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A Found Poem For Nurses Week

May 11, 2015
Badruddeen, via Flickr

Badruddeen, via Flickr

The poem below, originally published in our May 2005 issue, is by Veneta Masson, MA, RN. It’s a “found poem,” a form of poetry in which the poet assembles phrases selected from a source or sources. The lines here come “from actual posts to an Internet bulletin board,” but they could as easily be comments on AJN‘s Facebook page! The author is a nurse and writer living in Washington, DC (more about her work can be found here).—Jacob Molyneux, senior editor

Nurses Week—What Did You Get?
Hi, everyone! Just curious to see what you received for Nurses Week.

Denim shirts with the company logo

Swiss Army–type knives with fourteen blades

Carnations in dollar-shop vases

One wilted rose

Soap on a rope

I think I’m worth more than this

A live band at the Holiday Inn

A potato bar luncheon

If you weren’t there, you got nada

Nothing

Not a thing

A PA announcement thanking the nurses

We dug out our caps & wore them all day
our VP of Nursing came to the unit and stayed for an hour
we sat with her & shared our stories of why we went into nursing

We got pizza one day (if you were there) and ice cream one day (if you were there)

Rolos, Skittles and M&Ms—give me the tools to do my job
instead of tote bags and candy

A drawing for some pretty cool prizes—movies, massages, a month off call

A bonus

We got to work overtime!

I presented my findings to the Executive Team and found out Tuesday
that they had approved another nurse . . . the best thing I   could have gotten

One of my patients agreed to an interview with a local paper
and our story made the front page

Read the rest of this entry »

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The Borders of Loss: An Early First in One Nurse’s Career

May 8, 2015

Julianna Paradisi, RN, OCN, is an oncology nurse navigator and writes a monthly post for this blog. The illustration below is hers.

Peds Ward (2008), charcoal, graphite, flash, and acrylic. By Julianna Paradisi

Peds Ward (2008)/charcoal, graphite, flash, and acrylic/by Julianna Paradisi

Working in oncology, the topic of whether it’s crossing a boundary for nurses to attend the funeral of their patients comes up. Sometimes, however, we’re carried across that boundary by our heartstrings. The first patient funeral I attended was that of my first patient.

During Jack’s short life, he was the first assignment of many a new nurse on the pediatric unit where I was hired as a newly graduated nurse. He had lived in the hospital his entire life.

Jack was nearly ten months old when we met. Born with a congenital illness requiring multiple surgeries, he failed to thrive. A nasogastric tube snaked through his nose into his stomach so he could conserve the calories burned eating from a bottle or spoon. As Jack’s nurse, I mastered the skill of nasogastric tube feedings.

Most parents bond with their chronically ill babies, but it takes a big commitment on their part. Babies like Jack do not look like the pictures of healthy babies in magazines. They are cloistered in an isolette and connected to machines by feedings tubes and IV pumps. Weeks go by before they can be held.

Jack’s mother had all but abandoned him, a phenomenon sometimes occurring when children begin life with extended hospital stays. Susceptible mothers simply stop coming to visit. Phones calls to Jack’s mother were rarely returned; if they were, she vaguely promised a date and time for visits, but rarely showed.

Occasionally, a caseworker would locate her, and explain that Jack would be put into foster care for abandonment. This would prompt a string of visits. She’d bring a toy, and talk about taking Jack home. She learned to feed him by holding a 60 cc syringe skyward as formula trickled through the tube taped to the side of her baby’s face, and into his stomach. I wonder if she wished she could simply hold Jack as he bottle-fed, the two of them gazing into each other’s eyes, the way mothers expect to do?

But she was young; it was too much for her. After a few visits, she’d disappear again. In her defense, no other family visited in her absence—a clue to her lack of social support.

In this manner, Jack became the “child” of the pediatric nurses, raised by a tribe of women. We took turns caring for him. Day shift nurses bathed him, dressed him in clothing they bought, and stimulated Jack’s mind with brightly colored toys that rattled or squeaked. Night shift nurses bathed him again, dressed him in footed fleece pajamas we bought, and read bedtime stories while rocking Jack to sleep. He loved music and singsong rhymes. His dark eyes fought to stay open in his pale face until defeated by sleep.

Attempts at feeding Jack met with resistance. The effect of long-term use of an NG tube was Jack’s aversion to putting anything in his mouth, including food. To maintain nutrition, his doctors were forced to surgically insert a gastric tube into his belly. Bolus feedings caused Jack to vomit, so they were converted to continuous drip. Clamped to an IV pole, a feeding pump followed Jack wherever he went, down the pediatric unit halls.

