A Health Care Proxy and an Act of Moral Imagination

“What would Joanna have wanted?” the ICU fellow (Dr. Smith) asked Sam, Joanna’s nephew and health care proxy, for the second time this week. Sam considered the question, furrowed his brow, and said, “I still don’t know, doc.”

The human costs of indecision.

Uncertainty can at times be better than false certainty. This may even be so, up to a point, when a loved one is on life-support and subject to invasive and painful procedures. It takes time to absorb the reality of a situation.

But any nurse can tell you that, at some point, indecision becomes a decision in itself, one that can lead to many unwished-for consequences.

Seemingly unanswerable questions.It

The quotation at the start of this post is from this month’s Reflections essay, “What Joanna Would Have Wanted” (free until July 15). The story, by nurse Jennifer Chicca, MS, RN, evokes the overwhelming sense of responsibility faced by a thoughtful young man in the role of health care proxy to a beloved aunt.

How is possible to be sure what someone would want, or not want, when their end-of-life wishes have not been clearly spelled out ahead of time? […]

2019-07-01T15:50:47-04:00July 1st, 2019|Nursing, nursing stories, patient experience|1 Comment
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Does Everything Happen for a Reason? One Oncology Nurse’s Perspective

Does Nature Argue Fate? The Acorn Contains The Tree/
charcoal, pastel, and ink on paper/ Julianna Paradisi 2019

The human need to find meaning.

“Everything happens for a reason” is a saying I hear a lot in my nursing practice, from patients and coworkers alike.

The need to find meaning in the events of our lives, good or bad, appears to be a distinctively human trait. Ancient Greeks believed Clotho, one of the Three Fates, spun the lives of humans. In medieval times, Anglo-Saxons may have believed in wyrd, a concept similar to fate in our modern language. Elsewhere, the idea of karma teaches a cause and effect perspective on this life, and on future lives. These are only a few examples.

Learning to ask ‘why’ as a pediatric ICU nurse.

I began questioning if everything happens for a reason as a pediatric intensive care nurse at the beginning of my career. Asking “why?” is a natural response to watching a child suffer. Why is a baby born without a functional left ventricle? Why does an infant contract leukemia or a brain tumor?

Certainly genetics or environmental factors cause some cases. Regardless, it’s difficult to understand […]

2019-06-27T09:53:05-04:00June 27th, 2019|Nursing, nursing stories, patient experience, Patients|1 Comment
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‘Worth Its Weight in Gold’: The Small, Unexpected Triumphs of Nursing

“Nursing is a job that sometimes finds you investing emotionally in things you never expected to care about.”

How many times have you waxed enthusiastic at work about something that people who aren’t nurses would find weird, or even downright gross? Eyeing a patient’s Foley bag and exclaiming about how great her urine looks…praising a young man for coughing up gobs of sticky sputum….

Illustration by Pat Kinsella for AJN.

The challenge of obtaining a specimen.

In this month’s Reflections column, “Worth its Weight in Gold” (free until July 7), visiting nurse Jonathan Robb describes his efforts to obtain a urine sample for culture from an elderly woman who has minimal bladder control.

Most of us are familiar with the balancing act of obtaining a specimen under conditions that cause discomfort or embarrassment to a patient. We cajole and gently press for whatever has to be done, trying to maintain a relaxed atmosphere while hiding any urgency about completing the task that we might feel. This delicate pas de deux has the potential to be very stressful for both parties.

Robb’s sometimes comical descriptions of the contortions necessary to meet his particular challenge will ring true to nurses.

“…despite the fact that […]

2019-06-17T10:16:20-04:00June 17th, 2019|Nursing, nursing stories, patient engagement|0 Comments
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Healing Words: A Critical Care Book Club

I was always a reader. The days of the Scholastic book fair during elementary school were among my favorites. Although it doesn’t appear in my CV, my first job was working in the school store. With every shift I worked, the smell of blank sheets of paper, the thrill of a pencil awaiting to be sharpened to that perfect point, or the ballpoint and ink pens in a rainbow of colors stole my hard-earned quarters.

‘Is it on the NCLEX?’

But reading novels during nursing school was just plain hard. There were competing priorities, a brain brimming with vital information, and sheer exhaustion at the end of the day. Assigned readings presented an overwhelming amount of contextual information. And then there was the constant attention to evidence, protocols, and clinical practice guidelines. The “need to know” information took priority; the sheer pleasure of losing oneself in a story—whether novel or memoir—was lost.

During my senior year, in an advanced illness course, my professors assigned a novel-style memoir, Bed Number Ten by Sue Baier. To this day, I can remember the reactions to the assignment: “A book? Who has time for that?” “Are we going to be tested on this book?”

Or, most importantly: “Is it on the NCLEX?”

The influence of a patient’s story on a […]

2019-05-29T08:45:40-04:00May 29th, 2019|narratives, Nursing, nursing perspective, nursing stories|2 Comments
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In Nursing, What Does It Really Mean to Trust Your Gut?

The March Reflections essay in AJN touches on several big questions:

  • How can you tell if a patient presents an immediate suicide risk?
  • What do nurses really mean when they speak of ‘trusting your gut’?
  • And what are the limits of advocating for a patient when a nurse finds herself in potential opposition to a physician?

by Annelisa Ochoa for AJN

In “Mr. Blue and His Six Cats” (free until April 1), nurse Mariya Rader vividly and economically describes a series of tense events that occurred one shift in the ER where she worked early in her career.

The clock is ticking: should the patient brought in by EMS be discharged because he denies suicidal intent? We follow her persistent search for the right course of action through a series of encounters with the caring team of paramedics who brought him to the ER and are familiar with his ways, the inexperienced new resident physician, and the patient himself.

Trust your gut?

The author had always heard nurses say to ‘trust your gut.’ But what did it really mean?

Remember, I was still relatively new to nursing; I hadn’t yet learned to depend on myself. But I had this sick feeling deep down that I couldn’t shake. I […]

2019-03-06T09:59:32-05:00March 6th, 2019|Nursing, nursing stories|2 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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