Weight Management for Nurses: The Why’s and How’s of Losing or Maintaining Weight

Weight Management for Nurses: The Why’s and How’s of Losing or Maintaining Weight

weight management

As you well know, America is in the grips of an obesity epidemic. According to the National Institute of Diabetes and Digestive and Kidney Diseases, over 70% of adults are considered overweight or obese, which is associated with multiple medical conditions. Nurses, as role models, advocates, and educators, are poised to make a difference in reversing this trend.

Unfortunately, nurses are not immune to weight problems themselves. In fact, research suggests the rate of overweight and obesity within the profession is on par with the general working-age population.

Here nurses and wellness professionals offer savvy advice for managing weight and fitness.  Even for those working long, stressful, rotating or night shifts that offer few healthy food and exercise options.

Becoming a Healthy Role Model    

Many nurses feel hypocritical telling patients to exercise and eat right if it’s obvious that they don’t walk the talk. Maybe that’s one of the reasons nurses enjoy a stellar reputation for honesty and trustworthiness, according to annual Gallup polls.

Yes, nurses are role models for patients, but there’s another professional reason to take care of one’s weight and fitness—the health and longevity of your career. The American Nurses Association Code of Ethics for Nurses includes several mentions of the importance of self-care (e.g., “The nurse owes the same duties to self as others”).

Nurses Helping Nurses

Many nurses know about the power of a group for establishing healthier habits like eating better and moving more. Most of those groups are comprised of people from all walks of life. But you may find there’s even more power in teaming up with fellow nurses who understand the struggle, especially if they’ll be around regularly to hold each other accountable.

Victoria Randle, MSN, NP-C, is a family nurse practitioner in the Atlanta area and cofounder of Nurses 4Ever Fit. Since January of 2018, the organization has held monthly in-person events at venues such as a nurse-owned yoga studio. “We all have a special bond that only another nurse can understand. It’s a platform for like-minded individuals to talk together, it’s a form of therapy, a form of camaraderie, and you can get your fitness in,” she explains.

Randle says the emphasis is on fitness, rather than diet, because “I see a lot of nurses who are vegan, for instance, and they don’t seem healthy. The element that’s missing is movement. When you’re 90 and you don’t have good muscle tone or you have brittle bones, that’s not healthy.”

Also, many women say they are “fearful of going to a gym because ‘I’m afraid people will look at me and judge me’ but here we’re all learning, and it’s a judgement-free zone,” she adds.

Saturday morning fitness sessions are only part of the Nurses 4Ever Fit experience. “We’re going to do an annual retreat. We take a weekend away and it’s a form of therapy. It includes a massage or a hot tub together,” she explains.  “Exercise is good, but it’s not everyone’s idea of self-care. The nature of a nurse is to care for others and put the patient first. So, when it comes time to care for yourself, you don’t have much left. That is embedded in you—the workplace culture needs to change. Nursing school actually taught that if you get a 30-minute break in a 12-hour day, you’re lucky!”

Healthy Workplaces Equal Healthy Nurses

Some hospital systems have started programs to ensure that healthy food and fitness opportunities are available to their nursing staff.

MD Anderson Cancer Center in Houston, Texas, is lauded as an outstanding example of a wellness workplace. Evan Lee Thoman, MS, PMP, CWP, wellness specialist in the HR Wellness and Recognition unit has been in health promotion field for 13 years.

He works to find out what other employers at other top hospitals and universities are doing to engage employees toward a healthier lifestyle. And he investigates what his own hospital’s employees want before offering up a range of at-work health initiatives.

“The program is different for every unit. I go in and have a conversation with the leadership and we may do a needs and interest survey. We’re asking: ‘What do nurses need?’,” Thoman says. For instance, “we had many questions in one unit regarding how to make use of dental insurance. Who would not have guessed that medical consumer information was a top concern?”

But it was, so the wellness department set up a program to fill the knowledge gap. They aim to provide education and services to every shift ranging from an on-site fitness center and gym membership to ergonomic assessments and resources to address compassion fatigue, resiliency, and spiritual care.

Workplace leadership that buys into a wellness culture will reinforce the healthy behaviors that nurses must adopt. Thoman helps nurses to create those wellness habits, without overwhelming them. He asks them: “Who’s going to be your support system? Who’s going to hold you accountable?” The wellness team is there, of course, but so are fellow nurses and nurse leaders. “We get the best results and greatest engagement when we have a leader who walks the talk,” he says.

For example, nurses are notorious for neglecting to take meal or water breaks. “If you eat lunch it’s almost like you’re the weak one on the unit,” he says. “We’d been talking to nurses about planning their meals but then we thought, maybe we can bring something to the nurses. So now we try to take snacks to each department—‘Here’s a little something, a granola bar or piece of fruit, to fuel you during the day.’ We also stress micro breaks and encourage them to find five minute for a snack, go for water.”

When overworked and overstressed nurses complain that they don’t have time to take care of themselves, Thoman suggests gardening, journaling, or even coloring as a way to decompress.

Because nursing is a predominantly female occupation, Thoman notes that rest and relaxation may be difficult for women who do double-duty as caretakers at work and at home. Then there are the biological factors that may hamper a woman’s weight management efforts.

“From a weight-loss perspective, men tend to have more lean muscle than women, which burns more calories than body fat at rest, so, at the onset, men may lose weight a little faster,” explains Thoman, who was previously a university strength and conditioning coach.

Exercise Early, Exercise Often

Cara Sevier, RN, codeveloper of Nurses 4Ever Fit and the CEO of Cara Sevier Industries in the Atlanta area, knows that exercise isn’t always convenient for busy nurses working crazy shifts or living in extreme weather zones.

When nurses tell her that they have difficulty finding time to exercise, she asks them to challenge that belief. Even nurses with legitimate time constraints, such as parents of young children. “They call it a time barrier or challenge, but we say it’s a self-care issue; they feel guilt over finally taking care of themselves first,” she says.

