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jeastridge BSN, RN

Faith Community Nurse (FCN)

BSN, RN, Faith Community Nurse

Content by jeastridge

  1. - A colleague makes a disparaging remark about a political candidate that you like. - A patient makes a racial slur against a national leader while you are caring for them. - An offensive political television show is on while you are making a home visit. - Two co-workers frequently bicker about their disparate views in the break room, making it an unpleasant place to eat lunch. - You overhear someone on your unit making incorrect statements about a group of immigrants. While you may not have experienced all of these scenarios, chances are that you can identify with some of them or even just with the tension of differences of political persuasion that is all around us. With our country being divided into political parties, we often find ourselves feeling pushed into a corner, forced to mentally take a stand and then feeling frustrated for not being able to express ourselves freely. It is a given that our workplaces should be free of partisanship and places where we can work cooperatively to care for our patients with the utmost professionalism and with the encouragement that we need to keep improving and doing our best. What do we do when we feel that freedom hampered by vocal expressions of partisanship, bigotry or even hatred? Recognize that these struggles are nothing new. While the stress of these political times may be distressing to us all, this is not the first time that we have encountered a climate of contention in our workplaces. Nurses have always been at the forefront-crossing bridges that divide people and nations. With nuns as nurses and Florence Nightingale as a shining example of light, we continue to push forward to be the best we can be: providing excellent care in the midst of strife; not joining in where racism rears its ugly head; doing our best to provide perspective and correct information while staying out of arguments. As professionals, we have been through wars, segregation, oppression and we are one of the forces for good that rises above the fray, using our hands to bring a spirit of good and kindness and gentleness. See beyond the words. Nationalistic fervor, bigotry and racism can be thinly disguised manifestations of fear. While the voices are loud, what lies behind is often feelings of insecurity, sadness and loneliness. In his book, Rising Out of Hatred: The Awakening of a Former White Nationalist (Saslow, Eli: Doubleday, 2018), Saslow, a Pulitzer Prize winner author, tells the story of Derek Black, a product of a white supremacist family who denounces the views he had been steeped in after coming in contact with people in college who lovingly introduce him, through long-term relationship building, to truths that he had never considered. The kindness of a group of Jewish students who invite him to their weekly Shabbat meals, broke through years of indoctrination in false science and facts. Friendship, kindness, love and genuine relationship ultimately prevailed and led to profound life-changes for Black and his future. He wrote, "People who disagreed with me were critical in this process. Especially those who were my friends regardless, but who let me know when we talked about it that they thought my beliefs were wrong and took the time to provide evidence and civil arguments." ((p.225) As nurses, we too have the opportunity to persevere in doing good, to provide accurate facts with a dose of loving-kindness and to be patient as those around us consider new views. While the workplace is definitely not the place for political discussions, it can be a place for continuing to develop meaningful friendships that lead to long-term change. Be the best you can be. At one time in my career, I had a boss that was somewhat erratic and demanding. I would vent my frustration to a trusted co-worker from time to time and her response was: "Keep being excellent. No one can argue with excellence." The same advice applies to nursing in our current times. While we may desire to flee from settings that are full of argument and division, sometimes it is simply not possible to leave our current situation. Being excellent professionals, even in the midst of trying time, can help us grow as persons and as professionals, committed to excellence in all things. Listen, listen. And ask questions. When I was dating my husband, I remember using a curse word/slang word that wasn't part of his family's lexicon. My father-in-law didn't say anything or correct me, but his silence spoke volumes and was louder than any sermon. Sometimes when our co-workers or patients say things that are bigoted or offense or simply inflammatory, we respond best with our silence or with a well-positioned question such as: "What makes you say that?" Sometimes, just hearing ourselves say inappropriate things out loud can be clarifying and help us see the error of our own ways without the added burden of someone condemning or shaming us. This too shall pass. Ultimately, we must take the long view in our professional life as well as our personal struggles. While the current climate of political strife is distressing, with strength and determination we will see it through; with perseverance and professionalism, we can influence the current times for good, becoming agents of change and positivity.
  2. I checked my phone as it buzzed with a text message: "Dad's in the ER." Heart sinking, I replied to my friend, Martha, "What's up?" She went on to explain that her dad, a long term Alzheimer's patient who lived in assisted living had taken a sudden turn for the worse. He had been in and out of hospice so I knew that she was trying to avoid a hospital stay and also knew that this event might be hard on her and on her dad who didn't do well when moved out of his familiar environment. Despite our best preparations and long term plans, sometimes our loved ones' life endings don't go quite as we had hoped. The Hospice and Palliative Care disciplines have made huge inroads in helping us all shift our expectations at the end of life, but as individuals and a society, we are not there yet. We continue to see astounding statistics regarding long ICU stays and extreme interventional care when there is minimal expectation of improvement or quality of life. In his article on end of life in intensive care, Curtis states: "Four decades of research on end-of-life care suggests that people who are dying often spend their final days with a significant burden of pain and other symptoms and that many receive care they would not choose (End-of-Life Care in the Intensive Care Unit )."Haunted by the times when there is survival and discharge and patients make gains toward returning to their previous levels of function, we resist making changes that would seem to limit that avenue of care. We all want what is best; there is no doubt about that. As we celebrate Hospice and Palliative Care Week, let us consider the importance of helping our families and communities have the opportunity to lean toward wholistic, peaceful end of life care while at the same time leaving the door open for those that have different end of life care goals. First of all, the terms "hospice" and "palliative care" are easily confused, even among health care providers. Palliative Care: medical and related care provided to a patient with a serious, life-threatening, or terminal illness that is not intended to provide curative treatment but rather to manage symptoms, relieve pain and discomfort, improve quality of life, and meet the emotional, social, and spiritual needs of the patient. Unlike hospice, palliative care can and should be delivered while patients continue treatment for their diseases. Hospice: a program designed to provide palliative care and emotional support to the terminally ill in a home or homelike setting so that quality of life is maintained and family members may be active participants in care. The two terms are not mutually exclusive and in our current practices, they tend to intertwine with palliative care often entering the picture first, as the patient continues in treatment but needs supportive symptom management; later, as treatment becomes ineffective or no longer wanted, the patient and family transition to hospice care, usually provided by an agency in the home setting, wherever that home is: traditional housing, assisted living or nursing home. Occasionally, communities have access to a hospice house and patients will receive end of life care there for situations that require active symptom management beyond the scope of home care. As professional nurses, we desire to provide the very best care we can for our patients. We want to be agents of positive change, ensuring those in our charge have the information they need and the access to receive the type of care they choose. As advocates, it is important that we are fully informed about options, changes, and approaches to end of life. Advance care planning is part of the answer. Often during an admission, we are asked to interact with our patients regarding whether or not they have a living will or have engaged in any discussion with their loved ones about end of life care. While this can be awkward, our own attitudes can help pave the way for this discussion to happen-all with the end goal of providing our patients with the care that they choose. Talking about what we want ahead of time, does not necessarily ensure that it will happen, but it does pave the way for the possibility. So what can we do? Understand the terms involved so that we can explain and answer questions. Get additional training, if desired, on how to approach these discussions. Advocate for wholistic end of life care, if we know that is what the patient desires. Ask questions at crossroads in decision making to clarify where we are going in care goals and ensure we are on the same path the patient and their family desire. Martha's dad ended up spending a restless night in the hospital and going back to his regular facility the next day with hospice. This happened because his daughter was able to clearly state her goals of care for him, articulate his needs, and advocate for what she knew was best. Despite pressure to stay inpatient to manage symptoms of agitation, she had a bigger picture view that informed her choice to get him back where he would be most comfortable. He died peacefully with her at his side a few days later. World Hospice and Palliative Care Day 2018 is a time to take stock, see where we have been and consider our path forward. As we pause to assess, we can be inspired to move forward with new energy and enthusiasm.
  3. jeastridge

