Parkinson’s Indepth How Are Cognitive Deficits Diagnosed.

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How are Cognitive Deficits Diagnosed?

 

  • Cognitive disorders are commonly assessed and diagnosed by:
    • Interviewing the person with PD.
    • Asking family members or caregivers about their observations.
  • Administering cognitive screening tests such as the Mini-Mental State Examination (MMSE) or Montreal Cognitive Assessment (MOCA).The neurologist will ask questions that evaluate the person’s understanding of where and who they are, the date and year, attention, memory, language and problem solving skills.
  • The neurologist may refer the patient to a clinical neuropsychologist for a more detailed assessment.
  • A neuropsychological assessment can be an important diagnostic tool for differentiating PD from other dementing illnesses such as Alzheimer’s disease (AD), stroke or dementia.

 How are Cognitive Changes in PD Different than Alzheimer’s Disease?

Parkinson’s disease

  • Overall, dementia produces a greater impact on social and occupational functioning in PD than with Alzheimer’s disease (AD) due to the combination of motor AND cognitive impairments.
  • There is some overlap between symptoms and biological changes seen in AD and PD, however, it is less likely for both disorders to occur at the same time.
  • Development of the dementia in PD patients represents progression of Parkinson’s disease, usually after several years of motor impairment.

Alzheimer’s disease

  • Alzheimer’s is a fatal brain disease  that causes a decline in memory, thinking and reasoning skills.
  • Dementia is the hallmark symptom of Alzheimer’s disease as people become confused about time and place, have difficulty recognizing people and places they know, remembering how to do simply daily tasks, and often experience mood changes.
  • Whereas, dementia may or may not occur in patients with PD.
  • In fact, according to recent research 30% of PD patients DO NOT develop dementia as part of their PD progression.

If you are interested in learning more about our Parkinson’s fitness video series please follow this link. NEVCO Education

For further information on Parkinson’s Disease you can visit  

http://www.michaeljfox.org or http://www.pdf.org/en/index, http://www.parkinson.org/

 

Parkinson’s Indepth Look At Cognitive Changes

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What Specific Cognitive Problems Do People with PD Face?

 1) Attention:

  • Difficulty with complex tasks that require patient to maintain or shift their attention.
  • Problems with mental calculation of numbers or concentration during a task.

2) Speed of Mental Processing:

  • Just as movement can be slowed in PD, thinking abilities can too.
  • This slowing in thinking is often associated with depression in PD.
  • These problems can be seen as a delay in responding to verbal or behavioral stimuli, taking longer to complete tasks, and difficulty retrieving information from memory.

3) Problem-solving or executive function:

  • Trouble planning and completing activities
  • Difficulties in generating, maintaining, shifting and blending different ideas and concepts.
  • More concrete in approach to tasks.
  • Patients with these deficits often benefit from regular cues or reminders and greater structure of activity.

4) Memory deficits:

  • The basal ganglia and frontal lobes of the brain may be damaged in PD and are the areas of the brain important in organization and recall of information.
  • Difficulty with common tasks such as making coffee, balancing checkbook, etc.
  • Patients with full-blown dementia will experience both short-term and long-term memory impairment.

5) Language abnormalities:

  • Many PD patients complain of word-finding problems, or the “tip of the tongue” phenomenon.
  • Problems in naming or misnaming objects seen in the middle to late stages of PD.
  • Difficulty with language when under pressure or stress.
  • Difficulty comprehending complex sentences where the question or information is included with other details.
  • Many patients experience problems with production of language and dysarthria.

6) Visuospatial difficulties

  • Can be seen in different stages of PD.
  • During the early stages of PD, patients may have difficulty with measuring distance and depth perception, which may interfere with the patient’s ability to park the car or remember where the car is parked in the parking lot.
  • During the later stages of PD, in combination with dementia, some patients can experience problems with processing information about their surroundings or environment.
  • Subtle visual-perceptual problems may contribute to the visual misperceptions or illusions that are often seen in PD.
  • Patients are usually susceptible to visual misperceptions or illusions in low-light situations (i.e. nighttime) and if they are experiencing other visual problems like macular degeneration.
    Many persons with PD complain of slowness in thinking and difficulty with word-finding.
  • At their most severe, patients may experience problems telling apart non-familiar faces or in recognizing emotional expressions on another person’s face.

