We Haven’t Made You Better: Orthopedic Trauma and Emotional Healing

Learning that healing the body isn’t always enough.

For much of my career as a trauma ICU nurse and orthopedic trauma nurse practitioner, I focused on building my knowledge of pathophysiology and mastering the assessment and procedural skills required to care for trauma survivors. After a decade of practice, I felt like I had entered the “expert” phase of clinical competence described by Dr. Patricia Benner in AJN in 1982.

But I was completely ignorant of a giant hole in my practice. A trauma survivor pointed out this gap during a routine clinic visit. Ms. H was six months removed from an ankle fracture she’d suffered in a motor vehicle collision on her way to work one morning. On exam, she had regained full strength and range of motion, the fracture was healed on radiographs, and her pain was limited to a minor ache after extended activity. She’d healed remarkably.

I told her that she had done an excellent job with her recovery and could resume her life, including going to work. I’ve come to believe that Ms. H’s response to this assertion changed my entire perspective on patient care. “I can’t go back to work,” she said. “Since the accident, I can’t get in a car without having panic attacks.”

I […]

2022-09-16T11:39:37-04:00September 16th, 2022|Nursing, nursing research, Patients|0 Comments

Writing as Another Tool for Coping as a Nurse

“I recall wondering where this process had been all my life. Of course, it had always been there. It simply hadn’t occurred to me that writing could be such an effective tool for examining, reflecting, processing, and learning.”

‘Like a girl playing dress-up in a nurse uniform.’

by hannah olinger/unsplash

At age 19, I graduated with an associate’s degree in nursing, passed my boards, and went to work in a regional hospital near my college, in the city where I grew up. My geographical radius was as puny as the range of my life experience. I feigned excitement about the new job, but I was overwhelmed. I knew I needed more of everything: experience, education, tools for coping. Eventually, I discovered one of the missing tools was writing.

I entered every shift with anxiety, certain I would walk in on a patient or situation I was ill-equipped to handle. At night, I tossed with worry. When sleep came, dreams became nightmares of IVs running dry and patients coding.

I had only myself to blame. As a teen, I wasn’t ready to decide what to do with my life. I knew nursing was a noble profession, and my parents nudged me toward a program that was economical, efficient, and allowed me to live at home. […]

Identifying and Addressing the Profound Mental Health Effects of Climate Change

Residents amid homes consumed by flood and fire, White Sulphur Springs, WV, June 2016. Photo © AP Photo / Steve Helber.

A new word for an era of increasing environmental instability.

A lot of attention is currently paid to the physical impacts of climate change, including extreme heat events, droughts, extreme storms, and rising sea levels. Far less attention has been paid to the psychological impacts of this change. For example, you may not be familiar with the term “solastalgia.” It’s related to the older word “nostalgia,” but was created to reflect the environmental and often related sociopolitical uncertainty of our current times—that is, of change that’s slow and incremental, and often even denied, and then sometimes rapid and catastrophic and impossible to ignore.

The term is explained in more detail in an April feature article in AJN, “Climate Change and Mental Health,” by Janna Trombley, Stephanie Chalupka, and Laura Anderko:

Solastalgia is a term coined a decade ago by philosopher Glenn Albrecht . . . It refers to the psychological distress resulting from degradation […]

NP’s Model Helps Prevent Mental Health Issues from Slipping Through the Cracks

Brenda Reiss-Brennan, PhD, APRN.

When psychiatric NP Brenda Reiss-Brennan started her independent family therapy practice in 1978, she began to get referrals from primary care providers who were unsure how to handle their patients’ mental health needs. Working with one patient at a time limited her ability to reach many people, so in 1984 she developed a model to train other nurses, primary care providers, and clinics in treating patients with mental illness. The model eventually caught the attention of Intermountain Healthcare, a nonprofit health care system located in Salt Lake City, Utah, which piloted a program featuring the model in its primary care settings.

The care model, which became known as Mental Health Integration (MHI), integrates the treatment of mental health conditions such as anxiety, depression, and substance abuse into the primary care system. Instead of handing out a referral to an external provider and losing patients to follow-up, the MHI model ensures that patients’ mental health conditions and general health care needs are treated in the same primary care practice. Patients receive education materials, are screened for suicide, and are provided a safe environment in which to discuss their mental health concerns. “Patients […]

2016-12-15T16:34:32-05:00December 12th, 2016|Nursing, nursing roles|0 Comments

Patient Satisfaction and Nursing: Listening Matters, Whatever the Situation

By Amanda Anderson, a critical care nurse and graduate student in New York City currently doing a graduate placement at AJN. Her last post on nursing and patient satisfaction surveys is here.

by runran/Flickr Creative Commons by runran/Flickr Creative Commons

During this hospital stay, how often did nurses listen carefully to you?
1. Never
2. Sometimes
3. Usually
4. Always

Listening Carefully About Patients
“Her crit is dropping with each bowel movement, and she just won’t stop bleeding,” said my night shift colleague during the early moments of my shift.

As soon as she finished telling me the rest of my new patient’s care, I got on the phone for the ordered blood. Waiting for the first of many products to be delivered, I went to see her. As I poked around the hanging drips and fluids, checking dosages and orders, setting alarm limits, I heard my patient’s voice:

“Hello, hello? I’m so anxious. I just fell asleep for a moment and now I’ve woken up and I’m terrified. I think I need to be changed again, and I just don’t know what to do, and who are you?”

My colleague, busy with the details of resuscitation, hadn’t said much about my new patient’s anxiety. Anxiety, too often coded as neediness, is clinically important, especially in a patient with questionable stability, and doubly in a patient whose […]

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