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  • Dec 6

    We already know that caring for patients comes with a tremendous amount of stress.

    Nurses are regularly charged to be the calm face in the room with patients, family members, and even doctors. Who among us hasn't had to remain steady and focused when faced with a daunting task or emergency event that would cause a non-nurse to curl up in a ball on the floor?

    So how do nurses remain that tower of strength in stressful situations? Is it built-up callousness because we've seen so much? Perhaps for some, but others may use something deeper, more meaningful so patients and family members feel they can put their faith in the nursing staff -- the staff who remain so strong when others feel their worlds crumbling down around them.

    From my own experience and that of nurse friends and colleagues, I've pulled together a list of tips and techniques for nurses to use in those moments where high anxiety may threaten our resolve, but where we must keep ourselves together.

    Call on your spirituality

    One of the strongest tools, no matter our belief system, is our spirituality. This belief that there is a force bigger than ourselves that connects us to our fellow humans can help us lower our stress levels in moments of great crisis in nursing. Our spirituality gives us hope, which we can then pass on to patients and family members through calming words and presence.


    Keep a talisman in your pocket

    One of my nurse friends had a "worry stone", a polished stone with a slight groove in the middle of it, that she holds in her hand when she has to have a difficult talk with a patient or family member. She says the cool, smooth surface of the stone helps ground her and no one ever sees how nervous she may be.


    Use essential oils


    In one Planetree Hospital where a nurse colleague works, the nurses use a few drops of lavender essential oil on cotton balls placed around the room instead of always using Ativan to calm patients. The same can work for nurses with a few drops of lavender on the inside of a scrub top or on a cotton ball pinned to the inside of the scrub. Body heat will naturally carry the scent upward. Any essential oil with a pleasing scent that calms can be used discreetly. There are also beautiful aromatherapy necklaces, bracelets and earrings that allow the scent to rise, but not mushroom around you so others will not inhale the fumes.


    Build your support team


    Have you ever worked with a fellow nurse who appeared not to have one friend on the nursing team? That's a tough way to practice nursing. Your support team will not only step in to help you with a patient when needed, but also be there to build you up and stay strong during stressful times. A cardiac care nurse I know says she thanks the heavens for her team when there is a code blue because she's nervous every time. She knows she can lock eyes with one of her nurse friends on the unit enabling her to keep herself together and focused during the code. Knowing which people are going to have your back, not simply to assist with tasks, but also give you that emotional support when needed, gives nurses a sense of security in knowing they are not alone.


    Focus on the joy and privilege of nursing


    This isn't always easy, especially when nurses are in an active code, in the middle of a surgery that's not going well, or in any other life and death situation, but focusing on the amazing privilege we have to affect someone's life... to touch so many lives in a meaningful and deep way, can help us call upon that part of us that patients and families look up to for help. Not everyone can do what we do. Not everyone has the dedication to learn ALL that we must learn AND keep learning in order to care for patients. Not everyone has the resolve to keep caring, day after day, year after year. But we have that. We have those incredible gifts. And they are not small gifts. Sometimes knowing how much we are needed and that we have these things to share with our fellow human beings that could change their world helps us build our own resolve in this incredibly stressful and rewarding career.



    Let's hear from you! What would you add to the list above? What's one thing you can share with everyone reading, as another tip for dealing with stressful situations? Leave your comment below, and as always, thanks for reading!

  • Dec 5

    Can We Talk? End of Life Discussions


    Jan busied herself at the bedside of her patient, a woman she had seen before during a similar admission for COPD. As the woman struggled to breathe, Jan could easily read the panic in her patient's eyes. She changed a sweaty pillowcase, put the head of the bed up slightly and readjusted the fingertip pulse ox that beeped repeatedly.

    She started to back away to look at the patient's med list and see what was due, when the patient caught her hand, "Can we talk?" Jan's mind raced ahead to the other patients she was responsible for, before settling back into place and focusing in on her struggling patient's face. She knew, in her heart, what this conversation would be about. It was important and not the kind of talk that could be rushed. She pulled up a chair and sat up to maintain eye contact.

    She held the woman's fingers and asked, "What have you got on your mind? How can I help?"

    "I don't want this," the woman said, while rolling her eyes in an arch to indicate the bedside with its surrounding drips and machines. "I want to go home."

    Broaching the subject of death is hard for anyone. Sometimes, being at the bedside, we are the ones that patients open up to. How do we handle it when it happens? Whether we are at the bedside in the hospital, or in home health, and even in an office setting, we can be at the front lines of a critical discussion. Do we know what to say and do?

    Here are some points to consider when we face a similar discussion:

    • Be fully present

    Eye contact, physical touch, body posture all play an important part in sending the message that we are really here, ready to listen and help. Many of us feel distinctly uncomfortable about having end of life discussions-after all we work to make life better, to prolong active life, to maximize function. But there are times in our profession when we need to be the midwives that help our patients find their way forward when they feel they are at a dead end. If we are able to allow them to talk, help them express their wishes, we can help them find a way toward peace and hope even in the face of death.

    • Listen and ask questions.

    In nursing school we all learn about asking "open-ended questions." This is the time to employ that skill, allowing the patient to say what they need to say, even if it's not pleasant or even if it's not what you are hoping they will say. Being a good listener is hard work, especially when the person is struggling to express themselves or when we feel hurried by other pressures.

    • Help define goals.

    Goals can engender hope and focus. At this stage, the goals sometimes seem rather small-to get home and sit in a favorite recliner with their dog, to hold a grandchild, to enjoy some time on the porch. Knowing what they want can help us know how to proceed. But what if their wishes seem completely unreasonable given their fragile condition? Again, listening is key. Sometimes simply verbalizing their goals is enough to satisfy the longing for reality to be different; it can be enough to help them get through this day.

    • Know your resources.

    As nurses, it is important to know the resources we have available to us, whatever our setting might be. Whether it is a palliative care team, the hospice liaison nurse, the case manager or a physician, having a solid knowledge of how to proceed from this point can be valuable to our patients. Do you know the difference between Advance Directives and the POST form? Do you know what qualifies as a hospice diagnosis? Do you know what services are available at home for those who want palliative care while continuing to pursue treatment? Can we be gentle guides along the way as we help our patients understand what "Full Treatment" means vs. "Limited Additional Treatments?" Being well versed in this subtle, but important aspects of end of life care can make us even better nursing professionals.

    • Gently direct.

    Sometimes having this conversation can take a long time. It is important, critical really, to know how to direct the conversation and begin the process of referring the patient to the doctor or the case manager. Depending on the setting, we may need to continue to help the patient clarify their wishes or we may need to introduce the concept of another person who can discuss this fully with them, at length, and fill out the appropriate forms to document their wishes.


    In a few minutes, Jan was able to ascertain that her patient would need further counseling and the opportunity to fill out paperwork. She outlined the steps she planned to take in calling the doctor to come in and discuss next steps. Then she went on to offer some medication for symptom management before moving on to her other patients. As she left with her cart, she looked back to see the woman breathing more easily and dozing off.

