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jeastridge BSN, RN

Faith Community Nurse (FCN)

BSN, RN, Faith Community Nurse

Content by jeastridge

  1. jeastridge

    Is Nursing Kind?

    Thank you for your thoughtful comment! I appreciate what you shared: kindness generally comes right back at you!
  2. jeastridge

    Is Nursing Kind?

    Truth. Thanks for your comment. Your patients are lucky to have you as their nurse!
  3. At a recent family reunion, a relative who has type 1 diabetes showed me her discrete continuous glucose monitor attached to her underarm. “And it displays on my mom’s phone too, so if I have any problems, she is alerted!” The teen quickly and deftly checked her sugar, switched to her insulin pump and punched in the correct numbers to make the necessary adjustments. Her mom seconded the revelation with her enthusiastic approval, “It’s really revolutionary!” From continuous glucose monitors, to home sleep tests, to remote telemetry to artificial intelligence programs that can predict oncoming sepsis or help to interpret EKGs and radiographic tests, technology continues to make big strides into the healthcare arena. As professional nurses, are we ready? Do we know how we can maximize our influence, improve our knowledge and grow in adaptability so that we make sure the new tech is serving the patient well and not just a fancy, expensive and relatively useless device? What is AI? Artificial intelligence (AI) is defined as “the theory and development of computer systems able to perform tasks that normally require human intelligence, such as visual perception, speech recognition, decision-making, and translation between languages.” Predictive modeling and big data analysis are the way of the future — not only will AI insert itself into patient care, it has the potential to effect major changes in the delivery of care. “If we don’t mediate this technology, someone will do it for us,” says Richard Booth, an assistant professor of nursing at the Arthur Labatt Family School of Nursing in London, Ontario. He goes on to say that we have to be looking ahead and helping to define which roles will be taken over by assistive devices and which nursing roles remain solely under the purview of human nurses. Booth says, “We have to plan our own obsolescence to some extent because some predictable nursing work and activities that aren’t extremely complex will be automated. AI and new technologies hold both pitfalls and promise. Potential pitfalls include: Computers compete- Computers and monitors often take nurses’ attention away from the patient. While they focus on the monitors, they may miss important visible and audible clues and make the mistake of putting machine over mindfulness. Alert fatigue - Machines often cry “wolf,” and falsely alert or have their parameters set incorrectly. So much so, that bedside caregivers often ignore the blaring alarms, confident in their ability to respond should a real emergency occur. We have all been past nursing stations where alarms are going off and because they know everything is ok, the annoying sounds are treated as background noise by necessity. Machines misread - EKG are “read” incorrectly by the AI in the machine, pulse oximeters go off when the patient is simply cold, false alarms keep us scurrying to respond and sometimes make it more likely that a real problem will go unnoticed. Promises include: Machines never get tired. Continuous monitoring of pulse and respiratory rate and pulse ox is incredibly valuable and helpful. Gone are the days of waiting for the q4h vitals in acute care settings. Machines remember. Whether keeping track of blood sugars or blood pressures of apnea or any number of other parameters, machines are just about perfect with the mundane tasks that humans often are imperfect with: those repetitious and boring but completely necessary levels and numbers that we need to track. Machines are perfect with some chores - Correctly identifying a patient with a scan, long a source of confusion and mistakes, is no longer so fraught with trouble. Machines never mess up on stuff like that! And they don’t mind recording and tallying up encounters, medications, location, etc. Machines monitor continuously - The nurse can be free to check on other patients because she can know that the machines will alert her if a critical problem develops.A nurse who has been in practice for 50 years, once told me that when she first started working “on the wards” at night, she sometimes had to bring the patient’s bed out into the hall to be nearer to her so that she could watch for changes in color or respiratory status. Her eyes and ears and touch were the only assessment tools that she had! Thank goodness, we have moved on from there. Nurses are essential parts of the healthcare team. All the changes in technology and the predictive help of AI will not alter that. But we owe it to ourselves and to our patients to be vocal parts of the change process, keeping up with innovations and monitoring our own responses and our patients’ responses. After all, no technology ever cared.
  4. jeastridge

    3 Ways Nurses Heal After Mass Casualties

    What a wonderful comment! Thank you for including your thoughts here. I know it will benefit many, and I greatly appreciate it. Joy
  5. Mass casualties, shootings, horrific motor vehicle accidents, untimely deaths, abuse, lingering deaths that are not peaceful, medication errors, neglect—the list of causes of trauma in nurses is long and impossible to enumerate completely. We all know what it is: these are the events that keep us awake at night, even though we are bone-tired, worn out in body and soul. Try as we might, we can’t forget that haunting look, the moment of discovery, the pain, the guilt the utter tragedy of traumatic events. A recent article about the killings in El Paso states, “The story of their lifesaving labors at the El Paso hospital, the only one in a 270-miles radius prepared to treat complex trauma patients, is one of heroics in the face of violence, and of the doctors and nurses, who, once the adrenaline rush died down, struggled to live with the horror of what they had experienced." (Surgeons Labored to Save the Wounded in El Paso Mass Shooting) Oddly, in order to result in lingering mental health side-effects, these tragedies don’t have to happen to us, necessarily. We can experience trauma even after events that have happened to our loved ones or to someone we know or to someone we heard about on the news. Traumatic events are universal: most of us suffer through some in our lifetime. But the residual effects of trauma and the associated losses can be debilitating at times. What is PTSD? Post traumatic stress disorder (PTSD) is most commonly associated with veterans and refers to their emotional, physical and psychological difficulties after single event trauma or after multiple events accumulate. We read about their nightmares, their anger, their difficulty sleeping and their problems with everyday life. “PTSD is a mental health problem that some people develop after experiencing or witnessing a life-threatening event, like combat, a natural disaster, a car accident, or sexual assault.” (PTSD: National Center for PTSD). PTSD can be short term or a more persistent condition that hampers the person’s ability to live well and fully. The Trauma Healing Institute identifies several characteristics of trauma and emphasizes the importance of addressing all aspects of trauma so that true healing can take place: Trauma overwhelms normal coping Trauma is difficult to put into words Trauma shatters dignity Trauma destroys choice Nurses can also experience symptoms of PTSD related to their work in highly charged emergency situations. Most recently, the shootings in Kentucky and Texas have brought to the fore the need for nurses and other medical professionals to care for their minds and spirits after the horror of caring for the victims of shootings, especially those that involve high numbers of mass casualties where lives depend on nurses and other medical professionals to work with efficiency and to cope with multiple needs at one time. But even on routine days, nurses can experience the trauma of caring for victims of accidents or crimes. We can be traumatized by procedures we are a part of that don’t go well, by patients that die on our watch, by places where we feel we didn’t do all we could have done. How do we carry on when these events keep coming up and clouding our thinking? How can we take care of ourselves during tragedy? 1 - Be alert for signs that you are struggling and get help if needed If you are normally calm and can deal with adversity or failure well, but then all of the sudden, you are flying off the handle and fussing about things that didn’t disturb you before, it may be time to look deeper and to ask yourself if you may need to get help. It is not unusual to have problems with anger, sleep, attention for a few days or weeks, but if the problem persists, get help with a counselor or other mental health professional. Getting help is important and necessary if the aftereffects of trauma persist. 2 - Sleep While this bit of advice only applies after the initial episode of trauma, it seems that some recent studies show that sleeping after a traumatic event can help to lessen its after-effects and shorten the length of time that the episode causes distress (Sleep helps process traumatic experiences). While this theory is still being studied, it appears to support what we may feel instinctively—a good night’s sleep helps. The common adage, “Sleep on it,” reminds us that sleep will help restore some order to our confused and disturbed thoughts after trauma. 3 - Connect After trauma, it is often helpful to spend time with others, to talk about what happened (if that is possible), to join a support group, to let friends and family nurture you if they offer. While traumatic events and PTSD symptoms may lead the sufferer to want to withdraw from others, the healing happens in community and communication. Nursing can be full of traumatic episodes. As professional nurses, we must continually work to stay healthy in mind, body and spirit so that we can, in turn, help others.
  6. jeastridge

