Category Archives: Posts About Nursing

New This Week at TheONC & at Scrubs Magazine

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This week for TheONC I blog about nurses helping patients stuck at anger in their grief process. These nonviolent patients are difficult to bond with because the anger is often expressed as dissatisfaction with their caregivers, sometimes disruptive of work flow.  Staying engaged in their care is challenging, but not impossible.

TheONC is an online community for oncology nurses and care teams. Join the conversation. Like us on Facebook, and follow us on Twitter @The_ONC.

Yes, that’s me talking about my fear of “big, hairy adult patients” while transitioning from pediatric intensive care nurse to adult oncology nurse in Theresa Brown RN’s article, Field of Dreams published in the summer 2012 issue of Scrubs Magazine. (By the way, I found I enjoy adult patients more than I ever expected!) Theresa interviewed several nurses about how they arrived in their specialties. She explains her own journey too. Scrubs is available at uniform stores, and by subscription.

Nurses Week: New Posts For TheONC

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From Cradle to Grave: The Color White, Charcoal, ink, watercolor on paper by jparadisi

Whether you’re an aspiring artist, writer, or cancer patient, support groups can offer encouragement and resources to help you on the journey. This week at TheONC, I write about unexpected pitfalls of support groups, and how to spot a healthy one in my post Support Groups: In Sickness and In Health.

Last week, TheONC posted my blog, Controlling Our Own Image. Identity is a theme I work with often both in paint, and words. I have some strong thoughts that it’s time nurses create the image we want the media to portray. The post received a flurry of well thought out comments. If you’re not a writer or artist, it’s worth thinking about how you can improve the image of nursing in your own practice.

TheONC is an online community for oncology health care providers to share information and resources. Follow us on Twitter @The_ONC and Like us on Facebook.

Happy Nurses Week!

Diplomacy, Apologies and Boneheads

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Bone Head watercolor and charcoal 2012 by jparadisi

Diplomacy is as necessary to successful nursing as IV skills, medication administration accuracy, and critical thinking. In fact, diplomacy is a subheading of critical thinking. Further, apology is a subcategory of diplomacy. During a recent shift at the infusion clinic, I had plenty of opportunity to practice both.

Nurses are well familiar with these shifts: They start looking like a doable workload. Then nothing goes as planned and you and your coworkers spend the entire shift chasing after it like a pack of grey hounds trailing behind a rabbit on a track. Unexpectedly, the rabbit jumps the track: Medications are not delivered on time from pharmacy. The patient needing a nurse inserted PICC is vein-less, requiring radiology placement and transport to their department; this delays the patient’s antibiotic treatment. The home infusion company is late delivering the continuous chemotherapy infusion for another patient left twiddling his thumbs waiting. IV pump alarms ring longer than anyone can bear, and nothing is on time per the electronic medical record. Meanwhile, the phones never stop ringing! 

These factors cost patients lengthy waits. During such shifts, I say, “I’m sorry” to patients all day long. For the sake of diplomacy, I can’t explain the bonehead roadblocks I’ve endured while trying to move their day forward as efficiently as possible. Diplomacy also prevents me from telling the bonehead roadblock he or she is a bonehead roadblock. I remind myself everyone, including me, makes mistakes, and to show a little love to the bonehead on the other end of the phone, because my turn will come.

My last patient of this shift doesn’t understand my explanation of why her care is delayed. Her sister eyes me suspiciously from a chair. I know she thinks I’m the bonehead. I stay the course, however, and it all works out. The patient eventually received safe treatment.

At the end of these shifts, it’s the outcome that matters. No one really cares who’s the bonehead.

What Drawing Has in Common With Nursing

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Self-Portrait. Pencil on paper 2001 by jparadisi

Telling Our Stories to Benefit Others is my latest blog post for TheONC; the online community for oncology care teams. Registering for TheONC is free for oncology nurses.

