When Nurses Hurt Nurses

“
All persons ought to endeavor to follow what is right, and not what is established.” Aristole

Several weeks ago, I came across a LinkedIn post by Aryana Rivera about bullying. In the post highlighted how someone had attempted to bully her online. Fortunately, Aryana called it out publicly, giving her followers a clear view of what it was and what it wasn’t. Her courage prompted an important conversation in the comments section.

Coming across that post took me back to a version of myself that existed years ago before I had grown into my professional and personal identity. Back then, I could not speak up. I could not speak out and this made me wonder: how many new nurses recognize bullying when it happens especially when it comes from colleagues? 

Bullying in nursing by nurses refers to repeated, harmful behaviours by one nurse or a group of nurses towards another. These actions may be verbal, physical, psychological, or professional in nature and typically occur over a prolonged period. Unfortunately, such behaviours are often cloaked as “tough love”a form of professional initiation but they are, in reality, a toxic culture that spreads like cancer through the lymphatic system of healthcare settings.

Bullying manifests in different forms. Based on who is involved, we can categorize it as:

Lateral Violence – bullying between peers at the same level.

Vertical Violence – bullying from a superior (e.g., a charge nurse to a staff nurse), or even from staff towards a manager.

In terms of presentation, bullying may be:

Covert – subtle actions like exclusion, silent treatment, eye-rolling.

Overt – open acts like yelling, mocking, or public insults.

Examples of bullying within nursing include:

• Undermining another nurse’s work or competence.
• Spreading rumours or gossip.
• Withholding essential information.
• Sabotaging assignments (e.g., mis-labelling charts.

Globally, the seriousness of bullying in healthcare is well acknowledged. The World Health Organization (WHO), American Nurses Association (ANA), and the International Council of Nurses (ICN) all recognize workplace violence including bullying as a public health concern. Should we be worried? Yes, we absolutely should be. Recent studies affirm this concern. A narrative review found that horizontal violence disproportionately affects new graduates and less-experienced nurses, who are especially vulnerable to repeated harm by their peers (Gaffney et al., 2021). Similarly, a meta-analysis conducted in Ethiopia between 2016 and 2024 showed that 39.4% of nurses had experienced workplace violence, including incivility and bullying. Some individual studies reported prevalence as high as 61.3% (Abate et al., 2024). Comparable data from Kenya, South Africa, the United States, and the United Kingdom consistently highlight high rates of bullying in high-stress units such as ICUs, emergency departments, and teaching hospitals (Park et al., 2022). 

Causes

Research shows that bullying is often rooted in stressful working environments with high workloads and inadequate support (Sellers et al., 2019). It thrives in hierarchical systems, where poor leadership and lack of accountability create loopholes for toxic behaviours to flourish (Kim, Y. et al., 2023). It is further sustained by burnout, unresolved trauma, and a workplace culture that normalises “toughening up” junior staff (Kim, S. C., & Kim, I. H., 2024).

Consequences

For the nurse being targeted, the consequences can be devastating: anxiety, depression, post-traumatic stress disorder (PTSD), burnout, and ultimately, withdrawal from the profession.

For patient care, bullying leads to communication breakdowns, reduced collaboration, and medical errors. Patients may feel the effects through poor care quality or increased complaints.

At the organizational level, bullying contributes to high turnover, low morale, and tarnished reputations—especially in institutions that train or mentor nurses (Chang et al., 2022).

Correcting it

As Individuals:

1. Keep detailed records of bullying incidents.
2. Seek mentorship or peer support.
3. Use assertive communication to set boundaries.
4. Report incidents through formal institutional channels.

At the Organisational Level:

1. Enforce clear anti-bullying policies.
2. Establish a zero-tolerance culture, modelled by leadership.
3. Introduce mandatory training on respectful communication.
4. Create support structures such as counselling and ombudsman services.
5. Encourage bystander intervention and safe reporting systems.

At the National/Policy Level:

1. Strengthen labour laws that address workplace harassment.
2. Include civility and professional ethics in nursing curricula.
3. Promote unions and professional associations that defend nurses’ rights.

In summary , by fostering a nursing culture where respect, compassion, and collaboration exist we can replace intimidation and silence. We must move from a culture of endurance to one of dignity because healing is not just for patients it starts with us.

References

Abate, B. B., Chekole, Y. A., Kassa, A. M., & Kassie, A. M. (2024). Prevalence of workplace violence and associated factors among nurses in Ethiopia: A systematic review and meta-analysis. BMC Nursing, 23(1), 105. https://doi.org/10.1186/s12912-024-02660-y

Chang, H. E., Hur, J., & Park, S. (2022). Impact of nurse–nurse collaboration and communication on patient safety and quality of care: A systematic review. International Journal of Environmental Research and Public Health, 19(17), 10855. https://doi.org/10.3390/ijerph191710855

Gaffney, D. A., DeMarco, R. F., Hofmeyer, A., Vessey, J. A., & Budin, W. C. (2021). An integrative review of nurse-to-nurse lateral violence and bullying in the United States. Nursing Forum, 56(1), 69–84. https://doi.org/10.1111/nuf.12512

Kim, S. C., & Kim, I. H. (2024). The effectiveness of cognitive rehearsal programs in reducing workplace bullying among clinical nurses: A meta-analysis. BMC Public Health, 24(1), 569. https://doi.org/10.1186/s12889-024-18969-x