    End of life discussions need to happen, and sometimes we are the ones who are there. Being prepared and willing to listen, we can provide valuable care to our patients who desire to make choices about their end of life care.


    Joy Eastridge, BSN, RN, CHPN

    Reading a recent news article about a man who was found with a Do Not Resuscitate message tattooed on his chest prompted me to write this article. To read more about that news story, go to Living Will Tattoo

  • Dec 4

    My husband is obese, has Diabetes and is non-compliant when it comes to checking his blood sugars and following a Diabetic Diet. And his A1C is over 8, and that really scares me. He's already been thru open heart surgery to fix four blockages, a stent put in two years later, and now is experiencing shortness of breath. So back for more tests and another possible surgery. Things are happening that have me worried and I am starting to feel afraid that I could lose him.

    The most frustrating part is that I know what he needs to do to improve his chances of living longer and healthier but I can't get him to do it. I'm sure it hasn't been easy for him living with "Nurse Wellness" since he's addicted to junk food and doesn't want to change from pizza and hamburgers to whatever I have concocted that is super healthy and not loaded with sugar and grease. A definite dilemma, but it doesn't mean that I give up trying to change him, despite knowing you can't change anyone but yourself.

    I will admit I have had to get sneaky over the years trying to trick him into adopting healthier eating habits. For example, when I started my own wellness business with a focus on nutrition, I really learned the facts about using "food as medicine" so I was very motivated toward helping him lose weight, bring down those blood sugars and maybe get off of the many drugs he was on.

    One of the programs I had at my disposal was called a Sugar Cleanse and it was part of a weight loss program, so I thought this would be perfect for him. It consisted of replacing meals with shakes for 5 days, taking vitamins twice a day, eating nutrition bars in between meals and after 5 days he could lose 5 pounds. But how to get him to do it?

    Step one. I knew that he had loved having milk shakes as a treat, so I suggested he might like to try one of my nutrition shakes. And guess what - he liked it! Step one was accomplished and he was willing to drink a shake every morning for breakfast.

    Step 2. Getting him to take the vitamins. He was already taking medications for his Diabetes, so what's a few more pills? I told him they had been giving me more energy, I felt better and was sleeping better so he decided to give them a try. So I added them to his pill box and he took them all together without flinching. Just a few more pills – no big deal.

    Step 3. Getting him to do the 5-day Sugar Cleanse. Since I hadn't tried it myself, I wanted to know what it was like so I could better support my customers about what to expect. I also knew that it helps with weight loss and blood sugar control so I asked him to do it with me and he said YES! And he agreed to check his blood sugars during the 5 days to see if it was working. NOTE: I believe that even tho he originally seemed to be resistant to changing his lifestyle toward more healthy living, he really did want to get healthier but didn't know how to proceed. Sometimes when something comes along that sounds like it could work and is non-threatening, people jump on board. Timing is everything!

    And so the experiment began. Day one his blood sugar was 180, and by day 5, it was 90. He was thrilled! And guess what - he lost 11 pounds over 5 days to my 5. Yes, men seem to lose weight faster than women – not fair! Now he was on a roll and stayed on a modified version of the program for the next 6 months, lost over 40 pounds, got off of his blood pressure and cholesterol med and one of his Diabetes meds. And felt a whole lot better and became a believer in eating "low glycemic" foods for weight and blood sugar control.

    So being sneaky and trying to trick him into making some healthy lifestyle changes may not seem fair, but a girl's got to do what a girl's got to do. And in this case it worked.

    But now for the rest of the story. I wish I could say that there is a happy ending and he stayed super healthy for the rest of his days. But truth be told, this plan worked for several years but gradually his food addiction sneaked back in with his old habits and he gained all his weight back and finally ended up taking insulin for his Diabetes.

    So here we are again, back at the beginning. However, this time we're older and now I'm worried that his life could be in jeopardy. But my nature is not to give up. Especially when I know the results he had before were spectacular and life saving. I am also armed with success stories from other clients who use this program and are healthier and extremely grateful to have found something that works, when all the meds in the world have not helped. Even one man was able to drop his A1C from 8 to 5 and resolved his Diabetic Neuropathy! And again I am amazed at the power of "food as medicine".

    So rather than giving into the fear of the "inevitable" with my husband, I prefer to take the high road and become the "trickster" again and try to work my magic once more. After all, he is worth it and the path of healthcare with all those drugs and procedures should be the "path less traveled". Wellness is the way to true health and longevity.

    Do you have a spouse or partner who has health issues you wish you could change and how are you handling it? Please share your stories so we can learn from your experiences.

  • Dec 4

    You just finished your third twelve hour shift in a row. As you go to clock out, you hear the charge nurse singing your name and praises. This can only mean only one thing - they need help tomorrow. But, it's your day off! You mentally scan your calendar for tomorrow starting at 5am, since you will be awake anyway and there is nothing scheduled. Nothing! Quick, think! Can you take another day of this? You take a mental inventory of how you feel and there it is - back pain!! If you are going to pick up one more shift, you are really going to need to work on your back. But how?

    According to spineuniverse.com in the article, "Back Care for Nurses", nursing easily tops the list of occupations as most associated with work-related musculoskeletal disorders. In 2012, The Bureau of Labor Statistics found that nursing was in the top occupations for nonfatal occupational injuries requiring days away from work. We were joined by maintenance workers, landscapers, janitors,, nursing assistants and material movers. Musculoskeletal disorders accounted for the majority of the injuries, this includes sprains and strains. The back was the most common body part to suffer.

    Prevention

    Being a worker's compensation case manager, I can tell you from personal experience that sprains and strains run rampant in all industries where lifting, pushing, pulling and rolling are part of the daily gig. Nursing certainly falls into the mix. I have worked with many nurses to get them the care they needed following back injuries. The one thing I can't do at the point they become my client, is prevention.



    Here are the basics of spine health every nurse should know:

    Equipment

    Use Equipment When Available. Yes, it may take you a few extra steps to get the lift or the gait belt. But, isn't your back worth it? Of course it is!

    Use a gait belt when available. Make sure it fits snugly around the waist of the patient. Belts with hand straps make it easier for you to grasp comfortably. If the patient is ambulatory, but needs extra support, place the walker in front of them to help them balance. Always put the side rails up when you are rolling a patient in bed. Ask them to help support themselves by holding onto the side rail. If a Hoyer lift is available, use it.

    Make sure equipment is in good working order. This may mean reminding management to send equipment to maintenance. If you are having trouble with a piece of equipment, make sure you put in the designated spot for repairs. Don't ever take the risk of another staff member or patient being injured because you didn't take the time to put poorly functioning equipment where it needed to go.

    Staffing

    Injuries may occur during times of inadequate staffing. Let's face it, we are more likely to take shortcuts when we know everyone is busy. This is an unsafe practice. Even when staffing is low, don't risk your spine health. Wait on others to help you and certainly still use the equipment as it was intended.

