We often make plans for many things in our life, such as buying a first home or car, weddings, graduations, family trips, college applications, and baby showers, just to name a few; but one thing most of us don’t make plans for is “end of life.” As nurses we all have admitted patients to the unit and asked the question “Do you have a living will/advance directive?” This question is asked as part of the routine admission process in the ER, long-term care, or if a patient is having surgery, but how many of us actually have one of our own?
Last month I attended the Black Nurses Rock 3rd Annual Convention and had the opportunity to attend the session “VITAS Advanced Care Planning.” This was a very valuable, informational, and eye-opening presentation. It was amazing that in a room of over 200 nurses, only a handful actually had their own living will/advance directive. As nurses, we always care for others and forget about ourselves. Although we know that death is part of the life-cycle, this is often a difficult topic to discuss. One of the key points that was addressed was “starting the conversation.” We all need to get our affairs in order to make our wishes known to family and friends. There is enough stress with losing a family member, so there does not need to be the added stress of trying to deal with making hard choices without knowing your wishes.
We all need to take the time to address and make sure that family members will not have to guess what is wanted at the end of life. There was a document presented called “Five Wishes,” which is very clear and easy to understand. It is a living will that addresses the personal, emotional, and spiritual needs, as well as the medical wishes that a person wants. This living will is more personal than the standard living will and helps you and your family plan ahead for end-of-life decisions. It is divided into five parts and addresses the following topics: the person that you want to make care decisions for you when you cannot, what medical treatments you want or do not want, how comfortable you want to be, how you want people to treat you, and what you want loved ones to know.
The Five Wishes document is valid in the District of Columbia and 35 states, but you are encouraged to still complete a standard living will/advance directive if your state is not included. One quote that had a great impact from the keynote speaker, Captain James Dickens, DNP, RN, was “Stay ready, so you will be ready.” So, what are you waiting for? Start planning today for the peace of mind for you and your family.
For more info on Five Wishes, visit https://fivewishes.org.
Raise your hand if you need this season’s first major holiday, Thanksgiving, to give you an extra push to focus on how much you have to be thankful for in your life.
Most nurses do!
But it doesn’t have to be that way. You can experience the cozy feeling of gratitude this November by taking a moment each day for a special time of reflection. The warmth generated from mentally saying thanks will spread to your loved ones, and then to your health care colleagues, patients, and their families.
We’re encouraging you to start your Thanksgiving celebration with this three-step gratitude practice. Even the busiest nurse can fit it in and recoup that investment with greater health and happiness:
- Starting today, notice and list three things that you’re grateful for. It doesn’t have to be a major item and it doesn’t have to be new on your list. (If you’re grateful for that first cup of coffee in the morning, go ahead and list that every day.)
- Continue noticing and listing for the several days leading up to Thanksgiving. You can get fancy with a special “gratitude journal” or stick to a simple notebook. In a pinch, you can write in the margin of your desk calendar or weekly planner.
- At Thanksgiving Day dinner, say a word or two about your gratitude list. Suggest that everyone at the table share what they’re thankful for, if they’re so inclined. The lull between the meal and dessert is a nice, relaxed time to exchange these types of reflections.
A side bonus: who knows, you may have developed a new routine of taking a couple of moments to note your blessings each day. A habit like that has the potential to see you happily into 2019.
How does seeing and appreciating all that is good in your life increase your well-being?
Research suggests that it trains our brains over time to focus on what’s right and good and plentiful—versus what’s wrong or bad or in short supply. Robert A. Emmons, professor of psychology at UC Davis, is a leading authority on the science of gratitude and how it leads to a healthier, happier life.
In one of his studies, health care practitioners kept a gratitude journal (similar to what’s described here) for two weeks and saw a 28% decrease in perceived stress and a 16% drop in depression. Other studies demonstrated physical health benefits, such as lower blood pressure, from a gratitude practice. For more on Emmons’ work, check out “Gratitude is Good Medicine.”
Wherever you are on your journey towards self-care, as long as you’re taking steps forward, like jotting down three things you appreciate, that’s reason to be thankful!
According to the American Medical Association (AMA), physician-assisted suicide (PAS) is defined when “a physician facilitates a patient’s death by providing the necessary means and/or information to enable the patient to perform the life-ending act.” A variety of terms have historically been used to describe an event when a physician uses lethal medications on a terminally ill patient for the purpose of easing their suffering. The term “physician-assisted suicide” was conceptualized to accurately reflect the relationship between the doctor and patient while denoting the etymological roots of suicide as “auto-killing” or “self-killing.” After years of courtroom and political battles, Montana, Washington, and Oregon are the only U.S. states that currently allow PAS as a result of the Death With Dignity Act enacted in 1997.
