Monthly Archives: July 2014

Shaving As a Metaphor for Nursing

BY: Fidelindo Lim, DNP, CCRN

Over the course of history, people have used metaphors to explain, contrive, reflect, and refute human phenomena. Health care (and all its challenges) has stimulated prolific metaphors to find meaning in its success, but more so in its failures. Military metaphors abound. Health providers are referred to as an “army” who “fight” in the “battleground” against the “enemy,” whether it’s a new strain of resistant organism or a bureaucratic misstep. As health care takes on a business model, metaphors derived from economics become commonplace, turning patients into “consumers” in the competitive “market” of “products and services” with an end-goal of reaching the highest “rating.”
Patients often resort to metaphors to cope with their suffering. Years ago when I was interviewing a patient who came in for rapid atrial fibrillation, he described what he was feeling “as if there was a hummingbird inside my heart; flapping its wings so fast and ready to fly out of there!” The book Illness as Metaphor by Susan Sontag is an example of an eloquent reflection and critique on the use of metaphor in the face of cancer.

Why do we turn to metaphors? The answer is simply because human nature is so vast and mysterious and our language limited. In our search for meaning we draw on symbolic language to derive some sense from our experience. As a nursing faculty, I use metaphors as picturesque clues to illustrate caring that is grounded in an examined experience. One experience I had serves as a metaphor for nursing itself.

A Perfect Picture

One day in August, I assigned a nursing student to care for Mr. C., a homeless 50-year-old Chinese man who originally came in for a drug overdose-related respiratory failure and a fractured hip. With the combined powers of antibiotics, mechanical ventilation, surgery, round-the-clock nursing, and the innate resiliency of the human body, he got better. After an extended stay in the ICU, he was transferred to a medical unit. There he remained in transition limbo for over a year. He was no longer sick enough to be a “patient,” but no facility would take him because he had no health insurance. In essence he was domesticated yet undomiciled.

In between meals and medications, he would be spotted sitting quietly in the chair, looking brittle but never complaining. His toothless smile charmed the nursing staff. The conspicuous absence of any visitors made him mysterious, at least to me. With the passing of time, Mr. C’s facial hair started to grow. He resembled a sage with an overgrown Fu Manchu. Somehow shaving was never mentioned during hand-off, though at some point he expressed his desire to shave.

Amidst the cacophony of acute care hustle and bustle, I chanced upon a scene worthy of a Vermeer painting. A faint mid-day light was breaking through the shutters; a student wearing a blue isolation gown was standing with his back towards the door shaving the patient. A white towel was carefully draped over the patient’s chest and shoulders and half his face was covered with foam. Realizing I was unnoticed, I stood by quietly and observed. With surgical precision and the seriousness of a psychiatrist, the student caressed the patient’s sunken cheeks with a razor, all along keeping a measured conversation, punctuated by the tap, tap, tap of the razor against the side of the basin that was now a hot soup of discarded facial hair and lather. An effusive “thank you” and a bow of approval from the patient concluded the shave.

Returning the next day, I found the patient’s bed occupied by another person. I was told Mr. C. suffered a cardiac arrest overnight and was now in the ICU. There I found him unresponsive and attached to a ventilator. On his clean-shaven cheeks rested the holder of the endotracheal tube. For a few minutes I stared at his “brain dead” state and thought about the still-life scene I witnessed a day before. I recall how he demurred about keeping a “soul patch” just below his lower lip. Now he was surrounded by machines and devices that seemed to rob him of his humanity. The shave the day before was one of his last conscious close encounter with nursing and communion with fellowmen.

The Metaphor of the Shave

Perhaps I am romanticizing the idea that Mr. C’s pre-arrest shave was akin to physical purification, an ablution before his final transition to the unknown. He died the following morning. This episode prompted me to consider shaving patients as a metaphor for nursing itself, at least for patients of a certain gender.

The physical closeness required in shaving someone embodies the nurse-patient relationship, of being with and within reach when we are needed. Shaving brings a semblance of normalcy to the quotidian of life which nursing is meant to restore. Shaving personifies “a.m. care” and inspires gentleness in the caregiver because of the attendant risk of injury. Because shaving takes time and is not considered a priority intervention, it challenges the nurse to organize his or her work flow and make time for it. Making time is one of those competencies that ironically takes time to master.

Perhaps shaving, like bed bath, can be delegated but it would be a missed opportunity for the nurse to bond with the patient. The act has the potential to reveal instead of reduce the patient to a task to be done. Conversation, the essence of nurse-patient rapport, is easily conjured during shaving. It invites the nurse to enter into empathetic discourse that encourages further reflection in both patient and nurse. Ultimately, these reflections may validate the very reasons why we are in nursing.

