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  1. 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 8 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 #1: 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 #2: 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 #3: 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 #4: 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 #5: 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 #6: 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 #7: 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 #8: 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
  2. jeastridge

    How Much Time Do I Have?

    How much time? She looked up at me with pleading eyes, her head resting on a freshly laundered pillow case and her hair, still damp, laid out against the white expanse to dry. Her voice was firm as she asked the question that was on her mind. Taking a deep breath of the oxygen that ran to her nose she said, "How much time do I have?" She was not old. Certainly not old enough to die. Just in her late 60's, recently a new grandmother again, she found herself with much to live for and yet with each deep cough she knew the lung cancer was getting ahead of her. As I wrapped up my hospice visit, I sat back down beside her, to focus in on her question and to carefully think through just what to say-and what not to say. Whether you work in the emergency room, in a doctor's office, on a med-surg unit or hospice-whatever your field is-the critical question about how much time remains comes up from time to time. How we answer or don't answer that question can have a profound impact on our patient's well-being. Admittedly, with hospice patients there is at least some expectation, given clinical parameters, that the patient has six months or less to live. But that time frame varies widely and despite our best efforts to meet guidelines that outline expected decline, each person is an individual case where death can creep up unexpectedly or sit coyly in the background long beyond its expected arrival. Answering this particular question well requires sensitivity, knowledge, and honesty. When any of us faces a shortened life-span, we want to know what to expect. Terminal illness is accompanied by a host of unknowables. Measuring the time left is difficult because of each person's individual disease and progression. We expect the lowered immunity, potential for infections and complications that come along but those are often countered by deep wells of resourcefulness in the individual, and a love and zest for life that triumphs over all expectations. So what do you say? Probably the #1 answer to that question is, "I don't know" While this is technically and existentially true, it can be an easy way out for us as professionals. I think a more complete answer involves telling the patient that while we cannot predict with certainty, we pledge ourselves to let them know if we see a change that would indicate the time is near. We can add to that teaching about what generally happens as the time of death nears: increased fatigue, loss of appetite, less time being alert and a gradual shut down of body systems.For family members, there are many books that describe in more details the dying process and what to expect. "What do you think about how long it will be?" A second way to address the question involves reflecting it back to them and asking them what they have been told, what they are most concerned about, what is bothering them in particular at this time. This may sound like an evasive maneuver, but it truly does help to clarify the issue, and often what we are hearing is not what they are really asking. When it comes to death, most of us don't want to know specifics as much as functionality-how long will have have with my loved ones? Will I be able to talk/communicate? Will I be in pain? As nurses, we cannot promise total freedom from pain or discomfort but we can offer our commitment to work hard to alleviate symptoms to the best of our ability in conjunction with our health care team. "Ask you doctor" This is certainly not recommended phrasing, but sometimes, when all the tests are not in, when the biopsy is still pending, when treatment options are uncertain, we do the patient a disservice by trying to address this end of life question too directly. It can be especially true when dear Aunt Sue has breast cancer and so-and-so died of breast cancer and "I just know I am going to die of it too." The underlying tone of the premature question is one of fear and panic. Sometimes, what is most helpful to to ask the patient (or relative) to wait until all the tests are in, the treatment options are laid out, then resume the discussion. It is not helpful to lay awake at night worrying about something that hasn't happened and may never happen. In these cases, our role becomes one of comforter, of listener, and of encourager. Try to be as honest as possible And, no, this does not mean laying on the unvarnished truth with a heavy stroke. There is no such thing as "false hope." Hope is hope and we all need it to continue to survive for even a day or an hour. During admissions, I often tell patients, "Coming into hospice does not mean that you have given up. It means, instead, that modern medical science doesn't have any great treatment options to offer you and your family at this time. But miracles do happen and they can happen even in the context of hospice." This is completely true and I have seen patients "graduate" from hospice as their condition improves. Honesty is the best policy always and at this critical juncture, people really need someone who will maintain eye contact, extend a caring hand, offer a hug, and say truthfully, "I don't really know how long this journey will be. But I do pledge that our team will walk with you through this time and do everything that we can to help you on the journey. We will be with you." Those words can cut to the heart of the fear of being left alone, of suffering without relief. We always need one another, but when it comes to dying, the gift of presence is the best gift their is. I tried to address my patient's question as honestly as possible. In the course of the conversation, I found out that her new grand baby was due to come for a visit in a week. Her question centered on wondering if she would be here then, and more importantly, would she be able to hold the little one. I told her we would do our best to help her marshal her strength for that event and that we would do everything we could to help her be alert enough to enjoy some grandmother time. What about you? Have you found some particular wording that helps you talk with patients about this difficult topic? How do you answer the question, "How much time do I have?"

