Thursday, June 26, 2008

When Faith Meets Healing

Faith plays a key role when designing healthcare facilities with Muslim patients in mind

By Zabihullah Noori

When their mother was hospitalized with cancer, Azra Hussain and her family stayed with her around the clock in rotating shifts. They prayed five times a day in her room at the Mayo Clinic Hospital in Scottsdale, Ariz. Their mother took comfort as she listened to her husband, son and daughters take turns reading verses from the Quran.

Regardless of what country or culture they come from, Muslims are usually family oriented. Whether it’s celebrating a birthday or visiting a patient in the hospital, they prefer to gather in groups. When Muslims get sick, they go to the doctor, but the family members also pray for the patient’s recovery. It’s not only the faith of the patient but also “the faith of the family members,” says Hussain, who heads the Islamic Speakers Bureau of Arizona.

Like most Muslims, the Hussains believe that faith plays a key role in the healing process. They believe that although Allah [God] is the ultimate healer, physicians or medicine can facilitate healing. In the words of Prophet Mohammad, “When the disease meets the medicine that is prescribed for it, the disease will be cured by the will of Allah.”

It’s not easy to provide patients of a particular faith with everything they need, especially when they represent only a fraction of the population. Muslims, for example, comprise less than one percent of the country’s 300 million people, according to the 2007 U.S. Religious Landscape Survey. But when faith plays a key role in healing, as with Muslims, designing healthcare facilities with these patients in mind could aid the healing process.

Demographic research would indicate the spiritual needs of the population in a given area. In places with a significant Muslim population, for example, designers could consider installing at least one Turkish (Middle Eastern) bathroom in each hospital. Each prayer requires ablution—washing the private parts, hands, mouth, nose, face, forearms and feet, as well as touching the head with wet hands. It’s easier for Muslims to wash their feet in a Turkish toilet, which is sunk into the floor, than in an American-style sink.

Within patient rooms, flexible elements could accommodate members of different faiths. Easy-to-move furniture would give Muslim family members ample space to pray. This flexibility would also allow room for those who practice Eastern Orthodoxy rituals to kneel, while facing east, and recite the Creed. The Creed is considered a statement of faith in times of hardship.

Yet even when hospitals try to accommodate Muslim patients, it’s not always easy. The chief of Dewsbury and District Hospital in Yorkshire, England, ordered the staff to turn Muslim patients’ beds so they faced Mecca. One nurse, however, found it difficult to move the beds without disturbing other patients. According to the Daily Mail Web site, the nurse said, “It would be easier to create Muslim-only wards with every bed facing Mecca than dealing with this.”

Another consideration is food. Hussain was concerned about her mother’s diet, so she reminded the staff that Muslims don’t eat pork. “[Food] brings a level of comfort to the patient,” Hussain said. “It’s one less thing they’re worrying about—and one more thing that the calories in the body could be used to heal the body.”

Hospital-issued garments can be a concern as well. Muslims value modesty, so clothing must not reveal certain parts of their body, such as cleavage and thighs. Some hospital gowns are short and therefore make women feel uncomfortable.
When patients are admitted, hospitals ask about allergies, smoking and drinking habits, but not always about religious concerns. Hospitals could consider asking about dietary needs and clothing preferences at the time of admission, which would benefit members of other faiths as well.

Interactions with nurses and doctors of a different gender can also make both male and female Muslim patients feel uncomfortable. This is of concern with nurses who wash patients, for example, but not with those who bring food or change the bed linen. If a Muslim woman has a soar throat, she’ll visit a doctor of either gender, but if she has breast cancer, she’d prefer a female doctor.

Emergencies are exceptions, of course. “When vital statistics are dropping,” Hussain said, “nobody cares as long as the patient gets the care that’s necessary.”

Designing healthcare facilities with Muslim patients in mind could help facilitate the healing process. But for the faithful, the ultimate healer remains Allah. “If we go directly to the source,” Hussain said, “we have faith that He will only do whatever is best.”

Every Second Counts

Long waits in an emergency department can make the difference between life and death

By Zabihullah Noori and Tiffany Tcheng

Kelton Aker knows what it’s like to wait in an emergency room in unbearable pain. In the summer of 2006 Aker, his wife and a few cousins were camping in Arizona’s White Mountains. While playing Frisbee, Aker slipped and fell. “I knew something was wrong because I couldn’t breathe,” he said. He suspected he had a collapsed lung.

The closest hospital was in Springerville, a town about 40 miles away. Aker knew the small rural hospital couldn’t handle the case, but it was the only option. A friend drove him there as fast as he could.

