A New Year’s Resolution: Oatmeal for Breakfast

A New Year’s Resolution: Oatmeal for Breakfast

The alarm goes off; you groan. How can it be time to get up already? You check the clock, hit the snooze button, and decide to skip breakfast in your head. You can eat something later—there’s no time.

Now that a new year is upon us, it’s time to renew some healthy habits. Many people resolve each new year to exercise more frequently or to eat healthier. I’ve got an easy suggestion for your nursing new year’s resolution: One of the best habits you can instill in your day is simply to eat breakfast before your shift.

As nurses, we know and can recognize the symptoms of hypoglycemia in our patients. But so frequently, the symptoms of low blood sugar are manifesting in ourselves and we don’t even notice. It is so important to eat breakfast, as it helps energize your morning, stabilize your blood sugar, and set you up for clear thinking and communicating at the beginning of a 12+ hour day.

Eating something in the morning is better than eating nothing, but some choices are better than others. The best breakfast choices are usually high in protein, fiber, heart-healthy fats, and complex carbohydrates. (And no, that mug of coffee doesn’t count as breakfast!)

Especially during winter, I urge you to try a bowl of oatmeal. Quick-cook oats take just two minutes to cook in the microwave, and they are so versatile. Try adding dried mango and shredded coconut, applesauce and cinnamon, or fresh fruit and Greek yogurt. Top with some raisins or nuts for added protein. Oatmeal is filling: it contains both soluble and insoluble fiber, which helps regulate your blood sugar and reduce your cholesterol levels. Even better, oatmeal is cheap! An entire canister of oats is usually less than $4 at the grocery store.

Oatmeal can be quick and easy to make and prepare (I set mine out the night before in a microwave-safe container, so in the morning I just add water and go), and I guarantee it will keep you full longer than that cup of coffee or berry smoothie. Overnight oats are a unique twist and make prep in the morning even faster. If you aren’t into hot cereal in the morning, try an oatmeal bar, the powerful effects of the oats are still available in bar form too, although be wary of excess sugars.

Whatever you grab as you walk out the door, make sure you’re setting yourself up for the best shift you can possibly have. Our job as nurses is hard enough without doing it on an empty stomach.

Preventing Patient Falls in the Emergency Setting

Preventing Patient Falls in the Emergency Setting

The emergency department (ED) presents a set of unique challenges for patient care, not the least of which is unstable patients who are at great risk for falls. I once heard a nurse educator proclaim: “Everyone is a fall risk in an ED.” From the elderly to the acutely ill, most patients in the department are at possible risk of falling, whether due to their age, their complaint, or the medications and treatment they are receiving. Additionally, many EDs do not have bed or chair alarms available for gurneys to assist with patient falls. Fall prevention is almost solely in the hands of the busy ED nurse.

Here are six ways you can help prevent patient falls in the emergency setting.

1. Use universal falls precautions.

All patients—from the 30-year-old with abdominal pain to the 65-year-old post–total knee replacement—are at risk of falling. In your own practice, using universal falls precautions can be helpful. Treating all patients as though they have the same risk for falls is a good start. Additionally, performing individual fall risk assessments on each patient at the beginning of his or her visit is important to both assessing risk and documenting that risk in the medical record. If completing a falls risk assessment is not mandatory at your facility, consider printing out the Morse Fall Scale and attaching it to your ID badge for quick reference. A standardized tool can help you quickly quantify the risk of patient falls so you can intervene accordingly.

2. Plan your interventions.

My personal favorite fall prevention intervention is the call light. On patient care whiteboards in the ED rooms, I write my name and the phrase, “Please use your call bell for ANY reason” on the board. I orient patients to the call bell immediately and make sure that it is in reach. I explain to them why both side rails need to stay up. Additionally, you may place fall risk socks (or grippy non-skid socks) on your patient as soon as you get them undressed into a gown. Use a fall risk yellow arm band if they’re available to you.

3. Orient your patient.

“I’m going to be your nurse today, and the best way we can work together is for you to help me keep you safe.” I remind patients that even if they feel fine, that trying to get up after laying down or after receiving high-risk pain medications can cause them to feel weaker or dizzier than they might imagine. I encourage patients to use the call bell so I can help assist them out of bed for any reason, but it is also important to set expectations. “It may take me a few minutes to respond, but I will be there as soon as I can.” Try to point out IV lines and oxygen tubing to patients as well as their EKG cables and monitoring leads to remind them that they will need to stay in bed and cannot get up without assistance.

