Allied Health World Blog

An important factor to consider in your allied health career growth and development is finding and establishing one or more mentoring relationships.  What is a mentor?  A mentor, traditionally, is an experienced person who works with a new health care professional, nurse, or protege to help develop professional goals and plans.  A mentor is also a good support for the a new employee’s professional growth and development.  You will discover, as you read on in this blog, that there are many different types of mentoring relationships, both formal and informal, that can help you take your career to the next level.

A traditional mentor – Someone with whom you have created a formal partnership for mutual benefit.  This type of mentor is someone you would be in touch with on a regular basis for good advice, to discuss things that may be unclear, to ask questions, and to use as a sounding board to get feedback.  A mentor will listen to your goals, and dreams, and help to give you direction and suggestions that will keep your career on track, encourage you, and let you know when you are straying off track.

A mentor can also help a new allied health professional by increasing your exposure and visibility in the workplace and in your profession by introducing you to influential people, vouching for you, and recommending you when certain opportunities come up.  A mentor can teach you things, give you perspective, and act as a role model.  Health care facilities can often be fast paced, big, and with many different types of professionals.  Anything a new health care professional can do to stand out will be beneficial.

The mentoring relationship/model has been popular for a long time in the business and social communities but it is still a relatively new concept in the health community.  Mentoring can be a rewarding experience for the protege as well as the mentor.

An infection control program is designed to minimize the spread of infection.  Most infection control programs use isolation procedures that separate patients with certain transmissible infections from contact with other patients.  Such procedures also limit contact with hospital personal and visitors.  Isolating a patient can only be done with doctor’s orders because the patient is suspected of having a contagious disease or because the patient’s immune system is compromised.  A private room with an isolation notice on the door is usually used to isolate patients.

There are several types of isolation programs that can be used depending on the type of isolation that is needed for a particular situation.

Protective/Reverse Isolation
Patients who are at a greater risk for infection are placed in protective or reverse isolation.  This type of isolation requires health care workers and visitors to take protective measures to prevent transimitting infection to the patient.  Usually patients with compromised and supressesed immune systems require isolation, such as burn patients, organ transplant patients, AIDS patients, and neutropenic chemotherapy patients.

Traditional Isolation
Traditional isolation systems were initially created by the Center for Disease Control (CDC) to prevent the transmission of many diseases.  The CDC created two categories of disease to distinguish and group the main causes for isolation.  Category-specific isolation covered many different diseases and was extremely costly.  Disease-specific isolation was based on how a disease transmitted.  Specific isolation precautions were recommended for each type of transmittable disease.

Universal Precautions
This procedure for isolation was introduced in 1985 after healthcare workers were being infected with HIV from needlesticks and exposure to contaminated blood.  This new procedure of isolation had body fluids considered potentially infectious.

Body Substance
Body substance isolation was created to prevent infection from diseases before they are even diagnosed.  This type of isolation is used when health care workers wear gloves when having contact with any moist body substance.

Undoubtedly, you have spent a great deal of time in nursing school discussing the nurse-patient relationship.  Presumably, you have also discussed the concept of the “therapeutic relationship.”  A therapeutic realtionship between practitioner and patient, in simple terms, is one in which optimum results for the patient can be achieved.

This brings us to the subject of dating your patients or getting romantically involved with them.  Although this is considered taboo in many cases, I know of a few nurses who have married former patients.  Occasionally you will even hear of a nurse who marries a patient currently in his or her care.  While it may appear to have worked out well for a few, understand that you are treading on thin ice, and slippery legal advice if you move in this direction.  Some states in the United states have laws prohibiting sexual contact between caregivers, and their charges.  this is obviously very serious.  If you are suspected of impropriety or accused of the same, it can minimally result in disciplinary action by your employer and/or state board of nursing or other governing body.  Many consider dating and sexual activity with patients, at the very least, unethical and unprofessional.

Here we get into issues of professional boundaries.  The intimate nature of nursing care, both physical and emotional, can lead to a misunderstanding of feelings and relationships.  Also, there is an unequal balance of power in the relationship, with the nurse clearly having the upper hand.  The patient is very vulnerable, the nurse has access to personal information about the patient and the nurse has access to all of that information.

Getting romantically involved with a patient – with or without sexual contact – compromises the professional association.  There is a delicate balance required to maintain appropriate boundaries in the therapeutic relationship.  So…as a general rule when thinking of getting involved with a patient….not a good idea.

The internet is another way to stay connected to your profession.  It gives you access to a broad pool of people, events, and opportunities.  Not only can you contact people and stay in touch with them by e-mail and via social media sites such as Twitter, Linked-In and Facebook, but you can also participate in listener and discussion groups.  Here you can network with others, find all the latest information on the nursing profession, and research virtually anything you need to know.

