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  1. tnbutterfly - Mary

    Another Year of Blessings

    No....this is not an early New Year's story filled with resolutions. Today is my birthday and I have been thinking back over events of this past year. Birthdays are good times to celebrate....not just with cake and presents, but celebrate life itself. Life is a blessing that we sometimes take for granted. We just assume that life will continue....that tomorrow will come and the sun will shine. But as we get older, we see things differently. I've been a patient in the Emergency Room twice in past 12 months. Fortunately I was not admitted. What a blessing. But being on the other side of the bedrails certainly gives you a different perspective. You realize you are not in charge......you feel the physical and emotional pain of the uncertain situation. What does this have to do with nursing, you may be asking. As nurses we deal with patients and families who are going through challenging times. Some of them are dealing with the end of life......either theirs or a loved ones. Thing are not happening as they planned. The sun does not seem to be shining. As I look back over this past year, I think of the patients and families that I have been called upon to care for. As a parish nurse, I have the opportunity to walk alongside many people as they go through challenging times. Most of these folks I have known for a long time. Sharing this walk with them has been a real blessing to me. It is a very humbling experience to be called upon to provide spiritual support. I look at their lives in the past and in the present. I am sometimes overwhelmed by the physical challenges that they are dealing with. The one couple that keeps rising to the surface of my thoughts is an elderly couple in their late 80's. They lived happily at home alone, the wife being the primary caregiver for her disabled husband. Being an octogenarian did not slow down this woman at all. She is woman of strong faith. I always looked forward to my visits with them in their home. On one visit we discussed the possibility of getting inpatient PT for her husband as he appeared to be getting weaker. She had prayed about it and knew she couldn't care for him by herself unless he got stronger. A few days later, she fell and broke her leg. When I got to the ER, the woman was surrounded by friends. Although she was in pain and was preparing for surgery, her main concern was for her husband. They have no living children, however fortunately her daughter-in-law was visiting from out of state. The entire time this woman was in the hospital, her only concern was for her husband. After surgery, she immediately began planning to go to the same facility where her husband was so that she could be with him while she received physical therapy for her leg. She took seriously the vows she made on her wedding day sixty-some years ago....."to have and to hold from this day forward, for better for worse, for richer for poorer, in sickness and in health, to love and to cherish, till death us do part, according to God's holy ordinance; and thereto I plight thee my troth." In fact, she quoted this to me. She got her wish and was discharged to the same SNF where her husband was a patient. I went by to visit them the day she was discharged. The sight that I saw when I walked into the room brought tears to my eyes. The two beds were pushed together, they were holding hands and smiling lovingly at one another. Reunited again. Once again complete. It did not matter to either of them where they were. They were together. This is true love.......even after all these years of marriage. What a testimony. And what a blessing. When I think about this...... it has given me a whole new outlook. Here is a lady who was obviously in pain. But her spiritual and emotional pain far outweighed her physical pain. Doctors and nurses too often try to address the physical pain, often overlooking the spiritual needs....the things that give real meaning to one's life. Sometimes the emotional and spiritual needs are more unbearable. This couple have been a real blessing to me this year. I need to remember this as I grow older, as my body parts don't work as well as they once did......celebrate with each year that passes, and look at the many blessings God has put in my life. You might like to read Be the Nurse You Would Want as a Patient; Munchausen by Internet: The Lying Disease that Preys on the Heart, and other articles in my blog] Body, Mind, and Soul
  2. jadelpn

    Losing my religion

    Ah, the lively religious debate. As nurses, we all take care of a multitude of patients, all with specific, and sometimes not so specific, emotional/spiritual needs. And unless one works within a religious entity, here's my take on why a nurse's own religion needs to stay in the nurse's personal life. 1. Patients do not come to a facility seeking religious conversion. So a nurse should never take advantage of the fact that patients can be fragile, they may be in the bargaining portion of their grief process, and they do not give medals for saved souls. 2. Patients in general have their own set of religious values, beliefs, circumstances therefore, do not come into a facility to be converted into a nurse's own. If you are somehow "appalled" at someone's religious traditions, know your resources, and how to contact them to assist the patient. 3. If faced with a patient that is life or death, they have stressors that the nurse can empathize with, but we really have not a clue the unique circumstance that a patient is feeling. Act ethically as a nurse, not the time to push religious agendas. 4. We are required to meet the spiritual needs of a patient. Not ourselves. 5. Patient have the right to change their mind. When faced with a life and death there are and will be patients who decide to drop their religious restrictions. It is their right to do so. Please do not try and then convince them otherwise. 6. There are multitudes of people in the facility, the community, who know a heck of a lot more about one's particular religion than perhaps the nurse does. Use them. 7. It is interesting to know and understand someone else's religious beliefs. So take note for future reference. There are multitudes of religious and variations thereof in the world, so it can only help next time if a nurse has a general idea. 8. It is a huge grey area to participate in a religious act while someone's nurse. A nurse can pray for someone privately at home if you are so inclined. 9. There are certifications for nurses to become religiously affiliated should that be your forte. 10. Be respectful, but set limits to your participation, to your thought process in religion, and always have a plan "b". If you are not comfortable with providing certain care due to your own belief system, then what? Always have a plan of action if this is the case. Remember, you may have a patient who is not religious at all. That requires just as much respect and support as the devoutly religious. Compassion and empathy are not exclusive to any particular religion dogma, or no religion, nor will a nurse particularly "go to Hell" if they are providing ethical care to a patient. Patients have choices, and if a prudent nurse is acting in the best interest of what a patient wants for treatment at any particular point in time, all the better for it.
  3. jaelpn

    Forever Love

    The first time I met Bill, he was sitting straight up in his wheelchair. He was a tall lanky man, almost my height while sitting in his chair. Soft spoken, gentle to the touch; his brown eyes gleamed with a story of a hard-working life. He grew up in a small town, worked hard during the day on his farm. Raised two children with his loving wife and lost her years ago. "She was the love of my life- the woman that carried me through any hardships, who was there with me through all the joys, pains and laughter in life. I miss her the most when I close my eyes at night, because she is no longer laying next to me for me to talk to about the simple things of life." He would look at my face, look at my name tag, and say..."you share her name..." Often, I would be doing my hs med pass and come to his room. I would knock and say, "Bill, it's the nurse, may I come in?" "Oh yes...my dear. Please, come sit with me for a few minutes." He would light up in an instant. "Today wasn't a good day. My arthritis is acting up and I have been thinking about my wife." He often would tell me stories of their life together- young kids that barely knew what life was to bring, but knew their young love was meant to be. Back in those days, your first love, your one true love, was the one you married. "The first time I laid eyes on her, I knew she was a beauty. I couldn't take my eyes off of her, and when I held her hand and asked her if she wanted to share her life with me, I knew right then we had it made. Maybe I didn't have a whole 'lotta money back then, but she saw more richness in my love, anyway." I got married this past June- James and I met five years ago, and the first time I met his gaze with mine, I knew there was something there. I didn't have many boyfriends for being 24, didn't have a whole lot of trust in my heart for someone to once again "stop talking to me for no reason" ...but this was different. I still laugh at how my best friend since 6th grade got me to meet her cousin. She had us meet a week after my nursing school graduation- she just said, "at least meet him- if it doesn't go well, then I will stop trying to set you two up. Promise." He drove up in his silver oldsmobile, daunting a faded yellow college football shirt, jeans and a pair of beat up old shoes. He was nervous, I could tell. He sat next to me in a lawn chair and made small talk. He was curious, yet hesitant (I couldn't stop looking at you hun- your red hair and green eyes..." ) Love is something you can't guess at. You can't aim for the sky if you don't know where the stars are; much is the same about love. You know love is out there but you can't aim for it without knowing how or when or where it will be. Once you find that love, you can't let it go. After four and a half years together, on Christmas day, he got on one knee in front of his family, looked up into my eyes, and asked me if I would share the rest of my life with him. It felt like a million stars came bursting into my sky, and I said, "Yes, of course!" We walked down the aisle in June... a small, imperfect wedding, a lot of nervous laughter, our closest friends and family watching us as we gave our vows to each other. We promised to always be there to share life, through sickness and health... til death do we part. ...I'd like to think this is how Bill's life went. Through his wife's sickness and health, he stayed at her side. A few days ago, while resting in bed on a cool sunny day, overlooking the rose garden, Bill rested his eyes and passed away. I'd like to think that as I sat there and watched his eyes flutter, I was a part of a love story. My name was the same as his wife's... and as much as he missed his wife laying next to him every night, maybe it was only meant to be that I, only baring the love of his life's name... sat next to him as he went to meet her in Heaven. I hope that James and I get to build our lives together, and be able to tell a story as Bill and his wife Julie did. Love is forever... and this story will always, always be forever in my heart.
  4. jerolez

    How Far Can You Nurse?

