A Nurse’s story

I share this story, understanding you do not typically have day-to-day interaction w/pts on one of our clinical in-patient Units.

2

Presence is “being there.” (Osterman, 1996)

“Presence requires empathy and a willingness to be vulnerable…” (Stanley, 2002)

“As health care professionals we can be a ‘healing’ --

Hopeful

Empathetic

Attentive

Loving

Intentional

Nourishing

Grateful presence taking care of the physical, mental, and

spiritual needs of our patients in our encounters with them, bringing them back to health and wholeness.”

(Perez, 2004, emphasis mine)

Exhausted Too tired to care Broken Angry Upset Frustrated Burned out Demoralized In spiritual crisis Feel unsupported Always in a rush

Between now and our second session, use “Elephant in the Room” to determine if there are any elephants… in regards to relationships among the staff.

Talk about these “elephants” with each other.

Determine how you will deal with each one. Share discoveries/insights with your DNE. Need assistance? Talk with DNE. If DNE needs assistance, she will talk with me.

“Being fully in the present moment necessitates emptying oneself of personal desires, setting aside thoughts of the past or future, resisting the urge to plan what we will say or do, focusing solely on the person before us, and believing that this moment is the only one possible.”

(Stanley, 2002)

(Pizanti, 2006)

Compassion “compatai”- to suffer/experience with

Not pity, mercy, sympathy or empathy

Living in human suffering

Moved to act

(Pizanti, 2006)

Nurses Are exposed to biological, psychological,

sociological and spiritual trauma and stress during caregiving events and over time

Trauma -- Acts of Nature

Evil -- Acts by another person

(Pizanti, 2006)

Nurses

Injured in body – mind – spirit May not care for yourselves as for others

Affect ability to care for yourselves & others

(Pizanti, 2006)

Psychological side effects

Critical of others

Apathetic attitude

Depersonalizing patients

Feelings of low personal accomplishment

Frustration with others

(Pizanti, 2006)

Psychological side effects (cont.)

Boredom

Depression

Anxiety

Hopelessness

Poor concentration & irritability

Feelings of alienation and isolation

(Pizanti, 2006)

Social side effects

Abuse of chemicals

Spending less time with patients

Exhibiting tardiness-absent

Medication errors

(Pizanti, 2006)

Social side effects (cont.)

Poor record keeping

Impersonal/stereotyped communication

Sarcasm

Cynicism

(Pizanti, 2006)

Physical side effects

Rapid pulse

Insomnia

Fatigue

Reduced resistance to infection

Weakness and dizziness

Physical side effects (cont.)

Memory problems

Weight changes

GI complaints

Frequent or lingering illnesses

Hypertension

Head, back, or muscle aches(Pizanti, 2006)

Spiritual side effects

Doubt about own value system or beliefs

Draw conclusions: i.e. a major change is necessary such as divorce, a new job, or relocation

Become angry or bitter at God

Withdrawing from fellowship

(Pizanti, 2006)

(Irish adapted Pizanti, 2006)

Addictive behaviors

Divorce and broken relationships

Anxiety

Depression = repressed anger “The purpose of depression is to bring you to the

place of letting go.” -- Archibald Hart, Ph.D. Suicide = anger turned inward

Homicide = anger turned outward

(Pizanti, 2006)

Job dissatisfaction – Leave of absence

Errors – cynicism

Loss of compassion

Loss of job/credentials

Since the beginning of 2015, did any of these statements describe how you have felt ?

 

1. Hypervigilance and an exaggerated startle response – being on guard and jumpy.

2. Irritability or angry outbursts

 

3. Nightmares and trouble falling or staying asleep

4. Emotional numbness, lack of interest in activities and difficulty feeling love and joy.

5. Avoiding thoughts and situations that are reminders of a traumatic event.

Did any of you identify any of these statements as descriptive of your life?

(No hands…)

Can anyone tell me what these questions describe? 

“Replenishing Ourselves as Caregivers”

“Self ‘Debriefing’”

“Keeping a Journal”

“No Time to Cry”

Filled with compassion…

Yet facing these traumas…

WHY NURSING?

NURSING’S HIGHEST CALLING —CARE OF THE HEART…

You are doing this because you LOVE it!

You are doing this because you have a CALLING!

1) Be gentle with yourself. 2) Remind yourself that you are an EMPOWERER, not a

magician. You cannot change anyone else; you can only change how you relate to them.

3) Give support, encouragement and praise to your peers and supervisors. Learn to accept praise in return.

4) Remember that in the light of all the pain you see, you are bound to feel helpless at times. Admit it without shame. Caring and being there are sometimes more important than doing.

5) Learn to recognize the difference between complaining that relieves and complaining that reinforces negative stress.

 

6) Before retiring for the night, focus on one or more good thing(s) that occurred during the day.

