Hope is a Feathered Thing

Hope is the thing with feathers t
hat perches in the soul,
 and sings the tune without the words, 
and never stops at all,

And sweetest in the gale is heard;
 and sore must be the storm
 that could abash the little bird
 that kept so many warm.

I’ve heard it in the chillest land, 
and on the strangest sea;
 yet, never, in extremity, 
It asked a crumb of me.

Emily Dickinson

A few weeks ago I witnessed a miracle.

No, really, I did.

While running along the Willamette River in Portland’s Waterfront Park, a flock of seagulls (not the punk group; the kind with feathers and wings) scavenged for food several yards ahead. From the neck of one of the birds a plastic grocery bag dangled in the sight breeze like a cape.

In 2011 Portland’s city council outlawed the use of plastic grocery bags by retailers for environmental reasons. This sea gull’s plight illustrates one.

The bag was a death sentence. Besides scavenging, gulls feed by dipping for small creatures from the river, and this action will fill the bag with water. When the bag becomes heavy enough, it will sink below the river’s surface and drown the gull.

From habit, my nurse’s brain searched rapidly for an intervention. Briefly, the ludicrous image of me somehow restraining the bird and removing the bag flashed by, but before I was completely convinced of this impossibility, the birds took flight and landed on the river including the unfortunate gull with the plastic bag cape fluttering behind.

“Oh no,” I thought.” I’m going to watch the poor bird drown.” Mesmerized the way people become when they can’t avoid watching a train wreck I stopped running and leaned against the rail of the sea wall, following the bird with my gaze.

The gull bobbed on the river’s current, the plastic bag making him easy to spot. He dipped forward and placed his beak beneath the surface of the water. I saw the bag fill, then sink. Pulled down by the weight of it, the gull fought, flapping its wings wildly as it struggled to take flight.

“This is it, I said out loud, though no one else was watching.

But it wasn’t it. Miraculously, the bag slipped away from the gull and he was airborne. I watched the bag, half submerged, float down the river like a malignant cell seeking another victim.

Okay, maybe it wasn’t a miracle, but it felt like one. I had been so sure the gull was doomed.

Maybe the miracle is that I received an object lesson about embracing phenomenon, to stay hopeful, to marvel.

Because hope is a feathered thing.

Book Review: Nursing From Within, a Fresh Approach to Putting Out Fires and Self Care Work Arounds

In her book, Nursing From Within, a Fresh Approach to Putting Out Fires and Self Care Work Arounds, Elizabeth Scala, MSN, MBA, RN takes on the chronic dissatisfaction most nurses experience at some juncture in their career. With change rapidly dominating the landscape of health care delivery, nurses are stretched to the breaking point in their ability to provide safe, patient centered care.

Nursing From Within, a Fresh Alternative to Putting Out Fires and Self Care Work Arounds by Elizabeth Scala, MSN, MBA, RN

Nursing From Within, a Fresh Alternative to Putting Out Fires and Self Care Work Arounds by Elizabeth Scala, MSN, MBA, RN

This problem is not new in nursing, according to Scala. In fact, it’s existed in some form or another for decades. Scala considers,

It is possible that nursing, the entire profession as we know it today, is stuck. Bogged down from the energy that is created with the funnel. Looking left and right, turning around or glancing above us-who do we see? What do we hear? Where do we go for answers?

We hear the same things, talk about the same things, and live the same things.

While nursing has come a very long way in terms of scientific skills and critical thinking, can we say the same thing for our own personal and professional evolvement as a whole? Are we developing in a way that will help us to thrive and move forward as a group? Or is the mindset of ‘this is how it’s always been done?’ keeping us stuck in the funnel of nursing limitation?

 In a conversational voice, Scala uses stories from her personal experiences to illustrate how she changed from a nurse on the brink of burnout into one with an expanded viewpoint of where an open mind and change from within can lead. The creative career solution she chose at the book’s ending surprised me. It validates the versatility of a nursing license, but I’m not sure it answers the question at the heart of the book’s premise.

However, this does not take away from the truth of Scala’s observations, or the value of the  tools she presents for self care. Scala’s openness and authenticity shine through. Her topic is important, demanding recognition and discussion among nurses. I found much of what she wrote inspirational.

Nursing from Within: A Fresh Alternative to Putting Out Fires and Self-Care Workarounds is available now. Get your copy today by visiting Elizabeth Scala’s website or purchase directly from Amazon

Normal Is a Cycle on the Washing Machine

In my mind, as long as the weather is good, summer isn’t over. However, the beginning of the new school year, and the return of football indicates that ritual outweighs my imagination.

