|APNA News: The Psychiatric Nursing Voice
Ann Kelly, MSN, RN
If you truly know somebody’s story, there’s no way you can’t care about them. You still may not like them, but knowing their story gives you empathy and compassion. We bring ourselves to work with us, more so probably then anybody else. We can be wonderful with patients no matter what’s going on in our lives, even though we’re not so wonderful with one another.
It has been 21 years since the San Diego Nursing Society named Ann Kelly it’s Nurse of the Year. But it was only a few years ago, when asked to do a C.E. presentation at a nurses meeting, that Kelly took a fresh look at literature and got a new perspective.
“All my career,” she recently noted, “I have done in-house consulting…where a group will be having a difficult time and ask me to facilitate. I never really thought of it as workplace violence.”
Most of this “horizontal violence” is mental and verbal, she explained – pears roll their eyes when you ask them a question or ask for help.
This subtle undercurrent of what conventionally is called interpersonal conflict is “really violence because it just undermines the social network that is so important when we’re working with one another,” Kelly said. “So it’s subtle violence.”
Next came the idea of training nursing students so that culture will change through them. “That’s really my dream,” she said. “If nurses would just take care of themselves, then we’d do a much better job and the quality of care would automatically improve – that that it’s bad now.”
Kelly hopes to do a pilot study with students this year.
In conversation, Kelly doesn’t come off as self-aggrandizing when she says that a couple of good friends sit next to her at meetings and “won’t let me raise my hand” to volunteer. When other people don’t come forward, though, it drives her nuts.
For Kelly, an assistant professor at National University, volunteering might seem the last thing to contemplate, since her activities have ranged over and beyond the following:
- Instruction of ADN- and BSN-level students in fundamentals, psychiatric, pharmacology and nursing leadership, including coursed development, classroom and clinical supervision, and student evaluation.
- Direct clinical care for persons with mental health needs in the acute medical/surgical hospital setting as well as the behavioral health setting.
- Development and presentation of educational programs including objectives, evaluation, and testing for both nursing and interdisciplinary staff.
- Supervision of multilevel staff including orientation, scheduling, evaluation hiring and termination.
- Participation in accreditation and special recognition processes.
Along with workplace violence, Kelly, who holds a master’s degree, focuses on how to meet the mental health needs of severely ill medical patients.
“Patient activation” is key – getting patients involved in their own care. “The patient is the center of care and needs to tell us the direction to go,” Kelly said, citing a heart failure patient who told her, “Don’t you be telling me about my diet.”
She assured him that the staff didn’t want him to give up anything. Pick something daily, weekly and monthly to look out for, she said, and then tells him, “You come back, and we’ll help you make a plan.”
“That’s very much meeting him where he is,” Kelly continued. “He started reading labels – soup with incredible amounts of salt. He made his own broth and did so well, he could go off some of his medication.”
Soup isn’t the only non-medical weapon in Kelly’s arsenal for healing. She’s in favor of therapeutic touch – which can raise boundary issues in care – and the “mantram.” Repeating one’s chosen mantram – a world or short phrase – is a spiritual, calming technique brought to this country from India in the 1970s by Eknath Easwaran and championed in cardiology by Herbert Bensen starting in the late ‘80s.
The mantram, a mental speed bump or pause button, exists at a special place for Kelly: the “psycho-spiritual intersection.” Kelly uses it whenever she’s a passenger in a car. “It’s made a huge difference,” she said, adding that her husband of 37 years, Tom, and others have remarked on the change.
“You use it when you don’t need it, get in the habit, and then, as soon as you think you could’ve used it, use it – just to get in the game.” It comes in handy when the grocery line behind someone with “21 items and 22 items” or when traffic backs up.
“It takes a while for it to take,” Kelly said. It connects you to the best part of your inner self – compassion, hope, inner joy, whatever works for you… The whole idea is that the mantram goes across that crazy monkey mind, from what you’re going to eat to that your big toenail hurts. It stops the chatter. It’s a pause button.”
Her neighbor mentioned using it while having a marital dispute, she said. It gave her enough time to decide that it was worth continuing with the argument without emotional overtones, rather than just plunging into it. “Sometimes just the choice is what’s so cool,” Kelly said.
Written by Mary Marks