Sunday, January 27, 2013

Remember The Time.....

By Chiqui Raveloski

Picking up the #lastprintissue of Newsweek from the bookstore was a bittersweet moment. The magazine featured successful printed issues from the past 80 years which helped shape the society and the world as it is right now. Leafing through the glossy pages brought back so many memories. How life was then, compared to now. And I realized, life was not different, it is the same life. I just learned to adapt with time.

I can't help but let a feeling of nostalgia embrace me. Turning the pages of this iconic magazine brought me back to my earliest memory as a  5 year old - walking by the beach in the Philippines with my grandmother during sunrise. This memory, so many years ago, still bring calmness, stability, and security even now. I can still hear the seagulls, the waves, and salt water smell as I am writing about it right now. I can hear her saying "Mag-ingat ka, iha", "Take care, little one".

Those were also the words my grandmother told me before I left the Philippines for the USA many years ago.  The anticipation of being on the other side of the world brought this unexplainable feeling of eagerness and excitement of things to come.. I can still remember the whiff of US air when I first stepped outside of the airport  Back home in the Philippines, opening a box of gift from a family member in the US gives out this certain "stateside" smell. The scent of something better, something new. So, this hint in the air when I first came out of the airport made me realize, I had arrived.

Seeing his eyes for the first time reminded me of the blue waters in the Philippines. His blue eyes became my window to the beach my grandmother and I used to walk along every morning. I was home. I knew somehow there was a connection as he drew me in closer with his wit and funny jokes which made me laugh all the time. He became my best friend, my  husband and father to our wonderful daughter

The arrival of our daughter in the family 16 years ago is a memory that stands out from all the rest. Giving birth to our daughter was the most beautiful thing God had ever granted us. She is our miracle baby not only because she conquered 2 months of prematurity. She remains to be an instrumental key to letting me and my husband find out who we truly are and what we are capable of.  Because of that, we are solid as individuals and as a  family unit. Memories of her as a baby, the "baby smell", her giggles, crawling all over the apartment we lived in, with her knee pads on, her first baby steps, first day of kindergarten, middle school, and high school.....Oh time went by so quick.

My husband and my daughter were my support through nursing school. Everyone knows how demanding nursing school can be. My husband helped me through all the tough times and celebrated all the fantastic times.  My daughter respected my study time. In between the chaos, she even helped me organized my study materials and looked for missing folders when I cannot seem to find them. When I went back for my RN-BSN program, she even helped me understand statistics. I remembered her saying, "Oh Mom, this is 8th grade math!",,,,, What?

My first day as a full fledged floor nurse was overwhelming. I almost headed back home when the nagging feeling of apprehension for the unknown combined with the enthusiasm of making a difference took over me. But, armed with the nursing process, stethoscope, bandage scissors, calculator, to name a few, each day brought unique experiences. These experiences revealed strengths to nurture and improve upon. 

As I write this blog, my emotions went through several directions. The nostalgia I felt in the beginning, still tugging at my heart strings. Yet, the reality is I cannot hover around how my life used to be. It is how I went through each and every prominent milestone  which made the person I am right now. My hope is that each day. my mind and heart stay open for all the lessons waiting to be learned.

Sunday, January 20, 2013

Third Shift Blues

By Chiqui Raveloski

Another hectic night on the telemetry floor. The usual patient load with many different attitudes to deal with. But, trying to be good tonight....I made my own attitude adjustment.  "Bahala Na", "May God be with us all".

Older adults have special powers. Growing up in the Philippines, we were taught to "respetuhin mo ang mga matatanda", "Respect your elders". Did not really know why, You just did. They were put on a pedestal, a throne, a powerful agent of  wisdom.

When I came to America, things were different. I still hold the same values for the elders, but. society has a different way of portraying them. Remember the commercial, "I've fallen and I can't get up !"? It was and still a humorized catchphrase due to bad acting. They are acting alright. Because older adults are capable of so much more than meets the eye.

