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Post by medic09 on Jul 13, 2011 23:12:42 GMT -5
Absolutely excellent. Mazal tov to you, and all Am Yisrael!
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Post by medic09 on Jul 12, 2011 8:39:49 GMT -5
I recently commented in a discussion among mostly rabbanim about the need for better human qualities in medical care, starting with interviews and education/school. My comments below. Like all mussar, this ought to be our daily commitment, no? Rav X, This is indeed a critical area needing improvement; and one that is revisited from time to time around the world with little lasting change. I think it is appropriate that treating every patient as bearing tzelem Elokim (respect) and as kin (love) be promoted by community rabbanim. Patients are an especially vulnerable group, and therefore prone to heightened experiences of anxiety, pain, etc. Medical providers of all levels and stages - EMS, ED staff, inpatient staff, outpatient staff and family physicians - need to be acutely aware of this; and sympathetic to it. I try in some way to treat my patients this way, and due to avonotai harabbim, I succeed inconsistently. A few brief thoughts on this. 1. One issue is simply a lack of insight. An example is how we treat homeless patients. Dirty, smelly, sometimes unpleasant individuals come to the ER; and of course the staff aren't thrilled to deal with them. Maybe since I am a (Tzahal) veteran I sympathize more, knowing how many of these people are veterans who are paying a permanent price for serving civil society. Many start unknowingly self-medicating for anxiety and PTSD with drugs and alcohol, and soon find themselves broken addicts. Alternatively, many homeless people are mentally ill. After discussing this with some of our techs in the ER, and modeling how these people might be better treated, I see a real improvement in some attitudes. But it needs constant reinforcement. 2. I have often said, only partially in jest, that direct care providers should be at least 30 years old and have lived a bit. In the American system one becomes a doctor or nurse by going straight from HS to college to med school to residency. What do these kids understand about their patients' lives? What do they know about babies or old people? When did they have a chance to develop real-world adult insight, social skills, or common sense? 3. Time and money. I recently returned to ER work after a year-long hiatus for injuries. A young couple (wife suffering chronic intractable mysterious pain) told me how grateful they were I had stepped in to replace the first nurse who worked with them. Even though the wife continued to suffer, they appreciated my attitude and attention and said it really transformed their suffering. Colleagues commented that patients were positively affected by me. But I was told I spend too much time with each patient. We have to keep bodies moving through the ER. It is inefficient and costly to spend time listening, talking, just relating. We don't get paid for that. Back when my wife ran her own practice, she figured she spent between 2 and 4 times as much time with each patient as the insurance companies actually paid for. That means earning far less. And every kupat holim doctor can certainly tell a similar story. 4. Let's face it. Some people just aren't as nice as others. Eventually, that will be across the board. So, if a doctor is too curt or worse with the patients, he probably isn't much better with the nurses and techs. Not for long, in any case. I had one physician tell me, 'I'm just not as nice as you' after I argued for a little more time and care for a patient. 4a. A corollary is that some folks are just way more cerebral and less personal. My father's physician graduated high in his Harvard class. But he was a technocrat. He ordered lots of tests, but hardly touched the patient. Eventually that leads (and did in my father's case) to bad medicine. Providers have to get close to and personal with a patient to discern what may really be happening with them. But some providers, especially higher levels like physicians and specialists, are drawn to their profession for the intellectual challenges rather than the personal contact and care. So, they can be more distant and cold when relating (or not) to the patient. 5. It is easy to teach quantifiable things like competencies. Kindness is something that we really have to believe in, and have to buy into. I believe and advocate that after immediate safety, kindness is our first task. That is not how we teach physicians and nurses. A well known EMS educator out here teaches his crews to remember that patients are often having the worse day of their lives when they call us. Or they think so, anyway. 5a. Large programs always deal better with measurable qualities. Grades. Outcomes. Numbers. It doesn't matter if it is an elementary school or med school (or rabbinical school). When teaching 30 or 50 or 100 students it is much easier to measure them up by their grades than individual qualities. So, even after careful selection of candidates, we still end up with a far greater emphasis on masses of information (essential), on grades and skills. Personal instruction and promotion of personal qualities would require much more personal education. Too expensive and inefficient. Patient care is little different. I have never been asked if I was especially kind to anyone today. I, and the physicians, are asked to see a certain number of patients in a certain amount of time and space. We have to contend with this every day, in every stage of our education and practice. We have to be determined that it not effect us personally, or dictate how we treat patients. We also have to be determined to have a personal positive impact, instead. Sur m'ra v'aseh tov. In the end, who we are and what we really believe remains the foundation of our patient care practice. See again my #2 above. Personal depth, mussar, and strength need to be founded before school, and forever more reinforced. When young soldiers go to Tzahal, the yeshivot hesder stay in touch, constantly supporting them. The questions of halacha and mussar are continually addressed before, during, and after their service. But it is no secret that many of the soldiers around them behave more badly. Why would we expect any different anywhere else in society? Mordechai Y. Scher NREMT-P, FP-C, RN Emergency Dept., C/SVRMC, Santa Fe, NM, USA Western States Air Medical, Las Vegas, NM, USA Beit Midrash Kol BeRamah www.kolberamah.org
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Post by medic09 on Jun 28, 2011 14:37:22 GMT -5
There are some other possible considerations here.
