Do no harm

I have been a nurse for many years and one could say I’ve been around the block a few times. I still love my job and I feel strongly that most of us who work at the bedside taking care of the sick are here for the right reason. I believe most Doctors think they’re doing a good job. Certainly all of our ICU Physicians in the Medical Intensive Care that I work in are wonderful dedicated and caring. Yet something is not right!

The numbers of Americans addicted to Prescription drugs has skyrocketed. Worse than that is the needless and inefficient use of medications.  We are poisoning people instead of helping them. We are killing not curing them. The Pharmaceutical Industry keeps churning out growing numbers of drugs. They advertising their medications on TV and even with the long lists of side effects people take these poisons. They’re advised to ‘ask your physician if this medication is right for you’. Primary Physicians seem to prescribe vast numbers of unnecessary drugs to hapless patients who will take anything they are told to take.

Why is this happening and who benefits?  No need to answer that was a rhetorical question. It’s very clear to all but the people who are suffering the consequences i.e. the patients. I have admitted people with some of the newer more expensive drugs even though one has to wonder if the old and proven drug wouldn’t have been a better choice. Pharmaceutical companies are making money and they line the pockets of Physicians who feel they are entitled to the kickbacks. It’s a very bad thing.

I had a patient recently admitted with malignant hypertension. She had a long medical history and a lengthy list of medications she takes every day. She admits she takes 2 mgs Ativan orally 3 times a day. Her urine drug screen confirms this. Yet that Ativan was not on her Med Rec and so it was not being given. Her admitting doctor says her hypertension is because she’s noncompliant with her medications.  I know that’s not the reason we have her on a Nipride drip and it’s obvious she’s in withdrawal. Where does she get the Ativan? She says the express clinics. No records of Ativan that’s not right.     

I see patients with Medication Reconciliation forms that are pages long. It’s out of control. We have to step back from all the pills and give patients other choices to get their health and lives under control. There is not a pill for every aliment, we need to educate and motivate our patients to healthier choices. We have to remember to ‘do no harm’. 

Dora Meulman  

Be nice please...Pretty please

You’ve heard the old saying one rotten apple can spoil the barrel; well the same is true with people. There is nothing worse than having to spend time or be around someone who is always whining and complaining. Nothing is ever good enough their glass is not only half empty it’s dry. Their stories or problems are the only ones they are interested in. They monopolize the conversation and their negative vibe brings everyone down, it’s all about them all the time. This is especially true in the workplace they can make a happy place a misery just by being there.

For a manager these people are a nightmare, they need to be encouraged to move on as quickly as possible before their poison spreads and infiltrates the rest of the staff.  Ignore them and before you know it you’ll have a mutiny on your hands. That’s because emotions are contagious. Badness can spread like a wild fire and the only way to douse it is to build a firewall.

In nursing we unfortunately see this person regularly. They have the power to ruin your lunch break if they happen to be present. It’s enough to give you indigestion and the only solution is to loose oneself on the web and tune them out. Making you antisocial but that’s better than crazy. I could feel sorry for them if I didn’t dislike them so much.

Is life really that bad? When you start your day do you intentionally think I will make all around me miserable today. Do you know you’re a sour tart or do you think that your ranting is a normal way to behave? I think it’s a habit, a rotten nasty habit that you’ve allowed to get out of hand because no one has had the balls to tell you to stop. It’s an attitude and it’s less stressful and much healthier to have a good attitude than a bad one. So be nice please...Pretty please.

Dora Meulman

Denial

Denial is a psychological defense mechanism in which confrontation with a personal problem or reality is avoided by denying the existence of the problem or reality. We frequently see patients in denial about their health problems. Just recently we had a patient in his fifties who ignored his sore toe. By the time he sought medical attention the toe was gangrenous and he ended up with a below the knee amputation. Post-surgery he became depressed and refused to follow Medical advice. This led to further problems and it was decided he could not go to rehab so he was sent to a nursing home to recover. He was at the nursing home exactly one week when he developed pneumonia and was admitted to the hospital in Septic Shock. That's when I first met him in ICU.
When a patient is first admitted to ICU we attach them to the monitors, we then assess them and they're seen by their admitting doctor. We receive orders to get blood cultures and other labs, start IV's, and give the medicines that have been ordered by their doctor. It's a very busy hectic time especially if the patient is very sick like this gentleman was. As nurses we are responsible for the admitting paperwork. This is a tedious task, none of us like it but it has to be done. So once the patient is settled we will generally get the family to assist us with this. This patient was sedated on a ventilator, he looked horrendous far older than his actual age. His 2 daughters in their mid to late twenties came into the unit. They both stood at the end of his bed in a state of shock. The younger one put both hands to her face took a big gasp and whispered Oh Daddy...she then bowed her head and sobbed. The older one trying to be strong bit her lip. They were a sad sight to see. I'm a seasoned ICU nurse but sometimes it just hits you like a bat. It was all I could do not to cry.
Refusing to admit the truth or reality of something unpleasant is amazingly common it's almost a defense mechanism for some. You see people with advanced cancers they admit they haven't felt well for a while, they've worried they might have cancer and yet have not seen a doctor. Often they haven't spoken to family members about it. It's like they think if I don't talk about this it will go away or get better on its own. The ulcer stinks to high heaven and they put on perfume or cologne to hide the stench. They use peroxide and an assortment of creams and portions and it continues to get worse. After a while they're too embarrassed to go see a doctor because they fear their reaction at letting it go so long. They don't want to be thought a fool. They live in denial a negation in logic.

