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jeastridge BSN, RN

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BSN, RN, Faith Community Nurse

Content by jeastridge

  1. jeastridge

    Racism in Nursing: Is It Real?

    Hope is invented every day. - James Baldwin Racism Among Nurses is a Real Thing Nurses on the non-caucasian spectrum of melanin content in their skin can tell you—if you ask. In this Summer of upheaval, we hear the headlines every day: Black lives matter, economic and racial inequities in COVID-19 care, police brutality, health care workers marching for justice for all, discrimination against immigrants—the list of troubles is long and complex. In all this turmoil, we want to make sure that we listen carefully, as nurses, to the stories our co-workers tell about their own experiences, because facts inform, but stories inspire. Racial Discrimination: It is Real I am a white, middle-aged nurse. I feel uncomfortable writing an article about racism experienced by my non-caucasian colleagues, but I would like to start a respectful conversation on this forum. I would like to hear your personal stories of times when you feel you might have been discriminated against because of the color of your skin. I have been reading Ijeoma Oluo’s book, So You Want to Talk about Race? And, it’s hard stuff. No one enters the waters of a race discussion well. We all bring mounds of baggage to the table with us. We speak from our own limited perspective and we often lack the humility to truly listen to the people around us as they share their frustration and anger about how they are treated simply because of the color of their skin. We have a hard time allowing people who have suffered discrimination for years to tell their stories. We react sometimes by being defensive, by denying their emotional response, by walking away, even by closing down. Oluo introduces the discussion about racism by telling a story of someone walking down the street, being repeatedly hit on the arm by passersby. The victim can’t leave. They don’t have the option of walking another way and are forced to suffer the pain and discomfort each time. Finally, someone, gesticulating wildly, hits his/her arm one more time, and it is the last straw. The victim lashes out angrily. The person gesticulating reacts defensively, of course, since they meant no harm. But the harm was already done many times over and the response was a spilling out of pent up rage, anguish, and pain. Her story spoke to me, because it is hard for us to listen well, to hear uncomfortable stories, especially when they come coated in a long history of abuse, discrimination, suffering—generations of it, really. We may not be the immediate cause, but by golly, being white, we are certainly part of the system that created the injustice to start out with. White Privilege: It is Real As a white, American nurse, I have benefitted, all my life, from white privilege, even though I have been largely unaware of it. The easements along the way may be small things, but in the scheme of life, they count. “White people become more likely to move through the world with an expectation that their needs be readily met.”1 The system that perpetuates discriminatory behavior toward non-Caucasians, in general, and Blacks, specifically, has produced rotten fruit. The deaths of many innocents—Ahmaud Arbery, Breonna Taylor, George Floyd—have recently revealed anew the true danger of being Black in this country. Those dangers and disadvantages exist in the nursing community, as well. “Two studies examining racial/ethnic bias in RN promotions (Hagey 2001; Seago and Spetz 2005) found evidence of discriminatory practices that limited advancement opportunities for minority RNs."2 The systemic problems that lead to discriminatory practices in nursing are not going away overnight. Sadly, they are a product of lives lived in a system that perpetuates white wealth and advancement to the detriment of others. Changes will require a concerted effort on all our parts—especially in the white community—to be aware of inequities and do our best to put action behind our words of solidarity. Yes, we must pass laws, train and re-train, but we also must live awake and alert, watching for those unconscious biases that frame these differences from the beginning. We must find ways to learn more and to listen better. When our co-workers speak up, let’s believe them and not discount their stories of injustice. Let’s be careful of how we talk, the things we say casually, the hurtful putdowns that slide out unaware. Let’s pursue ways to help each other succeed because it is truly in our mutual success that we find the fulfillment we seek. We Can Reinvent Hope We can have the hope that James Baldwin assures us of in the quote at the top, but we must also let go of complacency, ignorance, and white privilege in nursing, while continuing the difficult conversations. Will You Tell Your Story? Maybe some of you can share your stories below. Let’s share and support one another respectfully as we try to come to a better place together in this anti-racism journey. References 1 - What Is White Privilege, Really? 2 - Racial/Ethnic Pay Disparities among Registered Nurses (RNs) in U.S. Hospitals: An Econometric Regression Decomposition
  2. jeastridge

    Nurses Inspiring Hope During Hard Times: 3 Helps to Share

    Thank you for sharing your helpful ideas and strategies. Joy
  3. “Am I going to die?” I could hear the naked fear in Jim’s voice as he whispered his deepest concern while I sat beside him. Still in his prime at 56, pancreatic cancer had quickly robbed him of his strength, stripping off muscle-mass and leaving his body ravaged by a disease that gained too great a foothold before being detected. Barely able to sit on the side of his hospital bed, using oxygen to help him breathe, he struggled with pain that kept him from resting well. All the while, he didn’t want to burden his anxious wife and children who took turns staying beside him and tending to his increasing needs. As a former Hospice Nurse and Faith Community Nurse (FCN), I have encountered many situations like Jim’s. They are so hard—so hard for everyone involved, and nurses are often the ones that walk beside terminal patients when their needs are most acute. Although some physicians and other members of the care team are involved at intervals, nurses tend to be the ones most present, working to provide symptom relief on a day-to-day basis. How can we be agents of hope in these tough situations? How can we have hope enough to share when we are struggling too? Our patients need us to help them have hope now more than ever. Whether they are terminal, like Jim, or trying to get through difficult treatments, or going through a surgical or medical recovery, these times add even more anxiety to an already hard time. COVID-19, racial tension, political upheaval—through it all the important work of nursing goes on. People are still in treatment, seeking help, needing nurses to be there for them in their time of need. Here are some ideas to keep in mind Renew our own sources of hope I have a friend that has a table lamp that is solar-powered. If it doesn’t get enough sunlight, it does a poor job of illuminating the darkness. Maybe we can see a connection with ourselves in that example—staying connected to our power source, our source of energy and renewal is essential if we are to keep doing our jobs well through this difficult time. If we are spiritual people, then finding scriptures, devotionals, podcasts that help us stay grounded and hope-filled. Some nurses find peace in listening to music or in meditating. Many of you are now probably laughing, thinking that this feels out of touch with your life because besides work you have kids, a family, meals, laundry, and financial concerns. Who has time to meditate? We all hear the clarion call of our busyness but we cannot afford to let our tank of hope run dry. If we do, we risk burn-out and illness from within. So putting in those earbuds on the way home, waking up 10 minutes early to take a moment of quiet—everyone has to find their own path to renewal. What do you do to stay hopeful? Maybe you can share your ideas with others. Talk it out or work it out Working through COVID-19 stress and continuing to function with excellence is beyond challenging—it verges on impossible. The stress can accumulate and fill up our insides in ways that are troubling: loss of good sleep, over or under-eating, substance abuse, and the list goes on. To avoid internalizing, we must find ways to talk it out. This can take a variety of forms including journaling, joining a support group, talking with a spiritual director. Getting the stress out can also mean going for a power walk or a run or a yoga class. All of these ideas can help. What do you do? Know your anchors All of us are going to have different coping mechanisms. As nurses and as humans, we work to be aware of the people around us that help us to be hopeful and those that take away from our stockpile of hope. Toxic people can strip away the work we do with a few words of criticism or anger. Protecting ourselves from them during this time is important. When we are feeling low on hope, we have to lean into those relationships that feed our souls and insulate ourselves from those folks that do the opposite. Of course, it is not always possible to stay away from a toxic boss or in-law, but recognizing their effect on us and being conscious of the need for self-protection is a starting point. How have you been coping during these times of crisis? How do you maintain boundaries? During the dual crises of COVID-19 and our national struggle for racial equality, we can find ourselves seriously depleted in mind, body and spirit. Being attentive to our own needs can help us navigate these troubled waters, and help us be able to respond to patients like Jim by being fully present.
  4. jeastridge