Aker waited 30 minutes for a chest X-ray. The results showed that two severely broken ribs had punctured the plural cavity, causing his lung to collapse.

He wanted to be transferred to Yavapai Regional Medical Center in Prescott, closer to where he lived. But Yavapai Regional didn’t have a level-one trauma center, so Aker was airlifted to Banner Good Samaritan Medical Center in Phoenix. It’s one of seven level-one trauma centers in Arizona—five in Phoenix, one in Tucson and one in Flagstaff.

A small plane carried Aker and his wife to Sky Harbor International Airport in Phoenix. By the time they landed, he had endured four hours of severe pain. A team at Banner Good Samaritan treated him immediately. Five days later, he was discharged.

Aker’s ordeal lasted many painful hours because he was injured in a remote location, but he actually spent only 30 minutes waiting in the emergency department (ED)—and that was for an X-ray. Not everyone is so lucky.

According to the Los Angeles Times, Edith Isabel Rodriguez died of a perforated bowel in 2007 while waiting in the ED at Martin Luther King Jr.–Harbor Hospital in Los Angeles. A video shows her thrashing around on the floor in her own blood and vomit for 45 minutes. A janitor cleaned up around her, but no one tried to help.

Rodriguez’s case brings into question the care that patients receive in the emergency department during their most traumatic moments. Once reserved for urgent situations, EDs are being used more and more as primary care facilities. The result: longer wait times.

But pointing fingers at just one factor is unfair. EDs are complex. Long wait times also stem from staffing shortages, population growth, uninsured patients and design factors.

Shrinking EDs

In Arizona the number of emergency departments hasn’t kept up with the rapidly growing population. “You don’t see a lot of emergency departments growing in size,” said Davey Ellison, nursing director of the Emergency Department at Banner Estrella Medical Center in Phoenix.

In fact, ED staffs are shrinking. As more and more people swarm the ED, the patient-to-physician ratio becomes smaller. And the wait times grow longer.

Some 10,000 physicians were serving an estimated population of more than 6 million Arizonans in 2006, according to the Arizona Department of Health Services and the U.S. Census Bureau. Of those 10,000, only about 500 were emergency physicians.

The University Medical Center in Tucson is in danger of losing its level-one trauma status because of the limited supply of surgeons. These physicians are always on call. “The lifestyle of a trauma surgeon isn’t the one that works well with a nice lifestyle,” said administrative director Michele Zimba.

A shortage of ED nurses also contributes to long waits. “Many hospitals will not allow a new graduate out of nursing school to work in an emergency department because the patients are too sick and they don’t have enough experience,” said Dr. Bob Dietrich, an ED physician at the Mayo Clinic in Scottsdale, Ariz.

But even experienced nurses can handle only so much. Ellison estimated that ED nurses get burned out after five years. When they leave, the ED loses valuable experience and knowledge.

Some ED nurses stay much longer. Caryn Unterschuntz, who was an ED nurse for 19 years in the Chicago and Phoenix areas, avoided burnout by moving around to different hospitals. “People either like ER, or they don’t,” she said. “The people who like ER like critical thinking and problem solving.”

To offset the physician shortage, Ellison hires nurse practitioners and physician assistants to help out in the ED so patients are seen quicker. Often, when patients are discharged from the ED, they’re instructed to follow up with a primary care physician within two to five days. But they usually can’t get an appointment in that timeframe, so they end up in the ED again.

Unterschuntz recommended giving nurse practitioners an office in the ED, where they can see referrals from busy primary care physicians. “It’d provide excellent follow-up for the patient and alleviate [trying to get into a primary care office],” she said.

Staffing at Banner Estrella depends on patient arrival patterns, such as the time of day and the day of the week, and the severity of the patient’s condition. Based on those patterns, overlapping 8-hour, 10-hour and 12-hour shifts accommodate patient and staff needs during the busiest times.

To retain ED nurses, Ellison allows them to choose between shorter shifts more days a week ands longer shifts fewer days a week. Experienced nurses screen patients to determine their acuity level. This keeps the flow of patients moving and results in higher patient satisfaction scores.

The experienced nurses also teach newer ones. “They love it,” Ellison said. “They get to teach, and they don’t have to stand” as long as they would if they were working an ER shift.

Primary care facilities

Also contributing to long waits is the fact that the ED is turning into a primary care facility. On average, 219 people visited an ED in the United States every minute in 2005, according to the National Hospital Ambulatory Medical Care Survey. Many of them didn’t have insurance, so their only option was the ED. The U.S. Census Bureau estimates that about 47 million people in the U.S. are uninsured. That includes more than a million people in Arizona alone.