Sevier has personally experienced that challenge and now meets it by waking up at 3:00 a.m. to drive to a gym 30 minutes away. Though the gym is open only Monday through Friday, she maintains her schedule seven days a week. “I found out I had to be consistent or I was thrown off. It gives you a peace in your body that you’re doing something for yourself—getting up at 3:00 a.m. for a 4:00 a.m. class,” she explains. “It takes discipline, forcing yourself, forcing my body to get to my highest physical self. On the weekend, I will find a cycle class or something else to do. Is it easy? No. It’s a lot of sacrifice, but it’s worth it.”

On the other hand, we do need adequate sleep to stay slim—and to stay sane. One study at Columbia University suggests that getting less than four hours of sleep a night could raise your obesity risk by an astonishing 73%. (Seven hours a night is the sweet spot.) Nurses who work overnight or pull 12-hour shifts are also at greater risk for weight gain, according to a University of Maryland study. Scientists suspect that when circadian rhythms get thrown out of whack, so do hunger and fat hormones, which results in excess pounds. Or perhaps lifestyle factors lead tired nurses working off-hours to make poor food choices and avoid exertion.

Become a Healthy Living Warrior

Uniqua Smith, PhD, MBA, RN, NE-BC, associate director of nursing programs at MD Anderson Cancer Center, slowly gained weight after transitioning to an administrative role. But with the help of a fitness boot camp and workplace wellness challenges, she started making healthier food choices and exercising consistently.

“On Sunday, you had to send in a picture of all the groceries you just bought—to show that there are no snacks, no high-sugar foods,” she explains about a challenge with friends, using a social media app for accountability. “For the weekly weigh-in, you had to take a picture of your feet on the scale.”

“Workplace weight loss challenges, like the March Madness challenge, keep you going when you have a month-long goal,” Smith explains. “You’re also motivated because you don’t want to let your team down.”

A little over a year later, she’d lost 40 pounds through calorie-cutting, portion control, and cardio exercise. Only 10 more pounds to reach her goal weight, but then came a diagnosis of breast cancer.

“I truly believe everything happens for a reason: 2017 was about getting myself together health wise,” she says. “It got me ready for 2018, when I had to fight for my life. It gave me the strength to fight cancer.”

After six months of chemotherapy, she underwent three separate surgeries over the next several months.

“I went through 16 cycles of two different types of chemotherapy. It takes a big toll on someone—I lost my taste buds and energy,” she says. “It took me literally an hour to take a shower, which before that took 10 minutes.”

She started exercising again slowly, at the beginning of 2019, after the last of her surgeries. From walking to running and then completing a 5K, she challenged herself to get to her previous state of fitness.

Smith is now a healthy living spokesperson and encourages everyone to eat clean and condition their bodies so they’re strong enough to fight any disease that comes their way.

Don’t Fool Yourself

For many nurses, weight gain happens slowly, and they may not even notice it at first. Or they have a pattern of yo-yo weight loss and gain, with pregnancy, holidays, or shift work.

Sevier knows what that’s like. “Even at my highest weight—I reached 188 lbs—I told myself every story in the book. ‘Maybe these scrubs had shrunk in the hot water. Oh, wait, is this the U.S. size or the European size?” But those excuses didn’t hold up under examination and soon she started working out with a trainer at a gym. “Now scrubs that were once tight on me are loose,” she adds.

Though it may be painful to face facts, research shows that being aware of and tracking certain behaviors can help drive healthy habits. A daily food log, whether paper or digital, can help some people to lose weight or keep it off. You can’t argue with the truth, when it’s detailed right in front of you, in black and white.

Feed Yourself Healthy Meals, Healthy Snacks

If you’re like most nurses, you struggle to plan, shop, and cook yourself nutritious meals and snacks. Regular meals may go out the window, replaced by chaotic eating habits. But simple meal planning strategies can help nurses to eat well.

Tiambe Kuykendall, BSN, RN, a clinical nurse at MD Anderson Cancer Center, does everything she can to fight off chaotic eating. “I work in pediatrics and our [patients’] parents want to feed us all the time. Nobody ever buys us a fruit basket, though we would enjoy it,” she notes. “I’ve realized that I have to pack a healthy snack to make sure there is one at work.”

But desserts, junk food, and other caloric gifts and treats aren’t the only landmines threatening your waistline at most nurses’ stations. “In my unit, someone will bake chocolate chip cookies two or three times a shift. We’re surrounded with unhealthy snacks—chocolate, cookies, chips, pizza, and other junk,” she explains. “But the wellness department brings snacks on a weekly basis—granola bars, bananas, apples, and popcorn. When everyone is trying to be healthy it makes it so much easier.”

Kuykendall notes that when she works out in the morning, her level of energy is much higher later. She’s made other changes in the a.m., too: “I don’t drink energy drinks anymore, just green tea in the morning before I go to work, and sometimes in the afternoon.”

She avoids the cafeteria even though there are healthy food options there. “We have a 30-minute lunch break and MD Anderson is huge, so the cafeteria lines are long,” she says. “Yesterday I planned meals for the next three days and will bring my own lunch and snacks. You can make small changes, like eating grapes instead of candy. I don’t advise that you deny yourself all the time, but indulging should not be the norm.”

Ditch Dieting in Favor of Mindful Eating

Most nurses are familiar with programs such as Weight Watchers, and in fact, some hospitals hold on-site meetings. But there’s been a nationwide shift in attitudes away from dieting and toward a focus on healthy living. Mindful eating is one such approach.

“We don’t promote any particular diet, or if you don’t follow a diet, we want to teach people to simply be aware of why they eat,” explains Mark Mitchnick, MD, CEO of MindSciences, Inc, a New York City developer of digital therapeutics apps. “Right now, it’s keto, but we don’t want to chase fads.” The company’s Eat Right Now app teaches users about the habit loop and how to navigate triggers to eating.

