Should we believe what we read in professional journals?

When I pick up a professional journal, I am already convinced that what I read is based on impartial research and evidence. But should I be?
My assumption that articles are being provided by professionals with the public interest as a priority is the wrong assumption. I was unaware until just recently that pharmaceutical companies and medical device companies can be very generous in order to receive positive press about their latest drug or gadget. While, as a health care professional, I would like to believe that other health care professionals can provide unbiased research despite the gifts, I am not that trusting of human nature.
To be fair, journals are taking steps to prevent this practice of padding their publications with articles favouring the “latest and greatest.” Until it becomes routine, and every journal checks the background of their authors, I would suggest a double-check on that research your case may depend on.

Can there be a budget during a pandemic?

It is well established that we are about to face a flu season that will take a heavy toll on health care workers as well as the general public. Meetings are held to provide information and plans on how to cope, but there are also phrases like “we still have stay within budget” from administration. This sets a dangerous environment where the cost of caring for the ill and dying takes precedent over the actual care needed. Can there be a budget during a pandemic? Bureaucrats and politicians think so. Front line health care providers do not. Managers are pressured to keep their budgets under control under all circumstances.

As a nurse, I have to question just how safe patient care will be during this crisis. Increased staff shortages will be a certainty with health care workers ill themselves or caring for family members. Paying overtime for replacement staff is already discouraged so how do units replace badly needed staff to care for the ill in the hospitals? There will be a lack of equipment as unit budgets are stretched to pay for supplies. There are already reports of defective protective equipment from poor quality sources and from being stored under the wrong conditions.

The fallout from the H1N1 pandemic will resound for years. No doubt it will also find its way into lawyers’ offices and court rooms. Perhaps there the question of how much a pandemic will cost will be answered.

Cutting the Heart Out of Health Care

As a Registered Nurse at an acute care hospital in the province of> Alberta since 1988, I would like to call attention to an issue that will have a devastating impact on the quality of health care and patient safety in this province.

Health Minister Liepert announced that the nursing shortage in Alberta went from 1400 nurses to 30 in a single day. This was not some miracle. What it means is that a hiring freeze was implemented and vacant Registered Nurse positions mysteriously disappeared. I am writing to tell you that the nursing shortage is NOT over in Alberta and that we need to hire RN's more desperately than ever.

"Replacing" RN's with Licensed Practical Nurses and Patient Care Assistants is not the answer, but rather a question of fiscal short-sightedness. Studies show that investing in Registered Nurses can SAVE money in the long run, with reduced hospitalization times and fewer adverse patient outcomes. If immediate action is not taken, the situation is likely to worsen.

Recruiters from other provinces and other countries have become very active here and we are in serious jeopardy of losing more nurses. Senior nurses are looking to retire in the next few months rather than face more cutbacks like those we had in the 1990s. Memories are vivid of the last cutback experience from which Alberta has never truly recovered.

Registered Nurses are the very heart of health care, and many of us fear that Minister Liepert's dangerous experiment of cutting RNs will leave Alberta's health care system dead on the operating table.

Canadian Health Care

There is a concerted effort in the US to establish a health care system which combines private health care and publicly funded health care. In some ads, the Canadian public health system is villified with "facts" which are not accurate. I will be the first to admit that our system has its problems but patients in urgent need do get timely care and their families are not financially devastated by that care.

That being said, the real truth about health care in Canada is that a private system has always co-existed with the public one. There has always been an option to pay a fee for access to private clinics, private diagnostic facilities and private surgical services. It is a business which exists within its own world and much of the general public remains completely unaware that a dual system exists.

I have worked within both of these health care options in Canada. Each has its strengths and its weaknesses. The future of health care will be a blend of the two and it remains to be seen if the mix will create a better system or weaken the one that is already in place. Holding health care institutions and providers accountable will ensure that patients will not have to pay a high price along the way.

Ultrasound Gel—Moms and babies at risk

Two infectious pathogens have been found growing in bottles of ultrasound gel in Canadian health care facilities. The connection was discovered by tracing skin infections on moms and babies who had recently had ultrasounds.

Ultrasound gel is often kept in squeeze bottles left with the machines that require it. Ultrasound machines and fetal monitors are the most common places you would find the gel. It does not contain any anti-bacterial properties.

The theory is that the nozzle of the bottles are coming in contact with the patient’s skin thereby contaminating the tip and allowing the pathogens to then find a great place to grow within the bottle. Gel that is heated only speeds the process of bacterial growth. Then this gel is used on the next patient. Suggestions for preventing the spread are to ensure bottles do not have direct contact with the skin and cleaning the nozzles of the bottles with an anti-bacterial wipe after each use.

A concern which crosses the mind of a nurse is one of infections that were missed. How many new moms developed wound infections following delivery because of the ultrasound gel used on their abdomens throughout the labour or prior to their caesarean section? How many babies developed skin infections that were never traced back to the gel?

Technique is so important to the outcome of a patient's care. And more attention needs to be paid to the systems in place to prevent infection and how they are actually followed on the front line of health care.

Physical Condition of Hospitals

When was the last time you spent time in a hospital ward looking closely at the physical condition of the building?

Did you notice the chipping paint? The peeling wallpaper? The cracks in the floors? The stained ceiling tiles? The upholstery that was worn thin and so stained it can't be cleaned anymore? The blinds that are missing slats and won't open or close? The curtains that are worn and stained? The bed linens that are stained? The clutter of equipment in the hallways and rooms?

I notice these things every time I step into the hospital ward I work on. I do my best to make sure stained linen is changed before my patient ever goes near the bed. That stained curtains are taken down and replaced. But it is impossible to hide the deterioration of everything else.

The patients who are admitted to hospital are acutely ill or requiring some immediate intervention. Mothers are arriving to deliver their babies. The physical environment should be one of impeccable cleaniless and condition. Yet Canadian hospitals are often falling far short of this standard under the guise of fiscal restraint. Even if the money would be spent to restore the units, there isn't any place to physically put patients while the work is done.

Can a hospital defend its infection rate and care when it can't provide patients with an environment that promotes health and healing?

Canadians give clear message on health care

As early as July 2008, Leger Marketing did a study which showed 70% of Canadians believe prescription medications are prescribed more often than necessary. The same study showed one third of Canadians do not believe the Canadian health care system meets their needs.

The lack of confidence in health care to meet their needs is a powerful commentary on the current state of healthcare in Canada. Recent changes to some provincial health care systems will result in even less ability for Canadians to access the care they need, when they need it.

Patients who enter a system when they are already doubting their care may be more likely to seek compensation for negligent care. Adding to this atompshere is the lack of trust simmering between front line staff and management. Internal strife directly impacts patient care-- and the patients know it.

A legal nurse consultant assists attorneys faced with these claims primarily through careful analysis of the choronology and the care records to determine if the facts translate into merit. This "weeding out" process helps reduce costs while also establishing a base for claims which move forward.