Gourmet food, wireless access, waterfalls in the lobby. These are some of the things hospitals are doing to accommodate their customers (it's hard to call them patients when it seems we're more concerned with how they rate the hospital than their medical outcome). But according to at least one survey, what patients really want is kindness.
According to a survey by Wakefield Research for Dignity Health, one of the five largest health systems in the U.S., 87% of Americans feel kind treatment is more important than other key considerations in choosing a healthcare provider. The survey asked specifically about choosing a physician, but the findings can likely be expanded to the entire healthcare experience.
Even more surprising is that 64% of those surveyed reported having experienced unkind behavior in a healthcare setting, including the failure of a caregiver to connect on a personal level (38%), staff rudeness (36%) and poor listening skills (35%).
The consequences of this poor treatment are significant. The survey found that when people experience unkindness in a healthcare setting they feel their quality of care is negatively affected (93%) and withhold information (54%).
Dignity Health recently launched a project called Hello Humankindness. It has great examples demonstrating that as humans we have the capacity to be kind to each other. And it doesn't take much.
Another cool project Dignity introduced is the Great Kindness Challenge. They have designated Aug. 9, 2014 as a day devoted to performing as many acts of kindness as possible. They even provide a list in case you need help. (I'll remind you of this in August!).
They are also challenging students to do 50 acts of kindness between Jan. 27-31. Let's join them! Despite the fact that as a nurse you are in one of the most compassionate professions, according to this study, you're not always nice - not to mention the whole bullying thing you do to each other. I challenge nurses to join students across the country and go beyond your usual and do 50 additional acts of kindness!
Veronica Thompson, RN-BC, MS, FNP-BC, is on the clinical faculty in the Division of Education and Organizational Development at Montefiore Medical Center, a teaching hospital in Bronx, N.Y.
More than 28 years ago, I began my nursing journey in Jamaica, West Indies. During my career, I completed a B.S. and M.S. in Nursing and finally a Ph.D. in Education Leadership. In my role on the clinical faculty at Montefiore, I interact with a large number of new graduate registered nurses, which has increased my awareness of some of the issues they face as they move from the classroom into the clinical setting.
While conducting research for my dissertation, I learned that new registered nurses continue to face challenges, such as communicating with the members of the health team, handling the workload and time management and prioritizing as they transition into the clinical setting.
The new nurses leave the comfort of the classroom, where they are supported by their instructors, into a clinical setting where they experience fear, anxiety and feeling unprepared for the role. Clinical leaders and senior nurses should provide an environment which is nurturing and supportive for the young inexperienced nurses. These nurses are going to be our replacements someday - it is our responsibility to provide them with the tools for success.
Some ways we can assist the new nurses is to acknowledge their limitations and develop plans to help them master essential skills. Secondly, we must recognize that the new nurses are in the novice phase and require timely, well-planned orientation and a supportive post-orientation plan. Experienced nurses should mentor the new nurses and arrange for added time and activities to address their learning needs.
I can recall my first experience as a new nurse and how scared I was as I walked into a patient care area. Luckily, I had been an intern for a year, where experienced nurses mentored me and I learned the role and responsibilities of the registered nurse. This internship helped me learn essential skills - time management, prioritization and how to communicate with the health care team. All of this is so important for the new nurse to have a smooth transition into the clinical setting.
I was provided a special experience in the early years of my career and I'm committed to ensuring that same level of mentorship and care is provided here at Montefiore! We're all one big team and these nurses are the future caretakers of this community - we owe to them to make the transition as smooth as possible.
The first time I saw a Pink Glove Dance video I was perplexed. Is this really how hospitals are spending their time and money? These are professionally produced videos using hundreds of hospital employees and a ton of resources. I can't imagine the time and money dedicated to creating these. And what's the point?
Then I watched a few more. I smiled and cried, and watched more videos.
Now in its third year, the Medline has announced the winners of the 2013 Pink Glove Dance competition. It's not all glory and fame for the winners, people with cancer also benefit from the program.
The winner is chosen by online voting. Geisinger Health System, Danville, Pa., got the top spot this year. As a result, $25,000 was donated to a charity of their choice -- the American Cancer Society, providing free transportation for treatment to central Pennsylvania breast cancer patients in need. In addition, Medline, sponsors of the Pink Glove Dance, and participating hospitals will donate another $1 million to the National Breast Cancer Foundation and various local breast cancer charities nationwide. More than $2.2 million has been donated through the campaign and Medline Foundation since 2005.
So, videos of dancing in hospitals. Really? Yep.
Congratulations to the top winners and everyone who participated in the competition. To see all the videos, go to http://www.pinkglovedance.com/
I live in South Florida very near to the Gulf of Mexico, but I’m
not exactly an avid fisherman -- although most everyone I know has a good fish
story to tell.
