A Pediatric ICU Nurse Finds Relief in Not Compartmentalizing Hard Emotions Like Grief

Editor’s note: Hui-wen Sato is a pediatric ICU nurse in California and a regular writer for this blog who has gone deeply into the topic of grief, her own and that of patients and their families. Her insights reverse our usual ways of understanding grief, finding a generative energy instead of a wasteland. Here is a key passage from a TED-style talk (see video below) she gave at the last End Well Project conference in November 2023. End Well is “a nonprofit on a mission to transform how the world thinks about, talks about, and plans for the end of life.”

“And so I realized that what I was going to need to learn how to do was not compartmentalize, but integrate all of my experiences into all of who I am. And as I started to learn how to integrate all of my experiences, there came a curious relief and freedom with this integration. Because I no longer had to pretend that I didn’t grieve for my patients. I could just grieve. And I could then get in closer and actually learn more about who they were, who their families were, and I could start to provide a kind of care I think I perhaps had always wanted to provide, but perhaps was a little too scared to get close enough to learn how.”

2024-03-28T14:03:14-04:00March 28th, 2024|end of life, Nursing, pediatrics|0 Comments
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The Pitfalls of Being the ‘Nice’ Patient: A Nurse’s Perspective

Image Brent Keane/via Pexels

I have often heard health care professionals in various environments say, “If you’re nice to the nurses and doctors who take care of you, you’ll get better care.” As a bedside nurse myself, I understand the sentiment. No busy health care worker loves being met with antagonism or pressing demands that don’t strike us as critically urgent.

But when my husband and I both became patients with serious illnesses last year, we learned the clinical pitfalls of being the nice patients. I am left wondering how patients should be expected or permitted to advocate for their own care without worrying that they will be frowned upon or brushed off because they’re perceived as “difficult.”

First cautionary tale.

In early 2022, I discovered a small lump under my right breast that I initially wrote off as a cyst. Surely, I told myself, as a woman in her mid-40s with no risk factors for breast cancer, this had to be benign. A screening mammogram in May 2022 gave me an all-clear, and I went on my way.

But by November, I knew the lump had grown. I reached out to my PCP to ask for a diagnostic mammogram, and he emailed back a casual reassurance. “I know you’re worried, but […]

2024-02-07T16:57:09-05:00February 6th, 2024|Nursing, nursing stories, patient experience, Patients|14 Comments
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Caring for the Patient You Never Had a Chance to Get to Know

“For months, we simply knew him as this often agitated, sometimes unstable, generally nonverbal, nonpurposeful patient whose actual personhood seemed, if I’m honest, unrecoverable. We didn’t even know who we were trying to recover…”

This month’s Reflections essay in AJN is by Hui-wen Sato, a pediatric intensive care nurse in California. This piece is difficult to describe because it fits no clear category; this is also what makes it alive and engaging.

In “Beholding the Returning Light,” Sato explores the the experience of caring for a patient without ever having had a chance to get to know that person. What do you feel for that patient, and how much do you invest yourself in his or her possible future?

The ‘unthought known.’

Such questions and others may exist on a subconscious level throughout an ordinary work day for nurses in a number of settings. Sato, as she traces the sequence of events, her own emotions, and the role of the patient’s family, adroitly brings them to the surface. […]

2019-11-06T13:33:46-05:00November 6th, 2019|Nursing, nursing stories|0 Comments
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November Issue: Chronic Pain and Opioids, CVDs in Pregnancy, Preventing Patient Self-Harm, More

“[S]eeing this patient, his return, his presence, his enduring love, was a gift. Because some days in health care, you don’t really know what hope you are fighting for or for whom.”—Hui-Wen (Alina) Sato, author of the November Reflections column, “Beholding the Returning Light”

The November issue of AJN is now live. Here’s what’s new:

CE: Implementing Guidelines for Treating Chronic Pain with Prescription Opioids

An overview of five tools outlined in the CDC’s 2016 opioid safety guideline—prescription opioid treatment agreements, urine drug screening, prescription drug monitoring program databases, calculation of morphine milligram equivalents, and naloxone kits—and their relevance to primary care nurses.

CE: Gestational Hypertension, Preeclampsia, and Peripartum Cardiomyopathy: A Clinical Review

The authors discuss three of the most common pregnancy-specific cardiovascular diseases and their risk factors, prevention, assessment, and management.
[…]

2019-10-28T10:00:42-04:00October 28th, 2019|Nursing|0 Comments
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Amidst Nursing’s Daily Challenges, a Longing for Enduring Meaning

Early ideals, current reality.

I recently co-facilitated a breakout session at a national nursing conference in which we had the participants reflect upon life experiences that sparked their initial desire to go into nursing.

Some knew from a very early age that they were drawn to providing care for others. Others, like myself, were second-career nurses who had spent time in other professions before making our way into nursing.

