Tuesday, June 21, 2016

Interconnectedness…The Foundation of Holistic Nursing and Living

The view from one of the many wonderful beaches
in Okinawa. Balance, beauty, and the clear blue sea.
I recently attended the American Holistic Nurses Association annual conference in Bonita Springs, Florida. I had been anticipating this conference since attending the 2015 conference in Branson, Missouri. Immediately upon arrival at the Ft. Myers airport, I felt at peace. I walked through the airport doors and was welcomed by the balmy Florida air, and it took me back to a place, which I called home for over three years – Okinawa, a small subtropical island in the Ryukuan island chain south of Japan.  The palm trees, bright sun, and warm breeze with afternoon showers felt like home. Don’t get me wrong. I love my home now in the mountains of West Virignia. But there is just something about the beach that feeds my soul. I enjoyed more time outside in those five days in Florida than I probably had in a month at home. Of course, not needing to maintain a house and go to a job did allow more free time. I think it felt like home because I found my calling in holistic nursing during my time on the sunny happy island of Okinawa. 

Most conferences are about workshops, classes, dinners, networking, and well….work. The AHNA conference never feels like that for me. Yes, there are workshops and classes, but these classes do not feel obligatory. There is always something on the workshop list for the day that I am excited to attend because there is just so much to learn and share about holistic nursing. One day it was learning about bringing holistic services to your facility. Another it was self-hypnosis. But my favorite was a workshop with a nurse who shared her journey in making self-care a priority. During the class, we discussed the barriers nurses struggle with to care for themselves as the multifaceted people we are.

The underlying story is that holistic nursing isn’t just a niche or focus area for nurses. Sure, I am an ICU nurse. Others who attended the session worked in Labor and Delivery or Case Management. But we are holistic nurses in all of those roles and beyond. Holism is a way of living. I met men and women who are helping their communities, growing their families, and influencing the future of nursing. But what resounded with all of us is that we embrace and celebrate the connection we have to each other, the planet, our families, and our communities. It is so much bigger than you, them, or me. Holism is about all of us, together.

I purchased a small selection of AHNA bookmarks to share with my nursing peers during the conference. The back of the bookmark has a list entitled Nurture the Nurse From A to Z.  It includes a tip on how to nurture us for each letter of the alphabet. But holism isn’t just for nurses or even healthcare professionals. If we take a full reflective look at our lives, we will see how our roles at home, at work, at school, and within our communities are connected and influence each other. And by nurturing ourselves, we can be our bests in each of those roles. But they are not individual roles. They are each one part of a whole person, and each of those roles has an affect on the others.  I can’t be holistic in the ICU with my patients without being holistic with my peers or at home. These roles cannot be compartmentalized. And they shouldn’t be. I am a much better mom, wife, farmer, and community member because I found and embraced holism in my nursing role. And my life has been enriched because I take time to nurture myself. Do I always have time to go to a yoga class or have a massage? Heck no! But I feel nurtured at the end of most days even if I fall asleep in my bed without a meditation because I practice many of the A to Z tips listed on that bookmark as part of my daily life, because I don’t compartmentalize my roles. I have chosen to embrace my interconnectedness with this world and among my varied roles in life. And you can too. I’ll share a few below.

I found this heart-shaped leaf in my drive, reminding
me to always love myself.
Accept yourself, Empower yourself, Love yourself – This seems simple, right? But I spent much of my young adult life trying to fit into a mold that was never meant for me. I was the smart athlete who actually enjoyed art class and the literary classics that my peers groaned about discussing in English class. Then, I was a military spouse, who honestly didn’t love it. Every time my husband was up for re-enlistment I secretly hoped that he would choose not to continue on with that career, even though I didn’t know what we would do if he chose to leave that role. I always longed for something more, to celebrate my passions. But, I didn’t engage in literary discussions about what F. Scot Fitzgerald meant in that chapter of The Great Gatsby because no one else in my class wanted to hear it. I continued to attend spouse functions even though I didn’t enjoy them. And honestly, I wasn’t able to fully accept myself until I was thirty years old. When my husband finally left the military and we began a whole new life. I decided to start going after the things I enjoy and leaving behind those that I do not. So you might see me at the baseball field with my kids and then at a poetry reading or local band’s show the next day. And next week you’ll probably see me at the wellness fair, because all of those things are important to me. But you won’t find me at an obligatory event, and I won’t hesitate to share my opinion on the current political environment or a literary classic or on the most recent research around reiki, aromatherapy, meditation, or medical marijuana – even if you “don’t get the hippie stuff”. I’ll share it with you because I have finally accepted embraced my true self.

