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Simulation lab, war room help prevent medical errors, improve doc-nurse communication


By Ilene MacDonald


Despite new technology and evidence-based guidelines, medical mistakes happen too frequently and may lead to as many as 400,000 preventable deaths each year.

But two new programs, launched at the University of Virginia Medical Center, offer a new approach to patient safety that may prevent medical errors, WVTF Public Radio reports.

This year the organization introduced a simulation lab in the pediatric intensive care unit. The "Room of Errors" features high-tech infant mannequins attached to monitors. When doctors and nurses enter the lab, they have seven minutes to determine what is wrong.

As part of a recent exercise, a doctor-nurse team worked together to spot 54 problems with the scenario, including the fact the ventilator wasn't plugged into the correct outlet, the heat wasn't turned on and the potassium chloride was programmed at the wrong concentration.

The interpersonal, team-based learning approach helps doctors and nurses improve their ability to make decisions together and communicate with one another, Valentina Brashers, M.D., co-director of the Center for Interprofessional Research and Education, an effort headquartered at UVa's Schools of Nursing and Medicine, told WVTF.

"Knowing that there are others that you can work to think with you and share with you their concerns as you work through difficult problems makes care provision a much more enjoyable and rewarding activity. It reduces staff turnover. It creates an environment where we feel like we're all in it together with the patient," she said.

The pilot proved so successful that the medical center intends to roll it out to the entire hospital.

In its quest to eliminate medical mistakes at the organization, UVa also launched a second patient safety initiative that calls for hospital administrators to meet each morning to talk about any problems that occurred in the previous 24 hours, according to a second WVFT article.

The "Situation Room" features white boards and monitors, where administrators review every new infection and unexpected death and then visit the places where the problems took place.

Sometimes the solutions are easy fixes, such as a receptionist who removed a mat that caused patients to trip at the entrance of an outpatient building. Others, caused by communication problems, are more complicated, Richard  Shannon, M.D., executive vice president for health affairs, told the publication. To address it, Shannon wants to shake up the medical hierarchy where the physician sits at the top.

"The physician may spend 20 minutes at the bedside a day. The nurse is there 24/7 and has about 13 times more direct contact with the patient than does the physician," he told WVFT. "You can't have someone at the head of the pyramid who is absent a lot of the time."

Finally, to encourage better communication among caregivers, patients and families, Shannon now encourages healthcare professionals to make rounds in the afternoon, when visitors are on premises.


Heart association offers tips for good teamwork in OR


Improving communication and strengthening teamwork among cardiac surgery teams are among recommendations for reducing preventable mistakes in the cardiac OR, according to a statement from the American Heart Association.

The statement provides recommendations for improving patient safety after the association reviewed evidence-based research focused on communication within and between teams, the physical workspace and the organizational culture of the cardiac OR.

"In multiple studies, self-assessment of communication and teamwork skills by surgeons and anesthesiologists is disturbingly discordant with the opinions of their associated nursing and perfusion staff," the statement authors wrote. "Surgeons rated the teamwork of other surgeons as high/very high 85% of the time, but nurses rated their collaboration with surgeons as high/very high only 48% of the time."

The authors also noted that in the OR, "conflicts are often poorly managed through avoidance, yielding or competition, when collaboration and compromise would yield a better outcome. Collaboration and compromise are particularly difficult when there is status asymmetry, whereby one member has greater power or seniority, such as physicians with nurses or an attending physician with residents."

Highlights of the statement, published Aug. 5 on the website of the journal Circulation, include: 

• Using checklists and/or briefings before every cardiac surgery, followed by postoperative briefings;

• Developing institutional policies to define disruptive behaviors by medical professionals in all hospital settings, with transparent, formal procedures for addressing unacceptable behaviors; 

• Establishing an institutional culture of safety by implementing a robust quality improvement system that encourages input from all team members to continuously identify and correct safety hazards. 

"From the data available," the authors wrote, "it appears that teams should be trained as teams, not as individuals; that use of simulated scenarios is effective; that both executive leadership and nurse managers are critical to effective implementation; and that repetition, continued coaching or both are required to strengthen and maintain benefits."

The authors noted the critical elements of teamwork can be summarized by the Six Cs: communication, cooperation, coordination, cognition, conflict resolution and coaching.

The statement is available as a PDF:


Interprofessional education: The answer to better healthcare communication


by Courtney H. Lyder

In a recent editorial in The New York Times, Theresa Brown wrote about how clinical hierarchies and the impact of conflict between nurses and physicians can be deadly for a patient. She said "when doctors and nurses don't get along, it's the patient who suffers."

