Thursday, May 14, 2015

The Value of a Nurse

It was a familiar walk.  One I had made countless times.  Over the years I had entered the Children's hospital Operating Room (OR) on a regular basis to observe and support surgeons during surgery.  It was my job.  I worked for a minimally invasive surgical device company and I loved it.  But, today's trip up to the second floor was not for work.  This time was different. This time I was on the other side of the double doors marked, "Authorized personnel only." They were doors I had walked through many times, but had never been forced to wait behind.   Today would be filled with deja vu and reflection because today the little person walking down the long corridor to the OR was my son.  My little boy. My everything. And I was overcome by emotion.

What must he be thinking?  I was his mommy and I was handing him over to complete strangers in scary masks and hats.  I told him to do whatever they asked and had allowed them to poke him with needles and take him away from me when he was terrified.   As I watched a nurse take my little boy into the OR, I knew what he would see.  Bright lights, computers, a huge anesthesia cart, empty canisters and TV screens.  I pictured him assessing the room and climbing up to the giant operating table.  I wondered if he would be afraid of the scopes lying on the sterile scrub table?  Afraid of the room?  I was relieved he chose his dad to go in with him. Looking him in the eye and seeing his fear was overwhelming me.

I immediately flashed back to work and the first time I had to go into the OR at the children's hospital. It was about two months into my new job and I was excited to see my first major pediatric Urology case. I remember it as clear as yesterday.  The patient was a 12-year old girl with a congenital condition that caused her to manufacture kidney stones like a production line. I would see nothing like it again in a child. I was there to assist with the machine that broke up the stones and removed the fragments from the kidneys. It was a long and tedious process.  The normally two hour surgery was finally aborted after six hours.  What I remember so clearly about this case was that this was the first time that I became acutely aware of the nurses.  Six hours of observing them in the OR that day gave me a whole new appreciation for all the intangible things they do that makes them special. It was the day I noticed them do so many things that I've come to associate with nursing and yet are not in the nursing job description.

While the surgeon was worried about his patient and her kidneys, the nurses were worried about the child and her family.  It was a beautiful balance that exemplified the importance of each of their roles.  While the surgeon was ordering more suction, it was the circulating nurse who noticed the little girl had cold feet and ordered socks.  While the urology nurse was prepping the patient for another access point she took the time to adjust the pillow that was slipping out from under the little girl's head.   When the two hour mark passed, it was the scrub nurse who looked up at the clock and reminded the doctor that the surgery was taking longer than planned and her parents were probably worried. He thanked the nurse and sent someone to update the family.

Sitting in the OR waiting area the vivid events of this day flooded back to me.  In large part because I finally understood.  During our pre-op meetings we saw two doctors and probably five different nurses. It was the nurses who we we interacted with most of the time.  The nurses answered most of our questions and gave us our instructions.  It was the nurses who tried to make my crying child laugh.   The surgeon who came in to speak with us was kind, patient and sweet.   The surgeon smiled at my son and said hello, but she was all business, efficient and serious.  I now understood why.  She did not want to have the image of my son's face and tears in her mind as she tried to find out what was wrong with him.   She needed to be focused on the procedure and the medicine, not on the fear of the child or his family.

I felt blessed that I had seen the OR from the perspective of doctors and nurses. Knowing there would be so many nurses in the room gave me immense comfort. The doctors may have been in charge of overseeing his medical care, but it's the nurses who determined my son's overall experience.  I knew It would be the nurses who made sure his stuffed shark got the same hospital band as my son.  It would be the nurses who made sure his feet were warm and his body comfortable.  They would be the ones transferring him and holding his hand as he fell asleep. And I knew it was the face of a nurse that my son would first see when he opened his eyes from the anesthesia.  It was her arms that would hold him when he freaked out.  Her hands keeping him from pulling the tubes out of his nose and mouth. Her voice telling him it would be ok and that he was safe.  It would be a nurse who would come and get me when he cried for his mommy.