If you are interested in learning more about our Parkinson’s fitness video series please follow this link. NEVCO Education

For further information on Parkinson’s Disease you can visit  

http://www.michaeljfox.org or http://www.pdf.org/en/index, http://www.parkinson.org/

Cognitive Changes in Parkinson

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Cognitive Changes

Many persons with PD complain of slowness in thinking, loss of memory, decreased attention span, and difficulty with word-finding. Learn more now about cognitive changes as they relate to PD.

What Cognitive Changes Occur with PD?

The term “cognitive” refers to thinking or the processes involved in knowing or putting together information.

  • It includes a variety of mental skills such as attention, problem-solving, memory, language, visual-perceptual skills, and other aspects of reasoning and general intellect.
  • Many persons with PD complain of slowness in thinking and difficulty with word-finding.
  • Research has found that mild symptoms of cognitive impairment occur in PD patients.
  • Some patients report mild improvements in motivation and concentration after taking anti-Parkinsonian medications.
  • These medications, however, do not typically improve other aspects of memory and thinking abilities.

While approximately 50% of patients with PD will experience some form of cognitive impairment, not all individuals will be diagnosed with full-blown dementia.

In general, mental and motor decline tend to occur in parallel as the disease progresses. Significant cognitive impairment in PD is often associated with:

  • Caregiver distress
  • Worse day-to-day function
  • Diminished quality of life
  • Poorer treatment outcomes
  • Greater medical costs due to nursing home placements
  • Increased mortality

Next week we will take a deeper look into the cognitive problems with Parkinson’s Disease.

If you are interested in learning more about our Parkinson’s fitness video series please follow this link. NEVCO Education

For further information on Parkinson’s Disease you can visit  

http://www.michaeljfox.org or http://www.pdf.org/en/index

Does Diet Impact Parkinson?

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Today we have some great information from The National Parkinson’s Foundation.

If you or someone you know has Parkinson’s disease (PD) you are not alone.  In the United States, 50,000-60,000 new cases of PD are diagnosed each year, adding to the one million people who currently have PD. The Center for Disease control rated complications from Parkinson’s disease as the 14th leading cause of death in the United States. Worldwide, it is estimated that four to six million people suffer from the condition. There is hope, however, as scientists work towards a cure and make progress in identifying the best treatment options for patients. Learn more about PD now.

What are some common nutritional concerns for people with PD?

1. Bone thinning

  • Studies have shown that people with PD are at increased risk for bone thinning.
  • As PD advances it can increase the likelihood of falls.
  • For those with PD, it is especially important to eat meals that provide the bone-strengthening nutrients including: calcium, magnesium, vitamins D and K.
  • Regular exposure to sunlight is also important, as it increases vitamin D in the body and serves as a bone-strengthening agent.
  • Walking and other weight-bearing exercises can also help in keeping bones strong and less likely to fracture or break.

2. Dehydration

  • PD medications can raise the risk for dehydration leading to: confusion, weakness, balance problems, respiratory failure, kidney problems and death.
  • Drink plenty of fluids throughout the day to avoid dehydration.

3. Bowel impaction

  • PD can slow the movement of the colon, thus causing constipation.
  • Therefore, you must get enough fiber in your diet.
  • If the constipation does not get resolved it can lead to bowel impaction where a mass of dry, hard feces becomes impossible to pass normally.
  • When bowel impaction occurs it may require hospitalization and even surgery.

Did you know that in the United States alone, dehydration is responsible for 1.8 million days of hospital care each year (about ten days per patient) and costs more than $1 billion annually?

4. Unplanned weight loss

  • People with PD often lose weight without meaning to, due to nausea, loss of appetite, depression and slowed movement.
  • Unplanned weight loss along with malnutrition can lead to a weakened immune system, muscle wasting, loss of vital nutrients and risk for other diseases and possibly even death over an extended period of time.

5. Medication side effects

  • While medications play an important role in managing the symptoms of PD they may also have unwanted side effects.
  • Taking more than one medication may increase the level of unwanted side effects.
  • Common side effects include:
    • Nausea
    • Appetite loss, often followed by weight loss
    • Edema (fluid retention)
    • Compulsive eating and weight gain
    • Talk to your doctor if you are experiencing anything unusual.

6. Protein-levodopa interaction

  • One of the more important medications used to treat PD is levodopa.
  • However, levodopa must compete for absorption from the small intestine with proteins in food, and it may be necessary to take care with the timing of meals and medications.

