One of the toughest things nurses face is caring for themselves, and eating for optimal nutrition at work is especially problematic. Filling up on whatever is around can actually zap your energy and lead to longer-term health problems. And a recent study proves the grab-and-go in the break room is challenging for everyone.
A recently published study by the American Society for Nutrition shows that relying on food in the workplace might actually hurt your health. In a time crunch, buying quick take out in the cafeteria, granola bars or candy bars at a vending machine in the hall, or a juice or soda for a pick-me-up can wreak havoc on everything from your blood pressure to your weight.
Even if you resolve to spend nothing on food at work, you aren’t out of the woods. The candy dish that remains filled with tiny pieces of chocolate, the birthday cake for a coworker’s big day, and the party leftovers that appear in the kitchen or break room all add unexpected calories to your daily or weekly total.
The study’s author, Stephen Onufrak noted in his presentation abstract the dietary quality of foods obtained in the average work setting of the study provided less nutrition and a higher ratio of sodium and fats than healthy guidelines recommend.
Even worse, you often aren’t even aware of what you’re eating. A few small cookies barely make a dent in your hunger, but easily pack a lot of fat and calories to your day with little nutritional value. And because nurses work a physically demanding job, eating on the run is pretty common. Sometimes you think it must be better to grab a slice of coffee cake than nothing, and sometimes it is better to do that. But planning ahead and having a yogurt that’s just as fast to eat, string cheese, whole-grain crackers, or a handful of dried fruit and nuts that provides fiber, protein, and a few vitamins to boot is a better choice and provides longer lasting energy.
If it’s the social aspect of workplace eating that appeals to you, just be aware of your intake. Allocate what you are willing to splurge on and what you won’t really miss. Advocate for healthier choices when food is supplied for meetings, lunches, or celebrations. Also be your own cheering section. Take the time to stash your favorite snacks in your bag so you can feel social, but still fuel your body with healthy foods. As with any behavior change, it helps to enlist support. Find a buddy who can help you resist the urge to nosh on whatever is closest at hand.
With healthier eating comes many benefits, but feeling better is one of the biggest benefits of all.
You gave your patient a shot and he or she passed out! What did you do wrong? Nothing.
No patients were harmed in this photo.
Vasovagal syncope is one of three related syncopes that share a common pathophysiology. Together, they are called reflex syncope. The three are vasovagal, carotid sinus, and situational. Vasovagal is what just happened to your patient. Pain, seeing blood, emotional reaction, and prolonged standing are triggers of vasovagal syncope. Situational is triggered by urinating, coughing, or swallowing. Carotid sinus is triggered by stimulation of the nerve bundle located in the carotid sinus of the neck.
These neurologically induced losses of consciousness are brief and resolve without specific treatment. They are usually preceded by feeling dizzy, sweating, tunnel vision, odd feeling in the chest, or feeling very hot or very cold. The pathophysiology is an abrupt slowdown of the heart rate and a dilatation of the blood vessels leading to hypo-perfusion of the brain. Basically, the pump can’t get blood to your brain and you pass out…and you fall down.
First of all, it’s important to NOT PANIC. There is nothing you can do to fix it. Prepare for it by observing your patient immediately after giving an injection or drawing blood because these are prime times for a vasovagal episode. Make sure the patient is already seated and if you notice your patient is getting pale, sweaty, stuttering, or acting odd, gently guide your patient to a lying position with the feet up. Sometimes the loss of consciousness comes with muscle twitching that looks like a seizure. Unlike a seizure, there is no prolonged postictal period, muscle clenching, or incontinence. While the loss of consciousness will resolve as soon as the patient lies (or falls) down, he or she will probably pass out again if he or she gets up so keep the patient under observation and lying down. It’s a good idea to get serial blood pressures so you can document the resolution. Every five minutes is fine. Your first blood pressure will be low with a heart rate in the 60s or high 50s. Over the next five to 15 minutes the vasodilatation and bradycardia will resolve without intervention but if you let the person stand up…boom! Don’t let the patient get up until they have a documented normal BP and HR. You can bring them a blanket, a drink of water, some juice, anything you like. Nothing is going to make it resolve any faster.
