Articles: Combating Stigma [HIV/AIDS Part 2]

Part 1 conveyed my personal experiences and views on caring for patients with HIV and AIDS. In this post [aka Part 2] I want to share some research and outside opinions that have been published on stigma associated with HIV/AIDS among health care workers. Adding on to the resources I mentioned at the end of Part 1, Avert.org is great for health care workers to expand their perspective. The site states, "Stigma and discrimination in healthcare settings are not confined to developing countries." They give recommendations for ways to combat stigma in health care settings:

"Health care workers need to be made aware of the negative effect that stigma can have on the quality of care patients receive; they should have accurate information about the risk of HIV infection, the misperception of which can lead to stigmatising actions; and they should also be encouraged to not associate HIV with immoral behaviour."

Recent research has been focused on experiences of the patients seeking treatment, counseling, and support. The findings of research of this nature are essential to health care workers. This site reviewed a published study, and reported, "Stigma in healthcare settings was especially upsetting if it involved indifference or awkward social interactions." This statement in particular resounded with me as I remembered the experience I relayed in Part 1.

I found an excellent article (available online!) from the Journal of the International AIDS Society, entitled "Combating HIV stigma in health care settings: what works?." The authors base their recommendations on the following claim:

"...there are three main immediately actionable causes of HIV-related stigma in health facilities: lack of awareness among health workers of what stigma looks like and why it is damaging; fear of casual contact stemming from incomplete knowledge about HIV transmission; and the association of HIV with improper or immoral behaviour."

Being attentive to the above causes of stigma in health care settings can make a difference. If you are aware this stigma exists, you can evaluate its presence and effect on the health care setting you work in. In many circumstances, an unfamiliarity and perceived foreignness of HIV/AIDS prevents us from knowing how to establishing a trusting relationship with patients living with HIV when we encounter them. I recently read a study about increased protection of confidentiality and more knowledgeable interactions with HIV/AIDS patients among African nurses than nurses in Western health care settings. It reminded me of the remarkable care provided by the nurses in Uganda (as described in Part 1). Unfortunately, due to saving complications in CINAHL, I can't find it. If anyone comes across it, please let me know!

Update on Sudan: Southern Sudanese voted for the referendum. Now let's hope the split goes as smoothly as possible, and any massive killings are avoided.
Update on Egypt: I'm sure you have seen images and stories the crisis/chaos that's happening in Egypt. It will be interesting to see the uprising's continued influence in both Africa and the Arab nations.
Update on Midwest Blizzard: I'm enjoying the first snow day that my school has had since 1978. :)

Caring for Patients with HIV/AIDS [Part 1]

Last semester, I cared for a patient with a diagnosis of cryptococcal meningitis, an opportunistic infection secondary to the patient's HIV. At first it was an odd experience for me because it was the first HIV patient I had cared for since my experience in Uganda, and the only HIV patient I had cared for, or encountered, in clinicals. In this particular situation, I felt there was an unspoken uncertainty among the nurses on how to address or go about this positive HIV status. The family of the patient clearly felt it too. I overheard one of the family members say to others in the room, "I just feel as if they aren't telling me something." The family was aware of their loved one's HIV status, so that was not the perceived "secret" being kept by the staff. Somehow the knowledge that this was an HIV positive case changed the manner the nurses approached the patient, the patient's family, and their care overall.

The nurses in Uganda approached each patient who was HIV positive with an acute awareness of the impact of HIV and AIDS. The case was handled in a delicate manner in order to respect the privacy of the patient. The nurses used the term “ISS” [Immune Suppressive Syndrome] to avoid the stigmatization that came along with the dreaded “HIV.” Their understanding of the complex effects of HIV/AIDS on their patients allowed the nurses to also speak frankly and openly. The open dialogue between nurse and patient seemed to maintain their dignity as a person, and not a diagnosis.

The most enriching experience I have had learning about HIV/AIDS was in the city of Arua in northern Uganda. My other nursing friend and I traveled to visit Indiana natives and friends at Radio Pacis. We were scheduled to appear on one of their English health segments. The other guest was a man named Wadri. Together we all discussed the importance of communicating as a couple about your HIV status and going to get tested together. He was well spoken and very knowledgeable about HIV/AIDS, a result of sponsored training and education. Wadri has been HIV positive for about 20 years, which is remarkable since he was diagnosed during the beginning stages in the discovery of HIV/AIDS. Another remarkable thing about Wadri is that he is open about his HIV status, and speaks on the radio every week as an openly HIV positive person. We spent part of our short time at Radio Pacis with Wadri, walking through the city, and talking about his life. He took us to the local AIDS Information Center, and taught us more about what he wants to do for the community as an HIV positive person. Wadri is the paradigm for what mutual openness about HIV/AIDS can do for the community and health care.

