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  1. As a new Nurse I have been dealing with it. when I was a student it was fine because I know I was a student and the instructors were there to help. but now I come really early and sit in my car in the parking lot thinking about the shift not knowing whats going to happen in the shift. I always sometimes think management is going to find something about me or make a case on me where they can blame me as I have seen that many times over the past year.
  2. Aliceozwalker

    Extreme Anxiety and Nursing

    Good afternoon everyone, Sorry in advance for the long post. I am looking for support on what to do in this situation. For background information, I have been a nurse for exactly one year now. I am currently working as a nurse at two locations (a busy medical floor at the hospital and in the community). I have diagnosed generalized social anxiety, social anxiety disorder and a history of depression. I have had five suicidal people who I was close to in my life, one of which who did hang themselves while I was in university (this all becomes relevant to the post). 2020 was a very challenging time as I feel it was for a lot of people. I started nursing by myself in February and felt extremely blue for a while and felt the patient loads at the hospital were very intense. In April, I had a panic attack while at work (hospital) and was sent home. My manager then called me and told me that I should go on short-term disability and seek some professional help. I did get a psychologist and saw them every week for 2 months, I currently see them once a month as therapy is expensive and not covered. However, recently another patient came forward and told me a similar "If I die it is all your fault" sort of statement and again I did get triggered and went into this almost panic state loop for a full 24 hours and called in sick. I have talked to my therapist about it and she states that it is a fear-based reaction surrounded in guilt for not being able to save or help the suicidal people in my life toppled with my already high level of anxiety. We are looking into trying to help me with this problem but she states I will likely always be an anxious person. The issue is that even after a year at the job, I feel frustrated as I still have extremely bad anxiety when going into the hospital and a bit at the hospice. I have to practically drug myself (9mg of melatonin and 50mg of gravol) to fall asleep before day shifts as if I don't I will wake 5-6 times over the night or have a nightmare and wake up in a panicked state unable to get back to sleep. When I do go to work, I feel sick for the first few hours before and during my shift. It's not unusual for me to feel nauseous, lightheaded, dry heave, get a pounding headache, etc. I feel a sense of dread every time before I go to work and have gained 25 pounds since starting nursing. While on my shift, I can't relax and often spend my time charting during my breaks. I had hoped that my symptoms would get better as time went on as new grad nerves can be a thing. My psychologist states that I do have a pattern of avoidance and worries that if I leave the hospital job that it won't really help me overall since wherever I go my anxiety still follows. I'm just not really sure what to do at this point. I spent five years getting my degree in nursing and worry that even if I switch professions that the anxiety will still be there. On the flip side maybe there is an environment that isn't so fast-paced, with no knowledge of what you are walking into day by day. I'm curious as to what other people who struggled with anxiety or mental health do to keep going on. I'm starting to wish that I got sick or injured so that I wouldn't have to go in anymore. Any suggestions, insights or personal experienced would be much appreciated.
  3. After five years at the bedside working in a Trauma ICU, I look back fondly on my time in nursing school. I recall walking into the Trauma Unit as a practicum student, listening to report on a young gunshot wound patient, and feeling terrified. Modeling myself after the strong nurses I came to know during those early days has shaped my entire career. Despite my positive experience, I could go back and give my student self a few pieces of advice. Here are four things I would want to know if I were a student today: TIP #1: Don’t Get Bent Out of Shape About That “B” Nurses working in an ICU often have a reputation for perfectionism. Many memes on social media cast the ICU nurse as “OCD”. This stereotype holds true for my experience as an ICU nurse but it was true of me in school as well. I remember agonizing over my grades. My classmates and I were competitive with each other over who made higher scores. Now I recognize there was no reason to lose a minute of sleep. Nursing school is not supposed to be easy and making a “B” shows you have a grasp on the concepts with a little room to grow. This is a great place to be as a student. No one should enter the nursing workforce feeling like school was easy and the job will be easy too. Furthermore, a “B” average will not stop you from advancing in your career. Graduate nursing programs will still welcome you. This is especially true if you have relevant experience on your resume. So rest easy students, you’re doing great. TIP #2: Prioritize Assessment Skills Assessing your patient is the most important aspect of your job. Your formal, head-to-toe assessment takes place at the beginning of your shift but you will assess for changes every time you walk into the patient’s room. Vital signs, neurological status, patient-reported feelings and demeanor, medication effects, IV patency, equipment function, and any other relevant information are all a part of assessing each patient. Experienced nurses make it look easy but it takes practice to recognize subtle changes. When you are a student, really focus on assessing your patient during your clinical time. Through practice and observing others, you will find a rhythm. There is no part of an assessment that is insignificant. When a patient experiences a decline, the medical team will look to the nurse for all the information regarding the change in condition. It is critical for you to be able to confidently speak to your patient’s clinical picture. TIP #3: It’s OK If You Don’t Know What You Want To Be When You Grow Up To say the field of nursing is broad would be an understatement. Nursing school teaches the basics of mostly hospital-based nursing care with small introductions into other areas. Your initial degree is only the beginning. As a nurse, you can work in multiple environments including adult med/surg, various ICU settings, pediatrics, hospice, dialysis, corrections, home health, special procedures, and many many more. The doors are open to becoming a Nurse Practitioner or Certified Registered Nurse Anesthetist. Maybe you’re interested in nursing administration, education, or informatics. You will learn so much wherever you go but take comfort knowing you can change the direction of your career at any point. As you approach graduation, you will submit applications and begin interviewing. Take a job that feels like a good fit and know that your career may take many turns through the years. TIP #4: Hold on to Nursing School Friendships Nursing school is a bubble. Everyone is wrapped up in the next assignment, NCLEX prep, and inside jokes with the people you now spend the most time with. It feels like this closeness will never break. Late night confessionals, motivation when feeling down, and lots of laughing characterize those nursing school bonds. Maybe your class has a social media group and maybe you and your closest allies have a text chain. This daily chatter will always be a part of your life that you look back on with a smile. As soon as you graduate, some of those bonds will break. There are classmates you will never see again. It’s a weird feeling. Work hard to bridge those gaps and hold onto your closest nursing school friends. Keep those calls and texts going because there will still be times when you need that late night motivation and those belly laughs over good memories. You will look back and recognize it truly was a treasure. Nursing is a wonderful career filled with many opportunities. As a nursing student, feeling anxious and excited about the career in front of you is part of growing into your role. It is a part of your life you will never forget. Make the most of your time in school and be confident that you have chosen a challenging yet valuable path.
  4. No End in Sight? Then imagine that you face this every day without an end in sight. No easy answer to life and death questions Who gets put on a ventilator? Who gets to wear the PPE? How do we let people die alone without anyone by their side? How do we choose which patients to treat? By age? By co-occurring diseases? By COVID-19 positive status? No end to emotional trauma of workers Overwhelmed by death, uncertainty, and patients’ fears as they struggle to live Witnessing helplessness that families and loved ones feel Powerlessness in the ability to protect without proper equipment Deep sense of aloneness leaving a hospital shift to return home where they may be responsible for getting loved ones sick Witnessing the pain, fear, and terror, that trauma survivors have endured Feeling emotionally numb or shut down Difficulty sleeping More irritable Using destructive coping (over/under eating, substance abuse, engaging in risky behavior) Losing a sense of meaning in life Feeling hopeless about the future Experiencing relationship problems. What are you feeling right now after reading this list? And there may be even more challenges than the ones I have listed to consider. We definitely need to pay attention to the immediate and residual effect of all of this on our front line peers. So what mechanisms can be put into place to support this “deadly” situation so we can provide an EMOTIONALLY PROTECTIVE SHIELD around our heroic workers for their wellbeing? Emotional Protective Equipment (EPE) University of Wisconsin-Madison Health Psychologist Shilagh Mirgain says now is the time for people to develop what she calls Emotional Protective Equipment (EPE), a powerful set of practices that can improve mood, lower anxiety and foster greater well-being through learning to direct kindness and care towards one’s own and others’ suffering during this time. Regularly engaging in self-compassion is linked to increased resilience, improvement in mood, lowering of anxiety, and strengthening of well-being. Here are strategies that can be utilized daily. Treat yourself as you would a small child. How would you reach out to comfort yourself as a child who is hurting? That little child is still a part of you, so picture her and tell her how amazing she is. Give yourself permission to be imperfect. Strive for basic competence. Do the best you can and that is all you need to do. Progress, not perfection. Engage in mindfulness moments. Take time to pause and get in contact with the emotional upset you may be experiencing so you can give yourself the care you need. Acknowledge the fact that “It is what it is” and accept and move on. Bring your awareness into the present moment, take a breath, focus on grounding yourself, and feel that for this moment you are in control and can manage. (Do this as often as you can) Manage your Mind. When your mind views stressors in a negative way we tend to experience increased stress and poorer coping. Instead, view the same stressor as a challenge to remain resilient. Consider yourself being chosen for this work because you were meant to be in this place at this time and are up for the challenge. Cultivate an attitude of gratitude regarding the superior work you are doing to save lives and provide comfort. Seek out social connection Remember you are not alone. Create a list of all the people you can rely on to talk to and share your experiences. A problem shared takes half the burden off of you. Find safe ways to strengthen your social support, spend time with loved ones while still practicing physical distancing and masking as applicable. If you can’t be with them physically, schedule times every day – even if it is just 5 minutes – to decompress by sharing what you are feeling. Share with your workmates as well. A situation like this often leads to life-long bonding, much like military soldiers who go into battle together and always have that common bond. Allow time to just “goof off” with someone else with no particular reason other than to feel better. Recognize our common humanity. We are more alike than we are different as we go through some of these same stressors during the pandemic. Now is the time to break down the divide between us, to move past limiting perceptions of one another. Be aware of your personal biases and cultivate kindness toward others and yourself. Upload this link “Loving Kindness by Karen Drucker” to your cell phone and play as often as needed. Overall, remember we are all in this together. Feel free to share the strategies that work for you!
  5. Deb_Aston

