Tuesday, February 25, 2020
Sunday, February 23, 2020
Keeping Your Patient Informed
Keeping Your Patient Informed
The rapid pace of healthcare can often have 15-20 people in a patients room in the span of a few hours. They are anxious, vulnerable, perhaps alone, confused or medicated. They aren’t sure what is said, who is saying it or what it all means. It can lead to poor patient experiences and possibly poor outcomes.
Many institutions have taken to using communication boards or white boards to put pertinent data on for the patient and family. When filled out they are marvelous, when outdated or blank they are not only worthless but may further lead to confusion. And in addition surveys elicited that compliance with use and engagement of the team members made keeping them up to date and accurate the greatest challenge.
Depending on the practice at your facility, being committed to the process can make the difference between a safe, positive experience and and high risk, disappointing one. Safety is a focus of CMS, tJC and NDNQI to name a few. Reducing falls, hospital acquired injuries or illness and errors can be reduced or eliminated when patients, family and care providers are all on the same page.
A few key pieces of information shared at the beginning of shift and refreshed throughout the day include:
1. Introductions - Who will the nurse, nursing assistant, provider or other team members be providing care. Check the arm band.
2. Daily Plan - Review what will be going on for the morning; tests, therapies, treatments, bathing, etc
3. Meals and Meds - When will meals be delivered? What meds will they be taking, why and what will they experience. Check the arm band.
4. What are they waiting for - Case management to plan discharge, surgery, doctor or follow up care
5. What is your plan - when will you be back in the room, what will you be doing with them or for them during the shift
6. What is the discharge plan - every day it helps to remind them what has been completed and what still needs to happen for them to go home
7. Make sure they are prepared for the day - Emergency light in hand, bed in low position, alarm on for those at risk, bedside table at hand and free of as much ‘junk’ as possible.
Taking time to make sure they are informed will reduce anxiety, improve engagement and reduce risk of injury. The patient and family will also be more comfortable with the care they see. Communication received from the nurse and provider will greatly improve patient satisfaction.
Jlg5.9.18(c)
Communicating Together
Communicating Together
Todays favorite communication is anything but face to face. Most people are using some form of digital technology; texting, social media, selfies, email. Few enjoy the art of writing letters, still a favorite of those from days gone by. Telephone calls are even less often selected in favor of call screening. Leave a voicemail, get one back. Or virtual calls which permit muting, blocking cameras, multitasking. You get the feeling people don’t really want to talk to each other. They don’t want all the drama, transparency, time needed to invest.
This can play a serious role in the ability to have meaningful conversations which are critical to the work place. While many nurses are cheery and able to have conversations, some nurses really struggle. They don't know how to deal with emotions in conversations and any confrontation is typically drama filled due to the lack of experience having hard conversations.
What used to be a daily occurrence is now almost a lost art. The good news is that the skill can be learned and mastered, allowing for joyful and serious communications to occur without a major event. There are a few key points to mastering the art of conversation and confrontation.
1. Know yourself - There are some great tools to discern your personality type. They are great assessments that help you identify your personality, favorite style of interaction.
2. Know your team - These same principles apply to the team you work with. It helps to understand how each person scores so that you can understand more about what makes each person tick.
3. Acknowledge your emotions - It is normal in a day, whether at home or work, that you will have an assortment of emotions (anger, joy, playfulness, sadness, etc). It is OK to have any of these, or all of these. If something or someone has made you angry, own it.
4. Start all complaints with the person involved, not everyone else - gossip does not solve anything . It is gossip when you talk about the issue with the rest of your work mates. This causes division and emotions to build that can fracture the workplace and make it a drag to be there.
5. Have your conversations in private - make them factual, not emotional. Use ‘I’ statements not ‘You’. And stay committed to get resolve. That may mean taking the high road, apologizing. Nurses are the most trusted profession so we need to start with each other. Honest, direct conversations.
If you are not comfortable speaking, talking in serious conversations or need to master skills for crucial conversations you may want to check these out:
b. Top 5 Leadership Personality Tests http://www.doseofleadership.com/top-5-leadership-personality-tests/ (your facility or organization probably has one of these tools)
c. Crucial Conversations and Crucial Confrontations - two great books that will tell you a lot about you and those you want to relate better with
While it may take some practice to master the art of communication, start by being sincere and don’t stop until you get it right. Lay your device down, sit relaxed, make eye contact, listen well and hear what they are saying. You will learn much, grow more and become the best team member ever!
Jlg5.9.18(c)
It's Ok To Say 'I Don't Know’ - Nurse Grid
It's Ok To Say 'I Don't Know’
Nurses are the most trusted profession on the planet according to Forbes (Niall McCarthy Jan. 4, 2018). In the article ‘America’s Most and Least Trusted Professions’ nurses are still number one! It actually recognizes them as the most honest and of high ethical standards. This is a testament to the trust patients put in nurses when they check into the hospital or care facility. They are vulnerable and do not have the expertise (in most cases) to know what is wrong, or understand much of what is said. They look the nurse straight in the eye and count on the sound, ethical and honest response they will get.
It stands to reason that not all nurses are reliable, but they are fairly evident in the course of the day. Those are the staff that never answer the call lights, aren’t available to help and refuse to ask questions. You know this group. Fortunately this group is very small. It is important to hold them accountable, have direct conversation with them and if needed take those to the manager.
The challenge that may present for many nurses is the ability to acknowledge they need help or information before they can complete a task or provide care. When a nurse walks into the room to talk to a patient they are expected to give an honest, accurate answer. Patients count on that in order to feel safe, know they have the right information and feel confident with any decisions they need to make. Some nurses will try to answer based on assumptions or what they think they know. Some will just stare! But a trustworthy nurse will admit they may not have the answer but assure the patient they will go get it. They won’t lie, bluff or make it up as they go.
Jennifer was in a hurry to discharge an ER patient. Goals to meet, wanted a break, basically time for them to go. She had a new employee with her and the two of them opened the ER curtain and without introductions announced that Cody needed to eat crackers to assure they will stay down then he could go home. ‘Are those crackers?’ his mom asked. ‘Yes!’ ‘He has Celiac disease’, his mom replied. Staring straight back at mom, ‘Yeah!’ Mom knew already the nurse did not know where this conversation was going. ‘He can’t have gluten.’ ‘Yeah,’ still with the crackers stuck out to hand the boy. ‘Crackers are made with gluten.’ ‘Yeah!’ The mom sighed and provided the education ‘Gluten is a protein found in wheat, rye, barley. Those crackers are made with wheat. If he eats wheat he will become very sick and we will be going no where.’ Still staring, almost as in a contest, she finally said ‘You need to find something he can eat then so he can go home.’
