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jeastridge BSN, RN

Faith Community Nurse (FCN)

BSN, RN, Faith Community Nurse

Content by jeastridge

  1. Cindy was an older new grad. She went back to school after a long and successful career as a chemist, deciding that she wanted to be a nurse and explore other avenues of service for her “second half” of life. Capable and efficient in her first line of work, it was a shock to find herself as a novice where everything felt unfamiliar and where mastery was a ways off. Her first place of work was on a busy ortho floor. The second week at work, she called me crying. “Their expectations are so high. They keep threatening me.” I tried to listen without judging or offering advice, but something just seemed off. Every few days she texted or called and what she described didn’t seem like anything I had ever experienced as a nurse: where there should have been mentoring, there was censoring; where there should have been guidance, there was abandonment; where there should have been counseling, there was silence and isolation. The source of most of the problems was her preceptor, a young nurse, who my friend described and very physically attractive but unkind. As it turns out, she was a bully. Nursing is Not Immune to Bullying While we would hope that in such a caring profession, we would find a greater percentage of people with compassionate care agendas, sadly there are also a number of practitioners who exhibit the characteristics of a bully: they are critical, negative, they isolate their victims, avoid meeting with them, and generally make life miserable. According to a study by Etienne, “Bullying in the nursing workplace has been identified as a factor that affects patient outcomes and increases occupational stress and staff turnover.” (Exploring Workplace Bullying in Nursing) Signs of Bullying The trouble with bullying is that it is often subtle and therefore difficult to recognize as such. While the playground bully may be overt and even violent, the adult bully is usually disguised under heavy layers of professional accomplishment and years of experience with manipulating others. They come in all shapes and sizes, both men and women, old and young. The “mean girls/guys” from 7th grade grow up, don’t they? But sadly, they sometimes don’t leave behind their old ways of treating others, and they bring those tactics with them when they put on their scrubs and head to the nursing workplace. One of the primary manifestations of bullying is that the victim often feels that it is all his/her fault. After exposure to the bully’s tactics, they may even think to themselves, “If only I did this or that better, then they would not treat me this way.” The thought processes at the center of the bully/victim relationships can sometimes be lifted straight from our textbooks about abuse. Just as victims of domestic abuse many times blame themselves, nurses who are victims of bullying find themselves looking inward and wondering if there is something wrong with them. What are some of the classic signs of a bully boss or co-worker? 20 Subtle Signs of Bullying at Work More Subtle Signs Deceitful and manipulative- making promises but not keeping them or using promises to purposely disappoint. Shaming and blaming- bullies want the victim to blame themselves. Ignoring or undermining work- purposely “forgetting” to notify someone of meetings, belittling their work or accomplishments. Intimidating and criticizing- setting impossible standards and even threatening. Diversion and mood swings- bullies might avoid the victim so that the work issues cannot be resolved in a timely manner; and they are subject to widely varying moods (which boss/co-worker will be coming to work today? The sweet one or the nasty one?) Overt Bullying Aggression and intrusion- actual physical altercations with the bully entering your personal space. Belittling, embarrassing and offensive communication- using their position to cause you harm, either physical, psychological or professional. Coercion and threatening- pushing the victim to do things they don’t feel comfortable doing and using threats of termination or other punishment to get compliance with their demands. So, if you or someone you know is being bullied in the workplace, what can you do? Document- Keep a record of any threatening or inappropriate emails, texts or interactions. Should it become necessary to report the bad behavior, it will be important to have specific occurrences, words used, and frequency of episodes. Also, learn your workplace policies on bullying and what your recourses are. Detach- Try to look at the occurrences in light of how this person treats others. Have you been “picked out” for special scrutiny? Bullies are sometimes bullies across the board but at times they pick out a few victims, zero in on those and treat others as allies, making the other staff members into (sometimes) unwitting accomplices for their own bad behavior. Dare to Defy- Standing up to a bully is hard and practically can be impossible. Often, persistent bullying requires cutting our losses and moving on to another position. But adult and boss bullies—like those on the playground—can respond to pushback: maintaining eye contact, standing firm, ignoring or not acceding to their demands. This is harder to do than it sounds, because the victim of a bully at work frequently is not in a position to resist and finds themselves being jerked around by the perpetrator’s continually changing and escalating demands, whims and moods. Defend- Be on the lookout for bullying behavior around you and if you see something, say something. As for Cindy, in the end, she resigned after 3 months and went in search of another job—certainly not the route a new nurse wants to have on her resume—but a physical and psychological necessity given the bullying she experienced. After the rocky start, she went on to have an extremely successful career as a nurse and to find the profession a satisfying fit for her talents. Have you witnessed bullying in your workplace? How have you been a victim of bullying?
  2. jeastridge

