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Insights Blog

When you hear your peers tell their own nursing stories, you gain insight into how you may want to handle your professional growth, patient care, self-care, patient advocacy, and more. You may also want to share your own stories by submitting a blog for possible publication.

November 14, 2018

By: Geraldine Mceachern, MBA, BS, RN

Is it incivility, horizontal violence, bullying, ageism, policy failure or racism? It’s difficult to comprehend the lack of compassion and humanness from one nurse to another. It happened to a nurse with a stellar reputation for over 45 years who was dedicated to her patients, profession, and staff around her.

One day this nurse was staring at the patient census board for longer than a couple of minutes.  Another nurse, who felt the action was “a bit off”, reported it to her nurse manager at the end of the shift. The nurse manager asked the nurse whose behavior was reported to sign for a drug screen. The nurse had no employee representation. Her immediate supervisor was not there, and no one followed the policy of the observation period asking this nurse if she had difficulty sleeping, was not feeling well, or if she was taking cold medications. Instead, she was made to believe if she did not sign the drug screen she would be fired. After signing, the nurse was escorted off the floor by security to an occupational health nurse who tested her for drugs and alcohol, all of which were negative.

Can you imagine the nurse’s . . .

November 7, 2018

By: Susan B. Fowler, PhD, RN, CNRN, FAHA

Imagine being stuck in a hospital room day after day, for as many as 21 days, not seeing or experiencing a change of scenery except for a stretcher ride to the radiology department. This is often the case for individuals suffering a subarachnoid hemorrhage (SAH) from an aneurysm rupture.

At the hospital where I work, we found that this difficult experience can be eased through brief excursions outdoors. I’d like to share our experience with you, so you can consider implementing something similar in your organization.

The challenge

An aneurysm occurs when part of an artery wall weakens, allowing it to widen abnormally or balloon out. When an aneurysm leaks or ruptures blood enters the subarachnoid space, which is the space below the arachnoid and above the pia, or covering of brain tissue. This is diagnosed as an SAH. Degradation products of blood can cause vessel and muscle damage resulting in severe narrowing or blockage of cerebral arteries. This is referred to as vasospasm, which can be benign or devastating.

Vasospasm may be manifested angiographically, clinically, or both. Vasospasm, or narrowing of the blood vessel, occurs 7-10 days after the hemorrhage, and spontaneously resolves after 21 days. Interventions . . .

October 29, 2018

By: Erika Lugo, BSN, RN, PCRN

As nurses we deliver crucial care to patients. We help to support families in times of distress, welcome new life into the world, and help provide care at the end of life. This fast-paced, high-stress environment can adversely affect our health and happiness. Practicing mindfulness can be a powerful tool to help us focus on what is truly important. By being more mindful and compassionate towards ourselves and our health, we can be more present and “in the moment” with our patients. As humans, we often react too quickly to situations, not thinking about the effects our actions and words have on others. Evidence suggests that mindfulness-based interventions and practices can benefit nurses both personally and professionally.

What is mindful speaking?

We all know that communication is the basis of any relationship and is of utmost importance in the nursing profession; however, the concept of mindful speaking is rarely discussed. Mindful speaking implies having the ability to speak to someone with awareness of what you are saying and the tone in which you say it. Mindful communication also involves listening and using nonverbal cues with kindness, compassion, and attention. Before speaking we should all ask ourselves three . . .

October 23, 2018

By: Roric P. Hawkins MBA, BSN, RN

It’s common for those who see demonstrations of mechanical patient-lift equipment to praise them as excellent tools.But when it comes to using this equipment in clinical practice, do these praises warrant such accolades?

Rarely have I encountered a patient-lift device incapable of performing to its intended specifications. Seldom have I come across a patient-lift device that I did not like. But as a safe patient handling (SPH) consultant, I’ve discovered that what’s more important than my preferences are the thoughts and perceptions of the staff I’ve asked to use these devices. Staff voices are key.

