jen promesJennifer L. Promes is a gerontological clinical nurse specialist and Magnet Program director in Omaha, Nebraska. In this post, she describes an experience she had early in her career while working as a certified nursing assistant in a nursing home’s memory support unit.

Daniel had a kind, mild-mannered disposition, but because of his advanced dementia he would sometimes become agitated and belligerent, especially at night. Most of the staff didn’t want to help him prepare for bed. I knew Daniel was much more cooperative if you distracted him by talking about his past, so one night I volunteered to help him with his personal care.

All of the residents had just finished their evening meal and were waiting patiently at their tables to be assisted back to their rooms for the night. As I approached Daniel–a short, stocky bald man in his late 80’s with thick-rimmed glasses, always dressed in a button-up flannel shirt, polyester slacks, and square-toed, diabetic shoes—I could tell he was “working on something.” He had a table knife in his hand and was prying at the seam between the two leaves of the table. He was quietly muttering something under his breath as he worked, his head nodding as he grew more tired.

Daniel would “fix” anything he could get his hands on. A farmer in his younger life, he had many years of experience with problem solving. After watching him for about a minute, I told him that he’d better get to bed so he could get up early in the morning to feed his cows. Seeming to accept my reasoning, he put the knife down.

I pushed his wheelchair into the bathroom in his room and suggested he wash his face and brush his teeth before bed. Expecting an agitated response, I was surprised when he agreed to my suggestion. I thought it would be best to continue to engage him in discussion about his farm while helping him get ready for bed. As we talked he didn’t seem to notice me helping him onto the toilet or helping him brush his dentures.

I guided him back into his wheelchair, took off his glasses, and washed his face with a warm washcloth. As I moved the washcloth over his cheeks he looked up at me and said, “That’s warm . . . that’s nice.”

In that moment I looked directly into his eyes, which were more grey than green and had pretty advanced cataracts. I had the sudden impression that I could see the dementia in his eyes. Looking past the cloudiness of his lenses deep into his eyes, I found nothing but a dark empty blankness. It was as though he didn’t see my face in front of him at all—his eyes didn’t deviate from their forward stare. An eerie feeling washed over me, as if I were standing in the presence of a ghost. […]

Summertime: Time to Write

karindalziel/ via Flickr Creative Commons karindalziel/ via Flickr Creative Commons

July 4th has come and gone and summer still stretches out before us. For many, summer is a time to relax and take things a bit slower. Working moms and dads don’t have to deal with school projects; faculty have no or at least fewer classes to teach. It’s the perfect time to write—or at least start—that article you’ve had on your “To Do” list for the last year (or two or three).

Many budding authors tell me that the hardest part about writing is getting started, so here are suggestions from a pair of editors and writers who teach writing workshops (included, along with several other writing tips, in my 2014 editorial on the topic):

  • Set a consistent time to write, even if it’s only 15 minutes a day. Make an appointment with yourself and honor it as you would an appointment with someone else. Make yourself sit down and write—and write anything to begin; you don’t need to start at the beginning or do an outline. Once you get rolling, you can always write for a longer time.
  • “Start anywhere, but start. And keep your hand moving, whether you’re using a pen or a keyboard. Whether it’s because of muscle memory or the mind–body connection, this works. Random thoughts will morph into coherent sentences, which you’ll later organize into paragraphs; before you know it, you’ll have 500 words and a good start to a short essay or an article.”


July 11th, 2016|career, narratives, Nursing|1 Comment

AJN News: A Role for Nonmedical Workers, Adult Vaccinations Revisited, Teen Pregnancy Drop, More

AJN’s monthly news section covers timely and important research and policy stories that are relevant to the nursing world. Here are some of the stories you’ll find in our current issue (news articles in AJN are free access):

A community health worker meets with a patient in Baltimore, Maryland. Photo by Francis Ying / KHN.

Nonmedical Workers: A Growing Asset to Communities

Outcomes improve, costs drop, and nurses’ workloads benefit when nonmedical community health workers are available to serve as liaisons between health systems and patients. Programs to train more of these workers are gaining attention in states across the country.

