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Simply brilliant: the booze-o-meter, the nine-inch plate, and the sleeve song

kids sneezing in sleeves 
December 27, 2009 -- Several press pieces this month highlight deceptively simple nursing innovations with great potential to improve health. Two focus on helping people avoid deadly overindulgence. Today, the Deadline Press & Picture Agency (Edinburgh, Scotland) ran an article by Rory Reynolds about "former nurse" John Sharp, now a local council member, who has invented a glass design that shows drinkers how many units they are drinking, in an effort to reduce what the piece calls Scotland's "binge-drinking culture." (Of course, Sharp is no more a "former" nurse than a physician who no longer practiced would be a "former" physician.) On December 15, the Miami Herald ran a substantial Q&A between Teresa Mears and Christine Bromley, who practiced for years as a home health nurse before starting One Helping Helps Many, a company that sells nine-inch dinner plates to help people maintain portion control and thus reduce overeating. And on December 9, the Cleveland Banner (Tennessee) published an item by Linda Womack about Misi Rollins Austin, a clinical nurse manager for a local school district who created the song and video "Aim for Your Sleeve," sung to the tune of the Addams Family theme, to help kids remember how to reduce the risk of infection when they cough or sneeze. Each of these ideas helps people think more clearly about basic daily decisions, and they may seem simple. Indeed, they would likely be mocked mercilessly on the most popular Hollywood shows like House and Grey's Anatomy, which glorify high-tech interventions and convey little sense of broader public health issues. But these nurses' innovations could make the difference between life and death for many. We thank those responsible for these press items.

"Former nurse patents booze-o-meter glass"

"Changing diets on nine-inch plates"

"'Aim for your sleeve' song meant to help cut germ spread"

 
"Former nurse patents booze-o-meter glass"

The Deadline agency article "Former nurse patents booze-o-meter glass" explains that "former Scots nurse" Sharp has "successfully patented" a glass design that "can be printed on wine, beer and spirit glasses to provide a visual of how much booze is being consumed." Although Sharp is reportedly "now a councillor for Moray Council," that does not make him a "former" nurse; nursing is a profession, not a part-time temporary job. And although there is nothing here to relate Sharp's idea to the specifics of his nursing background, it is the kind of pragmatic intervention at which nurses excel, and one which, the piece notes, "could become a regular sight in bars across Scotland."

Most of the report consists of helpful quotes. Sharp explains that "alcohol is measured in units, but nobody really knows what a unit is. There are no glasses available that actually measure units so I began to investigate." Although the piece does not say how Sharp plans to distribute the glasses, it does say that he hopes that the government and "pressure groups" will help him promote the glasses, since, as he notes, "there could be fairly vested interests against such an idea by drinks producers and those who make and sell alcohol, because that's their business."

The piece also consults several health experts about the idea, though none appears to be a nurse, even though nurses are perhaps most likely to confront the effects of excessive alcohol consumption and they have been at the forefront of efforts to address it in the U.K. Professor Grant Cumming, who seems to be a public health expert, notes that Sharp's idea could have real effects:

The idea is brilliant, what you're doing is graphically seeing how much you're drinking... We've got to do something, because as taxpayers we can't afford it. The whole thing is about modifying behaviour, it's gently nudging our behaviour, it's just making you think a bit more -- it's as simple as that.

Health Secretary Nicola Sturgeon adds: "Studies have shown that while many people know that the daily unit guidelines are three to four for men and two to three for women, they find it hard to relate that to their own drinking." And Jack Law, who directs Alcohol Focus Scotland, confirms:

[W]e know that there is a limited understanding of what a unit of alcohol actually means in terms of a drink. People think that a glass of wine is one unit of alcohol, but of course this depends on the strength of the wine and the size of the glass.

All of these quotes are helpful, because they aren't just general testimonials. They explain why Sharp has put his finger on a key but overlooked element of alcohol abuse, the ease with which people--who have been drinking, after all--can lose track of how much they've had.

