DiversityNursing Blog

A nurse scientist and an engineer created a smartphone application for patients with heart failure — and the patients participating in a pilot study said they’re finding it useful in helping them make the right choices about their health, according to an article published online by the University of South Florida in Tampa.

Called HeartMapp and now copyrighted by USF, the device can be used on Android smartphones by patients with congestive heart failure.

Ponrathi Athilingam, PhD, assistant professor at the USF College of Nursing, and Miguel Labrador, PhD, professor in the Department of Computer Science and Engineering at the USF College of Engineering, created HeartMapp. Their goal was to improve patient self-care and reduce costly hospital readmissions.

“As a cardiology nurse of 25 years, I know that patients with heart failure, who must follow an intricate medication regimen and self-management practices at home to stay healthy and prevent getting admitted to the hospital, struggle with self-care,” Athilingam said in the article. “After patients leave the hospital, they are alone. However, they do have a phone as a companion. So, we developed this easy-to-use, patient-centered technology to help them keep their heart health on track.”

Monitoring vital signs

The app has six modules which help patients monitor their vital signs, perform breathing and walking exercises, take their medication, read educational information on heart health and see how they’re doing. The app also reminds them to check their weight and blood pressure in the morning and assess any symptoms.

Patients check the app to see if they’re in the green, yellow or red zone. The green zone means they’re doing fine, according to the article. “The red zone means they’re gravely ill and need to immediately go to the hospital,” Athilingam said in the article. “But the goal is to have patients note when they’re in the yellow zone so they can contact their physicians and work to get back to the green zone, she said.

Athilingam and Labrador are testing HeartMapp with nine patients from the USF health cardiology clinic, and USF hopes that will lead to making the app commercially available, according to the article.

The app creators also wrote several articles about small studies they’ve done regarding the app’s usage.  In one study, they surveyed 25 patients with congestive heart failure and 12 healthcare workers via questionnaires.  In that study published by the journal Applied Nursing Research, the authors, which included Athlingam and Labrador wrote that “patients reported moderate self-confidence in using HeartMapp.”

They also wrote in the abstract: “The healthcare members demonstrated high confidence in recommending HeartMapp to patients and in utilizing data from HeartMapp for clinical decision making.”

To be successful in their role, nurses have a long list of skills and traits they must possess. Yet some days it can feel as if they need one more: mind-reading.

Patients aren’t usually the best at communicating what they want. This is somewhat understandable, however, since it’s intimidating to be in any unfamiliar situation, let alone one as stressful as a hospital stay.

1. Transparency

Most of your patients will have limited to no clinical knowledge, which means they might not even know what they don’t know. While they may not fully comprehend the complexities of every procedure or medication, the patient doesn’t want to be kept in the dark about their treatment. You certainly don’t want to overload them with terminology or the mechanics behind each medical device but you also want to keep them as informed as possible.

It’s reasonable to assume “ignorance is bliss” for patients (especially if their treatment is particularly overwhelming) but trying to protect patients by restricting what is communicated regarding their care prevents them from making the best decisions about their treatment.

Make sure the lines of communication are open between the care team and the patient as well as their family. If lab results indicate a change in the patient’s condition (be it minor or major, negative or positive) let the appropriate care team members know as soon as possible so they can inform the patient. If a procedure will be delayed, inform the patient and give them your best estimate of how long they will have to wait.

2. Respect

Every member of the hospital staff has a busy schedule from the moment they walk in the door each day to the moment they leave. Nurses have many patients for which they are responsible, so sometimes small courtesies can be sacrificed in the interest of efficiency. Though the nurse may not intend to offend a patient by quickly entering a room, checking their vitals and moving on, the patient may not realize the full scope of the nurse’s responsibilities and interpret this as disrespectful.

Nurses and other healthcare providers can do a few simple things to show respect to patients:

• Knocking before entering a patient’s room
• Introducing him or herself
• Addressing the patient by his or her preferred name
• Explaining the purpose of their visit
• Ensuring the patient understands how to contact a nurse and navigate the hospital

Patients also want to be consulted on their condition and have their concerns acknowledged. While sometimes patients may feel it necessary to share information that isn’t necessarily relevant to their treatment, they’ll still appreciate you taking the time to listen to what they have to say. Plus, a minor complaint they happen to mention in passing might indicate a more serious issue that may have gone unnoticed had the patient not brought up the symptom.

3. An Invitation to be Involved

Inviting patients and their families to be actively involved in making decisions about the patient’s treatment is an important part of patient-centered care. Provide patients with helpful resources and tools and help guide them through the decision-making process. Patients want to feel as if they are truly a part of their care team and aren’t simply following orders over which they have no say.

Ensure the patient feels comfortable asking questions. Encouraging patients to ask questions allows them to feel more in control of their care and helps prevent potential treatment compliance issues due to misunderstandings.

Not only will this practice help patients, but research by U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality has also shown that engaging patients and their families had the following benefits for hospitals:

• Enhanced financial performance
• Higher CAHPS scores
• Better patient outcomes

Ultimately, your goal as a nurse is to provide the best experience for your patients. You’re committed to administering high-quality care and being candid, showing respect and encouraging involvement can also help increase patient satisfaction.

