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Topics About 'Nurse Patient Relationship'.

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  1. Have Nurse

    It Never Occurred To Me.

    We'll call him John. John was 7 feet 2 inches tall. At 65 years of age, he had long brownish-gray hair, that he wore in a clumsy ponytail. He suffered from morbid obesity which made it difficult to ambulate as evidenced by his shortness of breath. A Viet Nam veteran, homeless, was found wandering the streets with a very high blood glucose level. He claimed he didn't know he had diabetes, which was possible. John hadn't seen a doctor in years. He was polite and cooperative, up independently and ambulating in the halls when we met. He had a distinct strong body odor. His day nurse informed me earlier that "He won't take a shower." I wondered why. Remembering that there is a reason for every kind of behavior, I decided to mull it around a bit before broaching the subject. He shared with me stories of his military service, how he got to be homeless and how he found himself in the hospital. "I was married once," he began. "It lasted 20 years....but then...she got sick and I couldn't keep up with the bills. We lost our house, she died....and suddenly it was all gone." He was sitting on his bed. I had pulled up a chair. It wouldn't be long before I had to do rounds again for vitals and meds, but I sensed a wounded spirit in him. A burden not just on his body, but in his heart as well. The elevator doors down the hall opened. The smell of hot food wafted down the halls. "John, " I asked gently, "Is there anyone I can call for you? A friend? Anyone?" He shook his head sadly. "Supper trays are arriving. Will you eat?" I was worried that his blood sugar would take a dive if he didn't. He nodded. I smiled at him and retrieved the tray. I still hadn't asked him about his refusal to take a shower. He allowed the staff to change his towels and linens. As John ate his supper, I reviewed his chart again and noticed how many times the previous shifts had offered him hygiene assistance but he would politely refuse. I also noticed that no one had charted on asking him why. Looking at the Allergies section of the chart, I noted no issues with soap or laundry products. Was he afraid of water? How long had it been since he had a decent shower or bath? Our homeless communities have access to showers and facilities so I was coming up empty on this one. Since he was a veteran, I knew he could handle it if I was direct with him, but it would need to be tempered with respect. Off I went down the hall. I walked into his bathroom, turned on the shower, set up supplies and towels and brought in a clean fresh oversized gown and fresh robe. He glanced up in surprise. I smiled at him and pulled up the chair again. His eyes still had that hint of sadness, so I reached for his hand and said: "John, part of my duties as your nurse is to not only keep you safe and help you get better, but I owe you the honor of being truthful and to offer possible solutions when at all possible. The staff, as well as myself, have noticed that you have not been able to get a shower in during your stay. You are beginning to give off a very strong odor and I am concerned that along with your medical condition, that you may be setting yourself up unknowingly for infection. The odor comes from bacteria, which loves to grow in dark, moist areas." I took a breath. "There are places on your skin that you need to get clean." I wasn't prepared for his response. "Well, " he began slowly, "I want to take a shower. But I didn't want to embarrass the young ladies taking care of me.....I'm so big and I can't reach where I need to, and I didn't want to make those young girls uncomfortable." This man was a true gentleman. "John," I asked, " I would not be uncomfortable with assisting you. Will you allow me?" He nodded with relief. I smiled. "After you, Sir." Yep, there's a reason for every kind of behavior. And sometimes, it's just plain courtesy.
  2. nilknarf

    The Gift I Didn't Want to Give

    If Carrie Lawson had tried to invoke a feeling of serenity by the way she'd designed her home, she'd succeeded. The walls were a painted light green, and the curtains a complimentary olive. The furniture looked plush and comfortable. The lighting and soft music added to the overall charm of the room. But Carrie had never planned for the latest addition to the room: a stark, steel-railed hospital bed. On that bed was her husband, Jeffrey. On the day I met him, Jeffrey put that room to its ultimate test: congested, jaundiced and moaning incoherently; Jeffrey was a stark contrast to the room's serenity. Jeffrey was one of my first hospice patients. I'd spent the previous two weeks working with a nurse who had 30 years' hospice experience. I'd tried to absorb all the knowledge she'd given. I thought I was ready for the "Jeffreys" I'd have to care for. My introduction and opening explanations to Carrie fell flat. Her responses to me were quiet and clipped. I felt her hostility before I'd had a chance to warrant it. My questions drew eye rolls before she gave me brief, clipped answers. Her eyes kept drifting to Jeffrey; then they'd stare off into the distance. All my training hadn't prepared me for stiff, rejecting posture and her unwelcoming ears. As the visit ended, I asked if she had any questions. She asked why one of his symptoms seemed to be increasing so quickly. Relieved that she seemed to want clinical knowledge, I gave her a brief review of Jeffrey's disease and its anticipated course of progress. My words were met with silence. But, then, her anger came. "I want a different nurse," she spat. "You act like he's a page in a textbook and like you're looking at a scorecard for his future." Her words hit me hard. I'd wanted so much to be a comfort to her. My heart filled with remorse and fear: what if this was how I'd be greeted by all my future patients? But I swallowed my pride and finished the visit as quickly as possible - and later, asked my supervisor to send a different nurse for Jeffrey. That was hard, because what if the supervisor wrote me off as a bad risk for this job? She didn't. Instead, she reminded me one of the ways people try to regain control is by expressing anger. She pointed to my account of Carrie's flattened responses to my questions. She asked me to imagine how it might feel to Carrie - who had, obviously, worked so hard to instill a sense of serenity into her life. She asked me how that person might feel; to have to cope with uncertainty and chaos, in the form of her husband's illness and impending death. She asked me to try to understand that Carrie might be very angry at this intrusion into the serenity she'd planned, for her life. I began to understand: since Carrie would likely find it difficult to be angry at her husband, she had to find a target for that anger. She had found one: me. "In a way, you gave Carrie a gift," my supervisor told me. "You gave her someone to be angry with." Seeing the sense of this didn't make it easy to accept Carrie's angry rejection - but it did make sense. In time, I would meet many other "Carrie's" - and those words have always stayed with me. I remind myself that sometimes, one of the gifts I can give someone is the gift of someone to be angry with. It's not a gift I want to give, but it may be the one that someone most needs.
  3. Roy Fokker

    Mothers Day

    I bought a motorcycle last year. I've always loved riding and I've been wanting to get one for years. I finally cashed in some vacay time and bought a Honda Shadow 750. I love the bike and ride as often as I can - even commuting to work. It is very therapeutic - cathartic even - for me. I get extra depressed in the winter because I'm not on my bike. What does all this have to do with nursing and Mothers Day? Well, earlier this year, when I took my bike out of storage, my Mother made a quiet request: "Be a darling. I would love it if you could call me when you reach work and before you leave for the ride home at the end of the day." I essentially pooh-pooh'd her concern and essentially never really honored her request. Mom never brought it up again. Fast forward to yesterday. Charge nurse recd. an alert from EMS that they were bringing in a young MVA/ATV victim - intubated. Unresponsive but un-cooperative on the scene. Looked bad. Mind you, the ED at this time is its usual bedlam: Shift change due shortly, monitors and alarms going off, people talking in the crowded department, overhead pages announcing bake sales in the cafeteria, phones ringing constantly... KWIM? A few minutes after this call and before the patient arrived in the ED, the secretary answered what seemed like a routine phone call. But with each passing minute, the look on her face got more and more strained. I mouthed a silent "Need help?" to her and her eyes practically screamed, "HELP ME!" She put the call on hold and walked over to me (even though she was sitting opposite me at the desk.) "I don't know what to do! It's a patient's Mother and she's calling about her son. I've tried looking him up with what detail I can get from her - by the way, it must be an awful cell phone connection because she keeps cutting out. But I can't find him on our campus. He can't be an admit (ER and Inpatient use different charting systems) because she says he must have been brought here just recently because she was notified just now. Some kind of mudder/ATV incident or something? That last part sent a spark through my brain. As I was walking back after I'd discharged one of my patients, I passed the charge nurse desk and overheard her ask one of our techs to clear one of our trauma rooms and set it up for an intubated patient. I wondered 'Hmm, maybe this Mom's son and the tubed patient we're supposed to be getting are the same?' "So anyway, I tried checking with XYZ Campus and they didn't have anyone by that name there either" the secretary continued. That's unusual because the secretaries do this on a daily basis. They know how to look up patients and records better than the nurses and docs. Records are their bread-and-butter. "By the way, I'm not even sure that's the actual name either. The phone connection is awful and she's so upset that she's not answering questions appropriately!" "I'll speak to her. See what I can do", I said with a smile. I put all the cheeriness I could muster into my voice "Hello my name is Roy. I'm a nurse in the Emergency Department. How can I help you today?" The voice that responded drained what cheeriness and sunshine I had left in me. I didn't need to be a psychiatrist to hear the desperation, anxiety, anguish, heartache, dread, and pain in that voice. "PLEASE! HELP ME PLEASE! My name is Jane Doe and my son was brought to your hospital! They told me he's in bad shape. Can you..." "Ma'am, what's your son's name?" "John Doe. He has..." *cuts out* "...old. He said he was" *cuts out* "friends. Are they..." *cuts out* "...EASE HELP ME!" "Ma'am I'm so sorry but I kept losing you during your last conversation. Could you please repeat that slowly..." "He has red hair! He's a good kid! *sobs* PLEASE HELP ME! His ID says 100, Main Street, Anytown but that's not true *sobs* He lives with me! 10, Home Street! *sobs* PLEASE HELP ME!" "Ma'am, what's the last name, first name and date of birth on his ID? It might make it easier to locate your son." *sobs* "My son is John Doe. He was born 01/01/1991. PLEASE HELP ME! IS HE ALIVE?! IS HE BREATHING?! THEY CALLED MY YOUNGER SON WHO TOLD ME THAT HE WAS IN BAD SHAPE! IS HE DEAD?! OH GOD PLEASE...." The sobbing had turned to crying. My usual calm demeanor had turned to anguish! Anguish because my heartfelt every *sob* and plea entrained by the Mother. I was starting to get frantic because I couldn't locate her son ANYWHERE on our 5 campuses! I was just about to put Mom off hold and ask her if EMS or whoever called her had specified where they were taking her son, when out the corner of my eye, down the hall, EMS rolled in with a fairly young looking intubated patient. On a hunch, I said, "Ma'am, I've very sorry to put you on hold again but it will be for just a second." I put her on hold, made laser eyes at the secretary and said: "run down to ambulance receiving and get me data on whom/what the patient is!" She needed no encouragement - ran down to the Charge Nurse desk, got info and ran back. "It's a 20 some year old, intubated patient. Name is John Doe. Found unconscious by friends. Unknown downtime." "Ma'am, I think your son just arrived at my Emergency Department. This is go..." "IS HE OK?! IS HE BREATHING?! *sobs* SIR, YOU HAVE TO HELP ME! *sobs* IS HE ALIVE?! YOU HAVE TO TELL ME!" That last part was expressed as she dissolved into tears and crying. There are very few times I hate my job. This is one of them. I 'hate it' because I hate giving people bad news. "Ma'am - I'm so sorry I can't give you more information. But your son just got here and I can promise you that the best medical team in the world will be looking after him." "IS HE ALIVE? IS HE BREATHING? (Anguish still in her voice) "Ma'am, your son just got here." I looked over and saw the team swarming him in the Resuscitation Room - docs, nurses, techs, respiratory therapists. I saw a multitude of complex machinery being used to try and keep the patient alive. My heart sank. That's usually not a good sign. "Ma'am, he's alive as of now. He's very sick BUT ALIVE, as of now." "NOOOOO! NOOOOO! MY BABY!" she wailed. I felt horrible. I didn't want to crush her spirits but I didn't want to give false hope either. Besides, I barely knew anything of what was going on with the patient. What I did know what that Mother and Son (even unconscious) needed each other. As gently as I could, I spoke into the receiver again "Ma'am, please listen to me. Your son needs you right now. Where do you live?" *sobs* "Farawaytown" Ouch! But at least she isn't screaming hysterical anymore... "OK. I need you to call your youn..." I paused as the secretary slipped a note in front of me - 'EMS dispatched a patrol car to the address of the Mother to escort her in.' "Ma'am, the EMTs just told me that a police car has been sent to your address to escort you here. Call your younger son and have him come too. Either as a driver or as someone to help you. Please DO NOT drive yourself." *sobs* "My son is already on his way!" *sobs* "Good! Do you know where this hospital is located?" "Yes." "Good! Ok. I'm so sorry Mrs. Doe." "Thank you so much Sir! Thank you for your help!" *sob* I looked at the receiver incredulously and hung up. I probably delivered the worst news she's probably ever heard in her life and she ends the call by thanking me?! I shook my head and took a deep breath. One of the other nurses from night shift stepped up to me and said "Hey Roy! Wanna give me report and get outta here?" "Brother, you have noooo idea!" As we were punching out after shift, my colleagues and I commiserated over the case. We all agreed that it was a horrid story and we all felt bad for the patient and his family. On my drive home, all I could think of was that anguish and pain in that poor mother's voice. That phone call played back over and over again in my head. Heck, it's playing back in my head right now (and I have the goosebumps to prove it.) As I parked my car and walked home, I noticed that the light was still on (it was well past midnight.) Mama is still up... I shook my head. My parents are retired and split their time living with my older Brother and Me. For years I've told Mother she doesn't have to stay up for me. That I'm a grown man now and I can take care of myself. But she insists. She says she can't sleep until she knows I'm home and safe. I unlocked the front door and walked in. Mother looked at me and smiled. She looked worn and tired but she still smiled and said "Ah! You're home! How was your day?" I didn't bother taking my jacket or shoes or my backpack off. I walked straight over, gave her a bear hug and a kiss and said "I think I'll call you when I get to work from now on." Mama just smiled and said "Good!" I still haven't told Mama about the case - because I know she'll worry. She worries enough as it is. I'm just gonna try and be a better son... - Roy PS: That phone call hit me like a wrecking ball. I just couldn't bear to even 'imagine' my dear Mama on the other end of that phone call. Talking to who knows who as she's frantic about the status of her son? And what was I pooh-pooh'ing anyway? A mothers love and concern for her son? What kind of a special, ungrateful, dimwit was I?! I was raised in a culture that didn't have special holidays for "Mothers Day" and "Fathers Day." Where I come from, everyday is 'Mothers Day' and 'Fathers Day.' 'Honor your parents, for not only did they give life to you; they sacrificed a lot to try and make sure you had a better life than they did.'
  4. classicalcat

