Remembrance

November is a month to reflect on how very lucky we are to live in a country like Canada!

I always spend some time looking back at what nursing was like for those brave souls who volunteered during the conflicts we were a part of as a nation.

Remembrance Day focuses on the brave soldiers and members of all the services who fought to keep us safe and free. And so it should. Anyone who has been a part of, or looked back on these periods of our history, will find that it wasn’t all guts and glory. It was a hard, long, punishing, soul-draining effort by young men and women in all but perfect conditions.

I also look at the efforts of the nursing/medical services during those very troubled times. Countless hours of surgery, bedside care with the bare minimum of equipment/ medications and always……. not enough hands to do all the work.

So many of our modern day practices rose from these times. From disinfection of areas/ instruments, separation of diseases to limit spread, discovering Penicillin to treat infection, development of transfusions of blood/ IV fluids for traumas to the start of frontline Casualty Clearing Stations, treatment of wounded on ships and EVAC practices of the more ‘modern’ conflicts, just to name a few.

In all of these areas, nurses worked tirelessly to keep the soldiers alive, and either send them back home or back to the front to continue the effort.

If you get a chance look at the Veterans Affairs Canada website:  veterans.gc.ca 

The Nursing Sisters of Canada article is particularly informative.

In November,  remember all that gave their lives so we may be free. And  remember our sisters.

 

Pastry

Pastry, pie crust, pie dough…….

I have struggled with this form of baking since I started baking with my Mum. Seriously, the best pie crust pastry came out of her kitchen at any given time. She throws all the ingredients in her bowl, uses her well worn pastry blender and whips up a masterpiece that gets placed in a pie plate and filled with all kids of good filling…. Apple, peach, rhubarb custard. Amazingly flaky and delicious!!!!

I have tried every kind of recipe imaginable. From the best pastry chefs to the well-used well-tested recipes from friends claiming “This is the best recipe and it’s no fail!”

Fail I have……until….

I stopped trying to be a perfect pie crust maker.

In baking(cakes, cookies, muffins etc) I’m secretly fascinated by the precise measuring in these recipes and the exact instructions. (thanks Dad). The outcome is realitively consistent for me. BUT PASTRY……sigh…

When does one stop incorporating the fat into the flour?, how big are “pea-sized crumbs” or when is “until sufficiently blended”? And then gathering the mixture and not “working it too much” on a “lightly floured surface??” always baffles me…..I want a well rounded smooth round of dough that looks like a ball!

Long story short, I just now loosely measure the flour, throw in the salt and measure the shortening, hope I’m incorporating the liquid enough, roll it into a ball, cut it in half and throw it into some plastic wrap to rest in the fridge for an hour or so.  I use the pastry recipe on the shortening box….and have overcome my insecurities to produce a not half bad pastry. (Most of the time!)

Lesson here: Just do it!

I’m really looking forward to the cooler weather….it means fruit pie, meat pie, pot pie and Tourtiere!

Let me know in comments your favourite pie story!

Ears

In Emergency Medicine, you first meet patients on the worst possible day of their life. They have come to you for help, an explanation, some comfort, a second opinion or just to have someone  hear them. And we do.

One of the most useful senses a nurse has after her eyesight and touch is her hearing. It has always amazed me that we can block out all of the peripheral noises and din in the ER and be able to compassionately, calmly and quietly get to the root of what ails the person, by listening.

We can hear what the patient’s  complaint is but can better tell the extent of the problem by the tone of their voice as well as hear any strange body sounds that are occuring that could give us even more clues.

One memorable example of this for me was a rather nasty meningitis outbreak in the late 80’s when I worked Pediatrics. Parents would present with a fevered baby and have impatient requests for us to “do something because the Tylenol isn’t working!” The child would look normal sitting in their car seat with a snowsuit on. Once out of the suit the temperature of the skin, the glassiness of the eyes and the abnormal cry would put us all on alert. The cry of a child in pain with a headache is one thing but that high-pitched increased intracranial pressure cry is something you never forget once you hear it. It meant a quick triage into an isolation room, medication and IV on standby and a doctor assessment sooner than later.

You can hear when a congested cough sounds more like failure…..or a palliative breathing is near to end of life. It just sounds different. Croupy cough vs. an asthmatic cough, a marbles in your mouth sinusitis voice vs. a muffled swollen throat epiglottis voice. There are so many!!

Ears…..with or without a stethoscope, they can detect so many subtle changes from the norm. Your ears can also just listen when a patient needs you most.

