Understanding Diabetes with Kimberly Ellis

Understanding Diabetes with Kimberly Ellis

Understanding Diabetes with Kimberly Ellis

Understanding diabetes is a long-lasting health condition that affects how the body turns food into energy. The food you eat is broken down into sugar and turns into glucose. It is then released into the bloodstream.

What is Diabetes?

When the blood sugar goes up, the pancreas is signaled to release insulin. It is the key to letting the blood sugar into the body’s cells. It is then used as energy. 

Having diabetes means your body does not make enough insulin. It cannot use insulin well either. Too much blood sugar stays in your bloodstream when insulin isn’t enough or if the cells stop responding to it. It could lead to serious health problems like loss of vision, heart diseases, and even kidney problems.

Understanding Diabetes is Important

In this episode, we welcome our guest, Kimberly Ellis. She is a Family Nurse Practitioner specializing in diabetes education and management, chronic disease prevention & management. She is also an expert in patient and provider engagement and culturally responsive care in marginalized communities.

Kim has a decade of experience and knowledge in Primary Care, Long Term Care, Medically Assisted Weight Loss Clinics, and Community Health.

Her consulting firm, Ellis Diabetes Education & Consulting, LLC., assists health organizations in developing Clinical Initiatives, Strategies, and Implementation aligned with the Quadruple Aim of Healthcare to improve health outcomes in their unique demographic.

QUESTIONS FOR GUESTS

The questions below are some we’d like to tackle. We go off-topic all the time so we don’t expect to hit them all. If you have any ideas please let us know. Looking forward to our conversation!

  • Can you give us a little background about yourself? 
      1. What got you into nursing? 
      2. Is there a reason why you pursued the nurse practitioner route? 
      3. What made you specialize in Diabetes education?
  • With diabetes and even nondiabetics, we pay attention to the Hgb A1c.
      1. What is it?
      2. How do we use it to predict diabetes? 
  • How is diabetes developed over time?
      1. What is prediabetes? 
    • “According to the CDC, more than one-third of American adults are categorized as “prediabetic.”  That’s 88 million people!  The sad part about it is that a large number of people do not even know that they have prediabetes.” [1] 
  • We love talking about prevention. 
    • Illnesses affect everyone individually and the only way to prevent them is for the individual to do something about it. No one can help you better than you can help yourself, good health is our own responsibility. 
  • Key risk factors
  • Age 45 or older
  • Overweight/Obese
    1. How does being overweight lead to diabetes? Can we touch base on the physiological process of how obesity leads to diabetes?
    2. How does insulin resistance fit into this picture?
      • Obesity causes stress in a system of cellular membranes called the endoplasmic reticulum (ER), which in turn causes the endoplasmic reticulum to suppress the signals of insulin receptors, which then leads to insulin resistance.
      • The endoplasmic reticulum is a network of membranes found inside cells. It is responsible for processing proteins and fats.
      • As you enter a state of overnutrition, as we often do living in our supersized society, all of those nutrients that come in need to be processed, stored, and utilized and the ER factory is overworked and starts sending out SOS signals.
      • These SOS signals, he said, tell cells to dampen their insulin receptors. Insulin is the hormone that converts blood sugar to energy for the body’s cells.
      • When there’s too much going on, the cell knows that insulin is out there, but doesn’t want insulin receptors signaling for more insulin because there’s already enough on board. This has a downside because insulin soon loses its ability to help clear sugar from the body [2].
  • A sedentary lifestyle (physical activity <3x/wk)
  1. How does a sedentary lifestyle contribute to diabetes/prediabetes? 
    • Is it because it leads to obesity or is there a different underlying reason?
    • A low amount of activity leads to more circulating glucose and metabolism change. Activity leads to an increasing amount of work on our muscles and body leading to a higher demand for nutrition, our body uses up and needs the circulating glucose [3].
  • First-degree relative with Diabetes Type 2
  • A personal history of gestational diabetes

When someone develops gestational diabetes does that just show that the person is more likely to develop diabetes based on a genetic predisposition? 