    The Nurse Optimist

    The Nurse Optimist Being on the consumer side of nursing is eye-opening. As they wheeled my mother back to the holding area, I walked beside her, ready to take her hearing assistance devices once the staff were done asking her questions and going over the pre-op procedure prior to the repair of her fractured hip. It was out of the norm for me to be back there, so I tried to be as inconspicuous as possible and stand clear of any traffic. The nurses, anesthesiologist, surgeon came and went, each with their own list of questions and duties, but all with compassion in their eyes and kindness in their touch. I felt proud to be a nurse as I stood by, watching my peers make things better, safer, as perfect as possible for my dear mom and the other patients around us. My mom's nurse, in particular, stood out. She wasn't bubbly or perky which might have been annoying at the time, but she was simply correct for the situation: professional, reserved, and above all, caring. I had seen her before as we walked the same halls from time to time, but I had never witnessed the way she took care of her patients before. Back in pre-op and PACU, she was in her element: confident and comfortable. As she finished up her duties and told mom there would be a slight delay, she asked mom if there was anything else she could do. Mom, deeply spiritual, said she wanted to have prayer and the nurse stood with her and held her hand as I prayed. Respectful and calm, she helped mom deal with the delay in an already stressful time after a fall, the resultant pain and unexpected surgery. As I left the area carrying my mom's various hearing devices, I thought about the nurse's approach. What was it that made her so special? How can we be that nurse that we all want to have when we are facing a life-crisis? Focus on the positive As nurses, each day we have a choice of how we view our world. Yes, there are lots of negatives but my goodness, let us not forget the strides we have made and the positive outcomes we see every day. We participate in grand miracles of healing almost daily and yet we often cannot see the bigger picture of good and instead focus in on what is wrong. There are lots of things that really do work well: we generally have adequate linens, food, hygiene supplies. Trash gets picked up, ice is available, antibiotics still kill germs (most germs...), surgery still repairs broken hips and ruptured colons, blood products are available to restore life, and the list goes on. When we pause to consider the good, and to be thankful, we can put the negatives back in the perspective they need to be in. It is important to address our shortcomings, to see our faults, to correct mistakes, but none of us thrive in a clime of fear and judgment. We all need to continue to encourage and lift one another up. Caring doesn't cost The nurse that took care of mom conveyed true compassion. It wasn't sappy or dramatic; it was genuine. She was a professional who did her job well and truly cared for her patient. What was noticeable also was what she didn't share: she didn't tell us about herself or about her lack of sleep or her aching feet or how short staffed they were. Those things might have been true but if she had shared them with us, we could not have helped her and it would have diminished the comfort she provided. There are times to share personally, but the bedside is not one of them. The last thing our patients need is to have to take care of us. Practice empathy How does true compassion differ from pity and sympathy? If words are kin to one another, then compassion and empathy are cousins who walk around in each other's shoes helping one another out, while pity and sympathy feel bad and sit side-by-side and don't do much. Empathy requires practice, digging deep in ourselves to find ways to connect with our patients and their needs. Empathy anticipates needs and works to implement them. Being empathetic can be draining but it is also one of the ways that we get into a space in our practice that is truly rewarding. When we are in it for the long haul, our rewards come from empathetic responses that bridge barriers and allow us to truly care for others as fellow humans. Mom went on to an uneventful recovery, surely assisted by a great nursing, surgical and rehab team. The care and compassion of the nursing staff around the time of her surgery left a lasting impression on me and renewed the desire to provide more of the kind of care we experienced.
  4. Renewed Passion and Dedication to Nursing Profession Do you ever feel depleted like you might have lost some of your passion and dedication to the nursing profession? How can we combat that tendency and turn the tide? Recently, PBS ran a special report by historian Ken Burns about the Mayo Clinic in Rochester, Minnesota-"The Mayo Clinic: Faith, Hope, Science." The documentary details the clinic's founding as well as its mission and development over the years. Started after a devastating earthquake in central Minnesota in 1883, it combined the profound work ethic and dedication of a country doctor, William Worrall Mayo, with the vision that came to a nun of the Franciscan Order, Sister Mary Alfred Moes. Together, they are largely responsible for pushing forward a hospital system whose name is synonymous with hope. The nuns were the first nurses and their devotion to their patients legendary. Eventually, they started the St. Mary's Hospital School of Nursing (1906) and their motto was: "Enter in to learn - go forth to serve." Their students learned how to care for patients but more than that, they learned to see each new patient as Jesus Christ, meaning that as they served, they were to serve as if the one they worshipped were the patient. While most of us are not nuns and many do not follow Christianity as their religion or have a particular spiritual tradition, all nurses can see the beauty of this sense of mission and calling in nursing. Looking at the history of a venerable institution such as Mayo Clinic, now with branches around the country and the world, we are inspired to examine further the origins of our own calling to nursing as a profession. Do we feel a sense of mission and purpose? Are we in our chosen field for the opportunities that it gives us to serve our patients? We live in a time of deep disillusionment with our hospital systems. Increasingly, it feels that we have lost the personal touch. From the first encounter with our patients, we may find ourselves overwhelmed by well-intentioned barriers to care. Just to list a few... Excessive questions posed by our time-sucking EMRs Requirements to list cautions that seem out of touch with reality. Difficulty in coordinating and communicating with all involved in care due to the well-intentioned but at times onerous privacy limitations of HIPAA. Insurance dictates that limit and define what we can and can't do. Scheduling and assignments that spread us too thin and force us to push ourselves to points of discomfort and possibly even danger. Costs, costs, costs... While the Mayo nurses lived in a simpler time, it was also a more difficult time. Without the benefits of wide-ranging medications, antibiotics, technology they no doubt frequently found themselves helpless in the face of disease and death. But somehow, in spite of their limited knowledge and abilities, they reach across the years to inspire us today. How can we be agents of change and good in a profession that meets challenges at every turn? Keep up the good work! Excellence is the best way to defeat the naysayers that flee the profession. Let's be proud, be great at what we do, and serve well. Renew our devotion to our patients. As long as we are serving ourselves, we will be disappointed. There is no salary that is high enough, no schedule that is accommodating enough, no facility that is perfect enough. When we focus inward, we will always find room for complaints. Life is like that; it's always going to be hard. But keeping our eyes on doing good and then doing better will help us maintain that spirit that will pull us through. While higher salaries and more convenient scheduling can certainly contribute to our well-being, they are illusive goals that can result is less satisfaction that we originally thought they might. We can all relate to thinking that the next position will be better. It is, of course, true that some nursing jobs are toxic, some bosses really do a terrible job and sometimes we have to leave and start over. But often, our contentment results more from blooming where we are planted than with finding the exactly perfect garden. Be the change you want to see (Ghandi). Every floor, unit, practice, agency needs that nurse that helps to set a positive tone. While venting as a group can provide temporary relief, it may leave us with a sense of let-down in the end and rarely provides that fuel we need to keep going and re-charge our batteries. Being positive and encouraging doesn't mean we have to be super-cheerful and always sunny but it can mean that we refrain from dwelling on the negatives and tend toward highlighting the positives. Notice the word "tend." No one is perfect and we all enter into negativity from time to time but the long-term benefits of finding points of satisfaction are undeniable. If you didn't get to watch the documentary on Mayo, it's highly recommended viewing. Looking back at our history as nurses, our initial calling and passion can help re-energize us to stay in it for the long haul, serving our patients to the best of our ability.
  5. jeastridge