A lot of studies show that poor communication is linked to adverse patient outcomes. For example, of the 1,243 sentinel events reported to the Joint Commission in 2011, communication problems were identified in 60 percent.

By its very nature, healthcare is complicated; it is a rapidly changing environment and unpredictable. Professionals from a variety of disciplines can care for a patient during a 24-hour period, which can limit the opportunities for face-to-face communication.

Physicians and nurses are expected to work together, not only practicing side by side, but interacting to achieve a common goal: the health and well-being of the patient. But there are several factors that can make effective communication between nurses and physicians particularly difficult to achieve, including historic tension; conflicting viewpoints based on education, training, communication style; and terminology and existing communication processes that are inefficient at best.

With the focus of healthcare moving increasingly to the team approach, it becomes even more critical for physicians and nurses to work in collaboration. Higher education institutions including UCLA and the University of Virginia, for example, are working to improve how nurses and physicians work together before they enter the clinical environment.

The University of Virginia now requires interprofessional education for its nursing and medical school curriculums. Courses, training modulus and even faculty members are shared across both disciplines. Medical and nursing students are taught to respect each other's areas of expertise.

In the Fall of 2008, the UCLA School of Nursing and the David Geffen School of Medicine at UCLA, introduced a pilot program to integrate nursing students (in this case advanced practice students) and third-year medical students. The result was an innovative program that focused on content, such as communication with patients, ethics, behavioral medicine and other psychosocial issues. The idea was to get the two groups working together sooner rather than later so students from both schools could develop team-building skills, increase their awareness of each other's roles and get used to working together in making decisions to improve patient outcomes.

Our initial results indicated the students found the experience to be of great value. In addition to assisting students with their clinical decision-making skills, the discussions that took place during the course provided an excellent forum in which the nursing and medical students gained a better mutual understanding.

I believe collaborations like this represent the future of medical and nursing education. No two groups of health professionals are more interrelated in practice, and by starting here, we allow them to understand each other and to grow up together as students.

We are now taking the next step by creating assessment tools to evaluate interprofessional competencies not only in the classroom but in clinical practice settings as well. Tools such as an iPad app will allow instruction leaders to assess actual collaborative practices through observations and walk-throughs in clinical settings. Our ultimate goal is to disseminate the tools with a wider community.

Patient safety needs to be our top priority. Successful delivery of healthcare needs to be interdependent and respect shown for the education and knowledge of each team member. Interprofessional education is an excellent start.

Courtney H. Lyder is dean and professor of the UCLA School of Nursing, professor of Medicine and Public Health as well as Executive Director of the UCLA Health System Patient Safety Institute and Assistant Director of the UCLA Health System.

Source: Hospital Impact

Launching yourself in nursing leadership


By Rose O. Sherman via American Nurse Today

Editor’s note: At American Nurse Today, we believe every nurse can be a leader. This article is the first in what will be occasional guest blogs by Rose O. Sherman, founder of the Emerging RN Leader blog ( In addition to her guest blogs, Rose will contribute articles on a regular basis to help nurses achieve their leadership potential.

 You may know that you want to be a nurse leader but are unsure about your next career step. It is important to recognize that you don't have to be a chief nursing officer or a nurse manager to "lead." You can begin leading from wherever you are in the organization. If you manage your career around this concept, you will focus less on your linear progression up the career ladder and more on your own personal mastery and impact.nurse 5

An important question to ask yourself as you begin your leadership journey is whether you have the qualities that nurses look for in their leaders. Successful leaders are unable to achieve goals without inspired and motivated followers. We have all probably observed nurses who have been placed into leadership positions and had the formal title of leader but are not successful in capturing the heart and soul of those they lead. John Maxwell, in his book The 21 Irrefutable Laws of Leadership, makes the important point that leadership is above all the ability to influence others. We know from research some key qualities that nurses look for in their leaders include:

  • ·       A commitment to excellence
  • ·       Passion about their work
  • ·       A clear vision and strategic focus
  • ·       Trustworthiness
  • ·       Respectfulness
  • ·       Accessibility
  • ·       Empathy and caring
  • ·       A commitment to developing others

Honest feedback about whether or not you demonstrate these qualities is important at the beginning of a leadership career. A good mentor can help you grow as an emerging nurse leader and open doors to new learning. Unlike the preceptor relationship, which you may be familiar with in the clinical setting, a mentor provides career guidance and helps you become more aware of your strengths and areas where you need development. An ideal mentor for an emerging nurse leader is someone who is knowledgeable, has leadership experience, and is interested in helping you to grow.

