Mothers inspire daughters in untold ways, including choice of profession. However, that dynamic takes on special meaning when the profession is nursing during a pandemic – and when the mother and daughter work at the same organization.
Such is the case with Jonna Dube, MBA, BSN, RN and her daughter Alex Dube, BSN, RN.
After graduating with a BSN in 2019 from Massachusetts College of Pharmacy and Health Sciences, Alex was hired as a new graduate nurse on the inpatient pediatric floor at UMass Memorial Health.
Then, COVID-19 hit, and Alex’s career path took an unexpected turn.
“I was so happy that we were able to go to the COVID ICUs and be that extra helping hand, because that’s what nursing is.”
Instead of starting her new graduate program to care for children, Alex wound up with her fellow graduate nurses helping patients in COVID units. Most of her time was spent on the newly established prone team, where she worked with other nurses and respiratory therapists to get intubated, sedated COVID patients into a prone position to improve their respiration.
“Going from what I thought was going to be working on the pediatric unit to the adult ICU couldn’t have been more opposite from what I expected going into nursing,” Alex said in an interview. But “it was such a good idea to take all the new graduate nurses and put them where they needed us. That’s what nursing is. It’s being helpful when needed, where needed. I was so happy that we were able to go to the COVID ICUs and be that extra helping hand where they needed us because that’s what nursing is.”
Alex admits she felt scared as a new nurse who never worked in an ICU before. But, she says, she was proud to be able to help take care of these COVID patients.
Following mom’s footsteps
Alex says that her mom’s influence “absolutely” played a role in inspiring her to take up nursing.
“My mom is one of the only ones in our immediate family in the medical field,” Alex says. Alex admired her mom for being the go-to person for medical concerns. “I always admired her for that and I always wanted to do that. I wanted to be someone who can be helpful and have a job where you make a difference every day. My mom was always that person and I always knew I wanted to do that in any capacity, and nursing just seemed like the best way that I could help as many people as I could.”
“Nursing just seemed like the best way that I could help as many people as I could.”
When learning that her daughter wanted to become a nurse, “honestly my first response was just joy,” says Jonna, obviously proud of her daughter. “Alex puts 100% into everything that she does and helping people is such a gift. I always say I’m so happy for the patients and for the community because she’s a great person and she’s an even better nurse. I was thrilled that she wanted to go into nursing,” Jonna says.
A nurse at UMass Memorial since 2002 when she was an emergency department RN in the new grad program, Jonna currently serves as senior director, government program operations and care pathways. In this position, she works to ensure exceptional care for patients during a 90-day continuum related to the Medicare bundled payment initiative, ensuring they avoid emergency department readmissions.
At the start of the pandemic, Jonna opened a nurse triage command center with 10 nurses from the organization. The center took calls from patients in the community who had COVID symptoms or questions, triaged them, and sent them for testing if they met criteria. The team then delivered all of the results as well as education.
“This was my proudest and most rewarding endeavor as a nurse and as a leader at UMass Memorial Health that I was blessed to be a part of,” Jonna says. “We were not at the bedside, but we definitely had a huge impact on mitigating emergency department visits as well as stopping the spread of the virus through education.”
Return to peds
This past summer, Alex transitioned to pediatrics, where today she works as a staff nurse. She also currently is a student at MCPHS University in the family nurse practitioner master’s program.
Alex admits times have been challenging. “I don’t know any other nursing,” she says. “Pandemic nursing is kind of all I know.”
However, she remains enthusiastic and optimistic. “As challenging as it’s always been, it’s never made me question what I’m doing,” Alex says. “I knew going in that my whole job was to help other people. And we still get to do that. It’s gotten harder and it gets difficult sometimes. But our goal is to help the public and that’s what we keep doing, as challenging as it is.”
“I’ve never worked harder than I have these past two years, but I’ve never been more motivated or inspired by the work that we’re doing today.”
Jonna credits her organization’s senior leadership with helping staff through these tough times. “The leadership has been so uplifting, inspiring. They kept the communication going. They’ve helped us to make sure that it’s really important that we take care of ourselves right now so that we can take care of other people.”
