Patients Change Us: A Formative Nursing Experience

From boliston, via Flickr From boliston, via Flickr

Many years ago, I was given the greatest gift by a patient who had no idea he would change my life and define my professional outlook as a nurse. While not every nurse will be fortunate enough to have such an explicit experience of the effect of the care they provide so early in their career, I believe that each patient you come in contact with is changing your life as much as you are changing theirs.

Quantity of Care vs. Quality of Care

Nursing has evolved into a highly technical profession grounded in scientific evidence, a profession that works to improve patient outcomes and shorten hospital stays. Research and technology support this work in innumerable ways.

But while nurses must be technical experts, drug experts, and efficiency experts, they must also do their best to alleviate the suffering of those in their charge. These many concurrent demands can result in high burnout rates among nurses as well as fragmented care for patients.

The quantity of care today’s nurse provides must go hand in hand with the quality of care. My own definition of quality care is focusing on patients as more than just a set of signs, symptoms, numbers, and processes in need of monitoring and adjustment. Recognizing patients as individuals and making our time at the bedside meaningful is often as important as accomplishing our clinical goals.

Caring with Kindness

When I entered nursing, due to many personal constraints I was required to advance within the profession step by step, from medical assistant to licensed vocational nurse to registered nurse, until ultimately obtaining my master’s degree in nursing.

During the time I was in my registered nursing program, the hospital where I worked as an LVN experienced a strike by the registered nurses. The LVNs like me were asked to take varied duties. Since I was also in an RN program and close to graduating, I was placed under the direct supervision of an RN and physician to provide care in the ICU. The patient to whom I was assigned was a young man who had broken virtually every bone in his body in a motorcycle accident, had casts, open wounds, and was comatose.

While he definitely needed an ICU level of care, he was considered a “safer” choice for an LVN becoming an RN. Each day, his open wounds needed care and, despite his casts, he needed regular repositioning. I had never before cared for a patient with so many complex needs on a regular basis. […]

Are the Benefits of Nutrition for Cardiovascular Health Being Undersold ?

By Betsy Todd, MPH, RN, CIC, AJN clinical editor

By Eric Hunt/via Wikimedia Commons By Eric Hunt/via Wikimedia Commons

A nutrition conference at which physicians and medical students outnumber either nurses or dietitians is a rare event. This was the case at last month’s International Conference on Nutrition in Medicine: Cardiovascular Disease in Washington, DC, cosponsored by the Physicians Committee for Responsible Medicine (PCRM) and George Washington University.

The speakers, shared a wealth of data on the influence of different types of diets on weight, blood pressure, lipids, serum inflammatory markers, hemoglobin A1c levels, and diseased coronary arteries. More than one pointed out that we too often overestimate the benefits of drugs and medical procedures and discount the effectiveness of diet and lifestyle changes. Some highlights:

Does heart disease begin in utero? Children who are large for gestational age (> 95th percentile) and those born to overweight mothers are at increased risk for cardiovascular disease (CVD). Vascular physiologist Michael Skilton, PhD, associate professor at the University of Sydney in Australia, has also identified microscopic lesions in aortic endothelium of babies born small for gestational age (< 10th percentile). He suggests that their diets include the American Heart Association’s recommendations for omega-3 fatty acid intake beginning in childhood (breast milk, flax seeds, walnuts, or child-friendly omega 3 supplements can be used in lieu of fish-derived omega 3s when mercury is a concern).

Children and heart disease. Gerald Berenson, MD, director of the Tulane University Center for Cardiovascular Health, led Tulane’s Bogalusa Health Study in Bogalusa, Louisiana, beginning in the 1970s, and he and his team published dozens of pioneering articles on childhood risk factors for CVD. Berenson refers to childhood obesity, glucose intolerance, hypertriglyceridemia, and hypertension as a “deadly quartet” leading to the development of CVD early in life. He and his team instituted ongoing, comprehensive health education for elementary school students focusing on nutrition, exercise, cognitive behaviors, and self-esteem.

CVD risk reduction in children through diet. Michael Macknin, MD, professor of pediatrics at the Cleveland Clinic Lerner College of Medicine/Case Western Reserve, recently studied the impact of both the standard American Heart Association (AHA) diet and a plant-based, no-added-fat diet on CVD risk reduction in obese, hypercholesterolemic children and their parents. In just four weeks, the AHA diet led to statistically significant decreases in weight, mid-arm and waist circumference, and myeloperoxidase (MPO, an inflammatory marker for heart disease). The plant-based results were even more striking: statistically significant reductions in weight, cholesterol, and many other measures.

