THE VIDEO THING.
IT'S NOT GOING AS SMOOTHLY AS I WAS HOPING IT WOULD GO.
I PROBABLY SHOULDN'T HAVE THIS ON CAMERA FOR THOSE GUYS.
SO YOU WILL HAVE LOVELY VIDEOS ON BACK INJURIES.
ALRIGHT. BACK INJURIES.
BACK INJURIES IS WHERE WE LEFT OFF WITH OUR ACTIVITY AND EXERCISE,
SO THAT'S WHERE THE CONTENT WAS FOR THAT.
AND CERTAINLY YOU CAN READ THE STATS.
I JUST WANTED TO TELL YOU A LITTLE BIT MORE ABOUT BACK INJURIES.
AND THAT IS, THAT ONE, 87% OF ALL NURSES HAVE REPORTED A BACK INJURY.
IS THAT STAGGERING TO YOU?
THAT WOULD BE, LIKE, THIS WHOLE ROOM EXCEPT FOR YOU THREE.
THAT IS A LOT OF NURSES.
THAT'S A HIGH INCIDENCE OF INJURY.
IN FACT, NURSING HAS THE NUMBER ONE INCIDENTS OF BACK INJURY.
WE HAVE MORE INJURIES THAN CONSTRUCTION WORKERS, THAN FARMERS
AND WHO ELSE IS ON MY LIST?
AGRICULTURAL WORKERS, MINERS AND CONSTRUCTION WORKERS.
THAT'S HUGE. SO WE HAVE A LOT OF INJURY.
IT IS MORE THAN DOUBLE, IN FACT, AMONG CONSTRUCTION WORKERS.
WE ALSO HAVE ONE OF THE HIGHEST RATES IN THE WORLD OF INJURIES IN THE US.
NEW ZEALAND HAS THE LEAST.
WE HAVE 47% AND 66.8% OF NURSES IN THE NETHERLANDS.
SO I GUESS WE COULD GO WORK IN NEW ZEALAND.
THAT WOULD BE BEAUTIFUL COS THEY HAVE LESS BACK INJURY THERE.
SO I DON'T KNOW THE REASON FOR THAT.
BUT THEY ALSO SAY THE RISING RATE OF OBESITY HAS INCREASED THE RISK OF INJURY TO NURSES,
BOTH PATIENTS AND TO NURSES THEMSELVES.
SO WHAT ARE WE GOING TO DO ABOUT IT?
WELL, ONE OF THE HERE SAYS, 'EDUCATION OF LIFTING TECHNIQUES
AND TRAINING AND BODY MECHANICS WILL REDUCE INJURIES.'
AND THE FACT OF THE MATTER IS IT WON'T.
WE TRAIN YOU ALL WE WANT, BUT THAT ISN'T GOING TO REDUCE THE INJURY.
IN FACT, SOME OF THE RESEARCH ISN'T EVEN APPROPRIATE FOR OUR TRAINING.
THEY ACTUALLY DO THE RESEARCH ON BACK INJURIES ON MEN.
AND THEY HAVE MEN LIFTING BOXES WITH HANDLES.
AND THAT'S HOW THEY DETERMINED WHAT WAS SAFE BODY MECHANICS.
WE KNOW WHAT BODY MECHANICS ARE. WE KNOW WE NEED A BODY STRAIGHT.
WE KNOW WE NEED TO KEEP OUR BACK STRAIGHT.
WE WANT TO USE OUR BIGGER MUSCLES OF THE THIGHS AND BUTTOCKS TO SUPPORT US
AND NOT JUST USE ARE ARMS AND HAVE THINGS WAY OUT OR BENT AND SO FORTH.
SO THEY DECIDED TO DO SOME RESEARCH ON MEN AND THEIR BODY MECHANICS.
SO THEY LIFTED THESE BOXES WITH HANDLES THAT WERE 50-POUND BOXES, I BELIEVE.
AND THAT'S HOW THEY WERE STUDYING THE MECHANICS OF THE BODY.
WELL, THEY DIDN'T STUDY WOMEN. THEY DIDN'T STUDY THE NURSING PROFESSION TO ACCOUNT FOR --
WE DON'T LIFT BOXES WITH HANDLES.
WE LIFT PEOPLE WITH FLAILING ARMS AND PEOPLE THAT ARE COMBATED
AND PEOPLE THAT ARE DEAD WEIGHT.
AND SO THEY DIDN'T DO ENOUGH RESEARCH ON THE POPULATION.
NURSING IS STILL OVER 80% WOMEN.
IT'S GOT MEN INTO TWO. OBVIOUSLY ABOUT 20% MEN.
I THINK IT'S LIKE UP TO 18 OR 19%.
AND SO THEY'VE GOT TO DO STUDIES ON BOTH GROUPS OF PEOPLE
SO THAT THEY'RE CREATING EQUIPMENT AND HELPS APPROPRIATE FOR BOTH OF US.
WHICH MEANS YOU GOT TO BE CAREFUL IN WHAT YOU DO.
HERE IS WHAT THEY DEFINED AS THE HIGHEST RISK TASK THAT WE DO.
THEY IDENTIFIED 16 STRESSFUL TASKS IN A NURSING HOME.
AND THESE ARE THE ORDER THEY RANKED 'EM AS FAR AS THE MOST STRESSFUL.
TRANSFERRING A PATIENT FROM TOILET TO CHAIR.
TRANSFERRING A PATIENT FROM CHAIR TO TOILET.
TRANSFERRING A PATIENT FROM CHAIR TO BED.
TRANSFERRING FROM BED TO CHAIR.
FROM BATHTUB TO CHAIR.
FROM CHAIR LIFT TO CHAIR.
YOU GET THE COMMON DENOMINATOR?
- CHAIR.
- IT'S THE TWISTING MOTION OF GOING FROM ONE POSITION TO ANOTHER...POSITION,
WHILE MOST OF THEM WERE A SEATED POSITION.
SO IT WAS THAT UP AND DOWN TWIST MOVEMENT RANKED THE HIGHEST.
I LIKE KNOWING THAT SO THAT I'M USING MY BEST BODY MECHANICS
WHEN I'M MOVING SOMEONE FROM THOSE POSITIONS.
AND THOSE ARE THE POSITIONS I WANT HELP WITH IF I'M GOING TO BE DOING THEM.
SECOND. AFTER THAT GROUP OF TWISTIES, THEN THEY HAVE LIFTING A PATIENT IN BED.
NUMBER ONE, WE TAUGHT YOU.
PUSHING A PATIENT OR PULLING A PATIENT SIDE TO SIDE IN THE BED.
THEN CHANGING AN ABSORBENT PAD.
MAKING A BED WITH A PATIENT IN IT.
UNDRESSING A PATIENT AND TYING SUPPORTS,
SO PUTTING ON AND OFF RESTRAINT
COS YOU HAVE TO BEND IN THOSE WEIRD POSITIONS TO THE BED FRAMES.
FEEDING A BED RIDDEN PATIENT.
HAS ANYBODY FED ANYBODY IN A BED BEFORE?
DO YOU FIND THAT YOU LEAN AND FEED THEM AND IT'S VERY STRAINING ON THE UPPER BACK.
ALTHOUGH, MOST OF OUR INJURIES ARE LOWER BACK COS I'VE SEEN THAT,
BUT IT'S THIS BENDING FORWARD THAT JUST STRAINS THIS BACK.
AND IT SEEMS LIKE THIS A NOTHING ACTIVITY, RIGHT?
BIG, HUGE ON THE BACK. SO BE CAREFUL.
I CAN REMEMBER FEEDING PATIENTS GOING, "GOD, WHAT'S THAT ALL ABOUT?"
BUT IT'S IN OUR TOP TEN.
AND THEN FINALLY MAKING A BED WITHOUT A PATIENT WITHOUT A PATIENT IN IT WAS IN THE TOP 16.
SO, THEY'RE VERY, VERY STRESSFUL MANEUVERS.
BECAUSE THEY'RE NOT JUST STRAIGHT UP AND DOWN WHERE WE CAN JUST GLOUTS AND OUR THIGHS,
THEY'RE TWISTY MOTIONS AND BENDING LOW MOTIONS.
SO GET THOSE BEDS UP HIGH, KEEP YOUR BACK STRAIGHT
AND USE AS MUCH AS YOU CAN OF YOUR THIGHS, AND GET HELP.
I WAS SHOWING SOME PEOPLE A VIDEOTAPE IN THE SKILLS LAB
AND I'LL GET THE REST OF YOU IN THERE SOON.
AND IT'S OUR NUMBER ONE ERROR WHEN WE ARE MOVING PATIENTS, NOT GETTING ENOUGH HELP.
