DiversityNursing Blog

The Joint Commission defines a hand-off as a transfer and acceptance of patient care responsibility achieved through effective communication. It is a real-time process of passing patient-specific information from one caregiver to another, or from one team of caregivers to another for the purpose of ensuring the continuity and safety of the patient’s care.

Nurses typically take great pride and exert painstaking effort to meet patient needs and provide the best possible care. Unfortunately, too often, this diligence and attentiveness falters when the patient is handed off, or transitioned, to another health care provider for continuing care, treatment or services. A common problem regarding hand-offs is communication. Expectations can be out of balance between the sender of the information and the receiver. 

Please understand we know how incredibly busy you are every minute you are working. We appreciate transitioning patient information to the next caregiver is critical and that you do everything in your power to be clear and concise. These guidelines are meant to be helpful and reinforce what you most likely are already doing to keep communication transparent and smooth.

Abuse occurs in many areas of society and takes many forms. Some examples may involve the abuse of a child by a parent or caregiver; the abuse of a parent by an adult child; or the abuse of a spouse. In addition to the physical aspects, abuse can include emotional battering, financial exploitation and sexual assault. Many of these result in health problems for the victims. Your role in dealing with victims of abuse is multifaceted.

One of the most common and deadly forms of child abuse is not physical violence, but neglect. According to data from the National Child Abuse and Neglect Data System, neglect was a contributing factor in more than 71 percent of child maltreatment fatalities in 2011.

Possible signs of child maltreatment may include:

◗ Developmental delays
◗ Speech disorders
◗ Failure to thrive
◗ Poor hygiene
◗ Inappropriate seasonal clothing
◗ Lack of supervision
◗ Unattended medical needs
◗ Chronic truancy
◗ History of psychological disorders

When assessing a patient, you should be aware of the following physical signs of injuries related to domestic violence:

◗  Black eyes
◗  Bruises in various stages of healing, particularly on breasts or genitalia
◗  Symmetrical bruises on upper arms, wrist or neck
◗  “Bathing-suit pattern” marks that are covered by clothing
◗  Subdural hematomas
◗  Patches of missing hair
◗  Fractured mandibles
◗  Ruptured tympanic membranes
◗  Lacerations around the eyes and lips
◗  Rib fractures
◗  Unexplained venereal disease or genital infections
◗  Recurrent urinary tract infections
◗  Anal or genital bleeding or injury
◗  Marks consistent with the size of objects such as cigarettes or belts
◗  Signs of neglect, such as malnutrition, poor hygiene or skin ulcers
◗  Use of makeup or other methods to hide indicators
◗  Injuries not consistent with explanation of how they occurred

However, it is unlikely the patient will present with a physical injury. They will more likely present with issues such as:

• A stress-related illness
• Anxiety, panic attacks, stress and/or depression
• Drug abuse including tranquilizers and alcohol
• Chronic headaches, asthma, vague aches and pains
• Abdominal pain, chronic diarrhea
• Sexual dysfunction
• Joint pain, muscle pain
• Sleeping and eating disorders
• Suicide attempts, psychiatric illness
• Gynecological problems, miscarriages, chronic pelvic pain

The patient may also:

• Appear nervous, ashamed or evasive
• Describe their partner as controlling or prone to anger
• Seem uncomfortable or anxious in the presence of their partner
• Be accompanied by their partner who does most of the talking
• Give an unconvincing explanation of the injuries
• Be recently separated or divorced
• Be reluctant to follow advice

All Nursing schools include information about how to detect child and domestic abuse within the curriculum, but the practice of detection can be difficult. Most inpatient and outpatient facilities now require questions about personal safety and domestic violence screening questions as part of the intake process. In your role as the attending Nurse, it's important to ask these questions with intent and ensure the patient has enough time to answer. Do not rush the patient as they are most definitely scared. Some practitioners even wear buttons or badges that say, "It's okay to talk with me about domestic violence." Only ask questions about domestic violence when the patient's partner is out of the room.

