RNL Year End Sampler

7/25/2019 RNL Year End Sampler

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DEAR READER,2015 has been an exciting year at the Honor Society of Nursing, Sigma Theta Tau International (STTI), particularly for our online member magazine,Reflections on

Nursing Leadership. TheRNLwebsite has seen tremendous growth, surpassing all previous readership records thanks to support from members like you.

OurRNLeditors work hard to publish articles that STTI members will find informative, relevant, and even inspirational. As 2015 comes to a close, we are pleased

to present to you our second annual year-end sampler, highlighting some of our most popular articles as well as some of our personal favorites from the year. Please

consider this gift a small token of our appreciation for all you do to support STTIs efforts not only to publish books, scholarly journals, and articles, but also to

improve global health through our many programs, events, and relationships. We hope you enjoy reading this compilation as much as we enjoyed bringing these

articles to you.

Thank you for your engagement and support, which allow STTI to fulfill its mission of advancing world health and celebrating nursing excellence in scholarship,

leadership, and service.

Wishing you all the best in the coming year.

Dustin R. Sullivan

Publisher
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DEAR READER,For the second time, we offer this year-end sampler containing articles that have been published inReflections on Nursing Leadership(RNL). In 2015, as in 2014,

we have chosen content that, in addition to representing the diversity and wide-ranging interests of members of the Honor Society of Nursing, Sigma Theta Tau

International, also pulls on a few heart strings.

Dennis J. Cheek, PhD, RN, FAHA (Beta Alpha Chapter), the Abell-Hanger Professor in Gerontological Nursing at Texas Christian University-Harris College of

Nursing and Health Sciences, gets excited about communicating to nurses the importance of becoming educated about pharmacogenomics and precision medicine.

He shares that excitement inWHY NURSES NEED TO BE INFORMED ABOUT PHARMACOGENOMICS.

Shela Akbar Ali Hirani, MScN, RN, IBCLC, Advanced Diploma in ECD (Rho Delta Chapter), assistant professor, Aga Khan University School of Nursing and

Midwifery in Karachi, Pakistan, writes aboutTHE MAGICAL ROLE OF PLAY THERAPY.

Maria Cho, PhD, RN (Nu Xi-at-Large Chapter), assistant professor, Department of Nursing and Health Sciences, California State University, East Bay, normally

gives assignments to her students, but she gives herself an assignment inFACING MY FEAR.

Carrie Sue Halsey, MSN, CNS-AD, RNC-OB, ACNS-BC (Upsilon Kappa Chapter), clinical nurse specialist and natural birth and breastfeeding advocate, foundherself experiencing Grade A, certified nursing burnout. Find out what she did to recover and regain perspective inNURSE BURNOUT: WHEN PASSION

ISNT ENOUGH.

Karen Roush, PhD, APN (Upsilon Chapter), assistant professor of nursing at Lehman College in the Bronx, New York, is a long-time editor and writer. InWHY

WRITE? she shares with nurse colleagues around the world six reasons for telling their stories.

Diane Sieg, RN, CYT, CSP (Alpha Chapter), author, yoga teacher, mindfulness coach, and former emergency room nurse, shares 7 HABITS OF HIGHLY

RESILIENT NURSESthat will change you as a nurse and positively influence other aspects of your life.

Cindy Hatchett, MSc, RN, RM (Tau Lambda-at-Large Chapter), nurse practitioner and resident of South Africa, is the author of The Lamplight Narratives, a new

monthlyRNLcolumn. A voice for the voiceless, she recently wrote about THE LADY OF THE SHEDandTHE COWBOY.

Gretchel Ajon Gealogo, PhD, RN, MHR, MSN, CMSRN, RN-B (Delta Alpha-at-Large Chapter), is a medical-surgical nurse. It was a patient with dementia who

inspired her to do her dissertation work in pain communication and, ultimately, to develop a conceptual model for person-engaged dementia care. Learn more in

HER NAME WAS LYDIA.

Thanks again for the many ways you give year-round as a nurse.

James E. Mattson

Editor,Reflections on Nursing Leadership
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Why nurses need to be informed aboutpharmacogenomics

Dennis J. Cheek,PhD, RN, FAHA

(Beta Alpha

Chapter), is the Abell-

Hanger Professor in

Gerontological Nursing

at Texas Christian

University-Harris

College of Nursing and

Health Sciences, with

a joint appointment in

the School of Nurse

Anesthesia. He iscoauthor of Mastering

Pharmacogenomics: A

Nurses Handbook for

Success.

ORIGINALLYPUBLISHED:6/11/2015http://www.

reflectionsonnursingleadership.

org/Pages/Vol41_2_Cheek_

Pharmacogenomics.aspx

Understanding precision medicine ispart of properly caring for patients.Like many of my nurse colleagues, I became a nurse to care for

patients and their families during times of need. Besides delivering

care, I administered scheduled and as-needed drugs to patients,

monitoring them for expected responses as well as possible adverse

reactions. In a large majority of cases, prescribed medications

worked as predicted. Occasionally, however, adverse reactions

required interventions.

My nursing education, which began in the early 1980s, includedthe usual courses: fundamentals, obstetrics, pediatrics, medical-

surgical, critical care, leadership, and, of course, pharmacology. In

the pharmacology course, the focus was on specific drugstheir

indications, typical side effects, and nursing interventions. This

provided a strong foundation for my nursing career in critical care.

The nurse-pharmacology disconnectMy first position was in a cardiac surgical unit where patients

recovered postoperatively from coronary artery bypass or valvereplacement. After several years, I returned to school to complete

my Master of Science in Nursing degree with an emphasis in

critical care nursing and nursing education. I had courses in

advanced physiology, advanced pathophysiology, nursing theory,

nursing research, and nursing education. During this time, I began

to teach in both clinical and academic settings. In the academic

setting, I noticed that nurses were not teaching pharmacology

courses, and I found this interesting in that administering

medications is one of the important tasks a clinical nurse is

responsible for overseeing.

In 1991, I was accepted into a doctoral program with an emphasis

in cellular molecular pharmacology and physiology. This was atremendous learning experience, and I developed, with regard

to pharmacology, skills in cell culture and isolationspecifically

endothelial cellsas well as molecular investigation of receptor

activity. The only problem was that the model was based on an

animal modelthe guinea pig. And what does this all have to do

with my patients?

