Category Archives: Uncategorized

Occupational Violence

work place violence

Menendez, C. C., Lipscomb, J. A., London, M., Chen, Y., Flannery, K., Watt, M., & … McPhaul, K. (2012). Safety climate and workplace violence prevention in state-run residential addiction treatment centers. Work, 42(1), 47-56.
Magin, P. J., May, J., McElduff, P., Goode, S. M., Adams, J., & Cotter,G. L. (2011). Occupational violence in general practice: a whole-of-practice problem. Results of a cross-sectional study. Australian Health Review, 35(1), 75-80. doi:10.1071/AH10874
Wei, C. Y., Chiou, S. T., Chien, L. Y., & Huang, N. (2016). Workplace violence against nurses–Prevalence and association with hospital organizational characteristics and health-promotion efforts: Cross-sectional study. International Journal of Nursing Studies.
Miedema, B., Hamilton, R., Lambert-Lanning, A., Tatemichi, S. R., Lemire, F., Manca, D., & Ramsden, V. R. (2010). Prevalence of abusive encounters in the workplace of family physicians A minor, major, or severe problem?.Canadian Family Physician, 56(3), e101-e108.
Spencer, S., & Johnson, P. (2016). De‐escalation techniques for managing aggression. The Cochrane Library.
Yang, L. Q., & Caughlin, D. E. (2016). Aggression-Preventive Supervisor Behavior: Implications for Workplace Climate and Employee Outcomes.Journal of occupational health psychology.
Preventing Workplace Violence: A Road Map for Healthcare Facilities. (2015). Retrieved January, 2016, from

look (listen and feel) or just treat?


Is that even an option? Raise your hand if you or someone you love has ever been given a medication without even being examined. Recently that is the trend, and if we pause and look at who to blame, I believe it is a joint effort. My baby is cry and pulling on her ear, he is not eating or playing we must give him something, but they are afraid of the doctor, so the doctor does not give them a check up. This and a hundred more scenarios of a similar case are what causes false treatment and misdiagnosis as well as the feared creation of a super bug. Science is telling us its against good practice to treat ear infections, children get better all on their own if you allow their body to heal.

“Parents, if their child is up all night screaming and tugging the ear, they want something to make the child feel better,” says Dr. Richard Rosenfeld of the State University of New York Downstate Medical Center, who helped write the new guidelines.

But about 70 percent of children get better on their own within two or three days, and about 80 percent are better within a week to 10 days, he says.

And he says there are some real downsides to using antibiotics when they’re not necessary: They can cause upset stomachs, allergic reactions and other problems. And they can contribute to the development of superbugs — infections that are getting harder and harder to cure.

You heard it, straight from the horses mouth. So lets slow down hug our babies when they do not feel well and push forth, take their temperatures, read about fevers and try a little harder to be parents when that is an option.


Sixteen-year-old John Doe enters the emergency room completely naked requires immediate attention for their psychosis. This is an adult emergency room and the patient must be transferred for their dehydration/renal disparities to the neighboring hospital. The neighboring hospital staff is hesitant to accept for they are not a psych facility and it is not in the best interest for this patient to be received by this facility. Supervisors are called and the plan of care is discussed the CEO accepts the patient wants them to get hydrated and then transferred to the psych facility.

This readers is called FRAGMENTATION in our health care system, health care is a business and the evidence is loud and clear for the patients are not receiving the care they need. “Fragmentation or looking at a problem from a narrow perspective leads to concerning issues that can cost a persons life. Underlying the current healthcare failings is a critical under appreciated problem: fragmentation—focusing and acting on the parts without adequately appreciating their relation to the evolving whole. This unbalance, this brokenness, is at the root of the more obvious healthcare crises of unsustainable cost increases, poor quality, and inequality. Fragmentation is at the heart of the ineffectiveness of our increasingly frantic efforts to nurture improvement.”


The answer? Looking at the person as a whole, going as far as to having a relationship with the person and knowing what their about in order to understand their sufferings. We have moved far from knowing and loving the person and too much into how do I make money from this person’s health and vulnerable state. There is far to much detachment and isolation where there was once a relationship and care. Personally I believe its an integrity issue, we need to pray for a solution.

What about the Appendix?