Sigh.

It’s good to let an imagination run free from time to time, so I took the summer mostly off from blogging.

Preparing paintings for display. Image and paintings by jparadisi 2014

Preparing paintings for display. Image and paintings by jparadisi 2014

I’m back.

I think there’s a tendency to view creative work as less taxing, dare I say less challenging, than nursing. I wouldn’t say less, so much as different: Different types of knowledge, different sets of skills. The biggest difference, I think, lies in accountability. Harsh criticism of their work can damage an artist’s psyche.Missing a deadline for a post or art exhibition is unprofessional and negatively affects the editors and curators writers and artists work with. It leaves them in the lurch, which in turn negatively impacts the artist’s career.

In nursing, however, medication errors can seriously impact a patient’s health, with potential life-changing consequences for patient and nurse.

I discovered something this summer: Taking time off from creative projects creates a vacuum into which other projects, out of nowhere, are sucked in, filling the “free” time I worked so hard to create. I see this phenomenon in the lives of the retired too. In fact, I often tell my Mom, “You’re scaring me; retirement looks twice as busy as working life, without the paycheck.”

Mom just smiles, and says, “Remember, ‘normal’ is a cycle on the washing machine. Don’t wait for things to slow down. They won’t.”

She’s right.

An unexpected project close to my heart this summer was the opportunity to hang my paintings and monotype (one of a kind) prints in a health care setting. It is a very satisfying experience to work with a design team to select and hang art with the intention of improving patient experience. In the past, I’ve sat on selection committees choosing artists for hospital art commissions, but this was my first experience as the selected artist.

For me, it came together when a patient, unaware that I am the artist, made this remark about the art, “It makes me think of other things than why I’m here.”

Bingo. That’s exactly the result I was looking for.

The Adventures of Nurse Niki is back too. The latest episode, At The Raleigh, posted Monday.

Summer vacation brought fresh insights, generating posts for AJN’s Off the Charts. In a drop-in life drawing studio I drew a connection between art and nursing. A road trip with my husband inspired this post. And a close call with danger inspired yet another.

Normal is just a cycle on the washing machine.

 

 

 

Where Science, Humanity and Art Converge

JParadisiRN blog began by discussing art and nursing. For the most part it remains so, through observations of the way science, humanity, and art converge, transferring these observations into blog posts.

Nursing is a tactile profession, at least when practiced at the bedside. It’s difficult to do the work of a nurse without actually touching people. Nurses learn that some skin or veins are so tough they almost repel an IV catheter, while other types are so fragile, even the paper tape used to secure a dressing or IV can easily tear it.

Nurses bathe the newborn’s firm, plump flesh, or rub lotion into the loose, wrinkled flesh of the elderly to prevent its breakdown. We measure and weigh the under and overweight, then calculate body surface area to administer the correct dose of chemotherapy.

This summer, I enrolled in an open life drawing studio. A model sits for a few hours, while artists, in meditative silence, draw the human body on paper.

Drawing is also a tactile experience: holding charcoal against toothed paper, making shapes and lines into limbs and torso, adding shadow to give them volume.

Patients and models allow nurses and artists into the sacred space of their nakedness. This privilege demands respect. Administering nursing care to a patient, or capturing the model’s likeness on paper requires concentration, skill, and love of humanity.

 

Latest Posts: AJN’s Off the Charts & New Nurse Niki

Drawing From Life is my latest post for Off the Charts, the blog of the American Journal of Nursing. It posted yesterday. Often the lines between art and nursing easily blur, like soft charcoal lines smudged on paper. You might want to check it out, or leave a comment.

The Adventures of Nurse Niki now posts new episodes on Mondays, instead of Thursdays. Be sure to read week’s episode, Moving On..

The Adventures of Nurse Niki Moves to Mondays!

The Adventures of Nurse Niki

The Adventures of Nurse Niki

I’m having fun re-prioritizing a few things, one of which is my other blog, The Adventures of Nurse Niki: fiction so life like, it’s almost real. I’m enjoying writing fiction more than I’d expected. Niki and her friends have integrated into my waking life, and the story lines come faster than I can write them down. Therefore, The Adventures of Nurse Niki will post on Mondays instead of Thursdays.

