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Moving On After Your First Patient Death
In nursing school, RNs learn about death and the care of dying patients, but nothing can totally prepare them for encountering patient death in real life. The blow is always heavy and gut-wrenching.
When nurses are asked to recall their first experience of patient death, they cannot recount the details without feeling deeply moved by those memories. Some are haunted by their patients’ faces as they took their last breath. Some are stricken with guilt, asking themselves what they might have done wrong or what more they could have done to keep their patients alive.
They find themselves saying, "I must have given up on the CPR too early,” and "I should have reported the drowsiness much earlier," or asking themselves, "Was it the additional pain meds he took?" The feelings of failure can be so intense that some even leave the profession, because they are unable to cope.
Seeing life taken away from someone you have cared for is difficult, even if you muster all your strength and accept this inevitable part of a nurse’s life. A patient’s death impacts you significantly and can make you question both your nursing abilities and your vulnerability as a human being. It can also reawaken past hurts brought about by a loved one's death.
As nurses face this reality, they must take the next step and move on. They have to overcome. Their capacity for caring must continue, because the bereaved family (as well as the other patients) need their attention.
If you find yourself in a similar situation, here are some ways to cope:
1. Give yourself time to express and process your emotions.
Cry if you have to. Say your goodbyes to the patient. Acknowledge your own feelings and accept the loss. Ask your colleagues for support. Tell your supervisor, who has gone through a similar situation, and they will encourage you. Give yourself some time to recover and regain your confidence in caring for others.
2. Do not blame yourself or anyone else.
Do not cling to the feelings of guilt. Do not beat yourself up over it or blame someone else for your patient's death. However, if the death is indeed caused by an error on your part, report to your supervisor and follow institutional policies on how to handle such cases.
3. Recognize that patient death is a part of nursing life.
As a nurse, you must be able to provide care efficiently, even right after the experience. Remember that you still have the patient's family to care for. Your strength at this point can help them immensely in their grief.
4. Learn from the situation.
Whether regarding your nursing skills or your personal life, a patient's death can teach you a lot of lessons. Use the situation to learn how to better yourself as a nurse and value life more, while becoming more proactive in saving other patients' lives.
5. Try meditation to relieve stress.
Give yourself a break. Take deep breaths and meditate to free your mind of the memories. Give yourself time to heal and take care of yourself. Spend time with family and friends. Write down your thoughts to help process how you feel.
Nurses are the backbone of the healthcare industry. As such, they are admired for their dedication and their compassion for patients, and experiencing their first patient death can often give a whole new meaning to caring.
Posted: 2/5/2018 12:39:07 PM
The Challenges of Caring for Young Patients with Eating Disorders
About 8 million Americans have eating disorders. Ninety-five percent (95%) of those people are aged 12 to 25. Ten percent (10%) start to experience eating disorders at ten years old or younger. There is a 119% increase in hospitalizations in children younger than 12 years of age from 1999 to 2006, due to eating disorders. These numbers are alarming, and over time, nurses find themselves caring for more young patients who struggle with eating.
For starters, nurses in primary care spot red flags of the possibility of a child with these conditions. Weight loss or failure to gain weight expected of a child's height and fluctuations in weight are the hallmarks of disordered eating. During a more detailed physical examination and history-taking, nurses may also possibly note dental caries and gum diseases, dull hair, fine body hair, or alopecia. Other warning signs include amenorrhea in teen girls, claims of being “fat” even if underweight, and reports of heavy exercise, anxiety, depression, and unusual eating patterns by either the patient or the family.
Now, let’s look at a few more numbers in order to better understand how nurses come into the picture to address the challenges of treatment:
One in every five people, or 20%, with severe eating disorders will die without treatment. With treatment, that number drops to 2-3%. However, only about 60% of those treated ever recover.
You see, the role of nurses in decreasing the number of affected children and adolescents is critical. Yet, nurses are faced with the challenges of providing proper care, some of which we have compiled below:
1. THE SECRETIVE NATURE OF PATIENTS CAN BE OVERWHELMING.
Nurses unknowingly or inadvertently play detective when caring for people with eating disorders because they have to look for telltale signs of purging, concealing or throwing out food, or any other means of reducing weight in secret. If they miss the signs, nurses can feel guilty and inadequate.
2. NURSES FEEL FRUSTRATED ABOUT DIFFICULT AND UNCOOPERATIVE PATIENTS BEING RESISTANT TO TREATMENT.
The resistance is difficult to deal with, using just therapeutic words. For example, nurses might encounter a patient with anorexia nervosa, who became unconscious and is receiving treatment. Once some strength is regained, the patient repeatedly pulls out their nasogastric tube.
3. NURSES FEEL THAT PATIENTS KNOW MORE ABOUT THEIR DISORDER THAN THEM, which is the case most of the time in adolescent patients. Power struggles happen because they lose control of the patient and the treatment.
4. THE NURSE CANNOT TRULY COMPREHEND WHY A PATIENT WOULD STARVE THEMSELVES AND NOT EAT.
With anorexia nervosa, for instance, although the condition is well-discussed in nursing books, encountering these patients in the real world brings out questions about how someone can override a very natural instinct for survival, that is, eating.
