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Nursing Ideas: Great Canadian Nurse Blog With Worldwide Implications

May 22, 2010

I just wanted to take a moment to thank Rob Fraser for re-posting one of my previous blog posts about podcasts. In doing so, I wanted to challenge other nurses from around the country to begin working with Rob or on sites similar to Rob’s. His site, http://www.nursingideas.ca, is a demonstration of the vast potential of blogging in nursing (or any profession for that matter). The interviews and videos, writing, thoughts, and comments all provide a unique place for presentation of nursing ideas from top Canadian nurses and an honest open dialog about those ideas. I have seen very few other nursing organizations utilize the internet, the great equalizer, in the way that some of these great nurse bloggers are, presenting ideas in an open content format to spark dialog. Nurse bloggers are doing this and Rob is a stellar example.

Thank you Rob for creating a safe, thought-provoking, and ingenious place on the web for nurses from all over the entire world to come and think.

P.S. Shout out to another great Canadian nurse blogger who makes me laugh, think, and comment – http://torontoemerg.wordpress.com/

And don’t forget Phil Baumann, Lorry Schoenly and other greats!

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Oh Yeah! Nurses learning social media as a viable health care communication venue

April 27, 2010

I teach an informatics class to BSN completion students. The class is an intensive 6 week block class that is 3 hours of credit in an online format. In light of this truth, the class is often a frightening prospect upon entry. (Sort of like riding the rock-n-roller coaster at the MGM theme park for the first time).

However, with the rapid changes in both technology and communication some knowledge in social media, appropriateness of website information, and effective writing is critical to nurses. The class emphasizes the clinical information system and the EHR, but in an effort to bring knowledge on general technology and communication, assignments relating to social media and blogging  were born.

My students often cringe at my assignments; to create and maintain a twitter account, attend at least one online chat, procure legitimate followers, and complete all written work for the course in blog format (which means developing their own blog). I have found that this type of work for students is like White Castle burgers… they either love it or hate it, but in the end they all develop an appreciation for it.

Armed with information on communication, social media, valid website interpretation, their own interest in subject area, and a need to practice developing their school work and research for an audience beyond the course faculty and a grade, they work hard to develop legitimate learning through new means of communication. This semester’s class was no different. Below I provide links, with their permission, to some of their greatest works…. their Webliographies and blogs. An effort to put sound information about internet links together in one place. They did a great job!

Congratulations to the NUR 3563 class of SBU for the spring of 2010. You set the bar high for those that will follow.

http://jlanurse.wordpress.com – Multiple Myeloma

http://jessblaha.wordpress.com/ – Oncology Nursing Society

http://nursemichelle.wordpress.com/ – HPV

http://horsejunkey.wordpress.com – Schizophrenia

http://www.nursechenene.wordpress.com – Macular degeneration

http://leeamyc.wordpress.com/webliography/ – Nursing burnout

http://cebunurse.wordpress.com– Antiaging

http://knwanurse.wordpress.com Lou Gehrig’s Disease

http://susug514.wordpress.com – Asthma

http://nursedave4.wordpress.com – Cardiac Dysrhythmias

http://www.cmjarvis.wordpress.com – Exercise and disease prevention

http://WindsorRN.wordpress.com – Stroke rehabilitation

http://ytleyva.wordpress.com/ – CHF

http://AMartinRN.wordpress.com – clinical nurse specialist (informatics)

http://rnlife.wordpress.com/ – Multiple sclerosis

http://momofzejt.wordpress.com – Pediatric Obesity

http://lacyphillips1.wordpress.com – Pancreatitis

http://rnladyffchick-r-u-prepared.blogspot.com/2010/03/when-disaster-strikes.html – Emergency Preparedness

http://neuronurse22.wordpress.com – Alzheimer’s Disease

http://rowlettrn.wordpress.com/ – L&D

http://ezernurse.wordpress.com – TB

http://oncnurse66.wordpress.com – End of Life

http://sumtip.wordpress.com – MS

http://amysgerd.blogspot.com – GERD

Nursing Curriculum: Why do some of us still teach drip rates? (thoughts on tradition versus EBP)

March 24, 2010

Todays thoughts are prompted by excellent questions from my friend and nursing faculty Paul Pope. He really got me to thinking…. (dangerous I know).

Nursing students and faculty alike, I am curious about a few things that I hope you can comment on, helping to shed light on current trends in nursing education. Granted, we do not have to embrace or teach every new trend that comes along, but EBP is strong and needs consideration in curriculum. So, I am wondering how many of you still teach or learn certain things. Here are just a few of my questions/thoughts:

Do we still teach/learn drip rates based on medical tubing size? (how many of you out there seriously hang fluids to gravity on a regular basis… I mean there is so little time to teach them other important things…)

How many of you had an honest to goodness nursing informatics class in your curriculum in the last few years?

How many of you have switched/updated text books, but are still using the same powerpoints for lecture that you developed over 5 years ago?

How many of you still teach/learn: dorsal gluteal IM injections, aspiration with insulin injections, blood glucose checks at 5am are still good for dosing insulin prior to the breakfast tray at 7am, etc… or instead have you added new focus to preventative care, educating nurses on patient education and prevention on topics like weight loss, mammograms (if they even need one), vaccinations, etc.