    Ghosts Are All Around Us

    Ah, the questions that our children ask: "Where did I come from?" "How does Santa Claus fly around the world in ONE NIGHT?" or... "Do you believe in ghosts, mommy?" Some questions are easier to answer than others. I have never seen a ghost--that ethereal mist that makes the hair on the back of your neck stand on end. The kind that makes the room suddenly turn bone-chilling cold. But that doesn't make me doubt their existence. As a nurse, I have seen their influence: the ghosts of the past--those shadowy glimpses of those who once lived, who never leave us. The ghosts of the present, who haunt us daily. Those of the future, who we would like to change, but wonder if we can. It was a beautiful summer day, when the sky was so blue that it seemed endless. This outside beauty seemed an unfair contrast to the dark, gloomy room, as I held the hand of my dying patient. "Martha, is that you?" he said as he looked at me. "No, I am not Martha, I am the nursing assistant," I replied. I knew that he had lost his wife a few years ago. "Martha, please stay, "he cried. "I am here," I said. "I am not leaving." He died peacefully, with his wife's name on his lips. On this day, I was the ghost. I had another patient, a new mother who seemed overly concerned about everything that her newborn was doing or not doing. "I think his lips are blue!" she would say. Or... "can you please check his temperature again? He seems too hot." Or... "he just isn't breathing right." It was kind of driving me crazy on a day that was already busy. Near the end of the shift, I finally had some time to go through the rest of her chart. And there it was: She had lost her first baby to SIDS, when he was only two months old. On this day, her first baby was the ghost. When I was a nursing student, I had to do my obligatory four-day rotation in mental health. I had mixed emotions about this. On one hand, I was thinking, this could be a nightmare, and on the other hand--it might just be interesting. It was actually a little of both. I was given a lot of autonomy at the facility, given that I was a nursing student. The nurse in charge basically said: here is a list of "safe" patients--you can give them their meds this morning. Um, OK. As I made my way around the unit, I wasn't sure what I expected, but I encountered patients who seemed very ordinary to me. Until I went into the fifth room. I heard voices from behind the closed door. I thought it was a private room. When I knocked and entered, there was a man sitting on his bed having a conversation. He questioned....and he answered. "Who are you talking to?" I asked. "The Prophet Elijah," he answered. What am I supposed to say now? I dove right in. "Can you tell me your name?" "God," he answered. Oh. I double checked his wristband, and gave him his meds, while he continued his conversation. On this day...the ghosts were within his mind. It was a cold, rainy day in December. I walked into my patient's room, not knowing what to expect. The report on paper didn't look so good. Teenage mother, history of depression, history of abuse. The scene was surprising. A lovely, young mother sat in her bed breastfeeding her baby. "Look, she has latched on this time without help!" she exclaimed with pride in her voice. "Good job!" I replied, sharing her enthusiasm. Then I noticed another woman in the corner of the room. She sat in the rocking chair with a sullen look on her face. She looked unkempt and smelled of cigarette smoke. Her hands were shaking. "I need to get some fresh air," she said and exited the room quickly. My patient looked embarrassed for her mother. The mother didn't return that day. We had an order not to let the stepfather into the unit due to his history of abusing our patient. I got to know my patient throughout the shift. She was tearful at times. "I am so scared that I will end up like her...she has made such bad decisions...bring that %^hole into our house." I realized that the ghost of her future self was haunting her. "You aren't your mother, and the decisions you make will be your own," I said. So many times in my nursing career, I have felt more of a counselor than a nurse. But I have come to realize that nursing is all of that--you can't separate taking care of the physical body from that of the mind and spirit. We have to take care of the patients and their ghosts--they are all around us.
  5. It was shortly after labor day when I walked into the emergency room to see a client who had been found unresponsive and rushed to the hospital. I walked to the front desk, identified myself, and requested to see him. The woman behind the desk smiled kindly at me and asked: "Are you family?" I opened my mouth to respond and closed it again I did not know how to answer. This client, who had I known for 5 years, had no family. When a coworker visited him in the hospital weeks before, she had been present when a staff member asked him about family members. He had been very clear on the fact there was none. Was I family? When my normally calm administrator called me, her voice broke when she asked me to go to the ER to check on him, as she had just gotten a call from a very upset and worried aide. She had known him for much longer than I had, had gone to see him recently in the hospital, and was genuinely upset. It was her that had visited him a few weeks ago in the same hospital. Clearly, she was his family. Was I family? His aide was upset because she cared for him and had been with him more often than her own child. He has suddenly declined, and he needed her. She had come at all hours of the day and night, paid and unpaid, to care for him. She was scared. Of course she was family. Was I family? I had spent my drive there thinking of him. But I had also thought just as much about the girls in my office, all who had gotten out of their beds to care for him late at night, supported him when he was sad and angry, and loved him through it all. Girls who answered the phone at 1 am when he needed something, who talked to him during the day when he called for reasons that weren't really reasons. Of course, they were family. Was I family? She asked again. Yes, I replied. I am part of his family. And after the kind liaison sat me down and handed me tissues, I sat with him til it was time for me to go tell our family he was gone. When I arrived back at my office, I hugged, cried with and held our family, as we mourned one of our own. I don't say this enough, but I thank God for our family I wonder sometimes if other nurses or medical professionals go through this. I know we are taught not to form intense attachments to patients as it could cloud our judgment. I feel like my attachment to some has actually helped. Knowing them as well as I do has let me pick up on little things I may not have otherwise. These bonds have allowed my staff to care for patients in a way they normally wouldn't be able to. For patients like this one, who had no one but us, how does one walk into his home on a regular basis and not feed the basic human need for human connection? Isn't it part of our job to care for the client both physically and emotionally? Mental health and physical health can and often do go hand in hand. No one should be alone in the world. Especially not when so many people go in and out of their home every single day. Honestly, I feel like many nurses and medical professionals do. Doesn't everyone have that "one patient"?
  6. Cynthiahowardrnphd

