Girl On Point Freelance Writing Clips

If a survey were conducted throughout the hospital questioning what brought employees to Mercy San Juan, their answers would be as diverse as the backgrounds they come from. Each brings with them different experiences and personalities that when combined, form a potpourri of strengths and weaknesses. The enormous task each unit must endure on a continual basis is that of melding the best of everyone to achieve the highest of standards, often in spite of their differences.

Within the whirlwind of increased patient loads, budget restraints, added legal requirements, and reduced resources, it is no wonder that every now and then we must remind ourselves -- and each other -- of our mission and philosophy and our personal obligations to health care. Sometimes – when we least expect it – that reminder appears much like a rainbow after an intense shower, a new birth of spirit that warms our soul and revives our sense of purpose. Often such a rainbow brings a reminder of the dedication others around us possess that we overlook on a day-to-day basis. Together and individually, we have the ability to make a difference in the lives of those we care for.

As health care becomes more challenging with each passing day, nowhere are the heartstrings of patients and those who diligently care for them more readily visible than in our emergency room. Each passing shift hurtles staff through a vast array of emotions, pushing them to the limits of compassion and frustration.

To each patient who enters the ER registration area, his or her need is urgent. The patient's emotional condition is often as unstable as the injury or illness, adding to the stressful environment. For truly critical patients, their physical and emotional needs must be addressed immediately despite the status of the unit at that moment. Concerned family members await information and personal contact from staff, placing additional demands on the department. Yet, through it all, the staff manages to provide for everyone because of their ability to depend on the strength of each other.

As shifts come and go, training and instinct command a first-rate performance. From the clerks to the techs, the nurses to the doctors, patients are bandaged, admitted, and referred. The ER frequently seems to be the human “pit stop” in the “Medical 500.” The pace is fast and time is of the essence.

And then it happens. A patient arrives who will ultimately affect all who participate in the patient's care and the unit as a whole. The patient requires the best of those who are on duty, extracting from them the lessons of the training and finally, their deepest emotions, normally suppressed into control to survive within our environment. The downpour before the rainbow begins.

Perhaps it is the courage of a patient facing the pain and fear of an aneurysm that feeds the strength of the staff in the trauma room – a dedicated team bonding skill with time, sealed with prayer. As the patient is transferred to ICU, the staff takes a moment to acknowledge each other's professional contribution and share in the reality of an uncertain tomorrow. Together, they realize they made a difference today.

Oddly enough however, our greatest strength as a team occurs during those times when skill, experience, and even prayer is not enough. This was an overwhelming realization for me during a recent shift in the ER. We were addressing our third “code III” in less than 45 minutes when a fireman (still in the ER from a previous code) carried an unconscious youth from a car into the unit. The boy's face was blue and his body seemed lifeless. The staff, seriously taxed from the three previous codes, rushed into what can only be described as supreme action to administer resuscitation.

My job as the unit clerk was to transcribe each aspect of care as it occurred, to watch and record the actions of all who would struggle to achieve what ultimately proved to be impossible for this young boy. For those present, the words of the ER physician to “stop the code” were heavy, sending a numbing sensation racing through the department much like electricity following the path of least resistance. Staff members and other patients were unable to escape the devastation. I watched as the physician defied the words himself, and I realized for him this was especially painful. We all knew that the best of the best was given, and yet it was not enough.

The following hours brought continued stress and reminders of the loss as family members were admitted into the examination room. We found comfort in knowing that for another life would be made possible through the donation of organs so generously offered by the boy's parents. Many of us have children the same age as this boy, making his life all the more precious to us. We would all go home and kiss our children that night.

On this sad morning, I recorded more than the vitals and status of patients or the motions of an incredible team doing what they do best. I was witness the strength of the human spirit, the skill of a finely orchestrated team, the endurance of emotion, and the compassion that would revel itself as our most valuable tool. It was a day in which staff members would prove themselves not only dedicated to their work, but also dedicated to each other. Hand in hand, they guided each other through the pain and created a rainbow of caring and support. I was never more proud to be a part of our ER and grateful for the tenderness extended to me by my co-workers so that I too could survive the suffering.

