Once upon a time, two women in their late sixties met at church and soon became friends. Letty is now 76 and Martha 74. Martha is a widow and moved to Letty’s small town after her retirement and the death of her husband to be near her children.
Last week, Letty sent me this email, in narrative form. As a retired nurse educator, I immediately recognized a “clinical vignette” that I most certainly would use if I were still teaching nursing. In my module on therapeutic communication, I would ask the students to identify and analyze the RN’s “nursing interventions” that made a significant difference in Martha’s experience of having a CT scan. The vignette could also serve as an insight into the needs and friendships of older persons.
See what you think.
I spent the morning with Martha at the hospital – she needed a CT scan and just wanted me along – again made me aware of what it is to be a widow! I could go back into the area where she was “prepped” for it. We sat in chairs side by side, and the nurse, an RN, offered us warm blankets while she did what she had to do, and then Martha had to drink some barium. When the nurse brought out the four bottles, Martha right away said, “I can’t do that.”
And I said, “Too bad it isn’t flavored like I did with the Go Lightly with Crystal Light.”
Immediately, the nurse said, “I can get that!” And off she went for a package of fruit flavoring and came back and mixed some in the first bottle.
Martha took a sip and said, “I can do that.” Over the hour she got three bottles down – and that was it. As the nurse kept chatting with us, Martha kept sipping, and then it was time to go for the scan. Later the tech told her they got great pictures! What a relief. Martha doesn’t like to drink much, so this much fluid really was hard to do.
The nurse was most patient with Martha’s request, and told her how to just sip away. On a scale of 1-10, she was a 10. I told her about you saying nurses don’t get near the credit for all they do, and I think she used a phrase similar to what you wrote or Marianna [my friend at nursingstories.org] wrote! The RN is normally an ICU nurse, but said she does this to keep her sane!
She was everything you’d want in a nurse under these circumstances – Martha was a bit nervous about it, and her BP was high, and the nurse just calmly said, “It is okay. Just check it on your own sometime.”
Martha has always had a great BP, but lately it has been high, so her doctor suggested she go to the same place, at the same time of day, to monitor it for a couple of weeks. The nurse told her the same thing. Martha is on some low dose of a BP medication until she sees her doctor again next week. It has been good where she has gone to test it lately. I think she just was more anxious when she saw all she had to drink.
Another case of being a widow and how it is to do these things alone! She hates to ask for help but knows I am always willing to be there. Her daughters would have to take off from work, and they have done that when she asks, but she feels that isn’t nice for them. She could have gone alone, but was concerned about how she might feel afterwards, and that was before she knew she would have to drink that stuff!
She took me out for a late breakfast – a place we went to once in a while when we used to live nearby. So a pleasant ending to it all.
Heartwarming, right? How would you feel in Martha’s situation?
Can you see why Letty rated the nurse as a “10”? Offering warm blankets, getting the flavoring, giving instructions how to sip, chatting for distraction, being patient, being calm…
No doubt, as you read this story, your own experiences crowded your mind. Know that you have a right, as a patient, to be treated in all encounters with competence, respect, and compassion.
Thanks to Letty (not her real name), one of my sisters, for permission to print her story about her morning with her friend Martha (not her real name). “Letty” had no idea that she’d given me such good material to show the holistic care of a nurse!
Last week I read an article about “patient activation” with some amusement. Activation sounded like batteries. Did patients need a couple of Triple As inserted into the soles of their feet to get involved in their own health care?
The article defined patient activation as “understanding one’s own role in the care process and having the knowledge, skills, and confidence [italics mine] to take on that role.”
Chuckling to myself, I thought of the mid-seventies when I was a student in an RN-to-bachelor’s degree program. My friend and I were taking a nursing concepts course and learning about theories of nursing for the first time. In Dorothea Orem’s1 developing conceptual model of self care, we learned about patients’ self-care agency—agency referring to the knowledge, motivation, and skills required for them to meet their own health care needs.
Sitting in the back row of the class, my friend and I dissolved into giggles. Agency reminded us of insurance, not nursing. After all, we’d been nurses already for fifteen years and had functioned just fine, thank you, without knowing a thing about our patients’ self-care agency. We had learned and practiced nursing under the medical model, a model based on body systems, medical diagnoses, and physician-ordered treatments.