How many med-surg courses still cover open prostatectomies or open GB removal and not care for the laparoscopic gastric banding patient, etc…?

How many of  you learned/taught anything but acute care nursing (meaning nothing outside of the hospital) in your basic RN programs? (Seriously, does the majority of health care not happen outside of the hospital?)

Does your nursing school offer their courses in odd blocks like 2 hours credit, so that transfer of those hours out becomes difficult for students or so you can cram more into the curriculum and still have ‘less hours’ for your degree?

Is nursing education still fragmented, teacher centered, centrally controlled, pre-digested material as Warick put it way back in 1971 (Allen and Jolley, 1987)? Why do we still remain so fragmented, from state to state, school to school, nurse to nurse, in what we agree to be foundational nursing knowledge.

These are just questions I have. Maybe this is not happening and we are all good and do not need to change anything. If so, wonderful. I am not an expert at all on the subject and am on a fact-finding an anecdotal evidence mission. I look forward to feedback on this topic.

There are some interesting discussions going on out there on this topic and some organizations are getting together to unify and change nursing education to meet new patient demands, encourage community and preventative health education, and teach congruent curriculum. Further, we are nursing! Adaptable, flexible, and the executors of great health care. Ideas and discussion can bring us to consensus to provide the most excellent nursing education.

For example, check out what the Oregon Consortium for Nursing Education is doing – http://ocne.org/curriculum.html (thanks @maryannagordon from twitter land). Open discussions on nursing education have also occurred at the RWJF through the future of nursing project. Standards for curriculum, like the AACN’s Educational Standards, are an excellent place to start but widely open to interpretation.

The ultimate goal is providing the most appropriate preparatory education for nurses that covers a good foundation of nursing to spark critical thinking and cover major areas of health care for our patients. Not everything can be covered, but also, what do we need to let go of?

Why Printed, Peer-Reviewed Nursing Journals Will Go Away and 10 Leadership Tips for Nurses (Random thoughts for a March afternoon)

March 7, 2010

Hello nursing gang! I know you all were anticipating my next blog post with utter excitement! I have been working on so many things and have missed you all, but I wanted to share a couple of things that have been on my mind with you. So read on and be amused, outraged, informed, or simply entertained.

Why I think print peer-reviewed nursing journals are and will go away. It has been my observation over the last several months that more nursing journals have moved to an online format. The ANA and Sigma Theta Tau International have both greenly placed their journals online and such a move brings cheers from their members, however these journals remain available only to membership (see my brief list of online nursing journals below). Say good-bye to paper and hello to open access, if you want to be hip and with-it in the information age.

The future and present of nursing publication is web-based; saving time, cost, and trees. One can only hope that the months that it takes for articles to be reviewed for publication will also be diminished. This great span of time, from submission- to review- to revision- to resubmission of an article, is one of the greatest hindrances to rapid publication of vital nursing information and while peer review and editing are an important part of integrity in the nursing science information process, speed is much needed. In my humble opinion the time factor in peer-review may be holding things up a bit, that’s where our nurse bloggers will come in. My greatest hope is that more journals will consider opening up guest blogging and journal spots to students, both graduate and undergraduate, to make more nurses part of the process of publishing. Nursing students, in my opinion, carry some of the most up-to-date nursing science information by nature of their constant work in libraries and on projects, having much to lend to the discussion of nursing science.

Further, I would like to challenge nursing organizations who publish ground-breaking nursing work, such as the new scope and standards of nursing practice that the ANA is working on, to begin to open such documents up in availability to the entire world and not just their membership. For example, I find it ridiculous that a copy of the nursing code of ethics from the ANA cannot be downloaded by anyone interested in what nursing ethics should be (this would include government officials, patients, physicians, and nurses around the world). Let’s be more transparent and accessible to nurses and patients; in that we will find our relevance for putting such information on the web.

Either way the publication world, nursing, education, and technology are changing rapidly and nursing science must change with it. Leaders in publication, communication, social technology, and blogging like Phil Baumann, Rob Fraser, Barbara Olsen and others will help lead us in the right directions. Perhaps, blogging will lead the way and organizations who are actively transmitting information will follow in good nurse bloggers’ footsteps. Some organizations are ahead here and should receive big Kudos, such as the INQIR. Below is a list of online nursing journals and nurse bloggers to check out.

10 Tips for ANY nurse about leadership. I teach administration and leadership to RN-BSN completion students. Having a strong clinical background, when I was assigned this class I was quite challenged by the material in it. Finding mostly very dry information about staffing ratios, budgeting, and time management, I wondered if many of my students would really take interest in the information I was presenting? While such information is vital to a nurse manager, as my husband would say, textbooks  rarely end up on the best seller list and there are obvious reasons why. My observation of dry text and dry subject matter leads to disinterested students who are simply trying to get through a class and get a degree. This is not the atmosphere I want for my students. On the contrary, I want them to love nursing as much as I do. This goal led me on a quest to begin investigating nursing administration and leadership from a perspective of personal interviews and reading outside of the discipline of nursing. (Yes nurses, did you know that business gurus write much more interesting and applicable text on administration and leadership than we do?) While observing and learning, I realized that any nurse, whether bedside or boardroom, could utilize some basic tips.

