DiversityNursing Blog

From WorkingNurse.com By Elizabeth Hanink

Work-life balance is more than good time management. It means having a professional life and personal life that are integrated so well that each part enhances the other. That takes self-knowledge and self-discipline—two traits that we need to cultivate if we ever hope to achieve the balance that brings enjoyment along with achievement. It is a life-long process that requires daily fine-tuning.

All sorts of people have trouble with work-life balance. What makes nurses especially vulnerable is that so much of our professional life is beyond our control. We can’t change the fact that most nursing jobs involve tricky schedules, heavy work-loads, and tons of variables that can shift by the hour, yes, even by the minute.­ Most of us are additionally burdened by wanting to give good care.

But not having the power to manage many aspects of our jobs doesn’t mean we have no control. Nurses can be like the sleeping elephant, unaware of its strength. If you want to make your dreams come true, wake up to your own power, to the role you play in your own life. Taking control is the key. If you live in a constant state of reaction, you give control to someone else. Time management only enters the equation when you use it as your tool to gain control: over a day, a month, a life-time.

Remember Nursing 101

Where to start? You don’t need a new system of thought. What you learned in nursing 101 about nursing process will serve quite well here. Remember how assess, diagnose, plan, implement, and evaluate worked for all nursing problems. It works for the big picture of your life, too and helps you get the minute by minute obstacles out of the way so the bigger pieces fall into place. It does you no good to manage a perfect work day, every day even, if there is nothing left for family or fun or personal growth.

Let’s start with assessment. What do you want—what is important to you? Knowing that, and it can take some time to figure it out, makes all the difference. Do you want, in the next hour, to have all your charting completed or do you want to be sure that all your patients have a clean, neat room with trash picked up and tray tables cleared? Do you want in five years to have an advanced practice degree or do you want weekends free for hobbies? Do you want to own a home or vacation every year in a different country? All of these are commendable goals but which are yours? Only you really know.

The second step is diagnosis. What is keeping you from achieving your ambitions? Are you stuck in the land of “after this happens?” as in I’ll get to my charting after I have rechecked all the rooms. Or I’ll start school after I feel more settled at work? Or could you be like the man in the Chinese proverb waiting for roasted duck to fly into his mouth? You will wait a very, very long time. The important ingredient is taking responsibility for what is lacking. This step does not allow placing blame anywhere but on you.

No time to linger. Now that you know what you want and why you don’t have it, move onto the third step, planning. This involves setting priorities. Out of all the things you want, what is most important? It might be different every day, it might vary by what age you are at a given time, or it might vary by what is realistically possible given your circumstances. If you already have three young children, then the Peace Corps is not feasible.

Your self-knowledge that came through assessment is critical in this step. And because you are employed as a nurse, again, you might not have total control minute by minute. But taking your theoretical goal for today as wanting to get all the charting done on time, how are you going to achieve that with a last minute admission? Take the time to assess where you are and plan. Write it down, even if jotting down will delay you, what 15 seconds. Maybe the new goal will have to be leaving only 15 minutes late instead of the usual hour that a last minute admission would ordinarily require.

Now it’s time to implement and here is where some time management skills can play a part. If you are lacking these, get some. Study the nurses around you who do manage to get it all to happen, because some tricks do not come naturally. Not every experienced nurse is savvy in these skills but most who last in a hectic hospital environment have a clue, and you can learn from them.
There’s a ton of specific information out there.

Role Models

Kathy Quan, RN, has written a book on time management just for nurses, Tips and Strategies for Effective Time Management for Nurses. You can download it as an ebook. If you are a new graduate, try The Everything New Nurse Book also by Kathy Quan(www. kathyquan.com). Her website and those of others are full of suggestions. If you can get work under control, you will have much more energy left for the rest of life. And don’t wait to get started on that. Life doesn’t wait.

Don’t forget, there are nurses who manage to have long careers meeting interesting challenges and still live interesting lives outside of work. What is the secret, you might ask.

It isn’t a secret says Tilda Shaloff, RN. You have to set priorities (remember planning?). She uses a daily written list (no Blackberry for her) that she often formulates while walking her dog. It contains, every day, day in and day out, 17 items. The number 17 has private significance for her. Your number could be different. The act of writing the list helps her organize what has priority and what can wait.

She also delegates. Her children have always been paid to help around the house and her husband has always been willing to participate fully in chores. She also, and this is key, arranges her clinical work schedule to suit the other important things in her life—her writing and public speaking. Being the author of several books and a very popular motivational speaker, Shaloff says, takes tremendous energy. But these activities are important to her and so she makes the effort to have the time and strength. It is a conscious choice. She can do speaking and writing and work in an ICU but not other things. You need to make the same choices. It might mean saying no to being room mother or working the polls on election day. Or it might mean having a clean as opposed to an immaculate house. Make your life and your job work for you.