And while what I’m about to say may sound like another one of
those, it is not:
There’s a new treatment option for the millions of people out
there suffering from chronic wounds -- namely, fish-skin technology.
The manufacturer, Kerecis Limited, announced Nov. 7 it had received 510(k) clearance from the FDA to market the proprietary fish-skin, Omega3, tissue-regeneration technology for the treatment of chronic wounds in the U.S.
Fish skin, it seems, comprises much of the same material as human skin, with the addition of Omega3 polyunsaturated fatty acids. The new curative products are intact, decellularized fish skin sheets, which have had all cells and antigenic materials removed. The products are made in Iceland from fish harvested in the North Atlantic.
According to the manufacturer, when the product is
inserted into or onto damaged human tissue, protease activity is modulated and
the fish skin is vascularized and populated by the patient's own cells, ultimately
converted into living tissue. Marketed under the name MariGen
Omega3, the FDA says it is indicated for the management of chronic wounds, including diabetic,
vascular and other hard-to-heal wounds.
Each year about six million Americans alone suffer
from problem wounds caused by diabetes, circulatory problems and other
conditions, according to the FDA, with 1.1-1.8 million new cases added each year, and so one can only
begin to imagine the infections, amputations and deaths chronic wounds are causing on a global scale.
"Despite a clear need, few treatments are consistently effective
in accelerating wound closure in people with chronic wounds," says
Gudmundur Fertram Sigurjonsson, CEO, president and chairman of Kerecis Limited.
"The FDA approval represents an important milestone for Kerecis, as we now
have an approved product in the largest market for biological products
Hopefully, the fish-skin technology will be a milestone for many more
as well, who will finally be able to tell the story about their chronic wound
that got away.
Sharon Nam Dobbs is a registered nurse who is committed to education and professional growth. Educated in Canada, she received a diploma in nursing in 2003 from George Brown College; a BSN in 2005 from Ryerson University; and an MSN from University of Toronto in 2007. She has worked in community nursing, geriatric nursing, nursing education, general internal medicine, neurology, and bariatrics. She has worked in Canada and the U.S. and currently works as a bariatric nurse at Toronto Western Hospital.
When my union forwarded a link to a petition to cancel a new reality show, "Scrubbing In" that was described as being "highly offensive," and which depicts nurses in unprofessional, inappropriate activities, I automatically signed the petition, and forwarded to family and friends on my Facebook page to also sign. I thought that anything that got my union so riled should be taken seriously.
Receiving a notification from my adult son that he hated the trailer and thought it was "an abomination and an insult" to my honor, I was more than a little curious about the trailer itself. I watched it and was horrified at the portrayal of the nurses in the show.
We have advanced into a "reality" age in which we have an unquenchable thirst of the most outlandish of "daily" activities. We live in awe of the most degrading of human activities. We watch in glee as people dispute about their innumerable sex partners, about the paternity of their children, and about any number of topics. We watch child prodigies perform as seasoned chefs, and hunger for fights amongst mothers of child beauty queens. We have become a depraved society in which nothing is sacred, and everything is fair game.
But, one wonders, what does that have to do with nursing? Reality TV doesn't necessarily depict real life, does it? While that may be true, reality TV gives the impression that what they portray actually happens.
Now, in a profession in which nurses fight daily for respect and to be taken seriously, in which so many television shows have negative portrayals of nurses, and in which nurses must constantly (and almost unsuccessfully) be proving themselves to their patients, the families and friends of patients, and even to their own colleagues in other disciplines, why would any nurse embrace a television program that basically prove the misconception that exist about nurses?
Real Housewives, The Bachelor, Gator Boys, Say Yes to the Dress, Hard Knocks...
In today's entertainment industry no person, place, or profession is safe from the reality television craze. And now, thanks to MTV, nursing is no exception.
Tonight, the network that brought us The Real World and Jersey Shore will premier Scrubbing In a show that follows the lives of a group of travel nurses working in Orange County, Calif.
"Relocating from across the country, these nurses have left their hometowns and lives behind for short-term hospital contracts, with the added benefit of exploring a new city," according to MTV. "For Tyrice, Chris and Fernando, this isn't their first tour and they're considered experts of the program. For first-timers Adrian, Chelsey, Michelle, Crystal, Nikki and Heather, this is a new journey they're embarking on together, looking for a change from their previous nursing jobs."
And if the trailer is any indication these young professionals work hard and play even harder.
The "reality" in reality television should often be taken with a grain of salt, but where do you draw the line between entertainment and misrepresentation?
A Change.org petition was started urging MTV to cancel the show because it "does not and cannot depict the lives of professional nurses and it is an insult to the nursing profession as a whole."
