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  1. vmbennett

    The Patient was a Retired Nurse

    The author was being oriented in intensive care units when she was assigned to her exemplary case. This case involved an elderly ventilated lady that was alert and oriented, capable of making her own decisions and facing the end of life decisions. The elderly lady had several comorbidities, including respiratory distress, diabetes, congestive heart failure, and a history of a stroke. The patient knew that if we took the ventilator tube out of her mouth, she would not be able to withstand life very long. She was a retired nurse and understood the ramifications and was prepared for the outcome. ComorbiditiesThe patient’s respiratory distress had developed into acute respiratory distress syndrome (ARDS). Additionally, she had congestive heart failure, which causes fluid to increase around the heart, causing it to pump inefficiently. These symptoms made it harder to extubate this patient. The elderly patient also had diabetes and a history of a stroke. Although her diabetes was being controlled based on an A1C of six, and she had no deficits from a previous stoke, she was ready to see her husband again. The combined symptoms from her disorders and with the blessing of her family, this patient decided to be extubated. The pathophysiology progress of ARDS was explained by palliative care as neutrophil activation due to inflammation, which is significant in the pathogenesis of ARDS. The patient and the family members verbally acknowledged the possibilities of multiple organ failure, pulmonary hypertension, and a high mortality rate. Additionally, palliative care explained that there are no single biomarkers to predict the outcome of ARDS in an elderly patient, but numerous different pathways are involved in the development, which increases the risks for a poor outcome at an advanced age. Although the family members were not agreeable with the patient's decisions and very tearful, they were all respectful. Patient's JourneyThe journey involved a retired ventilated nurse that was alert and oriented, capable of making her own decisions and facing the end of life decisions. She was writing messages on our communication board and texting with her phone to communicate. She had been in intensive care for several days, and we were unable to wean her from the ventilator during the daily spontaneous breathing trials. She had lost her husband several years earlier from cancer and wanted to be with him. Palliative care had been consulted and met with the patient and the family members. The patient kept her dignity, which included autonomy and control over the daily activities and circumstances. The patient's self-determination allowed her to feel that life still had worth and importance despite the current circumstances. The patient understood the meaning of comfort care and withdrawing care. She knew that if we took the ventilator tube out of her mouth, she would not be able to withstand life very long. She understood the ramifications and was prepared for the outcome. To the author, this was a well-educated elderly lady with independence and dignity. The patient kept her dignity, which included autonomy and control over the daily activities and circumstances. The patient's self-determination allowed her to feel that life still had worth and importance despite the current circumstances. The author observed the elderly lady facing the end of life decisions had identified with her illness, age, and comorbidities. The cause of her death would be by her hand and decisions. The patient would determine the timeline, and the consequences were that she got to meet her husband again. Other consequences the patient thought about was leaving her children and grandchildren, but the patient expressed a weary life and determination to be pain-free again. The treatment the patient chose was comfort care to relieve her suffering. After caring for this patient on many occasions, becoming a confidant to the family members and a friend to the patient, we withdrew care. As an orientee, the author was not fully aware of what comfort care meant. The author was instructed to get pain medications from the Omnicell to administer to the patient. As the author administered the medications, the patient's heart rate and respiratory rate began to diminish. As an orientee, this response was alarming, but as an intensive care nurse, composure was vital. At that moment, the author was confused, irritated, and doubted what she had just done as a nurse. We are taught to do no harm. What had just happened? The author had been listening to the palliative care team for days talk about comfort care and peace, but details had not been explained. The author certainly had not expected to be the one pushing the final medication before the patient's last breath. As the author stood there holding the patient's hand, watching the monitor, passing out tissues to the family, and feeling as though she had done something wrong, the patient took her last breath. It was not a sudden death but a peaceful one. This incident made the author doubt her career choice, her faith, and the intention of the medical field. This situation was the most uncomfortable and spiritually confusing event of the author's life. As the author drove home that evening, tears of forgiveness rolled down her cheeks. The author went to the hospital chaplain and the palliative care team for guidance and clarification. The circumstance was explained as holistic care, focusing on psychosocial, psychological, and spiritual characteristics of care for the patient and family. This experience was the author's first experience watching the role of a palliative care team, experiencing grief for someone that the author had not known very long, watching a person pass away, and witnessing a faithful family lose their mother. The family stated that medical treatment would have prolonged their mother's life without offering