Without a doubt, the management support and personal gifts offered each day by staff members represent the success of those standards we work so hard to achieve. Everyone giving their all… in a heartbeat .

The specific cause/cure for TMJ/TMD continues to elude researchers, and in most cases, involves several joint-related disorders and symptoms, thus making individual diagnosis and treatment options necessary. Often acutely painful, TMJ/TMD involves inflammation and/or degeneration of the joint and muscles associated with chewing.

The temporomandibular joint connects the mandible (the lower jaw) to the temporal bone, located at the side of the head directly in front of the ears. While these joints are flexible, allowing for movement up and down and from side to side, muscles that attach and surround the joints control the jaw's position and movement. The rounded ends of the jaw -- the condyles -- slide easily within the joint socket and are aided by a soft disc, which acts as a shock absorber within the joint itself and keeps this movement smooth.

• Myofacial pain; a discomfort or pain in the muscles that control the jaw, neck, and shoulders. The most common form of TMJ/TMD

• Internal derangement; a dislocated jaw, displaced disc, or injury to the condyle.

• Degenerative Joint Disease; Osteoarthritis or rheumatoid arthritis within the jaw joint.

For most, the discomfort associated with TMJ/TMD is generally mild, temporary, and resolved with little or no intervention. But for a growing population compromised predominantly of women, intervention is necessary and may involve the simple use of an oral appliance (often referred to as a “splint” fitting over the top or bottom teeth) that provides relief to the joint and muscles, anti-inflammatory medications, and in some cases, more aggressive, irreversible alternatives such as surgery. To date, treatments that are reversible in nature (splints, medication, stress reducing exercises) are considered preferable to the irreversible nature of surgery. However, in cases of trauma, surgical correction may be necessary.

In mild cases, physical therapy provides a conservative treatment option that can be continued at home. Focusing on muscle stretching and relaxation techniques, when used in combination with anti-inflammatory drugs patients often report significant relief of muscle spasms and associated pain.

Common signs and symptoms include, but are not limited to (one or more) of the following:

• Painful clicking, popping or grating sounds in the jaw joint when opening or closing the mouth.

• A sudden, major change in the bite (the way in which one's upper and lower teeth fit together).

Because symptoms vary from patient to patient, a thorough dental examination and complete medical history are necessary for an appropriate diagnosis and treatment plan. Regular X-rays are usually inadequate for the diagnosis of TMJ/TMD, although in cases involving arthritis, trauma, and increased severity of pain, magnetic resonance imaging (MRI) can be helpful.

(2002 Cappi Award Winner in the Category of Best Individual Public Relation Tool, Brochure)

Cover Title: California's Emerging Health Care Advocate: You! Understanding Your Choices & Your Rights

Managed care organizations are made up of networks of physicians, hospitals, and other health care providers. When you choose a health care plan, you're agreeing to abide by that plan's guidelines -- those procedures, services and restrictions that are outlined in a plan's Explanation of Benefits. Each plan carries its own restrictions and may deny you access to outside doctors or specialists, improved medications, experimental procedures and preventative measures.

Your first challenge is to understand the types of plans available to you and their unique features.

The more traditional “fee-for-service” plans that most of us grew up with are still available in California today, but are generally the most expensive type of plan.

• Fee-for-service plans will pay (on average) 80% of those charges “allowed” by the benefits they outline. What is considered “reasonable and allowable” on their fee schedule may be far less than what your doctor charges for office visits, labs, and routine x-rays. You'll be responsible for paying the difference.

Large companies often finance their own medical plans referred to as “self-funded”, and contract with a plan administrator to manage it. Often that plan administrator is an HMO or a PPO. Employees typically recognize the HMO/PPO name, yet have no idea their plan falls under the category of “self-funded”. Check your ID card. In most cases your medical identification card will list your company's name, as well as, the name of the plan's administrator (HMO/PPO) for customer service or billing questions.

“What difference does it make if my plan is a company “self-funded” policy?” It could make a great deal of difference! California's new and aggressive laws enacted to protect consumers do not apply to “self-funded” company plans. If you're not sure if your company's plan is “self-funded” ask your plan administrator or Human Resources Department.

