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Mind Over Matter

February 3, 2012

I’ve been hearing the phrase, “mind over matter” since I was just a kid. Up until now I was a firm believer in that school of thought and believed in its powers.  Now, after a recent experience with a patient, I’m not fully convinced of its efficacy which has really made me contemplate the way I view medicine and nursing care.

Generally when I’m caring for patients in a lot of pain, feeling anxious and scared I pull the “mind over matter” bit out of my bag of tricks and coach my patients through guided imagery to think of places that make them feel relaxed and happy. Often I find myself asking, “Has anyone shown you the relaxation tv channel here yet?” Sometimes we talk about favorite music and TV shows and whatever distracts my patients from their ailments and it often works very well. In nursing school we learned that the use of guided imagery during acute distress may not be applicable, but I’d never seen it not work–until now.

The other day I cared for a patient suffering with what I would call severe anxiety. The patient was recovering from cardiac surgery and the anxiety was a secondary problem exacerbated by the hospital stay. My patient would hyperventilate and get so worked up that their oxygenation status would decline drastically, they’d be covered in sweat, and were barely able to articulate their needs. I like to think I am able to “talk down” patients suffering from anxiety attacks as I’ve been successful many times before. With this patient, I was unable to get them to respond to my “mind over matter” techniques. I tried providing massages, replacing cool cloths for the patient to wipe the sweat away,  turning on the relaxation station, repositioning, offering pain medications, administering ativan, coaching them through guided imagery and more. The patient didn’t really know why they felt anxious.

In the hospital, depending on the patient’s history and diagnosis, we like their oxygen levels to be at least 92%. For reference, a “healthy” adult without respiratory distress should be at about 96-100%. During my shift this patient’s oxygen levels would range from 85% to 90% even with oxygen therapy. My patient denied shortness of breath, difficulty breathing, headaches, and chest pain. It was difficult to determine if the decreased oxygen status was a result of pathological/physical findings (which was a possibility) or because the patient was so anxious, at times voluntarily holding their breath. I found myself sitting on the edge of my patient’s bed throughout my shift trying to get the oxygen levels to increase by titrating the liters of oxygen and providing relaxation techniques. Of course the MD was notified and respiratory therapy was on their way to evaluate my patient, but I felt defeated. After everything I tried, I could not get my patient’s oxygen level to the level it needed to be. My patient could not mentally focus on guided imagery during this time of acute anxiety and the anti-anxiety agents were the only thing that could help them during this time.

Prior to this situation, as mentioned above I really believed “mind over matter” and other relaxation techniques would work during these times, and I was skeptical of anti-anxiety agents and still am to some degree, but for this patient it was the right thing. At the end of my shift, the patient’s oxygen levels did increase to about 92% after working with the respiratory tech. I’ve learned that guided imagery/mind over matter, while extremely helpful in many situations is not always going to work during times of acute anxiety.

Aha! Doctors Are Real People Too!

January 25, 2012

The other day a fellow nurse and I sipped coffees while stuffing our faces with homemade bagels and pastries at a unique bike-friendly cafe that allows you to bring your dog in while you hang, sit for hours using free wifi, and shower. Yes, I did say shower. There is a bathroom with a fair-sized shower and a sign that reads, “feel free to shower, make a donation” above a tin can. This place is extremely bizarre, but really special. The warehouse style decor, paired with the extremely nice staff and good tunes always makes for weird, funny conversations. Interestingly we began talking about work at the hospital, comparing funny and sad stories about our experiences. Quickly, the conversation turned to our experiences working with doctors.

I recall her asking me, “Do you know Dr. so and so? Well he is said hi to me in the hall the other day.” I replied, “Wow, Dr. so and so said hi, to you?” Reading that sentence aloud as I type it sounds so incredibly silly. Dr. so and so is one of the residents at our hospital who is very nice to the nurses and works collaboratively with everyone. Despite his positive demeanor and inspiring work ethic, myself and other nurses find ourselves surprised when he says hello to us outside of a work conversation, for instance while passing by in the hallway. Going back to what I said in my previous entry, a hierarchy is often present between doctors and nurses. Because of this hierarchy, it makes simple events, such as a doctor asking how your day is going, seem monumental and shocking. Of course, this could all be attributed to the new graduate RN syndrome, where it feels like everyone is so much more experienced than we are and seemingly have better things to do than chit chat with us.

