DiversityNursing Blog

By David McNamee

Between 1990 and 2013, global life expectancy increased by nearly 5.8 years in men and 6.6 years in women, according to a new analysis of the Global Burden of Disease Study 2013 published in The Lancet.

"The progress we are seeing against a variety of illnesses and injuries is good, even remarkable, but we can and must do even better," says lead author Dr. Christopher Murray, professor of Global Health at the University of Washington. 

"The huge increase in collective action and funding given to the major infectious diseases such as diarrhea, measles, tuberculosis, HIV/AIDS and malaria has had a real impact," he says. 

"However, this study shows that some major chronic diseases have been largely neglected but are rising in importance, particularly drug disorders, liver cirrhosis, diabetes and chronic kidney disease."

The analysis suggests that life expectancies in high-income regions have been increased due to falling death rates from most cancers - which are down by 15% - and cardiovascular diseases - which are down by 22%.

In low-income countries, rapidly declining death rates for diarrhea, lower respiratory tract infections and neonatal disorders have boosted life expectancy.

Despite the increases in global life expectancy by nearly 5.8 years in men and 6.6 years in women, some causes of death have seen increased rates of death since 1990.

These increased causes of death include:

• Liver cancer caused by hepatitis C (up by 125%)
• Atrial fibrillation and flutter (serious disorders of heart rhythm; up by 100%)
• Drug use disorders (up by 63%)
• Chronic kidney disease (up by 37%)
• Sickle cell disorders (up by 29%)
• Diabetes (up by 9%)
• Pancreatic cancer (up by 7%).

HIV/AIDS has 'erased years of life expectancy' in sub-Saharan Africa

The report also points to one notable global region where life expectancy is not increasing. Deaths from HIV/AIDS have erased more than 5 years of life expectancy in sub-Saharan Africa, say the authors. HIV/AIDS remains the greatest cause of premature death in 20 of the 48 sub-Saharan countries.

Since 1990, years of life worldwide lost due to HIV/AIDS is reported as having increased by 334%.

In Syria, war is the leading cause of premature death - the conflict caused an estimated 29,947 deaths in 2013, and up to 54,903 and 21,422 deaths in each of the preceding 2 years.

Countries that the authors consider to have made "exceptional gains in life expectancy" over the past 23 years include Nepal, Rwanda, Ethiopia, Niger, Maldives, Timor-Leste and Iran - where, for both sexes, life expectancy has increased by more than 12 years.

Life expectancy at birth in India increased from 57.3 years for men and 58.2 years for women in 1990 to 64.2 years and 68.5 years, respectively, in 2013. The authors say that India has made "remarkable progress" in reducing deaths, with the death rates for children dropping 1.3% per year for adults and 3.7% per year for children.

The report also welcomes dramatic drops in child deaths worldwide over the study period. In 1990, 7.6 million children aged 1-59 months died, but this death rate was down to 3.7 million by 2013.

Igor Rudan and Kit Yee Chan, from the Centre for Population Health Sciences and Global Health Academy at the University of Edinburgh Medical School in the UK, write in a linked comment:

"Estimates of the causes of the global burden of disease, disability, and death are important because they guide investment decisions that, in turn, save lives across the world.

Although WHO's team of experts have been doing fine technical work for many years, its monopoly in this field had removed incentives to invest more time and resources in continuous improvement [...] the competition between WHO and the GBD [Global Burden of Disease Study] has benefited the entire global health community, leading to converging estimates of the global causes of death that everyone can trust."

 

Source: www.medicalnewstoday.com

By Marie Ellis

It is well known that exercise is good for the mind and body, but to what extent does the neighborhood or community in which we live affect our physical and mental health? New research from the University of Kansas suggests the walkability of a community has a great impact on cognition in older adults.

Previous studies have detailed the importance physical exercise has for executive function in older adults.

But how can the layout of a neighborhood encourage its residents to get out and walk? This is precisely what Amber Watts, assistant professor of clinical psychology at the University of Kansas, wanted to find out.

"Depending on which type of walking [leisure vs. walking to get somewhere] you're interested in, a neighborhood might have different characteristics," she says. "Features of a neighborhood that encourage walking for transportation require having someplace worth walking to, like neighbors' houses, stores and parks."

She adds that neighborhoods that encourage leisure walking have "pleasant things to look at," including walking trails and trees, and they should feel safe.

Her research, which she presented yesterday at the Gerontological Society of America's annual meeting in Washington, DC, suggests that neighborhoods that encourage walking can protect against cognitive decline in older adults.

To conduct her research, Watts used geographic information systems (GIS) to judge walkability. This involved maps that measure and analyze spatial data.

Better physical and mental health

Detailing how she collected her data, Watts explains:

"GIS data can tell us about roads, sidewalks, elevation, terrain, distances between locations and a variety of other pieces of information. We then use a process called space syntax to measure these features, including the number of intersections, distances between places or connections between a person's home and other possible destinations they might walk to."

She also looked at how complicated a route is from one location to another: "For example, is it a straight line from point A to point B, or does it require a lot of turns to get there?"

To conduct the study, Watts and colleagues tracked 25 people with mild Alzheimer's disease and 39 older adults without any cognitive impairment. Using the space syntax data, they created a "walkability score" for the participants' home addresses.

Then, they estimated the relationship between a person's neighborhood scores and how well they performed on cognitive tests over 2 years. The cognitive tests included three categories: attention, verbal memory and mental status. The team also factored in issues that might influence cognitive scores, including age, gender, education and wealth.

Results from the study suggest that communities that are easier to walk in are linked to better physical health outcomes - such as lower body mass and blood pressure - and cognition - including better memory.

