One can easily surmise that Nurse Ratched was not drinking kale smoothies, jogging daily, and taking long, hot baths. The facets of compassionate nursing care that Ratched famously lacked, such as kindness and generosity, seldom come from a nurse experiencing a sense of deficit within themselves. A lackluster approach to one’s work is generally the prerequisite for what is now a bonafide medical diagnosis: burnout.
The old adage goes something like this: you can’t give what you don’t have. This is no less true for nurses than for anyone else. The work of an effective nurse requires the maintenance of a certain level of physical fitness, sound sleep practices, sensible nutrition, and the fortification of a positive and resilient attitude. This is because the nursing model demands not just the carrying out of physical tasks, but a wholehearted relationship with the patient as a human, rather than a set of symptoms. Nurses can best enter into this dynamic with their own health and well-being needs already met.
More than Full-Time
Although many nurses work a full-time 40-hour workweek,
additional overtime and
per diem work is common. Because nursing skills are in high demand, it is
easy for a nurse to take on more than a full-time workload. In addition, many
nurses continue their schooling after being licensed as registered nurses, to
advance their career as either nurse practitioners, in leadership roles, or as
nurse educators. With these demands, in addition to personal and familial
responsibilities, one can see why some nurses let their own health lose
A Picture of the Healthy Nurse
A well-rounded routine of well-being includes the obvious undertakings of healthy eating, regular exercise, and adequate sleep, in addition to the oft-forgotten needs of fun, leisure, social support, and hobbies. Many studies show the importance of these seemingly superfluous features of one’s lifestyle as incredibly important to health and well-being. A rich lifestyle filled with healthy activities and robust relationships may be more valuable than the income overtime generates for many nurses, and for their patients.
Self-care for Caregivers
For the nurse who scoffs at the idea of self-care, consider this — self-care is not an alternative to patient care, but an essential feature of it. Nurses who score higher on happiness index scores are more motivated in their work and demonstrate the enhanced quality of their nursing practice. Furthermore, a well-rested nurse is a more patient nurse, and a fit nurse is a more energetic, capable nurse. Lifestyle balance that allows for creativity, friendship, recreation, and sound physical health help nurses cope with the gravity and sometimes tragedy encountered in their work.
Each nurse is free to determine for themselves what work/life balance, fulfillment, and well-being mean to them. For some, financial responsibilities may necessitate extra work; however, there is no nursing job worth sacrificing one’s health for.
According to the CDC, about one in nine women
experience postpartum depression. Oftentimes, nurses may be able to recognize
this in their patients and assist them in getting help. First, though, you have
to know what you’re looking for.
Susan Altman, DNP, CNM, FACNM, a clinical assistant professor and midwifery program director at the NYU Rory Meyers College of Nursing, has been a midwife for more than 20 years. She took some time to answer our questions on recognizing postpartum depression in new moms.
What are the main symptoms of postpartum depression in new moms? How can nurses learn to recognize what are the signs of PPD as opposed to something else?
Many women who give birth experience changes in mood due to significant changes in hormone levels after the birth. These changes do not cause depression in all women. The most common of perinatal mood changes in the postpartum period is postpartum blues or “baby blues,” which manifests itself with such symptoms as sadness, crying, and mood swings. Most often these signs begin 5-7 days after the birth, lasting just several weeks.
PPD, a major depressive disorder, can also begin in
the days following birth, and may be mistaken for baby blues at
first. But the symptoms are more commonly noticed several weeks
or months after the birth, and their duration is usually much longer. Symptoms
are more severe in PPD than they are in postpartum blues. Those diagnosed with
PPD often have symptoms with severe features such as feeling sad and hopeless,
crying for no apparent reason, being worried or overly anxious, oversleeping,
having difficulty concentrating or remembering things, losing interest in
activities that were once enjoyed, being angry, withdrawing from family and
friends, not feeling emotionally attaching to baby, and thinking about harming
Nurses and midwives are experts in assessment and
should carefully investigate and look more closely at the postpartum person who
is frequently crying, having trouble sleeping, reports low energy or appetite
changes or loss of enjoyment of activities that were once enjoyed.
It is important to be mindful that increased anxiety is often associated with perinatal depression, so assess for signs of this as well. A thorough, comprehensive review of the person’s prenatal history in order to flag certain risk factors for PPD is important to help clinicians distinguish between diagnoses. Risk factors include prior history of any depression or mental illness, stressful life events during pregnancy, and little or no social support, just to name a few.