A healthy diet with plenty of water is the foundation for good health, regardless of whether or not you have PD. However, for those with PD, it is even more important. The reason why it is so critical for those with PD is that healthy eating can help keep your bones strong, thus decreasing the likelihood of a fracture if you fall. It also helps you fight constipation, which is common with PD.

The following are a few guidelines for healthy eating:

  • Eat a variety of foods to get the energy, protein, vitamins, minerals and fiber you need for good health.
  • Balance the food you eat with physical activity.
  • Maintain or improve your weight to reduce chances of having high blood pressure, heart disease, stroke, certain cancers and most common types of diabetes.
  • Choose a diet with plenty of grain products, vegetables, and fruits, which provide vitamins, minerals, fiber, and complex carbohydrates and which can help you lower your intake of fat.
  • Choose a diet low in fat, saturated fat, and cholesterol to reduce your risk of heat attack, certain types of cancer, and to help you maintain a healthy weight.
  • People with PD often lose weight without meaning to, due to nausea, loss of appetite, depression, and slowed movement. Unplanned weight loss together with malnutrition can lead to an weakened immune system, muscle wasting, loss of vital nutrients and risk for other diseases.
  • Reduce your sugar intake! A diet with lots of sugar can have too many calories and too few nutrients. It can also contribute to tooth decay.
  • Reduce how much salt and sodium you eat to help reduce your risk of high blood pressure.
  • Drink alcoholic beverages in moderation as they have empty calories and little to no nutrients. Drinking alcohol can also cause many health problems and accidents.

If you are interested in learning more about our Parkinson’s fitness video series please follow this link. NEVCO Education

For further information on Parkinson’s Disease you can visit  

http://www.michaeljfox.org or http://www.pdf.org/en/index


Learning Cultural Diversity in Nursing: Building Rapport Part Two

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Rapport is defined in the American Heritage Dictionary of the English Language as a noun meaning relationship, especially of mutual trust or inherent emotional similarity or natural personal attraction.

Part two of our series will focus on we communicate and how we present ourselves when we communicate

The way we say it. (How we communicate to the patient)

It involves mutual trust. To attain emotional trust of your patients you need to know their emotions. Your speech needs to originate from the same emotional platform.

To illustrate this concept we will use the example of teacher and student, while this example is not directly connected to nursing, remember a allot of your job is teaching the patient or the caregiver on healthcare issues.

 For instance, a teacher may have a set of preconceptions regarding the way parents train, discipline and otherwise mold the lives of the little ones they teach. The teacher may or may not be right about some but not necessarily all parents. The parents will fall somewhere in a continuum of good to poor parenting skills.

If the teacher looks at the parents with the preconception of being poor in parenting skills, unless a Oscar caliber actor, the presentation wave length will not harmonize with the majority of parents. That is because we give off signals as to what we truly believe within our speech. The ones she does connect with will have further fuel to look down on the others.

If however the teacher approaches the audience from the viewpoint they are doing all they can, it will be possible to connect with a majority of the audience.

How?

A Teacher would first have to frame a viewpoint that if a parent was doing the best they knew how to, they were doing the best they could. If a parent was doing the best they physically could, be it economic reasons, physical limitations, or educational reasons, then no improvement would be possible.

That is, without further training. There is room for improvement. However, it is not the teachers place to improve the world. The only improvement purview is the children.

So in speaking to the audience from a kind, empathetic, and understanding viewpoint, they would relate to the teacher as a concerned party. The first harmonization on the way to making rapport has been taken. Harmonizing with the audiences view of the world they live in.

Next comes the inherent emotional similarity. Nobody loves the children more than the parents. When that love is shown within the smile and audience contact of the speaker in relation to the children, a connection is made. A harmonization takes place. The audience feel like we can trust this teacher with our children. They will love them almost as much as the parents will.

Then comes natural personal attraction. If the teacher can love the children, then can the same emotions be extended to the audience. Relate it to being an aunt or uncle to the children. What does the audience now become to you. Your brothers and sisters.

The commonality of peoples viewpoints and thought processes that harmonize with each other is the final harmonization. Here, even if viewpoints are diametrically opposed, if as a speaker, it is possible to frame the opposing viewpoint within one that can be accepted or embraced, you will have one of the essential elements needed to attain rapport.

Finally, the third pillar.

The way we present ourselves.

To add the final element, mirror and approximate their movements. To do this, if they are rather rigid and formal, be formal, if they are out going and friendly, be that from the platform. Let your body language talk to them the way their body language is talking to you.