A “self-funded” company plan is not considered to be an insurance company, and therefore, is not regulated by the state of California. Instead, they fall under Federal jurisdiction. For example: In the case of a lawsuit, Federal ERISA law applies. If you win your lawsuit, your monetary recovery will be limited to only those expenses for treatment and possibly attorney's fees. Health care plans regulated by California law, however, could also be liable for damages for the loss of a loved one, other medical expenses, and emotional distress.

Sidebar: If you are currently enrolled in your company's “self-funded” HMO plan you are not protected by the laws set forth for consumers of California.

Webster's New World Dictionary offers, in part, the following definition of the word, process : A continuing development involving many changes . So it has been in California since 1995, when a new law became, in actuality, a process -- one of implementation and education, structure and definition. Title AB890, California's Universal Screening law for Domestic Violence, requires that all healthcare providers implement a screening policy that includes the following:

• A written/formal policy and procedure for screening potential victims of Domestic Violence

Viewed as an important step in the identification of domestic violence victims, and certainly, a positive step by all accounts, still, the task of identifying those at risk can be like driving in dense fog, especially when the bridge leading up to the Emerald City of safety is still under construction. It is a process that has identified, among many things, the need for not only enhanced multi-agency cooperation, but a level of commitment from those whose initial contact is absolutely vital to its success and very often, the first line of defense for victims; the emergency room nurse.

Domestic violence screening policies commonly begin with a variation of the following: Are you now, or have you ever been in the past, a victim of violence, physically, emotionally, or verbally? Allowing for the various faces of abuse in their inquiry provides, for example, the opportunity to identify seniors who feel their safety is in jeopardy. Some facilities, however, have created a policy in which only women of specific age groups are interviewed, excluding not only older women wrongly assumed to be at a lesser risk, but to the exclusion of men as well. Therein lies the vague boundary of the law, which some argue, diminishes its effectiveness and overall success.

The majority of RN's in emergency medicine value their role as proactive and vital. Male nurses voice some concern that female patients are less likely to respond honestly to their inquiries, if at all, and seek solutions that invite dialog with their female counterparts. During an informal and anonymous survey conducted by this writer -- as a means to reflect only individual opinions from the RN's in the trenches rather than to form a conclusion on a specific facility's effectiveness in policy -- Northern California emergency department nurses were candid in their comments, stating in overwhelming numbers, their support of such a patient intervention policy. That being said, however, many voiced a diminished confidence in the current system's ability to adequately identify and follow up on a patient, mostly due to poor cross-agency communication and interaction.

While most ER nurses comply with dedication and professional regard without hesitation, some confess to feeling as if their role is ultimately, serving only to collect time-consuming information with little if any, understanding of the outcome of their efforts. In some cases, nurses voiced concern regarding various discrepancies in response patterns by law enforcement agencies. Placer County Sheriffs, for example, were noted by some as being more supportive of nurses and patients, aggressively responding to phone reports when a nurse suspects an injury resulting from domestic violence.

Sergeant Robert McDonald of Placer County Sheriff's, Crimes Against Persons agrees that AB890 is a positive step against all forms of domestic violence, and considers the initial assessment performed by emergency room nurses to be his strongest tool. While not able to comment statistically on the impact of AB890 in Placer County, Sergeant McDonald is quick to add, “Even one identified victim is success enough.”

Progressive in many aspects and continually expanding its domestic violence policy, Mercy Healthcare of Sacramento includes all persons, regardless of gender or age, in their assessment procedures. While domestic violence knows no cultural or affluent boundaries, the presentation of such within various cultures and orientations can be unique. Staff education is a key element in Mercy's philosophy and mission.

A veteran R. N. of Mercy's emergency department, and an expert in the area of domestic violence, Jane Cohill is respectful of the challenges facing emergency room nurses regarding the identification and reporting process of victims. Currently assigned to Strategic Learning Development at Mercy Healthcare of Sacramento, Cohill is the co-chair of Mercy's Family Violence Committee, and also co-chairs the newly formed H.P.D.V.N., Healthcare Providers Domestic Violence Network; a consortium of healthcare providers, community outreach organizations, and law enforcement agencies. “The goals of H.P.D.V.N.,” Cohill explains, “are to better interface the policies and procedures of healthcare providers with those of supporting agencies, and to improve upon response coordination.”

