When I meet someone who is passionate about their nursing practice, I like to step aside and let them shine. Tami Zwiefka has been a stakeholder at CTCA - Midwestern for the past four and one half years. While working as a care manager in our Stem Cell Transplant Unit, Tami learned a lot about Monoclonal Antibodies(Moab) and Small Molecule Inhibitors (SMI). According to Tami, "One of the first Moab's developed was Rituxan. Rituxan has become a staple drug in a very high percentage of treatments offered as first line therapy for lymphomas. SMI's used to treat hematological malignancies in stem cell patients offer close to 100% response, down to the molecular level for Chronic Myeloid Leukemia (CML)." She then added,"The SMI therapy for CML specifically targets the BRC-ABL molecular marking antigen. This has resulted in giving many patients a cancer free life. The new generation of targeted therapies are really exciting and I hope that you find this introductory article helpful."
Thank you Tami for such an interesting article and challenging questions. If anyone else would like to share their expertise on a subject, please let me know - Melissa.
Please enjoy our February Journal Club reading is Targeted Therapies .
Questions- please remember no copy and pasting, no one sentence answers.
1. Explain the differences between chemotherapy and targeted therapies. Include a
comparison of side effects.
2. Please describe the mechanisms of how a Monoclonal Antibody works, and show
an understanding of ligands and fragment antigen binding.
Just For Fun - when I worked in the infusion center, one of my patients came dressed for her appointments as Minnie Mouse. She wanted to surprise her oncologist and tell him she was having side effects from her targeted therapy. From the reading, explain the joke she was trying to make about the drug she was receiving for treatment (oncology humor).
Discussion Question
At the right hand side of the blog is a link to Theresa Brown's New York Times Wellness Blog. Theresa Brown is a former oncology nurse who is now working in hospice. Please pick one of her articles that speaks to you and share your thoughts on the blog.
Please send your answers to melissa.luebbe@ctca-hope.com
No article for March, we will finish Journal Club with articles for April and May!
The editorial I chose to read was “Feeding the Nurses.”
ReplyDeleteFOOD. I’m sure that everyone would agree that for nurses who work in direct patient care, it’s often sorely missed. Of all the areas I have worked at CTCA, the 2 which were the most distressing for me, meal-wise, were inpatient and infusion. Surely most of us have found ourselves in the following situation, at some point in our career: 5 people calling at once--a PCT relaying that a patient needs prn pain meds, another patient waiting to be discharged, a doctor who is rounding, lab calling in a critical value, and imaging requesting lift help. The icing on the cake would be a call from the unit secretary, cheerfully announcing “You’re getting an admission!”
Like many peers, I constantly found that the hours slipped by, only to be reminded by my stomach growling. I am sure I ate my weight in break-room graham crackers, on many an occasion. Let’s face it: we can take care of ourselves and eat when we have meal-time coverage, and if a fellow nurse is overwhelmed herself, this isn’t a realistic solution. Now, I know that this topic is as old as dirt…the fact that acuity in oncologic care is quite high and that MRMC patients are scheduled tightly only exacerbates the issue.
In any case, like the article reads, if food was ever kindly delivered, it turned out to be the BEST day! I literally felt like the heavens opened up, and I swear I could hear angels singing Handel’s “Hallelujah” chorus. And let me tell you: this news travels fast around the unit! I always made it a point to personally thank the donor.
One day, it was my turn to pay that kindness forward: my first son was a preemie and spent his first 3 weeks in the NICU. I brought treats to the nurses on so many occasions. I could feel their joy, for I knew how they felt. (Once a nurse, always a nurse).
When I was a CNA at another hospital we often would get food from family and patients. We often asked that question, was it in the patients room? For example: sliced birthday cake, slices of deep dish pzza, or cookies (homemade). Now this question did not come from a negative place like all patients were gross, it came from the fact that our floor was the unofficial isolation floor with visitors who didn't follow precaustions so you never really knew. Anyhow..... When my mom was a patient on a ortho floor on her birthday. I was bringing cupcakes to cheer her up and to butter up her staff. I brought the team their own box of cupcakes. I stopped by the nursing station and announced my mom's birthday offered up the cupcakes and added, "These are for you all, they were never in the room" They pounced. Gone in 60 seconds. My mom said later that day, she didn't know whay happened but everyone was so nice tonight. I giggled.
DeleteI read “Feeding the Nurses.” I purposely chose this article because it hits close to home. All the time, especially during the holidays we have patients returning to our department and bringing us goodies (cakes, cookies, candies) to say thank you and to let us know they haven’t forgotten what good care we took of them when they were undergoing radiation treatment, even if it was many years in the past that they treated. It is also a wonderful reminder that what we are doing is making a difference in other people’s lives. Theresa stated that food is an occupational hazard, and I can’t agree with her more! There are many times I won’t be hungry but the food is there and looks so good, I can’t resist!!
ReplyDeleteFood is an occupational hazard I agree. I've gained the freshman 15 since starting here about 2 years ago. On top of that my hormones are crazy now that my dirty 30s are ending and I am pushing 40. I've purchased a rowing machinem, I am pushing veggies and water to make enjoying a free lunch a bit more freeing!
DeleteI agree, the food can sometimes be in overabundance and you really have to police yourself:-) I am always touched when a patient brings in a homemade item, as I think of their heart, their intention, and the effort that was probably required in making the item for us. Even if the food is store bought, the intention is the same and equally touching. Food is many times an expression of love and gratitude. Keep up the rowing Kate-I like to row as well:-)
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ReplyDeletePractice makes perfect. This was a great read. In the clinic the nurses were given a 10 minute in service and a poster board, (that was excellently done by the way), and told now you can give Zoladex. This subQ shot comes as a pellet. It is delivered with a needle similar in size to the needle used to infuse steaks and other large meat products with marinade. From the shouts coming from the peanut gallery, I knew, I wasn’t the only nurse scared out of my comfort zone. The drug rep came in a few times and brought a clinical practice model but we all know it helps learn the steps but it is always very different when your practice model has a name and a face that you have grown to think of like family. I know I didn’t want someone who isn’t the expert sticking that thing in me!!!!!!!!!!
ReplyDeleteLike all things in life policy and procedures change. Sometimes change is slow and sometimes change happens overnight. This one happened overnight. So I could protest, refuse, and complain or I could learn. I am a nurse that floats in between two very different scopes of practice. Some days I wear my Urology/surgical nurse hat other days I am thrown to the medical oncology floor. Usually if I am being floated to med/onc it is because we are short nurses. When we are short nurses that mean there are less nurses to ask for help. I have learned to adapt to my surroundings, adopt a new way of thinking and preform in the moment as the best nurse I can be.
I was blessed with a great teacher. The provider allowed me to take my time as she held my hand through the process. This shot is usually given after a lidocaine injection to the area. It is given in the subcutaneous tissue and is spring loaded. She let me watch several patients from beginning to end. She gauged my level of confidence and suggested that I start the process of learning. Step by step she guided me through the process. I now am competent and can give this shot on my own. It isn’t scary at all. This provider handpicked my first patient and we both came right out and said this is my first time. Being open and honest in this case was wonderful as the patient understood that in order to run you must learn to crawl. Every situation is different and every nurse and supportive staff works in different ways. I am thankful that the stars aligned. Being a nurse can be very overwhelming.
Wow! I pray I never have to get that injection! I googled it to see a picture to get a better understanding of that horrid sounding needle!! Talking about going outside of your comfort zone, we very rarely have to remove epidural catheters, but when we do, I know I always get a little nervous prior and with good reason!! If you aren't nervous to do something like that, then I think that is a problem!
