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Just Your Average Superhero Nurse

super hero nurse capeA week in the life of a nurse – Nothings special, you say? That depends. Some people might have a different perspective. Let’s take a peek.

You just happen to walk by a room and see an elderly patient teetering and ready to say hello to the floor. You swoop up. steady them and avert a fall.

You notice a very slight flush on your patient’s face. By instinct, you stop the transfusion and check vital signs. Sure enough, she is just about to become symptomatic.

One night shift, your oncology patient, who has almost no platelets, gets a visit from her husband. Somehow you have a hunch that they plan to have sex. You gently explain her condition and why they need to wait. His thankful response for you telling them, in time, makes her love him even more.

You spend your lunch break visiting with a depressed patient. For him, having a chance to talk and be heard infuses new hope into him. You return to work feeling infinitely happier than if you had eaten a meal.

Your combative dementia patient becomes calm and engaging when you play her era music for her. You then are able to successfully feed her and administer her meds as well.

Your DNR patient begins his trip to the other side – and suddenly the family makes him a DE patient (Do Everything!) You ask them if they are sure – explaining reality and making sure they can handle it. They snap back to their senses, and they decide to honor the patient’s wishes.

Through it all – vomit and diarrhea on your shoes, having to keep calling other departments and doctors, having to take yet another interruption (with a still-full bladder), IV’s that blow, specimens that get flushed, getting two admissions at once, and all the rest – you rock.

What does it feel like to be a superhero nurse? You may not think that way about it – but consider that by your actions above, you prevented: a hip fracture, a potentially life-threatening transfusion reaction, hemorrhage with heartbreak, suicide, starvation and dehydration, and certain torture.

Now, what do you say? Put on that cape, superhero nurse! You deserve it!

Cheers!

BTW – this cape can actually be found for sale on Etsy!

Here is something cool to stick on your mirror or car window: SUPER HERO NURSE RN Registered Nurse 4.5″ (color: WHITE) Vinyl Decal Window Sticker for Cars, Trucks, Windows, Walls, Laptops, and other stuff.

Emotional Needs of the COPD Patient


We have all seen the anxious side of COPD patients. But had you thought much about their depressive side?

The Journal of Thoracic Disease , describes a a Turkish study on male COPD patients and the emotional characteristics common to their condition. The article explains why “COPD patients are exhausting for health care workers to work with and generally non-compliant.”

The study noted a connection between alcohol consumption and depression in some COPD patients. And they said that the alcohol consumption was prevalent in those who were not on psychotropic medications.

COPD patients were found particularly susceptible to panic attacks. That would seem to correlate with their lower scores in self-directedness and resourcefulness during dyspnic episodes.

  • They scored high in: harm-avoidance, anticipatory worry, fear of uncertainty, and fatigability.
  • They scored low in: self-efficacy, problem-solving, self-directedness, and cooperativeness.
  • They described themselves as: immature, weak, fragile, blaming, destructive, ineffective, irresponsible, poorly integrated, need others to make decisions. They worry, feel uncertain, and feel fatigued much of the time.

A Japanese study, found at NAOSITE describes similar personality traits in depressed COPD patients.

Of particular interest, a study, Anxiety, Depression and Traits of Personality in COPD Patients , conducted in San Paulo, Brazil, noted “Their interpersonal relationships display the same “obstructive” pattern as their respiratory difficulty.”

This is a very interesting topic, but what we are after is how to connect better with COPD patients and serve them well in light of their unique set of personality traits.

NCBI Resources says, “…treatment of concurrent psychiatric disorder leads to improvement in the physical as well as the psychological state of the patient. Panic anxiety as well as generalized anxiety in COPD patients is most safely treated with newer antidepressants…”

However, a study done by Science Direct shows that the studied COPD patients with depression often refused antidepressants because of fear of side effects and because they were already on so many medications.

But they did note a very positive connection between successful smoking-cessation and COPD patients who did take their antidepressant.

About.com talks about smoking-cessation, in COPD patients, and three key elements that help: Nicotine replacement therapy, antidepressant like Wellbutrin, and Clonidine.