Do you see what opportunities were here? She had a number of opportunities to gain trust, build relationship and provide confidence that she was of high integrity having the patient as her first priority. Introductions are always critical, it shows the intention of having a relationship even if it is brief. Admitting you didn’t read the record, don’t know what Celiac disease is or don’t know what gluten is are all ok! As a nurse you don’t want to make a mistake, give a wrong medication or not do the correct assessment before completing a procedure. You can’t know everything and won’t as there are new discoveries everyday. Jennifer was not practicing that number one rated nursing practice. I am not saying she didn’t care, but perhaps didn’t want to admit she didn’t know.
Always introduce yourself, it’s what kind people do. Never be afraid to say ‘I don’t know!’ It shows that you have the best interest in mind for your patient. Ask someone else for help if you can’t find the information you need or help in doing a procedure for the first time. You will have a great career knowing that in every situation you did what you could to build trust and provide the best care possible. ‘Hi I’m Susan. The doctor would like to see if Cody can eat something and keep it down. I see he has Celiac disease and has gluten listed as an allergy. Can he eat crackers?……..What can he eat? We have applesauce, jello and pudding. We might have popsicles. Would any of those work?’ There is one happy mom, looking at the nurse who took an extra minute to know her son and make sure he would go home safe and sound.
Jlg5.18.18(c)
What Have You Done?
What Have You Done?
by Judy Gates - Friday, 28 September 2018, 11:25 PM
For the third time today she called me to come back to her apartment. She had 'unprogrammed' the television remote again and was angry, threatening to leave her assisted living facility. I came in, slammed the door and went straight to the tv. Frustrated, I picked up the oversized remote, punched the keys and laid it down by her chair. I turned around and plopped down on the sofa. The soft, plush fabric under my fingers was almost calming. I rubbed it while I tried to not sound as frustrated as I felt when I talked to her.
She cut me off before sound came out of my mouth and proceeded to tell me how she was angry I tricked her into moving, took away her car and now she was going to walk out the door. She was not making eye contact but staring at the door and grinding the bridgework in her mouth.
I looked around the room. It was a beautiful apartment for which I had bought almost all new furniture. I was envious in some ways. I looked at the picture of my dad and silently wondered what he would tell me to do. I could smell the popcorn from the game room down the hall which permeated the building every afternoon. It was making me hungry. I was thinking I could grab some on the way out.
We sat quietly for a bit and I finally decided I would go. She started at the beginning again, yelling about her life situation. 'What have you done to me?' She did not understand why she couldn't live alone, why I was locking her up. She stood up as if she was going to walk out the door behind me, lost her balance and nearly tripped over her shoes which she had taken off after the last time I had come back. She sat back down, wringing her hands, lips tight. She never took her eyes off the door.
It was clear there would be no way to resolve this mood. I walked over to her tv, turned on the weather channel so she could hear the music, kissed her on the cheek and left. Guilt and failure followed me home. I was crying at the overwhelming hostility and anger from her. I called to check on her about an hour after I got home. She was playing BINGO
JLG 9.28.18
Prejudice: Is it you?
Prejudice: Is it you?
Judy L Gates, MSN, BC, CWS, FACCWS
Daily we are confronted with situations or people that can be difficult to manage due to prejudice. It includes a bias or judgement related to lifestyle, economy, ability, looks, race, speech, beliefs, and the list goes on. I am speaking of our prejudice, nurses and healthcare workers, not theirs. We roll our eyes out loud, clear our throats often, sigh deeply, tap fingers or pens. Perhaps find many reasons not to enter the room, always have a call to take, you know the drill. So much of our communication is ongoing even when our lips are closed. Patients aren’t dumb, they have used the same strategies perhaps themselves. The one thing they know for sure is, you don’t want to care for them.
Now it does not imply you are a bad person or don’t care, though it could appear that way. But it does mean patients or their families are neglected. They are in the hospital, away from their routine, friends, comfort. They are completely vulnerable. They can’t get medicine when they hurt, get up to a chair so they can eat. That takes you! They may need help to take a walk or go to the restroom, from you. Can you imagine if it was you that needed this help? Your parent or child?
Let’s consider this scenario....
A 24 year old man, was admitted for pneumonia. He was not cooperative with breathing treatments, throwing the mask at the therapist. He yelled for the nurse constantly. He was thirsty, hungry, wanted help with the tv. He complained of headaches. His dad would stay with him most of the time. If no one came in he would go looking for a nurse to help his son.
No one wanted this patient, too needy, yelling and he would hang on to your hand forever if you went in.
It’s your first day back and so you are getting this patient. Everyone smirks and winks at each other. You’re not dumb either! So you straighten up, take a deep breath and walk in. After your assessment you come out and there is no yelling, no nurse button, no dad chasing you down. The entire day is peaceful. Everyone wants to know your secret.
What do you think?
The answer was simple, ‘I talked to him and held his hand’. Mic drop!
You see, she walked in and left all the stories and ‘trash talk’ at the door. She cleared the white board, if you will, and met him with a smile. Dad noted that she was the first nurse to walk in with a smile and actually talk TO his son or hold his hand. Full on eye contact! After helping him find his favorite show, getting food ready and listening to his joke she waved goodbye and went to her next patient.
So the rest of the story, David (the 24 year old) had Down syndrome. He couldn’t speak very well but liked to! He told jokes that didn’t make sense, but he still found them very funny. He loved Barney and Sponge Bob. He loved pizza and chips and diet pop. When he was afraid and didn’t understand things he would become angry, cry and throw things. His dad had watched nurses and healthcare providers avoid, dismiss or talk around his son. For many they weren’t comfortable as they had never been around someone with disabilities. For others they would get frustrated being hovered over by the dad.
