I have something a little different for the March Journal Club posting. To the right side of the blog I have a link to articles written by Theresa Brown, RN for the New York Times blog "Well" from 2009 to 2011. Your assignment is to select one of her articles, and to blog about how it spoke to you as an Oncology Nurse. I personally feel that reading her articles are like eating potato chips, "you can't read just one". Please remember HPAA with your posts and enjoy!
Theresa Brown, RN works as a clinical nurse, specifically an Oncology( hooray!) nurse in Pennsylvania. Prior to living the life we are all so familiar with, she received a PhD in English from the University of Chicago. Her column "Bedside" appears on the New York Times op-ed page as well as on the Times blog "Opinionator." Critical Care: A New Nurse Faces Death, Life, and Everything in Between (HarperOne, 2011, paperback edition) is her first book.
I read "Need Sleep? Stay Out of the Hospital" dated September 7, 2011. This article defintely caught my interest. I worked for 5 years 7pm-7am. I always felt awful having to wake patients in the middle of the night. I worked on a busy med-surg/Oncology floor. Vitals were most always every 4 hours, lots of blood products and IV antibiotics to be hung. Leaving the pt for sleep was very difficult. I would try to be quiet and group things together but this was not always possible. When pts would complain about not getting to sleep or comment that they were actually able to get some sleep, I would always tell them, "You know that you are close to going home if you get to sleep while you are in the hospital"! This is really the truth!
ReplyDelete"Need Sleep? Stay Out of the Hospital"
DeleteI too worked 7pm-7am for many years on an oncology floor. As much as we bundled care, patients were woken frequently during the night. Central line blood draws were started at 4am so results were ready by 7am MD rounds. Antibiotics were often on a 0600 schedule.
Although I did not need any nursing care from midnoc to 0800, as a patient I did not get any sleep. Even if my alarms weren't going off, you could hear other patient's alarms. You could hear call lights, staff outside the room, carts being wheeled down the hall, and even patients snoring in the room next to you! To understand the noise level in a hospital, every doctor or nurse should have to spend one night in the hospital!
I read "Feeling Strain When Violent Patients Need Care". Because most of our patients in outpatient are typically upbeat, we can forget that cancer patients can be very sick and not feel so great. Usually their body language and/or facial expressions speak for themselves. Occasionally, a patient will be "mad at the world", and feel that it's OK to unleash on the nurse. I have been in that situation where I have felt threatened. It's important to let your supervisor and other nurses that may be caring for the patient to know what's going on, for everyone's safety. And sometimes it's important to ask for help in letting the patient know their behavior is not appropriate.
ReplyDeleteI chose the article "When Hospital Visitors Get Sick". This reminds me of our patients who come here for their outpatient visits and are sent to the OICC or ER for immediate needs. The visitors are then triaged based on their current complaint. The difference here is that our visitors are our patients and must wait lengthy waits because of their outpatient status. Patients find this very frustrating because of the inconvience and the additional cost. I did find all of her articles interesting however. This one just hit home.
ReplyDeleteI read "When nurses make mistakes" It is very interesting because she talks about a time she picked up an extra 4 hours on top of her 12 hour shift, something I do regularly and so do many other nurses on the 3rd floor. What is worse? Having a tired nurse working a 16 hour shift or having to work short staffed? Anyway, long story short, she was to give chemo to a patient, only gave one of the two medications only to find out by phone call the next morning that she had missed giving the second drug, luckily it wasn't expired and the patient was still able to receive the drug.
ReplyDeleteWhat I got from this is we are only human, we make mistakes. That is why things are in place at work, like the drug scanner. As much as it upsets me at times for not working correctly or giving me a hard time it is there for a reason.
Also, if a mistake is made. Don't just write it off and move one. Use it as a learning experience. Don't let that mistake be a wasted one. It also makes me rethink the 16 hour shift thing.... although it is hard to say no when you know your coworkers are going to be a 7+ patients a piece if you don't stay, mistakes can just as easily be made if a nurse has too much on their plate.
Also reading "feeding the nurses" made me think about a particular patient (who has passed)daughter brings us homemade chocolate chip cookies every week and the are still warm! She has been doing this since he passed, which has to have been almost a year ago now. It's just amazing to me that we made such an impact on her, that she takes time out of her schedule to do that for us. Makes me believe we are doing something right, even if not all stories have a happy ending. (I need to stop reading these blogs, or I will keep wanting to comment on them. :-))
DeleteI read "Nurse and Patient, Sharing Laughter". Our GI team is great with humorous comments that the patients really seem to enjoy....we have such plentiful ammunition! Having fun in such an environment as a cancer hospital would seem odd to "outsiders". Dr. Vashi's Christmas tree from staff was made of lots of blown up green gloves molded together with fingers resembling branches. The patients cracked up.