Rapport is not some trick. It is not necessarily a gift. It is something that can be learned. It will take practice, experimentation and constant learning. It requires constant and never ending improvement. Can anyone learn it? Anyone who is willing to apply them selves can.

This is said from personal experience. When you have someone come up to you and they express how your care and communication has touched them. How somehow you got inside their mind and got them to turn off their filters. How your nursing got them to consider or even accept something that was otherwise a closed issue, you will know you have attained rapport.

Learning Cultural Diversity in Nursing: Building Rapport Part One

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How Can You Attain Rapport With Your Patient

Rapport is defined in the American Heritage Dictionary of the English Language as a noun meaning relationship, especially of mutual trust or inherent emotional similarity or natural personal attraction.

In psychology it is considered an important feature or aspect of subconscious human interaction. It relates to commonality of peoples viewpoints and thought processes that harmonize with each other.In the field of Neuro Linguistic Programming it is taught rapport can be obtained with the control of body functions like breathing, hand-body-face gestures and eye movement. It is thought that if you follow or match the person your trying to gain rapport with in these functions (respiratory rate and depth for instance) you will gain rapport.

Additionally developing skills like active listening will further enhance this ability.

The ability to attain rapport in a one on one situation is evident. Is rapport possible for a nurse with an patient. Can a nurse learn how to connect with the patient on a subconscious level?

The answer is yes.

To prove the reality of rapport to a large audience, if you watched AI and saw the little boy robot laying in the bottom of the pool how did you feel.

Or Robin Williams in Millennium Man, did you feel a connection.

Did you hurt when you saw C3PO and R2D2 were being hurt? These were just actors and even just robots in some cases. It was all special effects.

Yet the story and words were so compelling, you had feelings for the people or actually the robots they were portraying. That feeling, those emotions were rapport.

Yes, even with out special effects and the multi-million dollar contract, you can develop rapport.

Same Wave Length.

The first concern with rapport has to do with the first pillar of great communication. It has to do with what you say.

Take the patient down the path of something they will find agreement with or comfort in. Validate their feelings and conclusions. Approve of them.

Then offer new ways to accomplish the goal within the frame work of what they think is acceptable. In other words, within the same wave length.

Look for the same wave length words that will keep the spam filters of our mind turned off and the receptors open. Look for words that build mutual trust. Words that build relationship.

Relationship building words might include sincere praise. Honest compliments could work. Hearty commendations too. Use what will allow the audience to see you as seeing them in their world. Any words that allow you to connect to them.

One word of caution. It has to be sincere and honest. A patient will be able to discern insincerity.

 

Emotional Similarity

To create emotional similarity or natural personal attraction mirror the style of words they use. Don’t use words above or below their socioeconomic level. Talk and use the words as if you were one of them.

Don’t imitate colloquialisms unless you’re a native speaker.

For instance, how would you tell someone they have a terminal illness? Think about this one. How would you want to be told?

 

More importantly, how would you tell someone else so as to deliver the message how they would like to be told. How would you tell it if you were a parent, a grown child, an employer, an employee telling a fellow employee? What words would you use?

 

Consider the words to use to build rapport with an patient. The ones they will want to hear. But don’t over do it so much that you appear as familiar unless you are. Act as though you’re a guest who has been told to make your self at home but still recognizing that you’re a guest.

One caveat, if they are not out going and friendly, still use a friendly conversational style. Be friendly but tone it down.

Use expressions and words that express the commonality of viewpoints. This is one of the reasons it is important to know your audience. To attain commonality you need to meet and greet. But that is not enough. You need to ask viewpoint questions.

 

To find viewpoints and save the individuals from feeling like your putting them on the spot, ask questions related to what popular opinion is. What are the feelings of the folks/ people/ the neighbors/ the community/or what ever you pick up on as the local way of referring to the audience at large.

Next week we will, give attention to the second pillar of great rapport. 

The way we say it.

 

Learning Cultural Diversity in Nursing: Basic Concepts Part Two

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Cultural Diversity in Nursing
Commonalities and Differences to Public Speaking

The cultural diversity in nursing can be mastered by learning the model of thinking that successful public speakers use to communicate to audiences. Likewise public speakers can improve their public speaking by looking at the challenge presented in the cultural diversity in health care and specifically, nursing.

The core commonalities of nursing and public speaking involve education, motivation and implementation of the teaching. The diversity spoken of here includes ethnic groups, people of color, marginal and or vulnerable people in society.