In those days we even had to call the doctor for an order to shampoo a patient’s hair.
In the interim, however, nursing scholars had made significant advancements in formulating our own theories of nursing that described the art and science of nursing, enabling us as a profession to think within a nursing framework. Simply put, instead of “doing physician-ordered treatments to” our patients, we adapted the well-established scientific method into a five-step format called the nursing process, to work collaboratively with our patients to (1) assess their nursing care needs, (2) make nursing diagnoses, then (3) plan, (4) implement, and (5) evaluate their care, with the goal of assisting them to achieve an optimal level of self care.
It was an exciting time for nursing. A drastic change in thinking from working dependently under physicians to working collaboratively with them, and, in some cases, independently.
I digress! Now I’m reading the definition of “patient activation” and am riveted to my nostalgic bookshelves where my old textbooks have found a permanent home. I find three editions of Orem’s Nursing: Concepts of Practice and a user-friendly “primer for application of the concepts” that I used later in my teaching. I read again about knowledge, motivation, and skills. What goes around comes around, comes to mind. And I’m proud of the early nursing scholars for their seminal theoretical work.
But, no doubt If I were sitting in a class today learning about patient activation, batteries would come to mind, and I’d be back to giggling. However, it’s not a laughing matter. According to the article, “patients who are actively involved in their health and health care achieve better health outcomes, and have lower health costs than those who aren’t.”
Applying this notion to my scabies story of last week, I did not need batteries to activate me to seek a doctor’s help, the relentless intense itching did that on its own. No doubt seeing my internist, then a dermatologist promptly led to a quick diagnosis and treatment so that my symptoms are mostly gone and my costs have been kept to a minimum.
I bring up this experience because in my Web search on itching, I read dozens of posts by people suggesting a myriad of home remedies to quell the scratching. I read of people being too embarrassed to see a doctor. I read of months, even years, of undiagnosed, probably under-treated, bouts of itching causing much distress.
I think now about how desperate I was for relief over the three days between my doctors’ visits. I think of how much time I spent searching the Web and scanning shelves at Walgreen’s for products that might kill off the invaders of my body and sanity. And I think how my anxiety would have been compounded if I didn’t have access to health insurance.
As it was, I had insurance and the knowledge, motivation, and skills to seek the proper treatment. Without these, it’s highly doubtful I would have better health outcomes and lower costs than people who don’t have these resources.
Read the article yourself about the concept of patient activation, and see how it applies to you and your relationship with your health care providers. Get activated. Get engaged in your own health care. If we all do this, and if our health care providers work with us, we’ll have better outcomes. Plus, we’ll know we’re doing our part to be as healthy and happy as we can be, while, at the same time, helping to contain our ever-increasing health care costs.
Read an additional response article by Jacob Molyneaux, Senior Editor at AJN Off the Charts.
1Orem, D. (1971). Nursing: Concepts of Practice. New York: McGraw-Hill.
I wish I had something more soothing to write for you today. But last Monday, after a three-day hissy fit of prickly-burning body-wide itching, a dermatologist looked at the tan line on my back and asked, “Where’s this tan from? And how long ago did you get it?”
“Aruba. Three weeks ago,” I said.
“Then I think you have scabies,” he said. “With the intense itching, that’s my best bet.”
Gads! In my distant past, in nurses’ training, I recalled learning about scabies, only I thought they only occurred in a third-world country. I wanted to disinfect myself immediately.
“The time’s right for the incubation period,” he added. “Hotel linens, maybe.”
As I sat obediently on the exam table, my mind buzzing with my recent history, I thought, “Is this really happening, Lois?“
A few days before, while having coffee with a friend, my left hand had turned blue. For no reason, and had stayed that way for a few hours. The next morning I called to see my internist. By that afternoon when I saw him, I had developed a rash over much of my body. And it was starting to itch.
Blue hand and rash and itching. Connection? “We better do some tests,” he said. “With your autoimmune history, there may be something going on.”
