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Are You a Well Being?

March 23, 2011

By Shawn Kennedy, AJN editor-in-chief

Flower Bowl, Spa / Badruddeen, via Flickr

A tweet from the UK’s Nursing Times recently caught my eye. It was directing Twitter followers to a post on its Web site, asking what “well-being” meant to them. The post discusses the work life vs. home life seesaw and whether readers’ chosen careers leave them time to enjoy other aspects of life. There’s actually a national well-being debate in the UK, where the Office for National Statistics is seeking public input in developing new measures of national well-being.

We measure well-being here in the U.S. too, with the CDC’s measures of health-related quality of life (HRQOL) index. While noting that “there is no consensus around a general definition of well-being,” the CDC sketches the concept of well-being in the following way:

“. . . at minimum, well-being includes the presence of positive emotions and moods (e.g., contentment, happiness), the absence of negative emotions (e.g., depression, anxiety), satisfaction with life, fulfillment and positive functioning. In simple terms, well-being can be described as judging life positively and feeling good. . . . physical well-being (e.g., feeling very healthy and full of energy) is also viewed as critical to overall well-being.”

Most people I know say they’re working harder than they ever did before. I see single parents and don’t know how they work full-time, deal with childrens’ schedules and needs, and make time for themselves. (I guess mostly they don’t—especially the part about making time for themselves.) I know many people who’ve taken on additional jobs—they teach but now also work per diem, or they work full-time in one setting and pick up weekend shifts elsewhere.

I’m sure patients feel the pressures, as we rush in and out of rooms, checking bar codes and IV pumps, and then whisking away to do it again in another room. Or what about in home health care, where visiting nurses don’t have time to “visit,” or even in psychiatry, which has morphed into a “get-em-in, get-em-out” assembly line. (See this recent post re. the demise of talk therapy.)  I hear from nurses who say that we’ve cut costs as much as we can—there’s no “doing more with less”; we’re doing less with less, and not doing it well. This discourages many nurses and can lead to burnout.

So I wonder: Do most nurses have a sense of well-being? Do you?

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Posted in healing/holistic, home care nursing, international nursing, nursing perspective, professional identity, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , , , | 13 Comments »

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Japan Earthquake Aftermath: What Nurses Need to Know About Radiation Exposure

March 16, 2011
Airborne radioactive material can have an effe...

Possible routes of radiation exposure. Image via Wikipedia

By Maureen Shawn Kennedy, editor-in-chief

The pictures are horrifying. First a 9.0 magnitude earthquake, then a tsunami, and now the Japanese people are perilously close to another disaster from radiation leaking from damaged nuclear power plants.

The death toll, already in the thousands, possibly tens of thousands, will undoubtedly climb without the intervention from disaster relief organizations, which may be reluctant to send their responders into areas with high radiation. After its ships and crew were exposed to radiation from a leaking reactor (the New York Times reported that the deck crew on the U.S.S. Ronald Reagan was exposed to radiation that “caused them to receive a month’s worth of radiation in about an hour”), the U.S. Navy repositioned its ships further off the coast of Japan as a precaution, and is conducting relief operations from the north, away from the wind currents.

There’s been much discussion in the media about the effects of radiation, what levels are harmful, etc, and nurses may indeed receive questions from patients or families with members participating in relief efforts. Here are two articles from AJN that will help you answer questions (they’ll be free until April 18):

Here’s an excerpt from the first of these two articles:

PATIENT DECONTAMINATION
• Remove the patient’s clothing and dress him in
scrubs or a gown.
• Rinse contaminated areas of his body with saline
solution or deionized water.
• Shower or bathe him, using mild soap and
cool-to-warm water.
• After the bath, discard the sponge or washcloth
according to radioactive-waste disposal methods.
(The water should be saved in a drum or carboy;
clothing, sponges, and washcloths should be disposed
of in a radioactive-waste can.)
• Flush open wounds with saline solution or deionized
water.
• Use standard sterile practices when administering
injections, suturing, or other procedures that puncture
or break the skin.

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Posted in international nursing, nursing perspective, public health nursing, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , , , , , , | 3 Comments »

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Harm Reduction or Stigmatization: What’s Your Approach to Drug-Addicted Patients?

November 1, 2010

By Alison Bulman, senior editorial coordinator

How much of your nursing education focused on how to handle drug addicts and substance abuse? Probably not much, according to speakers at a recent event I attended with my colleague Christine Moffa, AJN’s clinical editor, at the Center for Health, Media, and Policy at Hunter College.