    It was the first time for me to be far from my family. I decided to work as a nurse in the middle east since 2002. It was a new experience. Particularly in Riyadh where the center for muslim religion can be found. I was not the religious kind, but as I stay longer I fully understood the importance of faith and belief especially during time of despair when a person is about to meet his Creator. Hospital is not a nice place to die, well, considering that dying is not an event to look forward to, but, really the hospital is not the place. I nursed a patient who is fully aware of his disease - advanced stage colon carcinoma placed under palliative's care with 3 signatures for NO CODE. You see, the culture in the middle east is quite complex if I will pattern my practice from the place where I come from - Philippines. In the middle east, the family take a big consideration of the patient's feelings. The family would know the disease of the patient and the patient will be the last person to know, but with my patient's case, he firmly stood for his right to be informed. There were other complications involved as my patient is 95 years old with diabetes, colostomy, pressure sore on the sacral area, bedridden and skin and bone but because of his educational attainment as a lawyer who practiced outside middle east, it was easy for me to communicate. I had my last 3 day shifts with him that only with me he revealed he feels he is dying. He asked me if I could be a GINNIE granting him his last 3 wishes to enjoy life. I agreed telling only to the possible ways as I told him I am not a real GINNIE, then he would laugh out. Wish number 1 is to place the position of the bed towards the direction of the QIBLA - direction of the holy mosque since he is occupying the whole room as he is for contact isolation. Without hesitation I granted his wish. Then he said that will be for that day as he knows I am still having 2 more days for him. I didn't realize that he is already starting to recite the SHEHADA - a part of the Holy Quran consisting of a powerful prayer for the body to be cleansed as the spirit is preparing to leave earth. He became quiet. The family, ob visiting hours were worried that he does not have the appetite for his meals. The next morning, he greeted me with a smile although he is looking pale, I did not tell him so. I still want to make him feel confident like the old lawyer that he was. He told me his angel reminded him of his second wish. He asked me to tell the doctors to discontinue the medications as he knows there will be other patients that may benefit from the medications that will be issued to him, instead. Right in front of him I paged the physician and the physician knew why and second wish has been granted. He told me, tomorrow I should prepare for his full bath. Then I knew that his time will come. He was becoming restless that night as he knows the night shift will be giving him a bath. The night shift was so ashamed to hand him over to me as she could only change his diaper and the rest of the cleaning he said will be done on my shift. The whole shift, I was so patiently waiting for him to tell when I can start bathing him. He said, "I am waiting for my daughter who is coming from the eastern part. Of all the children that I have, she is the only one who cannot tolerate seeing me this way. I want you to wash me the best wash I could have so that when I die today, at least she will see me as handsome as I was. She will be with his MUTAWA (muslim priest) husband who will see me then will pray over my soul. Then you know that my time will come." It was almost 3pm when I finished bathing him with his wife. I never saw the wife crying at all. She was even telling jokes, which some I am not well versed of since they were in arabic, but the mere fact that the laughter was so loud, I just laughed along believing it was really that funny. He asked me to place him under a white sheet only. Few minutes after preparing him for his visitors, the call for prayer is announced. Then he started to gasp breath helping himself to wait until the daughter arrives. When his daughter came, my patient greeted her. Telling how he became happy for his last 3 days with me and how patient I was with all his wishes. I was asked to leave the room, then the MUTAWA started to pray over. The male relatives were all waiting outside the room. And when I heard the daughter's cry, I knew he already passed away. I have learned that it does not matter which part of the world we may be, death is a phase in life where we all need to be prepared of. It was a challenge on my part trying to understand and adopt on what my patient is trying to tell from the wishes he asked, If I have become the kind of nurse who will only think of what the doctor orders, what due medication is to be given and how long I can only stay with him to attend for my other patients, dying for this particular patient may not be as easy as it had been. I have to coordinate with my charge for a lighter load for my other patients as I relayed to my charge nurse his wishes that might consume considerate time for me to handle him. I knew I had done something great for him and his family.
  5. tnbutterfly - Mary

    When Nurses Cry

    Although it's been more than 30 years ago, I remember the occasion very clearly. My first death on Peds as the charge nurse. It was horrible. A four-month old with a congenital heart defect was to be discharged that afternoon. He was to go home and grow a bit more before undergoing a surgery that would correct his heart anomaly. I had just come from the room not 5 minutes earlier and the baby was laughing and playing on his father's lap. So cute..... The frantic father suddenly appeared in the hallway with the baby in his arms. He was no longer laughing but his little body was lifeless, his face very pale. We rushed him to the treatment room as the code was called and the baby's physician was notified. Any code is unpleasant, but a code blue on a Peds floor is a dreadful experience. The tiny treatment room was alive with a high level of anxiety and activity as the many responders crowded around the tiny pale body. Many were unsure of dosages for one so small, but were willing to help in what ever way they could. The baby's pediatrician arrived and took charge. Despite the long and valiant efforts of many, the baby did not survive. We were all exhausted......emotionally and physically. The family was devastated as was the entire medical team, tears streaming down the faces of many. There were so many tears. Even the pediatrician was crying. So very sad.......... The parents were holding onto one another, sobbing quietly, as the doctor and nurses tried to offer their support. In the face of such an overwhelming and painful crisis, nurses were able to make a difference that day as they provided tender and compassionate care to the mother, father, and extended family....through their tears. Because of the very nature of our work, nurses encounter many situations of grief, death, sorrow, and crisis. While we frequently witness others crying around us, we try to maintain a "level of professionalism", keeping our emotions in check, especially in front of the patient and/or the family, or other staff. Some people view a display of emotion as weakness, and will suppress their feelings, remaining controlled at all times. As a nurse, it is certainly necessary to control your emotions so you can handle a situation and provide safe and appropriate physical care for the patient. But periodically, not showing our emotions.....our humanness......is viewed as cold and unfeeling. In certain situations, expressing genuine emotion can be a sincere way to provide emotional support. Nurses work very closely with their patients, providing intimate care to the whole person on a daily basis. We see their struggles against their disease; we hear their cries of pain. As we share intimate and intense conversations with patients regarding their care as well as their fears and concerns, we get to know more about them as a person. Because we get to know them and their families so well, we end up caring for them. It is easy to become attached, even though we try to put up our professional boundaries. Patient suffering and death does affect us as nurses. How we respond is different for each of us. As nurses, we strive to provide compassionate care, sharing in the grief, loss, and fear experienced by patients and their families. We want to do more than just go through the motions, becoming numb to the pain of others. Seeing that doctor cry openly after the death of that infant so many years ago, made a profound impact on a very young nurse who was just embarking on her career. My level of respect for him as a doctor and a person grew. Since that time, I have seen many nurses and doctors shed tears in the presence of the patient and/or family. These days, I more often care for people on the other end of the life cycle. I am often called upon to stand alongside someone as they take their last breath. I still get tears in my eyes, but I don't even try to hide them. To read more articles, go to my AN blog: Body, Mind, and Soul Be the Nurse You Would Want as a Patient From the Other Side of the Bed Rails - When the Nurse Becomes the Patient when-nurses-cry.pdf
  6. tnbutterfly - Mary

