As we get ready to turn our calendars to December, we reflect on the passing month of November, and its designation as Lung Cancer Awareness Month. Throughout this past month, advocacy groups and organizations have pushed to raise awareness and educate readers en masse about the deadly illness. As the leading cause of death from all cancers, lung cancer remains a tough battle to fight for patients. According to the CDC, lung cancer affects 215,951 people in the United States, with nearly 75% of all patients succumbing to their illness. It is important during the month of November to not only to focus on lung cancer, but on respiratory illness as whole – such as COPD and mesothelioma.
What is Lung Cancer?
Lung cancer can refer to both small-cell and non-small cell lung carcinoma, which is characterized by the uncontrollable growth of cells in the lung tissue. While tobacco smoking and secondhand smoke are by-and-large the primary causes of the disease, heredity and environmental factors can also contribute to the diagnosis. Radon, a radioactive gas found in the soil, and other airborne pollutants, like arsenic and diesel exhaust, are also known causes.
The symptoms of lung cancer are chest tightness, shortness of breath, chronic cough, coughing up blood, and fatigue. Once a biopsy is performed and the cancer is officially diagnosed, patients can expect to undergo a regimen of advanced treatment, but there remains no definitive cure. It is important to note that prognosis varies highly based on the stage of the cancer—which generally dictates the type of treatment a patient can expect to receive. Currently, chemotherapy, immunotherapy, radiation, and surgical removal of tissue are the most prevalent forms of care.
Advanced Respiratory Illness
While the awareness of lung cancer is widely known, many other serious illnesses lack cognizance. Two of the most rampant respiratory diseases aside from lung cancer are Chronic Obstructive Pulmonary Disease, commonly known as COPD, and mesothelioma. COPD is an umbrella term for several different ailments, the most common being emphysema and chronic bronchitis. Like lung cancer, COPD is most commonly caused by smoking, but many environmental hazards can cause the illness. Air quality issues, such as pollution and chemical fumes, can cause the disease. There is no cure for COPD, and most patients are faced with progression of the illness as they age, many times causing death.
The exposure to asbestos, a silicate mineral formerly used in construction, has also proven to be extremely dangerous to human health. The material is known to break and fragment, creating small particle dust that is inhaled. Once inhaled, the accumulation of asbestos dust settles in the lining of the organs indefinitely, where it can begin to cause illness. Asbestos is most commonly linked to mesothelioma, a rare and aggressive cancer. Mesothelioma most commonly affects the lining of the lungs, but can also affect other areas of the body. Prognosis for the disease is very poor, as most patients are faced with 12-21 months of life expectancy. Treatment of the disease generally consists of a combination of radiation, chemotherapy, and sometimes, surgical removal of the affected area.
How to Promote Wellness
While lung cancer, COPD, and mesothelioma all pose very serious health risks, there are steps we can take to continue to maintain health and wellness. The most important step to take to ensure lung health is to stop smoking today. Tobacco smoke accounts for 85% of all lung cancer diagnoses, and can greatly exacerbate the severity of any other lung disease. Steps to ensure respiratory safety on the job site, especially for construction workers, can greatly reduce the chances of exposure to carcinogens. Buildings constructed before 1980 in the United States run the risk of asbestos contamination; if you suspect your home may contain asbestos, do not remove it yourself – use a licensed professional. Above all, a continued healthy lifestyle and exercise can safeguard your well-being, and keep you at your best for years to come.
Conflict resolution is an essential skill for every nurse. Conflict in the workplace may be unavoidable, but it can be minimized and resolved. Learning to resolve your conflict effectively and early—in a way that does not increase your stress level—is important.
Nurses can experience different types of conflicts including personal, interpersonal, and interdepartmental conflicts. Any conflict can interfere with workflow and harmony. Conflicts can also decrease productivity and damage self-esteem. However, not all conflicts are bad; occasionally a conflict can be good for change in the workplace.
Here are some tips to improve your conflict resolution skills.
