Lollipop and Halo-halo Moments: Mindful and Intentional Self-care

 

It is not easy to be a nurse nowadays, not even for a staff nurse or a nurse leader. Amidst all these uncertainties, nurses struggle with the stressors of an increasingly demanding profession. Nurses hold the fabric of patient care in a stressful environment. What if the fabric is frayed at the edges? How can nurses take care of their patients when they need help themselves?

The job is emotionally exhausting, and we often try to continue caring for our patients to the point of burnout and, in some cases, clinical depression. We survived the Covid-19 pandemic four years ago, but it had an immense impact on our mental well-being. The statistics show a dire picture of post-traumatic stress disorder and suicides in the healthcare profession.

Mental Health and self-care

The American Academy of Nursing (AAN) Expert Panel issued their Consensus Statement in the spring of 2023 about the drivers of Nurse Suicide: the stigma associated with asking for and receiving treatment to support mental health, job-related stressors, and lack of access to mental health treatment.

The National Academy of Medicine suggested a bundled approach to sustaining a positive work environment, reducing the stigma for those seeking mental health care, and focusing on the mental well-being of healthcare workers.

On November 20-22, 2024, the 1199SEIU League of Registered Nurses held a nursing conference in Montego Bay, Jamaica, titled "Empathy in Action: Caring Beyond Ourselves and Honoring Self-care." I was honored to be one of the instructors. My topic was "Finding Your Joy by Finding Your Lollipop Moment."  It was a truly enriching experience to promote self-care and mental health to about 148 nurses who traveled to Jamaica. I dedicated my presentation to two of my former staff nurses who we lost to suicide.

Lollipop Moment

Although the topic was somber, it was uplifting as we discussed ways to find joy in our personal and professional lives. I encouraged the audience to share their "lollipop moment," which was originated by Drew Dudley, a dynamic leader, author, and inspirational TED Talk speaker. A “lollipop moment” is when someone said something or did something that fundamentally made your life better.

Nurses make a difference every day, but sometimes, they must be reminded about their lollipop moments. The nurses did not take long to share their proud moments of touching someone’s life, whether a patient or a fellow nurse. It was heartwarming when one participant thanked her mentor (who was also present) for her guidance and support during the COVID-19 pandemic.

One nurse approached me after the session to express how empowered and inspired she was. She acknowledged that she needed to hear all the instructors drive home the truth that nurses must place themselves at the forefront of mental health care.

Halo-halo moment

Then, I introduced my Halo-halo moment, when I pause and enjoy my comfort food, forget my A1C (blood test to diagnose Diabetes), and savor the incredible moment of finding joy in the simplest things. Halo-halo (“mix-mix”) is a popular cold dessert in the Philippines made up of crushed ice, evaporated milk, sweetened kidney beans, coconut strips, toasted rice, sago, leche flan, and ube ice cream. My son Jordan described it best.

 

Caring beyond ourselves

We also went to a local school to distribute book bags to grade-school children, who welcomed our group with shy smiles but were eager to hug anyone who opened their arms to them. The group of nurses also visited churches and a local hospital to conduct community teaching on kidney health, managing severe bleeding, and maternity child health.

 

Mindful and Intentional

We must be mindful and intentional as we seek our moments of joy to keep our mental well-being. We must maintain our focus on strengthening the morale of our nurses. We need to help and support each other.

The Jamaica trip was restorative and invigorating. There were singing, dancing, and laughter. There was healing.

The nurses enjoyed the amenities of the inclusive resort but also ventured out of the hotel to experience other attractions. As Bob Marley sang, "One Love, one heart. Let's get together and feel all right".

Stethoscope

Dear The View hosts,

That was a token apology. In fact, your misguided attempt to explain made your original ridicule even much worse. That was a prime example of ignorance and disrespect about a profession that deserves much more recognition.

Flashback to last September 13, 2015, in the Miss America pageant. For the talent portion, Miss Colorado opted out of a gown and proudly wore her nurse’s uniform with a stethoscope draped around her neck. Kelley Johnson offered an impassioned and heartfelt monologue about her experience as a nurse to an Alzheimer’s patient.




The View hosts proceeded to ridicule her choice of talent presentation. Michelle Collins remarked, “She came out in a nurse's uniform and basically read her emails out loud and, shockingly, did not win.". Joy Behar, who just recently returned to the show, wondered "Why does she have a doctor's stethoscope on?". A female with scrubs and a stethoscope. The implication is that a nurse does not have the right to use a stethoscope.




Of course, the backlash from the nursing community was explosive. Social media erupted with rightful indignation from the nurses, the doctors, and the general public.