Watts and her colleagues believe their findings could benefit older adults, health care professionals, caregivers and even architects and urban planners.

Do mentally complex neighborhoods act like a brain-training game?

Though elaborate community layouts may be expected to confuse older residents, Watts and her team found that they actually serve to keep cognition sharp.

"There seems to be a component of a person's mental representation of the spatial environment, for example, the ability to picture the streets like a mental map," Watts says.

She adds that complicated environments may demand more intricate mental processes in order to navigate them, which could keep the mind sharp. This is in line with previous studies, which have demonstrated how staying mentally active helps to preserve memory.

"Our findings suggest that people with neighborhoods that require more mental complexity actually experience less decline in their mental functioning over time," Watts adds.

She explains that a challenging environment keeps an individual's body and mind healthy:


"With regard to the complexity of neighborhood street layouts - for example, the number of turns required getting from point A to point B - our results demonstrate that more complex neighborhoods are associated with preserved cognitive performance over time.


We think this may be because mental challenges are good for us. They keep us active and working at that optimal level instead of choosing the path of least resistance."

A National Institute on Aging grant, KU Strategic Initiative Grant and Frontiers Clinical Translational Science award helped fund the study.

Source: www.medicalnewstoday.com

As seen in The New York Times    

There is already a shortage of doctors in many parts of the United States. The expansion of health care coverage to millions of uninsured Americans under the Affordable Care Act will make that shortage even worse. Expanding medical schools and residency programs could help in the long run.

But a sensible solution to this crisis — particularly to address the short supply of primary care doctors — is to rely much more on nurse practitioners, physician assistants, pharmacists, community members and even the patients themselves to do many of the routine tasks traditionally reserved for doctors.

There is plenty of evidence that well-trained health workers can provide routine service that is every bit as good or even better than what patients would receive from a doctor. And because they are paid less than the doctors, they can save the patient and the health care system money.

Here are some initiatives that use non-doctors to provide medical care, with very promising results:

PHARMACISTS A report by the chief pharmacist of the United States Public Health Service a year ago argued persuasively that pharmacists are “remarkably underutilized” given their education, training and closeness to the community. The chief exceptions are pharmacists who work in federal agencies like the Department of Veterans Affairs, the Department of Defense and the Indian Health Service, where they deliver a lot of health care with minimal supervision. After an initial diagnosis is made by a doctor, federal pharmacists manage the care of patients when medications are the primary treatment, as is very often the case.

They can start, stop or adjust medications, order and interpret laboratory tests, and coordinate follow-up care. But various state and federal laws make it hard for pharmacists in private practice to perform such services without a doctor’s supervision, even though patients often like dealing with a pharmacist, especially for routine matters.

NURSE PRACTITIONERS In 2012, 18 states and the District of Columbia allowed nurse practitioners, who typically have master’s degrees and more advanced training than registered nurses, to diagnose illnesses and treat patients, and to prescribe medications without a doctor’s involvement.

Substantial evidence shows that nurse practitioners are as capable of providing primary care as doctors and are generally more sensitive to what a patient wants and needs.

In a report in October 2010, the Institute of Medicine, a unit of the National Academy of Sciences, called for the removal of legal barriers that hinder nurse practitioners from providing medical care for which they have been trained. It also urged that more nurses be given higher levels of training, and that better data be collected on the number of nurse practitioners and other advance practice nurses in the country and the roles they are performing. Tens of thousands will probably be needed, if not more.

Mary Mundinger, dean emeritus of Columbia University School of Nursing, believes highly trained nurses are actually better at primary care than doctors are, and they have experience working in the community, in nursing homes, patients’ homes and schools, and are better at disease prevention and helping patients follow medical regimens.

RETAIL CLINICS Hundreds of clinics, mostly staffed by nurse practitioners, have been opened in drugstores and big retail stores around the country, putting basic care within easy reach of tens of millions of people. The CVS drugstore chain has opened 640 retail clinics, and Walgreens has more than 350. The clinics treat common conditions like ear infections, administer vaccines and perform simple laboratory tests.

A study by the RAND Corporation of CVS retail clinics in Minnesota found that in many cases they delivered better and much cheaper care than doctor’s offices, urgent care centers and emergency rooms.

TRUSTED COMMUNITY AIDES One novel approach trains local community members who have experience caring for others to deliver routine services for patients at home. Two pediatric Medicaid centers in Houston and Harrisonburg, Va., have tested this concept to see if it can reduce the cost of home care and avoid unnecessary admissions to a clinic or hospital.

The aides are trained to consult with patients over the phone by asking questions devised by experts. A supervising nurse makes the final decisions on the care a patient requires. The community aide may visit the patient, provide care in the home and send photos or videos back to the supervising nurse by cellphone.

The aides are typically paid about $25,000 a year, according to an article in Health Affairs by the pilot study’s leaders. The study concluded that the program would have averted 62 percent of the visits to a Houston clinic and 74 percent of the emergency room visits in Harrisonburg.

The aides cost $17 per call or visit, compared with Medicaid payment rates of $200 for a clinic visit in Houston and $175 for an emergency room in Harrisonburg.

SELF-CARE AT HOME A program run by the Vanderbilt University Medical Center and its affiliates lets patients with hypertension, diabetes and congestive heart failure decide whether they want a care coordinator to visit them at home or prefer to measure their own blood pressure, pulse or glucose levels and enter the results online, where the data can be immediately reviewed by their primary care doctor. The patient could consult by phone or e-mail with a nurse about his insulin dosage, but there would be no need for a costly visit to a doctor.

