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A Glass Half Full

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“For what you see and hear depends a good deal on where you are standing: it also depends on what sort of person you are.” 
― C.S. Lewis

I sit here alone with my two dogs on a snowy afternoon. My alone time often brings on my anxiety as my mind is able to wander. I am stuck inside with a frozen tundra outside. My breakfast plans have been canceled. My husband was picked up to work at the hospital and will be remaining there for 1-2 days. So, I sit. The dogs start barking because they hear kids screaming outside. That is when I think of perspective.

When I was younger, snow days were the best. We got to get off school, enjoy the one time a year we could sled and build a snowman, while my parents were upset because the roads were icy. At that time, we were young and didn’t care because we got to play all day. As an adult, I observe the snow from afar and sit in my cozy home with my anxiety creeping in as I know I’ll be sleeping alone and forcing myself to keep busy. But that is all perspective. Why am I anxious that it is snowing as an adult when before it brought so much joy? How selfish it is of me to be experiencing these feelings when I am resting in a warm home on my day off. I can drink as much coffee as I want to. I can cuddle with my pups and watch as much Netflix as I want. Why does my mind immediately go to anxiety-provoking thoughts? It is all about perspective.

I choose to find the joy in everything. Those kids’ screams are so happy as they get to sled down the parking lot. I get to blast worship music and sing as loud as I want to (and not well) because my husband is not home. I can choose a chick-flick if I want to. I choose to enjoy the beauty of the white blanket of snow (and ice) that is out my window because I have no responsibilities today. I choose to see an unfortunate situation from a positive perspective. I choose to always see the glass half-full.

Until next shift,

Shania

A Passionate Purpose

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“If you can’t figure out your purpose, figure out your passion. For your passion will lead you right into your purpose.” —Bishop T.D. Jakes

Wasted time is my biggest fear. Time only moves forward and you cannot get it back. So many people simply settle for the ordinary, go the safe or easy route, and fail to really question what they want to accomplish in their lives.

Begin by exploring what you love to do, then figure out how to make that a career. Anything done with true passion, will make you so much more successful. Even if you have to study extra hard or work longer hours, pursuing your passion will lead you to your purpose and all of that time is time well spent.

The biggest breakthrough I had as a nurse was that the bedside is not where I saw myself forever. I often would have feelings of anxiety, fatigue, and just not looking forward to going into work. Living a life with that constant rotation “just gotta get through these 3 shifts, then it’s the weekend” is not a healthy way to live. We spend a majority of our lives working, why should it be something that is only done to live for the weekend? Why not pursue a career that does not even feel like we are working? That is a life I want to live. Sure, a job is a job and must make ends meet, but it does not have to be stressful or anxiety-provoking 100% of the time.

Recognizing my thoughts and feelings led me to pursue a job change and my voice acting career. I love nursing, but the bedside was burning me out. I was offered a night charge position and really enjoy it so far. The change of pace and daily routine have improved my anxiety and does allow more time for acting auditions!

My ultimate career goals in life are to allow voice acting to be my main source of income and work PRN at the bedside. Nursing is a career I enjoy, but acting is my passion and I will live to pursue it.

Until next shift,

Shania

If your leg hurts, don’t wish to cut it off

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A woman in her 50s was treated in a burn center and brought to our facility for continued medical treatment of her delayed healing leg. It looked like she got her lower leg stuck underneath a lawn mower, when it was actually due to a heating pad. Surgery was done to clean out the wound and remove dead tissue. External fixation was placed to ensure proper placement. After 3 months of hospitalization, the patient decided to get it amputated due to the severe pain. She was also aware that even if the leg healed, it would take extensive rehab to ever walk again.

This scenario justifies the importance of pain management and education. Pain is now seen as the 4th vital sign. We ask everyone if they are in pain and will medicate the said pain if present. Many patients immediately expect narcotics and opioids to be the only relief for their pain. Educating on nonopioid or no nonpharmacological pain management is crucial to effectively treat pain. These modalities include NSAIDS, ice/heat therapy, massage, imagery, and movement among others.