Nurses need to openly and respectfully engage the HIV/AIDS community, and fulfill their obligation to the community by being their sound voice in health care. Nurses have to ensure they are aware and comfortable in their care for patients with HIV and AIDS. Otherwise--like anything-the perceptions, ignorance, and uncomfortable issues surrounding HIV and AIDS will impede nurses from optimally caring for their patients. Nurses and nursing students can seek out resources to help develop their knowledge and awareness. The Association of Nurses in AIDS Care [ANAC] is a leader in research, information, and career development for nurses. On their website, ANAC states, "All nurses need to think of themselves as HIV nurses." HealthHIV provides a plethora of educational resources, and can lead you to other organizations dedicated to the same purpose. The Act Against AIDS campaign is yet another great resource for both health care providers and the community. The University of California at San Francisco [UCSF] has a Nursing HIV/AIDS Center that has links to nursing research they h

ave completed. It's important to realize that HIV/AIDS does not just affect Africa and developing countries. In recent years, it seems as if HIV/AIDS has been driven out of the focus of many Western health care providers and consumers. The United States Healthy People 2010 and 2020 include HIV in its objectives. HIV remains a major health concern in Western health that should not be avoided. Nurses worldwide can continue to lead the way in fostering openness, awareness, and respect for people affected by HIV and AIDS.

Fight for Democracy in Egypt

Have you heard or seen about what's happening in Egypt?
The people are not merely engaging in protesting--they are fighting for democracy. The current president, Hosni Mubarak, has been in power since 1981. One person, one party in control over a country and its people for 3 decades! At the end of my History of Africa Since 1800 class last semester, I chose to do a presentation on Egypt. It's a fascinating country, and not because of our ideas of an Egypt of pyramids, King Tut, and Cleopatra. Egypt is an African country with tons of influence with its location at the Nile River delta, and the country's recent push for industrialization. Egypt of course has a hugely significant role in maintaining the stability of the Arab region. Egypt's intertwined political, geographical, and religious influences are evident in the country's recent developments: attacks against the Coptic Church; a plethora of modern youth pushing for the spread of modern ideas; and progress in the role of women in Egyptian society.
The seeds for the Egyptian's uprising were planted in the December 2010 elections. The opposing parties claimed fraud and rigging of the parliamentary elections by the government's ruling party. Anger ensued, and thus the ball was rolling.

Now, partly in response to politics in Tunisia, the Egyptian people have decided it's time to get Mubarak out of power. All eyes should be on Egypt. This is a long time coming, and the stability of Egypt threatens the stability of African and Arab nations. And the outcome of this uprising may give us some insight into the future of democracy in Egypt. Check out the BBC's news coverage in Egypt. I particularly like the photo seen below. The West might think feminism is dead in Egypt, but this picture certainly shows an Egyptian woman with power!
Update: I apologize for my long silence in between posts. It seems I'm still adjusting to my new schedule. Now that I'm settled in with clinicals, everything should balance out soon enough. Thanks for your patience! Look for more posts this weekend!

Random Links to Check Out

1. I have another professor that's a fan of concept maps [For more info-See this post]. My prof recommended this site today. You can actually create your own concept map online. The site is basic & easy to use. Another plus is that you end up with a neat, colorful map that's easy to read. This site would be great for creating concept maps to put up in your room, office, or workplace as a visual reference and informational guide.

2. Yet again, Invisible Children has led me to an interesting site. IfItWereMyHome.com allows you to compare what your life in the United States would be like if you had been born in another country. And it's not just developing countries. Canada happens to be the featured country of the week. I'm pretty Irish, so what if I were born in Ireland? Turns out I would have a greater chance for being unemployed and make less money, but I would have more free time and even live just a little bit (0.17 years) longer!

American Stalemate

Saturday was the 38th anniversary of the United States Supreme Court decision in the case Roe v. Wade. Tomorrow is the annual March for Life in Washington, D.C. where anti-abortion/pro-life activists will march to the Capitol building for their cause. I thought it was fitting that I discuss it, especially since abortion has been addressed quite a bit in the media recently [in particular with health care reform].

Abortion is one of those controversial issues that make most people vaguely uncomfortable and, in many debates, very angry. Consequently, it's difficult for something to actually being done regarding the issues surrounding abortion. Currently, neither side wants to admit that there's a stalemate.

Think about it: The media will occasionally cover a story on abortion, and the extremists on both sides of the abortion debate are cited. Each side vilifies the other, and spends the majority of their energy trying to dismantle the primary opposing claims to their stance. As far as the middle ground goes, the majority of people stand wherever is the easiest, appeasing both sides, in line enough with their philosophy about life.

I would merely like to bring to attention two major consequences of this stalemate:

1. Women are suffering at the expense of this debate. Roe v. Wade was, in fact, decided on the role of women in society. Now the reasons why women seek abortion are overlooked, and instead the opposing sides of the abortion debate rage on in their accusations against each other. In the midst of this stalemate, women are not being fully supported before and after pregnancy. For example: 38.5% of single mothers are in poverty (2009 Census data), which is a percentage that is steadily increasing. Both sides agree that there is a need, as President Obama said in his 2007 presidential campaign, "...to prevent the kinds of situations that lead to women having to struggle with these difficult decisions and we should be supportive of those efforts." Each person can interpret this statement differently, but the point is that abortion is not a sign of women being supported. In fact, it's quite the opposite. Whatever your views are, supporting women before and after pregnancy is not out of the question.

