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  1. Story #1 “Oh, I work a couple of shifts per week. Just enough that I can get out of the house and feel like I’m contributing, but not so much that I’m letting someone else raise my children.” These words spoken to me in passing cut like a dagger to my worn-out-mama soul. Her innocent implication that I let someone else raise my children as a full-time working mother piled on to the thickly layered “mom-guilt” I already put on myself. The cruel irony of this moment was that the words came from the mouth of my hospital nurse, as I was recovering from surgery, unable to be with, much less care for, my children in my current state. I was already in physical pain, and rather than alleviate my pain as her job should have been, she added emotional pain to my heart and mind. I feel certain that the nurse did not intend to wound me with her words. She was just “making conversation.” But what she failed to remember was that just another day at work for her was a huge life-altering experience for me. A hospital is a workplace for many, but for those of us lying in the beds, it’s often a scary and intimidating time. I implore you, keep your words positive and uplifting, or don’t say anything at all beyond the standard phrases of patient care. What you say can be just as much of the healing process as what you do.” Story #2 “I was in a rehab facility recovering from surgery to repair a shattered leg. I was in a lot of pain and had the feeling I was being judged unfairly as a ‘complainer.’ I just couldn’t get comfortable and desperately needed to talk with a doctor who had the authority to make some changes. During my discussion with the bedside nurse, she said, ‘You’ll see. Good will come out of this. Just think positive thoughts.’ Yikes. I know she meant well but that was NOT what I needed to hear. It may indeed be true eventually, but what I replied was also true, ‘I don’t need to hear that right now. I need words of comfort.’ Honestly, I don’t know if she even registered what I said.” Improving Communication Our words matter, don’t they? These simple comments, probably intended as attempts to connect, are received in a completely different way by the suffering patients. Sadly, the words linger long after the event and sometimes are repeated often as the patient struggles to make sense of a tough time. How do we improve our practice so that we don’t commit these types of gaffes? Researcher Brene Brown says, “Rarely can a response make something better. What makes something better is connection.” Making gentle connections without adding to our patient’s pain is our challenge, isn’t it? While this type of sensitivity may come more naturally to some than to others, all of us can learn and become better nurses in the process. Keep it Professional When we are in the patients’ room, our conversation and concern should be about them. We are not center stage. If they ask personal questions, it is courteous to answer, but generally, they are just being polite and they don’t really have the energy to know or care about our extended family or our troubles with our children or whatever our concern of the day might be. If the patient is argumentative or disgruntled or venting, we can begin to feel defensive and be tempted to offer them correction (or more!). Once a friend taught me the technique of saying, “Hmm. I had not looked at it quite that way…” and then let the sentence trail off without engaging. Another tool that can help us here is to answer their question as succinctly as possible and then turn it back to them with a question that helps us understand them better. Be Empathetic Our patients are sicker than ever before. Their family members are often super-stressed. As professional nurses, our job is to care for them to the best of our ability while recognizing the strain they are under and giving them extra grace in their time of need. Sometimes simply being present, prompt and professional is our best response—no particular words needed. Repeat What They Said Many of us nurses remember learning in nursing school about being good active listeners and reflecting back what the patient tells us by saying things like, “So you are saying…” In other words, finding ways to clarify what they say to make sure we are on the same page. Be Genuine When we are confident and comfortable in our own skin, we transmit that to others and help them feel comfortable as well. Being genuine does not mean that we tell people what we think, it simply means that we acknowledge their inherent dignity as persons and that we care for them with competence and professionalism, meeting their needs in the best way we can. No One is Perfect We are all going to be less than stellar nurses from time to time, but we must also keep trying to improve as we move forward in our careers.
  2. There is a reason why nursing students avoid meeting with a nursing instructor. If fact, there are several reasons. It’s not just the intimidation factor or the words “you're really inconveniencing me” written all over the instructor’s face. It’s talking with the instructor, walking away and thinking, “what did I just say?”. Most likely, your faculty appreciates your initiative in asking a question or voicing concern. You can reduce your stress and get the most out of your faculty interactions with a little pre-meeting prep work. Let’s look at a few guidelines to point you in the right direction. Take Action Nursing school can be very confusing. Everything is a new experience from lectures and skills, to clinical assignments. Students often make the mistake of “getting stuck” in coursework because they don’t understand what the instructor expects. The semester marches on, due dates arrive and the student just “wings it” instead of asking for help. But, faculty are not mind-readers and it is up to you to initiate a meeting. STEP 1 Tips for Requesting Faculty Time Avoid confronting your instructor in front of the class and putting them “on the spot”. Read the syllabus and course information to determine if the instructor has preferred methods of communication (email, phone, office stop-by, etc). If you stop by the instructor’s office, make sure it is during office hours. Be specific on why you need to schedule a meeting. Offer several time alternatives and be open to other forms of “meetings” (phone, on-line chat) STEP 2 Do The Prep Work Be sure to review the course policies, syllabus and any applicable instructions before your visit. The answer to your question may be hiding “in plain sight”. Ask yourself, “why do I need to meet and what do I expect to get out of the meeting?”. STEP 3 Tips for the Meeting Show respect Arrive on time Use the person’s name Make eye contact Speak clearly, using positive language Stay within the allotted time-frame STEP 4 Show What You Know Briefly express some interest in the course content Express enthusiasm for what you have learned STEP 5 Avoid Dumping You want to be specific about your question or concern. You don’t want to spend the meeting time with your instructor on everything but what you need. Here are a few examples: Don’t: “I don’t understand assignment 2. What are you wanting us to do.” Do: “I am confused about the care planning process, specifically, how to assign a measurable outcome." Don’t: “I missed lab and did the class do anything that will be on the test?” Do: “Is there a convenient time I can practice in the skills lab? I want to catch up with the class since I missed class.” Don’t: “I made a D on our test. What am I doing wrong?” Do: "I did not perform well on the last exam and want to do better. I would like to tell you my main study strategy and would appreciate any feedback or suggestions." STEP 6 Own Your Part Take responsibility for any mistakes or oversight on your part. Be honest and express what you will do differently moving forward. “I now realize the importance of spending time reviewing lecture notes after every class”. “I apologize for being late to clinical. Moving forward, these are the steps I will take to ensure punctuality.” Before You Leave Be sure you and your instructor are on the same page and what are the next steps. Stop and ask for clarification (if needed) before you leave Express gratitude for the meeting. Remember You have the right to ask questions and seek clarification. You also have a responsibility to do so tactfully, and decisions made by the instructor should be respected. What tips can you share to help other students make the most out of faculty interactions? Interested in more information? Check out these resources: Tips on Communicating with a Professor Meeting With Your Professor
  3. Communication: A Vital Utility Communication can be defined simply as the sharing of information. Even more broadly, communication can be distilled down to the act of a sender producing the content of a message in any of the many forms available to us, to then transfer this information from one entity to another at varying speeds.[5] A receiver intercepts the incoming message, then proceeds to decode the content into terms that are easy to comprehend, and that reduces the chances of error.[5] In healthcare, error is evaded at all costs as the consequences can be catastrophic, and in some instances, permanent. That is why so much effort is put forth to ensure that the means of communication is operating at peak effectiveness at all levels and why simply communicating with one another is not as straightforward as it may seem. How we communicate with one another in practice is largely based on the mode by which information is transferred from one provider to the next. Even more, the logistics of the message, that is, the organization of the content, word choice, and use of clinical terms is also seen as paramount to the productiveness of communication.[4] “Huddle” is one of the numerous communication strategies that is recommended by the Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense (DoD) in response to a publication from 1999 titled, To Err is Human, which presented what seemed to be an inconceivable figure of annual mortality rates due to medical errors.[3] This figure presented an astonishing 98,000 deaths annually due to what is defined as failure to do what was intended or failure to implement the correct plan to accomplish a common goal.[3] Among the contributory factors, failure of communication, however defined, was implicated in this avoidable reality.[3] An entire curriculum had been created in response to these issues as existing team-based training programs lack sufficient evidence in regards to their effectiveness, and were not designed to retrofit or conceive new programs based on their existing architecture.[4] At some point between 2001 & 2003, AHRQ and DoD almost decided to base their program on the Federal Aviation Administration (FAA) circular for airworthiness for commercial and private aviation. However, this was scrapped and TeamSTEPPS was created.[3] TeamSTEPPS is an acronym that reads; Team Strategies and Tools to Enhance Performance and Patient Safety. It is a curriculum aimed at practice investigators and those at the institutional level to implement, to, well, strategize the team approach and to streamline the care process, while improving upon patient safety. This U.S based program is making its way to Canada in collaboration with the Canadian Patient Safety Institute.[2] So, whichever preconceived notions you had regarding the utility of a.m team huddle, as you can see, there is a reason for it, and more importantly, there are people who see a larger vision over the horizon- as you should too. Team huddle is just one of many interventions aimed at improving communication.[1] (See pocket guide). What Does “Huddle” Mean? Team huddle is an event that typically takes place at routinely scheduled times on a daily basis and involves relevant members of the care team. It is a meeting that tends to take place early on in the day and lasts for about 10-20 minutes.[8] The goal of team huddle is to communicate pertinent information regarding patient care as well as unit and hospital operation. It is a tool used to facilitate communication between team members face to face, in an open forum, usually at or near the nurses station.[8] Similar to a town hall event, participants are there to listen and share without fear of judgment or being penalized for holding a certain opinion or thought. Team huddle gives team members the opportunity to adapt their workflow for the day and prioritize patient and unit needs.[8] Members of the team are given the opportunity to communicate information that brings necessary parties to the forefront of an imminent problem or concern, and in turn, contribute to the formation of a timely solution. Typically those involved in huddle include front line providers, management, unit attendees, clerical staff, and any one of the many other important stakeholders involved in patient care.[8] However, this does vary on an institutional basis. Team huddle can be seen as a preventative strategy that allows the unit to run smoothly and efficiently. Time can then be spent focusing on quality patient care, instead of putting out fires that could have been prevented. Huddle should be held at the right time, at the right place, and with the right people.[8] Why Are Team Huddles Effective? Team huddles provide a forum in which open discussion can take place regarding patient care. Topics that are typically discussed include goals for the day, patients to be discharged or transferred, patient-specific care plans such as falls prevention, unit census, workload/assignments, etc.[6] Discussing patient care using prioritization hierarchies and anticipating patient needs allows front line staff to plan out their day right from the get-go. This allows the team to be efficient, flexible, and adaptive for when the high volumes, heavy workloads, and admission/discharges begin to consume the day. And of equal importance, huddle provides the opportunity to connect leaders with front line staff and to bring awareness to safety and quality control concerns from both ends.[7] “Plan to Prioritize and Prioritize with a Plan” Huddles are most engaging when they are structured, but brief, and perceived as valuable. This fosters engagement from members of the team, and hopefully over time, becomes a staple within the units practice culture. Having everyone on the same page in such a fast-paced and high acuity environment is paramount. This can only be accomplished through effective communication and joint effort among those involved. Going Forward … What may seem like a sacrifice of your time may actually be a time-saver in the long run. I guarantee that no one in healthcare has ever said “too much information is bad” or “less information is more”. I am certain that having the opportunity to mention that the confused 90yr old in room 424 (1) is known to bed exit and does not yet have a plan in place to prevent falls, will surely save you more time in the long run. Because post-fall orders, calling family, charting, speaking to the multidisciplinary team, and dealing with avoidable injury would suck more time out of your day than spending 10 minutes attending huddle. Bar none. And of course, the care we work so desperately hard to hold to the highest standard would be flagged as preventable if appropriate intervention had been taken. We certainly do not want that for our patients. Nor do we want to foster a culture in which we become complacent with being “reactive” as opposed to “proactive” towards our day to day efforts.
  4. In choosing a career as noble and honorable as nursing, having the responsibility of being trusted to care for those who are stricken with illness should always be considered the core of our profession. However, we sometimes overlook the feelings of patients as individuals in our role as caregivers. It is imperative that we, by whatever means necessary, take the time to remember that the duty of the nurse is the pinnacle of patient care. While physicians diagnose and treat illness, nurses are responsible for the care and wellbeing of the patient as a fellow human being. Far too often nurses become caught up in the institution of a hospital, and by that, fail to remember it is we who are the very heart and soul of that institution. We are the believers. Every once in a while there comes a situation that reminds us what it really means to be the patient. This is usually a rare time when someone else is responsible for caring for us. I have one such example which offered me an opportunity to take a step back and realize just how frightening medical care can be for the patient. I would like the opportunity to share it with you. I had a perplexing reaction in a doctor's office during an appointment to start the course of vaccinations required for my nursing career. Mind you, I have always had an uneasy feeling of the doctor's office stemming from my association of the white-coated doctor and paper covered examination table equating to something being wrong. My blood pressure skyrockets concurrently with an elevation in pulse but this is the extent of my reaction. That is until this day. As the nurse came into the room with a clipboard serving as a tray to five syringes I sat quietly without the slightest inkling that my calm condition was to change in the very near future. I watched the nurse as he prepared the first of the syringes, the tuberculosis test is given just under the surface of the skin, and offered my forearm up for the injection. As he inserted the needle I felt fine. It wasn't until I saw the bubble rise on the surface of the skin that things went downhill fast. Instantly, I went white with sweat running profusely from my face. I removed myself from the table and sank to the floor as my vision spotted white. I was terrified and I had no clue as to why this was happening. After reassurance from the nurse that there was no danger, I lifted myself into a chair knowing there were four more shots still to come. I closed my eyes, the sweat now making watermarks on both my pants and shirt and prepared myself as much as possible for the next shot. With each additional shot came the same terror. When it was over I was required to sit and collect myself for twenty minutes so I did not faint. It was one of the most traumatic personal events I remember in my adult life. After leaving the clinic I half racked my brain for explanations and half tried to think of how I could make it through the last two series of vaccinations I still had to complete my immunity. At this point, I had no answers. The next time I went I had my wife accompany me to see if that would alleviate the problem. It did nothing. During the span of the six months from start to finish I searched and searched for an explanation with no real answers. On the last visit, I only had one shot to get this time and willed myself to finish, I decided to ask the nurse why this could be happening to me. I told her I had not been afraid of needles since I was a child, having no trouble with even a shot in the eye a few years ago, but was all of a sudden deathly afraid of them again. I ended by telling her that I was quite embarrassed that I was going to be a nurse who was afraid of shots. This made her laugh. It was in her taking the time to sit with me and explain this both being a common occurrence and a manifestation drummed up from childhood that I found my answer. She said I was afraid of shots as a child, grew out of it as I got older, and something since the last peaceful injection resurfaced my fear of shots being unsafe. As I thought for a moment it became clear what triggered the fear reaction. Microbiology class! She was right. She gave me some exercises to do before the shot, talked me through the safety of what she was putting in my body, and calmed me by allowing me to face my fears and work through them. My shot was a breeze. I've had another since and still no reaction what-so-ever. Today I am still astounded that something I was afraid of as a child could surface so profoundly out of the clear blue as an adult but it has helped me to realize that we truly are a product of experience. I had a revelation from my experience which I will carry with me for the rest of my life. I learned the value of a nurse as a caregiver. In other words, within the care of two nurses, I was given insight into the difference between a "good nurse" and an "average nurse". I realized the profound effect that a "good" nurse can have far beyond the walls of a hospital in a patient's life. The nurse who continued to administer shots during my anxiety without taking the time to "care for me" made me feel as though I was being rushed through an assembly line while the nurse who was interested in helping me beyond the scope of the requirement for employment saved me from a considerable hardship in life which I may not have ever sorted out without her. In her taking the time to comfort me and help me to the best of her ability she alleviated my stress and helped me to solve a problem; both of which I will always remember and love her for doing. In retrospect, I can see that her actions were selfless and had benefits for me which she was never aware. Let me explain. Before going in for my last shot I made a decision that if the situation dictated the same result in anxiety as the previous ones, I was going to speak to a physician concerning the prescribing of something to help me cope with injections in the future. It was this nurse that helped me to circumvent this course of action and allow me to face a fear rather than just treat the symptoms of that same fear. I can only believe that each of us is blessed with the desire to go above and beyond what is required to do all we can for our patients. In the monotony of our work days that give them the illusion of running together at times, there are things which we must remind ourselves at all times are by no means monotonous. These "things" are not really "things" at all. They are people. They are individuals, each patient unique, which make them different from any other as well as from us. No matter if you have an example of your own that you use to remember what it means to be in their position or your welcome use of mine, try to remember the next time you see a face as you enter a room that it belongs to a human being and that human being is in dire need of all that you have to give.
  5. jeastridge

