Managing caregiver stress and preventing burnout.

Managing caregiver stress and preventing burnout.

Why is managing stress so important?

http://www.webmd.com/balance/stress-management/effects-of-stress-on-your-body

Stress that continues without relief can lead to a condition called distress — a negative stress reaction. Distress can lead to physical symptoms including headaches, upset stomach, elevated blood pressure, chest pain, and problems sleeping. Research suggests that stress also can bring on or worsen certain symptoms or diseases.

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How does stress affect the immune system?

Stress can make up ill as it affects out immune system.

http://www.apa.org/research/action/immune.aspx

“For stress of any significant duration – from a few days to a few months or years, as happens in real life – all aspects of immunity went downhill. Thus long-term or chronic stress, through too much wear and tear, can ravage the immune system.

The meta-analysis also revealed that people who are older or already sick are more prone to stress-related immune changes. For example, a 2002 study by Lyanne McGuire, PhD, of John Hopkins School of Medicine with Kiecolt-Glaser and Glaser reported that even chronic, sub-clinical mild depression may suppress an older person’s immune system. Participants in the study were in their early 70s and caring for someone with Alzheimer’s disease. Those with chronic mild depression had weaker lymphocyte-T cell responses to two mitogens, which model how the body responds to viruses and bacteria. The immune response was down even 18 months later, and immunity declined with age. In line with the 2004 meta-analysis, it appeared that the key immune factor was duration, not severity, of depression. And in the case of the older caregivers, their depression and age meant a double-whammy for immunity.

Emerging evidence is tracing the pathways of the mind-body interaction. For example, as seen with the college students, chronic feelings of loneliness can help to predict health status — perhaps because lonely people have more psychological stress or experience it more intensely and that stress in turn tamps down immunity. It’s also no surprise that depression hurts immunity; it’s also linked to other physical problems such as heart disease. At the same time, depression may both reflect a lack of social support and/or cause someone to withdraw from social ties. Both can be stressful and hurt the body’s ability to fight infection.

Managing stress, especially chronic or long-term stress (even if it’s not intense), may help people to fight germs. When burdened with long-term stressors, such as caring for an elderly parent or spouse with dementia, health can benefit from conscientious stress management.

Finally, the newest findings on social stress underscore the value of good friends; even just a few close friends can help someone feel connected and stay strong. Social ties may indirectly strengthen immunity because friends – at least health-minded friends — can encourage good health behaviors such as eating, sleeping and exercising well. Good friends also help to buffer the stress of negative events.”

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Preventing and dealing  with caregiver stress.

I first want to clarify what I mean when I say “caregiver.” I’m talking about the main person who is doing the hands on care. The wife, husband, mother, father, daughter, son or other people who is the number one person caring for someone.

Lot’s of people interface with caregivers. We do as nurses. You do as friends, family and neighbors. We get to go to the house, spend an hour, do our assessment, say what we think and then leave the person behind to deal with this on their own.

My general attitude is everyone is different, every one has different coping skills and styles. It’s our job as nurses, friends, families and neighbors to be accepting and to be helpful. Everyone copes with this differently but the needs still remains the same.

The one point I always try to make is this: This will end and at the end of the day when you have to make peace with yourself and move on in your life will you being to look back and say “I did everything I could and I am at peace.” I think the best way to get to that place is not getting burnt out.

The most important thing that a caregiver can do for themselves is to make sure they leave time for themselves and do something, even if its the littlest thing, every day. Being a martyr is a sure road to burnout and feeling like your stuck in a situation.

I know it hard. Sometimes there is no one around to relieve you and you feel like this is on your shoulders. Some places have great resources and some places have next to none.

In this day and age unless you can afford it there’s not a lot of help out there and if there is the older person living by themselves they get addressed first before the person with a caregiver. (Unless the person is under Hospice)

I thought instead of just googling I’d ask my friends first what they thought. So here goes. Some of these folks are in the medical field and some are or have been the main caregivers for a family member.

This is what they had to say:

Carol said “Get help!”

I know that’s a tall order sometimes. Many people can’t afford help. The first thing you should do is call your Elder Hotline. Our number around here is 866-684-5884. There is a process and it takes a while  to this so don’t wait until you need something. Do it now so by the time you need it the information is there.