On various occasions, patients offer to “tip” me for shaving them. A similar response has not been evoked by emptying a bedpan or a commode. Somehow, shaving elicits gallantry in male patients of a certain age. Perhaps it brings them back momentarily to a proud time in their life when they were able to dispense reward to others. Being offered money by a patient, no matter how innocent, stirs professional distress among nurses. A polite refusal is all that is required and inwardly remind oneself that the true reward is simply hearing a patient exclaim that the shave made him “look like a million dollars.”

Notes: The above article is previously published in the American Nurse Today magazine on June 2014 Vol. 9 No. 6. Click on: http://www.americannursetoday.com/article.aspx?id=11628&fid=11574

 

Fidel Lim Photo (2)

Fidelindo Lim, DNP, CCRN

Fidelindo Lim is a clinical faculty at NYU College of Nursing and a per diem nurse educator for NYP Weill Cornell and Hospital for Special Surgery.

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Interview with Ian Saludares, MPA, BSN, RN, CCRN

Nurse Leader of North Shore-LIJ Health System, Nurse Manager of Lenox Hill Hospital’s Cardiac Intensive-Care & Cardiac-Telemetry Units, and Treasurer of NYC Men In Nursing

by Ana Cheung, BSN

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Ian Saludares’ Nursing Career

Ian Saludares, MPA, BSN, RN, CCRN, currently leads the cardiac intensive-care and cardiac-telemetry units as Nurse Manager of North Shore LIJ’s Lenox Hill Hospital. His nursing career began in 1994 when he graduated from the University of Santo Tomas in the Philippines with a Bachelor’s Degree in Nursing. University of Santo Tomas is one of the oldest universities in Asia and celebrated its Quadricentennial (400th) Anniversary in 2011. Saludares worked at University of Santo Tomas Hospital until 1999 when he relocated to New York.

Following, he served many years as a Clinical Nurse I at the New York Presbyterian Hospital and registered nurse at St. John’s Riverside Hospital as well as Lawrence Hospital. In May 2011, Saludares earned his Master’s Degree in Public Administration (MPA) with a Concentration for Nurse Leaders from New York University’s Robert F. Wagner Graduate School of Public Services.

In November 2011, he joined the health care team at Lenox Hill Hospital, first serving as an Assistant Nurse Manager within the CCU and Telemetry units before being appointed to Interim Manager and eventually promoted as Nurse Manager. Since 2013, he has also been working as a Nurse Administrator (Per Diem) for New York Presbyterian at The Allen Hospital. Saludares is certified in Critical Care Nursing (CCRN) by the American Association of Critical Care Nurses as well as Advanced Cardiovascular Life Support (ACLS) and Basic Life Support (BLS) by the American Heart Association. Presently, he is preparing to become board certified as a Nurse Executive (NE-BC) by the ANCC – American Nurses Credentialing Center.

Saludares is the treasurer of the NYC Men In Nursing group (also known as the NYC Chapter of the American Assembly for Men in Nursing) and has been a member since the chapter was founded in November 2013. He is also a member of the American Organization of Nurse Executives (AONE), the American Association of Critical Care Nurses (AACN), the Philippine Nurses Association of America (PNAA), and the University of Santo Tomas Nurse Association International (USTNAI). Saludares was interviewed by the American Organization of Nurse Executives in a feature article titled “My Leadership Story” for their September 2011 edition, Voice of Nursing Leadership.

 

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Photo of Ian Saludares with colleagues at North Shore-LIJ May Leadership Gathering (l) and at Nursing Leadership Luncheon (r). Photos courtesy of Ian Saludares.

 

Nurse Leadership Accomplishments for 2014

During this May’s celebration of Nurses Week at North Shore-LIJ, Ian Saludares was presented with the organization’s very first “Distinction In Leadership Award.” He was selected for the award because he “demonstrated leadership that inspired staff to improve patient care; influenced leadership in nursing through innovative approaches and assisted others in their professional development; created a healthy practice environment for all staff; as well as participated in development of aspiring leaders and served as a mentor,” as per the award criteria. Saludares was honored for his achievement in nursing leadership at North Shore-LIJ’s Award Ceremony hosted by the Council for Nursing Recognition and Retention.

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Photo of Saludares and his Nursing Team of 5 East/ 5 Lachman (l) and with colleagues during the Nurses Week Appreciation Breakfast at Lenox Hill Hospital (r). Photos courtesy of Ian Saludares.

