Thyroid Changes Are Often Overlooked

Thyroid Changes Are Often Overlooked

The thyroid gland might be small, but any changes to its function can pack a huge wallop on how you feel every day. During January’s national Thyroid Awareness Month, pay attention to any possible symptoms that could indicate problems in you or any of your patients.

According to the American Thyroid Association (ATA), some of the more common diseases of this small gland include an overactive thyroid (hyperthyroidism), an underactive thyroid (hypothyroidism), and even thyroid cancer. Symptoms of these endocrine diseases can overlap with each other and can be mistaken for many other conditions.

Hypothyroidism

Symptoms of hypothyroidism are frequently dismissed by patients. As a nurse, your patients may complain about being excessively tired or lacking energy or even that they have a worsening mood. They may have noticed their hair is thinning or falling out or seems especially brittle. Hypothyroidism can cause people to gain weight and to feel cold in temperatures that were previously comfortable. Often, people will attribute these symptoms to stress, a particularly busy time, or seasonal changes.

Hyperthyroidism

It might seem that symptoms of hyperthyroidism would be the polar opposite of having hypothyroidism, but that’s not always the case. Because hyperthyroidism can speed up the metabolism, patients might also pass off symptoms like a racing heart, more-than-normal sweating, or mood changes to job stress, lots of activity, or even an increased fitness routine. But they can also experience the fatigue and hair loss that hypothyroidism presents. Some patients may notice more prominent eyes (Graves’ disease) or even feel their thyroid gland itself is enlarged.

Thyroid Cancer

According to the American Cancer Society, rates of this cancer have increased in the last decade in young adults (3 percent increase annually) and adolescents (4 percent increase annually), and even those who have had no prior thyroid problems can have thyroid cancer. This highly treatable cancer often presents as a lump in the neck rather than with symptoms like those of hyperthyroidism or hypothyroidism, and even blood tests don’t show anything abnormal.

If any of your patients mention these symptoms, a blood test may be in order. According to the ATA, a simple lab test will check thyroid hormone levels. If the levels of thyroxine (T4) or triiodothyronine (T3) or of the thyroid-stimulating hormone (TSH) are too high or too low, follow up will help determine next steps of medication, treatment, and referral to a specialist. If you or they notice any kind of lump in the thyroid gland, follow up tests are necessary to check for cancer.

Thyroid problems are fairly common and approximately 20 million Americans have some kind of thyroid disease. Listen to your patients as they describe any physical, cognitive, or emotional changes they have experienced to help detect any changes in the early stages.

Holding Safe Holiday Celebrations

Holding Safe Holiday Celebrations

In 2020, COVID-19 has made a lot of changes. So as the holidays are rolling around, it’s not surprising that it would change how they are celebrated.

Oftentimes, nurses would have potlucks during various shifts at work, hold present exchanges, and play games. But life has changed.

We reached out to get some tips on how nurses can hold safe holiday celebrations while at work.

From Jenna Liphart Rhoads, PhD, RN:

  • Have a toy drive for children in need: in exchange for bringing in a brand-new toy for a child in need, nurses could be given a raffle ticket to win something like a massage, an extra 8 hours of PTO, or a gift certificate for a new set of scrubs.
  • Staff nurses could bring in an ornament to help decorate the unit Christmas tree
  • A snowman decorating contest: nurses could anonymously color or decorate a snowman (or snowwoman). Staff could then vote on their favorites, and a winner gets a prize.

From Alaina Ross, BSN, RN:

  • On the floor of the hospital where she works, the nurses are having a catered lunch from a local restaurant. “[This] reduces the risk you’d get with a potluck of 20+ different dishes being cooked in 20+ households. The lunch comes from a clean and safe kitchen at a restaurant—and has the double bonus of supporting a local business,” says Ross.
  • Secret Santa Gift Exchange: “The Secret Santa style gift exchange reduces exposure and interpersonal contact, as there isn’t a large group get-together like you’d have with a white elephant exchange or party. It’s just one person secretly delivering a small gift to another by leaving it in their locker.”

