Depression in Women

Depression is also known as Major Depressive Disorder (MDD) or clinical depression. It is due to a disorder of the mood that often causes feeling of sadness, loneliness, and lack of interest. Untreated symptoms can lead to emotional and physical problems which may interfere with normal functioning, daily routine, and develop feeling of hopelessness.

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Pathophysiology
There is no unique or true causes associated with depression. However, scientists believe that it is due to chemical imbalance ( neurotransmitters’ functions), physical changes in the brain (ex: Traumatic Brain Injury), hormones imbalance or changes, sudden change in lifestyle, environment and life stressors.

Risk factors
Genetic predisposition, sexual orientation, substance abuse, previous history of mental illness, traumatic events, chronic & terminal illness, body image and some medications such as, sleeping aids and blood pressure pills. ( please discuss your medications with your doctor)

Symptoms
Sadness, hopelessness, unworthiness, lack of interest, withdrawal, angry, mood changes, sleep disturbance, anxiety, agitation, disturbed thought process, poor judgment, unjustified headaches and persistent pain.

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Population
Depression is very common among teen girls and women due to normal body changes and life situations. Teen girls often show lack of interest in school and activities. They also have poor attendance, lack of commitment, sad feeling, body weight issue, eating problem, trouble making or keeping friends and poor performance in school.

If untreated, teens might become a danger to self and others. They might become violent with active suicidal ideation. Some of them might cut themselves or become addicted to illegal substances or engage in dangerous activities. Scientists have associated bullying to depression in teens.

Women
Most women demonstrate signs of anger, fatigue, lack of interest in intimate relationships, poor judgment, poor leadership at home and lack of family engagement and minimal interaction with their children. Depression is also very common following birth due to sudden life changes of caring for self and newborn. Those women also show lack of interest in caring for their newborn. They feel overwhelmed, agitated and make poor decision. Failure to identify the early signs of postpartum depression can lead to adverse outcome or death. ( Andrea P. Yates family tragedy in Texas- mother killed all five of her children while husband was away)

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Treatment & Recommendations
See your doctor and discuss symptoms immediately. Tell a friend or someone you trust. If you observe the signs in people around you, please persuade them to seek medical assistance. Follow treatment team’s recommendations and complete treatment in its entirety even when symptoms improve. 

Conclusion

As a nurse, I am always grateful for my health because I have the privilege to care for teens and adults with depression, and it is very sad sometimes to observe what patients and their health care partners have to cope with. It is very complex to manage young girls and women who struggle with depression. Parents, please observe your children’s behaviors and initiate open discussion to promote trust and comfort. Do not be judgmental because depression can happen to anyone. If you can’t provide your assistance, it’s better to let someone else support the person. Remember, depression is a condition not an illness, so people are able to live their normal life while under treatment. The condition becomes worrisome, when symptoms interfere with normal functioning.

Sophia Georges, MSN,RN


Nursing and Finances

It has become a social stigma that nurses make a lot of money. As a nurse, I am often curious about the definition of ” lots of money” because I am still hoping to reach that goal after eleven years of nursing. Nursing salaries vary across the United Sates because cost of living depends on geographic location or the state. I live in the Washington DC metropolitan area which is one of the biggest metropolitan area in the United States. Therefore, cost of living is higher in comparison to other states along with housing.

The minimum wage in Washington, DC is $14 and $10.00 in Maryland with expectation to increase to $15 by 2025. It is very common for Maryland residents to seek employment in Washington,DC due the proximity of both states. The average nursing salary in Maryland is $75,250.00, and the median housing cost in Silver Spring, MD is $ 407,900. 00. It is very expensive to live in the DMV ( DC, Maryland & Virginia) area , so I learned to follow household financial goals to avoid being influenced by social expectations.

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Personal Finances

Financial management is not part of the nursing program. Therefore, nursing students do not learn how to manage their finances following graduation. Unfortunately, nursing students are often encouraged to take student loans because the nursing shortage enables nurses to acquire employment shortly after graduation in the DMV area. By the time most new graduate nurses obtain their first job, a loan payment is often due within six months.