Most importantly, providers must listen to
what the person is saying about what they are feeling or experiencing. Most patients
know that something is not right. They know themselves the best.
a nurse recognizes some of the signs in a new mom, what should s/he do?
Approach the mom? What should s/he say? Please explain.
Nurses and midwives who suspect postpartum mood
disorders in anyone they take care of must intervene. PPD should not be ignored.
In approaching a mom, nurses and midwives need to
let the person know what symptoms they are observing and why they are concerned.
The person must be educated that postpartum depression is common and that they
are not alone. Explaining that PPD is simply a complication of birth can be
helpful. Always acknowledge that the person has done nothing wrong. Include
that although PPD may be difficult to deal with, it is possible that with the right
individual treatment and emotional support, management of symptoms and recovery
is very likely.
the mom denies it. What should the nurse do then?
From my experience, when someone is approached, they
rarely deny it. They often already know that something is not right in how they
are feeling, and they are often relieved that someone has reached out to them
to help. Again, telling them that they are not alone and that there is care
that they can get which can make them feel better is helpful.
If the person really does deny it and does not see the need for help, this is where family members and friends should be recruited to help. Family and friends may actually have already recognized the symptoms of PPD in this person and are often very willing to get involved. They can help reinforce what the nurse has explained and encourage the person to meet with a mental health care provider. They can also offer ongoing emotional support, assist with transportation to appointments, and care for the baby or help with household chores—freeing up the person to go for care. Again, underscore that the person is not alone in this recovery process.
if the nurse recognizes the symptoms after the mom has left the hospital—like
in a home health visit? What should s/he do?
Because, in most cases, PPD does not manifest
itself until weeks or months after birth, it is quite common that the nurse who
works at the bedside immediately postpartum will not be the one to recognize
the signs and symptoms of postpartum depression.
Our standard system of postpartum care for birthing individuals is generally only a postpartum visit at six weeks after birth with little or no communication until that visit. Many suffer with signs of PPD during this six-week window, not knowing that what they are feeling is not normal and may require professional help. More often than not, recognition of signs and symptoms of PPD can come from nurses other than those working in the postpartum unit. For instance, nurses making home visits, taking office phone calls, or perhaps taking care of the baby in the pediatrician’s office are sometimes the ones who bring the symptoms to the postpartum person’s attention.
Any nurse who recognizes PPD has the responsibility to educate and then provide resources and referral to providers skilled in caring for those with symptoms noted. In this way, nurses can be instrumental in helping women get the care they need in a timelier manner.
Nurses are incredibly resilient. Each day, they wake up, throw on a set of scrubs, and head into work to perform a demanding 12-hour shift—all while striving to provide the best possible care to their patients. Then, they get home and fall asleep, only to begin the process all over again.
But as a nurse, you know that this barely touches the reality of the situation. In the United States, most hospitals and clinics are woefully understaffed, which often forces nurses to work longer shifts and manage far more patients than they can actually handle. The unfortunate result is nursing fatigue, a common condition which can make you feel both mentally and physically exhausted for days, weeks, or even months.
Almost all nurses have experienced nursing fatigue at some point in their careers, so don’t feel guilty over it. Instead, you can try these seven strategies to combat the effects of nursing fatigue.
1. Leave work at the door.
clock out from work, it’s important for you to clock out mentally as well.
Leaving your work at the door is essential for avoiding compassion fatigue, a
condition which results from repeated exposure to patient suffering while
working in a high-stress environment.
In a 2017 study published in the European Journal of Oncology Nursing, researchers found that nurses were more likely to experience compassion fatigue when they were more self-judgmental. If you come home from work and feel guilty about all the things you could have done to make your patient’s life easier, you won’t give yourself time to recharge for the next shift.
2. Practice different forms of self-care.
Nurses go from patient-to-patient, checking their vital signs, administering medicine, and assisting them with daily activities. As a result, it’s easy to get so caught up in caring for patients that you forget to take care of yourself.
To be on top of your game each day, it’s critical that you do things for yourself on a regular basis. Some self-care practices you can try include: going for a walk in nature, starting your day with meditation, or signing up for a healthy subscription meal service.
If you tend to feel guilty about treating yourself, make your forms of self-care double as a bonus for work. For example, do arm work every other day to help lift your patients or invest in the new pair of nursing shoes that you’ve been eyeing for months.
