Barcelona Day 3: Elections & Opening Ceremonies

Saturday, 27 May 23:00

Before I was approved to attend and cover the International Nurses Council (ICN) Congress this week, I had no clue about many of the things I’ve been writing about for the last few days. Apart from a few friends in college who were into medical missions, nursing, to me, as I mentioned in my blog post of last week for AJN Off the Charts, was solely a local, American concern.

While the governing body of ICN announced elected board members this morning, I shamefully realized I knew little or nothing of many of the new, celebrated leaders or their respective member countries. When Pam Cipriano, President of our professional nursing organization was named elected member of the board, I wondered how many of my colleagues or nursing friends knew about her work, platform, or even of her name. As I feverishly Googled the emoji of the United Arab Emerites flag to send out a congratulatory tweet about AJN International Advisory Board Dr. Fatima Al Rifai’s similar election, I realized didn’t have the slightest idea about the UAE’s nursing population, leadership structure or professional progress. I had no clue how I would learn all of these new people and concepts, but knew, as I experienced more and more, that I now wanted to try.

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Later, after 8,00+ international attendees filled the Olympic Village that overlooks the city of Barcelona for the opening ceremonies, I watched country after country of National Nursing Association representatives (including American Nurses Association) take their places in the opening parade, and marveled at how many truly diverse cultures of care crossed the stage waving their countries’ flags into the spotlight.  My awe doubled when I, a member of the press and a nurse, was allowed backstage to the delegates VIP area, and then shorly after, to stand directly in front of the oncoming parade and honor delegates through my documentation of their participation.

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Most of all, I found it breathtaking to become a living mix of the things that inspire me daily – nursing and writing. To be a badged member of the press, but with insight and emotion about the goings on around me at the opening ceremonies, made me realize just how valuable diversification in nursing really is. If only we would start to realize that nursing is a foundation for every area of business, education, clinical practice and more, and that our true impact, as Judith Shamian, acting president of ICN, would say, is determined, not so much by who we are or who we work for, but how we choose to innovate our profession through our time and talents, not just our day jobs.

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And so, when one of my personal, early nursing heros, Dr. Linda Aiken, came to the stage to accept the “Nobel Prize of Nursing” (a description I’m not sure that I agree with, since nurses should also be winning the real Nobel Prize, no?), I clung to her words as not just a nurse, but as a nurse who is also a scientist of nursing. For the first time, I saw how important her work of science creation is, how the necessary, undeniable, extensive, replicable and global body of evidence that she led for the benefit of our profession stemmed not just from her initial clinical training, but from her passion to forward the profession as a whole, through actionable and quantifiable evidence.

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Of course, some of the nurse-centric entertainment after the awards ceremonies made this nurse cry and marvel at the magnitude of this profession that I so deeply love, but it was the presence of so many nurses communicating and celebrating together that touched me deepest. Likely for the first time in my ten year career, I connected with the need to actualize the massive, inherent value of the hard work that we must begin to do – with our voices, our written words, and our brains – together, and for each other’s future.

When I’d captured enough, I snuck out and walked to the metro with a group of international nurses that I met along the way, the city skyline closing the night in a dusky blue behind us.

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Barcelona Day 2: A Real Spanish Hospital + Art Walkathon

Friday, 26 May 23:00

The days seem endless here, in a good way. This sleepless, sun-filled city bestows enough hours of positive, brilliant energy in the day to stave off an entire season of winter blues. Right now, as I struggle to stay awake enough to keep my promise to myself to reflect and write at the end of each day, a ska band is playing a slow version of Lady Gaga’s Bad Romance  just half of a block from my balcony window. I’m officially enamored with Barcelona.

This morning, I met AJN Editor-in-chief  Shawn Kennedy at the Centre Convencions International Barcelona to observe the meetings of the Council of National Nursing Association Representatives (CNR), and check in as a member of the press. This is acting President Judith Shamian‘s final Congress, and I was sad that my jetlag kept me in bed past the opening presentation that commended her advocacy and celebrated her coined phrases – challenges to the global nursing community to act, have a voice, get involved in policy.

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After a sunny coffee break where Shawn and I caught up and made a plan for our coverage throughout the week, I met up with NYC colleages to tag along on a tour of Hospital Clinic Barcelona that Dr. Beth Oliver, Vice President of Cardiac Services for Mount Sinai Health System, had arranged for a handful of nurses through an international contact. We met with members of the nursing leadership team, who personally walked us through a presentation of the hospitals history, architecture, place in Spain’s universal health care structure, and current clinical offerings. After this, we headed to the floors, where we saw intensive care units that were higher tech and more sophisticated than any I had ever seen or worked for in New York. It wasn’t until after we finished and entered the noisy streets that Beth and I turned to each other and said, “Oh my goodness, did you notice how quiet it was in every floor?”

