Infection Control Nurses: Rx For Sanity: Triage, Love and Laughter!


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Virginia Association for Professionals in Infection Control and Epidemiology from 09/15/2011

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Infection Control Nurses: Rx For Sanity: Triage, Love and Laughter!

  1. 1. Rx For Sanity: Triage, Love, & Laughter! Patricia L Raymond MD FACG Rx for Sanity, Norfolk VA
  2. 2. “ Does It Make Your Ears Wiggle?” -N.E. Raymond
  3. 3. Traits which make a good HCP lead to ‘compassion fatigue’ <ul><li>Strive for perfection </li></ul><ul><li>Seek and accept responsibility </li></ul><ul><li>Willingness to defer gratification and to sacrifice </li></ul><ul><li>HCP isn’t what we do, it’s who we are </li></ul>
  4. 4. Compassion Fatigue <ul><li>Not related to: </li></ul><ul><ul><li>Hours worked </li></ul></ul><ul><ul><li>Practice specialty </li></ul></ul><ul><ul><li>Managed care prevalence </li></ul></ul><ul><ul><li>Government interventions </li></ul></ul><ul><li>Related to loss of perceived control, loss of personal-work balance </li></ul>
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  6. 6. Sometimes you have to take your brain and stomp on it a little. It just gets caked up. Mark Twain
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  9. 9. Your Prescription for Sanity <ul><li>Triage: your professional life </li></ul><ul><li>Love: Family, finances, & mental health </li></ul><ul><li>Laughter: Personal health </li></ul> And we’ve only 60 minutes to change your life!
  10. 10. Triage: Your Professional Life
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  12. 12. “ Please back in for prompter service.” Sign on our endoscopy suite door
  13. 13. No time for Information Overload <ul><li>New information </li></ul><ul><li>Reading? Who has time to read? </li></ul>Debbie Waiz 15 th Annual Endoscopy Symposium
  14. 14. Hand washing 101 <ul><li>Jet air dryer </li></ul><ul><ul><li>blows at speeds of 400 mph </li></ul></ul><ul><ul><li>capable of blowing micro-organisms up to 2 metres away </li></ul></ul><ul><li>Warm air hand dryer </li></ul><ul><ul><li>spread micro-organisms up to 0.25 metres </li></ul></ul> Paper towels no significant spread of micro-organisms.
  15. 15. Drying method: Effect on bacterial count <ul><li>Paper towels </li></ul><ul><ul><li>Decrease of 24% </li></ul></ul><ul><li>Hot-air drier </li></ul><ul><ul><li>Increase of 117%! </li></ul></ul>
  16. 16. It’s not my job. RIP
  17. 17. Bacteria = back door to cafeteria
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  22. 22. Dressing geeky for health
  23. 23. Stressors in Infection Control <ul><li>Compliance with bloodborne pathogens and tuberculosis regulations/standards </li></ul><ul><li>State and federal laws/regulations relating to infection control and disease issues </li></ul><ul><li>Risk assessments and exposure control </li></ul><ul><li>Cost effective programs that are practical application of infection control principles </li></ul><ul><li>Ventilation, filtration, separation of clean/dirty, decontamination </li></ul>
  24. 24. The Impact of Hospital-Acquired Bloodstream Infections <ul><li>RP Wenzel MB Edmond, MCV </li></ul><ul><li>Nosocomial infection rate of 5% </li></ul><ul><ul><li>10% are bloodstream infections </li></ul></ul><ul><ul><li>attributable mortality rate of 15% </li></ul></ul><ul><li>Eighth leading cause of death in the US. </li></ul>
  25. 25. (Causes of death in the US) <ul><li>Heart disease </li></ul><ul><li>Cancer </li></ul><ul><li>Stroke (cerebrovascular diseases) </li></ul><ul><li>Chronic lower respiratory diseases </li></ul><ul><li>Accidents (unintentional injuries) </li></ul><ul><li>Alzheimer's disease </li></ul><ul><li>Diabetes </li></ul>