    Intensive Prayer Unit

    Many patients find prayer to be very comforting and uplifting. Several hospitals, such as Johns Hopkins Hospital in Baltimore, utilize a program called Intensive Prayer Unit to help address one's spiritual needs. The program's goal is to provide prayer support, upon request, to patients and families who want to receive a spiritual expression of love and concern. This program provides a way of sharing the hope and strength that goes beyond our technical limitations. Volunteers from area churches commit to pray each day for specific patients who have requested prayer. Upon admission, patients are given an Intensive Prayer Unit information packet. If they desire to participate in the program, they complete the application form that asks for the patient's first name, a brief description of the patient, his or her medical situation, and what specific prayer requests may be in order. The completed form is directed to the Pastoral Care Department and then to a specific prayer-giver in a participating local congregation. The prayer-giver agrees to pray for the anonymous patient daily for 15 days. For many, prayer is communication to a higher power when all else seems powerless. Prayer can offer any of us hope and healing in the darkest times. Prayer helps us to reach out to something greater and wiser than our limited selves. The Intensive Prayer Unit is ecumenical and voluntary. It is not meant to take the place of a patient's church or family. Prayers for the patients and families are lifted up by strangers out of love and a genuine sense of faith in God's healing power. For more discussion about meeting the patient's spiritual needs, please read the following articles: The Nurse's Role in Providing Spiritual Care - Is It OK to Pray? What is Parish Nursing?
  7. Spirituality is a personal, abstract component in people's lives that can have different meanings based on different life experiences. One's own experiences help to shape what spirituality means to oneself. Spirituality can be a very personal subject, and I was very lucky that Leslie Lobel, a social worker at my place of work, shared her personal views on the subject with me. Although religion and spirituality are not the same, Leslie's view on spirituality reflects her own religious beliefs. Leslie defined spirituality as one's personal relationship with Christ, a "spiritual person walks with the Lord."Leslie is not only describing her personal definition of spirituality, but a religious belief as well. Leslie identifies herself as a spiritual Seventh Day Adventist, who has grown into her own spirituality as she has grown as a person. Leslie has always been on a quest for spirituality and had a love for "philosophical wonder." Leslie believes her spirituality matured when she was introduced to the faith. Leslie tries to live her life as a good person, and her spiritual growth increases on a daily basis. There are personal challenges working in the healthcare setting that test Leslie's spirituality. Part of Leslie's spiritual philosophy is that life is to be balanced and harmonious. Leslie explained, "as Eve was made from Adam's rib, and Adam was made by God in his image, everything was good and harmonious." "We are to live our lives that way," Leslie believes, "thy life is supposed to reflect the good of others." Caring for patients who lead their life differently is a personal challenge, as Leslie must put aside her own spiritual belief system. Literature Review Spiritual care and spirituality are concepts inseparable from nursing and healthcare (McSherry, Cash, & Ross, 2004). Many government documents mention spirituality and spiritual care as part of health care, but difficulties arise when establishing the exact meaning of what spiritual care is to each individual. An article, written by McSherry, Cash, and Ross (2004), sought to understand the definition of spirituality in regards to the four major world religions. The nurses who partook in McSherry, Cash, and Ross' study were able to define spirituality, keeping it separate from religion. However, the patients involved in this study were unable to come to a definition that would separate spirituality from religion (2004). When looking at the way spirituality was viewed by different groups of people, multiple variances arose. The span of answers led the researchers to conclude that it is impossible to define spirituality as it applies to all religious groups. The result from this study implies "that any attempt to define precisely what constitutes spirituality may be fraught with difficulty" (McSherry et al., 2004, p. 939). McSherry, Cash, and Ross concluded that, if an individual's spirituality is not addressed and taken into consideration, then the spiritual care being given by a caregiver may be broken (2004). The second article, written by Clarke (2009), sheds light on the lack of criticism within the sources used by nurses to define spirituality. The author mentions how several literature reviews have never been critiqued and that these reviews lack sources for definitions, which creates biased literature (Clarke, 2009). Also, Clarke's article critiques many definitions by labeling them as too broad or unable to be used in practice (2009). Many of the sources used in nursing literature to define spirituality come from many disciplines, not just from the nursing profession. Yet, the literature makes no mention of this variability (Clarke, 2009). Although most literature defines spirituality as being separate from religion, Clarke's article states that researchers should define both spirituality and religion, and then come to a conclusion on how to define spirituality separately from religion (Clarke, 2009). Psychosocial care is not the same as spiritual care, but due to the lack of exact definition of spiritual care, many nurses believe they are the same (Clarke, 2009). Clarke believes that using religious language terms such as "holy" will help to define spirituality; however, due to the forced separation of spirituality and religion, religious language cannot be used (Clarke, 2009). Difficulty arises when trying to define spirituality in the scholarly setting due to anxiety surrounding the topic and the inability to define spirituality as an exact science (Clarke, 2009). If the nursing field starts "accepting that a one size fits all model is inappropriate and by directing our attention to finding if there is a more practical and user friendly way to incorporate spirituality into practice," then we can explore a better spirituality model (Clarke, 2009, p. 1672). The third article written by Ronaldson et al. studied the influence of the work environment on nursing perspectives of spirituality and spiritual caring (2012). The authors assessed the spiritual practices of both acute care and palliative care nurses when caring for their patients. Each group of nurses had different factors to consider. The acute care nurses averaged ten years younger than the palliative care nurses. Moreover, the palliative care nurses had more time with their patients and support when performing spiritual care. The biggest barrier in preventing spiritual care in practice for both nursing populations was the lack of time when caring for patients. The palliative care nurses were found to have advanced spiritual care practice skills and an intensified personal spirituality, which contributed to the frequent practice of spiritual caring-an integral part of holistic nursing (Ronaldson et al., 2012). Patients who are ill with life threatening diseases may find comfort, control, meaning, and personal growth through spirituality (Van Leeuwen, Schep-Akkerman, & Van Laarhoven, 2013). A nurse must perform a spiritual assessment in order to tend to patients' spiritual needs. The nurse participants in this research study evaluated two spiritual assessment tools: the Spiritual Health Inventory and the Spiritual History. The Spiritual Health Inventory tool was found to be the most direct method, allowing the nurse to speak with patients' and more properly asses their spiritual needs (Van Leeuwen et al., 2013). All nurses should become accustomed with the concept of spirituality and the "implementation of spiritual assessment in daily nursing practice is urgently needed" (Van Leeuwen et al., 2013, p. 214). When taking care of a patient, one way to implement spiritual care is to use artistic creativity to create a relaxed emotional state in a patient, which helps the patient to heal. The change in attitude from stress to relaxation arouses the parasympathetic nervous system, alerts the autonomic nervous system, and can decrease a patient's pain perception (Lane, 2005). The Lane article gave a brief overview of the history of spirituality and creativity in healing, noting that this concept is not new. Nurses and hospitals which incorporate art when caring for patients (music, poetry, dance, writing, guided imagery and prayer) create opportunities for spirit-body healing experiences (Lane, 2005). The most widely studied art form in the hospital is music, which has been shown to decrease pain and anxiety (Lane, 2005). Lane's article also reflected on the healing effects of drawing, dance and writing in journals on patients in the hospital setting, and concluded that creativity and spirituality should be part of the healing modality (Lane, 2005). The nurse must implement creativity and spirituality, since "creativity and spirituality allow nurses to transform learning and change nursing care" (Lane, 2005, p. 125). Giving spirituality a distinct definition has proven to be a difficult task. Many researchers have unsuccessfully tried to define spirituality. Nursing, as a profession, agrees that spiritual care is important to healing, but being able to implement the current nursing literature on spirituality in the healthcare setting is virtually impossible. Much of the current nursing literature on spirituality lacks criticism, and the sources lack merit. The degree of spiritual care a patient receives in the hospital setting varies, dependent upon the nurse's own view of spirituality. Spirituality assessment tools should be used to close the gap in the variance of care. Art and creativity can help in the spiritual caring process, putting patients in a more relaxed state, helping them to heal holistically. Discussion To me, spirituality means to be at peace with the mind, body and spirit, and have serenity with my own feelings. This state of spiritual peacefulness is not one that we are born with, but one that evolves through time and different situations. I believe that the definition of spirituality is different on an individual basis because it is based upon one's personal view on caring. I tend to prioritize making myself happy. When I am stressed or do not feel good about a current situation, I am in a place of emotional turmoil, unable to heal, chaotic and in need spiritual comfort. The articles I have chosen were meant to create a caring, full-circle, spiritual experience. These articles included: the ability to define spirituality, the problems with current spiritual definitions and literature, how individual spiritual beliefs of nurses can effect spiritual caring, tools that can be used to assess a patient's spirituality, and how creativity can be used to help patients achieve a sense of spiritual peace and healing necessary for health. I agree that spirituality is not definable on a broad spectrum and that the literature surrounding spirituality in nursing needs to be carefully scrutinized prior to publishing to determine if it is based upon poor sources. I believe in holistic nursing, providing the best care to my patients and that spiritual assessment should be included upon the admission process to the hospital. I hope that more hospitals seek resources to help all nurses explore to define a personal spirituality, and and allow for an incorporation of the spiritual care of the patient as part of the hospitals caring modality. One aspect, not included in the articles I chose, was how nursing "burn out" effects spirituality. The article written by Ronaldson et al spoke about barriers to spiritual caring and never mentioned any spiritual fatigue. I think that a nurse who is unsupported in their spiritual caring can face a spiritual fatigue similar to caretaker fatigue. I am spiritual by trying to keep my emotions at peace at all times. I have come to the realization, that when I am emotionally and spiritually at peace, I treat others differently and become more intuitive to others' needs. I cannot control the emotions of others, but I can offer teaching tools for others to create emotional serenity in their life. Spirituality is a characteristic of being human that is shaped by one's personal experiences and surroundings. The articles used in my literature review have given me further insight into the difficulties and challenges surrounding the ability to define spirituality and partake in the spiritual caring of patients. I hope that the topic of spiritual care in nursing will progress forward and more resources will arise to make spiritual caring an integral part of the health care system. work-cited.txt
  8. Ahvegas