WE JUST TRY TO DO IT OURSELVES. WE DON'T WANT HELP.
BACK SUPPORT. HAVE YOU SEEN THOSE BACK BELTS THAT THEY WEAR.
YOU SEE 'EM ON GROCERY STORE WORKERS AND STUFF. THEY DON'T WORK.
THEY THINK THEY WILL BECAUSE THEY THINK IT'S A REMINDER
OR THEY THINK IT'S GOING TO PUT SOME EXTRA PRESSURE ON YOUR BACK SO THINGS DON'T BULGE.
BUT THEY FOUND THAT'S JUST ANECDOTAL THINGS
THAT PEOPLE MADE UP WHO MANUFACTURED IT, THAT IT WORKS.
BUT THEY DON'T HAVE ANY CONCRETE EVIDENCE OF THAT WHAT SO EVER.
SO DON'T DEPEND ON A BACK BRACE...
TO THINK THAT'S WHAT'S GOING TO MAKE YOUR BACK STAY IN POSITION.
AND THESE ARE MY TWO FAVORITES OF THE MYTHS. YOU CAN READ THE REST ON BLACKBOARD.
IT SAYS IF YOU BUY LIFTING EQUIPMENT, STAFF WILL USE IT.
NOT TRUE.
I CAN'T TELL YOU HOW MANY HOSPITALS I'VE WORKED AT.
I KNOW THERE'S FOYER LIFT'S THERE SOMEWHERE.
KAISER HAS THE BEST EQUIPMENT.
THEY HAVE THESE MACHINES THAT WILL TAKE PEOPLE FROM SITTING POSITIONS
AND STAND THEM RIGHT UP. THEY HAVE THIS THING THAT WILL TAKE PEOPLE DOWNSTAIRS.
YOU COULD SIT 'EM IN AND IT TAKES THEM DOWN THE STAIRS. COOLEST THING YOU EVER SAW.
DOES ANYONE USE IT? NO.
BUT IT'S THERE. THEY TOLD ME ABOUT IT.
I'VE EVEN BEEN IN SERVICED ON IT, BUT I'VE NEVER SEEN ANYONE USE IT.
NOW I HAVE SEEN 'EM USE SOME LIFTS,
AND IN OTHER HOSPITALS YOU MIGHT SEE A LIFT COME OUT HERE AND THERE,
BUT THE THING IS WE'VE GOT TO USE THE STUFF.
AND THEN WE GOT TO USE IT RIGHT.
WE GOT TO USE IT SAFELY. WE GET IN INTIMIDATED BY IT BECAUSE...
WELL, WHICH IS MYTH NUMBER 2.
IF YOU WRITE A NO-LIFT POLICY, NURSES WILL STOP LIFTING.
I THINK, MR. HOOD MENTIONED THAT HOSPITALS ARE MAKING THESE NO-LIFT POLICIES.
THEY DON'T WANT ANYONE LIFTING. SO THEY HAVE MACHINES, THEY HAVE ALL THIS EQUIPMENT.
AND PEOPLE DON'T USE IT. THEY JUST GO, "OH, THIS ISN'T A BIG DEAL."
AND THEY LIFT ANYWAY OR THEY DON'T KNOW HOW TO USE THE MACHINERY
OR A HOSPITAL WILL HAVE A NO-LIFT POLICY
AND WON'T HAVE THE MACHINES TO SUPPORT THE POLICY.
SO WE'VE GOT TO BE PROACTIVE AND SAY, "I NEED THIS, I NEED HELP,
LET'S GET THE MACHINES OUT, LET'S NOT SETTLE."
BECAUSE IT'S THAT ONE LITTLE THING THAT TWEAKS YOUR BACK OUT.
YOU THINK ALL IS WELL AND IT'S THAT LAST FEEDING YOU DO OR THAT LAST PULL UP AND YOU'RE DONE.
SO BE CAREFUL WITH YOUR BACK.
BACK SAFETY IS AS SAFE AS YOU MAKE IT.
AND THAT'S TRUE. THERE ARE A FEW CAN REMEMBER THINGS. LIKE I A PATIENT ONE TIME. SHE WAS 94.
SHE HAD HER FIRST GALLBLADDER -- HER FIRST SURGERY EVER. SHE'D NEVER BEEN A HOSPITAL,
NEVER SEEN A DOCTOR. HAD TO HAVE HER GALLBLADDER OUT.
I HAD TO WALK HER AROUND THE NURSING STATION. CUTE LITTLE THING.
AND IT WAS A CIRCULAR STATION, SO THE ORDER WAS TO WALK HER AROUND TWICE.
I WALKED HER AROUND ONCE AND I SAID, " OH, SHE'S 92. I'LL WALK HER SLOW."
AND SO SHE SAYS, "DO WE GO BACK?" I SAID, "OH, NO, WE HAVE TO GO ONE MORE TIME."
SHE SAYS, "THEN PICK IT UP, HONEY."
SO I WALKED HER A LITTLE FASTER AND THEN I WENT TO PUT HER IN THE CHAIR
AND WHEN I PUT HER IN THE CHAIR I DIDN'T GIVE HER GOOD ENOUGH DIRECTION.
AND SHE GRABBED ME BY THE NECK AND PULLED ME DOWN.
SHE WAS A SWEET, LITTLE 92-YEAR-OLD LADY, BUT SHE TWEAKED MY BACK.
SO I WAS OUT FOR A COUPLE DAYS TAKING MY MUSCLE RELAXANTS.
SO THAT'S FUNNY.
SO YOU NEVER KNOW. THERE ARE STRANGE LITTLE THINGS THAT HAPPEN.
ALRIGHT. SAFETY AND RESTRAINTS. WE'RE GOING TO MOVE ALONG ON THAT.
AND BECAUSE YOU'VE DONE ALL YOUR READING AND I KNOW YOU KNOW IT BACKWARDS AND FORWARDS,
I AM JUST GOING TO HIGHLIGHT A FEW THINGS.
I'M GOING TO JUST OUTLINE THE MATERIAL FOR YOU
AND I WANT TO STOP AT A FEW SECTIONS. AND THEN WE'RE GOING TO DO A CASE STUDY TODAY.
BECAUSE I THINK IT'LL PUT IT ALL TOGETHER FOR US.
BY THE WAY, I READ ALL OF YOUR, 'WHY YOU WANT TO BE A NURSE.'
AND WHAT KIND OF LEARNER YOU ARE. THAT WAS VERY INTERESTING.
NOW I CAN'T WAIT TO LEARN YOUR NAMES SO I KNOW WHO I WAS READING ABOUT.
I WAS LIKE, "I DON'T EVEN KNOW HALF THESE PEOPLE.
SO I'LL READ THEM AGAIN LATER AND THAT'LL BE FUN."
BUT THIS IS WHO ARE GROUP IS. WE HAVE 58% OF US WHO ARE VISUAL LEARNERS.
36% WHO ARE HANDS-ON KINESTHETIC.
AND ACTUALLY THERE WERE, KIND OF, DUPLICATIONS.
THERE WERE A FEW PEOPLE WHO SAID THAT THEY WERE BOTH.
WE HAVE 9% OF US THAT ARE AUDITORY LEARNERS.
12% THAT MEMORIZE AND READ. AND 9% THAT AREN'T SURE.
SO WE WILL CAPITALIZE ON YOUR LEARNING STYLES.
AND SEE IF WE CAN CAPTURE YOUR LEARNING.
YOU GUYS LIKE TO GET IN THERE AND JUST DO IT, SO WE'RE GOING TO DO IT.
AND THAT'S GOING TO REQUIRE YOU READING
SO THAT WE CAN WORK WITH SOME CASE MATERIAL
AND SO THAT WE CAN DO SOME OBJECT LESSONS AND SO FORTH.
AND...
ALRIGHT, SAFETY. WE HAVE BASIC NEEDS.
DID YOU FIND THE SAFETY CHAPTER KIND OF STRANGE ACTUALLY?
IT'S KIND OF A STRANGE CHAPTER. I MEAN THEY'RE TALKING ABOUT POLLUTION AND WATER,
AND YOU'RE THINKING, "I'M GOING TO BE A BESIDE NURSE. WHAT'S THIS ALL ABOUT?"
BE A CRITICAL READER. JUST BECAUSE IT'S IN THERE WHAT VALUE IS IT?
I MEAN, IT IS VALUABLE. BECAUSE WE DO NEED WATER AND POLLUTION IS HUGE.