substantial benefits. Nursing incorporates numerous characteristics of care, including ethical decision making, supporting families and patients through the death and dying process and pain management. It is challenging to teach curricula on empathy, sympathy, the dying process, different healthcare system policies and practices, and the numerous interpretations of end-of-life progressions. As an orientee, effective communication skills from the leaders could have enhanced the experience, built trust, increased knowledge, and diminished career doubt. Provider's Professional RoleA provider’s professional role when dealing with end of life decisions is to listen and discuss the wishes of the patient and family members. It should be routine as providers in a primary care setting to offer a living will/advance directive to every adult patient regardless of their age. Options and choices in the document should be read and explained so that the patient gets a clear understanding. A provider can educate the family and patients on who can sign as a witness, what is involved in decision making, and suggest someone who will respect their wishes. A provider should encourage the patient to discuss this decision with all family members involved before this document is needed. To prevent disagreements during the implementation of living will or advance directive, it is essential to begin the dialogue process concerning the end of life strategies early. A non-crisis situation is an ideal time to have discussions about the end of life. The patient and family members can think clearly, discussing values, and ask questions. When approaching these conversations, the patient should feel safe, heard, and valuable. Autonomy should be given to the patient, and providers must explore cultural aspects and expectations of care with the patient and family. Providing information and education on what to expect, support groups, and discussing needs and expectations with the patient and family are vital. ConclusionAlthough the retired nurse passed away, a positive outcome was accomplished. The patient kept her dignity, which included autonomy and control over the daily activities and circumstances. Her quality of life was maintained until her last breath, and her family experienced a serene and peaceful passing. The patient's choices displayed her self-determination without external influences from her family, and her stress was limited due to managing and adapting to her illness. This patient demonstrated a journey of courage, love, faithfulness, kindness, and consideration. The retired nurse’s life story will forever be described as the author's epiphany in her nursing career and a hero. This encounter taught the author a deeper meaning of compassion, patient autonomy, understanding, and the true meaning of a hero.
  2. ljo28

    What is Your Nurse Hero Story?

    Nursing - My Calling, My Passion, My Profession I am a nurse. I have been a nurse for as long as I remember. Nursing has been my calling, my passion and now my profession. In these difficult times of global pandemic, I have been detailed to help out in the most needed areas, which is taking care of COVID patients in the ICU. Although I don’t currently work in an ICU, with my long-standing critical care experience, I feel comfortable in taking care of the critically ill patients. My Responsibility This is my job and my professional responsibility as a nurse, and I am more than happy to do my part. Initially, I had mixed reactions including anger and frustration to my deployment, I now am able to see the bigger picture, and have a whole different perspective about the situation. I consider myself fortunate to be a part of this global pandemic response efforts in my own little way, and am grateful for the experience of a lifetime, knowing that my efforts are making a difference. Nurses Being Taken For Granted I do however, have an issue with how nurses are being treated. While being beyond happy that now, nursing as a profession is globally recognized and elevated to a level like never before, the fact that the nurses at grassroots are taken for-granted is concerning. We are required to work with minimal supplies. When I say this, I am not referring to the specific institution that I work for, because thankfully we have a steady supply of necessary inventory. I am talking about the global and national situation affecting the entire frontline workers. I am talking about the plight of all the nursing friends and acquaintances far and near, who are forced to work with minimal supplies. The infection control guidelines are being constantly changed and lowered to accommodate the scarce supply of available PPEs. The hospital policies are changed to what we know do not align with the best practice guidelines that we have been following before the pandemic. This is very demoralizing for a profession which has historically been known to stand up for the ‘right thing to do’ principle. Besides, nurses are being given nominal monetary incentives just for the sake of it, which I consider very degrading and undermining to the amount of risk and stress that we are going through. Some institutions, are giving a one-time incentive, which is equal to or less than what a nurse would typically earn in one week. We would have been just fine without this namesake monetary incentive. Discounts and Freebies Many companies are offering discounts and freebies for the frontline workers, which is very much appreciated by the entire nursing clan. We all are aware of our love for free stuff. These freebies also include the much-needed meals during the difficult times, and collectively we are thankful for every bite of it, because we are tired, stressed and have no strength left to cook. We are thankful for the generosity and outpouring of love and encouragement from the community that we serve for. We are grateful for the acknowledgement of the risky work and appreciation parades by the police and firefighters, and