Anyway, back in the cafe, my fellow nurse friend also said to me, “Another Dr. so and so friended me on facebook! How weird is that?” As my jaw dropped I couldn’t help but wonder why that doctor would do such a thing. It was then that I caught myself…I realized I was guilty of contributing to the unnecessary hierarchy between doctors and nurses. If I didn’t like the hierarchy between nurses and doctors and wanted to do something about it,  I realized that I needed to send my own thoughts to the curb. I would never feel shocked if a respiratory therapist, case manager, social worker, fellow nurse or virtually any other coworker friended myself or another nurse on facebook, or said hello in the hallway, so why is it such a big deal if a doctor wants to become friends with a nurse? Doctors are real people too. Most of the time they are not big, scary, intimidating beings, and it’s unfair of nurses to treat them as such. Conversely, it’s also important for those doctors to treat the nurses with respect as well and not as subordinates, but I’m finding that more often than not in my new job doctors and nurses do work collaboratively with respect towards each other.

Just the other day I saw Dr. so and so running down main street and another Dr. so and so strolling the bike path with their significant other in street clothes, not in scrubs. It really is true, doctors are real people too!

What are the Rules?

January 15, 2012

In nursing school, or at least in mine we were always taught to respect doctors and there was always an unspoken hierarchy that was vaguely referred to in lecture, at clinical and in lab. My professors would speak of their experiences and encourage us to stick up for ourselves as nurses and for our patients, but there was still a strange fear present. Our professors would imply that many doctors were intimidating and not respectful to the nurses.

In one of my first clinical rotations in pediatrics I was waiting for a resident to change the written order for a dose of a child’s asthma medication that was due. As I waited for the order to be changed and the resident didn’t answer my page, I felt frustrated. This child needed his asthma medication and it had been decided during rounds that the dose prescribed to him was not working properly. When I saw the attending physician down the hall I thought, “I’ll just take initiative and ask him to please change the order in the computer since he is the one who dictated the order change to the resident.” I approached the attending physician and politely reminded him that the order hadn’t been changed and asked if he wouldn’t mind fixing it so I could give the medication. The attending physician looked at me with a blank look in his face and said, “I’m an attending, I don’t write orders. Residents write orders” as he walked away from me. At the time I thought, “since when are there rules stating who I can and can’t talk to? And if there are rules, what are they and why haven’t I learned them?”

I remember feeling dumbfounded. First of all, at that point in nursing school no one had ever explained to me that attending physicians are not the “go to” person to get orders changed, and also I thought to myself,  he’s a physician, he has an MD, he technically can change the order so why won’t he do it? The anger I felt in that situation made me want to yell at this doctor. What ever happened to the patient coming first? Anyway, as my professor learned of this incident she told me, “I understand you’re frustrated, but that is how things are. You can’t ask an attending physician to do a resident’s job.” Ever since that incident I was nervous about starting work as an RN. While I do respect the chain of command and of protocols, I believe more in what is right for my patient. I would never go out of my way to contact an attending physician, but if he or she is right in front of me when a resident is no where to be found, you better believe I’m going to ask him or her to do exactly what is within their scope of practice as an MD.

Now that I am working as a nurse, I have run into similar situations, but for the most part the attending physicians that work on our unit are pretty receptive of nurses, especially us new graduate nurses. I think the communication between doctors and nurses still needs to be revamped and improved. I don’t think it’s right for a nurse to feel intimidated by a physician, and at the same time I don’t think it’s right to assume a physician is going to be a jerk who won’t work well with the nurses. It seems as though both physicians and nurses could benefit from taking communication courses together to hopefully get rid of some of those stereotypes that some physicians believe to be true of nurses and vice versa.

Stay tuned for my next entry, “Aha! Doctors Are Real People Too?!”

Keep the Spirit of Love Alive

January 8, 2012

Recently my grandmother passed away. Since her death I have not been able to find the words to write another entry and it just didn’t seem ok to write about my day-to-day nursing thoughts while not addressing my grandmother’s death. I wasn’t ready to write about her until now, so here goes.

My grandmother was an amazing and stunning woman. She had a beautiful singing voice and many people thought she sounded exactly like Judy Garland. She had the most gentle touch and demeanor. My grandmother had so much love to share even when she was diagnosed with Parkinson’s Disease several years ago. She never complained about her debilitating illness. When it took away her ability to sing, my grandmother would still sing along to my grandfather’s piano playing while expressing so much emotion with her hand gestures, and her voice, though shaky still sounded beautiful.

My grandmother and I wrote letters to each other and in many letters, she would end it with, “Keep the spirit of love alive.” I find myself saying this everyday. I think of the saying when I talk to my parents, siblings, friends, and boyfriend and I repeat it to myself when a patient at the hospital frustrates me. The saying makes me feel close to my grandmother, as though she’s right there with me.