How do you know it’s vasovagal syncope? Easy: Did you just give this person a shot, draw blood, or let them see a bloody bandage or wound? If so, did they then get pale and sweaty and fall down? When they were horizontal, did the loss of consciousness resolve? Yes? That’s it! The only thing you can do wrong is try to stand them back up again!
So what do you do if this happens to your patient? To recap, don’t panic, make sure the patient is safe, call for help, get serial blood pressures, and observe the patient until the BP and heart rate are normal. Usually there is no need to call for an ambulance unless the patient actually fell down and hit his or her head or the symptoms are not resolving.
Remember, it’s a common occurrence and patients that are prone to it will probably do it again. You didn’t do anything wrong!
For 41 years, nursing assistants have celebrated National Nursing Assistants Week during June. Career Nursing Assistants Day on June 14 kicks off the week of honoring the nursing assistants who care for elderly or disabled patients, especially in long-term care facilities, hospice care, home care, or nursing homes.
According to the National Network of Career Nursing Assistants, nursing assistants are a vital connection to patients as they help them with the basic care and activities of daily living. They help patients feel cared for and comfortable, while also providing the essential hands-on care that keeps patients healthy. While helping patients do things like bathe, eat, or gain movement, they are also able to form trusting relationships. Nursing assistants spend so much time with patients they are able to get to know them and learn about their lives.
When patients are away from the comforts of their home or far away from family and friends, nursing assistant s give a companionship so necessary for feeling better. They provide a gentle care from which patients and residents feel respect and a sense of belonging. When nursing assistants greet them by name and ask about their health or their physical ailments, they are taking an assessment of how the patient is doing on a basic physical level. Those are assessments that are essential to the medical team that oversees the patient.
But because of their close proximity to people, nursing assistants are also able to ask about the favorite foods of patients or residents, their upbringing, how they celebrated milestones, and family and friends who were once or are still close to them. They may get to know the visitors who come often and are able to hear and share stories with them. With that kind of knowledge, nursing assistants have many topics of conversation they can use to engage patients. Their familiar presence becomes reassuring and comforting as a patient’s moods may go up or down or as their physical discomfort increases or decreases.
According to the Bureau of Labor Statistics, the demand for this role will continue to rise at a faster-than-average rate. Those looking to get into this career field will find plenty of opportunity to offer compassionate and skilled care to populations that needs it most. The median salary of $27,500 annually will fluctuate with location and demand, and you’ll need to pass a competency exam. Like other jobs in the medical or care field, the work can by both physically and emotionally demanding, but the rewards of caring for patients and making a difference in their lives is great.
Help celebrate National Nursing Assistants Week by noting and thanking nursing assistants for the tremendous work they do.
The Patient Self-Determination Act, passed by Congress in 1991, requires hospitals, nursing homes, and other health facilities to provide information about advance directives to patients and to keep a record of any completed documents. An advance directive is a legal document outlining a patient’s preferences for treatment at the end of life. It allows patients to name a person (“agent”) to decide for them if they are unable to decide. As the population of older Americans is increasing, one in five Americans will be over age 65 by 2030 and a life-threatening situation such as cardiac or respiratory arrest can occur at any time. Nurses need to take an active role in educating patients about the different types of advance directives and must talk with their patients and families in terms of their goals of care and preferences for end-of-life care to ensure that patients’ wishes for care at the end of life are known and respected.
Here are three tips to help you integrate them into your daily practice.
1. Review and verify the patient’s advance directive status at his or her first patient contact.
Nurses can help patients explore treatment options and prepare them to participate and discuss with physicians in making the best possible option based on their preferences.