    The Calm After the Storm

    You can’t calm the storm, so stop trying; what you can do is calm yourself, the storm will pass. (Timber Hawkeye) This has been a year of being tested on many levels… emotionally, physically, and mentally. We have all been under quarantine for several months during the Covid 19 pandemic, and most recently, the great racial divide has come to a blistering head, and we are faced with the harsh reality that even in 2020, all men and women are not being treated equally. There is a deep pain that has been centuries in the making, and countless events of injustice that have been normalized for far too long. How are we handling the stress and loss of control that surrounds us on a daily basis? I, for one, am struggling. I find myself feeling anxious from the minute I wake up and listen to the Morning News, to the minutes that I finally lie down in my bed, trying to shut my brain off from the noise that is somehow silent on the outside, but deafening, and relentlessly loud on the inside. But it is the time in between those hours, when we are at work, and trying to do the best that we can to carry on with our lives, that can be the most difficult. We struggle to block out the “noise” and strive to make a difference with our patients and their families during a 12+ hour shift. We also have our own families who need us to keep it together, and function in a somewhat “normal” capacity, during a time where nothing is “normal” and hasn’t been for a while. That storm To say that I am a little on edge, well, that may be the understatement of this really challenging year. Unfortunately, as a nurse, we have to try to remain calm when everyone around us is screaming. Yes, during an emergency we focus on the task at hand, and trust that our training will automatically kick in when it’s necessary; that’s the easy part. The hard part is when we are not in an emergency, and we “lose it” over something that may not have triggered us so easily before … maybe over an error with the schedule, or sitting in traffic, or scrolling through social media and reading a post that angers you to the core because you thought your friend was smarter (and better) than that…yeah, it is in those moments where you start to have your own personal “storm”, and it isn’t pretty, and it definitely doesn’t cast a beautiful rainbow in the aftermath. This kind of storm can get you into some hot water if you are unable to reel it in. Loss of control and our response I think we all manage stress, fear, and anxiety differently, but for some of us, loss of control is one of the most difficult obstacles to overcome; at least it is for me. I’ve always told my daughter that you can’t control how other people act, but you can control how you respond or react … that advice is on point, and easy to say, isn’t it? However, it is not always easy to do. Sometimes we don’t know how we will react until it happens to us … we can respond differently depending on the circumstances of the moment. For example, we may be able to remain calm and composed if we are in a great mood and slept for more than six hours … or if we are working with our favorite nursing team… but maybe the words (themselves) are not the issue, but the tone is what rubs you the wrong way? Maybe you just want people to care more, and be more accountable … like you… maybe that would make things different and more palatable? What can I do to prevent, or calm the storm? I’ve been doing some research and soul-searching to identify ways that I can try to improve my own ability to manage stress, and react in a calm(er) manner when faced with a situation that makes me want to scream a few expletives at an unsuspecting person. I sought advice from two of the smartest people that I know, and they gave me great insight into actions that I could do (immediately) to improve how I respond to either (a) prevent the “storm” from happening or (b) how to de-escalate it if that ship has already sailed. One of them is a friend and colleague, Dr. Mark Stein, who shared with me some things that have worked for him, and are based on conjecture, bitter experience, and frustration with other approaches; they are: Identify what the current problem is, and determine what you want to happen to fix it Find common ground in whatever the dispute is Nobody likes being told they are wrong, even if you prove it with facts (especially if you prove it with facts, I may add) Imagine being them, and try to determine what they are saying, and why they are acting that way; in most cases, they are afraid, and in over-their-head with the problem, and they want someone to help solve their difficulties Offer to help figure out the problem with them Provide a compliment, or kind word to them about something that they did that was good Lastly, and he couldn’t stress this enough, bring in doughnuts from a good bakery, “not just Dunkin’”; sharing food breaks down barriers, and has always worked for him when interacting with a potentially difficult person or group Dale Carnegie (1981) believed that the only way you could get someone to do anything was to (somehow) make the other person want to do it. Carnegie (1981) also quoted John Dewey, a great American philosopher, who believed that the deepest urge in human nature was the desire to be important. I believe that with this kind of thoughtful insight into human nature if one can take a few minutes to process some of the issues that have led to a dispute, and strategize how best to address it, in a positive manner, the outcome would be far better than if you allowed yourself to show anger or frustration. In the end, no one really “wins” an argument; according to Carnegie (1981), the only way to get the best of an argument is to avoid it altogether, because even if you “win”, you still “lose”; making someone feel bad, or inferior, will cause resentment, and that is not a battle worth winning. My last thought on this subject Try to be mindful of some of your own control issues and triggers; not everyone has the tools in their toolbox to manage extreme periods of stress and environmental obstacles that are out of their control. We are in unchartered waters when it comes to coping with being bombarded by tragedies and heartbreak in the News and many social media outlets on a daily basis. FACT: We need to take time to embrace silence and focus on being mindful of our own needs, while showing empathy to others. No one truly knows what others are going through in their personal lives. Please be safe out there, and may tomorrow bring us closer to peace, equality, and justice.
  6. COVID Anxiety and StressIt’s been a difficult few weeks, regardless of your professional background—nursing, social work, disability management or another discipline—or care setting. Clients are growing more anxious, their caregivers more stressed and your colleagues more isolated. In addition to dealing with the pressures associated with COVID-19 at work and tending to the needs of their clients, many case managers are also juggling their own family pressures and obligations at the same time. And yet, there you all are, providing advocacy and support. Making connections. Ensuring clients receive the care they need when they need it. Coordinating care in a strange and confusing time. And I know many case managers are on the front lines of the pandemic, caring for clients and working to keep the rest of us safe. On behalf of the Commission, “Thank you,” and know that we are here for you. Operational ChangesWhile we are all practicing social distancing: we telecommute, and all meetings are conducted remotely; we also continue to maintain regular business hours (8:30 am - 5 pm EDT). Of course, the COVID-19 social distancing requirements have made it necessary for us—like so many other organizations—to make operational changes. To keep you apprised of these changes we have created a dedicated webpage to update you regarding how to get certified and stay certified. HighlightsApril 2020 CCM exam administration moved to August for those professional case managers who want to get certified: As you may also already know, we have canceled the April CCM exam. Those originally scheduled to take the exam in April are now eligible to do so between Aug. 1 and Sept. 19 as part of an extended testing window.Spring 2020 CCM Renewal window extended so you can stay certified: If your CCM is due to expire May 31, 2020, you will now have until June 30, 2020 to complete the CE requirements and apply for renewal.2020 New World Symposium: Did you change your attendance from in-person to virtual due to COVID-19? By now, you should have received information on how to access seven complimentary CEs. This gives you the full number of CEs originally offered through the in-person conference. If you haven’t received any notifications, please let us know at ccmchq@ccmcertification.org.Tools to help you cope focused on COVID-19 response podcasts: In our next few podcasts, we’ll discuss ways to manage stress, relieve anxiety, cope with isolation and support caregivers during this pandemic. These ”Take a Listen” podcasts, as well as our library of previous recordings, are available here.Speaking of stress…A stress response can suppress the immune system and contribute to anxiety and depression. The Commission wants to help. Here are a few tips and strategies to help you manage your stress levels. Limit media consumptionUncertainty provides a fertile breeding ground for anxiety, but so can paying too much attention to the coronavirus-related news and social media. While we should all stay informed to stop the spread, it is important to strike a balance and reduce our media consumption. For me, that may mean listening to reliable news sources a couple of times a day and checking www.CDC.gov for updates. For you, it may mean avoiding social media altogether for a couple of days. Find that balance that brings you peace. BreatheYes, I know. That always seems to be the go-to therapy for stress. But it works! We know breathing exercises, like this one here, help us relax, reduce tension and de-stress. Did you know the breathing center directly influences higher-order brain function? Scientists even know which neural pathway controls this process. (It’s a fascinating read, if you’re interested: Science 31 Mar 2017). Interested in trying some new techniques? WebMD lists several stress-reducing breathing techniques.This Medical News Today article explores “4-7-8 breathing.”Harvard Health discusses how breath control can help “quell errant stress response” and provides guidance on getting started.Consider adding a meditation app to your phone, such as the “Calm” appPractice social distancing, not social isolationWe all need to keep our physical distance and wear gloves, masks, etc. But that does not mean we need to live and work in isolation. You may already be using video tools to stay in contact with clients, colleagues and friends. If not, think about setting up a video chat. You could even go old school with a phone call to bridge that gap. Even for the most introverted among us, isolation is unhealthy. So, as the old AT&T commercial says, “Reach out and touch someone.” Just don’t touch them. A note of gratitudeFinally, I want to thank every one of you on the front lines of this pandemic. Your fierce compassion and almost-unimaginable courage inspire us all. Words are inadequate, but Fred Rogers came close: “When I was a boy and I would see scary things in the news, my mother would say to me, ‘Look for the helpers. You will always find people who are helping.’ To this day, especially in times of ‘disaster,’ I remember my mother’s words and I am always comforted by realizing that there are still so many helpers—so many caring people in this world.” All that’s left to say is, again, “thank you.”
  7. jesslahti future LVN

