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Topics About 'Empathy'.

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  1. jeastridge

    How to Listen: Do Nurses Do It Best?

    A few weeks ago, several of us nurses got together for a cup of coffee outside of work, a rare event but an occasional holiday celebration. We sat around a table, holding our hot drinks and warming our fingers from the bitter cold outside. After some light banter, one of our colleagues shared a recent difficult encounter with a patient, one that left her feeling defeated and out of sorts as a professional. We all listened intently, and it was interesting to observe the various responses from her friends and co-workers. Because our responses were so reflexive, it made me think that we might also respond this way in other situations. Is good listening a skill we can learn and get better at? Consider the responses from around that table and think about how you respond to patients, co-workers, family members that share vulnerably with you. 3 Responses 1. Almost before she could finish her story, one of the group asserted loudly (even pointing a finger in her direction), “I would not take that. I think you should respond by saying…” She went out to detail how the conversation might have gone had she been a participant, laying out clearly what she saw as the answer to her friend’s problem. Her body language, her forcefulness, her certainty all seemed to push the storyteller back in her chair, away from her cup of coffee, as she raised her eyebrows questioningly. “Do you really think so?” She queried, her hurt and confusion visible and audible. 2. A second person listened a little longer then said, “Well, I don’t think you should feel that way at all.” She continued to “should” all over the teller, minimizing her struggle and essentially asking her to harness her feelings into something less hurtful than they really were. “Shoulding” is so common, isn’t it? 3. The third person, the speaker’s close friend, remained quiet through the various exchanges, allowing the story to have plenty of time and space. She leaned forward a little before quietly offering her empathetic response: “What happened to you really stinks. I am so sorry that you had to go through that.” To me, it felt like she came alongside her friend and figuratively put her arm around her shoulders, sharing the difficult space and sitting with her as she felt the feelings she was feeling. Same story, three very different responses. Where do you see yourself? Ideally, we would like to say that we are consistently in #3, but most likely, we vacillate in our responses, employing all 3 from time to time and moving back and forth. Adviser The advice-giver meant well, but she effectively shut down communication, didn’t she? By delivering her pronouncement, she declared that she knew what was best and how that situation could be resolved. As unrealistic and presumptuous as her response is, we see it and experience it often, don’t we? People want to “set things right” by their standards and don’t want to leave a lot of uncertainty hanging around. While it is possible to offer advice, people rarely really want it, even if they ask. Generally, people need to work out their own individual approaches, their own answers, in their own time. Occasionally, if we have been in the exact same situation (unlikely) we can share what we did, but most of the time, those who share with us are looking for validation, a careful listener, and help in the form of a well-placed question such as, “So how do you feel about things now?” The advice-giver’s body language also closed more doors. Finger-pointing rarely feels good to the recipient of the gesture. It can be a strong, power-loaded motion, one that requires careful thought before deployment. “Should-er” The “shoulding” friend also delivered a put-down, didn’t she? We have the right to our feelings even if our feelings are not right. Feelings are proprietary. We acknowledge them, deal with them in our own way and hopefully find a path to mastery over time but “shoulding” brings some shame into the picture and makes us ask ourselves, “What is wrong with me to feel this way?” Of course the “should-er” doesn’t mean to elicit these feelings at all; she simply wants to make everything “all better” and smooth over discomfort. She longs to fix it, doesn’t she? As nurses, we can be attracted to the profession because we long to help our patients. This charitable desire has a dark side which is the “fixer” of the profession—always knowing what is best for others and letting them know what we think instead of allowing them to feel their own feelings and find their own way. If not carefully monitored, our desire to help can morph into control and manipulation and codependency. Empathetic The third friend’s empathetic response felt the most compassionate to me as I observed these interactions among friends. While the first two seemed to close doors of communication, the third response pushed the door ajar, allowing for future conversation and more opportunity to discuss the hurtful occurrence and to process it. The conversation at the table moved on to less heavy topics and we continued to share and laugh as our coffee cooled, offering healing and support to one another. Long after we went our separate ways, I thought about what I had witnessed and how many times we miss the mark in our responses to others. Were #1 and #2 “wrong” and #3 “right?” Well, yes and no and maybe. We are not perfect humans. We must offer each other grace and forgiveness every day if we hope to find any joy at all in this life. Friends sometimes say the best thing and sometimes not. We don’t discount their input either way, and we usually try to overcome differences. But such conversations shine a light on how we communicate and can help us to pause and think as we listen to someone’s story, careful as we try to respond with empathy and concern.
  2. jeastridge