AND EVEN THOUGH WE TAKE IT FOR GRANTED
THAT WE TURN ON THE SINK AND WE GET SOME PRETTY DECENT WATER
BUT THERE ARE REALLY POCKETS OF EVEN ARE OWN AREA THAT DOESN'T HAVE WATER.
THEY ARE GETTING WATER THAT'S CONTAMINATED FORM WELLS OR THEY MAY NOT HAVE RESOURCE TO WATER.
YOU'VE GOT HOMELESS. AND SO WE HAVE TO TAKE INTO CONSIDERATION
ARE PEOPLE HAVING ACCESS TO CLEAN WATER. IN ADDITION, OXYGEN --
WE LIVE IN THE CENTRAL VALLEY. ARE WE ON IT WITH THE POLLUTION?
WE KNOW ALL ABOUT ABOUT IT. AND WE KNOW THAT IT EFFECTS -- WE HAVE HIGH INCIDENTS...
ASTHMA AND RESPIRATORY PROBLEMS. OUR SCHOOLS, WHEN I WAS SCHOOL NURSE FOR MY BRIEF THREE MONTHS,
WHICH I HOPED I'D BE TODAY. I'D NEVER SEEN SO MUCH ASTHMA. THESE KIDS, ALL OVER THE PLACE.
AND IT'S OUR AREA. WE JUST HAVE SO MANY POLLUTANTS IN THE AIR.
AND WE'RE IN THIS CENTRAL VALLEY WHERE THE AIR DOESN'T MOVE WELL
AND SO IT EFFECTS THE HEALTH OF THE PEOPLE IN THE AREA.
NUTRITION IS CERTAINLY SIGNIFICANT.
AND YOU CAN GET EXPOSED TO CERTAIN POISONINGS IN FOOD.
THERE IS TWO COMPONENTS TO NUTRITION AS WELL.
ONE, WE NEED ADEQUATE NUTRITION AND PEOPLE DON'T GET ADEQUATE NUTRITION FOR VARIOUS REASONS.
MAY IT BE POVERTY, MAY IT BE PREFERENCE...WHATEVER,
CONVENIENCE, LIFESTYLE, THEY'RE NOT GETTING THE NUTRITION THEY NEED.
AND CERTAINLY I FOOD CAN GET CONTAMINATED.
AND I WANTED TO ADDRESS CONTAMINATION HERE FOR A MINUTE.
WE DID TALK TO YOU ABOUT IT, OTHER THAN TO TELL YOU THAT YOU CAN INGEST TOXINS IN THE FOOD.
STAPHYLOCOCCAL AND OSTERIA BACTERIA ARE THE MOST COMMON.
BUT YOU CAN HAVE E. COLI, SALMONELLA, SHIGELLA AND OSTERIA.
HEPATITIS A IS SPREAD BY PEOPLE CONTAMINATION OF FOOD AND WATER AND MILK.
SO HOW DO YOU PREVENT FOOD POISONING?
I JUST THOUGHT THEY WERE MISSING THIS ONE POINT OF VIEW.
AND THAT IS TO ASSUME THAT ALL FOODS, MAYBE, HAVE FOOD BORNE ILLNESS.
THINK OF ALL FOODS AS POTENTIALLY HARBORING SOME KIND OF BACTERIA.
SO THAT YOUR HANDS NEED TO BE WASHED,
FOOD PREP SURFACES AND UTENSILS NEED TO BE WASHED THOROUGHLY
BEFORE AND AFTER HANDLING RAW FOODS. AND SOMETIMES WE TAKE FOR GRANTED
OR THINK THAT MAYBE A RAW CARROT OR A RAW LETTUCE ISN'T A BIG DEAL,
BUT RAW FOODS THAT HAVEN'T BEEN CLEANED CAN ALSO HAVE BACTERIA
AND THEN WE PASS THAT ON TO OTHER FOODS.
CHICKEN IS HUGE. RAW CHICKEN CARRIES SALMONELLA. YOU GOT TO BE CAREFUL ABOUT THAT.
DON'T USE THE CUTTING BOARD AND JUST RINSE IT WITH SOME LUKEWARM WATER
AND THINK ALL IS WELL. IT'S GOT TO BE DISINFECTED BETWEEN USES OF CERTAIN RAW FOODS.
THE REFRIGERATOR NEEDS TO BE SET BELOW 40 DEGREES.
SO EVERYONE GO HOME TODAY AND CHECK YOUR FRIDGES. AND MAKE SURE THEY'RE BELOW 40.
AND FOODS THAT ARE HEATED, NEED TO BE HEATED ABOVE 140.
SO THOSE ARE ARE TWO CRITICAL PARAMETERS IN FOOD CONTROL.
BECAUSE IT'S AT OVER 140 THAT WE KILL MOST MICRO ORGANISMS.
REMEMBER, WHEN YOU'RE OUT A POT LUCK -- I LOVE POT LUCKS.
I JUST WANT MY VERY BIG THINGS. BUT HONESTLY WE DON'T KNOW HOW ANYONE PREPARED IT.
AND HOW LONG HAS IT BEEN SITTING OUT.
AND THE BASIC GUIDELINE FOR FOOD THAT'S SITTING OUT
IS THAT IT NEEDS TO BE MAINTAINED ABOVE 140.
AND YOU SHOULDN'T LET ANYTHING SIT OUT MORE THAN TWO HOURS. NEVER.
THOSE TURKEY DINERS WE HAVE SITTING OUT FOREVER OR WHATEVER WE DO.
AND SO BE CAREFUL ABOUT THAT
AND RAW FOODS OUT AT A POT LUCK ARE PARTICULARLY DANGEROUS.
SO YOU LOOK AT YOUR POTATO SALADS, MAYONNAISE ARE A BIG, HUGE SALMONELLA CARRIER.
AND I JUST STAY CLEAR OF THEM.
THE MACARONI IN THE PASTA SALADS.
- YOU KNOW THE VENDORS THAT -- UP AND DOWN THE STREET AND THEY SELL THE CORN.
THAT'S MAIZE THEY USE, RIGHT?
- CORN? - YEAH.
USUALLY BETTER. BUT I DON'T KNOW. YOU'LL HAVE TO ASK 'EM.
[SPEAKING TOGETHER]
...AND THEY DON'T HAVE IT REFRIGERATED .
THEN DON'T EAT IT. BECAUSE THAT'S MY I THOUGHT ON THEM.
WHEN I DOUBT, THROW IT OUT. OR JUST DON'T EAT IT.
AND SO THINGS THAT YOU THINK ARE SKEPTICAL, STAY AWAY.
BECAUSE IF YOU GO FROM THE PRINCIPLE OF, ANY FOOD CAN HARBOR BACTERIA,
LOOK AT WHO'S PREPARING IT. I WAS OVER HEARING MR. HOOD TALK TO ONE OF THE GROUPS.
I DON'T KNOW WHO. YOU GUYS WERE THERE, BUT HE WAS TALKING ABOUT FOOD HANDLERS.
HAVE YOU WATCHED THE PEOPLE IN YOUR FAST-FOOD RESTAURANT?
OH, FRIGHTENING. I JUST THINK, PLEASE KEEP MY IMMUNE SYSTEM WORKING.
BECAUSE I JUST DON'T KNOW WHEN THEY WASHED LAST.
WHICH BRINGS ME TO ANOTHER INTERESTING INCIDENT. I WATCHED OPRAH SOMETIME THIS SUMMER.
AND SHE WAS DOING SOMETHING ON PRODIGY CHILDREN.
DID YOU SEE THAT WHERE THERE WAS A HIGH SCHOOL GAL,
WHO DEICED FOR HER RESEARCH PROJECT
THAT SHE WAS GOING TO CHECK THE WATER IN FAST-FOOD RESTAURANTS.
AND SO SHE GOT A STERILE SPECIMEN CUP AND SHE CHECKED THE ICE MACHINES
AND THEN SHE TOOK A SPECIMEN FROM THEIR TOILETS.
SHE DID THAT FOR I BELIEVE 6 OR 8 RESTAURANTS.
TOOK THEM TO A REPUTABLE LAB AND HAD THEM CULTURED.
AND IN ALL CASES THE ICE WATER HAD MORE MICRO ORGANISMS THAN THE TOILET WATER DID.
SHE REPORTED THAT TO THE FAST-FOOD RESTAURANTS.
THEY DID A REPEAT STUDY OF THE FAST FOOD RESTAURANTS. THEY WENT BACK AND THEY RE-TESTED THEM.
THEY DON'T TELL THEM I'M COMING TODAY OF COURSE.
