Nurse Educator Nursing Instructions For Extended: Fill & Download for Free

You can only do one thing at a time, how do you imagine somebody gloved up would be able to both cut and administer needed anesthetics to the patient? The answer would be no, even in under very primitive circumstances there would have been a semi-educated nursing aide maintaining the anesthesia once the doc has induced it, knowing how to top up the needed meds as instructed by the doc.I once met an older colleague, who in the late sixties having been posted to an outpost in the former West Irian, nowadays the Indonesian Province of Papua, (the only doc within a circumference of 200 km) running a primitive clinic with two nursing aides who also doubled up as rowers and tree hut builders during their extended tours of the area using a dug-out canoe, had to first put the patient to sleep using open ether anesthesia using a simple open face mask (no controlled airways, high risk for vomiting and aspiration, but that was all he had), then washing up and performing a cesarian section, his first ever, with his OB textbook open on the table next to the the operating table, all the while trying not to inhale too much of the ether fumes, while the patient’s whole tribe stood waiting outside brandishing spears, manchetes and such. They all made it….

In addition to once having spent 114 days on hospitalized pregnancy bedrest, I have also helped various family members and friends when they were hospitalized.I should say, I received exceptional care during my own extended hospitalization. However, the circumstances were unusual. I was the only long-term obstetrics inpatient in a small, rural hospital. The specially negotiated fee for my care was a significant help in covering the fixed costs of the hospital’s OB unit. Also, at the time, I was an employee of that hospital, and I was able to work from my hospital bed.The comments below, which are negative in tone, are based on my experience helping ill family and friends. Note that these comments are specific to U.S. hospitals, and may not apply to hospitals in other countries.1) Generally speaking, you don’t want to be in a hospital unless you absolutely, positively need to be there. Patients in a hospital setting have little to no autonomy, suffer significant sleep disruption, and are exposed to a significant danger of hospital acquired (nosocomial) infections.2) Nurses and other staff members are typically being pulled in so many different directions that they are unable to provide an appropriate level of hands-on, timely patient care. In some hospital settings, the most highly trained floor nurses (typically, RNs) may not be providing any hands-on patient care at all, as they may need to devote their time to distributing medications that cannot be dispensed by a staff member with a lower level of certification.3) If you are very ill, you will fare best if a rotating cast of family and friends can be with you 24 hours per day. When you are ill, it’s hard to advocate for yourself. Here are some things that such people can do:a) If your hospital stay is planned, work with the admitting physician BEFORE you go into the hospital to ensure that your list of diagnoses, medications, allergies and drug contra-indications is current and accurate. The hospital staff will administer meds according to written orders. If a medication is not on the written list, you will not receive it unless and until you perform the labors of Hercules to get that list revised. For instance, a patient who is taking a medication for depression or anxiety will not receive that medication in a hospital setting unless the admitting physician has put it on the written orders. You may need to get the prescribing physician to connect with the admitting physician or hospitalist to add a missing med to the hospital orders. If you have known allergies or known adverse reactions to specific meds, confirm that these are all properly documented.b) Do not make the mistake of thinking that you can bring medicines from home or that you will be allowed to self-administer such meds in the hospital. They will be lost or confiscated. If possible, check to make sure that medication orders are being properly administered.c) TAKE NOTES. Physicians come when they come, and they come and go very quickly. A family member should take notes of anything a physician says and be prepared to share those notes with the patient (who may be groggy, or unconscious, or unable to absorb or remember what the physician says), as well as with other clinicians. Try to always be physically present during any shift change (usually, 7 a.m., 3 p.m. and 11 p.m.). If the departing and arriving nurse have a quick debrief at the patient bedside (unlikely, but it sometimes happens), keep your ears pricked to make sure key issues/changes are communicated.d) Be nice to each and every member of the hospital floor staff. They are overworked. Understand that any comfort request you make will typically take minutes or hours to be addressed. A family member who ingratiates himself or herself with the floor staff may be able to go and get you a warm blanket, or a ginger ale, or saltines. Learn the names and faces of the individuals who are assigned to you during any shift.e) A family member who is assertive can ask visiting physicians and nurses to wash their hands before examining you. There are still far too many hospital staff members who do not wash their hands between patients. This is a leading cause of nosocomial infections.f) There are nursing tasks that your family may be able to learn to do to help in your care. For instance, when a family member was hospitalized in the Intensive Care Unit, his wife learned to suction his upper airway. This allowed for a faster response when he indicated that he was in respiratory distress.g) If your family member/friend is in pain, be sure you understand the specifics of any pain med instructions. For instance, it may be that they will not receive pain meds unless or until they ask for them. If you know that, you can advocate for them.4) Even in the case of an emergency admission, there are a few things you can grab that will make your stay more comfortable. These include a charger or charging station, a phone or iPad with your favorite music and/or movies previously downloaded, earbuds, a notepad and a pen. For a planned stay, ask your physician if you can bring your own pyjamas (or at the least, PJ bottoms) and bathrobe.I could go on, but that’s a start . . . .1. Sleep Deprivation: Sleep Deprivation in Hospitals Is a Real Problem, Why won't hospitals let patients sleep?, Why Hospitals Should Let You Sleep2. Nosocomial Infections: Why Hospitals Should Let You Sleep, Hospital-Acquired Infection: Definition and Patient EducationP.S. Edits - with thanks to Vinod Pillai for the suggestion:5) Hospital architecture is confusing and this is detrimental to patient care, comfort and outcomes, as well as to staff happiness and efficiency. It’s my belief that there are special programs for