2. Assess the patient’s educational needs.
Patients must be provided with complete information about advance directives and have the opportunity to discuss all of their alternatives and options. Having sufficient knowledge will enable patients to make sound and knowledgeable decisions about their own advance directives. Their education should also include the benefits and risks associated with their choices. It is important for nurses to understand their workplace policy and procedures about advance directives and take any available education about advance directives to increase their knowledge.
3. Advocate for your patients’ decision representing what is best for them.
Nurses have an important role to promote their patients’ decision concerning the treatment or withdrawal of medical care and completion of advance directives. Understanding the options available to the patient can help nurses confidently and purposefully address their patients’ needs. It is imperative that nurses are knowledgeable about their state and federal laws related to end-of-life care and are able to answer the patient’s questions concerning different types of advance directives.
Every workplace has its challenges. But, on the flip side, each has its advantages as well. We asked Beverly A. Ely, APRN, FNP-C, who works as a Family Nurse Practitioner in Harrogate, Tennessee, about what it’s like to see patients in a rural area.
Beverly A. Ely, APRN, FNP-C
What kind of work do you do?
I currently am a Family Nurse Practitioner and work with Lincoln Memorial University/DeBusk College of Osteopathic Medicine. We have 2 clinic locations that serve the University and the public. In the clinic, I see patients of all age groups from newborns to the elderly.
Working in a rural area is quite different from what most nurses do. Have you worked in a more urban or suburban area before this? If so, how does working in a rural area differ from those places?
My career spans over many decades and regions. I began a career in nursing in the late ‘80s. I graduated from Lincoln Memorial University with a degree as an Associate Nurse. I chose to begin my nursing career in Knoxville, TN and commute back and forth. Working in a suburban area, I encountered larger volumes of patients in which needs were very different than those in an urban location.
The urban area is different than the area where I first began my career. Coming back to it was a different experience, but one that has proven to be the most rewarding. I help them meet the simplest of everyday needs and assist them with coping skills to understand a diagnosis—this is rewarding. That is what I cherish about rural health and the people of the Appalachian area. I can now say that I can give back and serve the people that have given me so much.
Why did you choose to work in a rural setting? What kinds of patients do you tend to see? How are they different from those you saw in a more urban setting?
I chose to work and serve in the rural area of Appalachia because the needs are so great. I completed 29 years as a suburban nurse and saw many different classes for people. The common denominator for both is survival.
What have you learned from working as a nurse in a rural area?
I have learned to be patient and compassionate. I have learned that there is very little that we truly need in order to survive.
What are the biggest challenges of working in a rural setting?
The biggest challenge is compliance and understanding of their illness.
What are the greatest rewards?
Seeing people feel better and the smiles on their faces.
What would you say to someone considering moving to work in a rural area? What do they need to be willing to do or deal with?
I would voice that rural health is the most rewarding field that you can chose. It requires you to have compassion and patience.
Is there anything else about working in a rural area that is important for people to know?
Yes. Do I plan to continue here? The answer would be YES. It is the most rewarding of my 30 years as a nurse that I could have ever imagined. I’m compassionate and love the people of Appalachian and desire to see them live life to the fullest.
With hurricane season fast approaching, individuals in vulnerable areas are preparing for the possibility of an active hurricane season. Last year was a particularly active season that affected the Caribbean and most of the Gulf Coast areas. As health care providers, nurses are particularly affected due to our responsibilities to both our patients and families as well as ourselves. This can be not only physically stressful, but also emotionally taxing on the individual.
In August 2017, Hurricane Harvey hit the Texas/Louisiana coastal areas and caused massive flooding, damage, and fatalities. The Texas Medical Center in Houston sustained flooding that stranded many hospital staff and patients for several days while the hurricane lingered in the area.
Heidi Aghajani is a nurse employed in the Houston area who spent six days working at the hospital during Hurricane Harvey while also being responsible for her family at home. She shares her story and expresses how she was affected during our interview.
What do you think went well with the hurricane preparation efforts of the hospital?