7) Be a resource to yourself through creativity and new approaches, changing your routine often and your

tasks when you can.8) Schedule withdraw periods during the week, and limit

the interruptions to this time away from your usual tasks. 9) Use empowering words: Say "I choose" rather than "I

should,” “I ought to,” or “I have to." Say “I won't" rather than "I can't."

10) Learn how to say “No.” i.e., if you never say "No," what is your "Yes” worth?  

11) Frustration and irritability are far more harmful than admitting that you are unable to do something.

12) Put a lot of laughter and joy in the fabric of your life.

McIntier, 1996.

Session #1 May 14, 2015 – the Director of Nursing Education & I had not developed an Implementation Strategy, New Steps – to apply principles.

The outcome: When Session #2 started July 9, 2015, I took an informal pole of both Day & Night shift staff – between 40 & 50 people. Here is actual question I asked from Powerpoint:

Question (honest answer, please): How many of you have used ANY of the handouts you received on May 14th to help you address some issues that are most pressing/distressing right now?

“To mourn is to heal.” Alan D. Wolfelt, 2003

“Inspiration without perspiration is stagnation” Terry L. Irish, 2015

“ If you fail to plan, you plan to fail!” Unknown

“Claiming you are FINE and that you don’t need to improve on any of the topics highlighted today only means you are Frustrated, Irritated, Neurotic, and Exasperated – but you are not FINE! “ Terry L. Irish, 2015

Step 1. Peds Issues List (PIL) By Sept. 25, rank all issues on handout from most to least urgent,

sign, and submit copy to Barb S.

Step 2. Accountability Partners (AP)Choose an AP from Nurses in this room today who are part of this training program, and

submit names to Barb by Wednesday, Sept. 30th.

Step 3. Plan of Action (POA)With your AP, prioritize your TOP TWO ISSUES and begin developing your POA to correct

these. Meet with Barb by Oct. 2nd to detail this Plan.

Step 4. Initiate Your Plan – Issue #1Work your Plan to address/resolve your #1 Issue and submit a written report of the outcome

to Barb by Wednesday, Oct. 14th.

Step 5. Initiate Your Plan – Issue #2Work your Plan to address/resolve your #2 Issue and submit a written report of the outcome

to Barb by Monday, Oct. 26th.

Notes: If you have questions, check with Barb.

If Barb has questions, she will check with me.

I am available, should you wish to talk or meet with me: Ext. 85781 Pager 0023 tirish@coh.org

Chaplain Terry Irish

tirish@coh.org

626.218.5781

Anandarajah, Gowri and Hight, Ellen. Spirituality and Medical Practice: Using the HOPE Questions as a Practical Tool for Spiritual Assessment. Am Fam Phy 63(1):81-88, 2001.

Fitchett, G., & Canada, A. L. (2010). The Role of Religion/Spirituality in Coping with Cancer: Evidence, Assessment, and Intervention. In J. C. Holland (Ed.). Psycho-oncology, 2nd Edition. New York: Oxford University Press.

Mockenhaupt, B (2015). The Long Shadow of PTSD. AARP Bulletin/Real Possibilities, 10-14.

Osterman, Paulette, and Schwartz-Barcott, Donna. Presence: Four Ways of Being There. Nurs For31(2):23-30, April-June, 1996.

Peery, B. (2009. What’s in a Name? PlainViews, 6(2).

Perez, Jacqueline C. Healing Presence. Care Manage J 5(1):41-46, Spring, 2004.

Pizanti, Robin W. Chaplain (MAJ). (2008). Spiritual Care of the Nurse: Healing Body-Mind-Spirit. Department of Ministry and Pastoral Care, Walter Reed Army Medical Center.

Puchalski, C., & Romer A.L. (2000). Taking a spiritual history allows clinicians to understand patients more fully. Journal of Palliative Medicine, 3 (1), 129-137. 

Puchalski, CM, Ferrell, B, Virani, R, Otis-Green, S, Baird, P, Bull, J, Chochinov, H, Handzo, G, Nelson-Becker, H, Prince-Paul, M, Pugliese, K, Salmasy, D. Improving the Quality of Spiritual Care as a Dimension of Palliative Care: The Report of the Consensus Conference. J Palliat Med 2009; 12:885-904.

Puchalski, CM, Handzo, G, Prince-Paul, M, Otis-Green, S. Improving the Spiritual Domain of Palliative Care. American Academy of Hospice and Palliative Medicine, Preconference workshop, San Diego, March, 2014.

Spiritual Care of the Nurse, CH (MAJ) Robin W. Pizanti, RN.

Stanley, Karen J. (2002). The Healing Power of Presence: Respite From the Fear of Abandonment. Onc Nurs For 29(6):935-940 .

Wolfelt, AD. (2002). Healing A Parent’s Grieving Heart. Fort Collins, CO, Companion Press.

Wolfelt, A. (2003). Understanding Your Grief. Fort Collins, CO, Companion Press.