ReplyDeleteI have a nurse friend currently battling cancer. She has turned her own experience into a hilarious journal on facebook. For example, on her last day of chemo she had a picture of herself doing a "pole dance" as she twirled around the IV pole atop her infusion pump. In another picture she commented that she was "naked with friends" and she appeared bald with a couple of cute, bald babies. She has shown her incredible spirit even though recent news has not been very good.
That is awesome! I love to hear stories like that. Yes, humor and laughter go a long way
DeleteI also read “When Nurses Make Mistakes”. I only wish I could not relate with the message in the article. Unfortunately I have been there. Worked the extra hours, made mistakes and would have done anything to undo what had been done. There is no feeling as sick as when you make a mistake. It is unconceivable. But it is the reality. As nurses we expect to be above making mistakes and do everything possible to avoid them. Unfortunately we are human too. Bottom line, we all do our best but what about when our best is not good enough? The article especially spoke to me as a valuable reminder how important it is that we need to take care of ourselves to prevent errors from occurring.
ReplyDeleteI found myself reading several 0f Theresa Brown's articles not just one and yes they are like potato chips, and you really cannot choose just one. Whether you are reading when nurses make mistakes, when hospital visitors get sick, or practicing on patients ;it all speaks to you as an oncology nurse.I think we all have worked that extra shift maybe when we should have not or should of said no instead of yes, increasing the chance of error or mistake. We hope we have never hurt somewone and also hope we learn from it and never encounter the same circumstances again. I agree with Debbie we are human and by taking care of ourselves better we will be better for our patients peers and or families as well. I also find the article, Practicing on Patients truthful. As we continue in our practice , we are always in someway "practicing to become expert." and have always appreciate and value those patients who have let us become the oncology nurses we are and will continue to be. Nancy C
ReplyDeleteI read Simple Gifts on the Hospital Floor. This article talks about co-workers stepping up to help you when you need help. In the article it talks about a nurse who lost the PCA key to the pumps for the floor and could not stop what she was doing to retrace her steps (which included going through the garbage). Luckily, she had two co-workers that were available to help and sifted through the garbage and found the key. This was a great article to show the spirit of teamwork and support between staff.
ReplyDeleteI believe that one of the ways patients/caretakeres show gratitude is through providing food. It is a way of saying thank you for caring. I also feel that it may be a means of closure when a loved one dies or a patients treatment ends. It may also be a way to provide some small bit ofnormalcy in the chaos of cancer, by doing something a person may love to do.....BAKE
ReplyDeleteI enjoyed reading about contact with patients outside of the clinic arena. This happens to all of us. In these encounters, I am unsure if the patient wishes to be recognized when with their companions, or wishes to ignore the encounter with medical staff as they may not have shared their diagnosis and treatment with their companions. I wait for the patient's lead, giving them control over the situation. Years ago, at an airport, I ran into a widow of one of my favorite patients. The widow, S., and I conversed, then she gave me her business card asking me to call so we could start golfing. We each had started golf lessons and were fairly poor in our golf abilities. We started golfing, having dinners, lots of "girl talk." We became close friends, she eventually was in my wedding. S. has become an important person in my children's lives. We still stay in touch and visit, although she lives 2 states away. Interesting how out of the ashes of the tragic cancer diagnosis and death of her husband, S. losing the love of her life, grew a friendship lasting a lifetime.
ReplyDeleteThese short articles were fantastic. I especially liked the one titled "A nurse, a patient and a Television". This reminds me of a time in the past when I was working on a med-surg floor and how important those small things are to patients. I had a similar story where a patient had been in the hospital for a couple weeks. One night he was really crabby and irritable, which was out of character for him. He did not confide in me but I felt strongly that I needed to do something. So at lunchtime, I grabbed my lunch and asked if I could sit with him. He was delighted! He told me that was just what he needed. His attitude changed for the remainder of his stay. That was one of the best 10 minutes sharing it together with him.
