[CLINICAL ROTATION] Patient by Patient

 

 

Patient by Patient

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.

Wishing you a wonderful weekend. 

Be well.

 

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.

[TAKE ACTION] Clash on VHA Nurse Oversight

“Clash on VHA Nurse Oversight”

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.”

Let’s educate Congress and stand together,

https://secure3.convio.net/ana/site/Advocacy;jsessionid=720139F447D2BD3F34EC66F18CE94035.app338b?cmd=display&page=UserAction&id=437

NINR’s Pediatric Palliative Care Available to Patients and Families

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.

[OPPORTUNISTIC LEARNING STRATEGY] Pharm-mercials & Pharm-marketing

ImageThey’re everywhere.  You’ve seen them, ignored them, recycled them and changed the channel on them.  They… are pharmaceutical ads.

Pharmaceutical companies spend exponentially more money and other resources on medico-marketing then they do on research.  Over $57 billion per year (that’s billion, with a “b”) in 2005.  “Pharmarketing” is highly controversial.  However, it’s ubiquitous nature can be a beneficial to the opportunistic student. 

When a moment (or ad) presents itself, read, or listen up.  Review the drug trade and generic name, side effects, contraindications… Repetition via different media, at different times, in varied locations reinforces learning and memory. 

Another benefit?  Some of the most frequently prescribed drugs and those that are being pushed out the hardest by pharmaceutical companies are the meds in the media that also end up in your med pass. In nursing, learning must be continual to stay up to date on changes and advances in evidence based practice, in protocol, in research… New developments  arise every moment of every day.  Creating a habit of catching learning opportunities can be a powerful tool to keep in your nursing bag throughout your career as a nurse. 

So next time a pharm-mercial pops on, or a full-page magazine ad presents itself; listen up, give it a quick scan and solidify your learning on-the-go!

[LEGISLATIVE ADVOCACY] Nurses Speak Up About Rape in the Military

In 2012, 3,374 brave men and women in our military reported an incident of sexual assault.

It is estimated that 26,000 sexual assaults happened in our armed services last year.

This means only an abysmal 13% of cases in the military are reported, compared to 40% reported in civilian cases.*

Why the discrepancy?

The issue of reporting in the military is complicated but heightened awareness with skilled professionals and targeted programs will increase the likelihood of reporting.

We believe, sexual assault nurse examiners (SANEs) are an integral part of the solution.

The National Defense Authorization Act (NDAA) would establish training requirements for sexual assault nurse examiners (SANE) performing examinations of victims in the military. Introduced by Senator Barbara Boxer (D-CA), these provisions would ensure SANEs be available at every military facility so that victims receive an examination within 24-hours of an assault. ANA along with twelve other health organizations sent a letter to Senator Boxer expressing support for this amendment.

It is time for you to ensure victims of sexual assault have access to safe, quality examinations. Please write your Senator and ask them to include the Boxer amendment today.

https://secure3.convio.net/ana/site/Advocacy?cmd=display&page=UserAction&id=435

Watch: The Invisible War:  http://invisiblewarmovie.com/

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If We Could Look Inside Other People’s Hearts

My host hospital showed us this video  from the Cleveland Clinic in Ohio today… If you haven’t seen it, please take four minutes to watch. 

It’s a brilliant reminder that, on a daily basis, people lives shift and change as do their joys and burdens.  Whenever we encounter another, we see them through the lens of what is happening in our lives, through our “bubble.”  What if we took into account what other people are struggling with, or moving through?  As nursing students, I think that many of us are drawn to nursing because of our deep care and concern for what others are going through and how their life events impact physical and emotional health, but I thought that this video really drove that point home. 

I hope that you will watch and consider how much influence our care, ability to listen, to communicate therapeutically, and our empathy impact our patients, their families, our coworkers and our own perception of life. 

Be well.

 

“Could a greater miracle take place than for us to look through each other’s eyes for an instant?”

Henry David Thoreau

 

[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.

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Nursing students lack effective role models for infection prevention: Study

Nursing students lack effective role models for infection prevention: Study
100 percent of student nurses surveyed observed lapses in infection prevention and control practices during their clinical placements, according to a British study published in the September issue of the American Journal of Infection Control, the official publication of the Association for Professionals in Infection Control and Epidemiology (APIC).

New Beginnings

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First, let me say that I am thrilled to have been accepted into the nursing program.  It has been a long time coming for me.  I first applied to the program in 2000 and was accepted.

When I received my letter, I was beyond excited, however, I had two small children at home, I was a single mom working nights to be with the kids during the day.  I was recovering from treatment for ovarian cancer and I passed on the opportunity.  At the time, I had numerous credits that would have transferred.  I had no idea that child care was available on campus and my goal seemed temporarily out of reach.

I had developed a passion for expectant moms and birthing women prior to the birth of my own daughter.  My own pregnancy greatly heightened this passion and I began completing trainings to become a doula, a monitrice and then a lay-support midwife.  I read voraciously and felt like I couldn’t get enough.  I became a legislative advocate for the rights of women and for breastfeeding, both public and private.  I felt like brining my own child into the world had rebirthed me, had given me a cause to have a voice, and had made me love and appreciate my body in ways that I never had before.

At the time, I owned a restaurant and coffeehouse in Bowling Green, Ohio which my husband and I sold in 1997 after the birth of our son to move to Ithaca.  Once in town I aspired to become active in the birth community, but my husband and I separated within 6 months, I went to live with the kids and a family whom I barely knew with no car, no job, no money, and very little self-esteem left.  Two weeks later, I was diagnosed with ovarian cancer.

During and after treatment, I was amazed at the work of some of the nurses in surgery and oncology.  I knew who would be kind, who would laugh at my discomfort-inspired jokes, and who just wanted to knock out their hours.  I could tell who was there because they loved people and loved nursing, and who was there for a job.  The nurses who were filled with compassion, kindness, and caring in the face of a difficult job kept the flame on nursing alive in me.

Years later, after a subsequent diagnosis and treatment for breast cancer, a catastrophic spinal injury and myriad late effects; my kids are now teenagers and I am moving toward my dreams and goals of working as a nurse.  In the past 15 years, I have become a staunch patient and legislative advocate.  I have a passion for the young adult (AYA) cancer community and speak nationally and internationally about the special needs of AYA’s living with a cancer diagnosis.  I wish to develop the skills needed to be able to continue to serve my community in the most effective way possible.  I think that as a nurse, I have more to contribute to changing the conversation around cancer, cancer research, legislative policy, and community as well as global health.  I look forward to taking time to go abroad and work with populations who are disadvantaged due to lack of knowledge, lack access to appropriate health care/diagnosis/treatment/medications, cultural norms which prevent care and place an unbearable burden of stigma on individuals and families who are ill.  In my role as a nurse, I wish to serve and I look forward to the opportunities and the challenges which lie ahead and the recognition of self which changes and grows with every new challenge.  I am honored and humbled to be a part of the nursing community.

“The beginning is the most important part of the work.”
Plato, The Republic