Saving Lives

Last year, at the ASPAN Conference held in Grapevine, TX, the opening speaker talked for almost an hour about the negative media portrayal of nurses in popular television programmes that include Soap Operas, prime time TV shows such as House and Gray's Anatomy, Scrubs and many more. At the time, there were many people in the audience who spoke up and expressed their opinion that it was 'entertainment', 'nobody believed it to be truth' and that 'some people take themselves too seriously.' I tended to side with them, but then I found a site called The Truth About Nursing which I found to be very interesting. I think my opinion has shifted somewhat. Why can't television programmes be entertaining AND factual? For years it has been driving me crazy that a patient on Life Support is intubated and talking with the side rails down, or on nasal prongs and 'close to death.' One time, I think it was on the Y&R, a young child on life support (and nasal prongs) died while the nurse was just standing there, sadly watching the child die. No CPR, no attempt at any kind of calling out for help...just the thin annoying pitch of a flat line on the monitor. That's just one example.
Anyway, it's food for thought. We all know the important work that we do, and that hospitals around the world could not function without Nurses. Isn't it time that we get the respect that is due?

If you are interested in reading more about this, here is a book that is being promoted by The Truth About Nursing:
Saving Lives: Why the Medias Portrayal of Nurses puts us all at Risk

Information from the dust jacket of Saving Lives:
Popular TV shows like Grey’s Anatomy, ER, and House lead people to think that nurses simply push gurneys, drive romantic plots, and provide a human backdrop for the real action. However, those of us among the 12 million nurses worldwide know the reality is far more fascinating, demanding and important.
Written by the leaders of The Truth About Nursing, the organization at the forefront of challenging and changing representations of nurses, Saving Lives highlights the essential role nurses play. It explores the public’s perception of nurses and spells out the greatest myths about nursing, drawing on examples from television shows, ads, news, and other media.
Saving Lives exposes the media’s role in reinforcing stereotypes that help fuel the nursing shortage. But it is also a call to action. Saving Lives offers concrete steps to help nurses and their supporters educate the public about nursing.
For millions of people worldwide, nurses are the difference between life and death, self-sufficiency and dependency, and hope and despair. Nonetheless a lack of appreciation for nursing has contributed to a global shortage that is one of our most urgent public health crises. There are not enough nurses available to monitor patients, provide high-tech treatments, advocate for patients, and teach patients how to live with their conditions. Poor understanding of what nurses do undermines claims for adequate staffing, and leads to a lack of resources for nursing practice, education, and research. All of that means worse patient outcomes, including death.
Saving Lives is destined to change public perceptions, thereby empowering nurses and helping them get the respect they need to save lives.

The "Not What They Say I Am" flyer sends a message that many media depictions of nurses are not accurate and that nurses object to them, in part because they undermine nurses' claims to adequate resources. This is a key message of the Truth About Nursing, and one explored in detail in our new book Saving Lives.

The ironic "Hooray for Hollywood" flyer sends the message that, in our view, there has been little for nurses to cheer about in recent Hollywood depictions of their work. Popular TV shows like "House" and "Grey's Anatomy" have repeatedly offered inaccurate and damaging images of nursing, and we hope the flyer will cause those who see it to reconsider those images. The small print on the flyers directs people to our book and The Truth's website.

Find more information at http://www.truthaboutnursing.org/

I'll throw the question to you. Do you think that the media's portrayal of nurses is disrespectful and highly inaccurate, or do you think it's all just entertainment and there shouldn't be a big deal made about it?

Opinion - 'Do we really need all these nurses?'