1. Practice active listening and communication skills.
Practice listening to what the other person has to say, without interrupting. Make sure you understand what the other person is telling you. Communication provides an opportunity to share thoughts and problems as well as the reason why they are having conflicts. Face-to-face communication is more effective than other forms because it allows for an active exchange of information. It also allows you to observe important nonverbal cues from the other party. It is important that you use open-ended questions to make sure each side understands what the other person thinks and how he/she feels. This invites people to delve deeper into the problem and find the root cause for the conflict.
2. Stay calm and recognize the conflict.
Being calm and aware of your emotions are vital aspects of conflict resolution. Recognizing the legitimacy of conflicting needs and analyzing them in an environment of compassionate understanding will lead to successful problem solving. Use critical thinking skills to analyze the problem and plan your strategy, including what you want to say, and then write it down and rehearse it. Create a note card, if necessary, with your main talking points.
3. Maintain a positive attitude and practice managing your emotions.
A positive attitude is what you need to solve half of the problem. Emotions play a greater part in most decisions so recognizing and understanding your emotion will help you control your emotional response.
“Anybody can become angry – that is easy, but to be angry with the right person and to the right degree and at the right time and for the right purpose, and in the right way – that is not within everybody’s power and is not easy.” — Aristotle
As Americans with chronic illness are living longer, more patients and families are faced with difficult questions about quality end-of-life care and what makes life worth living. As November is National Hospice and Palliative Care Month, it is important to bring this critical conversation to the forefront and encourage nurses who are on the frontline working with patients and families to be aware of the difference between palliative and hospice care, when they should be discussed and implemented, and the critical need for both services.
Defining Palliative and Hospice Care
There has been a shift in thought over the last forty years, with the recognition that extending life isn’t necessarily more important than quality of life, and palliative and hospice care have helped support this critical gap. However, confusion exists between the two, with most people familiar with hospice care but unsure about the term palliative care. While the disciplines may offer overlapping benefits at times, palliative and hospice care are distinct.
Palliative care is a specialized area of medicine that focuses on quality of life and relieving the symptoms of patients with serious chronic illnesses, such as heart and lung disease. Palliative care providers address the whole patient – spiritually, emotionally, and physically – and look at the big picture of how patients’ illnesses can affect their lives as they know it. Patients can continue to receive aggressive curative medical treatments, such as chemotherapy or dialysis, while receiving palliative care. These specialists help begin a dialogue between patients and their families about how to best live with disease or illness, discuss the need for advanced care planning, and also assist in making sure that families understand the patients’ wishes. They do not replace any of a patient’s health care team, but instead add a layer of support to improve their overall well-being. Patients seeking to improve their quality of life at any stage of their disease, can seek the assistance of a palliative care specialist, and there is no time limit for when or how long a patient can receive palliative care.
While also palliative in nature, modern day U.S. hospice care began in the mid-1970s, and is a type of specialized care for individuals who are certified by a physician as having a terminal illness and are expected to live for six months or less. Patients seeking hospice care have expressed a wish to have symptom management as well as emotional and spiritual support. The focus of hospice is caring, not curing, and is aimed at relieving pain and allowing a patient to die where and how they want. It can be delivered in a patient’s home, a long-term care facility, or a free-standing hospice home. The hospice team creates an individualized plan of care aimed at alleviating a patient’s suffering, allowing them to pass away with peace and dignity, while also providing support for the patient’s family.
Introducing Palliative Care to Patients
Palliative care should be introduced early in a chronic disease. Often it is added to the health care team too late in an illness trajectory, when patients are approaching or eligible for hospice care, when multiple hospitalizations have occurred, or when they have had a dramatic decline in their health. Like many medical issues, early intervention is imperative, and adding a palliative care specialist early helps patients have a sense of empowerment in making decisions about their life and health. Research shows that early involvement of palliative care specialists can actually help patients live longer.