    Depression + Anxiety as a Nurse

    Hi guys, I’ve had depression & anxiety for many years, if not forever really. I am very worried about my mental health affecting my nursing ability. I am currently in lvn/lpn school, doing well. Should I just drop out and be a CNA? Thanks guys & Happy early Thanksgiving ♥️
  8. The ebb and flow of life bring moments of peace and contentment. Occasionally, stress and anxiety are a normal part of life, especially when faced with change, challenge and difficult decisions. Everyday events, children going to school, job promotions, illness, vacations and more, cause some level of anxiety. During these times, anxiety levels heighten temporarily but most people work through and shake off the worry. However, there are those who are weighed down with excessive worry and unable to work through the anxiety. Generalized anxiety disorder (GAD) characterizes a condition of extreme and excessive worry that is usually accompanied by physical symptoms. Symptoms may include trembling, muscle tension, twitching, irritability, sweating and feeling light-headed. Diagnosing GAD The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) characterizes GAD as having excessive worry more days than not for at least (6) six months. Excessive worry is worry or tension without a specific threat or that is out of proportion to the actual risk. The following table provides a comparison between “normal” or reasonable worry and excessive severe worry. Everyone experiences stress and anxiety intertwined with relaxed and peaceful moments in life. But what happens when anxiety becomes a roadblock in your ability to function in day to day activities and relationships? This article explores what happens when excessive worry leaves you unable to work through stressful situations. Reasonable/Normal Anxiety Excessive/Severe Anxiety Not in the way or interrupt your daily routine (job, school, social life etc) Able to control anxiety effectively Unpleasant, but does not cause emotional or physical distress Lasts for only a short period of time Significantly disrupts routine life Unable to de-escalate or control Extremely upsetting/stressful Worry about things and feel like the worst is always around the corner Excessive anxiety experienced most days than not Without panic attacks present, we may think we are "just worrying too much." Our struggles of constant worry may be minimized or dismissed and, in turn, not properly diagnosed. Most of us feel worried at some point in our lives and experience situations that can cause us to feel anxious, so what are professionals looking for to help determine if someone struggles with GAD? An evaluation of symptom criteria, as outlined in The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (also known as the DSM-5), is the first step—and looks for factors like excessive, hindering worry paired with a variety of physical symptoms, then use of proven diagnostic assessments to make a diagnosis and rule out other possibilities. Symptoms The DSM-5 outlines specific criteria to help professionals diagnose generalized anxiety disorder. Having a standard set of symptoms to reference when assessing clients helps them to more accurately diagnose mental health concerns and, in turn, provide a better plan of care. When assessing for GAD, clinical professionals are looking for the following: The presence of excessive anxiety and worry about a variety of topics, events, or activities. Worry occurs more often than not for at least 6 months and is clearly excessive. The worry is experienced as very challenging to control. The worry in both adults and children may easily shift from one topic to another. The anxiety and worry are accompanied with physical or cognitive symptoms. In addition to behavioral symptoms of GAD, the presence 3 common physical symptoms (In children, only one symptom is necessary) supports the diagnosis of GAD. Many of the symptoms are associated with the “fight or flight” response to anxiety. Supporting symptoms for diagnosis would not be attributed to any other physical problem or illness. Physical symptoms include: Tensing of muscles and body aches Headaches Feeling tired, low energy Shakiness or muscle “twitches” Difficulty swallowing Difficulty falling asleep or staying asleep Difficulty concentrating- mind drifts off or goes blank Irritability Increased sweating Increased pulse or palpitation Nausea Feeling dizzy Tingling in arms or legs Feeling out of breath or smothering sensation Flushing Increased trips to the bathroom Other symptoms that are not related to any other cause GAD is Treatable GAD is typically treated with psychotherapy, medication or both. Psychotherapy helps to identify sources of anxiety and effective coping strategies for relieving excessive worry. Coping strategies may include meditation, imagery, relaxation techniques, restructuring negative thinking patterns and healthy lifestyle changes. Ultimately, the goal of psychotherapy is to change the way we react to stressful triggers or events. Medications are sometimes used to help relieve symptoms but are not a cure for GAD. Antidepressants, specifically serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs and monoamine oxidase inhibitors are often used as first line medication treatment. Beta blockers, used to treat high blood pressure, may also be prescribed to help with the “fight or flight” symptoms of anxiety. Benzodiazepines are often used for acute and short term relieve of symptoms. There are drawbacks due to the risk of tolerance, dependence and abuse of benzodiazepines. Buspar is a non-benzodiazepine medication specifically for the treatment of chronic anxiety. Risk Factors We all experience stress and anxiety at one point of our lives. Researchers are finding both genetics and environment can contribute to the risk of anxiety disorders. Risk factors may include: Traits of shyness and behavioral inhibition as a child Exposure to stressful and/or negative life events in early childhood or adulthood Family history of anxiety or mental disorders Substance abuse or other health conditions (i.e. thyroid disorders, heart arrhythmias) can also produce or exaggerate symptoms of anxiety. For more information: Newman, M. G., Zuellig, A. R., Kachin, K. E., Constantino, M. J., & Cashman, L. (2002). The reliability and validity of the GAD-Q-IV: a revised self-report diagnostic measure of generalized anxiety disorder. Behavior Therapy, 33, 215-233. National Institute of Mental Health Fact Sheet
  9. If you think you know the correct diagnosis for this Case Study (CSI)...Do not post the answer here.Instead, post your answer in the Admin Help Desk. We don't want to spoil it for others who are late in joining us. In a few days, after the diagnosis is posted, Admins will announce the names of those who correctly identified the problem. We hope to turn this into a friendly competition with more Case Studies to come. You can ask questions and comments below. Chief Complaint“My son died a month ago. He was stationed in Afghanistan. I think I’m still in shock. For the last few weeks I haven’t slept well. I keep waking up in the middle of the night, my heart pounding, out of breath, and now on top of that I’ve been feeling nauseated. I even threw up yesterday. I wonder if I have the stomach flu. I’m just praying I don’t have another migraine coming on.” History of Present IllnessA.W. began to experience shortness of breath and racing heart approximately two weeks ago, primarily at night. Nausea began two days ago with two episodes of emesis yesterday. Admits to burning pain in her throat that she attributes to heartburn. Ms. W. has been depressed and anxious since learning of her youngest son’s death. Ms. W. states she has been feeling more tired than usual, but attributes it to lack of sleep and stress over her son’s death. Most recent migraine was over a month ago. General AppearanceLooks anxious. Eyes wide, blinks a lot, shoulders tense, diaphoretic, occasionally rubs stomach just under sternum. Pt appears female, skin is brown in color, appears stated age, looks slightly overweight with weight carried around the middle. Okay super sleuths, what’s going on here? What information do you need? What would you do first? What labs do you want? What other diagnostic tests should we run? Ask me some questions! REMEMBER: DON’T post the ANSWER HERE! Ask questions and I’ll give you more information.
  10. Recently, it has come to my attention that MDs have been targeted for over prescribing narcotics for pain control. My mother has become one of the victims of these new laws that have made it difficult for primary care physicians to assist patients with managing their pain. First of all, I would like to say that this is a quality of life issue and for those that do abuse drugs under a physician's care, their plight is not what I am writing about. This is not the case with my mother. Her pain medications have been well controlled. My mother has back pain and tremors that have caused her much distress since her mid-50s and before 2 years ago, she had never been on narcotics. Getting her to go to the doctor was a strain and now it has become a necessity. Her pain is constant with intermittent acute episodes. It is also difficult to deal with because she has progressively become more forgetful and confused with personality changes over the last 5 years. She fell and broke her hip 1.5 years ago and her shaking makes her a much higher fall risk and her pain makes her a suicide risk. My sister and I are trying to keep her at home, but the anxiety and pain keep her awake. For fear of loosing her pain management regime, she had elected not to change physicians. This was a mistake. This primary care doctor has a wonderful nurse practitioner that understood her condition. Her doctor was asked for a neurology consult and pain management consult and instead was condescending and rude. She has been on Norco 7.5 and Ativan 1 mg BID for 1 year and intermittent use before this for approximately 1 year. Her medications where well controlled and changing them had been discussed repeatedly with no results. Upon her final visit to her doctor's office, my mother had been complaining about a strange intermittent sharp pain in her peri area. My sister had requested the nurse practitioner for the pelvic exam and the doctor insisted on doing it himself. He abruptly cut my mother off about her pain complaints and stopped all pain medications and prescribed her Prozac. At other visits, I requested attention be given to her signs and symptoms of dementia that have made her anxiety and pain control worse. At her last visit he accused my mother of being a drug addict and refused to listen to her or my sister. I can go on and on, but I know that had she changed her MD sooner, this may not have happened. She did change physicians and her new physician was as rude as her previous one. This time I was present. It was obvious this doctor had in some way communicated with her previous physician. Her new doctor was up front about not prescribing narcotics. I told her that I understood her position, but could she at least prescribe enough to get her through till her pain management appointment. My mother interrupted me by having a fit in her office, but not directed at the doctor. It was due to lack of sleep and her mentality. It is obvious that my mom has progressive dementia and that her actions were directly from her frustrations. The dementia symptoms started years before the narcotics were in place and her demeanor was always calm and kind before. We, as medical providers, can debate the side affects of anxiolytics, especially on the elderly and why, but the big picture is informed consent and quality of life. I have been a nurse for 20 years and I was trained repeated that we are NOT rehabilitation nurses and that pain is subjective. Any nurse with experience, knows what I am talking about.
  11. Jonny-anderthal