From Thomas Uzuegbunem, BSN, RN:

  • He also suggests that instead of having a potluck to order from a restaurant that does individual servings (for example, Chinese food, etc.). “One person can take responsibility for ordering, and everyone can reimburse that person through PayPal or Venmo,” Uzuegbunem says.
  • Play Fantasy Sports or a unit game on smartphones: “These are good options to get a group of people involved while still social distancing.”
  • Digital Secret Santa: This is like regular Secret Santa—except for the large gathering. “You’ll pair people up and then the purchases will be either digital or mailed to their homes.”

Have a wonderful holiday season!

Who Nurses the Nurse?

Who Nurses the Nurse?

The contributions of a nurse in today’s crisis – stricken society are countless, especially in the midst of this pandemic. For that reason, thorough explanation of the nurses’ role is imperative for greater appreciation. Nurses have well known responsibilities including but not limited to recording medical history, vital signs and symptoms, patient advocacy, monitoring patient health and administering medications and/or treatments. Nurses collaborate with members of the interdisciplinary team for better patient outcomes and educate patients and their families about the management of illnesses. In academic settings, we educate aspiring nurses and propel them to achieve their goals in the midst of challenging life circumstances. As they say, nurses wear many hats, and as a result, nurses are burning out.

A nurse must advocate for patients beyond the health care environment while utilizing a holistic care approach; a patient may be admitted to a hospital or other health care setting for a particular ailment. However, the nurse must question this patient’s ability to care for themselves on their own, and if incapable, ensure that adequate support is in place upon discharge. Nurses also care for patients’ families. Often times, difficult conversations must occur and nurses are challenged to interact with those on the receiving end. Nurses are usually the first to notice irregularities due to the first phase of the nursing process – assessment. Nurses are the punching bags for the frustration of others on a daily basis. While nurses ought to possess qualities of resiliency, they are also human, and if empathic in nature, easily carry the stress of others on their shoulders. Hence, while taking work load, work environment, and coping mechanisms into consideration, nurses are at increased risk for burnout.

Burnout is defined as a state of emotional, physical, and mental exhaustion caused by excessive and prolonged stress. It occurs when you feel overwhelmed, emotionally drained, and unable to meet constant demands. It has many physiological effects. In a recent study conducted by Salvagioni et al (2017), burnout was a significant predictor of the following physical consequences: hypercholesterolemia, type 2 diabetes, coronary heart disease, hospitalization due to cardiovascular disorder, musculoskeletal pain, changes in pain experiences, prolonged fatigue, headaches, gastrointestinal issues, respiratory problems, severe injuries and mortality below the age of 45 years. Specific to nurses, in a 2019 study, 14.4% were found to be unengaged with their work, 41% of those respondents reporting feelings of burnout. Due to the physical and emotional demands of the job, nurses ought to be cognizant of the warning signs of burnout (anxiousness, chronic fatigue, insomnia, and frequent illness) because they are putting their health in jeopardy. Please take into account that these statistics are not reflective of the impact COVID-19 has had in the nursing industry. Therefore, in 2019 – 2020, these statistical figures are presumed to be more alarming.

In September 2018, I recall being transported by an ambulance from a clinical setting to the hospital. Runs of atrial fibrillation and ventricular tachycardia flooded the heart monitor as I struggled to maintain my strength, oxygenation and my life. “Look! You can show these rhythms to your students!” said the EMT as life threatening rhythms printed from the monitor. My usually jovial self immediately thought, “Did he really have to say that and could this get any worse?”

At the time, I was a nursing education supervisor for a technical school. The program grew exponentially and I was expected to supervise both day and evening programs. This not only meant overseeing and executing the curriculum’s development and application, but also subbing for instructors as necessary, which was quite often. I was a single mother in need of more support. My divorce was recently finalized. Ageism and racism were also my contenders in the work environment. I was challenged when giving direction to a group of women, my staff, who were older and looked different from me. I was expected to provide hope for my students who had lost hope in themselves due to extenuating life circumstances. Inadvertently, I experienced the warning signs of burnout such as anxiousness and chronic fatigue, but ignored them, leading to my experience in September 2018.

In the year of 2019, I went on a quest to find a work environment that was more holistic and welcoming. The familiar saying, “Nurses eat their young” resonated within me. My mental health suffered as I experienced feelings of being unappreciated and belittled. Nonetheless, in the midst of all of this rain, the sun did shine again. I decided to return to my home district as a school nurse, which gave me an opportunity to give back to my community and encouraged healing for my broken soul.