Call the local chapter of the appropriate disease and see if someone can come out and talk to you about the disease and what is available to you. Often they have respite set up and know everyone who is available.

Call your church or temple and ask if there is anyone available to help. Many times they will mention this at services and people will volunteer.

Lisa Ray said

“#1 Take care of yourself first and foremost … it may sound selfish but it is not. If you are not emotionally and physically healthy then you can’t help the other person. #2 Ask or pay for help. Don’t turn away help … accept the gift. You are not the only one that can care for your loved one. Let other family members become involved in the care. Or pay someone to help. #3 Don’t take the mean things they say and do personally. They are sick and realize they have lost much of their independence, this is an expression of that frustration #4 Join a support group… you will learn things from others & help others with your experiences. #5 This also goes along with #2 Get out of the house and have fun, stay in contact with your friends, don’t become isolated.”

Aimee Said:

For sure don’t become isolated. I broke free finally in June and took a long weekend to myself and went to Missouri and met up with some other ladies. It didn’t go over well but he survived it. Never had been away without him. I never let him play that card. He tries often but when there is something he wants to do he finds a way. Take time for yourself and do whatever it is you love to do. Meet up with friends, take that trip and take care of yourself. And try not to stress (easier said than done) about that next scan or blood test. It is what it will be and I can’t change that.”

Susan said:

“Take time for yourself. While helping with my father’s cancer and death I would get their local paper (very small town) and circle garage and estate sales.  Then I would steal away for a few hours every Friday to treasure hunt. Try to keep some of your own little routines and hobbies going during this time. It was fun to share my finds and create memories with my parents while giving me something else to focus on.”

Irene said:

You must have someone to come in to give the caretaker a break from the emotional roller coaster

Eileen said: Have a network of friends or support group to support you the caregiver.

What is caregiver burn out?

http://www.webmd.com/heart-disease/heart-disease-recognizing-caregiver-burnout

“Caregiver 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. Burnout can occur when caregivers don’t get the help they need, or if they try to do more than they are able — either physically or financially. Caregivers who are “burned out” may experience fatigue, stress, anxiety, and depression. Many caregivers also feel guilty if they spend time on themselves rather than on their ill or elderly loved ones.”

What Are the Symptoms of Caregiver Burnout?

“The symptoms of caregiver burnout are similar to the symptoms of stress and depression. They include:

  • Withdrawal from friends, family, and other loved ones
  • Loss of interest in activities previously enjoyed
  • Feeling blue, irritable, hopeless, and helpless
  • 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
  • Irritability

What Causes Caregiver Burnout?

Caregivers often are so busy caring for others that they tend to neglect their own emotional, physical, and spiritual health. The demands on a caregiver’s body, mind, and emotions can easily seem overwhelming, leading to fatigue and hopelessness — and, ultimately, burnout. Other factors that can lead to caregiver burnout include:

  • Role confusion: Many people are confused when thrust into the role of caregiver. It can be difficult for a person to separate her role as caregiver from her role as spouse, lover, child, friend, etc.
  • Unrealistic expectations: Many caregivers expect their involvement to have a positive effect on the health and happiness of their loved one. This may not always be realistic.
  • Lack of control: Many caregivers become frustrated by a lack of money, resources, and skills to effectively plan, manage, and organize their loved one’s care.
  • Unreasonable demands: Some caregivers place unreasonable burdens upon themselves, in part because they see providing care as their exclusive responsibility.
  • Other factors: Many caregivers cannot recognize when they are suffering burnout and eventually get to the point where they cannot function effectively. They may even become sick themselves.

I’ve heard many people say to me “She was the mother and I was the child now i’m the mother and she is the child.’ It may feel that way but it not. Your still the child taking care of your mother.

More Ways to Prevent Burnout.

  1. Find someone to talk to. There is always someone to talk to and sometimes just saying things out loud can make you feel better.  If you have a computer there are many Facebook groups that you can join and speaks to others. In this day and age if you join a local support group online you can also benefit from the other member’s knowledge of resources.
  2. Be realistic about your loved one’s disease.

http://www.helpguide.org/articles/stress/caregiving-stress-and-burnout.htm

A list much like the the one my friends made above.

