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Saturday, October 14, 2017

Ensuring Safe Transitions of Care: We Can and Should do Better






Transitions of care occur when a patient moves from one setting to another. Transitions are when the patient is most at risk for a medical error or injury to occur. To prevent unintended injuries and setbacks there is a focus throughout the healthcare industry to improve processes in identifying patients at risk and implementing strategies to ensure safe transitions of care.  

Many factors contribute to ineffective transitions of care as patients move from one setting to the next. The root causes often differ from one health care organization to another, but three major causes have been identified. They include: 
  • Communication breakdowns
  • Patient and family education breakdowns 
  • And accountability breakdowns.

A friend of mine recently experienced a setback in her transition of care after having a subchondroplasty procedure done on her left foot in an outpatient surgical center. She posted that she was nervous about the surgery, but felt it was necessary due to the pain she was experiencing. Many of her friends responded to her post and wished her well and hoped that she would come through the procedure without any complications and would get some relief from the pain she has been dealing with.

Unfortunately, the next post on her Facebook page shared that she had an unfortunate accident as she transitioned from the outpatient surgery center to home. This note was posted by her husband and said: “Mary is in the hospital with a compound fracture of the left ankle which she sustained when entering our condo following her foot surgery this morning. She had received a nerve block for the procedure and it removed all semblance of control and she rolled her ankle as she came into the condo. To repair the compound fracture of the ankle, she required surgery, a hospital stay and will require extensive physical therapy.

I was shocked and saddened when I read the post as it shows what happens when a person had an unsuccessful transition of care. I don’t have any of the details that lead up to this event, but it seems like this was a preventable injury that could have been avoided with better communication and proactive planning.  As a result of an unsuccessful transition of care, the patient suffered a serious injury which complicated her current condition, required emergency surgery, a hospital admission, additional pain and suffering as well as extensive rehabilitation to help the patient relearn to walk. 

When transitioning from one setting to another, it is important for the nurses, the patient (if able) and the caregiver take the time to look at the patient’s overall condition to make surer the discharge plan is safe and meets the needs of the patient. The patient and the caregiver should not be in a rush to go home that they leave the facility without thinking of barriers they may face at home. In the same vein, the nursing staff has to take time to talk to the patient and the caregiver to make sure they can handle the patient’s condition in a safe manner.  

I am not sure what happened in this case, but I know that something went terribly wrong and as a result, the patient has had a major setback. I encourage every patient and their caregiver to ask questions, and if you are not comfortable with the plan of care or you don’t think you can function safely as you transition from one setting to the other to ask for help. Asking for a nurse case manager or patient advocate to assess the situation to ensure you are safe is a critical step that should happen before every transition takes place. These professionals have the skills and expertise to assess the situation and inform the team of the barriers or issues that can cause an unsafe transition. 

In my friend’s situation, maybe staying longer in recovery or being admitted till the nerve block wore off would have been safer than allowing her to go home with no feeling in her leg.

Unfortunately, there is a push to do more and more procedures as an outpatient. In the past, the patient would have been admitted till the nerve block wore off reducing the incidence of injury.  The key to is to identify those patients at risk and to err on the side of safety. As a healthcare team, WE  have to do better!


Resource:

Transitions of Care: The need for a more effective approach to continuing patient care. To access this article, click here 
   

Monday, October 2, 2017

Breast Cancer Awareness: Strength, Courage and Hope




October is Breast Cancer Awareness Month. To bring awareness and hope, I share a note Betty Stover, a good friend and colleague wrote about her experience as a Breast Cancer Survivor. I hope her words will give all who read this post hope, strength and courage.  


BREAST CANCER AWARENESS MONTH – OCTOBER 2017

BY Betty L. Stover, RN

Many men and women, this year, will be told: “YOU HAVE BREAST CANCER.” Early detection is paramount to treatment and eradication of this horrible Disease. It could save your breast and/or your life, to live longer and enjoy the active lifestyle you experience prior to your diagnosis.