As a survivor of burnout and the consequences that came with it, I feel the need to bring awareness to the fact that nurses need to be nursed. So, who nurses the nurse? If possible, nurses must nurse themselves by doing the following:

Evaluate Your Own Personal Life.

Ask yourself, have I recently experienced life changing events and have I taken enough time to ride life’s emotional rollercoaster? Trying to balance work and these emotions can lead to a very bumpy ride (burnout). One may need to request time off from work or even take a leave of absence. Taking these actions does not mean that you are weak. It just means that you are taking a step closer to healing.

Identify Sources of Support.

As John Donne said,No man is an island. No man stands alone.” It is impossible to navigate through these difficult times in solitude, so finding a trusted confidant is important. It may be a family member or a close friend. For some, it may involve getting help from a licensed therapist. Once having adequate support systems, you will come to the realization that you are not alone. This notion generates healing thoughts and behaviors.

Ask For Help.

Nurses have a tendency to practice autonomy and often forget about asking for help. We always give but do not want to receive.

Diet and Exercise.

You are what you eat, therefore in order to promote feelings of wellness, we need to eat foods and participate in activities that support wellness. Overall, one should base their diet on whole grains, increase fruit and vegetable consumption, and reduce fat, salt, and sugar intake. We should also aim for 30 minutes of moderate physical activity daily.

Watch Your Water Intake.

Men and women need approximately 3 liters of fluid daily, however water requirements vary depending on weight. As it pertains to burnout, water can help maximize physical performance. Water also significantly affects energy levels and brain function.

Make Time For Hobbies.

Do not forget about your interests. Make time for these activities. It could be as simple as listening to music or watching an interesting TV show. I’ve always loved dancing. Since my experience in 2018, I joined a ballroom dancing/social community.

Practice Mindfulness Meditation.

This is the practice of actually being present in the moment which in turn trains you to become more mindful throughout the day, particularly during stressful situations. There are an abundance of mindfulness meditation exercises that can be found on the internet. I do these exercises daily.

Get Enough Sleep.

We need at least seven to nine hours of sleep daily to function at our best. If you are having a hard time achieving this, talk to your doctor. You can consider non-pharmacological methods such as teas and lavender oils. According to the National Sleep Foundation, obtaining healthy sleep is important for both physical and mental health, improving productivity, and overall quality of life.

Watch Your Appearance.

If you think you look good, chances are you will feel good too. Participate in practices that enhance positive feelings about personal appearance. Do a facial. Get your eyebrows waxed and your hair done. Do you!

The above recommendations highlight the importance of self-care. I urge each and every nurse to take part in such practices before it is too late. The disease processes that result from lack of self-care are probable, but preventable. So before you become dependent on a caretaker due to illness, remain independent by being your own best nurse.


Special Thanks: Desmond & Lillieth Gayle; The Wong Family; Nayomi Walton, PhD, RN; Therelza Ellington, RN; Anisa Cole, LCSW; Bloomfield Public Schools

5 Ways to Enjoy the Outdoors This Winter

5 Ways to Enjoy the Outdoors This Winter

A typical winter’s colder temperatures and messy weather makes getting outside more challenging for many people. This year, with so many people spending more time inside and isolated from others, winter could spike loneliness and poorer health.

Spending time outside in the winter has lots of health benefits. It is often invigorating being in the fresh air and moving around can help combat the unhealthy habits of being too sedentary.

But motivation to get outside and get moving is sometimes tough to come by—especially if you’re not someone who naturally thrives on colder temperatures (yes—those people do exist!). Thankfully, it’s possible to learn to manage the cold so you can stay healthy, improve your mood, boost your resilience, and even keep your social life active!

1. Bring Out Your Inner Meteorologist

Listen to the news, check online, or install a weather app on your phone to keep up with changing weather forecasts. Pay attention to the real feel temperature—that tells you what the air really feels like once wind, humidity, and temperature are factored in. The real feel temperature can make all the difference to getting outside comfortably. A day that’s 40 degrees and sunny with no wind is going to feel a lot different from the same temperature with no sun and strong wind gusts.  Know what kind of weather you’ll be out in so you can plan the right way.

