Swine flu is making its roots firm worldwide. Till now more than 450 deaths have been reported worldwide. Recently, the spread of Swine flu is being reported in the India. Swine flu is basically a disease caused by the H1N1 virus that infects pigs. This disease has been spread from the pigs to the humans. The first outburst of this disease was noted in 1918. Many people were infected by Swine flu; the number was noted to be around five hundred million. The deaths reported were between 50 million and 1 hundred million. Later on it was observed in 1976, 1988, 1998, 2007, and now in 2009. This disease gets transferred by the H1N1 infected pigs to the humans basically in the pig farms. There is no need to worry as the Swine flu is curable. Vaccination is also available for the disease. But, I would always suggest that prevention is better than cure.

Here are some precautionary measures for swine flu?

1. The first precautionary measure is to avoid contact with the pigs (swine). If you have pigs in your area then please inform the local municipal office so that he can take care of those pigs by keeping them isolated.

2. Swine flu is communicable disease, so use the face masks to protect from the swine flu antigens.

3. Cover your nose and mouth when coughing or sneezing, using tissue when possible. Dispose this tissue by using only once.

4. Avoid visiting the crowded places like theaters and prayer halls. This can be the spreading ground for Swine flu

5. Maintain good hygiene. Wash your hands frequently with soap and water to reduce the spread of virus. It would be better if you use alcohol sanitizers or Dettol for washing hands.

6. Take a special care of children because they easily get infected with the Swine flu. It is okay if you don’t send them to school for few days. Many schools have even announced holidays.

7. Avoid eating outside food because it may be contaminated and may make you infected with the virus.

8. Don’t use the public urinals because many people spit there, which could lead to the spreading of the disease.

9. Drink the boiled water only.

These are the precautionary measures for the Swine flu. If you follow these then there are no chances of getting infected with Swine flu.

Note: There is as such no vaccination against the Swine flu; many companies are making fake announcements. Yes, you can cure it with the help of the pill known as Tamiflu.

I never in my wildest dreams imagined women’s underwear styles would one day become a major–even ruling–interest in my life.

It would have seemed as unlikely as winding up in a nursing home while still in my early 50s.

Yet both happened–simultaneously–earlier this year.

For reasons that will become obvious I developed what I ultimately called a “bottometer” to predict daily attitude (health, happiness, etc.) while confined in a skilled nursing facility. It was a negative scale. The more repulsed and aggravated and irritated I was by unwanted, yet unavoidable, closeup views of VPL’s and/or panties and/or their silhouettes, the better I actually felt overall.

The sight of a low-rise crimson tanga with a broad black lace trim screaming through stretched white poly-cotton pants could raise my ire (what could she possibly be thinking) enough to provide me with adrenaline sufficient to last a day or more.

But I’m getting ahead of the story.

Brief: A traditional rise panty with full coverage in the rear. For a modern take on a classic silhouette choose a brief in seamless microfiber. –Bare Necessities® Panty Glossary  

My dining companions at the nursing facility were three older women with long experience with nursing homes–in general and with this one in particular. Two were in their late 70s and one was in her late 90s (she was the most independent, able to wheel herself around in a wheelchair). All of them loved to sing and I was always willing to join in with them. I surprised them by not only knowing favorites like “Bicycle Built for Two” and “Ivan Skavinsky Skavar” but also standards like “Twilight Time” by The Platters:

Heavenly shades of night are falling
It’s twilight time
Out of the mist your voice is calling
It’s twilight time
When purple colored curtains
Mark the end of the day
I hear you my dear at twilight time

We got along very well.

Their most consistent complaint (and it came up daily in one form or another) concerned aides who “dressed like sluts” and “always seem to be scratching”–even in church.

I hadn’t noticed the latter habit, but once pointed out to me I couldn’t seem to escape it. It was, after all, happening at eye level.

“Would you like dome more coffee?” an aide would ask–handing me a cup with one hand while scratching away with the other.

My companions’ theory was that if those aides cared so little about themselves you just knew where we ranked.