Kathleen Singleton, RN, MSN, also makes choices. As the president of the American Association of Medical Surgical Nurses she has a serious obligation on a national stage plus the obligations of her “day job.” For her the secret is, of course, organization, and she is very dependent, she says, on any electronic help she can get. But the real key for her is negotiation and flexibility. Singleton makes her day job work for her.

She has had scads of practice at this; she worked over the years from nursing attendant to MSN all while working full-time. She thinks any nurse can do it. Instead of moaning about them, make the weekend and shift obligations work for you, she says. Take advantage of your ability to trade shifts. Work with your fellow employees and supervisors to have everyone gain. Negotiate your holiday obligations in such a way that the schedule then allows you to do what is vital to your happiness. In Singleton’s case, her employer, an affiliate of the Cleveland Clinics, allows her maximum flexibility in scheduling in exchange for her willingness to be quite flexible in what is required of her.

Keep in mind: achievement without enjoyment is not the way to balance. Taking control is. Plan, choose, and readjust. Balance is achieved both daily and over the long haul and can be different for each of us each day. Adjust as needed, both the goal, and the implementation because there is more than one way to success.

A Jar Full of Rocks

Here’s a strategy to visualize how, without planning and taking control, you can work very hard all day or even all your life and still have no accomplishments and no satisfaction. Picture a large jar like one that old-fashioned delis kept pickles in. Or the type that holds pretzels from Costco. Fill it as full as you can with large rocks. Now fill in the other spaces with small pebbles. Next add sand. Isn’t it amazing how much sand fits into all the nooks and crannies between the rocks and pebbles? Last fill with water. Quite a bit goes in, doesn’t it, despite all those rocks.

But stop. What if you had poured the water in first? It would be impossible to get even one large rock in without spilling everywhere. Now think of all the things you want to do, today and in life. Make sure the large goals, the large rocks, are what you really want from life — to have more education, to write a book, to own a house, to run a business. You choose. Then fill in with the small pebbles. Do they support the rocks? If you took away three pebbles---a ho-hum hobby, a favorite TV show, or say time on Facebook, would you have room for another large rock? And what about the sand in your life? Is it helping you toward your goal or is it just getting between your toes? Are you drowning in all the water that fills up your life? Is the water keeping you from getting any large rocks into the jar?

As for those nurses like Singleton or Shaloff who work, have a rich personal life, and still have time to pursue advanced degrees or run side businesses? Look at what they don’t do. You will probably find they have eliminated those things that don’t move them toward their goals. They don’t know about the latest episode of American Idol. Maybe they don’t have the latest French tips from the manicurist. They dare to bring store-bought to the potluck. They have made the choice that these things matter less than achieving their goals.

You need to do the same. Just remember. To avoid the pickle jar trap or the “as soon as” trap or any other trap that is robbing you of a good work-life balance, you need to take time now to decide what is important (assess),what is keeping me from it (diagnose) how do I get it from here (plan) and execute. Reassess frequently and adjust as needed. Now you have balance.

From NurseZone.com By Christina Orlovsky

June 13, 2012 - As the population ages and the need for health care increases, access to care is often a challenge, based on location, provider availability, chronic conditions and economic factors. One potential solution to a number of these challenges is the umbrella of care called telemedicine.

According to the American Telemedicine Association (ATA), telemedicine is defined broadly as the delivery of any health care service through any telecommunications medium--for example, a patient seeing a doctor, nurse or allied health professional via a videoconference, rather than in-person, or a patient with a chronic condition utilizing an in-home device to monitor vital signs and transmit data to a nursing center for assessment and medical intervention.

“The one thing that ties all telemedicine together is that it involves a clinical health care service, it directly contributes to the health and well-being of patients, and the patient and provider are separated by some geographic distance,” said Benjamin Forstag, senior director of communications for the Washington, D.C.-based ATA.

Nurses are directly involved in the virtual delivery of health care through telehealth nursing, defined by the ATA as “the use of telehealth/telemedicine technology to deliver nursing care and conduct nursing practice.”

According to Cindy K. Leenknecht, MS, ACNS-BC, chair of the ATA Telehealth Nursing Special Interest Group (SIG), nurses hold a variety of roles in the telehealth arena, depending on their individual scope of practice. They utilize telemedicine technology in the ICU, nursing homes and home-health environments.