    The Nurse Optimist

    I love your response! Way to go and BE. Joy
  6. jeastridge

    Renewed Passion and Dedication to Nursing Profession

    Thank you for your nice comment. I wish you all the very best as you set out to return to nursing. We welcome you back and need your enthusiasm. I also thank you for the recommendation and I will check it out. I'm a Mother Teresa fan!
  7. jeastridge

    Nurse Mentors: A Mantra for Life

    While out walking in my neighborhood, a young woman I know who graduated 6 months ago, caught up with me and we started walking together. After catching up with her news of being a new hire at the local hospital, she nearly broke down and said, "I feel so overwhelmed all the time. I don't know if I am going to be able to do this. There is often no one to help and sometimes when I ask, I feel stupid. What do I do?" We all know the importance of getting off to a good start in nursing. Having a good mentor can make all the difference between having a colleague who is a successful professional and having another person drop out of nursing to pursue other lines of work. As long term nurses and dedicated professionals, what can we do to be better mentors to those starting out? While an initial positive experience is critical, good mentors are important throughout our careers. Whenever we start a new position, even within the same unit, we look around for that person who can guide us along the way. I remember with fondness the long-term nurse who guided me through the first few months of working with hospice. She was affirming, competent and available. When I started making home visits on my own, she made sure that I knew who to call, even if I couldn't reach her. She outlined potential problems I might encounter before the visit and outlined possible strategies for tackling complications. So what makes a really good mentor and how can we be that person for others? Be kind - It may seem counterintuitive to put this quality first, but kindness shows respect to others and to ourselves. Kindness undergirds the kind of people we want to be and what we would like to see in others. Sarcasm, belittling, gossiping, cutting remarks, excessive or unnecessary criticism all have no place in our mentoring relationships. As professionals, we must start out by looking inward, checking our own motivations and goals before launching into a mentoring relationship. Regardless of the outcome, when we are kind we can almost always look back without regrets, knowing that we did our best. KIndnesses are long remembered and rarely forgotten. Sometimes it is the small things that make our day and help us to get through our work with a sense of accomplishment. Being kind in mentoring other nurses is key to being the best possible professionals. Be available - This one is hard and made harder by our erratic schedules and low staffing. But it is essential that we find ways to be as available as possible when we are in a formal mentoring relationship. By passing the baton to someone else, we can let our new hire know who he/she needs to look to should questions arise. Also, through the wonders of cell phones, we have the ability to be more available to one another in emergency situations; by making it clear what those are and setting defined limits, we can enter into and maintain healthy mentoring relationships with one another. Just as my mentor tried to think ahead and let me know what to expect and what problems I might encounter, so too, as mentors, we can have some idea of what might happen and guide our new charges along the way. The idea of "Well, I had to learn it the hard way; they will too," is cruel and unnecessary and ultimately not in our patients' best interest. You may be thinking that you would never do that, but we have to examine ourselves closely and make sure that we are erring on the side of support and encouragement instead of defaulting to letting people learn by making their own mistakes. Be enthusiastic and grateful - Recently I read an author that said that accounting for all variables such as age, income, health, etc., that the happiest people were those that exhibited two characteristics: they slept well and had an attitude of gratitude. Have you ever been around a "Debbie Downer" or "Dustin Depressed" nurse? There is nothing quite like it to suck the air out of the room and take the joy out of being in nursing, is there? We all know that nursing is hard-that's a given. We don't need to have the hard parts outlined and underlined every day. Instead, we need people around us that can lift us up, co-workers who are full of respect for their patients, that accept others non-judgmentally, and that do their work with patient professionalism. As we mentor each other, we don't need to ignore the difficult parts, but we also don't need to spend all our time focusing them, pointing to them and taking about them. There ARE good things too. As mentors and great nurses, let us be the ones that highlight the good and show gratitude wherever we can. When we give one another the benefit of the doubt, we allow ourselves the freedom to continue to enjoy our profession. When we are grateful for the good things around us, we open the door to more joy in our work. Be excellent - I recently attended a conference where one of the speakers said, "Always go beyond. Do it with excellence. When you do that, we experience freedom in your work." As nurses we have choices every day-not so much about what we do, but about how we do it. To be great mentors, we want to lead the way in going that second mile for others, putting the needs of our patients before our own and recognizing that in serving others we can find our calling. Nursing is so much more than a job. As my young friend and I finished up our walk, I tried to give her some pointers in how to proceed, encouraging her to persevere and to also seek out other mentors who provided an example of kindness, availability, enthusiasm and excellence. Throughout our professional lives, we are mentors to others, both the newcomers and the long-lived peers. Let's be the kind of nurses that to others want to follow!
  8. I heard her yelling as I walked down the hall of the Neuro ICU toward her room. As her Parish Nurse, I had visited the 90 year old Nancy on multiple occasions in her home, then in the assisted living facility she went to before hearing that she was hospitalized with an unknown infection and was not doing well. I put on the protective isolation garb and slipped through the sliding glass door only to hear magnified the screams and yells that were already audible down the hall. Nancy's two nieces stood by, one of either side of the bed, trying to calm their aunt who appeared to have acute confusion probably associated with her current condition -later diagnosed as a UTI. As soon as Nancy saw me, she reached out her mittened hand-"Help me! You've just got to help me get these off! Listen, you know me, you know that I don't like to be tied down. Now, if you want to, you CAN help me. Just do it. I need you." Gulp. Even knowing that the mittens were on for a reason, I had to dig deep to respond in any sort of way that might possibly be helpful. I tried to use a soothing manner, a calm voice, reassuring her that I would look into it and see what we could do. My lack of immediate action only seemed to inflame the issue further and her screams reached a new crescendo of volume. Eventually, finding that I was not being helpful at all, quite possibly the opposite, I retreated to the hall, out of the line of her sight and motioned for one of the nieces to join me in the hall. We talked things over and I discovered that this acute episode had been going on for almost 16 hours, enough to wear them both out. As we talked, I looked for answers to pertinent questions: What was the plan? How far along into the plan were we? What had Nancy expressed as her wishes? What could we do to help make Nancy more comfortable whether in full treatment mode or not? Nancy's nurse happened along, and we began to discuss the plan together. As Nancy's long term advocate (she only had these nieces and no other family), the niece expressed again that Nancy had repeatedly stated her desire to "die peacefully," as recently as 2 days before this episode. The nurse was able to clarify that things did not appear to be going well and that she showed some signs of organ failure. We went on to ask the nurse to page the doctor so that everyone could understand the plan and get a clearer picture of the way forward. In the end, the nieces decided to make her a DNR and they requested sedation and pain medication. As advocates for our patients, it is hard sometimes to determine the way forward. Whether we are the parish nurses, case managers, facility nurses or ICU floor nurses, as professionals we all want to do our very best for our patients. Sometimes, in this day and age of having to float to cover the shifts, and having EMRs that fail to tell us the whole story, we flounder and find ourselves unsure how to proceed because we simply do not have enough of the background story to know what the patient and the family would want. How do we get around this current state of affairs? How can we help each other be the best advocates possible for our patients? Listen- When families come to visit, ask a few well-placed questions about the patient, where they lived prior to this stay and what they mentation level was. Families often think that nurses can somehow magically tell that their loved one has been suffering from Alzheimer's for the past couple of years and is declining rapidly. They often assume that we know more than we do, thinking that all those forms they filled out previously have made their way into our hands. Sadly, we know that communication is one of our biggest current problems in medicine -a complete irony since we spend a great deal of our time documenting and, in theory, communicating. Advance Directives-We always ask if people have one, but we less often check to see what it says. "Even though advance directives have been promoted by health professionals for nearly 50 years, only about a third of U.S. adults have them, according to a recent study." (Americans Still Avoiding End-Of-Life Care Planning : Shots - Health News : NPR) It's helpful, for example, to know if the patient who has had a stroke is adamantly opposed to feeding tubes. If we know that, we are looking at a different type of care going forward. Of course, Advance Directives can be changed by the patient and care proxy in real time, but establishing the groundwork of what they say initially can help everyone involved to stand on firmer footing. Anticipate problems- As professional nurses, we know how to look ahead at what might be coming down the care pathway. We might see the beginning of an attack of acute anxiety in an inpatient such as Nancy, at which point we could consider asking the family or facility if this has been a problem in the past or is it new onset. As we give them instructions for care after discharge we look ahead at what might come up and what they can do to address problems: practical suggestions that address particular issues that are likely to surface, e.g. UTI after Foley inpatient, weight gain with CHF, insomnia with Prednisone, etc. After those days in ICU, as her condition continued to deteriorate, Nancy was transferred to inpatient hospice care and died peacefully about a week later. Although I felt bad that she suffered so much during her illness, I was also grateful to be able to advocate for her in a meaningful way. What are some practical ways that you advocate for your patients?
  9. jeastridge