BREAST CANCER IS SURVIVABLE – Most patients are able to travel the road of diagnosis, surgery, radiation therapy, chemotherapy and perhaps a clinical trial. These are innovative therapies providing progress in treating and caring for breast cancer patients. Clinical trials bring hope that a cure will be found while participating is a powerful motivator to bring home to others. An important aspect of this disease is emotional, bringing anxiety, “why me”? Living along, depression, loss of companionship, who will watch my kids, clean the house, etc. Using different scents in the home for relaxation, yoga, Pilates, maintaining your health, good nutrition (consult a dietician) and follow-up visits with physicians help many people. Some people find exercise helps them and a group called  (SOS) SAVE OUR SISTERS, the Dragon Boat Team in Miami, has strenuous activities that have proven to strengthen the upper body while providing camaraderie and fun for men and women; a proven after treatment benefit.

SUPPORT – Support plays a large part in the disease journey, whether it be family or friends with you thought the good or bad or your Bosom Buddies or any support group. Your Buddies, who have traveled this road or are going along it now, understand the issues and can give you a voice of experience. What do I do for nausea? Is the medication my doctor ordered right for me? What happened when you took it? How long will I have this pain? They meet with you or take you to your doctor’s appointments, see you through surgery and recovery, attend appointments and treatments with you, and are always available by telephone, even in the middle of the night.

YOUR BOSOM BUDDIES gave me the support and love I needed during my journey as my family lives in other states. I have been involved in many events I would not have heard of without MY BOSOM BUDDIES. I always say to people, “Breast Cancer is the best things to happen to me” and they think I am crazy (maybe?). I have made many new friends and gained a new lifestyle.

I could not end this without sharing the love and support of my church family during my journey. They took me into their arms and were beside me during this bumpy road of Breast Cancer. My children and I thank them from the bottom of our hearts.

We know that God is Still Speaking!

SCHEDULE YOUR MAMMOGRAM TODAY


DO A SELF EXAM WEEKLY

Sunday, September 24, 2017

The Power of Rehabiliation







Last week I was invited to attend a patient reunion at HealthSouth Rehabilitation Hospital in Sunrise Florida. I was a patient at HealthSouth after I completed chemotherapy to treat the Brain Tumor I was diagnosed with in November 2014. Once the course of chemotherapy was completed, I was debilitated and needed help with all of my activities of daily living.

Being admitted to the inpatient program was the last thing I wanted to do, but as a nurse and a case manager, I knew I needed help and the inpatient program was the best way for me to get that help as it would be an intensive program that would help me improve.

So, one day in early April, I called the HealthSouth facility near my home. I talked to the Director of Case Management and explained what was happening and that I needed her help. She got me an appointment with the Physiatrist so he could evaluate me and determine a course of treatment. Once he evaluated me, he agreed that I needed inpatient rehabilitation and would contact my hematologist/oncologist to discuss his plan of care. Once he got the ok, I was scheduled for admission. 

The plan was for me to be there for two weeks. After two weeks, I would be re-evaluated to see what the next steps would be.  During those two weeks, I learned how to walk in spite of having bilateral foot drop and neuropathy in my legs. I learned how to use my hands as they were also impacted by the neuropathy. I received cognitive therapy that helped me learn how to improve my cognition, compensate for challenges I was having with organization, memory, and management of simple tasks. Most of all I regained confidence in myself.

The therapists were innovative and pushed me past what I thought I could do. They explained what they wanted me to do and pushed me to do the exercises that helped me improve. The other patients I encountered in the gym also motivated me as they worked to address their challenges. Those two weeks were hard, but they proved to be the best two weeks of my life. I learned what I needed to do to heal and found that by following the therapist’s directions I improved and was able to get back to a functional person.

After I left the inpatient unit, I went to outpatient therapy to continue my program. Over the next few months, I became stronger and was able to perform all of my activities of daily living by myself. My husband was there to help, but I no longer told him “I can't-do it” but started to say, “Let me try it.”  

As I sat and listened to the other patients who spoke at the reunion and shared their stories about how they came to HealthSouth, how they progressed in their programs, and how they are doing today, I was overwhelmed and humbled to be among them. A number of patients had strokes, some had catastrophic injuries and others had various complex conditions that left impaired in various ways.

What was amazing to me was their positive attitudes and their resilience. Most were doing well and had gotten back to their lives despite lasting impairments. Some were still working to get back. Many were still in therapy or were waiting for prosthetics and other equipment that would help them to move forward.  

Most patients could talk for themselves, but a few needed help as they could not talk or could not hold the microphone themselves. Family members filled in for them to share their experiences and how they were doing today. Family support is an important part of the rehabilitation process. It was evident from the various people who spoke how they too were impacted.  

