Tuesday 24 May 2022

Nursing, Nursing Career, Nursing Exam US, Nursing Responsibilities, Nursing Professionals

A few weeks ago I heard a doctor tell me, “That is a five-shower case.” My mind automatically started to think about what physiologic cascading effect he might be referring to. After witnessing my perplexed face, he gently responded by saying “after five showers, I might be able to stop thinking about that one constantly.” There was something so comforting in hearing that I would not be alone in my confusion, sadness, or insufficiency towards the events that had transpired during that shift.

I had a small degree of peace that occurred thinking of the visual of showers clearing out my headspace from thinking and dreaming about work. I think so often we forget to allow ourselves the space to acknowledge that our work can be emotionally draining and difficult to process through and that we are not the only ones processing this response.

It has always been interesting to me which cases stir up an emotional rise, and which horrific stories turned out to be unpredictably easy to move on from. Sometimes the sad cases for other people make me question whether or not I have the capacity for an emotional response anymore. Then a seemingly standard patient will cross my path and something about their story makes it hard to shower off.

After working in a critical care setting for multiple years, most nurses carry at least one or two patient stories near to their hearts for years to come. However, our nursing culture has taught us to normalize the unthinkable, and quickly pick up the pieces and move on to the next patient. Most call it compartmentalizing. The longer you do this - the easier (at times) it becomes and it even becomes our norm. Spilling over into our personal lives more often than not.  Or, maybe a more likely scenario is that many nurses don’t talk about these stories because it feels too personal. After seeing and witnessing some of the most gut-wrenching and raw moments, it almost feels insincere to share their stories with complete strangers of the patient.  After all, how can you put into words the gravity of watching air leave someone’s lungs forever, and see it strip part of the life away from their family while watching it happen?

I have come to realize that I get to participate in some of the most sacred and horrifyingly tender moments in some people’s lives. They are the moments that movies layer with soft music and a dramatic crescendo to help produce an emotional reaction for the audience. Unfortunately, when you are in the room with the patient and watching the scene unfold before your own eyes, it doesn’t need music to cause the feelings to swell inside of you. They are the moments that have small details that will be etched into your mind for weeks to come. The sound of a cry, the position of the hands, the words families choose to speak during the remaining few moments with a loved one, or the lingering eye contact that you had with the patient right before they lost consciousness.

These images have woven their way into my dreams and my subconscious thinking for short periods after caring for the patient, and so often they are moments I don’t want to share with anyone else, because although I don’t see it as a burden to carry, it feels like I witness such an intimate moment of closeness with that family, that it isn’t my story to share.

The moment on replay for this five-shower case occurred when the patient ripped off her BiPAP, grasped at my arms, and looked me directly in the eyes saying “what you are doing isn’t working. Change something.” And I couldn’t.

We were doing everything we could at that moment to help her, but it just wasn’t enough. We debriefed everything that had occurred later that night, and the “what if” questions began flowing. What if we could have gotten better IV access a few minutes sooner? What if we could have given more fluids and meds seconds earlier? What if the family had called 9-1-1 twenty minutes quicker? A lot of the five shower stories make you question your competency as a provider when you become fixated on these questions. Did I do enough? Could another nurse have kept the patient alive?

Five showers. Sometimes time and leaning against a wall with hot water pouring over the body can wash off more than just small dirt particles. I hope we get to a point as collective healthcare providers that we allow for a space to process and grieve the intense interactions we often witness and stop downplaying the notion that the “strong ones” don’t need to pause and reflect. Each individual absorbs emotional reactions and attachments to very different stories, and we need to have empathy for allowing them the ability to feel whatever reactions it might stir. Sometimes it is sadness, other times anger, but I have also seen some nurses completely shut down in a response to a positive emotion that they might not have received in their own walk of life. Maybe they just need five showers to process through it and come out on the other side as a more whole, and complete human.

Source: nurse.org

Thursday 12 May 2022

Healthcare, Health Professionals, Nursing Skill, Nursing Responsibilities, Nursing Career, Nursing Professionals

Recently, a draft of a U.S. Supreme Court decision regarding Roe v. Wade was leaked to the press. The draft of the decision indicates that the court will overturn the previous decision that made abortion a constitutional right. This would allow individual states to create their own laws regarding the legality of abortion and restrictions limiting access to the procedure. 

What is Roe v. Wade?