    Nurses: Compassion Experts

    Below are three instances where a dose of compassion resulted in good medicine. Case 1: “I feel like my body is betraying me. I’m only 55 and everything seems to be falling apart,” the patient I was sitting with cried as she spoke with the nurse that was getting her admitted. The nurse paused her typing, turned her body slightly to face the patient, and with genuine compassion in her voice said, “I’m sorry you are having to go through this. All this testing can’t be fun.” The patient visibly relaxed and the tears that threatened seemed to dissipate. Case 2: The patient was all set to go to surgery. I was there with her pastor to pray for this major procedure to remove cancer from her colon. Her husband hovered nearby and as they started to roll her stretcher out, he clung to her hand. The intake nurse was there, and he gently slowed the gurney and spoke to the husband, touching his arm, “We will take good care of her. If you will go through those double doors to the waiting area, we will be in regular contact with you throughout the surgery.” His manner and calm demeanor spoke volumes. The husband released the stretcher and kissed two fingers before touching them gently to his wife’s lips and mouthing the words, “I love you.” Case 3: The patient had been in the ICU on life support for several days. The situation looked grim and the prognosis was not good. As the Parish Nurse, I visited daily and tried to help the family as it became clearer that we were looking at considering end-of-life issues with this wife, mother, and grandmother in her early 70’s. The bedside nurse was so helpful! She was competent and busily tended to the patient’s multiple lines, continuous dialysis and ventilator. Her manner was simply reassuring. She talked in low tones and did her best to answer questions that the family expressed. They sat anxiously by, and some of them stood in the hall. No doubt crowd control had to be trying this nurse’s patience, but she did not let it show. She steered the family away from the bedside and into the waiting area so that she could have more space to provide the necessary care, but even in doing so, she communicated volumes about her empathy toward this tight-knit family and their grief. As the Parish Nurse, I tried to help transition the family to a better space and continued to provide a listening ear and to help in interpreting what was going on. The American Nurses Association’s broad definition of nursing states: There is a lot to love in this definition because nursing is truly about so much: the stated and unstated. Compassion may not be part of the official description, but it is often part of the force that draws people into nursing and certainly one of the motivators for staying there even when times are tough professionally. So being a compassionate nurse is a good thing. We all get that. But if we are not particularly bent that way, how do we cultivate that characteristic? Also, if we are just plain worn out and tired, how do we stay compassionate? Isn’t it “fake” to pretend that we feel something we don’t? If we really want to be authentic people, shouldn’t we be honest with our patients when we are not having a good day? Compassion is an action more than an emotion. When we are professionals, we can act with compassion even when we are having a difficult day and do that without “faking it” or lying or trying to muster up some artificial warm and fuzzy feelings. Professionalism simply means that we understand the scope of our work and that part of it is trying to make a better day for our patients. We do that best, when we act with compassion—in some small way seeking out a position of empathy. This can be trying with our difficult patients, but part of being a consummate professional is knowing how to make that happen even when we don’t feel so inclined. Compassion rises from a well that can run dry. We have all been around the nurses that have run out of steam professionally: they have had to work too long and too hard and under undesirable circumstances. Let’s be honest and name it: Nursing really stinks sometimes. But as professionals, we keep trying to support each other and encourage one another to be our best selves. No, we will not succeed every day—no one does—but we can prod each other on and help each other seek ways to refill that well of compassion when it threatens to hit bottom. Genuine compassion sometimes means not communicating your own personal issues. In our own lives, we have struggles so it is easy to forget that the patient is not there to hear about them. They are in their own time of trial and often cannot cope with hearing about someone else’s—even if it’s as simple as your flat tire on the way to work this morning. Really, our patients need our professionalism to trump our own need to share. Listening and caring about their needs is what we are trained to do. Whether brand new or benefitting from long years of experience, nurses can have uniquely helpful perspectives in their area of expertise. Whether in the hospital or out; whether corporate or private; facility or outpatient—in any and all settings nurses who show compassion offer true help.
  3. xwill327

    Interview with the Psych Nurse

    It’s great when a psych nurse can be empathetic to their patients from the education they received in nursing school combined with previous patients they have cared for. I believe they can give even better care when they had experienced it first hand. Countless times patients have yelled at me, “you have no idea what I am going through.” My one colleague has experienced being admitted to an inpatient psychiatric unit. I wanted to understand her experiences and how it impacted her career as a Registered Nurse in Psychiatry. We worked together and I was immediately drawn to her passion for the field of psych nursing and just her as a person. We became close and were able to share stories about work and eventually our life struggles. We disclosed personal experiences with each other. Not only was she a runway model (super cool), but she also struggled with an eating disorder and mental illness. To my surprise, she had been admitted to an inpatient psych unit. I had always wondered what it would be like to be the patient. Here are some views of the psych nurse as the patient: Has anything on the job ever triggered you from personal experiences? My first week on the floor, I was called to a behavioral health crisis on the medical floor: essentially meaning a medical admission lost their mind… I was called in to help restrain an anorexic patient who was refusing treatment. She was not a danger to herself or others and restraining her would go against my ethics, as well as, and more importantly, it was against the law. I did nothing though! I just stood there, watching her be tied down so they could enforce the treatment that she had refused. All I could think of was, “what if I had been restrained for my anorexia turning my hospital stays.” It would have been nothing less than scarring. That thought repeated in my mind as I remembered back to a time when I still denied my emotional disturbances, just as that girl was as she screamed she was fine. Since then I have learned to be an ally to ED (emotionally disturbed) patients, as I know the world of medicine as a whole for the most part avoids them like the plague! How do you feel when you know you helped someone who had a similar issue as you? I will always think back to this one patient in particular who I will refer to as K. If I can think back to someone I feel I helped, it would be her. I was placed on a one-to-one with her following her attempt to hurl herself through the glass window in her room. She was placed on a suicide watch one-to-one which meant one person watching K. Usually this job is given to a PCA (patient care assistant) or a Behavioral Health Tech. However, we were short staffed that evening so as charge nurse I took the role. I had to be within arm distance of her at all times. To say the least, K. was not having me when I entered the room. My close proximity only bothered her more. Despite her attempts to avoid even eye contact I continued my attempts to make conversation. After my relentless conversation prompts, she began to engage with me. We began to joke and she laughed with me. I stayed with her for nearly three hours that evening. The next day K. approached me and said, “I think I get what you were talking about with good things still having a bad side and bad things having a good, like last night, bad-I tried to jump out a window, good- we got to talk and have fun.” My heart sunk and it remains the largest thank you of my career. I am not out to save the world; that would only be a disappointing pursuit. But, if I can help a suicidal patient laugh for a couple hours, I cannot go home with my head hanging down. What is your take on the inpatient experience? Is it beneficial? How would you change it? I don't know if you meant my personal stay in the psych ward or my time working in them. Seeing that I have now experienced both I can say that after my 4th stay I stopped attempting to make light and accepted I would do anything for them never to have happened. Despite this speaking in terms of my work they each had enormous importance. My first stay at 18yrs I learned how to relate to the fear that comes with admission and of its great unknown. My second, I learned the shame that comes along with it and the anger when you have to be admitted against your will. My third stay was due to a head trauma, not psych symptoms, I was placed in the ward purely because of my history. There, as I came back to reality from the two cracks in my skull, I found out what is was like to lose your voice to your overshadowing past. My fourth stay I went in attempting to get ECT, which I was denied. Already a psych nurse at the time, I had far more insight into the world of outpatient but not inpatient. I learned about the frustration in delaying the discharge process. Only because of my further protest did my 72 hour letter not continue to stretch in time. Most patients don't know their rights: such as a 72hr letter to demand discharge. Are you open with your coworkers on your background or remain private? I remain more than private. I was having vicious side effects causing me to shake and tremor constantly. I looked like a wreck as well. To explain this I would blame my other and more acceptable meds treating for my epilepsy. At times, I went as far as to claim having other disorders to explain my symptoms away. My anorexic appearance I denoted to marathon training despite not having worked out in a year for fear of increased hunger. I wish I could be more honest with my coworkers but the way they talk about these disorders and how they talk about the patients afflicted… I just cannot imagine them thinking of me that way. How do you strive to break the stigma of mental illness? How can others in your opinion? I strive by simply getting up everyday. I have a fortune I carry in my wallet that has the quote, “Heroism is the endurance for one more moment more,” which is far easier said than done. It was only recently that I have admitted to myself I am in fact disabled by my disorders. Despite being crippled by them my unwillingness to let them win as well as at times pure denial of them… has allowed me to achieve both personal and professional success even when it seemed everyone else assumed I would fail. How others can break the stigma is to talk about it. If there were simply more numbers of people talking about their disorders, I truly believe even more would come forward and the rest of the world might not be so uncomfortable. Thank you to my colleague and cheers all!
  4. Kelsea1214

