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A Voice for Nursing

Part 3: “Self-Care: Are you kidding?”

May 19, 2020

Nurses are notoriously bad at self-care. We care for others. That’s our passion, our calling, as well as our job. Our own care tends to come in second (or third or fourth) behind all those we care for.

Nurses work late, regularly skip lunch, and delay bathroom breaks – all to put their patients first. In the time of COVID, as we face dangerous exposure and worry about our families, self-care can seem egocentric. To some, even the term self-care provokes a sense of unconscious selfishness and resulting guilt.

So I was not surprised when I asked a group of front line nurses, what they do for self-care? They laughed in response: “Self-care: Are you kidding? We complain a bit and then get back to work.”

Yet, we are getting tired of this pandemic; we’ve been frightened and may still feel worry daily.  Many of us continue to see extremely high levels of suffering and death – and worst of all - patients dying without loved ones at their side. In parts of the country where the crisis is improving, we are still caring for seriously sick people and may still be short staffed. We feel fatigue on so many levels. 

Nurses are also reporting they get inundated with self-help emails, social media suggestions, employee health reach-outs, webinars, and journal articles. The COVID crisis has spawned a new term: “resource fatigue”!

In the midst of this, how do you approach taking care of yourself?  How can you actually make time for yourself? Here are ideas provided by front line nurses to help simplify your thinking. Take 10 minutes to make a list of what might work for you:

  1. What are the “firsts”? What has to come first when you get home? Can you find joy in any of these responsibilities?
    Nurses tell me that walking the dog or bedtime stories can lead to a new sense of appreciation when viewed next to the enormity of what they have witnessed during their shift.
  2. What do you love and cherish most? What gives you joy? Or strength? How can you get more of this?
    Nurses tell me they have found find new appreciation for simple pleasures- like fresh air and sunshine, a hot bath, or a junk romance novel. Take a look at this video for a new appreciation of usual activity, entitled “How to take a walk.” 
  3. What does your physical body need? Exercise? Better sleep? A haircut? 
    Nurses admit that these are often the needs that go first in order to conserve energy for the demands of patient care. Making concrete plans might help. Make formal calendar dates for a Zoom exercise class with friends, intimate time or a YouTube guided haircut. Meeting basic needs can become special events.
  4. Now the hard part: self-reflection and mindfulness.
    Nurses say they have no time to process in the midst of a crisis. That’s ok. Do what you can to stay healthy through the worst times. Let off steam in small increments if needed. Can’t talk about it? Journal it! The Internet has journal guides of every type (no promotions here: just Google around to find what might work for you). Here are some suggestions from nurse-journal-ers. Look for these online:
    1. A journal with guidance from Michele Obama
    2. Tiny, little pocket notebooks (3 x 5 inches) “I get out thoughts on the bus, so I can be there for my kids when I get home” 
    3. The quirky “Wreck this Journal
    4. A variety of themed ideas were recommended: religious or spiritual journals, humorous journals, artsy journals, and even one-line-a-day journals for those who really don’t want to write much!
  5. Be aware of signs that you need real help. 
    The above suggestions are simple, “starter” ways to think about self-care. However - be aware of when you are heading for burnout or mental distress. Are you experiencing excessive emotions, fatigue, irritability, sleeping/eating issues or signs of depression? If so, it is time to reach out to the mental health resources available to you. Talk to a friend, colleague or supervisor if you are not sure where to start.

These are some simple self-care starters. Please share your ideas with us at ELNEC so we can help each other stay strong!

Remember: A Voice for Nursing is a Voice for Patient Focused Care! 

Dorothy Wholihan, DNP, AGPCNP-BC, ACHPN, FPCN, FAAN
Clinical Associate Professor
Director: Palliative Care Specialty Program
NYU Meyers College of Nursing


Part 1: Lessons Learned from the COVID Surge

April 24, 2020

Nurses at the epicenter of the COVID pandemic continue to struggle daily to save lives in rapid decline, comfort hoards of dying people, while worrying constantly about carrying the virus home to those they love.

Nowhere has been harder hit than New York City, as a gateway entrance to our country and a densely populated city.  Although the curve may now be flattening, patients, families and staff still suffer, as death tolls continue to be high.

What can nurses from other parts of the country learn from those who have worked through surge conditions? We interviewed nurses from all kinds of settings to ask: What would you tell a nurse who has not yet seen the worst COVID has to offer? New York nurses offer advice might help fellow nurses as they work to prepare for surge conditions.

Question # 1:  How can we get our patients ready?
  1. Be proactive! Palliative care specialty teams should have a seat at the planning table, and nursing voices must be heard, or we will be swept along without a voice, and patient care will suffer. 

  2. As hospitals prepare, stockpiling PPE and ventilators, prepare your patients too! Speak to primary care providers, senior centers, residential facilities and churches. Strategize to contact all patients who are at high risk for complications: elders, those with multi-morbidities, residents in nursing facilities, & those with serious illness. Remind your patients of that palliative care motto: “Hope for the best and plan for the worst”.