Savoury

I’ve been asked to share some savoury recipes!

I’m into simple cooking. Good ingredients with a minimum of prep and fuss.

My savoury recipes can be found in the “Links” menu at the bottom of the webpage for now. I’m in the process of developing a new ‘look’ for kakenurse to incorporate all the recipes in an easy menu style.

Click on the little green circles at the bottom of the webpage and the recipe will appear.

It’s been a great few months sharing recipes and nursing posts with all of you! Thank you for the awesome feedback and positive comments.

I’m enjoying every minute I spend searching for these recipes and hope you get as much pleasure out of making and sharing them.

K

 

 

Crisp

I went on a fruit buying drive this morning! I spent a few hours combing what the region had to offer and settled on a few baskets of various varieties of Niagara’s bounty.

Peaches are just starting, plums both purple and yellow have arrived  and apricots are ripe and fuzzy. One of the stands I stopped at had a mixed basket of all of these fruits so I pounced on it. Visions of a warm fruit crisp started dancing in my head on the short drive back home.

Thank goodness it was a little bit cooler today than it has been. Crisps are baked in a 350F oven for about an hour. (heating up the kitchen in the summer is not always a good thing to do)

While the most popular crisp still manages to be apple, I have been known to pull anything edible in the fruit bowl (not bananas sadly) that is nearing its best by date and covering it with a flour-oatmeal-brown-sugar-butter mix to pop in the oven. Is there anything more lucious than warm baked fruit with vanilla ice cream or whipped cream oozing all over it?

Drooling yet again………

The combinations are endless. Blackberries and Apples, Peaches and Blueberries, mixed stone fruit with grated zucchini and ginger…….you name it, you can “crisp’ it! You can even use sweet potato and or squash……

Enjoy this special time of year by baking a crisp. It’s easy, requires very little prep and is always a welcome dessert at a picnic or potluck.

Let me know what you decide to put in yours!

 

 

Intravenous

In-tra-ve-nous

ADJECTIVE: existing or taking place within, or administered into, a vein or veins.

A large part of my work day in both the ED and now in Same Day Surgery (SDS) revolves around the insertion of an intravenous device in order that we may do a wide variety of tasks. The evolution of the I.V. over the last 34 years has seen us go from metal needles without any flexibility to a state-of-the-art safety spring-loaded ultra flexible plastic catheters that can remain in the vein for days.

The Intravenous (IV) can be put in any vein in the body (ask an ER nurse where the weirdest place was that they’ve inserted one of these)  and is used to give basic fluids, give medications/boluses in a life/death situation or provide a port for numerous blood samples, introduction of anaesthetics and doses of antibiotics and pain medication.

I’m often asked to help when a patient proclaims “I don’t have any veins at all” or a colleague states they don’t have as much experience as I do, and would rather I give it a shot first. And then there is the statement newer nurses hate to hear….”No one ever gets my IV and you’re not trying if you’re not good at it”……sigh. How is a new nurse ever going to get any experience?

IV insertion requires patience, skill and a little bit of luck. Finding the vein is the challenge and making the commitment to insert is your hurdle. Take a moment to explore all of your options before you choose. Of course when your patient can’t wait… then go big or go home! (Antecubital with a #16)

When I first started in the Peds ER trauma room, I was almost horrified to see the team leader pull a chubby toddler’s head over the stretcher end to expose the external jugular site when extremity IV’s were proving to be difficult to find. We also did a lot of scalp vein insertion, which again, took some getting used to as well as cut downs….anyone remember those?

An IV can save a life, it can miraculously rehydrate a floppy infant and give pain numbing happiness to those with chronic illness. Be patient with yourself and always remember to tell your client the truth. Yes, it’s going to hurt BUT getting a small pinch now may save their life later should anything go wrong.

 

Compote

NOUN- a dessert made of fruits cooked with sugar and or spices. 

Do you ever go and buy a few baskets of peaches, flats of strawberries/raspberries or too many pints of blueberries and have them sit on your counter…only to move them to the fridge to try and preserve them a little longer because you can’t possibly eat one more of the luscious little morsels????

I have a very simple solution to using up the fruit if jam making isn’t in the cards for the day they start to turn into over ripe mushiness.

Consider a compote.