The four rights of pharmacogenomics

During the summer of 2000, while I was attending the inauguralSummer Genetics Institute, sponsored by the National Institute of

Nursing Research, the initial rough draft of the Human Genome

Project (HGP)a complete genetic sequencing of several men and

womenwas completed. The HGP has led to several important

discoveries, and from it has come pharmacological matching

of drugs with the genetic makeup of individuals. Its called

pharmacogenomicsthe right drug for the right patient at the

right dose and at the right time.

A broader perspective, or personalized medicine, is tailoringpharmacological treatment to a patient during all stages of care

prevention, diagnosis, treatment and follow-upbased on his or

her individual characteristics, needs, and preferences. For me, all

the pieces of the puzzle had come together.

Since that time, I have continued to teach about the genomic

implications of pharmacology and what they mean to clinical

as well as advanced practice nurses. I am excited that extensive

pharmacogenomics work continues to be done. Since completing

the Human Genome Project, the Federal Drug Administration
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(FDA) has identified more than 150 drugs for which there are molecular

biomarkers that may aid in improving therapeutic outcomes and reducing

adverse drug reactions. Thirty percent of these drugs and biomarkers are for

oncology patients.

For exampleAn exemplar comes from the cancer community. After a human epidermalgrowth factor receptor (HER2) biomarker was identified, which is resident

in 30 percent of breast cancer and increases adverse outcomes, a humanized

monoclonal antibody to HER2trastuzumab, also known as Herceptinwas

developed that targets the HER2 biomarker and reduces adverse outcomes.

A second exemplar comes from treating HIV/AIDS patients with antiviral

agentsspecifically, abacavir, either alone or in combination with another agent.

Approximately 10 percent of patients receiving abacavir develop multiorgan

hypersensitivity, and, for some, its fatal. Hypersensitivity to this drug has been

associated with patients who are carriers for the allele HLA-B*5701, which

can be identified with genetic testing. The FDA has issued a post-marketing

recommendation that patients be tested before initiating or restarting the drug,

either alone or in combination. This recommendation has also been added to the

monograph insert.

A third exemplar is the prodrug clopidogrel, the antiplatelet agent used to reduce

platelet aggregation in patients with acute coronary syndrome. When prescribed,

this drug requires a functioning cytochrome 450 (CYP450) in the liver to

convert the enzyme to an active metabolite. The specific enzyme is CYP2C19.

In October 2013, the FDA approved a point-of-care device that enables a

simple buccal swab to detect whether the patient has the normal or wild type,

or the mutant version of the specific CYP2C19 enzyme. This will indicate if

clopidogrel will be converted and protect the patient, or if the prodrug will not

be converted and put the patient at further risk for clot formation.

This area of pharmacogenomics continues to expand. In 2015, the Obama

administration announced the Precision Medicine Initiative. An emerging

approach for disease treatment and prevention, it takes into account individual

variability in genes, environment, and personal lifestyle. While significant

advances in precision medicine have been made for select cancers, the practice is

not currently in use for most diseases. Many efforts are underway to help make

precision medicine the norm rather than the exception. The goal is to expandthe base tenet of pharmacogenomics: the right patient and the right drug at the

right dose.

Ask me about pharmacogenomics andprecision medicine!I get excited about communicating to nurses the importance of being informed

about pharmacogenomics. They need to be educated about it and, more

specifically, understand the Precision Medicine Initiative and how it applies

to each patient. When fully instituted, no longer will drugs be ordered for thegeneral patient on a trial-and-error basis. Instead, prescription of medications

will be based on patient genotype and phenotype.

As patient advocates, nurses will need to be prepared to educate patients and

families about genetic testing and how this information can be used to make

decisions about pharmacological management. Nurses will be responsible for

educating, informing, and discussing with patients, from a pharmacogenomics

perspective, the best possible health outcomes and the role precision medicine

will play in their overall treatment plan.

I am passionate for nurses to be informed about pharmacogenomics and

precision medicine because they are responsible for providing quality care

to patients, administering prescribed medications, and monitoring expected

responses as well as potential adverse reactions. As nurses of today and the

future, we are vital members of the entire health care team and will need to

maintain pharmacogenomic competency to properly care for our patients.


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The magical role of play therapy

Shela Akbar AliHirani, MScN, RN,

IBCLC, Advanced

Diploma in ECD,

(Rho Delta Chapter),

is assistant professor,

Aga Khan University

School of Nursing and

Midwifery in Karachi,

Pakistan.

ORIGINALLY

PUBLISHED:1/8/2015http://www.


org/Pages/Vol41_1_Hirani_

PlayTherapy.aspx

Low-cost therapy helps pediatricpatients cope with hospitalization.

Working in a pediatric setting is a rewarding and most challenging

experience. From the perspective of the patients, the hospital

is a source of stress. The bright lights, high noise level, painful

procedures, bitter flavor of medicines, physical separation from

parents and loved ones, unfamiliar hospital routines, and, most

importantly, the childs disease process all serve as sources of

toxic stress for pediatric patients. Not every child is resilient to

these stresses, and these traumatic experiences affect not onlythe architecture of a young childs developing brain but also

pose negative impacts on growth, developmental coping, self-

management skills, and compliance with the treatment regimen.

Play therapy is one therapeutic intervention that can serve a

pivotal role in preparing sick children for hospital routines,

informing them about management of their disease processes,

relieving anxieties associated with hospitalization, diverting their

minds during painful procedures, and promoting their cooperation

with diagnostic procedures and treatment plans. The literature

shows that play therapy serves as a developmentally appropriate

strategy for pediatric patients and aids in reducing patient fears

and anxieties. Play therapy also enhances sick childrens cognitive,

social, and physical development and promotes compliance and

self-management skills (Boyd et al., 2009; Goymour et al., 2000;

Hirani, 2013; Hockenberry & Wilson, 2007; Jun-Tai, 2008;

Murphy & Garry, 2002).

Age- and disease-specificAs a pediatric nurse educator with expertise in early childhood

development, I took the lead in incorporating low-cost play

therapy for hospitalized children in the baccalaureate pediatric-

nursing curriculum at Aga Khan University. Each year,

undergraduate nursing students who take the pediatric-health

nursing course at Aga Khan are offered a play-therapy workshop

during which they are taught use of low-cost play therapy, based

on disease type, for patients in specific age groups. The students

take keen interest as they observe preparation of age-appropriate

play therapy for sick and hospitalized pediatric patients. For thepast few years, we have observed that, on one hand, introduction of

this workshop enhances creativity, critical thinking, and problem-

solving skills of nursing students, while, on the other hand,

providing insight into the feelings of hospitalized pediatric patients

who are experiencing multiple stressors.