Here’s how patients and families can be prepared:

  • Identify & assign a health proxy, and talk now about what matters to you should a worst-case scenario occur. Patients, who deteriorate, do so very quickly! When things go downhill, it may be too late for considered thinking. 
    Here is a guide that can help with health planning.

  • Prepare a just-in-case “Go” hospital bag. Include anything you might need for a hospital stay (families often cannot visit at all):  Consider packing ahead or making a pack list for last minute items. Label everything with your name.
    • Cell phones or tablets & chargers
    • Personal medications (a list and the actual medications since there may be drug shortages, especially for inhalers) 
    • Glasses and hearing aides!
    • A copy of your proxy and advance directive 
    • Phone list of important family contacts (and identify one main person who can be the main contact for everyone)
    • A few (just a few!) comfort items that may be important (religious item, family picture, etc)

  • Some patients may deteriorate before they even get settled in a hospital unit. Consider a personal checklist: “Things to know to take good care of me.” Consider including the following information:
    • Is religion important? 
    • How do you like to be called?  
    • Who is the most important person to call?
    • Any other personal or medical information of importance?

Here is a video that can help you think about a Go Bag.

Remember: A Voice for Nursing is a Voice for Patient Focused Care! 

Dorothy Wholihan, DNP, AGPCNP-BC, ACHPN, FPCN, FAAN
Clinical Associate Professor
Director: Palliative Care Specialty Program
NYU Meyers College of Nursing

Part 2: Ready at the Bedside

May 6, 2020

Being a nurse in the midst of COVID entails physical stamina – but also an amazing degree of flexibility and creativity. Nurses have been struggling with the “not good enough” syndrome, where they are challenged by providing a level of care - which while appropriate and effective in times of true crisis -  nonetheless falls below the high level of care they want to provide for patients. That is: to plan care thoughtfully and deliberately, to take extra time to bear witness and comfort patients, and to connect deeply with families. Optimal care is not always possible in a pandemic!

This situation calls for hardiness and spirit – and a degree of creativity - to provide the best care under extreme conditions.  An oft-heard quote: “Out of chaos, comes opportunity” can be amended to “Out of chaos, comes innovation.” 

We urge you to write, post, and share through our ELNEC media – or even just to a group of colleagues during a break – some of the innovations that nurses are spearheading. By sharing these creative best practices, nurses across the country can better prepare to adapt to the chaos of COVID bedside nursing. Here are some ideas nurses are sharing:

1. Raise your voice and be heard!  At times, as the care provider spending the most time within COVID rooms, nurses frequently report they have been left out of the loop: missing rounds, not adding to medical/care plans, at times feeling they are swept along without contributing. To improve team communication, nurse Jhoanne Hilario, from NYC, developed her own “ICU RN-Provider Checklist”. She uses this list to check in with the medical staff daily, while introducing herself to unfamiliar, sometimes less experienced volunteers and those rotating from other services. Most importantly, the checklist ends with a discussion of goals of care. Take a look and edit to make one of your own! 

2. Creativity for logistics at the bedside. Nurses are frequently at the heart of innovation. Examples include: Placing IV pumps and vent controls outside rooms, taping off the floor for safe PPE donning & doffing areas, and using dry erase reminders on ICU room windows. Click here for a chart of logistic innovations developed by nurses that prove  - “When there is a nurse around, there’s a work-around” (Newby, et al 2020) 

3. Patient-Centered Care.  Nurses consistently cite patient isolation as one of the more distressing aspects of COVID, as patients die without family and surrounded by caregivers in impersonal masks. For those not actively dying, emotional distress, depression and delirium can develop. Nurses brainstorm and innovate, for example using Face time on cellphones and placing IPADS on IV poles to provide face-to-face connections. And watch this humorous CNN video about making connections while masked. 

Remember: A Voice for Nursing is a Voice for Patient Focused Care! 

Dorothy Wholihan, DNP, AGPCNP-BC, ACHPN, FPCN, FAAN
Clinical Associate Professor
Director: Palliative Care Specialty Program
NYU Meyers College of Nursing

References:

Moos, J. (April 10, 2020). Medical workers combine heart and art for their patients [Video]. Retrieved from https://www.cnn.com/videos/us/2020/04/15/medical-employees-wear-photographs-over-gear-moos-pkg-ebof-vpx.cnn/video/playlists/wacky-world-of-jeanne-moos/

Newby, J. C., Mabry, M. C., Carlisle, B. A., Olson, D. M., & Lane, B. E. (2020). Reflections on Nursing Ingenuity During the COVID-19 Pandemic. The Journal of neuroscience nursing, Published online 2020 Mar 27. doi: 10.1097/JNN.0000000000000525