Taking this idea a step further, a hospital in Sweden, prodded by a kidney dialysis patient who thought he could do his own hemodialysis better than the nursing staff, allowed him to do so and then teach other patients, according to the Institute for Healthcare Improvement, a nonprofit organization in Cambridge, Mass. Now most dialysis at that hospital is administered by the patients themselves. Costs have been cut in half, and complications and infections have been greatly reduced.

HEALTH REFORM LAW The Affordable Care Act contains many provisions that should help relieve the shortage of primary care providers, both doctors and other health care professionals.

It provides money to increase the number of medical residents, nurse practitioners and physician assistants trained in primary care, yielding more than 1,700 new primary care providers by 2015. It offers big bonuses for up to five hospitals to train advanced practice nurses and has demonstration projects to promote primary care coordination of complex illnesses, incorporating pharmacists and social workers in some cases. And it offers financial incentives for doctors to practice primary care — like family medicine, internal medicine and pediatrics — as opposed to specialties.

These are all moves in the right direction, but they will need to be followed by even bigger steps and protected from budget cuts in efforts to reduce the deficit.

From Human Resource Executive Online By Katie Kuehner-Hebert

It's one thing to be bullied by a co-worker or a boss, but simply witnessing the behavior in the workplace can be enough to make a worker call it quits, according to a study of "ambient" bullying.

Researchers at the University of British Columbia in Vancouver, Canada surveyed 357 nurses in 41 hospital units and found a statistically significant link between working in an environment where bullying was occurring and a desire to leave the organization. The study was published last month in the journal Human Relationsby SAGE.

"We underestimate the power of the impact of just being around bullying in the workplace," says Sandra Robinson, a professor at UBC's Sauder School of Business and one of the authors of the study.

"For those seeking to influence problematic behavior, they need to be sensitive [to the fact] that the impact of such behavior transcends the person or the group . . . actually being bullied, and that there may be other victims who are impacted by the harmful behavior, whether it comes from their supervisor or co-workers," Robinson says.

Marianne Jacobbi, senior editor at Ceridian/Lifeworks EAP programs in Boston, says research has shown that ambient bullying, or "indirect bullying" is pervasive -- 70 percent of employees say they have witnessed other people being bullied or mistreated at work.

"Bullying has a negative effect on team relationships, which creates a toxic work environment," Jacobbi says. "When [people] witnesses bulling, they think, 'This could be me next,' particularly if it's their boss."

Indeed, research has also shown that 72 percent of all bullies are bosses, she says.

HR managers should encourage an environment in which people feel safe to discuss bullying they've witnessed, and assessed that their comments will remain confidential whether they come to their boss, the HR department or the organization's employee-assistance program, Jacobbi says.

"The most important thing is creating a climate where people feel they have someplace to go when they feel uncomfortable," she says.

Ken Zuckerberg, director of training at ComPsych Corp. in Chicago, says HR managers not only have to watch out for employees with low morale after witnessing bullying, but also employees who try to appease the bully and make bad business decisions to avoid getting on their bad side.

When dealing with bullying behavior, organizations should treat it as a performance problem first and foremost, Zuckerberg says. A common mistake that HR managers often make in these situations is to take on the role of a counselor and try to figure out what is going on in the bully's life to cause them to act that way.

"One word of caution ? you want to continue to manage performance, but you don't want to be diagnosing mental-health issues," he says. "Most HR managers are not clinicians and they instead, should refer the bully to their EAP for help in uncovering what might be core issues behind bullying."

Seymour Adler, a partner with Aon Hewitt in New York and an organizational psychologist, says some people who witness bullying in the workplace feel they've been put in "a totally untenable situation of whether or not they need to try to be a hero."

"Who knows what the consequences will be if they do something about it, so they end up being passive about it," Alder says. "That can really be very corroding to their self-esteem, to how they view themselves as human beings."

If top-level managers are bullies, HR managers need to risk confronting them for the sake of the rest of the organization, he says.

"[HR managers have] the responsibility for the motivation, effective use and treatment of all of the human capital within their organizations," Adler says. "They need to be true to their value system, even if it ends up costing them their job."

From thestarpress.com By Michelle Kinsey

MUNCIE — Indiana University Health Ball Memorial Hospital wants to make sure that every person who walks through their doors gets equal treatment.

That commitment has landed the hospital at the top of a list, as the first in the state to be designated as lesbian, gay, bisexual, transgender (LGBT) friendly by the Human Rights Campaign, the nation’s largest LGBT civil rights organization.

The news came in the form of the HRC’s annual Healthcare Equality Index for 2012, which looks at how equitably healthcare facilities in the United States treat their lesbian, gay, bisexual and transgender patients and employees.

IU Health BMH was one of 234 nationwide — but the only one in the state — recognized as a “Leader in LGBT Healthcare Equality,” meeting all four core policy categories — patient non-discrimination; employment non-discrimination; equal visitation for same-sex partners and parents, and training in LGBT patient-centered care.

“We are proud of the recognition,” said IU Health BMH President and CEO Mike Haley. “It’s the result of a lot of hard work.”

That work began two years ago, after a transgender patient claimed she was mistreated in the hospital’s emergency room.

Transsexual Erin Vaught claimed she was called “it” and “he-she” and eventually denied treatment when she went to the ER on July 18, 2010, for a lung condition that was causing her to cough up blood.

Complaints were filed days later by Indiana Equality and Indiana Transgender Rights Advocacy Alliance and the incident went viral, with the hospital receiving criticism nationwide, and beyond.

Ball Memorial Hospital released a statement saying the hospital was conducting an internal review.

The result?

“We failed to meet their needs,” Haley said. “We acknowledged that openly.”

Then they went a step further.

