Though health care is always changing, people who work in it seem to find the process difficult. Not that I think health care providers are alone in finding change a challenge, but it is interesting that people working in these areas continue to work in them, sometimes feeling a lot of anxiety about change knowing that change is inevitable and will be on-going. It's not like say, working as a philosopher, where change might be a little less frequent.
I am in a new position again at work as educator, which is a good change, but of course comes with its' own stress adjusting to a new position, trying to learn a whole new set of skills, changing to non-shift work life (which is more difficult for me than shift work-I like longer shifts with more time off). Happily, this week after 2 weeks in my new role, I thought, 'I like this job!' This may be a new record for me as it takes me a long time to adapt to new things and I stress a lot about having to do new things perfectly. Nevermind that this is impossible.
So, how have I managed to enjoy it when usually I feel a lot more stress at this point in changing work roles/jobs?
I think I have forced myself to do different things even though they stress me out. I have worked on seeing mistakes as learning opportunities-clichéd, but necessary if I am to live with my errors. I have to tried to also admit, recognize when I have screwed up. I really hate doing this, it is terribly uncomfortable for me. Medication helps. Another big part of it is enjoying my area of work-working in the hospital in psychiatry is where I want to be, so switching roles within that environment, still means I am in a field of work that I love. I feel valued with the work I do and I feel that I can promote change, and I can see the change I am promoting! Though it is not without its' struggles, I do see it as benefiting patients in a meaningful way, which really makes me feel pleased.
On that note, a policy change which a group I am a part of, looks like it will be implemented within the whole health region-not just our little corner of it! I feel a huge sense of satisfaction with this-because even though implementing this policy has been stressful at times, it seems that others see it as a useful and patient centred approach!
Saturday, January 16, 2010
Sunday, September 20, 2009
CBT
I went to a workshop on CBT (cognitivebehavioural therapy) for psychosis this week and it was very well done. The presenter was a Dr from Britain and he was lovely-down to earth, funny, with a lot of good information. As he presented you could easily understand his perspective on mental illness/psychiatry-which was that the person with the disorder was the expert in their life and what they needed to be well-rather than the medical system telling people what they needed to improve things.
This is a perspective that I believe is sorely needed in health care and especially psychiatry. I suppose by my statement it could be presumed that *I* am the one calling the shots by telling health care providers what they need to do, but to be honest I think that ethics and ethical care are not relative theories based upon what each person deems ethical. I think that ethical care can be brought down to right/wrong, good/bad in some situations. We need to be gathering perspectives, respect different cultures, and respect individual choice, but in the case of people providing care I believe that there should not be an option in terms of whether following ethical practice. Too often in psychiatry I think that we dismiss the patient's rights/beliefs/thoughts/ choice and cover ourselves with the thought that 'oh, they can't decide that right now, they aren't capable of making that decision' and don't look for ways in which people can manage their own care. We have case conferences where everyone except the patient is there determining the course of their life. We force people to take medications that we ourselves wouldn't touch with a 10 foot pole and then wonder why they 'go off their meds'. We enforce blanket rules with little consideration for individual need and then wonder whay someone 'acts out' when getting frustrated. We certify people, taking away their right to move freely, make life impacting decisions about own health care and then wonder why they get mad at us and resist being involved in the health system.
I get frustrated when our college of nursing responds to poor ethical practice with the reply, 'well, you have to work within the system, it'll confuse the patient if you don't follow the system's way of doing things' even when the way of doing things does not fall within best practice, prudent nursing, or minimal ethical standards. Can someone explain to me how this is OK? Why is this allowed? Why aren't people fighting this?
Before you know it, I'll be the weird activist standing outside health care facilities with a sign, people giving me funny looks as they make a large circle to avoid me.