    Training

    All nurses should be trained on proper body mechanics. Stand tall (both figuratively and literally) when you are being a nurse! Work on maintaining good posture. Minimize twisting, bending and lifting, when possible. If you see another nurse, especially new grads, participating in an unsafe practice, make sure you bring it to their attention in a gentle manner. Their back will thank you.

    Self-Care

    You must take care of your back, both on and off-shift. Exercise and stretching are necessities. Make exercise a priority. Activities such as walking, swimming or exercise bikes use your core muscles and strengthen your back.

    Bend at the knees and hips. We are all guilty of not following this rule. It is such an easy way to take care of your back. Be sure to carry objects close to your body to provide the support you need to carry the extra weight.

    When sitting for long periods of time, make sure you are sitting up tall. Avoid slumping over. Keep both feet flat on the floor. It is so tempting to tuck one leg up under your bum, but this can put extra stress on back muscles. And, just as you ensure your bed bound patients are turned on a schedule, do the same for your back! Change positions every few minutes.

    Consider quitting smoking. Smoking decreases the blood flow to our body, in particular to the discs. The lack of blood flow can lead to disc degeneration.

    What other spine health tips do you use as a nurse? Have you ever suffered a back injury at work? If so, what do you do differently now to stay say? Let's talk spine health!

  • Dec 4

    In part one of this article, Keep What You Love, Return The Rest: Healing with EMDR, I described Eye Movement Desensitization and Reprocessing - a therapy being used to treat PTSD and other forms of trauma. In part 2, I will address some concerns surrounding mental health issues, discuss the phases of EMDR therapy, and describe my experience with EMDR for childhood trauma.

    My goal in writing about EMDR is to provide nurses with options. As a nurse, I always feel empowered when I can suggest something to a patient, friend or family member who is struggling. I want to add tools to your toolbox for dealing with mental health issues. A second goal of writing about mental health issues is to work towards removing the stigma of having a mental health diagnosis. I am hoping that you might read my article and realize you are not alone. I would like to show you that a person with a mental health diagnosis can be open and vulnerable without shame. Maybe my experiences will lead someone else to find successful treatment, or at the very least provide hope that successful treatment is possible.

    However you define it, not all trauma causes Post Traumatic Stress Disorder. PTSD is a psychological diagnosis, well defined in the DSM-V. The best way to get a diagnosis and find appropriate treatment for mental health issues is to see a certified, licensed therapist. I defined trauma in another article I wrote about Tapping, or EFT as an event, situation or circumstance that overwhelms ones present coping capacity. The dictionary defines it as a disordered psychic or behavioral state resulting from severe mental or emotional stress or physical injury.

    It is possible to experience severe mental or emotional stress or physical injury with no lasting effects. This would be the best-case scenario, since bad things do happen to people. It would be incredible if we could process stressful experiences so that we don't experience a disordered psychic or behavioral state. I am thinking of my husband, whose mother died of cancer when he was only nine years old. She was only 40 when she died after a long, painful struggle – much of which was witnessed by my husband. We have talked about her death and the circumstances surrounding it multiple times. Our marriage counselor assured me that it is possible that, though her death was painful, my husband might be just fine, with no signs of being affected emotional or physically. You might meet another person who had the same thing happen to them who has continued disturbances into adult-hood, including invasive memories, difficulty trusting, attachment issues, or phobias. There is no correct way to respond to trauma (though there are tools we can add to our emotional toolbox that can help us respond with resilience –a subject I will definitely be writing about!). We are all unique beings who respond the way...well the way we do.

    My story is that I was sexually molested by my stepfather from the time I was 10 until I was 16. It's a long, messy story and I won't go into all the details here, but I will say that as a result of that traumatic series of events, I have experienced a disordered psychic or behavioral state. I have a hard time coping with some situations, despite many years of therapy. I am looking for a way to decrease my reaction to stressful situations so I can behave with professionalism no matter what the circumstances. I want to respond the way my logical mind knows I should. I began EMDR therapy about 6 weeks ago with the hope that it might solve some of my problems.

    According to the EMDR Institute, EMDR is a form of psychotherapy using eye movements or other forms of bilateral stimulation to assist clients in processing distressing memories and beliefs. EMDR focuses on three things: a) Past memories, b) Present disturbances and c) Future actions. The goal of EMDR is to completely process the experiences that are causing problems, and to replace them with new, adaptive ones. Unlike many other therapies, processing doesn't mean rehashing the trauma in detail, it means setting up a new learning state; one that will allow experiences that are causing problems to be resolved and then be stored appropriately in the brain. Basically you keep what works. You keep the positive lessons you have learned from the experience, but you get rid of the negative beliefs and body sensations. Proponents state that EMDR leaves you with understanding and perspective that leads to healthful and useful interactions.

    EMDRIA (EMDR International Association) describes the eight Phases of EMDR treatment. Phases one-to-three lay the groundwork for treatment for specific events. Studies show that reprocessing for a single trauma can take as few as three sessions.

    1. History and treatment planning (1-2 sessions): In these sessions, you identify the target memory or memories. Keep in mind that none of the memories have to be discussed in detail. Though I am seeking treatment for childhood trauma, my therapist and I (let's call her Pam) ended up settling on a more recent memory to tackle first. We chose getting fired, which I have described in detail in a previous article. That event continues to cause me significant shame and emotional distress.

    2. Preparation (1-4 sessions): these sessions involve establishing relationship and trust with the therapist. My therapist, Pam and I spent several sessions in which I talked about my current state of mind. I discussed my current state of mind, described how I am triggered, and how I deal with friends, family and life stressors. Pam led me through an interesting exercise in which I completed several drawings, which she then interpreted with me. The goal of these sessions was to create a safe environment in which I felt like I could revisit some traumatic experiences. We also worked on relaxation techniques so I could calm myself during and after a session. For me, this involved visualizing a safe place – for me this involves running in the woods at dusk, on a trail near the water with sunlight filtering through the trees into my eyes.

    3. Assessment: In the assessment phase, you identify aspects of the target memory, selecting a specific picture or scene from the target event, and then express a negative self-belief associated with that event. I pictured the days leading up to getting fired, as well as the meeting in which I was terminated. I identified the self-belief I am worthless. This was hard for me, because I know intellectually that this statement is not true...though it feels true. Who wants to go back there? I want to just forget it ever happened, not relive it! I then picked a positive statement I would rather believe, like I am worthy. Another example: the negative I am in danger followed by the positive I am safe now. I then estimated how true I feel the positive belief is using the 1-to-7 Validity of Cognition (VOC) scale (1 equals completely false and 7 equals completely true). I rated my belief at a 5. During this phase I also identified physical sensations associated with recalling the target memory and rated the disturbance caused by those sensations using the 0-to-10 Subjective Units of Disturbance (SUD) scale (0 is no disturbance, and 10 is the worst feeling you've ever had). I rated my sensations (tightness beginning in my solar plexus, tingling in my hands and feet, buzzing or fuzziness in my head) as an 8.

