[I put Claire Temple there because she is the only nurse on TV that I’ve seen that actually acts like a nurse. Like, she breaks scope of practice all the freaking time, and there was that little incident where she abandoned her patients without telling anyone, but in Daredevil S1E2, I was thoroughly convinced of Rosario Dawson’s nurse status. And that’s saying something, cause you all know I’m picky.]
Nursing publicity actually sucks (see chapter 21 of this textbook), so here are some fun facts to get you thinking in the right direction when you’re writing, reading, or otherwise applying your knowledge of the nursing profession in a creative way:
1. Nurses treat reaction to disease. Literally our job is to assess and treat the reaction a person has to a disease process, or what impact a disease has on a person physically (are they in pain? having trouble breathing? can’t walk?), mentally (does a disease process alter how they think, their quality of life?), emotionally (are they devastated by a prognosis? depressed by their inability to act as they used to?) and spiritually (what is their relationship with their belief system? has it changed in response to disease? how do they feel about that?). In contrast, a physician treats the disease itself.
2.Nurses have a system of diagnosis and care planning that is unique from that of a physician. Medical diagnosis of course is taken into consideration when treating a patient and planning care, but remember that we are treating a reaction to a disease process, and so our diagnoses are those reactions. Some examples include:
Sleep deprivation
Impaired gas exchange (difficulty breathing)
Decreased cardiac output (less (or too little) blood getting out of the heart)
These are usually written as part of a larger “Diagnosis Statement” which goes something like this: “Impaired gas exchange related to bronchospasm as evidenced by expiratory wheezing, abnormal blood gases, patient statement of ‘I can’t breathe’ and medical diagnosis of acute asthma exacerbation.” Nurses then plan and carry out interventions to improve the patient’s condition. Often, this goal coincides with the physician’s plan of care, and a nurse can ask a physician for orders if they feel the patient needs something that requires such an order.
3.There are different “levels” of nursing. These are:
Nurse Aide (NA or UAP): 2 weeks-3 months of training. Nurse Aides carry out patient care activities such as bathing and dressing, they can measure patient intake and output, take vital signs (depending on facility), take blood sugars (depending on facility), remove IVs and Foley Catheters and do other duties as assigned by the Registered Nurse or Licensed Practical Nurse they work under. Must have passed either State Licensure or a facility-based training program.
Licensed Practical Nurse (LPN): 1-1.5 years of training. These are starting to go out of style and mainly found either “grandfathered in” in hospital settings or working as supervisors in nursing homes. In addition to all things listed above, they can do a full assessment and basic nursing interventions, including placement of IVs an Foleys, pass (most) medication, collect samples for testing, take health histories, supervise Nurse Aides, and other duties as assigned by a Registered Nurse. LPNs must have taken and passed national licensure (NCLEX-PN in the USA).
Registered Nurse (RN): 2-4 years of training, usually with an accompanying associates’ or bachelors’ degree. Registered Nurses can do all of the above, as well as administer all medications, do full range of IV therapy, write and make plan of care for nursing diagnoses, follow ACLS protocol (without deviation), do nursing research and supervise LPNs and NAs. Training for RNs focuses a lot more on critical thinking and research skills. RNs must have taken and passed national licensure (the NCLEX-RN in the USA). This is generally what people think of when they think of a nurse.
Clinical Nurse Specialist (CNS): 6-8 years of training. CNSs are masters’ or doctoral prepared nurses who specialize in one area or population, usually in the inpatient hospital setting (though some specialties practice in community or mental health settings). They provide higher-level care in their specialty and are able to perform procedures outside an RN’s scope of practice. CNSs also teach, supervise and conduct nursing and medical research within their specialty. CNSs have either extremely limited or no prescriptive privilege (they can’t prescribe medication).
Nurse Practitioner (NP): 6-8 years of training (minimum Doctor of Nursing Practice (DNP) degree by 2030). NPs can often practice independently in a primary care capacity (varies by location), and have a broader scope of practice than a CNS. In a primary care capacity, they can prescribe medication, do office-level medical procedures and refer to specialists. NPs also do research, teach and supervise nurses in hospital and long-term acute care facilities.
4.Nurses are expected to question orders and advocate for their patients. We are the end-point of all orders and the last line of defense before an order hits a patient in a hospital setting. In the USA, a nurse is legally responsible for questioning orders and may choose to hold an ordered medication or intervention if they think it will harm the patient (we do have to immediately call the physician and ask for another order, but we can do it).
