Code Blue Cath Lab

"code blue" free ai image from www.craiyon.com

I hunched over at my desk, again trying to keep up with the incessant flow of emails in my inbox. I was staring at my coffee, now lukewarm, and I could see the creamer curdling on the inner rim of the paper cup next to my phone as another sick call came in from the staff, informing me that another person would not be there to fulfill staffing needs in our department.

My ergonomic work example will never make it to the safety messages where we are reminded to sit up straight, keep feet flat on the ground in good posture, and ensure the computer screen is at eye level to reduce strain on the neck and back from sitting. Most days, I sit at my desk with the hips of my chair low enough to spring, leapfrog up, and dash out of the office quickly. Realistically, I sit in a way that makes it look like I am about to dive right into my screen.

Email management, somedays, is like breaching a damn, and unfortunately, the spillway of messages from separate departments comes continuously, some needing immediate responses; some emails don't make a bit of sense and are often written in a way that assumes you know what the sender is communicating, email etiquette as it is is an art, and some have not learned the skill.

It is difficult to sit at my desk and find time to peal away and round; however, it is an automatic one that raises and lowers, and to my left, a space heater that is on a medium setting every day, excluding weekends because the average temperature in the office is around 55 degrees, cold enough for me, to keep a heater running. The department is usually cold, sterile, and uncomforting, typical of an operating room environment; you never want to stay there any longer than you need to, which is the feeling you get. Most hospitals are set up that way. However, we make the office more comforting, welcoming, and warm by adding personal touches with pictures, plaques, and, most importantly, snacks, coffee, and sodas.

During the day, oftentimes, the staff drop by to say hello or get a snack from the repurposed file cabinet in the office; I do not think it has ever had an office file of paperwork with dividers in it. Instead, it became the snack shop file cabinet, and the staff prefers salty, crunchy, and fatty foods during the day to break up the routines of procedures. Feel-good foods like fatty chips, sugary candies, and caffeine are the ingredients that keep staff up and running in a cardiac procedure environment. We know we should consume the types of foods and snacks sparingly, but in a stressful, oftentimes spur-of-the-moment, ever-changing environment, how harmful can it be to staff for peace of mind and tranquility?

Typically, chips and crackers fill the cabinet with a few chocolate bars, the small ones like bite-sized, or they come by to get a coffee from the abused, worn-down Keurig. The staff also comes by to drop in for a schedule adjustment, review a pay discrepancy, or escalate a ticket for some repair needed either with the hospital building itself or with the numerous technical equipment native to the cath lab. Most of the time, they come by to get coffee and snacks and seek an opportunity to talk, share, and check in. I like it when they visit us in the office. I pause, pull my face and eyes away from the computer screen, and gaze in their direction, looking for nonverbal cues to engage and see how they are doing. Sometimes, the staff visits, and they have an agenda or a need and are obliging and ready for me to assist; I get after addressing any issues with no delays.

The ticket repair requests on an average day can be countless. However, we can often solve this immediately and get our computers, monitors, imaging equipment like X-rays, and picture-taking gear back online with a simple reboot. We continue our procedures sometimes, though we have to escalate and request a ticket to higher echelon support from industry experts and technological skills field experts to get our equipment back online when the usual restart techniques that the staff know how to do are insufficient. I always ask myself what astronauts do on the Space Station when they have computer glitches. Do they call and put a ticket into IT like we do?

Days like this are typical, familiar, and routine in the work we do in our service area, and believe it or not, code blues are also typical, familiar, and routine in our area where we treat heart problems. One day, however, was not so usual for me.

On the day that we had anesthesia available, those were the doctors who helped our patients sleep and manage their pain while we did our heart procedures. It was a standard case where we performed our aortic valve implant cases during the middle of the week. The technology to help patients is cutting-edge and innovative. It gives older adults who typically have difficulty catching their breath better ability to get dressed, brush their teeth, or give themselves a bath or shower. They need assistance with better breathing and heart function because they have leaky valves as they age. Not being able to breathe affects their ability to go to the grocery store, pick up basic needs, and do activities that a younger middle-aged person takes for granted. Again, these types of procedures are typical for the staff.

Sitting at my desk, jumping into emails, toggling back and forth between Google Chrome and Microsoft Edge, and performing administrative tasks, the overhead paging system, loud and audible, the voice booms and explodes from the speakers above, from the organization's operator, whose voice is very distinctive and articulative when she speaks, "Code blue, third-floor cath lab, code blue third-floor cath lab."