    How to Listen: Do Nurses Do It Best?

    A few weeks ago, several of us nurses got together for a cup of coffee outside of work, a rare event but an occasional holiday celebration. We sat around a table, holding our hot drinks and warming our fingers from the bitter cold outside. After some light banter, one of our colleagues shared a recent difficult encounter with a patient, one that left her feeling defeated and out of sorts as a professional. We all listened intently, and it was interesting to observe the various responses from her friends and co-workers. Because our responses were so reflexive, it made me think that we might also respond this way in other situations. Is good listening a skill we can learn and get better at? Consider the responses from around that table and think about how you respond to patients, co-workers, family members that share vulnerably with you. 3 Responses 1. Almost before she could finish her story, one of the group asserted loudly (even pointing a finger in her direction), “I would not take that. I think you should respond by saying…” She went out to detail how the conversation might have gone had she been a participant, laying out clearly what she saw as the answer to her friend’s problem. Her body language, her forcefulness, her certainty all seemed to push the storyteller back in her chair, away from her cup of coffee, as she raised her eyebrows questioningly. “Do you really think so?” She queried, her hurt and confusion visible and audible. 2. A second person listened a little longer then said, “Well, I don’t think you should feel that way at all.” She continued to “should” all over the teller, minimizing her struggle and essentially asking her to harness her feelings into something less hurtful than they really were. “Shoulding” is so common, isn’t it? 3. The third person, the speaker’s close friend, remained quiet through the various exchanges, allowing the story to have plenty of time and space. She leaned forward a little before quietly offering her empathetic response: “What happened to you really stinks. I am so sorry that you had to go through that.” To me, it felt like she came alongside her friend and figuratively put her arm around her shoulders, sharing the difficult space and sitting with her as she felt the feelings she was feeling. Same story, three very different responses. Where do you see yourself? Ideally, we would like to say that we are consistently in #3, but most likely, we vacillate in our responses, employing all 3 from time to time and moving back and forth. Adviser The advice-giver meant well, but she effectively shut down communication, didn’t she? By delivering her pronouncement, she declared that she knew what was best and how that situation could be resolved. As unrealistic and presumptuous as her response is, we see it and experience it often, don’t we? People want to “set things right” by their standards and don’t want to leave a lot of uncertainty hanging around. While it is possible to offer advice, people rarely really want it, even if they ask. Generally, people need to work out their own individual approaches, their own answers, in their own time. Occasionally, if we have been in the exact same situation (unlikely) we can share what we did, but most of the time, those who share with us are looking for validation, a careful listener, and help in the form of a well-placed question such as, “So how do you feel about things now?” The advice-giver’s body language also closed more doors. Finger-pointing rarely feels good to the recipient of the gesture. It can be a strong, power-loaded motion, one that requires careful thought before deployment. “Should-er” The “shoulding” friend also delivered a put-down, didn’t she? We have the right to our feelings even if our feelings are not right. Feelings are proprietary. We acknowledge them, deal with them in our own way and hopefully find a path to mastery over time but “shoulding” brings some shame into the picture and makes us ask ourselves, “What is wrong with me to feel this way?” Of course the “should-er” doesn’t mean to elicit these feelings at all; she simply wants to make everything “all better” and smooth over discomfort. She longs to fix it, doesn’t she? As nurses, we can be attracted to the profession because we long to help our patients. This charitable desire has a dark side which is the “fixer” of the profession—always knowing what is best for others and letting them know what we think instead of allowing them to feel their own feelings and find their own way. If not carefully monitored, our desire to help can morph into control and manipulation and codependency. Empathetic The third friend’s empathetic response felt the most compassionate to me as I observed these interactions among friends. While the first two seemed to close doors of communication, the third response pushed the door ajar, allowing for future conversation and more opportunity to discuss the hurtful occurrence and to process it. The conversation at the table moved on to less heavy topics and we continued to share and laugh as our coffee cooled, offering healing and support to one another. Long after we went our separate ways, I thought about what I had witnessed and how many times we miss the mark in our responses to others. Were #1 and #2 “wrong” and #3 “right?” Well, yes and no and maybe. We are not perfect humans. We must offer each other grace and forgiveness every day if we hope to find any joy at all in this life. Friends sometimes say the best thing and sometimes not. We don’t discount their input either way, and we usually try to overcome differences. But such conversations shine a light on how we communicate and can help us to pause and think as we listen to someone’s story, careful as we try to respond with empathy and concern.
  6. Co-worker conflict can be uncomfortable, casting a dark cloud over the workday. Anyone can have a bad day and it is often played out with irritability, raw emotions and thin patience. But, if a co-worker conflict is affecting your work or causing discontent, it is time to take positive action. Your first reaction may be to avoid the issue or escalate it up to your boss. But, with these 6 tips, you can begin to address the situation yourself. Approaching a co-work may feel awkward at first, but your confidence will build with practice and experience. Tip One: Take time to cool down and reflect. Engaging in conflict resolution with a co-worker when you are angry is the easiest way to shut down open communication. Anger takes away our ability to think and problem solve rationally. Walk away from the situation and take the time needed to cool off and reflect. Tip Two: Think about the problem. The old saying “there are two sides to every story” is true when you begin to reflect on both your own and your co-workers perspective of the problem. To explore your perspective, ask yourself: What is the conflict really about? What is it about the issue that has me upset and angry? Do I have underlying concerns, wants or needs that are not being met? What is needed to improve on my circumstances? To explore the other person's perspective, ask yourself: How might they see the situation? How might they view my actions? What needs might she/he have? What is important to the other person? Keep in mind that assumptions, misperceptions and unmet expectations is at the core of most conflict. Tip Three: Plan out the conversation. One strategy for not allowing your emotions to drive the interaction is to plan out the conversation. Start by removing the relationship you have with your co-worker from the equation and focus on the facts to better deliver the message. Practice describing the problem in a non-blaming and non-personalized way. Be sure to address the problem as mutual (our problem) and use “I” statements to communicate your perspective. Tip Four: Don’t gossip or vent to others. It is tempting to talk to other co-workers and seek validation that you are in the “right”. However, the person you are in conflict with may hear you are talking “behind their back” and escalate the situation. It is best to keep the matter confidential. Tip Four: Choose an appropriate time. Find a time (sooner than later) that is convenient to both you and your co-worker. Also, it is important to have the discussion in a private place with little to no interruptions. Tip Five: Communicate effectively. When you approach your co-worker, make your intentions clear, assuring them you want a good working relationship. Your colleague may initially become defensive and possibly assume you want to continue the disagreement. It helps to describe the problem without blaming, put downs and over-generalizations. Here are a few other tips for effective communication: If you feel you may have had a role in creating the conflict or regret how you handled the situation, sincerely apologize upfront. Ask the person to tell you how they see the situation before you share your grievances. This will help lower their defensiveness. Be ready to listen attentively to the other person’s concerns. You may not realize how you are contributing to the problem or how your behavior is being perceived. Having a face-to-face discussion with effective communication supports conflict resolution in the following ways: Gives the other person a chance to explain themselves Gives the other person a chance to apologize (when appropriate) Gives both of you an opportunity to understand how each views the working relationship Allows negotiation of ways to better work together Tip Six: Work toward a solution together Avoid focusing on who is right and who is wrong. Instead, work with the other person to identify possible solutions that work best, meeting the needs and wants of you both. This may take more than one meeting, so keep working at it. It is worth the effort in the long run. Tip Seven: Ask for help when needed. Sometimes co-workers are unable to resolve workplace conflict between themselves and the working relationship takes a toll on productivity. In this case, you will need to identify the proper channel, such as the supervisor, to further discuss the problem and move forward. Conclusion Working together to solve conflicts within the workplace could lead to a closer and more effective working relationship. Down the road, when you or your co-worker have a bad day, you will find yourselves committed to a better way of handling any conflict situations that arise. Let us hear from you! What do’s or don’ts do you have to share with readers? Want to learn more? Check out these additional resources Seven Steps for Mending Relationships With Colleagues How to Handle Conflict in the Workplace
  7. It is inevitable. Your path will intersect with difficult patients over your nursing career. Angry, manipulative or overly needy patients can quickly wash away your already strained patience. Patient emotions surrounding loss of independence, stress and fear are often the driving factor behind difficult behavior. Difficult patients generally fall within four common types, which are often dependent on the driving factor. Understanding these types will help you remain compassionate and keep the lines of communication open. The Dependent Clinger Dependent clingers begin the patient-nurse relationship with a healthy dose of praise. Clingers often make statements such as: “What an angel, I knew you could help.”, or “You are such a wonderful nurse”. While we all like to get compliments, clingers use flattery as a way to manipulate. Clingers may have an endless stream of needs and demand chunks of your time. Unfortunately, we often over-extend ourselves and feel drained at the end of the day. We resort to avoiding the patient and they will act out to regain your time and attention. The Entitled Demander This patient type knows exactly what they want, when they want it and how they want it done. Instead of flattery, the demander will use anger and intimidation. Examples may include demands for: Unnecessary lab work Immediate appointments or notification of physician Certain medications and treatments Unnecessary referrals or consults It is not uncommon for demanders to threaten attorney contact or lawsuits. In reality, all the posturing is just a smoke screen for feelings of powerlessness and helplessness. Help-Rejectors This frustrating type has many physical or other complaints but rejects help when it is offered. The relentless “complain and reject” cycle may make this the most difficult type to manage. You may successfully put out one fire, but help-rejectors quickly replace it with another. A medication may be prescribed for an issue and you notify the patient. The patient’s response? “I have already tried that and it won’t help”. The Noncompliant How many times have you witnessed someone smoking with oxygen, drinking alcohol with liver cirrhosis or a patient refusing to take needed medications? The noncompliant often seems to be completely unaware of how their poor health decisions are going to play out. According to the Journal Neurology Clinical Practice, underlying anxiety or depression disorders could be contributing to noncompliant behavior and keeping them from good health. It is frustrating when we, as nurses, are unable to educate or persuade the patient into complying with the treatment plan. Tips for Dealing With Difficult Patients When a patient is angry, frustrated and acting out emotions, it is hard not to take it personally. However, it really isn’t about you, but more about their unpleasant set of circumstances. Nurse consultant, Julianne Haydel, advises “Continue to do your job and don’t let their negativity get in your head. Just knowing that the nastiness is not about you is a good start.”