundred million cases a year of dengue fever infect the known human patient population.

Patients who might experience basic symptoms of dengue fever should be questioned for recent activities such as drinking local tap water, ingestion of imported fruit, outdoor recreation near surface water areas, and foreign travel to tropical weather states (such as Florida) or Indian, South American, or Middle or Far Eastern countries where modern sanitation is compromised. Flower beds, standalone planters, pet dishes, and rain collection containers can collect mosquito infected material and spread the disease.

Mosquito repellants and double screens can increase protection from dengue fever contraction. Parents (and caregivers)should look for clothing that “holds” DEET or other mosquito repellant products well. Clothing and skin can be sprayed. Worldwide children age 15 and below represent 90% of severe shock cases of dengue fever, termed dengue shock syndrome (DSS). But American patients of dengue fever can be adult or juvenile. Astonishingly, the disease can be benign. Nurses should screen for background on foreign travel to rule out the patient being a carrier.  The coagulation into the bloodstream and tissues causes the denge hemorrhagic fever. DHF patients can develop shock (DSS).

But dengue fever today exists in the United States and modern civilized countries in an outbreak that makes medical healthcare communities uneasy. Nurses must be up to date and wary of new presentation of likely symptoms. What used to be an exotic disease can now come by courtesy of a local canal or aqueduct. Water literally around the house, such as lawn irrigation or plant beds can serve as mosquito nesting grounds. Climate change, weather patterns, and activity involving egg travel in produce or lawn products, for example, can spread the disease further.

 

 

 

The Mechanics of Nursing

nursing equipment

vital statistics 

One of the realities of every profession is that an occupationally trained worker must provide some part of their own tools of the trade. Perhaps they prefer a certain brand or model, and/or the facility hospital or nursing home does not provide up-to-date or working machines at all. Officially, a hospital or long term care facility will monitor the medical equipment, but this does not always happen. Nurses are often “stuck” using equipment that is borderline inoperable or unreliable. This is a very serious medical issue because the nurse must be able to trust the statistical metrics to assess and record the patient’s condition.

Due to low budgets and straining costs, many facilities may not have the money to replace aging or broken equipment. Thus the patients are relying on the nurses to be able to do a manual job of taking blood pressure stats every time. This can be time-consuming and a stressful part of the nurse’s day, when conflicting patient needs stress the limited time a nurse has to finish tasks. A professional nurse must be able to contend with broken or inoperable equipment and yet smoothly transcend this challenge for ongoing patient care.

One of the parts of nursing that always gets nurses technically caught out is the working and proper maintenance of the medical equipment. Many a testing and practicals skills environment training stresses the use of blood pressure tests using the old-fashioned lub-dub method. But many professional nurses grow to rely on the wrist machine, used to calculate digitally the readout of the patients blood pressure and oxidation. Investing in this mechanical device can save time and trouble taking vitals readings.

A nurse working at a hospital or long term care facility should catalog the errors they observe using a particular piece of equipment and report this in writing to the charge nurse or to the Director of Nurses. They should note for the record in the licensed nurse progress notes how many times the attempted the vitals test and what the time was from beginning to end. This can be verified using a video camera or the notes of the charge nurse.

It is important for any nurse to immediately report a malfunctioning piece of equipment to the working charge nurse per shift, additionally. Taking a digital picture with your cellphone may also show the strange result or wrong code on the LED that multiple attempts can give. This advise is not just boilerplate for an in-service or training video. A nurse should use their own judgment and be ready to submit this letter anonymously to whistleblower line or local ombudsman or patient safety suggestion box.

Documenting the issue with the nursing equipment that it is not operating correctly and the serial number or identification tag will also assist inventory staff using this complaint to take the unit in for repairs. This way the nurse has a concrete record of their own observations and the method they used to pass the information up the chain of command. Sometimes the persons in charge of purchasing and equipment maintenance don’t have any interaction concerning the operability of the equipment, when in fact a vitals cart or heart monitor may need replacing.

Other equipment related to patient safety is elevators, stairs, fire escapes, visitor chairs, bed rails, bathroom safety rails or bars, light fixtures, air conditioners or heaters, and more. Elevators should work without strange or unexpected delays, or stops on unselected floors. Lighting and access to floors using fire escape doors or flights of stairs should be reviewed for safety practices. Lack of integration of security responses for patient alarms and wheelchair alarms can make a nursing ward seem like a zoo of noise, buzzes, and call light alarms.

But specialized equipment is not the only device that a nurse should review for safety. A nurse should always give the equipment a “weather eye” and see if the cord goes in smoothly and does not pull away from the electrical socket, or that the wheels or runners turn and move smoothly. A tray table or table-based electrical equipment aid to nursing may need to be monitored for electrical discharge. A nurse should report when a patient organize belongings or possessions in a manner that conflicts with safety standards.

Even finger protectors made of plastic can prevent paper cuts. This is a serious problem for blood contamination of medical records and documents, as well as droplet contamination between nurse and patient. Given the amount of time that nurse spend handling the chart pages, even a small paper cut can become painful upon repetitive action.

As always, the most highly scrutinized equipment for nursing use is the needle. Privacy, calm and well-lit circumstances in administering patient care, and a good understanding of the patient is required. Advise the patient when you are going to stick them, how long it will be, how the site looks, and ask them again before you inject the needle if they are ready. This use of courtesy centerlines patient dignity even during a difficult procedure. Improving stick skills should be paramount. Causing bruises or painful injection sites repeatedly in a patient can result in being written up by a supervisor. Continuous disregard of patient dignity and skin fatigue or tearing, bruising or discoloration due to improper needle skills can be means for dismissal.

All in all, there are numerous challenges to safeguarding patient safety and mechanical device security in the occupational nursing workplace. But with attention to detail and a good attitude, the professional nurse can overcome obstacles while providing excellent patient care.

 

 

 

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