ReplyDeleteI read the article "Seeing a Patient Outside the Hospital." This is something I have often wondered/worried about...How would I react? What would or should I say? I think working at a place where many of the patients travel a distance this doesn't happen too often. However, I live only 10 minutes from the hospital and many of the restaraunts and stores nearby are the ones I tend to go to. There have been times where I have seen a patient at Walmart or Applebees. Those particular times I have not addressed them as I was out with my family and they were with theirs. However, it is a reality that it could and probably will happen to most of us someday. It's nice to have read this article to remind myself that they are still people who carry on with their lives whether they are in or out of the hospital setting. I, too, read a few other articles as well. I remember Melissa sharing some of these when I worked with her in the infusion center. The one that sticks out without me even having to re-read it is the one where Theresa took the time to watch the television show with the patient. There were many times when I worked on the inpatient unit that I wanted to be able to take more time with patients to really get to know them. At that time, though, the floor was so hectic that it always seemed as though there wasn't time to do this. Now, I wish I would have just slowed down a bit and been able to REALLY get to know more of my patients.
ReplyDelete"Bringing Home to the Hospital" spoke to me in many ways. It has been my privalage as a nurse and dog owner myself to allow patients that I have cared for a meeting with their pet. Pet therapy allows for the inner sole to be feed. The smell and touch of a pet is truely healing in itself. Another thought is bringing home into the hospital about actions that would of occured at home that family think they can not do in the hosptial. One of my patients, wanted so dearly to hold, cuddle and be the baby girl that she use to be with her dad who was now dying. She did not believe she could do that is his hospital room. I spoke to her and said it is okay to get in bed and cuddle with him and let him know you are still daddy's little girl. I returned and found her in the bed laying her head on her dying dad's chest. That was a moment that will never be forgot for her nor I...all because we allowed this hospital room to become home.
ReplyDelete“One Nurse, One Patient” article written by Theresa Brown, RN, was an excellent description of the daily life of a nurse. We have so much compassion for our patients that sometimes we aren’t aware of how much stress we deal with until the end of the day at home when we have the time to actually think about our day. Nurses become too complacent when dealing with the daily stressors of patient care. It is imperative to take the time to decompress at the end of the day in order to continue to give the best patient care and avoid burnout and compassion fatigue.
ReplyDeleteI read "One Nurse, One Patient" and I thought it was a great description of a nurses day in oncology. I work in the infusion department and there are times when I have six patients recievimg chemo treatments at one time. I can relate to her experiences of patients having adverse reactions to their treatments. Some signs of a reaction are very clear, but when a patient calls and says they don't feel right, despite their vitals being stable, it always puts me on alert! I have only been working in oncology for about one year and a half, but before this I worked as a rn for 9 years. If there is one important thing I have learned over the years, it is to trust your gut feeling. I would rather call for help and not need it ,than not make that call and have something really bad happen.
ReplyDeleteWhen nurses make mistakes
ReplyDeleteThis could be any nurse, working in any big city or small town hospital. Just reading what happened to Kim saddens me, so I can only imagine how devastating this must have been for Kim. Having devoted your life to making a difference in so many others and now the unthinkable happens, you make a mistake that contributes to someone’s death and now you see that your profession is just as fragile. Anytime you lose a job it’s as if you’re going through a nasty divorce, now you have to start all over, you may even start to question your ability to do this job especially when you are suspended and later fired from the only career you’ve ever known. With the number, fast and hectic pace and turnover of patient’s every day I can easily see how mistakes can be made in my own department. On a Monday you still have to deal with the patients that have not been seen by an oncologist plus the ones that are coming in that day, at times it can become overwhelming and mistakes can happen. This article was one that really hit home for me.
Journalphoria
ReplyDeleteSeeing a Patient Outside the Hospital
During my years of nursing there are many times that I have run into patients or their families outside of the hospital. When I would run into family members who I have taken care of and family who have had loved ones that have passed on, it can be difficult to know how to respond. I always wonder if I will remind them of a painful memory of their loss. Are they glad to see me, and do they want to acknowledge me? It can sometimes be awkward on what to say and how to respond. I usually wait for a leading before going forward. I see a lot of patients at church who come from the hospital, or church members that become patients here at the hospital. I found that there are boundaries I have to set depending on either circumstance involving the two situations when it comes to privacy of personal or medical to protect myself and the patient. I have to be so careful in dealing with patients outside the hospital with their spiritual care and the rules of HIPPA.
