A little over a year ago, before Twitter was the tech/pop culture phenomenon it is today, doctors like myself had a problem: how do you identify other health professionals on Twitter? (At the time, there must have been at least dozens. Dozens.)
When FriendFeed debuted, I created “The Doctor’s Room,” which was populated by both Twitter feeds and RSS feeds of physicians. Unfortunately, the “room” feature was poorly designed by FriendFeed (which has since been acquired by Facebook). Like the Yahoo Pipes experiment, the FriendFeed room was an educational failure. Read more »
I use Twitter and I like it. As a registered nurse, twitter helps me promote health and wellness and it helps me educate the public on vital health topics.
It allows me to tweet about an upcoming radio show, link to informative websites and blogs, or retweet (RT) a tweet.
I can read about the latest breaking health news, learn about the latest in health 2.0 and
sometimes it simply allows me connect with colleagues and consumers in a fun and friendly fashion.
Twitter has become a source for obtaining the latest news and information. Short snippets of info flow to and fro faster than you can say “uncle.”
In 140 characters or less you can say what you need to say. While some tweets aren’t relevant, I mean really, do we need to know that you’ve waiting in a long line at Starbucks for your café latte? No, but sometimes the mundane tweets helps humanize you a bit.
When a Tweet passes my way that is directed from Dr. Sanjay Gupta, CNN (@sanjayguptacnn), Gwenn O’Keefe, MD, (@drgwenn), Jennifer Shu, MD (@livingwelldoc), Val Jones, MD (@drval), Kevin Pho, MD (@kevinmd), CDC, (@cdcemergency), Daniel Sands, MD (@DrDannySands), or American College of Emergency Physicians (ACEP), (@emergencydocs); just to name a few, I can feel good knowing that the 140 characters or less of info is accurate, reliable and trustworthy.
Educate the Public
Doctors, nurses and other health care professionals can provide accurate,complete, reliable and trustworthy health information.
Tweeting is the perfect opportunity to help educate the public.
I asked three doctors who use twitter to share their thoughts. Here’s what they said:
Kevin Pho, MD, a primary care physician and a nationally recognized medical commentator who publishes provocative medical commentary at KevinMD.com -
Twitter offers an opportunity for doctors to provide instant feedback, faster than they can even from blogging. This can range from providing updates on surgery, which Detroit’s Henry Ford Hospital has done, to giving opinions on the latest, breaking studies. Twitter can provide more transparency to what goes on in the physician’s world, and allow both patients and other doctors to interact with one another in a quick, convenient way.
When we graduate medical school and say the modern Hippocratic oath, we promise to not only do no harm but care for people by respecting the society in which they live. Like it or not, technology is part of that society so we have a responsibility to not only respect it but learn it and use it for the greater good of family health in whatever ways necessary and on whatever platforms are available.
Daniel Z. Sands, MD, Director of Medical Informatics at Cisco IBSG and a primary care physician at Beth Israel Deaconess Medical Center -
By following tweets from health information sources that they trust, people can get general health tips, preventive health information, disease specific information, and even suggestions about to be more engaged in their healthcare. You might also get health coaching from a health professional, a health coach, or even peers (“Did you exercise today?” “I walked 5110 steps today—how many did you walk?”).
The take-away message
Everyone needs to be alert regarding the tweets they receive. Just because a tweet is about a health topic, that doesn’t mean it’s accurate.
Health consumers need to check the source. Doctors and nurses can help educate the public on vital health topics with information that is accurate, reliable, and trustworthy.
Like most of you, I’m continuing to watch the events unfold in Iran via Twitter and YouTube. Not surprisingly, given the escalating violence, doctors and nurses are caught in the crossfire. This video was posted on YouTube on June 16th. One woman who I’m guessing is a nurse is showing a sign that says that 8 people were martyred. Toward the end of the clip the young man (whose voice breaks down many times) is saying that he witnessed the brutal beating of women and children. He speculates that the attackers were Lebanese Hezbollah. Hat tip to Andrew Sullivan, The Daily Dish.