1. LISTEN with an open ear to all parties. Listening without bias or preconceived ideas, really listening, is an art form. For those of us who’s brains and mouths go 100 miles an hour, and who are used to having to fight for any progress we make in a discipline, workplace, or for our patients, find difficulty in really listening. In a 2007 article in Business Week writer Carmine Gallo says that this is a key trait of good leaders. Often as nurses we pride ourselves on truly listening to and advocating for patients, but how often do we do this for each other?

2. Be a good follower. Any leader is only as good as their followers, and the best leaders are sometimes the best followers. Think about the outstanding leaders you know who are integral team players, who show humility, letting others take they lead when necessary, listening openly to others’ visions and ideas, and supporting other leaders constructively. Honestly observe a good leader and often you will note good follower characteristics. Does this mean be a blind sell-out follower? No, but a good follower knows how to be a constructive part of a team, how to remove roadblocks to get their leader and team to the ultimate goal, and how to act instead of just waiting for someone else to do so (sounds like the description of a good leader doesn’t it?).

3. Take chances and risks, even if it might mean failure. Good leaders take risks. Do they gamble with followers? Sometimes, but I would venture to say not much. Taking risks does not necessarily mean endangering people, it means moving out of the entrenched. Let me give you an example. A recent dean I worked for had an issue with the size of employee e-mail storage, finding no resolution with IT, she moved forward with public e-mail sites for all of her faculty. The idea worked out beautifully and although she risked the scorn of her peers and the IT department, she did what was best for her faculty. She promised the IT department that when they came up with a better solution than hers, she would gladly change to their solution. Her quick action helped not only faculty, but students as well. Risk taking does not have to exactly look like this, but it could. Maybe for you it is going out and writing a patient information handbook for your unit that you have been thinking is badly needed (even if gets rejected how much will you learn and inspire others?), or maybe its a simple patient care change. Come on nurses….. take a risk!

4. Stay focused on a few projects/causes and do not get roped into everything. Good leaders usually have enormous amounts of energy, they are the nurse who volunteers to teach CPR, help with new nurses orientation, and bake cookies for the staff meeting etc…. You know to whom I am referring. Often, these good leaders get roped into too many good causes. There are more than a million good nursing causes out there and a million more projects to be involved with. I urge all nurses to pick only a few, no more than three, and keep focused. When you conquer those projects or causes then move on to a new one, but do not take on more than 3 projects at a time. Too much of a good thing tends to burn out our brightest stars quickly.

5. Share your vision clearly and frequently. The good old elevator speech works best, but honestly share your cause and ideas often and with everyone, even if your cause is as simple as moving the trash cans to a different position in the patient room. Tell your boss, your colleagues, people who work in different departments, the janitor, your twitter friends, whoever will listen. Casting your vision and energy wide and repeating it often is how you get people to buy in. Likewise, sharing performs a second important function… it helps others refine or edit your vision/idea to make it more workable. Keep it brief though, no one wants to hear you go on and on.

6. When you are sharing vision or leading with a specific project, clearly lay out your values with the team. Too often we assume, as nurses and humans, that others buy into our value system simply because they signed onto our project. It is important in the beginning of any project/meeting/organization to clearly layout what the values of the team will be. A good leader might even let the team decide what values will be cherished. Clear values help a team with vision and progression to the goal. If you see a group doing cool things odds are they have a team approach to mission and values… not some organizational top-down, printed on a website, fake mission…. you nurses out there know what I’m talking about :).

7. Cultivate new leaders. Good leaders take others under their wing and mentor them to greatness without an official program or direction. I have observed that the best leaders grow new leaders under them, from the beginning. They take their mentees to board meetings, involve them in heading up projects, and simply interact with them through daily duties. Often times, the best leaders build something critical that is the only way to build new leaders…. RELATIONSHIP. It is not succession planning and it is not all business, but something deeper entirely. Think back to the best nurses who precepted you in your first days as a nurse, they were generally the best unit leaders even without rank or title. Didn’t they inspire you on to more? Now go and do likewise.

8. Network. Anytime, anywhere, try to meet new nurses in your field who are doing new things and pick their brain. This means you are going to need to join at least one nursing organization and be ACTIVE (don’t just put it on your resume as a way to get hired at the next job interview). You also may need to learn how to use technology to socially network with other nurses. Twitter, LinkedIn, and Facebook are offering boundless opportunities for this. However, your local nursing organization is a good place to start. Six Pixels of Separation, a great blog on leadership and business recently advised that to build a good community (read in here vision/project/cause) you have to be an active community member first, the same goes for leadership.

9. Keep Learning. The best nursing leaders are always on ‘learn’ mode. Does this mean continue on in school? Maybe, but more than schooling good leaders do journal or blog reading, go to specialty conference every few years, or simply read a book. Hint, disciplines outside of nursing have much to teach us… try reading in science, business, communication, journalism, and even leadership to give your practice an exciting new charge.

10. Write things down. I know this sounds silly, but the best leaders I have seen are constantly writing down thoughts. They either jot them down in a notebook, twitter, blog, etc… They also do cool things like plus and minus lists, writing down both short and long-term goals, and they generally like lists. Famous chef Rachel Ray stays up late into the night to write down recipes. Famed leader Bill Hybels in his book Axiom even encourages journaling, plus-minus lists, and a cool short-term organizational method called the six-by-six. Whatever your take on leadership, good leaders, write things down.