    I Am Not A Storyteller

    I am not a storyteller. I am not a person whose story needs to be heard. But I have met those whose story is worth telling. And so I will set forth to the best of my ability to share their story. It is not one person, not one story, but a story of many. It is a story of life, and death. A story of how we do not always choose our path, our fate, our death. But I have learned that we can alter all of these. We can choose to change the direction of our path, accept our fate, and choose how to die. And by doing so, gracing the world. Let me take a moment to say that I do believe in God. I am also a spiritual person. I believe that the energy we put into this world, somehow makes it back to us. Perhaps not in this lifetime, but sometimes, in another. I believe in a good God, I do not believe that my God makes bad things happen. I don't believe that God makes people sick, suffer, or inflict harm upon others. Bad things happen. God's presence in my life gets me though those times. That being said, I will share this story of grace, undeniable grace. A story of strength, love, happiness, sorrow, loss, and will. It is a story that will forever be a part of me, burnt into my memory, my soul, touching the deepest part of my visceral being, changing my actions from that point forward. Bringing me to tears with a thought, and also a smile that comes with those tears. There are no words to give this human experience the spiritual essence it was. I will try to be a storyteller. I knew a girl; she was to me, simply put, a smile. A big beautiful, smile. She lived with ease, and made a room glow. I didn't meet her in perfect circumstances. In fact, I met her in the worst of circumstances. She had a diagnosis of relapsed cancer. But, still, she smiled. Through every horrible, miserable step, she smiled. Her mother was there; ever present, and they had a connection that was palpable. Having been thru a previous diagnosis and treatment, this was not a road they were ready to embark upon. But yet, there she was. In my hospital, smiling. Things went well, and bad. Things were better, then worse. Staff and this girl connected. She wasn't a chatty girl, but when she spoke, there was a purpose. And I just wanted to be a part of it, of her, because I could not get her smile out of me. Time passed and cancer decided to fight hard. But, this girl, this mother, they embraced each other, they prayed, and they made decisions that I can not begin to imagine. You know, the questions of more treatment vs no treatment. Palliative treatment vs experimental treatment. And then the proverbial elephant in the room presented itself, only no one knew about this elephant. The girl with the smile, her mom was pregnant. How does a mother have these discussions with her girl with a smile? How does she hold her belly and feel that life inside her, while having those discussions about treatment? She did, they did. Oh, they did. And the bond grew, you could feel it. They made choices, difficult choices, as a team. The three of them, the mom, the baby yet to be, and the girl with a smile. They decided to go for it. Get the experimental treatment, just go for it. There was a baby coming, and the girl with a smile wanted oh so much to meet that baby. I wanted her to see that baby. We all wanted her to see that baby. So, away they flew, the mom, the baby yet to be, the girl with a smile, and the unwanted passenger: cancer. Life can be mean, and cancer can be brutal. It steals, and robs, and it slowly tortures. Cancer destroys. It rips and tears, and sometimes doesn't give up, until, well, until it wins. And so this story goes, the mom, the baby yet to be, the girl with a smile, and cancer, they all flew back home. I can't tell you how they felt, I can tell you they clung to one another. But still, she smiled. Now, new discussions needed to occur. Tears were shed, and lines were drawn. Clear, clear lines were drawn. This girl with a smile, she was going to see the baby yet to be. There were no papers to be signed, they decided those decisions were going to wait, no; this baby was going to meet the girl with a smile. We were all in for this fight. We were praying, we were helping to comfort, and we were loving. Me, I was angry, personally, very angry, I hate cancer. I wanted the baby that was yet to be, to get here, so the girl with a smile could know it, so it could know her. But who am I? Certainly not anyone who is worthy of telling this story, still, here I am. Now, like then, I was trying to make sense of this reality. I am a nurse, just a nurse. I have no great gift. I give medicine, hold hands, wipe tears and pray. I have witnessed life winning, and loosing. All my years have taught me that I do no have answers. I do not dictate the plan. That, I have learned, is between people and their God. I simply help them see those plans thru. I personally believe in a time, a time between life and death. Most people never get to witness this moment. It is a moment with clarity. A clarity you can see, feel, and touch in space, it is a physical moment. This is the moment when a dying person decides. They decide to live, or to die. Some, like our girl with a smile, choose. She chose to take action. The spiritual me, I believe that she and the baby yet to be made their own plan, with the help of God. You see, the girl with a smile was tired, so very tired. And yet, she wanted to meet the baby yet to be. So, in a moment, a plan was formulated, a spiritual plan...but those are the best kind really, are they not? And there we all were, fools, thinking we were in charge; doctors, nurses, social workers, housekeeping, child life, all of us. Fools. Like we knew what was really going on. Stupid, stupid people we were. You see, this girl with a smile and the baby yet to be, they were in charge, they knew. And so it went on that magical, life changing, devastating day. The baby made its presence known, it wanted to come into the world, wanted to see the girl with a smile. Tired, the baby knew she was tired, and it wanted to hurry up and meet her. Mommy hadn't planned on this, you see, she was suppose to meet the baby yet to be in another hospital. She thought she needed to leave the girl with a smile to go have the baby. No, my head screamed no! I knew if that energy was not around the girl with a smile, she would slip away. So again, very quickly, decisions were made. And the mommy and the baby yet to left her side, but at the same hospital as the girl with a smile. And I told her. I held her hand and told her they were right downstairs. And when that baby came we were going to go see them, she was going to meet the baby yet to be. That became my purpose...but again, I am a fool. Decisions were made, the mommy called the girl with a smile and they spoke, mommy was signing the papers, the Do Not Resuscitate papers, it was going to happen. Because mommy did not want to see her first baby, the girl with a smile, on machines. They had talked about this many, many times, and it was what they wanted. "ok mommy", said the girl with a smile, she was present, she knew it would be soon, she knew she just had to hold on for a while longer, and she would see her mom and meet the baby that was yet to be. Quietly, inside, I fell apart. And the plan continued, with the grace of God and the administration of a very humble children's hospital. Sometimes things are bigger than us, and universally, much more important. And somehow, this magic the girl with a smile and the baby yet to be had, well, this magic spread like a fire. It touched people who had never met them or never even heard their story. And thru God, people made more decisions, administrators made calls, they made the extraordinary happen. Some things are more important than us. The phone rang, mommy told the girl with a smile the baby was here, and he wanted to meet her. Everyone cried. Just a while longer. Then, something wonderful happened. The door opened and in came the mom, her entire post-surgical team, her anthologist, the baby and his nurse into the room of the girl with a smile. There were more tears. Tears of joy, of sadness, and of deep, deep pain. I have done this before, I have helped children die. I have held their hands, and the hands of the families. But, I have never stood in the presence of God. And yet, there I was. I could feel him. He was there. Two hospital beds locked together, two bodies intertwined, tears, and a baby in between them. An image I will never, ever forget; not in the deepest part of my being. A mother, a baby, the girl with a smile, cancer, and God. And that mother, she was the unsung hero. She held her babies, and cried, and prayed. We spoke of miracles and memories. She held her newest baby and fed him. And then, she gently handed him to his father, and she was present, she was her mommy, and the girl with a smile knew. She felt it. She was a big sister, and she was a daughter, and she was a part of a miracle. She made that happen. Her spirit, her presence, her being, her smile. She touched people. She touched me. She helped me feel my God in a way I never had. She saw her plan thru, her and her conniving partner, baby yet to be, who, all of a sudden, was. I saw a miracle. And I will allow that miracle, her, to live on thru me; my actions, and my belief that there is a God. I will be forever grateful, for she choose me, and my tiny humble hospital to touch lives. She lived about 7 hours after the baby was born. She waited for everyone to be there. It was her moment, her plan. She waited for everyone, and that is one of the last things her mother said to me, "this is all she ever wanted...for everybody to get along". Families are strife with difficulties, but let a baby and a girl with a smile set the plan, and you begin to realize how insignificant those difficulties, and you, actually are. Some thing's are more important than us. And there I was. I was humbled, I was numb. I prayed, held hands, and wiped tears yet again. It was time for me to say goodbye. I told her she had done it, she was a part of a miracle. She touched people. She met her brother, she brought family together, and it was ok to be tired. And I loved her. And I would never be the same. I am not a storyteller. This is not my story. This story belongs to a girl with a smile and a baby. I am not a storyteller, but, it is a story worth sharing, is it not?