But it’s not just the uninsured who are crowding EDs. A recent study in the Annals of Emergency Medicine attributed increasing ED usage to patients who have had complications after a medical or surgical procedure and then go to the ED because they can’t schedule a timely appointment with their own physician.

Dr. Dietrich estimated that nearly 70 percent of the ED patients at Mayo come in with non-emergency problems, such as the flu or back pain. Patients with life-threatening conditions are seen first, forcing those with less severe ailments to wait longer.

“Patients [should] understand that they don’t go to the emergency department unless they have an emergency,” he said.

Unterschuntz said “minute clinics,” or the medical clinics located inside Wal-Marts, might reduce the patient volume in the ED as people get used to stopping there for a backache as well as a backpack.

The time of year and holidays, such as Christmas and Thanksgiving, force people to rely on the ED because primary care facilities are closed. Wait times are also longer during cold and flu season—or during Arizona’s blistering summers, when people suffer from heat stroke.

But no matter why patients come to the ED, they should receive quality care. “We want to know that we met your expectations,” Ellison said, “regardless of what you’re here for.”

Designing an ED

To shorten wait times, hospitals across the nation are using a form of split emergency department. First, a nurse determines the severity of the patient’s condition. Those who are bleeding or showing symptoms of a heart attack, for example, are sent to acute care. The others go to the intake area. About 70 percent of admits at Banner Estrella end up in the intake area for tests, lab work and other medical screening.

People tolerate waiting better if they understand where they are in the check-in and treatment process. To keep patients informed, Banner Estrella implemented the Next Step Process in May 2008. Maps of the ED in English and Spanish are posted throughout the area. Dots indicating “You are here,” like those on shopping mall maps, show patients where they are in the ED process and what the next step will be. Patients also receive a diagram of the ED and a brochure describing each step in the process.

One time-saver is the electronic medical record system. Instead of relying on intermediaries like lab or pharmacy techs, physicians themselves order the lab work, tests and prescriptions. This reduces transcription errors. Lab and test results show up on the electronic medical record immediately, thus eliminating the need for someone to run lab results to the physician or nurse. Healthcare providers can obtain full patient histories through the electronic medical record system. Thanks to state-of-the-art medical imaging equipment, the turnaround time on lab tests is very good, Ellison said.

Scottsdale Healthcare in Scottsdale, Ariz., posts the ED wait times on the home page of its Web site for its three facilities. The information is automatically updated every 10 minutes.

Although the wait time can’t be guaranteed when the patient arrives, it helps people decide where to seek treatment.

Even with these time-savers, patients still have to wait. Comfortable surroundings can ease anxiety and pain. Banner Estrella recently recovered its weathered chairs and painted the waiting room in pleasing earth tones. The floor tiles were replaced with terracotta-colored rubber, which is gentler on the feet. Complimentary coffee and a wall-mounted television make the wait a little easier. The walls outside the ED will be covered in slate tile to make the area feel more welcoming. Additional housekeepers were hired to keep the ED tidy.

From the bottom up

No matter how comfortable the ED, the most important thing is that patients feel they’re being cared for. One way to ensure quality is by fostering good teamwork. “You can have any design, any workflow process,” Ellison said, “but they’re only going to work if you have the right people [working], and everybody does it together.”

Another way to improve quality is by soliciting feedback from many sources. “For years we’ve had people at the top telling us how to do our jobs,” said long-time ED nurse Caryn Unterschuntz. “And now we need to start looking at the workers who are doing the jobs because they know how to improve the situation….They can save the companies money and find better practices.”

The next time a hospital is considering an expansion, Ellison suggested consulting a management engineer to evaluate and assess the flow in the ED, including the nurses and staff who care for the patients. Feedback from patient satisfaction surveys could be taken into consideration as well. After a thorough study, the engineer can relay the information to the architect.

“That way, we’re not designing our process around the building,” Ellison said. “We’re designing the building around the process.”

Click on the headline to visit the Healing Web site.

Cronkite School Proud of Holy Hunger’s Recognition

The 15-minute student documentary won two Awards in one year, which not only made the producers proud of their production, but also brought honor to Cronkite School of Journalism and Mass Communication and its faculty.
The article below describes how the Cronkite faculty feels about this film and its producers.

June 18, 2008

Documentary Wins Recognition for Students

A documentary produced by three Cronkite students has won awards for excellence in national and international competitions.