We spent time talking about our early idealism about the profession and the various experiences or issues that have challenged our ideals over time. I was struck by the deep and broad range of emotions in the room: pride, frustration, hope, discouragement, cynicism, and longing.

‘An almost palpable ache.’

It is the longing that stood out to me the most.

The nurses I met in that room, and nurses I meet everywhere, certainly express longing for better staffing, improved systems that facilitate smoother workflow, and a supportive work environment. But these are all longings that tie into one deeper longing, which is a longing for enduring meaning in our day-to-day work—as hard as some days may be—and a broader […]

2019-05-06T09:17:18-04:00May 6th, 2019|Nursing, nursing career, nursing perspective, writing|1 Comment
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Strong Nursing Management Empowers the Why

“Our managers are effective leaders because they care for us, which empowers us to care for others, and for this we are indescribably grateful.”

I recently had the opportunity to speak at the American Association of Critical-Care Nurses (AACN) UCLA Chapter 2018 Leadership Symposium, which centered around AACN’s current theme, “Guided by Why.” Along with AACN president Christine Schulman, other nurses and I explored the importance of staying connected to our “Why” in the midst of considerable challenges in and to our profession.

I found myself considering not only my original answer to “Why do I want to become a nurse?” but also “Why do I stay in nursing?” I found that a significant part of my answer to the second question has to do with the managers I am privileged to work under. It is their strong management that continually fuels my underlying “Why.”

Genuine care for staff well-being.

Our managers demonstrate to us time and again that they see and value us as people, not just cogs in a wheel that needs to keep turning at all costs.

Self-scheduling allows for flexibility. In our unit, we have self-scheduling: all nurses determine their own shifts, so long as every shift is staffed with the minimum required number of nurses and everyone […]

2018-03-05T08:23:27-05:00March 5th, 2018|Nursing, nursing career|1 Comment
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Intimate Strangers: A Pediatric Intensive Care Nurse Reflects

By Lisa Dietrich for AJN.

“How do I talk about these things with a stranger unless I know how to be intimate?” asks pediatric intensive care nurse Hui-wen (Alina) Sato, the author of “Intimate Strangers,” the Reflections essay in AJN’s August issue.

Sato writes about “walking intimately . . . through the most devastating hours of her life” with a woman she’s only just met—even as her role as a nurse involves ending the life-sustaining treatments of this mother’s child.

Nurses will tell you such experiences can be common in their profession. But essays like this remind us that such experiences are also remarkable. Sato is the type of nurse who ponders her role, who stops after the fact to wonder what it means to be a participant at such moments in others’ lives. […]

2017-08-04T10:51:54-04:00August 4th, 2017|Nursing, nursing stories, patient engagement|0 Comments
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The Inner Stretch of Nursing

There is a level of discomfort nurses are pushed to that goes beyond tight staffing, busy 12-hour shifts, and mental tracking of our patient’s disease process. It is the inner stretch of our emotional, relational, and spiritual muscles. We are pushed to wrestle with questions and issues beyond what we find comfortable, and then we must learn to live with a certain unresolved level of discomfort. We can’t go back to a perhaps safe naïveté about life as we knew it before we saw how indiscriminate some forms of suffering and death could be. Our own theological wonderings come to light, and our capacity for vulnerability and intimacy is tested when certain patients find a way past the self-protective walls we put up. Sometimes, all the big questions of life loom over us in the course of one 12-hour shift.

We are stretched in how we think about quality of life.

My everyday thoughts about quality of life usually revolve around the quality of my relationships, how much free time I had to enjoy my hobbies, what delicious food or special coffee treat I might enjoy today, how much traffic I encountered, and whether my kids seem to have everything they need. I’ve had my share of personal trials and tribulation, but overall I live a life […]

2018-01-18T10:06:13-05:00July 14th, 2017|Nursing|4 Comments
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How to Support the Nurse in Your Life

A quick Google search for “how to support nurses” reveals an emphasis on recommendations for hospital management on developing structured support for nurses at an organizational level. The search also captures popular articles on how nurses provide support to their patients. Ironically, the query results provide no resources to inform the nurse’s closest support system—families and friends—as well as the general public about what kind of support the nurse really needs and how to better provide it.

I attribute these search results, at least partly, to the fact that we nurses don’t always know how to articulate what we need. Some forms of support, such as treating a nurse to a mani-pedi or a spa day (or a parallel form of relaxation for our male colleagues) are of course always appreciated. But I’m talking about support of a more substantial sort, and this is why:

The reality: Consider the real experience, and thus the real needs, of the nurse.

When I consider the experience of nurses shuttling between full 12-hour shifts immersed in the care of complex and sometimes dying patients and periods of comparatively calm ordinary life with family and friends, I sometimes think of military members who have witnessed the horrors of war and are seeking to reenter “normal” life in a peaceful country. While members of […]

2018-01-18T10:07:18-05:00June 14th, 2017|Nursing|6 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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