DiversityNursing Blog

In the wake of media focus on the trials and bravery of nurses in the context of the Ebola crisis, leaders in the fields of nursing and clinical ethics have released an unprecedented report on the ethical issues facing the profession, as the American Nursing Association prepares to release a revised Code of Ethics in 2015.

The report captures the discussion at the first National Nursing Ethics Summit, held at Johns Hopkins University in August. Fifty leaders in nursing and ethics gathered to discuss a broad range of timely issues and develop guidance. The report, A Blueprint for 21st Century Nursing Ethics: Report of the National Nursing Summit, is available in full online at www.bioethicsinstitute.org/nursing-ethics-summit-report. It covers issues including weighing personal risk with professional responsibilities and moral courage to expose deficiencies in care, among other topics.

An executive summary of the report is available at: http://www.bioethicsinstitute.org/wp-content/uploads/2014/09/Executive_summary.pdf

"This blueprint was in development before the Ebola epidemic really hit the media and certainly before the first U.S. infections, which have since reinforced the critical need for our nation's healthcare culture to more strongly support ethical principles that enable effective ethical nursing practice," says Cynda Hylton Rushton, PhD, RN, FAAN, the Bunting Professor of Clinical Ethics at the Johns Hopkins School of Nursing and Berman Institute of Bioethics, and lead organizer of the summit.

The report makes both overarching and specific recommendations in four key areas: Clinical Practice, Nursing Education, Nursing Research, and Nursing Policy. Among the specific recommendations are:

• Clinical Practice: Create tools and guidelines for achieving ethical work environments, evaluate their use in practice, and make the results easily accessible.
• Education: Develop recommendations for preparing faculty to teach ethics effectively
• Nursing Research: Develop metrics that enable ethics research projects to identify common outcomes, including improvements in the quality of care, clinical outcomes, costs, and impacts on staff and the work environment
• Policy: Develop measurement criteria and an evaluation component that could be used to assess workplace culture and moral distress

What does this blueprint mean for nurses on the front line?

"It's our hope this will serve as a blueprint for cultural change that will more fully support nurses in their daily practice and ultimately improve how healthcare is administered -- for patients, their families and nurses," says Rushton. "We want to start a movement within nursing and our healthcare system to address the ethical challenges embedded in all settings where nurses work."

On the report's website, nurses and the public can learn more about ethical challenges and proposed solutions, share personal stories, and endorse the vision of the report by signing a pledge.

"This is only a beginning," says Marion Broom, PhD, RN, FAAN, Dean and Vice Chancellor for Nursing Affairs at Duke University and Associate Vice President for Academic Affairs for Nursing at Duke University Health System. "The next phase is to have these national nursing organizations and partners move the conversation and recommendations forward to their respective constituencies and garner feedback and buy-in. Transformative change will come through innovative clinical practice, education, advocacy and policy."

At the time of publication, the vision statement of the report has been endorsed by the nation's largest nursing organizations, representing more than 700,000 nurses:

• American Academy of Nursing
• American Association of Critical-Care Nurses
• American Nurses Association
• American Association of Colleges of Nursing
• American Organization of Nurse Executives
• Association of Women's Health, Obstetric and Neonatal Nurses
• The Center for Practical Bioethics
• National League for Nursing
• National Student Nurses' Association
• Oncology Nursing Society
• Sigma Theta Tau International

Source: www.sciencedaily.com

Source: University of San Francisco Online

By Debra Wood, RN

To achieve the national goal of improved health outcomes, many researchers and health advocates agree that patients must assume a greater role in managing their health

care. But how can facilities and health systems accomplish this kind of patient engagement? The answer may rest with nurses and nurse leaders, who have long overseen patient education about how to care for chronic conditions and make lifestyle changes to improve health.

“Promoting patient education has always been a part of our nursing role and obligation to the
patient,” said Debi Sampsel, DNP, MSN, BA, RN, chief officer of innovation and entrepreneurship at the University of Cincinnati’s College of Nursing in Ohio. “It has been a long-standing practice that nurses involve the patient across the life span in their own care.”