Respirology points out many of the same issues as the other articles. But they are different in that they also discuss educating COPD patients in areas of relaxation therapy, self-management programs, supportive therapy, and self-help groups.

Empowerment seems to be what is very strongly needed in this group. So my favorite of all these resources is Respirology , which actually gives hope and action steps for COPD sufferers.

With all of these findings in mind, you can easily deduct which empowering nursing interventions will boost the self-confidence of your COPD patients. When they understand one correct action and perform it, with good corresponding results, you will have placed a tool in their belt and made them stronger.

As you work, to help you save time, it would surely help to carry your own pocket sized CMS 50-DL Pulse Oximeter with Neck/Wrist cord .

And to see what your patients are (or should be) reading about their COPD, see: Positive Options for Living with COPD: Self-Help and Treatment for Chronic Obstructive Pulmonary Disease (Positive Options for Health) .

Cheers!

Emotional Needs of the “Type A” Cardiac Patient

Heart Red

Generally speaking, cardiac patients have traditionally been labeled with the infamous “Type A” personality. These folks are wired to be impatient, competitive, dominant, and sometimes hostile.

Plus, according to  www.ncbi.nlm.nih.gov , a “Type D” personality (D for depression) has been more strongly associated with heart disease than any other personality trait.

So your Type D patient has underlying Type A traits. Or is it the other way around? Either way, you have to go in with a plan.

According to http://circ.ahajournals.org , a “typical coronary personality”, when hospitalized, usually acts aggressive, compulsive about goal achievement, and ambitious.

The articles cited are very interesting. But all that is really necessary here is to find out how to gain the confidence of these patients and get them to vote in favor of their potentially life-saving treatments.

The focus, besides laying your Stethoscope on them, is to educate the patient so that they can overcome their own objections. Be a sounding board for them.

Six easy steps in overcoming objections are found at: http://sales.about.com .

  1. Listen to their stated complaint – including surrounding clues.
  2. Repeat it back to their ears – leaving opportunity for clarification.
  3. Explore the reasoning – drawing them out with additional questions.
  4. Answer the real objection – ie: their fear.
  5. Bounce it back to them – to confirm that you’ve answered their objection fully.
  6. Redirect the conversation – with a quick summary and request for permission to follow doctor’s orders with them.

The reason patients might refuse doctor’s orders is usually because of lack of information. Answering objections may feel like sales sometimes, and modified sales techniques are definitely useful. But it is mostly just a matter assess, diagnose, plan, act (teach) evaluate, and repeat. Now here is the follow-through.

According to http://sales.about.com , here are three basic ways to close, and I’ve provided nursing examples:

  1. Assumptive – ie: “Will your family bring your tennis shoes for the treadmill test – or will you be wearing your hospital footies?”
  2. Time-limit – ie: “I can understand you not wanting to be rushed into having this test done. Your doctor feels strongly that, because of XYZ, it would not be safe or prudent to let this test wait for a more convenient time.”
  3. Custom – Once you fully understand what is driving them, say how you are prepared to meet all of those issues with – “So you want to understand your diagnosis as soon as possible, and you would like to be inconvenienced as little as possible, with minimum out-of-pocket expense. Are there any other specifications that I haven’t addressed?” Wait for their answer. Then go on with, “Luckily, our busy, state of the art equipment and highly trained staff have created an opening for you at X:o’clock tomorrow morning.”

We negotiate every day. And, for the sake of your terrified cardiac patients, you know you will do what you have to do to best serve them – even if it it means using the style of education that sometimes is found in selling manuals.

Approach it with HEART, and you will gain their cooperation and improve their odds of long-term survival.

Speaking of heart, be the envy of all your work-mates, and hear heart sounds better, when you rock this 3M Littmann Master Classic II Stethoscope, Black Tube, 27 inch, 2144L . Black and gold. What a beauty!

Cheers!

Emotional and Spiritual Aspects of Diabetes

Blood Sugar CheckingDiabetes is not for wimps. People must be empowered to master it. Diabetics are susceptible to discouragement – often related to knowledge deficit and unrealistic expectations.