  1. Ask for help.
  2. Give yourself a break
  3. Practice Acceptance: Focus on the things you can control,find the silver lining,avoid tunnel vision.
  4. Take care of your own health: Exercise, meditate, do yoga, eat well and don’t skimp on sleep.

Cyndi Lenz is a psychiatric home health nurse in the Treasure Coast.

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Big Sugar Summit: Wolfram Alderson “Sugar is Toxic “

Big Sugar Summit:  Wolfram Alderson “Sugar is Toxic ”

“The only food item that isn’t on the label is added sugar.”

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Wolfram Alderson, Founding Executive Director, Institute for Responsible Nutrition

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I’m looking forward to the final video with all the slides but this will get you really excited about seeing the entire finished product.

This piece is so important because not only can I share with you guys but I can share with my patients. Most medical people do not pay attention to this information and do not know anything about Metabolic Dysfunction. My own ARNP told me my fatty liver was genetic ( which I don’t doubt its part of it being that I’m Jewish and my ancestors ate things like chicken schmaltz, chopped liver, bagels and cream cheese. The list goes on.

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One of things that I learned is that its impossible to loose weight when you have fatty liver disease. The whole thing makes me very sad when I’ve spent a life time taking good care of my liver and now its screwed up.

Sugar is a huge part of this and also a huge part of the inflammatory process.

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I can tell people this stuff (Including my own cardiologist who looked at me like I have 14 heads) (and my cousins who blow me off.) I can tell them that a peanut and jelly and white is not a heart healthy diet. I can tell them they can give me a smoothie with whole milk if they don’t have almond milk because whole milk has less sugar in it that low fat milk. I can tell them anything that is low fat is high in sugar which is worse for us that the fat and in fact we need fat for our brains.

greatist.com/eat/healthy-fats-best-foods-for-brain-health

The Best Foods for Your Brain (And Why We Might Owe Fat an Apology)

(I’m talking good fat so don’t get too excited.)

“The Top 3 Dietary Fats for Better Brain Health

1. Polyunsaturated Fat
Polyunsaturated fats contain the essential fatty acids (EFAs) omega-3 and omega-6. Our brains need these fats to function properly (studies also show that eating high quantities of omega-3 fatty acids are linked to reduced rates of major depression, but our bodies are unable to produce them. This means it’s important that we include these fat sources in our diets.

2. DHA
An omega-3 fatty acid, DHA has been shown to help brain functions like memory, speaking ability, and motor skills. Increasing dietary levels of omega-3s has been shown to help improve conditions such as depression, bipolar disorder, and ADHD.

3. Saturated Fat
Saturated fat is actually one of the main components of brain cells, and is therefore necessary for healthy brain function. In one study, it was found that people who ate more saturated fat reduced their risk for developing dementia by 36 percent. Saturated fat also provides benefits for the liver and immune system and helps maintain proper hormone balance.”

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Because if you have dementia does it really matter if your cholesterol is high?

http://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/statin-side-effects/art-20046013

And if you have fatty liver disease what are these statins doing to you? For a long time every doctor is ordering statins for people and what is the connection between this dementia. No offense to them but they don’t have to take care of our elderly parents with dementia.

As nurses, teaching nutrition is our greatest gift because we need a doctors order to tell patients to take  Omegas but we certainly don’t need one to tell them to eat foods rich in omegas. We can tell people “Eat a healthy diet that’s low in saturated fat, trans fat, refined carbohydrates and salt, and rich in fruits, vegetables, fish, and whole grains.”

or

“Eat good whole foods. Don’t eat anything from a can or a box. Eat lots of fruits and vegetables.”

Why? Because there is sugar in everything. It’s added to make thing taste better.

Sorry for the rant. Back to Wolfram. Here are some noteworthy quotes.

“75% percent of our healthcare costs are related to preventable conditions.”

“You are what you metabolize not what you eat.”

“74% of food at the supermarket has added sugar in it.”

“Sugar is hidden in our food supply. 47% in sugary beverages.”

“Total fat consumption has little impact on obesity.”

“if you look back at the last decades at the low food marketing scam which has been selling us low quality carbohydrates with processed food and added sugar in it.”

“The human organism can survive without carbohydrates but not without protein and fats.”

