Dibuho 2013: Roles of Modern Nurses and the Gapuz Exchange

Hey Readers!

I'm finally launching the Dibuho Project! This means give-aways, reader's participation, and bragging rights to come! 

What got me going was this little exchange with Mr. Ray Gapuz, owner of the oh-so-famous R.A. Gapuz Review Center. Here are a couple of screen shots:

I will say two things: (1) I studied at that review center and I believe we were taught that comprehension is essential to passing the Nursing board exam and (2) I passed the Nursing board exam, so if I lacked comprehension, it must mean that I got my license out of pure luck. Woah.

This exchange got me thinking on the role of the nurse in the modern times, and since I'd really love to know what people think, I decided it would be good to make this topic Codswallop's first dibuho. 

I'm going to be giving away a bunch of stuff, including a free BLS or Heartsaver training, 50% off ACLS training, and 35% off EMT-B training, all from our good buddies at HealthCare Advantage Training Institute. For those who'd love to have the BLS and ACLS, then you'd be much happier to know that these courses are American Heart Association certified. Talk about going international. Also, the EMT-B program is a licensure training which is TESDA accredited. I've seen the HCAI facility, questioned their people with my usual mataray-eyebrows, and am satisfied enough to say that their training is well worth your time (I fell in love with the simulation-ambulance!). Interested parties can check them out here.

All that gift cards and freebies plus this amazing piece of literature by Bob Ong are yours by just giving me insights on what you think the role of the nurse will be. Pretty good deal, if you think about it. 

Here's how to win. It's as easy as pie:

1. Like Codswallop's official Facebook page.

2. PM Codswallop your name, contact details, and answer to the question below.

3. Post your answer in the comment section of this blogpost as well.

4. My fave answer will get freebies galore, and I'll get in touch with the guy or the gal with the most awesome response for the prices.

Ready, reader? Express your dibuho now!

Love from,

Janina ^_^

Debunking Duesberg Hypothesis

A/N: Below is my first essay for the online course on AIDS that I am taking. It is my attempt to squeeze in the everything in my head in only 600 words. I am sharing this with you because, although not the best, I am proud of it. This one is dedicated to the friends who inspire me to pursue bigger and better things. Don't worry. I promise to do better on my next essay.

Photo from worlddomination.com

Among the many AIDS denialist theories, molecular biology professor Peter Duesberg’s is possibly the most popular, if not the most controversial. In 1998 study, Duesberg zeroed in on drug use and anti-retroviral drug therapy as the catalysts of AIDS. He showed that majority of those with AIDS in the United States and Europe were recreational drug users. Another similarity was the use anti-retroviral drugs (ARVs).[i] Of course, other men and women of science did not take these propositions sitting down. On Duesberg’s website is a quote from a great scientist, Albert Einstein: “The important thing is to never stop questioning.” Those who were unconvinced by the Duesberg Hypothesis did just that.

In his study, Duesberg pointed out that in the early 1980s, those who were diagnosed with AIDS were also mostly homosexual men with multiple sex partners, and who used recreational drugs as aphrodisiac or psychoactive stimulants, some of which introduced to the body intravenously. This was one of the reasons why he pointed to drugs as a cause of AIDS.i Closely associated with the onset of AIDS is the decline in the CD4 cells, which are damaged when the virus replicates. This drop is an important basis in diagnosing if a person has developed AIDS. The study Does Drug Cause AIDS?, published in Nature in 1993, showed that the CD4 count of those who were seronegative or HIV-negative individuals regardless of drug use had relatively stable CD4 count. Furthermore, this entire group’s CD4 level stayed well above the normal value (600-1,200 cells per cubic millimiter[ii]) from 1986 to 1990. In contrast, regardless of drug use, CD4 cell count of those who were seropositive (positive for HIV) declined significantly. It is interesting to note that the 

