Wednesday, March 27, 2013

My Appreciation Of Life

By Chiqui Raveloski

Growing up as a type 1 diabetic was not fun at all. Growing up was challenging enough, and to have type 1 diabetes made it even tougher. There were periods of rebellion, denial, asking the "why me?", and even trying to pretend that I don't have the illness. Yet, reality can rear its head in the most unexpected moments, and you find yourself regretting the things you have done, wishing you could turn back the time and straighten up, so you can somehow prevent complications. 

I am not really sure how to say this, or how to blog about it. I'm not even sure I am ready. All I know, is that for whatever reason it may be, my attitude toward my diabetes changed 17 years ago... when reality kicked in. Since then, I am trying my best to enjoy life, see life, and experience life everyday I wake up. I see things different. I see myself different. I cannot foresee the future. But I can see the most important things in life.

My life changed, and I have to adapt to changes. What I really feel guilty about is that my husband and daughter have to adapt to the things and changes I have to go through. It's not fair for them. Sometimes, I feel like they were dragged into this situation when they do not need to be. Yet, I find strength and courage when they tell me everything is going to be matter what.

This courage gave me so much to live for. More than I can even imagine. I decided then to become a stay at home mom, watched our daughter grow, to become the most independent, confident, and smart 16 year old that I have ever met. I watched my husband stand by my side, through doctor's appointments, through nursing school, through the tough and fantastic times. And now as a nurse, I make it a point to do my best, to make a difference, to somehow give back for all the lessons I have learned.

The lessons I have learned made me appreciate more of the simple things I just let pass by. The beauty of the sunrise, spring, and flowers blooming - signifying new life, new hope, new dreams. The beauty of sunset, fall colors, and winter snow -  signifying there is tomorrow to wake up to, and that snow eventually melts giving way to spring all over again,. 

It all comes in a full circle. Reality brings us back to where we need to be. Even if it means that time might not be enough to see everything I want to see. I am thankful for the time I have right now. Hoping and praying to see more of how beautiful life can be.

I love yellow daisies !!!

Tuesday, March 26, 2013

Standing Up For What Is Right

By Chiqui Raveloski

“It is the Divine Order....Being fake is dead and truth is in bloom". Those were the words of a very good friend of mine said when we were having a discussion about being true to yourself and what you believe in. The world is full of uncertainties, and sometimes, you, as a nurse, find yourself lost in the sea of emotions and chaos.  And the only thing you can depend on is yourself to anchor you back to what is important.

Then I started thinking. What is the divine order? Growing up in a Catholic country of the Philippines, God is the answer to everything. And I began to search  for a meaning. And the divine order was summarized as 
" trusting God to give you discernment, to lead, guide, direct, protect, and give you wisdom". It is so much like the "Bahala Na" concept, an attitude / value, embedded in our culture .

With all this talk about the divine order and Bahala Na, I cannot help but think about the moments in my nursing career where I stood up and advocated for patients the best and honest way I can. Against what bureaucracy dictated me to do, there were situations where I had to look deeper within myself and focus on what is important - my personal and professional values as a nurse, for the sake of patients' care and safety.

Like the time, as an ER case manager, I advocated for a patient to be re-admitted back into the hospital 24 hours after discharge.. The patient was discharged with a $900 dollar prescription for blood thinner to treat PE's.The patient showed up back to the ER because the patient cannot afford the medication. Now, the discharging physician wanted the patient to get the AM dose of the medication in the ER and have me set up indigent prescription - Tricky.

 I spoke with the discharging physician and lead case manager and told them that this patient was unsafely discharged. What should have happened was for the patient to stay in the hospital, get the INR to a therapeutic level, then transition to a more affordable medication before discharge.

As an Emergency Room Case Manager, my main job is to screen admitted patients for medical necessity and appropriateness. It is more of the business and financial part of nursing where revenue is looked upon under a microscope. Sometimes, I am in the middle of the ER physicians and Hospitalists, in making the decision whether to admit patients or not. And in the present culture of patient safety, I always stand by the very same concept to achieve the outcome most desirable for my patients, and the values I swear to keep.