Kim, Y., Lee, E., & Lee, H. (2023). Horizontal violence and turnover intention among registered nurses: A meta-analysis. Journal of Nursing Management, 31(1), 3–13. https://doi.org/10.1111/jonm.13746

Park, M., Cho, S. H., & Hong, H. J. (2022). Interventions for workplace bullying in healthcare: A scoping review. Journal of Advanced Nursing, 78(1), 18–29. https://doi.org/10.1111/jan.14990

Sellers, K., Millenbach, L., Ward, K., & Scribani, M. (2019). The degree of horizontal violence in RNs practicing in New York State. Journal of Nursing Administration, 49(3), 136–142. https://doi.org/10.1097/NNA.0000000000000724

Contained Chaos

 “Be kind, for everyone you meet is fighting a battle.” Plato

For anyone who has ever assisted in or performed an intubation, the intensity of those few moments is unforgettable. No matter how prepared you are: mentally, technically, emotionally there’s always an inner dialogue running: Is everything ready? What if this fails? You're praying silently, hoping everything goes as planned. Yet, despite meticulous preparation, some days just don’t cooperate. The laryngoscope light may fail at the worst possible moment, the blade might not fit right, or excessive bleeding may obstruct your view. In such high-stakes scenarios, clinical knowledge is vital but what often makes the difference is quick thinking, emotional regulation, and having a solid backup plan (A, B, C… sometimes even D). But here's the uncomfortable truth: these emotionally charged moments don't only test the skill of the intubating clinician they test the entire team and unfortunately, not everyone rises to the occasion with grace.

When Pressure Breeds Hostility

Instead of shared focus and calm, some situations devolve into finger-pointing, passive-aggressive comments, or open hostility eg greater risk of cross contamination. Colleagues may blame one another or the institution for missing equipment or poor outcomes. But when tools are available, and there has been a lapse in individual preparedness, the responsibility must be owned. It may be an unpopular opinion, but in any setting where resources are present, you are responsible for ensuring all necessary tools are functioning and ready before beginning any critical procedure. This is not about perfectionism it’s about patient safety.

A Culture of Safety Starts With You

Blame culture erodes trust and teamwork. According to the Agency for Healthcare Research and Quality (AHRQ), a true culture of safety relies on mutual respect, shared responsibility, and open communication. It's about preventing errors before they happen, not assigning blame after they do (AHRQ, 2019).

When emotional outbursts replace communication, or when anger clouds clinical reasoning, we don’t just create a toxic workplace we compromise the care we’re meant to deliver. That’s not just a personal failure; it’s a systemic risk.

Own Your Emotions  and Your Growth

We are human hence frustration is inevitable but how we manage that frustration especially in moments of high pressure determines whether we’re promoting a culture of safety or chipping away at it.

If you find yourself struggling with repeated irritability, misplaced blame, or emotional overload, it’s okay to seek help. Therapy, peer support, reflective practice, and even anger management are all valid tools for professional development. Emotional maturity is not optional in healthcare it’s part of our duty of care.

Reflection as a Clinical Skill

In those moments that haunt us or humble us we must ask:

What could I have done differently?

Did I lead with safety or react with ego?

What will I do next time to uphold care, not just competency?

Reflection is not indulgence it’s a clinical skill. It allows us to learn, improve, and safeguard both patients and colleagues. 

In conclusion, no shift will ever be perfect. equipment fails, situations escalate. emotions rise but how we show up for our team and patients when it matters most that’s what defines our professionalism.

So before you blame a colleague, raise your voice, or dismiss a mistake pause. Breathe. Reflect. Because contained chaos only leads to safe care when it’s met with clear minds, respectful communication, and a shared commitment to better.

Reference:

Agency for Healthcare Research and Quality. (2019). Culture of safety. Patient Safety Network. https://psnet.ahrq.gov/primer/culture-safety

Beyond the title

"Just as there are two sides to every story, there are two sides to every person. One that we reveal to the world and another we keep hidden inside." Emily Thorne

 Nurses, whether practicing or not are endlessly fascinating individuals. We’re a diverse tapestry of creativity, drive, and dreams that society rarely gets to see. All too often, we’re boxed into one narrow identity: “the nurse” but that’s only a slice of who we are.

When we take on non-clinical roles bakers, writers, cat enthusiasts—they assume we’ve “left nursing” forever. That notion couldn’t be further from the truth. Yes, we carry skills and values from our profession into our lives, but they don’t define the entirety of who we are. I am a nurse, yes but I’m also an awesome baker, I am also a writer and  I’m obsessed with cats. I’ve built a life around these passions and stories that deserve unpacking ( possibly at a different time  and forum). I bring richness to the table when we step outside rigid boxes and so do my colleagues and so if you're a nurse scared to explore what else you're good at  do not be because you’ll be amazed how much of your spark you’ll find again in this process.

Why Hobbies Matter for Nurses

Engaging in activities beyond work isn’t indulgent it’s essential.

Research shows that leisure activities reduce stress, anxiety, depression, and job burnout (Chang et al., 2007; Iwasaki, 2006; Chiu et al., 2020). In one study involving 176 nurses, a simple hospital-based leisure program led to improved well-being across five domains: detachment, mastery, autonomy, meaning, and social connection (Chen et al., 2022). Similarly, a large meta-analysis of over 93,000 adults found that engaging in hobbies was associated with significantly greater health, happiness, and life satisfaction, regardless of employment status or health background (Mak et al., 2023).

Intrinsic joy and fulfillment comes from having something just for you something that isn’t measured by clinical outcomes or patient satisfaction surveys.

