JeanstarMSN
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Over the years I have done my share of patient education, preparing each patient before surgery. This period of time can elicit a range of emotions, mostly fear and anxiety. Family members are often included in the conversation. Fear of the unknown and worries about the risks involved, no matter how remote, can feed these emotions. My belief is that it is my responsibility as a nurse that my patients be well informed about what is going to happen during their surgery and how they will be cared for post-operatively. Also important in the conversation is compassion for the patient and family. Being and active listener and observer can help you to pick up on unspoken concerns. Acknowledging those concerns can make a huge difference in your patient’s experience. Close to my heart is a patient named “Joe”. Joe was 75 and was a retired Navy seal. Always in good shape for most of his adult life, he never thought he would be facing heart surgery for a valve replacement. He had been frustrated with increasing fatigue and exercise intolerance. Joe started to think maybe he’s just getting old. He was a proud military man and didn’t want to admit he needed help. His wife tried to help by suggesting a healthier diet but he wasn’t feeling any better. Then his symptoms progressed to chest pain and shortness of breath. Fearing he was having a heart attack, he knew he had to see his doctor. His doctor told him it could be related to his heart valve so he referred him to a cardiologist who did an echocardiogram and a cardiac MRI to get a better look to see what the problem was. He gave Joe the difficult news that he had aortic stenosis. Joe had some options, he explained. He could have open heart surgery which involved a long recovery, but he told Joe that because of his good health up to this point that he was a good candidate for the new TAVR (Transcatheter Aortic Valve Replacement) procedure. He explained the procedure and how it is less invasive than open heart surgery with a quicker recovery. Joe decided to have it done. On the day of surgery, Joe was keeping a brave face for his family. His wife and daughter were at his bedside. I could tell they were anxious and worried. I answered all their questions to lessen their fears and to reassure them that he would be in good hands. It was time to go to the OR and I noticed Joe was holding something in his hand. He reluctantly gave it to his wife at the last second as he was wheeled out. I saw that it was a bracelet. His wife told me he was worried about being without it because he wears it all the time. She showed it to me and it had a bible passage engraved on it. I told his wife I had an idea but had to check with the OR staff first. I called the circulating nurse and explained about Joe’s bracelet. I asked if she could do me a favor and read Joe the passage as he drifts off to sleep before the procedure. She said she would and she did! I found out after the procedure that she whispered the passage in his ear multiple times as he fell asleep. I was called when he was transferred to PACU and given report that his procedure went well with no complications and that he would be returning to the unit in a couple of hours. He was waking up but was still groggy. His wife and daughter were in his room nervously waiting for his return. I let them know his procedure was done and he was doing well in recovery. I told his wife what the circulating nurse did for me. She teared up and hugged me! What a special moment in my career that I will never forget! The cardiac surgeon did not work on his own that day. We, as nurses, were his compassionate professional team. It warms my heart to think about Joe and how we all came together to calm his family, feed his soul at his most vulnerable time, and to improve his quality of life. I was off for a few days but found out Joe did well post-operatively and was discharged home.
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The Joint Commission's position states that the requesting unit that a nurse is to float to must be a similar unit1. That way the nurse can acclimate easier and function in a competent manner. This prioritizes patient safety. The requesting unit is probably short-staffed which can mean a heavy assignment awaits you. The staff here may not be willing to help you out as much as the people that know you on your home unit. You feel like an outsider especially if the nurses are impersonal because you're not a regular member of their group. Some tips for dealing with these unsettling feelings: 1- Be Professional You know you are confident in your nursing skills. Be proactive, introduce yourself, and be respectful of the team. Make sure you know who the charge nurse is and use her as a resource. 2- Ask for Help If there is any task that you are unfamiliar with or are feeling overwhelmed, communicate this to the charge nurse. Maybe the assignment can be changed or the charge nurse can be a resource person and help you with an unfamiliar task. Remember patient safety should always be your priority. 3- Get to Work Try to be open-minded if you have to learn a new task or a different way to do a skill. Offer to help out with other patients, be flexible. Try to make a good impression by having positive interpersonal and professional skills. 4- Be Reflective Think about how your shift went and your feelings about the experience. Don't be too hard on yourself. Sometimes floating to another unit means you have to deal with a negative, stressful atmosphere. Maybe you didn't get the support you needed? Maybe you didn't feel accepted in the group. You're unhappy you had to eat alone. If the atmosphere was chaotic or hostile, try not to be too critical of yourself. You know you're a good nurse that cares about her patients. The more experience you get floating, the less intimidating it will be because you will learn to adjust to the group dynamics of the new unit. When you get better at your people skills you've won half the battle. Emerging Themes A phenomenological study revealed that six themes surfaced when nurses were interviewed about their feelings about floating2. The six themes were: Chaotic workflow process Unfair patient care assignments Unfamiliar work environment Psychological components, sociological factors Physiological needs Chaotic Workflow Process Nurses reported a lack of