Sampsel finds nurses strive to and take great pride in promoting healthy lifestyles. And research has demonstrated that active, engaged individuals have far better health outcomes. The University of Cincinnati includes health promotion in the nursing curriculum and gives students an opportunity gain patient-engagement experience while working with the homeless and elementary and secondary school age youth.

“What’s new is old,” added Patrick R. Coonan, EdD, RN, NEA-BC, FACHE, dean and professor at the College of Nursing and Public Health at Adelphi University in Garden City, N.Y. “I went to nursing school 35, 40 years ago and what did they teach but to be the patient advocate, to teach the patient. But we got away from that in the last few decades.”

Coonan pointed out that today’s consumers and patients, particularly baby boomers, are better informed. They often turn to the Internet for facts, but he called it a nursing professional’s obligation to verify whether the online information is accurate. Boomers are not going to settle for a paternalistic “Just take this pill” without knowing why and how it will benefit them. And that often falls to the nurse.”

“We have to get away from the patient-doctor or patient–nurse relationship that is almost like a parent–child relationship, in existence for many years, to a more informed and empowered [consumer] who will take responsibility for their health,” said Rosemary Glavan, RN, MPA, CCM, senior vice president of clinical operations at AMC Health, a telehealth provider based in New York. “Baby boomers have been go-getters and always wanted to be in charge. They want to be empowered.”

Advocating with a personal connection

“As patient advocates, nurses and nurse leaders play a key role in promoting patient engagement,” said Cynthia M. Friis, MEd, BSN, RN-BC, associate association executive for SmithBucklin’s healthcare and scientific industry practice in Chicago. “Nurses are privileged with having the opportunity to spend more time with the patients to assess, plan, implement and then help clarify the plan of care with the patient and his/her family or caregivers. Nurse leaders are key in helping to ensure this role is realized. Nurses can do their jobs better with the full support of our nurse leaders.”

Nurses ask questions, she added, and draw patients into thoughtful discussions about their care, helping them move forward when they feel overwhelmed and understand how to best care for themselves.

Establishing principles of engagement

Patewood Memorial Hospital in Greenville, S.C., participated in a national study by the Agency for Healthcare Research and Quality (AHRQ) and in the development of theGuide to Patient and Family Engagement in Hospital Quality and Safety.

Recommendations in the AHRQ guide include:

• Working with patients as advisors;
• Communicating effectively; 
• Giving bedside shift reports, where nurses do not talk with each other but involve the patient and family members he or she wants to participate; and 
• Engaging patients in transitions to home.

The hospital has experienced improvements to its HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey since implementing the program.

“The patients and families are much happier,” said Kerrie Roberson, MBA, MSN, RN-BC, CMS, nurse educator at Patewood. “Patient engagement is a partnership with the patient and families, and they trust you more when they see you are open about their care.”

Nurses at Patewood are leading discussions about patient engagement across the Greenville Health System and have begun sharing their experiences with others.

Other nurses gathered to develop Guiding Principles for Patient Engagement, released last year by the Nursing Alliance for Quality Care (NAQC), which was supported by the Robert Wood Johnson Foundation.

Principles in the NAQC guide include:

• Having a dynamic partnership with patients and their families; 
• Respecting boundaries; 
• Maintaining confidentiality; 
• Adhering to responsibilities and accountabilities; 
• Recognizing patients able to engage; 
• Appreciating patient rights; 
• Sharing information and decision making; and 
• Advocating for the patient.

“Patient-centered care and engaging patients is very important to improving quality outcomes, which includes reducing cost and better health of populations in the community, but also reductions in disparities of care,” said Maureen Dailey, PhD, RN, CWOCN, senior policy fellow for nursing practice and policy at the American Nurses Association (ANA), a member organization of the NAQC. “The patient is at the center of the team and must assume accountability for self-care and part of the outcome. But that evolution has yet to take place.”

