DiversityNursing Blog

By Laura Krantz

A new regional public health nurse will help three local towns tackle a big problem: making sure residents take their medications properly, officials said Tuesday.

Thanks to a wellness grant administered by the MetroWest Regional Collaborative, nurse Alyssa Kaiser has been hired part time to run preventative medicine programs in Ashland, Hopkinton and Medway. The programs will range from mental health to concussion safety to fall prevention for the elderly, local health agents said Tuesday.

"I’m able to be creative and implement a lot of programs I don’t think just being a clinical nurse you’re able to do," said Kaiser, 30, recently graduated from the Mass. College of Pharmacy and Health Science’s Worcester campus.

She said she is eager to begin learning the major health needs of each town.

"What I’m trying to do is trying to take a look at all of the town sand trying to see what are the issues…in each one of the towns and what can we do to help solve that problem or prevent these issues?" she said. "I don’t think that has been addressed before."

The nurse is meeting with local officials this month. Once her work is in full swing, one of her main goals will be to encourage residents, especially seniors, to properly administer their medications.

"There’s such a large amount of the elderly population that becomes sick from either taking too little of their drugs or too much," said Stephanie Bacon, Medway’s health agent.

According to a 2010 article in the New England Journal of Medicine, as many as half of all patients do not adhere faithfully to their prescription medication regimens, resulting in more than $100 billion spent annually on avoidable hospitalizations.　

The article said unorganized care as well as psychological issues, health literacy and side effects can lead to people not taking their medicine properly.

Kaiser said many adults, not only seniors, struggle to take medicine properly. They can receive dangerous combinations of medicines from two different doctors or have dietary restrictions that interfere with a medicine, for example.

"It’s a huge, huge issue," she said.

Kaiser will work with seniors, schools and sports groups on topics including mental health and abuse, disease prevention and nutrition.

She was at the Medway senior center Tuesday talking with seniors about medicine adherence, Bacon said.

Hopkinton Public Health Administrator Ed Wirtanen Tuesday said he is thrilled to have a nurse in an era of shrinking budgets and an uncertain future of public health. He said the town hasn’t had a nurse since at least 2008.

"We’re desperately trying to get a nurse," he said.

Bacon said Kaiser will also help the elderly prevent themselves from falling. For seniors, a single fall can cause health complications from which many never recover.

"Literally, a fall can be the end of their life," Bacon said.

Those who do recover often live in fear of falling again, she said. The nurse Tuesday gave out spike-type tools to put on the bottom of canes to help prevent falling in icy weather, Bacon explained.

Mark Oram, Ashland health agent, said people often set up pillboxes but don’t always adhere to the plan.

He said the nurse will also film public service announcements for local cable access channels in the three towns. The part-time position is scheduled to run through July but Oram said they have asked that it be extended through the end of 2013.

Source: MetroWest Daily News

BY SCRUBS EDITOR

Every week we scour the Internet for controversy, quotes and stories related to nursing and the things you care about. Tune in to read our roundup every week!

1. Does your fatigue have anything to do with the length of your shift? According to this study — YES. It does! 

So how did this happen in the first place? Amy Witkoski Stimpfel, a fellow at the University of Pennsylvania School of Nursing, explains:

“Nurses traditionally worked eight-hour days. Then in the 1980s and 1990s, when some structural changes in health care and cost containment measures [were] put in, it was actually less expensive to have nurses work 12-hour shifts, because that [meant] only two nurses per day [were needed] instead of three. So nurses began working these 12-hour shifts. In fact, they decided that they really liked it because it offered better work life balance. Nurses could work three days instead of five, so they had more time off with their family and friends and fewer commutes. And they had more time to go back to school. So it’s really become very prevalent.”

Source: Knowledge @ Wharton

2. Nurses love their career choice, but 30% say they aren’t happy with their jobs.

Harvard Business School professor and author Clayton Christensen describes motivation like this: “[It] means that you’ve got an engine inside of you that drives you to keep working in order to feel successful and to help the organization be successful. It causes you to keep at it through thick and thin. Motivators are things like, ‘I have the opportunity to achieve important things,”I learn ways to be better,’ and ‘I’m an important part of a team.’ If you have those kinds of experiences every day, you’re motivated, and you’ll be satisfied.”

Source: Health Leaders Media

3. San Francisco nurse wins national award for her book detailing her transition to life coaching.

On why she flipped careers:

“I wanted to help people who wanted to make transformative, positive change in their own lives,” said Linda Bark, who runs the Alameda-based Bark Coaching Institute. “Coaching can be for life transitions, business decisions, health–either way, it is about helping a person make a change by listening to one’s whole self. What I invite people to do is to see what information they’re getting, not just from their thinking minds, but from their bodies.”