DeleteThe story I chose to read from Theresa Brown, RN is Nurse and Patient, Sharing Laughter. The article is a tribute to the humor that patients use when diagnosed with cancer. There have been several patients that I have encountered over the years that use humor as a coping mechanism. Sometimes the humor is inappropriate and at times may not be funny but it is how the patient is managing their stress level. As a nurse, sharing some laughs with our patients helps to lighten the mood while still remaining professional. The last sentence of the article refers to sharing laughs and lifting the dark cloud by the disease of cancer. How true this statement is!
ReplyDeleteI love this idea and it is very true. Scientist says laughter releases endorphins and helps reduce pain for starters. It is also a wonderful way to connect with our patients on a level other than doom and gloom.
DeleteI agree often times laughter/humor really is the best medicine!
DeleteLaughter is a great method to build rapport with patients who also like to joke or use witty comments. Sometimes the darker humor is questionable, I am unsure if I should join in their laughter, so I smile. Patients here say how nice it is to not have everyone so serious, they want to laugh.
DeletePracticing on Patients
ReplyDeleteBy
Theresa Brown, R.N.
I chose this article as I have been on both ends of the spectrum both as a nurse and patient. I recall many times learning a new skill and being a new nurse gaining expertise through practicing on the patient. Just as people are different so were the responses and acceptance levels of this practice. Truth be told practicing in a skills lab is great for technical steps but just like snowflakes no 2 patients are alike and the real experience is gained by practicing on patients. That said it is ultimately the patients discretion to allow this to occur- and some are more willing to be guinea pigs than others. As nurses we are first patient advocates and should honor their decision. I have myself experienced unpleasant outcomes as a patient with failed student attempts on lab draws but felt it my duty though I was unwell I still let them try. So I do understand what it is like to not feel well and want to just pass to be practiced on and feel obliged each time a patient allows me to practice a new skill on them.
Sorry that I have to reply under your post. It wont let me respond any other way.
DeleteRegardless, the article that I chose was A Hollywood Movie takes on Cancer by Theresa Brown, R.N.
I thought this was a pretty good blog post. Its difficult to capture the true spirit of healthcare. Lord knows that many healthcare provides scauff at the healthcare related movies and shows like Grey's Anatomy that are extremely inaccurate and portray nurses and other healthcare workers in a negative way. I haven't seen this movie mentioned, but she seems to think that it was portrayed accurately and captured the emotion of cancer.
She also ellaborates that cancer doesn't have to change your life. And gives examples that bad relationships prior to the diagnosis will still be bad after. Family that annoyed you before the diagnosis will still annoy you after, although you may appreciate them more. This made me think of so many stories that I hear from patients that make them appreciate life more and people more. And rid themselves of toxicities (both physical, emotional, and chemical) post diagnosis. Some have even said, that it has changed their life so much for the better. I think sometimes its difficult for us to imagine that, watching them endure so much throughout their journey.
Sorry I had to post here too, site wouldnt work. I read the article on patients interrupted sleep in the hospital. I am a big advocate of keeping patients informed and educating and patients in advance of events that will be happening to them as they are shuttled through the hospital with consults, testing, treatments etc.. I think it gives them some sense of control and maybe if they know that they will have interrupted sleep it wont be perceived as so offensive. I agree with Kari and have spoken with many patients who believe that their cancer changed them or the better, even improving family relationships.
DeleteThanks Kari. I agree that the drama of television and movies gives a pretty inaccurate picture of real life in a hospital. While it appears to be all sex, drugs, and fun, it is Hollywood. Thank God we aren't really like that and patients do have life changing and positive experiences because of us.
DeleteLisa Hammons RN
ReplyDeleteI chose the blog article "Feeling Strain When Violent Patients Need Care". In the hospital, no matter what the specialty, there is always the potential for violent patients. Some specialties such as ER and Psychiatric have a much greater potential for violent patients than others. We must take care of those patients, but it is important to protect ourselves as much as possible and I think that hospitals need to offer as much protection for staff as possible as well. I am fortunate to have never have a serious event happen but many others haven't been that fortunate. I have had my hair pulled by an Alzheimer's patient and had a confused patient hit me with a telephone, but those were minor compared to what can happen. I've never felt threatened in person by a patient, although I once had to take care of a prisoner in a hospital. He had a guard with him in the room at all times and the prisoner was always very polite to me, but I am sure I would have felt very uneasy had the guard only stayed just outside the room when I was performing care. Today, not only do we have to worry about the potential for violent patients, whether it be their usual nature to be violent or whether it be illness or drug related, we also have to be alert to the potential of violent and/or emotionally disturbed family members. We have all heard news reports of family members returning to kill a doctor who they held responsible for the death of a family member.
I also gravitated toward the article regarding patients who may exhibit violent tendencies. Our own patients have become increasing rude, disruptive, and verbally abusive. Our tolerance seems to have no limit for patients behaving badly. One patient that comes to mind threatened a physician, yet still returns for treatment. In the course of one week recently, security was called to monitor a (new) patient who became verbally abusive with staff and threw things at a door. Another patient created chaos with each provider as he meandered through the new patient process – and continues to do so at each visit. Yes, they have met with Social and had a “talk to.” A cancer diagnosis should not provide a free pass. I’m fearful that one day a short fuse will erupt into physical violence.
DeleteHaving trouble with the post also...I am responding to the blog by Theresa Brown RN titled "Need sleep? Stay out of the hospital". I have always heard a hospital is no place to get rest. The poor patients are constantly woken up, whether it's during the night or day. We have to get vitals, draw labs, give meds, to do hourly checks. Or maybe it's not even staff that's waking them up. It could be the confused post op patient down the hall crying out. We give the patients their PM care in hopes that it will help them sleep, but ultimately their best sleep will be home in their own bed.
ReplyDeleteTina, yes you are definitely correct. Nobody gets sleep in the hospital. I recall several times patients asking if they can take a nap. I usually say "good luck". I let my PCT and coworkers know, but if a doctor shows up or there needs to be labs drawn or a scan, unfortunately that usually takes precedence. The noise outside the rooms is a problem too. A new protocol we have to follow on third floor now is that if the patient is a fall risk the blinds and door must be open at all times. We all know sleep is good for healing and restoring the body so getting out of the hospital as soon as possible is probably very beneficial for the patient.
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ReplyDeleteI chose "Bringing Home to the Hospital". I am a firm believer of bringing items from home to lift the spirit of the patient and make them more comfortable in their environment that they have so little power in. When my Mom was at a larger academic institution for her chemo(6 weeks in pt)we brought items in to comfort her but were limited, we were told due to her immunosuppression and the for the safety of the entire unit. I was able to bring in a radio/CD player so she could listen to her favorite music-she did not like TV. I made a little candle arrangement appropriate for the season(fall) using battery powered tealights. I brought watermelon from home for Mom as that was the only thing that tasted good to her. We decorated her walls/doors with pictures of the family and positive words. It helped but sadly it never was enough-it was still a closet-sized, century-old, dark, depressing, noisy(CTA train passed regularly outside her window and her shared wall with the hallway had the door pad mounted on the other side and EVERYONE felt the need to punch it in order to open the unit doors) room. Florence Nightengale would not have approved. For myself, I can think of nothing better than to have my dog close at my side if I ever find myself in a health crisis where I cannot be at home.
ReplyDeleteYes, I am a big proponent of having a patient's favorite music playing for them, whether it be for a long inpt stay or in hospice at the end of life.
DeleteI am writing about the post on a Hollywood Movie takes on cancer. I am glad the movie depicted cancer care and the disease realistically. I once had a clinical nurse specialist that told me that if a family is dysfunctional before an illness, they will still be dysfunctional after a diagnosis of cancer, or any illness. Communication will not improve. This is very true. Same is true of a patient--he/she may not be any more compliant with cancer than he/she was with Diabetes.
