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jeastridge BSN, RN

Faith Community Nurse (FCN)

BSN, RN, Faith Community Nurse

Content by jeastridge

  1. Story #1 “Oh, I work a couple of shifts per week. Just enough that I can get out of the house and feel like I’m contributing, but not so much that I’m letting someone else raise my children.” These words spoken to me in passing cut like a dagger to my worn-out-mama soul. Her innocent implication that I let someone else raise my children as a full-time working mother piled on to the thickly layered “mom-guilt” I already put on myself. The cruel irony of this moment was that the words came from the mouth of my hospital nurse, as I was recovering from surgery, unable to be with, much less care for, my children in my current state. I was already in physical pain, and rather than alleviate my pain as her job should have been, she added emotional pain to my heart and mind. I feel certain that the nurse did not intend to wound me with her words. She was just “making conversation.” But what she failed to remember was that just another day at work for her was a huge life-altering experience for me. A hospital is a workplace for many, but for those of us lying in the beds, it’s often a scary and intimidating time. I implore you, keep your words positive and uplifting, or don’t say anything at all beyond the standard phrases of patient care. What you say can be just as much of the healing process as what you do.” Story #2 “I was in a rehab facility recovering from surgery to repair a shattered leg. I was in a lot of pain and had the feeling I was being judged unfairly as a ‘complainer.’ I just couldn’t get comfortable and desperately needed to talk with a doctor who had the authority to make some changes. During my discussion with the bedside nurse, she said, ‘You’ll see. Good will come out of this. Just think positive thoughts.’ Yikes. I know she meant well but that was NOT what I needed to hear. It may indeed be true eventually, but what I replied was also true, ‘I don’t need to hear that right now. I need words of comfort.’ Honestly, I don’t know if she even registered what I said.” Improving Communication Our words matter, don’t they? These simple comments, probably intended as attempts to connect, are received in a completely different way by the suffering patients. Sadly, the words linger long after the event and sometimes are repeated often as the patient struggles to make sense of a tough time. How do we improve our practice so that we don’t commit these types of gaffes? Researcher Brene Brown says, “Rarely can a response make something better. What makes something better is connection.” Making gentle connections without adding to our patient’s pain is our challenge, isn’t it? While this type of sensitivity may come more naturally to some than to others, all of us can learn and become better nurses in the process. Keep it Professional When we are in the patients’ room, our conversation and concern should be about them. We are not center stage. If they ask personal questions, it is courteous to answer, but generally, they are just being polite and they don’t really have the energy to know or care about our extended family or our troubles with our children or whatever our concern of the day might be. If the patient is argumentative or disgruntled or venting, we can begin to feel defensive and be tempted to offer them correction (or more!). Once a friend taught me the technique of saying, “Hmm. I had not looked at it quite that way…” and then let the sentence trail off without engaging. Another tool that can help us here is to answer their question as succinctly as possible and then turn it back to them with a question that helps us understand them better. Be Empathetic Our patients are sicker than ever before. Their family members are often super-stressed. As professional nurses, our job is to care for them to the best of our ability while recognizing the strain they are under and giving them extra grace in their time of need. Sometimes simply being present, prompt and professional is our best response—no particular words needed. Repeat What They Said Many of us nurses remember learning in nursing school about being good active listeners and reflecting back what the patient tells us by saying things like, “So you are saying…” In other words, finding ways to clarify what they say to make sure we are on the same page. Be Genuine When we are confident and comfortable in our own skin, we transmit that to others and help them feel comfortable as well. Being genuine does not mean that we tell people what we think, it simply means that we acknowledge their inherent dignity as persons and that we care for them with competence and professionalism, meeting their needs in the best way we can. No One is Perfect We are all going to be less than stellar nurses from time to time, but we must also keep trying to improve as we move forward in our careers.
  2. jeastridge

    When Nurses Say the Wrong Thing: 4 Ways to Improve

    You make many good points. Nursing is not an easy job and home care poses even more challenges in terms of boundaries. Thank you for sharing your experiences and perspective. Joy
  3. jeastridge

    When Nurses Say the Wrong Thing: 4 Ways to Improve

    You sound like an amazing nurse. I loved reading your comment. Thank you for sharing! Joy
  4. jeastridge

    When Nurses Say the Wrong Thing: 4 Ways to Improve

    You are right. There are probably better examples out there. Readers? Joy
  5. jeastridge