This is a perspective that I believe is sorely needed in health care and especially psychiatry. I suppose by my statement it could be presumed that *I* am the one calling the shots by telling health care providers what they need to do, but to be honest I think that ethics and ethical care are not relative theories based upon what each person deems ethical. I think that ethical care can be brought down to right/wrong, good/bad in some situations. We need to be gathering perspectives, respect different cultures, and respect individual choice, but in the case of people providing care I believe that there should not be an option in terms of whether following ethical practice. Too often in psychiatry I think that we dismiss the patient's rights/beliefs/thoughts/ choice and cover ourselves with the thought that 'oh, they can't decide that right now, they aren't capable of making that decision' and don't look for ways in which people can manage their own care. We have case conferences where everyone except the patient is there determining the course of their life. We force people to take medications that we ourselves wouldn't touch with a 10 foot pole and then wonder why they 'go off their meds'. We enforce blanket rules with little consideration for individual need and then wonder whay someone 'acts out' when getting frustrated. We certify people, taking away their right to move freely, make life impacting decisions about own health care and then wonder why they get mad at us and resist being involved in the health system.
I get frustrated when our college of nursing responds to poor ethical practice with the reply, 'well, you have to work within the system, it'll confuse the patient if you don't follow the system's way of doing things' even when the way of doing things does not fall within best practice, prudent nursing, or minimal ethical standards. Can someone explain to me how this is OK? Why is this allowed? Why aren't people fighting this?
Before you know it, I'll be the weird activist standing outside health care facilities with a sign, people giving me funny looks as they make a large circle to avoid me.
Saturday, August 22, 2009
Teaching
Who knew? So, I start teaching at the university! Psychiatry clinical to 3rd year nursing students-I have no idea what it will be like. I feel like it will be a good opportunity to promote the idea that mental health nursing is 1) not scary 2) found everywhere in nursing 3) a fantastic place to work. I don't think that everyone will agree with #3, but I should be able to reinforce #'s 1 & 2 and perhaps people will believe that psychiatry is Pretty Awesome.
It feels strange to be teaching-title is Clinical Associate. Maybe I need business cards?
I don't actually start with students until mid-Oct, until then I kind of hang out-go to some meetings and try to wrap my mind around what I will be doing.
I didn't think I would be teaching at this point in nursing, but I actually am quite excited about the prospect. I think it really does have to do with wanting to promote psychiatry as a great area to work in. People get so weirded out by it and there is a lot of stigma to overcome. As mental health professionals we don't do any favours by making comments at the nursing station that reflect poorly on our clientele. Honestly, I have been thinking about how to prepare students for that-appreciating humour and using it as a release while at the same time respecting patients all the time. Also to remind myself in the future that kind of talk is not appropriate-whether I am teaching or working as a floor nurse. Hmm, I already sound like a Matron.
It feels strange to be teaching-title is Clinical Associate. Maybe I need business cards?
I don't actually start with students until mid-Oct, until then I kind of hang out-go to some meetings and try to wrap my mind around what I will be doing.
I didn't think I would be teaching at this point in nursing, but I actually am quite excited about the prospect. I think it really does have to do with wanting to promote psychiatry as a great area to work in. People get so weirded out by it and there is a lot of stigma to overcome. As mental health professionals we don't do any favours by making comments at the nursing station that reflect poorly on our clientele. Honestly, I have been thinking about how to prepare students for that-appreciating humour and using it as a release while at the same time respecting patients all the time. Also to remind myself in the future that kind of talk is not appropriate-whether I am teaching or working as a floor nurse. Hmm, I already sound like a Matron.
Saturday, August 1, 2009
Private health care
So, surgery done on my knee finally and at private clinic a few days ago. There was actually no difference in care or even really how it looked, I thought. Perhaps a nicer bathrobe to wear while waiting to go into OR. And the OR had this huge bank of windows looking out on a lovely view.
Because my surgery was work related I got my surgery done quicker-I must remember to ask Dr how long it would have taken at private clinic.
I don't feel bad at all about having it done quicker as I was thoroughly sick of using crutches-but don't know if it had been coming out of my pocket if I would have paid for it. I guess considering that my wage is being paid while I am off, it didn't affect me too much but if I had to be without income it might have been another situation.I would've had to do a cost-benefit analysis. Plus I also justify that the longer I am off, the more it costs as the gov't in essence pays my wage. If I had said no, will wait in line with everyone else-wouldn't have been covered at all. Rationalizations.
