Proximity to vulnerability

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES
Mitra Sadigh
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Sometimes that protective barrier can make us feel more safe</i>.</p><p>It wasn't the woman who arrived obtunded after ingesting an unknown substance in an attempt to end her life, but the disgruntled complaints that she not only needed resuscitation, but had also “sh*t herself.” The sighs of exasperation when she soiled herself again.</p><p><i>It wasn't the process of uncovering what medication had been overingested, but watching the nurse meticulously wipe the dried, pressed fecal matter from the completely unconscious patient who hours ago had decided this life was not worth living</i>.</p><p>It wasn't the survivor of gun violence who repeatedly screamed in pain when the leg the bullet had lodged in was poked and prodded. It was staff rolling their eyes as she continued to vocalize and emote. The disbelief that she could be in so much pain against the belief that she shouldn't have been “out in the streets.”</p><p><i>It wasn't seeing a leg swell up with such tension that it might burst, but watching a resident rush out of the room in tears with the patient's scratch marks across her abdomen</i>.</p><p>It wasn't the teenage survivor of sex trafficking who was brought to the ED against her will because she lacked a safe place to sleep. It was hearing the passing of her story from EMS to nursing to residents about how “difficult” she was and “good luck dealing with her.” That she had “probably spent every night with a new man, ‘getting some.’”</p><p><i>It wasn't the physician returning disappointed after being unable to appease a teenage survivor of sex trafficking. It was hearing her say that the patient had called her a “bitch” and watching her remove herself from the care team</i>.</p><p>I ask you to reflect with me. What is more frightening?</p><p>The “agitated” patient who might raise their voice and threaten or losing the ability to recognize a desperately frightened human staring back?</p><p><i>Losing compassion for a desperately scared human staring back or being another survivor of workplace violence</i>?<span><sup>1</sup></span></p><p>Resuscitating someone who has attempted to end their life or being comfortable publicly humiliating them in their most vulnerable moment as they are being pulled back from the brink of death?</p><p><i>Expressing momentary frustration after repeatedly cleaning feces from an unconscious patient post–suicide attempt or internally holding endless resuscitations internally to the point of becoming another healthcare worker suicide statistic</i>?<span><sup>2, 3</sup></span></p><p>Witnessing someone endure the pain of a gunshot or being a person who assumes that others deserve the violence they suffer?</p><p><i>Distancing from patients by assuming people deserve what they suffer or absorbing the reality of senseless tragedy, battling PTSD from the countless victims of gun violence heard screaming down the ED halls</i>?<span><sup>4</sup></span></p><p>Absorbing the tragedy of a teenage survivor of sex trafficking or failing to recognize that she is just a child and that the police surrounding her room are scaring her?</p><p><i>Misrepresenting a survivor of sex trafficking or reaching an impasse where only substance alleviates the feeling of hard work going without appreciation or impact</i>?<span><sup>5</sup></span></p><p>In the ED, we cannot prevent life's grief from suffocating someone's will to live any more than we can prevent the landing point of a bullet or unspeakable harm to a child. We cannot prevent tragedy from making our days feel heavy any more than seeing yet another bullet wound or teenager who never had a chance at childhood. But we can do more to protect ourselves, our patients, and our passion for this work.</p><p>Recognizing that health care training alone is inadequate preparation for managing the challenges of the ED environment, we must expand our toolkit. We can dive deeper into our internal landscape to learn to build resilience<span><sup>6</sup></span>; better manage our biases<span><sup>7-9</sup></span>; equip ourselves with more intentional coping strategies<span><sup>10</sup></span>; and turn to mental health experts to help us reform our support systems. We can employ methods of nonviolent communication, self-awareness, and self-regulation that are utilized by others who work in emotionally charged settings. 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引用次数: 0

Abstract

With every shift in the emergency department (ED), I am reminded that each of us is only one or two steps from being extremely vulnerable.

My difficult moments have not been as colored by patient stories as by their stories being lost and misconstrued; spun and respun to maintain distance between staff for whom it's another “day on the job” and patient for whom it may be the worst day or era of their life. The protective barrier transforming an individual in need of help into a problem to be dealt with.

My difficult moments have not been as colored by patient stories as by the ways that another “day on the job” for health care workers can easily become either the worst day or worst era of their life. Sometimes that protective barrier can make us feel more safe.

It wasn't the woman who arrived obtunded after ingesting an unknown substance in an attempt to end her life, but the disgruntled complaints that she not only needed resuscitation, but had also “sh*t herself.” The sighs of exasperation when she soiled herself again.