    Nurses Inspiring Hope During Hard Times: 3 Helps to Share

    Thank you for your powerful suggestions and insights. Joy
  5. jeastridge

    Tips for Nurses on Zoom

    Overcoming the Challenges of Zoom COVID-19 has brought along with it many changes, including nurses’ expanding use of technology to stay connected and to help their patients. Office visits, presentations, group meetings, and other gatherings are now happening on Zoom. As the months go by, we can expect even more usage of technology to substitute for in-person meetings, and it is entirely possible that these will persist even after the threat of the virus is gone. As we face new frontiers in technology in medicine, let us help one another adjust and maximize our success by sharing ideas. Below are some approaches to making the best of leading or participating in Zoom calls. If you have others, feel free to add them on below. As we face cancellations, alterations and modifications related to COVID-19, one bright spot has been the ability to use Zoom technology. Many people, of all ages, have been able to download and figure out Zoom on their smartphones, tablets or computers. While Zoom is fabulous for helping us gather in a virtual room, the process of leading a meeting, or even just participating effectively, can present new challenges. Leading a Zoom Meeting STEP 1 Plan Ahead Schedule your Zoom meeting and send out the meeting ID and password in plenty of time. Plan to double check and send out an extra reminder just before the start time. STEP 2 Assign Someone to be Backup When you send out your notice, send out the phone number for someone who can be a back-up tech person especially if it is going to be a large meeting. This can relieve interruptions and make the meeting feel smoother for the other participants. STEP 3 Set Up Before the meeting, set up the space where you will do your meeting. It helps not to have too much background clutter or a long view of the whole room. During this COVID-19 crisis, I have been surprised by all the national newscasters who have invited the nation into their dining rooms or living rooms. It’s interesting, but can be distracting! Also, set your computer up on a book or other elevated surface so that the camera is directed right at your face instead of capturing a less flattering shot going up from your chin! Of course, turn off all the background noise, including the television in the other room. It is surprising how much of the background noise gets transmitted through Zoom. Also, consider asking your participants to mute themselves so that accidental sounds don’t distract everyone. STEP 4 Redundancy in Notifications When life is more normal, people know what to expect and don’t have to think so much about the details of gathering. When using a new app, most of us need an extra measure of grace and a little more time. We also need frequent reminders via several communication methods—facebook, text and email. The leaders’ proactive approach can help minimize stress. STEP 5 Consider Your Own Appearance Whether you are a man or a woman, it is time to spruce up a little! It is considerate to look professional even if you are participating from home. STEP 6 Greetings It helps if the host can be present a few minutes before the start time. It is nice to be on hand to greet everyone by name and have each person say something to get started. Having an opportunity to speak initially, even if it is just to say name and job title, can break the ice and help folks participate more as the meeting continues. If you are talking with a patient via Zoom, be aware they may be nervous and unsure. So setting them at ease will make your visit more productive. STEP 7 Start as Promptly as Possible People like to know what to expect. Starting on time respects their time and gives everyone a much-needed sense of structure during this time where many of us feel somewhat “off quilter.” STEP 8 Assign Participants Ahead of Time and Have an Agenda Assign participants ahead of time and have an agenda- If someone is giving a report or going to be asked to participate in some way, it may be helpful to consider giving them advance warning. Also, asking people to raise their hands if they wish to speak can help the moderator/leader notice them—especially in a meeting that is crowded. Additionally, an agenda is essential to a well-run meeting. STEP 9 Ask Questions Leaders may want to plan to ask questions during their presentation to allow those in the meeting to have an opportunity to speak. It is hard to pay attention via zoom—even harder than when meetings are in person—so leaders do well to keep monologues short and to the point. STEP 10 Close Well Everyone appreciates a leader who ends on time. Because of our altered circumstances, people can lose track of time and prolong meetings unnecessarily. It helps to have an agenda, stick to it and announce is there are variations, including going over time. TIP: Zoombombing Zoom has recently implemented additional security measures to ensure that “Zoombombing” --people entering your meeting uninvited-- doesn’t happen. It is important to use both the Meeting ID and the password each time. The company that supports Zoom has been very responsive and worked to address problems as they come up. They also send out frequent evaluations so that users can let them know if there are issues. Patients and groups will respond well if they feel welcomed and heard. As a leader, your preparation time and the energy you put into making things go smoothly matters just as much now —maybe more—than ever.
  6. jeastridge