Source: The Oakland Tribune

Article Source: Scrubs Magazine

BY SCRUBS EDITOR 

There are lots of medical dictionaries out there, but it seems that Taber’s Medical Dictionary for Mobile + Web–which is used a ton in nursing schools–is one of the top choices. If what they claim is true (“including 30% more medical terms than any other app,” “used most amongst healthcare professionals”), then we can see why!

Taber’s contains more than 60,000 terms, 1,000 photos, and 600 patient care statements, making it a hugely comprehensive health science dictionary. The iTunes page boasts that “Taber’s goes beyond in-depth definitions with nutrition and alternative therapy coverage, medical abbreviations, symbols and units of measurement, immunization schedules, nursing diagnoses, links to pronunciations, and more. This powerful app contains the information you need to answer critical questions at the bedside, in the classroom, at home, or in the office.”

What nurses love about Taber’s: 

“The index is super easy to use. Very nice to be reading my nursing e-textbook and switch to my e-Taber’s and get more info. I highly recommend this!” – Space Queen, Amazon.com

Taber’s Medical Dictionary for Mobile + Web features for all iOS devices:

• Optimized interface
• Universal Index Search – find topics across all indexes
• Personalized favorites
• Superior navigation

Taber’s Medical Dictionary for Mobile + Web features for iPad:

• iPad-specific interface – not just an enlarged iPhone app
• Side-by-side reading and navigation panes

PLEASE NOTE: This application requires a paid subscription to the online Taber’s Medical Dictionary for Mobile + Web service.

Source: Scrubs Magazine

New delivery models will bring an increase in community-based facilities

With population health gathering momentum in the wake of health care reform, more hospitals are either constructing community-based settings or are including them in their plans. The goal is to offer sophisticated levels of care at patient-friendly sites and reduce costs with fewer hospital admissions.

Montefiore Medical Center is a perfect example of what is expected to become a growing trend. It recently announced plans to lease a new 11-story, 280,000-square-foot building at Hutchinson Metro Center, a mixed-use development in New York City.

The project, scheduled for completion in the third quarter of 2014, will provide space for multidisciplinary care and integrate technology that allows Montefiore to provide necessary treatments without the need for hospitalization.

"This new tower will allow Montefiore to bring the health care of tomorrow to our patients here in the Bronx," says President and CEO Steven M. Safyer, M.D. "We are reshaping outpatient care and establishing leading practices that provide Montefiore's world-class treatments through multidisciplinary teams at a hospital without beds."

The decision to develop a freestanding ambulatory facility emerged because of several factors, including the ability to provide high-tech imaging and surgical procedures in an outpatient setting, says Ed Pfleging, vice president of engineering and facilities.

The site will include 12 operating rooms and four procedure rooms that will allow difficult cases requiring a hospital-type setting to be scheduled more easily and completed quickly, he says.

While not all new off-campus facilities will be as large as this one, the 2013 Hospital Construction Survey conducted by H&HN's sister publication, Health Facilities Management, and the American Society for Healthcare Engineering also identifies a trend involving increased community-based health care.

Of the 612 survey respondents — who include vice presidents and directors of facilities management and operations at U.S. hospitals — future facility development plans and construction projects include:

• 11 percent, ambulatory surgery centers, 
• 11 percent, satellite offices catering to specialities;
• 15 percent, outpatient facilities in neighborhood settings; 
• 12 percent, urgent care facilities in neighborhood settings;
• 15 percent, new medical office building construction.

According to the National Association of Community Health Centers, the number of Americans who rely on community health centers for care is expected to double to an estimated 40 million by 2015 — from about 20 million in 2010. The Affordable Care Act allocated $11 billion to expand these centers, including $1.5 billion for construction.

Richard Taylor, managing director, health care solutions group, Jones Lang Lasalle, a real estate services firm based in Chicago, says health care systems are evolving into integrated delivery systems that reach out to their customers through a variety of facility types.

"It's all part of that overall trend that you can track back to the health care legislation and consumer preferences," he says. Lower cost of delivery and competition are two other key factors in the trend, he adds.

Marisa Manley, president, Healthcare Real Estate Advisors, agrees that the drive is in full swing for hospitals to move urgent, ambulatory and primary care to community-based sites to meet patient preferences and to cut costs.

Another positive outcome of the trend is that hospitals likely will start to utilize some of the empty buildings and office spaces caused by the Great Recession in addition to building new facilities when necessary, she says.

Source: H&HN

Patient satisfaction scores soar after hospital trains staff to treat patients — and each other — with respect.

When Laurent Gueris took over the housekeeping department at Providence Little Company of Mary Medical Center in San Pedro, Calif., the staff of 15 was well-trained in cleaning, but any people skills they had, they'd picked up on their own. Some entered rooms without knocking, did their jobs wordlessly with heads down, and then rushed out. Wanting to be invisible, they instead came off as sullen and unhelpful.