    The Nurse Empath

    I wonder if every nurse feels as much like a sponge as I do. Does every nurse get random flashbacks of that patient two years ago whose hand you held as he took his last breath? Or of how you watched the love of his life, the stoic and statuesque woman by his side, literally collapse like a house of cards onto his frail chest, sobbing for them both to go back to the first time they met? Does every nurse then remember how your mind wandered in that moment to the patient in the adjoining room, who is incessantly ringing her call bell because you forgot to get her that vanilla pudding you promised her 30 minutes ago? Does every nurse get into their car at the completion of that shift, turn their ignition on, pause and exhale for the first time that day? Am I the only one who is a weeping sponge? I left my second-degree nursing program a freshly packaged sponge, ready to absorb all of the knowledge a career in nursing had to offer me. I was neat and tidy and dirt-free. Literally the underside of my new fancy clogs had never touched the surface of a hospital floor. As I walked through my first year as a nurse, my shoes got a little dirtier and I became a little more saturated with emotion. I cried ALOT. I had never seen someone die before, let alone be the one administering that last dose of morphine. I never before had to watch the dreams of a teenage boy be ripped right out of his hands because he was in the wrong place at the wrong time. A gunshot wound to his abdomen would obstruct him from playing college football and he would lose that full ride to the prestigious university. He tells his crying mom that "everything will be okay" and only when she leaves the room does he break down in front of me. How much emotion can one sponge absorb? Who will wring us out? I began my most recent nursing position as a system wide float nurse with a new vigor and a new promise to myself-to no longer be a sponge. Oh how naive I was. I was approximately two seconds into this new position before I flung myself back into the treacherous, emotional waters of healthcare. I can't help myself-I'm an empath. What I've learned over the years is that self-awareness is key and this requires self-reflection. Think back on your best and worst days in your career. What worked and what didn't? Jot those things down. Reflect on what is most important to you in your work life. What are your non-negotiables? Two of mine are work culture and my own mental and emotional health. I know I need a break from the bedside and my chapter in bedside nursing may be shorter than some others. Guess what? That's okay! We cannot help the people around us if we ourselves are bleeding out. Take care of yourself physically, mentally and emotionally. One of the first people I reached out to when I knew my emotional wellbeing was at stake was my current manager. He is a tremendous listener and support system-I knew he'd have my back. For me, this chapter hasn't all been bleak. I've met some fantastic people whose stories have inspired me, and they've helped to wring me out along the way. We the nurses, the sponges of healthcare, go from room to room tidying up life's little messes. We absorb. I am a weeping sponge and it is time for me to wring myself out. Don't be afraid to recognize if it is your time, too.
  5. jeastridge