    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.
  4. ~"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!
  5. According to Pullen and Mathias (2010), a therapeutic nurse-patient relationship is defined as a helping relationship that's based on mutual trust and respect, the nurturing of faith and hope, being sensitive to self and others, and assisting with the gratification of your patient's physical, emotional, and spiritual needs through your knowledge and skill. In other words, a therapeutic nurse-patient relationship focuses mainly on the patient. I have come to believe that the modern day nurse-patient relationship is undergoing some serious strain due to several factors, including short staffing, high nurse-patient ratios, and time constraints combined with sicker patients who are actually requiring more of our time with each passing year. The nurse must spend an inordinate amount of time completing redundant documentation in several different places, hunting for supplies, wearing multiple hats, and performing other tasks. For instance, if the need for a cleanup arises and the housekeeping staff has left for the day, nursing staff must address it. If the remote control is not functioning properly and maintenance staff is nowhere to be found, the nurse is usually the person who must try to resolve the issue. Essential ingredients of the nurse-patient relationship, such as mutual trust, confidence, and regard for one another, simply take some time to build and maintain. This bond is something that cannot be fostered within a matter of a couple of minutes. It takes time. However, today's harried healthcare system does not realistically allocate enough time in each shift to foster the most solid nurse-patient relationships possible. I honestly believe that the vast majority of nurses display caring and compassion as much as humanly possible during each interaction, but some caregivers do not always have the time to communicate their concern effectively to all patients and their families. As a result, some patients and family members who do not sense this concern might feel displeased and be more prone to file complaints or pursue legal action for poor outcomes. Past studies have shown that patients and families are more likely to refrain from submitting complaints or filing lawsuits if they experienced therapeutic nurse-patient relationships and perceived that their caregivers actually cared about them. Therefore, I feel that it is in the best interests of all healthcare facilities to increase staffing, decrease the outrageous nurse-patient ratios, and basically allocate more time to allow nursing staff to foster solid nurse-patient relationships. After all, it will save facilities a great deal of money later on down the line. work-cited.txt
  6. 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.
  7. 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.
  8. 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. For more information download the NCLEX Study Guide ebook... allnurses® Ebooks Library 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! Resources 2018 National Health Care Retention & RN Staffing Report
  9. 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.
  10. 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.
  11. 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.
  12. Jb4564

    Speak It, Write It, Repeat It

    Verbal communication is the sending and receiving of information between two or more people using speech. The goal of communication is to convey information from one person to another. There are many barriers to communication including foreign language, distractions, lack of attention or interest, and differences in perception and viewpoint, just to name a few! These barriers multiply without the benefit of face-to-face communication. The telephone is the quickest and most convenient when contacting patients and their families. Most of us carry our phones with us wherever we go and are multi-tasking as we take phone calls. The listener's distractions and barriers can make it difficult to listen and process information. The message you intend to send may not be the message that is received. It is important to get feedback from the listener to verify the message has been clearly understood. Our outpatient/inpatient pediatric Cardiology service sees a diverse population of pediatric cardiology patients. Some of these patients receive sedated echocardiograms; others we prepare for the cardiac catheterization lab or the operating room. These patients are given NPO instructions either in person or via telephone the day before their scheduled appointment. We were experiencing a higher than expected volume of patients that were arriving without having adhered to the NPO instructions that were given by telephone resulting in many procedures being cancelled or delayed. The nurses in the unit decided to start a "Speak It, Write It, Repeat It" guideline for giving the telephone NPO instructions. During the pre-admission phone call the parent is asked if it is a convenient time to receive and write down the NPO instructions for the procedure their child is scheduled for. Many parents are driving or at work when we call to give the pre-instructions. This question requires the parent to stop what they are doing and devote their attention to the information. If the parent is not able to interrupt what they are doing to write down the instructions, arrangements are made to contact the parent or patient at a later time. The NPO instructions are age specific and patient specific. The NPO time is longer for a patient receiving formula vs breast milk. Some of our families add food and supplements to the milk which makes it a solid food, so culturally we have to be aware of the differences in our multi-cultural patient population. A translator is used to help ensure understanding and compliance. The cardiac unit RN calls each patient and gives the patient specific NPO instructions including the rationale for an empty stomach for general anesthesia or sedation. The instructions are spoken by the RN and it is requested the parent write the instructions down as the instructions are being given over the phone. Once the instructions have been completely conveyed to the parent, the parent is asked to read back the written instructions to the RN. Any discrepancies will be immediately rectified and any questions answered. When the patient arrives in the unit for their procedure, the RN asks the parent when the last time was the patient had food, milk and or breast milk, and clear liquids. We have not had to cancel or delay any surgical cases, cardiac catheterizations or sedations since the implementation of "Speak It, Write It, Repeat It". Our patient's NPO compliance is now at 100%!! The Barriers to communication can occur at any point in a conversation. Barriers can lead to confusion or distortion of the message with wasted time and money the result. Clear concise messages with feedback from the listener can save time, save resources, and increase staff and patient satisfaction.
  13. Jacqueline.Damm