discrepancies in the CD4 decline of those subgroups with varying drug use were only very slight.[iii] As the seronegative drug users do not experience a collapse in their immune system, these statistics strongly suggest that drug use does not affect the progression of the infection. This conclusion was further strengthened by a study entitled Recreational Drug Use and T Lymphocyte Subpopulations in HIV-uninfected and HIV-infected Men, published in 2008, which looked at the correlation of CD4 and CD8 count with drug use in men who have sex with men (MSM). Here researchers “found no clinically meaningful associations between use of marijuana, cocaine, poppers, or amphetamines and CD4 and CD8 T cell counts, percentages, or rates of change in either HIV-uninfected or -infected men.”[iv]  These studies are very strong evidence against the Duesberg Hypothesis.

Another controversial clause in the denialist’s claims is that anti-retroviral drugs are the actual cause of AIDS. Antiretroviral drugs act to inhibit viral replication, preventing the increase in concentration of HIV in the system. It was observed in a study conducted by Division of Infectious Diseases and Hospital Epidemiology, University of Zurich, in 1999 that 6.6% out of 2,675 HIV patients on highly active antiretroviral therapy (HAART) achieved and maintained undetectable viral loads. Viral load is, of course, correlated with the progression of disease.  Several studies also correlated ARV use to significantly slowing down the progression of the disease. In the clinical trial called BW002, Azidothymidine  efficacy was compared with placebo in 282 patients with  AIDS or late signs of HIV infection. In the trial, only one of the 145 patients treated with the drug died whereas 19 out of 137 patients treated with placebo died within six months.[v]

Properly questioned and dissected, it seems that the Duesberg hypothesis cannot to stand the test of science.

---

^a,b,1http://www.duesberg.com/papers/pddrgenetica.html

2 http://aids.about.com/od/newlydiagnosed/qt/cd4.htm

3 http://www.aidstruth.org/denialism/myths#m2

4 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2691391/ 

5 http://www.niaid.nih.gov/topics/HIVAIDS/Understanding/howHIVCausesAIDS/Pages/relationshipHIVAIDS.aspx

More Than the Character, the Issue

Roughly a week after digital uprising catalyzed by Cynthia Villar’s controversial TV interview where she inadvertently made use of the term “Room Nurses”, the senatoriable sat down with the officers and members of the Philippine Health Bloggers Society.

This is her side of the story, albeit not verbatim.:

The question Winnie Monsod gave was regarding the closing down of nursing schools roughly 5 years ago. Mrs. Villar stated that she acted to intercede between CHED and the Nursing schools that are foreclosure out of concern for the students who would be displace should these learning facilities be really closed. Her answer was rooted on her business sense – that what you invest on should have some form of profit. In this case, the senatoriable believes that those who may not be able to continue their education because their schools will be closed down should still have opportunities for employment. She believed that those who may be displaced should these schools be closed may still be “room nurses”. In this context, she was not talking about BSN graduates or Registered Nurses, but undergrads. Thus, her use of the words, “hindi naman gaanong kagalingan”. She said that a person who has received a BSN has better competencies than undergraduates, but that these “room nurses” can still earn a living. The term “room nurse” was not an insult, but a statement of a fact.

From left to right: Yours truly, with PHBS Chairman Nr. Alvin Dakis,
meeting with Mrs. Cynthia Villar

Before you guys run after me with pitchforks and burn me like Inquisition-crazed Catholics of the Dark Ages, I just want to clarify - this is a report of what occurred during the meeting and not in any way a defense for Mrs. Villar. Should you find her explanation acceptable or not is up to you.

Of Questions

These events have led to a massive wave of reaction in social networking sites. Statuses, memes, and tweets showed the fury of hundreds of nurses here and abroad. Many proclaimed that they will not vote for her in the coming elections, and many invoked the power of potassium chloride to permanently shut the senatoriable up.

I have a simple principle: You may call a spade a space, and thus refer to a person as an idiot should said person be a legit idiot. Let us admit it. It was a bad move for the senatoriable. Or bad editing on the part of the TV station. Overall, it leaves a nasty taste in the mouth. 