  • A personal history of Polycystic Ovary Syndrome (PCOS)
      1. How does PCOS play a role in a higher likelihood of diabetes? 
      2. Is it directly related to PCOS causing insulin resistance?
  • Racial Group: African American, Hispanic/Latino, American Indian, Pacific Islanders
  • Is diabetes reversible? 
  • What are the keys to proper diabetes management and something everyone should know?

ENDING QUESTION

Before we end the show we have one last question we like to ask all our guests. If you had the opportunity to have a Cup of coffee with anybody one last time, who would it be & why? 

Stay Connected!

Catch more on Kimberly through her socials, and connect with her on Instagram at @thediabetesNP. Visit her Facebook page at Kim E., the Diabetes NP, or check her YouTube channel, Kim E., the Diabetes NP here.

For more information on diabetes management, you can visit her website at https://www.ellisdiabetes.com/. Or check out her LinkedIn profile at https://www.linkedin.com/in/thediabetesnp/.

Want to learn more about diabetes? Click on our full episode here 👇

TIME STAMPS:

00:00 Intro
02:03 About Kimberley
04:00 Common Problems In Communities
08:18 What Made Kimberly Specialize In Diabetes Education?
10:17 The Difficulty In Educating People About Diabetes
12:44 The Physiology Of Diabetes
16:14 Does Glucometer Really Help Detect Diabetes?
18:33 Why Is It Crucial To Prevent Diabetes?
20:28 When Is The Ideal Time To Check Your Blood Sugar?
23:01 What Should A Person With Prediabetes Do?
26:23 Is Diabetes Reversible?
30:10 Frequent Misdiagnosis of Diabetes
32:51 Ethnic Groups And Cultures Susceptible To Diabetes
34:47 About Gestational Diabetes?
38:09 Diets To Help You Avoid Diabetes
42:34 Improving Eating Pattern
44:23 Kimberly’s Role As A Healthcare Provider
47:11 How Can We Raise Awareness About Diabetes?
48:55 What healthcare professionals are lacking?
54:06 Wrapping up the episode

EP 169: The Misconceptions of Nursing With Theresa Brown

EP 169: The Misconceptions of Nursing With Theresa Brown

The Misconceptions of Nursing With Theresa Brown

Misconceptions of nursing – what are they? How can we help highlight these issues? Nursing is a profession that isn’t for everyone. But some excel greatly in this career. And while nursing is a remarkable career that provides essential services, there are still misconceptions about it. What are the misconceptions about nursing? How can we uplift nurses?

In this episode, we would like to introduce you to Theresa Brown. Theresa Brown is an author of the New York Times bestseller The Shift. She earned a Ph.D. in English from the University of Chicago and taught English before flipping her career into nursing. She now holds lectures on issues related to nursing, healthcare, and the end of life. 

Her new book titled Healing is out now, where she tells a powerful story about navigating healthcare after a breast cancer diagnosis. 

QUESTIONS FOR GUESTS:

The questions below are some we’d like to tackle. We go off-topic all the time so we don’t expect to hit them all. If you have any ideas please let us know. Looking forward to our conversation!

  1. What made you shift focus from academia to pursue a career in nursing? What made you choose oncology, palliative, and hospice? 
  2. During your first year as an oncology nurse you experienced a sudden death of a patient, how did that make you feel and how did you process those emotions?
  3. Your book Critical Care is an account of your first year as a nurse, what was your biggest take away and how were you able to deal with the emotions and workload of a new nurse?
  4. How different was the reality of nursing compared to your expectations going in? 
    1. What do you think are the most common misconceptions about nursing?
    2. What are the struggles you’ve noticed nurses faced?
  5. Going from nurse to patient, how was it navigating through a healthcare system that you’ve worked in?
    1. What were your first thoughts when you were diagnosed with cancer?
    2. How were you treated? Were physicians and other medical staff transparent and timely? Did you feel that you were getting the appropriate “help’?
    3. Do you feel that you were left in the dark or weren’t given the full picture of your situation?
  6. Being both a patient and a nurse, what would you like to change in healthcare or in nursing? Did healthcare fail you?