    Complacency in Healthcare

    Webster's Dictionary defines complacency in a way that we, as a people, can all understand. As nurses and caregivers, we know deep down that complacency is taken to an entirely different level within our scope. It is a weighted situation that causes a slew of issues of which safety takes precedence over all. Let me reel you in a little deeper... As a nursing student, I followed a wound care nurse that was performing a monthly study on the prevalence of wound progression while in the hospital. We rounded on a patient's room and whipped off their socks. In an instant, we were stunned to find a blackened foot that had completely lost perfusion-- when? No one knew. The report from the nurse, "I just didn't think of taking off their socks when checking pulses." When inquired as to why, 'I... I guess I just got lazy.' This patient lost their foot. Once again, as a nursing student in the GI suite watching colonoscopy after colonoscopy, a woman came in for a study due to an extensive family history of colon cancer. As the probe was removed and she was slightly stirring from her twilight sleep, someone made an inappropriate joke at her expense. The entire room started laughing. The patient then looked up at me with tears in her eyes, "They are laughing at me, aren't they?" I lied in order to save face. Uncool my friends. Uncool. A nurse I was working with a fellow comrade who felt too proud to ask for help with a blood infusion on a cardiac step-down unit. As I'm sure you can assume, this patient suffered from pulmonary hypertension as well as a very poor ejection fraction with apparent symptoms of heart failure exacerbation. They ran the blood too fast, didn't inquire to the MD about Lasix in conjunction with the infusion. Here comes massive fluid overload and a rapid response call. Avoidable? Indeed. Taking a step away from nurses, call into question a physician who flits in and out of the hospital who thinks that a ticking time bomb of a case (pulmonary hypertension, hypertension, kidney failure without dialysis and COPD) isn't worth abrupt addressing. I walk in and find the patient talking one minute, unresponsive the next. After bedside intubation and a run down the hallway to the ICU, the patient almost died (bless vasopressors). When the physician rounded on the floor they peeked into the room-- "Oh, they are gone, I'm assuming to the ICU? [shoulder shrug] Okay." May I mention not answering pages (most of them stat) and the fact that physical compensation wore out and almost killed this man. The physician had no shame. One last example... A CNA rounded on a patient in my unit. This individual was extremely confused, was assisted to the bathroom, then helped back to bed. Great right? Wrong. The bed alarm wasn't set nor were the bed rails up. I was running down the hall when I saw the patient literally roll out of bed and smash their head on the floor. It was a sound I would love to forget. I am sure that many of you will look at these cases and think words like: negligence, ethical issues, etc. You are right for sure. But what I can also bring to the table about all of these stories is that each of the individuals involved had been approaching their jobs with a complacent attitude. All differing levels, but it was present, and it was absolutely affecting their care. Complacency is a filthy animal. It makes Facebook at work more important than hourly rounding. It makes that extra long break of greater importance than double checking those pulses post cardiac cath. It means blowing off education and cheating on hospital required testing and skills check-offs because "we just don't have time." We all know that our jobs hold immense importance and are very high risk, to us as well as those we see on a daily basis. If you think about it, the decisions we make on a daily basis can stop or even restart a heart. I don't know about you, but to me, this will always be an immensely frightening aspect of our careers. What I ask of you is if you feel yourself sliding, none of us are above it mind you, take a step back. It is of utmost importance for us to draw the line when it needs to be marked (WITH BLINDING SIGNS). We need to understand our limits as caregivers. In order to save ourselves as well as our patients and our teams we have got to have to courage to state when our threshold has been met. I can recall in the last two weeks when I had to draw the line and ask for help because I couldn't take another [insert touchy situation here], or I would just break. IT'S OKAY! YOU ARE HUMAN! We are fallible and at times inflexible. Let that crazy super-nurse idea in your head relax and take a reprieve. I will never forget what an amazingly talented ICU doctor and anesthesiologist told me that day I left the GI suite with the laughing matter. The doctor grabbed me by the arm and reminded me in all seriousness, "It is our job to protect and do no harm. Every day this is our goal. As soon as you see yourself sliding, it's time to stop before you hurt someone." So use those days off. Ask for help. Take a mental health day. Because when we allow for complacency to take over and rule our care, that is the day that a nurse did more harm than good. Florence expects the best, our patients expect the best, their families, the doctors, even you. So let's provide the best care we can. In doing this we need to know our limits and be willing to draw those lines.
  14. 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.
  15. 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.
  16. Ruby Vee