What do you think? Does Scrubbing In undermine the integrity of the profession? Will you tune in tonight or boycott the show altogether?
Alexandrine Pinault is a senior nursing student at University of Maine at Orono
In answer to your editorial of September 9th about school nurses' roles in addressing school children health concerns and the need for more school nurses, I would like to add some elements from the National Association of School Nurses (NASN) and discuss prevention of obesity at school.
According to NASN, the most prevalent student health concerns are obesity (32%), vision deficiencies (24%), medication for longer than 90 days (13%), mental/emotional/behavioral problem (10%) and asthma (10%).
As explained in the Student-to-School Nurses Ratio Improvement Act 2013H.R.1857, the benefits of having a school nurse in buildings are numerous in regard to children's health and school performance. In addition, it saves other staff a considerable amount of time in addressing issues for which they lack training. The NASN and Healthy People 2010 recommend a school nurse ratio of 1 nurse for 750 students; less when special services are needed. However, there is disparity among states, with ratios ranging from 1:396 in Vermont to 1:4,411 in Michigan. Northeastern states, in general, have some of the best ratios.
Obesity is obviously a major concern and preventive actions could include basic cooking programs along with basic nutrition concepts starting in elementary schools.
Experimental nutrition curriculums have been successfully developed in some schools. A 2011 article by Walters and Stacey report of a 12-year program in New Mexico were children had hands-on lessons. Some of the benefit listed include the compatibility with other academic topics such as reading and mathematical skills as they are involved in cooking, openness to other cultures, development of social skills, an increased knowledge and interest in healthy food as evidenced by children eating a variety of food especially vegetables. These findings are consistent with other studies. These programs could be initiated by school nurse in a multidisciplinary approach.
Federal and state regulations try their best to improve the quality of the food available to children in schools but children need to become active players and not passive consumers of goods at the hands of the food industry. Many families do not have the time or the knowledge to cook healthy meals and this fundamental skill is often no longer transmitted. With more than 30% of children and adults over-weight or obese, and the millions of dollars spent on treating chronic diseases related to obesity, treating the problem at the root is an absolute necessity.
Healthy children learn better! School nurses make a difference. (2011, August). https://www.nasn.org/portals/0/about/press_room_faq.pdf
Student-to-School Nurse Ratio Improvement Act of 2013 bill summary. (n.d.)https://www.nasn.org/PolicyAdvocacy/StudenttoSchoolNurseRatioImprovementAct
Walters LM, & Stacey JE. Focus on food: Development of the cooking with kids experimental nutrition education curriculum. Journal of Nutrition Education and Behavior,41(5), 371-373. http://dx.doi.org/10.1016/j.jneb.2009.01.004
have a confession to make: I suffer from White Coat Syndrome. My brow sweats, my
heart pounds and my blood pressure spikes with each doctor’s office visit. Some
call it White
I finally have a doctor who understands this, after seeing another who insisted
on prescribing blood pressure medication for me instead of hearing me out. We even joke
about it, my good doc and his nurse and me; but only after the
readings on my wrist monitor taken before and after a few visits proved my blood
pressure is completely normal outside his office.
addition to never wearing a white coat, something that helps a lot is that my
doc is very quick-witted and always up for a chat about most anything, which is
usually what I have to offer, i.e., something I’d been thinking of mentioning to
him that has nothing at all to do with my general health and well-being let
alone the reason for my visit (diversionary tactics).
visit, when I was telling him all about a friend who used e-cigarettes to quit smoking.
She found that what she was really addicted to was drawing the smoke into her
mouth, and the inhaling and the exhaling. So she just bought the non-nicotine
cartridges instead and satiated her oral fixation with the vapor. Two months
later and she still doesn’t miss the nicotine. [Check out one of the features
"Nixing Nicotine" in our Lifestyle
for Nurses section sponsored by Dansko for more tips on quitting
But I digress (an effective diversionary tactic,
One of the other things my doc does to put me at ease is when he
comes in to the room he sits down in a chair. Although to be honest, I did not even realize this was
making me feel better until I
happened upon a study about sitting docs having happier patients by
researchers at The University of Kansas Hospital Spinal Cord Injury Center in
Kansas City, Kan.
Among the many fascinating things they discovered was if a
doctor sat down during an office visit they were perceived as spending 40% more
time with their patients, whose satisfaction scores increased accordingly. Many patients said they felt their doctor had been in the room
for at least five minutes when in reality it had not been much longer than a
And it can work for nurses, too, experts say, many noting that
the simple act of sitting down in a chair near the head of the bed instead of
standing at the foot of it makes a patient feel as though the caregiver is taking greater interest in them and actively listening to their story.