Overall, incorporating the play-therapy element into the nursing

curriculum works very well. Play therapy enables many children

with chronic diseases to vent their feelings through pretend play,

drawing, and painting. Through puppet shows, doll play, and

storytelling, children with oncological disorders who experience

the side effects of chemotherapy learn to cope with their disease

process and regain self-esteem. Many pediatric patients diagnosed

with insulin-dependent diabetes learn to administer insulin

injection to dolls and then to themselves, thereby helping to rid

them of needle phobia.
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Snakes, ladders, rattles, and wind chimesPlay therapy that incorporates socialization and limb movement helps children

with fractures and contractures gradually gain mobility. Through use of a

specially designed snake-and-ladder game that includes health messages,

children with poor eating habits learn the importance of a proper, well-balanced

diet. (A healthy diet leads to climbing the ladder, and an unhealthy diet of junk

foods results in being bitten by the snake.) Play therapy also works for very

young children. Handmade, colorful rattles and wind chimes help stimulate

development of sick infants, newborns exposed to phototherapy, and babies in

incubators who were born prematurely. These therapeutic tools also promote

interaction of infants with caregivers and surrounding environments during

hospitalization.

To conclude, play therapy has magical effects on all aspects of health, coping,

growth, and development of sick and hospitalized children. Implementation

of this intervention is effective for sick children of all ages. Considering the

tremendous benefits of play therapy, it is recommended that nursing schoolsencourage students to design age-appropriate, low-cost play therapy for

hospitalized children. In so doing, they will help pediatric patients cope with

hospitalization and reduce the adverse effects of toxic stress associated with their

disease processes and hospitalization.

ReferencesBoyd, M., Lasserson, T. J., McKean, M. C., Gibson, P. G., Ducharme, F. M., & Haby, M.

(2009). Interventions for educating children who are at risk of asthma-related emergency

department attendance. Cochrane database of systematic reviews, 2:Art. No. CD001290. DOI:

10.1002/14651858.CD001290.pub2

Glazier, T. (1997). Play therapy for the children in the emergency department. Australian

Emergency Nursing Journal, 1(2), 52-53.

Hirani, S. A. (2013). Use of play therapy in educating asthmatic and diabetic pediatric patients:A pilot clinical project at a private tertiary setting in Karachi, Pakistan.International Journal

of Nursing Care, 1 (1), 83-87.

Hockenberry, M., & Wilson, D. (2007). Wongs nursing care of infants and children. (8th Ed.).

New Delhi, India: Mosby.

Jun-Tai, N. (2008). Play in hospital.Pediatrics and Child Health, 18 (5), 233-237.

Murphy, J. E., & Garry, L. (2002). The efficacy of intensive individual play therapy for

chronically ill children.International Journal of Play Therapy, 11(1), 117-140.


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Facing my fear

Maria Cho, PhD,RN (Nu Xi-at-Large

Chapter),is assistant

professor, Department

of Nursing and Health

Sciences, California

State University, East

Bay, in Hayward,

California, USA.

ORIGINALLYPUBLISHED:

1/15/2015http://www.reflectionsonnursingleadership.

org/Pages/Vol41_1_Cho_

FacingFear.aspx

A teacher gives herself an

assignment.I have been teaching nursing students in various programs for

five years. I enjoy teaching, but it takes courage to stand in front

of people. Although I have improved every quarter, I still have to

repeatedly go over the material I am teaching, review PowerPoint

slides and quizzes, and read recently published articles on the

subject. If I were to tell my students that I am afraid of public

speaking, they would not believe me. I am usually quiet in big

meetings and hesitate to ask questions in a group setting. Id rather

ask questions of the speaker individually. I dont know if this isbecause of my personality, my cultural background, or my gender.

My specialty is oncology nursing. As an oncology nurse, I have had

much experience working with elderly patients, which has led me

to be interested in geriatrics. I love to listen to life stories of older

people; they always remind me of what I need to focus on in my

life at this moment and what my priorities should be.

Easy foryouto sayIt was an honor to be selected for the interprofessional and

multidisciplinary geriatric faculty development program

established by the University of California San Francisco, but my

joy was short-lived because of my passive nature. Attending the

programs monthly meetings was challenging and took courage. At

the first meeting, I was intimidated by several things: 1) the diverse

professions and impressive backgrounds of other attendees, 2) thenontraditional format (it was not the usual classroom teaching

and learning style I was familiar with), and 3) speaking in front of

people. Of the three, I was most uncomfortable with speaking up

in the classroom.

When I applied for the program, I assumed the course would

be taught through lectures and PowerPoint slides. However, all

of the lectures involved various ways of learning the material

experiential learning as well as both small-group and large-group

discussion. I enjoyed the small groups and tried to activelyparticipate, but I found this a challenge in large groups and only

participated twice in class discussion. This experience made me

think again about why I am not verbally active in the classroom.

Is it because I have public-speaking anxiety or because I am self-

conscious of my accent, grammar, and enunciation?

I am an immigrant, a female who grew up in the Korean culture.

Although I know asking questions and sharing thoughts contribute

to active learning, I am not comfortable with doing that. During

my education in Korea, asking questions was not allowed in theclassroom. Teachers taught you what you didnt know, so you

needed to respect them. Even when the teacher was wrong,

students were not allowed to correct him or her because it would

be embarrassing to the teacher.
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I am not sure if my reserved personality led me to be who I am or if I am a

product of suppression that was present in my Korean learning environment.

However, I have noticed that even younger generations of Korean people

display similar characteristics in the classroom setting. Korean culture is heavily

influenced by Confucian values, where there is a moral responsibility to respect

someone who has higher status than you, such as government officials, teachers,

and doctors.

Breaking freeFace-saving to avoid shame, another crucial cultural factor in my upbringing,

may account for why I am not comfortable speaking in front of people, especially

to a multidisciplinary team and large audiences. In other words, I do not want

to be judged by my verbal communication skills. This behavior, however,

became a cell that locked up my creative ideas and questions. Differences in

communication styles that relate to gender, values, and expectations are common

in all workplace situations, but individual personality and culture also play asignificant role.