Opinion - 'Do we really need all these nurses?'
Toronto Star, March 10, 2009
Sioban Nelson

If there's one thing nurses know, it's that tough economic times tend to mean cuts to the profession. This has been the pattern over the decades, where nursing from Toronto to Manchester to São Paulo has all too frequently been the health-care service sector that takes the hardest and deepest cuts when the economy takes a nose dive.
There is an obvious reason for this. Nursing salaries account for a major percentage of health-service budgets. As CEOs and CFOs are driven to reduce spending and create efficiencies, the first question that comes to mind is usually: "Do we really need all these nurses?"
This is at one level a legitimate question. The drive to answer it has spawned an entire science that measures workload and efficiency, examines the relationship between the number and skill level of nurses on patient outcomes, and analyzes the relationship between staffing profile turnover and burnout.
The Lawrence S. Bloomberg Faculty of Nursing, through its nursing research unit and faculty research, has made this faculty one of the top sites in the world for health-services research in nursing and health care.
But the question "Do we really need all these nurses?" is not only an empirical one that good research can answer. It is also a rhetorical question that reflects a worrying attitude toward nursing that has bedevilled the profession for more than a century.
Even today, when we finally have the data to show that quality nursing staff is strongly correlated with patient outcomes (including mortality), the question continues to be raised. The tradition of seeing nursing as a resource to be built up in good times and trimmed back in lean times dates back to the very beginning of professional nursing.
For most of the 20th century, nursing-student labour fuelled the engines of the modern hospital. Hospitals hummed with industrious nurses washing patients, bed-making and establishing military order and cleanliness. Behind the scenes, student nurses rolled bandages, mended surgical gloves, sterilized and packaged all the sterile materials and packs, sorted laundry items, stocked and restocked drugs and supplies, cooked special diet meals in ward kitchens, distributed all meals and fed all patients. Nurses managed the wards, their patients, the operating room, the hospital budgets and overall operations.
There was clinical work, too. Early transfusions involved six nurses managing the two patients, careful handling of the delicate glass equipment and ensuring constant flow to prevent clotting. Hypodermic injections involved oil-lamp heating of solutions, and nurses did a great deal of dispensing work in the everyday course of caring for their patients. Pre-antibiotic era nursing meant lengthy and complex irrigations of wounds and douchings.
When students graduated from their programs and completed their staff nurse year, they made their way into the few senior roles that existed within the hospital sector or moved into the community, public health and home-nursing sector, where experienced nurses held their own.
Back in the hospitals, the priority often was volume rather than quality. Young girls were worked hard and long with poor remuneration and little respect for their contribution to patient care. High burnout rates, workplace injuries and poor health status have been the norm for hospital-based nurses around the world for far too long.
It also has led to the idea that nurses are in a sense a disposable resource, replaceable and interchangeable like front-line soldiers in early 20th century warfare. Despite clear advances in nursing's position in many parts of the world, including Canada, with each turn of the economic screw, nurses feel the vulnerability of the sector.
Every time we cut nurses, we hit a pipeline. It is not today's nurses we affect but the next 10 years' worth of nurses. In five years' time, with normal attrition and the retirement of the boomers, there will inevitably be more panicked calls for nurses - but where will they be?
Every time nursing jobs are cut, smart young high-school students watch and learn. They choose other careers. Meanwhile, health-service providers cut services and shed nurses. Overwhelmed services can't cope with the demands of students. They cut places. So when the pendulum swings it is impossible to increase the number of nursing student seats.
Meanwhile, entrepreneurial governments and private providers scour the world for nurses, causing more inequity and suffering in their wake as they contract large numbers of nurses from countries that can ill afford to lose them.
What are the implications for health care with today's economic crisis? The rise in chronic illness along with the aging RN workforce make this a critical moment for the future of our health-care system. If we cut off nurses now, we will feel it for the next decade and beyond -and it will be bad.
Do we really need all these nurses? We do.
We need new graduates developing their skills and knowledge in a safe and supportive environment so they do not burn out and leave. We need advanced practice nurses bringing creative and cost-effective solutions to complex system problems. We need nurse practitioners to provide access to the great number of people the system currently fails and to keep costs down. We need them to prevent illness, manage chronic disease and to keep people well and safe in the community. We need them to track us through the highly dangerous space of the acute in-patient sector and ensure that we avoid life-threatening complications, are well-informed and educated about our treatment and its consequences, and go home in the best position possible to undertake self-management of chronic conditions.
To cut nurses is to cut the system's capacity to do this now and into the future. It is in everyone's interest to make sure our decision-makers understand this and are held accountable for the consequences of their actions. As members of the profession and members of the public, it is our job to ensure this.
Sioban Nelson is dean of the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto.
Sheree BondPublic Relations TeamOntario Nurses' Association85 Grenville Street, Suite 400Toronto, ON M5S 3A2(416) 964-8833, ext. 2430

Inattentional Blindness: What Captures Your Attention?