1. Nursing Central

Unbound Medicine’s award-winning Nursing Central app is available on Android and iOS devices. Users are satisfied with its extensive drug and disease information. Nurses and students are able to work more efficiently thanks to Nursing Central providing detailed information on diseases, tests, drugs and procedures on the go.

What users are saying:

“This app is awesome! I love that it has all the necessary references. The search is great and pulls up the item in all the references…”

Rating:

Cost: Free

Available: Android and iTunes

2. Diseases Dictionary

A free Android and iOS app, Diseases Dictionary offers a long list of illnesses and conditions nurses are apt to encounter, along with symptoms and preferred treatments. Nurses and students can type in the symptom and a list of possible diseases will appear; this app provides comprehensive information about how to deal with symptoms/how to prevent the disease; and how to improve knowledge about diseases.

What users are saying:

“High informative. I recommend this app.” “A Must-Have app! What an educative app!”

Rating:

Cost: Free

Available: Google Play and iTunes

3. Black’s Medical Dictionary

For over a century, medical professionals have relied on Black’s Medical Dictionary. With over 5,000 definitions of medical terms, this app features a navigational display with rich media experience; user-friendly, intuitive interaction; and the ability to share with friends using social media features. Reviews are mixed, with some users complaining of the app’s $14.99 price tag.

Rating:

Cost: $14.99

Available: Google Play and iTunes

4. The Color Atlas of Family Medicine

2,000 full-color photographs will help you visually diagnose common and uncommon conditions and diseases encountered in clinical practice. At $124.99, it’s not ideal for nurses on a budget — but satisfied users report that the app’s thorough explanations and color pictures are well worth the money.

What users are saying:

“Full of pictures and useful facts about diseases and treatments…I refer to it often in my practice.” “Great primarily outpatient reference.” “Very impressed with the app, good photo resolution when searching for specifics.” 

Rating:

Cost: $124.99

Available: Google Play and iTunes

5. Merck Manual

The oldest continuously published textbook for English-speaking medical professionals, the Merck Manual is free on iTunes. This app includes “How to Do” videos on numerous outpatient procedures and physical examinations; quizzes that check knowledge of medical disorders, symptoms and treatments; interactive case simulations that test the ability to treat a specific patient over the disease course; and editorials written by top medical experts. Some users believe it is a must-have for nurses, but others feel it’s difficult to navigate.

What users are saying:

“I downloaded this new Merck Manuals reference when I saw it first available, and have the home user version too.” “Offline use and excellent interface!”

Rating:

Cost: Free

Available: Google Play and iTunes

6. MedPage Today

Get up to date with the latest developments in the medical world with MedPage Today, MedPage is the leading source for breaking medical news, daily coverage of over 30 specialties, annual coverage of over 60 meetings and symposia and free CME and continuing education credits.

What users are saying:

“Very good app for doctors. Awesome and authentic information with reference.” “Best app for medical students, but needs more details.”

Rating:

Cost: Free

Available: Google Play and iTunes

7. Pedi STAT

Satisfied users on iTunes claim that Pedi STAT is the easiest medical app to use. Described as a rapid reference for RNs, paramedics, physicians and other healthcare professionals caring for pediatric patients in the emergency or critical care environment. The Google Play version costs $7.87.

What users are saying:

“Great resource for paramedic, CCP, or ER RN, use it frequently. “Awesome…use this app in clinical situations a lot.”

Rating:

Cost: $2.99

Available: Google Play and iTunes

8. NurseTabs: Fundamentals

The NurseTabs series offers a thorough overview of several important topics, with many concepts discussed in video form. App users will have access to over 120 skills and procedures separated by topic areas learned through fundamental nursing courses. After selecting a skill, you’re presented with the equipment needed to perform the procedure and a step-by-step of how to perform it safely. The app is $9.99, but in-app videos cost another $4.00 — a fact that does not please some users.

Rating:

Cost: $9.99

Available: Google Play and iTunes

9. NurseTabs: MedSurg

Another valuable app in the NurseTabs series, MedSurg focuses on diseases and conditions. This app is suited for novice nurses and nursing students with over 340 common diseases and disorders that are separated by the body system. Once a disease/disorder is selected, nursing processes, managing client care and tons of other useful information is at your fingertips. Like Fundamentals, it costs $9.99. The two apps are available in bundle form for $19.99 on Google Play.

What users are saying:

“Good for students, but basic and vague for nursing…” “I am an LPN a charge nurse and I love this app. So easy to use. Every diagnosis u can think of is on the app…”

Rating:

Cost: $9.99

Available: Google Play and iTunes

10. Nurse’s Pocket Guide

The Nurse’s Pocket Guide is constantly updated with new information on diagnosis and interventions. Each diagnosis listing includes a definition, related factors, defining characteristics, prioritized actions/interventions, NIC/NOC classifications and documentation of guidelines. The free app is available on iTunes and Google Play.

What users are saying:

“It’s a good app if you are willing to pay for (in-app purchases).”

Rating:

Cost: Free

Available: Google Play and iTunes

11: Voalte One

An HIPAA-compliant app, Voalte One provides exceptional communication for caregivers. It provides alarm and nurse alert notifications, text messaging on easy-to-use app. It also offers VoIP calling. This tool helps streamline communications in tough situations. It’s easy to use and provides a way to gather information immediately. 

