Saturday, December 27, 2014

Personal Educational Philosophy



I love my job as a nurse educator. My goal is to mentor nurses to achieve their highest potential. As a nurse educator, I am doing my share to influence nurses (future and current) to provide the best possible care to the patients under their care. As others have done for me, I want to pay forward the excellent mentoring that have guided me and inspired me to make a difference in my patients’ lives.

I believe in the enormous influence of education in changing lives. The great Nelson Mandela once said, “Education is the most powerful weapon which you can use to change the world” (Durando, 2013, para. 12). I believe that the student I teach will someday save someone’s life. My personal educational leadership policy has never wavered since the first day I was given a new nurse to precept. At that time, I just had finished my first year of work as an emergency nurse so I expressed my discomfort in being a preceptor to my head nurse. She looked me in the eye and said, “Your face lit up when you do patient teachings. I saw how your patient was so grateful to you for your clear and patient instructions. You are a born educator.”

I believe in the inviolable privilege of caring for a patient in need. As the nurse educator in a busy emergency department and as an adjunct clinical faculty, I always instill in my students and my nurses the love and respect for the profession. I encourage them to hold in their heart the passion for the job. I constantly remind them of Jean Watson’s saying “Caring is the essence of nursing and the most central and unifying focus for nursing practice" (Watson, 1985). Nurses need to embrace the profession and the unique opportunities it gives in service of others.

I believe that in today’s global society, we need to teach all healthcare personnel to respect cultural diversity. Having worked in an inner city hospital for twenty-one years, I appreciate the kaleidoscope of cultures that had enriched me as a nurse and as a person. The healthcare community is a microcosm of cultures that presents distinct and increased challenges to the delivery of safe and compassionate patient care. Leininger’s Theory of Culture Care Diversity and Universality provides a valuable framework for the healthcare professional to attend to the needs of their patients in a culturally congruent way (Leininger, 1995). Nurses are in an excellent position to foster cultural tolerance and respect for the similarities we all have.

I believe that interprofessional collaboration and team-building are crucial to ensuring patient safety. Medical errors and catastrophic injuries may be avoided with improved team dynamics and communication (O’Daniel & Rosenstein, 2008). Collaborative practice among the physicians, nurses, and other members of the healthcare team promote shared mental models and efficient communication (IOM, 2010).

I believe in nurse empowerment. As the largest healthcare group, nurses should be vocal advocates for positive innovations in the workplace and the school community. Nurses need to recognize their collective power in producing ground-breaking solutions and demanding change in the healthcare community. I encourage the nurses to explore new frontiers in nursing excellence and to practice evidence-based practice. As recommended by the Institute of Medicine, nurses should prepare to practice to the full extent of their scope of practice (2010).

I believe in the concepts of emotional intelligence and transformational leadership. I will role-model presence and vision in leadership and will integrate the concepts of emotional intelligence in my professional relationships (Marshall, 2011). As Marshall wrote, “Change is a journey taken with those with whom you work” (2011, p. 90). As a change agent, I need to prepare myself fully for the challenge of leading the way in a complex healthcare landscape.

Looking back on that day when my head nurse started me on my way to a career in nursing education, I can only marvel at the sense of achievement it had given me. I reflect on the lessons learned and on the great memories along the way. Nursing had been good to me. I had given my all to this profession, but the rewards I received for my efforts are immeasurable.


As First Aid Instructor, Philippine National Red Cross





References:

Durando, J. (2013). 15 of Nelson Mandela’s best quotes. Retrieved from http://www.usatoday.com/story/news/nation-now/2013/12/05/nelson-mandela-quotes/3775255/
Institute of Medicine. (2010, October 5). The future of nursing: Leading change, advancing health. Washington, DC: The National Academies Press; 2010. Retrieved from http://iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx.
Leininger, M. (1991). Transcultural nursing: the study and practice field. Imprint, 38(2), 55-66.
Marshall, E. S. (2011). Transformational leadership in nursing: From expert clinician to influential leader. New York, NY: Springer Publishing Company
O’Daniel, M. & Rosenstein, H. (2008). Chapter 33. Professional communication and team collaboration. Retrieved from http://www.ahrq.gov/professionals/clinicians-providers/resources/nursing/resources/nurseshdbk/ODanielM_TWC.pdf
Watson, J. (1985). Nursing: Human science and human care. CT: Appleton-Century-Crofts. 2nd printing 1988; 3rd printing 1999. NY: NLN (Jones and Bartlett).


Excerpt: ASU Educ Philosophy- JCS

Saturday, October 18, 2014

Nursing Humor

Nursing life is hard enough. These are uncertain times of economic realities and of frightening illnesses. As a bedside nurse, you have to contend with long schedules and heavy workload. Believe it or not, nursing leaders complain of the very same thing. Just a different perspective.