. After this first step, there are other tips to help you move forward with a difficult patient. Recognize Early Signs You may be able to avoid or deescalate a situation by picking up on early signs of upset or anger. These signs may include a change in behavior, tightened jaw, furrowed brow or other outward signs of building frustration. Also, consider other sources for the behavior, such as, pain, uncomfortable symptoms or other underlying problems. Gain Your Own Emotional Control It is easy for our own emotions to become heightened when faced with another person’s anger, frustration and dissatisfaction. However, you will be able to better address the situation if you don’t react, be proactive and think about your body language. Listen Empathetically A quick way to calm a difficult patient is to listen and react with empathy. It may be the patient just needs to vent and tell “their story”. Rather than being defensive, listen respectfully and remind yourself the patient is in an unfortunate situation. Everyone one likes feeling important and knowing they are cared for. Avoid Arguing This can be a hard one, especially if you are taking the patient’s behavior personally. Our first response is to go into a detailed explanation of why their medications are late or their needs are not being met. Try simply apologizing and reassure the patient you will address the problem. Set Boundaries Sometimes patients may have unrealistic or seemingly endless demands. In these cases, set consistent and clear boundaries and keep interactions standard. It is also helpful to have consistent boundaries set across the interdisciplinary team. Don’t Accept Abusive Behavior It is sometimes difficult to draw the line between abrasive and abusive behaviors and may depend on your work environment. Always alert your immediate supervisor if a patient continues abusive behavior after being told it is unacceptable. Implement your facilities protocol immediately If you feel a patient's behavior is placing you, or others, in physical danger. A Part of Nursing You will deal with difficult patients throughout your nursing career, it is unavoidable. And, even the most difficult patients deserve our best care. By practicing these tips, we can focus on providing quality care while setting boundaries for ourselves. Additional Resources 6 Tips for Dealing with Difficult Patients Dealing with the Difficult Patient
  8. Have you ever considered that nursing excellence allows physicians to provide compassionate, patient-centered care? A recent study conducted by Press Ganey revealed that comprehensive nursing practice in high-performing hospitals creates high patient satisfaction rates for both nursing and physician delivered services. What is the professional practice environment really like? It's free of disrespectful, rude, and disruptive behaviors between staff. Professional relationships don't focus on power or the abuse of it. This allows the work being done to center around the patient, and not on how one group is defending itself against the other. A healthy workforce also consists of effective communication, collaboration, and mutual respect. Understanding the Nurse-Physician Connection Ask any nurse, and frankly, any physician and they are likely to tell you that the relationships between nurses and physicians matter. Knowledge of the professional practice environment is critical to not only to collaboration but also to nurses’ recruitment and retention rates. The professional practice environment is where medical and nursing care happens. Depending on how the nurses and doctors feel about the workplace and their collaborative roles with one another impacts quality. So is the professional practice environment really like? It’s free of disrespectful, rude, and disruptive behaviors between staff. There is no abuse of power or relationships between nurses and physicians and allows for work satisfaction for both professionals and quality patient care. It’s filled with communication, collaboration, and mutual respect. Nursing Excellence Initiatives The American Nurses Credentialing Center developed the Magnet Recognition Program for hospitals. It started in 1983 when they conducted a research study and identified 14 characteristics that made some organizations more able to recruit and retain nurses. Not only does the program require excellence, but it needs to be guided by a visionary nursing leader who supports, advocates, and practices nursing excellence. The 14 characteristics of nursing excellence, according to the American Nurse Credentialing Center include: Quality of Nursing Leadership Organizational Structure Management Style Personnel Policies and Programs Professional Models of Care Quality of Care Quality Improvement Consultation and Resources Autonomy Community and the Healthcare Organization Nurses as Teachers Image of Nursing Interdisciplinary Relationships Professional Development Nursing Excellence, Hospital Scores, and Physicians Press Ganey's study explored the relationship between Magnet status and National Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. This standardized publicly reported survey looks at the patient's perspective on hospital care, including the environment and how well physicians, and nurses communicated with them during their care experience. The Press Ganey survey found a connection between Magnet Status, which indicates nursing excellence, and higher patient ratings of their doctor’s skill, responsiveness, and bedside manner. While the difference appeared subtle in number, there was a meaningful difference in the patient’s perceptions. Out of 123 Press Ganey client hospitals, the survey found that 45 percent of those in the top quartile for engagement of physicians were also Magnet hospitals. Compare this to the 16 percent of bottom quartile facilities who also shared the Magnet designation, and you can see how nursing and physician care must be intertwined to deliver care that is perceived by the patient as having them in the center and being of the highest quality. Improving Nurse-Physician Relationships Considering that only about 8 percent of all hospital in the US achieve Magnet designation, we must find ways to enhance the nurse-physician relationship outside of this prestigious designation. Here are a few ways you can work on your relationship with the physicians in your facility to increase collaboration and positively impact patient outcomes. Practice as a Team While nurses spend far more time at the bedside than doctors, it’s critical that we remember that we each have a unique role in patient care. Share in the responsibility of patient outcomes with all staff members and work collaboratively. Uphold Professionalism When nurses uphold professionalism, the workplace runs smoothly. This includes simple things like getting to work on time, avoiding negativity, and working both autonomously and collaboratively. Develop a Strong Sense of Advocacy One of the pillars of nursing practice is to work as a patient advocate. You must learn to speak up for the patient and let the physician know your observations and thoughts about the patient’s condition. This can be difficult, depending on the type of relationship you have with the physician and other clinicians in the healthcare setting. Practice Effective Communication The ability to communicate with coworkers, including doctors, is critical to positive patient outcomes. You must learn to organize your thoughts before you pick up the phone. If you find yourself struggling to communicate concisely, check out a few different communication tools that can help you standardize your reports to the physicians and fellow nurses. Having a clear report can help the receiving clinician understand the patient’s needs better so that a comprehensive plan that addresses the most critical areas can be developed. How do you feel about your relationship with the physicians in your facility? Do you think that you have a good relationship, built on mutual respect? We would also love to hear from nurses who work in magnet hospitals to learn how you feel about your ability to support physicians and how the two groups work together. Let us know what you think by commenting below. Reference: How Great Nursing Improves Doctors' Performance
  9. As nursing students, our duties make the best part of our stay in the college, and being with group mates who are very out-of-this-world really freaks us out, especially when we have a case presentation, a thesis for the research, and to make it worst, you are the group leader! So here's the deal to conquer your group mates' stubborn attitudes. They have types, of course: The Friendenemy (Friend or enemy?) Enjoys with you and very reliable during "inuman" or "happy-happy" moments, and definitely when you have a BP apparatus and thermometer that she "consciously" forgets every time your having your duties. How to fight it! If you are the group leader, set up rules for all of you to follow,and have some penalties for a change, like 1 peso for every loss of one apparatus, your group can use the collected money for special purposes, like paying for a compulsory contribution. If you are not the group leader, confront the friendenemy and tell her politely that it's not good to borrow every time you're having duties, after all, the clinical instructor will check your things beforehand. The "OC-OC" (Obsessive-compulsive) The obsessive-compulsive group mate of yours who wants to finish the thesis and the case presentation paper works "STAT"! The catch: She wants you to do the same! How to tame! Talk to her in polite manner that cramming is very unacceptable for her other group mates and humility is important. If you are the group leader, make up a printed schedule for our group so that time can be maximized for all of you to do the thesis or case presentation, this will lessen the stress brought by the "OC-OC". The last-2-minutes group mate The exact opposite of the "OC-OC", she loves to send the whole group into " Panic land" when she did the 20-pages drug study and nursing history, two minutes before your case presentation. How to cease her! Have her work the not-so-important parts of the case presentation or thesis, like the introduction, acknowledgment and the table of contents. Make her think by being frank to her and tell her that being late is not good, especially if she will be a registered nurse in the near future. The Know-it-all girl/ boy She's / He's full of confidence (extremely full of it!) and gets really upset and mad when her opinions and suggestions were not done or praised. She/ He also gets mad when she's/ he's not getting the case presentation part that she/he desires, like having the Pathophysiology and Anatomy lecture rather than getting the 3-paged drug study part. Everyone else just favors her due to fear. How to fix it! Make her feel like she's not the only Ms./Mr. Perfect in your group. If you are the group leader, make a "draw-lots" for your tasking. Fold pieces of paper with your tasks written in each of it, and make them pick one of these. So that they cannot complain about what they got. Equality is the real deal here, and as they say, majority rules! The Mushroom The one who shows up during peak hours of duty (graveyard duty) and takes her absences during the day of your case presentation (with her part as the Pathophysiology and Anatomy lecturer) without prior notice. How to stop it! Divide the tasks in your group without hoping him/her to come during the presentation,or better yet, divide his/her tasks to the rest of the group so that in case she/ he takes the absent mode again,your group will not panic and your ready for the presentation. There you have it! Once you encounter these freaks, you better watch out and never let them ruin your precious duty memories!
  10. HangInThere

    Who is in Charge Here?