  26. 26. HAI & Trauma Patients <ul><li>4.5 of every 100 patients admitted to the hospital get HAI </li></ul><ul><li>Trauma patients who develop HAIs have up to six times the in-hospital mortality rate </li></ul>
  27. 27. DWA (doctors with attitude) apple
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  29. 29. Exercise: The Perfect Day <ul><li>Get out your pen, and go to page two! </li></ul>
  30. 30. Professional Rxs <ul><li>Seek clinical satisfaction </li></ul><ul><ul><li>Opportunity vs. Obligation </li></ul></ul><ul><ul><ul><li>WHY not WHAT </li></ul></ul></ul><ul><ul><li>Think creatively: challenges are opportunities </li></ul></ul><ul><ul><li>Raise the bar: Evidence based medicine </li></ul></ul><ul><ul><li>Be a partner: proactive and critical thinking…ask questions, ask questions, ask more questions </li></ul></ul>
  31. 31. Critical Incident Stress <ul><li>Create a healthy work environment </li></ul><ul><ul><li>Humor </li></ul></ul><ul><ul><li>Take your breaks </li></ul></ul><ul><ul><li>Debrief/ dump toxins </li></ul></ul><ul><ul><li>In house stress management: Exercise, Tai Chi, yoga, meditation </li></ul></ul>
  32. 32. People treat you the way you teach them to treat you. ~Jack Canfield
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  39. 39. Are you joyous at work? <ul><li>Did I bring joy? </li></ul><ul><li>Did I find joy? </li></ul> Egypt afterlife
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  43. 43. Other ways to find joy in the medical workplace <ul><li>Disease of the month </li></ul><ul><li>Body art- sharpies, bottom décor </li></ul><ul><li>Ownership of their health- Nona’s book </li></ul><ul><li>Cartoon book </li></ul><ul><li>Butt Meddler, butt-ons, joke books </li></ul>
  44. 44. Rx for Information Overload <ul><li>“ Car College” </li></ul><ul><ul><ul><ul><ul><li>15 min each way daily commute </li></ul></ul></ul></ul></ul><ul><ul><li>15 min each way x 10 trips weekly = </li></ul></ul><ul><li>2.5 hours per week </li></ul><ul><li>46 weeks per year = 119 hours per year </li></ul> Needs card- Zazlove Regional and national society meetings
  45. 45. “ The great use of a life is to spend it on something that will outlast it.” William James
  46. 46. Find your Windmill <ul><li>Develop new tools: research, technology </li></ul><ul><li>Public education </li></ul><ul><li>Mentoring of new nurses </li></ul><ul><li>Your health facilities stats- do you take pride? </li></ul><ul><li>International, national, state or local Consider petitions, politics, publicity </li></ul>
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  48. 48. Your mission in life is where your deep joy and the world’s deep hunger meet. ~Richard Nelson Bolles
  49. 49. Love: Family, Finances & Mental Health
  50. 50. The Art of Healing W.H. Auden <ul><li>Most patients believe </li></ul><ul><li>Dying is something they do, </li></ul><ul><li>Not their physician, </li></ul><ul><li>That white-coated sage, </li></ul><ul><li>Never to be imagined </li></ul><ul><li>Naked or married. </li></ul>
  51. 51. Family and Medicine <ul><li>Divorce rates 10-20% higher than general population </li></ul><ul><li>Do we leave our communication skills at the office? </li></ul> Ann Int Med 2001 Sou Med Jou 2000
  52. 52. Financial stresses <ul><li>35 to 45 y/o average personal debt equals 95% of annual income </li></ul><ul><li>Most spend less than 1 hour per month on retirement planning </li></ul><ul><li>2 of 3 HCPs does not have a will </li></ul>
