Does there need to be a paradigm shift in how exercise is used in oncology (if it’s being used at all)? I was reviewing my blood work after my recent stem cell transplant and noticed that my hemoglobin and red blood cells had dropped 47% from my normal health to their lowest values two weeks after my transplant. I then checked at what altitude a 50% drop in oxygen would correspond to. A 50% drop in oxygen represents an altitude of over 19,000 feet. Mt. Everest south base camp is 16,700 feet. I spoke with a couple of altitude and exercise experts to confirm my comparison. They suggested that in many ways a chemotherapy related drop in hemoglobin (carries oxygen) would be more difficult than the physical challenge of a drop in the partial pressure of oxygen due to ascending to high altitude. No wonder many cancer…
To amend the Public Health Service Act to increase the number of permanent faculty in palliative care at accredited allopathic and osteopathic medical schools, nursing schools, and other programs, to promote education in palliative care and hospice, and to support the development of faculty careers in academic palliative medicine.
On busy days, it can be easy to flit from patient to patient with a laser focus on what our patients “need” in the moment, meeting that need, making sure the call bell is within reach, and heading off to the next patient, or call bell. On those days, it is important to remember that what all of our patients needs is personalized care, therapeutic communication and the feeling that they have been listened to and heard.
This week we seemed to have a number of crotchety and uncommunicative patients. That kind of patient can really make the day longer and more challenging. Talking with patients who just want us out of their space for whatever reason can be difficult. I had a wonderful conversation with my patient’s partner who was also a cancer survivor. She had popped in on her way to Rochester for a biopsy. Her boyfriend, my patient, was a completely different story. He wanted nothing to do with me. He was relatively tolerant of my necessary assessments, but wanted to lay back, enjoy the morphine drip and nap in peace. Even his physicians wanted him to go home, but –with no roommate- the hospital environment was pretty chill riding the opioid pony. The only real distraction was me.
In these situations, I think that it is important for me to remember that all patients have individualized needs. Although I have an assessment sheet that I am anxious to fill with details that are important to personalize my care, that sometimes that means care from a distance. Re-approaching, re-framing, and re-phrasing during hourly rounds to address questions and concerns sometimes doesn’t draw a patient out. In those cases, providing care with respect to their desire to be left alone is also part of nursing and frees us up to pop into other rooms and ask how people are doing and if they need anything. Nursing care is determined patient by patient.
It was comforting to hear some of the other stories from fellow students in post-conference of their patient experiences. It seemed like it was just “that kind of day.” It was also encouraging to hear about some of the brilliant successes that fellow students had, as well.
Going into next week, I am looking forward to the opportunity to take on more patients, to get in another med pass and to have my observational experience. So much to look forward to as I reflect on the near-misses and successes of the week.
To amend the Public Health Service Act to revise and extend the program for viral hepatitis surveillance, education, and testing in order to prevent deaths from chronic liver disease and liver cancer, and for other purposes.
Thank you to the newest Cosponsors. Please thank your legislators for supporting legislation that YOU believe in. If they are not listed as Cosponsors, touch base with them and let you know what you support. Your voice goes a long way towards creating change.
“Let’s talk about sex, baby Let’s talk about you and me Let’s talk about all the good things And the bad things that may be Let’s talk about sex Let’s talk about sex Let’s talk about sex Let’s talk about sex
Let’s talk about sex for now to the people at home or in the crowd It keeps coming up anyhow Don’t decoy, avoid, or make void the topic Cuz that ain’t gonna stop it Now we talk about sex on the radio and video shows Many will know anything goes Let’s tell it how it is, and how it could be How it was, and of course, how it should be Those who think it’s dirty have a choice Pick up the needle, press pause, or turn the radio off Will that stop us, Pep? I doubt it All right then, come on, Spin” ~Salt N Pepa
The second sheet of the Patient assessment can be daunting. However, it is the part that I love best. I love people and it’s important for me in my role as a student nurse to find out what is really going on with them on a personal and psychosocial level. All the issues that concern them when they return home can hit like a freight train and returning to daily living can provide numerous challenges. The second sheet can give them the opportunity to start thinking, marinating – if you will – about reentry into their roles and relationships after their hospital stay, procedures, and subsequent home care. Sexuality is one of those issues.