“We’re just really blessed to be able to make a difference in people’s lives every day,” Jonna says, echoing her daughter. “And that’s what inspires me. I’ve never worked harder than I have these past two years, but I’ve never been more motivated or inspired by the work that we’re doing today.”
The American Association of Critical-Care Nurses (AACN) has created a guide to help those who have been vaccinated to engage in constructive conversations with family members and friends who are hesitant about the vaccine. The toolkit is part of AACN’s Hear Us Out campaign to report nurses’ reality from the front lines of the COVID-19 pandemic and urge those who are unvaccinated to reconsider.
“COVID-19 is still here. The majority of patients with COVID we’re seeing in ICUs haven’t been vaccinated, and their journey often ends with a nurse holding their hand as they die,” said Beth Wathen, AACN president and a clinical practice specialist in Denver. “Nurses need allies to end this pandemic, and productive conversations about the vaccine among family, friends and those who trust each other can open minds.”
The toolkit includes tips to help individuals prepare for potentially challenging conversations and talk with those who hesitate to get vaccinated. It provides resources to continue the conversation, including tip sheets, links to trusted information sources, short videos of nurses sharing profound experiences of taking care of unvaccinated patients with COVID-19 and more to help keep talking with people about the importance of getting vaccinated.
“This toolkit offers straightforward tips to keep sensitive conversations from becoming confrontational,” said Stephanie Burdick, a community health strategist in Salt Lake City. “It fills a critical gap in community health education as the public prepares to celebrate the upcoming holidays with friends and loved ones.”
A recent AACN survey of more than 6,500 acute and critical care nurses found that 76% of respondents say that people who have yet to be vaccinated threaten nurses’ physical and mental well-being. It also found that 92% of nurses surveyed said they believe the pandemic has depleted nurses at their hospitals and, as a result, their careers will be shorter than they intended.
“We know that people in communities with low vaccination rates are at greater risk for becoming seriously ill with COVID-19 and dying from what is now largely a preventable disease,” said Amanda Bettencourt, AACN president-elect and an assistant professor in Philadelphia. “The pandemic has brought the nursing profession into crisis, and the public is a critical part of the solution. The fastest way out of this is by more people getting vaccinated.”
To learn more about how AACN is helping Americans have informed and constructive conversations about the decision to be vaccinated, visit hearusout.com.
In September, when Texas’ near-total abortion ban took effect, Planned Parenthood clinics in the Lone Star State started offering every patient who walked in information on Senate Bill 8, as well as emergency contraception, condoms and two pregnancy tests. The plan is to distribute 22,000 “empowerment kits” this year.
“We felt it was very important for patients to have as many tools on hand to help them meet this really onerous law,” said Elizabeth Cardwell, lead clinician at Planned Parenthood of Greater Texas, which has 24 clinics across the northern and central regions of the state and provides care to tens of thousands of people annually.
Most of their patients — who tend to be uninsured and have annual household incomes of less than $25,000 — had not known about SB 8 the first several weeks after implementation, said Cardwell. But once they learned about it, patients seemed to rush to get on birth control, she said.
SB 8 allows private citizens, in Texas or elsewhere, to sue anyone who performs an abortion in the state or who “aided or abetted” someone getting an abortion once fetal cardiac activity is detected. This is generally around six weeks, before most people know they’re pregnant. It’s had a chilling effect in Texas, where access to abortion was already limited.
Medical staffs are doubling down on educating patients about birth control. They recognize the strategy isn’t foolproof but are desperate to prevent unintended pregnancies, nearly half of which nationwide end in abortion.
“It’s more important now than it ever has been,” said Cardwell. “I’ve been in abortion care 30-plus years, and my go-to line was ‘You’ve got plenty of time. You don’t have to feel rushed. Talk with your partner. Talk with your family,’” she said. “Now we don’t have that luxury.”
Patients, too, seem to feel a sense of urgency. During September, according to data from Planned Parenthood of Greater Texas, medical staff provided patients with some form of birth control — for example, pill packs, Depo-Provera shots or IUD implant insertions — in more than 3,750 visits, 5% more than in September 2020.