The following questions may be helpful when assessing a patient for abuse, maltreatment, or neglect: 

• I noticed that you have a number of bruises. Can you tell me how they happened? Has anyone hurt you?
• You seem frightened. Has anyone ever hurt you?
• Have you been hit, slapped, kicked, pushed, shoved, or otherwise physically hurt by someone within the last year?
• Sometimes patients tell me that they've been hurt by someone at home or at work. Could this be happening to you?
• Are you afraid of anyone at home or work, or of anyone with whom you come in contact?
• Has anyone forced you to engage in sexual activities within the last year?
• Has anyone prevented you from seeing friends or other people whom you wish to see?
• Have you signed any papers that you didn't understand or didn't wish to sign?
• Has anyone forced you to sign papers against your will?

In a clinical setting, your most important role is to provide a safe environment for your patient; treat your patient's injuries; and observe, listen, and document the facts. Treatment focuses on the consequences of the abuse and preventing further injury. If the patient is in immediate danger, separate the patient from the perpetrator whenever possible.

Your next important job is to refer your patient to the appropriate authorities and/or agencies. Even if you aren't sure but suspect that your patient is a victim of abuse, report your suspicions. You won't be penalized and you may save your patient's life.

Additional resources are only a phone call away. These include hotlines such as:

* National Domestic Violence Hotline: 1-800-799-SAFE (7233); TTY: 1-800-787-3224

* ChildHelp USA National Child Abuse Hotline: 1-800-4-A-CHILD (422-4453); TDD: 1-800-2-A-CHILD (222-4453)

* National Youth Crisis Hotline: 1-800-442-HOPE (4673)

Substance Use Disorder can affect anyone regardless of age, ethnicity, gender, economic circumstance or occupation. Substance Use Disorder in Nursing is one of the most serious problems facing the profession today.

This disorder is more common in Nursing than many believe. The American Nurses Association (ANA) estimates that 6% to 8% of Nurses have a drug or alcohol problem that impairs their practice. 

Nurses are often handling powerful painkillers and other prescription drugs. This accessibility increases the temptation to use. In fact, a study showed that Nurses who handle drugs are more likely to have an addiction than Nurses who do not.

Any healthcare facility will tell you that when they have great Nurses, they want to hold onto them. Most state Nursing boards understand that addiction is a disease and Nurses should have the opportunity to pursue recovery without worrying about losing their job. 

Non-disciplinary programs are now used by a growing number of state Nursing boards. These programs provide rapid involvement in a rehabilitation or treatment program and remove him/her from providing care until safety to practice can be established and confirmed.

It is not easy for anyone with a substance abuse disorder to ask for help, and that can be especially true for Nurses. However, recognizing that there is a problem and asking for help are the two steps that can truly turn things around. If you or someone you know is struggling with SUD please use the resources below.

RESOURCES

For Nurses with SUD

The National Council of State Boards of Nursing (NCSBN) offers an Alternative to Discipline Programs for Substance Use Disorder directory here for Nurses to locate alternative to discipline programs for SUD in their state if available.

For Nurses Concerned for a Colleague 
This NCSBN online brochure, What You Need to Know About Substance Use Disorder in Nursing, informs nurses of their ethical and professional responsibilities about reporting suspected or know SUD in colleagues.

For Employers
See Chapter 6 of NCSBN’s SUBSTANCE USE DISORDER IN NURSING: A Resource Manual and Guidelines for Alternative and Disciplinary Monitoring Programs offers a comprehensive examination of SUD in the healthcare workplace, particularly for Nurse managers.

For Nursing Students
Although not specifically for Nursing students, the NIH’s National Institute of Drug Abuse College-Age & Young Adults’ webpages, contain resources for how and where to get assistance for substance abuse, as well as drug facts, infographics, and more. Currently, there is very little updated guidance for Nursing students with substance use disorder. Nursing students may want to consult their health care provider, college health center, or employee assistance program.

According to Penn State College of Medicine researchers, patients' perceptions of the hospital they're being treated in may be improved by artwork. This could be a low-cost way to help improve patient satisfaction.

"It is relevant to hospital administrators who are under increasing pressure to improve care quality and the patient experience. People often find medical environments stark and uninviting, and artwork is a way to humanize hospital rooms and perhaps make them feel warmer, more inviting, and less 'medical," said Daniel George, associate professor of medical humanities.

Cleveland Clinic emailed former patients, inviting them to respond to a survey about the health system’s art program. Out of the more than 1,000 respondents that had visited Cleveland Clinic within the previous 12 months, 826 (76 percent) remembered noticing the art collection.