  9. I walked onto the floor of the Oncology unit ready to start my day. It was a busy teaching facility but I had been there long enough to be comfortable in my RN role and not much surprised me anymore. It was a typical bedside RN position, little time for actually "caring" for a patient or family, just performing the usual tasks and routines. In addition to Oncology patients we also received overflow from other units including trauma patients awaiting transfer to long term care facilities. As I got report from the night shift nurse on one particular patient I immediately thought oh no, I am not going to have time for this today. Johnny was a young man who had been in a car accident and was now brain dead. He was waiting for transfer to a long term care facility. I knew there would be family issues to deal with and sure enough I was right. I walked into the patient's room and was immediately met by the patient's Dad with a barrage of questions regarding the (perceived) lack of care and his list of demands. I did my best to explain the situation to Dad but it only made him more upset. I did my work and escaped as fast as I could. Over the next few days Dad opened up to me explaining that he felt guilty about his son because he had provided the car that his son was driving. No matter what I said to him he never wavered in his guilt. I came back to work after a few days off to again have Johnny as my patient. Dad opened up to me further explaining that he (also) felt guilty because he is a Christian and didn't feel that he had done enough to assure that his son was also a believer and had accepted Christ as his Savior, and now that he is brain dead he is unable. I was uncomfortable (even though I am also a Christian) and turned toward the door (to again escape) but felt called back, I realized how important this was to Dad (and Johnny) and had no choice but to stop and talk with him. We talked for a few minutes and I explained that (as a Christian) I believe since God has made us in His image we are comprised of body, soul, and spirit. And, since Johnny's physical body was alive that means his spirit is also, and that just because our medical technology says that Johnny is brain dead that doesn't mean that God cannot speak to and hear him. We talked a little more and eventually held hands and prayed over this young man asking God to converse with Johnny and give him the opportunity to accept Jesus as his Savior. I could feel the Spirit in that moment, and could see the wave of relief come over Dad knowing that his son was given the opportunity for salvation. We are all taught in nursing school how to provide spiritual care (appropriate to each individual patient of course); unfortunately, because of the workload this is rarely possible. We are all human beings (body, soul, spirit) and therefore we should do what we can to provide spiritual care to all people as such. I know that there is very little time during a busy day for spiritual care; but what each of us can remember is that even 10 seconds can make a huge difference in someone's life. It only takes 10 seconds to show kindness to others, a brief word or smile can do wonders and sometimes can be life changing. I had to overcome my own insecurities and also take time (that I didn't have) to provide spiritual care, but felt better after doing so. So what is the point? Realize that all human beings are comprised of body, soul, and spirit; therefore, we should care for ourselves in all three areas so we are empowered to care for others in the same way. We really do reap what we sow and taking care of other's souls (mind/emotions) will, in the process, take care of our own souls as well, (thus providing us with the byproduct of happiness). I know that nurses are extremely busy, but if we keep ourselves open to when the spirit calls. and fight that urge to escape, both patient and nurse will benefit greatly. I know many of you have similar anecdotes to share. If you don't that is alright, it is never too late to start your story now, you will have opportunities. Let's vow to make 2017 the year that we be kind to others and provide spiritual care as we are able, not just to our patients but all people we interact with. Want to be happy...apply the 10 second rule as much as possible
  10. "Please pray with me," my patient pleaded as I gathered up my bag and prepared to leave our admission visit. The social worker and the patient's caregiver had already stepped outside and were talking on the porch landing. I looked at my patient whose eyes betrayed fear over what was to come after being diagnosed with an inoperable and widely metastatic cancer just a few days before. Still relatively young in his late 50's, he could see and feel that he did not have long to live. I put my things down and sat beside his bed in the chair I had occupied for the previous two hours while the hospice social worker and I went through the admission process with him. He offered his hand and I held it, praying a simple prayer for comfort and peace. As professionals, we are called to provide care for the body, the mind and the spirit. It is not often that we are asked to do something as overt as praying with a patient-but it does happen. How we feel about this can vary widely depending on our own faith walk and what we think about sharing that with others. Admittedly, in this particular situation, we had two hours of talking, listening, getting to know this gentleman; we knew where he was coming from. There were religious symbols in the house and he verbally confirmed his particular faith during our assessment. Hospice may be singular in the nursing realm in that spiritual care is an expectation, an active part of what we do. But in all fields-everything from office nursing to ICU to surgery-we meet our patients in times of crisis and fear. Spiritual comfort, when requested, can be a very helpful part of excellent nursing care. In practical terms, however, the very thought of praying with someone may send shivers of unease and discomfort down the staunchest nurse's spine. What if they are Christian and we are not? Or Muslim, or Jewish or Hindu, or Buddhist, or Agnostic? How does all that work and how do we help without hurting? There are no easy answers to this question but let's explore together some ways we can prepare to offer spiritual care if requested. Listen first People will very often answer frankly and let you know what would be helpful. Ask a question, "How would you like me to pray?" or "What do you want me to pray for?"Sometimes just holding their hand and having a moment of silence can bridge the space between us and our patients, helping them to know that we are on their side and will help however we can. Plan ahead for how to respond If you are uncomfortable with any type of faith discussion, it is important to still allow the patient to feel validated. If you are unable to pray or provide the comfort they seek, have a Plan B ready. Tell them, "I know that this is a difficult time. Let me call the chaplain to talk with you about this. Thank you for sharing with me." Thanking them for sharing helps them not feel embarrassed for asking and lets them know it's ok. In planning ahead, we might also consider using some more universal prayers, things like "The Serenity Prayer" or a beautiful poem that speaks to us or the 23rd Psalm if the patient is Jewish or Christian. Be respectful While providing nursing care, part of our professional duty is to give spiritual care-according to the patient's needs and beliefs, not our own. So this would not be the time to proselytize but instead, to respond according to the faith journey that the patient has expressed, letting them guide the conversation. If we believe firmly in our particular faith (and to be a good practitioners of our faith then we surely must!), it can be hard to simply accompany the faith journey without interjecting our own beliefs, but this is one of the ways we show care and compassion in providing spiritual care. We can remain true to ourselves and at the same time be true to our charge as excellent professionals who seek to offer healing to the whole patient: mind, body, and spirit. Use the gift of presence and touch as part of the whole approach We have all known the patient who "lays on the call bell" or calls the office every day or has 101 complaints when they talk with us. While frustration can be our knee-jerk reaction, our professionalism calls us to look deeper, to move beyond the surface complaints and to listen with the ears of the spirit, asking ourselves, "So what is really going on here? Is there something I'm missing?" Loneliness, fear, pain are all aggravated by and expressed in illness. As nurses, we cannot underestimate the power of the gentle touch on the shoulder, the eye contact, the active listening that says, "I truly hear what you are saying," or the simple, "I'm sorry you are going through this." After our prayer, I reviewed our plan for a return visit and reminded my patient of our plan of care and asked him to call with any questions or concerns, hoping in this way to give him tools to manage his anxiety. Then I told him, "We will walk this journey with you." Those words seemed to help and I saw his shoulders relax against the pillow, the tension easing for the moment. You may have experiences with being asked to provide spiritual care. How did you feel about it? What did you do? Do you have any tips that might help other nurses in the same position?
  11. jadelpn

