From Can't to Can

I sat down with a group of nursing students to debrief a long couple of days working on the floor. I wanted to take a step back and look at nursing care from a new perspective. Today's meeting was not to necessarily given information, but allow them to reflect on their practice. 

So you've got the whole "care for your patients physical needs down", so how do you care for them emotionally, mentally, and spiritually?  I asked

One girl looked up briskly with a fire in her eyes and stated, "It's impossible. I just can't!" She was visibly upset by the question, and initially my thoughts went to rephrasing the question since it must have been misunderstood. Of course everyone can care for the whole person, I thought. Then she began to explain how difficult it was to care for patients who didn't want to be helped and how she felt unqualified to give advice or to know what to say to these people. It broke her heart that in a profession she was so passionate about, she was not feeling successful in truly helping her patients. 

How often as healthcare providers do we feel this way? How often are patients brought through the doors only to refuse the help we offer or accuse us of neglecting their needs when the plan of care isn't exactly as they dictate it? 

As a student she was frustrated by the lack of response and enthusiasm she received from her patients when she put her whole soul into educating and empowering them to own their health. 

I validated her feelings and affirmed her frustration. The reality is that you cannot help people who don't want to be helped. So then, let's look at what we can do. We can genuinely care. We can find a way to relate to these people, hear where they've come from, what they love, and what motivates them to live each day. Maybe it's seeing a picture of their pet at home or asking about family or hobbies. We can find one way to genuinely connect to these people and relate to them. 

Patients want to  be treated not as patients, but as people. We have to learn to bridge that to be one in the same. 

If you walk in to a room to educate a patient at discharge after connecting with, listening to, and relating to this person for two days, the chances of them hearing what you're saying is far greater than the patient you haven't taken the time to understand. People listen to those whom they feel genuinely care.

   I listed to a CHF patient talk about his love of cooking and later incorporated that into educational teaching about diet modification. The patient was able to look at how he could be creative with recipes as opposed to feeling like his passion and love of cooking was being taken away from him. 

When it feels like "I can't", it's time to take a step back, take a breath, and simply focus on what "I can". You won't always get through, but if you stop and take the short time to have to sit, actively engage, and listen to a person, you know you gave all that you could. Sometimes, that is all you can do.

What Lights You on Fire?

I was sitting in a conference today struggling to keep my focus as the "food coma" started to set in after lunch. I was losing track of nursing history when the conversation took a turn as the question was posed:

How do you define nursing?

It took me a minute. The speaker continued to talk about the art of nursing and the beautiful profession that it is.

How many of us recognize the value in nursing, in what we do every day?

What a powerful question. To me nursing is the ability to meet people where they are each and every day and provide care for not just the physical, but also the emotional, and spiritual aspects of the person. "Cura Personalis" as the Jesuits would say...

This conversation lit a fire in my heart. I absolutely love what I do and feel blessed to be able to say that. I enjoy going to work each day, love the people I work with, and feel privileged to have the knowledge base to practice in the world of healthcare, but it's really easy to lose sight of the purpose that connects me back to this.

How often do you roll out of bed to the mundane tasks of the day? Maybe behind a desk, a paper that needs to be written, a presentation given, proposal created, work published, food served, meeting attended, one more patient to see...

How many of us chug a few cups of coffee each morning to "get through" what we have to do to pay the bills and just survive until Friday (or if you're a nurse, your next string of days off)?

What lights a fire under your butt? Seriously?! What gets you excited to get out of bed? What makes your heart happy? What makes you smile? What do you live for?

Use this each and every day to reconnect to your purpose. Each one of us has special gifts that are utilized in different ways. How can you use your gifts each day to motivate you through the hard times and focus your energy on positive, life-giving things?

I pray each morning that God uses my hands and feet to do His work. This reminds me why I do what I do.

Write yourself a sticky note on your mirror, put it on your coffee cup, or set a reminder in your phone to remind you that you are amazing, wonderful, and can make a difference in a small way each day by showing up and being present. Every day you have something to offer. Don't let a day pass you by without giving it your all in whatever it may be that you do. Make each day, moment, and interaction purposeful and see how it changes the way you see the day. Reconnect to why you do what you do.

Make your ordinary extraordinary.

Let it Go

It was a busy day in the ER and I glanced at my computer before entering the new patient's room to see what was coming my way. Doc had already ordered labs which meant sticking the kiddo and starting an IV. This task, while a basic nursing skill, was always emotional with kids. Deciding I would be prepared, I grabbed the numbing shot from the fridge to help make the experience a little less traumatic for the patient. 