Could this be you? Have you seen it, or done it? What can you do to help your patient or you have a better experience? Here are a few suggestions:
Avoid the subjective stuff from others
Walk in with a clean slate for the shift
Smile, and don’t be afraid to hold hands
Laugh even when it is not funny
Include the patient in every conversation
Treat each patient the same as your favorite person
Change, by example, the culture one nurse and one patient at a time
As the parent of an adult with special needs and a 44 year healthcare career in my pocket I can tell you I have seen it. I fear it will happen to my son! I want to know that when he is afraid, sick, can’t be understood, can’t find his show that someone (any one of you) will take that extra 5 to help him. Make time, in the midst of the rapid pace, to take 5 for any patient or family that needs reassurance, compassion, a hand held. The reward is great for you and priceless for that individual! You can make a difference, one encounter at a time!!
‘To the world you are only one person, but to one person you may be the world!’ Bill Wilson
JLG 5.31.18
Judy L Gates, MSN, BC, CWS, FACCWS
Daily we are confronted with situations or people that can be difficult to manage due to prejudice. It includes a bias or judgement related to lifestyle, economy, ability, looks, race, speech, beliefs, and the list goes on. I am speaking of our prejudice, nurses and healthcare workers, not theirs. We roll our eyes out loud, clear our throats often, sigh deeply, tap fingers or pens. Perhaps find many reasons not to enter the room, always have a call to take, you know the drill. So much of our communication is ongoing even when our lips are closed. Patients aren’t dumb, they have used the same strategies perhaps themselves. The one thing they know for sure is, you don’t want to care for them.
Now it does not imply you are a bad person or don’t care, though it could appear that way. But it does mean patients or their families are neglected. They are in the hospital, away from their routine, friends, comfort. They are completely vulnerable. They can’t get medicine when they hurt, get up to a chair so they can eat. That takes you! They may need help to take a walk or go to the restroom, from you. Can you imagine if it was you that needed this help? Your parent or child?
Let’s consider this scenario....
A 24 year old man, was admitted for pneumonia. He was not cooperative with breathing treatments, throwing the mask at the therapist. He yelled for the nurse constantly. He was thirsty, hungry, wanted help with the tv. He complained of headaches. His dad would stay with him most of the time. If no one came in he would go looking for a nurse to help his son.
No one wanted this patient, too needy, yelling and he would hang on to your hand forever if you went in.
It’s your first day back and so you are getting this patient. Everyone smirks and winks at each other. You’re not dumb either! So you straighten up, take a deep breath and walk in. After your assessment you come out and there is no yelling, no nurse button, no dad chasing you down. The entire day is peaceful. Everyone wants to know your secret.
What do you think?
The answer was simple, ‘I talked to him and held his hand’. Mic drop!
You see, she walked in and left all the stories and ‘trash talk’ at the door. She cleared the white board, if you will, and met him with a smile. Dad noted that she was the first nurse to walk in with a smile and actually talk TO his son or hold his hand. Full on eye contact! After helping him find his favorite show, getting food ready and listening to his joke she waved goodbye and went to her next patient.
So the rest of the story, David (the 24 year old) had Down syndrome. He couldn’t speak very well but liked to! He told jokes that didn’t make sense, but he still found them very funny. He loved Barney and Sponge Bob. He loved pizza and chips and diet pop. When he was afraid and didn’t understand things he would become angry, cry and throw things. His dad had watched nurses and healthcare providers avoid, dismiss or talk around his son. For many they weren’t comfortable as they had never been around someone with disabilities. For others they would get frustrated being hovered over by the dad.
Could this be you? Have you seen it, or done it? What can you do to help your patient or you have a better experience? Here are a few suggestions:
Avoid the subjective stuff from others
Walk in with a clean slate for the shift
Smile, and don’t be afraid to hold hands
Laugh even when it is not funny
Include the patient in every conversation
Treat each patient the same as your favorite person
Change, by example, the culture one nurse and one patient at a time
As the parent of an adult with special needs and a 44 year healthcare career in my pocket I can tell you I have seen it. I fear it will happen to my son! I want to know that when he is afraid, sick, can’t be understood, can’t find his show that someone (any one of you) will take that extra 5 to help him. Make time, in the midst of the rapid pace, to take 5 for any patient or family that needs reassurance, compassion, a hand held. The reward is great for you and priceless for that individual! You can make a difference, one encounter at a time!!
‘To the world you are only one person, but to one person you may be the world!’ Bill Wilson
JLG 5.31.18
Optimist Training 101
Optimist Training 101
I have those in my life who always see the glass more empty, who have mastered the 'yeah but what if.....'. It is so much easier for them to plan for the failure, disaster or disappointment then it is to be hopeful for the success, the solution or the joy.
Why is that?
I will be transparent, I get depressed. It's true. And it can be overwhelming, dark and highly negative. I can give up hope when I listen to the negative words and corrupt whispers. But it is in that rapid slide spiraling downward that I must make an intentional choice. I can listen to the voice telling me that I am not worthy, unloved, will never have anything or I can stand up, speak against it and choose joy. It is a choice, and it is born in the battlefield.
Words are powerful, they can bring death or life. If you agree with that negative voice, if you speak life into it, if you agree with it then do not be surprised that you do not have the life you 'think' you desire. It, the enemy, has already won. If you agree you won't ever have things, get things, have success, feel better, get help, etc, etc. then it is likely you will not! You are choosing that, you are choosing to be defeated. YOU!
The enemy is so sneaky, and before you know it you have fallen into the trap. But do not be in despair. There is hope, there is a way, you can change the course! Choose a different path. It will seem fruitless, silly or even a failure. I've been there, I know. But if you speak 'life' long and loud enough, you will see it! You will rise above the shade and into the light. You will start to think more positively, you will feel more hopeful, your glass will seem more full!
Yes, this is the God part of the message. We are powerless without Him. He is a gentleman though and He will never force you to change or make you do anything. He never has! But He will gladly and eagerly walk with you, cheer you on. He wants only the best for you. The spiritual warfare is centuries old. Get into the battle, and move. He will show you the way out.
Then refuse! Refuse to speak negatively. Refuse to hear the gossip. Refuse to believe the chatter. Turn away from those who seek to destroy you and toward the one who holds the prize. Trust me, I fight this battle often. If I didn't change course or change the conversation I would surely die in the muddle. But because I fight, I rise above it all! I can face a new day. Don't give in, don't give up.
