What is Nursing in Today’s World

In the words of Florence Nightingale:

“Nursing is an art: and if it is to be made an art, it requires as exclusive a devotion, as hard a preparation as any painter’s or sculptor’s work; for what is the having to do with dead canvas or dead marble, compared with having to do with the living body, the temple of God’s spirit? It is one of the Fine Arts; I had almost said, the finest of Fine Arts.”

In today’s world, many people do not respect nurses and the work that they do.  There are many types of nurses in different fields.  I personally have had the privilege of working as a nurse in medical-surgical units, labor and delivery, legal nursing,  home care, case management, workman’s comp, and field nursing.  The experiences that I gained in working in all of these different areas of  nursing make me who I am today.

Through out the past month, these same nurses that did not receive any gratitude have now started to receive recognition, some negative and some positive.  Nursing as we know it has changed many lives.  We have had to adapt to the way that we reach out to our patients for their protection and ours through telehealth nursing.  For many patients, this has been a great thing because they can still talk with their nurse and their doctor.  I see clients in their home and doctor’s offices, but during the COVID-19 shelter in, I have had to reach out by telehealth to my clients in order to continue to provide the services that they need.

Many people have been so scared that they are losing sleep and feeling stress due to not working and how are they going to pay their bills.  Then there are the nurses that work frontline in the hospitals and doctor’s offices and the nurses that now have to see patients through telehealth measures.  One would think that those of us that have jobs still amidst this pandemic would be grateful and kind, but instead, for some people, it is causing stress and anxiety as a result of undisclosed fear.

Fear’s acronym that has been shared is false evidence appearing real.  In this case, though it is fear of the unknown.  Will there be work, will I get infected? Will my family be okay?  These are all questions that go through people’s minds.  What can we do as nurses?  Pray and ask God for that peace to be the light in the midst of darkness.  Second, understand that we can’t change the world and those that are in it; but we can change the way we look at it and how we handle circumstances.

A friend paid me the greatest compliment the other day, he said “Rosie Moore you followed The Great Physician! Bringing healing and hope to those in despair.  keep up the good work.  There is a crown waiting for you!”  So today know that every type of nurse is important whether in the frontline or via telehealth.  When COVID-19 is over, never forget what our country went through and the work that nurses and other healthcare workers did.

 

When a Pregnancy is not Viable

I think that this is a hard decision for any mother to make when she is told that her baby may not be viable.  I can see several ethical things here that would make a decision difficult to make.  First of all, there is the termination of the pregnancy recommended because the baby will not be viable at birth, and then there is the religious aspect.  These are both ethical situations that can be very difficult for parents when they have to make a decision.  Doctors make decisions based on the viability of a baby and feel that if the baby will not make it, the pregnancy should be terminated.  In a Christian hospital, for example, these conversations may not happen, because they do not do terminations of pregnancy, so that suggestion would not be made. However, at a non-Christian hospital, that type of discussion may happen there frequently.

Each hospital should have an ethics team to explain the choices to the mother so that a mother that does not believe in termination is aware that she does have the right to keep the baby until he passes.   Allowing the parents to use their own judgment in a case like this,  provides for better healing as they cope with the impending loss.  The termination of a pregnancy before its time is devastating to any parent. A parent’s religious beliefs in the Lord keep them holding on for a possible miracle and we should not interfere in their decision making.  If the miracle does not happen, those parents will find the way to grieve the loss but at least they were offered a choice and will not have to worry that the choice was not given to them and they will not have to live with the “what ifs.”  This would be their way of coping with the death of that child (Denisco & Barker, 2012).

References

Denisco, S. M., & Barker, A. M. (2012). 25. In Advanced practice nursing: Evolving rules for the transformation of the profession (2nd ed., pp. 547-567). Retrieved from https://campus.capella.edu/web/library/home

Rosie Moore, RN, DNP

Visit my Website to learn more www.rosiemoore27.com
Follow me on Facebook https://www.facebook.com/rosiesnursecorner/

Should APN’s Have a Higher Standard of Education?