    INTRODUCTION Townsend (2009) describes anxiety as an overarching worry or "feelings of uncertainty and helplessness" (p. 15) Anxiety is placed on a continuum from mild to panic and associated with perceptual alterations that range from established coping mechanisms to inability to cope with one's environment. Someone experiencing mild anxiety is typically unaffected by the onslaught of physiological effects and learning is enhanced. The level of anxiety is inversely proportionate to its effects on cognition; the ability to learn, to concentrate and to comprehend diminishes equally as the level of anxiety progresses to the panic state (Townsend, 2009). While mild anxiety can actually enhance learning, moderate to severe anxiety hinders learning. There are core concepts that outline an anxiety disorder; experienced distress, behaviors become maladaptive, psychological implications, sense of helplessness, and loss of contact with reality are all dependent on severity (Townsend, 2009). Under a cloud of anxiety, all calmness and focused cognition are hindered by distress; an acute sympathetic nervous system (SNS) overhaul. The body enters a fight or flight mode, which is crucial to survival in the wild but can become detrimental in today's world where threats to survival are not as common. This SNS response to external stimuli creates physiological changes. The physiological changes ultimately lead to learned behavioral changes. As humans experience the change our behavior reflects adaptation to the physiological changes and environmental stimuli (Townsend, 2009). This exemplifies an adaptation method crucial to survival. Common treatments for anxiety are psychotropics, drugs that influence the mental state of the individual (Townsend, 2009). Like all drugs, there are side-effects and no drug is perfect. More importantly, as we begin to alter the chemistry within our brains, we also alter the receptors therein. These changes in brain chemistry begin to inhibit daily functioning and can leave a patient with a choice of anxiety or numbing medications. Therefore, nurses have a moral imperative to treat an anxiety patient beyond pharmacological means; education and recognition of the antecedent, response, and behavior are essential in treating anxiety disorders. RESEARCH Anxiety can be a normal physiological response that aids in coping with stress brought on by a heightened sense of danger or unpredictable event. This supplies humans with a protective barrier to emotional and environmental stressors, much like our immune system aiding in our defense against invasive organisms or foreign bodies. And, just like with the immune system, the defense mechanisms have the potential to become overwhelming and deteriorate one's well-being. As anxiety pervades into one's learning or ability to perceive the environment, it becomes a disorder, and all benefits are lost. The response no longer serves a purpose but becomes maladaptive. The psychological implications and sense of helplessness are both dependent on the severity of the anxiety (Townsend, 2009). Although direct causes or triggers may not be seen, symptoms of anxiety can be detected by a diligent nurse. Symptoms of anxiety such as nail biting, pacing, yawning, and fidgeting are all recognizable symptoms that a nurse ought to recognize. Breathing relaxation exercises (BRE) have been shown to decrease anxiety in hospitalized & pre-operative patients, including those who have had traumatic experiences. The theory behind the breathing relaxation exercises is that deep, regular breathing returns adequate oxygen to the circulating blood, thereby reducing the effects of increased anxiety ["irregular, shallow breathing" leads to "lethargy and physiological distress"] (p. 134, Wong, Chair, Leung, & Chan, 2014). Simple breathing relaxation techniques reduced anxiety in patients under increased stress; furthermore, the study by Wong et al. (2014) aimed to use brief educational interventions (BEI) to improve outcomes between two groups of post-op patients. BEIs are described as simple BRE, pre-operative information and "what to expect" postoperatively. Proving that an informed patient will often yield the best prognosis. Results revealed that there were improvements associated with pain, anxiety, and sleep after simple BRE (Wong et al., 2014). Educational interventions, such as recognizing and then reducing anxiety, would likely impede the building anxiety. Nurses and patients learning to address signs and symptoms may be the crux of the anxiety disorders. Anxiety takes many forms and as it worsens, can restrict all rationale. When is it feasible for a patient to recognize anxiety, or furthermore recognize the source of such anxiety during the moment of acute anxiety? The effects of anxiety can be disturbing to or even go unnoticed by the person experiencing them. In a study comparing patients with higher anxiety levels associated with coronary heart disease (CHD) and individuals with mild-moderate anxiety levels, an increased level of cortisol in the waking hours was seen in the patients with higher reported anxiety levels (Merswolken, Deter, Siebenhuener, Orth-Gomer, & Weber, 2012), thus showing a connection between anxiety and cortisol. An increased anxiety level is likely to produce an increase in cortisol on a consistent basis. This increase in cortisol places the body on high alert, as needed to respond to the antecedent; in the case of anxiety disorders, the antecedent is not one of extreme danger. If this antecedent is as simple as sitting for an exam or engaging in social contact, the rise in cortisol and SNS response is likely to affect the social interaction or exam score negatively. The act of thinking while experiencing heightened cortisol levels tends to be less assiduous and more frantic. This challenges the ability to provide a negative feedback control mechanism to the person experiencing anxiety, which is exactly what cognitive behavioral therapy (CBT) aims to provide. CBT is part of an emerging field of psychology known as applied behavior analysis (ABA), and can be challenging to implement. The treatment of CBT aims to recognize sources of behavior and in doing so, implement behavior that promotes coping or is a non-detrimental behavior. In addition to CBT, a mindfulness approach is thought to enhance the effectiveness of CBT. This new approach, mindfulness-based cognitive therapy (MBCT) aims to shut down the psychological experience, therefore decreasing or inhibiting the cortisol release and physiological sense of anxiety (Kaviani, Javaheri, & Hatami, 2011). Kaviani et al. (2011) suggest that mindfully recognizing thoughts of depression as just that, thoughts, depression can be objectively recognized and separated from the subject of self. The same approach can be applied to anxiety. A patient experiencing anxiety can simply recognize the anxiousness as a thought, a feeling, something that is occurring in the mind and respond in kind. By mindfully recognizing the thought as it is, then exploring said thought cognitively, the subject is likely to find a new, more fitting response to the source of their anxiety. ABA and CBT follow models of learning; the experience of an antecedent, or stimulus, is followed by the response, or behavior. Methods of MBCT include sitting meditation, walking meditation, yoga and mindful-breathing in the wake of stress or anxiety. These methods implemented by Kaviani et al. (2011) showed a decrease in the experience of anxiety, more specifically decrease in "negative automatic thoughts and dysfunctional attitudes" in subjects during exam periods (p. 292). The ability to be mindful in the face of anxiety can be difficult, but with proper educational interventions, patients can begin to achieve mindfulness. ETHICS Patients are humans too. With each physiological disease, there is some psychological component, and with each psychological disease, there is some physiological component. Therefore, we as nurses must maintain the person as a whole, including the mind, body, and spirit. We cannot treat the body without treating the mind, thus we cannot treat the mind without the body. Lachman (2009) states that the nurse practices with compassion for the individual and their "inherent dignity" without reservation to their "personal attributes" or "nature of health problems." Keeping this provision in mind, we as nurses must maintain the ability to recognize each individual's psychological needs and be aware of their fluctuating psychological states just as we must be aware of physiological changes. If we are to only focus on the patient's physiological needs as they prepare for surgery; how will we address their post-operative concerns? Surgery alone can be scary to the individual. As nurses, we must validate and by asking and listening we will then be able to address concerns. Once concerns are addressed, nurses can better aim their treatment on informing or educating the patient. We must be sure to assess the patient's knowledge level and understanding, much the same as we are to assess their vital signs. Aiding in their recovery or treatment should go beyond handing over a prescription and saying "good luck." Nurses must ensure an understanding of the treatment. And in many cases, the treatment's course or outcome is heavily influenced by their understanding and willingness to participate. Delve deep and correct the underlying problem. As the nurse's commitment is to the public, whom the nurse serves (Lachman, 2009). The nurse plays a pivotal role in the healthcare team. By acquiring the patient's trust and creating an empathetic environment, the nurse is more likely to have a greater impact on the client's self-care. Ultimately improving the prognosis. Nurses obligations are first and foremost, the patient's well-being. Promoting appropriate and correct self-care can be the most beneficial, proactive measure. We cannot prevent recurring infections without first treating the underlying problem. The evidence of medicine-resistant bacteria is present and antibiotics are losing effectiveness. By following this example, we look beyond the bacteria causing the infection and address the bacterias placement. Creating new policies that aim to institute proactive measures in patients through education and understanding, such as implementing and promoting hygiene (hand washing) and explaining that probiotic flora is essential. As the first provision states, nurses are to treat all patients equally, excluding differences in social and economic respects. Implying that a nurse should start with an assessment of the basic understanding of hygiene, or what ails the patient. Before assuming the patient knows how to correctly wash their hands. If the patient understands that washing with soap, water, and friction, then they are more likely to increase the prevention of recurring infections. Once a basic understanding is met, the underlying issue can be corrected. Much like a patient experiencing an anxiety disorder, are we to discuss pharmacological methods without first explaining mindfulness methods? The pharmacological methods often have great success initially, but once the medications are discontinued the anxiety disorder is likely to return. Possibly a relapse can occur as the brain adjusts to the psychotropics or the patient decides to stop the medication. The patient is either trapped in a pharmaceutical cloud or under the weight of their anxiety. To aid in the escape, the nurse must first assess the patients understanding of their disorder. After a proper assessment only then can the nurse continue the nursing process, developing a plan and implementing the interventions. For example, explaining to the patient a mindfulness approach to recognizing the source and encourage exploration of their thoughts in relation to the anxiety. In educating the patient of anxiety disorders, the nurse is likely to prevent a relapse of the disorder. Anxiety is not typically a condition that evaporates after it runs its course. Fully explaining anxiety and mindfulness to a patient can take more than a few minutes, the task may require multiple meetings. Update the setting with resources available to (almost) everyone. In today's economical and political systems, reducing costs is of great importance. What must we sacrifice in order to reduce costs? This is in a time where repeated, scheduled clinical or hospital visits can certainly stalemate the system. Anxiety is likely to increase as patients are rushed in and out of offices, left feeling ignored as a nurse charts on a screen, or left ignored in a stagnant waiting room. With today's technology, telenursing may be more beneficial than ever, and especially in patients suffering from anxiety disorders. Cases, where the patient experiences an unfamiliar environment, can increase anxiety, and if the patient's anxiety stems from the hospital or clinical setting, a home-health nurse or telenurse can offer viable substitutions. Offering more personalized care may not necessarily demand more time, but allow the patient to feel as if they received more time from the nurse. Improving the healthcare environment in which the nurse practices is a key element to excellence. Lachman (2009) explains that the ethical nurse promotes the values of nursing through their personal approach as well as their fellow nurse's approach to the healthcare environment. The individual nurse upholds and challenges others to uphold all the provisions of the American Nurses Association (ANA) code of ethics. By doing so, the nurse exhibits excellence in practice as well as promoting excellence. Promoting excellence, can and should reach to the community. After all, nurses serve their public. Education on diet, hygiene, and overall health is essential for challenging the community to excellence. Much like working with anxiety, educating the patient of their anxiety and challenging, or rather encouraging the exploration of their thoughts and fears is essential to treatment. Challenge, not only our patients but ourselves and our fellow nurses (or student nurses) to practice excellence by going beyond the clinical setting. Instituting proactive measures in the community is certain to improve the healthcare setting as a whole. CONCLUSION Available information, purposeful education, and spreading awareness are paramount to success in relation to improving patient outcomes. Treating a patient with pharmacological interventions is a small part of a nurses goal; although it may dominate the daily routine with extra protective measures and extra security precautions to prevent abuse. Educational interventions should be the bulk of the anxiety disorder treatment programs. Often in parallel with short-term, pharmacological interventions, educational based treatments are most successful for long-term treatment. Patients suffering from anxiety disorders will likely benefit from acknowledgement of the source and corrective techniques to recognize and reduce the onset of anxiety. Much of the basis of CBT or MBCT are to take a moment to pause and reflect on the source of the disorder. The more likely a patient is to recognize the source of anxiety then the more likely they are to maintain control over anxiety. And with anxiety, like any disease, what could be better than exemplifying control over what ails the patient. By providing information, education and recognition, ownership and control can shift from the nurse's caring hands to the patient's autonomous hands References Barlow, D. H. (2002). The experience of anxiety. In Anxiety and its disorders: The nature and treatment of anxiety and panic (pp. 1-15). New York City: The Guilford Press. Retrieved from Google Books Craske, M. G., Rauch, S. L., Ursano, R., Prenoveau, J., Pine, D. S., & Zinbarg, R. E. (2009). Review: what is an anxiety disorder? Depression and Anxiety, 26, 1066-1085. Kaviani, H., Javaheri, F., & Hatami, N. (2011). Mindfulness-based cognitive therapy (MBCT) reduces depression and anxiety induced by real stressful setting in non-clinical population. International Journal of Psychology and Psychological Therapy, 11(2), 285-296. Lachman, V. D. (2009). Ethics, law, and policy: Practical use of the nursing code of ethics: part 1. MEDSURG Nursing, 18(1), 55-57. Lachman, V. D. (2009). Ethics, law, and policy: Practical use of the nursing code of ethics: part 2. MEDSURG Nursing, 18(3), 191-194. Merswolken, M., Deter, H., Siebenhuener, S., Orth-Gomer, K., & Weber, C. S. (2012). Anxiety as predictor of the cortisol awakening response in patients with coronary heart disease. International Journal of Behavioral Medicine, 20, 461-467. Retrieved from 10.1007/s12529-012-9233-6 Townsend, M. C. (2009). Mental health/mental illness: historical and theoretical concepts. In Psychiatric mental health nursing: Concepts of care in evidenced-based practice (6th ed.). (pp. 11-27). Philadelphia, PA: F.A. Davis Company. Wong, E. M., Chair, S., Leung, D. Y., & Chan, S. W. (2014). Can a brief educational intervention improve sleep and anxiety outcomes for emergency orthopaedic surgical patients? Contemporary Nurse, 47(1), 132-143.
  12. bbear2102