Rating:

Cost: Free

Available: Android and iTunes

12. NursingCenter CEConnection

Earning continuing education credits can be a challenge, but NursingCenter CEConnection makes it easy. Thanks to this easily accessible app, you can view CE courses and complete them offline whether you’re at home, on your commute or on your shift. Once you return to a wifi connection, your assignments will automatically sync with your CE Planner account and access your certificate.

Rating:

Cost: Free

Available: Google Play and iTunes

13. Heather’s Nursing Cheat Sheets

Download Heather’s Nursing Cheat Sheets on your Android device and get ready to access the detailed information you need, when you need it. The app has a temperature conversion chart, a neurological coma scale, and several other helpful cheat sheets. It is important to know that the information in this app is compiled from a variety of sources and you should always know your own facility’s protocols.

What users are saying:

“Amazing app! As a RN working bedside in the critical care setting, this is my quick go to tool…” “Great reference tool!” “Awesome! A student nurse’s dream!”

Rating:

Cost: $2.99

Available: Google Play

14. Davis’s Drug Guide For Nurses

With information on over 5,000 generic and brand name drugs, Davis’ Drug Guide is a great and comprehensive tool. With practical information on trade name and generic drugs, each focuses on safety and patient care, including information on dosing and administration, interactions, side effects and patient teaching. The app has numerous rave reviews on Google Play.

What users are saying:

“I love the website, but the app is frustrating because I cannot search medications…” “Fast, easy access to information without having to lug a book around…”

Rating:

Cost: Free

Available: Google Play and iTunes

15. Epocrates Rx

Available on iTunes and Google Play, Epocrates Rx boasts high ratings on both platforms, and 1 out of every 2 physicians rely on Epocrates to enable better patient care. The app offers detailed information for a wide range of brand, generic, and over-the-counter medications. A one year Epocrates Plus subscription is available for $174.99.

What users are saying:

“Superb guidance.” 

Rating:

Cost: Free

Available: Google Play and iTunes

16. I.V. Drug Handbook

Published by McGraw-Hill, this useful Android app helps nurses successfully carry out one of the profession’s trickiest tasks. It features several helpful learning tools, including a ‘Favorites,’ ‘Recent’ and ‘Word of the day’ features to help you further enhance your vocabulary from an extensive library. The Google Play version is free, but offers in-app purchases.

What users are saying:

“Very ok.” “Stellar”

Rating:

Cost: $44.99

Available: Google Play and iTunes

17. NCLEX Flashcards

Whether you’re currently in nursing school or could use a refresher, the NCLEX Flashcards app has over 1,600 practice questions, quizzes, mnemonics, and strategies. Bonus: If you purchase the mobile version, you’ll be granted access to the full-featured online version. The Google Play version is free, but offers in-app purchases.

What users are saying:

“Love it buy after 2 questions it stops, please fix!” “Excellent! Very helpful and it makes it easy to remember everything.” “Good app for NCLEX review…it does freeze at times.”

Rating:

Cost: $3.99

Available: Google Play and iTunes

18. Nursing Guide App

Quantum X. Inc’s Nursing Guide App offers a range of information for nursing students and experienced nurses alike. Equipped with mnemonics, articles and tips and quotes, this app was created to share basic to complex information about the nursing field.

What users are saying:

“Very helpful.” “Excellent. More than expected.” “Does not give full info…”

Rating:

Cost: Free

Available: Google Play and iTunes

19. Critical Care ACLS Guide

The Critical Care ACLS Guide is the smartphone age’s response to a classic, twenty-year-old booklet that made it easier for nurses to check doses and interpret EKGs. You can have immediate access to critical information loaded with rich content, detailed illustrations and features including quick navigation, expanded search capability, calculators and custom bookmarks.

What users are saying:

“Effective.” “Well designed to provide fast information.” “Better than expected for immediate needs.”

Rating:

Cost: $7.99

Available: Google Play and iTunes

20. NurseGrid

Scheduling can be a hassle for nurses, but with iTunes’ NurseGrid, it doesn’t have to be. Used by over 200,000 nurses, the app allows for schedule management across several work sites. Because of this app’s user-friendly features, it only takes a few seconds to create your shift calendar for the next few months. You also have the opportunity to connect with other NurseGrid users who work in your department.

What users are saying:

“Nice app. I love how easy it is to add my work schedule and that my coworker can see my schedule.” “Sluggish, but a great app on iOS.” “It’s okay. It shows my shifts and is easy to add shifts…”

Rating:

Cost: Free

Available: Google Play and iTunes

21. Nursing Procedures

Nursing Procedures focuses largely on providing nurses the best resources before they begin a procedure. Ranging from assessments to medication administration to code blue situations. As a bonus, you’ll get a Weekly Funny once a week that gives you a funny video, quote, picture or meme to cheer you up. The iTunes version is free.

What users are saying;

“Great app but please add more procedures to the midwifery aspect…” “Please add the requirements for the various procedures. That I think will help us a lot.” “Great app.” “It’s a great app. Easy to use and understand. Big ups.” 

Rating: N/A

Cost: $0.99

Available: Google Play and iTunes

22. Nurses First

The Nurses First app features daily nursing tips, fun facts, nurse quote section, Vines section and a giveaway section. Information is pulled from the top nurse blogs and fan sites; everything you need to know in one mobile app.

What users are saying:

“Perfect app for nurses. This one has it all.” “I keep opening this app, even while I’m at work…it just makes the day go well.” “I am so glad I downloaded the nurses first app. LUV it.”

