rnl year end sampler
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R E F L E C T I O N S O N N U R S I N G L E A D E R S H I P Y E A R - E N D S A M P L E R
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DEAR READER,2015 has been an exciting year at the Honor Society of Nursing, Sigma Theta Tau International (STTI), particularly for our online member magazine,Reflections on
Nursing Leadership. TheRNLwebsite has seen tremendous growth, surpassing all previous readership records thanks to support from members like you.
OurRNLeditors work hard to publish articles that STTI members will find informative, relevant, and even inspirational. As 2015 comes to a close, we are pleased
to present to you our second annual year-end sampler, highlighting some of our most popular articles as well as some of our personal favorites from the year. Please
consider this gift a small token of our appreciation for all you do to support STTIs efforts not only to publish books, scholarly journals, and articles, but also to
improve global health through our many programs, events, and relationships. We hope you enjoy reading this compilation as much as we enjoyed bringing these
articles to you.
Thank you for your engagement and support, which allow STTI to fulfill its mission of advancing world health and celebrating nursing excellence in scholarship,
leadership, and service.
Wishing you all the best in the coming year.
Dustin R. Sullivan
Publisher
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DEAR READER,For the second time, we offer this year-end sampler containing articles that have been published inReflections on Nursing Leadership(RNL). In 2015, as in 2014,
we have chosen content that, in addition to representing the diversity and wide-ranging interests of members of the Honor Society of Nursing, Sigma Theta Tau
International, also pulls on a few heart strings.
Dennis J. Cheek, PhD, RN, FAHA (Beta Alpha Chapter), the Abell-Hanger Professor in Gerontological Nursing at Texas Christian University-Harris College of
Nursing and Health Sciences, gets excited about communicating to nurses the importance of becoming educated about pharmacogenomics and precision medicine.
He shares that excitement inWHY NURSES NEED TO BE INFORMED ABOUT PHARMACOGENOMICS.
Shela Akbar Ali Hirani, MScN, RN, IBCLC, Advanced Diploma in ECD (Rho Delta Chapter), assistant professor, Aga Khan University School of Nursing and
Midwifery in Karachi, Pakistan, writes aboutTHE MAGICAL ROLE OF PLAY THERAPY.
Maria Cho, PhD, RN (Nu Xi-at-Large Chapter), assistant professor, Department of Nursing and Health Sciences, California State University, East Bay, normally
gives assignments to her students, but she gives herself an assignment inFACING MY FEAR.
Carrie Sue Halsey, MSN, CNS-AD, RNC-OB, ACNS-BC (Upsilon Kappa Chapter), clinical nurse specialist and natural birth and breastfeeding advocate, foundherself experiencing Grade A, certified nursing burnout. Find out what she did to recover and regain perspective inNURSE BURNOUT: WHEN PASSION
ISNT ENOUGH.
Karen Roush, PhD, APN (Upsilon Chapter), assistant professor of nursing at Lehman College in the Bronx, New York, is a long-time editor and writer. InWHY
WRITE? she shares with nurse colleagues around the world six reasons for telling their stories.
Diane Sieg, RN, CYT, CSP (Alpha Chapter), author, yoga teacher, mindfulness coach, and former emergency room nurse, shares 7 HABITS OF HIGHLY
RESILIENT NURSESthat will change you as a nurse and positively influence other aspects of your life.
Cindy Hatchett, MSc, RN, RM (Tau Lambda-at-Large Chapter), nurse practitioner and resident of South Africa, is the author of The Lamplight Narratives, a new
monthlyRNLcolumn. A voice for the voiceless, she recently wrote about THE LADY OF THE SHEDandTHE COWBOY.
Gretchel Ajon Gealogo, PhD, RN, MHR, MSN, CMSRN, RN-B (Delta Alpha-at-Large Chapter), is a medical-surgical nurse. It was a patient with dementia who
inspired her to do her dissertation work in pain communication and, ultimately, to develop a conceptual model for person-engaged dementia care. Learn more in
HER NAME WAS LYDIA.
Thanks again for the many ways you give year-round as a nurse.
James E. Mattson
Editor,Reflections on Nursing Leadership
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Why nurses need to be informed aboutpharmacogenomics
Dennis J. Cheek,PhD, RN, FAHA
(Beta Alpha
Chapter), is the Abell-
Hanger Professor in
Gerontological Nursing
at Texas Christian
University-Harris
College of Nursing and
Health Sciences, with
a joint appointment in
the School of Nurse
Anesthesia. He iscoauthor of Mastering
Pharmacogenomics: A
Nurses Handbook for
Success.
ORIGINALLYPUBLISHED:6/11/2015http://www.
reflectionsonnursingleadership.
org/Pages/Vol41_2_Cheek_
Pharmacogenomics.aspx
Understanding precision medicine ispart of properly caring for patients.Like many of my nurse colleagues, I became a nurse to care for
patients and their families during times of need. Besides delivering
care, I administered scheduled and as-needed drugs to patients,
monitoring them for expected responses as well as possible adverse
reactions. In a large majority of cases, prescribed medications
worked as predicted. Occasionally, however, adverse reactions
required interventions.
My nursing education, which began in the early 1980s, includedthe usual courses: fundamentals, obstetrics, pediatrics, medical-
surgical, critical care, leadership, and, of course, pharmacology. In
the pharmacology course, the focus was on specific drugstheir
indications, typical side effects, and nursing interventions. This
provided a strong foundation for my nursing career in critical care.
The nurse-pharmacology disconnectMy first position was in a cardiac surgical unit where patients
recovered postoperatively from coronary artery bypass or valvereplacement. After several years, I returned to school to complete
my Master of Science in Nursing degree with an emphasis in
critical care nursing and nursing education. I had courses in
advanced physiology, advanced pathophysiology, nursing theory,
nursing research, and nursing education. During this time, I began
to teach in both clinical and academic settings. In the academic
setting, I noticed that nurses were not teaching pharmacology
courses, and I found this interesting in that administering
medications is one of the important tasks a clinical nurse is
responsible for overseeing.
In 1991, I was accepted into a doctoral program with an emphasis
in cellular molecular pharmacology and physiology. This was atremendous learning experience, and I developed, with regard
to pharmacology, skills in cell culture and isolationspecifically
endothelial cellsas well as molecular investigation of receptor
activity. The only problem was that the model was based on an
animal modelthe guinea pig. And what does this all have to do
with my patients?