SO THE LABORATORY PEOPLE ACTUALLY WENT IN TO DUPLICATE THE STUDY,
AND SAMPLED THE WATER AND THE TOILET WATER -- ICE WATER AND TOILET WATER
AND FOUND ONLY ONE OF THE FAST-FOOD RESTAURANTS MADE ANY CHANGE IN THEIR PRACTICE.
SO WHAT DID THEY FIND? E.COLI. SO WHAT DID THAT SAY?
SOMEBODY WASN'T WASHING THEIR HANDS.
NOW, HOW YOU WATCHED IN YOUR FAST-FOOD RESTAURANT
HOW THEY GET THE ICE TO THOSE ICE DISPENSERS?
IN THOSE BIG, WHITE BUCKETS. I ALWAYS WONDER, "IS THAT THE MOP BUCKET?
YOU KNOW, LAST TIME I WAS GETTING MY ICE, I WAS GOING,
"PLEASE GOD, LET THIS BE A CLEAN SAMPLE." WOULDN'T THAT HELP US COPE WITH ICE.
BUT THEY'RE NOT ALWAYS HAVING AS CLEAN PRACTICES AS WHAT WE WISHED AND HOPED FOR.
AND SO WE ALL BECOME VICTIM TO THAT. SO WHEN IN DOUBT THROW IT OUT.
AND FINALLY CANNED-FOOD ARE A HIGH -- WHAT'S THE WORD I WANT.
RISK AREA FOR BOTULISM. THEY ALL NEED TO BE BOILED.
ANY OF YOUR CANNED-FOODS NEED TO BE BOILED ABOVE 140 TO KILL THOSE FOUR.
SO YOU'RE GREEN BEANS AND SO FORTH, DON'T TASTE 'EM BEFORE YOU BOIL.
BY BOILING IS CANNED-FOOD OKAY?
UH-HUH. ANYTHING THAT GETS IT ABOVE 140. THOSE ARE YOUR PARAMETERS.
SO IT MIGHT BE WORTHWHILE TO INVEST IN A FOOD THERMOMETER. THEY'RE CHEAP.
COUPLE BUCKS. JUST STICK IT IN. HOW HOT DOES IT GET.
ESPECIALLY WITH YOUR COLD FREEZER MEATS AND YOUR CANNED-FOODS.
ALRIGHT, TEMPERATURE AND HUMIDITY IS CERTAINLY IMPORTANT IN THE ENVIRONMENT.
WE LIKE TO HAVE A TEMPERATURE THAT'S BETWEEN 65-75.
AND I'M THINKING IT'S LIKE 78-80 IN HERE RIGHT NOW. IT'S SO HOT.
YOU KNOW WHY DON'T YOU OPEN UP THAT DOOR AND IF THEY GET NOISY WE'LL JUST CLOSE IT.
BUT NO ONE'S OUT THERE RIGHT NOW. IT'S JUST BLESSED HOT HERE.
THERE IS TWO TERMS I JUST WANT TO GET INTRODUCED TO YOU
AND THAT'S HYPOTHERMIA AND HYPERTHERMIA.
WE'RE ACTUALLY GOING TO ADDRESS THEM IN MORE DETAIL WHEN WE DO VITAL SIGNS,
BUT JUST SO WE UNDERSTAND WHAT THEY ARE,
HYPOTHERMIA IS WHEN THE CORE -- OH, I FEEL COLD AIR ALREADY, JUST WONDERFUL.
IS WHEN THE CORE BODY TEMPERATURE IS BELOW 95. HYPOTHERMIA.
YOU CAN HAVE SOME GERIATRIC CLIENTS THAT JUST BECAUSE THEIR METABOLISM IS SLOW,
THEY KEEP THE BODY TEMPERATURE AROUND 94-85.
THAT'S GOOD. AT LEAST IT KEEPS SOME AIR FLOWING. THANK YOU.
BUT BELOW 95 IS HYPOTHERMIA.
HYPERTHERMIA IS EXPOSURE TO HEAT. WE'VE HEARD A LOT ABOUT THAT IN RECENT DAYS AROUND HERE.
AND THAT'S SOMETHING THAT RESULTS IN HEAT EXHAUSTION OR HEAT STROKE.
WE'LL DIFFERENTIATE BETWEEN THAT WHEN WE DO VITAL SIGNS,
BUT HEAT EXHAUSTION IS WHEN YOU'VE JUST BEEN -- YOUR ENERGY HAS BEEN EXHAUSTED.
AND USUALLY THE TEMPERATURE ISN'T MUCH ABOVE 100 OR 101,
BUT PROFUSE SWEATING THAT LEADS TO DEHYDRATION.
BUT HEAT STROKE IS USUALLY OVER 105 DEGREES BODY TEMPERATURE.
AND THEY'VE LOST THE ABILITY TO SWEAT AND SO THEY CAN'T COOL THEIR OWN BODY OFF
AND THEY CAN ACTUALLY GET A TEMPERATURE OF 113.
WHICH I FIND ABSOLUTELY FASCINATING AND CERTAINLY BRAIN DAMAGE.
[REMEMBER, I SAID THAT POINT.]
WE NEED REGULAR ENVIRONMENT SO THAT WE KEEP OUR TEMPERATURE AS CLOSE TO NORMAL AS POSSIBLE
OR THAT RANGE OF NORMAL, WHICH IS 96.6 TO 100 DEGREES.
ALRIGHT.
THERE'S PHYSICAL HAZARDS THAT EFFECT US AS FAR AS SAFETY.
AND THOSE ARE MOTOR VEHICLE ACCIDENTS OR ACCIDENTS IN GENERAL.
WE ALREADY TALKED ABOUT KIDS.
MOTOR VEHICLE ACCIDENTS ARE THE LEADING CAUSE OF UNINTENTIONAL DEATH.
THAT'S AMAZING, ISN'T IT?
FOLLOWED BY FALLS, POISONING, DROWNING, FIRES AND BURNS.
AND FALLS ARE THE MOST COMMON CAUSE OF HOSPITAL ADMISSIONS
OR TRAUMA FOR OLDER CLIENTS.
AMONG PEOPLE OVER THE AGE OF 65,
HIP FRACTURES RESULT IN MORE HOSPITAL ADMISSIONS THAN ANY OTHER INJURY.
SO FALLS ARE A HUGE DEAL.
WE'RE GOING TO TALK A LITTLE BIT ABOUT HOW TO PREVENT THOSE.
LIGHTING IS IMPORTANT, INSIDE AND OUT. IT REALLY HELPS PREVENT SOME INJURIES.
WHAT IF YOU CAN SEE STEPS AND OBSTACLES? YOU WANT TO HAVE GOOD LIGHTING.
SO PATHWAYS AND PATIOS AND DRIVEWAYS NEED TO BE LIT WELL SO THAT PEOPLE CAN SEE.
NIGHT LIGHTS ARE IMPORTANT, ESPECIALLY FOR THE ELDERLY
BECAUSE THEY GET A LITTLE DISORIENTED AND THAT'S WHERE THEY HAVE A LOT OF THEIR FALLS.
GETTING UP TO GO TO THE BATHROOM. BECAUSE THEY'RE UP MORE THAN YOUNGER PEOPLE ARE.
OBSTACLES CAN AFFECT SAFETY AND THERE ARE CERTAINLY MANY OF THOSE IN THE HOME.
THROW RUGS, DEBRIS, WET SPOTS, CLUTTERED AREAS.
IN THE HOSPITAL WE HAVE TO CAREFUL ABOUT SPILLS AND WET SPOTS.
AND YOU HAVE TO BE PROACTIVE ABOUT THAT.
IF YOU SEE A WET SPOT, EITHER YOU NEED TO THROW SOMETHING ON IT
OR MAKE SURE SOMEONE TAKES CARE OF IT SO THAT THE FALL DOESN'T HAPPEN.
WE NEED TO MAKE SURE THAT BEDSIDE TABLES AND OVERBED TABLES ARE --
FREE UP CLUTTERING. YOU WILL BE AMAZED AT THE AMOUNT OF JUNK THAT GETS PUT OUT FOR PEOPLE.
AND THINGS GET DUMPED OVER AND SPILLED. AND THEY DON'T KNOW IT'S SPILLED.
SOMEBODY TRIPS OVER AND SLIPS ON IT AND --
WE JUST NEED TO BE, KIND OF, A CLEANING TEAM.
IT'S PART OF WHAT WE DO TO MAKE SURE THAT PEOPLE ARE SAFE.
THERE ARE TWO KINDS OF FALLS THAT -- WELL, THERE ARE TWO REASONS FOR FALLS.
AND THAT IS EITHER INTRINSIC AND OR EXTRINSIC FACTORS.
INTRINSIC FACTORS ARE THINGS INSIDE THE PERSON THAT WOULD CAUSE THE FALL
LIKE AN ILLNESS OR A DRUG THERAPY.