2. The driving force behind this stalemate is ignorance. People quickly form opinions on abortion from the media, their religion, their friends, their family, their age group, etc. There are not many people who actually have informed opinions on abortion. The debate has been raging on for 38 years after Roe v. Wade. Almost two decades of passionate debates has led us further and further away from the truth. My advice is to steer away from mainstream media. Figure out your reasons for your opinion [religion, feminism...] and then find the most original, unbiased sources of those reasons [example-the pioneers of feminism, church documents, etc.]. Abortion is not something that you should be apathetic about, considering it's significance in politics has been unchanging for two decades now.


That's my brief commentary on the abortion stalemate. It shouldn't have made you too uncomfortable or angry. Before the two decade mark of Roe v. Wade, educate yourself on what to do about the two major consequences of the stalemate. If you aren't from the U.S., your country probably has the exact same, if not similar, stalemate so this applies to you too!

Syringes and HIV

This innovative idea is important. Marc Koska has drawn attention to the re-use of syringes by health care workers, which is not always addressed when it comes to the spread of HIV. It's not necessarily an effective or fool-proof idea, especially when the syringes are used by intelligent individuals like nurses. In Uganda, we used these syringes sometimes. And we were promptly taught how to get around the built in safety mechanism. The nurses had a system to get around it, which was typically used in a safe way. For example, if you had a child who had regular oral electrolyte supplements through an NG tube. The large syringes used for this were in short supply, and also happened to lock after you pushed it all the way through. The stomach is not sterile, though, so the syringe was re-used-only for that child. We re-used a syringe for drawing up Quinine for malaria treatment. The syringe was used throughout the day, but never actually in contact with a patient's IV. The medication was injected directly into a sterile bottle of D5 (we used D5 with Quinine to prevent hypoglycemia). One thing that never occurred was actually injecting different people-be it subcutaneous or intramuscular-with the same syringe. [This is one of the problems Marc Koska addresses.]

Along with the new syringes, it is necessary to implement measures to increase awareness in the areas at risk for the re-use of syringes. Education among staff at clinics has the potential to make a tremendous impact. Programs that ensure proper disposal and clean up of the used syringes could go a long way. Most importantly, consideration of the context in which the re-use of syringes in clinics is essential. To an outsider, it probably seems disgusting and irresponsible that nurses could possibly do this. What if you had to treat fifty patients with the supplies shown in the picture to the right? Clearly this is not a black and white matter. With anything in nursing, there has to be a multifaceted approach to any problem. Nurses do more than give a medication for a simple solution. You assess, intervene, analyze, evaluate, and teach.

I'm not sure if this problem exists in Western hospitals and clinics....any experiences of problems with syringes in these settings would be appreciated. It could be more of a problem with wasting syringes in Western health care. I have had nurses open a syringe packet simply to demonstrate something then dispose of it without putting the (sterile) syringe to use. I'm not implying that nurses look to re-use syringes. I did not approve of-and felt uncomfortable with-some of the times the nurses in Uganda re-used syringes. [I simply did not participate in medication administration that I thought was unsafe.]

Nurses and health care workers need to be aware of their potential role in spreading HIV when re-using syringes. Nurses everywhere have to realize the importance of syringe use to the situation in which they are working. And as for Marc Koska-he does do more than just distribute syringes! Check out Marc's non-profit: Safepoint. He has even done projects in Uganda!

Music Wednesday: South African Music

It's halfway through the week, and most of us are getting tired. So I figure Wednesday is a good day for some uplifting music. Besides, relaxation can help us become more innovative thinkers! If you enjoy this Music Wednesday, I would be more than happy to make this a blogging tradition of mine.

Moving on...

I am more than a little biased when it comes to the video above featuring Vusi Mahlasela performing with Dave Matthews Band [DMB/Dave]. My family and I have been listening to a version of DMB's Everyday with Vusi for probably a couple years now [it's one of my dad's favorites]. Not to mention I have been to 7 Dave concerts, and I currently have 607 Dave songs in iTunes. [In case you were wondering, my love for DMB stems from my older brother and cousin.] Even if you hate DMB, watch the video. Vusi is entertaining up until the last second of the song. The dancing really steps up after about 5:15 in the video, so you can always skip to that.

Vusi is a native South African just like Dave Matthews who is from Johannesburg. The "About Vusi" part of his website begins by saying, "Vusi Mahlasela, is simply known as 'The Voice' in his home-country, South Africa, celebrated for his distinct, powerful voice and his poetic, optimistic lyrics. His songs of hope connect Apartheid-scarred South Africa with its promise for a better future." If you do not know about the violent racism of apartheid in South Africa, you need to. The disturbing part of this product of colonialism is that it was not dismantled until 1993, and its effects are still evident today. I learned about the destruction of the apartheid in South Africa in my History of Africa Since 1800 class last semester. In his book The African Experience: An Intoduction, Vincent B. Khapoya says, "It was the place where the humiliation and the degradation of African people has been articulated as an ideology, codified into law and institutionalized as the system of apartheid." For an easy, short read about the effects of apartheid in S.Africa, I recommend Peter Abrahams' novel Mine Boy,which is a novel that exposes the conditions that blacks in S.Africa endured through the story of a young mine worker.