Nobody is strong all the time. Let us examine some emotional hurdles common in diabetic patients and ways to help them succeed.

What makes diabetics fail to care for themselves well? Compliance is usually driven by emotions. Let’s take a look at patient hindrances.

Fear – They fear learning the physiological changes associated with prolonged untreated blood sugars.

Self-esteem – Some people equate their BG level with their identity and believe that their diabetes actually defines them.

Self-doubt – Often times, patients do not even know if they are failing or succeeding in their treatment plan.

Denial – Many diabetic patients act like they believe at least a few wrong beliefs about their diagnosis and treatments, so they can justify cheating.

Spiritually – Diabetes is generally classified by science as an autoimmune disorder. Some define this process by saying the person hates their own self.

Guilty – Many have triggered their own diabetes by their poor lifestyle choices.

Some might have trained a team of well-meaning enablers to “help them”.

Depression – This can be psychologically or physiologically induced – or both.

What can you do to help while the patient is under your care?

Time is usually limited, so make each interaction count. They must internalize what you teach them.

Find out what is blocking them from learning, and overcome that issue with your best therapeutic compassion combined with clinical knowledge. The better you engage with the patient, the more effective will be your teaching.

Find something about their personality that you like, and focus on that with them, so they will feel liked. Encourage them to recognize their personal value and start to like themselves.

Try to notice any of their positive efforts, and cheer them on.

Ask their doctor to explain to the patient the exact desired details they need to know about their exercise and treatment program. Then patients will be able to judge whether or not they are succeeding.

By way of praying for them, encouraging them, and teaching them with heart, you can reach them and help produce a happier, more motivated patient.

When you show them compassion, in a way that they perceive, it is most likely to have a powerful impact on their willingness to try.

My resources for this post are: http://www.onetouch.com/articles/shouldknow and http://www.medicalnewstoday.com/articles/222766.php and A More Excellent Way : A Teaching on the Spiritual Roots of Disease .

Cheers!

9 Tips for When Nurses Get Floated

floating angel 3Getting floated can be as simple as working in the next unit down the hall. Or it can involve floating from your familiar geriatric unit to working in the prison-hospital building down the street. In either extreme, getting floated to another unit can be stressful for many.

Each hospital unit has its own personality, norms, and culture. While some units do express gratitude for the floating nurse’s willingness to help them, other units are famous for dumping their most difficult patients on their float nurses.

How do seasoned nurses cope with getting floated? 

1. Take a deep breath, and comfort yourself, knowing – this is only for 12 hours – and make up your mind that you will make it a good shift – even if it is not what you planned for.

2. Find out and log (maybe in your iphone or on your clipboard) the codes to supply rooms, etc. Then the next time you work there, you feel a little more comfortable.

3. Realize that your anticipated 12 hours might be cut short. So get your assessments done, meds passed, and documentation done fast. And report to the next nurse what is not done, so you don’t get into trouble later.

4. Learn your CNA’s name, and endear yourself to them. You know how vital they are to your day.

5. . If you have a lunch buddy, then you will have somebody besides the charge nurse to answer your questions. Offer to help them with something/anything at least once before lunch. Then they are more inclined to help you too.

6. Encourage your lunch buddy to break first. Take great care of their patients while they away. And insist on carrying both companion phones whenever they are off the unit.

7. Staying connected can help. Some nurses call their home unit to report how their day is going. Your nurse friends will enjoy hearing from you and knowing how you are being treated.

8. Take your lunch away from your float unit, and leave your companion phone with your lunch-buddy. You totally deserve for your break to be a true break.

Some nurses say (about being floated), “Its better to be with the devil you know than the one you don’t know.” Maybe, but there can actually be some advantages to floating. Its a great opportunity to network and meet other nurses (who might be floated to your unit one day.) You might make a new friend and expand your nursing knowledge. Change can be stressful – but it can also be very valuable.

9. So number 9 is – keep a contagiously positive attitude. You never know the difference your presence might make to somebody – or how they might touch your heart. Maybe, by getting floated, you will experience a divine appointment. And, who knows? Your smile, in that place where you don’t usually go, might be just the thing that helps another person make it through the day.

