Burnout can be defined as depletion of your physical and emotional energy
for over a long period of time due to unrelieved pressure from your job.
So many nurses have been burned out in the past.Some of them changed jobs,relocated,
got married,develop health issues, but so many are still hanging in,doing it differently
with smile on their faces,coffee in the hands,friendly environment and doing what they love.
The ball is your hand.Nursing is a very beautiful ,fantastic,lovely but challenging profession.
You make the best of it.I love it and so will you.
I have been burnt out in the past without realizing it until someone pointed it out.
Over fourteen years ago ,it all started when I told one of the doctors that I worked with, that I saw him ,the managers and everyone working in our unit in my dream .And that we were preparing for JCAHO(Joint Commission on Accreditation of Health Care Organization) visit.(JCAHO came to our hospital that year and we scored 93%,I was one of the coordinators in my unit)He replied,” if you saw us in your dream then you are definitely burnt out.So please evaluate the jobs that you have and see which one is giving you stress the most.If it is this job or any other job .Whatever it is, you must leave it immediately.”I did not like the doctor’s suggestion.I thought that he hated me. Two days later my manager called me into her office to tell me that my Primary doctor called and said that I needed emergency surgery.And that I must go for the surgery immediately.I told my manager “NO” the doctor just wanted to make extra cash.I do not want to go.I do not need any surgery.She replied,”YOU MUST GO BECAUSE IF ANYTHING HAPPEN TO YOU ,WE WILL NOT BE LIABLE”. So I left very uncertain of what will be my faith.I had my surgery done.It was the removal of cyst .I returned to work immediately.I love working .Working was my only language that I speak.One year later I decided to move on and left that hospital but never stopped working.But drastically reduced my hours,learned to speak up ,make friends and then learn to educate and delegate.Also learn to listen to my body.
TEN FACTORS THAT CAUSES BURNOUT.
(1)Unrelieved pressure from work.You work in a hostile and unconducive environment.You are constantly harassed ,rather than encourage and support you.Or Charge nurses give you the worst assignment and bully you all the the time. The other nurses do not like you because you are inexperience or not one of “them” or from the Registry.You come to work tortured,ridicule and relegated to the background.That is working in a stressful,dangerous environment
(2) Lack of support : You are single or divorced and has no support,friends or families to help you.
(3) Difficult Co-workers: You have difficult co-workers that are not supportive.
Their main agenda is to see you fail.They are not happy if you sit down to review
your work or chart. And their popular language is that “she does not belong here”
(4)Having a lower degree: BSN rather than associate degree is much better.
You have more respect. And the doctors want to communicate with a BSN
than associate degree.There is a proverb that says,”If you want to eat a toad get
the juicy one”.
Nursing profession have so many specialty ,bedside Nursing is one of them.
(5) Bedside :Bedside Nursing can be emotionally draining.You see so many trauma on a daily basis.You watch people of your age ,your dad age ,your son’s age your brother age die of various diseases from gunshot wound to cancer, car accident. Nurses experience death,and complication lost of limb can be so emotional and can affect the ability to continue.
(6) New Nurse: Lack of knowledge and inexperience can make it difficult for new nurses.
There is the unrealistically high aspirations in Nursing Program that teaches “the perfect patient situations”,which most often does not exist.It is surprising to the new nurses when the those situations in nursing schools does not apply in the real world.They start to feel incompetent and lack of resources at the beginning of their career.
Rome was not built in a day so new nurses should learn to ask questions rather than development attitude.What attitude do you want to show when you are inexperience?.And the experience nurses should learn to support their own.The doctors knows when we have new nurses and they (doctors) react to their inexperience. Who is that nurse that called me? She does not know anything.Doctor :she is new ,please be gentle ,we want them to stay I replied.Do not chase them away please.
(7) Lack of Respect among the healthcare Team.Respect is reciprocal.Please give me some.
(8) Under staffing: Sometimes there is not enough staffing ,so we have to manage the limited
staff that we have.With long hours of work,and maintaining a high quality standard of care.
(9) Delegation: Most Nurses do not know how to delegate or they believe that it will not be delivered the way they want it.In an attempt to do it all without seeking help could contribute to burnt-out.
