Remembering children and families in a humble moment of service, silence, and song.
Remembering children and families in a humble moment of service, silence, and song.

This weekend I sang in the volunteer choir at the annual memorial service organized by the hospital where I work as a staff nurse.  Having one voice in a choral ensemble is a mighty humbling experience.  Amplified by the emotion of looking into the eyes of an audience of bereaved families, I'm reminded that loss and grief can underpin some of our best efforts to preserve life.  I've written about how saying goodbye to patients at discharge can be one of the hardest parts of the job.  Harder, is saying goodbye at the end of life...to patients, and to grieving families.

As hospital staff, it is a privilege to extend our support to families grieving the loss of a child with the Ribbons of Remembrance service.  I'm so grateful for the efforts of our memorial service planning committee and our chaplains for hosting a service that reflects diverse beliefs and traditions.  Singing in the choir has proven to be a way for me to process the waves of loss, grief, and bereavement that come with this work.  It's not unexpected to witness loss when caring for critically ill children.  Nonetheless, you're never prepared for the moment of looking into the eyes of parents who have just lost a child.

My aunt is a nurse anesthetist.  She's shared a lot of moving accounts with me over her 45 years in practice...some for shock value, others for instructional value.  One case she shared that has really stuck with me was how she was told by colleague to deal with her first loss and move on, because her next case was coming in ten minutes.  She shared that story with me years before I was a nurse, and I remember wondering how she could in fact move on to the next case...in ten minutes, no less.  She explained that there's a job to do, that each practitioner has a responsibility to find ways to grieve these losses, and that hopefully, you're part of a compassionate team that offers a human touch in caring for one another.

The first time I witnessed a death in my nursing career, I documented the details like a slide show in a personal journal I keep. I pulled that journal off the shelf after attending this weekend's memorial service.  I wrote about the loss the day after it happened...right after attending a debriefing for providers. The journal holds a chronological play-by-play of what I witnessed, and the details of each caring and compassionate gesture extended by the mature care-team members who knew that I was witnessing death in my role as a nurse for the first time.

What the individuals on that care team did for me when I witnessed that loss of life was instructional in action.  One nurse got a blanket from the warmer and wrapped it around me with a hug.  Another told me to take a walk around the block, and to find her when I came back inside.  A surgical technician told me that he might look composed in the moment, but that when he got in his car, he would cry; for the team, for the family we were serving, and for the child we lost.

One of the chaplains at this weekend's memorial service held a special moment for the children where he read a story by Ellen Yeomans, Lost and Found.  The story is about death, told through the eyes of a sibling.  This young voice wonders why her parents say that her sister Paige died, but her grandparents say, "We lost Paige."  She wonders if she is still a sister, and if her sister is lost, can she be found?  In the end, she discovers that she will always be a sister, and that her sister can be found in memories of the heart.

Hearing this story while standing among fellow choir members at the Ribbons of Remembrance Service, looking out into the eyes of these bereaved families while singing, I was reminded that grief is processed in waves.  I am still a nurse to those children who we have lost.  These families who came to remember their children shine a light on the places we can find them in our hearts.

After the first rehearsal I attended in preparation for the memorial service, I cried in my car the way I sobbed on the drive home after being involved in my first case that ended in loss.  I was reminded that there's a place we tuck grief that re-opens over time.  I felt it open up again when I recently received a call from a nurse I've had the honor of mentoring over the past couple years.  She was sustaining her first loss in the patient-care setting.  We cried together.

Like so many other aspects of nursing, what helped me feel prepared to process this loss with my mentee was the human touch modeled by members on that care team who helped me begin to process the first death I witnessed.  Digging further back to the instructional value of my aunt's first account of dealing with a patient loss, I heard myself recount the advice that we have a job to do and a responsibility to find a way to process losses.  This journey has not been as lonely as I once anticipated, thanks to opportunities like singing in the hospital's choir and thanks to being a part of a compassionate team who cares for one another.

Editor's note: I've found the article, "Strategies for Teaching Loss, Grief, and Bereavement," in NURSE EDUCATOR, Volume 28, Number 2, March/April 2003 to contain some helpful exercises and resources on how caregivers can work together to process loss and find comfort in these most difficult times. 

I love hearing from readers.  How do you process loss in your career?  How do you practice self-care while extending care to the patients and families we care for in these most difficult times?  Please feel free to comment here or to reach out by email at: natalie@thereflectivenurse.com

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Editor's note: Double feature on the blog today in honor of Mother's Day!  Jenny Sackey's son Calvin is following in his mom's footsteps in health care career aspirations.  Some excerpts from a recent scholarship essay Calvin wrote pay special tribute to the insights he has gained from his mom. Beyond the meaningful reflections shared here below, Calvin's essay highlighted how he is channeling his life experience to find a volunteer opportunity to mentor biracial students who may be facing some of the challenges he either experienced or witnessed in his formidable years.  Calvin's remarks demonstrate that what we show our children in our actions will forever speak louder than our words.  Thank you to this mother-son dynamic duo for staging this Mother's Day blog takeover!       

UMD sophomore Calvin Sackey reflects on how his Mother, Jenny Sackey is always behind him.
UMD sophomore Calvin Sackey reflects on how his Mother, Jenny Sackey is always behind him.

