Thank you, Eileen!

For this post, I would like to refrain from my usual stirring of the pot and, instead, in honor of the upcoming Nurses Week, share a story.

In May 2009, during Nurses Week, I was having lunch at my desk and reading the news online when I was struck by the headline ‘School nurse dies saving coach.’ I clicked on the link, and it took me to a clip on the website of a local news station in California. That’s where my relationship with Eileen Bowden and her family began.

Bowden, a school nurse for California’s Santa Clara School District, was responsible for covering five schools in the county. She just happened to be at the right school at the right time for one very fortunate soul. A softball coach collapsed on one of the fields of the school she was at that day. Nurse Bowden was summoned from her office and rushed to the scene where she performed CPR until paramedics arrived and transported the coach to the hospital. Minutes later, Bowden collapsed and died. The coach survived and is alive today, due to the quick action taken by Bowden. As a side note, the incident took place on the coach’s birthday.

Eileen Bowden

Not only was I moved to tears by this story; I was moved to action. Within minutes, I contacted the school where the incident had occurred, and the principal returned my call the following day. He was very kind and stated that he would make contact with the family on my behalf. Within a few days, Barbara Butler, Eileen Bowden’s sister, contacted me.

I explained to Barbara that I had seen Eileen’s story on the news. I also told her that, although I was not a runner, I was training for my first-ever half-marathon so I could experience running across the Golden Gate Bridge. But now, I said to Barbara, instead of running the San Francisco Half Marathon for the personal experience, I would like to do it to raise money to start a scholarship in Eileen’s memory. She agreed, and that call became the kickoff for the Eileen Bowden Memorial Scholarship, administered through the Foundation of the National Student Nurses Association, with which I have been involved ever since my days as a nursing student, 20-plus years ago.

I immediately went to work raising awareness of the need for school nurses and for funding students who have an interest in school nursing. I put up a website, emailed friends and colleagues, started blogging and tweeting, and, with my new purpose, rededicated myself to training for the half-marathon.

As I have stated, I am not a runner, and training was hard. Living in Austin, Texas, only compounded the difficulty. The race was to be held in San Francisco in July, where the average high temperature is 69 degrees Fahrenheit (21 degrees Celsius), but the average high in Austin in June, when I was training, is 92 degrees Fahrenheit. This meant getting up most mornings at 4 a.m. so I could get my training in before the Texas heat would get the best of me. Just about the time I was questioning my sanity and ability, my next round of motivation came. I received a handwritten letter and a check for $25. This gift—and it truly was a gift—was from an 80-plus-year old registered nurse on a fixed income. Her name was Betty Bowden. She is Eileen’s mother.

Well, the training didn’t get any easier, but my motivation was strong. Before I go further, I must acknowledge that my wife was with me on this journey every step of the way. The night before the run, we were sitting together in our hotel room contemplating a Wall Street Journal headline we had seen just days before—“The San Francisco Half Marathon, the race that real runners fear” —when the phone rang. It was Eileen’s nephew. Suddenly, I had no fear of what I would take on at 5 a.m.

The next morning, with my wife at my side, I completed my first-ever half-marathon, raising more than $4,000 for the newly established Eileen Bowden Memorial Scholarship. Little did I know it was the beginning of a journey to create a permanently endowed scholarship for students interested in pursuing a career in school nursing.

The following year, I was once again training to run in San Francisco to raise more funds for the scholarship when Tom Grant contacted me. Tom is Eileen’s brother-in-law. In 2010, he, too, was not a runner. However, inspired by my efforts, he had begun training for New Jersey’s Long Branch Half Marathon, which coincides with the New Jersey Marathon, and was calling to ask if I would help him replicate what I had done to raise awareness and funds. Not only did I say yes, I asked if I could run with him. I can’t begin to tell you what an honor it was to run by his side and cross the finish line together in his first-ever half-marathon.

To run a half-marathon (13.1 miles), you need all the help you can get!
Before running New Jersey's 2010 Long Branch Half Marathon together,
Tom Grant, brother of Eileen Bowden, and Ken Dion pose for the camera with
an energy product designed to help them make it across the finish line.

A highlight of making the trip to New Jersey was having the opportunity to stay with Tom and his wife Rosemary, Eileen’s other sister. And if the kindness they showed me was not enough, I had the honor of spending the evening with Betty Bowden, Eileen’s mother. We stayed up until late in the evening, sharing stories about the joys and sorrows we experienced as nurses. Mostly, the joys!

Eileen was the epitome of what nursing is all about. She was active in her community. She chose to work as a school nurse to assure health and health education for the future of our country. The single mother of an adopted daughter, she was a daughter, a sister, a friend. She was also a member of the Honor Society of Nursing, Sigma Theta Tau International.

So, on the fifth anniversary of Eileen Bowden’s passing, I would like to dedicate this Nurses Week blog post to her and others like her who have made the ultimate sacrifice in the service of others.

