When Words Do Harm

When Words Do Harm

Last year, the American Diabetes Association prohibited the use of the word “diabetic” to describe patients in its publications. And at a recent conference, the group cautioned health care providers against using the “ic” term and other words that might alienate patients.

Among the objectionable words: “uncontrolled,” “non-adherent,” and “non-compliant.” Even using words like “good” and “bad” to characterize a patient’s blood glucose levels can have a negative impact, diabetes experts say, leaving patients feeling judged and stigmatized.

Better choices, they say, would be “in range” or “out of range,” or “high” or “low” — and it’s not just a matter of semantics. How we talk about diabetes directly impacts patients’ behavior.

If this sounds a bit far-fetched, think about it this way: When you tell the night shift nurse during bedside shift report that “Mr. Smith is a 54-year-old diabetic” you’ve just defined Mr. Smith’s entire being by his disease. When you jot down that Mrs. Jones has been “non-compliant” because she hasn’t been regularly testing her blood glucose levels, she feels the sting of a scolding—and maybe a sense of personal failure, too.

At the end of the day, these judgmental words and phrases can erode an individual’s motivation and actually worsen their blood glucose control. That’s because it contributes to “diabetes distress”—the fear and futility that creeps into a patient’s head when the process of managing diabetes begins to seem overwhelming.

It’s not just in the endocrinology clinic that words can do harm. A 2010 study published in the journal Spine found that patients with low back pain had a more negative perception of their prognosis when their physicians attributed their back pain to a “degenerative” process involving “wear and tear” of the spine or “crumbling” or “collapsing” discs.  In essence, when it sounded bad, the patients viewed their condition as worse than it necessarily was—and that hopeless mindset made them more hesitant to engage in therapies that might actually improve their health.

The impact of word choice is especially evident in psychiatric care and nurses should be careful to avoid using stigmatizing language. In an article published last year in the Journal of the American Medical Association, then-drug czar Michael Botticelli and Harvard professor Howard Koh opined that it wasn’t all that long ago that individuals with mental illness were referred to as “lunatics” and the hospitals where they were treated as “insane asylums.”

Just as those insensitive terms were appropriately abandoned, we need to rethink the way we talk about problems like addiction. A patient isn’t a “drug abuser;” they’re a “person with a substance abuse disorder.” Instead of referring to drug results as “clean” or “dirty,” they should be characterized as “positive” or “negative,” or “substance-free.” The word “drug habit” is problematic too, because it can imply that a substance abuse disorder is a personal choice, rather than simply a disease.

As we incorporate a better vocabulary into our practices, we must also remember that non-verbal language can be just as powerful as the spoken word.

For me, that lesson became crystal clear several years ago while caring for a patient who’d been hospitalized for a warfarin-associated G.I. bleed.

It had been a rough 24 hours, but after several bags of vitamin K, the patient appeared to be improving significantly. His INR was coming down and the attending had just told him that he was out of the proverbial woods. So I was flummoxed when the patient burst into tears as I was taking his vital signs.

“Are you in pain? What’s wrong?” I frantically asked.

The usually cheerful, middle-aged man grabbed my hand, sniffled, and in between unrestrained, breathless sobs asked me if he was dying. “I’ve been watching you all morning,” he confided, “and every time you take my blood pressure, you have this terrible, serious look on your face—so I figured I must be dying and you’re just too nice to tell me.”

That day I learned that language is more than just words, and I began to practice my poker face.

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.

4 Ways to Relieve Tension Headaches

4 Ways to Relieve Tension Headaches

A few days ago, a friend of mine asked me if I had any tips for managing tension headaches; she’s been experiencing them more frequently from working long hours as an ER nurse. Like many nurses, she spends most of the day on her feet. By the end of her shift, her muscles feel stiff, her head is pounding, and she needs a few, quick tools to relieve her pain. If you experience tension headaches while at work, hopefully, these tips will be useful to you as well.

1. Loosen up your muscles

In an online article, Mayo Clinic recommends the application of heat or ice to loosen up tense neck and shoulder muscles. “Use a heating pad set on low, a hot water bottle, a hot shower or bath, a warm compress, or a hot towel. Or apply an ice pack (wrapped in a cloth) or a cool washcloth across the forehead.”