As an activist for his fellow Africans, Vusi is lucky to have survived and thrived after apartheid. His work and music is very significant in that context. Besides, he is a hilarious dancer and excellent singer. Here are a couple more Vusi videos (without DMB):

Live at the S.Africa World Cup last summer

Live at a TED Global Conference

Enjoy trying to learn Vusi's dance moves!

Community Health Nursing Surprises

My first clinical rotation for the semester is community health. Today was one of our two orientation days, and we spent the day visiting a few of the different sites we can choose from. I have been pretty negative about this semester's clinicals, thinking that this "just isn't my thing." Today really surprised me though. Eventually, when that inevitable burnout comes, I could see myself working in some kind of community health nursing role. I have been able to establish a couple friendships with my clients in home health, and today I could see how that allowed me to be more open to the sites. I also found myself getting excited as I identified the many similarities the services provided had to my experiences in Uganda. Although the context and intensity of the settings are drastically different, the principles for community health are the exact same. Immunizations, poverty, preventative health, communicable diseases, prenatal care, and on and on....nurses in both the United States and Uganda can have a tremendous impact in these areas.

Another surprising part was the public health nurses' positive and welcoming attitudes at all of the sites-my professors included in that. They really are excited about the work they are doing, and their compassion for their clients was very evident. They face challenging situations, and yet they expressed hope for the future of health care. The director at one of the sites mentioned this video from Healthiest Nation. It's a short and basic video, but it causes you to shift your focus away from the more expensive side of nursing that occurs in hospitals. Our life expectancy in the United States is actually decreasing for the first time in years due to health problems like obesity, hypertension, diabetes-all of which are highly preventable with public health.
I thought this course and clinical would not help me develop skills useful in a hospital setting. However, today helped me realize that I can take part in public health by educating the patients while they are in the hospital. It's the perfect opportunity to assess and intervene to help a person's social, financial, environmental and psychological health.

As the nurses we met today pointed out-it's up to my generation of nurses to change the focus to the health of the community. For now, I'm just relieved that I can actually look forward to learning something useful this semester.

Powerpoint and Critical Thinking

Update: In addition to the reading and assignments I received today [my last first day of class ever], I am going to take on some new books. The first is Lipstick in Afghanistan and the second is The Designful Company: How to create a culture of nonstop innovation. The latter I discovered from this post on the blog Nursetopia, which is concise, informative, and a great nursing blog to follow.
Today one of my professors referred to an article from The New York Times that discussed the effectiveness, or lack therof, of powerpoint presentations when she was discussing her teaching methods for the course. I think I found the article she was referring to, and it's entitled "We Have Met the Enemy and He Is Powerpoint." It's an interesting commentary of the overwhelming use of powerpoint in the Army to explain extremely complex situations. There's no need for uproar about war strategy here-our purpose is only to evaluate the significance of the article's claims for nursing. The article states, "Commanders say that behind all the PowerPoint jokes are serious concerns that the program stifles discussion, critical thinking and thoughtful decision-making." I think it's fair to say that nursing education addresses complex issues, and powerpoint is commonly used to explain these complexities. I can't tell you how many trees I have killed printing off pages and pages of powerpoints for my nursing lectures. I have relied heavily on them in every nursing class. Outside the classroom, I have encountered powerpoint at a continuing education critical care conference organized by a local hospital. Every physician, surgeon and nurse presenting at the conference used a powerpoint presentation. I do understand the necessity for powerpoint in nursing. The issues are so complex and can often be easily broken down into simple categories such as assessment, diagnostics, treatment. The simplicity of a powerpoint presentation can be much easier to understand than dense textbooks or research articles.

So it may be necessary sometimes, but is powerpoint an effective teaching method? I am typically an A/A- student, but I have all too often studied hours and hours for nursing exams and not done well on them. What did I use to study in these instances? Powerpoint. Finally this academic year, I have cut down on study time and improved my test taking skills by using concept maps. With med-surg and oncology clinicals junior year, we had to complete concept maps as a part of our clinical paperwork. I had excellent professors that were difficult graders on these, but now that I look back their feedback and teaching with the concept maps helped develop my critical thinking skills. The outline we used junior year was basic, and already designed by our professors. It required you to fill in the primary diagnosis, assessments that are necessary for that diagnosis, and the previous medical history. Then you had to fill out four boxes with a nursing diagnosis, priority of that diagnosis, and the specific assessment data from the patient. This method was often effective in learning how to break down and prioritize assessments and interventions for patients with multiple diagnoses.

My professors last semester taught us how to use concept maps in a more complex way for learning lecture and clinical material. The lecture was advanced med-surg, so the content was very complex. We used concept maps mostly when reviewing for exams. This allowed my peers and me to interconnect topics-both recent and older course content. Concept maps forced me to critically think about the lecture content. In contrast, powerpoint often led to me dozing off, even in spite of excellent professors and very interesting content (ARDS, MI, trauma, etc.). The pictures are of a couple of my own concept maps from studying last semester. Please keep in mind these were probably done between 2 and 3 in the morning....