ISMP (United States) Medication Safety Alert! Febuary 26, 2009 Vol. 14, Issue 4
Inattentional Blindness: What Captures Your Attention?
A nurse pulls a vial of heparin from an automated dispensing cabinet (ADC). She reads the label, prepares the medication, and administers it intravenously to an infant. The infant receives heparin in a concentration of 10,000 units/mL instead of 10 units/mL and dies.

A pharmacist enters a prescription for methotrexate daily into the pharmacy computer. A dose warning appears on the screen. The pharmacist reads the warning, bypasses it, and dispenses the medication as entered. The patient receives an overdose of the medication and dies.

A nurse reaches in the refrigerator for a piggyback antibiotic for her patient. She reads the label, spikes the bag with IV tubing, and administers the medication to her patient. The patient receives a neuromuscular blocking agent instead of the intended antibiotic and dies.

A pharmacy technician labels and delivers an IV infusion to the dialysis unit. The nurse reads the pharmacy label and hangs the bag while preparing her patient for dialysis. The patient receives sterile water for injection instead of 0.9% sodium chloride and dies.

A nurse picks out a prefilled syringe of pain medication for her patient. She reads the label and administers the medication intravenously. The patient receives hydromorphone instead of morphine and experiences a respiratory arrest.

All of these actual errors, and many more in healthcare and other industries, have happened under similar circumstances: the person performing the task fails to see what should have been plainly visible, and later, they cannot explain the lapse.(1) In many cases, people involved in the errors have been labeled as careless and negligent. But these types of accidents are common—even with intelligent, vigilant, and attentive people. The cause is usually rooted in inattentional blindness, a condition all people periodically exhibit.(1)

How do we process information?
Most mental processing occurs outside of conscious awareness. The amount of information that can be taken in by our senses is limitless. But the brain has very limited resources when it comes to attentiveness. Our senses receive much more information than can possibly be processed at one time. To combat information overload, the brain allows large amounts of information through almost entirely unassimilated, peeling off just a few pieces of selected information for a closer look.(2)
In deciding what to focus on, the brain scans about 30-40 pieces of information (e.g., sights, sounds, smells, tactile information) per second, until something captures its attention.(2) Our attention filter selects just a small amount of information to process, and anything leftover gets short shrift. The rest of the information never reaches our consciousness—thus the term inattentional blindness. Unfortunately, the brain is a master at filling in the gaps and compiling an integrated portrait of reality based on just a flickering view.(1)
Accidents happen when attention mistakenly filters away important information and the brain fills in the gaps with what is aptly referred to as a “grand illusion.” (2) Thus, in the examples above, the brains of the individuals involved in the errors filtered out important information on medication labels and computer screens, and filled in the gaps with erroneous information that led them to believe they had the correct medication or had read the warning appropriately.

What captures your attention?
Visual attentiveness, or what captures your attention, is shaped by four factors.

Conspicuity. The degree to which an object or piece of information jumps out to capture your attention falls into two categories: sensory conspicuity and cognitive conspicuity. Sensory conspicuity deals with the physical properties of information. For example, a high degree of contrast with the background is the most important feature in making information conspicuous,(1) and luminance (brightness) contrast is more important than color contrast.(3) Factors such as bright colors, movement, and flicker do not ensure conspicuity;(1) however, pre-attentive properties (the brain automatically processes the information without being aware of it) such as color and shape have been used successfully on visual displays to call attention to specific items or categories.(3)

Cognitive conspicuity deals with the perceived relevance of the information. The “cocktail party” effect(4) is a classic portrayal of this factor. This is the term used for the phenomenon of being in a crowd, listening to a conversation, and still being able to hear your name mentioned across the room.(3) Functioning somewhat like the volume control on a radio, you can turn down the volume of background noise at a cocktail party and turn up the volume as you listen attentively to one conversation at a time. While engaged in conversation, if someone behind you mentions your name, you are automatically attracted to the other conversation because it is meaningful to you. Meaningful visual information can also jump out at you automatically, such as scanning the newspaper and finding your attention drawn to articles that include the first name of your child. Attention to something of particular relevance can also be purposeful. For example, you may scan a luggage carousel for your black suitcase, looking purposefully for the broken wheel or yellow ribbon that distinguishes your suitcase from all the other black suitcases on the carousel.