hospital architects, wherein they learn to design structures that are confusing both externally and internally. The exception that proves the rule is the exterior signage for emergency rooms. It is almost always easy to find your way INTO an emergency room, though generally not so easy to find your way out. Also, children’s hospitals often attempt to compensate for poor design by using a lot of color coding on signs, floors and walls to help people find their way from any Point A to Point B.How the Architecture of Hospitals Affects Health OutcomesThe Impact of Facility Design on Patient SafetyWhy hospital architects need to talk to nursesAn Easier Hospital | Gensler Research Institute | Research & Insight | Gensler6) When you are discharged from the hospital, do the extra work to make sure that ALL of your treating physicians are given correct information on the medications that you were given during your hospital stay, so that you can ensure continuity of medication as appropriate. There are many pitfalls here. To name just one: If you were given opioid painkillers in the hospital, these will likely not be reflected in reports generated by regular pharmacies. In the current U.S. climate, this may mean that a pain specialist will be unwilling or unable to prescribe the same dosage of pain medication that you were given in the hospital (their prescribing patterns are monitored by computer, and jumping to a high pain prescription from nothing or a low prescription will result in their getting into trouble). If that should happen, you may begin your first days at home experiencing both extreme pain and narcotics withdrawal, with limited to no ability to address either problem.P.P.S. Edits7) If you would like the medical staff to be able to talk about you with anyone else, please be sure and fill out HIPAA paperwork naming those specific individuals in advance of your hospital stay. Give them copies of the paperwork so that they can show it to staff, because it may very well not make it into the system.8) The hospital will very likely encourage you to fill out living will type paperwork. While you’re contemplating death anyway, consider the consequences if you die and no one knows any of your user names and passwords. Take appropriate action to protect your loved ones from that headache. If you don’t, the consequences will include Facebook reminding all your FB friends about your birthday for years to come, while LinkedIn will celebrate your job anniversaries in perpetuity. Not to mention the impossibility of accessing the photos you may have stored on iCloud and the more solvable but nevertheless difficult issue of regaining access to your financial accounts.9) On a more cheerful note, if you’re able to enjoy good food, don’t subject yourself to the banality of one size suits all hospital food. Order pizza to be delivered. Or have your friends and family bring good food to you.10) If you want visitors, give your friends and family suggestions that will make it easier and more comfortable to visit you. Put on a cheerful face. Send them an advance note prohibiting them from buying you anything at the hospital gift shop. Ask them to bring specific things that you would enjoy or appreciate. Include in your list thoughtfully chosen gifts for physicians, nurses and other staff. Don’t don’t forget the people who clean your room, bring your food, and may be able to get you such coveted goodies as warm blankets and cold ginger ale with saltines, and to get them more quickly than the overworked nursing staff. Cards that show some thought . . . show some thought. Nurses vary in whether they want or don’t want food gifts, as well as in whether they are allowed to accept them.P.P.P.S.11) I have recently learned that it is still possible (if you have enough money) to hire a private duty nurse to care for you - and only for you - during a hospital stay. Here is a link to a New York Times story about this phenomenonNurse Deficit? Affluent Patients Hire Their Ownand to a NYC agency that provides private duty nurses:Private Duty Nursing | Access Nursing ServicesI do not know whether all hospitals are open to such arrangements, how responsibilities are shared with hospital staff, or indeed anything more than what I just said.12) The website just referenced provides a useful list of Safety Tips for Transitioning from Hospital to Home, including the importance of knowing the possible bad side effects of any new medications or therapies, having a plan to get home safely and to live at home safely (think fall prevention), as well as making arrangements to come home to a nicely stocked refrigerator.13) If you are stable, ask your medical team if you may be allowed to sleep through any otherwise scheduled vitals checks. If the answer is yes, ask a physician to put written orders in your chart instructing the nursing staff not to take your vitals when you are asleep unless there is some specific clinical reason to do so.14) Ask to have your discharge instructions as early as possible, For instance, if you are being admitted to the hospital for a scheduled procedure, ask to have the standard discharge instructions before you schedule the procedure. This will allow you to know and plan for any requirements/recommendations that you might not otherwise anticipate. You don’t want to learn for the first time upon discharge that there is a six week anticipated recovery period during which you are not supposed to life anything heavier than 10 pounds . . . and etc.

The one where you can become a nurse in.Here are the rules for Canada.Becoming an RNYou also have to immigrate to Canada.The entire process is set up for self-service. Here is the full set of instructions.Canada prefers young and well educated immigrants. If you are, your path will be short and sweet.First try your luck on the fast route. This may give you a Permanent Residence visa in as little as a few months, if you are really good:Immigrate as a skilled worker through Express EntryIf this fails you, and you will know in the first ten minutes, then there is the long and arduous way. Start your process here:Do you want to come to Canada, or extend your stay?Every step is explained and clear. Just answer ALL the questions honestly.Be patient, it takes from one to five YEARS to get a visa. Any visa costs about CAD 2,000 to get. You also need to prove that you have CAD 12,300 for yourself, more for a family, BEFORE you get a visa.There are no shortcuts. Don’t waste your money on agents, lawyers or consultants. (I said that.) All they do is to take your money and some may even delay the process so they can charge you even more.Looking for work is pointless. No Canadian company will even look at your resumé before you are in the country with a visa. Canada is a country of well educated people. 53 % of all working age Canadians hold at least a Bachelor’s degree, that is the highest rate on the globe. I doubt that your skills are interesting and unique enough that any one will choose you over an applicant that is nearby.(Sorry.)