On a final note about leadership it has been my experience that the best leaders are often not in administration, but in the trenches. They mobilize and inspire colleagues. One thing I tell my students is that to be the best leader you don’t need a title. Simply being a nurse means leadership.

Online Nursing Journals and Great Nursing Blogs

ARHQ Morbidity and Mortality Rounds on the web – http://www.webmm.ahrq.gov/

Evidenced Based Nursing online at the BMJ (60 day free trial) – http://ebn.bmj.com/

The Journal of Undergraduate Nursing Scholarship – http://www.juns.nursing.arizona.edu/

The American Journal of Nursing Online (MY FAVORITE :)) – http://journals.lww.com/ajnonline/pages/default.aspx

Online Journal of Rural Nursing and Health Care – http://www.rno.org/journal/index.php/online-journal

Lippincott’s Nursing Center on the Web (another favorite)http://www.nursingcenter.com/home/index.asp

STTI’s Journal of Nursing Scholarship (have to be a member to get the goods) – http://www.nursingsociety.org/Publications/Journals/Pages/JNS_main.aspx

ANA’s Online Journal of Issues in Nursing (again membership =’s goods) – http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN.aspx

*remember you can search almost any journal online to see what is in their journal, but again article access is problematic (I guess that’s another reason to be a student all of your life – online library access)

Bloggers I love!!!

Blog of the Interdisciplinary Nursing Quality Research Initiative from RWJFhttp://inqri.blogspot.com/

Tech and Nursing talk from Phil Baumann – http://philbaumann.com/

Nursing ideas and nurse leaders speak at Nursing Ideas by Rob Fraser http://www.nursingideas.ca/

Safety nurse leader Barbara Olsen keeps us all safe at Florencedotcomhttp://florencedotcom.blogspot.com/

Great and funny nurse writer Mother Jones at Nurse Ratchedhttp://nurse-ratcheds.blogspot.com/

Nursing Jobs keeps a great blog with discussion on important national nursing issues http://www.nursingjobs.org/blog/

Dr. Lorry Schoenly teaches us about correctional nursing at her bloghttp://lorryschoenly.wordpress.com/

There are more great nursing resources out there on the big WWW, but these are a few of the best.

Eating Disorders Part 2: Body Image, Eating Disorders, Westernization, and Global Progression

February 13, 2010

This post is Part 2 in a series on body image and eating disorders. Here the research behind the theory of ‘Westernization’, gender roles, and the effect of both on eating disorders globally.

Women, Politics, Culture, Media and Development of Eating Disorders

It is strongly established that in American and Europe eating disorders are diseases that primarily afflict caucasian women. Although, closely tied to factors such as personality, family, and media exposure; gender’s relationship to disordered eating is one that has been limitedly explored. What ‘is’ is simply accepted as the hallmark of a disease in a certain population, that population being women. However, eating disorders have also been compellingly tied to a rise in industry and affluence in cultures (1,2, 3, 4, 5).

Historically, this tie to industry and affluence appears in the United States where issues such as ‘weight phobia’ did not exist until the 1930’s, when the ‘tuberculin look’ ushered in thinness as a cultural image of beauty (4). Previously, in American history full-figured features in women were coveted as a sign of prosperity. This fuller ideal is present in many non-industrialized and developing nations and was once thought to be  a protective cultural factor against the development of eating disorders. However, rates of eating disorders are rising despite this cultural preference, even in non-white female populations globally (3, 5, 6, 7, 8, 10, 11).

Westernization

In the countries where disordered eating rates are rising the most rapidly, western culture and media is becoming more accessible. Western culture as a concept is also linked to ‘modernism’, together they represent elevated consumerism, independence, capitalism, changes in women’s roles or opportunities, idealization of self-discipline, media saturation and access to communication and entertainment outlets (10). This western culture, first emphasized in America and Europe, has spread quickly to other nations since World War II. There is some discussion in literature about whether westernization is a shift in culture or a mark of class that the indigenous culture is pursuing. Either way, the link between changes in culture to a more westernized model, either way rates of eating disorders have been strongly linked (5, 9, 10, 12). For example, Japan is the first non-western nation to become, over a period of time, highly industrialized and economically powerful after World War II. Over this same period of time the rates of disordered eating in Japan has greatly increased, now closely resembling U.S. prevalence rates (11).

Strongly tied to industrialization is media, which takes multiple and varied forms including advertising, and becomes widely available to young women within a culture that is becoming more westernized. There is very compelling research evidence to support that media, in its varied formats, affects women’s views of their body, body satisfaction, body image disturbance, and increases the rates of eating disorders (1, 5,  8, 13, 14).  Western media sources are noted for their extremely thin depiction of women. Exposure, particularly through print media, advertising, and magazine images create insecurities and social comparisons between self and the images portrayed in the magazines (15, 16). These images are interpreted and sold as ideals of beauty, which women need to achieve to obtain a companion and happiness.

Eating Disorders Globally

The rates of eating disorders are increasing around the globe, with the greatest increases occurring in the last few decades. In countries that were previously believed to be without disordered eating, such as China, cases are now being reported. Other areas such as South America, Japan, and India rates of eating disorders are now comparable to British and the U.S. (2, 4, 11). To understand eating disorder rates, movement from strictly Caucasian American and British populations to minorities in these countries and then subsequent countries will be reviewed in future posts.