I started paying my student loans as soon as began working. However, I realized that It will take me many years to pay the balance off. I decided to increase the payment, so I can be bad debt free soon. My biggest advice is to pay off student loans before buying any car or a house. I learned from my mistakes. It is so much easier to pay off student loans in a year or two based on your salary. I highly suggest that you rent a room, a basement or return to your parents’ house while paying off consumer debt. You will save so much more money if you are able to live a low key life for a few years.

Eliminate Bad Debt

It took me a few years to realize that buying consumer products with credit card was a bad idea unless I pay the balance off before the end of billing cycle. Credit cards can be useful for leveraging on investment deal when some type of return is guaranteed. I strongly recommend that you use cash when possible and save as much as you can to maximize your buying power. I started this bad debt free journey a few years ago, and it’s all worth it. As Dave Ramsey mentioned once, “ Nurses act your wage” Please do not be influenced by social stigma. It is smart to act cheap! I have been acting cheap lately and it feels so good.

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Lesson learned

Nobody cares what car you drive or what name brands your wear as long as you are happy. All watches will tell you the time ,and a decent car will facilitate transportation like any other car. Most rich and famous celebrities do not pay for their expensive and flashy items. They are often paid to display or promote the brands so average customer like me can buy the item full price. Stop the bleed! It is psychological manipulation of our emotion. Nurses, save your money and kindly decline expensive or grandiose festive because you are not irreplaceable. You work hard for your money, so avoid wasting in.

Maximize Your Wealth

First, you have to create a personal budget and follow it faithfully. It is important to save six months worth of your monthly expenses in case something happens to you. As a nurse, you should easily be able to invest 10% of you gross income in a retirement investment plan or sign up at your job if offered. I highly recommend that you save 20% for down payment on any mortgage loan to save on points and interest rate. I am truly speaking from past mistakes and personal experience. I accumulated bad debt at some point in my life and thought it was normal until I realized That I was digging my own hole. I eventually worked hard and paid off all consumer debt, and it feels so good.

Once you eliminate bad debt, you can save to invest and hope for some returns. You can invest in something that you feel comfortable with and that will be profitable. I like This quote from Warren Buffet “ do not test the water with both feet” so you should stratify your investment. In addition, It is preferable to hire a certified financial advisor when you ready to invest.

I suggest buying clothing and other households items during off season sales. I have been doing that for years, and that strategy has saved me a lot of money. You can also try brand names for less at other discounted stores or local factory outlet. For children three and below, I usually buy few items at a time and no more than 2 pair of shoes because they grow really fast. Lastly, use coupons to save extra bucks when possible.

Conclusion

I learned that I am the only person that can control my finances and that I should make good decision now to avoid struggling or financial hardships later in life. It feels good to pay off bad debt while increasing wealth. Personal finances should be taught in high school to promote awareness about financial crisis and hardship. Nurses, we should avoid living a life that only fulfills society’s expectations but rather live a bad debt free life in order to build generational wealth.

Sophia Georges MSN, RN


Cultural Competence in Nursing

Most healthcare organizations have incorporated cultural competence in their staff orientation training program in order to promote individual centered care and by assessing patient’s cultural, social and linguistics needs. Cultural competent organizations invest in diversity training and promote cultural oriented activities. It is important for healthcare staff and specifically nurses to obtain information about patient’s cultural heritage and modify environment when deemed safe and appropriate. Madeleine Leininger is the pioneer of transcultural nursing and challenges nursing to be culturally competent when caring for their patients. She also states “inadequate knowledge of cultural factors represented a missing link in her ability to provide care” (Leininger, 2002).

The Heritage assessment provides a guide to culturally oriented questionnaire during assessment and enables staff to learn about patient’s’ ethnic, socio-economic and cultural background. Learning about different cultures can be challenging but fascinating. I would like to discuss some health tradition amongst Haitians, Nigerian, and Ethiopians.