    The Nurse Optimist

    The Nurse Optimist Being on the consumer side of nursing is eye-opening. As they wheeled my mother back to the holding area, I walked beside her, ready to take her hearing assistance devices once the staff were done asking her questions and going over the pre-op procedure prior to the repair of her fractured hip. It was out of the norm for me to be back there, so I tried to be as inconspicuous as possible and stand clear of any traffic. The nurses, anesthesiologist, surgeon came and went, each with their own list of questions and duties, but all with compassion in their eyes and kindness in their touch. I felt proud to be a nurse as I stood by, watching my peers make things better, safer, as perfect as possible for my dear mom and the other patients around us. My mom's nurse, in particular, stood out. She wasn't bubbly or perky which might have been annoying at the time, but she was simply correct for the situation: professional, reserved, and above all, caring. I had seen her before as we walked the same halls from time to time, but I had never witnessed the way she took care of her patients before. Back in pre-op and PACU, she was in her element: confident and comfortable. As she finished up her duties and told mom there would be a slight delay, she asked mom if there was anything else she could do. Mom, deeply spiritual, said she wanted to have prayer and the nurse stood with her and held her hand as I prayed. Respectful and calm, she helped mom deal with the delay in an already stressful time after a fall, the resultant pain and unexpected surgery. As I left the area carrying my mom's various hearing devices, I thought about the nurse's approach. What was it that made her so special? How can we be that nurse that we all want to have when we are facing a life-crisis? Focus on the positive As nurses, each day we have a choice of how we view our world. Yes, there are lots of negatives but my goodness, let us not forget the strides we have made and the positive outcomes we see every day. We participate in grand miracles of healing almost daily and yet we often cannot see the bigger picture of good and instead focus in on what is wrong. There are lots of things that really do work well: we generally have adequate linens, food, hygiene supplies. Trash gets picked up, ice is available, antibiotics still kill germs (most germs...), surgery still repairs broken hips and ruptured colons, blood products are available to restore life, and the list goes on. When we pause to consider the good, and to be thankful, we can put the negatives back in the perspective they need to be in. It is important to address our shortcomings, to see our faults, to correct mistakes, but none of us thrive in a clime of fear and judgment. We all need to continue to encourage and lift one another up. Caring doesn't cost The nurse that took care of mom conveyed true compassion. It wasn't sappy or dramatic; it was genuine. She was a professional who did her job well and truly cared for her patient. What was noticeable also was what she didn't share: she didn't tell us about herself or about her lack of sleep or her aching feet or how short staffed they were. Those things might have been true but if she had shared them with us, we could not have helped her and it would have diminished the comfort she provided. There are times to share personally, but the bedside is not one of them. The last thing our patients need is to have to take care of us. Practice empathy How does true compassion differ from pity and sympathy? If words are kin to one another, then compassion and empathy are cousins who walk around in each other's shoes helping one another out, while pity and sympathy feel bad and sit side-by-side and don't do much. Empathy requires practice, digging deep in ourselves to find ways to connect with our patients and their needs. Empathy anticipates needs and works to implement them. Being empathetic can be draining but it is also one of the ways that we get into a space in our practice that is truly rewarding. When we are in it for the long haul, our rewards come from empathetic responses that bridge barriers and allow us to truly care for others as fellow humans. Mom went on to an uneventful recovery, surely assisted by a great nursing, surgical and rehab team. The care and compassion of the nursing staff around the time of her surgery left a lasting impression on me and renewed the desire to provide more of the kind of care we experienced.
  6. mother/babyRN

    The Sweet Old Man in Room 724...

    One can forever discuss the unmistakable magnificence of mountains or sunsets, or millions of other unforgettable miraculous occurrences. So many moments we take for granted, assuming other such moments will follow with scarcely a thought as to how fleeting they really are...Life is not a promise, but a gift...Not everyone can "see" the subtle nuances we are so fortunate to experience as time carries on. Vast sky, awash in color in early gray dawn; vivid palettes of rich oranges and pinks seeping silently toward the city like perfectly tinted paint on some ghostly artists' easel...This is what I see as the days old night retreats... Today I was humbled...I'm not certain why the feeling occurred today as it was, until then, a day not unlike any other. I wanted so badly to reach out and stroke your forehead, all the while imagining if I were you I would need to know that someone cared. Odd, you can't see or hear me, cannot comprehend...those tired eyes, which are absolutely the most beautiful shade of light powder blue, just like my gramma's, tell me as much...Or do they? I never knew you. Then, suddenly, you were my newest patient-Mr. A, the CVA in 724. Massive stroke with little hope of recovery. Until then, that is exactly how I thought of you...Until today...Until this very moment.... You must have been a grand gentleman. Stories regaled by the fire in the cool briskness of late autumn. I suspect bold gregarious yarns accompanied by rounds of barreling laughter and peals of delight from scads of grandchildren gathered gleefully at your feet, mesmerized in rapt attention as grampa spun tales by the fire under a dark blue velvet, flawless star flecked sky....Sparkling, dancing eyes and work roughened gentle hands, wisps of white hair ruffled in the face of a breeze on the open sea. I think you must have sung songs too..I can't explain but somehow I'm sure of it. Sad that you may never again know anything of the world, at least as YOU knew it...I don't know you, but somehow I already miss you. I grieve for you, your life and what might have been but can now most probably never be. I remember my own grampa and the way he smelled-pipe smoke and rootbeer....I memorized every little wrinkle when he laughed...You remind me of him...... Can it be that you are no longer even aware of your own existence? I pray not. I think not, for somehow you have connected with me and touched my heart. Your tortuous, labored breathing makes my own drawn and painful, and as I caress your weathered face, I see no tears in your eyes but in my heart I know that they are there. Mine have joined them... I wonder, God, what if the man inside can hear me? What if everything is understood? How frustrating, no, how absolutely terrifying not to be able to reach out, but to merely exist. To move, to be alive, yet not... So, I will touch and comfort you, feed and bathe you, keep you warm and manintain your dignity, and even if you never again stir, we will know, you and I, that we are somehow responsible for each other, for you have touched my heart without uttering a single word...You have made me a better nurse and are an unforgettable immortal lesson on my journey to the future.... Go on dreaming Mr. Al, for I am here for you... I will always care... Written by : Martha RN
  7. Snorkelgirl4