    Nurses and Ebola

    For sure! Joy
  7. jeastridge

    Nurses and Ebola

    Ebola is back in the headlines. With a new outbreak that has spread beyond the borders of the Democratic Republic of Congo (DRC) into neighboring Uganda, fear has spread along with it. As the local communities in the DRC work diligently to halt the spread of the vicious Ebola virus, they are getting help from abroad from a variety of sources, including the United Nations (UN) and the World Health Organization (WHO). Hampering their efforts is the ongoing violence in the DRC against aid workers and treatment facilities. Since the first case was diagnosed on August 1, 2018, there have been 198 attacks, destroying facilities and making treatment much more difficult. On July 31, 2019, the WHO and the UN issued the following statement: On the Eve of 1-Year Mark, WHO Calls Ebola in DRC 'Relentless' 5 Years Since First Case of Ebola Treated in Atlanta Many remember five years ago, August 2, when Kent Brantly, MD, who treated Ebola in Liberia became infected. He was air-lifted to Atlanta and was the first Ebola patient successfully treated at the Serious Communicable Disease Unit (SCDU). In addition to Brantly, three others were treated successfully and have recovered. Nurse Heroes in Ebola Care Caring for the ebola victims of 2014 was a learning experience for all the staff of Emory’s special unit. Together they perfected the donning and duffing of protective equipment (the most dangerous part of the process for healthcare workers). Nurse Jill Morgan, BSN, RN, who works in intensive care at Emory, became, in her own words, “A warrior for personal protection that works for bedside nurses.” Sharing her expertise with others, she perfected a system of removing gloves. She also emphasizes the importance of providing care “with a buddy system,” where healthcare workers watch each other and help one another not break technique. Nurses and others caring for Ebola victims were inspired by Susan Grant, then chief nurse executive of Emory Healthcare. She wrote in an article for the Washington Post, “We can fear, or we can care.” Emory University Hospital and system took their role as leaders in the fight against Serious Communicable Diseases and did what they could to help make it a national learning experience by posting their progress on websites almost immediately. They pioneered the more interventional care of Ebola patients, using ventilators, dialysis and other intensive care processes to treat the multiplicity of symptoms brought on by Ebola Virus Disease (EVD). A nurse in Texas who contracted Ebola five years ago, Amber Vinson, RN, still works as a nurse. In this month’s Emory Magazine she says, “I learned the importance of providing clear, simple information about diseases, transmission, and treatment to the public. The lack of public knowledge was a challenge. Fear made some encounters difficult.” (p23) What is Ebola Exactly? First identified in 1976 near the Ebola River in the DRC, Ebola continues to surface intermittently in sub-Saharan Africa. It starts with fever, and severe flu-like symptoms of high fever, muscle pain, debilitating viral symptoms which then progress to vomiting, diarrhea and bleeding disorders. Dehydration can be rapid and deadly in countries with less established advanced medical care. With a survival rate that averages out at about 50%, it is extremely deadly and contagious with a long incubation period (2-21 days and maybe more) which allows for people to spread the disease widely before showing signs of illness. Routine monitoring to determine onset of disease involves taking the exposed person’s temperature. Routinely, exposed persons are isolated for 21 days to prevent possible transmission. NBA Player Helps with Ebola Treatment In January, 2019, Hall of Fame MBA player and philanthropist, DRC native Kikembe Mutombo, toured the Emory University Hospital’s SCDU. He said that the DRC “represents in many ways the perfect epidemiological storm” because of poverty, poor health services and a high rate of infectious diseases. (https://news.emory.edu/stories/2019/01/er_mutombo_scdu_ebola/campus.html) Mutombo has built a hospital in his home country and continues to work to improve conditions there. Is There a Vaccine? There is a vaccine available, but it is currently in testing and used on a compassionate basis with those most at risk for developing the diseases. Called rVSV-ZEBOV, it is considered experimental at this point. Approximately 100,000 persons have been given the vaccine so far and the results are encouraging. Ebola continues to be a tremendous threat as authorities announced July 31, 2019 that there were two new cases in Goma, DRC, a city of 2 million that is also home to an international airport. The patient had a wide-ranging number of contacts prior to diagnosis. This case and many others like it, highlight the tremendous difficulties authorities face as they confront this deadly disease and stalk it to the point of extermination.
  8. jeastridge