    Death Is A Journey

    It is always a good thought when one decides they would like to die at home. Surrounded by loved ones, in their own beds. But as the time grows near, many decide that they would rather be in a hospital room, surrounded by loved ones, with a nurse who gives the medical care so that the patient and the family can connect, remember, and say all of those things that they ever wanted to say in a focused way. The job of the nurse needs to be non-obtrusive, but consistent. Which is not always an easy task. Often, nurses are the "control" in what is otherwise a non-controlled situation. Communication is essential, as family reacts better when they can help make decisions (if you think that your mother is uncomfortable, please ring for me, otherwise I will be back in a half hour). There are patients who react poorly to pain medication, as if they are a "type A" in control person, the feeling of being on a "trip" is something that they don't like, and will often fight. So go easy. It is a well choreographed ballet of pain control and functional level until the patient is able to learn to go with it, and fall into the ebb and flow of comfort and peace. I always remind myself of a little rhyme my grandmother used to say "Very softly I will walk, very softly I will talk". The nurse is the leader in the atmosphere in the room. Patients are really very vulnerable when death is staring down at them. But some of the things that they will say to you is so profound, rich with life lessons, that it can be the most rewarding time for them, and for you. It is so important for a family to say that it is OK for someone to let go. Which is a heart wrenching process, but never the less an important one. The ultimate goal is peaceful. As pain free as possible. With people talking and singing and guiding or silence and praying and the sunlight streaming in. Really listen, and you can hear a brilliant mind at work. Some patients will give you every bit of advice that you would ever want, what you should be cooking for dinner, get your haircut honey to you need to be married and have kids. Other patients will reminise about the time in their lives they were young and fun and full of life. Still others will tell you that their loved ones who have passed are just right there waiting for them, and take their last breath. In the end doens't matter if as a nurse, you are religious, non-religious, spiritual or non-spiritual. You will, however, feel like you have taken a surreal journey. What matters is that the patient experiences peace, and is able to die in the way they would like to, whenever humanly possible, and as nurses, it may come a time that you can make that happen for someone. They say that life is a journey. I would add that so is death. You begin to face things that you never may have thought possible. It is a journey of the spirit, if not a spiritual journey.
  12. As nurses, we wear many hats. To name a few: we are caregivers, providers, assessors, comforters, encouragers, teachers, an ear to listen. Are we to be evangelists or preachers? In my opinion, no and....yes. I believe that it is appropriate to share my faith when the patient has already started the conversation and I am adding to it. Here are a few stories to make my point. It was 6:40 pm. Twenty minutes left until shift change. (At last!) Of course, this is when my new admit wheels down the hall. I knew she was coming so I was able to finish my other duties and check on other patients before she arrived. I greeted the patient with a smile and introduced myself. She said hi and smiled back. She said "You're a Christian aren't you?" She saw the look on my face that said "Wow, how did you know?" She then smiled again and said. "I can tell by your smile, you have a glow of happiness. You must know the Lord." She was a very spiritual lady. She was there for 24 hour cardiac observation. We talked and shared our love for the Lord for a few minutes while I checked her vitals and got her settled in her room. We prayed for her situation. She also prayed for me and then I said thank you and goodbye. I went on to shift change report. We both left that situation blessed and at peace. One more. Some time ago I worked in a surgery center preparing patients for surgery. A patient walked in to my area and sat in the chair. My job was to screen the patient and start an IV. We hit it off from the get go. We learned quickly that we were both Christians. (You know, the smile/glow thing?) I only had one arm available to start an IV due to health issues with the other arm. She also said that she was a hard stick and from her body language she didn't like needles. I tried once but wasn't successful. She asked if anesthesia could start the IV. I let the doctor know and went on to my next patient. She was a very difficult stick, small veins that blew easily. The doctor and a few other nurses tried with no success. I was busy with my new patient but would look over to her wishing I could hold her hand while they tried to start her IV. When I finished with my patient, I had a moment to go talk with her. She was almost in tears. She really didn't like IVs but could not have surgery without it. Surgery was needed. The doctor did not want to postpone the surgery if possible. When I went to the patient I saw one vein on her hand that was like a neon saying "pick me! pick me! I'm the one!" I asked the patient and anesthesia if they minded if I tried "one more time". The patient said ok. I didn't want to use a tourniquet. I will have the patient hang their hand over the chair. "gravity is my friend" I always say with hard stick IVs. When I hang their hand over the arm of the chair, I need to be lower. I will put the stool low or sit on my knees. I was on my knees and the patient grabbed my hand and started praying. (She read my mind, I wanted to pray too.) We both prayed, quietly, only loud enough that we could hear each other. I prayed that God would use this situation for His glory. That it would be a witness to others in the room that God can do anything. Even something as easy as calming a patient and getting a good IV. After we finished praying I was about to start the IV. I started praying again while I was starting the IV. I instantly felt her body and hand relax. I got it! She was so happy. She gave me a big hug and a peck on the cheek. I found out later on that at her post op visit she described the whole story to the staff at the doctor's office. She couldn't remember my name but I was "the little angel who started her IV". Times like these stories, this is when I believe it is appropriate to share. When the patient starts the dialogue. If it is started by the nurse and the patient is not a believer I think it can come across as unwelcomed. We as Christians are to go about the world spreading the good news. But I believe this should be done on our own time, not our employers. What about you? Do you like to share with your patients? Any thoughts?
  13. mln48

    Seeing is Believing

    John and Mary, both eighty-five years of age, had been married for sixty-five years. Folks said they were like two peas in a pod. They never had the good fortune to be parents, but they were devoted to each other. They often said they had never had a crossword. One summer evening while coming in from the garden, Mary fell. She was taken by ambulance to the local hospital. In the emergency room, she was seen by Dr. Henry, our small town's only surgeon. He explained to John and Mary that a broken hip was the result of her fall. Dr. Henry explained that the fracture was in the neck of the left femur. He said surgery was needed to repair the fracture with a pin. John and Mary discussed the options that evening. John was fearful that Mary would not survive surgery because of her age. They were aware of the risks of anesthesia. John expressed his concerns to Dr. Henry. Although Dr. Henry understood their fears, he said Mary would probably not be able to walk again without the operation. Reluctantly Mary signed the consent form for surgery. The operation was scheduled for the next morning. The couple was praying together when John thought of praying for healing. He had never prayed to be healed before. There never had been a need. He was advised by a friend from church to lay his hands on Mary's hip while he prayed. John proceeded to pray with his hands on Mary's hip. He asked God to heal Mary. He sat by her hospital bed and prayed continuously all night. While Mary slept he prayed. He said later that her hip area underneath his hands felt warm to his touch. He was an old man and, though he didn't complain, his back hurt and his joints were stiff and he was very tired. Still, he prayed for his Mary. He couldn't help but think what his life would be like without her. He prayed harder. He prayed longer. Toward dawn, Mary awoke to warmth in her left foot. She later said it felt like it was inside her foot. The warmth moved to her leg and felt even warmer. It continued to travel up her leg until it stopped at her broken hip. It stayed there and felt almost hot. John's hands were still on her hip and he was still praying. Mary knew when it was accomplished. She told Dr. Henry when he came in to visit her before the surgery. She told him she had been healed. He was skeptical, but she refused to go to surgery without another x-ray. Dr. Henry told me later that he ordered another x-ray,"just to humor her." It showed a healed fracture. He said,"I wouldn't have believed it, if I hadn't seen it with my own eyes." He was holding two films; the one from the day before which showed a fracture of the neck of the femur and this day's film which showed a healed fracture. Mary walked out of that hospital with her beloved.
  14. jenakjar

