Nursing/Caregiver Stress

 ONS 

Welcome to today's hot topic chat! Today's speaker is Dawn Camp-Sorrell, talking to us about nursing and care giver stress. Welcome Dawn!

 dcamp-sorrell 

Hello and welcome!

 dcamp-sorrell 

We will be discussing caregiver stress, burdens, and your stress.

 dcamp-sorrell 

First of all, do you have any burning questions?

 dcamp-sorrell 

Would you like to share any experiences you have seen in the work place with caregivers being burden?

 oncnurse 

What are your recommendations for dealing with hostile family members?

 dcamp-sorrell 

What a great question.

 dcamp-sorrell 

I recommend approaching in a calm cool manner. To ensure the situation is calm.

 dcamp-sorrell 

I always reflect what the person is trying to say and repeat their exact words.

 willow 

I ask them what is bothering them.

 dcamp-sorrell 

Sometimes they don't even realize that they are being hostile.

 dcamp-sorrell 

Willow, what a great approach!

 oncnurse 

True, but can seriously hamper your work and also upset their family member.

 dcamp-sorrell 

Yesterday, I had a hostile patient when I confronted him about smoking, yet he couldn't afford his meds.

 dcamp-sorrell 

I simply waited for him to lash out at me and then reflected what he was doing.

 dcamp-sorrell 

The bottom line was and which he admitted, if he gave up his 2 pack a day habit, he could afford his meds.

 willow 

I am not good at reflecting, it always comes out wrong. Could you give and example of how this works for you?

 dcamp-sorrell 

Oncnurse, I think it’s more of time to reflect what I need to do next. In the case of yesterday patient, I almost felt as though I needed help to deal with him.

 dcamp-sorrell 

Willow, its hard

 dcamp-sorrell 

For example, yesterday I told him that I was making a suggestion. One that he did not have to do.

 dcamp-sorrell 

I then pointed out that he had a choice and that was not mine.

 dcamp-sorrell 

Often times you can repeat exactly what the hostile person tells you and let them think about their behavior.

 dcamp-sorrell 

With that said, sometimes that doesn't work.

 dcamp-sorrell 

Hostile folks are just trying to be in control of a situation in which  they have no control.

 dcamp-sorrell 

There really is nothing about cancer care that can be controlled. Would you agree or what are your thoughts?

 willow 

I usually just treat them calmly and politely with minimal time to encourage acting out.

 dcamp-sorrell 

Great willow! I agree.

 dcamp-sorrell 

I'll admit, the patient yesterday apologized for his behavior and said he needed to stop smoking.

 oncnurse 

Family members have to deal with all of the stress of the medical experience but then have no control over what is happening. The patient can make decisions for they (at least often) and the family can't control that either. Makes people who are used to controlling everything very unsettled.

 dcamp-sorrell 

How true oncnurse!

 dcamp-sorrell 

For those with type A personality the cancer experience is very difficult!

 oncnurse 

How do you not take all of the hostility home with you? It's exhausting....

 dcamp-sorrell 

What a great question!

 dcamp-sorrell 

This is very difficult for me. I have to really put forth a great deal of effort not to take it out on my family.

 dcamp-sorrell 

When you are the scapegoat, which you are in these hostile situations, you come home drained.

 dcamp-sorrell 

I often talk to other nurses before going home and vent the whole situation, if time.

 dcamp-sorrell 

I feel if I talk with someone about the situation, then I don't have to get re-living the situation in my head. You know, “did I do the right thing”?

 willow 

I refuse to give them space in my head, I carpool and it’s an hour commute so my coworkers help me vent.

 dcamp-sorrell 

Another thing, I often will write down the whole conversation and give it to my boss. This way I can release whatever negative feelings I was having.

 willow 

Usually if someone is really acting out our manager steps in to try to make them "happy".

 dcamp-sorrell 

Willow, how nice is that!

 dcamp-sorrell 

It is wonderful to have a great supportive manager. I've been in positions where I did not.

 dcamp-sorrell 

Often, hostile folks can make your life terrible, especially when they report you for something you did not do.

 oncnurse 

That carpool is a therapy session! Great.

 willow 

One thing I try to tell my coworkers (and I work in two different onc infusion clinics) is that some things are better handled by managers. If I can get the manager working on something that I can’t resolve anyway, then I can keep moving forward with my other patients.