Adriene Harris, RN, BSN
New Patient Clinic / Team Lead
O: (847)872-6246
W: cancercenter.com
Hospitals in Atlanta (Fall 2012), Chicago, Philadelphia, Phoenix and Tulsa
I agree with Theresa Brown in her article, "One Nurse, One Patient". We are forced to make what could be life-or-death decisions for our patients, and the responsibility of that can be overwhelming. Administering chemo or blood, and knowing there is the possibility of a reaction is always on our minds. We are fortunate, however, that we always have other nurses-infusion nurses, OICC nurses and of course the Code Blue team if needed.
ReplyDeleteJournalphoria
ReplyDeleteSeeing a Patient Outside the Hospital
During my years of nursing there are many times that I have run into patients or their families outside of the hospital. When I would run into family members who I have taken care of and family who have had loved ones that have passed on, it can be difficult to know how to respond. I always wonder if I will remind them of a painful memory of their loss. Are they glad to see me, and do they want to acknowledge me? It can sometimes be awkward on what to say and how to respond. I usually wait for a leading before going forward. I see a lot of patients at church who come from the hospital, or church members that become patients here at the hospital. I found that there are boundaries I have to set depending on either circumstance involving the two situations when it comes to privacy of personal or medical to protect myself and the patient. I have to be so careful in dealing with patients outside the hospital with their spiritual care and the rules of HIPPA.
A Nurse, A Patient, and a Television....
ReplyDeleteI read this article and it really hit home with me. Due to low staffing on our unit lately, sometimes we can be really busy and not give our patients the one on one emotional nursing that we would sometimes like to be able to give. This was a great reminder that we really do need to spend that extra time with our patients...its important for their emotional health.
I read the article about Nurse and Patient Sharing Laughter. It is always refreshing to share laughter with a patient and/or family. While it is sometimes used by patients as a coping mechanism as the article points out, it can also be used to break the ice. As oncology nurses we are frequently faced with tense and difficult situations with our patients and their caregivers. I'm not suggesting the use of off-color jokes or anything, and there are certainly situations when humor would be inappropriate. However, there are many times when sharing a smile or a laugh can ease the tension and reduce the anxiety that is often present in our daily work. And patients appreciate the opportunity to interact in a way that makes them feel like a friend, not only a patient (which Theresa Brown mentions in another article).
ReplyDeleteWith looking at all the amazing articles from Theresa Brown, I read the article Practicing on Patients. When I first started nursing, I never felt comfortable placing IVs/ mediports on patients. Then, like all of us RNs, the more and more I practice and gained confidence, I became an expert. I, now in the infusion center, am the iv nurse(along with working with patient infusion treatments)Our patients particularly dont like to be practiced on; they like to be "poked"one time and one time only. Patients state they feel comfortable and at ease knowing that I will be placing their IV or inserting their mediport needle. I enjoy guiding, encouraging, and teaching my co-workers to take time, if thats possible, to practice on a patient, or even on eachother, to gain their own confidence and becoming experts themselves. Practice makes perfection. And like the article states, "Everyone needs to learn sometime". so why not start now. :)
ReplyDeleteA Nurse, a Patient and a Television..
ReplyDeleteThe article helped to reinforce of listening to what is important at that moment from the patients point of view. We all know that the 'paper work' isn't going anywhere. Throughout the day taking the few extra moments to truly connect with the patient continues to make my career choice a rewarding one.
When nurses make mistakes
ReplyDeleteThis article made me feel sad for the both the nurse and pt/family. It hit me that this could happen to me.kim devoted 27 years of her life to taken care of others and one mistake took her whole life away.
I chose the article Nurse and Patient, sharing laughter. Some of the patients share humor others are very anxious. It is a joy to know that after speaking and answering questions and educating our patients they can be more relaxed and ready to go on with more information to help in their situations. Either way, sharing laughter or being able to help refocus our patients in empowering ways is gratifying.
ReplyDeletei liked the article titled "Simple Gifts on the Hospital Floor". This is about a nurse who lost her PCA key and her co-workers helped her find it in the wastebasket. Their teamwork is fantastic! I, too, belong, to group of staff in SCTU that has a good teamwork. We all pitch in when necessary to help our patients. Even just answering call light or beeper of IV machine of patients not assigned to us. My manager is also fantastic in giving gifts. She remembers us on our birthdays(we get a gift and also celebrate with birthday cake) and christmas.
