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

Friday, August 28, 2015

Following My Heart Path

I feel like I have found my place. My home. A way to be true to my holistic nursing heart.

For the last several months I have struggled with the holistic nurse within and the standard staff nurse role that I needed to form myself into each time I arrived to the hospital for the next 12 hour shift. When I say struggle. I mean s-t-r-u-g-g-l-e. At times I found myself pondering career changes.

My desire to lead others down their own path of wellness through holistic means has made my reality – medication pushing, electronic health record charting, alcohol based hand sanitizer using (bleh!) – even more of a stressor than it was when I was just trying to figure out how to get through each shift with 5 sick patients relying upon me.

I attended the American Holistic Nurses Association conference this year in Branson. For the last couple of years I have been trying to figure out how to get out of the western medicine based bedside nursing role to be more true to my heart path of holistic wellness. You know, less drugs and lengthy hospital stays, more meditation and self-care (by my patients and myself in theory).

It has seemed so overwhelming though as each shift brings something new to take time away from actually being with my patients. More charting requirements, more patients, less staff. You all know the struggle. I kept talking about holistic nursing and how I wouldn’t mind bedside nursing care if I only had the time to practice holism while performing the other necessary tasks. If staffing were better, and I only had four patients to care for, or if I didn’t have to do so much charting I could do more. But we all know that the problems with staffing and nurse to patient ratios are not going to be resolved in the near future. This is not a new issue. It just continues to grow. I continued to feed myself that negativity until I dreaded each shift. Each day I awoke with dread in my heart. What chaos would I walk into that shift? What wouldn’t I be able to do? What guilt would I walk to my car carrying home that night?

We recently relocated to a rural area of West Virginia for our family farming journey. I took a new job at a local community hospital…as a staff nurse. I started dreading the job before I even started. Even though I was excited to start a new adventure and the nursing director was excited about my passion for holistic health care, I knew the reality – staffing shortages, too many sick patients, too much charting, not enough actual time to be with my patients. I had psyched myself out before even stepping foot onto the nursing unit.

These past couple of weeks something has changed within me.  I decided that I couldn’t wait for nursing shortages and ratios to be improved. I would never be happy at the bedside if I didn’t follow my heart path to practice in a truly holistic manner if I continued to drink in the negativity.

So I went back to what I know works. Self-care. It’s easy to take care of everyone else and then go to bed at night exhausted and never doing a thing for yourself. There are numerous studies and self-help resources for nurses to prevent burn out and care fatigue. We know that nurses who take better care of themselves are happier in their jobs. That is apparent to their patients. Patients pick up on our energy – good and bad. They know when you are extremely busy or distracted. So I quit neglecting myself.

I’ve restarted regular home yoga practices, incorporating a meditation to seal up the goodness. I start my day with the essential oils that my body is calling for. This helps ground and center me. When I go to work, I pack my lunch to bring nutritious meals from home rather than purchasing cafeteria food. I listen to rejuvenating and encouraging nursing podcasts during my commute. Before I walk in the front door of the hospital I take a few minutes in my car to relish the sacred breath and prepare for my day. When it’s hectic at work and it seems like I won’t make it to the end of the shift in one piece, I smile, take a breath, and return to my center – my heart and continue caring for my patients.

Instead of rushing through medication passes and assessments, I linger in my patient rooms. I get to know them and allow them to get to know the real April. The one who homeschools her children (with lots of help from her husband). The nurse who envisions a better care system that focuses on prevention and health maintenance instead of managing illnesses.

I used to be too timid to talk about Reiki, Yoga, or meditation to my patients. I just knew everyone would think I was crazy. That they just wanted me to give them their medications, do what the doctor says, and bring them a cup of coffee when they wanted. I was jaded. This new approach has allowed me to see that our patients want these resources. They want to be connected with their nursing staff. And they want to hear my “hippie” information and how it can help support their health (most of them anyway).

I had convinced myself that I needed to leave bedside nursing in order to practice in a fashion that is true to my holistic nursing heart. It turns out that I needed to get out of my head and into my heart. There is enough time to be with our patients. So I will continue to hold a hand, allowing the positive energy that a patient needs to flow from the universe through me and to her. I will continue to listen to the widowed elderly man’s stories about his wife. I will honor their individual needs. I will be present and connected – to my patients and my heart center.

With Love and Gratitude