All expressed their gratitude to the therapists and staff who helped them get to where they are today. It was fulfilling to look around the room at the therapists, the case managers and the other members of the HealthSouth Staff. Many had smiles on their faces and tears in their eyes as each person shared their experience. They were proud of their work and how they helped so many ‘move on’ despite their complex conditions.

As I have said before to those who have followed my journey in Nurse Advocate, I know I am not the person I was before the Brain Tumor, but I am grateful to be alive and to do the things that I am able. Going through a life-altering event, helps you understand what is important and how little things really do matter.  

I was happy to attend the patient reunion at HealthSouth and grateful to the entire team for their work and dedication.


Be well! 

PS. I wrote a post on resilience on April 16, 2016, after my rehabilitation journey. If you missed it, here is the link http://www.nursesadvocates.net/2016/04 

Sunday, September 17, 2017

10 Lessons Learned as a Hurricane Evacuee






Last week, the US Virgin Islands and the State of Florida took a direct hit from Hurricane Irma. I have lived in South Florida for 29 years and have been through 5 major hurricanes, but this one seemed different. The news reports were saying South Florida (where I live) was going to experience winds up to 185 miles per hour. As we watched the news, my husband said he was going to secure the house and we were going to evacuate. I was relieved as this was going to be a huge storm and I was scared. Being disabled, I could not help with the preparations outside but did what I could do inside our home. Our goal was to leave early so we could stay ahead of the traffic as others (tens of thousands) decided they would do the same thing. We were on the road 4 days before the storm was to make landfall in the Florida Keys. In this weeks, Nurse Advocate, I wanted to share what I learned from this experience.

1. Plan ahead and heed the official warnings: The Atlantic hurricane season runs from June 1 to November 30 with the peak period from early August through the end of October. During this time, newspapers provide checklists that help people know how to prepare before any hurricane materializes. As we know, it is better to prepare before a hurricane is on the way. Once the word goes out, people begin to panic, rush to the stores to buy supplies and purchase gas for their cars and generators. Those who have experienced a major hurricane, realize the work that goes into preparing for a hurricane. Taking the time to get your house and supplies in order will help you avoid the rush and the panic.

As Hurricane Irma approached there was a rush at grocery stores and gas stations. Many people who waited could not get what they wanted and panic set in. It is suggested that you have water and food you can prepare that does not require electricity for at least 3 days. As I write this Blog post, it is eight-day past the storm and thousands of people are still without electricity and some are without clean water. The temperatures are in the 90s so you can imagine the challenges many people are facing.  

2. Evacuate if you can. If you live in an evacuation zone, the officials will alert you if you have to evacuate. Those who are outside of evacuation zone can stay, but it was recommended that if you can, you should think about evacuating as the devastation expected was predicted to be monumental. We were told to gather up all your important papers, take photos of the inside and outside of your home and get on the road. It was recommended that those who evacuated should plan to stay away at least 10 days. This is because if the storm hits your area, you may not be able to return for some time. As we learned with past hurricanes, waiting is the hardest part. 

We decided to evacuate and left our home a few days before the storm so we could get ahead of the traffic. Where we live, it takes about 9 hours to get out of the State of Florida. This means you need enough gas to travel and refuel along the way due to the length of the State. Hurricane Irma was a huge storm so thousands of people decided to leave their homes for family and friends. As the storm approached the lines of cars increased and gas and hotel rooms became scarcer.

The direction of the Hurricane was a challenge for the experts to predict so thousands of people from all over the state were preparing to leave and hoped they were making the right choice as to where they would go.  That meant gas stations along the major routes would be taxed. We left early enough that we did not run into much traffic, but many people who left later were in traffic jams. There are only a few major routes out of Florida and with so many people leaving all at once, you can imagine the traffic. So again, planning ahead is important.

3. If you know where you are going and will need an overnight stay, call head for a hotel. Finding a hotel was difficult. Most hotels along the main routes were sold out. We thought we were going to have to sleep in the car our first night on the road, but we found a room at the last hotel we stopped. Many people slept in their cars at rest stations as there were no rooms available. Another problem that became evident, was for people who had pets. Many hotels are not pet-friendly, so finding a hotel with a pet can be a barrier. As the storm direction became clearer, Governor Scott asked hotels to consider reversing this policy and allowing pets to stay at those hotels who were not pet-friendly. Many did change the policy but charged an extra fee, so many found the costs of hotel rooms to be very high. We stopped along the route to eat and use the facilities and I noted many people were traveling with large families, children and the elderly were most apparent.