To manage the challenges cultural diversity presents, nurses have been referred to as cultural brokers. Cultural differences may result in the expression and description of their symptoms in ways that are less familiar to the listener.

Simple Cultural Diversity Solution

Diversity is so varied and is constantly changing how can one keep up with all the changes?

An example of constant change is the knuckle bump also called the fist bump. A 2010 study found that the about 50% of North Americans prefer the knuckle bump vs the hand shake. The reason for the change was to prevent the spread of germs. Yet immigrants from other countries still offer a hand shake and may not be familiar with the knuckle bump.

A simple way to learn is adopting a simple process to understand and learn the cultural diversity of those being provided care and or the cultural diversity in healthcare. Here are some of the skills public speakers do to become masters of cultural diversity. Nurses could do the same.

Learn to Listen-Hearing vs Listening

Hearing is the ability of perceiving sound by the ear. If you hearing is intact, hearing happens.

Listening requires conscious effort to choose to do. Listening requires a measure of mental concentration so that your brain processes meaning from words and sentences.

Hearing and Listening: The Difference and Definition

Listening is more than the sum of its parts. There are various kinds of listening.

Listening for information

Information could include facts, figures, details, knowledge, instruction, advice, guidance, direction, counsel enlightenment, news words, thought content or knowledge. Listening can be to understand or to learn.

Listening for Emotional Content

Emotional content is the underlying feelings that are based on emotion rather than reason. It can also include things like the tone for voice, gestures, body language and micro-expressions.

Is the person happy and satisfied or dispirited or dejected. Is there anger or pleasantness noted in in the affect. proud or humble emotions manifest by speaker.

Listening for the Unspoken

Listening for what is unsaid what is implied but not stated, inhibited from being said or what may really be meant.

What is Involved in Effective Listening?

Listening is defined as applying oneself to hearing something. In verbal communication it is to hear while giving attention to what is being said. It is an ability that can be cultivated and practiced into a skill. From this standpoint it can be viewed as an art.

As a public speaker, it is an art that requires a conscious choice to master. As a married person, it is a necessity.

The Listening Test

This will help you master your listening efficiency.

Now the test.

For one whole day, your entire time your awake, devote yourself to not making any comment, giving an opinion, not even validating anything said by anyone else.

Not even a yes. This might require some artful and creative thinking. You might respond to someone calling out to you with something like…did you call? If someone needs an affirmation, the challenge is giving it while delivering a legitimate question rather than something nonsensical.

All that is required to pass the test is to listen. If needs be, you can ask more questions to further your ability to listen. Offer no comment, suggestions, or affirmations.

Do this for an entire day.

Most people who have tried it have found it too difficult to do.

This will help you to learn how to listen. Really listen to what others are saying.

More important than passing the test is the value of what you will learn. You will start to see how often you speak. You will start to find something wonderful as well. You will become very much liked by those around you.

Why, because people appreciate someone who is a good listener.

NEXT WEEK WE WILL LOOK AT BUILDING RAPPORT.

 

 

 

Learning Cultural Diversity in Nursing: Basic Concepts

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With the new year upon us NEVCO Education is producing a new program on a very important topic in healthcare…Cultural Diversity.

Below is a companion guide for our upcoming production on cultural diversity.

Lets take a closer look at three skills needed to master learning cultural diversity in nursing and cultural diversity in healthcare. It is also known as multiculturalism. The diversity spoken of here goes beyond ethnicity and people of color. Marginal and or vulnerable people in society are also included.

Learning Cultural Diversity in Nursing The 3 Helpers

Learn to Listen

Learning listening skills.
It is necessary to know the difference between hearing and the various types of listening.

Learn Curiosity

Curiosity for knowledge about the culture or the audience (read: patient) you are going to speak to. Fro instance, to those of other nationalities, simply ask, how do you say hello and how to say good bye. This process shows the audience (read: patient) that you are interested in them and their culture.The cultural difference in nursing faces the same common challenge public speakers face, reaching the audience mind. In health care, nurses are teaching just one person or a few if the family are included in the education. Public speakers can be speaking more often to many, even thousands and only occasionally a few or one.

Learn to Build Rapport

Building rapportis considered an important part of subconscious human interaction.The American Heritage Dictionary of the English Language defines it as a relationship, especially of mutual trust or inherent emotional similarity or natural personal attraction.