For some nurses, just getting noticed in their organization can be a challenge, especially if it is very large or if you work a night tour. When opportunities become available for advancement, you want to be someone that the nurse leaders in your organization think about as a great candidate, so consider these tips:

 1. Look professional

First impressions do count if you want to get noticed. Professional dress and being well groomed matter in creating a good image. When nurse leaders see nurses with wrinkled scrubs and dirty shoes, the impression is generally not favorable. You want to be remembered as someone who will be a good candidate to represent the organization.

2. Stay updated

It is important to stay updated by reading professional journals and attending educational programs. Be a "go-to person" for new information in your specialty area. In addition to staying updated clinically, pay attention to the news and what is happening with health policy. Think about how proposed changes in health reform could impact your organization and share your knowledge with other staff. Recognize that health care is also a business and become knowledgeable about the business of caring.

3. Take leadership roles

Take leadership roles at the unit level. They can be small but it is a great way to get started. Volunteer to take a leadership role on a unit shared-governance committee. Take charge when you have the opportunity. This is an excellent way to connect with other staff and leaders in your organization.

4. Volunteer for task forces and committees

Volunteer for organizational committees and task forces, even if it does mean coming in on your day off to participate. Leaders do notice when staff members are committed enough to an organization that they are willing to give back some of their personal time to be involved in activities.

5. Participate in organization-sponsored community activities

Join the heart walk team, the breast cancer walk, the March of Dimes, or other teams your organization may put together to support the community. Get others on your unit to join you. You will find that organizational leaders participate in these activities, and it can be a great way to introduce yourself in an informal setting and meet many new people.

6. Be professionally involved

Join a professional nursing association and attend the local meeting. You will probably meet staff and leaders from your organization that you might not interact with in other forums. Local professional associations are always looking for members who are willing to assume some leadership responsibilities. Holding office in a local association can be a good way to gain recognition.

7. Serve as a preceptor and cheerleader to other staff

Be ready to share your skills and knowledge with others. Sharing and volunteering to be a preceptor can be a great way to get noticed. Your manager will appreciate your willingness to be a strong team player. Be the first to congratulate others for their achievements and be the person who helps create a healthy work environment on your unit.

8. Keep your commitments

I once asked a great nursing leader what he attributed his success to. He told me that he did what he said he was going to do when he said he was going to do it. This will get you noticed, he assured me, because so few people actually keep their commitments. This is really great advice. If you volunteer, be sure to follow through.

There has never been a better time to choose nursing leadership as a career goal. The retirement of a large number of baby boomer nurse leaders will result in great career opportunities by the end of the decade. Oprah Winfrey often says that luck is preparation meeting opportunity. The time to start preparing for these opportunities is now. 

7 Reasons Why Successful Nurse Entrepreneurs Blog or Write Articles


By Lea Rae Keyes via Nurse Entrepreneur Network

There are a few things any nurse entrepreneurs can do to increase their likelihood of being successful. One of the easiest and most powerful is to blog or write articles. This is also a very low cost way to promote your business. If you are wondering what blogging or writing articles has to do with the success of your business, read on....


1.  Develops your brand - Your brand tells your potential customers what you stand for, what you deliver, and portrays an overall experience. It tells your potential customers why they should buy from you.

2.  Helps people get to know you - Blogging is a way for you to share your personality and brand so your potential customers have a feeling that they know you or are at least getting to know you.

3.  Establishes you as an expert -- Blogging gives you the chance to share your expertise and knowledge with a larger audience.

4.  Helps to create community -- As you blog your audience will begin to add comments. Next they will start commenting on each other's postings and ultimately a community will begin to be form in a space you created.

5.  Aids your 'know, like, and trust' factor -- The more people read with you have written the more they feel as though they know you. As this continues they begin to like and trust you. People are far more likely to buy from someone they know, like, and trust.

6.  Enhances readability -- When you blog or write short articles it is easy for your audience to scan or quickly read what you have written. If your target audience can quickly read what you have written they are more likely to do this than if you are writing a long, complex newsletter or white paper.

7.  Increases you chances of being invited to write for others -- Blogging helps others notice you and then ask you to be a guest blogger for them. When you guest blog for someone else it broadens the number of people exposed to your writing.