Even nurses in the trenches find ways to keep their passions alive:

“I crochet… keeps me relaxed… clear my mind from things that aren’t work.” (Reddit user, as cited in Chang et al., 2007)
“I bake sourdough bread… maintaining the culture feeds my science‑y side.” (Reddit user, as cited in Iwasaki, 2006)

Hobbies aren’t distractions they’re lifelines.

How to Reclaim Your Identity (and Your Spark)

1. Start small – Ten minutes of baking, writing, knitting, or pet care can reset your emotional state (Mak et al., 2023).

2. Schedule it – Treat your hobby as an appointment, not an afterthought.

3. Seek mastery – Hobbies build confidence and activate your brain’s reward system (Chiu et al., 2020).

4. Share with peers – Whether crocheting in the staff room or sharing cupcakes, hobbies help reduce emotional exhaustion and foster connection (Chen et al., 2022).

A Call to Rediscover Yourself

Nursing isn’t your whole story, it’s the chapter you write, not the headline on your book cover. Stepping into the other parts of yourself isn’t betrayal. It’s liberation. So if you’re boxed in by expectations dare to break out. Bake. Write. Dance. Skate. Code. Serenade your plants if you want to (I won’t judge—my cats  and I do it). That spark you’ve dimmed? Watch it glow again because when nurses bring the full spectrum of who we are compassion and curiosity, limits and limitless selves then both we and those we care for shine brighter.

Remember "Your nurse skillset is powerful but who you are beyond the shift is your superpower.

References

Chen, S., He, X., Xu, Y., Li, L., He, L., & Zhang, Y. (2022). Effects of a hospital-based leisure activities programme on nurses’ stress, burnout and well-being: A mixed-method study. Journal of Nursing Management, 30(3), 685–693. https://doi.org/10.1111/jonm.13571

Chang, P. J., Wray, L., & Lin, Y. (2007). Social relationships, leisure activity, and health in older adults. Health Psychology, 26(4), 378–385. https://doi.org/10.1037/0278-6133.26.4.378

Chiu, M., Lin, C., Wang, W., & Fang, C. (2020). The effects of leisure activities on mental health and life satisfaction among older adults. Aging & Mental Health, 24(8), 1260–1268. https://doi.org/10.1080/13607863.2019.1590307

Iwasaki, Y. (2006). Leisure and quality of life in an international and multicultural context: What are major pathways linking leisure to quality of life? Social Indicators Research, 82(2), 233–264. https://doi.org/10.1007/s11205-006-9032-z

Mak, H. W., Fancourt, D., & Burton, A. (2023). Engagement in leisure activities and wellbeing across different age groups: A large-scale analysis in over 93,000 adults. Nature Medicine. https://doi.org/10.1038/s41591-023-02345-9

Redefining the narrative

"To do what nobody else will do, a way that nobody else can do, in spite of all we go through; that is to be a nurse." Rawsi Williams

Who Really Understands What Nurses Do?

The truth is, many people don’t.
They see the tasks we perform but not the expertise behind them. They witness us checking vitals, administering medication, or assisting with hygiene, and assume that’s all there is to nursing.

But nursing is not a job defined by routine tasks. It is a profession rooted in critical thinking, compassion, technical skill, and autonomous decision-making. Yet time and again, our role is simplified, shrunk into a sentence, reduced to stereotypes, or misunderstood entirely.

It’s time we change that.

We need to reclaim the conversation and redefine our role, not just for ourselves, but for the future of healthcare. Nursing is leadership. Nursing is advocacy. Nursing is science. It’s coordinating complex care plans, managing emergencies, guiding families through difficult decisions, and championing patient rights when no one else will. 

We must challenge the outdated lens through which nursing is viewed. Because until we do, the public will continue to underestimate the value we bring, and that misunderstanding can cost lives.

So let’s be bold about what we do. Let’s speak up. Let’s show up. Let’s teach the world that nursing isn’t “just” anything
It’s everything when it comes to patient care.

Stop Saying Nursing Is a Calling-It’s a Profession

Let’s be clear: nursing is not a calling. It’s a profession greatly rooted in science, skill, education, and critical decision-making. Calling it a "calling" may sound noble, but in reality, it’s often used to romanticize or justify the challenges many of them man-made that nurses face daily. From understaffing and poor remuneration to unsafe work environments and emotional exhaustion, these issues aren’t part of some divine vocation. They are systemic problems that require practical, policy-driven solutions. As nurses we didn’t sign up to be martyrs. We are trained to be competent, respected healthcare professionals, deserving of fair treatment, proper compensation, and a safe, supportive working environment.

When Blame Becomes a Bandage: Rethinking Negligence in Nursing

One question always lingers in the background of public discourse: “But what about the nurses documented to have been negligent?” It’s a valid concern, one that demands careful, contextual reflection. I can’t speak for every nurse, and I won’t defend wrongdoing but what I can do is ask: from what lens are these cases being viewed? Too often, the scrutiny is one-sided. The public sees the outcome, not the environment that created it. Many nurses operate in toxic systems, hierarchies where dysfunction starts at the top and trickles down to the caregivers. Workplaces where policies contradict practical realities. Where expectations rise, but support doesn't. Where the scope of practice is clearly defined, yet routinely denied in execution. In such systems, errors become more likely, not because of incompetence, but because of burnout, moral distress, and systemic failure and because nurses are the ones constantly present with patients, they become the easiest targets for blame, expected to manage crises they were never equipped to handle alone. It’s not an excuse. It’s a reality. A reality that becomes clearer to those who understand grief, trauma, mental health, and the emotional toll of caregiving because the truth is: while one incident may be manageable, repeated exposure to high-stakes suffering without relief renders even the strongest nurse humanly inept at some point. Negligence should never be ignored, but neither should the system that cultivates it. Until we start evaluating these situations with empathy, understanding, and systemic awareness, we will keep confusing cries for help with acts of harm.