    Compassion: A Dirty Word

    I'm beginning to feel as though the word "compassion" is a dirty word. Maybe it's the way people use it these days. It doesn't seem to be about an actual feeling of empathy toward a patient, family member or even a colleague. It seems to be more about "ME ME ME." The word is used more as a bludgeon to impugn someone's character, motives or behavior than as a descriptor. It's used to induce -- or to attempt to induce -- feelings of guilt rather than to praise or validate. "I'm pregnant and I don't think I should have to bend, lift, take isolation patients or work twelve hour shifts. My co-workers aren't helping me at all. Where is the compassion?" (Perhaps the co-workers are tired of being dumped on, of doing all the bending, lifting, taking isolation patients and doing 12 hour shifts while Princess is languishing at the nurses's station complaining about her nausea and regaling all with tales of her latest OB visit.) "A mistake was made and a patient didn't die, but they're firing me anyway and I can't get unemployment. Why no compassion for me?" (Of course *I* didn't MAKE the mistake -- it just happened. Or if I did make it, it was because the charge nurse was mean to me, my Granny is in the hospital, I didn't get much sleep because the neighbors were so noisy and no one taught me how to give meds anyway. Just a wild guess, but no compassion for you because you're so busy feeling sorry for yourself that you're not taking personal responsibility for MAKING the mistake in the first place, and you don't seem to grasp the potential ramifications of the mistake.) "The nurse wouldn't give me extra water after that doctor made me NPO, find a charger for my cell phone or a bed for my girlfriend to spend the night with me. She/he was polite and professional and all, but she/he wouldn't put out the warm fuzzies and the pillow fluffing. That nurse has no compassion!" (This usually comes after the patient in question has verbally and/or physically abused the nurse and questioned his/her parentage and sexual proclivities. Nurses, being human and all, aren't usually inclined to go above and beyond for people who aren't nice to them.) "You are all MEAN! You're just jealous because I'm so much younger, smarter, better educated and more beautiful than you. It's true that nurses eat their young. And I thought nurses were supposed to be compassionate!" (Is it really "eating your young" if the "young" is so obnoxious, entitled, lacking in basic social graces and self-centered they cannot interact as adults and professionals with the adults and professionals around them? Trust me, Honey, if you were nicer to those old, fat, dumb, uneducated and ugly nurses who work at the same place you do, you might not have cause to complain about they way they treat you. Not that that would stop you from complaining anyway . . . . .) "It has always been my dream to be an ER nurse, but you people are all scaring me! I never want to be as jaded and cynical as you! You should all quit and find another career because you have no compassion!" (Yes, it is my mission in life to avoid scaring anyone reading a vent thread and I'll hop right on that change of career thing -- as soon as the mortgage is paid, the bills go away and I have time and money to go back to school to learn to be something that requires no compassion!) It's been a long time since I've seen anyone use the word "compassion" in a positive way. It's getting so I cringe when I see the word in type or hear it -- usually in a complaint because someone didn't get everything they wanted or felt entitled to.
  17. 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
  18. 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!
  19. CheesePotato