are thankful for the generous donations from the community, and please know that every bit goes a long way. All this cheer does make this misery a little bit bearable for the moment at least, but in no way does this make the reality of the situation go away. Day in and day out we walk into our work areas speculating what lies ahead of us, how are we going to get through this day, and this feeling does not end today nor will it end tomorrow or soon enough. Heroes or Just a Nurse My rant is also about being labelled “a hero” for doing my job. I am not “a hero”, or “a warrior.” I am “just a nurse” (pun intended) doing my job. Is it affecting my life- yes!! Both professionally and personally. My life is turned upside down. My family is put at risk because I am in the thick of the sickest of the sick. My schedule has changed drastically. And it is not just me. Nurses all over are dealing with situations like this. I know a lot of fellow colleagues who are staying away from home, sleeping in a camper or staying at a hotel (thanks to AACN for their partnership with Hilton group to provide free room to their members), to avoid exposing their elderly grand-parents, parents, immune-compromised family members or children and the trauma they are going through on a daily basis. The professional standards that nursing has operated on forever, are being challenged. Compassion and caring have a whole different meaning. Calling us “a hero”is for doing my job? I am not a hero. Give me the love, support, compensation and recognition that I deserve. Nurses Uniting to Face COVID and Supporting Each Other We as nurses have come together to face this, and stand as a team helping, supporting each other emotionally and professionally. But for the better good, I hope that we learn from this as a community and globally, so that never again will human race find itself in a situation like this.
  3. PCU_RN9

    The Superpower of Compassion

    Emergency room exam rooms are particularly terrifying when you are seven years old. Don’t worry, I’m not here because of me, I’m here because my grandpa is very ill. My grandpa spends a great deal of time in and out of the hospital. He is what the nurses and doctors call a “frequent flyer.” When he isn’t in the hospital, he lives at home with my mother and me. Ever since I can remember, my grandpa has been sick. He has diabetes, colon cancer, heart problems, lung problems, high blood pressure, just to name a few. I used to be really scared of all of the beeping machines, alarms, and the serious looking staff in the hospital. That all changed the day I met a nurse named Clara. Clara was the ER nurse assigned to take care of my grandpa who was brought to the hospital because he was having some trouble breathing. When my grandpa was sent off for testing Clara took me aside and showed me how all the cool hospital gadgets worked and even introduced to some of her nurse and doctor friends. I decided that day that Clara was a superhero and one day I would be a superhero like her. I didn’t know it at the time, but my family and I would develop a bond with Clara over the course of the next few years. You could tell just by looking at Clara that she was a nurse who was enthusiastic about her job and loved helping others. My grandfather was not an easy patient by any stretch of the imagination and at times could even be belligerent. My grandfather did not get along well with most staff members, but he got along with Clara. Clara was a seasoned nurse. Not only did she take excellent care of my grandfather, she was witty and turned his anger and fear into smiles and laughs. As stated by Arthur Ashe, ‘true heroism is remarkably sober, very undramatic. It is not the urge to surpass all others at whatever cost, but the urge to serve others at whatever cost.’ I believe this quote is a great description of a hero. Is a hero someone who performs a grand act of bravery, such as sprinting into a burning house to save someone while risking their own life? Of course, and that’s what we often see on television shows and in the movies but there is more than one way to define a hero. To me, a hero is a humanitarian who is compassionate, caring, and goes above and beyond the call of duty with nothing to gain. In this definition, Clara was a true hero. Trips to the emergency room were as common as rain in Seattle. Often times, nobody was readily available to watch me, so I tagged along for many of the emergency room trips. My grandfather was a WWII veteran with a very rough exterior that not many people were able to break through. Clara was one of the few people who was able to turn his harsh demeanor to laughs and smiles. Clara performed her nursing duties with skill and competence, always explaining what to expect. On slower shifts, Clara spent time with me demonstrating how to use equipment such as the stethoscope, blood pressure machine, and heart monitor. By this point, I decided I definitely wanted to be a nurse. Thinking out of the box, Clara knew my grandfather was an uncontrolled type II diabetic who didn’t check his glucose levels often enough. Clara advised me to remind my grandfather to check his glucose levels so I could help him become healthier. I took this notion to heart. I began helping my grandfather check his glucose levels and documenting his numbers. I was taught what normal glucose levels were and reminded him to eat healthier meals when he went to eat foods such as doughnuts. Because my grandfather saw how serious I took this, he began watching his diet and overtime his glucose levels became more controlled. Because of Clara, emergency room visits became a little less scary for my family. Because of Clara, I learned that nurses have the power to improve people’s lives. Because of Clara, I learned that compassion goes a long way. Because of Clara, I knew at a young age that I wanted to become a nurse so that I, too, could help improve the quality of life of others, all while putting a smile on their face.