Most of us eat for a variety of reasons, most often the trigger doesn’t have anything to do with physical cues. “Sometimes it’s that you’re hungry, and sometimes it’s that you’re stressed, or you’re tired, or it’s a fight with your significant other,” Mitchnick says. “You can learn to separate the trigger from inappropriate behaviors and do something more productive. If you’re stressed about an upcoming test, study, don’t eat.”

The app helps people to break the habit loop through educational content in a highly sequenced series of 28 modules. It’s constructed to deliver a module a day, which takes only eight minutes, and which can be repeated as desired. A user can also access lessons when on a just in time basis. When feeling a craving, they can bring up a short series of questions to help shape their response to it.

A scientific study showed a 40% reduction in craving-related eating—eating for reasons other than hunger—after use of the app.

In addition to the mindful eating app, there is one to relieve anxiety and one for smoking cessation. “A lot of behavior people would like to change in a high-stress field like health care—smoking and eating—is actually stress-related. Ask yourself: ‘Do I have an eating issue or an anxiety issue?’,” Mitchnick  advises.

It’s not easy for nurses to stay slim, but it’s worth doing. Shift work, long hours, sedentary lifestyle, heavy lifting, high stress, and fatigue can be overcome with a mindful approach.

Gaining Policy Expertise and Influence Through Voluntary and Service Opportunities

Gaining Policy Expertise and Influence Through Voluntary and Service Opportunities

As nurses we are actively engaged in advocacy activities through our professional and specialty nursing organizations. However, an increasing number of nurses are informing the political discourse by serving as volunteers for a growing list of consumer oriented organizations such as the American Association of Retired Persons (AARP), Susan G. Komen, and the Lupus Foundation of America, all of which have local affiliates across the country. These and other organizations often provide advocacy training for their volunteers along with opportunities to engage in advocacy days.

Serving as a volunteer for these and other organizations enables nurses to use their expertise and strong familiarity with consumer concerns to inform advocacy efforts on behalf of diverse constituents.

Nursing’s engagement in this capacity compliments the current push to ensure that 10,000 nurses are placed on boards or coalitions by 2020. As of October 2019, 6,751 nurses have been placed on a diversity of boards which provide invaluable opportunities to utilize nursing expertise at the local, state, and national level, according to the Nurses on Boards Coalition.

Perhaps less popularized are calls for applications to serve on advisory boards and councils for elected officials. For example, in Illinois at the beginning of Governor Pritzker’s tenure as the state’s 43rd Governor, the governor’s office released a call for applications for volunteers to serve on a number of advisory boards. Some of the opportunities were directly related to health such as the State Board of Health. Other non-health specific opportunities were suitable for nurses to lend their expertise on topics such as aging, the environment, or child welfare. Such engagement

Resources

Nurses on Boards Coalition

Nurses can sign up for alerts and potential opportunities.

The Federal Register

Nurses can check this listing of federal agency meetings and calls for applications to serve on advisory councils in addition to a listing of meeting times and agendas for numerous federal agencies. Free subscription.

is critical to infusing a health-in-all-policies perspective into the decision making process. Illinois is not alone in this regard. Other states and municipalities have opportunities in which nurses can use their expertise to help inform elected officials about health-related matters.

For example, Catherine Waters, RN, PhD, FAAN, professor at the University of California Sans Francisco, is an accomplished nursing faculty member with expertise in community health, health disparities, and health equity. She served five years as a health commissioner for the San Francisco Health Commission. Waters not only used her expertise to shape the policy discourse around health issues impacting her city, but also developed additional skills in diplomacy, consensus building, and budgetary decision making.

In Minnesota, Shirlynn LaChapelle, an expert nurse clinician, serves as a nurse consultant to the state’s Attorney General Keith Ellison. In this capacity she serves as a member of the Attorney General’s Advisory Task Force to Lowering Pharmaceutical Drug Prices. As a nurse, she brings real life examples of how people struggle to secure access to affordable health care and life saving medications.

In Washington, D.C., Catherine Alicia Georges, EdD, RN, FAAN, professor and chairperson of nursing at Lehman College and the Graduate Center of the City University of New York is a long-term volunteer for AARP and an AARP board member. In 2017 she was elected to serve as the organization’s National Volunteer President from June 2018 through June 2020. Georges serves as the lead national spokesperson for the organization and helps to shape the policy agenda for AARP.

From a federal government perspective, some federal agencies or departments have been mandated by law to establish an advisory council. Advisory councils are mandated to include a variety of expertise including consumer representation. Many nurses serve on federal advisory councils providing recommendations to agency directors on issues germane to the agency’s mission or strategic initiatives. For example, a number of nurses continue to serve as members of the National Advisory Council for Nursing Research and the National Advisory Council on Nurse Education and Practice. Nurses also serve on federal advisory councils that are not specific to nursing but can benefit from nursing’s expertise in patient care and health care in general. For example, the National Institute on Minority Health and Health Disparities and the National Cancer Institute have selected nurses to serve as members of their advisory councils. These members join other members in weighing in on federal funding issues and shaping priorities for advancing the Institutes’ mission.

Nurses who aspire to serve in these capacities must always be prepared to respond in case there is a call for applications. Keeping one’s resume/CV up to date is key as some calls for applications may have a short turnaround for submissions. Keeping a nominator bank with a list of individuals who can provide an accurate and firsthand account of one’s excellence and contributions is also important. Nominators can be called upon to help verify an application or be asked to provide additional information that informs the selection process. In some instances, nurses can pursue opportunities to serve on advisory councils or committees through self-nomination. Either way, strong letters of nomination are often required.