    Five Little Words

    Memo from the desk of Your Friendly Neighborhood Sociopath For some reason, in my world, there seems to be waves of emotion that hits in a near cyclic manner. And I am most certainly not referring to hormones or my own off kilter dysfunction shabbily passed off as humanity, thank you very much. No, I am referring to days, even weeks, where it seems like everyone around me feels the need to have a good cry. From fellow nurses, to family members, to patients, heck, even managers, it would seem that no one is safe from the trickle of unbidden water works or even outright sobbing. It's a bizarre phenomenon and one that makes me feel about as awkward as a head-gear riddled middle-schooler, pressed against the wall in a lightly mildew scented, "mood-lit" gymnasium, resisting the urge to scratch inappropriately and anxiously waiting for the one and only James Bobby to ask me to dance to Journey. Not...not that I would know what that would feel like or anything. Digress. So odd how the ability to multitask can pay off at strange times. In the middle of a relatively busy surgery, up to my elbows....literally...in specimens, over the gurgling hiss of suction and the tonal whine of the cautery, from the back corner where a nursing student huddles watching the procedure I hear, 'sniffle' . Now, normally a wayward runny nose does not cause any alarm, but when coupled with distinctly watery eyes and a noteworthy brow furrow, I'm willing to bet dollars to donuts there is a chin wibbling beneath the surgical mask. Abandoning my specimens, I slipped over to the observing nursing student and made the horrible mistake of asking, "Do you need to sit down? Are you alright?" Hmmm. I'll admit, not my most observant or therapeutic communication garnished moment, but it was enough. The sniffles deteriorated to barely restrained crying and yes, as a matter of fact, she did need to sit down. Eventually, she and I stepped out of the room and had a little chitty chat in the locker room, complete with foghorn nose blowing and a few too many hugs for my comfort. However, what she needed from me in that moment was for me to be there and she reminded me that sometimes we just need someone to say five little magic words. This rambling mess is dedicated to her and to any student nurse, new grad, veteran nurse, and nursing manager out there. I am going to give you five words--just five little magic words because sometimes we just need an outside source to say them, mean them, believe them: It's going to be okay Really. I promise, from the bottom of my heart, eventually it will all be okay. It may not be perfect, or painless, or exactly the way you hoped/dreamed/prayed/demanded it would be, but it will be okay. That moment of overwhelming frustration you experienced today? It will pass. That time when you couldn't help but roll your eyes because the world annoyed you? Yeah, we've all been there. When you spouted a cuss word conveniently in front of your boss? In hindsight....that's kinda funny and let's face it, we are all prone to slips. And it is so easy to become our own saboteur. When ensnared in that horrible moment of self-doubt, when all your thoughts form a razor-edged maelstrom of demeaning self-abuse, replaying, replaying, replaying the mistake, the moment you coulda-woulda-shoulda done something different, better, faster, stronger and UGH! How could I be so stupid?! Stop. Stop now. Why? Because you are human. Because you deserve better than to be attacked by the one person who should always be supportive: yourself. You need to embrace yourself as your own ally. For pity's sake, there are enough people in this world trying to bully others--please do not bully yourself. Be kind. Be gentle. Be forgiving. But be smart about it. Learn. Grow. Adapt. Excel. You are wonderful. You are amazing, unique and truly special. Your supposed flaws are nothing more than quirks that make you more than fantastic, in fact they make you interesting; they add flavor to the gourmet dish of spectacular you. I am not just saying it--I believe it--I know it. Because I'm hardcore like that. The equation is simple: You = awesome. And not because you are a member of the nursing community. I want you to remember something very important: RN does not a person make. RN should not define you. I beg of you, do not limit your potential to two little letters. There should always be more to your identity than your job, regardless of how much you love it; and if you take a moment to think about it, there always will be something more to you. Remember that, please. Embrace it. Internalize it. There is more to me than RN. Remember it when others try to pull you down. Remember it when you feel like a cog in a machine. Remember it when you're pulled into the gaping maw of the work place Drama Monster. Remember it when, for one scary moment, you stop seeing something good in yourself. There is more to me than RN. So who are you? Allow me to go first: I am CheesePotato. I hate thunderstorms with a passion but I love booming surround sound. I like to think I can sing and I have a bad habit of forgetting to put on pants before walking in front of the bay windows overlooking my back yard (and yes, I'm sure I've scarred a few neighbor children for life and no, I do not have Alzheimer's). I have the handwriting of a serial killer. I drool on my pillow when I sleep and wake up mad as hell regardless of time of day. I used to play Dungeons and Dragons when I was young and to this day still own a twelve-sided die. I am a terrible cook. Like seriously. I could burn a stick of butter left out on the counter top to defrost. I'm overbearing, petulant, and slightly deranged. I lose my car every time I go into a store. I can recite Edgar Allen Poe's "The Raven" from memory. I have this strange Rain Man like ability to memorize song lyrics but, off hand, I couldn't tell you a normal BUN lab level if my soul depended on it. I am CheesePotato. And, I just so happen to be a nurse.
  20. 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 ConnectionAsk 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 InitiativesThe 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 LeadershipOrganizational StructureManagement StylePersonnel Policies and ProgramsProfessional Models of CareQuality of CareQuality ImprovementConsultation and ResourcesAutonomyCommunity and the Healthcare OrganizationNurses as TeachersImage of NursingInterdisciplinary RelationshipsProfessional DevelopmentNursing Excellence, Hospital Scores, and PhysiciansPress 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 RelationshipsConsidering 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 TeamWhile 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 ProfessionalismWhen 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 AdvocacyOne 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 CommunicationThe 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
  21. spotangel