One day one of the younger women, who had been uncharacteristically morose during the meal, suddenly burst into tears.

We discovered, in bits and pieces over time, that earlier in the day an aide had wheeled her out into the hall in order to do something in the room. The aide then went around a corner and promptly forgot her.

“I could hear her every once in a while—she was complaining to another aide about how a resident had filed a complaint against her and how terribly unfair it was—but she just left me there. After a while—a half hour or more–I really needed to use the restroom. But I was stuck out there with no way to call anyone for help. I yelled a couple of times, but nothing.”

What happened next wasn’t the worst case scenario, of course—that would be death—but it was adequately humiliating. My companion was left feeling helpless.

“I’ve placed my life in the hands of someone so stupid she wears a bright red bra and panties under a white uniform. I guess I should be glad I only wet my pants.”

“Well,” another of the women said, “her chartreuse undergarments are even worse. I think they glow in the dark.”

We had to laugh—it hurt too much not to.

Bikini: A moderate coverage silhouette offering more coverage than a thong, but not as much as a brief. Bikinis have waistbands which usually lay somewhere between the navel and hip (unless Low Rise) and have semi-hi-cut legs and a moderate coverage back. String bikinis offer considerably less coverage than an average bikini. Bikinis are a super comfortable medium coverage silhouette that won’t show thru under heavier fabrics like denim or wool. –Bare Necessities® Panty Glossary

When I was in nursing school 30-plus years ago several of the older biddy nurses spent what seemed an inordinate time on appearance.

At that time female to male ratio in nursing was about 18-1 and we men were novelties.

The dress code called for a white skirt and “one or two slips as needed” along with a white blouse “made of material substantial enough to obscure undergarments” and a smock. Dresses were discouraged but, if worn, had to be cut in such a way the hemline didn’t rise when the woman reached straight overhead. Pants were banned outright.

The older biddy nurses had been known to stand a young nurse in front of a spotlight (legs apart, hands raised ala Di Vinci) to make sure her clothing was adequately opaque.

The concession–and single rule–added for men was white pants, white shirt and white smock “of material and design commensurate with the goals of the rules for women.”

Low Rise: A panty with a rise of 7 inches or less. The rise is the measurement between the waistband and the first horizontal seam. We categorize low rise into three categories: Modest Rise–6-7 inches; Low Rise–4.5 to 5.5 inches ; Daringly Low Rise–4 inches or lower. –Bare Necessities® Panty Glossary

Another strange obsession of the older biddy nurses was the relative position of the nurse and patient. There were right ways for entering and exiting rooms, taking vitals, etc. Some procedures (major dressing changes for example) were “blocked” as elaborately as a Broadway play.

The major rule–one that seemed silly to us–was never turn your back on the patient. Like a television evangelist, you were supposed to go about your task without ever completely breaking eye contact—even when it required contortions.

What the older biddy nurses didn’t tell us (or at least the men) but almost certainly knew was a person stuck in a bed or wheelchair or even chair has a butt-high line-of-sight. Add that to the unavoidable close proximity involved in nursing care and the consequences start at unpleasant and move downward. I never really understood this until I changed roles.

Thong: A popular panty silhouette with a triangle shaped front panel, thin side panels and minimal coverage in back for a no-show look under clothes. –Bare Necessities® Panty Glossary

Make no mistake: I was in a first class skilled nursing facility and received first class care. Any complaints I make–stated or inferred–are broader than a single facility and tend to be universal.

Staff-wise at my skilled nursing facility the overall female to male ratio was about the same 18-1 as when I was in nursing school. The nurse to aide (including tech) ratio was about 1-12 and and the therapist (physical and occupational) to aide ratio about 1-6.

Everyone, but nurses and techs in particular, worked a lot of double shifts (16 or 20 hours) or quick returns (back after only 8-12 hours off). At least once I noticed none of the nurses on my floor left at shift change–although a couple changed work assignments.

The food service workers were polite and, for the most part, efficient. The cooks I met were very good and willing to make special dishes when asked in advance.

