Treating a patient with a mental health issue is unique within the medical field. They are often dealing with paranoia, anxiety, social withdrawal, depression, or a combination of these symptoms and others.
In addition, society has generally been slow to acknowledge and accept mental illness. There is a still a feeling that a patient may be “faking it” or just needs to “get over it,” so it’s important that we help our patients understand their mental health treatment options.
Right now, there is no genetic test that can determine if a patient has a mental illness or if he or she is likely to develop one, as exists with breast cancer.
However, there are advancements in the field that the public is starting to embrace. Most Americans (67%) say they would be willing to take a genetic test to determine the best treatment plan for mental illness if they received that recommendation from a clinician. That’s an increase of 4% for that question over last year, according to the 2017 Genomind Mental Health Poll.
While the people polled were more open to taking a genetic test if diagnosed with cancer (76%), heart disease (75%), or diabetes (72%), the disparity between the acceptance of genetic testing for mental health treatment and for the treatment of those other chronic illnesses is shrinking.
As a psychiatric and addictions advanced practice nurse, I think there are reasons for this change. First, more Americans in the poll said they knew an immediate family member, relative, or friend diagnosed with mental illness (31% stated this, which is up 3% in the past year). There were large increases the answer to this question among Hispanics (a 9% increase) and those in the South (an 8% increase), compared to the 2016 results. When we know someone dealing with a mental health struggle, I think we are more willing to understand and accept expanded mental health treatment options.
I believe there is also an increased understanding that prior to genetic testing, all we had with pharmacotherapy as clinicians was an often lengthy trial-and-error process based on the symptoms presented, the clinician’s education and experience, and the drug’s indications.
Monitoring for Polypharmacy
Clinicians and patients are also increasingly concerned about polypharmacy, the concurrent taking of multiple medications, which is especially prevalent in the elderly. The use of genetic test results to better understand polypharmacy could be another way to build support for such testing.
For example, I treated a 74-year-old woman who initially presented with 26 different medications (over-the-counter, supplemental, and prescription) that she was taking on a daily basis.
Because the patient’s symptoms were not well controlled, the information offered through the genetic test results and an online drug interaction tool were especially helpful in suggesting which drugs may have been contributing to adverse effects, which drugs may have been less effective based on her genetic variants, and which drug–drug interactions may lead to potentially harmful events. The tool that I use, the Genomind Drug Interaction Guide (G-DIG), also allows clinicians to assess how smoking or drinking coffee can affect the patient’s specific drug metabolism.
Utilizing the results from the patient’s genetic test and the information from G-DIG, I was able to explain to the patient the drug–drug interactions that might be interfering with her overall well-being.
Additionally, I was able to determine which of the various drugs she was currently taking would likely not have the intended effect or, worse, lead to some of the side effects she was experiencing based on her unique genetic variants. The patient and her family were eager to begin chipping away at the medications which testing had indicated had a potential lack of efficacy or an increased risk of adverse events.
As the patient’s medication profile was extensive, we began slowly, so her medical condition would not become destabilized. Over a period of a few months, we were able to eliminate 10 drugs from her regimen. The patient began to experience greater energy, less pain, increased motivation, and overall a better self-reported quality of life.
An important point to emphasize is that the genetic test is neither directive nor diagnostic. For those prescribing advanced practice nurses and other clinicians who may feel challenged by interpreting the results of genetic testing, I can assure you it is well within your ability to do so and that the companies that offer the testing have extensive clinical support teams to guide you through the results and the pharmacological decision-making process if the need arises. I will also point out that genetic testing to personalize medication decisions is not a new science: Oncology clinicians have been utilizing such reports for years to personalize chemotherapy regimens for their patients.
With the ability to test for drug metabolism, drug–drug interactions, and the possibility of how or if a drug will work for a patient, more individuals are now willing to explore genetic testing to clarify and personalize mental health treatment for psychiatric disorders. In my experience, the ultimate result has been healthier and happier patients.
A NICU admission is inherently stressful and difficult for many families to bear. Often, a NICU admission is completely unexpected. The separation of mother and child, along with a baby’s critical health care needs, can be traumatic. Social workers are uniquely equipped to serve the needs of both the medical team and the family. The role of the social worker in the NICU is to strengthen and empower families, encourage family resilience, and promote positive developmental outcomes for babies through assessment, advocacy, and support.