“It’s one thing to apologize,” he said. “It’s another to say, ‘And furthermore, I want this hospital to be considered as a place anyone would want to go if they needed a hospital.’”

Haley issued a challenge to all physicians, employees and volunteers to meet every HRC key indicator.

Ann McGuire, vice president of human resources for IU Health BMH, led the hospital’s efforts. Members of the LGBT community were asked to help.

Jessica Wilch, board member and past president of Indiana Equality, an LGBT rights group, said she was a “believer in what (IU Health BMH was) trying to do” from the first meeting.

“When this went viral, my concern was that BMH would take the stand that this was an isolated incident and just pacify the process,” Wilch said. “Instead they saw it as a teachable moment.”

New policies were drafted and training was developed.

In addition to hospital leaders, anyone a patient would come in contact with was involved in the training, McGuire said, adding that it was about more than just a tutorial. It was about “eye-opening” conversations.

Wilch agreed, saying that face-to-face conversations with the LGBT community were essential.

“We could talk freely about the things we have encountered and then come up with ways, together, to handle it differently,” she said.

Overall, the HRC reports the number of American hospitals striving to treat lesbian, gay, bisexual, and transgender (LGBT) patients equally and respectfully is on the rise.

This year’s survey found a 40 percent increase in rated facilities.

Last year, IU Health BMH was short a few policy additions for the leadership HRC designation, but was still recognized for its efforts.

Wilch said she was not surprised the hospital “hit all of the marks” this year.

“They have become, essentially, one of the leading hospitals in the country, because it really started with them,” she said. “They were the ones who reached out to us and said ‘How can we make this better? How can we do the right thing?’”

Haley said he believed the training and policies developed at IU Health BMH will be used “across IU Health.”

IU Health BMH has also set out to look at other ways to expand their “best practices” when it comes to diversity, McGuire said. The hospital has been hosting Palettes of Diversity events, which have celebrated not only the LGBT community, but other cultures.

“We are making sure we are hard-wiring an environment recognizing and supporting diversity for all who come here,” Haley said.

McGuire agreed.

“It’s about relationships and dignity and respect,” she said. “It is uniqueness that each of us brings that makes us stronger as a community.”

And, McGuire would tell you, as a hospital.

By Elizabeth Landau via CNN

(CNN) -- Hospitals near Aurora, Colorado, were flooded with victims after a movie theater shooting Friday morning.

An Aurora Fire Department call log reveals the urgency of the situation.

"If they're dead just leave them," a voice tells a fire department responder who reported that police said there may be a number of people dead inside the theater. "We're in a mass casualty situation at this time. Please make sure that you guys set up some kind of transport officer over there that can contact the hospitals so we don't overload one."

The emergency department at Denver Health Hospital was chaotic as staff prepared for the arrival of patients from the shooting, said Dr. Christopher Colwell, director of emergency medical services there. The hospital received seven victims, but called in extra personnel and was ready to take in more patients.

"You're not sure how they're going to arrive to you, so you prepare for the worst," he said.

Shooter had 100-round rifle magazine

Gunshot wound patients are fairly regular at Denver Health, although not on this scale, he said. In a mass shooting situation, staff assess the severity of the wounds and what steps must be taken -- some need to go straight to the operating room, others can wait, still others may not require surgery.

Colwell was a physician who treated victims at the scene of the Columbine High School shootings in 1999. Five patients were transferred to Denver Health; all survived.

"We have obviously done a lot of training exercises since then to try to prepare for an event like that," Colwell said.

Dr. Frank Lansville, medical director of emergency services at Aurora South Hospital, told CNN his hospital had seen 18 patients so far, 12 of whom suffered from gunshot wounds. There were several tear gas victims who were stable, he said. They had been seen, decontaminated and discharged. "The others had horrific gunshot wounds to various parts of their body," he said.

At Aurora Medical Center, the first victim of the movie theater shooting came in before the staff had even heard about the attack, said Tracy Lauzon, director of EMS and trauma services at the hospital.

Few hints of movie-theater shooting suspect's past

Soon after, the trauma surgeon learned more victims were headed their way. Four other trauma surgeons, two orthopedic surgeons and various other physicians came to help. Six patients have gone through surgery.

Aurora Medical Center has taken in 15 patients from the shooting, she said. Eight have been treated and discharged from the emergency room; the other seven were admitted.

"We do drills twice a year anticipating this kind of thing, so people are very well prepared and the hospitals are very well prepared," Lauzon said.

Most of the hospitals in the Denver area follow established federal guidelines for emergency response, said Nicole Williams, spokeswoman for Swedish Medical Center, which treated four victims from the shooting at the movie theater. "We were extremely prepared coming into this," she said because the hospital has already completed a couple of disaster drills this year.

During such a drill, a mass page goes out to the hospital administration alerting officials that EMS has multiple patients who could be transported to area hospitals, and the staff is told be on standby. Emergency workers call the hospitals to see how many beds are available and how many critical patients they can take.

Then, the hospital brings in essential staff, in addition to extra trauma surgeons or other specialists as needed.

"It's a very controlled atmosphere," Williams said. "We all try to stay very calm and just serve the community to the best of our abilities."

Theater shooting unfolds in real time over social media

Staff at Swedish Medical Center's command center fielded hundreds of phone calls "from very panicked people looking for their husbands, their wives, their children," Williams said.

Swedish Medical Center was still treating three patients for gunshot wounds: an 18-year-old male in fair condition, a 20-year-old male in critical condition and a 29-year-old female in critical condition. A fourth patient, a 19-year-old female, came in a few hours after the shootings with minor injuries, possibly caused by shrapnel. She was treated and released.