The food was better than most institutional food and at time it bordered on being very good. Soups were especially good and desserts were particularly decadent. Maintaining an appetite was not a chore.

My dealings with the administration were limited, but typical—some anonymous bureaucrat or another would get excited because this or that form was incomplete and the nurse or aide would calmly help the patient take care of it in order to “keep them off your back.”

String Bikini: A bikini with thin string sides. This traditional silhouette offers comfortable, minimal to moderate coverage. String bikinis that are seamless, or constructed of smooth fabrics like microfiber and mesh virtually disappear under medium to heavy fabrics. –Bare Necessities® Panty Glossary

All the horror stories about untrained and unqualified nursing home workers who are misused and exploited by their employers had me prepared for the worst, but they proved untrue. Yes, some were better than others and yes, some complained about their working conditions, but as a whole the employees were capable of doing their job and seemed to be glad to be doing it.

An unusually large percentage of the workers were also attending school in order to move up the pecking order in the nursing home.

Almost all of the aides were already certified, but several housekeeping and food service workers were working toward aide certification. Aides were working toward certification as med techs or lab techs or licensed practical nurses. LPNs were working to become registered nurses and two-year RN’s were working toward bachelor’s degrees.

But almost none of them said they were working on advancement as a way to get out of nursing homes. While the rest of the medical world may look down on nursing home workers, many of the workers at this nursing facility said it is closer to the old-fashioned ideals of nursing that made them get into the field in the first place.

Tanga: A moderate to minimal coverage European panty silhouette with back coverage that is more than a thong but narrower than a bikini. Tangas are a comfortable way to transition from a bikini to a thong. –Bare Necessities® Panty Glossary  

I was checked and settled in by a nurse who had no visible panty lines–something I didn’t appreciate at the time, but soon came to realize had been very special. Of my generation–she may have been a little younger–her attire included a blouse buttoned to the neck and a covering smock. Even though she was wearing pants, I have to believe the old biddy nurses would have approved.

What put me in a nursing home was a staph infection that required intravenous antibiotic treatment every four hours. I had just spent about three weeks in the hospital with septic arthritis in my right knee complicated by pneumonia and, of course, the infection. The physical therapy department had taught me to get around with a walker, but I was not yet allowed to do so on my own.

I had come from the hospital with a Peripherally Inserted Central Catheter, or PICC, hooked to a vein in my right arm. Six times a day a nurse came in and hooked me up to the antibiotics. Each treatment, in theory, took about half an hour. The vagaries if the IV pump and viscosity of the antibiotic IV fluid meant I was pretty much tied me to the bed for the duration of the treatment.

Additionally, four times a day—every six hours—a tech would give me a breathing treatment for asthma and the lingering effect of the pneumonia. This also took about half an hour.

Five days a week I also had physical therapy and occupational therapy–each an hour more or less. Add three meals a day in a dining facility and it’s obvious I had no long stretches of free time.

Boyshort: Boyshorts offer full coverage in a modern silhouette. Boyshorts are a perfect everyday alternative and offer comfortable coverage under clothing. A coulotte is a European version of a boyshort. –Bare Necessities® Panty Glossary  

The drastic difference between the attire of my initial nurse and her subsequently introduced aide not only set off my bottometer—which I didn’t know I had until then—it may have also calibrated it.

Just after I finished a late supper in my room (I’d missed meal time) the aide came in, announced it was my bath night, and said, “But I guess you don’t want a bath or shower yet.”

I disappointed her I could tell, but during those three weeks in the hospital I had only been allowed an occasional “whore’s bath” and was ready to pay any price for hot water, soap and shampoo.

As I said earlier, I was technically still wheelchair bound, so the trip to, and preparation for, the shower was somewhat complicated. Also, the PICC in my right arm had to be covered and waterproofed.