3. Use your vacation days.
vacation days, so remember to use them. Taking time off work is key to
preventing burnout and will help you return to work feeling refreshed and rejuvenated.
If your nursing unit schedules vacations at the start of each year, be sure to
get your days in the books—even if you don’t have anywhere in particular to go.
In fact, planning a “staycation” for yourself may be the perfect getaway. You can recharge your batteries by relaxing at home, catching up on things you’ve been neglecting, and spending quality time with the family.
4. Unload your brain after each day.
particularly tiring shift, sometimes you just need to declutter your mind and
get all your thoughts out of your head. One way to do this is by writing them
down on paper or typing them into a Google doc.
Untangling your mind and getting the thoughts out of your head can lower your mental brain fog and allow you to relax after a shift. The process is simple: Just set a timer for 15 minutes and unload your thoughts. Once the time is up, delete your document or click out of it. Reading it over again will only put the words back into your head.
5. Change your work environment.
While it’s no secret that most hospitals and clinics stretch their nurses far too thin, some take it to another level by creating an environment that is downright dangerous. If your health care institution has a poor nurse-to-patient ratio and no system in place to provide help for nurses, it may be worth it to begin searching for a new job.
Though nursing is an in-demand field, finding the right fit can be trickier than it sounds. Don’t be afraid to explore different health care settings to find your ideal work environment. While you might take a pay cut in some instances, the change could be the key to preventing nurse fatigue.
6. Find a specialty you love.
easier to prevent nursing fatigue when you truly love what you do. If being a
registered nurse just isn’t working for you, consider switching to a nursing
specialty that makes you happy to stroll into work each day.
While you could always take a nursing specialty quiz to help you nail down your career, one of the best ways to get a feel for a particular specialty is hands-on experience. Are you interested in a position as an emergency room nurse? Talk with the ER manager and let them know you’re ready to help. There are hundreds of nursing specialties, so be sure to explore all your options to find a job that truly ignites your passion.
7. Explore new hobbies.
needs a hobby that allows them to decompress and wind down from work. Finding
joy in a new hobby can combat nursing fatigue by giving you something to look
forward to after a shift.
Some of the best hobbies for nurses often double as stress-relieving activities, such as painting, knitting, woodworking, and jewelry-making. Be sure to explore hobbies that get your heartrate up. Getting involved in a pickup soccer game, going ziplining with friends, and enrolling in a martial arts class can help keep your mind off work while improving your mood.
Long shifts combined with understaffed nursing units are the perfect storm for nursing fatigue. While some health care facilities are working to address the problem, it’s important for you to be proactive about your health and happiness. With the help of these strategies, you can fight back against nursing fatigue and prevent it from affecting your personal and professional life.
According to the Anxiety and Depression Association of America, anxiety disorders are the most common mental complications in the United States affecting more than 40 million adults in the U.S. or at least 18% of the population every year. Although anxiety disorders are highly treatable, only about 36% of anxiety patients receive treatment.
Several factors can lead to anxiety. Some of
these factors include brain chemistry, genetics, personality, and drastic life
changes. We are all, therefore, prone to anxiety.
Anxiety affects us differently. Some people
might feel unprepared, unsure, or nervous when trying something new or before
giving a speech. These feelings may manifest in physical symptoms such as
headaches, shortness of breath, or clammy hands.
Anxiety is actually an adaptive response that
can help us cope with challenges or day to day threats. These responses can
help identify and avert potential threats, encourage us to work harder, etc.
However, when we don’t respond well to these triggers, they can become
maladaptive leading to clinical anxiety disorders.
There exist many medications to deal with this
condition. Some of the common drugs include tranquilizers like Valium and Xanax
and selective serotonin reuptake inhibitors like Zoloft and Prozac. While some
of these drugs may work, some people may not respond well. There have been
cases where patients fail to see any changes or are unable to tolerate the side
effects. Also, drugs such as Xanax and Valium can be highly addictive.
For this reason, more and more people are
looking for natural alternatives that can help them cope with anxiety
disorders. This is where CBD comes in. But the question is, can it work?
FIRST THINGS FIRST:
WHAT IS CBD?
CBD (Cannabidiol) comes from the cannabis
plant. It is one of the 120+ chemical compounds (cannabinoids) that are
naturally produced by the plant. Unlike THC (tetrahydrocannabinol), another
popular compound in the cannabis plant, CBD is not psychoactive. This means
that you won’t get the ‘high’ that is usually associated with cannabis
CAN CBD HELP WITH
Cannabidiol has been touted for its many health benefits, including remedying chronic pain, depression, cancer symptoms, and now anxiety.