Be present in the moment – We are always busy. We celebrate having too many things on our plate, how little sleep we get; the list goes on and on. But we miss out on so much by being busy. Life is not about how many things we can cram into our day. It’s about enjoying whatever things we choose to put on that list. So if something doesn’t bring true joy, I would challenge you to rethink your to-do list. Even if you can’t reduce your list, you can choose to do only one thing at a time. Do not try to have dinner with your family and respond to work emails. Put the computer away and be present with your loved ones. The emails can wait. Your family can’t. If you’re rushing between meetings or other tasks, take a moment to notice the breeze or the new flowers that have emerged along the roadside. Or even just how your feet feel in the shoes as you walk down the hall. What are the smells that you notice? Or the sounds? This, my friend, is being present.

This tree growing through the limestone demonstrates our
interconnection to all other life on Earth. 
Connect with nature – Many of our jobs keep us inside. If you can, take your lunch outside in the sunshine. Or make time on your day off for a walk in the park or on a nature trail. Plant a garden to tend and harvest from this summer. Even in the winter we can connect with nature by making bird feeders from pinecones or just watching for nature out our windows. I feel renewed after being outside for a while, whether it’s on a walk or just sitting on my porch. A couple of days ago, I was feeling a bit overwhelmed. The weather was changing, and a storm was quickly approaching. I took my yoga mat to the covered porch and had a short meditation while the light rain and wind blew around me. It was magnificent and the absolute highlight of my day!

Maintain wellness, Nurture your spirit, Quiet your mind – These go hand in hand in my book. We cannot maintain wellness without nurturing our spirit in whatever way fulfills us or with a frazzled mind. With our minds constantly running, we set ourselves up for the stress trap. But we can avoid this trap by practicing meditation, prayer, or just gentle quietness as part of our self-care routine. There is no shortage of guided meditations, spa-like soothing music via instrumentals or Tibetan bowls or even nature sounds on YouTube. Here is my personal playlist. I have short five minute meditations, full body scans, and long recordings of calming music. So, something for whatever I need and whatever time I have to reset at that moment. We can also support wellness through exercise and nutrition. A whole foods focused diet can be easily incorporated into our routine. Plus, going out to the local farmer market provides us with an opportunity for physical activity and socialization to further nourish our bodies.

Use your gifts and talents freely - Share what you love with others! I am always amazed at the people who want to learn about my holistic nursing or who want to hear about my family’s farming ventures. I used to hesitate to share my gifts and talents. Now I share them freely. And so should you!

Friday, May 27, 2016

Nurse-to-Patient Ratios and How it Affects You

On June 12, I joined hundreds of other nurses from across the country on the lawn of the U.S. Capitol for a rally and spoke with staffers from my state's representatives offices about the need for nationally regulated patient ratios. I also recently became a member of National Nurses United, the largest union and professional association of registered nurses in U.S. history. 

Why is this significant? If nurses are saying that there are issues with staffing practices at hospitals and longterm care facilities then the general public who receives this medical care, should be worried too. Nurses are concerned because the ongoing focus on profit by corporate healthcare organizations is impeding our ability to provide safe and effective care to you and your loved ones.

In previous posts, I have shared how feeling like I was being expected to care for too many patients affected my ability to provide holistic care and incorporate integrative therapies at the bedside. But being holistic and getting to know their patients is the least of many nurses concerns around the country. They want to know they didn't cause harm to any of their 8+ patients on a medical surgical unit, 5+ patients on the stepdown/progressive care unit, or in some places 4+ patients in the intensive care.

I can relate as I too have worked in a for-profit hospital where nurses were routinely understaffed and continuously expected to do more. More charting, more rounding, more medication administering...more more more...with less nurses and less nursing assistants and unit secretaries to help. Why? Because if they can make us provide care for more patients with less staff then the corporation will make more profit. Pretty simple answer, right? But instead, we are providing less real care and causing more harm to our patients and ourselves.