The perception of PAS is a highly controversial topic within the nursing profession because it centers on the decision of terminating a human life to ease physical and emotional agony. For centuries, issues related to PAS have been zealously debated, with neither advocates nor opponents gaining much ground. Currently, those who favor PAS view the process as a peaceful and painless death while those who oppose it believe that the consequence of any form of suicide will ultimately result in irreparable legal and ethical ramifications. With recent societal and technological advancements in science and medicine, choices involving both life and death have become much more complicated in recent years. As a result of this worldwide controversy in health care, many nurses nationwide are now forced to deal with this ethical dilemma head on.
Risks and Benefits
Like many controversial topics in contemporary society, there are numerous risks and benefits nurses must be familiar with when it comes to justifying PAS. Those who support PAS argue that people should have the right to choose the timing and manner of their death in the event of an adverse clinical aftermath. Proponents of PAS strongly believe that allowing a patient to needlessly suffer can cause additional pain and distress, which can ultimately eliminate whatever shred of dignity the patient may possess. As a result of this realization, many proponents believe that PAS can provide patients with a unique treatment alternative to their incessant agony.
Despite the urgings of proponents however, many opponents argue that the sanctity of human life should be continually honored and respected in spite of physical or emotional discomfort. The argument contends that only God Himself has the authority to give and take life, and that individuals should not be allowed to take any life, including their own.
Lastly, the potential for PAS is tremendously high in vulnerable populations because of their lack of access to quality health care. Since PAS may become a cost-containment strategy that can lead to serious litigation if not performed properly, opponents strongly forbid PAS to stop these abuses from occurring.
The Impact of Nursing in Physician-Assisted Suicide
PAS is an exceptionally controversial issue because it encompasses both legal and medical ramifications centered on the individual’s unique moral and ethical principles. With the ever-expanding ability to both prolong and end life, nurses must not only remain cognizant but also prepared for any and all repercussions associated with life and death situations.
Suicide is a rising epidemic in today’s contemporary society. According to the World Health Organization (WHO), globally nearly one million people die each year at their hands, by an act of suicide and more than thirty thousand people die annually in the United States alone. Since the risk for suicide is largely determined on a continuum, the severity of suicidality can vary with individual circumstances. Because of this realization, nurses play a pivotal role in suicide prevention because they often have the greatest number of opportunities to identify and recognize suicidal patients and tendencies in the health care arena.
Suicide Screening Strategies
While many hospitals are working diligently to comply with the Joint Commission in implementing suicide-screening questions, there is limited evidence available to guide suicide risk initiatives in the inpatient clinical setting. To help resolve this issue, researchers developed the Ask Suicide-Screening Questions to Everyone in Medical Settings tool (asQ’em), aimed to identify suicidality in the inpatient units and subspecialties. The asQ’em two-item screening tool is a unique instrument designed specifically for nurses to administer to medical-surgical patients at risk for suicidal tendencies and predispositions. Due to the straightforward nature of the asQ’em suicide-screening questionnaire, researchers have found it to be an efficacious method in properly recognizing suicidality in susceptible patients across the health care setting.
Applicability in the Clinical Setting
Although suicide risk assessments are an essential tool in the hospital setting, there is a growing body of evidence suggesting the underutilization of suicide screenings among medical-surgical patients. As a psychiatric-mental health nurse, I understand the importance of assessing patients for suicidality because it provides me with vital information on how to properly care for patients suffering from suicidal thoughts.
The asQ’em suicide-screening questionnaire is a tremendous tool that can be easily implemented in all inpatient units because it consists of two questions that determine if patients are at risk for suicide as a result of their present thoughts or past behaviors. Based on their answers, nurses can consequently determine if the patient exhibits enough significant emotional distress to ensure proper safety measures are in place before subsequent inpatient treatment and stabilization.
As a result of this realization, increased efforts must be made to ensure suicide-screening tools are readily available to not only uncover meaningful clinical data but also promote safe holistic nursing practices to preserve the health and well-being of suicidal patients nationwide.
The term “self-care” is a big umbrella that covers a ton of wellness topics, such as life-balance, stress relief, weight management, fitness, relationships, spirituality, and much more. It’s tough to pinpoint just one life arena you’ll want to make changes to in order to become happier and healthier. But it’s possible and may make your self-care journey easier.
Here’s a tip: Start with sleep.
