Now that spring is upon most of the country, it’s a good time to refresh yourself about understanding tick-borne disease, learning how to protect yourself, and recognizing signs and symptoms of infections in yourself and in your patients.
Lyme disease gets most of the tick-borne disease headlines, but there are plenty of other illnesses caused by ticks that cause just as much misery and potentially life-changing harm.
Ticks tend to live in wooded areas and fields with tall grasses. The feed on blood, so small rodents like mice or larger animals like deer, moose, or human beings make perfect hosts for these bugs. Household pets that go outside are also known to bring ticks into your home where they can drop off on floors and furniture and attach to people. They will attach to their host and can remain attached for days, transmitting diseases along the way. According to the Centers for Disease Control and Prevention, some of the more well known tick-borne diseases include Lyme, bartonella, babesiosis, anaplasmosis, tularemia, and Rocky Mountain spotted fever.
Most people can see the larger ticks, but they can get into areas that you won’t notice immediately – like your back, your feet, under your arms, or your scalp. But the ticks in the larval stage are nearly microscopic and are almost invisible unless you are searching for them. Even then, they are tough to see. And many ticks transmit a chemical that acts like an anesthetic, so your skin might not be irritated when they are biting you.
The first step in tick-borne illness is preventing yourself from ever getting it. That means treating your indoor/outdoor pets with tick medication that will both repel ticks from your animals and kill any that attach.
When you are outside, cover up with long pants tucked into socks and long sleeves if you are taking a hike or gardening. Use bug spray containing DEET to keep ticks off your exposed skin, but make sure you wash it off when you come in. And when you do come in from outside, head straight to the shower. Take your clothes off (from underwear to socks to coats) and pout them in plastic bags if you can’t get them right into the washing machine. Wash your clothes and then put everything in the dryer to kill off any ticks that might still be attached.
If you do notice a tick, pull it off with tweezers by grabbing the tick at the head and pulling hard enough to remove the whole tick. You want to make sure the head is not still burrowed into the skin. If that happens, you might need to get it removed (yet another bonus when you are working with nurses!). Wash the area and your hands and then apply an antibiotic and a bandage. Watch for signs of infection around the bite (or a Lyme-alert of a bulls-eye rash). Also pay attention to how you feel—any joint pain, fevers, flu-like symptoms, headaches—could signal a tick-borne illness.
Generally, treatment will consist of several weeks of antibiotics, but some people suffer longer-term issues. According to the Lyme Disease Association, there’s debate in the medical community, as some health practitioners believe Lyme is exceptionally difficult to diagnose and eradicate. Other believe the lingering symptoms some patients feel are related more to an autoimmune issue.
Either way, a tick-borne illness is miserable to deal with and your best course of action is prevention. You don’t have to avoid the outdoors, but take precautions and check yourself, your family members, and your pets when you all come in from the outside.
Although patient safety affects each and every one of us, it’s not always a topic people dwell on. But nurses do and they will join the National Patient Safety Foundation (NPSF) in celebrating Patient Safety Awareness Week from March 12 to 18.
“Everyone is a patient and patient safety is a public health issue,” says Sara Valentin, CMP for NPSF, assistant vice president and program lead for Patient Safety Awareness Week. “But unless you are in the health care field or a patient or a family member of someone who has experienced medical harm in some capacity, you wouldn’t know about it.”
Patient Safety Awareness Week aims to educate and inform people about patient safety with tips for taking charge of your own health or for working in a health care setting. “Preventable medical harm is one of our top issues we focus on,” says Valentin. “Wouldn’t that be wonderful if that never happened again?”
One look at the news shows new systems and approaches have significantly reduced the instance of medical harm, but it still happens. “We have made progress, but we still have a lot to do,” says Valentin. “This is a good time to stop and pause and look at the work people have done.”
NPSF generally chooses a few topics to focus on during each annual Patient Safety Awareness Week and communication and medication safety are especially noted this year. And while there are lots of events to participate in and educational and practical tips to learn and share, Valentin says the NPSF also says a little levity helps keep the topic fresh. The organization is encouraging anyone to spread the word that “We are all patients” by posting photos of themselves in hospital gowns or in patient care settings using #WeAreAllPatients.
NPSF is celebrating National Patient Safety Week in many ways. They will host a Twitter chat (@theNPSF), “Patient Safety: What Patients Want (and Need) to Know,” on Tuesday, March 14, from 1 to 2 pm (ET). Use #psaw17chat to participate.
