Am I an ex-homemaker already?

 As I get further into nursing school, one thing is for certain: the workload of school is increasing. While there may have been the same number of hours in classes in the first semester, the academic demands of the third semester (out of four total) are three to four times greater. No longer can I do an hour here, and hour there, and then a few hours on one day to keep up. It's two to four hours per day, every day. 

Which means that is two to four hours per day that I cannot take care of things around the house.

This thought popped when thinking about Thanksgiving. We have 8 people coming over, so having dinner for 12. I'm going to make turkey, stuffing (okay - dressing,) mashed potatoes, and mac 'n' cheese. I was also going to make pumpkin pie and gravy. All from scratch. Okay, I wouldn't make the the bread for the stuffing from scratch. But, I would chop everything, use gizzards for the gravy, and make chicken stock from chicken bones and mirepoix, make the pie crust from scratch, and make the filling from scratch (like, roast the pumpkin and sweet potatoes) and so on. 

However, in the next three weeks of school, I have a major project, several smaller projects, and a couple hundred pages to read (and comprehend and be able to make healthcare decisions based on.)

So now I get to make a choice: do homemade, or semi-homemade.

I think that the choice is simple, but it rips my heart out. 

I think we all have a craft that can be replaced by today's automation and prefabrication. I don't want to say that it's a shame, exactly - it enables people to use their time for the pursuits of their fancy. 

Of course, a whole discussion could be made about the choices that people make. For example, better to learn to cook, sew, or build, or to binge watch Netflix and scroll through social media?

So, as I make my list, I think I'm going to have to choose which thing I make from scratch. I'm pretty sure that I'll stick to turkey, that unforgiving protein that is so easily ruined (and so often,) mac 'n' cheese (which is primarily made by my younger child,) and mashed potatoes (because that's really easy and forgiving.) Stuffing: you're coming out of a box. Stock: box. Whipped cream: can. Gravy: can.

I recently heard someone say (I wish I could cite the source right now) that you don't know when it is that you'll do something for the last time. It could be getting picked up and held by your parent, picking up and holding your child, or seeing a friend. For a homemaker, there will be a last time that I walk a child to school. A last time that I yell at a child for failing to do a chore or for talking back. There will be a last time that I clean up a child's mess. A last time that the child walks through the door after school, home safe and with something new to tell me. There is a last time. 

Perhaps last year was the last time that I will have made everything from scratch. Will I miss it? I just don't know. 

Open letter to grocery stores

 Dear Grocery stores,

I have a suggestion for a change or addition you can make to help people shop and make good decisions.

First, let's talk about why people go to the grocery store: to buy food to prepare to eat.

Where do they get their ideas? Usually at home, but sometimes people go to the store and do the same thing they've done: wander around until they get inspiration (or resignation.)

On the other hand, we've seen an emergence of services like Hello Fresh, Blue Apron, etc who create meals and portion out ingredients that are delivered to your door.

However, many people like the social experience of going to the store. Here's how you, the grocery store, can profit by having a big brick-and-mortar store.

First, have meal ideas ready-to-go! You should have both print and QR options. You should have two different ways people can take advantage.

1) You have the meals prepped and ready for a person to pick up. It should also have a list of optional / essentials that people may / may not have in their kitchen (oils, salt/pepper, etc.) Have the aisle AND shelf location to find these things. How to make more money? Get sauce companies to sponsor their product, such as Tobasco, etc AND include the aisle and shelf! 

2) Help people put a meal together. An example: Salad! Seems simple, right? But many don't know how to use radiccio, chard, and other lettuces and just go for romaine / iceberg (which are fine.) So: educate them! 

Here's how it might look like:

Start with your produce: greens (lettuces), fruits (tomatoes, mangoes, avocado), chiles, peppers/cucumbers, roots. Have a sample of what a person might buy (1 head romaine, 1 cuke, etc.)

Then protein. Give them the choice of fresh, frozen, or pre-cooked.

And keep going. Tell the person where they can find the stuff EXACTLY and then what they may want to add to their order (dessert, chips, etc.) 

You also have prepared foods. Sell the thing you're advertising! In this way, your back-of-house prep team can make these meals to take away ready-to-eat OR ready-to-cook. Saves time and money.

Use what's cheap and in season! Increase your margin by creating menus that feature items that are both profitable and affordable. Everybody wins! Have date night options, family options, holiday options. Keep thinking! 

However, the current system of a big store is old thinking. Future-proof yourself by helping your customers get what they don't know they want. 

Thanks!

-DowntownDad

Patient teaching: understanding how to communicate with the nursing staff

 I was thinking about some other things I can do when I become a nurse. One of the things I can do when I come on for my shift change is orient the patient to the communication tools. 

While some patients can certainly become overbearing, I also wonder if fear and anxiety can be relieved if the patients know how to get in touch with me and how to use the communication tools to get what they need? 

For example, we give them a call light and the nurses sometimes wear a phone that looks like a walkie talkie. 

The question I have is this: do they know how and when to use them? 

I don't think it would take more than 10 or 15 seconds to say go ahead and push the call light. Then, I can quickly hit the cancel button and say, "See, that was easy." 

Then I can show them how to get in touch with me on my phone.