The hospital constantly informed staff of the hurricane via text messages, emails, and even huddles with managers about what’s happening, what to expect, and the time frame of when to expect it.
When did that start?
It started probably about 4-5 days before we knew the hurricane would hit.
When did your hospital notify you that you would need to come in as the ride-out team?
They notified us that Saturday before the storm hit Houston.
For the preparation, how many days’ worth of clothes, food, etc. did they tell you all to bring?
We were told to bring 4 days’ worth of clothes and food.
How long were you assigned to the hospital following Hurricane Harvey’s landfall?
We ended up staying for six days.
Were there any specific preparations your unit used that were particularly helpful?
They stockpiled patient supplies such as syringes and medications days in advance to last through the hurricane because they knew we would not get supplies.
Have you experienced any other natural disasters since becoming a nurse? If so, how would you compare that experience to your experience with Hurricane Harvey?
I was a nurse during Tropical Storm Allison where everything flooded badly so I would say that this time around the Medical Center itself was much more prepared with the underground doors and shutting streets down.
Explain your feelings regarding the uncertainty of the condition of your family, home, while you were at the hospital?
There were a lot of emotional breakdowns; a lot of people cried. The first couple of days were good, but about the third or fourth day it got very emotional. If you called your family and they didn’t answer or if you heard something on the news about an area that your family was in it just became very stressful and a lot of nurses really had some long periods of just crying; just wanting to get out and wanting to be with their families.
Do you feel that these emotions could have interfered with a nurse’s ability to care for their patients?
I don’t think we would admit that, but we did offer each other breaks during our shifts to get some alone time. I ended up on night shift so we kind of traded off letting people nap and just get away and just take moments because during the daytime a lot of people could not sleep because of the helicopters and the tornado threats.
Did you view news coverage of the damage of Hurricane Harvey during the storm? If so, how did that affect you or your colleagues?
Yes, we watched it nonstop. We were obsessed with watching it actually. It was on every TV on our unit and if you saw an area that was close to your family it really affected people. You would hear nurses say, “Oh my God, my son is in that area” or “That’s were my family is staying.” It was sad.
Did you personally have a conflict with your responsibilities as a nurse and your responsibility to your family?
Yes. You’re going to make me get emotional [with tears in eyes]. Yes, the conflict was: do I stay home and take care of my family, or do I perform my duty as a nurse and take care of my patients? I knew that my son would be with my family who would take care of him just as I would, so I found comfort in that and I was able to just be a nurse.
Were there other nurses on your unit whose family had to evacuate, and were they aware of the evacuation?
Yes. We had a nurse that learned that her husband and mother were evacuated off their roof while she was working and had to be taken to a shelter. She was very emotional.
Do you feel better prepared for any future natural disasters having experienced Hurricane Harvey? Why or why not?
Yes. I know now what needs to be in my disaster bag for real [laughing].
Will you volunteer as part of the predesignated ride-out team again? Why or why not?
I think I would because my son is older, and I would hate for someone who has a younger child to have to do that, but yes, I would.
Is there anything you would have done differently if you could?
Yes, I would have planned my bag better. I ran out of personal supplies, clothes, and food. I would have probably stockpiled my locker days before.
Any additional tips for other fellow RNs regarding how to personally prepare as a ride-out team member during a hurricane?
No one can prepare you or train you on how to handle the fear you will feel in your heart and the long days of relentless worry. But the same patients I was there to take care of, ironically, in a way took care of me. It’s amazing how grateful they were that we were there for them. That helped me focus on my duties and remind myself that this is what nursing is all about. We don’t run from it. We run to it. This is who we are.
Hearing nurse Heidi’s story only reminds us how amazing our nursing profession is. Nurses will continue to perform during natural disasters, but we must also remember that they too are going through this experience. They have family and friends out in the community that they cannot help. They are experiencing emotions that they will never allow their patients to see. They are having thoughts in their minds on whether they made the right decision on being a nurse or a loved one. But this is what nursing is all about. This is who we are, and this is what we do.