June 26, 2017

What Talking Can Accomplish


I've been the patient many times, I've been the family member at the bedside numerous times, and in some instances, something was lacking: communication. 

I've witnessed and experienced a new wave of nurses (new in terms of demeanor) - individuals who don't communicate well or at all. It's as if they see you as a barrier to them going to lunch or taking a break, and they express that annoyance with small gestures and lack of eye contact. Listen, I'm a nurse. I know you work hard, but we all work hard. Healthcare is complicated and messy, and if you "ain't here for that," you might want to find a different profession. I tell new nurses all the time, "Critical care is messy, people die, issues occur, you will disagree with some elements, but this is healthcare. If you don't dissect those concepts in a constructive manner, you're going to have a hard time here." Communication is necessary, its lack of presence leaves room for assumptions to form. Assumptions create their own set of problems further down the road. Regardless of nursing specialty, you must execute and reciprocate dialogue. Here are a few tips to help you to understand the art of communication as a nurse.

Tip #1: Ask The Patient & Family What Their Needs Are

Okay, so you've gotten the bedside nursing report, it's now time to introduce yourself and find out the needs of the patient and their loved ones. Often, you can defuse anger with simply asking, "How can I help you today?" or "Is there anything you want to tell me before I start my first assessment?" If you don't know me personally, I worked as a server at a Red Lobster for about three years (excellent place, great folks). In that position, I learned a lot about how people work and how they will open up with prompting. You'd be surprised by how many people will remain angry for hours, but when asked what's wrong, will immediately calm themselves down mid-conversation simply by talking it out. It’s as if the question itself opens a valve, and the pressure is relieved slowly. Each word can be self-soothing. Some people don't know why they are angry, but once prompted to express themselves, are able to sift through their emotional waters and find the reasons why. Listen, you don't need to be a doctor to help people. You are a caregiver - don't forget how powerful you are and what you can use to help your patients or their friends and family members.

Tip #2: Help Individuals In Need Get Their Needs Met

If you get a response that is above your pay grade so to speak, you then politely explain your professional scope of practice and any limitations that would hinder an immediate response. But please, don't end the conversation there! After clarifying your role, explain you will contact the appropriate parties to get their concerns heard and addressed. People don't like hearing what you can't do for them. They want to listen to what you can do. Express what you can assist them with and be helpful, even when you can't truly solve the problem entirely. The goal is to change the negative situation into a positive one. I'm not saying be fake and sarcastic. I'm telling you to be honest, genuine and to work toward helping individuals in need. There have been any moments in my career where a patient just wanted to talk, find out what time it was or simply needed help finding a television channel. It's not always bad or impossible feats. Nursing is the tough profession. Nursing can cause emotional, physical, even spiritual burdens for some people. Nurses might often feel like they must jump over several hurdles in order to do just one task. But, never forget where you are and what your job is. You've signed on to care for the sick. You can't then get irritated when they need you. That's the whole gig!

Tip #3: Consider How You Communicate - Style, Tone & Volume

We have all been there, we've all needed help in some way and from someone. I was involved in a car accident a few years ago. I was strapped to a board and wore a cervical collar for a full hour in a hallway. It was terrifying. My legs were injured. Hell, I didn't even know if I could walk. My knees hit the dashboard pretty hard, and I didn't know the extent of the damage at that time. Everyone around me was ignoring me. I heard one nurse talking about her upcoming trip to Colorado and another nurse complaining about her working on her daughter's birthday. I tried to remain calm and center my thoughts, but my claustrophobia was getting the best of me. Being unable to move your entire body was downright terrifying. So eventually I spoke up and said, "Excuse me ma'am, can you please..." One of the nurses rudely cut me off and replied, "You can't move or get up until a doctor sees you. Be still. They will be with you in a minute!" It wasn't the message itself that pissed me off. It was her tone and dismissive attitude. She had no idea what I wanted or needed, and yet, she dismissed communication with me promptly. Nurses are busy. I'm a nurse, I feel your pain, but we're always busy. There isn't a time you're not busy, so that's not an excuse to be rude or short with people in crisis who might be having the worst day of their life. We all have our moments, but as a professional, those outbursts and unfortunate events should never at the patient's expense.