    Tips for Nurses on Zoom

    We are all getting tired of zoom at this point but it seems to be a necessary part of our lives for a while. Starting promptly and ending promptly are keys to a good meeting, in my book (even in "normal" times). One of the hard things about zoom is that leaders and can sometimes let things drag on and it's hard to say "I have to go."
  7. “I am so sad,” my four-year-old granddaughter said. Her words made my heart ache as I hugged her. Why are you sad, honey?” I asked, knowing full well why she was so sad. Her little world had been turned upside down by the novel coronavirus. The predictable routine of pre-school, playdates, birthday parties, outings had been replaced by prolonged stays at home and prohibitions against reaching out to other children or adults not in her quarantine circle. When I talked with my daughter-in-law, Mary Beth Wierman Eastridge, she agreed with me that we could work on a project together to write and illustrate a book for children to help them and their families understand and cope with the virus. We set ourselves an ambitious timeline and were able to complete the project and get it out as a free download: eastridges.com/covid. I am a Parish Nurse or Faith Community Nurse in my town. As such, I work with all ages, but now that I am a grandmother I have a special interest in children and young people. Working within the faith community during this trying time involves answering questions, guiding people to accurate information, helping parishioners cope with diseases unrelated to COVID-19, praying for them, and listening. Caring for our littlest ones, even babies, is particularly hard. As families find themselves working from home, or unemployed and at home, children are sometimes caught in the middle of times of high stress. How can we help our kids? What can nurses do to be a resource? Provide age-appropriate materials. When our granddaughter asked, “What is a virus?” It was tempting to go into a long, scientific monologue, something that would surely go right over her head and probably not be helpful at all. Instead, by sharing this book with her, we can talk about answers she might understand: “teeny, tiny” and “invisible.” This is challenging in a time when materials are still under development. With the suddenness of onset of this crisis, we all find ourselves looking around for ways to help. Listen first. When children ask questions, they often want to know less rather than more. Listen first and zero in on what exactly he/she is asking and then try to answer as clearly and as succinctly as possible. Keep the routine. Children often value and thrive on routine. They like to know what to expect. We laugh in normal times when they want to watch the same movie over and over or wear the same favorite sweatshirt. But these childhood characteristics become even more pronounced during times of change, illness and high stress. Anything we can do as nurses to promote a routine, to let kids know what to expect, and to allow for “sameness” will help children who find the ground is shifting under their feet. Set an example- Children follow and mimic well. They learn how to cope by watching the people around them cope. A calm adult, who shows competence, can help a child survive the unpredictability of a stormy time. What do you do if you don’t feel calm? Refrain from falling apart in front of the child. While this is easier said than done, don’t underestimate the impact of your attitude on those around you, especially the little ones. Nutrition and sleep Children need nourishing foods and good sleep—this much is obvious, so why even point it out? In times of crisis, it is tempting to cut corner and let mealtime go or allow children excessive snacking, less napping and more screen time. Without a doubt, screen time if preferable to screaming time, so if it is a choice between the two, the answer is easy. Setting aside consistent “quiet times” can help with the routine and also give the parent/caregiver some down time to recuperate their own energies. When children feel stressed, they will often react by having “bad dreams” and waking up frequently. While this is normal, it can add to the disruption the family is already experiencing. Reassuring the child and their family that this will pass, can make it more bearable. Set boundaries Setting boundaries—even if kids don’t like them—makes them feel secure. As nurses, we can help families understand and implement maintainable boundaries. Granted, this is not always possible, but we can encourage others and lead the way. Exercise It is a known fact that kids have a lot more energy than adults do. This can be a particular challenge during a time of quarantine and limited availability of outside play. Some parents are employing creative strategies to help their little ones get out some of their energy in constructive ways. There are dance parties, yoga classes for kids, relay games and a host of other productive ideas. Watch for abuse When parents/caregivers are under stress and kids are acting out, we see a possible set-up for abuse. As nurses, let’s be particularly alert to the possibility of abuse and try to intervene before it happens. COVID-19 has brought nurses again to the forefront of the national battle for health. We are on the frontlines in so many ways, including with our own families. What ideas do you have for helping kids cope during this time of COVID-19? Free Download Conquering COVID-19
  8. Thank you for sharing. I am sorry that you are going through such a hard time. While COVID-19 is hard for everyone it sounds like it has hit your family extra hard. Is it possible that you can find someone just for you to talk with? It might help to unburden a bit with a professional. All the best to you--prayers that this difficult situation is resolved soon.Joy
  9. Please do! Feel free to share. We want to help as many kids and their families as we can! Joy
  10. Thanks! I am so glad you like the artwork. Mary Beth did a great job. I hope your grandchildren like it, too, and that many children will find it helpful. Joy
  11. jeastridge

    My Inspiration to Become a Nurse

    So glad you went for it! Sometimes I think our workplaces are full of people who were afraid to do what they REALLY wanted to do--that kind of start doesn't make for very satisfying careers (e.g. #3 on your list...)! I am glad you followed your heart. Joy
  12. Interview With a Psychiatric NurseThis interview with Morgan L., an inpatient psychiatric unit nurse, started before the onset of the novel coronavirus. During the time of the interviews for this article, she volunteered to work with any patients infected with the virus. At this writing, the patients suspected of having COVID-19 are being sent to a nearby hospital for observation. She remains on standby to work in that capacity if needed. 1. I understand that you volunteered to work with COVID psych patients. Why?I volunteered to work with COVID psych patients because our administration said that if they didn’t have any volunteers, they would pick staff members from each unit, but certain staff members would be excluded if they had young children or were caring for someone elderly/immunocompromised. I knew I would be picked if I didn’t volunteer, and I didn’t want my administration to essentially say that my life is less valuable because I’m not actively caring for a child or elderly family member. Right now we don’t have a COVID unit, we are screening patients and watching for symptoms. If they have symptoms, we isolate them, send them for testing, and they usually get admitted to the hospital if they’re positive to be monitored for decompensation. We will only open a COVID unit if we see a significant surge in psychiatric patients with the diagnosis. 2. How has it been so far?COVID has been stressful on our unit - we’ve seen a lot more admissions for suicide attempts, anxiety, and drug relapses because patients can’t handle the stress of being out in the world right now. We’ve restricted a lot of our previous activities to limit patients’ exposure, so we no longer go to the cafeteria, have visitation, or go to activities groups. This causes the patients to be on the unit a lot more, cooped up with one another, and we’ve had a lot more disagreements and codes because of it. Needless to say, we’re all ready for this to be over. 3. Where are you from? What interested you in nursing?I was born and raised in Maryville, Tennessee. I initially became interested in healthcare when I was diagnosed with aortic valve regurgitation at the age of 12 after frequently experiencing shortness of breath and fainting spells. The nurses who cared for me throughout the numerous tests did everything they could to make me feel comfortable, even when they were going out of their way. I realized then that I wanted to do something with my life in which I could help people feel safe and loved when they’re scared. 4. Where did you go to school?I went to the University of Tennessee, Knoxville, for undergrad. I was delayed in school for a year and took three years to finish nursing school due to an arm injury that left me unable to move my arm. My current credentials are BSN, RN. 5. Where have you worked in the past?Throughout my undergrad I worked as a pharmacy technician at a chain pharmacy. The job was very stressful but I learned a lot, especially with medications. I also was a healthcare coordinator at a Summer camp in Occidental, California, for two summers, where I ran the first aid center and managed nurses and camp staff. I did my practicum during my senior year at Peninsula Behavioral Health and continued to work there as a behavioral health technician until I graduated and until I started work as an RN. 6. What interested you about psych nursing?Originally, I was interested in pediatric nursing due to my previous positive experiences. In a leadership program in college, I was paired with a child psychiatrist and spent many hours shadowing her as she worked in both inpatient and outpatient settings. I came to realize that while I love kids, I do not love the nursing aspect of caring for kids (LOL). I was very interested in the psychiatric side of things, and loved my clinicals in psyche nursing that followed. 7. What do you like about psych nursing?I love being a psychiatric nurse because I feel as if I can care for people who are not only suffering mentally, but are also fighting against the stigma of mental illness that exists in the world. I feel like patients who have mental illness are not only fighting their depression/bipolar/schizophrenia, etc, but are also fighting to inform others that their illness is real. A lot of patients have never had anyone listen to them before, so it is good to be this person for them. 8. What do you dislike about psych nursing?The hardest part about psychiatric nursing is balancing both mental illness and behavioral problems. A lot of patients have never had anyone listen to them before, so they have learned to make their presence known by acting inappropriately. Behavioral modification is necessary for these patients, and it can be exhausting. 9. Can you think of a particular case that stayed with you? That impacted your practice in a positive way?The case that comes to my mind is a patient from about four months ago who tried to commit suicide by driving her car off a cliff. She was severely injured and came to us after spending 2 weeks in the ICU She had a broken leg, a broken wrist, and over 50 stitches in her face. She was in a wheelchair because of a femoral cast, leaving her unable to walk. When I came on as her nurse the first day, I noted that her hair was matted. She told me she hadn’t had a shower since before her suicide attempt - 2 weeks in the ICU and no one had bathed her! (Except for a sponge bath in bed). Later that day, a tech and I took her to the walk-in shower and helped her shower, and I spent over an hour combing the glass, dirt, sticks, and blood out of her matted hair. She told me all about her family and how she had three children at home. She was a single mom, and two of her kids had disabilities, and her husband died unexpectedly the month before. She had become overwhelmed. It became very apparent to me how quickly certain life circumstances can change someone who previously had never been depressed and how mental illness truly does affect all of us. She became a new person after that shower, and had a more positive outlook solely because someone took the time to listen to her. This is why I love psych! 10. What advice would you give other nurses that might want to pursue psych nursing?I think if a nurse wants to pursue psych nursing, they need to make sure that they can aim to be non-judgmental with patients. A lot of our patients are judged in every other area of life, and they need a place to be where they won’t be looked down upon because of their choices. Also, have boundaries! Patients (especially those with addiction disorders) can be manipulative and will try to push you. It’s important to have boundaries with patients and stick to them.
  13. jeastridge