    Shoulda, Coulda, Woulda

    What a good comment! Thank you for sharing. I vote that you keep a copy of what you wrote and refer to it prn! You have a great attitude. Joy
  10. jeastridge

    Shoulda, Coulda, Woulda

    As I logged off my computer for the day, I sighed deeply and then wondered at myself. It had been a good day, really good actually. Why was I feeling burdened and guilty? As I headed to collect my things, I pushed myself to think a little more on the subject. I realized my sigh and my feeling of defeat were because I had left some minor things undone. While I prioritized well all day, and delegated appropriately, I remembered with niggling clarity the small, less important chores that I had been forced to relegate to the pile of "things left undone." As I walked toward my car, I forced myself into a positive self-talk conversation, emphasizing the good and closing off the impulse toward perfectionism that threatened to steal my peace and joy in my job. As nurses, we face this dilemma on an almost daily basis. How do we keep ourselves healthy in mind, body and spirit when the voices of defeat rise up and threaten to undo us? Ghandi once said, ""Happiness is when what you think, what you say, and what you do are in harmony." Our wholeness and health depend on the balance we maintain, on our ability to have integrity in all we do, say and think. Professionally, this is hard because we often have to chose between important tasks or feel that the tyranny of the urgent circumvents our best efforts and forces us into doing the less important things first. How can we find the balance we need to continue to be wonderful, caring nurses who maintain our focus on excellence, all the while being well-rounded people in our outside lives? What is the key to this type of intentional living? Staying well in spirit. Whether you are a family caregiver or a professional nurse, neglect of spiritual well-being can quickly lead to depletion of the well of emotional energy that we draw from. We have all felt that sense of creeping burn out when we put in too much overtime, when we feel ourselves tearing up on the way into work. Although times of trial come to all of us, they are not maintainable over the long term. Somehow, we have to find ways to re-fuel and re-energize our spirits: through readings, meditation, communion with nature, nurturing relationships, self-care of all types. I have a friend who works with staffing at a hospital. He said that he has heard nurses say, "There is no amount of money that can make me come in on my day off." He was shocked that they would say this, but I really wasn't. At some point, our emotional/spiritual well-being are in crisis and there really isn't any type of monetary reward that can entice us to give that up. Our dilemma, of course, is when this is in direct conflict with the patients well-being. Maintaining Our Priorities To keep our priorities in line, we have to first have some clear idea of what they are. It is sometimes helpful for us to write down our top 10 items. While realizing that these re-order from time to time, most of us will feel more "whole" if we work to keep work, family, spirit, exercise, civic commitments, professional development all in some sort of line up that feels comfortable. Guilt Can Grab Our Gumption "Shoulda, coulda, woulda"-the ugly 3-can put us and others into a tailspin of misdirection. It is helpful to remember that most of us do not set out to intentionally make a poor decision. Instead, we consider what we know today-at this moment in time-and do the best we can with the information available right now. Hindsight sometimes reveals that we might have acted differently, but there is great freedom from guilt when we know we tried our best. Accepting Help On the Way to Health Sometimes we get too busy during the course of day and others are not quite as busy. When they offer to help, we may pridefully be tempted to say, "No, I think I've got this." Instead, be thinking of ways that others can help, delegate and just say, "Yes!" Working together builds the team and helps us all out in the end. Comparisons Can Lead to Despair We are all different. We have a variety of skills, strengths and weaknesses-that is a good thing. However, our human tendency sometimes is to compare ourselves with others and listen to the negative voices in our heads that tell us we are not quite measure up. The truth is, we all excel at something. And we all have weaknesses. Positive self-talk can help us walk through the times of discouragement. All of us, from time to time, feel inadequate, unprepared, less intelligent, forgetful, etc. There will always be someone who is better looking, has healthier relationships, is wealthier, knows all the answers...the list goes on. For us to succeed long term as professionals, it is critical that we understand that others' strengths do not take away from our own and that we, too, have areas of achievement. By the time I got to my car, I was feeling better about the day. Chin up, shoulders back, I began to look forward to a nice long walk with my dog. Tomorrow was a new day!
  11. jeastridge

