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DiversityNursing Blog

A Nurse Scientist and An Engineer Create Heart App

Posted by Erica Bettencourt

Thu, Apr 06, 2017 @ 03:40 PM

heartapp.pngTwo professors at USF collaborated to work on improving self-care at home for patients with congestive heart failure. Another goal was to reduce their hospital readmissions. They knew most patients are living on their own after they get out of the hospital and it can be a challenge for patients to keep up with their regimen. They teamed up to create an app that could help them.
 
Learn all about it in the article below. Perhaps you have an idea that can help your patients and their families?

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.”

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Topics: smartphone applications, heart app, congestive heart failure

3 Things Patients Want from Nurses

Posted by Pat Magrath

Tue, Apr 04, 2017 @ 04:03 PM

hospice-palliative-care-2-1.jpgMost Nurses deal with patients every day, particularly in a hospital setting. You are on the go the moment you enter the hospital and often don’t have time to catch a breath, let alone grab a sandwich or take care of personal needs. Because you’re so busy, you may not have the time to really connect with each patient.

No one is blaming you. You’re most likely overwhelmed and focused on doing all the details your job entails. This article may be helpful in guiding you to understand what the patient is looking for from you. Let us know your thoughts.

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:

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.

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Topics: patient satisfaction

2017 Best Nursing Apps

Posted by Erica Bettencourt

Mon, Apr 03, 2017 @ 04:08 PM

appsfornurses.jpgNurses are on the move and they aren't carrying around medical books and a computer to help them when they need it. Wait, on second thought, that little smart phone in your pocket is just that, a computer, filled with apps catered to your needs. 
 
If you need definitions to medical terms, there's an app for that. There's also one that will keep you up to date on medical news and others that will provide you with information on specific diseases and medical cases. If you haven't looked into apps that can help you out in the Nursing field, here's a list of the best of the best. 

 

Nursing Central App1. 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: 4-star rating

Cost: Free

Available: Android and iTunes

Diseases Dictionary App2. 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: 4-star rating

Cost: Free

Available: Google Play and iTunes

Black's Medical Dictionary App3. 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: 3-star rating

Cost: $14.99

Available: Google Play and iTunes

The Color Atlas of Family Medicine App4. 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: 5-star rating

Cost: $124.99

Available: Google Play and iTunes

Merck Manual App5. 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: 4-star rating

Cost: Free

Available: Google Play and iTunes

MedPage Today App6. 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: 4-star rating

Cost: Free

Available: Google Play and iTunes

Pedi STAT App7. 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: 4-star rating

Cost: $2.99

Available: Google Play and iTunes

NurseTabs: Fundamentals App8. 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: 4-star rating

Cost: $9.99

Available: Google Play and iTunes

NurseTabs: MedSurg App9. 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: 4-star rating

Cost: $9.99

Available: Google Play and iTunes

Nurse's Pocket Guide App10. 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: 3-star rating

Cost: Free

Available: Google Play and iTunes

Voalte One App11: 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: 4-star rating

Cost: Free

Available: Android and iTunes

NursingCenter CEConnection App12. 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: 3-star rating

Cost: Free

Available: Google Play and iTunes

Heather's Nursing Cheat Sheets App13. 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: 5-star rating

Cost: $2.99

Available: Google Play

Davis's Drug Guide For Nurses App14. 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: 4-star rating

Cost: Free

Available: Google Play and iTunes

Epocrates Rx App15. 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: 4-star rating

Cost: Free

Available: Google Play and iTunes

I.V. Drug Handbook App16. 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: 3-star rating

Cost: $44.99

Available: Google Play and iTunes

NCLEX Flashcards App17. 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: 4-star rating

Cost: $3.99

Available: Google Play and iTunes

Nursing Guide App 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: 4-star rating

Cost: Free

Available: Google Play and iTunes

Critical Care ACLS Guide App19. 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: 4-star rating

Cost: $7.99

Available: Google Play and iTunes

NurseGrid App20. 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: 3-star rating

Cost: Free

Available: Google Play and iTunes

Nursing Procedures App21. 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

Nurses First App22. 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: 4-star rating