The four rights of pharmacogenomics
During the summer of 2000, while I was attending the inauguralSummer Genetics Institute, sponsored by the National Institute of
Nursing Research, the initial rough draft of the Human Genome
Project (HGP)a complete genetic sequencing of several men and
womenwas completed. The HGP has led to several important
discoveries, and from it has come pharmacological matching
of drugs with the genetic makeup of individuals. Its called
pharmacogenomicsthe right drug for the right patient at the
right dose and at the right time.
A broader perspective, or personalized medicine, is tailoringpharmacological treatment to a patient during all stages of care
prevention, diagnosis, treatment and follow-upbased on his or
her individual characteristics, needs, and preferences. For me, all
the pieces of the puzzle had come together.
Since that time, I have continued to teach about the genomic
implications of pharmacology and what they mean to clinical
as well as advanced practice nurses. I am excited that extensive
pharmacogenomics work continues to be done. Since completing
the Human Genome Project, the Federal Drug Administration
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(FDA) has identified more than 150 drugs for which there are molecular
biomarkers that may aid in improving therapeutic outcomes and reducing
adverse drug reactions. Thirty percent of these drugs and biomarkers are for
oncology patients.
For exampleAn exemplar comes from the cancer community. After a human epidermalgrowth factor receptor (HER2) biomarker was identified, which is resident
in 30 percent of breast cancer and increases adverse outcomes, a humanized
monoclonal antibody to HER2trastuzumab, also known as Herceptinwas
developed that targets the HER2 biomarker and reduces adverse outcomes.
A second exemplar comes from treating HIV/AIDS patients with antiviral
agentsspecifically, abacavir, either alone or in combination with another agent.
Approximately 10 percent of patients receiving abacavir develop multiorgan
hypersensitivity, and, for some, its fatal. Hypersensitivity to this drug has been
associated with patients who are carriers for the allele HLA-B*5701, which
can be identified with genetic testing. The FDA has issued a post-marketing
recommendation that patients be tested before initiating or restarting the drug,
either alone or in combination. This recommendation has also been added to the
monograph insert.
A third exemplar is the prodrug clopidogrel, the antiplatelet agent used to reduce
platelet aggregation in patients with acute coronary syndrome. When prescribed,
this drug requires a functioning cytochrome 450 (CYP450) in the liver to
convert the enzyme to an active metabolite. The specific enzyme is CYP2C19.
In October 2013, the FDA approved a point-of-care device that enables a
simple buccal swab to detect whether the patient has the normal or wild type,
or the mutant version of the specific CYP2C19 enzyme. This will indicate if
clopidogrel will be converted and protect the patient, or if the prodrug will not
be converted and put the patient at further risk for clot formation.
This area of pharmacogenomics continues to expand. In 2015, the Obama
administration announced the Precision Medicine Initiative. An emerging
approach for disease treatment and prevention, it takes into account individual
variability in genes, environment, and personal lifestyle. While significant
advances in precision medicine have been made for select cancers, the practice is
not currently in use for most diseases. Many efforts are underway to help make
precision medicine the norm rather than the exception. The goal is to expandthe base tenet of pharmacogenomics: the right patient and the right drug at the
right dose.
Ask me about pharmacogenomics andprecision medicine!I get excited about communicating to nurses the importance of being informed
about pharmacogenomics. They need to be educated about it and, more
specifically, understand the Precision Medicine Initiative and how it applies
to each patient. When fully instituted, no longer will drugs be ordered for thegeneral patient on a trial-and-error basis. Instead, prescription of medications
will be based on patient genotype and phenotype.
As patient advocates, nurses will need to be prepared to educate patients and
families about genetic testing and how this information can be used to make
decisions about pharmacological management. Nurses will be responsible for
educating, informing, and discussing with patients, from a pharmacogenomics
perspective, the best possible health outcomes and the role precision medicine
will play in their overall treatment plan.
I am passionate for nurses to be informed about pharmacogenomics and
precision medicine because they are responsible for providing quality care
to patients, administering prescribed medications, and monitoring expected
responses as well as potential adverse reactions. As nurses of today and the
future, we are vital members of the entire health care team and will need to
maintain pharmacogenomic competency to properly care for our patients.
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The magical role of play therapy
Shela Akbar AliHirani, MScN, RN,
IBCLC, Advanced
Diploma in ECD,
(Rho Delta Chapter),
is assistant professor,
Aga Khan University
School of Nursing and
Midwifery in Karachi,
Pakistan.
ORIGINALLY
PUBLISHED:1/8/2015http://www.
reflectionsonnursingleadership.
org/Pages/Vol41_1_Hirani_
PlayTherapy.aspx
Low-cost therapy helps pediatricpatients cope with hospitalization.
Working in a pediatric setting is a rewarding and most challenging
experience. From the perspective of the patients, the hospital
is a source of stress. The bright lights, high noise level, painful
procedures, bitter flavor of medicines, physical separation from
parents and loved ones, unfamiliar hospital routines, and, most
importantly, the childs disease process all serve as sources of
toxic stress for pediatric patients. Not every child is resilient to
these stresses, and these traumatic experiences affect not onlythe architecture of a young childs developing brain but also
pose negative impacts on growth, developmental coping, self-
management skills, and compliance with the treatment regimen.
Play therapy is one therapeutic intervention that can serve a
pivotal role in preparing sick children for hospital routines,
informing them about management of their disease processes,
relieving anxieties associated with hospitalization, diverting their
minds during painful procedures, and promoting their cooperation
with diagnostic procedures and treatment plans. The literature
shows that play therapy serves as a developmentally appropriate
strategy for pediatric patients and aids in reducing patient fears
and anxieties. Play therapy also enhances sick childrens cognitive,
social, and physical development and promotes compliance and
self-management skills (Boyd et al., 2009; Goymour et al., 2000;
Hirani, 2013; Hockenberry & Wilson, 2007; Jun-Tai, 2008;
Murphy & Garry, 2002).
Age- and disease-specificAs a pediatric nurse educator with expertise in early childhood
development, I took the lead in incorporating low-cost play
therapy for hospitalized children in the baccalaureate pediatric-
nursing curriculum at Aga Khan University. Each year,
undergraduate nursing students who take the pediatric-health
nursing course at Aga Khan are offered a play-therapy workshop
during which they are taught use of low-cost play therapy, based
on disease type, for patients in specific age groups. The students
take keen interest as they observe preparation of age-appropriate
play therapy for sick and hospitalized pediatric patients. For thepast few years, we have observed that, on one hand, introduction of
this workshop enhances creativity, critical thinking, and problem-
solving skills of nursing students, while, on the other hand,
providing insight into the feelings of hospitalized pediatric patients
who are experiencing multiple stressors.