    Nurses and Bullying: 4 Things You Can Do

    You bring up some good points. Thank you for sharing your perspective. Joy
  3. jeastridge

    Nurses and Bullying: 4 Things You Can Do

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

    Nurses and Bullying: 4 Things You Can Do

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

    Nurses and Bullying: 4 Things You Can Do

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

    Nurses and Bullying: 4 Things You Can Do

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

    Nurses and Bullying: 4 Things You Can Do

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

    Nurses and Bullying: 4 Things You Can Do

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

    12-Hour Shift | Life of a Nurse

    Great article! Thanks for sharing. You are a credit to the profession! Joy
  10. jeastridge

    Breast Cancer Simplified

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

    Breast Cancer Simplified

    My phone lit up with a message from a friend in a nearby town. “Let’s get together for lunch this week.” I responded with, “Sure, what’s up?” Her answer made me sit down. “Breast cancer.” Breast Cancer Statistics The “C” word is met with foreboding by us all, but breast cancer brings along with it a special dread to women: possible breast-altering surgery, treatment that can include chemo and radiation and the increasingly less likely risk of death. With statistics showing that according to the National Cancer Institute (NCI), “12.8% of women born in the United States today will develop breast cancer at some time during their lives,” and “2.6% of women in America will die of breast cancer.1 As scary as that statistic is, the NCI emphasizes that the same numbers also show that there is a 7 out of 8 chance that an individual woman will NOT have breast cancer in her lifetime. All the statistics invite us to careful monitoring, including regular mammograms after age 40 or 50 for women with average risk. Additionally, many physicians recommend genetic testing such as for BRCA gene if there is a higher than average family history of breast cancer or any ovarian cancer. How to Reduce Your Risk All women have the opportunity to adhere to healthy lifestyle choices that can help decrease their chances of getting breast cancer including2: Limit alcohol. Greater alcohol intake=greater risk. Don’t smoke. Weight control. Physical activity. Breastfeed. Limit duration and dose of hormone therapy. Avoid radiation and environmental pollution. Treatment Options As professional nurses, we often get asked questions about breast cancer and treatment options. Unless we are actively working in the field, we are not usually qualified to answer questions and often must refer to others or to reliable published material. However, it is important for us to stay up-to-date and understand some of the more recent changes in breast cancer treatment. Staging According to LaCosta Brown, RN, MSN, OCN, a nurse navigator for breast cancer, a lot has changed in staging breast cancer since January 2018. Previously, staging involved one sheet of paper, one chart essentially, and noted tumor size (T), nodal status (N), and metastasis (M). The TNM staging method had been around for a number of years and served as the guide to defining surgery and treatment options. However, for the past 2 years, grade and biomarkers are also taken into consideration. The total picture is the TMN + G + B. Grade Grade refers to how abnormal the cancer cells are when examined under a microscope and range from G1 - Well-differentiated (low grade) to G3 - Poorly differentiated (high grade). Essentially, the higher the grade the faster the spread of the disease. Biomarkers - HER2neu Biomarkers include estrogen receptors, progesterone receptors and HER2neu (Human epidermal growth factor) status. 80% of tumors are hormone-positive and thus respond to treatments that help to curb their growth, treatments that include drugs like Tamoxifen and Arimidex. So if cancer responds to hormones, it is Estrogen or progesterone positive and therefore would respond to these drugs that specifically work to slow down and impede tumor growth and spread. These long term “chemo pills” are generally used for 5 years. This anti-hormonal therapy can prevent breast cancer re-occurrence. HER2 is a protein that when present can cause cell growth and survival. Being HER2 positive opens up the possibility of treatment with Herceptin or Perjeta. HER2 presence is considered, according to Brown, as a “foot on the gas. It is go-go. The treatment modalities of Herceptin and Perjeta put on the brakes and slow or stop the growth of the tumor cells.” According to the CDC, if cancer is the “house” the 3 markers are “keys” that can help treatment get inside and destroy or slow down the cancer cell. If the “house” doesn’t have any one of the 3 keys, it is called “triple-negative.”Triple-negative breast cancers, or those that don’t respond to anti-hormonal treatment, make up less than 20% of all breast cancers. Along with surgery, the treatments include chemotherapy.3 Immunotherapy for breast cancer is also a growing field and one where promising research is being done. The new methods of precision evaluation breast cancer include genetic profiling of the tumor specimen and are much more specific and helpful in terms of specifying treatment options and helping patients decide how to proceed. New Treatment Options In years past, radical mastectomies were the treatment of choice for most breast cancers. As medical knowledge and treatment options have developed in recent years, more women are able to get simple lumpectomies and follow that up with the appropriate treatment given their staging. They may be able to have sentinel node identified at the surgery for biopsy instead of removing all the axillary nodes, reducing the problem of lymphedema of the arm after surgery. My friend and I met for lunch and talked at length about her plans for surgery and follow up treatment. Along with the technical and medical conversation, we reconnected with each other’s lives, offering one another emotional and spiritual support, realizing that as important as all of the staging and drugs and treatment info is, so also is the support we offer one another when going through diagnosis and treatment. References American Cancer Society- https://www.cancer.org/cancer/breast-cancer/about/how-common-is-breast-cancer.html Mayo Clinic - Breast Cancer Prevention: How to Reduce Your Risk - https://www.mayoclinic.org/healthy-lifestyle/womens-health/in-depth/breast-cancer-prevention/art-20044676 Centers for Disease Control and Prevention: Triple-Negative Breast Cancer https://www.cdc.gov/cancer/breast/triple-negative.htm
  12. So very sad. Thank you for sharing your story and for doing your best under tragically difficult circumstances.
  13. jeastridge