    Part 2: The Good the Bad and the Ugly Boundaries

    The Ugly (Absent) Boundaries Let's first look at what happens without any boundaries. Not being able to set any boundaries or limits can result when someone does not like being alone or when they are not aware of their own needs. Physically this can show up with people not respecting the personal space of others and emotionally by feeling everything very intensely. This person may over react to what is going on and be overly dependent on others for their emotional wellbeing. Have you had any coworkers or friends who always needed reassurance from you? On the other hand, a person without any boundaries may also hold onto resentments for a long time and feel like a perpetual victim. This would be a negative Nancy always complaining about how they were wronged somehow. You can see how not having any boundaries can make relationships and communication difficult. To make things worse, a person who cannot set boundaries can be very critical of others when they attempt to set limits. This can create a backlash of guilt and or frustration as the healthy person seeks to move away from individual who has not yet recognized they are their own person. Regardless of how hard it is - continue to set limits and speak up for yourself lest you end up in the codependency trap. If you are this person who has not set boundaries and recognize that you are just too dependent on others for their approval, congratulations! Awareness is the first step to making changes. Begin with small changes that have low risk. For example, if friends want to go to a certain restaurant and you really want to go to another one, make the suggestion for your choice. Then as you build a comfort level expressing your preferences you can take bigger risks with boundaries at work. The Bad (Rigid) Boundaries Getting along with someone who cannot set boundaries can be initially easier than some who has rigid boundaries. Eventually, they both will chip away at successful and healthy relationships. Someone with rigid boundaries may appear still, stoic, standoffish having difficulty with physical and emotional closeness. This makes it tough to build trust in a relationship as this person is hard to read and can come off as disinterested or indifferent. They may end up feeling misunderstood because their lack of emotional expression is misread by others. Other people may be resentful because this person does not participate in the relationship. At work, this person may be consistent yet not able to give back to others and read the cues that someone needs help. They may wait to be asked for help rather than initiate an offer. Again this causes problems with those people who are more emotionally available. If you are this person who watches everyone else engage but holds back out of fear of exposing too much or feeling awkward, start by observing someone you admire. What are the gestures they use to engage that you could model? Start small as it really is the small shifts in behavior that make the biggest impact. Try smiling more. Smiles are so universal and a smile will break the ice and encourage a connection. With patients put a hand on their hand or a light touch on the shoulder to let them know you care and are there for them. As you allow your own feelings to come forward and gently guide you, you will be able to relax your boundaries and join in. The Good (Healthy ) Boundaries What do healthy boundaries look like? Unfortunately, there is not always an effective role model in the workplace. Setting boundaries is NOT a place you arrive at and then never again experience an awkward moment. It is dynamic and you will continue to grow in this skill. Keep that in mind so you have realistic expectations for yourself. A person with healthy boundaries is very clear about what they like and don't like. If you struggle with boundaries this may come off as irritating, selfish and elite. "Who does she think she is, asking to go to the first lunch..." This may be a reaction to someone making a request for lunch because they know their blood sugar drops and if they did not eat early, their energy levels wane. Why wouldn't you want to ensure you have the option in order to do your job well? You can tell this person is not elite and or entitled because setting healthy boundaries means you also respect those of others and you are able to compromise and negotiate when needed. This person shares their viewpoint and is open to hearing a different view from others. Respecting other people's physical and emotional space, this person asks permission before touching someone or asking personal questions. As you go about developing this critical skill of setting boundaries, spend a little time checking in with yourself and finding out what is important, what you need from others, what is negotiable and what isn't. Initially, you may err on being too rigid if you have never set limits before - that is ok. Keep working at it. You may be too loose and will quickly learn as you get overwhelmed with other people's demands. Tune into your emotions, learn from them and then take action. Your life will only be as good as your ability to take care of yourself. You are worth it. For Part 1 of this series, please go to Let Negativity Roll off Your Back: Learn to Set Boundaries
  7. I observed the following clinical scenario several times over the last few months and wonder if it is just episodic events or something more. There is a type of patients who openly abuse acute care system. Such patients have a multitude of chronic conditions which can be managed successfully on outpatient basis, but willfully ignore all recommendations, teachings and the rest of it. Instead, they come to ER within 24 -72 hours after discharge stating symptoms which, as they know perfectly well, would warrant readmission, such as chest pain. Once admitted, they terrorize providers and the rest of staff, refuse interventions which are recommended, demand increase of opioids, benzos and other "good stuff" and, in general, refuse to go home till receiving as much of "customer experience" as possible. The cycle is repeated X times. Then, one beautiful day, karma struck. The patient somehow bent the stick too much and totally and profoundly upset provider and nurses. Therefore, he couldn't get more of his beloved dilaudid 1 mg IVP Q2h, no more phenegran IV, appropriate 2 grams sodium/ADA1500 diet instead of regular, no private room which "they always put me in because that's what I want", and his call lights are somehow always got answered the last. Nurses even stop obligingly wipe his butt upon demand, even though "they always did it for me before". After a couple of temper tantrums, the patient leaves AMA or upon the first opportunity to do so, with a loud promise to (never shop there again) never come back to this bad, bad hospital where "nobody cares for me". That all is a common and well known and I wouldn't bother with it. But I saw several times recently that the patients in question truly disappeared from the ER for several weeks and, when they finally came back, they were there for legitimate reasons. Moreover, their behavior changed quite a bit. They stopped doing things which caused acute decompensations, such as skipping insulins and breathing treatments. They started to take most of their meds regularly, not only "ma' pain pills". They became more flexible with home and office care. They get flu shots and avoid large gatherings of people during flu season. In other words, they finally started doing what we wanted them to do for years before. I was so mystified that I asked two of them, indirectly, what happened. The answers were: since I cannot get what I want here, then I do not want to go here anymore unless there is no choice; so, I am just trying to stay out of this hospital. You told me that I have to do (X, Y, Z), so I give it all a try, so I might not have to go where I was treated so badly and couldn't get what I wanted. These observations prompted me to ask a silly question: can "customer service" paradigm actually attract chronically sick patients with significant knowledge about the system in hospitals and therefore negatively affect their health on the long run? And, as an opposite, can lack of "customer service" prompt these patients to finally take better care of themselves and therefore provide significant benefits for them? I would be thankful for others' observations and ideas about this topic. "Customer service" is pushed down the throats of all health care providers nowadays, but I never saw any research showing its benefits or lack of them in terms of long-term disease process.
  8. Patients come in all sorts of flavors. You have your frequent flyers, your noncompliants, your criminals, and your sweet little senior citizens. All patients are different, and this is part of the joy of nursing. Everyone has their own story, and we get to listen to them, help them, and see them flourish. While not everyone agrees with it, patients come in all kinds of sexual orientations, too. You can have those who are gay, bisexual, transexual, or transvestites. Just a normal day on the job for a nurse, right? Sexual identity is a hot button issue, and it is becoming hotter. The internet almost blew up a few weeks ago about a Michigan law that purported to allow EMS personnel to deny treatment to patients who identified with a particular sexual identity. Supposedly, this bill allowed medical personnel to refuse based on religious beliefs. You can't believe everything you read on the internet, folks, and there is more to this story than meets the eye. It still brings up the ethical question: can medical workers refuse to treat those who violate a strongly held religious belief? What the Michigan Bill Says The bill currently under consideration in Michigan is called the Religious Freedom and Restoration Act, or RFRA. It is currently in the Michigan house, where it was proposed, and still has to work through the system and be signed by the government before it is law. Therefore, the RFRA is not a law in Michigan, despite what the internet says. It is a long, long way from that, and it could change drastically as the politicians get their hands on it. No need to worry, really. It's just an idea at this point. Another crucial bit to understand is that the bill does not specifically give medical personnel the right to refuse treatment to gay people. The bill doesn't mention medicine or homosexuals at all. Instead, the bill suggests that a person who is by law required to act can choose not to act due to a strongly held religious belief. This means that it could be used as a defense in court if the one who should act is sued by the one not acted upon. Mostly, this would entail civil cases, but this isn't where the story ends. Possible Scenarios Arising from the Bill As most lawyers do, far more has been read into this bill than originally intended. Opponents of the bill have suggested that this law could be applied to medical personnel, from doctors to nurses to EMTs. In fact, it could affect any person required by law to act, and they would be in their rights to refuse. Please note, this is not what the bill says, but it is merely a possibility that could be read into the law to protect a medical professional who didn't act when they were required to. It also brings up the idea of religious freedom. If you know that someone is gay and you disagree with that, do you have to act? The proposed law technically says no. When you hold a sincere and strong religious belief about something, the state cannot force you to act against those beliefs -- even if it means that someone else suffers because of it. This is a bit about the separation of church and state in addition to medicine. How far do religious beliefs go? Can you refuse someone anything because they don't agree with your religious point of view? For instance, should you be forced to rent your property to someone who is gay? According to this law, you wouldn't have to, and that would get you out of a discrimination suit. Should Healthcare Workers have the Right to Refuse Treatment? Despite the fact that this bill is far from a law and despite the fact that it doesn't directly affect medical workers, it does bring up a disturbing question: do nurses have the right to refuse to treat patients who are gay? Look at it this way: Do we have the right to refuse treatment of someone with HIV or Ebola? Do we have the right to refuse treatment of a patient whose religion is different than ours? Do we have the right to refuse treatment to those who have a violent criminal past? I have taken care of child molesters, rapists, and murders. I certainly don't agree with their actions, but I took care of them to the best of my ability. Why is it different for someone of a different sexual orientation? It all boils down to the patient. Here is someone sick in front of you. Does it matter how they have sex? Does it matter what they believe? Do you have the right to play God and decide who lives and who dies? No matter who our patients are, I believe that we have the legal and ethical responsibility to care for them to their last breath. We didn't come into nursing to pick and choose those that we will care for, and politics does not belong at the patient's bedside. Instead, nurses should care for who they are charged with -- criminal, homosexual, black, white, Islamic, or whatever. No one should be denied care, and that includes the modern day lepers, those with a different sexual identity. References Michigan House Bill No. 5958; Accessed January 9, 2015 http://www.legislature.mi.gov/documents/2013-2014/billengrossed/House/pdf/2014-HEBH-5958.pdf Snopes; Slake Michigan; Accessed January 9, 2015 snopes.com: Michigan Exempts Emergency Medical Personnel from Treating Gay People?
  9. Jacqueline.Damm

    Complacency in Healthcare

    Webster's Dictionary defines complacency in a way that we, as a people, can all understand. As nurses and caregivers, we know deep down that complacency is taken to an entirely different level within our scope. It is a weighted situation that causes a slew of issues of which safety takes precedence over all. Let me reel you in a little deeper... As a nursing student, I followed a wound care nurse that was performing a monthly study on the prevalence of wound progression while in the hospital. We rounded on a patient's room and whipped off their socks. In an instant, we were stunned to find a blackened foot that had completely lost perfusion-- when? No one knew. The report from the nurse, "I just didn't think of taking off their socks when checking pulses." When inquired as to why, 'I... I guess I just got lazy.' This patient lost their foot. Once again, as a nursing student in the GI suite watching colonoscopy after colonoscopy, a woman came in for a study due to an extensive family history of colon cancer. As the probe was removed and she was slightly stirring from her twilight sleep, someone made an inappropriate joke at her expense. The entire room started laughing. The patient then looked up at me with tears in her eyes, "They are laughing at me, aren't they?" I lied in order to save face. Uncool my friends. Uncool. A nurse I was working with a fellow comrade who felt too proud to ask for help with a blood infusion on a cardiac step-down unit. As I'm sure you can assume, this patient suffered from pulmonary hypertension as well as a very poor ejection fraction with apparent symptoms of heart failure exacerbation. They ran the blood too fast, didn't inquire to the MD about Lasix in conjunction with the infusion. Here comes massive fluid overload and a rapid response call. Avoidable? Indeed. Taking a step away from nurses, call into question a physician who flits in and out of the hospital who thinks that a ticking time bomb of a case (pulmonary hypertension, hypertension, kidney failure without dialysis and COPD) isn't worth abrupt addressing. I walk in and find the patient talking one minute, unresponsive the next. After bedside intubation and a run down the hallway to the ICU, the patient almost died (bless vasopressors). When the physician rounded on the floor they peeked into the room-- "Oh, they are gone, I'm assuming to the ICU? [shoulder shrug] Okay." May I mention not answering pages (most of them stat) and the fact that physical compensation wore out and almost killed this man. The physician had no shame. One last example... A CNA rounded on a patient in my unit. This individual was extremely confused, was assisted to the bathroom, then helped back to bed. Great right? Wrong. The bed alarm wasn't set nor were the bed rails up. I was running down the hall when I saw the patient literally roll out of bed and smash their head on the floor. It was a sound I would love to forget. I am sure that many of you will look at these cases and think words like: negligence, ethical issues, etc. You are right for sure. But what I can also bring to the table about all of these stories is that each of the individuals involved had been approaching their jobs with a complacent attitude. All differing levels, but it was present, and it was absolutely affecting their care. Complacency is a filthy animal. It makes Facebook at work more important than hourly rounding. It makes that extra long break of greater importance than double checking those pulses post cardiac cath. It means blowing off education and cheating on hospital required testing and skills check-offs because "we just don't have time." We all know that our jobs hold immense importance and are very high risk, to us as well as those we see on a daily basis. If you think about it, the decisions we make on a daily basis can stop or even restart a heart. I don't know about you, but to me, this will always be an immensely frightening aspect of our careers. What I ask of you is if you feel yourself sliding, none of us are above it mind you, take a step back. It is of utmost importance for us to draw the line when it needs to be marked (WITH BLINDING SIGNS). We need to understand our limits as caregivers. In order to save ourselves as well as our patients and our teams we have got to have to courage to state when our threshold has been met. I can recall in the last two weeks when I had to draw the line and ask for help because I couldn't take another [insert touchy situation here], or I would just break. IT'S OKAY! YOU ARE HUMAN! We are fallible and at times inflexible. Let that crazy super-nurse idea in your head relax and take a reprieve. I will never forget what an amazingly talented ICU doctor and anesthesiologist told me that day I left the GI suite with the laughing matter. The doctor grabbed me by the arm and reminded me in all seriousness, "It is our job to protect and do no harm. Every day this is our goal. As soon as you see yourself sliding, it's time to stop before you hurt someone." So use those days off. Ask for help. Take a mental health day. Because when we allow for complacency to take over and rule our care, that is the day that a nurse did more harm than good. Florence expects the best, our patients expect the best, their families, the doctors, even you. So let's provide the best care we can. In doing this we need to know our limits and be willing to draw those lines.
  10. saramoss04

    My Most Memorable Patient - Geraldine

    Patients create a lasting memory for numerous reasons. There are the very critical patients who may not have a positive outcome but you know you learned some valuable lessons from; there are the funny patients who always make you laugh either appropriately or inappropriately; there are the really gross patients whom you can only talk about with fellow co-workers (because normal people would not be able to handle it); and there are the patients who you just want to take home with you as a mother, father, sister, brother, or grandparent. Geraldine falls into the last group of patients - someone you just want to take home with you. Geraldine was a patient on our floor, one of whom I had the pleasure of caring for one day. She was a pleasant 94-year-old woman who was content to read the paper and sip on her morning coffee. As I came in to do vital signs she put down the paper and we began to chat. She then said to me in the sweetest Boston accent, "Lawbster - I just love lawbster! Look at this restaurant (pointing to add in the paper for Bone Fish Grill) have you ever been here...they have lawbster!" I told her yes I had been there and it was really delicious. After some additional small talk about how much she loved seafood she asked if I would like to go to that restaurant with her one day. She was just the sweetest elderly woman I had ever met and I just instantly loved her! I said I would love to and she then proceeded to write down her phone number and address. Not much time had passed into the day and she was to be discharged. I learned that she drove herself to the hospital (yes she still drives and lives alone) but her son did not want her to drive home that day. We set up transportation for her and as I stood waiting for her at the front desk, she came walking down the hall, all five feet of her, dressed in her clothes with her purse around her arm ready to go. I am not sure why but I will always remember that moment and how cute she looked. Fast-forward a few weeks - maybe even a month or two and as I was cleaning out my workbag I found the note with Geraldine's phone number and address. I thought to myself, "Oh what the heck I will give her a call." So I called and Geraldine remembered me and exclaimed how much she was hoping that I would call. She said she told everyone about me and when she was in the hospital another time with her son she tried to call different units to see if I was working so she could come and see me (she couldn't remember which unit I worked on). We made plans to go to Bone Fish Grill and from that point on became very close friends. For the next few months, Geraldine and I would have our dates. We would chat on the phone about once a week and we would go out and do different things, we went to Panera Bread; we went and had Tea one afternoon at an English Tea Shoppe complete with scones and small cucumber sandwiches; we went shopping together; and she even made a spaghetti dinner at her house complete with salad, bread, and dessert. Geraldine introduced me to all of her friends and even her son that lived in the same building. She was like my grandmother and we were friends. One day I called Geraldine and she told me that her son, who was ill and in and out of the hospital very frequently, had passed away. She was so sad to have lost her son and to add to the grief and pain her other son, who lived up north, was coming down to get her to take her back to live with him and other family. Her son that passed was the only family that lived in Florida and now that he was gone, her son was moving her up closer to family. She was devastated to leave the place she had known for more than thirty years. As she continued to tell me the story she cried and I found myself sad and crying as well. She was my friend and we always had fun together and now she had to leave. Not only did she have to leave but also she was doing so against her will and just after her son passed away. I asked her when she had to leave and she told me she was leaving on a plane in two days. I promised Geraldine that I would come over right after work the next day to say goodbye. The goodbye was sad. Not only for losing my friend but also for seeing how sad and upset she was about the whole thing. I met her son, the one moving her up north, and he pulled me aside and said thank you for being such a good friend to her. He said that she talked about me all the time and how much she looked forward to the times we would talk and go on outings. It meant a lot to her and her whole family. The way he made it sound was as though I was doing a job - I tried to explain that I really loved being with her and I was sad she had to leave. Her house was all in boxes and she sat on the couch as her son sold her car (no more driving) and packed a suitcase. The house that she had always kept so clean and organized and decorated sat in boxes. After about two hours I said my last goodbye and went home. She left on the plane the next day. Geraldine has been up north for just about eight months. During this time she celebrated her 95th birthday and has moved into a new apartment that she says is so big she might just get lost. We still talk weekly and she tells me how much she hates the cold weather. When she asks how the weather is in Florida I don't have the heart to tell her it's now December and it is still 80 degrees (she loves the hot weather). She constantly asked if my boyfriend had proposed to me yet, and if he hadn't she was going to have to have a word with him (he did and she was over the moon happy). She has taken pictures of her apartment and sent them and I sent her pictures of my new home, she always asks how the house is coming along. And just this past week I told her I was planning to come visit her this spring and she could not believe it she was so happy she almost cried. Every conversation she tells me she loves me and misses me and I tell her the same. She is my little Geraldine. There are so many other stories and little things that make Geraldine the most memorable patient/person I have ever known. Just as much as I am told that I make her day when we talk and do things, she makes mine as well. I miss her dearly but am happy to be able to talk with her and to be able to make a trip to see her. Anyone who knows me knows about Geraldine and that to me makes her my most memorable patient.
  11. spotangel