Gaining additional expertise through volunteerism and service can be a strong catalyst for future opportunities in the policymaking arena. My earlier volunteer work with Susan G. Komen positioned me to pursue a board position creating a pathway to become chair of the local affiliate’s Public Policy Committee.  This volunteer experience continues to be one of my most influential gateways to more opportunities in the policymaking arena. Each time I apply for opportunities, I include this as one of my most valuable springboards for developing expertise in providing testimony and gathering evidence to provide a persuasive argument before elected officials. Nurses can gain substantive and meaningful expertise through voluntary and service activity that will enable them to rise to higher levels of engagement and influence in the policymaking arena. So, go for it!

Complementary and Alternative Medicine: What Nurses Need to Know

Complementary and Alternative Medicine: What Nurses Need to Know

Complementary and Alternative Medicine: What Nurses Need to Know

Acupuncture, aromatherapy, supplements, and the like—more and more people across the nation are using these therapies. Because a number of these people will be your patients, it’s important for you, as a nurse, to know complementary and alternative medicine and about how to get more education if you’d like to implement them into your practice.

First, let’s make some distinctions: while “complementary” and “alternative” both represent the same types of therapies, they are different. Both words refer to non-mainstream treatments such as aromatherapy, meditation, massage, etc. However, when a health care provider uses complementary medicine, it’s used in conjunction with common, Western medicine. When the provider uses alternative medicine, it’s used in place of common, Western medicine.

Within this article, we will use the abbreviation CAM, which stands for complementary and alternative medicine. The focus here is not on if it’s used with or without Western medicine, but how it is used with patients at all.

Why Learn About CAM?

If CAM isn’t used yet at every health care facility, then why should nurses learn about it? “Patients are using them. Time and time again, research finds that the majority of the population is using integrative health products, and this rate is much higher for patients with higher socioeconomic status and/or patients who suffer from chronic health conditions,” says Jessie Hawkins, PhD, director of the Franklin School of Integrative Health Sciences. “Without guidance from their care providers, patients are left to self-educate through online sources. This results in reduced efficacy at best and injury at worst.”

With so many patients using CAM, Mollie Aleshire, DNP, MSN, FNP-BC, PPCNP-BC, FNAP, DNP program director and clinical associate professor at the University of North Carolina at Greensboro School of Nursing says, “It is essential that nurses have knowledge about common CAM and obtain information to elicit use of CAM therapies from the patient history.”

“It’s important to help patients get information from reliable sources and to know if a suggested alternative treatment, such as herbal supplements, may interfere with the medications they are currently prescribed or may be detrimental to their health,” says Tina M. Baxter, APRN, GNP-BC, president and CEO of Baxter Professional Services, LLC.

“Patients are now looking for alternative therapies. A lot of people don’t want to go with pharmaceutical drugs anymore,” says Jennifer Burns, NMD, founder of Burns Integrative Wellness Center. “It’s nice to have other modalities to help the patients.”

“It’s important for nurses to learn about alternative therapies because they offer patients new avenues that may improve their conditions and overall health,” says Linda Steele, PhD, MSN, BSN, APRN, ANP-BC, program director for Walden University’s nurse practitioner programs.

The Most Commonly Used CAM

According to Baxter, there are eight most commonly used CAM therapies in health care: acupuncture, aromatherapy, hypnosis, massage therapy, meditation, Tai Chi, therapeutic touch, and vitamins/herbal supplements. These, she says, are the most researched and studied.

“For example, aromatherapy oils are now used post-op in some hospitals to reduce anxiety and pain after surgery so that patients will require less pain medications. Meditation has been used in psychiatry through progressive muscle relaxation, guided imagery, and mindfulness meditation to augment the practices of cognitive behavioral therapy and dialectic behavioral therapy. Tai Chi has been shown to improve balance and flexibility for older adults and thereby reducing falls in long-term care and community settings,” explains Baxter. “Herbal supplements such as CBD oil have shown some efficacy in reducing seizures, pain, and anxiety. Hypnosis is a treatment that is offered for smoking cessation and obesity treatment. Massage therapy and acupuncture have been demonstrated to be beneficial in addiction treatment. Therapeutic touch has been demonstrated to help with pain in some instances by manipulating the energy fields that surround the body.”

Audrey Christie, MSN, RN, a self-employed holistic wellness practitioner, says that CAM has become more common because of evidence illustrating their benefits. “Things like aromatherapy in labor and delivery units, as well as mindfulness and meditation or Reiki-style practices, are becoming more and more mainstream,” Christie says. “They can help with pain reduction, mindset, relaxation, anxiousness, and many other aspects of the body-mind connection. In recent years, science has been beginning to catch up to what we have known intuitively for years.”

Hilary Erickson, RN, BSN, a labor and delivery nurse and creator of Pulling Curls says that if patients are pregnant with breech babies, she will often recommend that they see a chiropractor, as she believes that a skilled practitioner may help prevent them needing a C-section.

Christie makes another good point: “All therapies were once considered alternative—even antibiotics. We know that there is far more to healing than just applying a chemical compound or mechanical procedure to the human form—that intrinsic mind and spirit aspect can be a real determining factor in whether or not a patient gets better.”

Getting Educated

Don’t be like your patients and simply look up information about CAM online. If you want to implement it into your practice, it’s necessary for you to get some kind of formal education.

“Integrative health is a concept that is rapidly growing and expanding worldwide. Sales of dietary supplements are up year after year, and the industry itself is a multi-trillion-dollar global market. Patients are using alternative therapies, and that use is increasing,” says Hawkins. “Continuing education in integrative health is one of the best career investments a nurse can make.”

But there are other reasons to study CAM. “Nurses should be skilled in the therapy before providing it, and it should abide within hospital policies so that they can maintain the standard of care the hospital wants them to provide—and so that they are protected,” cautions Erickson.

A number of our sources recommend that nurses first look to the American Holistic Nurses Association for educational opportunities in CAM. The organization offers certification as well as online training programs.