 The the rising and falling and pulling of her uniform (raising her arm bared her midriff, for example) during the pre and post shower procedures revealed—to my amazement and slight disgust—a taste for daringly low rise panties of hot pink lace. Continuing the theme of too much information, I also learned her left breast (ala Janis Joplin) had a tattoo of a heart; the right side of her chest was tattooed with a vine that spiraled around the breast several times before ending in a blossom on the aureole; a stylized floral motif of some kind was tattooed on the area above her pubic mound; and her right hip cheek had a tattoo of a cartoon character.

 Despite a haze made of fatigue, medication and hot steam my bottometer screamed. This is not the stuff on which dreams are made.

Hipster: A mid coverage panty, which is a moderately low rise cross between a bikini and a brief. Hipsters are a modern and comfortable take on the classic brief and are less bulky than a boyshort. Hipsters are virtually invisible under mid-rise pants. –Bare Necessities® Panty Glossary

Before breakfast the next morning a physical therapy tech came to evaluate me. I told her I could get around fine using the walker and then set about killing myself to prove it.

It worked. She put me in a category that said I could go (using the walker) without an escort to meals, activities, etc. I still had to have an escort to and from the shower, but not in it. It’s hard to describe how good this makes one feel.

Past bad experiences taught me how easy it is to loose range of motion, so I tend to attack physical therapy full force and them push my limits. If pain allowed (and I was more than adequately doped up) I’d add 10 repetitions to whatever the tech asked and always try to walk twice as far as expected.

Many of the routines involved counter pressure provided by the therapist or tech and the resulting twisting and turning for position meant there were times it felt like we were playing “Twister” or wrestling in slow motion.

During one of these awkward positions I realized the therapist was dripping sweat on me. Worse, I realized this meant I had undoubtedly been dripping sweat on her for quite some time. But we both politely ignored it and went on with the exercise.

After several weeks I progressed to using a cane—a degree of freedom that seemed unbelievable after being dependent on a walker for so long. I was even, very slowly, beginning to handle stairs. I began to believe the light a the end of the tunnel was not a train approaching a a high rate of speed.

G-String: A minimal coverage panty with string sides and back. Similar to a thong, some manufacturers use the terms interchangeably, but in general G-strings offer ultra minimal coverage. These tiny panties are virtually guaranteed to eliminate panty lines. –Bare Necessities® Panty Glossary

I’m not sure when my brain death began. It’s just something residents of nursing homes slip into. We did a lot of strength and rage-of-motion exercises for our upper and lower body, but no one was really looking out for our minds.

Sure, the aides dragged everyone they could to various activities. Get them out of their room and etc. But activities often meant little more than mindlessly staring at different walls.

My roommate watched television every waking hour he wasn’t eating or going through physical therapy. Fortunately for me he was deaf and watched it with the captions ion but the sound muted.

I read. As often the case when faced with short snatches of time to fill I read passages from “Desert Solitaire” by Edward Abbey. I read it for comfort and inspiration. Abbey’s book is my “New Testament” I suppose—I carry it around as a companion. Through the years I have read it while hiking, camping, traveling, waiting. I keep copies of it in almost everywhere and have been know to force copies on friends and strangers.

“Has joy any survival value in the operations of evolution?” I read after randomly opening the book. “I suspect that it does; I suspect that the morose and fearful are doomed to quick extinction. Where there is no joy there can be no courage; and without courage all other virtues are useless. Therefore the frogs, the toads, keep on singing even though we know, if they don’t, that the sound of their uproar must surely be luring all the snakes and ringtail cats and kit foxes and coyotes and great horned owls toward the scene of their happiness.”

But Abbey began losing against the institutional soporific impress of the nursing home and I was approaching desperation when I pleaded with my son to dig out a copy of another nearly constant companion: “The Character of Physical Law” by Richard Feynman. Sure enough, he found a copy under the driver’s seat of my car (taking advantage of my confinement he was borrowing it—the car that is).

“The age in which we live is the age in which we are discovering the fundamental laws of nature, and that day will never come again,” Feynman wrote. “It is very exciting, it is marvelous, but this excitement will have to go. . .