Overall, incorporating the play-therapy element into the nursing
curriculum works very well. Play therapy enables many children
with chronic diseases to vent their feelings through pretend play,
drawing, and painting. Through puppet shows, doll play, and
storytelling, children with oncological disorders who experience
the side effects of chemotherapy learn to cope with their disease
process and regain self-esteem. Many pediatric patients diagnosed
with insulin-dependent diabetes learn to administer insulin
injection to dolls and then to themselves, thereby helping to rid
them of needle phobia.
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Snakes, ladders, rattles, and wind chimesPlay therapy that incorporates socialization and limb movement helps children
with fractures and contractures gradually gain mobility. Through use of a
specially designed snake-and-ladder game that includes health messages,
children with poor eating habits learn the importance of a proper, well-balanced
diet. (A healthy diet leads to climbing the ladder, and an unhealthy diet of junk
foods results in being bitten by the snake.) Play therapy also works for very
young children. Handmade, colorful rattles and wind chimes help stimulate
development of sick infants, newborns exposed to phototherapy, and babies in
incubators who were born prematurely. These therapeutic tools also promote
interaction of infants with caregivers and surrounding environments during
hospitalization.
To conclude, play therapy has magical effects on all aspects of health, coping,
growth, and development of sick and hospitalized children. Implementation
of this intervention is effective for sick children of all ages. Considering the
tremendous benefits of play therapy, it is recommended that nursing schoolsencourage students to design age-appropriate, low-cost play therapy for
hospitalized children. In so doing, they will help pediatric patients cope with
hospitalization and reduce the adverse effects of toxic stress associated with their
disease processes and hospitalization.
ReferencesBoyd, M., Lasserson, T. J., McKean, M. C., Gibson, P. G., Ducharme, F. M., & Haby, M.
(2009). Interventions for educating children who are at risk of asthma-related emergency
department attendance. Cochrane database of systematic reviews, 2:Art. No. CD001290. DOI:
10.1002/14651858.CD001290.pub2
Glazier, T. (1997). Play therapy for the children in the emergency department. Australian
Emergency Nursing Journal, 1(2), 52-53.
Hirani, S. A. (2013). Use of play therapy in educating asthmatic and diabetic pediatric patients:A pilot clinical project at a private tertiary setting in Karachi, Pakistan.International Journal
of Nursing Care, 1 (1), 83-87.
Hockenberry, M., & Wilson, D. (2007). Wongs nursing care of infants and children. (8th Ed.).
New Delhi, India: Mosby.
Jun-Tai, N. (2008). Play in hospital.Pediatrics and Child Health, 18 (5), 233-237.
Murphy, J. E., & Garry, L. (2002). The efficacy of intensive individual play therapy for
chronically ill children.International Journal of Play Therapy, 11(1), 117-140.
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Facing my fear
Maria Cho, PhD,RN (Nu Xi-at-Large
Chapter),is assistant
professor, Department
of Nursing and Health
Sciences, California
State University, East
Bay, in Hayward,
California, USA.
ORIGINALLYPUBLISHED:
1/15/2015http://www.reflectionsonnursingleadership.
org/Pages/Vol41_1_Cho_
FacingFear.aspx
A teacher gives herself an
assignment.I have been teaching nursing students in various programs for
five years. I enjoy teaching, but it takes courage to stand in front
of people. Although I have improved every quarter, I still have to
repeatedly go over the material I am teaching, review PowerPoint
slides and quizzes, and read recently published articles on the
subject. If I were to tell my students that I am afraid of public
speaking, they would not believe me. I am usually quiet in big
meetings and hesitate to ask questions in a group setting. Id rather
ask questions of the speaker individually. I dont know if this isbecause of my personality, my cultural background, or my gender.
My specialty is oncology nursing. As an oncology nurse, I have had
much experience working with elderly patients, which has led me
to be interested in geriatrics. I love to listen to life stories of older
people; they always remind me of what I need to focus on in my
life at this moment and what my priorities should be.
Easy foryouto sayIt was an honor to be selected for the interprofessional and
multidisciplinary geriatric faculty development program
established by the University of California San Francisco, but my
joy was short-lived because of my passive nature. Attending the
programs monthly meetings was challenging and took courage. At
the first meeting, I was intimidated by several things: 1) the diverse
professions and impressive backgrounds of other attendees, 2) thenontraditional format (it was not the usual classroom teaching
and learning style I was familiar with), and 3) speaking in front of
people. Of the three, I was most uncomfortable with speaking up
in the classroom.
When I applied for the program, I assumed the course would
be taught through lectures and PowerPoint slides. However, all
of the lectures involved various ways of learning the material
experiential learning as well as both small-group and large-group
discussion. I enjoyed the small groups and tried to activelyparticipate, but I found this a challenge in large groups and only
participated twice in class discussion. This experience made me
think again about why I am not verbally active in the classroom.
Is it because I have public-speaking anxiety or because I am self-
conscious of my accent, grammar, and enunciation?
I am an immigrant, a female who grew up in the Korean culture.
Although I know asking questions and sharing thoughts contribute
to active learning, I am not comfortable with doing that. During
my education in Korea, asking questions was not allowed in theclassroom. Teachers taught you what you didnt know, so you
needed to respect them. Even when the teacher was wrong,
students were not allowed to correct him or her because it would
be embarrassing to the teacher.
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I am not sure if my reserved personality led me to be who I am or if I am a
product of suppression that was present in my Korean learning environment.
However, I have noticed that even younger generations of Korean people
display similar characteristics in the classroom setting. Korean culture is heavily
influenced by Confucian values, where there is a moral responsibility to respect
someone who has higher status than you, such as government officials, teachers,
and doctors.
Breaking freeFace-saving to avoid shame, another crucial cultural factor in my upbringing,
may account for why I am not comfortable speaking in front of people, especially
to a multidisciplinary team and large audiences. In other words, I do not want
to be judged by my verbal communication skills. This behavior, however,
became a cell that locked up my creative ideas and questions. Differences in
communication styles that relate to gender, values, and expectations are common
in all workplace situations, but individual personality and culture also play asignificant role.