All of us in healthcare need to embrace this and learn more and make it part of our lives the daily conversations with our patients so I hope we can engage Wolfram in more of these conversations.

Like for instance. What do you do for a fatty liver besides cutting out all the bad foods?

Thank you Wolfram for coming to our conference and we hope to hear lots more from you!

This was my blog post from before the conferance

https://cyndi-lenz.com/2015/06/19/sugar-its-killing-us/

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Nursing Ethics: Alcoholism , nurses, IPN, and “ego”

I think its very difficult when your not an alcoholic and you have you have to deal with people who are actively.  It’s impossible to be around their behavoir especially when someone doesn’t go to AA and think they can do this themselves or think just not drinking is the answer. It’s even harder when that person is a fellow nurse or doctor or healthcare worker because in that case you have an ethical responsibility to do something. Actually the responsibility goes beyond ethical. In Florida is required.

We, nurses,  have an ethical responsibility to report. We have an ethical responsibility to help. Don’t let anyone tell you any different.

http://www.nursingworld.org/codeofethics

Moral courage helps us address ethical issues and take action when doing the right thing is not easy. Moral courage involves the willingness to speak out and do what is right in the face of forces that would lead us to act in some other way.

Your a nurse 24 hours a day.

Take a moment to remember the nurse who said she wasn’t working as a nurse and therefore she wasn’t going to perform cpr.

http://www.medscape.com/viewarticle/781098_3

http://scrubsmag.com/emt-faces-criminal-charges-after-reportedly-failing-to-provide-care/

Believe me when we screw up the first thing that is pointed out is that we are nurses.

So I think it’s important to understand our responsibilities.

http://www.nursetogether.com/ethical-issue-in-nursing-when-your-colleag

http://drug.addictionblog.org/nursing-code-of-ethics-should-nurses-report-co-worker-drug-use/

So I found this article and I really loved it.  It deals with one issue. EGO and ego. This is one thing that can drive you crazy while dealing with a patient. client , friend or family member. I hope it will help others understand.

http://www.thejaywalker.com/pages/tiebout/index.html

“Dr Harry M. Tiebout

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Dr. Harry M. Tiebout, a psychiatrist, was an early pioneer in coupling the principles and philosophy of Alcoholics Anonymous with psychiatric knowledge of alcoholism. A strong supporter of A.A. throughout his life, he consistently worked for acceptance of his views concerning alcoholism the medical and psychiatric professions. He served on the Board of Trustees for A.A. from 1957 to 1966, and was chairman of the National Council on Alcoholism in 1950.”

An incredibly thoughtful man.

 

http://www.silkworth.net/tiebout/tiebout_egofactors.html

some of my favorite parts.

 The first question, what factors in the individual must surrender received passing attention in the article on compliance. There, relative to the difficulty of surrender, I noted that “the presence of an apparently unconquerable ego became evident. It was this ego which had to become humble.” The first part of the present communication will be devoted to an elaboration of the nature of this ego factor.

Let us take the same trait of doing everything in a hurry and apply it to the word “immature.” Few will deny that jumping at conclusions, doing things as speedily as possible, give evidence of immaturity. It is youth that drives fast, thinks fast, feels fast, moves fast, acts hastily in most situations. There can be little question that one of the hallmarks of the immature is the proneness to be under inner pressure for accomplishment. Big plans, big schemes, big hopes abound, unfortunately not matched by an ability to produce. But the effect upon the adult of the persisting infantile quality to do everything in less than sufficient time can now be seen in a clearer light. The adult trait is surely a survival from the original psyche of the infant.”

“Inability to Accept Frustration

The last trait carried over from infancy is the inability to accept frustration. In an obvious sense, this inability is another aspect of the king within, since one of the prerogatives of royalty is to proceed without interruption. For the king to wait is an affront to the royal rank, a slap at his majesty. The ramifications of this inability to endure frustration are so widespread, and the significance of much that occurs in the behavior of the alcoholic is so far-reaching, that it seems advisable to discuss this trait under a separate heading.”

There are plenty of incredible articles written by Dr Tiebout and how I wish I just knew one psychiatrist who put the amount of thought and compassion into his work as opposed to being there to write a prescription every fifteen minutes. Drugs have taken over our beloved practice of psychiatry. Sometimes good. Sometimes not so good.

