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Carol Bush

Carol Bush

Oncology, Telehealth & Entrepreneurship
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Carol Bush specializes in Oncology, Telehealth & Entrepreneurship.

Carol is Content Strategist, Writing Coach and Owner of The Social Nurse. She is founder of The Healthcare Writers Network. She has over 30 years experience as an Oncology Nurse & Clinical Consultant and is a graduate of the Mayo Clinic Social Media Residency. Carol followed a circuitous route to a career in oncology. Her first undergraduate degree is in Ag Journalism. A nursing degree followed 10 years later, after three children and an unknown number of pizza suppers. She lives on four peaceful acres, with her sweetheart, Don. She enjoys gardening, cooking, and stalking her adult children via social media.

Carol Bush's Latest Activity

  1. Thanks! I love the challenge of home care & hospice! One of my favorite nursing prn roles was working as a Hospice Triage Nurse every other weekend. (putting the kiddos through college!) I learned a lot from families AND a lot about Nurse Macgyver - ing!
  2. To begin this story, you are a home-care nurse, and a good one at that! You receive your initial intake referral form. The internist has asked you to go admit a 76 year old woman on 4 liters of oxygen, with shortness of breath and low oxygen saturation due to Congestive Heart Failure. She was just discharged from the hospital yesterday. On the drive over you are thinking about what kind of mobility and assistive devices she might benefit from, whether a home health aide will be of help, etc. ( This will be a quick in and out visit, you think to yourself). You get to the home and ring the doorbell, and are invited in by a overweight gentleman in his 50's who smells of cigarettes. Being the astute nurse that you are, you look around as you are escorted to your patient. While following the long trail of oxygen tubing, you see empty fast food containers, caffeinated soda cans, ashtrays, a jar of bacon grease next to the stove.....oh my! You enter the room where your patient is and find at least 5 people reclining watching "the judge shows". The whole family has shown up to meet the nurse! So much for getting in and out in a timely fashion. As you are taking your history and physical you realize that Mrs. Smith (who is so fragile and sweet by the way), lives here with her son and their family. Mrs. Smith is a lifelong smoker, with Type 2 diabetes and hypertension. Her husband passed away suddenly of a heart attach a few years ago which prompted her to move in with her son. You review her lengthy medication list which includes every thing from insulin to anti-hypertensives, diuretics, blood thinners, inhalers etc. On exam she is short of breath at rest, "junkie" lung sounds, blood pressure is elevated, 3+ pitting edema in her lower extremities, her heart rate is controlled and she has an 02 saturation of 88% on 4 liters of concentrated oxygen. You can see the revolving door of the hospital moving as you continue to assess. (As the well read and current nurse that you are, you know that CHF has a high rate of hospital readmission and can be prevented.) You take a deep breath and open up your mental Mary Poppins bag of cardiac education tools to keep sweet Mrs. Smith home with her family and for that matter maybe impact her family members health as well. You take out a balloon (great tool for nurses to keep in their pocket especially any heart health nurse). Comparing the balloon to the heart, blow up the balloon to over inflation and then let the air out a few times. This gives a visual demonstration that the balloon walls weaken and become flimsy with bunches of less toned muscle that create a decrease in the ability to squeeze out the blood your body needs for energy and oxygenation. There are a few reasons for that. Just like every other muscle in your body, it needs exercise, good nutrition and care. You continue by scaring the stuffins out of the patient and her family with your smoking around oxygen lesson. You tell her about the patients you have cared for that have burned their nasal hairs and nasal passages while smoking with oxygen via nasal cannula. In case that didn't effect them all, you share the story of an elderly smoking patient who set her apartment on fire and sent the lady in upstairs apartment to the burn unit . She fell asleep with her cigarette lit and the tanks exploded! Softening things up, you go on to explain that smoking not only affects your lungs, but also is a vasoconstrictor which worsens the hypertension and workload of your already tired heart. Next you ask about nutrition and diet. Mrs. Smith's daughter-in-law proudly states that they made Mrs. Smith's favorite dinner last night as a welcome home celebration....baked ham, mashed potatoes with gravy (of course), and collard greens with fat back and sweet tea! Holy sodium batman!! That explains our edema already this morning! Sigh....so you dig out the cardiac/ heart failure diet pamphlet packed full of low sodium, low fat, caffeine free, lean meat, high veggies and fruit and fiber filled alternatives to the family's recipes from Great Grandmama. (you hope it doesn't just get used as a good spot to place your coffee cup on). After many grumbles and eye rolls, you explain that caffeine is also a vasoconstrictor and that the fats produce sludge in the arteries making matters of the heart worse. Sodium pulls in fluid and since the heart is not strong enough to manage that extra fluid, it hangs out in the legs, feet, hands and worst of all the lungs. You take out a scale from your bag of tricks to leave with Mrs. Smith and ask her to log her weight daily to keep track of how much fluid she may be retaining. You go on to demonstrate some very light physical exercises, (perhaps cardiac rehab may already be initiated), that can be done in the chair and encourage movement around the house to help with fluid reabsorption and also to prevent blood clots from sitting still too long. Blood clots can also form in the heart since the heart muscle is weak and may not be squeezing all of the blood out of the chambers each time leaving pooled blood prone to clots. You review the importance of taking all of her medications on time each day and encourage a pill box to help keep track of what she has and hasn't taken for the day. We all forget! Review the protocol for chest pain including nitroglycerin sublingual tablets in the discussion, if prescribed, and of course when to call the home health nurse, doctors office or in emergency, 911. You realize that somewhere along this education session, you have all sets of eyes on you and the "judge show" has been silenced. Maybe, just maybe you affected some of the family members health choices in this process. You have provided all the tools Mrs. Smith AND her family can use to help her heart function to the best of its ability....and made some bonus listeners say "hummmm.....maybe i should cut back on fats, sodas and get a walk in a few days a week". So to wrap up this tale, you place a "NO SMOKING! OXYGEN IN USE!" sign on the front door as you leave that visit. You continue to follow and care for Mrs. Smith and her family. You modify treatment plans as you communicate with her physician when needed and begin to notice the lifestyle changes necessary to optimize your patient and family's health. Good work home care nurse extraordinaire! Check out these Resources! A great website for grocery shopping tips and info: Family Grocery Shopping Tips, 5 Easy Ways to Find Healthier Options at the Grocery Store. For Your Patient Education Library Patient Education Resources for Healthcare Professionals. How about a Blood Pressure Wallet Card for your patients? https://millionhearts.hhs.gov/files/BP_Wallet_Card.pdf
  3. Carol Bush