    Emotional Empathy: I Carry You With Me

    It was a typical day in the emergency room. Ambulances were consistently calling and patients who walked in were lining up to be triaged. I was somewhere between working up a cardiac patient and a gastrointestinal bleed when I saw her... Tears were freely flowing down her cheeks, and I could tell that whatever was going on was truly painful. As she was being taken to a room that I was assigned to, I braced myself mentally as to not get too emotional upon meeting her. I took a few deep breaths and entered the room. To my surprise, she was not my patient....her husband was. As I began to assess him, I asked questions. The only response he could muster with his blank face was "for my family". His wife started crying more heavily, so I handed her a small box of tissues from a drawer in the room. After a few moments, she was able to speak clearly. She said "He has been addicted to drugs for years and wants help so that he can be a better husband and father to our child." I was speechless for a few moments, but I regained my professional demeanor and helped comfort her while medically working up her husband. The process for being transferred to a psychiatric facility for detox out of the ER was always complicated. The psych facility in connection with our hospital had very strict criteria for admission. The process of finding out whether or not a patient could be transferred and admitted sometimes took hours. Tests had to be performed to ensure that the patient had no medical concerns. An evaluator would then go to the ER to interview the patient. Other factors also came into play. I always believed the system was a disservice to our patients, but my hands were tied. After ensuring my other patients were safe and stable, I entered the room again. The ER case manager was speaking to both the patient and his wife.....and she was crying heavily. She began blurting out words of frustration as our case manager explained that the patient did not meet criteria for admission to the psych facility. The case manager provided the patient's wife with community resources and other information to help the patient....and it was at that moment that I knew the situation had taken a turn for the worse. The patient began slowly shaking his head. He ripped out his IV, and mumbled who knows what under his breath. His wife screamed "It took everything for him to walk in here and give up his pride to get help. He is not going to go somewhere else now because the psych facility you talked to made him feel stupid! It has taken years for me to get him here!".......She followed him out the ER doors without taking any papers. She left looking incredibly defeated, and I felt like we had failed her. Fast forward to two months later. I was at a county fair at a vendor table for a company I was representing. I looked up at those same brown eyes that were so full of tears in the ER. She was alone, and she did not recognize me (maybe because I had worn glasses that day in the ER). She was incredibly outspoken and friendly. She kept coming back to my table for candy, which I gladly allowed....At the very least this woman deserved the entire bag. As the hours went by, and after enough visits for candy, she began to open up to me. She explained that she had a craft business and traveled to various county fairs throughout the South for extra income. She said that she had been doing so well that she actually made a full time job of it. Unfortunately, she was going to have to find a "real" job for insurance purposes because she was getting a divorce. I felt my heart drop in my chest as I recalled the events of the ER upon hearing that word...divorce. How I wish I could have done more for her. Although she seemed much stronger in such a short amount of time, I know that the pain was there deep inside. At the end of the day, I hugged her and helped her stuff her remaining crafts into her van. She explained that she was on the way to another big event and needed to make several more wreaths. She was happy with her sales for the day, and I was happy to see her smile. She drove away, and I haven't seen her since....but I carry her with me. I pray she knows that even when it seems that nobody sees her tears, I do. I hear every teardrop loud and clear....and I carry her with me.
  8. jadelpn

    A Mile in Their Shoes

    There's an old saying "don't judge unless you have walked a mile in their shoes". One of the more difficult aspects on becoming a nurse is seperating your private "you" from your nursing "you". There has been more than one discussion on "hating" a certain patient group. That they are too difficult to care for, emotionally and/or physically challenging, that you are not one with their culture, their lifestyle, their choices. If you step back for a moment and think about how you as a nurse have the opportunity to keep your patient's dignity intact while providing excellent care, you can define your practice as a nurse. Life is full of could've, would've, should'ves. As nurses, we are only educators. We don't own time machines to catapult someone back in time to change things for a patient. We can only go on from here. To remember that you can only educate a patient so much, empathize with their condition and the challenges that it presents, that you care about how they are cared for--this all goes a long way to ensure that a patient's condition doesn't worsen (causing more patient discomfort) than what they present with. This is also a good opportunity to get creative. If you need to figure out how to care for a patient's challenges, brain storm. What can you do and how can you do it so that the patient is the winner? Use your brain and your resources. Ask seasoned nurses how they do what they do. Part of patient care is the person's well being emotionally. So save the judgement. A facility should feel safe. If you have patients who are emotionally upset over their perception of care, this can add to an already diffcult patient assignment. Not to mention it is wrong and mean. So really learn cultural competencies. Embrace the notion that patients have ideas different than your own, have customs or religions or definitions of family that may be the opposite of what you as a person feel is not "right". That's ok, but it is not ok to make a patient's perception as such that they feel less of a human because of it. So in your nursing practice, be sure that a patient's needs are put before your own personal thought processes. Regardless how a patient presents, disease is not illnesses of moral failing, or poor self control, of poor choices. There are disease processes that have developed from choices or lack of, however, one can not assume that because someone is over-weight they eat too much, that they have chronic pain they are drug addicted and or "seekers", that they have COPD because they smoke, liver issues because they drink, psych issues because they are the generalized "crazy". Get those assumptions out of your head now, and it can only strengthen your practice as a nurse. Patient's perception of care is becoming big business for facilities. With that being said, it should become a practice norm for you. When you are in your own life, in your own skin you can choose to act how you would like to. When you are responsible for the care and comfort of a patient, use your character and integrity as a nurse. It can make you well rounded, well respected, and an integral part of a nursing team.
  9. White Shoes