Florida has an awesome impaired practitioner program. Here is the one for nurses. There is also one for doctors and for pharmacists.

http://www.ipnfl.org/

Florida is one of the first programs and the program is an alternative to discipline. It’s approach is non punitive.  Here is a link to some great videos. It’s actually grounds for disciplinary action not to report. So it even goes beyond ethics to being a part of the Florida Nurse Practice Act.

http://www.ipnfl.org/ipneducational.html

here is the video on you tube

So as usual, not the blog I wanted to write but the blog that evolved.

What’s the best way to deal with an active alcoholic in your midst? What do you think?

Volunteerism : Medical Reserve Corp : Here when you need us

Volunteerism

44% percent of American’s volunteer.

I feel like all the work I do for the water is a full time job. It was great this week that I got to take a day off and do some training with my fellow Medical Reserve Corp volunteers.

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http://www.floridahealth.gov/programs-and-services/emergency-preparedness-and-response/disaster-response-resources/mrc/

The Florida Medical Reserve Corps Network was established to effectively facilitate the use of private volunteers in emergency response.

What is the Medical Reserve Corps (MRC)?
The Medical Reserve Corps (MRC) is a national network of local groups of volunteers committed to improving the health, safety and resiliency of their communities. MRC volunteers include medical and public health professionals, as well as others interested in strengthening the public health infrastructure and improving the preparedness and response capabilities of their local jurisdiction. MRC units identify, screen, train and organize the volunteers, and utilize them to support routine public health activities and augment preparedness and response efforts.

Program Overview

The Florida Medical Reserve Corps Network comprises 33 Florida MRC units covering all 67 Florida counties.

Florida Medical Reserve Corps units are community-based and function to locally organize and utilize health professionals and other volunteers who want to donate their time and expertise to promote community health and respond to emergencies.

The following occupations represent some of Florida’s MRC Volunteer specialties.

  • Advanced Registered Nurse Practitioner
  • Clinical Social Worker
  • Counselor, Mental Health
  • EMT-Basic
  • Licensed Practical Nurse
  • Marriage & Family Therapist
  • Medical Records and Health Information Technologist
  • Medical and Clinical Lab Technician
  • Medical and Clinical Lab Technologist
  • Paramedic
  • Pharmacist
  • Physician
  • Physician Assistant
  • Psychologist
  • Radiologic Technologist / Technician
  • Registered Nurse
  • Respiratory Therapist
  • Social Worker
  • Veterinarians

Also, the MRC needs non medical people to assist. By joining I’ve been able to go to some really interesting educational opportunities and some I even get credit for. I’d much rather go to active learning then sit in a chair all day and it gives you a good opportunity to meet other medical people in your community besides the ones you work with.

The Florida  MRC has saved the state over 1 billions dollars.

Here is a map of the different MRC’s.

http://www.floridahealth.gov/programs-and-services/emergency-preparedness-and-response/disaster-response-resources/mrc/_documents/fl-mrc-network-map.pdf

Yesterday, I participated with my Martin County Medical Reserve Corp in a statewide Radiological Exercise.

Every time there is a disaster I ache to go there and help. The first time I did work like this was after Hurricane Andrew.

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me in homestead after hurricane andrew

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homestead after hurricane andrew

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homestead after hurricane andrew

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hurricane andrew medical team

The exercise was called the

Black Pearl Radiological Exercise.

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Black Pearl is the name of the room at the really awesome Treasure Coast Public Safety Complex in PSL. The same training center the fireman complained about during the last election. Seriously great venue. I think if its good enough for the entire state to come to it should be good enough for the Martin County Firemen.  Took me 35 minutes to get there from Jensen Beach

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We hope it never happens but in reality we have to be ready if it does.

One of the best parts of the day is pets were included today and we had some awesome dogs.

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I am pleased we are including pets and other animals. In case of an emergency we just can’t leave them and run. One of the issues we had after Hurricane Katrina is that a bunch of NGO’s went up there and created more havoc then good. One of goals of this team is to reunite pets with their families. That made me so happy.

A while back there was a huge fire in Boulder and people had relocate their horses to the fairgrounds. Once an area was evacuated there was no going back.