Jack never gained enough muscle strength to learn to walk. At the nurses’ station he watched us work, seated in a walker on wheels he was never strong enough to move on his own. Often, he was sick.

At Christmas, Jack’s room was a kaleidoscope of gifts. Every pediatric nurse with young children brought them to visit, bearing gifts they’d wrapped themselves: “For baby Jack, spending Christmas in the hospital.” For many, it was their first opportunity for empathy.

Time went by, and no one claimed Jack. His condition stabilized, he began to gain weight, and discussions about his discharge began. None of us could bear the thought of Jack living with strangers in a home for medically fragile children, away from us, his family.

Not surprisingly, a nurse stepped up. She decided to become Jack’s foster mother. She began the rigorous process required by the state. She decorated a room for Jack. Read the rest of this entry »

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Seeing Potential: The Joys of Teaching Nursing

May 6, 2015

By Ruth Smillie, MSN, RN, associate professor of nursing at Saint Josephs College, Standish, Maine.

"Buck Up," by zenera / via Flickr.

by zenera / via Flickr.

The day I come to class pregnant is one of my favorites. I really hate to be pregnant; I’m 55, grey haired, and way too old to be pregnant. My students are obviously surprised when I waddle in swaybacked with my sudden eight-month pregnancy. They snicker and smile, and then the magic begins.

As each one brings up the “change” they were assigned, I acquire the mask of pregnancy: larger breasts (made from paper bowls), kidney stones and gallstones (collected from outside), more blood volume (once, in a soda bottle), varicose veins (pipe cleaners or string), and so on—all carefully attached to me by duct tape.

I look and feel ridiculous and we all laugh a lot, but that’s not the point. The point is that they remember the changes of pregnancy. Embarrassing as it is, I would do it every day if it helped them learn. I love to teach nursing and it has been an amazing experience.

Students have no idea how incredible they are. Most of mine are just out of high school, young and unaware of their potential. But they have it, and I can see and feel it. I love watching students help change a newborn’s diaper when they are as nervous as a new dad fumbling with the wipes.

Chatting and gently holding those brand-new legs, connecting with the family, becoming a nurse—not any nurse, an amazing nurse, right there before my eyes. These are the moments I get to be a part of; while they are caught up in their inexperience, I can begin to sense what they will become: nurses who will connect with families, talk to patients, care about people. These are nurses who I’ll be proud to have known long before they realized who they would become.

Nursing education isn’t known for its stellar paycheck. In fact I could make more working at the hospital, lots more. Others are quick to point out that we get summers and holidays off. Great perks: time to write, research, and develop new classes and improve old ones. Now snow days, those are cool, if only it didn’t put us behind in the classroom! Read the rest of this entry »

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Nurses Week: An Annual Occasion for Mixed Feelings and a Little Reflection

May 4, 2015

By Shawn Kennedy, AJN editor-in-chief

by rosmary/via Flickr

by rosmary/via Flickr

It’s here again, that week set aside to remember the accomplishments of Florence Nightingale and the good work all nurses do. Many nurses I speak with don’t like this annual event and feel it represents a patriarchal tradition that diminishes our professionalism. One nurse recently said to me, “Do they have a Neuroscientists Week, or an Attorneys Day?” (Actually, a Google search reveals there’s a “Be Kind to Lawyers Day”! But you get the point.)

Others say that Nurses Week provides an opportunity to promote our profession and gain recognition for what we do, even if only for a week—and that’s better than nothing. Organizations do seem to have evolved from the “Love a nurse prn” shoelaces to more substantial recognition, like a lunch with a noted speaker, or better yet, recognizing the achievements of their own staff.

On the other hand, I was surprised last year when I asked on AJN‘s Facebook page what nurses’ workplaces were doing for Nurses Week and many nurses replied, “nothing.” That word was often followed by some derogatory remarks about the facility.

I have mixed feelings, but I guess I fall more into the camp of using Nurses Week to remind everyone—including ourselves, colleagues, employers, and the public—of the complex and vital work nurses do. Without nurses, there is no health care system. Nurses Week is an opportunity to honor those among us who have achieved excellence and gone “above and beyond” in their work. Still, as a blog post from a few years back (“Superlatives: An Alternate List for Nurses Week”) gently suggests, honoring needs to be appropriate to the seriousness of the work we do and not be trivialized with meaningless trinkets and goodie bags. Read the rest of this entry »

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Cochrane Reviews: An Oft-Overlooked Evidence Source for Nurses at the Bedside

May 1, 2015

By Amanda Anderson, a critical care nurse and graduate student in New York City currently doing a graduate placement at AJN.