If you want a low cost, effective way to become better known you need to add blogging to your marketing plan mix.

Niche Job Boards: How They Are Integral to a Successful Recruitment Strategy


By Suvarna Sheth,

There's been a lot of contentious chatter lately on the state of job boards as social media moves in. Some say job boards are waning in popularity, while others say they're not going anywhere. The fact is the number of job boards are still proliferating and they are widely used by advertisement agencies and HR departments for many professions from retail to research. We speak to some industry insiders for their views on the importance of job boards in implementing an integrative recruitment strategy.

Bruce Dorskind, president of the Dorskind Group, a strategic consulting firm specializing in marketing communications, global recruitment, and business has seen the advertising recruitment industry evolve over decades, from one that relied 90% on print media to one that is dominated by digital media today. Dorskind claims there are over 10,000 job boards in the United States and probably 100,000 around the world, and growing.
"The big general job boards, Monster, Hotjobs and Career Builder were very important early on," says Dorskind," because they educated the public about the concept of a job board." They were basically a game changer says the industry veteran. "What the big job boards did was it sold the American public the idea that a job board is a viable way to find a job."Nurse on Computer 3

But today, 20 years into the concept of a job board, the market has changed, according to Dorskind. "Like every nascent market, it starts out in a very general way, and migrates to the specific," he says.

In the beginning, Dorskind explains everyone from the person working behind the retail counter at Wal-Mart to the person developing next generation pharmaceuticals for Genentech went to the same job board. "Now, the market has moved from general to segmented and you have the opportunity to only deliver your message to the specific group of people you are interested in through a targeted job board.

The niche job board has managed to be a very successful model for many reasons. One is that it has allowed employers to get resumes or responses from people that are relevant. "And it allows you to pay for the candidates you are getting, while with a general job board, you're paying for the entire audience, 95% of who aren't qualified," says Dorskind.

Still, not all niche job boards are successful. The ones that are, according to Dorskind are the ones that get their visitors involved, constantly produce fresh material, have current and real jobs and promote potential advertisers.

Dorskind says ad agencies and individual employers have five benefits to using niche job boards: you have a targeted audience, you can build a brand among the people you're trying to reach, they tend to be far more cost efficient, they tend to be where you're competitors are advertising, and they tend to do a better job reaching the passive job seeker than the general job boards.

Whether a particular recruitment strategy involves using large or niche job boards, Dorskind recommends ad agencies to use the strategy that meets their client's needs most efficiently.

"Certainly if they're looking for hundreds of people working in thousands of different locations for a retail store, then a strategy of being on a large job boards makes sense," he notes.

The problem for ad agencies, according to Dorskind is that there are too many job boards, and there is too much noise in the marketplace and within given industries. "In healthcare, there are over 500 job boards and it's impossible to keep up with all the new job boards unless it's a dominant player in its market," he adds.
Dorskind says niche job boards are a way to go for recruitment advertising. "I think in a world where technology is changing as quickly as ours and the options are as great as ours, there is no one solution," he remarks.

Like Dorskind, Sean Quigley, senior director of digital media at Bernard HODES Group says it's the obligation of the ad agency to do what's best for the client.
Quigley, who works on building strategies for clients and formulating digital media plans based on a given budget and set of targets, says there's definitely a shift going on in the recruitment world because of digital media.

And that's why he says it's not only about job postings at Hodes. "E-mail campaigns, banners, videos, as well as traditional job boards and niche job boards are all usually considered as part of a recruitment strategy," he says, "It's different for every client and there are more options on the table now so we're looking to take advantage of everything we can," he says.

According to Quigley, it's also important to have strategy on some of the more generic boards because that's where a lot of the target is ending up anyway. "On the other hand, we do see awesome results on more targeted job boards, which preform extremely well and rise to the top, delivering great results for certain accounts," he states.

For example, for a large pharmaceutical client who was more engaged in science oriented candidates, Quiqley and his team did extremely well on, using large posting packages and creating a very strong branding presence throughout the site including e-mail sponsorships and a continual presence on the BioSpace pages. "BioSpace was an extremely beneficial option for us to have; it really helped us reach our client goals," he says.
Adele Mirabelli, a field sales representative within the healthcare division of onTargetjobs works with ad agencies to create media plans and posting packages for their healthcare clients.

She says the benefits to using a niche job board is quality vs. quantity. "Clients may not get as many candidates but the few that they do will be better qualified candidates," she states.