Mental workload and task interference.
Inattentional blindness is more likely to occur if part of your attention is diverted to secondary tasks, like answering the phone while entering prescriptions into the computer, or even thinking about your dinner plans while transcribing an order. We all learn to function amazingly well while multi-tasking, but more complicated tasks require our full attention. However, auditory tasks (listening to the radio) will interfere less with visual tasks (seeing a pedestrian crossing the road) than would a second visual task (focusing on a street sign).(1)
Low workload causes boredom and reduces the mental attention given to tasks, as does carrying out highly practiced tasks, such as drawing medication out of a vial into a syringe. In fact, we spend a large majority of our waking life functioning with the equivalent of an automatic pilot, with occasional conscious checks to ensure tasks are being carried out properly. This makes us particularly prone to inattentional blindness. Reliance on technology has also lessened our ability to notice abnormalities.

Expectation.
Expectation has a powerful effect on our ability to pay attention and notice information. If the medication we are looking for comes in a carton with a highly stylized label, we come to expect this presentation every time we look for the medication. If a new medication comes in a similar looking carton, our brain may not pay attention to any information that disconfirms our belief that the new medication is the old one—a well-known phenomenon called confirmation bias to which highly experienced practitioners are most prone.
Our past experiences also teach us what is relevant. Errors occur when new or unusual circumstances happen in highly familiar situations. The nurse who picked up a vial of heparin in the wrong concentration had never experienced removing the wrong medication from an ADC cabinet before this event. The pharmacist who did not notice important information on a computer warning had rarely encountered a clinically significant computer alert. The nurse who picked the wrong pain medication from the narcotics cabinet did not remember making such an error in the past. Each of the practitioners in the examples above had subconsciously learned that there was nothing important to see when carrying out these tasks. Nothing had ever happened, so attention was automatically filtered away from the details to conserve mental processing.

Capacity.
The capacity to pay attention is variable from person to person and influenced by age and mental aptitude. From time to time, attention is also variable within an individual due to influences such as distractions, alcohol, drugs, and fatigue.
It is difficult to reduce the risk of inattentional blindness, as it is an involuntary and unnoticed consequence of our adaptive ability to defend against information overload. Error-reduction strategies such as education, training, and rules are of little value. Instead, efforts should center on increasing conspicuity of critical information, and decreasing diversions of attention and secondary tasks when carrying out complex tasks.
References: 1) Green M. “Inattentional blindness” and conspicuity. Visual Expert 2004 (www.visualexpert.com/Resources/inattentionalblindness.ht ml). 2) Angier N. Blind to change, even as it stares us in the face. The New York Times April 1, 2008 (www.nytimes.com/200 8/04/01/science/01angi.htm?_r=2&ex=1207713600&en=204&oref=slogin). 3) Federal Aviation Administration (FAA). FAA human factors awareness course. (www.hf.faa.gov/webtraining/Intro/Intro1.htm). 4) Arons B. A review of the cocktail party effect. MIT Media Lab; 1992. (www.media.mit.edu/speech/paper s/1992/arons_AVIOSJ92_cocktail_party_effect.pdf).

Updates and Spine Program

It's time to update this Blog!
A warm welcome to Prema Arulanantham who survived the George Brown Critical Care course and is now finished her orientation to PACU. Stacey Lauzon is currently in the GBC Critical Care Course, and we wish her continued success as she starts Phase 2 of the program.
Farewell to Betty Manino who remains within the PeriAnesthesia environmentand in the Endoscopy Clinic, and Nadiya Arkhipova who has returned to the TECC program.

The Surgical Short Stay Unit continues to expand! They are now up to 8 beds and patients now also include Spinal patients who stay for one night in the SSSU and are transfered to the Holland Centre in the morning.

For more information on the Spine Program, click HERE!