Changing ones behavior is not easy. Although it may be a challenge for me, I

am planning to do the following to change my behaviors: 1) I will actively look

for opportunities to speak up in meetings. 2) To meet more people and become

more comfortable interacting with faculty members, I will attend more meetings

and sign up for committee activities when opportunities arise. 3) To overcome

my fear of speaking in front of people, both within nursing and outside of

nursing, I will seek out and attend meetings of the local chapter ofToastmasters

International.4) I will work to positively visualize myself giving successful classpresentations and participating in class discussions. And, 5) I will not focus on

my limitations, but on the strength I can bring to the meeting or discussion.
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Nurse burnout: When passion isnt enough

Three actions saved this nurses career.When I was 16, I joined the millions of teens scraping grease and

taking orders at a fast-food chain. I went on to become a restaurantmanager. I have spent time working at a gas station, as an in-home

childcare provider, and as a librarian assistant. These occupations

were hard work and paid poorly. I was tired and sweaty, but happy. I

think back to that freckle-nosed sprite wearing a purple visor with a

burger embroidered on it, and I realize I have come a long way.

That young woman would never have dreamed that, someday,

her minimum-wage paycheck would grow to become what her

professional nursing salary is today. Standing behind that fast-food

counter, she could not have guessed she would save someones life,deliver babies, or hold someones hand as that person let go of this

world. When I think about how amazing it is to be a nurse, it is hard

to imagine that anyone would get disenchanted with the profession,

but I did.

All the jobs leading up to nursing school were like romantic flings.

I never took them too seriously. I accepted them for what they

weresteppingstones to my real career. Nursing is what I decided

to marry, professionally speaking. I fell in love with it, we dated for

several years during nursing school, and we made it official when Ipassed the NCLEX. The honeymoon period was both exciting and

terrifying. After the first few months, we settled into a comfortable

rhythm, and life seemed perfect. All my romantic ideas about

becoming a nurse were realized.

After the honeymoonOver time, the newness wore off. I had issues with the hours,

charting, constant alarms, staff meetings, new products, new

policies, staffing shortages, belligerent patients, and backbreaking,

emotionally taxing work. All the flaws I had ignored during my

infatuation with nursing became reasons to be unhappy. A few of

my friends left nursing in the first two years after graduation. I

considered taking the same route, but felt guilty for wanting to

leave.

A common perception in nursing is that bedside nursing is the real

nursing. Leaving the bedside is tantamount to abandoning your

ideals. At my former position, I was directly involved in empowering

bedside nurses, improving patient outcomes, and increasing nursing

education and satisfaction. All of these efforts, supported by hospital

administration, did not prevent me from wanting to drive my

car into a ditch on the way to work. I was experiencing Grade A,

certified nursing burnout.

Nurse turnover and burnout are hot topics in health care. With

nursing positions predictedto increase 1.5 millionby 2022, it is

vital that nurses remain in health care. Turnover is expensive. For

the average U.S. hospital, it costsmore than $4 million a year.

The number of hospitals that have implemented retention plans

is increasing. These strategies are important and, it is hoped, will

increase nurse satisfaction and prevent compassion fatigue, burnout,

and exiting of nurses from the profession.

Up to the nurseUltimately, hospitals are not responsible for keeping nurses engaged.

As employers, they have a vested interest and should be applauded

for encouraging nurse engagement, but each nurse needs to discover

what motivates him or her to be the best possible. Provision 5.2

of the Code of Ethics for Nursesaddresses the moral responsibility

nurses have to themselves. The nurse is responsible for preventing,

managing, and recovering from nursing burnout.

Carrie Sue Halsey,

MSN, CNS-AD,

RNC-OB, ACNS-BC

(Upsilon Kappa),is a

clinical nurse specialist

and natural birth and

breastfeeding advocate

who resides in Houston,

Texas, USA. She teaches

childbirth classes for

expectant parents and

assists mothers with

breastfeeding goals.


5/11/2015http://www.


org/Pages/Vol41_2_Halsey_

Burnout.aspx
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I did not drive my car into the ditch that day, or any of the days I was working

through my disenchantment with the profession. Eventually, I grew tired of

complaining about all the reasons I was unhappy with my job. My face hurt from

forced smiling, and I did not want to pretend I was happy taking care of patients.

My family started to notice I was not acting my happy self. I did not want to

leave the house on my days off. I had let my job suck all the good energy out of

my life.

The stress and fatigue did not originate solely from nursing. I had personal

struggles that were compounded by my dissatisfaction at work. When nurses

have stressors outside of work that are unmanaged, it is difficult to draw on the

inner strength it takes to guide others through illness and recovery. We give until

there is nothing left to give, and then, like an undernourished plant, we wither.

A qualitative studyfound that nurse burnout is caused by 1) short staffing, 2)

not being able to care for patients as well as the nurse would like, and 3) feeling

that there is no advancement potential. Many nurses spend their entire careers

at the bedside, loving to care for and directly serve patients. However, for those

who want to step away from the bedsidetemporarily or permanentlythere

are options. Nurses are needed as leaders, scholars, advocates, writers, legal

experts, board members, inventors, teachers, entrepreneurs, and more.

A choiceI had a decision to make. As in marriage, I had a choice: cut my losses or

rededicate myself to what I had fallen in love with all those years ago. When I

examined my strengths and desires, I realized I needed more from nursing. I

love taking care of patients. Patients have taught me more about compassion,

patience, tolerance, service, and bravery than any school could have. My personal

passion is guiding women throughout the birth process. It is an honor to care

for women, babies, and families. But, despite my passion for the work, I allowed

myself to admit I did not want to be a bedside nurse long-term. I considered

other options, including leaving the profession.

Three actions saved my nursing career.1) I followed my dream.

A colleague who knew I was struggling with burnout asked me a question that

changed my path. What would make 8-year-old Carrie happy? It sounded silly

at first, but, as I gave the question weight, it made perfect sense. The answer was

simple: Eight-year-old Carrie wanted to be a writer.

I started writing. My first modest writing accomplishments were press releases

and a no-byline, trade-magazine article. I startedmy own nursing blog,

focusing on my passion for perinatal education. My writing has allowed me to

reach more nurses and women than I thought possible. Using the knowledge

I gained at the elbow of my patients, I educate and uplift people all around the

world as a freelance nursing writer and blogger.

2) I became board certified.

Two years had lapsed since I graduated with my masters degree in nursing,

and I had not yet become certified or licensed as an advanced practice nurse.

My intense burnout caused me to feel it wasnt worth the effort. After a

particularly bad month, I decided it had been long enough. Revisiting what I

learned in school helped dispel the myth that true nursing occurs only at the

bedside. I knew I had the potential to expand my nursing scope, and I made

the appointment to sit for the board. I took the exam. I passed. The sense of

accomplishment was energizing and changed my outlook on my career potential.