    How Nurses Can Help Improve Vaxx Rates

    Facts vs. Myths Myth - Herd Immunity The office nurse addressed the mom after reviewing her chart, “So it looks like it is time for Christopher's shots.” She listed what was due and then the mom countered that she did not want the vaccinations. The nurse began to explore further, “So why would you say that?” The mom was well-read and listed off her concerns regarding the safety of immunizations. The nurse presented information about the specific concerns that mother put forth. The mother countered with the concept of “herd immunity” and how her child was unlikely to get sick because so many other children were vaccinated. The nurse patiently went on to explain the recent outbreaks of common childhood diseases and the seriousness of some of these illnesses. Myth - Getting sick builds the immune system The final argument the mom submitted was that “getting sick builds their immune system.” The nurse responded from something she had read in a nursing journal, “Yes, but you wouldn’t break a child’s leg just because you think it will grow back stronger.” She said it with humor and the mother laughed as the nurse exited the room to gather more information and let the physician know about the mother’s concerns. Fact - Responsibility for Public Health When he came in, he talked with her more about “herd immunity” and the responsibility we all have to protect everyone’s health; the risks to her child were extremely small. With recent outbreaks on the rise, her child would be more at risk than ever. Unfortunately, this exchange is real and although the details are changed somewhat, this is an actual patient interaction. All too often physicians and nurses are spending valuable care time trying to educate parents and counter rumors, unfounded and false information, and myths about vaccinations. Studies show that patients trust doctors and nurses above other sources of information. In fact, "73% of people worldwide would trust a doctor or nurse more than any other source of health advice, including family, friends, religious leaders or famous people.” (https://wellcome.ac.uk/reports/wellcome-global-monitor/2018). Why do vaccination myths proliferate? Why do myths and misinformation seem to proliferate at a rapid rate in our time? Why do people seem to be more inclined to believe hyperbole and “personal testimony” over the factual studies evinced in medical journals? Here are some possible explanations to think about regarding fringe news becomes mainstream: The internet may make “fast food” learning the norm. With a headline-grabbing statement, unscrupulous players can manipulate public opinion to serve their own purposes. The average person doesn’t have the energy to distinguish between true and false. In more modern news, we are subject to input that requires less critical thinking and leans instead toward emotional responses with split-second judgments. Studies have found that older adults (ages 60+) are much more susceptible to believing untruths without question. There is a general distrust of government, studies and science as people are bombarded with conflicting information and a plethora of sources. The prevalence of misinformation is so high that some colleges are offering actual courses in identifying “***.” In one syllabus the professors state: “Our aim in this course is to teach you how to think critically about the data and models that constitute evidence in the social and natural sciences.” (http://www.openculture.com/2017/01/calling-***.html) How can parents validate sources of vaccination information? In their recent publication, “Making PIES out of PEACH,” a number of nurses with advanced degrees who are with the Vaccine Task Force list some of the problems with the anti-VAXX movement and their publications and information. The list of issues includes: outdated information, biased sources, discredited sources, selective information, false information, and irresponsible actions. In Engaging in Medical Education with Sensitivity (EMES), the authors conclude: “EMES recommends that healthcare providers listen to and respect concerned parents.” For parents, they offer a number of recommendations including caution about sources of information, offering practical suggestions about how to check sources and how to read studies. They suggest, for example, that parents stick to “.edu” or “.org” sites and be cautious about “.com” addresses online. Some other highlights include checking dates on studies, reading about the authors, noting the disclosure section and checking to see if the study was repeated. The CDC and the American Academy of Pediatrics both publish thoughtful and thorough vaccination information, attempting to answer every question put out there by concerned parents. While the anti-vaxx movement has grown and continues to produce erroneous information at a rapid pace, the trust parents place in nurses and doctors remains high. What can nurses do? As professionals, we must become well-informed and be prepared to answer incorrect statements with facts based on valid studies. We must not give into anger or to passivity in our responses. We must continue to be educated, to understand statistics and studies, to be able to discern what is factual and what is not. It is our job to help keep children and the larger population healthy by using every means at our disposal to spread the most accurate studies available. I recently was helping out my daughter and took my granddaughter to visit her pediatrician’s office for her shots. The nurse administered her vaccinations flawlessly and provided the necessary paperwork. After the visit, the nurse again showed great finesse charming my little one with a sticker and silly faces. As I left, I thought about the great influence nurses have in an office setting and beyond, making the most of the few minutes of contact they have with the child, parents or extended family. We can, and must, continue to use our influence to promote information that leads to genuine health improvements for all.
  9. jeastridge

    How Nurses Can Help Improve Vaxx Rates

    Thank you for your thoughtful response. You offer some concrete suggestions that have potential for making a difference. Joy
  10. jeastridge

    How Nurses Can Help Improve Vaxx Rates

    Agreed. Not recommended as a response. Joy
  11. jeastridge

    Nursing Responds to New Superbugs

    Nursing Responds to New Resistant Germs C. Diff, MRSA, VRE, CRE, VRSA, Neisseria Gonorrhoeae, Tuberculosis—the list of drug-resistant microbes and fungi continues to grow at an alarming rate. The Centers for Disease Control (CDC) goes so far as to call "antibiotic resistance the biggest public health challenge of our time." (Centers for Disease Control and Prevention (CDC) Biggest Threats and Data). In its report, the CDC lists 18 different bacteria and fungi that are threatening and grades them as to whether they are urgent, serious or concerning. To this already long list of deadly and difficult to treat diseases, we add Candida Auris (C. Auris) a fungus that has led to recent outbreaks around the world, most recently in New York. Candida Auris presents a significant threat to global health for several reasons: It’s often resistant to a variety of treatment options It’s easy to misidentify and therefore mistreat. It seems to thrive in healthcare settings which makes it more dangerous to our patients. New York State’s health officials are reacting by working together to contain C. Auris’ spread, uniting to identify and fight this new threat. The state’s commissioner of health and the experts from CDC met in May 2019 with 60 hospital leaders to propose new guidelines in their state to stop the spread. Some of the challenges they are facing include having adequate lab resources to accurately identify the organism, and the difficulty in containing C.auris geographically as it seems to stick to surfaces and be hard to clean. "One hallmark of C. Auris is that it can be very difficult to clean from equipment or clothing, and it may spread through the air. Officials suspect that the spores can be shaken loose from bedding and they have been known to cling to walls and ceiling tiles." (To Fight Deadly Candida Auris, New York State Proposes New Tactics) Additionally, other states are beginning to see evidence of outbreaks. From New Jersey to Illinois a number of cases have been reported. One significant problem is the culture of secrecy that surrounds finding C.auris in facilities. The reluctance to report may contribute to the problem of containment as hospitals and care facilities find themselves facing fear from the public. In an article on the global threat of fungal diseases, Matthew Fisher states: To avoid a global collapse in our ability to control fungal infections and to avoid critical failures in medicine and food security, we must improve our stewardship of extant chemicals, promote new antifungal discovery and leverage emerging technologies for alternative solutions. As drug-resistant microbes proliferate, nursing may need to change and adapt to combat the challenge. We may need to take an even stronger leadership role in preventing the spread of disease. As professional nurses, we are always compliant with the rules related to careful handwashing and isolation precautions, but we may need to become even more fastidious about the most minor points that could contribute to the spread of these super-bugs. Since the time of Florence Nightingale, we have been at the forefront of promoting cleanliness as part of the active healing process. In more modern times, cleanliness, careful technique and strict adherence to disease prevention protocols can be a strong defense against these hospital-acquired infections (HAI) that can quickly compromise our patients’ care. General guidelines for stopping the spread of infectious disease are basic to nursing practice and include: Using good hand washing hygiene Practicing careful and consistent aseptic technique Methodical and thorough cleaning and disinfection practices Standard precautions and safety devices Education Bundle strategies for infection prevention Being healthy (fit for duty) when at work (Adapted from: Nursing Made Incredibly Easy! Your role in infection prevention) Besides being careful in our adherence to great nursing protocol and care, what can we do as citizens of this country and of the world? It might be helpful to consider writing our Representatives in Congress and other leaders to request that they allocate additional funds into government-sponsored research to develop new treatments for these super-bugs. Since the potential returns for these short term treatment medications is less, it is hard for pharmaceutical companies to have the long term vision to invest what is necessary to develop drugs to treat infection. It is also important for us as individuals to take precautions to minimize our own use of antibiotics and to help others understand why, as well. In a culture where bad news travels even faster than a wayward resistant microbe, we can only combat fear with true knowledge and excellent technique, prodding one another to continuous excellence without any possibility of incorrect procedure. When we work with assistants, students and other ancillary workers, our willingness to help them understand the critical nature of what we are doing can help us do our best to fight the battle against the spread of HAI. As thoughtful professional nurses, we can take a real leadership role to inspire and motivate our peers, the team of physicians and our entire care group in moving to contain and discourage the spread of these difficult to treat germs.
  12. jeastridge