1. The insurer here might refuse him as having a pre-existing illness/injury. I don't know how that works; but it isn't all that unusual.
2. Does he have family in Australia? Hernia surgery isn't typically too big a deal. He could go visit his family, they could look after him during a short recuperation; and then he could come home to you. Not the best way, but it wouldn't take long and you could stay home and 'tend to business.' Many families have done stranger things.
Working as a CNA while you finish nursing school is altogether not a bad idea. It isn't the best paying job; but it won't take you far from your studies.
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Post by medic09 on May 31, 2011 10:42:41 GMT -5
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Post by medic09 on May 15, 2011 10:21:19 GMT -5
Hey Achot, I didn't realize there were Smilies just for Sefirah! ;D
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Post by medic09 on May 13, 2011 12:01:20 GMT -5
Shalom Moshe! Welcome to the forums. Nice to see another XY on here. ;D
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Post by medic09 on May 11, 2011 15:50:45 GMT -5
Well, I think we've covered every observant Jewish nurse in New Mexico!
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Post by medic09 on May 10, 2011 11:17:25 GMT -5
Welcome to the forum, ntinarn! If the programs being considered are from a reputable school, then it hardly matters. Most employers and graduate schools don't care all that much where the BSN is from, as long as it is legit. Personally, I would look for (if it exists!) a program that doesn't have as much management-oriented courses. Those are the courses most of my classmates hated and found largely a waste of time. Impossible to avoid completely, though. What makes the BSN is typically management and nursing theory, a very basic research class, and some community and public health material. Keep in mind, too, that there are perfectly good RN-to-BSN programs that are entirely distance learning. That's a good option if you're working, raising a family, marrying off children, etc. Happy Yom HaAtzmaut!
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Post by medic09 on May 9, 2011 19:16:18 GMT -5
Cross-posted to Kol BeRamah.
