Tuesday, March 31, 2009
deja vu?
back to school yesterday to seal my fate for the next 8 months or so. the feeling of getting back to school where i crampled my 2 years reading and making sense studying is really weird. everything is the same yet so different. i went to the library after submitting my documents and found my ex-classmates studying in there. it felt like we are still classmates but the fact is that they are students there but i am not (at least not yet). it was nice to be in a library, the stillnes of the air with voices interacting in hush hush manner with the fear of being picked by the librarian felt great. but the smell of the dirty carpet nearly suffocated my to death! lol... yah, its great to be a student (full-time) again!
Monday, March 23, 2009
nothing is constant in life only..changes. change is inevitable and although i thought i love changes, i am wrong. i prefer not the boat not to rock when the wave is still and the air is fresh of cuz unless i am the one that initial the rocking. heehee..
in the past when there is massive movement such as people leaving/ transfering out, i get upset and depress but now when i hear others leaving or witness others transfering out, i keep my cool and smile. perhaps its cuz i don't throw in as much feelings and desire bonding with others? afterall people are bound to leave and eventually it just me alone, so saving the heartache and painful goodbyes.
my workplace will surely be different when i am back in 1 year time. but then again... i might never step into my current ward again. =_=
in the past when there is massive movement such as people leaving/ transfering out, i get upset and depress but now when i hear others leaving or witness others transfering out, i keep my cool and smile. perhaps its cuz i don't throw in as much feelings and desire bonding with others? afterall people are bound to leave and eventually it just me alone, so saving the heartache and painful goodbyes.
my workplace will surely be different when i am back in 1 year time. but then again... i might never step into my current ward again. =_=
a good news
nearing the end of the wick...that's how burnt out i am. day in and out the same old same old. waiting for the august to seal my fate, to stay or to stray. then an alternative pop up, advance dip? so... i waited and waited and finally the result came, i am accepted! =) keekee...
i was initally planning to leave after august, if i was not offered anything. =p go to another org. and experience different things, or at least go to another ward to learn new stuff. being accepted in med-surg give me exposure to increasing more things and diseases. i think the stress level is going to be high but the thrill of learning (if only with no exam!!!) is wonderful. plus tat will means sat and sun and public holiday will be officially off!!! lol... =)
i was initally planning to leave after august, if i was not offered anything. =p go to another org. and experience different things, or at least go to another ward to learn new stuff. being accepted in med-surg give me exposure to increasing more things and diseases. i think the stress level is going to be high but the thrill of learning (if only with no exam!!!) is wonderful. plus tat will means sat and sun and public holiday will be officially off!!! lol... =)
rumbles...
taxi drivers must be hit hard these days that they must restort to dishonest way/s to get more money in the most justified way.
my recent and numerous encounters-> tell mr cab driver to stop "here pls", he will move the car a little more and til the $$ jumps another 20 cents then stop completely. the 1st few times, i thot never mind its only 20 cents. but now i think it totally dishonest and shamless! the tactic of moving the car, forces the client to stay on the cab, who in their right mind will jump out of the car?! but also when the car is struck in a taxi-stand, but i am running late already, i just want to hop out of the cab and run into the building but mr taxi driver will step on his accelerator to 'pump out more petrol" to increase the fare. *pull hair*
recession = an increase in crooks?
my recent and numerous encounters-> tell mr cab driver to stop "here pls", he will move the car a little more and til the $$ jumps another 20 cents then stop completely. the 1st few times, i thot never mind its only 20 cents. but now i think it totally dishonest and shamless! the tactic of moving the car, forces the client to stay on the cab, who in their right mind will jump out of the car?! but also when the car is struck in a taxi-stand, but i am running late already, i just want to hop out of the cab and run into the building but mr taxi driver will step on his accelerator to 'pump out more petrol" to increase the fare. *pull hair*
recession = an increase in crooks?
Thursday, March 12, 2009
wound workshop
interesting workshop. but i wonder why only S&N doing such talks? it seems the other companies aren't very interested in getting out business? we are talking of MASsIVe amount of $$, why aren't they doing the much needed marketing and advertisement? perhaps they don't have enough $ to start the money rolling in or the lack of expert? hmm,....
i found 1 area particularly interesting to me. flushing the wound with solution vs the traditional cleansing with guaze/ cotton dipped in solution. i remembered being taught by someone (wonder who...hmm..) that if we cleansed with the guaze/ cotton we can mechanically "wipe" off the 'dirt' or whatever that is sitting on the surface of the wound but if we flush the wound the 'dirt' would not be totally cleared out. so i had always support the traditional method of cleansing the wound unless left with no choice (deep but with narrow entrance wound) then i will have to flush. yet i still disapproved flushing cuz not all of the 'dirty solution' will be flushed out... err... hard to explain maybe let me draw an example...