    Dog Therapy As Good Medicine For Seniors

    What are your thoughts about dogs in the hospital?
  13. Hospice: 3 Ways Hospice at the end of life is focused on the whole person and their needs for symptom management, their psychosocial needs as relates to their significant others, and their spiritual care at the end of life. In these three case stories by a Faith Community Nurse, we see how hospice can be about much more than simply physical comfort at the end of life. A hospice team composed of nurses, aids, social workers, administration, chaplains and more, can play a part in helping the patient and family to the point of death and beyond. Hospice nurses work in different settings, often during the course of the same day, often visiting in a home, then in a nursing home, hospital or an assisted living facility. Sometimes facilities do develop a preference for one hospice agency over another, but according to the law, hospice agencies are to be presented fairly by case managers, physicians and others who have an opportunity to refer to hospice. 1. Hospice in the Nursing Home There are some nursing homes that resist hospice care. Since hospice services are included in Medicare, it is difficult to understand why there would be any resistance. Nursing homes often do a great job taking care of patients in rehab and those who are under long term care but most could benefit from expanding their care to include hospice expertise as the end of life approaches. (The Gerontologist, Vol 46, Number 3, p325-333) The FCN, Stephanie, caught up with Edward as he walked along the sidewalk with his walker outside the assisted living facility. After exchanging greetings and small talk about the weather, she asked him how his wife was doing. Mary had been suffering from Alzheimer’s Disease for several years and had experienced a recent decline with a significant loss of interest in her surroundings, as well as diminished energy, appetite and less recognition of her family and caregivers. The family had called in their Faith Community Nurse to discuss hospice but found that Edward was hesitant to take the step. As they walked along on the late summer afternoon, enjoying a cool breeze they talked about Mary’s condition. He said, “I think she would do better if she tried harder. She just needs more stimulation.” The couple had been married for over 60 years, and his longing for her, and the grief that he was already experiencing at the thought of her impending departure from this earth were clear. Mary lived at an adjacent nursing facility so they kept moving in that direction as they talked about the recent changes. “Edward, I know your family has been talking about hospice. Are you interested in talking about that? Are there any questions that I can answer for you?” “I don’t want to do that!” He exclaimed with a flash of anger. “I want to get her into rehab. That would help more than anything.” She let the topic go for the time-being as we finished the short walk and headed into Mary’s room. In subsequent days, as Mary continued to decline and spend more and more time asleep or unresponsive, the path forward became even more clear. His daughter said, “The facility is managing the end of life symptoms well, but we need hospice for dad. Hospice might give him the support he needs to change directions and let her go.” The daughter brought up the excellent point that sometimes hospice is as much for the family and the staff as it is for the patient. Sometimes there are minimal symptoms to manage, and physical problems are not the primary concern, making the support for the family a priority. Also, in a situation with a long-term resident of a nursing home, the transition to hospice can help everyone at the facility change directions to a more palliative care frame of mind with less interventional care considered. Hospice can assist the patient, the family and the facility in being on the same page. 2. Hospice in the Hospital Shirley had experienced a difficult year:a broken hip with a stay in a rehab facility, another fall with broken ribs and pneumonia, chronic pain from degenerative changes, diagnosis of atrial fib with anticoagulation therapy, a loss of mobility and function as well as a loss of many of the activities she enjoyed in life. Her husband, Carl, was a diligent caregiver, installing ramps, assistive devices, chair elevators and much more, to make their home navigable for her. In their mutual devotion they faced each day together, not without frustration but generally glad to have more time with each other. Their FCN provided support, helping to coordinate their congregation’s attention so they it decreased their sense of isolation and helped them to stay involved as much as possible. After a long stint in rehab, Shirley was finally getting out and about more and beginning to feel a little more like herself when one day she felt sick to her stomach, vomited blood and passed out. She was rushed to the hospital where she coded and was placed on life support. Her husband knew that she did not wish to have advanced interventional care but at the moment of crisis could not face “letting her go,” as the staff said. After several days on a vent with valiant attempts to prolong her life, it became abundantly clear that the end was near. The medical staff talked with Carl and the children who had gathered. They wept and mourned there in the ICU as respiratory therapy came to disconnect the ventilator. The FCN was with them and tired to provide information, assistance and support. Shirley continued to breathe after the discontinuation of life support so she was transferred to a hospice unit where their professional help aided the family during the time of transition. Shirley continued to receive optimal symptom management for respiratory distress before passing peacefully a few days later with the children and her beloved, Carl, standing at the bedside. Hospice in the hospital plays a strong role in helping make death easier and in bringing everyone together as they transition from the hyper-active interventional mode to the slower pace of accompanying someone who is on their final journey. The hospice team during this time can help the family who may struggle with how the whole end of life process has gone and who may worry about whether or not they have done the right thing in choosing hospice. 3. Hospice at Home The FCN got a call from the family. Arnold was ready for hospice care. After a 2 month battle with metastatic esophageal cancer, he and his wife were ready to change directions from interventional care to comfort care and hospice. His cancer, found in an already advanced stage, threw out complications faster than they could be addressed and brought under control so that he could qualify for any type of therapeutic regimen. After dealing with hypercoagulability that brought about ischemic pain in his feet to breathing problems related to tumor growth, they realized their time was too short to spend it in the cramped bays at the emergency room. He wanted to be at his country home, enjoyed the views from the front window, basking in the warmth of family and friends during whatever time he had left. While 27% of hospice patients are in a facility, 66% participate in hospice from their own home. (2013, National Hospice and Palliative Care Organization) Home care is truly the most common model of hospice care and when engaged early enough, allows for the time for the organization to fully deploy its range of helpful care options. After visiting with the family, the FCN let them know how to initiate hospice services with the company of their choice, smoothing the way for hospice care to come into the home after a referral from the primary doctor. Hospice at home, in the hospital or in the nursing home can serve the patient and family well as they look for ways to help everyone involved come to terms with the separation caused by death.
  14. The facts are startling: - Nurse Neils Hogel was convicted of killing 85 people in his care. - He was sentenced to life in prison (the maximum sentence). - He killed patients in three different facilities. - He is the most prolific serial killer in peacetime Germany. - The judge called his crimes “incomprehensible.” - Fellow employees are also being charged with negligent homicide. Rumors Wherever Hogel worked, the rumors followed. His patients died after he injected them with a variety of drugs to provoke a heart attack. He said he intentionally brought about cardiac crises in some 90 patients in Delmenhorst because he “enjoyed the feeling of being able to resuscitate them.” Reportedly, he would administer life-threatening drugs and then come back to the bedside to heroically attempt to resuscitate his victims, tragically earning the name “Resuscitation Rambo” for his efforts and even proudly wearing a misguided necklace of empty IV tubes that was given him as a reward. Desire for Attention After being transferred to an anesthesiology unit, a doctor noticed the perpetrator’s attempts to push himself into the spotlight during resuscitation efforts and told him his services were no longer needed. Others noticed his involvement in a large number of cases where the patient arrested and/or died but did not follow up. Convicted & Sentenced Hogel was convicted in 2015 and currently serves a life sentence and the prosecution continues to pursue additional cases against him with new convictions this month. Susanna K., one of those who worked with him said, “In the beginning, you just think it’s fate. But at some point, you grow distrustful.” In the trial, she went on to say that she and her colleagues talked about the events and their suspicions but did not go forward with a more formal complaint. In a country that highly values privacy, they didn’t see it as their business. Failure to Report In addition to Hogel, investigations are in the process against six fellow employees in one of the hospitals where he worked. The defendants are accused of negligent manslaughter because, despite their suspicions, they failed to follow up and report what they saw. He went to several facilities and help a variety of positions until he was finally apprehended and stopped. Breaking the Silence In the end, it took a nurse to break the “Code of Silence” that made all these murders possible. Frank Lauxtermann, a former colleague of Mr. Högel’s, was the first nurse to break the silence. In Germany, privacy is highly valued and despite suspicions, many felt it was not their responsibility and that they might be reprimanded for reporting their suspicions without absolute proof. Frank Lauxtermann, nurse, and the first person to break the silence In the United States, being a whistle-blower is also a risky endeavor, one that takes great courage and often involves personal sacrifice. Many industry whistle-blowers end up losing their jobs and do not have their efforts rewarded in the workplace. “The study of 25 workers who revealed wrongdoing in their organizations such as banks and healthcare found that whistleblowers lost their job either by being pressured out of the organization or being dismissed. At this time, eight doctors or nurses face charges of perjury for their part in lying to cover up the lack of follow-through that made the mass murders possible. Families of the Victims Family members of the dead, continue to struggle and ask questions as the process of prosecution unfolds over a timeline of years. The murders started in the late 90’s. The first arrest was in 2006. Several trials have happened since then as the cases grow. Meanwhile, families suffer pain, grief, and loss. Christian Marbach, whose grandfather was a victim, asked: “If it is possible that in Germany more than 300 deaths over 15 years can be swept under the carpet, what else is possible?” What could possibly motivate someone to do such evil? Dr. Karl-Heinz Beine, a psychiatrist in Germany, examined the perpetrator and said he appeared to be “driven by narcissism and a need to fill a deep lack of self-worth.” In court, even during current proceedings, observers report a remarkable lack of empathy for the victims or their families. Beine went on to say that he hoped this trial would raise awareness of the need for healthcare professionals to report suspicious behavior and to follow-up. Now 40, Hogel is incarcerated but according to Arne Schmidt, the detective who leads the Oldenburg police investigation into the killings, “I personally am convinced that the defendant continues to live out his narcissism today.” What Can We Learn From This? What can we learn from the horrific events in Germany as they continue to unfold? Many questions remain, but we have to search out ways that we can avoid the same outcome. What happened in Germany can happen again here or elsewhere. It is our duty as professional nurses to protect our patients to be alert and willing to take prompt and measured action. If we see something, let’s say something.
  15. jeastridge