And you call that an apology? Thanks, but no thanks. Joy Behar said that she “was not paying attention”. Did the neurons misfire and you were not able to associate the scrubs with a healthcare worker? Aren’t you being paid to know what you are commenting on?

Michelle Collins profusely praised the nurses, even asking our “bosses” to give us raises. Poor Michelle, her statement was just “misconstrued”. Whoopi accused nurses of taking things out of context and of not knowing that the stethoscope statement was just a joke. Raven Symone called out the nurses for not listening to the intent.

No, I am not too sensitive. I listened to everything you said in defense. And I do have a sense of humor. At this point, you should have been educated enough about the many uses of the stethoscope in the nursing world. The internet is full of stories about how nurses make a difference every day. Even better, you should realize why the outrage from the nurses is justified.

How about spending an hour or two following an emergency department nurse around? And then maybe, you can try another apology.

When Nurses Cry

The viral picture of a doctor grieving after a patient died resonated with me. The loss was palpable; the helplessness was disturbing. It has struck a chord in every other person who works in the medical field. A poignant image that happens all the time, it is replicated in the privacy of the staff lounges, in the restrooms, in the offices, and anywhere nurses and doctors are able to escape for a few moments to grieve.

I have cried many times in my nursing career. For those we have lost and those we cannot help.

I spent my first four years in the US in a chronic care hospital on Roosevelt Island in New York. My first patient death experience was an end-stage renal disease patient who suffered a cardiac arrest. The other nurses who helped me do the post-mortem care were as distraught as me. Our tears mingled with the bath water as we washed the patient’s uremic skin and combed her gray matted hair.

There were more patients in that unit who died after her. 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 mourned their passing because the families had long abandoned the patients.

When I started to work in the emergency department, I taught myself to be stoic. It was my shield against the pain of tragic loss, my armor to protect my heart from shredding whenever a patient died. I could not afford to be burned out. The compassion and empathy remained, but breaking down in tears is something I avoided.

Death is a constant in the emergency room. Some of those deaths were hard and brutal, unexpected and difficult to accept. However, there were some deaths that were almost a welcome event, especially for those chronically-ill patients who lived through extreme pain. For them, death released them from hell on earth.

Every so often, something pierced through the thick armor I built around my emotions.

I cried for one young man who came in traumatic arrest after a motorcycle crash.

I cried with a wife and her son when the patient died after they signed the Do Not Resuscitate papers.

I cried when the cardiac ultrasound revealed no cardiac activity. The patient was one of our own nurses who came in cardiac arrest after collapsing on her way to work.

I cried with the elderly husband who grieved for his wife of fifty years.

I cried when a six-month-old baby drowned in bath water.

I cried with the nursing staff when one of our favorite “regular’ drunks died from hypothermia.

I cried when the seventy-year-old woman who swallowed cocaine bags to earn money for her daughter’s cancer treatment died on the way to the OR.

I cried when a young pregnant mother succumbed to her injuries after she was struck down by a forklift. I cried for her baby who survived but had brain damage.

After I cried, I went back to work. Such is the life of those who work in the medical field. There is always someone who needs our help, someone who needs his Dilaudid. Breathe in, breathe out. There was not enough time to lament the loss of life because there are so many more who need our attention.

But there are also times when I cried for joy.

Many years ago, a boy was hit in the middle of his chest with a baseball. He went into cardiac arrest, in commotio cordis, and was rushed to the OR. Three weeks later, the boy returned to the ED with his mom to thank the ED and surgical staff for their heroic efforts of saving him. The boy named Pedro beamed as he was surrounded by weeping nurses.

There are many moments of happiness in the midst of the darkness in the medical world. We have saved many patients, eased the sufferings of those we cannot save, and touched many lives along the way. Caring for someone does have many rewards.

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 accounted for 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, 2014, 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 to 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 healthcare 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, smallpox, 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.

Get Naked, Get Wet

"If you fail to prepare, be prepared to fail."- M. Spitz


Of all the things that I teach in my CBRNE class, this is what my students remember most. "Get Naked, Get Wet". It's not a rallying cry for indecency. Not that they're unnaturally preoccupied with nudity, but hey, that's just what might save you from that nerve agent.

The class is more popularly known as Bioterrorism. Actually, it's more than just smallpox rashes and anthrax ulcers; more than just donning and doffing the Haz-Mat suits. It's CBRNE- Chemical, Biological, Radiological, Nuclear, Explosives.