This patient had several moderate dose narcotics available as well as IV ketoralac/ Toradol. The only medication that was actually effectively for a long duration was the Toradol.

Toradol is classified as an NSAID and can only be given up to 5 days to prevent GI bleeding and kidney issues. However, with it being an anti inflammatory, this medication was greatly effective for a recently amputated leg. The patient was aware of that and only requested the Toradol for her pain. Education is key.

Aside from the pain management of this woman, her positive outlook on her situation is also what leads to positive healing. She repeatedly stated how God will bring her through any situation she faces. She was confident that this was in her plan and was determined to do anything it took to heal her body.

We actually developed a good rapport after realizing we both favor a particular pastor and both plan on attending his church after the pandemic.

It is important to not simply treat the patient, but to try and communicate with them as human beings. You never know who is in that bed.

When I was going off shift, she reminded me that if my leg was ever hurting, not to wish to cut it off.. I plan to take that advice to heart.

Until next shift,

Shania

If I could only have half of the faith… angels in disguise

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50 y/o female with multiple myeloma and leukemia presents to the ER for a fever… a medical emergency in one receiving chemotherapy due to myelosuppression.

She has been in and out of hospitals to receive chemo and then be readmitted for the side effects of cancer.

I walk into the room and she is diffusing essential oils, she is riding around the hall and her room in her wheelchair, she is cracking jokes, she is laughing, and has the biggest smile on her face, and she asks about everyone’s personal lives when they walk into the room. I have never met someone with as much hope, faith, joy, and someone who as closely resembles Jesus as this precious woman.

She told me that Jesus will put angels in your path and I was one of hers. I can say that Jesus put her as my angel during my past three, challenging shifts.

Covid has brought a much higher acuity census to the caseload and this week has been stressful, challenging, and draining.

Her joy and optimism brought the just needed light into my week. I fortunately was able to sit with her for quite some time as I administered blood transfusions.

The highlight of my entire nursing career thus far was when she asked to go to the main lobby to play the grand piano. I was able to wheel her down in her wheelchair with her IV pole, mask, and lots of hand sanitizer to go sit and play her joyful noise. I couldn’t help but become teary eyed.

Even through everything that she was facing, she continued to minister to others and bring such joy into their lives. If I have half of the faith of this Godly woman, I will be okay.

It is a reminder that even on the toughest days; take a deep breath and trust that God has your back.

Until next shift,

Shania

Sample Patients in Medical-Surgical Nursing

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**Identifying patient information has been altered to protect patient confidentiality

Patient 1: 68 y/o male with spinal stenosis and resulting functional paraplegia presents to the ER with abdominal dissension, nausea, vomiting, and diarrhea. Pt was found to have a small bowel obstruction. GI order NGT to low-intermittent wall suction (LIWS) for decompression. The patient also has a history of vascular dementia and delusional disorder. He frequently asks for food, water, and repeatedly states that nursing is starving him. Fortunately, pt eventually had several BMs and will get an abdominal X-ray to assess for small bowel obstruction resolve and hopefully NGT removal.

Patient 2: 75 y/o female is brought in with family c/o AMS. Lab work reveals a UTI and acute renal failure. Both BUN and Cr are critical and does not decrease for several days. CT abdomen reveals possible myeloma. Family does not yet know this and nursing must not reveal these results until oncology confirms.

Patient 3: 50 y/o male comes to the ER with abdominal distention, nausea, vomiting, constipation, and failed paracentesis outpatient. GI attempts EGD and colonoscopy, however pt unable to tolerate Golytely and/or enemas. Imaging reveals a colonic volvulus (twisting of the intestine)- a medical emergency. NGT placed for decompression, as patient continues to vomit. Surgery consulted brings pt for immediate colectomy with ostomy placement. Unfortunately was this patient’s h/o CKD and CHF, pt will likely be transferred to CCU post surgery. Family care during this surgery is crucial as they wait to hear how the pt recovers.