Although using a heating pad at work might not be practical, resting an ice pack on your neck when you’re at lunch or on a break might be an easy fix to help lessen muscle tension and mitigate your headache.

2. Try some breathwork

In February, we discussed some of the benefits of breathwork, like encouraging relaxation, reducing anxiety, energizing you, and lessening the feelings of physical and mental stress. Additionally, breathwork can decrease muscle tension, particularly if you try The Five Count Breath. This technique, implemented in Pilates exercises, oxygenates your body and reduces muscle tension in the rib cage and thoracic spine. Here’s a recap on how to use this simple breathing exercise:

Start with a slow inhale through your nose to the count of five. Then, exhale your breath through your mouth also to the count of five. Picture yourself wringing all the stale air out of your lungs and replenishing them with fresh air. With each breath, imagine the tension dissolving from your head, neck, shoulders, and back. Repeat this cycle five to 10 times or whenever needed to reduce overall physical and mental stress.

3. Sneak in a neck stretch

The chin tuck is an effective way to stretch your neck muscles. Sit comfortably in a chair with your feet flat on the floor. Draw your shoulder blades together and keep your head facing forward. Gently move your head back, making sure to keep it level; you don’t want your chin to lift up or dip down. Hold this stretch for five seconds and repeat five to 10 times.

4. Treat yourself to a massage

If you’re not finding relief with basic measures, consider getting a massage. The American Massage Therapy Association believes that massage can be used to alleviate tension headaches and improve postural alignment. Looking for an excuse to treat yourself to a little TLC? Now, you have one!

How Do You Handle Difficult Patients?

How Do You Handle Difficult Patients?

Every nurse has them—the difficult patients that, no matter what good is happening in their lives, are just really negative with their attitudes all the time. So what can you do to help them and to help yourself, as it’s not easy to deal with so much negativity?

Dr. Jodi De Luca is a licensed clinical psychologist who has been working in hospitals for years and currently works in an Emergency Department at Boulder Community Hospital in Colorado. She’s the “go-to” person, especially when patients are negative or challenging to work with.

“In-patient hospitalization or a visit to the ER can be a threatening and stressful experience,” De Luca explains. “From an emotional and psychological perspective, the visit can be overwhelming.” She says that everything from the loss of control, fear of procedures, fear of death, and the like can terrify patients. “Nurses in particular bear the brunt of the negative behavior.”

It’s important to know how to deal with these patients because they can cause nurse burnout, increase anger and resentment toward the patient, and other patients suffer or can be neglected because all the nurse’s time is spent on this particular patient.

De Luca has some tips for nurses on dealing with these kinds of patients:

1. Setting structure and limits are key.

Be direct when clarifying limitations, particularly in explaining to the patient what is unacceptable and disrespectful behavior.

2. Eliminate the unknown whenever possible.

Knowledge gives the patients power and control.

3. Whenever possible, offer the patient realistic options of care.

By doing so, the patient feels empowered in his/her decision making and may feel validated and more in control. As a result, the behavioral manifestations may be reduced.

4. Ask questions that elicit a sense of control for the patient.

Ask questions such as: What would make things better? What options do you propose? If this option is not possible because of (the reason), but these options are available, which do you think would be best for you?

5. If possible, have nursing and medical staff alternate work load with a negative patient.

This gives everyone a chance to mentally recharge and prevents the negative patient from monopolizing all of your time.

6. Find out what the patient’s expectations are.

Are they realistic? Can they be accommodated? Are there options?

7. Explain to them how their behavior negatively affects their overall well-being and treatment.

When patients are under duress, particularly in a hospital setting, they are often unaware of their own behavior.

8. If possible, have a third party present when you are dealing with difficult patients.

Document not only behavior, but also what the patient states verbatim. Documentation and third-party witness is our best defense particularly with regards to future potential repercussions, complaints, and litigation.

9. Consider engaging the assistance of the Behavioral Health Team at the hospital.

Psychologists, psychiatrists, case management, and social workers can help provide treatment recommendations for the staff as well as the patient and to rule out any other potential contributors to the behavioral disruption and negativity (such as medication reaction, delirium 2nd to metabolic insufficiency, infections, etc.).