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Caribbean- Haiti

During an interview with three different families from Haiti, I realized that health practices and traditions are different across the world. Among the families were Caribbean (island), Ethiopia and Nigeria.We discussed the principles used during health maintenance which is personal or public health services offered in the promotion and restoration of health (world health organization). Health maintenance in an island in the Caribbean (Haiti) is a constant struggle considering the socio-economic status of the population and scarce resources. The health care system is not regulated and patient’s rights are often ignored and violated. It is very common to experience substandard care and adverse outcomes in Haiti. There is limited or restricted insurance system that only a few privileged groups have access to. The majority of the population have minimal to no access to health care and are treated differently based on their financial status. Family members or significant others are expected to be available during hospitalization in case medical staff need to acquire additional medical supplies. Patient’s family often brings food from home because they prefer home made meals and assist with most of the activities of daily living.

The Haitian culture is blended with African, Spanish and French considering its history. The culture is rich in tradition and yet remains very unique and fascinating. Despite the constant economic instability, Haitians remain resilient and very proud of their culture and health traditions. Some of them believe in treating their body like a temple which means eat the right food, avoid smoking, alcohol and promiscuous lifestyles, engage in some type of physical activities and be spiritually engaged with God. Children are encouraged to play outdoor sports regardless of their family background. They often play soccer, basketball, volleyball and tennis in school, on the streets or at a sport club. Most Haitians walk at least two to three miles daily involuntarily due to expensive transportation system and lack of infrastructure. It is considered normal to walk to a store and they believe in fresh (organic food) or home grown products. Most Haitians do not use microwave often since meals are prepared daily. Therefore, most of them do not like to eat left over foods. Honey, palm oil, castor oil and herbs are considered miracle remedies to almost every disease or illness. They use a lot of natural remedies and do not always believe in prescription drug. Meat is brought and cooked daily and deep freezing is not common practice among Haitians.

They protect themselves against diseases by constantly drinking herbal tea specific to the geographic region of the country. Others believe strongly in castor oil and use it for cold relief, to treat cuts, burns, bruises, fever and joint disease such as arthritis, swelling, minor sports injury. About 90% of the population will have a bottle of that oil in their medicine cabinet and use it wisely since supply is sometimes limited. Honey is also very common and they are persuaded that it is the best because it is raw and unrefined. Honey rhum Barbancourt, tea and local lime juice are the remedies to treat a cold, fever and other body aches. They also use other rituals such as carrying their rosemary around their neck for protection or sometimes a special made items or a protective symbol of some sort with them all the times. Helmet, braces and other protective gear are expensive there, so it is not common practice for young children to protect their head and other joints. Health restoration usually happens at home with family members taking turn during the process. Family is the support system there and is very important to them. Family members will travel across the country to support each other and will bring natural remedies from the country side to assist with the recovery process. Most of the families can not afford restoration in health care setting, so they prefer to take the patient home to avoid medical cost. They also pray a lot during the process or will do ritual dances and ceremonies by “Voodoo” priest, a pastor or chaplain. Some catholic, will hope for a quick response from Virgin Mary and often pray the Saints to ask for forgiveness and mercy. Those who are protestant will pray God and let it be up to his power to heal the ill. Finally, family members will make soup and tea daily to promote wellness and assist in the recovery process.

Implication for Nurses

If you are a nurse caring for Haitians, you should expect a lot visitors from church, temple or from the family. They will also bring home made meals because the hospital food is bland according to many Haitians. Nurses should also expect prayers and scripture reading, so modify the environment to meet the patient’s needs. Nurses should educate patients, family and visitors about hospital protocol to avoid misunderstandings. They might need a cross, rosemary or items specific to their beliefs. Lastly, most Haitians speak Creole not French, so translator might be needed.

Ethiopian Culture

Ethiopian’s culture does not differ much from Haitian’s culture. After interviewing a family who lives next door, I noticed some similarities in health traditions such as herbal and fresh food. In that culture, the family mentioned that their body was very important to them and treats it well. The family mentioned that health maintenance includes living a good life without drinking, clubbing, eating process food, microwave food and smoking. They also mentioned the importance of physical activities and stated that most Ethiopian will walk three to four miles daily. They eat mostly fresh fruits and legumes and a lot of them do not eat pork for religious reason. The family talked about the importance of fasting to cleanse the body and promote healthy lifestyle. They will fast almost every two to three months according to the same family. They walk to places and drink herbal tea as cleanser and remedy. They are very involved in outdoor activities and encourage children to play sports. They use religion as their main protection and use bees and special bracelets to protect themselves against certain diseases. They avoid late night partying and drinking to promote healthier body and one should avoid contact with the ill to prevent disease transmission. They believe in early bedtime to promote optimal health. When sick, family members or friends will make home remedies prior to seeking physicians’ advice. If long term recovery is needed, the family will care for the patients at home to avoid medical bills. They believe in home remedies and family members provide direct care to their relatives.

