DiversityNursing Blog

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.

The Nursing profession has long emphasized its commitment to social justice and health equity. Nurses are known for advocating policies and regulations that are inclusive and lead to positive patient outcomes. However, an essential component of promoting health equity is acknowledging individual unconscious biases and understanding how they may impact the care that's provided.

According to the Institute for Healthcare Improvement, implicit bias, also known as unconscious bias, is “the bias in judgment and/or behavior that results from subtle cognitive processes (e.g., implicit attitudes and implicit stereotypes) that often operate at a level below conscious awareness and without intentional control.” 

Social Psychologists theorize that the content of our unconscious biases are learned from the society in which we live. From a very early age, all of us are repetitively exposed to certain ideas from our family, friends, neighbors, teachers; and, from the constant input of various forms of media. Over time, these ideas become embedded in our belief system and are activated automatically and unconsciously.

In the context of health care, unconscious bias can lead to health disparities such as the under treatment of conditions like pain, cardiovascular disease, asthma and mental health in racial and ethnic minorities. One of the things that accounts for health disparities is unconscious bias in health care providers. Not only does unconscious bias contribute to under-treatment, but studies have shown that providers with more implicit biases are more likely to have negative interactions with patients. This impacts trust and the likelihood that patients will seek health care. 

There are ways we can prevent this.

Notice Your Assumptions

Everything from language barriers to job status to regional inflections can cause people to assume a patient has certain traits, behaviors, or beliefs that you might not agree with. Notice that feeling when you are trying to explain treatments to a patient, when responding to their needs, or when dealing with an extended and involved family.

Follow the National CLAS Standards

The National CLAS Standards are a set of 15 action steps intended to advance health equity, improve quality, and help eliminate health care disparities by providing a blueprint for individuals and health care organizations to implement culturally and linguistically appropriate services.

Explore awkwardness and discomfort

It’s okay to feel outside your comfort zone or to be unsure of what to feel, do or say. In a world in which people mostly back away from discomfort and awkwardness, that could be the source of the greatest learning.

Training

Rather than making changes from the top of the business and hoping it trickles down into every area, unconscious bias training provides each individual employee with an understanding of the impact they can have by changing their way of thinking.

Unconscious bias training is geared around three things: awareness, impact and action. We can build awareness about why biases exist (and individual ones we hold), demonstrate the impact they can have on our decisions, actions and working patterns, and finally, agree how we can take action to ensure they are not expressed in a way that could negatively impact the work environment.

Although many healthcare providers don't see themselves as being biased, it's a common and persistent problem. If left unrecognized and unmanaged, unconscious bias can lead to health disparities, resulting in potentially negative consequences for patients. The strategies above can be used by Nurses and other healthcare professionals to overcome unconscious bias and provide optimal patient care.

If the idea of chatting up a complete stranger in hopes of landing your next job gives you sweaty palms, dry mouth, and the jitters, you are not alone. Networking is difficult, even for the most sociable types of people. Think of networking events as a low-pressure way to make new connections and stay engaged in your industry.

Networking is also a great way to make personal connections and build relationships with other Nursing professionals so that you can share tips and advice, lean on each other for support, and converse.

Join Organizations

Every healthcare specialty has its own professional organization. These organizations offer many training and conference events, which are excellent opportunities for networking. They'll also help you stay current of the latest practice, regulation and technology developments that are relevant to your field.

Attend Conferences

When attending conferences use these tips.

• Wear your name tag on your left lapel so you don’t block your name when shaking hands. If you fill out the name tag yourself, print clearly so your name and title are visible from about 5 feet away. That way, others won’t need to squint at your chest to read your name.

• Keep your handshake firm and friendly. Don’t hang on, and don’t pump! Remember to make eye contact, and smile.

• Keep breath mints handy. Networking usually takes place around drinks and food, and the first thing that greets a new contact shouldn’t be the garlic and onion dip.