“They are reaching into many remote sites using telemedicine, including homes, monitoring for congestive heart failure, diabetes, COPD, hypertension, etc., where they monitor vital signs and question responses, evaluate and call patients to clarify symptoms, and advise on further actions to take, such as call a physician, take a forgotten medicine, etc.,” she explains. “They also deliver timely education and reinforce that education.”

The ATA stresses that telehealth nursing is not a specialty area within nursing. In fact, any nurse who has ever spoken to a patient over the phone has practiced some form of telehealth. As such, the same qualities that attribute to nursing success at the bedside come into play with telemedicine.

“Telehealth nurses need the same nursing skills as all nurses practicing in specialty areas, but with an ability to utilize the technology to the best of its ability to assess and communicate the patient’s physical and mental status,” Leenknecht said. “Excellent organization, critical thinking and communication skills are required also, but the most important skill is to understand the technology and its potential and limitations and have the intuitiveness in how to utilize it to provide the care needed at the time.”

Treating millions of veterans across the miles

One health care system that is uniquely positioned to provide telemedicine services to its patients is the Veterans Health Administration (VHA), the health care arm of the U.S. Department of Veterans Affairs. Responsible for the care of 5.6 million American veterans each year, the VHA utilizes telehealth in a number of ways to be able to meet the health care needs of its extensive patient population, spread out across the entire country.

“In total, in fiscal year 2011, VHA provided telehealth services to 380,000 veterans,” said Adam Darkins, M.D., chief consultant of care coordination services for the VHA Office of Telehealth Services. “We anticipate that number will rise this year by somewhere between 30 to 50 percent.”

The primary use of telehealth for the VHA is through home telehealth, managing chronic conditions like diabetes and depression for 74,000 veterans in their own homes, through the use of telehealth devices that monitor vital signs such as weight, pulse, blood pressure and blood glucose, and ask questions on a daily basis about symptoms and behaviors. A care coordinator--usually a nurse employed in a full-time telehealth role--manages a panel of these patients from a remote location with the goal of educating patients and their caregivers, monitoring their disease symptoms and daily behaviors, and intervening when they’re alerted to warning signs.

“These programs were built to support aging veterans who, as they get older, are living longer and staying healthier and, like all of us, would prefer to live independently,” Darkins explained. “The care coordinator works in partnership with the patient, their family caregiver and their community caregiver to help people with multiple hospitalizations transition home after a discharge, educate them about care management, and intervene early to prevent readmissions. We have seen outcomes of a 30 percent reduction in hospital admissions and bed days of care.”

The anticipated increase in need for care is accompanied by an increased need for care providers--and a need for training.

“These are new areas of care that aren’t taught in schools of nursing or medicine, so one thing the VHA has done is created a training center for each of its areas of telehealth that train to the order of 2,500 people per year, with 90 percent of the training taking place online,” Darkins said, adding that he often sees highly trained nurses turning toward telehealth.

“What we find is often very experienced nurses toward the end of their career are attracted to this and say ‘This is why I came into health care,’” he concluded. “It really gets to the heart of providing holistic care where there’s a real need.”

From pr-inside.com

Vocational Nursing students at Stanbridge College met with over 40 representatives from Southern California healthcare employers to schedule interviews, hand out résumés and gain insight to their future careers.

Stanbridge College, a technical college that offers training in Healthcare and Information Technology, hosted over 40 representatives from Southern California healthcare employers at the Vocational Nursing Career Fair on June 6th. Over 150 students networked with representatives from skilled nursing facilities, home health organizations, hospice organizations, hospitals, medical offices and other healthcare facilities. Many of the students and alumni made lasting impressions on the employers that lead to potential job interviews.

According to Alice Brinkmann, VN student who is scheduled to graduate this July, “I was blown away by yesterday! I handed out my résumé to 10 employers and by 3pm I had email [responses] from 8 out of 10 employers.”

Subsequently, Ms. Brinkmann stated that she received four more interviews as a result of the connections made at the career fair.

Arman Goshtasbe, Assistant Director of Career Services at Stanbridge College also emphasized the positive results of the career fair. He stated, “One student came to me and within 30 minutes had two interviews.”

Stanbridge College offers career fairs as part of its career preparation for its students and alumni. The Career Services Department at Stanbridge College offers assistance with job placement, résumé preparation, mock interviews and career advising. Alumni members are able to receive life-long job placement and access to educational workshops for continuing education.

Mr. Goshtasbe continued, “I think the career fair was a great success. Our VN students came prepared with questions and were very engaged in conversation. I think they walked away with a clear picture of where they need to grow professionally. Many of the employers were also very impressed by the event and our students.”

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."

