Should the Paramedics take on the role of Rural Home Health Nurse?

What do you think?
Earlier this week I attended a 3-hr of public hearing in Sacramento where a variety of speakers were debating a pilot program proposal for an increased role of PARAMEDICS in managing chronic care diseases when attending to home care needs of patients (in rural on inner city areas they say).

While I fully support the notion that something must be done with the dreadful state of CA public health, access to medical care and adherence to home care / discharge plans, with all due respect and deference to paramedics, to manage a chronic condition in a home setting takes fine tuning and years of studies and practice. Just because nobody is bleeding does NOT mean it is not critical, problematic or very complexed issue to deal with.
There is a reason new grad RNs are NOT hired for home health because you MUST have experience in dealing with the disease management before you will be even considered to be sent out there making decisions on location!

It is usually the patients who are not bleeding or vomiting or collapsing that are the biggest problem in a home health setting, those who sit quietly, those who if you don’t know what and how to ask OR if you don’t know what signs to look for – usually, they are the ones who don’t even tell you! They don’t wanna be a ‘bother’ – I’ve heard that SO MANY times from grandmas and grandpas
(Again, I am talking about chronic disease management in home care, not discharge home from tonsillectomy, for example)

To manage chronic care diseases, you must know and understand the disease process, the disease signs & symptoms, to know how it was managed in a hospital, what can be the side effects of any of the above, what to look for, how probable complications look like even before they become major problems…. And finally, you must understand how to fine-tune the care!
Again, paramedic are GREAT and FANTASTIC at what they do, which is the FIRST phase of giving emergency care, I worked with them for many years on 2 continents (and in Czech I worked in the department!), so my hats off to you, but to manage the last part so-to-speak of care such as COPD or CHF or HTN or DM – that takes years of training, learning and practice!

Also, I am NOT saying we, the nurses, are fine-tuning or managing the treatments, that’s why we have specialists such as fantastic pulmonologists, but we the nurses are fine-tuning the plans of care upon discharge, the follow ups and the adherence to those. At least that’s what the nurses should do – but we don’t have them!
WHY?
Because the State cut the budget in 2011 and DHS and DSS just don’t have the funding! Those positions got cut. …Now we see how much it actually cost us because just because you cut a position or access to care here does NOT mean those patients will not seek the treatment or medical attention elsewhere. Now, all those trips to ERs – they get very expensive for the State! And now with added millions of new patients via Obamacare – don’t get me even started!

While I fully support the need for a change and innovation in our roles and in health care system delivery overall, in fact I have been calling for it for some time now, I do not believe paramedics as chronic care managers or home health caregivers are the long-term solutions to our much bigger problem.
They are trained as ‘ready to go’ as first responders, and I believe they are the BEST in the WORLD, but not as chronic care or home health care giver, and 16-18 hours of added education will not change that.
… At the same time, I absolutely understand what they are trying to do or accomplish and WHY!
I get it, I understand.
But I don’t believe this is the right solution.

Ukraine Today: Political Realism First, Please!

Ukraine Today: Political Realism First, Please!

marketa houskova |Educate Influence Make a Difference

(original post on humanitarian situation written on Feb 20th, 2014 in Sacramento, CA, USA. Updated based on last week’s cease-fire and political agreements on Feb 24th, 2014 in Sacramento, CA, USA)

czech vlajka znak

I was a young Czech nurse when the atrocities were happening in the Balkans, and NOBODY from the EU moved a finger, nobody helped them! I often asked myself what would have I done…?

While I had no influence over it, as after the Velvet Revolution in Czechoslovakia, after 40 years of oppression, and 20 years of Soviet occupation, I finally was allowed to travel abroad and I left home.

I looked after children, cleaned houses and pubs, learned English by myself at nights, held 2-3 jobs in order to follow my dreams of studying and obtaining my Nursing licenses in Canada & USA, only to go further towards my biggest dreams of earning multiple university degrees in global politics…

View original post 1,246 more words

Ukraine Today: Political Realism First, Please!

Ukraine Today: Political Realism First, Please!