    Nurse in Germany Convicted of Killing Patients

    I know...there is that sick, sad feeling for the people that saw it and suspected something was going on but didn't say anything...
  16. jeastridge

    Nurse in Germany Convicted of Killing Patients

    So sad. I'm sorry for what happened to you.
  17. jeastridge

    Nurse in Germany Convicted of Killing Patients

    I do hope that we learn from history. And I hope that we see stories like this one as warning and a guide.
  18. jeastridge

    Nurse in Germany Convicted of Killing Patients

    The truly evil people are few and far between but they often leave devastation in their wake.
  19. jeastridge

    Humble Nurses Do This

    Good article! Thanks. Humility is not a virtue that comes easily to most of us. It's good to be reminded of how important it is to know our limitations and to set boundaries.
  20. I read my email and felt that sinking sensation—change is coming and fast. The memo stated that in 7 days we would be changing over to the new system. Despite months of preparation, the looming deadline was anxiety-provoking. Would it go well? Would I be able to adapt? Would our patient care suffer? These and many other questions repeated in my mind as I clicked my laptop shut for the day, hoping that I would be ok with the changes. Nursing is all about change, isn’t it? Just when we feel we have adjusted to the new technology, system, machine, arrangement, we get the memo from administration, “Be aware that we will be converting to xyz next week.” Adapt accordingly. Some change is good and leads to improvement. Some change is pretty neutral and some is just plain old bad. The fact remains that we all have to learn to cope with changes and to keep our morale and practice intact no matter how much change comes at us and how fast. How do we stay on an even keel when faced with change? Stay centered When change comes, we all hope to be that unflappable nurse that handles everything with grace, quietly, serenely coping with the new skill or information that he/she is required to master. But no. Reality rarely resembles the dream and most of us struggle mightily to keep our composure, to learn the new way and to not allow our patients to experience any adverse effects. I recently attended a memorial service for a Jewish friend. The rabbi spoke eloquently and wisely about life truths. One thing he said really stayed with me, and compelled me to go back later and listen to the recorded service to capture accurately what he said. Here is the quote from Rabbi Wolfe Alterman from Asheville, North Carolina: “If you see what is in need of repair and a way to repair it, then you are seeing what God has called you to do. If you only see what is wrong and ugly in the world then it is you yourself that is in need of repair. And all of us are in need of repair in one way or another. There is so much in need of repair that this task feels overwhelming.” He finished with a quote from the Talmud: “You are not required to complete the task, neither are you free to ignore it.” Whether or not you are religious in any way, it is possible to see the thread of truth in both statements. We live in a broken world where people get sick and often die; where tragedies happen but where goodness also abounds. When we are able to stay centered on who we are, what our skills are, what our goals are, we are better able to identify our role in the change process and help in the repairs the change is attempting to make. The second quote is also freeing because it helps us shake off the guilt when the desired change doesn’t turn out as we had hoped. We have to continue to try; we cannot quit. Not every change is going to go well or produce the desired results. By not ignoring the problem and doing our best to effect change, we may have at least improved some part of the issue by trying. Stay flexible We have all heard the refrains, “That is not the way we do things,” or “The administration doesn’t care about nursing” or “I wish we could go back to the good old days of nursing.” When we read these phrases we hope that we are not the ones speaking them but, truth be told, we all struggle from time to time when asked to do something new or to endorse and support change when it doesn’t seem to be for the better. Staying flexible and seeing new possibilities is hard, especially as we gain age and experience. Becoming more set in our ways can go hand in hand with being around for a while and it can also mean that we run the risk of being the “stick in the mud” when it means adapting to a new EMR or to a new staffing system. In Simon Sinek’s book, Better Together, he encourages, “Don’t complain, contribute.” It is up to each of us to seek out the positive. Complaining can be a bad habit that threatens our well-being and the general feeling on our unit or office. Sometimes we think that venting our concerns helps to release tension and provides us with much needed psychological relief but the opposite may be true. Complaining can be a habit that drags us down and pulls those around us with it. On the other hand, making a contribution, or suggesting a positive change can do a lot for our job satisfaction and help to influence our whole workforce. I remember working with one of the women from housekeeping that was particularly upbeat. No matter how many rooms were switched out, no matter how much extra she had to do, she seemed to find a way to keep her comments positive and to refrain from complaining. And people noticed. We all loved working her hall! As we face repeated change, it may help us to look back and see times when change did turn out for the better; we can take encouragement from those times and be those nurses that smile and say, “Let’s see what we can do with this!”
  21. Download allnurses Magazine I liked to take care of my younger brother and he cooperated with my schemes in make-believe which meant he sometimes had to drink whatever “medicine” I came up with and submit to a variety of bandages made from scarves or my mother’s sewing scraps. Over time, I became an avid reader and enjoyed adolescent fiction about nurses as well as biographies of Florence Nightingale and Clara Barton. In high school I started reading nursing journals that a nurse friend shared with me and took all the science classes my tiny high school could offer, begging our teacher for independent study so I could learn more about biology. The idealized version of nursing that made up my early dreams gave way to reality as I launched into the true study of nursing and put in all the long hours to make my goal a reality. It was harder than I had anticipated, and I had to study hard to make it happen and to pass the terror of the boards. While in school, I started working as a nursing assistant in a children’s hospital and as a personal assistant to a handicapped student. All of this gave me a little taste of what would become a lifelong vocation—helping others and working to provide healing or comfort any way that I could. My formation as an RN, a Real Nurse, started small, with the little ones in pediatrics and went on from there. I remember how hard those first few months of night shifts were. As a charge nurse on a pediatric ward, I struggled to learn and to be a professional, quickly realizing that this job might not have been the best choice for someone just learning the ropes of the profession. I didn’t know how much I didn’t know. I don’t remember doing a lot of great things during that year—in fact, it was really a divine grace that I didn’t make some egregious mistake! The memories of that time flash by in black and white like a dim slide show: the child with asthma who nearly arrested before I could get the resident to come, the toddler who was a “failure to thrive” for whom I bought a small toy, the angry mother that didn’t like my attitude, the commute to the downtown hospital late at night, the wards with 8 kids each… From peds I found a different calling with adults on a general medical/surgical floor. There I learned to balance time demands and prioritize my work, honing the skills needed to be efficient, and cramming my brain with some of the more practical knowledge that doesn’t always get included in the general nursing curriculum. The slide show continues, picking up more hues as it