From Advance for Nurses

Findings from the NLN's Annual Survey of Schools of Nursing Academic Year 2010-2011 attest to the continued need for more nurse faculty to meet the needs of the U.S. healthcare system.

Conducted October-November of last year, the NLN survey reveals demand for pre-licensure program entry continues high despite a shifting student demographic, while competition for entry into post-licensure is increasing.

Unfortunately, notes NLN CEO Beverly Malone, PhD, RN, FAAN, the percentage of post-licensure programs that turned away qualified applicants also rose between 2009 and 2011.

Most strikingly, the percentage of MSN programs turning away qualified applicants jumped by 15 percent over the past 2 years, from just one in three programs to almost half in 2011.

The survey also shows the percentage of racial-ethnic minority students enrolled in pre-licensure RN programs fell from a high of 29 percent in 2009 to 24 percent in 2011.

The majority of that decline stems from a steep reduction in African American students enrolled in associate degree nursing programs, which dropped by almost 5 percent to 8.6 percent in just 2 years.

Hispanics remain dramatically underrepresented among nursing students as well, according to NLN, representing only 6 percent of baccalaureate and associate degree nursing students.

But while educational capacity is still insufficient to keep up with demand, some promising trends were uncovered by the survey, says NLN president Judith Halstead, PhD, RN, FAAN,

"For example, the percentage of male pre-licensure graduates in 2011 was up to 15 percent after inching up only a percentage point a year since 2009," she notes. "In addition, the percentage of pre-licensure RN students over age 30 has declined in recent years."

From WorkingNurse.com By Christine Contillo

It’s clear that we’ve not just entered the Information Age — we’ve exploded into it. Information exchange is critical to both the advancement of science and patient care, and the impact of the Internet in the medical field has been enormous. Practitioners are now able to jump the barrier of time and access research findings worldwide; and in nursing it’s caused the creation of an entire subspecialty (nursing informatics) meant to manage the amount of information available.

But nurses studying informatics aren’t he only ones finding ways to improve their skills by surfing the web. According to a survey of the American Academy of Nurse Practitioners, more than 98 percent of nurses responded that they use the Internet or email. The survey continued to ask in what way the Internet was used, and the answers may surprise you.

No More Pencils, No More Books

Beginning with nursing education, students everywhere have access to virtual classrooms and degree programs. Online education means that the limits previously imposed by location and time become less important. Busy students with a computer, or those in the workforce trying to fit school into their already packed schedule, should be able to find a few hours at home for study.

Similarly, many states now require continuing education (CE) for licensing. Nursing needing those hours can get them without leaving home, which in many cases removes important constraints such as child care. Sites such as WorldWideLearn.com allow the student 24/7 access to courses and technical support. Employers can select educational seminars and show them in real time in a conference room or select courses that have been archived for their nurses to watch later.

Nurses were instrumental in developing accredited online continuing education for Wild Iris Medical Education. The company established the site Nursing Continuing Education to help nurses (and other health professionals) across all 50 states fulfill CE requirements. Prices range from free to $65 depending on the individual requirement and number of contact hours offered. Fees can be paid with a credit card — how else? — online.

Podcasts

For those nurses who are pretty comfortable with technology, podcasts are another avenue to investigate. Similar to audio versions of magazines, they can be heard on MP3 players for up-to-date information. Check out PodFeed.net and searching “nursing” or listen to “Nursing Education on the Go” at Podcast Alley.

Streaming Radio

Somewhat similar to podcasts is streaming radio, or radio shows that are available worldwide. AM/FM radio is usually limited by geographical distance, but streaming radio listeners only need access to the web, some free software to download, and a set of speakers.

Barbara Ficarra, RN, BSN, MPA, is a nurse educator in the metro-NYC area and host of “Health in 30,” which airs live at 5:30pm on Fridays on WRCR-AM 1300. Ms. Ficarra lines up expert guests for her weekly show, announces the topic ahead of time, and fields questions as they are phoned in. Without the Internet her show could only be heard locally, but the vast audience afforded by online listeners has enabled her to win wider recognition. In fact, in 2007, she won the Excellence in Journalism award given by the American College of Emergency Physicians.

Blogs

Nursing blogs are web logs and can range from silly to academic. Just as journals are intimate thoughts, blogs can detail nursing practice issues, patient stories, fears, triumphs or even family and leisure activity. Blogs allow nurses to vent their frustrations to their peers and share valuable resources for patient care. Following a few favorites allows you to peer into the mind of the writer. The ability to comment allows you to enter into an electronic relationship that nurses in remote areas may treasure. Certainly information about individual patients must protect their identity, but sharing the means of resolving practice issues helps to improve practice standards everywhere.