    "Who is in charge here?" said Mr. D, a 67-year-old retired police sergeant with dementia. "Mr. D., I'm the Charge Nurse tonight," I said. "What's your concern?" "No! Who is the manager of this institution? I wish to make a formal complaint," said Mr. D. "The manager's name is Ms. G.," I said. "This place is run like a madhouse!" he shouts. "I don't know when my blood will be taken and I don't know when my medication is coming!" His voice deepened and he fixed his stance. "They took my phone, and my mother is worried about me, and how can I call my mother? They took my damn belt, and my pants are falling down!" "Okay, let's take one thing at a time," I said. "You took my phone! Who has my phone? Where's my phone?" he said as he glared at me. "That, oh Charge Nurse, is against the law!" Just then, my colleague Nurse Maria approached us. She stood about 8 feet to the side of Mr. D. She said, "Mr. D., do you have your mother's phone number?" Still staring at me, Mr. D answered, "I have it in my mind." "Let me write it down for you," Nurse Maria offered. "It's 3:30 a.m. You're in the hospital, and everyone is sleeping. In the morning after breakfast, the phone is turned on. I can help you make the call. Let me write that number down." Mr. D nodded while still glaring at me, and said the telephone number. She wrote it down and said, "Now you can rest, Mr. D., because you will call her in the morning. Remember, Juliana and I will help you make the call." Mr. D. did not break eye contact with me but also nodded. Nurse Maria said, "Now, it's a good idea to go back to bed." Mr. D. nodded and turned toward his room. What happened? As the interaction escalated between the patient and me, a more experienced nurse interpreted the emotional nature of Mr. D.'s demands and acted as a third party to diffuse the situation. Veselinova (2014) writes, "An individual with dementia may be sensitive to the tone of voice and may feel intimidated or frustrated by extreme levels of speech and tone" (p. 164). Nurse Maria introduced a calm, measured verbal redirection that was fluent with Mr. D.'s actual need for emotional support. Nurses who adapt the way they communicate can encourage increased communication with individuals with dementia (Veselinova, 2014). Through the night, to build the rapport initiated by Nurse Maria, I returned to Mr. D. to address his needs. He told me he could not sleep, so I offered to set up a recliner near the TV in a quiet corner of the unit. Once his feet were up with a pillow behind his head, he said, "This is fine." Later on, when he said, "I'm tired of this," I walked him to the dining room for a change of scene. The next night at 4:00 a.m., I asked if he would like to play cards to pass the time. He replied, "Black Jack." We played until 5:00 a.m., and that's when he began to tell me about his memories, his family life, and his police work. The interactions with Mr. D showed me that once a patient has at least one of his needs met, he feels heard and understood. Nurse Maria's keenly placed offer to redirect the patient initiated a workable relationship between a patient with dementia and me. Not only did this diffuse a situation that might have escalated, but it also opened a door to a trusting relationship between Mr. D. and me. The next night, Mr. D actually slept a few hours and at 4:00 a.m., he asked me to play Black Jack with him again. When your patients angrily confront you, what do you do? Reference Veselinova, C. (2014). Influencing communication and interaction in dementia. Nursing and Residential Care 16(3), 162-166. Retrieved from http://www.magonlinelibrary.com/toc/nrec/current
  11. Nurses must relay important information to colleagues and supervisors, doctors and healthcare providers, patients, and concerned family members. Developing effective communication skills is a key element of a successful nursing career in healthcare. Learning to navigate potentially challenging workplace dynamics is crucial to maintaining the safety and well-being of patients and practitioners alike. In addition to creating a stressful work environment, communication difficulties can lead to adverse health outcomes and a potential increase in patient mortality rates. A study by The Joint Commission concluded that 70 percent of reported sentinel events had been caused by a breakdown in communication among healthcare professionals. For nurses, acquiring a skill set that includes effective communication is crucial and a critical component of advanced education and training for nurses. This article highlights some of the potential challenges in the nurse-patient, nurse-nurse and nurse-doctor relationships, as well as tips on how to navigate and work within difficult situations in the workplace. Challenges in the Nurse-Patient Relationship Patient care is at the heart of nursing, and a desire to help people is one of the reasons many enter the field. Nevertheless, the unpredictable nature of practitioner-patient dynamics often tests the professionalism of nurses. Nurses are meeting patients at their most vulnerable, which can create tension, fear and other difficulties. Breakdowns in communication between nurses and patients happen. For example, patients may have difficulty concentrating on what their healthcare providers are telling them in a stressful moment, or they may be too concerned about their medical issues or distressed by pain to give nurses their undivided attention. Tip: Slow Down Nurses can be overwhelmed by the number of patients in their care and are expected to be on top of their tasks even in the tightest of time crunches. The need to multitask while checking on a patient is understandable, but slowing down and giving the patient your undivided attention may save time in the long run. Experts recommend sitting next to the patient, making eye contact and asking open-ended questions. Don’t dismiss patients’ feelings; instead, acknowledge that you understand their frustration. If a patient doesn’t seem to be listening or understanding instructions, try to find visual aids that may help him or her process the information. Challenges in the Nurse-Nurse Relationship Nursing tends to attract a diverse group of individuals in terms of age, gender, ethnicity and background. Though this is one of the industry’s strengths, it can also pose certain communication challenges for nurses. For example, there may be generational differences in the approach to patient care and medical operations within the unit. Toxic or deeply stressful work environments can proliferate, which adversely affects nurses of all levels. In addition to potentially reducing the quality of care nurses provide, a dysfunctional work culture can also lead to staff turnover and absenteeism. Tip: Have a “Cup of Coffee” Conversation This doesn’t actually mean going out for coffee with a colleague, though that could help. A “cup of coffee” conversation is a communication tool that can help nurses address a specific issue with a colleague. The goal is to focus on a single instance that may have created questions or concerns. Have this conversation in private and in a neutral location. Maintain a respectful and nonjudgmental attitude and briefly state the concern. It’s best to simply ask the other person to think about the situation. Finally, remind your colleague that he or she is a valued staff member. Challenges in the Nurse-Doctor Relationship At its best, the relationship between a nurse and a physician is one of respect and collaboration. Unfortunately, there are certain dynamics at play that can make communication challenging. Despite the increasing responsibilities of nurses, many still perceive doctors as being at the top of a hierarchical chain of command. As a result, some doctors dismiss nurses’ expertise or minimize their professional advice. Nurses may then feel pressured to keep their opinions to themselves. In addition, some doctors are not always aware of the scope of a nurse’s role when it comes to patient care and the daily pressure that nurses are under. Tip: Use SBAR to Report Patient Issues SBAR — Situation, Background, Assessment and Recommendation — is a communication technique to improve communication between nurses and physicians. This communication model allows you to organize your thoughts to convey information clearly, promptly and accurately. The first step is to briefly state the problem (the situation) to the doctor. Be sure to provide the doctor with all relevant information (the background). Then, share with the doctor what you believe are the potential causes of the problem (your assessment). Finally, be clear about what is required to address the situation (your recommendation). This framework allows nurses to communicate their concerns and needs to doctors while remaining focused on patient care. Final Tip: Feel Secure in Your Clinical Expertise Nursing is an incredibly rewarding field, but it is also highly competitive. Interpersonal skills and effective communication strategies can go a long way toward building a satisfying career. Nurses can foster their leadership qualities by seeking higher education. Students in a graduate nursing program, for example, can develop advanced skills in conflict resolution, interdisciplinary collaboration and sophisticated decision-making by enrolling in an online Master of Science of Nursing after earning a Bachelor’s in Nursing degree. With a refined skill set and deeper knowledge, graduates will feel empowered to speak with more authority in front of doctors, colleagues, and patients, as well as to voice their concerns from a place of confidence. What are some of the challenging dynamics you are experiencing in your nursing relationships and what are your tips to make them better? Please share your thoughts in the comments below! Sources: American Nurse Today, “Not Just ‘Eating Our Young’: Workplace Bullying Strikes Experienced Nurses, Too" American Nurse Today, "Promoting Professionalism by Sharing a Cup of Coffee" DailyNurse, "Improving Patient Safety, Part 1: Communicating With Providers" DailyNurse, "Tips for Communicating With Your Patients" Institute for Healthcare Improvement, “SBAR Tool: Situation, Background, Assessment, Recommendation” Nursing Center, "Nurse/Physician Relationships: Improving or Not?"
  12. Health systems have to be forward thinking and use creative strategies to recruit good nurses. According to an NSI Nursing Solutions’ 2016 National Healthcare and Retention RN Staffing Report, it costs a conservative estimate of $54,400 to replace each nurse or $373,200 for every percentage point change to the turnover rate. About 81.8% of organizations say retention is a top priority, yet only 51.5% have a formal retention plan in place. Health systems often focus on recruitment efforts and fail to look at internal factors contributing to the high rate of nurse turnover. The reality of the healthcare environment results in nursing caring for sicker patients with more to do and less time. The benefit of nurse satisfaction is improved nurse productivity and patient care. Nurses need to be recognized and valued to remain once they have been hired. Nurses leave a job for a variety of reasons such as lack of professional development opportunities, lack of recognition, not enough staff, too many responsibilities, and better pay. Research shows nurses stay in jobs when the nurses feel valued, respected and appreciated. Managers play an important role in creating a culture that promotes building relationships with nurses and makes them feel important and valued. A study conducted by the Annals of Behavioral Medicine measured the heart rate of 100 nurses at Scottish teaching hospital while they were doing nursing tasks in real-time. They found nurses felt less stress if they felt like they were in control of their activities, valued and appreciated. Recognizing the important contribution of nurses does not have to be complex or time-consuming. Consider these easy ways to improve nurse and leadership relationships. Set a tone of cooperation and teamwork. Management sets the tone for employees and the work environment. Nurse managers must make a conscious effort to create a culture of cooperation and teamwork. Nothing brings down the mood of employees like a nurse manager who goes straight to their desk with an attitude of disengagement. Make communication a priority. Good communication and clear expectations are good for nurse morale. Nurses are more confident when they know what is expected of them. Staff wants to be kept “in the loop” on what is happening in the organization. Transparency makes nurses feel like they are trusted and an important part of the team. Meet with staff regularly to share information, provide praise and recognition and to encourage feedback. Praise more than you criticize. Just think about all the information flowing to nurses from their managers. A nurse frequently is informed of chart audits, holes in staffing, documentation issues and much more. There seems to be no shortage of feedback on working harder and areas identified for improvement. Nurse managers should praise more than they criticize. Share with staff when audit findings improve and benchmarks are met. Giving a sincere “thank-you” or “good job” in real time makes a big difference. Solicit their ideas and opinions. Nurse managers are often perceived as being too removed from bedside nursing and not in touch with the day to day challenges nurses face. Unfortunately, the perception of management disengagement is often an accurate read. Ask what about their jobs is working and what areas need to be addressed. Encourage staff to be part of the solutions for daily challenges. Also, follow up and communicate what is being done to address the issues they identify as a source of job dissatisfaction. Recognize the warning signs of low morale. Nurse managers need to be alert for signs of low morale in staff and themselves. Morale can change quickly and it is important to be in touch with day-to-day events. Remember, morale comes from the top down and staff can recognize when a manager’s attitude shifts. Here are a few warning signs: Negative attitude that lowers patients’ quality of care Low productive Resentment towards coworkers Talking about others negatively Lack of attention to details Increased absenteeism or tardiness Withholding important information When employees feel valued, they are more likely to stay with an organization despite challenges and bumps in the road. Nurse managers have an incentive to retain good nurses- improved performance and patients outcomes. Nursing by nature a stressful job, but perhaps with a sincere effort to make staff feel valued nurse managers can significantly improve the work environment. Resources Article- How to Make Employees Feel Valued Article- Stress Levels Higher for Nurses Who Feel Undervalued
  13. Mark Twain once said, “The difference between the almost right word and the right word is really a large matter - ‘tis the difference between the lightning bug and the lightning.” This is precisely how you must think of people first language. While it isn’t wrong to say, “the asthmatic,” “the stroke patient,” or “the autistic child,” It indeed isn’t correct or the best use of your written or spoken words. Here’s a quick review of using people first language and how you can put it to work in your documentation, reports, and other healthcare-related writing and speech. What is People First Language? It might sound simplistic, but people first language means that you put the person before the disability or diagnosis. When writing or speaking about a person, you should use words that describe what a person has, not what the person is. A few examples include: Say - "I’m caring for Michael, a child with autism." Don’t say - "I’m caring for Michael, an autistic child." Say - "Jane uses a wheelchair." Don’t say - "Jane is wheelchair bound." Say - "I work with people who have disabilities." Don’t say - "I work with the disabled." History of People First Language The fight for equal treatment of people with disabilities began in the 1970s. Public Law 94-142 was enacted in 1976 to include children with disabilities in public school systems. The next notable change for people first language came in 1990, with the passing of The Americans with Disabilities Act. This law prohibited discrimination based on disability in jobs, transportation, and schools. It offered protection to more than 40 million children and adults with disabilities. Language in previous laws changed from “handicapped” to “people with disabilities,” too. While we have made significant strides to limit the disparities for people with disabilities, we still have more progress to make. Understanding the Power of Language Words are powerful. They boost spirits, cut barriers, and connect people. When used in the wrong way, they can cause others to disconnect and withdrawn from their surroundings. Without even knowing it, healthcare providers can create barriers with their written or spoken words. Consider these two ways to document the same information: Non-People First Language: Stroke patient, 61 years old arrived to the floor at 801 am. He is myopic and has a cancerous history. He is handicapped with left-sided weakness of upper and lower extremities and emotionally disturbed. The patient will likely be wheelchair bound during the hospital stay. People First Language Mr. Jones, a 61-year-old male with recent stroke symptoms arrived to the floor at 801 pm. He wears eyeglasses and has a history of prostate cancer. The assessment revealed left-sided weakness of upper and lower extremity. He is tearful when discussing his condition. Due to the weakness, he will be using a wheelchair when out of bed. These two passages conveyed the same information. However, by applying people first language, the second example expresses compassion, empathy, and inclusion. Here are several tips that will help you use people first language in your daily practice. Offer Respect When communicating about people with a disability, think about how you would want that person to be described if they were your mother, father, child, or close friend. Would you want someone to say “the deaf boy in room 3 needs help,” or would you prefer to hear someone say, “the boy who is hearing impaired in room 3 needs help.” It’s not difficult to use people first language, but it might take a little effort. Remember the Person Always lead with who the person is first. Use words such as person or individual to remain politically correct. You could also use their name, such as “Mr. Jones” or “Richard.” By using their name or a term like “person” you are removing the idea that their diagnosis is more important than who they are as an individual. Avoid Pity When you use words like “handicapped” or describe that a person is “suffering from” a diagnosis, it suggests pity. Invoking this emotion indicates that the person living with a disability is living a life of less quality. Talk About It If you are uncertain how to refer to a person - just ask. It might be uncomfortable the first time or two, but once you do this a few times, it will come easier. Imagine that it is similar to asking a person their name - you want to know because you care. Describing a person who has a disability is the same. Ask them how they prefer you discuss their unique qualities with them and about them with others. You can also find a People First Language Style Guide that offers guidance on how populations of people with specific disabilities prefer to be described. Focus on Abilities Emphasize what your patient can do, instead of focusing on what they can’t do. Instead of saying, “Mr. Jones is unable to ambulate.” Consider saying, “Mr. Jones can independently go from lying to sitting and needs assistance with ambulation.” In both examples, you’re saying the same thing, but the second describes Mr. Jones’ abilities, not his disabilities. Do you have experience with people first language? Do you find it difficult to use? Leave your comments below so that we can discuss this critical topic further.
  14. traumaRUs