Rude Nurses? Let’s Talk About the Culture Behind the Curtain

We’ve all heard the stories, or lived them. The nurse with the curt tone. The one who snapped instead of soothed. The one whose words felt more like a warning than a welcome, but before we reduce these individuals to one trait or label the entire profession, we need to pause and ask: Why are some nurses rude? The answer isn’t always simple because human behavior is shaped by both nature and nurture—and nursing is no exception. Some people, yes, may simply lack empathy. But for many, it’s a learned behavior often shaped by training environments where kindness wasn’t modeled, or workplaces where survival meant keeping emotions in check. When nursing schools operate on hierarchy and fear rather than mentorship and support, that culture spills into practice. Then there’s frustration the deep, unspoken frustration. Many nurses invested years of effort, late nights, grueling exams, and emotional strain to earn their license, only to step into a system where their worth isn't reflected in pay, respect, or working conditions. Schedules are brutal especially in the private sector and sleep is rare. This often leads to our personal relationships suffering. Poor pay then results to our Finances being stretched and with every sacrifice, the gap between what we hoped for and what we face grows wider. None of this justifies mistreating patients. But it does help us understand where the sharp edges come from. Change won’t come by calling nurses out, it will come by calling systems in. We need to improve how we train, support, and reward our healthcare workers. We need to model kindness, offer mentorship, and ensure that those giving care are cared for too, because sometimes, all it takes is one healthy, empathetic environment to turn a once “rude” nurse into a remarkable one.

Navigating Different Encounters with Nurses: A Practical Guide for the Public

Whether you've had a positive or challenging experience with a nurse, understanding the context and responding with awareness can significantly improve not only your experience but ours too. Behind closed doors, nurses are often reminded to act from a place of awareness and emotional intelligence. However, based on everything we've just unpacked, how realistic is that expectation in every situation? The truth is, we can always try but the chances of success are far greater when awareness and empathy are shared responsibilities, not burdens placed on one side alone. To support that shared effort, here are some practical tips for navigating various encounters with nurses:

1. If You Feel a Nurse Is Being Rude or Cold

Try This:

• Stay calm. Don’t escalate. A harsh tone may be the result of burnout, not personal animosity.
• Use respectful curiosity. “You seem a bit rushed, can I ask when might be a better time to talk?” opens the door without sounding accusatory.
• Offer kindness. Sometimes, a simple “I know it’s been a tough day thank you for being here” softens even the hardest exterior.

Nurses  often carry emotional burdens and deal with back-to-back patients. A little empathy goes a long way in humanizing both sides of the encounter.

2. If You Feel a Nurse Is Negligent

Try This:

• Speak up calmly but firmly. “I’m concerned about how this was handled—can we go over it together?”
• Document details. If something feels off, note the time, actions, and outcomes. Be specific.
• Escalate responsibly. Use proper channels talk to the nurse manager or patient advocate before assuming ill intent.

Systems often fail nurses just as much as they fail patients. Before placing blame, make sure you’re seeing the full picture, and don’t hesitate to involve someone who can help clarify or intervene appropriately.

3. If You’re Confused About What a Nurse Actually Does

Try This:

• Ask questions. Nurses are educators too. Ask: “Can you explain what your role is in this process?”
• Avoid assumptions. Don’t refer to them as “just the assistant” or “the helper.” Nurses are autonomous professionals.
• Respect their judgment. They assess, plan, and make critical decisions not just follow orders. However, if in doubt its within your legal right to seek a second opinion.

Understanding their role builds trust and enhances communication, making your care more collaborative and effective.

4. If You Meet a Nurse Who’s Truly Exceptional

Try This:

• Say thank you—with specifics. “The way you explained my treatment plan made all the difference.”
• Leave a review or write a note. Nurses rarely get credit for their wins.
• Nominate them. Many hospitals have internal awards or recognition programs.

Positive reinforcement strengthens morale and helps shift the culture of nursing toward one of pride and respect.

5. As a Patient or Caregiver: What You Can Do to Support Nurses

• Practice patience. Nurses may be handling life-or-death situations in other rooms.
• Be honest and clear. Speak up about your needs, but try not to demand immediate action unless it’s urgent.
• Be a partner, not a passive recipient. Engage in your care by asking questions and taking notes.
• Advocate for systemic change. If you notice staff stretched thin or unsafe conditions, talk to hospital leadership. Complaining to the nurse caring for you just reinforces their frustration and in all honesty what do you want them to do. Unless they are the leader themselves. Advocacy isn’t just for insiders.

6. As a Fellow Nurse or Healthcare Worker

• Model empathy. New nurses especially need kindness, not criticism.
• De-escalate, don’t humiliate. Support your peers privately and constructively.
• Speak up for culture change. Push for better training, mentorship, and emotional support structures.

In summary, let’s build a culture where empathy and accountability coexist, where we as nurses feel safe to care, and patients feel safe in our  care. Behind every nurse is a human being, sometimes hurting, sometimes healing but always trying. Understanding our world doesn’t excuse poor behavior, but it can transform how we all respond to it.