According to the NPSF website, a free webcast, “The Voice of the Patient and the Public,” is set for Wednesday, March 15, from 2 to 3 pm (ET) and includes several prominent panelists. Registration is required online at http://bit.ly/psawweb17.
According to Valentin, “Medication itself is a big topic.” NPSF plans to offer information, resources, and facts to help people protect themselves from medication errors and to make anyone handling medications aware of where things could go wrong.
Good communication is a significant deterrent to medical errors, but in the hectic health care world, it requires constant diligence from everyone. Patients can look at their relationships with health care providers as partnerships where they should ask questions and clarify instructions until they really understand what the final plan is.
Nurses can give their patients the time to ask questions. Even when it seems like you cannot squeeze one more minute out of the day, spending a few extra minutes to make sure a patient understands the proper medication, the correct dose, and instructions for taking it is essential. She says, “You can ask, ‘Do you have any more questions,’ or ‘Are you comfortable with what we have talked about?’” Some patients are especially easily overwhelmed in a medical setting and might not listen to each and every thing you are saying. Giving one last opportunity to clarify things can prevent mistakes.
And nurses can continually tweak their own processes. Nurses also need to listen to each other carefully to make sure they are both communicating and understanding everything that is needed and being said.
And while this one week will highlights the critical importance of avoiding errors, Valentin says nurses know it’s a 24/7 issue. “Every day is patient safety day,” she says. “This is a week to celebrate, but it’s something we work on every single day.”
There’s no denying the correlation between nurse staffing levels and patient outcomes. As the Baby Boomer generation continues to retire, the need for additional medical attention increases (hospitals, aging facilities, etc). But because the nurse population mirrors the overall population, this means we also face a bubble of nurses entering retirement, reducing the number of experienced health care staff available to serve patients and creating new stresses on health care teams and health care facilities. A recent article in the Wall Street Journal stated that the United States is in the midst of a nurse retirement epidemic. These and other trends are creating exposures nurses are facing today and into the foreseeable future.
Risk experts at Nurses Service Organization (NSO) identified key risks for nurses as a result of staffing shortages:
1. Higher patient loads.
The Affordable Care Act has impacted the volume of individuals with health insurance, including individuals with complicated issues who once used to only seek treatment when necessary through the ER. This larger and more complex patient load places additional pressures on nurses. When care suffers, positive outcomes are negatively impacted, which only strikes down hospital reimbursement rates, making it all the more difficult for hospitals to be able to afford additional highly qualified nurses. It’s a vicious cycle.
2. Extended hours.
As shifts stretch (often last minute), fatigue becomes more of a factor, mental acuity may suffer, and the opportunity for an incident increases. When combined with increased patient ratios, nurses have more opportunities to, inadvertently, make mistakes and injure those they serve or themselves. These added hours also can create job dissatisfaction, which stresses health care teams and staffs.
3. Increased responsibilities.
Nurses are at the center of patient care, acting as an advocate between patients and physicians, and patients and family and friends. More and more, nurses are becoming accountable for the coordination of care and providing informed discharge notes for patients, which extend the potential to impact outcomes and the nurse’s exposure beyond the facility walls.
4. Greater likelihood of “floating.”
The nursing shortage creates gaps in coverage and the need for additional nurses to ‘float.’ Unfortunately, when nurses are assigned to an area they are unfamiliar with, or when a team of nurses has a professional from another department entering their zone, it can create confusion and issues. In fact, the most recent NSO claims report shows agency nurses (who often are sent to help facilities fill gaps in coverage) were involved in nearly 25% of the closed claims in the study. We can expect these workplace dynamics will continue to evolve as facilities move nurses as needed to address shortages on the fly.
5. New nurses entering the workforce.
The next eight years will see a steady stream of new nurses entering the workforce to replace those retiring. Much like nurses who float, these new nurses will need experience, on-the-floor training, and mentoring to acquire the skills needed to master their environment.
As the country continues to see an increase in the number of people ages 65 and up as well as more patients entering the health care marketplace, the nursing shortage will continue to be a concern. This rising concern has the potential to place all nurses into higher risk working conditions they need to protect themselves, and their careers, against.
February is all about heart health—what you can do to improve it, ways to prevent damaging it, and finding out what heart-healthy habits work for your lifestyle. Stress is a big contributor to poor heart health, so relieving stress is a natural way to improve your odds.
