Who among us remembers the billboards and advertisements for the Coppertone baby?  You know, the one where her little dog was pulling down her bathing suit bottom and showing her tan?

Every summer when I was growing up, my parents would pack up their six fair-skinned Irish kids and head down to Wildwood, NJ.  Before heading to the beach, I remember my mom slathering me with Coppertone. I don’t know what SPF it was; but I do know that years later, my back is still a freckled mess.  I visit a dermatologist annually to keep tabs on those freckles.

Today, we know there’s no such thing as a “healthy” tan. Far from it. Although advertising has conditioned us to see tanning as attractive, studies have proven that both sunburns and tanning assault the skin’s DNA.

So while you’re planning your summer getaway, remember these tips. 

• Wear Clothes.  Seems like a simple piece of advice, doesn’t it?  Shirts, hats, shorts, and pants shield your skin from the sun’s harmful ultraviolet (UV) rays.  A long sleeved shirt is a good start.
• Sunburn – the skin reddening caused by overexposure to the sun’s ultraviolet (UV) radiation — may seem like just a temporary irritation, but sunburns can cause long-lasting damage to the skin.
• Find Shade. Or make it. Picnic under a tree, read beneath an umbrella, take a canopy or umbrella to the beach.
• Plan Around the Sun. If you can be flexible scheduling time outdoors, go outside in the early morning or late afternoon when the sun is lower in the sky.  Ultraviolet (UV) radiation peaks at midday when the sun is directly overhead.
• Babies under six months old should never be exposed to the sun.  Their skin is not yet protected by melanin.
• Babies older than six months should be protected from the sun and wear UV-blocking sunglasses to protect their eyes.
• Children are especially at risk. One blistering sunburn in childhood or adolescence more than doubles your chances of developing melanoma later in life. Don’t take the risk. Protect your child.
• Don’t be fooled by labels that boast high SPFs.  Anything higher than “SPF 50+” can tempt you to stay in the sun too long, suppressing sunburn but not other kinds of skin damage. The FDA says these numbers are misleading. Stick to SPF 15-50+, reapply often and pick a product based on your own skin, time planned outside, shade and cloud cover.
• Ingredients matter. Avoid the sunscreen chemical oxybenzone, a synthetic estrogen that penetrates the skin and contaminates the body. Look for active ingredients zinc, titanium, avobenzone or Mexoryl SX. These substances protect skin from harmful UVA radiation and remain on the skin, with little if any penetrating into the body.
• Special Message for men: Wear sunscreen. Surveys show that 34% of men wear sunscreen, compared to 78% of women. Quit being a stud and start using it now to reduce your cumulative lifetime exposure to damaging UV radiation.
• Got your Vitamin D? Many people don’t get enough vitamin D, which skin manufactures in the presence of sunlight. Ask your primary care provider to test your Vitamin D level.  Ask also for recommendations on supplements.  You can also increase your Vitamin D by spending a few minutes in the sun without sunscreen.   Emphasis on “a few minutes.” Again, check with your primary care provider for advice.
• Sunglasses are essential. Though Hollywood may argue with me, sunglasses are not just a fashion accessory.  Sunglasses protect your eyes from ultraviolet (UV) radiation, a cause of cataracts.  So, don’t go out in the sun without your Foster Grants!

Instead of a tan, go with your own glow!

For more information about sun safety, visit the Skin Cancer Foundation at www.skincancer.org or the Environmental Working Group’s 2010 Sunscreen Guide at www.ewg.org/2010sunscreen/.

Nurses, doctors, techs, clerks, we’re all human.  Many of the staff at BI/Deaconess may have known some of the victims of the bombing, maybe had known the MIT police officer who was shot and killed.  Who knows, they may live in Watertown, MA, the town where he was captured.  And yet, when the young man suspected of carrying out the atrocious violence arrived needing treatment, they needed to somehow put their feelings aside and treat him with no judgment.  And trust me, having cared for patients who were criminals—none who had carried out such heinous acts–it’s hard, but they will do it.

They will do it because they are professionals who not only are licensed, but who have taken oaths to serve their patients to the best of their abilities (among other things).  But, still, they are human.  And likely they were watching the news throughout the week after the bombings.  So, today, as I go about my day, I will be thinking of the physicians and nurses, and all the ancillary staff who will be involved in caring for this young man.  It is not going to be easy.

I WAS lucky enough to actually get the CNO on the phone, but that was where my luck stopped.  Upon introducing myself and explaining why I was calling, she launched into a voice-raising tirade that her nurses “were not going to give any medical information over the phone.”  I was surprised by the energy behind her resistance.  Even when I calmly pointed out that the patient had signed an authorization and had identified us as able to speak with staff on her behalf, she would not relent.  Did I mention it was Friday afternoon?

Not in the mood to argue with her, I tried my best to de-escalate and get off the phone knowing I was not going to change her mind.  When she persisted, I did consider ever so briefly that I wanted to say, “OK, so your nurses won’t give medical information.  What information WILL they give??  Flight information?”  Just to poke her into realizing the absurdity of what she was saying.  After all, it’s a hospital!