A literature review-on the significance of concept mapping- entitled "Concept mapping: an effective, active teaching-learning method" was published in Nursing Education Perspectives in 2006. Clayton concludes, "Despite the limitations in these studies, it seems apparent that concept mapping has the potential to be an effective teaching strategy in nursing education." Hopefully more studies on the effectiveness of concept maps in nursing education will be completed in the near future. Until then, I challenge you to fight against the dullness of powerpoint. Critical thinking is essential to excellence in nursing, so for your next continuing education hours or nursing class, go beyond bullet points on a powerpoint slide.

Action on AONC, Snow, and Sudan

Remember when I said I was the queen of sleep deprivation? Many times, that is related to the reality that I am also the queen of procrastination. My family claims it's a "Maguire" trait, with my brother winning the ultimate procrastinator award by a landslide. That's one of the reasons why The Art of Non-Conformity was very appropriate and useful for me. In addition to transforming your views, AONC has the purpose of inspiring action. Of course throughout the book I was constantly envisioning my goals and projects I could start working on. However, I think it's best for my procrastination if I focus on daily action towards my goals. [Especially with the onset of senioritis and the threat of the mentality that claims "It's senior year, live it up!"] To ensure that you are productive, the author Chris Guillebeau states, "Create a continual metric for your most important work."

Tomorrow I head back to school-hoping I make it through the snow and hoping I can find the entrance to buildings in the 40 inches of snow. I have to evaluate how I am going to spend my time in my very last semester. My classes-finally all nursing-consist of the following: Community Health Nursing, Psychiatric Nursing, Nursing Research, and a self-designed Independent Study [includes clinical on an intermediate care unit & working one-on-one with one of my favorite professors]. In addition to classes, I am the president of a club, designated secretary of another club, peer mentor to first year nursing students, peer minister in campus ministry, and somewhat of an athlete [I'm technically done with my season, but there's still the pressure of staying in shape]. Not to mention it's my last few months living within a ten minute walk of the majority of my closest friends. So here's my "continual metric for [my] most important work":
1. Have two people review my resume each week. [My brother worked in a career office for 3 or 4 years- he had about 200 people review his resume.]
2. Read for a half hour each day [does not include reading for class].
3. Do 30 NCLEX questions each day.
4. Review ten medication flashcards each day.

I figured that's easy enough-give up some Facebook, have an extra cup of coffee to skip a nap...

Lastly, I have been trying to keep updated on the voting process in Sudan. The Sudanese are voting on a monumental referendum that would declare Northern and Southern Sudan separate countries. There has been strong support for passing the referendum, but there are major concerns over the potential for extremely violent backlash. The United States media has failed to bring attention to the voting in Sudan this week. For international news, I have found BBC news to be very informative. Check out BBC's special report page on the Sudan referendum to read more on the referendum. Here are two short videos that offer some information and perspective:

My Impressions: Art of Non-Conformity

I have some good news--in the 24 hours between Wednesday and Thursday nights, I was very productive. I worked 16 hours and managed to finish two books! While it's fresh in my mind, I want to share my impressions of Chris Guillebeau's book The Art of Non-Conformity. I have briefly mentioned this book in my previous posts Reading Suggestions and Reasons Why. My parents, caught up on the word "conformity," claimed that I didn't have any problems with questioning the norms. However, the author's intentions are far from my parent's initial impressions about rebelling against what most people enjoy or like. Instead, this book challenges your approach to your career and life goals in an enriching and inspiring method. Chris verifies this in the first sentence of the book by stating, "The purpose of this book is to transform your thinking about life and work."

Chris is believable and compelling because he has successfully lived out his book since his 20's. Countless authors make claims and suggestions in their writing, but fail to actually apply them to their own life. Christ provides you with examples from his own life for each major principle, and concurrently he encourages you to individualize the process for your interests and goals.

To benefit from the ideas presented in his book, Chris says the following: "You must be open to new ideas. You must be dissatisfied with the status quo. You must be willing to take personal responsibility. You must be willing to work hard." If you meet those, then he challenges you to fully evaluate what you want most out of life. The way he does this abruptly made me realize that I had never fully determined what I did want out of life or my true life goals. It got me thinking, "What I am I actually working towards?" [One of Chris's life goals happens to be traveling to every country in the world by the time he is 35. Currently he is at 149/192-you can track his progress here.]

Chris maintains that most people don't live to retire, but rather they live to work. For many, work gives them purpose, meaning, and even happiness. However, valuable time is wasted on pointless work. Therefore the goal is to continuously be focused on doing "great work" and eliminating all of the things wasting your time (meetings & emails are included in this).

Chris intertwines multiple steps and parts to the process of dedicating your life to great work, so I will leave that to your reading. I have given you the idea behind the book. Now I want to answer a couple questions on my impressions.