 dcamp-sorrell 

That is a very good point! One that we should all consider!

 dcamp-sorrell 

Actually that is your manager's job---to saveguard the staff.

 willow 

That is exactly right, some of my colleagues get into a fuss about things they have no business being involved with because they have no way to resolve them. A two minute call to patient support services can save a day of grief.

 oncnurse 

Do you recommend that caregivers set up respite care help or adult day care for their family members? Does it matter the age of the caregiver (whether older caregiver or adult child of the pt)?

 dcamp-sorrell 

Absolutely, what a great point! Why take on the extra stress- in the grand scheme there is nothing you can do about the situation.

 dcamp-sorrell 

What a great way to reduce stress- adult day care.

 dcamp-sorrell 

Actually the studies are very limited and in the oncology population are lacking.

 dcamp-sorrell 

Studies thus far have shown that benefit to the caregivers is not established as of yet.

 dcamp-sorrell 

With that said, I would think it would be difficult on the caregiver to transport and try to rest with their love one away from them. Again, it would be a lack of control in the caring process. What do ya'll think?

 dcamp-sorrell 

A multi-analysis study showed that respite care may reduce burden and stress but did not draw any conclusions. I would think it would benefit the caregiver.

 oncnurse 

I think especially if the pt has neurological deficits (mets and/or brain tumor) that change their personality especially.... this can be a real god send for family. I think they are relieved for a break. I have some personal experience with this - just a couple of hours a few days a week gave you space to breathe.

 dcamp-sorrell 

How true!

 willow 

I imagine that would be very helpful.

 dcamp-sorrell 

You would not be able to leave the patient in fear of the patient doing something to themselves or to the home.

 oncnurse 

I think we sometimes forget that that family members is still trying to function in the world, is not in the hospital... is trying to go to work, pay bills, take care of children...yet experiencing all of the stress of the medical issues.

 dcamp-sorrell 

This would be very similar situation to those with dementia. I would have a hard time leaving them if I thought they may turn on the stove or start water to fill the tub for a bath. Just because their mind is not in tune to the world.

 dcamp-sorrell 

I can't begin to imagine the stress of the medial stuff with the daily living stuff. That would be hard. So often as nurses we forget that.

 dcamp-sorrell 

When Mom was diagnosed with colon cancer; for 16 weeks it was difficult to manage her care at home and try to work. Thank goodness she was mentally alert.

 dcamp-sorrell 

Yet, I could not leave her alone. What a nightmare to find competent people to help me during the day and night.

 oncnurse 

What is more stressful for you as the nurse to deal with - the patient or the family?

 dcamp-sorrell 

Finding reliable help for patients in the home is difficult. Have you experienced this?

 dcamp-sorrell 

I think the family is. Their expectations are often way out there.

 oncnurse 

Do you recommend support groups for your families? Or other interventions?

 dcamp-sorrell 

Great thought! You know the ONS PEP card agrees with support groups. Are ya'll familiar with the PEP card?

 willow 

We recommend support groups and give out flyers.

 oncnurse 

Willow, are your support groups done by social work, nurses? Outside the organization?

 willow 

All of the above

 oncnurse 

Sounds like you have a lot of good resources for people.

 dcamp-sorrell 

Unfortunately, we don't have a social worker. We refer our patients to ACS (American Cancer Society) and the Leukemia Society. The hospital sometimes offers classes.

 willow 

I just give out the info and invite them to check it out. Yes, there is good support.

 dcamp-sorrell 

The nurses have a difficult time finding time to do support groups which is a shame.

 oncnurse 

Do either of you find it helpful to have nursing debriefings after stressful events on the floor- patients that "turn", deaths?

 dcamp-sorrell 

Our nurses tend to do one-on-one with the patient support. Our families sometimes don't get that benefit.

 dcamp-sorrell 

Yes, we try to do debriefing.

 dcamp-sorrell 

I find it helpful to remember all the positive things about the patient. Sort of going down memory lane.

 willow 

Yes, we cry or hug or problem solve with those involved in the trauma, and if you didn't happen to be there that day, you just listen and offer support.

 oncnurse 

I want to work where you work!

 dcamp-sorrell 

Willow, where do you work? Inpt or outpt? I want to work with you.

 willow 

One hospital I work at has a beautiful memory board where obituaries are posted and you…

 willow 

…can learn more about…

 willow 

…your patient’s life before he or she became a patient.