(10) Lack of Emotional intelligent: It is very important to know how to deal with people.It is always good to understand people that you work with before dealing with them.Because we have the individual differences.If you do not know how to fit in,it can be very deterimental, frustrating and can contribute to burn out.
3 SIGNS AND SYMPTOMS OF BURNT OUT.
(1) Emotionally exhausted.This is much more than tiredness after working eight
hours and you want to go home and rest.This is complete fatigue.
Asking you to do one more problem will upset you or too much to ask.
(2)Depersonalization: This is a situation where the nurse has no feelings for the patients
that he/she is taking care of.All the patients are the same in her/his eyes.
There is no individualized plan of care.He/she became a slective listener.
The nurse does not have feelings for the patients that he/she is taking care of.
(3)Decreased in Personal Accomplishment:In this situation a competent nurse becomes
the nurse that barely provide minimal patient care.
Patients are dissatisfied with Nurse care.This is a situation where
there is unhappy outcome.The nurse in this stage feels other nurses
are better so my effort will not yield any difference or a better positive outcome.
Nurses experience death,and complication lost of
limb can be so emotional and can affect their ability to continue.
7 WAYS ON HOW TO PREVENT BURNOUT.
(1)ACKNOWLEDGEMENT: Identify when you feel burnout.
Provide an equitable assignment.Work should be assigned
effectively.Please do not overload the highly competent nurses.
(2)SELF CARE: Take time to care for yourself.Exercise,meditate.Take your
PTO ,have time for you.You earned the PTO is yours,use it but do not abuse it.
(3)STRONG TEAM :Find time to develop strong ,and compassionate
co-workers who are supportive. I can tell you that they do not need to
speak the same language with you,but they are great team players.
(4)RESILENCE : Develop a coping mechanism in other to alleviate burnout.
Preserve Nursing morale,and avoid role confusion.Salary most often is not the number one factor but if the physical enviroment is not conducive.The salary becomes a serious issue.Is the environment clean,safe?What is the organizational climate? Is the establishment friendly?Is it difficult to interact or communicate with other nurses.
(5)EDUCATION: Educate yourself,subscribe to Nurses Journal.Stay current in Nursing practice.
The ANA Ethical Code for Nurses is that Nurses must maintain competency in Nursing profession.
(6) SAFE TIME: Delegation could be the fundamental key to successful management of your time.
Delegate correctly to the right professional.Understand the roles of the Nurse,Case manager,the CNA,Manger,PT so that your needs will be met.
(7)Realistically look at your environment Do you have any control?But you can control yourself,your mood,and your behavor.Do not be too apologetic.Prevent defensive mechanism.Acknowlege your limitations.
Pressure ulcer in a simple term is known as bedsores or decubitous ulcers.
They are localized damages to the skin.They are very expensive to treat,
so the best thing is not to develop pressure ulcer.The hallmark sign of pressure
ulcer is that they usually develop over Bony Prominence due to unrelieved pressure
such as the back of the head,sacrum,coccyx,hips,ankles,elbows, occipital,shoulder,
ischium,ilac crest,medial malleolus,lateral malleolus etc.Development of pressure
ulcer around the ears is due to equipment.
Pressure ulcercould be a combination of pressure and friction.
If you are alert and oriented x4,walking,able to comprehend,not incontinent.
Will you develop pressure ulcer?The answer is “NO”.
So if you are compromised,you stayed in bed for too long or in one position
for too long.And you are not able to repostion yourself because
you are bed ridden or wheelchair bound.Then pressure ulcer will develop.
due to unrelieved pressure.
When there is a limitation in the flow of blood in the area where there is pressure
bedsore will develop. Pressure ulcer or bedsore is categorized in stages.
You cannot talk about pressure ulcer without understanding the BRADEN SCALES.
Please look up on Braden scales.It is a scale for predicting pressure ulcer risks.
And understanding who are at risk for developing pressure ulcer.
The Braden Scales for Pressure ulcer is as follows:
Lowest risk 15-18
Moderate risk 13-14.
High risk 10-12
Highest risk 9.9 and below.
When you think about Braden Scales think about the following.
Is the patient able to respond to pressure?.
To what degree is the skin expose to moisture?
Is the patient active?