Be contagious!

Cheers!

What to do When Docs are Bullies

blue spotted lizardDoctors who bully nurses, and don’t return pages, are a real danger to the safety and recovery of their own patients. What can a nurse do? Here is a quick fix to get you by until you learn more in-depth, victorious strategies.

Taking on a professional, kind, relaxed, confident attitude can partially penetrate the hard exterior of some otherwise antagonistic doctors. Showing respect for their level of expertise and business can elicit at least their tolerance of you.

Whenever a bully doctor must be called for patient problems, approach them with your most competent, organized self. Conduct all of your encounters with them “by the book”, (if possible, with witnesses around), and document everything.

Habitual hostile behavior from doctors must be discussed with your manager, and the offenders need to be written up. Only when enough written complaints have been submitted will the hospital board be able to take disciplinary action.

Make sure your witnesses will speak up when the time comes. You might ask them to sign your written complaints due to occasional high staff turnover rates.

Document the extra efforts you took to advocate for your patients – including following the chain of command until you get the needed orders. Include the doctor’s quotes in your write-ups. Keep your manager informed.

Whatever a bully’s reason is for their behavior, it is not your problem. Sympathizing or rationalizing only serve to enable the problem to continue. There is no place for sympathy in this setting because your patient’s life may depend on getting timely orders.

Muster all of your intestinal fortitude, and call them as quickly as you would call a friendly doctor. Your patients may, or may not, thank you for it. But your conscience will be clear.

Thankfully, most doctors are not bullies, and they do return pages. Usually the work environment is friendly and cooperative. But when doctors bully nurses, patient safety is put at risk. And it is the nurse who will get blamed for any bad outcomes – unless there is documented, witnessed proof about efforts to reach the doctor and those results.

These measures, of course, could be modified for any career field. Bullies clog work flow at best – and harm others at worst. But you can protect yourself and others from them with learned techniques.

To get an even better grasp on handling all sorts of toxic people in your workplace, you will want to check out: Toxic Coworkers: How to Deal with Dysfunctional People on the Job .

Meantime – stay safe!

Cheers!

Nurses – Love the Learning and Prevent Burnout

IMG_0040This post is my opinion – based on what I have seen, experienced, read, and learned in my 22 years in nursing at the BSN level.

Nurses and nursing students who stay in learning-mode are happier people. There are always new meds, new techniques, new diseases, and new         treatments to learn. Just to survive, nurses need to feed their love of learning.

Where-ever learning is concerned, no matter the curriculum, structure, style, or abilities of those teaching – “Wisdom is the principal thing;               therefore get wisdom: and with all thy getting get understanding.” Proverbs 4:7 KJV.

The TLB words it this way: “Getting wisdom is the most important thing you can do! And with your wisdom, develop common sense and good judgment.”

And lastly, the NCV says it like this: “Wisdom is the most important thing; so get wisdom. If it costs everything you have, get understanding.”

Why am I carrying on about learning? In nursing, learning is a matter of personal survival. It truly is the magic key to a long, happy, and lucrative career. The overflow of that is that your patients benefit.

It is a known fact: your seven patients of 20 years ago, and your six patients of 10 years ago, were easier to care for than your five patients of today.

Every year, insurance companies find ways to raise the “severity of illness” and “intensity of service” requirements for hospital inpatients. So, yes, your patients are sicker, and your work is more intense. And it will most likely keep getting worse.

Do you remember Erickson’s stages of psychosocial development? Well, I discovered another stage that he forgot to include. Somewhere in the midst of their careers, nurses enter the life-stage called “passion for learning vs career burnout.”

Have you noticed that professional health care workers of all types who love in-services are happier people than the ones who do not? The more you learn (eventually), the more you earn. It will pay off in many ways.

The ones who just want to maintain the status quo have already failed the challenge. There is no possibility of maintaining the status quo in hospital nursing. It only gets harder.

Nurses who keep their love of learning alive can better apply new knowledge to the changes in the healthcare system. If they do not, they are likely to burn out quickly and leave the field in bitterness.