It wasn't the process of uncovering what medication had been overingested, but watching the nurse meticulously wipe the dried, pressed fecal matter from the completely unconscious patient who hours ago had decided this life was not worth living.

It wasn't the survivor of gun violence who repeatedly screamed in pain when the leg the bullet had lodged in was poked and prodded. It was staff rolling their eyes as she continued to vocalize and emote. The disbelief that she could be in so much pain against the belief that she shouldn't have been “out in the streets.”

It wasn't seeing a leg swell up with such tension that it might burst, but watching a resident rush out of the room in tears with the patient's scratch marks across her abdomen.

It wasn't the teenage survivor of sex trafficking who was brought to the ED against her will because she lacked a safe place to sleep. It was hearing the passing of her story from EMS to nursing to residents about how “difficult” she was and “good luck dealing with her.” That she had “probably spent every night with a new man, ‘getting some.’”

It wasn't the physician returning disappointed after being unable to appease a teenage survivor of sex trafficking. It was hearing her say that the patient had called her a “bitch” and watching her remove herself from the care team.

I ask you to reflect with me. What is more frightening?

The “agitated” patient who might raise their voice and threaten or losing the ability to recognize a desperately frightened human staring back?

Losing compassion for a desperately scared human staring back or being another survivor of workplace violence?1

Resuscitating someone who has attempted to end their life or being comfortable publicly humiliating them in their most vulnerable moment as they are being pulled back from the brink of death?

Expressing momentary frustration after repeatedly cleaning feces from an unconscious patient post–suicide attempt or internally holding endless resuscitations internally to the point of becoming another healthcare worker suicide statistic?2, 3

Witnessing someone endure the pain of a gunshot or being a person who assumes that others deserve the violence they suffer?

Distancing from patients by assuming people deserve what they suffer or absorbing the reality of senseless tragedy, battling PTSD from the countless victims of gun violence heard screaming down the ED halls?4

Absorbing the tragedy of a teenage survivor of sex trafficking or failing to recognize that she is just a child and that the police surrounding her room are scaring her?

Misrepresenting a survivor of sex trafficking or reaching an impasse where only substance alleviates the feeling of hard work going without appreciation or impact?5

In the ED, we cannot prevent life's grief from suffocating someone's will to live any more than we can prevent the landing point of a bullet or unspeakable harm to a child. We cannot prevent tragedy from making our days feel heavy any more than seeing yet another bullet wound or teenager who never had a chance at childhood. But we can do more to protect ourselves, our patients, and our passion for this work.

Recognizing that health care training alone is inadequate preparation for managing the challenges of the ED environment, we must expand our toolkit. We can dive deeper into our internal landscape to learn to build resilience6; better manage our biases7-9; equip ourselves with more intentional coping strategies10; and turn to mental health experts to help us reform our support systems. We can employ methods of nonviolent communication, self-awareness, and self-regulation that are utilized by others who work in emotionally charged settings. We can refresh our perspective by creating a standardized definition of patient-centered care11 and taking steps to protect patients from further harm while in the ED.12-16 We can improve collective support by integrating regular group debriefing17 and more robust support in the workplace.18

We can commit to cultivating a beginner's mind with patients, approaching with curiosity rather than assumption or shut down. We could pause before reacting to a screaming patient and ask what is causing the patient to scream. Pain? Fear? Adrenaline? Overwhelm? Do they need pain medication? A hand on the shoulder? A few minutes alone?

We can commit to cultivating a beginner's mind with ourselves, taking a moment to pause before reacting and asking the pertinent question of what we need at that moment. A snack? Three deep breaths? Positive affirmation? Someone else to see this patient?

We can call on the strengths of our interdisciplinary teams, from chaplains who beautifully model holding emotional space and navigating tender moments to social workers who are champions of connecting patients with pertinent resources. We can speak up about the current overflowing and understaffed state of EDs, calling for new roles like patient advocates.19, 20 Rather than grinning and bearing, we can use our collective voice to share our struggles on greater platforms and push for deeply needed change. Rather than becoming disullusioned with the barriers in the care we provide, we can advocate for our patients more broadly. We can collectively work towards evolving ourselves, our work, and the ED environment in ways that better serve us and our patients.

The author declares no conflicts of interest.