    When Nurses Say the Wrong Thing: 4 Ways to Improve

    Thanks for your comment. As nurses, we certainly have our hands full. As you point out, neither of the examples cited was particularly egregious. We have all certainly seen worse! But I used those because they were little things but in both cases the patients brought those up with me much later. Yes, they are subtle but I thought they might effectively highlight how even small comments carry heavy weight coming from the nurse. Joy Well said. "It should be a rarity." It happens, but being on guard and being careful about what we say is a beginning. Thank you for your comment! Joy
  6. jeastridge

    When Nurses Say the Wrong Thing: 4 Ways to Improve

    I hear you. Thanks for sharing. We do live in a tough time, for sure. Joy
  7. jeastridge

    When Nurses Say the Wrong Thing: 4 Ways to Improve

    Well said. Joy
  8. jeastridge

    When Nurses Say the Wrong Thing: 4 Ways to Improve

    We can always learn more, do better, and grow professionally. Thank you for your comment. Joy
  9. jeastridge

    I can’t stop crying over a bad death

    Thank you for sharing so vulnerably. I am glad that you wrote this because this was a really hard experience. Maybe another nurse will get some encouragement from your willingness to share. Bless you.
  10. jeastridge

    When Nurses Say the Wrong Thing: 4 Ways to Improve

    I hope these examples serve as simple reminders that even innocuous comments can be misconstrued. You are right, we would have to go around in complete silence if we were to never mess up, but we can all find an occasion, from time to time, to be more careful about our conversation. Thank you for your comment. Jo
  11. jeastridge

    When Nurses Say the Wrong Thing: 4 Ways to Improve

    You are clearly a compassionate and involved nurse. This article is meant to encourage us all to do better where we can, not to be critical of the good things we are already doing. You will probably agree, that most of us have some room for improvement at some point. Joy
  12. jeastridge

    Nurses and Lice: Practical Tips

    The Dreaded Diagnosis: Lice As Chris, RN, took report for the day shift in the Pediatrics ICU, she overheard the dreaded words: lice. Tuning in, she paid attention as the staff discussed a 3 year old being treated for RSV who was improving but began vigorously scratching her head, to the point of leaving marks along her hairline and around the base of her neck. When the night nurse leaned in to examine her head, she noticed the lice moving. Drawing back, she motioned for the doctor who was nearby to step over. Together, they confirmed the unpleasant diagnosis: lice infestation. Pediculous humanous capitis or head lice, are “ 2.1–3.3 mm in length. Head lice infest the head and neck and attach their eggs to the base of the hair shaft. Lice move by crawling; they cannot hop or fly.” - Parasites - Lice - CDC They feed on human blood and lay their eggs, called nits. Who Gets Lice? Almost on cue, all the staff felt their scalps crawling and began to have the urge to scratch. While lice are not a health hazard, per se, there is a strong stigma attached to having lice. The truth is, however, that the infestation affects all socioeconomic levels and all ages but primarily children in crowded conditions, especially Caucasians. “Head lice are more common in girls than in boys and are more common in Caucasians than in African-Americans. Anyone can get head lice. It is not a sign that a person is unclean.” - Head Lice - Cleveland Clinic Chris said, “It is unfair to equate lice with poor hygiene. At times, they do go together as families who live in conditions where there is no running water or access to lice treatment, can have significant problems. These issues will often become apparent at admission during the history-taking process. Sometimes we see red flags that alert us to check. But sometimes, we miss the infestation as we are busy prioritizing other needs that are more life-critical and it is only after they are stabilized and doing better that we detect lice. Lice is an equal opportunity infestation.” Chris elaborated that the detection of lice almost always fills everyone with dread because lice can be so hard to eradicate. It takes a concerted effort, treatment of the whole family, cleaning of all linens, car seats, upholstery—it’s a job! How do you diagnose lice? Scratching When people have lice, they usually scratch vigorously, so hard, in fact, that they sometimes have scratches along the hairline and around the ears and at the base of their necks, where the lice are most likely to take up residence. Children will employ a “two-handed scratch” where they get both hands up to their heads. Their hair will often be tangled and messy because of the scratching. Visualize In the hospital, to diagnose it, you have to see a louse and have it confirmed by a second person, usually the doctor. Also, sometimes the nits, little white eggs that cling tightly to the hair shaft, are the first sign. So what do nurses need to know? And how do we best help ourselves and our patients? Getting Rid of Lice Getting rid of lice is not always easy. It requires dedication and persistence but it can be done. By encouraging our patients and their families in a straightforward, professional manner, we can maximize their confidence and their potential success. Reading about it on the internet can sometimes raise unreasonable fears of “super lice” and persistent infestations. It might be helpful for us to give our patients guidelines from trusted sources such as the CDC and Cleveland Clinic. The CDC.gov site has thorough and practical recommendations. Treatment with lice/egg killing pyrethrins is the beginning of the process. Some pediculocides are ovicidal and some are not. Sold over the counter in kits, the shampoos are generally effective in eliminating the lice. Following up with dedicated hair combing for nits is critical. Otherwise, the eggs will hatch and the infestation will return. Some sources advise treatment of the head, treatment of the environment, daily nit removal and then a repeat treatment in 7-10 days with continued combing after that if nits are found. If treatment with over the counter kits is not effective, patients can follow up by contacting their primary care provider for perscriptions which go by brand names such as Sklice, Ulesfia, Ovide and Natroba. Practical tips on combing it out: Wearing gloves, brush the hair first to get the snarls out (then clean the brush). Treat the hair as per directions on the box. Divide the hair into very small segments. Using a nit comb from kit, comb through thoroughly, using detangle spray. (Sometimes provided in kit) After each pass of the comb, wipe it off on a paper towel or toilet paper and discard into a prepared trash bag. Wash all combs, brushes, towels, hats, etc. after each treatment. After initial linen and pillow wash, consider changing pillowcases and washing favorite blankets or stuffed animals daily throughout duration of the process. Internet solutions are plentiful. Some of them have merit such as the “goop” that helps make the hair slick and easier to comb through after the initial treatment. Additionally, parents can find community and support online, when sometimes talking with family or other parents is hard. Prevention? The usual recommendations involve keeping hair pulled up and back off the face, not sharing brushes, combs or hats and prompt treatment when problems are discovered. Lice treatments can be expensive for parents on a limited budget. It is important that we be sensitive to this and try to help parents find funding for treatment kits as well as for the laundry a lice infestation generates. Working together in hospitals, schools and daycares, we can help promote prompt treatment and fewer cases of head lice. Are you itching yet????
  13. jeastridge