2. Dress the Right Way

Being active outside is a great way to clear you mind, reduce stress, and boost your immunity. But if you’re shivering because you’re too cold or sweating because you’re overheated, your mind isn’t going to focus on anything but being uncomfortable. Dress in layers when you’re heading out and if you’re planning to move—from a moderate to fast paced walk or more intense—dress so that any sweat isn’t absorbed by that first layer. Moisture-wicking clothes keep you warmer because they don’t get damp from sweat which means you’ll be more comfortable.

3. Don’t Forget the Extras

Make yourself comfy by protecting you head, feet, and hands. Hate hats? Use an ear warmer band. You ears are going to get cold quickly, especially if there’s wind. If it’s especially cold and windy, a thin glove under a thicker mitten or heavier gloves will help. Use heat pads in them if you tend to get very cold extremities. The same goes for your feet. Moisture-wicking socks layered under wool socks keep your feet dry and warm. Protect your face with a gaiter or scarf over your face covering.

4. Have the Right Equipment

Snow and ice can make the simplest hike perilous, and you don’t want to fall. Wear proper shoes that have thick rubber soles because running sneakers are no match for a patch of ice on the sidewalk or on the trail. If you aren’t out all the time, investing in a pair of inexpensive shoe coverings (like Yaktrax) gives you extra traction on slippery surfaces. If you’ll be out when the sun is setting or rising, have a flashlight. And wearing reflective gear and bright colors at all times of the day and night will help drivers see you. That’s as easy as putting on a reflective safety vest over your coat—no need to buy a new coat or clothes.

5. Get a Crew

The pull of staying inside can be pretty strong. If you meet up with a friend for a socially distanced walk or join a group dedicated to being outside, you’ll be much more motivated to keep those commitments. And you’ll be more successful at keeping with your plan. Meeting someone outside for some exercise will help stave off the loneliness that is so common right now during the pandemic. If meeting up isn’t easy, plan to make a date to call someone so you can talk and get outside (just use one earbud, so you can hear what’s going on around you).

This winter, try to get outside for some sunshine and fresh air and see if your mood, and your health, improves!

Getting Your Zzz’s: Sleeping and Shift Work

Getting Your Zzz’s: Sleeping and Shift Work

Shift work — so many nurses do it or have done it at least once in their careers. While patients definitely need care around the clock in certain settings, the nurses who care for them also need sleep.

According to Amy Witkoski Stimpfel, PhD, RN, an Assistant Professor at the NYU Rory Meyers College of Nursing, “Shift work—particularly nights and evenings—misalign our body’s natural circadian rhythms. Simply put, as human beings we were not made to be awake late at night or very early in the morning,” she explains. “Thus, there is a cascading effect on this circadian misalignment on the rest of our body’s functioning.”

The biggest problem with this is that nurses must be able to provide safe care and going without sleep can be problematic. “Obviously sleep disruption is one of the biggest and most dangerous consequences of circadian misalignment caused by shift work. Being sleep deprived is also especially difficult because we are not good judges of how impaired our functioning is when we are sleep deprived. So, as nurses it can be very dangerous to practice when sleep deprived,” Witkoski Stimpfel says.

She cites the National Academy of Medicine, which recommends that nurses not work more than 12 hours every 24-hour period or 60 hours per week. There is also evidence that shows nurses should work a maximum of two to three shifts in a row.

Witkoski Stimpfel gives the following tips for nurse on how to best perform at their jobs when working overnight shift work:

  • Achieve enough adequate sleep during off shifts
  • Judicious use of caffeine
  • Use blue-blocking sunglasses on the way home after a night shift
  • Use blue-blocking apps/filters on smartphones and other electronic devices before getting sleep
  • Limit voluntary overtime hours
  • Have a bedtime routine that doesn’t include alcohol, nicotine, or other drugs
  • The bedtime routine can include taking a bath, listening to music, medication, talking with a spouse, friend, or family member—these will all help the body to shut down for rest.