When I got home, I sat at my computer and Googled blue hand and rashes and intense itching. What I read about made me want to plan for my final days. As a nurse, I always plan on the worst thing. Liver failure, maybe. But my bathroom mirror said the whites of my eyes were still white. Not jaundiced.
Calm down, I told myself that evening while I searched the shelves at Walgreen’s, coming home with $36.00 worth of anti-itch products. To say I was merely being attacked by a colony of ants picking and scratching their way over and through my body does not give them nearly enough credit for the massive destruction these creatures, whatever they claimed to be, were rendering on my sanity as well as my body.
When the blood tests came back normal (thank goodness!), I called a dermatologist, pleading with the receptionist that I get in stat! She gave me an appointment in one hour. I was there twenty minutes early, and now I sat with a most probable diagnosis of scabies.
Never mind the blue hand episode.
Have you ever seen scabies? Gross, is my best word. But to think they were burrowing their ugly prickly bodies under my skin was a thought I tried to suppress. But suppression was not possible when my mind was consumed with relentless itching from their chaotic tunneling activity.
That evening, with $28.00 more of products, I covered my entire body from hairline to soles of feet (well, I had a little help from my ever-forbearing husband) with this prescription scabicide cream that was supposed to kill my new enemies. Envisioning, that by using this cream, I was murdering the creepy mites threw out any thoughts of pacifism and threw in gratitude for research and development and pharmaceuticals.
The next morning, per directions, I showered. Ideally, the murdered mites had surfaced somehow and would disappear down the drain. Since they are too small to see with the naked eye, I did not have the pleasure of visually wishing them a stinky sewer burial.
But here’s the thing. Scabies don’t leave that easily. With the rash now mostly gone, the itching continues with intense waves of discomfort. And, in this hot-water-wash-everything era of my life, I’ve read that scabies can stick around for several weeks or more, leaving their eggs and, of all things, their excrement under my skin. Don’t their parents have any manners? You’d think they’d teach their kids about the use of restrooms.
I see the dermatologist again this morning. On my visit a week ago, he did a biopsy also, so I’m hoping nothing more serious shows up in that sample. If not, I may just have to adjust to accommodating my unwelcome visitors while I do my utmost to encourage them to make their final exit ASAP. Like, here’s your hat, now please hurry.
I’ll give you an update next week. Meanwhile, I sincerely hope you don’t start to itch. This is no fun. No fun at all!
Want a hug?
As she lay dying from pancreatic cancer, Nurse Martha Keochareon wanted to do more than plan her funeral. So she called her alma mater and offered to become a “case study” for nursing students. She reasoned she could help students learn about the dying process while, at the same time, it would be a way for her “to squeeze one more chapter out of life.”
I loved this story. First, as a retired nurse educator, I was struck by Nurse Keochareon’s selfless giving. I could identify with her desire to teach; as nurses we are taught, along with being caregivers, to be teachers (as well as communicators, researchers, leaders and more). I believe we consider it a duty and a privilege to empower our patients or students with the resources they need to function successfully in their lives.
Second, Nurse Keochareon had lived with pancreatic cancer for more than six years. Her story of this unusually long experience would have been of great interest to me because my brother died from that type of cancer in less than a year. What did she know about her prognosis from the beginning? What type of treatments did she have? What quality of life did she have during that long period of time?
And third, I love how she expressed the personal benefit she would get out of sharing her story with nursing students: “to squeeze one more chapter out of life.” For anyone, writer or reader, who enjoys books, just muse about this phrase for a minute…to squeeze one more chapter out of life.
Let’s rephrase that into a question we can ask ourselves: If I had one more chapter to squeeze out of my life, what would I want to write in that chapter? Based on the “to do” list I compiled recently on a beach chair in Aruba, I have at least ten things to cram into that chapter. And that’s just for starters.
What about you?
Read Nurse Keochareon’s story, featured in the January 11, 2013 New York Times.
That was me. And like others in these first waves of feminism, I, after some painful soul-searching (chapters 5 and 6 in Caring Lessons), ventured out of the kitchen and nursery and went back to school and carved out a career.