The family members of the victims at the hospital have been notified, Williams said. "All of the victims have loved ones -- family or friends -- by their side, while they're here," she said.

Kari Goerke, Swedish Medical Center's chief nursing officer, worked in the operating room in the aftermath of the Columbine shootings of 1999. Swedish Medical Center treated four Columbine victims, all of whom survived.

"We had them all in the operating room within an hour of the event," Goerke said. "That gives them much better chances."

The staff responded with expertise and compassion both in 1999 and on Friday morning, she said.

Aspiring sports reporter killed in shooting

"Afterwards you kind of think about what's happened and the shock and awe of the whole situation and how horrific it is," she said. Her voice cracked as she discussed the emotional aftermath. "Taking care of kids is always hard. I'm a mom, I can relate. That makes it difficult."

But, she added, "it's what we're trained to do."

By Diane Sparacino via rn.com

Imagine a world where hospitals have become so noisy that the annoyance has topped hospital complaints, -- even more than for the tasteless, Jell-O-laden hospital food (Deardorff, 2011). If you’re a nurse, you know that we’re already there -- with noise levels reaching nearly that of a chainsaw (Garcia, 2012). In fact, for more than five decades, hospital noise has seen a steady rise (ScienceDaily, 2005).

But it wasn’t always that way. At one time, hospitals were virtually noise-free like libraries -- respected spaces, preserved as quiet zones. The culture was such that a loud visitor might be silenced by a nurse’s purposeful glare or sharply delivered “Shhh!” As early as 1859, the importance of maintaining a quiet environment for patients was a topic for discussion. In Florence Nightingale’s book, “Notes on Nursing,” she described needless noise as "the most cruel absence of care" (Deardorff, 2011).
 
Fast forward to 1995, when the World Health Organization (WHO) outlined its hospital noise guidelines, suggesting that  patient room sound levels not exceed 35 decibels (dB). Yet since 1960, the average daytime hospital noise levels around the world have steadily risen to more than double the acceptable level (from 57 to 72 dB), with nighttime levels increasing from 42 to 60 dB. WHO found that the issue was not only pervasive, but high noise levels remained fairly consistent across the board, despite the type of hospital (ScienceDaily, 2005).

Researchers at Johns Hopkins University began to look into the noise problem in 2003. They maintained that excessive noise not only hindered the ability for patients to rest, but raised the risk for medical errors. Other studies blamed hospital noise for a possible increase in healing time and a contributing factor in stress-related burnout among healthcare workers (ScienceDaily, 2005).

Technology is, of course, partly to blame. State-of-the-art machines, banks of useful alarms, respirators, generators, powerful ventilation systems and intercoms all add up to a lot of unwanted racket. When human voices are added to the mix, (i.e.  staff members being forced to speak loudly over the steady din of medical equipment), it’s anything but a restful environment. For the recovering patient in need of sleep, that can be a real issue (Deardorff, 2011).

Contributing to the problem, experts say, are the materials used in hospitals. Because they must be easily sanitized, surfaces cannot be porous where they could harbor disease-causing organisms. Rather than using noise-muffling materials like carpet, acoustic tiles and other soft surfaces, hospitals have traditionally been outfitted using smooth, hard surfaces – especially in patient rooms. Good for cleanliness – not so great for dampening sounds, which tend to bounce around the typical hospital (Deardorff, 2011).

Which brings us to the most recent research, published January 2012 in the Archives of Internal Medicine. In the report, Jordan Yoder, BSE, from the Pritzker School of Medicine, University of Chicago, and his colleagues associated elevated noise levels with “clinically significant sleep loss among hospitalized patients,” perhaps causing a delay in their recovery time (Garcia, 2012). During the 155-day study period, researchers examined hospital sound levels. The numbers far exceeded (WHO) recommendations  for average hospital-room noise levels, with the peak noise at an average 80.3 dB – nearly as loud as a chainsaw or electric sander (85 dB), and well over the recommended maximum of 40 dB. And while nights tended to be quieter, they were still noisier than recommended allowances, with “a mean maximum sound level of 69.7 dB” (Garcia, 2012).

Perhaps most interestingly, the researchers broke down the sources of noise into categories: “Staff conversation (65%), roommates (54%), alarms (42%), intercoms (39%), and pagers (38%) were the most common sources of noise disruption reported by patients” (Garcia, 2012). "Despite the importance of sleep for recovery, hospital noise may put patients at risk for sleep loss and its associated negative effects," they wrote. In addition, researchers found that the intensive care and surgical wards had some work to do in dampening noise levels, with ICU peaking at 67 dB and 42 dB for surgical areas. Both far exceeded WHO’s 30 dB patient room recommendation (Garcia, 2012).

Besides patient sleep deprivation, which itself can lead to a multitude of health problems including high blood sugar, high blood pressure and fatigue, studies have reported that elevated noise levels can increase heart and respiratory rates, blood pressure and cortisol levels. Recovery room noise causes patients to request more pain medication, and preterm infants “are at increased risk for hearing loss, abnormal brain and sensory development, and speech and language problems when exposed to prolonged and excessive noise” (Deardorff, 2011).

There is still more research to be done, of course, but Yoder and his colleagues had good news, as well; much of the hospital noise they identified is modifiable, suggesting that hospitals can take steps to successfully create a quieter environment for both patients and healthcare providers (Garcia, 2012).

