Pushing Back Against Fear

I am not very good about guarding what I say. I am awkward and often say the wrong thing. If an act, statement, or policy is harmful, unproductive, or meant to limit my ability to improve, I tend to speak before my passion can be tamped. I have gotten in trouble for making a “thing” out of a moment and bringing a concern to light. Unfortunately, there have been plenty of inopportune misunderstandings, and my actions negatively hurt myself or others, creating fear instead of change.

We encounter fear in many forms; fear of loss, fear of harm, fear of the unknown, fear of physical, psychological, and emotional pain, fear of inadequacy, fear of punishment and repercussions for ourselves and those we love, and more.

The use of fear to align others with a specific ideology, behavior, or action is written throughout history. Fear motivates positive and negative responses and can create those responses en masse if utilized correctly. Fear can motivate a kind of peer pressure so intense that those who do not conform encounter danger to themselves and their family simply by choosing not to follow and not to be afraid. Fear shut down the world and had neighbors calling authorities on neighbors for simply being outside their front door.

I understand that fear is an amazing change agent! Targeting one person on a team, when that person is leading a policy change or encouraging transparency and a better environment for the team can quash all momentum and stop any movement toward change. Using fear to set an example works.

This is especially true in the patient care setting, where the use of coercion, threats, gaslighting, narcissistic behavior, deflection, and fallacy is used to gain patient compliance. It can happen to anyone, even the most seasoned patient advocate I know.

I encountered the use of peer pressure and fear of failure in a recent conversation with an MD influencer. This MD used her platform and personal success with an elective 39-week induction to encourage her followers to comply with her preferences. I spoke up, but the replies were invalidating, and some were downright mean because I was not a doctor. It did not matter what ACOG statement I shared (the doctor’s governing body) supporting informed choice or the research indicating the benefits of spontaneous labor in low-risk pregnancies and the risks of elective induction…I was told my experience did not count because I didn’t have the ‘right’ credentials and did not know what I was talking about.

As a nurse, I have stood at a patient’s bedside listening to their provider use these tactics to gain consent or listened as the patient is told that they do not have the experience to make medical decisions regarding healthcare interventions.

Fear is used to create doubt and compliance en masse, because if the system can make you feel like an outsider, it is easier for it to control you.

So....what is the answer?

In my experience, finding those who think and believe like you. Want a homebirth? Find others who have birthed at home. Want to give birth in a birth center, extended breastfeeding (breastfeeding > 2 years old), not circumcise your son, or make other care decisions considered not mainstream? Find those who have made those choices, and the fear is melted away with support and knowledge.

This is a special note to those we turn to for support in our choices. To those who help us navigate informed choices and our options, please remember yours is not to convince but to guide, support, and ease the fear that comes when we venture away from the influencers and followers. It is easy to become the fearmonger when you have convinced yourself that your choices are right for everyone or that you know best because of your training and credentials. We need you to push that aside and support informed choice so that every voice can be heard.

Fear...it has had enough control!  It is time to be brave!

Everything Has Risks

I am a fierce supporter of informed choice and autonomy in healthcare. I have worked for 23 years to give my clients and patients the freedom to choose what they feel is best for them. That means carefully educating to avoid bias, coercion, intimidation, or the appearance of authority.

“Every choice we have made leading up to that moment has created outcomes that pertain only to us and only to that moment.“

Informed choice involves the review of the risks and benefits of options and is not solely a medical treatment issue. It often impacts the choices we make in our daily lives that have little to do with healthcare. Additionally, the choices we have made before this point, especially the choices we have made with our bodies, and our lifestyle, impact our options and the risks of those options.

This is the risk-benefit ratio. These are the options and choices where you have to consider the risks versus the benefits and is highly individualized. My risks and benefits pertain to my circumstances and center around previous choices and outcomes. This is the reason why routine care policies and standard practices can be harmful. Every choice we have made leading up to that moment has created outcomes that pertain only to us and only to that moment. It is our risk-benefit ratio, and no one has the right to tell us what risks are too much, and what benefits are too few or vice versa.

I have had clients/patients who want their nurse or provider to make their care decisions. In those cases I take that responsibility very seriously and try to consider the risks and benefits within their treatment. I then introduce options with the least risk first, ask their preference, and continue to involve them in their care as much as they desire. I never want to be responsible for making decisions for a human who can choose for themselves. Even as a parent, the “because I said so” was very rare, and there were almost always two choices and an explanation of why. I’m not going to let you run into the street and get hit by a car or grab a hot pan, but if you try to do those things, we will talk about the risks.