HOW DOES CBD WORK?
Before we delve deeper into this subject, it
is worth noting that most studies describing how CBD works for anxiety are
preclinical and based on animal models. This means that more research is still
needed to ascertain the effectiveness of CBD as a natural remedy for anxiety.
That said, Cannabidiol exerts several actions
on the brain that may help explain why it may be an effective treatment for
5-HT1A is a subtype of the serotonin receptor.
According to experts, anxiety can be treated using medications or drugs that
target the serotonin system.
Selective serotonin reuptake inhibitors (SSRI)
such as Zoloft and Prozac treat anxiety by inhibiting the re-absorption of
serotonin in the brain. This ensures that serotonin is available in the
synaptic space, which helps the brain cells to transmit more serotonin signals.
It is believed that this can help boost moods and reduce anxiety. (Of course,
the actual biological process is more complicated than this)
Just like selective serotonin reuptake
inhibitors, Cannabidiol may boost serotonin transmission.
According to a study conducted by Spanish researchers,
CBD can enhance 5-HT1A transmission and can actually affect serotonin faster
than standard selective serotonin reuptake inhibitors.
The hippocampal is a vital brain area
responsible for critical roles such as cognition and brain formation. Scans on
patients suffering from anxiety or depression have often shown a smaller
hippocampus. Depression and anxiety medications, therefore, aim at triggering
neurogenesis (birth of new neurons)
In a study involving mice, it was discovered
that repeated application of Cannabidiol may help boost neurogenesis. A
growing body of research suggests a link between CBD, SSRIs,
neurogenesis and anxiety and depression.
Based on these findings, researchers are
bringing forward data suggesting that CBD may help improve the common
anxiety-disorders in humans.
SUGGESTING CBD MAY HELP TREAT ANXIETY
A study carried out in 2010 found out that CBD
could help remedy symptoms in social anxiety disorder (SAD)
patients. Follow up brain scans on the group revealed altered blood flow to the
brain parts concerned with anxiety and mood regulation. In this study, CBD was
not only found to be effective in making people feel better but also altered
the way their brains responded to stress and anxiety.
In 2011, another study was conducted to find out
whether CBD could remedy social anxiety disorder. In a public speaking test
that followed, people who received 600mg CBD experienced less anxiety, had less
cognitive impairment, were more relaxed and comfortable than their counterparts
who received a placebo.
A 2015 analysis of existing studies concluded
that Cannabidiol has great potential as a natural remedy for different forms of
anxiety including panic disorder, social anxiety disorder, post-traumatic stress disorder, generalized
anxiety disorder, and obsessive-compulsive disorder.
In 2017, researchers from Sao Paulo University
in Brazil found out that CBD helped reduce anxiety in patients with social phobia.
It is clear that more studies on human are
still needed to ascertain the link between anxiety and CBD. However,
preliminary findings validating CBD’s efficacy as a natural remedy for anxiety
It is important that all stakeholders in the
health sector come together and see if there is a way to improve this natural
compound to produce even better results. This should be treated as a matter of
urgency, given the huge economic and social cost that anxiety impacts not only
in the US but across the globe.
In recent years Cannabidiol (CBD) has been
proven to help treat the symptoms of anxiety, epilepsy and pain. Now, new
research is emerging that CBD may be part of the next wave of antibiotics used
to treat bacterial infections.
Drug resistant diseases are on the rise and
reaching a critical level affecting all countries. In April 2019, the World
Health Organization released a groundbreaking report “demanding
immediate, coordinated and ambitious action to avert a potentially disastrous
drug-resistance crisis.” If no action is taken, it is estimated that diseases
that do not respond to drug treatment could cause 10 million deaths a year by
2050. This epidemic will result in a global economic crisis similar to the 2008
This week new evidence came out that CBD could be one of the next new treatments to help fight the threat of drug resistant bacteria. Mark Blaskovich, PhD, presented research at the American Society for Microbiology annual meeting. Blaskovich is a senior research officer at the Centre for Superbug Solutions at the Institute for Molecular Bioscience at the University of Queensland in Australia.