ENDING QUESTIONS:

Before we end the show we have one last question we like to ask all our guests. If you had the opportunity to have a Cup of coffee with anybody, dead or alive, who would it be & why? 

You can check out Theresa’s book Healing: When a Nurse Becomes a Patient at https://www.theresabrownrn.com/Or stay in touch with her through Twitter @TheresaBrown for more information.

To understand more about the misconceptions about nursing, check out the full episode here 👇

TIME STAMPS:

00:00 Intro
01:42 What made you shift focus from academia to pursue a career in nursing?
04:55 What made you choose oncology, palliative care, and hospice?
07:34 The biggest takeaway as an oncology nurse
11:26 The struggles of nursing school
14:25 Tips for dealing with emotions after a patient’s death
23:05 Being a cancer patient
28:12 What patients really need from nurses
32:31 Realizations to improve healthcare
36:59 What would you like to change in healthcare or in nursing?
46:34 How does it feel to be out of leadership status?
50:25 Who do you want to have one last cup of coffee with?

 

 

EP. 168 Empowering Nurses with Alice Benjamin

EP. 168 Empowering Nurses with Alice Benjamin

Empowering Nurses with Alice Benjamin

Nurses are the backbone of healthcare, and we take pride in that. However, there are times when nurses don’t feel like they are as important in our community. A bad work environment can also add up to the stress that many nurses feel. In some cases, many nurses do not feel like their efforts are given enough recognition, so they don’t perform well, or worse, they don’t provide quality patient care any longer. 

While many nurses take their profession seriously, some are not sure anymore. What can we do to help our fellow nurses? Is there a way to inspire and encourage them to do better? What needs to improve in a nurse’s work environment to help them feel empowered?

In this episode, we would like to introduce you to Alice Benjamin, better known as Nurse Alice, America’s favorite nurse. She is a cardiac clinical nurse specialist and family nurse practitioner with over 23 years of healthcare experience. Alice is Nurse.org’s Chief Nursing Officer and Correspondent and hosts the popular ‘Ask Nurse Alice’ podcast. 

QUESTIONS FOR GUESTS:

The questions below are some we’d like to tackle. We go off-topic all the time so we don’t expect to hit them all. If you have any ideas please let us know. Looking forward to our conversation!

  • Being in over 20 years in healthcare, what are some changes you would like to see in healthcare? 
  • How do you think the pandemic has affected nurses? 
  • How should new nurses empower themselves going into this profession in 2022? 
  • What do you think about the RaDonda Vaught case?
  • She was sentenced on Friday to three years of probation in a Nashville criminal court. After the probationary period, she could ultimately have her conviction dismissed.
  • Found guilty in March of two charges, criminally negligent homicide and abuse of an impaired adult, after a medication error contributed to the death of 75-year-old Charlene Murphey in December 2017.
  • What are some of the biggest challenges you have taken on recently? 
  • What is something nursing has thought you that you can apply in life? 

ENDING QUESTIONS

Before we end the show we have one last question we like to ask all our guests. If you had the opportunity to have a Cup of coffee with anybody one last time, who would it be & why? 

Socials:

Learn how to become an empowered nurse by watching our full episode. Click here for more 👇

TIME STAMPS:

00:00 Intro
01:35 About Alice
02:30 What are some changes you would like to see in healthcare?
06:26 How can we improve the healthcare system?
09:46 Reasons for some patients’ noncompliance
15:24 One-size-fits-all patient treatment does not always work.
17:57 How should new nurses empower themselves?
20:26 How to be a better nurse
24:13 What are the challenges of being a nurse
29:52 Thoughts about the RaDonda Vaught case?
43:31 The last one cup of coffee with?

EP 167: Should You Start in a CVICU as a New Grad?

EP 167: Should You Start in a CVICU as a New Grad?

Should You Start in a CVICU as a New Grad?

Start in a CVICU as a new grad? Why not! One of the exciting areas to start working as a nurse is in the Cardiac ICU. The cardiovascular Intensive Care Unit or CVICU is a hospital ward that caters to and cares for patients with ischemic heart disease and other severe heart conditions. 