3) I quit my job.

For months, I wrestled with leaving my job. I liked my colleagues and patients.

There were parts of my job I knew I would miss. I knew my job, and I did it

well. I wanted to stay to work on quality and safety projects that would positively

affect patient care. I wondered if I should weather the storm and hope for the

changes I wanted to see. In the end, I decided to move on to a different hospital.

Transitioning to a better-fitting role was the key to ending my burnout. I

stopped questioning if I should leave nursing.

Nursing and I are back on good terms. I enjoy the many ways I am able to use

my nursing talents, and I am looking forward to a long career as a nurse.
http://bit.ly/1SQRf55http://1.usa.gov/1SXiVFIhttp://1.usa.gov/1SXiVFIhttp://bit.ly/1Q4Es1qhttp://bit.ly/1Q4Es1qhttp://bit.ly/1Q4Es1qhttp://bit.ly/1SQRf55http://bit.ly/1Q4Es1qhttp://1.usa.gov/1SXiVFI


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Why write?

Nurse stories are about lifeitsmessiness and its truths.

Why write?is a question that often comes up in my work ofmentoring nurses in writing. The question doesnt arise as often

with faculty members, who are expected to disseminate research

findings and are required to publish to get tenure. Nor does it

come up with nurses working in the policy arena, who understand

the necessity of writing to create change and promote a health

care agenda. But nurses working as clinicians dont see writing as

integral to what they do.

While its true that you can provide excellent clinical care without

ever publishing an article, writing will enrich your practice,enhance your experience, and create more positive outcomes for

your patients. If writing isnt part of your nursing life, I encourage

you to start. And if it is, I encourage you to expand your writing,

try a different genre, reach a new audience, or consider a new

purpose.

Write to improve patient care.Nurses do amazing work. We conduct research, develop innovative

approaches to care, and carry out quality-improvement projectsthat change outcomes and make a real difference in patients

lives. When you solve a problem, discover previously unseen

connections, or find a better way to care for patients, writing

enables you to disseminate your knowledge beyond the bedside for

the benefit of many.

For example, take a quality-improvement project youve completed

on your unit that has resulted in positive outcomes for your

patients. Perhaps they are better able to self-manage their diabetes

or are more prepared for a complex surgery, resulting in less fear

preoperatively and improved pain management postoperatively.

Talking to co-workers spreads the information within your unit

or to the wider facility. Presenting at a conference shares it with afew hundred or even a thousand attendees. But publishing has the

potential to spread the information to thousands of nurses across

the country and around the world.

Write to bear witness.As nurses, we are present at the most profound eventsfrom the

beginning of life to the end of life and everything in between. We

are there with the mother who hears her babys first cries, and we

are there with the mother whose baby is born in awful silence. Weare there with the patient who awakens from surgery to hear his

or her prognosis, and we are there as that patient figures out what

that prognosis means.

Sharing these stories offers meaning and insight to other nurses

and those who experience situations similar to what we write

about. These stories ease suffering and provide paths to new

perspectives that help people heal. When people recognize

themselves in stories, they realize they are not alone, that others

have been where they are and have made it through.

Write to share your own stories.When we write about our own experiences, we communicate the

unique perspectives of two worldsthe world of the healer and

the world of the sufferer. We cannot separate our stories from what

weve learned and lived as nurses. When our personal stories are

embedded in that knowledge, they gain power and have potential

to be transformative.

Karen Roush, PhD,

APN (Upsilon

Chapter),assistant

professor of nursing at

Lehman College in the

Bronx, New York, USA, is

the author ofA Nurses

Step-by-Step Guide to

Writing Your Dissertation

or Capstone.Roush

served for many years

as editorial director and

clinical managing editorfor theAmerican Journal

of Nursing (AJN)and

continues her affiliation

with the journal as an

editorial consultant.


6/25/2015http://www.


org/Pages/Vol41_2_Roush_

Write.aspx
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I am a survivor of intimate partner violence (IPV) and, as a nurse, have cared

for many patients who have experienced IPV. Writing as both a survivor and

nurse gives a weight to what I write that neither perspective alone would have.

It engenders trust and credibility and, therefore, creates an opportunity andI

believea responsibility to share my personal story for the possibility of change.

Recently, I visited a class of graduate students to talk about writing. They

had been assigned to read some of the pieces Ive written about IPV over the

years, including opinion pieces, blog posts, poems, and research findings. The

responses of two students illustrate the impact writing can have.

The first confessed that, when she saw the topic of the reading assignments, she

was not happy. I thought, Oh no, this is going to be such a downer. But the

insights she gained from reading about IPV in those formatsstories, poems,

and opinion piecesmade her realize how little understanding she had of the

experienceof IPV and how her misconceptions had resulted in her providing poor

care to women who suffered from it. She was determined to change her practice.

The second student was a woman who was in an undergraduate class I had

visited a few years earlier, a class that also had read some of my writing on the

subject of IPV. Now, in this graduate-level class, she asked if she could read

something she had written. It was a personal essay about reading my stories and

how it had given her courage to finally speak about her own experiences as a

survivor of IPV. Through writing, she was able to break through the silence and

isolation and begin to heal. These two examples illustrate the tremendous power

of writing to transform lives, professionally and personally.

Write to tell the stories of others.Nurses have a long history of speaking up for the vulnerable and the voiceless,

beginning with Florence Nightingale, a prolific writer, and onward to nurses

such as Lillian Wald, the great pioneer and champion of public health nursing.

Wald published a series of articles in The Atlantic Monthlythat later evolved into

her book, The House on Henry Street. In the articles and the book, she told stories

of the poor and disenfranchised that she and her organization of nurses cared

for, a population of new immigrants to the city who were unable to speak for

themselves.

As Wald writes in The House on Henry Street, Conditions such as these were

allowed because people did not know, and for me there was a challenge to know

and to tell (p. 8, italics original). Speaking about a story or a project resonates in

the moment, but writing can resonate through time. A hundred years after she

wrote them, Lillian Walds words enhance our understanding of social injustice

and move us to do something about the injustices we see today.

Write to understand.Writing forces us to see gaps in our thinking. We cannot write well about a topic

unless we understand it completely. When we see gaps, two things may happen:

1) We go out and seek more information, which may cause us to question

preconceived ideas, change perceptions, and open ourselves to discovery of new

ideas, or 2) we begin to formulate questions that will guide research to help fill

the information gaps. Eventually, writing leads to new understanding, not only

for ourselves but for other nurses and health care professionals.