As it turned out, I finally did speak with the hospital attorney who agreed that the signed consent did give us the ability to speak with the nursing staff AND the physician staff on the patient’s behalf.  We did get the information we needed to help the patient and her family.  And I gently suggested to the attorney that she might want to speak to her Chief Nursing Officer and update her on the legal guidelines that her nursing staff SHOULD be following.

It makes me sad when nurses block other nurses (or anyone for that matter) when there is no good reason other than obstructing the flow of communication.  And we wonder why healthcare needs reforming!

Recently, we were working with a patient who had been hospitalized for several weeks.  Several transfers through different units in the hospital contributed to the family’s confusion about their mom’s plan of care.  They had a multitude of questions….Was she going home?  Which doctor was covering her?  Why was she having more trouble breathing?  Guardian Nurses got involved and began to initiate requests for a family meeting so that the clinical team could sit down with the family and explain what was going on. 

Our requests went to physical therapy, and social work, and various other integral departments.  Then we asked nursing.  More specifically, the nurse manager on the current unit.  (Understand that throughout the hospital there were signs touting the facility’s patient centered care and high patient satisfaction scores.)  It took a little while before we got a response because the nurse manager was out of her office. 

When she did become aware of our request, she told our nurse advocate that she would not be able to attend the family meeting because she had a budget meeting.   Incredulous, the nurse advocate tried to gently point out the irony but the nurse manager was not amused and maintained that she could not attend.  

Patient centered care?  Sure, as long as it doesn’t interfere with any meetings!   

Patient centered care is just that—PATIENT CENTERED.  Not bureaucracy centered.

It’s not our team I’m worried about!  It’s the other guys!

Just this week, we had two cases of hospital staff not wanting to speak with us DESPITE a signed HIPAA form being on the patient’s chart.  When asked “why not?,” the nurse responded, “I have to check with my manager.”   Check with your manager about what? 

In the other case, our patient/client was talking with his nurse advocate on the  phone when the nurse assigned to him came into the room.  Since we had wanted to talk with her, our patient thought he’d just hand the phone over to his nurse and we could talk with her.  He said, “I’d like you to speak to my nurse advocate, Debbie, and answer some of her questions.”  The staff nurse accepted the phone and proceeded to tell Debbie, “I’m sorry, I can’t speak with you. I don’t have the patient’s consent.”  Um….have you ever heard of verbal consent?

I understand the need to maintain patient’s privacy when it comes to healthcare information.  But using HIPAA as a tool to NOT communicate with a patient’s family or advocate is not the intent of the law.  If a patient consents, whether it be a signed consent form or a verbal consent for a phone conversation, it’s consent. 

The #1 problem in healthcare today is communication.  Don’t use HIPAA to make it worse!

What about families who, in addition to preparing for the storm, were also  caring for or dealing with loved ones with dementia or Alzheimer’s Disease?  We say thanks for many things, but having a capable, functioning mind in the midst of a storm should rank right up there near the top! 

As we learn from yet another natural disaster, please take note of the information below to better prepare your loved one with dementia for the next storm or evacuation.

Advance Preparations

• If your loved one lives in a residential facility, find out about its disaster and evacuation plans. Ask if you will be responsible for evacuating your loved one.
• Prepare an emergency kit whose contents might contain:
  • healthcare provider’s name and phone #s
  • spare pair of eyeglasses
  • velcro shoes/sneakers
  • supplies of medications
  • easy on/off clothes
  • incontinence products
  • extra ID items such as ID bracelet
  • copies of legal documents
  • copies of medical documents that indicate current condition and current meds
  • copies of insurance and social security cards
  • use waterproof bags to hold meds and documents
  • recent photograph of the person
  • bottled water
  • favorite item or foods, liquid meals
  • pillow, toy, or something else to hug
• Consider enrolling your loved one in Medic Alert + Alzheimer’s Association Safe Return, a 24-hour nationwide emergency response service for individuals with dementia or Alzheimer’s that wander or have a medical emergency.

Pending Storm or Disaster

• Get yourself and your loved one to safe place
• If need is to evacuate, do not delay. Try to leave as early as possible to minimize long delays in heavy traffic
• Alert family, friends, medical personnel that you are changing locations, and give them your contact info. Keep them updated as you move.
• Purchase extra medications
• If your loved one uses oxygen, be sure to obtain portable tanks.
• Make sure other people, besides medical personnel, have copies of your loved one’s medical history, meds, family contacts and healthcare provider information.

During an Evacuation

People with dementia are especially vulnerable to chaos and emotional trauma. They have a limited ability to understand what is happening, and they may forget what they have been told. Be alert to potential reactions that may result from changes in routine, traveling, or new environments.

• When appropriate, inform other (airline attendants, hotel or shelter staff) that your loved one has dementia and may not understand what is happening.
• Do not leave your loved one alone. It only takes a few minutes to wander away and get lost.
• Changes in routine, traveling and new environments can cause agitation, wandering, increase in behavioral symptoms including hallucinations and sleep disturbances.
• Do your best to remain calm. Your loved one will respond to the emotional tone you set.

(With thanks to the Alzheimer’s Association.)