When they say "Do not judge a book by its cover", they know what they're talking about. I'm sure fellow nurses out there, you probably had experienced what I am about to tell you.

Two of my patients that night were an 82 yo female, we will refer to as ET, with altered mental status, frail, refused to take medications. Another is an 83 yo female, we will refer to as "Mammi", weak, sweet, who likes to get out of bed to wander around.

ET was placed in a room nearest to the nurse's station during the day shift. She had been "off the wall", no regards for her safety, pulling lines, screaming , you get the picture.  She was placed on a very close watch. ET's family also paid her a visit and helped watch her. Day nurse said that the family approached her several times to see if ET can be off the IV fluids because she constantly tried to pull the line. Day nurse finally wrapped the IV site with soft gauze and placed mittens on both her hands.

ET's family left at the start of my shift. I checked on her often and  I can see her moving around the bed. Well, she wore me out. ET did not go to sleep. At around 4 am, "gut feeling" told me to check on her again and this time, I saw her biting off her mitten. ..What?!....pulling and tugging trying to free herself. And for what mighty powers she had, she was able to free one hand , pulled her briefs off and I caught it just in time before she can pull out her IV.

I summoned for help so we can get her situated. Got her out of bed to change the bed sheets quickly. My bad.....ET's energy caught me off guard that I almost landed on my face on her dirty bed. She was pushing, pulling, every which way she can . She was so wired up, nothing can stop her.

Finally calmed her down, and I heard a bed alarm, thinking to myself, Oh no not Mammi, Oh yes it was! When I got to her room, Mammi managed to walk to the bedside chair with her heel boots on!.....Can you imagine walking with those boots on? How?!..., sat on the chair, with her briefs off,  thinking she was in the commode... Really?.... Cleaned her up, got her safely back to bed, turned the bed alarm on, side rails up x4.
I'm worn out!!!

Excuse me, bathroom break.

OK I'm back So funny.
I was using the bathroom, and out of the corner of my eye I saw

this cat        

staring at me. Really?! My daughter's cat Mozart.

Hospital is a threatening environment for patients. Yet,  these ladies proved that no matter where and how, older adults have determination you do not underestimate. However, determination can sometimes go a little too far and safety becomes compromised.

As nurses, we respect the role of autonomy in older adults, maintaining their independence. At the same time, we are aware that a part of the normal aging process may present someone as incompetent.  In situations like these, safety becomes  the priority of care. A balancing act between autonomy and protection for someones’s well-being demands ongoing nursing assessments and interventions. Hoping...... desirable outcomes provide meeting physiological needs, security and self actualization.

Young at heart.

Tuesday, January 15, 2013

Who Advocates For Nurses????

By Chiqui Raveloski

To all my fellow nurses out there, hope everything is well. It has been a very hectic week at work. I am sure you noticed the hospital patient census had been reaching its all time high nowadays. This goes the same for doctor's offices, clinics, and other healthcare settings. As s matter of fact, normal operations were in full steam during this past holiday season. It has not been the same as it used to be.

Another change we had seen is the influx of individuals, young and old, with increasing number, severity, and duration of chronic illnesses. Due to the recent recession, layoffs were rampant and more uninsured patients are entering the healthcare system very sick. They wait till the last minute to seek medical attention. These illnesses requires specialized plan of care. As a result, Emergency Rooms everywhere are crowded with patients requiring several levels of care. This increases patient volume in the ER resulting in long waiting period.

The plot continues to thicken when caring for patients are further dictated by managed care systems, government assistance, protocols, extensive amounts of documentations, and the list goes on. In the midst of it all, nurses being in the forefront are placed in a very critical position of safely managing and advocating for those in need. Yet, when it is all said and done, who advocates for nurses?

In the present culture of patient safety, nurses are constantly reminded of how quickly events can be turned against them. A perfect example is handling 6 -7 high acuity patients in a med surg / telemetry floor. Nurses continue to work under the umbrella of keeping patients safe through the 5 Rights, read back and verified, keeping up with vital signs, blood sugars, telemetry strips, input and output, etc. However, one slip and a rapid response could be in your way. And as nurses try even harder to keep patients free from harm, who watches out for nurses' safety? 