    4.Desensitization: the focus of this phase is on disturbing emotions and sensations – this is where the bilateral stimulation occurs. Anything being measured by the SUDs rating is targeted here, including other memories, insights and issues that might come up. Pam brought out a bilateral stimulation gadget
    emdr-buzzers-jpg
    that had a controller with two cords, at the end of each cord was an egg-shaped, green, plastic thingy that I held in each hand. Pam had me think about the target memory and asked me to really try to get into all the negative shame and beliefs of that memory, though I didn't have to express any of it out loud. During this time, the small eggs vibrated in my hands in alternating fashion. This was really, really hard for me. I tried to put myself back into the memory of being fired, but it was so scary and so painful. I kept thinking, this is stupid, this will never work, why can't I just get over it?

    5. Installation – the goal here is to concentrate on and increase the strength of the positive belief, eventually accepting the full truth of the positive statement at level 7. After holding the buzzing eggs for a minute or so, Pam had me visualize my safe place, and the buzzing in the eggs got deeper and slower. It was SO. WEIRD. It also felt good, though I can't explain why. I don't think my beliefs budged an inch. I also think I didn't really get into the bad places the way I really needed to for maximum effect. I wish Pam could come over and be there with the device when I am just waking up in the morning, fully reliving the whole experience, in full-out, red-faced shame mode.

    6. Body Scan: after positive beliefs have been strengthened, the next phase involves visualizing the original target and noticing any residual tension. Any leftover tension is targeted for more processing. This part is well supported by research – studies of memories of traumatic events show that information about the event tends to be stored as body memory rather than narrative memory (the body keeps the score). The goal of EMDR is to help those body memories disappear.


    7. Closure: this phase ends every session. Closure ensures you leave feeling better than you entered. Pam led me through a "light installation" in which I visualized my safe place, and a beautiful blue, gold light suffusing my entire body. Calming techniques are used to help you regain equilibrium. This part was awesome. I felt truly relaxed when we were done.

    8. Reevaluation: this phase opens every new session. I will be going in again this week, and since I have only had one desensitization session, I am looking forward to seeing how my first reevaluation goes. We will be checking SUDs and VOC scores, and doing a body-scan for tension and other physical symptoms.

    I know that this process may take a long time, but I have decided (for now) to believe it can work for me. EMDR can work quickly for some people, but I am anticipating that until I focus on the past memories really contributing to my problems, I may never fully heal. Believing I can fully heal continues to be a problem. I keep getting stuck in this script in my head that says, "you are just broken, and you can't ever be fixed" – alternating with, "if you just tried hard enough, you would be a better person". If you have thoughts like these, then you know why I am so dedicated to getting rid of them. I am so tired of the mean voices in my head, and I am hoping EMDR will silence them at last. You can Google EMDR stories and see many different opinions about whether or not it works. I urge you to talk to a trained, licensed, certified therapist to decide if EMDR is right for you. This article is not advocating for EMDR, it's about EMDR as an option for treatment. Be gentle with yourself and others and let me know if you want to hear more.

  • Nov 29

    Patients can change the trajectory of our careers and lives. The power of human relationships is undeniable. As a nurse, we go to work with the intent of helping and blessing others with our gifts, but oftentimes, we are the ones who walk out of the building blessed. In almost 20 years of nursing I have encountered a few patients who have touched my life deeply. One patient, Mr. G, a man who was at the end of his journey and, Baby B, a neonate who was short on life and big on lessons.

    I met Mr. G as a brand new graduate. He came to my unit every few months to receive his chemotherapy. He was in his 50's with grown children and a wife who was just as delightful as he was. The first time I met him, something clicked between us, a natural bond was created. Over the course of the next year, anytime he came to the unit it was known he would request me as his nurse.

    I would take breaks in his room so that we could talk about life in general. Sometimes it was jokes and lighthearted conversations and other times, we shared tears. He taught me that life was fragile and to live each day to the fullest. I remember one day coming in at 7am and as soon as I hit the floor, he requested me. He was not a fan of the night nurse and wanted to tell me all about an incident that occurred. As I listened to him talk, I knew there was more to this request to see me than just a disagreement with the night nurse. As he spoke, he started to cry and then confided in me that he was not responding to the chemotherapy as he had in the past. He was told they had no other treatment options for him. I remember sitting next to him, holding his hand when I realized that he was not just a patient, but a friend.

    During my career, I have remembered Mr. G many times. When I was uncertain about my path or questioning my career choice, I remembered him and his wisdom. When I had a bad day and didn't think I could go back to work in the morning, I thought of Mr G. He gave me a reason to keep moving many days.

    Baby B came into my life at the beginning of his short journey on earth. He was a twin and was blind, deaf, lacked the drive to breath and had physical deformities. The doctors knew in utero that there was a twin to twin transfusion in which his sister received more of the nutrients, affecting his size and development. She was a healthy, normal baby. Baby B came to the Neonatal Intensive Care Unit on his birthday, which also happened to be mine. He was accompanied by his dad, who came to trust me like part of the family during the 38 days of Baby B's life.

    I took care of him almost every shift I worked. He never looked at me or smiled for me to know that I was familiar to him. But, in the middle of the night when I had "cuddle time" with him, he would nestle up against me with a familiarity that was undeniable. His parents always said it brought them peace knowing that I was there with him at night for "cuddle time", as well as the nursing care.

    His parents went through hell and back during his 38 days of life as they had to defend their decision to withdraw life sustaining measures. I will never forget sitting in a care team meeting when one physician told his parents that he could live for several years with a tracheostomy and feeding tube. His mom, with tears in her eyes, asked what kind of life that would be if he never knew he was here or enjoyed life. They envisioned a boy who would run, play in mud puddles and swing a bat. Ultimately, the parents' wishes were honored and Baby B peacefully left this world.

    This baby taught me endless lessons that I have revisited time and again during my career. He taught me to never judge a book by it's cover. He was not a "normal" looking baby, but he was valuable and brought a tremendous amount of good to this world. He taught me to really listen to family members when they spoke. Not listen to respond, but to listen to understand what they are saying and feeling. And, most importantly, he taught me the value of life, no matter how long or short it may be.

    Some patients come into your life for a short period of time, but leave a permanent print on your heart. They teach you lessons far greater than those in any textbook or lecture hall. You learn more about yourself and the world in general from the interaction with these patients than you could have ever imagined possible. Have you had experiences of unforgettable patients? How did you meet them? What did they teach you? Were you able to let them know what they meant to you? I would love to hear your stories of unforgettable patients.

  • Nov 29

    Sanoviv is a benchmark of where healthcare needs to be in the future in order to survive. Oh and did I mention, this amazing facility is located one hour from San Diego – across the border into Mexico. That's why they can use other healing modalities we are not allowed to use in the U.S. with proven results of success. They still treat patients with major chronic degenerative diseases in traditional ways (like stage 4 cancer when the patient has been written off by our system), but they also offer a functional medicine approach that focuses on the whole body, mind and spirit in consultation with physicians, nurses, chiropractors, nutritionists, dentists, psychologists, and spa therapists. A true patient-centered approach that leads no stone unturned.