1. What are my criticisms of the book?
Chris states, "As a part of the experience of being alive, I believe we're looking to find our place in the world. On a planet of seven billion people, where do we fit in? This is essentially the central question of life..." I definitely am critical of that statement and many more he makes throughout the book along these lines. At the end of the book, Chris dedicates an entire chapter to our need to leave a legacy behind. Although your legacy and finding where you fit in the world are important, I do not believe these are our motivations in life. Our human nature causes us to have an eternal desire to be satisfied in something more, something greater. I believe this is our desire to seek fulfillment in God, and these desires are only fully and truly satisfied in Him. As Saint Augustine wrote, "You have made us for yourself, O Lord, and our heart is restless until it rests in you." We seek love, joy, peace, happiness-which are all manifested in Christ.

2. What does this book mean to nursing?
The practice of nursing is often guided by the safe way of doing things. Safe, in this case, meaning "the way we have always done things." Evidence-based practices in nursing, prime examples of innovative approaches to patient care, interrupt the monotonous ways of going about your day. Stepping out of the safety zone and actually focusing on great work can add a lot to improving the quality of nursing care. Rushing through patient assessments and encounters may seem necessary with the fast-paced environments on hospital units, but does that really achieve great nursing?

Nursing is on a fence right now. With the struggling economy and potential for system overload with the new health care reform, nursing can easily spiral downward. It's obvious that nursing dissatisfaction is rapidly rising with these tensions. If nurses take charge and challenge the old way of doing things, nursing has the potential to pull through strongly. Is the current way of doing things sustainable? Do you really think that your day is filled with great work? Instead of wishing that the circumstances of your job were different or better, take action on your ideas.

Continuing to consider the implications of the ideas of The Art of Non-Conformity, here are two quotes to reflect on this quote that you can find in Chris's book:

"I don't understand why people are frightened of new ideas.
I'm frightened of the old ones."
- John Cage

"The gap between ignorance and knowledge is
much less than the gap between knowledge and action."
-Annonymous

Sleep Deprived

I am the queen of sleep deprivation.

I have worked the 12-hr night shift in home health many times. Last semester I worked several 12-hr night shifts for my clinical last semester, and I will do the same this spring. I loved the night shift....until I couldn't fall asleep until 5 am after I finished them.

The problem is that I thrive in the night hours. Before tests and papers, I can be found up until 3 or 4 in the morning. This has led to difficulty staying awake in class, illness, and burnout. [See picture on right-reenactment of me sleeping in my classes in Rome.] Just last night I found myself up until 3:30 am, just by reading and brainstorming. This is a bad habit that I need to break. I am keenly aware of my sleep deprivation's negative effects on my productivity and ability to make the most of my days.

I realize I need to work on improving my sleep patterns and preventing sleep deprivation before I become a registered nurse and it takes on the potential of causing errors and harming my patients. Sleep is not a joking matter when it comes to our career, health, and overall happiness. But sometimes it takes some humor about sleep to get us to pay attention...Watch this video for a humorous feminist perspective on sleep and then think about how not getting enough sleep has affected you!

Certainty in Hope

"Together with evaluation, diagnosis,

prognosis and treatment of a disease
we need to know its meaning" (1).
- Elvira Parravicini, MD

As a college freshman in 2007, I received endless positive feedback about my decision to be an intended nursing major. As I enter my last semester, I have been hesitant to fully embrace my career option. Class discussions last semester among other senior nursing students revealed that many of my peers feel the same way. Nursing students observe the toll of stress on nurses, and hear them voice their complaints. I distinctively remember a nurse telling me-during a clinical observation of a nurse supervisor-to "turn back now." I refuse to accept a hopeless view before I even begin to practice nursing. So I ask: Is there any approach that will preserve the meaning in nurses' work?

Spring 2009, I was led to the writings of Father Luigi Giussani (1922-2005) and Communion Liberation (CL), a Catholic lay movement. Giussani challenged youth to judge and engage the reality around them with a Christian approach. The CL university students I met-through a CL vacation in the beautiful Lake Tahoe in the summer of 2009-grappled with the realities presented to them in a wide span of majors, anything from astronomy to history. I questioned how I could apply Giussani's often dense and philosophical approach to a field that often leaves no toleration or room for the continuity of faith and reason. I soon learned of an annual CL MedConference for doctors and nurses. The 2009 MedConference was a response to a "growing dissatisfaction among health care professionals" (2). The theme of the conference was "Medical care and the person: the heart of the matter." After browsing the conference's transcripts, found on the conference's website, I have focused on the keynote address by Giancarlo Cesana, MD entitled "Hope and Care."

Cesana went back to the beginning of Western medicine in order to conclude that "...medical care was born out of a positive and meaningful approach, which finds its consecration in the Christian conception" (3). He challenged health care professionals to unite in friendship, acknowledging the fact that our knowledge and charity is not viable alone. Cesana stated, "Medicine calls us to rebuild humanity from the great limit, represented by disease and from others, more subtle, such as our limits in intelligence and morality" (3).

This approach requires the recognition that the discoveries of science and medicine originate from our desires for something greater-for truth, love, friendship. As Cesana pointed out, "The truth is that science is not enough" (3). Science cannot satisfy a patient's human needs when confronted with an illness. The patient has a need to restore their dignity in the meaning of their life amidst the serious limitations of illness. We have to go beyond mere medicine & technology to truly fulfill our roles as nurses.

