Journaling – Experimenting

Journaling came up several times this week. Nurse leaders in a Leadership Academy spoke about change efforts they were making at work to increase involvement of patients, reducing noise in the hospital, trying to help their teams work better together. I spoke with someone facing increased symptoms also receiving more and more friendly, loving advice about treating those symptoms from professionals, friends and acquaintances. Each of these people could benefit from journaling. Life is a continuous experiment. Keep trying stuff – some works, some doesn’t. I find it helps to keep track in relative real-time. Going back to see where I’ve come with information to pass on to colleagues and caregivers. Journaling is writing it down – on paper or electronically. If you hadn’t noticed, this blog is a very public way for me to journal.  So, with the nurse leaders, journaling is taking a moment periodically, every day or week, to jot down emotions, activities, responses, movement, barriers. For the person at the center of care, jot down symptoms, what makes it better, what makes it worse, what you tried, what was suggested that you didn’t try, what would you like to try? Check out DayOne Journaling if you have an Apple device.  Paper is always good, too. If you are a caregiver or friend of the person at the center, offer to keep the journal for them. It’s a bridge builder.


I went to my primary care doc last week for some blood work. The best practice means of checking a person’s identity is for the professional drawing the specimen to ask a person their name and date of birth and confirm that these are the same as the order/prescription and label. The technologist did not. When I suggested that she follow this practice, she was clearly annoyed with me.  I spoke with someone yesterday who was in the middle of an ultrasound and the technologist asked, “Oh, are youxxxx?  I forgot to check.”  These occurrences are low risk (unless you need another stick because the wrong blood tubeswere used or the resulting diagnosis is really for someone else). But it’s a good habit to expect confirmation of identity when somethingis done to you.

I also have been participating in my Town Disability Commission as a citizen volunteer. I’d like to be appointed as a member.  I’ve found that the selection process lacks transparency-every citizen does not have an equal chance to be considered or selected.
Both these stories reflect on the challenge of advocacy.  How do we stick up for ourselves among well-meaning people who don’t follow best practice. I find it difficult to advocate. I don’t want to be a pain. I’m a bridge builder, not a fighter. I’m at my best when I focus on the prize.  In the first example, I tell the lab person that confirming identity is critical – to me and to her. What a shame (or how devastating) in the rare instances its wrong. For the Town, being sure that the town follows its published practice, that all citizens have equal opportunity to take part, and that access for the disabled in improved. How far do I go?  The most passionate advocates seem to have been burned by a bad practice. I want to avoid that for me and mine.

Managing Pain

Several blog posts these past weeks on pain management. Read one here from Engage the Patient.  Everyone has pain.  Some are called stoic, some sensitive. I remember when my son, Mike, had a lung tumor removed.  Curled up in a fetal position, hardly able to breathe, he told a nurse that his pain was a 6!! A six?! How could that be? I was talking to someone this week, recently diagnosed with pancreatic cancer, about a new sensation in her abdomen – a pressure. As we explored the new sensation, she said, it’s not pain. It’s a pressure in the morning. It travels, one day here, the next day there in my abdomen. It doesn’t affect my life. It’s annoyingly noticeable. Gets better as the day progresses. I’ve found for myself, that becoming one with unpleasant, unwelcome, strange sensations helps me manage and not freak out too much. For me its neuropathy – electric, radiating tingles or zaps often in my hands and legs, sometimes elsewhere, lasting moments.  Seriously annoying, but doesn’t affect my life. Nowhere near as bad as a toothache. Acupuncture keeps it at bay, reducing intensity and frequency. It’s good to be intimately knowledgeable about pain and share that with your health team. What’s it like? How has it changed? What works to decrease it? What doesn’t? Some people welcome help understanding their pain better. Shouldn’t pain sensation, what helps and what doesn’t be core health information – included with medications, health team members, diagnoses, and procedures? I have found that people at the center of care get this, most health professionals and information technologists don’t. I’m sure they or their loved ones have pain too. What’s missing here?


I’m on vacation visiting a friend who I first met when I was 8 years old. We’ve been close friends ever since.  His wife asked me how I became a nurse. Well, I was 19 looking for a job and had a choice between reading water meters and becoming a psychiatric nurses’ aide. Reading water meters paid more,  but I would have had to cut my shoulder length hair. I chose to become a psychiatric nurses aide. The Director of Nurses guided me to nursing school. My old friend’s mom, counseled me to become a doctor. “No” I said, “I’d rather take care of people.” My friend’s mom was a social worker, she valued taking care of people.
So I’ve been a nurse for 40 years – a rich and wonderful profession. I’ve had a meaningful and never-dull career working in home care, physical rehabilitation, emergency, acute,and intensive care, consulting, quality improvement, managed care, and informatics.
Here’s to vacations! We all need a break – patients, caregivers, nurses, and leaders. Give us all a break. Please!

Get to here from there – lessons from a teenager

I was 17, hitchhiking through Europe, found myself lost, hiking alone through the Rondane Mountain Range. A rookie mistake. I’m geographically challenged, I’d been warned not walk by myself. I had a map, a compass, some food and water, and no sense. I was hiking a trail from one hikers’ chalet to another.  Mountains were giant mounds of boulder rubble from glacier melt.  The trail was marked by big red T’s painted on rocks. With my infinite wisdom I decided to follow a stream below the trail markings.  Naturally, I got lost, couldn’t find the trail. Compass and map were useless to me. That night I wrote a letter to my girlfriend, If you get this I probably didn’t make it. I’m such an idiot. The next morning I woke up, made a little ramen breakfast and headed toward the stream to wash up and fell over a rock – with a big red T on it.  I stood on the rock and looked until I saw the next big red T, went to that one and so on and so on.

big red T
Today, I’m challenged and energized by large change projects in health care – Researching, selecting, and implementing an electronic health record,  designing and creating an outcomes management system, advocating for people at the center of care.  Now that I’m seasoned I know that massive change projects require equal measures of sense and standing on a big red T, looking for the next one, going there, and on and on.