But through all the difficulties of being a nurse, there are rewards that keep us going. We survive the trials and become better nurses. Nurses live for the simple pleasures- a thank you from a patient, a life saved, recognition for a job well done, and a chuckle shared with co-workers.

We learn to keep our sense of humor. Because if we cannot laugh at ourselves, how fun can life be? If we always get offended by somebody else’s humor, how can we find joy in life at all? If we find fault in everything, how can we appreciate anything? If we cannot take things lightly, how can we forget the sad things we see at work?

Here are some of my favorites:












Saturday, August 9, 2014

At The Front Lines


Nurses and doctors have died at the front lines. In a war against a dreadful disease. In Ebola-ravaged West Africa, about 60 healthcare workers are accounted for the 8% of about 1,000 fatalities since the outbreak of the viral hemorrhagic fever six months ago. Two American missionaries who were in the midst of the fight against Ebola in Liberia, a doctor and a medical hygienist, contracted the disease and have been flown to an Atlanta hospital for treatment.

They are true healthcare heroes, part of those at the front lines who have to contend with poor healthcare infrastructure in Africa, countries further overwhelmed by the virulence of the epidemic.

Dr. Kent Brantly and Nancy Writebol are heroes who lived, thanks to an experimental drug. Dr. Samuel Brisbane, Dr. Sheikh Umar Khan and Dr. Modupeh Cole, sadly, succumbed to the fight of their lives; they are heroes. Other nameless nurses and healthcare workers have also died as heroes.

Countless other workers carry on in the struggle to survive, while working in extreme conditions, in hot protective suits and ill-equipped centers. They are also heroes.

And the brave men and women keep coming back. Monia Sayah, a nurse with Doctors Without Borders, spent 11 weeks in Guinea. Despite the challenges of working in sweltering heat amid a community distrustful of foreigners, she was still willing to return to West Africa.

This Friday, August 8, The World Health Organization (WHO), finally declared the Ebola outbreak an international healthcare emergency.

And yet, there are more healthcare specialists being deployed by Doctors Without Borders to West Africa. A renewed call to action to help out. This is reminiscent of the firefighters in the 9/11 tragedy who trooped up the World Trade buildings while the panicked masses stormed out.

Some people had blasted the US government for daring to bring the infected missionaries to our shores. Men and women who live in gilded towers shake in their pedicured toes as they questioned why Americans are being subjected to a possible epidemic in our midst. Phobic individuals who could actually afford a "bubble world" propagate fear to protest the transfer of American citizens in a hospital whose staff is well-trained in all matters infectious.

Susan Mitchell Grant, chief nursing officer at Emory Hospital, wrote in her op-ed piece:

“Most importantly, we are caring for these patients because it is the right thing to do. These Americans generously went to Africa on a humanitarian mission to help eradicate a disease that is especially deadly in countries without our health-care infrastructure. They deserve the same selflessness from us. To refuse to care for these professionals would raise enormous questions about the ethical foundation of our profession. They have a right to come home for their care when it can be done effectively and safely.

As human beings, we all hope that if we were in need of superior health care, our country and its top doctors would help us get better. We can either let our actions be guided by misunderstandings, fear and self-interest, or we can lead by knowledge, science and compassion. We can fear, or we can care.”

http://www.washingtonpost.com/posteverything/wp/2014/08/06/im-the-head-nurse-at-emory-this-is-why-we-wanted-to-bring-the-ebola-patients-to-the-u-s/?tid=pm_pop

As a nurse, I understand the moral and ethical responsibility and I take pride in doing the right thing. Even far away from West Africa, healthcare workers everywhere are faced with the unknown. Violent patients, mysterious diseases, uncertain diagnoses, unsafe times.

I have taught about Ebola, small pox, and pneumonic plague in my Emergency Preparedness classes, so I know how frightening and how challenging these diseases are. As I chanted "Isolation, isolation, isolation", I hoped that the nurses take heed and isolate patients as the need comes up.

A triage nurse is at the front lines. All she can do is to be alert for the signs, to protect herself, the patient, and the community she serves. The nurses, doctors, and other healthcare workers are well-aware of the immense challenges they face, and yet they choose to stay. The courage and the dedication are awe-inspiring.

We are in the business of saving lives. This is what we’ve signed up for. We choose to care.




Addendum: More names were added to honor the sacrifice of those generous souls who passed away and to celebrate those who are still fighting for the people of West Africa.

Sunday, May 4, 2014

I am a Nurse



I am a Nurse.

Whether I spend most of the time at the bedside or in front of students, I am still a nurse. Every day, my goal is to influence a nurse to do her very best, as others have done before. I am but one of the fortunate ones given the privilege to serve and to make a difference.