As patients we often see nurses executing the doctors orders. However, it is my hope that the nurses who helped my son in the OR that day know that they did so much more for him.  While their job to help manage the execution of medical care is important,  watching them with my little boy showed me what it is that makes them so valuable.

So, to all the nurses who helped my son, Thank you. Thank you for holding his hand and taking away his fear. Thank you for dealing with the emotion and the pain and crawling into his cot to hold him when he was scared. Thank you for being an extension of mommy when mommy couldn't be there.  Thank you for seeing a child and not another patient. It may have been his Doctor who treated my son as her patient, but it was the nurses who humanized him.   It was the nurses who gave him back his status as my little boy.  You never forgot what really mattered. For that I am eternally grateful.

Written by Heather Conner

Friday, May 8, 2015

New recommendations for treating patients with high blood pressure and cardiovascular disease

Scientific Statement"

March 31, 2015 Categories: Heart NewsScientific Statements/Guidelines

Statement Highlights
  • Three professional organizations have issued a joint statement on treating high blood pressure in people who have been diagnosed with coronary heart disease, stroke or other forms of heart disease.
  • The statement reinforces the goal of reducing blood pressure to under 140/90 in order to reduce the risk of heart attack and stroke.
  • Patients should know their blood pressure, make lifestyle changes to reduce their risk of heart attack and stroke, and work with a physician to safely lower their blood pressure.
This article was published in DALLAS, Texas on  March 31, 2015 .  The American Heart Association came out and discussed a new scientific statement issued jointly by three medical organizations and published in the American Heart Association’s journal Hypertension, which addresses how low healthcare providers should target the blood pressure when treating patients with high blood pressure who also have vascular diseases."The document provides an up-to-date summary on treating hypertension in patients who have both high blood pressure and have had a strokeheart attack or some other forms of heart disease, said Elliott Antman, M.D., President of the American Heart Association and professor of medicine at Harvard Medical School."1

In the article; “The writing committee reinforces the target of less than 140/90 to prevent heart attacks and strokes in patients with hypertension and coronary artery disease,” he said. “This is important since confusion has arisen in the clinical community over the last year regarding the appropriate target for blood pressure management in the general population.”1
The American Heart Association, American College of Cardiology, and American Society of Hypertension have 
issued a joint statement regarding this issue. 
According to this joint statement, "while a target of less than 140/90 is reasonable to avoid heart attacks and strokes, a lower target of less than 130/80 may be appropriate in some individuals with heart disease who have already experienced a stroke, heart attack, or mini-stroke (also called a transient ischemic attack or TIA) or who have other cardiovascular conditions such as a narrowing of leg arteries or abdominal aortic aneurysm."1
The committee states that lowering  a patient's b
lood-pressure can be done safely, and the vast majority of individuals will not experience problems when standard medications are administered correctly. However, the joint statement recommends that healthcare providers use extreme caution in patients with coronary artery blockages, advising that "blood pressure should be lowered slowly, and not strive to decrease the diastolic (lower number) blood pressure to less than 60 mm Hg, particularly in patients more than 60 years old."
The group writing the article and recommendations offer specific, evidence-based recommendations and contraindications to help healthcare providers select which 
anti-hypertensive medications to use in patients with various types of heart disease. 

“In the spectrum of drugs available for the treatment of hypertension, beta-blockers assume center stage in patients with coronary artery disease,” said Clive Rosendorff, M.D., Ph.D., who is the chair of the writing committee, as well as a professor of medicine at the Icahn School of Medicine at Mount Sinai in New York.  He is also the director of graduate medical education at the Veterans Administration in the Bronx.   Beta-blockers not only slow the heart rate and reduce the force of cardiac contraction, both of which reduce the heart’s consumption of oxygen. They also increase blood flow to the heart by prolonging the time between contractions, which is when blood flows into the heart muscle.

Additional Resources:
  1.  Association, A. (2015, March 31). New recommendations for treating patients with high blood pressure and cardiovascular disease. Retrieved May 8, 2015, from