  4. NurseSamm

    My Nurse Hero

    I had just started my first RN job on the blood and marrow unit. Early on I realized this unit was tough and many of the patients die, but I knew it was where I was meant to be. This story is about a nurse who is a nurse hero- and the person who inspired me to pursue my doctorate in nursing practice. I met this nurse less than a month after working on the BMT unit. By then I had learned the privilege of administering a stem cell transplant- that meant a new chance at life, and the privilege of helping someone die peacefully. This nurse was fighting acute leukemia At first when I walked into her room for day shift she intimidated me. She was nauseated and asking for Ativan, she was strong and demanding and she instantly recognized me as a new graduate nurse. After the first shift with her I relaxed, and she started to teach me lessons. She taught me how to “properly” get the bubbles out of IV lines, and tricks like having her raise her arm to get blood to draw from her central line I would bring her coffee with meds and she would jokingly scold me saying prioritizing my time didn’t include bringing her coffee! I knew she was a nurse from the day I met her, first because she was brilliant and second because as my patient, she was teaching me how to do my job. The other dead giveaway was her love for coffee and how she would teach a class from her mac during chemo. Some days she was weak On those weak days her sarcastic wit never diminished, but it was clear she was fighting. She still got up every day and walked laps in the hall. When she found out her cells were not responding to chemo and she relapsed, her first sentence was “okay, what trial can I do?”. She was a fierce fighter and ended up in a trial of CAR-T cells (something brand new at the time). While being her nurse we had conversations of my future and how I had considered going to nurse practitioner school but was not sure this was the right move for me. When the day came for transplant ... I was assigned another patient but she requested I be her nurse. The transplant went well, and I was excited what this could mean for her survival. The next day the night nurse told me she was having a reaction- Cytokine release syndrome. This causes a massive inflammatory response and for her-cardiogenic shock, DIC, and multiorgan failure. She looked absolutely miserable and unrecognizable when I went in her room. Over the next 2 days I watched her suffer and tried to keep her pain, fever, and confusion repressed as she transitioned to comfort cares. By the end of my third 12-hour shift she was almost unresponsive, her words meek whispers. I felt helpless. I couldn’t believe how fast this brilliant, witty, spit-fire woman had become too weak to sit up in bed. Then she whispered ... At the end of my shift, I held her hand, thanking her for teaching me. Asking her if there was anything I could do to help, she whispered ... ... go get that doctorate because you’ll make a damn good NP one day I felt the tears well up and told her I would. I applied to the program later that night. I am halfway through my doctorate now and think of her often. She was one of the greatest hero’s nursing will ever know. 
