Nursing and Technology

First gentle readers, I'd like you all to listen to this music video while reading my newest ethics post.

This is mainly because this damn song played in my head throughout the entire class last week. Is it stuck in your heads yet?

I've been thinking about this post for a while now and I am finding it really hard to write. My first impulse is to say that I don't care about technology or how it might affect my career. Maybe it is closer to the truth to say that I don't find it that interesting and hope that it will not affect my career in ways that I have yet to understand. Of course I want the increased efficiency and continuity of care that comes with electronic charting, but before listening to last week's ethics lecture, I never really thought about what is lost due to increased technology. When we chart electronically now, our words are chosen for us, we simply click the box that best fits what we see. What happens when our assessments do not fit into one of the chosen boxes? There is a small place at the end of the chart where we can add a comment, but how many nurses take the time to do this? How many nurses on future shifts take the time to read this?

When I think about all of this, a great quote comes to mind. Cate showed it to me. (OK, she also blogged about it - in case it looks familiar.) It was used in one of her grad school books - "Educational Action Research: Becoming Practically Critical," by Susan E. Noffke. While the quote was used for a book about education, I think it can just as easily apply to nursing.

"I am done with great things and big plans, great institutions and big success. I am for those tiny, invisible loving human forces that work from individual to individual, creeping through the crannies of the world like so many rootlets, or like the capillary oozing of water, yet which, if given time, will rend the hardest monuments of human pride." - William James

This has everything to do with what I think of as nursing. This has nothing to do with technology.

While writing this, I am also reminded of one of the nurses I work with on the Blood and Marrow Transplant unit. She has immigrated here from Liberia. If you have payed any attention to the Strib's coverage of the Liberian immigrant issues here in Minnesota, you might recognize her because her family has been the focus of a few articles. As I know her on our unit, she is a great nurse. I believe she has been working on the unit for over 20 years. She knows more than I can currently comprehend about our highest acuity patients. Yet she is still trying to gain citizenship to the United States. Just last week we were in the break room and I noticed she was studying for her upcoming citizenship exam. She told me she had failed her first attempt because it was computerized and since she has never really learned how to type, she cannot complete the exam within the mandatory time limits. Would it be allowed, she could easily take a written format, but since everything must be standardized and electronically graded, she finds herself still waiting for citizenship and unsure of her future in this country. How is this helping?

OK, one more time, but specifically, just the technology part:


Awwwww yeah.

If you're feeling sad and lonely, there's a service I can render...

No, don't call me, rock out in your bedroom to this:



OK well, maybe you can call me too.

Is anyone feeling the need for a dance party? My place? Next weekend? Eh?

Trust the Nurse

Last week instead of the usual ethics class we were offered a chance to see a dramatic reading of the play Miss Evers’ Boys. The play was presented by the U of M’s medical school, the Center for Arts and Medicine, and the Guthrie Theater. It was performed in one of the big med school auditoriums is the Phillips-Wangensteen building. Do you know the ones I am talking about? With the vertical wood slats on every wall making it look very 1970s and cozy? The audience consisted of nursing and med students, a few faculty, and interestingly, some folks from MPR’s All Things Considered! I have yet to look for it, but apparently they covered the event and included some interviews from students. Sadly, I declined an interview out of shyness. That could have been my 15 minutes!

In case you are unaware of the play, Miss Evers’ Boys tells the inexcusable story of The Tuskegee Experiment. It focuses on the lives of the men in Macon County, Alabama who were recruited by a Nurse Evers to participate in the study of untreated syphilis on African-American men. What makes this play so important for future health care professionals, especially nurses, is not only the ethical issues surrounding honesty or human subjects but the trust that these men put into Miss Evers. They believed in her as a nurse to have their best interest in mind. The story tells the progression they made, the men not realizing the truth of their involvement in the study, the nurse slowly realizing how integral a part she played in keeping the men in a study that was not in their best interest.

Afterwards, a question was posed by the actors – could this story, this study, happen today? The responses from the crowd (along with my own sentiments) went something like this: The inherently unequal administration of heath care has not changed but has instead become global. We might like to think that we, as a culture, are above this sort of thing now. It was only in 1997 that President Bill Clinton finally made an official apology to the men misused by the study. The fact is that the valuing of certain lives over others has not changed. The reason why we do not see such atrocities here in the US is because these affairs are now conducted in other countries, on people we do not generally know about. When a country does not have the legal framework to regulate research, what ethical guidelines or fundamental human rights are scientists or companies to be held to?

How different is Uganda from Tuskegee?

It is not a matter of if or when, but where it is happening now. Who do we value more than others? What does care mean for the patient? As future nurses we need to address our own assumptions and prejudices. The more we can communicate on a human level – talk from one human to another instead of from a position of authority - the harder it will be for us to see people as means to an end. This is where the unique position of a nurse fits in really well. I believe that nursing is inherently on the human level, on the patient’s side, helping the patient navigate and live through their experience in the medical world and come through it still a whole person.