    Nurses: Compassion Experts

    Below are three instances where a dose of compassion resulted in good medicine. Case 1: “I feel like my body is betraying me. I’m only 55 and everything seems to be falling apart,” the patient I was sitting with cried as she spoke with the nurse that was getting her admitted. The nurse paused her typing, turned her body slightly to face the patient, and with genuine compassion in her voice said, “I’m sorry you are having to go through this. All this testing can’t be fun.” The patient visibly relaxed and the tears that threatened seemed to dissipate. Case 2: The patient was all set to go to surgery. I was there with her pastor to pray for this major procedure to remove cancer from her colon. Her husband hovered nearby and as they started to roll her stretcher out, he clung to her hand. The intake nurse was there, and he gently slowed the gurney and spoke to the husband, touching his arm, “We will take good care of her. If you will go through those double doors to the waiting area, we will be in regular contact with you throughout the surgery.” His manner and calm demeanor spoke volumes. The husband released the stretcher and kissed two fingers before touching them gently to his wife’s lips and mouthing the words, “I love you.” Case 3: The patient had been in the ICU on life support for several days. The situation looked grim and the prognosis was not good. As the Parish Nurse, I visited daily and tried to help the family as it became clearer that we were looking at considering end-of-life issues with this wife, mother, and grandmother in her early 70’s. The bedside nurse was so helpful! She was competent and busily tended to the patient’s multiple lines, continuous dialysis and ventilator. Her manner was simply reassuring. She talked in low tones and did her best to answer questions that the family expressed. They sat anxiously by, and some of them stood in the hall. No doubt crowd control had to be trying this nurse’s patience, but she did not let it show. She steered the family away from the bedside and into the waiting area so that she could have more space to provide the necessary care, but even in doing so, she communicated volumes about her empathy toward this tight-knit family and their grief. As the Parish Nurse, I tried to help transition the family to a better space and continued to provide a listening ear and to help in interpreting what was going on. The American Nurses Association’s broad definition of nursing states: There is a lot to love in this definition because nursing is truly about so much: the stated and unstated. Compassion may not be part of the official description, but it is often part of the force that draws people into nursing and certainly one of the motivators for staying there even when times are tough professionally. So being a compassionate nurse is a good thing. We all get that. But if we are not particularly bent that way, how do we cultivate that characteristic? Also, if we are just plain worn out and tired, how do we stay compassionate? Isn’t it “fake” to pretend that we feel something we don’t? If we really want to be authentic people, shouldn’t we be honest with our patients when we are not having a good day? Compassion is an action more than an emotion. When we are professionals, we can act with compassion even when we are having a difficult day and do that without “faking it” or lying or trying to muster up some artificial warm and fuzzy feelings. Professionalism simply means that we understand the scope of our work and that part of it is trying to make a better day for our patients. We do that best, when we act with compassion—in some small way seeking out a position of empathy. This can be trying with our difficult patients, but part of being a consummate professional is knowing how to make that happen even when we don’t feel so inclined. Compassion rises from a well that can run dry. We have all been around the nurses that have run out of steam professionally: they have had to work too long and too hard and under undesirable circumstances. Let’s be honest and name it: Nursing really stinks sometimes. But as professionals, we keep trying to support each other and encourage one another to be our best selves. No, we will not succeed every day—no one does—but we can prod each other on and help each other seek ways to refill that well of compassion when it threatens to hit bottom. Genuine compassion sometimes means not communicating your own personal issues. In our own lives, we have struggles so it is easy to forget that the patient is not there to hear about them. They are in their own time of trial and often cannot cope with hearing about someone else’s—even if it’s as simple as your flat tire on the way to work this morning. Really, our patients need our professionalism to trump our own need to share. Listening and caring about their needs is what we are trained to do. Whether brand new or benefitting from long years of experience, nurses can have uniquely helpful perspectives in their area of expertise. Whether in the hospital or out; whether corporate or private; facility or outpatient—in any and all settings nurses who show compassion offer true help.
  14. jeastridge