Rating:

Cost: Free

Available: Google Play

23. IV Drip Rate Calculator

Most features of the IV Drip Rate Calculator app are available on modern pumps, but modern pumps aren’t always available. With this app you can add a drug amount in mg, mcg, grams or units to a volume of fluid, select the dose ordered and the ml/house necessary to deliver that dose will display. Several satisfied users claim that the app has made their jobs easier.

What users are saying:

“Good math, would be better if you could scroll the screen to the next couple fields..” “Good for when I need to think faster while multi-tasking.”

Rating:

Cost: Free

Available: Google Play

24. IV Infusion Calculator

This simple and straightforward iOS and Android app work whether you are using gravity or pumps. It will give you your answer in mL/hr, gtts/min and gtts/15 seconds. This app also includes an IV Push calculator and a Fluid Rate calculator. The Pro upgrade to the app costs $0.99.

What users are saying:

“Very useful and covers all types of calculations I use.” “I use this app every week.”

Rating:

Cost: Free

Available: Google Play and iTunes

25. Nursing Reference Center

Amp up your nursing skills with Nursing Reference Center. The app provides relevant clinical resources to nurses, directly at point-of-care and offers the best available and most recent clinical evidence from thousands of full-text documents. Note: to use the NRC app, you must obtain an access key.

What users are saying:

“Wonderful resource for nursing staff.”

Rating:

Cost: Free

Available: Google Play and iTunes

26. Lippincott Nursing Advisor

Quick answers for pressing medical questions are available on the iOS Lippincott Nursing Advisor app. Although many facilities offer free use of the app, some users must make in-app purchases. You’ll have access to regularly updated clinical content by a team of nurses and clinical subject matter experts as well as the ability to add your own protocols and notes.

What users are saying:

“Time saver. I bought this app mainly to benefit my Lippincott account was such a huge pain…this however has saved me time and headache and I can get it on my phone as well.”

Rating:

Cost: Free

Available: Google Play and iTunes

27. Wellbeing For Nurses

Stress and fatigue make it a challenge for nurses to stay healthy. Wellbeing For Nurses Magazine aims to combat this with a useful app. You’ll have access to monthly doses of in-depth articles that focus on the fields of health, happiness, and well-being.

What users are saying;

“Perfect…” and “A good one.”

Rating:

Cost: Free

Available: Google Play

28. Intensive Care Medicine

Stay up to date on the latest research with the Intensive Care Medicine app. Google Play users appreciate the free app’s advanced search and article saving capabilities. This app comes from the Intensive Care Medicine journal that continually publishes review articles, original papers, and education articles written by leading members of the medical community.

What users are saying:

“Very nice, but should allow members to use their individual subscriptions to access.”

Rating:

Cost: Free

Available: Google Play and iTunes

29. Organs 3D

Brush up on your anatomy with Organs 3D, which has tens of thousands of positive reviews on Google Play. The nursing app features 3D models, video, audio lectures, quizzes and text to create a rich learning experience for users.

What users are saying:

“I liked it. It gives brief explanation of most internal organs.” “Graphics quality is very low…” “Five stars. This is exactly what I’ve been looking for great 3D image!”

Rating:

Cost: Free

Available: Google Play and iTunes

30. Nursing Jokes

Nursing is a notoriously stressful profession, and sometimes, what you need most is a lighthearted break from the anxiety. Look to Nursing Jokes on Android for some necessary humor to get you through long shifts.

What users are saying:

“Repetitive. Not enough content and not all that funny.” “Good, funny jokes.”

Rating:

Cost: Free

Available: Google Play

31. MediBabble Translator

MediBabble is a professional-grade app that provides medical interpretation for healthcare workers and nurses. This app aims to improve safety and efficiency nurses can provide to non-English speaking patients. It aims to allow users to communicate faster, on the go, with those who do not speak English.

What users are saying:

“Very useful…” and “Amazing for gathering information!” Users say the app is “very good for asking patients questions and describing their conditions…”

Rating:

Cost: Free

Available: iTunes

32. IDdx: Infectious Diseases

This app allows users to search by description and lists a number of infectious diseases that could relate to it. It lists symptoms and conditions of diseases to allow for fast recognition and diagnostic support. The searchable component of this app helps users to quickly find vivid images and information so that fast response time is possible. It displays pictures for diagnostics and support for emergency situations.

What users are saying:

“Very fine reference especially with multiple sources integration…” and “Using patient systems was effective for a precise conclusion.”

Rating:

Cost: Free

Available: Android and iTunes

33. Skyscape Medical Library

The SML app is a tool to support diagnostics for physicians and nurses. It pulls from 400 resources from various associations to make finding information easy. Searches by keyword are easy and highly effective. A total everything-you-need tool, this app makes it easy to find key information whenever it becomes immediately necessary and you’re on the go.

What users are saying:

“It’s a go-to app for medical information…”

Rating:

Cost: Free

Available: Android and iTunes

34. Eponyms

Eponyms features hundreds of common and obscure medical eponyms for easy searching and verification. It allows users to quickly look up the meaning of a term, no matter how obscure or unique it is, to find out what it refers to. This makes finding information faster than trying to navigate complex medical conditions by limited names.