• Keep your business cards handy (a business card holder is best), but don’t throw them at everyone you meet. Hand your business card to a contact so it’s right side up and facing that person. When someone hands you a business card, take a moment to look at it; then say thank you and carefully put it away. 

Use Social Media

Social media sites, such as LinkedIn and Facebook, allow you to connect with industry and professional organizations, as well as individuals. This will keep you up to date on upcoming training and informational events in your area. LinkedIn is especially useful to reach out to potential mentors and experienced professionals who may provide future references.

Use Existing Connections

It’s important to realize that your professional network isn’t just the people you know. It’s exponential beyond that; the people you know have connections, who have connections, and so on. Reach out to your existing colleagues in the medical world and ask for introductions to people they think you should know.

When it comes to networking in the Nursing field, it’s to be understood that it’s a two-way street. While it’s reasonable to look out for one’s own professional interests and aims, it’s also important to help someone in need. Whenever you receive a professional request, please consider it as if you need it for yourself. Try to remain open to whatever comes your way and be ready to provide a helping hand to others in need. This also applies to your social media accounts. Try to maintain a good response rate and interact with people whenever and wherever possible.

Don't forget to follow up

Leaving at the end of a networking event can mean your mind is swirling with leads for future positions, ideas for your resume, and new mentors to reach out to in the coming days. Before you lose the momentum of the connections you’ve just made, remember to follow up. Send a quick note by email or LinkedIn to the people you’d like to stay in touch with.

Professional networking is one of the best approaches to land the job you want. Do you have any tips to offer? We'd love to hear them! Please comment below. 

Technology continues to revolutionize healthcare and we have entered an exciting new frontier of state-of-the-art gadgets and high-tech communication systems. Some of these changes are made possible by our growing ability to utilize big data to improve outcomes through the field of health informatics; others by awe-inspiring advancements in medical science, telecommunications, and even robotics.

Vein Finding Tool

EchoNous Vein is designed for Nurses inserting peripheral IV catheters by providing an immediate and clear image of veins using just two-button controls. The easy-to-use device also includes optimized settings for use with adults and pediatrics.

“As it is often times the first interaction a patient has with care providers, a failed IV insertion not only holds up care from the beginning, but can impact a patient’s HCAHPS satisfaction survey. For both adults and pediatrics, our new vein finding tool was designed to help reduce ‘hard sticks’ and improve patient satisfaction,” said Kevin Goodwin, CEO of EchoNous. “Critical care Nurses understand the value of not only quickly locating a vein, but receiving reliable information about vessel quality, so we look forward to hearing their direct feedback how our vascular access tool does both, with the ease of a few on-screen touches.”

Stethee ‘smart’ stethoscope

The newly launched, FDA-cleared Stethee Pro features technology to capture and analyze heart and lung sounds and data via Bluetooth, operating around smartphone applications for both Apple iOS and Google Android devices.

“The Stethee system has the potential to transform healthcare. We are on the forefront of a new era in healthcare driven by artificial intelligence and its ability to significantly improve our ability to care for patients. This innovative technology can significantly help drive efficiency and productivity and empower healthcare providers worldwide by providing real time data and clinical interpretation" Dr. John Sperling of the Mayo Clinic said in a press release.

chip monitors blood sugar levels

The company Admetsys has created a solution that can constantly monitor blood sugar levels in real time. Its artificial intelligence algorithm then triggers its software to either administer glucose or insulin via the drip that a patient is connected to. The drip is connected to a screen. The screen shows the metrics for the patient.

"It is a laboratory on a chip. This is what will be able to replace what is in the laboratory," Timothy Valk, co-founder of Admetsys, told CNBC.

"This device was suggested by Nurses. The Nurses' workload is astronomical. They need to be doing other things that are more appropriate for them, than running in and manually doing a glucose or drawing blood, their time is costly," Valk said.

patient monitoring system reducing fall rates

Hospitals are implementing the AvaSys TeleSitter video-observation system to improve patient safety and lower staffing costs.