“Holy Hunger in the Midst of Plenty” follows Muslim students at ASU as they observe Ramadan, a month-long religious observance emphasizing prayers, fasting, charity and self-examination.

The 15-minute student documentary, produced by Jamie Murdick, Stjepan Alaupovic and Zabihullah Noori, won a 2008 Bronze Telly Award as well as a Videographer Award of Distinction.

The Telly Award is one of the most prestigious awards given for video and film production, television programs and commercials and work created for the Web. Productions in more than 200 categories are judged on their individual merits, and the best are given Silver or Bronze awards. The Cronkite School entry was honored in the category for documentary film work produced at schools, colleges and universities.

The Videographer Awards is an international awards program directed by communication professionals to honor talented individuals and companies in the video production field. Entries number in the thousands from all 50 states and multiple countries. The Cronkite School documentary, entered in the “Produced by Students” category, received the organization’s highest award.

Murdick, Alaupovic and Noori, all recent graduates of the Cronkite School, created “Holy Hunger in the Midst of Plenty” last year while students in Professor John Craft’s documentary production class.

Craft said that Noori, a graduate student at the time and a Muslim, was interested in how Muslim students try to adhere to their faith and still fit into a secular culture at ASU, especially during Ramadan. The idea grew into a semester-long team project.

“They told the story very well, and in today’s world this is an important story,” Craft said.

The documentary was aired on the premiere episode of the KNOW99 Student Film Hour earlier this month on Cox Channel 99.

It is the second documentary produced under Craft’s direction to win national recognition this year. Ray Gonzales, who received his Master of Mass Communication from the Cronkite School in December, won both a Bronze Telly Award and a Broadcast Education Association Best of Festival Award for “Lessons in Loyalty,” a documentary on the internment of the more than 100,000 Japanese Americans during World War II.

Click on the headline to read the article on Cronkite Web site.

Monday, June 02, 2008

فیصله نهایی محکمه سید پرویز کامبخش یکبار دیگر بتعویق افتاد

سید پرویزکامبخش که دستانش با ولچک بسته بود توسط دونفر—یک افسر نظامی و یک کارمند امنیت ملی— امروزیکشنبه ، اول جون به محکمه آورده شد. بعداز اینکه قاضی حکم کرد، دستان کامبخش را از قید ولچک رها کردند. منشی جلسه مقاله طولانی را، که به ادعای دادستان، تحقیق و نوشته کامبخش بود، بخوانش گرفت که بیشتر از نیم ساعت طول کشید.

جریان قضیه
سید پرویز کامبخش متهم به بی حرمتی به دین مقدس اسلام و پیامبرمسلمانان حضرت محمد (ص) و نوشتن این مقاله از هفت ماه بدینسو درزندان بسر میبرد. موصوف ازطرف قاضی محکمه ابتدائیه ولایت بلخ محکوم به اعدام شده است، اما ازاینکه محکمه بلخ علنی وعادلانه نبوده، کامبخش از شهرمزارشریف به زندان پلچرخی درکابل انتقال شد. ودوسیه وی نیز به محمکه استیناف راجع شد. کامبخش از یکماه بدینسو بیشتر ازدومحکمه را درکابل سپری کرده که در هردو بارقاضی فیصله نهایی را به محاکم بعدی موکول ساخت. درآخرین محکمه که هفته گذشته دایر شد، کامبخش وکیل مدافع خود را انتخاب کرد. قاضی محکمه ازمحمد افضل نورستانی وکیل مدافع کامبخش خواست تا دفاعیهء خودرا تقدیم کند. نورستانی گفت که قبل ازاینکه دفاعیه را پیشکش کند بایست به اعتراض که درپروسه تحقیق دارد باید رسیدگی صورت گیرد. نورستانی طی درخواست اعتراض کرد که به موکل اش درریاست امنیت ملی بلخ شکنجه صورت گرفته که باعث کسر استخوان بینی و بیجاشدن استخوان دست کامبخش شده است.

فیصله محکمه
دراخیر جلسه قاضی فیصله محکمه را چنین اعلام نمود
"بعداز غوروبررسی درخواست وکیل مدافع سید پرویزکامبخش، درنتیجه تصمیم به این شد که برای تعیین عدالت و روشن شدن حقایق ورفع اعتراض وکیل مدافع، سید پرویز کامبخش غرض معاینات به ریاست طب عدلی معرفی و اعزام گردد. بعداز حصول نظرریاست طب عدلی تاریخ جلسه قضائی بعدی تعیین خواهد شد."