    My Experience With Burnout

    For me it started four years ago. Like many nurses I was experiencing burn out. I had been a critical care nurse for six years in a large university medical center. In the beginning I started to feel a lot of anxiety when at work. I had the skill and the knowledge to do the job but over the years the emotional and physical stress had caught up to me. I preferred to work night shift and with that came the overwhelming responsibility of watching over the waves of new nurses that would all start on nights. There would be shifts when I would look around and realize that my options for resources that night were nurses with less than one year of experience. I would just hope that everything went smoothly. I started looking for jobs outside of the ICU environment. Every time I would think about leaving the job that I had loved for so long, I would think it's not time yet, I will know when I've had enough but not yet. So the emotional blows kept coming and I kept barely holding on because I knew that I was making a difference in the lives of my patients. To help with the burnout I started cross training in different areas. That helped for a little while as it changed things up for me. I would talk things over with my supervisor, who was also a great friend. She suggested going back to school. She knew that this was something that was always in the back of my mind and encouraged me to get started. Just as I was finishing up my school application the educator position for our ICU opened up. Instantly I knew I had to apply. I thought it was the perfect move for me. I thought for sure this would help me re-ignite my passion for critical care nursing. I got accepted into the Masters in Nursing Education program and got the educator position at the same time. I was so excited for both. School was a big adjustment and very stressful but I was really enjoying the new role as educator. I felt like I was making a difference again and impacting the new nurses as they went through their internships. This was merely just a band-aid for what was still looming below-burn out was still present, I was just distracted from it for a while. The demands of the job increased my fire and passion slowly decreased. I was working long hours and filling in on the unit when we were short. I felt like I was being pulled in a million directions. I wanted to make sure that the new nurses had the best chance for success, I wanted to give my patients the best care possible and I wanted my ICU to be the best in the hospital. Nurses on the unit were also showing signs of burnout and disengagement. Negativity was spreading like wildfire. It was really hard to keep trying to be positive when I was surrounded by negativity. Seasoned nurses were starting to leave, others were starting nurse practitioner programs, and some were transferring to different departments or hospitals to change their scenery. There were not many of us who thought we could sustain life as an ICU nurse for the rest of our careers. We found solace in talking to each other but that did not solve any of our problems, just let us know that we were not alone. The demands on the nurses were constantly growing yet the time to complete the growing amount of tasks was not. I would try to talk to family and they would try to help, but they just could not understand. They would try and remind me of the good that I was doing and the lives that I was positively affecting. My response would always be "but at what cost?" This job was killing me-emotionally, physically and spiritually. I now knew it was time to let go. At this point I had now been an ICU nurse for over 10 years. The thought of leaving the ICU broke my heart but I had to finally put myself first. I started looking for jobs but I really wasn't sure what I wanted to do. I was just about to finish my masters program so there were many options open to me. While I was searching for jobs and interviewing for various positions I attended the American Association of Critical Care Nurses National Teaching Institute. I went with a heavy heart knowing that I would not be an ICU nurse for much longer. I soaked in all the education that I could and enjoyed every moment. For the little time I had left I wanted to try and make a difference in my ICU. It took me a couple of months to find the right job but I did. I took a job as a nursing supervisor in an outpatient clinic. It was so hard to face the reality of leaving what was always my dream job but I knew I had to do it. I really enjoyed my new job. I started working out with a trainer, eating healthier, and since it was a Monday through Friday job I was finally on a normal sleep schedule. I still mourned the loss of my identity as an ICU nurse but it finally hit me that I did not miss the reality of what it is now to be an ICU nurse, but what it used to be. I could not ever get that back and that gave me comfort in my decision to leave. Looking towards the future I still have a passion for nursing and changing lives, I will just have to figure out a new way to do it. My dream to impact the nursing world is still very much with me. Jessica Strasen RN, BSN, MS
  13. Maureen Bonatch MSN

    The Hidden Weight of Worry

    Don't worry, be happy. This carefree song emphasized not letting worries steal our happiness. If only it were so easy to completely forget our worries and smile. Sometimes we might think we've done just that. It might seem that there is no reason not to smile yet we're burdened by the weight of worry. We may not even realize the worry is there until the event we've been focusing on with apprehension comes to fruition. Often it passes us by without the impending doom we assumed would accompany it. Only then do we feel some of the tension lift-until the next needless worry begins to gnaw at our thoughts. Worrying About Worry It's almost impossible to eliminate all worry, and we really wouldn't want to. Adaptive worry, is what drives our survival instinct. It can help us focus, work harder and provide motivation to push ourselves further than we would otherwise. It's maladaptive worry that steals our sleep and has us fretting about the uncertainty of the future. This isn't the same as suffering from anxiety, depression or burnout. These are the everyday worries that are out of our control, or that we've allowed our imagination to inflate, until it consumes our thoughts as we fear all the what ifs? What if I can't find a parking space? What if I look like a fool giving that presentation? What if I fail that test? What if I sleep in and I'm late? What if they don't like me? Worrying about things you have no control over can create a vicious cycle. When you lay awake worrying about the next day you might end up sleeping in, or worry might keep you from concentrating on your studies and then you aren't prepared for the test. Slow the Cycle Sometimes dealing with the uncertainty is worse than dealing with the issue itself. Generally, most worries never come to fruition, or often these events don't have the catastrophic effects worth the energy you've invested. It can be hard to see what you can and can't control if you're feeling overwhelmed. Worry can be bad for your health and add to your stress by stealing your sleep, or prompting you to indulge in poor health habits to try to distract your thoughts from worry. Taking the time to reflect can help determine which worries are better off eliminated. Has worrying about this ever changed the outcome? Can I learn something from this experience for the next time? Is it worth the worry? What's the worst thing that can happen? Do I really care about this that much? Coping with Worry We may not be able to stop worrying, but identifying our worries might help us learn to accept them and reduce some of their heavy control over our thoughts. You might still worry, but when you realize what's causing the underlying distress you can determine if it's worth the trouble. It might take someone else pointing it out to realize it's not kryptonite but just a harmless old rock weighing us down with worry. While planning an upcoming vacation, I worried about all the things I needed to do. My husband, an expert at evading little worries said, "You haven't even gone on vacation yet and you're worrying about when you're getting groceries when you come home?" His incredulous look and simple statement made me realize that this was a ridiculous worry. We weren't going to starve if I didn't make it to the store the day after we returned. There are many ways to work on reducing your worry, but none will be effective unless you individualize it based on what works best for you. A few ways to halt, or reduce, worry include: Take the worry out of your thoughts - write about it, or talk to a friend or therapist Relax- practice yoga or mindful meditation, exercise, or watch a funny movie, or listen to music Forget about it - trust yourself to handle the situation, or snap a rubber band on your wrist when you find yourself worrying, or channel Scarlett O'Hara and schedule worry by deciding to think about that tomorrow Just do it- address the source of worry and tackle that task Lighten your Load Worry can be a good thing, if we use it to keep us safe, increase our productivity and motivate us. It's when we worry about the little things that we have no control over, or that we might later realize were kind of silly to worry about in the first place that can cause us undue stress. Unburdening ourselves from these little worries that weigh on our conscious can help us enjoy each day more and worry less about tomorrow. Do You Have Tips on Worrying Less?