    Shoulda, Coulda, Woulda

    I'm so glad it was helpful. Have a great day! Joy
  12. jeastridge

    Learning to Talk

    The doctor walked into the exam room where the patient sat on the edge of the exam table. In her late 50's, she was slender and held herself erect, tense as if preparing to slide off that paper-covered surface. The young doctor, maybe in her mid 20's self-consciously shuffled the papers she had in her hand. She stood a couple of feet from the patient and made eye contact. "I have the results of your tests, Mrs. T.," she said in a somber voice. "I've been anxious to hear them," was the reply. "You have a malignancy." The words were followed by a shriek of joy from the patient. "Oh, good, I was so afraid you were going to say that it was cancer." She held her hands to her mouth and seemed to hold back sobs of relief. The doctor began to stutter and her eyes widened, "No, yes, I mean...What I meant to say is that it is cancer, Mrs. T. I'm sorry I wasn't clear." The patient's relief gave way to a horrified look, followed by tears and mumbled words, "It can't be; it just can't be." Fortunately, the above scenario was part of a practice session in a class for medical students. The "doctor" was a young first year, learning that it matters what words we use when we talk with patients. I can remember as a hospice nurse, doing admissions and being careful about word choice. After explanations of our services, detailed checklists and signatures, the process usually culminated with a question and answer session just to make sure the patient and their family knew what to expect from us, their new hospice nurses. We tried to wait until the patient or the family asked about topics related to prognosis and then double checked to see what their medical provider had already communicated. Sometimes they did ask the tough questions: "So how long do I have?" or "What is going to happen as I die?" or "What do I do if I get to where I can't communicate?" It's important to consider how we answer questions that our patients pose to us and that we impart what truth we can with gentleness and compassion. In discussing this topic, my friend said, "Yes nurses need to talk....and so do doctors. Many times the doctor has told the patient a lot about their condition thinking they have covered everything. But the patient is confused by the 'Doctor Talk' and is embarrassed to ask for clarification. Then it is left up to the nurse to be the interpreter." How do we know what to say? Ask Questions Back First Clarify what they know, how much information they have and how they have interpreted what they know so far. It's Perfectly Fine to Say, "I Don't Know" Sometimes it is exactly the right thing to say. We are not at liberty, as nurses, to impart information about prognosis or testing unless the doctor has already had a chance to talk with them. Then we can clarify or help them understand what was said and what it means. It can be helpful to go one step further and say, "I will try to find out," but only when we really feel some measure of confidence that we will be able to find out. If we say we will and then get busy and don't get time to follow up, we will want to be sure and let the patient know what we were not able to follow up. Otherwise they may feel lied to or betrayed. Answer Only What They Ask We learn this with kids, often by answering a different question than they intended to ask. If the patient asks, "Will I have pain?" then it is helpful to answer that question and talk about strategies we will help them use to cope with the pain, without going into other symptom management problems that might arise later. Staying focused on the question at hand is hard to do, but an important learned skill. Know Yourself Work on your own issues when it comes to talking with patients. If people frequently mention that you talk a lot, then it might be time to pause and hold back from saying everything you think needs to be said. If you are quiet and maybe answer questions with one word responses, it may be time to expand your horizons in terms of patient conversations. Learning new ways to communicate with patients is not necessarily a skill that comes naturally; as with all of our professional nursing skills, we must hone our trade, observe others who are experts in the field, and learn as we go. Sometimes You Have to Initiate the Questions Part of being good at caring for our patients involves listening to what they don't ask as well as what they do. When a patient is silent, appears distressed or depressed, it may be time for the nurse to ask probing questions. I can remember a hospice patient who never, ever had any questions. He was dying from lung cancer and breathing made a lot of conversation difficult, but he was closed off from his family and from us as his hospice nurses. We tried to engage him but our usual approaches just didn't seem to break through. Finally, one of the PCTs sat down next to him and said, "I'm worried about you. You are awfully quiet. Will you share with me what's on your mind? I promise I will listen and try to help as best I can." The patient went on to share his anger about his condition and the fact that he did not want to be in hospice-he wasn't angry with us, he said, just the fact that he was sick. Their conversation ended with her squeezing his hand and acknowledging that she had really heard him, "I'm sorry that this happened to you. It really stinks." That encounter seemed to help break the ice in our caring for this man. He never did talk a lot or ask many questions, but her question to him seemed to clear the air. Whoever thought nurses need to learn to talk? As with all areas of nursing, learning to talk with patients and communicate well is a skill. It may come more naturally to some than to others, but there is no doubt that we can all improve, take hints from one another and offer pats on the back to our peers who do a good job talking.
  13. The patient came in by ambulance after a motor vehicle accident. His body was intact because the impact had not been severe, but it appeared he had had a medical event that precipitated the crash and the team was getting no response to their all-out efforts to revive this gentleman in his 50's. The chaos of the initial moments of the code passed, and the ER bay settled into the rhythm of chest compressions, respirations, defibrillation, medications...and starting over, doing it again. After 40 minutes, the ER physician in charge suggested that they call the code and name the time of death. As machines were turned off, an unnatural quiet settled over the room and one of the team members, a nurse, called for a moment of silence to honor the man who had just passed on. "We are with this man who has just died. Let us honor the significance of his time of passing with our own moment of silence." At that, the group in the room, nurses, respiratory therapists, physicians, residents and pharmacists all paused. Some closed their eyes, as if in prayer, and others just stood quietly, observing in their own way, the significance of this patient's passing. Having a moment of silence after a death in the hospital or other facility is an idea that started with Jonathan Bartels, RN, a palliative care liaison at the University of Virginia Medical Center in Charlottesville. Whether in the ER, ICU, other hospital setting or extended care facility, the moment of death is a significant event-no matter what faith tradition team members and caregivers originate from. The pause, taking a minute, sometimes less, to acknowledge the person who has died shows respect: respect to both the deceased and to ourselves as members of the care team. The way a pause shows respect to the person who has died is obvious-offering a moment of silence acknowledges that this body was once someone's loved one. The manner in which a pause shows respect to the team is a little less easily understood. Often, as nurses and other professionals, we do not know much at all about the person we are providing urgent care for- but this makes no difference. The team gives the life-saving efforts their all, trying everything to get the best possible outcome for the patient. By pausing after a death, instead of walking away, the team takes a moment for closure, to acknowledge their own hard work and expertise and the fact that there may be a sense of disappointment that the outcome was not what they hoped. By taking a moment, pausing briefly, team members can allow themselves the grace of reflection before moving to the next patient. We can acknowledge that the team has just shared an experience and there may be pain involved for some. This small time of self-care might possibly help some professionals stay healthy mentally, spiritually and emotionally as they offer care over the long haul to others. According to Bartels, "The pause slows our racing minds, offering mental space so that we are not drawn into the vortex of failure versus success." (The Pause) It is important to allow team members to participate or not, according to their own needs and inclinations. For some, it may be exactly the right thing to do, taking that minute to be fully present, to acknowledge this person who has just died; for others, all of that is too difficult during the workday and they prefer to wait and pause in their own way and time. Proponents of the pause advocate for a religiously neutral observation, suggesting instead that each person in the room feel free to respond privately according to their own religious faith. With this in mind, the pause doesn't run the risk of becoming about one particular person's faith tradition but instead about the patient who has died and about personal self-care. The Pause is moving beyond the University of Charlottesville in Virginia. Marilyn Reiss-Carradero, Critical Care, Rapid Response Team at Santa Clara County Valley Medical Center, states: "CPR, electricity and jabbing in a litany of tubes can be viewed as a barbaric way to die. The "pause" or the "moment" helps to humanize this experience and to provide a moment of dignity to a life lost. It should be taught right alongside BCLS/ACLS." ("A Moment of Silence" Crit Care Nurse published online October 29, 2015) Her response was written as a follow up to Bartel's article and reveals the timeliness and potential importance of a practice as simple as an intentional pause after a death. It is important to remember that any team member can call for a pause-whoever is present at the bedside during the time of death can ask for everyone to stop just a minute and remember the person that died, celebrating them as someone who was loved and who loved. The Pause is for those that are present, who worked together to try to save the life; for the people in the room, not necessarily for the whole unit. What about at your facility? Would you consider initiating a pause? How do you think it would be received? Is this a practice that you think might be helpful to you and to others? Joy Eastridge
  14. jeastridge

    A Pause at the Moment of Death: Your Thoughts

    Thank you, Johnathan, for helping get The Pause started! And thank you for your input here. All the best to you. Joy
  15. jeastridge