  5. PrudenceNurse

    My Inspiration to Become a Nurse

    I write fiction. I could compose a lovely story about the magnificent women who inspired me to become a nurse. I could tell you in poetic prose about their near-saintly lives, deep caring for their patients, and a profound love of humankind. It would not be difficult to embellish this tale in such a way that a tear might come to your eye as you read about these epitomes of professionalism and compassion. I write fiction. But in this case, instead of an idealized nursing story, I’ll tell you what really happened. I don’t really know why I chose to be a nurse. I was a Candy Striper volunteer in middle school and early high school. It has always seemed natural to be a nurse, so maybe I didn’t choose this career; possibly it chose me. However, there were a few women whose presence affected the course my young adult life took; either positively or negatively, their actions motivated me to be a nurse. The First The first person who contributed to my path toward nursing was my best friend in high school. It was the Summer before our first year in college and I had signed up for the pre-requisites to be a Radiology Tech. One day, completely surprising us both, I told my friend I did not really want to shoot X-rays for the rest of my life. Stunned, she asked me what I did want to do. In a rare moment of self-awareness, I told her I wanted to be a nurse, but I was scared I could not do it. She did not hesitate before telling me that I could do it, that she thought I would be a wonderful nurse, and that I should go and change my major the next day. And here I am. The Second The next woman who was instrumental in my career in this field was my grandmother. I have pictures of her in her twenties in a starched white uniform and hat, white shoes and stockings. Her title was ‘nurse’, though what training she had beyond high school is unclear. Her patients were residents of a state asylum for the mentally ill which was founded in 1869. My grandma was born in the first few years of the new 20th century, so she would have worked at the Anna State Hospital in Illinois in the nineteen-twenties. If I was writing fiction, I would tell you that I became a nurse after seeing pictures of my grandmother in her ‘whites’ and hearing how she attentively cared for her charges, thoughtfully ensuring that each of them had daily time outside in the fresh air and natural light in accordance with the ‘Kirkbride Theory’, a popular approach to the healing of the mentally ill during that time. Again, that’s not true. The only stories I have heard about my grandmother’s job in the asylum were that she worked nights and that she met my grandfather there when he began working as an orderly. The words that my grandma spoke that contributed to my 36-year career as a nurse were not ‘inspiring’ as such. What she said to me when life was really difficult and I didn’t know how I was going to manage a full-time job, family, and school was: “If you quit nursing school now, you’ll never go back.” Being the rebellious sort I am, I had to do it then, so though it took me seven years to complete a four-year program, I did indeed finish my BSN--just to prove grandma wrong. That was probably her plan in the first place; though I’m sure she never took a psychology class, she was smart about things like that. If she had not provoked my obstinate nature, I might have gone on to work in a bank, sell shoes, or manage an apartment building, all of which I did while in school. But here I am. The Third The third woman who influenced me was my first med-surg nursing school instructor. I don’t know if she was ‘burnt out’ and needed to retire, didn’t like me personally, or was just trying to weed out as many members of my class as she could, but she bullied and frightened and threatened me and a few other students for an entire semester. The culmination of that class was her question to me, “What are you going to do after graduation, Linda? You certainly are not going to be a nurse.” All these years later it would still be satisfying to call her or write to her and say just one thing: Well, here I am. The Fourth The fourth woman whom I credit for my career was an obstetrics instructor who actually was professional, compassionate and caring to her patients… and her students. She helped me by encouraging me to go ahead with my senior year despite the fact that the due date for my second child—much loved but not well-planned—was the day after my potential graduation. (My son actually managed to time it a little better than that; I received my nursing pin and lit my Florence Nightingale lamp with my class on Friday and he arrived on Monday.) Thankfully, I believed that instructor when she assured me that I could do it, just as I had believed my best friend seven years before. They were both right, because here I am. No Regrets I’ve never regretted becoming a nurse. This job has brought me joy, fulfillment, connection, and friendship. It has helped me to develop self-awareness, integrity, and empathy in addition to giving me a body of knowledge and skills that is still growing. I’ve also left work many days in tears of grief, frustration, or anger. Does all of this sound familiar? It sounds like life to me, and here I am.