Nurse who saw me preop did not help my pre-surgery anxiety. Seemed nice enough, but too high energy and said 'oh my god' 'if your finger starts going blue then it's time to cut off the ring. Your finger will swell during surgery' when looking at ring finger as I couldn't get my rings off. Thanks, I knew that. Finger is swollen because joint does this weird double jointed thing, ring is bent and finger got puffy from me trying to pull the damn thing off. My pulse remained at 113-if she thought it would go down after that reassuring discussion it didn't. As it turns out finger was fine. didn't become gangrenous. The nurse who showed me into the OR was much calmer and nice. After the 1st anxiety-provoking nurse left the room after giving Richard and I a bunch of post op instructions, Richard turned to me and said 'what do we do?'. Teaching was not absorbed.
Because my surgery was work related I got my surgery done quicker-I must remember to ask Dr how long it would have taken at private clinic.
I don't feel bad at all about having it done quicker as I was thoroughly sick of using crutches-but don't know if it had been coming out of my pocket if I would have paid for it. I guess considering that my wage is being paid while I am off, it didn't affect me too much but if I had to be without income it might have been another situation.I would've had to do a cost-benefit analysis. Plus I also justify that the longer I am off, the more it costs as the gov't in essence pays my wage. If I had said no, will wait in line with everyone else-wouldn't have been covered at all. Rationalizations.
Nurse who saw me preop did not help my pre-surgery anxiety. Seemed nice enough, but too high energy and said 'oh my god' 'if your finger starts going blue then it's time to cut off the ring. Your finger will swell during surgery' when looking at ring finger as I couldn't get my rings off. Thanks, I knew that. Finger is swollen because joint does this weird double jointed thing, ring is bent and finger got puffy from me trying to pull the damn thing off. My pulse remained at 113-if she thought it would go down after that reassuring discussion it didn't. As it turns out finger was fine. didn't become gangrenous. The nurse who showed me into the OR was much calmer and nice. After the 1st anxiety-provoking nurse left the room after giving Richard and I a bunch of post op instructions, Richard turned to me and said 'what do we do?'. Teaching was not absorbed.
Monday, July 20, 2009
Being a Patient
I have been crabby most of the day-feeling like I'm bored, but can't really do anything because of my knee not cooperating, don't want to read, crabby with Richard, wanting to get stuff done but can't really do much, slightly angry about that, and wanting to get out of house-though was out earlier and didn't really do much to improve my poor humour.
Which led me to think, 'so this may be on a small level what it feels like for some people who have a chronic illness'. I say on a small level because I know this will correct with surgery, I'm not really in any pain-only discomfort when I overdo it, and I have adequate resources to deal with the situation-I'm getting paid my salary, getting treatment paid for, and getting it quicker-jumping the queue because it is work related.
But..it does give me a good insight into how frustrating it is to have a condition impacting my ability to live normally-not able to do the things I used to take for granted, and seeing how it impacts my relationship with people around me. Having to ask for things that I was able to do by myself, and getting angry over having to ask. Getting used to not having things done in the time and way that I am used to. This makes me appreciate the difficulty and enormous life-changing circumstances that others deal with. What would it be like to be so depressed that I couldn't leave bed? How would it feel to live with hallucinations and paranoia that others were wanting to kill me? And to have difficulty processing information in understanding that it is an illness to begin with? How it would feel to know that others around you are tired of dealing with your illness and are questioning whether they can live with you and know that the disease is not going to go away? To deal with knowing that life will never be the same?
At a recent seminar I heard that people with a high IQ who live with schizophrenia are at higher risk of dying by suicide (and overall risk of dying by suicide if you have schizophrenia is high-according to several documents 10% of people with schizophrenia die by suicide-though some articles state that rate may be lower-5% and again several note that if living with schizophrenia-40% may attempt suicide-huge numbers) as when some people understand the entire impact that schizophrenia may have on their life-they are unable to manage the impact of this and suicide. Pretty sobering and frightening to think of how hopeless people feel when thinking of their future and what they will do in it.
How would I feel to deal with knowing that the entire way I had pictured my life was not going to happen? Of course, we all deal with life changing directions multiple times, and know that plans more often than not, will not be what we had thought. But coping with such a different direction? I think that as a nurse I have frequently not paid enough attention to the strength and resilience people demonstrate in living through and making a quality life with their diagnosis/disease/illness.