From there, I parted ways with my US friends and spent the rest of my day walking the city. I hiked up the hill (and stairs!) to the Museu Nacional d’Art de Catalunya, watched the city behind eager tourists taking selfies, and perused their collection of international art, particularly enjoying a simple, small exhibit by a Barcelona native, Torné Esquius, called “Poetics of the Everyday.” The empty halls of the museum posed a stark contrast to the heavily trafficed museums back home, and I enjoyed taking my time to look at pieces, or taking no time at all.

While I love site seeing and art viewing, my favorite part of my second day in Barcelona was spending time learning from other nurses at the hospital. I most enjoyed hearing the details of the Spanish health care system, and the structured take the government has on educational levels, specializations, labor agreements, and advanced degrees. I marveled at the detail of the presentation materials given by these nurses who spoke of their many degrees and accomplishments, seemingly spurred on by the laws in place here in Spain that systematically move nurses through required educational minimums for practice; structure that we sorely lack in the US.

I also loved “collecting” the simple design solutions that this hospital had mastered: Huge numbers on each glass sliding door of each room. Buttons that made the lights in the ceiling mimic the pattern of the sun to decrease delirium. Basic, clear hand hygiene signs. Plastic, easily cleaned room-dividers instead of fabric curtains (brilliant!). A code cart with a compartment that had a clear, locked lid containing the intubation blade and battery pack in plain view, right next to the defibrillator. Even in rooms so small that bed rails touched each other, I didn’t hear a single call bell ring, and nurses seemed engaged and happy, even with patient rations higher than our own.

Perhaps I am just seeing everything with vacation eyes. I don’t know. Either way, the day brought me closer to the realization that there is so much to learn, so many perspectives to consider, so much to be open to. I can hardly wait for the day tomorrow, when thousands of motivated nurses will end their journeys together at the Congress’ opening ceremonies. Being here makes me remember why I love our profession so much, how unifying it is, how our common struggles, maybe not exactly the same, only bring us closer together and more apt to move in unison.

 

Day 1: Barcelona, ICN 2017

Thursday, 25 May 23:00

On my calculation, I’ve been in Barcelona for about 15 hours now. Minus the few winks I managed between backaches in my cramped coach class seat, I think I’ve been awake for going on 36. If that’s not any forwarning about the quality of this blog post, I’m not sure what to tell you.

All in all, I’m here, and had a great first day in this city that is new to me. I spent the day with nurse colleagues breakfasting on a rooftop overlooking the ocean, traipsing around tourist sites and hidden local shopping jems, drinking a glass of Cava, and talking nursing in preparation for the International Council of Nurses Congress, which starts Saturday. I’m here reporting for the American Journal of Nursing, and so far, I’m impressed with the city.

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Barcelona is clean, modern, accessible and easy to navigate. People are helpful and cordial, and the food is good. I have yet to encounter a Barcelonian who doesn’t speak English; I feel no shame (or impossibility) maneuvering my way through dinner-ordering and direction requests in my native tongue.

This Americentric mindset makes me reflect, always, when I travel in foreign lands. My recent international experience is mixed, albeit not that vast – in Brazil, the majority of people speak very litte or no English, and so speaking my preferred tongue is simply not an option. I must stumble through broken fragments of mispronunciations mixed with fervent body language. In contrast, when my husband and I visited Portugal last year, I was able to poke my way around in cautious, respectful English, for the most part. Here, there’s no hindrance, and I find myself not really even trying to inflect or attempt. The acceptance of English dominance is apparent, expected, perhaps even embraced, at this first glance.

It’s interesting, to start this week of covering an international meeting of nurses by thinking about the insecurities of inter-linguistic maneuverings. Should I assume, like I too often do with varying foreign language travel requirements, that my naturally dominant perspective is the best? The one to mimc? What can I learn from the culture here, the collective narrative of health? How is my own native perspective getting in the way? How can I, in preparation for talking with some of the most prominent and accomplished nursing leaders of the world, remove barriers to my own opennness and recognize the things I, as a member of a global community, need to start stretching myself to do and learn?

New Writing, New Measurements

I‘ve been writing a lot lately – at work, at clinical. I’ve been forcing myself to submit things, too. I’ve long known that my biggest barrier has been my lack of effort. It’s odd — the rejection letters encourage me, because it just feels good to get myself out there. The experiences have been valuable.

Last month, I had a piece published with Pulse, an e-literary journal out of the Department of Family and Social Medicine at Montefiore Medical Center and Albert Einstein College of Medicine. Working with the editors was fantastic. The piece, which stemmed from a post-ICU-shift draft, blossomed under their guidance, and with it, my understanding of my own voice, and the mind of the reader.

When the piece finally went live, I was sincerely touched by the beautiful response I received on the site. Readers crafted careful and insightful comments, erasing my doubt. Pulse shows no altmetrics – I could not count how many people passed my story on, or how many likes it received. My only measurement came in short, intentional statements of support. As I read them, I felt enriched and supported in my work.