(original post on humanitarian situation written on Feb 20th, 2014 in Sacramento, CA, USA. Updated based on last week’s cease-fire and political agreements on Feb 24th, 2014 in Sacramento, CA, USA)

 

czech vlajka znak

I was a young Czech nurse when the atrocities were happening in the Balkans, and NOBODY from the EU moved a finger, nobody helped them! I often asked myself what would have I done…?

While I had no influence over it, as after the Velvet Revolution in Czechoslovakia, after 40 years of oppression, and 20 years of Soviet occupation, I finally was allowed to travel abroad and I left home.

I looked after children, cleaned houses and pubs, learned English by myself at nights, held 2-3 jobs in order to follow my dreams of studying and obtaining my Nursing licenses in Canada & USA, only to go further towards my biggest dreams of earning multiple university degrees in global politics, global health & regional development & administration at prestigious U.S. universities (CSUSM and UM). CSU grad kept her ‘eye on the goal’ – San Diego Union-Tribune San Diego Union-Tribune regional newspaper did an interview with me about my road towards BA in Political Science Magna Cum Laude coming from post-Communist country.

To this day, I am ashamed to be European for our utter failure in the Balkans! Seeing the almost unrepairable damage that conflict left until today, over 18 years later, is utterly heartbreaking. We all bear responsibility.

For better or worse, the ONLY leader who proved to LEAD was U.S. President Clinton, who due to the long-standing ‘Monroe Doctrine’ did not and could not put “boots on the ground” as Americans love to say, but instigated aerial raids. President Clinton’s role in this conflict is being discussed even today, however, speaking as someone who has deep historical roots to Peoples abandoned and left ‘behind’ by the Western powers in their time of need, without any help… (i.e. The Munich Agreement of 1938, The Prague Spring of 1968 -> followed by foreign invasion of my beloved homeland by 5 foreign armies, led by, you guessed it, the Soviets and their criminal leader Leonid Brezhnev). Trust me when I tell you, you want help, any help!

California Capitol Sacramento

It is only here, in this country, where we have the incredible luxury to discuss and criticize actions of which we quite often know very little. BUT, let me finish, it is a part of our political system, it is a part of democracy and as a democracy “groupie” myself, I fully respect and admire this system very much. In fact, I have been actively involved in the post-communist transition to democracy and democratization of institution in Czech Republic on the local political level for past 20 years, and it is Job’s job. It is only when you are on the ground, demonstrating against the power that is usurping you and denigrating you, waving your flags, being beaten and shot that you are looking towards the skies hoping to see some allies and The Allies!

 

For my beloved Czechoslovakia in 1968, the year my amazing parents got married and sadly also the year their HOPE and DREAMS were squashed by the Soviet invasion, there were, for very obvious Cold War reasons, no sky allies or any Allies… And we (as in my fellow countrymen, since I was not even ‘an idea’) were looking up and waiting, every day! In the years afterwards, during the deep Normalization process (just a different word for Communistic indoctrination enforced by the Soviets), we were secretly listening to the Radio Free Europe and Voice of America (both I believed financed by the U.S.) in our basements, faced with hard jail time if caught, waiting for hours to hear our country even being mentioned! And this is how people of Ukraine feel today.

We are amalgamate of our previous experiences, and I really do “FEEL” the past plight, hurts and betrayals of my people and my country. Well, visiting every concentration camp around during yearly school ‘day trips’ since 2nd grade left DEEP scars and nightmares in my soul. At the same time, it also cemented such un-moveable human resolve, built foundation for my ‘Fight-or-Flight‘ (political & systemic) response, and cemented my strong sense of protection, responsibility for others, and especially for those weaker and unable to look after themselves => any more questions why I am a nurse, political operator and a humanitarian? Nope, did not think so.

We have a collective responsibility and we have obligations.

Now as a proud (dual Czech and) U.S. citizen and a highly degreed and educated RN and a political operator, at this point my love & passion for politics, strategy and campaign goes away and my nursing and humanitarian responsibility takes over. That is exactly WHY I DO politics, to PREVENT bloodshed! However, once you cross over a certain threshold, it is no longer about my ability “to do” politics but about my ability to “take care of people”. People need help no matter who is shooting at them and my nursing training and practice precludes me from judging my patients, and that I had some I did not like in my 15+years! Period.