ReplyDeleteI would like to share a story about a patient who lost her rosary from Rome. Apparently, she left in her bed and went ambulating in the hallway. When she came back to her room, her bed was already made up and she was tired from walking and just laid down in bed to rest. She remembered her rosary around 6pm when her visitors came 'cause they pray the rosary together. She asked me if i have seen her rosary 'cause she knew the last time she saw her rosary was in her bed. I went searching in our linen container but alas, the housekeeping took it down to the basement ready for pick-up. Fortunately, the linens haven't been picked up so I was able to go through the mountains of linens from all over the floors. I kept praying that I hope I could find that rosary. And my prayers was heard. I felt great joy when I was handing that rosary to the patient.
I read the article, "When Nurses Make Mistakes". This article had a huge impact on me because it just shows that in an instant your life can change. I am interested to know if Kim was working overtime or the night shift. I use to work the night shift and would have to review the patient's charts and complete 24 hour checks. In the hospital setting it is a 24 hour enviornment but not everyone's body is not able to work 2nd or 3rd shifts.
ReplyDeleteWhile I was working at a previous hospital I would find errors from the overnight pharmasists. Another time I found an error where the weekend nurse "who works at another hospital during the week" verifed the wrong medications on a patient's admission and the patient had been getting medications that were not hers for the duration of two days. I happened to catch the mistake when I was giving the patient the medications and as I am listing them off, she is looking at me like I had three heads. I asked her what the matter was and she said that she hadn't been taking these medications before. I went back and looked in her chart and I found that the pharmacy profiled anther patient's medications under her name and the night nurse who did the 24 hour check the night of her admission missed this error. She was lucky that she was only getting extra vitamins but it could have been fatal. As humans we all make mistakes, learning from those mistakes is what makes us grow and become better.
I read the article "When Nurses Make Mistakes". It is our responsibility as nurses to keep our patients safety our most important priority. We as human makes mistakes and it should serve as a lesson forall of us .It is bad enough for the family of the patient, more so with the nurse who makes the mistake.
ReplyDeleteThis is a very good article. I am positive a lot of Nurses can relate to this. No matter how excellent nurse you are,when you committ a mistake, they will always remember it.Being honest is the first step, accept that you are human, that you can make mistakes. Be humble and take responsibility. Having a team who will back you up, like the physician. is very reassuring to know that. And I agree working over 12 hours unhealthy physically & mentally.
ReplyDeleteWe have to take care of ourself in order to give be able to care for our patients, caregivers 100 %. I really like all the articles, It help us nurses to be very cognizant and be extra carefull. Also that these situations happens to a lot of us. Thank You for these excellent articles.
A Nurse, a patient and a Television was the article that sparked my interest! I recall an invitation to watch Prince William and Kate Middleton's royal wedding one evening while rounding at the start of my night shift. My patient smiled and requested minimal interruptions for the following two hours, as she wanted to nap to ensure she would be up for the televised wedding that night/early morning. She then extended an invitation and asked that I bring as many nurses as I could. I was not able to stay long, but I did manage to catch the bride's arrival and as she walked down the aisle. An isolated and grumpy patient suddenly smiled and conversed endlessly.
ReplyDeleteI chose Caring for the Chart or the Patient? The days of paper charting and hand written medication sheets were filled with the possiblity of serious errors and ommissions. But I do remember spending the majority of my shift in the patient's room, and not charting at the desk. I hope in the future, changes in the amount of charting required will be made so that today's bedside nurses can spend more time assessing and caring for their patient's. I know in my heart, no one ever went to nursing school so that they could sit behind a computer for a large portion of their shift.
ReplyDeleteamong many great articles i chose "Caring for the chart or the patient" because it is very difficult for me to accept the amount of charting that has to be done and time "wasted" at the computer when I know that I could use this time at the patient's bedside.
ReplyDeleteA Hollywood Movie Takes On Cancer:
ReplyDeleteI too was skeptical to watch his movie, as I am to watch any movie on a health related issue. Because I feel they do nothing but downplay the situation and show all the negative side effects, mood swings, ect. But as Theresa states, it's not like that at all. It shows real situations and doctors that talk to you as if you were an MD yourself but, doesn't over glorify it. She also states sometime it gives patients a fresh outlook on life and I couldn't agree more. It gives people that time to sit back and really focus on what is important in life and what it's.
I read "Feeding the Nurses". Many families are strapped financially and want to give us something to show their thanks for taking good care of their family member. Really what else could they give that every one can enjoy "FOOD". Giving of the food is comforting to the caregiver as many times they feel helpless and now they are able to help. No matter what the gift is, it is from their hearts to show appreciation for a job well done.
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