Many people in the healthcare field ask if an advanced practice nurse should have a higher standard of education?  in my opinion, yes, an advanced practice nurse should have a higher standard of education.  They are the leaders that are setting examples for the new nurses coming on board.  If we do not improve the profession, then anyone can say they want to be a nurse but not have the right criteria to be a nurse.  Nurses are taking care of people’s health and in some instances the patients are critical; they should have a level of education that is higher.

Advanced practice nurses that are teaching our new nurses coming into the profession,  definitely need to be at a higher level.  If they are not teaching, then they are in management or conducting research.  A great way that they can practice their speaking in impacting our nursing laws is starting locally with the Florida Nurse’s Association.  There is a local chapter in many cities and they speak about nursing issues that are both at a local and national level. They have the ability through the association to bring it for review; in our state, for instance, they can bring the concern to Tallahassee so that they can get it resolved or even brought up nationally to Washington.  If as nurses we do not get involved in healthcare, then what will happen is we will allow politicians who are not involved in the day to day care of patients, to make decisions that too often are not good choices for our healthcare system.

Rosie Moore, RN, DNP

Visit my Website to learn more www.rosiemoore27.com

Follow me on Facebook https://www.facebook.com/rosiesnursecorner/

Use of a Nursing Theory

In the neonatology world, there are a lot of different cultures that come through the Neonatal Intensive Care Unit (NICU).  It is also a longer time span to work with families, than on a regular medical-surgical floor.   Florida is a  transient state with many people coming on vacation and moving from out of state; this impacts nursing with a diverse culture.  Today we will explore cultural diversity as it pertains to religious beliefs.  In neonatology, three theories come to mind King’s views, Roy’s views, and Neumann’s views.  The theorist that many Neonatal Intensive Care Units (NICU) use is the Roy Adaptation Model (DeNisco & Barker, 2013).

The Roy Adaptation Model is known to focus on spiritual matters and promoting health amongst a family-centered type of care.  In the NICU, this especially holds true, because of the critical illness faced daily by the families.  The Roy Adaptation Model helps families adapt to a changing environment and deal with the quality of life or in some instances death.   In the NICU, Roy’s model works well as the nurses acclimate the parents, to the NICU and what is happening with their baby. The nurse may find a challenge when some of the babies need blood transfusions and the parents refuse for cultural or religious reasons (Alligood, 2013).

One particular faith, Jehovah’s Witness, does not allow for blood transfusions.  This is something that is very important when you have a baby in the NICU that is in need of a blood transfusion and the parent will not consent.  In some cases, the treating neonatologist will get a court order to do the transfusions.  In an extreme emergency, if two doctors sign off that it is an emergency, then the baby will receive the transfusions while they await the court order.  As a parent of a premature baby myself, I could not imagine not doing everything I could to save my child.  But in this case, Roy’s Adaptation Model may not be the best model to use, trying to involve the parent in a delicate situation.  The parent refusing to allow treatment of transfusions to their baby would be a hindrance to use Roy’s theory which is to promote a family-centered type of care involving the caregivers in the decision making and treatment (Meadow, Feudtner, Matheny Antommaria, Sommer, & Lantos, 2010).

The principle of autonomy allows the individual to make their own decision and select what is in their best interest.  Now in this instance when the baby needs a blood transfusion, there cannot be an autonomy decision, because what the parent feels is in the child’s best interest, may not be.    We may not agree with the family, but as nurses, we need to respect the other person’s customs and beliefs while at the same time being ethically correct in saving a baby’s life.  Now, as long as the baby is being taken care of and there is not a medical threat to the baby’s life some recommendations can be reviewed to try and find an alternative form of treatment.

 

References

Alligood, M. (2013). Nursing Theorists and their Work (8th ed.). Retrieved from http://online.vitalsource.com/books/9780323091947

DeNisco, S. M., & Barker, A. M. (Eds.). (2013). Theory-Based Advanced Nursing Practice

2nd ed., pp. 6-17). [Vital Source Bookshelf].