Numerous studies have demonstrated the increased risks that our loved ones are subjected to when receiving care at a facility with inadequate staffing practices. Increased risk of developing pressure ulcers, hospital-acquired pneumonia, falls, medication errors, respiratory failure, cardiac arrest, readmission, and death are a few examples. *see references listed at bottom of this page*

Nurses are selfless creatures by nature. We work extra hours, stay late, skip lunch breaks, take the rare bathroom break with the ASCOM phone attached to our hip, and join committees. Not because we have nothing else to do, but rather because we don't want to leave our nursing colleagues short-staffed or put our patients at risk of further complications due to short-staffing. But nurses are humans too. I have previously written about the importance of self-care to avoid burnout and caregiver fatigue. Some of the main risk factors for nurse burnout is unsafe staffing practices and increased stress from their job related to these expectations. In one study, 83.7% of nurse participants reported that the number of nurses working on their departments is not sufficient for the amount of work (Obradovic, Obradovic, Cesir-Skoro, 2013). Nurses leave the career they worked so hard for and felt called to because of these issues, leaving us with even fewer nurses at the bedside and perpetuating this cycle. According to Twibell & St. Pierre, roughly 30% of new graduate nurses leave their roles within the first year and 57% within two years, citing heavy workloads, inability to ensure patient safety, and insufficient time with patients as reasons for leaving. The cost of replacing a nurse who leaves is more than $80,000 (2012). 

The view of corporate healthcare in America is too short-sighted to see the simple solution. By providing better staffing ratios we would be providing safer and more comprehensive care to our patients, improving staff job satisfaction and reducing nurse burnout, and ultimately saving billions of dollars by preventing readmissions, reducing errors, and shortening length of hospital stays.

Nurses are organizing and have been for several years on this matter. In 2004, California passed the only government regulated nurse-patient ratios after nurses and patients united to demand safer practices. Why is it now, 12 years later, we cannot have those same regulations in hospitals and longterm care facilities all across America? Greed! Corporate healthcare is not in the business of keeping you healthy. They are in the business of making money like the rest of corporate America, and their practices are self-serving and putting you and your loved ones in danger. 

Would you want your mother or grandfather to be my third patient in the ICU? Or the 8th patient for a nurse on the medical surgical floor? Trust me, you don't. When nurses are expected to provide care beyond safe levels patients suffer: mistakes are made, tiny changes that could save your loved ones life are missed, and they miss out on the potential caring moments that we nurses long to cherish with them. We are rushed, flustered, stressed out, and afraid that we will bring harm to those we work so hard to help. So, what can we do? We need to be active in our government and let our voices be heard. Nurses can join movements and organizations such as National Nurses United or Nurses for National Patient Ratios Facebook Group. Non-nurses who want to be involved and spread the word about safe staffing can find more information on the National Campaign for Safe RN-to-Patient Staffing Ratios

Please feel free to share this information and contact me directly at nurseapril@holisticheartrn.com for more literature and conversation on this very important issue.  And continue to follow me as progress is made on this matter. 

Resource list
Aiken L, Clarke S, Sloane D, Sochalski J, Silber J. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Jama [serial online]. October 23, 2002;288(16):1987-1993. Available from: MEDLINE Complete, Ipswich, MA. Accessed May 27, 2016.
Cho, Eunhee,PhD., R.N., Chin, Dal Lae,PhD., R.N., Kim, Sinhye,M.S.N., R.N., & Hong, OiSaeng, PhD, RN,F.A.A.N., F.A.A.O.H.N. (2016). The relationships of nurse staffing level and work environment with patient adverse events. Journal of Nursing Scholarship, 48(1), 74-82. doi:http://dx.doi.org/10.1111/jnu.12183
Harless D.W. & Mark B.A. (2006) Addressing measurement error bias in nurse staffing research. Health Services Research 41 (5), 2006-2024.
Harless D.W. & Mark B.A. (2010) Nurse staffing and quality of care with direct measurement of inpatient staffing. Medical Care 48 (7), 659-663.
McHugh MD, Ma C. Hospital nursing and 30-day readmissions among Medicare patients with heart failure, acute myocardial infarction, and pneumonia. Med Care. 2013;51:52–59. 