"I am a sophomore in college majoring in biology, attending University of Minnesota – Duluth in pursuit of my dream to become a Physician’s Assistant or a Registered Nurse.  A lifetime of admiration for my mom has inspired my career aspirations.  A lifetime of watching her model the best advice she’s ever given me is helping me to reach my goals.

Before college, I remember receiving advice from respected coaches, teachers, and mentors who encouraged me to look at college as a full-time job.  I don’t think I fully understood the advice before getting into the context of university life, and I struggled to balance the new freedoms and responsibilities that seemed to be placed on me all at once.  I realized in my struggle that it was not just advice I needed to get me through the challenges, it was a role model.

Anyone who knows me well will tell you I have always been a ‘momma’s boy’ – I’ve always looked up to my Mother with immense admiration. While she was pursuing her Associate of Science degree in Nursing at North Hennepin Community College to become a Registered Nurse, she was also busy mothering three young children while working a full-time job as a Certified Nursing Assistant and trying to live a “normal” life as well. She consistently demonstrates that the only way to balance multiple responsibilities and to be successful is to develop a disciplined work ethic.

An important accompanying piece of my Mother’s best advice that has always helped me when making a decision is to ask myself, “How will this affect me in 10 seconds, in 10 days, and in 10 years?” My Mother modeled this advice.  By way of watching her overcome the challenges related to balancing so many caregiver roles, I’ve seen her model the advice to look at balance as a full-time job.  It is from my Mother where I was inspired to learn and mimic her work ethic and to follow in her career path. More, it is from my mom that I learned that it is my duty to pass what I have learned through experience to help others when they are struggling to have their brightest future possible."

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Jenny Sackey
Jenny Sackey, RN, ponders the dynamic topic of disparity in this guest reflection.  Inspired by hearing a local physician speak in her place of faith practice and her place of nursing practice, Jenny listened with her head and her heart to statistics and to a message she is responding to with this guest blog reflection.  Read on to see how Jenny processed questions about racial disparity that she is now posing in her practice.

On a recent Sunday morning, my husband and I headed into town for one of our favorite weekend activities: Sunday service at St. Joan of Arc church.  I was particularly enthusiastic to hear the featured guest speaker this occasion, Dr. Stephen Nelson, a local pediatric hematologist-oncologist.  His talk, 'Racial Disparities in Health Care,' was right up my alley!

Dr. Nelson was given all of about 15 minutes to express his message.  He did not disappoint.  A few compelling statistics coupled with his insights on biases left me with one question: why?

Why do we make judgements? How do judgements impact our subjective assessments – especially in a clinical environment? What is at the root of our categorical assessments based on race?  These questions swirled in my mind in the context of being a nurse, a mother, and a citizen.

Dr. Nelson offered a comparison scenario: caring for a child of a 17-year-old single Black mother from North Minneapolis versus caring for a child of a Caucasian mother from Edina.  He admits to catching himself making those quick judgements towards the 17-year-old Black mother. "Does she have insurance?  Will transportation be a barrier to make appointments? Will she comply with treatment plans?"  Dr. Nelson’s transparency helped me shift my question from why to whatWhat do I do with the recognition of biases I’ve discovered?

Soul stirring talks like Dr. Nelson’s – receiving a message that marries my values with my faith while forcing me to evaluate how my convictions are exercised in my career…this is what privilege feels like.  Being in a moment where I can look at the gaps that exist in our society, and thinking about how those gaps impact societal values, faith, and conviction...I felt truly privileged to entertain all these thoughts.  I told my husband that we had to stay to meet this speaker.  I had to thank Dr. Nelson for pushing the envelope on my thoughts.

The line to meet and greet was long and the opportunity to express my gratitude felt swift.  Upon meeting and sharing with Dr. Nelson that I am a nurse - and that his talk would impact my practice, he asked where I worked.  What a treat to learn next that he was scheduled to come and speak at the hospital where I’m employed!

Fast forward three weeks.  I went in on my day off to hear Dr. Nelson expand his experience with confronting racial disparities in health care in a different dynamic environment: my workplace.  The context of hearing what he had to share in my place of faith context held up now in my place of employment was rich.  There was more time at this presentation – and I was astounded by the unabridged variety of examples Dr. Nelson shared to illustrate the struggle of racial disparity in this nation and in my home state of Minnesota. I’ll try to recap some of the examples from my notes (without specific citation) that were hardest for me to digest.

  • I would not have guessed that Minnesota has one of the highest rates of racial disparity in the US.
  • Minnesota is a national leading state for education. Yet for our African American population, the 4th grade reading level is the same as in the state of Mississippi (who has less dynamic educational outcomes to herald). Fourth grade level is a significant turning point for students transitioning from word recognition in reading to reading comprehension.
  • African Americans have a 3:1 unemployment rate ratio.
  • There are 10 times as many African Americans incarcerated versus Caucasians.
  • On any given day in Minnesota, a Black person is 20 times more likely to be stopped for a traffic offense than a white person.
  • African Americans have a higher infant mortality rate.
  • African Americans wait longer in the ER than a Caucasian patient.
  • It takes 3+ hours longer for the African American to go to the the ER for an injury v.s. a comparable injury that a Caucasian patient would go to the ER for, likely due to socio economic barriers.
  • It takes 20 minutes longer for the hospitalized African American patient to receive pain meds when calling out for them.
  • In 2004, there was eight times the financial support for Cystic Fibrosis research (majority Caucasian persons-affected disease) versus Sickle Cell Disease (majority Black persons-affected disease).  Sickle Cell Disease also has a higher population of patients than Cystic Fibrosis does. Today, there is 11 times the financial support for CF.
  • There has been a decrease in Black Registered Nurses and Black MDs from the University of Minnesota. Last year, The UofM graduated one Black doctor.