    I Owe It To My Dad

    I remember the day it all started. It was a simple index card with steps carefully written by my mother. Chronological ordered words instructed my 79-year old father on how to start his car and put it into drive. Those simple routine steps were fading away in his mind. For over 35 years, he had hopped in his car, 6 days a week, to drive to his small retail men's clothing store for business. Once known names were slowly disappearing. Newly acquired memories were gone almost as quickly as they were experienced. I questioned the safety of my father driving to work when he needed written instructions to turn over the engine and put it into gear, but he was not willing to relinquish his keys or his freedom just yet. However, soon thereafter, my dad became very ill with intractable diarrhea. He quickly became confused and unable to function in his weakened dehydrated state. His attempt to leave the house for work ended up with a trip to the emergency department. The following days were a chaotic blur of into the emergency department, back home, back to the emergency department, diagnosis of clostridium difficile, a cholecystectomy, saddle pulmonary embolism, and ulcerative colitis. Finally, he was admitted to the hospital with a team of physicians frantically attempting to balance his precarious state of bleeding and clotting. I spent my days communicating with the clinicians about his bleeding bowel and his dropping hematocrit. I was, at that time, a weekend quarterback of nursing of sorts. I had always loved medicine but I had never pursued it educationally. Now, I was the designated medical intermediary for my father. A colonoscopy would confirm an advanced state of ulcerative colitis with purulent and necrotic tissues in need of emergency excision. Post-operatively, an ileostomy saved my father's life. As he hovered in and out of consciousness on a ventilator, I hovered up and down the hospital halls praying for his life to be extended. In those dark, bleak hours and days and weeks that followed, I grappled with the meaning not only of my father's life but the purpose of my own. As a divorced mother of a small child, I lived with my parents and became the caregiver, along with my mother, to my father. Nursing him back to health drew me further into the path I would follow going forward. Several years later I graduated in nursing and became a registered nurse. My love for my dad certainly influenced my decision to change my course in life towards nursing. Nursing was an extension from my home into the workplace. The twelve years I was blessed to care for my dad and his many varied physiological challenges were the richest nursing experiences I ever had. Whether it was caring for his ileostomy, healing a wound, stabilizing him after an epileptic episode, or reminding him at 3:00 a.m. it was not time to go to Burger King, it formed my soul as a nurse. I would never see the world the same again. I served as a hospice nurse for several years but in the final months, days, and weaning hours of my father's life, any preconceived notions I had about nursing and life were radically transformed. All the studying, all the early morning clinical rotations, all the late nights, and all the migraines came together in that moment. I sat next to him those final 48 hours as his life, as he wavered between this world and the next. I held his hand, I washed his feet, and I wiped his brow. I administered palliative medications to soothe his breathing and his terminal agitation. I cared for him as a nurse; I spoke to him and I loved him as a daughter and as a best friend. His final breath forever altered who I was as a person and as a nurse. I would never see another patient simply as a patient, but as a friend, as a person loved by so many. Nursing has taught me so many life lessons, but the greatest lesson of all, compassion, I owe it to my Dad.
  15. tnbutterfly - Mary

    Nurses Coping with Personal Grief

    How many of you have felt helpless or guilty when caring for a seriously ill or dying patient? How many become overwhelmed with emotion after a particularly "bad death", or the death of a patient you have allowed yourself to become attached to? What should nurses do to avoid the pain that such circumstances often cause? Or are there appropriate ways to deal with these feelings? Too often we think we are to be "pillars of strength" in times of crisis or death. While we provide supportive care to patients and families, we fail to recognize our personal need to process loss. We fail to see our need to grieve. In order to offer compassionate care for the critically sick and for the dying, as nurses we must be able give of ourselves without being destroyed in the process. For self preservation, we may resort to ineffective coping mechanisms such as withdrawal, psychological numbing, and avoidance of personal involvement with patients. Failure to work through the grieving process leads to potential burnout. As nurses, we strive to provide compassionate care, sharing in the grief, loss, and fear experienced by dying patients and their families. We want to do more than just go through the motions, becoming numb to the pain of others. What are some of the ways you have found to cope with the repetitive emotional strain that you face on a daily basis as you care for people in physical, emotional, and spiritual pain? It is important that we see ourselves as humans and recognize the emotional reactions that traumatic events evoke in us. Acknowledgment of our vulnerability to tragedy is a fundamental factor in the way each of us handles the senseless losses we are faced with every day in our professional lives. Feel free to share your stories of situations that have been particularly difficult for you to deal with. We can learn from each other.
  16. jeastridge