    3 Ways Nurses Dispense Rx: HOPE

    Gathering my thoughts and hospice computer, I climbed the outdoor steps to the second-floor apartment. The gloom in the small room was palpable as I entered. Crowded together on the couch sat a group of relatives and sitting close by in a worn recliner was the patient, a man in his late 60’s, jaundiced skin betraying his terminal diagnosis of advanced pancreatic cancer. On the arm of his chair, arm circled protectively around the top sat what appeared to be a daughter. After the introductions and greetings, we began to talk about what hospice is and does and how our services might be of help during this time. The patient waved his hand weakly to indicate his desire to speak, “This is it, isn’t it? I don’t have any more hope.” It seemed almost as if everyone took a collective breath, held it and turned to me, waiting for some word that would help them through this impossibly difficult moment. What would you say at this point? As professional nurses, we are present to help people wherever they are on their journey. From pediatrics to geriatrics and everywhere in between, we work to help people recover, rehabilitate, or compensate. Sometimes, we find ourselves in situations such as the one describe above which fits the traditional definition of “hopeless,” and yet, we are there to help inspire some degree of hope, however small. What is Hope? The stuff of life... As long as we have some hope, we can keep pushing forward. A thought process... Researcher Brene Brown says, “I was shocked to discover that hope is not an emotion; it's a way of thinking or a cognitive process. Emotions play a supporting role, but hope is really a thought process…” (http://www.bhevolution.org/public/cultivating_hope.page) A tool to face the day... Sometimes we hear ourselves or our colleagues referring to a reluctance to encourage “false hope,” or the possibility of inspiring unrealistic expectations in our patients. Given the definition above, maybe false hope is not such a concern since hope might be more about giving those in our care the tools they need to face the day, so they can manage to wring out a bit of joy even in the midst of terrible trials. Hope fills the balloon of life... We talk about hope all the time: I hope it doesn’t rain; I hope I don’t spill spaghetti on my white blouse; I hope he passes his test; I hope he gets better; I hope I will be forgiven. It is the same word, but holds vastly different meanings! Hope is hard to pin down—it fills the balloon of life and floats, held by a string of desire, tightly wound around our fist of determination and strong will. We won’t let go, for as long as there is hope, there is life. So what is our role as nurses in inspiring hope? Set goals. While it is impossible to foresee the future, with our knowledge base, we can help our patients set goals they have the ability to meet. We can help them set goals for today, e.g. “Let’s focus on getting bathed and dressed and sit in the bedside chair for 20 minutes. Does that sound good to you?” Meeting goals, even small ones, helps us to feel a sense of achievement and success which gives us hope for reaching other, more long-term goals. Focus. When life feels out of control, our patients may need help in focusing their goals and hopes on a more short term accomplishment. After a major stroke, or some other serious health set back, people have a hard time with looking too far ahead. We can help them reframe their thinking and thus give them true hope. By listening carefully and asking questions, we can help guide them to their own goals, zeroing in on what matters most. Reframe. When we get down to the nuts and bolts of life, time on earth is always rather limited. But when our patients and their families face a hospice nurse at the door, the limitations seem rather glaring and hope appears to take its bright light over into a corner where it is hard to reach. By helping our patients reframe their thinking to goals that are achievable in this new setting, we can help them have hope. For example, finding out what really matters to them in terms of pain management, family time, and closure can help leave them with a measure of hope. What to say? As I faced the family, I breathed in too, silently praying for inspiration and desperately asking for wisdom. “This is pretty hard, isn’t it? What is the hardest part for you?” I asked. He went on to talk about his fears of being a burden and of having pain that would be out of control. Once I understood his greatest concerns, I was able to help him and the family make plans for caring for him and was also able to describe some of our pain control plans. As we spoke, I could feel the gentle presence of hope re-enter the room. While the hope of eradicating his pancreatic cancer through treatment appeared to no longer be an option, there were other parts of his story that opened themselves up to hope and plans. Make each day as good as it can be... As I gathered my things two hours later, I touched the patient’s hand and spoke to him and his family, “None of us knows what tomorrow holds. But we will do our very best to care for you and to help make each day as good a day as it can be.” https://youtu.be/U92nQRS2vok/
  14. jeastridge