Cohill further provides pro-active training for Mercy's emergency department nurses enlisting speakers and representatives from Sacramento County's diverse advocacy network. As a result of Cohill's efforts, Mercy's comprehensive policy (which currently includes Critical Care Units and Adult Medicine) will soon expand to the departments of Pediatrics, Neonatal, and ICU, and within 2 years, involve every entry of care within Mercy's facilities.

As the process of compliance with California's AB890 evolves, no doubt many of the programs initiated to assist emergency department nurses will provide insight to healthcare providers on a statewide and national level.

Nikolay Soltys, a 27-year old Ukrainian immigrant, rocked Sacramento, California last August setting in motion a nationwide manhunt – the largest of its kind with roots deeply embedded in domestic violence.

Charged with the brutal murder of his pregnant wife, Soltys is also alleged to have stabbed to death his aunt and uncle, as well as, his 10-year old nephew and 9-year old niece. He is also alleged to have stabbed his 3-year old son after sexually assaulting him and leaving his body in a cardboard box found abandoned in a field.

Soltys had a history of abusing his wife in the Ukraine and his ongoing abuse in the states was known to her family and within their community. He was feared. On the backside of a photo, Soltys wrote that he was angry with his wife for “talking out” about him to their family.

A more tragic case compelling law enforcement, the judicial system, healthcare workers, and community resources into action on behalf of victims of domestic violence with immigrant status doesn't exist. Sacramento County's response has been swift, molding new lines of communication within not only the Ukrainian community, but also educational forums that encompass other ethnic communities as well.

During “The Many Faces of Domestic Violence” educational conference sponsored by the Healthcare Provider's Domestic Violence Network (HPDVN), participants were guided through some of the challenges faced when victims seek help through silence; when speaking for themselves is not an option due to language or cultural barriers.

Michael Rodriguez, M.D., M.P.H., an Assistant Professor in the Departments of Family and Community Medicine, and faculty member of the Medical Effectiveness Research Center for Diverse Populations at the University of California, San Francisco, provides research and develops policy on violence prevention, medical education and cross-cultural medicine. In a recent study involving focus groups comprised of Latino, Caucasian, Asian, and African-American female victims, factors that pre-disposed or interfered with a victim's ability to disclose domestic violence to their healthcare provider was examined. Threats of retaliation from their abuser, embarrassment, and concerns about police involvement were standard among all groups, but social, institutional and provider barriers were evident among the non-white, or economically “poor” participants.

Access to a provider in which a victim can rely upon – build a trusting relationship with over time – is often difficult for those who lack sufficient insurance, or no insurance at all. Within the often crowded setting of local clinics or emergency rooms, research participants commented on the failure of healthcare providers to question injuries that did not coincide with their stated source or project a sense of concern, which they stated perpetuates the “devalued” sense of a patient already reluctant to disclose and dependent on further inquiry. The healthcare provider's facial expression, eye contact, and tone of voice were identified as subtle, but important ways of showing concern and developing trust, but inquiry was vital.

The focus groups also identified a wide range of physiological, social and institutional factors that affect their willingness to seek help, factors that operate simultaneously to make disclosure extremely difficult. Often times, an abuser will threaten the immigration status of his partner as a means to control and isolate them. Victims are usually unaware, as are healthcare providers, that they can file for immigration status independently where domestic violence is documented. A healthcare provider's ability to articulate this when it may be a factor can reduce a victim's fear and support the availability of victims assistance and outreach programs locally.

In cases of non-English speaking victims, healthcare providers are often too quick to utilize an intimate partner, child or family member as an interpreter and are warned against doing so. An abusive partner will retain control, while children and family members can influence, and in many cases prevent the patient from disclosing abuse for many reasons, cultural and economic fears/barriers being the most common. All avenues of interpretation should be exhausted prior to the use of a partner, child, or family member, or the patient instructed to return for follow-up in the near future as a last resort. A more appropriate interpreter can be provided at that time, arranged by the healthcare provider.