What about their nutritional intake?
Can patient reposition self in bed or can patient ambulate(That is walk).
How to prevent Pressure Ulcer:
To prevent pressure ulcer is to understand the skin,nutritional intake, the Braden scales,
immobility,various types of wound including their origin, wound care.
These are very important as an healthcare professional.
The right equipment should be in place for bariatric patients.
According to the National Center for Health Statistics report shows that 30% of
American adults are obese-over six million Americans.
Reposition patient every two hours while in bed,and evry one hour while in the wheelchair.
(PT/OT ) Physical and Occupation therapists should be ordered for all patients.
Physical therapist should evaluate who need therapy and who need treatment.
Physical and occupational theraist clearance sould be done before discharge
home or SNF or REHAB transfer.Each patient situation is different.
Nurses should encourage and assist in early ambulation and other activities
of their patients.
Nurses are to medicate patients for pain thirty minutes prior to physical activities.
Unnecessary immobility should be discouraged by the nurses.
The GOLD STANDARD will be getting the patient ready for physical activities as
long as it is NOT against doctor orders.
Is there an OVERHEAD TRAPEZE for the patient to turn and
reposition self while in bed?
Avoid Electrical blanket under an immobilized patient with very low Braden Scales. During repositioning ,watch out for bony prominent areas.Protect bony prominent areas.
Can the patient eat independently?
Does patient have adequate nutrtion.
Is there a recent weight loss >5% in 30days.
What is the prealbumin level?
WNL > 16 mg/dl
What is Albumin level?
But if the patient is trauma patient,inflammation or has infection.Plasm prealbumin level can be false result since the prealbumin level has been affected due to trauma,or infection or inflammation.Then the C-reactive protein test can be use instead.It is the doctor decision if he/she wants to do that.
The importance of adequate nutrition cannot be overemphasized.
Evaluate PO intake that is can the patient tolerate food by mouth very well ?.
Eating 80-100%. Is patient getting enough nutrient?
If NO can the patient swallow?
Does patient need swallow evaluation?can your patient chew?
If NO Speech therapist and nutrition consult will be ordered by the doctor.
Speech therapist will evaluate for swallow and make recommendation.
Registered Nutritionist will make recommendation on type of feeding.
Tube feeding type for example Glucerna.1.0,1.5, jevity 1.0 or 1.5,Suplena
based on patient disease process and notify the doctor
on their recommendations.
And the doctor will write the orders.
Does the patient need Tubefeeding,TPNor PPN ?
If your patient is not getting adequate nutrion,notify your doctor so that
he or she can order Nutrition Consult.
And the Nurse will execute the orders.
Next concern do the hospital beds have moisture control assistive device?
Is redistribution of pressure and comfort provided for patient?.
Are the patient feet off -loading from the mattress?.
Understanding of the wound that you are dealing with is very important because
successful treatment involves not just the wound but a complete knowledge of the
patient with the wound.
For example who is this patient?
Does the patient have diabetes,vascular disorder,anemia,hypothyroidism,
Is he/she a cigarette smoker?
In order words, good assessment of the comorbidities
are very important for adequate wound healing.
HOW DO I HEAL THE WOUND.
Assess location of wound,type of tissues,etiology of the wound,wound
suroundings, amount ofexudate,odor,pain, signs and symptoms of infection.
Is the wound viable?
What are the factors affecting the wound?.
(A) Maintain moist environment for the wound to heal.
(B)Keep the wound surrounding clean.
(C)Avoid early closure of the wound that is not ready to be closed.
Why? Because it will be back to SQUARE ONE.
When it becomes clear that the drainage from the wound is winding
down,then the wound is getting ready to be closed.
Where are you my love?You stood like you evolved.You are my sweet dove. If you are sweet candy. Then I crave for sweet candy. I am ready to eat up the candy. And worry about tooth decay later. We giggle with each other.Holding hands on the street.You rebuilt and organized me.We jump up together. Happy and sad together. You lifted me up.And now I can fly.We play with each other.Dive into the Ocean with each other.Peaceful and divine.Our eyes spark at each other. “The world can stop turning, the Sun can stop burning,Who can tell me that love is not worth going through?. If it falls apart,I will understanddeep down in my heart ,the onlydream that meant a lot to me, has come true.In this life,I was loved by you” –Bette Midler.You held my hands.And I held your hands.When I see you I behave.I have lots of curves.I feel like a new me. “What the heart gives cannotgo away,it is kept in the hearts of others” –Robin St. John.Now I am alive .I am your beloved.And you are my beloved.“I have learned not to worryabout love,but to honor , its coming with all my heart”. -Alice Walker.Love me in the light and in darkness.I promise to do the same.
