Environmental behavior : walking & biking

"Walking is man's best medicine."

~Hippocrates 

I might add "bicycling" to that quotation too! According to my Noom app for my phone in the last 7 days I have walked 26 miles and biked 15 miles. This doesn't even take into account the thousands of steps I take during a 12 hour shift at work. 

These last few moves have reminded me how often human behavior is shaped by the built environment. In our previous location I was in my car at least once a day to do anything. Additionally,the idea of walking the dingoes was a chore fraught with stress as dogs would come out of their yards to attack my pups; walking on the street rather than sidewalk was a somewhat safer option but still unpleasant when dodging vehicles.

Our new neighborhood has nice sidewalks that encourage activity and neighborhood community. Like our Portland home, we have met the neighbors and know their names! Parking in downtown here takes just as long as a bike ride to down town and one is definitely better for your blood pressure than the other. Additionally, bikes are fairly common here and cars know to watch for cyclists. I maybe drive 1-2 times per week for errands that require a vehicle - like groceries for the week.

In our ongoing national critique of obesity the human environment is often missing from the discussion. Food deserts breed fast food and unhealthy food options when grocery stores are lacking. Unsafe, unpleasant streets breed more driving rather than walking or biking. It's not surprising our population struggles with its waistline when we spend more time behind the wheel. 

The last 7 months of living rural were terrible for my health and now I'm slowly chipping away at the 30 pounds that I gained there from not enough exercise (despite dogs walks) and the amount of time I spent driving to get anywhere (even if it was to go hiking or walking my 5-7 miles a shift). It was a self study in how environment shapes behavior and it was humbling.

Although in the ICU I do a lot less teaching than I did in the IMCU, this is a consideration that I keep in the back of my mind - where do my patients live? Just like air pollutants or water pollutants can poison the human body the built environment constructed without regard to human body can cause an equal amount of damage. 

There is not an easy or quick solution to these - sidewalks are not poured over night and bike lanes are expensive to build, but the conversations are definitely the beginning.

eICU: A really neat resource!

This is a link to a really great article about the eICU (electronic intensive care unit) at my hospital. It explains how this resource works and how great it is to have extra hands on deck when managing a critical patient with rapidly changing conditions. I have worked with the eICU nurses a couple times in the last 2 weeks and have come to really appreciate how they have a 'bird's eye view' of vital sign trends and labs.

Dr.Pate's Prescription for Change: St. Luke's eICU

So far so good...

This week marks my third week of orientation. It has been a very challenging but enjoyable process. I have encountered very complicated patients and worked diligently to heal and comfort side by side with my preceptors.

A few things that have been of interest in the last 3 weeks:

• Although I am in a medical ICU we are apparently referred to as the CCU (coronary care unit). Why this is no one seems to know. And our surgical ICU is referred to as just the ICU.
• I worked with my first balloon pump. Although I will not have a balloon pump patient for probably 2-3 years (they require specialized training)this was a very interesting experience. We literally did not leave the bedside for 12 hours at a time because it is such a delicate and dangerous piece of equipment.
• I worked with a  Swan Ganz catheter, though not a common piece of equipment anymore, it is still seen in critical care occasionally. This is also a delicate and potentially dangerous piece of equipment, but one that I could be working with in the future. I took my first PAWP (that stands for pulmonary artery wedge pressure), where a balloon on the Swan Ganz cathether is inflated inside the pulmonary artery (the artery with deoxygenated blood that travels from the heart to the lungs to pick up oxygen) to capture the approximate pressure inside the L atrium of the heart. This was a terrifying/thrilling moment in my life crystallized by the fact that I had an audience that included not just my preceptor but a handful of nurses from the unit that wanted to come see a Swan Ganz cath.
• We are the only nurses that get floated outside of the hospital. Apparently if the Meridian St. Luke's is short staffed we can be sent over to help. This is quite different from floating to another unit in the SAME hospital and unfortunately requires a car.
• I completed my second telemetry course. This time it was partially online with the American Heart Association and partially done with a real human being. It was excellent, but also provided a sense of accomplishment because I had real life examples to base my questions on. I also realized that all those squiggly lines have become somewhat second nature to me and the class did not feel overwhelming like the first time.
• I started the ECCO (electronic critical care online) program through the American Association of Critical Care Nurse (AACN). This has been a challenging and rigorous course, but completely applicable to my work. I feel like I am in nursing school again, but at least I get a paycheck with it and a lot less tears ;)
• We are officially moved into our new home! I'm a mile from the hospital, 2 blocks from hiking trails, and 1 mile from downtown. On Saturday I went paddle boarding on the river with a coworker from the SICU and her husband and we finished the day at Boise Fry Company (the yummiest fries I have ever eaten). It felt like a "typical Portland day" and I slept the best sleep I've had in half a year. It was awesome.

Off to unpack some more boxes...