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The ‘Clog Kick’: In Trying Times, Adapting to the Loss of a Palliative Care Team’s Essential Rituals

Palliative care, under optimal circumstances.

I work as a palliative care NP on an inpatient consult team at an academic medical center in Massachusetts. In the best of times, palliative care teams are exemplars of interdisciplinary functioning. According to nationally accepted consensus reports, since palliative care is holistic in nature, it must be administered by a team that can address the multidimensional elements of suffering for both patients and families in the setting of serious or life-limiting illness.

In my experiences on two interdisciplinary palliative care teams, we were damn strong together. We met each morning to divvy up the workload; around the crowded table were NPs, physicians, chaplains, social workers, sometimes a pharmacist or a librarian, and a bevy of rotating students of all disciplines. On the table was often food: from someone’s garden, our own kitchens, or the grocery store bakery.

A ‘thread of lightheartedness’ amidst the heaviness.

The work was seemingly endless (as many people as there were around the table, there were scores more patient consults), and the situations were heavy and complex. We took our work seriously because the situations we waded into day after day were often worst-case scenarios for our patients and their families.

But there was also a thread of lightheartedness that ran through the days and weeks. We prioritized team and clinician wellness, and often laughter was the centerpiece of the table. We strategized together, cried and fretted about our patients, roared or seared in frustration, and yes, we watched funny cat videos to keep the […]

2021-02-23T17:02:36-05:00February 18th, 2021|COVID-19, Nursing|0 Comments

The First Injection

A nursing professor, now administering Covid-19 vaccinations as a volunteer, looks back on her 40 years of giving injections. The first one was the hardest. 

‘I could have easily given up that day.’

I reviewed the chart the night before—“40 units of NPH insulin subcutaneous before breakfast”—then went home to practice the technique. With a tiny needle and a small volume of medication. I used an orange to simulate the skin and gain confidence in how to puncture the skin and push the plunger to inject the medication.

As I entered the ward with my fellow classmates the next morning, I felt prepared to give my very first injection. I removed the insulin from the refrigerator and began to warm the vial between my fingers. I carefully selected the 100 unit insulin syringe. As I slowly drew up the dose, nervously flicking the air bubble out of the top of the syringe, my clinical instructor watched from the side.

Before we went into the room I checked the record for site rotation—right side of belly. I swallowed hard. We knocked and entered the room, introducing ourselves and our plans for the patient’s morning insulin. The older man lying in bed nodded approvingly. When I pulled up his gown and searched the right side of his belly, I began to have doubts. I hadn’t practiced an injection in the belly and the man’s skin was dry and wrinkled—nothing like the smooth skin of the orange I’d used the night before.

I swabbed the area with the […]

2021-03-12T15:19:08-05:00February 10th, 2021|Nursing|2 Comments

Who’s Going to Smile at My Baby? When the Pandemic Comes to the NICU

From the doorway, I watched the mother gently stroke her newborn’s forehead. “I love you,” she whispered. “I’ll be back soon.”

As a resource parent in the neonatal intensive care unit (NICU) at a large children’s hospital, I am privileged with the task of offering support to families. This was a typical stop in one of many patient rooms. As I gingerly entered the room, the mother glanced up at me, tears welling in her eyes as she scrambled to adjust her mask.

“I’m sorry,” she stammered. “I didn’t want to cry.” A tear rolled down her cheek.

“Not at all,” I replied. “I understand. It’s hard being a mom in the NICU, now more than ever.”

I invited her to share her feelings, hoping to offer some help or comfort. Wiping her cheek with her sleeve, she explained that the pandemic visiting rules had made it difficult to be at her baby’s bedside.

“I have other children, and I need to go home to watch them. The hospital rules say I am the only person allowed to take off their mask in her room, but she needs to see faces for her development. Who is going to smile at my baby when I’m not here?”

Speaking from personal experience.

2021-02-08T09:43:44-05:00February 8th, 2021|family experience, Nursing, Patients, pediatrics|0 Comments

The Unsung Heroes of Hospice Are Family Caregivers

Nurses who find their vocation in hospice may be among the most understanding people on earth. As a nurse who has helped many, perhaps hundreds of patients transition into palliative care and hospice, I thought that I would be prepared to handle placing my father into home hospice after a stroke. At 90, my father had vascular dementia due to chronic infarctions. The call from his provider informing me that he had had an embolic stroke with a hemorrhagic component was not completely unexpected. After his anticoagulation was reversed, I knew that he was likely to have another stroke soon.

Walking the tightrope: daughter, nurse, caregiver.

I guess that’s the curse of the nurse. No false hope for me. As the nurse in the family, I walked the tightrope of caregiver, support person, and grieving daughter. The help from the hospice team was extraordinary, but the overall care and responsibility was placed on the family. It was a bit of a shock to me. I can’t imagine how families without members in health care manage.

My father did not pass his swallow test, and he had left-sided paralysis; however, he was initially able to communicate, with some effort. In fact, the priest who saw him on the first day was obviously curious as to […]

2021-01-14T11:15:10-05:00January 14th, 2021|family caregiving, family caregiving, Nursing|2 Comments

‘What a Decade This Year Has Been’: Nurses Worldwide Double Down on Commitment to Care

The year nobody expected.

A mere dozen months ago, we were all set to celebrate the International Year of the Nurse and Midwife, poised to shine in the global spotlight with the spring release of the first State of the World’s Nursing report. There were plans to fete us with dinners and awards. “Give them ribbons, buttons and badges to wear,” one website suggested.

How quaint and frivolous that sentiment seems now in light of the continuing shortages of the masks, face shields, gowns, and gloves that we need to protect ourselves, our patients, our families and communities from COVID-19

Nurses in the spotlight.

The pandemic changed everything—except for the fact that nurses did land squarely in the spotlight this past year. Nurses—as always—were asked to multitask when the first confirmed cases led to sustained global transmission. We dug in even as we pivoted, attempting to prevent hard-won health gains from being reversed. For example, women still needed prenatal care. Lockdowns didn’t preclude families from requiring essential preventive and lifesaving treatments for countless infectious and chronic diseases—including malaria, HIV, TB, diabetes, and cancer—that suddenly took […]

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