“There are some complementary certificates available, such as the two-year program with alternative therapies expert Dr. Andrew Weil,” says Steele. “Many nurses also get certified as a licensed massage therapist or acupuncturist.” Steele also notes that some conferences, like the annual one offered by the American Academy of Nurse Practitioners, may offer CAM single sessions and in-depth training.

“We train nurses to become board certified health coaches, herbalists, and aromatherapists. We focus on these specific areas because they are the dominant integrative health fields in nursing practice,” says Hawkins, speaking of the Franklin School of Integrative Health Sciences.

“These therapies complement a nurse’s practice by providing additional tools that can be used to boost overall quality of life as well as patient compliance with wellness programs. For example, much of the research on aromatherapy is specific to pre-procedural applications such as anxiety relief before a surgical intervention. For many applications of herbs and essential oils, there is high quality evidence supporting its use,” explains Hawkins. “Sometimes this evidence also clarifies its use. For example, recent research we conducted found that children with an autism spectrum disorder respond differently to pre-procedural aromatherapy than the general population. This helps to demonstrate not only that these interventions work, but with which populations they are found to be effective.”

Most nurses can streamline their training at Franklin because they have general health education. Nurses train via interactive distance learning—so they can still work—and most complete their programs within a year.

While many institutions teach CAM, Christie advises nurses to use caution: “Only spend time and money on accredited schools. The kind of education they need depends entirely on the state in which they are practicing.”

“Medicine is evolving, as is the state of health. It’s critical to explore options and be at the forefront of new therapies. In fact, most nurses took an oath to continue educating themselves,” says Christie.

CAM and Patients

While many patients will be using some form of CAM, you may encounter some who aren’t. As a result, you’ll need to explain it to them to make them comfortable.

“Never force them,” says Christie. “I try to come from a place of explaining it on their level. If you think of something like a breathing technique and work from there—often in conversation and assessment—you can find a connection to discuss with the patient and make them comfortable. If they never get to comfortable, I try to send them with some education to learn more about the therapy on their own time.”

Steele suggests that nurses begin by giving basic tips to their patients to improve their overall health and wellness. “Ask the patient to identify what types of therapies they have heard about and what their level of comfort with them is. Always assure them that they will have access to different medical recommendations, including alternative therapies, if and when they are ready to take that step,” says Steele. “Stress the idea of complementary medicine and nursing as a blend of both Western traditional medicine and Eastern modalities, which are more than 2,000 years old. Patients become much more comfortable when they realize they have choices in their health care.”

Baxter says that she explains to patients that there is research and evidence for the prescribed therapy as well as how the therapy may benefit them. “I would be very careful, as some clients are concerned about promoting a specific religion when you talk of medication and Tai Chi. I encourage the clients to think of it as learning to ‘quiet your mind’ and ‘learning to move your body to promote healing’ as opposed to supporting a particular ideology,” she says.

Cautions to Keep in Mind

With any kind of health therapy, there are cautions to be aware of. For example, just because vitamins and other supplements are sold over the counter, that doesn’t mean that they are safe at all times. Steele says that there are still precautions nurses should take. “As with any medical or physical therapy, all have side effects and can cause potential harm or injury to the patient,” she says.

“Avoid a one-size-fits-all approach. Like medications, what works for one person may not work for another. I have clients who do not respond well to aromatherapy but may respond better to some acupressure,” says Baxter. “I would make sure that if I am recommending any treatment, I would first research it for the evidence that it may be effective and make sure that you are qualified to provide the service that is offered. For example, Tai Chi is of great benefit to older adults, but I am not a certified instructor. I do know some basic moves from a video that I will often demonstrate to the other health care providers to show them the movements, but I refer clients to a certified instructor if they want to take the class.”

Hawkins stresses that nurses need to know if their individual state or facility where they practice allows alternative therapies. Some don’t. But they also need to know how the therapies, if allowed, will affect their patients as well.

“Nurses should be aware that alternative therapies are not free from risks and contraindications. Many of these therapies interact with conventional medications or treatments, and many others pose risks to patient health,” says Hawkins. “There are also restrictions on how these therapies should be used, even on otherwise healthy patients. For example, some essential oils can slow breathing in infants. Others can cause someone who does not typically burn to get a sunburn. Studying integrative health provides the framework needed to keep patients safe.”

Strategies of Incorporating Palliative Care as a Direct Care Nurse

Strategies of Incorporating Palliative Care as a Direct Care Nurse

Palliative care is defined as a practice with emphasis on maintaining and improving a patient’s quality of life that can be incorporated at any stage during the disease process. With a focus on symptom management and identifying clear goals of care, palliative care plays a vital part in optimizing quality of life. Currently, palliative care services are offered at a multitude of health care organizations that may consist of a team of physicians, advance practice nurses, social workers, chaplain services, etc. And although palliative care can be beneficial for the patient and their loved ones, there are still many barriers preventing its integration in care delivery. This can result from a misunderstanding of what palliative care can offer, its presumed synonym to hospice, late referrals to the palliative team, or a complete lack of consultation where a patient could have benefited. However, how can direct care nurses integrate the principles of palliative care in their everyday clinical practice?

Palliative care is multifaceted; however, some essential components include pain control, symptom management, and addressing goals of care.

Pain Management

Regarding pain control, the direct care nurse can begin by completing a comprehensive pain assessment. By understanding how to properly assess a patient’s pain, nurses can have a better understanding on how to effectively treat it. While the Numeric Rating Scale can provide some insight to the severity of pain, nurses can also utilize the OPQRST mnemonic to supplement their pain assessment.

  • Onset: Was the pain sudden or developed gradually? What were you doing when the pain began?
  • Provocation: What makes the pain worse? What makes the pain better?
  • Quality: Could you describe the pain? Words like sharp, stabbing, burning can help the nurse better understand what the patient feels.
  • Region: Is the pain localized in one area of the body or does it move?
  • Severity: From a scale of 1 – 10 with 1 being minimal pain to 10 being extreme pain, how would you rate your pain?
  • Time: When did the pain start? Have you experienced this type of pain before?