But what good does it do, really? Sure, the pictures are funny, the name-calling’s hilarious, the Senora Santibanez memes are unforgettable, but do they solve issues?

The question of what Mrs. Villar can do to pacify our collectively (butt)hurt pride as professionals is not THE question, or if it is, it pales in comparison to what is really important. THE question is what WE can do to ensure that our profession will never be at the business end of insults, intended or otherwise, ever again.

I mean, if Mrs. Villar were to go down on her knees, beg for forgiveness (she did already, sans the kneeling), take up BS Nursing like she tweeted, and donate money to nurses, would it solve our problem?

I think we know the answer to that.

Let me just say, “Dude, it’s your Facebook account, and Cybercrime is on TRO. You can do whatever the hell you like.” But if we seriously divert this much energy to trying to solve our real problems, we’d probably be a lot closer to the solution than we are today.

These are the stuff we should really be concerned with:

Question: Why did nurses react so violently to Mrs. Villar’s proclamations? I mean seriously, KCl injections are like the epitome of violence.

Answer: Because we’re tired of our profession being looked down on.

Question: WHY is the nursing profession being looked down on?

Answer: Several reasons: because nurses have been stereotyped as doctor’s assistance since the beginning of time; because in the Philippines, if you’re a hospital nurse and you’re earning PHP8,000 per month, you’d be so thankful you’d kiss any imaginary god’s feet; because we are unemployed, underemployed, employed in jobs that we’re not even supposed to do, and there was a time we needed to pay and kiss arse to even be considered as volunteers; because we have been stereotyped as an unpatriotic selfish bunch that would give an arm and a leg just to get out of this self-proclaimed godforsaken country and go to better places, preferably with white-skinned citizens; because the quality of nurses we are producing is dropping at an alarming rate, as shown by the decline of Nursing Licensure Exam passers; because people don’t seem to see just how important a nurse is in the health care system – that Philippine health care would perish without us. Lots and lots of factors, really.

Question: What do WE do about these reasons then? That’s right, not the government. WE.

FUNNY! And the Hello Kitty Cap is cute.
 How does this solve unemployment again?

Your move, Nurse. 

Janina Santos is the Founding President of the Philippine Health Bloggers Society. She is also Secretary of Publications and Media Relations and Corporate Treasurer of the Alliance of Young Nurse Leaders and Advocates International, Inc. However, this is her personal blog and does not, in any way, reflect the official statement of the organizations regarding this issue.

10 Stupid Ways an Idiot Nurse Can Seriously Hurt You (or Kill, for that Matter)

(Why Nurses Can't Be Idiots Part 2)

We all know what happened: Cynthia Villar, Winnie Monsod, a killer question, and a roadkill answer that pissed off a significant portion of the Philippines' 700,000 nurses. 

Nursing youth leader Alvin Dakis
comments on Mrs. Villar's allegedly derogatory
 comments regarding "room nurses".

Truth #1: Unless you have the dough, you can't choose your health provider. 

Truth #2: And let's face it - you're probably as poor as I am.

Truth #3: If you get stuck with an idiot health care provider - an idiot nurse, for instance - then there is a very big probability that you'll have a very bad time. 

Truth #4: A safe nurse is a smart nurse, because a smart nurse knows the hows and the whys behind patient care. A smart nurse will be careful of rendering patient care so as not to hurt his or her client. 

Truth #5: No, you don't spent most of your hospital time with doctors. They pop in for a few minutes to see how you're doing, and leave the rest of the caring to "room nurses"
Truth #6: If your nurse is an idiot, you might end up in the morgue instead of going home. Seriously. Expiration. Death. Meeting the Maker, if you believe in that stuff.

Don't believe me? Here are 10 stupid ways an idiot nurse can seriously hurt you.