    Parish Nurse in Transition

    When Granger Westberg started Parish Nursing back in the mid-80's, medicine was very different than it is now: EMRs were unheard of, people had long hospital stays for what we now consider same day (same morning!) surgeries, costs had yet to get out of control, pharmaceutical companies were not profit centers and advanced interventional care, transplants, genetic-based therapies, and other cutting-edge medicine were just glimmers on the horizon. As medicine and nursing have continued to change over the years, Parish Nursing has also evolved. We have gone from a fairly tight circle of influence that was largely defined by a particular congregation to a ministry that often reaches out in a variety of directions, helping to care for the community at large. Now often known by the appellation "Faith Community Nurse," Parish Nurses are making inroads at being one of the most important pieces of the transitional care picture in modern medicine. The FCN is uniquely positioned in the community to help accomplish the goals of serving the community and promoting health and wellness for the larger area. In churches, schools and community centers, FCNs work closely with individuals and groups. With front row seats to times of illness, wellness and everything in between, some of the ways FCNs serve include: Promoting Emotional and Spiritual Wellness through Support Groups By hosting Grief Support Groups and Caregiver Support Groups, the FCN contributes to improved community mental health and general well-being. By being able to identify problems early, the FCN can intervene before deeper problems develop. He/she can play a role in suicide prevention and mental health crisis identification by making appropriate referrals sooner. Additionally, the FCN helps keep mental health care as part of the whole picture of wellness, not just a crisis mentality with the emergency room as front line. Diabetes Prevention and Improved Compliance with Treatment Knowing their congregation's health and their goals, helps the FCN support the educational process that is ongoing in the health system and can identify reasons for non-compliance along with potential ways to overcome that chronic problem. Additionally, the FCN knows all the resources available in the area-from the health department, the doctor's offices, to seminars, to the YMCA. They are able to refer people in appropriate ways. Long-term Management of Hypertension The FCN helps monitor BPs, provide for home monitoring by securing devices and training people to use them. The FCN is also uniquely suited to re-enforce medication management, assist with compliance issues and assist with financial hardship associated with drug costs. Weight Management for Adults and Adolescents The FCNs consistently offer programs to help people improve their overall wellness: walking programs, Weight Watchers, the Daniel Plan, Hiking Clubs, sponsoring sports teams through City Parks and Recreation, promoting YMCA and other gyms, sponsoring exercise classes at the church, etc. Together, these activities add up to increased activity and better all-around health for our church families and the community beyond. The FCN generally plans activities starting in the home congregation but opening them to people in the general community. None of these activities is ever closed off to members only-they are always open and inviting to anyone that would like to participate. Additionally, the FCN is able to cooperate with city-wide or state-wide initiatives, joining more regional programs and encouraging the congregants to participate and bring others along into a healthier lifestyle. Opioid Crisis The FCN is in an important leadership role as they work together to address the current opioid crisis. All persons involved understand that this is a multi-layered problem with no simple solutions, but as liaisons to their communities, FCNs are uniquely positioned to make fast-track improvements and to implement programs that are effective. He/she can determine how to best address this national crisis in the confines of that particular congregation's needs and begin work in a multi-faceted way: prevention with children, education with pre-teens, crisis-intervention and treatment with addicts and support for associated family and community members. Advance Directives/Living Wills The established FCN has the trust of the community. He/she is able to offer opportunities for people to better understand the decisions they will face at the end of life. By working often with the older adult population, FCNs are uniquely positioned to make a difference in how we spend resources during the last few weeks of life. Access to Health Care The FCN serves as a triage nurse within her community. Often members ask for referrals, discuss insurance concerns or ask for financial help in addressing access to care. The FCN can help steer people in the right direction and distinguish fact from fiction for patients who are unsure. Transitional Care This role has been growing larger over the past few years as the patients are leaving inpatient stays sooner and with greater acuity to recover at home. FCNs have the ability to call or visit, to do medication reconciliation, to make sure patients have their prescriptions filled, to double check on equipment needs, nutritional needs and appropriateness of care. They are particularly well-equipped to answer triage questions and help patients know whether they need to return to the point of care for additional help. The FCN is an important part of the new health care system. While knowledge has expanded and modalities of interventional care have grown by leaps and bounds, hands-on care and connection with compassion have not always kept pace. The nurse in the faith community is the perfect person to help address this disconnect and build bridges of care.
  16. As my friend, Julie, and I settled into a booth at a local coffee shop with our steaming brews, we chatted about our work. She told me about her contract work as a Data Collection Nurse. "The best part is the flexibility and the fact that I can leave my work at work," she said. "For this time in my life, it's the right fit." What kind of training and experience did you have in nursing before you got this job? I have a BSN but they will hire ADs or RNs for this work, as well. I have been in nursing a long time and some of my experience includes: ER, ICU, Med Surg, Dialysis, Nursing Administration, Insurance Case Management, Utilization Review, and Private Duty. Where do you work when you do Data Collection? I go to the insurance company's office (they pay mileage from home) or sometimes I am in doctor's offices working with their EMRs there. It's important for people to know how confidential everything is-it is really a priority concern all the time. The patient's information is always secure and that is at the forefront of what is important to insurance companies. There can be some travel involved since the insurance company's office is not always close by. So what is the nitty gritty of Chart Review and Data Collection? Our work is to examine charts for compliance with national standards. If the office is in compliance, then they are eligible for incentive pay from insurance companies. In other words, the measures are supposed to show that the patient is getting the are they are eligible to get. We look at multiple charts, often randomly selected. For example, we might gather all the charts of people who have diabetes and then look through them to see the latest A1C and urine testing. Or we might pull the charts of everyone with diabetes and hypertension, measuring more than on quality standard at a time. Another example is when we look at adolescent weight management and check the charts for BMI. We might also look at the care of the elderly and examine transitional care parameters. We work with HEDIS which is: "The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by more than 90 percent of America's health plans to measure performance on important dimensions of care and service. Altogether, HEDIS consists of 94 measures across 7 domains of care." (HEDIS & Quality Measurement) Why do insurance companies want this information? Data collection for ensuring quality care through quality measures is a pretty recent event. Providers are now required to maintain records (often by using EMRs) that can allow insurance companies to try to follow up on whether or not the patients they insure are getting excellent care. So my job is to go into the chart and figure out and count compliance with the standards. Providers receive incentive pay for meeting the stated standards. How did you get started doing Data Collection? I was at the point in my life and in my family's life where I needed more flexibility. We still needed some income from my work but I could not work the regular nursing shift work at that time. I saw an advertisement for a temp agency that was hiring for this work. The pay and the hours immediately attracted my attention. I started out working 3 months out of the year, but I have extended that over time. I also have open folders on Career Builder and indeed.com. Now that I have so much experience, I get calls asking me for more contract work. It's been a good fit with our lives. What would you say are some drawbacks of this type of work? It's not full time I work through a temp agency There are no benefits It's not a social job; I often work alone It can be tedious There are not a lot of new challenges daily Independent (This can be on the "good" list and on the "bad" list) Some phone work is involved, coordinating with doctor's offices and getting information as needed What are some things that you appreciate about this work? It pays well It's flexible It's temporary I can leave my work at work I feel like I make a difference, helping to ensure that patients get the care they are supposed to get I like the autonomy. This job is very much for a self-starter and a person who can see the job through independently. You really have to be a self-manager The job is not difficult and it does have its rewards As we finished up our coffee, we agreed that while Data Collection is not for everyone, it can be just the right fit for some nurses at particular times in their careers.
  17. In today's world, we hear a lot about utilization review, prior approvals, allowable days, meeting criteria and many other phrases that are bandied about but which provoke little clarity. Although we understand the importance of rising health care costs, we also sometimes struggle to put together the roles that insurance companies, providers and medical facilities play in this complex dance of working to provide the best care possible. Utilization review nurses are one part of the puzzle: they are constantly at work advocating for patients and for their employers to make ongoing health care possible. Recently, while having supper with my friend, Ann, I asked her about her work as a Utilization Review Nurse. What kind of training and experience did you have before you got work as a UR nurse? I had a RN, BSN and many years of experience working in a variety of nursing settings, including ICU, ER, Dialysis, Medical/Surgical, Floor Management, Dialysis, Case Management and private duty Pediatric Vent Nursing. The extensive experience helped me get hired to work UR but I started there because I was pregnant and needed a job that was just a little less physical to help me through my difficult pregnancy. UR nurses need to have a thorough understanding of nursing skills and medical conditions to help them understand and make important critical thinking decisions. What did you like about being in UR? I liked that I could use all that knowledge I had worked so hard to gather and apply it in a new way. I also liked it when I could be an advocate for the patient-both in getting more information and in providing them with supportive information. I felt like it was important work in that I was there to make sure the patient got what they needed and that the hospital was clear on length of stay, tests and other aspects of the care. It is full time. Some companies do hire through temp agencies to see if the nurse is a good fit for their company. I like to learn and have an inquiring mind. In UR, it helps to be curious and want to find out more. This work rewards self-starters and people who have strong follow-through skills. Were there downsides to UR work? Looking at data all day long can be blinding. Often we work in the insurance company's office. Sometimes UR nurses work from home. There are times when we advocate for patients and the medical director doesn't see it our way and denies the claim-that can be hard. For UR nurses that work in the hospital, it can be difficult for other nurses to understand what they are doing. At times, UR nurses may face some degree of suspicion or maybe just a sense of being outside the "group." Ann went on to say, "Utilization Review Nurses can work for insurance companies or for hospitals. At insurance companies, they are part of the team that reviews the charts looking at diagnoses, criteria for a number of days and contributing information. At hospitals, they often work with the Case Management Team to make sure that the hospital gets reimbursed for the care they provide. At hospitals, they might talk with a variety of team members including other nurses to corroborate the need for the inpatient days." The American Nurses Association states, "UR nurses are employed in inpatient and outpatient clinical settings, the insurance industry, and managed care companies. They serve as liaisons among the patient, provider, and third-party payer to help prevent overuse or misuse of medical resources in an effort to maximize provider reimbursement and minimize consumer payments." (Is utilization review the career for you? - American Nurse Today) In our conversation, Ann emphasized that UR nursing is a great field, but it is not for every nurse. Besides a lot of experience in nursing and a BSN, UR nurses need to be able to stay focused over long periods of time on complicated material that may not be self-evident. In other words, the nurse has to be willing to keep investigating, "digging" if you will, to uncover the necessary facts. As well as being detail-oriented, the effective UR nurse will know how to be a strong decision maker but balance that with being a team player. He/she will often work with the entire medical team and will need to be able to clearly communicate findings and next steps. It is also important that the potential UR nurse have a good phone presence. It is not necessary to have any special certification in order to start work as a UR nurse. Hospitals, facilities and insurance companies generally provide orientation and training to do the job. Additional certification is available later for those who wish to further their careers including Certified Case Manager Training and certification through the American Board of Quality Assurance and Utilization Review Physicians. After talking with Ann, I felt like I had a much clearer picture of what UR Nursing is all about. Bottom line: regardless of their employer, UR nurses work hard to help patients get the care they need.
  18. jeastridge

