Adapting to the Emotional Toll of Nursing

take2refectionsillustrationsept2016New nurses may find themselves confronted with great human suffering, enormous technical challenges, and the norms and pressures of the nursing profession and the individual workplace.

Most eventually learn the skills and knowledge they need to succeed in the profession. But some may struggle more than others with the emotional intensity of the work. A question that seems to come up a lot when nurses write about their work goes something like this: How do you keep caring as a nurse and not get burned out? How do you develop a resilient professional persona?

This month’s Reflections essay, How I Built a Suit of Armor (and Stayed Human),” by Jonathan Peter Robb, enumerates the challenges faced by a sensitive new nurse and the ways he found to protect himself over time. Here Robb, a district nurse for the National Health Service in London, England, describes one kind of challenge he faced:

The weight of being responsible for a person’s health wasn’t one I had prepared for. Sitting in lectures doesn’t train you for the moment when you’re standing at the end of a bed looking at a patient who is struggling to breathe, semiconscious (but who just last week was sitting up and talking), and thinking: Did I miss something? Is this my fault?

As Robb writes, “caring hurts.” Gradually he found himself building defenses that helped him to continue doing the work. Robb calls the development of these defenses “building a suit of armor,” one he can take off when he goes home to his family—but as he describes the process, it seems clear that he’s never allowed himself to slide into callousness about his patients.  […]

September 14th, 2016|Nursing, nursing perspective, Patients|0 Comments

On the 15th Anniversary of 9/11, Lingering Pain

Skywards by aussiegall / Louise Docker, via Flickr. Skywards by aussiegall / Louise Docker, via Flickr.

Yesterday was the 15th anniversary of the September 11 attacks.  On my way to work in Manhattan on Friday, I listened to a radio program about the lives of some of those who were involved one way or another in the tragedy of that day.

I heard the shaky voice of a Boston airport ticket agent who had assisted one of the hijackers to get on one of the flights that struck the World Trade Center. He’s met some of the victims’ family members and say that he still feels tremendous guilt and suffers from bouts of depression, especially on anniversary dates. He now works for Homeland Security. […]

September 12th, 2016|nursing perspective, Public health|0 Comments

Viewpoint: Some Arguments for More Autopsies

Detail from Rembrandt's 'The Anatomy Lecture of Dr. Nicolaes Tulp' Detail from Rembrandt’s ‘The Anatomy Lecture of Dr. Nicolaes Tulp’

When families ask whether they should get an autopsy, what will you tell them?

When I was a nursing student at the University of Michigan, we learned anatomy by working on human cadavers. The experience left me with a deep appreciation for the beauty of the human body (even when ravaged by disease) and fundamentally shaped my view of a nurse’s role in health and healing.

The Viewpoint essay in the August issue of AJN,When Families Ask About an Autopsy,” reemphasizes the role of the human body as a teaching tool. Author Billie Holladay Skelley points out that autopsies can also

  • provide definitive answers about the cause of death (offering reassurance to family members).
  • reveal undiagnosed genetic conditions.
  • improve our understanding of diseases and disease trends.
  • and foster advances in treatment.

Virtual or minimally invasive autopsies may be more acceptable to some families while still offering some of the benefits of a full autopsy. […]

August 19th, 2016|Nursing|0 Comments

Nurses Take Action on Moral Distress (Updated Post)

Nurses gather at the Johns Hopkins School of Nursing to address this growing problem.

A nurse struggles to reconcile repeated surgeries and transfusions for a premature infant with the child’s slight chance of survival. An oncology nurse knows a patient wants to refuse treatment but doesn’t do so because his physician and family want him to “fight on.” A nurse on a geriatric unit knows she is not giving needed care to patients because of inadequate staffing.

From left, Katherine Brown-Saltzman, Kathryn Trotochaud, Lisa Lehmann, Heidi Holtz From left, Katherine Brown-Saltzman,
Paula Goodman-Crews, Lisa Lehmann, Heidi Holtz

Situations like these are not rare for nurses and often give rise to moral distress—that is, when nurses recognize their responsibility to respond to care situations but are unable to translate their moral choices into action.

Moral distress in nursing has risen to unprecedented levels, contributing to burnout and staff shortages and imperiling safe, quality health care.

Seeking solutions.

Nursing researchers, clinicians, organization representatives, and other stakeholders convened in Baltimore on August 11-12 for an intense invitational workshop called State of the Science Symposium: Transforming Moral Distress to Moral Resiliency in Nursing. The meeting focused on how to best address moral distress.

The 46 participants heard from experts on what’s known from research and what’s still being debated, potential avenues for study, and what, despite the dearth of hard data, appear to be promising practices for dealing with moral distress. (For more on the intersection of moral distress and moral resiliency, see “Moral Distress: A Catalyst for Building Moral Resilience” in the July issue of AJN.)

After identifying what seem to be the essential elements of helpful initiatives and models, participants worked in groups to brainstorm strategies for developing resilience and creating healthy work environments that will promote safe, quality care for patients and their families. […]

August 16th, 2016|Nursing, nursing perspective|0 Comments

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