Information Sites

According to Family Nurse Practitioner Roseann Neuberg, the impact brought by the Internet to her clinical nursing practice is “huge,” and she identifies it as a valuable source of patient education material. “There are just so many things I can do in terms of patient education,” she says. “I can look up issues or treatments while my patient is sitting right next to me. I can print it up, hand it out, and be sure that they understand what I’m saying before they leave. When I prescribe a medication I can check the price and look for alternatives. I can even use a program to check for drug interactions.”

Tracy Plaskett, a staff nurse at Beth Israel Hospital in New York City, says, “When I get my patient assignment, I’m able to look up any unfamiliar terms in the notes instantly. I can check spellings and make sure that medication orders are correct.”

Ms. Neuberg is quick to point out that she sticks with sites she knows are accurate and updated frequently in order to feel confident that the advice she is giving is sound. Two such sites are UpToDateOnline.com and Epocrates.com, which provide current information about clinical management and treatment of disease. Both require a subscription and password.

Mobile Medicine

Lynda O’Grady, RN, has found another important use of the Internet. Ms. O’Grady is part of a large travel medicine clinic, assessing international travelers who participate in academic programs, sometimes to remote and disease-infested areas. Using special software she’s able to assess their individual medical risks. If she has questions she can access advice from organizations like the Center for Disease Control and the World Health Organization. But what she finds most helpful is her membership in the International Society of Travel Medicine. Through a listserv available only to members she’s able to gain up-to-the-minute answers to questions posed, such as, “Where is the nearest medical clinic to Daar es Salaam?” or, “What do you recommend for altitude sickness for a patient allergic to sulfa?” Thousands of members pose and answer questions for each other, some providing clinical advice that only a person actually living in that area might be able to give.

Support Groups for Patients

Nurses may want to suggest online communities to patients experiencing chronic illness or going through debilitating treatments. Immune-compromised patients may be unable to attend in-person meetings, but staying in touch with a virtual group may allow them to feel less isolated. CancerCare is one professional association that helps organize free groups for patients as well as their caregivers. Virtual communities and forums have been vital to patients sharing treatment experience and offering support to each other.

Consults

The Internet can be used in a novel way for clinical consults. One home care nurse described how she and her colleagues became discouraged trying to evaluate decubiti. When described in the paper chart by different clinicians using different languages or terms it was often difficult to determine if progress was being made. Solution? They used a digital camera to capture an image that could be sent daily via the web to the practitioner. In this case a picture really was worth a thousand words.

Job Searches

Work-related issues can be shared via the Internet. Nurses interested in relocating can do a web search to conduct virtual tours of hospitals they might be interested in, file an application online, get driving directions, or book travel plans through a travel site such as Velocity. When looking to change jobs they can post their resume online. Even low-cost phone communication can be run through Vonage or Skype — both require an Internet connection and headset instead of a phone line or cell phone.

Creating Community

The Internet facilitates a feeling of community and can create the ability to investigate job issues easily. Union members can use online forums to discuss contract negotiation issues, salary, benefits and legal information. New healthcare legislation and practice agreements, as well as regulatory mandates, can be tracked through blog sites. There is just no excuse now for remaining uninformed.

Brian Short, RN, discovered the importance of a nursing community over a decade ago. When Mr. Short was still a nursing student, he created AllNurses.com for the purpose of online support and education. Two years ago the site claimed to cover 400 nursing topics every day and a total of 1.5 million posts. In an interview given at the time of its 10th anniversary, Teresa Burgess, RN, pointed out the importance of the online nursing community for its ability to be used for mentoring and creating a sense of shared purpose.

Let’s end with a word of warning, however, when it comes to using the Internet. While the examples given prove that use of the Internet can be beneficial to nursing practice, we must all bear in mind that much of what we find there remains anonymous and subject to scrutiny.
Our own critical thinking must be used to determine when and how best to use the available information, and to evaluate the value and truth of what we read. Certainly if what we find can nudge us toward being better health professionals, then the monthly cost of Internet service and the time spent in connection with others is well worth it.

by Jennifer Etienne and Anna Diane
Boston College William F. Connell School of Nursing

Our names are Jennifer Etienne and Anna Diane, and we are currently senior nursing students at Boston College. This past January, Boston College’s Connell School of Nursing sponsored a nursing service trip to Leogane, Haiti as a part of the community health clinical requirement. This service trip included Boston College (BC) nursing students, nurse practitioners and registered nurses. We held mobile clinics for ten days and saw over 1100 patients. Over the course of our trip, we encountered many patients who we will never forget.