But reducing stress, especially when you’re a nurse, is not always as easy as it sounds. Sure, you can try (and probably have great success with) yoga classes or even with the scientifically proven meditation. But if you want to find something a little off the beaten track, try these odd ways to give your stress the boot.
1. Bake Bread
Baking bread is such a huge stress reliever that some medical professionals tell their patients to try it. But you have to put the bread machine away for this one. This is bread baking the old-fashioned way. All the banging and kneading of the dough not only gives your upper body a workout, but the repetitive motion is incredibly soothing. Then call a friend to come over and share your wonderful loaf of bread.
2. Laugh Really Hard
There are lots of formal and informal laughing groups that gather strictly for the purpose of laughing. People get together and try to force a few big laughs, but the resulting honest laughter can really relieve your stress. You can also get your laugh meter going the old-fashioned way. If you want your laughs to come from something funny, tune your radio into some comedy stations, download some funny podcasts, or get some comedians’ CDs from the library. You might have to seek it out, but ticking your funny bone really is good for your health.
3. Carry a Fragrant Cotton Ball
This might sound weird, but carrying around a cotton ball infused with an essential oil can have a huge impact on your mood. Carry your scented cotton ball in a baggie or a small plastic container (remember the idea of this blog is weird ways to relieve stress!) so you can sniff it periodically throughout the day. Lavender is an excellent and well-known relaxing scent. Citrusy scents like lemon, lime, or grapefruit are invigorating and might help your brain out of an afternoon slump.
4. Rest Your Eyes on Beauty
When there’s no way you can step outside or escape to the blue ocean of the Caribbean, find an app with a flickering fireplace or with soothing ocean waves or the bird songs in a rainforest. Spending a few minutes looking at something peaceful (bonus for added sounds) will bring your blood pressure down a few notches even if it’s not the real thing. You can spend just a few minutes gazing and then get back to your day a little more relaxed.
5. Watch a Sad Movie
This is not for everyone! But if you are one of those people who feels relieved after a good cry, you might want to turn on a good tearjerker. A good crying jag can release a lot of pent-up emotions and, in fact, get rid of some of the stress you’re holding in. But, if you’re someone who takes a long time to shake the sad feeling of movies that make you weep, skip this tip.
Finding out what makes you feel better is always good–even if it is a little out of the ordinary. In the end, what matters is your health, so find a great stress reliever and stick with it..
Hospitals will face a major dilemma if the current federal administration repeals the Affordable Care Act (ACA) without a suitable replacement. The ACA offers millions of Americans affordable health insurance, and hospitals have seen their revenues, and their quality of care, rise as those newly insured citizens access their services. If the ACA goes away, those health care patients and their accompanying insurance payments disappear, putting even more stress on today’s health care labor force. With profit decline comes employee decline, both in number and quality. This will first and foremost affect nursing staff, putting some out of work and others in-over-their-heads.
An Uncertain Health Care Future
Before enactment of the ACA, existing law required (and still requires) that health care facilities provide “stabilizing care” to any person who requests services, regardless of their ability to pay. Medicaid covered these costs. Without ACA coverage, many patients will be forced back to receiving only the substandard “stabilizing care,” and will not receive the services they need to regain their health.
In that circumstance, the medical facility will be forced to balance the volume of unsubsidized, stabilizing care offered against the revenues generated by paying patients, cost reductions, or staff workload increases. If they offer excessive unsubsidized care, they risk declining income levels, staff numbers and possible bankruptcy. If they provide too little, they risk losing their Medicaid/Medicare funding. In both cases, the facility, its staff, and America’s uninsured patients will suffer.
Unpaid Care Is Expensive for the Medical Office …
Every medical consultation generates a series of cost-creating actions, from those of the scheduling secretary to the attending medical professional, and all the way through to the deposits made by the final billing clerk. According to the American Hospital Association, hospitals provided $35.7 billion in uncompensated care to their patients in 2015 alone. When a hospital absorbs these losses, it is also forced to reduce the services it can afford to provide.
Consequently, it is not unheard of for doctors to reduce the size of their bills by limiting the services they provide or the number of recommendations they make, based on their perception of what the patient can afford. Other studies confirm that uninsured patients are checked into a hospital for shorter stays, and they are offered fewer interventions for their condition. For the health professionals, these painful decisions are in direct conflict with their oath to provide the best care possible for every patient.