4. Evacuating is expensive, so the cost of evacuating has to be taken into account. It is not cheap to evacuate. Gas, lodging, food all need to be accounted for. The cost of evacuating is the reason many people decide to stay put and take their chances.  During our trip, I got an email from our Insurance Company that said if you were in an evacuation zone, keep your receipts and they would reimburse for gas, food, and lodging. This was a relief for many and a goodwill gesture from the insurance company. We were not in an evacuation zone so we could not take advantage of this, but for those who were, it was a relief.

5. Stay connected on social media:. In the impacted areas, many people used social media sites like Facebook to tell their friends and family what stores had food and ice, what gas stations had gas and how long the lines were and where people could get plywood and batteries. This really helped people to know where to go to get the items they needed. It was also helpful to know how people were doing. For me, it provided a support system to know we were not alone and our families and friends were safe or if they needed help. 

6. Have a Plan B: when we got to our first destination in Destin FL, we found people to be very supportive and friendly. We met people from all over the state who were ‘running from the hurricane’. All had stories of how their trip went and the experiences they had. It was reassuring to be in a safe place with people who were understanding and empathetic. 

On day two of being in Destin, we stopped at the desk to add a few more days onto our stay. We were told that the storm took a new direction and now was heading west. As a result, we were informed that they might have to evacuate the hotel and would get the final ruling later in the day. As a result, we decided to leave (to stay ahead of the traffic). We headed further west to New Orleans. I had called Marriott and we were able to find a Courtyard that allowed us to wait out the storm. Being in New Orleans was fun, but it was stressful as we knew what we were facing, but we made the most of it and had some fun.

7. The Path of the Storm is Unpredictable. The experts were doing their best, but Hurricanes are erratic and difficult to predict 100%. Hurricane Irma was so big it touched the entire state. Most events were canceled and all were on guard as the storm approached.

8Find Shelters where you can be safe. If you decide to stay and wait out the storm, find out where the shelters are, so if you need help, you can get it. I have an Aunt who lives on the west coast of Florida. She is in her mid-80s and very active. She said she was staying put in her home as she did not know where else to go. I urged her to find out where the shelter was and to secure a spot just in case. it was good she did, as the storm turned at the last minute and put her area into an evacuation zone. She and her son did go to a shelter and were safe as a result. 

     9. Looking at the Damage: As the storm moved forward we began to hear reports of how the Islands, the Keys and the South and West Coast of Florida fared as Hurricane Irma continued on its path northward. Damage was being shown and the impact of the damage started to come out. Our State was hit again and it would take time to recuperate. Other areas such as the US Virgin Islands were devastated and their future is unknown. Very sad. 

10. Going Home is as Stressful as Leaving. Three days after the storm passed through South Florida, we started hearing from our neighbors that our house was ok and we had electricity so we decided to head home. As we started on our way, we realized all the people who evacuated would also be returning, so again, we had to be aware of our gas levels and worry about the routes we were taking as thousands of people would all be heading in the same direction to get home. Through Social Media and text messages from friends, we learned about a number of apps we could download to our cell phones that could alert us to traffic jams and alternate routes which proved helpful. 

As we were anxious to get home, we decided to drive straight through from New Orleans to Fort Lauderdale. My husband is a trooper and likes to drive so he was able to meet the task. I am still not able to drive due to my disability so I was grateful he has the stamina and the fortitude to drive the entire way. We left New Orleans about 10am and arrived at our home at 1:30am. We stopped a few times along the way. We were grateful the traffic flowed without long stops and allowed us to make good time as we headed home. 

It was dark when we pulled into our development so we could not see much. We got up early the next day and took a look around our home. We found lots of trees down, leaves all over, but thankfully no damage to the house. The storm did not drop a lot of rain, so there was no flooding as had occurred in Houston TX a few weeks before. 

Overall our area fared well but other areas not as well….As most people reading this post know, the US Virgin Islands and the Florida Keys were hit really hard. We also learned the West Coast of Florida (Naples, Marco Island and areas up the coast) got the brunt of the storm. Further north, Orlando and Jacksonville were also impacted. Today, as I write this post, there are still thousands of people without power, running water and phone/cell service. Many are struggling and we are finding out how bad as horror stories hit the news of people who have died or suffered major health conditions due to lack of air conditioning as they still have no power. 