Also, she says clients can get lost within a general job board. "They have so many more jobs and unqualified candidates and at times healthcare employers can get lost in the mix of all the other industries out there."

Since niche job boards are focused and targeted to one industry, it makes it a lot easier for job seekers to find the jobs that they are looking for.
Mirabelli can't say without a doubt that niche boards are more successful than larger boards because it depends on the client and the job advertisement. "A lot of factors come into play when it comes to measuring success for our clients and the job boards they use," she says. However, with the economy picking up and recruitment opportunities on the rise, there is a need for better qualified candidates.

And when it comes to finding quality, Mirabelli is hearing that her clients are not finding it on general job boards like Monster. She finds that specifically healthcare employers are using niche job boards more because they are finding that the quality of the candidates is better.
Mirabelli says a lot of ad agencies use niche job boards for some of their client's hard to fill vacancies because they find they can reach a higher caliber of job seekers through them.

"At the end of the day, it's all about ROI and the quality of the candidates that they bring on board," she says. Like Dorskind and Quiqley, she notes that ad agencies need to recommend the best solutions out there to ensure that their clients are performing as well as possible.

This is true today, especially when everyone is tightening their belts and spending less. "When budgets are being cut, ad agencies really need to focus on what is the best solution for their clients and how they can help their clients achieve the best ROI," Mirabelli comments.

As for whether niche job boards are going to survive the rampant changes going on in digital media, Quiqley has no doubt. "Any site that's able to attract a high value audience that is engaged in looking for jobs-that's always going to be something that's going to be valuable," he notes.

"I don't see any evidence for job boards becoming extinct," Quiqley states, "While social media is powerful and is going to get more and more important, it's a different function in terms of actually being a destination where someone in a given career can look for job openings," he says.

The digital media expert says the business model for job placement on social media sites hasn't really developed yet, and while the potential may be there, nothing compares to achieving goals in a measurable way than job boards, SEO, smart placement of advertising and e-mails to targeted candidates.
"None of them are going to be replaced," he says, "there are different stages and audiences you're simultaneously reaching with these tools, so none of the individual tactics are going to be completely ruled out because of social media," he comments.

Supreme Court upholds Obama health care mandate


From USA Today

WASHINGTON – A narrowly divided Supreme Court upheld President Obama's health care law Thursday in a complex opinion that gives the president a major election-year victory.

The historic 5-4 decision will affect the way Americans receive and pay for their personal medical care in the future. It upholds the individual mandate that most Americans get health insurance or pay a penalty — and it was the penalty, or tax, that ultimately saved the law.american flag 2a

Chief Justice John Roberts announced the decision that allows the law to go forward with its aim of covering more than 30 million uninsured Americans. He argued that the mandate is constitutional only because the penalty "functions like a tax" and is therefore allowed under Congress' taxing power.

"Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness," Roberts wrote.

The court's four liberal justices, Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor, joined Roberts in the majority vote. They argued for a more sweeping approval based on the commerce clause, but the end result was the same.

Conservative Justices Samuel Alito, Anthony Kennedy,Antonin Scalia and Clarence Thomas dissented. Kennedy, who was thought to be the most likely swing vote, delivered a scathing denunciation from the bench.

"The majority rewrites the statute Congress wrote. … What Congress called a penalty, the court calls a tax," Kennedy said. "The Affordable Care Act now must operate as the court has revised it, not as Congress designed it."

President Obama, speaking from the White House after the decision, said, "Whatever the politics, today was a victory for people all over this country whose lives will be more secure because of this law and the Supreme Court's decision to uphold it.

"It should be pretty clear by now that I didn't do this because it's good politics," Obama said. "I did it because I believed it was good for the country."

Roberts — a conservative appointed by President George W. Bush— provided the key vote to preserve the landmark health care law, which figures to be a major issue in Obama's re-election bid against Republican opponent Mitt Romney.

Telemedicine: Virtual Patient Care and Collaboration


From By Christina Orlovsky

June 13, 2012 - As the population ages and the need for health care increases, access to care is often a challenge, based on location, provider availability, chronic conditions and economic factors. One potential solution to a number of these challenges is the umbrella of care called telemedicine.