Patient 4: 30 y/o female comes to ER with c/o uncontrollable abdominal pain and ascites. Pain management is the main goal for nursing. Balancing IV pain medication for breakthrough with PO medication along with treating the side effects of nausea and pruritus is the challenge. **Patients with liver failure/cirrhosis are difficult cases as all lab work is often abnormal.. critically low H/H, elevated clotting factors, and elevated LFTs must be monitored.

Patient 5: 75 y/o male presents with abdominal pain, N/V/D. Pt is diagnosed with diverticulitis and will be treated with IVF, bowel rest (NPO), and finally diet advancement as pt tolerates.

**All of these cases are in a single shift. Some days are much easier than others and vice versa. Prioritization is key in these situations.. “Who will die first?” Remember the ABCs and include pain as top priorities. Leave charting for later, and keep all patients informed of rounding times, to limit call lights.

Med-Surg is also funny in the sense that you haven’t performed a nursing skill in a while or a certain skill increases anxiety, and the next shift you will have to perform it. This shift was that for me. I was always nervous around NGTs because they are easy to come out, some are hooked up to suction and others are not, placement must be checked frequently (ph), and patients are always anxious to pull them out. After this recent shift, I am comfortable with them!

Until next shift,

Shania

Things I’ve Learned in Quarantine- A Personal Retreat (part 1)

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  1. Staying positive doesn’t mean you have to be happy all of the time. It means that on hard days, you know that there are better ones coming.
  2. Take every day to count your blessings. I have a healthy family, a paying job, a home, etc.. Social isolation began about 3 weeks after the Nashville tornadoes. There were families who lost everything and now had to remain inside a stranger’s home until it was safe to rebuild. 340 employees were furloughed at my hospital, I am very fortunate.
  3. Being alone with my thoughts sucks. My anxiety exacerbates when I am isolated. This led to phone calls, video conferencing, among other activities to stay connected without complete social distancing.
  4. Joy and tragedy can coincide. When I run through the neighborhood, I see positive quotes from children written in chalk. Countless videos have been posted about people placing thank you signs around the hospitals for front-line staff. One of the most memorable videos is from a city in Georgia who stood on their balconies and congratulated nurses as they changed shifts at a highly populated hospital. Volunteers have made masks and donated food to essential workers and those in need.
  5. I love Yoga! A friend introduced me to online Yoga videos and I do at least one every day I am off work. It’s a relaxing work out, forces me to stretch, and allows me to be present in the moment.
  6. I love community. Before all of the forced social distancing, I willingly social distanced myself. It is easy to want to stay home and relax alone without having to worry about the schedules of other people. It is easy to text, call, or FaceTime a friend for social interaction. It is easy to choose to be virtually present for a race, meeting, etc rather than physically being present. But now that virtual interaction is the only safe means of connection, I realize that relationships and community are so important for a healthy soul. Being engaged in the lives of your friends, coworkers, church, group hobbies, and family creates a sense of self-worth. I may not be fully willing to go out of my comfort zone and seek connection, however when I do, I always feel so much better after. The conversations that can be had with people with common interests and those in my daily circles improve my life. Connections and experiences are what is remembered for years to come, not what I gift or create myself.
  7. The rise of telemedicine.
  8. Homemade peanut butter cups are easy and delicious. Not to mention they are great with afternoon coffee!
  9. I have grown more in love. This “staycation” with my fiancé has allowed us to do all of the things we enjoy for multiple days in a row.. morning coffee while reading on the couch, yoga, running, netflix marathons, cooking, and just being in each other’s presence. I was worried about our October wedding (we have been planning for 2 years) not happening, but just going on a big adventure together wouldn’t be so bad.
  10. I have revamped my acting career.. more info to come.
  11. I am the 2020 nursing preceptor of the year.
  12. I ran my first half marathon in 2 hours, 14 minutes, and 32 seconds.
  13. I enrolled in a clinical trial to test the use of plaquenil for COVID prevention.

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615-856-8181
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