When implementing SPH programs, the overarching challenge revolves around the idea of inserting mechanical machines into settings that are intended to be nurturing and caring. It’s difficult for caregivers to find common ground between professional compassion and mechanical hoists/technology, especially because this level of innovation hasn’t previously existed in patient-care settings. Therefore, we need to ask ourselves: Are patient-lifts as good as advertised? Understand that if the purpose for patient lifts is to protect caregivers from injuries, then the answer is found within the beliefs and perceptions of the caregiver.

Listed below . . .

October 10, 2018

By: Name withheld by request

Editor’s note: This blog is a supplement to the continuing nurse education program “Suicide among nurses: What we don’t know might hurt us.” It illustrates how our unrealistic self-expectations as nurses can lead us down unfortunate paths. The author’s identity is not shared per request; unfortunately, there is still stigma associated with substance misuse. We thank the author for the courage to share this personal story and urge nurses to seek the help they need.

As one life ends another begins—a spiritual lesson and coping mechanism that I taught myself early on to ensure survival. Making sense of the tragic loss of life had always been challenging for me. I always thought it was quite ironic hearing “Brahms Lullaby” echoing from labor and delivery as my patient would take his or her last breath. Fresh life combined with one ending seemed logical to me. It is neutral, loss mixed with gain.

All nurses deal with life and the loss of life in different ways. My approach was effective. I witnessed and held the hands of many dying patients. I would cry, and I rationalized the loss. I would go home and hug my wife and . . .

By: Name withheld by request

Editor’s note: This blog is a supplement to the continuing nurse education program “Suicide among nurses: What we don’t know might hurt us.” It illustrates how our nurses colleagues too offer suffer in silence, reluctant to seek help. The author’s identity is not shared per request; unfortunately, there is still stigma associated with mental health issues. We thank the author for the courage to share this personal story.

Burnout, compassion fatigue, and lateral violence often coexistwith, or contribute to, depression in nurses. Untreated depression can lead to thoughts of self-harm and in the worst-case scenario, even suicide. This account describes my journey along the downward spiral of depression. It illustrates the barriers nurses face to get the help they need, and system issues that can exacerbate the problem.

I hope that my story helps humanize the issue of depression in nursing, so that we can begin to work as a profession to remove treatment obstacles and create preventive measures to optimize the health of our nursing workforce. When I became a nurse, I finally felt like I was a part of something bigger, better than what I ever was as an individual. I had an . . .

By: Arlene W. Keeling, PhD, RN, FAAN, president of the American Association for the History of Nursing

“ . . . Of all things in the world, the tuberculosis question is a social question and the causes of tuberculosis (outside of the bacillus) are social problems that need the ballot for their changing (such as bad housing, overwork, underpay, neglect of childhood, etc.). Take the present question of the underfed school children in New York. How many of them will have     tuberculosis? If mothers and nurses had votes there might be school lunches for all those children . . .”

— Lavinia L. Dock

 In 1908, Lavinia Lloyd Dock, a progressive era nurse and political activist for women’s suffrage, wrote to the American Journal of Nursing, admonishing the Nurses’ Associated Alumnae for its vote —“by a large majority” in attendance at the convention—against women’s suffrage. Dock went on to express her shock and humiliation that nurses could not be depended upon “to take instinctively the intelligent and above all the sympathetic position on large human questions,” and then used the example above, noting that there were, as we would say today, “social determinants” of disease, and how nurses could use the power of their votes (if they were allowed to vote) to change these conditions.

Lavinia Dock, who graduated from Bellevue in . . .

September 26, 2018

By: Roric P. Hawkins MBA, BSN, RN

As I prepare for my evening workout at the gym today, it’s more than likely that I will use weights greater than 35 pounds when performing various exercises. I’m no stranger to the gym (even though I don’t go as much as I should anymore), so my previous training, coupled with years of experience, has taught me how to use good judgment as well as execute proper body mechanics in effort to avoid and reduce the risk of injuring myself. Repetition has allowed me to feel confident that I’ll achieve the benefits associated with working out with barbells and dumbbells without hurting myself in the process. Besides, having lifted weights for over 25 years, I have been fortunate to not ever have sustained a severe injury.

Many of us approach going to work every day with this same level of confidence. We know that most of our patients will certainly weigh more than 35 pounds. Because we have been formally trained and have many years of experience to rely on, we are confident in our abilities to execute good body mechanics to avoid injuring ourselves. Repetition has allowed us to feel confident in the idea that . . .

