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Posts Tagged ‘nurse’

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Photo: Sarah Johnson/
The Guardian 
A remote nurse oversees a virtual lunch for older people in Helsinki. “The client feels like they are a part of a bigger thing. It’s also guaranteed that they eat properly,” she says.

Because my sister’s brain cancer is so troubling and her needs for care are growing so fast, I have started to give more serious thought to my own future and the more-common problems of ageing. I may never bite the bullet about a retirement community, but I plan to look into what they offer just in case.

Meanwhile Finland, which seems to be on the cutting edge of everything from preschool to end-of-life care, has set an example of keeping people in their homes longer using technology, as costs for in-person services increase.

Sarah Johnson writes at the Guardian, “It’s 11.30 am on a midweek June morning in Helsinki, Finland. Duvi Leineberg, a remote care nurse, is doing the lunch rounds. But instead of jumping in a car and visiting each person one by one, she is sitting in an office looking at a large computer screen where she can see into seven people’s homes. Most are sitting at a table preparing to tuck into some food.

“This is a virtual lunch group, set up to make sure older people receiving home care services in the city eat regularly and at the right time. Leineberg runs the session. She starts by checking everyone has their food and that it is warmed up. Some have soup, others have pre-prepared meals that have been delivered by home care services. People also sip coffee.

“One screen shows an empty backdrop and she calls the home to check her client is all right. He walks past the screen but says he isn’t hungry and doesn’t want to eat right now. Leineberg then asks everyone if they have any plans for the afternoon. A few reply that they will go out for a walk.

“A former hospital nurse, Leineberg sees the value of such groups. ‘Firstly, the client feels like they are a part of a bigger thing. It’s also guaranteed that they eat properly. If I spot anything that seems out of the ordinary, I can call the home care nurses who will pay them a visit if necessary.’

“Her clients are also fans of the lunch group. Riitta Koskinen, 80, says through a translator: ‘I’m old and living alone and it’s nice to have the company. We eat at the same time – food tastes better when you’re with others – and I’ve really enjoyed it. It makes me eat and it’s good to see other people.’

“Finland has a rapidly ageing population and recruitment problems in health and care. By 2070, one in three Finns is expected to be over 65. At the same time there has been a huge decline in the birth rate and the number of Finns of working age is expected to fall by around 200,000 by 2050. As a result, the demand for and cost of care services are growing while tax revenues are decreasing. …

“The virtual lunch group is one aspect of Helsinki’s remote care – where clients have a tablet that links up with remote care nurses in a service centre. Remote care appointments are set up to check on clients throughout the day and to make sure they take the relevant medication. There are 800 home care clients, and nurses carry out 24,000 remote care visits a month. By the end of 2019, the service hopes to cater for 1,100 clients. …

Over the course of one shift, a remote care nurse can carry out over 50 visits – which works out almost 90% cheaper than if they had knocked on each of their client’s doors.

“Little wonder that the city’s service centre is hoping to start a remote dinner group soon as well as other sessions. They already take clients virtually to concerts and shows. Hanna Hämäläinen, who works as a planner at the service, remembers when she took 64 clients virtually to a carol concert. A screen was placed on the front row and the priest greeted them while they watched at home on their tablets. She remembers: ‘The funny thing is that even if some had memory problems, they knew all the lyrics. That is the power of music and made me see that if there’s a concert, we should be there.’ …

“Roope Leppänen, medical director of Espoo hospital, … maintains that remote care will never fully replace physical care but that, with advancing technology and future generations that are used to digital life, it will become more and more important. But he doesn’t expect it to totally replace physical care services. ‘People will need physical visits as well. It’s my belief that [remote care] can’t completely replace that, but tech will make [things] even easier in 10 years time.’

“Both the staff and patients I meet seem to like it. Tiina Kosonen, a remote care nurse, says she is able to build close relationships with her clients. ‘I like it and the patients get a lot from it. It’s really intensive this contact. We look into each other’s eyes and talk together face to face.’ ”

More at the Guardian, here.