“We don’t get to choose the risks or consequences, as they are a part of the natural order of humanity.“

The fact is, everything has risks, even those choices that do the most good or have the highest reward, we perceived the benefit so greatly outweighs the risks that we do not consider there to be negatives. We don’t get to choose the risks or consequences, as they are a part of the natural order of humanity, and even when we only see the benefits or positives of our choice, there will be a negative aspect.

“My risks and benefits pertain to my circumstances and center around previous choices and outcomes. “

For those that do not want children, either temporarily or permanently, the risk of pregnancy is so high that they will do everything to prevent it. They accept the risk of their decisions, namely birth control or surgery, because the risk of a pregnancy is much higher. For those who want children, they view pregnancy as a positive without risk, or the benefits so greatly overshadow the risks they are minimized to the point of null. However, the risks still exist, and usually show up to be dealt with; such nausea and vomiting, fatigue, stretch marks, bone and joint aches, and ultimately birth.

“However, the choice is ultimately ours, and no one has the right to remove our ability to choose which risks and benefits are acceptable to the individual.“

When we generalize healthcare and create an environment where everyone has the same interventions, we take away informed choice and force negative impacts creating a high risk, low benefit care environment. This is especially true with “you will” interventions – and often these are presented as you will have or we will be doing this intervention, and the options are often timed. For example: at 20 weeks you will have an ultrasound – at 37 weeks you will have a GBS (beta-strep) swab – we will break your water at 3 pm. These are suggested as interventions without risk, or where the benefit is assumed and the risk minimized, yet no one but us can assess the risks and benefits, and there lies the problem. For me, the option presented may carry acceptable risks, but for you the risks may outweigh the benefits and carry more harm.

“Additionally, the choices we have made before this point, especially the choices we have made with our bodies, and our lifestyle, impact our options and the risks of those options.“

I live the consequences of my choices. Yes, some of those choices impact others around me, and that should be considered in the assessment of risks and benefits. However, the choice is ultimately ours, and no one has the right to remove our ability to choose which risks and benefits are acceptable to the individual. As patients we have the right and responsibility to question, investigate, research, and expect feedback regarding our options. As providers we have to acknowledge that we do not fully know the risks or benefits for our patients, and since we do not live their life, we have to defer to their personal assessment. This means taking the time to listen and educate without the bias or our belief system or personal experiences.

*Sometime the options available are outside of the providers skills or ethical beliefs. The solution is referring or deferring to a different provider that can meet your patient’s needs.*

Part 1 Being a Nurse During Covid

*Disclaimer: I will not waiver that personal autonomy and informed choice is a human right. No one has the right to coerce, threaten, mandate, or legalize away the right of each of us to choose our risk. I do not have to agree with your choices to support the right to determine what risks and benefits are acceptable in your decision-making.

There are many activities that humans participate in where they have chosen their comfort with risk, yet other humans find those activities too risky. I have no desire to skydive, swim with sharks, free climb a cliff, ride a motorcycle, race a car, use tobacco, use marijuana, etc. For me, those carry too much risk. However, I had several children; I became a nurse, stopped for and ran toward accidents, broke up fights, and defended a victim, putting my safety at risk. Personal risk evaluation is just that, personal. No one can tell you what risk ratio is appropriate for you.

The hospital is a hard place to be for staff and patients right now. We have lived in a constant state of stress and anxiety. Restrictions in the name of Covid and safety have removed support from friends and family that often grounds us and helps us feel safe when we are sick. We have forsaken therapeutic touch and empathy for patient isolation and PPE, setting restrictions and limitations where people need humanity. The fear and politics of Covid have created a system of isolation so complete that some patients would rather go home to die than sit behind a closed door fighting to breathe. The very thought of being isolated from friends and loved ones is so debilitating that patients refuse medical help or leave AMA to continue to have access to that support system.

Nurses are used to working around hospital politics and red tape while advocating for their patients. The current environment goes beyond these limitations and creates daily moral and ethical challenges that drain us emotionally and psychologically. Every shift comes with the knowledge that we are short-staffed and do not have the resources to care for our patients the way they need us to care for them.

I know some amazing nurses, and yet no superpower on earth can make time slow or create resources out of air. While doing our best is not enough, it is all we have to give, and we have given our all every shift for the past year and a half. We are required to stretch ourselves beyond the stretchable in the name of sacrifice. What started in March 2020 has turned into a constant draw of energy that has brought us to our surge capacity both emotionally and psychologically.