References

1. Becker, A., Burwell, R., Navara, K., & Gilman, S. (2003). Binge eating and binge eating disorders in a small-scale, indigenous society: the view from Fiji. International Journal of Eating Disorders, 34, 423-431.

2. Bhugra, D., Bhui, K., & Gupta, K. (2000). Bulimic disorders and sociocentric values in north India. Social Psychiatry Psychiatric Epidemiology, 35, 86-93.

3. Cummins, L., Simmons, A., & Zane, N. (2005). Eating disorders in Asian populations: A critique of current approaches to the study of culture, ethnicity, and eating disorders. American Journal of Orthopsychiatry, 75(4), 553-574.

4. Miller, M., & Pumarega, A. (2001). Culture and eating disorders: A historical and cross-cultural review. Psychiatry, 64(2), 93-110.

5. Tiggemann, M., & Ruutel, I. (2001). A cross-cultural comparison of body dissatisfaction in Estonian and Australian young adults and its relationship with media exposure. Journal of Cross Cultural Psychology, 32(6), 736-742.

6.  Abrams, L., & Cook, S. (2002). Sociocultural variations in body image perceptions of urban adolescent females. Journal of Youth and Adolescence, 31(6), 443-450.

7. Alegria, M., Woo, M., & Cao, Z., et al. (2007). Prevalence and correlates of eating disorders in Latinos in the United States. International Journal of Eating Disorders, 40, S15-S21

8. Cash, T., & Pruzinsky, T. (2002). Body image: A handbook of theory, research, and clinical practice. New York: Guilford Press.

9. Hesse-Biber, S., Leavy, P., Quinn, C., & Zoine, J. (2006). The mass marketing of disordered eating and eating disorders: the social psychology of women, thinness, and culture. Women’s Studies International Forum, 29, 208-224.

10. Lester, R. (2004). Commentary: Eating disorders and the problem of “culture” in acculturation. Culture, Medicine and psychiatry, 28, 607-615.

11. Pike, K., & Borovy, A. (2004). The rise of eating disorders in Japan: Issues of culture and limitations of the model of “westernization”. Culture, Medicine and Psychiatry, 28, 493-531.

12. Lake, A., Staiger, P., & Glowinski, H. (2000). Effect of Western culture on women’s attitudes to eating and perceptions of body shape. International Journal of Eating Disorders, 27, 83-89.

13. Gunewardene, A., Huon, G., & Zheng, R. (2001). Exposure to Westernization and dieting: A cross-cultural study. International Journal of Eating Disorders, 29, 289-293.

14. Shuriquie, N. (1999). Eating disorders: A transcultural perspective. Eastern Mediterranean Health Journal, 5(2), 354-360.

15. Byrd-Bredbenner, C., & Murray, J. (2003). A comparison of the anthropometric measurements of idealized female body images in media directed to men, women, and mixed gender audiences. Topics in Clinical Nutrition, 18(2), 117-129.

16. Morrison, T., Kalin, R., & Morrison, M. (2004). Body-image evaluation and body-image investment among adolescents: A test of sociocultural and social comparison theories. Adolescence, 39(155), 571-592.

Health Assessment Resources on the Web, how to make a podcast, and random thoughts

January 31, 2010

Well, it is time to share some good internet information with all of my nursing friends out there. I had more than one thought this week so I am writing about a few issues…. Read on and Happy Almost February

Health Assessment Resources on the WWW

Key to the foundational knowledge of any nurse is the ability to perform an exemplary health assessment, whether beginner or returning to school for a graduate nursing degree. The internet has provided a new medium through which to reach students at any geographic location at virtually any time of day. This makes access, comprehension, and visual/audio opportunities unending for our students. The following websites offer great supplemental learning of the physical examination through interaction, video, and audio.

The Health History: Of note, before I progress into this further, I want it to be known that I feel the most important part of any health assessment is not the physical exam, but the health history. A good, complete, and culturally competent health history will not only direct the examiner toward potential problems, but inform about areas of preventative needs and patient education, such as the need for adult immunizations, smoking cessation, or even grief counseling. Many of these things cannot be discerned by the physical exam alone. The physical exam is an unfortunate emphasis of many health assessment classes and basic RN programs. Unfortunately, the internet echos the same gap in emphasis with numerous physical examination resources and very few health history examples, forms, reasoning, etc….

The Physical Exam: I am not going to belabor the things we all know about a health history. Providing a warm room, privacy, equipment, good lighting, WASHING the HANDS in front of the patient, and actually meeting and talking with the patient, clothes on, before they don an ultra comfortable and stylish examination gown is basic groundwork for a good exam. There is truly an art to the physical exam and starting at the head and working your way down (head-to-toe) is best, helping to keep things organized. The following internet video/audio/interactive websites are excellent adjunct additions to any health assessment course, or simply as a refresher.