1. During the first the first hour of a typical morning duty, a "Room Nurse" will be going around, checking your IV fluid, making sure that it is properly calibrated. If an Idiot Room Nurse regulates a patient with cardiac insufficiency's IV fluid at 25 drops per minute, instead of 10 drops, then the patient may suffer fluid volume overload, which will stress the heart, which will cause it to need more and more oxygen to keep on functioning, which the diseased heart may not be able to provide in the first place. End stage? Heart attack.  

2. Here's a classic example, and one that's been going around Facebook for a few days now: bolus injection of potassium chloride. Trivia: KCl is used for lethal injections.

3. When a bedridden patient goes into cardiac arrest and the Idiot Nurse performs CPR and forgets the friggin' CPR board (which you put under the patient), said Idiot Nurse can break the patient's ribs and the fractured bones can stab the lungs. Ouch.

4. Administering an IM injection without making sure that there are no air bubbles. Hello thrombus and embolus!

5. Getting an indwelling urinary catheter is painful to begin with. The catheter is held in place by inflating a balloon which sits in your bladder with sterile water. Now imagine the idiot nurse pulling the damn catheter out of your hole down there WITHOUT deflating the balloon. The pain is enough to give you nightmares of holy hell for several nights, I imagine. 

6. Turning stroke patient q2 (every 2 hours) without pulling the side rails up is asking for an accident. Hala sige, ihulog ang pasyente!

7. Cleaning your open would sans gloves after taking care of a patient who defecated. Oh yes, it's an infection waiting to happen.

8.  If your reproductive health nurse is an idiot and counsels you to use combined oral contraceptives regardless of your sky-rocketing blood pressure, you're going to have a bad time. 

9. During surgery, an idiot nurse might just hastily count and recheck the instruments and materials used. You know what that means? You might have a used gauze left in your tummy, and no one would know any better...that is, until you're sick again. 

Photo courtesy of Nathalia Laguitan, RN. Nursing students are trained in special areas such as the National Center for Mental Health, where they learn not just the physical science of health, but the behavioral aspect as well. Being a holistic practice which focuses on the entirety of the person instead of just parts, nursing is a demanding course as well as a profession. Have you ever tried running after a mental health patient before? Nurses might have to do that. I did.







10. If an idiot nurse gives a schizophrenic patient a pencil in art therapy, and said patient goes berserk, then, friends and neighbors, we might have injury in our hands. Several, for that matter.

The hubbaloo involving Cynthia Villar's controversial comment about "Room Nurses" has barely left the frying pan, when this silly little girl made a mistake of running off with her (mouth) keyboard, this time calling nurses idiots and asserting that we are "hindi kawalan". Oo nga naman, we're just roughly 700,000 of the population and a major source of remittance that's keeping the country's economy afloat. 'Di nga talaga kawalan. This screen cap is currently being circulated around Facebook and Twitter. Little girl, you better pray that you never EVER get an idiot nurse if you get hospitalized.

Photo from Shane Magsino, RN. This was taken during our
oath taking ceremony at PRC. Before being able to actually
take the oath, though, we had to wait outside, in the blistering
heat, wearing our thick white uniforms, from 7AM to
around 2PM. We were trained to be patient as well
as to be smart. It takes a lot of brain to be a nurse.
It takes a lot of heart too. 

Truth #7: We worked our arses off to get to where we are, to earn our BSN degree, to pass the board exam regardless of typhoon, heart break, flood, personal misery, earth quake and whatever else that was thrown at us. We are NURSES. We do not deserve to be called idiots. We do not deserve to have the word "lang" or "only" next to our profession. Because if we did, then it might be fair to warn you : be very, very afraid.

Invite to readers: Please feel free to add more to the 10 Stupid Ways through sharing your ideas in the comment box below. Despite the annoyance brought about by what has been happening in the past few days, that doesn't mean we can't laugh about it a little, right? And maybe we'll scare these people enough - these people who are supposed to be making our training better and more competent, instead of settling for "hindi naman kailangan masyadong magaling". Maybe we'll scare them into doing their jobs. 