Changing ones behavior is not easy. Although it may be a challenge for me, I
am planning to do the following to change my behaviors: 1) I will actively look
for opportunities to speak up in meetings. 2) To meet more people and become
more comfortable interacting with faculty members, I will attend more meetings
and sign up for committee activities when opportunities arise. 3) To overcome
my fear of speaking in front of people, both within nursing and outside of
nursing, I will seek out and attend meetings of the local chapter ofToastmasters
International.4) I will work to positively visualize myself giving successful classpresentations and participating in class discussions. And, 5) I will not focus on
my limitations, but on the strength I can bring to the meeting or discussion.
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Nurse burnout: When passion isnt enough
Three actions saved this nurses career.When I was 16, I joined the millions of teens scraping grease and
taking orders at a fast-food chain. I went on to become a restaurantmanager. I have spent time working at a gas station, as an in-home
childcare provider, and as a librarian assistant. These occupations
were hard work and paid poorly. I was tired and sweaty, but happy. I
think back to that freckle-nosed sprite wearing a purple visor with a
burger embroidered on it, and I realize I have come a long way.
That young woman would never have dreamed that, someday,
her minimum-wage paycheck would grow to become what her
professional nursing salary is today. Standing behind that fast-food
counter, she could not have guessed she would save someones life,deliver babies, or hold someones hand as that person let go of this
world. When I think about how amazing it is to be a nurse, it is hard
to imagine that anyone would get disenchanted with the profession,
but I did.
All the jobs leading up to nursing school were like romantic flings.
I never took them too seriously. I accepted them for what they
weresteppingstones to my real career. Nursing is what I decided
to marry, professionally speaking. I fell in love with it, we dated for
several years during nursing school, and we made it official when Ipassed the NCLEX. The honeymoon period was both exciting and
terrifying. After the first few months, we settled into a comfortable
rhythm, and life seemed perfect. All my romantic ideas about
becoming a nurse were realized.
After the honeymoonOver time, the newness wore off. I had issues with the hours,
charting, constant alarms, staff meetings, new products, new
policies, staffing shortages, belligerent patients, and backbreaking,
emotionally taxing work. All the flaws I had ignored during my
infatuation with nursing became reasons to be unhappy. A few of
my friends left nursing in the first two years after graduation. I
considered taking the same route, but felt guilty for wanting to
leave.
A common perception in nursing is that bedside nursing is the real
nursing. Leaving the bedside is tantamount to abandoning your
ideals. At my former position, I was directly involved in empowering
bedside nurses, improving patient outcomes, and increasing nursing
education and satisfaction. All of these efforts, supported by hospital
administration, did not prevent me from wanting to drive my
car into a ditch on the way to work. I was experiencing Grade A,
certified nursing burnout.
Nurse turnover and burnout are hot topics in health care. With
nursing positions predictedto increase 1.5 millionby 2022, it is
vital that nurses remain in health care. Turnover is expensive. For
the average U.S. hospital, it costsmore than $4 million a year.
The number of hospitals that have implemented retention plans
is increasing. These strategies are important and, it is hoped, will
increase nurse satisfaction and prevent compassion fatigue, burnout,
and exiting of nurses from the profession.
Up to the nurseUltimately, hospitals are not responsible for keeping nurses engaged.
As employers, they have a vested interest and should be applauded
for encouraging nurse engagement, but each nurse needs to discover
what motivates him or her to be the best possible. Provision 5.2
of the Code of Ethics for Nursesaddresses the moral responsibility
nurses have to themselves. The nurse is responsible for preventing,
managing, and recovering from nursing burnout.
Carrie Sue Halsey,
MSN, CNS-AD,
RNC-OB, ACNS-BC
(Upsilon Kappa),is a
clinical nurse specialist
and natural birth and
breastfeeding advocate
who resides in Houston,
Texas, USA. She teaches
childbirth classes for
expectant parents and
assists mothers with
breastfeeding goals.
ORIGINALLYPUBLISHED:
5/11/2015http://www.
reflectionsonnursingleadership.
org/Pages/Vol41_2_Halsey_
Burnout.aspx
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I did not drive my car into the ditch that day, or any of the days I was working
through my disenchantment with the profession. Eventually, I grew tired of
complaining about all the reasons I was unhappy with my job. My face hurt from
forced smiling, and I did not want to pretend I was happy taking care of patients.
My family started to notice I was not acting my happy self. I did not want to
leave the house on my days off. I had let my job suck all the good energy out of
my life.
The stress and fatigue did not originate solely from nursing. I had personal
struggles that were compounded by my dissatisfaction at work. When nurses
have stressors outside of work that are unmanaged, it is difficult to draw on the
inner strength it takes to guide others through illness and recovery. We give until
there is nothing left to give, and then, like an undernourished plant, we wither.
A qualitative studyfound that nurse burnout is caused by 1) short staffing, 2)
not being able to care for patients as well as the nurse would like, and 3) feeling
that there is no advancement potential. Many nurses spend their entire careers
at the bedside, loving to care for and directly serve patients. However, for those
who want to step away from the bedsidetemporarily or permanentlythere
are options. Nurses are needed as leaders, scholars, advocates, writers, legal
experts, board members, inventors, teachers, entrepreneurs, and more.
A choiceI had a decision to make. As in marriage, I had a choice: cut my losses or
rededicate myself to what I had fallen in love with all those years ago. When I
examined my strengths and desires, I realized I needed more from nursing. I
love taking care of patients. Patients have taught me more about compassion,
patience, tolerance, service, and bravery than any school could have. My personal
passion is guiding women throughout the birth process. It is an honor to care
for women, babies, and families. But, despite my passion for the work, I allowed
myself to admit I did not want to be a bedside nurse long-term. I considered
other options, including leaving the profession.
Three actions saved my nursing career.1) I followed my dream.
A colleague who knew I was struggling with burnout asked me a question that
changed my path. What would make 8-year-old Carrie happy? It sounded silly
at first, but, as I gave the question weight, it made perfect sense. The answer was
simple: Eight-year-old Carrie wanted to be a writer.
I started writing. My first modest writing accomplishments were press releases
and a no-byline, trade-magazine article. I startedmy own nursing blog,
focusing on my passion for perinatal education. My writing has allowed me to
reach more nurses and women than I thought possible. Using the knowledge
I gained at the elbow of my patients, I educate and uplift people all around the
world as a freelance nursing writer and blogger.
2) I became board certified.
Two years had lapsed since I graduated with my masters degree in nursing,
and I had not yet become certified or licensed as an advanced practice nurse.