    I wish I could see you!

    Mr. Francis Ross's eyes were closed, his breathing shallow. I walked into his room. He was surrounded by his family. To the outside world they looked like a very close knit family. I knew better, bearing witness to the daily infighting inside and outside that hospital room. The reason was very simple. Francis was dying, was a DNR and the family stood to gain a lot of money. There was a tiny hitch. The ex-wife Clarissa had showed up now professing undying love for him. She claimed that he was going to get better and that she would nurse him back to health. Francis clung on to her and her words. His children could not stand her; calling her a fake, gold digger. They felt that he could not see past her honeyed talk. Matter of fact, he could not see as he was blind now. The diabetes had claimed his eyes. Francis had left his wife to marry Clarissa when he was a hot shot lawyer. His wife died a few years later and their children held that against him. Later when his luck and money were down Clarissa left him, divorced him and got married to someone else younger and richer. Francis realized his mistake, reached out to his children and mended his fences. For the next 20 years as he got sicker, his kids took turns to bring him to the hospital. This seemed to be his last visit as he was in multi organ failure. No medical treatment was working. Somehow, Clarissa found out and was back in his life. The evening before, I heard that there had been a bedside wedding. The children had found out that Clarissa was back in their father's life and were livid. Looking at the fatigue on Francis face, I gently herded the group out of the unit and went back to him. His BP was low and his labs had looked real bad. Since he was on palliative care we were giving comfort measures only as per his wishes. "Annie?" "Yes, Francis?" "I need your help." "What can I do to help you?" "I need a priest. Can you get me one?" "May I ask why?" "I want to get my last sacraments and confess. I know I am dying .Aren't you Catholic?" "Yes! Let me see what I can do. How do you feel about dying?" "What can I do? I can't change it. I want to talk to a priest." I called our hospital page operator who had all the on call and on duty pager numbers. The priest had gone on vacation to Africa and would not be back for 2 weeks. The backup number went to a message center. I called the Nursing Supervisor and asked for help. She made a few calls but could not get anyone. I then thought of calling my local parish priest who looked like a Chuck Norris double. Father Nick aka Chuck Norris, was a young and energetic priest. Bless his heart; he made that half an hour ride in 15 minutes and got preferred parking by the hospital entrance as I had called security at the front desk. Father gave him his last rites and he was at peace. I thanked father and he left. I allowed the family to take turns to visit and then leave. Clarissa left saying that she would be back after a quick shower. Four hours passed, no Clarissa. Francis condition was worsening although he remained alert throughout. It was almost time for me to leave. I gave report to RN Joan Wallace. Also updated her that Clarissa may return after her shower! I went to Francis's room. "Goodnight Francis! See you tomorrow!" "Annie will you come in here please!" I stepped closer. "Can I give you a hug? Thank you for calling father Chuck Norris (I had told him that Father Nick was a Norris double!). I feel so peaceful". We chuckled softly in perfect accord. "Sure, Francis, I love hugs! You are very welcome!" I hugged him gently as he was all skin and bones. "I wish I could see you child!" "You never know Francis, you just might! Remember our motto; never lose hope. Bye Francis!" "Bye! Annie! Bless you!" Hoping to see him the next day, I left. It took me half hour to reach home. Thankfully I got a parking on the street after a couple of drive arounds. Walking into the quiet apartment; I let a sigh of relief. The day was over. As it was summer, the sky was still bright and there was plenty of sunshine in the room. My husband had taken the older two who were toddlers then, in the double stroller for a walk in the park and was not back. As I sat down in my living room and untied my shoe laces, I froze. I could feel a presence in the room but could not see anyone. The air was still and expectant. In my bones, I felt, I knew it was as if someone was watching me. Strangely, I was unafraid and it felt peaceful and not scary. I instinctively looked at the clock. The time was 8.42pm. "Francis, if that is you, go in peace to God! I guess you can see me now! Glad you got me with only my shoes off!" I was unaware of the tears trickling down my face as I smiled at my weak joke. Just as it came, it was gone. I hurriedly removed my shoes, washed my hands and picked up the phone. I called my unit and asked for Joan Wallace. Joan picked up the phone. "Annie, you won't believe this!" she said in a rush. "Remember Francis, that sick guy in room 684?" "Yes?' "He just passed. The Nursing Attendant went to take his vitals and found him pulseless. The doctor pronounced him. He is calling Clarissa and his children now." "What time was he pronounced?" I asked quietly. "Around 8.40pm" How on earth did he know where I lived, I wondered. I sat and said a prayer for his soul. As I pondered on the visit, I realized that he had made his wish come true as anything was possible now that he no longer was burdened by his earthly body. As I opened the door to welcome my noisy family back and hugged the kids and their dad, I whispered to the still air, "It was good to see you Francis! Remember, never lose hope! With hope, all things are possible!"
  12. dpgRN

    The View From My Frames

    Different types of frames There are frames that embellish photographs, and there are those which enhance a letter page. While some frames cast a protective shadow around an eye to block the blinding ray of a sunny glare, others spark style and glamour onto the eyes that peek through them in order to view the world. Then there is the frame of mind; that intangible ability to see cups half full, to view the good masked in the evil, or even the frame of mind that can see the hope that transcends a disheartened state. My kind of frames My kind of frames vary; an assortment of numerous shapes colors and sizes. Some are round, others with leopard print, some are metal and some made of plastic, some are funky, or rather crazy, and few are classic. I choose mine to match my outfit, or to bring color, style and individuality to my green scrubbed attire. Some of my frames cover my face more than others, but all of my frames window the eyes that view the discomforts my patients experience, the stress their family endures, the helplessness they feel as they depend on my care, and their hope that can easily shatter into despair. The eyes that blink behind the glass sees a human surrendered to their most vulnerable state; when they are succumbed to dependence, when their fate is unknown, when their dreams of another tomorrow are uncertain. My patients frames Curled up in a bed, branded by their birth date and a bar-coded number, a human being with a whole life full of complexities is simplified to a body in a bed, chained to an IV pole, and labeled with a diagnosis. Really they are a power house. They worked three jobs to provide for their kids as a single mom, the world traveler who loves to live life and see the world, and the mother with hopes to continue to expand her family. They clutch onto hopes for their future, as they balance onto the tottering grasp of today. As I walk in to each room, I must to see them through the lens of the ill, so that I can attend to their needs and help them progress their capabilities. I must see a person who needs several medications, and who must rely on me to eat, sleep or move. I see to it that their physical safety is ensured. Behind the glare of my frames are pupils that widen when a light of hope casts a hopeful beam on my patient's prognosis; it constricts when uncertainties of test results dampen a projected diagnosis. The lacrimal ducts leak tears as my comatose patient's son sings her a new song he learned that day in school, or when my patient learns that their cancer is back. I must wipe the dust, grime and tears from the glass filling my frames and I go about my day. What they see From their bedside view, they see a little person with an ID badge toddling about in her clogs, adorned in green scrubs, and a head of curls that tangle around a rubber stethoscope. Her eyes are hidden behind colorful frames as she looks at the body under the sheets as she introduces herself. She examines the body and shares the plan for the day. What they see, is the person on whom their life is dependent upon for the next 12.5 hours. This short little, green scrubbed, curly head, crowned with a colorful set of frames; will be their eyes when they walk so they don't trip over wires and tubing, the eyes that will position them in bed. Those eyes sheltered behind the frames will detect the downhill or upward movements of their state of health. That being lays there with hope that the eyes hiding behind the leopard, or the bright red plastic frames will sympathize and understand their state. They hope that those eyes can look past the bed, and to the person laying in it, to see the life that lived before the body involuntarily elected to battle an unwanted illness. The eyes behind the frames will utilize their vantage point to see both the needs of the being in the bed, and still perceive what the person was before, and their needs that transcend the medications, diagnostic tests and therapies. Different frames Really, there are two sets of eyes that are looking through the glass lenses held together by my frames. One set in search of hope and understanding, the other set striving to provide that hope and to understand. Each day, their eyes will meet mine and look through the same glass through which I view them. Each day both sets of eyes strive to meet an identical view.
  13. In October 2016, I was hit by car while crossing the street. A medical helicopter transported me to the hospital where I spent three nights in the ICU, followed by two months on the critical care trauma unit. I had sustained numerous and severe internal and external injuries which required major medical intervention. During my (too long) stay, many nurses cared for me. A year and a half later, I still marvel at the dedication of several of them. Fortunately, much of my hospital stay is a blur. However, I can still vividly recall how much their commitment to my emotional well-being in addition to my medical needs helped during those physically and emotionally painful--and seemingly endless--months. Fortunately, many nurses understood that I was more than just a vessel with medical problems; I was a person with complex emotions. Sustaining, coping with, and healing from my injuries while spending months in the hospital took an enormous emotional toll on me. I experienced anxiety, boredom, loneliness, helplessness, and dependence. Throughout this traumatic experience, some of my nurses had the insight and empathy to treat me as a human. Their concern for, and attention to, not only my physical needs but also my emotional needs meant the world to me. The nurses were very busy. They had multiple patients with many needs, some of which required immediate attention. Therefore, it is understandable that they were not always able to spend extra time to support my emotional needs. But when they had--and took--the extra time to really be with and help me as a whole person, it had a far greater impact on my well-being and healing than did any pill or injection. How can nurses contribute to emotional healing? Reduce loneliness and boredom My hips, femurs, and one tibia/fibula were broken. As a result, I was unable to bear weight (i.e., stand) for two months. Fortunately, the hospital unit had ceiling lifts (aka "full body slings") so that I was not completely bedridden. Even though it (literally) took as much time to get me out of my room and into the lobby of the unit (where the nurses sit and other patients walk around) as I then actually spent there, some nurses were willing to load me into the lift and then wheel me out into the hall multiple times each day. Staying in my room all day was incredibly lonely and boring. Their willingness to spend this time enabled me to leave my room, sit up, see and talk to people, have a change of scenery, see that there was life outside of my hospital room, and have a much-needed distraction from my emotional and physical pain. Provide reassurance against anxiety After two months, my orthopedic surgeon wanted an x-ray of my legs and hips. The needed images required me to stand up for the first in two months. I was terrified that I had "forgotten" how that I would fall and re-injure myself, and that my hospital stay and recovery would be prolonged. Knowing how scared I was, one of my most dedicated nurses decided to accompany me to the x-rays. When I saw her turn in her pager so that she could devote all of her attention to me, I knew that I would be okay. She informed the radiology technicians that I was terrified and constantly reassured me that she would not let me fall. Now, after almost complete recovery, it is hard to imagine that I was so afraid of standing up. However, I remember that day very clearly. It was extremely difficult for me to put any weight on a leg that had been shattered and pinned back together and a heel that would not touch the ground. Knowing that my nurse would not let me fall physically or fall apart emotionally provided me with the comfort I needed to view standing up as an exciting (albeit terrifying) accomplishment. Her support was priceless. Diffuse my pain During another extremely uncomfortable surgical procedure that required me to be awake, another devoted nurse stayed and held my hand the entire time. She constantly reminded me that I would make it, that I was being brave, that I was almost done, and (showing how well she knew me) that, once over it was time for ice cream!. She encouraged me to keep squeezing her hand to help diffuse some of the pain that I was experiencing and talked to me in order to distract me. That procedure stands out as one of the worst parts of my hospital stay (and that is saying a lot, given how many there were), but I also remember how much more bearable it was with the support of my nurse. Just be with me One night I woke up feeling a burning from one of the medications running down my throat (where it was not supposed to be going). After my nurse fixed the tube, I was so terrified to return to sleep, fearing that I would not live through the night. Despite my nurse's reassurance that she would not let anything happen to me, I was too scared to try to sleep. She said that she would stay with me until I fell asleep. She pulled up a chair and sat in the dark so that I would know she was watching in case I started choking again or could not breathe. I remember opening my eyes a few times and seeing that she was still there with me. Her presence was exactly what I needed. Help me retain some independence Once I was able to get out of bed and bear weight, my nurse (who had been encouraging me to take every little step possible towards independence and caring for myself) spend extra time to help me use the commode and then the actual toilet. She also helped me take my first shower in over two months. It took about an hour, and, because we had to leave the shower curtain open, it created a mini-flood. It would have been easier and faster to have me use the bedpan and be sponged off and leave the "real stuff" for a rehabilitation facility to deal with. However, she was willing to put in the extra time and energy to help me move towards feeling more like a "person" rather than a bedridden patient. I hope that the nurses know how much they helped me emotionally. I was in so much pain at the time that I was unable to adequately express how grateful I was for the care they provided. The pain of my accident, injuries, and hospital stay has (fortunately) reduced over time. In contrast, my appreciation for the emotional support these nurses provided has grown. They truly helped me in many ways.
  14. dpgRN

