Monday, September 29, 2008

A Tribute To Nursing

By Linda S. Smith, MS, DSN, RN, CLNC
Professor and Nursing Program Director, Idaho State University

To venture the task of discussing the great people and events that have made American nursing the powerful profession it is today, is to undertake an impossible task. I do firmly believe, however, that a taste of history is somewhat like eating one Idaho potato chip - it will stimulate and support a lifelong interest in the subject.

We in nursing are fortunate indeed to be able to emulate the leadership and political savvy of Florence Nightingale. She, more than any nurse before or since, shaped and expanded quality health care throughout the British Empire and world. Most people, however, think of Florence Nightingale only as the founder of nursing education. Though this is true, her contributions exceed far beyond nursing and into the realm of illness prevention, health promotion, and community health and safety.

Florence Nightingale (born 1820) was better educated than most men of her day. She was an accomplished linguist, mathematician, statistician, philosopher, and historian. She understood that contrary to the belief of the day, forward thinking people could alter their destiny. She had an insatiable curiosity and a probing, analytical mind. But her greatest handicap by far was being a woman.

Despite this handicap, Nightingale created and developed a system of education affording women a respectable profession. Additionally, she used her strong political powers to enact hospital and military reform. She reformed health care for the British Empire, including India. Nightingale presented rationale for her decisions and needs with expert mathematical skill. She used the power of the press and her own outstanding prolific writing abilities to keep public health issues in full view of the people.

Nightingale was a national heroine and she used this popularity, along with her expert health care and political knowledge, to influence major leaders, including the queen of England.

US Nursing

In the early 1900s, American women did not have the right to vote nor were they allowed political status. Though nursing was almost exclusively female, nurses as a group were enormously conservative in their approach to the women's movement. In 1907, at the 10th annual convention of the Nurse's Associated Alumnae of the US (now known as the American Nurses Association), the question of women's suffrage (right to vote) was hotly debated and a resolution in support of the women's movement defeated.

Nurse Lavinia L. Dock, however, stands out as one of the strongest, most pro-feminist American nurse of all time. She marched in Washington and went to jail for her belief in equal rights for women. When, in 1920, congress passed the 19th amendment to the constitution giving women voting rights, Dock continued her equal rights crusade in opposition to countless other discriminations against women. Her basic premise, until she died, was that all people are equal.

The power of the press was the motto and mission of Nurse Sophia Palmer, first Editor and Publisher of the American Journal of Nursing. Palmer had great insight into the need for nurses to control their own profession. Her editorials helped create the first American nursing licensing laws and boards in 1903. Palmer took risks and made a major difference for us all. Because of her and others, boards of nursing govern American nurses and American nurses have legal standards for practice and education. These standards forbid unqualified, unlicensed persons from calling themselves registered nurses or RNs.

This is an exciting time to be a nurse! Because of increasing population census, a growing number of elders, expanded technology, health care reform, and emerging nursing roles, many new nursing jobs in Idaho will surface. These new jobs will require well-educated, dedicated, competent, caring, decision-makers and client advocates. Nationally, the healthcare system will require more than 1.2 million new nurses over the next decade. That means that the second largest number of new jobs among all occupations will be for RNs.

RNs work to promote health, prevent disease, and help patients and families cope with illness and disability. They are advocates and health educators for patients, families, communities. RNs develop and manage patient treatment plans; instruct patients and families in proper care; and help individuals and groups take steps to improve or maintain health and quality of life.

Though there will always be a need for hospital nurses, in the future, a growing number of nurses will be employed in home health, long-term care, hospice, parish nursing, prison care, community care, surgical centers, and ambulatory clinics.

This week, please stop for a moment to thank a nurse who has helped you or someone you love find health, wellness, strength, and an improved quality of life. Individuals, families, communities, organizations, specialties, and health services have discovered the importance of quality nursing. Florence Nightingale, we are proud to be walking in your nursing shoes.

Thursday, September 18, 2008

Why Does She Stay?

Why does she stay?

*Female victims of domestic and partner violence


Linda S. Smith, MS, DSN, RN, CLNC

Professor and Director, Associate Degree Registered Nurse Program,
Idaho State University

"Husband suspect in city killing. Police say a 25-year-old man is suspected in the death of his 26-year-old wife who was bludgeoned (in the head) to death. The man is scheduled to appear in court this morning and police said they would seek first degree murder charges."