Interestingly one of the arguments for our continued sacrifice comes from the choice to become a nurse, as if obtaining a nursing degree automatically makes one a permanent martyr for the sake of the medical system’s greater good. I don’t know about you, but no nurse on this planet could have foreseen Covid when they chose nursing for their degree. The very fact that choosing nursing as a profession equates to sacrifice of ones mental and physical health highlights why nurses are leaving bedside critical care and choosing travel and contract nursing. AT some point, we have to take our advice and focus on our physical, emotional, psychological, and familial health.

Polycystic Ovarian Syndrome/Disease

I wrote this paper several years ago, and sadly as I review current PCOS treatments I find not much has changed. We are still utilizing many of the same medications and focusing on fertility and symptoms. In fact, over 13 years later and nothing has changed. In healthcare, women are still second-class citizens and sit behind in medical advances.

For more information visit

www.mayoclinic.org/diseases-conditions/pcos/diagnosis-treatment/drc-20353443

And

www.pcosaa.org

Introduction

Polycystic Ovarian Syndrome is a lifetime health issue that affects only women. Initially, it was connected to infertility; however, scientists now know that the effects of Polycystic range from puberty to death. Polycystic is currently considered an endocrine disorder and not just an infertility issue.

What is PCOS?

Barber (2006) states, “Polycystic Ovarian Syndrome (PCOS) is a heterogeneous (women only) condition that affects approximately 6-10% of U.S. women and is associated with metabolic syndrome, which very often coexists with an overweight or obesity health issue.” PCOS seems to come in two forms, hormone-resistant and insulin-resistant. While the results seem to be the same and are treated similarly, each has different symptoms initially. PCOS usually manifests itself when a young woman gets her first period or after her first pregnancy.

In women with hormone-resistant PCOS, the ovaries do not make enough hormones to mature the waiting egg for ovulation. Instead, the egg accumulates fluid, and a cyst forms, ovulation does not occur, and the body does not produce the hormone progesterone. The primary symptom is anovulation in these women, or a menstrual cycle spanning greater than 45 days. The lack of ovulation and the lack of progesterone creates infertility, which creates an imbalance in the endocrine system, leading to further hormone imbalance and eventually insulin resistance.

In women who have insulin-resistant PCOS, the body does not respond to insulin. To combat this, the body creates an excess amount of insulin, dropping blood sugar levels. Insulin balance is essential to hormone balance and production, leading to carbohydrate craving as the body attempts to balance the low blood sugar levels. As the blood sugar level comes up, the insulin level again rises. A vicious cycle of high caloric intake, weight gain, and eventually hormone resistance and infertility. Barber (2006) says, “The presence of insulin resistance in women with PCOS (largely reflecting impaired glucose disposal in skeletal muscle) was established initially in 1980 by Burghen et al….There is some controversy regarding the presence of insulin resistance in lean women with PCOS. Possible reasons for this controversy include the use of variable definitions of PCOS and differences in ethnicity, family history of type 2 diabetes and personal history of gestational diabetes in women with PCOS and controls between studies.”

Symptoms of PCOS

Polycystic is a complex syndrome. The symptoms are often variable, broad-based, and similar to other syndromes and disorders, making PCOS intricate and sometimes difficult to pinpoint. The list of symptoms is hugely generalized, and many symptoms are directly connected to obesity.

Durso (2004) states that women with PCOS often have many of the following symptoms:

~ anovulation (absence of ovulation) or infrequent menstruation with heavy periods. *Note menstruation may occur in the absence of ovulation.

~ infertility because of anovulation

~ Hirsutism on the face, chest, stomach, back, thumbs, and toes

~Acne, oily skin, or dandruff

~ Balding, voice deepening, increased muscle mass, decreased breast size due to the overproduction of testosterone.

~ Abnormal weight gain or obesity

~ Type 2 diabetes

~ High cholesterol

~ High blood pressure

~ Thickened dark brown or black skin on neck, arms, breasts, or thighs

~ Skin tags in armpits and neck areas

~ Sleep apnea or excessive snoring

Diagnostic Tests

The process of diagnosing PCOS is complicated and depends on the level of understanding and knowledge of Polycystic by the primary care provider and the technology available in the patient’s area. Because the field of symptoms varies so greatly, testing should be comprehensive as well.