    3 Ways Nurses Dispense Rx: HOPE

    Brene Brown always gives me a lot to think about! Thanks for your comment. Joy
  15. Bah humbug! Driving to the hospital, I reached over and clicked off the Christmas music that proclaimed a commercialized version of the holiday was fast approaching. I just wasn’t in the mood for “jolly” when all around me, I witnessed sadness, loss and broken hearts. Besides the heaviness for my patients, I also felt burdened by the expectations of others’: gifts, meals, cards, cookies all seemed to sweep through my busy mind, riding on the wings of a tornado-like wind that whipped the whole mess into a funnel cloud and plopped it all in my lap, there to sit with the other normal chores which required attention—just the usual laundry, grocery shopping, car maintenance (yes, mine was in the shop again…) routine. The "Right Way" I know. I know. It’s supposed to be fun and meaningful. The expectation is that this time of the year, focus solely on the reason for the season (for Christians, that is the birth of Jesus and for others maybe it is family gatherings and gift-giving with love). Whether you have a spiritual bent or not, we all know what it is to feel the pressure to do things the “right” way and the subtle competition to manage it all with great aplomb. As a Faith Community Nurse, one of the things I do is visit people when they are in the hospital with a focus on helping them transition to an appropriate post-hospital stay location. For some, that is as simple as suggesting rehab facilities to the family, and for others, it is helping them prepare to take a loved one home to a greater level of care than previously. At Christmas, illness, falls, disease, cancer do not go away. In fact, their prevalence and effect seem more pronounced as others hang garland and put on old Christmas sweaters and indulge in homemade Christmas candy. Charlie's Story I pulled into a parking space and headed up to visit Charlie, a parishioner who had been in the hospital for an extended stay with complications from a routine surgical procedure. Already elderly, Charlie’s small family was mostly gone, and he had very few resources. I sat down and caught up on the last two days’ news when the Case Manager stopped in to discuss possible placement in a local nursing home. Charlie was sad but resigned, realizing that he couldn’t go home and that he needed the rehabilitation this facility offered. But it was almost Christmas. And it was sad. I saw his eyes sparkle with unshed tears and squeezed his hand, offering the gift of presence and silence. He returned my gaze with a small smile and said, “I’m not worried. I will be ok. I have faith.” Charlie’s words both encouraged me and challenged me. His ability to maintain perspective in the midst of great obstacles inspired me to shed some of my feelings of resentment and heaviness and to replace those negative feelings with something that comes from light and life and love. In those few moments, I tried to reframe my own thoughts and ask myself a few questions about how I can face excessive expectations and maintain my morale? How to Encourage Others As nurses, how can we keep working to encourage others even when we feel discouraged ourselves? Keep first things first- Even in the middle of a busy season, let us not forget to maintain our centeredness—whether it is reading a spiritually encouraging book, doing Yoga, going for a brisk walk outside, corporate worship—whatever feeds our spirits needs to take precedence over the other chores that might try to crowd it out. Busyness has a way of wanting to be more important than it really is, doesn’t it? Get rest and eat right. We can provide well for our patients, our co-workers or our families if we are running on empty. It may mean turning off that TV or letting our Facebook feed rest for a few days, but it is critical care for our bodies to get balanced rest and food, especially during the busy and challenging holidays. Maybe find someone to talk to. Holidays can bring out our own pasts and our sadness over previous losses. Unfortunately, this has a way of spilling out all over our lives in strange ways. We find ourselves angry and frustrated “for no reason” and over-reacting when someone asks us to bring a side dish to a gathering or participate in a secret Santa exchange…Over the top responses can signal that there is more going on than we are consciously aware of. When we feel like a pressure cooker waiting to explode, it may be time to pro-actively seek out some help in the form of a spiritual adviser or a trained counselor. Working hard in a therapeutic counseling relationship can be some of the best investments we make in time and energy. Working through past trauma and grief pays off big dividends in the present as we try to be the best nurses possible for our patients and the best family members we can be to our families. Cut yourself some slack. When the external pressures are high, sometimes it helps to acknowledge it and to also accept our own limitations. Perfection can be the enemy of well-being. As I wrapped up my visit with Charlie, he said, “Thanks for coming. It will be a good Christmas no matter where I am.” After a quick prayer, I left and walked back toward my car, feeling lighter than when I came, daring the “Bah-humbug” spirit to try to bother me again!