We were amazed by the beauty and kindness of the Haitian people despite all the myriad challenges of their daily lives. We saw many of the common medical conditions that we see in the U.S., such as hypertension, GERD, and diabetes. Due to the area’s extreme poverty, most of our patients had not received health care in years- if at all. A typical day consisted of waking up at 6 a.m., eating breakfast, and packing up a truck with all of the medications and supplies that we had restocked and repacked the night before. We worked with the resources that were available in the community. We set up the clinic with a triage station, consultation, and pharmacy that were situated in the home of one of the individuals within the community. We were fortunate to have a Haitian dentist participate in our clinic as well. Generous neighbors were kind enough to donate chairs and tables for use in our clinics. The women’s privacy room for pelvic exams was constructed from two sheets and a cement wall on a slab of pavement, and the dentist did his work in a reclining lawn chair. In spite of these challenging conditions, our clinics were very successful with the individuals within the community, as exemplified by their gratitude.

The truth is that the people in Haiti receive little healthcare and basic problems often become major health concerns, which is very frustrating to us as future health care providers. This experience illustrated the importance of preventative health care measures. Preventative health care measures, such as providing health education, not only empowered the people, but also gave us a chance to interact with our patients. For example, we crafted and brought cycle beads, which we handed out to the women who we saw in our clinics. These beads help women with family planning as an alternative to birth control contraceptives because many Haitian women do not have the choice to take birth control or access to contraceptives.
It was clear that education was the most important aspect of health promotion and health prevention in Haiti, because it gave the Haitian people a sense of autonomy. For example, simple measures such as demonstrating to Haitians how to properly carry a bucket of water by evenly distributing their weight could help prevent future back problems. We realized, however, that in order to educate the Haitian people on preventative measures, we had to consider what resources were available to them. For instance, teaching a group of Haitian families how to reduce their risk of hypertension would be difficult since measuring cups and nutritional labels are not always available to them. However we could overcome the issue by demonstrating the healthy amount of salt used to prepare meals by using the tip of one’s pinky as an alternative measuring device. Such measures could help to reduce the risk of hypertension in Haitian families and significantly improve overall health. We believe that the use of primary prevention can help to prevent illness in Haiti and empower the people to make their own healthy choices.
Even though we treated more than eleven hundred patients, the realization that the majority of Haitians still lack access to basic health resources was overwhelming. Despite this sad reality, the people we met and the patients we treated assured us that our work was appreciated and worthwhile. Treating this population was an extremely moving experience. We were able to immediately see the difference that we were making, whether it be through treating a baby with scabies or rehydrating a child, the patients were enormously appreciative. This trip has forever changed how we view the care that we will provide as future nurses. We are more aware of the issues that affect Haitians, such as a pervasive lack of health education and the need for more culturally sensitive health care providers. This experience has further motivated us, because as minorities, we recognize our important role in communicating, advocating, and initiating preventative programs to help improve the care and quality of health of minorities. We hope to apply our nursing skills, education, and experiences to help decrease health disparities both within the U.S. and other countries.

Thank you for allowing us to share about our experience in Haiti. We strongly encourage others to consider doing nursing work abroad. In addition to helping those in need of care, such trips endow nurses with truly invaluable perspective into the issues that face the world of health care. With hope, the insights that nurses gain through these types of trips will benefit their patients for years to come.

From Advance for Nurses

When a patient enters a hospital, she enters an alien environment. 

Her personal things, even her clothes, are set aside. She is given to wear a billowy gown that is not merely unflattering but starkly revealing if one's free hand isn't vigilant about keeping it cinched.

Inside this linoleum landscape of wheelchairs and rolling beds, where strangers in scrubs politely jab and weigh and probe her, the only haven that offers her a modicum of quiet in which to gather her thoughts and to reclaim herself, to semi-relax, to take stock, or just to escape into the beams of an innocuous sitcom floating overhead - the only personal space in this impersonal world is that humble but all-important retreat, the patient room.

Respecting the sanctity of the patient room is the first lesson Pam White, RN, gives when teaching the basics of relationship-based care (RBC).

"When I talk to nurses, I tell them 'We all have busy lives taking care of many patients, but before you walk across the threshold of a patient's room, pause, take a deep breath, let other things go and prepare to focus on that patient's needs,'" said White, director of nursing administration at Mayo Clinic Health System in Eau Claire, WI. "I always reinforce the need for them to reintroduce themselves to each patient every time they enter the room."

RBC - a philosophy based on honoring and respecting your relationship with your patients, your co-workers and yourself - is fast emerging as the care delivery model of necessity.

Experts say respecting patients will become more and more important as healthcare adopts its new culture of accountability. Reimbursement will hinge, in part, on patient satisfaction.