FOR EXAMPLE, PARKINSON'S OR A STROKE. THERE IS NOT MUCH THAT WE CAN DO ABOUT THAT.
IN PARKINSON'S PEOPLE SHUFFLE THEIR FEET.
AND IF SOMEONE HAS A STROKE, THEY HAVE WEAKNESS ON THAT SIDE,
SO WE CAN'T FIX THAT NECESSARILY, BUT WE CAN MAKE SURE THAT THE ENVIRONMENT
OR THE EXTRINSIC FACTORS AREN'T ADDING TO THEIR PROBLEMS.
SO EXTRINSIC FACTORS WOULD BE ALL OF THOSE THINGS OUTSIDE THE PERSON.
SO REMOVING THROW RUGS SO PEOPLE DON'T SLIP ON THEM IS A HUGE INTERVENTION
FOR A LOT OF PEOPLE.
BATHROOMS ARE A PLACE OF A LOT OF HAZARDS.
ISN'T THAT AMAZING? YOU THINK A BATHROOM IS JUST A BATHROOM,
BUT THERE ARE A LOT OF HAZARDS THERE. NON-SKID STRIPS NEED TO BE PUT IN TUBS.
THAT'S THE NUMBER ONE REPORTED INCIDENT OF FALLS IN HOTELS IS FALLS IN THE TUB.
AND SO THEY'RE REALLY PRETTY ZEALOUS, MOST HOTELS ANYMORE,
ABOUT GETTING STRIPS IN THEIR TUBS SO PEOPLE DON'T FALL.
WE NEED TO DO THE SAME THINGS IN OUR HOMES
SO THAT PEOPLE AREN'T FALLING.
WE NEED GRAB BARS IN HOMES, ESPECIALLY FOR THE ELDERLY
SO THAT THEY CAN LOWER THEMSELVES AND GET THEMSELVES BACK UP.
AND ELEVATED TOILET SEATS ARE SOMETHING YOU MIGHT WANT CONSIDER
OR TALK TO A PATIENT ABOUT, BOTH IN THE HOSPITAL AND AT HOME.
AND AN ELEVATED TOILET SEAT IS JUST THAT. IT'S SOMETHING THAT FITS RIGHT ON THE TOILET
AND IT ACTUALLY MAKES THEM SIT ABOUT A FOOT HIGHER
SO THAT PEOPLE THAT TROUBLE GETTING UP AND DOWN, THEY HAVE TROUBLE WITH THEIR KNEES,
THEY JUST HAVE TO GO DOWN A LITTLE BIT GRAB THEIR HANDLE BAR AND COME RIGHT BACK UP.
SO IT'S NOT AS FAR.
YOU'D BE SURPRISED HOW LOW YOUR TOILET SEAT ARE.
KIND OF THINK ABOUT THAT THE NEXT TIME YOU GO.
LOOK AT ALL THE STUFF YOU GOT TO DO IN THE BATHROOM NOW. NOW YOU GOT OT LOOK AT NUMBER TWO
AND YOU GOT TO SEE HOW FAR WOULD DADDY GO.
BECAUSE IT IS PRETTY FAR.
THERMOSTATS NEED TO BE SET ON OUR HOT WATER HEATERS AT AROUND 105 TO 108.
BECAUSE OF SCALDING AND BURNS.
ESPECIALLY YOUR DIABETICS AND YOUR ELDERLY WHO DON'T HAVE GOOD SENSATION.
THEY DON'T KNOW IF IT'S TOO HOT AND THEY INCUR A BURN.
MEDICATIONS NEED TO BE LABELED APPROPRIATELY.
AND PEOPLE HAVE THEM IN THEIR MEDICINE CHEST.
YOU'D BE SURPRISED AT HOW PEOPLE KEEP THEIR MEDS. AND YOU HAVE THEM PULL 'EM OUT
AND THEY HAVE ALL DIFFERENT COLORS IN ONE LITTLE BOTTLE AND THAT'S THEIR PILLS.
I JUST DON'T THINK IT'S CONVENIENT.
SO I'LL BE A LOT OF FUN WHEN YOU TAKE CARE OF ME WHEN I'M 80.
BUT HELPING THEM LABEL STUFF SO THEY KNOW WHAT'S WHAT.
AND SO FAMILY MEMBERS CAN HELP THEM GET THE APPROPRIATE MEDICATIONS.
SECURITY IS IMPORTANT.
BREAK INNS. MY FIRST THOUGHT WAS JUST HAVING A SAFE ENVIRONMENT TO LIVE IN.
BUT ALSO FIRES LEAD POISONING AND CARBON MONOXIDE.
FIRES ARE MOST OFTEN STARTED BY CIGARETTES. I THINK THAT WAS IN YOUR READING.
LEAD POISONING MOST OFTEN HAPPENS WITH PAINT AND POTTERIES.
YOU WANT TO BE CAREFUL AND SEE WHAT PEOPLE HAVE IN THEIR HOMES
WHEN YOUR DOING HOME ASSESSMENTS.
AND THAT'S BASICALLY WHAT I WANTED TO MENTION.
OH, I LOVE THE TIMING OF FIRES.
BETWEEN 10-6 O'CLOCK IN THE MORNING.
10 O'CLOCK AT NIGHT TO 6 O'CLOCK IN THE MORNING IS WHEN MOST FIRES HAPPEN.
- IF ANYONE'S BEEN SMOKING IN BED.
- SMOKING IN BED. EXACTLY.
YOU'VE READ OVER THIS. INFANTS, TODDLERS AND PRESCHOOLERS.
THEY'RE AT RISK FOR INJURY AS RELATED TO ACCIDENTS. THEY'RE EXPLORING THE ENVIRONMENT.
IF YOU'VE WATCHED A TODDLER FOR ANYTIME AT ALL THEY PUT EVERYTHING IN THEIR MOUTH,
YOU KNOW, WHEN THEY'RE TRYING IT OUT. AND THEY'RE PULLING THINGS OVER ON 'EM.
AND SO INJURIES HAPPEN RELATED TO THAT.
SCHOOL AGE CHILDREN ARE MORE ACTIVE RIDING THEIR BICYCLE AND GETTING INVOLVED IN SPORTS.
THEY'RE STILL AT THAT CLUMSY AGE.
THEY'RE STILL NOT FULLY DEVELOPED AND SO THEY INCUR INJURIES THAT WAY.
ADOLESCENCE, MOTOR VEHICLE ACCIDENTS, WE SAID THEY'RE NUMBER ONE.
BUT ALSO, SUBSTANCE ABUSE, SUICIDE
AND SEXUALLY TRANSMITTED DISEASES ARE HIGH ON THEIR HIT LIST.
OLDER OR -- ADULTS, THEIR INJURIES AND RISKS ARE RELATED TO THEIR LIFESTYLE HABITS.
SO INTERESTINGLY AND YOU'LL NOTICE THIS ESPECIALLY WHEN YOUR STUDYING GERIATRICS
AND YOUR DOING YOUR NEWBORN NURSERY CARE,
WE'RE THE MOST SAME WHEN WE WERE BORN.
ALL OF US ARE MOST SAME. WE HAVE THE MOST SAME DEVELOPMENTAL ISSUES AT BIRTH.
AND WE'RE ARE THE MOST DIFFERENT IN OUR GERIATRIC YEARS.
BECAUSE AS LIFE PROGRESSES -- BECAUSE OF OUR LIFESTYLE CHOICES,
STRESSES THAT WE'RE UNDER, THE HOBBIES THAT WE PICK
WE BECOME MOST DIFFERENT AS WE GET OLDER AND THAT BEARS ITSELF OUT.
OLDER PEOPLE HAVE A HIGH INCIDENTS OF FALLING
AND THAT'S RELATED TO THEIR MUSCULAR SKELETAL CHANGES. THEY HAVE OSTEOPOROSIS, ARTHRITIS.
MUSCLES HAVE GOTTEN WEAKER. THEY'RE NOT ABLE TO BEAR WEIGHT AS WELL.
THEY DON'T HAVE AS MUCH ENDURANCE. THEIR REFLEXES ARE A LITTLE SLOWER.
THEY HAVE SENSORY CHANGES. YOUR EYES CHANGE. YOU THINK IT WON'T HAPPEN TO YOU, BUT IT DOES.
OVER 40 THINGS JUST START GOING DOWN. I JUST WANTED TO TESTIFY.
AND THEN THEY HAVE CHANGES IN THEIR GENITAL URINARY SYSTEM.