Patients who suffered a heart attack and need close monitoring are also placed in this unit. The same goes for patients recovering from heart surgery and with other severe conditions like cardiomyopathy, arrhythmia, heart infection, or unstable angina. 

Most patients in the CVICU often have various complications such as respiratory failure and renal failure. Therefore, medical staff who work at CVICU are required to have the ability to practice systemic intensive care.

In this episode, we introduce you to one of our followers, James Hatano. James is a New grad nurse in the Cardiac ICU at a Trauma 1 hospital in Cleveland, Ohio. He is also a certified CrossFit coach and a baseball coach. Today we will talk about his new grad experience as a Cardiac ICU nurse. So if you are interested to start in a CVICU as a new grad, this episode is for you. 

QUESTIONS FOR GUESTS:

The questions below are some we’d like to tackle. We go off-topic all the time so we don’t expect to hit them all. If you have any ideas please let us know. Looking forward to our conversation!

  1. Your BSN is your second degree, you also have a degree in exercise physiology. What made you decide on exercise physiology and then what made you transition into nursing?
    1. Are there some aspects of exercise physiology that have helped you in nursing school, being a nurse, and/or with life in general? 
    2. How did you survive nursing school? What do you think was the key? Time management, good schedule, etc…?
  2. Was the Cardiac ICU something you wanted to get into right off the bat? 
    1. Why did you choose the Cardiac ICU? Do you fit the typical cardiac ICU stereotype? (craziest lives but neatest lines, control, OCD)
  3. Biggest difference between nursing school and the ICU?
    1. What’s something you wished you knew going into school?
    2. What did you struggle with most in school? What do you struggle with most now?
    3. Tips for nurses trying to join the ICU.
  4. Nursing is stressful, we can agree that it is never going to change. No matter if there are appropriate ratios and great morale, working with patients that are very sick you’re always going to have that stress on your shoulders.
    1. What do you do to help balance that stress, do you have any issue with not leaving it at work and bringing it home with you?
  5. You’re big into fitness you’re even one of the top 50 fittest nurses in the world, how has that helped you through life?
    1. How has fitness played a role in your life and how has it helped you with nursing?
    2. How has your exercise changed over time?
  6. The drive podcast by Peter Attia, what got you into it and why do you enjoy it, what do they talk about?
  7. Chop wood, carry water book, would you recommend that book, why and/or to whom?

ENDING QUESTIONS:

Before we end the show we have one last question we like to ask all our guests. If you had the opportunity to have a Cup of coffee with anybody one last time, who would it be & why? 

You can find James on Instagram @jameshatano to know more about CVICU nursing.

You can also watch the full episode here 👇

TIME STAMPS:

00:00 Intro
00:45 Episode Introduction
01:33 About the guest
03:29 James Hatano and nursing
06:46 How does nursing school impact life
09:57 Transitioning out of nursing school
12:17 Life lessons you learned from being a CVICU nurse
13:51 Struggles as a new grad
20:03 Balancing Work and Life
22:15 Managing time
25:03 Managing relationship
30:32 How is it working with a female dominant profession
33:44 What would you like to improve in the healthcare system
37:00 A thing that you always have
39:47 The person outside nursing
43:52 Personal interests
46:34 Who would you want to have the one last cup of coffee?

Ep. 166: Being a Travel Nurse Practitioner With Ebony Thyme

Ep. 166: Being a Travel Nurse Practitioner With Ebony Thyme

Being a Travel Nurse Practitioner With Ebony Thyme

Besides travel nurses, we also have traveling nurse practitioners. What is a traveling nurse practitioner anyway? By definition, they are healthcare professionals who work at a facility away from their home base. They act as immediate and often temporary staffing for healthcare facilities. 

Traveling nurse practitioners often work in senior care centers, hospitals, clinics, stand-alone emergency rooms, urgent care locations, and other healthcare facilities where there is a need for registered nurse practitioners. These facilities could need assistance from an NP because of patient overflow or a full-time employee on an extended leave or have retired.

They are also like travel nurses. The only difference is that a traveling nurse practitioner’s contract can last one day to one year. Meanwhile, travel nurses go on contract for as long as 13 weeks. 