Kangaroo-A-Thon: Promoting Positive Touch

Kangaroo-A-Thon: Promoting Positive Touch

While working in a NICU setting, we as staff get used to the long-term admissions, fragile 24-weekers, and the deer-in-headlights look from caregivers during those first few weeks. Feelings of inadequacy and lack of control can easily creep into our most experienced and knowledgeable caregivers when their baby is the patient. Much of this time, caregivers look to the medical team to provide care to their babies and can easily forget the power they have as a caregiver. Kangaroo care (skin-to-skin) holding gives back a huge level of control as caregivers are able to provide undeniable benefits to their baby that no nurse or doctor can provide.

What is skin-to-skin holding?

Kangaroo care involves direct skin-to-skin contact between the caregiver and infant. This type of touch stimulates the C-afferent nerves, which are packed under the sensitive skin on our chests. Research shows that activating these nerves with positive touch leads to a release of hormones that promote many positive benefits including: brain growth and development, digestion and weight gain, immune system benefits, reduced stress and crying, stability of heart rate and breathing, temperature regulation. These nerves send a message to the brain that produces oxytocin, which creates physiological and psychological benefits. All of these positive outcomes greatly affect an infant’s hospitalization as they are provided with real human connection with the people that love them the most.

For caregivers, this special time with their infants promotes bonding, positive coping, and emotional connection during this stressful time. Caregivers are empowered to make observations about their babies, engage in their daily care, and learn appropriate ways to stimulate their infant which increases collaborative care between caregivers and nurses.

What is a Kangaroo-A-Thon?

A Kangaroo-A-Thon is an event to promote this wonderful skin-to-skin holding between infants and caregivers! The event was held over the course of 13 days to allow for maximum opportunities for participation. Nurses were instrumental in being available, providing education, and supporting our caregivers to engage in the act of skin-to-skin care. Caregivers were encouraged to hold their infants skin-to-skin as long and often as possible (and was safe) during these 13 days. A plethora of prizes were raffled off to caregivers and nurses as the unit was decorated with kangaroos and hearts to support our “Heart-to-Heart” theme.

What happened?

We had a tremendous response across all disciplines and especially with our caregivers.  The number of families participating in the event increased over 50% from the week prior to the event and our total number of hours documented rose from 140 hours to just over 304 hours.  Caregivers were asking more questions and becoming more confident and capable partners in their baby’s care.  All in all, we had a very fun time promoting, supporting, and running this event. Skin-to-skin care is a simple yet extremely effective tool that turns even our most cautious caregivers into confident, knowledgeable, and competent partners.

3 Budget-Friendly Ways to Relax this Summer

3 Budget-Friendly Ways to Relax this Summer

Nursing is a demanding job and you’re probably looking forward to taking some time off this summer.

Summer is the time of year for backyard barbecues, lounging by the pool, and jetting off for a much-deserved vacation. With so much going on during the fleeting summer months, it’s easy to wreck your budget.

Here are a few budget-friendly ways to relax this summer.

1. Keep Food Costs Down

It’s easy for food costs to balloon up during summer. Who wants to cook in a hot kitchen when you can relax over a summer salad on a restaurant patio? However, lots of restaurant visits is a sure way to increase your food budget.

Consider stocking up on fresh produce at your local farmer’s market and trying out new delicious salad recipes at home. The prices are often cheaper than conventional grocery stores and visiting the farmer’s market is a fun, frugal outing and a great way to support local farmers.

Find other food staples at discount grocery stores such as Aldi or stock up at Costco. Enjoy dinner outside with friends and family in your own backyard or have a picnic at a local park.

2. Staycation

Staying close to home can save you hundreds of dollars this summer.

Grab a free local attractions guide from the library or grocery store and commit to doing something in your own hometown that you’ve never done. You may be surprised at all of the activities and events available that are a short drive away from your front door.

If you do venture further from home, be sure to calculate the cost of driving versus flying. The free online tool, Travel Math, will calculate and compare the costs of driving versus flying to your destination.

3. Simple Pleasures

Summer is a great season for celebrating the simple pleasures of life such as good weather, a bike ride, or a cool drink in hand while reading a juicy novel by the pool.

If you follow these tips, you’re sure to have a relaxing summer that will keep you and your budget happy.

What fun plans do you have this summer?