    Unlike my latest experience with a traditional medical consult for my husband who will soon be undergoing a cardiac catheterization with the possible placement of a stent, all the nurse and physician were interested in doing was "telling" us what was going to happen next, as opposed to investigating all about his lifestyle and what factors might impact him now and in the future related to this situation. Once again I was aware that he was only having his heart treated, and not his whole being.

    So my latest trip to Sanoviv reminded me of simple strategies that we could all start implementing with the end result of helping others achieve true healing instead of just getting body parts fixed. Here are some ideas for you to consider. Of course it would be great if you could actually implement all of these things for the benefit of our patients in one fell swoop. But realistically, if you would make a commitment to start the process of taking one small step in a healing direction, that could start the ball rolling or even just begin the conversation – that would be great progress.

    Remove toxins from the environment.
    Our bodies are overloaded with toxins and we are exposed to more and more in great amounts every day. Here is one example. Consider how much hand sanitizers are being used in most businesses to the point where people are afraid of germs and getting addicted to using them constantly. Many hand sanitizers expose you to potentially harmful chemicals and may compromise your long-term immunity. Take home message – just like we learned in school – wash your hands with soap and water.

    Use organic cotton clothing washed in toxin-free cleaning solutions.
    Think about how much of the time your skin is in contact with clothing, pajamas, sheets. If fabric smells like something, it is probably tainted by chemicals used in detergents, and those chemicals pass into your body thru your skin. Find out what products are being used to clean fabrics in the hospital and in your home and change it to something toxin free.

    Encourage positivity
    Use a positive tone and use positive words when conversing with patients and co-workers. Make sure TV programs being shown convey a pleasant feeling. At Sanoviv, prior to surgery, patients attend a laughter yoga class. Laughter decreases stress hormones and increases immune cells and infection-fighting antibodies, thus improving your resistance to disease. Laughter triggers the release of endorphins, the body's natural feel-good chemicals. Endorphins promote an overall sense of well-being and can even temporarily relieve pain.

    Serve healthy whole food
    Food is medicine. Everyone at Sanoviv eats food that is mostly plant-based and organic at a ratio of half raw and half cooked. They have an organic garden to grow their own food, and when they can't get everything they need, they carefully select produce from other trusted sources. They also protect from potentially harmful pathogens by cleansing produce in a colloidal silver fruit and vegetable wash.

    Provide communal dining
    At Sanoviv all patients (except those too ill to join in) and guests eat together in a common dining room to provide socialization, positive support, and to feel more human and not so isolated as we do with patients. Negative conversation is discouraged.

    Create a calm environment
    At Sanoviv, soothing music is provided throughout the facility which has a calming effect during treatments and meals. Gentle chimes are used to wake up in the morning. A quiet room is available in view of the ocean providing total silence while patients recline with multiple pillows positioning them comfortably.

    Bring in nature as much as possible
    Patients receiving IV's are in recliners and outside on the deck overlooking the ocean and listening to the ocean waves. Walking barefoot in the soft grass (Earthing) is encouraged to release any buildup of the negative effects of all the technology we are exposed to from EMF. (Electromagnetic frequencies). Multiple healing pools outside are used for natural detoxification and water exercise.

    Hopefully these healing strategies give you "food for thought" and may inspire you to take positive action toward small steps that can improve and heal our non-healing healthcare system. Please share your insights and experiences, especially what you see already working!

    References:

    Benefits of a Quiet Body

    Functional Medicine

    Healing Through Laughter Yoga

    Healthy Home Tips

    Organic Cottons

    Sanoviv

    Scientific Reasons Why Being in Nature is Relaxing

  • Nov 29

    If you read most any blog about how to work with others and you will likely learn about generations. But, have you ever thought about what motivates each generation and how we can use that at the bedside, on the phone or in the homes of those we care for? It has been a very intriguing concept to me lately, so of course, I turned to research! Let's look at the 4 adult generations in the U.S today and find out what makes them tick and how we can use that in our daily practices.

    First, what is a generation?

    A generation is a group of people born around the same time or raised around the same place. People born around the same time share certain characteristics, preferences, and values. Of course, people are still individuals and are certainly not a "one-size-fits-all" solely based on their generation. But, there are general similarities for those born in the same time period because they experienced the same events or trends around the same age through the same methods of engagement, such as online or on television.

    So, how could this information help us when we are attempting to engage with our patients, communicate with them and teach them important self-care tips? Let's explore!

    Traditionalists were born in 1945 or before. They have been influenced by World War II, the Korean War, the Great Depression and the Space Age. Their parents survived the Great Depression, so hard times are something they understand. However, later on in their life, they experienced many prosperous years as well. They value dedication, honor and loyalty.

    These patients want respect and dignity in this time of their life. They respond best when addressed by Mr., Mrs. or Sir. They like formal communication and want to feel that they are building relationships with caregivers. They may have the same physician for years and years, if possible.

    When caring for a Traditionalist, you may notice they appear quiet, disengaged or even stoic. Try to give them space as they are may simply be slow to warm-up to new people, places and experiences. Due to their age, we may overlook their ability to speak for themselves and make their own decisions. Even if they have a spouse, child or other caregiver with them, engage with them when discussing their care. They have lived a long life and want to be respected and understood.

    In today's healthcare environment, we are moving at rapid speeds towards technology. This may not be their strong-point. Ensure that you have face to face conversations with Traditionalists in which you speak in clear, concise statements. Provide written instructions when possible. They will feel more confident about their ability to carry out the self-care techniques you taught if they have instructions printed out for their reference.

    Baby Boomers were born between 1946 and 1964. Their generation has been influenced by Civil Rights, the Vietnam War, the Sexual Revolution and Space Travel. Being born after WWII, they grew up to be the radicals of the 70's and the yuppies of the 80's. Being promised the "American Dream" from a very young age, they pursued it.

    Baby Boomers as a generation are optimistic and want to take on responsibility. They have been dedicated to their careers for many years and are now learning what it means to be retired. As a patient, they engage best with in person, face-to-face communication. They are typically okay if you call them by their first names, but it is best to ask for permission first if possible.

    They like to have a friendly rapport with those they come in contact with and enjoy feeling valued and needed. Having a strong desire to succeed may make it difficult for them to begin to deal with failing health due to the aging process. They have long been a generation who valued independence.

    While they can certainly remember many years without computers and cellphones, they have learned how to utilize technology as a means to survive in both their personal and professional lives. However, don't assume either way. Make sure you are providing written instructions and engaging in meaningful face-to-face conversations when possible. If you have the ability to offer them tech-savvy ways of connecting with your facility, be sure to give them the opportunity.

    Generation X was born between the years of 1965 to 1976. They were young during Watergate and remember events such as Y2K. They are the first generation of latchkey kids and two family incomes. They grew up being independent and seeing an increase in divorce.

    Gen-Xers tend to be direct and use many principles of straight talk. As a generation, they are highly educated and have learned to be technologically savvy, even though they can remember life without computers and cellphones. They value balance, so chronic illness can certainly send them into a tailspin quickly.

    They are very good with searching for information on-line and given their desire for independence, may be likely to self-diagnose. Because of their motivations toward success, keep teaching to a formal, structured format with lots of resources. Allow them to ask questions and provide feedback in order to ensure they have learned what you have taught them about self-care.