I haven't given up hope yet. Have you?

Why Nurses Can't Be Idiots Part 1

When I was in college, I dreaded being handled by San Juan de Dios’s infamous nursing clinical instructors. Horror stories of these CIs’ near-terroristic approach to training student nurses were passed down from generation to generation, rendering newbies to the Nursing program shivering with fear. Their training styles and strictness were legendary. When being handled by an SJDcian clinical instructor, mistakes were punishable with not just the low scores, but with some nasty tongue whipping.

These clinical instructors were known to be unforgiving of idiots. Those who are naïve enough to believe they can survive their duty rotation without having to know why a stroke patient needs ulcer meds, or without obsessively-compulsively monitoring a patient’s IV fluid rate would usually find themselves a sobbing pile of mess outside the area, possibly for the rest of the 8-hour shift.

Before we set foot in the clinical area, we were expected to know how to do a procedure by heart. Our CIs expected us to understand every single nursing, medical, and sometimes psychiatric care given to our patients in relation to said patient’s pathology. They expect us to be caring in rendering nursing interventions, but also clinical in our approach to dealing with patient problems. We were not doctors, and we did not have to explain lab results, but we were still expected to know when values should already cause panic, then push aside that panic and render appropriate measures to secure a patient’s wellbeing. In other words, it was either we pass their critical eye, or we spend 8 hours standing in the hall way.

I dreaded being handled by these infamous clinical instructors, but when I was in the 3^rd year of my nursing education, I understood why a nurse’s training had to be brutal: it was because we were dealing with lives. The smallest mistake can harm a patient, can disable him. I learned that decisions regarding care that is not evidence-based and not rationally made can most certainly kill. I learned that, unlike some politicians who are campaigning for office this year, nurses don’t have any right to be morons, because the cost of idiocy is something that can’t be paid. People’s lives are at stake.

The dwindling standard of nursing education has long been an issue. It is manifested by the abysmal passing rate on the Philippine Nursing Licensure Examination. The cause has been proven to be the mushrooming of fly-by-night schools that started offering nursing just because it was a fad several years ago. The driving force of these schools, in other words, was not to educate but to invest in what seemed to be booming business at that time. The result: low-quality graduates. Unfortunately, some people in power would rather side with these businesses than those who spend money on getting education. Thus why “nursing schools” with pathetic passing rates were never closed when they should have been.

Just last night, I heard the most preposterous, blood-pressure-rising excuse from a former congresswoman who is now running for senator: "Hindi naman kelangan magtapos ng BSN ang mga nurses sa atin kasi gusto lang naman nila maging isang room nurse sa Amerika. Hindi naman nila kelangan maging magaling."

Here's the vid. Knock yourselves out. In fact, bang your head on the wall real hard if you're still voting for this woman.

Oh, my. Here's my response, even if the former congresswoman will probably not see it: 

Madame, I beg to disagree. You see, nurses have no right to be nurses if they are incompetent. In fact, they have no right to be mediocre, so your ideology of giving them mediocre education is unacceptable. We must always pursue for competence, safety and effectivity in the practice of our profession. That is why we have the nursing licensure exam. That is why we practice injecting our classmates with water before we actually do it on patients. That is why we have related learning experiences. That is why we have hardcore clinical instructors that would drill pathophysiology, pharmacology, and the patient’s psychology into our heads relentlessly.

Also, not every single nurse who went to those nursing schools you, Madame,  refused to close down want to be “room nurses” in America. Some of us want to be advocates, teachers, community organizers and leaders, policy-makers, public servants (which does not necessarily mean politicians). To these nurses deserve mediocre or sub-par education as well? We often forget that the contribution of the nurse to society goes beyond the clinical area, and regardless of the setting of the nursing care, we should never settle for anything less than highly skilled and knowledgeable professionals.