Think of Joshua and the wall of Jericho. Small army, big wall. God says circle the city, silently for 6 days and on the 7th silently then blow a horn. 'Yeah, right' is my first thought. I'm never going to get in that city, win a battle with our tiny force, be able to walk one time around the city in silence! BUT they remained intentional, they followed His directions. They chose to believe even if it made no sense at all, and there it was, walls crashing down. Mic drop!
So, remain positive even if it seems completely impossible. Refuse to say or think a single negative thought. Reject the noise of the enemy (which may be disguised as a spouse, friend, boss, etc). Expect to receive. You are no different than the little army with Joshua, and your need is likely not larger than a city with a huge wall! It's time to take on the enemy! God provided them a way. Don't believe for a minute you are of any less value. Looking forward to the changing winds!!
jlg 6/17/18 (c)
I have those in my life who always see the glass more empty, who have mastered the 'yeah but what if.....'. It is so much easier for them to plan for the failure, disaster or disappointment then it is to be hopeful for the success, the solution or the joy.
Why is that?
I will be transparent, I get depressed. It's true. And it can be overwhelming, dark and highly negative. I can give up hope when I listen to the negative words and corrupt whispers. But it is in that rapid slide spiraling downward that I must make an intentional choice. I can listen to the voice telling me that I am not worthy, unloved, will never have anything or I can stand up, speak against it and choose joy. It is a choice, and it is born in the battlefield.
Words are powerful, they can bring death or life. If you agree with that negative voice, if you speak life into it, if you agree with it then do not be surprised that you do not have the life you 'think' you desire. It, the enemy, has already won. If you agree you won't ever have things, get things, have success, feel better, get help, etc, etc. then it is likely you will not! You are choosing that, you are choosing to be defeated. YOU!
The enemy is so sneaky, and before you know it you have fallen into the trap. But do not be in despair. There is hope, there is a way, you can change the course! Choose a different path. It will seem fruitless, silly or even a failure. I've been there, I know. But if you speak 'life' long and loud enough, you will see it! You will rise above the shade and into the light. You will start to think more positively, you will feel more hopeful, your glass will seem more full!
Yes, this is the God part of the message. We are powerless without Him. He is a gentleman though and He will never force you to change or make you do anything. He never has! But He will gladly and eagerly walk with you, cheer you on. He wants only the best for you. The spiritual warfare is centuries old. Get into the battle, and move. He will show you the way out.
Then refuse! Refuse to speak negatively. Refuse to hear the gossip. Refuse to believe the chatter. Turn away from those who seek to destroy you and toward the one who holds the prize. Trust me, I fight this battle often. If I didn't change course or change the conversation I would surely die in the muddle. But because I fight, I rise above it all! I can face a new day. Don't give in, don't give up.
Think of Joshua and the wall of Jericho. Small army, big wall. God says circle the city, silently for 6 days and on the 7th silently then blow a horn. 'Yeah, right' is my first thought. I'm never going to get in that city, win a battle with our tiny force, be able to walk one time around the city in silence! BUT they remained intentional, they followed His directions. They chose to believe even if it made no sense at all, and there it was, walls crashing down. Mic drop!
So, remain positive even if it seems completely impossible. Refuse to say or think a single negative thought. Reject the noise of the enemy (which may be disguised as a spouse, friend, boss, etc). Expect to receive. You are no different than the little army with Joshua, and your need is likely not larger than a city with a huge wall! It's time to take on the enemy! God provided them a way. Don't believe for a minute you are of any less value. Looking forward to the changing winds!!
jlg 6/17/18 (c)
Deep Thoughts
Deep thoughts for a Monday!
Han Solo- Look, your Worshipfulness, let’s get one thing straight. I take orders from just one person: me.
Princess Leia Organa- It’s a wonder your still alive.
We know this person. A colleague, employee, partner. They will not ask for nor take direction, help, counsel. They may desperately need it but can’t seem to admit it. Some see asking for help as weakness. They don’t embrace the group think or recognize the group impact from their actions. In the work world, just like our private world, we suffer or celebrate based on the actions of each individual. The answer comes from a simple change of mind. Applied to the way we work and the decisions made it could literally change the course of the world you impact.
Spock-The needs of the many outweigh the needs of the few or one. 🖖
Posted first on Linked In (6/25/18 jlg(c))
Han Solo- Look, your Worshipfulness, let’s get one thing straight. I take orders from just one person: me.
Princess Leia Organa- It’s a wonder your still alive.
We know this person. A colleague, employee, partner. They will not ask for nor take direction, help, counsel. They may desperately need it but can’t seem to admit it. Some see asking for help as weakness. They don’t embrace the group think or recognize the group impact from their actions. In the work world, just like our private world, we suffer or celebrate based on the actions of each individual. The answer comes from a simple change of mind. Applied to the way we work and the decisions made it could literally change the course of the world you impact.
Spock-The needs of the many outweigh the needs of the few or one. 🖖
Posted first on Linked In (6/25/18 jlg(c))
Healing & Humor - Nurse Grid 6.25.18
If we do not address the heart, help to support the spirit and coping elements of the patient, we may ‘heal’ a short term medical problem but have ignored the patients emotional resolve to have long term success.
When things don’t go the way we expect, we have to laugh!
“As it is not proper to cure the eyes without the head, nor the head without the body, so neither is it proper to cure the body without the soul.”— Socrates
If you go into a patient room to do the initial assessment, you want to be sure to assess the entire patient. In documenting the assessments, a clock model is used to reference the location of wounds, scars, devices etc. An actual clock does not work with only one hand nor does the body work without key body parts. If we do not address the heart, help to support the spirit and coping elements of the patient, we may ‘heal’ a short term medical problem but have ignored the patients emotional resolve to have long term success. Socrates knew his stuff!
History of Humor
A number of theories have been proposed to define the human condition and its use of humor. The word humor is derived from the Latin umor which means fluid or liquid, to be moist. As early as 2500 BC ancient Chinese, Greek and Ayurvedic medicines linked the body to the earth’s elements, which were converted during digestion to three fluids; vatta (wind/breaths), pitta (bile) and kapha (phlegm). In 400 BC Hippocrates helped refine these into four humors which Gelan wrote extensively on in the 2nd century. It was ultimately determined that one’s fluid or ‘umor’ was thought to dominate personality and health problems. It should be the focus of physician and caregivers alike to keep the humor in balance. A diagnosis of ‘good humor’ did not imply the patient was funny, but doing well. Literally 4,500 YEARS later we use these same concepts to make an initial assumption of the patient. If one appears happy, carefree and lighthearted, one is judged to be fine, o.k., doing well and coping well, regardless of any ailment. If you look at the humors I am guessing it reminds you of someone, a patient or family member.