Dr. Jennifer Liedtke, a family physician in West Texas, said she and her nurse practitioners explain SB 8 to every patient who comes to their private practice and saw a 20% increase in requests for long-acting reversible contraceptive methods, known as LARCs, in September.
LARCs, a category that includes intrauterine devices and hormonal implants, have become increasingly appealing because they are 99% effective at preventing pregnancy and last several years. They are also simpler than the pill, which needs to be taken daily, or the vaginal ring, which needs to be changed monthly.
Still, LARCs are not everyone’s preferred method. For example, inserting an IUD can be painful.
A doctor’s office is one of the few opportunities for reliable birth control education. Texas law doesn’t require schools to teach sex education, and if they do, educators must stress abstinence as the preferred birth control method. Some doctors opt to explain abortion access in the state when naming birth control options.
Liedtke is used to having to explain new laws passed by the Texas legislature. “It happens all the time,” she said. But the controversy surrounding SB 8 confuses patients all the more as the law works its way through the court system with differing rulings, one of which briefly blocked the measure. The U.S. Supreme Court heard related arguments Nov. 1.
“People just don’t understand,” said Liedtke. “It was tied up for 48 hours, so they are like, ‘It’s not a law anymore?’ Well, no, technically it is.”
Not all providers are able to talk freely about abortion access. In 2019, the Trump administration barred providers that participate in the federally funded family planning program, Title X, from mentioning abortion care to patients, even if patients themselves raise questions. In early October, the Biden administration reversed that rule. The change will kick in this month. Planned Parenthood can discuss SB 8 in Texas because Texas affiliates do not receive Title X dollars.
Dr. Lindsey Vasquez of Legacy Community Health, the largest federally qualified health center in Texas and a recipient of Title X dollars, said she and other staff members have not discussed abortion or SB 8 because they also must juggle a variety of other priorities. Legacy’s patients are underserved, she said. A majority live at or below the federal poverty level.
Nearly two years into the covid-19 pandemic, “we’re literally maximizing those visits,” Vasquez said. Their jobs go beyond offering reproductive care. “We’re making sure they have food resources, that they have their housing stable,” she said. “We really are trying to make sure that all of their needs are met because we know for these types of populations — patients that we serve — this may be our only moment that we get to meet them.”
Specialized family planning clinics that receive Title X dollars do have proactive conversations about contraceptive methods, according to Every Body Texas, the Title X grantee for the state.
Discussions of long-acting reversible contraception must be handled with sensitivity because these forms of birth control have a questionable history among certain populations, primarily lower-income patients. In the 1990s, lawmakers in several states, including Texas, introduced bills to offer cash assistance recipients financial incentives to get an implant or mandate insertion for people on government benefits, a move seen as reproductive coercion.
“It’s important for a client to get on the contraceptive method of their choice,” said Mimi Garcia, communications director for Every Body Texas. “Some people will just say, ‘Let’s get everyone on IUDs’ or ‘Let’s get everybody on hormonal implants’ because those are the most effective methods. … That’s not something that’s going to work for [every] individual. … Either they don’t agree with it philosophically or they don’t like how it makes their body feel.”
It’s a nuanced subject for providers to broach, so some suggest starting the conversation by asking the patient about their future.
“The best question to ask is ‘When do you want to have another baby?’” said Liedtke. And then if they say, ‘Oh, gosh, I’m not even sure I want to have more kids’ or ‘Five or six years from now,’ then we start talking LARCs. … But if it’s like, ‘Man, I really want to start trying in a year,’ then I don’t talk to them about putting one of those in.”
The Biden administration expected more demand for birth control in Texas, so Health and Human Services Secretary Xavier Becerra announced in mid-September that Every Body Texas would receive additional Title X funding, as would local providers experiencing an influx of clients as a result of SB 8.
But providers said improved access to contraception will not blunt the law’s effects. It will not protect patients who want to get pregnant but ultimately decide on abortion because they receive a diagnosis of a serious complication, their relationship status changes, or they lose financial or social support, said Dr. Elissa Serapio, an OB-GYN in the Rio Grande Valley and a fellow with Physicians for Reproductive Health.