What users are saying:

“Excellent. Very thorough.” And “”Really nice app, very helpful, but needs more eponyms added…”

Rating:

Cost: Free

Available: Android and iTunes

• Nursing Central app is available through the Amazon store and is compatible on some Android devices.
• Ratings are based on the current app version for either Google Play or iTunes stores. Ratings are current at the time of publishing.
• For clarity, ratings have rounded to the whole number. Please visit the app store to review the current ratings.
• Some apps may require you to purchase. Some additional costs may also incur after initial payment. Please refer to the app’s terms of service agreement before purchasing.
• Some apps may require you to sign up before using.
• Some free apps may have in-app advertising or purchases.
• Please refer to the app’s compatibility requirements as they may not work on all devices.
  
  

Pamela Moss Blais, 55
Hospice Admissions Nurse
Norfolk, Virginia

As a hospice admissions nurse my job is to explain the process to new patients. I’m the very first face they see as they embark on their journey. That’s what I call it, a “journey.” Since I admit patients I don’t carry a caseload. I meet them once and then they float out of my life.

I was an ER nurse for 18 years. I saw patients who were resuscitated whether or not it was ethically correct. I saw families get hope when there was clearly none.

In hospice, the family is your patient. They’re truly living their darkest days. For many of them, this admissions meeting is an overwhelming process. Every emotion that they have inside of them that maybe even hasn’t ever surfaced might come to the top. But I don’t want families to cry.

During that first meeting I don’t say: “So this is what we do for people who are dying.” I say: “Hospice is not about dying. It is about living the remainder of your life how you want to. Not how I want you to, not how your husband, wife, daughters, or sons want you to, and not how the doctor wants you to, but how you want to.”

If you think about the last time you went to the doctor, he probably said, “Okay, this is what I think. These are the tests I want to run.” Nobody asks you, “What do you think? Does this sound reasonable? Do you want to do it?” Nobody tells patients how their quality of life is going to go down the toilet when they get chemo. So it’s sometimes hard for patients to wrap their head around the idea that everything is their choice now, they’re driving the ship. That’s the mission of hospice.

I encourage my patients to live because I want them to know: This is not about assuming the sick role. This is about getting up every day, taking a shower, getting dressed — if you can do that — eating, going out with your family — whatever it is you want to do. I recently met with a patient who was a plane enthusiast. He wanted to go to some Top Gun show in Delaware. I encouraged him to go …

I believe that the people who are most successful at hospice are good observers. They can read vibes and figure out the situation before they say a word. Sometimes I meet with patients in the hospital. Sometimes they’re in a nursing home. Often they are in their home. Before I even begin to discuss hospice, I try to figure out the patient’s faith. Do they even have a faith? I don’t ask directly … I do some detective work. If I’m at their house I look for crosses or iconography. I’ve seen people from all walks of life: Jewish, Buddhist, Jehovah Witness, Wiccan.

I think hard about my physical presentation. I don’t want anything too flashy or festive. Today I have on blush and lipstick and a little bit of eyeliner, but it’s very conservative. So is my dress. I make sure there’s no cleavage exposed or anything that would offend. I’m Jewish, but I don’t wear any religious jewelry. When I see someone dressed in scrubs that have Froot Loops on them or something, I say to myself, “Really? You look like you are in pajamas.”

My dad a pediatric allergist/immunologist in Norfolk. I used to go with him to the children’s hospital to watch. But the pivotal moment came the summer just before I graduated college, this was during the Carter administration. I was sitting by the local pool and overheard some women talking about all the cuts to education and how they might lose their jobs. I had studied special education and taught art at camp for mentally challenged kids, and I loved it. But would I have a job?

Then my brother who is a year older than me broke his neck when he was body surfing in the sea. He was 25 and home for the weekend from college. He suggested that I become a nurse, I spent so much time caring for him.

The other night I admitted a woman who has metastatic bladder cancer. I was instructing the family to give medicine, but I could tell they were nervous. They said they knew how to do it, but the mother was refusing. You could sense the stiffness and the fear in the room. And once I showed them how to do it, it was like an immediate Aha! Immediate relief. Because they realized, I can do that. I did that. These little tiny steps are big.

There’s so much information that has to be explained, I have to use my words very carefully. I want them to know there is a light. I want them to see that and feel it when I do my mission.

Sometimes the family members will ask, “Well, what do I say to my mom? I can’t say, ‘Hey how was your day?’ I can’t ask questions about the future.” I say, “Talk about the past. Talk about stories, trips you went on together. Ask them to tell you stories you have never heard. Talk about fun times. That’s how you comfort your loved ones when you don’t know what to say.”

There was a patient I admitted who had two daughters who work in the health-care field. They said something like, “I checked her blood pressure.” I said, “Why did you do that? I don’t want you to feel you have to assume the role of a nurse. I want you to be the daughter.”

I want to know when I leave the house or the hospital or the nursing home that the family and the facility staff feels okay. Not great. Because they’re not going to feel great. But that they feel okay with the situation and that if anything happens, they’re going to reach out to us and we’re going to be there. If you sense a problem, even if it’s tiny, even if you’re not sure it’s a problem, call us. We would rather you call us 20 times a day with a little tiny problem than let it escalate.

I spend a lot of my time alone in my car, traveling to see patients. Sometimes I’m putting in over 100 miles a day, driving all over Virginia. On an eight-hour shift, I usually process two admissions. On a 12-hour shift, I can do three.

