Physicians become more like nurses!

/ Jane K. Dickinson / 5 Comments

I was so excited to see this article today! My first thought was, “Wow! They are finally teaching physicians to be more like nurses!” These principles are the very same ones I learned in nursing school twenty years ago. Did you? Do we still use them in nursing? Healthcare has evolved over those twenty years, and I must admit I have not been in a bedside nursing role for most of them. So I can’t really say if nurses in hospitals are using effective communication skills, patient-centered language and the like. In diabetes education (a multidisciplinary specialty) we are still pushing for improvements in these areas.

And patients are demanding this change! Patients are being asked (required?) to be more “engaged” in their health care, and many want to be. We are evolving into a health care system of connections, and away from the assembly-line, “do what you’re told” mentality. If this is ever going to be effective, we all have to play ball – nurses, physicians, patients, and everyone else.

Let’s do this!!

What Not to Say to a Nurse — Hooters Opens Nursing School

/ monashattell / 3 Comments

“Male Nurses Make More Money” was published last week in the Wall Street Journal. As a registered nurse and a woman, I was angered and appalled at the comments that this article spawned, about the sexualized physicality of women nurses.

Here are just a few of the comments:

“Just another happy old guy” wrote: “I only accept female nurses at my bedside. The lovely smile, sweet perfume, and wonderful bosoms make my day, every day. A guy tending me is advised to wear a steel cup.”

“cdg” wrote: “Female nurses with large bosoms should earn more than their male (or flat-chested female) counterparts.”

“Steve” wrote: “I think female nurses should be paid on the basis of how hot they are.”

And finally, my personal favorite, which was posted by “MCP”: “Hooters is going to start a nursing school.”

I should say right now that I am not against Hooters. I’m not against women (and men) who work at Hooters. In fact, this post is not even about Hooters. I was just so struck by the phrase, that I just had to title this post with it.

I realize that I’m probably at fault here, because I thought that we as a society had gotten past sexy nurse costumes for Halloween. In fact, I now know that the “naughty nurse” is alive and well. An episode of the NBC sitcom “Whitney” is one recent example.

It’s not all bad news. There are others out there such as Sandy Summers of The Truth About Nursing, and those at National Nurses United who fight for nurses (male and female nurses) to promote the profession and to expose these stereotypes in the public domain.

Now, perhaps those who posted those comments to Male Nurses Make More Money were just joking. If so, I guess I just don’t think sexist nurse-talk is funny.

I’m a nurse. I’m a woman and I have a PhD. Don’t insult me with your talk of “boobs” and sweet-smelling perfume.

This article originally appeared on Huffington Post on March 8, 2013.

Follow Mona Shattell on Twitter: www.twitter.com/@MonaShattell

Becoming the Transformed Nurse

/ Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 2 Comments

“Nursing worldwide has been so confined and controlled by external material, physical reality, found within Westernized medicine and institutions, that it has almost lost it own heritage and purposive existence. It has been so consumed by the modern demand for technological competencies it now is faced with having to restore the under-developed ‘ontological competencies’ so essential to nursing’s maturity and survival as a distinct caring-healing profession” Jean Watson, 2002, p. 2.

How do we come back to the heart of nursing as healing, where so many of us wish to dwell and practice nursing? I ask myself this question frequently and I wonder about the challenges that we face as nurses and educators in supporting one another to create caring-healing spaces. Dr. Watson (2002) called for us to do this by healing our relationship(s) with self and others, creating meaning around our own concerns related to profound and compassionate caring and healing practices in nursing as service, gaining deeper understandings of and thereby transforming our own and other’s suffering, and accepting impermanence and the cycle of life.

This statement makes sense to me, but I also understand that nurses who have not been exposed to Watson’s theory, or who struggle to understand the deep implications of healing and personal evolution, may not grasp the call that Dr. Watson is making here. To simplify this statement a bit, I believe that she is calling for us to be each on our own healing and caring journey; walking into our own suffering, and continually working toward healing ourselves, helps create in each of us a greater capacity for caring for others and remaining compassionate at the bedside.