Needleman, J., PhD., Buerhaus, Peter,PhD., R.N., Pankratz, V. S., Leibson, C. L., PhD., Stevens, S. R., M.S., & Harris, Marcelline,PhD., R.N. (2011). Nurse staffing and inpatient hospital mortality. The New England Journal of Medicine, 364(11), 1037-45. doi:http://dx.doi.org/10.1056/NEJMsa1001025
Twibell, R., & St. Pierre, J. (2012, June). Tripping over the welcome mat: Why new nurses don’t stay and what the evidence says we can do about it. American Nurse Today7(16). https://americannursetoday.com/tripping-over-the-welcome-mat-why-new-nurses-dont-stay-and-what-the-evidence-says-we-can-do-about-it/
Obradovic, Z., Obradovic, A., & Skoro, I. C. (2013). Nurses and burnout syndrome.Journal of Health Sciences, 3(1) Retrieved from http://search.proquest.com/docview/1660377054?accountid=458

Sunday, May 15, 2016

Are you nourishing your body?

I frequently write about nourishing ourselves through self-care: meditation, yoga, aromatherapy, nature. But what I most often find myself counseling others about is nutrition. We know that what we eat influences our health. I certainly can tell when I've been eating well and when I haven't. Hippocrates said, "Let food be thy medicine and medicine be thy food." As a nurse, I provide nutrition education to patients following strokes, heart attacks, receiving antibiotic therapy, and suffering from constipation. But I also recognize that it's not just the patients who need nutrition education. My peers and our society as a whole need a diet revolution. We live in a time where the fast food drive thru and boxed "foods" are the norm. Numerous studies link this type of diet to chronic illnesses and obesity. I enjoy preparing nutrient dense meals with fresh and quality ingredients. I don't think food should have ingredients, but should be ingredients.  

My husband manages our community's online farmers market, and we are both heavily involved in educating customers and community members about whole foods nutrition. I am also the co-founder of the soon-to-be Greenbrier Valley Chapter of the Weston A Price Foundation. If you are not familiar with the Weston A Price Foundation or Dr. Price's work, check it out at www.westonaprice.org.  The foundation's dietary teachings center around the preparation of traditional and whole foods to promote health. Many of the recent clean eating diet fads share similar ideals: less processed foods, more fresh ingredients, smaller serving sizes. All of which are important factors in promoting health through nutrition. 

However, a key element missing from these other diets is fermented foods. People have been fermenting foods since the beginning of humanity. It is a traditional method of food preservation. Fermentation also makes food more digestible and nutritious. Fermented foods such as kimchi, milk kefir, sauerkraut, natural picked, and yogurt are imperative in providing our body with important probiotics. I bet you have heard about probiotics before, but do you really understand and appreciate their role? 

Probiotics are edible products containing the helpful bacteria such as Lactobacillus or Bifidobacterium that normally inhabit the human digestive tract.  These bacteria help to digest food, helping to keep the digestive system in balance and functioning properly. They are also extremely helpful in supporting the immune system, particularly when taking antibiotics, which can wipe out intestinal bacteria indiscriminately, including those that help keep the intestinal tract healthy. I have worked at hospitals where supplemental probiotics are added to the patient's medication list as part of an order set when antibiotics are prescribed to help prevent complications from antibiotics. And yes, you can take a probiotic supplement, but isn't it much more fun to consume your probiotics?

Basic vegetable ferments are quite easy and can be accomplished in your home kitchen. Give this easy recipe a try to promote microbial diversity within your body and expand your food horizons.

Quick Kimchi
adapted from Nourishing Traditions

1 head pak choi, chopped or shredded
1 bunch green onions, chopped
2 carrots, finely grated
4-6 French Breakfast radishes, grated and some of the greens
4 cloves garlic, peeled and minced
1 tablespoon freshly grated ginger
½ teaspoon (or more if you like spicy) dried chile flakes or red pepper flakes
2 tablespoons Himalayan Pink Sea Salt (or other quality salt)
4 tablespoons whey (from whole fat organic yogurt or from your fresh cheese, milk kefir, or yogurt making)
*You can omit whey if you need a dairy free recipe but use an additional 1 tablespoon salt. This will result in a slightly saltier kimchi and may need a longer fermentation.