Writing also helps us make sense of this world of health and illness, trauma and

redemption that we inhabit. We are called upon day after day to deal efficiently

and logically with suffering, to apply science and rationality to the irrational.

Amongst all the equipment, diagnostics, and data, writing keeps us connected to

humanity. It helps us interpret and analyze our actions and reactions. It helps us

see some small part of ourselves in our patients and, as a result, to be that much

more empathetic and to go back the next day and do it all again. Maybe better.

So, why write?

Our experiences as nursesour storiesare about life, all of its confusedmessiness as well as its transcendent truths. Few other professions put

members in the thick of it like nursing does. When we write about it, we make

connections, improve care, and transform lives. Isnt that the very essence of

what nursing is?


14/20


7 Habits of highly resilient nurses

They are associated with qualities ofmindfulness.

More than 40 percent of hospital nursestoday suffer fromthe physical, emotional, or mental exhaustion characteristic of

burnout. The result of unmanaged stress, burnout accounts for

what is often a negative perception among nurses of their work

and workplaces. If we as nurses can change our perceptions of our

work and work environments, we can change our experiences.

Resilience is the capacity to accurately perceive and respond

well to stressful situations. With the uncertainty, transition, and

reorganization associated with health care, resilience is more

important than ever if todays nurse is going to thrive.

TheAmerican Psychological Associationsuggests that several

factors help usdevelop and sustain resilience. They include

maintaining good relationships, accepting circumstances that

cannot be changed, keeping a long-term perspective, sustaining a

hopeful outlook, and visualizing ones wishes. These factors can be

developed and sustained with one critical skillmindfulness.

Mindfulness is paying attention, on purpose, to the present

moment. We exercise our mindfulness muscle with practices

such as deep breathing, meditation, and movement and bycultivating, through intentionally acquired habits, certain qualities.

Below are seven qualities of mindfulnesstogether with associated

habitsthat highly resilient nurses practice. Developing these

qualities will help you thrive in nursing and every area of your life.

Beginners mindis approaching familiar and unfamiliar things

in life with a sense of curiosity and the wonder of a child, instead

of from the perspective of an adult who, based on expertise and

judgment, makes certain assumptions.

Habit: Approach your next meeting, physician call, intake, or family-care

conference as if it were your first, with fresh eyes and open ears. Use an

I dont know mindset (even if you think you do know), and notice new

possibilities that appear.

Letting gois not giving in or giving up, but releasing the need

to control the outcome of a situation. The essence of mindfulness

is becoming aware of your thoughts, feelings, and sensations and

then letting them goagain and again and again.

Letting go is always the most popular mindfulness practice I teach,

especially with health care providers. All the exposure we have to

pain and suffering can invoke a lot of negative feelings, including

helplessness, and its important to be able to let go.

Habit: Reflect on a thought or feelingmaybe even a personyou are

holding onto right now that is not serving you. With each inhalation,

say let to yourself, and with each exhalation, say go. Each time you

exhale, visualize the word, image, or person you are letting go of floating

farther and farther away.

Compassionis the desire to alleviate suffering by expressing a

fundamental loving kindness. More simply, it means to be kind.

Compassion is why we chose nursing, but sometimes, when

dealing with a noncompliant chronic patient, an irate physician, or

an unrealistic family member, we forget. Compassion begins with

kindness to ourselves and is contagious.

Habit: When you are feeling completely overwhelmed with a thought,

feeling, or sensation, take a five-minute compassion break and ask

yourself, What do I need most right now? Lunch? Sleep? A walk

outside? Help? Be kind to yourself by making sure you get it.

Diane Sieg, RN,

CYT, CSP (Alpha

Chapter), is a former

emergency room nurse

turned speaker, author,

mindfulness coach,

and yoga teacher. The

author ofSTOP Living

Life Like an Emergency

and other books, she is

also the creator of the

30 Days Mindfulness

ChallengeandYourMindful Year.

ORIGINALLY

PUBLISHED:

3/19/2015http://www.


org/Pages/Vol41_1_Sieg_7%20

Habits.aspx
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15/20


Gratitudeis seeing and appreciating the blessings of life that surround us all

the time. Practicing gratitude is active and starts with the simple decision of

choosing what to focus on. What we focus on expands in our field of vision, and

when we focus on disappointment, we see lack and limitation. When we choose

gratitude, we focus on abundance and opportunities, and we attract more of

those assets.

We may think we have to be happy to be grateful. Just the opposite is true. Weneed to be grateful in order to be happy. We give little thought to so many things

we take for granted, such as having a secure job to support ourselves, enjoying

good health, and, as nurses, having our expertise and skill sets that make such an

incredible difference in how people live and die every day.

Habit: Start and end your shift with three things for which you are grateful. Include

yourself, family, friends, colleagues, and anyone else in your life.

Authenticityis being true to your personality, spirit, or character, despite

external pressures. It is honoring yourself by standing in the truth of who you

are, even if others have different expectations and desires for you.

Authenticity allows you to live a more open, honest, and engaged life. Authentic

people feel better and are less likely to turn to self-destructive habits for solace.

They tend to be purposeful in their choices and are more likely to follow

through on achieving their goals. Being authentic is how you truly connect with

your work, your relationships, and yourself.

Habit: Try telling the complete truth for one whole day. When someone asks you a

question, consider how you would respond if you were completely honest. You will soon

realize how often we stretch or leave out the real truth about how we feel or what wethink. Ask yourself right now, What am I pretending not to know?

Commitmentis being dedicated to do thingspersistently, patiently, and

maybe playfullyeven when you dont want to. Being committed to something

doesnt have to be hard. In fact, it can actually be pleasant, because you are doing

what you really believe in.

We cannot live to our fullest potential until we fully commit. It doesnt matter

if its a diet, an advanced degree, or five minutes spent engaging in mindfulness

practice. When we truly commit to something, we become bigger than our

excuses, such as I dont have time for this or Its not that important or Ill

start tomorrow.

Habit: Acknowledge your favorite excuse for not keeping commitments to yourself, and

replace it with a new mantra, such as: Bring it on! I am worth it! I commit, no matterwhat!

Trustmeans embracing faith over fearnot the kind of blind faith where you

believe everything you hear and live in denial, but an overall confidence that you

ultimately are resilient, resourceful, and totally capable of getting to the other

side of the situation.

Nurses have great intuition. We use it all the time in patient care, when we have

a gut feeling or hear a little voice telling us something we may not want to hear.