For me, experiencing a loss as a nurse feels completely different than it did before I was a nurse. Sure, the grieving process is still similar, but I found myself intellectualizing what was happening to my grandmother medically as she was passing. As my grandmother spent her last days in the hospital following her massive stroke (6 hours away), I questioned the doctors’ plan of care, the drugs they were or weren’t giving her, the decision to place or not place a feeding tube, and most of all I kept asking my mother on the phone, “are the nurses turning her in bed at least every 2 hours?” When my mom replied, “the LNA just told me that because she has the IV it’s hard.” My grandmother, a tiny woman, had one IV…Hearing this made me almost lose my mind. Where I work patients have chest tubes, multiple IVs, urinary catheters and sometimes multiple IV poles…and we still are able to turn and reposition our patients. After that my grandmother did in fact get repositioned in bed every 2 hours once my mother confronted the nurse.

It wasn’t until my boyfriend helped me to realize that in my trying to be a nurse to my own grandmother I wasn’t allowing myself to mourn the pending loss. He helped me let go and for that I am so thankful. I had to tell myself, “You are not at work. You are not a nurse right now” and in doing so, it helped me realize what my grandmother wanted and accept the situation to allow her to go in peace.

Now as I have returned to work, I think of my grandmother every day. I think of her when I am helping a patient wash up, or when I am turning a patient in bed. I think of her when I give meds to a patient or when I speak to a family member of a patient. Each time I try to imagine that the patients are my grandmother or my family members and remember how I felt when we went through our own loss. I can only hope that in my grandmother’s passing, it will help me to be a better nurse because it has certainly made me look at life, religion and family in a new perspective.

Don’t Get Pneumonia

December 17, 2011

Well, it’s finally happened, I’m sick. I had a nice long streak of being healthy. To be exact, 7 months free of colds! I knew getting sick was inevitable though; I just started the job at the hospital in September, am constantly around sick people and that with the cold weather setting in, well it’s a recipe for sickness! For the last 3 months of the new job all I have been saying to myself is, “just don’t get sick, whatever you do, don’t get sick!”

Unfortunately I did get sick, and no, it wasn’t a cold. I’ve got pneumonia. Pneumonia! What the hell is up with that?! Perhaps it was the worst, waking up at 5am with the chills even though I was wrapped up in my sleeping bag covered with a down comforter, and 3 blankets wearing a sweatshirt, pants and wool socks while my teeth chattered as loud as hail falling on a tin roof. After a minor anxiety attack over what was happening and a panicked phone call to my boyfriend at 5:30am who calmly explained that chills were part of infection  (he’s not a nurse) did my nursing voice come back into play and said, “Ok go get some Tylenol, drink some water, and wait for the fever to break” which it did, leaving me with an intense sweating situation, but we won’t get into that.

It was the above situation that made me succumb to the realization that I would need to go to the walk-in clinic at my place of work.  I was hesitant because after all, I’m a nurse; I know what’s wrong with me. Would they think I didn’t know how to take care of myself if I showed up to the clinic? Oh well, I had no choice I knew I needed antibiotics. Upon arriving at the clinic I refrained from telling anyone I was a nurse at the hospital. I didn’t say anything while they made me put on the hospital gown which was a bizarre feeling, took my vitals, and gave me a heated blanket. It wasn’t until the nurse rolled the COW (computer on wheels) into the examining room and began taking my medical history that I let on that I too am a nurse at the hospital. “Ohhhhh, you’re a nurse?” The RN said nurse with a sing-song tone, and sounded relieved as she said, “so you know all about this process then.” I could only nod. This was precisely why I did not want to mention the nurse thing. It felt so weird to be on the other end of the questioning and even though I was facing the back of the computer screen I knew exactly what cells on the computer the nurse was typing in.

After the doctor examined me and a chest xray confirmed that, yes, I do have pneumonia, I said, “why me?” desperate for an answer to put my mind at ease. “Hard to say” she said, “probably caught it from a patient. Take your antibiotics, get lots of rest and drink plenty of fluids” she explained while I started to panic thinking, “Oh no! I can’t miss work!”

Despite the many lectures spent talking about pneumonia in nursing school and the many days spent caring for patients suffering the at times debilitating illness, I still find myself surprised by how much pneumonia kicks your ass. Little did I know that on my sick days at home, pneumonia would still require me to be a nurse…to myself.

