Aging in Chicago: A New Adventure for Fall 2014

“Listen actively with respect,” said the speaker, adding “Be succinct and to the point.”

Last week, I attended this orientation session to the OLLI program at Northwestern University in Chicago. OLLI stands for Osher Lifelong Learning Institute. Across the country, 120 such programs exist, all associated with colleges. Having taught group dynamics and observed many over the years, I appreciated this heads up to monopolizers and spoilers of any group gathering.

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At Northwestern, between their Evanston and city campuses, nearly 900 students participate in this “cooperative learning community.” In the study groups, members have the opportunity to progress “from avid listener to active contributor to discussion facilitator to coordinator.”

I’ve never attended a formal peer-led educational program. Of course, all my formal education was teacher-led or coordinated. And the Basic Program at the University of Chicago that I completed a year ago was teacher-led. My only experience with anything led by peers was in Bible studies where I bristled at the “blind leading the blind.” As a former teacher, I always want someone in the room to be much more knowledgeable in the subject area than I. In Bible Studies, for example, give me a theologian versed in the Hebrew and Greek origins of Scripture.

But, after hearing friends rave about OLLI, I’m trying this method of learning by taking a course titled U.S Healthcare: Promise Unfulfilled. The course description asks, “Can our health care system work better, cost less and deliver higher quality?” Proposed and moderated by a pediatrician and a consulting executive (sounds like they’ll know more than I!), enrollees are invited to examine “the politics and policy decisions that got us to our current system…from the first health care plan to Otto Bismarck’s Germany to the Affordable Care Act” and more.

When I found this course among the dozens offered, I signed up. As a nurse and proponent of life-long learning, I can think of no better topic to explore at this time in our history, along with peers interested enough in the same thing to enroll and discuss respectfully as members of a group.

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In case you’re wondering, I did have to sign up for second and third choices. My second choice was Christianity: The First Three Thousand Years; my third, Exploration of Brain and Mind. They will have to wait.

If you are retired and have some free time, what are you doing this fall to challenge your brain? Simply, but importantly, caring for yourself as health falters? Caring for family or friends? Going to church, plays, symphonies, operas, lectures?  Volunteering? Exercising? Reading? Cooking? Blogging? Help add to this list!

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Caring Lessons / Printers Row Lit Fest / Chicago 2014

Hey, everybody! Drop by this Saturday between 10 and 2 to see that Caring Lessons and I have finally made it to the Printers Row Lit Fest. Special pricing for the Fest will be $10.00 (normally $13.99). We’ll be located at the book tent labeled Y, as in Yes.

IMG_0428Ever since Caring Lessons came out almost four years ago, I have wanted to be a part of my favorite two-day Chicago event. So last year I asked a vendor, “What do I need to do to get here?”  A few weeks ago, I finally did what he said—join the Chicago Writers Association. Almost immediately, one of their members emailed that he had time periods open at his Rook Creek Books tent. So I purchased a 10 to 2 time slot on Saturday to display and promote the memoir of my nursing career, Caring Lessons: A Nursing Professor’s Journey of Faith and Self.

IMG_0424If you’ve never been to Printers Row, the neighborhood on South Dearborn between Congress and Polk use to be the center of the city’s publishing and printing industry. The first Fest, known as Printers Row Book Fair, featured 40 booksellers and attracted about 6,500 attendees. Now, 30 years later, there will be about 150 booksellers and 20 times the crowd, and will host more than 300 authors and presenters at various events (Printers Row, Chicago Tribune, June 1, 2014, p. 21).

Rook Creek Books is sharing the Y (as in Yes) tent on Dearborn, six tents up from Polk, with the Chicago Public Library and Sears Home Services.

IMG_0427So make your trip to downtown Chicago this weekend and immerse yourselves in all things books and authors and writing. I’ll be watching for you!

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Read more about my experiences with the Chicago Tribune‘s Printers Row here.