According to the American Telemedicine Association (ATA), telemedicine is defined broadly as the delivery of any health care service through any telecommunications medium--for example, a patient seeing a doctor, nurse or allied health professional via a videoconference, rather than in-person, or a patient with a chronic condition utilizing an in-home device to monitor vital signs and transmit data to a nursing center for assessment and medical intervention.Nurse on Computer 2

“The one thing that ties all telemedicine together is that it involves a clinical health care service, it directly contributes to the health and well-being of patients, and the patient and provider are separated by some geographic distance,” said Benjamin Forstag, senior director of communications for the Washington, D.C.-based ATA.

Nurses are directly involved in the virtual delivery of health care through telehealth nursing, defined by the ATA as “the use of telehealth/telemedicine technology to deliver nursing care and conduct nursing practice.”

According to Cindy K. Leenknecht, MS, ACNS-BC, chair of the ATA Telehealth Nursing Special Interest Group (SIG), nurses hold a variety of roles in the telehealth arena, depending on their individual scope of practice. They utilize telemedicine technology in the ICU, nursing homes and home-health environments.

“They are reaching into many remote sites using telemedicine, including homes, monitoring for congestive heart failure, diabetes, COPD, hypertension, etc., where they monitor vital signs and question responses, evaluate and call patients to clarify symptoms, and advise on further actions to take, such as call a physician, take a forgotten medicine, etc.,” she explains. “They also deliver timely education and reinforce that education.”

The ATA stresses that telehealth nursing is not a specialty area within nursing. In fact, any nurse who has ever spoken to a patient over the phone has practiced some form of telehealth. As such, the same qualities that attribute to nursing success at the bedside come into play with telemedicine.

“Telehealth nurses need the same nursing skills as all nurses practicing in specialty areas, but with an ability to utilize the technology to the best of its ability to assess and communicate the patient’s physical and mental status,” Leenknecht said. “Excellent organization, critical thinking and communication skills are required also, but the most important skill is to understand the technology and its potential and limitations and have the intuitiveness in how to utilize it to provide the care needed at the time.”

Treating millions of veterans across the miles

One health care system that is uniquely positioned to provide telemedicine services to its patients is the Veterans Health Administration (VHA), the health care arm of the U.S. Department of Veterans Affairs. Responsible for the care of 5.6 million American veterans each year, the VHA utilizes telehealth in a number of ways to be able to meet the health care needs of its extensive patient population, spread out across the entire country.

“In total, in fiscal year 2011, VHA provided telehealth services to 380,000 veterans,” said Adam Darkins, M.D., chief consultant of care coordination services for the VHA Office of Telehealth Services. “We anticipate that number will rise this year by somewhere between 30 to 50 percent.”

The primary use of telehealth for the VHA is through home telehealth, managing chronic conditions like diabetes and depression for 74,000 veterans in their own homes, through the use of telehealth devices that monitor vital signs such as weight, pulse, blood pressure and blood glucose, and ask questions on a daily basis about symptoms and behaviors. A care coordinator--usually a nurse employed in a full-time telehealth role--manages a panel of these patients from a remote location with the goal of educating patients and their caregivers, monitoring their disease symptoms and daily behaviors, and intervening when they’re alerted to warning signs.

“These programs were built to support aging veterans who, as they get older, are living longer and staying healthier and, like all of us, would prefer to live independently,” Darkins explained. “The care coordinator works in partnership with the patient, their family caregiver and their community caregiver to help people with multiple hospitalizations transition home after a discharge, educate them about care management, and intervene early to prevent readmissions. We have seen outcomes of a 30 percent reduction in hospital admissions and bed days of care.”

The anticipated increase in need for care is accompanied by an increased need for care providers--and a need for training.

“These are new areas of care that aren’t taught in schools of nursing or medicine, so one thing the VHA has done is created a training center for each of its areas of telehealth that train to the order of 2,500 people per year, with 90 percent of the training taking place online,” Darkins said, adding that he often sees highly trained nurses turning toward telehealth.

“What we find is often very experienced nurses toward the end of their career are attracted to this and say ‘This is why I came into health care,’” he concluded. “It really gets to the heart of providing holistic care where there’s a real need.”

Parents no impediment to care of kids in ED


From News

Contrary to what many trauma teams believe, the presence of family members does not impede the care of injured children in the ED, according to a study.

Professional medical societies, including the American Academy of Pediatrics and the American College of Emergency Physicians, support family presence during resuscitations and invasive procedures. The degree of family member involvement ranges from observation to participation, depending on the comfort level of families and healthcare providers.describe the image

"Despite the many documented family and patient benefits and previous studies that highlight the safe practice of family presence, trauma providers remain hesitant to adopt this practice," lead author Karen O’Connell, MD, FAAP, a pediatric emergency medicine attending physician at Children’s National Medical Center in Washington, D.C., said in a news release.

