Forum Replies Created
-
Posts
-
Mindy- My coworkers and I work really well to make sure that everyone takes a 30 minute lunch and we give each other 15 minutes breaks as we need them. Honestly, my unit is unlike any other I’ve ever worked on before because my colleagues genuine care about each others overall well being.
I’ve worked in the past with those nurses who are perfectionist and can’t let go of the control to take a break or lunch. continue to encourage them to take care of themselves by taking a lunch.Megan, What a great point! I too believe you would see a positive correlation with nurse retention and a medical center’s implementation of RBC or something promoting self-care. Like anything in life the more we invest in something the larger your return will be. The more nurses become a active participant in the relationship based care model hopefully they feel increased job satisfaction and most importantly we see higher patient satisfaction. Patient satisfaction I feel is also directly correlated with nurses job satisfaction.
I’m proud to be a SSCBC infusion nurse and my coworkers have actively created a environment that encourages self care and care of colleagues. The culture on my unit supports a healthy work day by ensuring we get the necessary breaks needed to regroup and give 110% to our patients.
I do strongly believe in the power of a nursing unit and their ability to create a culture that promotes self care and care of colleague. I honestly can say I’m working in just this environment. I hope our inpatient nurses feel the same way because the sky is the limit when a nurse finds this type of unit.
Blackwell- You made some great points. I try to show up everyday thinking “how can I make my work day great?” I will continue to encourage stress reduction techniques to all my nursing colleagues so that I can ensure a healthy work environment during a pandemic.
Greg, I agree coping skills to combat emotional distress need to be taught during nursing school or hospital orientation. New grads need the tools for building resilience so that they can have a long and healthy career.
I JUST CAME ACROSS SEVERAL RESOURCES THAT ARE AVAILABLE TO US AS OSU EMPLOYEES.
Tess
Launched in March 2020, in partnership with ImpactSolutions, Tess is a mental health chatbot that is available to provide emotional support, evidence-based education and delivers coping skills and strategies via text. Tess is available to employees and their families. To begin chatting, text “Hi” to 415-360-0023. Use the company code “Buckeyes” when prompted to begin texting with Tess.People like texting with Tess because she is always there, ready to chat and completely confidential. There’s no judgment or bias, which helps people open up about topics they might otherwise avoid. If someone is experiencing a panic attack at work, for example, they can connect with Tess and get support at that moment. It’s quick and discrete. Sometimes people just need to vent and they worry about burdening their friends and families with their negative emotions. Tess helps create that time and space for self-reflection. We have members who chat with Tess every night before they go to sleep as a way of processing their day and letting go of their worries.
A chatbot, powered by Artificial Intelligence (AI) has it’s limitations – it’s not a human and not intended to diagnose or treat disease. If Tess is not meeting your needs, and you would like to talk to a professional (human ), we have 24/7 support: Request a counselor online, by calling 800-678-6265 or by emailing eap@osumc.edu.
Free Counseling (EAP)
Issues at home can impact our work lives, and stress from our jobs can affect our relationships at home. You have access to the Ohio State Employee Assistance Program (EAP) that offers tools and resources to help address complex issues that can be affecting your mental and emotional well-being.JustBreathe Resource Center
Why does breathing matter to reducing your stress? Learn more about why breathing matters, practice techniques and order JustBreathe stickers.Guided Imagery & Mindfulness – 20 Free Audios
Guided imagery audio exercises are intended to help de-stress your life, declutter your mind, and help you get above the pressures of your life. OSU Health Plan Manager Patrice Rancour developed and narrates these three-to-six-minute guided imagery exercises promoting good health and well-being. Download them to your phone or music player for a quick and easy way to relax no matter where you are.Telephonic Mindfulness Coaching
The Ohio State Employee Assistance Program (powered by Impact Solutions) offers mindfulness coaching for employees and their family members. Receive five free coaching calls with a mindfulness coach each year. You can request a mindfulness coach by using this new online form, contacting eap@osumc.edu or by calling (800) 678-6265.My stress level has increased expedientially since March 2020 professionally and personally. In the past some of the coping methods offered to me seemed silly and now that I’m living in a pandemic they don’t seem so silly.