We are all sexual beings. That’s how we are created. Our identity is tied into our intimate life whether with a partner, or with ourselves and physical and emotional trauma effect the way that we perceive ourselves and our roles in our relationships. “I feel like I’m not whole.” “Who would want me looking the way that I do?” “I can’t even bear to look at myself, how is my partner ever going to find me attractive again?” These are just the tip of the iceberg when it comes to the questions patients have about their sexual identities and their roles as a partner with whom they have an intimate relationship.
I love the second page. Sometimes, I can nonchalantly ask very personal questions during the assessment. Sometimes not. Patients in a hospital setting can feel very vulnerable, but they can also feel a desperate need to talk with someone about their pressing and sometimes embarrassing questions. Only a select few patients will initiate a conversation about intimacy, but gently developing a rapport and a feeling of mutual trust can powerfully influence their ability and willingness to open up about such deeply personal issues.
Often, I introduce the subject when I am doing something else. They don’t have to look me in the eye. I gauge their receptiveness in their response. I revisit the subject when we discuss their discharge from the hospital, again, gently. I leave the conversation open for further discussion and I remind them that they can talk with me –confidentially- about anything that is on their minds, or hearts. I follow-up late with an open-ended question about how they are feeling about resuming daily life activities and again state my willingness to talk about any concerns they may have and list a couple of pertinent topics, slipping intimate relationships into the conversation.
In my work in the cancer community, one of the topics I speak about and have participated in panels and radio programs about is sexuality. In these settings, I have the benefit of creating a completely safe environment and offering myself up for additional time to share in their questions, or concerns after the session, via facebook, by email, etc.
I primarily work with young adult cancer survivors who have LOTS of questions about resuming sexual activity, psychosocial effects, partnering, parenting, fertility, the whole gambit. Honoring that time together, listening to their concerns, reframing, and asking questions to gain more insight into their situations and deeper issues is important to me. I think that this is one reason that I love the second sheet. Co-creating a safe environment where a patient can offer up very personal and intimate concerns and have them listened to, addressed, and normalized is a gift to me.
Today, after clinical in post-conference I had a moment to reflect about why the second sheet comes so easily to me when so many students struggle with it. I think the answer lies in that that I have done this, I have read and researched, I have had my own personal experiences where I wished that someone had discussed the myriad effects that a procedure, or treatment would have on my self-image, immediate effects on my body, long term psychosocial effects and late effects. My nurses seemed so busy. So unavailable. I didn’t want to “bother” them with issues that were not applicable to their job, or care. There were no bonds formed and certainly no place to think about, or discuss what might happen next. The second sheet came as a complete surprise to me. I would have never fathomed that we could, or should introduce these types of conversations.
So, I relish the opportunity to incorporate the second sheet. To delve into a patient experience on a holistic level. The reality of time constraints for RNs is becoming more real to me as clinicals progress. Nurses are busy. There is little, or no time –often- to ease into delicate, yet important subject matter. I am relishing the opportunity to forge these relationships, to create a space for learning, understanding, teaching, and support that I hope to continue to create space for as a practicing RN.
Did you see? On January 26, 2014 the Wall Street Journal published an article that is making headlines. The article opened by saying “The Veterans Health Administration is taking heavy fire from doctor groups over a proposal to let nurses with advanced training practice medicine without physician supervision throughout the VHA system—even in states where laws require more oversight.”
Along with 40 other nursing organizations, ANA stands behind this change. Nurses are rising up across the country to let their Member of Congress know this is important to us. Please urge your Representative to support VHA’s recent change in their Nursing Handbook.
We need your voice!
Unfortunately, more than 60 physicians groups and a handful of Members of Congress have signed letters to the Department of Veterans Affairs expressing “strong concerns” that the proposed new nursing handbook would “effectively eliminate physician-led team-based care within the VHA system.”