communication between the charge nurse and the floater. There is no orientation to the unit. Some requesting units act like just because it's the same hospital you know where everything is. That's not always the case, different units store their supplies differently and I know from my own experience I have spent countless wasted time just looking for something. If I was unable to find it, I have to wait until someone is not busy to help me. That causes a delay in patients' care which frustrates me to no end! Unfair Patient Care Assignment Nurses who participated in this study reported getting the worst patients on the unit that nobody wants to have on their assignment. Either you get the first admission right at the busiest part of your day or you get patients that are very needy, or you get lots of discharges then you have to get lots of admissions since you're the one with the least number of patients at any point. Also, nurses reported patient rooms were on opposite ends of the unit instead of concentrated in one area. Unfamiliar Work Environment When working on an unfamiliar unit, your confidence can take a hit. Not knowing certain protocols for post-op patients, for example, can be stressful. Not knowing that these patients need frequent vitals, frequent assessments, and what you need to document for the post-op period is something that needs to be communicated but sometimes is not. Lack of help and lack of teamwork can make a floater feel very lost and displaced. Not only that, but you start to feel like a bad nurse. These feelings make for a very long shift. Psychological Components Just finding out that you are floating at the beginning of the shift is very unsettling. It feels like you know you are going to have a bad day. If you could stay on your home unit, you could have a bad day but at least you are with your home team. Going to another unit makes a bad day so much worse. To know you have to float ahead of time could help with the anxiety that takes over when you find out. Sociological Factors Staff nurses can be unfriendly and unwelcoming to floating nurses. Some don't even acknowledge your existence. When you have to ask for help, it feels like you are being a burden just to have someone help you find a pillow for a patient. Unit managers need to step up to the plate and encourage a positive team atmosphere. FACT: Float nurses should be acknowledged and appreciated. Physiological Needs Planning meal breaks can be difficult when floating to another unit. The charge nurse should make sure everyone gets a break but it can get busy and hectic. Sometimes meal breaks are delayed or missed. A 30-minute meal break is required by law but actually getting it can be a challenge. The staff nurses on the requesting unit are all going to cover each other for their breaks. FACT: Floaters need to speak up for themselves but be respectful. A literature review of this issue was conducted. The theme that emerged was simply that nurses hated to float. What followed was the development of the Float Ally Model 3. This came about because some requesting units did not provide orientation or resources to help the nurses acclimate to the unit and the patient population. With the implementation of this model, float nurses and aides are assigned a staff person to be their "ally" throughout the shift, orienting them and checking with them intermittently. The float staff is also given a packet to let them know if they need to attend rounding with the doctors and how to find supplies. When the shift is over, the float nurse is given a "caregiver celebration", a written thank you for helping the unit in their time of need. The results for the six-week pilot program for this model was an increase of satisfaction rate of 28-41% before the model up to 80-90% after the model. Clearly, it doesn't take much to help a coworker feel appreciated. A little kindness towards each other can go a long way to make the floating experience more positive. It is suggested to be a mentor4, especially if the floater is a fairly new nurse and maybe is floating for the first time. Help that nurse to grow in their skills and cultivate their critical thinking. Be a leader, share your knowledge, help them to learn from your mistakes. References 1Addressing floating and patient safety 2Exploring Nurses' Feelings on Floating: A Phenomenological Study 3Nurses Create a Model to Enhance the Float Experience: Allies Support Unit-to-unit Float Nurses 4The Mentoring Relationship: Advantages for Both
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Any nurse, new or seasoned, can feel overwhelmed at times at work. It can be a challenge to learn the art of delegation. Without it though, a nurse can become fatigued, stressed, and depressed. On the other hand, delegating tasks effectively can improve coworkers’ ability to work together as a team. Not only that, but delegating can improve the response time to patients’ needs, which in turn, improves patient satisfaction. Isn’t that why we’re all doing what we’re doing, to make patients feel cared for and feel better? Delegation Entrusting and empowering someone else to do a part of your job is a learned skill. As a nurse, when you delegate, you are showing your coworker that you have trust and confidence in their abilities. You are giving them a chance to become better at what they do and improve their skills. Delegation, however, has an accountability piece to it that means that you, as the nurse, must follow up and make sure the task was done completely and correctly. Patient safety and patient well-being are the focus here. At the end of the shift, you are responsible for everything that happens with your patients’ nursing care. If you are working with a nursing assistant that is new to working with patients, you have to do more follow up. This can also give you a chance to give that assistant a pat on the back or some supportive direction. We are all a team and must learn to work together for the benefit of the patient. Plan Ahead There are many things to consider before the delegation process begins. Here’s a checklist you can use the next time you want to delegate efficiently: Decide what task you want to delegate. Choose who should carry out the task, are they capable, is it in their scope of practice. Decide when the task needs to be done; is the patient ready, is there a deadline like getting a patient bathed before