    When the Patient Refuses Hospice

    Thank you! It's always good to try to look at the whole picture. It's complicated, for sure, and becoming more so...I appreciate your feedback and thoughtful input. Joy
  19. jeastridge

    When the Patient Refuses Hospice

    George stepped out of the hospital room and shut the door softly behind him. As his Faith Community Nurse, I had just stopped by to check in and asked him if it might be a good time to talk. "She just dropped off to sleep after the pain medicine," he said. "We can talk for a few minutes." We stepped to an alcove at the end of the hall where we found two chairs in a private spot. George's weary eyes filled with tears as he started to talk; he pulled off his glasses, wiping them rhythmically with the end of his sweatshirt before putting them back on. I offered tissues and encouraged him to tell me how things were going. "We've been married over 30 years now, and Kathy has always been so stubborn and determined. I admire that about her, but right now it is so hard. I think she hates me..." His voice trailed off and I asked him why he said that. He went on to explain that Kathy had metastatic colon cancer and was currently being treated conservatively for a perforated bowel which the doctors hoped would seal up on its own, given time, antibiotics and intravenous nourishment. But through the entire hospital stay, the medical team had been very discouraging about her prognosis, saying there was little else they could do in terms of interventional care. "Palliative Care came yesterday, and it did not go well." George sighed and almost laughed when he told me how strange the conversation had been with Kathy absolutely refusing to consider end of life care and the Palliative Care Team wanting to introduce the idea of hospice. Then his face turned dark again and he said, "That's when she turned on me! She said I am not on her side. I was just asking questions of the team, wanting to know what hospice means in a situation like this. She asked me to leave the room and said she could make her own decisions. She wants to get a referral to another medical center to be evaluated for more surgery. You know they won't do that! Why, she can't even be moved at this point." He cried for a few minutes and I reached over to pat his shoulder in an attempt to comfort him. "Even pain management is a problem. She keeps refusing pain meds and she is in so much pain. The Palliative nurse presented several options, including patches. What do you think of that idea? She says the pain meds will keep her from enjoying the grandchildren when they come in this week-end." George looked at me questioningly. As Faith Community Nurses, we are trained to listen, ask questions and help people to navigate difficult waters. Because of the common thread of faith, we are free to offer spiritual guidance as requested and as seems appropriate. I asked George if he would like me to pray for wisdom and he tearfully agreed, saying that would be helpful. After prayer, we read a few scriptures and then we discussed potential paths forward. What does a patient and their family need at a time like this? How can we see beyond the spoken words to the messages the patient and their family are relaying to us? How can we be true advocates for a patient who wants to make a different decision than we see as medically indicated? How can we, as professional nurses, find ways to be nonjudgemental and supportive in the face of limited treatment options? The patient needs to feel supported Because Kathy was coherent and able to make her own decisions, she wanted to exercise whatever control she could. It was clear that she understood the severity of the situation, but she remained in strong denial, unwilling to do anything that she perceived as "giving up." She had always been a valiant fighter; her message to us was that she didn't want to change that in her last battle. As George and I talked, he became clear that she wanted him to be her advocate, always in her corner, helping her face the end of her life in the way that suited her best. As George said, "She always been determined. She's not going to change now; not when it matters so much. She wants us to remember her as someone who never quit fighting." The patient needs accurate and helpful information for her particular situation Because Kathy's need for control was so strong and her suffering so intense, she came across as impatient and exasperated with staff that she didn't feel would bend enough to her way of seeing things. She made it clear she did not want IV drugs and that she wanted to go home so she could get stronger to have surgery. From that point, Palliative Care directed their energy to working on getting her pain under control with Fentanyl patches along with a shorter acting opiate. They tried their best to ask questions and listen, listen. Over the ensuing days, George began to act as her strong advocate, helping the staff to support her and acting as a go-between when needed. Hospice isn't always possible Hospice just wasn't an option at this time for Kathy and George. Sometimes, patients and families struggle to find common ground around the topic of hospice. Despite the best education and information Kathy adamantly refused to consider the service and Case Management began to focus, instead, on getting the necessary equipment in the home and supporting George so he could take care of her there. We made sure George had all the information he needed about hospice and about how to initiate that service should Kathy change her mind in the days and weeks ahead. He proactively interviewed a hospice team and got the number to call in his phone. Kathy ended up going home with George and a team of neighbors taking care of her. With her abdominal pain under control she began to take a few bites of food and appeared to enjoy being in familiar surroundings. They made a trip to the doctor via ambulance for her routine treatment and blood work. Their children and grandchildren came in from out of town. Kathy orchestrated the purchase of a new grill and then ordered up a huge cook-out while she sat poolside in the chaise lounge, wrapped up, holding George's hand, and enjoying the site of her family gathered around, enjoying life. Joy Eastridge, BSN, RN, Certified Lay Minister Parish Nurse UMC
  20. jeastridge