    Nurses: Compassion Experts

    Dear Meagan, Thank you for sharing this thoughtful comment. As you say, connecting with our patients' "story" in some way, helps us to continue as compassionate professionals--for the long haul. Have a great day as you care for others! Joy
  15. It happened on July 15, 2017. Loretta Seymour sat in the emergency room of a hospital in Ontario with her dying father. Diagnosed with prostate cancer the year before, he had been transported to the local ED for end of life symptom management. He was on massive amounts of pain medicine, but he continued to suffer, physically and spiritually. Feeling helpless beside her father, Seymour remembers a nurse coming in and providing a comforting presence that night. Her name was Omolara Ishola. When Seymour said her father was afraid of dying, Ishola offered to pray with the dying man. After that, she sang a song and then brought extra blankets to help keep her patient’s feet warm. These acts brought comfort and peace to both Seymour and her dying father. Now, two years later, Seymour recently connected with Ishola via social media and they went on to meet in person. Expressing deep gratitude, Seymour spoke with Ishola through her tears and thanked her for what she had done that night. Characteristically, the nurse responded by saying she felt, “Humbled” by the recognition. She went on to say, “As a nurse, you do what you do not for the recognition. Patient care is provided because you want to make a difference in people’s lives. When you’re a nurse, you step into people’s lives most of the time at a very vulnerable moment and I have learned to understand that every man, every woman, every child, is someone’s relation, not just a number.” Ishola’s example is inspiring. Even more, it compels us to examine our own practice for places where we can improve. Even the most seasoned nurses can benefit from taking a step back, from time to time and seeing areas where they might improve their practice. How Can We Make More of a Difference? Provide spiritual care- Assessing for spiritual care needs and making sure those needs are met is an integral part of excellence in nursing care. While we may not feel comfortable praying with a patient, we can all take steps to call the chaplain or the patient’s spiritual advisor. Ishola’s approach went beyond the ordinary; she made an assessment of the need and realized that she was able to help meet the need. Focusing on patient dignity- As Ishola said, everyone is someone’s relation, and everyone is more than a number. When we see them in their dying moments, as body functions shut down, and pain is front and center in our list of concerns, we continue to see their humanity. How can we show this in practical terms? Employing appropriate touch- When we connect with the patient by touching their hand or shoulder, or trying to warm their feet, we go beyond medical interventions and reach the humanity of our patient. Touch centers them and us in the present, and lets them know we are with them. Addressing the patient and family appropriately- This nursing care intervention applies at all times, not just in the time surrounding death. Speaking to our patients with dignity and concern, conveys professionalism and can increase trust; trust will ease discomfort and anxiety. Addressing them appropriately goes beyond using surnames (or first names, whichever the patient and family prefer). It extends to talking directly to the patient when possible, using low tones to protect privacy and ease feelings, and not “talking over” the patient. Focusing on the environment- Protecting our patients’ dignity also means being conscious of not talking loudly in the hall and being continually self-aware when with the patient and family so as not to increase their distress. The time surrounding the dying process is often difficult and precious time to the family. Of course, circumstances differ: it goes without saying that an untimely death is harder than an expected one, but even so, an elderly 95-year old’s death —even if anticipated—calls on us to be especially respectful and cautious in dealing with the feelings of those at the bedside. It is never easy to say good-bye to a loved one. Make Encounters Positive For Seymour, who continues to mourn her father’s passing, the nursing care she and her dad received in the emergency room that night made a huge difference. She feels that by contacting Ishola she has completed a task that would have pleased her father, “I feel like my dad’s message of thanks is passed along to her…I can’t tell you how thankful I am for this beautiful soul being there, comforting him.” As professional nurses, we have many opportunities to impact our patients on a daily basis. Our approach and our attitude matters. As Ishola said during her encounter with Seymour, “At every point, I remind myself these are human beings, these are people you’re touching and you must make every encounter positive.”
  16. jeastridge

    Is Nursing Kind?