I’ve been in the trenches. I’ve worked in labor and delivery, I’ve worked in the pediatric ICU, I’ve worked in Medserv, I’ve worked in home health, I’ve worked for a cardiologist in an office setting. I worked in the ER. You can’t be a nurse unless you care about people. It’s exhausting in every way. Spiritually, psychologically, emotionally. Nursing has been my life. This is the unfortunate thing about nursing. I love nursing, but it’s extremely hard to find a work-life balance.

I’ve been a nurse for 25 years and I don’t even make $40 an hour. You’re on your feet for 12 to 14 hours a day, and rarely do you get a lunch or even a bathroom break. Most nurses work their entire career and never get a break. When people say,”There’s such a nursing shortage,” this is why. It’s a struggle for the nursing profession as a whole and they still haven’t figured it out.

My hospice-admissions job is the first I’ve ever had where I actually can say, “Y’know, I’m hungry. I’m going to go to a WaWa and get a cheesesteak.” But still, the only thing that gets me through the work week is that I’m off Fridays, Saturdays and Sundays.

I work Monday through Thursday, 40 hours — on paper. When I come home at night, I start in on the homework. Each admission is two to three hours of paperwork. That’s the killer. I spend the night buried in paperwork.

The company I work for is trying to rethink the flow of the documentation, but some of this stuff is based on federal requirements, the Medicare/Medicaid requirements, and all the insurance companies follow federal guidelines. They’re not going to rework the wheel. These things have to be done right if we want to get reimbursed. There’s no shortcut.

But I cannot work 12 hour shifts anymore. I have a daughter in college and a 15 year old who I rarely see during the week. I told my boss, I need to be home at dinner time so I can get organized, so I can talk to my daughter. She’s a teenager. She needs her mother.

We struggled to be parents. I had seven pregnancies but I only have two children. Being a mother is still my dream. I don’t want other people doing my job. Our other daughter was very sick a couple years ago. That was actually why I left the ER. And I told my husband, “You might put your job before us. But I’m never going to do it. I’ll be working at McDonald’s before I put my job before my family.” Luckily right now, my boss understands the struggle.

A lot of nurses feel like they don’t have value. I will admit it’s hard when you feel worthless. I’ve tried to make an impact with every job I’ve ever done but rarely got accolades. A couple of weeks ago, I really thought about leaving hospice. I’m tired. I’m fed up.

And then all of a sudden, people are telling me I do a good job. People have started copying the way I put my notes in. I got a little promotion and was asked to be a mentor. It’s been hard for me to accept it. It’s just so odd after so many years trying to climb the ranks in health care. I called my husband and said, “Something suspicious is going on.” People are complimenting me. Why all of a sudden now? I took it as a sign that, for now, I will stay in hospice. Maybe I’m truly having an impact.

Sometimes, I’m taking care of people who are my age or younger. Imagine being robbed of your life during your 50s. You have every right to be the angriest person in the world. You’re going to die, you see it. The end of the tunnel — you can see it. I can’t see the end of my tunnel. I’m not dying. These people know it’s coming. It might not be next month, but it’s going to be in the next six months. If you were told today you had six months to live, just think how differently you would look at your life … That gives me perspective. I regularly think, “Is my life really that bad? I’m having a bad day, but is it that bad? Am I this person? Am I dying?”

Let’s face it, it is often hard for a patient whose first language is English to navigate the technical medical vocabulary that we use in our healthcare system. Patients who don’t speak English well—or at all—are considered to have low health literacy. This is not necessarily a reflection of their intelligence, but rather of how hard it can be to educate them about their medical status, treatment plans, etc.

A language barrier can also make it hard for nurses to honor patient preferences, answer questions, and establish a trusting relationship—particularly when cultural differences exist regarding the patient’s concepts of wellness and illness. Perhaps most troubling is the fact that informed consent becomes a sticky issue, both legally and ethically, when a patient cannot understand his condition or ask questions about treatment options.

In regions with large Hispanic or Asian populations, many healthcare facilities have staff nurses who are bilingual. But what happens when you are caring for a patient that you can’t communicate easily with?

The ideal situation would be to use a professional translator who has training in medical vocabularies. These professionals are often available through a staffing service or a 24-hour telephone translation line. If you have access to these services, be sure to take advantage of them. And if you frequently encounter situations in which you feel a translator is required but none is available, you can encourage your hospital to contract with a translation service.

Often, friends or family members of the patient can step up to bridge the language gap. It’s advisable to use these ad hoc interpreters only as a last resort, because these non-professionals are more likely to make mistakes that can affect clinical outcomes. Friends or family members may have low health literacy themselves, may not fully understand a medical term that has no direct translation, or may inject their own personal views into the dialogue to the patient as an attempt to be helpful. The more complicated the medical case, the higher the likelihood of translation errors.

If you are communicating through a translator of any sort, there are a few things to keep in mind:

• Begin by briefly advising the translator what you need from him/her: to translate the words of both parties as literally as possible, without adding or leaving out anything.
• Ask the translator if he/she knows of any general cultural beliefs that might come into play during medical treatment—such as a cultural preference for avoiding conflict, avoiding interactions with a person of the opposite gender, or avoiding anything that might seem like questioning the authority of a clinician.
• If the translator contracts with your employer, there is probably already a signed HIPAA agreement in place. If a family member or friend is translating, advise that person that the information being translated is considered confidential.
• Document the name of the person translating in the patient chart.
• Use the “teach back” method to convey medical information. You’ll be doing it through a translator, but the process can still help you assess how well the patient has understood the information being provided.