Ellen Cole, the researcher I mentioned a few weeks ago, also had a gut reaction to Friedan’s book: “It turned my life upside down.” Now, at 71, she is interviewing seventy year olds from the Silent Generation (those born between 1925-1942) to see how our generation is transitioning to old age from those jobs that filled our lives. From her findings so far, she and her colleague, Jane Giddan, have come up with three “lessons” for “aging gracefully.” I’ll relate them to a few examples from my life now.
The first lesson is “accepting old age.” It’s funny how this old age stuff creeps up on you; it seems one day I was marching along meeting hourly appointments, and the next day I was happy to have one outing a day. I have found it helpful to focus on what I can do rather than lament the opposite. I no longer take my health for granted. I’m thankful I can see, hear, walk, talk, and eat. I have learned to be content with just that one outing a day. I have learned that wrinkles can make you look carved with wisdom.
The second lesson is to “banish the thought of ‘retirement’.” We don’t have to quit working if we don’t want to, but, if we do, we can do whatever we want to do. It feels prophetic now, but, more than twenty years ago, respondents from my doctoral research on older persons’ leisure, said, “I can do what I want, when I want, and for how long I want.” And that is the beauty of not having to have paid employment. I can get up when I want and read all day if I wish. With no grandchildren nearby and a self-sufficient husband, I have lots of free time, but I have found I had to replace my passion for nursing with another, and I’m grateful that a long dormant interest in writing surfaced immediately upon my retirement in 2000.
And the final lesson is “finding a community and immersing yourself in it.” If you need people like I need people, this is key. I feel truly blessed to live, for the first time in my life, in a city high rise. I don’t have to drive anywhere to find community. I’m only an elevator ride away from our gym, pool, and monthly building parties and book club meetings.
I’m next door to the historic Chicago Cultural Center with its Renaissance Court, run by the Chicago Department of Family and Support Services, where I’m taking an aerobic class three mornings a week.
I can walk to my regular meetings with my writing group, a staple in my life for over ten years.
I can walk to our church where I can also take classes. I just finished a course on the definition of marriage from Greco-Roman times, through Biblical times, to the present. This knowledge will be of interest as I follow the Supreme Court decisions on same-sex marriage.
I can walk to my University of Chicago class at the Gleacher Center which offers more non-credit courses in the humanities than I have time left to take.
And this short list does not even talk about being able to walk to symphony, opera, plays, or restaurants of every flavor. Or shopping. Or my favorite coffee shops. I’m writing this piece in my cozy Caribou on Michigan Avenue, surrounded by eighteen people, mostly young, working on their laptops. The young woman three feet from me just sneezed. I said, “Bless you.” She looked over at me and said, “Thank you.” We exchanged smiles.
And, of course, there are more places to meet people by volunteering; my most memorable experience in retirement has been with the Mental Health Ministry of my church with our goal of promoting awareness and education related to persons and families living with mental illness.
What about you? Have you or a parent or a friend accepted getting older? Have you considered what retirement means? Have you built in sources for sustaining community?
Consider these thoughts for your New Year’s resolutions. Happy New Year!
If you’d like to read more about Cole’s study of seventy year olds and/or participate, log on here: www.70candles.com
Photo Credit: Wikipedia
- What Boomer Women Can Learn About Aging From (Gasp) Older Women (theatlantic.com)
- Seventy: A Major Milestone for Women? (loisroelofs.com)
- What Is the Secret to Aging Gracefully and Happily? (acculturated.com)
“If only” runs through my mind as I remember our 50th reunion of a week ago.
Twenty-nine of forty classmates (three have died) met at Camp Geneva in Holland, Michigan, from Tuesday afternoon through Thursday morning. Many of us, as proud members of the Blodgett Memorial Hospital School of Nursing Class of 1962, had not seen each other since our graduation ceremony at Fountain Street Baptist Church in Grand Rapids, Michigan.
A year ago, we gradually formed a committee of nine to plan a reunion with not much more in mind than to provide an opportunity for classmates to renew acquaintance and celebrate having been nurses for half a century with our theme of 50 Years of Saving Lives.
But much more happened as we found out during our wrap-up session the final morning. And this is where an “if only” comes in. I wish I would have had the presence of mind to whip out a pen and jot down some comments. Here are a few to the best of my recall:
“I feel now, if I’m vacationing where any of you lives, I’d be comfortable calling you up and dropping in.”