    The Right to Hope

    I'm a nurse. I see a patient. I see a human blanketed in white hospital linens, and adorned by more wires than an electrician can handle. I listen intently to the rhythmic tunes emanating off the monitors, I examine their awkward, dancing lines. I scrutinize the rise and fall of a chest, managed by a machine nearby, as its oscillating movements mimic a real, independent breath of life. I see a monitor with its colors, lines and numbers. I hear it beeping. I view the chart, and its whole list of diagnosis. I stare at the labs and test results and I understand the severity, and the magnitude of their values. I read the doctor's notes and comprehend their impression of the prognosis. I then go about my tasks hoping to prove that prognosis wrong. I am a nurse, but I am also just a regular human being. I stare back the the human opposite me, in the bed, under the blanket, wearing the wristband. This human battling a complex version of health, stares back at me. What they see at this time, I do not comprehend, but I imagine them before they lay in this bed.What did they do? What did they sound like? What were their passions? What gave them joy? Who were they before they were succumbed to 12 hours of my care each day or night? I say health because as I see it, there is a line of health and a line of illness, and then there is medicine. Thus, my job as a nurse is bridge each of those parallel lines, so that I can help the human under my care cross those lines from illness to health, via the interventions of medicine. So, I see this complex picture and I wear both of my heads, my nurse head and my human head. With my nurse head, I fear what the numbers and prognosis are telling me, and with my human head, I hope to paint a cleaner picture and a sturdier bridge for this shambolic, fragile, effigy of a human being. With my human head, I stare at the image again, and I spy a tiny flicker, coruscating from the dark walls once enveloping the glim aura of a dark, chaotic, glim prognosis, with a glimmer of light. That flicker is the family and friends at the bedside, holding onto the human wearing the wristband, who appears to be lifeless, under the wires, tubes, and lines. They carry an instrument that I often, inevitably lose as don my nurse head and manage a patient to help them battle their illness. They may not wear a stethoscope, green scrubs, hold a needle, manage the maze of wires and tubes, or understand the jargon of medical terms, but they carry a vital instrument that is often lost to a human in the battle that succumbed them to this messy picture of health. It's their instrument of hope. I am familiar with this instrument, of hope. I have used it before. But as a nurse, to get my job done, to help fulfill that beacon of hope, I must lay that instrument aside and deal with the reality of the numbers, rhythms, and complications that are alerted to me with the alarms emanating from the blaring monitors. I must educate the patient and their family of the reality on my side of the parallel lines. I must intervene when needed, even when it may hurt. I must deal with the unwanted bumps in the road, and reveal it with its sharp and painful reality. When on the other side of the parallel lines of health, illness, medicine and the human roadmap it crosses, I am intentionally blinded to the hopeful outcome, because I understand the meaning of their values and the denotations of the jargon it speaks. I am a medical provider and yet I am human. I understand, and I want the outcome you want. But, my hope, while wearing the provider (nurse) head, is blinded by knowledge and experience. I think I know the only possible outcome. Providers often challenge that hope, and wonder why the family won't let that patient give up. Won't let that patient go more peacefully. We as providers know the outcome from medicine. What we don't know is the person; who they are, what they would want, and what they are leaving. We also don't know when a miracle might happen, and as much as we may doubt the ability for that miracle. We provide our care via science, research and with medicine, not with miracles; and so we can leave that up to family and the patient, and then we must support their hope for that miracle. The reality is that many of us want to live, and we choose life. As providers we help reach that choice of life, within our medical means and capabilities, but until we feel we can. Once we feel like our ability to provide the means of life have been worn out and limited by medicine and scientific evidence, we succumb and offer the patient and their family to allow nature to take the patient on its own inevitable journey in a more peaceful way, if that is what they want. The challenge we face, is when our medicine mind sees the ineluctable outcome, but the patient still holds on to the one last string, to keep that straggly line on the monitor from falling into a dreaded straight line. Do we push our harsh medical reality out there, or we do keep fighting with them and allow them to hold on and hope until there is nothing to hold? I used to have an opinion on this. The patient is suffering, is it even fair? Why "waste" interventions if we know the outcome? That right of hope, is for the patient, but it is also the right that lifts the family through the process and allows them to continue living even when the battle of their loved one has been lost. For without it, what do they have when that life has gone? You see, as a medical provider, your patient is not just the human that the charts, numbers and monitors are slandering about. Your patient is also the people who care for them, who know what we don't about them, other than their physical features and medical history. Sometimes we must consider the other part of the patient in the clinical picture, the one sitting on the side, and holding the hand of the human wearing the wristband with a medical record number. As clinicians we must also uphold to certain standards, and a code of ethics; to do good, do no harm... We must also respect and uphold to our patients rights. This right to hope, is a patient's right. When I say patient, I mean their family too. Sometimes a patient is too sick, and too busy fighting to hope, and then there is their family who must cope. How do they cope, when there is a strangulating sense of unknown, looming before them? When the fear of loss consumes them? When the trepidation builds up and then falls with every setback throughout recovery? With the frightening new appearance of their once vivacious loved one, now consumed by wires and machines, only a ghostly image of their vibrant lively self? It is with that thing called 'hope'. With illness, a human may lose everything; independence, ability to care for one's self or others, to wear the clothing they choose to style, travel to places they wish to explore, taste the flavors of food, and the freedom to live the life that living has to offer. What most patients and their family can choose to hold onto, despite every bump and obstacle along the journey towards health, is the hope that they will make it there. It is hope that allows them to get up each day and be there for their family member. It is hope that guides their decisions for care. It is hope that allows them to comfort their loved one and support their journey to wellness. It is hope that leaks onto the patient themself and helps them put up a fight. But then, when if the fight is not won? Has all that hope been for naught? Something in my personal reality, recently clarified this. I have recently witnessed the greatest undeniable faith, hope and belief, that was so admirable, it changed the way I think in this regard within my profession. I have witnessed the faith of family, friends, a community and even strangers. Some even saw the fragile proximity to the straight line, understood the severity of the prognosis, and still held on to hope. They held on even when they were told it was hours, they held on even as the the angel of death loomed over them like a crazed enemy, ready to strike and win a fight. They didn't let go of that hope as the angel of death struck. They didn't blow out that flicker of hope even when there was no breath to prove life; they transformed that flicker of hope into a fire of faith, to carry them forward when death had its way. Their hope was not for naught. Without hope, death may have won the battle over many, with hope it managed to win the battle of one, everyone else won with a flaming fire of faith, to keep them going even when the sheets were drawn and a stone replaced the living human in the bed. When a person is sick we hope for them, when they are gone, we hope for us; the people who love and care for that person. Once they are gone, they aren't pained, and they have no battle to fight, of which hope can serve as their armor. Once they are gone, it is the hope that helps those that hoped for them while they were living, to win the battle of their absence. It is this same hope that helps heal those they left with the living. As human being and also a nurse, while my medical knowledge helps me save lives with the interventions I perform, that same knowledge strangles the power of hope from within me, as it gets blinded by the facts and numbers of the many unfortunate realities I encounter daily. I lose sight of that right to hope from time to time, and I've judged it from my nurse head, even as I empathized from my human head. While I have challenged that level of hope with my medical head, I now envy that hope as I see it transformed into a valiant leap of faith and strength that helps the living humans left, to cope. Sometimes, I wish not to be blinded by my medicine head and share that hope and belief that things will turn out ok for every patient I care for. When fate has its way despite the sweat and toil of any medical intervention, and when that hope does not transcend to the patient, let it also transcends to those who struggled to save the life and so that they can stay strong and continue to fight more battles to save lives. My journey as a nurse is exactly this. To see every challenge in the light of a possible, "hopeful", road towards recovery and life, rather than a road to death, despite what medicine tells me. Treat each human with the harsh knowledge of medicine, care for that human with the fiery warmth of a human heart.[
  15. nurseed12

