The Power of Storytelling

Storytelling is powerful. Do I even have to tell you this? You know this, from marketing to movies, to songs to any media we interact with, storytelling is the most powerful tool humans use to communicate ideas. And now, companies like Google are using data as a way to tell a story.

Storytelling in healthcare has been limited in some ways. Medical shows and movies are often focused on physicians. You have the occasional appearance of other professionals, like with Nurse Jackie, but doctors are the story most of the time.

With this narrow view, those of us in health care find our stories overlooked and unaccounted for. Nurses, for example, are often voted the most trusted profession in America, but often find that the public understands very little about our work. Sometimes, our own colleagues understand very little about our work. The same goes for some other unaccounted for professionals, like Occupational Therapists.

With the rise of social media and new platforms for storytelling, you find that a lot of people traditionally left out of storytelling are finding a platform to share their stories. The questions for health care professionals is what story are we telling and who are we telling it to? What stories do we want to tell?

This is our opportunity to tell our stories about the real work of caregiving. Beyond the role of angel, beyond the role of extra in the scene just following doctors’ orders, we can talk about our experiences in our own voices. What story are you going to tell?

In a couple of months, I am going to be able to share with you how I am working with storytelling and I can’t wait. Stay tuned!

Historical Trauma in Caregivers

Nurses are angels.

Nurses are heroes.

Nurses are the most trusted profession.

Nurses are humans with human experiences.

Sometimes messages about nursing involve an image of nurses that are amazing and often superhuman. They work 12-hour shifts caring for the sick and dying without thanks or a primetime tv show (that’s for the doctors). This image is because nurses do work hard and they do this work is often very difficult circumstances. They chose a profession that relies on the combination of science and compassion to help people through the most difficult moments of their life.

But nurses are not angels and they are not superhuman. They are very human.

There is a lot of discussion about burnout in healthcare these days. Part of that is a greater body of research on burnout that is finally reaching the bedside. The other part of that is in an era of social media, where nurses are finding a voice to talk about it. Under the umbrella of burnout comes compassion fatigue, vicarious trauma, and secondary traumatic stress. One often mentioned but not detailed point in the literature about burnout is how personal trauma increases your risk for burnout, compassion fatigue, etc. In fact, a recent study of 211 students in a BSN program saw a correlation between adverse childhood experiences (A.C.E.) and burnout.

According to the CDC, “Adverse Childhood Experiences (ACEs) is the term used to describe all types of abuse, neglect, and other potentially traumatic experiences that occur to people under the age of 18. “

The research on A.C.E. originated in a Kaiser study of around 17,000 participants. The study found a significant relationship between A.C.E. and health and well being. A.C.E. are organized into three groups, abuse, neglect, and household challenges. The higher the number of A.C.E., the higher the risk for negative outcomes like depression, substance abuse, cancer, and more. A.C.E. increases a person’s chronic stress and may make them more likely to engage in risky behavior. People with a score of six or more tend to die 20 years earlier than those without. As a reminder, having adverse childhood experiences doesn’t mean you will also have all of those negative effects, and some people are quite resilient.

This area of the research is especially interesting to me for multiple reasons, but the primary reason is that when I look at the A.C.E. survey, I have an A.C.E. score of 7. And I did experience some of those lasting impacts (hello teen pregnancy). But I chose a career where I believed I could make a difference and help others because of my adverse childhood experiences. In fact, in nursing school, I was voted the most caring nurse. I see similar reasons in my nursing students too. They often talk about wanting to make a difference.

We know that A.C.E. are not uncommon. So what happens to the nurses with A.C.E. when they care for others? According to that 2018 study, student nurses with higher numbers of A.C.E. had a higher level of burnout and depression. And one thing I tell my students about our most difficult life experiences is that one day you inevitably run into something that brings up those past experiences. It may be your patient reminds of yourself or someone you knew. It may be that your patient is experiencing the same adverse event you did. We are often in a caregiving moment that also brings us face to face with our life experiences. Nurses need to be prepared for how to handle it. In school, we often learn how to use therapeutic conversation skills or lifespan psychology to care for our patient. But there is not enough conversation about how our experience impacts our care or how we manage our emotions through it.