I am not shutting down JParadisiRN blog. This is a shift, not an ending. I’ll still post thoughts and images. In the meantime, tune in on Mondays for new episodes of  The Adventures of Nurse Niki: fiction so life like it’s almost real, starting today.

You can discuss or interact with Niki on The Adventures of Nurse Niki’s Facebook page. Please don’t forget to “Like” it too. Show Niki some love! Thank YOU!! to the readers following The Adventures of Nurse Niki, the retweets of @NurseNikiAdven (Hashtag #NurseNiki) and those who Like Nurse Niki’s Facebook Fan Page. The support is very much appreciated!

 

 

 

The Sacred Space of Patient Care

One of my hands is soaking in a shallow bowl of soapy water, while a nail technician holds the other, turning it one way, then the next. She files my chipped and broken nurse’s fingernails into a more attractive shape. As she does so, she says “relax” whenever I hold my hand too stiffly for her to manipulate it. This catches my attention, because I had just come from work, where I’d spent the day starting IVs in patients, telling them, “relax,” so the catheter would thread more easily into their veins.

by jparadisi

by jparadisi

I often preface starting an IV with, “I know this is easy for me to say, being I’m not the one getting stuck with the needle, but the more relaxed you are, the easier this will be.”

I realize that a manicure is a much more pleasant experience than having an IV placed. What manicures and IV starts have in common, however, is the need to trust someone, often a stranger, touching your body, and literally putting yourself in their hands.

With this in mind, I’m astounded by the trust patients put in nurses. I mean, think about how we poke them with needles, whether in their chest ports or in peripheral veins, and then infuse chemicals otherwise known as “chemotherapy” into their bloodstream; medications so potent that the patient signs a consent allowing us to do this to them. The chemicals are so powerful, in fact, they can cause other varieties of the very disease (cancer) we administer them to cure.

This is a pretty huge demonstration of trust.

Once a hairstylist stylist told me, “When I cut someone’s hair, I’m in their sacred space.” I’ve kept this statement in mind ever since, whether it was performing a bed bath in the ICU, or now, taking a blood pressure or drawing blood from a vein with a butterfly needle.

No matter how clear our communication with patients, no matter the level of caring we demonstrate, if we forget that we have entered the sacred space of our patient’s body, these administrations will not be received with the intended appreciation.

Developing a soft touch in patient care, whether it’s honoring an adhesive allergy by finding a less irritating occlusive dressing, offering to numb a peripheral IV site or port before inserting a needle into it, or simply placing a hand on the shoulder of a patient who is visibly upset, are ways we tell patients we respect the sacredness of their bodies. We are there to help them relax.

Nurses Make Birthdays, One Year at a Time

by jparadisi

by jparadisi

Part of our institution’s medication administration policy is asking patients to state their name and birth date, scrutinizing the information against the medication label. Patients of a certain age, more women than men, customarily wince while saying the year in which they were born. Often they say, “I’m getting so old.”

Perhaps it’s none of my business to respond, but as a cancer survivor and an oncology nurse, I can’t seem to help it. This reply escapes my mouth with hardly a thought in between: “That’s what we do here. We help you grow old, one birthday at a time. That’s why you and I are here.”

It always gets a laugh, and more often than not a, “Well, I suppose you’re right. That is what we’re doing here, isn’t it?”

Like many things in life, the ability to enjoy growing old is a matter of perspective.

It’s a funny world we live in. People bemoan their birthdays and growing old; yet endure chemotherapy and procedures, fighting to add years to lives threatened by disease.

I don’t love the effects of aging on my body. I color my hair to hide the gray. I exercise and eat right, and avoid over indulging in things that destroy a body’s ability to maintain its health. But these things enhance life, they do not prevent the inevitable. I know my days are limited. I know some day I will cease to exist in the manner I do now.

You may feel depressed by reading this post, but I say to you, knowing that life is finite is the most freeing of all thoughts. It bestows the gift of living everyday to the fullest, to make choices honoring integrity, and loving relationships. Life is too short to dwell in unhappiness. This is the least that nurses can do to honor the memory of the patients we have known and lost: live life as if each day were the last.

And, yes, I will take another slice of that birthday cake.

New Post: The Art of Nursing

May is all warm and fuzzy with Nurse’s Week. May renews love for what my mentor once dubbed “The noblest of professions.” May also marks the birthday of Florence Nightingale, the founder of modern nursing. I am a fan of Nightingale, her work, her integrity, and her devotion to nursing’s science.