The event was focused around a clip (longer than the one above) from “Bevel Up: Drugs, Users and Outreach Nursing,” an award-winning film by Canadian documentary filmmaker Nettie Wild. (A photo of a street nurse from the program appeared on AJN’s cover in July 2009, along with an article about the program.) Fiona Gold, BA, RN, and Juanita Maginley, MA, BSN, RN, whose work in Vancouver is the subject of the film, spoke on the panel about the value of harm reduction and about the systemic flaws and tendency to stigmatize drug addicts that prevent health care from reaching this population.

The powerful clip showed street nurses searching the city’s alleys and housing complexes for drug addicts, dealers, and sex workers. They carry bags full of syringes, condoms, and crack pipe mouthpieces which they deliver to those willing to take them. They ask street patients whether they might be pregnant, have unsafe sex, may have a disease, and if they want to have the nurses draw blood for testing.

The outreach project started in response to Vancouver’s alarming increase in HIV infections. Medical services were not reaching the most vulnerable people, so nurses devised a plan to go to them, a strategy they referred to as “meeting the client where they are.”

The nurses in the film show an amazing ability to balance gentle persistence and respect for the autonomy of their patients. We all know that some health care workers, including nurses, can be contemptuous of drug addicts, and may perceive addiction as self-indulgent and little more than a burden to the system. And far more money is spent on criminalizing drug use than on treating drug addiction as a disease.

My colleague Christine’s reaction to the clip reflected her experience as a nurse: ED nurses’ job “is difficult, and patients who are using drugs are not always easy to deal with.” But she also stressed that nurses don’t have a choice who they work with, and that the best approach we can take is to make sure they get enough training, both at school and at work, to meet the needs of this population.

To order the DVD of this film, which includes  a teaching module, go here. It’s sure to start some lively conversations among health care workers.

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Posted in advocacy/political action, HIV/AIDS, international nursing, media depictions of nursing, nursing innovations, nursing perspective, patient perspective, public health nursing, videos | Tagged , , , , , , , | 22 Comments »

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In Her Own Words: Pakistani Flood Victim Focuses on Providing Essential Medical Help to Others

September 30, 2010

Yesterday we posted here on the threats facing medical aid workers in unstable countries, with a special focus on the work of the international aid organization Merlin in Pakistan following this summer’s catastrophic flooding. Today we publish a first-person account by Azra Habib, a Lady Health Worker who has been working for Merlin’s diarrhea treatment unit (DTU) in the flood-affected Charsadda district of Khyber Pakthunkhwa. She, like many health workers, has opted not to focus on the potential risk she faces or her own family’s losses, but instead on the immediate need for basic health care services.—Jacob Molyneux, senior editor/blog editor

Azra Habib at a Merlin Diarrhea Treatment Unit in Pakistan

I’ve recently taken a new post as a Lady Health Worker for a diarrhea treatment unit (DTU) at the Charsadda District Hopital in KPK. After the floods there were many villages in the district with no clean water, and the demands on this specialized ward can be extreme. Having lost everything, many people don’t have the resources to get transport to the hospital. Often, by the time they get here, patients are moderately or severely dehydrated and need to be admitted. There are 40 beds but we’ve had as many as 189 patients arrive on the ward in a day.

A toddler recovering from dehydration brought on by acute watery diarrhea

Early one morning, not long after I started my position here, I was about to sign off from my night shift duty. A woman came in, crying out with a child not yet three years old in her arms. She was screaming, “He is not moving, he is not responding.” He had been suffering from diarrhea for two days. When the doctor saw him, he noted that his condition was grave and we started immediate treatment: an IV line to restore his fluid loss and antibiotics to treat his infection.

The boy had lost his father and 5-year-old sister in the flood. This meant that his mother had no one else left. I asked if I could take care of the child and continue my shift rather than sign out, and the doctor allowed me to do so. So I put in all my efforts to his recovery and the child started to respond in the evening. He remained in the DTU for five full days, and when he fully recovered he was discharged.