“It’s the very best that we can do,” said Cardwell, of Planned Parenthood of Greater Texas. “There’s no 100% effective method of birth control.”
As angels have been known as messengers and guides from time immemorial, it is not necessarily hyperbole for patients and families to refer to hospice liaison nurse – and Nurse of the Week – Ligaya “Joy” Villanueva Bercasio, BSN-RN as an “angel.”
Of her calling as a nurse, Bercasio says “Caring, I think, is really a feeling of happiness for me. You know, fulfillment. I really do believe it is a calling for me. I’m in the right profession, I think.”
The depth and extent of the 30-year nursing veteran’s compassion moved the son of two patients so much that he has virtually adopted her as an honorary family member. Bercasio, who works at Hawaii’s St Francis Healthcare System, was a true guide to Roland Bueno as she comforted him after his parents died. She first met the Buenos in September 2020, when she visited them to talk about providing hospice care for their father. Their encounter was far more eventful than any of them had anticipated.
Almost at once, they established an unusual rapport. As Bercasio recalls, while talking with Roland, his mom, and his father, it felt “like we’ve known each other for a long time… You know, we really established rapport [in a] very short period of time! Nana sharing her love story in the Philippines with Tata, showing their pictures and everything.” (Angels tend to be welcomed on that sort of beyond-first-name basis).
Ligaya “Joy” Villanueva Bercasio, BSN-RN.
But the visit had a dramatic conclusion. “Nana” had left the room, and as Bercasio was readying to leave, they heard a loud thump in the house. She recalls, “Me and Roland ran back to inside the house and we saw Nana on the kitchen floor unresponsive, not breathing, and no pulse. So I immediately did CPR on her, hoping we could revive her.”
Sadly, although Bercasio was initially able to get a response from Nana (Ms. Bueno), Roland’s mother passed away in the hospital. Shortly afterward, her ailing, grieving spouse followed her.
An encouraging force
A Nurse of the Week who didn’t miraculously save lives? As nurses know well, caring doesn’t end with a patient’s passing. Nursing care extends to relatives as well, and nurses often have a very special gift for connecting with and supporting families in the throes of loss. It was Bercasio’s strong and reassuring presence after that loss that inspired Roland Bueno to nominate her as a “healthcare hero” of Hawaii’s health system.
“My mom and dad had passed very close to each other, just unexpectedly, and she was so integral to that process of accommodating us — not just the health things, but she was just really an encouraging force in our family,” Bueno declared. He told Hawaii News Now, “I’ve heard you can’t change the world, but you can change the world for one person, and I’ve been on the giving end of it, but I have not been on the receiving end. So she really changed the world for our family, too.”
Nurse of the Week Kashon Holmes, RN is also our candidate for Father of the Year. Holmes had long dreamt of becoming a nurse. He had done his homework early and was keenly aware that school would require an intense commitment and focus. “I tell people nursing school will not be cheated on,” Holmes told a reporter. “You need to be 100 percent in, or it’s not going to work out.”
Back in 2002, Holmes was ready. Shortly after his first son, Kashon, Jr., was born, Holmes enrolled at Maria College School of Nursing in Albany, NY. However, while the young man was grinding away to prepare for his 2003 final exams, he realized that his calling should perhaps have been midwifery: yes, the stork was on its way to bring another little addition to the Holmes family. So, would he have to settle for being a distracted, part-time parent for the next three years? Having already missed out on some of Kashon, Jr’s first milestones, Holmes just didn’t feel like he could become a good nurse if he was an absent dad. Giving up the nursing program was a painful sacrifice, but he felt there was only one choice. “Knowing that I had to take care of my son and raise him and everything, that wasn’t a hard decision,” he says.
So, for the next 18 years, Holmes worked a variety of jobs, including security guard positions and—when things were especially rough—as a school hall monitor. But it was worth every moment he was able to spend with his sons, Kashon, Jr. and Jashon (both of whom had Dad as the coach of their high school wrestling teams). As the boys grew up, though, and started to graduate from high school, Kashon Holmes, Sr. still “felt a little incomplete.” He had more time on his hands, still yearned to be a nurse, and maybe it would be good for the boys to see Dad knuckling down to study for his Chem Lab tests: “I thought I could be a good example for them in the house, studying every day,” he told his local news station.