I entered the room where patient and family were watching cartoons and the kiddo seemed calm enough. Her eyes met mine and looked my scrubs up and down until they came to rest on the medication in my hand. Her eyes widened and she began to hyperventilate and her volume escalated: "Oh my gosh what is that? You're going to poke me oh mY GOSH YOU'RE GOING TO POKE ME!!" The tears began as she tried to get off the bed and to mom. 

"Hold on there, hun, this is not a needle". I revealed to her the object in my hand as I sat on the stool beside her. "And we haven't even met yet!" I exclaimed with a smile, trying to earn her trust. She lowered her voice and came back to the center of the bed. "Tell me why you're here". 

The young girl voiced her complaint of belly pain and I chatted her up as I assessed her condition. I looked her square in the eyes and began to explain why we needed to draw blood and start an IV. Her eyes widened again and she demonstrated extreme anxiety for a kid her age with writhing, hyperventilation, and escalation of worries not typical for her age. She was a "drama queen" as her mother put it, laughing.

"Deeeeeep breath," I encouraged her. I worked with her on breathing as I explained the process. She voiced that the needle was what scared her most but then insisted on seeing it and wanted to watch; both of which started the panic cycle all over again. At each step she freaked out a little more. I looked to mom and we began to brainstorm distraction techniques. Mom's eyes lit up as she exclaimed: "I know! While the nurse pokes you, we'll sing Let it Go!" Brilliant! She, as any other mother in this day with a daughter between the ages of 5 and 11 knew the ultimate calming mechanism. She got the patient to agree. I applied the numbing medication which gave a loud whoosh  noise as it was administered. After a few breaths from the tears from that, we began to sing. Mom, patient, tech, and myself included were in full blown song of Disney's famous Let it Go. Sure enough, the patient calmed and blood was successfully drawn. 

While comical at the time, I walked out of the room reflecting on anxiety as a whole. Patients come to the ER in times of trial and they, along with family are wrought with anxiety of different levels. "Letting it go" is a lot easier said than done.

How often do we carry the anxieties of our lives with us?

When the anxieties of life surround and overwhelm me I take a deep breath and step back. How much control do I have in this moment? For what I can't control I pray that God takes away the anxiety to allow me to focus on what I can change. Worrying doesn't make it better, just more stressful. So when work is crazy and I'm frustrated, anxious, and tired, a little bird comes to the back of my head and begins to sing to let it go....

and I stop, pray, let go, and let God.

I'm Here to Care

When you work in the Emergency Department you see all walks of life. All classes, races, and ages. You see the broken and those who seem to have it all together. You see the athlete, the child, the working man/woman, the provider, the caregiver, the lonely, the abused, the addicted....

It can be easy to become jaded and write people off when you see the same patient for the same reason for the 3rd time that month because they chose not to care for themselves or couldn't care for themselves at home. Or when the demanding patient barks orders at you without the slightest thought of "please" or "thank you". Or the drunk patient who you've advocated for all night only to have them take a swing at you and spit at you.

Those are the hard days. Those are the days that many go home and wonder "why do I go back?" "why do I put up with that treatment?" But to let these experiences overwhelm  your day is to ruin your spirit, your passion, and your heart as to why you did this in the first place. We do it because we love. We want to give back, we want to help people. You have to count the wins in a day, even if it was just one. When you see the glass half full, the day is better and you are able to let go of the encounters that start to beat you down. 

There was  patient who nearly brought me to tears. He was psychotic and extremely emotional. I gave him every ounce of patience, time, and attention to help calm him down and ease his paranoia. I felt I gave him great care, and he about broke my spirit because nothing was going to satisfy him. I was exhausted and feared coming back to care for him again. Yet that voice in the back of my head said he deserves the same care as everyone else. He is not in his right mind. Meet him where he is. Take a deep breath, smile, and know that you can only help those who want help. 

Last week I oversaw a student starting an IV for the first time. She palpated for a vein and made small talk with the patient. Feeling over one in the crook of the elbow she looked to me for confirmation on her vein of choice. It was a bit scarred. The patient nodded, "It's a good one if you go right above the scar. I used to be an IV drug user".

His honesty was much appreciated. Often you approach a stick a little differently knowing the veins of IV drug users are either few and far between and/or much harder and require more force to hit.

"Thanks for the heads up!" I told him. I explained to the student how this was helpful information in starting his IV. We continued as we had before and the significant other looked up at us with relief. 