ReplyDeleteI can totally relate to the Theresa Brown's article "Need Sleep? Stay out of the hospital. I worked 7p-7a for 7 years on a Med-surg/Oncology floor. The majority of our Oncology patients were those with leukemia and lymphoma. They would be hopsitalized for about 3 weeks with each chemotherapy regimen assuming that all went well. These patients were very high acuity. They required lots of blood products, and antibiotics. Very frequent vital signs, assessments and verifications were required all day, which includes night time.
ReplyDeleteMany of the oncologists would round at 0600, therefore labs were done at 0400. Patients would often get a little annoyed. I always joked with them and assured them if they find that thery are getting a full nights sleep that this is a good sign that they will be getting discharged soon!
I had to reply to this comment because for some reason it is not allowing me to post. Working on the floor on night shift for me was challenging when it came to patinet advocacy for sleep. We all know without being a nurse that rest is the best for the ill. However, when your a patient in the hospital that is almost impossible with the constant disruption of care providers that need to see each patient. I found that just trying to cluster things together as much as possible to minimize the amount of interuptive sleep was the most i could do. Patients dont always understand the necessity for the constant people in and out of their room but taking the time to explain the importance of all roles invloved and ease them as well. I myslef have been a patient and still found it hard to accept.
DeleteI chose Feeding the Nurses too. Throughout my many years of nursing, it seems that nurses get excited when receiving gifts of food. The thoughts and thank you's expressed and the true meaning behind giving touches our hearts. Whether home made or store bought we really appreciate it, even though are waist lines may increase. It is that extra touch that makes us smile, and also know that we made a difference.
DeleteThe article about watching TV with the patient is so true. "Only connect" says it all. Connecting with our patients, seeing them as human beings with lives outside of the cancer diagnosis is so important. I try to remember details unrelated to the cancer diagnosis when I see patients in follow up appointments. I try to ask about the European cruise they took, how is the new granddaughter, did you retire and how is that going for you? I want them to know I see them as a person with interests and normal life experiences, not to be viewed as a patient with labs, tests,and appoitments. Sitting with the patient, sharing the TV program was good medicine.
ReplyDeleteDoona - I agree that connecting with pt's makes or breaks many of the visits. Before I preop teach or see pt I read their history and this is beyond the medical history. Where are they from, type of work, kids...Just yesterday I discovered through the care managements notes that my patient had gotten married between visits. I got a card, the clinic got a cake and we went and sang "happy wedding " to the patient and his new bride. Taking time to connect is many times better than any drugs.
DeleteI also agree with Donna that connecting with patients is very important. I talk with them about something that they are interested in. This helps the patients to relax especially when they come to an appointment very tense.
DeleteI read the article about when visitors of patient's get sick. In summary, the article talks about a patient's family member complaining of chest pain while she is discharging the patient. Because the family member is not a patient, she has to decide how to address this situation. The family member was a young woman not appearing to be in distress. But when Theresa addressed the chest pain and asked if she had ever had chest pain before, the young woman replied that she had, with her heart attack. Hearing chest pain and history of heart attack makes most nurses think about calling a code. Theresa explained that she wanted to get the family member urgent care, but the family member appeared stable so she decided to take her to the ER via wheelchair. While taking her to the ER the family member started to deterioriate which made Theresa second guess her decision not to call a code. She further explained the reasoning for not measuring vital signs or working up the patient: she did not have a health history to go off of, she did not know her medications/allergies, she did not know her baseline vitals signs, etc..
ReplyDeleteThis article made me view patient's family members and caregivers in a new light. They too could become my potential patients.
This article speaks to our unique situation at CTCA. We have patients here for weeks and months at a time along with their caregivers. We need to educate the caregivers on the resources that are here for them while there are on our hospital grounds and also to keep in mind that we as stakeholders need to follow the protocols like Theresa did in the example in her article.
DeleteI chose the article on "When Nurses Make Mistakes". I think as nurses we have all make a mistake at one point or another in our careers. This does not go to say that it will never happen again as it very well could easily happen. Safety methods implemented in the work place are very important for nurses involving medication and its administration. Mistakes may not always involve a medication error but those can have serious consequences for our patients. This nurse had been in nursing for 27 years with lots of experience under her belt which shows that we can all make mistakes at any time and under different circumstances. We should never get comfortable with what we do even when we have done it a hundred times over. It is that one instance that can change a nurses or patients life forever.
ReplyDeleteVery interesting points. All of us are human, and it doesn't matter how many years of experience we have, it doesn't make us perfect. There are so many interruptions, or nurses suffering from fatigue that mistakes are part of it. We need to make sure that we take care of ourselves, and make sure we come to work well rested so mistakes caused by fatigue can be avoided.
DeleteBrenda
I chose the article on "When Nurses make Mistakes" as well. I agree with Pam and Brenda stating we are only human and we all make mistakes. I truly believe this and truly hope each and every one realizes it. I believe everyone goes into healthcare to do good and that noone tries to harm. It is ok to say "I don't know" and seek out the answer. That is the great thing about CTCA we have so many staff around us to ask. However, sometimes in our particular setting many of our patients have flights to catch and are very anxious to get out the door. I try to take a deep breath for them because when we are rushing that is typically when mistakes are more likely to happen.
DeleteI chose the article: When Hospital Visitor's Get Sick. I enjoyed this article as it has happened to me before, and it is very likely that it has happened, or will happen to each and every nurse that works in a hospital setting. Our critical thinking skills kick in, especially when someone says they are having chest pain, and has had a MI in the past. What is the best course of action to take? If you call a code are you over reacting? If you ignore it, or think it is indigestion are you not doing what is in the best interest for this persons health? It is hard when they are not a patient, as we have no medical history, no consent to treat, and no doctor on board to write or give orders. I think she did the best thing, and what I would have done in this situation and get them to the ER as quickly as possible. You may get some strange looks as if you were overreacting, but in the end, you were doing what was in the best interest of the caregiver. To err on the side of caution is better than not doing enough for them that could have caused detrimental side effects for them long term. Whatever you do for them is better than doing nothing. I'm sure that whether you over reacted, or did exactly the right thing, that in the long run, they are grateful to you for whatever help you gave them.
ReplyDeleteBrenda
I completed agree with you brenda. I can't begin to tell you how many times this has happened in the 7 years that i have been a nurse.
DeleteI chose “When a Nurse Disagrees with a Doctor”. I probably can’t even count the times this has happened in my 5 years of nursing practice. I will usually state my opinion to the doctor on the case or others in the care team. Sometimes plans for the patient are changed. Sometimes they are not. I remember one instance early in my nursing career that I was very uncomfortable carrying out a doctor’s orders. I spoke with the doctor and my manager at the time. The doctor criticized me and called me out on my lack of knowledge. My manager said something to the effect of “just think of who pays you”, insinuating that I should follow orders for job security purposes. I don’t remember exactly what happened but I know I didn’t carry out the order. I kept my job and all was fine. I still question orders frequently even if I sound “uneducated”. I agree with Theresa, the patients well-being should be our main concern.
ReplyDeleteI think it is great when a nurse questions a physican's order that doesn't sound right. I would rather question it and get an educated rationale from the doctor, than carry out an order that could potentially cause the patient undue harm. Just this week I questioned why a patient was admitted without a specific medication ordered and the response was that the patient was confused and therefore the medication should not be ordered. Unfortunately the doctor had received an incorrect report from the ER physician and still needed the medication. As much as we should follow and carry out these doctors orders, it is just as important to make sure that we question things that just don't seem right.
DeleteI still struggle with this because I've only been a nurse for a short time. I feel nervous sometimes to disagree with a doctor, but like Jessica said, I would rather be provided with education so that I can know for the future. Sometimes I just simply do not understand the rationale, other times the physician realizes the rationale may not be best and may change the order. The patient is number one and it's our job to always keep that in mind.