Cost: Free

Available: Google Play

IV Drip Rate Calculator App23. 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: 4-star rating

Cost: Free

Available: Google Play

IV Infusion Calculator App24. 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: 3-star rating

Cost: Free

Available: Google Play and iTunes

Nursing Reference Center App25. 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: 4-star rating

Cost: Free

Available: Google Play and iTunes

Lippincott Nursing Advisor App26. 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: 3-star rating

Cost: Free

Available: Google Play and iTunes

Wellbeing For Nurses App27. 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: 4-star rating

Cost: Free

Available: Google Play

Intensive Care Medicine App28. 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: 4-star rating

Cost: Free

Available: Google Play and iTunes

Organs 3D App29. 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: 4-star rating

Cost: Free

Available: Google Play and iTunes

Nursing Jokes App30. 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: 3-star rating

Cost: Free

Available: Google Play

Medibabble Translator App31. 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: 3-star rating

Cost: Free

Available: iTunes

IDdx Infectious Diseases App32. 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: 4-star rating

Cost: Free

Available: Android and iTunes

Skyscape Medical Library App33. 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: 4-star rating

Cost: Free

Available: Android and iTunes

Eponyms App34. 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: 4-star 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.

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Topics: nursing apps

The Nurse Who Admits Patients to Hospice Care

Posted by Pat Magrath

Thu, Mar 30, 2017 @ 03:39 PM

stethoscope-black-white-antique-doctor-medicine-healthcare.jpg
Are you a Hospice Nurse or have you thought about becoming one? Perhaps you’d like to understand what this job entails. This article is written by a Hospice Admissions Nurse and she explains her role very honestly. She’ll tell you what her days and nights are like. The questions she’s asked by families and patients.
 
She emphasizes the importance of doing what the patient wants. She’ll ask how they want to live their final days. What they’d like to see and do. I appreciate her candor and would love to hear your comments.

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?”

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Topics: hospice, hospice nurse

Two Parents Thankful For A Nurse Who Happened To Be Driving By

Posted by Erica Bettencourt

Wed, Mar 29, 2017 @ 02:12 PM

Walker_032817_29baby_2940x.jpgThankfully Nurse Markey decided to take a different route to pick up her step-kids at school because she ended up at the right place at the right time.

A couple who wanted to have a natural birth were getting more than they bargained for on a very special day. As much as they wanted to, they couldn’t deliver in the hospital. The baby had other ideas and they ran out of time. Markey sprung into action and helped the couple. 

She’s thankful for the experience. Normally she’s around at the end of a patient’s life, but this time, she was there from the very start. Continue reading below for more details about what happened that day.

Michelle Markey sensed that something unusual was going on Friday morning as she drove down Route 101 in Wilton, N.H. “When you’re a nurse, you look at the whole situation,” she said.

And the situation she saw signaled distress. A young man was standing next to his truck, pacing, cellphone pressed to his ear. Markey pulled over.

Crammed in the front seat was a woman in full labor, the baby’s head showing. Markey is a cardiac nurse at Tufts Medical Center. She had never delivered a baby.

Orion and Janella White had wanted a natural birth for their second child, and nature was certainly taking charge.

Janella had been feeling some cramping overnight, but she told Orion not to worry when he got up for work early Friday. When their daughter was born two years ago, Janella had contractions for two days and spent six hours in labor at the hospital.

Even if this one took half as long as his sister, they still had plenty of time to get to the Birth Cottage, a birthing center in Milford where they hoped to deliver the baby in a homelike setting.

So Orion headed out to his job as an aircraft mechanic in Westfield, Mass., an hour and 25 minutes from their Rindge, N.H., home.

About 8:30 or 9 a.m., Janella could tell that the baby was coming that day. She texted Orion that he might want to head home, but that there was no rush. By the time Orion arrived, though, she knew it was urgent. Orion grabbed some pillows, and they took off.

“We started out, and I was, like, ‘Look out for the bumps!’ ” Janella said. “About eight minutes into the ride, I said, ‘Who cares about the bumps, let’s go!’ ”

But as it became clear they wouldn’t make it in time, Orion pulled over and called their midwife, Adrian Feldhusen. 