"You know, she said. You guys are so great. The last hospital we went to, the second he said that the nurse totally gave him the cold shoulder and was stand-offish the rest of the time".

This took me back. Wow. I turned to her and said gently "We're not here to judge. We appreciate the honesty and just want to see him get better".

It was a beautiful moment that reinforced to me the importance of just caring. We are called to "love our neighbor as ourselves" and "treat others as we would want to be treated". I go to work to serve others and to care, to be the hands and feet of Christ in my work. There will be days that are hard, days that make me cry, and days where I wonder why I am in the profession I am, but I go back to moments like this and remember that I won't always be able to fix it all, but I can give nonjudgmental care and respect to each person that walks through that door. Sometimes that's all you can do, and sometimes that's all they need.

Raise 'Em Up...to God

Running around the lake on a beautiful, sunny Denver day while listening to my ipod I couldn't hellp but observe all the people I passed. Such a variety...There was the young man lying in his hammock taking a nap, the fishermen, the couple holding hands out for a walk, the young girl running, the dog walkers, the group of women chatting while simultaneously pushing their strollers with sleeping babies...so many smiles, so many different walks of life, and all out enjoying the beautiful day God provided. 

Keith Urban's song "Raise 'Em Up" came next on my playlist and I smiled. It's just one of those feel-good, down to earth songs. 

Raise 'em up, I'm talking 'bout lighter on Saturday night

the band plays a song you like and you sing along...

The song celebrates the good times, the sad times, and all those times you celebrate in life. How often do we take those life experiences for granted? Even soaking in the sun and out on my run that day, the song made me stop and thank God for all he gives. 

All the time we toast and celebrate success, job promotions, graduations, sports success, academics, etc., but how often do we toast to life? How often do we lift our hands up to God to toast to Him and all He gives us every day. 

Everyone likes a celebration. Why not find a reason to celebrate today?

Raise em' up
Trophy high
Raise em' up
To the sky
Raise em' up
Show everybody that new born smile
Raise em' up
Tall and strong
Raise em' up
Right from wrong
Raise em' up so dang high they can hear God singing along...

God at Work

Did you know at 13 weeks a fetus has a head, eyelids, fingers, toes, fingernails and fingerprints? It has a beating, developing heart, a bladder that begins to function, and arms and legs. It has a torso, ears, and is a very small child, typically about 6.7cm long. You read these things online and in the text books, but it is hard to conceptualize the thought of a human being this small at this stage...

When the young woman came in at 13 weeks pregnant with a large amount of vaginal bleeding we anticipated a miscarriage. She and her husband requested not to go to the OR until products of conceptions were seen. "Products of Conception" is the medical term that refers to pieces of the placenta or fetus that are retained during a miscarriage. Our concern was the amount of blood being lost. A miscarriage has the potential to turn into a life-threatening situation if the mother becomes hemodynamically unstable. Since she was stable, we agreed to watch her longer.

I made sure the sweet young woman was comfortable and went about checking in on my other patients. My heart ached for this young patient. I have not yet had children, nor do I see it in my near future, but I could not imagine what it would be like to carry a child inside you and then lose it to natural causes. There was such love between the patient and her husband. There was sadness in their eyes, but words and actions of care, commitment, and unconditional love. Through good and bad. 

I noticed a priest in his white collar and black shirt and pants enter the room and exit with the husband. I reentered the room to check on the patient and assess the blood loss. I asked about the priest who they explained was a friend of theirs from their Catholic church. How special that in the wee hours of the morning their priest was willing to rush down to be with them for a few minutes and offer prayer and support during this difficult time. 

Discussing their priest and parish I connected with them identifying myself as Catholic. Not working my normal shift that evening and issues of life being so central in the faith, I felt like God had been at work in placing me with this family on this night. I understood why she did not want to go to the OR yet, wanting to ensure the baby had every chance, respecting the life of that 13 week old inside her. 

Out at the nursing station I sorted through all the paperwork for a miscarriage.  Options for burial, the need to send the fetus and placenta to the lab to ensure nothing was retained, and the large, clear bucket that was sent from lab to obtain any products of conceptions. The bucket made me uncomfortable. It felt so strange to think about placing pieces to send to the lab. I understood the importance of making sure no products were retained (which could cause severe hemorrhage and endanger the mother), but it just felt so inhumane. I put the bucket to the side deciding I would cross that bridge if anything was delivered before she went upstairs. The papers broke my heart. I had never dealt with a miscarriage before and was unsure how to approach the paperwork with this couple. It was all still so fresh and in progress...

