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Sunday, September 25, 2016

Considering Spirituality and Faith in Managing Life’s Challenges





Of the many things that assisted me through my healthcare journey, I have to say that my faith helped me the most. I have not talked about this before because it is personal. However, recently, I have been thinking about how important my faith was to me during my healthcare journey, that I wanted to share a few thoughts on this topic as it might help patients and caregivers consider the value of Faith and Spirituality in managing life’s challenges.

As I progressed on my journey, I realize that I took my faith for granted till I was diagnosed with a Central Nervous System Brain Tumor. I would go to church, say my prayers, try to live my life as a ‘good Catholic.' However, it was not till I got sick that I realized how important my faith was and how much courage I received from my faith. I needed to know that there was,  a higher power if you will, that I could turn things over as I had no control. Because of my faith, I believed turning to God would give me strength to face the challenges of fighting cancer. I gained peace of mind from the prayers I said and were said for me by family and friends.

When I was in the hospital, I looked forward to the visits from the Catholic priest from Camillus House who was assigned to Sylvester Cancer Center. He made rounds on the patients who had asked to see him. I learned about the opportunity to see a priest, from the Unit Secretary who worked on the floor I resided for my chemotherapy. She said if you want to see the priest, call the operator and give her your name and room number. That way she will put you on the list, and the priest will see you when he makes rounds. The priest did come to visit me several times during my various stays. We had good conversations that lifted my spirits and helped me see some of my fears more clearly which helped me cope better.

When I was home, I received Communion from the team of Eucharistic Ministers from my church, St. Gregory the Great. By calling the Parish office and putting my name on the list, it allowed the team who coordinated home visits to know that I was requesting a Euchuristic Minister to visit and receive Communion as I could not get to Mass. I looked forward to them coming, talking with them and taking a minute to say a pray. It was comforting, and I am thankful for the opportunity they provided to turn my attention away from myself and focus on my faith.

In doing research for this post, I read about Victor Frankl, a psychiatrist who wrote of his experiences in a Nazi concentration camp. He shared: “Man is not destroyed by suffering; he is destroyed by suffering without meaning” My faith gave me meaning and helped me cope with the challenges my husband and I were facing. One of the challenges all involved in healthcare face is trying to help people find meaning and acceptance in the midst of their suffering. Experts, remind us that religion and spirituality form the basis of meaning and purpose for many people.

So many people struggle with the physical aspects of their disease, yet when we are faced with our mortality, we are faced with mental and spiritual suffering as we try to find answers to some of the deepest questions of life. Some may ask: Why is this happening to me now? What will happen to me after I die? Will my family survive my loss? Will I be missed? Will I be remembered? Is there a God? If so, will he be there for me?

I remember a conversation I had with a friend via email as I was trying to rationalize how and why I got a brain tumor. Here is a snippet of our e- conversation: Take a minute to ponder her words.
How does illness happen? Why does illness happen? The 'why' and the 'how' are connected. Medicine can give us their best interpretations but rarely know 'how' we become ill and even more importantly 'why' we become ill. Since illness is our experience, we must answer these questions for ourselves. The author's position is grounded in the psycho-somatic connection that we rarely live in until we are sick. Illness demands our attention and maturity.  We are called to become our own healers. What we thought were important changes. What we thought was urgently becomes less demanding. Our indispensability becomes humorous. Our isolation is broken by our dependence on others.  We change because the world is the same, but different. We are humbled! Illness that threatens our life can actually save our life if we go-within to become our own healer. 

If you are a patient reading this post, take some time and reconnect with your faith. Take time to reach out to your place of worship and request a visit or to be put on the prayer list.  Take the time to read thought provoking books allows you time to explore your feelings, your joys, your fears, and uncertainties. Doing so allows you to unburden yourself so you can cope better with the challenges and uncertainty you face. 

If you are a patient, I hope this post gives you the inspiration to explore your faith and experience the healing power it can bring.

If you are a healthcare professional reading this post, take time to talk to your patients and their caregivers about their faith and provide the privacy they need to practice their faith. 


Thank you for reading this week’s post in Nurse Advocate! Sending positive thoughts to you and yours.

Saturday, September 17, 2016

The Teachable Moment



Today, finding that ‘teachable moment’ is so important. Life is all about learning, gaining a better understanding of the events taking place so we can make better choices that can enrich our lives. This could not be truer than in healthcare. 