    Millennials or Generation Y were born between 1977 to 2000. They have grown up in the digital age and do not know life without computers, cell phones, tablets and more. School shootings and terrorists attacks have been a common part of their life, along with the attacks on the World Trade Center on 9/11. They are a generation that is savvy to receiving technology. They have grown up as children of divorce and as a generation, want to make the world a better place.

    If you will be teaching a Millennial about self-care, be ready and armed with information and aps. They learn through digital and electronic communication. They use email and voicemail and will likely do an online search of their diagnosis before you can get to the room to explain it. Because they are so tech savvy, they are not always the best at verbal communication and may not interact with you when teaching. They are motivated by personal goals, which can be used as a method to engage with them.

    Have you ever thought about how to engage with your patients based on their generation or life experiences? This idea is fascinating to me and I would really enjoy hearing your thoughts and stories.

  • Nov 29

    Every time there is some horrible mass casualty that happens anywhere in the world, we see immediate and intense video, usually raw footage, streamed live to our computers, TVs, and smartphones. All at once we are not only processing that something horrible has happened/is happening, but we are also visualizing the hysteria, loss, and destruction simultaneously. As nurses, we are not only seeing these things happen, but as soon as we realize it's either happening (or not) in our town, many of us are wanting to go right out and help. How often have you seen something horrible happen, like the Las Vegas shooting, Texas church massacre, or any other mass tragedy, and thought "It's not in my city, but what if it was?"

    According to the National Institute of Mental Health, 7 or 8 out of every 100 people will experience Post Traumatic Stress Disorder (PTSD), which can be brought on after surviving a dangerous event, having a friend or loved one involved in a dangerous event, or after the unexpected loss of life of a loved one. Less than half of these people will seek help for treatment of their PTSD. The VA National Center for PTSD reports rates of PTSD after bombings around 34% and mass shootings 28%, which are high numbers, considering the volumes of people impacted by each event. With all of these mass casualties happening annually and all of the visualizations of these acts of terror, I wonder if these numbers might start to jump even higher with the increase of mass casualty events, especially with healthcare workers?

    There are some people that are now afraid to fly after 9/11, afraid to go to concerts after the Manchester bombing and the Las Vegas shooting, afraid to send their kids to school after the Columbine and Sandy Hook shootings...need I go on? There are a lot of regular activities that people of all ages are afraid for their lives to do, because of possible bombings, shootings, etc. And then there are nurses and other healthcare workers that leave their homes every single day to go take care of other people, and when these mass casualties happen, we are expected to perform at the top of our abilities...and somehow not be focused on what might be going on with our families, letting them know we are OK, are they? What about the staff that suffers PTSD and have to go to work every day? Do you feel that way or know any colleagues that do?

    At most, if not all, hospitals, there are Employee Assistance Programs (EAPs) that can help anyone who may be suffering from PTSD related to these mass casualties. I think that as much as our job is to care for our patients, we also owe it to each other to look for these signs in our colleagues and either speak to them personally to try to get them some help, or talk to their manager to make sure that they speak to them and offer assistance. I had to do this just last week, and I really wasn't sure how the conversation would be received by a colleagues manager, but they had actually seen some changes in their employee's behavior and appreciated my feedback and the employee got the help they needed.

    According to the National Institute of Mental Health, the signs and symptoms of PTSD are:

    • Flashbacks (reliving recent trauma)
    • Frightening thoughts
    • Avoiding talking about the event(s) that caused trauma
    • Easily startled
    • On edge/tense/short-tempered
    • Difficulty sleeping
    • Angry outbursts
    • Negative thoughts about oneself or the world
    • Distorted feelings of guilt or blame
    • Loss of interest in normally enjoyable activities


    Displaying even one or two of these signs can mean that you/your colleague may have PTSD. You don't have to have every single sign for a diagnosis, so if you notice these changes, especially noticing a change in temper or other behaviors, please speak up. Talk to your manager, a friend, a colleague, if you notice any of these symptoms in yourself, and get the help you need to get back to feeling yourself!

    We are on the frontline of saving people's lives when these are mass casualties, so let's make sure that we are all looking out for one another, taking into account our own mental health and our colleagues as we navigate through these scary times.

  • Nov 27

    NurseNeLz, Nurses have actually found that the IVEA is exceptionally practical, namely because it was designed by nurses. I hope you'll take a look at the photos at The IVEA. Patient Mobility Made Safe, Easy and Efficient | Ivea and see just how well it fits bedside. It's tight turning radius also allows it to fit easily in most bathrooms. Everything about the IVEA was designed to make the nurse's job easier and safer and to make patients happier and healthier.

  • Nov 26

    As we walked around the track together, my friend shared some of her nursing job frustrations with me. She had been in her current position for a little over 2 years. Long enough, she felt, to know whether it would be a long term good fit. "It's getting harder and harder to give my patients the care that I want to give them." She went on to vent about some other more minor concerns and then said, "But there is a job that looks good on another unit. Do you think I should consider switching?"

    A recently published study sponsored by the Robert Wood Johnson Foundation shows that "an estimated 17.5 percent of newly-licensed RNs leave their first nursing job within the first year, and one in three (33.5%) leave within two years." (Nearly One in Five New Nurses Leaves First Job Within a Year, According to Survey of Newly-Licensed Registered Nurses - RWJF). High turnovers are hard on the hospitals and hard on the nurses. Although stressful for all involved, job changes within the profession seem to be a very common occurrence.

    So, if you are not currently satisfied with your job, is it time to jump ship or should you just sit tight? The answer is, of course, it depends. Here are some things to think about; questions to ask yourself as you consider.


    1. The grass is always going to be greener.


    It is simply human nature to feel like we are missing out on something wonderful, just down the hall, on that other team, or maybe across town at the fancy, new hospital. Most of us struggle to be content in other areas of our lives, as well. We want things that are just out of reach: the better car, the bigger home, more stuff from our etsy-fueled dreams. However, if we are honest with ourselves and with others, we soon realize that sometimes our desire for change and newness is simply that: restlessness for the elusive perfection-that job where everything will be good and we will be fulfilled as nurses. Bottom line: sometimes we are the ones that need to change, not the job.



    2. Toxicity varies, but most jobs have stuff we strongly dislike.

    I can remember struggling to adjust to my first nurse manager and her style. She was abrupt and often came across as unfeeling. Many times, I cried after my shift. But gradually I came to realize that her military training occasionally clashed with civilian life and my 20 something tender heart. Over time, I came to respect her vast knowledge and value her judgment. In a case like that, staying the course paid off huge dividends. I learned a lot. But environments that support bullying, that allow verbal abuse, that condone rudeness, should not be tolerated. Out of self-respect, it is important to be able to identify unprofessional behavior and draw the line, leaving that work behind and washing your scrubs in extra hot water before heading to a new position. Bottom line: know how to identify a truly toxic job.