    Hands of Love

    They couldn't safely give care to everyone who needed it because there was one particular lady who was very confused and had an exceptional case of restlessness that evening. She would try to wander continually except for brief 3-5 minute periods where she would fall asleep in her chair, only to awaken and try to walk again. Recently, though, her health had declined and she could no longer ambulate independently. The staff just wasn't able to offer the one-on-one care she required and still meet the needs of the other residents. I came down to the unit specifically to stay with this lady for the sake of her own- and the other residents'- safety. As the evening progressed, I remember at one point holding this dear soul's hands in mine as I walked backward and faced her as she shuffled along. I had taken care of her before but never heard her speak a word, and really doubt that she could even see very well, if at all. She never gave any response when I spoke to her... the only thing that indicated that she ever knew someone was with her was that occasionally in the past if she happened to touch my hand, she would grasp it and bring it to her lips and give it a tender kiss. It seemed that the only thing that mattered any more to this frail dear was human contact and love. So at that moment, as I had her hands in mine, I pondered her life. Who was she in years past... who did she love, who were the ones who had loved her??? Suddenly I was overwhelmed with a feeling that this woman was very, very precious to God. Although her life here on earth seemed to be only a confused wandering anymore, in God's eyes she was absolutely precious. His treasure. I remember gazing at my patient's gnarled frail hands with a sense of awe much like I have experienced when I first saw my own children's tiny fingers when they were born. I found myself filled with a sense of honor to be able to take care of this woman in the closing days of her very long life. Little did I know that she would die unexpectedly a few days later. Indeed, I was one of her last caregivers. Since that day, I have truly appreciated the tender moments of frailty I have witnessed with the elderly. Whether I am removing their stockings or helping them brush their teeth or transporting them through the hall in a wheelchair, I am honored to have the opportunity to take care of people who are so precious to God Himself. It's with the love that I sensed that evening as I held this dear lady's hands that I drew this picture. The man's hands represent Jesus' own, tenderly caring for the lives and hearts of the frail and needy... for anyone who, indeed, cannot even care for themselves. I hope this is a blessing to you. Jyvonne (White Shoes)
  10. nurse grace RN