    I Lost My Baby And My Phone!

    The night Nursing Supervisor was giving me report. I was taking over half the hospital including ICU, CCU, ER, LR, NICU, Postpartum and a bunch of other units. The supervisor told me about a patient who was on one to one observation and security watch. During my rounds I went to her unit. I spoke to the nurses who were all having a rough time with her for the last few days. I could hear her yelling at the top of her lungs demanding her phone and her speech reminded me of the Jerry Springer show! Every second word was a curse word! She recently had a fetal demise and had multiple psy hospitalizations in the past. I was told that a situation developed the day before and security watch was initiated along with one to one observation. The father of the baby was barred from coming in and as he stirred up the patient and set her off every time he was at the bedside or on the phone with her. Finally the situation became so hostile that he was barred from coming into the hospital.She was refusing medications and was very labile. The doctors wanted her to sign a behavioral contract before the phone was returned and she refused. The nurses went in and offered medications for agitation and she refused. I walked in quietly into the room and introduced myself and shook her hand. She looked me up and down. I softly told her, " I am so sorry for your loss." I asked her if that made her sad and angry. She nodded her eyes never leaving my face.I asked her did it feel like a hole in her heart? She nodded again, her face crumpling. I then looked her straight in the eye and asked, " May I give you a hug?" She nodded. I took out my ID from my white coat, laid it at the bedside table along with my report and stepped closer to her bed. I opened my arms and she fell into them sobbing. I held her murmuring reassurances and acknowledging her loss. I told her that she was a brave and strong woman and would get through each day, one day at a time. I told her that it was ok to get sad and mad after losing her baby but it was not ok to hurt herself or others in the process. I requested her not to hurt herself or others. I looked behind me at the staff and the security guard and told her, " All these people you see are here to help you not hurt you. You have to remember that every day they get up from their warm beds and come out in this cold weather to the hospital to help patients like you. They have families that want them safe home and the end of the day. So please don't hurt my staff or yourself". She nodded and smiled through her tears. I was struck at how that smile transformed her face and commented, " How pretty you look when you smile!" One of the staff commented that she also had a beautiful voice and could sing! Now that she was calmer, I asked her if she would sing for us. After the initial bout of shyness, she started singing, "Amazing Grace how sweet the sound". She sounded like an angel! I joined her in the second stanza and so did half the staff there and the security guard in his baritone! It was a beautiful moment and there were a lot of smiles and tears! I thanked the lord in my heart that he choose to change an ugly situation into something beautiful that we could all relate to. I went back to the nurses station and asked security to bring up her phone.We convinced her to sign a behavioral contract. Although she was upset that she could not keep the phone for long periods of time, we reassured her that it was all dependent on her behavior. The charge RN convinced the doctor to leave her phone with her for the time being as she was calm playing on the phone and reaching out to family. She also wanted to see pictures of her daughter who had died who she had named Lilly, that she had on the phone. The last I saw her, she was quietly playing on the phone. I left the unit satisfied that she was in safe caring hands.
  22. dianah