Roe v. Wade is the name of the lawsuit that eventually made its way to the Supreme Court and led to a decision by the court to make abortion a right. “Jane Roe” was actually Norma McCovey, a 22-year-old unemployed single mother who sought an abortion in Texas when she became pregnant with her third child. She sued the state of Texas and challenged the state’s law that only allowed abortion when it was the only way to save the mother’s life. Roe argued that the law was vague and a violation of her constitutional right to personal privacy.

As the district attorney of Dallas County, Texas, it was up to Henry Wade to enforce the law and defend the state. Eventually, the Supreme Court had to make the final decision about whether the Constitution recognizes a woman’s right to end her pregnancy through abortion. Ultimately, the court decided in a 7-2 vote that the Constitution did protect a woman’s right to abortion, but that the government also had a responsibility to protect human life. As a result, the court concluded that abortions within the first trimester were legal.  

In the years following Roe v. Wade, there were many challenges to the decision. In 1992, the court issued another important decision in the case of Planned Parenthood v. Casey. Pennsylvania wanted to include a 24-hour waiting period in the abortion law. Another conservative court voted to protect abortion rights, but they also opened the door for states to implement their own restrictions.

Why is the Supreme Court Ruling on Abortion Rights Again?

The current case that is scheduled to be decided this summer is Thomas E. Dobbs, State Health Officer of the Mississippi Department of Health v. Jackson Women’s Health Organization. In 2018, the state passed an act that bans abortions after 15 weeks, which is significantly earlier than the 24-28 week standard outlined in Roe v. Wade. The Jackson Women’s Health Organization sued the state and two courts have already declared the law unconstitutional. However, the Supreme Court decided to review the case.  

While it can be difficult to wade through all the legalese, essentially, a decision to uphold the law would undermine both the Roe v. Wade and Casey decisions. Similar laws have been struck down in other states, but the recent leak of the decision draft revealed that the court plans to rule in favor of Mississippi.   

What Would a Roe v. Wade Reversal Mean for Nurses?

Nurses, along with other medical professionals who provide abortion services could find themselves being legally targeted by state laws. For example, a Texas law that is already on the books allows people to file civil lawsuits against providers. Alabama is also looking to enact a law that would hold physicians criminally responsible with a maximum sentence of life in prison. Essentially, a medical procedure that has been legally performed for decades could now put medical professionals in both civil and criminal danger and the laws and penalties would vary from state to state.

In many cases, nurses are the first point of contact and information for patients looking for information about reproductive health. As part of their own education, nurses are trained to provide comprehensive information and care to each patient. More restrictions around abortions have the potential to create a barrier that would prevent nurses from fully and safely executing their responsibilities.

What Would a Roe v. Wade Reversal Mean for Healthcare?

If the Supreme Court declares the right to physical autonomy is not an innate human right and not protected by the Constitution, then states would have the authority to decide their own laws and restrictions. Currently, 13 states have already passed “trigger laws” which would ban abortions the moment Roe is overturned. Inversely, 17 states along with Washington DC have taken steps to protect abortion rights.     

With different states and jurisdictions implementing different laws and restrictions, it is going to create a confusing landscape for healthcare providers to try and navigate. Some anti-abortion states are making sure that doctors won’t be able to transfer patients to other states to receive the procedure. If they violate the law, they could face a variety of consequences that would include taking away their ability to practice medicine. Ultimately, the healthcare system and providers will be facing a legal minefield.  

What Has Been the Public Response?

The American Nurses Association, American Medical Association, and the U.S. Department of Health and Human Services are just three major organizations that have made public statements in support of everyone’s right to make personal and private decisions about their reproductive health. As you might expect, people are taking to social media to share their own stories and opinions about this divisive topic.

TikToker Rocio Castillo posted a video talking about her own experiences saying, “I'm a woman who's had two abortions. It was hard, but I don't regret it." 

On Twitter, @allycatra87 asked “Overturning Roe v. Wade will not eliminate abortions. It will eliminate safe abortions. How many people will be injured and die because they couldn't choose their own path?"

While the leak regarding the Supreme Court decision was technically only a draft, it has set off a firestorm on all sides of the issue. The final decision won’t be handed down until the end of June or early July. Until then and well after, nurses, healthcare providers, elected representatives, and the public will be continuing the fight; both for and the right to make personal decisions regarding reproductive health.

Source: nurse.org



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