Yom Hazikaron 5771 יום הזכרון תשע"א Yom Hazikaron. Remembrance Day or Memorial Day for the fallen of Israeli security forces and victims of terror. For me, sitting in Santa Fe, New Mexico, this may be the loneliest day of the year. In front of me, on the wall behind my desk, is a bulletin board with all manner of important mementoes and reminders. A photo of my wife painting the scenery as viewed from Manara, overlooking the Hula Valley. A panorama of the view from our apartment in Kiryat Shemonah. A photo of Rav Tzvi Yehudah Hacohen Kook. The chief medic symbol from my IDF service. My IDF dog tags. The photo of a grave. The headstone reads: דניאל (דני) האז. בן שושנה ומאיר. "Daniel (Dani) Haas. Son of Shoshanah and Meir. Born in the USA, made aliyah in 5739. Fell in battle in Lebanon in Operation Peace for Gallilee, the first day of Av, 5742. Age 26 when he fell. May his soul be bound in the bond of life." Danny was my friend. He came from Cleveland, Ohio to live and build in Ofra, Shomron, Israel. We had common friends in Ofra. We started our army service together in the Nahal brigade. He died in battle with terrorists in southern Lebanon during his first reserve duty call-up. A Jew committed to building a Jewish society in Israel based on Hashem's Torah. A Jew committed to building that society with his hands, and his blood. In Israel, when the observance of Memorial Day and Independence Day was being established, the Chief Rabbinate determined that if either day fell on Sunday, they would both be pushed off into the coming week to avoid desecration of the Sabbath with people rushing to ceremonies and preparations on Saturday night. In America, there is some discussion if Yom HaAtzmaut (Independence Day) and Yom Hazikaron (Memorial Day) should similarly be pushed off as is done in Israel. Why not? Because 'Memorial Day isn't so relevant to American Jewry', and so we aren't concerned with the practical issues of possible Sabbath violation. 'Memorial Day isn't so relevant to American Jewry'! What a horrible thing. But sadly true. When I first came to the USA to teach, I found myself embroiled in a controversy. The Jewish Community Center in our city was hosting a Yom HaAtzmaut/Independence Day celebration the night starting the Hebrew date of the holiday. The event was starting well before sundown, with music and dancing. This was a desecration of the solemn and sacred nature of Memorial Day! How could this be? I contacted the organizers, and they were completely unaware of the significance of the day before Yom HaAtzmaut. They also said they couldn't or wouldn't change the planned start of festivities. So I told my students that year to boycott the event if it weren't changed. My students, God bless and keep them, pressured the organizers and some modifications were made at the last minute. Natan Alterman wrote a poem called the Silver Platter. מגש הכסף. It is a response or illustration of Ben Gurion's lament that we didn't receive a Jewish State on a silver platter. Many fought and died, and continue to fight and die, so that we may celebrate this most wonderful time in our history. My long-missed friend Danny is one of 22,867 soldiers and civilians who have been killed fighting for and defending the cause of modern Zionism. They, Alterman wrote in his poem, are our silver platter. All of us who in any way, shape, or form benefit from the State of Israel today owe them our highest debt of gratitude. But many American Jews, including many American rabbanim, observe that 'Memorial Day isn't so relevant to American Jewry.' Shall we leave it that way? Rav Yosef Dov Halevi Soloveitchik was famously opposed to unnecessary ceremony and symbols. One year he spoke before the gathered members of Mizrachi Religious Zionists (as related in נפש הרב, pg. 99-100) on the topic of the flag of Israel. At first glance, a flag has no place in halacha and no real significance in Jewish life. It seems, however, that there is indeed a halacha in Yoreh Deah that relates to the importance of the flag. We know from the g'mara in Moed Katan that the sages instituted that everyone should be buried in similar plain shrouds. What is the one exception to this? If a Jew is found killed, he should be buried in his bloody clothes as evidence of his violent death. In Heaven they should see this, and this should awaken heavenly justice against the killers, and heavenly mercy on the deceased and his community. So too, the flag of Israel. At the end of the War of Independence, it was determined that whatever territory was in Jewish hands at the time of cease-fire would be recognized by the UN as part of the new Jewish state. Whatever was in Arab hands, would remain outside the state. So much blood was spilled, so many Jewish soldiers fell figuratively and literally placing a Jewish flag on the soil of the Land of Israel. Therefore, said Rav Soloveitchik, the flag of the State of Israel has a similar importance to the bloody clothes of the murdered Jews. When that flag waves, it should awaken heavenly mercy on all of the people of Israel. In The Rav Speaks, on page 139, this idea appears: "How much more is this so of the blue and white flag, which has been immersed in the blood of thousands of young Jews who fell in the War of Independence defending the country and the population (religious and irreligious alike; the enemy did not differentiate between them). It has a spark of sanctity that flows from devotion and self-sacrifice. We are all enjoined to honor the flag and treat it with respect." There is a story told of Rav Shlomo Zalman Aeurbach, that appears in the frontispiece of Rav Rimon's הלכה ממקורה: צבא. Once a student from Yeshivat Kol Torah approached Rav Shlomo Zalman Aeurbach zt"l and asked him, 'may I interrupt my studies (of Torah) to travel to prayer at the graves of the righteous/tzadikim?' Rav Shlomo Zalman answered him, 'it is preferable to remain in the yeshiva and learn (Torah).' The student asked, 'is there no place for going at times to the graves of the righteous to pray? Does the rav not go at times to pray at the graves of the tzadikim?' Rav Shlomo Zalman answered him, 'in order to pray at the graves of tzadikim there is no need to travel to the Gallilee. When I feel a need to pray at the graves of the righteous, I go to Mount Herzl(Israel's national military cemetery in Jerusalem), to the graves of the soldiers who died for the sake of God.' May Hashem open our minds and our hearts to appreciate the great gift he has given us in Israel; to appreciate deeply the manner and cost by which it comes. We did not receive the State on a silver platter. Pray that by the merit of Danny Haas and all the men and women with him in their special place before the heavenly court, we should be privileged to see the ultimate redemption of Israel and the world complete. By their merit.