4. Active toileting.

One of the biggest reasons that patients fall is because they have to use the bathroom. For male patients I always place “just in case” urinals at the bedside, and I encourage female patients to use the call bell as soon as they think they have to use the restroom. It is also recommended that you offer toileting as frequently as possible so that you are able to prevent the “have to go right now” urge that draws patients out of their beds.

5. Teamwork works.

It would be impossible for a nurse to be able to be in all of his or her patients rooms at all times, especially within the environment of the ED. If you have a patient who is a high fall risk, who perhaps has dementia or is uncooperative, notify your charge nurse and your colleagues on the unit. Try to move the patient to a room in sight of the nurses’ station or near a hallway. Keep the curtains to the room open if possible to allow as much sight as possible from passersby. If staffing allows, perhaps you could request a safety sitter to help watch the patient to keep them safe.

6. Speak up.

If there are conditions on your unit that continually put patients at risk for falls, report them to your manager and supervisors. It is everyone’s responsibility to help prevent patient falls.

Using Communication to De-escalate Conflict Situations

Using Communication to De-escalate Conflict Situations

The combination of pain, stress, uncertainty, and a lack of control can be a recipe for conflict. Think about the times in your career you’ve heard things like, “What are we waiting for? Why aren’t you helping me? Do you know what you’re doing? When is the doctor coming? This is ridiculous.”

We encounter difficult patients and experiences all the time. Because of the additional stress that the medical or hospital setting can induce, small stressors can become escalating and potentially dangerous situations. When patients are scared, anxious, or in pain, otherwise benign miscommunications can be amplified. Conversations can quickly become confrontations.

Therapeutic conversations are part and parcel of a nurse’s daily work. One of the most important things we do for our patients is communicate. As the nurse, we often act as liaisons between family, patients, and physicians. Good communication can be the difference between a good interaction and a poor one. Preventing escalating behavior before it starts can keep everyone safe.

Naturally, you cannot control other people’s behavior, but you can control your response to it. Below are some tips for how to defuse and de-escalate conflict interactions.

Start with empathy. When someone first starts to become anxious or upset, try to start by considering why. Are they in pain? Are there precipitating factors that are contributing to their outburst? Try to use your active listening skills to show the person respect. Reflect back to the patient, repeat what they are saying, and really put yourself in their position.

Stand back. Have you ever heard that communication is 7% verbal and 93% nonverbal? Uncross your arms, use an open body stance, and position yourself in a respectful and non-confrontational pose. Approach patients from the side, and try not to back anyone into a corner. Maintain a safe talking distance. Most people are more comfortable with about three feet of buffer.

Be mindful of how you say it. Verbal communication encompasses tone, inflection, and volume. When someone begins to escalate a situation, be sure to use a slow, calm, and low volume for communication. Matching their aggression does not help defuse a situation.

Set limits. When patients get upset or defensive, sometimes it is because they are seeking information. Try to provide information about their care or answer their questions within the context of limits. For example, a statement such as, “When you keep your voice down, I will be able to tell you why we are waiting” can help set expectations of behavior.  

Drop your own defensiveness. When a patient starts to get anxious or upset, he or she tends to act irrationally and become very defensive. When someone lacks a sense of control, he or she may start yelling or start actively refusing the plan of care. When you in turn become defensive, this only matches their energy and leads to even greater irrationality. Try not to take actions or words personally and remember to maintain professionalism.

Know when to remove yourself from a situation. There are many reasons that you may need to get a coworker or teammate to “tap in” and help you with a situation. If you are ever truly feeling threatened, do not handle the situation alone. Keeping yourself and your patient safe at all times should be your main priority. 

De-escalating anxious or tense situations helps prevent violence or conflict and keeps everyone—staff and patients alike—safe. There are several courses available for certification in therapeutic interventions and crisis prevention. Visit the Crisis Prevention Institute to learn more.