Guess who is back

Keep going. Quietly. Powerfully. Authentically.

Because when you’re truly ready, they won’t need an announcement. They’ll see the results.

To anyone working on personal goals:

Silence, when used with intention, is one of the greatest tools you’ll ever own.

In a world that urges us to overshare, to explain every move, to be loud with our plans—choose to move quietly, with purpose.

You don’t owe everyone an explanation. Not everyone deserves to know your story.

Growth is often a quiet process.

It’s in the early mornings when no one is watching,

The late nights filled with second-guessing,

The quiet sacrifices no one applauds,

And the silent prayers whispered between exhaustion and hope.

While others are loud about appearances, choose to be loud in discipline.

Choose to:

• Refine your craft

• Secure your academic papers

• Build authentic networks with mentors who stretch your vision

And when you feel tired, overwhelmed, or unseen—write it down, reflect, pray about it.

Because one day, when preparation meets opportunity, nothing—and no one—will stop your rise

For instance,

•Oprah Winfrey was raised in poverty. But behind the scenes, she honed her storytelling and public speaking skills long before she ever stepped on a stage.

•Dr. Ben Carson went from poor grades and a troubled environment to becoming one of the world’s most respected neurosurgeons—through silent, consistent effort, and unwavering faith.

• Wangari Maathai, often dismissed and doubted, educated herself, mobilized grassroots efforts, and became the first African woman to win a Nobel Peace Prize.

They didn’t explain.

They executed.

And the world adjusted.

This is why I created the Raywan Nurses Reflective Journal—a simple, intentional tool to help nurses, students, and professionals make sense of their journey.

This journal is more than paper—it’s a companion for your inner work, helping you:

• Process your daily practice

• Track your emotional and intellectual growth

• Stay grounded during difficult rotations or seasons

• Align your purpose with your professional steps

Whether you're on the ward, in school, or working behind the scenes of your dream, reflection prepares you for greatness.

Let's be great together.

CLEAVE

"Grief is not a disorder, a disease or a sign of weakness. It is an emotional, physical and spiritual necessity, the price you pay for love. The only cure for grief is to grieve." Earl Grollman

Since the last blogpost things have been quite challenging. I have had to do a lot of introspection. More intently  into the parts of me that I avoid exploring. Using the word arduous would be an understatement. I have experienced a lot of grief in different spheres and this had led me to try learn and unlearn from my previously held misconceptions. From this I have learnt  three main lessons. These are;

Lesson 1. Grief is personal

"Nothing that grieves us can be called little; by the external laws of proportion a child's loss of a doll and a king's loss of a crown are events of the same size." Mark Twain, 'Which Was The Dream?'

In our setup, grief is synonymous with loss of a loved one. However, that is propaganda. in my experience grief has been

1.  Walking past a friends gate and wanting to call but suddenly realizing that she is deceased. 

2. Watching my classmates graduate before me due to unforeseen circumstances.

3. Witnessing a friend achieve a goal yet nothing is forthcoming for me.

4. Loss of relationships... and so forth, in summary it has been a lot

All this scenarios gave me the same exact feeling. It was a feeling of great physical and emotional distress.

Lesson 2. Grieving is a process

Several theories have been developed to try explain grieving  for better understanding. The general conclusion is that grieving is indeed a process and its not linear. Their is no specific timeframe that guarantees things get easier nevertheless understanding what one is going through is the beginning of moving ahead. 

Lesson 3. It is inevitable

A not so fun fact is that at one time or another grief must befall us .

as I conclude  all this experiences have led me to have a better appreciation of Arthur Goldens words “Grief is a most peculiar thing; we’re so helpless in the face of it. It’s like a window that will simply open of its own accord. The room grows cold, and we can do nothing but shiver. But it opens a little less each time, and a little less; and one day we wonder what has become of it.”

References

Hamilton I. J. (2016). Understanding grief and bereavement. The British journal of general practice : the journal of the Royal College of General Practitioners, 66(651), 523. https://doi.org/10.3399/bjgp16X687325

RECIPROCITY

 “What is tolerance? It is the consequence of humanity. We are all formed of frailty and error; let us pardon reciprocally each other’s folly – that is the first law of nature.”Voltaire

Just as there many facets to the lives we live so are there many facets to human emotions. Hospitals are multifaceted; in one room a family is celebrating a new baby who has been born, news of a full recovery of a family member while in the adjacent room, a family is grieving for they have lost a baby/pregnancy/parent/partner. You get the gist, right? The common denominator is a healthcare team trying to manoeuvre all this simultaneously while not wishing to display the roller coaster of emotions they might be going through. This leads to mental, emotional and physical fatigue. To cope most health workers find some really dark humour in unpleasant situations.  What some organizations and people outside our field forget is that we are humans with real emotions. We get angry, we get sick, we get frustrated, we get sad and we get overwhelmed among other emotions and feelings. We are human beings with emotions and blood running through our veins.