    Are We Too PC?

    So, with the current controversy about "Baby Its Cold Outside" raging on the radio and social media I got to thinking and thinking and thinking....are we as a country just becoming too PC? "Baby Its Cold Outside" was originally written in 1944 by Frank Loesser's as a jazz standard. Is it a song about date rape or just a catchy tune? Should it be "banned" from the airwaves? I vote NO! This is just a catchy tune, nothing more, written in a more innocent time in our history. Here is a video that depicts the song first as a man trying to convince a woman to stay a little while longer which has garnered criticism and a second version where its the man that wants to leave and the female is trying to convince him to stay. Do you feel differently about each version? Or again, is it just a catchy tune? Being PC isn't a new idea. In another life in the 1970's early 1980's, I was a USN broadcaster serving in Japan. We had what was called, "host country sensitivities." For instance, when giving the weather, we were not allowed to say, "there's a nip in the air." Some other issues: we weren't allowed to discuss the nuclear bomb attacks on Hiroshima and Nagasaki. And we couldn't call the Emperor by his first name as this was considered disrespectful. I can see how we need to be sensitive when we serve in the military overseas and need to blend in. However, here in the US nowadays we seem to be resorting to not wishing to offend anyone. And it seems as though others agree with me. "The most recent national survey from Fairleigh Dickinson University's PublicMind finds that 68 percent agree with the statement: "A big problem this country has is being politically correct." So, how does this relate to nursing and medicine? "After 25 years, the MCAT is being revised, becoming longer (by three hours) and covering a broader range of topics than simply chemistry, physics and biology. One quarter of the new test covers "psychology, sociology and the biological foundations of behavior." More specifically, students will be tested on "social inequality, class consciousness, racial and ethnic identity, institutionalized racism and discrimination, and power, privilege and prestige." Most of us would agree that widening the scope of physician education is important. There are many more social issues nowadays, more poverty, more people that feel disenfranchised. In this venue, it's important to be inclusive. Can we be inclusive without crossing over into not offending anyone? And, most of us have had to sit through in-services about cultural awareness, even generational awareness. Has this resulted in stilted communication? Must all our communication be so "aware?" Do you think before you speak? Do you consider generational differences when communication with co-workers, patients? Where do patients fit in? Should patients expect all of their needs to be met? Where do we draw the line between being PC and enabling? When discharging patients from the hospital nowadays, follow up appointments are made, prescriptions electronically sent to pharmacies, perhaps home health arranged and other case management needs that are met. Then, the patient states, "I need a ride to my appointments." When did this become the responsibility of the healthcare system? While we are all striving to reduce readmission rates, when does the responsibility of transportation become the patients' responsibility? Or is it PC to say, "Oh I can get you a cab voucher"? Are we making healthcare too accessible? As a nation, shouldn't we "man up" and be responsible for our own lives? That means taking care of ourselves, communicating our needs in a clear manner, being honest in our dealings with others and overall being a worthwhile citizen? What are your thoughts? Are we too PC? References Baby Its Cold Outside: A Brief History of the Holiday Song Controversy Farleigh Dickinson University Poll, October 2015 Politically Correct Medical Schools
  15. Identifying Common Collaboration Challenges Major factors that affect collaboration include communication, respect and trust, unequal power, understanding professional roles, and task prioritizing. Let’s take a look at how each one of these factors plays an integral role in the effectiveness of collaboration: Communication Let’s face it, our entire healthcare system is built upon the ability to communicate patients’ needs to the appropriate services and providers. In a system that is already overwhelming, breaks in communication happen often. From in-person communication to telecommunications, there are lots of opportunities for miscommunication to occur between members of the interprofessional team. The bottom line is that when communication is ineffective, the interprofessional team does not work together in harmony, thus collaboration efforts become compromised. Respect and Trust There’s been a long-running issue with mutual respect and trust between the different healthcare providers. According to a recent study, nurses report that some physicians are unwilling to listen to their inputs regarding patient care. Whether the physician has valid reasons for not acknowledging the nurses’ input or not, this is often perceived as disrespectful. Naturally when someone feels disrespected by a person or group of people, then trust for that person(s) becomes diminished. This phenomenon occurs among all members of the interprofessional team, and is not unique to nursing alone. Unequal Power and Autonomy Power and autonomy disparities are often attributed to the different levels of education, status and prestige that is unique to each profession. Additionally, the influence of traditional stereotypes where nurses were often viewed as the handmaidens of physicians and should not question a doctor’s order also plays into this barrier to collaboration. Unfortunately, even in the year 2019, nurses are still not being invited to the table to share their problem-solving skills, offer innovative solutions, or contribute in the decision making processes that ultimately affect them and the work environment around them. Understanding Professional Roles It is not uncommon for healthcare professionals to have a vague understanding of the roles and responsibilities of other healthcare professionals. For example, nurses understand what a physical therapist does for their patients, however, they do not understand the intricate details of the assessments, tools, billing and documentation that physical therapists complete throughout the day. If healthcare professionals knew more about the specific roles and responsibilities of each of their team members, then collaborative efforts would come much easier. Task Prioritizing One of the biggest challenges with effective collaboration is task prioritizing. One example that appears a lot in research is nursing’s lack of attendance and participation in interdisciplinary rounds. From nursing’s perspective, patient care does not cease during rounding and for that reason, many nurses have a difficult time pulling away from providing care long enough to participate in interprofessional collaboration. Similarly, doctors often demonstrate a sense of “urgency” and “lack of time”when communicating with nurses, which makes a nurse feel that the doctor is “bothered or uninterested” in what the nurse has to say. In both examples, task prioritizing is misunderstood among healthcare team members which is a major barrier to collaborative efforts. Negative Impacts of Inadequate Interprofessional Collaboration Efforts Whether interprofessional collaboration efforts are interrupted by poor communication or misunderstandings of roles and responsibilities, patient safety becomes compromised. Breaks in communication, decreased respect and trust, unequal power and autonomy, not understanding professional roles, and interdisciplinary task prioritizing conflicts are all contributing factors to decreased patient safety practices. When patient safety practices, such as initiating the high falls risk protocol, or interviewing the patient for allergies, are not completed for any or all of the above reasons, poor patient outcomes are soon to follow. According to Gobis, Yu & Reardon (2018), patients always suffer the consequences of ineffective interprofessional collaboration. For example, when doctors do not include the nurse in care planning, or spend a limited amount of time explaining findings and expectations to their patients, it can lead to nonadherence and distrust in the doctor’s ability to manage their care. Medication and care plan nonadherence is an important public health consideration, which affects health outcomes and overall healthcare costs. If collaborative efforts among all members of the healthcare team are suboptimal at any point, the patient may not receive the care that they need. Although decreased job satisfaction may be common among all members of the healthcare team due to high levels of stress caused by ineffective interprofessional collaboration efforts, nurses are among the most dissatisfied. According to the 2018 National Health Care Retention & RN Staffing Report, the current United States nurse turnover rate is 16.8% and is projected to increase over the next decade. Evidence suggests that increased nurse turnover directly impacts decreased patient access, patient safety and quality of care which ultimately leads to adverse patient outcomes. If interprofessional collaboration efforts do not improve across all care settings, turnover rates will create catastrophic disparities for our patients and our communities. Current Initiatives to Improve Interprofessional Collaboration, Communication and Streamlined Care Practices There are a lot of recommendations that current researchers are making to improve upon interprofessional collaboration efforts. Let’s take a look at the top five recommendations: Improving Communication Practices Effective communication is key. One of the best ways to enhance communication is by streamlining communication processes to reduce the amount of hand-off. Hand-off can be defined as “an exchange of information from one source to another, or from one person to another.” One of the ways that healthcare facilities addressed this issue many years ago was by eliminating the 8-hour shift option and implementing 12-hour nursing shifts. Not only did the hospitals save money by having one less shift to staff, but they also improved hand-off communication among nurses. Much like the game telephone, when messages are passed from person to person without streamlined efforts to help keep messages clear and accurate, some of the information may get missed, or misunderstood. Additionally, implementation of standardized hand-off reporting tools have also improved communication between shifts. The use of standardized hand-off reporting tools among doctors, nurses, and other members of the interprofessional healthcare team improves communication and decreases miscommunications regarding patient needs and care that is required. Research suggests that healthcare facilities invest in communication streamlining products and processes that will help to enhance interprofessional collaboration. Increasing Mutual Respect and Trust Among All Members of the Healthcare Team Mutual respect and trust among all members of the healthcare team is essential to effective collaborative efforts. Professionalism, collegiality and accountability are some of the suggested concepts to be considered. In addition, having a shared understanding of specific roles and responsibilities across the healthcare team also helps to improve trust and accountability. When roles and responsibilities are clearly defined, all members of the healthcare team can effectively work together in anticipating the needs of their patients. Creating a Culture that Supports Equal Power and Autonomy When members of the interprofessional team support one another by recognizing each member’s unique skill set, strengths, and individual contributions to safe and effective patient care, this helps to build a culture of equal power and autonomy over each specific profession. For instance, when doctors understand that nurses work towards upholding patient safety standards at all times, regardless of time, financial, or other organizational constraints, they are able to better support nurses in achieving this goal. By allowing each healthcare professional to have autonomy over their contributions and skills sets in the delivery and coordination of patient care, collaborative efforts improve. Rather than hospital administrators making decisions over patient care processes and unit flow, each interdisciplinary profession should have an equal voice in making these decisions and doing their part in making the magic of teamwork happen. Incorporating More Resource Personnel to help Cover Patient Needs During Interprofessional Collaboration - such as during Care Plan Meetings and Clinical Rounds One of the biggest challenges in establishing effective interprofessional collaboration efforts has been “lack of time and resource personnel” (Reeves, Xyrichis & Zwarenstein, 2017). Many nurses report that making interprofessional rounds is difficult when there are patient needs that need to be addressed. One recommendation to help alleviate this barrier to effective collaboration would be to establish “coverage” while the healthcare professional is removed from their patient care and coordination tasks so that they can spend quality time focusing on collaborative efforts. Much like nurses rely on the charge nurse, or another staff nurse to cover their patients while they take a break, members of the interprofessional team can have their colleagues cover their pages, phone calls, and patient care needs while they are participating in interprofessional collaborative activities such as clinical rounds. Holding Nurse Leaders and Healthcare Facility Administration Accountable It is important that we communicate our needs to nurse leaders and facility administration when moving towards establishing effective interprofessional collaboration. If administrators are not provided with this essential information, then we cannot hold them accountable for meeting our needs. One way to ensure that your nursing leadership, as well as facility administrators, are receiving the message is by submitting your communications via company email. Communication via email creates a permanent and trackable communication log that is helpful in tracking a discussion, thus reducing the likelihood of the receiver “forgetting” about the conversation. In addition to email communications, scheduled meetings with a recorder - someone who types up summaries of meeting topics, discussion and outcomes, is also a helpful method to bring forth necessary change within facilities. Advocating for scheduled meetings, shared governance, and leadership accountability are great ways to ensure that your voice and ideas for improving interprofessional collaboration efforts are being heard. Begin by asking for an opportunity to meet with your nursing leadership so that you can have a detailed discussion. Be sure to always send a follow-up email that summarizes the discussion you had, and the expectations established. This will create an agreement in writing that will help to hold everyone accountable for doing their part in enhancing interprofessional collaboration. Do you have any tips, recommendations, or strategies to help improve interprofessional collaboration in your healthcare workplace? Have you participated in a committee that focuses on improving interdisciplinary collaboration? If so, please contribute to this discussion by leaving your thoughts in the comments section below! Best Wishes, -Damion
  16. deniseschmittrn

