give your patient a fast hug once a day

原谅我..我在google上搜"Hug"的图片时，就出现了这个..Snoopy狠狠地抱住Peanuts..

以下是以为资深的icu的资深医护人员的感想：

在加护病房中，每个健康照护专业人员都拼命地照顾病患..

＂但是常常一忙起来，就会头痛＂，喔..不是啦，那是某各贵死人不偿命药物的广告台词..

常常一忙起来，就像机器人做事了..

怎么说，护理人员忙着写纪录，翻身，给药，抽痰，应付暴乱..

医师忙着开药，主治医师忙着挡驾，病患家属约谈..其他人负责装忙..(那是我啦..歹势)..

这时候，你需要一些东西来提醒你是不是忘了什么?

这时候，你需要让你的大脑＂清新＂一下 (卖口香糖吗?)

有人提出了一个蛮有趣的短句，叫做"Fast Hug"

F = Feeding: 记得给你的病患足够的营养与热量，别让他饿到肚子不能打仗了..25 Kcal/kg是最基础不过的热量标准，请一定要记得!!

A = Analgesia: 你在加护病房对他进行许多不是很舒服的服务，再加上原本疾病的苦痛，是否需要给他止痛药物呢? 怎样能够减少它的痛楚呢? 请好好考虑一下..

S = Sedation: 个人认为，这是蛮大的一个挑战，好的sedation一定可以让他上天堂 (转到普通病房)，坏的sedation一定会让他住套房 (继续呆在你的病房)，记住微熏的镇静安眠是最佳的准则..

T = Thromboebolic prevention: 预防静脉栓塞，这在台湾反而非常非常少用，许多病患一来，凝血功能都不好了，这不但反应国情的不同，还反应出病患族群的不同..

但是，请注意，某些特别高度风险危险群，列如过去已经有DVT/PE病史，特殊容易血液栓塞的体质 (APS，Protein C缺乏，ATIII缺乏，Prothrombin基因突变，记的遇到这些病患跟我讲一下，不常见阿..)，或是接受特定术式病患，这些东西还是要派上用场的..

H = Head of the bed elevated: 把床头摇高吧，这个小举动可以降低呼吸器肺炎的发生率，但护理人员都知道，床头摇高，病患就很容易滑下去..(冏)

U = stress Ulcer prevention: 讲很多次了，根据1994年烹饪大师 (Cook) 的研究结果，加护病房中，发生压力性溃疡最大的危险因子就是使用呼吸器与凝血功能异常，这两类病患在我们的病房又占绝大多数，因此压力性溃疡的预防绝对是重点中的重点..(但有空再说..)

G = Glucose control: 血糖控制，这就要问问我们的哈医师了，他每次查房都一定会确认病患的血糖，我是比较反对在加护病房使用超长效胰岛素..因为在加护病房常常因为一堆原因使病患NPO..如果他不幸必须突然NPO..然后又没人发现他打了超长效胰岛素，那他的血糖..就会..(不敢想象)

这个简短的记忆方式，虽然没有涵盖所有面向，但电视机前面的你 (明明没有电视机)，是否都注意到了呢?

记得每天至少一次，拥抱一下你的病人吧!

learning by doing

There is really only one way to learn how to do something and that is to do it. If you want to learn to throw a football, drive a car, build a mousetrap, design a building, cook a stir-fry, or be a management consultant, you must have a go at doing it. Throughout history, youths have been apprenticed to masters in order to learn a trade. We understand that learning a skill means eventually trying your hand at the skill. When there is no real harm in simply trying we allow novices to "give it a shot."

Parents usually teach children in this way. They don't give a series of lectures to their children to prepare them to walk, talk, climb, run, play a game, or learn how to behave. They just let their children do these things. We hand a child a ball to teach him to throw. If he throws poorly, he simply tries again. Parents tolerate sitting in the passenger seat while their teenager tries out the driver's seat for the first time. It's nerve-wracking, but parents put up with it, because they know there's no better way.

When it comes to school, however, instead of allowing students to learn by doing, we create courses of instruction that tell students about the theory of the task without concentrating on the doing of the task. It's not easy to see how to apply apprenticeship to mass education. So in its place, we lecture.

There are better alternatives to teaching people of all ages new things. Here are three efforts headed by Roger Schank that are all based on the learn by doing approach.