“There will be a degeneration of ideas, just like the degeneration that great explorers feel is occurring when tourists begin moving in on a territory.”

Yes, but there will always be something new under the sun. Every answer launches a new line of questions.

“The world is so full of a number of things, I’m sure we should all be as happy as kings.” So goes Robert Louis Stevenson’s “Happy Thought.” Of course Stevenson also said, “To travel hopefully is a better thing than to arrive.”

Concerning quantum mechanics Feynman said: “I am going to tell you what nature behaves like. If you will simply admit that maybe she does behave like this, you will find her a delightful, entrancing thing. Do not keep saying to yourself, if you can possibly avoid it, ‘But how can it be like that?’ because you will get ‘down the drain’, into a blind alley from which nobody has yet escaped. Nobody knows how it can be like that.”

Paul Dirac said, “A physical theory must possess mathematical beauty.” One problem with Feynman is his beauty sometimes obscures his mathematics. Feynman makes things seem so logical we forget the underlying complexity—we think we understand more than we actually do because Feynman has made it seem so obvious.

Brain fuel for surviving IV therapy. For blacking out the fact the nurse’s underwear is so tight it has divided her bottom into what appear to be several balloons on the verge of explosion. For every action there is an equal and opposite reaction. Entropy must increase. But please, not yet.

Back to Abbey:

“Civilization is Jesus turning water into wine; culture is Christ walking on the waves;

“Civilization is a youth with a Molotov cocktail in his hand; culture is the Soviet tank ort the L.A. Cop that guns him down;

“Civilization is the wild river; culture 592,000 tons of cement;

“Civilization flows; culture thickens and coagulates, like tire, sick, stifled blood.”

Hi-Cut Brief: A moderate to full coverage panty with a very hi-cut leg. Some women find that hi-cut briefs offer a bit of tummy shaping. –Bare Necessities® Panty Glossary

When I was finally given my walking papers from the skilled nursing facility I faced one final hitch. The nursing facility rules said the PICC in my right arm could only be removed by a registered nurse. Unfortunately my wing didn’t have an RN on duty at the time. One would have to be brought in from another wing.

She was, of course, busy with patients on her own wing and then busy with patients on other wings who, for one reason or another, required the services of an RN. I ended up waiting—futilely—for several hours.

Then—at shift change—my LPN grabbed an incoming RN in the parking lot and convinced her to take care of me before she reported to her own wing.

The RN was very nice and seemed very professional, but when she bent over to remove the PICC the waist of her pants—inches from my nose—pulled down just enough to reveal a tattoo of a butterfly. Framed by the straps of her thong.

My bottometer told me I wasn’t leaving a moment too soon.

 White ladies pants
Upon the old clothesline;
Polka-dotted bloomers
Oh my gosh they’re mine!
Oh don’t you wish
That you could wear them too?
That will only happen
When the seat wears through.

Report on 2009 World Market Forecasts for Imported Preparations for Perfuming or Deodorizing Rooms ( http://www.bharatbook.com/Market-Research-Reports/Report-on-2009-World-Market-Forecasts-for-Imported-Preparations-for-Perfuming-or-Deodorizing-Rooms.html ) Provides all information of Preparations for Perfuming or Deodorizing Rooms market worldwide.
 
 
 This report was created for strategic planners, international marketing executives and export managers whose primary concern is the world market for preparations for perfuming or deodorizing rooms. With the globalization of this market, managers can no longer be contented with a local view. Nor can managers be contented with out-of-date statistics that appear several years after the fact. A methodology is developed, based on macroeconomic and trade models, to estimate the market for preparations for perfuming or deodorizing rooms for those firms serving the world via exports and foreign direct investment. It does so for the current year based on a variety of key historical indicators and econometric models.
 