THEY HAVE NOCTURIA, WHICH IS JUST GETTING UP AND GOING TO THE BATHROOM AT NIGHT.
URGENCY AND INCONTINENCE IS MORE FREQUENT IN THE ELDERLY THAN IT IS IN...
ALRIGHT.
MOST OF THAT WE JUST TALKED ABOUT.
ALRIGHT, WANTED TO GET TO THIS.
ONE OF THE THINGS THEY MENTIONED IN YOUR BOOK WAS THAT MEDICAL ERRORS
IS A HUGE INCIDENT
AND A CONCERN FOR THOSE OF US THAT ARE IN THE MEDICAL FIELD.
AND SETS PEOPLE UP FOR INJURY.
MEDICAL ERRORS ARE HUGE AND I JUST WANTED TO EMPHASIZE THAT A LITTLE BIT MORE HERE.
AND THAT IS THAT RESEARCH HAS SHOWN THAT AT LEAST 98,000 AMERICANS, JUST AMERICANS,
DIE EACH YEAR DUE TO MEDICAL ERRORS.
THAT IS HUGE. AND YOU KNOW WHO THE MAJOR CULPRIT IS.
NURSES.
THAT IS HUGE. WE GOT TO DO SOMETHING ABOUT THAT.
THE CDC REPORTS THAT 90,000 DEATHS PER YEAR ARE DUE TO HOSPITAL ACQUIRED INFECTION.
90,000 DEATHS.
THAT JUST TELLS YOU PEOPLE AREN'T WASHING THEIR HANDS ENOUGH,
ISOLATING THOSE GERMS, I MEAN, WE STUDIED THE CHAIN OF INFECTION.
WHAT'S GOING TO STOP IT? AND THAT'S GETTING RID OF SOME OF THOSE --
THE SPREAD OF INFECTION.
THERE IS ESTIMATED 1500 -- THIS IS TERRIBLE, FOREIGN BODIES LEFT IN SURGICAL PATIENTS ANNUALLY.
FOREIGN BODIES, MEANING THEY LEFT A SPONGE, HEMOSTAT OR SOMETHING.
SURGERY IS WORKING ON IT.
I KNOW THAT THEY'VE BEEN PROACTIVE ABOUT MAKING SURE THAT DOESN'T HAPPEN.
WHO WANTS A SPONGE LEFT IN 'EM?
SO YOU'LL SE HOW THEY ARE ADDRESSING THAT WHEN YOU GET TO ERRORS.
MEDICAL ERRORS IS NOW THE SEVENTH LEADING CAUSE OF DEATH IN THE US.
MEDICAL ERRORS.
THAT'S HUGE.
THE TOTAL NATIONAL COST OF PREVENTABLE ADVERSE OUTCOMES IS -- IN OTHER WORDS,
WE SPEND IN EXCESS OF $17-29 BILLON ON ERRORS THAT COULD HAVE BEEN PREVENTED.
THAT IS A LOT OF MONEY.
SO WHAT IS KEEPING US FROM CREATING A SAFE ENVIRONMENT.
WELL, THIS IS WHAT THE RESEARCH HAS SHOWN.
I JUST WENT TO THIS MEDICAL STUDY -- OR RESEARCH STUDY CONFERENCE IN MAY
AND THIS IS WHAT THEY DETERMINED.
AN ENVIRONMENT WHERE ONLY THE PHYSICIANS CALL THE SHOTS IS AN ENVIRONMENT FOR ERROR.
THAT MEANS THERE IS NOT ENOUGH COLLABORATION BETWEEN NURSING AND ANCILLARY PERSONNEL.
AND THE OTHER THING THEY'VE DECIDED
IS THAT WHEN NURSING AND PHYSICIANS WORK AS TWO PARALLEL ENTITLES
IN WHICH THEY JUST DO THEIR THING AND WE JUST DO OUR THING
AND WE DON'T EVER GET IT TOGETHER,
THERE IS A HIGH INCIDENTS OF MEDICAL ERRORS.
SYSTEMS THAT REACTIVE RATHER THAN PROACTIVE IN MAINTAINING A SAFE ENVIRONMENT
CREATE A BARRIER FOR SAFE CARE.
IN OTHER WORDS SOMETHING HAPPENS, "OH, NO. OH, NO. WE'VE GOT TO FIX IT.""
INSTEAD OF, "OH, WE DON'T WANT THIS HAPPEN. LET'S PUT THIS IN PLACE."
WE'VE GOT TO BE PROACTIVE INSTEAD OF JUST GOING, "OH, WE'RE ALL DEAD."
OBVIOUSLY WE DIDN'T HAVE A PLAN.
AND THIS WAS ONE OF MY FAVORITES AND I EVEN MENTIONED IT IN OUR FIRST SESSION.
AND THAT IS THERE IS A HUGE DISCONNECT BETWEEN WHAT STUDENTS ARE TAUGHT IN NURSING PROGRAMS,
AND HOW THEY PRACTICE AFTER GRADUATION.
WHAT HAPPENS THE DAY THAT WE, YOU KNOW, PUT THAT TASSEL TO THE OTHER SIDE?
IT DOESN'T MEAN EVERYTHING YOU LEARNED IN SCHOOL IS OUT. "AND NOW I'M ON MY OWN. THANK YOU."
HELLO. WE'VE GOT TO MAKE SURE THAT IVORY TOWER NURSING CONTINUES TO PROPAGATE ITSELF.
AND THAT NURSING STUDENTS AND GRADUATES ARE STANDING UP FOR WHAT THEY KNOW
TO BE BEST PRACTICE.
INSTEAD OF GOING, "WELL THAT'S THE WAY THEY DO IT, SO I'M JUST GOING TO TO IT THAT WAY."
NO. A HUGE DISCONNECT HERE IS CAUSING UNSAFE ENVIRONMENTS FOR PATIENTS AND STAFF.
AND NURSING GRADUATES. THAT WOULD BE YOU GUYS ARE SOCIALIZED TO BE COMPLIANT,
JUST FOLLOW ALONG, PASSIVE, DON'T UPSET ANYBODY
AND SUPPORTIVE OF THE STATUS QUO IN THEIR NEW SETTINGS.
WE'VE GOT TO TEACH YOU TO BE A LITTLE MORE CONFIDENT
AND NOT AGGRESSIVE, BUT ASSERTIVE ABOUT WHAT YOU KNOW TO BE RIGHT
AND WHAT YOU WANT TO DO TO MAINTAIN YOUR LICENSE.
SO WHAT THEY'VE DONE TO ADDRESS THIS PROBLEM
IS CREATED WHAT THEY CALL HIGH RELIABILITY ORGANIZATIONS.
IN OTHER WORDS AN ORGANIZATION THAT WOULD OPERATE SO THAT INJURIES DON'T HAPPEN.
AND SO THAT PEOPLE ARE SAFE.
AND THEY'VE DEFINED A HIGH-RELIABILITY ORGANIZATION, AN HRO AS A HIGHLY COMPLEX,
HAZARDOUS TECHNOLOGICAL SYSTEM THAT FUNCTIONS WITHOUT HAVING ERRORS
OVER LONG PERIODS OF TIME.
THERE ARE EXAMPLES OF HRO'S AND YOU PROBABLY HEARD OF THEM.
BUT YOU KNOW THE SAFEST PLACE THAT YOU CAN BE IS IN AN AIRPLANE.
THEY ARE A HIGH RELIABILITY ORGANIZATION. THEY ARE TIGHT.
THERE ARE NO ACCIDENTS -- WHEN IS THE LAST TIME, YOU KNOW, A PLANE WAS DOWN.
THEY ARE FLYING MILLIONS EVERY DAY.
AIR TRAFFIC CONTROLLERS, AIRCRAFT CARRIERS
AND NUCLEAR POWER PLANTS ARE HIGH RELIABILITY ORGANIZATIONS.
THEY ARE A SAFE PLACE TO OPERATE.
AND THEY HAVE GOT HUGE STANDARDS WITH WHICH THEY COMPLY TO KEEP THEIR ORGANIZATIONS SAFE.
PRIMARY PRINCIPLES OF AN HRO ARE THIS. PATIENTS' SAFETY IS THE FIRST PRIORITY.
THEY'RE ALWAYS LOOKING OUT FOR WAYS TO KEEP A PATIENT SAFE AND THEN BEING PROACTIVE ABOUT IT.
TEAM WORK IS THE PRIMARY OPERATING PRINCIPLE.
WORKING TOGETHER. IT'S NOT JUST NURSES,
IT'S NOT JUST STUDENTS DOING THEIR THING.