We have a lot different kinds of animals and they need to be dealt with. Cows, goats, chickens (I’m not sure if you can decontaminate a chicken.)

So I was really happy to see these guys there.

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State Agricultural Response Team

http://flsart.org/

And so happy to see this guy.

Andy Bass

Andy Bass

(sorry for the crappy photo Andy)

He is the Operations Assistant, Field Team Leader and Trainer for Florida State Animal Response Coalition.
Florida State Animal Response Coalition was formed by many diverse groups of highly qualified animal responders dedicated to protecting the entire family during disasters. When a hurricane, fire, tornado or other disaster threatens the state of Florida, we will be there to assist with teams of professionally trained volunteers dedicated to care for the animals that rely on us.

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I felt like I was with my people! Andy made this – He called it SART Identification! LOL So good to know there are compassionate experts on the ground in case of a disaster.

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I love the paw marks.

You don’t have to be an expert to be part of the team. I’m certainly not. Experts are provided. We had plenty of acronyms there today.

So if you have some time contact your local Medical Reserve Corp. I promise they will only call you when they need you.

Dorothea Dix Psych Nurse and Social Reformer

There are wonderful nurses throughout history that have made changes that have benefited us all.  Dorothea Dix is one of my favorite historical nurses.

http://www.biography.com/people/dorothea-dix-9275710

Dorothea Dix was an educator and social reformer whose devotion to the welfare of the mentally ill led to widespread international reforms.

Synopsis

Born in Hampden, Maine, in 1802, Dorothea Dix was a social reformer whose devotion to the welfare of the mentally ill led to widespread international reforms. After seeing horrific conditions in a Massachusetts prison, she spent the next 40 years lobbying U.S. and Canadian legislators to establish state hospitals for the mentally ill. Her efforts directly affected the building of 32 institutions in the United States.

Here are two I worked in as a mental health tech.

My first job as a Mental Health Tech.

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http://en.wikipedia.org/wiki/Metropolitan_State_Hospital_%28Massachusetts%29

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http://en.wikipedia.org/wiki/Danvers_State_Hospital

It was a good idea to let the Mentally ill be separate from those who are in jail. Unfortunately, what happened next is not a pretty story leading up to the emptying of state hospital and now we are back to where she is now where people cannot get good mental health care and many people end up in jail instead of treatment where they belong.

http://womenshistory.about.com/od/civilwarnursing/a/nurses_circular.htm

The following is a document written by Dorothea Dix to lay out the requirements for women who would work in the nursing service for the Union Army during the American Civil War.

  • Circular No. 8., by Dorothea Dix

    Washington, D. C., July 14, 1862,

    No candidate for service in the Women’s Department for nursing in the Military Hospitals of the United States, will be received below the age of thirty-five years, nor above fifty.

    Only women of strong health, not subjects of chronic disease, nor liable to sudden illnesses, need apply. The duties of the station make large and continued demands on strength.

    Matronly persons of experience, good conduct, or superior education and serious disposition, will always have preference; habits of neatness, order, sobriety, and industry, are prerequisites.

    All applicants must present certificates of qualification and good character from at least two persons of trust, testifying to morality, integrity, seriousness, and capacity for care of the sick.

    Obedience to rules of the service, and conformity to special regulations, will be required and enforced.

    Compensation, as regulated by act of Congress, forty cents a day and subsistence. Transportation furnished to and from the place of service.

    Amount of luggage limited within small compass.

    Dress plain, (colors brown, grey, or black,) and while connected with the service without ornaments of any sort.

    No applicants accepted for less than three months service; those for longer periods always have preference.

    Approved,
    William A. Hammond,
    Surgeon General.

History of Social Reform in Nursing

Healthcare workers: Listen don’t judge

As a nurse,   I  get to interact with all kinds of patients. Many who make a full time job of going to the doctors. those who hate going to the doctors, those who go and don’t listen, those who go and follow all instructions to a t.
As a patient. I’m a bad patient. Not really really bad. I just have a lot of disagreements with what is the right path. And honestly I don’t want to hear it. I don’t want to be talked to – i want to have a conversation.

My first  trip to the hospital in 33  years had to do with a nasty gallbladder. All kinds of health care practitioners marched into my room in the er and even my sister remarked “well you won’t be eating that food anymore.”

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