What was the knowledge gained from the article? Dr Michael Kelly and Mari Tyson Staff RN reviewed with us the power of compassion and how it is essential to the practice of nursing. They also went as far as saying that it should be implemented with ALL nursing activities. They spoke of the evidence that supports improved patient care when empathetic and compassionate care is provided by the nurse. The article then goes on to state that the nurse is at risk for developing compassion fatigue.
According to Vaclavik (2018) moral distress is when a nurse performs duties that are contrary to what she or he believes is right but feels powerless to change actions.
Both articles identified reasons why a nurse could experience emotional distress due to their profession. They also give us suggestions on how to decrease emotional distress. According to Kelly (2016) mindfulness is a tool to combat stress and burnout because it enhances one’s self-compassion and empathy towards others. Vaclavik (2018) had several suggestions of stress reduction methods that were most successful were work–life balance events and the critical debriefs.
Will the research/information in this article change or influence your practice? If so how? I know that I’m personally going to need to focus on reducing my stress personally and professionally over the next year so I’ve found these articles to be very helpful. I also know from past professional experience the environment in which I work directly impacts my mood so it would be beneficial to me to be an active participant in any kind of stress reduction programs. Currently on my unit one of my colleagues Grace Chapman wanted to help by starting a book club with just this theme.
The book is The Miracle Morning.
What other questions does the article raise about current practice? Many of my friends and family are nurses and a common theme I’ve notice is that none of us are able to get a assigned 15 minute break in addition to our 30 minute lunch. Even more bothersome is many of the nurses I know aren’t even able to get a uninterrupted 30 minute lunch break. Is this the culture in which we live or is this just acceptable in healthcare in the United States? I’ve been asked many times by upper management why nurses aren’t staying at the bedside. How can we participate in debriefings and mindfulness therapy when many inpatient nurses don’t even get a 30 minute lunch. These breaks are even more essential when we are trying to wear masks and socially distance ourselves from colleagues.
Ohio State is wonderful place to work because they provide continuous education and process improvement but do they give us enough time to implement these self care practices.
Do you agree/disagree with the conclusions of the author, why? I agree these methods of stress reduction will work when implemented daily.Mindy,
I agree with Kelly I don’t include lymphedema in my initial chemo teaching. I feel that Chemo teaching is a lot of material to go over. I’ve usually addressed it when surgery is brought up. I guess after reading this article I should bring it up when patients have radiation as well.
Last week I cared for a patient who had a PSH/PMH lumpectomy and radiation. She developed Upper Extremity Lymphedema four years after treatment. She was doing lawn work and unfortunately got several bug bites on the side of her lumpectomy/radiation. She had Upper Extremity swelling initially from the acute trauma which later developed into permanent lymphedema.
I wanted to share this story because it is a low life time risk for these patients. She stated that she has been selective on what shirts she buys because often her arm doesn’t fit into many shirts.
Amoreena- Thanks for the surgical oncology voice when it pertains to these articles. I’ve only worked in infusion and medical oncology so it’s refreshing to hear what is being done on the surgical side.
It sounds from your response we’re very proactive here at the breast center because we do bioimpedence measurements for our patients prior to any surgery that can involve the lymph nodes and then completed at certain intervals after surgery if multiple lymph nodes are removed.
Are these measurements obtained by the lymphedema clinic?
Maybe you could help me, if I have a patient whom I’m concerned about lymphedema I usually get a consult with Physical therapy to be further evaluated? Is there anything else I should be doing to advocate for my patient?1.What was the knowledge gained from the article?
After reading, The Legacy of lymphedema: Impact on nursing practice and vascular access it provoked several questions on whether the my practice will be changed in the future. I think it’s the nurses responsibility to review the risk factors their patient has for lymphedema prior to obtaining peripheral vascular access ie. axillary node dissection, mastectomy, receiving chemotherapy, obesity > 30 BMI, and arm swelling.