My intense burnout caused me to feel it wasnt worth the effort. After a
particularly bad month, I decided it had been long enough. Revisiting what I
learned in school helped dispel the myth that true nursing occurs only at the
bedside. I knew I had the potential to expand my nursing scope, and I made
the appointment to sit for the board. I took the exam. I passed. The sense of
accomplishment was energizing and changed my outlook on my career potential.
3) I quit my job.
For months, I wrestled with leaving my job. I liked my colleagues and patients.
There were parts of my job I knew I would miss. I knew my job, and I did it
well. I wanted to stay to work on quality and safety projects that would positively
affect patient care. I wondered if I should weather the storm and hope for the
changes I wanted to see. In the end, I decided to move on to a different hospital.
Transitioning to a better-fitting role was the key to ending my burnout. I
stopped questioning if I should leave nursing.
Nursing and I are back on good terms. I enjoy the many ways I am able to use
my nursing talents, and I am looking forward to a long career as a nurse.
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Why write?
Nurse stories are about lifeitsmessiness and its truths.
Why write?is a question that often comes up in my work ofmentoring nurses in writing. The question doesnt arise as often
with faculty members, who are expected to disseminate research
findings and are required to publish to get tenure. Nor does it
come up with nurses working in the policy arena, who understand
the necessity of writing to create change and promote a health
care agenda. But nurses working as clinicians dont see writing as
integral to what they do.
While its true that you can provide excellent clinical care without
ever publishing an article, writing will enrich your practice,enhance your experience, and create more positive outcomes for
your patients. If writing isnt part of your nursing life, I encourage
you to start. And if it is, I encourage you to expand your writing,
try a different genre, reach a new audience, or consider a new
purpose.
Write to improve patient care.Nurses do amazing work. We conduct research, develop innovative
approaches to care, and carry out quality-improvement projectsthat change outcomes and make a real difference in patients
lives. When you solve a problem, discover previously unseen
connections, or find a better way to care for patients, writing
enables you to disseminate your knowledge beyond the bedside for
the benefit of many.
For example, take a quality-improvement project youve completed
on your unit that has resulted in positive outcomes for your
patients. Perhaps they are better able to self-manage their diabetes
or are more prepared for a complex surgery, resulting in less fear
preoperatively and improved pain management postoperatively.
Talking to co-workers spreads the information within your unit
or to the wider facility. Presenting at a conference shares it with afew hundred or even a thousand attendees. But publishing has the
potential to spread the information to thousands of nurses across
the country and around the world.
Write to bear witness.As nurses, we are present at the most profound eventsfrom the
beginning of life to the end of life and everything in between. We
are there with the mother who hears her babys first cries, and we
are there with the mother whose baby is born in awful silence. Weare there with the patient who awakens from surgery to hear his
or her prognosis, and we are there as that patient figures out what
that prognosis means.
Sharing these stories offers meaning and insight to other nurses
and those who experience situations similar to what we write
about. These stories ease suffering and provide paths to new
perspectives that help people heal. When people recognize
themselves in stories, they realize they are not alone, that others
have been where they are and have made it through.
Write to share your own stories.When we write about our own experiences, we communicate the
unique perspectives of two worldsthe world of the healer and
the world of the sufferer. We cannot separate our stories from what
weve learned and lived as nurses. When our personal stories are
embedded in that knowledge, they gain power and have potential
to be transformative.
Karen Roush, PhD,
APN (Upsilon
Chapter),assistant
professor of nursing at
Lehman College in the
Bronx, New York, USA, is
the author ofA Nurses
Step-by-Step Guide to
Writing Your Dissertation
or Capstone.Roush
served for many years
as editorial director and
clinical managing editorfor theAmerican Journal
of Nursing (AJN)and
continues her affiliation
with the journal as an
editorial consultant.
ORIGINALLYPUBLISHED:
6/25/2015http://www.
reflectionsonnursingleadership.
org/Pages/Vol41_2_Roush_
Write.aspx
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I am a survivor of intimate partner violence (IPV) and, as a nurse, have cared
for many patients who have experienced IPV. Writing as both a survivor and
nurse gives a weight to what I write that neither perspective alone would have.
It engenders trust and credibility and, therefore, creates an opportunity andI
believea responsibility to share my personal story for the possibility of change.
Recently, I visited a class of graduate students to talk about writing. They
had been assigned to read some of the pieces Ive written about IPV over the
years, including opinion pieces, blog posts, poems, and research findings. The
responses of two students illustrate the impact writing can have.
The first confessed that, when she saw the topic of the reading assignments, she
was not happy. I thought, Oh no, this is going to be such a downer. But the
insights she gained from reading about IPV in those formatsstories, poems,
and opinion piecesmade her realize how little understanding she had of the
experienceof IPV and how her misconceptions had resulted in her providing poor
care to women who suffered from it. She was determined to change her practice.
The second student was a woman who was in an undergraduate class I had
visited a few years earlier, a class that also had read some of my writing on the
subject of IPV. Now, in this graduate-level class, she asked if she could read
something she had written. It was a personal essay about reading my stories and
how it had given her courage to finally speak about her own experiences as a
survivor of IPV. Through writing, she was able to break through the silence and
isolation and begin to heal. These two examples illustrate the tremendous power
of writing to transform lives, professionally and personally.
Write to tell the stories of others.Nurses have a long history of speaking up for the vulnerable and the voiceless,
beginning with Florence Nightingale, a prolific writer, and onward to nurses
such as Lillian Wald, the great pioneer and champion of public health nursing.
Wald published a series of articles in The Atlantic Monthlythat later evolved into
her book, The House on Henry Street. In the articles and the book, she told stories
of the poor and disenfranchised that she and her organization of nurses cared
for, a population of new immigrants to the city who were unable to speak for
themselves.
As Wald writes in The House on Henry Street, Conditions such as these were
allowed because people did not know, and for me there was a challenge to know
and to tell (p. 8, italics original). Speaking about a story or a project resonates in
the moment, but writing can resonate through time. A hundred years after she
wrote them, Lillian Walds words enhance our understanding of social injustice
and move us to do something about the injustices we see today.
Write to understand.Writing forces us to see gaps in our thinking. We cannot write well about a topic
unless we understand it completely. When we see gaps, two things may happen:
1) We go out and seek more information, which may cause us to question
preconceived ideas, change perceptions, and open ourselves to discovery of new
ideas, or 2) we begin to formulate questions that will guide research to help fill
the information gaps. Eventually, writing leads to new understanding, not only
for ourselves but for other nurses and health care professionals.