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Some initiatives that are costly up front have benefits that far outweigh those costs but don’t show up for years. Even then, people may disagree about what caused the outcomes.

One such initiative sends nurses to new mothers who are young, poor and often friendless to help ensure that their babies get a leg up in life.

At the Washington Post

“A high school senior learns that she’s pregnant — and she’s terrified. But a registered nurse comes to visit her in her home for about an hour each week during pregnancy, and every other week after birth, until the baby turns 2. The nurse advises her what to eat and not to smoke; looks around the house to advise her of any safety concerns; encourages her to read and talk to her baby; and counsels her on nutrition for herself and her baby.

“This kind of support, with trained nurses coaching low-income, first-time mothers, is among the most effective interventions ever studied. Researchers have accumulated decades of evidence from randomized controlled trials — the gold standard in social science research — following participants for up to 15 years. They have consistently found that nurse coaches reduce pregnancy complications, pre-term births, infant deaths, child abuse and injury, violent crimes and substance abuse. What’s more, nurse coaches improve language development, and over the long term, cognitive and educational outcomes.

“Nurse coaching is a vital tool that addresses both the liberal concern about income inequality and the conservative concern about inequality of opportunity. …

“Still, nurse coaching reaches only 2 to 3 percent of eligible families. Which raises the question: if it’s so successful — and people on both sides of the aisle support it — why can’t it be scaled to reach every eligible family?”

There are two stumbling blocks according to the reporters: First, funding must be cobbled together from numerous unpredictable sources; second, the costs are up front, whereas the benefits to government and society appear over time.

“If nurse coaching were fully scaled to reach every eligible family, the costs to state and federal governments would outweigh the savings for the first five years. But then the savings would start to outweigh the costs. Over 10 years, the net savings would be $2.4 billion for state governments and $816 million for the federal government.”

So the question becomes: do we have the patience? More here.

A similar initiative that Suzanne started supporting when she lived in San Francisco focuses on homeless mothers. Read about the great results of the Homeless Prenatal Program here.

Photo: iStock
When nurses coach low-income moms, their babies benefit.

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Some years ago, the John Adams family biographer Paul Nagel introduced me to physician/poet Norbert Hirschhorn. Paul told me that Bert was on the team that helped save thousands of lives in Third World countries simply by distributing water to which sugar and electrolytes had been added. (A National Institutes of Health paper references Bert’s 1973 research on “oral glucose electrolyte solution for all children with acute gastroenteritis” here.)

A special NY Times science supplement on Sept. 27, 2011, “Small Fixes,” reminded me of Bert and the notion that small innovations can have a huge impact.

Among the great stories in the supplement. is this one about Thailand’s success fighting cervical cancer with vinegar.

It turns out that precancerous spots on the cervix turn white when brushed with vinegar. “They can then be immediately frozen off with a metal probe cooled by a tank of carbon dioxide, available from any Coca-Cola bottling plant.” The complete procedure, which can be handled by a nurse in one visit, has been used widely in Thailand, where there are a lot of nurses in rural areas.

In Brighton, Massachusetts, Harvard’s George Whitesides founded Diagnositcs for All to commercialize his inventions, including a tiny piece of paper that substitutes for a traditional blood test for liver damage. Costing less than a penny, “it requires a single drop of blood, takes 15 minutes and can be read by an untrained eye: If a round spot the size of a sesame seed on the paper changes to pink from purple, the patient is probably in danger.” Read the Times article.

Amy Smith at MIT is another one who thinks big by thinking small. Read about her Charcoal Project, which saves trees in poor countries by using vegetable waste to make briquettes for fuel.

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Pippa Jack at the Block Island Times reports today on a Rhode Island humanities grant for post-production work on a local film. The film is called “Island Nurse” and is about island treasure Mary Donnelly.

“The filmmaker, Sue Hagedorn, who is also a nurse practitioner, retired nursing professor and summer resident of the island, shot the intimate footage over the past two years, following Donnelly as she made house calls, visited with family, did non-profit work and remembered the past. Next she will film other people, collecting stories about the frail-looking but dynamic woman who has tended to the sick here for two generations.” Read more here.

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