The sound of operating room doors opening more rapidly down the hallway, footsteps outside 

my office pacing a little more frantically, and an overall sense of hurry, rush, and scramble is par for the course. I get up from my desk, take a deep breath, put my pen in the v-neck collar of my thin scrub top, adjust my eyeglasses, put my paper-printed daily schedule in the left pocket of my scrubs with my iPhone, and head into the surgery procedures suites pass the warning red lines on the floor to the operating procedure area to discover which out of the five labs in our department is the code blue occurring.

I know that out of the five of our rooms, one of them is performing the aortic valve repair. As I gathered my bearings and took another deep breath in, because after 22 years of taking care of sick heart patients, although not as close as before since my new role, I thought to myself, which never gets easier, please, God, let the aortic valve patient be okay, not that the other patients are any less important or those cases any less critical or essential. Still, in my heart and mind, I could sense that my thoughts and prayers might have been silent as I saw the crowd of necessary staff, providers, and emergency professionals heading in the direction nervously and eagerly with equipment, additional supplies, and resources for life-saving, to the room and place that I feared most—the aortic valve repair. 

Teamwork 2.0

images from www.lmpartnership.org/tools/leading-change-together

Can we ask those we lead, "Are you willing to take ownership of your actions, decisions, and attitudes in the workplace?" Or should leaders hold employees accountable for their actions, decisions, and attitudes? Let us examine two viewpoints.

Accountability or Ownership

According to an article in Nursing Management, the authors suggest that workplace cultures emphasizing accountability rather than ownership are socially dissatisfying in three distinct ways (Tye et al., 2022). First, people associate the vocabulary word accountable as antagonistic. Secondly, accountability is always and ultimately personified and rarely objectified to a place or thing as being responsible for the outcome of an action, either intentionally or inadvertently; ultimately, a person is involved. Lastly, using accountability as a metric for performance promotes low expectations (Tye et al., 2022). The onus to empower others to take ownership of their actions, decisions, and attitudes and to make them congruent with their values and beliefs continues to be an area needing more attention.

Compare what Stephen Covey addresses in his book, The Speed of Trust (Covey, 2018, p. 210), accountability is associated with the trust of direct reports in any workplace where the employees know, believe, and understand that those who diverge from the workplace norms will be held responsible to their actions, decisions, and attitudes. Most people will agree that there is a fine line between the two ideas discussed. However, at least in the literature, it is worth noting that two different viewpoints exist to compare the accountability concept regarding workplace culture.

Policies and Procedures

According to Marquis & Huston (2021), organizations have policies and procedures in place to ensure that, first and foremost, a written set of goals, mission statements, and the aim of an institution are recorded, albeit in a condensed format, to guide its employees to align with the institution's directives.

Furthermore, as healthcare leadership academics, the authors indicate that policies and procedures are in place to guide healthcare practitioners in their practice according to accreditation and licensing standards for all providers. Marquis & Huston (2021) further explain that processes are written down for healthcare providers, or procedural steps available for reflection on how to do a particular task, function, or procedure in delivering healthcare services.

An organization's attendance policy is an example of a policy for professional conduct. In contrast, the written rubric or steps and processes for removing intravenous sheaths to prevent bleeding and obtain hemostasis are examples of procedural documents to guide the how-to of specific skills, operations, and actions. Both are developed to control organization and individual professionalism, organizational citizenship, and best practice models and interventions.

Policies and procedures are the guidelines that promote organizational congruency and ensure continuity of practice (Marquis & Huston, 2021). They should be evidence-based and based on best practices, ultimately providing the backbone and means for leadership to maintain a reference point for the superintendency of its employees.

Labor-Management Partnership

Can superintendency be shared in the workplace between leadership and staff? Scholars and others who have written and published extensively from experts in business relations and management strategies believe so.

Consider what Cohen et al. (2010) report when discussing the theoretical concepts of teams that work together in a unit or, otherwise known as the unit-based team approach to solving and working together to accomplish organization goals when addressing patients' ability to get access to the hospital, the patient's perception of the type and quality of care and their perceptions when receiving medical services, affordability, and medical waste reduction as well as cultural indexes of staff satisfaction in the workplace.

Most pointedly and worth noting is the correlation between the quality of the care given to patients in departments where the staff and providers have an antagonistic relationship (Cohen et al., 2010). The functionality of the teams working together ideally involves a physician stakeholder, although not always the case, staff participation, union representatives, and managers collectively to address the goals above. The literature demonstrates empirical evidence of the connection between teamwork and quality of patient care.

In summary, workplace cultures can aim for an environment where a mixture of accountability and examples of trust in all individuals in a department team are lived out and tempered to a construct of individual and team ownership. In addition, organizations have specific policies and procedures that provide the framework, structure, and guidance for organizational mission, align with industry standards and benchmarks for the patient's benefit, and provide internal control for situations where deviance and variance arise. Furthermore, recognizing the valued importance of teams in the healthcare sector improves patients' experiences. As recalled by Cohen et al. (2010), teamwork reduces the time spent waiting for patients to receive appointments and care. When organizations strive to make the workplace safe for patients and employees, contributing to lowering reported injuries, teams can positively impact safe practices.

