Archive for the ‘healing/holistic’ Category

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Hard to Resist, They Come With Health Benefits

March 28, 2014

By Shawn Kennedy, AJN editor-in-chief

ForestWe used to have a dog, a black Lab named Sam. We thought he was especially smart, though a bit of a character. He was a wonderful pet and when he died, we were heartbroken.

We didn’t want another dog right away, but it took a while to stop looking for him to greet us each time we walked in. And he wasn’t there to eat the pizza crusts or a Chinese fortune cookie (he’d sit patiently to hear one of us read his fortune to him—and yes, our kids thought we were crazy).

But as my friend Helga said, “The longer you go without a dog, the easier it is not to have one.” Eventually we got used to being in a non-pet household—we could make spur-of-the-moment decisions about going to dinner right from work or away for a weekend without a second thought of “What about Sam?” There was no need to negotiate who would do the morning walk or the evening walk when it was raining or bitterly cold out.

(How many nurses working full time have dogs, I wonder? Given the responsibilities, owning one can be a scheduling challenge, or a budget challenge for those who hire dog walkers. But then, seeing a dog at the end of the day may also be a nice change from seeing patients and colleagues, and research suggests that owning a dog is good for one’s health—petting is associated with lower blood pressure, and of course, long walks are good too.)

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NPR Syndrome

February 21, 2014

Julianna Paradisi, RN, OCN, writes a monthly post for this blog and works as an infusion nurse in outpatient oncology.

calligraphy, 36" x 24," mixed media on vellum, 2007,  by julianna paradisi

calligraphy, 36″ x 24,” mixed media on vellum, 2007, by julianna paradisi

Compassion fatigue is a syndrome commonly known to nurses and other professionals involved in patient care. It is the result of constant exposure to traumatic events occurring to others. Its effects on the psyche of nurses are widely studied, recognized as a factor in burnout and self-medication, and sometimes result in nurses leaving the profession.

My clinical practicum as a nursing student, nearly 30 years ago, was in oncology. There I saw patients succumb to cancer. Many were young adults. One left behind a grieving husband, and an infant. It was heartbreaking. I asked my preceptor, a skilled, compassionate, and uncannily jolly nurse, how did she avoid burnout? I did not know about compassion fatigue yet.

She wisely replied, “You need to develop a happy, fulfilling personal life outside of nursing. You have to shut it off when you leave the hospital.” It was good advice.

I took it to heart, and over the years developed a happy, fulfilling personal life. However, turning it off when leaving the hospital is more of a challenge lately. In a similar way that an opportunistic, secondary infection makes the flu lethal, the rapid influx of news by way of our digital culture is a secondary infiltration into our lives, making it difficult for sensitive souls to “shut it off” after leaving the hospital. For lack of a better term, I’ve dubbed this digital age barrage “NPR Syndrome.”

Before going further, I want to state that NPR (National Public Radio) is a respected source of news. As more and more broadcast news reports are indistinguishable from infomercials, NPR plays an important role in bringing serious news from around the world to our attention. I coined the term “NPR Syndrome” simply because I was listening to NPR when it occurred to me how challenging it is to escape compassion fatigue outside of the hospital.

The amount of suffering in the world is overwhelming to nurses.

There is not enough time to volunteer for all of the projects close to our hearts. There is not enough cash in our wallets to hand out to every homeless person we meet, or fill the shelves of food banks. There are not enough blankets to donate to shelters for the cold and displaced. Resources for brave souls traveling to developing countries to provide vaccinations and drinking water are too few. And then there are the refugees of war we see in flight every night on the evening news. It feels like we are using a Band-Aid to stop the flow of a bleeding artery.

The result is that many nurses feel guilty over having happy, fulfilled personal lives, lives that sustain us to go back to our jobs providing skilled and compassionate nursing care to our patients, where we again encounter compassion fatigue.

A lot of nurses have stopped reading, listening to, or watching the news altogether, and at over three million strong in the United States, this is a lot of political power gone to waste through being uninformed. Read the rest of this entry ?

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The Hospital as Foreign Country

February 7, 2014

Capture“A Foreign Place,” the February Reflections essay by Barbara Sosman, delves into one patient’s experience of the sometimes inscrutable, sometimes terrifying, sometimes humorous events and encounters in one small corner of a hospital.