Writing also helps us make sense of this world of health and illness, trauma and
redemption that we inhabit. We are called upon day after day to deal efficiently
and logically with suffering, to apply science and rationality to the irrational.
Amongst all the equipment, diagnostics, and data, writing keeps us connected to
humanity. It helps us interpret and analyze our actions and reactions. It helps us
see some small part of ourselves in our patients and, as a result, to be that much
more empathetic and to go back the next day and do it all again. Maybe better.
So, why write?
Our experiences as nursesour storiesare about life, all of its confusedmessiness as well as its transcendent truths. Few other professions put
members in the thick of it like nursing does. When we write about it, we make
connections, improve care, and transform lives. Isnt that the very essence of
what nursing is?
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7 Habits of highly resilient nurses
They are associated with qualities ofmindfulness.
More than 40 percent of hospital nursestoday suffer fromthe physical, emotional, or mental exhaustion characteristic of
burnout. The result of unmanaged stress, burnout accounts for
what is often a negative perception among nurses of their work
and workplaces. If we as nurses can change our perceptions of our
work and work environments, we can change our experiences.
Resilience is the capacity to accurately perceive and respond
well to stressful situations. With the uncertainty, transition, and
reorganization associated with health care, resilience is more
important than ever if todays nurse is going to thrive.
TheAmerican Psychological Associationsuggests that several
factors help usdevelop and sustain resilience. They include
maintaining good relationships, accepting circumstances that
cannot be changed, keeping a long-term perspective, sustaining a
hopeful outlook, and visualizing ones wishes. These factors can be
developed and sustained with one critical skillmindfulness.
Mindfulness is paying attention, on purpose, to the present
moment. We exercise our mindfulness muscle with practices
such as deep breathing, meditation, and movement and bycultivating, through intentionally acquired habits, certain qualities.
Below are seven qualities of mindfulnesstogether with associated
habitsthat highly resilient nurses practice. Developing these
qualities will help you thrive in nursing and every area of your life.
Beginners mindis approaching familiar and unfamiliar things
in life with a sense of curiosity and the wonder of a child, instead
of from the perspective of an adult who, based on expertise and
judgment, makes certain assumptions.
Habit: Approach your next meeting, physician call, intake, or family-care
conference as if it were your first, with fresh eyes and open ears. Use an
I dont know mindset (even if you think you do know), and notice new
possibilities that appear.
Letting gois not giving in or giving up, but releasing the need
to control the outcome of a situation. The essence of mindfulness
is becoming aware of your thoughts, feelings, and sensations and
then letting them goagain and again and again.
Letting go is always the most popular mindfulness practice I teach,
especially with health care providers. All the exposure we have to
pain and suffering can invoke a lot of negative feelings, including
helplessness, and its important to be able to let go.
Habit: Reflect on a thought or feelingmaybe even a personyou are
holding onto right now that is not serving you. With each inhalation,
say let to yourself, and with each exhalation, say go. Each time you
exhale, visualize the word, image, or person you are letting go of floating
farther and farther away.
Compassionis the desire to alleviate suffering by expressing a
fundamental loving kindness. More simply, it means to be kind.
Compassion is why we chose nursing, but sometimes, when
dealing with a noncompliant chronic patient, an irate physician, or
an unrealistic family member, we forget. Compassion begins with
kindness to ourselves and is contagious.
Habit: When you are feeling completely overwhelmed with a thought,
feeling, or sensation, take a five-minute compassion break and ask
yourself, What do I need most right now? Lunch? Sleep? A walk
outside? Help? Be kind to yourself by making sure you get it.
Diane Sieg, RN,
CYT, CSP (Alpha
Chapter), is a former
emergency room nurse
turned speaker, author,
mindfulness coach,
and yoga teacher. The
author ofSTOP Living
Life Like an Emergency
and other books, she is
also the creator of the
30 Days Mindfulness
ChallengeandYourMindful Year.
ORIGINALLY
PUBLISHED:
3/19/2015http://www.
reflectionsonnursingleadership.
org/Pages/Vol41_1_Sieg_7%20
Habits.aspx
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Gratitudeis seeing and appreciating the blessings of life that surround us all
the time. Practicing gratitude is active and starts with the simple decision of
choosing what to focus on. What we focus on expands in our field of vision, and
when we focus on disappointment, we see lack and limitation. When we choose
gratitude, we focus on abundance and opportunities, and we attract more of
those assets.
We may think we have to be happy to be grateful. Just the opposite is true. Weneed to be grateful in order to be happy. We give little thought to so many things
we take for granted, such as having a secure job to support ourselves, enjoying
good health, and, as nurses, having our expertise and skill sets that make such an
incredible difference in how people live and die every day.
Habit: Start and end your shift with three things for which you are grateful. Include
yourself, family, friends, colleagues, and anyone else in your life.
Authenticityis being true to your personality, spirit, or character, despite
external pressures. It is honoring yourself by standing in the truth of who you
are, even if others have different expectations and desires for you.
Authenticity allows you to live a more open, honest, and engaged life. Authentic
people feel better and are less likely to turn to self-destructive habits for solace.
They tend to be purposeful in their choices and are more likely to follow
through on achieving their goals. Being authentic is how you truly connect with
your work, your relationships, and yourself.
Habit: Try telling the complete truth for one whole day. When someone asks you a
question, consider how you would respond if you were completely honest. You will soon
realize how often we stretch or leave out the real truth about how we feel or what wethink. Ask yourself right now, What am I pretending not to know?
Commitmentis being dedicated to do thingspersistently, patiently, and
maybe playfullyeven when you dont want to. Being committed to something
doesnt have to be hard. In fact, it can actually be pleasant, because you are doing
what you really believe in.
We cannot live to our fullest potential until we fully commit. It doesnt matter
if its a diet, an advanced degree, or five minutes spent engaging in mindfulness
practice. When we truly commit to something, we become bigger than our
excuses, such as I dont have time for this or Its not that important or Ill
start tomorrow.
Habit: Acknowledge your favorite excuse for not keeping commitments to yourself, and
replace it with a new mantra, such as: Bring it on! I am worth it! I commit, no matterwhat!
Trustmeans embracing faith over fearnot the kind of blind faith where you
believe everything you hear and live in denial, but an overall confidence that you
ultimately are resilient, resourceful, and totally capable of getting to the other
side of the situation.
Nurses have great intuition. We use it all the time in patient care, when we have
a gut feeling or hear a little voice telling us something we may not want to hear.