If we became nurses because we felt called to nursing, we can come back to that original calling and work toward Nightingale’s model of nursing as a spiritual-sacred healing practice. As Watson (2002) reminded us, when we are on the healing path ourselves, we can strive to be fully present with the patient through creating a caring-healing space. In this space, we reflect healing and enact transpersonal caring in such a way that our work as nurses becomes the most rewarding part of our lives, as we connect deeply with another human being and recognize our interconnection with all.

Part of my own healing process has included a journey into yoga practice and yoga teaching. Interestingly, even as I have encountered great healing for myself with yoga, I also find great healing for others and myself when I share the process of teaching yoga. This sort of mutual healing space that is created in a yoga class, is the same sort of space that many nurses are striving for in their caring work.  One of the challenges then becomes how to create the time and space within your practice to connect deeply with your patients, to hold with them a space for healing, and to bring true meaning to your healing work as a nurse?

Unfortunately, there is a perpetuated myth that transpersonal or deep caring- healing takes too much time and is usually left for last after all of the technical demands of the nurse are met, once the charting has been done, once the patient has been stabilized, and so on. I posit here that with practice and with work on one’s own personal caring- healing journey, the nurse can strive for learning to create a caring-healing sustainable practice with everything she does for patients.

Being present to patients and briefly breathing for a minute to set an intention for caring healing spaces does not take more time, though it may take practice, commitment, and reminders for the nurse to return to that healing space again and again and again throughout her busy day. Managing one’s stress and practicing healing for oneself are also the keys to learning to create caring at the bedside on a regular basis, and that may take more time out of one’s personal life, however if one is committed to nursing from a caring-healing space, then that time is an investment for oneself and a requisite to enacting a caring- healing practice.

And nurses may ask “why?”… why bother to create these spaces when it is not valued by the larger demands on the nurse, and takes a personal effort that is likely not always recognized or rewarded? My thoughts on this are:

  • If we are not supporting healing we are not nurses, we are technicians. If we lose our value of caring in nursing; we become heartless and our value to society at large diminishes or or is distinguished completely.
  • Patients, and their resultant expression of satisfaction, demand a healing presence.
  • One way to ensure the nurse has a long and fruitful nursing career, and does not burn out or become ill from stress of the job, is to for the nurse to enact a sustainable caring-healing bedside practice, that is deeply related to her own personal healing journey.
  • Because much much of what is going on in hospitals currently is ethically unsound, as damage is done to patients on a regular basis in the hospital environment and unfortunately nurses may also be subject to, or become an aspect of, said damaging environment.

I would like to expand a bit more on this last aspect. According to the New England Journal of Medicine, we now know that patients are leaving the hospital setting with what is being called post hospitalization syndrome, which is basically another term for PTSD related to hospitalization (Krumhloz, 2013). Indeed hospitalization for injury also increases one’s risk for depression and PTSD (Zatsik et al, 2008).

This sort of evidence should be generating questions for nurses, ranging from how they might be contributing to patients’ stress, to how they might be impacted by an environment known for stress induction, to how they are supporting the creation of caring-healing environments to counteract this stress.

Ethically, as purveyors of healing, we are obligated to examine our nursing practices with more depth and determine how we are going to create and be the change that our patients and the world are calling us toward.

“As nurses and nursing enter into this transpersonal aspect of our work, as we are re-patterned  so is our environment, our systems, and our culture. We then, individually and collectively, become the transformed nurse; we become the ethos and culture of caring and healing, living out our timeless heritage and most extant caring ethic, theories and philosophies in our lives, and our work” (Watson, 2002, p. 7).

References:

Krumholz, H.M. (2013). Post hospital syndrome: An acquired transient condition of generalized risk. New England Journal of Medicine, 368, 100-102.

Watson, J. (2002). Nursing: Seeking it’s source and survival (editorial). ICU and Nursing Web Journal,9, 2-7.