Even when you can’t get out to meetings and events, you can log on the internet anytime and get advice and information from a real person or from a data source.  The internet is a very convenient form of networking and a source for staying up-to-date on your chosen profession.  The following are a few way to put the internet to work for you.

One way to stay in touch is to visit general websites that pertain to your allied health profession – There are many nursing related websites that offer information on practice-based issues, legislative issues, and career and professional development.  Some post weekly articles, have e-newsletters you can subscribe to, and offer opportunities to ask questions of an expert.  Some sites even offer cyber mentoring!  Signing up for an e-newsletter is an excellent way to keep abreast of your profession.  An e-newsletter is delivered to your e-mail account on a predetermined schedule, such as weekly or monthly.

To stay current on the happenings in your profession, it is essential that you regularly visit the sites that pertain to your allied health profession.  An example might be: The National Nurses Association, the Nurses Student Nurses Association etc….Refer to the Resources section for numerous valuable websites.

Join a listerv – A listerv is a group of people with a similar interest or background who post messages about various subjects.  These posts are delivered to your e-mail account on a regular basis.  Those who subscribe to the list can respond to those posts, submit their own question or comment, or just read what others are talking about.  The great thing about a listerv of peers is that you can post a question or concern and get some feedback or advice from others on the list.

Years ago I worked with a heart surgeon who always looked very unkempt.  For example, he would wear a shirt with a pocket that was torn, and would be held together with a safety pin.  Whenever I would see him, my instincts would kick in and make me want to run down the hall to ask him to take off his shirt so I could mend it for him really quick like.   Of course I never did….and neither did he or anyone else, because the pocket of that ripped shirt remained torn for the rest of the time I worked there.  I don’t know if he wore the same shirt all the time or if all his shirts were torn.  Regardless, I heard he was a good surgeon, but nonetheless, I remember thinking that I wouldn’t want him to operate on me because he might try to safety pin my heart together rather then fixing it properly.

Likewise, when I had abdominal surgery years ago, there was a nurse who would occasionally come in and check my dressing and incisions.  She smelled like cigarettes and often had stains on her clothing or looked tired and overdue for a shower.  I don’t mind disheveled friends, but for some reason, I didn’t feel comfortable with her touching my wounds.  Obviously, appearance does matter.  Look good and your patients will trust you and feel more comfortable in your care even before they get to know you.  How can a patient trust someone to care for them when they don’t take the time to care for themselves.

Personal protective equipment like gloves and gowns can prevent contamination and transmission of organisms.  Healthcare personnel should wear protective clothing items during patient-care activities that could possibly allow for the splashing or spraying of blood or other body fluids.  Protective clothing should also be worn if a healthcare provider enters an isolation room.

Clean, nonsterile, fluid resistant gowns are generally effect barriers against splashing or spraying fluids.  They can also be worn to prevent their clothing from getting soiled during patient-care activities.  Sterile gowns are best worn when a healthcare provider comes into contact with a patient’s that have compromised immune systems.  This helps to prevent any contaminants on the healthcare providers clothing from coming into contact with the patient.

Most gowns are made of disposable cloth or paper.  They are typically one size, with long sleeves and knit cuffs.  The gowns usually fasten in the back so that the front panel is completely blocked.

When a gown is put on the inside should be the only surface that is touched.  This prevents the outside of the gown from becoming contaminated.  When worn properly, a gown’s sleeves should be pulled down to the wrist.  The belt for the gown should be tied and gown should be overlapped at the back to prevent any exposure of clothing.  Be sure that the gown is securely fastened.  The gown can be removed by sliding the arms out of the sleeves.  The gown should be folded so that the contaminated sides of the gown end up inside and not exposed.

Lab coats are similar to gowns and are also worn to prevent soiled clothing and to protect the skin from sprays of blood or body fluids.  If you are a phlebotomist, you are required to wear a lab coat.  There are certain lab coats that are made with fluid-resistant cotton or synthetic materials.  These types of lab coats should be worn for specimen collection.

There are several important guidelines to follow when collecting coagulation specimens.

-It is no longer necessary to clear a needle of potential thromboplastin contamination by collecting a few milliliters of blood in a plain red top tube for PT or PTT tests.  A clear tube should be used for all other coagulation tests.

-For coagulation tests, sodium citrate tubes must be filled completely to obtain a 9:1 ratio of blood to anticoagulant.  This ratio can become altered if the patient’s hemoglobin level is abnormally high or low.  If this is a concern, a special collection tube can be requested to have the anticoagulant volume adjusted.  Blue top tubes are designed for fibrin degradation (FDP) or fibrin split products (FSP) and should not be used for coagulation tests because they contain different additives and have different volumes.

-Never try to combine two partially filled tubes together to obtain a full tube of specimen.  The  anticoagulant-to-blood ratio will not be more than necessary and will cause inaccurate results.