 In what follows, this report begins by summarizing the world exporter’s market for preparations for perfuming or deodorizing rooms. The total level of exports on a worldwide basis is based on a model that aggregates across over 150 key country markets and projects these to the current year. From there, each country represents a percent of the world market. This market is served from a number of competitive countries of origin. Based on supply-side dynamics, market shares by country of origin are then calculated across each country market. These shares lead to a volume of import values for each country and are aggregated to regional and world totals. In doing so, we are able to obtain maximum likelihood estimates of both the value of each market and the shares that competitors (countries serving that market) are likely to receive this year. From these figures, world rankings are calculated to allow managers to prioritize markets. In this way, all the figures provided in this report are forecasts that can be combined with internal information for strategic planning purposes. Of the 150 countries considered, if a country is not reported here it is therefore estimated to have only a negligible level of trade in preparations for perfuming or deodorizing rooms (i.e. their market shares are close or equal to zero percent). “Preparations for Perfuming or Deodorizing Rooms” as a category is defined in this report following the definition given by the United Nations Statistics Division Classification Registry using the Standard International Trade Classification, Revision 3 (SITC, Rev. 3). The SITC code that defined “preparations for perfuming or deodorizing rooms” is 55354 . This report is updated on an annual basis.
 
 For more information please visit : http://www.bharatbook.com/Market-Research/Deodorants.html
 
 Or
 
 Contact us at:
 
 Bharat Book Bureau
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 Email: info@bharatbook.com
 Website: www.bharatbook.com

It may seem like a strange question. But if you are making efforts in your everyday life to be green, it should extend to that most private of rooms. And we are not talking paint, here! We are talking about what you are and are not doing to make your bathroom more Earth-friendly.


In addition to the environmentally sound things you already do, such as recycling and using those dandy reusable grocery bags, there is much more you can do to live a greener life.


Think about your bathroom…really think.


1. Water usage


Water conservation is a bigger deal than most people might think. It takes energy to heat water, and unless you are using all solar or wind energy all the time, you are burning fossil fuels in order to have hot water and a toilet that does not sweat in the summer. Consider switching to a low-flow shower head or even a water-conserving toilet in order to both save water overall and decrease energy usage. (If you have a water bill, your savings will help pay for switching.) Get into the habit of conserving water during your daily routine. Turn off the water while brushing your teeth, shaving your legs, or waiting for your conditioner to do its job. In the bath, consider not filling the tub as high as possible. Use the lowest water temperature you can stand while showering, and set a timer for three minutes. (If you can’t get your body clean in three minutes, there is a problem!) And if you have kids, train them from an early age to use the timer otherwise they will be in the shower until the hot water runs out.


2. Lighting


Daylight is free and does not cause pollution. Let light in to your bathroom, especially during the cooler seasons, and it may help heat the room. Similarly, close shades and curtains during the hotter seasons, keeping heat out as much as possible so that the air conditioning has less work to do. Switch to compact fluorescent bulbs, which use less electricity and last longer than incandescent bulbs. Buy night lights with a sensor that shuts them off during daylight.


3. Personal care products


As you use up items in your bathroom, seek out more environment-friendly skin care products, hair care products, and cosmetics, which are not only better for your body but better for the Earth because they are produced with the environment in mind. Look for labeling that designates them as organic, not tested on animals, containing all natural ingredients, and verify that the package is recyclable.


4. Towels


Consider replacing old towels with those made of organic cotton, hemp or bamboo fiber, all of which are made from renewable sources. Take it one step further and seek out thinner, waffle-weave towels instead of thick, fluffy ones as they will take less time and use less energy in the dryer. Reuse your towel several times before washing, too. You come out of the shower clean, so your towel cannot be very dirty! Always wash your towels in a full load of laundry, and use environmentally safe detergent. Old towels can be turned into a reusable shopping bag or beach tote, if you are a crafty person. Send your old towels to an animal shelter, or even cut them up for rags instead of throwing them away.


Believe it or not, you can have a big impact in these littlest of rooms by making wise choices. Thinking a bit about how the bathroom fits into the environmental “big picture,” along with taking steps such as taking reusable bags with you to the grocery store or using public transportation will go a long way toward making our planet a better place to live.