5. IT ALSO IMPACTS THE NURSE’S OWN BODY IMAGE ISSUES.
Nurses themselves may be battling body image concerns, and feel that they are ineffective providers of care to these patients.
6. NURSES CAN GET DISCOURAGED BY THE FLUCTUATIONS OF PROGRESS IN TREATMENT.
Nurses have goals they set with patients. And often, just when everything is falling into place and objectives are about to be met, the patient backslides and nurses find themselves back at square one. The sudden reversal can breed frustration and resentment in nurses.
7. A NURSE MAY LACK EDUCATION AND TRAINING IN THE CARE OF PATIENTS WITH EATING DISORDERS.
The treatment for anorexia nervosa and other similar conditions is very complicated. As a result, nurses feel that they lack adequate knowledge and training to make treatment successful. They do not feel confident and engaged to meet recovery goals with the patient.
The road to addressing the challenges of caring for young patients with eating disorders may be a long and bumpy one, but the future is hopeful if you focus your attention on finding solutions.
Posted: 1/8/2018 1:51:43 PM
The Signs of Substance Abuse in an Impaired Nurse
Diane, a mother of two, has been a nurse for eight years and has a consistently excellent record of performance at work. She seems to have it all together in both her work and family life. At home, she cares for her 5-year old son, who has Attention Deficit Hyperactivity Disorder (ADHD), and a toddler attending daycare. At night, she works in a nearby hospital. Coworkers and patients have high opinions of Diane, because she always has an energized “Hello!” for everyone, all the way until morning, when everyone else is feeling beat. She also looks underweight, and others speculate it is because she frequently skips her breaks.
Everyone was shocked when they learned that her RN license was revoked because she had been abusing Ritalin, a drug prescribed for her son, and which has similar effects to cocaine. Diane’s Ritalin abuse started out for a seemingly harmless reason, to keep her up when her then newborn was sick. However, her drug use spiraled out of control and she started looking for reasons to take the drug.
Substance abuse is a huge social problem, and it is present in healthcare as well as the general public. An estimated 10%-15% of all healthcare professionals abuse substances, such as drugs and alcohol, in their lifetime. According to the American Nurses Association, these numbers are also true for nurses, meaning that for every ten nurses, one of them is likely struggling with addiction.
Impaired nurses are a danger to themselves, their coworkers, and especially their patients. As an RN yourself, it is your duty to look after patients' safety at all times, so be wary of nurses who may be abusing drugs or alcohol. Remember that these nurses will do their best to conceal their addiction and appear normal, but there will usually be indications that give them away. Be alert for these physical signs of substance abuse:
1. Unsteady movement or gait
2. Tremors of the hands
3. Slurred speech
4. Pupil dilation or constriction
5. Sudden loss of consciousness
7. The smell of alcohol, possibly disguised by breath mints
Nurses who abuse substances will also exhibit changes in behavior. Behavioral manifestations of substance addiction are usually observed earlier than the physical signs. Changes in behavior may include:
1. Frequent tardiness and absenteeism
2. Frequent bathroom breaks
3. Taking breaks alone, in isolation
4. Concealment of needlestick marks by wearing long sleeves
5. Unusually high or low energy in doing tasks
6. Increased instances of errors
7. Lack of focus
8. Lying or defensive and aggressive behavior
9. Patients reporting little or no improvement in pain, even at higher doses of prescribed narcotics
10. Insisting on taking shifts or caring for patients where there is access to prescribed narcotics
11. Discrepancies in narcotics counts and signing out of wasted narcotics
What should you do if you suspect that a colleague is abusing substances?
When you highly suspect that a coworker is abusing substances while rendering patient care, do not condone the behavior. Stop them from performing care procedures, especially if they are about to administer medications. Sometimes, nurses will cover up for their impaired colleague, particularly if they are friends, but this enabling behavior will lead to more harm for the coworker and more danger for patients. Report your observations to the head nurse immediately. Make sure to follow organizational policies regarding reporting nurses who provide care under the influence of illicit substances.
Posted: 12/8/2017 12:58:10 PM
Does Organizational Change Make You Cringe?
Does organizational change make you uncomfortable as a nurse? Do you find yourself resisting when new protocols are imposed? Have you gone with the flow of change, only to tell yourself that the old way was much better? Or are you a nurse manager who is having difficulty getting the staff nurses to participate in change initiatives?
Change has this primary intention: to improve the current situation and produce a better outcome. As noble as this intention seems, disturbing a process that everyone is already comfortable with is like stirring sand into water. It results in murkiness, and it may take some time before the sand settles down and the water becomes clear again.
In healthcare, change is inevitable, and it is a necessary part of the continuous pursuit to improve services. Nurses find themselves in a position to accept the new way of doing things, even if they are resistant to the idea. But because embracing change will surely be a part of your career as an RN, it will help to consider the following tips to get you through every change process happening in your organization:
1. Be pro-active about being fully informed.
One reason nurses resist change is that they do not have all the information about the initiative. They may hear about the proposal for innovation from a colleague who is against the idea, and the negativity can spread like wildfire. Nurse managers may find themselves frustrated while trying to encourage the staff to participate.