It’s also critical that nurses and doctors are aware of the benefits of palliative and hospice care, and that they present the added health care layer in a positive way to patients, at the appropriate time for them to reap the maximum benefits of these important specialties. Doctors and nurses need to have confidence in their knowledge of palliative and hospice care, and understand that patients don’t need to choose between the two. They both have an important place in the medical field.
With the average life span in the United States now nearly 80 years old, and medicine continuing to advance, quality of life and end-of-life care will continue to be significant issues and discussions facing our population. Knowing when and how to incorporate this layer of support into your patients’ health care plan will help you provide the best possible care for your patients.
As families and friends gather for Thanksgiving Day this year, there will likely be oft-repeated tales about favorite recipes or the family stories that always make everyone laugh. In the midst of these gatherings is an excellent opportunity to learn more about what makes your family unique – in every sense of the word.
In 2004, the Surgeon General, through the Department of Health & Human Services, designated Thanksgiving as National Family History Day. This is an opportunity for all families to learn more about the common and rare diseases that can run through several generations.
As you all reminisce about holidays gone by, it’s a good time to begin documenting the various health conditions family members have. If you have high blood pressure and other relatives do too, it’s a great opportunity to educate the younger family members about the disease in an open, honest, and informed manner. The teens in the family don’t need to be terrified about the potential for heart disease or diabetes, but they should be armed with information about how they can help keep themselves healthy.
National Family History Day gives families a chance to uncover common threads they might not have realized. While the Surgeon General’s office found that most Americans believe in the important of knowing a family history, only about one-third have ever tried to document their own family’s health history.
What should you ask about? Really anything that might help you. Once you know the common threads, you can all learn about how to stay healthy or manage those specific conditions. For instance, are there relatives with breast and ovarian cancer (especially early onset) from generations ago? What about testicular cancer? When everyone is together, you can act as an educated group to make sure family members are getting appropriate testing or monitoring.
Because the Surgeon General considers family history as such an important health indicator and screening approach, the office has created the My Family Health Portrait online monitoring tool to help families document conditions and diseases. This tool means the documented history can be shared among family members and updated as health changes occur. Family members can even bring a copy of the document to healthcare visits to help inform their health team about important information.
Nurses don’t need anyone to tell them what kind of a predictor family history is. Each day, they see families with shared conditions. But if they don’t discuss their own detailed family health histories and if they don’t always ask the right questions, they could be missing some important health information of their own. Many families don’t talk about things like reproductive health problems or of mental health issues. Some might not discuss alcoholism or addiction. But each of these health conditions provides an essential piece of a family’s health picture.
Before you begin this process, the Surgeon General’s office has prepared some tips to help you. You’ll want to be ready to get the information, but realize you might not get everything on the first try. Make sure you are clear about what you are doing and why. Some people don’t like to talk about their health issues, but if they realize it could help save a loved one, they might look at your information gathering in a very different light.
Consider this an ongoing conversation among family members, and that Thanksgiving is just a start. Realize not everyone will be on board. Get as much information as you can without upsetting anyone. Be encouraged by what you can find out – you are helping your family now and for generations to come.
With dozens and dozens of nursing specialties, some nurses take varied paths to end up in the specialty that is the best fit. Many try different health care situations or medical training before deciding that one area of nursing is the career where they will make the impact they want and will satisfy their professional goals.
Jose M. Maria, MS, FNP, RN, CEN, director of emergency services at Brookdale Hospital and Medical Center in Brooklyn, New York, says he came to emergency nursing after gaining training and experience as an EMT and paramedic. “Emergency medicine was the next logical choice in starting my nursing career,” he says. “I haven’t looked back since.”
Maria, a native of the Dominican Republic, says his specific EMS experience really gave him a solid foundation to know what he wanted and provided him with the essential capability for any emergency nurse. “It allowed me to develop the skills to adapt to any situation while keeping a cool head,” he says.
But emergency nurses also benefit from having more than a cool head and a great skill set, says Maria. The flexibility to move from one situation to another one that is entirely different is essential for a successful emergency nurse. And then there’s the part where you work your tail off. An emergency nurse who doesn’t complain about the task (or 20 tasks) at hand and does what’s needed will have a much easier time working in such a fast-paced environment.