"A common concern among medical providers is that this practice may hinder patient care, either because parents will actually interfere with treatment or their presence will increase staff stress and thus decrease procedure performance."

The aim of the study was to evaluate the effect of family presence on the trauma teams’ ability to identify and treat injured children during the initial phase of care using the Advanced Trauma Life Support protocol. ATLS is a standard protocol for trauma resuscitation shown to limit human error and improve survival.

Over a four-month period, researchers reviewed recordings of 145 trauma evaluations of patients younger than 16. Of the patients, 86 had family members present.

Investigators compared how long it took the trauma team to perform important components of the medical evaluation (such as assessing the child’s airway, breath sounds, pulse and neurologic disability, and looking for less obvious injuries) when families were present and when they were not. Investigators also compared how frequently elements of a thorough head-to-toe examination were completed.

Results showed no differences in the time it took to complete the initial assessment with and without family members present. For example, the median time to assessing the airway was 0.9 minutes in both groups. In addition, the researchers found no difference in how often components of the head-to-toe exam were completed. The abdomen was examined in 97% of all patients when families were present, for example, and 98% of patients when families were not present.

"Parents are increasingly asking and expecting to be present during their child’s medical treatment, even if it involves invasive procedures," said O’Connell, who also is an assistant professor of pediatrics and emergency medicine at George Washington University School of Medicine and Health Sciences.

"We found that medical teams were able to successfully perform needed evaluation and treatments of injured children both with and without family members present. Our study supports the practice of allowing parents to be present during the treatment of their children, even during potentially painful or invasive procedures."

How the Internet has Changed Nursing


From By Christine Contillo

It’s clear that we’ve not just entered the Information Age — we’ve exploded into it. Information exchange is critical to both the advancement of science and patient care, and the impact of the Internet in the medical field has been enormous. Practitioners are now able to jump the barrier of time and access research findings worldwide; and in nursing it’s caused the creation of an entire subspecialty (nursing informatics) meant to manage the amount of information available.

But nurses studying informatics aren’t he only ones finding ways to improve their skills bynurse on computer surfing the web. According to a survey of the American Academy of Nurse Practitioners, more than 98 percent of nurses responded that they use the Internet or email. The survey continued to ask in what way the Internet was used, and the answers may surprise you.

No More Pencils, No More Books

Beginning with nursing education, students everywhere have access to virtual classrooms and degree programs. Online education means that the limits previously imposed by location and time become less important. Busy students with a computer, or those in the workforce trying to fit school into their already packed schedule, should be able to find a few hours at home for study.

Similarly, many states now require continuing education (CE) for licensing. Nursing needing those hours can get them without leaving home, which in many cases removes important constraints such as child care. Sites such as allow the student 24/7 access to courses and technical support. Employers can select educational seminars and show them in real time in a conference room or select courses that have been archived for their nurses to watch later.

Nurses were instrumental in developing accredited online continuing education for Wild Iris Medical Education. The company established the site Nursing Continuing Education to help nurses (and other health professionals) across all 50 states fulfill CE requirements. Prices range from free to $65 depending on the individual requirement and number of contact hours offered. Fees can be paid with a credit card — how else? — online.


For those nurses who are pretty comfortable with technology, podcasts are another avenue to investigate. Similar to audio versions of magazines, they can be heard on MP3 players for up-to-date information. Check out and searching “nursing” or listen to “Nursing Education on the Go” at Podcast Alley.

Streaming Radio

Somewhat similar to podcasts is streaming radio, or radio shows that are available worldwide. AM/FM radio is usually limited by geographical distance, but streaming radio listeners only need access to the web, some free software to download, and a set of speakers.

Barbara Ficarra, RN, BSN, MPA, is a nurse educator in the metro-NYC area and host of “Health in 30,” which airs live at 5:30pm on Fridays on WRCR-AM 1300. Ms. Ficarra lines up expert guests for her weekly show, announces the topic ahead of time, and fields questions as they are phoned in. Without the Internet her show could only be heard locally, but the vast audience afforded by online listeners has enabled her to win wider recognition. In fact, in 2007, she won the Excellence in Journalism award given by the American College of Emergency Physicians.