I felt a rush of emotions as I listened to these statistics, took notes, and considered what I was hearing in relationship to the privileges I’ve appreciated as a White female.  I felt disheartened and almost guilty.  Since hearing this impactful message from Dr. Nelson that day, I’ve been moved to channel the impact of the chord that was struck in my personal and professional life as a nurse.  I strive to be more intentional.  I follow Dr. Nelson’s plea to anyone pondering privilege to ‘lean into’ observations of disparity.  My hope is that with my newly heightened awareness, I become more active in my voice against racial disparity and less tolerant of observations to this end.

This topic also has immeasurable impact on my personal life.  I am the wife to a kind-hearted African man.  I am the mother to three beautiful biracial children, and the grandmother to one adorable biracial grandson.  I work with intelligent, talented, African Women, and I have many African friends I hold dear.  I’m deeply saddened to consider how the aforementioned statistics have or might impact their lives.  As I read this post to my husband to seek his thoughts, he said, "It's very simple. Treat others the same way you would want to be treated."

Can you reflect on a time when you have witnessed racial disparity in health care?  Think about how that realization felt. Could you have leaned in to make a difference in yourself or in the situation? It's never too late.  Please, lean in.  Please, ask why.

Please, ask, “What do I do with the recognition of biases I’ve discovered?

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Editor’s note: Jenny Sackey has been a Registered nurse for nine years. Jenny went back to school to complete her nursing degree while she was raising a family, as it was always her desire and goal to be a nurse. Prior to going back to school, she worked many years as a nursing assistant for Presbyterian Homes and Services. Her first job as a Registered Nurse was at North Memorial Medical Center on the Mother Baby unit, where she worked for three and a half years.  It was always her dream to work with new moms and babies. In 2010, Maple Grove Hospital opened.  Jenny had a strong desire to be a part of that new hospital, and soon thereafter accepted a position in the Family Birth Center.  This past year she accepted a position as a PCF, (Patient Care Facilitator), a leadership role for the unit. Jenny loves being an integral part of this fast paced unit, and will tell you she has the best colleagues to be found.  She is honored to be a part of her patients and families birth experience.  Jenny describes this as being privileged to be a part of one of the most special life events a family will ever encounter.  Jenny never loses sight of the privilege of impacting this precious milestone in patient and families’ lives. 

Mercy Hospital, Coon Rapids, was among countless institutions who featured a ceremony to collectively honor upwards of 30,000 organ donations that occurred in 2015.
Mercy Hospital, Coon Rapids, was among countless institutions who featured a ceremony to collectively honor upwards of 30,000 organ donations that occurred in 2015.

Editor’s note: The Reflective Nurse supports Donate LifeNational Donate Life Month (NDLM) is recognized each year in April, featuring an entire month of activities to help encourage Americans to register as organ, eye, and tissue donors. Reflecting on NDLM 2016, I’m grateful for receiving my first invitation to a Gift of Life Ceremony by way of my friend Tanya, a LifeSource Ambassador who shared her family experience with organ donation at the Gift of Life Ceremony at Mercy Hospital, Coon Rapids, this past week.  Tanya and I took pause to merge and ‘dual sig’ the following reflections on this moving event.

DonateLifeLogo Color PMS

My reflection:

Epictetus said, “It’s not what happens to you, but how you react to it that matters.”  Insightful guy that Greek philosopher, Epictetus.  What a moving privilege in this life to see people bring this insight to fruition.

I’ve written about my dear friend Tanya, who serves as her mother’s primary caregiver in the journey through a heart transplant that happened earlier this year.  A nurse with critical care experience at the bedside, Tanya has confided private details of her latest critical care experience: providing primary care for her mother.  I am consistently moved by how she has reacted to all that’s happened to her mom, to her immediate family of five, and to herself on this road that has required an all-terrain approach.  So when she asked me to come hear her speak publicly about her passion for sharing the message, “Donate Life,” it was kind of a no-brainer.  I was there.

In the 20-some months since Tanya’s mom learned that she needed a heart transplant, Tanya has reacted with a posture of propelling most of her work and volunteer efforts toward the cause of donating life.  She donates blood.  She made a shift in her nursing career to have a hand in the critical, behind-the-scenes work of bone marrow transplants.  And she volunteers in the community as a LifeSource Ambassador, giving public speeches about becoming a donor.  It’s not what’s happened to Tanya, it’s how she’s reacted to it that matters.

The opening remarks made by hospital administrators at Mercy Hospital’s Gift of Life Ceremony heralded the life-giving power we can sustain once we’re gone.  We have a choice to become a donor and to make that wish known on our licenses and to our loved ones.  But why would we do that?  Enter the personal stories shared by Tanya, daughter of a heart recipient, and Brian Salisbury, cornea recipient and donor father.  Different accounts but same message: the foresight of reacting to loss of life by giving the Gift of Life was what we were all present to honor with donor families at this moving event.