Tip #4: Tap Into Empathy, Your Greatest Communication Skill

Healthcare is largely based on communication. Whether you're administering medications during a code blue or calling the husband of a patient who is in respiratory distress, communication is fundamental. You must learn to respect people and their emotions. You must help them in any way you can, within reason of course. Empathy can't be taught. I've even seen the lack of empathy get a few people fired. Treat people like they are family members and have patience with them. Sometimes education is necessary. Don't overlook that some people are illiterate or have no medical background. You have no idea how paralyzing it can be to see a loved one in critical condition. Let them process what's happening. It might be an everyday event for you, but to them, this entire process is new and possibly overwhelming. Let them work through that and be there when they need you. This isn't about guaranteeing miracles or fixing the impossible. It's about understanding people and listening to them. You are the professional. You are at work. Be present and be aware, because when you don't, patients notice, their loved ones definitely notice, and eventually your peers will notice. We are all humans just trying to care for ourselves and our loved ones. Don't undermine that bond just because it doesn't involve you.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Hypoglycemic reactions are common complications of insulin use. The signs and symptoms of hypoglycemia may be divided into those resulting from stimulation of the autonomic nervous system and those from neuroglycopenia.

June 25, 2017

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Occasionally, prebreakfast hyperglycemia is due to the Somogyi effect, in which nocturnal hypoglycemia leads to a surge of counterregulatory hormones to produce high blood glucose levels by 7 AM.

June 24, 2017

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Insulin glargine is usually given once in the evening to provide 24-hour coverage. This insulin cannot be mixed with any of the other insulins and must be given as a separate injection. There are some patients who need twice a day therapy.

June 23, 2017

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
The targets for blood glucose control should be elevated appropriately in elderly patients since they have the greatest risk if subjected to hypoglycemia and the least long-term benefit from more rigid glycemic control.

June 22, 2017

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Strenuous exercise can precipitate hypoglycemia, and patients must, therefore, be taught to reduce their insulin dosage in anticipation of strenuous activity or to take supplemental carbohydrates. 

June 21, 2017

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
In the United States, Medtronic Mini-Med, Animas, Insulet, Roche and Tandem make battery operated continuous subcutaneous insulin infusion (CSII) pumps. These pumps are small (about the size of a pager) and very easy to program.

June 20, 2017

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
NPH (neutral protamine Hagedorn or isophane) insulin is an intermediate-acting insulin whose onset of action is delayed by combining 2 parts soluble crystalline zinc insulin with 1 part protamine zinc insulin.

June 19, 2017

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Intravenous infusions of regular insulin are particularly useful in the treatment of diabetic ketoacidosis and during the perioperative management of patients with diabetes who require insulin.

June 18, 2017

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Regular insulin is a short-acting soluble crystalline zinc insulin whose effect appears within 30 minutes after subcutaneous injection and lasts 5-7 hours when usual quantities are administered.

June 17, 2017

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Patients with chronic kidney disease should not be given metformin because failure to excrete it would produce high blood and tissue levels of metformin that could stimulate lactic acid overproduction.

June 16, 2017

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Metformin’s therapeutic effects primarily derive from the increasing hepatic adenosine monophosphate-activated protein kinase activity, which reduces hepatic gluconeogenesis and lipogenesis. Metformin has a half-life of 1.5-3 hours. 

June 15, 2017

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Nateglinide stimulates insulin secretion by binding to the sulfonylurea receptor and closing the ATP-sensitive potassium channel. This compound is rapidly absorbed from the intestine, reaching peak plasma levels within 1 hour.

June 14, 2017

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Repaglinide is structurally similar to glyburide but lacks the sulfonic acid-urea moiety. It acts by binding to the sulfonylurea receptor and closing the adenosine triphosphate (ATP)-sensitive potassium channel.

June 13, 2017

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
For maximum effect in reducing postprandial hyperglycemia, glipizide should be ingested 30 minutes before meals, since rapid absorption is delayed when the medication is taken with food. 

June 12, 2017

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Glyburide, glipizide, gliclazide and glimepiride should be used with caution in patients with cardiovascular disease or in elderly patients, in whom prolonged hypoglycemia would be especially dangerous.

June 11, 2017

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Sulfonylureas are used in patients with type 2 but not type 1 diabetes, since these medications require functioning pancreatic B cells to produce their effect on blood glucose. Sulfonylureas are metabolized by the liver.

June 10, 2017

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
The mechanism of action of the sulfonylureas is the insulin release from pancreatic B cells. Receptors on the surface of pancreatic B cells bind sulfonylureas. Glyburide has the greatest affinity and tolbutamide has the least affinity.

June 9, 2017

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Circulating lipoproteins are just as dependent on insulin as is the plasma glucose. In type 1 diabetes, moderately deficient control of hyperglycemia is associated with only a slight elevation of LDL cholesterol and serum triglycerides.