Even the Secretary of the Veterans Administration, Secretary Eric Shinseki, who credits a nurse with saving his foot when physicians wanted to amputate it in Vietnam, says the change “will increase access to care and ensure continuation of the highest quality care for our nation’s veterans.”
The National Institute of Nursing Research (NINR) recently launched a new public health awareness campaign—Palliative Care: Conversations Matter—with the goal of increasing understanding of the use of palliative care (comprehensive treatment of the discomfort, symptoms, and stress of serious illness) for children with serious illness.
Support, in all forms, can have an incredibly positive impact on patients as they are dealing with their disease symptoms, but often there is hesitation in recommending palliative care for children.
“Initiating palliative care conversations is often hard for both providers and families, especially in the pediatric setting,” said Dr. Patricia A. Grady, NINR director. “While it may not be an easy conversation, recommending palliative care to patients and families early can improve patient experiences with care. We hope this campaign and its resources will help ensure that palliative care is considered for every child and family navigating a serious illness.”
Through evidence-based research, NINR brought together patients, providers, and families to analyze expectations and changing needs. The Palliative Care: Conversations Matter campaign resources include:
Informational video vignettes, which offer advice to providers about how to start palliative care discussions with patients and family members and features a mother’s perspective on palliative care after her daughter’s difficult diagnosis.
Customizable tear-off pads of patient education sheets in English and Spanish, which encourage providers to have discussions with patients and their families by providing answers to common questions about palliative care and resources to support conversations.
To learn more about the Palliative Care: Conversations Matter campaign or to download or order campaign materials, visit the NINR website or call 301-496-0207.
On a physiological level, excitement and nervousness act very similarly in the body. Starting clinical rotation in a new venue with a new instruction and a different group of students produces both…
Our car-poolers were no different than I was heading up to the medical center. Were we going to find our way there? How were we going to navigate the car park, the supply rooms, the med-surg floor?
Fortunately, we were met with a great deal of help and support. There was less nail-biting once we met our preceptor, our guide-nurse and received our fancy student badges. (Huzzah!) We were reassured that we were not in it alone, that we would encourage each other and come to rely on the strengths and support of our cohorts who will, inevitably, become some of our closest allies this semester…
It is an exciting semester that we begin. Fresh. Newbies. Probies. Attending to the needs of our clients and delving into unexplored areas of learning. It is a challenge and an opportunity and reframing our nervousness as excitement is the first step to walking confidently into a patient’s room and being the support that our clients need us to be
We did it once, but now we need to make it permanent. Last year, we celebrated postponing the enforcement of the required physician’s signature for APRNs to order durable medical equipment (DME).
Here’s the catch.
It was a postponement without a firm date. So, at some point in 2014, APRNs will no longer be able to order DME without a physician’s signature. The Center for Medicaid and Medicare Services delay was a step in the right direction, but now we need a new plan.
Congressman (D-WA) just introduced legislation to eliminate the physician required signature for ordering DME. His bill would remedy the current DME face-to-face requirement and allow providers, such as APRNs, to document that the face-to-face encounter was completed.
Congress has returned to work after closing out 2013 with positive momentum towards repealing Medicare’s flawed sustainable growth rate (SGR) formula. Lawmakers passed separate legislative proposals in key committees in the House and Senate that would finally repeal the SGR and fix Medicare for patients.
Bipartisan negotiations over those legislative proposals are now underway. Congress will effectively be in session for just six weeks from now until March 31.
It is time for Congress to bring repeal of the SGR across the finish line before payment cuts threaten physicians and patients once again.
Tell Congress that patients must see action on repealing the SGR before March 31!
You can send an email to your representative and senators or place a phone call today via the ANAs toll-free grassroots hotline at (888) 434-6200.
Urge lawmakers to reinvigorate bipartisan efforts to repeal the SGR and ensure that progress does not stall before March 31.
Be sure to visit FixMedicareNow.org for the latest information and resources on the AMA’s campaign to engage physicians, patients and policymakers in the effort to repeal the flawed Medicare SGR formula and achieve reform that will transform Medicare into an effective, 21st century model of care.
The Other Side of the Stethoscope 