The, “Donate Life” flag was raised in front of Mercy Hospital to close the Gift of Life Ceremony.  Names of the five donors cared for at Mercy Hospital this year were read, and we paused in a moment of awe for the twelve lives that were changed forever for receiving the Gifts of Life given by these donors. Donating life does not remove the pain of losses sustained.  But there is power in knowing that in moments of great loss, we can give great gifts.

My reflection on this event is dedicated to my friend Tanya, who has reacted with her whole heart to express gratitude for the heart her mother received.

Tanya's reflection:

“I was honored to be asked to speak at the Donate Life Ceremony this week at Mercy Hospital to celebrate Donate Life Month.  When the email came through, I replied and accepted with only enough pause to ensure that it wasn’t a night with 4 kid activities (only 3!).

I have only had the opportunity to share our story of organ donation on one other occasion, in a completely different setting.  In December I spoke in a hospital setting to a very small group of new ICU RN’s who were receiving their required training on when to initiate a call to LifeSource.  I am a nurse, so I felt safe and secure speaking to a group of peers…a small group of peers! I brought photos and choked back tears through almost the entire time I spoke. Speaking of my speaking; I plowed through my story at a blaring speed and I don’t even know that they were able to decipher my words. They did see my tears, they did see the photos I brought, and I did see one RN wiping away tears.

This upcoming speaking engagement would be very different. Speaking to donor families, recipient families, and hospital staff. They anticipated a group of around 50 people.

When I spoke in December, it felt good to talk. It allowed me to give something back while waiting for this gift. I was able to share the story, spread the word, share the hope and stress the importance of nurses in caring for those who are waiting.  Putting a face to the story of transplant.

Fast forward to this past Thursday. I felt rusty. I felt unsure and I was a ball of nerves. Frankly, I asked more than once, “WHY did I think I could do this?”  I hadn’t spoken since my mom received her Gift of Life. And can I tell you, it has been a very long road post-transplant. I was terribly worried that if I shared the story, the journey, and the challenges of recovery, I would make a donor family feel that in some way I (*we) were ungrateful for this tremendous gift.  In addition, I was moderately terrified that our donor family would be in attendance.  I would hate for the dates to line up and have something click when they heard my story. So I made the timeline vague and hoped for the best.

Upon arrival I saw the LifeSource hospital liaison I know (she’s awesome), and the chaplain (also quite incredible). Both came over to say hello and I met my fellow speaker who was both a Corneal Transplant recipient and donor father.   Things were falling into place.

I was very nervous before I spoke. Heart pounding, shaky knees, quivery voice.  I was grateful that Natalie agreed to join me at this event.  It was calming to know that I was not alone in this big auditorium and to know that someone believed in my ability, my story, and my strength.  As I continue to find my voice and what this life experience is teaching me, I am so grateful she has been willing to encourage me and hold me up on terrifying days just like this.

I was the 4th speaker, following two medical directors from the hospital.  I had written a long, detailed account of my mom’s journey to transplant (3.5 pages single spaced. Seriously?!)  Of course, upon standing in front of this room full of donor families, my reading completely went out the window. I paraphrased, jumped all around, and skipped some rather pivotal pieces (in my opinion) of our story.  I choked up twice. Twice? No, maybe thrice. Be that as it may. I didn’t make a big, ugly cry face. (Also a huge concern) …I was able to keep sharing.  I had revised my story on the train just 2 hours before and as I closed I was so very grateful my very jumpy and emotional brain remembered what I had added so hastily on the train.  I think it was the very most important part of our story and I think it was so important on this, of all nights to say:

“As I acknowledge every milestone in my mom’s healing from her heart transplant; one month, two months…I hold our Donor Family in my heart, as they too are acknowledging their own milestones in loss and healing.”

What I find more important than sharing our story leading to transplant is ensuring all donor families know that their decision and gift means something. Not just that day, but every day. The day of transplant I thought of our donor family all day.  The day after, and every single milestone I noted for my mom’s recovery, I have held the family with me as they grieve and heal and miss their beloved family member.

I am so very honored to share our story, to express gratitude for the Gift of Life, and to hopefully sway one more person to have the conversation with those they love before they find themselves in a dire situation.

Please, Donate Life.”

Editor's note: I love hearing from readers.  I'd especially love to hear your account of participating in lifesaving actions as listed and linked below! Are you a donor?  Do you give blood?  Have you considered joining the Bone Marrow Registry?  Opportunities to Donate Life abound.  I welcome your comments here, on Facebook, or, feel free to reach out to me at: natalie@thereflectivenurse.com

Register today to be an organ, eye and tissue donor

The need is constant. The gratification is instant.  Give blood.  (American Red Cross).

Take your first step to being someone’s cure by joining our bone marrow registry today.  (Be the Match).

Be a LIFESAVER.
Be a LIFESAVER.

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This is not just a t-shirt. Still Kickin is a vibe. And there are heroes behind these words.
Still Kickin is building a braver, more supportive world. One shirt, one person, one workout at a time.