What a contrast, when the story ran again this week on KevinMD, a popular medical social media site. While the story currently has five thousand Facebook shares after just two days on the site, and has bolstered my Twitter following faster than a year’s worth of writing, this success feels different. Distant.

Pulse is a pretty pared down operation. It doesn’t charge for subscriptions, which come in your inbox once a week. It has a very small social media presence – the editor runs a public Facebook group, but posts only seem to come with the Friday evening release of pieces. The site itself isn’t anything exceptional to look at.

And yet, their influence is powerful. It wasn’t via social media that I initially found out about them, after all. The simple line, “This story was first published in Pulse,” caught my eye, at the end of a beautiful, simple, physician narrative in the Washington Post last year.

It’s an interesting comparison, this less-is-more thing. I’m new to being conventionally published, but I do a lot of social media work. It’s thrilling, to watch likes and shares tick upward, and I know I’m not alone when I admit to loving those small, circular notifications that pop up, silently affirming. “Applause,” whether written or clicked, feels great.

Seeing my story on a site as big as KevinMD is an honor, truly. But somehow, the quieter, more intentional audience at Pulse holds a new draw for me, amidst my oft-instantaneous world of e-work. Perhaps it’s because the feedback there infers actual comprehension. Time spent. Care and thought taken, in response to my own care and thought. Other people, reading my story as simply that – my story, not just something their friends will like.

While likes don’t necessarily mean careless reading, and comments don’t necessarily mean the opposite, the successful simplicity that I found in this new audience is refreshing. It makes me want to keep on sending stories out there, just to see who will stumble upon them, and who will sit with them for awhile.

Within Normal Limits, Except:

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I stared at my options under “Psychosocial Assessment,” blinking away my recent sleep. Typically, I quickly click through this section of my charting, most of my patients falling within normal limits. Yesterday, though, the start of my weekend of work, I paused over my “exception” choices. Labile wasn’t applicable, but Flat seemed generous. Muted? No, this man, my patient, was closer to Catatonic.

Granted, his heart’s insufficient aortic valve did little to help his breathing, which likely nixed whatever shred of chattiness he might’ve possessed at baseline. Even so, it didn’t take too much effort to get him to tell me, in a painfully monotone voice, that he: Failed to achieve his career dreams and thus led a meaningless existence, had no friends or family or visitors of any kind, and had felt sad like this since he was eight.

Forty-something years later, and there I was on the side of his hospital bed as his nurse. I could see he wasn’t faking. I liked him, strangely. I didn’t want him suffering this way. I also wanted to be sure he was safe with himself.

“Hm. Any luck exploring this sadness? Interest?” No.

“You know, a lot of people find relief with medication.” Alcohol helped before I quit, no meds now, thank you.

Now for the really awkward, delicate, there’s-an-inquisitive-woman-on-the-other-side-of-the-curtain question:

“Any plans on making an unconventional, undesirable exit while you’re here with me?” Pause. Naw, I want to find out how things end.

With that important piece of info behind us, I let him sleep away Saturday. Lasix pushes and vital signs did little to lift his silent state, his breathing remaining quick and shallow throughout my shift. No smiles from him, no agreements to wash or walk. Just sleep, food, breath, depression, sleep.

His mood wore on me, oddly. I found myself withdrawn, quiet. My usual banter with colleagues subsided and I spent the day busy with my work, growling at the tedium and at the persistent rain outside.

There was little to do for my patient but be consistent. I said no more about antidepressants or psychiatrists, although I did report our chat with the house staff. Each hour, I checked, I watched, I smiled, I tried. I was both jealous of this man, and deeply saddened by him – he got to spend his day in bed, the way I wished to, but he was so very alone. He seemed to know his depression so well that he cozied up with it, rejecting all other possible options of comfort or solution.

Today, I returned and he was better. His breathing had eased, and while his smiles didn’t gleam, they snuck out crooked and delayed. “That was a joke,” he’d say after Sahara-dry attempts at humor. He showered. He shaved. He asked for the paper. He certainly hadn’t reached Manic, but he’d moved up to Muted.

His affect change made me think. I was sure he was clinically depressed yesterday. But seeing his physical state improve, tugging his mood along with it, I wondered if the egg or the chicken was to blame. Was it just the extra fluid we got rid of? Was it sleep he needed?

While he remained in a state that was less than happy, he joked with me whenever I engaged him, and I found his lifted mood pulled mine up, too. I wasn’t so sad for him anymore, and I enjoyed the times I was called to his bedside, my co-workers, and the sunshine outside the unit’s many windows.

“What is wrong with your patient? He’s mean,” I’d heard a few times over the weekend. I didn’t scoff; at first encounter, he was quite prickly. But I had an inside view of the minutiae of his improvement – his body first, then his spirit. He was sick; did it matter where from?

As is my self-ish custom, I didn’t formally say goodbye at the end of my shift, but I did run to the bodega and grab him his Daily NewsI left it with his night shift nurse, happy for a return to Normal.