September, 2008 Archive

September 18, 2008, 9:07 am

Grand Rounds, Change of Shift and Radio Daze!

This is hilarious!

The Ammonia Phone? It’s for asthma, bronchitis and consumption.

I think the only thing it consumed was your money.

The description alone is priceless.

I post it today in honor of this week’s Grand Rounds held over at Nurse Ratched’s Place with the theme of the Grand Rounds Medicine Show.

This would have fit right in!


For those of you looking for Change of Shift, Emily at is working hard to get the edition up by this evening. I’ll send the announcement once it is posted.


Tonight I have the honor of being the guest on the Doctor Anonymous radio show! I’ll be talking about the BlogWorldExpo (leaving tomorrow morning!) and what we hope to accomplish with them in terms of putting together a MedBlogger track for next year.

The show starts at 9 pm Eastern, 6 pm Pacific

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September 14, 2008, 11:45 pm

Weekend Warrior – Off Duty Doings

He was wonderful!

I saw Lindsey Buckingham on Saturday night at the Palace of Fine Arts in San Francisco.

Here’s an artist who maybe puts out a solo album every ten years and then he puts out two in two years!

“Gift of Screws” (a reference to an Emily Dickinson poem) is more upbeat than last year’s very introspective “Under the Skin”. It comes out on Tuesday and will be on iTunes and

I love everything he’s ever done.

I could have sat there all night just listening to his guitar.

If you click the link above, you can hear the first “single” off the CD, “Did You Miss Me”.

It’s worth the click!


We kicked major Michigan behind this week!

After last year, it’s nice to see the “old” Irish spirit back in the team.

Next week is our first away game, so that will be a big test of how far the team has come.

Geeze, I talk like I played the game, but trust me, if you could see me during the game you’d see I expend just as much energy!

I still miss Brady Quinn, though.


Of course the reason I still miss Brady Quinn is that, uh, he hardly plays during Browns games at all !

With all due respect to Derek Anderson, he just is not all that and a bag o’ chips.

It’s time to put Brady out there. Let’s put it this way, he can’t be any worse than Anderson.

I actually got to see a game (as opposed to listening on tonight and may I say something with the utmost sincerity? Just between us?

I hate the Steelers. With a passion.


Be still my beating heart!

Jeff Scott Soto’s new CD, “Beautiful Mess” is now on iTunes.

Geeze, maybe I need a music blog!

“21st Century” is the first single and the video is great (click link). I’ve met Jeff and the guitar player, Gary Schutt, and you will never find more down-to-earth, nicer guys.

I actually managed to act like a mature, professional adult in their presence.

Seriously! I didn’t swoon until I got home!

If you go see the Trans-Siberian Orchestra this year, Jeff will be with them on the west coast tour, so you’ll get to see him in person!


And last but not least, even though he isn’t in the Chase for the Sprint Cup, Kasey still ran a respectable 11th place today.

Although to listen to the announcers, he barely existed at all.

Thank goodness I have TrackPass so I can listen to Kasey’s in-car radio while I follow the race on the computer AND watch it on TV at the same time.

Hey! Being a NASCAR fan is labor intensive.

Actually, I just needed an excuse to put this photo up – it’s my desktop image!

(Photo by Jason Smith/Getty Images for NASCAR)


I now return you to the regularly scheduled nursing blog.

Hey, a girl’s gotta have a little fun now and then, right?

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10:19 pm

Send Them Off in a Letter to Yourself

Can you believe this?

I don’t know about you, but some of my favorite moments in nursing school were spent in “Circle Time”!


This looks like a kindergarten class listening to teacher read a book!

What, they only had one piece of paper to go around? I realize this was before the advent of technology, but surely the Gutenberg press had been invented by then!


Discharge instructions.

One of the most important duties I have in the ER is educating my patients on what is happening to them, what they need to do after discharge and when/where to follow up.

It’s disturbing to learn they understand very little of it.

It’s even worse to learn that they don’t know that they don’t know.

Check out this story from Reuters.


I had a hard time believing that so many people have so little comprehension of what they are told.

Until I started wondering why.


Of course they aren’t going to remember much.

1. They are under stress – anyone who comes into the ER, as a patient or a family member, comes in with some amount of anxiety. The ability to retain information is inversely proportional to the amount of anxiety experienced (The Law of Diminishing Retention. I just made it up.)

And then,

2. They are in pain – isn’t that the reason most people show up at the ER? Something hurts. How much information can be retained when you’re in pain?

But wait…

3. We treat the pain – usually with a narcotic. Now the anxiety (and, hopefully, pain!) is gone/diminished but the patient is groggy. How much do you remember under the influence? Of anything?

Now add to the equation the reality that…

4. Most people don’t have a clue about how their bodies work – really, they don’t. Take the average person off the street with no medical background and ask them to explain what cholelithiasis is. Or viral gastroenteritis. Or cellulitis. Now take a person who is (a) under stress, (b) uncomfortable and (c) narcotized and tell them all about what is wrong with them, anatomically, physiologically….


See where I’m going with this?

And then, finally…

5. They want to get out of the ER – take all of the above, add a wait time (some facilities are worse than others), add the time it takes to get the labs and diagnostic results back, give the doctor some time to explain those results and then give the nurse time to type up the instructions and explain them to the patient.

The patient who just wants to leave.

By then, I’m sure we don’t have their undivided attention.


But…isn’t that why we give written instructions to go?

Well, yeah, but do the patients really read them? My guess is no.

So, when I do patient education (aka discharge instructions), I do the following:

1. I educate as I go. I don’t wait to bombard the patient at the end. If the patient is sedated, I can talk to family members.

2. Keep is simple. I do a quick overview of the problem, what symptoms to look for, what to expect from the medications, and who to follow up with and when.

3. I highlight parts of the instructions that the patient needs to know right then (see #2).

4. I tell the patient and the family members that it is extremely important that the discharge instructions are read in full, not necessarily right when they get home, but within a few hours.


Those written discharge instructions cover all bases in terms of what the patient needs to know, what they need to do, when they need to do it and why they need to do it. We use a very thorough system and I add information specific to the patient.

I have a suspicion that the inability to articulate what is happening or when to follow up has a lot to do with patients not referring to their written instructions – doesn’t seem like a single patient in the above linked study referred to any discharge papers when interviewed.

The patient needs to take responsibility for their own health education once they leave the ER and keep those discharge papers.

Or maybe they should take Steely Dan’s advice and…

Send them off in a letter to themselves!

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About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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