Avoiding Burnout: Self-Care for Nurses

Avoiding Burnout: Self-Care for Nurses

You know the feeling. It’s your third shift in a row, it’s a particularly difficult patient or family, it’s a heartbreaking story, it’s an intense diagnosis, it’s short-staffed night on the unit. Nursing is profoundly tiring—physically, emotionally, and intellectually. Our shifts are long: Even on a normal day, by hour number 10 you may be feeling strained. You can pull from your reserves, but sometimes there isn’t anything left. You have compassion fatigue. You’re experiencing caregiver burnout.

These moments on the unit can be tough. You may feel yourself start to become anxious, or more stressed out that normal. An otherwise meaningless interaction with a doctor, colleague, or patient can leave you nearly in tears. What can you do to avoid burnout?

First of all, in the heat of the moment, take a second to breathe. Try to center yourself by inhaling through your nose and breathing out through your mouth for at least five breaths. This can help calm your body and mind, even when you don’t think it will work.

After your shift ends, it’s time to practice self-care. As nurses, it can be incredibly difficult for us to do this. But just like oxygen masks on an airplane, we all know deep down that it is difficult to care for others when we ourselves are in a fragile, fatigued place.

In theory, the easiest two things to control are our diet and sleep. In practice, we know this isn’t always the case. Aim for quality over quantity: If you can’t get enough sleep, try to make it the best sleep possible. Spend time enhancing your sleep environment with room-darkening shades, white noise machines, comfortable bedding, and a great mattress. Use the “do not disturb” feature on your cell phone. If you’re a night shifter, you could write a note on on your front door that anyone who rings a doorbell will be met with fire and fury.

For your belly, try to pack healthy, filling options for meals and snacks. Aim to always eat breakfast. Low blood sugar can easily translate into crankiness, so try to stay ahead of your curve by packing granola bars in your scrub pockets or bringing easy to eat meals for times when you can’t get a lunch break. (Which, let’s be honest, is every day.) 

Most importantly, assess yourself. We as nurses are in the business of assessing our patients, but we rarely turn that critical eye on ourselves. Try to really check in with your emotional reserves, and try to find healthy ways to process your stress. Make a care plan for yourself, and re-assess frequently. 

Quality Compressions and Tips for Better CPR

Quality Compressions and Tips for Better CPR

Perhaps you give CPR (cardiopulmonary resuscitation) almost every shift, and you consider yourself a code blue champion. Maybe you work on a med-surg unit or in a surgery center that rarely has to code a patient. Despite the ACLS (Advanced Cardiac Life Support) certification card in your wallet, you may find your skills need brushing up on. Below are some tips for ensuring that you are providing excellent CPR.

1. Get your hands on the chest quickly.
As soon as you notice that a patient is pulseless, place your hands on the chest to start compressions while yelling for others to help. Minimize interruptions to CPR.

2. Use your equipment.
If possible, use a stool so that the compressor is at the proper height, and also place a backboard or use the backboard setting on a mattress to get the proper resistance for compressions.

3. Go fast, but not too fast.
Occasionally compressors get so full of adrenaline that they compress at a rate of 120-150, which is too fast to allow for ventricular filling. The rate should be between 100-120. Tip: Music services such as Spotify actually have entire playlists created for the ideal rate of CPR!

4. Depth is important.
Get the proper depth to allow full recoil of the chest. The recommended depth for adults is 2 to 2.4 inches. Sometimes this may mean lifting your hands completely off the chest after each compression.

5. Too much of a good thing.
Pause for breaths without an advanced airway, but also be careful not to “overbag” the patient. Excessive ventilation can increase intrathoracic pressure and decrease coronary perfusion pressure.

6. Use end tidal to measure your compressions.
End tidal carbon dioxide monitoring can reveal the quality of your compressions. End tidal greater than 20 is associated with greater survival outcomes. Values of less than 20 indicate that you need to adjust your rate and depth. If end tidal suddenly jumps into the 40s, you likely have return of spontaneous circulation.

7. Switch compressors to combat fatigue.
Proper CPR is exhausting. Switch every two minutes, and you can give epi every two compressors.

8. Designate a CPR coach.
If you have extra eyes or hands, designate a CPR coach who will monitor the depth and rate of compressions and who will help ensure that compressors are switching appropriately and end tidal is appropriate.

High quality compressions lead to greatly improved patient outcomes.