Below are the first two paragraphs, but as always, it’s worth clicking through and reading the entire essay (the PDF version is best). This one would be particularly hard to summarize; it takes us to unexpected places.—Jacob Molyneux, senior editor

The flow of life and death in a hospital is mysterious, like the sound of a foreign language, and the mysteries that bring us here are profound. Stretched out in an unfamiliar hospital bed, I suppress realities, aware that tomorrow a scalpel will remove an enlarged node for a biopsy. The biopsy will show what I sense, a cellular chaos that threatens my life. Soon my disease will be presented like an offering. What will I do with it?

A room can become a universe and time there an infinity. This room is inhabited by women, of whom I am the youngest by decades  . . .

As always, comments are welcome.

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Bed Bath: The First Day of the Rest of Her Life

January 6, 2014

BedBathIllustration“Bed Bath,” the January Reflections column by pediatric nurse practitioner Kathleen Hughes, is a description of giving a first bed bath as a nurse after many years working in other professions. It’s not the first essay we’ve ever published about giving a bed bath, but it’s wise and meditative and well worth a read. Here’s a small section of this short essay, but please read the whole thing.—Jacob Molyneux, senior editor

An Ivy League degree and 15 years of teaching and writing did not prepare me any better than my mostly 20-something counterparts in the ways of giving a bed bath to a 72-year-old man I’d never met. What might be different for me is that I have known many kinds of professional challenges. What might also be different is that I have lived enough longer to have attended my father’s hospital-bound illness and death, and to have given birth to and cared for two young children. And so when I washed this man, I was washing my father, I was washing my children; I became one of those people who cared for us. Though giving a bed bath is not anything like lecturing to AP students on Faulkner, or writing a newspaper article on gun control or university library funding or modern exorcisms, I am not sure that either of those tasks made me hunker in a corner for five minutes, gathering myself before striding into the room. I’ve also never left a room feeling like I’ve had as simple and visceral an impact as I did that morning.


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The ‘Dialectic at the Heart of Healing’

December 13, 2013

Capture
By Jacob Molyneux, senior editor

Here are the opening paragraphs of the short intro I wrote for our special December edition of the Reflections column. Since the illustrations are an important part of this column’s presentation, I’d suggest clicking through to the PDF versions of the articles linked to below:

“There is a dialectic at the heart of healing that brings the care giver into the uncertain, fearful world of pain and disability and that reciprocally introduces patient and family into the equally uncertain world of therapeutic actions.” —Arthur Kleinman, The Illness Narratives: Suffering, Healing, and the Human Condition

In recent years, the role of narrative in medicine and nursing has gained (or perhaps regained?) a certain amount of respect.

Some advocates value the stories of patients and practitioners because they bring us in from the cold, reminding us of the human side of an increasingly technology-driven field. Others argue for narrative as a crucial source of knowledge about disease processes and best practices, yet another form of evidence in the constant quest to improve outcomes. Others focus on the therapeutic aspect of such writing, our deep need to make sense of encounters shaped by loss, pain, and suffering, whether witnessed or experienced.

The Reflections column has been appearing monthly, with rare gaps, since 1983, when AJN debuted this and other new columns (as well as its editorial board). Reflections essays exist to give a voice to those who have a story to tell about health care, whether they be nurses, patients, physicians, or family members of patients. Read the rest of this entry ?

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Come Into My Parlor

September 27, 2013

Amy Getter, MS, RN, lives in Eugene, Oregon, where, in her own words, she “works with people with life-limiting illness who are enrolled in a hospice wherever they consider ‘home.’”

by Ramon Peco/via Flickr

by Ramon Peco/via Flickr

I fondly remember becoming acquainted with my first “parlor,” in a 100-year-old home that my family moved into during my teen years. The walls were dressed in faded, peeling, paisley-patterned wallpaper and a tarnished brass chandelier hung from the ceiling. French doors closed it away from the rest of the living area, giving it a slightly mysterious aura. Far-off city lights blinked at me from elongated paned windows. I immediately claimed it as my bedroom.

The word parlor (derived from the verb “to speak”) may have first been used in medieval monasteries. An “outer parlor” was designated for receiving outsiders and attending to business needs and the “inner parlor” was for the monks’ private use. During the mid-19th century, formal parlors evolved and could be found in homes like the one my family lived in.

Weddings, funerals (being “laid out”), and other social events occurred in the parlor. Home businesses emerged (such as “funeral parlors”—offering an option for laying out the deceased in someone else’s home!). In recent years, care of the infirm and preparation of the dead have been removed from the home, along with their unpleasant reminders of frailty and mortality, relegating the ailing to hospitals and nursing homes where they can die unobtrusively, apart from the daily existence of families.