5.Nursing is applicable in extremely diverse fields that have nothing to do with clinical nursing care. For example, there are:
Forensic Nurses, who collect evidence from victims of crime
Nurse Advocates, who are practicing lawyers who also hold degrees in nursing
Nursing Informatics Specialists, who design computer systems and technology applicable to nurses and healthcare
Insurance Nurses, who work as liaisons between the insurance industries and patients
Nurse Administrators, who work the business end of healthcare
I have no concept of the pain scale, like…I just realized that last week I said I was in especially awful hip pain and when my pt asked to rate it I said “3”. And then this week I said I felt a lot better than last week and when she asked me to rate it I said “3”. I really don’t know what the numbers are supposed to be. I know it’s supposed to be out of ten but like. I think I rate the pain by what time of the day it is. Like “i will rate the pain I’m in at a 5 at the end of the day, so compared to what my pain level will be later, what I’m feeling right now is a 3.” I also think i rate in overall pain rather than specific pain? Like, systemically I’m at a five. Some parts will be worse or better but i just rate it all at five because that’s the average
Day 18 of Black History Month and I’m honoring Henrietta Lacks. She was an African-American woman whose cancer cells are the source of the HeLa cell line, the first immortalized human cell line and one of the most important cell lines in medical research.
The federal government has issued new rules aimed at eliminating systemic gender bias in medical research. It’s no longer enough for scientists testing drugs and doing other kinds of research to include women in clinical studies at the end of the process, the National Institutes of Health says. From now on, scientists must begin using female subjects in their very first laboratory experiments — including female animals and female-derived cells.
Researchers [have often] avoided using female animals for fear that their reproductive cycles and hormone fluctuations would confound the results of delicately calibrated experiments.
That laboratory tradition has had enormous consequences for women. Name a new drug or treatment, and odds are researchers know far more about its effect on men than on women.
It’s been 25 years or so since gender bias in medical studies emerged as a major women’s health issue. Women now make up more than half the participants in government-funded clinical research, but they are still often underrepresented in clinical trials carried out by private companies.
Partly as a result, women experience more severe side effects from new treatments, studies have shown.
Yet clinical studies are just the last stage of the lengthy process of developing drugs and medical devices. And even in NIH-funded studies, female subjects continue to be hugely underrepresented in earlier stages of lab research, Roni Caryn Rabin reports.
Bias in mammalian test subjects was evident in eight of 10 scientific disciplines in an analysis of published research conducted by Irving Zucker, a professor of psychology and integrative biology at the University of California, Berkeley. The most lopsided was neuroscience, where single-sex studies of male animals outnumbered those of females by 5.5 to 1.
Even when researchers study diseases that are more prevalent in women — including anxiety, depression, thyroid disease and multiple sclerosis — they often rely on male animals, Zucker has found.
Zinc supplementation may exacerbate rheumatoid arthritis (RA), new laboratory data suggest.
In monocytes from rheumatoid arthritis patients, plasma zinc concentrations and Zip8 expression were increased, and Zip8 expression correlated with more severe disease. Thus, inhibiting zinc influx into monocytes and macrophages could prevent excessive inflammatory responses that occur in diseases such as rheumatoid arthritis – the researchers concluded.
University of Connecticut bioengineers have used piezoelectric biodegradable nanofiber tissue scaffold technology to successfully regrow cartilage directly in a rabbit’s knee, an achievement that could represent a promising hop toward healing joints and treating disorders such as osteoarthritis, in humans.
The team, headed by UConn bioengineer Thanh Nguyen, PhD, implanted a biodegradable piezoelectric poly(L-lactic acid) (PLLA) nanofiber tissue scaffold into the knee of rabbits with major cartilage defects. The polymer effectively acts as a battery-less electrical stimulator, which generates a tiny burst of electric current when subjected to force—for example, when the rabbit walked or hopped. This charge promoted cell colonization and growth into the cartilage of the test animals. Encouragingly, rabbits treated using the piezoelectric scaffold implant in combination with 1–2 months of treadmill exercise demonstrated completely healed cartilage.
A new type of diagnostic blood test has been shown to accurately detect cancer in patients with non-specific symptoms, such as unexplained weight loss and fatigue, as well as differentiating between patients with localized and metastatic disease.
This makes it the first blood-based cancer test to determine the metastatic status of a cancer without prior knowledge of the primary cancer type.
In a study published this week in the journal Clinical Cancer Research, researchers from the University of Oxford analyzed blood samples from 300 patients with non-specific but concerning symptoms of cancer using a technique called nuclear magnetic resonance (NMR) metabolomics.
Unlike conventional blood-based tests for cancer, which look for genetic material from tumors, the NMR-based technique uses magnetic field and radio waves to analyze levels of metabolites in the blood as biomarkers to distinguish between different cancer states.