A functional assessment plays a very important role in controlling pain as well. For example, if a patient states no pain staying in only one position however discomfort when standing or sitting, that patient would be described as having limited functional ability due to inadequate pain relief. Providing efficient pain relief does have its barriers. Patients may be hesitant to accept narcotics in fear of being seen as drug-seeking or they may feel apprehensive to admitting they have pain. Because of this, education is especially important to allow patients better control of their symptoms.

Additional tools that a nurse can incorporate in their pain assessment are noticing body behaviors, like those presented in the Face, Legs, Activity, Cry, Consolability (FLACC) scale for children as well as non-verbal adults. A patient may state minimal pain; however, grimacing, clenched teeth, sweating, and tachycardia might indicate otherwise. Finally, when an intervention is implemented, such as medication, a pain reassessment should be conducted within an appropriate timeframe to evaluate its effectiveness. However, if repeated ineffectiveness of the current pain regimen, nurses should feel empowered to inquire about a proper pain management consult if services are provided at that health care institution.

Symptom Management

From a physiological standpoint, multiple symptoms can prove to be quite challenging in supporting a patient’s comfort level. Symptoms such as shortness of breath, consistent coughing, fatigue, nausea, vomiting, constipation, and diarrhea can be a difficult burden. Hospitalized patients introduced to new medications and treatments are at risk for developing side effects, which is why medication education is especially important for patients in understanding what they may expect. For example, opioid treatment may be met with resistance for fear of its constipating side effect; however, effective management is possible by addressing fears, providing education, and potentially supplementing with a stool softener.

While pharmacological interventions are utilized more often in the hospital environment, manipulating the environment can provide some benefit as well. For example, in conjunction to oxygen support and medication, having a fan blow cool air in the direction of the patient or lowering the temperature in the room can provide some additional relief. Dyspnea is not always caused by a patient’s low oxygen saturation as contributing factors such as anxiety could produce the feeling of difficulty of breathing.

Coughing can interfere with adequate sleep and oral intake and can lead to physical exhaustion. Positioning and removing environmental irritants can be supplementary interventions that can be utilized alongside medications. A full respiratory assessment should be conducted, especially in regard to assessing the characteristics of a patient’s cough. Adjectives such as dry, moist, and productive can help the provider prescribe the appropriate medication.

Constipation and diarrhea attributed by underlying disease or medication side effects are distressing and exhausting symptoms that impacts patient mood and dignity. What can be done to help alleviate these symptoms? In regard to medication-induced constipation, commonly seen through opioid usage, prophylactic laxatives/stool softeners can be started to help potential side effects. Having a consistent regimen and re-evaluating its effectiveness allows the nurse to assess if the patients’ constipation is being managed appropriately.

Communication

Communication is the foundation of palliative care; through proper communication and transparency amongst the health care team can patients and families make informed decisions around their treatment options. The nurse is pivotal in accompanying the patient through the illness journey, whether it be simply through active listening and presence to ultimately providing guidance regarding treatment effectiveness. This nurse-patient relationship is built on trust and through supporting patients and families to be active participants in their care.

How can direct care nurses improve their communication skills, especially when it comes to a goal of care conversation? One strategy that can be implemented is to utilize open-ended questions. Questions such as “What do you understand about your medical condition?” elicits the patient’s perspective of their disease course. The conversation can delve deeper potentially into the patient’s perspective of their prognosis and the treatment options they believe to be available. This Ask-Tell-Ask strategy explores the patient’s understanding first before the nurse provides information. This back and forth cycle between the patient and nurses addresses four main principles: the patient’s perspective, information that needs to be delivered, response to the patient’s emotions, and recommendations from the nurse. When delivering information, the nurse should avoid using medical jargon and speak in simple terms. Finally, trust and compassion provide a foundation of effective palliative communication. Many times, when palliative care is discussed, the conversation can be somber as it may be dealing with advanced illness and burdensome symptoms. Therapeutic presence results in empathy, thus creating a safe space to discuss difficult issues.

Conclusion

Unfortunately, barriers still exist that prevent palliative care from being effectively delivered to those patients who would benefit from it the most. Palliative care is time and time again mistaken with death or hospice, thus resulting in reluctance to appropriate consults being in place. Additionally, some nurses may feel inadequate in engaging the patient and family in palliative topics or believe that these conversations should be solely conducted by the physician. Nurses need to be involved in overcoming these barriers to reduce misconceptions and ensure that other health care providers, patients, and families understand the benefit of palliative care implementation. These benefits include early focus on comfort treatments, reduction in cost of care, and overall decreased length of stay. Nurses play a crucial role in palliative care, and with continued self-education and engagement can the direct care nurse utilize their skills and knowledge to benefit their patients by acting as that essential extra layer of support.

Conquering a Disability and Becoming a Nurse

Conquering a Disability and Becoming a Nurse

Nursing can sometimes be a difficult profession for many of the men and women who choose to give their lives to the service of others. However, many nurses bring additional challenges to their calling, such as physical and mental hurdles that extend beyond the nursing experience. Although physical disabilities can make nursing hard at times, mental roadblocks are just as common and essentially hidden from teachers, coworkers, and sometimes the nurses themselves.

The good news is, though, dealing with an invisible challenge isn’t insurmountable.

For example, attention deficit disorder (ADD) can cause difficulty focusing, brain fog, and trouble concentrating. Nursing school requires attention to detail and focused concentration. Yet, this is just one of the many challenges that nurses can overcome—and many have.

For instance, Carin Shollenberger, RN, CRNA, has had ADD since childhood. She wasn’t diagnosed until well into adulthood, and she could have let it hold her back.

“Not being diagnosed impacted my ability in succeeding to my highest potential in nursing school and anesthesia school,” Shollenberger says. “With ADD, the ability to focus on what you are told to focus on is nearly impossible.”

