NR 393 Discussion Reflection on Careful Nursing

Oh man do I have a great example of how my nursing education affected a patient’s healthcare decisions! At one of my SNF’s, there was an older gentleman who came to us with second-degree renal failure, moderate liver failure, COPD, and risk for diabetes. One day, while doing rounds, there was a very strong smell of marijuana down one of the hallways, and it was brought to my attention by multiple staff and patients. At this point, I had a good relationship with the suspected patients, as there were 2 people staying in the room where the odor was coming from. I went into the room, and point-blank asked – “who’s is it? I don’t care that you have it, that you smoke it, or whatever excuse you are going to give me to cover this up.” Of course, the suspected patient owned up flushed it in front of me, and it was never an issue again (at the facility). I started to notice that this patient would go out nearly every day, and come back just a little too happy, if you know what I mean. As this was a little more than I felt comfortable to handle, I brought it up to my superiors and it was decided that every time this patient went out, he would be immediately tested for any drugs of abuse and alcohol – or they were at risk of losing their residency within our facility.

This patient pulled me aside and asked me, “why y’all being so harsh. It’s just some beer and weed with friends”. I told him that after my shift was over, I would spend some time talking with him about why these behaviors are so risky, and unacceptable at our, or any, SNF. What he chose to do in his own home was on him, but these behaviors were strictly forbidden during his stay with us. After the shift change, I kept my promise. I explained to the patient all the current health issues were worsening with the use of drugs and alcohol, and how it was negatively affecting their health. We went to the patio, where no one could hear us but I was still in sight of another nurse. I spent probably an hour with this patient, dumbing medical terms down to everyday English so that this patient could understand why we were so strict. The patient complied, actually reversed a lot of liver and kidney damage, and was able to come off oxygen once he was discharged some weeks later. They came back to the facility a few weeks after discharge and asked for me. The patient explained that no one had ever taken the time to explain why behaviors such as drinking a few beers with the crew and taking a few hits of pot could be so dangerous to the body. The patient had returned to tell me that they had just had the best checkup in years. Liver, and kidneys continuing to recover – and that since the day I took the time to sit down with them – they hadn’t even touched a cigarette. While it may be a time-consuming process, sometimes a little bit of humanity to our patients can truly make a huge difference. I know beyond any doubt that my time that day probably gave this patient years on their life – and so did they.

I had a patient that was bordering being diagnosed as a diabetic. I used my education for prevention of diabetes to explain to the patient what she needed to do to ward off this condition, before it became worse. She told me she has been borderline for sometime, and now the doctor was saying that it had to be called what it was, and move to a plan that included insulin coverage. Of course, hearing about insulin coverage made her open her eyes more. She told me she has been battling her weight for sometime, gets no exercise, and has high blood pressure. She was easy to talk to as she was about my same age. In short, I went over diet and exercise with her, and explained how these factors can affect diabetes and her high blood pressure. I also gave her some more medical information as in how the pancreas works and how sugar is stored and used in the body. I even showed her pictures of how diabetes can affect parts of the body, such as the feet and toes, which were not pretty, and explained about neuropathy. These were all of course factors that the doctor had been telling her over the years, but the motivation to lose weight and exercise did not ever stay long with her, so she continued to fail. I suggested that she try a weight loss group or friend for motivation. However, I believe that in learning about insulin being a part of her life and the pictures that I showed her, she appeared to take diabetes more seriously. She thanked me before she left the hospital for taking time to talk with her and said she was willing to make changes. I have not heard about her or from her since she left the hospital, but she did appear to be willing to make changes. I hope she did.

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I thought it was interesting to see how you compared the transmission of health education in Catharine McAuley’s time as compared to today. I feel like today if you have any sort of symptoms you can easily access the Internet or phone call a doctor where as you are correct that in her time they would have had to print it and word of mouth would have been how they communicated with each other. I think that there has been much advancement in healthcare but I never thought about improvements in technology allowing information to be dispersed at a quicker pace. This is an interesting year especially to think about it because of the pandemic. We knew about the pandemic before it was even present in the United States because of technology and the Internet where as in her time they would have had to wait until the news came by boat or even worse, wait until it was infecting people around. When I thought of health education I thought about teaching about taking care of yourself where as you are also correct that information is only useful if it can be shared with others.

For McAuley’s 10 concepts of careful nursing, I chose to discuss self-care. I think given the current events ( particularly in my area of central PA) it is a timely discussion. Mother McAuley was a nun and educator of the poor. I think it was incredibly insightful that at that time, even a charitable nun recognized the need for nurses to care for themselves, so that they may care for others. Last week I went to renew my BLS certification. the instructor knew all of us very well, as we have all worked together for a long time. Her opening statement made an impact on me. She said the first rule of BLS is to check the scene to make sure it is safe. In the setting of the COVID surge that we are seeing, that means to check to make sure you have the PPE, check to make sure you are safe to go into the room, and check your colleagues to make sure they are safe too. We are usually so focused on compressions, pulses and breathing, and the patient’s condition, self-care to ensure that you are safe during the scenario.