Census statistics indicate that nearly 47 million U.S. residents speak a foreign language at home, with a quarter of them reporting limited proficiency in English. These numbers practically ensure that you will encounter a language barrier at some point. Despite the difficulty in communicating, remember that you, as a nurse, are still responsible for providing a quality experience for the patient, including protecting his dignity, ensuring comfort, and advocating on his behalf. You also have to be diligent about assuring the data you document is as accurate. 

The latest CBSN Originals documentary, “Gender: The Space Between,” takes a deep dive into the complexities of gender identity and gender expression. While transgender stories have become more visible in the media, there are many identities and terms outside of the two most culturally accepted genders — man and woman — that fall under the trans umbrella. And in many social circles, the vocabulary related to gender identity is unfamiliar or inaccessible.

Gender identity is an extremely personal part of who we are, and how we perceive and express ourselves in the world. It is a separate issue entirely from sex, our biological makeup; or sexual orientation, who we are attracted to. There are dozens of dynamic and evolving terms related to how people identify. While this glossary cannot cover every possible identity a person might have, it provides definitions for some of the most common vocabulary necessary to understand the layered world of gender.

Below is a guide to some of the topics and terms discussed in “Gender: The Space Between,” as defined by the Human Rights Campaign, GLAAD, The Trevor Project, and the National Center for Transgender Equality.

Gender Identity Definitions

Agender: A term for people whose gender identity and expression does not align with man, woman, or any other gender. A similar term used by some is gender-neutral.

Bigender: Someone whose gender identity encompasses both man and woman. Some may feel that one side or the other is stronger, but both sides are present.

Binary: The gender binary is a system of viewing gender as consisting solely of two identities and sexes, man and woman or male and female.

Cisgender: A term used to describe someone whose gender identity aligns with the sex assigned to them at birth.

Dead name: How some transgender people refer to their given name at birth.

Gender dysphoria: Clinically defined as significant and durational distress caused when a person’s assigned birth gender is not the same as the one with which they identify.

Gender expression: The external appearance of a person’s gender identity, usually expressed through behavior, clothing, haircut or voice, and which may or may not conform to socially defined masculine or feminine behaviors and characteristics.

Gender fluid: A person who does not identify with a single fixed gender, and expresses a fluid or unfixed gender identity. One’s expression of identity is likely to shift and change depending on context.

Gender identity: A person’s innermost concept of self as man, woman, a blend of both, or neither – how individuals perceive themselves and what they call themselves. Gender identity can be the same or different from one’s sex assigned at birth.

Gender non-conforming: A broad term referring to people who do not behave in a way that conforms to the traditional expectations of their gender, or whose gender expression does not fit neatly into a category.

Gender questioning: A person who may be processing, questioning, or exploring how they want to express their gender identity.

Genderqueer: A term for people who reject notions of static categories of gender and embrace a fluidity of gender identity and often, though not always, sexual orientation. People who identify as genderqueer may see themselves as being both male and female, neither male nor female or as falling completely outside these categories.

Misgender: Referring to or addressing someone using words and pronouns that do not correctly reflect the gender with which they identify.

Non-binary: Any gender that falls outside of the binary system of male/female or man/woman.

Passing: A term used by transgender people which means that they are perceived by others as the gender with which they self-identify. 

Queer: An umbrella term people often use to express fluid identities and orientations. 

Sex: The classification of a person as male or female at birth. Infants are assigned a sex, usually based on the appearance of their external anatomy.

Transgender: An umbrella term for people whose gender identity and/or expression is different from cultural and social expectations based on the sex they were assigned at birth.

Transitioning: The social, legal, and/or medical process a person may go through to live outwardly as the gender with which they identify, rather than the gender they were assigned at birth. Transitioning can include some or all of the following: telling loved ones and co-workers, using a different name and pronouns, dressing differently, changing one’s name and/or sex on legal documents, hormone therapy, and possibly one or more types of surgery. 

Transsexual person: A generational term for people whose gender identity is different from their assigned sex at birth, and seek to transition from male to female or female to male. This term is no longer preferred by many people, as it is often seen as overly clinical, and was associated with psychological disorders in the past.

Two-spirit: A term that refers to historical and current First Nations people whose individual spirits were a blend of male and female. This term has been reclaimed by some in Native American LGBT communities to honor their heritage and provide an alternative to the Western labels of gay, lesbian, bisexual, or transgender.

The squeak of tennis shoes moving quickly across the linoleum floors adds to the cacophony of alarms and beeps pulling nurses and doctors in every direction on the acute care floor of Florida Hospital Memorial Medical Center.

In the midst of the commotion, nurse Kelly Northrip sits quietly at the bedside of a patient, listening with the kind of intensity that doesn't come natural to most.

"I get told all the time I spend too much time with my patients, so to speak, and I say there is no such thing," said Northrip, a licensed practical nurse. "Each one is a learning experience."

