(GOOD NEWS AFTER THE ARTICLE) This study shows so much of what’s wrong with medical research today | The Incidental Economist

This study shows so much of what’s wrong with medical research today | The Incidental Economist.

I won’t wade too deeply into this pool right now. Every moment I spend is borrowed time from NCLEX studying. But it’s worth mentioning that despite the incredibly difficult environment of academic research I see all around me nurse researchers doing what nurses are known to do–finding a way to make it work. They are making efforts to conduct unit-based research and if appropriate expand evidence based practice to other units and through professional networks to outside health systems. This research focuses on patient safety, quality improvement, and money savings to patient and health care system. Simple, cheap, and effective are markers of success. The example of using the blood pressure cuff to reduce kidney damage in cardiac surgery is right up the alley of unit-based nursing research.

Recognizing bedside nurses as professionals with the capacity to contribute in this essential way to the improvement of care (and bottom line) is mandatory for health systems moving forward. We are endlessly capable when given the time, the tools, and the support to make positive changes. It’s a super bonus that we aren’t stuck with the difficulties ($$$, popularity contests) of grant-dependent research.

At the health system I trained in a nurse is championing Enhanced Recovery After Surgery (ERAS) protocols. Unit by unit she is getting buy in and rolling it out. I’ve seen her data: it is significant. Patients are going home sooner and healthier.

So my plea to my fellow nurses is publish your work! Read each other’s studies! Let’s flex our skills. Let’s brag on each other. There’s a lot to be proud of.

Waiting for NCLEX.

Good news: I graduated! Along with the smartest, finest looking group of nurses this side of anywhere. We are all pretty sure we’re going to fix health care. Be on the lookout.

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Bad news: I hurt my back moving boxes and carrying around my 45 pound child.

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Good news: It’s you and me laptop stuck in a supine position!

I’ve been meaning to blog you this: my short piece of writing was published as an editorial in the Washington Post and then recorded for airing on local NPR affiliate WVTF. I AM LIKE FAMOUS. In all seriousness I am very humbled at how a wee handful of words caused a number of wonderful people to go out on a limb for me and support what I’ve done. My school values writing and reflection as a part of creating resiliency in nurses. My clinical faculty encouraged me to submit my writing. And a very awesome former journalist current writer went out of her way to help get my piece published. You people get a round of applause.

Now that I’m 95% RN I’m waiting for the boards to make it official. I’ve been transcripted, fingerprinted, background checked, notarized, certified by mail, and written many checks. So now I anxiously thumb through NCLEX licensing exam study guides as I wait for the Board of Nursing to approve me for an opportunity to sit for the big test. I secretly love it.

RFK on MLK and the actual struggle.

Graduate school has decided to be acutely painful in its final days. I’m couch-surfing through my last week. After that my friends I will resume responsibilities as mother, occasional blog writer, and amateur critic of everything that crosses my path.

Had to share this as I went down a rabbit hole on a health policy paper and ended up at this speech–recommended by my #1 policy prof via a note on an old assignment, “one of the most powerful political speeches of the modern era,” and what do you know all of a sudden I have time to look it up. RFK quotes Aeschylus. And the people of the Starbucks are used to my crying by now. You’ve seen it before? Are you watching the news? Watch this again.

Robert F. Kennedy delivered this impromptu speech announcing the death of Martin Luther King, Jr. to a largely African American audience in Indianapolis. His brother was dead 4 years, and he would be assassinated before the spring was out.

Have we become so cynical that our leaders are unable to move us? Or is it the patina of time that makes this sound genuine? Listen anyway.

Poetry Monday

Saturday I had the pleasure of listening to Margaret Mohrmann give the keynote at the UVA’s End-of-Life conference. Blow. Me. Back. The weight of the subject matter and her nimble language. The stories steeped in years of experience ecclesiastical and medical. Is frank compassion a thing? I think it may be her thing. One of the two times she made me well up (for my patients, for my loved ones, for me, for my fellow RNs & MDs, for humanity):

A Blessing for a Friend on the Arrival of Illness
by John O’Donohue

Now is the time of dark invitation
beyond a frontier that you did not expect.
Abruptly your old life seems distant.
You barely noticed how each day opened
a path through fields never questioned
yet expected deep down to hold treasure.

Now your time on earth becomes full of threat.
Before your eyes your future shrinks.
You lived absorbed in the day to day so continuous
with everything around you that you could forget
you were separate.

Now this dark companion has come between you.
Distances have opened in your eyes.
You feel that against your will
A stranger has married your heart.
Nothing before has made you feel so isolated
and lost.

When the reverberations of shock subside in you,
may grace come to restore you to balance.
May it shape a new space in your heart
to embrace this illness as a teacher
who has come to open your life to new worlds.
May you find in yourself a courageous hospitality
towards what is difficult, painful and unknown.

May you use this illness as a lantern
to illuminate the new qualities that will emerge in you.
May your fragile harvesting of this slow light help you
release whatever has become false in you.
May you trust this light to clear a path
through all the fog of old unease and anxiety
until you feel a rising within you,
a tranquility profound enough to call the storm to stillness.