You have to be present to listen to your inner voice and then choose to trust it,
for your patients and for yourself.
Habit: Practice trusting your inner voice. Saying no to one thing allows you to say yes to
something else. Say no to an extra shift, a new project, or a lunch date on your day off if
your inner voice is guiding you to say yes to something else.
Resilience in nursing is not an option. We have to stay confident and strong in
body, mind, and spirit, and this requires us to practice mindfulness.
Since mindfulness is focusing on one thing at a time, start with one of the habits
described above that speaks to you the loudest, and go from there. These sevenhabits will change your perception because they will change youyou will
become highly resilient both as a nurse and in every other aspect of your life.
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The lamplight narratives
I am an advanced practice nursea nurse practitionerworking for a
nongovernmental organization (NGO) in Southern Africa. We receive
referrals from hospitals, clinics, private doctors, lay care workers [carers],and other individuals in various communities. We visit people in their
homes when they are ill. Every day is a challenge, because I never
know what I will have to deal with. The goal of our team is to provide
palliative, holistic care to everyone we visit, which means we try to relieve
suffering, whether psychosocial, environmental, physical, or spiritual.
Many of the people I see do not have the wherewithal to write their own
stories, so I will be their voice. As a candle-lit Turkish lantern illuminated
an uncertain pathway for Florence Nightingale, I offer these narratives to
help light the way for others who have also chosen the noble profession ofnursing.
The lady of the shedAn image that has burned itself into the very depths of my psyche
is that of a lady we were fortunate to find.
On the far boundaries of the Bitou area, carers, who work in
the area they live in, had heard talk of someone who needed my
assistance. They had tracked down a relative of the woman and
determined where she was located.
To get there, we navigated a long dirt road filled with potholes. It
was tricky driving, indeed, and I felt for a moment I was on one of
those TV auto-rally shows where drivers compete in the back of
beyond. The family member had come with us to show us the way.
After what seemed an eternity, we turned off the road into a farm.
I thought the relative was going to lead us to the farmhouse, but
he kept walking. All the way, we were followed by a pack of large
dogs. Eventually, we came upon a shed, standing alone in the
middle of the veld. The relative unlocked and pushed open the
door, which was attached to the shed with large bolts. He then
opened another door to the left and stood back for us to enter.Upon entry, I put my medical bag down on the floor, and the
young man closed the other door to keep the dogs out.
The room was quiet and dark, and I was immediately struck by a
rancid smell. There was no electricity for a lamp and, with very
little light entering the room, my eyes took awhile to adjust. Once
I could see better, I moved further in, where I was able to make out
a small bundle near the far wall. I realised with horror and shock
that the bundle was a human being, a tiny, middle-aged woman
lying very still in a fetal position on a gray blanket spread out onthe concrete floor.
We found a small window and pulled back the makeshift curtains.
The womans head rested on a pillow, which also cushioned a few
small pieces of cooked chicken, a small pile of rice, and a heap
of shriveled vegetables. Flies were everywhere, and they were
enjoying the feast.
Upon closer examination, I determined that, other than her head,
this tiny lady was unable to move any part of her body. She was
facing the door, and when she saw us her eyes filled with anxietyand wariness. Thoughts shrieked through my mind: Was she
locked in this room to prevent the dogs from gaining access to
her? Who would leave a human being like this? Not even animals
are treated so! A mattress and a wire bed stood against the wall,
unused because she was incontinent. The food on her pillow, her
meal for the day, had been strategically placed so she could reach it
with her head if she was hungry. But how could she chew? She had
no teeth!
Cindy Hatchett,
MSc, RN, RM (Tau
Lambda-at-Large
Chapter),is a nurse
practitioner who works
for a nongovernmental
organization (NGO) in
Southern Africa.
ORIGINALLYPUBLISHED:The lady of the shed:8/31/2015
http://www.reflectionsonnursingleadership.
org/Pages/Vol41_4_Col_
Hatchett_shed.aspx
The cowboy: 12/1/2015http://www.
reflectionsonnursingleadership.
org/Pages/Vol41_4_Col_
Hatchett_cowboy.aspx
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After we spoke to her and explained that we were there to help her, she
smiled. A stroke had robbed her arms and legs of movement. Untreated with
physiotherapy, they were frozen in fixed contractures. Although she tried to
speak, we could not understand what she was saying. Her body was covered in
sores, and the adult nappy that she wore was soaking wet, as was the blanket.
Both the community carers and I were so moved and horrified by the situation
that we worked in silence most of the time, speaking only in hushed tones soas not to frighten her. After making the woman as comfortable as we could, we
informed social workers, questioned the person who had been looking after her,
and sent the woman to the hospital.
The last glimpse I had of this lady was a gummy smile, which conveyed more
than words could have described.
A sad and blatant fact is that she was receiving a disability grant from the
government so she could survive, be cared for, and have sufficient food. The
people who had been caring for her had been abusing this provision. They had
taken on responsibility for her care but were spending the money on other
things.
This tiny lady died not long after we found her. If only we had been able to
intervene sooner. She will never be forgotten!
The cowboyAn 86-year-old gentleman who lives in the Western Cape, South Africa, has been
a patient of ours for the past year. A man of great dignity and pride, he is also
incorrigible!
He has cancer that has spread to multiple parts of his body and regularly takes
oral morphine syrup for pain relief. He has refused further treatment and is
happy to carry on his life without the discomfort of chemotherapy and radiation.
He stays with his daughter and grandchildren in a small house. He speaks with a
deep, gruff voice, has only two front teeth remaining, and has a ready smile and
quip whenever I visit.
Dressed smartly, he walks about the streets of the township with a knobkerrie,
a wooden walking stick that has a bulbous top, making him look almost regal. A
leopard-skin cowboy hat, broad black belt, and jeans are his favourite outfit. On
special days, he adds either a rather worn tweed or scuffed-leather jacket.
This gentleman loves to sit on an empty paint drum outside his house to soak up
the sun. He also has a spare drum, which I have been invited to sit upon on many
a visita privilege. Catch a glimpse of him, and one might imagine that he is a
wise tribal elder.
I saw him walking in the road just the other day, looking rather handsome
indeed, like a cowboy. He even walks like one now that he has to wear adult
nappies due to the disease.
Today, he made me realise that life and its small pleasures never have to end.
He has found a girlfriend in another part of the township and walks to her
place every day. He doesnt carry his morphine with him, but rather a flask of
Sedgwicks Old Brown Sherry, which he says is much better than the medicine!