In this episode, we welcome our guest Ebony Thyme, a full-time Travel NP and a full-time wanderlust. A free-spirited individual with eight years of nursing experience. She also worked as a Travel NP in four states and has traveled to more than 30+ countries. Ebony’s background includes Family Medicine. Before her NP journey, she was also an ICU Nurse.

QUESTIONS FOR GUESTS

The questions below are some we’d like to tackle. We go off-topic all the time so we don’t expect to hit them all. If you have any ideas please let us know. Looking forward to our conversation!

  • Can you tell us a little bit about yourself?
      1. How did you get into nursing?
      2. What made you be ICU?
      3. What made you transition into being a travel nurse practitioner?
  • What made you enter into a traveling career?
      1. What have you learned? 
      2. What was the hardest thing for you to get used to?
      3. Advice to anyone that wants to be a travel RN or NP?
      4. How is the market for travel nurse practitioners? 
        1. What are some of the expectations and responsibilities? 
      5. What was your favorite state to travel to for work?
  • You’ve been to 30 countries, why do you travel so much?
      1. What have you learned from exploring so many cultures? 
      2. How has it expanded your mind and perspective?
      3. How important is it for you to travel and why should people do more traveling?
  • As an NP, how were you able to make your career give you financial freedom and the ability to control where your time goes?
  • What are you currently working on?
    1. NPing around the US?
    2. Travel boot camp? What is it?
    3. Locum Tenen Guide? 
    4. Thyme Talks podcast?

Before we end the show we have one last question we like to ask all our guests. If you had the opportunity to have a cup of coffee with anybody one last time, who would it be & why? 

You can catch Ebony on her Instagram accounts at @ebbthenp and @frontpage_eb. For her master class, podcast, and other sites, check out the links below:

If you are interested in becoming a traveling NP, watch the full episode here to learn more 👇

TIME STAMPS:

00:00 Intro
02:02 Plugs
02:56 About the Guest
05:27 The difference between Travel Nurse and a Travel NP
09:01 What is transitioning from Nurse to NP look like?
13:15 Advantage of a Nurse Practitioner
15:11 3 tips for nursing students
19:02 The importance of self-care
22:22 Solo traveling experience
24:31 Fears and Expectations
26:11 Difference between living on the east coast and the west coast
29:08 The humbling life in other countries
34:32 Places you should visit
35:35 What kept Ebony busy
39:51 Things I wish I knew earlier in my career
42:10 The worst contract
45:15 Toxic workplace
49:54 Who would you want to have a cup of coffee one last time?

 

 

EP 165: Ethics of a Full Code, DNR, Partial Code

EP 165: Ethics of a Full Code, DNR, Partial Code

Ethics of a Full Code, DNR, Partial Code

Full codes and partial codes cannot be avoided whenever there is an emergency. But the question is, should people have an option to be a partial code? Is there any benefit to partial codes? Many people think there should only be two options; full code or no code.

What is the code status?

Code status is used in all hospital settings. All patients admitted to a hospital or outpatient center are assigned a code status. A code status essentially means the type of emergent treatment a person would or would not want to receive if their heart or breathing were to stop. 

Your chosen code status describes the type of resuscitation procedures you would like the health care team to do if your heart stopped beating and/or you stopped breathing. During this medical emergency, resuscitation procedures are provided quickly to keep you alive. This emergency procedure is commonly known as cardiopulmonary resuscitation or CPR. 

In the same way, there are different treatment options and goals. The expected outcomes after cardiac or respiratory arrest differ depending on the person, the severity of illness, the cause of arrest, and other factors. It is essential to discuss code status before a crisis occurs and as a condition changes.

Outcome of Resuscitation

Cardiac arrest is when the heart stops beating. About 350,000 cases occur each year outside of a hospital, and the survival rate is less than 12 percent. CPR can double or triple the chances of survival.