    Today is a New Day and it Starts With Me

    Nursing is plagued by poor interpersonal relationships as evidenced by the term nurses eat their young. Poor interpersonal relationships among many nurses stem from poor communication, incivility and disruptive behaviors, misattributions of intent behind certain actions or behaviors and sometimes it stems from what Brene Brown describes as shame. Many nurses treat each other in a way that is in direct opposition to what nursing represents-caring. Thompson (2018), a national workplace bullying expert, termed these behaviors as Nursezilla. You know that nurse, s/he is the one all of us have met and have tried to ignore or work with, or avoid over the years. This individual reigns over the workplace spewing their poison onto everyone they come into contact with creating a very unpleasant work environment. Not all of us are like that, and I for one, am so tired of hearing how badly nurses treat each other. Nursing needs a counterculture to exemplify what we really want as a profession, respect, and recognition for the level of knowledge and expertise we are able to contribute. The change can come today and it starts with me and you. Facing the conflicts head-on with assertive communication strategies is the first step to healing our relationships-one at a time. We can do this by developing our communication skills. Taking the time to develop your competency in communication will prepare you to confront the disruptive behaviors without getting caught up in the emotionality of the situation. Why? Well, for one thing, it isn't personal-and as women (sorry, most nurses are women) we have a tendency to take things personally. There are a couple of wonderful books that have helped me to realize this concept. The Four Agreementsis one book and the other book is I Thought it Was Just Me. Both books helped me to see a different perspective-as nurses, we are hard on ourselves and on each other. Sometimes we just have to say and believe "I am Enough". There are several assertive communication models published in the literature. Therefore, this leads me to believe that there is not a one size fits all. Skilled communication is not as intuitive as we would like to think. Therefore, it is necessary to experiment, find the one that is comfortable for you, and practice, practice, practice. Assertive communication strategies require practice to create a new habit and a new way of approaching difficult conversations. I have discovered the D.E.S.C. model to be effective where D stands for describing, E stands for explaining or express your concern, S stands for suggesting an alternative, and C stands for consequence. This model is applicable to multiple situations. Another approach I have used is Cognitive Rehearsal as suggested by Griffin (2004, 2014). Use reflective practices, practice assertive communication without being aggressive when you are about to have a difficult conversation, and be aware of your own negative contributions to difficult interpersonal relationships. Another assertive communication strategy utilizes scripted responses to incivility. Through scripted response, we are able to manage our emotions. Poor interpersonal relationships among many nurses stem from poor communication, incivility and disruptive behaviors, misattributions of intent behind certain actions or behaviors and sometimes it stems from what Brene Brown describes as shame. I think it is time for all nurses to step back and reevaluate our interpersonal relationships and the work environment and challenge ourselves to recognize that talented person with whom we work. The choice is ours to elevate the profession. The success of others does not diminish our value and contributions to the profession. Take care of each other and build each other up. References: Brene Brown Renee Thompson
  17. ~"Sleazy car salesman." ~"You can't trust them. They're like used car salesmen: so pushy. And they lie to you, too! ~"Snake oil salesman." ~"It's just so uncomfortable negotiating my salary. I just took whatever they gave me." ~"Well, I didn't want to brag." ~"I'm a nurse; not a businessman!" ~"All those guys in the business suits call the shots. They don't listen to the nurses. Let's see THEM take care of the patients!" YES, nurses are salespeople! That means we're persuaders and influencers. It's inherent to the job, actually. Some may just not notice it. But acknowledging this is empowering! Sales is a noble profession. It gets great products and services we believe in into the hands of people who can benefit from them. A good salesperson listens to their customer and demographic. (That's "Assessment"-the first step of the nursing process.) They help you find and solve the problem (Diagnose, Plan, Implement: steps two-four) of not being able to afford or obtain what will benefit you. They break through limiting beliefs like, "Sales is sleazy." (It can be. But in the right hands it's persuasion. For example, nurses persuade patients to get out of bed after cardiothoracic surgery even though it hurts because it helps their lungs recover from the procedure better and gets them home sooner. We tell them, "Don't worry. Before we get you out of bed we'll give you pain medicine.") This opinion is bred from personal experience. As a nurse who buys from garage sales and resells on Amazon, hires and fires writers for his book publishing business, thanks customers for five star reviews, and rectifies my occasional one-star reviews, I have learned and grown with sales/persuasion skills. I carry this over to the hospital when I (a nurse with five years' experience) listen to a new physician who's only been in practice for three months explain her rationale for a treatment I don't believe in. I ease her concerns about the pros and cons of various interventions, and I propose a better solution that's as close to a win-win (for us and the patient) as possible. I used sales and persuasion to get accepted into Nursing Anesthesia school because I'm not shy about promoting a "product" I believe in that I also believe can help the school. This product is myself, my skills, my aspirations, my experiences. I put their minds at ease knowing they're accepting a dedicated student who won't fail and make their attrition rate for this year's class rise. I believe this so much that I encourage other nursing professionals and aspiring Nurse Anesthetists to learn sales to benefit their lives. I sell them on the idea of sales. This happens informally as we sip coffee in between seeing patients and more formally on social media platforms like Instagram as a healthcare influencer. And I'm encouraged by my peers who share stories of prompting change on their nursing units. The American Association of Critical-Care Nurses' November 2018 edition extols the benefit of being poised when the author states it was implementing charisma into her educational proposals to her coworkers that made her effectual in persuading them to buy new equipment she knew would help their patients. She had the research, the formal education, and the evidence base to make a strong logical argument, but she lacked the salesmanship to recruit the emotional side of her audience. So she sought advice on how to do this. After implementing new persuasive techniques, she achieved her goal and the unit and its patients are better off! Sales has a place in nursing because it is essential to communication in all humans. Nurses work with people and people need encouragement from fellow people who have their best interests at heart. Better your nursing career by incorporating sales!
  18. Melissa Mills