Meadow, W., Feudtner, C., Matheny Antommaria, A. H., Sommer, D., & Lantos, J. (2010, April 13). A Premature Infant with Necrotizing Enterocolitis Whose Parents are Jehovah’s Witness. Pediatrics, 126(1), 151-155. http://dx.doi.org/10.1542/peds.2010-0079

The Pain of a Child and Jean Watson’s Theory

What a difficult job it is for nurses that take care of kids that are in pain; these nurses make a difference in each child’s life that they touch.   Jean Watson’s theory of human caring is a good example of our human caring for others.  Jean Watson’s theory of human caring focuses on giving as an extension of self.  It is about instilling faith and hope in a person (Alligood, 2013).   When a person is sensitive to another person’s feelings, it helps to build a trusting relationship.  It is important to acknowledge the positive and negative feelings that a person puts out to another person.

Jean Watson believes in her theory that we experience personal growth through teaching and learning as well as spiritual and socio-cultural well-being.  Jean Watson’s theory emphasizes spiritual and nursing practice, which in turn will promote caring and love to the patient.  This will then develop into a caring relationship.    The theory allows the nurse to understand the other person’s perspectives on things and form a mutual bond.  It also promotes growth when a caring environment is formed allowing the patient to be who they are and be accepted for it.  In the case of caring for a child, it creates a  natural caring environment that will help the child and the parent cope during a difficult time.

References

Alligood, M. (2013). Nursing Theorists and their Work (8th ed.). Retrieved from http://online.vitalsource.com/books/9780323091947

Dr. Rosie Moore https://rosiemoore27.com/

Dealing with Pain and Activities of Daily Living

When someone is in pain, the painful stimulation must be removed in order for them to function. In looking at the activities of daily living such as hair brushing, dressing, and many others, makes anyone in pain lack motivation to function.     When physical therapy is ordered for patients, especially in the home setting, they at times lose their motivation because of the same thing, it is too painful.  But if we as nurses write the plan of care and recommend to the physician to have medications given to the patient about 20-30 minutes before therapy, then the patient may be able to work through the therapy that may be otherwise painful.

With dependent care, it is always a difficult thing if the patient is coherent enough to know that they need help.  As home care nurse, I saw this frustration in many of my patients because their mind was intact, but with an injury or disease process that prevented them from taking care of themselves.  This is when our compassion as a nurse can show the patient that there are ways that they can still remain independent by giving them choices whenever possible.  For instance what foods they like to eat within their diet, what time of day they want their bath. Everything depends on when they have the help available, but at least whenever they can make a decision, give them that option so that way they can feel that they have some decision making power (Alligood, 2013).

References

Alligood, M. (2013). Nursing Theorists and their Work (8th ed.). Retrieved from http://online.vitalsource.com/books/9780323091947

Dr. Rosie Moore https://rosiemoore27.com/

Strategies on Cultural Competence

In my own nursing career as a supervisor for field case managers, I have encountered patients and staff that come from diverse cultures. Every two weeks, our entire region would participate in something called Grand Rounds.  During those rounds, our medical director would review four cases that had been submitted for evaluation and best treatment options.  My team consisted of different cultures.  We had some wonderful nurses from different Caribbean Islands, some of them had a very strong accent, but that did not stop them from providing good care.

During one of our grand rounds, the medical director selected two of my case managers to present their case.  This case was presented in our own team meeting and we thought it would be a great one to present.  The one case manager we will call her Ms. R. presented a case about a member that had too many cats in the home and she was having difficulty staffing the case with home health aides because no one wanted to go in the home with so many cats. The medical director gave his evaluation of the case and the case was closed with the new information for the nurse case manager to implement.

During a manager meeting with about six other managers, the topic of case presentations came up and how each team needed to submit two cases per week, even if they were not selected for grand rounds.  A manager from England, who spoke with an English accent, stated that my team presented a lot of cases all the time.  I  stated that our strategy in our team meeting was to bring two cases every week so that everyone had a chance to comment. It also served as a good practice for the nurse presenting the case if the member was selected for grand rounds.  The English nurse manager asked me how I even understood Ms. R. and a few other staff from the islands that I had.  I politely let her know that I did have a diverse team and every one of them was a great nurse and social worker and did their jobs quite well.  As for understanding them, I listened to what they were saying intently and I did not multitask when they were speaking so that I could capture every word they said. Her response was I am glad that they are on your team (Clark et al., 2011).