Nursing is not for the faint-hearted. It is not for those who expect a calm and uncomplicated journey to retirement. This profession does not promise a day free of stress and challenges, nor full compensation and even appreciation for services rendered.

It is for those men and women who recognize the difference they make for those patients faced with the uncertain and sometimes the inevitable. Their hands are there to support the weak and to provide dignity even during the most unfortunate times.

Nurses have to cheer their patients up, to encourage and to nurture, but sometimes to hold their patients' hands when everything else had failed. They touch lives every time, every single day.

Nursing is for those who share a special place in their hearts for those struggling with pain, or those who need a gentle touch, or those who need a willing listener to even the most mundane of complaints.

Nurses accept the call for compassion and grace. The rewards are emotional and spiritual, probably some extra points in heaven.

Nursing makes me a better person. That is why I am still a nurse.







Saturday, March 22, 2014

Nursing, Thirty-one Years Ago…





Nursing, thirty-one years ago…

Like a cliché, it seems only like yesterday. But one only has to look at the hands wrinkled by countless handwashings, it orientates me to the fact that “Man, I have been a nurse for a very long time”.

I am a nurse educator, so I welcome new nurses to the fold. I do not get threatened by the generation gap because I am energized by new knowledge and technology. It is exciting times for a nurse today with advanced medicine, electronic documentation and nurse empowerment.

But I do feel protective of the special gift that senior /seasoned nurses bring to the table. The experience of thirty-one years have not only made me stronger clinically, but have also given me a better perspective of the impact of these nurses to the patients who will only benefit from knowledge earned through hard work and determination.

I truly support the tremendous contribution that the seasoned nurses had given to the profession, and they will play an important role in guiding the new nurses today to realize their full potential. Sadly, there is a sense of "entitlement" on both sides. There should be a better way to bridge the gap between generations. Patients do not really care what the nurse's highest academic degree is as long as they get compassionate care from the nurse.

Having learned from my mistakes , I respect myself even more today. Unencumbered by false modesty, I can proudly and humbly say that I am a damn good nurse, not because of any advanced degree but because I learned patient-centered care long before it became a buzzword.

Thirty-one years ago, I stepped into Coler Memorial Hospital on a cold January morning. Our group of young Filipino nurses newly-flown to New York was culture-shocked. I thought that our patients spoke with difficult accents, all slangs yet full of grammatical errors. I was convinced that the doctors misspelled their orders and were insulted when we questioned duplicate medications.

Our nursing supervisors towered over us with doubt written on their faces. They probably were wondering how these naïve, young women could stand up to the bossy LPNs who used to rule the roost. We were usurpers to the throne. We didn’t know any better and how dare we come to this place expecting to find our way into their nursing world.

But dared we did. We held our own, learned the slang, and worked our way to earn the respect. Not only of our supervisors, but mostly by our patients who delighted in our enthusiasm and compassion. My supervisor Ms. Covington used to challenge me to go beyond my comfort zone. Somehow the patients who were abandoned to our care became our own grandparents.We held their hands and listened to their nostalgic remembrances of lives spent caring for their loved ones. We dried their tears just as we dried our own tears of loneliness for families left behind in the Philippines.

“You’re my favorite, Cerrudo.”, one of the chronic dialysis patients rewarded me with this one day. I quickly bragged to my friends about how I finally won over the most difficult patient in the unit. My friends did not even give me time to relish my victory; Sessa told them the same thing last week. I was Sessa’s favorite that time because I slipped her an extra ice cream.

My first unit was the Medical ICU. One part was the chronic ventilator unit where patients remained attached to ventilators; we became experts with trache care, suctioning, and communicating with our patients the best way we could.

Mr. Alston used to clench his jaw and blink his eyes three times if he wanted things done. One bedridden patient could only give a lop-sided smile if we positioned him right. Mrs. Richards frowned if we didn’t tuck her bedsheets right and gave us thumbs up when we did . Young Alli smiled at every thing we did for her, as we wiped the drool on her neck, cleaned her trache and brushed the tangles on her hair. I massaged the contracted feet of my ALS patient who continued to have a vibrant mind while his body wasted away.

The patients were our family… and every time one passed away, we cried with the rest of the staff. Most of the time, the nurses were the only ones who grieved their passing because the families had long abandoned them.

Two years later, I was promoted to a head nurse position in a general med-surg unit with 40 patients. I took my share of duties as part of functional nursing. There was usually one medication nurse who starts and finishes the day giving meds with printed medication cards; from back to the front of the unit where meds were given thru gastrostomy tubes. Another nurse and I worked with a group of two nurses’ aides as we fed, bathed, exercised, and walked the patients. At 3pm, we started our narrative charting, our notes the same every day except for the vital signs and whether patients had bowel movement or not.