Zatsik, et al. (2008). A national US study of post traumatic stress disorder, depression, and work and functional outcomes after hospitalization for traumatic injury. Annals of Surgery, 248, 429-37.

Language in Nursing Practice

/ Jane K. Dickinson / 7 Comments

I have found myself on a journey that I can no longer avoid. In 1992 I gave an inservice on language to a group of staff nurses on a pediatric unit in a large, teaching hospital. I was then a student in an MSN program (Pediatric Clinical Nurse Specialist Track). The focus of my talk was refraining from calling patients by their diagnosis (the “appy” in room 3 or the “sickler” in room 25, etc.).

I have since chosen a career in diabetes education and management, and twenty years later I am amazed at how often I see and hear the word “diabetic.” I was giving an inservice (on diabetes) to nurses who provide staff education and was amazed at how many negative and judgmental words I heard. Open up any journal, book, magazine, blog, and it’s impossible to avoid seeing this kind of language.

The health care system has been trying to evolve for years (giving some credit here), from one that is paternalistic, controlling, and about healing the sick, to one that is accepting, supportive, patient-centered and about preventing disease. From one that is about the provider to one that is about the patient. But we are not there yet. And our language is, in my opinion, one of our biggest barriers. We need to talk the talk before we can walk the talk.

Words that come to mind include “compliance,” “must,” “should,” “have to,” “need to,” “I want you to…,” non-compliant,” any word that labels a patient (diabetic, asthmatic, leukemic, sickler, and so on), “control,” “good/bad,” and many more that I can’t think of at the moment.

I truly believe that words matter. Even the most caring nurses use words/phrases that hurt – mainly because they “grew up” using them, and often because it’s just faster and easier to use them. But patients deserve to hear words that build them up (strength-based) and put them at the center of their care (patient-centered). Patients deserve to be thought of, approached, and addressed as human beings with a lot more to them than a disease, illness, infection, procedure, or what have you. And it’s true for conversations about patients as well (for instance, at the nurses station or during report).

Those of you who work in health care settings probably (undoubtedly) hear these and more words/phrases every day. You may even have become immune to them. Can I ask a big favor? Can you pay close attention in the upcoming days/weeks, and jot down any judging, negative words/phrases you hear? Could you then come back to this blog and post the words in the comments section? Thanks for your help with this little project! I would also love to hear your thoughts on how we can change the language that is used in health care.

The nursing revolution will not be televised: Part III, the work of consciousness evolution

/ Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / Leave a comment

If you are following these postings, you may have begun to wonder, ” well how can I, an everyday nurse, take on the enormity of changing myself; I have always been this way, these are engrained patterns, and I don’t know how to change”. I have outlined a few steps here, though the reader is encouraged to also discover their own healing path.

I. Start looking at the basics of your human needs.

Most nurses have some exposure to Maslow’s Hierarchy of Needs, and the more we learn about psychoneuroimmunology (PNI), the more we know the importance of  laying the foundation of good health behaviors in order to achieve “self-actualization” or consciousness evolution; we can also use this model to begin to visualize that as we move toward your own growth, healing, and self-actualization experiences, we can then prepare to support others (ie our patients and our colleagues) to do the same. From a PNI perspective, if the base of the hierarchy is not addressed, we will be in a physiological chronically stressed state, leading to not only feeling bad and functioning poorly, but also toward an inflammation state and a genetic-chromosomal expression that leads to illness and disease.

Many nurses need to start with attending to the basic physiological needs. As research has shown that most nurses get an average of only 6 hours of sleep before any given shift, for many nurses, this will be the way to begin: first, learn to honor your sleep in order to best care for your own PNI and set the stage for consciousness evolution. Additionally, with erratic schedules and nurses’ long 12 hour shifts, diet and exercise habits that are proven to support a strong PNI, personal stress resilience, and consciousness evolution, may be missing and this useful information is never readily available for the people in need.