After much discussion, the patient was re-admitted back to the hospital. I was thankful for this outcome because my conscience will not let me rest if it went the other way around. 

In the physician's defense, the patient was discharged with the knowledge that the patient was to follow up with the hematologist to transition to a much affordable medication. Yet, I explained that the patient is self-pay and setting up indigent prescription in an ER setting is almost impossible. It was a weekend and the patient needs the medication right away and on a continuous basis. 

So, I guess, my friend is right. Let the divine order lead you, guide you, and protect you. It is a matter of staying true to yourself, against all odds. Standing up for what is right truly reveals pure honesty which in turn. shines truth to everything around you. 

As nurses, we are always torn in between management's demands, budget cuts. and patients' needs. Stand up for what you believe in. It can get tricky at times. But, " Malinis ang konsiyensiya mo"" . "knowing that your conscience is clear" and your heart in the right place, is letting your inner strength guide, direct, and protect you for the sake of humanity.

Wednesday, March 20, 2013

My New Nikon

By Chiqui Raveloski

I was never the writer. I took the pictures. Taking photographs has always made me felt adventurous, artistic, connected. I used to take plenty of pictures especially when our daughter was growing up. Capturing that special moment in a photograph gave me a sense that time had stopped and I just want to stay there.

But then, life happened and the camera was put to the side. The artistic endeavour was diverted into the art of nursing. Creativity took on a different side, while my mind and heart stayed connected to things I love.

As the signs of spring peeking everywhere, (here in my part of the South), I cannot help but think about new beginning, flowers blooming, and birds chirping. I also had a strong yearning to take photographs of this wonderful and constructive season. I had mentioned to my Hubby that I wanted a new camera and to my surprise, a box was waiting for me to open when I came home from work one evening.

Yes, it was the camera I have been wanting, sitting inside a gift wrapped box by the dining table. It is a Nikon Coolpix P510 . The camera has so many features. System overload. So, I decided to just take random pictures using easy settings for the meantime. Here’s a few of what I have taken so far.

What are you looking at?

Here I am in my Ninja mode!

Do you smell that ?

I'm "peeling" beautiful !

C'mon spring!

I work at that hospital.

Well, there you are ! I had fun doing this. I'm looking forward to learning more about the camera and posting more photographs in the near future.

 Until next time!

Monday, March 18, 2013

A Teachable Moment

By Chiqui Raveloski

Patient education is one of the most important aspects of nursing care. It builds patient's self-esteem, self-awareness, sense of responsibility, and effective coping mechanism. Furthermore, it reduces readmission rates in hospital, rise in healthcare costs and decreases mortality and morbidity across the lifespan.

Nurses have to assess patient's barriers, readiness, and knowledge level before they start the teaching process. Nurses include these in their care plans and have to evaluate outcomes continuously. Yet, sometimes we do come across situations where teaching becomes tricky. I believe it''s because patients become intimidated with the unfamiliarity of hospital environment and confusing medical jargons, In turn, it throws them off out of the norm, making the learning process tougher to deal with.

School was tough growing up for me. I was not your A student. I struggled through a lot, simply because I had a hard time understanding the materials. And as I got older and went back to nursing school, I found out in my own little ways a more effective way of learning the materials. One way is to relate a concept to an event or certain aspect in my life and I can somehow get clarity.

When I worked in the orthopedic floor, I had a 55 year old male patient who had a right total knee replacement. He was POD #2 and I noticed his frustration with the rehab process. I am big on pain management, so I made sure to medicate him for pain, on a regular basis. Toradol was my drug of choice. I started paying him more attention because he was struggling with the coping process.

