Self Control

NPR Morning Edition often has pretty interesting stories.
http://www.npr.org/2011/02/14/133629477/for-kids-self-control-factors-into-future-success?ps=cprs
I am very glad they reported on this one, and it will worth sharing this link with parents. I taught high school for five years and showed my students a video of young preschool children being asked to wait a few minutes to eat the marshmallow sitting in front of them, and if they could wait they would be rewarded with two. My students also watched  how preschoolers behave with food when no adult is around, or with parenting styles that tend to restrict food choices. It was always a thought provoking discussion.

Too often parenting behavior is a reflection of how we have been parented. We tend to parent impulsively unless we plan to do otherwise. Parents need good role models and support. It is hard work in an age of instant gratification to wait for anything! Support is as critical to parenting as it is to the development of any other habit.

I have not yet read Mary Alvord's new book Resilience Builder Program for Children and Adolescents. I have placed it on my "to do" list and hope to include more information about it in a future blog. Since it provides strategies for teaching self control - it should be useful to clinicians as well as parents.

Concerns about heart disease and diabetes in children, secondary to increased caloric intake and decrease in exercise, may warrant more attention to parenting and teaching  self regulatory behaviors. Assessing this area of child development and providing ongoing anticipatory guidance to parents and day care centers is a start. For those of you in DNP programs, this may be an area for further research.

Licensure by endorsement

After 20 years of living in Alaska, my husband and I are leaving this beautiful state for the "lower 48." It is a big move that has been instigated by my husband's retirement and a need to be closer to my grown children and grandchildren. This is a good thing, perhaps one of the best reasons for moving. Still it is hard to uproot from a truly beautiful place, with abundant clean water, views to die for, and wonderful friends. Not that Sitka does not have challenges, can you say, r.a.i.n.f.o.r.e.s.t?

We lived in Seattle and there are plenty of jokes about rain in that area - but living in any community in Southeast Alaska brings a new reality about that climate zone! You do come to love the many shades of grey and appreciate the rain for the clean water, abundant salmon streams, and cheap hydro-electricity it affords. In many ways, Sitka is one of the best kept secrets in the United States - a real gem of a community in terms of quality of life.

So I am now in the position of changing my license to practice from Alaska to another state. I think what surprised me most is that I need to go back to the schools of nursing I attended and have yet another transcript sent to a Board of Nursing! Why do we make it so hard? Does one State not trust that another State has done due diligence to determine that I am indeed who I say I am and safe to practice? It makes sense that I need to apply to another State for permission to practice in that State - after all, our republic grants individual states  rights to regulate and manage their own affairs in these matters. I am not asking for a "universal" license! I am asking for common sense to prevail, and for nursing to examine how barriers that are self created can contribute to a nursing shortage.

I realize that I am speaking to the choir here, but perhaps this is an area that our leadership can influence change for the future. Lets find ways to be more" inviting" to nurses as they move in this mobile society we live in!

MAPS AND DIRECTIONS

I work with adolescents. I should know that I need to break down directions, instructions into small parts - with a visual - like a map! Looking at the many pamphlets and handouts we have in our clinic, I am curious why there is so much information on a page? Perhaps it is time to rethink the way we distribute information to teens. How about if we just give a few facts with pictures, and then, for the curious and bright, we offer them links to Internet sites for additional reading.

Recently I have sent a few teens to the hospital, which is just a 5 minute walk down a driveway from our clinic, only to have them get lost and end up in the wrong clinic - sometimes being seen again for the same problem! Before the teen leaves me, I show them a map of the hospital, tell them where to go and what to do when they are finished. It seems straightforward enough, but the results tell me otherwise.

Enter technology! Nearly every teen in my practice has a cell phone - and not hidden! What if they enter in the phone the directions and time? Will that improve the referral process?

Remember the Palm Pilot TX? What I loved about that handheld technology was that you could "beam" information from one persons' Palm to the next. I want to "beam" information to my  teens! I need the speed of beaming to make it work for a busy clinic practice.

Suggestions are welcome - how can we reduce our paper dependancy and yet give fast and accurate information in our practices? Inquiring minds want to know!

Narrative Medicine

I have mentioned before that I enjoy reading a blog by pediatrician Bryan Vartabedian, MD-http://33charts.com/2011/02/narrative-medicine-parallel-chart.html#comments.

He had a link today for a graduate program at Columbia University in Narrative Medicine - see   http://ce.columbia.edu/Narrative-Medicine

I have so many books that I have loved because they humanized the medical experiences of people. Case studies are clinical - we look for medical details and clues to help us work through the assessment process and develop differential diagnosis. Even the social history is clinical, factual, and dry. Not that I am arguing to change our charting! For legal reasons documentation should be factual and concise. It would be an interesting "book club" of sorts to develop case studies that were narrative versions of what we really experience with out patients.

These are books that capture for me a narrative experience of medicine. 

These books enlightened my soul and brought a fuller dimension to the disease process we humans experience.  I would love to hear of books that have inspired you. I would also love to hear your thoughts about "Narrative Medicine" and how you think it could enhance the work we do as PNP's! 

The Future of Nursing

According to the Future or Nursing Website: "The ultimate goal of the Future of Nursing:Campaign for Action is to improve how health care is delivered to better meet the needs of all patients.  The Committee of the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine was tasked with creating a blueprint on the role of nurses in the design and improvement of public and institutional policies at the national, state and local levels.

The Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine was chaired by University of Miami President, Donna Shalala and vice-chair Cedars-Sinai Health System and Research Institute Vice-President and Chief Nursing Officer, Linda Burnes Bolton.  For a complete list of Committee members and their bios, please visitwww.iom.edu/nursing." 

In case you are new to this huge report you may want to click on this link to see the 8 recommendation of the IOM   http://www.thefutureofnursing.org/recommendations#

Of particular interest to me is the recommendation to double to number of nurses with a doctorate by 2020. It is clear we need more nurses with doctorate to teach so that we can increase the number of students that can be accepted into nursing programs.

I am sure we will be hearing a lot about this at the NAPNAP annual meeting. If you know of meetings in your area that are discussing the Future of Nursing Report and Recommendations - be sure to let the NAPNAP national office know!  CPNP voices should be heard!