The results Blaskovich shared at ASM Microbe
showed that CBD has a surprisingly powerful antibiotic effect against
Gram-positive bacteria that was comparable to existing antibiotics, including
vancomycin and daptomycin. The in vitro study led by
Blaskovich found that CBD is active against Gram-positive bacteria such
as Staphylococcus aureus (Staph) and Streptococcus
Even in low concentrations, CBD had positive
effects in treating methicillin-resistant S. aureus (MRSA). This bacterium is
widely known for being the common cause of hospital-acquired infections and is
resistant to some forms of antibiotics. The CDC reported that MRSA resulted in 20,000
deaths in 2017 and is considered a significant cause of mortality in the United
Blaskovich tweeted this week that “Cannabidiol shows
promise against superbug infections.” He also stated that they reviewed CBD’s
ability to kill bacteria. “In every case, CBD had a very similar potency to
that of common antibiotics.”
Though this research is unpublished it may be the next breakthrough to combat the growing problem of antibiotic resistant strains of bacterial infections. Blaskovich has received a grant from Global Antibiotic Research & Development Partnership (GARDP) to assist in the research to find ‘5 By 25’. The ambitious project’s goal is to develop and deliver five new treatments by 2025 in response to the growing burden of antibiotic resistant infections. According to GARDP “Alarming levels of resistance are now reported in countries of all income levels”. This is resulting in thousands of newborn deaths and patients that have infections that do not respond to any available antibiotics. “Drug-resistant infections already cause at least 700,000 deaths globally each year.”
As more countries legalize cannabis, and
research restriction are lifted, clinical trials involving CBD and THC will be
able to proceed similar to other drug trials. We are optimistic that similar to
the FDA approval of cannabidiol to treat
epilepsy, more research will emerge involving the medicinal properties of the
various cannabinoids found in cannabis.
Posttraumatic stress disorder (PTSD) affects a large portion of our population, in particular veterans and victims of sexual or physical assault. While the current standard is to treat PTSD with antidepressants, these medications are not always effective and are associated with low remission rates. This is especially true for combat veterans who are notably resistant to pharmacotherapy. As cannabinoid receptors play a big role in PTSD, the use of medical cannabis offers a novel mechanism of treatment.
“Cannabinoids help the mind with the natural process of forgetting painful memories. This has been extremely positive for those who have experienced traumatic events. The ability to forget the trauma helps with anxiety, night terrors, and depression. Many times, patients suffering from PTSD treat those symptoms with multiple medications that have their own side effects. Access to medical cannabis has helped patients improve their quality of life after major trauma,” says Nikki Wright, the COO and co-founder of Medical Marijuana 411.
Changes in brain pathophysiology are linked to PTSD, in
which activity in the fear center of our brains, the amygdala, increases while
areas associated with executive function and memory decreases, upsetting the
body’s ability to respond to stress. PTSD is further marked by an imbalance of
important neurotransmitters, such as serotonin and norepinephrine, and symptoms
present as intrusive memories, avoidance, negative changes in thinking or mood,
and alterations in arousal and impulsivity.
The active ingredient in cannabis is a class of compounds
called cannabinoids. While we most often associate cannabis with tetrahydrocannabinol
(THC), there is another cannabinoid at play that deserves our attention. Cannabidiol
works to minimize the “high” from THC with neuroprotective and
anti-inflammatory properties that help mediate pain, nausea, muscle spasms, and
Our body has its own endocannabinoid system loaded with
receptors that help us maintain homeostasis in response to change; they affect
memory, mood, appetite, stress, sleep, metabolism, immune function, and
more. Stimulation of cannabinoid receptors has been shown to increase
behaviors that allow us to cope with stress, as well as fire off serotonin and
norepinephrine, facilitating the release of both excitatory and inhibitory neurotransmitters
needed to maintain balance.
In PTSD, the role of cannabinoid receptors should not be
underestimated. A decrease in active cannabinoid receptors has been observed in
patients with PTSD, and using medical cannabis provides a different
mechanism of action in which receptors found in altered regions can be
activated. Stimulated cannabinoid receptors in the amygdala, for example,
potentially decrease unpleasant memories, fear, and anxiety, while receptors in
the hippocampus decrease hypervigilance and hyperarousal.
Medical cannabis shows promise to provide significant relief from PTSD symptoms, but the concern of developing a cannabis use disorder should be weighed, especially among a vulnerable population. Additional hurdles for the medicinal use of marijuana is differences in state eligibility, non-standardized distribution policies among dispensaries, and financial barriers in which medical cannabis is not covered by insurance.