Electroconvulsive Therapy (ECT) is an effective treatment for major depression with an eficacy rate of 80% or more,which is equal to or better than response rates to ANTIDEPRESSANT medications in some patients. It is particularly useful for people who cannot tolerate or fail to respond to the use of medication treatment.
There are various Reseaches from MAYO CLINIC ,JOHN HOPKIN’S University,and others but they did notallow to download for your references.You can reference them .Also talk to your doctor or healthcare provider for educated information.
Provide educational support to patient and family.
Assess pretreatment protocols to ensure that it was according to hospital procedures.
Assess the patient behavior ,memory and functioning ability before the ECT.
Patient should remove prothesis before treatment to prevent damages or loss.
The Nurse should prepare and monitor patient during the actual ECT procedure.
Patient should use the bathroom before procedure to prevent incontinent.
THE TARGETED BEHAVIOR OF ECT/EFFECTIVENESS.
4. Severe psychosis with acute onset,life threatening psychiatric conditions.
Rigidity of parkinsonism or the neuroleptic
1.Education on procedure and expected effects to patient and family.
2. Encourage expression of feelings by patient and family.
3. Reinforce teaching after treatment.
4. Check emergency equipment before treatment/procedure.
5. Maintain NPO(Nothing by mouth) Status for 4-8hours
6. Remove harmful objects such as denture,jewlry before treatment.
7. Check vital signs ,maintain airway,assist to ambulate,
offer analgesia or antiemetic as needed.
8.Remain with patient before and during treatment.
9. provide support.Your focus should be on that patient only during treatment.Do not combine with other assignment.
10.Reorient patient and assist family members after procdure.
Informed means educated, provide knowledge,schooled, discussed.
Consent means approved, agreed, accepted the information given, given permission for the procedure to be perform.
Informed consent can be defined as the permission given by a patient to the doctor for treatment with the full knowledge of understanding of the benefits and possible risk.
The patient have learned and discussed the benefits and risk involved.
The Medical or surgery procedures must be clearly written and there should be no abbreviation.
The name or names of the doctor (s) and associates well written.
The consent will be signed by a mentally capable adult patient,alert and oriented ×4.If patient is a child a designated adult who has the legal authority will sign.
If a patient cannot sign and the family cannot come to the hospital consent can be signed over the phone with two Registered Nurses.
Please read up on the process of obtaining consent if patient cannot sign. Every facility has their policy and procedures.
So please comply with your hospital policy and procedures.
The Nurse will withness the consent and it will be dated and signed.
Blood transfusion form is usually part of the surgical consent form in case you will need blood.
Since you have agreed to the surgery ,pre operative teaching will begin, this include that you should remove jewelry, remove your dentures, denture cup will be given, no prosthesis.Do not wear anything except the hospital gown,you will be given a special bath (CHG bath) to make sure that you are clean and no contamination before surgery.You will be taught on how to use incentive Spirometer,and also how to do deep breathing because you will need to do deep breath after surgery and use incentive Spirometer 10×1hour, while you are wide awake.(Ten times every hour while awake)Please my dear patient make sure that you use it,because you need to expand your lungs after surgery.This will prevent you from developing pneumonia.
The Nurse will get the preop checklists ready,your chart ready and the ticket to ride ready.Your vital signs taken before going to surgery and after you returned to your unit.
And you the patient will relax,smell good,feel good and ready to put the surgery behind you.
When I hard my surgery(Myomectomy) in June 2nd 2001,I just looked forward to the end of my pain and my misery.
And since then the pain was gone and no more bleeding.
Thank you Doctor Thomas Lee and thank God.And also thank you Doctor Charles Ho that introduced me to doctor Lee.
I am sure that you have all retired by now.God bless you all.