Northrip knows firsthand the impact a few extra moments can have on a patient. If any of her patients doubt her, she might tell them about the golf ball-sized tumor that was discovered on her brain or the surgery she endured, answering doctors' questions while they probed her brain.

Usually, it's enough for Northrip simply to be there for her patients, hearing their concerns and reassuring them that everything will be all right. She's experienced that firsthand as well.

A DREAM THREATENED

After 18 years in the restaurant industry, Northrip embraced a career change to pursue her dream of becoming a registered nurse. After graduating and starting her career as a licensed practical nurse, Northrip's newly established career was almost sidelined forever when a tumor was discovered in her brain last summer.

Overnight, the career she had worked so hard for was in jeopardy, and so was her life.

Northrip's specialists presented her with three options: do nothing; do a biopsy and determine how to proceed; or, the riskiest option, an awake craniotomy.

"Doing nothing wasn't an option for me, for us," said Northrip, whose husband and two kids supported her decision to go with the most aggressive option.

In an awake craniotomy, the patient is awakened after surgeons open the skull. That way doctors can ask a series of questions while removing the tumor and ensure other areas of the brain aren't damaged.

Sounding just like an eager nursing student, Nothrip described the prospect as "scary and exciting at the same time."

"I was more nervous than she was," said her husband, Steven.

But the surgery is rare — and risky. Her doctors recommended that she seek out surgeons who were specialists in the procedure.

"He said you'd be better off going somewhere where they've done thousands. If it won't bankrupt you, go to Duke," she recounted. On a morning in August 2016, Northrip and her family loaded up into her brother's motor home to drive from Florida to North Carolina so that the drowsy Northrip could sleep during the trip, a symptom of the tumor. After three blown tires, and countless frazzled nerves, the motor home delivered them safely to Duke University Hospital where Northrip would undergo brain surgery the next morning.

Northrip remembers being wheeled into the operating room for the surgery, where a big TV on the wall showed images of her brain. After being put to sleep, Northrip awoke to a bright room full of people and the distinct sensation of pressure in her head.

"I could feel the doctor working in my head," she recalled. "I could feel him working in there and I actually spoke to him and he spoke back. I could feel discomfort, but not great pain."

As the surgical team began to remove Northrip's tumor, they asked a series of questions to ensure they didn't affect other areas of her brain.

"He had me move my feet, wiggle my toes, do a number of things. I just tried to relax, and they tried to keep me calm through the whole thing. I can remember almost everything. I can even remember their faces."

The surreal experience of being conscious during brain surgery left Northrip feeling "very much awake and alive."

The next thing Northrip recalls is waking in a recovery room, feeling like she was being hit in the head with a hammer — proof she had survived the surgery.

The pain subsided when Northrip received the news she had hoped for — the tumor was benign, and she wouldn't have to undergo chemotherapy.

"The only thing I would be required to do was an MRI every year," she said.

Other challenges still lay ahead.

THE RECOVERY

While insurance covered a large portion of the rare surgery, Northrip and her family still had numerous medical bills to pay on top of regular living expenses. Family, friends and coworkers rallied to the family's aid, hosting golf and dart tournaments and online fundraising campaigns.

"It makes you think, 'What did I do to deserve this?' I don't look in the mirror every day and say I'm a wonderful person. I don't think you ever feel deserving," Northrip said. "You're just trying to do your thing, trying to be a good, decent person and do things to the best of your ability."

The outpouring of support continued into Christmas when her family was adopted by the hospital staff, who bought presents for the kids. Northrip's co-workers also provided gift cards for the family.

The financial help allowed Northrip to focus on recovery and her goal of getting back to the job she loved. She pushed herself hard through physical therapy with the goal of coming back to work quickly but learned she couldn't force her body to recover faster than was possible.

The emotions of the recovery caught her off guard.

"I didn't think anything about the after, I just jumped in (to the surgery) with both feet and thought I would deal with it as it came," she said. "It was a very eye-opening, learning experience."

Physical therapist Donna McQuade worked with Northrip and knew the obstacles she would have to overcome to return to the job.

"When you do the job every day, you forget what it takes," McQuade said. "But having had such an extensive surgery, I don't think she was aware how much it affected her emotionally."

True to her persistent nature, Northrip tried to come back ahead of schedule, only to realize she wasn't ready and needed to continue her physical therapy.

"She's been doing it for so long she just didn't realize how much strength it took" to work a nursing shift, McQuade said.

Northrip persisted, and in January she returned to work.

"It's really miraculous, the amount of time from when she found out she was sick to when she was back to work," said McQuade.

While the experience challenged Northrip in more ways than she expected, being on the other side of the bed brought her a rare perspective that changed the way she views her job.

"Prior to this, I could only sympathize with my patients," Northrip said. "But after being hospitalized I can truly empathize and identify their anguish and stress."

To her coworkers, there was little doubt she would return and be a better nurse for her experience.

"We knew she would be back and rise to the challenge," said McQuade. "She's got a good support system here because she's a good support system to us."

Being back at work has also allowed Northrip to pursue her original goal, to become a registered nurse.

After years of applying to a full program, Northrip's application was recently accepted and she started school to become a registered nurse — while also returning to work.

"Ironically, I didn't expect it to be happening my second week back to work. I kind of bit off more than I could chew," Northrip said. "I don't take it lightly. I know it's a privilege for me to be working where I am. I want a better life for me and my family and help others to the fullest extent."