Implication for Nurses

The care approach should be individualized to meet the cultural needed in addition to what is mentioned above.

The last culture is Nigerian which is again not very different from the other two. The Nigerian family wanted to talk about pregnancy, giving birth and post partum care. When a woman is pregnant, she is still actively involved in households‘ activities and outside work as before. Prenatal vitamin is not very common; therefore, families will make healthy meals to the mother and encourage the mother to eat extra since she is eating for two. Most of them will not see a physician for prenatal care, but they will instead visit local midwife and plan a home birth delivery. The woman will avoid direct contact with most people to protect the fetus. They will increase their calories and fluid intake and will eat mostly legumes and meat stew to promote healthy development of fetus. During delivery, the woman family must arrange to be present and bring grocery items to prepare meals for the next month post partum. The woman will choose medicine free birth and will deliver either at home or a birth center. Midwives will make necessary arrangements and prepare the family for the delivery process. Shortly after birth, the new mother will remain inside the house for a minimum of 30 days. Her immediate family will make fresh healthy meals and will encourage her to eat a lot to replace energy lost during labor. The new mother will only allowed hot meals and drink and nothing cold will be given until a month later. The new mother will perform warmth sitzbath for several days to promote healing after birth. The new mother will also wear an abdominal binder very tight to shape up abdomen post partum. The family could not provided care after c-section since she said it was not common practice in their tribes. The baby will remain inside for at least 30 days as well and depending on the family financial status, newborn babies do not always have access to a private pediatrician. The neonate are mostly breast fed since formula is expensive and there is no government subsidized program like the United States. When the mother is fully recovered, family will go back to their villages and the husband will reward his in laws with monetary compensation, cattle, clothing and much more.

Nurses should expect large group of visitors and home rituals perform while in the hospital during birth and postpartum. The new mother will need more blankets and additional gowns compare to other patients.

It was very interesting learning about all the different cultures and comparing some of their traditions. One can conclude there is no good or bad culture,and it is all about education and acknowledgement of each other’s culture. If healthcare professionals fail to assess cultural needs and background, they will not be able to fully understand patients’ behaviors and beliefs during nursing care. It is beneficial for nursing staff to assess their patient’s ethnic, socio-economic and cultural background when caring for patients. The Heritage assessment is one of the helpful tools used in regard to that. However, one should further assess patients’ beliefs and culture based on patients report.

http://web.ebscohost.com.library.gcu.edu:2048/ehost/pdfviewer/pdfviewer?sid=0f032b8b-0646-4982-9868-048bc6cb35ab%40sessionmgr114&vid=4&hid=119


Medication Management

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Medication History

Healthcare providers and nurses are required to obtain a complete list of medication from each patient on admission in order to comply with the Joint Commission 2019 National Patient Safety Goal # 3 ( NPSG 03.06.01) and other accreditation standards. Healthcare staff should educate each patient about the rationale for collecting information about medication history and current list to improve compliance with the process. All healthcare facilities should develop a medication management plan in order to promote patient safety and prevent adverse outcomes.

Providers

It is often difficult to persuade patients to provide a complete list of home medication. It has been surprising to notice that a lot of patients do not know the correct instructions about their medications. Some patients love to keep their medication and are not always willing to share information with healthcare staff.

Providers are responsible to obtain complete medication history and current list from each patient. They will complete a medication reconciliation based on clinical symptoms and treatment plan. A medication reconciliation requires medication review and validation for continuation or discontinuation. Therefore, the providers will decide what medication to order and discontinue during the entire length of stay. They are also responsible to approve the use of home medication and other therapeutic substitution. Providers often mention medication plan in their admission note. Finally, a complete Medication order must include the right patient, medication, dose, frequency, time, indication, and route.