a procedure. Explain how the task needs to be done such as documenting all input and output for a patient, encourage the coworker to ask for help if needed. In a recent correlational research study1, with a convenience sample of 362 nurses, ambulating and feeding patients on time and doing mouth care were the tasks most missed by nursing care. The reasons behind it were short-staffing, lack of material resources, and communication. These tasks are some of the most basic needs that we can do for our patients. These are also some of the most basic tasks that can be delegated. Example You go into work one day, get your assigned patients, and realize the unit is short-staffed that day because a nurse and an aide called out sick. Their replacements won’t be there for another four hours. So for those first four hours, you’re slammed!! Quickly you have to think on your feet! Findings2 revealed a tendency for nurses to delay the decision to delegate but no one nurse can do it all. So you start to think about delegating to your competent coworkers. Make sure they understand what they need to do for the patient and follow up to make sure it gets done. Our patients depend on us at their most vulnerable times to take care of them. It’s not their fault that we are short-staffed. We need to work together as a team and support each other in the process. Delegating can be often easier said than done. You as the nurse have to uphold the accountability that your patients are receiving quality nursing care on your watch. Ensure that each team member is aware of what the task is that they are being asked to do and what is expected of them. At the same time, be approachable in case the coworker needs help. Help team members understand the level of commitment that you want from them but don’t be a mean nurse. There is nothing worse than working with someone who has no respect for their other team members. Remember, the nursing field is not just a job but its a commitment to our patients. Provide support to your team members and give positive feedback to a job well done. References Five Rights of Nursing Delegation 1Missed nursing care and its relationship with confidence in delegation among hospital nurses 2Improving patient care outcomes through better delegation-communication between nurses and assistive personnel
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My patient, Frank, was a diabetic. Many of his health problems stemmed from his lack of education about controlling his blood sugar. Without intervention, Frank would have become a more unstable diabetic. His demeanor was apathetic. He did not understand how bad his health could get without self-management of his diabetes. At times he seemed overwhelmed and depressed that he had this condition. My goal was to empower him and to get his wife involved so that she could support him along the way. Meet Frank Frank is a 67-year-old man with type 2 diabetes. He came to the hospital after several episodes of dizziness and a subsequent fall at home. He was diagnosed with diabetes but was having symptoms for 2 years before his diagnosis. He was told these symptoms, such as frequent urination and increased glucose levels, were pre-diabetic. He is overweight with a body mass index of 35.8 kg/m. A recent visit to his doctor for his yearly physical showed lab result values of fasting blood glucose level of 192 mg/dl. He was recently started on Glyburide to be taken daily but he stopped taking it because he said it made him sweaty and irritable. He also takes Lipitor daily to control his high cholesterol. In the last few months, his wife suggested taking vitamin supplements in an attempt to control his blood sugar and help him with weight loss. He stopped taking these when he did not feel any improvement. When talking to Frank and his wife he revealed that he does not check his blood sugar at home. "I don't even own one of those gadgets to check my sugar.” He states his blood sugars always come out high so what difference would it make to check them. He says he's a "real meat and potatoes man". He also says pasta and bread are among his favorite foods. His wife says she has offered him lower-calorie foods but he describes them as "tasteless". He drinks 8 ounces of wine with dinner each evening. He does not smoke, quit 10 years ago after a 50 pack/year history. He recently retired after 33 years as a truck driver. He lives with his wife of 40 years and has two married children. His father had diabetes but Frank still has limited knowledge about managing his own diabetes. Since his retirement one year ago, Frank has tried to play more golf and do more gardening to try to increase his physical activity. Despite his efforts, he has gained over 20 pounds. He has never been educated about a diabetic diet. Nurse in Action While Frank was in the hospital I arranged for a nutrition consult. He and his wife acknowledged that they needed help to figure out dietary restrictions for glucose control and weight management. Frank's wife suggested they take a 20-minute walk after breakfast every day. She also said she was thinking of getting a treadmill so Frank could keep up his walking in bad weather. She seemed relieved that she too was feeling more empowered about how to help Frank. Metformin was prescribed for Frank to take twice daily. I explained the gastrointestinal side effects and to take his medicine with food. During his hospitalization, he and his wife learned how to check his blood sugar. He refused a prescription for Vasotec for blood pressure control. His perception was the more medications he took, the sicker he would become. His wife wanted to try a "natural solution". They both wanted to just focus on the weight loss and glucose control. Importance of the Role of the Nurse My experience with this patient reinforced to me the importance of the nurse's role as part of the healthcare management team. The patient was at a point in his health status that he could have experienced worsening diabetes control had he not been educated. It really surprised me how much he did not know about his health. I got some insight into his understanding of diabetes and his health belief system. What did I do for Frank? I empowered him, I helped him take ownership of his health, and I gave him the information he needed to make better decisions about his health. I'm no hero. My hope is that I made Frank his own hero.