As a nurse, make it a habit to know all the latest updates and understand the purpose for change.
2. Always give feedback.
Providing feedback makes you involved from start to finish. It enables management to hear your ideas so they can make informed decisions about the change.
If, as a manager, you find that a feedback platform is inadequate or missing, suggest an open-structure communication system that will connect management and staff.
3. Be involved during the planning stage.
Make sure to attend meetings that are open to staff during the planning stage. If you are a nurse manager, take the time to represent your unit and make higher management consider your opinions on the matter.
Being involved from the start of a change process makes you excited to know if the initiatives have served their purpose well.
4. Participate in the process.
By this time, you have gained all the right information about the project and you have shared your suggestions. The next step is to give your best efforts to make it work. Be a team player and show enthusiasm. Others will feel your optimism and will likely embrace the new idea, too.
5. Give feedback on how the initiative has impacted you, patient care, and the organization as a whole.
This evaluation will help determine if the project is successful in meeting its goals, or not.
Abandoning an old system and welcoming a new one is not without its hurdles. Many times, it will take a lot of trust, patience, and continued support to sustain the initiative. Being involved from the start is a great way to be motivated to finish the feat that you have been part of, and it also makes you a co-owner of the change. After all the implementations are complete, you can feel proud that you have been a part of a successful endeavor.
Posted: 11/14/2017 12:23:09 PM
Communication Issues in Nursing
Communication failures rank first among the most common causes of medical errors, significantly impacting hospitals and healthcare delivery. And because nurses are at the forefront of patient care, the situation puts the spotlight directly on them.
Communication is crucial in healthcare because it builds trusting nurse-patient relationships and facilitates inter-professional collaboration. Communication must be understood in a different context as that of information. Information is something that you just give out or disseminate, while communication is getting your message across and receiving a reply in the process.
Nurses serve as a common gateway that accommodates the messages relayed among various professionals. Physicians give the orders out and ask about the patient’s condition through nurses. RNs coordinate the care of other clinicians and therapists. Nurses talk to the patient and their families to know their concerns. They act as a liaison between care providers and patients, so their role calls for excellent collaboration skills. When nurses fail to properly communicate, various patient care processes, as well as the interrelationships within the organization, will be on the line.
Here are common communication problems that nurses need to address in the workplace:
1. SPEAKING WITHOUT CLARITY. When there is not enough clarity as nurses speak, errors are bound to happen.
Consider this scenario:
The nurse says to the patient, “Take your pill for hypertension once a day.” The patient obliges. But because the patient considers their diuretic as the main medication for hypertension, the patient took it before bedtime. The next day, the patient complains of a lack of sleep during the night because they were up too many times to go to the bathroom. Being clear, in this case, is saying, "Take one tablet of Quinapril every night before bedtime," while showing them the medication.
2. USING A DISRESPECTFUL TONE OF VOICE. Whether talking with a patient or colleague, the tone of voice conveys the most meaning. If someone says “sorry” without really meaning it, we would certainly know that they are not sincere. A disrespectful tone is a formidable barrier to communication. It breeds anger, resentment, and the need to retaliate. It fosters a culture of fear, where bullying and incivility become an accepted part of a nurse’s job. Additionally, using a monotonous, robotic tone to talk with a patient, conveys a lack of sensitivity and empathy, which will make the patient hold back information and become uncooperative.
3. FAILURE TO RECEIVE OR GIVE FEEDBACK. Receiving feedback makes communication closed-loop. Without affirming that a message is understood, the message becomes open to misinterpretations that can easily lead to errors. Without receiving or message becomes open to misinterpretations that can easily lead to errors. Without receiving or giving a reply, the nurse is simply informing, not communicating. So, if a nurse performs health teaching with a patient without evaluating what they understood, proper communication has NOT taken place. Similarly, when a staff nurse consults the charge nurse and does not receive a reply, they readily interpret this as lack of interest on the part of their supervisor. In a fast-paced environment such as the operating room, it is important to be completely understood as a speaker and to understand clearly as a recipient. Closed-loop communication is tantamount to saving patients’ lives. The success of the unit lies primarily on this concept of collaboration.
4. FAILING TO SPEAK UP. Nurses who consider themselves to be “at the bottom of the food chain” rarely speak up when they see a potential error or become witness to a mistake. Keeping quiet about matters of safety is as dangerous as injuring a patient. Both put patients’ lives in jeopardy. Nurses tend to be quiet when they see that their own interests are at stake if they take a stand, so they choose not to get involved and live with the difficulties. But failing to point out possible areas of improvement blocks the way for solutions and results in both unsafe practices and unhealthy inter-professional relationships.
Nurses cannot be effective in their work if they do not master the art of communication. Failing to get your message across and be understood will ultimately lead to career setbacks and negative feelings about nursing. Proper communication must, therefore, be learned and practiced.