  53. 53. Substance Abuse <ul><li>One in seven nurses during their career </li></ul><ul><ul><li>Similar frequency to general population </li></ul></ul><ul><ul><li>Through legitimate Rx or diversion </li></ul></ul><ul><ul><li>Demerol is drug of choice </li></ul></ul><ul><ul><li>More common among nurses with access to substance (ED, ICU, Endo) </li></ul></ul> West J Med 2001
  54. 54. Substance Abuse: Your Choices <ul><li>No action </li></ul><ul><li>Enable </li></ul><ul><li>Report </li></ul><ul><li>50% report blackouts during patient care while using </li></ul> West J Med 2001
  55. 55. Nurse suicide <ul><li>One of the top five causes of death in nurses </li></ul><ul><li>Six times higher rate than general public </li></ul><ul><li>Felt to be related to CI stress </li></ul><ul><ul><li>Unrelated to incidence of substance abuse </li></ul></ul><ul><ul><li>MD suicide (2 x male MD, 4 x female MDs) IS related to substance abuse as predictor </li></ul></ul>
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  57. 57. Exercise: Focus Points Go to page 3! <ul><li>People </li></ul><ul><li>Work </li></ul><ul><li>Food </li></ul><ul><li>Clothing </li></ul><ul><li>Shelter </li></ul><ul><li>Money </li></ul><ul><li>Fun </li></ul> Repeat q 3 months
  58. 58. Personal & Family Rxs <ul><li>Take control </li></ul><ul><ul><li>Make time for family </li></ul></ul><ul><ul><ul><li>Become a ‘Multi-Shirker’ (Scott Adams) </li></ul></ul></ul><ul><ul><ul><li>Hire a wife! </li></ul></ul></ul><ul><li>Fee only financial advisor, or self-educate about financial health </li></ul><ul><li>Seek NHP (nursing health programs) for yourself or others </li></ul>
  59. 59. Laughter: Personal Health & Wellness
  60. 60. The Science of Wellness
  61. 61. The Science of Wellness <ul><li>Stop smoking </li></ul><ul><ul><li> </li></ul></ul>
  62. 62. The Science of Wellness <ul><li>Stop smoking </li></ul><ul><li>Eating habits </li></ul>
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  69. 69. Peter Walsh- Does This Clutter Make My Butt Look Fat? Brian Wansink- Mindless Eating
  70. 70. The Science of Wellness <ul><li>Stop smoking </li></ul><ul><li>Eating habits </li></ul><ul><li>Exercise 30 minutes daily </li></ul>
  71. 71. Exercise as Medicine <ul><li>Cardiovascular disease, CHF, CVA, PVD, Type II Diabetes, Obesity, Dyslipidemia, Cancer (breast, colon, prostate, pancreas, melanoma), Asthma, COPD, Osteoarthritis, Rheumatoid Arthritis, Cognitive Dysfunction </li></ul> Booth, J Applied Physiology 2002;93:3-30
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  73. 73. <ul><li>Hi, </li></ul><ul><li>This is a hassle to remind you to Have you exercised today? Remember that your health is more important than what you do. Meditate and journal today too. Be in balance. Breathe. So get to it! </li></ul><ul><li>You'll be sent one of these hassles roughly every 2 days. </li></ul><ul><li>Thanks, -- The HassleMe Team </li></ul>
  74. 74. HassleMe Because sometimes in life, you just need to be nagged...
  75. 75. The Science of Wellness <ul><li>Stop smoking </li></ul><ul><li>Eating habits </li></ul><ul><li>Exercise 30 minutes daily </li></ul><ul><li>Sleep 8 hours a night </li></ul>
  76. 76. Aging and sleep <ul><li>Lancet 1999 </li></ul><ul><li>8 hours verses 4 hours in normal college students </li></ul><ul><li>glucose intolerance identical to early adult type diabetes </li></ul><ul><li>TSH & cortisol levels like elderly </li></ul><ul><ul><li>Mall study: </li></ul></ul><ul><ul><li>13 % less max happy with each hour < 8 </li></ul></ul><ul><ul><li>7 = 87% 6 = 74% 5 = 61% </li></ul></ul>
  77. 77. The Science of Wellness <ul><li>Stop smoking </li></ul><ul><li>Eating habits </li></ul><ul><li>Exercise 30 minutes daily </li></ul><ul><li>Sleep 8 hours a night </li></ul><ul><li>See a physician </li></ul>