    Mentoring: A Nursing Connection

    As of the latest statistics the average age of a nurse is 41 years old and more than 50% surveyed has decided nursing as their second career (Jones, 2016). Hired nurses are of a much later age group and is noted that these nurses bring more energy, more focus, and more mentorship to the practice (Saunders, H., & Vehviläinen-Julkunen, K., 2016). What second career nurses exhibit has been demonstrated to improve patient outcomes (Johnson, Butler, Harootunian, Wilson, & Linan, (2016). Younger nurses hired need a mentorship programs to enhance their knowledge and skills. These programs also equip them with tools to survive their first year of nursing. One tool that I use at the bedside with newer nurses is the tool of gaining a connection. Having a connection aids in the growth of trust with the patient and knowledge within the new nurse or nursing student. One unfortunate patient event aided my demonstration of the connection within our patient population. As a cardiac nurse, I helped Mr. J. S. heal after an unfortunate snakebite. This created a series of medical issues for Mr. J. S. and concerns for his wife. I mentored a new student who was afraid of snakes but not afraid of the medical management that ensued in Mr. J.S.'s care. He was intubated, on several drips, he was "touch and go" for several days., prior to my receiving him as a patient. Once we were able to start weaning the medications to keep his blood pressure at an acceptable level, stop giving antivenom, and wean him from the ventilator he started to come around slowly and also recognize his loved ones that surrounded him for days. Again, this was my time to connect and mentor. As a mentor, I attempted to gain a connection with my new student. One night I started my shift and I just opened up the conversation of how Mr. J. S. came across the snake at first. Did he like snakes? Did he go around snakes often? His wife of 13 years started to tell me the story even as I was giving him nightly medications down his feeding tube. She said: "He loves snakes and other reptiles. He always wanted to keep a few. The family and the kids said no. So, he actually goes out fishing and attempts to connect with one from time to time. He has no intention to keep, just admire. He learned so much from his dad that was his connection to nature. He wanted to somehow carry that tradition to his next adventure." His wife mentioned this with tears in her eyes, knowing that her husband may not be doing well and slowly dying. Others may fear snakes, even reading about them but me I am different. I wished to connect. Her not knowing that I enjoy several reptiles myself. I opened up the conversation further. "Nursing is not my first career. Biology is my first career. I love turtles. I studied several classes of turtles and with this knowledge and experience gained a fascination for other reptiles including snakes. Some of the fellow nurses may consider me weird but like in most cases I am fascinated. " With snakebites especially if the snake is caught, it needs to be brought with the patient. I have had other snake bite patients and we would store the snake on the counter inside the patient's room. I would be the only one of the staff fascinated enough to admire what was in the jar. Of course, the subject was already dead but venom can still carry on with contact. So, knowledge is power in this case because I noticed the type of snake and how dangerous this creature is to this patient. His wife and I spoke over several hours interim of myself taking care of my other patients. She seemed at the end of the conversation connected and relieved in some small way. She gave me a warm smile at the end of our conversation and said she needed to go home to take a nap. We said our goodbyes and she went home...but with a small connection somehow. The next morning, she had arrived early. Mr. J. S. was extubated and off two of the medications keeping his blood pressure at a stable level. When she entered his room he started the conversation by saying "hello honey and how long have I been here". She looked at me in tears and this time with a strong grateful smile. I couldn't have been more pleased. Again ... a connection. Nursing is not just patient care it is also about making a connection. It is hard to receive trust from our patients but if one can achieve a connection the trust will come and build as the relationship continues. References Johnson, W. G., Butler, R., Harootunian, G., Wilson, B., & Linan, M. (2016). Registered Nurses: The Curious Case of a Persistent Shortage. Journal of Nursing Scholarship, 48(4), 387-396. DOI: 10.1111/jnu.12218 Jones, S. J. (2016). Establishing a Nurse Mentor Program to Improve Nurse Satisfaction and Intent to Stay. Doctor of Nursing Practice Capstone Projects. 15. Encompass: A Digital Archive of EKU's Creativity, Scholarship and History Capstone Project Saunders, H., & Vehviläinen‐Julkunen, K. (2016). Nurses' Evidence‐Based Practice Beliefs and the Role of Evidence‐Based Practice Mentors at University Hospitals in Finland. Worldviews on Evidence‐Based Nursing, 12 (21), 1-10. DOI: 10.1111/wvn.12189
  16. jeastridge

    Learning to Talk

    The doctor walked into the exam room where the patient sat on the edge of the exam table. In her late 50's, she was slender and held herself erect, tense as if preparing to slide off that paper-covered surface. The young doctor, maybe in her mid 20's self-consciously shuffled the papers she had in her hand. She stood a couple of feet from the patient and made eye contact. "I have the results of your tests, Mrs. T.," she said in a somber voice. "I've been anxious to hear them," was the reply. "You have a malignancy." The words were followed by a shriek of joy from the patient. "Oh, good, I was so afraid you were going to say that it was cancer." She held her hands to her mouth and seemed to hold back sobs of relief. The doctor began to stutter and her eyes widened, "No, yes, I mean...What I meant to say is that it is cancer, Mrs. T. I'm sorry I wasn't clear." The patient's relief gave way to a horrified look, followed by tears and mumbled words, "It can't be; it just can't be." Fortunately, the above scenario was part of a practice session in a class for medical students. The "doctor" was a young first year, learning that it matters what words we use when we talk with patients. I can remember as a hospice nurse, doing admissions and being careful about word choice. After explanations of our services, detailed checklists and signatures, the process usually culminated with a question and answer session just to make sure the patient and their family knew what to expect from us, their new hospice nurses. We tried to wait until the patient or the family asked about topics related to prognosis and then double checked to see what their medical provider had already communicated. Sometimes they did ask the tough questions: "So how long do I have?" or "What is going to happen as I die?" or "What do I do if I get to where I can't communicate?" It's important to consider how we answer questions that our patients pose to us and that we impart what truth we can with gentleness and compassion. In discussing this topic, my friend said, "Yes nurses need to talk....and so do doctors. Many times the doctor has told the patient a lot about their condition thinking they have covered everything. But the patient is confused by the 'Doctor Talk' and is embarrassed to ask for clarification. Then it is left up to the nurse to be the interpreter." How do we know what to say? Ask Questions Back First Clarify what they know, how much information they have and how they have interpreted what they know so far. It's Perfectly Fine to Say, "I Don't Know" Sometimes it is exactly the right thing to say. We are not at liberty, as nurses, to impart information about prognosis or testing unless the doctor has already had a chance to talk with them. Then we can clarify or help them understand what was said and what it means. It can be helpful to go one step further and say, "I will try to find out," but only when we really feel some measure of confidence that we will be able to find out. If we say we will and then get busy and don't get time to follow up, we will want to be sure and let the patient know what we were not able to follow up. Otherwise they may feel lied to or betrayed. Answer Only What They Ask We learn this with kids, often by answering a different question than they intended to ask. If the patient asks, "Will I have pain?" then it is helpful to answer that question and talk about strategies we will help them use to cope with the pain, without going into other symptom management problems that might arise later. Staying focused on the question at hand is hard to do, but an important learned skill. Know Yourself Work on your own issues when it comes to talking with patients. If people frequently mention that you talk a lot, then it might be time to pause and hold back from saying everything you think needs to be said. If you are quiet and maybe answer questions with one word responses, it may be time to expand your horizons in terms of patient conversations. Learning new ways to communicate with patients is not necessarily a skill that comes naturally; as with all of our professional nursing skills, we must hone our trade, observe others who are experts in the field, and learn as we go. Sometimes You Have to Initiate the Questions Part of being good at caring for our patients involves listening to what they don't ask as well as what they do. When a patient is silent, appears distressed or depressed, it may be time for the nurse to ask probing questions. I can remember a hospice patient who never, ever had any questions. He was dying from lung cancer and breathing made a lot of conversation difficult, but he was closed off from his family and from us as his hospice nurses. We tried to engage him but our usual approaches just didn't seem to break through. Finally, one of the PCTs sat down next to him and said, "I'm worried about you. You are awfully quiet. Will you share with me what's on your mind? I promise I will listen and try to help as best I can." The patient went on to share his anger about his condition and the fact that he did not want to be in hospice-he wasn't angry with us, he said, just the fact that he was sick. Their conversation ended with her squeezing his hand and acknowledging that she had really heard him, "I'm sorry that this happened to you. It really stinks." That encounter seemed to help break the ice in our caring for this man. He never did talk a lot or ask many questions, but her question to him seemed to clear the air. Whoever thought nurses need to learn to talk? As with all areas of nursing, learning to talk with patients and communicate well is a skill. It may come more naturally to some than to others, but there is no doubt that we can all improve, take hints from one another and offer pats on the back to our peers who do a good job talking.
  17. sbush86

    "Bad Patients" - A Labor of Love

    Who was your last "bad" patient? Mine was ThreeTimes an Hour. At least,that was the average timing of my patient ringing the call bell that night. Often times he rang more (rarely less), leading to a night remembered as one of the longest shifts of my nursing career. All thanks to a pesky prostate and an elderly gentleman who required assistance to stand. Its funny to look back and think about how much time I spent in that room, helping this man onto thin, frail legs as he attempted to hold on to the plastic urinal with equally frail hands (always with my hand underneath it - never trust shaking fingers to hold a urinal, as I have learned the hard way!). As soon as he produced more liquid gold, I would help him back into bed, ensure his pillow was fluffed and the call button was in reach, and then run out of the room to check on my other patients, get tasks done, and chart as much as possible before the inevitable ring of the call bell returned, marking another twenty minutes as passing. By the time morning rolled around, I was exhausted. The addition of the straight forward task of helping Three Times an Hour to my other workload meant I was one tired lady. When the next shift finally came in, they saw the haggard look in my eyes and assumed the worst - was this a "bad" patient? We have all been there. You walk in at the start of a shift, and see the look in your colleagues' eyes. "Is this a bad patient?" we wonder (or perhaps say brazenly aloud). Is this one who demands much but needs very little - Rude and Condescending, perhaps? Bed-Ridden While On Lactulose, maybe? Needs a Linen Change As Soon as the Bed is Clean (also known as the Back Slayer, the Blanket Hog, or the Leaky Rowboat)? The list goes on for what constitutes, in a broad term, a "bad patient". For myself, however, I have learned much and can appreciate much from these less than savory folks, these who are eagerly dumped onto the next shift as quickly as possible. Don't get me wrong - I get exhausted and frustrated as well, telling myself vehemently that "this isn't what I went to school for!". This particular night was no different - I found myself cursing under my breath each time the call bell went off, each time I found myself already running behind on a myriad of tasks ("why do old guys have to pee standing up? Why?!"). Every twenty minutes, I was expected at the bedside, not to help perform life-saving care or even contribute to the overall diagnostic standing of this man, but to help him with something he genuinely needed assistance with. But isn't this the heart of nursing, all jokes aside? No, we are not merely bedpan cleaners, butt-wipers, or order-followers - we are much more than that. But at times, in these more humbling moments of humanity, I would see in myself what is terrifying to comprehend - my own vulnerability. I see the future: I am not sick, my parents are not sick, my siblings are not sick, we are not weak or fragile - but we will be. Even more frightening? The knowledge that such frailty is not limited to the old; physical demise cannot be compartmentalized to worry about later. And that, I believe, is what makes nurses so special. We see in others, on a regular basis, that which the rest of society gets to conveniently forget about - that is, at least, until they or a loved one are the ones clasping the bedrails with trembling hands. We act as caregivers and healers, but also asa barrier - the very sick can present an ugly truth to those who retain their health. They are, in the very seconds we are cleaning them up, helping them stand, or turning them over, facing the very thing humans like to forget about- demons that we as nurses can stand between, and, for the moment, at least,form a wall of caring that can make even the smaller things feel like uplifting victories. Often, when I drive by hospitals, I look up at the windows and wonder what illness lies behind them, what battles are being waged, but more often than not, I also think about who is performing the exhaustive, thankless work of the Three Timesan Hour patient, my brother or sister aiding in the quest to maintain dignity. I wonder, as I steal a glance up at what must be windows to inpatient units of all kinds, if others do the same - do other caregivers feel moments of solidarity with the souls working that day? Do others feel the pain and fatigue of their cohorts, valiantly working inside? It can be hard to explain to others why nursing is so special, how we not only make a difference for others, but how those we care for can give to us more than weever expect. It can be frustrating to be reduced to a doctor's handmaiden or a glorified pill-pusher. People wrinkle their noses at our stories,and tell us they don't know how we do it. I am grateful for the chance to do it. It isn those moments of looking into someone's eyes as they are frightened, alone, depressed, or embarrassed that I find my work the most humbling. While it may be easy to say,as a new nurse, that you never want a shift like that, you never want to givethe immobile patient a Kayexalate enema or have the patient who needs so many little things that they amount to an enormous mountain, I believe they are necessary for building stronger nurses - if we allow it, those patients can teach us more than we ever imagined. I don't remember my other patients from that night - their acuity, their needs,their care escapes me - but I remember very strongly this man and the care I provided him. Although he was my most recent, Three Times an Hour won't be my last "bad" patient. Next time, in the midst of perspiring profusely onto my scrubs as I perform whatever draining task awaits, my hope is that I remember how I feel when I am outside looking up at the hospital, oddly thankful for the opportunity to humble myself and be called a nurse, holding the beasts at bay.
  18. Ashley Hay, BSN, RN