  14. According to the 2018 National College Health Assessment, only 1.6 percent of college students felt no stress over the past 12 months. Whether you are a pre-nursing student, enrolled in a nursing program or working towards a different degree, your coursework has probably left you with a healthy dose of anxiety. Stress is uncomfortable, but it is also a normal and necessary part of life that helps us to meet the challenges we face. When Stress Becomes Unhealthy We have all experienced stress at different times in our life. Most stress is acute (I.e. preparing for exams) and does not lead to serious health problems. In fact, it can give you the motivation needed to study and prepare. However, stress becomes “chronic” when it occurs over a long period of time. Chronic stress is often caused by our response to situations that are beyond our control. It is the most dangerous type of stress and is characterized by feelings of hopelessness with no end in sight. The toll chronic stress takes on our bodies can lead to permanent health problems, such as heart disease, depression and suicide. Types of Student Stress Dr. Karl Albrecht, a social activist and management consultant, categorized stress in four types- time, anticipatory, situational or encounter stress Let’s take a look at the characteristics of each type. Time Stress Time stress often occurs when we worry about not having enough time to complete all of our tasks. As a student, you may worry about meeting an assignment deadline or juggling the time demands of your home life. Anticipatory Stress This type of stress occurs when you feel uncertain about what is to come. You may be nervous about starting nursing clinicals or an upcoming presentation. Situational Stress Let’s say you come down with the flu and now have 2 exams to make-up. Situation stress occurs when you are in an upsetting situation that you cannot control. Other examples include an unexpected family emergency or “going blank” when giving a presentation. Encounter Stress College students sometimes feel stress about seeing certain people, either alone or in a group. You may have a clinical instructor that is intimidating and spending time with this person causes anxiety. Or, it could be that you dread seeing a certain person in one of your classes. Spring Semester Stressors to Expect Your time as a student will be more productive and enjoyable if you are able to manage your stress levels. Although the experience of stress is highly individualized, there are some common Spring semester stressors that weigh down college students. January-February Stressors Adjusting to new coursework and unfamiliar faculty Loss may be experienced if classmates do not return Flu season, colds and inclement weather may interfere with class schedules and academic performance The “newness” of college has worn off for first-year students Shorter days and less time outdoors contribute to higher rates of seasonal depression Senior nursing students must adjust to their preceptor and add preceptor hours to the semester’s already packed schedule. March Stressors Academic pressure may be mounting due to procrastination in coursework and/or lack of time. Mid-term exams and term paper deadlines may all be due Tensions among classmates may begin to rise as individual stress levels increase. Increase in socializing and potential increase in drug or alcohol use may lead to time management issues. Mid-term grades are issued April Stressors Spring fever with increased socialization and activity Academic pressure persists as exams and assignments are piling up High time for colds, allergies and possible stress-related illnesses Time management is challenged with the activity that comes with the Spring months Anticipation of taking the NCLEX exam for senior nursing students Plans being made for childcare for Summer semester Job hunting for Summer work. May Stressors Final exams and end-of-semester pressure Summer plans (housing, work, travel, home responsibilities) need to be worked out Sadness over leaving friends Graduating students working to meet final program requirements and may be beginning job interviews You can access a complete list of college life stressors here. Spring Flight or Fight It’s often hard to recognize when our bodies are responding to accumulated stress, especially in the thick of coursework. It takes a toll on the body when episodes of upset stomach, increased heart rate and cold sweats occur frequently over a period of time, Effects of long-term stress may lead to hypertension, migraine headaches or heart disease. Increasing your awareness of sources and types of stress can help you manage the semester’s challenges easier. Stay tuned for a follow-up article on what you can do to lower your stress levels while navigating the demands of college. What other common Spring stressors have you experienced? Additional Resource: Stress in College Students for 2019
  15. Our lives are filled with unrest. Unless you live on a secluded island, you are exposed daily to news of economic strife, poverty, disease, natural disasters, violence and the list goes on. It’s enough to cause anyone to lose hope, and nurses are not immune. However, nurses are in a unique position to support hope in those experiencing fear, grief, loss, illness and death. In the book, Hope in the Age of Anxiety, authors Scioli and Miller bring light to the nature of hope. Arguing there are 9 forms of hopelessness, the authors suggest a person can be empowered when knowing the specific form they are facing. Through understanding, hope can be restored and used to face life’s challenges. 1. Alienation Individuals who are “alienated” believe they are somehow “different” from everyone else. As a result, they feel unworthy of love or of supportive relationships. Already feeling forgotten by others, an alienated person may further distance themselves as protection from further pain or rejection. 2. Forsakenness This form of hopelessness is similar to alienation and occurs when a person feels completely abandoned during a time their greatest time of need. 3. Uninspired Hopelessness may be grounded in a lack of inspiration in a job or creative process, such as writer’s block. Underprivileged minorities may have greater difficulties with inspiration if opportunities for growth are limited and valued role models are lacking. 4. Powerlessness Powerlessness occurs when a person perceives that their own actions will not significantly impact a current situation. The sense of powerlessness may be related to a lifelong pattern of helplessness, lack of personal resources and inability to use other resources. 5. Oppression Oppression occurs when a person feels they will never be able to overcome life’s obstacles and challenges. A person may feel “kept down” or “down-trodden” by race, social status, a relationship or any other factor preventing them from having opportunities or freedom. 6. Limitedness This form of hopelessness occurs when someone feels as if their own skills are lacking and they don’t have what it takes to succeed. It may be the person is financially disadvantaged or have a severe disability contributing to the sense of limitedness. 7. Doom People who are diagnosed with serious, life-threatening illness or those worn out from frailty and chronic illness are most vulnerable to this form of hopelessness. The person is weighted with despair that their life is over or death is imminent. 8. Captivity Captivity can lead to two types of hopelessness. The first is when a person is physically or emotionally held captive by an individual or group. Prisoners often fall into this category, as well as victims of a controlling and abusive relationship. The second subtle form is “self-imprisonment”. This form occurs when someone is unable to leave an unhealthy relationship because their sense of self-worth will not allow it. 9. Helplessness This form occurs when someone feels exposed, vulnerable and unable to live safely in the world. Individuals who have experienced trauma or repeated exposures to uncontrolled stressors may have an internally established belief of helplessness. How Can You Overcome? Overcoming Alienation, Forsakenness and Lack of Inspiration Three common cognitive distortions drive alienation, mind reading, over-generalization and all or none thinking. The remedy for alienation is examining emotional evidence by surveying how others experience you. It may help a person feeling forsaken to not overgeneralize to a small sample of experiences, but rather, focus on a more extensive sample. By looking at the bigger picture, it is likely that hope will emerge. For all or none thinking, the antidote is thinking in shades of grey and opening up to the possibilities in one’s life. Overcoming Doom, Helplessness and Captivity Scioli and Biller suggest a strategy of “examining the evidence” when doom is a result of “jumping to conclusions” especially with a medical or psychiatric diagnosis. Examine the facts by researching the diagnosis or situation to avoid drawing conclusions based on fallacy. Overcoming Powerlessness, Oppression and Limitedness Three cognitive distortions are at the root of powerlessness, discounting the positive, personalization and labeling. All three cognitive distortions discount personal accomplishments and successes. Examining the evidence is a good strategy to cope with discounting the positive. The authors suggest making a list making a list of personal, occupational or social successes, especially in the area being discounted. What do you think? Do the author’s 9 forms of hopelessness give you a better understanding of your client’s distress? Resources Hope in the Age of Anxiety: A Guide to Understanding and Strengthening Our Most Important Virtue by Anthony Scioli and Henry B. Biller (Oxford University Press).© 2009 by Oxford University Press. Content from Chapter 13- Overcoming Hopelessness: Escape from the Darkness Cognitive Distortions
  16. Ahvegas