Effective public speakers learn how to do it. Nurses can likewise master learning cultural diversity in nursing.

There may be no studies to show this yet, but theoretically, the better a nurse is able to learn cultural diversity in nursing, the better the outcomes will be in the care of the patients.

Cultural Diversity in Nursing

Cultural diversity has an impact on both health care in general and nursing specifically. The variety or the cultural makeup (multiculturalism) of a group or organization or region can have profound effects on the care they receive.Nurses deliver their care within both social economic cultures as well as the health care culture. Culture focused assessments are essential. Mastery of cultural diversity in nursing will help.

Assessing an Emergency Room Visitor and asking if the patient had diabetes resulted in the patient looking at me like I had two heads. A more experienced nurse came up from behind and asked the patient if they had sugar. The patient said that they did. What is unique is this was not someone from a different country. It was someone from a different culture within my race. The cultural differences in nursing need to be recognized to provide the best nursing care possible.

Cultural diversity can be related to…

  • age
  • education
  • gender
  • mental disabilities
  • mores
  • physical
  • regional locations
  • sexual orientation
  • racial
  • ethnicity
  • socioeconomic background

Just as the patient with diabetes mentioned above with diabetes knew of the disease as having sugar, various cultures around the world may have different expressions for various physical, emotional and spiritual concerns. Even within the culture there may be vast differences.

My heart hurts to a North American may refer to heart attack where my heart hurts may mean emotional hurt from the loss of a loved one.

Nurses often take a pragmatic approach to working with the culture of patients and families. This approach has to be flexible to allow for differences within cultures.

Next week we will delve into greater detail the concepts and ideas outlined in this article.

Excellent Nursing Care: So you want to be a nurse.

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A very wise and experienced nurse Ruby Vee wrote this article. We at NEVCO feel that not only the article be made required reading for those interested in becoming a nurse but should be provided to the patient (yes,patient, not client) and their family upon admission.The public will have valuable insight into what a nurse does exactly.

Do you want to be a nurse? There’s more to it than a calling. Here are some questions to consider.

I’ve been a nurse for a LONG time — probably longer than most of you reading this have been alive. Had I known what I was getting into, I probably would not have gotten into it. Fortunately, I had no idea. I say fortunately, because nursing has been an interesting and flexible career that has afforded me a nice lifestyle and kept me from being bored. I wouldn’t go back and change my mind about going into nursing if I could..

Oh, and I met my husband at work. Another bonus!If you’re considering a career in nursing, make sure you’re clear on why you’re considering it. I’m not here to cast aspersions on anyone’s motives for wanting to be a nurse. After all, mine weren’t all that altruistic. I wanted a degree that would enable me to be a sought-after employee rather than me having to face rejection after rejection while hunting for a job. I know that doesn’t apply now, but it did then. And my mother, who had always wanted to be an LPN, told me that I should go to school to become an RN because “all they do is sit at the desk and drink coffee and flirt with the doctors while someone else does all the work.” It should be noted that my mother’s closest proximity to hospital nursing were her two stays in the maternity ward, as they called it then. The fact that she didn’t know what she was talking about has NEVER stopped her from having a strong opinion, however.Some people go into nursing as a “calling.” They figure that all they need is a compassion or a desire to help people or a willingness to put the patient first at all times and pour heart and soul into their care. Those things are nice, but a calling alone is not enough. You need to be a good enough student to graduate from a very difficult course of study and then a good enough test taker to pass the licensing exam. You need to be able to memorize drugs and their standard doses, uses and side effects, read and understand written English and be able to make yourself understood both orally and in writing. You need to be able to prioritize, to multitask and to run your buns off for twelve hours straight with only the briefest of breaks. Compassion is nice, but I’ll take the nurse who has mastered critical thinking . . . I’ve worked with both and been under the care of both. In the best of all worlds, a nurse has both compassion and critical thinking skills, but compassion can be faked. Critical thinking cannot.A strong stomach helps, too, but is not essential. That, too, can be developed. Do you hate the sight of blood? You can get over that. My husband did. But it’s not just blood. Sputum is my own personal vomit trigger. I’ve seen other nurses puke right along with their patients. You’ll have to clean up poop and pee and all sorts of other bodily fluids, and you’ll have to do it with a smile and without making the patient feel worse about it than they already do.There are those who go into nursing so they can take care of cute little babies all day, or maybe it’s sweet little old ladies. I’ve taken care of a number of sweet little old ladies, but then there are the immigrants from Hades who make your entire shift a misery, and you have to take care of them as if they were likable, too. The cute little baby who “fell off the table while I was changing his diaper” for the fourth time this month may wind up in your care and no matter what you think of the mother, you can’t tell her. If you don’t think you’d have the backbone to contact Child Protective Services, consider growing one. Pediatrics is a popular choice because everyone loves little children. Consider the fact that some of your patients may be victims of child abuse, and the abuser is right there in the room with them asking when they can go home. Or that sweet little boy with the big blue eyes may be dying of leukemia. The neonate in your NICU may have been born addicted to heroin and is going home with his mother anyway. No body likes to see this things happen, but as a nurse, you’ll see them. And worse. It’ll tug on your heartstrings, or it’ll rip your heart right out of your chest and shred it. But you WILL see these things or worse, and you’ll need to deal with them.