When nurses are drilled on how to use their senses to assess patients, those with ADD must marshal all of their will to get the job done. Success is doable, but it requires a strong effort and indefatigable motivation to overcome a brain that fights back.

It isn’t merely issues with focusing that can potentially stand in the way of a successful nursing career. Post-traumatic stress disorder, or PTSD, can make entering the nursing field complicated. Some of the tasks asked of nurses can trigger unwanted emotions and feelings.

Miranda Gallegos, RN, is one such nurse who has succeeded in nursing and even flourished while facing PTSD. Like most nurses—those who enter nursing with relatively few challenges and those who have to work harder to attain the same goals—she dedicated her life to making nursing work for her no matter what.

In fact, Gallegos states, “I found nursing school to be a welcome distraction and almost a period of remission. I had no interest in my peers so I could 100 percent focus on my studies. I did have a tendency to zone out or dissociate in times of stress.”

Gallegos, a hard worker, took refuge in the high attention to detail that nursing requires. In her case, her PTSD symptoms could help her to push through and succeed.

And this is the point: nurses who are faced with physical and mental challenges can become excellent nurses. Nursing may seem intimidating, especially to someone who is struggling. Nursing can sometimes seem impossible as a profession with a diagnosis of an attention disorder.

Yet these two women have shown what can happen with effort.

“My tip to prospective nurses would be to seek professional help sooner,” advises Shollenberger. “I would have told my past self that it was not normal to procrastinate nor was it normal to have the inability to focus on school work while most everyone else could. I didn’t know that I could be helped!”

Gallegos agrees: “I found that nursing school really empowered me to get help. Once I got help for my conditions my grades went from B’s to A’s. I didn’t know I had something wrong at the time until through school I learned about these disorders and realized I fit into a lot of these categories and symptoms.”

Surely, early detection is key. If you are having trouble with focusing or intense anxiety, these are symptoms worth checking out. Nursing is hard enough as it is, and no one should work with any hindrance that can put a patient in danger. Examine yourself. Know yourself. Discover what your needs are to make nursing a success.

Shollenberger found that both nursing school and anesthesia school could prove challenging before she knew about her ADD.

“In nursing school, I did not have a husband or kids. My friends in the dorm got a visit from me several times a day when it was time to study. In anesthesia school, it was even tougher with a family. I wish I would have been diagnosed and treated early on…it wouldn’t have been so stressful.”

Gallegos found that her PTSD actually helped her be a better student and a better nurse.

“PTSD has a known symptom of hyper vigilance and I use that to my advantage. I am able to quickly scan whole pictures and scenarios to develop my assessments and my priorities,” she explains.

These nurses have documented challenges they faced when they entered the profession. Both faced them head on and used their diagnoses to make their skills better than they may have been without them. Although they both walked a hard road at times, they have succeeded well in the profession.

What is it that helps them overcome what could be a daunting challenge? What should other nurses know about traveling down this road?

“My tips for other nurses is to just keep your head down, study, and do your work,” Gallegos explains. “Focus on lots of self-care, whatever that means for you. Don’t worry about what other people are doing.”

Nurses tend to compare themselves to others, trying to be the super nurse that doesn’t need any help. For someone facing additional challenges, this could be disastrous. Focus instead on introspection and using your unique skills to make yourself the best you can be.

Shollenberger sums up her positive nursing journey this way: “Before my diagnosis, I felt like a failure because even though I got good grades, my struggle to get them was real. I felt even more of a failure in anesthesia school because I couldn’t skate by the skin of my teeth anymore. Once I had the diagnosis, a lot of what happened in my life made sense, but I still had to work to overcome the adversity. Medication helped but knowing in my mind that I could overcome this was an even bigger push to succeed.”

Greater Houston Nurses Taking it to the Streets

Greater Houston Nurses Taking it to the Streets

Homelessness is a global issue. It is on the rise and it impacts health physically and mentally. According to a recently published article in BMC Public Health, emergency departments are more often used by the homeless population for acute health care versus accessing preventative health care services. A 2018 study published in SAGE Open reported that the homeless population experiences health disparities with multiple chronic health conditions, mental illness, substance abuse, and depression.

The U.S. Department of Housing and Urban Development, Office of Community Planning and Development provides an Annual Homeless Assessment Report (AHAR) to Congress. On a single night in January 2018, there were 552,830 people who experienced homelessness in the United States. Most were sheltered (65%, 358,363) compared to 35% (194,467) who were in unsheltered locations. In the United States, 17 people per 10,000 experienced homelessness in 2018. Some of those who were in shelters (3,864 people) stayed in beds that were funded because the president declared natural disaster after four Hurricanes (Maria, Irma, Harvey, and Nate) and wildfires in the west. Twenty percent (111,592) of the homeless were children, 71% were over 24 years of age, and 9% ranged from ages 18-24. There were more men in unsheltered locations compared to women. Almost half (49%, 270,568) of the homeless people identified themselves as white compared to black/African Americans (40%, 219,807).

In the state of Texas on a given night in 2018 there were 25,310 homeless people. There were 9 homeless people per 10,000 in the general population of the state. Individual estimates of homelessness in Texas was 19,199; 6,111 for people in families with children; 1,379 for unaccompanied homeless youth; 1,935 for veterans; and 3,269 for the chronically homeless individuals, according to the 2018 AHAR report.

Houston is the fourth largest city in the U.S. with over 2.3 million people, according to the U. S. Census Bureau. In January of 2019, there were 3,938 homeless individuals (unsheltered and sheltered) in the cities of Houston and Pasadena and Harris, Fort Bend and Montgomery Counties.