In our NICU, social workers see any family with an identified social risk factor and all babies born at or below 32 weeks gestation or any gestational age with a critical or chronic health need. When social workers meet with families, they assess the family’s social environment and mental health, the family’s strengths and needs, and any potential risks that may be present for the baby. Social workers also provide a brief orientation to the NICU and anticipatory guidance around what to expect throughout the NICU admission. Social workers educate caregivers about postpartum depression, coping with having a baby in the NICU, and adjustment to a child’s chronic illness. Throughout a baby’s NICU stay, social workers continually work with families to assess for postpartum depression, develop coping strategies, and assist with bonding with the new baby.
If a situation arises which presents a risk to the baby, social workers will sometimes contact child protective services to ensure a safe discharge plan for the baby. Child protective services has the ability to assess the caregivers in their home environment and provide intervention beyond the scope of the hospital. Involving child protective services does not always mean that a baby will not be discharged with their caregivers, but rather serves as a bridge to provide additional supportive and protective services to the families.
Social workers also act as advocates for families during a baby’s NICU stay, both within and outside the NICU. In the hospital, we can advocate for families by acting as a bridge between the family and the medical team. Social workers facilitate family meetings, help families articulate the questions that they have to the team, and help identify and correct communication breakdown between the provider and the family. Social workers also act as advocates by ensuring that a family has access to all community resources that may be beneficial for the family or the baby. Social workers can assist with public aid applications, home visiting and parenting support program referrals, and Early Intervention referrals upon discharge. Social workers also advocate for safe discharges for babies by advocating for families to receive appropriate teaching and support prior to discharge. Throughout the wider hospital, social workers advocate for cross-culturally informed and trauma-sensitive practices, polices, and procedures.
Throughout a baby’s NICU stay, social workers provide support to the family. Sometimes, this means providing supportive counseling, anticipatory guidance, or reminding a family of their strengths. Other times, this means validating and normalizing a family’s feelings, providing a safe space for a family to vent, or helping a family to process their NICU experience. We can also help moms understand and identify symptoms of postpartum depression in themselves, and can connect moms to counseling resources when necessary. Social workers also provide grief support during a loss or a baby’s sudden clinical decompensation. Often, social workers provide crisis intervention to support families in situations of extreme stress or family conflict. Social workers can also help to coordinate an interdisciplinary team response to a family’s crisis to ensure that each team member’s strengths and expertise are best utilized.
Social workers work closely with the interdisciplinary team, including nurses, to provide support to families throughout the patient’s hospitalization. Social workers depend on report and documentation from nurses about the daily care that a family is able to provide from their child, and what teaching or additional resources that a family can benefit from. Social workers also use nurses’ observations, assessments, and expertise to help identify which families may benefit the most from the social work intervention. Nurses can identify the need for a social worker when they notice a family having difficulty coping or difficulty learning a baby’s complex care needs who may benefit from additional resources. Nurses can also provide great insight into a family’s normal visitation schedule, preferred communication style, and coping with a patient’s NICU admission. Social workers consider nurses’ observation and insight when completing assessments and planning interventions.
As a social worker, I strive to meet families where they are at. In the NICU, families can experience a range of emotions—feeling thrilled that their new baby is here, being terrified about their baby’s medical status, being anxious and uncomfortable in the ICU environment, being angry at the loss of a hoped-for birth experience, being confused by medical lingo and NICU procedures, and being excited to take their baby home. No matter what a family is going through, I hope to be an empowering and helpful presence as I support them with my clinical skills and knowledge.
“Give every day the chance to become the most beautiful day of your life.” —Mark Twain
Today more than ever, nurse educators must consider global health when planning and developing nursing courses. A 2007 study published in the National League for Nursing’s research journal, Nursing Education Perspectives, found that globalization has had a significant impact on health and it is imperative to include global health topics in all nursing curricula. Topics should include: the role of the global health nurse, various diseases, and the impact of global diseases on health care. Cole Edmonson and colleagues argue that in order to effectively address global health preparedness there needs to be interprofessional cooperation among non-profits, private companies, and governments.