Upon leaving the clinic and heading home the echoing, phlegm-filled cough continued and I found the nurse voice in my head asking, “How productive was the cough? What color is my sputum? Is the blood gone from my sputum?” And then came the chest aches where I found myself over-analyzing every ache and pain in every crevice of my chest cavity where the little voice said, “What are the characteristics of the pain? Is it relieved when the coughing stops, or does the pain persist? Oh my God, I must be having an MI (heart attack).”

Now as I continue to recover, I see the difference between getting sick as a healthcare professional vs. a non-healthcare professional. In one way it’s nice to understand everything that is going on, but at the same time, it’s absolutely exhausting constantly wondering about what complication I could be experiencing next! I’m told this is the curse of the new nurse and that the hypochondria will pass. But what I want to know is how you don’t freak out when you actually do have an illness. Nobody teaches you that. Ok, I know that I’m getting better day by day, and that, come on it’s only pneumonia, but I just hope that in the future I can leave my nursing analysis for my patients at the hospital and let the providers at the clinic analyze my illness so I can get some rest. Moral of the story, don’t get pneumonia.

Stay tuned for more entries once I recover from pneumonia and am back at work getting new material to write about!

I am a Nurse

December 8, 2011

I recently traveled to New Jersey  to help my grandparents host a holiday party. Many of their long-time friends attended and I was the only attendee under the age of 50. The guests had a field day asking me about my life and what I planned to do in the future, and how my brother and sister were doing, and etc, and etc, and etc. In between setting up the food and handing out beverages to the 25 or so guests, one woman whom I’ve known since birth said to me, “Are you the one who works on that television show?” Trying not to sound annoyed and come across as rude, I politely said, “nope, that would be my older sister.” The guest then said to me, “Oh… [pause]…what do you do then?” “I am a nurse” I replied forcing a smile. The woman looked confused, her eyebrows slanted upwards as her mouth cocked to the side and she said, “A nurse? [pause] Oh [pause] I see.” “Yes” I proclaimed. “I love nursing, it’s an amazing profession and I’ve learned so much” I said trying not to show how annoyed I felt. I was about to launch into my spiel about how nursing is (often) a completely understated profession, but remembered I was speaking with an older lady who truly didn’t mean anything by what she said.  Instead, I chose to explain what my job description entails and what kind of patients I care for. After explaining what I do in the hospital the woman looked at me and said, “I didn’t realize nurses are responsible for so much!” Aha! Case in point!

This scenario turned out to be the perfect opportunity to tell people what nurses do! I realized that if I wanted to continue to raise awareness towards the nursing profession, in addition to the blogging, I must spread the word in “real” life too! Maybe next time I run into the woman from the party at another family function she will ask with interest, “how is work going at the hospital?”

Stay tuned for more entries!

Here or Up Above

December 1, 2011

I recently cared for an elderly patient awaiting a risky procedure. The procedure, if successful would reduce uncomfortable symptoms this patient was experiencing. The patient and family members were on board with the procedure and the patient was hopeful for a positive outcome, but had also accepted the reality of the situation.

It was later brought to my attention that the patient was documented as a full code status. A full code status means that in the event that something goes wrong during your stay in the hospital, the team will do everything in their power to bring you back, whether it’s through a ventilator to help you breathe, shocking your heart, etc. This patient had expressed serious concern over their status and desperately wanted to be DNR (do not resuscitate). At first this confused me because the patient was electing to have such a risky procedure done. Even so, the patient still wanted the procedure, but stated if an undesired outcome were to happen during the procedure, they by no means wanted to be kept alive.

After consulting with my preceptor and charge nurse I quickly contacted the patient’s physician and explained the situation to them. The physician came and assessed the patient and after talking with the patient, changed the code status in the computer to what the patient wanted. After this happened, the patient and family thanked me repeatedly while grabbing my hands with tears in their eyes. My patient looked me in my eyes, reached for my arms, and as my patient gently shook both my arms they said, “Dear you are something, I love you, you’re an angel.” For that moment in time my connection with my patient and their family members was very strong. We all held hands for probably only 15 seconds or so, but it felt like minutes. This experience validated what I already knew about nursing, that it is so important to advocate for your patients. Your patient’s wishes are one of the most important aspects of the care you as a nurse will provide.

 I don’t know the outcome of the procedure, and I’m uncertain if I ever want to find out.  I can still hear the voice of my patient in my head so clearly and witnessing the most positive outlook of my patient will always be a lesson for me to look on the bright side regardless of the predicted outcome of a situation. Whatever the outcome turned out to be, I can only hope that the patient is comfortable and at peace whether they are still with us or up above.