    Hints for Med/Surg Nursing

    My number one tip for med/surg nurses is to connect with your patient, make eye contact and listen to what they have to say. They are someones mother,father, sister, brother, son, daughter etc. Wouldn't you want your family member treated that way ? Don't be afraid to show that you are human, that you have feelings and above all that you care. My second tip is to watch what you say about patients while you are at the nurses station. Believe it or not voices travel and patients can hear alot better than you think they can. Don;t embarass yourself by being caught saying something you really didn't mean. Never be afraid to call the doctor if you are concerned about your patient. That is why they are the doctor! So what if he/she gets mad--it is your license and the patients life on the line. He can go back to sleep.Tell them what the patient needs when they make rounds---approach them, they are human too- you are with the patient the whole shift , they spend ten minutes with them. Treat your coworkers with respect, especially the techs because they will save you alot of work by being there for your patients when you have to chart etc. Smile and be kind to the other nurses and help them if you can, it is better to be a team player than a disgruntled one. Be gentle with the elderly patients because they have seen alot more life than you and have earned some tender loving care. Move them gently, talk to them, and yes, you can even touch them. You might be surprised at how nice they are and how much knowledge they can share with you. Please treat them the way you would want your grandparents to be treated. Have empathy for the addicted souls that cross your path. Yes, they did bring it on themselves, but... who are we to judge? There is a person on the otherside of that behavior and we don't know what drove them to drugs, alcohol etc. We really need to believe that they are in pain---maybe it is psychological and not physical. We should not be so quick to label someone "drugseeking". Always quest for more knowledge to improve your practice and patient care. I try to learn something new everyday or apply something in a different way. Take time to smell the coffee, compliment a coworker, take a deep breath, and of course go to the bathroom. Take your breaks because if you don't take care of yourself, how can you care for your patients? And lastly, don't be afraid to feel sad, or down if you lose a patient because every now and then one of them will really touch you and it'll hurt to lose them. Remember the best things about them and that you gave them wonderful care. Be Proud YOU ARE A NURSE!
  11. "I just wanted to tell you 'thank you', I can tell you really care." Anonymous, 2015 So often I have heard this statement from my clients. Not to toot my own horn, but I began to wonder personally how much my empathy for the mentally ill population promoted my competency in providing optimal care. So I began to analyze the fundamental components of my work as a psychiatric registered nurse that are conducive to promoting my psychiatric clients' stability. The fundamental foundation in initiating competent skills as a psychiatric nurse is similar to any specialty in nursing. We must implement the necessary processes of providing the standard of care by using the method known as the nursing process. The nursing process includes the following steps: Assessment, Diagnosis, Planning, Intervention, and Evaluation. In saying such I would like to rephrase these steps into the perspective of a mental health nurse. In similar order of the nursing process assessment is viewed as "I need to know what you are experiencing so I can help you", diagnosis as "I listened and acknowledged your needs", planning as "This is what we can implement to meet your needs", interventions as "let's apply these individualized strategies and alleviate your acute circumstances", and evaluation as "How did this work for you? ". Each stage conveys the primary idea of client - focus care; centering around the client's individuality. However, with clients experiencing severe depression, paranoia, and/or psychosis establishing rapport is essential in obtaining accurate data to promote stability (Decety & Fotopoulou, 2015). This requires implementation of the vital principle of Jean Watson's Theory of Human Caring which is to promote the client to achieve HIS/HER optimal being of holistic health (Suliman, Welmann, Omer, & Thomas, 2009). For the psychiatric nurse this requires empathy that encompasses finding understanding of the client's current stressors, perceptual, and actual needs through genuine interest that encompasses calculated verbal and non-verbal communication (Derksen, Bensing, & Largo-Janssen, 2012). Finally, the "light bulb" illuminated for me on the reason why my clients felt potentially more considered than their peers. It was a simple math equation of caring by distinguishing individuality, building rapport through sincere, calculated, verbal/nonverbal communication that resulted in an accurate empathic understanding of my clients. Thus, a healthy nurse-client relationship is established providing a platform for a conducive and productive recovery from acute mental illness. The following were communicative actions implemented: "I need to know, so I can help you": Establish rapport/ building trust, by active listening, respecting individuality, giving time, maintaining individuality actions throughout each stage Nonverbal communication i.e. body movement, facial expression Removing overwhelming stimuli Discussing more than the reason for admission but general topics of conversation; "implementation of "soft concepts of empathy with hard science" (Derksen, Bensing, & Largo-Janssen, 2012, p. 2). "I listened and acknowledged your needs": (Decety & Fotopoulou, 2015) You have noted the external symptoms of this patient The patient has shared, their internal symptoms experienced You have noted the congruency or non-congruent behaviors/symptoms in their diagnosis "This is what we can implement to meet your needs": Active participation in planning with a client to meet his/ her needs; promoting compliance Confirmation of short and long term goals; the steps in which the client desires to reach these goals Suggestions offered and multidisciplinary, familial, and outpatient supports established "Let's apply these strategies according to your circumstances": Implementation begins, support measures positioned to encourage Consensus of specific supportive mechanisms implemented by the multidisciplinary team, and family The flexibility provided to the client's circumstances "How did this work for you?": The noted growth, stagnant, or regression of results reviewed Challenges acknowledged, barriers noted Suggestions on interventions that may promote his/her desired outcomes To successfully implement these steps it is necessary to seek an understanding of the clients' individuality which takes effort, establishment of rapport, and time. Empathy is an essential factor to obtain accurate data, individualize interventions, and best outcomes addressing the clients' uniqueness. As a psychiatric nurse one noted that empathy plays a significant role in providing competent care and optimizing positive outcomes for my acute mentally ill clients. (Decety & Fotopoulou, 2015). Empathy allowed me to care for the client's individuality by grasping an understanding of their personal strengths, struggles, and journey to mental stability. Likewise, empathy is the foundation for competent psychiatric care. References Decety, J., & Fotopoulou, A. (2015, January 14). NCBI Resources. Retrieved March 5, 2015, from PMS US National Library of Medicine; National Institutes of Health: Why empathy has a beneficial impact on others in medicine: unifying theories Derksen, F., Bensing, J., & Largo-Janssen, A. (2012, December 19). NCBI Resources. Retrieved March 5, 2015, from PMS US National Library of Medicine; National Institutes of Health: Effectiveness of empathy in general practice: a systematic review Suliman, W., Welmann, E., Omer, T., & Thomas, L. (2009). Applying Watson's Nursing Theory to Assess Patient Perceptions of Being Cared for in a Multicultural Environment. Journal of Nursing Research, 293-299.
  12. marcos9999

    Nursing Compassion

    Most days are different but we go about our routines on the floor much the same way. We take orders from doctors; finish treatments; tell families bad news; coexist with the terrible and the beautiful daily. We take care of patients, and try to understand their suffering and pain. But somehow it all sits over there in the corner and it doesn't affect us too much - someone needs to do the work. Somehow when I wear the scrub I feel I have special powers. I create a safe barrier and add a little bit of a denial mixed with oblivion. It is a protective insulation that I need, without it I would not be able to accomplish the difficult tasks nursing requires. But we also shield our emotional responses. The intense emotions of death and pain are strong and we don't need to go there with our patients. So, we create another barrier. If you get sucked into the emotional vortex you're no longer able to think rationally. We can feel empathy for the suffering of others but we can't get involved on a personal level. If you allow that to happen you'll quickly lose control of the situation you suppose to oversee. These safeguards we construct are on automatic pilot and every nurse has his own method of coping. Without them it would be hard to survive nursing. This is so true to ER nurses who are usually at the edge. Hospice and oncology nurses know too well not to get emotionally involved. So, we go about our business day in and day out. Pick up our check and that is about it. But then something happens. Because we are all human beings we cannot protect ourselves indefinitely from emotions. We share the same emotions whether we want it or not. The unpredictability of events can affect our own health, and sooner or later make us vulnerable. Something happens to us and our safe barrier is suddenly broken for a moment. There is always a trigger and we all have our own breaking point. Your own emotional vulnerabilities combined with the never-ending hard emotion repetition, end up fragilizing us. Maybe a cancer patient reminded you of your mother; a child or a family member. A smell triggered something deep within you. It is usually something that finds a parallel with our own life and struggle. Suddenly the fear of others become our own fear. What was once safely insulated from you become raw and vivid like it's happening to you. Like you can taste the bitter pills you've been passing. You can feel the pain and It can be quite overwhelming. But if you ever had it, there is nothing to worry about. It doesn't usually last for too long because our barriers quickly regain their hold. If that happened to you before you're not alone and there are reasons to feel proud. People have different levels of sensitivity and they see the world in different ways; but in the end, we are all humans and share the same emotions. It is good to feel the bitter taste occasionally because you establish a true connection to what you do. It helps you to have more empathy to the people you are taking care of. It is a reminder to slow down and pay more attention and show some real empathy rather than a fake one. When you say "this must be very hard to you" it will be deeper and more meaningful. It ultimately helps you to be a better nurse and a better person. A nurse that is not just made up of science and numbers but one able to understand the deep emotional struggles your patients are going through. After many years of nursing people can develop a tough skin, and it becomes easy to become a cynic. But even for the hardest person there is always a soft spot. We all can feel these things. Think that someday you can be sick and needy. And how would you want to be treated? Look at the old and frail and think that someday you'll be there too. This is a very interesting exercise every nurse should pay attention to. What do you think?
  13. vadushkas_nurse