As the immigrant population within the United States grows, it is imperative that engagement with one's patients, their injuries and familiarity with the cultural barriers that may impede disclosure of violence are better understood. The dream of a “free” American lifestyle is a glorious one, however, traditional cultural standards are often intensified during stressful and uncertain times of transition. Without knowing precisely what structures are currently in place to assist those patients suspected to be victims of domestic violence, healthcare providers are ill equipped to properly support a victims need to disclose and seek shelter.

With fewer opportunities to seek traditional medical care, immigrant victims must rely on all healthcare providers -- including those who perform dental and optical care – to evaluate the discrepancies, inquire about their risk factors, and inform them as to the availability of services for their personal safety and that of their children.

Ophthalmologists are considered to have a unique opportunity for detection and disclosure as a higher rate of injuries occur to the face. Barbara Arnold, MD, believes that delay of care and other telltale signs are recognizable and must be learned. Her participation in the conference was to help pave the road for such an education to healthcare providers in Sacramento County. With over 3,551 cases of domestic violence reported in the county last year, it's an education that cannot be delayed.

Placer County Youths At Risk Find an Alternative to the Streets and Juvenile Hall

Until recently, intervention efforts on behalf of pre-delinquent youths in crisis who had not yet broken the law, but were at risk (runaways, truant, behavioral issues), proved difficult. The task of evaluating the emergent needs of a youth was often encumbered by the lack of an appropriate facility in which to offer temporary placement, allowing for a “time-out” period for both the youth and the family unit as a whole during which counseling and/or other multi-disciplinary services could be engaged.

For a great many of these children, juvenile hall is unwarranted and inappropriate, as is leaving the youth in his/her home environment where escalation of risk factors is likely. But with no viable alternatives available, law enforcement often found themselves frustrated by the lack of options.

The Placer County Probation Department has contracted with Koinonia Foster Homes to provide the county's first Crisis Resolution Center, designed to provide aggressive, integrated services to pre-delinquent youth and their families in a collaborative and pro-active manner that addresses the root causes of problems and prevents escalation of adverse behavior, all of which decrease the likelihood of a youth's entrance into the juvenile justice system.

Bill Ryland, Group Home Administrator for Koinonia couldn't be more pleased or optimistic about the future for at-risk children within Placer County. “Because this is a multifaceted and collaborative effort, timely and appropriate intervention long before a youth might otherwise become a part of the juvenile court system is possible. In simple terms, that means we can make a substantial difference early on.”

The Crisis Resolution Center provides a 24-hour hot line (available to youth and family members) 1-866-251-7584 and outreach services that include, but are not limited to, conflict resolution, individual/family counseling and appropriate referral services. The center also provides a six-bed licensed facility for the temporary housing of runaway and homeless youth within Placer County. We invite you to attend the Center's celebration and support this pro-active and positive undertaking.

Addressing the special needs of foster children once abused, neglected or abandoned, and those of the families who open their homes and hearts to them can be arduous, but Koinonia continues to meet those challenges by incorporating comprehensive training programs and a superior commitment to the “individual child” through the diligence of its highly professional staff.

Regional offices in northern, southern and central California, and Nevada administer to 16 additional district offices, all of which have unique geographical and socioeconomic needs specific to their area, and in many cases, vastly different laws and policies governed by state and county law. Consistency throughout the years in their ability to address and fill, the wide range of childcare voids often found within the foster care community, is the hallmark of Koinonia's claim to success.

Regarded as a leader in the care of at-risk children and the recruitment of new foster homes, Koinonia's regional offices helm agency-wide programs that encompass a wide range of needs including, but not limited to: adverse behavioral and emotional patterns, maintaining siblings within a singular environment, programs for the medically fragile, chemical dependency, transitional living, job training, and emergency, short-term placement for crisis resolution.

In his “ Ode to Koinonia ”, written for the agency's 20 th year anniversary, Jerry Johnson (a veteran Koinonia administrator of 14 years) speaks of the camaraderie -- the selfless giving of those who have stood the test of time and tragedy on behalf of children throughout the region. And the children they help? His words say it best with…

Koinonia's success stems from its passion and commitment, all that radiates from the Northern California Region; home to Koinonia's roots and the corporate offices in Loomis, California. With 137 foster homes currently serving over 200 children, the Northern California Region supports 5 district offices located in Loomis, Sacramento, Modesto, Fairfield and South Lake Tahoe.