Add salt to pak choi in a large bowl and use hands to massage. This draws out the moisture in the pak choi, creating the brine which will ferment your kimchi. Let rest while you chop and grate the remaining ingredients.

Add remaining ingredients to salted pak choi and mix again with your hands.

Transfer your kimchi to a quart jar or other fermentation vessel. Use a pounder or meat hammer to press down until the brine comes to the top of the kimchi. If your brine doesn’t quite cover your kimchi you can add a little extra water.

Seal with a lid and keep at room temperature for 3-5 days then enjoy! If your kimchi is still a little salty for your liking you can continue to ferment at room temperature or in a root cellar or basement until it meets your taste preferences. Kimchi and other fermented vegetables will keep for several months in cold storage.

Try your homemade probiotic filled kimchi on a fish taco, as a salad or soup topping, or as a simple flavorful side with any meal. It is also very tasty on your farm fresh breakfast eggs.

The ingredients for kimchi are very flexible. You can use summer cabbage, Napa cabbage, pak choi, or even beet or broccoli greens. Any type of radish will do, but the traditional radish is the Daikon, a long white radish that looks somewhat like a very large white carrot. The same is true for onions. If you don’t have green onions use some fresh chopped white or yellow onions.

Make the recipe your own and use what you have. The whole idea of fermentation is to store your fresh and healthy vegetables for future use. You shouldn’t have to make a special trip to the grocery store for a special type of onion, radish, or cabbage. I was able to use garlic from a friend's fall harvest, pak choi, onions, and radishes from the Monroe Farm Market (shameless plug for our local online farmers market) and only purchased the carrots and ginger from a grocery store because they are not available locally.

For further information on fermentation check out Wild Fermentation by Sandor Ellix Katz and Nourishing Traditions by Sallon Fallon.

Wednesday, April 27, 2016

Nursing....a fluid definition

I often say that I've been a nurse since I was six years old but became an RN in 2010. I grew up in a house where I helped care for three different grandparents as they passed on from this life due to cancer and complications from various chronic illnesses. 

I was exposed to the hospital environment at a very young age and began to appreciate the role of nurses almost immediately. Even at the young age of six, I recognized that it was the nurses who were in and out of my grandmother's hospital room with each IV beep or to administer pain medications and change central line dressings. As I matured I was introduced to the world of cardiac surgery, in the early 1990s when only a handful of facilities were performing coronary artery bypass grafts. It was a nurse who explained how the procedure would be performed to help my grandfather's weak heart and sparked my interest in cardiac nursing. In my senior year of high school, I was deeply involved in the discussion with my family regarding decision-making and how to best help my other grandfather in his final few months of life.

All of those experiences helped shape the nurse I am today. It just took a while for me to realize it. After all of my exposure to death and cancer I thought I would avoid the sad parts of nursing and go into a specialty where I could help people get better and go home. I immediately went to work on a cardiac stepdown unit providing care for patients with acute and chronic cardiac issues.

Looking back, I realize that was insanely naive of me. Of course people die before, during, and after cardiac surgery and from cardiac complications. I mean, I learned about all of the things that could and do go wrong in nursing school. But I could explain the cardiac cycle backward and in my sleep, and I knew all of the various medications we could use to treat just about every problem. So as a new grad, I set out to change the world and never lose a patient. Because, after all, isn't the point of healthcare keeping people alive?

Obviously, it didn't take too long for me to realize that all of the medications and procedures in the world wouldn't be enough to keep everyone alive. It took even longer for me to understand that the point of healthcare might be to keep people alive, but that goals in nursing are often quite different. And even longer for me to appreciate the beauty and grace of dying in peace and with dignity.I have been so lucky to witness a family matriarch tell her family that she is tired and ready to leave this world, and I have watched a husband lie in bed cuddling his passing wife in her final hours. And you know what? I don't run from death anymore. I find those situations so fulfilling. Not because I want to see people die or lose their loved ones, but because I see that they are loved and appreciate that final phase of life. I cherish the connection that I have with my patients and their families. I relish every opportunity to bring comfort in those situations.

