DiversityNursing Blog

Without cultural diversity amongst healthcare providers, it is almost impossible to provide quality nursing care to people from different ethnic and socioeconomic backgrounds. A multicultural representation of nurses, physicians and clinicians is important to ensure the healthcare being delivered is sensitive and meets the physical and holistic needs in our “patient palette”.

In the United States, a rise in the population and increase in minorities further challenges our healthcare system to provide appropriate care to the ever changing population it serves.

Some of the major findings in a study on the changing demographics and the implications for physicians, nurses and other healthcare workers conducted by the US Department of Health and Human Resources are bulleted here:

• Minorities have different patterns of health care use compared to non-minorities. Disparities in access to care account for part of the difference in utilization.
• Demand for health care services by minorities is increasing as minorities grow as a percentage of the population. Between 2000 and 2020, the percentage of total patient care hours physicians spend with minority patients will rise from approximately 31percent to 40 percent.
• Minorities are underrepresented in the physician and nurse workforce relative to their proportion of the total population.  As minorities constitute a larger portion of the population entering the workforce, their representation in the physician and nurse professions will increase. The U.S. will increasingly rely on minority caregivers.
• Minority physicians have a greater propensity than do non-minority physicians to practice in urban communities designated as physician shortage areas. An increase in minority representation in the physician workforce could improve access to care for the population in some underserved areas.

The study also summarizes: “Advocates for increased minority representation in the health workforce argue that increasing the number of minority physicians will improve access to care for minorities and vulnerable, underserved populations. These advocates argue that increased representation of minorities in the health workforce not only will increase equity, but will also improve the efficiency of the health care delivery system”. (HRSA 2000)

Men (of all backgrounds) are also far under-represented in nursing.  Less than 1 percent of the population are male nurses.

As our nursing population lacks diversity, statistics show that the US population is becoming more diverse and will continue on through the decades.

Below are projections for the increase in diversity amongst minorities in the United States:

Source: Modified version of Census Bureau middle series projections.

As our demographics continue to change, one of our greatest challenges is getting hospital organizations along with healthcare administration to realize that, in order to provide the best care and ensure successful patient outcomes, we have to embrace diversity. This is especially challenging to nurses because they will be expected to deliver care that encompasses these differences. Many nursing task force teams and associates have been organized to address this issue of healthcare diversity, such as:

• Asian American/Pacific Islander Nurses Association, Inc. (AAPINA)
• National Alaska Native American Indian Nurses Association, Inc. (NANAINA)
• National Association of Hispanic Nurses, Inc. (NAHN)
• National Black Nurses Association, Inc. (NBNA)
• Philippine Nurses Association of America, Inc. (PNAA)

For nursing care of all cultures and backgrounds, we owe it to our profession to increase our awareness and get involved to ensure delivery of the best care possible. One of the most important steps any of us can take is to first embrace diversity.

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.

From Advance for Nurses By Beth Puliti

The Institute of Medicine recently appealed for a change in nurses' roles, responsibilities and education, proposing to implement nurse residency programs to assist in the clinical practice transition (Advancing Health, October 2010).

The Hospital of the University of Pennsylvania, Philadelphia, identified the need for support much earlier.

Its Gateway to Critical Care Program started 10 years ago and offers new nurses and registered nurses with less than 1 year of critical care experience the opportunity to work alongside experienced ICU nurse preceptors to become safe and competent critical care nurses.

"The competency-based orientation program helps foster the knowledge and skills necessary to care for patients within the different critical care units in our hospital," said Lisa Fidyk, MSN, MS, RN, coordinator of the Gateway to Critical Care Program.

Catering to the Adult Learner

Participants enrolled in the program adhere to an educational plan that defines competency expectation, patient assignment and preceptor/learner responsibilities.

"We base our program on Patricia Benner's From Novice to Expert model. We work to assist the graduate nurse's progress from advanced beginner to competent nurse utilizing her framework," explained Fidyk, who is also a professional development specialist in the Department of Nursing Education, Innovation and Professional Development.