Today, there is a focus on ensuring that the patient is the central member of the healthcare team. Evidence shows the the more we engage the patient, the better the outcomes will be. 

Everything we do as healthcare professionals revolves around the patient, so it is in our best interest to educate and empower them, so they are informed, educated and know the choices they have regarding the treatment they receive. Many healthcare professionals are more cognizant of this and are taking the time to educate and empower the patient and their family, so they understand their conditions and the plan of care. 

In this week’s post, I would like to highlight two examples of 'teachable moments' I experienced during my healthcare journey. Each helped me be a more informed patient so that I could help myself heal and better participate in my care. 

The first example came when I was in the hospital getting my 5th round of chemotherapy. My nurse for the day came in and introduced herself. We talked as she updated the whiteboard in my room with her name and how I could reach her if I needed her. Then she turned to me and asked me what my goals were for the day.  I looked at her for a minute as no one had ever asked me that question before. She explained to me, she wanted to help me reach a few of my goals today, but to do that she needed to know what they were. I thought about it and told her that I wanted to get a shower. I also said that I wanted to take a walk so I could get out of my room for a little while. These were not easy goals to achieve as I was hooked up to IVs and needed help to get into the shower as I was very weak. The nurse was not put off by the task. She said, ok, let me check on my other patients and then I will be back so we can get started on helping you meet these goals.

When she returned, she got me ready to take a shower. She gathered towels and put a chair in the shower so I could sit down once I got in there. I asked her about the IVs, and she said, don’t worry, we can unhook you for a short time. She then went and got a shower sleeve that she put over my arm where the pic line was so it would not get wet. This allowed me to wash myself and not get the line wet. It felt great having hot water run over my body. I was even able to wash my hair. Once done, I put on a clean gown which felt great. She reconnected the IVs, and I  got back into my bed to clean sheets. My nurse and the aide were able to change my bed while I was in the shower. 

After I had rested for a while, the nurse came back and asked me if I was ready for my walk. She got me up, and we took a short walk up and down the hallway. It was fun seeing the other patients and staff whom I passed. Each said hello and asked me how I was doing. I felt good and I was glad that I had achieved my goals. I was grateful to my nurse for asking me what they were.

The second teachable moment occurred during a conversation my husband, and I had with the pharmacist who was a member of my oncology team. It was Week 4 of my chemo treatment. My Hematologist had just told us that my tumor was GONE. Both my husband and I were in shock, as we had not expected that news so early in my treatment. 

As my team was making rounds, the pharmacist stayed behind for a minute to ask me a question. After I answered him, he asked me if I had any questions for him. I took this opportunity to ask him how the tumor could be gone? I told him we were happy and grateful, but we did not understand how this could happen just after three treatments. He explained to us that the protocol I was on was meant to work fast - if it was going to work. As a result, the team expected the tumor to be gone after the 3rd round of which is why they scheduled the MRI after the 3rd chemotherapy treatment. He explained that in my case, the tumor was very receptive to the chemotherapy and as a result, the tumor was gone. His explanation helped me to understand and realize there was a science to the treatment I was receiving. His explanation made me very grateful that I had been referred to my hematologist who had specialized in the type of tumor I had for years, had developed a protocol to treat the tumor type and that my tumor was receptive to the therapy and was GONE. 

I asked the pharmacist about re-occurrence. He said ‘there is a high probability of re-occurrence, but that is why the doctor will watch you for two years.’ I asked him if the tumor returned would I get the same type of treatment. He said that he did not know and that my hematologists would determine the course of treatment if and when the tumor reoccurred. He said, for now, just relax.

These two examples showed me the importance of finding the teachable moment and taking advantage by educating and empowering a patient.  Each example allowed me to be involved and better participate in my care. It showed me that, by setting goals and asking questions, I could better understand my care and help myself heal.

If you are a patient or a caregiver reading this post, I hope the words empower you to ask questions, so you better understand your care. Each member of your team is there to help you to understand your diagnosis and the plan of care that in place to treat your condition. If you have questions or want to do some things that will help you to feel better, do not hold back. Know that taking care of you is the most important thing that they have to do.