I did resign from this position and unfortunately, four of the team went to this one manager and the other nine went to someone else.  But of the four there was one that was from Haiti, one from Grenada, one from Puerto Rico, and the other one was African-American.  I heard from all four about the poor treatment they were receiving from this manager. Of I course could only listen since I no longer worked there, but this was a perfect example of how not all nurses follow the code of respect for other people’s cultures.

With patients, it is the same thing, as nurses,  we are not always going to understand what someone is saying whether it is a language barrier, dysphagia from a stroke, or dementia, but we need to read the body language.  We need to fine tune our ears to try to understand what the person is saying. Living in Florida I am exposed to many cultures.  I myself am of Hispanic descent and although born in the states, I understand the diverse cultures that are here.

In integrating health teachings, many materials are available in Spanish and Creole, for the ones that are not, the use of translation companies are available through hospitals or managed care companies to help with the teaching that will be offered to the patients.

References

Clark, L., Calvillo, E., De La Cruz, F., Fongwa, M., Kools, S., Lowe, J., & Mastel-Smith, B. (2011, May-June). Cultural Competencies for Graduate Nursing Education. Journal of Professional Nursing, 27(3), 133-139.

A Review of a Nurse’s Role

A nurse can play three different roles as part of an interprofessional team.  The three roles consist of a nurse, nurse leader, and nurse educator.   The inter-professionalism team consists of other healthcare workers as well, not just nurses (Sommerfeldt, 2013). However, as nurses, the roles can be at different levels depending on the patient’s condition.  At my previous job, I worked as a complex case manager.  The team consisted of registered nurses, social workers (masters prepared) behavioral health specialists, community health workers, and nutritionists.  The nurse case manager managed the patient but if there was an issue with the patient in the home setting that required community resources, the community health worker would be consulted to assist in those needs.  If the member had psychological issues or other financial issues that required the need of a social worker or behavioral health specialist this referral would be added as well.  There was collaboration on the plan of care and all participated because we all were looking at the patient as a whole, not just as the part that each discipline took care of.  If a member was not able to pay his light bill or water bill due to financial difficulties until those needs were met through resources, any teaching that the nurse would do would be in vain.  A person cannot focus on teaching for their health or anything else if their mind is on their current financial strain, not their medical condition. In this instance, the nurse is playing the role of the nurse leader.

When a patient is in the hospital a nurse can also play the role of a nurse that is doing dressing changes, medication administration, and other treatments.  The nurse’s role in the interprofessional team may consist of the doctor, physical therapist, and dietitian, this would be more medically involved because maybe the patient is recuperating from heart surgery and requires a lot of care initially.  The patient may be on a special cardiac diet, which can also be explained by the treating nurse, however in this instance, the member is starting something new, so a consult from the dietitian can help the patient understand the diet and the nurse can reinforce the teaching.

The nurse educator as part of the interdisciplinary team can be seen for example in a disease management setting.  This type of setting also has multiple specialties that can follow the patient.  In this instance, the nurse educator is educating the member on how to empower themselves and learn about managing their chronic disease by learning about taking their medications, following a diet and exercise program, learning to check their blood sugar, or blood pressure.  The nurse educator can document what the patient learned based on return demonstration in the plan of care.

All three roles bring value to the scenario that they are in because the nurse will be around the patient most of the time.  In each role, the nurse is responsible for all aspects of the patient’s care.  Regardless of which role the nurse is playing, working on an inter-professional team is a style of partnership that allows decision making to be collaborative (Sommerfeldt, 2013).  It takes many people to working together to get a patient discharged to his home.