Humor as Part of Healing
Healing is the focus of medicine. We want to first, do no harm. ‘I shall be loyal to my work and devoted towards the welfare of those committed to my care’ is the last line of the Florence Nightingale Pledge. We see people in need and want to fix them. If we could define genuine success we would see a patient:
- Accept the difficult life situations
- Owning the actions and reactions to them
- Remaining open to others, understanding their point of view or decisions
- Laughing at or with others
- Able to problem solve, make the big decisions
- Empowered to do what is needed.
Adding humor improves the client’s self-understanding and behavior such as pointing out absurdities, giving examples of illogical reasoning, or repeating an amusing punchline. Inoffensive humor or joke telling about common experiences can be a safe way to initiate assessment of coping and reduce anxiety. It helps to relieve tension and permit a more transparent conversation as well.
Laughter itself is therapeutic for any number of psychological and physical reasons. Huge to the healing process is the sense of power laughter provides. It is a spontaneous, physical exercise increasing cardiac circulation and pulmonary function. It also fosters a positive and hopeful attitude which can be replicated with each giggle and guffaw. Additionally, there is sound correlation between decreased depression or risk for depression in those populations that can see or express humor.
Perspective is everything. Both humor and the observation of those in situations worse or different than ours helps to keep emotion and acceptance more positively framed. And the most obvious benefit to humor is the ability to endure the uncomfortable emotions and situations that all patients encounter in healthcare settings. Face it, a colonoscopy has a room full of strangers focused on the wrong side of the patient. It is a very vulnerable situation, fortunately rarely critical but always humiliating. That same element of laughter helps when gowns fall open, gases pass and messes are made. I remind every patient that expels ‘anything’: better out than in!
When Emotions Are Part of the Job
There is a risk to sharing emotions, good or bad, when we are in healthcare. The nurse or doctor can feel the same as the patient, feel failure in our efforts, feel anger and frustration when the patients don’t or won’t listen. We can grieve, often becoming attached to the patients or families, or both. Their loss becomes ours. The weight of day to day care of those in need can even lead to the physical and emotional distress we are trying to help the patients overcome. Planning for humor and those activities that permit decompression are critical if the nurses and providers are going to prevent burnout.
It is very easy to ‘wear’ the emotions of the patients, as well as to become hostile in response to their failure to follow orders. In a single day the nurse or provider can journey through the entire spectrum of emotions depending on each individual interaction that is experienced. One movie character said ‘I don’t just have one emotion. I am an actress, I have them all!’ Healthcare is the exact same. Depending on the patient load cared for each day every emotion can be experienced. This can result in ‘compassion fatigue’ which is the result of not caring for themselves. As a caution, this emotional anchor can also be placed on us by peers who are negative, hopeless, angry, etc. It can be an attack from both sides.
As a result, health professionals working in a stress-filled environment must have and mature the ability to see the humor in a situation and to laugh freely with coworkers and if appropriate patients. It can be an effective way to take care of your own body, mind and spirit. It can lift the spirit’s energy level and avoid the complexities of emotional overload. It does not condone cruel, mean spirited or rude jokes but supports the common ground of the human condition.
Patients also have a risk to accepting humor as the stress they experience is not dependent solely on external events, but also on their own perception of what the events mean to them personally. The interpretation of stress is very individual. One person is having an appendectomy and they are smiling, joking a bit, light hearted. Another person, experiencing the same procedure but is very morbid, sad, uncertain of tomorrow. I have always referred to this as the ‘Tigger and Eeyore syndrome’. One person is bouncing off the walls, not touched at all by the circumstances of life while the other is feeling near death by the very thought of it. Basically, how the individual looks at the situation determines if it will be perceived as a threat or challenge.
From a health perspective, the emotions and moods experienced directly affect the immune system. Positive emotions can create neurochemical changes that may buffer the immunosuppressive effects of stress. Studies have demonstrated that when encouraged and guided to use humor there is an increased sense of ‘cognitive control’. They may not be able to control events externally but they can control how they view these events and what emotional response they choose to apply to them.
The solution to shedding the negative and putting on the positive starts simply with reflection. ‘How did we get here?’ To have the best response leave your computer at the door and pull up a chair, 5 minutes! Encourage discussion, emotions, assess the patients view of the situation (threatened or challenged) then help the patient and family to reframe it. Often that is identifying the meaning in the process or chain of events. The patient may feel that coming to the hospital is a punishment for eating the wrong foods when they are diabetic rather than seeing that coming to the hospital is what has caused them to understand the disease, take their diabetes mores seriously. They have the opportunity each day to make new decisions and control their outcomes! That is power.
What Is Appropriate Humor?
So, what exactly is humor? Great question. There is certainly a great diversity in what each person finds funny. Laughter itself is a sound that can occur on its own merit. It does not require a joke, it is the physical chortle that can occur. Humor on the other hand, is the interpretation of what someone says, does, thinks is funny. Your sense of humor is developed in early years by external (parents, teachers) and internal (emotional, spiritual) influences.
Humor cannot always be shared. It is subjective and dependent on personal preference. To use humor for healing, it may take a couple of attempts to find what the patient, family or your colleagues think is funny. Good listening and observation skills can usually provide a sense of connection and idea of typical interactions. No one who has met my family would doubt we deal with life with humor. We tease, joke, find the positive in the ‘negative’ and laugh, often! We choose that reaction to the things we experience and frankly I am so glad we do!
A great exercise is to read some cartoons, bumper stickers, tv shows, etc and see how they make you feel. Were they funny to you? Then ask your social group or peers what they think about those same things. It is an easy and sometimes eye-opening way to get to know each other but also helps to contrast what funny is to the people around you. Of course, it never hurts to just laugh, for practice! There are certainly lots of health benefits. Laughter has been called the latest weapon in the fight against heart disease once the University of Maryland researchers reported that heart-healthy people are more likely than those with heart disease to laugh frequently and heartily, and to use humor to smooth over awkward situations.