moves forward through time: the man bleeding out that I transferred to the ICU in a big hurry (and I ran over someone’s toe with the bed on the way—and no, they didn’t get seriously injured but I was horrified!); my first time doing CPR and feeling the elderly lady’s ribs cracking under the pressure of my wrists and then the tears later in the locker room; being asked to teach a group of peers about acid/base levels in a staff meeting—all of these blend to make a picture of years that added up to a satisfying experience and made me much more competent as the RN I longed to be. The step into home health in a backwoods town in Tennessee brought me out of the hospital and into living rooms. Pulling from past experiences, I was able to build higher on that wall of competence, again starting at foundational principles and learning from others as well as from my own interest. The interactions with people in their own settings brought with it the realization that the patients are ultimately in control of their own bodies and their own decisions and it was my job to help them have the tools they needed to maximize their own goals for health. This ability to see the limits of my own interventional care brought a new dimension to nursing and gave me a greater respect for my own limits and the boundaries between medical care and the individual’s choice. In the hospital setting, it was so much murkier as patients submitted (mostly) to what the doctor prescribed and adopted a more passive role of recipient, blending back into the whiteness of their crisp pillowcases with resignation. At home, even the very ill patients were more likely to express themselves, to be comfortable in their own choices and to challenge the edicts handed down by medical staff. Over the years of traveling through t the hills and hollows of mountain villages, the slide show becomes brighter, clearer but also holds the shadows of difficult days replete with defeat: the elderly man in the overalls, living in a hermit's cabin, legs swollen with cellulitis, stasis ulcers draining, who proudly proclaimed, “I ain’t movin’” and pointed to a shotgun to emphasize his statement; the bed-bound woman whose bed sat smack dab in the middle of the living room as family members rotated sleep so they could keep her turned in a timely fashion; the mouse that ran under my legs while I sat perched on the edge of a dirty couch causing me to leap up in a most unprofessional way; the edentulous woman, mouth stuffed with snuff who unexpectedly sneezed—I had to change uniforms! The attraction to hospice nursing should have been clear from the beginning but didn’t come into stark relief until a beloved sister-in-law lay dying at a hospice house from the ravages of ovarian cancer. I admired the care, consumed the comfort greedily and promised myself that as soon as I could, I would pursue this new passion. Hospice nursing also took me out and about and again placed me squarely in the center of the patient’s own domain. Clearly, in rounding the bend and heading toward home, the patient and their family were firmly planted in the driver’s seat and I sat behind, offering simple suggestions to help make the way less confusing and to shine a small light on the path ahead. I learned a lot about the blessing of using my skills quietly and respectfully, always trying to be aware of who was really in charge and fitting in without imposing my will. My knowledge and skill set continued to expand as the dying required creative and caring solutions to all the myriad ways the body can break down at the end of life. Defeat was not an option, and working with the team at hospice, we worked hard to circumvent the impossible and to find a way toward our ultimate goal which often included making the passing as easy and as peaceful as possible. In this new setting I learned the truth of the maxim: “People don’t care how much you know until they know how much you care.” (attributed to T. Roosevelt). My technical knowledge and nursing skills were all tested and tried and sharpened but the “soft” nursing skills grew even more as I learned to communicate better, to “read” the situation in the room, to help patients and family move to a new place in their view of their situation. In this expanded nursing theater where life and death live intertwined and the distance between them grows smaller, I learned to respect the limits of my skills and to understand that sometimes the gift of presence was all I could offer. Coming to the end of myself as a nurse gave birth to a more profound respect for my work and my colleagues. The team approach of hospice helped me to broaden my horizons and see up close and personal how the social workers, aides, chaplains and physicians all worked in a fine concert to play the music the patient wanted to be played, as they directed the symphony from their place on the bed or the couch or the front porch. As nursing butted up against the hard wall of death, I found myself with renewed courage to face the unknown and to help others prepare for that same encounter someday. The slide show from the years in hospice is bright with the edges tinged dark from the sadness of loss as patients transitioned on from us to their next stop: the elderly couple who held hands and looked with longing into each others’ eyes; the young man surrounded by his boisterous friends who slipped away peacefully right in the middle of their conversation, surprising us all; the humor of knocking on the door of the wrong “yellow house on the left” and announcing that I was the hospice nurse; the occasional families whose motivations and possible drug diversion made our jobs difficult; watching youtube videos in the car to refresh my skills in changing specialized dressings; the long drives following GPS instructions into rutted roads that gave way to dilapidated, thrown-thrown-together houses with a dozen dogs; the sometimes angry family who saw us not as angels of mercy but harbingers of death; the exhaustion of caregivers etched with stark clarity on pale faces that mixed resignation with relief and grief. Faith Community Nursing was simply a logical next step, blending those carefully practiced assessment, teaching and leadership skills into a position of trust within the staff of my local church. Over the years, things have changed as the moniker Parish Nursing has given way to the more inclusive “Faith Community Nursing” but the work itself has remained unaltered. Being an FCN is a natural morphing for a nurse who sees the intersection of life and death as not an end point but as a transition and as such, a call for us all to do what we can to make the most of every day on this side, living well in the body we have for now. As an FCN, I work to help people maximize health through interpersonal relationships, increased activity, medication management and mobility protection. Assessing, teaching, visiting, planning, coordinating all come together as a lifetime of nursing experience coalesces into work that uses all the collected ingredients to make a work of nursing art, not perfect to be sure, but blended nicely and resulting in a worthwhile final product. Here, the slideshow glows with the brightness of an updated powerpoint: opening the door of an independent living to see an elderly man with a rapid respiratory rate and probable pneumonia and getting him to the hospital; teaching CPR through fatigue; organizing a group walk/hike; participating in advance care planning by teaching about “5 Wishes;” helping coordinate volunteers to visit the homebound and let me know of any needs; working to organize food delivery to those experiencing times of illness or grief. The beauty of a career in nursing is the variety that is possible. Every experience, every position, every shift brings new insights and learning. As nurses, we walk through the department store of experiences and fill our buggies with patient encounters that help shape us, with responsibilities that stretch and grow us and eventually with the wisdom to practice our profession well, becoming a credit to our peers. As we all take stock of our practice and celebrate the nursing profession, let us encourage each other along the way: it won’t all be good, but through perseverance, our slideshow of memories can be bright.
  22. jeastridge