DeleteI really enjoyed the article “Sharing Laughter”. Sometimes the old expression “Laughter is the best medicine” does have truth to it. Laughing is healthy; we even have Laughter Club here at CTCA! Laughing can simply be a way of dealing with stress/anxiety, a coping mechanism. As a matter of fact, I have the pleasure of caring for some of those patients that use that coping mechanism every time I see them in clinic. I have a few patients, mostly men, some of my favorites actually, they come to the clinic joking around, kidding about everything, nothing is serious, and everything is fine… Sometimes this makes a serious assessment very difficult and lengthy but eventually it is complete and the experience with that patient of quality. I laugh with them and really enjoy the experience because I know this is the way they deal with an extremely stressful situation and I am happy to be there to help them through.
ReplyDeleteI agree with Cindy, Laughing really makes a difference in our lives , most especially our patients who are goimg through a lot.Sometimes it is their way of coping up with whatever they are experiencing right now
DeleteI choose the article on charting. A patient with multiple wounds to chart on can take longer than the actual care. I am torn on the charting becuase I did litagation for a number of years and have seen cases won and loss because of charting. I have watched charting go from charting q 2 hours - how many ways can you say a patinet was sleeping on night shift - to flow sheets with only "charting q 3 days or a change in condition. You usually did not know what was going on. I miss the "free charting" where we truly charted how the patient was feeling, how they responded to certain tx's without having selected answers. I anotate when the expression or choice I want is not available. I have been supoened for depositions and have been an expert witness so no matter how difficult the charting is my goal is to express the patients concerns, how the wound "looks" and remember if I go to court I need to have a clear picture of what I saw and did. I try my best to do not allow charting to interfere with the care of the pt. If I have to stay exstra to chart I will but the pt comes first.
ReplyDeleteI was taught early in my nursing eduation to document in a manner that provides a clear picture to the reader. The person reading the documentation should be able to visualize the exact situation in which you are documenting. I could not imagine trying to remember something from decades, or even months ago, and that is why it is critical to document appropriately and exactly as it happens.
DeleteWhen nurses make mistake:
ReplyDeleteNo one is perfect. Personnaly, I have witness this kind of situation myself, it happened to one of my co-worker. Just like the nurse on the article, she was a seasoned RN, work many years in ER and probably gave the same medications properly a thousand times. One busy night, a patient with allergic reaction to something came in with hives all over his body but without any respiratory distress. ER MD ordered the usual cocktail of Benadryl, Solumedrol and Epinephrine. She gave all the medications IV push including the epinehrine which supposedly to be given IM or SQ. I found her patient crying, complaining of chest pain, HR on the 140's on the monitor and very restless. Luckily, the patient was OK after few hours of monitoring in the ER and was discharge home. Although nothing happened to the patient, she felt so bad and have to leave the floor ( ER )for few hours to gather herself back together because she knew that she could have harmed that patient she was trying to help.
I opted to read the article by Theresa Brown"Bring Home to the Hospital". this article was me and my son. It is very hard to take a three year old and a mother into a oncology setting weeks at a time over a 3 year period. I brought his dinosaurs, teddy bears, blankets, PJ, movies, books and his most needed comfort item, my long ponytail hair for him to hold onto. Bring home to the hospital during a stressful, scary time for a toddler helped him and me cope with the reality of it all. That little bit of "normal" goes a long way. The most valuable lesson learned. Live with the CANCER do not let it LIVE you. This is exactly it. By bring a little bit of home into the hospital, it is not allowing it to live you.
ReplyDeleteWhen Nurses Make Mistakes
DeleteThe title of this blog caught my attention, as we struggle with providing the best nursing care to such a sick population of patients. It is definitely a concept that all nurses think about all the time. We ponder over making the right decisions, implementing the right nursing interventions, and beating ourselves up for making mistakes. This profession is so special because we care extensively about making mistakes, and doing everything in our power to prevent errors. Unfortunately circumstances arise that leave us in situations that create less than a safe place. It is critical for our profession to maintain professional accountability and be responsible for our own actions, even if it means we have to admit our mistakes. In the end, the patients are the ones that benefit from honesty and the ability for nurses to do what's best through honesty in their practice.
It is so hard during emergency situation to be calm. I always talk myself to be calm and focus. In this situation, I will call a rapid response team so proper treatment will be administered to the patient right away.
ReplyDeleteI chose " When the nurse disagrres with a doctor" I believe we are the patients advocate, their voice when it comes to their treatment , we have the right to question is we think that it could potentiall y harm the patient.Our patients safety is our responsibility
ReplyDeleteI read "Caring for the Chart or the Patient?" THis speaks volumes to me because as we have all heard before "If it isn't charted, it isn't done" Sometimes though I feel like the volume of charting and the way we chart in the system takes away care from our patients. I feel that charting is a barrier to providing care. While it is important to do, I feel that if there was a way to simplify charting, it would be very beneficial/helpful so I can focus more on my time with my patients.
ReplyDeleteI totally agree Amy. Our patients are very unique too, and sometimes we spend more time with them on an emotional level instead of a medication and skills level. That is hard to express in a chart.
DeleteI like to talk about "When I disagree with a doctor". It is always hard to question a doctor everybody knows that, but sometimes it is feasible by the manner how you tackle the situation. It works at times when instead of questioning do a suggestion or viewing your opinion. Sure I have instances when doctors called me "stupid or you don't know anything" It is very hard to stand up for what you believe is right.Anyway I just want to convey my gratitude to CTCA at MRMC for the We Are Safe campaign & launch. with the Safety Behaviors we are able to use these for accountability, reliability and being empowered to use We speak up for safety using ARCC, Ask a question, Make a Request, Voice a Concern, Use Chain of
ReplyDeleteCommand. Our culture has changed so much empowering us, Stakeholder to ask fo Patient's Safety.
I chose the article "Need Sleep? Stay out of the Hospital". How true is this for our patients? They receive chemotherapy and blood transfusions far into the night so that they can make their 8 am flight home. We have so many patients from out of state that we have to be increasingly conscious of time when providing care. Patients themselves will sometimes say that they know they won't get sleep tonight because they have to leave really early. I think we do a good job of doing our best to provide the patients with sleep and cluster their care and education. Sleep is just so hard when we constantly want vital signs and to make sure we educate them on what medication they are getting and why so that we promote safe practice. Sleep is so important for healing the mind and body and I feel like if we do our best and try to explain our rationales to the patient, they will understand that we truly want them to sleep, but also want to make sure they are stable and well cared for.
ReplyDeleteI chose "Need Sleep? Stay Out of the Hospital". We always tell our patients to get rest. When they are admitted to the hospital that's one thing that they do not get enough of. We wake them up for vitals, blood work, blood transfusion, and chemo. Patients also have a hard time sleeping in hospitals because it is not their home and they are use to their own bed. Confused patients are also very restless because their surroundings are not familiar. Patients try to make the best of it but I know they can't wait to get out of the hospital to get the rest they need.
ReplyDeleteI picked "Need sleep? Stay Out of the Hospital." Quality sleep at the right time (mostly at night) plays a critical role in maintaining good health, healthy brain function, and well-being throughout the life span. We know that the moment patients are admitted, they go through multiple activities including diagnostic tests, early morning lab draws, procedures, surgeries, multiple interviews, conversations, and visits from multidisciplinary team, scheduled assessment times to continually monitor them on the first critical hours/days of admission, pumps beeping throughout the night, and etc., enough for our patients to be in a state of sleep deprivation. This alone can greatly impact mental, physiological and emotional state. I am sure most of us experience being sleep deprived and we know how we feel after all. In consideration, we need to ensure that our activities are coordinated as much as possible and take a moment to give our patients short naps during daytime if they did not have enough rest at night. I am sure, patients wish to be home sooner because as the saying goes, "There is no better place than home," is always everyone's wish when they are in a different place or environment at the time.
ReplyDeleteThis comment has been removed by the author.