Having the opportunity to write about creativity and its place in the oncology setting allows me to blog out loud the internal dialogues about painting, writing, and nursing I’ve had ever since I came out of the closet as an artist over a decade ago.  I have found these words of Goethe’s true:

“Whatever you do, or dream you can, begin it. Boldness has genius and power and magic in it.”

In my pursuit of living creatively, I frequently find magic in the convergence of science, humanity, and art. For instance, take this passage written by Peter Steinhart:

To draw anything you have to find a connection with it. You have to turn off the noise that keeps you from focusing. You have to let the object stir you to empathy or ennoblement or joy or compassion-even to fear. You must see that things are a part of your world in some special way before you can attend to them.

Now re-read the same passage, with a few simple changes:

To be a nurse, you have to find a connection with people. You have to turn off the noise that keeps you from focusing. You have to let patient care stir you to empathy or ennoblement or joy or compassion-even to fear. You must see that your patients are a part of your world in some special way before you can attend to them.

When making art, or practicing the art of nursing, it all boils down to focus and connection. Whichever you are doing today, find that focus and connection. Someone’s life will be better, because you did.

A Get Well Card for Warren Buffet

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photo: jparadisi

As an oncology nurse, if I listened to the family members of an affluent, elderly patient debating at his bedside his right to receive cancer treatment, insisting he is too old, I would suspect elder abuse, and call for a social service consultation. Yet, this very scenario is occurring throughout the media in response to Warren E. Buffet’s announcement last week that he has stage I prostate cancer and will undergo eight weeks of daily radiation treatment, beginning in July.

The hullabaloo is in regards to guidelines established by the U.S. Preventive Services Task Force (USPSTF) recommending that men over age 75 not receive prostate cancer screening, aka the simple PSA blood test. 81 year-old Buffet not only received the PSA test, but when the results came back raised, he under went a prostate biopsy, which is also a no-no for a man his age per USPSTF guidelines. This is how his prostate cancer was diagnosed.  USPSTF recommendations for treating slow-growing stage I prostate cancer consist of a digital rectal exam (DRE), and PSA test every 3-6 months, with annual prostate biopsy (see link above). Mr. Buffet’s choices for cancer treatment drives at least one oncology urologist batshit. By the way, the USPSTF is the same task force that presented new mammogram guidelines in 2009, sending women’s health groups to arms.

I’m no expert on prostate cancer, hell; I don’t even have a prostate. But if I did, I would consider it my right to choose how to treat it if it were diseased, assuming I am presented with appropriate choices. There are a few things I do know: Warren Buffet is one of the good guys. An outspoken advocate of fair play, he proposed The Buffet Rule a $47 billion tax increase on the nation’s richest households, which the House voted down earlier this month. He is also one of 81 billionaires pledging to give away more than half their personal wealth to philanthropy when they die.

Do I believe Warren Buffet deserves special health care privileges because he is powerful, wealthy, and generous? No. I believe everyone has the right to their informed health care choices, and have those choices respected by their providers, families, and friends, without scrutiny. A cancer diagnosis and treatment is difficult enough without this added burden, whether the patient is unemployed, homeless, or the third richest man in the world.

A man with the power and affluence of Mr. Buffet is most likely unconcerned about the opinions of the media, and even less with mine. But for what it’s worth, Mr. Buffet, from an oncology nurse in Portland, Oregon, I wish you the best throughout your cancer treatment, and send positive thoughts for a speedy recovery.

The Rise of Blogs in Nursing Practice

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Joni Watson presents blogging’s validity as a useful tool for the professional growth of nurses in her article, The Rise of Blogs in Nursing Practice, published in the Clinical Journal of Oncology Nursing (CJON, April 2012, Vol. 16, No. 2). In the article, Watson guides nurses through integrating blog information into their practices.

Joni Watson authors the blog Nursetopia, and contributes posts for the ONS blog Re:Connect.