This story really upset me because I work with medical students at UGH (Undisclosed Government Hospital), and because I have children who are the same age as these victims. The eye witnesses reports come from medical students who hid when Iranian militia and police raided a Tehran University dormitory in the middle of the night. Hat tip to Nico Pitney of the Huffington Post. As we witness history, we will continue to witness the murder of innocent people.
“At the same time, Iran’s Interior Ministry ordered a probe into an attack late Sunday night on Tehran University students in a dormitory reported to have left several students dead and many more injured or arrested. Students say it was carried out by Islamic militia and police. Iran’s English-language Press TV said the ministry urged Tehran’s governor’s office to identify those involved. Iran’s influential speaker of parliament, Ali Larijani, condemned the attack.
Students’ Web sites reported mass resignations by Tehran University professors outraged over the incident. One medical student said he and his roommate blocked their door with furniture and hid in the closet when they heard the militia’s motorcycles approaching. He heard the militia breaking down doors, and then screams of anguish as students were dragged from their beds and beaten violently.
When he came out after the militia had left, friends and classmates lay unconscious in dorm rooms and hallways, many with chest wounds from being stabbed or bloody faces from blows to their heads, he said. The staff of the hospital where the wounded students were taken, Hazrat Rasoul Hospital, was so shocked that they went on strike for two hours, standing silently outside the gate in their white medical uniforms.”
Network technology giant Cisco Systems, Inc. invited nurses to offer focus group feedback on a recent study that showed that 92% of nurses believe that communications lapses adversely affect patient safety. I joined five nurses in a cozy break out room at the HIMSS convention center and asked about their real-life experience with communications lapses in the hospital. Here are the highlights:
1. Technology Isn’t Perfect – although some hospitals have instituted bar code scanners and wireless computers to help to reduce errors, these devices often drop their connections. One nurse said that the devices actually slow down the process of distributing medications, and bypassing the system simply results in a loss of automated medication cross-checking. The devices don’t perform well in the case of an electrical surge, and nurses often waste time finding computers on wheels (affectionately known as “COWs”) that have a full battery.
2. Where’s The Patient? - the group of nurses all agreed that poor coordination of care inside the hospital can harm patients. Some nurses expressed frustration at having proceduralists and radiology teams remove the patients from their rooms without scheduling it with the nurses. They explained that nurses give out medications at specific times, and when the patients are taken to another part of the hospital without their knowledge, then they can’t plan to give them their medications appropriately. Missed doses or missed meals (for patients with diabetes for example) can result in dangerous hypoglycemic episodes, syncope, and various other harms.
3. Where’s The Pharmacist? – easy access to hospital pharmacists is critical for all clinical staff. One nurse relayed the shocking story of a med tech who was unable to get in touch with a hospital pharmacist to confirm I.V. zinc dosing in the NICU, and gave such an overdose that one of the premature babies died.
4. Where’s The Doctor? -during an audience poll at the Cisco booth, most nurses rated physicians as the hardest staff to get a hold of in the hospital setting. There is regular confusion about who’s on call, and there is often no direct line to call the physicians.
5. Where Are The Nurses Aides? – when it comes time to transfer patients (who are often very heavy) or move them in bed, nurses often have no way of finding peers to help them lift the patients safely. This results in wasted time searching for staff to assist, or even worse, can result in low back injury to the staff or patient falls.
6. Language Barriers - when patients are transitioned home from the hospital, they are often given complex instructions for self-care. These instructions are particularly hard to follow for patients whose native tongue is not English. Nurses see many re-admissions based on language-based miscommunications.
7. Decision Support Systems – one of the nurses suggested that a recent study showed that the number one source of clinical information for nurses was their peers. That means that nurses turn to other nurses for educational needs more often than they turn to a textbook or peer-reviewed source of information. Nurses would like to have better access to point-of-care decision support tools for their own educational benefit and the safety of patients.
8. Change of Shift – nurses identified shift changes as a primary source of communication errors. Technology that enables medication reconciliation is critical to safe continuation of inpatient treatment. One nurses said: “shift changes is when all the codes happen.”