Go to Still Kickin on the web and you can read about how this 501(c)(3) non-profit organization started with a tee shirt.  This is not a, "been there, done that, got the tee shirt" reflection.  This is a reflection inspired by Still Kickin founder, Nora McInerny Purmort, who gave the talk, "I HAVE NO IDEA WHAT I'M DOING" at THE COLLECTIVE, a LAB pop-up event at Loring Social in Minneapolis, this weekend.

Nora's talk was an account of how she became a widow, wrote a book, and started a non-profit in one year.  Her candor and delivery style is witty, honest, and refreshing.  After hearing her speak on this one occasion, I'm already pre-ordering her book, It's Okay to Laugh (Crying is Cool, Too) and I'm marking my calendar for her book launch party on May 24.

There was a message Nora illuminated in her talk that really resonated with me and the nurse pal who invited me to the event. The message felt akin to the privilege of being a nurse or a caregiver who comes into peoples' lives when they are going through a crisis.  "You can fall through space and strangers can catch you," Nora said.

Nora tells about the backstory and the future of 'Still Kickin' in her talks and on her website. These words were displayed on the vintage tee shirt her husband was wearing the day he had a seizure that lead to three years in treatment for brain cancer.  The rest of the story is a compelling account of how people they know were joined by strangers from the internet in fundraising activities that exceeded their needs.  And now Nora revisits that catch she eluded to by facilitating the same kind of efforts for Still Kickin Heroeseach month.

This is where that message about strangers catching strangers resonates with caregiving professions...and wow, that's a humbling part of the job.  We're the ones who might meet you for the first time when you show up in our emergency department, when you come back to our unit after an emergent surgery, or when your child is diagnosed with a condition that will change their course and yours.  And we go from zero-to-sixty with you.  You are a stranger, but we do what we can to catch you. And here's the thing, you catch us, too.

You amaze us with your willingness to let us into such private, guarded, uncharted moments in your life.  You catch us by showing resilience, or maybe by exuding strength in honest tears, and by moving on with diagnoses that are hard to live with while we are simply trying to support you.  We catch each other in some of our most personal and professional moments of vulnerability, and that's where the healing relationship begins.

As a nurse, I see the context of tragedy in the immediate moment of diagnoses, in the acute care phase of an illness, and in maintaining necessary boundaries to protect patient and professional privacy. Our relationship ends with discharge, but we don't stop caring about patient and family outcomes at that juncture.  We are privileged to walk part of the path with you but we don't ever see (in full color) the layers outside the walls of the clinical environment where we meet.

But there are universal truths in what patients and families have to say about what they are going through when illness strikes.  And just like a patient/family panel is always my favorite part of conferences or continuing education offerings, I took so much away from reading accounts springing from Still Kickin heroes, like Scott Serene's on thisdaddys_blog authored before his death.  I'm profoundly moved by the universal truths I can read into the experience of a patient I don't know because of what I've seen people endure on our leg of the journey together.

This post is dedicated to patients and families I have and have not known, to caregivers like my friend Ashley who recognize the value of getting to talks like Nora's to stay inspired in the work we do as nurses and humans, and to the Still Kickin vibe.

I love hearing from readers.  Please comment here, on Facebook, or reach out to me at: natalie@thereflectivenurse.com to reflect and connect. 

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Mary Mueller, BSN, RN, enjoys a daily meditation practice that she carries with her in her travels and in her 40 year career as a pediatric nurse.
Mary Mueller, BSN, RN, enjoys a daily meditation practice that she carries with her in her travels and in her 40 year career as a pediatric nurse.

I recently got a gentle order from my doctor to look into Mindfulness Based Stress Reduction (MBSR) as an approach to help overcome some of the health issues I’ve been facing this year: severe asthma exacerbations, migraines, and GI distress. My physician extolled the virtues of reducing stress in relationship to boosting the immune system, being more in touch with the warning signs our bodies give us when we are getting ill, and being more in touch with ourselves to in fact heed those warning signs when they come -- instead of pushing through to the point of illness. I know of two dear friends and nurse colleagues who have done the 8-week MBSR training, and of course I reached out and shared my MBSR prescription with both of them. One of those women is Mary Mueller, a nurse mentor and colleague I’ve known since before I knew I wanted to be a nurse! When I told Mary I was going back to school to become a nurse, she generously gifted me the stethoscope she used in nursing school and a starched white nurse hat.

When I told Mary I was planning to enroll in an 8-week online Mindfulness Based Stress Reduction program, she generously gifted me the following insights:

“Before taking the Mindfulness class by Jon Kabat-Zinn, I had some experience with meditation through Yoga. I noticed how calm and peaceful I felt even after 5 minutes of laying on the floor on my Yoga mat. I also had difficulty dealing with the stresses in my life. I am a reader, loved reading self-help books, read so many books about meditation, Buddhism, ways to look at my life in a healthier way. I visited some Meditation Centers in the Twin Cities, took a meditation class at one. It was difficult to motivate myself to have a formal practice at home or use the meditation in my daily life. I saw this class listed in the Wellness Center at Penny George Institute of Health and Healing and decided to give it a try, especially since it came with Nursing CEUs and I used MNA money to pay for the class.