 

Chronic Itching: Hope on the Horizon

Readers of this blog know that I have lived with chronic itching for over a year. Some moments are really yuk, but I continually remind myself to be thankful to God for the good days, for the simple fact that I’m able to walk, talk, see, hear, and eat.  And write. And take classes. And walk Michigan Avenue. And the list could go on.

And, today, was an especially good day as an article in the New York Times addressed chronic itching. Dr. Lynn Cornelius of Washington University School of Medicine was quoted as saying chronic itching is a “huge clinical problem and a huge unmet market.”  Amen.

I do not subscribe to the New York Times, but friends here in IL and in MI and NC sent me the link. I am grateful!

Unless a person suffers from chronic itching, I think it’s impossible to know what it’s like to live with bees attacking you or fire ants hosting parties on your body. As in other diseases, the sufferer knows best the experience of living with the symptoms.  And sufferers, in general, know best the feelings of hopelessness and the importance of hope.

Articles such as this one in the New York Times give hope. The article affirms that the study of chronic itching is a relatively new science. It affirms, for those of us living with chronic itching, why we’ve desperately plodded through the medical and alternative medicine community only to come up with few to no answers. It affirms through description of research findings that there are legitimate causes for our symptoms.

It says, what we knew all along, we are NOT hypochondriacs. Or a bit off our rockers.

Please take a few minutes to read the article: Itching: More Than Skin-Deep – NYTimes.com. And please share the link with your friends and/or social media sites cited under comments. I can assure you that someone will know someone who, like me, will be grateful for the information.

How is your doctor’s nonverbal communication?

Last week I praised my internist’s therapeutic communication skills and promised I’d write about some bad experiences soon that I’ve had during my nearly 15-year history of fibromyalgia. So today is the time to give you one example that still floors me years later.

Petunias on the Chicago River yesterday. A  peaceful scene to keep you calm if you identify with this story!
Petunias on the Chicago River yesterday. A peaceful scene to keep you calm if you identify with this story!

Some back story. When I taught nursing, therapeutic communication was my favorite module, both in a beginning concepts course and in a senior level mental health nursing course. Part of teaching that module included learning therapeutic nonverbal communication.

The doctor in my example could have benefited from taking my class and learning about SOLER skills for his nonverbal communication or body language.

S=Face your patient squarely. Adopt a position that indicates involvement.

O=Adopt an open posture. Crossed arms and legs can be signs of lessened involvement.

L=Lean toward the patient.

E=Maintain good eye contact. Communicate “I’m with you.”

R=Try to be relatively relaxed while engaged in above behaviors.

The following example is of a visit to a GI (gastrointestinal) consult about pain under my right rib cage. My internist at the time wanted an opinion from a specialist in this field.

Waiting for the doctor, I was heartened to see on his diplomas that he graduated from the same university as I and must be about my age. Naively, I thought, since he got an MD and I got a PhD in nursing about the same year, age-wise that would raise my chances of liking him.

The minute he walked in the room, I sensed this was not going to go well. Dressed in a crisp white lab coat, he passed my back and sat behind a humongous desk that separated us, grunted hello, adjusted his glasses, and, without looking at me, read the forms I’d filled out.

He confirmed I was there for pain on my right side below my rib cage. Then he told me to go across the hall and put on a gown. There he pummeled my abdomen without saying a thing, or looking at me, and then said to get dressed and meet him back in his office.

Once there, he  leaned back in his chair and said in a clinically efficient, detached manner, “I don’t deal with pain above the waist, and yours is above your waist.”

Duh. Pain above the waist was why I was there. So what does a patient say in that setting? I get tongue-tied, a problem I rarely have, but it strikes me in doctors’ offices.

When I recovered from my shock, I asked, “Can you give me any idea of what may be causing this pain?”

Leaning back even further, plus crossing his arms, he said in a dismissive tone, “Over 50 percent of my fibromyalgia patients have irritable bowel syndrome, so you probably have it. I’ll give you a prescription.”