I wrote an article last May 2013 year asking  Should the EU Care About Syria? The Balkans, Anybody?

Now, the question is HOW much, WHO should and WHY “they” should be concerned over Ukraine! ‘They’ as in the now portrayed as Evil The West / EU vs. the always evil East / Russia.

I don’t know about you, but I picked my ‘evil’ long time ago (and we are very happy together, thank you very much). I already lived under devil dominant depressing doormat of freedom-non-existent Soviets. I will pick The West in any shape or form, any time … and yes, I will get lots of criticism for it, but I am strong I can take it.
What I will never do, however, is to apologize for my views of Russia. I lived it, I survived it, I got out. Thank god I now have my beautiful blue U.S. passport!

Ukraine today is at the crossroads.

Country is divided, economically bankrupt, feels betrayed and lied to, plus people are in deep mourning. However, on the other hand, once the elation of a certain part of population over ‘their’ victory will wean off and reality of bad economy, current lack of leadership, deposed president MIA and the looming threat of Russia not far away will set in, people of Ukraine will have a lot to deal with. During my research, I found ONE thing they all agree upon (well, mostly) – they want to keep Ukraine united, as in NOT split in the Western and Easter / Russian parts. If I were at the negotiating table, I would hold on to this and would NOT let go…

 

I do hope those strong and determined people are ready, prepared and aware that much harder task is ahead of them! Sitting across from your political opponents and rival who you hold responsible (and vice-versa) for what just transpired, will truly show how dedicated and serious about DEMOCRACY the people of Ukraine really are.

Knowing how Russian tyrant Putin feels about Ukraine since he considers it to be a part of his Mother Russia and the center of Pravoslav religion, holding them hostage at will over access to natural gas and other resources and aid … and hearing as a freedom loving and globe-trotting Czech the same tyrant Putin saying that he ALSO consider my Czech Republic to be still under his sphere of influence, my heart stopped!

We’ve already been there, it was hell, and nobody wants to go back…

It is my unequivocal belief we all have global roles to play, we all can help and serve wherever we can.

Thus I am able to feel the plight, fear, resolve but also the uncertainty of people of Ukraine today.

Ukraine has difficult times ahead, and nation-buidling, state-craft and democratization of institutions while re-building trust in government and placing transparency into old systems are amongst the MOST difficult and HARDEST of social and political projects. Look at the U.S. how they are struggling with it around the world, and they have been living it for well over 200 years! Now look at the post-communist countries of Eastern Europe having their “freedoms” for about 20 years… Need I say more?

Hippocrates, the Original Public Health Care Worker?

Hippocrates, the Original Public Health Care Worker?

Recently, I watched a videotaped lecture by the famed Dr. Carl Taylor, MD DrPH (1916-2010), the founding father of then-new academic discipline called International Health. Dr. Taylor’s lecture, taped few years before he died at the age of 93, was called The Key Studies of Primary Health Care and it was available on the Johns Hopkins open access website. This interesting lecture was actually a part of Dr. Taylor’s teaching curriculum at the Department of International Health that he established at his beloved Johns Hopkins. His love, however, was to travel around all corners of the earth and help communities empower themselves!

Johns Hopkins hospital, Baltimore MD

Currently, I am taking Health for All Through Primary Health Care class through Johns Hopkins, and if we realize that by all accounts the most important Alma Ata Conference was held in 1978, that we are faced with a certain crisis of unfulfilled Millennium Development Goals (MDG) by 2015, and that more people live in abject poverty today than ever before – we begin to truly appreciate the genius of Dr. Carl Taylor’s approach and his vision for not only health care as such, but for PRIMARY HEALTH CARE especially!

images-2

WHY is primary or community health care THE point? Simple: If the government doesn’t do it for you (i.e. the Top-Down model) the people must do it for themselves (Bottom-Up model)… Hopefully with some help and guidance from global health or international organizations, sure, but by leading themselves nonetheless.