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Simone Biles withdrew from some of her Olympic events because she felt like her mind and body were not in sync. Bedside nurses quite often feel the same way ... mind and body out of sync. Have you ever been at work and felt like you were being pulled in multiple directions? You are trying to start your shift with your first patient in an organized way. This is not possible!! One patient is calling for pain medications, another unstable patient is climbing out of bed with the bed alarm blaring, and we do not have enough staff today to answer all the call lights and alarms going off! Welcome to a typical day in the life of a bedside nurse It's like being the short-order cook at a crowded diner. You are trying to keep up but you also have to be the hostess, the waitress, the busboy/busgirl and sometimes the manager at the same time! Before having one sip of your coffee, you are being hunted down by nurses from the previous shift who want to unload report on you and go home. Your morning flies by. Halfway through your shift you still have not got a chance to go to the bathroom and you are feeling it from the super-sized coffee you drank this morning to wake yourself up. The Price of Caring In reality, for many nurses, the situations we encounter at work can leave us feeling hopeless and powerless. Physical and mental fatigue can seriously impact the quality of your life. Compassion fatigue (CF) is the accumulation of months and years of exposure to patients with emotional pain. We, as nurses, want our patients to know that we feel their pain, their physical and emotional pain. CF is the price of caring. You probably know that constant exposure to traumatic situations can lead to depression and anxiety. You have likely wondered why you feel this way. Let's talk about what you can do right now to help yourself feel more positive. Being proactive about your mental health is just as important as your other everyday needs. What is Compassion Fatigue (CF)? The concept "compassion fatigue" was coined by nurse Carla Joinson in 1992. As she described it, she noticed that nurses dealing with frequent heartache had lost their nurturing ability. This phenomenon is a combination of secondary traumatic stress (STS) and cumulative burnout (BO). STS is a state of stress which is extreme tension and preoccupation with emotional pain. BO is a state of mental and physical exhaustion caused by having to deal with a constantly stressful environment. CF is characterized by feeling burdened by another person's suffering, reduced ability to feel sympathy and empathy, blaming others for their suffering, loss of job satisfaction, insomnia, and alcohol and drug abuse. Decision-making can be negatively affected along with a caregiver's ability to adequately care for their patients. CF can be the cause of some nurses leaving their jobs and/or their nursing careers. How to Deal with Compassion Fatigue: 3 Interventions Mindfulness Are you aware how you act on your days off? Ask your family or your main sources of support. Do they feel like you enjoy your career? Are you constantly complaining to them about your job? Are you able to separate work from home? Work environment tips Educate yourself about what resources might be available at work. Employee Assistance programs may offer assistance and counseling. These programs can help with stress reduction at work, work-life balance and effective communication strategies. Vocalize your needs to your coworkers instead of trying to do everything yourself. Don't be afraid to delegate tasks. Support groups can also help to allow you to debrief a situation and focus on what you accomplished rather than missed opportunities. Alternative approaches such as massage, journaling, prayer or meditation are valuable ways to reduce work-related stress. Self-care CF can threaten the quality of our abilities as a professional nurse and our quality of life. Most of us only allow a small amount of time to being selfish of our well-being. A mixed methods study done by Katherine Valentine Upton in an acute care setting showed the prevalence of CF in acute medical care nurses and its damaging effects from stress. The results of the study also showed the moderating effect of self-compassion. A self-care plan should include exercise, proper nutrition, spiritual health, and social activities. You must give as much importance to self-care as you do eating and sleeping. You need to take care of YOU! References Simone Biles: what if nurses followed her lead? Compassion fatigue. The cost of caring Compassion Fatigue among Healthcare, Emergency and Community Service Workers: A Systematic Review Nursing on empty: compassion fatigue signs, symptoms, and system interventions An investigation into compassion fatigue and self-compassion in acute medical care hospital nurses: a mixed methods study