DeleteA Hollywood Movie Takes on Cancer - I find this post very interesting being a breast cancer survivor myself. She states that as an Oncology nurse she didn't want to go see a movie about cancer that "got the HollyWood treatment". She didn't want to see cliches, or simplified portrayals of cancer. I share her sentiments. She makes me want to see this movie, however, because she was pleasantly surprised at the more realistic approach they took. Cancer doesn't always change your life - some relationships remain the same. I would argue this one a bit. Some relationships go through surprising changes like falling apart suddenly, or deepening in the most touching ways. The over-arching message that cancer CAN change your life because many people look deeper into the meaning of their lives during cancer and want more meaning in their lives after cancer. It is an interesting take. My take is that cancer will change you, so ultimately it will change your life because you won't be the same person after a diagnosis of cancer. The degree of change probably depends on how much the process affected you on all levels; mind and body. Or if you are determined not to change - you won't, but most people have to process the experience and change at some point. At that point, you change and so does your world.
ReplyDeleteI enjoyed the article 'Nurse and Patient, Sharing Laughter'. We have all heard that laughter is the best medicine and I truly believe that this is a large part of the coping process for patients. Cancer is a very serious diagnosis and this sometimes causes the patients to become very serious during the treatment process. I have had patients like this and when I try to make a light-hearted comment, it isn't taken as such. On the other hand, I have one patient in particular who always has jokes to tell when he comes to the clinic, some of which are not funny or appropriate. But I have learned to let him tell them because he is coping with his diagnosis. Many patients enjoy telling stories about their families or stories of things that happened since we saw them last. Laughing with our patients helps us bond with them. I also feel that it helps make their journey a little easier knowing that when they come to have treatments, they will be able to relax even just a little bit.
ReplyDeleteI agree with you sometimes laughter and making fun of ourselves is a coping mechanism. I enjoy patients who have a witty/dry humor that many would take as mean and grouchy because most of the time once you get to know the patient you discover that they are the nicest/sweetest person trying to mask their fears/anxiety.
DeleteThe article I choose is Need Sleep? Stay Out of the Hospital. As a nurse I have spent a lot of time trying to stay ahead of every IV and tube feeding so they wouldn't run dry. I also worked tirelessly to give breathing treatments on time to vent patients to keep their secretions under control, help ease their breathing and keep them comfortable and all alarms silent. Having been a patient many times, I know how very important it is to maintain a quiet and serene environment. Every disruption in sleep leads to stress and anxiety and can cause a slower healing process. Many people have a hard time sleeping in a bed that's not their own and you factor in an illness, surgery and a hospital stay they are even more likely to have sleep issues. We all have to work harder not to cause sleep disturbances and to do what is best for the patient at all times.
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DeleteI enjoyed reading the article, "Bringing Home To The Hospital". Even though I work in the outpatient setting, I appreciate all we do here at CTCA to facilitate this feeling of home for our patients. Whether it's ordering a birthday or anniversary cake for them, or having Tori The Labradoodle stop by, our efforts to make them feel valued and, dare I say, normal, are so important. Our patients are so much more than their disease, and the more we can do to bring value to their personhood, the greater the trust that is built. And the greater their sense of validation and satisfaction.
ReplyDeleteIt is very unfortunate that patients can't get sleep when they are in the hospital. I know that it is very difficult for me because it is unfamiliar and I tend to sleep lightly. Sleep is so important for physical healing and well-being, but until there is a shift in the expectations of doctors, insurance, and society in general, I am afraid there won't be much change. It is funny though that doctors wouldn't call people at home until later in the morning because that is the societal norm. Why is it that they can disrupt people during normal sleeping hours just because they are present at the hospital? Of course, the doctors have to try to fit everything in to their very tight schedules. It is just a shame that this has become accepted in our society when sleep is so very important.
ReplyDeleteI reviewed a few of the blog posts and chose to comment on "Bringing Home to the Hospital." I have often looked at hospital rooms and seen neutral colored walls, very little natural light, institutional type decor and bedding, etc. Nothing like someones home. I like how the author described hanging flowers on the walls for color and pictures of the patient's family/friends/pets. This paints a wonderful image of how one patient decided to bring home to the hospital. I am thankful that with the opening of the inpatient tower, cancer patients here can have a more comfortable setting to healing in, including natural light, spacious rooms, etc. Also, in the article, the patient requested her dog to come visit her. Pet therapy is invaluable. When the logistics of our patients' pets can not come here, we have Tori! Finally, taking one step further, I think it would be healing to help inpatients travel to the courtyard to be outside!
ReplyDeleteThe article seemed to bring home the acknowledgement that chart documentation has been streamlined to include assessments and patient responses to medical treatment for the most part. Nurses engage in many activities that are caring and make a difference but are mostly undocumented due to time and rigid charting format.
ReplyDeleteIm sorry- I forgot to add that the blog was "Caring for the Chart or the Patient".
DeleteI picked and read the article, “Seeing a Patient Outside the Hospital”, by Theresa Brown. I love running into a patient outside of work. I do have a funny feeling sometimes though, thinking about HIPAA. There have been many times when I send a card or gift to a patient or patient’s spouse but we have shared each other’s contact information. There have been patients that we have not exchanged contact information and I wish that I had so I could send them a card or email, but due to HIPAA, I am unable to retrieve their information unless they are being seen or treated within my department. Many times after patients have surgery, they proceed with their medical oncologist and I never hear from them again. I wish the circumstances were different sometimes.
ReplyDeleteI have had this experience too. It is especially difficult when the patient volunteers medical information in public.
DeleteNurse and Doctor, Neighbor and Friend
ReplyDeleteCalling patients after a discharge from the hospital is something that is new for me with combining the role of the clinic nurse and care management. Sometimes we call patients that are post-op. I have not worked with surgical patients in a long time. Fortunately our surgical care managers have been extremely helpful. By gapping medical and surgical oncology continuity of care provides better quality of care for our patients.
The article I read was called "One nurse one patient", which talks about the dilemma that most of us face on a daily basis. We as nurses are taught to multitask and take care of all our patients even if we are extremely busy. This article touches on guilt that we face when we cannot do this because one of our patients needs our attention more than the others. I know for a fact that I feel awful when I can't equably divide my time between my assigned patients. The need may vary from something urgent like a code or just needing a little extra TLC. In the situation of a code most patients are very understanding and empathetic that someone else needed you more. In the other scenario it's kind of difficult to explain to your other patients that you weren't around as often as you would want to because your other patient needed someone to talk/vent to. This type of guilt is something that we face on a regular basis but in the end we have to remind ourselves that we are only one person and that if we can make a difference in one person then we have done our job well.
ReplyDeleteUnable to post without entering as a reply-
DeleteI especially like the article “When Nursing Is a Team Sport.” It really resonates so many daily, fundamental issues that are a priority to me as we all work together to accomplish the same goal of providing optimal care and outcomes for the patient. Nothing annoys me more than when someone says or implies “it is not my patient” or “it is not my problem.” Dr. Atul Gawande states in his book “that health care has evolved to be much more of a team, rather than an individual effort… success now requires … knowledge that outstrips any one person’s abilities…” And while I think most of us would agree with that statement, as Theresa Brown summarizes so accurately that “working as a team may be the model, but in reality we often fall short. People are stressed or tired, egos get in the way….” In my opinion the article was a healthy reminder that we will find increased fulfillment and enjoyment at the end of the day that was “virtually nonstop and stressful” when we meet the ideal of working effectively as a team.
I really enjoyed Simple Gifts on the hospital floor. It made me reflect back on my days working my first job as a nurse in a childrens nursing home in Chicago. I had the best nurses, and aids, we all got along and we were a real family, it made coming to work so pleasant and fulfilling. We spent holidays together and never complained. Each shift would help out the next shift,if one of the kids started seizing each nurse knew there role. That's how nursing should be in my opinion.