Homicide is one complication of domestic and partner violence. Other complications are the more than two million abused women* each year seeking medical help for injuries. She may be stabbed, kicked, pushed into fires, thrown through glass, or downstairs, strangulated (called throttling), and raped.
Results of these violent crimes are seen everywhere -- in clinics, hospitals, schools, churches, community centers, and psychiatric departments. Healthcare professionals see the results and the complex costs for persons, families, and communities. Sadly, ever more cases of abuse are surfacing.
Battered women are found in all socio-economic groups and all education levels. They are partners of postal clerks, physicians, ministers, construction workers, policemen, bankers, and mechanics. It may be hard for friends and associates to believe he* could be doing the things she describes.
Jane Doe is an example. “Jane” was admitted to the orthopedic unit of a hospital having suffered compression fractures of the lumbar spine after jumping out of a second story window. When Jane’s husband beat her with everything he could find, Jane jumped to escape his attack.

Why does she stay?

Importantly, abused women often wish to see an end to the abuse but not necessarily an end to the relationship. Therefore, the question, "Why does she stay?" is complex. Often perpetrators have isolated female victims from friends, family, employment, money, and education. Abusers may become pathologically enraged.

One of the most dangerous times for her is when the perpetrator knows or suspects that the woman is going to leave. He will perceive her leaving as his own loss of control – that is often when the lethality of the abuse escalates. The average woman will try to leave seven times before she effectively separates from the violent perpetrator. But each time she returns, she puts herself in great danger. Perpetrators will do whatever it takes to keep their victims from leaving.

Victim and perpetrator often have grown up in an atmosphere of abuse -- learning violence first hand. This “training” may contribute to the woman's feelings of low self esteem and acceptance of abuse as a way of life. Abuse is compounded by a lack of resources and the woman's own feelings of responsibility for holding family and relationship together. Fear and intimidation increase by threats such as, "I'll kill you and the kids if you don't do as I say." “If you try to leave, I’ll find you and kill you.” “You are too stupid and ugly to be able to do anything on your own.” Alcohol and other drugs may give perpetrators yet another excuse for unacceptable behavior. Also, victims may turn to alcohol or drugs in attempts to medicate their mental and physical pain.

Helping the female victim

Abused women may not be able to remove themselves from a domestic or partner violence situation without help and support; victimized women may return to the abuse because they can’t find resources to sustain their leaving.

Five common behaviors used by perpetrators:
1. Physical abuse such as kicking, hitting, strangling, using a weapon;

2. Sexual abuse such as forced sexual activity

3. Psychological abuse such as threatening/humiliating the victim by saying "I'll take the kids," or "I'll kill myself;” name calling; forcing the victim to perform humiliating acts

4. Isolation such as preventing victims from seeing or talking to certain people such as shelter advocates, family, or friends; monitoring mail, phone calls, mileage, and daily activities; slashing tires or keeping victims from transportation, employment, education

5. Intimidation: such as physically intimidating without actually causing bodily harm; injuring or killing pets; destroying prized possessions

If allowed to continue, violence often escalates.

Support from the entire community is essential.

All persons have the right to physical and psychological safety. Unfortunately, assault behavior is occurring everywhere. If you or someone you love is experiencing violence, please get the needed help. For more information, contact the National Domestic Violence Hot line at or calling 1-800-799-SAFE but if you fear retaliation, do not use your home computer; access this link on a “safe” computer system such as at your local library or school.

*Though this article focuses on female victims of partner violence, the author recognizes that women may be perpetrators as well as victims and men and boys are also victims.