“I said: ‘Her water broke, and she can feel the head.’ She said, ‘OK, pull over, and I’ll walk you through this.’ ”

He pulled into the driveway of a condo development. A stranger pulled up behind them and called 911. 

Markey arrived seconds later. It was strange she was even driving on this road. She was off from work and heading to pick up her stepchildren at school, but she had some extra time and decided to try out a different route.

The Whites were relieved to have a nurse on hand. Markey was relieved to have a midwife on the phone. Feldhusen told Markey how to turn the baby’s head to release the shoulders. The baby came out quickly, but he wasn’t crying.

At the other end, Feldhusen heard the phone go dead. Not given to panic, she figured someone put it down. So she grabbed her bag to head out.

Meanwhile, Markey smacked the baby, gingerly. 

“He started breathing, then he stopped,” Markey said. “I hit him a little bit harder, then he started crying a little bit.” 

Keihin White had successfully entered the world, sharing a birthday with his 26-year-old father, who stripped off his shirt and wrapped the baby in it.

The ambulance came moments later, and Feldhusen arrived as Janella was being put on a stretcher. She joined mother and baby in the ambulance, where she delivered the placenta, cut the cord, and helped Janella start breast-feeding.

The Whites spent the night at St. Joseph Hospital in Nashua and went home Saturday. On Tuesday, Keihin had his first checkup with the pediatrician — all was well. And later that day, the Whites reunited with Feldhusen and Markey in Milford, and told their tale to the press.

Markey isn’t thinking of taking up obstretrics. But she was glad to have helped. As a cardiac nurse, she deals a lot with people who are dying. It felt good to be at the other end. 

“To see someone be born is amazing,” she said.

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Topics: emergency delivery, nurse hero

Cultural Competency: Bridging the Language Barrier

Posted by Pat Magrath

Tue, Mar 28, 2017 @ 02:08 PM

nurse-and-patient.jpgDepending upon your physical location of employment, whether it’s in the city, suburbs or rural area, you may encounter language barriers with your patients every day or maybe only once or twice a year. Whatever the frequency is for you, it’s important that the information you have to deliver is conveyed as clearly as possible. Some medical terms we use here in the US may not have clear translations in your patient’s native language.
 
What are you to do? This article will help guide you in these situations. Perhaps you’ve encountered a language barrier predicament that you’re willing to share with our Nursing community that would be helpful?

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. 

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Topics: cultural competence, language barrier

Gender Identity Terms You Need To Know

Posted by Erica Bettencourt

Fri, Mar 24, 2017 @ 04:33 PM

untitled-collage.jpgAfter reading this article, I am happy a documentary like this, “Gender: The Space Between,” airing on March 27, 2017 on CBSN is coming out. Even though I try to stay educated on people's rights and beliefs, I didn't know what many of the gender identity termsmentioned below meant.
 
Familiarizing yourself with these gender identity terms and their meaning can help you better connect with your patients. Our patient's needs are changing. Understanding these changes will help you provide the best possible care for them

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, GLAADThe 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.

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Topics: gender identities

Minding Our Lives

Posted by Pat Magrath

Thu, Mar 23, 2017 @ 12:12 PM

Mind-full-or-mindful-604x270.pngA few years ago, I attended a conference where Ron Culberson was a featured speaker. Every few months since then, I receive Ron’s eNewsletter and I always find what he has to say inspiring. He points out the everyday things in our lives and how we need to slow down and be present.
 
Often, he talks about our family and professional interactions and how things we say and do can be misinterpreted. How other things happening in our lives distract us when we should be focused on the present and what is happening right now.
 
I hope you can take a few minutes and read his article about mindfulness. I found myself nodding in agreement and thinking you are so right. I hope this article will help you in your everyday life.
 
I know this has happened to you. You’re driving down an interstate highway when your mind begins to wander. Maybe you’re thinking about your boss’s rude behavior or how nice it would be to make a career change. You start imagining all the jobs that might fit your skills. Maybe you should open a coffee shop or be a consultant and work from home. The ideas are coming fast and furious, and you start to get excited about all of the possibilities. Then, it hits you. The reality of your situation sinks in. You passed your exit ten miles ago.