-> the patient's wound cavity is 4 cm deep and 5 x 7 cm wide. slough covered the surface of the wound and the exudate is moderate. let says we flush the wound with N/S and by means of gravity, the top of the wound is adequately cleansed via the flushing method but... the top of the wound kept having a pool of 'used solution' building up. the area in my view is thus not totally or thoroughly cleansed. although we will end our cleansing with drying the wound with gauze but... the bottom was still not cleansed. instead of saying it was flushed clean, i would think of it as soaked. (get me point?)
so when the Sis said we should FLUSH the wound, i was a bit err... in doubt. but my co-workers all agreed that it should be the way to go. hmm... o_O?? i wondered. so i got on to curtin univ. library online to search for research paper to support my view. this is what i found...
13psi irrigation using a 30-60ml syringe with a 18-20G needle versus cleansing with gauze Infection One controlled trial without randomisation (Hollander et al 1998) compared wound infections and cosmetic appearance in wounds (non-bite, non-contaminated, facial and scalp lacerations) that were irrigated with normal saline and those that were cleansed with gauze and normal saline. No difference in infection rates between the groups was noted however, optimal cosmetic appearance at the time of suture removal was higher in the non-irrigation group.
but the situation above is on clean wound (which should heal regardless of lor) and i also saw this...
Healing One trial (Griffiths et al 2001 ), undertaken on chronic wounds, reported that there was no statistically significant difference in the number of wounds that healed after cleansing with tap water or normal saline. However, it should be noted that this trial was of a low power to detect a clinically important difference as statistically significant (49 wounds and only three infections).
Cost analysis The use of tap water was reported to be inexpensive compared to the use of normal saline in the only RCT that reported this outcome (Griffiths et al2001). In 2001, the estimated cost per dressing using normal saline was AUD$1.43 plus the cost of the dressing, compared to AUD$1.16 using tap water. The trial also indicated that if the wound was cleansed during showering, the only cost would be the dressing. Additional costs for the saline group included staff time, and materials and equipment used for the dressings.
interesting....
i found 1 area particularly interesting to me. flushing the wound with solution vs the traditional cleansing with guaze/ cotton dipped in solution. i remembered being taught by someone (wonder who...hmm..) that if we cleansed with the guaze/ cotton we can mechanically "wipe" off the 'dirt' or whatever that is sitting on the surface of the wound but if we flush the wound the 'dirt' would not be totally cleared out. so i had always support the traditional method of cleansing the wound unless left with no choice (deep but with narrow entrance wound) then i will have to flush. yet i still disapproved flushing cuz not all of the 'dirty solution' will be flushed out... err... hard to explain maybe let me draw an example...
-> the patient's wound cavity is 4 cm deep and 5 x 7 cm wide. slough covered the surface of the wound and the exudate is moderate. let says we flush the wound with N/S and by means of gravity, the top of the wound is adequately cleansed via the flushing method but... the top of the wound kept having a pool of 'used solution' building up. the area in my view is thus not totally or thoroughly cleansed. although we will end our cleansing with drying the wound with gauze but... the bottom was still not cleansed. instead of saying it was flushed clean, i would think of it as soaked. (get me point?)
so when the Sis said we should FLUSH the wound, i was a bit err... in doubt. but my co-workers all agreed that it should be the way to go. hmm... o_O?? i wondered. so i got on to curtin univ. library online to search for research paper to support my view. this is what i found...
13psi irrigation using a 30-60ml syringe with a 18-20G needle versus cleansing with gauze Infection One controlled trial without randomisation (Hollander et al 1998) compared wound infections and cosmetic appearance in wounds (non-bite, non-contaminated, facial and scalp lacerations) that were irrigated with normal saline and those that were cleansed with gauze and normal saline. No difference in infection rates between the groups was noted however, optimal cosmetic appearance at the time of suture removal was higher in the non-irrigation group.
but the situation above is on clean wound (which should heal regardless of lor) and i also saw this...
Healing One trial (Griffiths et al 2001 ), undertaken on chronic wounds, reported that there was no statistically significant difference in the number of wounds that healed after cleansing with tap water or normal saline. However, it should be noted that this trial was of a low power to detect a clinically important difference as statistically significant (49 wounds and only three infections).
Cost analysis The use of tap water was reported to be inexpensive compared to the use of normal saline in the only RCT that reported this outcome (Griffiths et al2001). In 2001, the estimated cost per dressing using normal saline was AUD$1.43 plus the cost of the dressing, compared to AUD$1.16 using tap water. The trial also indicated that if the wound was cleansed during showering, the only cost would be the dressing. Additional costs for the saline group included staff time, and materials and equipment used for the dressings.
interesting....
Thursday, March 5, 2009
show u something very funny
was doing some research on F.Nightingale and these were what she said!