There are so many subtle choices. How can you give the best care?

worka worka worka!

This is what I've been up to instead of writing my papers:

Listening to the newest Savage Love Podcast - Dan gives a stern warning to all fag hag havees by comparing having a fag hag to owning a dog. Hilarious!

I found this nugget on nontalk.com (who also links to Dinosaur Comics, Julia!):

I can only hope that my paranoid schizophrenic patients never actually see this video. Some already think that the TV is talking directly to them. All hope would be lost.

I also started knitting my mustache/beard hat:
(ehhhh...I tried to take a picture of it on my cat's head, but my crappy camera has apparently died. Boo. Urns.)
Thank you Rachel and Katie for helping me figure out the crazy instructions. So far, it doesn't fit my head yet. Hopefully I will finish it before it warms up.

I've also been IM'ing with Anisa about our easy classes and how they make it sooooo much harder to combat senioritis procrastination. Thank you Anisa, for helping me to not get any real work done. I could do it without you, but it would be way less interesting.

*On a side note to all my gentle readers, the recent blogs about my ethics class are actually for my ethics class. So if they seem out of left field or kind of boring, I'm getting a grade for it folks.

Take Back The Loser!

I am reposting this poster design from Feministing.

Even though I am sure all of you read that blog daily, I guess it is possible you might have missed this funny response to some anti-feminist BS brought to you by the Independent Women's Forum. You know, with a name like Independent Women's Forum, you would think they'd be cool. For shame.

The Homeless Experience

Last week's ethics class was guest lectured by David Schultz who works in the Adult Mental Health Division of DHS. He was a great speaker - engaging and funny. I like how he gave us his standpoint before lecturing to us - that during the Vietnam War, he was a conscientious objector, but that he firmly believes in each citizen giving a few years of their time for their country. For Schultz, this time was spent on the streets, homeless. He worked closely with Catholic Charities and spent two years on the streets getting to know people, trying to help them, and in the end, learning a lot about survival and what it means to be alive and live in poverty.

Schultz's lecture was given on Ash Wednesday. Many of my fellow nursing students were already donning the dark grey crosses on their foreheads. It was interesting to see these students warm to him based on their common faiths. The tone of the room quickly changed though when he began to ask us how we interact with homeless people. Specifically, he asked us whether we always, sometimes, or never give money to panhandlers. Then he asked us why. There were a variety of responses. Those that said they never give generally gave the reason that they were too broke themselves. Those that said they only sometimes give explained that they didn't want to support drug or alcohol habits, they didn't always have cash on hand, or they feared being robbed. Overarchingly though, most people's responses were defensive and angry. People who once felt a kinship towards Schultz now felt attacked by him. It is amazing how powerful one simple question can be. By asking us this, Schultz forced us to address our own unstated prejudices about the homeless population.

So I turn this question to you, gentle readers. Do you give to homeless people asking for money, food, or work? And why or why not?

As for myself, I would say that I generally do. There have been exceptions, for example, when the person asking for money could not keep their balance and smelled strongly of alcohol. At that time, I thought to myself, what good could my charity be for this person right now? In this state, do they really need more alcohol? Thinking about this, I realize my own prejudices. Who is to say the person will use my money for alcohol? Should it matter? I generally feel that when I do give money, whatever the person spends it on is what they feel that they need at that time and it is not for me to judge. So why do I make the exception when they are intoxicated?

After I got home from this class, I talked about the lecture with Cate. She brought to my attention another blog that dealt with this exact same topic. In the post from Nothing But Bonfires, the blogger describes (in a less than sensitive way) an encounter she had with a homeless woman in the entryway of her apartment building. What she did not expect was the rash of comments left by readers who were appalled by her derogatory descriptions of the homeless woman. In response, the blogger left this post. While in her first post, the blogger did use the offensive rhetoric of "crack whore," she attempted to redeem herself in her second post by acknowledging something Schultz also emphasized - that the worst thing a person/group of people can do to another person/group of people is to not recognize their existence.

sci fi meets nursing

My ethics class last week covered the topic of genetics. Our guest speaker was Jeff Kahn, director and professor of the Center for Bioethics at the U of M. Cate pointed out that the book Better Than Well, which I have been 1/2 way through reading for over a year now, was written by Carl Elliott who also works in the Center for Bioethics. I wonder how well they know each other. Are they friends? Ooh, Elliott does mention Kahn in his acknowledgements section. I can only imagine the great conversations they must have.

So just two days prior to this lecture, I watched The Boys from Brazil – a movie made in 1978 starring Gregory Peck, Sir Laurence Olivier, and… wait for it… Steve Guttenberg! (A very young and strapping Steve Guttenberg, I might add.) This movie totally set the tone for the lecture for me. If you haven't seen it and don't want me to ruin it for you, stop reading. But it is basically about Dr. Mengele (Gregory Peck), a nazi, who figures out how to clone humans. He had a creepy research lab in Paraguay (for some reason, not Brazil) where he impregnated a bunch of women with little baby Hitler clones.