    Breaking Bad News: What's A Nurse to Do?

    So glad you found the videos helpful, Nancy!
  4. Carol Bush

    Breaking Bad News: What's A Nurse to Do?

    Thanks for your kind words! I look forward to reading your blog! Have a great day!
  5. Repeat after me: "Money is a tool." As part of our toolkit, it's something we can gain competency in managing, just like other tools we use in our nursing practice! First, a couple of disclaimers: 1. I am not a financial adviser, nor a financial expert. I have had life experiences not unlike many of you: putting a spouse (and 3 kids!) through college; divorce, the stock market crash and caring for elderly parents 2. Today I am writing from a woman's perspective. This is not because I don't respect the experiences of my male nursing colleagues. This is just the lens through which I see the world. Women are working and earning more than ever before, and, because women tend to live long lives, they have a better-than-average chance of inheriting assets or a business at some point. Let's consider these facts from the Department of Labor We now account for more than half of U.S. college undergraduate and graduate students. We make up roughly half of the U.S. workforce. Our average incomes have increased 91% from 1970 to 2010. More women now out-earn their husbands. These ongoing shifts in education, employment, earning power, and wealth ownership present challenges and opportunities that we must ALL learn to integrate with our hopes and goals for ourselves AND our loved ones. Yes, you read that right...our loved ones Sometimes parents ask their adult children for money, as they struggle with the financial stress of debt, a job loss or the rising cost of retirement living. For those of us with elderly parents, 76% of adult children say they are providing them with financial assistance, according to Pew Research YOWZA...that is NOT something I planned on...did you? The Time is Now Fidelity conducted a poll which revealed more than half of the nurses surveyed said they "lack confidence in making financial decisions". The primary factor being that they did not have time to focus on it. No matter the stage of your career, it's time to start caring for yourself. As the saying goes, "If you don't look after yourself, no one else will." What was that I said? Yourself? Who's that? You are so busy caring for your patients, family, and friends; you forgot about YOU! We owe it to ourselves to be smart with our money. Here are FIVE ways you can get started today! 1. Pay Yourself First! Sounds simple enough, but so many people don't put money away each month. One of the greatest mistakes we make is living paycheck to paycheck, without respecting ourselves and our future first...by saving. Take the first step by saving for a rainy day fund that covers 3 - 6 months of expenses. Then, start researching mutual funds so you can earn interest and that sweet financial manna known as 2. Put as Much into Your 401K as Possible If you work for an employer that provides ANY percent match for your 401k contributions, that's FREE MONEY, folks! Go after it! Even if you don't get a match from work, try to max out your 401k or IRA...or put away as much as you can. This money goes into your 401k or IRA tax-free, which means all that extra tax-free money can grow and earn interest over time. ( PS...Remember, I'm not a financial expert!) Read more on the IRS website: 2016 Retirement Account Contribution Limits. 3. Follow the Money If you love numbers, this is a piece of cake. For those of you a little less enamored by numbers (like me)...this may sound awful. I have found one of the best ways to set up & follow a budget is to make it fun! Here are two tools you can use....for FREE...that I have found helpful. Try them both and see which works best for you. Dave Ramsey's EveryDollar Tool - You can budget from your computer, iPhone or Android device with this cloud based tool. It tells you where "every dollar" is going. Try it for a few months to see if you guess correctly. Success Tip: It takes a little while to get organized at first. The extra time spent organizing will pay off! At the beginning of each month, you will be ready to take it on because you have already planned it out. Mint - This is another great free tool to help manage your finances. And yes, there is an app for your phone! A word to the wise: don't focus so much on achieving the zero budget as much as the every dollar tool. 4. Learn a New Skill & Monetize It! If you are not making enough money at work or dream of one day owning your own business (a risk that could pay off handsomely), learning a new skill can increase your value to your employer or give you something you can build your business around. Feel like it's hard to stand out in the nursing crowd? What about leveraging your clinical expertise and your love of writing into a new gig? (hint. hint) A Nurse who can also write clear and compelling articles about say...orthopedic surgery...or carpal tunnel syndrome...? That's a nurse who could leverage their expertise to ask for a raise OR set up a lucrative side gig as a freelance healthcare writer! 