There’s even hope, the scientists say, for cranky people who rarely laugh and for those without a sense of humor: They can learn! Some evidence suggests that the effects of a chortle, snicker, or guffaw include reduction in stress hormones such as cortisol, and reduction in blood pressure. That in turn may reduce heart disease risk. It has been reported that mental stress can impair the endothelium, the protective barrier lining the blood vessels. Usually, you laugh in a group or with at least one other person (although Clark is quick to point out there’s nothing wrong with a good belly laugh when you’re by yourself). In his oft-quoted study, published in the American Journal of the Medical Sciences in December 1989, he found that laughter is a good kind of stress: It reduces blood levels of cortisol, epinephrine, and other substances. Increased cortisol and epinephrine levels tend to suppress the immune system, so decreasing their levels is believed to be beneficial. Laughter may go a long way to reducing pain, as well. At UCLA, a five-year program called UCLA/Rx Laughter, in which researchers studied the effects humorous videos have on young patients’ perception of pain.
Application of Humor
Application of humor should be easy, but clearly many struggle. We are faced with any number of opportunities to lighten the mood, some we may have experienced ourselves in the course of our lives. I have observed some easy examples from the bedside. One was a patient who complained about the inadequate length or coverage of their gown to which the nurse responded: “Well, you know your doctor admitted you for observation.” Or on another occasion I heard: “It’s a designer creation by Seymour (Butts).” Another moment of humor presented itself after a difficult procedure to which the nurse said, “I bet it is hard to believe I am on your side!” By acknowledging the patients circumstance and making a subtle barb can demonstrate confidence and can give the message that it’s ok and you are in control.
To gain confidence in this whole laugh at work concept, there are many books written by former patients, themselves inspired by their circumstance. They found humor and storytelling to be a way to validate their experience and share their perspective. Some personal favorites include:
- Surviving the Cure by Janet Henry
- They Tore Out my Heart and Stomped the Sucker Flat by Lewis Grizzard
- Patients at Large by cartoonist Tom Jackson
- Please Don’t Stand on my Catheter by T. Duncan Stewart
- Have a Heart by Wilford Nehmer Jr
- I’d Like to Buy a Bowel, Please! by Brenda Elsagher
“Life does not cease to be funny when someone dies, as it does not cease to be serious when people laugh.”— George Bernard Shaw
I would modify this by saying: “Life does not cease to be funny when someone has cancer, as it does not cease to be serious when people laugh.”
“Show me a patient who is able to laugh and play, who enjoys living and I’ll show you someone who is going to live longer. Laughter indeed can make the unbearable bearable!”— Dr. Bernie Siegel, a cancer surgeon
Finally, respect the boundaries of humor. It certainly produces a bond between the nurse and the client. It also facilitates rapport and self-disclosure, it helps establish a more collaborative and friendly relationship. That being said we should not forget to be cautious. Humor can be used if the client invites it. Culture, generation, age, religion, ethnicity, disability and other population factors or differences can influence both the type of humor and the initiation into the nurse patient relationship. By using keen observation skills, you can tell a lot about what would be appropriate for the patient. As the moment presents itself you are able can introduce levity and have some fun, for the patient’s sake and for yours!
Guest Post: Judy Gates, RN, MSN is a Banner Health Clinical Education Director and is accountable for providing managerial and clinical education support. She has worked as a pediatric and trauma ICU nurse and wound care consultant. She is a published author and thought leader.
- HEALING, HEALTHCARE, HUMOR, NURSES
Reunion
Reunion
Have you been to one? Family, neighborhood, work, school? What a wonderfully awkward time. I must say we all looked nearly the same i.e. 40 years has not so completely disfigured our faces and bodies that we could, at a minimum, recognize the person! For many of us it was a series of internal musings:
I know we went to school together.
I know I recognize your face.
I can't remember why.
Did we like each other?
Were we friends, frenemies or strangers?
Do you still act the same, and if so, is that a good or bad thing?
I watched the room full of former students, whether strangers or best friends, return for our 40th high school reunion. I heard stories of joy, accomplishment, change, tragedy and sorrow. I saw some that were in the middle of their own personal battles. I learned of a couple that kept their circumstance unspoken despite the impact on them emotionally or physically. The stories of life, work, relationships and hopes for the future were telling of each life journey. So what do we take away from a reunion weekend that only happens every 10 years? A few observations for me:
Time flies!
We all had ‘life’ change us.
Some have lost someone (children, spouses, marriages, parents or others) they love.
Some have traveled to far away places though they long to be home.
Some have sacrificed to care for others.
Several gave up their own dreams to help someone else achieve theirs.
Some have retired or celebrated a life change.
And there are those who have remained exactly the same!
So one can be sure of this: we remember good times from school, we might forget the details, life has happened to us all, we have experienced many different journeys, there is some amazing strength in the class, we can't judge the books by their covers, we all know who Bob Hope and Carol Burnett are, we will always have a Warrior connection, we don't know the heartache or difficulties each has faced, school did not teach us about caring for our parents, we don't see as well as we did at 18, we talk about things now we never would have mentioned in school, we have all made it this far, only time will tell what is next, we will always be #wshsclassof78
jlg (C) 7/22/18
Have you been to one? Family, neighborhood, work, school? What a wonderfully awkward time. I must say we all looked nearly the same i.e. 40 years has not so completely disfigured our faces and bodies that we could, at a minimum, recognize the person! For many of us it was a series of internal musings:
I know we went to school together.
I know I recognize your face.
I can't remember why.
Did we like each other?
Were we friends, frenemies or strangers?
Do you still act the same, and if so, is that a good or bad thing?
I watched the room full of former students, whether strangers or best friends, return for our 40th high school reunion. I heard stories of joy, accomplishment, change, tragedy and sorrow. I saw some that were in the middle of their own personal battles. I learned of a couple that kept their circumstance unspoken despite the impact on them emotionally or physically. The stories of life, work, relationships and hopes for the future were telling of each life journey. So what do we take away from a reunion weekend that only happens every 10 years? A few observations for me:
Time flies!
We all had ‘life’ change us.
Some have lost someone (children, spouses, marriages, parents or others) they love.