Of the 826 respondents who noticed the art, an average of:

• 73 percent said it somewhat or significantly improved their mood. Results were even higher among the subset of respondents treated for breast cancer (78 percent), generalized anxiety (81 percent) and post-traumatic stress disorder (PTSD) (84 percent). Results also were higher the longer the hospital stay. For example, 91 percent of two- and three-day visitors reported that the art improved their mood.
• 61 percent said it somewhat or significantly reduced their stress. Results were even higher among the subset of respondents treated for cancer (65 percent), generalized anxiety (69 percent) and PTSD (81 percent) — as well as among the subset of two- and three-day visitors (72 percent).
• 39 percent said it somewhat or significantly improved their comfort or pain level. Results were even higher among the subset of respondents treated for cancer (43 percent), osteoarthritis (47 percent), generalized anxiety (49 percent) and PTSD (54 percent).

According to research done by Stine Maria Louring Nielsen and professor Michael Finbarr Mullins of Aalborg University in Denmark, patients noted that the mere presence of the artworks inspired confidence that the hospital was well cared-for, leading them to expect a high level of care while staying there.

Arts in Medicine is a national and international program that brings healing arts into healthcare systems. One of the oldest programs is at Duke University, said visiting artist Elizabeth Garlington, which made bringing the program to Haywood, a Duke LifePoint hospital, a logical extension.

Party of 7

Susie Nix, Michelle Moore, Amanda Loye, Natalie Deal, Ashley Davis, Abby Lucas and Katie Jones all work together in Labor and Delivery at Cone Health Women’s Hospital in Greensboro, North Carolina and all seven of them are expecting at the same time! 

The due dates are between August and December this year.

Loye is expecting twin boys, Moore, Deal, Davis and Lucas are expecting boys, while Nix and Jones say they don't want to know the gender until the baby is born.

All of the women will be giving birth at Greensboro hospital, of course. 

Multiple maternity leaves aren’t an issue since they have a full team of 85 Nurses in the unit.

Loey said that being pregnant and working with expecting mothers makes it easy to start a conversation with the patients. “It gives you something to talk about right off the bat!” she said.

"The 6-pack"

Over at Wake Forest Baptist Medical Center in Winston-Salem, N.C. we meet Nina Day, Bethany Stringer, Emily Johnson, Nikki Huth, Sabrina Hudson and Katie Carlton.

According to one report, their patients refer to them as the fabulous "six-pack." 

“Of course, people say, ‘Is there something in the water?’” Carlton said. “It really intrigues people and gives them something to focus on when they are there.”

They are a tight-knit group of Nurses who love that they’re sharing this experience. 

“People being pregnant together may not be a rarity,” Hudson said. “We are just really excited about our babies and being able to share play dates. I don’t think that after the pregnancies are over we will stop sharing milestones together.”

Their due dates range from July to December. Hospital spokeswoman Eryn Johnson reassured those concerned, that the hospital has made plans to continue patient care when the women take maternity leave.

"All of these Nurses have spoken highly about sharing their pregnancy journeys together along with the support, advice and tips they’ve been able to share,"  Johnson said. "Quite the bond that’s been established."

Large job boards like Indeed and Glassdoor compete to display millions of jobs. Niche job boards like our DiversityNursing.com job board, help you reach a more precise audience.. 

Niche job boards are generally smaller job boards that are location or industry focused. Many niche job boards are sponsored and/or maintained by industry leading professional associations. From a recruiter’s perspective, the industry focus of niche job boards helps to target job advertisements toward qualified candidates. 

Healthcare organizations need to look at the importance of the recruiting function, and how, if recruiters are able to bring more high-quality talent into the organization, that level of quality will cascade through everything else employees do, ultimately impacting the delivery of patient care.

Recruiters like posting jobs on niche boards because they know everyone applying is in the right place. Applicants won’t find search results for jobs in other professions so recruiters won't receive resumes that don’t match the job description they posted. This leads to smaller candidate pools, allowing the recruiter more time to consider each application. 

According to a Nurse.com article, smaller job boards are familiar with particular specialties, job titles, certifications and keywords your desired audience uses and requires. They understand and stay up-to-date on the hiring trends for their niche profession. For example, if a large organization is laying off workers, a niche job board can help you target a specific market.

Niche boards offer branding opportunities like job alerts, job board widgets, banner advertisements, and company profile pages like DiversityNursing.com's Employer Profile.

