Let’s Talk About Sex.

“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.

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[THE FIRST STEP] Beginning

Faith is taking the first step even when you don’t see the whole staircase.

Martin Luther King, Jr.

Beginning is key.  The first step of any journey is often the most difficult.  Fear, self-doubt, challenges, and lack of support can keep us stuck, but once we begin, things shift.

I first applied to nursing school thirteen years ago.  At the time, I would have had fewer prerequisites to take, a strong support system, and could have had my doctorate by now.  I had survived ovarian cancer and felt an urgency to move forward, but my kids were still babies.  So, I chose to be with them.  I wanted to be with them.  I didn’t want to miss a step, or be of divided mind.  I was a single mom.  I worked while they slept and spent our days experiencing the world together.  It was a difficult, yet delicious time.

We have had many adventures since that time.  We have all grown.  I have no regrets.  My children gave me the opportunity to fully experience my childhood as well as theirs.  Now, as teenagers, their mommy has gone back to school.  My roles are many and varied, but the role of mommy remains in the forefront.

It was a difficult choice to finally dive back into school, take all my prerequisites, and apply to nursing school.  Creating a personal path when life is filled with uncertainties can deter us from committing to taking the first step on a new journey.  It takes courage and inspired action to begin.  Each beginning opens the door to a path of self-discovery and transformation.  Beginning can bring new confidence, revive inner passions and foster personal development and spiritual growth.  I am looking forward to savoring each step through my training. I know it will challenge me physically, emotionally and spiritually, but I don’t feel daunted as I step into uncharted waters.  I have gathered my courage, my patience and my faith in myself, my family, my classmates and my instructors and I take the first step.

I welcome the challenge and each day I choose the adventure over comfort and my path continues to be revealed.  Life is filled with uncertainties, obstacles, and challenges.  The “right time” may not exist.  Creating a path to the door where the first step lies is half the battle.  When you get to the precipice and look over the edge, what you see may frighten you.  There’s never a shortage of “what ifs.”  The leap of faith is often not a leap at all, but a step, in faith, towards a new beginning.

Resources for Those with Cancer & Student Loan Debt

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If you have seen the news recently, you know that student loan debt in the United States is at an all-time high. It currently totals over $1 trillion, more than 6% of the overall national debt. With this high level of student loans, the delinquency rate has risen too, from 7.55 percent in 2008 to 10.9 percent in 2013. This is the national trend, and people with cancer often face additional challenges in paying off student debt— for example, if they have to postpone finishing a degree or if they can’t work right away because of treatment.While there is no magic answer, information about how to deal with student loans can help. The nonprofit American Student Assistance recently released a comprehensive guide to student loan forgiveness and discharge. The section on Medical Debt is especially helpful for people with cancer facing student loan debt. Download it here. The National Consumer Law Center also provides information with its Student Loan Borrower Assistance Project: http://www.studentloanborrowerassistance.org/.

[VOICES of EXPERIENCE] Advice for Nursing Students From the Field

ImageSome words of experience from men and women who are working nurses in a variety of settings, with myriad skills, perspectives, and levels of education.  Thank you to all of the nurses who have been so forthcoming in sharing their views and experiences !

“Nursing is an art and a person needs to have that inner desire to help others and at times wear their hearts on their sleeves. I have been in the medical field 27 years, I started out as a Medical Assistant in Denver, CO than realized I was doing almost all that an RN was doing than returned to college in Washington and it was like boot camp but it was worth all the sweats, blood and tears I shed, now I am 2 classes from graduating with my BSN since that is what employers are looking for. I have loved all the different types of busting I have done and if you find yourself liking to teach than get out and get your degree MSN and get some experience under your belt and colleges are needing teachers. I have found my love in wound care and that will be my next degree wound care specialist if anyone knows of a great school. Nursing is awesome.” ~Jodi

“You should ask recent grads in your area how the job market is, or look in job postings to see if they hire new grads.  Nursing school is challenging. Start listening when anyone around you talks about their health problems. Ask them about their signs and symptoms. Try to find people who have recently entered the programs you’re interested in and ask them how it was for them, see if they have any tips for you.”  ~Dawn

“Congratulations! Now, prepare yourself for the most grueling years of your life. Nursing school can be intense (no social life for 2-4 years), but it is more than worth the grind. Go for Bachelors; and when applying for a job try to find places that have some type of Nurse Residency programs for new grads. Nurse residency programs help ease graduate nurses into “real” nursing and taking a full patient load, and can help provide great learning and mentoring opportunities.” ~Lyla