On behalf of all those you have touched—especially this nurse—thank you, Eileen!

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Choices

What an amazing time we live in! I was sitting in a chair in the sky, enjoying a cold refreshing beverage and watching the evening news—live—while traveling at 500 mph, when two separate human-interest stories piqued my interest.

The first, about the rise of heroin use in the United States, featured two mothers, both of whom shared stories about their children’s experiences with the drug. Sadly, the child of one of them had died. The other mother then talked about her son, a popular high-school athlete who had overdosed. Now in his mid-20s, he suffers from severe mental and physical disabilities, while both he and his family struggle to cope with the activities of daily living and long hours of therapy. His prognosis is fair, at best, and he will never return to his former level of ability.

Jenny Bonner/iStock/Thinkstock

Another young man, featured later in the program, had just entered high school when his father, then in his mid-40s, was diagnosed with incurable cancer. The son, not particularly athletic but motivated by devotion to his father, vowed to win the state championship in wrestling, in his weight class. For three years, he began each day at 6:30, lifting weights, and spent the rest of the day doing nothing but health-promoting activities. He achieved his goal, won the state title and, at the end of the championship match, saw his opponent congratulate his father and give him a huge hug.

These seemingly unrelated stories caused me to pause and ask myself: Is it possible that, if the resources expended on the young man who suffered from a heroin overdose had been directed toward finding a cure for the cancer contracted by the second young man’s father, might the father’s prognosis have improved?

Health care science and technology are advancing at a mind-boggling rate, while the ethics and laws guiding the use of newly discovered science fall further and further behind. My question to you is this: If health care is a right, what responsibilities go with that right? In the face of limited resources, do we deny health care to individuals who make poor health choices when the care involved is directly related to those poor choices? What do you think?

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sgima Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

The provider side of big data

We have entered the age of “Big Data.” I’m not certain how this age differs from the Information Age, but a statement by Dan Ariely, James B. Duke Professor of Psychology and Behavioral Economics at Duke University’s Fuqua School of Business and director of Duke’s Center for Advanced Hindsight, provides an interesting perspective: “Big Data is like teenage sex: everyone talks about it, no one really knows how to do it, and everyone thinks everyone else is doing it, so everyone claims they are doing it.”

So, if we are in the prepubescent stage of health care informatics, what does the future hold?

allanswart/iStock/Thinkstock

The focus of big-data analytics today is on what I like to refer to as “patient-side data.” Investments being made to analyze patient-side data, evidenced by IBM’s recent agreement to implement natural language processing (NLP) in Cerner’s electronic medical record (EMR), are staggering. These data analyses run the gamut from genomic deconstruction for the purpose of individualized chemotherapy intervention to population-based trending of indicators beyond imagination. If these analyses result in actionable information, which I have no doubt they will, the actions required will not take place in a vacuum. More data is needed if these new discoveries are to reach their full potential.

I am a believer in Occam’s razor, a principle of parsimony. To paraphrase, the solution with the least number of variables is usually the one that should be employed. The Synergy Model, just one such parsimonious exemplar, provides a framework that may help us think about the other side of the big-data coin—“provider-side data.” The Synergy Model tells us that both patient and provider have specific characteristics which, when aligned, optimize patient outcomes.

We’re just beginning to scratch the surface in capturing and interpreting patient-side data, but we’re even further behind the curve when it comes to the provider side of the equation. Not long ago, the most we knew about members of our staffs is that they had licenses and could fog mirrors. With the advent of learning management systems (LMS), we can now track employee education. However, this remains a highly compliance-driven function. 

With the advent of the EMR, we’ll be able to aggregate provider-patient interaction data, such as the number of specific procedures completed by a practitioner. Data like this can be used for purposes such as credentialing and certification—in other words, quantitative data generated to support compliance-driven activities. Will the holy grail of improved patient outcomes be found in the check boxes of an EMR or the compliance report of an LMS? I think not.

Just as patient characteristics described by the Synergy Model relate to data found in the patient narrative, so too provider characteristics relate to data found in the provider narrative. Whether the professional narrative be found in the EMR (through documentation of patient interactions) or the professional’s development record (a narrative resource as rich as the patient's narrative), they are equally important in influencing patient outcome.

So, as we mature in the age of big data, what will the role of provider-side data be? Will it be purely regulatory, or will it begin to capture today the qualitative provider-side data we need to influence patient outcomes in the future?

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Hacked!

If you are reading this blog, you are being hacked! It is virtually impossible to live in modern society without creating a digital footprint. From cookies implanted in your browser from every website you visit to every credit-card transaction you make to every text, tweet, post, and email, you are being digitally deconstructed. The digital footprint you are creating is not only being followed, it is being backtracked to predict future behavior, as evidenced by Apple’s acquisition of Topsy.