My definition of nursing has evolved over the last eight years, and I'm sure it will continue to evolve. I always wanted to be a nurse so that I could help people. I think that it is a commonly shared idea among nurses. We want to help people. Sometimes, nursing is helping a new mom master breastfeeding. Sometimes it is cheering when a patient has a bowel movement after a major gastric surgery. And sometimes it is helping a patient make arrangements to live out the remainder of her days surrounded by loved ones in the comfort of her home where there are so many happy memories. Quite often nursing isn't keeping people alive or saving people, but it's always about caring, compassion, and human connection.

Want to stay current on what is going on with Holistic Heart RN? Like my Facebook page at https://www.facebook.com/holisticheartrn/?ref=aymt_homepage_panel to see new blog posts, holistic health and wellness articles, and join in on discussions regarding holistic nursing, healthcare, and lifestyles.

Friday, March 11, 2016

Being Present with Yourself and Your Patients

As nurses, we must juggle the varied needs of others throughout our shifts, and it continues when we go home. We hear about nursing burn out in the news, nursing journals, and within nursing social networks. There are many factors at play when nurses burn out, but I think much is related to the lack of human connection with our patients. Today's computer-centric, task-oriented, high patient loads and acuity world of nursing is causing us to lose sight of what brought us to nursing in the beginning. So how do we stay present and connected in this modern age of nursing? Being present. How can we be present in the midst of a chaotic shift caring for five or more patients? Practice mindfulness.
I have a psychologist friend, who introduced me to mindfulness. He encouraged me to practice mindfulness even when I was busy. I learned that I didn't need to sit for a meditation session to be present. Rather than just rushing down the hallway to the next meeting or next patient, I started paying attention to how my feet felt in my shoes as they were making contact with the floor and how the breeze felt while it blew my hair. I began to incorporate this attention to myself while I was sitting at my desk performing chart reviews or while I waited at a traffic light. 
Presence can be nurtured through mindfulness meditation. Meditation doesn't have to mean sitting in a room by yourself with music playing for an hour every day. I know that's what most people think of when they hear the term meditation. An easy introduction to mindfulness meditation is through a quick five minute body scan first thing in the morning or right before you go to sleep. You can do this while resting comfortably in your bed. Some nice relaxing music is helpful though.
Start by bringing your attention to your breath, not trying to change anything at this moment. Then you can move on to checking in with your toes, feet, legs, hips, hands, arms, stomach, shoulders, neck and head. How do each of those areas feel? Do you notice tension, cold, etc? Then go back to your breath. You may notice after only a couple of minutes of really tuning into your body that your breath is different. Perhaps it is slower, steadier, or deeper. You can then incorporate yogic or deep breathing techniques to further regulate your breath. Breathing in through your nose and out through your nose, gradually increase the length of your in-breath from a count of 3 to 6 and your out-breath from a 4 count to 7. Again, do as much as you are comfortable with at this time. You will increase your capabilities with each practice. I'll bet that you are feeling more relaxed and in tune with yourself at the end of your meditation.
The most important part of the nursing process isn't my skills or passing medications at a certain time. It's not performing the best dressing change or starting an IV in the first attempt either. It's the patient! We can become stressed about that balance though, causing our attitudes to suffer, and thus influence how we provide patient care. In our struggle to provide more patient-centered care, we can become so overwhelmed that our relationships with our patients suffer.
We can choose to be truly present while we are with each patient. While administering the IV medication or helping our patient bathe we are often thinking about all of the other tasks that are still to be completed. Instead, let's choose to be present. Choose to only think about what you are doing with that one patient at that particular moment. Engage them in conversation. Offer words of support. Seek to know more. Notice the coolness of the refrigerated IV antibiotic in your hand or your patient's soft voice. It really does make a difference, for the patient but also for us. By choosing to be present, we are nurturing a connection with our patients while nurturing our own compassion and spirit. Everyone benefits.
A quick example in practicing presence at the bedside...
I was caring for an elderly female with chronic pain and COPD. She became very anxious in the evening when her daughter went home. Upon completing vital signs, the student nurse came to me urgently to let me know that the patient had a very rapid respiratory rate and was complaining of difficulty getting her breath. Her oxygen saturation was normal though on her baseline 2L of supplemental oxygen via nasal cannula. The student was nervous and didn't understand why this was happening. When we re-entered the patient's room, I realized her daughter had left and we quickly reassessed the patient. Vital signs were all within normal limits besides the rapid respiratory rate. Sure, it was possible that the patient was in some sort of acute respiratory distress or having some other complication, but my intuition led me to believe that this was her anxiety. I could have simply told the patient that her vital signs were normal and to try to calm down, leaving her with the anxious feelings to address independently. Instead, I engaged the patient. I explained that her vital signs were fine but that I recognized that maybe she was feeling a little anxious without her daughter at her bedside and offered to be of some support. The patient readily agreed. I pulled up a chair, took her hand and coached her through a yogic breathing technique to promote relaxation. Within five minutes, her respiratory rate had returned to normal and the patient reported feeling much calmer. I was then able to further engage this patient and help her to see how she could easily go back to her breath when she noticed any anxious feelings. She was empowered. My student was exposed to this practice. And even I felt better after this interaction. 
Another example...
My family has a small dairy goat herd here in rural West Virginia. We feel very connected to all of our animals, but the goats in particular as they will provide us with fresh milk to nourish our bodies. We only developed this herd last fall, and this will be our first spring of milking. We are, by all definitions, novice goat keepers. When a young female delivered a baby unexpectedly in late January, we were less than prepared. Mama was young and did not know how to care for the new baby. She was very scared and confused. So were we! But we knew that if we didn't figure out how to help Mama and Baby quick, that Baby wouldn't live. We spent the entire day with that Mama and Baby, helping them to bond, but mostly just being present. We rested in the field with them. We cuddled the baby to keep her warm in the beginning when Mama was confused and scared. Our presence and mindfulness of Mama's and Baby's needs encouraged this mama and kept her baby alive. Mama eventually figured out how to let Baby nurse and to nurture her. We had a thousand other things to do that Saturday, but our priorities had to change to meet our farm family's needs, much like my priorities as a nurse often have to change to meet my patients' needs. This was the ultimate exercise in mindfulness and presence. These are practical tools that can be utilized with our families, animals, patients, and ourselves. 
Mama Reese and Baby Eka after some much needed TLC and presence from us. This was on the day Eka was born. We named her Eka because it means first in Sanskrit, and she was our first kid born on our farm.