September 14, 2018

By: Russell Griffin, LP, FP-C, and Paula Patterson, RN

Editor’s note: Griffin and Patterson share their experience with low-dose, high frequency CPR training.

Paula Patterson: I had been a nurse for more than 40 years when I had—for just the second time in my career—the opportunity to save a patient from sudden cardiac arrest.

It happened fast. After a successful procedure, my team was transferring the patient to post-op. I was finishing up my paperwork and preparing to turn my attention to my next case when one of my colleagues rushed into the room with a crash cart. Within seconds, I found myself on a stool next to my patient’s stretcher, beginning compressions to maintain blood circulation while his heart wasn’t beating effectively. The patient was revived in less than two minutes, confused, but on the road to recovery after his very near-death experience.

While I was thankful for this outcome and proud of the way my team had worked together in an emergency to save the patient’s life, I couldn’t help but compare the experience to the last time I had witnessed a cardiac arrest on the job. That patient had survived, too, thanks to the quick action . . .

September 4, 2018

By: Amil Tan, MSN, MHC, RN

Falls, typical incidents among older adults in the nursing home, are associated with debility, functional impairment, and mortality. Falls resulting in injury and medical complication have proven to be costly, and once the elderly fall, they develop a fear of falling again. This fear reduces movement adding the risk of developing a co-morbid condition such as pressure injury, pneumonia, and depression related to feelings of isolation. Falls thus affect the quality of life among older adults.

State regulation on elderly care mandates institutions to incorporate fall intervention programs into their policies. Nurses have an active role in assessing the risk of falls and implementing an evidence-based intervention to prevent and minimize the impact of falls among vulnerable individuals. Understanding current knowledge about falls in the elderly and evidence-based fall intervention and strategies can help nurses keep patients safe.

Falls in older adults

Falls are associated with multiple risk factors, including biological, behavioral, and environmental.

Biological factors can be older age, chronic diseases, low vitamin D level, urinary incontinence, gait and balance disorder, orthostatic hypotension, chronic pain, and altered sensory perceptions.
Behavioral factors include lack of exercise, fear of falling, feelings of anxiety, symptoms of depression, low self . . .

August 21, 2018

By: Roric P. Hawkins MBA, BSN, RN

Just this past week, I encountered two situations that I found to be interesting. The first has to do with recommendations suggested by a committee member in an organization for which I’ve consulted for some time. The second, similar situation happened in a class I was teaching for new hospital employees. Though different in context, both presented the same great take-home points that I believe are worthy of discussion.

Two scenarios

During a committee meeting to improve a safe patient handling (SPH)-related process, a prospective algorithm presented for consideration was rebutted by a well-respected senior leader committee member. In his refute, he explained how the process could be simplified if we were to consider product “A”for the initial patient transfer. He continued by saying that once the patient had reached their destination, then we could implement product “B”as the patient-handling device of choice, which would effectively conclude the patient-handling process safely. As the committee member was concluding his thought, I couldn’t help but think that what he was saying was not only absolutely correct, but that we both had seen this process work very well in other facilities. I also knew . . .

August 14, 2018

By: Eric Keller, BSN, RN

Growing up I heard a lot about the importance of a good attitude and a strong work ethic. As a father I am passing down those life lessons to my children, carefully making time for teachable moments when their desire to play overshadows their responsibility to clean and prompts them to sweep their mess under their bed.

My mother continues to remind me that I used to hide all my toys under my covers when I had to make my bed. Despite my childhood lapses, I’ve always found it easy to work hard toward a goal or something that I wanted, but working hard and tirelessly on a seemingly meaningless task was something I found difficult. It wasn’t until I was in the Army that I found the secret—attitude. Attitude is everything, whether the task feels meaningful or it’s something that has to be done, but isn’t much fun, like cleaning up emesis from an unresponsive patient.

In aeronautics, attitude refers to the position of the nose of the aircraft in relation to the ground. The fuselage and tail follow the nose of an aircraft and wherever the pilot positions the nose determines the flight . . .