“Research holding the torch of knowledge” (1896) by Olin Levi Warner. Library of Congress, Thomas Jefferson Building, Washington, D.C./Photo by Carol Highsmith, via Wikipedia

Long ago, in an ICU far away, I picked up the habit of saying, during rounds, “Well, you know, research suggests the practice…” I have trouble remembering who taught me this tactic, but it has always been a highly effective way of advocating for my patients.

The eyes of doctors, never ones to be silenced by a nurse who reads research, usually light up at the challenge.

I’ll admit that, for a while, many of my conversational citations came from ‘clinical pearls’ or tidbits I read from certifying organizations via social media. While my knowledge was based on credible sources, my analysis was topical, at best.

Then I started graduate school. Although my program isn’t a clinical one, the need to seek out evidence for class assignments intensified my practice of trying to apply research evidence at the bedside.

It’s tricky to find and discuss credible research as a bedside nurse. Services like Lexicomp and UpToDate, which most hospitals hold subscriptions to, compile current research for clinician use and provide comprehensive information that’s far more credible than Wikipedia. But they’re exhaustive and often require a pretty hefty chunk of time to really analyze and understand. Printing out a 37-page document to hand to an attending on rounds isn’t a practice I’d recommend.

So how do we get reliable, evidence-based information efficiently when it’s needed? It wasn’t until deep into grad school that I started to realize that Cochrane Reviews were sometimes the best bedside research translator out there. The Cochrane Collaboration is an international, nonprofit organization that performs systematic reviews on peer-reviewed journal articles. The reviews are considered, by my professors at least, often the best form of evidence. Short summaries and abstracts are free to all users and are easy to find via PubMed and print. (Full access is subscription based, at least in the U.S.)

‘Sedation vacations': yes, no, maybe? A topic I’ve always loved to use my research line on is the practice of ‘sedation vacations.’ When patients are deathly ill and ventilated, their lives depend on the use of sedatives. However, studies have linked lengthy use of sedative agents to serious complications—drug bioaccumulation, postextubation delirium, decreased quality of life, and adverse events, to name a few. Hence, the daily sedation vacation was born.

Most ICUs these days require a daily sedation vacation for intubated, sedated patients. There’s little doubt that patients are often oversedated, and the practice of pausing the sedation to see if they wake up and then readjusting their sedation according to policy can cut excess use. Some units allow nurses to perform the practice without input from an attending physician. Others rely on a case-by-case method. I’ve worked in both, and in both have said the words, “You know, research calls for daily sedation vacations, and this patient meets the criteria. Should I move forward?”

In most such instances, a sedation vacation was authorized for the patient, and sometimes a discussion of current practices was stimulated by my reference to research. I’d always thought that sedation vacations were a validated, proven, evidence-based practice, and had always advocated for them when my patients met clinical criteria. Read the rest of this entry »

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Good Jokes, Bad Jokes: The Ethics of Nurses’ Use of Humor

April 29, 2015

By Douglas P. Olsen, PhD, RN, associate professor, Michigan State University College of Nursing in East Lansing, associate editor of Nursing Ethics, and a contributing editor of AJN, where he regularly writes about ethical issues in nursing.

Humor has real benefits. But when does nurses’ joking about patients, each other, and the care they provide cross a line?

Photo from otisarchives4, via Flickr.

otisarchives4/Flickr

“Nurses make fun of their dying patients. That’s okay.” That was the provocative title of an op-ed by Alexandra Robbins in the Washington Post on April 16. The author’s treatment of the topic was more complex than the title suggested, but some examples of humor given in the article were troubling.

For ethical practice, nurses must consider if it is ever appropriate to discuss the clinical care of patients for humorous purposes. An easy answer would be—never. If patient care is never joked about, then no one’s feelings are ever hurt and nothing inappropriate is said as a joke. However, my experience as a nurse in psychiatric emergency and with human nature suggests two arguments against this approach:

  • Jokes will be made despite any prohibition.
  • Considerable good comes from such humor.

If jokes are going to be told anyway, it’s better to provide an ethical framework than to turn a blind eye. If joking about patient care is sometimes acceptable and sometimes not, nurses’ jokes are more likely to stay ethical if they consider in advance under what conditions it’s ethical to joke and how one distinguishes ethical from unethical humor.