Can’t deal with crazy people? Obviously psych won’t be for you, but you’ll deal with psych patients in ER, ICU and Med-Surg as well. And in Rehab, the endoscopy suite and even in the nice outpatient clinics with the great fountains and real paintings. Not just crazy patients, but crazy visitors as well. You’ll also have to deal with people who are drunk or DTing, high on drugs or withdrawing and with people who are just plain entitled, nasty and mean.

Still interested in a career in nursing? Understand that hospitals are open for business 24 hours a day and 365 days a year. Working nights, weekends and holidays is a given. I don’t understand how so many people manage to make it all the way through nursing school without it dawning on them that they, too, will really have to work an overnight shift, but there are some every year. And there are those who are convinced that they are so special they shouldn’t ever have to work those undesirable shifts. Honey, if you’re that special, don’t take a job in the hospital. (But that’s where the money is, you say? Make up your mind. If you want to work in the hospital setting, you take the bad with the good)

If you live in the snow belt, you will be expected to work when it snows. Even if it snows a lot. Every year, there are posts from new nurses who don’t feel they should have to drive to work in a blizzard. They have small children or their car isn’t good in snow or they’ve never learned how to drive in the winter. None of those are good excuses, and you WILL be expected to work. If there’s a hurricane, bring four days worth of clean underwear and prescription medication, because you’ll be at work for the duration. Or you won’t have a job. Have a plan for your dog, your children and your elderly parents because part of working in a hospital is coming to work when everyone else stays home. And while I’m touching on that topic, you will be coming to work when the neighbors are hosting the neighborhood Block Party, when your husband is out of town on business and when your kids are sick. Have a plan in place for those times.

We see posts frequently from folks who want to know which specialty requires the least math, or if they really have to be able to do math at all. The answer to the second is “Yes.” The answer to the first is less polite. Your patient is 198 pounds and the physician has ordered 2.5 mg. per kilogram of medication per day in two equal doses. How much do you give now? And that’s an easy one.

There are the posts from those who wish to choose the specialty with the lowest stress level. My stress level peaks when I’m in the well-baby nursery and those kids start shrieking for what is probably a very good reason, but I can’t figure it out. Home Health makes me shudder . . . I remember my Community Nursing clinical as a special slice of hell and hope I NEVER have to enter a patient’s home again. A nice calm, code, though is another story. Your mileage may vary. I haven’t heard of ANY non-stress specialties, however, and even if there WAS one, you’d have to get through nursing school and acquire some experience before you’d be qualified for a job like that.

If you’re the type of person who looks for unfairness or bullying everywhere you go, you’ll find it in nursing . . . whether or not it actually exists. Better to go into it looking for smart, helpful team workers who will save your butt when it needs saving and teach you something while they’re doing it. You’ll find more of those if you’re looking for them. And if you cannot handle criticism, get over it. Lives are a stake here, and if I see you doing something stupid, I’ll tell you about it BEFORE you can harm your patient. In private if possible, but if not, not. One thing nursing schools don’t teach — and should — is the ability to handle negative feedback constructively. It’s a valuable skill in any career, but it’s vital in nursing.