When we practice this presence with our thoughts and physical selves, we are better prepared to bring that presence to our patients, even on our busiest shifts. Once comfortable, it is easy to introduce the practice of mindfulness or other relaxation techniques such as guided breathing exercises to our patients for their own personal use, encouraging them to be more active in their own care. 
So go forth and breath.
With love and gratitude,

April, RN 

Thursday, February 18, 2016

Aromatherapy and Self-Care for Nurses

In a previous post I mentioned that I use essential oils in preparation for my bedside nursing shifts. I began using essential oils nearly four years ago. I was introduced to Lavender and Tea Tree oils for use with the washing process when i began using cloth diapers with our youngest son. It was a pretty basic introduction, but my interests grew from there. Soon, I had friends and family asking for my suggestions in the use of essential oils for everything from sore muscles and headaches to improving sleep and skin care. As a nurse, I felt the need for further education in the topic of aromatherapy so that I could make informed recommendations. Last spring, I enrolled with the Institute of Integrative Aromatherapy and began studying under the direction of a very knowledgeable holistic nurse and aromatherapy expert.  I guess you could say that aromatherapy was my introduction to the world of holistic nursing.

Today, I thought I would introduce a few of the essential oils that I utilize frequently to support my role as a holistic nurse and the methods of application.

I have made a combination of Angelica, Ylang Ylang, Juniper, and Cedarwood oils in distilled water as a body spray. This is a great combination for first thing in the morning as it helps keep me centered and grounded.