According to Vaillant (1992), humor is among the most mature of the defenses. “Like hope, humor permits one to bear and yet to focus upon what is too terrible to be borne” (Vaillant, 1977). Those who have experienced the stress of intense clinical practice know the value of finding humor in life’s tragedies. In addition, patients who are able to cope with their physical and emotional pain are often those who find the humor in tragedy.

Still, some attempts to make people laugh are unkind, and it hurts to be the subject of others’ laughter. Vaillant distinguishes humor from wit, noting that humor never excludes (1977). It may help nurses to enjoy the beneficial effects of humor and avoid the effects of harmful humor if we attempt to identify some characteristics of appropriate humor. Watson (2011) offers some useful suggestions for self-examination to determine the acceptability of clinical humor:

  • Is the joke about the patient, the situation, or the clinicians themselves?
  • Does the joke reveal disdain or contempt for the patient?
  • Could the joke affect care? An example might be jokes suggesting that a patient deserves pain or disability. Wear et al. (2006) demonstrated that medical students treated patients considered responsible for their pathology as “fair game” for derogatory humor. And nurses have more difficulty empathizing with patients they consider responsible for their pathology (Olsen, 1997). Therefore, jokes enhancing this perception could erode a nurse’s relationship with that patient.
  • What is the underlying intent of the joke—is the motive to influence clinician behavior or attitude? This includes both harmful and helpful intent. Some jokes could be used to gently chide a clinician toward more empathy. Upon hearing a nurse refer to drug-seeking patients in a derogatory tone, I may retort, “Of course they’re lying about their pain. What would happen if she told the triage nurse that she has a five-bag-a-day habit and her dealer is out of town?” The comment generally gets a laugh, and my goal is to give the nurse a chance to consider the patient’s perspective and perhaps see the situation less as despicable deception and more as the desperation of unmet needs.
  • Is it true humor—that is, is it inclusive, a clever juxtaposition, insightful—or is it simply mean-spirited mockery of another’s misfortune? This distinction is subtle and is often dependent on personal intuitive reaction: Does it feel cruel, callous or uncaring? Do you feel shame at saying or hearing it? Does laughing at the joke make you uncomfortable? These reactions vary widely, as can be seen in the public debate regarding what is called “political correctness.”

Filter yourself when thinking to tell a joke and reacting to another’s humor. Pause a moment before telling the joke or reacting to another’s comment; let your intuition and values weigh in. Then, speak—or don’t.

A more difficult ethical issue is whether it is acceptable to make potentially hurtful jokes if one can reasonably ensure that the joke remains within the clinical circle. Read the rest of this entry »

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The Challenge of Eating Disorders: A Teacher Learns a New Mindfulness Technique

April 27, 2015

“She’s brought a cup with her. This is not unusual. Clients often bring food or drinks they’re required to finish—but when Mariko reaches inside the cup, I hear the brittle clicking of ice and look closer. There’s no beverage. She pulls out a piece of ice and, without a word, curls up on her side, cradling the cube tenderly in her palm.”

By Jacob Molyneux, senior editor

Illustration by Anne Horst for AJN.

Illustration by Anne Horst for AJN.

We hear a lot lately about mindfulness and its benefits in the workplace for dealing with stress, increasing productivity, and the like.

It’s been pointed out lately that mindfulness has become a tool with many uses, some more in keeping with its role in various spiritual traditions than others. Such traditions seem to use meditation practices in order to cultivate compassionate awareness of the varieties of suffering arising from the impermanence of everything from pleasant and unpleasant feelings and the weather to the lives of our loved ones.

This month’s Reflections essay in AJN is by a mindful movement teacher at an eating disorder treatment center. Eating disorders can involve mental and physical suffering that’s unrelenting and self-sustaining. Many clinicians and therapists find patients with eating disorders very challenging to work with. The essay, called “Distress Tolerance,” tells the story of an encounter in which the patient teaches the teacher a surprising new mindfulness technique. Here’s the opening:

How are you?” Asking this question always feels ridiculous, especially with someone undergoing eating disorder treatment, but I say it automatically.

“Average,” Mariko responds quietly, tucking a strand of limp, jet-black hair behind her ear as she bends to select a yoga mat and two pillows.

“Average” is code for something much worse. Though she is in group treatment, it’s just us today. Her group tends to be small—and volatile. I blink in surprise as she chooses her spot, unrolling her mat quite close to mine.

Read the rest of this entry »

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