    Nurses Make a Difference: Memories of a Lifetime in Nursing

    Thank you! It was fun to look back and write about the journey. Joy
  23. Senator Maureen Walsh: When Do Nurses Have Time to Play Cards? Really???? Last Tuesday, April 16, the Washington State Senate was debating a bill that offered to protect nurses’ break and lunch times. During the discussion, one of the senators, Maureen Walsh, offered the following comment: “By putting these types of mandates on a critical access hospital that literally serves a handful of individuals, I would submit to you those nurses probably do get breaks. They probably play cards for a considerable amount of the day.” Her comments made headlines which led to a twitter storm with nurses once again at the epicenter of a healthcare debate. As a first-term state senator, Walsh represents the 16th district of Walla Walla in southern Washington state. Washington State Nurses’ Association (WSNA) was quick to respond to the comments and called them “patronizing and demeaning.” The head of WSNA, Matthew Keller, went on to say, “No, Senator, nurses are not sitting around playing cards. They are taking care of your neighbors, your family, your community.” The measure under consideration has the support of WSNA and it passed in the Senate but it passed with the two objectionable amendments attached: one to limit the number of hours nurses can work and one to remove the protections for meal and break times. It remains to be seen whether the governor will sign the bill —there is no indication at this time of Governor Jay Inslee’s stance regarding the bill. The WSNA has vowed to fight the amendments. Walsh later put forth additional comments that stated her support for nurses during a statement to KEPR TV, "The comment made about the ability to play cards was referring to the staff at the very rural and small critical access hospitals who may only serve a handful of patients and the staffing mandates are unnecessary.” She went further in her comments to the Tri-City Herald on Saturday saying, “I was tired. I said something I wish I hadn’t.” The backlash on social media and Twitter was swift and loud with many responses highlighting the general sentiment that nurses are often not afforded the respect they have earned and deserve. With a profession made up of almost 3 million strong, it would appear from comments such as the senator’s, that we don’t always receive recognition for what we do. It is also apparent that there is a real lack of understanding in the general public about exactly what our role is in the healthcare system. Because we do so much and in such a wide variety of settings, it IS hard for us to explain even to our family members what exactly occupies those 12 grueling hours each shift. I can remember struggling to share with my parents what it was that I did as a new graduate. They would ask me well-intentioned questions such as, “Did you give any medicines today?” As kind as they were, their difficulty in even knowing what to ask me about revealed how little they understood. Their struggle matches that of the public at large who would be hard pressed to say much about what nurses actually do. One obvious point that comes from this episode is that Maureen Walsh and all our elected officials need to take the time to get to know better what they are talking about as relates to the legislation at hand. It is impossible to make good legislative decisions if you have no concept of the role these professional nurses play in the healthcare realm. We hope that the groups that represent us, the professional organizations that many of us join and pay our dues to, will take this opportunity to offer to educate the senators of Washington State and to use this platform to share information about nursing as a profession with the country at large. One of the reasons Walsh’s comments strike such a nerve is that they are the exact opposite of what most nurses face on the job. As a group, we tend to struggle daily with being short staffed and feeling spread so thin that we are unable to complete even the essentials much less the optional duties. The chronic callbacks, the sense of needing to work while not feeling well, and the documentation pressures seem to mount every day. All of these current realities make the senator’s comments like a public slap in the face of a profession that works hard, a lot, under tough conditions, doing all we can with less and less. This imprudent and insensitive remark by Walsh can become an opportunity. We can use our voices to let others know what we really do. We can become our own best advocates by not letting this mean-spirited comment be the winning note in a discordant world. This reminds me of another degrading comment made by a clueless individual about a certain nurse on a public stage wearing a doctor's stethoscope...
  24. jeastridge