OPETA website from the University of Florida – http://opeta.medinfo.ufl.edu/

LEARN HOW TO EXAMINE website from Dr. Diane Davitt, PhD, RN – http://www.webster.edu/~davittdc/index.html

LEARNERS TV Video Examination Series – http://www.learnerstv.com/lectures.php?course=ltv032&cat=Medical&page=1

THE INTERACTIVE GUIDE TO THE EXAMINATION at OSU – http://medicine.osu.edu/exam/Pages/index.aspx

How to Make a Podcast for Your Course, to Send to Someone, or For Anything Else

Audio podcasts are a great way to ‘verbally’ connect with students and people, without the need for synchronicity in schedules. They also offer a great way for lectures, thoughts, etc. to be downloaded to iPods and played over and over. I am continually surprised at how many of my colleagues find this notion ‘scary’ and therefore resort to the same methods of communication without trying new ones. It is one of the easiest things in the world to do, so here is a step by step to help you along….

For you PC users (yes that means WINDOWS)

1. Go to the little search box in your start menu and type in Sound Recorder.

2. You will then need a microphone of some sort, many laptops now come with this ‘built in’ so when you hit the red record button you are good to go, however…. many desktop computers do not. A great plug-in headset like this one from Logitech can be purchased cheaply. (I have a new noise canceling one that loads in my USB and it totally ROCKS)…. anyway….

3. Simply make sure your microphone and headset are working and hit record.(I recommend having a script ready and reading through it a few times or your lecture notes handy).

4. You have now made a recording. Save the file to where you like and give it a unique name. NOW…. there is more to do… you can’t just post this file, because it is not an MP3 file its a .wav.

5. Download a great free MP3 file converter like this free converter touted by CNet.

For you Mac Users

1. To make easy MP3 recordings Mac is going to ask you to buy Quick Time Pro. If you already have this, then simply open it and record away and save as an MP3 file.

2. For those of you who don’t have Quick Time Pro, I recommend free recording software like Audacity for Mac.

3. Once you install it to your applications folder, simply open it, and click in on the red button to record. Remember to make sure your headphones and microphone work (see above PC directions), practice your recording, and then record and save. (There is a great You Tube tutorial here.)

4. In this Audacity software you need to be sure to EXPORT your file as an MP3 file to get your podcast, from the file menu. Do not save it as an audacity file. (You will need the LAME plug in to convert this to an MP3 file. Do not worry, this is painless. Just download it at the time of your Audacity download. They run simultaneously.)

It is easy, quick and can be loaded to most LMS, even e-mails and webpages. How cool is that?!!

Other Thoughts…. One of my internet friends, Rob Frasier, asked me, in response to a blog post, a very important question that academic faculty and students need to ponder about the internet. He asked if copyright would be an issue when students post papers and assignments to the WWW. I have to say that the answer to this is both yes and no.

Yes, because if students post a paper to their blog without citations or references then there are some major copyright violations, however they should be learning proper formatting in school. ‘Yes’ also because if students turn the same paper in for more than one course (a NO-NO for you students) then plagiarism programs like TurnItIn should pick up on those and alert the instructor. Students should not post their papers until after turning them into the course instructor and should also alert the instructor that the assignment has been posted to the student’s blog as well. (note* This is good brownie points for you students and really gets some great miles out of the things you are turning in. I am a firm believer that the world needs to see what students are working on. I avoid this problem all the way around as I will discuss below.)

No…. I say ‘No’ because the student’s work belongs to them and if they are writing and publishing their own blog, then they can post their work their without copyright infringement or plagiarism. I always caution students to make issues they write about devoid of direct patient information and at first when they begin to post I have them use assignments that are not specific to patient encounters, until they get the hang of de-identifying writing. Further, I simply avoid the entire TurnItIn issue with their work by having them only turn things in through blog postings in one of my classes. Creating and maintaining blogs teaches a bit about social media, encourages good writing output from the outset, and offers a continuing forum for students to practice written communication.

I also say ‘No’ because I think that we nursing faculty have a big hang up with the importance of the assignments we create. We cause our students much strife by creating varying writing assignments in courses with different topic sets, thus not allowing our students, even at a basic education level, to develop a body of knowledge that they can command. For example, BSN completion students often work in specific clinical areas where they have some expertise. Generic BSN students and even MSN students, although gaining basic nursing science foundational knowledge, often have subject areas they are interested in or want to know more about. We, nursing faculty, need to facilitate this curiosity from their first writing assignments so that they can continually build this body of knowledge and interest throughout their program of study. Say a student is interested in lung cancer, then in their cultural class let them write about cultural issues in some aspect of nursing patients with lung cancer, in community health let them write about lung cancer prevention, in leadership let them implement a change project concerning lung cancer, and in theories and research let them write a literature review or concept analysis on some aspect of lung cancer.

If we begin to use technology to enhance nursing learning and begin to think ‘outside the box’ in ways that our students can synthesize and express knowledge, the whole of health care will be much better served. Go NURSING!

Eating Disorders, Disordered Eating, and Insulin Omission in Type 1 Diabetic Adolescent Females: What’s all the fuss about? (Part 1 of a Series on ED)

January 17, 2010

For those of you out there who routinely care for adolescent females with or without diabetes this next series of posts is for you. We will move through the global nature of eating disorders, body image and females, disordered eating in adolescents, and disordered eating in special populations. I am beginning the series at a place where it should in theory end, because this topic is one of the most critical to anyone who cares for an adolescent female with Type 1 diabetes (T1DM). These girls who have T1DM and DEB begin in pediatrics and end up with adult endocrinology when their complications begin to surface. For those of you who don’t care for this population in a specialty area, your knowledge about this phenomenon is even more critical, because you care for them in other places. School nurses, pediatric clinic nurses, pediatric urgent care nurses, women’s health nurses, public health nurses, …. ANY nurse…. this post is for you.