 
"Changing diets on nine-inch plates"

9-inch platesThe Miami Herald item "Changing diets on nine-inch plates" has a fairly in-depth Q&A with Christine Bromley, a Fort Lauderdale woman who "worked for many years as a nurse, teaching her recovering cardiac and diabetes patients how to eat right." This is better than "former nurse," though we like "practiced" better than "worked" as a nurse. The item's introduction notes that Bromley "didn't always take those lessons [about eating right] home, and she struggled with her weight for years." So Bromley created One Helping Helps Many, a company that sells nine-inch dinner plates as "part of what is called the Small Plate Movement, which advocates that both families and restaurants downsize their plate sizes[, citing] studies that show that people eat less when the food is served on smaller plates." Bromley donates 15 percent of the company's profits to charities that help children.

Bromley explains that her practice as a home health nurse "was mainly teaching patients."

I taught them how to change their lifestyles, and a big part of that was their diet. Though they were taught that they had to cut down their portions, they fought it all the way. They didn't know how to change a lifestyle. It all began with the plate. We had tools that showed where the vegetable goes, where the protein goes, and it was much smaller than the average 12- or 14-inch plate. ... I had battled the bulge my whole adult life. I had gone to every diet center and did great, and then when it came time for maintenance and returning back to normal food, I blew it because I was going back to the big plates.

Bromley goes on to discuss some of the roots of the difficulties with portion control, including the childhood injunction to clean your plate, and cultural practices that associate eating more with family bonding. She says that when she discovered the small plate movement, she was surprised to find that there were actually not any mainstream nine-inch dinner plates available. So she made some. Bromley also explains the difference small plates can make:

Our plates have increased in size since the '60s to 36 percent bigger. They said just by cutting down a plate two inches, from 12 inches to 10 inches, you cut calories 22 percent. If you eat like that for one year, you'll lose 15 to 20 pounds. I know from nursing that just a 15-pound weight loss in someone who's overweight improves their health dramatically.

And Bromley offers some advice that readers can use to maintain a healthy weight whether they buy her plates or not, noting that people can always eat on nine-inch salad plates, and that in any case, "eating three meals a day is the best defense against overeating." By allowing Bromley to explain what she is doing with the plates, the piece gives readers a good sense of the thinking behind the plates and shows that nurses are knowledgeable, articulate public health advocates.

 
"'Aim for your sleeve' song meant to help cut germ spread"

kids sneezing in sleevesThe Cleveland Banner item "'Aim for your sleeve' song meant to help cut germ spread" reports that Misi Rollins Austin, who is clinical nurse manager for Bradley County Schools and a school nurse at Oak Grove Elementary, wrote "Aim for Your Sleeve" to "encourage[] students to practice frequent hand washing and basic hygiene to prevent spreading flu and other common seasonal illnesses." The chorus of the song, which is sung to the tune of the Addams Family theme: "When you cough, when you sneeze, aim for your sleeve." Austin also created a DVD with elementary kids singing the song and demonstrating the idea in it, to help people see what she means by "aim for your sleeve." (See the video.) She explains:

The song encourages the kids to cough and sneeze into their arm instead of their hands, because hand washing is not always available and germs can be spread so easily. It's very age appropriate and it's fun. After coming up with this song and teaching the kids, we saw results very fast.

Austin sent a copy of the DVD to the Tennessee Association of School Nurses. The Association asked her to present the video at a conference, and she was then "overwhelmed by requests for the DVD from school nurses all over the state." Austin "hopes the song can remind students to be more health conscious and help cut down the number of unhealthy students." The report might have given more detail about how the sleeve practice can prevent infections, and the effects of influenza and other illnesses on public health, as well as on the students' education. But the piece is still a good example of a striking public health innovation by a school nurse.

Nursing innovations like these can be easy to ignore or undervalue. They often build on ground-level insights about how the social environment and personal practices affect people's health, such as how people eat, drink, or respond to apparently minor irritations like the need to cough or sneeze. However, these ideas are based on nursing training and experience, they apply prior health research, and they often have the potential (as the ideas above do) to save many lives. But because these ideas may not inspire as much shock and awe as high-tech innovations like a new kind of transplant procedure or a new "miracle drug," the ideas are likely to receive far less attention, respect, and funding. The heroes on the most popular Hollywood shows, like Greg House, would doubtless have nothing but contempt for these ideas, although the nurse characters on NBC's Mercy have repeatedly come up with comparable innovations to help patients.

If nursing was funded according to its potential, the world would likely be a very different place. In the meantime, press articles like the three described above are an important way to help the public understand the value of nursing ideas, and we commend those responsible.

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