AND IT FEELS LIKE THAT SOMETIMES AND IT WILL FEEL FRUSTRATING
BECAUSE YOU WANT TO FEEL INCLUDED IN THE WHOLE GROUP
SO THAT PATIENTS ARE GETTING GOOD CARE.
AND COMMUNICATION NEEDS TO BE CLEAR, EFFECTIVE CONTINUOUS AND REWARDED.
WE'RE GOING TO TALK A LOT ABOUT COMMUNICATION
BECAUSE I THINK IT'S CRITICAL TO SETTING YOUR FOUNDATION HERE.
AND WHAT THERAPEUTIC COMMUNICATION IS,
HOW TO BEST COMMUNICATE WITH DOCTORS.
THERE'S AN S-BAR THEORY THAT'S BEEN IMPLEMENTED WHERE --
I'LL ADDRESS THAT LATER, BUT IT'S WAYS
THAT WE CAN BE SUCCINCT ABOUT OUR INFORMATION,
TELL WHAT WE WANT TO TELL,
ASK FOR WHAT WE WANT IN RETURN FOR OUR INFORMATION, WHAT WE EXPECT.
AND THAT WAY COMMUNICATION IS ALWAYS CLEAR.
SO, HERE'S SOME THINGS THAT THEY --
I'VE JUST PICKED OUT THAT ARE RELATED TO YOU
THAT THEY GAVE US GUIDELINES FOR, A SAFE ENVIRONMENT.
AND THAT IS THAT NEW GRADUATES SHOULD NOT BE PLACED
IN A CHARGE NURSE POSITION FOR 12 TO 18 MONTHS.
YOU GUYS SHOULDN'T BE IN CHARGE. THEY SHOULDN'T SAY, "OH, GOOD. WE'RE SO GLAD YOU'RE HERE."
AND THEN THEY PUT ON THE NIGHT SHIFT AND YOU'RE THE CHARGE NURSE.
YOU SHOULD RUN SCARED.
THAT IS NOT A HIGH RELIABILITY ORGANIZATION.
ALSO, THEY SAID MEDICAL ERRORS ARE THREE TIMES HIGHER
WHEN NURSES WORK MORE THAN TWELVE AND A HALF HOURS.
THREE TIMES HIGHER. IN FACT, THE INCIDENCE --
THESE AREN'T. YOU KNOW IF THEY HAVE THAT ON THERE?
I'LL MAKE IT UP TO YOU.
NO, THESE ARE JUST FREE. AND HERE'S -- THIS IS A GREAT ONE.
MORTALITY. SO WHAT'S MORTALITY? - DEATH.
- DEATH IS RAISED TWO TO THREE TIMES HIGHER,
SO THE DEATH RATE WHEN NEW GRADUATES ARE ON THE NIGHT SHIFT.
HO-HO-HO. AND WHERE DO THEY PUT YOU? NIGHT SHIFT.
NOW IT'S NOT SO BAD THAT A NEW GRADUATE BE ON THE NIGHT SHIFT,
BUT THE WHOLE NIGHT SHIFT CAN'T BE STAFFED WITH NEW GRADUATES
OR PEOPLE WILL DIE. THAT IS THE RESEARCH.
SO YOU NEED TO LOOK AT YOUR CENSUS
WHEN YOU START FINDING YOUR FIRST JOBS AND GO,
"WHO'S GOING TO HELP ME? WHO'S MY PRECEPTOR?
WHO'S THE MENTOR? HOW'S THIS STAFFED?"
I HEARD RECENTLY WHEN SOME OF THE STUDENTS I TALKED TO AT FRESNO STATE SAID,
"YEAH, ALL THREE OF US ARE ON THE NIGHT SHIFT."
AND I WAS LIKE, "GOD HELP 'EM."
YOU KNOW, GOOD KIDS, THEY STUDIED HARD.
BUT...TOO MANY. TOO MANY.
SO VERY FRIGHTENING.
ALRIGHT, SO KEEP THAT SPEC IN MIND.
CHEMICAL -- I DON'T KNOW WHY MY WIRELESS KEEPS ACTING UP,
BUT THERE YOU GO.
CHEMICALS ARE SOMETHING THAT WOULD CAUSE INJURY, MERCURY --
MOST OF OUR ENVIRONMENTS, I JUST WANTED TO MENTION ARE MERCURY-FREE.
WE USED TO HAVE MERCURY THERMOMETERS.
WE USED TO HAVE MERCURY IN THE BLOOD PRESSURE SPHYGMOMANOMETERS.
WE DON'T ANYMORE BECAUSE IF THE MERCURY IS SPILLED,
IT'S A HAZARDOUS SPILL AND WE HAVE TO CLEAR ROOMS
SO THAT BIOHAZARD CAN COME IN AND GET THE MERCURY OUT OF THERE.
LATEX. MOST OF OUR ENVIRONMENTS ARE LATEX-FREE AS WELL
BECAUSE THERE'S JUST TOO MANY ALLERGIES.
AND PEOPLE WERE DEVELOPING ALLERGIES THAT DIDN'T HAVE 'EM,
SO MOST OF THE TIME LATEX IS JUST NOT AROUND.
IN FACT, I THINK AT CHILDREN'S, I DON'T EVEN THINK THEY ALLOW BALLOONS IN.
ONE, IT'S A HIGH INCIDENCE OF ASPIRATION FOR KIDS,
BUT ALSO THE LATEX IS A PROBLEM.
AND IN ALL OF YOUR INSTITUTIONS, YOU NEED TO BE AWARE THAT WHERE CHEMICALS ARE USED
THEY HAVE TO HAVE WHAT'S CALLED MATERIAL SAFETY DATA SHEETS,
SO THAT IF YOU WERE EXPOSED TO SOMETHING,
A CHEMICAL, A CLEANSER THAT'S AROUND,
THERE HAS TO BE AN ANTIDOTE OR THERE HAS TO BE SOME KIND OF INTERVENTION
THAT THEY KNOW IS EFFECTIVE AGAINST THEIR CHEMICAL.
AND THEY'RE REQUIRED TO HAVE 'EM ON ALL THE FLOORS.
SO THAT'S KIND OF A FUN THING TO ASK IS WHERE ARE YOUR MSDS'S?
ALRIGHT, FALLS. LET'S GO TO THAT.
ACCOUNT FOR 90% OF ALL REPORTED INCIDENCE IN THE HOSPITALS. WE TALKED ABOUT THAT.
THERE ARE CLIENT-INHERENT ACCIDENTS AND I'M SURE YOU READ ABOUT THAT.
AND THAT'S WHEN THE CLIENT CAUSES THEM TO THEMSELVES VERSUS PROCEDURE-RELATED.
AND LET'S JUST CLICK ON...
WE NEED TO BE ASSESSING FOR ALL OF THOSE THINGS WE'VE JUST TALKED ABOUT.
I THINK ASSESSING FOR RISK OR FALLS,
I WOULD FOCUS YOU BACK ON THAT FALL TOOL, DID YOU TAKE A LOOK AT THAT?
THEY'RE RISK FOR FALL.
IT'S REALLY A GREAT... BOX IN YOUR BOOK.
IT'S A RISK ASSESSMENT TOOL AND IT DESCRIBES HOW
IF THEY GET MORE THAN 15 POINTS ON ANY OF THOSE CRITERIA,
THEN THEY'RE AT HIGH RISK FOR FALLING.
AND WE THEN AS PRACTITIONERS NEED TO PUT --
INSTITUTE FALL PRECAUTIONS. WHICH WILL BE,
ONE, NOTIFYING PEOPLE, MAKE SURE BEDS ARE IN LOW POSITIONS AND SO FORTH.
SO MAKE SURE AND LOOK AT THAT. AND THAT'S PAGE 969 IN YOUR PERRY POTTER.
THINGS WE CAN DO TO PREVENT FALLS.
MAKE SURE THAT THERE'S PROPER SUPPORT AND SECURITY FOR YOUR PATIENTS
WHEN THEY'RE WALKING AND AMBULATING.
MAKE SURE THAT TWO SIDE RAILS ARE UP ON THE BEDS AT ALL TIMES.
MAKE SURE THE BEDS ARE ALWAYS IN A LOW POSITION.
AND THAT'S ONE OF THOSE THINGS YOU'RE JUST GOING TO HAVE TO GET IN YOUR CONSCIOUSNESS.
YOU KNOW THAT RAISING THE BED, LOWERING THE BED. RAISING THE BED, LOWERING THE BED.
COS YOU'RE SO EXCITED THAT YOU GOT IT UP IN THE RIGHT POSITION
AND YOU GOT 'EM ALL MOVED AND YOU JUST WANT TO TELL SOMEONE.