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Nurses

Nurses are responsible to collect medication history and enter the information in the medical record. If patients are unable to provide the name of the medication, nurses can obtain description of the medication and indication ( 1 pink tablet daily for blood thinner). Nurses should inform patients or health care partner to bring the actual medication in pharmacy dispensed bottle. Nurses should not prepare medication because it is not within the profession’s scope of practice. However, Nurses can reconstitute medication based on manufacturer or pharmacy guidelines.

Nurses do no complete medication reconciliation but rather add information in a database for safety and cross reference. Nurses should educate patients about not keeping medication in their possession while under the care of medical professionals to prevent therapeutic duplication and possible harm . Nurses should secure all patients’ home medication and return medication based on discharge instructions. Nurses should verify medication order and also use critical thinking during medication administration to prevent medication errors.

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Unfortunately, providers are human being and do make mistakes. Nurses are the last discipline to conduct medication verification prior to administration. Therefore, prudence is highly recommended during medication administration. I successfully caught many medications errors during my years of nursing, so nursing vigilance can prevent adverse outcomes. I always verify the last time someone removed the medication from the dispenser or the last time it was signed as given to prevent error. Nurses should review medication that requires therapeutic lab monitoring closely by following agency’s guidelines. Finally, nurses should educate patients about new medication, the indication, side effects and adverse reactions.

Pharmacy

In most facilities pharmacy staff is responsible to procure, prepare , dispense medication, review provider’s order and validate the order for nursing to administer. Pharmacy also clarifies order with provider when indicated and provides specific supplies to facilitate safe medication management. Pharmacy is also very resourceful and can be consulted for medication guidance. Pharmacy also manages therapeutic dosing and lab associated with some medication. Please review your facility’s policy for guidance.

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Medication management requires a multidisciplinary team approach and can be complex in some instances. Healthcare professionals are responsible to discuss medication management with every patient and provide education to patient or health care partner in accordance with Joint Commission and organizational standards. Successful medication management can prevent adverse outcomes and patient’s harm.


Heat Exhaustion

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Last week, I discussed heat stroke and hope my readers learned safety tips to prevent injury during extreme heat wave. Most people confuse heat stroke with eat exhaustion, so I will establish the difference today in a few paragraphs.

CAUSES

The condition is due to heat exposure in combination with humidity and/or strenuous activity in high temperature. It is failure of the body to maintain core temperature i.e normal body temperature. The human body is often unable to regulate its temperature if physically over exerted. Therefore, the body looses its natural ability to cool down by producing less sweat. The condition can be alcohol induced or associated with dehydration. If the symptoms persist, it can lead to heat stroke which is a more severe heat related condition associated with prolonged heat exposure. Please read previous post to learn about heat stroke.

SYMPTOMS

Symptoms can be sudden or progressive and include some of the following signs: sweating, rapid pulse, moist skin, faintness, dizziness, fatigue, hypotension, weakness, muscle cramps, nausea and headache.

RISK FACTORS

The following are risk factors:

Pediatric and geriatric population, immunocompromised individuals, obesity, heat sensitivity and individuals under certain medical treatment or prescribed drugs.

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MANAGEMENT or PRECAUTIONS

Seek medical assistance if symptoms are severe. Consult a medical provider before engaging in serious physical exercise. Avoid the heat, protect your skin from the heat, apply sun cream, stay hydrated, wear loose clothing and do not stay in hot car.

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Untreated heat exhaustion can rapidly progress to heat stroke which is considered to be a medical emergency. It is important to follow safety measures when exposed to the heat. You should avoid prolonged exposure to the heat and ensure you are well hydrated and medically cleared before engaging in physical activities in the heat. You can prevent organ damage related to untreated heat stroke if you follow the safety tips mentioned above.

Sophia Georges MSN, RN


Choosing a Retirement Home or a Long Term Care Facility

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It can be overwhelming to find a safe retirement home or long term care facility. It is beneficial to plan for retirement living ahead of time to avoid financial burden. Retirement living can be expensive, so it requires financial planning and some type of support system. There is no right nor wrong process, but there are some safety measures that should be considered when choosing a retirement home or long term care facility.