    How About... a HUMAN CULTURE

    He and I often discuss that religion and cultural titles are often used interchangeably as descriptions, it has lead to some insightful understandings and meaningful conversations. I often find myself proudly exclaiming these descriptions to people when I talk about him, it is what makes him and what makes our relationship so special. Having been with my fiance going on nine years is a true blessing to me, his wisdom and love are beyond narrative. I have learned so much about culture and tradition from being a big part of his life. I struggle when people's first question to me is "well are you going to convert"? And I quietly wonder to myself, first, if I really need to explain my values to this person, and then secondly, I consider that this is an opportunity to share with others what great gifts choice, love, and life are (when you value the little things most). I feel proud to tell people that we have chosen a very unique way of sharing our lives. We participate in all the traditions we know and value. We chose to have an open and all-encompassing mind about things. What I love about living in Canada and the societal understanding of transcultural is that we embrace others for the uniqueness and that we are able to live the way that makes us happy. My loving relationship has increased my tolerance, empathy, and love for life and people. I feel that if people would be more open-minded and appreciative of family and relationships, then we could be more at peace and happy just living. I think that the uniqueness of different cultures is what makes each of us special and that much deeper of a friend, as there is so much to teach and share. The most important concept I think about when talking about trans culture is what matters most, is the human culture. we all have underlying fundamentals and similar genetic makeup. It is time to recognize what connects us as human and use the gifts of culture to share with others. We all share the possibility of love, life, choice, family, and happiness should be chose to search for them. When we all embrace our differences and uniqueness, we can then only find inner peace and further advance the human "being" culture. What I find interesting as I write this short story in Microsoft word, is that the only word with an unrecognized understanding by the computer spell check is the word transcultural. We as a society should be better than this and remember we are very lucky to have the abilities to think, learn and interpret!! Let's behave smarter than "word" and determine what transcultural means to us and act it out in the real world there is so much more to life than labels and separating people who are different. We are all human and that's what matters most.
  14. VivaLasViejas

    The Patients Who Break Your Heart

    Being only human, of course, we sometimes cross the line despite our best efforts...and the nurse whose restless dreams are unpopulated by the ghosts of past patients must surely be a rare bird indeed. I'll never forget: 1 ) The 29-year-old mother of four who was dying of cervical cancer. Cervical cancer! How many such ailments are both so easily cured, and so tragic when not caught in time? I cared for her during only a single shift, but something still haunts me about the way her mother sat for hours smoothing her long black hair across the pillow, and the quiet dignity that never allowed one word of complaint, even as the bitter pain of the disease and the heartache of her husband's deportation to Mexico at a time when she needed him most gnawed at her. Meanwhile, the children played quietly about the room as I performed the tasks which must be done; they seemed to know, somehow, that this was a solemn time, and yet they were polite and curious about what I was doing for their mother. I heard a few days later that she had passed on only a few hours after my shift ended; and my heart cried out angrily for an explanation which has never materialized, even to this day. I think maybe I am not meant to know...only to accept. 2 ) The elderly but still vibrant gentleman who had just been diagnosed with Stage III esophageal cancer and given an estimated six months to live. On the second evening after his diagnosis, he asked my advice on chemotherapy, radiation, and other matters; his mood was genial, and he seemed satisfied after I had presented him with several different options. At that point, he called his family together in his hospital room and talked with them for over two hours, after which discussion he put on his call light and asked me to walk with him around the floor for a short time. This I did gladly, as he was a very pleasant man and I enjoyed talking with him. Then he stopped me short with this six-word sentence: "I'm going to end my life". Of course, words of caution immediately sprang to mind---"You mustn't think like that", "Don't give up hope, there are still things they can do for you"---but died on my lips as I looked into his earnest eyes. This man meant what he said, and no psych consult, antidepressant drugs, or pleadings would stop him. I knew that as well as I knew my own name. Still, I begged him to reconsider, citing the devastation his suicide would surely wreak on his family and friends. Finally, he said, "All right, I'll think about it...for your sake." I was so happy that he'd decided to hold off on harming himself, I hugged him right there in the hallway, and when I discharged him home the following evening, he reassured me that he would still 'think about it' before coming to any decision. The next day---or so the local newspaper said---this dignified, self-determined man walked out into his garage and shot himself in the head. And I've never told anyone about the conversation we had that night in the hospital...until now. These are the patients who break my heart. Who is yours?
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