A Way of Being

RBC as a concept appeared in 2000 and coalesced in 2004 with the publication of Relationship-Based Care: A Model for Transforming Practice by Creative Health Care Management Inc., Minneapolis.

"It's a model, a philosophy, a framework and a way of being," said Mary Koloroutis, RN, who co-authored and edited that text. "RBC creates a methodology for aligning values and operations within a healthcare system so clinicians can establish relationships with patients," Koloroutis explained. 

Finding time to develop relationships with patients isn't easy for nurses, though. 

"Time is a nurse's greatest challenge," Koloroutis acknowledged. 

"You are dealing with large volumes of patients with highly complex medical needs," she said. "We don't have a long time to spend with a patient. It could be just 5 minutes at the bedside to learn about the person and plan their care."

However short, interpersonal time with patients is crucial for a successful outcome. 

"The role of the primary nurse is to understand who this patient is, and what it will take to prepare her and her loved ones to take ownership for her own care after discharge," Koloroutis said.

Family members "will be the village surrounding the patient, so they need to be every bit as supported as the patient is," she added. 

"The likelihood that a plan of care will be followed increases with their learning and understanding."

HCAHPS Survey

Communicating with patients is becoming as vital as vital signs. Officials from the Center for Medicare & Medicaid Services care so much what patients think they instituted the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.

HCAHPS asks patients to rate their hospital stays on a scale of one to five through a series of questions such as: How well did doctors and nurses communicate with you? How well was your pain managed? How clean was the hospital? How quiet?

"As of 2013, there will be reimbursement attached to HCAPS scores, so this is a strong push right now and part of why the patient experience is so potent and important," Koloroutis said.

ThedaCare, an integrated care delivery system in northeastern Wisconsin, increased its patient satisfaction scores by working with a firm called Simpler Consulting to adopt Toyota-inspired "lean" initiatives to streamline its processes and allow nurses to spend more time with patients.

For example, it implemented a variation of a Toyota production strategy called "kanban," so nurses have all the supplies they need at their fingertips.

"We have designed patient rooms so that 90 percent of all nursing supplies are stocked by a central stocking person, using the kanban system," said ThedaCare CEO Emeritus John Toussaint, MD. "Nurses are at the bedside nearly all the time. Medications are delivered directly to rooms in portable supply cabinets called nurse servers. There are no central nursing stations. They've all been eliminated."

Thanks to such changes, 95 percent of ThedaCare patients in 2011 gave top approval ratings when asked to assess their stay.

Eye-to-Eye Care

More time spent at the bedside "brings you to the heart of nursing," declared White, who instructs her nurses to sit down when interacting with patients.

"We typically stand up and over a patient," she said. "But research shows if you sit down and speak with them eye-to-eye, patients feel you spend more time with them - even if the amount of time you spend is the same."

She continued: "As a nurse, my needs for the patient are important, but they may differ from the patient's needs. For example, patients need to walk so many times a day, take so many pills. But those are not necessarily the goals of patients. We determine those goals simply by asking them. They could say 'I would like my hair washed,' or 'I would like to call my granddaughter.' Those things are important to them."

For hospitals thinking about instituting RBC, Koloroutis had this advice:

"Recognize that transformation is not a quick fix. It is a cultural evolution. Some aspects of RBC are already alive and well in every organization. Use them and build on that success. Commit to a 3-5 year process."

Healthcare workers, she concluded, "can grow weary of hearing about new programs. They'll ask, 'Is this another flavor of the month?' I say no. This is a way to get back to the basics, back to the care and service of patients."

From nursetogether

Everybody deals with fear and anxiety, however sometimes our anxieties can get the best of us.  Here are 6 tips on stress management and anxiety management in nursing to help you manage your daily challenges easily.

1.    Find a diversion  Often times, nurses get stressed when there is a lot going on all at once, particularly in the workplace. When this happens, take a deep breath and try to find something to do for a few minutes to get your mind off of the problem. You could take a walk, listen to some music, read the newspaper or do an activity that will give you a fresh perspective on things – when time permits.

2.    Positive affirmations work  Another technique that is very helpful is to have a small notebook of positive statements that make us feel good. Whenever you come across an affirmation that makes you feel good, write it down in a small notebook that you can carry around with you in your pocket. Whenever you feel anxious, open up your small notebook and read those statements.

3.    Take it one day at a time  In dealing with your anxieties, learn to take it one day at a time. While the consequences of a particular fear may seem real, there are usually other factors that cannot be anticipated and can affect the results of any situation. We may be ninety-nine percent correct in predicting the future, but all it takes is for that one percent to make a world of difference.