Operations

It is important to learn about the background of the facility you select. Past performance can be helpful and can influence decision making. You should also ask about maximum capacity and current operating beds or vacancies. Bed operations data might benefit you in many ways because retirement facilities strive to maintain the highest census or maximum occupancy when possible. You can also review financial statement online and perform comparative analysis within the region. You can save the information to disclose during a visit and while negotiating the contract. You should avoid facilities that are struggling financially because it might be challenging for them to meet their financial obligations which will affect their operations. Patients or residents should verify health care accreditation status and review patients’ complaints by visiting the health department’s website.

Physical Environment

As a Patient Safety Specialist, I highly value psychological safety and physical safety of every patient or resident. It is important to visit multiple facilities at different time of the day. You should select the busiest time of the day to conduct one of the visits in order to identify warning signs of substandard care. In addition, staff tends to be very busy and unable to provide undivided attention to patients or residents during peak hours. My biggest advice is to conduct a quick visual inspection of the physical environment i.e architectural designs, interior designs, entry points, exits, room sizes, showers, safety measures, cleanliness, clutter, medical equipment, nursing station, medication carts, treatment carts, shredder box, type of furniture, stained ceilings, dirty bathrooms, storage spaces, floor appearance, kitchen or pantry, common space, lighting, phones, computers, monitors, hand hygiene and physical security of the building or ward. In addition, you should address psychological safety i.e emergency plan and preparedness, active shooting training, inclement weather guidelines for staff, emergency response or medical emergency management, facility management, and chaplain service.

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Staff Level

It is important to inquire about staff mix in order to identify skill level , chain of command and supervisory authority. You should ask about continuous supervision during off shift because there is less nursing staff on duty at that time. It is safe to discuss availability of independent provider to address patients’ or residents’ medical concerns. You should also ask about approved staffing and nurse to patient ratio. There should be ancillary staff to assist with care planning and other personal needs. Futhermore, you should discuss Registered Nurse representation in the multidisciplinary team to review care planning and rehab to promote motor function. Lastly, it is crucial to discuss staff training and resources available to staff.

Rehabilitation Program

Rehabilitation program includes physical therapy, occupational therapy, recreation therapy, music therapy, arts, mental stimulation games, speech pathology, field trips, shuttle to local stores, group exercises and many more. It is very important to choose a facility with aggressive and effective rehabilitation program with the goal to promote physical activities and strength. The examples mentioned above should enable effective decision making. Next time you decide to transition to a retirement home or long term care, contact Nurse Sophie to assist you with the process.

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Patient Safety is my priority !

Sophia Georges MSN,RN


Preventing Heat Stroke

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Summer is the season to have fun with friends and family. Most people enjoy road trips, indoor and outdoor activities. I used to spend time with my grandparents in the country side when I was younger, and I truly enjoyed every moment I spent with them. As a nurse, safety is always my priority, and I love to educate others about healthy behaviors to avoid preventable injury. It was a hot day in Maryland today, and a heat advisory was in effect. Temperature was in the high 90’s, and it was hot and humid.

Heat Stroke

This condition occurs as a result of prolonged exposure to heat or following extreme exercise in the heat. The body overheats and temperature can rise up to 104 F (40 C) or higher. Normal body temperature is between 97(36 C) and 99 F ( 37.2 C). The condition requires emergency treatment to prevent acute multi organs failure due to severe dehydration, poor tissue perfusion and change in cardiac output. The brain is usually affected first, and most patients will demonstrate change in mental status, headache, dry skin, nausea, vomiting, fast breathing ( tachypnea) and racing heart rate ( tachycardia)

Wahoo Bay Beach Hotel Resort in Haiti.
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Treatment

You do not have to be a healthcare professional to save lives. If someone that you know exhibits the signs and symptoms mentioned above, please call emergency response (911) and ensure the scene is safe. Create a shade to prevent additional exposure to heat, remove heavy clothing, try to cool the body down with water, cool towels, fans, ice packs or use a spray bottle. Never feed nor offer drink to anyone who appears to be in acute distress unless you are a trained healthcare professional. Avoid excessive cold application to prevent nerve damage. The rule is to apply cool compress for 30 minutes or less.

Who is at Risk?

Pediatric and Geriatric population are at greater risk compare to young adults. However, young adults with underlying health conditions should consult their primary care providers before engaging in activities under the heat. Anyone with compromised health system is at risk ,and others with heat sensitivity might also be at risk.