  16. Cindy was an older new grad. She went back to school after a long and successful career as a chemist, deciding that she wanted to be a nurse and explore other avenues of service for her “second half” of life. Capable and efficient in her first line of work, it was a shock to find herself as a novice where everything felt unfamiliar and where mastery was a ways off. Her first place of work was on a busy ortho floor. The second week at work, she called me crying. “Their expectations are so high. They keep threatening me.” I tried to listen without judging or offering advice, but something just seemed off. Every few days she texted or called and what she described didn’t seem like anything I had ever experienced as a nurse: where there should have been mentoring, there was censoring; where there should have been guidance, there was abandonment; where there should have been counseling, there was silence and isolation. The source of most of the problems was her preceptor, a young nurse, who my friend described and very physically attractive but unkind. As it turns out, she was a bully. Nursing is Not Immune to Bullying While we would hope that in such a caring profession, we would find a greater percentage of people with compassionate care agendas, sadly there are also a number of practitioners who exhibit the characteristics of a bully: they are critical, negative, they isolate their victims, avoid meeting with them, and generally make life miserable. According to a study by Etienne, “Bullying in the nursing workplace has been identified as a factor that affects patient outcomes and increases occupational stress and staff turnover.” (Exploring Workplace Bullying in Nursing) Signs of Bullying The trouble with bullying is that it is often subtle and therefore difficult to recognize as such. While the playground bully may be overt and even violent, the adult bully is usually disguised under heavy layers of professional accomplishment and years of experience with manipulating others. They come in all shapes and sizes, both men and women, old and young. The “mean girls/guys” from 7th grade grow up, don’t they? But sadly, they sometimes don’t leave behind their old ways of treating others, and they bring those tactics with them when they put on their scrubs and head to the nursing workplace. One of the primary manifestations of bullying is that the victim often feels that it is all his/her fault. After exposure to the bully’s tactics, they may even think to themselves, “If only I did this or that better, then they would not treat me this way.” The thought processes at the center of the bully/victim relationships can sometimes be lifted straight from our textbooks about abuse. Just as victims of domestic abuse many times blame themselves, nurses who are victims of bullying find themselves looking inward and wondering if there is something wrong with them. What are some of the classic signs of a bully boss or co-worker? 20 Subtle Signs of Bullying at Work More Subtle Signs Deceitful and manipulative- making promises but not keeping them or using promises to purposely disappoint. Shaming and blaming- bullies want the victim to blame themselves. Ignoring or undermining work- purposely “forgetting” to notify someone of meetings, belittling their work or accomplishments. Intimidating and criticizing- setting impossible standards and even threatening. Diversion and mood swings- bullies might avoid the victim so that the work issues cannot be resolved in a timely manner; and they are subject to widely varying moods (which boss/co-worker will be coming to work today? The sweet one or the nasty one?) Overt Bullying Aggression and intrusion- actual physical altercations with the bully entering your personal space. Belittling, embarrassing and offensive communication- using their position to cause you harm, either physical, psychological or professional. Coercion and threatening- pushing the victim to do things they don’t feel comfortable doing and using threats of termination or other punishment to get compliance with their demands. So, if you or someone you know is being bullied in the workplace, what can you do? Document- Keep a record of any threatening or inappropriate emails, texts or interactions. Should it become necessary to report the bad behavior, it will be important to have specific occurrences, words used, and frequency of episodes. Also, learn your workplace policies on bullying and what your recourses are. Detach- Try to look at the occurrences in light of how this person treats others. Have you been “picked out” for special scrutiny? Bullies are sometimes bullies across the board but at times they pick out a few victims, zero in on those and treat others as allies, making the other staff members into (sometimes) unwitting accomplices for their own bad behavior. Dare to Defy- Standing up to a bully is hard and practically can be impossible. Often, persistent bullying requires cutting our losses and moving on to another position. But adult and boss bullies—like those on the playground—can respond to pushback: maintaining eye contact, standing firm, ignoring or not acceding to their demands. This is harder to do than it sounds, because the victim of a bully at work frequently is not in a position to resist and finds themselves being jerked around by the perpetrator’s continually changing and escalating demands, whims and moods. Defend- Be on the lookout for bullying behavior around you and if you see something, say something. As for Cindy, in the end, she resigned after 3 months and went in search of another job—certainly not the route a new nurse wants to have on her resume—but a physical and psychological necessity given the bullying she experienced. After the rocky start, she went on to have an extremely successful career as a nurse and to find the profession a satisfying fit for her talents. Have you witnessed bullying in your workplace? How have you been a victim of bullying?
  17. jeastridge