Tests that are conducted to confirm or rule out the presence of PCOS are:

~ Thorough medical history should include the age of the first period, length of time between periods, and quantity of flow in teens.

~ Physical examination including Body Mass Index and checking for excessive body hair, signs of Acne, loss of hair (balding).

~ Pelvic ultrasound including level 2 doppler color imaging of ovaries.

~ Comprehensive hormone panel blood workup including a pregnancy test, testosterone levels, DHEA-S levels, androstenedione levels, prolactin levels, thyroid levels, and 17-OHP levels.

~ Fasting glucose tolerance test or comparable insulin/glucose blood level test.

Treatment

The treatment options for Polycystic in the past have primarily depended on both symptoms and desired results. Until recently, the assumption of PCOS as a fertility problem lead to treatment by combined oral contraceptives. Snyder (2005) states, “For many years, oral contraceptive pills have been the mainstay of therapy for women with PCOS not desiring pregnancy. The best choices are the combined oral contraceptives (COSs). This hormonal therapy can regulate grossly irregular cycles, as well as decrease testosterone, thus decreasing the occurrence of Acne and Hirsutism.”

However, scientists now understand that uncontrolled PCOS can have lifetime health effects, and therefore treatment options have expanded to include hormonal, insulin, and weight treatments. Treatments currently available include:

Insulin regulating medications such as Metformin (Glucophage), used in patients with type 2 diabetes and those with insulin-resistant PCOS, is given to regulate insulin levels, decrease testosterone production, slow abnormal hair growth, and initiate ovulation. Many women who use Metformin for PCOS conceive within 2-6 months and use an insulin-regulating medication prior to conception and during the first months of pregnancy and may reduce the risk of gestational diabetes.

Although not the recommended first course of treatment, ovarian drilling surgery is available and can induce ovulation if the goal is pregnancy and not a PCOS treatment. While increasing the chance of conception, this surgery carries those risks associated with major surgery and is only suitable for one treatment cycle.

There are medications used to treat the symptoms of Polycystic such as Vaniqa, which slows hair growth, or Aldactone to treat hypertension and decrease free circulation testosterone levels. However, Snyder (2005) points out that “Currently, there are no FDA approved medications indicated for the treatment of PCOS. Any drug that is used in clinical practice is used off label.”

Currently, the most popular treatment for Polycystic is lifestyle changes and weight loss. Barber (2006) states that “Even modest weight loss of 5% of body weight has been shown to result in significant improvements in both symptoms of hyperandrogenism and ovulatory function in women with PCOS. There is no doubt, therefore, that adiposity plays a crucial role in the development and maintenance of PCOS and strongly influences the severity of both its clinical and endocrine features in many women with the condition.”

Without treatment, women are at risk for serious health problems. (NICHD 2004) states, “Women with PCOS can be at an increased risk for developing seral other conditions. Irregular menstrual periods and the absence of ovulation cause women to produce the hormone estrogen but not the hormone progesterone. Without progesterone, which causes the endometrium to shed each month as a menstrual period, the endometrium becomes thick, which can cause heavy bleeding or irregular bleeding. Eventually, this can lead to endometrial hyperplasia or cancer. Women with PCOS are also at higher risk for diabetes, high cholesterol, high blood pressure, and heart disease.”

Conclusion

Scientists now know that Polycystic Ovarian Syndrome is no longer just a fertility issue but a lifetime health issue for women. The consequences of ignoring this disease are severe and life-threatening. Because acknowledgment of PCOS as a health issue is relatively recent, many women have gone untreated and are now dealing with the long-term health effects of this disease. Women who suspect PCOS in their family or who are experiencing any of the symptoms of Polycystic should seek out a provider who is knowledgeable about the syndrome and its health risks to obtain current and comprehensive treatment.

Reference:

Barber, Dr. T. (2006). Obesity and Polycystic Ovary Syndrome. Clinical Endocrinology, 2006;65(2):137-145. Retrieved October 2006, from http://www.medscape.com

Durso, Nancy (M.D.). (2004). What is Polycystic Ovarian Syndrome (PCOS)? Retrieved October 2006, from http://www.4woman.gov/faq/pcos.htm#3

Kusku, Naci K. (MD), & Koyuncu, Faik M. (MD). (2002). Insulin and Oral Antidiabetic Agents for Treatment of Polycystic Ovary Syndrome. Medscape General Medicine, 4(4). Retrieved October 2006 from http://www.medscape.com/viewarticle/440584_1