Support services are doing the best they can, and families and friends are urged to check on the elderly and report problems to the police.  This Monday, our public radio station, WLRN will have a ‘post-mortem’ of the storm preparedness and take calls from the public and government officials so we all can learn from this experience and find ways to do better the next time.

As I mentioned, people we met along the way and in areas where we stayed were very nice and helpful. The Welcome Center in New Orleans was great and gave us good ideas on things we could do, places to eat and support that we would get through the storm.  People were generous with their time and advice. Also, we were overwhelmed by the support from our family and friends. We kept people updated via text messages and phone calls. Many of the phone companies said they will wave the fees for data usage which was helpful. Keeping the phone charged was a priority so we had a way to communicate. Many people who stayed during the hurricane found they were without their communication devices which caused and is still causing ng much anxiety.

As we adjust and come to know the damage caused by Hurricane Irma my husband and I are talking about what we need to do to better secure our home for the next hurricane. We know we will have to invest in some upgrades like permanent shutters or replace windows that are not hurricane ready. As we get older, it is unclear how much longer we can do the work it takes to prepare and secure our home as well as tackling the clean up after the storm passes. All options are on the table.  

One thing most people agree on is, that with global warming, hurricanes and other natural events will become more intense and our areas are more at risk. Taking the time to prepare our homes, look at evacuation routes and have the necessary insurance will be important going forward.

Stay safe!

PS. Let me know how you and your families fared during Hurricane Henry and Irma. Sharing stories help others learn. Leave a post or shoot me an email at allewellyn48@gmail.com

Additional Comments

I talked to two friends of mine who rode out the Irma at their homes in South Florida. One was in South Miami and the other in Tamarac Fl. Both said they had transistor radios that were battery operated that really helped them during the storm, especially with the Tornado warnings. When the warnings came, they would move to a walk-in closet and wait for the all clear. They said these were scary and nerve-wracking as they did not know what to expect. The radio's helped as it kept them connected especially after the power went out.


Sunday, September 3, 2017

The Rise of the Empowered Consumer






Today consumers are being asked to take a more active role in their health and healthcare. But to be effective, they need help to understand how the system works and what their role is in the complex world of healthcare.

If we are honest, most of us don’t worry about our health care or how to use the health care system until something happens to us and we are thrust into a complex, fragmented and costly system. By taking the time to learn how the system works and our role in the system before we need it allows us to be in a better position to make informed decisions regarding our health and health care. 