    3. Boredom is not a good reason to go.

    I cringe when I hear someone say, "This work just isn't challenging enough for me." It is painful to hear because every job out there-if it involves nursing-can be challenging. There is always room to go above and beyond; to be and do more than is expected; to learn and create improvements. Every patient has something to teach us-people are a never-ending story and we have much to learn from one another. The daily practice of being a great listener can renew our flagging energies. When we get discouraged, we can listen more carefully to those around us and find new reasons for curiosity and gratitude. I remember meeting an older gentleman who was caring for his wife in the nursing home. She was our primary focus and the center of our conversation. I didn't really get to know him until years later, after she had passed and he became the patient. His stories of being injured in the Pacific during WW2 shook me because I thought about how I almost missed knowing him, and hearing all he had done. Bottom line: Boredom says more about us than about the job.



    4. Some of the long-term job satisfaction comes from long-term work
    .

    Developing relationships and becoming an expert in the field can both contribute greatly to job satisfaction. Working relationships with other nurses, physicians on staff, ancillary providers and environmental workers can take years to develop. Those relationships tend to build and progress through experiences together, bonding the team even as expertise develops. It is an earned recognition that makes someone "the best stick" on the floor or the "go to" person for wound care or "the best diabetes teacher ever." This potential source of professional satisfaction suffers when we change jobs. While we can still be an expert, it takes time for people to learn to trust us and for those working relationships to develop-again. Bottom line: Life is all about relationships.



    5. Change happens.

    If a position was good and things got bad, then chances are it will circle back around-eventually-and be good again. Meanwhile,we can all be agents for change, helping to make difficult situations better. We can influence the culture of our floor or unit or office for the good. We can work has the superior professionals that we are, holding ourselves and others to a higher standard, working always to provide the most excellent patient care. Bottom line: Change is the only constant.



    My friend ended up staying with her job-for now. What about you? As you consider your options or talk with other nurses, what are some of the things you think are important to consider? What is your bottom line?

  • Nov 24

    I started as a freelance writer back in 2012. I always loved to write short stories and poetry ever since I was a little girl. Science and math were my strong subjects in school, but, I loved to write, even if I wasn't the best writer.

    The Single Teen Mom

    During the first year of my son's life, I struggled to get food on the table and pay our bills. I became a registered nurse as a single mom in 2006, and finally, money wasn't scarce. After graduation, I worked in labor and delivery at a small community hospital. I went on to work at a county hospital in the worst part of Cleveland, Ohio and loved it. I made my way back to the community hospital to a middle management position, became certified in inpatient obstetrics and married my husband.

    Shortly after, he adopted my first son and we had our second son. I was offered a day shift position and worked prn for a home care company caring for the high-risk pregnant population in the bad parts of Cleveland, again. I loved the work, and I loved to side hustle at prn jobs to make extra income, I never felt the burn out feeling I saw my other coworkers have.

    But, I still loved to write.

    Writing on the Side

    My grandmother became ill with cancer in early 2013. I was at her bedside towards the end stages. I brought my laptop to write while she slept. I started making money (a whole $5 for 300 words), but it sparked something inside of me. I made that first amount through a content mill. Content mills are companies that have clients post writing gigs, but only pay pennies for the content. It's never a way to make a living, nor do I recommend it. When I wrote for that amount, I didn't know there was another way.

    I could do this to make extra money.

    My income started to rise as I Googled everything from

    • "How to make money as a writer from home"
    • "work at home jobs for nurses"
    • "work at home jobs for moms"
    • And more


    My goal was to be home more with my sons. I also wanted to pursue my BSN, which I did, all from home.

    I Quit My Homecare Job

    I obtained my concealed carry license to carry a gun for when I was in trouble at the home care job. Several patients recommended me to carry, so I thought "I better protect myself." I loved the work, and the patients, but the company cracked down on how much we made as nurses, and simply, it wasn't worth my life. My husband was nervous for me, and I started to see why.

    Soon after I started making money writing, I quit my homecare job. It's difficult when your heart is into the parents to simply quit, but I had to, and now I am safe and making a living from home. Now, I look back wondering what took me so long.

    Nowadays

    My income started to quickly rise from my measly $5/300 words to $60/mo then $300/mo to $1K/mo and now I have earned around $2800/mo, part-time, remember it's my PRN job now. I work around 10-12 hours per week for my writing job and 24-36 hours a week for my hospital job.

    I still work my part-time hospital job because I can't see myself staying home yet. I love what I do! I love my patients and my experiences with them. I love the doctors I work for as well.

    But, I love working from home! I didn't realize how much I could help people with their company's missions and patients with true information from the internet.

    I Networked

    In 2016, I met a friend who has another social media site. We chatted and laughed about our journeys and wondered how we haven't run into each other in the past 4 years when we were doing the same thing online [the World Wide Web is huuuge].

    At the time she shared with me her visions of another social community. I was invited to help develop and maintain the community. Networking proved worthwhile in helping me to meet not only my friend but other nurses who want to start writing. It is important for nurses with like interests to be able to have a place to network.

    My Business


    As for my business, WriteRN.net:

    • I have an email list where I share my income reports and resources with my readers
    • I have 1:1 coaching services and client services
    • I have weekly blog posts to help freelance writers

    Allnurses provides great exposure to nurses all over the US! You can start writing with them by submitting an article. When you have some writing experience under your belt, you can apply to be one of their writers.

    My mission is to help nurses get started building their freelance businesses. I hope my journey has inspired you to start your #nextprnjob.

  • Nov 23

    Update (November 21)

    We had a lot of great captions! It was really hard to choose but we selected 8 captions for you to vote on.

    Top 8 Captions Poll is now available!

  • Nov 14

    November 12-18, 2017, is National Nurse Practitioner Week.

    I became a nurse practitioner (NP) in part because I received excellent care from one years ago. I imagined myself helping others in a similar way, giving back to society by providing the kind of comprehensive, individualized, health care that had been so helpful to me personally. Little did I know that my work as an NP would put me on the front lines as the healthcare industry experienced a sea change in response to an aging population and the advent of new technologies.

    You likely already know that NPs are registered nurses with additional education, at the masters or doctorate level, which allows them to diagnose and manage acute and chronic illnesses, prescribe medications, and order diagnostic tests and treatments. NPs also routinely integrate health promotion, disease prevention, counseling, and patient education to help patients understand the big picture of their overall health. This comprehensive approach to whole-person health is particularly useful in a population that is aging and plagued by chronic disease. Some 75 million baby boomers will become senior citizens over the next decade, and 50 million of them are expected to have multiple chronic conditions.

    According to a 2012 Economist article on the future of medicine, the health problems of the 21st century cannot be resolved by 20th-century approaches. The article also points out that because trends in medical education have consistently emphasized treatment of communicable diseases and acute injury, many of today's physicians are often not adequately prepared to care for patients with chronic conditions. An additional factor is that physicians graduating from medical school today do not often choose primary care or family practice as a career focus. Nurse practitioners are filling these gaps. According to the American Association of Nurse Practitioners (AANP), 234,000 NPs are currently licensed in the United States, and some 23,000 NP students graduate each year.