  78. 78. Scott Adams/Dilbert: W.A.D. found 1998- 2 polyps 1999- 2 polyps 2002- no polyps 2007- 5 polyps (and a poor prep, it is rumored)
  79. 79. The Science of Wellness <ul><li>Meditate/ breathe/ journal/ spiritual </li></ul>
  80. 80. Spirituality & medicine <ul><li>Meditation </li></ul><ul><ul><li>Psoriasis, heart disease, chronic pain </li></ul></ul><ul><ul><li>UCLA meditation tapes to BP patients 73% reduction in medication, 50% stop meds altogether </li></ul></ul><ul><li>Journaling </li></ul><ul><ul><li>Smith Annals Internal Medicine COPD RA </li></ul></ul>
  81. 81. Spirituality & medicine <ul><li>Optimism </li></ul><ul><ul><li>Mayo clinic: pessimists risk factor for premature death, overall lower level of health, more use of medical resources and higher medical costs </li></ul></ul><ul><ul><li>Internal Medicine News: pessimism worsens lung function; pessimism equivalent to 20 pack- year smoking </li></ul></ul>
  82. 82. Debbie Waiz 15 th Annual Endoscopy Symposium
  83. 83. The Science of Wellness <ul><li>Meditate/ breathe/ journal/ spiritual </li></ul><ul><li>Happiness list </li></ul>
  84. 84. may my mind stroll about hungry, and fearless, and thirsty, and supple. ee cummings may my heart always be open
  85. 85. Debbie Waiz 15 th Annual Endoscopy Symposium
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  87. 87. G.A.S.H .
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  89. 89. The Science of Wellness <ul><li>Meditate/ breathe/ journal/ spiritual </li></ul><ul><li>Happiness list </li></ul><ul><li>Have Sex </li></ul><ul><li>Reassess quarterly </li></ul>
  90. 90. The Caerphilly Study: Smith, Frankel, Yarnell, BMJ 1997 <ul><li>N=918 males(45-59 y/o), 10 year f/u </li></ul><ul><li>Stratified to self-reported frequency of intercourse </li></ul><ul><ul><li>Low: Less than q month </li></ul></ul><ul><ul><li>Intermediate </li></ul></ul><ul><ul><li>High: BIW or more frequent </li></ul></ul><ul><li>Data adjusted for variables of age, social class, systolic blood pressure, smoking, baseline CAD, cholesterol </li></ul>
  91. 91. The Caerphilly Study: Results Low Frequency Intermediate Frequency High Frequency All Cause Mortality 1.9 CI 1.0-3.4 P<0.04 1.6 (CI 1.0-2.8) 1.0 Coronary Heart Disease 2.1 CI 0.9 -5.1 P<0.10 1.8 (CI 0.8-4.0) 1.0
  92. 92. Women vs. Men Quality vs. Quantity <ul><li>Sexual dissatisfaction for women is an independent risk factor for MI </li></ul><ul><ul><li>Abramov, Psychosom Med 1976 </li></ul></ul><ul><li>Lack of sex associated with death in men </li></ul><ul><li>Lack of enjoyment associated with death in women </li></ul><ul><ul><ul><li>Duke Study on Ageing </li></ul></ul></ul><ul><ul><ul><ul><li>Palrnore, Gerontologist 1982 </li></ul></ul></ul></ul>
  93. 93. Rx Yourself Now: <ul><li>If you really want to do something you’ll find a way. </li></ul><ul><li>If you don’t, </li></ul><ul><li>you’ll find an excuse. </li></ul>
  94. 94. The Science of Wellness <ul><li>Stop smoking </li></ul><ul><li>Moderate your eating habits </li></ul><ul><li>Exercise 30 minutes daily </li></ul><ul><li>Sleep 8 hours a night </li></ul><ul><li>See a physician </li></ul><ul><li>Seek the spiritual </li></ul><ul><li>Make a “Happiness List” </li></ul><ul><li>Have more/better sex </li></ul><ul><li>Reassess quarterly </li></ul>
  95. 95. SSDT: Not sex!
  96. 96. This is your prescription for sanity: <ul><li>Medicine is an opportunity, not an obligation </li></ul><ul><li>Self care is your right </li></ul><ul><li>Have more (or better) sex </li></ul>
  97. 97. “ Does It Make Your Ears Wiggle?” -N.E. Raymond
  98. 98. Don’t wait for a second opinion!
  99. 99.