Noshad Ali holds his 2-year-old grandson, Mohammad Faizan, who is recovering from severe dehydration brought on by acute watery diarrhea

A very personal catastrophe. I wanted to make sure he survived because I know what it means to lose everything and to be left with heavy responsibilities. Prior to the floods in Pakistan, I worked for five years in my village, Banda Malahar, as a health worker. At the same time, I was close to finishing my nursing and midwifery studies. I was in the process of taking my third-year nursing exams when the floods hit and destroyed the area where I live. That day, I was on my way to the city to take exams when I saw water was fast approaching on the motorway. As the bus driver backtracked, I saw all the bee boxes from the nearby farms, floating in the water. I suddenly forgot about my exams and started to worry about my home.

I couldn’t reach my family by phone, but I’d heard on the radio that all of Khyber Pakhtunkhwa had been affected by flash floods. When I finally reached my elder brother by phone the next day, he told me that the whole village had been swept was away by water and there was nothing left. He told me that my sisters-in-law and their children found refuge in a school, while my three brothers were living in a tent on the motorway. He told me that our parents refused to leave the house. So we had no idea if they had survived. I was horrified by the news and felt very restless.

Only silence. Eight days after the flooding started, I finally found my parents. They had found shelter in a school. A week later we returned to Banda Malahar, which was washed away. There was nothing left, only silence. I was standing in ankle-high muddy water and debris. We took the household items we could salvage and what we could find to pitch up a tent to live in. Neighboring families began returning, pitching tents in the footprint of where their homes had once been.

Now everyone is developing severe skin infections, or coming down with diarrhea and malaria, which my sister has also contracted. Living conditions prior to the flood were very poor and now they’ve gone from bad to worse. The floodwaters took everything we had; even my elder brother’s beekeeping business is finished. Read the rest of this entry ?

Posted in children's health, human rights, infection control, international nursing, nursing perspective, public health nursing | Tagged , , , , , , | 3 Comments »

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The Grave Dangers Facing Medical Aid Workers in ‘Insecure’ Regions

September 29, 2010

I recently heard from Jacqueline Koch, a senior communications officer with the global medical aid group, Merlin. As described in a recent AJN photo-essay on Merlin’s work in Gaza (for the best view, click through to the PDF version), the organization partners with local health organizations and trains health workers to provide care in response to natural and man-made disasters. Ms. Koch has now shared with AJN a first-person account of one Pakistani woman’s experiences working with flood victims, which includes a description of that worker’s own family’s suffering as a result of the flood. This account, which will appear tomorrow along with several photos, is prefaced below by Ms. Koch, who provides context for Azra Habib’s story. The security issues raised by Ms. Koch are frightening, in that we now see an already taxing kind of health care work becoming even more perilous because of the threat of physical attacks like the murder of 10 medical aid workers in Afghanistan back in August.—Jacob Molyneux, senior editor/blog editor

A toddler recovering from dehydration brought on by acute watery diarrhea in Merlin's DTU in Charsadda.

‘Senseless but simple.’ In Pakistan, alongside a breadth of man-made and natural disasters, there are many occupational hazards and cruel ironies, especially for aid and health workers. It’s senseless but simple: delivering aid, providing medical care, and saving lives can potentially make you a target.

For any Pakistani national health worker who is working for an international nongovernmental organization (INGO), the danger multiplies. Not only can they themselves be threatened, but so can their parents, siblings, spouses, children, and extended families. They face armed attacks, death threats, robbery, kidnapping for high ransom, and the very real possibility of murder.

Many must navigate these dangers by refraining from visiting nearby family, living in close proximity of their offices, and hiring guards to escort their children to and from school. When working in the field, many opt to leave hats and jackets with INGO logos and ID cards behind, alongside their BlackBerries and anything else that might identify them. They have little choice but to dramatically alter the rhythm of their lives in order to save lives—including their own. But these measures are not always foolproof.

Not just in Pakistan. Merlin, an international medical aid organization, recently published a report outlining the impact of violence, conflict, and insecure environments on health workers, who are central to achieving the United Nations Millennium Development Goals. For those delivering essential health care in fragile or conflict-affected states, it is “A Grave New World.”

As one female health worker in Pakistan in conflict-affected Swat Valley (and who asked for anonymity) noted:

“The militants were against family planning, saying women must stay in the home. As a Lady Health Visitor, I was suspected of providing family planning and therefore at risk. During the militant regime, I could not reach women, I couldn’t meet my patients. If someone knew what my job was, they would have cut me to pieces. I often think about it, I think about my children, because my job is something my family needs. My family needs my job to survive. But I had to stop working here during the regime. I left. While I was away, I thought about my patients, I thought about those who I left behind and who didn’t have anyone to care for their health.” Read the rest of this entry ?