As one begins to build a strong physiological basis for themselves, they are better prepared to address the safety needs stage of Maslow’s hierarchy: I believe this is of great importance to nurses, because on a daily basis, our safety issues and boundaries are pushed by our patients, patients’ family members, colleagues, and administrators alike. However, if we don not have our own basic physiological needs met, we may not progress toward addressing our safety needs and moving into a space where work group relations can be addressed and managed.

Nurses may choose to work with a wellness counselor, support group, or health-nurse coach to begin to manage and create a healthy lifestyle. We need to recognize that these habits are hard to create, but with continued support, we can create lasting healthy lifestyle behaviors.

II. Look to the Literature: Self-help and self-care tools abound

In the curriculum I have enacted in the RN- BSN program I have developed, it has become clear that nurses need specific tools to undertake the self-care and healing journey. Luckily, one does not have to look far to find these tools. Some recommendations I feel comfortable making to nurses, educators, student nurses , and whole groups of nurses looking to share this work together include:

Cheryl Richardson’s (2012) The Art of Extreme Self-Care: Transform Your Life One Month at a Time. In this book, individuals and/ or groups can work together to reflect and create real change in their lives. This particular book walks the reader through affirmations, to creating healing space, and learning to set limits with the “absolute no” process.

Another great work to support nurse’s on their healing journey and consciousness evolution process is Joan Borysenko’s (2012) Fried: Why You Burn Out and How to Revive. In this book, Dr. Borysenko, a pioneer in the research that emerged from Harvard’s Mind Body Institute, shares her own burn out scenarios and a step-by-step reflective process to help readers revive by examining their childhood roots of burnout, personality traits that may predispose us to burnout, and the revival process needed to move beyond burnout.

Creating work groups or informal groups that can share this healing process may be helpful, though certainly one can also work through this process on their own.

For those looking for what I might call a deeper journey toward the state of evolutionary consciousness a text entitled Integral Life Practice: A 21st Century Blueprint for Physical Health, Emotional Balance, Mental Clarity, and Spiritual Awakening (2008, Ken Wilber et al) may prove to be a challenging and useful endeavor. This book walks one through the lived process of addressing psychological shadow issues, while also focusing on the mind-body-spirit processes needed to support evolutionary consciousness growth.

III. Seek out counseling

As most nurses know, we want to support the healing of others through caring, which is the heart of nursing practice. But if this task becomes one of control and co-dependence, our workplaces may even morph into lateral violence as we reenact the patterns of our dysfunctional family’s and painful childhood experiences. Through work with the right counselor, we may find that we are able to identify these patterns, observe them, heal them, accept them, and detach from them as we create new ways of being. At this juncture, we then create new patterns for coping. Additionally, tools such as EMDR can help one to create new neural pathways of peace and well-being to attend to when life is stressful, rather than continuing to enter into old habits of fight or flight ad the ensuing dysfunctional behaviors that tend to dictate our reactions in unhealthy manners.

IV. Evolve your consciousness: The ancient tools

For many centuries, people have searched for ways to relief their suffering and find ways to grow spiritually and evolve their consciousness. We are only now coming to the point where we can link these endeavors to the PNI response; organizations such as the Harvard’s Benson- Henry Institute for Mind-Body Medicine, UCLA’s Mindfulness Awareness Research Center and the Center for Neurobiology of Stress, and The Institute of Noetic Sciences have taken the lead in this area.
Working toward mindfulness, using tools such as meditation and yoga help us to evolve our consciousness toward higher states and recognize our unity with others and the universe at large. Mindfulness means paying attention in a particular way, on  purpose, in a present way, while remaining non-judgmental and non-evaluative toward both the inner and outer environments. The video below from UCSF’s Osher Center provides a clear background on this process which directly relates to managing stress and evolving.

I would love to hear your thoughts and experiences around this process of personal consciousness evolution and the power it may have to transform our lives and realize our healing-caring nursing practices.