the illusion of the repeat.

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In musical notation, that snake-bite colon you sometimes see at the end of a notated passage is called a repeat sign.
It directs the musician to return to the beginning of the phrase or section and play it through again. To repeat it over.

But it is never a true repeat, because you can never play the same piece of music twice.
Although the musician returns over notation that is exactly the same, the flow and form of the music is always moving onward. Really, there are no repetitions.

As nurses we must always be very careful of repeats.

It is easy to fall into the trap of treating patients that return over and over with similar symptoms as exactly the same each presentation. Or to treat a particular condition or diagnoses as repeating itself identically amongst different patients. 
Or to expect that a task we frequently perform is going to play out the same way as the previous occasions.
To do so is to risk missing the onward flow and form within our patients individual lives.

Our nursing work calls for endless repetition. Drawing blood. Giving medications. Taking ECG’s. Writing notes. Looking after patients with the same diagnosis. Day after day. Year after year. We think we know what we are doing.
Going back over the same section again and again.

But the illusion of the repeat is something we must work hard to avoid.
We must not just play the music, we must listen, and oftentimes, allow ourselves to be played by it.

A beginners guide to interpreting an Arterial Blood Gas (ABG).

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Here is a short educational video I made a long time ago.
It was intended as a beginners guide to interpreting an arterial blood gas. I attempted to cut through the confusion and make it simple enough for even me to understand.

If you listen carefully you will hear my dog Smudge, who has absolutely no interest in ABG’s …. he just wanted me to come out and kick his soccer ball around with him.

Please let me know if you find it useful……


A beginners guide to interpreting Arterial Blood Gasses. from Ian Miller on Vimeo.

In His Arms.

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Take a few moments to watch this short movie directed by nurse Christine Girdham.

The film is dedicated to all those who have lost loved ones from pregnancy to birth.

Nathan and Emily are a happily married couple and are very excited to start a family. However, having a baby isn’t as easy as they thought. Together they make it through the challenge of falling pregnant, not realizing that their biggest challenge still lies ahead… Their lives are about to change forever!

This movie was a winner of the Maureen Pullman Encouragement award in the recent NSNMA short film festival.


how 5 nurses changed the world.

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This story concerns an ancient emergency department that had fallen upon hard times.

It was once part of a great hospital, but because of high workloads, poor morale and short staffing levels, its reputation was lost.
There were only five nurses now left in the whole place: the unit manager and four nurses (all over sixty years in age).

Clearly, their once strong nursing community was dying.

In the deep woods surrounding the hospital there was a little hut that a wise old professor of neuro-biology occasionally used to get away for some quiet contemplation.

The old nurses still had a well developed ‘gut instinct’ so they could always sense when the prof was in his hut.
One day it occurred to the unit manager that a visit the prof might result in some useful advice to save her department.

The professor welcomed the unit manager to his hut with excellent coffee and chocolate muffins.
But when the nurse explained the reason for her visit, all the prof could say was, “I know how it is” . “The spirit has gone out of the nurses. It is the same in my own town. Almost no one is interested in their problems any more.”

So the old charge nurse and the old prof wept together. Then they sat quietly and spoke of deep things.

When the nurse had to leave, they embraced each other.
“It has been a wonderful that we should finally meet after all these years,” the nurse said, “but I have failed in my purpose for coming here. Is there nothing you can tell me that would help me save my dying department?”

“No, I am sorry,” the professor responded. “I have no advice to give. But, I can tell you this …..that one of you is going to become a truly great nurse and change the face of your profession.”

When the charge nurse returned to the hospital her fellow nurses gathered around her to ask, “Well what did the wise old professor say?”

“Well…..the prof said something very mysterious, it was something cryptic. He said that one of us was going to change the face our profession. I don’t know what he meant.”

In the time that followed, the old nurses wondered as to the significance of the professors words.

Change our profession? Could he possibly have meant one of us nurses?
If so, which one?

Do you suppose he meant the charge nurse?
Yes, if he meant anyone, he probably meant the oldest and most senior nurse. She has been a leader in this department for more than a generation.

On the other hand, he might have meant Cathy. Certainly Cathy is a great nurse.
And everyone knows that David is a man of great knowledge and nursing wisdom. Certainly he could not have meant David!

Julie gets crotchety at times. But come to think of it, even though she is a thorn in people’s sides, when you look back on it, Julie has always given the best patient care. Maybe the prof did mean Julie.

But surely not Heather? Heather is so quiet, a real introvert. But then again, almost mysteriously, she has a gift for always being there when you need her. She just magically appears whenever the shit hits the fan.
Maybe Heather is about to change our profession.

But of course the prof didn’t mean me. He couldn’t possibly have meant me. I’m just an ordinary bedside nurse.
Yet supposing he did? Suppose I am about to change our profession?

As they contemplated, the old nurses began to treat each other with extraordinary respect on the chance that one among them might be the one to change the nursing profession.
Not only that, they began to treat themselves with extraordinary respect.

Patients still occasionally came to the Emergency Department set within this beautiful forest. To treat their colds and mend their wounds.

As they did so, they sensed the aura of extraordinary respect and compassion that began to surround the five old nurses. It seemed to radiate out from them and permeate the entire atmosphere of the place.

There was something strangely compelling, about it. Word got around, and more nurses came to see if it was true.
They brought their nursing friends to this special place. And their friends brought their friends.
Then some of the younger doctors who came to work in the department started to talk more and more with the old nurses. They too, began to treat each other with more respect. Then another, and another.

So within a few years the emergency department had once again become part of a thriving hospital and, thanks to the professor’s gift, a vibrant centre of excellence, that provided a deep and sustained healing in the realm.

And slowly, these nurses changed our profession. And the world.

[this is a slightly, um….modified version of a story that has been around for a long long time. Original author unknown.]

Featured image via: Jay Mantri