    How to Listen: Do Nurses Do It Best?

    A few weeks ago, several of us nurses got together for a cup of coffee outside of work, a rare event but an occasional holiday celebration. We sat around a table, holding our hot drinks and warming our fingers from the bitter cold outside. After some light banter, one of our colleagues shared a recent difficult encounter with a patient, one that left her feeling defeated and out of sorts as a professional. We all listened intently, and it was interesting to observe the various responses from her friends and co-workers. Because our responses were so reflexive, it made me think that we might also respond this way in other situations. Is good listening a skill we can learn and get better at? Consider the responses from around that table and think about how you respond to patients, co-workers, family members that share vulnerably with you. 3 Responses 1. Almost before she could finish her story, one of the group asserted loudly (even pointing a finger in her direction), “I would not take that. I think you should respond by saying…” She went out to detail how the conversation might have gone had she been a participant, laying out clearly what she saw as the answer to her friend’s problem. Her body language, her forcefulness, her certainty all seemed to push the storyteller back in her chair, away from her cup of coffee, as she raised her eyebrows questioningly. “Do you really think so?” She queried, her hurt and confusion visible and audible. 2. A second person listened a little longer then said, “Well, I don’t think you should feel that way at all.” She continued to “should” all over the teller, minimizing her struggle and essentially asking her to harness her feelings into something less hurtful than they really were. “Shoulding” is so common, isn’t it? 3. The third person, the speaker’s close friend, remained quiet through the various exchanges, allowing the story to have plenty of time and space. She leaned forward a little before quietly offering her empathetic response: “What happened to you really stinks. I am so sorry that you had to go through that.” To me, it felt like she came alongside her friend and figuratively put her arm around her shoulders, sharing the difficult space and sitting with her as she felt the feelings she was feeling. Same story, three very different responses. Where do you see yourself? Ideally, we would like to say that we are consistently in #3, but most likely, we vacillate in our responses, employing all 3 from time to time and moving back and forth. Adviser The advice-giver meant well, but she effectively shut down communication, didn’t she? By delivering her pronouncement, she declared that she knew what was best and how that situation could be resolved. As unrealistic and presumptuous as her response is, we see it and experience it often, don’t we? People want to “set things right” by their standards and don’t want to leave a lot of uncertainty hanging around. While it is possible to offer advice, people rarely really want it, even if they ask. Generally, people need to work out their own individual approaches, their own answers, in their own time. Occasionally, if we have been in the exact same situation (unlikely) we can share what we did, but most of the time, those who share with us are looking for validation, a careful listener, and help in the form of a well-placed question such as, “So how do you feel about things now?” The advice-giver’s body language also closed more doors. Finger-pointing rarely feels good to the recipient of the gesture. It can be a strong, power-loaded motion, one that requires careful thought before deployment. “Should-er” The “shoulding” friend also delivered a put-down, didn’t she? We have the right to our feelings even if our feelings are not right. Feelings are proprietary. We acknowledge them, deal with them in our own way and hopefully find a path to mastery over time but “shoulding” brings some shame into the picture and makes us ask ourselves, “What is wrong with me to feel this way?” Of course the “should-er” doesn’t mean to elicit these feelings at all; she simply wants to make everything “all better” and smooth over discomfort. She longs to fix it, doesn’t she? As nurses, we can be attracted to the profession because we long to help our patients. This charitable desire has a dark side which is the “fixer” of the profession—always knowing what is best for others and letting them know what we think instead of allowing them to feel their own feelings and find their own way. If not carefully monitored, our desire to help can morph into control and manipulation and codependency. Empathetic The third friend’s empathetic response felt the most compassionate to me as I observed these interactions among friends. While the first two seemed to close doors of communication, the third response pushed the door ajar, allowing for future conversation and more opportunity to discuss the hurtful occurrence and to process it. The conversation at the table moved on to less heavy topics and we continued to share and laugh as our coffee cooled, offering healing and support to one another. Long after we went our separate ways, I thought about what I had witnessed and how many times we miss the mark in our responses to others. Were #1 and #2 “wrong” and #3 “right?” Well, yes and no and maybe. We are not perfect humans. We must offer each other grace and forgiveness every day if we hope to find any joy at all in this life. Friends sometimes say the best thing and sometimes not. We don’t discount their input either way, and we usually try to overcome differences. But such conversations shine a light on how we communicate and can help us to pause and think as we listen to someone’s story, careful as we try to respond with empathy and concern.