Posted in children's health, human rights, infection control, international nursing, public health nursing | Tagged , , , , , , , , , , , | 4 Comments »

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Fighting HIV–AIDS with Public Health Billboards: September ‘Art of Nursing’

August 30, 2010

By Sylvia Foley, AJN senior editor

Public Health Billboard, Guinea-Bissau (detail)

On a recent trip to the capital of Guinea­-Bissau, Dawn Starin noticed numerous public health billboards urging people to get tested for HIV or to practice safer sex by wearing condoms. One of the six poorest countries in the world, according to the Central Intelligence Agency’s World Factbook, Guinea-Bissau faces an ongoing epidemic of HIV and AIDS. Prevalence is especially high in urban areas and among pregnant women and sex workers. Starin, a writer and a research associate in the department of anthropology at University College London, UK, was struck by the bright colors and larger-than-life figures in the billboards, and photographed several, including the one featured in the September Art of Nursing.

Are the billboards effective?  Starin writes, “Although the billboards are fabulous to look at, many health professionals I spoke with thought they exemplified time and money wasted, in part because of the high nationwide illiteracy rate.” One health worker emphasized the need for more culture-specific studies on sexual practices and tradition, so that appropriate education programs could be developed.

Starin has also photographed public art by Thongleum Damviengkum, a mixed-media artist whose work appeared in the April Art of Nursing. Damviengkum’s often witty pieces, intended to raise public awareness about HIV and AIDS and address the stigma associated with having the disease, are on display at a restaurant in Bangkok, Thailand. “Humor is important if you want people to listen,” he told Starin.

As always, Art of Nursing is free online (you’ll need to click through to the PDF files). We invite you to have a look and tell us what you think in the comments.

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Posted in art and nursing, HIV/AIDS, international nursing, public health nursing | Tagged , , , | 7 Comments »

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Watch Out for Dengue Fever in Travelers

August 2, 2010

By Diana J. Mason, PhD, RN, FAAN, editor-in-chief emeritus

Dengue Distribution, Western Hemisphere (CDC)

You may have heard that in late July the Centers for Disease Control and Prevention (CDC) issued an advisory on dengue infection, which can lead to dengue fever or dengue hemorrhagic fever, noting that dengue is becoming an epidemic in tropical and subtropical areas of the world, with recent or ongoing outbreaks occurring in Puerto Rico; in Key West, Florida; and the Caribbean. It’s particularly important for nurses to be alert for symptoms of dengue fever among people who have returned from travel to tropical areas. Symptoms may include fever, eye pain, joint pain, rash, and bleeding. The greatest danger is from dengue hemorrhagic fever, which can lead to death.

For more on dengue infection (including its detection, treatment, and prevention), see the April 2008 article on the topic in AJN. And as always, please let us know here if you’ve encountered it recently yourself as a clinician—or traveler.

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Posted in infection control, international nursing, public health nursing | Tagged , , | Leave a Comment »

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Scutari: A Blog Post Will Never Do Justice To This Visit

July 22, 2010

This is the second to last in a series of posts by Susan Hassmiller, Robert Wood Johnson Foundation Senior Adviser for Nursing, that chronicle her summer vacation spent retracing Florence Nightingale’s influential career.

Scutari was a “tragedy of epic proportions of which bureaucratic muddle and sheer human incompetence played the larger part, thrown in with a measure of bad luck.”

–Mark Bostridge, from his book, Florence Nightingale: The Making of an Icon

The Hospital: What Florence Experienced
It is almost incongruent that a woman who wrote more than 14,000 letters and 200 books said upon arriving at Scutari Hospital, a converted army barracks, that she was without words to describe what she saw. Of course, as time caught up with her, the words flowed quite freely. Death and mutilation surrounded her in this well-known deathtrap.  Her nurses slept (“in catnaps”) in cramped quarters. Men were cramped into rooms and spilled out into the long corridors as they lay on straw beds on cold stone floors. Attendants had to walk over the men who were, by Nightingale’s command, a requisite 18 inches apart. More men died than lived.