A couple of years ago I received a 4-year-old girl as an emergency while working in the Emergency department. Her eyes were jaundiced, her abdomen very distended, her skin very dry and itchy and when she cried there were no tears. For us that meant she was very dehydrated and whatever health issue she had grossly affected her liver. The team was all hands on deck and we did all we could but unfortunately, she never made it. The child's mother was informed and when I took her to view the body, I got overwhelmed. My throat felt tight, my eyes became glassy and I felt faint so I got a colleague to stay with her and quickly excused myself. I needed to step away immediately. I went to the farthest room I could find and tried closing the door not sure if I fully did and just cried my heart out. You know the ugly cry we all experience every so often. My heart felt broken I just couldn't make sense of it all. It was a hectic shift so as we cared for the emergency other outpatient patients continued to stream in. I must have stayed away for quite some time trying to compose myself when I had someone walk in. I was still whimpering behind the curtains and so I was quickly approached. It was a friend and he just stood there reassuringly periodically asking how he could help. I did regain composure and I walked out ready to face the next patient. I went back to the nurses' counter and the first thing that happened was a middle-aged man approaching me asking "Are there no doctors and nurses to attend to me just because of a so-called emergency." I was so irked but as expected I didn't reply as I wished. My generic response was" Apologies for the delay you will be attended to soon." As he existed we had a quick chat and educated him on what the ED is all about and what it means when a special code is called out.

It was a night shift so the next morning I analyzed the events and realized that both patients and health workers want to feel heard and appreciated but there's occasional ignorance in both parties to a large extent. For hospitals, a lot of emphasis is placed on short turnaround times but often it is not a common reality due to various factors within and beyond human control. Other times it is a very unhealthy mantra which states that a patient is always right. For patients, it is the belief that health workers should always be stoic.

 So how can we do better for the sake of humanity

1. Build awareness among those around you

Have TV monitors/pamphlets displaying basic information that's relevant to the patient groups at hand. 

2. Manage expectations

Language is a tool we often dismiss yet it can break or build relationships. Talk to the patients don't dismiss them, keep updating them. Institutions should have a program that serially educates personnel on better communication among themselves and with patients.

3. Keep evaluating institutional values and policies

There is a lot of value in having staff who are well cared for and prioritized. Physical, mental and financial support goes a long way to making staff feel valued and that's the perfect recipe for the provision of quality care.

4. Stop being self-centred

It's not always about you . There is more to life than you as one person 

In conclusion, “An individual has not started living until he can rise above the narrow confines of his individualistic concerns to the broader concerns of all humanity.” Martin Luther King Jr.

UNFILTERED

 "Your transparency will lead to other people's transformation."Trent Shelton

If there is one excellent lesson life is teaching me is that life is a journey, not a destination, wisdom does not come with age and in some instances, even the most intelligent person can be a dumb***. Yes, you read that right! Life has a way of evening out the playing field and I see this in my everyday practice. Wondering what I am going on you will understand as soon as you read through this post. 

As a young nurse( young is relative) I was always fascinated by patients who presented to the hospital with complications from poor treatment and lifestyle adherence to managing their previously diagnosed conditions. To give more insight here are a few examples a patient on TB treatment who had deteriorated to treatment failure directly as a result of noncompliance, a hypertensive patient who ended up with a hemorrhagic stroke because after diagnosis they stopped treatment when their symptoms abated,etc

I was well educated but relatively naive to the school of life so I had a very utilitarian way of thinking when it came to chronic illness. In my mind you got sick, you got diagnosed you got healed or you managed to maintain your quality of life. Well, this was how I had been. I have had my fair share of hospital visits by this time and honestly ninety percent of the time I tried to follow through. Notice that I said ninety percent. So one time I asked one of my then patients what hindered him from drug compliance and let me tell you on this day I learnt a lot. This then led me to be asking these questions what are the challenges you are experiencing with treatment or with the diseases that are currently under management.

I
would write a whole essay on this but here are a few examples.

1. Costly drugs or recommended treatment modalities 

While in placement in a rural facility, I met an elderly lady who had been diagnosed with hypertension. She had used medication for a month but then stopped because she could not afford her treatment unless her children catered for it. However, they were also unemployed so that was presently an impossibility.

2. Lack of understanding of the prescribed treatment

Still, on the aforementioned lady, she thought the medication she had been prescribed was for a few months and was only to be taken when she felt her blood pressure was elevated. This for her was whenever she developed blurry vision or swollen legs.

3. Limited knowledge of the implications of the disease process to their everyday life

One time I met a patient who had developed severe anaemia during pregnancy and she never followed up on her appointments. On delivery, she was in severe heart failure. She reported that she didn't know anaemia may lead to such severe symptoms or complications.

4. Stigma and discrimination

A young lad in his first year at the university campus was always in and out of the hospital with diabetic ketoacidosis. On his third visit, he revealed to me that he was experiencing challenges administering his insulin in a timely manner because he was often around his peers and was previously taunted when he administered it in their presence.

5. Unavailability of the drugs

Despite the development of an essential drug list by MOH patients always decry of medication unavailability.

6. Lack of continuity of care

One time a middle-aged lady with irregular bleeding told me she didn't know she was supposed to be reviewed after the completion of treatment. On her return visit the bleeding had been ongoing for about a month non-stop as she was waiting to see if it shall get better as it was not as heavy as when she sought treatment.

7. Personal preference

A patient once came in with a failing liver because he got diagnosed with an infection and he preferred herbal supplements as an alternative to the medications prescribed. 

8. Infomation overexpure

Often we find patients or caregivers who have a lot of information but not necessarily the correct treatment information. For instance, a young female presented to us with a history of irregular menses on further probing I learned she had using combined oral contraception to change her cycle dates as per need for over a year.

9. They felt disconnected from their care providers

An elderly patient shared with me that he has a challenge using medications prescribed by anyone younger than his sons. His youngest son was around forty at the time. He reported that the provider was always either on his computer and hence felt the provider was inexperienced to give him quality care. Unfortunately, on following up I learnt he had not been informed it was a paperless facility and he had never been in one.