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Post by medic09 on May 8, 2011 0:57:53 GMT -5
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Post by medic09 on May 6, 2011 17:07:16 GMT -5
Can we try to get Dr. Chaya Greenberg or someone else from Machon Tal?
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Post by medic09 on Apr 28, 2011 9:38:42 GMT -5
As far as 'what can we do'? The first answer is education. Aggressive, in your face education. We first have to break the barrier of total ignorance about such issues, beginning with community rabbanim, school administrators, etc.
It isn't enough to just say 'ushmartem meod...'. We have to show consequences of neglect, suggest solutions, and show how easy those solutions can be.
Great topic, btw. Thanks for bringing it up.
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Post by medic09 on Apr 15, 2011 2:05:38 GMT -5
Yah, good things to keep in mind! The truth is, I am looking into either Georgetown or Drexel online. I live in Silver Spring, MD so Georgetown is right here (Washington, DC), in fact I could go to their onsite program. But I thought that it would be convenient to go to class in my bedroom with my baby in the bassinet behind me. Drexel is in Philadelphia, so it would not be very far. You're right about the over the weekend visit thing. I already got wind of that and am trying to figure out if they'd let me come another time. Can't respond to everything you said now because I need to get to sleep, but ty again! And thanks for being super down to earth and giving me food for thought. Everything Bobbie says in on the mark. The voice of experience! If you think Shabbat or other religious issues will be a challenge (they will!) don't forget to consult with your rav. Many of us go to school and attend conferences from time to time and manage these challenges okay. One needs to be well-informed to know how to manage these things appropriately, sometimes without being unnecessarily strict. And of course, with a family you will have to be flexible and well coordinated with your spouse. The one distance program I am interested in requires on site participation each semester over a weekend. The first thing I did was to contact them about Shabbat to see if that can be worked out. If I hadn't received a positive response (no tests/writing on Shabbat, etc.), then I would have to think about something else.
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Post by medic09 on Apr 15, 2011 1:52:20 GMT -5
+1 to everything Achot said.
BTW, med students have it tougher. They learn straight off on the patient! Actually, that makes it tough on the patient. In contrast, when I was a young medic trainee in the IDF, we learned injections and IVs on our partners before having to implement this on someone else. And there were no dummy arms back then. Apparently nursing schools are worried about liabilities and so don't allow students to learn and practice on each other. My paramedic students still did, though. We taught our daughter phlebotomy skills on us (me and my wife).
Finding a vein, btw, is really more about feel than visuals. I think half or more of the hundreds of IVs I've done I have't really seen the vein. When I was trained to be a medic, we had to learn to do them in the dark. Since then everyone I've known who is really good at this agrees that palpating the vein is the more important notion, when possible. Eventually, you'll learn that for each patient you find the vein by any method that works.
Insertion technique simply requires practice. There isn't any other way that I know of. You have to develop a no-hesitation, quick, SMOOTH insertion. Practicing the steps may help. Anchoring the vein, mentally committing, and then a quick insertion. Don't forget follow through. Once the catheter is in, you still need to keep it there while removing the needle, attaching your IV set, and anchoring without losing the IV. So have your tape torn, or Opsite, etc. ready nearby. Many times I've been frustrated after losing an IV on a tough-stick patient.
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Post by medic09 on Apr 7, 2011 21:37:43 GMT -5
Congrats! I'm glad you can finally put that behind you.
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