I usually start by boiling some blueberries (about a cup) in 1/2 c. of water. Boil them just until they start to pop and the pot water turns a lovely purple. I add a tsp of lemon juice, a tbsp of white sugar and let it boil for a few minutes. In the meantime, mix 2 tbsp of cornstarch with 2 tbsp of cold water and whisk till dissolved. Add this slowly to the hot fruit mixture stirring until it gets thick and translucent. Remove from the heat and add 4-5 cups of other fruit….cut strawberries, peaches, blackberries, raspberries etc. and mix till the fruit is coated. You can sprinkle some ginger or cinnamon in to add some flavour. Remove from the pot and keep in an airtight container in the fridge.

I use this to top my plain yogurt in the morning, or to top cereal. It’s great for a healthy dessert, or with whipped cream on top.

Compotes have been around for centuries. Prior to our change to healthy eating, the fruit was boiled in a sugary syrup. Now you can get away with a tbsp or none if your fruit is sweet and ripe.

Enjoy!

 

Lay-off

I’m not feeling particularly caring at the moment.

After reading an article in the newspaper about Women’s College Hospital laying off 4 staff R.N.’s in their busy outpatient clinic, my caring meter has dipped to annoyed!

No, they are not in acute or critical care areas and no, they are not in a typical hospital bedside role. BUT they are providing a service to their patients, communities and other staff that is invaluable.
Why is this happening??
The bottom line is money. I don’t believe the spins they put on their reasons for these redundancies anymore.
Hospital businesses are treating their staff like any large company trying to balance their books. It doesn’t matter if you’ve had many years of service or that you provide extraordinary care. You are expendable and replaceable.
It leaves a bad taste in R.N’s mouths everywhere and fear in our minds.

The fear of not having a job at the blink of an eye.

I recently posted a picture on my FB page of a Resus Room trauma in progress. There were 7 nurses in the room with 5 at the bedside. While this is an extreme view of R.N. roles,  it cements the need to retain staff, not extinguish careers.

Layoffs….

They most certainly help to balance the books of the business, but leave a gaping hole in the real reason for it.

Caring for others.

Strawberries

June is my second favourite time of the Niagara fruit belt growing season. This area is renowned for its grapes…but then prior to that, in somewhat rapid succession, are all the other choices of fruit that grow so well here.

Strawberries grow low to the ground, are nestled in straw and require a fairly good back to harvest. (or knees depending on your picking stance.) Memories of running through the rows, sticky-faced and delirious on the smell and taste of the ripened fruit will stay with me forever. I’m not quite sure how many me or my sisters managed to get into a flat for Mum, but the freezer would be full of jam for us to spread on toast well into the winter months.

I again marvel at the tasks completed by the working housewife of yesteryear. I find it difficult to even manage a trip to the farm to sheepishly purchase an already picked flat of red gloriousness to take home….(eating a pint in the car on the way home of course).

Enjoy your strawberries while they last…use the Tea Biscuit recipe here, add a few tablespoons of sugar to the batter or sprinkle some course sugar on top of them after a brushing of milk. I whip fresh cream with vanilla/sugar and serve individual shortcakes for a quick, easy dessert. The simple ingredients really showcase the berries…after all, that’s what its all about!

Happy June!

Education

Do we ever stop learning?

Nursing is one of those professions that continues to evolve, change and grow almost daily. Just when you think you’ve got a handle on things another study is released that changes how you do a certain task or give a certain medication or chart a certain way. I secretly think its another reason why we all love it so much. That commitment to learning.

I’m always looking something up. Be it a medication who’s “other name” I can’t remember, or a question a colleague asks that I just can’t recall as quickly as I used to. Your Clinical Educator should be a friend!

The grumbling and groaning that occurs at certain times of the year on your unit usually coincides with the recertifications of our “mecca” courses. ACLS, PALS, PEARS, TNCC, ENPC etc. all evoke both fear and fascination in us all. We gather in groups, plunge ourselves into a simulation world for 2 days, and come up for air only to eat, down copious amounts of coffee and pee. Self- inflicted it may be be but oh so necessary to continue to be current in our practice.

A review of anything is always worthwhile. Cramming more relevant information into your already crowded mind is somehow comforting.

Don’t be afraid to ask questions no matter how stupid you may think them to be and look for those education opportunities that pull you out of your comfort zone. Conferences in other cities/towns and education sessions at different hospitals all provide some time away, some excellent opportunities to network as well as a chance to maybe see a new place, find a new restaurant and have a girls night out.

Education…..its a basic part of a nurses’ life but can be so much more than just the classes we attend!