 

The Art of Nursing by jparadisi

The Art of Nursing by jparadisi

So, please, don’t misunderstand when I say there is a quote by Nightingale from 1868 in which I find the tiniest flaw:

 Nursing is an art; and if it is to be made an art, requires as exclusive a devotion, as hard a preparation, as any painter’s or sculptor’s work; for what is the having to do with dead canvas or cold marble compared with having to do with the living body, the temple of God’s Spirit? Nursing is one of the fine arts; I had almost said, the finest of the fine arts.”

The troublesome part for me is describing “canvas or cold marble” as “dead.” As an artist, I tell you that there is no such thing as a dead canvas or sculptor’s stone. Yes, both are inanimate objects — no disagreement there. But anyone putting brush to canvas or chisel to stone knows that an interaction occurs between the artist and the medium. Writers know that a blank page stares back in judgmental and deafening silence. Art is a result of the interaction between the medium and the artist. As an art student, I once told an instructor, “I just want what I paint to look like what I see in my head.” Sympathetically, she replied, “That’s what all artists want. It never happens.”

Michelangelo said it best:

“Every block of stone has a statue inside it and it is the task of the sculptor to discover it.”

The personality of a canvas, stone, or blank page is manifested by its grain (tooth), flaws, and innate characteristics. Artists do not simply impose their will on canvas or stone. Art is the interaction between the artist and the medium.

So what does any of this have to do with nursing?

The art of nursing lies within a broader spectrum of skills than IV starts, and medication administration. It requires a nurse to discover the unique characteristics of each patient asking for help. Nurses chisel away at fear, pain, and grief to reveal a patient’s inner strengths and natural resiliency. We hold up a mirror, so our patients can see the beauty of the human spirit that we uncover.

Like canvas or stone, some patients are resistant to brush or chisel. Through devotion to our craft, we adapt our nursing skills to the realities of their character. Artists and nurses know a vision cannot be impressed upon a unreceptive surface, so we do what we can, knowing the result may fall short of our vision.

The nurse’s art, much like that of an artist or sculptor, utilizes the naturally occurring strengths and flaws in patients to create beauty from potential. The art exists within this interaction.

Happy Nurses Week!

The Adventures of Nurse Niki: Nurse Characters Doing Nurses’ Work

This post was originally published on RNFM Radio‘s blog October 2013

JParadisiRN

JParadisiRN

I’m one of those nurses other people hate watching TV medical dramas with. I shout out: “Intubate her now!” or congratulate myself on guessing a diagnosis from a minimal amount of script information. People watching these programs with me say, “It’s just a TV show.”

But the truth is, it’s not.

When the same nurse characters are recreated over and over for public consumption by the entertainment industry they become woven into public awareness, and accepted as fact. I wrote about this in a previous post for RNFM Radio.

After my appearance on RNFM Radio earlier this year, I realized I want to create nurse characters closer to the truth, struggling with feelings of social isolation caused by intimate association to the trauma of others, and the accountability to act on it.

Nurses do not only witness the suffering of others, nor do we only hold the hands of patients in pain, or their hair out of their faces while they puke. We assess their needs, get them the treatment needed to alleviate their symptoms, and administer it. Other times, we cover their profuse bleeding with our gloved hands, yell for help, and initiate the ministrations designed to help them hang on.

Except on TV. On TV, physicians do all of this work. In real life, I have had the pleasure of working with doctors who actually did hold the basin while a patient puked, and I’ve even had one assist with cleaning a code brown. These are special people, performing outside of the work doctors are usually expected to do, not because doctors wouldn’t necessarily do so, so much as because doctors are not usually present when these things happen, and nurses usually are.

Anyway, in The Adventures of Nurse Niki, nurses do the work of nurses. Physician characters appear proportionately to how they normally do in real hospital units: during rounds, when summoned from the call room, during codes, procedures, and for admissions and discharges. Doctors are not constantly at the hospital coordinating and administering patient care, because that is not their job. It’s the job of nurses.

None of this information is new to either nurses or anyone who has spent a lengthy time hospitalized, but it appears to be new information for producers and TV writers who continue to populate TV hospitals with doctors doing patient care, while the nurses stand by waiting to, or asking for, help. Some TV nurse characters enter medical school, I suspect, so they too can get a starring role.

The Adventures of Nurse Niki is an attempt to make a 3-dimensional main character whose life is interesting because she is a nurse, not because she works in the proximity of doctors.