As Fidyk mentioned, Benner's framework of skill acquisition and development of the essence of critical thinking is utilized in the Gateway to Critical Care Program. Goals are reached through segmented learning, faculty guidance, a supportive environment and preceptor/orientee relationships.

The 16- to 20-week program consists of 4-5 weeks of classroom/clinical and 11-16 weeks of full-time clinical. It enrolls new-to-practice surgical, cardiac, neuroscience, cardiothoracic and medical ICU nurses, as well as nurses from the emergency department. Fidyk noted the nurses learn from various teaching strategies, including classroom instruction, clinician-supervised skill labs and clinical experiences.

"The program caters to the adult learner and provides different ways for these nurses to learn about the critical care arena. We incorporate case studies, lectures, discussions and simulation to help them develop the skills they would need to care for critically ill patients," she said.

Throughout the program, nurses learn the following core competencies: airway and ventilator management; cardiac monitoring; critical care pharmacology; hemodynamic monitoring; arterial blood gases analysis; acid-based balance; pain, sedation, neuromuscular blockade; and end-of-life care.

Working Alongside Experienced Nurses

Clinical support comes in the way of clinical preceptors, Gateway to Critical Care faculty and critical care advanced practice nurses/clinical nurse specialists/clinical nurse IV staff nurses.

While enrolled in the program, nurses work beside experienced ICU nurse preceptors.

"A preceptor is a mentor," Fidyk said. "They work with that person when they are on the unit taking care of patients. Preceptors are experienced nurses who know what it's like to go through the Gateway Program, how to collaborate and how to make it a great experience."

When the nurses return to their floor, they practice and hone their skills with a preceptor for the duration of the program.

"My nurse preceptor was a nurse on the unit for 5 years," recalled Lauren Mang, BSN, RN, clinical nurse I in the neuro ICU at the Hospital of the University of Pennsylvania. "She was fabulous. She really gave me the confidence and courage I needed to become a better nurse."

Mang noted preceptors help new nurses become more at ease because, as an experienced nurse who knows the ins and outs, they are able to impart their knowledge at a comfortable level.

"She was there side by side with me until toward the end when she started to hide from me so I would learn how to answer questions on my own. She gave me the confidence to be able to do that," she said.

New Graduate Nurse Retention

After the Gateway to Critical Care program, nurses are enrolled in the Nurse Residency Program, a yearlong series of learning and work experiences designed to support nurses as they transition into professional nursing practice.

The Hospital of the University of Pennsylvania participates in the United HealthSystem Consortium (UHC)/American Association of Colleges of Nursing (AACN) National Nurse Residency Program and was actually the first Philadelphia hospital to participate in the National Nurse Residency Program.

The UHC/AACN Nurse Residency Program consists of an evidence-based curriculum developed by academic and nursing experts across the country. It boasts a reduction in voluntary turnover rate for first-year nurses to well below the median of 27.1 percent. Programs that have implemented this residency program model have attained retention rates of more than 94 percent.

Fidyk commented that both the Gateway to Critical Care Program and the Residency Program at the Hospital of the University of Pennsylvania act as a great support system, and with that support she's seen a "huge" increase in retention. A 98 percent retention rate to be exact.

A higher nurse retention rate delivers better patient outcomes by increasing the nursing staff's experience and competency. Retention also helps preserve new graduate nurses' knowledge, experience and competence gained during the first year of professional practice.

"I know a lot of hospitals don't have these programs, and when I was in a leadership class in nursing school, we actually talked about Penn's Gateway program. That really opened my eyes to research this program more," Mang said. "I needed just a little bit of extra help one-on-one and it really helps you with that. Right now, I'm only 11 months into this and I feel very confident and have learned a lot from this program."

Fidyk noted that, for most of the nurses who come into the program, it's their first job - and it's an intense arena.

"You're saving people's lives, you're dealing with emotional aspects of your job, you're coming in contact with many different healthcare providers - it's all very overwhelming. The Gateway to Critical Care Program is a great way to help new nurses figure everything out and have someone to talk to who will listen," she concluded.

From Nurse.com News

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

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

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

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

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

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

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

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

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

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