As for me, I would have never believed I would be interested in a discipline that does not have all the critical & intensive bells and whistles that only Code Blue, cardiac arrests, Swan-Ganz and ICP or resuscitation in hallways can provide and only critical intensive nursing can deliver. However, as my professional development began to move forward, I very slowly started to move away from all that acute rush in hospitals to seeing ‘Public Health’ from not only an administrator point of view, but also from the level of public health policy.

And that’s where it really hits you!

Saving people’s lives one by one thus making a difference in my patients and their families lives in ICU or OR or ER or PACU was wonderful and I loved every minute of my 13+ years on 2 continents and 3 countries! But, if you really want to make a difference, difference on a much broader global scale that is, you must look at the discipline of Public Health – and specifically, International or Global Public Health (as is my Masters Degree) through a different set of eyes and through completely different prism.

And this why I LOVE it so much!

In order to be successful and effective here, you must fully understand the intricacies of health care / patient care delivery, from there you must be abreast on how to deliver said services in a department or an organization, which is finally leading you to realization you can have influence through your earned knowledge and understanding over global issues, politics and public policies that are determined by international decisions via foreign policies. Those in turn deeply affect all those other social determinants of health which decide the actual individual health and well being – or not – of your people. … when they come to ICU and I can save them…

The astounding combination of my 3 professional loves and passions:  [Global] Healthcare, Politics & Administration all lead to my overall passion and I believe a certain inner sense of Global Public Health Administration. And that is why I slowly moved, over the span of several years and large sums of money for university education) from all the bells and whistles in intensive and critical care units to a global view of social determinants of health, determinants affected by political decisions.

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From Dr. Taylor’s lecture, we learned that the idea behind ‘community-based primary health care‘ is as ancient and as old as Hippocrates himself, as he began to treat sick people in the open, as in village squares where every person from the village could come and offer advice on treatment and getting better! While I don’t really agree with openly spreading germs to the village, the fact that Hippocrates did not isolate the sick, that he did not put them somewhere ‘away’ from the others, shows his initial foresight of holistic / community approach to healing and showed his outlook to the future foundation for community-based primary health care.

What I also did not know is that it was Hippocrates who first started to separate medicine from public health as he started to recognize that different geographical areas meant different patterns of diseases. That was a major fork in the road for healthcare where medicine has clearly different goals and different strategies from community-based primary health care.

images-3

Dr. Carl Taylor stated that in the early days, U.S. physicians viewed primary care as ‘individual’ care, while following approach originating in South Africa encompassed and recognized all aspects of health care in its Community Oriented Primary Care approach (COPC). Here again, many years after Hippocrates, we see the resurgence of the core idea that community is at the center of “health” and well-being of an individual thus of the collective “health” of the whole community.

In a historic context, I would compare this community centered resurgence of the South African (and later American and Israeli) approach to the recent resurgence of the principles of the Alma Ata Declaration. Lancet article (Walley et all. 2008) clearly states that the community-based or community-centered approach to public health is going through a re-birth of sorts as more and more studies show that Dr. Taylor’s SEED-scale approach, which clearly encompasses Kerrer’s South African COPC model, is an approach that takes all other, not only health and disease, but also other social determinants of health in account when dealing with “health“.

Walley says: “The emphasis must shift from single intervention to creating integrated, long-term sustainable and ethical health systems…” Nobody, not the U.N. or any NGO, can achieve this Alma Ata-centered goal without dealing with a host of other determinants. Sadly, for our global health care objectives, those determinants are decided and implemented (-or not-) by sovereign national governments.

images-1                   

Herein resides the problem.

Health does not happen in a vacuum! Very rarely do people get sick out of nowhere…

Health” happens as a result of… or a consequence to… certain political actions or social events.
The primary public health care problem we are discussing here, is a problem originating in poverty, lack of potable water, lack of safe environment, lack of developed infrastructure, lack of knowledge and awareness, and lastly, as a lack of political will.

images

That is why I applaud the resurgence of the Alma Ata principles taught by Dr. Carl Taylor and the ongoing recognition of the variety of other important aspects that influence, directly or indirectly, the overall status of public health and primary health care in particular.