At one point in the movie, a university scientist explains the cloning process. What it boils down to is that you take an egg, remove its inside bits, and replace them with a cell from whomever you want to clone. In this case, it was some old blood from Hitler. A picture of this process looked like this:

Maybe I would have been more easily frightened by the scary, sci fi cloning part of this movie if I had watched it in 1978. Now that cloning is a real possibility, the movie takes on a completely different tone.

In a recent Midmorning show on MPR, Kahn briefly talked about cloning. The surrounding topic was in regards to research that claims that it is possible to make a stem cell from an ordinary cell, such as a skin cell. This stem cell can then be turned into any other kind of cell you want to grow it into. Theoretically, it would also be possible to create a human embryo by these means. This clone would have the same potential as a naturally fertilized egg. Kahn points out that we have yet to see cloning used to make a human baby. Human cloning is actually illegal in most countries. Interestingly, it is not in the US.

In his lecture to my class, Kahn spoke about the ethical implications of genetic testing and in-vitro fertilization. For a visual aide, Kahn showed us this slide:

This picture is an example of what pre-implantation genetic diagnosis (PGD) entails. Doesn't it look creepily like the Hitler cloning pic? Eh?

In PGD, an embryo is created using in-vitro fertilization. After about 2 or 3 days, when the embryo consists of 8 cells, a biopsy is performed (as shown above). The DNA from the one cell that is removed can then be tested for various genetic diseases.

As an example of PGD, Kahn brought up the case of the Nash family. For anyone who has read Jodi Picoult's My Sister's Keeper, the book is based on the Nash case and delves into the ethics of PGD and how it affects the interpersonal relationships of the family members.

The Nash's first child was born with Fanconi Anemia. This disease is genetically recessive and both the Nash parents have one recessive gene. Children with this disease are born with dysmorphologies (such as having no thumbs or incomplete guts), reduced IQs, and are likely to get leukemia by around age 6. The Nash child did get leukemia and needed a stem cell transplant to survive. Unfortunately, there were no matching donors. The Nash's knew they wanted another child and instead of using PGD for the sole purpose of ensuring their next child did not have Fanconi Anemia, they also wanted to use it to select an embryo that would be an exact immune match for their older daughter. In this way, the Nash's could have a healthy second child that would also save the life of their first child.

The questions that must then be asked are:

1. Is this ethical? The Nash's did not manipulate genetics but rather selected one embryo over another for specific traits. Should traits be selected purely to avoid disease or may non-disease traits also play a part? In the Nash case, they did both.

2. Why does this case matter? We do not ask people why they choose to have kids. Should we be allowed to ask the Nash's?

3. What role do nurses play in such bioethical issues? In my opinion, one role of the nurse (in any situation) is to educate and inform people. The people in question can be patients, family members of patients, or the general public. In any of these cases, it is the nurse's job to make sure the person fully understands the issue at hand so they can make their own informed decisions based on solid, non-biased information as well as their own ethical standards. Complicated genetic testing and treatments need to be put into a language that anyone can comprehend. Moreover a nonjudgmental space needs to be created so that ethical implications can be openly discussed. Situations can become complicated however when a nurse's personal moral code conflicts with the interests of the patient. What modalities do we have to lean on when confronted with our internal ethical debates?

Super Bowl BMT style

This is what I've gotten out of the super bowl tonight working on the Blood and Marrow Transplant Unit:

Patient #1: "No no, watch this, watch this! I know you don't care, but humor me. He caught the ball by holding it to his helmet! His helmet!!! Can you believe that? Oh wow, his back must really hurt."

Patient #2 (regarding a commercial): "Oh god! He has those hooked to his nipples! Check that out! Oh god!"

Jenna, the secretary (aka Jenn-graf, aka Jenna-talia): "The Patriots are cheaters! Did you know that the Patriots were only good this year because they stole all the other teams' play lists? Yeah, cheaters."

Patient #3: "Oh man, oh man. Oh wow. Oh that was good. Oh. Oh man." (I then asked if he was rooting for NY) His response: "Oh man, that was so good. Oh yeah. Wow. Wow. Wow."

Nurse Joy: "Super bowl Sundays are known for sharp increases in domestic violence. I've seen it. Men just get out of control."

I feel like I've learned so much about football.

I couldn't be happier

I can officially say I bike in the winter! I am hooked! My ovaries must be made of a strong, reliable, yet adaptable ore substance! YES!

Best Dream Ever

I dreamt last night that I was dating a giant. By giant, I mean HUGE - 8 or 9 feet tall, head the size of my exercise ball. It was fun because he always carried me on his shoulders. Sometimes he would spin me around until I got very dizzy.