Now before you draw assumptions it's important, to be honest. I find it challenging complying to treatment. I am very diligent at my worst but immediately I start feeling better I am more inclined to skip a dose now and then and at times even stop treatment prematurely. Being a health worker doesn't make me immune to this challenge as I  become more transparent on this I'm learning that guarded exposure to patients can help them make better decisions and do better for themselves,. So if like me you are trying to be a better health provider learnt to ask obscure questions. Life is like a coin. pleasure and pain are the two sides. Only one side is visible at a time. But remember the other side is waiting for its turn.

If interested to read materials around this area look up the resources below

Faronbi, J. O., Faronbi, G. O., Ayamolowo, S. J., & Olaogun, A. A. (2019). Caring for the seniors with      chronic illness: The lived experience of caregivers of older adults. Archives of Gerontology and            Geriatrics, 82, 8-14. https://doi.org/https://doi.org/10.1016/j.archger.2019.01.013 

O’Donnell, A. T., & Habenicht, A. E. (2022). Stigma is associated with illness self-concept in     individuals with concealable chronic illnesses. British Journal of Health Psychology, 27(1), 136-158.     https://doi.org/https://doi.org/10.1111/bjhp.12534 

Sarker, A. R., Ali, S. Z., Ahmed, M., Chowdhury, S. Z. I., & Ali, N. (2022). Out-of-pocket payment for     healthcare among urban citizens in Dhaka, Bangladesh. PloS one, 17(1), e0262900. 

IT IS WHAT IT IS

“It’s not like I planned it. I never woke up from some rosy dream and said, “Okay, world, today I’m gonna spaz.” Shannon Celebi

A few years ago a female patient was brought in unresponsive. She was a high school student who had passed out during the second term final examination. According to the teachers, she just saw the examination paper and fainted. First aid was done but there was no response hence the teachers thought it best to bring her to the hospital for further evaluation. Our initial physical assessment was unremarkable. Her vital signs were all within normal ranges and when one tried to assess her pupils she would forcefully shut her eyes. Our immediate conclusion was hysteria. Was it an appropriate diagnosis? I will let you be the judge. After about an hour of observation, she immediately got up. You must be wondering what worked? Well, a cotton wasp laden with chlorhexidine was brought to her nostrils and immediately she got up.  This response assured us that she was in good health and hence she was discharged back to school with a prescription for better exam preparations. However, this marked the beginning of her frequent ER visits and it always coincided with the exam period.

The fourth visit prompted the need for a psychiatric consult and after assessment, she was taken in for psychotherapy and commenced treatment. According to her records, she is yet to turn up at the ER again and her final diagnosis was documented as Conversion disorder. 

So what is /hysteria? 

Hysteria broadly refers to a patient responding disproportionately emotionally to the situation at hand. It was scraped from the DSM  and in its place terms like dissociative and somatic disorders were introduced. Dissociative and somatoform disorders have been linked to patients who have experienced or witnessed trauma in some way eg physical, emotional, or sexual abuse (Verywellmind, 2022,Williams et al., 2020)

1. Dissociative disorders are further divided into;

• Dissociative amnesia, which involves forgetting personal information or not being able to recall certain events
• Dissociative fugue, which involves forgetting personal information combined with changing physical locations, sometimes creating a new identity in the process
• Dissociative identity disorder, which involves having two or more distinct personalities, each with no memory of what the other has done

2. Somatic symptom disorders -  involves having a significant focus on physical symptoms such as weakness, pain, or shortness of breath. This preoccupation with symptoms results in significant distress and difficulties with normal functioning. This includes:

• Conversion disorder (functional neurological symptom disorder)
• Factitious disorder (Munchausen syndrome imposed on one's self)
• Illness anxiety disorder (formerly hypochondriasis)

How do such patients present? They may present with one or a combination of the following symptoms (Verywellmind, 2022)

• Blindness
• Emotional outbursts
• Hallucinations
• Histrionic behaviour 
• Increased suggestibility
• Loss of sensation
• Being in a sort of trance
• Developing amnesia
• Experiencing paralysis
• Fainting or passing out (syncope)
• Having epileptic-like seizures
• Increased pain sensations
• Rigid or spasming muscles

Handling such patients requires patience and an acute sense of awareness of the possibility that there's more than what meets the eye (Levenson., 2023). Their symptoms may be very different from what is stated above. Presently there is an advent of many traumatic events. There are ranging from gender-based violence, civil unrest in different regions, deaths from emerging and emerging diseases, natural disasters etc It is our role to recognize and refer where we can. Often we act as a gateway to the quality of life our patients will get and hence we should choose the best. For most people, it is not a choice for them to present as the above patients. So be kind and keep your biases aside. It doesn't hurt to have several differential diagnoses, remember "there is a crack in everything, that’s how the light gets in."  Leonard Cohen.

References

Best Documentary. (1946). Let there be light. https://youtu.be/lW4E-MxFI_w

Levenson., J. L. (2023). Somatic symptom disorder: Assessment and diagnosis. https://www.uptodate.com/contents/somatic-symptom-disorder-assessment-and-diagnosis

Verywellmind. (2022). What Is Hysteria? https://www.verywellmind.com/what-is-hysteria-2795232#toc-what-is-hysteria

Williams, S. E., Zahka, N. E., & Kullgren, K. A. (2020). Somatic symptom and related disorders. Clinical Handbook of Psychological Consultation in Pediatric Medical Settings, 169-181. 