    Covid-19: What Nurses Can Teach

    One fact that stands out about this novel coronavirus is how little we really know even after we hit new daily world highs of cases. Currently, over 2 million cases exist and deaths stand at almost 150,000 worldwide. After a smoldering start in China, the virus has exploded on the world stage, infecting every country and continent except for Antarctica. Our efforts to contain, control and treat it are met with limited success. It is also true that the virus comes at a time when our country, in particular, is divided. People are responding to true science with skepticism and accepting rumors and conspiracy theory without question. It gets harder and harder to know which is which and as healthcare providers, we can find it challenging to distinguish and promote facts over fiction. Here are some of the questions we consider daily, trying to pin down easier answers: 1. What is the death rate? Because the illness extends over a period of days to weeks, measuring death rates from COVID-19 has been difficult. Best-guess estimates are currently somewhere between 1-3% with Italy reporting 12% and Germany 1%. Estimates vary so widely because the age of the persons contracting the virus can push that number up significantly. It is helpful to compare these to the known flu death rate which is 0.1% As time goes on, this number will become more accurate. For now, it is still largely in flux. Nurses need to recognize the difference between case mortality and infection mortality. The above numbers are case mortality, but infection mortality is largely unknown since we don’t test asymptomatic people at this time. 2. What are the symptoms? When we all first learned about COVID-19 we were told to watch for basically four symptoms: cough, fever, fatigue and shortness of breath. Coupled with recent travel, those symptoms were the ticket for getting one of the precious few tests. Time has altered our understanding of the presentation of the virus. Yes, the top four symptoms are still the gold standard, but the virus can vary its presentation by starting as a sore throat for a few days, maybe with a runny nose, then turn into fever and cough. A significant number present with gastrointestinal symptoms instead. Other symptoms include: headaches, body aches, severe fatigue, general malaise, chills, new onset loss of taste or smell. It is also disheartening that some people can have the virus and have zero symptoms. For the general public, learning and re-learning the symptoms—expanded as our knowledge expands—has been challenging. While they may be able to recite the first four, they may not be as versed on later accepted descriptions of possible onset. This makes it hard for an average person to consider they may have it when “all they have” is gastrointestinal discomfort and severe fatigue. 3. How is it transmitted? Because the virus is basically transmitted via droplets, coughing is the #1 mode of transmission. The novel coronavirus can survive on surfaces for variable amounts of time. It can also aerosolize which has made it particularly communicable in health care settings where breathing treatments, ventilators, Bi-pap and other pulmonary interventions tend to set the virus free in the air surrounding the infected person. The unpredictability of transmission has set many on edge because the virus is the great unknown. Where is it? How long does it survive on a shipping box, on a grocery store bag, on the countertop? All of these questions lead some to throw up their hands and give up trying, while others become excessively paranoid and struggle to continue with activities of daily living. 4. Viral load For most viruses, the amount of virus present at infection correlates with the illness severity. At this point, we do not know if COVID-19 follows the usual pattern of many other viruses. If that were the case, it would seem that people would get sicker when encountering more of the virus and less sick if subjected to a smaller viral load. At this point, scientists are still studying the behavior of this virus, which continues to be atypical in many ways. 5. Ventilator use COVID-19 has sparked intense discussion among medical professionals about the use of ventilators to treat the devastation inflicted by the virus on the lung tissue. The “standard” parameters for intubation do not seem to apply across the board, making what were once protocol-based decisions, much less reflexive. At this point, care teams are beginning to wonder if positional changes and other interventions are an important direction to focus on. Again, this virus is perplexing and far from predictable, making standard treatment options much less helpful. It is safe to say that over the next few weeks, care teams will continue to ask questions, explore answers and try new interventions. With time of the essence, we see medical providers taking bold steps to discover best treatment protocols. 6. Masks in public We are accustomed to seeing Asians wearing masks in public, even before COVID-19. Living in ultra-crowded conditions, they are forced to seek ways to protect themselves and others from potential illness due to infectious organisms as well as pollution. In the West, where masks have been less plentiful, we are now learning that they may be one of the keys to helping us slow the spread of COVID-19. As the saying goes, “My mask protects you. Your mask protects me.” As a kindness to others, and out of consideration for the possible protection that it may offer, we will all most likely need to wear masks for a period of time, especially as we try to re-introduce more “normal” life activities. As nurses, we help others by setting an example and instructing them to remember that the goal is not to eliminate all the germs but to lower the infectivity rate low enough so that the pandemic cannot sustain itself. 7. Physical distancing, washing hands, staying home While many questions remain, we do know that physical distancing is necessary for now and for the longer term. We will have to continue to practice obsessive hand hygiene and stay home a lot more. This requires that the entire society participate, otherwise it will not be effective. A friend said to me, “The real evil of this virus is that it has made every other person an enemy.” Her shocking statement rings true, as we all try to adapt and change our behavior. Just two short months ago, few people, not even the most erudite pandemic specialist could have predicted the extent of the disaster we find ourselves in: staying home with the economy at a standstill, airports empty, businesses shuttered. While the leadership and timelines are subject to argument and opinion, it is undeniable that nurses play an important role in combating and eventually dominating this foe.
  14. jeastridge