Prevention

Consult a medical provider before engaging in strenuous outdoor physical activities, know your limitation, wear appropriate clothing, stay hydrated with water instead of soda or caffeinated drinks, wear a hat, apply broad-spectrum sun cream with SPF of at least 15, wear shades and never sit in heated car.

Severe Complications

Acute multi system failure and possibly death when treatment is delayed.

Go to Haiti and enjoy a nice summer vacation at the beach!

Sophia Georges MSN,RN


The Business of Healthcare

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Healthcare in America is a billion dollar industry, and it is considered the largest employer. It is regulated by state and federal laws to protect customers and patients from harm and to make healthcare organizations accountable and transparent. Nurses do not often realize that they are influential stakeholders of an evolving industry with endless opportunities. The industry offers a variety of services with the goal to promote healthy behaviors and lifestyles changes. Today, I will focus on the business of managing patient care.

Patient Care System

In the past, many patients went to the Emergency Room ( ER) for the management of urgent medical symptoms. Whenever medical care is provided, a pay for service is generated. Most nurses do not think about the financial aspect of healthcare because they believe that their job is to provide care to patients and to educate them about disease process and outcomes. I believe it is important for nurses to understand the financial management aspect of their organizations because nurse patient ratio is affected by organizations’ financial performance. Nurses are not taught to perceive their patients as customers but are instructed to focus on care planning. Because of my banking background, I have always considered patient care management to be a financial transaction with some type of return on investment.

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Due to expensive fees associated with ER visits, the government has established billing guidelines related to service provided. Therefore, healthcare providers must follow the pay for service criteria to charge their patients. There is an established ratio for each service rendered to prevent overcharging the patients. Many healthcare organizations have invested in health promotion and prevention campaigns to promote early detection of disease process and to avoid expensive ER visits related to clinical symptoms that can be managed outpatient. This approach to patient care management has decreased unnecessary ER visits and has reduced associated costs.

Implication For Nurses

Nurses should strive to adapt to healthcare changes and identify business opportunities that might be available to them. Many acute care services that patients used to receive in the hospital are now provided outpatient or at home compare to years ago. Surgical team uses advanced technology to promote minimally invasive procedures and prompt patients recovery which will reduce hospital stay. There has been evidence associating length of stay with hospital acquired infections. In order to reduce nosocomial infection rates, the government establishes guidelines for healthcare reimbursement but denies payment for all medical conditions acquired in the hospital. This regulation has prompted healthcare organizations to revise health care deliver approach by adopting early discharges and by referring patients to community healthcare agencies. Lastly, patient can evaluate hospitals’ performance by accessing the link below. “medicare.gov/hospitalcompare.com” and identify top providers and top healthcare performers in specific region. https://www.medicare.gov/hospitalcompare/search.html?

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Nurses should anticipate employment growth in urgent care, ambulatory care, home care, tele-health, community nursing, rehabilitation, long term care and care management. Nurses can also manage community clinics and develop program to promote healthy behaviors and lifestyle changes. Furthermore, they can become small business owners by providing consultation services in area of expertise or by operating healthcare service agencies. The changes in the healthcare system has enabled the nursing profession to evolve because “improved patient care management and patient satisfaction and safety are achievable with interventions that nurses can initiate and carry out.” (Bassem et al, 2011).

Sophia Georges MSN,RN

Bassem et al. (2011). International Journal of Nursing Practice: The nursing rounds system: Effect of Patient’s call light use, bedsores, fall and satisfaction level. 17:299-303

Moore, A., Waters, A., (2012). Nursing Standard: Getting ratios right for the patients’ sake. 26 (31): 16-19


What is Dementia?

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Dementia is a disorder of some functions of the brain and mostly demonstrated by memory loss and impaired judgment. People who suffer from dementia often experience difficulty performing activity of daily living. The inability to complete certain tasks often leads to frustration. Some of the symptoms associated with dementia are exhibited by difficulty processing new information i.e short term memory deficit, trouble with speech, self care and inability to recognize objects and people. Dementia is not part of normal aging, but it is rather common in the geriatric population.