In fact, it was Hippocrates who preceded Alma Ata Declaration with his vision, when he involved and engaged the whole community in the treatment and planning of healing solutions… And that concept is THE cornerstone of  Alma Ata Declaration!

Ukraine Bloodshed: Political Advisor, Manager but Humanitarian and Nurse First n’ Foremost

Feb 20, 2014

Ukraine in flames

February 20th, 2014 in Sacramento, CA. USA

I was a young Czech nurse when the atrocities were happening in the Balkans, and NOBODY from the EU moved a finger, nobody helped them! I often asked myself what would have I done…?

While I had no influence over it, as after the Velvet Revolution in Czechoslovakia, after 40 years of oppression, and 20 years of Soviet occupation, I finally was allowed to travel abroad and I left home.

I looked after children, cleaned houses and pubs, learned English by myself at nights, held 2-3 jobs in order to follow my dreams of studying and obtaining my Nursing licenses in Canada & USA, only to go further towards my biggest dreams of earning multiple university degrees in global politics, global health & regional development & administration at prestigious U.S. universities (CSUSM and UM). CSU grad kept her ‘eye on the goal’ – San Diego Union-Tribune  San Diego Union-Tribune regional newspaper did an interview with me about my road towards BA in Political Science  Magna Cum Laude coming from post-Communist country.

To this day, I am ashamed to be European for our utter failure in the Balkans! Seeing the almost unrepairable damage that conflict left until today, over 18 years later, is utterly heartbreaking. We all bear responsibility.

For better or worse, the ONLY leader who proved to LEAD was U.S. President Clinton, who due to the long-standing ‘Monroe Doctrine’  did not and could not put “boots on the ground” as Americans love to say, but instigated aerial raids. President Clinton’s role in this conflict is being discussed even today, however, speaking as someone who has deep historical roots to the Peoples abandoned and left behind Ukraine needs the change to come from withind by the Western powers in their time of need, without any help… (The Munich Agreement of 1938, The Prague Spring of 1968 -> followed by foreign invasion of my beloved homeland by 5 foreign armies, led by, you guessed it, the Soviets and their criminal leader Leonid Brezhnev). Trust me when I tell you, you want help, any help!

It is only here, in this country, where we have the incredible luxury to discuss and criticize actions of which we quite often know very little. BUT, let me finish, it is a part of our political system, it is a part of democracy and as a democracy “groupie” myself, I fully respect and admire this system very much. In fact, I have been actively involved in the post-communist transition to democracy and democratization of institution in Czech Republic on the local political level for past 20 years, and it is Job’s job. It is only when you are on the ground, demonstrating against the power that is usurping you and denigrating you, waving your flags, being beaten and shot that you are looking towards the skies hoping to see some allies and The Allies!

For my beloved Czechoslovakia in 1968, the year my amazing parents got married and sadly also the year their HOPE and DREAMS were squashed by the Soviet invasion, there were, for very obvious Cold War reasons, no sky allies or any Allies…  And we (as in my fellow countrymen, since I was not even ‘an idea’) were looking up and waiting, every day! In the years afterwards, during the deep Normalization process (just a different word for Communistic indoctrination enforced by Soviets), we were secretly listening to the Radio Free Europe and Voice of America (both I believed financed by the US) in our basements, faced with hard jail time if caught, waiting for hours to hear our country even being mentioned! And this is how people of Ukraine feel today.

We are amalgamate of our previous experiences, and I really do “FEEL” the past plight, hurts and betrayals of my people and my country. Well, visiting every concentration camp around during yearly school ‘day trips’ since 2nd grade left DEEP scars and nightmares in my soul. At the same time, it also cemented such un-moveable human resolve, built foundation for my ‘Fight-or-Flight‘ (political not systemic) response, and cemented my strong sense of protection, responsibility for others, and especially for the weaker and for those who at that time were /are unable to look after themselves => any more questions why I am a nurse, political operator and a humanitarian?   No, did not think so 🙂

We have a collective responsibility and we have obligations.