Although these details and determinates in the scope of healthcare delivery require initiative, contributive sharing and collaboration, and appropriate resources and knowledge utilization for the best outcomes and organizational success, a reminder is that the patient is ultimately at the center of everything healthcare institutions do.

References:

Cohen, P. M., Ptaskiewicz, M., & Mipos, D. (2010). The case for unit-based teams: A model for front-line engagement and Performance Improvement. The Permanente Journal, 14(2), 70–75. https://doi.org/10.7812/tpp/09-126

Covey, S. M. R., & Merrill, R. R. (2018). The speed of trust: The One thing that changes everything. Free Press.

Marquis, B. L., & Huston, C. J. (2021). Leadership roles and management functions in nursing: Theory and application (10th ed.). Wolters Kluwer Health.

Tye, J., Hanrahan, K., Edmonds, S., Hyatt, D., & Tye, A. (2022). Courageous leadership for a culture of emotional safety. Nursing Management, 53(11), 16–23. https://doi.org/10.1097/01.numa.0000891468.54597.90

Abstinence Through Education and Faith

"beer and faith" free AI image creator www.gemini.google.com

Concepts such as spiritual disciplines have only become more pronounced as the life course broadens and the familiarity of youth begins to fade. Time wasted in youthful ignorance, however, is a friendly reminder that sobriety has brought more precise insights into how things of a spiritual nature have meaning.

According to (Hasin et al., 2022), the clinical insights that guide diagnoses for substance use challenges are found in the DSM-V and are as follows, presenting with at least two criteria that involve:

1. Drinking alcoholic beverages for periods longer than intended.
2. Periods of drinking are dedicated and are done to support the ability to acquire alcohol and or recover from drinking.
3. There is the presence of a persistent craving to drink.
4. Alcohol drinking impairs normal life functions, roles, and responsibilities.
5. Persistent alcohol use impairs interpersonal relationships.
6. Social activities and gatherings are disrupted secondary to increased alcohol use.
7. Drinking in such a way that becomes dangerous to self and others.
8. Drinking is continued despite knowing the adverse effects that have negatively shaped the self and others, both physically and psychologically.
9. Apparent tolerance is defined as needing more drinks to produce the desired effect and/or the desired effect not obtained by the same amount consumed.
10. Symptoms of withdrawal are defined as stopping drinking after a period of heavy consumption and, after stopping drinking, physical experiences of twitching and tremoring, nausea and vomiting, sweating, fast heart rate, agitation, anxiousness, and or seizure activity.

In addition, problems associated with drinking are a luxury for educated individuals. According to Schuckit (2018), most people struggle with drinking. It is common in those individuals with advanced education and those with family affluence and is more common in males than females. Chronic drinking can shave off roughly a decade of one's life.

Whiskey, wine, and beer are pleasurable to drink, easily absorbed on an empty stomach, and directly affect the body's brain, muscles, and feel-good receptor centers (Schuckit, 2018). A pint of IPA, two fingers of Garrison Brothers, and a glass of Merlot become dose-dependent when consumed regularly and consistently. Drinking will need to proliferate to achieve the desired effect of reduced stress symptoms, and drinking will eventually progress to the need to consume more or drink more substantial types of drinks with more potent alcohol content, for example, transitioning from beer to bourbon, also known as tolerance.

Unfortunately, as Schuckit (2018) points out, a negative cycle of attitude, cognitive, personality, and physical changes associated with anxiety-reducing effects and feeling of muscle relaxation, all positive desired reasons for drinking, are part of the brain pleasure-seeking loop and circuitry that are temporary and are followed and accompanied by feelings and experiences of depression and restlessness when the drinking is stopped.

Although some believe that consuming alcoholic beverages has physical benefits, the evidence supporting such claims continues to be debated as the effects of the chemistry-related changes on the brain, central nervous system, psychiatric disturbances, gastrointestinal effects, heart, and lungs, as well as the interpersonal, communal and societal disadvantages from chronic drinking are evident (Schuckit, 2018). The explicit goal is to recognize those with dependence, treat acute symptoms, and find sources and resources to support rehabilitation and recovery for long-term abstinence and sobriety.

Cutting Alcoholic Ropes and hanging on to God's Hopes

It is important to remember that as disciples, the efforts to help others are not in vain. Seeking ways to better another individual through helping and support is not unnoticed, and being neighborly is never wasted and always in season. The faith that Christians lean on is the hope of a savior who will make good on his promises as they exercise their faith in his actions on the cross.