Around the country, “quiet campaigns” have been launched by hospitals in an attempt to dampen nighttime noise. Besides dimming lights and asking staff to keep their voices down at night, they are working to eliminate overhead paging systems, replace wall and/or floor coverings – even the clang of metal trashcans. Northwestern's Prentice Women's Hospital in Chicago was built with noise reduction in mind, replacing the idea of centralized nursing stations with the advent of smaller, multiple stations (Deardorff, 2011)

Billed as “one of the nation’s largest hospital construction projects,” Palomar Medical Center in North San Diego County is a state-of-the-art facility that has been designed “to encourage quietness,” according to Tina Pope, Palomar Health  Service Excellence Manager. Slated to open its doors this August, the hospital will feature a new nursing call system to route calls directly to staff and help eliminate the need for overhead paging, de-centralized nursing stations and clear sight lines, allowing staff to check on patients without having to leave unit doors open. With measures already in place including “Quiet Hospital” badges on staff and posters at the entrance of every unit, a “Quiet at Night” campaign (9 p.m. – 6 a.m.), and a “Quiet Champions” program that encourages staff to report noise problems, Palomar is one of a growing number of hospitals working toward a new era of quiet.

By Debra Wood via NurseZone.com

July 12, 2012 - Who says that mentorships are only useful for new, fresh-out-of-school nurses?  Health care facilities, schools of nursing and professional associations are trying new approaches to reach out and support nurses throughout their careers, resulting in benefits for all parties involved.

Mentors can guide a nurse’s career and help the mentee weigh alternatives and avoid pitfalls; at the same time, mentors enhance their own skills and the profession as they pass along knowledge and intangibles necessary for success. And employers can realize a double bonus--by improving retention rates at both levels within their workforce.

“Mentors are critical to our profession,” said Lois L. Salmeron, Ed.D, RN, MS, CNE, ANEF, associate dean for academic affairs and professor at the Kramer School of Nursing at Oklahoma City University in Oklahoma. “This is one way to nurture our own and retain nurses.”

The Kramer School offers a formal mentoring program, assigning a seasoned faculty member to someone new to the program, ideally team teaching. Most remain close after the one-year formal program ends.

“We view [mentoring] as key to a positive transition,” said Salmeron, who adds that mentors also are important when a nurse wants to change specialties.

Cynthia Nowicki Hnatiuk, EdD, RN, CAE, executive director of the Academy of Medical-Surgical Nurses, called mentors the single most effective way to help nurses learn a new role and increase their confidence.

“It provides a one-on-one opportunity for two individuals to teach and learn together,” Hnatiuk said.

“Mentorship is something that never really stops, and something each person has to take responsibility for themselves,” added Ora Strickland, Ph.D., RN, FAAN, dean of the Florida International University (FIU) College of Nursing and Health Sciences in Miami. “You will have many mentors through your career, and more than one mentor at one time, depending on what you are trying to gain skills in.”

Strickland has found most mentors enjoy the experience.

FIU offers a research mentorship program to increase the research productivity of its faculty and help them learn how to network, seek funding, conduct studies and publish their findings. The mentorships cross disciplines to encourage collaboration.

Formal mentoring programs

Many nursing employers provide formal mentoring programs.

UnitedHealth Group Center for Nursing Advancement built its own nurse mentoring initiative, leveraging best practices. It facilitates monthly in-person and virtual mentor/mentee interactions. Mentees submit profiles about development needs and potential mentors’ strengths, and the center electronically matches them. After the one-year mentorship ends, mentees can continue attending special events.

Dawn Bazarko, DNP, MPH, RN, senior vice president of the Center for Nursing Advancement, reports 100 percent of the first cohort of nurse mentees has continued working at UnitedHealth and 21 percent have received a promotion. The center is now building a new mentoring program for more seasoned nurses within the organization to take on broader leadership roles.

“We’re taking our experience to inspire and evolving that to address the needs of our senior nurses,” Bazarko said. “Nurses are critical to the people we serve, modernized health care and our business success. It’s a deliberate investment in their personal and professional enrichment.”

MedStar Good Samaritan Hospital in Baltimore also offers a formal mentoring program and has found it reduces turnover and increases productivity, reported Joy Burke, RN, MSN, CCRN, a clinical specialist at Good Samaritan. The hospital offers mentoring classes to prospective mentors, who must have at least two years of experience. Approximately 130 nurses have taken the course and are currently mentoring 67 novice nurses.

“The nurse has a friend, a buddy, someone they can call on,” Burke said. “They get critical feedback from the mentor.”

Huntington Hospital in Pasadena, Calif., pairs new hires with a mentor, said Lynette Dahlman, MSN, RN-BC, director of clinical education and academic partnerships. Serving as a mentor earns credit toward a nurse’s career ladder.

Nurses do everything they can to help a nurse grow, so they are proud to work alongside [of them],” Dahlman said.

Texas Children’s Hospital in Houston also offers a formal mentoring program. The hospital matches mentors and mentees with like backgrounds and with the skills the mentee needs. Formalized classes provide resources and an objective look at internal resources.

Kara Boakye, RN, BSN, CPN, nurse manager of the progressive care unit at Texas Children’s, said she has gotten to know herself better and become a better leader after being mentored by Emily Weber, RN, NEA-BC, nursing director for newborns at the hospital.

“I feel I gain just as much from the relationship, because it makes me pause and think about why I would make that decision,” Weber said. “Both parties gain a lot from it.”

South Nassau Community Hospital in Oceanside, N.Y., takes a slightly different approach with its mentoring program, designed to help nurses advance to the expert level. It matches nurses with potential to move up with outstanding stars who can mentor and coach them in communication skills, working within the organization and understanding the health care industry.

“Mentoring isn’t about clinical skills,” said Sue Penque, Ph.D, RN, CNP, chief nursing officer at South Nassau. “A mentor is above and beyond what you get in didactic training.”