 I can explain how each is answered. For example, in general, it is expected that the nurse assistants will respond to call lights before the nurses will. On the other hand, the phone number is directly to the nurse. So, if the patient just needs something like water or a simple comfort measure with their linens, that would be something for the nurse assistant and the call light is a good tool for that. 

On the other hand, if it's something more urgent and the patient is able to, calling the nurse is a better solution so that the nurse can respond more quickly and possibly put in orders or get in touch with a provider from the nurses station without having to first come to the room.

So far, one of the things I've noticed is that the nurses don't do a great job introducing themselves. This could be a great part of that process. I think I would immediately have more confidence in my care. 

Hemorrhoids and Capitalism

As I think I've said before, I'm a big fan of capitalism. Who was it who said something like, it's a terrible system, but it's the best system? Actually, they said it of democracy, but you can say it about capitalism, too. Innovation and self-determination drive improvement, among many other fine qualities. There is the long list of bad things, such as marketing, that contribute to capitalism's woes. I digress.

You know what's funny about capitalism? Preparation H. Instead of promoting a healthy diet to eliminate hemorrhoids and constipation, we market a med to relieve symptoms. 

The only capitalistic incentive to cure and prevent is money. For diseases keep getting passed, the cure will forever be needed; prevention is needed by new people and needs to be updated. But making a disease come to an end and never resurface is not in the best interest of medicine. Or rather, is not in the best interest of the bottom line.

I'll counter my Preparation H argument: isn't it great that someone came up with something for the inevitable number of people who, for whatever reason, suffer from hemorrhoids? And, how will those people find the product if not for marketing? From those who suffer from it to those who stock their shelves with such products, knowledge is the first step.

However, there's also no marketing for the relief of the causes, such as poor diet. Wouldn't it be nice to see information that we should get 2,000-3,000 mL of non-caffeinated water per day (both from liquid and solid sources)? That we should get at least 20g of fiber per day? That lack of physical activity is a contributing factor? That many meds and dietary supplements contribute?

What is the market for health promotion? I don't mean going to the gym - I mean going for a walk. There are no coupons for raw foods, only prepared foods. Just some of the challenges that our system faces. 

Looking ahead: Combating immobility

 I'm thinking about my future nursing practice. We're currently talking about mobility / impaired mobility. Could I carry a ball with me that I play a little catch with patients who are able? Everyone loves to play catch!

Could I have every patient who is able get up and walk a lap in their room every time I come in? For example, when I bring their meds, get up - even if just to stand up. Maybe walk 10 feet then back to bed. Just something to get them out and it may  not take a lot of time. 

What if they can't get up? Can I get them to roll side to side? Could they just dangle? Do some ROM and / or incentive spirometry as I prep their meds? I bet I could get some sort of board and / or bar to get them to do some leg presses or a sort of bench press while in bed. 

How about having an ongoing game like checkers, chess, or cards that I come and play for 5 minutes here and there? 

Can my patients text me instead of / in addition to call light? Teach them to send a text that begins with their initials and room#, then their need. Obviously, this only works if I have a work-issued communication device.

I'm just thinking a lot about what I'm seeing and experiencing as a nurse. I want to connect with my patients for the purposes of healing, not just get them in, get them out. 

Best Practices: change is hard for those who "Do"

 I'm in nursing school. I also think a lot about "best practices." 

Best Practices is the idea that there are ways of doing tasks or skills that are "better" than others. It doesn't usually mean that there is ONE best way, but that ways we thought were best may be superseded by a way we had never learned nor considered.

Let's take a daily task like brushing one's teeth for example. At what point did we learn that, 1) brushing for 2 minutes is best and 2) that brushing the gums is essential? '

Filing your nails? Best practices says to file in only one direction, rather than back-and-forth that we often see (even in salons.) 

So when I'm in nursing school and at clinicals, I hear a common refrain: that there is book nursing, then there is the real world. And I'm highly skeptical.

Skeptical with this caveat: part of our initial education told us that, as a novice nurse, we will want to do things "by the book," but that when we become a seasoned veteran, we will know that there may be methods, procedures, or processes that we have customized through trial-and-error. 

My skepticism is this: there is an accumulation of knowledge from all of these seasoned nurses who learn things by this trial-and-error that work better than the way they were taught in school. Some of these nurses take that knowledge, do studies, publish those, which are then put into books that teach the new wave of nurses. 

In other words, shouldn't these seasoned vet nurses consider that there may be thousands of other seasoned vets who have figured out a hack to various daily nursing challenges that can be incorporated for the benefit of the patient, the nurse, and the facility? I have to think so. 

However, when in class, I brought up something that I'd learned in my book that wasn't introduced in our lab. The professor said that she only used that method for a specific instance that didn't come up very often. However, the book cited a nursing research paper that said that their studies (reports from nurses) showed significant reduction in pain for patients when using a certain injection method every time this process was done. Now, I'm not a nurse, but why isn't this thing (that's in the book that they're using to teach us) something that they know about?

Furthermore, when I've been in the clinical setting, I'm not seeing it done. It's something that we should be seeing (or feeling) when we get our COVID vaccinations. Yet, the pharmacists who have given me the shots are not doing this. 

We learn that brushing our teeth for 2 minutes has significant benefits. Washing our hands for 20 seconds has significant benefits. 

Being me, I also think about the number of things that we do during the day for which there are updated "best practices" and there's no way to keep up with all of them. Sigh.