Marcy Phipps, flight nurse and writer

Good Medicine

By Marcy Phipps, RN, a regular writer for this blog. Her essay, “The Love Song of Frank,” was published in the May (2012) issue of AJN.

Last week I saw something extraordinary.

I watched the music of Amy Winehouse soothe a patient who was recovering from a traumatic brain injury while suffering withdrawal symptoms from certain street drugs. He’d been irritable and restless all day, fidgeting and climbing out of bed, unable to rest and miserable in his persistent unease. He wasn’t interested in television, was too agitated to read, and the Celtic flute music supplied on the hospital relaxation station was useless to him as a diversion.

But when another nurse and I pulled an old stereo from behind the nurses’ station and played Amy Winehouse’s “Back to Black” at his bedside, his demeanor changed as suddenly as if we’d flipped a light switch. He leaned back into his pillow, sighed, and said, “That’s nice.”

For the next hour he barely moved.

Those familiar with Amy Winehouse’s music will know how completely at odds her vibe is with the atmosphere in a hospital—and perhaps that’s why her music mesmerized my patient, relieving his intractable agitation more effectively than any medication.

I often forget about complementary therapies—like music therapy—in the ICU. Prescribed medications are almost always the first intervention for pain and agitation, and yet complementary therapies are sometimes hugely effective adjuncts and easy to provide. I’ve seen fury stopped […]

Marcy Phipps, BSN, RN, CCRN, CFRN2016-11-21T13:07:48-05:00April 22nd, 2013|nursing perspective|5 Comments

When Nurse-Patient Boundaries Blur, in Fact or Fiction

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Love Song of Frank,” was published in the May (2012) issue of AJN. She currently has an essay appearing in The Examined Life Journal.

Courtesy of the author

Professional boundaries, as defined by the National Council of State Boards of Nursing (NCSBN), are “the spaces between the nurse’s power and the patient’s vulnerability.” The NCSBN describes the nurse–patient relationship as a continuum, with “too little care provider involvement” at one end and “too much care provider involvement” on the other.

The ideal therapeutic nurse–patient relationship lies in the middle, with “no definite lines separating the zone of helpfulness from the ends of the continuum.” I don’t love the indeterminate nature of that definition, but I understand it.

Some time ago, I was surprised by a friendship that developed between a patient and me. It was an unusual circumstance, in that the patient was in the ICU for a very long time for chronic problems that didn’t affect his mental capacity. I was his nurse many times, and through idle chatter during routine care we discovered not only a shared appreciation of literature in general, but a fondness for many of the same authors and books. I started thinking of books I’d bring him, hoping to augment the tedium of his hospital stay. At some point, I started thinking […]

Marcy Phipps, BSN, RN, CCRN, CFRN2016-11-21T13:08:04-05:00March 15th, 2013|Ethics, nursing perspective, Patients|7 Comments

Unanticipated Codes

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Love Song of Frank,” was published in the May (2012) issue of AJN. She currently has an essay appearing in The Examined Life Journal.

Code cart/courtesy of author

My mentor once told me that there are almost never unanticipated cardiac arrests in the ICU. I’ve found this to be true. Certain indicators, like laboratory abnormalities or particular cardiac rhythms, can foretell a Code, and sometimes subtle signs trigger an instinctual foreboding that I’ve learned never to ignore.

The conviction that a Code Blue can be anticipated provides a sense of security; if the arrest is anticipated, then it may be preventable. And when it’s inevitable, at least anticipation allows for preparation. I strongly believe this. And yet this weekend my patient coded and I was caught completely off guard.

I had just remarked to one of my colleagues that my petite, elderly Chinese patient (some identifying details have been changed) was looking so much better than she had when I’d admitted her earlier that day from the floor—she’d been in respiratory distress, in a hypertensive crisis, and in need of immediate dialysis. All of the various specialty consultants had seen her and collaborated and I’d had the thought that Ms. M’s day would end very well, that it would be one of those nursing shifts where I’d see a metamorphosis […]

Marcy Phipps, BSN, RN, CCRN, CFRN2016-11-21T13:08:15-05:00February 20th, 2013|nursing perspective|5 Comments

The Depression Project

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Love Song of Frank,” was published in the May (2012 issue) of AJN. She currently has an essay appearing in The Examined Life Journal.

Wikimedia Commons

Lately, as a long-time runner, I can’t help but draw parallels between working on a nursing research project and training for a distance race set far in the future. Especially in the middle of a long run, when frazzled edges smooth out and clarity settles over me, the similarities between the two are striking. Both require inspiration and a goal, fluid planning and accommodation for the unexpected, and patience.

I casually refer to the nursing research project I’m involved in as “The Depression Project.” It was borne of concern among the ICU nurses about the mental states of the trauma patients in our unit. As the bedside care providers, we often come to know our patients very well; we don’t just care for these people, we sincerely care, and so we’re troubled when we observe, time and again, trauma patients who seem to lose the motivation to engage in their recoveries. They become flat and despondent; they lose hope.

It’s clear to the nurses that while the physical injuries sustained present enormous challenges, the emotional toll is sometimes just as debilitating—yet underestimated. And so we devised a study to illustrate the correlation of depression and recovery.

It’s […]

Marcy Phipps, BSN, RN, CCRN, CFRN2016-11-21T13:08:35-05:00January 9th, 2013|career, Nursing, nursing research, patient experience, Patients|4 Comments

The Patient With No Name: When Nursing Illuminates Literature

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Love Song of Frank,” was published in the May issue of AJN. She doesn’t usually write about books in her posts, so we hope you enjoy this change of pace.

I didn’t know much about The English Patient when I picked it up recently at a library book sale—I only dimly recalled that the novel had been made into a movie I’d never seen. Since it was published by Michael Ondaatje in 1993, I can hardly blame a lack of time for my lapse. Yet I found myself glad I hadn’t read it until now, as my own nursing experiences suffused my reading of it, leaving me more deeply moved than I might have been otherwise.

The novel is set in the final days of World War II, in a bombed Italian villa that had served as a war hospital. As the story opens, the makeshift hospital has been recently evacuated, with patients and medical staff relocating to Pisa. One nurse remains, though—a young Canadian named Hana. Described as “shell-shocked” due to her experiences during the war, she refuses to leave the damaged hospital or a nameless English patient, who she insists is too fragile to be moved.

Other characters come […]

Marcy Phipps, BSN, RN, CCRN, CFRN2016-11-21T13:08:53-05:00November 16th, 2012|nursing perspective, patient experience, Patients|4 Comments

About Marcy Phipps, BSN, RN, CCRN, CFRN

Good Medicine

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When Nurse-Patient Boundaries Blur, in Fact or Fiction

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Unanticipated Codes

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The Depression Project

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The Patient With No Name: When Nursing Illuminates Literature

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