Which led me to think, 'so this may be on a small level what it feels like for some people who have a chronic illness'. I say on a small level because I know this will correct with surgery, I'm not really in any pain-only discomfort when I overdo it, and I have adequate resources to deal with the situation-I'm getting paid my salary, getting treatment paid for, and getting it quicker-jumping the queue because it is work related.
But..it does give me a good insight into how frustrating it is to have a condition impacting my ability to live normally-not able to do the things I used to take for granted, and seeing how it impacts my relationship with people around me. Having to ask for things that I was able to do by myself, and getting angry over having to ask. Getting used to not having things done in the time and way that I am used to. This makes me appreciate the difficulty and enormous life-changing circumstances that others deal with. What would it be like to be so depressed that I couldn't leave bed? How would it feel to live with hallucinations and paranoia that others were wanting to kill me? And to have difficulty processing information in understanding that it is an illness to begin with? How it would feel to know that others around you are tired of dealing with your illness and are questioning whether they can live with you and know that the disease is not going to go away? To deal with knowing that life will never be the same?
At a recent seminar I heard that people with a high IQ who live with schizophrenia are at higher risk of dying by suicide (and overall risk of dying by suicide if you have schizophrenia is high-according to several documents 10% of people with schizophrenia die by suicide-though some articles state that rate may be lower-5% and again several note that if living with schizophrenia-40% may attempt suicide-huge numbers) as when some people understand the entire impact that schizophrenia may have on their life-they are unable to manage the impact of this and suicide. Pretty sobering and frightening to think of how hopeless people feel when thinking of their future and what they will do in it.
How would I feel to deal with knowing that the entire way I had pictured my life was not going to happen? Of course, we all deal with life changing directions multiple times, and know that plans more often than not, will not be what we had thought. But coping with such a different direction? I think that as a nurse I have frequently not paid enough attention to the strength and resilience people demonstrate in living through and making a quality life with their diagnosis/disease/illness.
Friday, July 10, 2009
Waiting
No change in knee status-continuing to wait for WCB to approve claim or at least process it. Since surgeon is on holidays, doesn't really make much difference, since I can't have surgery anyway. I see why people get so irate at waiting for decisions etc. as I am getting so irritated with this process. Still on crutches, knee still locked. It is good to be reminded of how frustrating the process is when you are on the receiving end of healthcare. Nevermind that I'd much rather be on the other end. Sigh.
Got together to review the new protocols for monitoring patients after being secluded and having rapid tranquilisation (giving people meds to calm them down after being extremely agitated). It was a really productive session and I think that what we developed certainly will help in monitoring patients and make us accountable in our practice. The tricky part is going to be rolling it out-how will people respond to these changes?
I find it interesting how in a rapidly changing environment such as healthcare, there are so many people who resist change. I know that I don't always respond well to change, but I do try to recognize that it is inevitable in life, not to mention in an area such as healthcare. What is it that we resist? Fear of the unknown? Fear that we won't be able to adapt? Anger that the other way worked perfectly fine, why should I change? Nothing bad happened before, why change now? Complacency that it is too much work to change, the way we do it now works, why go to all the trouble to change it? Given that one of my requirements as a registered nurse is to consistently be evaluating my own practice and developing goals for myself on areas to work on, I feel I have no choice but to do that. I suppose since I have been nursing for only 2 years, maybe I'm used to always having to reflect on my work as I did it all through nursing-constantly being evaluated and constantly having to develop goals. I got tired of it, but in retrospect, it helps now as I don't mind asking for feedback on what I'm doing. Not that I am happy when I screw up, but I thinking I am finally able to see this as a learning opportunity, rather than a personal failure.
One of the great things about this committee is the positive patient focus and agreement that all the members have in working together to improve patient care, with similar ethical focus. Makes such a huge difference in committee work. Working in groups where everyone does not have the same focus or have other agendas makes group work loonnggg and painful.