    When the Patient Refuses Hospice

    The patient ended up having several good weeks at home with family in and out. Then she fell and had to go the ER for pain management. After that, she realized she was dying and hospice came in for a few days before she died peacefully at home, surrounded by her family. For her, it was the way she wanted it. As her husband said, "she fought it until the end." Lest this follow up note make things sound too rosy, it was not. Suffice it to say, there were times pain got out of control, frantic calls to doctors, bowel problems--in short, symptoms that could have been managed better and more appropriately with hospice--but the family muddled through and she was a warrior throughout. She did it her way. But it wasn't easy. Joy
  21. jeastridge

    When the Patient Refuses Hospice

    There are times when we do everything in our power and we cannot make the situation ok--at least safe and comfortable in our estimation. When those times happen, sometimes we have to follow along and let the situation unfold. In my experience, it's usually not long until something happens that forces a change. Hang in there. Joy
  22. jeastridge

    When the Patient Refuses Hospice

    Thank you. As it turned out, resources for this family were not a concern. I don't know about how the reimbursement for the ambulance went but I suspect that will have to pay for that privately. As time went on, they did have to adjust pain management several times through their oncologist. Joy
  23. jeastridge

    When the Patient Refuses Hospice

    see above.
  24. jeastridge

    When the Patient Refuses Hospice

    Thanks! I think the family ended up paying privately for the ambulance ride but it didn't seem to be a problem for them. The pain management plan was updated several times after the patient went home--a process that is easier with hospice but possible with education and dedication. Joy
  25. jeastridge

    Teen Mental Health: Problem Prevention

    When 17 year old Jordan Binion died from suicide, his parents, Deborah and Willie Binion, were devastated. The fact that he had been suffering from mental health issues prior to his death made the loss especially acute. As they tried to find their way forward through intense grief, they resolved to do their best to help prevent this from happening to other young people and their families. They realized that one of the problems contributing to increased suicide rates among teens in a sad lack of knowledge about mental health in general and what help is available. With 1 in 5 persons, adult and teen, being affected by mental health problems, it was clear the challenge was huge. They resolved to do their best to provide whatever help they could by establishing the Jordan Binion Foundation, a non-profit whose goal is to use the curriculum in schools to help provide information that is more thorough and complete. As nurses, we experience the frustration of seeing teens and children coming to doctor's offices, clinics, ERs and inpatient facilities with wide-ranging mental health problems. What we don't see as frequently, is a cohesive approach to addressing the needs of teens as relates to staying mentally healthy. As a society, we often don't seem to have the willingness to put money and effort into helping our young people stay healthy, help others, and seek help if needed. Mental illness is not considered to be preventable. All the education in the world cannot necessarily prevent a mental breakdown but education can and does help in other ways, including offering young people the tools to identify problems early, helping them reach out to peers in trouble and decrease the burden of bullying, shame and ostracism often unfairly paired with a diagnosis of mental health problems. Jordan Binion's family decided to speak out by advocating legislative changes and by developing a full-scale educational curriculum for high school students. Deborah and Willie Binion, co-founders, have made it their mission to reach out to as many young people as they can with a curriculum that is now in use in Washington State High Schools. Deborah Binion explains, "The curriculum is evidence-based and consists of six modules. The Stigma of Mental Illness Understanding Mental Health and Mental Illness Information on Specific Mental Illnesses Experiences of Mental Illness and the Importance of Family Communication Seeking Help and Finding Support The Importance of Positive Mental Health She goes on to say, "It also gives teachers the necessary literacy to foster positive mental health initiatives in schools, helps create safe and supportive environments for their students, and aids in mental health promotion and prevention, ultimately transitioning the school setting to be part of a comprehensive pathway to mental health care access and support for youth." As nurses, we are acutely aware of our deficiencies when it comes to addressing young people and their mental health. We all want to be part of finding a way forward and maybe this renewed focus on education and coping skills is part of the necessary focus. What are some practical ways we can contribute to better mental health for our teens? Support initiatives that identify and discourage bullying. While bullying has been around since the dawn of time and affects adults as well as children, children are uniquely affected by bullying because they lack the range of coping skills possibly needed to discourage this behavior from peers. We can be nurse advocates for kids in schools, clinics, doctor's offices, hospitals-wherever we find ourselves. We can stand up and show the compassion that identifies us as safe people for crisis management. Identify kids at high risk and address their needs intentionally with referrals and other interventions. As nurses, we sometimes have ringside seats to the first contacts kids have with the health care system. We can be part of advocating for them, teaching them tools to cope and instructing them on what to expect. Certain factors may increase the risk of developing mental health problems (Mental illness - Symptoms and causes - Mayo Clinic) in teens and adults. Those include: Having a blood relative, such as a parent or sibling, with a mental illness Stressful life situations, such as financial problems, a loved one's death or a divorce An ongoing (chronic) medical condition, such as diabetes Brain damage as a result of a serious injury (traumatic brain injury), such as a violent blow to the head Traumatic experiences, such as military combat or being assaulted Use of alcohol or recreational drugs Being abused or neglected as a child Having few friends or few healthy relationships A previous mental illness Teach Learning the signs of symptoms of mental health problems can give young folks the courage to go ask for help before the condition persists and perseverates. By teaching we may also help decrease the associated stigma attached to mental health problems, giving courage to friends who want to reach out but don't know how. Information holds the power to decrease fear and removing fear opens doors to treatment and longer term solutions. Advocate As nurses, we have the power to see problems and be part of instituting changes. Maybe we can encourage our schools to adopt a curriculum such as the one developed by the Binion Foundation, or we can come up with comprehensive ways to address mental health education in health departments, primary care offices, churches, community centers-wherever we interact with young people. We can also speak to our local, state and national leaders about taking steps to encourage mental health education. The Binion family has used a tragedy as a launching pad for good. Their efforts to promote mental health education in high schools is already producing fruit as some of their feedback shows. But there is much work to be done nation-wide to help our young people grow into healthy adults and as nurses, we can be an integral part of working toward solutions. Joy Eastridge How one family is educating students, teachers on mental health - NBC News

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