-Certain coagulation factors are less stable than others.  For example factors V and VIII are not stable and should be centrifuged and plasma frozen if lab tests can not be performed on them in a timely manner and especially if the specimens are to be transported.

-Coagulation specimens that are drawn from an indwelling catheter must be drawn following very specific guidelines.  About 5 mL of blood should be collected and discarded  before the actual specimen is collected.  If heparin was introduced into the catheter line than the line must be flushed with 5 mL of saline before the discard blood is collected and thrown out.

A nurse often has the responsibility of preparing medications for patients.  This process should only begin once the nurse has determined that the prescribed medication can be safely administered to the patient.  There are specific procedures that a nurse should follow when preparing a medication for a patient.

1.  The nurse should first wash his or her hands to prevent the spread of infection to the patient.
1.    A nurse should only prepare medications that he or she will be able to personally administer to the patient.  Medications should not be prepared all at once because it is likely that a different nurse may have to administer the other medications to the patient.  Nurses should only administer medications that have been personally prepared for the patient.
2.    Medications should be prepared in a quiet area away from distraction.  It is important the the correct dosage is administered.  Distraction can increase the chance for improperly dosed medications to be administered.
3.    Always double check the math when calculating doses so that mistakes aren’t made.  Ideally, a colleague can verify calculations if there is any concern.
4.    The medications that will be given to a patient that day should be stored in the patient’s medication drawer.  A medication administration record (MAR) should match the medications and dosage amounts that will be administered to the patient.
5.    The drugs listed on the MAR should be the same unless generic drugs are substituted in the name brand drug’s place.  A drug manual can clarify any questions about drug names and uses.
6.    The name of the medication should be verified at least three times before it is administered to the patient.  1) when it is removed from the medication drawer;  2)  when it is prepared for the patient;  3) before the medication is administered to the patient.

One of the most important first steps in blood collection concerns skin antisepsis, which concerns the destruction of microorganisms on the skin.  If the venipuncture site is not disinfected, any bacteria that is on the skin’s surface can get into the blood culture and cause inaccurate results.  The laboratory will make a note of any microorganisms that were observed in the blood specimen.  It is up to the physician to determine if any observed organisms pertain directly to the blood or if they are contaminates from the venipuncture.  The physician should carefully consider his findings because misinterpreting any findings could result in inappropriate treatment.  If the detected microorganism is mistaken for a pathogen the patient may be given medications that are unnecessary.

There are antiseptic techniques for blood collection that can help to ensure that the venipuncture sites  are sterile.  Swabsticks and special cleaning pads can be used to clean the skin.  Often these cleaning tools contain 10% providone or 1-2% tincture of iodine compounds.  Swabsticks that contain providone-iodine should be placed  at the site of the needle insertion.  This areas should be cleaned first and the swabstick should be moved outward from this site in concentric circles without going over the same  area more than once.  A 3 to 4 inch area in diameter should be cleaned.  Some patients are sensitive to iodine.  Because of iodine sensitivities, many health-care facilities use chlorhexide gluconate/isopropyl alcohol for antiseptic purposes.  These antiseptic liquids are usually used in blood culture kits that only require a one-step application and are effective with a 30-second scrub.

There are some physical conditions that are common during the first weeks after birth.  If you notice any of the following conditions, you should contact your pediatrician.

Abdominal Distention:  You will notice that your baby’s abdomen seems to stick out after large feedings and feels soft when touched.  This is common, however, if your baby’s abdomen remains swollen and feels hard determine when the last bowel movement took place.  If it has been several days since a bowel movement or if your baby is vomiting, you should call your pediatrician.  Your baby may be suffering from gas, constipation, or a serious intestinal problem.

Birth Injuries:  If your labor was difficult your baby may have birth injuries.  This is especially common in large babies.  A broken collar bone is a common birth injury that usually heals quickly if the arm on the side that was broken is bound and kept motionless.  A small lump may form  on the site of the fracture after a few weeks.  This is a common sign that new bone is forming to repair the injury.  Your pediatrician can advise you on how to care for any broken bones.

Muscle weakness is another type of birth injury that can occur when the baby’s muscles are stretched or when too much pressure is placed on the nerves attached to the muscles.  The face, shoulders or arms  are common sites for muscle weakness and will generally return to normal after several weeks.

Blue Baby: A newborn baby may have blue hands and feet.  Other parts of his body like his face, tongue, and lips may turn slightly blue when he is crying.  When he is done crying his normal color should return.  If your baby’s skin color stays persistently blue this may be a sign of a heart or lung problem.  You should seek emergency medical assistance immediately.

Coughing:  Your baby may cough a lot during feedings.  This is common during the first several weeks or months as your baby learns to nurse or bottle feed.  If your baby continues to cough or choke during feedings, you should consult with your pediatrician.  Your baby may have an underlying problem with his lungs or digestive tract.