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  1. Gooselady

    Denying Death As A Society

    Don't forget the ANGRY in denial patients and family, and coping with their open hostility, barely concealed contempt as if they hope you will screw up and vindicate them. I always wondered WHAT they were vindicating. When I worked medical oncology we did the comfort care for most of the hospital, while the patients (or more likely, their family) committed to denial end up in ICU and working in ICU must really be something else, just for this. We had a gentleman actively dying from metastatic lung cancer, had been on the floor for over two weeks slowly deteriorating. His family insisted upon full life support for him, for 'religious' reasons. I was in charge one night while we were waiting for him to code . . . and the family explained a little of their views. A DNR to them meant 'taking it out of God's hands". MOST of our comfort care patients became such without drama, but some did. It was the minority, though. That minority ends up on ICU and I can only imagine how this is for ICU nurses. My heart goes out to you all. It's not just denial of death. There are cultural issues too, that you won't learn on your mandatory education. From a Filipino friend I heard that to her family, a DNR means 'giving up', and you must fight fight fight to live, no matter what. My friend is a nurse and she admits she knows 'better', but this stuff goes deep down and isn't easy to change. Her mother is in her 90's and she dreads when this will be an issue for her and her family. I've been with people who truly felt assaulted when DNR was suggested for their terminally ill family member. I've witnessed contempt and disgust from nurses and doctors when a family refuses DNR or comfort care instead of plunging on with chemo and radiation. I don't think that's right either. We can't forget there are two sides to the patient bed. Ours is quite different, but not 'better'. We don't help anyone deal with their denial by condemning it or judging it. I don't have any answers, as if there WAS an answer to this. I don't want some nurse or doctor dictating the life and death of my child any more than the next person.
  2. Gooselady

    Social Skills in Nursing (Part I): The Art of Validation

    Excellent article on an important part of being a nurse. I think most of my social skills, which are pretty good, are because I've been a nurse most of my adult life. But I didn't start out that way, and until I 'got it' my life as a nurse was much harder than it is now. One big revelation to me (in hand with this article) was how much better my life in nursing was when I shifted my focus to the well-being of the others around me. I don't mean some codependent thing, just natural interest in what's happening to a fellow nurse, and definitely, giving positive feedback even to the biggest curmudgeon. It's kind of like 'feeling' your way around, there's no checklist or function chart. I remember cringing and being so focused on how I was treated, what I imagined was being said or thought about me. I was petrified of making a mistake or of being the black sheep. Somehow, not sure how, but it occurred to me that I was just plain feeling sorry for myself, and that drew a lot of negative attention (or, it appeared to). It's not like my job got better or my coworkers easier to get along with, it was the way I looked at things that changed. I still see all the insanity and chaos as much as I ever did. It bothers me as much as ever. I just don't take it personally, as if it were some kind of personal attack just to make my life suck (like, staffing issues). I have a choice to work or not in a poorly staffed unit. Hey, wait! It's understaffed EVERYWHERE. Literally. Some places worse than others . . . so lets find a better place. I think you do find what you are looking for If you are very anxious about how mean fellow coworkers are to you, you'll see EVERY LITTLE thing. I'm sure I've 'overlooked' a lot of evil thoughts along the way. What a lovely thing, really. Makes a hard job easier to tolerate. So nurse A isn't all that fond of me? That's her right. I don't like everyone either. There have been some nurses I really looked up to, and wondered what it was about them that they didn't seem so stressed, actually appeared cheerful almost no matter what. I'll admit I suspected some were borgs, how could anyone be so darn cheerful all the time? In THIS place? But they often complimented or gave positive encouragement. They could discuss an error with another nurse without the nurse feeling insulted. They could withstand verbal abuse from a patient's family with the most amazing dignity. Again and again, no matter what went on, they held their chin up, kept their sense of humor about themselves (I think this is key). Our job is hard. And we unintentionally make it much harder than it needs to be. "Social skillz" is the lubrication in a cranky mechanism called healthcare. You can be pleasant and polite with ANYONE, no exceptions. Even when they are spitting in your face, no need to lose your own dignity. You can have the most difficult conversations and maintain a pleasant facial expression and tone of voice. It takes practice. And no, it does not feel 'fake'. I do it from genuine respect, which I extend to myself as well as others. That's the idea, anyway, and no I'm far from perfect, but I've worked hard to 'get it' and I agree, it's made my life as a nurse SO much more satisfying.