Nursing blogs are web logs and can range from silly to academic. Just as journals are intimate thoughts, blogs can detail nursing practice issues, patient stories, fears, triumphs or even family and leisure activity. Blogs allow nurses to vent their frustrations to their peers and share valuable resources for patient care. Following a few favorites allows you to peer into the mind of the writer. The ability to comment allows you to enter into an electronic relationship that nurses in remote areas may treasure. Certainly information about individual patients must protect their identity, but sharing the means of resolving practice issues helps to improve practice standards everywhere.

Information Sites

According to Family Nurse Practitioner Roseann Neuberg, the impact brought by the Internet to her clinical nursing practice is “huge,” and she identifies it as a valuable source of patient education material. “There are just so many things I can do in terms of patient education,” she says. “I can look up issues or treatments while my patient is sitting right next to me. I can print it up, hand it out, and be sure that they understand what I’m saying before they leave. When I prescribe a medication I can check the price and look for alternatives. I can even use a program to check for drug interactions.”

Tracy Plaskett, a staff nurse at Beth Israel Hospital in New York City, says, “When I get my patient assignment, I’m able to look up any unfamiliar terms in the notes instantly. I can check spellings and make sure that medication orders are correct.”

Ms. Neuberg is quick to point out that she sticks with sites she knows are accurate and updated frequently in order to feel confident that the advice she is giving is sound. Two such sites are and, which provide current information about clinical management and treatment of disease. Both require a subscription and password.

Mobile Medicine

Lynda O’Grady, RN, has found another important use of the Internet. Ms. O’Grady is part of a large travel medicine clinic, assessing international travelers who participate in academic programs, sometimes to remote and disease-infested areas. Using special software she’s able to assess their individual medical risks. If she has questions she can access advice from organizations like the Center for Disease Control and the World Health Organization. But what she finds most helpful is her membership in the International Society of Travel Medicine. Through a listserv available only to members she’s able to gain up-to-the-minute answers to questions posed, such as, “Where is the nearest medical clinic to Daar es Salaam?” or, “What do you recommend for altitude sickness for a patient allergic to sulfa?” Thousands of members pose and answer questions for each other, some providing clinical advice that only a person actually living in that area might be able to give.

Support Groups for Patients

Nurses may want to suggest online communities to patients experiencing chronic illness or going through debilitating treatments. Immune-compromised patients may be unable to attend in-person meetings, but staying in touch with a virtual group may allow them to feel less isolated. CancerCare is one professional association that helps organize free groups for patients as well as their caregivers. Virtual communities and forums have been vital to patients sharing treatment experience and offering support to each other.


The Internet can be used in a novel way for clinical consults. One home care nurse described how she and her colleagues became discouraged trying to evaluate decubiti. When described in the paper chart by different clinicians using different languages or terms it was often difficult to determine if progress was being made. Solution? They used a digital camera to capture an image that could be sent daily via the web to the practitioner. In this case a picture really was worth a thousand words.

Job Searches

Work-related issues can be shared via the Internet. Nurses interested in relocating can do a web search to conduct virtual tours of hospitals they might be interested in, file an application online, get driving directions, or book travel plans through a travel site such as Velocity. When looking to change jobs they can post their resume online. Even low-cost phone communication can be run through Vonage or Skype — both require an Internet connection and headset instead of a phone line or cell phone.

Creating Community

The Internet facilitates a feeling of community and can create the ability to investigate job issues easily. Union members can use online forums to discuss contract negotiation issues, salary, benefits and legal information. New healthcare legislation and practice agreements, as well as regulatory mandates, can be tracked through blog sites. There is just no excuse now for remaining uninformed.

Brian Short, RN, discovered the importance of a nursing community over a decade ago. When Mr. Short was still a nursing student, he created for the purpose of online support and education. Two years ago the site claimed to cover 400 nursing topics every day and a total of 1.5 million posts. In an interview given at the time of its 10th anniversary, Teresa Burgess, RN, pointed out the importance of the online nursing community for its ability to be used for mentoring and creating a sense of shared purpose.

Let’s end with a word of warning, however, when it comes to using the Internet. While the examples given prove that use of the Internet can be beneficial to nursing practice, we must all bear in mind that much of what we find there remains anonymous and subject to scrutiny.
Our own critical thinking must be used to determine when and how best to use the available information, and to evaluate the value and truth of what we read. Certainly if what we find can nudge us toward being better health professionals, then the monthly cost of Internet service and the time spent in connection with others is well worth it.

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