接近脆弱性
在急诊科(ED)的每一次轮班中,我都会被提醒,我们每个人都离极度脆弱只有一到两步之遥。我的困难时刻并不是因为病人的故事而增添色彩,而是因为他们的故事被遗忘和曲解;被扭曲和重演,以保持医护人员与病人之间的距离,对医护人员来说,这又是 "工作的一天",而对病人来说,这可能是他们生命中最糟糕的一天或一个时代。保护性障碍将需要帮助的人变成了需要处理的问题。我的困难时刻并不是因为病人的故事,而是因为对医护人员来说,"工作中的另一天 "很容易变成他们生命中最糟糕的一天或最糟糕的时代。有时,这道保护屏障会让我们更有安全感。不是那个摄入不明物质后昏迷不醒、试图结束自己生命的女人,而是那些不满地抱怨她不仅需要人工呼吸,而且还 "拉屎了 "的人。当她再次弄脏自己时,护士们发出了气愤的叹息声。这不是揭露她摄入过量药物的过程,而是看着护士一丝不苟地擦拭完全失去知觉的病人身上干涸、压扁的排泄物。当她不断发出声音和表情时,工作人员都在翻白眼。不是看到她的腿肿胀得可能爆裂,而是看着一名住院医师带着病人腹部的抓痕流着泪冲出病房。不是因为没有安全的地方睡觉而被强行带到急诊室的性贩卖少女幸存者。她的故事从急救到护理再到住院医生都在讲述,她是多么 "难缠","祝你好运"。她 "可能每晚都和一个新男人在一起,'找点乐子'。"这并不是医生在无法安抚一名性贩卖少女幸存者后失望而归。而是听到她说病人叫她 "婊子",看着她从护理团队中消失。什么更可怕?是 "激动 "的病人可能会提高嗓门进行威胁,还是失去辨别一个极度恐惧的人的能力?是对一个极度恐惧的人失去同情心,还是成为另一个工作场所暴力的幸存者?对企图结束自己生命的人进行抢救,或者在他们最脆弱的时刻将他们从死亡边缘拉回来时,心安理得地公开羞辱他们?在自杀未遂后反复清理昏迷病人的粪便后表示一时的沮丧,或者在内心深处坚持无休止的抢救,以至于成为又一个医护人员自杀的统计数字?3目睹他人忍受枪伤的痛苦,还是假定他人遭受暴力是罪有应得?假定他人遭受暴力是罪有应得,从而与患者保持距离,还是接受无谓悲剧的现实,与创伤后应激障碍作斗争,因为在急诊室大厅听到无数枪支暴力受害者的尖叫?我们无法阻止生命的悲痛窒息一个人的求生意志,就像我们无法阻止子弹的落点或对孩子难以言喻的伤害一样。我们无法阻止悲剧让我们的日子变得沉重,就像无法阻止看到又一个枪伤或从未有过童年机会的青少年一样。但我们可以做得更多,以保护我们自己、我们的病人和我们对这项工作的热情。我们认识到,仅靠医疗培训不足以应对急诊室环境的挑战,因此我们必须扩大我们的工具包。我们可以深入了解自己的内心世界,学习如何建立抗压能力6;更好地管理自己的偏见7-9;为自己配备更有意识的应对策略10;并向心理健康专家求助,帮助我们改革支持系统。我们可以采用非暴力沟通、自我意识和自我调节的方法,这些方法是在情绪紧张环境中工作的其他人所使用的。我们可以通过建立以患者为中心的护理的标准化定义11 来更新我们的观点,并采取措施保护患者在急诊室内免受进一步伤害。 12-16 我们可以通过定期小组汇报17 和在工作场所提供更有力的支持18 来改善集体支持。我们可以致力于培养对患者的初学者心态,以好奇心而非假设或封闭的态度对待患者。在对尖叫的病人做出反应之前,我们可以停顿一下,问问病人尖叫的原因是什么?痛苦?恐惧?肾上腺素?不堪重负?他们需要止痛药吗?肩膀上的一只手?我们可以致力于培养自己的初学者心态,在做出反应之前暂停片刻,问一个相关的问题:我们此时此刻需要什么?一份点心?三次深呼吸?积极的肯定?我们可以借助跨学科团队的力量,从牧师到社工,他们都是守住情感空间、驾驭温情时刻的典范,他们是将病人与相关资源联系起来的倡导者。我们可以就急诊室目前人满为患、人手不足的状况大声疾呼,呼吁设立患者代言人这样的新角色。与其对我们所提供的医疗服务中存在的障碍感到失望,我们可以更广泛地为患者代言。我们可以共同致力于发展我们自己、我们的工作以及急诊室环境,使其更好地为我们和我们的患者服务。
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来源期刊
AEM Education and Training
AEM Education and Training Nursing-Emergency Nursing
CiteScore
2.60
自引率
22.20%
发文量
89
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