    STOP Measles: Nurses on Alert

    Looking through my Facebook posts the other night, I noticed our friendly local pediatrician had posted a photo of herself in the protective garb associated with examining someone with measles. It looked a little like a space suit and reminded the viewers of her site of the potential dangers associated with the current active measles cases in our country. The outbreaks of measles around the country, particularly in the New York area and in California are alarming. “From January 1 to April 26, 2019, 704 individual cases of measles have been confirmed in 22 states. This is an increase of 78 cases from the previous week. This is the greatest number of cases reported in the U.S. since 1994 and since measles was declared eliminated in 2000.” (https://www.cdc.gov/measles/cases-outbreaks.html) Mostly related to unvaccinated youngsters, this outbreak highlights with devastating clarity the problems that the unvaccinated portion of our population creates for the greater population. In 2018, the United States suffered 17 outbreaks, 3 of which were in New York State, New York City and in New Jersey. A variety of other pockets of infection accounted for the remaining cases, many related to travel abroad. A simple rash and runny nose are now viewed with a heightened sense of caution and alert. It is striking how contagious measles is. In fact, it is hard to believe that after an infected person sneezes or coughs, the airborne virus stays active in the air or on surfaces for two hours and anyone that passes through who is unvaccinated stands a 90% chance of becoming infected. The period of contagion is from 4 days before the outbreak of the rash until 4 days after, making for a long window of infectious opportunity. The efficiency of the contagion of this particular virus makes in a public health menace and a national scourge, set to upend many lives. Besides being highly contagious, the measles virus is also responsible for severe illness. The cough, coryza , conjunctivitis and high fever (up to 104 F) develop after an incubation period of 7 to 14 days. Before the rash breaks out, patients may exhibit Koplik spots (tiny white spots) inside the mouth. The rash usually begins 3-5 days after initial symptoms and spreads down from the head until it reaches the feet, gradually becoming more contiguous until many of the spots are joined. Medical care is supportive but complications are frequent and include ear infections with potential for permanent hearing loss, pneumonia and encephalitis. Children under 5 and adults over 20 are most at risk for developing problems related to measles infection. Nurses are on the front line when it comes to addressing the current cases and providing information. What do we need to do? Stay informed and provide patients and families with accurate sources of information: CDC.gov or your local health department. Encourage vaccination. This is a “well, duh” point but it has to be on the list. There are, however, a surprising number of questions to be answered. If you are not working directly with children or immunizations you may not be completely familiar with the protocol: The MMR (measles, mumps, rubella) is given at 12-15 months with the second dose at age 4-6. If the child will be traveling, the parents have the option of considering an accelerated schedule so as to avoid contagion. Adult vaccinations- There is lots of “fine print” related to the need for vaccination in adults, but bottom line: look at your immunization records to be sure you have been vaccinated. If you are traveling to an area with a current outbreak, you may want to consult with your doctor about your individual needs. One dose is 93% effective in protecting the recipient from measles and 2 doses are 97% effective. The Oregonian reports regarding its recent outbreak: "Between Washington and Oregon, 77 people got sick. The outbreak also forced schools to exclude unvaccinated students and teachers, disrupted local business in the Vancouver area and prompted a public health emergency declaration in Washington state.” The article went on to clarify that most of the cases were in children who were completely unvaccinated. Additionally, one person had to be sequestered in Hawaii and another in Georgia where they traveled before developing symptoms. Authorities are looking into the possibility that the outbreak was related to a child that traveled to the area from Ukraine. In our mobile world, where long-distance travel is increasingly easy, accessible and inexpensive, we will continue to see increased rates of spread of infection. As nurses, it is part of our work to stay abreast of the current events and to help transmit accurate information regarding vaccinations and their effectiveness to combat disease.
  25. Spending time with Luisa Carvajal, GN, was a real treat. She job shadowed me for the day to learn what Faith Community Nurses do. In the course of the day, we talked about her plans, her new job, her hopes and her concerns. Q: As you start your career, what would you like to say to all other nurses? A: We all had to start here. At some point we were all a Student Nurse and a Graduate Nurse. I know it’s tough to be patient. I know it has to be difficult but you also had to learn. I hope you are ready to put life into the next generation of nursing, to invest in us. Every day is what we make it together. I know that we have frustrations. Our patients are at their most vulnerable. We focus on the best parts as well as we can. Indeed we are messing with people’s lives. They will reciprocate the attitudes they see in us. Q: What made you want to go into nursing? A: A big reason was my grandmother who died from pancreatic cancer when I was in middle school. Because I had to help serve as translator for my family, I had to ask more questions so I could explain it and by doing that I got very interested in medicine in general and in nursing in particular. That was the big reason. I really just wanted to make a difference in patients’ lives just like the nurses made in my life. I also felt like God was calling me into nursing with my personality and the gifts he has given me. Not too long ago I came across an essay that I wrote for a ninth grade assignment. In it, I talked about going to ETSU the college that I graduate from! Q: You are from the country of Columbia. How did your family get here? A: We were able to do it the legal way, by getting a sponsor and visas through my grandmother’s citizenship. My mother and my two brothers all came. I was very young when I came. I started pre-school here and became a citizen while young. My mother worked all the time while I was little—several jobs. My grandmother was the one that took care of me. It was very hard—still is very hard— to lose her. Her illness made me want to be a nurse so I could take care of others the way those nurses took care of my grandmother and of me. Q: What frustrations do you anticipate as you start out in nursing? A: I guess the hardest thing is the biases that come with patients. By that I mean when people call the patient by their diagnosis not their name. I see things in practice that are not the way we are trained or the way we learn to do things. We can become jaded, tired and I understand but there is so much more to people than a diagnosis or a label. I hope I can keep my perspective and try hard to see patients as people who need help and not just a diagnosis. That’s a hard thing for me. Q: What do you really love about nursing at this point? A: I love the patient interaction. Our patients are at their most vulnerable time and we are the people that they can depend on; we can be the shoulder they cry on; someone they can turn to. I enjoy being with the patients and being able to do something, to help. Sometimes that means just listening and letting them vent. I also love all the opportunities that we have as nurses. With a BSN we can do so much! This is one of those fields where you are never completely “stuck.” We have so many options: there is inpatient, administration, community, even policy. In fact, I got to go to Washington, D.C. recently! Q: What did you do in Washington? A: I got to talk with our representatives. We went as part of the advocacy for Title VIII with the American Association of Colleges of Nursing (AACN). Our school sends faculty and one or two students each year to inform our senators and representatives of the importance of continuing to fund Title VIII which helps nurses who want to further their education. It provides for Nursing Education Loan Repayment and Nursing Scholarship Programs. We were also asking our representatives and senators to consider increasing funding for NIH research for nurses. I was there for 3 days and was privileged to meet with Senator Lamar Alexander, with an aide for Senator Marsha Blackburn and Representative Roe. It opened my eyes to a whole new field of nursing! Who knew? Q: You seem to have such a bubbly, happy spirit. What is your goal as you start your career? A: My goal is to go in every day with a smile. I appreciate being able to have this career and I am excited to start my new job. Nurses: welcome your new colleague!

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