We can all agree that our medical system here in America has one of the most intelligent technologies and most sophisticated systems. Our emergency rooms are bright and shiny and the doctors and nurses look like they know what they are doing. Nonetheless I had an 11 year old boy who came into the emergency room with sharp abdominal pain, nausea, low grade fevers and a distended abdomen. Diagnosis; constipation treatment and enema a large emergency room bill and the consequences a ruptured appendix and a 7 day hospital stay in the midst of his horse competition. We can all agree that we can’t always depend on the fancy technology or the bright and shiny lights. We have to know and be confident in it as others put the lives of the people they love in our hands as health care professionals.


The Cleveland Clinic gives a cheat sheet so the next time you’re in the ER at 4 am with your 6 year old that you can help the doctors and nurses do the best job they can do. It might save you a hospital stay and a heck of a lot of money.

What are the symptoms of appendicitis?
Symptoms include:

Pain when touched on the lower right side of the abdomen
Abdominal pain or tenderness, usually in the center of the abdomen above the belly button, then shifting to the lower right side of the abdomen. The pain increases when moving, taking deep breaths, coughing, or sneezing.
Fever, usually low-grade (under 100 degrees)
Inability to pass gas
Abdominal swelling
Lack of appetite
Note : Not everyone will have all of the symptoms.

If you have symptoms of appendicitis, it is important that that you do not take laxatives or enemas to relieve constipation. These medications could cause your appendix to burst. You should also avoid taking pain medications that could mask the symptoms the doctor would need to know about to diagnose the conditio

Use the breast

Breast Feeding is one of the joys of motherhood, society has rumored often about how breast feeding should be done less often instead of more frequently. Lets be honest breast feeding should be for at least the first 6 months and up to 2 years of age. Lets remain informed and enjoy this lovely season of life, because the baby will only be that precious gentle infant for so long. Breast feeding not only assists with immunity, mother baby bonding but can also save you lots of money. You and your family will know the best options for you but here are some facts to live by.
What to NOT TO DO during breastfeeding?
-Receive the small pox, and yellow fever vaccine
-Mother is receiving chemotherapy/radiation
-Avoid stress, relax, remain active
– If you have conditions such as HIV, TB breastfeeding should be avoided, but conditions such as a cold, flu, diarrhea will help the baby build antibodies as they ingest the breast milk.
What you should DO while breastfeeding?
-Drink plenty of fluids
-Limit sugars
-Limit caffeine to 1-2 cups a day
– Eat a well balanced diet
-Track how often and for how long the baby is feeding

bacille Calmette-Guerin


As a Guatemalan native I can relate to those babies who come into the hospital with questionable tuberculosis just because they come from a different country. A country where they received a vaccine because TB is prevalent. My heart beat is this, become informed because you’ll never guess what happens next. The American hopsital will run a TB skin test in order to rule it out, which will indeed come back positive, because the patient is making antibodies and now it will be the family who worries, the patient will receive a Chest Xray, countless labs that take days to result and be quarantined until one day a doctor decides thats enough.  As an informed consumer, a nurse, or a concerned member of society I encourage you to challenge doctors, nurses and all health care providers a like.

Standing up for the vulnerable is hard, especially because experts are working out of fear. Stand firm, be gentle and persevere. Use your resources. The CDC states the following “BCG, or bacille Calmette-Guerin, is a vaccine for tuberculosis (TB) disease. Many foreign-born persons have been BCG-vaccinated. BCG is used in many countries with a high prevalence of TB to prevent childhood tuberculous meningitis and miliary disease. However, BCG is not generally recommended for use in the United States because of the low risk of infection with Mycobacterium tuberculosis.” 

This is not outlier type of situation. This happens all the time. Our hospitals are filled with fearful and vulnerable populations.  We must not even begin to discuss cost because thats altogether upsetting as well. Lets put our hands on our hearts, stop looking the other way and stand up.

Nitropaste on nitropaste on nitropaste?


Chest pain in the hospital is the recipe for nitro paste. We were going through the morning medications and as our nurse applied a new paste on grandmas chest we remembered that when we had washed her up there was a one on her right leg that wasn’t removed. The nurse became embarrassed and lashed out in anger that someone had done that. We started searching grandmas body after that and found one more strip of nitroglycerin on her left leg. We came to the conclusion we would all assess the situation we had on our hands in order for grandma to be safe from then on. f23fd03e-ba6b-4a2b-b362-6a41690b45ca-04

Medical errors are a real thing, “To err is to human” we need to take that perspective as we think about the hospital. Nobody is without error. Being vigilant when your loved one is in the hospital is essential for the accountability to make sure nurses and doctors are focused.