"The thing I was really skeptical about was, will this make a difference? But the [system] really does work in 99 percent of the cases. It's amazing when you see it in action" said Terry Olinger, President of the Hospitals and Clinics Acute Care Group at Benefis Health System.

The AvaSys room unit is offered in three options. A mobile cart, a portable wall-mounted unit or a permanent ceiling unit.  It lets a single monitor technician keep tabs via video on up to 12 patient rooms from a command center. The command center is located at Benefis in the patient flow center. The monitor tech can use the two-way audio to immediately intervene when a patient is at risk of self-harm, such as a fall. The monitor tech can talk to the patient to verbally redirect them. If the situation is emergent, the tech can activate an alarm and a Nurse will know to get there right away. Overall, AvaSys helps improve staffing efficiencies by allowing Nursing assistants to stay on the floor instead of watching patients 1:1.

Scheduling and staffing technology built for nurses, by nurses

Joe Novello is a Registered Nurse and wanted to create a scheduling solution specifically focused on the needs of his peers. So he founded NurseGrid in 2013.

With NurseGrid, Nurses are able to digitally “raise their hand” so hospital managers know they’re available for extra work, or they can signal that they’re not looking for shifts.

There are other companies in the Nurse scheduling space, including McKesson, Cerner Clairvia and GE Healthcare Centricity. Novello says the other products began as online software then moved to mobile, while NurseGrid was developed as a mobile app and has a better interface. His product also provides real-time shift changes, while other software is focused on time keeping and building schedules.

The future of Mobile Devices

Key findings from The Future of Healthcare: 2022 Hospital Vision Study

• By 2020, usage of mobile devices is expected to grow by 40 percent for all hospital workers.
• 98 percent of alarms or alerts from patient monitoring equipment, electronic health records (EHRs) and biomedical devices will be accessed through a mobile device by 2022.
• In four years, 91 percent of Nurses could access EHR, medical and drug database references (92 percent), and lab diagnostic results (88 percent) using a mobile device.
• The use of mobile technologies could reduce 46 percent of preventable medical errors and care issues caused by the breakdown of communication by 2022.
• 77 percent of patients reported positive feelings toward clinicians using mobile devices in their care.
• 95 percent of patients are willing to share electronic health metrics with clinicians.

3D printing

In medicine and healthcare, 3D printing could not only revolutionize drug creation and the production of medical equipment, but it could also offer new methods for practicing medicine, optimizing supply chains, and propose cheaper and more personalized medical services. So what are some good examples? Let's take a look.

Ian McHale, a senior at the US Steinert High School created a blueprint for producing finger splints.

Prosthetics and implants can be 3D printed. Dutch surgeons replaced the entire top of a 22 year–old woman’s skull with a customized printed implant made from plastic.

Scott Summit 3D printed a cast for himself, becoming perhaps the first patient ever to have a shower with a cast on, but without a bunch of plastic bags wrapped around it. His physician could open and close the cast in seconds and it still held his wrist tightly. And it cost Scott around 50 dollars and a few hours to create.

A network of volunteers called the e-NABLING the Future project, share 3-D printing designs, video tutorials and other information about building prosthetic hands which enables volunteers, Doctors, Nurses or anyone in the field to make a difference by literally “giving a helping hand” to those in need.

Researchers at Harvard University were the first to use a custom–built 3D printer and a dissolving ink to create a swatch of tissue that contains skin cells interwoven with structural material that can potentially function as blood vessels in the future.

James Yoo at the Wake Forest School of Medicine in the US as well as researchers at the University of Madrid have developed the prototype of a 3D printer that can create synthetic skin. It is adequate for transplanting to patients, who suffered burn injuries or have other skin issues.