Some have traveled to far away places though they long to be home.
Some have sacrificed to care for others.
Several gave up their own dreams to help someone else achieve theirs.
Some have retired or celebrated a life change.
And there are those who have remained exactly the same!
So one can be sure of this: we remember good times from school, we might forget the details, life has happened to us all, we have experienced many different journeys, there is some amazing strength in the class, we can't judge the books by their covers, we all know who Bob Hope and Carol Burnett are, we will always have a Warrior connection, we don't know the heartache or difficulties each has faced, school did not teach us about caring for our parents, we don't see as well as we did at 18, we talk about things now we never would have mentioned in school, we have all made it this far, only time will tell what is next, we will always be #wshsclassof78
jlg (C) 7/22/18
I’m Sorry
I’m Sorry
For hurt
For lies
For suffering
For abuse
For illness
For loss
For disappointment
For poverty
For homelessness
For frustration
For loneliness
For war
For violence
For sadness
For failure
I’m sorry that in the midst of life
Difficult or unexpected things occur
I’m sorry I’m not there to hug you
And share tears and grief
I’m sorry I can’t take it for you
And hope I have never added to it
My heart and hope stand fast with you
As I lay it all down at the throne
I don’t know why hard things happen
I can’t explain why God allows it
But I know He has experienced it
At the horrible death of His Son
That hope rose with a dark sky
A torn vail and an empty tomb
Hope lives in the resurrected Jesus
Gloried, Ascended, Reigning
He knows all your suffering
He collects every single tear
But one day He’ll Call you home
And There you will be sorry no more
Jlg 10/31/18(c)
World Peace
World Peace
I grew up in the Cleaver family. That is what I always tell folks. We had the mom who cleaned while wearing a skirt and heals and a father who wore a suit practically everywhere. We dressed up for Sundays and holidays. We took family trips in the car, laughed a lot and left drool stains on the seat. There were three kids and we did not quarrel. How is that possible some ask. I honestly can’t say other than we genuinely liked each other and if anything, there were always some baked goods that solved any threat of a dispute. It certainly was not the view I found in other homes, families or the world.
I spent decades thinking of world peace as an unattainable goal. Though it was elusive I recently discovered it can be found right here on this planet. In all my wandering and human interactions is was nearly impossible to imagine it could really exist outside small, intimate groups. It is certainly not seen on the evening news, in the slur of opposing candidates, in the disparity in religion, in the hateful crime against humanity. But then I found it, buried in plain sight in a stadium holding thousands.
I had never noticed how negative some people could be until I was surrounded by only kindness. As a nurse you would expect kindness to be the norm of healthcare but indeed, it can be anything but that in the experiences faced daily. Angry patients, family or doctors is just a pimple in the complexion of ill will that can be seen in a hospital. I have had patients punch me, try to choke me, try to choke others, throw furniture and so much more. Granted some hard issues are faced but please and thank you should not be impacted in the course of the human experience.
My observation of human nature and or behaviors increased in sensitivity with the birth of a special needs child. I had been aware of many disparate responses to those with disabilities in my career prior to the birth of my son. I worked in several settings caring for special needs children and adults. I had seen and reacted to quite a few irreverent individuals in contact with my charges much like a mamma bear and her cubs. With my sons arrival those defensive instincts magnified exponentially.
In controlled safe spaces I found a compassionate and supportive network. Teachers, providers, aides, other families all who could see what I wanted to or hoped for. They pointed out things that I did not see in his ability and progress while helping me accept his current developmental accomplishments. But when walking down the grocery store aisle some eyes stared, people whispered, even Santa rolled his eyes. It was clear not everyone saw the beautiful boy I did. So I stayed close to the family of forever friends we were collecting along the way.
After many years I discovered what I long hoped for which is genuine world peace, found in the hearts and minds of a community who see all as friends, equals despite color, country or party. I had seen it in fleeting moments though it quickly vanished, like the sunrise, in the face of naysayers. I have imagined that if only these amazing people, these champions for goodwill could be seen as global ambassadors the uninspired would be able to see each other through very different eyes. I do believe unconditionally, perspective is everything.
I have watched some icons of this world walk away, around or into these beacons of joy while mocking them for their lack of. Lack of money, work, words, skill, ability. Yet this beautiful sea of smiles and hugs sees past that hurt and anger, embracing everyone they can. It is not that these people don't know that others are being mean, it is that it doesn't really matter. Though they might experience hurt feelings it often quickly dissolves any cruelty intended by giving back something that frankly, others don't deserve. This unified team operates out of grace and mercy.
This world peace happened in LA of all places. Riddled with crime, history, gang violence and tragedy a fresh wind momentarily cleared the smog. Who would have thought that was possible. It happened at the 2015 Special Olympics World Games. There were 7000 athletes from 170 countries with 30,000 volunteers and twice as many supporters. And there was joy. While I was whining about the heat and long lines, they stood patiently. While I wanted to sit down they waited full of excitement, in the presence of their friends, whether they knew them or not. I blamed, slurred, criticized while my son stood quietly. I apologized and he forgave me. "It's alright mom, I love you!" I scanned the crowd and it was evident, if anyone was cranky it was not the athletes or their peers. He reached up, hugged me and reassured me, it would be alright if I just take a deep breath and count to ten. I sighed deeply and knew he was right.
I met large groups gathering for the games in two of the host cities, our group entertained them with dance. The teams danced with us or stood by us or held our hands or sat near us. They celebrated, they smiled, laughed, hugged, helped each other though complete strangers. They spoke different languages, had varied abilities or ‘difabilities’ as our friend Tim Shriver says. World peace happened at the games and I am still full of humility and tears. It was a glimpse of what I think God intended when he put humans on the planet and I wait with anticipation to live in that state of joy again. I am certain God smiled at this international love fest at the games.
I have been that mom who wants to tell anyone who will listen everything her son has accomplished. I have even spent money to have the first two years of my sons life moved from VHS to digital and I discovered the most remarkable thing. What I saw, what I now realize I forced my loved ones to endure.....nothing. Hours of an adorable baby dressed in a variety of adorable clothes doing absolutely nothing. But wow he sure could do it well, smiling the entire time. Now as an adult he has eclipsed my wildest dreams and made me incredibly proud every day. He is my world peace. He demonstrates everyday the patience, kindness, charity and joy that I saw at those games. I stand in awe at times that I get to be his mom.