In this edition of Nurse Advocate, I  share 10 tips that each of us can use to help us to better understand the complex world of healthcare and our responsibility as consumers of health care.  See how many of these tips you are doing! If you have questions on any of these points, let me know.
  • Use the tools offered to you by your insurance company. When you are enrolled in a healthcare insurance plan, you are usually given a member handbook. If you are not given a hard copy, you might be directed to the company’s website where you can download it.  Regardless of how you get it, the first thing you should do is read it - as it will help you know the benefits offered to you as a member. Being familiar with your policy helps you know how you can use your policy to its full potential. If you have questions, do not hesitate to call your insurance company. The member service line is a good way to get information and have questions answered.  When you call, they will verify that you are a member, so have your insurance card in front of you. Have a notebook so you can take notes. Note the date and time of the call and ask for the name of the person you are talking to. This will help if you have to call back or have a problem. The person you are talking to is also taking notes on what they tell you. Many times they will give you a reference number so if you have to call back the reference number will allow your conversation to be recalled by another member of the member service team.
  • Select a primary care physician or PCP: Having a primary physician that you see on a regular basis allows you to build a relationship with your doctor so they know you and you know them. Your PCP will be the person you go to for your annual physical or when you get a bad cold or experience another problem that drives you to a doctor. Many PCPs are starting to have extended hours and may even have weekend hours so you can see them without taking time off from work. This is an important question you can ask when searching for a primary care physician.
  • Learn where the urgent care centers are in your area. If you can't get to see your primary care physician in a timely manner, you can go to the urgent care center. Urgent care centers are less expensive than the emergency department. If your symptoms persist, following up with your primary care provider is a must.  
  • Start your own file. Get a binder and put all of your paperwork into the binder. Keep in mind, you are the only constant in your care. Over time, most if not all of your providers will change. Keeping good records will help you update new providers as to your history. Whenever you see a doctor or get a diagnostic test, ask for the report so you can share it with your primary doctor and add it to your file. If you get an x-ray, you can get a disc of the actual films so the ordering doctor can see the films themselves. Take your binder with you when you visit your doctor.  Doing so allows you to provide information that your doctor may not have when they see you. Having this information will cut down on fragmentation and duplication. 
  • Take time to visit your insurance company website. The website has a wealth of information that can help you learn about how you can take care of yourself and other tidbits you can use to stay healthy. Accessing your insurance company web portal allows you to have access to your medical claims and know what has been paid and what is still pending. It is important to remember that you should not pay any medical claims till your insurance company pays their portion. Once they have paid their portion, you will get an EOB or Estimate of Benefits which shows what the bill was, what the insurance company has paid and what you owe based on your insurance plan. You should also review the bills to make sure what is charged was done. Mistakes can happen, so checking the bills for accuracy is important. 
  • Check to see if your primary care physician has a patient portal as many providers have these portals. They allow you to communicate with your doctor.  This is another tool you should learn about as it enables you to communicate with your doctor and have access to medical records they have added. Most of these sites have technical support to help guide you in navigating the patient portals so if you are having trouble call tech support.
  • Be prepared for your doctor appointments. Just as you prepare for any appointment you go to, you should prepare for your doctor’s appointment. Doing so allows you to get the most out of your appointment. Make a list of questions or things you want to share with your doctor. If you are not sure about something you are doing, you can ask the nurses or the medical assistant who work with your doctor. Today, most doctors have several people who work with them to help patient with challenges they face. This could be a nurse, a case manager or a patient advocate. These professionals have more time to spend with you so take advantage of them so you better understand the plan of care. 
  • Ask a family member or friend to accompany you to your appointment. Most people go to their doctor's appointments themselves and do fine. But if you are getting news on a new diagnosis, or have a health challenge, you might want to have a second set of ears to help you remember what your doctor said. Most doctors are used to having patients brings someone with them to appointments so don't be afraid. If you are comfortable, you and the person who accompanies you will see the doctor together to discuss your situation and ask any questions that may come up. Many times you will forget to ask something and the person with you can remind you. The person who is with you should take notes so, after the appointment, you can discuss the appointment and review what was said and what you need to do. Notes from the meeting can go into your binder so you can refer to as needed.
  • Follow-up on tests that you have done. Make sure you call the physician who ordered the test to check-on the results. Many doctors have their office staff call you with the results, but sometimes they forgot to call you with the results. Don't assume no news is good news. If you don't have your results in a few days after the test, call the office to find out the results. Many times you will be asked to come in for the results. 
  • Follow directions, but if something is not going as expected, call your doctor. When you see a doctor, a plan of care will be developed. You should be part of developing this plan to make sure you agree with it. Being part of plan development allows you to have a part in the process and helps to ensure your commitment to the plan. If the plan of care you and your health care team develop is not meeting your needs, make sure you let the doctor know. Sometimes the original plan might not work and it has to be modified. Your doctor will not know this unless you or a family member call the doctor to let them know. Don’t wait till your next appointment if you notice something is not right or the plan is not working as expected
I hope these points help you to realize that you are the most important member of YOUR healthcare team. Being actively involved will help you regain control of your life and ensure you are getting treatment that meets your needs.

Resources

I wanted to share some of the past issues of Nurse Advocate that have touched on many of the points discussed in this post. These articles share my personal experiences as I traveled through my journey. The articles show how I have learned how to manage the challenges I encountered.

·       Taking Charge of Your Health and Healthcare. To read this post, click here. 
·       Everyone needs an advocate when they are thrust into the complex world of health care. To read this post, click here
·       Seven Steps for Healing, To read this post, click here
·       The Patient as the Center of the Healthcare Team. To read this post, click here


Thanks for reading this issue of Nurse Advocate. Take care of yourself! 

Saturday, August 26, 2017

The Passing of My Cousin







I received terrible news this week that my cousin Paul Francis died suddenly.  He was 61 years young and had a beautiful wife and two grown children. I was not aware of any medical problems, so that is why his sudden passing is a shock to us all.