Emotional labor is a key aspect of burnout in new nurses.

So what can you do for yourself?

Learn about A.C.E. See what your score is (there are a few different questionnaires, this is one).

Develop a mindfulness practice. Yoga or meditation.

Get a therapist. Find strategies to help you work through your experiences and develop strategies you can use when you encounter triggers at work.

Have boundaries. Stop working extra or so many days in a row. Stop being the only nurse who will take the abusive patient that reminds you of someone you grew up with.

These events were out of your control, but what you do today is in your control.

Travel and Blood Clots: Should You Be Worried?

Staying healthy while traveling is important, especially in today’s world. Travel has become more accessible than ever due to a strong U.S. economy and airfare deals. The more we travel, the more we have to consider the health risks of travel. The Center for Disease Control (CDC) website lists common health travel concerns. These include things like medications, jet lag, mental health, bug bites, etc. One of the concerns on the list is Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE). When I travel, I know this is a risk, but I always wonder, how much of a risk is it?

What is a DVT?

A DVT is a blood clot that is formed in a large vein. This blood clot can block blood flow through the vein. The symptoms of a DVT is swelling, heat, redness, and/or pain in the arm or leg. A PE can occur when the clot breaks off and travels to the lung blocking blood flow in an artery. Symptoms could include chest pain, coughing up blood, a fast heartbeat, and/or difficulty breathing.

Are you at risk for a DVT?

The risk for a DVT depends on certain factors. Blood will clot with lack of circulation and with certain existing problems. The CDC advises about a general risk for DVT while traveling and with certain conditions. If you are traveling by plane, bus or train, your risk is increased by the length of your travel, how dehydrated you are, and by how little you move (which helps circulate your blood).

Your risk also increased with the following conditions:

  • A previous blood clot
  • A family history of blood clots
  • a known clotting disorder
  • Recent surgery, hospitalization, or injury
  • Using estrogen-containing birth control or hormone replacement therapy
  • Current or recent pregnancy (talk to your doctor about travel)
  • Older age (risk increases after 40)
  • Obesity
  • Active cancer (or undergoing chemotherapy)
  • Other serious illnesses (talk to your doctor about travel risks)
  • Any limitations in movement (casts, disabilities)

How do you prevent a DVT?

There are a few things you can do for DVT prevention:

  • Drink plenty of fluids
  • Avoid caffeine and alcohol to stay hydrated
  • Get up and move around every 2-3 hours if possible. If driving, make frequent stops (you will have to if you stay hydrated!)
  • Do lower leg exercises in your seat. Raise and lower your heels while keeping your toes on the floor or raise and lower your toes while keeping your heels on the floor.
  • Compression socks: In a Cochrane review (expert database for organizing scientific evidence) on DVT with air travel that lasts 5 hours or more showed a decrease in symptomless DVTs after flying. They help circulation in general, so if you get swelling in your feet while traveling, these could help. I find that my feet don’t get cold on flights when I wear them (I am always cold on the plane).
  • Medication for prevention of blood clots for certain problems (not common)

Where can I get compression socks?

They can be easily found online or at health or uniform stores (nurses wear them for work). They usually cost around $20 but they are a good investment and you won’t be wearing them every day. But when you are shopping for compression socks, you want ones that are going to work for you. They are usually a bit of work to put on and should be long enough to go up until just below your knee. They shouldn’t fall down when you walk. They should fit snug for the whole flight and shouldn’t loosen later in the flight.

Caregiver Burnout: How to Recognize Symptoms of Burnout

Caregivers

This one is for the caregivers. The parents, grandparents, children, spouses and other family members caring for loved ones. The partners, friends, foster parents and families of choice. The home health aides, nurses, social workers, occupational therapists and other professional caregivers. The emergency workers, international aid workers, and community outreach workers. You. The ones who are caring for someone who needs help.

Caregivers are doing the work in a variety of circumstances and for a variety of reasons. But ultimately those reasons boil down to caring, whether you’re getting paid or are doing it just because you see a need and want to help. And there are a lot of you out there. According to Caregiving and AARP in 2009, there were 16.8 million families caring for a child with special needs. According to the Bureau of Labor Statistics, 41.3 million Americans are giving unpaid care to elderly people. There are almost 3 million registered nurses in the US.