Risk Factors

There are various reasons that may cause an individual to experience homelessness. A 2009 study published in Psychiatric Services reported a significant association with childhood adversities and homelessness. The childhood adversities with significant findings include: having a history of running away, being ordered by a parent to leave the home, being neglected by a parent or caregiver, having a biological father incarcerated, being adopted, being in foster care, and the duration of welfare assistance before 18 years of age. Significant findings regarding socioeconomic situations included grade when respondent left school, economic difficulty in the past year, and currently employed. Mental health problems such as being diagnosed with depression and having a psychiatric hospitalization in the past five years were significant predictors of homelessness.

More recently, a 2019 study in the Community Mental Health Journal indicated the individuals with mental illness had high rates of homelessness. Addiction problems such as drugs in the past year was also a significant predictor of homelessness, according to the 2009 Psychiatric Services study. Oftentimes veterans return home after deployments to war zones suffering with invisible wounds such as post-traumatic stress disorder and traumatic brain injury. These individuals are at risk for experiencing homelessness, according to the National Alliance to End Homelessness (NAEH).

Homelessness can also be due to loss of property, family violence, or domestic violence. A 2018 study in the Journal of Community Psychology reported loss of support systems and social networks can also lead to a path of homelessness. Lower incomes often lead to an inability to pay for basics such as food, clothing, shelter, and transportation—and this places individuals at risk.

The Problem

It is a common sight in Houston to see homeless people living and sleeping on the streets. Whether you walk or drive around the city, you cannot help but see individual men and women panhandling in the streets, standing at corners and intersections. They will routinely walk up to your vehicle with signs, cups, and stretched out hands for money. The homeless can be seen sleeping on the sidewalks and huddled up against buildings and fences. Although shelters for the homeless exist and initiatives have been implemented in attempt to get the homeless off the streets of Houston, the homeless population is huge. Many people who are homeless still live in tent cities under freeways.

One might say, they want to be on the streets. One might say they do not want to follow the rules of the shelters. Therefore, they chose to be out on the streets. All of those sayings might be true. All the same, someone remains homeless.

One night during November 2018, I was driving home and it was very cold outside. The temperature was in the 30s or low 40s. I was overcome with sadness and sorrow to see so many people literally sleeping on the sidewalks without any shelter. I noticed that some did not have blankets. I found myself feeling so blessed and fortunate to not be living on the streets. But then, I wanted to do something. I said they need blankets and warm clothes if they will be sleeping on the streets in this cold weather.

The “BLESSED” sign

Community Outreach Project

As a Christmas project for the Black Nurses Association of Greater Houston (BNAGH), we decided to give out blankets and socks to the homeless people in Houston. One Saturday afternoon (December 8, 2018), nurses from the BNAGH gathered the donated items to be distributed and walked the streets where a group of homeless men and women gathered. We drove to a local fast food place near Midtown, between downtown and The Texas Medical Center, and parked with permission from the manager. While still in the parking lot, a man asked me if we were getting ready to do something with the homeless. He was told we were going to pass out blankets, hats, socks, bottled water, and brown bags with snacks (peanut butter cracker, cuties, and peppermint candy canes). He stated his name and the name of his company and said he was there with his crew to do a film about the homeless in Houston. He asked if he could film us passing out the items and we told him yes. He said he would put us in the credits.

As we gathered all the items in large black plastic bags and started walking with the water, people started coming toward us to get the blankets and socks and other items. We gave away every item that we had. We even had a set of towels and a bar of soap to give out. One man said he wanted the soap. One man and lady were yelling for us to throw a blanket over the fence to them. One lady asked if we had anything girly. She asked for a pink hat. Everyone was so appreciative. Only one person did not want the items. He said he wanted dollars. He walked back into the street, running from car to car begging for money. Overall, it was an awesome experience. We provided items to approximately 60 homeless individuals.

Taking it to the streets takes courage and a compassionate heart. The needs of the homeless are many. One might feel overwhelmed if trying to take on every issue alone. It will take many people and resources. However, everyone can do something to help improve the health and lives of others. That is what the nurses of BNAGH wanted to do and that is why you might see homeless people in Houston with a sign displaying the words “BLESSED.”

Houston nurses handing out supplies

Relevance to Nursing

Homeless Individuals are a vulnerable population and are sometimes considered invisible. However, they are not invisible. They can be seen and counted. They are at risk for health disparities including mental health issues. There were so many obvious needs. One was just basic hygiene. Nurses can advocate for housing because personal hygiene is important. Hand hygiene is the most effective way to prevent and control the spread of infection. Individuals experiencing homelessness face barriers to personal hygiene. For example, personal hygiene and self-care barriers are limited access to facilities for bathing, taking a shower, doing laundry, and washing hands. Such barriers to self-care and personal hygiene can cause one to be at risk for an infectious disease.

Some things that nurses can do to bring about change:

  • Contact local coalitions for the homeless for information about their goals and objectives;
  • Advocate for jobs and housing for the homeless;
  • Contact and lobby local and state congressional and legislative officials regarding policies to help alleviate homelessness in America.

Such efforts will help reduce health disparities among this vulnerable population.

Stepping out of one’s comfort zone is not always easy to do. The first step seems to be the hardest. However, if nurses are to make a difference, then we must rise to the calling, step up to the plate, and do something positive to make a change. There are so many things that can be done. What I attempted to do was to provide warmth and comfort to a few people on the streets of my hometown. However, I have been inspired to do more. Hopefully you will be inspired to do something to help the homeless in your community feel encouraged and strive to be healthier.


Acknowledgements: The author wishes to thank Betty Davis Lewis, EdD, RN, FAAN and the Black Nurses Association of Greater Houston (BNAGH) and Prairie View A&M University College of Nursing faculty members for donations, and the three other nurses from BNAGH (Patricia Boone, RN, BSN; Vivian Dirden, RN, BSN, MS; and Dametria Robinson, BSN, RN-BC) who also walked in the streets of Houston to distribute the items to the homeless and provided photos. In addition, the author wishes to thank Carmen Lewis, MSN, RNC-MNN, IBCLC for providing the “BLESSED” photo.