    COVID-19 and Faith Community Nurses

    For the past few weeks, my morning cup of coffee has accompanied an early morning check of the overnight news. While I am not a regular “news junkie,” I generally browse through it first, but this has been a different kind of time, flavored with a bit of urgency: reading with interest what the CDC has said and done overnight, checking to see whether there are new cases in our particular area, and getting caught up on the latest in research related to the novel coronavirus, also known as COVID-19. The Unknown The biggest revelation every day is what we still do not know: What precisely is the incubation time of this virus? How well do our antivirals work? When will we get a vaccine? What is the death rate, exactly? What stopped it in China? Was it social distancing or had all the susceptible people already contracted the disease? How many people have mild or asymptomatic cases that we don’t know about? We all search for and long to know answers to these questions. The answers are coming, but slowly. The test kits are also coming, but very slowly. We don’t really know what the state of current research is, or how close we might be to developing a test for antibodies (to see if someone has had it). We don’t know if anyone is close to developing some sort of vaccination or treatment. For now, we have little to go on. Preparation and Action So, how do we prepare for, and address a relatively unknown entity? STEP 1 Admitting we do not know is a start. As we make contingency plans, we must plan rationally and wisely for worst-case scenarios while hoping that the best will be a reality. STEP 2 Reaching out with hope and help to others. As humans, we need each other and social isolation plays havoc with that part of our make-up. Being conscious of our neighbors and friends who are lonely, is a starting point toward making a difference. Even while maintaining our “social distance” we can wave from a distance or smile to brighten up long days. STEP 3 Get outside. or my at-risk parishioners, I recommend some time outside, whenever possible. There is something about fresh air and open windows that helps clear depressing thoughts and make sadness and isolation more manageable. STEP 4 Plan for the long haul and hope for the short. Taking some time now to organize call groups, to plan for food deliveries, and to help with needed transport, can possibly help mitigate some of the deleterious effects of a long quarantine time. STEP 5 Encourage self-quarantine whenever there is any doubt. As members of the faith community, we want to be helpful to the public at large, and act as responsibly and selflessly as possible. Staying home when we feel the least bit ill, can be the first step. While most of us are used to trying to push through illness, it was never a great idea and now it is dangerous to others. As FCNs, it is often our job to educate our church community and to help them discern fact from fiction. In our time of information overload, that in itself is not an easy task. While it seems that misinformation spreads like an accelerant-fed-fire, the less sexy facts sometimes are ignored or not given the same attention and air or print time. Some of the messages we try to convey include: COVID-19 is a brand new virus and no one has built up immunity. While it can be mild in 80% of persons, the other 20% are at risk of needing advanced supportive care (possibly hospital-based). The initial symptoms are cough and fever and not the typical runny nose/congestion/sore throat picture we see with the common cold. (Unless, of course, it turns out that many of them do have this Coronavirus, and we just haven’t tested them.) It appears to be very contagious and we don’t know everything about how it spreads. Flatten the Curve In the USA, we would like to “flatten the curve” by practicing active social distancing and taking a break from usual activities. If we are successful, this will mean that while people will still get the disease, they will get it over a longer period of time and the burdened medical system will not be overwhelmed. The pandemic has been working its way around the world since January. Already we are seeing lessons learned in areas that have faced the outbreak and begun to see a decline, particularly South Korea where there are many Christian communities. In addition to the epidemiological concerns that all community health nurses have, FCNs have the additional opportunity to facilitate faith community fellowship, prayer interventions, and worship in ways that don’t spread the virus. Necessary Changes Over the last few weeks, churches have been trying to respond nimbly to breaking news. This is not a natural stance for religious congregations who tend to take things slowly, ponder over them, and then issue statements once unity is achieved. We have not had that luxury in this pandemic. We have had to look at situations, weigh options, take bold action by canceling many events, all the while working to stay connected and to continue to offer members of the faith community the support that they need. Many faith-communities have faced criticism for their actions: both staying open and closing down. As Faith Community Nurses, we are key to helping our leaders and parishioners understand necessary changes and, therefore, be better able to comply.
  15. Story #1 “Oh, I work a couple of shifts per week. Just enough that I can get out of the house and feel like I’m contributing, but not so much that I’m letting someone else raise my children.” These words spoken to me in passing cut like a dagger to my worn-out-mama soul. Her innocent implication that I let someone else raise my children as a full-time working mother piled on to the thickly layered “mom-guilt” I already put on myself. The cruel irony of this moment was that the words came from the mouth of my hospital nurse, as I was recovering from surgery, unable to be with, much less care for, my children in my current state. I was already in physical pain, and rather than alleviate my pain as her job should have been, she added emotional pain to my heart and mind. I feel certain that the nurse did not intend to wound me with her words. She was just “making conversation.” But what she failed to remember was that just another day at work for her was a huge life-altering experience for me. A hospital is a workplace for many, but for those of us lying in the beds, it’s often a scary and intimidating time. I implore you, keep your words positive and uplifting, or don’t say anything at all beyond the standard phrases of patient care. What you say can be just as much of the healing process as what you do.” Story #2 “I was in a rehab facility recovering from surgery to repair a shattered leg. I was in a lot of pain and had the feeling I was being judged unfairly as a ‘complainer.’ I just couldn’t get comfortable and desperately needed to talk with a doctor who had the authority to make some changes. During my discussion with the bedside nurse, she said, ‘You’ll see. Good will come out of this. Just think positive thoughts.’ Yikes. I know she meant well but that was NOT what I needed to hear. It may indeed be true eventually, but what I replied was also true, ‘I don’t need to hear that right now. I need words of comfort.’ Honestly, I don’t know if she even registered what I said.” Improving Communication Our words matter, don’t they? These simple comments, probably intended as attempts to connect, are received in a completely different way by the suffering patients. Sadly, the words linger long after the event and sometimes are repeated often as the patient struggles to make sense of a tough time. How do we improve our practice so that we don’t commit these types of gaffes? Researcher Brene Brown says, “Rarely can a response make something better. What makes something better is connection.” Making gentle connections without adding to our patient’s pain is our challenge, isn’t it? While this type of sensitivity may come more naturally to some than to others, all of us can learn and become better nurses in the process. Keep it Professional When we are in the patients’ room, our conversation and concern should be about them. We are not center stage. If they ask personal questions, it is courteous to answer, but generally, they are just being polite and they don’t really have the energy to know or care about our extended family or our troubles with our children or whatever our concern of the day might be. If the patient is argumentative or disgruntled or venting, we can begin to feel defensive and be tempted to offer them correction (or more!). Once a friend taught me the technique of saying, “Hmm. I had not looked at it quite that way…” and then let the sentence trail off without engaging. Another tool that can help us here is to answer their question as succinctly as possible and then turn it back to them with a question that helps us understand them better. Be Empathetic Our patients are sicker than ever before. Their family members are often super-stressed. As professional nurses, our job is to care for them to the best of our ability while recognizing the strain they are under and giving them extra grace in their time of need. Sometimes simply being present, prompt and professional is our best response—no particular words needed. Repeat What They Said Many of us nurses remember learning in nursing school about being good active listeners and reflecting back what the patient tells us by saying things like, “So you are saying…” In other words, finding ways to clarify what they say to make sure we are on the same page. Be Genuine When we are confident and comfortable in our own skin, we transmit that to others and help them feel comfortable as well. Being genuine does not mean that we tell people what we think, it simply means that we acknowledge their inherent dignity as persons and that we care for them with competence and professionalism, meeting their needs in the best way we can. No One is Perfect We are all going to be less than stellar nurses from time to time, but we must also keep trying to improve as we move forward in our careers.