Legro, Richard S. (M.D.). Diagnostic Criteria in Polycystic Ovary Syndrome. Seminars in Reproductive Medicine, Med 21(3):267-275, 2003. Retrieved October 2006, from http://www.medscape.com

Snyder, Barbara S. (2005). Polycystic Ovary Syndrome (PCOS) in the Adolescent Patient: Recommendations for Practice. Pediatric Nursing, 2005;31(5):416-421. Retrieved October 2006 from http://www.medscape.com

Lack of Family Intimacy and Its Effect on the Children

During my time as an elementary school art teacher, I can remember my shock the first time a child I hardly knew threw her arms around me in a tight embrace and exclaimed her love for me. Holding this tiny girl, I stood there and wondered why she would pick a stranger to show such affection to. Over the years, this scenario has played out a hundred times, and each time I reciprocate the embrace and assure the child that they are cared for; and each time, my heart breaks just a bit. It took me some time to understand that children like this are parched for parental intimacy and that it is not me but my smile and kind words that elicit their response. Oftentimes, I will say a small prayer for that child as I wonder what excuses the parents have made for being unable to love them.

There is an epidemic rarely spoken of, like a giant pink elephant sitting in the middle of the dinner table, everyone knows it is there, but they lack the strength or skills to get rid of it. Children learn their base behaviors and priorities at young ages from their parents. Parents are the primary role models of intimacy, creating nurture where nature can not. While some may have an ingrained tenderness, most adults learn how to interact with others from the example set by their parents. When the parent lacks the skills to show love, the child goes without nurture and lives void of the necessary love and attention they require to develop positive relationships. Children who go unnurtured and miss appropriate affection may lack security, have low self-esteem, and may be more likely to form inappropriate relationships at a very young age.

The perpetuation of generational abuse within families and the emotional and psychological trauma caused by such abuse leads to dysfunction, separation, divorce, and abandonment. Children who live in a home where the child is alone for long hours, in a stranger’s care, or have emotionally detached parents who rarely give positive emotional or physical attention may not understand what is missing or why. Children from homes where emotional or physical neglect occurred do not understand that their childhood lacked parental intimacy. They may see themselves as mishaps, with feelings of inadequacy without cause, and turn to drugs, alcohol, sex, or criminal activity to replace their parents’ love and attention. This seeking behavior is especially prevalent with children whose parents have separated or divorced. These children not only deal with the absence of intimacy, but they must also incorporate the feeling of their parents towards each other into their familiar relationships. Children of separation or divorce can encounter harsh and hostile behavior between their parents that often creates a situation where they are expected to choose between one parent and the other. As a result, the risk of mental illness and suicide is much higher than average. These children may carry unhealthy behaviors into their parenting, having no idea how to deal with their trauma; therefore, choosing to parent in the same manner as they were raised or refusing to parent at all.

The connection is what I describe as a love reservoir. We all have this imaginary reservoir or love tank, which is often needed to fill through nurture. An empty reservoir will drive a person to find a source of affection regardless of the supplier’s intent. Unfortunately, when our reservoir is chronically low, we often turn to self-destructive behavior to dull the feelings of want and need. We know that children who have the example of a loving parent and constant access to positive forms of physical and emotional attention are more likely to abstain from early sexual activity, avoid drug use, alcohol addiction, and are more likely to graduate from high school and attend secondary education. In addition, as adults, those who had a parental example of positive intimacy may be more likely to achieve positive long-term relationships and the ability to use positive intimacy in their parenting.

There are indications that another adult can take the place of the emotionally absent parent. For example, big Buddies, foster care, church youth groups, and after-school programs give these children access to appropriate intimate relationships that can break the familiar cycle within their family. In addition, these programs are often associated with counseling programs for wayward youth, which allows for emotional and psychiatric evaluation of at-risk children. Nevertheless, in many cases, there are long-term emotional issues that the adult child must continue exploring and dealing with to learn how to parent using positive emotional and physical.

Every time a young child throws their arms around me, I remember that what they need is a love fill-up. So, I gently hug the child back and sincerely tell them that they are loved, and I will often make a special effort to show that child positive attention. I know that I cannot save the world and that the child often needs more than I can offer; yet I wonder if my hug will be enough to remind them how precious they truly are and help them avoid the pitfalls their parents have placed in front of them.

https://www.attachmentparenting.org/

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Attachment Parenting Explained

What We Mean to Each Other

Christmas brings thoughts of family; and the New Year reminds us of new starts. However, for some families this means anguish, difficult memories, and turmoil. For them, the very thought of gathering with those they share DNA with causes anxiety, and even dread. This leads to increased depression, brokenness, and suicide attempts during the holidays.