If you are a healthcare professional reading this post, I hope this post helps you realize there are teachable moments in every encounter. Please take the time to engage your patients. Ask them questions, learn who they are and how they are feeling about themselves and their conditions. These conversations lead to those teachable moments that help your patients and their caregivers to be involved in their care.

If you have an example of a teachable moment that you experienced during your healthcare journey, please feel free to share in the comment section or by emailing me at allewellyn5@bellsouth.net

Thanks for reading Nurse Advocate and have a good week!


Monday, September 5, 2016

The Search for an Individual Health Care Insurance Policy: Not as Easy as it Sounds






In this week’s post, I wanted to share a challenge I had as I went about the process of searching for an individual healthcare policy to replace my COBRA policy as it was expiring. 

Having healthcare insurance has never been so important to me because I realize that having a good policy allowed me to have access to providers and hospitals who saved my life when I was diagnosed with a life-threatening illness in November of 2014.  

Today, most people receive healthcare insurance through their employer as part of their employee benefit plan. For most of my career, I have been fortunate to have an employer-sponsored health care plan and thought little of how my employer put together the package they offered. For those who do not have health insurance offered by their employers, the Affordable Care Act has created a way individuals can buy insurance through the Market Place.

When I was not able to return to work in March 2015, I was offered COBRA by my employer. The COBRA policy allowed me to continue my health care insurance plan without interruption. This was a huge relief to me and my husband as the policy allowed me to have access to the doctors who had the expertise to diagnose and treat me for the brain tumor that threatened my life. If I did not have that policy, there is no doubt that we would be in a tremendous amount of debt and worse, I might not have survived. 

COBRA is a bridge that allows a person who has to leave their job to continue their insurance coverage till they can return to work or get an individual policy. In most cases, COBRA lasts for 18 months but under certain circumstances, can be extended to 36 months. Most people return to work and continue coverage under their employer-sponsored health care plan. Others use the opportunity to test the waters of independent practice. For those who do not return to full-time work, or their employer does not offer insurance, they have to search for an individual or family healthcare policy.

Finding a health care insurance policy to meet an individual needs is not an easy job. As most people do not have experience to understand what makes up a good policy,  many people turn to an insurance broker to help them understand their options or to the healthcare marketplace that was created by the Affordable Care Act.  

The Affordable Care Act has changed many of the rules that in the past made it difficult for people who had a medical or mental health condition (often referred to as pre-existing conditions) to purchase health insurance. Before the ACA, insurance companies could deny a person coverage because they had a medical condition as part of their medical history. 

As a result of the ACA, this is no longer possible. Today, when you look for an insurance policy, your medical history does not come into play. This has helped many people be able to purchase health insurance who in the past would have been denied.

The ACA has also changed how people search for insurance. In the past, many people worked with an insurance broker to learn about the policies available and which one’s met their needs. Brokers had the expertise to understand how policies worked and could give their clients advice that served them well. Most times people would choose the policy that allowed them to see the doctors who were currently treating them and go to the hospital where those doctors had privileges. With the development of Healthcare.gov and State Insurance Exchanges, brokers are being displaced, leaving the search up to the consumer. 

The platforms that are in place allow the consumers to search for insurance. They are not difficult to navigate and provide information that enables the consumer to make an informed decision by comparing various policies which are available.

The Healthcare Market Place is available to help people search for insurance. This task may be easier for people who do not have medical conditions and do not have a preference as to the doctors they see or the hospitals they prefer to be treated if they had an injury or a sudden illness. However, for those who have specific choices, the process is not as simple.

To control healthcare cost managed care companies set up provider networks which members have to use or pay higher out of pocket costs if they decide to go ‘out of network.' This has raised the bar and put pressure on the consumer, especially those who have medical conditions which require continuous care to make sure their doctors are part of the managed care network when they search for health insurance.

Another cost containment strategy many managed care companies are implementing are narrow networks. Narrow Networks limit the number and type of specialists that members have access. If you want a plan with a ‘wide network’, you will pay a higher premium or higher out of pocket costs. 

Some companies also have tiers and categorize providers and organizations according to their specialty and risk factors for the patients they see.  Specialists who provide care to complex patients are classified in a higher tier, so the consumer needs to pay higher out of pocket costs if they want to see a specialist. Providers and organizations who are in the higher tier categories have higher costs than those in lower tiers. Diagnostic testing, lab work, and other services like rehabilitation programs may also fall into tiered levels.

As a result of these things, looking for a healthcare policy is complicated and raises the cost of insurance for the consumer.

What is even more frustrating is that the managed care insurance companies can choose to pull out of an area when they find the area is not profitable,  leaving members to find new coverage and providers. Providers also are in a precarious position as their rates are negotiated by the the managed care network as part of their provider network contracts.

Another thing that was eye opening for me as I explored new policies was unlike other types of insurance you may purchase; you cannot purchase health insurance other than during the open enrollment period (November-January) or when you have a qualifying event.

As with many things related to healthcare, the system seems to be set up to benefit the insurance company instead of the consumer. To find effective and affordable coverage, the consumer has a tremendous amount of work as they navigate a complex system with strict rules, regulations and high costs.  Little training is available to help consumers understand the complex insurance industry so consumers need to take the time to learn the system as much as they can when they are in need of a policy.

Here are some tips that I learned from my experience of searching for an individual healthcare policy. 

  • Give yourself time. It takes time to find the right policy, so give yourself the time to do the research and find a policy that meets your needs.
  • As for help:  if you know an insurance broker, set up an appointment to discuss the process of buying health insurance.
  • If you do not know a broker, each State and county has Insurance Navigators who can help you understand the process. Navigators are familiar with the plans in your area and can help you find a policy to meet your needs. If you find yourself confused, don’t hesitate to ask for help.
  • Take time to get familiar with the technology in place that helps you search for health insurance. The two systems I used to during my search were Healthcare.gov and Costco. (Yes, Costco sells health insurance, and you do not need to be a member to use the system). Both sites were user-friendly and allowed me to view and compare various plans and their costs. If you have questions, both have assistance available. 
  • Make a list of what you would like to have in a policy. If you want to see certain doctors or go to a specific hospital, write the names down so you can check various managed care networks you are considering to see if those providers and organizations are part of the managed care network. You can do this online by going to the specific managed care organizations website and clicking on the tab that says find a doctor. Plug in the names of the doctors or facilities. These online provider directories are open for anyone to search.
  • Once you checked the online network, call the provider to verify they are in the network. Many times the online information is not up to date, and a provider may have dropped out of the network in-between network updates, so checking with them is another step in the process. Most doctors and hospitals are used to calls verifying network participation so don’t feel shy about asking.
  • As you look at policies, compare several to see which one’s meet your needs. In addition to checking for providers you want to see, look at the premiums, the out of pocket costs, and the deductibles of each policy so you can see the differences and decide what you can afford.
  • Depending on your income, you may qualify for a subsidy or tax credit from Healthcare.gov. A subsidy can help you afford a higher price plan, so it is worth checking out.
I am happy to say that I found a policy that I believe works for me. My qualifying event that allowed me to buy insurance outside of the open enrollment period was that my COBRA policy was expiring on September 30th. Unfortunately, my premium is going up, and I will have higher deductibles and out of pocket costs with this new policy. This is because my choices were limited I live in Florida, and many of the managed care organizations do not offer coverage in the State so choices are limited. 

I will only have the new policy for a few months, until the open enrollment period opens November 2016.  Once enrollment opens the manage care companies release what States and Counties they will provide coverage for 2017 and the cost of each plan. Once this information is published, I will be able to review the choices and make a change if want. 

Insurance companies are getting very picky where they offer policies. As a result, consumers had limited choices and are required to pay higher premiums so it is important to review your choices carefully. 

In closing, I urge everyone to stay informed and up to date on what is happening in healthcare. It is important time and your voice is important.

I plan to stay informed on the changes taking place regarding healthcare insurance on the local and the national level. As an experienced healthcare professional who has gone through the process, I have a good number of suggestions to share that would improve the process. I have sent ideas for improvements to the State of Florida Insurance Commissioner, my State Legislative officials and my members of Congress and the Senate. 

Thank you for reading this week’s post in Nurse Advocate. I hope this post provides you with information can use if you find insurance for yourself, a family member or a friend, who find themselves in a position of needing to find a health care insurance policy.

If you have a tip you would like to share, please post a comment in the comment section or email at allewellyn5@bellsouth.net

Have a good week!