    A Path of Learning

    Over 30 years ago, I was a young 'float' RN doing morning Team Leader rounds in the Post Partum unit. I had just left a four-bed ward on my way to the next two-patient room. My mind remained on the mothers from that four-bed room, joyfully discussing and comparing their newborns, sharing names and hopes. As I entered the next room, I glanced at the information on my clipboard, locating the correct room and patient name. I smiled at the woman in the first bed, who looked, as did the mothers in the last room, healthy. She smiled back as I greeted her by name and asked, "and what did YOU have?" She didn't miss a beat but inclined her head as her smile grew broader. "You poor thing," she said. "I had a hysterectomy." She was most gracious about my faux pas, even laughed about it. I, however, after climbing the Mountain of Mortification, resolved from that point on to enter each room properly armed with the patient name and knowledge of diagnosis and the focus of this particular patient's care foremost in my mind. About six months later I floated to a DOU unit, what would today be called a tele unit. Again, I was Team Leader. I had reviewed the patient's names, diagnoses and where they stood in their treatment and recovery phases. It had been a particularly busy morning. My morning rounds had repeatedly been interrupted by pressing needs and I hadn't even talked with three of the patients on my team. I had inquired of their direct caregivers about the three patients, and in my running around had noted one of the patients, a man in his 50's who was recovering from an MI, walking in the hall. Relieved that he felt well enough to walk around, I continued at the more pressing duties. Around mid-morning, I finally got a chance to poke my head in his room to introduce myself and inquire about him. "I'm glad you're doing so well," I nodded. "What makes you think I'm doing well?" his eyebrows raised as he sat on the side of his bed. "Well, I saw you walking in the hall and I assumed you were doing well enough to walk around." "Young lady," he frowned. "Do you know what happens when you assume?" Dumbfounded, I shook my head. He continued, "You make an *** out of U and Me." Ah, and I embarked on another trip to the top of the Mountain of Mortification. I spent the next half-hour in his room, mainly listening to him but receiving a lesson in checking out details, asking pertinent questions and, most important, listening to the answers. We came to an understanding, he and I. He realized I wasn't willfully ignoring him and that I did care about his progress and about him as a person. In turn, I learned from him to revise my time management practices and to gain information directly from the patient, rather than from my own misconstrued hints and assumptions. In that first year as a young grad, I floated to the ICUs as well as the less-intensive units. One of my most memorable patients was a young man in the SICU who had been in an auto accident on his way from his wedding to the wedding reception. He had multiple rib fractures resulting in flail chest, which required ventilator assistance. He had chest tubes, an NG to suction, a foley, required frequent blood gases drawn (no A-line), many antibiotics and IV medications to be hung, rhythm strips to print out and examine, and other routine maintenance that was the standard of that day. I took his vital signs every hour, suctioned him, measured and emptied the foley, hung the antibiotics, drew blood gases, assessed his lungs, 'milked' the chest tubes, measured and emptied the NG canister, talked with him about what I was doing, assessed his IV sites, and wondered how he was doing mentally. Most of the time he seemed awake and alert. How, I wondered, was he feeling about all this? His long-anticipated wedding day so abruptly and painfully interrupted, and for how long? And, what residual scarring would remain when he left the hospital? He HATED being turned, and with those rib fractures, I certainly didn't blame him. I medicated him before turning him, warned him before I turned him and then waited for his signal that he was ready. In spite of the pain medication and preparation, he still grimaced with pain each time the deed was done. In spite of his many time-consuming and care-intensive needs, as a young nurse, I was proud of the way I'd cared for him and tended to all that needed doing for him. About two weeks later I happened to float to that same ICU. As I passed a cubicle I recognized him: sitting in a chair, chest tubes out, extubated, color in his face, able to talk! I was thrilled to see him and eagerly greeted him. He remembered me, said it had been a rough road, being in the hospital, but was hoping to go home in about a week. "Does anyone visit you?" I asked, remembering I'd never seen anyone visiting. "Yes, my wife works days but she comes by every night to visit." "So, tell me," I continued. "What do you think has most helped your progress, your healing, through all this?" I waited, thinking of all the nursing assessment skills I'd learned and used, and tasks I and the other nurses had performed, caring for him when he was so injured and helpless. "Most helped?" He paused, but only briefly. "Seeing my wife here every day. THAT gave me the will to go on, to get better." I realized he spoke the truth. He was not just 'a patient' who needed a bunch of nursing tasks done, important as they were. He was an individual and my teacher, guiding me to a greater appreciation for the human spirit and the power of love to provide hope in the face of extreme obstacles.
  23. 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.
  24. Jacqueline.Damm