    When You're the Patient

    A wonderful example of this was discussed in a recent article detailing one oncology nurse's blog post. It was written as an apology letter to her past patients. This after she, herself was diagnosed with cancer and realized her perspective may have been skewed. The article states, "In a blog post published on Nov. 14, titled 'Dear every cancer patient I ever took care of, I'm sorry. I didn't get it,' Norris, 33, who was diagnosed with stage III colorectal adenocarcinoma in September, apologized to every patient she's treated since she went into nursing." Norris continues on to say, "I didn't get what it felt like to actually hear the words...I didn't get how hard the waiting is...I didn't get how much you hung on to every word I said to you." Having been on both sides frequently, I can tell you firsthand it is different. The setting somehow feels unfamiliar, despite having worked in various healthcare settings for over a decade. I find myself eyeing up my husband, making sure we look presentable (what's with that?!). I feel a general sense of unease, subconscious (or very present!) anxiety and an eagerness for every provider I encounter to view me as the "easy" patient. One who doesn't ask for too much. One who is not too opinionated and has unwavering compliance. One who has a positive attitude despite circumstances. One who maybe isn't really me at all that particular day. When you are the patient a few things might seem a bit different... You're Extremely Observant When you're not the one completing tasks and running around in it, you realize just how much overstimulation there is in healthcare settings. I become incredibly hypervigilant and easily distracted. My brain is programmed to answer beeping IV pumps, buzzing beepers and ringing phones. Today, my role is different - but I still hear them and it drives me crazy. It's not easy to admit, but it may stem from feelings of being out of control. A stark contrast from working as a nurse in this very setting, where I am confidently calling many of the shots. You may find yourself reading into body language and facial expressions, heavily. I frequently feel overly sensitive to any slight whiff of annoyance from any healthcare provider. Did I say too much, go on for too long? Will my care be compromised... maybe they will come around less often if they think I'm annoying? You Notice the Chatter We're all guilty of it - after all, we're people too! Chatting quickly with a coworker about a recent TV episode, their family members, weekend plans, etc., seems harmless enough. But I can tell you, your patients are watching (and listening) way more than you may realize. This can be especially true when they are waiting for you to hang that IV bag in your hand. Talk of being overworked, lack of breaks and low staffing census can have major impacts on patients within earshot. It can increase their anxiety levels and leave them wondering if they are in safe hands. Wait Times We've all gone to welcome that patient to the unit - the one who is incredibly frustrated at the wait time. Patients can be upset when their appointment time is delayed over a multitude of reasons; childcare issues, time off work, inconveniencing caregivers, etc. What many of us don't consider is exactly what nurse Norris mentions in her blog post - how difficult the wait can be. This is especially true when patients are anxiously awaiting potentially bad news or worse... to be told their physician is out of ideas and doesn't know. Having to sit for any extended period of time can cause a major spike in stress levels, anxiety and mood swings. This can also be true with patients waiting for responses via telephone, email or online healthcare portal. Having been on the nursing end of telephone triage, I understand that messages need to be prioritized. However, being the patient feels very different. You are less concerned with the volume of calls the office may have to return because you want your important question answered. What doesn't seem pressing to you as the provider may be a pressing issue to the patient. After all, it was important enough for them to reach out. Every patient's experience is different. All should be valued and provided with compassionate & attentive care. Having a nurse with an open and empathetic state of mind can resonate deeply with many patients. What's your experience with being on both sides? Do you feel some nurses get too comfortable in their settings - forgetting about how the patients might feel? Share your story below! References: Oncology Nurse Diagnosed with Cancer Writes Apology Letter to Patients: 'I'm Sorry, I Didn't Get It'
  19. spotangel

    I Lost My Baby And My Phone!

    The night Nursing Supervisor was giving me report. I was taking over half the hospital including ICU, CCU, ER, LR, NICU, Postpartum and a bunch of other units. The supervisor told me about a patient who was on one to one observation and security watch. During my rounds I went to her unit. I spoke to the nurses who were all having a rough time with her for the last few days. I could hear her yelling at the top of her lungs demanding her phone and her speech reminded me of the Jerry Springer show! Every second word was a curse word! She recently had a fetal demise and had multiple psy hospitalizations in the past. I was told that a situation developed the day before and security watch was initiated along with one to one observation. The father of the baby was barred from coming in and as he stirred up the patient and set her off every time he was at the bedside or on the phone with her. Finally the situation became so hostile that he was barred from coming into the hospital.She was refusing medications and was very labile. The doctors wanted her to sign a behavioral contract before the phone was returned and she refused. The nurses went in and offered medications for agitation and she refused. I walked in quietly into the room and introduced myself and shook her hand. She looked me up and down. I softly told her, " I am so sorry for your loss." I asked her if that made her sad and angry. She nodded her eyes never leaving my face.I asked her did it feel like a hole in her heart? She nodded again, her face crumpling. I then looked her straight in the eye and asked, " May I give you a hug?" She nodded. I took out my ID from my white coat, laid it at the bedside table along with my report and stepped closer to her bed. I opened my arms and she fell into them sobbing. I held her murmuring reassurances and acknowledging her loss. I told her that she was a brave and strong woman and would get through each day, one day at a time. I told her that it was ok to get sad and mad after losing her baby but it was not ok to hurt herself or others in the process. I requested her not to hurt herself or others. I looked behind me at the staff and the security guard and told her, " All these people you see are here to help you not hurt you. You have to remember that every day they get up from their warm beds and come out in this cold weather to the hospital to help patients like you. They have families that want them safe home and the end of the day. So please don't hurt my staff or yourself". She nodded and smiled through her tears. I was struck at how that smile transformed her face and commented, " How pretty you look when you smile!" One of the staff commented that she also had a beautiful voice and could sing! Now that she was calmer, I asked her if she would sing for us. After the initial bout of shyness, she started singing, "Amazing Grace how sweet the sound". She sounded like an angel! I joined her in the second stanza and so did half the staff there and the security guard in his baritone! It was a beautiful moment and there were a lot of smiles and tears! I thanked the lord in my heart that he choose to change an ugly situation into something beautiful that we could all relate to. I went back to the nurses station and asked security to bring up her phone.We convinced her to sign a behavioral contract. Although she was upset that she could not keep the phone for long periods of time, we reassured her that it was all dependent on her behavior. The charge RN convinced the doctor to leave her phone with her for the time being as she was calm playing on the phone and reaching out to family. She also wanted to see pictures of her daughter who had died who she had named Lilly, that she had on the phone. The last I saw her, she was quietly playing on the phone. I left the unit satisfied that she was in safe caring hands.
  20. VioletKaliLPN

    Cancer Made Me a Better Nurse

    I have been a Nurse for five years, I love it. I work in a skilled Nursing facility, and I am a summer camp Nurse. Those are my two loves. Part of my job as a Nurse in a skilled Nursing facility is to give sad news, the other aspect is to be a Nurse to rehabilitation patients. We have hospice patients as well as many geriatric patients, so the sad news tends to be related to advising a family that a loved one is moving towards death. Our rehabilitation patients typically have a goal of returning home. They participate in PT, OT, and ST, all in an effort to regain their strength. The largest hurdle here is pain control. Surgery hurts, PT and OT hurt, and pain control is vital to a patient's success. I was a relatively healthy 31 year old female. I took a prozac a day and lamotrigine to manage my Bi polar sub-type II disease, it worked very well and I had been stable for years. I took a BP pill, but I am active, 5'6 and 132 pounds, so weight loss was not going to manage this case of hypertension. I was working as a Nurse, living life, having fun, so I considered myself fortunate. It was June 19th of 2014, just about three weeks prior my 32nd birthday, when those three words fell into my life "You have cancer." I felt a lump in my breast in early spring, so I went through all of the steps a patient normally would when they suspected a problem. I suspected a problem, but not Breast Cancer. I was diagnosed with Infiltrating Ductal Carcinoma. It was a nuclear grade of 3, 1.7 cm, and was ER+ PR+ and Her2+. I had an aggressive type of breast cancer, but I had zero family history. No explanation, no faulty DNA or genes, it was just a fluke. I began to grieve, I became angry, sad, strong, and defiant all at once. My life, my plans, what would become of them? My risk of recurrence was high, would I accomplish my dreams? Would my husband be able to handle this? What would I do? I made choices regarding my care. I saw specialists, attended support groups, and armed myself with information related to a disease that I was not accustomed to. I made the choice to have a bilateral mastectomy with reconstruction, and afterwards I would begin chemo. I went through surgery, and recovered well. I had a Bard port a cath placed for chemo, and I shaved my head prior to my first cycle. I also gave myself a pink mohawk, because when have I ever had a chance to do that?! For the first time in my life I understood what surgical pain felt like. I grasped it's intensity, it's hopelessness, and it's ability to be relieved. I experienced having a foley catheter post surgery, as well as it's removal. For one day I was unable to place my hands in a position to wipe my own butt. It was a humbling experience to feel that vulnerable, to NEED that help. I took more colace those weeks than I ever had my entire life, yet I still ended up with an impaction. Yes, I handled that myself. It sucked, but I experienced it. Chemo left me nauseated, unable to work, and further dependent on people to care for me. The Oncologist said that he had never seen someone as young as myself have such a reaction. My hemoglobin went down to 5.2, I earned my first blood transfusion for that. I still have my armband. I quit chemo after 4 of the planned 6 rounds due to poor quality of life. I also quit Herceptin 8 months into a 12 month plan. I found a new Oncologist whom I felt was more supportive, and she is amazing. I returned to work 2 months ago. I saw the healthcare world through a Nurse's eyes and a patient's eyes. I have experienced both worlds. I have an intimate understanding of what pain control does for quality of life and healing. I no longer look at a narcotic card and occasionally think "Wow, that is a high dose." I took that dose, maybe even more sometimes. I have an intimate understanding of vulnerability, losing the ability to care for ones self, and grieving the possibility that life may not turn out how I had hoped. Giving bad news comes with slower, more thoughtful words. I know what it is like to hear bad news, and the way it is relayed matters more than I have ever known. I have experienced pain, loss , sickness, and the need to make my wishes known in the event that I cannot do so. I truly understand quality of life over quantity. I offer the voice, touch, care, and compassion of someone who has been through hell and back. I am a better Nurse because I have experienced what a patient has. I have had the ultimate Nurse/patient relationship.
  21. Ballistex