When a child is admitted to the hospital, pediatricians have the same concerns that families have: make sure the child stays safe, comfortable, and as emotionally secure as possible.



In my childcare book The Portable Pediatrician, I talk about the emotional meaning of hospitalization for children of each age group from Birth to Five. (It’s in the “What If” section of each age-based chapter, along with such challenges as parental divorce, death of a pet, arrival of a new sibling, and so on.) While I still stand by that advice, there have been three big changes since then when it comes to keeping children as safe and as comfortable as possible:



1. A national shortage of nurses, including pediatric nurses, may require parents to step up their own role as caretaker to a greater degree one would ever have expected.



2. Physician care in the hospital is more likely to be directed by a “Hospitalist,” a doctor employed specifically to care for hospitalized children. Primary care physicians are fading from the picture, and sometimes parents need to be the link among three physician groups: primary care doctor, hospitalists, and specialists (in such fields as infectious disease, neurology, cardiology.) This is especially crucial if physicians disagree, and also at the time of discharge, when follow-up instructions can be crucial.



3. Over the last few years, the study called MRI has become much more available and more casually used. At the same time, there are no governmental regulations or oversight to make sure that safety is maintained. An ordinary thoughtless action, such as bringing an IV pole into the MRI suite, can cause disaster, even death; parents need to be present and watchful to help prevent such accidents.



My book What You Don’t Know Can Kill You, discusses in detail the implications of all of these changes, but primarily for adults. Parents of hospitalized children need a different take on these matters. I hope that reading these, even casually, before a planned or unplanned hospitalization, will tell you what to prepare for.



So here is my advice for parents on each of these topics, starting with the Nursing Shortage.



Nurses: Missing in Action



We are in the midst of a critical nursing shortage. Nurses are “aging out” — half are 45 and older. So there are fewer and fewer of them, which means that they have to work longer and harder, making it tough to recruit new nurses. And even if there were lots of candidates, there is a corresponding shortage of nurses qualified to teach them.



This shortage, with its avalanche of increased demands, is particularly hard on Pediatric Nurses, who went into the profession in the first place because they really like children, and who now rarely may get a chance to interact with anything that isn’t sounding an alarm.



The bottom line here is that when you assume a nurse is going to be there, for whatever situation, there just may not be a nurse available. You, the parent/grandparent/other loving adult, must step in. To do so, you need to be familiar with the contents of the child’s room, the ward the room is in, and solutions to common and to crisis situations.



Most especially, you need to bond with the nursing and helping staff, making yourself useful without being intrusive. If something needs to be cleaned up, or fetched, or changed, see if it is possible to do it yourself — ask a staff member if you’re not sure. If you think there is a problem, present it as your concern, not as a foregone conclusion that the staff person has erred. Once you have a reputation for being positive, helpful, and reliable, the staff will be even more responsive to your requests.



The Constant Grown Up



Someone competent, loving, and familiar should be with the child 24/7, both at the bedside and accompanying the child on any within-hospital trips.



When you stay overnight in the hospital, you need to be both self-sufficient and vigilant.



Self-Sufficient: Try not to ask the staff for help with your own needs. You must be responsible for your own food, drink, and hygiene products. A hospital overnight kit for the adult should include all your personal needs, a flashlight, and a sleep mask and ear plugs. I also recommend a shrill loud whistle to wear round your neck tucked into your shirt, to use ONLY if there is a true emergency and nobody comes to help.



Protect against hospital-acquired infections: Hospital-acquired germs can be very dangerous. Hand-washing is crucial, and nurses tend to be more fastidious than doctors about this. Nonetheless, keep a rub-in hand cleanser at bedside: use it yourself, and offer it to any professional or staff member before they touch your child.



Since both children and hospitals tend to be sticky, bring along a container of disposable antibacterial/antiviral wipes, and frequently clean off the surfaces that need it most — TV remotes, telephones (including your own cell), door knobs, bed control buttons, toys and dolls.