Nightingale in Scutari ward/Library of Congress, via Wikimedia Commons

Nightingale hardly slept, took her meals by the spoonful, and spent most of her time caring for the men, overseeing the band of nurses she brought with her (some were hardworking and disciplined, while others were not), administering the overall operation of the system, fundraising, constantly devising ways to make improvements to save more men and, of course, recording everything. She recorded for herself as evidence for her improvements and to teach lessons, but also to publicize the horrors of the situation to decision makers and the public back in London. The London Times and her good friend Sidney Herbert, the Secretary at War, made good use of her reports, which led to myths that she was a spy.

No man was ever allowed to die alone. Either Nightingale or one of her nurses stood over each man with an accordion lantern (not a genie lamp) day and night, to provide comfort until his passing. Nightingale was said to insist that she be present at every operation, as brutal as it was. Chloroform was not used until the second quarter of the war, well after Nightingale arrived.

What I Experienced…
Scutari is the current home of the Turkish First Army and its administrative offices. Security is extremely tight and no pictures were allowed. The Nightingale Museum, which is visited infrequently because special permission and logistics are required to get in, is in one of the four towers of the massive fortress structure. In the long corridors to get to the tower, marble floors now glisten and windows sparkle from daily cleanings—immaculate conditions are the order of the day.

So you have to use your imagination and historical reference to place yourself in her bloody boots. I did. I saw the rooms where they would have been, and imagined how I would have to listen to the screams of grief and step over those who have died. I imagined the nurses making their constant rounds, up and down these very long corridors, doing all they humanly could. I know now that there was no such thing as a “genie’s lamp,” as is the myth in all the pictures. What the nurses carried were cotton accordion lamps, one of which I purchased at the same Grand Bazaar in town where Miss Nightingale bought hers. I did shed a few tears when I walked away with my purchase, knowing what the lamp symbolized. Read the rest of this entry ?

Posted in infection control, international nursing, nursing innovations, nursing research | Tagged , | 4 Comments »

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Ms. Nightingale as an Applied Statistician

July 20, 2010
By Sue Hassmiller, PhD, RN, FAAN (latest in a series of posts by Hassmiller, who’s spending her summer vacation retracing crucial steps in Florence Nightingale’s innovative career)
 
Here at the home of Florence Nightingale, Embley Park (for more on Embley Park, see last week’s blog post), approximately 100 people have convened to study the impact of the “Lady with the Lamp.” The lady herself was multifaceted, and so is this crowd of scholars. There are nurse leaders, of course, but also museum curators, historians, educators, and biographers. They are all interested in their own piece, but also in how their piece fits into the bigger whole of her life. Today we heard Professor Thomas from the University of Southampton School of Business discuss her contributions as an applied statistician.
   

Nightingale in Scutari ward/Library of Congress, via Wikimedia Commons

Representing mortality. Early in her life, Ms. Nightingale identified the need for hospitals and healthcare systems to collect and use data to improve care. She asked what use are statistics “if we don’t know what to make of them?” She is credited with developing the famous “coxcomb” illustration, which was a multidimensional way of depicting mortality rates. She used statistics at Scutari Hospital (also called Selimiye Barracks) in Turkey to guide her actions and used statistics and data in the London Times to convey the travesty of the Crimean War. 

Institutional and cultural barriers. But Nightingale didn’t just rely on data for getting more of what she needed for the soldiers—she also used storytelling . . . a lesson that’s not lost on me in terms of affecting policy today. However, and this is a big however, just as they do today, politics, context, and culture reigned supreme. Read the rest of this entry ?

Posted in advocacy/political action, combat nursing, health care reform, infection control, international nursing, nursing perspective, public health nursing | Tagged , , , , , | Leave a Comment »

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Florence Nightingale and the Red Cross

July 19, 2010

By Sue Hassmiller, PhD, RN, FAAN, Robert Wood Johnson Foundation Senior Adviser for Nursing (this is the latest in a series of posts by Hassmiller, who’s spending her summer vacation retracing crucial steps in Florence Nightingale’s innovative career)

British Red Cross thrift store, Romsey, England

Anyone who knows me knows I am a devotee of the American Red Cross. After the Red Cross helped me find my parents after a Mexico City earthquake nearly 35 years ago, volunteering for them is how I spend my free time and my money . . . So when I travel, I always check in with the Red Cross, no matter the state, no matter the country, and tell them my story, and tell them: Thank you and keep up the good work.  Read the rest of this entry ?

Posted in international nursing | Tagged , , | 3 Comments »

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