    What you didn't know

    You knew I was late at bringing you the ice water you had asked for. I know you knew this because the nurse who relieved me that day told me about how you complained for quite some time about it. How you couldn't believe I couldn't keep up with the two patients I had in the CDU. You knew you didn't want to be in the hospital on Christmas Eve. You knew you had more important things to be doing. You knew you had family waiting for you to get home. But here are a few things you didn't know. You didn't know that my other patient, just across the hall from you, a 23 year old daughter of a loving family, mother of a 3 year old boy, had just gone from bad to very much worse. You didn't know how I kept my voice calm in the room as I told my aide to call for the doctor even though my internal voice was screeching. You didn't know how many times I kept telling myself this wasn't happening. I had taken a job away from my usual ICU so this wouldn't happen. You didn't know, as I did, that her heart was going to fail her three seconds before she did. You didn't know the fear in her mother's eyes as I caught her gaze as I was compressing her daughter's chest. You didn't know about the controlled chaos that the code team always brings with it, the intubation, the bagging, the endless rounds of code drugs. You didn't know the word I uttered when the doctor finally gave up, nor the hatred with which it was uttered. You didn't know how I begged him for one more minute even though I knew it would make no difference. You didn't know I was left alone in the room to clean up the aftermath, to make a very unnatural scene look somewhat natural for the family when they came back in. You didn't know that while I was getting that ice water that you received late I was thinking about what I could have possibly missed that would have made a difference. You didn't know that by the time I gave you that ice water I was blaming myself. You didn't know that after the family left I sat by her and told her how sorry I was that I failed. You didn't know how incredibly heavy her body was as I assisted the funeral home worker transfer it from my bed to his stretcher. You didn't know that on that Christmas morning I wouldn't be thinking of my son and his third Christmas, but of another 3 year old boy instead, a boy who would forever remember Christmas not as a time of joy, but instead as the day he lost his mother. You didn't know that a part of me will always remember it that way as well. You didn't know any of these things because I didn't let you see them as I gave you that ice water, late as it was. I simply apologized and asked if there was anything else I could do for you. The fact that you didn't know any of those things is a source of pride to me. It proves that I can go about my duties with a calm demeanor, regardless of what calamity may have happened. That fact says something about me, but as I get older I'm not sure it says anything positive. In fact, it seems to point to something very tiring indeed.
  22. As the EMS transport unit pushed the gurney out,I set my bag down on the empty chair before walking across the nursing home room to the Bob's side. I introduced myself as his hospice nurse and asked if he wanted to talk or if he had any questions for me. "Nope. Just want to smoke. Why won't they get me a cigarette?" I told him we would work on that and gently explained how the staff would help him get outside to smoke. He said he understood, but his expression of anxiety did not ease. "They told me at the hospital that if I came over here, they would let me smoke." I asked permission to do a brief assessment and reached to take his pulse. I noticed long tattoos on each arm and multiple scars of various lengths. His dyed black hair was thin from an unsuccessful round of chemotherapy. His teeth were decayed and several were missing. After I took his pulse, I gently squeezed his hand and assured him that we would work on getting him outside to smoke as soon as we could get him situated. I had previously read his discharge summary from a recent hospital stay and had also spent some time with his mother, getting the history and learning the sad turn of events that brought us to this day. Only in his 40's, this man had a terminal diagnosis of lung cancer now widely metastatic to his liver, bones and even brain. He was uncomfortable and angry. And afraid. His mother reported that he would not go to sleep, forcing himself to stay awake as much as he could. As the weeks moved on, his behavior toward the nursing staff at the facility became difficult. Demanding and loud, he repeatedly pushed the call bell and then seemed to make up needs to keep them coming back. His pain and anxiety medication required constant adjustment, but his biggest and most vocal complaint related to his desire to smoke: a big man, he also had ascites and lower extremity edema along with severe weakness. Getting him outside in a wheelchair was a very time-consuming ordeal. As hospice nurses coming in for visits and to help with personal care, we did our best to make the situation as good as it could be for our patient while also trying to be understanding about the nursing home staff's needs for support in providing the more intense care that Bob seemed to need. His anger and belligerent behavior had long ago strained to the breaking point his relationships with family and friends. Because he could be hard to be around, and at times verbally abusive, his family's very human tendency was to avoid contact with him or to keep their visits short which, paradoxically, was just the opposite of what he seemed to need. As nurses, how do we push through these difficult care situations? In our training, we learn strategies on how to listen, how to maintain boundaries, how to be professional even in trying patient encounters. But when challenging patients occupy a lion's share of our time, energy and emotional resources we can find ourselves feeling resentful and maybe even angry. What are some ways that we can continue to provide excellent and professional care in difficult situations? First, we can persevere through difficulty by keeping our own bodies and spirits in balance When we are exhausted, when our own wells of the spirit are dry, we find it hard to pull up a bucket of compassion and care to give to our needy patients. Getting enough rest, exercise, eating a well-balanced diet and maintaining outside interests can help us be at our best. If I had to guess, most of us nurses have a tendency to continue to provide care even when we are weak from hunger, dying to go the bathroom, and bleary-eyed from lack of sleep. It is not an ideal world, for sure, and some days are simply harder than others, but making a conscious effort to address our own physical and spiritual needs can be just the medicine! We can look beyond the annoying or difficult behavior to see the underlying cause Bob's situation reminded me again of how easy it is to get bogged down with frustration over how patients act, instead of looking at the root cause. It is hard to say what kind of person he was before the cancer, but with it he clearly became fear-filled. His demanding attitude, verbal abuse, refusal to give in to sleep and even his denial of his own feelings, highlighted that fear. As nurses, when we can step back a bit and ask ourselves, "What is contributing to this difficult behavior?" then we are on our way to developing strategies to address it. Whether it is fear-as in Bob's case- or something else such as a loss of control, unresolved grief from prior life events, unaddressed physical symptoms, looking past the here and now to what might be behind it all can help us be more patient. While fully addressing root causes is often beyond the scope of our immediate care for the patient, thinking about the behavior in new terms can help us find the emotional and physical energy that we need to continue to provide care. We can work as a team to plan out strategies for helping demanding, difficult patients This can mean scheduling room checks; planning to stop by his room before the call bell lights up; providing a supportive environment that encourages the family to stay with him; enlisting the help of social workers, chaplains, volunteers or other ancillary staff to cover the times when we simply cannot be present-all of these in concert can help alleviate a difficult situation. Bob's situation reminded me again of the importance of looking beyond the behavior to find the cause. As professionals, we can all benefit from a different type of vision: focusing on our personal well-being and also looking beyond to superficial to see our patient's motivations and needs with new insight. Joy Eastridge, RN, BSN, CHPN
  23. I heard her yelling as I walked down the hall of the Neuro ICU toward her room. As her Parish Nurse, I had visited the 90 year old Nancy on multiple occasions in her home, then in the assisted living facility she went to before hearing that she was hospitalized with an unknown infection and was not doing well. I put on the protective isolation garb and slipped through the sliding glass door only to hear magnified the screams and yells that were already audible down the hall. Nancy's two nieces stood by, one of either side of the bed, trying to calm their aunt who appeared to have acute confusion probably associated with her current condition -later diagnosed as a UTI. As soon as Nancy saw me, she reached out her mittened hand-"Help me! You've just got to help me get these off! Listen, you know me, you know that I don't like to be tied down. Now, if you want to, you CAN help me. Just do it. I need you." Gulp. Even knowing that the mittens were on for a reason, I had to dig deep to respond in any sort of way that might possibly be helpful. I tried to use a soothing manner, a calm voice, reassuring her that I would look into it and see what we could do. My lack of immediate action only seemed to inflame the issue further and her screams reached a new crescendo of volume. Eventually, finding that I was not being helpful at all, quite possibly the opposite, I retreated to the hall, out of the line of her sight and motioned for one of the nieces to join me in the hall. We talked things over and I discovered that this acute episode had been going on for almost 16 hours, enough to wear them both out. As we talked, I looked for answers to pertinent questions: What was the plan? How far along into the plan were we? What had Nancy expressed as her wishes? What could we do to help make Nancy more comfortable whether in full treatment mode or not? Nancy's nurse happened along, and we began to discuss the plan together. As Nancy's long term advocate (she only had these nieces and no other family), the niece expressed again that Nancy had repeatedly stated her desire to "die peacefully," as recently as 2 days before this episode. The nurse was able to clarify that things did not appear to be going well and that she showed some signs of organ failure. We went on to ask the nurse to page the doctor so that everyone could understand the plan and get a clearer picture of the way forward. In the end, the nieces decided to make her a DNR and they requested sedation and pain medication. As advocates for our patients, it is hard sometimes to determine the way forward. Whether we are the parish nurses, case managers, facility nurses or ICU floor nurses, as professionals we all want to do our very best for our patients. Sometimes, in this day and age of having to float to cover the shifts, and having EMRs that fail to tell us the whole story, we flounder and find ourselves unsure how to proceed because we simply do not have enough of the background story to know what the patient and the family would want. How do we get around this current state of affairs? How can we help each other be the best advocates possible for our patients? Listen- When families come to visit, ask a few well-placed questions about the patient, where they lived prior to this stay and what they mentation level was. Families often think that nurses can somehow magically tell that their loved one has been suffering from Alzheimer's for the past couple of years and is declining rapidly. They often assume that we know more than we do, thinking that all those forms they filled out previously have made their way into our hands. Sadly, we know that communication is one of our biggest current problems in medicine -a complete irony since we spend a great deal of our time documenting and, in theory, communicating. Advance Directives-We always ask if people have one, but we less often check to see what it says. "Even though advance directives have been promoted by health professionals for nearly 50 years, only about a third of U.S. adults have them, according to a recent study." (Americans Still Avoiding End-Of-Life Care Planning : Shots - Health News : NPR) It's helpful, for example, to know if the patient who has had a stroke is adamantly opposed to feeding tubes. If we know that, we are looking at a different type of care going forward. Of course, Advance Directives can be changed by the patient and care proxy in real time, but establishing the groundwork of what they say initially can help everyone involved to stand on firmer footing. Anticipate problems- As professional nurses, we know how to look ahead at what might be coming down the care pathway. We might see the beginning of an attack of acute anxiety in an inpatient such as Nancy, at which point we could consider asking the family or facility if this has been a problem in the past or is it new onset. As we give them instructions for care after discharge we look ahead at what might come up and what they can do to address problems: practical suggestions that address particular issues that are likely to surface, e.g. UTI after Foley inpatient, weight gain with CHF, insomnia with Prednisone, etc. After those days in ICU, as her condition continued to deteriorate, Nancy was transferred to inpatient hospice care and died peacefully about a week later. Although I felt bad that she suffered so much during her illness, I was also grateful to be able to advocate for her in a meaningful way. What are some practical ways that you advocate for your patients?
  24. My night started like every other night at work did. Clock in, look up patients and give out meds for my patient team of seven. I would also read telemetry strips, chart vital signs and do my assessments. But this night was anything but normal. Around midnight I went to check on my patients. One of them was awake just staring at the TV which was turned off. "Ma'am would you like me to turn on your TV for some distraction, or turn out the lights so you can get some sleep?" "No" she said, "I see spirits." Being a new nurse I had no idea what to do with patients who saw things that may or may not be there. So, of course, I play along. "What do you see? Where are these spirits?" "I see legs, long ones coming out of the TV. And over in the corner, there is a little boy playing with the blinds." "Ok ma'am" I say, "Why don't we get settled into bed, and I can get you something to help you sleep." I leave the room in search of some Ambien or Ativan. Please Lord let this patient have something in the Pyxis! Upon my return to the room with some Ambien, the patient is standing on her bed with an IV pole in her hand, swinging it at things that I cannot see. Seriously, is this the kind of night I'm going to have? Ok, strap on the crazy pants and here we go! I run and grab our tech on the floor, because he is about 6'5", and a weightlifter. He can handle this, right? Wrong!!! My patient kicks the tech and runs out of her room and down the hall, screaming at the top of her lungs, "They're after me, kill them, kill them!!" Now I am chasing after her. We soon reach her to bring her back to her room. After we got her back into her room and attempted to calm down the other (non-psych) patients on the floor, I called the MD. "Dr B, can I please get some Ativan, Geodon, or Haldol for patient X? She is seeing things, has kicked our tech, and is running through the unit scaring the other patients." "No, with a long drawn out o, I don't think she needs it. You can deal with her until 7 p.m. tonight right?" This was code to the nursing staff that I'm on call tonight and don't really want to put my name on anything. Awesome, right?! We managed to get her calmed down with the Ambien I had tried to give earlier. She became a resident of our nurse's station for the remainder of the night. What a great initiation to night shift I had! My patient that night had hospital psychosis. She was fine at home, but when she had to stay overnight at a hospital something in her brain clicked and she became confused and combative. Her son let me in on that little secret the next day stating that she gets this way in places she is not accustomed to. That night I realized that I love being a nurse. It may be really difficult at times, but it is those difficult patients that need the most compassion. My patient that night introduced me to the wonderful world of psych. She taught me patience, compassion, and understanding. It wasn't her fault that she was seeing things and her mind was telling her that we were trying to kill her. I learned so much that night and will never forget my first run-in with psychosis.
  25. nightmare

    A Place of Safety

    I always kind of assumed (yes I know, never assume etc) that after working in this environment nurses and carers become empathic with their patients. Like most of my breed, I am tired, burning out and jadedly cynical but I keep on going, why? Well here's why. Beginning of the shift, usual thing, get a report in the office. Now this office has a glass sliding panel which we can close for privacy. That night there were no patients around so it was not closed. As the report progressed there suddenly appeared, at the window, ahead. An agitated head, perched on a small body, shouting in at the window with terror-stricken eyes! This was our new patient, who had only been in a day. My colleague, an ex-hospital nurse with no empathy whatsoever for dementia slammed the glass shut and said,'oh just ignore that, it's been like that all day!' The outgoing shift, who were milling about outside the office waiting to go home also ignored the plies, no words of comfort or sympathy just an 'oh we're going home attitude'. The report continued with this agitated head popping up at the glass banging on it, shouting and crying for help. I found this very distressing and even more so because the patient was being ignored by those who were supposed to be looking after, and keeping the patient safe. I sent the carers on my shift out to try and calm the situation, much to the displeasure of the out-going nurse, but the patient would not go with them so they came back for the rest of the report. Report finished and the other shift gone, we started our shift. The patient had disappeared down the corridor. I had barely got the drug trolleys out of the drug room when the patient appeared again. crying, screaming, very, very frightened. I went to the patient and asked.' why are you crying'. It turned out that the patient was frightened of the other patients who also wandered the corridors, under the illusion that this was the patient's house and could not understand why these strangers were invading the house. Poor thing! I then set about the task of trying to orient the patient to where this was and why there were others here. The patient calmed down a bit. Just then one of our more vocal patients started up shouting and making those noises that are so frequently heard among the demented. Frightened again the patient just wanted to get away. I took the patient to their room, to a place of safety in a strange and confusing world. Immediately I opened the door the patient calmed, recognizing own belongings, pictures on the walls and ornaments on the table. The patient began to tell me about the people in the pictures and in minutes were all smiles, calm and happy. The 'buzz' I felt from helping to calm down this distressed person was like a tonic to my soul! This is why I keep doing this job, putting up with the never-ending paperwork, the demands for more and more efficient with less and fewer resources, the pay that does not quite meet the demands of living. I can make a difference in their lives, and they certainly make a difference in mine. At the change of shift, I made very sure that the patient would not just be ignored again, making it plain that the patient needed to return to a place of safety to be able to calm down and rest that poor, confused mind. I also documented this in the plan of care so that oncoming shifts would not just ignore the patient as well.