The following excerpt from Cesana's keynote address challenged my way of thinking. Studying at a liberal arts college and my clinical experiences have allowed me to remain in the perspective he initially introduces.
"It is commonly thought that doctors perform better if they learn different viewpoints of different cultures and if they are introduced to the awareness of their mistakes and even to a systematic doubt on what they have been taught. This is abstract and absolutely insufficient...doubt never helps to advance, and to deal properly with dramatic situations. Only certainty, documented by experience, helps; an open certainty, sure of the positive meaning of life, is not afraid of suffering, is able to recognize the unforeseen and the diversity"(3).

Nurses must protect their certainty in the hope that their practice can give to patients. There are nurses who are witnesses to this certainty. Surely you have worked with or know a nurse that is hopeful and positive, caring for a patients in a relational manner. The nurses that I worked alongside in Uganda this past summer are my witnesses that I want to follow. They face obstacles every day-not enough staff, large numbers of patients, lack of essential supplies, and heartbreaking loss of patients. One night at the clinic, the two other nursing students and I were present when a 7 month old beautiful girl named Moreen passed away from complications of malaria. We had helped care for the child, and the wailing of the mother was devastating to hear. The two nurses that night caught me off guard with their hope and
calmness. They were comforting us, and merely asked us to pray that God helped them through the night. These nurses were able to continue on with hope and love for their patients with the same approach that Giusanni and Cesana challenge us with.

Being able to link my experiences in CL and Uganda is part of my process of establishing my own certainty. Certain of the hope nursing can offer, I will be able to withstand the stress and limitations that inhibit health care providers.

(1) Parravicini, Elvira. "How do we take care of others? A proposal." MedConference 2009. June 12-14 2009. http://medicalconference.us/2009/.
(2) "About the MedConference." http://medicalconference.us/2009/
(3) Cesana, Giancarlo. "Hope and Care." MedConference 2009. June 12-14 2009. http://medicalconference.us/2009/.

Cure your Monday Blues

Have you heard of Invisible Children? It was started when a few college students traveled to Africa, and ended up discovering a horrible tragedy inflicted by the Lord's Resistance Army (LRA) in Northern Uganda. The LRA has since left Uganda, but now they have moved to the Democratic Republic of Congo and Sudan. The organization focuses on using media- like this video-to advance their cause. It's definitely worth checking out, and a movement worth participating in. The actual and real needs and wants of the African people are being met, which is an element often missing from many efforts to help Africa.

Anyways...the most recent updates on the Invisible Children website included a post about a humorous website called 1000 Awesome Things. The site has a description for each item on the lengthy list. Anyone can identify with at least one, if not all, of these awesome things. The author and inventive person behind all of this even published a book entitled The Book of Awesome. Here's a video with the author telling the story behind his creation:


So you stressed out and over-worked nurses and nursing students.....get excited because you get to experience something awesome all the time!!

#380 out of 1000: Hearing someone's heartbeat
Of course, the author describes the sentimental setting when you are lying next to your special someone and able to hear their heart beating. But nurses get to hear the clearest (hopefully not muffled!) heart sounds. Go back to your first days as a nursing student when you proudly took out your shiny stethoscope and showed your friends and parents how you could find their apical pulse. The next time you assess a patient, take just a few extra seconds and take in this phenomenal-and awesome-part of your day.

Reading Suggestions?

Since my Saturday will be filled with preparation for the Colts game tonight, I will have to keep this post short today...

Currently I am reading The Art of Non-Conformity and It's Our Turn to Eat: The Story of a Kenyan Whistle-Blower. I want to start searching for some non-fiction nursing books. It could be anything from research to personal stories to political discussions.

For my next reading endeavor, I have found Lipstick in Afghanistan. It seems like a compelling account of a nurse's work in war torn areas. It's easy to find books like this from physicians, but not as common for nurse's stories. Considering I can get it for under $20 and it's not available at my local library, I am going to go ahead and order it.


Does anyone have suggestions on must read books just for nurses???
Or do you have any books on your reading list that you haven't gotten to yet?

Now I'm back to helping my mom make chili....Go Colts!

Influence of Experience Abroad

"A journey is a person in itself; no two are alike.
And all plans, safeguards, policing, and coercion are fruitless.
We find that after years of struggle that we do not take a trip; a trip takes us. "
- John Steinbeck

I have been extremely fortunate to be able to travel and study abroad during my education. Since I am only in my first week of this blog, I want to introduce this part of my background since my experiences abroad will greatly influence this blog.

Fall 2008 I spent a semester in Rome, Italy. I had never been out of the country before heading over to Rome. In fact, I never planned or even wanted to study abroad at first. With some pushing from my dad, I applied to the Rome program simply to stop him from bugging me more. The idea grew on me, and it was one of the best decisions of my life. All of my courses in Rome were in the arts-Italian, philosophy, art history, moral theology. My world view was challenged, examined, and expanded. Needless to say, these few months changed the direction of my education and my approach to learning. It continues to be a part of my thinking and reflection. Previous to the trip I thought seeing Europe would appease the adventurer in me. But I kept my bags close by after I got home just in case...