Smaller job boards have staff who know your name and answer your calls and questions. They know your time is precious and good communication is key. That means you're talking to a real person not a voice recording. 

Niche job boards attract the right candidates that have the specialized skills and up-to-date experience that you're looking for. They also receive higher quality and more relevant applications. Therefore, niche job boards are the fastest way to find strong candidates, leading to lower cost-to-fill.

The United States has a massive Nursing shortage, and the problem is only going to grow. Due to an influx of patients into our health system, the retirement of baby boomers, and educational obstacles, Nursing positions aren’t being filled fast enough to keep up with demand.

By 2022, the American Nursing Association predicts the U.S. may need more than 1 million new Nurses to both care for a growing number of older Americans and replace retiring Nurses.

“I’ve been a Nurse for 40 years, and the shortage is the worst I’ve ever seen it,” said Ron Moore, who retired in October from his position as Vice President and Chief Nursing Officer for Charleston Area Medical Center.

More people have access to health insurance as a result of the Affordable Care Act passage in 2010. This has led to an increase in people seeking medical care. Another reason for the increase in patients is medical technology has advanced to the point that it has enabled people to live longer. The number of people over the age of 65 in this country is rapidly increasing. There are more Americans over the age of 65 now than at any other time in the country’s history. It’s predicted that this number will continue to grow, which means more people with health issues and more people in Nursing homes.

Students appear to have a high level of interest in a Nursing career. It pays well, has strong projected job security, and allows practitioners to do meaningful work. However, when applicants send in their transcripts, many are turned away or wait-listed. 

The problem in Nursing education is there aren’t enough teachers to educate student Nurses. Not only that, but the current faculty’s median age is in the 50s, so many of them will be looking to retire soon.

For those that do get accepted into Nursing programs, there’s the cost of schooling to worry about. Whether trying to attain a Nursing license through an associate, bachelor’s, or master’s program, the costs add up. Also those pursuing a specialty have to be prepared to devote years to their professional development. 

Grants and scholarships like the DiversityNursing.com $5,000 Education Award, can help with some of this burden, but unfortunately, there just aren’t enough to go around.

Seun Ross, Director of Nursing practice and work environment for the American Nurses Association, thinks focus should be placed on boosting resources available to Nursing schools so they can hire more teachers who, in turn, can train more students. She also said hospitals must invest in the experience of Nursing, buying cutting-edge equipment and cultivating an inclusive work culture in order to get the most out of their Nurses.

In terms of work environment, the American Nurses Association suggests introducing more flexibility into the work environment structure and scheduling programs; rewarding experienced Nurses for serving as mentors to new Nurses; and implementing appropriate salary and benefit programs.

Nurses comprise the backbone of the entire health care industry. Without them, the whole thing collapses. At every level, the quality of care and human touch necessary for positive outcomes link directly to the Nursing staff.

Mental health conditions do not discriminate based on race, color, gender or identity. Anyone can experience the challenges of mental illness regardless of their background. However, background and identity can make access to mental health treatment much more difficult.

July is National Minority Mental Health Awareness Month and the month offers organizations an opportunity to create mental health awareness in diverse communities. 

In May of 2008, the US House of Representatives announced July as Bebe Moore Campbell National Minority Mental Health Awareness Month.

The resolution was sponsored by Rep. Albert Wynn and cosponsored by a large bipartisan group to improve access to mental health treatment and services and promote public awareness of mental illness.

Bebe Moore Campbell was an author, advocate, co-founder of NAMI Urban Los Angeles and national spokesperson, who lost her battle with cancer in November 2006.

One in 5 Americans is affected by mental health conditions. Stigma is toxic to their mental health because it creates an environment of shame, fear and silence that prevents many people from seeking help and treatment. The perception of mental illness won’t change unless we act to change it.

Ways to get involved

• National Minority Mental Health Awareness Month Facebook page
• Tweet using #MinorityMentalHealth
• Take the pledge to raise awareness

America’s entire mental health system needs improvement, including when it comes to serving marginalized communities. With all of our help, we hope this month brings awareness to this issue. 

Communication in Nursing is essential to patient safety, health and well-being. As Nurses assume more complex roles and care for older and more culturally diverse populations, strong communication skills are critical.

“According to one study, effective communication reduces stress, promotes wellness and therefore improves the overall quality of life of patients. Below are some tips to help improve communication.”