He has been surrounded by amazing family, friends, teachers, mentors and absolute strangers who have watched him grow, who see his actions, who admire his kindness. When I was surrounded by all of those glowing faces it became clear that world peace can happen. I saw it first hand with a stadium full of people who looked at others as if they all matter. There was competition, there were winners and losers, but there were only cheers for friends whether they won or lost. It simply didn’t matter. I would give anything to see that again. And because I saw it once I have a dream, a hope that I will see it again.
jlg 11/26/18 (c) submitted University of Oxford
I grew up in the Cleaver family. That is what I always tell folks. We had the mom who cleaned while wearing a skirt and heals and a father who wore a suit practically everywhere. We dressed up for Sundays and holidays. We took family trips in the car, laughed a lot and left drool stains on the seat. There were three kids and we did not quarrel. How is that possible some ask. I honestly can’t say other than we genuinely liked each other and if anything, there were always some baked goods that solved any threat of a dispute. It certainly was not the view I found in other homes, families or the world.
I spent decades thinking of world peace as an unattainable goal. Though it was elusive I recently discovered it can be found right here on this planet. In all my wandering and human interactions is was nearly impossible to imagine it could really exist outside small, intimate groups. It is certainly not seen on the evening news, in the slur of opposing candidates, in the disparity in religion, in the hateful crime against humanity. But then I found it, buried in plain sight in a stadium holding thousands.
I had never noticed how negative some people could be until I was surrounded by only kindness. As a nurse you would expect kindness to be the norm of healthcare but indeed, it can be anything but that in the experiences faced daily. Angry patients, family or doctors is just a pimple in the complexion of ill will that can be seen in a hospital. I have had patients punch me, try to choke me, try to choke others, throw furniture and so much more. Granted some hard issues are faced but please and thank you should not be impacted in the course of the human experience.
My observation of human nature and or behaviors increased in sensitivity with the birth of a special needs child. I had been aware of many disparate responses to those with disabilities in my career prior to the birth of my son. I worked in several settings caring for special needs children and adults. I had seen and reacted to quite a few irreverent individuals in contact with my charges much like a mamma bear and her cubs. With my sons arrival those defensive instincts magnified exponentially.
In controlled safe spaces I found a compassionate and supportive network. Teachers, providers, aides, other families all who could see what I wanted to or hoped for. They pointed out things that I did not see in his ability and progress while helping me accept his current developmental accomplishments. But when walking down the grocery store aisle some eyes stared, people whispered, even Santa rolled his eyes. It was clear not everyone saw the beautiful boy I did. So I stayed close to the family of forever friends we were collecting along the way.
After many years I discovered what I long hoped for which is genuine world peace, found in the hearts and minds of a community who see all as friends, equals despite color, country or party. I had seen it in fleeting moments though it quickly vanished, like the sunrise, in the face of naysayers. I have imagined that if only these amazing people, these champions for goodwill could be seen as global ambassadors the uninspired would be able to see each other through very different eyes. I do believe unconditionally, perspective is everything.
I have watched some icons of this world walk away, around or into these beacons of joy while mocking them for their lack of. Lack of money, work, words, skill, ability. Yet this beautiful sea of smiles and hugs sees past that hurt and anger, embracing everyone they can. It is not that these people don't know that others are being mean, it is that it doesn't really matter. Though they might experience hurt feelings it often quickly dissolves any cruelty intended by giving back something that frankly, others don't deserve. This unified team operates out of grace and mercy.
This world peace happened in LA of all places. Riddled with crime, history, gang violence and tragedy a fresh wind momentarily cleared the smog. Who would have thought that was possible. It happened at the 2015 Special Olympics World Games. There were 7000 athletes from 170 countries with 30,000 volunteers and twice as many supporters. And there was joy. While I was whining about the heat and long lines, they stood patiently. While I wanted to sit down they waited full of excitement, in the presence of their friends, whether they knew them or not. I blamed, slurred, criticized while my son stood quietly. I apologized and he forgave me. "It's alright mom, I love you!" I scanned the crowd and it was evident, if anyone was cranky it was not the athletes or their peers. He reached up, hugged me and reassured me, it would be alright if I just take a deep breath and count to ten. I sighed deeply and knew he was right.
I met large groups gathering for the games in two of the host cities, our group entertained them with dance. The teams danced with us or stood by us or held our hands or sat near us. They celebrated, they smiled, laughed, hugged, helped each other though complete strangers. They spoke different languages, had varied abilities or ‘difabilities’ as our friend Tim Shriver says. World peace happened at the games and I am still full of humility and tears. It was a glimpse of what I think God intended when he put humans on the planet and I wait with anticipation to live in that state of joy again. I am certain God smiled at this international love fest at the games.
I have been that mom who wants to tell anyone who will listen everything her son has accomplished. I have even spent money to have the first two years of my sons life moved from VHS to digital and I discovered the most remarkable thing. What I saw, what I now realize I forced my loved ones to endure.....nothing. Hours of an adorable baby dressed in a variety of adorable clothes doing absolutely nothing. But wow he sure could do it well, smiling the entire time. Now as an adult he has eclipsed my wildest dreams and made me incredibly proud every day. He is my world peace. He demonstrates everyday the patience, kindness, charity and joy that I saw at those games. I stand in awe at times that I get to be his mom.
He has been surrounded by amazing family, friends, teachers, mentors and absolute strangers who have watched him grow, who see his actions, who admire his kindness. When I was surrounded by all of those glowing faces it became clear that world peace can happen. I saw it first hand with a stadium full of people who looked at others as if they all matter. There was competition, there were winners and losers, but there were only cheers for friends whether they won or lost. It simply didn’t matter. I would give anything to see that again. And because I saw it once I have a dream, a hope that I will see it again.
jlg 11/26/18 (c) submitted University of Oxford
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MAD Unified Life
MAD UNIFIED - MAD Unified Instructors: Patrick Burns, Michael Wakeford What is MAD Unified? MAD Unified Dance Crew met January 10th, 2020...
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MAD UNIFIED - MAD Unified Instructors: Patrick Burns, Michael Wakeford What is MAD Unified? MAD Unified Dance Crew met January 10th, 2020...