When work gets crazy, and I am starting to feel overwhelmed, I find a moment to slip into the lounge and apply a roll-on blend of Rosemary, Peppermint, and Sweet Orange essential oils diluted in fractionated coconut oil. If I have time, I like to combine this with a 1-2 minute deep breathing exercise to allow for the full effect of these oils. Rosemary is great for stress and is uplifting. Peppermint is also nice for stress and is useful in promoting concentration and mental clarity. Orange has been shown to be beneficial for anxiety and nervousness as it helps to promote relaxation. I find this combination very refreshing. It really helps me get through the rest of the shift and to feel balanced and focused. The great perk of a topical application is that you will periodically catch the scent as the oils are absorbed and evaporate from your skin. Your patients are likely to benefit from this blend also. I made holiday gifts for my nursing peers and included this blend in a mist bottle along with a few other treats. For the next several weeks, the nursing unit was scented with this combination, and the mood throughout the unit was much improved.

After a long and busy day, a soak for my tired feet is always nice. I often see peppermint epsom salt soak in stores. While peppermint can be nice and refreshing, I prefer a blend of Lavender, Geranium, and Ylang Ylang for the relaxing and soothing benefits to my tired feet. It is a great way to unwind and prepare for bed after a long shift or two. Even better than a foot soak is a full bath with dim lighting and relaxing music.

I love incorporating aromatherapy for self-care and for many more every day uses for my family. From deodorant and lip balm to cleaning solutions and fighting off sickness. Do you have a favorite essential oil? Mine is Lavender because it is so diverse in its benefits. How do you use aromatherapy? Self-care, during your shift, or in some other way? If you are not familiar with aromatherapy, I hope that this post has provided a starting point for further research. Please do not hesitate to contact me if you have questions about how essential oils and aromatherapy can support your nursing care.

With love and gratitude,
April, RN

Friday, November 20, 2015

When Holistic Interventions Don't Get the Responses You Expect

As I continue to strive to remain present at the bedside, I find that I often feel defeated. That I am not doing enough. I wear my "Holistic Nurse" pin on my badge. I center myself and apply my essential oils each morning. But I continue to find myself feeling frazzled and frustrated with the process throughout my day. When I leave work I find myself wondering if I did enough. Did my patient feel touched, appreciated, and respected. Was my intention to be present recognized?

Occasionally, I have a patient or family member express their gratitude for my work that day. They make known their recognition that I am juggling five or six other patients and that they appreciate the care I have provided, that they enjoyed having me as their nurse. I try to remember those moments when I start questioning myself.

A few weeks ago, I had a moment of realization. I was speaking to another nurse about a patient who had backed out on a standard endoscopy procedure. She was a high anxiety patient, who had struggled with the overnight prep. But even before I had left her the day before, she had mentioned that she was scared and didn't really want to have the procedure. Her mother had died after a complication during a similar procedure several years ago, and at the same facility. I tried my best to reassure her, to not discredit her concerns, but to help her come to peace with where she was along her health and care continuum. But despite all of the things I said and did, she still cancelled the procedure.

I was frustrated at that moment. I didn't let my patient know that though. I took my frustrations to my nursing peer. I was explaining to the other nurse how I had helped coach my patient in a session of guided relaxation and deep breathing that morning while her eyes were filled with tears and her voice shaky. I explained that I had been doing that with the patient since the day before to help ease her anxieties. I explained that I had performed a short Reiki session. All of these things had helped to soothe the patient, but she still declined the procedure.

The other nurse laughed at my description of the interventions I had been carrying out with this patient for two days. I realize that not every nurse practices this way, but that response really shook me. Later that day, the patient was discharged to home with a plan for outpatient follow up. Before the volunteer took her to her car in a wheelchair, she reached out and pulled me close. She hugged me tightly and for a long time. She whispered in my ear her thanks. She said the usual thank you's - for the care, education, and services provided. But then she said something I will never forget.  "Thank you for helping me be at peace with my health. Thank you for not making me go through with that test."

My eyes filled with tears. I didn't succeed in convincing my patient to go forward with a procedure that may or may not have been beneficial. I did something better. I supported a patient. I gave her the tools she needed to make a tough decision. My presence and care helped her to say no to something that she was feeling cornered into. She was empowered by my interventions.

As I reflect upon that laughing response I received, I am saddened that my nurse peer does not realize a whole dimension of nursing care that she is missing out on, that her patients are not receiving. I envision a time when those nursing interventions are a normal part of the care every nurse provides. I may not have gotten the responses I hoped for (from the patient or peer), but I believe the patient got what she needed. And that's what matters.

With Love and Gratitude

April, RN