The Lancet has published a special supplement on Transgender Health, which includes advice for health care professionals as well as calls for greater public health action towards stronger anti-discrimination policies policies, more gender-inclusive schools, bans on “conversion” therapies, increased access to affirming health care and surgery, as well as direction for further academic study, including prioritizing research in Asia,the Middle East, and Africa, and assessing the interplay between gender affirming therapies and interventions for chronic disease (e.g. in the case of diabetes).
In a recent report, researchers at Harvard Medical School brought up a promising yet eerie prospect in stem cell research– the development of synthetic embryos. Scientists are now able to assemble stem cells that can organize into embryo-like structures, and the day may not be far off when these cells lead to the development of complex human tissues and organs that can resemble those found in adult humans.
Sheefs, which stands for “synthetic human entities with embryo-like features”, exist even today but only as simple assemblies of cells.
From The New York Times’ article:
But in the future, they may develop into far more complex forms, the researchers said, such as a beating human heart connected to a rudimentary brain, all created from stem cells. Such a Sheef might reveal important clues about how nerves control heartbeats. Scientists might be able to use other Sheefs to test out drugs for diseases such as cancer or diabetes.
However, the full potential of this avenue of research may soon push the boundaries of what is currently legally acceptable. A rule that has been in existence since 1979 prohibits lab-raised embryos from being allowed to grow for more than 14 days. Scientists have largely found this to be a reasonable restriction because of how easy it has been to follow—until recently, scientists couldn’t even come close to keeping human embryos alive for even 1 week. But this may soon change.
Last year, two teams of scientists determined how to grow human embryos for 13 days. Those advances hinted that it might be possible to allow scientists to tack on a few days more, by changing the 14-day rule to, say, a 20-day rule.
A completely locked-in patient is able to type out words and short sentences to his family, including what he would like to eat, after being implanted with a device that enables him to control a keyboard with his mind.
The findings, published in Nature Communications,overturn previous assumptions about the communicative abilities of people who have lost all voluntary muscle control, including movement of the eyes or mouth, as well as giving a unique insight into what it’s like to be in a “locked in” state.
Locked-in syndrome – also known as pseudocoma - is a rare condition, where people are conscious and can see, hear, and smell, but are unable to move or speak due to complete paralysis of their voluntary muscles, eg as a result of the progressive neurodegenerative disease amyotrophic lateral sclerosis (ALS).
Scars are the part and parcel to our life experiences. They are the marks left behind that we can point to and say: when that happened, I got this. Every character will have a few scars. However, whether they got those scars on the battlefield or from running into a piano when they were six is anyone’s guess. It’s important to remember that all scars can have meaning and they do not necessarily rate importance based on how traumatic the experience receiving the scar was. Scars are part of your character’s physical history and a memory inhabits each that only they may know.
Scars can be an important physical indicator of a character’s life experiences and whether your character is a casual martial artist or a soldier, it’s likely that they’ll have at least a few. The character who the scar belongs to is the only one that can tell other characters what it means, only they really know the full extent of its history and what it reminds them of. So, when you are writing about scars, it’s important to track what a character will say, what they won’t say, and what the scars they carry can give insight into who they are and where they’ve been.
Scientists continue to study the evolution of the Ebola virus following the West African outbreak to determine how extraordinary numbers of humans became infected.
Their results showed genetic changes occurring as the virus transmitted from human to human.
To be sure, the theory was put to test. Researchers focused on the surface protein which the virus uses to bind a protein receptor on the surface of the target cell in order to gain entry. After identifying genetic changes accruing in the surface protein, synthetic clones were generated to see if mutant proteins behave differently to those seen in virus samples at the start of the outbreak.
The data was clear, a number of genetic changes that occurred during the outbreak increased infectivity. One change in particular, a substitution of an amino acid involved in receptor binding, was particularly striking: not simply because it dramatically increased infectivity, but also because it was present in viruses that dominated the West African outbreak.
Another twist from the study, mutations that increased infectivity in human cells seemed to reduce the ability of the protein to mediate entry into cells obtained from fruit bat cells - said to be the natural host for ebola virus.
Unprecedented number of human to human transmissions gave the virus an opportunity to adapt to humans; an opportunity the virus didn’t miss.
Images: Credit: NIAID; String-like Ebola virus particles are shedding from an infected cell in this electron micrograph. Credit: Nixxphotography; Ebola Virus Disease Credit: Credit Maurizio De Angelis, Wellcome Images; Ebola virus structure, illustration