ReplyDeleteHello Cheryl,
DeleteI agree with you!Our job will much easier if we all work with one another and look out for each other.We spend a lot of our time at work. In fact, there are days we spend more time with our peers than our children and spouses.Work would be much more enjoyable and better patient outcomes will result if we all work as a team and refrain from animosity.
I chose the article, “Practicing on Patients” to write about. I recently switched from working as an ICU nurse in a community hospital to an infusion nurse here at CTCA. While that doesn’t sound like a huge change there has been a big learning curve. The article refers to having to do new or very seldom used skills on patients. As a nurse you always want to comfort and provide the best quality care to your patient but when tasks need to be accomplished and you are new to them these ideals can come into conflict. I find myself feeling like this day in and day out. The patients recognize me as a new face and ask me how long I have worked here. I always feel like my answer is defending myself, giving them my pre-CTCA resume. Most times the patient probably isn’t assuming anything about my care or inexperience. Reading the article made me feel a little better. All nurses go through this. The best case scenario is that we use our successes and our failures as learning experiences and reflect on how we can provide the best care for our patients.
ReplyDeleteAmong her articles, I can relate to the topic Prolonging Death at the End of Life. Recently after years, I was faced again to care for a patient who was slowly dying but in this instance, the husband does not want to let go and wanted everything done inspite the fact that nothing can really be done. Even when the doctor talked to the husband heart to heart, the husband did not listen to it. He heels that a miracle can just be awarded and the wife will be healed. Many times as you think about this situation, letting go is the hardest thing to do. Who wouldn't want anything done for their love ones until the very end? But realistically, is that the kind of life you want to see for someone you love? Or I should say, does it make you feel better to see your love suffering and agonizing in death wherein fact you could have made it easier for her to let go and rest after a long venture of pain and sacrifices? I know its easier said thanb done, but it happened to me personally when my mom was in ICU and trying to win her battle over death. It wasnt easy to decide but because of love I felt that I made her leave knowing in her heart everything was going to be okay. For me, it is unfair that someone has to suffer just to prolong his/her life if in the end he/she will end up just that way.
ReplyDeleteSeeing a Patient Outside the Hospital by Theresa Brown is an article that will resonate with many of us, as we have all likely crossed paths with patients outside of the hospital. I have had a couple of encounters myself. The first time I crossed paths with a patient was at Target :) The patient merely looked away and continue on her way. Perhaps, I was a reminder of her reality and her cancer journey.There has also been other instances in which I run into patients and they immediately approach me and introduce the whole gang. I must say, I really don't know which reaction I appreciate best or prefer. While I'm certainly overjoyed to see patients resume their normal life, I can also relate with Theresa Brown and her initial reaction when she first encountered her patient post completion of treatment.
ReplyDeleteI like her blog about: A patient and a nurse, sharing some laughs, lifting for a few hours the dark cloud created by disease.
ReplyDeleteI have definitely heard a lot of silly jokes that I won't cite here. I think laughter and jokes are a coping mechanism that work well for many patients as they are going through treatment. Seeing patients in the surveillance stage continues to offer me jokes and laughter therapy
I
I love that line to Jessica. Sharing some laughs, lifting for a few hours the dark cloud created by disease. And I agree laughter is a awesome coping mechanism for our patient and I embrace the opportunity to share a joke or just laugh with a patient.
DeleteI chose the article "Need Sleep? Stay out of the Hospital" from Theresa Brown's blog. As a night nurse, this article really spoke to the mutual frustration my patients and I feel when scheduled care and unintended interruptions such as beeping pumps, interrupt their sleep. Sleep affects healing, which is a primary reason patient's are in a hospital. So it is ironic that they very things we do to monitor a patient and keep them well, so often interrupt their sleep. Fortunately, we now have private patient rooms on all the units, which does help to allow a patient less interruptions during the night, as the shared rooms often meant patients would wake each other through the night. There are things we can do to increase sleep and sleep quality in the inpatient units. Dimming hallway lights, and decreasing noise outside the rooms are easy to do. Clustering care and coordinating with PCT's, can decrease interruptions with the added benefit of increasing communication and having two sets of hands in the room. A rested patient is a happier patient.
ReplyDeleteMichelle,
DeleteI have had this conversation many times. You would think that once in the hospital, rest would be so easy. WRONG! Everytime I was patient on the maternity unit I don't think I would go an hour without someone barging in for vitals, meds, cleaning, housekeeping, meals, etc. It's frustrating and exhausting. There really should be a team effort to all go in at once to avoid multiple interruptions.
Very good point that sleep in the new tower is a little easier to obtain with private rooms. We really do everything we can for our patients to sleep at night especially knowing it's not always easy for night shift to sleep during the day with lawn mowers going in the summer, mail deliveries aggravating the dogs, phone ringing/texts, etc
DeleteI really connected with Practicing on Patients. As a port nurse we are not always successful when it comes to obtaining a blood return. Although it is not in our control we feel bad sending the patients out to the waiting room again to wait for the phlebotomist to perform an arm draw. Often times the patients will ask why we can't just draw the labs from their arm in the port rooms. They seem rather confused when I tell them we can't, which is true based on our protocol. If I were given the chance to do so, I'm not so sure I would be successul because that is not something that nurses are taught to do in school and most of the times not in the workplace either. If we are able to learn at some point, I'm sure that I also would be turned away at times but patients need to remember that we have to start out somewhere.
ReplyDeleteI read this article too and it reminded me of how hard it can be to learn something new without really being able to "practice". Patients place so much trust in us as nurses but it can be very hard when we are learning and do not always feel confident to do a certain task. But the feeling of accomplishment and mastering a skill is wonderful.
DeleteAfter reading the article: When Nurses Make Mistakes, it brought back a flood of emotions within me from remembering the guilt that I felt when I made a mistake that could have been lethal for the s/p Stem Cell Transplant patient I was caring for. I didn't even realize my mistake until I was assembling the tubes to draw blood on my patient who needed vancomycin peak and trough levels. As you probably guessed, I didn't give the vancomycin to the patient. I immediately notified the MD, informed him that I had just plain forgotten to hang it on time (it was a slow night, I had no excuse), that it was infusing (4 hours late) apologized profusely to the MD and to the patient, rescheduled the peak and trough levels and completed the appropriate safety report. The guilt that I felt gave my nightmares for 2 weeks, I felt sick to my stomach for days and every time that I saw the MD I apologized again. My paranoia over checking the patients lab results daily (I would call from home on my nights off) and making sure that the patient was not harmed as a result of my action also consumed me. It took a long time before I felt reassured that I didn't hurt the patient by my mistake. Learning to forgive oneself is the hardest.
ReplyDeleteWe have all made mistakes, as a nurse or as a regular person. I feel your pain, I too know that awful feeling in the pit of your stomach. I applaud you for stepping up and admitting the mistake.Learning to forgive oneself is the hardest, no doubt.
DeleteI liked the article "When the Nurse Disagrees with the Doctor." In it, the author recounted a disagreement she had with a doctor. When she communicated that to him, he dismissed her and told her that her input was not necessary. The nurse believed that the patient suffered as a result of the decision that was made on the part of the physician. The article was a good reminder that nurses need to be "aggressive advocates" for their patients. While we should always be polite and respectful, we need to remember our purpose in medical community. Just as the author said, "While my physician colleague said that nurses only see a snapshot, that picture is often one the doctor does not see."
ReplyDeleteI read the article on Nurse and Patient,sharing Laughter.I love the comment she made about finding these patients both funny and fascinating. None of us know how we will respond to a disease that would make us face our mortality unless we have been there. I know people have different was of coping. As nurse's we just have to respect what ever way a patient chooses to deal with something so devastating. I have had the pleasure of working with some awesome patient's and I saw strength in patient's that dealt with there journey with laughter. I do believe we have to Remember laughter because we will need it in this life and beyond.