Know that you can make mistakes when working nightshifts. “One of the biggest mistakes nurses can make when working night shift is to not sleep before a shift. Most studies on this topic indicate a small portion of nurses simply do not sleep before going into night shift, which is very dangerous,” says Witkoski Stimpfel. “Using melatonin or other sleeping aids should only be used under a provider’s guidance.”

If you have to switch from dayshift to nightshift in one week, Witkowski Stimpfel suggests the following, “It will be challenging to get “good” sleep when working one off night shifts, which is why that kind of scheduling should be avoided. If it happens occasionally, the nurse should try to get a nap before the night shift and definitely sleep as much as possible following the night shift. Using caffeine at the beginning of the shift and taking a walk or going up a few flights of stairs around 4 a.m. can help with alertness during the shift. If possible, using public transportation or having a friend or family member drive the nurse home after the shift could help to avoid drowsy driving,” she says.

Remember that these present, strange times we’re in have caused a lot of additional stress on everyone, especially health care workers. So it’s important to get the sleep you need. “The COVID-19 pandemic has placed additional and unprecedented stress on nurses, often resulting in disrupted sleep,” states Witkoski Stimpfel. “It is really important to reach out for help, whether it is therapy or counseling, meditation, a consultation with a sleep medicine physician, etc. Sleep is crucial for functioning across the board, both mentally and physically.”

Why the Great American Smokeout Is Important Now

Why the Great American Smokeout Is Important Now

With a respiratory virus pandemic surging through the world’s populations right now, the goals of the Great American Smokeout are as important and timely as they’ve ever been.

The COVID-19 virus can strike smokers and those with impaired lung functions especially hard, so the present is absolutely an important time to quit or to help your loved ones, colleagues, or patients with their quitting journey. The World Health Organization (WHO) offered this statement on its website, “Smoking any kind of tobacco reduces lung capacity and increases the risk of many respiratory infections and can increase the severity of respiratory diseases.”

Here are some facts about smoking from the American Cancer Society:

  • About 32.4 million American adults still smoke cigarettes.
  • Smoking remains the single largest preventable cause of death and illness in the world.
  • Smoking causes an estimated 480,000 deaths every year, or about 1 in 5 deaths.
  • More than 16 million Americans live with a smoking-related disease.
  • Once you quit, your body begins to recover and returns to a healthier state.

Whether you’re a smoker or are just interested in how to help someone you know who is quitting, giving up smoking is one of the most important steps to committing to a healthy lifestyle. In addition to reducing the risk of cancer that is inherent with smoking, those who quit are able to reap the many benefits of giving up smoking–from better heart health to saving money on nicotine products.

Here’s what you need to know about quitting smoking.

“It’s Not Easy” Is an Understatement

Those who have quit say it’s one of the hardest things they have ever had to do. Smoking is physically addictive, and it’s also emotionally addictive. People who are trying to quit are breaking their body’s real craving for a substance that it depends on. But they are also breaking an ingrained habit that may have been used to fill a void whether it is to soothe, energize, distract, or relax. Tackling both of those at the same time is challenging, but millions of people have proven it can be done.

If You’re Trying to Quit

Talk to people who have quit to find what worked for them and then explore every option. Look at your habits so you can identify your triggers and be ready to deal with them. There are support groups, medications, and resources that can help—the WHO even has an AI approach to quitting. Find someone who can help motivate you and keep you going when it’s hard—whether that’s a friend, loved one, or a professional. Accept that quitting smoking is going to be as difficult physically as it is psychologically. You’re giving up something that is part of your daily routine.

If You’re Trying to Help Someone Quit

The decision to quit is a deeply personal one. You can offer support and distraction and can be a buddy, but it’s not up to you whether the person you’re supporting succeeds. If you’re trying to help someone who is quitting, talk about what will aid them the most. Do they want you to check in with them at certain times when the urge to smoke might be strongest (when they wake up, during work breaks, after meals) or do they want to be the one to reach out? Would it help if you set up times to go for a short walk or could find a few fidgets to keep their hands busy? Remember, if they don’t succeed the first time they try to quit, they aren’t alone. It takes most smokers more than one try to quit for good.

Taking the first step toward quitting is significant. Stating your intentions is half the battle—then it’s finding and following the best process to success. Join others during the Great American Smokeout and start your path to a healthier life.