It truly made a huge difference in my life. The course made me really understand what meditation is, and how to create a daily practice. For me, meditation is becoming aware of how I was reacting to all the stresses and experiences in my life. Here's a list of most important realizations:
• I have learned how to love accept and be kind to myself. To be aware that I already have everything I need inside of me to be happy and content with me and the life I have created.
• I am not my thoughts, my thoughts come and go and I can let them go, go on to another thought and while I am sitting meditating I can give myself permission to sit with a thought, look at it say " oh that's an interesting thought", then go on to the next thought. I do not have to jump up and fix or react to the thought. I can observe it, be with it, and know that it is only a thought.
• I can be in the moment, then when my "monkey mind" starts off on a worry, rumination of past mistakes, regrets, future worries, anxious thought, i can notice what my mind is doing, and change my habit of staying with that anxiety or worry. It is a habit. I can let it rest, visit it another day, and go back to being in the moment, meditate on the breath, another thought, an object I see, or a sound I hear. Then when my mind wanders again I can recognize it happening, kindly say, "oh my monkey mind got me again," then each time it happens I am kind to myself, bringing the thoughts back into the moment, and continue on. I don't need to criticize myself, beat myself up. I can give loving kindness to me as I do with others.
• There are many people around me who struggle with the same sufferings and anxieties, we can all support each other, this life is about connecting to all around us, we are all in the same boat. We can accept and honor each other in this journey. We all want happiness, we all have basic goodness, and we all want to be free from suffering. We are in this together. This is comforting and calming. Meditation is not just about me sitting on my cushion. It’s about me taking care of myself with the intention of then being able to care for others. I think about that intention every time I meditate and it is very comforting.
Meditation has allowed me to accept myself as I am, and to take care of myself FIRST and then be kind and genuine to others. I am by no means perfect, I still have days where I get depressed, anxious, overwhelmed. Some days I do not know why I am even sitting there meditating, I do not understand in many ways why this works. But I see myself getting back on track more quickly and feeling more joy and appreciation and gratitude for all that is good in my life. We do not need to be perfect, just able to love and be loved. And be aware of all around us.”

When I asked Mary how mindfulness and meditation practices have affected her nursing practice, she offered this:
“Oh my gosh, meditation and mindfulness have greatly impacted my nursing care. I've learned how to take care of myself so I can genuinely care of others. I am more focused throughout the day. Nursing is all about thinking of others, what do they need now, what will they need when they are sent home, how do they feel, how can I help them relieve their pain. If I am mindful and aware of my needs away from work, I can be more mindful at work. If I am compassionate and kind, less judgmental to myself, I know then how to be that way with others. It's like I am practicing the art and science of caring for myself. Then, I can practice care on others. If I notice my thoughts, my feelings, and my responses to stresses, I can notice them in my patients and families and respond more effectively.

I have a formal meditation practice for 20-30 minutes a day. During that 20 minutes, I notice, I observe, I am aware of what is happening in my mind, my feelings, and my thoughts. I pause, I listen, I look, I hear. I then am able to notice and be aware of what goes on throughout the rest of the day. I have more tools in my box to cope with the stresses and chaos in life, both at work and at home. I have a more balanced life. To be a nurse, the balance is necessary.”

Mary's caption: I'm pictured here (right) with my very long time friend. We met in nursing school, 44 years ago. She is now a Nurse Practitioner with many degrees including one in Alternative Health and Healing. She lives in NYC, we talk all the time, about life, health and meditation. This picture is the two of us at my daughter's wedding, on the sandy beach where the wedding ceremony took place. It was lovely.
Mary's caption: I'm pictured here (right) with my very long time friend. We met in nursing school, 44 years ago. She is now a Nurse Practitioner with many degrees including one in Alternative Health and Healing. She lives in NYC, we talk all the time, about life, health and meditation. This picture is the two of us at my daughter's wedding, on the sandy beach where the wedding ceremony took place. It was lovely.

Editor’s note: Mary Mueller, BSN, RN, graduated with a BSN in nursing from University of Wisconsin-Milwaukee in 1976. She has been a pediatric nurse for 40 years at the time of this publication. Mary spent all but one year of her nursing career in a hospital setting. Her one-year break from hospital nursing was in 1978, when she was a VISTA Volunteer (domestic Peace Corp) in South Texas working with children of Migrant Farm workers. Mary has worked at Children's Hospitals and Clinics of Minnesota for 27 years. She started in the Special Care Nursery/NICU, migrated to the Float Team for 14 years, and is presently working in the Surgery Center at Children's/Minneapolis. Mary has been married for 34 years to her best friend and soulmate, Terry Dussault. Their family consists of three adult daughters; Emily, and husband Tanner, Lauren, and husband Chris, and their youngest, Carolyn, is a senior in college. Mary clearly lives the breadth and depth of her life and I am so grateful for the rich and insightful reflections she shared in the above guest blog post.

I love hearing from readers.  Share your comments here, on Facebook, or reach out to me at: natalie@thereflectivenurse.com

Gut check selfie.
Gut-check selfie.  Listening for bowel sounds in the lower left quadrant on post-op day one...been there, done that.

Admit it.  If you're a nurse, you've probably busted your stethoscope out to listen to your kid, your spouse...and maybe even yourself?  I recently caught myself - and caught up with myself in the same moment.

