30 - Sunday, June 21, 1987 - North Shore News A healthy responsibility Concern for wellness cannot, of course, be left to the senior years. We all have a responsibility to care for ourselves in a manner that provides us with the best chance for maintaining good health. Awareness of the value of nutrition and exercise and the harmful effects of the abuse of alcohol, drugs and tobacco continues to grow. The increasing determination of members of the community to live and work in a healthy en- vironment is evidenced in regulations such as the ones restric- ting smoking in work and public places, Lions Gate Hospital has joined the growing number of hospitals that are providing a safer and healthier environment for patients and staff by severely curtailing the areas where smoking is permitted. The enjoyment of being fit benefitted the hospital in the se- cond annual May 24th Lions Gate Medical Research Run, co- sponsored by the North Shore News. Pledges on runners raised funds for research aimed at enhancing health care for members of the North Shore community. Whatever our fitness level, we owe it to ourselves, our families and our community to become more knowledgeable in achieving and maintaining our own optimum state of good ealth. Nursing in today's hospital The public's perception of the role of nursing in the hospital has not kept pace with actuality. Only a small number of peo- ple in any community have first-hand knowledge of how nurses function in a hospital simply because the majority of people do not become patients. So, for many, it is an out-dated vi- sion of women in white who apply a set of basic skills under the direction of the doctors. This is indeed a far cry from the real world of a hospital! The explosion of new medical technology and procedures has made nursing a highly complex, specialized and constantly changing profession. Nurses are responsible for the total care of their patients and work as a team with physicians who rely on their monitoring and assessment. Intensive Care Unit patients require one-to-one, round-the-clock nursing care. Nurses represent a large portion of the health care team of a hospital. There are 1,400 nursing staff, or 782 full time equivalent positions, at Lions Gate Hospital. Of these, approx- imately 60 per cent are Registered Nurses, The other nursing positions include Licensed Practical Nurses (LPN's), Registered Psychiatric Nurses (RPN’'s), Nurses Aides, Orderlies and Ward Clerks. The shortage of RN's trained for critical care and medical/ surgical areas is shared by hospitals across the province. The need is for highly trained nurses able to work with the pro- liferation of new technology, medicines and procedures and the responsibility for monitoring and assessing their patients. The increasingly intricate nature of nursing has made it necessary to alter the mix of RNs and LPNs on hospital wards to include a greater proportion of RN's, The emphasis of the LPN's training on basic personal care makes them well-suited to nursing stable, convalescent patients. The pressure increases The increasing intensity of care and the unremitting occupan- cy rate places enormous pressure on the nursing staff at LGH. New equipment and new procedures, such as microsurgery, requires continual, intensive train- ing of OR staff. Last year there was an average of 10 more patients in the hospital to care for every day than the year before. More surgery is being performed every year — 15,050 procedures last year. The psychiatric ward has been extremely busy all year with the nursing staff caring for a number of acutely disturbed pa- tients. During the summer, Emergency coped with at least 24 extra visits each day — in August alone there were 752 more visits than in the previous August. It is not uncommon for the hospital to literally have a “full house” — more than 100 per cent occupancy with patients too ill to be released sleeping on stretchers in Emergency waiting for a hospital bed. Not only are there more patients, the patients are sicker. There are no “walking wounded’, no recuperating patients, no patients getting back on their feet after relatively minor surgery, With a growing demand for a severely limited supply of beds, only the most acutely ill are hospitalized. This means a con- tinually high stress level for the nurses. The patients need more intense care, constant monitoring. The nurses are employing complex, advanced equipment and potent new drugs and car- rying out increasingly complicated medical procedures. The Intensive Care Unit is an ‘llustration of the union of ad- vanced technology and concentrated care in today’s nursing. Patients in the six-bed unit need one-to-one, round-the-clock nursing care. The nurse does not leave the patient’s side dur- ing her 12-hour shift unless relieved for a break by another nurse. Most of the patients are unable to breathe unaided and are on ventilators which must be closely monitored. A patient may be attached to as many as four invasive lines measuring heart rate, arterial pressure, blood pressure in the heart chamber and intercranial pressure with the four readings monitored con- tinuously on the screen of one of the new Hewlett-Packard Monitors. The sightest change or deterioration in patient con- dition can be instantly recognized by a nurse trained in the subtleties of the patterns. Last year the Intensive Care Unit averaged 103 per cent oc- cupancy (a seventh bed can be pressed into service) and the high stress nature of the care is responsible for many nurses “burning out” and moving to other nursing areas. Operating Room nurses in a community hospital such as LGH must practice a versatility achieved through continual training. Instead of specializing in a particular area of surgery, they must be knowledgable, up-to-date and skilled in a whole range of surgical procedures. The hospital is performing both more surgical procedures on older patients and increasingly more complex procedures on patients of all ages. Joint replacements such as hips, shoulders, knees, fingers and even toes are very individualistic and require farniliarity with the con- stantly changing replacement designs. Procedures such as microsurgery and removal of tumours with the new Cavitron, which breaks up lesions by vibration, utilize very specialized, delicate equipment that requires great precision and intensive training of the nurses in the operating theatre. The increase in day surgery means that a single operating roorn may deal with as many as 16 patients a day. Nurses in day surgery must provide individualized nursing care for many different patients with many different needs during the course of a shift. seme Nurses on a medical/surgical ward receive major surgery pa- tients and transfers from the Intensive Care Unit. Many are on total parenteral nutrition, receiving all their nutrition through intravenous feedings because their systems are unable to ab- sorb nutrition taken by mouth. As on all wards, potent new drugs and complicated treatments, such as constant insulin infusion for diabetes patients, require precise understanding and careful observation and control. A rapidly changing field “Nurses are continually updating information, training on new equipment, learning about new drugs and procedures. If you are out of the field for a few months, you are behind. | notice it even after a 10-day vacation’ Diane Churchill, Head Nurse Medical/Surgical Ward. The pressures of patient care make it impossible for any but a very limited amount of training during the course of a work- ing shift. Most in-service training — the crucial updating of in- formation, acquisition of new knowledge and skills, and instruc- tion in the operation, monitoring and care of new equipment — takes place during a nurse's off-duty hours. It is common for a nurse to work a night shift, come in to the hospital for an in-service training session during the day, and work the following night shift. It is the equivalent of a worker with a nine- to-five job going to the office in the middle of the night to be trained on new equipment. Reassurance is a vital part of nursing care. Some things don’t change “Very many things are added te nursing. nothing is taken away" Donn Still, Head Nurse ICU. While nurses keep pace with scientific and technological ad- vances, they still must continue to fulfil their traditional role. The comforting, caring and reassurance provided by the nurse is more vital than ever to the well-being and recovery of the hospital's acutely ill patients. Patients must be fed, washed and made comfortable. They need emotional support and teaching to learn to cope with the nature of their illness or surgery. They and their families turn to the nurse for explanations and as a go-between with their doctor. They know the face and the voice that is always there, even in the middle of the night. They know that the nurse is the human bridge between the patient and the health care system. LGH'’s well-received public forums were filmed for television.