    8 Tips for Tough Conversations with Patients

    Informing patients of abnormal assessment findings or lab values can be hard. On the one hand, you want to be honest and forthcoming, yet, you don't want to cause unnecessary stress or alarm for the patient. How do you go about delivering this information in a seamless manner that meets all of the above? Here are a few tips you can put into practice today that will help you when discussing tough conversations with your patients. Pay Attention to Tone When you're talking to your patient about their test results, they're likely hanging on every word. And, it's not just the words you use, but the way you use them that they interpret. The tone of your voice communicates what you're feeling when you speak. Tone can be changed by other factors, such as how you're feeling that day or other things on your mind. You might not be good at understanding your own tone of voice when you speak. Whatever the reason, be sure that your words are correct and your tone is conversational and caring. Speak Clearly, Not Loudly Have you ever witnessed a conversation where someone didn't understand the information being given, and instead of changing the message, the speaker started talker louder? Unfortunately, we've all done this. When communication starts to get off track, you might naturally change your tone and volume without even knowing it. The next time you're having a difficult conversation with a patient, be sure to speak slowly and clearly. Keep the volume of your voice at a moderate level. Avoid Acronyms or Big Medical Words You talk fluent nurse, but your patients don't. Try to avoid acronyms and big medical words whenever possible. If you must use either, be ready to explain what they mean in simple terms. Know Your Audience This is one of the best communication tips for any type of communication. It doesn't matter if you're giving a lecture to nurses or talking to a patient - you should always know your audience. This means you might need to ask a few questions to gauge the patient's current level of understanding of their disease process. This can come in handy if the patient is a health care provider too. Remember that just because the patient is a nurse, doctor, or another clinician - they still need to be taught about their illness. And, they may have family or other caregivers with them, who need to understand the information so that they can support the patient. Stop Talking and Listen You might think that you need to tell the patient everything before you stop to assess where they are in the journey of understanding, but this might not be the best strategy. Try to pause after small bits of information and allow a little silence to enter the space between you and your patient. This gives them the opportunity to express understanding or ask questions. Listening is one of the best communication skills to know what your patient is understanding. And, you might also connect with them on a different level if you use active listening. Use Reflection to Gauge Understanding Also known as the "teach-back method," reflection gives your patient the opportunity to demonstrate to you what they've learned. To use this method, ask the patient to restate, in their own words, what you taught them. This allows you to check their level of understanding of the information you provided. Remember Your Body Language Speaks Too You walk past the nurse's station and notice a coworker talking to a family member. Your co-worker has their arms crossed over their chest, and they're looking down the hall at another nurse. You later hear them tell the unit manager they have no idea why the family member expressed concern about their communication skills. You silently replay the scene you saw earlier and thing to yourself - "it was your body language." Always strive to match your body language, words, and the intent of the conversation. If you want your patient to open up - you need to mimic this through your words and behaviors. Keep your arms down to your side or in your lap to show that you are open to receiving feedback. Maintain good posture and eye contact. Pay attention to the expression on your face, and smile, when appropriate. Assess For Communication Needs I recently witnessed an interaction between a registration staff member and a non-English speaking patient. First, the registrar increased the volume of her voice when she thought the patient wasn't understanding. Then, her tone changed, until she finally realized the patient didn't speak English. She quickly got on the phone with an interpreter, but while waiting to get this process started, the registration staff working with this patient ignored them. She didn't engage with the patient at all. In fact, she actually turned her back to the patient and even told another staff member, "They don't understand, so I'm just not talking to them." While the patient didn't understand the words, they certainly understood the body language and the message being sent by the staff member turning their back on them. Once the patient heard the interpreter speak their native tongue, everything about them changed - they smiled, their body language relaxed, and they maintained eye contact with the interpreter on the video call. This was an excellent example of what not to do when you have a patient with special communication needs. Remain open when communicating with patients so that you can recognize these needs. If a patient doesn't understand you, change your approach and then consider if there are special needs that you're not meeting. No matter how good your communication skills are, you can always improve. Challenge yourself to consider using just one of these tips the next time you're in a difficult conversation with a patient. Do you have other tips? Place your thoughts in the comments below, we would love to hear them.
  19. Feeling overwhelmed by her many job duties, the director of nursing (don) hastily sent out the following memorandum to the nursing staff at her facility. Instead of it being a polished professional communication, the memo is difficult to read due to poor grammar and faulty use of punctuation. After reading this memo, what sort of impression do you have of the don? Without ever having met her, could you even entertain the thought that she is a hard-working competent professional with many years' experience under her belt? Unfortunately, her poor writing skills have sabotaged her managerial and leadership credibility and make her look dumb. In fact, it looks like something a preteen in middle school would write: Like it or not, writing is an essential skill in contemporary society and you will be judged (either harshly or favorably) by your ability to communicate well in the written language. People instinctively evaluate a person's professional abilities based on the use or misuse of grammar. It is just as important for you to hone your writing skills while in nursing school, as learning to give an im injection or put in an iv. The ability to write well will get you far in your nursing career and gives you the competitive edge in a very tight job market. Common Grammatical Errors A singular noun (such as "patient," individual," etc.) should always be followed by a singular pronoun (he or she - not "they") and vice versa. Do not use a plural pronoun with a singular antecedent. Incorrect: a researcher must choose a population that best fits their hypothesis. Correct: a researcher must choose a population that best fits his or her hypothesis. Incorrect: it is important for healthcare professionals to stay current on the standard of care for his or her organization. Correct: it is important for healthcare professionals to stay current on the standard of care for their organization. Avoid run-on sentences Two or more independent clauses incorrectly fused together (generally by a comma) form a run-on sentence. To correct a run-on sentence, separate it into two or more sentences. Incorrect: Studies are conducted to determine the real and the true, researchers place great value on identifying and removing sources of bias in their study or controlling their effects on the study findings. Correct: studies are conducted to determine the real and the true. Researchers place great value on identifying and removing sources of bias in their study or controlling their effects on the study findings. Avoid sentence fragments A sentence fragment is a group of words that do not form a complete thought. Incorrect: the probability level at which the results of statistical analysis are judged to indicate a statistically significant difference between the groups. Correct: statistical significance is the probability level at which the results of statistical analysis are judged to indicate a statistically significant difference between the groups. Avoid the incorrect use of an apostrophe The apostrophe should be used to show possession. Incorrect: if there is evidence to support a researchers hypothesis, then the statistics are useful. Correct: if there is evidence to support a researcher's hypothesis, then the statistics are useful. An apostrophe should not be used to show the plurals of nouns (which, I have noted, is a common error among millennial students). Incorrect: a statistically significant result is when the results agree with those predicted by the researcher and back up the logical linking's developed by the researcher. Correct: a statistically significant result is when the results agree with those predicted by the researcher and back up the logical linkings developed by the researcher. Ensure the correct use of "who" and "whom." Incorrect: It is the critically thoughtful nurse whom realizes the need for adjustment to maximize quality of care. Correct: It is the critically thoughtful nurse who realizes the need for adjustment to maximize quality of care. Where there are words that sound alike but have different spellings and meanings (homophones), take great care in ensuring that you are using the correct version to fit the context. Most spell checker tools are useless in detecting an incorrect homophone. Examples: your, you're; there, their, they're; affect, effect; its, it's; to, too, two. Always remember that it is a very competitive world out there and you are selling yourself. First impressions matter. Good writing skills are essential to success in all your career endeavors. One little mistake in grammar, spelling, or punctuation can diminish your credibility, and ruin your resume, cover letter, or an otherwise stellar presentation. Don't allow poor writing to put your career on the skids. Let your writing skills accurately reflect the competent professional that you are. Online Resources Purdue Online Writing Lab Pronouns: Agreement With Antecedent
  20. Policies and procedures vary widely. By state, by facility, by unit. What is "common" for one facility, is not always common in another. Acute vs. LTC is apples to oranges. So as part of orientation, or as part of precepting a new employee, it is important to talk about and become familiar with policies and procedures that affect nursing practice. There has been a few threads popping up regarding "questionable" practices. Generally speaking, as nurses, we know what a "general rule of thumb" is. We have comfort zones, levels of ethics that we adhere to, safe practices. We are prudent. Everyone's intent is safe patient care, with the best patient outcome as possible. Even nurses who are burnt out or overwhelmed, we go to work everyday with an intent to cause no harm. Sometimes, some of us are confused as to how to deliver care to patients in a way that may be different than what we are taught, generally know to be true, or how we have practiced in the past. One of the ways that we can look to how a facility and/or unit wants us to practice is by asking where one can access policies and procedures. It is important to know where this information is, and that you have access to it. Not saying for a moment it needs to be read like a novel, however, it should be referred to with any practice questions that a nurse may have. Another way one can find out information is to ask in a staff meeting forum. If people deviate from set policy (and you may find that policies are really outdated) then the question to ask is why. A thought would be to update policy. A reminder would be that if in fact the unit is audited, what policies are still in play, and which have been deviated from? Sometimes it takes fresh eyes and new insight. To protect yourself, you should always carry malpractice insurance. This is a good protection. Obviously, if there's a huge disconnect over patient care and how nurses are practicing in outright opposition to safe care, this is a complete other story. In that instance, know where to go or not go with that information--your employee handbook is a good reference, as is your union contract if you are a union facility. If you are uncomfortable with what someone is asking you to do, then ask why it is that it is done that way. Think about how you are comfortable completing the task at hand, and talk about if you are able to do it that way. There is not just one means to an end. If you are able to talk about alternate orders that support what it is everyone is trying to accomplish with far less time wasting steps, then by all means ask. We can not go in and change the world. We can not go in and make sweeping assumptions on how things can be done our way, the better way, this way stinks. However, fresh eyes are interesting. And gives pause to how things can be done more efficiently, in a patient's best interest, and a lot less nerve wracking.
  21. It started as a lark -- I got a free all-in-one printer with my new computer. Mom's photo album was just sitting there in my dining room, waiting for me to decide what I wanted to do with it, so just for kicks, I scanned a photograph or two. or sixteen. Then the child came home with a school assignment: assemble a family tree. since I had all of mom's photographs right there, the child -- or maybe it was me -- decided that the family tree would be better with pictures of her ancestors. The photo album was a treasure trove -- pictures of my grandparents' wedding reception, my great grandparents as young adults, and even a photograph or two of my great-great grandparents. Two sets of them, anyway. The child's family tree was an enormous success and her teacher was suitably impressed at all of the family photos she'd included. Somewhere in between scanning in photos of the ancestors for the child's school project and wondering what to do with that photo album, I found myself scanning in all of the pictures . . . and then I started on grandma's photo album. then mine. I've burned out a scanner now, and while I'm waiting for amazon.com to ship me the new one, I'm writing. I went to visit mom last fall. I hadn't seen her for a few months -- she lives about a thousand miles away and a week with her costs me nearly a thousand dollars in air fare, car rentals, hotel room and meals. I can't visit as often as I'd like. I took my laptop this time, with the desktop and screensaver set to my photo library. Mom and I were sitting in companionable silence -- me working on the laptop and mom doing word find puzzles. Or trying to. I got up to use the restroom, and while I was gone, my laptop went into screensaver mode. When I returned, mom was staring at the screensaver, transfixed. "I know her," she said. "That was my great-grandmother. She died when I was just a little girl, but she had a pony and I used to love to ride it." Sure enough, the picture was of my great-great grandmother, and I vaguely remembered seeing pictures of mom riding a pony. The next photo came up -- my grandmother in her "gibson girl" getup, hair in a then-stylish bun on top of her head and a flower-bedecked hat in her hand. She was beautiful. That's my mother," mom said excitedly. "She was really brave -- she went out west on a train to teach the Indian children." I dropped the work, and my mother and I went through the photographs one at a time. It took most of the week, but I heard stories about my family that I'd never heard before. I'm trying to write them all down. I'd been worried about how I was going to spend the time with my mother. Her memory is sliding away and it's hard to converse with her. The pictures made it effortless. Mom was fascinated with the photographs and I was fascinated with her stories. There were pictures of my sister and me as babies, and mom recognized us immediately. "That's you," she'd say. "I made that dress for you for your first Easter outfit. I had one just like it." And moments later, there would be the picture of mom and I standing side by side in our matching outfits. There were pictures that brought back memories of stories I'd heard my father tell most of my life, pictures of events that only my mother remembered and pictures that neither of us could identify but my aunts could. Mom's fading memories of the past four decades or so didn't matter while we were engrossed in pictures from long before I was born. Last month I visited mom again, and while she's still fascinated by the pictures, her memories of them are sporadic. "That's you," she'd say, pointing at a picture of my sister eating chocolate pudding with more pudding on her clothes than could have possibly made it into her. And then she'd shake her head. "I'm not sure who that is." She's better with pictures from when she was a little girl. The next time I visit her even that may be gone. But thanks to the scanner and the photo album, I've had a magical week with my mother and I've heard stories about my ancestors I've never heard before. It's nice to have had that before those memories are gone.
  22. We all make communication mistakes. As a hospital-based nurse for over 30 years, I've certainly made my share, and witnessed many more. Along the way, I've picked up a few tips that I hope are helpful to students and new nurses. 1. Avoid loaded language Terms like "brain damage" and "life support" are riddled with emotion and unfavorable connotations for the lay person. Although it may seem counter-intuitive, there are times when "medicalspeak" is more effective for communication. It reframes concepts, sidestepping the emotion associated with certain terms in the vernacular. Think about what "life support" really means to us: vasopressors to maintain BP? A ventilator? Cardipulmonary bypass or ECMO? Then consider what it means to a layperson: impending death? Permanent dependence on a machine? A vegetative state? Hopelessness? Using medical terms for interventions is clearer and promotes understanding rather than distress. 2. Death is death Don't say "brain death" to families and loved ones when you mean death. The term "brain death" is not clear to laypersons; they might think it is reversible or different from "real death" somehow. "Brain death" is death. Humans do not live apart from a brain, although the heart may still beat. You and I understand this, of course, but laypersons often do not. Do not use euphemisms either. People need to hear words such as "death" and "died," not "passed on" or "expired." Do not risk miscommunicating about death by using polite terms. Families deserve and need clarity from health care providers in time of crisis. We can be compassionate while communicating clearly. Cultivate this skill in your nursing practice. Find people whose communication skills you admire and learn from them. 3. EVERYONE in a hospital room is stressed To patients and families, a hospital stay represents a crisis, and people in crisis have limited cognitive capacity. Their recall and processing are impaired. They may not communicate well with each other. This is why they will forget what you told them yesterday and you will have to tell one family member the same thing you told another family member. They aren't being difficult, they are in crisis. Antagonism from a busy nurse only escalates the crisis, so try to be patient, and use written resources to help provide answers to the common questions (location of bathrooms, visiting hours, etc.) Help the family identify a spokesperson who can act as the #1 go-to person for questions, and refer them to the spokesperson for daily updates. Don't allow yourself to get overwhelmed with inquiries from many people; politely deflect questions to the spokesperson or written materials. 4. Tell people what you're doing When you enter a patient's room, say, "Mrs. Jones, I have your atenolol, lovastatin, and IV antibiotic, carbepenem. Let's do the oral pills first, then I'll work on your IV medication." If someone interrupts you, say, "I'm giving medication (or whatever you're doing), and will be with you shortly." If you give the impression that you're not doing an important task, it's much easier for someone to interrupt. And don't forget that assessment and monitoring are also important. Nurses seem to forget that these essential responsibilities that are a huge part of our role save lives, prevent complications and promote healing. 5. Finally, know that you, like everyone else, will make communication errors If appropriate, admit the error and apologize. Rephrase what you said in a better way, and move on. You will show that you are human, that you care about communicating skillfully, and that you intend to make things right. And you will gain the respect of colleagues, patients and families. Although we all make communication missteps, communication is rarely, if ever, overdone in health care settings. Clear communication prevents errors. Try to default to more explaining, more clarifying, and more communicating, not less. You will find it makes you a safer and more effective nurse. Happy communicating!
  23. littlelight07