In addition, nursing schools need to help students translate theory into practical, patient-centered critical thinking. They also need to provide better-supervised clinicals, encourage use of mannequins more to hone skills, and incorporate computer skills, time-management skills, effective delegation, and assertiveness skills.

These last four are the basic survival skills that nurses need in order to survive. So if you are a nursing student, and your school is not providing enough of the above list, learn these things yourself. These are the life-skills that will keep your career alive and make you a happier person.

I have been at both ends of the spectrum. Trust me. Learning is more fun than burnout.

Cheers!

4 Ways to Better Serve the Cognitively Impaired

Alzheimer's Disease

The cognitively impaired patients you encounter may range from totally helpless to violent. Individual patient behavior will range in presentation and severity – and each patient will respond to interventions in their own ways. But studies have shown four ways of gaining trust and cooperation in most of these patients.

The picture here, showing brain changes caused by Alzheimer’s Disease, reminds us that the behavior changes are not the fault of the patients.

The days of restraints are quickly yielding to more creative, evidence-based interventions. You can go to http://www.nurse.com and look at an article called Calming the Cognitively Impaired, by Arlene Orhon Jech, RN, BSN to see the full documentation of the research for this post.

Regardless of whatever causes dementia, there still is no cure. And healthcare workers are faced with a seriously growing problem. So humane methods of behavior-management must be discovered, shared, and implemented. That is what this little post is for.

The first intervention, music, has been well-documented for its ability to reach the soul of withdrawn persons and produce animation and meaningful interaction with them.

For music therapy to be most effective, it should be the individual’s preferred type of music. To my thinking, this would include the type of music they loved when they were in their teens and up into their 30′s or so. Music soothes the savage beast and revives stony hearts.

Although there are great handfuls of benefits documented by many experts, you may find it more interesting to just try playing era music for some of your patients – and log the results for yourself.

Secondly, touch has been documented as calming for many. The types of touch include non-hurried, gentle: hand-holding and massage of back, feet, or hands. Results are greater when soothing conversation accompanies touch.

Some elderly also respond positively to the addition of scented oils with their massage. Be aware: the sense of smell, in the brain, is located very close to the structure responsible for memory. So scents can produce results that are profoundly positive or disastrous. I saw this one backfire once.

The third key is exercise. Studies show that elderly who exercised several times a week for 30 to 60 minutes may demonstrate improved cognitive function and may also delay the onset of dementia.

Of course you know that regular, effective exercise can also improve physical strength and coordination – thus decreasing falls and injuries. Music added to exercise sessions multiplied the benefits received in those studied.

Lastly, studies show that companion animal presence promotes exercise, socialization, continuation of routine activities, improves stress management, and even lowers blood pressure and cholesterol. Even short-term exposure to dogs or cats can reduce stress in those affected by all stages of dementia.

In summary, it has been discovered that integrating all four of these modalities into the daily care of the cognitively impaired yields improved nutritional intake, greater social interaction, less need for medication, and many other benefits.

To see more detail on this subject, including names of organizations who conducted the studies and their statistics, please refer to the article sited above.

Thanks for stopping by – and as always –

Cheers!


Nursing Task Coupons for Christmas!

What could bring cheer faster than having your coworker volunteer to start that difficult IV, draw that blood, insert that NGT, or other duties that you just do not have time for today? What could you give and not spend any money?

Gift icon

Yep, you got it! Give Nursing Task COUPONS this Christmas! But how can you offer this without feeling like you are getting screwed? (Please pardon my “French”.) We will cover that.

For starters, you can make them from almost any kind of plain paper that looks pretty to you. Do you remember when you used to make home-made Valentines? You could follow the same principle.

Write the task you are willing to perform on the coupon, and include the specific date that the coupon is valid. (You certainly wouldn’t want all the coupons to be redeemed on the same day or week!) Spread them out so that you have just one coupon redeemed each shift that you are working – say – through the month of January or so.