ReplyDeleteI also read the article on Nurse and Patient, sharing Laughter. I found that finding humor in small things and laughter, was often, an ice-breaker, with patients. It had to be used, carefully, of course, but a smile and giggle often broke the tension, of a first chemotherapy. I once had a husband and wife (husband was the patient), who brought in a book titled, of all things, "Stupid Men Jokes". Oh, we laughed over them and they gave me the book, which I still have. Sharing laughter seems often, just what is needed, to save a patient, from their very serious lives.
ReplyDeleteI remember a young woman, I cared for, over 25 years ago. She was dying, from breast cancer and was blind, from her treatment. Unfortunately, her oncologist was out that day and another was covering, for her. When he made rounds, her eyes were closed, he believed she was unconscious and he talked above her, not to her. As he rambled on, about her nutrition, I tried to hint, that she could still HEAR, but he wasn't taking the cues. After he finished his thoughts, on her TNA Ginny shocked him, shocked him, by smiling and saying "OH,YUMMY!" She and I laughed so much, the rest of the day, until I left. It was probably, her last laugh, she died that evening. I think of that often, and how Ginny needed and found humor, in her last hours.
i really believe in laughter is still the best medicine. i feel elated when i see pt. smile and laugh with me.You did a good job with your patient.
DeleteSeeing a patient outside the hospital
ReplyDeleteLike Theresa's story, I, too, feel happy to see our patients not only outside the hospital but also when they come visit us after their treatment. They are no longer bald and they look different with their newly grown hair. They also look like a different person from the patient that I used to take care of.
At that time, i used to see them ambulating in the hallway with their IV pole, bald, and wearing the hospital gown. Now I see them transformed and dressed up, with their new grown hair and make-up(on ladies).
I chose to read the article “Nurse and Patient, Sharing Laughter” written by Theresa Brown, R.N. Laughter is a natural human emotion. People use laughter in many ways; as a coping mechanism, to reduce stress, as an anti-anxiety treatment, for self-care, and during intense situations. It can be an ice breaker in awkward moments. We also know how laughter is contagious, at the very least laughter gets the attention of anyone that hears it. As nurses, we are taught to be non-judgmental of our patients, to respect their decisions and actions. This also holds true with patient’s emotions. Our Mind & Body Department at CTCA offers Laughter Therapy to patients and caregivers. There are proven studies how people have physical and emotional benefits from laughing every day.
ReplyDeleteI read "Need Sleep? Stay Out Of The Hospital" as I can relate to the article very well as she explained the sequence of events and balance needed for patient care on night shift. We want our patients to get adequate sleep but that is sometimes difficult to do with beeping pumps, every 4 hour vitals and assessments... And for the every hour DIEP flap patients - sleep is nearly impossible. Just tonight a patient's wife was hinting to her husband that walking every two hours would help his bowels for a bowel movement. Of course as his nurse I brought up the importance of sleep and suggestions on timing where he could walk AND maximize sleep. It's a fine dance trying to capture sleep while in the hospital.
ReplyDeleteAs a night nurse I agree. We do what we need to but are very aware we are disturbing their sleep. I sometimes have needed to remind patients that complain about staff being in and out of their rooms in the middle of the night that this is a hospital and we need to care for them regardless of what time it is. Of course this is always said with a smile!
DeleteI read the article on "Need sleep? Stay out of the hospital" and it couldn't be more true. I can relate in every aspect because most if not all patients do not get adequate rest while inpatient and it is even worse when they have multiple medications scheduled throughout the day. I always make my best effort to cluster my care whenever possible so that I am not constantly bothering the patient and this also includes scheduling all medications appropriately so that they are not receiving a new med every hour. There have been instances where I will even place a stop sign on the door so that other departments do not bother the patient if they are extremely exhausted and having an hour or two nap makes a huge difference. In the end, we all know the best sleep is at home in our own bed so the sooner they can appropriately be discharged is ultimately the best.
ReplyDeleteI read the article "Sharing Laughter." Patient's come to clinic they are nervous, and the tension is high. Sharing a smile or laughter at that moment means alot. Male patient's inparticular seem to have a nervous laugh, joking around, and not being to seroius. Sometimes it is difficult to get the true facts for an accuarate assessment because of how nervous they are. Caring for these patients-the laughter that can surround them. Sharing laughs, smiles, needed celebration, can lift these patients and bring things at ease for the moment. They do say the Benefits of laughter include: lowers blood pressure, good ab work out, lowers the stress level, improves cardiac health, boosts T cells, and produces a general sense of well being.
ReplyDeleteI read the article about seeing a patient outside the hospital. Last summer I was at my sister-in-law's community pool in a far away suburb. I looked up and there was a patient that I had seen in the clinic the day before. I wondered what I should do. Should I approach her? Or look the other way whenever she passed near me? I decided to not acknowledge her. Thankfully I was not wearing my purple scrubs! My reasoning was she was with a group of people who may or may not have known she is a cancer patient. I felt I would be infringing on her privacy if someone in her party wanted to know who I was and why I was enquiring after her health. I did not hide from her, I just simply pretended I had not seen her. If she had approached me that would have been different, or if our eyes had connected. I also could not tell anyone in the group I was with either. It made for an interesting time that day as I quite often passed close to her and the group she was with. It is a small world out there and you just never know who is around that corner.
ReplyDeleteI experienced a situation much like yours and it is difficult because it makes you feel unfriendly if you avoid contact but I feel it is up to the patient to initiate contact.
DeleteI read Practicing on Patients. Brought me back to just starting out as a new nurse with all the excitment and anxiety that goes with it. Performing a skill for the first time, while trying to gain your patient's trust, can be very challenging at times. Kind of a really weird idea when you really stop to think about it. And while it can be very difficult at times, I feel continuing to learn and grow is one of the best things about nursing.
ReplyDeleteMy thoughts are along the same lines. Being a new nurse! Everyone has to start somewhere. With time we all build our confidence, patients understand that.
DeleteI read the article, At home in the hospital. The article made me smile, as I have seen this many times here at CTCA. Many of our patients, especially those who are here for a long time, bring bits of home with them. The blankets made with loving care and prayed over by the church family, the cards and pictures taped on the beds, walls, IV poles. During the holidays, many of the patient decorate the IV poles and room.
ReplyDeleteWhen my father was in a rehab facility for one month, my siblings and mother, brought pictures of the grandchildren and great-grandchildren into his room, had his own clothes to wear, and made sure to bring in his favorite foods. This helped him to feel connected to all of us, and also less institutionalized.
I am so glad to work at a facility where we treat the whole person, and letting them bring home to the hospital, makes them feel like we deliver on our promise.
I read the article practicing on a patient. Reminds me of being a new nurse, not only. New nurse but everytime I have to perform a new task or task I have not done in awhile. Being confident in myself and not showing signs of being nervous helps the situation. If I do feel overwhelmed I continue to observe until comfortable. Nursing field you are always learning! Most patients seem ton understand that.
ReplyDeleteI read the article "A Hollywood Movie Takes on Cancer". I agree that having cancer or living with someone who has cancer doesn't necessarily change your life or who you are. I think of cancer as a stressor and when we human beings are stressed, we tend to react and respond in ways we are comfortable with. We don't develop "new" personalities, sometimes certain personality traits just get enhanced. Relationships don't magically become perfect. I believe that living with cancer can help you grow and refocus your priorities. It can help people stop putting things off and live for the moment.