Even though CPR can restart someone’s heart, it can also cause harm or even prolong the dying process. The success of resuscitative efforts is not like how it is on tv, that stats are low. In 2016, the survival rate for adults after a cardiac arrest was:

  • Out-of-Hospital Arrest: 12%
  • In-Hospital Arrest: Less than 25%
    • The average survival-to-discharge rate for adults who suffer in-hospital arrest is 17% to 20%.
  • Survival rates are lower for patients with advanced age, cancer, sepsis, renal failure, or liver failure. The survival rates for patients with a chronic illness or advanced illness average 5% and less than 1% respectively.
  • More than 40% of survivors are discharged with a significant decrease in their functional ability. 

Different Types of Code Statuses

Just like there are different treatment modalities there are different code statuses. There isn’t only 1 route and you can choose different options, however, there is a limit on what we can and can’t do. 

    1. Full Code: We do anything and everything to try and bring you back. This includes CPR, intubation, medications, lines, and procedures. 
    2. DNR: This is a Do Not Resuscitate order. When your heart stops we will not attempt to do anything. We will let you pass without any interventions. 
    3. Partial Code: This one can be a little complicated because there a few measures you can choose to have done or choose not to have done. 
      1. Meds Only: In this situation, if your heart were to stop we would not perform CPR or intubation. What we would do is use medication to bring you back. We can push epinephrine, give bicarbonate, start levophed or other pressors to try and keep your heart beating or start it back up. 
      2. No CPR: Some patients do not want CPR performed but are open to everything else. Defibrillation, intubation, and medication are all used. 
  • DNI – Do not intubate. There are patients that want everything to be done but not get a breathing tube placed

What is the Ethics of Partial Codes?

The main objection to partial code orders is that they are ineffective in sustaining life and can potentially deceive the patient and/or patient’s family into believing that resuscitation is possible when, in fact, the patient’s death is imminent. 

  • The concept is that you need hands on the chest to resuscitate someone. Once a heart stops beating there is no more circulation so there is no oxygen being fed into the tissue. Every second cell dies without any pressure from the heartbeat. 

People always want to make exceptions for everything. But when it comes to life it’s either you’re 2 feet in or 2 feet out. Is there such a thing as partial living? Then why should there be partial codes? Why should we hold back or delay treatment if the person/family is set on them surviving? Why not give them a full opportunity?

Many people would agree that there should only be 2 options; 

  1. Full code as in to do everything
  2. No code as in does nothing but comfort. 

It’s either we try to keep them alive or not. Why do people persistently make partial codes as in they want to “maybe” live? 

Why partial codes?

Many people don’t understand the reasoning behind a partial code. Let’s think about it. 

If you have ever seen a code blue with good chest compressions it is not a pleasant thing to witness. A lot of times a guy pushes on someone’s chest very hard and most of those times it leads to the sternum and other bones being broken. 

We can understand how enduring it is for the family to see. They see their loved ones and want them to at least have some chance. But partial codes give the lowest chance. 

  • Maybe there should be orders that state can intubate for respiratory distress but now when a pulse is lost. But then what if the pt loses a pulse during intubation. 

How much time do we have until brain damage?

  • When cardiac arrest occurs, cardiopulmonary resuscitation (CPR) must be started within two minutes. After three minutes, global cerebral ischemia, the lack of blood flow to the entire brain, can lead to brain injury that gets progressively worse.
  • By nine minutes, severe and permanent brain damage is likely. After 10 minutes, the chances of survival are low.
  • Even if a person is resuscitated, eight out of every 10 will be in a coma and sustain some level of brain damage. Simply put, the longer the brain is deprived of oxygen, the worse the damage will be.

TIME STAMPS:

00:00 intro
00:51 Plugs
01:23 Episode Introduction
02:37 What happens in a code status

05:25 A very slim chance of surviving a cardiac arrest
07:25 What is a code status?
09:16 Full Code, No Code, Partial Code
11:58 Family members are not educated well with code status
14:45  Partial Code rarely or does not work at all
17:45 Sad situation of a full code patient
20:12 How much time do we have until brain damage?
21:53 Call for physicians to step up and decide code status in real-time
25:12 Improvements that can be done
27:25 Patient’s family are very reliant on healthcare providers
30:27 Getting clear on what code to choose