How does this happen? How can we be so focused on our thoughts and still stay on the highway? And how can it be that we have no idea how far we’ve gone or how long we’ve been distracted?
 
Welcome to being human and having a mind that loves to wander. But don’t fret. It’s a problem that affects all of us.

I’m trying to be more mindful this year and I’m convinced that mindfulness is a skill that can make life easier and richer. Ironically, it’s a practice that most of us never learn. Instead, our minds get distracted by even the slightest of random thoughts. Yet the goal of mindfulness, and perhaps even life, is to stay focused on where we are in any given situation rather than being tempted by thoughts that lead us away from that moment.


Here’s an example of how our minds distract us.


Imagine that I’m having a somewhat heated discussion with my wife. Let’s pretend I’ve done something wrong. I say “pretend” because it’s never happened. But just go with me on this one. Suppose she is upset because I didn’t take the dog out and the dog decided to make a “deposit” on the floor. My wife is accusing
me of not taking the dog out.

The reality of the situation is that we didn’t take the dog out, and the dog pooped. That’s it. No more, no less. If both of us were being mindful of the situation, we would have recognized this and not given it a second thought. Unfortunately, our minds are not satisfied with that approach and prefer to look for more exciting problems. Our egos like drama and love to stir things up.


So, my wife’s ego may whisper something like this,
I was busy working on our tax returns. He knew I was doing something important and could have watched the dog. If he had just been more attentive to what I was doing and taken his turn with the dog, we wouldn’t have to clean up this mess.

Meanwhile, my ego might whisper something like this,
I didn’t want this dog in the first place. At my age, I want to relax. I don’t want to worry about a hyperactive, chewing and pooping machine. I don’t need to be potty training a dog. So, since she wanted a pet, she needs to be the one to monitor that doggone dog.

Then an argument ensues which on the surface, appears to be about the dog poop but in reality, is about the crap that our minds are telling us. And none of this is based on the reality of what really happened.


Does this sound familiar?


How many times have we reacted to our bosses, our partners, our children, or even our pets because of something our heads told us that distorted the reality of the situation. This is generally due to a lack of mindfulness. But there is a solution—it just takes a little effort.


Here’s a quick mindfulness test. Wherever you are right now, take a look around the room and see if you can find something you hadn’t previously noticed. If you’re in your home, this might be harder than if you’re in your office or in a public location. Nonetheless, give it a try.


If you found something, why hadn’t you noticed it before now? Most likely it’s because we typically experience our surroundings through the familiarity of assumptions. We expect to see the tree in the yard or the desk in our office but never really experience the colors, shapes. or sensations of those items as we would if it was a new experience. Ironically, every single second of every single day is a new experience since it’s the first time we’ve experienced that particular moment. So we should go into each moment with an openness to the newness of the experience.


To battle the distractions in our heads that steer us away from the present moment, we need to focus our awareness on right now. Here are two ways to work on this.


First, no matter what you are doing, look at it with fresh eyes in order to be surprised by the novelty of the experience. When we’re open to being amazed, we will be amazed.


The other day, I took a walk. It would have been easy to listen to music or a podcast while I was walking in order to make the most of my time. But the truth is, walking makes the most of my time. When I’m fully focused on the activity, the activity becomes fuller. So, during my walk, since I wasn’t listening to music, I heard a noise in the woods. I turned towards the noise and saw ten deer standing just a few feet away. We stared at each other for a couple of seconds. Then one of the deer snorted and they all galloped away. It was extraordinary. And I’m sure I would have missed it if I’d been focused on the music or a podcast.


Second, when you find yourself reacting to something with fear, anxiety, or some other emotion, ask yourself what’s really happening as opposed to what your mind is telling you is happening. Often, you’ll find that your reaction is based on something your mind is telling you rather than the reality of the situation.


Last week, my wife and I were driving to a college basketball game. About halfway there, I started thinking about something I had said during a presentation and began to worry that while the comment was funny, my client might have found it unfunny, or worse yet, offensive. For the next twenty miles, I could feel myself getting more and more worked up as I imagined that my client was angry with me and that she might not want to work with me again. I became tense, was short with my wife, and felt miserable. However, when I realized what I was doing, I refocused on the present moment and enjoyed the basketball game with my wife. The next week, I got an email from my client and she specifically mentioned how funny the comment in question was. So the reality in my car was not real. It was all in my head. And I spent twenty minutes of my life worrying about it. Thankfully, I made an adjustment before wasting my entire day.