In fact, you could present them in a box and have nurses pick the one they want with a date they are working. You could also include the words “attempt to” in your coupons, because some cases are just nearly impossible. And you could allow for a substitute date in case you are put on call or floated to another unit.

Here are some sample tasks that could repeat each week: Will attempt to: insert one IV, perform one blood draw, insert one Foley catheter, insert one NG tube, clean up an incontinent patient, ambulate a patient in halls, perform one dressing change, complete one admission, spoon feed one patient one meal, receive one post-op patient from PACU…

Usually, hospitals stock various colors of printer paper. So you might be able to create these at work during your break. You could cut some white paper into shapes, like a pine tree or star, and write on them. Then you could cut out a larger version of that shape from green paper – or red. Staple or tape the white coupon in front of the green – and you’re done!

Of course, if you do these at home, you could be more elaborate with it. You could include doily trim, glitter, and even envelopes!

Here is a sample of how it could be worded. “On presentation of this coupon, (Betty Boop) will attempt to start one IV on one patient. Coupon valid only on January 4, 2014 or January 5, 2014.”

Think of the 5-7 skills you are particularly good at, and offer those 5-7 skills in your coupons. Offer services that normally take only about five – ten minutes. Also, because of time-management issues, include that coupons must be presented to you before mid-shift.

The most important key is that you CHEERFULLY perform the task as the gift that it is. This is what will make your gift – a gift.

So that is one way to make your coworkers happy, give them value, and not spend any money. You are probably doing these tasks for others anyway (as favors), but now they will be gifts!

You are welcome!

Cheers!

Hospitals that Tolerate Bullies – Early Morning Code

Yelling Man

I am about to tell you a true story of a crisis that happened in 2011. And I ask you to consider what could have prevented it.

I received (mandatory bedside) report from the night nurse (I’ll call her Rose) that this one patient’s blood pressure had been low all night, she had been difficult to arouse, and her high blood sugar had been treated and not rechecked. The doctor was not notified because it was the hostile house doctor with a very ugly temper.

Rose was seasoned and well-respected, so I was shocked by this report and asked Rose if SHE was OK. I nudged the patient, and asked how she felt, and she complained clearly that she wanted to be left alone. This patient was very obese – in a “Big-Boy bed with an air mattress. She had orders to get her up in chair for each meal.

I told the CNA to please check this lady’s vital signs and blood glucose first and report them to me ASAP – before attempting to get her out of bed. I then I asked Rose to just report on the other patients quickly so I could tend to this one.

While receiving a rushed bedside report on the next two patients, we heard a man’s raised voice and a female voice trying to respond to him. This was obviously disturbing, but the two of us kept pushing on to try to finish report. When we exited the room of the fourth patient, we saw that our nurse manager was trying to get the lethargic patient out of bed with a hoyer lift! And a large angry man was towering over them – yelling complaints!

Come to find out – the man was this patient’s husband, who had arrived shortly after Rose and I left that room, and was bellowing about his wife still being in bed. The nurse manager had no clue of the patient’s level of stability, and she was trying frantically to placate him. She had also gotten her boss to help her since the CNA was busy!

Before I could get to that side of the unit and tell them to stop, they called a code!

Really!

Evidently, when they rolled her onto her left side, her heart couldn’t take the pressure. So there we were – air bed in full-inflate status, and us standing on stools doing CPR, and the husband still complaining! Meantime, Rose thrust her worksheet at me to serve as report on the fifth patient so she could go home.

The nurse manager and her boss had a mandate from their superiors to ensure patient and family satisfaction at all costs.  So, to keep the peace, they went against their own best judgement.

In addition, all the nurses on the unit were continually kowtowing to pacify aggression in patients and family members. Fear of yelling was the norm – even to the point of a nurse not calling a hostile doctor when she should have.

I have a lot more to say about this. But, for now, I’ll just say – yes, we brought the patient back and sent her to the ICU – and no, the husband never returned to apologize for being an unreasonable bully.

But what attitudes and policies can you think of that could have been put in place to prevent this kind of event? And how hopeful are you about the idea of Zapping Conflict in the Health Care Workplace ? I look forward to hearing your thoughts.

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