Adults and CVD. Adult research findings have been published for decades, including extensive documentation of the reversal of coronary artery occlusion as demonstrated by coronary angiography. (More than 20 years ago, angiographic evidence from the studies of Dr. Dean Ornish led to the first nonsurgical, nonpharmaceutical therapy for heart disease to qualify for insurance reimbursement.) Caldwell Esselstyn, MD, director of the Cardiovascular Prevention and Reversal Program of the Cleveland Clinic Wellness Institute, who reiterated the observation sometimes made that millions of people around the world who don’t eat as we do in the U.S. never develop CVD, emphasized as well that a no-added-oil, plant-based diet elicits a remarkably rapid response.  […]

September 14th, 2015|Nursing, personal health practices|0 Comments

Nurses Aren’t Just Healers, They’re Teachers Too: A Patient’s View

Illustration by Jennifer Rodgers. All rights reserved. Illustration by Jennifer Rodgers. All rights reserved.

A teeny red bump had mysteriously appeared on my left index finger. It hurt when I pressed on it. I figured it was nothing. . . .

That’s the start of the June Reflections essay in AJN, “Ms. Lisa and Ms. MRSA,” a patient experience narrative by freelance writer Shannon Harris. As luck would have it, the bump on her finger, it turns out, is not nothing. It’s MRSA.

The diagnosis takes a while. Finally the situation worsens, and surgery is needed. The author takes it all in stride, at least in retrospect:

The third physician stood out to me most. He asked to take a picture of my green and black, staph-infected finger with his iPhone. “Sure. Look at it! I thought this only happened to pirates,” I told him as he snapped away. He glanced at the young, button-nosed nurse standing beside him. “Don’t you want a picture? For your records?” he asked.

She shook her head, squinting and gritting her teeth. “I know. Yuck,” I said. I later shared photos of my infection journey online, to the great wonder and disgust of my friends and family. Before that, though, came surgery.

The author’s tone is light, but the situation is a scary one for any patient. […]

Strong Nurse and Patient Voices On the Blogs This Week

By Jacob Molyneux, senior editor/blog editor

Photo by mezone, via Flickr. Photo by mezone, via Flickr.

Here’s a short Friday list of recent smart, honest, informative blog posts by nurses, as well as a couple of interesting patient perspectives on prominent types of chronic illness and the ways they are talked about by the rest of us.

At Head Nurse, in “Yes…No. I’m Having Some Thoughts About BSNs,” an ADN-prepared nurse makes some familiar and some more surprising observations about the effects of the new policy of hiring mostly BSN-prepared nurses at her facility as it tries for Magnet status. For example, one of the effects she notes is “a massive drop-off in terms of the diversity of our nursing staff.” The move toward BSNs is obviously the trend in nursing, and is supported by research, but this doesn’t mean that there aren’t still two sides to the issue, or real unintended consequences to address as this change is gradually implemented.

At Hospice Diary, the blog of hospice nurse Amy Getter, there’s a post called “Hearts, Flowers, and Bucket Lists.” Reflecting on the imminent death of a patient, the author puts the popular notion of bucket lists into perspective:

“I think about some of the things I would still like to do in my life, and realize . . . . most of those wish-list items would be swept away in a moment, if I only had a little time this week. I would hug my kids harder and love more, and want to squeeze every last drop of time to put into my relationships that I will have to leave behind. “

Staying with the end-of-life theme for a moment longer, you’ll find at Pallimed, a very good hospice and palliative medicine blog, a new post with a to-do list that some of us or our loved ones really can’t put off until next month or next year: “10 Practical Things to Do When Diagnosed With a Serious Illness.”

Two consistently good nurse bloggers, both of whom have written for this blog or for the journal itself from time to time, happen to have reviews of books about aspects of nursing on their blogs this week. […]

Paired Glucose Testing With Telehealth Support to Empower Type 2 Diabetes Patients

Jacob Molyneux, senior editor

bloodglucosetestingType 2 diabetes is challenging for those trying to meet blood glucose target ranges, often requiring one or more daily medications, increases in exercise, changes in eating habits, and self-monitoring of glucose level. Those who are willing and able to learn about factors affecting their glucose level and to make small daily efforts in one or more areas have the potential to radically improve their sense of control over their diabetes.

This month’s Diabetes Under Control column, “Better Type 2 Diabetes Self-Management Using Paired Testing and Remote Monitoring” (free until April 1), presents a successful story of patient engagement in diabetes self-management. It describes the case of a participant in a clinical trial who, with clinician support, incorporated paired glucose testing (self-testing before and after meals) and telehealth (remote patient monitoring, or RPM).

The article is easy to follow and gives a series of biweekly updates on the patient’s progress. Before the study starts, she’s not very engaged in self-management. For example, she’s only testing her own glucose level three to four times a month. To get a sense of how much more empowered she’s come to feel by week 12 of the protocol, consider this brief excerpt: […]

February 13th, 2015|digital health, Nursing, patient engagement, Patients|4 Comments