Here's the backstory.  I've logged more time as a patient than as a nurse in the last six months, to include a surprise cholecystectomy (gallbladder removal) on April 1 - no foolin'.  Last week at my post-hospital follow-up appointment, my Primary Care Provider suggested I seek out a Mindfulness Based Stress Reduction program for its scientifically proven benefits for others who have struggled with the chronic issues I've been wrestling: asthma, migraines, and GI distress.  I'm committed to a nursing practice that starts with self care, so the notion of tapping into an internal resource to help heal what's ailing (among countless other benefits) had immediate appeal.  Add to that, two friends and nurse colleagues I hold in high regard have taken MBSR training and offer rave reviews...stay tuned for a guest post later this week!

There are upwards of 700 venues to take MBSR, worldwide.  Fluidity in time, cost, and flexibility are paramount for my participation at this juncture.  After a little surfing, I've landed on an online venue that is modeled after the University of Massachusetts Medical School's program founded by Jon-Kabat-Zinn, generously offered at no cost by a proclaimed, fully certified MBSR instructor.  Thank you, Dave Potter at Palouse Mindfulness for sharing this gift!
Foreshadowing?
Foreshadowing?  Pulling this title forward on my bookshelf among other activities to get in the mindfulness mood this week.  Note, this is not required text for the MBSR training.
I've started printing my MBSR Manual and reacquainting myself with the study of mindfulness this week - to include dusting off a book in my home library that I bought some 22 years ago, Wherever You Go There You Are, by Jon Kabat-Zinn, referenced founder of The Center for Mindfulness in Medicine's Stress Reduction Clinic, the place of origin of MBSR.
Care to join me on this 8-week online training in Mindfulness Based Stress Reduction? 

The price is right (free!) and you can access the course content and practices from anywhere.  This is my first foray into creating a discussion group around a topic that matters to me personally and professionally.  I'd love some company (and accountability) for the ride!

You can follow the highlighted links above to the free online course offering or seek out a venue or offering that resonates with you.  As I mentioned, there are upward of 700 venues, many offering live, instructor lead content and many offering CEUs (with potential for reimbursement for those who have education dollars to spend).

I plan to start my 8-week course this coming Sunday, April 17.  I'm told to account for about 30 minutes of practice per day during the two-month training, and to include a little extra time for watching video resources provided on 'day one' of each new week in the program.

Feel free to comment here, on the Facebook post, or email me at: natalie@thereflectivenurse.com to jump into the MBSR dialogue at any time over the next couple months!  I'll be creating a Facebook group to log weekly progress and anecdotal findings along this 8-week path to Mindfulness Based Stress Reduction.  Please reach out in any of the aforementioned routes to connect and request an invitation to the group.

Caregiver stress is real.  We can easily lose sight of self-care as we dole it out to others.  Hindsight, my tenacity in pushing through some of my own health issues to keep caring for others escalated matters to a state of health that was sub-par to the outcomes I aspire to deliver others.  As a nurse mentor recently reminded me, "You can't pour from and empty cup.  Take care of yourself first."

I think that nurses and caregivers of all kinds get very good at operating with our gas lights on.  Join me for this opportunity to fill the tank and to stop running on fumes.  Here's to starting best practice with our own self-care!

Natalie

PS: You need not be a nurse to join this dialogue or MBSR training!

Auscultation serves the science of nursing, and listening serves the art.
When I listened to my heart this fine Valentine's Day, I heard poetry.

My passion for playing with words is how I've come to reflecting on practice with this blog.  Today is Valentine's Day, so I'm inclined to reach for poetic inspiration in my reflection.  I had so much fun scratching out the following haiku:

Reach out, stethoscope:

extending from ears to heart,

listen to this life.

Nursing is often described as a science and an art.  Science drives the need to re-certify in basic life support every couple of years. I like to think that having a practice for creative expression is equally important.

I know a lot of nurses (and partners in healing) who have a creative practice outside of their professional practice.  Knitters, quilters, scrap-bookers, painters, chefs, and others.  Have you discovered how your creative expression overlaps with your professional practice?

An explanation and how-to on haiku is offered on a favorite writer's resource of mine: Creative Writing Now.  Check it out and give your hand in poetry a whirl with three little lines inspired by Japanese verse.  I love hearing from readers.  Share your prose or poetry here, on Facebook, or at: natalie@thereflectivenurse.com

 

 

 

 

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Yeng Yang, MD reflects on sharing a stage with nurses and other members of a cast and crew in what she describes as practice in a medical theater.
Yeng Yang, MD reflects on sharing a stage with nurses and other members of a cast and crew in what she describes as practice in a medical theater.

 

I am not a nurse and yet I am intricately tied to nurses in all that I do, in direct patient care and in the many aspects of my other nonclinical duties at the hospital. Even in my health care MBA program, I am interacting with nurses.

What I am thinking about is the relationship between members of the medical team and our abilities, or lack there of, to be truly present for our patients and each other. A patient is not cared for by just the physician or the nurse alone; there is a myriad of other teammates who interact with our patients and with us in order to create a symphony of care. Delivering great and compassionate health care is like live theater; it needs actors (medical personnel), a well-designed set (unit), and the stage (health environment/hospital). I find that the “medical theater” delivers its best performance when the cast and crew have presence of mind, when we commit to teaching and learning from each other in practice, and when we keep our patients center stage.

It has been shown that when team members act rudely or disrespectfully, a team performs poorly, whereas when team members act more positively or receive positive encouragements, it performs well under pressure. I have found many examples of performances that do not uphold best practice. Poor performance is often rooted in the stress of practice.