    The NP role emerged in 1965, primarily as a response to manage an existing and anticipated physician shortage. Although the role of NP has existed in the United States for more than 50 years, evolving and responding to the needs of a changing population and industry, not everyone in healthcare or the public fully understands the role of a nurse practitioner. Here are some facts about NPs that are worth knowing:

    The biggest difference between a medical doctor, a PA, and an NP is educational philosophy and background.
    NPs are NOT physicians, nor are they physician assistants; NPs did not go to medical school. Nurse practitioners are nurses first, which means their academic training is based on the nursing model, a fundamentally different way of thinking, distinct from the medical model under which physicians and physician assistants are educated and trained. Accredited nurse practitioner program curricula builds medical model concepts on top of a nursing model foundation.

    Some NPs may be doctorally educated.
    Nurses who have earned a doctoral academic degree may be referred to as "doctor," even though they are not educated as physicians and did not attend medical school. This is not meant to be confusing to patients or colleagues, but sometimes it can be.

    Licensure requirements for NPs vary from state to state.
    Although there are national certification exams for NPs, specific licensure requirements for NPs vary widely from state to state. NPs are able to diagnose and prescribe in all 50 states, with the ability to do so independently of physician oversight or prescription sign-off in 22 states and the District of Columbia.

    NPs may be specialists.
    Beyond primary care, nurse practitioners may choose to further their education in oncology, gerontology, pediatrics, psychiatry and other specialty areas.

    NPs represent one type of advanced practice nursing role.
    Other advanced practice nursing roles include nurse midwives, nurse anesthetists, and clinical nurse specialists. Each advanced practice role has its own specific educational, licensure and certification requirements.


    The fact that the NP role is built on the nursing model is the key to the value of NPs in the changing world of healthcare. The nursing model is holistic and humanistic at its core, providing an ideal foundation on which to integrate the more reductionistic medical model approaches. An integrative approach that marries systemic thinking with mechanistic techniques will be needed to navigate the future trajectory of medicine. Recall that the nursing model is uniquely comprehensive and holistic because it addresses the patient's response(s) to health threats and treatments, both current and potential. As emerging technologies such as genome analysis, artificial intelligence, and wearable digital devices democratize individuals' access to medical data, an educational, humanistic view of how technology impacts health will be in high demand. As such, the nursing model provides an ideal foundation for graduate-level education, positioning NPs perfectly to integrate emerging technologies, such as genome analysis and digital informatics (wearables) into the next generation of healthcare delivery.

    Whether you are already an NP, studying to be one, working with one or receiving care from one, take a moment this week, to consider the role of the NP. Ultimately, as health care continues to change, NPs will continue to provide high quality cost-effective, personalized health care – on the front lines, as part of a collaborative team in partnership with healthcare professionals at all levels.

    The AANP is the largest professional organization for NPs of all specialties in the US, and promotes National Nurse Practitioners Week each November to showcase the NP role. The aim of NP Week is to acquaint local citizens with the role of NPs as providers of high-quality, cost-effective, personalized health care and to highlight the value of NPs. NP practice offers a unique combination of nursing and health care service to patients. For more information, visit aanp.org.


    Questions for Discussion
    What has been your experience with nurse practitioners-working with them, receiving care from them, or even studying to become one?



    Sources and Resources

    Expanding the Role of Advanced Practice Nurses – Risks and Rewards

    Historical Timeline

    National Nurse Practitioner Week Resource Guide (AANP)

    The Nursing Site Blog: The Nurse Practitioner Will See You Now

    What's an NP?

    Why NPs are Important

    Squeezing out the doctor | The Economist

    The impact of the medical model on nursing practice and assessment - ScienceDirect

  • Nov 13

    December is National Handwashing Month, a global advocacy day dedicated to increasing awareness and understanding about the importance of handwashing.

    The Centers for Disease Control (CDC) considers hand hygiene to be one of the most important acts that hospital personnel accomplish on a daily basis. It is estimated that hospital personnel can wash their hands more than 100 times in a typical 12 hour shift. Some questions that healthcare workers have about hand hygiene are answered by the CDC:


    • Germs are everywhere. They are within and on our bodies and on every surface you touch. But not all germs are bad. We need some of these germs to keep us healthy and our immune system strong.
    • Your hands have good germs on them that your body needs to stay healthy. These germs live under the deeper layers of the skin.
    • Your hands can also have bad germs on them that make you sick. These germs live on the surface and are easily killed/wiped away by the alcohol-based hand sanitizer.
    • Using an alcohol-based hand sanitizer is the preferred way to keep your hands clean.
    • Alcohol-based hand sanitizers kill the good and bad germs, but the good germs quickly come back on your hands.

    Perhaps nowhere is handwashing more of a focus than at America's largest pediatric hospital, Nationwide Children's Hospital, based in Columbus, Ohio.

    AllNurses.com recently interviewed Dr. J. Terrance Davis, MD, Assistant to the Chief Medical Officer, Nationwide Children's Hospital. Dr Davis also is a Professor Emeritus of Clinical Surgery, Division of Cardiac Surgery, Department of Surgery, The Ohio State University College of Medicine.

    1. Your Zero Hero patient and employee safety campaign is laudable. How do you ensure "gel in, gel out" during each and every patient encounter?

    We did a military style "Stand Down" for 15 minutes one day in November of 2010 that was the culmination of a major hand hygiene effort that included placing hand gel dispensers everywhere, and holding a Safety Summit of all medical and hospital departmental leadership. Monitors from the Quality Improvement department continue intermittent monitoring, and compliance has remained ~95% to this day.

    2. Hand washing gel contains alcohol. In a children's hospital, how do you keep your young patients safe from ingestion or exposure to hand sanitizing gel?

    The dispensers are wall mounted, high, and need to be pressed from the top with a specific motion. In seven years of use of hundreds of dispensers throughout the hospital we have not had any such problems.

    3. How many times can you use hand sanitizing gel before it becomes necessary to use soap and water? Or is this necessary?

    It does not become necessary to use soap and water after any specific number of times of using the gel. Soap and water are indicated (as opposed to gel) if the hands are visibly soiled.

    4. How do you get all the parents and visitors to comply with hand gel use? What kind of signage do you use?

    We cannot mandate visitors or family to comply with gel in-gel out; but we do have signage throughout regarding hand hygiene. Mostly the culture is so strong that everyone entering and leaving are doing hand hygiene, so it tends to "rub off" on the families – albeit not to the extent present in our employees and medical staff.

    5. What else would you like our audience of >1 million nurse-members to know about this program?

    The "stick" we used to encourage compliance early on was that non-compliers identified by our monitors, were required to have a chat with the Chief Medical Officer (or his designee) if a member of the medical staff. Nurses or other health care professionals who were found to be non-compliant were required to meet with the Chief Nursing Officer or her designate. Getting "called up to the Principal's office" was apparently noxious enough that, once the word got out we were serious about this, non-compliance dropped dramatically. We did not have any repeat non-compliers.

    Here is a video about Nationwide's Hand Hygiene Program


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