Organovo successfully bioprinted liver tissues already in 2014. They seemed to be 4-6 years away from printing liver parts for transplantation. Bioprinted livers could also be used in the pharmaceutical industry to replace animal models for analyzing the toxicity of new drugs. A few months ago, Organovo launched its second commercial product, bioprinted human kidney tissue. The company suggests that within a decade we will be able to print solid organs such as liver, heart, and kidney.

Last year, the FDA approved an epilepsy drug called Spritam that is made by 3D printers. It prints out the powdered drug layer by layer to make it dissolve faster than average pills.

The technological advancements happening in healthcare today are truly life changing for both providers and patients. Whether it's a 3D printer creating a model of a person's heart, or a chip monitoring a certain disease, there's no doubt the future of medicine is heading in an exciting direction. We look forward to hearing your thoughts and ideas on medical advancements.

Sometimes recruiting and hiring managers unconsciously target diverse candidates who act like the majority rather than seeking to bring true differences to their organization. When you hire people who think and act like you do, it is comfortable. You know what they look and sound like, and uniformity feels easier to manage. However, doing so stifles diversity, a sense of belonging and innovation. When people who all think alike come together, they consistently dream up similar solutions. High levels of innovation only happen when you leverage the insights of people who see the world differently.

For diversity to bring strength, it must be valued and integrated into company practices and philosophy. This takes time and a commitment to celebrate diversity. It requires the willingness to be open-minded and non-judgmental about the value of differences.

The healthcare industry is constantly evolving, and with new services come new roles. Policies and regulations are always changing, new technologies are being used, and patient care is becoming more convenient for them with telehealth, transportation to medical appointments and increased access to health data.  Below you can learn more about some of the roles. 

Chief diversity and inclusion officer

The importance for healthcare organizations to have a Chief Diversity Officer on board has grown in the past 10 years as health systems have expanded and their patient populations have become more diverse.

Chief Diversity and Inclusion Officers main focus is to promote diversity and inclusion at the organization. Other responsibilities include vendor diversity and eliminating health disparities. Someone in this position should understand the health system's culture and its patient population. According to Modern Healthcare, providers argue that as they care for a larger and more diverse patient population—both inside and outside the hospital setting—a diverse workforce will help them better care for patients.

Population health executives

Population health management is becoming a central focus for more healthcare providers and many are considering adding a Chief Population Health Officer to the executive ranks.

Chief Population Health Officers are responsible for overall strategic direction and coordination of population health and care management. It is expected that a Physician would fill the role but, this Physician will have to have public health experience at a state or national level, have an advanced degree in business or health administration and have experience with team-based care.

Chief clinical officer

The demand for value-based care is growing and hospital executives are better aligning their services by hiring Chief Clinical Officers. This role is becoming clearly distinct from a traditional Chief Medical Officer.

The Chief Clinical Officer (CCO)  role takes on more of the patient engagement and clinical quality outcome work. They must understand lean performance requirements, a management style designed to reduce excess waste and care quality, be familiar with electronic health records as well as experience with the integration of quality data and, broadly, the ability to improve processes.

Physician leadership roles

As the hospital field tackles clinical integration, population health and performance improvement to drive transformational change, Physician leadership is crucial. Physician leaders should have exceptional people skills, be capable of communicating effectively and building trust across multidisciplinary groups. Management training and knowledge of leadership principles are also important.

Chief of staff

The Chief of Staff position has long been a fixture in the political arena as well as in the corporate world. It is fairly new but gaining favor in health care. Not to be confused with a Medical Chief of Staff, the organization’s Chief of Staff serves as the right hand of the CEO.

The health care Chief of Staff's duties depend on the CEO’s needs and what the organization demands of the Chief Executive. Responsibilities can encompass supporting internal operations and day-to-day management, as well as representing and even speaking for the organization in public and with external constituents. The Chief of Staff should fulfill high-level responsibilities befitting an executive.

According to Beckers Hospital Review, other executives, like Analytics Executives, Digital Executives, Technology Transfer Executives and Shared Services Executives are also on the rise.