"if the nurse is an intelligent being, and not a mere carrier of diets to and from the patient, let her exercise her intelligence in these things" - here she was talking about common sense-Nursing Theorist and their work, pg76
"she urges nurses to provide doctors with "not your opinion, however respectfully given, but your facts" She goes on to say, "if you cannot get the habit of observation one way or other, you had better give up the being a nurse, for it is not your calling, however kind and anxious you may be"-Nursing Theorist and their work, pg78
apart from air, light, warmth, diet, water, cleanliness and efficient drainage, she also said quiet was 1 of the main factor for proper healing! i certainly wish the hospital will reinforce that, cuz there are just too many people chatting loudly, laughing and kids screaming along the corridors!!
on another tone..
i think F.Nightingale was a damn cool lady and one with lots of might and zest. having been born into a privileged family with power and money, she was indeed the 'esther' of her time. God had position her strategically in that position for that special calling to be the agent of change. her being able to write and read gave her an advantage to communicate her finding and concern to the governors and others in power. although a female at that era is less looked upon, her family name placed her in such a position that the males had but no choice (even if MOST UNWILLINGLY) to look at her 'crap'. once past the initial hindrance, the figures and facts speak for itself. her advocating of cleanliness, clean water and proper drainage (sanitation) had brought more changes to human lives than the modern medical technology!
really... if you are new to nursing/ medicine, its one of the most trick MCQ question! clean water supply and proper sewage drainage system had saved more lives than modern medicine! of cuz, i recognise the effort put into sewage system and water supply from "Dr. John Snow, who showed that cholera was spread by water in 1854, and Edwin Chadwick, who came up with the idea of sewage disposal and piping water into homes in the 1840s. " taken from http://www.sewerhistory.org/articles/wh_era/brit_med_journal_contest/Sanitation.pdf
now... that's quite a piece of information right? so the next time when u take a dump on ur toilet bowel remember... lots of people (past and present) would love to have a chance to be like u-shitting in clean toilet and being able to flush off the waste with just a simple press of a button!
"if the nurse is an intelligent being, and not a mere carrier of diets to and from the patient, let her exercise her intelligence in these things" - here she was talking about common sense-Nursing Theorist and their work, pg76
"she urges nurses to provide doctors with "not your opinion, however respectfully given, but your facts" She goes on to say, "if you cannot get the habit of observation one way or other, you had better give up the being a nurse, for it is not your calling, however kind and anxious you may be"-Nursing Theorist and their work, pg78
apart from air, light, warmth, diet, water, cleanliness and efficient drainage, she also said quiet was 1 of the main factor for proper healing! i certainly wish the hospital will reinforce that, cuz there are just too many people chatting loudly, laughing and kids screaming along the corridors!!
on another tone..
i think F.Nightingale was a damn cool lady and one with lots of might and zest. having been born into a privileged family with power and money, she was indeed the 'esther' of her time. God had position her strategically in that position for that special calling to be the agent of change. her being able to write and read gave her an advantage to communicate her finding and concern to the governors and others in power. although a female at that era is less looked upon, her family name placed her in such a position that the males had but no choice (even if MOST UNWILLINGLY) to look at her 'crap'. once past the initial hindrance, the figures and facts speak for itself. her advocating of cleanliness, clean water and proper drainage (sanitation) had brought more changes to human lives than the modern medical technology!
really... if you are new to nursing/ medicine, its one of the most trick MCQ question! clean water supply and proper sewage drainage system had saved more lives than modern medicine! of cuz, i recognise the effort put into sewage system and water supply from "Dr. John Snow, who showed that cholera was spread by water in 1854, and Edwin Chadwick, who came up with the idea of sewage disposal and piping water into homes in the 1840s. " taken from http://www.sewerhistory.org/articles/wh_era/brit_med_journal_contest/Sanitation.pdf
now... that's quite a piece of information right? so the next time when u take a dump on ur toilet bowel remember... lots of people (past and present) would love to have a chance to be like u-shitting in clean toilet and being able to flush off the waste with just a simple press of a button!
creative thinking and learning
just a tot came to my mind today as i was listening to the on-line lecture. the lecturer said something tat went like this "i am not here to provide you the answer. you must find it yourself but i will however provide you with the information"
i went like..HUH? but if i am to seek for information not answers than why i need teacher, i might as well get a faciliator lor. i don't know if i am wrong to say that but i prefer teacher/ lecture telling me what is right and wrong, even if there is no ABSOLUTE wrong than tell me where and when should it be applied to make it good enough? i am getting all confused and frustrated with these "think for yourself" mode. if u throw a kid just a potty and u expect the kid to potty train themselve?!?!?
any teachers out there to straighten my thots?
i went like..HUH? but if i am to seek for information not answers than why i need teacher, i might as well get a faciliator lor. i don't know if i am wrong to say that but i prefer teacher/ lecture telling me what is right and wrong, even if there is no ABSOLUTE wrong than tell me where and when should it be applied to make it good enough? i am getting all confused and frustrated with these "think for yourself" mode. if u throw a kid just a potty and u expect the kid to potty train themselve?!?!?
any teachers out there to straighten my thots?
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