You have to be present to listen to your inner voice and then choose to trust it,

for your patients and for yourself.

Habit: Practice trusting your inner voice. Saying no to one thing allows you to say yes to

something else. Say no to an extra shift, a new project, or a lunch date on your day off if

your inner voice is guiding you to say yes to something else.

Resilience in nursing is not an option. We have to stay confident and strong in

body, mind, and spirit, and this requires us to practice mindfulness.

Since mindfulness is focusing on one thing at a time, start with one of the habits

described above that speaks to you the loudest, and go from there. These sevenhabits will change your perception because they will change youyou will

become highly resilient both as a nurse and in every other aspect of your life.


16/20


The lamplight narratives

I am an advanced practice nursea nurse practitionerworking for a

nongovernmental organization (NGO) in Southern Africa. We receive

referrals from hospitals, clinics, private doctors, lay care workers [carers],and other individuals in various communities. We visit people in their

homes when they are ill. Every day is a challenge, because I never

know what I will have to deal with. The goal of our team is to provide

palliative, holistic care to everyone we visit, which means we try to relieve

suffering, whether psychosocial, environmental, physical, or spiritual.

Many of the people I see do not have the wherewithal to write their own

stories, so I will be their voice. As a candle-lit Turkish lantern illuminated

an uncertain pathway for Florence Nightingale, I offer these narratives to

help light the way for others who have also chosen the noble profession ofnursing.

The lady of the shedAn image that has burned itself into the very depths of my psyche

is that of a lady we were fortunate to find.

On the far boundaries of the Bitou area, carers, who work in

the area they live in, had heard talk of someone who needed my

assistance. They had tracked down a relative of the woman and

determined where she was located.

To get there, we navigated a long dirt road filled with potholes. It

was tricky driving, indeed, and I felt for a moment I was on one of

those TV auto-rally shows where drivers compete in the back of

beyond. The family member had come with us to show us the way.

After what seemed an eternity, we turned off the road into a farm.

I thought the relative was going to lead us to the farmhouse, but

he kept walking. All the way, we were followed by a pack of large

dogs. Eventually, we came upon a shed, standing alone in the

middle of the veld. The relative unlocked and pushed open the

door, which was attached to the shed with large bolts. He then

opened another door to the left and stood back for us to enter.Upon entry, I put my medical bag down on the floor, and the

young man closed the other door to keep the dogs out.

The room was quiet and dark, and I was immediately struck by a

rancid smell. There was no electricity for a lamp and, with very

little light entering the room, my eyes took awhile to adjust. Once

I could see better, I moved further in, where I was able to make out

a small bundle near the far wall. I realised with horror and shock

that the bundle was a human being, a tiny, middle-aged woman

lying very still in a fetal position on a gray blanket spread out onthe concrete floor.

We found a small window and pulled back the makeshift curtains.

The womans head rested on a pillow, which also cushioned a few

small pieces of cooked chicken, a small pile of rice, and a heap

of shriveled vegetables. Flies were everywhere, and they were

enjoying the feast.

Upon closer examination, I determined that, other than her head,

this tiny lady was unable to move any part of her body. She was

facing the door, and when she saw us her eyes filled with anxietyand wariness. Thoughts shrieked through my mind: Was she

locked in this room to prevent the dogs from gaining access to

her? Who would leave a human being like this? Not even animals

are treated so! A mattress and a wire bed stood against the wall,

unused because she was incontinent. The food on her pillow, her

meal for the day, had been strategically placed so she could reach it

with her head if she was hungry. But how could she chew? She had

no teeth!

Cindy Hatchett,

MSc, RN, RM (Tau

Lambda-at-Large

Chapter),is a nurse

practitioner who works

for a nongovernmental

organization (NGO) in

Southern Africa.

ORIGINALLYPUBLISHED:The lady of the shed:8/31/2015

http://www.reflectionsonnursingleadership.

org/Pages/Vol41_4_Col_

Hatchett_shed.aspx

The cowboy: 12/1/2015http://www.


org/Pages/Vol41_4_Col_

Hatchett_cowboy.aspx
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After we spoke to her and explained that we were there to help her, she

smiled. A stroke had robbed her arms and legs of movement. Untreated with

physiotherapy, they were frozen in fixed contractures. Although she tried to

speak, we could not understand what she was saying. Her body was covered in

sores, and the adult nappy that she wore was soaking wet, as was the blanket.

Both the community carers and I were so moved and horrified by the situation

that we worked in silence most of the time, speaking only in hushed tones soas not to frighten her. After making the woman as comfortable as we could, we

informed social workers, questioned the person who had been looking after her,

and sent the woman to the hospital.

The last glimpse I had of this lady was a gummy smile, which conveyed more

than words could have described.

A sad and blatant fact is that she was receiving a disability grant from the

government so she could survive, be cared for, and have sufficient food. The

people who had been caring for her had been abusing this provision. They had

taken on responsibility for her care but were spending the money on other

things.

This tiny lady died not long after we found her. If only we had been able to

intervene sooner. She will never be forgotten!

The cowboyAn 86-year-old gentleman who lives in the Western Cape, South Africa, has been

a patient of ours for the past year. A man of great dignity and pride, he is also

incorrigible!

He has cancer that has spread to multiple parts of his body and regularly takes

oral morphine syrup for pain relief. He has refused further treatment and is

happy to carry on his life without the discomfort of chemotherapy and radiation.

He stays with his daughter and grandchildren in a small house. He speaks with a

deep, gruff voice, has only two front teeth remaining, and has a ready smile and

quip whenever I visit.

Dressed smartly, he walks about the streets of the township with a knobkerrie,

a wooden walking stick that has a bulbous top, making him look almost regal. A

leopard-skin cowboy hat, broad black belt, and jeans are his favourite outfit. On

special days, he adds either a rather worn tweed or scuffed-leather jacket.

This gentleman loves to sit on an empty paint drum outside his house to soak up

the sun. He also has a spare drum, which I have been invited to sit upon on many

a visita privilege. Catch a glimpse of him, and one might imagine that he is a

wise tribal elder.

I saw him walking in the road just the other day, looking rather handsome

indeed, like a cowboy. He even walks like one now that he has to wear adult

nappies due to the disease.

Today, he made me realise that life and its small pleasures never have to end.

He has found a girlfriend in another part of the township and walks to her

place every day. He doesnt carry his morphine with him, but rather a flask of

Sedgwicks Old Brown Sherry, which he says is much better than the medicine!