Nurses' and patients' safety are further compromised due to nursing shortage. For many years and counting,  "Nursing shortage" remains at the top of healthcare challenges. Perhaps we think it has been resolved. Yet, we see, hear and experience the dilemma over and over with no relief in sight. With the evolving healthcare reforms, many will be granted access to healthcare. The need for more nurses and healthcare professionals will remain an issue. Nurses are exhausted, working 12 hour shifts, with quick lunch breaks, if you are lucky. Can someone relieve us for a whole 30 minute lunch break? OK a bathroom break with no phone call, please!

Nurses should advocate for their fellow nurses. We need to stay together, remain together and rest together. Watching out for each other is the right thing to do. It invites the spirit of sisterhood/brotherhood, like family. When the spirit of family is present, a bond becomes strong, making the profession stronger than it has ever been. Watching out for each other can involve, looking out for a fellow nurse's patients during his/her lunch break, lending a hand during a complicated wound care, or helping with a new admission by simply placing a telemetry monitoring box on a patient.

The simplest of gestures can go a long way. It makes for a cohesive work area. This encourages nurses to make a "stick" to the floor while "sticking together" becomes a trending theme. Productivity increases, early burn out declines, and it becomes a safer environment for everyone. You know as well as everyone else, safety issues and medical errors are monitored very closely. This affects the overall reimbursement structure for healthcare settings. 

The hope is for nurses to start advocating not only for their patients but also for the profession itself. Some may choose to embark in managerial roles, standing up for the rest in front of the board room or congress. Nurses who choose to do this should have a very strong conviction to stand up and take a stance on what they believe in. But somehow, I feel like most nurses think this is a tall order. Why is that?

Nursing is an integration of knowledge, values, and concepts. The sole purpose is to form a meaningful relationship between mind, body, and spirit, forming self actualization. I truly believe that we  nurses  realize the importance of what we do. We take patients' safety first and ours last. Society will realize that  our actions are guided by our own knowledge, expertise, and professionalism. Actions speaks louder than words. 

The presence of "bayanihan" = "a spirit of communal unity or effort to achieve a particular objective" is important. Nurses have to be united in all things we believe is right.  And if we have to be in the background for now, that is OK. With patience, hard work and conviction, we will one day have a voice worthy of being heard. 

Saturday, January 5, 2013

Advocate For Your Patients

By Chiqui Raveloski

Nurses advocate for their patients. This is what nurses do. To advocate for a patient is a natural part of nursing care because it taps into our nurturing side. The need to take care of, "ipagtatangol" "stand up", and speak up for the ones who cannot becomes an ethical standard.

Advocating for patients can be challenging, particularly when conflicts arise between parties involved. Personal values and beliefs of the patient, family, physician and the nurse itself are at stake. Yet, nurses’ instinctual nature always points towards the direction of the patient .Sometimes, a nurse's personal value and beliefs might be put to the side to honor the patient's wishes.

In an ideal world, granting wishes does not take any effort. However, in today's complicated healthcare demands, protocols, and bureaucracy, advocating for a patient can be demanding. More often than not, patients are left lost inside a convoluted system. Being in the frontline, nurses are empowered to guide patients through the maze, put puzzle pieces together, in order to reach desirable outcomes.

Photo from:

Reaching a desirable outcome is an ultimate goal of nursing care. This is why, unknowingly, nurses probably do not even notice that they almost always advocate for their patients. From making sure the patient gets the right medication, performing a "time-out" during a procedure, making sure vital signs are within normal limits before discharging a patient home, are all acts of advocacy tailored to the safety and well being of each patient.

The role of a nurse as a patient advocate allows patients to move through the top of Maslow's hierarchy. In return, nurses find joy and contentment knowing that they made a difference in someone's life. When this happens, nurses find meaning to what and why they do what they chose to do. Nursing does not become a job. It becomes their life.