5. Start a Money Club Twelve years ago, I found myself going through a divorce after 20 years of marriage. Talk about something that messes with your finances!!! Nurses honor...it took me at least 2 years to recover financially! While spending hours researching on the internet, I found an amazing website that not only armed me with the facts which allowed me to negotiate my own divorce settlement, but literally changed my financial life. It's free and designed to help you succeed and prosper. (and yes, GUYS...you will find it equally valuable!) The non-profit Women's Institute for Financial Education (WIFE.org) is on a mission to empower women to deal more effectively with money. Trust me, this website is AHHHHmazing! From 21 day Debt Makeovers to financial calculators and online support, the founders have thought of it all! One of the most innovative features is The Money Club. Founders Candace Bahr and Ginita Wall have an aggressive goal: to have a million women actively involved in Money Clubs across the country. They have complete resources to start your own Money Club and lead your group on the road to success. All you need to do is gather together a group of friends or colleagues who are interested in improving their financial lives. You can begin with as many people as you feel comfortable with, and add more people as you progress. Starting a Money Club is FREE & easy. Check out these simple instructions. Will You Take Action Today? The power to change your financial life is in your hands. Each journey begins with a first step. I'm curious, what small step will you take today? Don't Forget to Check out these AWESOME Resources A Financial Check Up for Nurses A Budget Guide for Every Income: Infographic Money Matters: A Guide to Teaching Finances to Children
  6. Delivering bad news is difficult-so difficult that it takes finely tuned skills, coaching, and practice to do it candidly and respectfully. As an oncology nurse who has delivered plenty of disheartening news to families over 20+ years, I am constantly on the lookout for resources and helpful tips from others. Here are a few strategies you may wish to consider when sharing bad news: Step Up to Your Role Ask yourself, "What information will I deliver?" Think about how you would want it delivered to you. Most people do not like the "beat around the bush" approach. Be honest and truthful, without negativity and hopelessness. Share the Pain When the patient and family express their feelings, acknowledge their pain and express your honest concern. Try employing therapeutic conversational phrases like, "I hear what you are saying" and "I understand your concerns." Offer to connect patients and families to counselors or social workers as much as you can. Be present for questions and comfort. Listen Actively During difficult times, people feel a strong need to be heard and to know you care about them. Be sure you are attentive to the person who is talking. Eye contact is key, so avoid your tablet or writing notes during the conversation. Be there to give feedback without judging the situation. Avoid saying, "This is what I would do" instead say, "Consider this..." It's OK to Take a Stepped Approach When people hear frightening news, adrenaline floods their bloodstream and they respond with strong emotions. Critical thinking can be impaired. Be prepared to adapt your communication approach to the needs of those involved. I have learned to share clinical details about a diagnosis and plan of care in steps...when the patient is emotionally ready to receive. In a clinic setting, we don't always have the luxury of time. I have found that setting up a process for phone follow up with patients & families can really be helpful. It gives the patient time to process & the nursing team the opportunity to reinforce clinical facts and connect folks with evidence-based resources to support decision making. Practice Makes Perfect Delivering bad news is a skill we all need to practice. Why not practice with a colleague or friend? Beth Boynton, who is the author of Successful Nurse Communication : Safe Care, Healthy Workplaces & Rewarding Careers, posted an informative real life conversation with someone who was going through this scenario. According to a recent article from the Advisory Board, training yourself through coaching makes you two times more likely to use empathetic phrases than those who don't train for these specific conversations. Another helpful tip Boynton advocates which I have employed with success, is to use role play. Having a hard time getting creative? Check out this YouTube video as a guide for practice. While practice will help us prepare and hone our communication skills, sometimes it's good to focus on why we became nurses in the first place. We came into this profession because we excel at the science of caring. Caring through our nursing process and advocating for patients. Practicing the art of nursing by using our caring hearts to actively listen. The bottom line is, it's just the right thing to do. Boynton relayed a story of a physician colleague who made a home visit and shared these profound thoughts: When bad news needs to be shared, silence can be harsh. To quote Samuel Butler, "It is tact that is golden, not silence." What resources have helped you develop skill and empathy when sharing bad news? Read to Lead What's The Best Way to Deliver Bad News to Patients? SPIKES-A Six-Step Protocol for Delivering Bad News: Application to the Patient with Cancer How Should Providers Deliver Bad News?
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