And when it’s time to transition a patient to inpatient nurses, challenges remain. In fact, Maria says that transition point is one of the most challenging aspects of emergency nursing. “This is a common challenge at every organization I have been a part of,” he says.
Preparation and planning, as with any part of the emergency nurse’s job, can help. And finding out how other nurses work also helps inform your own practice. “I try to stay current in practice and use resources like ENA CONNECT and to speak with colleagues across the states,” says Maria. “Like many professions, preparation is key for success in the emergency department.”
But with those skills and responsibilities, emergency department nurses encounter a lot of critical and crisis situations to adapt to. For Maria, those situations reveal why he does what he does. “The most satisfying and most important part of my job is to save lives,” he says. “It’s a powerful and overwhelming feeling to have brought someone back from death and see them walking out of the hospital.”
Anyone considering emergency nursing as a career path can follow Maria’s advice to rotate through other specialties before deciding on the ED. Each area offers you a new set of experiences and training that will be useful in the emergency department.
“Because we see a wide range of complaints, we can actually help our patients,” he says. “Working in psychiatry for example, helps you build conflict resolutions skills, improve communication techniques, and builds patience needed in the acute psychiatric emergency. Working in the ICU, with their attention to detail, improves your documentation. Working on a medicine floor helps in time management skills. Working a surgical unit, improves your teaching techniques with patients.”
And while the emergency department is intense and fast, emergency nurses do find a way to offer each other the kind of support and camaraderie that is distinct. Their humor might even be considered dark, says Maria.
“People have a hard time understanding that even in the darkest of times, humor helps us deal with our internal anxiety about the cases we work,” he says.
Opioids are a type of narcotic pain medication that is used to control pain. Examples include meperidine, methadone, morphine, oxycodone (OxyContin), oxycodone with acetaminophen (Percocet), and hydrocodone with acetaminophen (Vicodin). There is an increasing number of patients with pain addicted to opioids. According to the Centers for Disease Control and Prevention, opioid overdoses have quadrupled since 1999. Nurses play a vital role in preventing opioid addiction in patients with pain through nursing assessments and monitoring of their patients.
Here are 4 essential steps that nurses can take to help prevent opioid addiction.
1. Perform a comprehensive assessment of pain by using a standardized pain assessment tool.
Nurses need to assess the individual patient’s pain location, characteristics, onset, duration, frequency, intensity or severity, precipitating factors of pain, and how the individual manages his or her pain.To learn more about pain assessment tools, visit www.paincommunitycentre.org/article/pain-assessment-tools.
2. Assess the patient’s pain management and medications used.
Pain medication should be matched to the individual patient’s needs. It is important that nurses assess the patient’s detailed medical history, including a list of currently prescribed and past medications, as well as a history of substance use or substance use disorders in the patient and the patient’s family. Keep monitoring patient use of medications and opioids to avoid overdependence or potential addiction.
3. Evaluate the effectiveness of the pain management through ongoing assessment of the individual patient’s pain experience.
Proper evaluation of pain management requires that all patients have a treatment entry diagnosis that is defined, standard, and objectively determined. An ongoing assessment of the patient’s pain experience during and after treatment is vital for preventing pain medication misuse. Patients can become addicted if they take pain medications or opioids too much or for a long period of time.
4. Educate your patients about pain management.
A better patient understanding of the nature of pain, its treatment, and the side effects and complications is one of the most important steps toward improved control of pain and pain medication use. Nurses should provide written instructions about dosage, adverse effects, how long the medication should be taken, and how to store and dispose of unused medication. Opioids can be dangerous if patients take them with alcohol, or with certain drugs such as antihistamines, sleeping pills, and some antidepressants. Nurses can also introduce the use of non-pharmacological techniques (e.g., relaxation, guided imagery, music therapy, distraction, massage, lifestyle modifications, and heat and cold application) before, during, and after feeling pain to control and reduce pain.