Nurse Amanda Eller in North Carolina shared this video comparing the lungs of a smoker with the lungs of a healthy patient. The damaged lungs belonged to a smoker who had smoked a pack of cigarettes a day for 20 years, Amanda wrote on Facebook.

The difference between the two sets of lungs is immediate before she even inflates them. 

As Eller explains in the video, the lungs collapse in a way not seen in the healthy set. She says, "The elastance is gone. So they will stretch out but then the recoil of them just snaps right back because there's nothing left to hold them open."

According to the American Lung Association, Every year in the U.S., more than 480,000 people die from tobacco use and exposure to secondhand smoke, making it the leading cause of preventable death in this country. Tragically, each day thousands of kids still pick up a tobacco product for the first time.

You know the old saying, “A picture is worth a thousand words”. Well this video is very powerful and conveys the damage done by smoking! Many Nurses see this kind of damage in the work they do, but many don’t. Please share with your colleagues and loved ones.

Major health care giants like Dana-Farber Cancer Institute and Massachusetts General Hospital have pledged to improve diversity recruitment of health workers. Reports showed a lack of diversity in hospitals and care discrepancies among patients. The hospitals plan to increase resources, hire executives focused on improving diversity and inclusion in their organizations, and more.

The lack of diversity in the healthcare workforce can impact patient care. Minority patients are more likely to seek out and follow advice from health professionals who look, sound, eat, worship and share the same cultural customs and values like they do. 

The U.S. population overall is changing and quite rapidly. In 2010, the number of residents age 5 and older speaking a language other than English at home had climbed 158% to 59.5 million from 23.1 million in 1980, according to the U.S. Census Bureau. By 2044, more than half the nation is expected to be made up of minority races or groups, according to a 2015 Census Bureau report.

Yet, statistics show healthcare isn't keeping pace with population changes. Minorities made up just 14% of hospital boards and only 11% of executive leadership positions in 2015, according to a survey from the American Hospital Association's Institute for Diversity in Health Management. This disparity exists even though minorities represent roughly 30% to 35% of patients in hospitals.

Dana-Farber Cancer Institute officials told Becker's Hospital Review they plan to hire a leader for diversity programs, and will require all faculty and administration to complete a bias awareness workshop, among other initiatives, as part of the institution's 2018 strategic plan.

Dianne Austin, workforce diversity program manager at Massachusetts General Hospital, told Healthcare Dive, "Mass General has an orientation where new employees attend a program on diversity and inclusion and learn about various resources available to employees, such as a citizenship program, careers days and school admissions officers. There are also multiple staff committees focused on improving diversity and inclusion."

Akron Children's Hospital supports a program that aims to improve Nursing diversity. The program's plan is to increase the number of interns in the program and provide tuition support during their senior year of college. The hope is that program participants will return to Akron Children's after graduation to begin their Nursing career.

 "Nursing diversity is vital to ensuring a positive experience for our patients," said William Considine, CEO of Akron Children's Hospital. "Not only does this program provide a valuable educational experience, it also helps Akron Children's recruit more prepared Nurses and helps our workforce reflect the diversity of the patients, families and communities we serve."

UC Health intends to contribute $1.5 million to create University of Cincinnati scholarships designed to diversify the medical profession. The hospital system hopes the scholarships will help all local health systems diversify their workforce when hiring doctors, Nurses, pharmacists and medical technicians. 

“We know through recent research that underrepresented adults in Cincinnati believe their race negatively impacts their treatment from medical professionals,” said Dr. Rick Lofgren, CEO of UC Health. “This investment is a step to improve health care for all of our patients and to foster a health care workforce that reflects the diversity of our population.”

Diversity & Inclusion initiatives can be difficult to sustain, but commitment to increasing D&I at all levels of your organization will bring new perspectives and values to your hospital/health system, which can help decrease health disparities across the board. Bravo to the healthcare leaders that are seriously acting on their D&I initiatives! Do you see progress in this area where you work or teach?