Global Health Nursing
Global health nursing roles include short and long-term engagements, and some schools even provide opportunities for their students, which can be quite rewarding. Global nurses can also practice within their own borders by practicing with a focus on health equity, says Thomas Quinn, MD, MSc, the director of Johns Hopkins Center for Global Health. For example, nurses can volunteer to teach in community-based education programs.
Nurses who are interested in global health can also make monetary donations or collect donation items for global groups that support a variety of global initiatives. For instance, the Peace Corps has volunteer opportunities and paid positions for nurses, and the International Volunteer HQ has myriad opportunities for nurses and students nurses to serve overseas. Another agency, Health Volunteers Overseas, seeks to recruit nurse educators and nurse practitioners to serve as clinical mentors and teachers. The assignments range from 2-4 weeks. Some nurses may choose to obtain full-time employment as international health nurses and/or international travel nurses and may work in a variety of settings and countries. There are many requirements to fulfill, and it can be a daunting experience to arrange for licensure, visas, travel, housing accommodations, and health requirements.
General Requirements for Nurses
- Minimum of two years experience
- Knowledgeable on communicable diseases
- Up to date on immunizations
- Available for entire length of time required
It is best to work with an agency who can help facilitate the experience and ensure that all requirements are met.
- United Nations
- World Health Organization
- The Peace Corps
- The American Red Cross
- Catholic Relief Services
- Centers for Disease Control
Nurse educators must stay abreast of current and future global health issues and continually update their courses. Global health topics may be incorporated into the curriculum as a standalone course or integrated throughout the curriculum. Hospital-based educators should also incorporate global health topics into their orientation and competency programs.
Key Global Health Issues
- Emerging Infectious Diseases
- Human Trafficking
- Nurses and Health Equalities
- Maternal-newborn health
- Preventable childhood illnesses
- Unsafe Drinking Water
- Infectious Diseases
- HIV and AIDS related illnesses
- UN Millennial Goals
Every day, Nancy Brook, MSN, RN, CFNP, sees breast cancer patients in an outpatient clinic at Stanford Healthcare. She says that most of her patients have metastatic breast cancer—cancer which has traveled to a site in the body beyond the breast. Brook, who offers cancer coach training for health care professionals, spoke to us about her role as a nurse working with patients who have breast cancer.
What do you do on a daily basis?
My role includes evaluating my patients to see how they are doing since their last visit, reviewing X-rays or other studies they may have had, and providing a lot of education about their next steps and treatment. I spend a lot of time assisting patients with navigating the health care system, which can be challenging.
How long have you worked in this position and why did you choose this type of work?
I have been part of this oncology team for nearly 15 years. I chose to work with this particular patient population for several reasons: first, because I felt that I could make a big difference in their lives. Second, I recognize that there are many opportunities to counsel and coordinate care, and I really enjoy that aspect of my work. Finally, I lost both my mother and grandmother to cancer and understand how complex this care can be.
What are your greatest challenges and biggest rewards from working in this sector of the nursing field?
The biggest challenges are managing time—our patients have many questions and concerns, and it can be difficult to spend as much time as we would like with each one. Also, our patients are often scared and anxious, which requires us to spend additional time with them and to have patience.
The greatest rewards are when our patients do well; when we see them recovered from a surgery or procedure, and they are able to be active and engaged in their lives. Then, having the opportunity to celebrate with them.
What advice would you give to someone thinking of pursuing nursing in this part of the field?
I would encourage any nurse who is interested in this kind of work to talk with colleagues who are in the field. Oncology includes many subspecialties, and it is helpful to have a good understanding of what the work will be like before you make a change. To get started, a license as a registered nurse is required. Some specialties may require a certification in chemotherapy administration. As an advanced practice nurse or nurse practitioner, a master’s degree and national certification is required.
Most adults work 8-hour days, but because nurses are superhuman we work 12-hour shifts. Working this long can seem daunting, but with a few tricks, you’ll be able power through your shift and be ready for another one the next day. Here are some suggestions to help you survive the long hours.