I have several suggestions:
1.  Try to get a position while you’re in school as a CNA or PCT, so you will have some direct experience with pt. care, and the nurses (& Manager) will get to know you. During this time, the Manager will be evaluating your interpersonal skills, to decide if they want you to be part of their team as an RN.
2.  Before graduation, apply at hospitals with a New Grad RN Residency Program, & try for one that provides 12 months of support, with classes and peer discussion groups. These programs have become a “best practice”, so getting into one is difficult. If you already work there as a PCT, & the Manager likes your work ethic, you’ll have the inside track.
3.  As an RN, the PCTs, as well as the other nurses, will watch you to see if you are able to work as a Team Member. You have to be willing to help others, in order to survive.
The worst thing is when an RN is seen sitting at the desk, whether charting or not, when everyone else is super busy–or when the RN “refuses” to do the dirty work. You must recognize that certain PCTs (& Unit Secretaries) hold “positions” as informal leaders in the unit culture. I remember one student in a BSN program who planned to be a Nurse Practitioner. She announced, in front of her peers, that she would not empty bedpans.
Good luck! ~Jean

Tapping Into and Cultivating Our Strengths

I have to admit that I was reluctant to spend the time necessary to complete the Strengths Quest Inventory… I purchased the StrengthsFinder 2.0 book written by Tom Rath a handful of years ago.  I had been doing some reading about the power of focusing on cultivating our strengths rather than continually focusing on improving our weaknesses, or areas where we needed development.  I found it particularly interesting because the concept was so counter to the way that our culture thinks and operates.  So, I bought the book.

I think I did the survey soon after, but realistically, I’m thinking that some time had passed.  I took the survey and printed out the results.  I was daunted by the 30+pages that contained my strengths, descriptions, activities that I could engage in to further develop and after a quick glance, I set the report aside until I had “more time.”  Unfortunately, “more time” never really seems to show up on it’s own.  So, I was a bit excited when the inventory was a part of our coursework.  I felt like the “assignment” validated the time that I would spend completing it.

My top five strengths showed up as Empathy, Activator, Input, Connectedness, and Relator.

I gave my report to my fiancé and listened to him laugh wildly as he read and said (over and over) “This is SO YOU!”  Yup.  It is me.

My strengths identified have served me well in past endeavors and, I think, will continue to serve me as a nurse.  Empathy has been noted in the social work research as the “antidote to shame and vulnerability” which is certainly important to clients who have chronic illness, who are unable to care for themselves, and who have general, or specific issue related to their bodies surrounding violence, abuse, and other painful experiences.  My experiences as a patient have fueled my empathy for the needs of a client.  Dignity, choice/control, compassion, respect, attentiveness, and kindness are all imperative and can be challenging to the busy and distracted nurse.  But I see this strength as a gift from the other side of the stethoscope.

My other four strengths seem to have a powerful interplay.  Activating is certainly fueled, in me, by giving input, sharing stories, connecting and relating with others.  Recognizing what other people are, or may be experiencing provides an insight into creating a dialog to support and move them to action with consideration for their fears and concerns.  Using the strengths of connectedness and relator, clients, friends, family, and community members are afforded the opportunity to see my imperfections and know that I recognized the struggles that we all encounter as human beings.  There is no perfect.  There is only moving forward and moving forward and moving forward.  It may be difficult, but understanding that sometimes we all live breath by breath  and creating/holding a space for that can empower the people around me and allow them the space to honor where they are and to creating a space and vision for where they are going.

I look forward to going back and taking stock of just how these strengths interplay and work together.  I have made (or strongly encouraged…) my fiancé and my teenage children to take the Strengths Quest Inventory.  I strongly believe that it has already begun to help us to understand each other by allowing us to acknowledge each other’s strengths and area where we have not understood each other’s actions, or behaviors in the past.  The Strengths Quest Inventory has been a real gift to me as well as my family and I applaud TC3 nursing faculty for including it as part of our curriculum.

~hcs

“We gain strength, and courage, and confidence by each experience in which we really stop to look fear in the face… we must do that which we think we cannot.”

Eleanor Roosevelt

“Strength does not come from winning. Your struggles develop your strengths. When you go through hardships and decide not to surrender, that is strength.”

Arnold Schwarzenegger