Nitroglycerine is given for chest pain, it dilates your arteries in order for you to have the increased blood flow. It has a killer headache side effect  thats invigorated times a hundred with 3 nitroglycerine pastes at once, just saying. Being a nurse and knowing the difficult, highly stressed environment take this advice Never trust too much, never not ask a question, stay vigilant it’s good practice for all of us.


Unfortunately we are experiencing a mental health epidemic. Nonetheless it’s a real problem and we must deal with it, even though giving a medication may be the easiest at the time, it’s not the most effective in the long run. Mental health is not exclusive to schizophrenia or bipolar but encompasses conditions such as anxiety and depression. I recently attended a nurse practitioner conference where a very passionate mental health practitioner spoke on the importance of NOT prescribing medication to individuals suffering from depression. It was a breath of fresh air, I was glad to hear him. His emphasis was on acknowledging you need help, consistent counseling and restoring hope.

The take home message was that in conjunction with counseling evaluate a two-week period trial period in which if the symptoms do not subside that a supplement can be used. SAMe has been used in Europe for osteoarthritis and depression. Your body makes SAMe internally but if you’re not creating enough then you can supplement it. In order for the supplement to work there are two activities needed in conjunction.

1, Being involved in activities


Recommended doses include:

For depression: 400-1600 mg per day

For osteoarthritis: 200 mg three times daily.

So before you begin taking large doses of prescription medications, get help, explore your options because going back from prescription medications is not an easy or pretty cycle. Ask for help, start with counseling and pray that your heart would be healed. Paul tells the Phillipians “Be anxious for nothing, but in everything by prayer and supplication with thanksgiving let your requests be made known to God. And the peace of God, which surpasses all comprehension, will guard your hearts and your minds in Christ Jesus.” Philippians 4:6-7


“It doesn’t get easier, YOU get stronger.”

be you, because youre amazing

“It doesn’t get easier, you get stronger.” Have you ever been going through something, and you never thought you would make it all the way? Every moment of nursing school was like that. Working 12 hour shifts without payment, studying for boards, working a part time job and trying to do it all with a level of excellence and integrity. During that time I think back to when I was working through those challenges, I made it. The reason I recount that challenge today is because I am feeling it, I am feeling the pressure of graduate school, working, planning a wedding and opening a start-up all while trying not to crack. I am fully aware that working in the health care field and having peoples lives as well as peoples children’s’ lives in your hands to care for and protect is filled with pressure. The pressure didn’t stop in the school of nursing but it definitely prepared me.

Lean not on your own understanding but in all your ways acknowledge HIM. “Count it all joy, when you meet trials of various kinds, for you know that the testing of your faith produces steadfastness. And let steadfastness have its full effect, that you may be perfect and complete, lacking in nothing” James 1:2-4 Through the process I recount verses and conversations of people who surrounded me. What words and inspirations like “mindset” really mean and how to prepare my heart in order to successfully attain my goals. The process of mindset, setting your eyes upon Jesus and surrounding myself with people who empower me and love me through the process is the only way to get through it.

So my advice to those of you doing hard things. Sit up straight, buckle up and “clothe yourself with dignity” for the Lord is good and the process is the beauty in the making.


Can I be any healthier?

Another healthy style trend to take on. Once you have mastered the Vitamix, your 3-5 day exercise routine added the proper vitamins to your diet and your how to reduce stress with me time then you can start thinking about the newest thing. A probiotic. Working on a pediatric floor where if the children are constipated we give them diarrhea and a probiotic and if they are having diarrhea we give them constipation with a probiotic. Why should adults be any different? I recently attended a nurse practitioner conference and there was a grand emphasis on probiotics for adults. Probiotics for UTIs, IBS, diarrhea, colitis but an even larger emphasis on just maintaining a healthy gut flora. Harvard medical recently wrote about the health benefits of probiotics “Self-dosing with bacteria isn’t as outlandish as it might seem. An estimated 100 trillion microorganisms representing more than 500 different species inhabit every normal, healthy bowel. These microorganisms (or microflora) generally don’t make us sick; most are helpful. Gut-dwelling bacteria keep pathogens (harmful microorganisms) in check, aid digestion and nutrient absorption, and contribute to immune function.” Moral of the story stop by your nearest health food store and pick up a friendly probiotic to continue being the healthiest you, you’ve ever been, the more variation amongst the colony forming units the better.