The upside of being followed is that you are offered things based on your preferences, from coupons to returns on Internet searches. The more information you are willing to share with vendors, the more they are willing to pay you through various rewards and loyalty programs. Many of the rewards seem enticing but, as Grandma said, “Nothing in this life is free,” and, in this case, the cost is the dark side of the digital life.

We have all come to ignore pop-up ads. However, in their time, they achieved their goal. They manipulated our behavior and generated revenue for search engines through pay-per-click programs designed to drive traffic to specific vendors. Our “free” searches were then used to drive ads to us, which put us at risk for having our behavior manipulated. And if media or government used those searches to manipulate our behavior, frightening scenarios could be imagined.

As disconcerting as those scenarios might be, equally alarming is the hacking we have seen played out in recent months. From monitoring of electronic communications to credit-card hacks spawned out of Eastern Europe, which, by the way, is not a new phenomenon. (See “‘Dark Market’ Takedown.”) There is a very dark side to our digital lives. Your life is being hacked, and you are an active participant in the process. You didn’t think that reward or email account was really free, did ya?

As part of “Building a better planet,” IBM has tasked its supercomputer, “Watson,” to analyze treatment and practice patterns of oncology practitioners with regard to outcomes. Additionally, these efforts include use of genomic analysis for development of targeted chemotherapy intervention. At this point, we are, whether we like to think about it this way or not, being genetically modified by the computers we have created. Presumably, given time, those same computers will have the ability to predict the future, just as they did with relative certainty in the consumer-behavior model. Do you really want to know how long you are going to live? Do you want other people to know that? And what about the ability to manipulate it? Off to the scary dark side we go!

As we genetically engineer and reengineer the planet, we are also making great strides in biomechanical engineering. We have seen the quality of life of veterans returning from conflict improve, due to advanced prosthetics. Cochlear implants have enabled the deaf to hear. Implantable defibrillators have saved countless lives. Envisioning a future enabled by implanted technologies, politicians have dazzled us with stories of implanted devices that warn of an impending heart attack by sending an email to the owner’s cellphone and calling EMS. Sadly, as promising as this technology is—and it’s within reach—it, too, comes with a dark side.

All of these auspicious medical devices share a common element—a microcomputer. Taking the next step and actually embedding computers in our bodies has done great good. However, computers, by definition, can be hacked.

The preceding thought brings a frightening new possibility to the phrase “having your life hacked.” If you thought having to replace your credit cards because you shopped somewhere was an inconvenience, it’s a really bad day when your implanted defibrillator gets hacked!

So, I have two questions for you: Are we ready for the first time this happens? And what do you think the reaction and fallout will be?

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Setting the stage

My first image of a nurse is still vividly and indelibly stamped in my mind. Her spotless white uniform was starched and pressed. The cap that identified her as a graduate of Bayonne Hospital School of Nursing was perfectly positioned on her head. Her navy-blue cape flowed in the breeze as she explained to me that she had to go to the park without me because, in case there was a disaster, she needed to practice helping people. I was 4 years old, and that nurse was my mother. The year was 1964.

Shortly afterward, we moved from Bayonne, New Jersey, to Miami, Florida, and my mother, who was single, did what many nurses do. To provide for her family, she took a good job that was available instead of the dream job she had hoped for. But she fell in love with long-term care and has been involved with it one way or another ever since. I recall pulling medical records—charts in those days—around in my little red wagon to the various facilities she worked at, doing my best to help.

As I grew older, she advanced in the profession. To expose me to the many facets of health care, she encouraged me to volunteer and assisted me in attaining, first, volunteer positions and then paid positions such as “transporter.” As with many nurses who had sons, she hoped I would one day consider being a physician.

As a teenager, I was scared to death by the thought of spending that much time in school. So, I took the passion for health care and helping people she had instilled in me and worked as an ER tech while becoming a firefighter paramedic. I loved my work but, after several years, the 24-hour shifts became daunting, and I decided it was time to go back to school and explore other professions.

I was standing in line to register for business classes when the thought struck me like a .45 slug to the back of the head: I did have a gift, and it wasn’t playing the guitar. It was being able to hold down my lunch and be compassionate in situations that would send some people running in another direction, screaming for help. I also realized that I had honed skills that should not be squandered. So, I registered for prenursing courses and have never looked back.

I’m sharing this story as my first blog post so that you know I have been close to health care and nursing all my life and am extremely passionate about both. A great deal has changed since that image of a professional nurse was imprinted in my mind. Some has been for good, some not so much. And, as we are all acutely aware, there is a lot more change ahead.

There are hundreds of blogs out there you could spend your most valuable asset—time—reading. I could write a similar talking-head blog, but I don’t believe the profession needs another. What is needed is respectful discourse about the topics of our time, and I hope this blog will be a catalyst for that. If you agree, let me know by posting a comment. If not, then don’t, and that will be my indication that I need go no further or that I need to find a different forum to stimulate conversation in hopes of positively impacting health care, nursing, and the population we serve.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.