Background. Let’s build from the basics, Type 1 Diabetes (T1DM) is an autoimmune disease, prevalent in 19 of every 100,000 Americans under the age of 20 (1), where there is insufficient insulin for metabolic function. Specifically, β-cell function in the pancreas ceases secondary to destruction by T-cell mediated responses (2). Many genetic and environmental triggers play roles in development of T1DM, with peak age of diagnosis between 10 to 14 years old (3).

The control of blood glucose levels in diabetes is important to prevent the onset of both short and long-term complications. The ADA recommends that, as a sign of control, Hemoglobin A1C levels (HbA1C) be monitored quarterly with a goal of 7% or less (2).  HbA1C levels, which correlate with average blood sugar readings over the previous 120 days, provide information about how well the medical regimen of the T1DM patient is working to control their blood glucose. Prolonged elevation of blood sugar levels leads to retinopathy, nephropathy, neuropathy, peripheral vascular, cardiovascular, and cerebrovascular disease (4,5).

Eating Disorders and Disordered Eating in Type 1 Diabetes. Eating disorders primarily affect young women and adolescents, being 3 times as high in lifetime prevalence among women than men (6). The mean age of onset of eating disorders ranges from 18 to 21, with some girls beginning as young as age 10 (6). Adolescent females with Type-1 diabetes have a two to four-fold higher incidence of eating disorders than their non-diabetic counterparts (7,8,9,10). More than just eating disorders, many girls engage in sub-clinical or disordered eating behavior (DEB). For diabetics, this becomes particularly problematic because their DEB of choice is insulin omission.

Insulin Omission. Insulin omission is a DEB weight loss method that is unique to adolescents with T1DM. Regardless of rates of actual eating disorders in general T1DM populations reported rates of insulin omission or dosage manipulation are high, between 14 to 73% (9, 10, 11, 12, 13, 14, 15, 16, 17, 18).

There is a significant risk for life threatening complications and mortality among DEB females with T1DM, where insulin omission is present (7, 19).  The majority of research in T1DM females supports elevated HA1C levels in the presence either of eating disorder, insulin omission, or both. Insulin omission results in increased rates of diabetic ketoacidosis, hospitalizations for acute illness, nephropathy, retinopathy, neuropathy and premature death (9, 12, 15, 18, 19, 20, 21, 22, 23).  Duration of insulin omission is the defining factor in rates and speed of development of nephropathy and retinopathy in T1DM females with eating disorders (17, 19). In essence, the girls with T1DM who omit insulin, regardless of eating disorder status, loose their eyes and kidneys at higher rates and more quickly than other T1DM adolescents with poor control.

Factors related to DEB in T1DM. There is a great deal of current research on factors related to DEB and prevalence rates. Factors strongly tied to DEB and insulin omission in T1DM adolescent females are: Body image (10, 21, 24, 25, 26, 29), elevated BMI (14, 21, 24), Depression (7, 17, 29), Self-esteem (21, 24), Feeling ineffective (25), Wishful thinking and emotional regulation (27), Diabetes management emotions (7, 28), Anxiety (7, 17), Negative family cohesion/communication (7, 17, 21), Maternal characteristics (14, 15, 26).

However, despite this mountain of research… no clinical guidelines for screening for this behavior, or even girls at risk for DEB and insulin omission, is non-existant. Further, no intervention research or recommendations have been made.

There is HOPE. Every good nurse knows that prevention is the key to any significant and costly illness. This is where we come in nurses. Now that we know the related factors, we can identify girls at risk for DEB in our practices and intervene on those factors. We can also look at simply screening for those who are high risk or engaging in this behavior in practice by two simple biological markers. It has been suggested that BMI and HgA1c level would be great biophysical screeners for this population (29). Further, RESEARCH on interventions and screening needs to be done, and who better to do that than nurses? The psychosocial, familial, and health care components of this complex phenomenon call for not only multidisciplinary research, but nursing to head such research teams. Are you ready to tackle this area nurses?

*Note: I am starting a pilot project to look at one intervention: Mothers and daughters, self-esteem, body image, and communication in high risk girls. Anyone want to join me?

References

1. National Institute Of Health. (2008, June ). National Diabetes Statistics, 2007. Retrieved August 11, 2009, from National Diabetes Information Clearinghouse Web site: http://diabetes.niddk.nih.gov/DM/PUBS/statistics/#d_allages

2. American Diabetes Association (2009). Executive Summary: Standards of medical care. Diabetes Care, 32(sup1), s6-s12. doi:10.2337/dc09-S006

3. Newhook, L., Curtis, J., Patterson, A., et al. (2004). High incidence of Type 1 Diabetes in the Avalon Peninsula, Newfoundland, Canada. Diabetes Care, 27(4), 885-888.

4. DCCT Writing Team (2003). Sustained effect of intensive treatment of type 1 diabetes mellitus on development and progression of diabetic nephropathy: the epidemiology of diabetes interventions and complications (EDIC) study. The Journal of the American Medical Association, 290(16), 2159-2167.

5. Martin, C., Albers, J., Waberski, B., et al. (2006). Neuropathy among the diabetes control and complications trial cohort 8 years after trial completion. Diabetes Care, 29(2), 340-344.