His daughter is frantic because she does not know where the girlfriend lives or
how she will find her father if he gets into trouble. She has even tried to lock him
in the house when she goes to work, but he climbs out the window!
We shall find out where the girlfriend lives and let his daughter know so she
does not worry. Today, he had a glint in his eye and a spring in his step. He is
happy and has made us smile, too. A rebel at 86, he is living life and enjoying
every moment!
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Her name was Lydia
I wanted her to know she mattered tome.She was a medical-surgical patient of mine on a very hectic night
shift. The unit was at maximum capacity and scarce on staff,
and several patients with delirium or dementia were considered
safety risks. Lydia (not her real name), a woman in her 70s, had
Alzheimers disease. Because she responded to staff reorientation
more readily than the others, she was not assigned a sitter. Instead,
she was placed in a room right next to the nurses station, with bed
alarms activated.
Lydias husband had stayed with her from the time shed been
admitted early in the morning until right before dinnertime.
After he left, she gradually became more confused. By the time I
received the shift report, the day-shift nurse was struggling to keep
Lydia from wandering out into the hallway.
Shes got that fractured right arm in a sling. She hasnt said
anything about pain since I medicated her this morning. Im
worried that shes getting more restless.
In the middle of the shift report, the bed alarm from Lydias room
sounded. I ran to the elevators and found Lydia waiting for thedoors to open. Hows it going? I asked. Where are you headed?
Im just not sure Im supposed to be here, she replied.
Miss Lydia, youre here in the hospital because you broke
your arm, and the doctors are trying to fix it, I explained. Im
Gretchel. Im going to be your nurse for tonight. How about
taking a walk with me back to where my desk and your room are?
Lydia obliged. Sure, but only for a little while. Im not sure Im
supposed to be here.
Thank you so much for agreeing to help me out, I said. We made
our way back past the nurses station to her room.
Here we are. Do you think you can hang out for a little bit while I
visit my other patients? I wont take long.
Look, Ive got all this to sort through and read. Lydia pointed
to the large stack of newspapers her husband brought to keep her
occupied. Dont worry. Ill be here doing my work, she reassured
me.
Minutes after Id finished visiting my other patients, the bed alarm
in Lydias room sounded again, this time accompanied by high-
pitched screams. I found her standing in the midst of torn-upclumps of newspaper pages that littered most of the room. Her
face was streaked with tears, and she howled in anger. I dont
know why Im here! Why am I here? I dont want to be here! The
sling that cradled her arm lay crumpled at her feet.
I approached her cautiously. Lydia, I said, Im going to come
closer to you because I just need to check your arm. Is that OK? I
just need to check.
She nodded slowly. Its OK. Im not hurt. Its just a little sore.
Now Im going to touch your arm, OK? Just to check. I
inspected it. I saw no changes.
She interrupted my inspection. I need to talk to my husband.
Now! Right now! I need to know why Im here, and he needs to
tell me.
I dialed the phone number he had written on the dry-erase board.
Sir, this is Gretchel, your wifes nurse here at the hospital. She
would like to speak with you. Can you talk right now?
Gretchel Ajon
Gealogo, PhD, RN,
MHR, MSN, CMSRN,
RN-B (Delta Alpha-
at-Large Chapter),
is a medical-surgical
nursing and pain
management certified
nurse, with special
interest in consumer
advocacy and research
partnerships with
cognitively impairedpopulations.
ORIGINALLYPUBLISHED:
8/27/2015http://www.
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org/Pages/Vol41_3_Gealogo_
Lydia.aspx
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He sounded worried. Of course. Is she OK? Do I need to come back? I just
need enough time to eat something and take a shower. I havent done either in
two days.
No, I think weve got things under control. But Lydia would like to speak to
you. Here she is. I gave the phone to Lydia.
Hello. I hope youre OK, she said. I couldnt find you. Why am I here? Didyou leave me? Is it OK?
As they finished their call, I quietly cleaned up the mess around the room. I
then repositioned Lydias arm back into the sling and reassessed her level of
discomfort. Tell me, Lydia. If you could give the pain in your arm a score from
one to 10, with zero being no pain, and 10 the worst pain ever, what number
would you give it?
She considered the question carefully, squinting her eyes in concentration.
Hmm. I think its a 7.5. Yeah. A 7.5.
Would you like to take some medicine to help with the pain? Its OK if you
dont want any.
No, I think Id better take some. I probably needed some earlier, huh? Itll help
me sleep.
One more thing. How can we make sure youll know right away where you are
when you wake up? Youre at _____ Hospital for a fractured arm, and the doctor
will decide in the morning if you need surgery or not.
OK, she agreed. Can you write something like that on the board?
How about we write it together? I suggested. By the time we finished, the dry-
erase board bore this note:
Hi, Lydia! Its Friday, March __, and you are at _____ Hospital. Im Gretchel, your
nurse. Your husband brought you here this morning because you broke your right arm
when you fell at home. He will be back in the morning to meet with your doctors. If you
need anything, Ill be outside your room at the nurses station. The door to your room is
open so I can hear you if you call for help.
After taking the pain medication, Lydia slept most of the night. Once or twice I
saw her sit up in bed, look out the window, read aloud the words on the board,
and go back to sleep. When I stopped by her room in the morning to say a final
goodbye, she held onto my hand after I gave her a hug.
I want to thank you for being patient with me last night. You know, I know Im
losing it, she admitted. Its hard, but it just is.
She wiped the tears rolling down her cheeks and averted her gaze to the view
outside her window, the bright sunlight illuminating her gray eyes. Lydia never
looked more beautiful to me than in that moment, and I have never forgotten
what she looked like then.
On my hour-long commute home that day, I realized that Lydia was the reason I
was a nurse and why I wanted to be a nurse scientist. The person-engaged model
for dementia care I developed as part of my dissertation is based on what Lydia
taught me: that persons with dementia are engaged citizens who express their
care experiences, make care choices, and contribute to health care team goals. Ashealth care providers, caregivers, and communities, we are obligated to listen to
what they have to say and to ensure they have opportunities to build and sustain
capacity to engage in their care.
I dont know what became of Lydia. I am pained by the inevitability of her
prognosis and its impact on her loved ones and the community to which she
belonged. But I am also encouraged by the thought that, during the short time
we knew each other, I was able to engage her so that she understood, without
question, how much I cared. Lydia mattered, and I wanted her to know she
mattered to me.
You still do, Lydia. You always will.
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