 oncnurse 

We have used memory books - same concept.

 dcamp-sorrell 

What a great idea! Yesterday, I had someone discuss using a memory book for all to use.

 willow 

I work outpt infusion clinics in two hospitals.

 dcamp-sorrell 

Wow! I guess it would save your sanity to work 2 places. Then, you would not have the time to get caught up in the nursing drama which is stress itself.

 oncnurse 

What do you think we can do as nurses to better support one another? Do you think this should be part of orientation?

 dcamp-sorrell 

Absolutely!

 willow 

I really like concept; one place I work will have nothing to do with them because they see it as just another task to be assigned; I have given up trying to show them the value of it.

 willow 

Be nice to each other, we don’t all have to be friends or agree, just be nice to work alongside of.

 dcamp-sorrell 

I think nurses can support each other just through the activities you have described.

 dcamp-sorrell 

I also think that learning that we don't all have to agree and we just need to work together for the patient.

 willow 

Agree

 oncnurse 

I think this is a major nursing cultural deficit- everyone has heard about the "eating our young" issues in nursing... but when it comes to stressful situations, we truly need one another. So hard to get people to realize that it makes their own life better too.

 dcamp-sorrell 

Often times this isn't easy especially when there is a nurse that just wants to clock in and out without giving extras.

 dcamp-sorrell 

It’s so important to support each other as a team. Patient care is a team effort not a single care .

 dcamp-sorrell 

So true. It amazes me why nurses can't work together as a team.

 oncnurse 

If every nurse realized that not dealing with stress effectively is really taking years off their own lives, they'd buy into making the work place a more supportive environment.

 dcamp-sorrell 

I do think starting in orientation to develop the attitude of working together is so impt

 oncnurse 

Willow, what is different at your two locations that you could point to – tangible things...that make the cultures so different?

 willow 

You have to let that stuff go or it will damage you, the nurse that just clocks in and out can be found in every institution and in every career, not just nursing. There are bad Wal-Mart people, bad doctors, bad priests, clocked out parents, etc

 dcamp-sorrell 

It is more stressful when you feel as though all your efforts are not going for the good of the unit or patient.

 willow 

One place really values the input of each and every nurse who…

 dcamp-sorrell 

How true willow! I'm thinking you are both seasoned oncology nurses!

 willow 

…wants to offer something…

 dcamp-sorrell 

Yes, Willow!

 oncnurse 

Willow, is that a top-down culture or grass roots? Do you know?

 willow 

Others gives lip service but only listens to a few.

 oncnurse 

Willow, is the role of manager in developing the "good” culture important, do you think? Or is it more good luck in the people who are in that "good “culture?

 willow 

Not sure about top down, sorry about typing issues!

 dcamp-sorrell 

! It seems to be that the manager is who is role modeling.

 willow 

I think the manager sets the tone. I have worked in many different areas

 willow 

And it’s always the manager.

 oncnurse 

Then even more important for managers to be reading this!

 dcamp-sorrell 

Without someone to show you the correct environment, the support, the team building skills, other nurses will lose the idea and the culture can't be cultivated.

 oncnurse 

Too hard for a staff nurse alone to try to change a culture.

 willow 

I agree but I also think that individual nurses can be a "light" per say by keeping ac…

 dcamp-sorrell 

I agree with you both, its got to be the manager. One who realizes that they can not be liked by all. That's not their job.

 oncnurse 

Keeping ac?

 willow 

…keeping their actions true to how they want everyone else to be treated.

 dcamp-sorrell 

Sorry willow, not sure what you mean by ac? In the south, that would be air conditioning!

 willow 

Sorry, this computer is new -funny keyboard

 willow 

yes

 dcamp-sorrell 

Willow, what's ac?

 willow 

A manager can’t do it alone.

 willow 

ac was part of the words action

 oncnurse 

OK!

 dcamp-sorrell 

I agree that a manager has to have the staff to buy into the positive actions.

 dcamp-sorrell 

Sometimes the manager has to do 1-1 with the staff to implement this change in culture.

 oncnurse 

And sanction inappropriate behaviors.

 willow 

I'm sorry but I need to take child to pediatrician appt, thanks for sharing.

 dcamp-sorrell 

Regardless of the location, it seems the manager can elicit support from 1 or more of the staff to help in the environment.

 oncnurse 

Thanks for your insights Willow!

 willow 

bye