For the Mentally Ill in Crisis, Someone Safe to Call for Help

A troubling encounter.

by julianna paradisi

Although it happened over two months ago, I’m still haunted by the memory, particularly during this cold, harsh winter following on the heels of a politically tumultuous summer and fall.

I’ve run the same loop along the Willamette River in Portland, Oregon, for years. This particular morning, a young man walked some 20 feet ahead of me on the sidewalk. He carried by its neck a 1/2 gallon jug of apple juice. Unexpectedly, he tossed an opened box of granola bars, with several individually wrapped bars inside, to the ground and kept walking.

He stopped abruptly at the same time I stopped to wait on the curb for traffic to subside so I could cross to the other side of the street, which is what I routinely do on my route.

We were now six to eight feet apart. From my peripheral vision I noticed him turn and face me. Because we’re in the middle of a pandemic, I was wearing a mask; this and my proximity seemed to disturb him. I stepped away a few paces, giving him more space.

Over my shoulder he said, “You’re a bitch.” I ignored him. He stepped closer, and repeated more loudly, “You’re […]

2021-02-25T10:54:11-05:00February 25th, 2021|mental illness, mental illness|0 Comments
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With Severe Mental Illness, A Vicious Circle of Stigma and Lack of Support

Although psychiatric facilities no longer treat patients the way movies like The Snake Pit and One Flew Over the Cuckoo’s Nest depicted, society’s treatment of people with mental illness is still lacking.

As a psychiatric nurse practitioner, I provide care for patients coping with the challenges of mental illness. Symptoms are often painful, life altering, and frightening. Sadly, patients experience additional suffering from the guilt, shame, and social isolation that comes with having a psychiatric disorder. That’s because mental illness continues to carry a stigma that inhibits people from seeking help and limits the amount of services available for those who do seek it.

Had they received the support they needed….

In this month’s Viewpoint in AJN, Juliet Hegdal, a family nurse practitioner, discusses the impact severe mental illness has on patients and their family members. The author shares what it was like being raised by a mother with schizophrenia and the lack of resources available to her and her family. She posits that her mother and society would have been better off had she received the support she needed. […]

2021-02-23T13:48:16-05:00February 23rd, 2021|mental illness|0 Comments
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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
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Decreasing ED-Acquired Pressure Injuries

Perfect candidates for developing pressure injuries.

The photos of EDs crowded with patients waiting for admission at the height of the COVID-19 surges brought back many memories of clinical days in Bellevue’s ED. But even on our worst evenings, it was never like what I saw in those photos in the news media. And in some places, the ED hallways still have lines of stretchers with patients waiting to be sent to units.

In busy hospitals, patients can wait hours, sometimes a full day, on stretchers in the ED, waiting to be sent to a patient care unit. And we know that if they are being admitted for inpatient care, they usually have complex medical needs—many of these patients may be unable to ask for help, be incontinent, or unable to move themselves. These patients are perfect candidates for developing pressure injuries (PIs).

PIs can develop in a matter of hours.

As an article in the February issue of AJN notes, pressure injuries can develop in a relatively short time (the authors cite studies that found hospital-acquired PIs can “occur in as little as two hours of unrelieved pressure”).

The article, “Pressure Injury Prevention in Patients with Prolonged ED Stays Prior to Admission,” details how a nurse-led evidence-based practice (EBP) team sought to decrease hospital-acquired pressure […]

2021-02-16T14:23:23-05:00February 16th, 2021|Nursing|0 Comments
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The Emergence of Sacred Space and Time in Hospice Care

I knew he was close. His breathing had changed, but I also knew it could be hours. It was 4:30 on a Friday afternoon and I was ready to be done with my week. The apartment was full of friends and family, full of an energy that was neither nervous nor productive. It felt like the buzz of being. The man’s wife and daughter were in the bedroom with him.

In the February issue Reflections essay, “The Car Ride Home,” author Paige Fletcher movingly evokes an episode from her experience as a hospice nurse. This one-page essay, which will be free until the end of February, is written with unusual clarity and restraint and is well worth the five or 10 minutes it takes to read it.

Fletcher writes convincingly of a sense of sacred space and time that can emerge as a life ends in a supportive home hospice setting. And she describes her […]

2021-02-16T15:30:52-05:00February 12th, 2021|Nursing|0 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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