Tuesday, September 9, 2008

Helping Someone Who Grieves


Linda S. Smith, MS, DSN, RN, CLNC
Professor and Director of the Associate Degree Registered Nurse Program
Idaho State University

Grief, loss, anger, despair, and guilt are human responses to any tragedy. They are normal, yet entirely unique, because each of us resolves grief and loss in our own way.
Accepting loss and even death is probably the hardest part about being human. When a friend or loved one is grieving, we may be afraid to get involved; to talk about the loss or death; to feel it for and with someone. We may say, "I hate going over there to visit, it's so depressing;" or "Why should I call or stop over; I can't do anything to make it better."
Yet, moods and reactions people have as they grieve a significant loss are often responses to how others react toward them and what others expect. With this in mind, it is easy to see how people "pick up" on the obvious and hidden "expected behaviors" from the persons who are closest to them. Therefore, if someone you know and love is experiencing grief, your reactions and responses to them can improve or worsen the situation.

First, friends and loved ones need to understand the fears of those who grieve. These fears include loneliness, meaninglessness, and continued loss. Families of persons who are dying experience profound grief and loss, anger, despair, depression, and even guilt but these emotions may occur very differently among members.

What to do if someone you know is grieving:

* Reach out to the person who is grieving; don't wait for him or her to come to you. Your presence as a good listener is almost more important than anything else you can do.
* Accept the person as a living, valuable human being
* Anticipate that grief work is extremely physical as well as psychological
* Express the simple yet profound, "I'm sorry."
* Allow the grieving person quiet time
* Listen, support, encourage, and share your own feelings. Be available as someone the person can trust.
* Through your responses, give the person permission to think and feel anything
* Allow loose ends to be tied; spiritual peace, financial matters, and funeral arrangements attended to, etc.
* Help persons review their lives for meaning and purpose. This could be done with a diary, a tape recorder, drawings, scrap books, or a photo album. Remind grieving persons of their accomplishments.
* Use culturally sensitive, appropriate touch as an expression of caring. After asking permission, you may chose to hold their hand, pat their arm, give a hug
* Help persons attend to personal grooming and exercise. Take a walk with the person, listen to music together, play a game, reminisce
* Call in a spiritual consultant if the person wishes
* Use open ended communication lead-ins like: "how…, what…, where…,
- “It sounds like you're feeling…;
- share with me…,
- help me understand…"
* Recognize that persons experiencing extreme grief and loss may have sleeping, resting, and eating difficulties. Therefore, call in healthcare resources and professionals as needed.
* Tell the person that you are interested in what they think and feel. Be receptive and nonjudgmental, acknowledging the actual, potential, or perceived loss
* Recommend support groups and provide this information when appropriate
* Give the grieving person the right to cry
* Allow the person at least a full year before major life-changing decisions are made

What NOT to do when communicating with someone in grief or crisis:
* Don't assume that all questions asked demand answers. A simple, "I don't know, but tell me your feelings” is one response to the unanswerable
* Don't meet anger with anger. Allow the angry, grieving person to express the anger without becoming defensive. Acknowledge and accept the anger by saying, "You sound angry…." "It must be so difficult (frustrating) for you …"
* Don't interrupt, expound, criticize, show impatience, judge, minimize, confront, abandon, or be dishonest.
* Don't ignore the person's mental and physical pain
* Don't try to replace grief with faith
* Don't reject the person's feelings with phrases like, "cheer up…" Everything will be fine…"
* Don’t wait to be asked for help. Often the “If you need anything, call me…” is never acknowledged. Better to say, “I’m picking up some groceries, what can I get for you?” and “Today is wash day, let me do a few loads for you.” Or “I brought over the lawn mower – how do you like the grass done?”

Caring for and about someone who grieves is a great privilege.

As you face someone who is experiencing grief and loss, please believe that your efforts are valued and needed. Your presence has a profound effect on those for whom you care.

Thursday, September 4, 2008

Patient Modesty

I received an email requesting a blog on a topic which needs to be addressed more openly: Patient Modesty.

While this is a very sensitive topic many feel that it needs to be more openly addressed. In researching this subject I was very surprised, and in some cases shocked, at some stories I read on behavior that ranged from inappropriate to outright sexual misconduct. These stories came from both persons in the healthcare profession, whether it was a nurse or doctor, and patients.

To open the dialog on this subject I would like to ask two questions:

1. How would you handle a situation if a doctor or nurse acted inappropriately in your presence (as either a patient or attending nurse/physician)?

2. What would you do if a patient trusted you enough to report misconduct of a colleague of yours?

For more information on the subject, please visit the following blog: