Push that reset button every day!

The new year provides an opportunity for each of us to reflect on lessons learned in the past 12 months and to reset life goals. I sometimes ponder how long it takes to arrive at the point where we avoid making choices that lead us to the same uncomfortable place. They may involve neglecting to take care of ourselves, failing to set and follow through on goals, or responding poorly to situations where people have hurt us. Whatever the case, the result is the same—an endless walk on a “hamster wheel” that goes nowhere.

For me, this past year has brought increased awareness of how quickly time is passing and how easy it is to not make the most of the time we have. I remember my beloved grandmother who firmly believed that taking time for granted is an irreversible mistake. By the time we realize our mistake, we find ourselves on the other side of an event that has disrupted our foundations. Clearly, we cannot stop time or reverse events that have already occurred.

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Tragic world events of 2015 remind us all that we cannot take life for granted. Time is a gift we should use for good, not for engaging in unproductive or destructive activities. Perhaps you are among those who pledged at the beginning of 2015 to use your talents and gifts to improve lives around you. Or you made a commitment to exercise more or eat better. If you’re like most, the result has been a mixed bag of successes and failures. The point is, we often find ourselves pivoting away from life-improving goals toward places of familiarity that do not move us forward.

How do we stay engaged in working toward goals that move us forward? We push the reset button every day! Each day, we resolve to be our best, fully committing ourselves to excellence in all we do, whether it’s exercise, work, developing friendships, or nurturing family relationships. Like you, I have learned many lessons over the years. One is, if I don’t take care of myself, I can’t improve the lives of those around me.

As you ponder what you want to accomplish in 2016, remember to invest in yourself so you can be that change agent who positively impacts the lives of others.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Afaf Meleis: A transformative leader

Every year, universities and other schools welcome students eager to commence or return to their academic pursuits, and every year I find myself reminiscing about my student days and the professors who significantly influenced my thinking about nursing.

Recently, I came across a poster that read “Honor your mentors,” and I began to ponder the importance of those words. Honoring a mentor is easy, deciding who to honor and how is more of a challenge. There were so many people who mentored me, either formally or informally, but there is one who simply “took my breath away.”

Afaf Meleis

It was my first doctoral class, and she entered the room with an unforgettable effervescence and extravagant display of intellect that was formidable. She is Afaf I. Meleis, PhD, DrPS (hon), FAAN, dean emeritus, University of Pennsylvania School of Nursing. I, of course, knew of her. Several of my professors in graduate school were former students of hers and often spoke about her.

The year was 1993. Before starting my PhD program, I had tragically lost my brother, so I was at a crossroads, trying to decide what to do with my career. Then it happened. In walked Professor Meleis, who, with her Socratic style, began querying each of us about the assigned readings. Instantly, I knew I was in the presence of a profound scholar, an intellectual giant. That day, I learned she had high expectations of her students, but, more importantly, she wanted to infuse us with her passion for nursing.

My classmates and I could not stop talking about her because most of us had not experienced anyone quite like her. Meleis role modeled being prepared and not shying away from challenges. Using epistemology and social theories, she raised our collective consciousness. I had many wonderful professors, but none like her. She taught me the significance of inductive and deductive reasoning—not only in the classroom, but also in life. It’s why she left such a prodigious impression on me. While I had always believed I was great at asking critical questions, under her influence my questions became more substantive and helped me become better equipped for wrestling with scientific complexities, as well as life’s challenges.

Through the years, I often wondered how one woman could have such an impact on so many people. I’ve come to realize it is her commitment to excellence and her passion for the profession that has been the cornerstone of her entire life. Her instincts and acute intuition are amazing! In meetings, she knew when to listen and when to share her thoughts. She told me not to waste time with petty battles but stay focused on the bigger picture and have a broad vision. She challenged me to live with purpose and not get distracted by detractors or critics, because their criticisms serve to chip away at our imperfections and make us more polished scholars.

I had the privilege of being her student at the University of California and a member of the faculty she led at Penn School of Nursing. As I continue to watch her evolve as a scholar and observe her vast energy and intellect, one thing is for certain—she exhibits the same passion for nursing as the day I first met her. Recently, Meleis was honored by the American Academy of Nursing as a “Living Legend.” It’s a title befitting a woman I consider a transformative leader, a mentor who is still changing lives nationally and globally.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Know your value

How many of us really know our value? What do you believe you are worth? Too often we define our worth through material objects or by what others think of us, but do you realize your value? In recent months, I have invested considerable time thinking about these questions and would like to share my reflections.

As we navigate life, we are faced with challenges at home, work, or school. In each of these contexts, we spend significant energy internalizing the opinions of others—in particular, those we hold in high esteem. A statement such as “I don’t believe you have what it takes to make it in this profession” can send one spiraling into an existential crisis. We’ve all been there. Whether we heard it from our parents, a college professor, or a supervisor, the impact of such words can be discouraging.

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My reflections awakened a memory of a college professor who once told me “I think you have chosen the wrong profession.” I recalled how devastating those words were. Traumatized, I remember taking a long walk to collect my thoughts. As his words descended into my psyche, I recall feeling anger, and I became motivated to prove him wrong. Lamenting my aggravation to another professor, she looked at me with a puzzled gaze and asked, “How can you let one man convince you to entertain the idea you were not called into nursing? I have heard you speak, observed you with others, and you have a special gift.” It felt good to hear those words, but it was a struggle to believe them.

That changed when I began remembering what teachers from elementary school to high school had told me: “You have a gift that you must share with others!” As I thought about what they said, I realized that my teachers and professors had more faith in me than I had in myself. In other words, I did not know my own value. As I progressed in college, I came to the realization that I had, indeed, chosen the right field, and that I had a lot of value to bring to the wonderful profession of nursing. Simply put, I began to know my value.

Experience has taught me that we come to know our value when confronted by challenges that test the fragility of our egos. Our success hinges upon our ability to recognize that the unique gifts bestowed on us cannot be replicated and that each of us, therefore, has a distinct contribution to make to the world. That contribution may be assisting others to heal, listening to those who are in despair, or helping someone navigate a medical emergency. The point is, you do have value. The challenge is to believe it.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Needed: Stronger partnerships between researchers and IRBs

Recently, I am across an op-ed piece about breaches of conduct in medical research that, I’m sure, you will find as disturbing as I did. As the former chair of an institutional review board (IRB), I was sickened to learn that, despite federal mandates that universities adhere to the Belmont Report principle to do no harm, violations of those regulations continue to occur.

When I was an IRB chair, we routinely reviewed clinical trials that were supervised by a data and safety monitoring board (DSMB), as well as other studies exempt from DSMB oversight. Then, as now, I was concerned that universities, relying on the honor code, have depended on principal investigators to report irregularities that occur while conducting research studies.

In pursuing scientific discovery, academic and scientific communities rely heavily on human volunteers when conducting research. However, it has become evident in some instances that publishing novel findings has taken priority over protecting human subjects. Belmont Report “do no harm” guidelines notwithstanding, some researchers are failing to show allegiance to this principle.

Nurses and other health care providers are well positioned to advocate for the highest ethical treatment of human volunteers. The challenge is how to structure this advocacy in a systematic manner that safeguards against potential abuses. In my view, academic centers do not have adequate resources to monitor research protocols. Consequently, investigators are left to grapple with ethical issues that, if not addressed properly, may result in unintentional harm to research subjects.

Advocating on behalf of human volunteers in research studies is tantamount to the advocacy nurses provide patients. Far too often, the consent forms used in conducting research are too complex for volunteers to comprehend, particularly as they relate to potential risks and benefits of a research study, as well as its method and design. Hence, it is incumbent upon investigators to do due diligence in creating forms that are clear and comprehensible.

Additionally, I propose that institutional review boards charged with overseeing research studies: 1) increase the frequency of their monitoring, and 2) that they deploy sufficient personnel to provide necessary oversight while avoiding unnecessary interference with execution of research studies. In other words, a partnership that benefits both investigators and research participants is needed.

From personal experience, I know it is easy for some investigators to regard the IRB as an adversary rather than the quality-assurance arm of their studies. But to ensure that protection of research volunteers is more than just a philosophical principle and that all volunteers who participate in research are well protected, I propose that stronger partnerships be forged between investigators and the institutional review boards to which they are accountable.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Addressing men's health

It’s the time of year when we focus on men’s health. (June is Men’s Health Month in the United States.) Far too many men fail to seek early detection and treatment of disease. For them, it is much easier to ignore a potential health problem than to address it. Lack of media attention on men’s health only exacerbates the problem.

I am not alone in grappling with how best to motivate men to abandon notions that keep them from seeking out health care. I am confident many of you have male family members and friends who are adept at disregarding your attempts to put them in touch with primary health care providers. So what is the best strategy to use to increase men’s compliance with having yearly physical exams?

Coercion and fear not the answer
It is best to avoid coercive tactics, because they don’t work. And don’t use fear as a motivator, because, for some, fear is the very reason they don’t seek out a primary-care provider in the first place. Using these types of messages only defeats the purpose.

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I have found that an effective strategy is a pragmatic approach, such as making this time of year an annual celebration of health. For example, in conversations I’ve had with various male audiences, I’ve learned they are more likely to go to a doctor if making an appointment becomes routine, or if a buddy encourages them to nip any potential health problem in the bud.

Like women, men care about their health and want long and prosperous lives, but the challenge is to get past the fear of finding that something is wrong, which, in their minds, translates to, “I won’t be able to provide for my family or take care of myself.” Whether such a negative prospect is real or perceived, it’s important to recognize that this belief is very real to them, and should not be disregarded.

Men helping men
One strategy is to meet men where they are. For example, a great way to spark dialogue is to hold health fairs in health clubs, churches, and barbershops. The objective is to keep the conversation light, but substantive. Another helpful tactic for recruiting men to dialogue about their health is to engage the help of male leaders in the community.

Men talking to men—either one on one or in a group—can be a powerful way to encourage discourse about health issues. To be effective, the messages need to be appropriately tailored to the audience. For example, college-age men need to learn about the importance of screening for testicular cancer and how to conduct self-examinations, because this age group is at the highest risk for this health problem. Again, it’s prudent to educate and then deploy college-age males to host health parties where they can discuss how critical it is to pursue early detection.

In my experience, utilizing men to engage other men in discussing health issues is a powerful approach that usually results in behavior change. When designing men’s health campaigns, we need to involve men in our efforts. Unfortunately, some men’s health programs focus too much on potential adverse outcomes rather than communicating effective prevention strategies. 

Do you have an effective approach?
Consider how you might engage men for participation in early detection and annual screenings. Clearly, ignoring one’s health only leads to higher health care costs, costs that early detection can largely prevent.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Healing after tragedy

Like so many Americans, I was outraged by events that took place this past week in Baltimore, Maryland, USA. While I do not assert to have all the facts, it is clear something went terribly wrong. In 2003, as a student in the Master’s in Public Health program at Johns Hopkins University in Baltimore, it was also clear to my classmates and me that economic disparity in the community was ubiquitous.

As the situation unfolded this past week, I found myself transfixed by the media coverage, but also disappointed in the outlets that focused on the few who decided to express their frustrations through destructive means rather than the vast majority of citizens who, to bring attention to a long-standing problem, protested peacefully. As I listened to a number of young people being interviewed, either in a school setting or on the street, I heard the chilling perceptions they communicated, of feeling left to fend for themselves and that their lives do not matter. Whether perceived or real, these beliefs, formed by their lived experience, demand an effective response by community leaders, as well as the federal government. Imagine believing your life does not matter! It is almost impossible to comprehend.

Like all wounds, this chasm is going to take time to heal. However, this is also an opportunity for health professionals to help bring healing to a community in pain. It is truly going to take a village to address the enormity of the deep-seated issues the community has long endured. Through this transformational event, we have all been reminded that economics and race still divide us, producing a narrative that creates misplaced fear about the very people who need our help the most.

Health care providers have a critical role to assume as Baltimore begins to move forward. So many of the youth and adults feel left behind. Hence, we need to provide not only advocacy, but also innovative vision that opens a way forward toward health and economic prosperity.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Daring to confront

Have you ever felt guilty for taking a stand against challenging behavior? If you have, you’re not alone. It’s certainly easier to delay confrontation than it is to decide, “Enough is enough,” and take action. Far too often, we allow wrong behavior to continue until an eruption occurs that could have been avoided had we dared to confront.

In an earlier post, I told you about confronting, as a nursing student, a physician who used finger-snapping as a means of communicating with nurses. Well, guess what? Years later, history repeated itself. By that time, I was a charge nurse, and I couldn’t believe I was, once again, witnessing a physician snap his fingers to get the attention of nurses. It was déjà vu all over again.

I still recall the outrage of the nurses. “He shows no respect for nursing staff,” some of them complained, but no one dared confront the physician about his behavior. The situation was delicate. After all, he was a surgeon who commanded power in that hospital. Colleagues said, “Never cross him. You’ll get fired!”

It was déjà vu all over again! 

— Photo by Ingram Publishing/Thinkstock   

Hearing those comments gave me pause, but I didn’t want to see nurses treated with disrespect. Usually, I didn’t have contact with this surgeon unless he wanted to complain that a nurse wasn’t moving fast enough. Another issue was that he would take all the charts, thereby creating problems for nurses who were trying to complete their charting in a timely manner.

Because politics and institutional power were involved, confronting this physician would not be easy, but I knew my nurse colleagues, who were fed up with his behavior and were losing morale, expected me to take action. After pondering what to do, I came up with a plan. The intervention would be simple. To force the physician to interact with me, all the other nurses would be with patients in their rooms.

Like clockwork, he came to the floor the next day to complete his rounds, this time accompanied by residents, and, as usual, the finger-snapping began. I intentionally ignored him. The snapping continued, but I remained silent. Growing frustrated, he finally blurted out, “Don’t you hear me talking to you?” He was speaking loud enough that the other nurses came out of the patients’ rooms, and the residents stood aghast. This was my opportunity.

Walking over to him, I said, “Hello, Doctor. My name is Chris. I am the charge nurse, and I have a simple request. Do not feel you need to snap your fingers to get my attention. I prefer that you address me as Chris. Also, I was wondering if we could agree on a time for you to chart so my nurses could have the charts back in time to complete their documentation?”

To my surprise, he responded, “No problem, Chris. We certainly do not want to increase the hospital’s budget,” and he chuckled. The residents stood with their mouths open. From that day forward, he never tried to get a nurse’s attention on that unit by snapping his fingers, and, yes, we were able to arrange for a suitable time for him to review charts.

Every nurse asked me, “How did you do that? I cannot believe his response.” The only insight I had to share was that, as a student, I had learned to assert myself and not allow a physician to treat me as an object—to objectify me—and my refusal to let him do so disrupted his improper behavior. Nurses do have power when we affirm our role and identity.

I knew that both the physician and I shared a desire for our patients to heal, and, to make that happen, we needed to function as a team. From that time forward, he would say, “Chris, how are my patients doing today?” I realize that communication challenges are complex, and confronting doesn’t always turn out as well as this encounter did, but the surgeon and I both discovered that a simple introduction that began with “Hi, my name is Chris” can stop disrespectful communication in its tracks and lead to positive outcomes.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.