    What they don't teach you in nursing school

    Great interpersonal skills - It all starts with attitude, but it doesn't end there. You will need wisdom. Intellect will only get you so far. We all know some intelligent people who are clueless, thoughtless, and careless. We simply can not avoid the 'attitude' elephant in the room! It's in every hospital, in every clinic, in short, clueless people are everywhere! But know this, you will never attain great interpersonal skills by osmosis. It's not hope so, think so, or perhaps so, you absolutely must have a specific interpersonal skill set to thrive in today's nursing environment. There is no getting around it. Anyone in the field can tell you of the horror stories of those clueless people who carelessly lose promotional opportunities, who thoughtlessly diminish work place morale, but do you not also know of the countless numbers of others who are mean-spirited, touchy, resentful, and fretful? They too have been carried away with the cultural tide. How many of us have thought or even said some of the following: "How could she do that?!" "What were they thinking?!" "I'm glad I'm not the manager. You couldn't pay me enough to deal with that ****" OK, so we all know the problem. So what's the solution? Is there even a solution? I mean, if we knew that we'd be rich, right!?! Let me tell you there is absolutely a solution. And if you look around you may well have an example of it right where you live and work. You know the people, never the majority, who seem to roll with the punches, keep a positive attitude, and never get carried away with the grape-vine. You know the grapevine I'm talking about, right? In fact haven't you "heard it through the grave-vine, that so-n-so did such-n-such to YOU KNOW WHO? No way!?! Get out of here!?! Seriously!?!. No ****!!!?! I can't believe it!?! To those who are already given way to a sour attitude, I'll tell you more in my next article but let me just wet your whistle by saying, start today by looking around you with a different focus. See this thing with different eyes. I mean to say this, in most environments there is usually that one or the few who never seem(s) to get caught up in the drama, who is/are not the touchy, fretful, resentful type. You know the one's. They are welcoming, professional, warm-spirited, and thoughtful. Think of it. They live or work in the same environment that you do. They experience the same insanity that you do. But they are different. Why? What do they got that you haven't got? You remember the time that so-n-so, said such-n-such to them. Recall how they responded. They didn't reply in like manner. They didn't go and talk to 15 other people about how sorry they were treated. They didn't spend the next day, week, month repeating the matter on Facebook, twitter, or any other social media. They didn't devise ways to get back at them. And the next time they saw the mean individual that confronted them, they were professional, even thoughtful. And when curious others asked them about it, they said nothing hurtful, mean-spirited, or demeaning about the mean person. Not only that, even their day did not appear to be negatively impacted. How could this be? Are they alien or secretly planning to shoot up the building? They have to have a lot of pent up anger inside, right? No, not at all. Learn from them. Take mental notes from them. Observe them. Take this on for curiosity and you can not help but gaining from them. Take this on as a practice and you will become like them.
  24. deborah911

    The Art of Caring and Compassion

    Good at IV starts- check. Telemetry trained- check. CPR and ACLS certified- check. We work so hard to have a resume that is full of experience and skills; but have we forgotten one of the most important qualifications needed to be a successful nurse? Do you have a heart for people? Compassion is one to the greatest talents that we can bring to our career and it is a gift that we are able to give to each of our patients. Not all areas of nursing embrace the skill or talent of expressing compassion. I entered the profession of nursing out of the desire to serve others and help them to meet their needs, whether they are physical, emotional or spiritual. I found in hospital nursing that there is rarely time to even address emotional health, and spiritual health...well, leave that to chaplains. But, we have to remember that nursing was born out of individuals desire to compassionately care for patients. Nurses did not have to worry about heart monitors and IV pumps alarming. Nurses had time to talk with young soldiers who missed home or the young mother who just lost a baby. Due to increasing technical demands and increasing workloads, the Art of Nursing has been replaced by a busyness that leaves nurses and patients frustrated. I have been fortunate enough to enter the field of hospice nursing, a gentle and holistic approach to meeting a patient's needs. I understand that my field allows and encourages more time to make connections and build a rapport of trust, but there are lessons that can be learned by busy hospital nurses. Take the time to see each patient as a person, not just a diagnosis. Instead of referring to "the cholecystectomy in room 212", try giving him or her respect and saying "Mr. Jones in 212 is ready for discharge". Some have considered it to be a form of self preservation; they do not desire to get too close. However, I have found just the opposite in my 18 years of practice. My experience as a nurse is so much richer when I am able to make a connection with my patient and help them to know I truly care about their outcomes. One of the most common complaints that I hear in my practice is, "They didn't listen to me in the hospital". Take time to listen and HEAR what your patient is saying. Caring for a person on an emotional level doesn't cross professional boundaries; you do not have to give your heart away in order to make someone feel important and valued. Additionally, statistics have proven that emotional health improves patient outcomes. That benefits the patient, the staff, the hospital and your community. So, take the time to understand and feel compassion, and then add it to your resume of skills. It's okay to feel and it's okay to experience empathy. A little pain helps remind you that you are alive. Take the time to care...the next life you save just might be your own.

    Using my Karate Chops in Nursing

    I was called to the main desk in the OR at the beginning of my shift because there was a problem with a patient. A couple of the staff knew I took Tang Soo Do, a Korean martial art, and thought I may be of valuable assistance. Now I know what you are thinking. We had a belligerent patient who I had to take down to save another staff member. Maybe it was a hostage situation, and I had to go in like Chuck Norris and save the day with my famous roundhouse kick. It was actually something I had never imagined. She was a sweet 87 year old Korean lady who spoke no English. Her daughter was with her in the preop area trying to help until a translator could arrive. Since I knew enough Korean from my martial arts to be dangerous, I tried to assist in keeping them as comfortable as possible before her procedure. "Annyeong-hashimnikka!" (Formal Hello in Korean) I said as I stepped into the lady's room. She grinned and waved at me. She started to talk very quickly, and I explained to her daughter that although I was not fluent in Korean, I did know a few words and phrases. I wanted to try to help her mother through the procedure without her feeling all alone in a strange place. The daughter was very grateful that I would take the time to do such a time consuming task for her mother. I told her that no patient should ever feel alone, especially in an OR. When it was time to head for her surgery, I walked back to the OR repeating "Shio." (Relax, be calm.) When we arrived in the OR, we got the beds lined up perfectly and the wheels locked in place. The CRNA looked at me and said, "Do your magic." I patted the OR table and told the lady, "Ahn Jo." (Sit here) She slid over to the table as I directed her to move her "Pahl," then her "Bahl." (Move her arms at the top, then her feet at the bottom to scoot over to the OR table.) When she was on the table and situated, I again said, "Shio." She smiled and nodded. Until they got her off to sleep, I stayed with her and held her hand reminding her to "Shio" throughout the procedure. She chatted with me the whole time, and although I have no idea what she was saying, I could tell she was happy to have someone that could speak to her and give her simple directions she could understand. She went off to sleep quite easily. After the procedure, I went back to be there when she awoke. She remembered me and smiled. I again said "Annyeong-hashimnikka. Shio." The CRNA took time to get her completely awake so she would be ready for her daughter to come to recovery and stay with her as well as the translator. Until then, I stayed with her and held her hand. She was sleepy from the anesthesia, but she seemed at peace knowing we were going to take good care of her and keep her safe. After she arrived in recovery, her daughter came to sit with her, and I explained what had happened in the interim. Her mother had been through a frightening situation with someone who only spoke a little of her language. I went back to check her about an hour later, and she was getting ready to return home. She stood up and with a bow said, "Ko Map Sum Ni Da." (Thank you very much) I returned her bow with "Chomane Yo." (You're Welcome) I learned that even the smallest thing we do for a patient will sometimes be of the greatest help. This patient was able to go through an important and frightening procedure knowing she was not alone with a nurse who only could communicate with her using a few words learned in a karate class. It made all the difference in the world.

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