Many of us with difficult pasts tend to collect friends that take the places of family members that are missing, or that we have removed from our lives. No matter how long these “Fremily” members stay in our lives, they play an integral part in how we adjust, grow and change. They mentor, they teach, they lead us to be better. They often show us that what we assimilated as normal, is actually dysfunctional, and in some cases harmful.

For me, these examples have taught me how to be a better mother, wife, friend, grandmother, coworker, Christian. I’m a better person because of those in my life who have loved and taught me. Those who give of themselves to others through example, time, and energy give us one of the greatest gifts we can receive: love.

When you grow up in an environment where interaction is unhealthy, you carry that disfunction with you into your adult relationships. The examples of love given by others teach us how to react, and interact in a healthier way. One of my favorite book series is The Five Love Languages by Gary Chapman. I found this book when our children were younger, and it truly helped me understand myself and others better.

My love language is service, with a small portion of physical touch that has been learned. My husband’s love language is words of affirmation combined with physical touch. I had to learn to be comfortable with hand holding, hugs, cuddling and other healthy forms of touch, because touch in my childhood home was either avoided or hitting. It took years to learn his love languages, but now I think I depend on it more than my husband. I have been blessed to have a husband who is kind, gentle, patient, forgiving and willing to go to marriage counseling to learn new ways for us to interact and react to each other.

In our lives, the examples of others impact who we are and who we become. When our example is hurt, anger, jealousy, emotional, physical, or sexual abuse we often normalize these behaviors. We then carry the negative into our adult relationships as we search out people who have those negative qualities we are familiar with. In contrast, those who are patient, kind and generous with their love help us to reprogram ourselves to become a better person. We then start to look for those characteristics in others, and we surround ourselves with that love.

I will ever be gratful to those who stepped in to my life to show me how to love better! They helped me become a better mother, wife, and grandmother. But most of all I’m grateful that they showed me that there was more than what I had learned as a child. The example of love is the greatest gift this world was ever given. We mean everything to each other!

It’s Your Choice

We are surrounded by information. It pours from our phones, computers, TV’s, radio, billboards and those we interact with. Twenty years ago, before Google, before bluetooth and smart phones your access to information was slow. Information was found in books, magazines, and newspapers along with news and TV talk shows. The flow of information was slow, and like J. R. R. Tolkien’s Ent Treebeard said: “And we never say anything unless it is worth taking a long time to say.” The slow nature of information created a solid platform of knowledge. For the most part, people took time to validate facts before publishing in print.

Today you can think a thought and spread it like a virus to thousands of people in multiple countries without it containing one solid fact. How can you make informed decisions when you can’t tell what is real and what is false?

So, the question is, does it matter if the information is proven or fake? No it truly doesn’t matter if the information is founded in reality. Believing the moon is made out of cheese, that Mars is inhabited by little green men, or the Earth is flat isn’t harmful, unless the decisions you make based off of that information create a risk to yourself or others. Believing doesn’t make it wrong, but it could be harmful to act on false information.

Informed choice requires the knowledge of the risks and benefits of the choices you have to make. I call this the Risk/Benefit Ratio. Everything has risks. Those risks are independent to the person making the choice. The same option can have completely different risks and benefits for different people. You are the only person who can decide what risks and benefits are acceptable for you.

Oftentimes our choices are emotional, and centered on our needs in that moment. Those needs can quickly change, and your choices change with them. What others see as odd usually makes perfect sense to the decision maker.

As a nurse I believe it is imperative that I take the time to understand why a patient is making their choices while assessing their knowledge base and assist them in gathering information and facts so they can make the decision that is best for them. I don’t have to agree to support you. Its not my life and I do not live with the consequences.

Each of us deserve to have access to the information we need regarding the risks and benefits of the choices we have to make, while feeling supported in our choices. We deserve access to unbiased, balanced information that help us to make the decisions that are best at that moment, void of coercion or any attempt to sway or gain compliance.

No one has the right to suggest, expect, sway or in any way force you to make a certain decision. The ideal is that you base your decisions on factual information founded in truth, regardless of the popularity of those choices.

It’s your choice and my job is to help you achieve your wants and needs to the best of my ability.