Revisiting the Adult Vaccination Schedule for Tetanus and Diphtheria

Results of a new study reveal that most adults remain protected from the two diseases for 30 years without booster vaccination—and call into question the potential benefits of a modified adult booster vaccination schedule.

Teen Pregnancies, Births, and Abortions Slow

Two new reports show that the birth rate among U.S. teens has dropped to its lowest point in three decades; the percentage of teen pregnancies ending in abortion also reached a historic low. Researchers attribute the downward trend to teens using birth control more often and waiting longer to have intercourse.

Rosalind LaRocque rallies outside of the Supreme Court in Washington DC. Photo by Jacquelyn Martin / Associated Press. Rosalind LaRocque rallies outside of the Supreme Court in Washington DC. Photo by Jacquelyn Martin / Associated Press.

Unions’ Right to Collect Nonmember Fees in Limbo

Due to a vacancy on the Supreme Court, a March decision on unions’ legal ability to collect fees from workers who aren’t union members resulted in a four–four split. The absence of a ruling means that the Court’s earlier ruling of the practice’s legality still stands—but a rehearing has been requested, which could drastically affect the future actions of nursing unions. […]

Is It Time to Retire the Term ‘Midlevel Practitioner’?

Rachel_Scherzer_photo_and_calloutWhat are the implications of calling advanced practice nurses “midlevel practitioners”? According to Rachel Scherzer, a nurse educator and critical care nurse, such a term pigeonholes APNs in an implied (and disproven) hierarchy of value and quality of care rather than in relation to specific competencies and expertise.

In the Viewpoint essay in the July issue of AJN, Scherzer describes some of the reasons why such terms aren’t just inaccurate, they damage the standing of the profession:

Policymakers use the term while developing health care policy, health care economists use it when reporting data and performing cost analyses, and other health care providers use it in the clinical setting. . . . This term is both diminutive and inaccurate, implying that these professionals cannot provide the same level of care as other members of the interprofessional care team. Referring to APNs as “midlevel” practitioners contributes to a general misunderstanding of their role and of the services they provide.


The View from the Other Side: When the Daughter is a Nurse

I knew where we were heading and it scared me. I didn’t want to have to think about decisions that would have to be made in the not so distant future. I didn’t want to be a nurse; I just wanted to be the daughter.

Flowers_in_the_field_(5832054482)I knew Marie was special the moment I met her. Her home was one where all were welcome, the coffee always hot and fresh, the house filled with family and friends, and everyone left with a full belly. She freely shared her opinion, whether or not a person sought out her advice.

I knew Marie for nearly 30 years. She was my mother-in-law. She was also my cheerleader, proud that I had come so far in my nursing career. She told everyone I was a nurse and often referred to me as her daughter rather than specifying that I was her daughter-in-law.

Fiercely loyal and loving of her large family, she always put their needs before hers. I worried about her because she smoked and rarely visited a doctor. With regard to health, she believed in the notion that if it ain’t broke, don’t fix it. But slowly, health problems began cropping up. After a hospitalization for heart failure, she was diagnosed with COPD and hypertension.

Still, she lived life much as she always had—until she had a stroke. After the stroke, she lost the vision in one eye and the full command of her body. But in reality she lost much more. She could no longer drive and became dependent on her husband and children for things she once did freely and independently.

Her helplessness made her sad and angry, despite our assurances that we were a family and would do this together. And we did for the next 16 months, an exhausting cycle of hospitalization to rehabilitation to home and back again as her health deteriorated.

My father-in-law tried to do it all. He needed help, but he refused—the cost, the stranger in the house, the feeling that he was supposed to do all this himself. My sister-in-law visited him every day and would help her mother and father with the day-to-day things that constantly need attention. I visited regularly as well, taking charge of what I did best—medicine, doctor appointments, assessing whether or not she was stable, and cooking her favorite meals.

Navigating the endless appointments, the medication regimen too complicated for anyone but a nurse to figure out, watching my father-in-law struggle that his beloved wife was not the same, and the ups and downs with her health took its toll.

I knew where we were heading and it scared me. I didn’t want to have to think about decisions that would have to be made in the not so distant future. I didn’t want to be a nurse; I just wanted to be the daughter. […]