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...