July 18, 2018

By: Roric P. Hawkins MBA, BSN, RN

In our efforts to bring about effective change to our workplace processes, too often we overlook ourselves as the reason why our initiatives sometimes fail to progress at the pace we prefer them to. We spend limitless amounts of time contemplating why staff is failing to respond to our efforts, when all the while we are essentially failing to respond to staff. Meaning, we tend to spend more of our time trying to convince staff that we are right and that our evidence-based methods are fluent, opposed to partnering to find the common ground that exists between what connects our theories to staff’s daily workflow and work routines.

Until we decide to put aside our stubbornness and work with our employees, we will continue to struggle as younger generation staff criticize our methods through their actions by not responding to our efforts. We must learn to work with their approach to patient care should we expect to achieve the outcomes we are looking for.

Finding common ground

I know I’m going to get a lot of push back for this blog but I’m writing it anyway. I have been highly critical of many recent observations of . . .

July 3, 2018

By: Amil Tan, MSN, MHC, RN

For the 10 years of my nursing career that I spent in the acute care setting, patient turn around was very rapid. There wasn’t enough time to get to know patients on a personal level. That changed when I started working in a nursing home. Care in a nursing home is more personal. Patients, whom we refer to as residents, typically stay on a long-term basis, so you get to know their complete medical and nursing history, activities of daily living, preferences, diets, and behaviors in detail. In addition to necessary care requirements, you get to know the resident on a much more personal level. The residents tell you their past stories of success and failures. They offer you great wisdom and advice. You get to know their family and their relationships. I often treat them not only as a resident but as a family member.

 A day in the nursing home: then

Let’s take a look at how care in the nursing home was delivered several years ago.

The nursing team in the nursing home usually consists of one RN, two licensed practical nurses, and eight certified nursing assistants to care for 80 residents. A typical . . .

June 27, 2018

By: Roric P. Hawkins MBA, BSN, RN

When most of us entered nursing practice, we recognized that lifting patients is an acceptable part of the job responsibilities, but rarely did we think of it as an occupational hazard. Before we started our professional careers, we understood that our patients would require some physical assistance from time to time, but never imagined that lifting could lead to debilitating career ending injuries.

It often amazes me to what extremes nurses are willing to go in care of a total stranger. There seems to be something in our professional DNA that transforms our mindsets once we’re assigned to the care of another human dressed in a hospital gown. Having been away from the bedside for some time now, when I look back it’s hard to understand why we allow people dressed in hospital inpatient attire to drive us to assume unnecessary injury risks when providing them care. We rarely consider ourselves to be victims of our own circumstances, yet we consistently jeopardize our most important asset, which is needed to competently perform our professional duties, our health.

Recap

As we pick up where we left off last month, the nuclear medicine department within one of my organizations was . . .

June 20, 2018

By: Leon Chen, DNP, AGACNP-BC, CCRN, CEN, FCCP

In 1976, Dallas police officer Robert Wood was shot and killed during a routine traffic violation stop. For 12 years, the killer remained at large while an innocent bystander by the name of Randall Adams was wrongfully convicted for the murder and was at one point sentenced to death. In 1988, a documentary about the case resulted in public outcry for a new trial. Multiple inconsistencies during the process of the trial were noted, and in 1989, the Texas appeals court granted Mr. Adams a new trial. Shortly after, he was released and all charges against him were dropped.

The actual murderer of the police officer was later executed for committing another unrelated murder. In a way, this documentary was the predecessor of later popular true crime documentaries such as “Making a Murderer”, “The Jinx”, and “Evil Genius”. During the initial murder trial against Adams, the prosecutor commented in his closing argument that the police are the “thin blue line” separating society from anarchy. The released documentary therefore took this line as its title. While the prosecutor did not create this phrase, the documentary did popularize it, and it’s now closely associated with the important role our police force . . .

June 12, 2018

By: LaQuana L. Smith, MSN, RN-BC

Communication is an exchange of information between two persons—a sender and a receiver. But it doesn’t end there. Feedback is an essential component because it closes the loop of the communication process: It validates how effective communication is and confirms exactly what is interpreted during the exchange of information.