The training I went through and the clinical instructors that I’ve been blessed to train under have taught me one very important thing: It takes a lot of brain to take care of people and to keep them alive. It takes a lot of brain to be a nurse. 

A Change of Heart

Confession: I was never proud to be a nurse.

This idiotic opinion was brought about by the fact that midway through my life as a nursing student, my aim of getting to greener pastures simply died. Or, at least, required more money, time, and almost everything else that I did not really have. There were more nurses that the Philippine economy can handle, and the countries the United States, the country that most want to penetrate suddenly went on financial crisis and implemented retrogression.

It was safe to say I was pissed. More so because I had given up my dream of becoming a journalist to pursue my loveless affair with Nursing.

I was narrow-minded and cynical. I guess being the go-to person in my community when there were medical emergencies was not enough to get Nursing pride through my relatively thick skull. I. Am. Sorry.

Despite this, I had my ideals. They were very simple ideals, but rather strong for someone as socially stoic as I am: zero-bullshit reproductive health policies and services that are centered on women of all ages, prevention of rape and survival of its victims, and respect of other's hard work and efforts.

I feel that should I be given the opportunity, I would go Gabriela Silang for these issues.


The Facebook Phenomenon

I started to aggressively campaign for the Reproductive Health Bill last year on Facebook. This is after meeting one of my vagina heroines, sexual health writer Ana Santos. I joined a group called RH Bill-I Support, where I met people who actually knew what they were talking about. It was a very good learning experience.

One person who stood out was Alvin Dakis, who, by the look of his cute-sometimes-goofy profile picture, seemed like the average dude to me.


The Man Behind the Picture

Can you blame me if I say he looks like the guy-next-door?

As usual, nothing is as they seem.

The average dude with the cute-sometimes-goofy profile pic is the founder and president of the Alliance of Young Nurse Leaders and Advocates. He is also the Philippine Fellow for the Philippine Young Leaders Fellowship 2011 Asia 21 Society. He writes a column for Vital Signs, and is a regular contributor for Mulat Pinoy.

More than his extensive resume, though, what is really inspiring about this not-so-average-dude-after-all is what he did not just for nurses, for for those who are often discriminated and set aside by the general populace of the Idiot Society:

It was through his leadership that young nurses finally found their collective voices to protest the blatant exploitation they are submitted to, exploitation hiding in the guise of volunteerism and training.

His outspoken support for the Reproductive Health Bill has caused a wave of response from the younger nurses, prompting them to be more socially aware of their responsibilities to their clients. To take a stand on the increasing number of maternal deaths, and the escalating statistics of HIV-Positives.

LGBT rights has come into better light because of his continuous campaign.

I have probably missed many other things, but the point is this: the things he did have caused the death of apathy.


Tangible

Whatever his achievements are, though, the great things about him are the very
simplest of things: He does not mind laughing and joking with his colleagues while riding the MRT during rush hour. He would happily wait for two over-excited gals to finish their make-up so they can look awesome for the launch of a video on HIV awareness. He will happily pour water for you when you dine with him, after a long and hard organization meeting.

Mostly, it is his ability to trust his members, despite the fact that they are not exactly the best. I know. I will probably never be the best member of AYNLA, but in some weird twist of fate I shall be forever grateful for, Alvin Dakis seems to trust me.

He will and always will be more than President Alvin Dakis, of AYNLA. For us who have had the honor of meeting and working with him, he will always be more than our leader. He is our Sir A.

Changing my heart

Alvin Dakis has, by example, taught me that, being in the nursing profession, I can be a much better Gabriela Silang for my advocacy.

And it is him that I should thank that I can finally say these words: I am proud to be a nurse.#

Nr. Janina Santos is the Secretary of Publications and Media Relations for the Alliance of Young Nurse Leaders and Advocates. She is also the owner of this blog, and a self-proclaimed bodyguard/bouncer for Nr. Alvin Dakis, together with her one and only babe, Nr. Tina Siuagan.