1. Put a snack in your pocket.
You may not always be able to take a break when you want to during your 12-hour shift. Emergencies or high patient censuses can cause you to have inconsistent break times. Instead of letting your energy plummet because you haven’t eaten in hours, try putting a snack in your pocket to munch on when you need to refuel. A small fruit and nut granola bar is the perfect size for your scrub pockets and easy to eat when you have a moment to spare.
2. Protect your body.
Being a nurse is extremely physically taxing. Protect your body, especially your back, when turning or getting a patient out of bed. Use good body mechanics or a mechanical lift if needed. Try taking some time before every shift to stretch and loosen any tight muscles to prepare your body for the long day ahead. If you do hurt yourself while at work, be sure to report it and get the help you need before the injury gets even worse.
3. Wear compression socks.
That’s right, compression socks aren’t just for your post-operative patients. Being on your feet for long periods of time puts you at a high risk for varicose veins, and wearing compression socks can help reduce that risk. Compression socks can also help reduce fatigue by improving blood flow and reducing lactic acid build up. If you find that your calves are sore and your ankles are swollen after working, you may want to try slipping on a pair of compression socks before your next shift. Your legs will thank you later!
4. Get off the unit during your breaks.
When you have a chance to take a break, really take advantage of it. Don’t eat your food at the nurses station. Getting away from your unit will help you relax more fully and enjoy your break. Give your work phone to another nurse. If you are answering phone calls and helping patients on your break, you will not be refreshed and ready to go when your break is over. Take your mind off of your patients by doing something during your break that you find relaxing, like reading a book or listening to music.
5. Invest in shoes that are right for your feet.
Some days you will be so busy that you could be on your feet for 12 hours straight. If you are wearing shoes that don’t fit properly, by the end of your shift your feet will ache and you could even have blisters. Go to an athletic shoe store to have your feet and stride analyzed by a professional who can advise on the best shoes for your feet. Don’t forget to replace your shoes every 6-9 months or when the tread wears down.
Losing a patient is one of the most difficult things that a nurse experiences. No matter how hard they’ve worked and how many interventions they’ve done, sometimes patients will still die. And telling the families is even more difficult.
Nurses in the Surgical-Trauma Intensive Care Unit at the Carolinas Medical Center (CMC) have found a way to bring some form of peace to the families, by giving them a Heartbeat in a Bottle.
Charis Mitchell, RN, PCCN, Clinical Bedside Nurse II for Carolinas Healthcare System at CMC, says that the Heartbeat in a Bottle originated at Sentara Norfolk General Hospital. She states that Michelle Cox, a traveling nurse, learned how to make them and brought the idea to CMC, and nurses began making them there in 2012. Mitchell learned to make them in 2014 from coworker and friend Maggie Reynolds.
“When a patient passes away on our unit or when we shift to comfort-oriented care, we print one of their last heartbeats, and place it in an empty medicine bottle,” explains Mitchell. They then place a ribbon on it and seal it to give to the family. Because each person’s heartbeat is uniquely theirs, it’s even more special.
Mitchell estimates that since CMC nurses have been making them, they’ve made a couple hundred of them for families. When word spread about the Heartbeat in a Bottle, Mitchell received requests from nurses throughout the Carolinas Healthcare System on how to make them. As a result, she’s made a tutorial so that any nurses can make them. (See how to make your own Heartbeat in a Bottle here.)
“I came into health care to heal, so I remember when a death of my patient felt like a failure,” says Mitchell. “There are times, as a nurse, that I still feel defeated at the literal loss of my patient’s life—as if we lost a battle. No matter what the circumstance is of how and why my patient died, I have found it’s my honor to provide them with a dignified death. I see Heartbeat in a Bottle as a way to take care of my patient’s family in a way that my patient would want them to be loved.”
Mitchell says that there are two reactions in play when a nurse gives the family a Heartbeat in a Bottle—the nurse’s and the family’s. “As for the nurse, you have to mentally prepare yourself to tell the family what you have for them. There’s this temptation that you have to be the strong one. But the truth is, it affects us too. When you give the bottle, you have no choice but to show your emotions and your vulnerability. You know it’s going to take more out of you than you necessarily have to give, but to help the family being the healing process makes all the difference.”