His daughter is frantic because she does not know where the girlfriend lives or

how she will find her father if he gets into trouble. She has even tried to lock him

in the house when she goes to work, but he climbs out the window!

We shall find out where the girlfriend lives and let his daughter know so she

does not worry. Today, he had a glint in his eye and a spring in his step. He is

happy and has made us smile, too. A rebel at 86, he is living life and enjoying

every moment!


18/20


Her name was Lydia

I wanted her to know she mattered tome.She was a medical-surgical patient of mine on a very hectic night

shift. The unit was at maximum capacity and scarce on staff,

and several patients with delirium or dementia were considered

safety risks. Lydia (not her real name), a woman in her 70s, had

Alzheimers disease. Because she responded to staff reorientation

more readily than the others, she was not assigned a sitter. Instead,

she was placed in a room right next to the nurses station, with bed

alarms activated.

Lydias husband had stayed with her from the time shed been

admitted early in the morning until right before dinnertime.

After he left, she gradually became more confused. By the time I

received the shift report, the day-shift nurse was struggling to keep

Lydia from wandering out into the hallway.

Shes got that fractured right arm in a sling. She hasnt said

anything about pain since I medicated her this morning. Im

worried that shes getting more restless.

In the middle of the shift report, the bed alarm from Lydias room

sounded. I ran to the elevators and found Lydia waiting for thedoors to open. Hows it going? I asked. Where are you headed?

Im just not sure Im supposed to be here, she replied.

Miss Lydia, youre here in the hospital because you broke

your arm, and the doctors are trying to fix it, I explained. Im

Gretchel. Im going to be your nurse for tonight. How about

taking a walk with me back to where my desk and your room are?

Lydia obliged. Sure, but only for a little while. Im not sure Im

supposed to be here.

Thank you so much for agreeing to help me out, I said. We made

our way back past the nurses station to her room.

Here we are. Do you think you can hang out for a little bit while I

visit my other patients? I wont take long.

Look, Ive got all this to sort through and read. Lydia pointed

to the large stack of newspapers her husband brought to keep her

occupied. Dont worry. Ill be here doing my work, she reassured

me.

Minutes after Id finished visiting my other patients, the bed alarm

in Lydias room sounded again, this time accompanied by high-

pitched screams. I found her standing in the midst of torn-upclumps of newspaper pages that littered most of the room. Her

face was streaked with tears, and she howled in anger. I dont

know why Im here! Why am I here? I dont want to be here! The

sling that cradled her arm lay crumpled at her feet.

I approached her cautiously. Lydia, I said, Im going to come

closer to you because I just need to check your arm. Is that OK? I

just need to check.

She nodded slowly. Its OK. Im not hurt. Its just a little sore.

Now Im going to touch your arm, OK? Just to check. I

inspected it. I saw no changes.

She interrupted my inspection. I need to talk to my husband.

Now! Right now! I need to know why Im here, and he needs to

tell me.

I dialed the phone number he had written on the dry-erase board.

Sir, this is Gretchel, your wifes nurse here at the hospital. She

would like to speak with you. Can you talk right now?

Gretchel Ajon

Gealogo, PhD, RN,

MHR, MSN, CMSRN,

RN-B (Delta Alpha-

at-Large Chapter),

is a medical-surgical

nursing and pain

management certified

nurse, with special

interest in consumer

advocacy and research

partnerships with

cognitively impairedpopulations.


8/27/2015http://www.


org/Pages/Vol41_3_Gealogo_

Lydia.aspx
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He sounded worried. Of course. Is she OK? Do I need to come back? I just

need enough time to eat something and take a shower. I havent done either in

two days.

No, I think weve got things under control. But Lydia would like to speak to

you. Here she is. I gave the phone to Lydia.

Hello. I hope youre OK, she said. I couldnt find you. Why am I here? Didyou leave me? Is it OK?

As they finished their call, I quietly cleaned up the mess around the room. I

then repositioned Lydias arm back into the sling and reassessed her level of

discomfort. Tell me, Lydia. If you could give the pain in your arm a score from

one to 10, with zero being no pain, and 10 the worst pain ever, what number

would you give it?

She considered the question carefully, squinting her eyes in concentration.

Hmm. I think its a 7.5. Yeah. A 7.5.

Would you like to take some medicine to help with the pain? Its OK if you

dont want any.

No, I think Id better take some. I probably needed some earlier, huh? Itll help

me sleep.

One more thing. How can we make sure youll know right away where you are

when you wake up? Youre at _____ Hospital for a fractured arm, and the doctor

will decide in the morning if you need surgery or not.

OK, she agreed. Can you write something like that on the board?

How about we write it together? I suggested. By the time we finished, the dry-

erase board bore this note:

Hi, Lydia! Its Friday, March __, and you are at _____ Hospital. Im Gretchel, your

nurse. Your husband brought you here this morning because you broke your right arm

when you fell at home. He will be back in the morning to meet with your doctors. If you

need anything, Ill be outside your room at the nurses station. The door to your room is

open so I can hear you if you call for help.

After taking the pain medication, Lydia slept most of the night. Once or twice I

saw her sit up in bed, look out the window, read aloud the words on the board,

and go back to sleep. When I stopped by her room in the morning to say a final

goodbye, she held onto my hand after I gave her a hug.

I want to thank you for being patient with me last night. You know, I know Im

losing it, she admitted. Its hard, but it just is.

She wiped the tears rolling down her cheeks and averted her gaze to the view

outside her window, the bright sunlight illuminating her gray eyes. Lydia never

looked more beautiful to me than in that moment, and I have never forgotten

what she looked like then.

On my hour-long commute home that day, I realized that Lydia was the reason I

was a nurse and why I wanted to be a nurse scientist. The person-engaged model

for dementia care I developed as part of my dissertation is based on what Lydia

taught me: that persons with dementia are engaged citizens who express their

care experiences, make care choices, and contribute to health care team goals. Ashealth care providers, caregivers, and communities, we are obligated to listen to

what they have to say and to ensure they have opportunities to build and sustain

capacity to engage in their care.

I dont know what became of Lydia. I am pained by the inevitability of her

prognosis and its impact on her loved ones and the community to which she

belonged. But I am also encouraged by the thought that, during the short time

we knew each other, I was able to engage her so that she understood, without

question, how much I cared. Lydia mattered, and I wanted her to know she

mattered to me.

You still do, Lydia. You always will.


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RNL Year End Sampler

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Transcript of RNL Year End Sampler