My sister-in-law and brother-in-law are visiting and we were talking about my work and she said 'it's great to see how passionate you are about your work. You've really found the job you love'. It's true, I do, and I don't understand how others don't feel the same way. I think this can be a problem as I get impatient and angry with people who just 'put in their time' the whole time they are at work. I think a weakness of mine is lack of tolerance for nurses who I perceive as not putting enough effort into their job or not doing their job up to my ethical standards. This obviously is not so good when I sit in judgement because then I can't recognize that there are different ethical responses to situations. How though, do you accept something when you believe it to be against our code of ethics? And how can I maintain my ethical principles without wanting to change situations to fit within the code of ethics? How many ways can you interpret the principle of maintaining dignity and actually maintain that dignity?
Got together to review the new protocols for monitoring patients after being secluded and having rapid tranquilisation (giving people meds to calm them down after being extremely agitated). It was a really productive session and I think that what we developed certainly will help in monitoring patients and make us accountable in our practice. The tricky part is going to be rolling it out-how will people respond to these changes?
I find it interesting how in a rapidly changing environment such as healthcare, there are so many people who resist change. I know that I don't always respond well to change, but I do try to recognize that it is inevitable in life, not to mention in an area such as healthcare. What is it that we resist? Fear of the unknown? Fear that we won't be able to adapt? Anger that the other way worked perfectly fine, why should I change? Nothing bad happened before, why change now? Complacency that it is too much work to change, the way we do it now works, why go to all the trouble to change it? Given that one of my requirements as a registered nurse is to consistently be evaluating my own practice and developing goals for myself on areas to work on, I feel I have no choice but to do that. I suppose since I have been nursing for only 2 years, maybe I'm used to always having to reflect on my work as I did it all through nursing-constantly being evaluated and constantly having to develop goals. I got tired of it, but in retrospect, it helps now as I don't mind asking for feedback on what I'm doing. Not that I am happy when I screw up, but I thinking I am finally able to see this as a learning opportunity, rather than a personal failure.
One of the great things about this committee is the positive patient focus and agreement that all the members have in working together to improve patient care, with similar ethical focus. Makes such a huge difference in committee work. Working in groups where everyone does not have the same focus or have other agendas makes group work loonnggg and painful.
My sister-in-law and brother-in-law are visiting and we were talking about my work and she said 'it's great to see how passionate you are about your work. You've really found the job you love'. It's true, I do, and I don't understand how others don't feel the same way. I think this can be a problem as I get impatient and angry with people who just 'put in their time' the whole time they are at work. I think a weakness of mine is lack of tolerance for nurses who I perceive as not putting enough effort into their job or not doing their job up to my ethical standards. This obviously is not so good when I sit in judgement because then I can't recognize that there are different ethical responses to situations. How though, do you accept something when you believe it to be against our code of ethics? And how can I maintain my ethical principles without wanting to change situations to fit within the code of ethics? How many ways can you interpret the principle of maintaining dignity and actually maintain that dignity?
Thursday, June 18, 2009
Injury Prone
So, sitting on the bed today I again threw my knee out. While putting on my knee brace, turned slightly on bed, pop from the knee, can't weight bear again. So, this is an interesting situation-what is it like to be a patient? Go to GP, who kindly fits me in within 1/2 hour. Refers me to ER, as still haven't heard back from orthopedic referral-going to ER results in quicker referral process. Richard is wheeling me around in wheelchair, as other option is to hop everywhere. I go through triage process, surprisingly, I am seen by ER Dr. and out of hospital by 1 pm, after getting there at 1130. Amazing, I kind of think-given about hearing about long time spent in ER and I knew this wasn't a serious thing-as in losing a limb, heart attack kind of thing. Now I have referral to orthopedic clinic for Tues. and am on crutches. Which of course, means I can't work. On the whole, it felt like I certainly got quick, effective treatment. I have to say though, that I think people responded slightly differently knowing that I work at hospital-a bit warmer, this may be just my perception and not accurate though. Plus, having a claim makes it quicker, and I don't think it was all that busy there today. I feel kind of embarrassed about being a patient-it does feel like I am putting people out. Not to mention how I feel about being off of work-as I am supposed to work this weekend- I wish I could just go and do something there, but seeing as how even navigating the house is problematic, I don't think it is an option.
On a positive note-the previous owners of the house had a grab bar in the bathroom-for the grandpa who was living with them. This has already come in handy.
On a positive note-the previous owners of the house had a grab bar in the bathroom-for the grandpa who was living with them. This has already come in handy.
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