Archive for August, 2010

CISM, comment

August 16, 2010

When reading through the blog I stumbled across the post ‘Critical Stress’. I am so pleased to see that someone not only has posted about this, but that it struck a chord in others as well. As an RN in a cardiac ICU I care for patients with chronic cardiac illnesses. Many of these patients stay with us for weeks and even months. Our most chronic patients tend to be those with end stage heart failure. In January of this year one of my patients that I had cared for over many months, passed away. This was a different sort of trauma than that of those who work in the ED or EMS experience. It wasn’t grusome, bloody, and no children were involved. I don’t think I gave the event enough justice because it wasn’t a blatant traumatic experience. Over the next two weeks following his passing, I began having terrible mood swings, I had sleep disturbances, and I began resenting my career as a nurse. Luckily I have an insightful and compassionate nurse manage who recommended bringing in the Critical Incident Stress Management team. When she first mentioned it to me I had no idea what it involved. A week later a group of nurses from my unit gathered for a meeting with the CISM team that they called a “debriefing”. It was a series of open ended questions that started a conversation amongst the group. In the end there were tears, confessions of fear and anger, frustrations, and sadness. Just to have permission to talk about our lives as critical care nurses and the amount of death that we see, we all felt more balanced afterward. It is important for health care workers to care for themselves and be able to recognize the effects of long term stresses related to caring for chronically ill patients. Thank you for posting a passage about stress management for those in the health care industry.

Original Post
December 30, 2008
Title: Critical Stress
I personally feel this is an important issue that is frequently swept aside in many critical incident situations. I have been both an EMT and an RN for many years, but have had very few debriefing sessions. Several occasions were warranted, such as a when an entire family perished in an MVC on Christmas Day, co-workers who were killed on their way into work, a colleague who successfully overdosed; to name just a few. The emotional and behavioral keynotes were especially noteworthy. It is no wonder that so many of my colleagues have turned to substance abuse and psychotropics to seek refuge. As for myself and a few others, we have turned to a higher power; after all there has to be more and a “better place.” I pray that is not a hollow promise. I and my co-workers have experienced many of the emotional stress responses: a. Agitation b. Anger c. Anxiety d. Apprehension e. Depression f. Fear g. Feeling abandoned h. Feeling isolated i. Feeling lost j. Feeling numb k. Feeling overwhelmed l. Greif m. Guilt n. Irritability o. Limiting contact with others (I found I withdrew and cuddled up with my Lab and quilting) p. Panic (what if I can’t make it through this shift?) q. Sadness r. Shock s. Startled t. Suspiciousness u. Uncertainty (constantly checking and rechecking your work, documentation, etc.) v. Wanting to hide (that never happened to me) w. Worry about others (BIG TIME!!). References Lynch, Virginia A. and Duval, Janet Barber. (2006). Forensic Nursing. St. Louis: Elsevier Mosby

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ELDER ABUSE

August 2, 2010

Not a week goes by when we do not receive an elderly patient on our floor who is covered by bruises. But what is the cause? Should we jumped to the conclusion that there has been abuse, or ignore what we are seeing? Knowing the sign and symptoms of abuse is extremely important, although most of the screening takes place in the emergency room, floor nurses also need to be aware.
Older patients are often on medications that can cause them to bruise more easily, their skin is also more fragile and tears easily, a client’s mental state may also be impaired. Continuing education is imperative so advanced assessment can be used to be able to distinguish between abuse and the symptoms that occur from medication or the normal aging process.

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CHRONIC PAIN AND DRUG ABUSE

August 2, 2010

It is an easy thing to look down upon someone who is a drug abuser, we live in a society that has very little compassion, and or understanding for these individuals. I have heard it time and again “They have done this to themselves!” But have they, what moves a person to become an addict?
The history of an individual tells us a great deal. Family history may reveal that someone is predisposed to addictive behavior, and then coupled with a severe injury that needed long term pain medication can be a recipe for disaster. Families are turned upside down, and torn apart, some never recover.
These individuals may be incapable of stopping on their own, there are many programs and institutions that specialize in helping those who have this disease, the only prerequisite is that they want the help. If someone does not want help there is no program or individual that can help them.
As caregivers showing empathy for those in these situations rather than being judgmental can be the difference in someone’s life.

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SUICIDE AN EPIDEMIC

August 2, 2010

On any given week at the hospital that I am employed by there are a number of clients on suicide watch. Many of these clients are also drug abusers, a very small minority have actually attempted suicide.
What brings so many to the hospital is the fact that everyone has to be taken seriously when they say they want to kill themselves. Whether it is the first or twentieth time they have said this.
Recently we had a young drug user hospitalized for stating she wanted to die, she had been cleared by the psychologist and was ready for discharge, when she found out she was not going to be discharged to the facility for rehab she had wanted, and was not going to be given the medication she had wanted once discharged she began crying and said she would jump off the roof. Once again she was given a 1:1 sitter to keep watch on her and the psychologist was re-consulted.
All patients whether we believe they are serious or using suicide as a manipulation, follow the same policy and procedure to assure the safety of those who may want to actually harm themselves. Even though this may be frustrating for all involved it is something that needs to be, if even just for that one client who may truly be in need.


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