Joni opened her article with paragraph from a JParadisiRN post (used with permission). Citing blog posts in journal publishing indicates the growing legitimacy of the medium.

Other blogs noted in the article are Emergiblog, Nursing Center’s In the Round (Lisa Bonsall), The Nerdy Nurse, and of course, Off the Charts, the blog of the American Journal of Nursing.

Knitting for Communication This Week at TheONC

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This week, I blog about Knitting and Communication for TheONC. It’s a confessional post about lacking the right words for a friend with cancer, and finding a way to communicate through the craft of knitting. Sometimes pushing through frustration is necessary in creativity and relationships.

TheONC is an online community for oncology health care teams. Follow on Twitter @The_ONC and Like us on Facebook!

Stains

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Stains photo: jparadisi 2012

It’s a rare night that I can’t sleep. I’m trying to remove, without waking David, yellow vegetable dye stains of crumbled bits of a bunny-shaped chocolate truffle I ate yesterday, from my favorite pair of white jeans. Undergoing their third washing, they appear permanently stained. Perhaps it’s time to pronounce them, but I’m not ready to let go yet. Why is it easier to remove bloodstains from clothing than yellow Easter candy dye? Sigh.

Not a single car or pedestrian moves along the street outside. If not for David’s rhythmic breathing I might consider I was left behind after the post-apocalyptic rapture.  I’m too much of an optimist to convince myself of this, however. I remember hearing of a boy, home alone, who locked himself in a closet, fearing the rapture occurred and he’d been left behind. His parents found him crying in the closet when they came home.

The yellow dye clings to the white denim like sin; evidence of enjoying a chocolate treat (gluttony), or simple sloppiness (sloth)? I only care because I really like these jeans.

How simple is my life, that a pair of stained jeans is the topic of a post?

I wonder if any of my patients are also sleepless tonight, wrestling with pain, fear or nausea? Are they afraid of being left behind, or more afraid of what they leave behind? This thought makes me sad. I’d rather think about removing yellow candy stains from my white jeans.

Is that a sin?

New Creativity Blog Post Up at TheONC

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This week’s blog for TheONC is The Art of Subtraction: More Thoughts on Clutter. The topic is based on my experience of watching a professional sculptor make a likeness of a model’s face, by removing clay, not adding. The experience opened up my eyes to a new way of living a creative life.

I am the guest at the baby shower who always wins that game where you shove a bunch of bubble gum in your mouth, chewing and chewing until you get a big, pink glob, which you are required to mold into the shape of a baby. The best sculptor wins. Here’s my secret for winning: put a tiny butt crack in the back of the bubble gum baby; it is irresistible to the woman judging it.

Shift Observations: The End of The Dinosaur

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photo: jparadisi 2012

With the care of an archeologist sifting for fossils, I hold his right arm for a second time, turning it to and fro, sliding my fingers up and down searching for a vein suitable to accommodate an IV catheter.  I’ve already looked once, and now return after a fruitless search of his left arm. Decades of chronic illness, medications, and simply old age have done their work, leaving my patient with a spindly network of fragile veins shifting loosely under his skin.

“Everyone should be born with a spigot,” I think silently to myself. “Why doesn’t this patient have a port?” I know the answer without consulting his physician: he is very old, and his illness will likely overcome him. The IV infusion I will eventually administer will not save his life, only limp him along a bit longer.

Outside, cold grey clouds shower a mix of horizontal rain and snow beyond the window of the infusion clinic. An unseasonal storm threatens what promised to be an early spring.

With a slight shiver, my patient asks if I believe in a climate change so powerful it could wipe out life on Earth. Before answering, I take in the wrinkled, reptilian-like skin of his forearm, which I continue to study. Without looking up, I respond to his question, “You mean, like the Ice Age that killed the dinosaurs?” He nods.

Magically, I feel a small, but plump vein. The IV goes in slick as oil on the first stick. I can’t believe our luck. “Yeah, I believe in climate change, but this storm will not be our extinction.”