6. Hudson, J., Hiripi, E., Pope, H., & Kessler, R. (2007). The prevelance and correlates of eating disorders in the national comorbidity survey replication. Biological Psychiatry, 61, 348-358.

7. Goebel-fabbri, A., Fikkan, J., Frank, D., et al. (2008). Insulin restriction and associated morbidity and mortality in women with type 1 diabetes. Diabetes Care, 31(3), 415-419.

8. Jones, J., Lawsone, M., Daneman, D., et al. (2000). Eating disorders in adolescent females with and without type 1 diabetes: Cross sectional study. The British Medical Journal, 310(10), 1563-1566.

9. Nielsen, S. (2002). Eating disorders in females with type 1 diabetes: An update of a meta-analysis. European Eating Disorders in Review, 10(4), 241-254.

10. Pinar, R. (2005). Disordered eatingh behaviors among turkish adolescents with and without tyupe 1 diabetes. Journal of Pediatric Nursing, 20(5), 383-388.

11. Ackard, D., Neumark-Sztainer, D., Schmitz, K., et al. (2008). Disordered eating and body dissatisfaction in adolescents with type 1 diabetes and a population-based comparison sample: comparative prevalence and clinical implications. Pediatric Diabetes, 9(4 part-1), 312-319.

12. Crow , S., Keel, P., & Kendall, D. (1998). Eating disorders and insulin-dependent diabetes Mellitus. Psychometrics, 39(3), 233-243.

13. Daneman, D., Olmsted, M., & Ryall, A., et al., (1998). Eating disorders in young women with type 1 diabetes. Hormone Research, 50(sup1), 79-86.

14. Maharaj, S., Rodin, G., Olmsted, M., et al., (2003). Eating disturbances in girls with diabetes: the contribution of adolescent self-concept, maternal weight and shape concerns and mother-daughter relationships. Psychological Medicine, 33, 525-539.

15. Neumark-sztainer, D., Patterson, J., Mellin, A., et al., (2002). Weight control practices and disordered eating behaviors among adolescent females and males with type 1 diabetes. Diabetes Care, 25(8), 1289-1296.

16. Peveler, R., Bryden, K., Neil, A., et al., (2005). The relationship of disordered eating habits and attitudes to clinical outcomes in young adult females with type 1 diabetes. Diabetes Care, 28(1), 84-88

17. Takii, M., Komaki, G., Ugchigata, Y., et al.,  (1999). Differences between bulimia nervosa and binge-eating disorder in females with type 1 diabetes: The important role of insulin omission. Journal of Psychosomatic research, 47(3), 221-231.

18. Takii, M., Uchigata, Y., Nozaki, T., et al.,  (2002). Classification of type 1 diabetic females with bulimia nervosa into subgroups according to purging behavior. Diabetes Care, 25(9), 1571-1575.

19. Takii, M., Uchigata, Y., Tokunaga, S., et al., (2008). The duration of severe insulin omission is the factor most closely associated with the microvascular complications of type 1 diabetic females with eating disorders. International Journal of Eating Disorders, 41(3), 259-264.

20. Bryden, K., Neil, A., Mayou, R., et al., (1999). Eating habits, body weight, and insulin misuse. Diabetes Care, 22(12), 1956-1960.

21. Colton, P., Olmsted, M., Daneman, D., Ryadall, A., & Rodin, G. (2007). Natural history and predictors of disturbed eating behavior in girls with type 1 diabetes. Diabetic Medicine, 24, 424-429.

22. Goebel-fabbri, A., Fikkan, J., Frank, D., et al.,  (2008). Insulin restriction and associated morbidity and mortality in women with type 1 diabetes. Diabetes Care, 31(3), 415-419.

23. Nielsen, S., Emboerg, C., & Molback, A. (2002). Mortality in concurrent type 1 diabetes and anorexia nervosa. Diabetes Care, 25(2), 309-312.

24. Engstrom, I., Kroon, M., Arvidsson, C., et al. (1999). Eating disorders in adolescent girls with insulin-dependent diabetes mellitus: A population-based case-control study. Acta Paediatrics, 88, 175-180.

25. Kahn, Y., & Montgomery, A. (1996). Eating attitudes in young females with diabetes: Insulin omission identifies a vulnerable subgroup. The British Journal of Medical PSychology, 69, 343-353.

26. Kitchler, J., Foster, C., & Opipari-arrigan, L. (2008). The relationship between nebative communication and body image dissatsifaction in adolescent females with type 1 diabetes mellitus. Journal of Health Psychology, 13, 336-347.

27. Grylli, V., Wagner, G., Hafferl-Gattermayer, A., et al., (2005). Disturbing eating attitudes, coping styles, and subjective quality of life in adolescents with Type 1 diabetes. Journal of Psychosomatic Research, 59, 65-72.

28. Affiento, S., Backstrand, J., Lammi-Keefe, C., et al.,  (1997). Subclinical and clinical eating disorders in IDDM negatively affect metabolic control. Diabetes Care, 20(2), 182-184.

29. Olmsted, M., Colton, P., Daneman, D., Rydall, A., & Rodin, G. (2008). Predictions of the onset of disturbed eating behavior in adolescent girls with type 1 diabetes. Diabets Care, 31(10), 1978-1982.