Through therapeutic communication, I found out that he worked as a contractor. He loves what he does and he wants to go back to work right away. Perfect! Bones = foundation! So, I started teaching him a concept that I believe he can relate to. I told him his bones, just like the foundation / trusses in a house need to be strong so the house can stay stable. He gave me a smile. His wife approached me later on that day and thanked me for making everything seem familiar for his husband.

I was taking care of a newly diagnosed type 2 diabetic on the telemetry floor. He had diabetic teachings done and it was discharge day when I took care of him.  Yet, I can sense that he was a little unsure of the whole concept of the disease process. I asked him what he did for a living and he told me he is a truck driver. Perfect! I told him pretend that his 18 wheeler has a small 4 cylinder engine.

The 4 cylinder engine is not enough to operate a huge 18 wheeler. I told him that his pancreas is like a 4 cylinder engine inside his body. It cannot supply enough insulin to keep his blood sugar under control. He needs to lose weight, eat right, exercise, and take his medications in order to control blood sugars effectively. He gave me a smile, nodded his head and thanked me for explaining the concept where he can understand better.

Patient education requires critical thinking. Nurses as critical thinkers have the ability to engineer through multiple tasks. Nurses are no longer simply responsible for giving out medications, communicating with physicians or other healthcare personnel, and coordinating care for the patients. We nurses now have a crucial role of making sure that patients are able to independently manage their disease. Through "pasensiya"- "patience", recognizing "teachable moments, and using basic principles, nurses truly make a huge impact not only in the quality of lives for patients, but also to the empowerment of the nursing profession. 

The Walking Dead...According to Freud

By Chiqui Raveloski

Sheriff Rick Grimes' state of mind and location upon waking up from his "coma" , in the hit show "The Walking Dead" can be interpreted in so many ways. There are no restrictions. Just pure thinking. I don't believe he woke up from a coma. He is still in a coma, just in a dream state. What we are seeing on television is the drama going on in his dream.

Zombies represents his insecurities, failures, and fears that are constantly coming back to life to engorge his  flesh and blood. Zombies are robbing him of the freedom to be the person he truly yearns to be. Each group of survivors represents the different stages and milestones of his life that he had accomplished, while others waiting for resolution.

Looking deeper, Sigmund Freud propose our personalities represent a "drama" inside our minds. "You" are a product of how opposing mental forces interact. For Freud, we are actors in the drama of our minds. Pushed by desire, pulled by conscience. Our personalities represent the power struggles going on deep within us.

Three main characters in Freud's "drama":
Id: Our impulses. An urge, impulse, or desire so strong that it just had to be satisfied. The id contains all of our most basic animal and primitive impulses that demand satisfaction.
Ego: Negotiates with the id, pleases the superego. Mediates between the id's demands and the external world around us — reality.
Superego: Keeps us on the straight and narrow. Superego is your conscience. It expects your ego to be strong and effective in its struggles against the id's force.

So, how does this all relate to The Walking Dead? With Rick Grimes as a central character, the following group/classification of major characters represent the "drama" inside Rick's dream. Let's group the characters according to Freud's classification.

The Governor- sinister motives and harbors many dark secrets
Merle - An extremely racist man, lived with a neglectful father and acted out against society,
Zombies - bite, infect..

Andrea - a former civil rights attorney. Andrea is intelligent, cautious.
Daryl - a faithful follower of Rick and Rick's right-hand man
Maggie - has held a strong sense of faith throughout the years
Glenn - keenly aware of the extreme danger of his missions on behalf of the group, but because of his youth is willing to take the risks.
Beth - sinks into a deep depression, contemplated suicide, but changed her mind. Beth becomes a more confident and useful member of the group

Carl - worships his father, and is frequently confronted with the realities of the harsh new world. He gradually begins to mature in his actions and thoughts.
Lori - Compassionate and empathetic, emotional center of the group.
Michone -  katana-wielding survivor accompanied by two walkers that are chained to her side-by-side with their arms and lower jaws cut off (to prevent their attacking her or anyone else
Hershel - a religious man, clinging desperately to the old-world values in order to preserve his sanity.