South Nassau conducts annual assessments of nurses’ strengths and performance to evaluate the effectiveness of the program. It also identifies experiences where people can grow and take on new responsibilities while the mentor is present and able to coach.

Finding a mentor

While a formal program might make it easier to connect with a mentor, nurses often can find one independently. Nurses should observe others who practice as they aspire to and approach that person, advises Hnatiuk.

Penque has asked a nursing leader in academia whom she admired to mentor her.

Strickland has approached subject-matter experts whose abilities and skills she respected and asked them for mentoring and has never been turned down.

Finding the right mentor “can be just as hard as finding a good husband or wife--and well worth the search,” said author and relationship expert April Masini of Naples, Fla. She recommended being persistent and trying until you connect with the right person; when you succeed, be careful not to seek more time than agreed upon and to respect professional boundaries.

The Academy of Medical-Surgical Nurses recently launched a free, self-directed mentoring program with online validated tools, including mentor and mentee guides, for nurses new to the specialty and those who are changing settings.

“We would love for people to use the resources,” Hnatiuk said.

Mentoring across the profession

In addition to mentors in clinical and academic settings, nurses also mentor each other in professional associations.

The Association of Pediatric Hematology/Oncology Nurses recently introduced a members-only, two-year mentoring program, which matches experienced mentors with mentees. The goal is to facilitate member’s career growth and leadership development.

Ramón Lavandero, RN, MA, MSN, FAAN, senior director of communications and strategic alliances for the American Association of Critical-Care Nurses and a clinical associate professor at Yale University School of Nursing in New Haven, Conn., said mentoring is embedded in the fabric of the association’s community of nurses. The organization has a formal process for newly elected board members, and chapter advisors offer mentorship to local leaders.

“Mentorship ranges from coaching on leadership development and succession planning to problem solving challenging situations,” Lavandero said. “A newer chapter known for its innovative activities may mentor an experienced chapter that wants to explore new direction.”

By Amy Standen via NPR

If there is a founding ethos in the world of high-tech startups, it's this: The idea is everything. Facebook's initial public offering might have seemed like the perfect illustration. A simple concept, conceived by a college student, became a $100 billion empire in just 8 years.

But if you look around California's Silicon Valley, ideas all seem to be coming from the same kinds of people. By a recent estimate, 1 percent of technology entrepreneurs are black. Only 8 percent of tech companies are founded by women. Facebook's Mark Zuckerberg isn't just a model of success in the Valley; he's a blueprint.

A new three-week boot camp for entrepreneurs is aimed at adding more diversity to Silicon Valley's startup scene.

Making Their Pitch In Silicon Valley

The New Media Entrepreneurship boot camp trains startup hopefuls to focus their business ideas and present them to investors. Some recent participants:

Seizing Opportunities, From An Early Age

It may be safe to say that some people are just born entrepreneurs. Take Chris Lyons of Johns Creek, Ga., outside Atlanta. When he was 12, he started mowing lawns.

"I'd take my mom's trash can and I would take my lawn mower," he says. "And I would push my lawn mower up and down the hill with one hand, and carry the rolling trash can for the other. I had over 30 lawns in my neighborhood. Then I bought a John Deere tractor."

Someone like that isn't going to stay in John's Creek forever. By the time he was 25, Lyons had set his sights on Silicon Valley.

"There's no other choice," he says. "Like, I want to be in an area that nurtures strong-willed, forward-thinking individuals. And there's no better place than Silicon Valley or San Francisco."

The thing is, when you look at Silicon Valley, especially at people who are starting businesses, they don't typically look like Chris Lyons, who is black.

And that is the whole point of the three-week boot camp for startups called NewMe, for New Media Entrepreneurship.

Reporting To Camp

On the first day of the camp, Lyons is sitting in the living room of a San Francisco townhouse, along with six other entrepreneurs — all women or African-Americans, most of them in their early 20s.

NewME director Angela Benton presents them with bags of swag — sponsor-donated items like shirts, headphones and mobile tablets.

Everyone here came with business ideas. Lyons' company is called PictureMenu, which he hopes will eliminate paper menus.

He's thinking big.

"We're trying to make this a worldwide mobile application," Lyons says.

The idea behind the boot camp is that when it attracts people like Lyons to the area, it also helps nudge Silicon Valley toward diversity.

And that, says venture capitalist and consultant Freada Kapor Klein, is something the Valley badly needs.

"This isn't about being bigots, this isn't about who's mean-spirited and who's enlightened," she says. "This is about how our brains are wired.

Klein says it's human nature: People tend to help people who look like them and who come from similar backgrounds. It's largely subconscious.

"We're not even aware of that hurdle that we've put in the place of a different kind of entrepreneur," she says.

Klein sees the NewME program as a two-way street because without diversity, the industry — and consumers — are missing out.

"If we've got a very insular world, then the kinds of companies that are created — most scratch the itch of a particular set of people and ignore everyone else," she says. "And I think that's the real loss for everybody."

Trouble With The Pipeline

One reason Silicon Valley is so homogenous is what's called the pipeline issue. There just aren't a lot of women, blacks and Latinos enrolling in science and engineering programs.

But there are subtler forces at work, too.

"No one's gonna say, 'I'm not gonna fund you cause you're black,' " says Chris Bennett, a NewME alum who is now a working entrepreneur. "No one's dumb enough to say that. But everyone will tell you that there is a bias."

Working with attorney Nnena Ukuku, Bennett started a Bay Area group called Black Founders.

"I think for some people it's sort of like a chicken-and-egg issue," Ukuku says.

"They've never seen a successful black entrepreneur, so it's hard for them to envision it. But then, they do exist ... it's just a mess."