    Kindness never goes out of style. One of the first lessons we learn in life that relates to how we treat others is often what we call The Golden Rule, “Do unto others as you would have them do unto you.” While this life-theme fits in beautifully in our spiritual lives, how does it apply to being a nurse? Does it? Can it? Is nursing getting harder? We are practicing in a hard time. Nursing is always hard, but for some reason, the last two decades seem to have progressed in ways that make nursing harder. There is a lot of focus on excellence, but not exactly the kind of excellence that leads to kindness. There is a lot of push for efficiency and flexibility, but sometimes we feel our personal lives sacrificed on the altar of corporate interests who often appear to completely disregard the meaning of the word kindness. The cost-cutting measures, pressures to document and concerns about staffing levels often bear down hard on the persons who work closest to the patients—the nursing staff. Whenever an organization goes through a re-alignment or sells out to another entity, it appears that one of the first measures submitted for scrutiny and possible “chopping” are nursing ratios and pay levels. Sometimes, our more service-oriented profession puts us at the bottom of the power structure and we find ourselves in the uncomfortable position of defensiveness, sometimes without adequate representation or voice on the boards that control outcomes. Additionally, years of medical malpractice lawsuits have yielded some unwanted results. While the ability to sue is still sacrosanct, the huge payouts over time have resulted in fearful institutions that carefully guard their territory and work hard to become impervious to lawsuits (an impossible feat, it appears…). The practitioners that find themselves in the crosshairs of this controversy are sometimes the nurses who document and document, using electronic medical records that are built as defense mechanisms instead of patient care tools. How do we keep being kind? Where does all this leave us in our pursuit to be kind to our patients and to truly care? How can we be persons and employees who set a good example that leads others to follow? 1. Stay centered. While our professional life may keep coming at us full force, it is up to us to practice good physical, mental and emotional self-care, practices that enable us to overcome obstacles and push forward with kindness in the face of the opposite. By investing time in daily meditation, exercise, prayer, journaling—whatever feeds your spirit—you maintain the integrity of self that promotes kindness even in oppositional environments. 2. Allow for the benefit of the doubt. People have bad days. They mess up. They are “hangry” (hungry + angry = trouble). They are grieving. They are going through life crisis. Their pet died. We just don’t know what kind of uncomfortable shoes our neighbors are walking in. Yes, they may just be “high and mighty” and mean folks but then again, what good does it do us to go with that assumption? The training on “Trauma-Informed Healing” encourages us to ask not, “What is wrong with you?” But instead ask, “What happened to you?” We can experience a refill of the blessed gift of kindness when we change our questions and look at others with eyes that allow for grace. 3. Be kind even when it is unreasonable. Most of us know that when we are offended, mistreated and stepped on, we want to retaliate. That is human nature. Nurses are human, for sure. We get tired of being at the bottom of the totem pole of consideration. We get tired of being asked to pick up the slack again and again. We get tired of adding thankless jobs to our list, simply because someone higher on the pay grade thinks it is a good idea. We have a choice to make every day: reply with anger or defensiveness or even with the simple truth (which can be harsh sometimes…), or find ways to continue in kindness—all the while seeking true justice. Being consciously kind! Social media is awash with quotes about kindness, some of them helpful and others, not so much. But the one that really sticks with me is by Brian Tracy: In life you can never be too kind or too fair; everyone you meet is carrying a heavy load. When you go through your day expressing kindness and courtesy to all you meet, you leave behind a feeling of warmth and good cheer, and you help alleviate the burdens everyone is struggling with. As nurses, we have a daily choice to make. We can succumb to the pull of unkindness and rail against the unfairness of our professional life or we can continue to pursue excellence all the while seeking true justice and improving conditions for ourselves as professionals and for our patients who depend on us. How do you work to stay kind?
  17. jeastridge

    Is Nursing Kind?

    Well said. True kindness sometimes doesn't appear to be "nice" because sometimes what is best for us, our patients and our co-workers doesn't look "nice" superficially. Thank you for your thoughtful comment. Joy Well said. True empathy and kindness are related, aren't they? Your patients are blessed to have you as their nurse! Joy
  18. jeastridge

    Is Nursing Kind?

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

    Is Nursing Kind?

    Truth. Thanks for your comment. Your patients are lucky to have you as their nurse!
  20. 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.
  21. 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
  22. 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.
  23. jeastridge

    Nurses and Ebola

    For sure! Joy
  24. 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.
  25. 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
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