    A Thief Named Alzheimer's

    It's a weird feeling. To love someone that isn't quite sure who you are. It grips you, right in the heart, the blank stare. The one where they look right thru you. And you wonder, are they trying to remember? Will I get lucky today? Sometimes, on a good day, you can tell by looking in their eyes, that they see something in you that clicks, reminds them of some other time. And on a great day, they remember your name. That's life with Alzheimer's. The cruel twist of fate that grabs your gut & robs your soul, little by little, every second, every day. It's saying hi to a stranger, & goodbye to a person that you love with every ounce of your being, who could care less. It takes you, piece by piece. In the beginning, you say to yourself, I can do this, but then you forget yourself, and you crumble. You cry, and pray, and miss someone, someone who is still physically there. You hold onto a person, but that person is gone. You pray a silent prayer every time, this day they will know me, know us, know our love. After a while, you don't even care that they don't remember your name, you just want that feeling, the one where it seems like they recognize you, and it makes them comfortable. Unfortunately, not all of our prayers are answered. You feel the cut, no matter how much you prepare yourself. It's the first glance that feels like a knife, then the blank stare that feels like someone twisting the knife in your soul. And then you bleed...as you hold them, and feed them, and clean them...you bleed. It's war, and you are the only soldier. The battleground is in your heart, and the weapons are empty stares. It's a war you don't win. No one comes to your rescue. No one knows your pain. No one that hasn't already fought their own war. It's not a disease that others easily relate too, it's not cancer or a heart attack. Those diseases cause everyone to rally. Everybody's your friend, your support. It's different with Alzheimer's. You're at home because your loved one can't go out. It causes confusion, anxiety, & paranoia. They forget to tell you they have to go to the bathroom, they forget how to stand, they forget how to eat, they forget you. They get scared, agitated, and you find yourself holding your breath a lot. Waiting and forgetting to breathe, fighting off your own anxiety, and asking yourself 'what could possibly be next?' So you're at home, alone. Isolation, desperation, and loss take control of you. You don't just lose your loved one, you also lose part of yourself. But it goes so much deeper than that because it saddens you that they forgot themselves. And they were amazing! Alzheimer's disease is a physical loss to an invisible disease. It's a killer. It's a goodbye every time you look in their eyes.
  17. Ashleigh Boyd Nurse