  16. The Dreaded Diagnosis: Lice As Chris, RN, took report for the day shift in the Pediatrics ICU, she overheard the dreaded words: lice. Tuning in, she paid attention as the staff discussed a 3 year old being treated for RSV who was improving but began vigorously scratching her head, to the point of leaving marks along her hairline and around the base of her neck. When the night nurse leaned in to examine her head, she noticed the lice moving. Drawing back, she motioned for the doctor who was nearby to step over. Together, they confirmed the unpleasant diagnosis: lice infestation. Pediculous humanous capitis or head lice, are “ 2.1–3.3 mm in length. Head lice infest the head and neck and attach their eggs to the base of the hair shaft. Lice move by crawling; they cannot hop or fly.” - Parasites - Lice - CDC They feed on human blood and lay their eggs, called nits. Who Gets Lice? Almost on cue, all the staff felt their scalps crawling and began to have the urge to scratch. While lice are not a health hazard, per se, there is a strong stigma attached to having lice. The truth is, however, that the infestation affects all socioeconomic levels and all ages but primarily children in crowded conditions, especially Caucasians. “Head lice are more common in girls than in boys and are more common in Caucasians than in African-Americans. Anyone can get head lice. It is not a sign that a person is unclean.” - Head Lice - Cleveland Clinic Chris said, “It is unfair to equate lice with poor hygiene. At times, they do go together as families who live in conditions where there is no running water or access to lice treatment, can have significant problems. These issues will often become apparent at admission during the history-taking process. Sometimes we see red flags that alert us to check. But sometimes, we miss the infestation as we are busy prioritizing other needs that are more life-critical and it is only after they are stabilized and doing better that we detect lice. Lice is an equal opportunity infestation.” Chris elaborated that the detection of lice almost always fills everyone with dread because lice can be so hard to eradicate. It takes a concerted effort, treatment of the whole family, cleaning of all linens, car seats, upholstery—it’s a job! How do you diagnose lice? Scratching When people have lice, they usually scratch vigorously, so hard, in fact, that they sometimes have scratches along the hairline and around the ears and at the base of their necks, where the lice are most likely to take up residence. Children will employ a “two-handed scratch” where they get both hands up to their heads. Their hair will often be tangled and messy because of the scratching. Visualize In the hospital, to diagnose it, you have to see a louse and have it confirmed by a second person, usually the doctor. Also, sometimes the nits, little white eggs that cling tightly to the hair shaft, are the first sign. So what do nurses need to know? And how do we best help ourselves and our patients? Getting Rid of Lice Getting rid of lice is not always easy. It requires dedication and persistence but it can be done. By encouraging our patients and their families in a straightforward, professional manner, we can maximize their confidence and their potential success. Reading about it on the internet can sometimes raise unreasonable fears of “super lice” and persistent infestations. It might be helpful for us to give our patients guidelines from trusted sources such as the CDC and Cleveland Clinic. The CDC.gov site has thorough and practical recommendations. Treatment with lice/egg killing pyrethrins is the beginning of the process. Some pediculocides are ovicidal and some are not. Sold over the counter in kits, the shampoos are generally effective in eliminating the lice. Following up with dedicated hair combing for nits is critical. Otherwise, the eggs will hatch and the infestation will return. Some sources advise treatment of the head, treatment of the environment, daily nit removal and then a repeat treatment in 7-10 days with continued combing after that if nits are found. If treatment with over the counter kits is not effective, patients can follow up by contacting their primary care provider for perscriptions which go by brand names such as Sklice, Ulesfia, Ovide and Natroba. Practical tips on combing it out: Wearing gloves, brush the hair first to get the snarls out (then clean the brush). Treat the hair as per directions on the box. Divide the hair into very small segments. Using a nit comb from kit, comb through thoroughly, using detangle spray. (Sometimes provided in kit) After each pass of the comb, wipe it off on a paper towel or toilet paper and discard into a prepared trash bag. Wash all combs, brushes, towels, hats, etc. after each treatment. After initial linen and pillow wash, consider changing pillowcases and washing favorite blankets or stuffed animals daily throughout duration of the process. Internet solutions are plentiful. Some of them have merit such as the “goop” that helps make the hair slick and easier to comb through after the initial treatment. Additionally, parents can find community and support online, when sometimes talking with family or other parents is hard. Prevention? The usual recommendations involve keeping hair pulled up and back off the face, not sharing brushes, combs or hats and prompt treatment when problems are discovered. Lice treatments can be expensive for parents on a limited budget. It is important that we be sensitive to this and try to help parents find funding for treatment kits as well as for the laundry a lice infestation generates. Working together in hospitals, schools and daycares, we can help promote prompt treatment and fewer cases of head lice. Are you itching yet????
  17. Gathering my thoughts and hospice computer, I climbed the outdoor steps to the second-floor apartment. The gloom in the small room was palpable as I entered. Crowded together on the couch sat a group of relatives and sitting close by in a worn recliner was the patient, a man in his late 60’s, jaundiced skin betraying his terminal diagnosis of advanced pancreatic cancer. On the arm of his chair, arm circled protectively around the top sat what appeared to be a daughter. After the introductions and greetings, we began to talk about what hospice is and does and how our services might be of help during this time. The patient waved his hand weakly to indicate his desire to speak, “This is it, isn’t it? I don’t have any more hope.” It seemed almost as if everyone took a collective breath, held it and turned to me, waiting for some word that would help them through this impossibly difficult moment. What would you say at this point? As professional nurses, we are present to help people wherever they are on their journey. From pediatrics to geriatrics and everywhere in between, we work to help people recover, rehabilitate, or compensate. Sometimes, we find ourselves in situations such as the one describe above which fits the traditional definition of “hopeless,” and yet, we are there to help inspire some degree of hope, however small. What is Hope? The stuff of life... As long as we have some hope, we can keep pushing forward. A thought process... Researcher Brene Brown says, “I was shocked to discover that hope is not an emotion; it's a way of thinking or a cognitive process. Emotions play a supporting role, but hope is really a thought process…” (http://www.bhevolution.org/public/cultivating_hope.page) A tool to face the day... Sometimes we hear ourselves or our colleagues referring to a reluctance to encourage “false hope,” or the possibility of inspiring unrealistic expectations in our patients. Given the definition above, maybe false hope is not such a concern since hope might be more about giving those in our care the tools they need to face the day, so they can manage to wring out a bit of joy even in the midst of terrible trials. Hope fills the balloon of life... We talk about hope all the time: I hope it doesn’t rain; I hope I don’t spill spaghetti on my white blouse; I hope he passes his test; I hope he gets better; I hope I will be forgiven. It is the same word, but holds vastly different meanings! Hope is hard to pin down—it fills the balloon of life and floats, held by a string of desire, tightly wound around our fist of determination and strong will. We won’t let go, for as long as there is hope, there is life. So what is our role as nurses in inspiring hope? Set goals. While it is impossible to foresee the future, with our knowledge base, we can help our patients set goals they have the ability to meet. We can help them set goals for today, e.g. “Let’s focus on getting bathed and dressed and sit in the bedside chair for 20 minutes. Does that sound good to you?” Meeting goals, even small ones, helps us to feel a sense of achievement and success which gives us hope for reaching other, more long-term goals. Focus. When life feels out of control, our patients may need help in focusing their goals and hopes on a more short term accomplishment. After a major stroke, or some other serious health set back, people have a hard time with looking too far ahead. We can help them reframe their thinking and thus give them true hope. By listening carefully and asking questions, we can help guide them to their own goals, zeroing in on what matters most. Reframe. When we get down to the nuts and bolts of life, time on earth is always rather limited. But when our patients and their families face a hospice nurse at the door, the limitations seem rather glaring and hope appears to take its bright light over into a corner where it is hard to reach. By helping our patients reframe their thinking to goals that are achievable in this new setting, we can help them have hope. For example, finding out what really matters to them in terms of pain management, family time, and closure can help leave them with a measure of hope. What to say? As I faced the family, I breathed in too, silently praying for inspiration and desperately asking for wisdom. “This is pretty hard, isn’t it? What is the hardest part for you?” I asked. He went on to talk about his fears of being a burden and of having pain that would be out of control. Once I understood his greatest concerns, I was able to help him and the family make plans for caring for him and was also able to describe some of our pain control plans. As we spoke, I could feel the gentle presence of hope re-enter the room. While the hope of eradicating his pancreatic cancer through treatment appeared to no longer be an option, there were other parts of his story that opened themselves up to hope and plans. Make each day as good as it can be... As I gathered my things two hours later, I touched the patient’s hand and spoke to him and his family, “None of us knows what tomorrow holds. But we will do our very best to care for you and to help make each day as good a day as it can be.”