I read a book when my children were young called Nana Upstairs and Nana Downstairs*—the story of a little boy who every Sunday visits the multigenerational home where his grandmother and great grandmother live. Nana downstairs makes meals and cookies and provides loving care for Nana upstairs, who sits in a chair, bundled in blankets. Little Tommy learns about families caring for each other, until Nana upstairs dies.

For many families, not only is Nana upstairs not allowed to stay in the home, but she is sent to a special “home” where strangers take care of her, and when she dies some strangers will take her body away in preparation for a funeral. Read the rest of this entry ?

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Delirium at the Hands of Nurses

September 11, 2013
by Augustin Ruiz, via Flickr

by Augustin Ruiz, via Flickr

Amanda Anderson, BSN, RN, CCRN, works as a nurse in New York City and is pursuing a master’s in administration from Hunter-Bellevue Scahool of Nursing at Hunter College. Her last post for this blog was “A Hurricane Sandy Bed Bath.”

Leo is young but I’ve cared for him in the ICU many times. It’s late, but he’s awake, talking, in a voice like Kermit the Frog’s. My eyes traverse the path between his, the patch of hair beneath his moving lips, and the newly healed trach site on his neck. He is too long for the bed frame that supports him—we’ve taken off the footboard, and his big feet stick out from the white blanket over his legs.

Tonight, Leo is stable, but this hasn’t always been the case; I’ve known him since the beginning, months and months ago. A long and nasty alcohol addiction led to a bad case of pancreatitis and multiple interventions to save his life. The saving is what I’m most familiar with—the sedated, unstable, intubated, tenuous Leo, not this chatty, relaxed, stable Leo.

Leo is my only patient tonight, a rarity in a busy urban hospital. The unit is empty and slow, not much care to give, nothing requiring immediate attention. So, I sit with him and talk about our common ground: what Leo survived.

It isn’t often that a MICU nurse gets a chance to hear the stories of a surviving patient. This isn’t because this one doesn’t care; it’s just that not all patients actually survive, or if they do, I don’t always see them when they’re able to talk about it. Leo asks a few questions of me, and then starts to tell me about his experience—the hallucinations that he remembers from when he was sick.

As this article summarizes, studies have found that posttraumatic stress disorder (PTSD) is common in patients after an ICU stay, attributed in some cases to high sedative use and related delirium, traumatic treatments such as intubation, and other factors. In a guy like Leo—close to seven-feet tall, outfitted with lines, drains, tubes, and monitors required to save his life—sedatives were a must. Read the rest of this entry ?

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‘The Nurse Who Changed My Treatment’

May 29, 2013
By Annalisa Ochoa, for AJN. All rights reserved.

By Annalisa Ochoa, for AJN. All rights reserved.

Two years ago, when I was diagnosed with advanced lung cancer in the ED of a large urban hospital, I asked a nurse if I could borrow her cell phone. Without hesitation, she handed me her Blackberry—this simple gesture was a first indication of the solidarity I’d come to feel with the nurses whose kindnesses have helped me heal.

We think it’s important to sometimes include a patient perspective in our monthly Reflections essay. “The Nurse Who Changed My Treatment,” the June Reflections essay, is by Nila Webster, who writes about the gestures by nurses, the little kindnesses and words of wisdom and encouragement, that helped her during her treatment for lung cancer and made her feel seen and understood. The essay is free, and short, so please click the link and give it a read.—JM, senior editor

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Good Medicine

April 22, 2013

musichospitalroomBy Marcy Phipps, RN, a regular writer for this blog. Her essay, “The Love Song of Frank,” was published in the May (2012) issue of AJN.

Last week I saw something extraordinary.

I watched the music of Amy Winehouse soothe a patient who was recovering from a traumatic brain injury while suffering withdrawal symptoms from certain street drugs. He’d been irritable and restless all day, fidgeting and climbing out of bed, unable to rest and miserable in his persistent unease. He wasn’t interested in television, was too agitated to read, and the Celtic flute music supplied on the hospital relaxation station was useless to him as a diversion.

But when another nurse and I pulled an old stereo from behind the nurses’ station and played Amy Winehouse’s “Back to Black” at his bedside, his demeanor changed as suddenly as if we’d flipped a light switch. He leaned back into his pillow, sighed, and said, “That’s nice.”

For the next hour he barely moved.

Those familiar with Amy Winehouse’s music will know how completely at odds her vibe is with the atmosphere in a hospital—and perhaps that’s why her music mesmerized my patient, relieving his intractable agitation more effectively than any medication.

I often forget about complementary therapies—like music therapy—in the ICU. Prescribed medications are almost always the first intervention for pain and agitation, and yet complementary therapies are sometimes hugely effective adjuncts and easy to provide. I’ve seen fury stopped cold by the slow drawing of a wide-toothed comb through someone’s hair, seen someone instantly relax when provided pictures of a beloved pet, and have witnessed music provide relief more than once.