    3 Simple Ways To Squash Compassion Fatigue

    Ever woken up covered in sweat at 3 a.m. wondering if you forgot to chart something at work? Or, how your patient is doing? Or, the mess you left at work? There’s nothing worse than the feeling you get when you think you should have done more. You’re tachycardic. You’re diaphoretic. And, it always happens at the most inconvenient time, doesn’t it? When you’re trying to walk out the door, or five minutes after you get home or the worst ... when you are trying to fall asleep. Whether it’s your charting, a late med or leaving your patient rooms a mess, doubting your every move can be a real pain in the ... But, we get over it because we’re human beings. Sure, it’s annoying, but generally speaking, life goes on. Continued doubt, lack of support, increased daily requirements with no end in sight is daunting. Not only does having to re-live your shift, replay your actions or recreate the real life scenarios in your head, it also wastes time that you could be enjoying for yourself. At best, you come off looking unprofessional and unreliable ... so you think. At worst, you lose a job - you lose money but save your sanity. As nurses, we’re busy. And I mean, reeeeaaaalllly busy. I don’t know about you, but I’m often running around like an idiot trying to take care of my patients but also help my team out. This is when things go a little awry. It’s not uncommon for nurses to feel like they are torn in 30 directions at once. Ingrained in our heads from school is: what’s the best option of these four correct answers ... But, very rarely do we feel like we walk away a winner; charting done at bare minimum, call lights and bed alarms constantly sounding, titrating drugs and scanning later, updating white boards, informing families, arranging rides, setting up follow-up appointments, researching geriatric psych facilities because the social worker is on-call and not answering, taking patients upstairs or to OP areas, giving medications to patients, comforting patients, attempting to advocate for your patients, educating staff and families ... the list can go on and on and on and on and on ... How? You Ask How can I walk away feeling like a winner and not take all the what-ifs with me?? Real-Time Transformative Response (RTR), my dear. Now, before you roll your eyes ... let me clarify a few things. What is Real-Time Transformative Response (RTR)? RTR is a technique that can be used at the hospital, home and anytime you are needing support to get out of the vortex of doom. You don’t have to give up control of anything. RTR is all part of creating a work environment that allows you to decompress, release stressors and stop taking everything home with you. Here are my top 3 life-saving tidbits, without which ... I’m not sure where I’d be! 1 - Understanding Our Bodies I like to think of Biofield Response as a bubble around our bodies. Although it’s important to understand what is going on inside our bodies, it’s just as important to know what is going on outside of them too. A simple way to think that homeostasis occurs when both inside and outside match. Biofield Response is the inner communication highway that is literally excreted into the world from our bodies, energy and frequencies. Have you ever just felt drained being around a specific person or go home feeling wiped out?! That’s because you are. Your energy is literally clogged. Like a bad carburetor. Throughout the day we are constantly exchanging energy and sometimes we gather too much of what we do not need. This is when you begin to feel bogged down, anxious, overwhelmed, or just plain over it. Understanding this was the biggest eye-opener of my life. I can actually take on the energy of others and make me feel even worse than I already do ... ?!!? As Einstein said: So, the environment we work in at the hospital isn’t always the most pleasant: people, surroundings and situations. So this means that the energy we take on while we are there is actually changing us physically, emotionally and mentally! 2 - Celery Juice Hands up if you suffer from: brain fog, chronic illnesses, and anxiety that are taking over your life from hospital-induced compassion fatigue. Celery Juice is an absolute godsend, especially if you have multiple issues going on, or even one. I totally get how strange it sounds but it’s a miracle in a cup. I began juicing and noticed within TWO days a total change in my body. TWO. I swear by it. My family does and so do hundreds of thousands of other people. Hands down ... 16 oz of celery juice on an empty stomach has single-handedly changed my life. Thank god for Anthony William. 3 - The Power Of Our Brain Without our brain, there’s no way we’d be functioning at the level that we do, right?! But, the brain is so much more than what we give credit. I can tell you that you can change your compassion fatigue, anxiety, overwhelm and stress in seconds. But, I can feel the eye rolls and mouse moving to X out of the screen ... BUT ... It’s true. You can change your past experiences that are tainting your current ones, and allow you to empower yourself with the gift of understanding how your neural pathways work. How you can repair, change and alter your brain sequences, triggers and creates a pleasant experience out of a traumatic one. The power of our brains is endless. Discovering that in less than 10 minutes, you can go from a 10/10 anxiety level from a past experience that is causing you PTSD and hindering your job ... Down to a 2/10 by using simple but proven techniques is what made me realize that our brain is an untapped mega machine. Compassion Fatigue is here to stay but there are so many things we can do to help ourselves. Corporate is just now awakening to the idea that maybe, just maybe they have induced this nursing syndrome. And, just maybe they need to fix it before just enough people quit that their hospital won’t function anymore ... Ashleigh Boyd, R.N. Nurse Anxiety Coach & CF Expert
  18. Spring Arbor University

    Conquering Stress and Anxiety - A Guide for Nurses

    As fast as new nurses are entering the workforce, established nurses are planning to go part-time, retire or exit the field. The American Nurses Association (ANA) reports that over 700,000 nurses are projected to leave the labor force by 2024. Knowledge is power, and education can do much to prepare nurses for today's fast-paced health care environment. Degree advancement also helps nurses secure better positions with better working conditions and pay. Today's online learning options provide flexibility previously unavailable to the working nurse, through MSN and Nurse Educator programs. The Road Map Out of Stress and Anxiety Is there a solution? Are there things that nurses can do individually and collectively? The good news is that stress and anxiety relieving tactics that address these issues are available. Seek a different position on a lower-acuity floor or seek a lower-stress nursing position, such as public health nurse, school nurse, nurse educator or nurse administrator. It's not always easy to pick up and change positions. Nurses have a strong sense of loyalty. Instead of choosing to leave for a job with more life/work balance, they sometimes remain until they can't take it anymore and end up exiting the field altogether. A nurse can inventory her/his values individually and create a mission statement for life and vocation. Burnout can be the result of a nurse's existential conflict of working beneath core values. Mindfulness training and reflective practices are being incorporated nationwide to improve the quality of life for employees and patients. Employee health centers in larger healthcare systems often have life coaches or access to holistic health services. Clarity of purpose serves as a shining beacon to better choices. When self-care is a top priority for nurses, they are more likely to do the things necessary for life/work balance when it's needed and not stress about it. Select a workplace where compassion practices are the norm. In this technological world, it is easier than ever to understand the pulse of an organization. When choosing a potential workspace, take the time to look at the employee reviews describing what it is like to work in the organization. When possible, work for a Magnet organization where wellness is a priority for patients and staff. Advance your education so that you are eligible for promotions and opportunities with better work hours and environments. There are a plethora of great online options that build in flexibility to degree advancement. Most magnet facilities prefer BSN preparedness. Join a nursing advocacy group on your unit, in your hospital or externally if that is the only option. Learn to set boundaries. Learn to say no when needed in both your personal and professional life. Eliminate extra activities. Make it a point to be early. Always. Show up first to your shift if you are usually running late and watch the magic on your co-worker's faces. Stop complaining. Learn to voice your needs respectfully and proactively. Don't gossip. It's diminishes everything and everyone. Assume responsibility for your actions. Be a part of the solution. Learn the scope of your practice and be clear about those boundaries. Learn self-care strategies such as doing things daily that make your happy Take time to figure out if there is anything that you can learn, do, or say differently to reduce stress. If technology issues are a continual problem, an easy solution is taking a class. Difficult relations with coworkers are a little more challenging, but look to see how you can change something about yourself first before tackling the others. If people are continually complaining that you have a harsh tone, respectfully consider that you may need to learn a more effective way of communicating. Any genuinely introspective and authentic effort you undertake to improve a situation or condition will not be in vain. Get help. Nurses know healing begins when the patient believes his voice has been heard. It is no different for nurses who are human beings too. If the problems are too big or overwhelming, find a therapeutic safe zone and get help. Do for yourself what you would tell your patients to do. Be courageous enough to do what is right for you. That's self-care in a nutshell. Advocacy For the Nursing Profession Nurses need to band together in advocacy and extend the loving care to themselves and each other as well as patients. Nurses need to mentor and nourish their young, advocate for their profession, and lead the charge into healthcare's future by putting the proverbial oxygen mask on themselves first. The flight attendant is right. You cannot help anyone else if you cannot breathe. We hope you enjoyed this article. Spring Arbor University provides online education opportunities for nurses who want to do more with your drive to make a difference. Gain career growth in primary or preventative care on your own schedule while you continue to work. Lead change, advance health, and go forward as you educate patients and families on their continued care. Contact us to find out more about our MSN-NP, MSN-NE, MSN/MBA, RN-MSN-NP, RN-BSN and other online nursing programs. Learn more here.
  19. SarahWRN

    New nurse anxiety

    New member to site, and Have a question for you all. I am a new grad RN, and am working at my first Job at a Rehab institute on the brain injury unit. I have been at this job for about three months now, and am beginning to experience a great amount of anxiety, and even slight depression about my work. Every time I leave I'm constantly thinking I missed something, or that I did something wrong. I decided to get on an antidepressant/anti anxiety medication to control these feelings. I am now on Lexapro 10 mg, and am hoping this helps. My question to everyone is, is this a normal feeling? Have any of you new, or even veteran nurses had these feelings, and if so, do they improve with experience? I hate going home wandering if I picked the right career field, I know I love being a nurse, but I believe the stress is just overwhelming me. Any input would be greatly appreciated!