Thankfully, the technology and staffing got much better. The suction EKG bulbs were horrendous, and left their distinct marks on our patients’ frail chests, the yucky gel too difficult to clean off. The manual mercury sphygmomanometer is now a thing of the past, now it’s just a button to push on the automatic cardiac monitor and we get a veritable data of riches: BP, HR, oxygen saturation, MAP, endtidal CO2.

Gone are the medication cards, those 2 by 2 index cards with hand-written transcription of medication orders, the dosage times written in black, green, and red. Gone are the Kardexes with nursing diagnoses that never changed. Gone are the hand-written doctor’s orders that were meant to confuse.

Back then, I was new, nervous, and unsure of my place in this world. Thirty-one years after I first stepped on American soil, I am still convinced that Nursing had given me valuable lessons along the way. That the rewards of nursing far exceed the material blessings. That the compassion I have shown my patients was the greatest gift I could have given them.

And now, as a clinical adjunct professor and a clinical nurse specialist, I try to impress on my students and nurses to remember why they chose this profession. I celebrate their need to explore new boundaries and to push the envelope but I remind them, as well as the seasoned nurses, to embrace their similarities and learn from each other.

When the patient needs a hand, it doesn’t matter if the hand that is offered is that of a baby boomer or a millennial. At the end of the day, the patients will remember a nurse who gave them the respect that they deserve.

Through the nurses I teach, I wish that a compassionate nurse lives on.









"My Firsts... as a Nurse in the US"- http://jcerrudocreations.blogspot.com/2012/03/my-firsts-as-nurse-in-us.html

Saturday, January 18, 2014

“You must be kidding!!!!"




“You must be kidding!!!!“

The ER is a very funny place. There are things here that defy explanations and stories that are just too crazy to be true. But if it happened in the ER, it must be true. We don't make these things up.


In a case worthy of “House”, some astute paramedics finally solved a baffling case of syncope.

For 3 consecutive nights at around 9pm, EMS had received a call from a wife that her husband had “fainted”. The husband was often hypotensive but quickly recovered in the ER after some IV fluids. All tests came out negative and the patient was discharged in the morning, only to come back the same night. The wife stated that her husband had no physical complaints all throughout the day, but then she would find him weak and faint at night time.

On the fourth call, the EMS crew noticed the patient’s bedside table. There were two tubes of medications side by side that the husband uses just before he goes to bed: one nitroglycerin ointment for the patch and one hemorrhoid ointment. One medication patch on his heart to make the heart blood vessels dilate, and one medication to relieve the pain and to reduce the swelling of the hemorrhoids.

It turns out that the patient mistakenly applies his nitro ointment to his hemorrhoids every night.





High-tech and TMI (Too Much Information) s0metimes provide an awkward scene at Triage. And the nurse gets uncomfortable being shown a "selfie" without any warning. On the other hand, it is better to look at an image than having to see it in real life.





Spell Check please….

I admit I’m a spelling snob; it’s a genetic mishap, a flaw in my character. Please forgive me, but it is too embarrassing to sit through a chart review with other departments having to defend sloppy documentation.

I’m not talking about common errors like lose and loose, your and you’re, break and brake, and there and their. Highly-educated people sometimes slip up with these mistakes. I can understand a typo here and there, but here are some egregious (and funny) spelling errors.

Reading some patient charts can be excruciating sometimes.

Deployed- “The airbag should have diploid.”
Phlegm- “The patient coughed up green flem
Purulent – “The wound has a pussy discharge” (not an actual misspelling, but just sounds wrong)
Circumcised- “He was not circussized”.
Rapport- “The patient maintains good rappore with family.”
Bizarre- “Wife said that patient was acting bazaar.”
Intubated- “The patient was incubated by the ED team.”
Gout- “The patient complained of pains from her goat

According to the Thesaurus, a typo is a mistake in printed matter resulting from mechanical failures of some kind. Typos are caused by fast and fat fingers. No, these are not typos. The last time I looked at the keyboard, “t” is two rows higher than “c” and “a” is way over on the left side of “u”.





EMS Narrative history text: (written in capital letters)
34 MALE AMBULATORY @ AMBULANCE. HE WAS @ HIS WORKPLACE HAVING DRINKS, BEERS, WHEN HIS HORSE BEGAN TO BREED PROFUSELY. IT STOPPED. HE IS INTOX. HIS GIRLFRIEND IS CONVINCING HIM TO GET EVALUATED @ HOSPITAL. HE DOESN’T WANT TO BECAUSE IT STOPPED. TXP BECAUSE HE IS INT. ON AND NOT IN A POSITION TO RMA. HE WAS@HOSPITAL LASTWEEK, AWAITING APPT. 14TH ENT.

The patient turned out to have a Nose Bleed. I wonder where the "Horse Breed" came from.



Thank you to Kirill, Tina and Janice for the material.