ReplyDelete:When Nurses Make Mistakes" We see it everyday. There is a meeting EVERY DAY of the safety events entered in our very own hospital. Nurses/Physicians are human, and errors happen. Luckily, most of the time they are harmless and the patient may never even know. Other times we are not so lucky. I am reminded of a time my infant son was accidentally overdosed with an antibiotic. It was flu season, the clinic was packed, and I had my 4 mo old in with a double ear infections. All was well. it was an easy diagnosis and should have been an easy "fix". It wasn't until a few days later when my son had uncontrolled diarrhea, was becoming dehydrated, and began having blood in his stool that I knew something was wrong. I returned a call to the doctors office and it was discovered that he had been dosed based on an 18kilogram baby, not 18lbs baby. We were immediately brought back in to the office for evaluation. The conversation I had with the MD was slightly disheartening. He apologized profusely and then stated they had always been taught NOT to apologize for anything as a MD because it assumes guilt. I just don't agree with this. I believe if you are honest and upfront with your mistakes it will be better received. Everything was fine and in the end nothing ever came of the incident.
ReplyDeleteI agree honesty is important to ensure that you acknowledge what has happened but that you also keep the patient and in your case the parent updated with what is going on.
DeleteI read the article that was written about the movie 50/50. I picked this because I have recently watched it and it really touched home for me. I like what she pointed out that a bad relationship is still a bad one when a person has cancer. I also like that she spoke to the fact that when patients hear that they have cancer they may not hear what else the doctor has to say. In the movie the young man finds out he has cancer and he does not hear what the doctor says after the diagnosis. He just thinks that he is young and healthy and does not understand how this has happened to him. This movie depicts what this young man goes through and you see his strength as well as his emotional ups and downs when dealing with the chemotherapy and life changes. It is a great movie and I like how it follows him through this part of his life. I recommend it for anyone who has not yet seen it.
ReplyDeleteKelly - you are so right!!! That is such a great movie. It really does a great job giving people the perspective of family and friends when someone is dx with cancer.
DeleteI read the blog on Sleep and the Hospital Setting. It really rang true from my experience as a night nurse (prior to CTCA). I don't think I was a good fit as a night shift RN; I felt so guilty waking people and knew I would be just as irritated as they were being disturbed during sleep. I tried to time meds/foley removal/labs all at the same time if possible, but sometimes circumstances dictated otherwise. Lack of sleep can be maddening and can affect your whole body, leading to poor healing. Since my time as a night shift RN, I've seen hospitals with signs reminding people to keep voices low and respect that patients are resting; I'd imagine this also positively impacts the staff as well.
ReplyDeleteI Read the article “One nurse, one patient” this article not only talks about the administration of Rituxan, and the possible serious side effects on the patients, and how quickly a patient can “crash”. But the writer talks about the decisions a nurse has to make throughout an 8 shift, such as; continue to administer a medication that could potentially cause a quick decline on a patient, and therefore having to devote most of her time to the one particular patient that has the highest needs. As a consequence she is forced to having to place her other three patients “on the back burner”. What Teresa Brown experienced when she had anticipated facing a busy day and having to care for four patients that day; but luckily she was training a student nurse and had to make the decision to focus on her one, and most critical patient, and having to “delegate” the care of her other patients to the nursing student. In many situations working on the floor we do not have nursing students, and we are caring for up to 4-5 patients and we know that if it was within our capabilities we would be spending more time with all of our patients equally. But, we all know that sometimes that is impossible and, in many occasions giving the patients’ medical status we have to devote more time to the one or two that need the most nursing care and vigilance during our shift.
ReplyDeleteHortensia Aiello
Hortensia- you have helped me many times on the floor. You are very caring to patients and staff.
DeleteI think when we are surrounded by a team of nurses/PCTs that can help us during times of crisis, it makes these moments so much easier. Often times, we do have a patient or two that requires more of our time than our other 2 or 3 and its so reassuring to me that i have a strong team backing me up and stepping in to support my other patients while I focus my attention where it is needed - Each unit/hospital needs to rely on team work to make the patient comes first, and I think we do a wonderful job with this at CTCA.
DeleteFor this blog post I choose to read Theresa Brown’s article titled, One Nurse, One Patient. This particular article really spoke to me because it is often difficult to spend that one on one time with our patients, which is ironic as this may be what they truly need. As pointed out in the article, it is often crucial for nurses to monitor and closely observe their patients. However, with current workloads, expectations, mounting responsibilities, and higher nurse-to-patient ratios, this is often overseen. As Nurse Theresa pointed out in the article, she was only able to spend the needed time with her patient as she had a nursing student available to check in on the needs of her other patients. I often find myself being spread too thin and not able to take care of my patients as I desire. Do you think Nurse Theresa would have been able to spend as much time with that one patient if she had not had the extra help? I do think that day could have played out much differently. Often I wonder if the administration and the higher up individuals realize how much is placed upon our shoulders and that nurse-to-patient ratios along with patient acuities is often overlooked. Wouldn’t our care be more sensitive and personable if we were staffed appropriately and able to spend more one on one time with our patients?
ReplyDeleteIn my previous roles at other jobs.... I was so naive, such a young nurse. I thought because I work with college kids they were all healthy or worked with young professionals in Chicago they were all "fit". Was I wrong. I really had to learn to take my time with each patient. To assess what they needed from me, this did teach me to become a much better nurse. Sometimes, I do feel that slipping away as we are required to do more with less every day. I do value all of the support I receive from the other nurses that I get help from every day and of course my co-worker - Melissa Luebbe.
ReplyDeleteI think the article that I most related to was the "One patient, One Nurse". Over the four years of being on the floor at CTCA, I have had to call multiple codes or seen patient's crashing rapidly and unexpectedly... The sheer panic of "what do i do next?" is always in your mind regardless of how prepared and knowledgeable you are. I related to this article in particular because I have administered chemotherapies that the patients have had a reaction to, and it truly is a horrible feeling of guilt that lingers in your heart and mind. In your best efforts to abide by the physicians orders and do what is best for this patient's disease, you are also administering a medication that causes unpleasant side effects.
ReplyDeleteI enjoyed reading this article because she made me feel like i was in her mind feeling what she was experiencing, as well as recalling my own experiences. Ultimately, she put the patient first in all her thoughts and actions... Something that all nurses need to be mindful of, even in the midst of a chaotic situation.
I really liked post "When nursing is a Team".As a nurse,i believe that teamwork is a vital in are profession.It helps working as a team because it can help with stress,you can get another perspective,and you can benefit from another nurse's experience.We (nurses) should become more comfortable asking for help and accepting it when we need it.
ReplyDeleteI agree on the need for teamwork. We are so overloaded with work that I think it is the best way to get the job done. I still work as a per diem as a visiting nurse, and I am on my own for all the care, documenting, and other paperwork. It is overwhelming, and I think being grouped with other nurses even in the case of home care to case share is the best way to do it. You can provide safer care, and decrease the chances of burn out. I really like being on a team of several nurses at MRMC for that reason.
DeleteI chose Caring For The Chart Or The Patient. I still work for VNA as a per diem, and in direct patient care it seems to get worse and worse. As nurses we spend a majority of our day strapped to some computer plugging in every detail. Unfortunately, we lose that time with our patient's, and I feel so sorry for that. There is no resolution to this problem, and I find that frustrating. We are a slave to the chart, and that is such a shame to the patient's that we care for.
ReplyDeleteBeena Patel
ReplyDeleteI chose to read the article " Need sleep? Stay out of the hospital". I agree with what Theresa stated in the article about how letting patient's sleep or addressing their insomnia isn't a priority in hospitals. I remember when i was working inpatient,this was a big issue. I am always instructing patient's after their chemotherapy infusions that they should take it easy and rest often. Each morning i came to work the patient's always complained that they never got to sleep and that their night nurse was so late in giving them their medications and not to mention the 5am blood draws and vitals at 11pm and 7am. Patient's has gotten extremely agitated and verbally abused the nurses because they were constantly in their rooms doing vitals or assessments. Its a shame but when we have medications to give at specific times and hospitals policies to follow, we don't always put sleep at the top of it all.
Taking the time to care for oneself physically, mentally and emotionally. Self care for me would be a hot bath, going for a pedicure or massage or just spending time with my family.
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