“I didn’t know what to expect, not having seen most of you since we graduated, but I’m so happy I got to know every one of you better than we ever knew each other in nurses’ training.”
“These few days have been more like a spiritual retreat than a reunion.”
These three responses were echoed by others. And, again, if only I’d had my pen and paper out even earlier during the sharing times of each classmate where we heard their individual accounts of how “my nursing education influenced my life, ” I’d have substantive material for dozens of blog posts.
A highlight of our time together was honoring our class scribe, Eileen Torrey. For these fifty years, we have mailed and, more recently, emailed her a letter every February that she has collated and mailed/emailed to each of us. Her keeping us in touch undoubtedly was instrumental in us being able to dig right in and get reacquainted. As a surprise, we gave her a gift for her faithfulness, shocking her as she opened a check for over $1000.00. I know we all felt we couldn’t put a price on what it has meant to get that letter every year.
What strikes me in retrospect is not only the bond we share as nurses and as seventy-plus-year-old women, but as Christians. As teenagers in nurses’ training, our faith wasn’t primary in our minds. Survival was…through thirty-six straight months intense with classes, clinicals, and working all shifts.
Now we were able to see how each person’s faith had guided their personal as well as their professional lives. We were able to see how important our stories were to each other as we listened to over six hours of individual story-telling and mingled with different people at each of the five meals.
We had a bunch of fun too with memorabilia:
Our parting was emotional as we sang farewell songs, including:
God be with you till we meet again;
By His counsels guide, uphold you,
With his sheep securely fold you;
God be with you till me meet again.
Till we meet, till we meet,
Till we meet at Jesus’ feet,
Till we meet, Till we meet,
God be with you till we meet again.
As I moderated this final session, singing Till we meet at Jesus feet drew my tears. This group of women had sustained me the week between the death of my nurse-mentor sister and her memorial service. I could not have been in a better place than with this sisterhood of faith-filled women.
And, yes, even though not planned as such, this reunion turned out to be much more than that…an inspirational spiritual retreat. And I think it did so because that’s just who we are.
We buried my nurse-mentor sister on Saturday, and we bury a beloved cousin tomorrow.
As I sit at my desk overlooking Chicago’s Millennium Park, the trees remind me that fall is a time of changing seasons, when greens turn to red to yellow to brown.
And the colors remind me of the changing seasons of our lives as reflected in Ecclesiastes 3: 1-8:
There is a time for everything, and a season for every activity under heaven:
a time to be born and a time to die, a time to plant and a time to uproot,
a time to kill and a time to heal, a time to tear down and a time to build,
a time to weep and a time to laugh, a time to mourn and a time to dance,
a time to scatter stones and a time to gather them, a time to embrace and a time to refrain,
a time to search and a time to give up, a time to keep and a time to throw away,
a time to tear and a time to mend, a time to be silent and a time to speak,
a time to love and a time to hate, a time for war and a time for peace.
As I worked on my eulogy last evening, I became more and more impressed with how much Kay, as the oldest of us Hoitenga Sisters, had unassumingly jammed into her life.
Enjoy her efforts, efforts she would call modest, with me in her newspaper obituary.
Meanwhile, before I attend her services this weekend, I’ll be attending the 50th reunion of my nursing program at the same school Kay attended, the Blodgett Memorial Hospital School of Nursing.
In fact, Kay and I went to some reunions of the school together. This brings back fond memories of her finding her classmates and me finding mine, then regrouping, comparing notes, and chuckling through our stories.
And this song fills my mind this morning as I hit the road, God be with you till we meet again…
By Karen Roush MS, RN, FNP-C, AJN clinical managing editor
What will it take to end the turf war physicians are waging against nurse practitioners? The latest foray is over who should lead patient-centered medical homes (PCMH). According to the American Academy of Family Physicians (AAFP), only physicians should. They insist that nurse practitioners do not have the knowledge or skills to do so and that expanding the NP’s role in primary care would create a "two-tiered health system," with patients who are cared for by an NP receiving a lower level of care.