 

References

Sommerfeldt, S. C. (2013, February 25 2013). Articulating Nursing in an Interpersonal World. Nurse Education in Practice, (13), 519. http://dx.doi.org/http://dx.doi.org/10.1016/j.nepr.2013.02.014

Importance of Professional Communication

Professional communication is very important when we are dealing with a patient’s health.  In this virtual world that we live in where more and more people are working in the field and from home, it is important that we maintain a standard of etiquette when speaking with people via electronic mail and in person. Rapid responses without thinking about them first can come across incorrectly in person and in writing.

In every organization, there are communication barriers, but overcoming them is part of being professional and respectful of others’ opinion.  One barrier that is seen in managers, is the inability to show respect to other team members and allow a learning environment.  This is a prime example of a barrier in a learning environment that will hinder an employee’s growth and affect the quality of patient care (Rubenfeld & Scheffer, 2014).

As a former manager of a team of nurses and social workers, collaboration existed in my direct report team, and as a team, we functioned using critical thinking, interdisciplinary team approach and collaborated on cases together.  But in the big picture of corporate America under the manager that I reported to, this was not acceptable, it was a multidisciplinary team.  In this type of team, there is only individual thinking in the group, meaning their way and no other opinions.  The focus will be on tasks and check off systems regardless if it is feasible to do (Rubenfeld & Scheffer, 2014).

Nurses do have the ability to be leaders and educators of a system that will stimulate change if they are assertive. In order to make an impact, a good team of interprofessional people is needed (DeNisco & Barker, 2013).  At the end of the day, the patient is the one who counts and the reason why changes are necessary. If more companies were focused on having a management style that was transformational vs transactional, this would alleviate the unnecessary resignation of employees, corrective action plans, and disgruntled employees.

In our team, for instance, a good way that we used to incorporate learning weekly was having one person do a case study and they would team up with another person on the team to present the case study on a difficult patient.  During this time the team had the ability to comment on the case, make suggestions and also refer to our medical director for review.

There are many teaching and learning styles that we can use to teach patients. The important thing is that no matter what we feel is our way or learning, not everyone will learn the same way.  Therefore as the nurse, we need to explore what is that patient’s learning style and teach in that way.  Another assessment the nurse can make in the home care setting is the readiness to learn.  If a patient is having difficulty paying his electric bill, he may not listen to the teaching on a diabetic diet and the foods that he is to be eating or buying, because he may not have the resources to purchase them.

In conclusion, managers and leaders need to be able to figure out a way to engage their teams, show them respect, praise them for a job well done and be able to involve them in the overall goal as a team vs. a transactional leader that dictates and causes poor morale amongst the team.

 

References

DeNisco, S. M., & Barker, A. M. (Eds.). (2013). The slow march to professional practice. Advanced Practice Nursing (2nd  ed., pp. 6-17). [Vital Source Bookshelf].

Rubenfeld, M. G., & Scheffer, B. K. (2014). Critical Thinking TACTICS for Nurses:Achieving the IOM Competencies (3rd ed.). [Vital Source BookShelf]. Retrieved from http://online.vitalsource.com/books/9781284059571

When a Patient is in Pain

Have you ever thought about your patients in the hospital that are under severe pain?  When someone is in pain, the painful stimulation must be removed in order for them to function. In looking at the activities that we do on a daily basis like brushing our hair, getting dressed and many others, I can see how many would not be motivated because of the pain that they are in.  When physical therapy comes around, they at times lose their motivation because it is too painful.  But if we write the plan of care and recommend to the physician that they have medications given to the patient about 20-30 minutes before therapy, then the patient may be able to work through the therapy that may be painful otherwise.

Some patients who are being cared for in the home setting may have experienced an injury or disease process that prevents them from taking care of themselves and they get frustrated.  This is when we can show the patient ways to remain independent and give them choices when possible.  For instance what foods they like to eat within their diet or what days they want their bath. Everything depends on when they have the help available, but at least whenever they make a decision, we should give them that option.  We can help the patient have some decision making power (Alligood, 2013).

 

References

Alligood, M. (2013). Nursing Theorists and their Work (8th ed.). Retrieved from http://online.vitalsource.com/books/9780323091947