Effective communication can be challenging, but some simple strategies can boost your chances of success.

Value of communication

Communicating with patients is often complex; each patient usually has multiple healthcare providers involved in his or her care. Effective communication is necessary to provide a positive benefit for patients. Communication with patients can help build a rapport, involve patients in decisions, reduce their anxiety, and increase their adherence, cooperation, and satisfaction. Ineffective communication contributes to poor outcomes, decreased quality of care, medical errors, and psychological stress for patients. It can cause them to feel unsafe and uninformed and to perceive staff as being inexperienced, incompetent, or unknowledgeable.

Effective communication is an important component of quality patient care. In acute care, there are specific communication questions used in reporting quality indicators. For example, there are questions about communication with nurses, communication about medications, communication about pain, and communication between the healthcare . . .

June 5, 2018

By: Eric Keller, BSN, RN

Thoughts crash in my mind, like a storm brewing in an endless sea of desolation fueled by anxiety and fear. It’s my first day on my own as a nurse—a day of reckoning. It’s a day I will remember for the rest of my life, one that I have been looking forward to with excitement and bewilderment. The anticipation leaves an unquenchable emptiness in the bottom of my stomach, causing my thoughts and emotions to take an uncharted journey through hopelessness and helplessness. Each minute of the shift is wrapped up in anticipation like a gift, waiting to be carefully unwrapped and enjoyed. The moments elicit questions not answered during orientation. I feel like a lone wave in the sea brewing into a storm.

I tried to rest on the eve of my first shift, but dreams of potential errors and mistakes kept me awake. As I tossed and turned, I forced my eyes closed, hoping the dreams would pass. Instead, my dreams became more realistic, and the line between fact and fiction slowly blurred until I was clocking-in and taking responsibility for the care of my patients—alone. I fumbled through simple tasks that were . . .

May 29, 2018

By: Roric P. Hawkins MBA, BSN, RN

As I recall one of my first experiences as a safe patient handling (SPH) consultant, I’m reminded of an unlikely department that introduced me to workplace injury prevention and ergonomic assessments. Although a high-flow patient care area, it’s an area that probably in most circumstances would not make it onto a SPH coordinator’s initial top list of priorities. But as fate would have it, the department manager made it a point to seek me out because she was told that I was being paid to develop solutions and that her department was definitely in need of an injury prevention solution. In her frustration, she also told me that she expected to get her money’s worth and that I needed to “make something happen”.

The problem

Always up for a challenge, I immediately recognized the manager’s frustration and addressed it by inviting her to the hospital café for a cup of coffee. The conversation was casual and non-threatening. Once the manager was comfortable, she began to open-up and provide details that were eye opening. As she began to explain what had been going on in her department, she talked about how for weeks . . .

May 22, 2018

By: Jon Templeman, BSN, RN

Memorial Day is one of those holidays that seem to welcome warm weather, barbecues, and time with family. For me and many others, Memorial Day also brings up memories of those who are no longer with us because they gave their lives in service to our country. We rely on Memorial Day and Labor Day to bookmark our summer seasons, but for my fellow Marines and me, these two holidays will forever be inextricably connected to what happened on September 4, 2000.

That Labor Day morning, I was serving as an airport firefighter in Yuma, Arizona. Hours before millions of Americans would start firing up their grills, and a year before the twin towers of the World Trade Center would fall, changing our country forever, a sudden event that matched the trauma of 9/11 for those of us involved would occur. This event would not only take a life and destroy careers, but it would ultimately shape my nursing practice in ways I am just recently realizing.

I was the junior Marine on my truck, with a crew of four, having arrived from the fire academy about 3 months earlier. We were eager to quickly check out our trucks . . .

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American Nurse Today attempts to select contributors who are knowledgeable in their fields.  However, it does not warrant the expertise of any contributor, nor is it responsible for any statements made by any contributor.  Nurses should not use any procedures, medications, or other courses of diagnosis or treatment discussed or suggested by contributors without evaluating the patient’s conditions and possible contraindications or dangers in use, reviewing any applicable manufacturer’s prescribing or usage information and comparing these with recommendations of other authorities.