Alzheimer’s disease is the most common form of dementia and is demonstrated by short term memory deficit, difficulty with language and speech and trouble mimicking motor movements. Scientific evidence shows severe brain cells damage in dementia which prevent normal cell communication by creating plagues deposits. The brain cells damage also create threads of protein that are twisted into tangles. This action interferes with normal transport system and may lead to death of brain cells.

There are over five million of people currently diagnosed with dementia/Alzheimer’s disease in the United States, and scientist expect this number to grow bigger in the near future. The disease is mostly common among geriatric population (65 or older) Alzheimer’s disease is also considered to be the 6th leading cause of death, but people usually live twenty years following diagnosis. However, others with more severe symptoms live on average four to eight years.

Vascular dementia is related to blood vessels damage in the brain, and some of the symptoms include memory loss, poor concentration, poor motor coordination ( tremors and shuffling gait) Frontotemporal dementia is mostly associated with damage to the frontal and temporal lobes and often leads to extreme behavior i.e anger, rudeness and inappropriate social interaction. People with that type of dementia often demonstrate cognitive deficit, lack of judgment, poor impulse control and lack of motivation and committment.

I will not be able to cover all types of dementia because there are many types that can be diagnosed following serial testing. I had the opportunity to manage the care of a group of retired residents diagnosed with a type of Alzheimer disease, and the experience has truly gratifying and has enabled me to appreciate life. I observed behavioral changes almost every day among the residents and noticed they have difficulty to express their immediate needs. They also demonstrated delay in response to stimuli and delay reaction to immediate danger. Based on the pathophysiology mentioned above, I knew the delay was related to interference in communication due to brain cell damages. Care givers should strive to reduce safety risk among people living with dementia.

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Caring for People with Dementia/Alzheimer’s disease

As you can see, people living with Alzheimer’s disease can be unpredictable and require constant supervision to maintain their safety. The goal is to provide individual centered care to promote compliance and maximize outcomes. Care givers should incorporate activities that interest those living with the disease. It is highly recommended to collect clinical data about personal hobbies, profession, skills and different activities. I learned that patients with dementia lose the ability to control their impulses and therefore, unable to formulate intellectual judgment and often unaware of misbehavior. However, they are able to retain life skills acquired many years ago. For instance, they might clean all day if they used to be a housekeeper or love playing with the phone if they held telemarketing or communication jobs in the past. In summary, they are often 20 years behind and remain trapped in the past.

A former preacher might spend most of the day reading biblical scriptures whereas, a singer might spend the day singing old lyrics. I must also add that people living with dementia respond well to music and art therapy. I strongly encourage relationship building in order to promote trust. When developing a care plan for people with dementia, it is important to include simple tasks that are short and easy to mimic, consider individual cognitive level and physical ability and modification in physical environment to promote safety. By now, I hope you understand that patience is very important when caring for people with dementia.

Managing Aggressive Behaviors

My professional’s approach when caring for patients with dementia is to monitor acute changes in behavior or mental status. Most acute illnesses in the geriatric population are demonstrated with neurological changes. When patients exhibit signs and symptoms of increased confusion, aggressive behavior, withdrawal , lack of interest in activities, I try to deescalate the situation first , assess vital signs, provide appropriate treatment when indicated and obtain orders from a provider for diagnostic testing to rule out acute processes. As the care giver, I have to protect the patient and understand that aggressive behaviors are often underlying symptoms of undiagnosed conditions. Care givers can also engage in different activities with patient and should strive to keep Alzheimer’s patients busy most of the time. Cognitive simulation exercises are very beneficial to those patients.

In conclusion, it is very challenging to care for people with dementia. However, person centered care often promotes collaboration and better outcomes. Aggressive behaviors are often associated with acute illness or process and should be managed immediately to prevent rapid decline. The geriatric population is expected to increase in the next 25 years with baby boomers reaching retirement age, so nurses should acquire disease specific knowledge and participate in training in order to provide patient centered care. Alzheimer’s disease is not associated with aging, but is mostly common among geriatric population. With patience and critical thinking, care givers will successfully provide safe care to patients living with dementia. Pharmacological intervention is often based on series of trial until patients demonstrate symptoms management.

Safety Advice: Never fight patients or people living with dementia!

Sophia Georges MSN, RN