The Holmes Men: Kashon Holmes and sons Kashon, Jr. and Jashon at the beach.
In 2017, 18 years after he’d had to withdraw, Holmes once again enrolled at Maria College to work toward his BSN. Then, in early 2020, he realized he’d be a graduate of the Nursing Class of Covid-19. The pandemic began filling New York’s hospitals—and essentially shut down all apparent opportunities for clinical hours. The astonishingly swift development of vaccines for SARS-CoV-2 luckily threw Holmes and his classmates a lifeline to graduation: soon, they were helping to vaccinate Albany and its environs. Kashon, Sr., now a Senior, quickly settled into his clinicals under the aegis of Nicole Pollay, the operations manager for a vaccine site at Hudson Valley Community College. Pollay recalls, “So many of them were nervous because they weren’t sure that they were going to be able to graduate until they were able to obtain those clinical hours.” The students’ gratitude for the opportunity, she said, “still gives me chills.”
Kashon Holmes, Sr. graduated on time in May 2021. The reaction of his youngest son, Jashon, must have made Holmes certain that his 18-year hiatus was worth every moment. “I feel proud of him,” said a teary-eyed Jashon. “He worked his butt off. He always was stressed, and like, he managed to do my wrestling and do school.” What greater tribute could a parent want?
For the full story, Mikhaela Singleton’s “Dreams Don’t Quit”—and an interview with Holmes—visit Albany’s Channel 10 site.
As a nurse, you care not only for the patient in the bed, but for the family of the hospitalized patient. Caring for families whose loved ones are in intensive care carries special challenges as the family members deal with the stress of having their acutely ill loved one occupy a terribly unfamiliar setting filled with complex, off-putting medical devices.
To reduce the stress those families experience, nurses should focus their interventions on valuing the role of family members in patient care, improving communication and providing accurate information, according to the results of research published in the February 2021 issue of Critical Care Nurse.
“Nursing Interventions to Reduce Stress in Families of Critical Care Patients: An Integrative Review” analyzed the literature about family stress in neonatal, pediatric, and adult ICUs. The researchers analyzed the results of 38 studies. They discovered four overall significant stressors: a change in parental role or in family dynamics; the appearance and behavior of the patient; the care setting; and communication and counseling with the healthcare staff. The interventions in each area include:
To reduce stress related to…
A change in parental role or family dynamics: nurses should allow family members to be present at any time at the patient’s bedside and on the unit.
The appearance and behavior of the patient: nurses should provide information about specific changes observed and encourage asking questions about them.
The care setting: nurses should explain the specific features of the setting, providing reassurance that it is normal for family members to require clarification and repetition of information.
Communication and counseling with the healthcare staff: nurses should establish a communication channel with family members and adapt information to their level of stress and ability to understand the situation.
Unlike other research, this paper groups findings together from neonatal, pediatric, and adult ICUs, instead of looking at each setting separately, notes coauthor Valérie Lebel, Ph.D., RN, professor, Department of Nursing, Université du Québec en Outaouais, Quebec, Canada, herself a neonatal intensive care nurse.
What’s more, previous research typically doesn’t define the concept of “family,” she notes in an interview. “As nurses, you have to adapt your intervention to the type of family,” she says. For instance, a nurse can ensure that a family who might be socioeconomically disadvantaged could have free hospital parking or tickets for a meal. “If you don’t adapt your intervention to your family, it’s really hard to make sure that you really have a partnership with them,” Lebel says.
With COVID, the interventions discovered by the paper, which was done before the pandemic, might be difficult to execute, Lebel notes. “It’s really hard right now to make sure to apply all those interventions,” she says. Still, the nurse needs to find a way to team with the family “no matter what.” If the family cannot be with the patient because of COVID restrictions, the nurse “should find a way to team up with them anyway, to give them information, and to make sure they understand what’s going on.”