  18. Bah humbug! Driving to the hospital, I reached over and clicked off the Christmas music that proclaimed a commercialized version of the holiday was fast approaching. I just wasn’t in the mood for “jolly” when all around me, I witnessed sadness, loss and broken hearts. Besides the heaviness for my patients, I also felt burdened by the expectations of others’: gifts, meals, cards, cookies all seemed to sweep through my busy mind, riding on the wings of a tornado-like wind that whipped the whole mess into a funnel cloud and plopped it all in my lap, there to sit with the other normal chores which required attention—just the usual laundry, grocery shopping, car maintenance (yes, mine was in the shop again…) routine. The "Right Way" I know. I know. It’s supposed to be fun and meaningful. The expectation is that this time of the year, focus solely on the reason for the season (for Christians, that is the birth of Jesus and for others maybe it is family gatherings and gift-giving with love). Whether you have a spiritual bent or not, we all know what it is to feel the pressure to do things the “right” way and the subtle competition to manage it all with great aplomb. As a Faith Community Nurse, one of the things I do is visit people when they are in the hospital with a focus on helping them transition to an appropriate post-hospital stay location. For some, that is as simple as suggesting rehab facilities to the family, and for others, it is helping them prepare to take a loved one home to a greater level of care than previously. At Christmas, illness, falls, disease, cancer do not go away. In fact, their prevalence and effect seem more pronounced as others hang garland and put on old Christmas sweaters and indulge in homemade Christmas candy. Charlie's Story I pulled into a parking space and headed up to visit Charlie, a parishioner who had been in the hospital for an extended stay with complications from a routine surgical procedure. Already elderly, Charlie’s small family was mostly gone, and he had very few resources. I sat down and caught up on the last two days’ news when the Case Manager stopped in to discuss possible placement in a local nursing home. Charlie was sad but resigned, realizing that he couldn’t go home and that he needed the rehabilitation this facility offered. But it was almost Christmas. And it was sad. I saw his eyes sparkle with unshed tears and squeezed his hand, offering the gift of presence and silence. He returned my gaze with a small smile and said, “I’m not worried. I will be ok. I have faith.” Charlie’s words both encouraged me and challenged me. His ability to maintain perspective in the midst of great obstacles inspired me to shed some of my feelings of resentment and heaviness and to replace those negative feelings with something that comes from light and life and love. In those few moments, I tried to reframe my own thoughts and ask myself a few questions about how I can face excessive expectations and maintain my morale? How to Encourage Others As nurses, how can we keep working to encourage others even when we feel discouraged ourselves? Keep first things first- Even in the middle of a busy season, let us not forget to maintain our centeredness—whether it is reading a spiritually encouraging book, doing Yoga, going for a brisk walk outside, corporate worship—whatever feeds our spirits needs to take precedence over the other chores that might try to crowd it out. Busyness has a way of wanting to be more important than it really is, doesn’t it? Get rest and eat right. We can provide well for our patients, our co-workers or our families if we are running on empty. It may mean turning off that TV or letting our Facebook feed rest for a few days, but it is critical care for our bodies to get balanced rest and food, especially during the busy and challenging holidays. Maybe find someone to talk to. Holidays can bring out our own pasts and our sadness over previous losses. Unfortunately, this has a way of spilling out all over our lives in strange ways. We find ourselves angry and frustrated “for no reason” and over-reacting when someone asks us to bring a side dish to a gathering or participate in a secret Santa exchange…Over the top responses can signal that there is more going on than we are consciously aware of. When we feel like a pressure cooker waiting to explode, it may be time to pro-actively seek out some help in the form of a spiritual adviser or a trained counselor. Working hard in a therapeutic counseling relationship can be some of the best investments we make in time and energy. Working through past trauma and grief pays off big dividends in the present as we try to be the best nurses possible for our patients and the best family members we can be to our families. Cut yourself some slack. When the external pressures are high, sometimes it helps to acknowledge it and to also accept our own limitations. Perfection can be the enemy of well-being. As I wrapped up my visit with Charlie, he said, “Thanks for coming. It will be a good Christmas no matter where I am.” After a quick prayer, I left and walked back toward my car, feeling lighter than when I came, daring the “Bah-humbug” spirit to try to bother me again!
  19. 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?
  20. A few weeks ago, several of us nurses got together for a cup of coffee outside of work, a rare event but an occasional holiday celebration. We sat around a table, holding our hot drinks and warming our fingers from the bitter cold outside. After some light banter, one of our colleagues shared a recent difficult encounter with a patient, one that left her feeling defeated and out of sorts as a professional. We all listened intently, and it was interesting to observe the various responses from her friends and co-workers. Because our responses were so reflexive, it made me think that we might also respond this way in other situations. Is good listening a skill we can learn and get better at? Consider the responses from around that table and think about how you respond to patients, co-workers, family members that share vulnerably with you. 3 Responses 1. Almost before she could finish her story, one of the group asserted loudly (even pointing a finger in her direction), “I would not take that. I think you should respond by saying…” She went out to detail how the conversation might have gone had she been a participant, laying out clearly what she saw as the answer to her friend’s problem. Her body language, her forcefulness, her certainty all seemed to push the storyteller back in her chair, away from her cup of coffee, as she raised her eyebrows questioningly. “Do you really think so?” She queried, her hurt and confusion visible and audible. 2. A second person listened a little longer then said, “Well, I don’t think you should feel that way at all.” She continued to “should” all over the teller, minimizing her struggle and essentially asking her to harness her feelings into something less hurtful than they really were. “Shoulding” is so common, isn’t it? 3. The third person, the speaker’s close friend, remained quiet through the various exchanges, allowing the story to have plenty of time and space. She leaned forward a little before quietly offering her empathetic response: “What happened to you really stinks. I am so sorry that you had to go through that.” To me, it felt like she came alongside her friend and figuratively put her arm around her shoulders, sharing the difficult space and sitting with her as she felt the feelings she was feeling. Same story, three very different responses. Where do you see yourself? Ideally, we would like to say that we are consistently in #3, but most likely, we vacillate in our responses, employing all 3 from time to time and moving back and forth. Adviser The advice-giver meant well, but she effectively shut down communication, didn’t she? By delivering her pronouncement, she declared that she knew what was best and how that situation could be resolved. As unrealistic and presumptuous as her response is, we see it and experience it often, don’t we? People want to “set things right” by their standards and don’t want to leave a lot of uncertainty hanging around. While it is possible to offer advice, people rarely really want it, even if they ask. Generally, people need to work out their own individual approaches, their own answers, in their own time. Occasionally, if we have been in the exact same situation (unlikely) we can share what we did, but most of the time, those who share with us are looking for validation, a careful listener, and help in the form of a well-placed question such as, “So how do you feel about things now?” The advice-giver’s body language also closed more doors. Finger-pointing rarely feels good to the recipient of the gesture. It can be a strong, power-loaded motion, one that requires careful thought before deployment. “Should-er” The “shoulding” friend also delivered a put-down, didn’t she? We have the right to our feelings even if our feelings are not right. Feelings are proprietary. We acknowledge them, deal with them in our own way and hopefully find a path to mastery over time but “shoulding” brings some shame into the picture and makes us ask ourselves, “What is wrong with me to feel this way?” Of course the “should-er” doesn’t mean to elicit these feelings at all; she simply wants to make everything “all better” and smooth over discomfort. She longs to fix it, doesn’t she? As nurses, we can be attracted to the profession because we long to help our patients. This charitable desire has a dark side which is the “fixer” of the profession—always knowing what is best for others and letting them know what we think instead of allowing them to feel their own feelings and find their own way. If not carefully monitored, our desire to help can morph into control and manipulation and codependency. Empathetic The third friend’s empathetic response felt the most compassionate to me as I observed these interactions among friends. While the first two seemed to close doors of communication, the third response pushed the door ajar, allowing for future conversation and more opportunity to discuss the hurtful occurrence and to process it. The conversation at the table moved on to less heavy topics and we continued to share and laugh as our coffee cooled, offering healing and support to one another. Long after we went our separate ways, I thought about what I had witnessed and how many times we miss the mark in our responses to others. Were #1 and #2 “wrong” and #3 “right?” Well, yes and no and maybe. We are not perfect humans. We must offer each other grace and forgiveness every day if we hope to find any joy at all in this life. Friends sometimes say the best thing and sometimes not. We don’t discount their input either way, and we usually try to overcome differences. But such conversations shine a light on how we communicate and can help us to pause and think as we listen to someone’s story, careful as we try to respond with empathy and concern.
  21. jeastridge