    Sticks and Stones

    I am not sure about other places, but at least where I've worked in the past, gossip is a rhino in a china store on a rampage with only one intent: to destroy. I believe that stress breeds an ugliness that starts in the back of our minds when our ego is going wild and we realize that our grasp on work situations are out of our control. Funnily enough, we will never be in control of a situation's outcome because it's just not our call. That is left to a higher power (if you will). When stress hits it's peak we all get desperate. It seems as though desperation is the catalyst to our tongues flapping in the wind. Personally, and in full recognition of my own shortcomings, I get wordy when I get worried. But my words are a double-edged sword that has the power to destruct and destroy. Just like that rhino in the china shop, I too have the power to wreak havoc in a place that already has enough issues of its own. I have been on the delivering and receiving end of gossip at work. I realized my problem one day when I was fuming over something that wasn't in my power, and yet I lashed out (in a desperate attempt for control) by choosing to gossip about something menial. My energy level at work started to plummet and I felt like I was falling apart. Why? Because what you put out there is returned to you. Gossip, in general, is cruel, but gossip at work is dangerous. Why? Well, let me tell you... There was a situation at work one time that was calling into question a nurse and their integrity, there was actually a law-suit situation going on and it was very touchy around the unit. The nurse in question had decided to pinpoint who they deemed initiated this investigation and reported them. This nurse traveled around the unit one-by-one picking anyone who had an ear to listen and then openly slandered their fellow co-worker. This news spread around the entire hospital. When this poor individual returned from vacation, they found out people had been slamming them while they were gone. Defenseless and upset, this person left the unit for good, and never looked back. Now, this is an absolute extreme case but think of the power our words have. Think of the power of our actions. Then, think about how we can weave and create whatever we want to slander someone. Whether there is truth or not to our accusations, whatever we say can filter to multitudes of people in our organization. Or worse... To patients and their families. I am not saying that if there is an issue going on that needs addressing, you ignore it. We all know that if there is a major problem that needs attention, we need to move up the chain of command. What I am asking, is that we stop tearing each other apart. Our work lives as nurses are hard enough. To add in gossip and its ability to sabotage relationships is all we "need" to bring our units down. We can be the catalysts in our own failure to act as a team. If we chose to lift each other up, rather than tear down, teamwork would take a turn that could positively influence our care, our energy when approaching work and work situations, as well as help us endure the long stretches of high-stress situations with a security blanket. We all know that there are times when issues need to be addressed. But, turning to your neighbor while charting and gossiping doesn't make for a good work relationship for anyone, nor does it fix the issue at hand. Trust cannot be built on a faulty foundation and more often than not, we allow it and welcome it with open arms in the workplace. If you need to blow off steam (and I know I do, daily) crack open a journal, talk to a removed person who does not contribute to your work atmosphere. We are human, and we all need to let our frustrations go. But tearing up a coworker to your fellow co-worker only allows that cycle to get started. Our focus needs to be to lift each other up, make it through what is (what I believe) one of the most trying jobs (but rewarding jobs) on the market, and furthermore find ways to help each other through our slumps. No matter how hard we try, home comes into work with us, and work has the potential to follow us home. Let's make a great effort to look out for one another. I know that I'd rather be focused on my patients instead of fuming over some gossip that had returned to me rattled off behind my back. The toxicity of negative words can and will ruin our will power where power and will need to be in full supply. Mutual respect will keep that machine well-oiled and running true. Are you up for the task? I know I am.
  25. 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