If you’ve read all this and you still think you’d like to be a nurse, good for you. In the 34 years I’ve been a nurse, I’ve been spit at, slapped, kicked, punched, cursed and threatened. I’ve also been the recipient of grateful smiles, wonderful thankyou notes and boxes of chocolate. I’ve had horrible days where I couldn’t do anything right and felt behind the whole day, and I’ve had wonderful days when I know I really made a difference to someone. I’ve worked night shifts, days and evenings and I’ve worked all of them in the same week. I’ve worked Christmases and Thanksgivings and Mothers Days and Easter. But I’ve had my birthday and my wedding anniversary off every year, and not many office workers can say that! When my car’s engine needed to be replaced and I had no money, I worked overtime. Lots of it. Can’t do that in the office. When I needed to be home with an elderly parent, I arranged my schedule so that either DH or I would be home at all times. Can’t do that in an office, either. I worked every weekend when I was in graduate school, going to school full time and working full time. When my then-boyfriend moved out on Christmas Eve, I traded shifts with a nurse whose boyfriend unexpectedly flew back from the Gulf War for Christmas, and when my father knew he wasn’t going to make it through the winter, someone traded shifts with me so I could drive 1000 miles to cook him Thanksgiving dinner. Not only would that not be an option in office work, office workers probably would not even think about it as valuable.

I’ve learned to laugh at things that would make me cry if I didn’t, and I’ve learned to appreciate what I have because plenty of people have less. I cannot imagine what my life would have been if I hadn’t been a nurse, and if I had to do it all over again, I would.

Advance Directives: A Sense Of Peace

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The article below explains what advance directives are and how your patients may look at them.

This article was published as a patient education article but we feel the ideas are universal and can also help you as the health care provider with useful information.

What is an advance directive?

An advance directive (sometimes called a special directive) is a document that tells your healthcare provider and family what kind of medical care you would want (or wouldn’t want) if you become ill and can’t speak for yourself. An advance directive takes effect only if you can’t express your wishes; for example, if you’re in a coma.

In a living will, one type of advance directive, you tell healthcare providers what kind of treatments you’d want (or would refuse to have) if you were dying and unable to speak for yourself, or if you become permanently unconscious. For example, you may state that you wouldn’t want to be kept alive on a breathing machine if you’re unconscious with no hope of recovery.

A living will won’t prevent you from getting medical care if you’re sick or injured. It simply informs healthcare providers about what kind of care you’d want if you were dying and couldn’t speak for yourself. You can cancel or change these instructions at any time.

A durable power of attorney for healthcare, also called a healthcare proxy or surrogate, is another type of advance directive. You use it to name someone you trust to make healthcare decisions for you if you can’t speak for yourself. Like a living will, it takes effect only if you can’t make medical decisions for yourself. The person you name must be at least age 18 and usually can’t be your doctor or other healthcare provider.

We have provided a short video below to illustrate the need and usefulness of advanced directives.

Which type of advance directive do I need?

The American Bar Association (ABA) recommends that patients have both a living will and a durable power of attorney for healthcare. Although a living will is more detailed, it may not cover a medical situation you experience in the future. In that case, having a durable power of attorney for healthcare lets a trusted relative or friend make decisions about a situation or treatment not covered in your living will.

Living wills and durable powers of attorney for healthcare are for everyone, not just older adults. Sudden illness or an accident can happen to anyone.

How do I prepare an advance directive?

Prepare any advance directive when you’re feeling well. Discuss your wishes with your family and with the one person you name to make decisions for you, so he or she will know what you’d want if you become seriously ill and can no longer speak for yourself.

Your healthcare provider or local hospital can provide you with forms to fill out. If you’re admitted to a hospital, you’ll be asked if you have an advance directive; if you don’t, the hospital can give you forms if you want them. For forms and an ABA toolkit, see Selected websites at the end of this article.

You don’t need a lawyer to write your advance directive, although you may want to ask one to help you. Follow legal requirements (as outlined on the form) for preparing valid documents and make sure you put the date on all your documents. Usually you’ll need two people to witness your signature; some states also require you to have your signature notarized.

Make several copies of your advance directive. Keep one for yourself and give others to your healthcare providers, lawyer, family members, and friends. Take copies of these documents if you’re being admitted to a hospital or long-term-care facility. If your wishes change, write new documents and destroy the old ones.

Nevco Education also provided important training for care givers and medical staff thru the use of intensive training and educational videos made so you can better understand how Advance Directives are so important.

Fern Wasserman:  President & Founder of New York Legal Nurse Consultants, Inc. wrote a in depth look at advanced directives for the health care professional, that NEVCO has as continuing education on out internet testing site.  Click here  to learn more about NEVCO Online training and Advanced Directives.

www.healthlibrary4u.com (Videos for the public) www.nevcoeducation.com (Videos for the health care professional)