Nurses must instill confidence and competence in patients’ self-care, Dailey explained. And patients need nurses to provide knowledge, support and symptom management.

“Nurses hold a central role in patient engagement,” Dailey concluded.

Combing nursing skills with technology

Along with the personal touch, many nurses are finding technology can assist with their patient-engagement efforts.

“As the responsibility of nursing advances to one of building and sustaining patient activation and the role of nursing moves to be more consultative across care settings, technology will play a vital role for both the nurse and the patient,” said Karen Drenkard, PhD, RN, NEA-BC, FAAN.

Drenkard, who has served as executive director of the American Nurses Credentialing Center (ANCC) and past director of the ANCC Magnet Recognition Program, will join GetWellNetwork in January as chief clinical/nursing officer, where she will lead the development of a nursing model of patient engagement. Her responsibilities will include studying and designing new ways to assess and improve patient activation through clinical practice and technology solutions across all care settings.

“Nursing can use interactive patient care technology to proactively engage the patient and shift the responsibility for completing certain care interventions,” said Drenkard, explaining patients can document daily signs and symptoms. Care providers use the network to send reminders about taking medications or the need for follow-up visits to their physician when data and input from the patient indicates the need to do so.

Susan Lucas-Conwell  -  12/3/12

Investing in ways to recruit, retain and develop women is not only a fair business practice, it is smart business. These three initiatives can help.

It has been an uphill battle to make room for women at the top. With Yahoo's appointment of Marissa Mayer, only 20 women — and that’s a record high — are CEOs of Fortune 500 companies. Though some progress has been made on this front, organizations can still do more to recruit, retain and develop women leaders because, as the numbers show, there’s a correlation between having more women in the boardroom and improved performance.

A Catalyst study comparing Fortune 500 companies in the bottom versus top quartile in terms of women’s representation on the board showed that the top quartile organizations outperformed the bottom by 53 percent more returns on equities, 42 percent more return on sales and 66 percent more return on invested capital.

Investing in ways to recruit, retain and develop women is not only a fair business practice, it is smart business. Here are three initiatives any organization can implement to create a culture where female leaders can thrive:

Cultivate community. Women excel through social support networks. Organizations can provide tools to facilitate a sense of community and support to develop female leaders. There are different ways that this can be done, and it should always be tailored to the unique culture within an organization.

One successful tactic is to sponsor and support employee resource groups for women. These groups offer a space for discussion and information to propel women in their careers. Mentoring programs can link female leaders with other female employees who are interested in pursuing similar career paths. Through sharing stories, experiences and advice, women can learn from success stories and avoid making the same mistakes. These relationships further develop female leaders and retain high-potential candidates for leadership roles.

Develop a diverse leadership culture. To attract and encourage women to pursue higher positions, it behooves companies to walk the talk and actually have women in senior-level positions. When female up-and-comers are able to see female role models attaining executive-level positions, it shows the possibility and demonstrates the company’s support of a diverse leadership culture.

An organization does not need to have a female CEO to demonstrate a genuine commitment to women’s career advancement. Women in leadership roles should span across the organization and across functions. Organizations can consider having advisory committees that appoint women to review challenges faced by female employees and suggest appropriate action to resolve issues.

Leverage technology. Technology should not only be used as a tool for employees to connect with one another, but also as a way to recruit potential employees. New technologies are available to facilitate employee communication like never before. Internal social networking sites allow for women to connect, communicate and collaborate with one another.

Organizations can pilot programs where women create webcasts for other women that are inspiring and informative on a variety of workplace topics such as leadership, communication, professional development and goal setting. Additionally, online training programs to help the workforce appreciate gender differences and leverage distinct strengths can also help develop a diverse leadership culture.

In addition to these initiatives, by offering progressive policies on maternity leave and work-life balance, organizations can better attract and retain a high-potential female talent pool. It’s not enough to create spaces for collaboration, information and social support; organizations need to track their initiatives and measure progress to ensure fair and equitable promotion of both genders.