    Nurses and Bullying: 4 Things You Can Do

    Thank you for your response and glad you stayed with it! Joy
  22. “Code Green 5th floor. Code Green 5th floor.” The hospital operator’s voice made my pulse skip a beat even though I was far from the announced location. Code Greens [in this case meaning a combative person who may be armed] have become more common as we face more crowds, more recreational drug users, and more angry, frustrated people in our facilities. As nurses, we are sometimes part of situations that lead to the dreaded “Code Green” announcement as we call out for the necessary help. We undergo training in how to respond and follow the required steps, but we do begin to wonder if the number of these types of crises is increasing, and if so, why? The Team Approach Some hospitals have successfully formed specialized teams to address Code Green situations and to help de-escalate highly charged encounters. At Pinnacle Health System in Harrisburg, Pennsylvania, their Code Green Response Team, started in 2013, has saved personnel and patient injury, money and time away from work. Their example may be trendsetting as other systems look to find ways to decrease violence inside our hospitals. Code green prevents workplace violence Trauma-Informed Care Another opportunity for learning and forward-thinking is the Trauma Informed Care Project .The training invites participants to acknowledge that past trauma affects daily behaviors. Children are especially vulnerable to the effects of trauma and many childhood experiences accumulate to produce adverse effects leading to the term ACES (Adverse Childhood Experiences). The website goes on to explain that the goal of this foundation and this project is “organizational structure and treatment framework that involves understanding, recognizing, and responding to the effects of all types of trauma. It emphasizes physical, psychological and emotional safety for both consumers and providers, and helps survivors rebuild a sense of control and empowerment.” During the training, participants are invited to re-think “acting out” and instead of asking “What’s wrong with that child?” Ask instead, “What happened to that child?” These subtle but significant shifts in thinking can help us move from finger-pointing and judging to more constructive patterns of interaction where healing can actually take place. Emotional trauma carries over, of course, into our adult years. If unacknowledged, untreated, unresolved, it can surface unexpectedly and often explosively, leading to our current question regarding Code Green. Victims of traumatic incidents can sometimes repress or “forget” the memories of what happened to them only to have those come back during challenging or stressful times —such as times in the hospital with a loved one or being sick and in pain themselves. The post-traumatic stress of past troubles can lead to excessive anxiety, anger, and unstable emotions. The Body Keeps the Score In his book, The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma, Bessel Van Der Kolk, MD, asserts that past trauma manifests itself in actual physical disease. If unresolved, trauma will eventually lead to physical illness in a variety of diagnoses. “Even though the mind may learn to ignore the messages from the emotional brain, the alarm signals don’t stop. The emotional brain keeps working, and stress hormones keep sending signals to the muscles to tense for action or immobilize in collapse. The physical effects on the organs go on unabated until they demand notice when they are expressed as illness. Medications, drugs, and alcohol can also temporarily dull or obliterate unbearable sensations and feelings. But the body continues to keep the score.”(p46) Responding Appropriately As nurses, we are occasionally faced with responding appropriately to challenging situations: talking an agitated patient down, listening well, knowing when to get help. How can we prepare ourselves to be even better equipped to face difficult encounters? Be in the Know Take mental health classes that are offered for CME; the Mental Health First Aid class is valuable as are the Trauma-Informed Healing sessions. Learning about mental illness, PTSD, and other psychiatric illnesses gives us a good preparatory knowledge base. Responding Empathetically When Possible This can help resolve some low-risk situations. Many people long to be heard, really heard. They may even realize that we cannot resolve their situation, but they don’t want to be brushed off. They want to know someone cares. For some, that may be the beginning of healing and just what is needed to get them through a rough patch. Call for Help as Needed There is simply no substitute for getting help when a crisis arises. Maybe your facility, like Pinnacle Health, can consider starting a Code Green Team which specializes in defusing and de-escalating crisis situations. Sadly, Code Greens are more common than we would like for them to be. There are a lot of hurting people out there: both our patients and those that are surrounding them in their time of illness. We have no way of knowing what trauma might have happened to our patients or their families and loved ones previously. But we do know that they carry those hurts with them when they come in for treatment. As nurses, we are often presented with really messy scenarios. Being professionals, we do our best to make the best of even the worst of times. What helps you to respond appropriately to tense situations?
  23. jeastridge

    Code Green and Emotional Trauma: How Nurses Help

    Thank you for your honesty. You make excellent point. The staff should always call a code green whenever there is a threat. I'm sorry it feels like the article implies otherwise. That was not my intent. Joy
  24. jeastridge

    Code Green and Emotional Trauma: How Nurses Help

    Thank you for your helpful comment. You highlight the importance of preparedness, knowledge and rapid response. Joy
  25. jeastridge

    Code Green and Emotional Trauma: How Nurses Help

    So well said. Thank you for your thoughtful comment and for sharing your perspective. You make some important points. Joy

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