Being mindful means being present to the reality of the moment. The present moment is all that matters. For many of us, our reality is not just in the present moment, but in our heads as we think about last week, next Tuesday, or when we were teenagers. That’s probably too much for our feeble minds to handle. Why not, instead, focus simply on now and make it as rich as possible? That’s how we mind our lives.

Topics: mindfulness, mindful

Cultural Competency: Matters of Modesty

Posted by Pat Magrath

Wed, Mar 22, 2017 @ 03:41 PM

nurse-and-patient-at-home-web.jpgGrowing up, we were taught to be modest. As we became adults and more comfortable with who we are as a person, modesty may have become more important in our lives, or perhaps, less important. It depends on our personal circumstances and beliefs.

Whatever our personal feelings are, as a Nurse, you must always be vigilant and respect your patient’s privacy. You already know this, but are you aware in some cultures, modesty truly is a virtue? For others, there could be a personal trauma, physical disfigurement, or psychological reason that produces tremendous anxiety when disrobing or showing any part of their body.

This article stresses the importance of being sensitive to each patient’s needs in delivering culturally competent care.

Many cultures and religions place a high value on modesty, particularly for women, associating it with honor and virtue. Often modesty is linked to styles of dress and circumstances under which an individual might feel comfortable being uncovered or touched. Yet, there are personal reasons for modesty too, so you’re likely to come across patients, both male and female, who have firm boundaries of privacy—including survivors of sexual assault and transgender patients.

Modesty can be so important to some patients that medical visits cause them a great deal of stress and anxiety. Some will shop around for a clinician of a particular gender or one who makes them feel comfortable—or even forego care completely. As a nurse, your ethical commitment to patient advocacy and patient dignity requires you to demonstrate cultural sensitivity to patients who value modesty. Making accommodations for a patient who values modesty is a form of holistic care, because it recognizes the individual’s emotional well-being.

In general, nurses should always preserve patient privacy, by providing gowns and cover-ups, pulling drapes closed, knocking before entering an exam room, etc. Whenever possible, go the extra mile, by providing scrub pants if a gown doesn’t close in the back or double-gowning a patient who will be leaving his room. Patients may know intellectually that healthcare providers “have seen it all,” but that doesn’t stem their embarrassment. You can also urge your employer to build an environment where patients feel safe, by speaking up about gowns that don’t close all the way or other modesty issues.

Cross-cultural patient encounters can often be challenging in terms of modesty. Muslim women are likely to request female providers only, and these requests might be hard to honor in small facilities or rural areas. They may also prefer to have their husband present during an exam or procedure, and may resist disrobing entirely—or uncovering their hair—for an exam. Women from certain Asian cultures also have a strong preference for female obstetrics staff. Ideally, nurses should be able to anticipate cultural requirements for modesty and make accommodations before patients become anxious or uncomfortable.

While the majority of nurses are female, many mistakenly believe that male patients really don’t care about modesty, but that often is not true. Many hospitals don’t have nearly enough male nurses or technicians on staff, but you should try your best to honor requests for same-gender providers for baths, catheterizations, or other intimate procedures. Always try to be sensitive to modesty concerns—even when it creates an extra step for you or takes more time.

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Topics: cultural competence, modesty

Nurse Uses Her Experience With Brain Tumor To Better Serve Patients

Posted by Erica Bettencourt

Tue, Mar 21, 2017 @ 12:06 PM

Screen Shot 2017-03-21 at 11.56.19 AM-274568-edited.pngYou take care of people in your job every day. However, if the tables are turned because you became ill and now it’s you being taken care of, the situation is bound to introduce you to a different perspective on how things feel. 
 
In the past, Nurse Kelly Northrip could only sympathize with her patients. Now she can relate to them and identify with things they are going through because she was once in their shoes. See how she pushed through her medical journey to come out the other side stronger and with an even better perspective for her patients. 

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."

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