4.    Find gratitude   Sometimes, we can get depressed over a stressful situation. When this happens, take a few minutes to write down all of the things that you are thankful for in your life. This list could include past accomplishments and all the things that you have taken for granted. The next time you feel depressed, review your list and think about the good things that you have in your life.

5.    Think positive  Challenge your negative thinking with positive statements and realistic thinking. When encountering thoughts that make you fearful or anxious, challenge those thoughts by asking yourself questions that will maintain objectivity and common sense.

6.    Divide and conquer  When facing a current or upcoming task that overwhelms you, divide the task into a series of smaller steps and then complete each of the smaller tasks one at a time. Completing these smaller tasks will make the stress more manageable and increases your chances of success.I know that anxieties and stresses can be difficult to manage, particularly for nurses; however, there are many helpful resources available. Managing stress and anxiety in nursing does take some practice but eventually you will improve in time.

From RNCentral.com

I love my computer. I drag it and my iPhone almost everywhere, including to the NANDA-I Conference I attended last week. I take notes while listening to speakers, I use my phone or my digital camera to record the slides the experts use in their presentations, I post conference updates on Twitter and Facebook, and I bring it all together for this blog. I live an e-life it seems.

This is important because it has a direct bearing on healthcare, nursing, and as it would seem, nursing language (what NANDA-I uses to define “the knowledge of nursing”). My vocabulary enlarged last week as I learned a new word, some new phrases, and some new perils to look out for when I am working at the hospital.

E-Iatrogenic

We should all know that “iatrogenic” means “of or relating to illness caused by medical examination or treatment.” One of the terms we see a lot these days is “HAI” or “hospital acquired infection.” This, along with other illnesses and injuries, which happen as a result of other medical care, are no longer being paid for by the Center for Medicare and Medicaid Services (CMS) or by most insurance companies. And, there is new area of concern of which we must be aware: E-iatrogenic issues.

In the simplest way I can explain it, all the computers we’ve come to rely on in healthcare have their own perils and we are really starting to see evidence of that.

Elizabeth Borycki, RN, PhD, is an assistant professor of health information science the University of Victoria, in British Columbia, Canada. While attending NANDA-I she presented a paper on identifying and reducing “technology-induced errors” (one of those new phrases) or e-iatrogenic.

Technology-induced errors are errors that arise from the design and development of technology and the implementation and customization of that technology. In 1995 the U.S. Institute of Medicine endorsed the use of electronic health records (EHRs) as an intervention that could reduce errors. Healthcare organizations around the world ran with it and some follow-up studies reported the systems could replace the number of errors happening each year.

However, 10 years later, journal articles started publishing findings that described how EHRs and component software systems could, in themselves, lead to errors. Some of the types of errors Borycki highlighted included automatic defaults, incorrect medication dosages, and incorrect patient data. She cited some of the factors involved in these technology-induced mistakes:

• Human factors including usability and workflow.
• Organizational behavior such as socio-technical issues and system/organizational fit.
• Software engineering including testing approaches.

While chatting with Borycki, after her presentation, we noted several ways these errors happen to all of us. For example, you put in some data but forget to hit return and “oops,” the patient’s last set of vital signs don’t actually get recorded. Or the drop down box you have to pick from auto-populates an answer if you don’t pick one, or something unusual happens and there is no free-text box to record the event—all of these are situations I’ve actually dealt with as hospital’s I’ve worked in become more automated. These are all potential patient safety issues.

And this brings us to why Borycki presented at NANDA-I. Borycki and her fellow researchers believe that we need to extend the NANDA-I taxonomy to include the emergence of these new patient safety issues. That is, technology-induced errors arising from the widespread implementation of health information systems. We need some new nursing diagnoses.

According to Borycki, examples of potential interventions include:

• Reporting if computer system is not working or is malfunctioning.
• Reporting if computer system causes hazards due to inefficiencies or negatively affects workflow.
• Awareness of limitations of computer systems in nursing.
• Questioning computer generated results that may not appear to match the right patient.
• Recognizing problems in dangerous “work-arounds” due to technology.
• Training on how to proceed in situations where a computer system goes down or is not available.

Nurses I have worked with come from many camps. Some like charting electronically, some miss paper charting (although there are error problems there too) and some want EMRs to work but don’t trust the systems. The reality is EMRs and electronic charting are here to stay. It is our job as nurses to get involved, to point out where entries could be more efficient or easier to use, to learn more about the systems we are given and use every day and to be proactive in finding the best possible means for using them. For that, we need a language because it all comes back to standardized communication techniques are the best ways to keep our patients safe—our primary concern as RNs. NANDA-I has a new challenge, defining the e-knowledge of nursing.