… And Hard on the Staff
One group of hospital workers that will certainly absorb a significant percentage of additional work due to funding cuts are the nurses. Reduced funding often leads to reduced staff numbers; remaining staff end up working longer, harder shifts, with more responsibility and less break time. And nursing is already a challenging job, with a high demand for significant physical labor that also takes an emotional toll. In fact, between 2002 and 2012, nurses have reported the highest stress levels of all health care professionals.
Additionally, long hours may not allow nurses to get the sleep they need. Inefficient sleep has been associated with a deficit in performance, caused by cognitive problems, mood alterations, reduced motivation, increased safety risk, and physiological changes. These effects only get worse with total sleep deprivation, common among nurses who work consecutive shifts.
Additional Stress Factors
Research reveals that the changes in the nursing profession in particular and the health care system in general, contribute significantly to the problem:
- Sophisticated technology offers immense benefits but adds additional layers of responsibility on already overloaded schedules;
- Burnout is common, too. Protocols can change as resources ebb; nurses are compelled to follow evolving practices without the opportunity to add input regarding their patient’s care. A 2012 study published by the Canadian Federation of Nurses Unions found high levels of burnout correlated to lower ratings for quality of care.
- Reduced staff numbers also drive nurses to work even when they are sick. Many choose to potentially infect their patients rather than leave their colleagues unsupported on shift.
The reality for America is that, before the ACA, unpaid hospital bills were often eventually born by other elements of the system, including taxpayers and patients who incurred higher medical care costs. Repealing it won’t save the country money, but instead will add extra stress to the system and further erode the health of millions of its citizens.
Of all the risk factors for heart disease, the areas you have no control over are often the ones that are especially troublesome. While you can make inroads to a healthier diet, more activity and exercise, reducing stress, and even taking appropriate medications, it often feels like there’s nothing you can do to change your family’s track record of heart disease.
As February is American Heart Month, now is a great time to take stock of your own heart health. Knowing that your family carries a higher risk for heart disease is actually a great motivator to keep your own heart as healthy as possible. In many cases, if you ramp up your efforts to control what you can, you can negate some of your family’s health lineage.
Can you change your family’s past? No – if you had a father and three aunts who died from heart disease in their 40s, you need to take that very seriously. But it doesn’t mean you will take the same path.
How can you beat your genetics?
Know Your History
The American Heart Association recommends gathering as much family history as you possibly can. If you are at least able to start with members of your immediate family, that will help you assess your risk.
Look for family members with a history of heart attacks, strokes, high blood pressure, high cholesterol, or congestive heart failure. Find out how old family members were when they were diagnosed and how old they were if they died from the disease. And try to notice any patterns – is the predominant problem heart attack or stroke?
Accept (But Don’t Give Into) Your Genes
There is virtually no way to change your genetic makeup. But if you carry an elevated risk, it can make you feel unsure of what’s to come. So while you can’t change your genetic cards, you can change how you live your life.
A lifestyle that is heart-healthy, heart-friendly, and heart-supportive can contribute greatly to your overall heart health and start to bring your elevated risk into a more normal range.
Talk with Your Team
Talk to your healthcare providers to make sure you are getting all the tests you need to uncover any early indicators of heart disease. Discuss medications and other therapies that can lower your blood pressure and your cholesterol and even get things like triglycerides into normal range.
Some minority populations are more predisposed to heart disease (including African Americans and Hispanics), so go over some of those risk factors. And have a discussion about any other conditions you may have that could put you at a higher risk including diabetes, depression, and even psoriatic arthritis.
Make Heart Health a Priority
No one else is going to put your heart health first, so that’s going to be up to you. Put caring for your heart at the top of your to-do list. That means taking a look at obvious things like your eating habits, your weight, your blood pressure and cholesterol numbers. But it also means making sure you get enough sleep (lack of sleep raises your risk of heart disease over time) and making sure you take the time for pleasure.
Loneliness also contributes to declining heart health, so develop a rich social life and figure out exactly what that looks like for you. Some people want three parties every weekend and others are happiest having dinner with best friends every couple of weeks or a favorite book club every week.
No matter what story your family health patterns reveal, it doesn’t mean that’s your destiny. With some changes and lots of diligence and close observation, you can keep you heart healthy and strong.