As like most families, we did not see each other much over the years. Everyone is busy with their own lives and time passes quickly. I would send the annual Christmas card…but took for granted that there would always be another occasion where we would see each other again.

As I thought about my cousin, I remembered the good times we had when we were kids. My father and his mother, were brother and sister. Our parents came from a large family of seven brothers and sisters (four brothers and three sisters).  Each brother and sister had a number of children so our extended family numbered many. As his parents had a huge yard and were generous in opening their home, we gathered there often when we were kids. As a result, our generation of cousins became life long friends despite the distances between us. Over the years we have gotten together for weddings, births, and yes, deaths that happened over the years. We always had good times when we were together and kept up to date through the years through our various family members and Facebook.   

Last year, my cousin Patty and I put together a family reunion. Cousins came from across the country to reunite and shared how our lives were going and exchange memories.  We had a great turn out with all of our cousins and many of their children in attendance. As I think back, I am so happy my cousin and I took the time to plan the event as now we are a smaller group.

The sad event of my cousin’s passing made me think about a verse I had always loved from the Bible: Matthew 25:1-13, “we do not know the day or the hour, but we shall know the season. Therefore, be sober and do not slumber". To me, this passage tells me to stay alert, stay in touch, don’t put off what is important as there may not be a tomorrow. 

Having recently faced my own mortality, I have tried to keep this parable in mind. But as time passes by, I feel like I am slipping back into old routines where I put things off, don’t tell people I loved them and take for granted the short time we have on this earth. The passing of my cousin is the stark reminder I needed to get back on track. 

As our family mourns the loss of my cousin Paul Francis as he is put to rest, please remember his family with a positive thought or simple prayer. 

In closing, as we do not know the day or the hour, stay alert, don’t take things for granted or put off those things that are important as life is short. 

Be well! 



Saturday, August 5, 2017

5 Tips to Consider when You Experience a Life Changing Detour.



As many of us know, life is full of detours. A detour is defined as a long or roundabout route taken to avoid something or to visit somewhere along the way. As with driving, a detour can cause frustration, angst, and anxiety so learning how to work through a detour is important. 

On November 24, 2014, my life took a major detour when I was diagnosed with a brain tumor. I had no warning to prepare myself for this detour and it completely knocked me off track.

Getting back on course has been an interesting journey. The journey has led me to visit places I did not know existed and allowed me to meet people who helped me get back on track, which I am grateful.

In this week’s Nurse Advocate Post, I share 5 tips to consider when you or someone you care about experiences a life changing detour.

1    Ask questions: When you are thrown off course, the best way to get back on track is to stop and ask questions. Find out where you are, and what roads lead to the main road that will allow you to make choices that can get you back on track. Remember when you are lost, no question is stupid or trivial, so don’t be afraid to ask questions as they help you make informed decisions.

2    Follow advice: Since you don’t know where you are, you will need to allow others to help you.  One word of advice is to use common sense when taking advice from strangers. Sometimes people are not good at giving advice or only see the situation from their point of view. Use common sense when taking advice from others. Does the advice you are being given make sense to you? Ask a few people what they think, do research from reputable websites and talk to people who have had a similar experience or know the area. In the end, you will make the final decision as what is best for you. Don’t feel pressured to make a quick decision, take your time and be confident in your own decision-making skills as you know yourself best.


3    Critically think: getting back on track can open new doors for you. So take the time to evaluate where you are in life and what your next steps are. Coming back after a life changing detour can give you a new perspective on life allowing you to see your path through a new lens. 

4    Expect bumps: when you are traveling a road you are not familiar, expect bumps along the way. Reviewing your goals and what is important to you will help you be able to make difficult choices along your journey. Take time to review your goals and how you want your care to be handled if you can’t make decisions. Taking time to discuss your wishes with your family and friends is important before setting out on your journey. Also, having a living will, health care surrogate and someone to manage your finances if you are unable is important to have in place. Having your decisions and directives written down and available to those you choose to make decisions in your place will make things easier for those who care about you. Take the time to prepare in advance. 


     5. Stay positive: staying positive will allow you to move forward and get you back on course.

I hope these tips help you on your journey called LIFE. We never know when a curve ball will throw us off course so being prepared for a life changing detour is important.

Stay well!

Photo Credit: I found the image for this article on the web and checked out Cam Taylor. He has a wealth of information for those whose life has been thrown off course. Click here to visit his site and explore the resources.