Summer 2010 I spent 7 weeks in Kyarusozi, Uganda-a very small trading center in Western Uganda. The program through my school was open to 6 students that included 3 nursing students and 3 education students that were uprising seniors. I was part of only the 2nd group ever to participate in this program. Of course, I wasn't so sure I even wanted to apply for this opportunity either considering I had never been on a major service trip or to a developing country. God intervened through a cross country team member (more on that later on in my blogging) and upperclassman nursing student (now a NICU RN) who went with the first group. She encouraged me and insisted I could do it. For 6 weeks we worked alongside staff at a clinic that was described as "deep in the bush," or in a very rural area. We saw a wide range of patients in the clinic's outpatient services, community outreaches, female ward, male ward, pediatric ward, maternity ward, and labor & delivery.

It took me months to see the impact my semester in Rome had on my life so I know that I'm applying what I learned in Uganda to my development as a nurse even more than what I'm aware of already. I want to be acutely attentive to the way these experiences have and are continuing to influence my approach to nursing.

I want to weave my insights and reflections from past experiences in Rome, Uganda, or just another clinical day in Indiana into my life as a nurse. I want to help give you the resources to take charge and apply the ideas you generate from your own experiences.

Are you an empowered nurse?

Last semester I completed my Nursing Leadership course. For one of our assignments, we developed a topic from our clinical hours observing nurses in management positions. Based on discussions during my experiences in this clinical time, I decided to address nursing satisfaction, or rather lack therof. With student access, I was able to utilize the nursing academic database CINAHL. Recently we have heard a lot about union strikes and media attention about nurse staffing ratios. I made the assumption that hospitals cutting back on staffing to save money primarily contributed to the current prevalence of dissatisfaction among nurses. I fumbled through brainstorming to narrow down my topic until I came across a common theme throughout studies done on nurse satisfaction. To avoid wasting time with useless searching online or in databases, use Purdue University's Online Writing Lab (OWL). I always have their site open when I am researching or writing any MLA or APA paper.

Moving on...my research led me to the numerous studies on nurse empowerment. Many of the studies measured the success of empowerment strategies with indicators of nurse satisfaction and innovative thinking.

I focused on two major studies for my literature review. Each one approached their thesis from a different angle:

• Focus #1: Management’s role in determining levels of nurse empowerment through the evaluation of job satisfaction and organizational commitment in relation to the originating factors of structural empowerment, interactional justice, trust, and respect. When evaluating the components of an empowered nurse, this study assigns significant implications to communication and interaction with management. Citation found here.
  
• Focus #2: Connecting the context of the structural environment to psychologically empowering elements, and furthermore linking this connection to positive effect on innovative behavior in nurses. The psychological dimension implicates the necessity for an ongoing interaction between structural forces of management, professional organizations, and other nursing structures with the nurse as an individual self-determinant over his or her practice. Abstract found here.

Here's a summary of some potential resolutions based on a small selection of studies:

• Nurses and management should collaborate to implement practices that correspond with recommendations made by professional nursing organizations. Example: AACN Standards for Establishing and Sustaining Healthy Work Environments that includes skilled communication, true collaboration, effective decision making, appropriate staffing, meaningful recognition, and authentic leadership.
  
• Nurses given informal power and impact by recognizing the meaning of their work in a shared governance model. Based on a strategy implemented for critical care units at the Miriam Hospital in Providence, RI. Citation found here.
  
• Other studies include an empowering nurse advancement system and promoting certification on critical care units. Find the Abstract of study on certification and advancement system with AACN standards citation.
  

Here is an excerpt from my conclusions after some evaluation of major studies on nurse empowerment:

Even in seemingly desperate times in healthcare, hospitals can implement programs that recognize the crucial role nurses have in determining the quality of patient care. Hospitals that incorporate nurses into planning and communicate effectively with nursing staff create positive work environments. The uncertainty in healthcare is a major stressor on nurses-affecting communication, commitment to the hospital, and a number of other factors that all in turn affect the quality of patient care.

Hospitals' increased attention and drive toward achieving Magnet status is a positive move for empowering nurses. Even among bloggers you can see hospitals attempting to achieve increased trust and open communication among management and employees. Paul Levy, the president and CEO of Boston's Beth Israel Deaconess Medical Center, has a blog about his experiences in this position called "Running a hospital." He has links to other "CEO Bloggers" if you scroll down along the sidebar.

For now, I am going to keep empowering strategies in the back of mind so I can look out for those in future employers. I'm aware that nursing is not always pretty, and it's definitely challenging when it comes to long hours, short staff, charting, and a lot of patients. That's why I am going to search for an employer that can effectively empower me and my coworkers as intelligent, capable nurses.

Nurses--Do you feel the management at your place of employment empowers you as a nurse? Have any strategies been implemented to promote the empowerment of the institution's nurses (as a whole or specifically on your unit)? Do you have any experience with trying to promote these areas of empowerment?

Nursing students--Have you worked with nurses who you recognized as being empowered? Have you received advice from nurses on what to look for when searching for future employers?