Ultimately, God sees the good in us and seeks a relationship with all people. Those who strive to please, obey, and serve him through the appropriate use of our talents, abilities, and skills to bring about his ideas and concerns for the world are what discipleship resembles: a student relationship with Jesus, the teacher.

God wants his realm and kingdom to look and feel a certain way; what we think how the world should look and feel often does not align with his views unless they are exercised in faith-based organizations, communities of hope and healing, and in the helping and serving organizations locally, and globally. It does not require much effort to see God working in the lives of humanity, which is an ongoing struggle because practicing the spiritual disciplines is hard.

It can be challenging to believe this about oneself, especially when comparing oneself to the standards set in Scripture. The words in the Bible are sharp and penetrating; they serve as both warnings and encouragements. They bring life while also providing caution to those who earnestly try, knowing that we are way off course on our best days.

However, with persevering intention and, of course, the grace or the state of being in a position where one is shown kindness when it is not deserved, that is the concept of grace, forgiveness, and the gift from God is a cycle describing the life and journey of those who have begun the Christian walk.

The author of this blog, a Christian believer, also has a personal story of challenges with drinking and searching for spiritual connection through his relationship with Jesus and overcoming the need to drink beer or whiskey to manage stress, anxiety, and symptoms of depression, insecurity, and loneliness from a chronic and life-long struggle for the need to prove one's self, to feel appreciated and valued that stems from early childhood adverse events.

At the time of this writing, the total number of days of no drinking alcoholic beverages, including beer, whiskey, and wine, is one year, eight months, and three days. That began with the help of peer support and talk therapy grounded in the meeting rooms of Alcoholics Anonymous. Through that trial, through seeking assistance while also trying to be a faithful follower and Christian, new insight has come at the time of sobriety.

In contrast, before, under the influence of chemical manipulation of alcohol on the body, mind, and psyche, the blog writer was blinded from concepts and themes that are clear now, whereas before they were cloudy, fuzzy, and out of focus, to explain it precisely before sobriety and after being sober is complex and obscure to put into words.

Meanwhile, as a Christian, the blurriness of faith, incessant doubt, challenges in perseverance, and struggles with temptations are all part of the Christian walk, which was not self-evident at the point of conversion. How could if, as a follower of Jesus, we are instructed to be sober, self-controlled, worthy of respect, sensible, and sound in the faith (The Holy Bible, New International Version, 1999, Titus 1:2), struggle with living in general?

If living and dealing with essential trials of life can be handled with, coped with, and dealt with through active faith practices, if challenges and struggles in life can be met with and treated with therapeutic journaling, counseling, reading and writing, prayer, worship, and spiritual relationships, how did the author treat those challenges through passive consumption of beer and whiskey? The answer to that question became crystal clear one day after a nervous breakdown and, after a willingness to admit a problem, sought help to quit drinking. New insights only became revealed after an intentional year-long, weekly participation in peer group therapy and aligned with common principles discovered in the 1930's-Alcoholics Anonymous.

As Alcoholics Anonymous outlines (AA, 2001, p. 263), the six-phase methodology that all individuals must apply for the best outcomes is: First and secondly, one must puncture the Ego and allow God to perform CPR; third, look inside and face the skeletons in the closet; fourth, find someone who can be trusted and tell the secrets that way down the mind and heart; fifth, begin immediately to make repairs and finally put into practice all those mentioned above intentionally every single day and help someone else.

As part of the six-step process in this blog post, the author of the Palate and Pabulum actively works to help others who may be struggling. The steps are best done, practiced, and carried out in partnership because who other than a person who has struggled with drinking is best equipped to help another with the same ailments?

References:

Alcoholics Anonymous. (2001). Alcoholics Anonymous big book (4th ed.). Alcoholics Anonymous World Services Inc.

Hasin, D. K., Blanco, C., Bochner, D., Budney, A. J., Compton, W. M., Hughes, J. R., Juliano, L. M., Kerridge, B. T., Potenza, M. N., & Schuckit, M. A. (2022). Substance-Related and Addictive Disorders. In American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (5th ed., pp. 543–666). essay, American Psychiatric Association.

Schuckit, M. A. (2018). Alcohol and alcohol use disorders. In J. Larry Jameson & Anthony S. Fauci & Dennis L. Kasper & Stephen L. Hauser & Dan L. Longo & Joseph Loscalzo (20th Eds., Vol. 2), Harrison's principles of internal medicine (pp. 3277–3283). McGraw-Hill Education.

The Holy Bible: New International Version. (1999). Cornerstone Bible Publishers. (original work published 1973)