Self Care is something I think that we are nurses need to recognize and work on. I know that I am guilty of this as well, taking extra shifts, working 12 plus hours without a break, and missing time from my family. I think we all just expect that it is part of the job. However, I think this is one of the biggest contributions to medical errors is fatigue. When I transferred to the ER/ trauma team, our supervisor had us all on a break schedule, because we all had to be ready to go at a moment’s notice. It was the first time in my nursing career where I was told to actually take my break. Personally, I recognized that I was making fewer errors and was more accurate and able to deal with the trauma when I was able to get a break and eat. Looking at my own career in nursing and seeing that they were able to recognize this back in the early 1800s demonstrates how hard nurses have been working since then. Now our area in Pennsylvania is experiencing a surge in COVID that is worse than the first wave and our ICUs are full. The concern for nurse burnout is real. This is not a new aspect of nursing, however, with the current environment, I think this topic will continue to be a central issue for all nurses during this pandemic.

I love that you chose self-care. I recently had come across an article about why a lot of nurses are overweight, and that it was central to a lack of self-care. As you said, we work 12+ hours without a break, caring more for our patients than ourselves. Instead of ensuring 10 minutes to eat a decent, healthy snack, we grab what is quick, easy, and what can be eaten on the run – sometimes literally. I have recently had some health issues, and was on a lot of steroids, and gained way too much weight. I try now to ensure I have healthy snacks with me, such as pre-peeled fruit, vegetables, or protein bars and shakes. Quick, easy, and can be eaten at the desk while we chart (just don’t tell Joint Commission)! We do our best to ensure that our patients are getting the best self-care possible, but we forget that we can’t take care of our patients unless we are taking care of ourselves. This is even more true right now as we deal with a new strain of the SARS virus, and we don’t know yet the exact implications in which it affects the human body. We know some, but every day it seems like a new acute symptom emerges, or a new long term side effect is noted. We can’t take care of others if our tank isn’t taken care of – and it’s especially true if we get sick!

Even before we were challenged by the pandemic nurses were bad at taking breaks. I wonder how the culture of not taking a break started. As a bedside nurse, this was always a challenge. I can honestly say that sometimes it was frowned upon by peers, because they didn’t want to cover another patient during break time. Sometimes it was the nurse who didn’t want to break, feeling that nothing could be left undone. As a manager, this was a continuous struggle. Sometimes breaks led to overtime on the back end. But then not taking breaks led to nurse burnout and errors. However, I see some departments such as the OR, that are excellent at taking the assigned breaks. How can you be a positive influence in changing this culture?

Thanks for sharing

I think self-care is very important for nurses which may be easily overlooked at times. Having that assigned break sometimes is the only way to assure that you can take a few minutes to sit and clear your head and hydrate yourself while running in such a busy environment. Our patients need us to be focused and at our best so we can provide the care needed. Your analogy said it best regarding BLS and making sure that the scene is safe first. Safety comes first and if we do not take care of ourself we will not be able to help anyone. This pandemic has been very challenging for everyone especially on the front lines in an emergency department. The organization I am at did not allow any personal time off for the height of covid and instead people worked around the clock for days on end. I do not think that was the best solution, but due to everyone getting sick one by one we all had to pull together and do what we needed to so I can understand how we end up neglecting other aspects in our lives. What I have learned works for me is that scheduling is the key, if you stick to it. For example, blocking off an hour or two for myself in my calendar as an appointment gives me some time to regroup and do something with my family or just time for me to relax at home.

I think self care was a good one to choose as well because of all the burn out with Covid 19. I have heard that places are running out of PPE and having to reuse them. The facility that I work at is reusing N95 masks currently. Not only have nurses had to deal with shortages in PPE but in staffing ratios as well, making it unsafe. Nurses need days off and time to themselves without feeling guilty. I think nurses forget to take care of themselves a lot, sometimes we even go without lunches to continue to care for others. It is important to remember self care and how our health and well being are also important in order to keep taking care of others. All the way back to the 1500s people looked as nursing as selfless: “Men and women who provided nursing care were viewed as altruistic and self-sacrificing.” ( Judd, 2013) We all have been guilty of not taking care of ourselves and I agree it’s something we all need to work on. Great post! Judd, D. (2013). A History of American Nursing. [VitalSource Bookshelf]. Retrieved from https://online.vitalsource.com/#/books/9781284044324/Links to an external site.

Thank you for sharing your post. I absolutely agree with you on how important it is to provide self-care. There is only so much we can do as nurses for our patients if we are not at our best physically and mentally. As professional health care providers, we are dedicated to serving others that we tend to neglect our own needs and healing. And when we do not check in on ourselves from time to time, we fail to properly de-stress. During my hospital shifts I noticed that when I did not check in on my needs often, such as hydrating when needed or getting something to eat, I would find myself low in energy, easily frustrated, and not in the best mood. This can easily be sensed with my coworkers and the patients I care for. And this could easily lead to tension and poor performance in the work place. When we are caring for any individual, we do not only care for their physical and emotional needs, but also their mental and spiritual needs. Without addressing all of these aspects in our patients, we cannot provide the highest standards of care. Each aspect is just as important as the next, and they are all connected. These aspects also apply to us nurses. And when we neglect to address our emotional and spiritual needs, especially in the work place, it can lead to additional stress (Crane & Ward, 2016). Unchecked stress hinders the quality of care we provide to our patients and the work place dynamics.

References:

Crane, P. J. & Ward, S. F. (2016). Self-healing and self-care for nurses. AORN journal, 104(5), 386–400. https://doi.org/10.1016/j.aorn.2016.09.007

NR 393 Discussion Reflection on Careful Nursing