Additionally, Saludares’ nursing leadership is reflected in his units’ high nurse engagement scores and patient satisfaction scores. Press Ganey and HCHAPS scores are at an all time high for all nursing sensitive metrics on both of his units. As a result, Saludares was asked to speak at North Shore-LIJ’s annual nursing leadership retreat in May, which was attended by more than 200 nurse leaders from the entire North Shore-LIJ Health System. “I was so proud to share the great and phenomenal work my team from 5 East/ 5 Lachman is doing,” he said. “Receiving my very first standing ovation was exhilarating. I’m confident more than ever that I’m part of a great organization that everyone else will try to emulate. This is just the beginning.”

 

6 Questions for Ian Saludares

What inspired you to become a nurse?

One of the primary reasons I took up nursing was to be able to help my family. During the early 90’s becoming a nurse was one the fastest ways to get to the United States. I am very fortunate that my sister was also taking up nursing at the same time. So we practically saved a lot of money for books and supplies for nursing school by sharing everything. During my 3rd year in nursing school, I realized that I could be really good at this profession and I’m very happy that I still feel the same way about nursing every single day.

How did you choose CCU and Telemetry as your nurse specialties?

As far as I can remember my dad, Leoncio, had heart problems, even when I was very young. When I was in my second year of nursing school, he was hospitalized for a heart attack. My career in nursing started on a very busy medical-surgical floor where I honed my clinical and time management skills. But I was always looking for an opportunity to transfer into the cardiovascular unit (telemetry.) After a year of working on the M/S floor, I was offered the opportunity to transfer to the Cardiovascular Unit at the university hospital I was working at and then eventually moved into the intensive care unit. Since then I have been in critical care all through my nursing career.

You are an amazing nurse leader and have been recognized as such by Lenox Hill Hospital and North Shore-LIJ Health System. You were also featured in the Worldwide Leaders in Healthcare publication and your patient satisfaction scores are through the roof. What can you share with us on what it means to be a leader and how to be a leader in nursing?   

I was very fortunate to be surrounded by amazing nurse leaders and mentors throughout my career. When I started my very first leadership role, I remember asking my nurse mentor, Dr. Reynaldo Rivera, what my top priorities as a new nurse leader should be. This is what he said:
1. BUILD strong relationships
2. Set CLEAR goals
3. It is all about EXECUTION – make things happen.
4. More importantly you need to INSPIRE others.

That’s what I have been doing on a daily basis—making sure I build strong relationships at all levels in every encounter I have. I make sure my entire team has a “shared mental model” by setting clear goals together. Everyone knows what is expected of them, where we are going and how we are going to get there. But more importantly I feel that my main role as their front line leader is to be able to inspire them every day so they are able to do their best work for our patients and their family.

Each year you participate in the American Heart Association’s Heart walk and last year you were the second highest fundraiser for your team. Why is this walk important to you and why should others consider supporting this cause?

This year was the 3rd year I participated in the NYC Heart Walk. The primary reason I participate yearly is to honor the memory of my dad, Leoncio, who died from complications of Cardiovascular Disease (CVD). According to the American Heart Association, Cardiovascular disease is the No. 1 killer of all Americans. In fact, someone dies from CVD every 39 seconds! Heart disease also kills more women than all forms of cancer combined. And congenital cardiovascular defects are the most common cause of infant death from birth defects. I’m hoping next year NYC Men in Nursing members can register as a group and support this cause.

What drew you to join NYC Men In Nursing and what is your role within the organization? 

Joining NYC Men In Nursing is my way of giving back to the nursing profession. I was fortunate to meet nursing leaders and clinicians all throughout my career through the different professional organizations to which I belong. The career path I took was very much influenced by all these wonderful nurses who mentored and guided me. I’m hoping to be able do the same for the younger generations of nurses.

How can joining a professional organization such as NYC Men In Nursing help members who are new nurses and aspiring leaders?

Being part of any professional organization gives you the opportunity to network with other professionals at the chapter or national level. It provides you with a lot of opportunities to learn from others and also opportunities to grow professionally within your career. I encourage everyone to take an active role in local and national professional organizations.

 

Nurses, nursing students and health care professionals interested in learning more about NYC Men In Nursing can visit our Facebook Page, stay up to date with our blog or email us at aamn.nyc@gmail.com for more information. We look forward to seeing you at our next board meeting or upcoming event!

 

NYU_scrubsAna Cheung, BSN

Ana Cheung is a May 2014 graduate of NYU’s Accelerated Baccalaureate Nursing Program and is one of the writers for the NYC Men In Nursing blog. She is interested in medical-surgical and community health nursing, as well as working with geriatric and under-served populations. As a native of Brooklyn, she is committed to serving her fellow New Yorkers.