"They would do their little cleanup and leave," recalls Gueris' boss, Providence CEO Nancy Carlson. "They were very intimidated by other staff in the hospital and they were not being respected and valued."

At first, Gueris, manager of environmental services, concerned himself with easy fixes in his department, like purchasing paper towel dispensers that didn't have to be changed as often and swapping out conventional mops for microfiber ones. But a trip to France to visit his dying mother in the hospital prompted him to think about bigger issues, such as getting his workers to say "hello," be pleasant, even chitchat occasionally with patients.

"One day, I would see a housekeeper who was very friendly and connected with my mom," he says. "And another day, somebody would just go into the room and not even knock on the door."

Gueris became a student of the hospital's staff, noticing how some were able to defuse difficult situations and others made it worse. He also saw how a few pleasantries — and treating difficult patients as otherwise decent people reacting with fear and anxiety to a very stressful situation — made a big difference.

Back home, Gueris introduced role-playing sessions. Every morning, the staff met to rehearse interactions with patients. Gueris offered guidelines, something they hadn't had: Knock on the door. Ask permission to come in. Introduce yourself and tell them you're from housekeeping.

At first, Gueris played the patient, really throwing himself into his role. Sometimes, he'd be angry, sometimes insulting — whatever he knew would push a particular worker's buttons. After the session, he gave pointers on such matters as looking people in the eye or defusing an overly flirtatious patient with "Thank you very much, I appreciate that, but I'm not interested."

Gradually, the staff started coming around. After six months, they grew confident to the point that they wanted to take turns playing the patient.

"They give each other a real hard time," Carlson says. "They come up with scenarios that really challenge their peers."

They also began challenging Gueris.

"I'd say, 'You didn't look me in the eye,' and they'd say, 'Yes, Laurent, I did.'" So he started recording the morning sessions, which the staff would watch, discuss and then erase.

He was expecting resistance with the videotaping, but didn't get much. "I'd been working with them for a while to build that trust," he says. "We did the first video, it broke the ice and, by the next day, they were fine with it.

"Seeing it on their own was very powerful," he adds. "Not just the eye contact, but their facial expressions, their body language. Maybe they thought they did not look nervous, but they were [twitching] their legs."

They now follow a script: "Hi, I'm here; my name is …. I'm here to clean your room. I'm hoping you're having a good day today; here's a flower," then hand the patient a card with a flower printed on it. Once the room is clean, they ask whether the patient would like his or her curtains open or closed and whether they need anything else.

"Even though they can't answer a clinical question or stop an IV from alarming," says Carlson, "they can move a telephone closer, get a blanket, or ask a nurse to come in and respond to a clinical concern or question."

The housekeepers' patient satisfaction scores have jumped from the 60th to the 70th percentile to the 90th percentile in 2012. For his efforts, the Hospital Association of Southern California named Gueris a Hospital Hero for 2012.

Gueris' training techniques are now rolling out to other parts of the hospital, starting with nurses' aides and administrative staff. "Our goal is to roll it out to anybody who has interaction with a patient, including the phlebotomist who comes in, sticks a patient with a sharp object and leaves," Carlson says.

Source: H&HN

By ANGEL McCURDY 

On any given day you can see a group of people sitting in a small corner at Emerald Coast Center nursing facility.

Members of the reading club deal with disease, death and heartache, but there are no tears because of the special attention Covenant Hospice volunteer Brice Horwell gives them.

They enjoy their books, some conversation and milkshakes Horwell brings.

Horwell does more than visit with patients. He becomes their friend.

Horwell brings fresh flowers to the nursing facilities he visits each week. He tours the halls to say hello to each person he sees; he knows most by name.

He also visits hospital rooms and people’s homes.

“I feel like I’m doing something,” Horwell said. “I don’t want to see anyone die alone.”

Horwell, who is retired from the Navy, has volunteered with Covenant Hospice for eight years. He visits his clients weekly, runs errands and finds ways to make hard days better.

“I‘ve done some weird things,” Horwell said, laughing. “There‘s a patient that loves pigs feet. I would never eat pigs feet, but I’m happy to go and get them.”

Tim Morgan is a member of the Emerald Coast Center’s reading club. Morgan, who is no older than 60 but suffers from kidney failure, says Horwell’s weekly visits add joy to his day.

“Life wouldn’t be what it is without this guy,” Morgan said. “He brings us outside contact and is a great conversationalist. It means a lot to have somebody come to visit.

“It really makes a difference and lifts your spirit.”

In the last year, Horwell has accumulated more than 350 volunteer hours through his weekly visits, 11th-hour work and Hospice’s We Honor Veterans.

“He is the last face they will see as a measure of comfort,” said Dennis Krebs, Covenant Hospice’s volunteer services outreach assistant. “That means something to him and it means something to the people he’s with.