Small measures, perhaps, but sometimes little things matter a lot, and good medicine doesn’t always come from a vial.

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The Seven Surprises: What I’ve Learned About Nursing Through Yoga

March 21, 2013

By Medora McGinnis, RN, whose last post for this blog was “Practically a Nurse: Life as a New Graduate RN.” Medora is now a pediatric RN at St. Mary’s Hospital in the Bon Secours Health System, Richmond, Virginia, as well as a freelance writer. As a nursing student she was the Imprint Editor for the National Student Nurses Association.

By HealthZone (The Star) [FAL], via Wikimedia Commons

Hot Yoga (Bikram), by HealthZone (The Star), via Wikimedia Commons

The room is dark, and hot; 105 degrees, to be exact. I carry my mat, towel, and water bottle to the back corner of the room and settle into my space. I drink some water and lie down, trying to let go of all of the thoughts racing around in my head. A few minutes later, class starts and we start breathing, moving, stretching, and sweating . . . and really sweating. I’m shaking as I try to hold my plank position (which I still have to modify on my knees), then relaxing into a forward bend. Breathing, drinking water, moving, and stretching—and without realizing it, my thoughts are only about the present moment.

When I decided to try hot yoga about a month ago, I knew it would help me reduce stress and gain flexibility, and I was even hoping I’d lose weight. As a present day RN and a former ballet dancer, I looked forward to some of the health benefits I’d heard about, as well as the possibility of gaining back some of my old self-confidence. I figured it would take a while—in my mid-30s and doing the mom thing, I haven’t had time (or made time) to consistently exercise. But after 30 days of practicing three times a week (and these are 75-minute classes, no less), I’ve noticed a few benefits that I never expected.

  1. Mindful eating. As a night shift nurse (and mom of four), caffeine is my friend. I tend to drink soda like it’s going out of style. I eat on the run, and I snack a lot on nights. But over the last month I’ve noticed that I’m drinking more water, and I’m more careful about what I’m eating. Drive-through on the way home? I’d rather stop at the store and grab something healthy. Soda? Maybe one (because I love them), but only as a treat halfway through my shift. And I’m craving sushi and salads instead of ice cream.
  2. Superstrength. I had no idea how much strength it requires to keep up with a full yoga class. I’ve been taking vinyasa flow classes, which just involve more “moving through poses” and linking them together rather than standing static and holding a pose. But regardless of the type of yoga, some serious strength is required. By my second class, I already felt stronger in certain poses and could really tell a difference.
  3. Compassion, for others and for myself. Who would have thought? As the instructors encourage us to “practice wherever we are” and modify movements as needed, I’ve learned to take it easy on myself—both physically and spiritually. We are all in a different place in our lives, working with what we have. Patience with my yoga practice has translated into patience with others, too.
  4. Confidence. Just showing up with my yoga mat three times a week for class has given me a renewed faith in myself. I am consistent, and I am capable! Gaining strength and flexibility and seeing the physical progress of my practice just help that much more.
  5. Slower pace. In class, we hear a thoughtful quote or passage at the start of each practice, and several of them have involved slowing down and breathing. When we are feeling rushed, slow down and take a breath. It’s a gift, and by slowing down we can enjoy each moment. I’ve noticed myself laughing more and stressing less.
  6. Savasana. This is one of the most powerful things I’ve learned—resting is doing something. Before class starts and at the end of each class, I mindfully lie on my back. Completely flat, arms by my side with palms facing up, eyes closed, just breathing. Concentrating on relaxing, sinking into the mat, and letting go of the fluttering thoughts—that’s what savasana (literally, “corpse pose”) means to me. And it’s remarkably rejuvenating.
  7. Less back pain, more energy! My favorite side effect of my first month of yoga? My back pain is less and less—I had lumbar surgery for a herniated disk about seven months ago, and haven’t done any regular exercise since then, until now. (Honestly, just working was all I could manage.) Now that I’m yoga-ing, my constant ache has lessened. I’ve also noticed that I seem to have more energy—during night shift, I don’t “drag” quite as much as before, and maybe don’t need that caffeine like I thought I did.

I’m kind of loving hot yoga. While I’m not really a fan of sweating, I love to imagine I’m sweating out toxins in my body and drinking in fresh, clean water. I love the way I feel after a good workout in class. And I’m loving the way I look forward to my next practice. I think I’ve found my new self-care method—what’s yours?

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