It's a sign of the times. Terrorism is alive and well. The terrorist attacks on 9/11 had shaken the collective consciousness of Americans. It ushered in a new era of fear; "the "mighty has fallen". We are vulnerable, and we must be prepared. The better prepared the nursing workforce is, the better our chances are to mitigate the impact of disasters.

Unfortunately, most hospitals choose to bury their heads in the sand. In their mistaken notion that 9/11 would not happen again and that somehow the man who ran away with the missing vial of smallpox would not even know what to do with it. There is no urgency in training front-line workers in recognizing and responding to a CBRNE emergency. What a damn shame.

As I had written before, on September 11, 2001, I stood on the platform of a Manhattan-bound E train to spend my birthday morning at the bookstore cafe in the World Trade Center. Just as the train was pulling into the station, something inexplicable gripped me. I turned around, crossed to the westbound platform to the train back home, to safety. Divine Providence.

I have taught CBRNE classes for about 13 years now; even before the World Trade Center attacks. I had gone to several emergency preparedness classes, even to faraway Alabama in a long-abandoned military barracks, just to be fully immersed in a full-scale disaster drill with 'disaster victims' in realistic moulage.



So, in all my classes, these are the highlights:

1. IF YOU SEE SOMETHING, SAY SOMETHING

The reminder is everywhere. The Metropolitan Transit Authority has even taken radio ads: "If you see a suspicious package or activity on the bus, on the train, or in the subway, don't keep it to yourself."

I preach Healthy suspicion without paranoia. Recognize when something is out of the ordinary. Be suspicious if patients flock to the ER with Flu-like symptoms in the middle of summer.

Dead birds outside your window? Don’t panic. Don’t imagine an apocalyptic scenario. The 3,000 red-winged blackbirds that dropped dead from the Arizona sky on January 1, 2011, were reportedly felled by trauma from the fireworks for the New Year's Eve celebration. That's what the National Geographics wrote. Uh, okay.

2. S-I-N

I teach my students to sin. That they should not rush into action unless they know what they're getting into. Only fools rush in.

S-I-N: Safety first, Isolate the problem, and Notify the authorities.

Knowledge is power. But how can you protect yourself and the people around you if you cannot recognize that you are looking at a patient with descending paralysis from botulism toxicity? How can you effectively treat your patients when you yourself have succumbed to the nerve agent? How can you ring the alarm when you don’t even recognize that something is so completely wrong?

3. ISOLATION FOR SMALLPOX, PLAGUE AND VIRAL HEMORRHAGIC FEVER (VHF)

Common presentation of fever, general malaise, and body aches can fool even the most astute triage nurse. The index of suspicion should be raised with the following: synchronous formation of rashes that start in the face and extremities (smallpox), hemoptysis, and rapid progression to acute respiratory failure (pneumonic plague), and bleeding (VHF). Thanks to those TV movies on Ebola, the public is aware of the devastating effects of the disease.

The most important takeaway is that these diseases can be transmitted from person to person. ISOLATE, ISOLATE, ISOLATE. Immediately.

4. PERSONAL PROTECTIVE EQUIPMENT (PPE)

In 1995, cult members in Japan released the nerve gas Sarin in the subway station. Twelve people died, but thousands more of the "worried well" rushed to the nearest hospital. Well-meaning nurses and doctors ran to meet the patients. No masks, no gloves, no gowns. Like soldiers running to the battlefield without guns. They did not S-I-N.

5. TRIAGE- THE GREATEST GOOD FOR THE GREATEST NUMBER

In normal times, the dying gets the most attention and the ED staff works hard just to prevent the patient from being another statistic. Disasters nullify what we hold dear in emergency nursing. Suddenly, the dying gets passed by. The limited resources demand that the rescuers spend time with those with a reasonable chance of survival, whether they're young or old. It would be devastating to turn your back on somebody, but what can you do if your resources are scarce?

6. GET NAKED, GET WET

As slogans go, this one just makes everybody smile. The light-heartedness is just a defense mechanism for the sobering fact that nerve agents kill. Modesty be damned. Get those clothes off and get wet, right now.

Decontamination is the physical process of removing debris, harmful substances, and chemical agents from the skin, clothing, and other items. Knowing that the clothes and the exposed areas of the body get the most contamination, it makes sense to undress right away and flush the debris with water.

Do not worry about the water run-off if your decontamination chambers are not equipped with such. Let the water run off to the sewer. The alligators will just glow in the dark. Who cares?



At the end of the class, there's that photo opportunity of posing in that Haz-Mat suit complete with the hood and the powered-air-purifying respirator (PAPR). Cool!