In a perfect system, our attention can be devoted to one thing at a time with presence at all times. We do not work in a perfect system.  But we can choose to be the best version of ourselves in practice with each other and furthermore, in practice with our patients. We easily spend more time together as staff than we do with the patients and families we serve. It is important for us to model positive behaviors of care giving for each other as we cohesively deliver care to others.

I hope that as practice evolves, we can all perform with patience and respect towards each other. One of my professors said that in order to promote growth in those we lead, we not only have to meet them where they are at, we need to truly care about them and their development.  I have found this to be true in my relationships with those whom I lead and with my colleagues. Our patients deserve the best versions of us when we deliver care at the bedside, their most vulnerable moments.  When we commit to delivering care to each other, it ultimately reaches the patients and families we serve.  That's the brand of care delivery that merits a standing ovation.

Yeng Yang, MD, FAAP, is Director of UMP Pediatric and Newborn Hospital Medicine at Maple Grove Hospital.

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Hand-stamped notecards covered my dining room table last August. Loving messages were written for a woman who was waiting for a heart. Yesterday she got that heart, and these notecards are going in the mail to decorate her hospital room.
Last August I hand-stamped a dining room table full of notecards the night before a benefit, Picnic with a Purpose. Loving messages were written by guests at said benefit for a woman who was waiting for a heart. Yesterday she got that heart, and next week I'll hand deliver these notecards to her - and to her new, grateful heart.

I work for a hospital that is sponsoring a wellness program that launched today: Attitude of Gratitude.  This self-accountability activity is one that aims to foster a grateful heart.  Tonight I reached out to a dear friend whose mom received the gift of life yesterday - a new heart.  I asked my friend if I could dedicate a blog post to her and to her mother as I reflect on fostering a grateful heart.  I'm so glad she said yes.

Two years ago Saturday I received a call from my friend Tanya.  She had just received the news that her mother needed a heart transplant.  For two years, I have watched Tanya and her mother do everything humanly possible to prepare for receiving this gift of life.  The to-do list was not short, nor for the faint of heart, but even with a heart that was failing her, Terry Olsen took stride to become the best steward she could be for an organ given by another soul.  And her daughter Tanya kept pace at her side.  Let me tell you one of the most heartfelt stories of gratitude I've ever witnessed.

A fellow nurse, I witnessed my friend Tanya read and research with a scientist's eye, the process and procedure she and her mom were preparing for.  She made countless drives with her mom to appointments, often leaving home before sunrise and returning after sunset.  She made and packed sandwiches and snacks to sustain long days of appointments and the miles between home and the facility where things were first scheduled to happen.  Then, she stood by her mother in seeking out a program and facility closer to home to endure transplantation.  This Sunday morning she met me for pancakes just three hours shy of her mom going into surgery to have her heart transplant, and I am so grateful for the window into this journey she has opened for my eyes and heart.  I have witnessed this miracle of organ transplantation through the firsthand account of my gracious friend and her mom, and I am beside myself tonight as I write this account of what it's been to witness this process.

How do you begin to follow-through on, "how can I help?" when you stand by someone who is preparing their mind, body, and spirit for what might be the best or the worst outcome imaginable in the advances of modern medicine?  This friend is the one who will swoop in on any friend to be there when the need arises.  She is the friend who never fails to send written thanks.  When preparing for the benefit I planned with others in our circle of friends, Tanya was the friend who was writing thank you notes to acknowledge the time and energy we were spending weeks before the benefit even occurred.  Little does she know, the gratitude is ours for being let in on this path of seeing what it means to foster a grateful heart.

On this journey to a new heart for her mom, Tanya became an Ambassador for LifeSource, the organization that saves lives through organ and tissue donation, serving communities in Minnesota, North Dakota, and South Dakota.  Tanya spoke to her first group of critical care nurses recently.  She reflected that many moments in a nurse's day are routine, but they are someone else's once-in-a-lifetime.

The miraculous advances in medicine that provide for transplantation are not every nurse's daily routine.  But one common denominator among nursing peers and our partners in healing is the fact that we are all on our own wellness journey while we deliver care to others.  I'm starting my Attitude of Gratitude challenge with a simple practice that is sure to be a source of personal wellness: a family gratitude journal to adorn our dining room table and conversation.  There are countless (and some elaborate!) examples of gratitude journaling, like this one from Writing Forward.  I spent less than $2 on a traditional composition notebook that is sure to hold a composition that reflects a daily Attitude of Gratitude.

This self-accountable journal practice is dedicated to Tanya, to her mother, and to the donor of Terry's gift of life.  May we all be so fortunate to be touched by stories that instill compassion as we aim to deliver our care with that touch.  To read more moving accounts of donating life, or to become involved in the mission of promoting organ and tissue donation, visit the LifeSource website.   If you have an account of a life-giving donation, of gratitude in practice, or of what's on your mind about nursing, I'd love to hear from you.  Feel free to comment here or reach out to me at: natalie@thereflectivenurse.org

Today I am grateful to know that my dear friend Tanya's mom has a new heart that is beating strong.
Today I am grateful to know that my dear friend Tanya's mom has a new heart that is beating strong.  Terry Olsen, you are the essence of a grateful heart.  Mine is forever touched for knowing both of your hearts.