I cycled her pressure which was still stable but continuing to drop. I decided to implement standing orders for fluid, even though she was about to be taken to the floor for an overnight stay and trip to the OR. I explained this to her and grabbed the fluids. Back in the room and hanging the bag the patient had a large contraction where she exclaimed "something came out". I looked down from where I was to see the 13 week old fetus attached to the umbilical cord, stillborn. 

My heart felt like it froze for a moment and I took a breath to be the best support I could for the mother and father. I was in shock. I had seen healthy, full-term babies delivered in nursing school, but never a stillborn and never this young. I hadn't expected to see a human-looking child. I thought "products of conception" would be pieces of tissue, undefined. But there was a beautiful, tiny baby. Not old enough to distinguish gender it fit in half of my hand with tiny fingers and toes, this beautiful creation of God.

"You just delivered the baby", I said softy. Would you like to hold it? She nodded, tears slowly leaking down her face, knowing the baby was not alive. The father immediately came to the side of the bed, placed his thumb on the baby's forehead and making the sign of the cross prayed, "I anoint you in the name of the Father, and of the Son, and of the Holy Spirit". I held back my tears at this beautiful display of faith as I left just long enough to grab the OB kit and the provider. 

After the clamping and cutting of the cord I handed the baby to mom. She looked lovingly on her child that was no longer here, but with God. I sat down by her bedside and assured her she could have all the time she needed. Knowing her faith was important and so crucial at this time I then asked if I could pray with her. Her eyes widened as she took my hand and said, "yes, please". I prayed out loud with the two of them as she squeezed my hand and held her baby in the other. I ended with the "Our Father" as the two of them joined in with voices strong and full of conviction". I left them to mourn together while I stepped outside with a coworker to cry  in private, my heart breaking for them and overwhelmed by the experience.

It was so sad, but so powerful. God was so present in the room that night, and it was so beautiful to see these people draw strength and comfort from Him in their time of need. As their sister in Christ it was an honor to care for them this night, and to be able to recognize her physical, emotional, and spiritual needs. I would not normally ask to pray with a patient, but knowing her religious background and seeing the husband rush to anoint the child upon birth, there was a tug at my heart to join with them and together bring God to the front. We are called to bring Christ to each other. 

2 Corinthians 1:3-4: “Blessed be the God and Father of our Lord Jesus Christ, the Father of mercies and God of all comfort, who comforts us in all our tribulation, that we may be able to comfort those who are in any trouble, with the comfort with which we ourselves are comforted by God.”

Give Life

I have the pleasure of being able to teach nursing students throughout the year, during which I don't think the students realize how much they teach me throughout the course of 5 weeks. One day during this rotation the students experienced the unexpected death of a patient. They stood against the wall of the room watching the nurses, eyes wide, and some filled with tears. We left the room to debrief where I learned that that was the first experience of death for many of them. 

In this moment there are lots of feelings. Why did this happen? Why him? What did we do wrong? People in the ICU with 10 different lines and tubes are often expected to pass, but not the person who was sitting there talking to you 10 minutes before. Justified, confused feelings and sadness. 

As nurses  a lot of times we struggle with the one thing in the day that didn't go right. The one patient you advocated for so hard who gets up and leaves AMA, the one who you sat and educated who at the end tells you they don't care and aren't going to change their lifestyle or help themselves, or the patient who takes out all their frustration by verbally shooting down your confidence to the point where all you can do is walk away so they don't see you break down and cry. 

This is why we work 3 days a week. Long shifts, but shifts that involve giving our heart and soul into the treatment of each patient who walks in the door. 

I told the students,  these days happen. These days happen and we learn from them in so many ways. How do you react to this situation? What feelings does it trigger? Reflect on these things, feel them, and develop a strategy to move forward when you see this again. How do you center yourself after you've been rattled? 

You have to remember the wins of each day and let go of the situations that bring you down. Remember the one patient who said thank you, the one patient that made you smile, the one patient who was so grateful that you took the time to sit and listen. Those are the wins of each day. 

Each and every day you walk into a patient room, give life. Bring something into that room that brightens that persons day. A happy heart, a smile, intentional interaction even if you're only there for five minutes. Whether they take it or not, at the end of the day you can leave knowing that you have given your all. You are proud of your care, proud of who you are as a nurse, and did your best to bring light, joy, and healing. 

We like to think  we have control in this profession. We don't, but we do have control over how we respond to situations and the attitude we carry every day. 

So whatever you do, whatever profession you practice, practice giving life with each interaction. You'd be surprised at the difference you will make.