  18. “Code Green 5th floor. Code Green 5th floor.” The hospital operator’s voice made my pulse skip a beat even though I was far from the announced location. Code Greens [in this case meaning a combative person who may be armed] have become more common as we face more crowds, more recreational drug users, and more angry, frustrated people in our facilities. As nurses, we are sometimes part of situations that lead to the dreaded “Code Green” announcement as we call out for the necessary help. We undergo training in how to respond and follow the required steps, but we do begin to wonder if the number of these types of crises is increasing, and if so, why? The Team Approach Some hospitals have successfully formed specialized teams to address Code Green situations and to help de-escalate highly charged encounters. At Pinnacle Health System in Harrisburg, Pennsylvania, their Code Green Response Team, started in 2013, has saved personnel and patient injury, money and time away from work. Their example may be trendsetting as other systems look to find ways to decrease violence inside our hospitals. Code green prevents workplace violence Trauma-Informed Care Another opportunity for learning and forward-thinking is the Trauma Informed Care Project .The training invites participants to acknowledge that past trauma affects daily behaviors. Children are especially vulnerable to the effects of trauma and many childhood experiences accumulate to produce adverse effects leading to the term ACES (Adverse Childhood Experiences). The website goes on to explain that the goal of this foundation and this project is “organizational structure and treatment framework that involves understanding, recognizing, and responding to the effects of all types of trauma. It emphasizes physical, psychological and emotional safety for both consumers and providers, and helps survivors rebuild a sense of control and empowerment.” During the training, participants are invited to re-think “acting out” and instead of asking “What’s wrong with that child?” Ask instead, “What happened to that child?” These subtle but significant shifts in thinking can help us move from finger-pointing and judging to more constructive patterns of interaction where healing can actually take place. Emotional trauma carries over, of course, into our adult years. If unacknowledged, untreated, unresolved, it can surface unexpectedly and often explosively, leading to our current question regarding Code Green. Victims of traumatic incidents can sometimes repress or “forget” the memories of what happened to them only to have those come back during challenging or stressful times —such as times in the hospital with a loved one or being sick and in pain themselves. The post-traumatic stress of past troubles can lead to excessive anxiety, anger, and unstable emotions. The Body Keeps the Score In his book, The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma, Bessel Van Der Kolk, MD, asserts that past trauma manifests itself in actual physical disease. If unresolved, trauma will eventually lead to physical illness in a variety of diagnoses. “Even though the mind may learn to ignore the messages from the emotional brain, the alarm signals don’t stop. The emotional brain keeps working, and stress hormones keep sending signals to the muscles to tense for action or immobilize in collapse. The physical effects on the organs go on unabated until they demand notice when they are expressed as illness. Medications, drugs, and alcohol can also temporarily dull or obliterate unbearable sensations and feelings. But the body continues to keep the score.”(p46) Responding Appropriately As nurses, we are occasionally faced with responding appropriately to challenging situations: talking an agitated patient down, listening well, knowing when to get help. How can we prepare ourselves to be even better equipped to face difficult encounters? Be in the Know Take mental health classes that are offered for CME; the Mental Health First Aid class is valuable as are the Trauma-Informed Healing sessions. Learning about mental illness, PTSD, and other psychiatric illnesses gives us a good preparatory knowledge base. Responding Empathetically When Possible This can help resolve some low-risk situations. Many people long to be heard, really heard. They may even realize that we cannot resolve their situation, but they don’t want to be brushed off. They want to know someone cares. For some, that may be the beginning of healing and just what is needed to get them through a rough patch. Call for Help as Needed There is simply no substitute for getting help when a crisis arises. Maybe your facility, like Pinnacle Health, can consider starting a Code Green Team which specializes in defusing and de-escalating crisis situations. Sadly, Code Greens are more common than we would like for them to be. There are a lot of hurting people out there: both our patients and those that are surrounding them in their time of illness. We have no way of knowing what trauma might have happened to our patients or their families and loved ones previously. But we do know that they carry those hurts with them when they come in for treatment. As nurses, we are often presented with really messy scenarios. Being professionals, we do our best to make the best of even the worst of times. What helps you to respond appropriately to tense situations?
  19. jeastridge