Why Sleep Is So Important
This is probably the number one area where you can improve your health and well-being. Nurses are notorious for not getting enough sound sleep on a regular basis—odd shifts and rotating schedules don’t help the body to regulate rhythms. Fatigue is one thing but it’s worst when a sleep-deprived nurse actually nods off while at the bedside or on the road after a late shift. Obviously, that’s extremely dangerous—for you, your patients, and everyone near you.
Most American adults don’t meet the guidelines for sufficient sleep (seven to eight hours) and many of us consider it a luxury we can’t afford, or try to “bank” shut-eye by sleeping for 5 hours on work nights and 10 on days off. We like to think that getting along on little sleep is a sign of superhero strength and those who prioritize rest are weaklings. None of those beliefs are accurate. Here’s how you can take care of yourself, in spite of our hyperactive society’s mistaken take on rest and sleep.
The Basics of Sleep Hygiene
Chronic sleep deprivation and sleep disturbances, such as sleep apnea, can be improved by following good sleep hygiene protocols. Try these tips:
- Cut out caffeine later on in the day. (That includes certain soft drinks and chocolate, as well as coffee and tea.)
- Drink alcohol in moderation, or not at all, because it’s more likely you’ll wake at night after a drink or two.
- Another reason to stop smoking cigarettes: nicotine interferes with sound sleep.
- Finish your last meal of the day a few hours before bedtime so you’re done digesting.
- Don’t do heavy exercise late at night, though gentle stretching or yoga can be a restful entrée to sleep.
Setting the Right Environment for Rest
Digital sights and sounds make it harder to slow down and get ready for bed. Younger nurses, being social media natives, are especially prone to texting, tweeting, Pinteresting, and streaming movies in their bedrooms. Make it a rule to keep your smartphone, iPad, or other devices out of your bed. That way, you won’t be tempted by social media, news, or entertainment right up to the time you turn off the lights. Some nurses even set a digital curfew and power down devices two to three hours before bedtime.
When Your Mind is Too Busy to Turn Off
Some nurses find that the simple act of journaling before bed helps them quiet the worry, anxiety, and fears that may be keeping them awake. Nursing is an emotional occupation and there isn’t always an opportunity to process what happens during the day while on the job. That’s when a notebook and pen by the bed can be a curative. One of the principal researchers in the area of journaling and health is James Pennebaker, a psychology professor at The University of Texas at Austin and author of “Writing to Heal.” His studies have shown that expressive writing (journaling) is a simple and effective way to relieve stress while boosting both mental and physical health.
Nurses are gaining weight. A study in the International Journal of Nursing Studies shows that the prevalence of overweight among U.S. nurses ranges from 30% to 55%. There are many things that impact a rise of overweight or obesity in nurses including stress in the workplace and shift patterns. In addition, most nurses are not engaged in weight management behaviors.
Maintaining a healthy weight can lower your risk of heart disease, stroke, diabetes, and high blood pressure. Here are four simple steps to take to keep a healthy weight.
1. Weigh Yourself Regularly
Weighing yourself daily or weekly provides a sense of accountability and is helpful for maintaining a healthy weight initially. It is a good idea to keep track of your weight so you can plan accordingly and adjust your diet and exercise plan as necessary.
2. Eat Healthy Foods
No matter what shift you take, try to eat your large meal towards the beginning of the shift, which will give you energy to get through the entire shift and to avoid starving yourself. Ensure your meal includes lots of fruits and vegetables, whole grains, and lean protein. Using online food trackers or apps such as MyFoodDiary or MyFitnessPal are helpful because they enhance your awareness of how much you are really eating. These tools usually provide specific information about how many calories and nutrients you consume. The key to maintaining a healthy weight is getting the right balance between the calories you are consuming and the calories you are spending.
3. Drink An Adequate Amount of Water
Drink water regularly, and before and during meals, which can promote fullness and increase your metabolism. Water can help you burn more calories and also control your appetite if consumed before meals. Bring a water bottle to work and fill it often. Avoid soda and sugary drinks because the extra calories from these drinks can lead to weight gain.
4. Incorporate Natural Exercise into Your Work Days
If you find it difficult to make time to go to the gym or keep up with a regular exercise program outside of work, you should incorporate physical activity into your workday.
Throughout your day, you should try to find as many chances to walk or move as you can, such as taking the stairs instead of the elevator, walking around your floor or between buildings, parking your car farther away, and walking during the shift from patient room to room. Hourly rounding to check on your patients, attending to pains, position, and bathroom requests are simple ways to increase your physical activity at work. This also helps to reduce call-bells and improve the nurse-patient relationship.