And so I asked the nurses what their ideal technology would do for them to help address some of the communications problems that they’re currently having. This is what they’d like their technology to do:
1. All-In-One – nurses don’t want more devices to carry around. They want one simple device that can do everything.
2. Call a code – with one press of the button, the nurses would like the device to contact all staff who should participate in resusscitating a crashing patient.
3. Lab Values – nurses would like the device to alert them of all critical lab values on the patients under their care.
4. Clinical Prompts – nurses would like reminders of clinical tasks remaining for individual patients (e.g. check blood pressure on patient in bed 3)
5. Call and Locate Colleagues – the device should function as a full service cell phone with pre-programmed staff names/numbers and team paging lists
6. Locate Equipment -nurses would like to be able to track and locate wheelchairs, electronic blood pressure cuffs, and other equipment throughout the hospital.
7. Translate Verbal Orders To Written Orders – verbal orders are more prone to errors than written ones. An ideal device would have a voice recognition system in it that would translate physician orders to text.
Is there such a device on the market today? There are many different devices that have the capability to do some of above, but to my knowledge there is no device that can do it all yet. Companies like Cisco are working hard to provide integrated solutions for nurses – and the Nurse Connect phone is an important first step. What technologies would you recommend to nurses?
More information about the phone (from press release):
Cisco Nurse Connect is a newly introduced solution that integrates nurse call applications, including Rauland-Borg’s Responder product lines, with Cisco Unified Wireless IP 7925G Phones to deliver nurse call alerts to mobile caregivers.
The Cisco 7925G Phone was specifically designed with the features necessary to support the unique safety and biohazard requirements of hospitals, including a battery that supports up to 13 hours of talk-time, ruggedized and hermetically sealed, and Bluetooth support for hands-free use.
The Nurse Connect Solution offers many benefits. For example, by reaching nurses on their mobile devices, the need to continually walk back to nursing stations or patient rooms is greatly reduced. Nurses can also have two-way communications with patients and send immediate requests to different levels of personnel after talking with the patient.
I was following an interesting conversation on Twitter between several nurses. They were expressing concern about how nursing stereotypes were damaging to their profession. I invited them to discuss the subject with me via podcast.I have summarized some key points below.
You can listen to the whole conversation here.
1. Nursing Instructor Shortage – nursing instructors make about 25% of the salary of nurses who do clinical work. Therefore, there are long wait times to enter nursing school due to instructor shortages. Many students can’t afford to wait, and choose other careers.
2. Inequality of Respect – some nurses feel that they have to continually prove themselves despite their training and qualifications. Patients often express disappointment or annoyance when they see a nurse practitioner (rather than a physician) in a group practice. Some doctors still expect nurses to give up their chairs when they enter the room.
3. Nursing Stereotypes – the “naughty nurse” and “nurse Ratched” images are still very much in the forefront of peoples minds when they think of nursing as a specialty. Some people believe that nurses simply pass out pills and make coffee, when in reality they are active in complex technical procedures and saving lives. These stereotypes and misconceptions denigrate the education and technical expertise of nurses.
4. Primary Care Doesn’t Pay: nurse practitioners incur higher debt and have lower salaries than specialist nurses. Just as in the medical profession, there are no incentives for nurses to choose careers in primary care.
Strengths of Nursing:
1. Nurses Are Better And Brighter Than Ever – since getting into nursing school is so competitive, the quality of individuals who are entering nursing school has never been higher.
2. Job Flexibility – nurses can easily transition to part time work for maternity purposes. Nursing careers offer a wide variety of work experiences – from nursing home work, to cardiothoracic surgery. One license offers hundreds of various opportunities.
3. Job Satisfaction – saving lives and serving patients contribute to a sense of job satisfaction.
What can be done to improve and advance the US nursing profession?
1. Establish an Office of the National Nurse. The National Nursing Network organization is promoting this initiative. The National Nurse would act as a government spokesperson for nurses- promoting preventive medicine, increasing awareness of nursing, and securing financial support for nurse education. He or she would be the chief nurse officer of the US public health service.
2. Do not be afraid to speak up. Nurses should feel comfortable defending their professional ideals, and discouraging stereotypes.
3. Blog to raise awareness of nursing challenges and successes.
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