So, if we do apply Freud's proposal to what The Walking Dead is really all about,  do you think this analysis make sense?

Sunday, March 10, 2013

Letting Go

By Chiqui Raveloski

Nursing is a 24 hour care job. Yet, we nurses forget that our 12 hour shift, ends when we clock out. We tend to review the past 12 hours over and over again. We do this while driving home, while in the shower, while eating dinner, etc.  We cannot seem to let go, especially when we’ve had a tough shift.

This is understandable. We take our profession seriously, and we always thrive for desirable outcomes. And when outcomes do not turn out the way we want to, we work even harder to achieve what we want.  As I had said before in my posts, nursing is an emotionally charged profession. Professional and personal values are at stake and challenges can be emotionally draining. More often than not, we go through many complicated protocols and procedures to satisfy patients’ needs and management’s expectations. During this process, we forget our own.

But somehow, we do get comfort knowing we helped meet someone else’s needs. This, I believe is our nurturing side and the nature of our profession. This is also why we have a hard time letting go of the whole shift once we leave it. We want to make sure that all interventions, documentations, re-assessments are done and done right! We leave work anxious, scared, and sometimes even paranoid. 

Nurses have to learn how to let go especially after a tough day.  Letting go decreases anxiety, increases mental health, lessens the possibility of early burn out. I know it seem easier said than done. But I've learned a few ways to shake off a tough day and settle my mind after a hectic day.

You can't control everything. But you know what you can – your mind. Decrease your anxiety level through deep breathing. We always encourage patients to turn, cough and deep breath. We need to practice what we preach. 

    Think about the good things that have happened. You’ve done an excellent job in taking care of your patients, and more. Appreciate what your fellow nurses, nursing assistants, unit secretaries, transporters, etc have done to make it work for you and your patients. It is a group effort. 

     In situations where letting go is absolutely hard for you, pray. It is not for everyone. But surrendering to the idea that there is something, someone, bigger than this world we live in that we don't have any control of, can somehow help you process thoughts in a peaceful manner.
      Encourage peace in your mind and heart through acceptance. Learn from it and find it in your heart to forgive yourself. Forgiveness is a decision to let go of your own resentment and anger to yourself and the people around you. This can lead to understanding what empathy and compassion is all about. We talk about this in nursing school. Yet, I believe it is a concept better understood if you learn it from personal experience. 

         "Utang na loob", a Filipino cultural value meaning "immeasurable gratitude", “a debt of one's inner self". We owe it to ourselves and society to live and learn. Enjoy the journey with family, friends, patients, and co -workers. Letting yourself go in a positive direction will let you shine though the darkness of it all.

        Saturday, March 2, 2013

        Why Do I Blog?

        By Chiqui Raveloski

        When I first thought about blogging, I wondered about what I wanted to blog about. I knew I had something to say, but how do I get my message across? So many topics came to mind yet, it always drew me back to two areas - my  nursing profession here in America and my Filipino culture. Then, I wondered again, and again.......How do I make this two work together? 

        I just started writing. 

        My first blog entry described the Filipino phrase Bahala Na and how it relates to my nursing profession here in the USA. Then came following blog entries about memorable nursing experiences, insights and philosophy. I also try to make it a point to include a Tagalog (my native language) word or phrase to tie in the content of  my blog. Why do I do that? I am not sure why. But, when I opened my email today and read a message from +Nursing that my blog made +Top 50 Nursing Blog, it all came to light. 

        Never in my mind could I had ever imagined that I could get this recognition. It is with great honor to be a part of this group. This gives me more inspiration to continue blogging about my nursing experiences and  my Filipino culture. It clearly shows that the nursing profession, no matter where you are, can bring nurses and cultures together, making it a strong, diverse, and respectable profession.

        Thank you to all the editors and readers who took time out to read my blog entries. To the Google communities I belong to for letting me join in your discussion and post a link to my blog. May our minds and hearts continue to support each other through blogging.