  6. Mom thanks 2 nurses that saved her baby by performing CPR after he was pulled unresponsive from a hotel pool. She writes, "You both forever will be our gift from God at a very dark moment. I believe God makes no mistakes and he sent his two angels on earth to save my son. I truly, truly thank you ladies with everything within me for saving my baby’s life.” https://www.mlive.com/news/muskegon/2020/01/forever-heroes-unresponsive-toddler-saved-by-nurses-at-hotel-pool.html
  7. Most people in the nursing community are at least somewhat knowledgeable about the stories behind the more popular historical figures of the profession. After all, instant name recognition occurs in the vast majority of nurses when the names Florence Nightingale, Dorothea Dix, Mary Eliza Mahoney, Linda Richards, Clara Barton, and Margaret Sanger are mentioned. We have all learned about these remarkable individuals and their achievements during the course of our nursing educations. These aforementioned women are arguably the pioneers of the nursing profession because, without their contributions, nursing might not have ever evolved into a profession in its own right. Nonetheless, many other wondrous nurses from yesteryear have faded into languid obscurity along with their stories and accomplishments. Susie King Taylor, the first African-American army nurse, is one notable historical figure whose story is rarely brought to light by modern day nursing textbooks. In the spirit of Black History Month, her story will be revived and she will be remembered for all the feats that she accomplished during her 64 years on earth. Susie King Taylor was born Susan Baker on August 6, 1848. She had been born into slavery in Liberty County, Georgia to parents Hagar and Raymond Baker, and was the oldest of nine children. In an era where formally educating slaves was vehemently against the law, her personal road to informal educational attainment began at age seven. It was during this time period that she started learning to read and write by way of attending a 'secret school' that was operated by a freed African-American female named Mrs. Woodhouse and her daughter, Mary Jane. She also received secret informal reading lessons from a white playmate named Katie O'Connor. At the age of 14, Baker and a number of other African-American people obtained their freedom by escaping to St. Simons Island, one of the Georgia Sea Islands. The year was 1862 and the U.S. was in the midst of the full-blown Civil War conflict. At that time, St. Simons Island was occupied by Union Army forces, and her advanced literacy skills had attracted the attention of several officers. After all, it was exceedingly uncommon for former slaves to be educated or even know how to read and write at a marginal level, but Baker was a resounding exception. She agreed to organize a rudimentary school upon the request of Commodore Louis M. Goldsborough, and thus, became the first African-American teacher at a freedmen's school in the state of Georgia. Baker taught basic literacy skills to 40 freed children and a handful of free adults. She taught at the school for approximately six months until the end of 1862, the time when St. Simons Island was evacuated. During her six months at the freedmen's school, she met and married Sgt. Edward King, a non-commissioned officer in the Port Royal encampment of the 1st South Carolina volunteers, which later changed its name to the 33rd U.S. Colored Troops subdivision. She followed her husband's regiment for three years, providing an assortment of services along the way. She taught Union soldiers how to read and write during their off-hours. She also served as a nurse, rendering care to wounded and dying soldiers and attending to injuries alongside camp doctors. Susie King made frequent visits to the first regimental hospital for black soldiers, located in Beaumont, South Carolina. It was at this hospital that she became acquainted with and worked alongside Clara Barton, the renowned founder of the Red Cross. King served as an army nurse until the Civil War ended in 1865. Her husband, Edward, died in 1866. After teaching freedmen in Georgia for several more years, she relocated to Boston with her two young children and eventually got remarried. She married a man named Russell L. Taylor in 1879 and, from this point forward, became known as Susie King Taylor. She spent her later years working as a domestic worker for a white Bostonian family before dying in relative obscurity in 1912. Susie King Taylor is one of the few African-American figures from the Civil War who captured her recollections in the written word. Her memoir, Reminiscences of My Life in Camp with the 33rd United States Colored Troops Late 1st S.C. Volunteers, tells the story of what is known about her life and experiences during wartime. Taylor's compassion for the sick, injured and wounded shine through her words. She writes, "It seems strange how our aversion to seeing suffering is overcome in war, --how we are able to see the most sickening sights, such as men with their limbs blown off and mangled by the deadly shells, without a shudder, and instead of turning away, how we hurry to assist in alleviating their pain . . . with feelings only of sympathy and pity" (Taylor, 1902). Taylor's accomplishments deserve to be highlighted since she lived a full life that involved unselfish service to others in the form of teaching and nursing. Allnurses.com Inc. wishes to keep the spirit and memory of Susie King Taylor alive. RESOURCES Butchart, R.E. (2013). Susie King Taylor (1848-1912). New Georgia Encyclopedia. Retrieved from Susie King Taylor (1848-1912) | New Georgia Encyclopedia Malburne, M. (2004). Summary of Reminiscences of My Life in Camp with the 33rd United States Colored troops Late S.C. Volunteers. Retrieved from Summary of Reminiscences of My Life in Camp with the 33d United States Colored Troops Late 1st S. C. Volunteers Taylor, S.K. (1902). Reminiscences of My Life in Camp with the 33rd United States Colored troops Late S.C. Volunteers. Boston, MA: Susie King Taylor.