WELL, PUT THE BED DOWN BEFORE YOU DO. SO BE CAREFUL ABOUT THAT.
HAND RAILS. LOCKING BEDS AND WHEELCHAIRS IS HUGE, SO THAT PEOPLE DON'T FALL.
NON-SKID SHOES. GOOD RUBBER TIPS ON CRUTCHES, CANES, WALKERS.
REMOVING OBSTACLES. ADEQUATE LIGHT.
KEEPING PERSONAL ITEMS WITHIN REACH.
YOU KNOW, SOMETIMES YOU GET THE BED LOW AND THE SIDE RAILS UP,
BUT THEN THE STUFF THEY NEED IS SO FAR,
THAT THEY REACH AND THEN THEY FALL OUT OF BED
OR THEY TWIST AND INJURE THEMSELVES, SO KEEPING THINGS CLOSE.
RESTRAINTS?
RESTRAINTS.
I WANTED TO GIVE YOU THIS LITTLE HANDOUT.
AND HERE'S A BUNCH. THIS IS THE FLOW SHEET FROM KAISER ON RESTRAINTS.
AND I KNOW WE TALKED A LITTLE ABOUT RESTRAINTS IN THE SKILLS LAB,
BUT I JUST WANTED YOU TO SEE HOW THEY REALLY TRACK 'EM
AND TELL YOU WHAT THE IMPLICATIONS -- THE LEGAL IMPLICATIONS ARE.
MOST RESTRAINTS --
YEAH, THERE'S PLENTY, SO, BACK ROW DO YOUR THING.
HERE ARE SOME BASIC GUIDELINES I JUST WANTED TO MAKE SURE THAT WE WERE CLEAR ON.
AND THAT IS THIS, YOU HAVE TO HAVE AN ORDER TO PUT ON A RESTRAINT.
YOU CANNOT JUST DECIDE TO PUT ON A RESTRAINT.
RESTRAINT ORDERS HAVE TO BE RENEWED EVERY 24 HOURS
IF THEY'RE A MEDICAL-SURGICAL TYPE RESTRAINT,
WHICH IS SOMETHING THAT WE WOULD DO TO HELP KEEP 'EM SAFE FROM --
SO THAT A PROCEDURE OR A TREATMENT CAN CONTINUE.
IF THEY'RE A BEHAVIORAL RESTRAINT,
WHICH IS USUALLY YOUR PSYCH STRAINTS, YOUR 5150'S.
AND YOU'LL TALK MORE ABOUT THOSE IN PHYSCH.
THOSE HAVE TO BE RENEWED EVERY FOUR HOURS BY A PHYSICIAN.
SO THAT'S LEATHER RESTRAINTS, SOMEBODY THAT'S ON PCP
AND THEY'RE, WOW, WILD AND HURTING AND THROWING THINGS.
THEY CAN BE PUT IN LEATHER RESTRAINTS WITH AN ORDER,
BUT IT HAS TO BE RENEWED IN FOUR HOURS.
THEY CAN'T BE KEPT LIKE THAT OR IN A STRAITJACKET OR SOMETHING LIKE THAT.
ALRIGHT, WE'LL MOSTLY BE INVOLVED WITH AT THIS LEVEL, MEDICAL RESTRAINTS.
MEDICAL RESTRAINTS HAVE THESE REQUIREMENTS,
THAT THEY CAN NEVER HAVE A PRN ORDER, THAT GOES WITH 'EM.
SO YOU CAN'T JUST SAY AS NEEDED.
WE HAVE TO DO EVERYTHING POSSIBLE
AND WE HAVE TO DOCUMENT THAT WE'VE TRIED EVERYTHING POSSIBLE
TO NOT RESTRAIN SOMEBODY.
WHAT ARE THE THINGS THAT WE WOULD TRY TO DO?
WELL, THEY LIST ON YOUR LITTLE PAPER, ALTERNATIVE MEASURES.
SO YOU TRY TO RE-ORIENT THEM, YOU TRY TO DISTRACT 'EM,
YOU TRY TO RELAX 'EM, YOU TRY TO CHANGE THE ENVIRONMENT,
PUT 'EM BY A PHONE OR A TV OR A CLOCK.
YOU RELOCATED 'EM CLOSE TO A NURSING STATION
OR YOU GAVE 'EM A ROOMMATE,
YOU CHECKED 'EM ALL THE TIME, YOU GOT A SITTER,
YOU TOOK 'EM TO THE BATHROOM, YOU HAD PEOPLE TAKE 'EM EVERY TWO HOURS.
IT DOESN'T MATTER WHAT YOU DID...
THEY KEPT PULLING THEIR IV OUT OR THEY KEPT PULLING THEIR NG TUBE OUT
OR THEY KEPT PULLING THEIR FOLEY CATHETER OUT, BALLOON INTACT
AND SO RESTRAINT WAS IN ORDER.
SO THAT THEY DIDN'T HARM THEMSELVES MORE.
SO WE HAVE TO TOTALLY GO THROUGH A LOT OF STUFF.
WHEN A RESTRAINT IS PUT ON,
WE HAVE TO GET PERMISSION FROM EVEN THE FAMILY MEMBER OR THE PERSON
AND SOMETIMES THAT'S HARD BECAUSE THEY'RE CONFUSED,
SO SOMEBODY HAS TO KNOW THAT WE'RE PUTTING IT ON
AND EXPLAIN THAT TO THE FAMILY MEMBERS.
AND THEN WE HAVE OBLIGATIONS TO MONITOR THAT RESTRAINT APPROPRIATELY.
REMEMBER OUR FIRST GOAL, A RESTRAINT-FREE ENVIRONMENT.
WE'RE GOING TO TRY EVERYTHING WE CAN DO
BECAUSE WHAT DO YOU FIND OUT WHEN YOU'RE READING?
RESTRAINTS HAVE -- CAUSE INJURY. THEY HAVE --
IN FACT, THEY CAUSE MORE FALLS THAN THEY PREVENT FALLS.
THEY DO NOT PREVENT FALLS.
WHAT RESTRAINTS DO IS IMMOBILIZE A PERSON AND THAT'S THE PURPOSE OF IT,
SO THAT THEY CAN COMPLETE A TREATMENT SAFELY.
CONSEQUENTLY, BECAUSE WE KNOW A RESTRAINT CAN CAUSE INJURY CLIENTS HAVE TO BE OBSERVED.
AND AT KAISER IT SAYS 15 MINUTES.
I KNOW JOINT COMMISSION IS MAKING A --
I TOLD YOU A 24/7 RULE.
THEY WANT 'EM TO BE OBSERVED EVERY, EVERY MINUTE OF THE DAY.
AND SOME HOSPITALS HAVE IMPLEMENTED A 15 MINUTE RULE,
I BELIEVE FROM OSHA GUIDELINES. DON'T QUOTE ME ON THAT, BUT THEY HAVE A 15 MINUTE RULE.
AND WHAT THAT MEANS IS THAT YOU'RE GOING TO VISUALLY --
SOMEBODY'S GOING TO VISUALLY LOOK AND GO,
"GOOD. THEY'RE STILL IN BED. THEIR CIRCULATION'S NOT CUT OFF.
THEY'RE BREATHING. THEY'RE OKAY.
THEY'RE NOT HANGING FROM THE SIDE OF THE BED ON A RESTRAINT."
THEY HAVE TO BE VISUALLY LOOKED AT.
BUT EVERY TWO HOURS, THAT RESTRAINT HAS TO COME OFF.
IT JUST CAN'T BE LOOKED AT IN TWO HOURS,
IT HAS TO BE PHYSICALLY BE REMOVED.
THE SKIN INTEGRITY HAS TO BE CHECKED, CIRCULATION HAS TO BE CHECKED,
THE EXTREMITY HAS TO BE PUT THROUGH RANGE OF MOTION
AND THEN THEY HAVE TO BE REPOSITIONED
INTO ANOTHER POSITION, A DIFFERENT POSITION.
AND I EMPHASIZED THAT IN OUR CLASS.
BUT YOU CAN'T JUST KEEP PUTTING THEIR ARM DOWN LIKE THIS
OR IT'S GOING TO GET STUCK LIKE THAT.
YOU HAVE TO PUT IT UP, PUT IT UP, PUT IT OVER,
DO SOMETHING SO THAT THAT EXTREMITY IS GETTING ARRANGED.
AND THEN ALL OF OUR OBSERVATIONS HAVE TO BE DOCUMENTED.
THE NURSE, DEPENDING ON YOUR FACILITY,
DOESN'T HAVE TO BE THE ONE MAKING THE OBSERVATION,
BUT THE NURSE HAS TO DO THE TWO-HOUR...