    Nurses and Bullying: 4 Things You Can Do

    What great suggestions! I especially like the idea of having cash on hand. Money can't do a lot of things but it CAN buy options. It can make life more bearable by providing that escape valve--just in case it is needed. Thank you for sharing your constructive ideas. Joy
  20. jeastridge

    Nurses and Bullying: 4 Things You Can Do

    Great story. Thank you for sharing. I was reading Richard Rohr's book, THE NAKED NOW, this morning and he says, "What you see is what you get. What you seek is also what you get. We mend and renew the world by strengthening inside ourselves what we seek outside ourselves, and not by demanding it of others or trying to force it on others." (p.160). You showed respect and behaved with decorum and integrity.
  21. jeastridge

    Nurses and Bullying: 4 Things You Can Do

    You bring up an important point: our personal lives can "bleed over" into our professional lives so easily. We also can have a tendency to promote co-dependency and tolerance of bad behavior based on excuses. While we all want to be sympathetic to the troubles our managers and co-workers are experiencing, we also want to keep our patients front and center--while at work, they are our #1 concern and responsibility. Thank you for your comment. Joy
  22. jeastridge

    Nurses and Bullying: 4 Things You Can Do

    You are right. There is a lot of truth to the need to find a way to stand up to bullies and to be firm. But it is easier for some people than for others, and in some cases, bullies make it impossible for victims to have a voice. I have no doubt that you are the kind of person that speaks up for others, as well. Thank you for your comment. Joy
  23. jeastridge

    Nurses and Bullying: 4 Things You Can Do

    Well said and so true. Thank you for your insightful comment. Joy
  24. jeastridge

    Nurses and Bullying: 4 Things You Can Do

    Agreed. Good dynamics on the floor and among staff members often starts right at the top. Joy
  25. jeastridge

    Breast Cancer Simplified

    Thank you for your comment and for sharing your experience. You have some important views for others to consider. I wish you all the best moving forward. Joy
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