PRESENTLY

“One of the most important things you can do on this earth is to let people know they are not alone.”

 Shannon L. Alder

 

Allow me to reintroduce myself, my pseudonym is Lilylovelong and I am on management for a severe anxiety disorder specifically Agoraphobia. I know right...You are shocked so was  I in the beginning. Most people choose to hide but I am not like most people and here is a snippet of my experiences.  I have a great support system and so far I manage it well. Some days have been rougher than others but it is well. Presently, it is been managed with medications, psychotherapy and counselling.

                                                                                      So what are phobias?

According to DSM V, a specific phobia is an intense and irrational fear of a specified object or situation. This overwhelming fear leads to avoidance behaviour or extreme distress. Globally, about 19 million people live with some form of phobia. Is this a significant or a non-significant figure? You be the judge.

How are phobias categorised?

The American Psychiatric Association lists phobias into three broad categories:

1.  Social phobias/social anxiety disorder - is marked by a fear of social situations in which a person might be judged or embarrassed.
2. Agoraphobia - involves an irrational and extreme fear of being in places where escape is difficult. It may involve a fear of crowded places or even of leaving one's home.
3. Specific phobias - it's the phobia of a specific object such as balloons, needles etc

What risk factors predispose one to develop phobias?

The Mayo Clinic (2022), lists the following risk factors

• Gender - Women have a greater risk as compared to men.
• Age - Specific phobias occur by age 10, however, they may develop later on in life.
• Family history - It may be an inherited tendency or learned behaviour eg when a child repeatedly observes a phobic reaction to an object or situation.
• Temperament -  Studies show that risk is higher in people who are more sensitive, more inhibited or more negative than the norm.
• Negative experiences - Experiencing a difficult, stressful, or traumatic event may trigger an onset of a phobia.
• Learning about negative experiences - Hearing about negative information or experiences

Causes 

There is no known specific cause. However, different research studies describe it as an interplay of the above-listed risk factors.

So what is Agoraphobia?

McCabe E. R. (2022), defines Agoraphobia as an irrational and extreme fear of being in places where escape is difficult. In my case, I do not handle crowded places well and when I do venture I always look and seat close to the nearest exit etc.

It can occur independently or alongside a panic disorder. Often occurs in females and is often affiliated with a mood disorder

 

How does it feel like?

I felt trapped in my own body, and my thoughts were erratic due to heightened senses. I had insomnia for several days on end, The thought of opening the door to step out induced panic attacks, I cancelled hanging out with friends and family, and I had to wear earplugs at all times or earbuds and play specific genres of music to keep me calm, I was increasingly agitated in noisy environments at some point I could no longer use public transport and had to use cabs to move around etc. Generally, It was a lot and that's when I decided to take myself in for a mental assessment.

 

What helps me cope?

1. My belief in God has given me peace that I can't describe.
2. Great support networks from family, colleagues, supervisors and my friends- They keep my mind focused on what matters.
3. My doctors for being great listeners, being accessible, personalizing care and for their patience.
4. Understanding that it's a season and the storm will be managed or completely alleviated. There is great progress thus far.
5. Having access to a lot of study materials has kept my mind calm on rough days as it's a great distraction.

 So what type of care did I need in my season?

Now that the shoe is on the other foot I have quickly realized that most of the care we offer is from a sympathetic viewpoint instead of empathy and that needs to change. In my crisis priority needs were

• Readily accessible practitioners- I needed constant reassurance and guidance on the different medications I was on.
• Living with a caregiver - Some medications gave me antegrade amnesia, blurry vision syncope episodes, and dizziness. this made me a hazard to myself. 
• Time off work- My body needed time to recover, rest and adjust to the treatment and this was facilitated.
• Financial planning strategies - Agoraphobia is an expensive disorder;  during crisis episodes, one only moves around in private means, I needed to be in the company of a familiar person, I needed mouthguards, noise cancelling devices,I needed to keep my possessions in storage etc.

As a carer how do you support someone with a mental illness? 

NB: The following advice is not recommended for all patient groups 

(Better Health Channel) 2022 summarises the care into

• Talking openly and encouraging patients to be honest with their friends and family about how they are doing
• Reading about mental illnesses from reputable websites, such as government or health organisation websites or books by specialists
• Encouraging patients to take an active role in their mental health recovery, get out and see people and enjoy a healthy lifestyle
• Setting limits and letting them know what you can do for them and what you are not able to provide
• Finding out about any local or online training courses for mental health carers
• Joining a mental health support group to meet other people in a similar situation
• Take any talk of suicide or self-harm seriously and speak to a mental healthcare professional about it as soon as possible
• Putting plans in place as a backup in case you go on holiday, have to leave town or are not able to care for them for any reason 

In conclusion remember, "Vulnerability sounds like truth and feels like courage. Truth and courage aren’t always comfortable, but they're never weakness." Brené Brown

References

Better Health Channel. (2022). Caring for someone with mental illness.             https://www.betterhealth.vic.gov.au/health/servicesandsupport/caring-for-someone-with-mental-illness

Mayo Clinic. (2022). Specific Phobias. https://www.mayoclinic.org/diseases-conditions/specific-     phobias/symptoms-causes/syc-20355156

McCabe E. R. (2022). Agoraphobia in adults: Epidemiology, pathogenesis, clinical manifestations,   course, and diagnosis. https://www.uptodate.com/contents/agoraphobia-in-adults