Within the framework of this expansive region, many of the greatest lessons on behalf of fostering children, those both difficult and rewarding, paved the road towards advancement of Koinonia's vision, past and present. Challenged by educational administrators, county and state agency representatives and communities who often voiced a fundamental distrust of foster parents and a reluctance to assist with special needs children, the programs designed and implemented in the Northern California region have spawned a new era of progressive, multi-agency collaboration.

As a testament to their ability to revive a once darkened spirit, that of a child with little hope, and trust all but extinguished, Northern California's regional goals to provide additional foster homes is compounded by the loss of some existing homes where many of the foster children have been legally adopted…although you'll hear no complaints, only cheers. Continuing their outreach to communities and local churches, recruitment of new foster homes remains a priority, as does their commitment to training, the provisions of social workers readily available for assistance, and expansion within the region into underserved areas.

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Excerpt: Feature Article; Healthcare

Is Your Man Getting “Stoned”?

We've all heard of seat belts, black belts, farm belts, and fan belts, but “stone belts”? Confused? Don't be. It's a well-known but rarely discussed claim to fame for the state of Tennessee, the West Coast, and spanning the east from Boston to Florida – all hot spots for the formation of kidney stones that is.

Most stones are forming right now, from June through August, and more than 1.5 million new patients will make their first kidney stone during 2001, effecting one out of every ten people. A whopping ten percent of all hospitalizations nationwide will come from patients who suffer with the acute formation of kidney stones, most of whom will be male.

While women have joked over the years about Mother Nature's revenge on men who compare the painful experience of passing a stone to that of childbirth, new studies suggest that the ladies resist that giggle – a 75 percent increase of new patients developing kidney stones reveals that women are catching up to their gender opposites in startling numbers.

The perpetuated myth for all stone-forming patients is that recurring stones are almost a sure thing. While true without proper preventative measures, it doesn't have to be so. With less effort than you might imagine, future stones can be avoided – even in those patients who have painfully suffered for years.

Research and clinical studies have proven for some time now that future stones are indeed preventable. The difficulty for patients is finding out how. Statistics suggest that Urologists seem less than anxious regarding the dissemination of information on the prevention of stones, opting for more traditional treatments such as pain medications, or invasive and surgical procedures after the fact, which for some patients can lead to the removal of one's kidney. Educated stone patients argue that many physicians are reluctant to spend time on preventative measures because of the built-in repeat business that accompanies future stones. But some physicians believe it is simply a matter of the physicians themselves, even urologists, becoming better educated.

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Sample Excerpt: Business to Business Brochure

Cover Title: Just The Fax™

Daily lunch specials by FAX

Cover Copy: It's 11:00 a.m. Do you know where your customers are?

Inside Body:

Just The Fax knows exactly where your customers are and we'll make sure they know about your lunch specials every weekday by 11 O'clock in the morning!

For less than you might imagine … We'll help you target your local customers every weekday with a faxed promotion that includes your lunchtime specials. Many of the businesses we serve order-out multiple meals at least once a week for lunchtime meetings. Shouldn't you be on their list of great choices?

Office managers, secretaries, and executives alike love the break from routine and look forward to their host of daily specials. Unlike a printed menu, there's nothing static about Just The Fax . There's something new everyday, so your name won't be stuck in a drawer with all the other tattered and torn menus.

Just The Fax will also help you to understand what your hungry customers like the most about of our service by conducting frequent surveys. We'll tell you what they say are the best menus, services, and promotions that keep them coming back again and again.

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Just The Fax is not only cost effective, but also easy to manage. Each night (by 7 p.m.) fax or call in your specials for the following day. If an emergency arises and your staff can't place the ad, we'll arrange to have a standby of your “all-time favorites” ready to go. Your staff can submit your ad specials daily or fax us a week in advance. The program is flexible and allows for changes anytime prior to 7 p.m.

Want to include a special promotion? No problem. For no additional charge, we'll place a tag line in your ad. You might consider:

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Free small drink when you mention this ad!

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Consider us your “business building” partner and get started today! What's for lunch?

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