Recently a medical oncologist here at SSCBC has questioned our policy on whether or not we should continue to avoid needles sticks on the affected arm due to recent research.
Our Policy:
Avoid IVs on the side of axillary node dissection, after radiation therapy, in the affected arm of
lymphedema or CVA patients or in patients with stage 4 or 5 kidney disease when possible. (Level
VII8)
The article Lymphedema. Clinical Journal of Oncology Nursing maybe question how well I assess my patient for lymphedema? I heavily use subjective symptoms when assessing my patient the only objective assessment I usual do in the infusion unit if the patient has unilateral swelling of the upper extremity.2.Will the research/information in this article change or influence your practice? If so how? I feel I’m going to educate the patient on their overall risk and let the patient be part of the decision on whether or not the affected arm is used.
I think after reading these articles it has helped sharpen my assessment skills for subclinical lymphedema.
3.What other questions does the article raise about current practice? How well do we provide patients with surveillance for lymphedema for those patient’s at risk? Does our surgeons measure the patients arms preop and postop and if so for how long postop do they measure the patients?I feel like this topic is still in a gray area as far as precautions on the affected arm. Personally, I’m always going to the unaffected arm first when any needle stick is needed. Why introduce that risk if it’s unnecessary.
4.Do you agree/disagree with the conclusions of the author, why? I agree with the author Reichart it is essential to have a protocol for Bioimpedance spectroscopy (BIS) and L-Dex device.
I agree with Larocque and and McDiarmid that long-held beliefs with regards to the risks factors and preventative measures need to be challenged, but I believe clinical data needs to be collected to support the use of the affected arm.
Larocque, G., & McDiarmid, S. (2019). The legacy of lymphedema: Impact on nursing practice and vascular access. Canadian Oncology Nursing Journal, 29(3), 194–203.
Reichart, K. (2017). Lymphedema. Clinical Journal of Oncology Nursing, 21(1), 21–25.After this discussion I feel that more evidence needs to be provided on whether or not cryotherapy helps the prevention on peripheral neuropathy. Maybe this could be a study we do here at the James.
Greg,
No we don’t keep track of our infusion patients here at SSCBC using scalp cooling. I do know that AC has the worse outcome with only 20% of the patients able to keep 50% of their hair after 4 cycles of Adriamycin and Cytoxan. The patients who are trying to work fulltime while undergoing chemotherapy seem to be the most interested in scalp cooling so that they’re able to maintain amenity during their treatment.Mindy- I think my patients have purchased cooling gloves from Amazon
Some nurses have expressed concern when our patients are icing their hands and feet because there is no way to control how cold they are making their extremities. They also voice concern that some taxanes can infuse for long periods of time a 3 hour taxol titration can be up to 4 hours long or more.
1. What was the knowledge gained from the article?
I chose these articles because it seems to me that more and more breast cancer patients receiving taxanes are interested in cryotherapy in the prevention of peripheral neuropathy (PN). These articles reminded me of those patient who have existing peripheral vascular disease and diabetes are at increased risk. I’ll use this information when assessing my patients prior to their chemotherapy. I wasn’t aware that 50% of patients receiving a taxane experience nail changes and peripheral neuropathy. I had never given much thought in the use of cryotherapy in prevention of nail changes but it seems to be a simple intervention.2. Will the research/information in this article change or influence your practice? If so how? I’m more inclined to recommend cryotherapy in those patients experiencing nail changes.
3. What other questions does the article raise about current practice? I would like to see larger studies done so that we can have more substantial evidence in support this intervention.
4. Do you agree/disagree with the conclusions of the author, why?
I disagree I think that cryotherapy works to prevent peripheral neuropathy.
Pauley- I too worry about our patients and whether or not they’ll be penalized for positive genetic testing. I had a 80 year old male patient today who has breast cancer and PMH of prostate cancer and was voicing worry about the results of his genetic testing which was still pending. He stated the reason why he received genetic testing was for his grandchildren.
Hopefully, there will always be laws in place to protect our patients from discrimination.