May you find the wisdom to listen to your illness,
ask it why it came,
why it chose your friendship,
where it wants to take you,
what it wants you to know,
what quality of space it wants to create in you,
what you need to learn to become more fully yourself,
that your presence may shine in the world.

May you keep faith with your body,
learning to see it as a holy sanctuary
which can bring this night wound
gradually towards the healing and freedom of dawn.

Universal health care through the lens of national history, identity.

The Lancet-The Trap of History

Every country has its own story, its own fears and dark shadows. One of the biggest unacknowledged challenges facing global health is adapting evidence to these national stories, resolving a persistent and troubling discrepancy between knowledge, history, and identity.

A MUST READ. Also though not directly related, an argument for liberal arts education as a grounding force in our science-and-tech obsessed world.

Short but oh-so relevant as we in the US scratch heads and gnash teeth and poor poor policy makers can’t seem to get a handle on HOW DO WE MAKE THESE PEOPLE HAPPY! My dream team that will save US health care: The Social Anthropologist, The Historian, The Sociologist, The Behavioral Economist, The Nurse!, and we’ll have a doc too if Atul Gawande has the time. He we be called The Atul Gawande.

Health policy incontrovertible truths

Sorry y’all for all the personal posts of late. I’ve had some trouble crossing the Lethe that runs between the hospital and my house (rt. 29). Forgive me, that’s the last time “death” becomes a tag in three consecutive posts.

From my policy textbook this AM, I thought I’d share:

The evidence that insurance and the access to care it facilitates improves health, particularly for vulnerable populations (due to age or chronic illness, or both) is as close to an incontrovertible truth as one can find in social science.” -Austin Frakt

Can This Treatment Help Me? There’s a Statistic for That – NYTimes.com

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Can This Treatment Help Me? There’s a Statistic for That – NYTimes.com

Who over the age of 65 doesn’t take an aspirin a day? For every medical intervention practitioners look at a cost/benefit analysis. Sometimes it’s a big deal–we surgically remove the tumor on your spine at great risk to your life and mobility, but there is a strong possibility of removing and curing your cancer–that benefit outweighs the risk. Sometimes it’s not. Take some calcium supplements. They might help but they probably won’t hurt. Just whatever!

Practitioners make recommendations based on studies and evidence which are analyzed using statistical methods. We know that the average person has no concept of what statistical chance actually means. We’re just hairless apes, y’all. The same is true for docs. And this nurse.

This article illustrates beautifully what we are talking about when we talk about the metric commonly used in analyzing efficacy of treatment: N.N.T. or number to treat. Eat it up. I feel like I learned a thing today.

Where the strength comes from.

This week has been crushing. Just crushing. I’ve been looking for something to settle the outrage. It’s the stuff needed by everyone who practices moral distress for a living. The things that get you by when 5 out of six patients in the ICU are bodies begging to be let die. When you feel helpless, without recourse, exhausted. When the news is just so bad.

Breathless diatribes to friends and family members do not work. Also, they are not appreciated.

Trolling twitter is an exercise in futility and will prevent you from sleeping at night. Not recommended.

So after alienating all people IRL and on the internet, I went to the books. My college roommate gave me a Maya Angelou book of poetry for my 20th birthday and I am forever grateful. (Although that night the only thing I was was debauched, later I was grateful. What a cool roommate). Angelou was given a diet of abuse and society’s garbage and still grew into a sterling woman, poet, author, activist. I mean a true gift to the human race. I could listen to her forever, but this excerpt from a Fresh Air interview where she talks about discovering the universality of poetry and recites a Shakespearean sonnet (spur of the moment, from memory) knocks. me. back.

*Listen to the entire Maya Angelou interview

This is what is doing it for me today.

Open Access. For journals. For everything.

The journals that publish those papers are, in many cases, for-profit institutions — and they prefer charging for access.

via The Gates Foundation pushes to make more academic research free and open to the public – Vox.

The (TAXPAYER FUNDED) National Institutes of Health, which spends about $30 billion yearly on medical research, began in 2008 requiring that research studies it funds be made open access a minimum of one year after publication. The Gates Foundation now requires that publication of the research it funds be openly accessible by the public starting now and for, like, ever–meaning that publishing in big brand name subscription-only journals might be off the table. This puts pressure on those journals to provide open access. HOORAY! Science evolves!

At the moment clinical research is the area of study least likely area to be open access. The community hospital I work at provides its clinicians no scholarly resources. My school bestie and I our putting our thesis where our mouth is by choosing to study and promote access to clinical resources for staff nurses…despite being told by every adviser we have that it’s a bad idea. We may (probably will) go down in flames, but sometimes the amount of push-back you get is proportional to how right you are.

Ethical problems crop up in establishments that sustain themselves by limiting access. Closed institutions embolden those with access to manipulate those without, provide a nice incubated broth for corruption, weaken the rigor of their founding principles, and encourage opacity to protect against anything that might devalue access.

Am I talking about academia? The journal Nature? Fraternities?

If you opt for open access and promote a culture of transparency you’ll get two things: 1.) Diffusion of knowledge making fertile ground for creativity and innovation, 2.) Confronted with the fact that there’s a lot of bad wood underneath the veneer. Which is the first step in getting that rotten stuff out of there.