25- The U.S. is trying to control what kind of health research is published

I know, I know, there is too much bullshit out there to focus on one thing.

I get it.

The purpose of Tuesday Top of Mind is to write about what fresh horribleness is happening in the healthcare realm.

Today, I want to write about the fact that the U.S. government is trying to control what kind of health research is published.

It is done to control what information is out there and, by extension, the U.S. population.

You see, they want to keep us dumb and to not have any avenue to question what is published.

I know that I am fairly new to nursing research but I am not new to nursing.

It is shit like this that allows them to put their knee to the neck of publishers so that the publishers will cave.

It is the bully in the room who takes control of your arm, usually bruising it, and hits you with your own hand, all the while asking “Why are you hitting yourself?” Dude, you are puppeting me and making me hit myself.

It is the bully in the room that has no intellectual curiosity and hates those of us who do.

It is the bully in the room that wants to bend all of science and academia to their will to declare the sky is green with screaming red polka dots and they’re just trying to protect you, boo.

All that they are asking about, if there is room for competing viewpoints, or does the articles get reviewed by lay people, and are the researchers transparent about who is funding them, makes me roll my eyes so hard I can see into last week. The kicker is what if the researcher got it wrong, what then?

They are definitely giving off “i’ve never read a journal article except for once and in that journal article there were no pictures so I didn’t understand it and it made my head hurt” vibes.

Yes, there are seldom pictures.

Yes, the researchers are upfront about each funding source. It is mandatory.

If the researcher came to the wrong conclusion they print a retraction. Like the retraction that the Lancet made for Andrew Wakefield about his flawed, doubly flawed, study of 12 cherry picked children that he said proved a vaccine link to autism. Bitch it did not.

Too late, that damage had already been done. We in healthcare deal with it every day.

Yes, competing viewpoints based in reality are welcome.

Oh, it’s the based in reality that you have a problem with?

I feel sorry for you.

Dissertation topic

On Wednesdays we wear pink. Deliberate Mean Girls Reference.

On Wednesdays, I write about the operating room Not so weird, considering Dispatches from the Evening Shift started as an OR blog. And then it became an operating room/nursing/post-it notes to me discussion/Tuesday Top of Mind where I discuss politics and things that are top of my mind/Cookie Thursday is a Thing/School Me Saturday blog.

Yeah, I know that the topic of my dissertation might be more of a School Me Saturday post but this is very operating room-centric. I just felt like it fit here best. And I’m doing an Alice in Wonderland theme for School Me Saturday for a few weeks.

My idea for the dissertation project that will take me nine months to do and write the damned dissertation (name of a dissertation service I’ve seen) is solidly in the OR.

Not to go too deep into the details but the OR is consumed with turnover.

This is not when people leave and new people are hired. While that is also called turnover, this is not it.

Turnover refers to the Wheels Out to Wheels In time. This is the length of time that elapses when one patient leaves the room (Wheels Out), the room is cleaned, the equipment is brought in, the next case is opened and counted, and the next patient enters the room (Wheels In).

There are industry standards. There are goal times that the hospitals strive to meet. The industry average is 26 minutes.

And I am over here doing 10-12 minute turnovers. Often in the same room, always with the same team, and always without anyone but us to clean the room/get the equipment/open and count the room.

The question is why.

Why is the evening night team so efficient?

So efficient that several doctors remarked on it. One of them went so far as to suggest they were going to schedule all of their cases after 1500.

The thing is… I don’t know.

Being a circulator is a job in a solo. We don’t know what the other circulators are doing.

This leads me to the pilot observation study that I will be doing as soon as the IRB allows.

It is my hypothesis that there are tasks that can be done to potentiate a faster turnover.

These are simple tasks.

Make sure there is no trash on the floor.

Make sure all the linen is in the linen bag.

Make sure all equipment is away from the OR table.

Make sure that all extra supplies are either put away in the room or readied to be taken out of the room.

Make sure all the suction cannisters are prepped for removal.

Be thinking ahead to the next case and the equipment that might be needed.

Be thinking ahead to the positioning requirements of the next case.

In other words, prepare to room to be left.

I only know what I do. I don’t know what other circulators do.

Hence the pilot study.

The pilot study will be in one hospital during the day shift.

The big dissertation study will be controlling as many variables as I can and observing in other venues. Such as a bigger hospital. Such as an ambulatory surgery center. Such as the night shift. Such as the weekend shift.

The thing I’ve learned about the dissertation during my program is to keep it simple.

There are many downstream effects that an efficient turnover can do. Keeping to the scheduled times. Getting people out of shift on time. Decreasing overtime costs.

The end goal is to create a checklist for pre-Wheels Out activities.

But that is NOT the dissertation goal. That’s for later.

Because creating a checklist and getting it validated can add 2 years to the dissertation time.

I don’t have time for that.

Remember. Keep it simple. This is not the best work I will ever do. This is not the most important work I will ever do.

The dissertation project is just enough. Because although there is a degree at the end, it is really about the journey.

School Me Saturday 2/3/24-first assignments of the semester

It is hard to go fully into the semester. I know. All the reading, all the getting to know the professor. All the getting to know the other students. It is hard.

Especially if you are not socially gifted.

Believe me, I know.

However, the first month of the spring semester should be just about over. This is about the time that the first assignments are due. This can be a variety of assignments, a paper, a discussion post, a test. School does it all.

The only thing I can tell you is to have a plan for the assignments. Make a schedule if you are gifted like that. Or, if you are like me and write a schedule only to ignore it, write down the assignments everywhere. As discussed, part of my process is largely mental and I do a lot of thinking about structuring assignments. I have heard over and over to use an outline for written assignments. Yesterday I did and I wrote down what each section of the paper was to cover, and the broad strokes of the beginning and conclusion. Where has that nugget of wisdom been all my life?

We’ll see how far that gets me in the next three months.

It wouldn’t be the start of the semester assignment season without technical difficulties.

You are not alone in this. My computer got replaced for the second time over winter break. All the software had to be re-installed. Including the specialized software for statistics.

Oh, boy!

Take a deep breath and make a plan to conquer your first assignments. The first one, I find, is often the hardest to get started. After all, students, like us, are coming off a break where we did little to nothing to prepare for school. It might take a minute to get our brains in gear.

Start your assignments! The checkered flag has been raised!

Yeah, that is a veiled attempt at a NASCAR joke.

Humor me.