I tried to tell him I did not have any symptoms of that disease, but he waved me off, wrote a prescription, stood up, handed me the prescription, and started to walk past me out of the room.

Tongue-tied again, I stood, feeling the color drain from my face, and feebly said Thank you. For what, I still don’t know, but suspect my childhood programming to be nice automatically kicked in.

Walking zombie-like down the hallway to the elevators, I felt sandblasted. When the elevator door opened and I saw that I was alone, I pressed the lobby button and burst into tears. And I wasn’t a kid; I was around sixty.

Now why couldn’t I have confronted this pompous fellow? What could make me slow on the draw in these settings? I have no problem thinking up things to say once I’m retelling my experiences.

What about you? How is your doctor’s nonverbal communication? If not good, do you confront, or are you temporarily stymied, like I am, when he or she doesn’t meet your expectations of a caregiver who cares?

Therapeutic Communication Skills – An Essential in Health Care

“Don’t let it happen again,” said Marianna Crane, my nurse practitioner friend. I could hear the disbelief in her voice.

Marianna and I share a history of graduating from diploma schools of nursing in the early sixties. At that time, a visible hierarchy existed in health care. Doctors were treated like gods. And, even though Marianna and I attended nursing schools many states apart, we were instructed to give up our seats for doctors when they entered the nurses’ station, to stand aside and let them get on and off elevators before we did, and to silently endure whatever tantrum they decided to have on any particular day.

My student days in the 60s.
My student days in the early 60s.

Over the years, the situation has changed. Not as much as some would like, but doctors and nurses now work more collaboratively than in our days of nurses’ training. But, as a result of the years enduring a subordinate role, we share a healthy resentment for doctors that still see themselves as gods. As for me, with those early beratings1 imprinted on my psyche, every doctor in my life has had to earn my respect before I accorded it. 

So, when I was talking across the miles to Marianna, I was telling her about a probably once-in-a-lifetime occurrence. On one of my many visits to my internist for my now months-long history of itching, just as he was leaving the room, I said, from my perch on the end of the exam table, “I have something to say that I’ve never said before.”

He turned from the doorway and looked at me. I swallowed. “You’d NEVER have caught me saying this before, but today I’m happy to be JUST a nurse.” His face stayed one of concern as he gave a gentle wave and left the room.

There, I had said it. JUST a nurse. In all my  twenty years of teaching nursing, I had preached to my students to NEVER say I’m JUST a student and, in my twenty years of practice before that, to my colleagues to NEVER say I’m JUST a nurse. I had a strong basis for saying this, of course, and, if they questioned me, I would remind them of the rigor and years of study required to become a nurse. 

So JUST was a word that JUST wasn’t in my vocabulary. But on that day in my internist’s office, I had come to a complete blank about whatever it was that was causing my body to continue itching. I had exhausted search words and websites. I had exhausted my run of specialists and alternative treatments. I had exhausted trying prescription and over-the-counter medications.

You might say I was JUST exhausted, too exhausted to be thinking clearly. But I know I was thinking clearly, and I was thankful for his listening to me these many months, taking my multiple concerns seriously, trying to help me feel better, replying promptly to my many emails, and never talking down to me or sounding paternalistic.

As anyone suffering from a chronic illness that invades their life and lifestyle knows, when you find a doctor that meets your needs, you are thankful. So I can excuse myself for saying I am “just a nurse.” I am a fortunate nurse who found a doctor I can respect. A doctor who exemplifies the therapeutic communication skills I used to teach my nursing students and expect to experience with all health care professionals.

Now, if you think I’m getting a bit sappy, sometime soon I’ll tell you about unpleasant experiences I’ve had in the past with doctors in my quest for relief from fibromyalgia. Stay tuned. And if you have a story, negative or positive, to add, please do!

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1 I have documented several of these “beratings” in Caring Lessons.

 

 

What do nurses do? Let me count the ways…

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!

Patient Activation – Nostalgia for Dorothea Orem!

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.

My dear friends!
My dear friends!

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.

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 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.