Dora Meulman

Your Voice

Studies show that HOW we say things is four times more powerful than WHAT we say.

7% is what we say

38% is how we say it

55% is non-verbal

I am blessed with a unique voice. People know me by my voice it is a big part of who and what I am. My voice has evolved and been remade many times over the years. I was born in Cork City Ireland. The Cork accent is lilting up and down melodic and full of colloquiums. It's easy on the ear but difficult for non Corkonians to understand. My parents, no correction my Mother and Grandmother enrolled me in singing drama and elocution classes. They did not want me to sound ‘common’. I went to school in London and returned in 94 spending a total of 14 years in England. This changed the tone and pitch and made me aware of the power of the voice. Add on the Americanization and I have the voice I have today.

Now I can change this voice at will and do regularly depending on who I’m talking to. When I’m in Ireland you’d never think I left her shores. At home and with friends I have my conversational voice. It’s Americanized Irish and has been strongly influenced by my husband Jeff who’s from Michigan.  I turn on the English influence if I want to sound smart or posh. When I teach my fitness classes I tend to speak slower, and use fewer words, mixed with non-verbal cues. I think that works best for me. I would say people wouldn’t need to see me to know who was teaching. 

Margaret Thatcher took elocution lessons for years and managed to lower her pitch and mellow her accent. She knew the importance of her voice if she wanted to have authority among men. I'd say it worked pretty well for her

BODYPUMP is a static program like teaching a class of students or doing a power point presentation. The most powerful tool we have to create contrast is our voice. How we say things is more important than what we say. I could tell you that you smell and your pants are on fire with a smile on my face and a high pitched voice. Chances are you would smile back at me because you didn’t hear the words but the intonation. Every 3 months we launch the new programs for Les Mills at the YMCA. These Kickoffs are great fun and highly anticipated by the members. Some of today’s music can be offensive to members. I usually get to teach these tracks because people don’t hear the offensive lyrics or language when I teach unless I want them to.   

I have five voices when I teach to match the highs and lows of the material or music.

1: CONVERSATIONAL- In the low parts, talking with the class. It’s friendly and easy on the ear. It’s natural but would be boring if that was all I used.

2: BUILD - To create anticipation and excitement and let the class know they need to listen.

3: BIG – To power and motivate.

4: INTENSE – A strong challenging focused voice that’s success and results oriented but not aggressive. It’s inclusive. Think ‘you can do it’ rather than ‘just do it’

5: SILENCE - Let the music or slide speak. You say it best when you say nothing, hold the silence, pause and breath. Most of us spend too much time talking about nothing. Then when you talk, talk to the class.

Have you ever gone to a class or presentation and found yourself bored to death. Not with the material but the presenter. There just isn’t enough coffee to save you from this person. They know all the material and you want to listen and learn. The power point is brilliant and yet it’s dull and you’re miserable. I guarantee you that the presenter spent long hours learning the material and putting the slides together but didn’t record themselves to hear how they sound to other ears. It’s something everyone who is going to stand in front of a class should do. Your voice won’t sound like you think it does. It can be shocking but it will make you better. Teaching and presenting is a Performance Art it takes practice and more practice to Master the powerful tool of your Voice.

Dora Meulman

Preceptor

Nursing is a very rewarding job and I love it but it can also be very stressful. This is especially true when you are a new nurse. The responsibility of taking care of someone very sick can keep you up at night. You got all the information in nursing school and now here you are, an RN and sick people need you to take care of them. As an experienced critical care RN I am frequently preceptor to new nurses on our unit. My job is to help them become familiar and comfortable on the unit. They spend 6 or more weeks with me before I hand them over to another nurse on the night shift and then when they are ready they are set free to work alone. During this time we usually become close. The older experienced nurses become friends, the young ones become like foster children. I'm fiercely protective of all of them, the bond is set forever and I really enjoy it.
The first few days of orientation we are getting to know each other. I introduce them to other staff members and try and make them comfortable in the unit. We usually take a few tours around the hospital which is a huge place to try and remember. If they are young inexperienced nurses they are like deer in the head lights at this stage, but with encouragement it doesn't take them long to settle in. I get them familiar with the documentation and get them to master this first. We are very lucky in our unit to have a large staff of attending physicians who love to teach and are very inclusive of new employee's. There is a lot to learn but everyone pitches in and we try to have fun.
As the weeks pass I allow them to take more responsibility for the care of the patients. This can be the reality check trying to learn how to prioritize your time and keep up with the work. Helping them to develop critical care thinking and at the same time showing compassion. It can be overwhelming for some, and they worry about when they will have to function alone. Helping them to learn their resources and who to go to for help. You can not take care of a critically ill patient alone you have to ask for help, sometimes loudly.
Other nurses can sometimes be less than patient. This is especially noticeable if we have to transfer a patient to another unit and I have the new nurse give report. What is it about nurses when we deal with each other during these transfers of patient care? Sometimes we become intimidating and are downright hateful! This same vibe can be there during shift change when we give report to the oncoming staff. Helping my new nurses through these landmines is all part of my job as their preceptor. Turning these negative moments into positives and seeing them develop into my peers...Priceless.

Dora Meulman