Some of you are working 12-hour shifts, some of you are working nights, and some of you are spending 30 unpaid hours a week providing for a child’s special needs. All of that work can put a strain on families or lead to burnout in caregivers.

Burnout

What’s burnout? According to WebMD, burnout is a state of physical, emotional, and mental exhaustion that may be accompanied by a change in attitude — from positive and caring to negative and unconcerned. The strain on family caregivers is influenced by a combination of stressors, resources (or lack of), and perceptions about their roles. These factors can lead caregivers to feel exhausted, overwhelmed and isolated. And caregivers typically don’t want to burden their loved one, which often causes them to internalize their feelings. The combinations of strain and internalized emotions can lead to health problems of their own in caregivers.

According to the Self-Healing Through Reflection Workbook, professional caregivers experience burnout as job stress that accumulates over time as physical, emotional, and mental exhaustion (Bush & Boyle). This experience is affected by workload, resources, personal coping skills, leadership and workplace support. The previously mentioned workbook is an excellent resource for nurses.

Symptoms include:

  • Withdrawal from patients, friends and family
  • Anxiety
  • Loss of interest in activities previously enjoyed
  • Feeling blue, irritable, hopeless, and helpless
  • Feeling “numb” or apathetic
  • Changes in appetite, weight, or both
  • Changes in sleep patterns
  • Getting sick more often
  • Feelings of wanting to hurt yourself or the person for whom you are caring
  • Emotional and physical exhaustion
  • Excessive use of alcohol and/or sleep medications
  • Irritability

Professional Caregiver? Click here to get the self-assessment to see if you are experiencing burnout.

Family/unpaid caregiver? Take this self-assessment to see if you may be experiencing burnout.

How to Stay Hydrated While Traveling

Water is Essential

Water is one of life’s most basic needs. You can’t live without it. Remember when we were in school and we learned that we were 70% water. It’s closer to 60%, but that’s still a lot of water.

So where is it and what does it do?

Water is in all of our body’s cells. Just think of how many things feel bad without moisture, our eyes, our skin, and our mouth and nose. Those things are more external, but we need that moisture internally too. It lubricates and cushions joints, regulates temperature, protects sensitive tissue like our brains. Our saliva, blood, and waste is made up of water. Some vitamins we take in need water to be absorbed. If we don’t get enough water, we may feel tired, dizzy and we may have some trouble with short-term memory and other cognitive skills. If we get too dehydrated, we can have a drop in our blood pressure and

So how much water should we drink in a day? According to the Institute of Medicine, around 80% of our water comes from fluid intake with the rest coming from food. In general, adult men should drink13 8-ounce cups and adult women should drink 9 8-ounce cups of beverages. If it is hot, dry, or you are working hard, you need to drink more.

However, when we travel, we sometimes forget about how important it is.

Stay Hydrated While Traveling

Here are 5 ways to stay hydrated while traveling:

  • Bring your own water bottle and keep water with you everywhere you go
    • We know airport water is seriously overpriced and it just adds more plastic into the environment. Instead, bring your own flask or water bottle to fill up once you are past security. If you are worried about space, get one with a carabiner that you can attach to your bag, so it isn’t taking up space inside your bag.
  • Choose water as your beverage when eating out
    • It’s fun to try the local aperitif, but make sure to drink a glass or two of H20 with meals.
  • Avoid drinking too much caffeine or alcohol
    • What’s a vacation without an espresso in Italy or coffee in Vietnam? I love coffee. But don’t overdo it. Caffeine and alcohol are both diuretics. They make you produce more urine to get rid of instead of keeping that fluid in the body.
  • Be careful about eating foods that can cause traveler’s diarrhea
    • Some street food, meat that is raw or at room temperature can be contaminated. Avoid buffets. Wash your hands. Some people pack antibiotics or drugs like Immodium for their trip, you can ask your doctor if they think its necessary.
    • While I have never been sick in another country, I have gotten sick right here in the USA. Sometimes we can’t control how people prepare food.
  • Use this map to see if the tap water is safe where you are traveling
    • Some places surprised me in eastern Europe (I already had tap water there without knowing about this and thankfully I did not get sick)