Removing Self-Imposed Roadblocks

It's a mess because tangled up in all of this are roadblocks that women and people of color often put in front of themselves.

Take, for example, NewME participants Rachel Brooks and Amanda McClure. One day I asked them why instead of NewME, they hadn't applied to a different, more established program, one that wasn't based on race or gender.

And when I asked them this, they seemed kind of stumped.

"I don't know, maybe it just felt a little out of reach," Brooks says.

"Definitely," McClure agrees.

"Maybe that's what it was," Brooks says.

"It wasn't in my realm of conception, you know?" McClure adds.

"That's a much deeper issue," says Ukuku, with a sigh and a laugh.

She's laughing, she says, because she hears this all the time. It's the mindset, Ukuku says, that people have to be brilliant, at the top of their game, to even take a stab at Silicon Valley success.

"And the people that sort of have that tendency to say that tend to be women and minorities," she says. "Whereas I'll talk to some of my friends who I adore, who don't fit into one of those two buckets, and they'll say: 'I got an idea. I'm going for it.' "

Ukuku says she recognizes this confidence because she's seen it among her own relatives back in Nigeria.

"They're the majority in that culture," she says. "There's just an assumption that you will, like — why would you not succeed?"

Campers Pay A Visit To Google

That confidence of belonging is exactly what the NewME participants are trying to cultivate on the program's second day.

They're at the Google headquarters in Mountain View. And guess what? It's exactly the dot-com fantasy everyone imagined it would be. Lyons sounds giddy.

"I just walked outside, and they're playing pool and drinking coffee," he says. "And I saw a yoga session when we walked in here."

But Lyons is nervous, too. Tonight is a bit of an initiation: An American Idol-style pitch session.

At the event, the emcee is Navarrow Wright, an established entrepreneur in the Valley.

"What we're going to do tonight is give the NewME founders an opportunity to pitch their companies for the first time in public," he says. "They will have two minutes to pitch their startup, and we will each have one minute to give feedback."

Making A Pitch To Investors

When it's his turn, Lyons walks up to the lectern and flashes a winning smile at the audience.

"How's everyone doing today? Good, good. Well my name is Chris Lyons and I am the founder and CEO of PictureMenu."

He starts out pretty strong.

"And what we do is we allow any restaurant the opportunity to transform your boring paper menu into a beautiful mobile application for your smartphone, for free."

But after that, things get a little muddy, as Lyons compares the service to the way you can upgrade a car. After he wraps up, the critique begins. One of the judges is Chris Genteel, Google's development manager for global diversity.

"It was a great first half of the pitch and the second half kind of went off the rails," he says.

As Genteel goes on, Lyons' face falls a bit.

"I think you gave me a lot of ideas in the beginning," Genteel says. "And then confused me with a lot of kind of features."

For Lyons and the others, it's just a starting point. They've got three months of training ahead of them. And their pitches are all going to need some work.

From Management-Issues.com

Many tribal cultures don't have a word for "boredom". Sitting under a tree for hours at a time, waiting in line to get water from the well, or walking four days to a nearby village for medical help is just a way of life. But as technological advances penetrate societies all over the globe, impatience is mounting everywhere.

Google slowed down the speed of search results by four tenths of a second to see what impact it would have. The result was eight million fewer searches a day! A quarter of us abandon a webpage if it doesn't load within four seconds. An email that doesn't get a response within 24 hours is considered unresponsive. And one USA Today study found that most North Americans won't wait in line for more than 15 minutes.

But "impatience" + "cross-cultural" don't work well together. Cross-cultural relationships and projects inevitably take more time, more effort, and more patience. Slowing down often goes against the grain of what we're trying to accomplish.

A volunteer construction team from the U.S. traveled to Liberia to put a roof on a Monrovian school. The Liberians were extremely grateful for the N. Americans' generosity but the first day into the project, the Liberians expressed concern about whether the new roof would be well-suited to the Monrovian climate and environment.

When they voiced their concern, the volunteers replied, "Look. You have to trust us. We've worked on buildings like this all over the world. We're only here for six days. So the only way we'll get this done is if we stick with our plan."

Three months later, a monsoon came in off the Atlantic coast and the new roof came crashing down. A couple Liberian students died and several others were injured. Sometimes our "efficient"(impatient!) approach is not so great after all.

Just about everything takes longer when working and relating cross-culturally. Communication, trust-building, and just getting things done requires more effort and perseverance. Whether it's dealing with long queues when traveling, merging different technology systems, or trying to get to the bottom of a conflict, understanding and effectiveness come more slowly when different cultures are involved.

Patience needs to be factored in from the very beginning of any cross-cultural project. Long before the U.S. construction team ever arrived in Liberia, a more thorough process of determining what the need was and how to best meet it would have been valuable.

For a fraction of the cost of shipping a team to Africa, the volunteers could have sent money to have local builders put on a new roof. Or with a deeper level of analysis, they may have concluded that the roof wasn't really the problem but instead, was a symptom of deeper problems of poverty and conflict that could be better addressed by partnering with development experts.

Full disclosure. I'm terribly impatient. I hate waiting in lines, I calculate which driving lane is moving fastest, and I want things to happen quickly and according to plan. But on the rare occasion when I exercise patience, the end result is almost always better: the partnership is richer, the project gains wider acceptance, and the money invested goes further.

In a world of instant information and feedback, it's counterintuitive to step back and move more slowly. But slow is the new fast when you're working across cultures. Take a deep breath and trust that something far bigger and better can be accomplished when you patiently persevere through the hard work of listening, understanding, and discovering the possibilities that may otherwise go unnoticed when rushing to the finish line.