Vigilant:



· Get to know your surroundings. Early on, get used to where these are: the Nurses’ station, the emergency exit, the source of drinkable water, and the public or visitors’ bathroom (unless you can use a private bathroom.) At the bedside, locate the “call” button for the nurse, and vow to use it ONLY in an emergency. Figure out how the bed buttons and side rails work.



· Remember that wards become darker at night. Make sure you can make your way around with your flashlight. Figure out what you are going to sleep on well before night falls, and get acquainted with that piece of furniture — and make sure it doesn’t obstruct the path to the child’s bed.



· Ask the nurse to give you a basic explanation of each of the “Lines” placed for your child. Lines are tubes: to deliver oxygen, fluids, medication, blood, liquid feedings; to collect for the lab or to evacuate stomach contents, urine, drainage, pus, air pockets. Each line should be clearly identified, so that the fluid or medication doesn’t go into the wrong tube — food into a vein, for instance. Ask how the lines are labeled or identified to be “foolproof” in this way.



And then, of course, keep a watchful eye when any substance is injected into a “Line.” If you think someone is about to make an error, speak up at once, but try to be vigilant, not offensive. “I’m sorry to interrupt, but I thought that that is the arterial line, and they said nothing should be put into it.”



If a change is made in lines — if one is going to be removed or added — make sure you understand why, and what it is for. If the person doing the procedure is one you don’t know, or is clearly a subordinate to the main doctor involved, make sure that the supervising physician has ordered the change.



Monitor your child:



Make friends with the Monitors.



Monitors are computers that receive and interpret the signals your child’s body is sending out. These signals are delivered as numbers via a “lead” placed on or in the body, transmitted by a wire to the machine. Most commonly, monitors measure heart and breathing rate, blood pressure (how hard the heart needs to work), and the blood’s supply of oxygen. Other monitors measure more special signals: the pressure of the spinal fluid, for instance.



The Settings on a monitor determine at what point the number value of each particular “vital sign” gets too high or too low, at which point the monitor should alarm. A heart rate over 150, say, or oxygen saturation under 90. These settings vary from individual to individual, depending on age and condition.



Well that’s all fine and good, but it doesn’t take childhood behavior into account. You may notice, and be alarmed, that when a monitor alarm goes off like a cat with its tail stepped on, it very often doesn’t get an instant full team response. Almost always, that’s because nurses, no matter how busy, know which children are in a precarious situation and which are not.



What if Timmy starts tantruming about the tapioca pudding and his heart rate goes up to 180? Or Nancy, also inflamed by the mere concept of tapioca, holds her breath until she turns blue and her oxygen drops, for thirty seconds, to 78? Or angelic little Franklin doesn’t like the itchy monitor leads on his chest and finger and in the space of fourteen seconds takes them all off and tries to eat them? Or chubby little Poppy sweats so much all her leads come unstuck?



But it can work the other way, too. Monitors can’t monitor everything — how a child is feeling, or talking, or behaving, or whether he looks as if he is going to throw up. They also can’t announce that even though the numbers are within the range of the settings, there is a sinister trend: say that over an hour the Oxygen Saturation falls from 100 to 93. Clearly, there is something wrong, but the alarm doesn’t go off. To spot the trend, somebody’s got to be watching the child. That’s what nurses used to do, back in the day — they would get to know their small patients and be alert to such changes. Now it’s up to YOU.



So keep your eyes open, and if you think your child’s condition is changing for the worse, press the Call Button. If no one comes, get out there in the corridor and snag the next nurse you see. Worse case scenario, blow that whistle.



Finally: yes, it’s nice to bring treats for the nurses. But even better, bring them real help, a positive attitude that assumes that they know what they are doing and have your child’s best interests at heart. A note of praise to the nurse, with a copy to the supervisor and the head of the hospital, goes a lot farther than chocolates. If you really want to bring a treat, fresh fruit is appreciated even more than processed sweets by most nursing staffs.



When you get home from the hospital, it’s always appreciated if you can drop a note to your pediatrician to report on your stay, and any comments on the care your child received.



Copyright © 2007 Laura Nathanson



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