BATHE (Background, Affect, Trouble, Handling, and Empathy)

Nurses and other healthcare experts have been looking for the key to a quality patient encounter that also fits within busy workflows. At the University of Virginia, researcher Claudia Allen, JD, PhD, developed the Background, Affect, Trouble, Handling, and Empathy (BATHE) method, designed to only take five minutes.

BATHE uses open-ended conversations between patients and nurses to build strong relationships that can often go beyond clinical needs. Understanding who the patient is as a person helps the nurse connect with the patient and make her feel more comfortable during a potentially tumultuous care encounter. To learn more about BATHE click here. 

Breaking Barriers for Effective Communication

Some health care organizations may still foster a culture that discourages employees from reporting negative events.  From an ethical viewpoint, patient safety takes precedence over loyalty to peers and superiors, especially when those individuals are not conforming to safety procedures.

As a step in promoting a culture of open communication, nurse professionals must display fortitude in reporting unsafe conditions and adverse events. In the modern caregiving environment, it is no longer acceptable to blindly follow instructions. Silence can lead to negative treatment outcomes, or worse – to a mortal event.

Active Listening

Active listening is an essential holistic healthcare tool. It is a non-intrusive way of sharing a patient’s thoughts and feelings. To practice active listening, follow these steps:

• Listen to what the patient is saying.
• Repeat what you heard to the patient.
• Check with the patient to ensure your reflection is correct.

The goal of active listening is to reflect the feeling or intent behind their words. You should listen to understand, not to respond. Practice active listening as one of several ways to build rapport.

If there seems to be a disconnect, reflect what has been said by paraphrasing. "What I'm hearing is…," or "Sounds like you are saying…," are great ways to reflect back. Don’t simply repeat what the speaker has said verbatim, though—you’ll sound insincere or unintelligent. Instead, express what the speaker’s words mean to you. Ask questions to clarify certain points: "What do you mean when you say..." or "Is this what you mean?"

In recent news, the deaths of Kate Spade and Anthony Bourdain have brought the issue of suicide into the spotlight. Suicide is the tenth leading cause of death in the United States, and one of three that is increasing. The other two are Alzheimer’s disease and drug overdose, in part because of the spike in opioid deaths, said Dr. Anne Schuchat, principal deputy director of the C.D.C.

Suicide rates from 1999 to 2016 increased in all age groups younger than 75 years, with the greatest increase shown in “middle-aged adults” aged 45 to 64 years, increasing 25 percent nationally. 

Research has shown that Physicians are twice as likely to commit suicide as the general population, and while there is a notable lack of information about the suicide rates for Nurses in the US, a report from the UK finds that “for females, the risk of suicide among health professionals was 24% higher than the female national average; this is largely explained by high suicide risk among female Nurses.”

Nurses are stuck between demands of the patient and demands of the system. When caring for patients, you are exposed to everything from debilitating diseases to traumatic situations. Without proper coping mechanisms – a support system to vent to after work, colleagues to share similar feelings with, a stable and supportive home life – the tragedies of daily work can take a toll on Nurses, one that is insidious and may not become evident until a breaking point is reached. 

Health-care organizations need to more proactively report suicide in their workforce, so we can begin to understand the drivers for suicide in health-care workers. Also institutions need to develop procedures and processes for grief recovery support for colleagues of the deceased. Many institutions shy away from even mentioning suicide at the workplace. There is concern for suicide contagion, an increased tendency toward suicide in the already predisposed upon hearing of a suicide.

Having a stronger ability to identify the warning signs of suicide can help healthcare professionals spot them in their peers—and themselves, said Joe Parks, M.D., medical director of the National Council for Behavioral Health. "We don't train Doctors and Nurses near well enough to ask for help for themselves," he said.

There are several warning signs providers can keep an eye out for, such as:

• Isolation
• Increased anxiety
• A sense of being trapped or a burden on others
• Increased use of drugs or alcohol
• Extreme mood swings
• Sleeping too much or too little
• Referencing or mentioning a desire to die

Resources

• If you or someone you know is in an emergency, call 911 immediately.
• If you are in crisis or are experiencing difficult or suicidal thoughts, call the National Suicide Hotline at 1-800-273 TALK (8255)
• If you’re uncomfortable talking on the phone, you can also text NAMI to 741-741 to be connected to a free, trained crisis counselor on the Crisis Text Line.