Now as a proud (dual Czech and) U.S. citizen and highly degreed and educated RN, at this point my love & passion for politics, strategy and campaign goes away and my nursing  and humanitarian responsibility takes over. That is exactly WHY I DO politics, to PREVENT this! However, once you cross over a certain threshold, it is no longer about my ability “to do” politics but about my ability to “take care of people”. People need help no matter who is shooting at them and my nursing training and practice precludes me from judging my patients, and that I had some I did not like in my 15+years! Period.

EU lagging behind, always

I wrote an article last May 2013 year asking Should the EU Care about Syria? The Balkans, anybody..?!?

Now, as if I had a premonition, similar problem is on the border with our Czech brothers, Slovakia! (and Poland, Romania & Moldova on my EU side) and the EU is STILL discussing and issuing statements about ‘freezing assets’ of the bad guys – on both sides. OK… and how is that gonna work from a logistical point of view, and MOST importantly, HOW is this gonna help the dying people of Kiev? This piece is NOT debating blame or who started what, this piece is strictly concerned with the PEOPLE and their medical and human needs. Period.

Knowing how Russian tyrant Putin feels about Ukraine since he considers it to be a part of his Mother Russia, holding them hostage at will over access to natural gas and other resource… and hearing as a freedom loving and globe trotting Czech the same tyrant Putin saying that he ALSO consider my Czech Republic to be still under their sphere of influence, my heart stopped! We’ve already been there, it was hell, and nobody wants to go back…

It is my unequivocal belief we all have global roles to play, we all can help and serve wherever we can. Thus I am able to feel the plight, fear, resolve but also the uncertainty of people of Ukraine. I promised myself, I will never sit on the sidelines, and I never do, should anything like that started to happen again especially in or around my original homeland and Europe.

I believe, this is my calling and my responsibility.

I can never let the Balkans repeat. Ever!

Awareness, Responsibility

http://www.usnews.com/opinion/articles/2014/02/20/ukraine-doesnt-need-sanctions-from-the-united-states-or-the-european-union?src=usn_tw

Tagged:

Stability: International Journal of Security & Development
University of Miami, Master of Arts in International Administration (The MAIA Program)
USAID – US Agency for International Development
International Rescue Committee
FEMA Federal Emergency Management Agency
CDC Emergency Preparedness and Response
People in Need – Official
The Relief Foundation, Inc.
USF Global Disaster Management & Humanitarian Relief
ReliefWeb
Humanitarian Assistance Program
European Commission – Humanitarian Aid & Civil Protection
Human Rights Watch
U.S. Department of Health and Human ServicesSee More

How does your humanitarian passion look like in 150 words?

Humanitarian aid.

Humanitarian aid. (Photo credit: United States Forces – Iraq (Inactive))

How does your humanitarian passion looks like in 150 words?

Humanitarian work, emergency planning & preparedness, disaster relief, deployment to affected regions and being on the front lines of people needing immediate and urgent help has always been my passion!

Ever since working as a nurse in Emergency Dispatch Unit & Urgent Care, or running to and managing Code Blue life-or-death situations and emergency C-sections at any given moment as a Nurse Anesthetist in a regional Czech hospital, always helping & saving people at the side of the road giving first aid or CPR (2x already), all the way to working 10 years as a critical care nurse responsible for the fundamental survival of very sick patients in ICU & Post-Anesthesia Unit while responding to hospital emergencies and Code Blue events again in an American hospital, my passion, enthusiasm, interest and dedication has always been there.

Whether it is organizing, managing, administering, itemizing, transporting or distributing disaster relief during 3-4 deployments to Haiti, bringing supplies to Africa, or immediately jumping in and doing all of the above on behalf of a city during several devastating events of massive floods in my home country of Czech Republic, seeing and experiencing both the human and material loss, I have always been very appreciative I can serve my global community with compassion, professional knowledge, technical expertise and advanced education.

This is how my passion looks like in 150 words!

How does YOURS look like??