    Running on Empty

    "Come to me, all you who are weary and burdened, and I will give you rest." Matthew 11:28 Tears spilled over as I clicked off my cell phone and started the car, instructing my GPS to take me to my next hospice visit thirty miles away. The tears were not, as you might suppose, out of sadness for the dying patient that I was headed to see; they were instead tears of fatigue and self-pity, of overwork and of frustration. As I drove, I struggled to re-direct my emotions and to achieve control over all these unwanted feelings that seemed to bubble up from murky depths of discouragement. Deep breaths, calming thoughts, a focus on the particular patient that I was about to see, and a silent prayer, all helped me gather myself to continue to offer the best possible care when I arrived at the home. Being a professional nurse of many years, I know the signs of compassion fatigue or just fatigue in general. But life is not an idealized parade of lovely patients in an orderly pattern, nicely separated by re-energizing breaks where well-balanced meals suddenly appear, consumed while a favorite selection of music plays in the background. Real life as a nurse looks more like concentrated discipline to stay focused on the needs of the patient, while dismissing or delaying the cacophony of missed messages, equipment failures, scheduling snafus, and documentation demands. With time and experience, we all learn to prioritize and master the art of offering ourselves without becoming completely depleted--that is, unless you look at days like the one I refer to above. If we are to be honest, we all have days like that one: days where we overextend ourselves physically, emotionally and spiritually; days where we give until we are running on empty. Are you a person that fills up your car's gas tank when it gets half way to empty? Do you wait until the light comes on? Or are you the person who waits until the car sputters a bit before coasting in to the nearest station? As nurses who are also spiritual beings, sometimes we expect to keep running on fumes. We don't take the time we need to in order to fill our spiritual tanks. Instead, we survive on "fast food" of the spirit. I work as both a Hospice Nurse and as a Parish Nurse. I am usually asked to help with the orientation sessions for the new Parish Nurses. My topic is usually, "Time Management." One of the things I tell the new Parish Nurses is: "Minister out of the overflow." Use your imagination to picture a cup, a chalice. Now pour water into that cup until it runs over, like a fountain. As long as our nursing and care for others comes out of the overflow of our hearts, then we will not run dry. We will continue to be able to give and meet others' needs. But when we stop the in-coming nurture of our own souls and bodies, and begin, instead to dip into the cup itself, then we quickly find ourselves in tears as we ride down the road or the elevator, ready to step out to another shift. If we keep our lives in balance, then we can be those excellent nurses that we so long to be. It is our work to overcome cynicism, doubt, frustration and to journey on as advocates, compassionate healers who reach forward through the maze of computerized care to see the patient and meet them where they are. We move beyond the chores to the connections, to the real and therapeutic touch. And we don't give up because it is so hard. Let me tell you something: nursing has always been hard and it always will be. We find reasons to complain--we are human, after all--but truly, we have more technology, more ability to relieve pain and suffering, more treatments and more understanding than ever before. Let's do ourselves and our profession a service by focusing less on what is wrong, and instead maximizing what is good. Mother Teresa once said, "If you can't feed a hundred, just feed one." The idea that we may not be able to do everything for everybody assaults us daily. But we can make one person's day better. One patient. One co-worker. One environmental services person. Just one. Being competent and compassionate nurses stems from a balanced life, one that focuses on mind, soul, body--or said another way: if we focus on spiritual nourishment and self-care then our words and deeds will be those of a nurse who is both competent and compassionate. Self-care is not a self-centered, self-absorbed state of mind. It is not the mentality of "I work hard, so I deserve what I take for myself." Instead, it is maintaining a rhythm of giving from the spirit and receiving into the spirit. It is nurturing our whole selves so that we can continue to give. George Saunders, a contemporary fiction writer, writes, "What I regret most in my life are failures of kindness. Those moments when another human being was there, in front of me, suffering, and I responded...sensibly. Reservedly. Mildly. Err in the direction of kindness. Do those things that incline you toward the big questions, and avoid the things that would reduce you and make you trivial. That luminous part of you that exists beyond personality--your soul, if you will--is as bright and shining as any that has ever been." Let us remember that between the twin hills of competency and compassion lies the mountaintop of the true art of nursing. It is a place we all long to do more than just visit. We desire to live there, day in and day out, creating art through our work and making a difference one person at a time. Joy Eastridge, RN, BSN, CHPN May 13, 2015
  17. As I continue to grow and find my way in this ever-so-changing world, I finally realize how important my upbringing was in building my core beliefs, morals, and values that will remain with me wherever I go and help guide me to healthier decisions not only for myself, but for my patients. Spirituality is a concept that has resonated with me throughout my life. To me, spirituality is about love and relationships whether it is the one you have with yourself or the ones you develop with family, friends, co-workers and your patients. It is one word that mirrors my personal and professional goal in life; being a driven person living in the present moment always opened to new ways to enhance my personal well-being and growth. My personal journey of self-discovery has made me understand who I am and who I wanted to become. I will identify some components of my family history which may explain why we act the way we do and how spirituality has a fundamental relationship to nursing. Understanding as well as contributing to the structure of my family is something of personal importance to me. Knowing the reasons behind my family structure or family dynamic is crucial when trying to decide how to contribute to it. I believe everyone needs to have a voice in a family, and this is why I am so lucky and proud to be in my family. We do not judge and we always hear the other person, regardless if we disagree. We are a Catholic family of an Italian descent; however we do not attend Church regularly. We are not so much religious, though we are spiritual and still believe in Jesus, have faith, and pray to God in our own ways. My mother always was and still is the backbone of our family, whose presence was never debatable. My mother's advice is priceless because she always allows her heart to guide, which enabled us to learn about our true selves and listen to our intuition. We all know the heart is the most vital organ in the body; but it is also so much more than that. Our heart is the soul of our emotional and spiritual existence. As nurses, we need to have an endless amount of compassion. Compassion for human life is unlike any other dimension. We have the capacity of becoming a hero in the eyes of our patients. If that is not the most rewarding feeling and achievement then I am sure to say that nursing is not for everyone. It takes a fine, rare breed to be a nurse. Praising every single nurse in one way or another during my day has become not only routine, but something I take pride in doing. I will always cherish the quality of independence that my mother instilled upon me at a young age. It is those little things that actually end up being so powerful later on in life. This has done wonders for paving the way upon entering the nursing field. I am open-minded, approachable, passionate and able to think effectively under pressure-all thanks to my mother. My family is a very verbal group of people who always share what we feel and rarely bottle up emotions. I never had to lie to my parents because I always felt I could go to them with whatever problem I had without the fear of rejection or disappointment. This is the exact way I want my patients to feel around me. One phrase that expresses the type of family we are is "what you see is what you get." Honesty was always a fundamental feature in our family. What I especially love and respect about my parents' home, is that there's never a time when it feels cold and disinviting. The household I grew up in had a very warm, genuine, and inviting presence to it. With that being said, I want to make it clear that my family is nowhere near perfect-we can be very loud at times (which is not for everyone), but our Italian heritage mixed with the personalities of my family members blessed us with a tremendous, even overwhelming amount of passion for life and compassion for people-owing to our very big hearts. Through constant contact, guidance, and constructive criticism from family members, my family figured out its own way on how to make togetherness work. It also allowed us to function as a team so that we were able to offer one another as much stability and harmony that we were capable of in a very organic way. This is something that I want to bring to my nursing career; making togetherness work is essentially teamwork. Teamwork is so important in a nursing milieu. It is intriguing to know that the standards we practice were related to and adopted by our ancestors. Sunday dinner starting no later than 2pm is a tradition that has been passed down. We usually get together with my mother's side of the family for holidays. However, March 18, 2005 marked a very tragic family event. My aunt Donna, my mother's only sister, died of Breast Cancer at 51 years old. She battled the disease for many years but then was in remission. When the cancer insidiously returned, it not only was in her breast, but rather had spread to her brain and many other organs. This continues to be a very heartbreaking loss our family encountered; no more Aunt Donna, no celebrating the holidays with her, and no time to catch our breath. Three months to the date, June 18, 2005, my very clever, wise, and exceptionally warm-hearted grandfather had passed away unexpectedly. He was driving to New Jersey to get gas, something he often had done because prices were lower there. He then started to feel confused. He knew enough to park his car near a stranger's home and asked them to call for help. Within hours, my adored grandfather had suddenly passed away from a CVA or stroke. My mother loves and has the most admiration for her father. This was always evident, as they both got along very well because of their very similar nature. It is safe to say that soon after these two catastrophic events, my family was in a state of depression; not just a sadness but relatively in a state of shock, denial, anger, depression, and grief. To this day, holidays are not the same; Life isn't the same. When we see the word family in the title of an article or a treatment plan, we quickly make many assumptions about its possible content based on our own ideas of what family means through personal experiences and professional training" (Bomar, 2004). This can lead us to either positive or negative thinking depending on how we perceive our own family. Stances on a constructive family dynamic must comprise both "connectedness and uniqueness" (Bomar, 2004). There are many clinical measures and characteristics of healthy families that are currently still being evaluated. "Clinical measures have been developed to evaluate dimensions of family interaction, strengths, coping with life events, and functioning..." (Bomar, 2004). Without the support of one another, we would not have gotten through that rough time period. Strengths we never knew existed inside us suddenly awakened, and my immediate family never missed an opportunity to comfort one another. Whether it was just sitting quietly with one another or venting so loud our neighbors could hear, there wasn't anything we weren't willing to do. All of these hardships have made me a better person because I had my family to fall on for support. All of these happenings led to lessons learned and a greater opportunity to utilize our spiritual beliefs. This is what is going to make me a dedicated professional able to evolve in the nursing profession. To my dismay, less than three years after my grandfather and aunt died, my maternal grandmother who I am thoroughly connected and close to, suffered a Transient Ischemic Attack (mini stroke). Excluding many of the details, she is immobile, her ability to speak is gone, and her quality of life diminished right before our own eyes. She has a one on one aide that comes over every day. My uncle comes over quite often to help with my grandma. My grandma lives with my parents and everyone does such a great job at making a very drastic life change manageable. I have two of the most unselfish and very patient parents out there. My grandmother suffered another stroke about a year and a half ago and is no longer the grandma I remember. I visit her often, but I frequently need to dig up the countless memories we had together to relive the good old times. I have made it my mission to create new memories with her, by treating spiritual needs with the same level of attention as physical needs. There is a lineage of heart disease on my father's side and stroke and cancer on my mother's side. I do not have the best odds going for me. My father had Coronary Artery disease and has had two Myocardial Infarctions (heart attacks). He underwent Triple Bypass surgery eighteen years ago due to atherosclerotic narrowing. I was young at the time, so the memory is quite vague. Now that I am old enough to understand what had happened, I see the severity of the situation and it worries me for his sake and for my future health status. My maternal grandfather lived life to the absolute fullest; therefore I believe his stroke was predominantly caused by lifestyle factors such as unhealthy eating. The same is true of my father; my grandpa and dad were best friends and truly enjoyed a life spent together eating big, elaborate meals. Put it this way, food in the Italian culture isn't necessarily the healthiest. We are never concerned that we may run out of food. There is always more than enough to go around. I have been in the health education/health promotion field for 11 years. My family's health history and my interest in the field helped my family adopt and implement strategies to promote optimal health. My brother had a Wilm's tumor at the age of 5. It is the most common form of kidney cancer in children. When many doctors gave my parents a bad prognosis, they still never gave up. They sought second, third, and fourth opinions from highly reputable doctors. My brother only has one kidney but he functions better than most healthy people. He is very health conscious and treats his body entirely like a highly functioning machine. Overall, my whole family is into health and wellness, aside from my father. My father was an avid smoker his entire life. Two months ago he decided to call it quits and has not had one cigarette. I am very proud and I am also keeping my fingers crossed. I feel that one of the main notions consistent throughout my life has been about healthy relationships. We have relationships with many different kinds of people; and those relationships differ depending on many factors that are associated with our own belief systems and ways of operating. The basis for the types of bonds and styles I use in communicating with others was introduced in my early childhood and continues to be existent into my adulthood. The way we treat people can be attributed to what we witnessed as children. "Families function to monitor not only internal interactions but also interactions with social, cultural, political, educational, and other systems" (Bomar, 2004). Positive relationships between family members has a direct correlation to how we interact with those not in our family. Knowing where we stand in regards to our own spirituality will help us become better nurses. The key to a successful life is having a support system that you can depend on. And with that being said, what better support system is there than your own family who will love you unconditionally?