Some call it "Therapeutic Presence" while others
refer to it as "Caring Presence." If the latter sounds familiar it may be
because a feature article by that title may have appeared in one of your recent
issues of ADVANCE. Written by holistic nursing expert, Veda
Andrus, EdD, MSN, RN, HN-BC, the article delves deeper into the meaning patients
put into simple gestures made by clinicians and offers ideas for how you can
incorporate being present into your nursing practice.
And as Andrus
points out, being a caring presence for patients is a notion that is especially
timely as the health reform law is implemented.
“Today, with the implementation
of the Affordable Care Act (ACA), value-based purchasing, the Hospital Consumer
Assessment of Healthcare Providers and Systems (HCAHPS), and a focus on the
patient experience, the stakes are even higher for nurses to provide sustainable
quality outcomes for their patients,” Andrus writes. “With a new focus on
reimbursement from CMS, nurses are now called upon to have an understanding of
and direct relationship with the business side of healthcare.”
Caring Presence article in its entirety here.]
I’m certain there are many of you who could tell us a story or two about making a
difference in a patient or family member’s life simply by being present and
listening when it mattered most. Or maybe you can share some tips for how to
spot the symptoms of White Coat Syndrome and prevent a patient like me from
being misdiagnosed with something more sinister.
way, we’d love to hear what you have to say by commenting on this blog [also don’t miss the ADVANCE blog The Politics
of Healthcare]. Or, share your experiences anytime via our interactive feature “Tell Us Your Nursing
Story” also in our special Lifestyle
for Nurses section.
In the month of October it's hard to forget it's Breast Cancer Awareness Month. More than any other "cause" breast cancer advocates have managed to take over entire cities, whether it's putting dye in their fountains or illuminating their buildings with pink.
Almost everybody jumps on the pink bandwagon, including many commercial entities. "Buy this pink thing to show your support"; "Buy our pink product and we'll donate money."
Just as when you are purchasing a product, buyer - or donator - beware of where your money is going. Many people have a soft spot for breast cancer and it's easy to either give to a charlatan charity, or spend money thinking you are making a huge difference for people with breast cancer.
Luckily, there are tools to help you make the right decision for yourself.
Scambook, an online consumer advocacy platform, warns of increasing breast cancer charity scams this time of year. It offers the following tips to help consumers avoid fraudulent breast cancer charities and related scams:
- 1. Do not respond to unsolicited (SPAM) e-mail.
- 2. Be skeptical of individuals representing themselves as officials soliciting via e-mail for donations.
- 3. Do not click on links contained within an unsolicited e-mail.
- 4. Be cautious of e-mails claiming to contain pictures in attached files, as the files may contain viruses. Only open attachments from known senders.
- 5. Make direct contributions to known organizations rather than relying on others to make the donation on your behalf. A non-exhaustive list of reputable breast cancer organizations can be found on thiswebsite, which rates the credibility of charities.
- 6. Validate the legitimacy of the organization by directly accessing the recognized charity or aid organization's website rather than following an alleged link to the site.
- 7. Verify the legitimacy of the non-profit status of an organization by using various Internet-based resources, which can also assist in confirming the actual existence of the organization.GuideStaris a free resource that allows users to peruse nonprofits' tax returns to see exactly how they allocate money.
- 8. Do not provide personal or financial information to anyone who solicits contributions, as providing such information may compromise your identity and make identity theft possible.
Breast Cancer Action is a self-proclaimaed "watchdog of the breast cancer movement." Its "Think Before You Pink" project was launched in response to the growing concern about the number of pink ribbon products on the market. "The campaign calls for more transparency and accountability by companies that take part in breast cancer fundraising, and encourages consumers to ask critical questions about pink ribbon promotions," according to its website.
If you want to buy a certain brand because it donates money to breast cancer research, it's your choice, of course, but you should know where your donation is going and exactly how much the company is giving. Also, there is something to be said about breast cancer events. Yes, these walks and runs have big overhead, but I have known people undergoing treatment who are encouraged greatly by attending these. You can't put a price on making a person with cancer feel these thousands of supporters are there for them.
Financially you make the largest impact by donating directly to a reputable breast cancer charity. Emotionally it may help to wear pink to show you care.
From funny skits breaking into sillier dance routines to hundreds of very carefully and cleverly choreographed productions, nurses from all corners of the U.S., Canada — and this year Panama as well — are submitting their videos for Medline's third annual Pink Glove Dance video competition to raise breast cancer awareness.
For more information about the contest, visit http://www.pinkglovedance.com/.
According to competition host Medline, since this year's competition launched July 1 more than 160 teams with 50,000 dancers from across the country, including hospitals, nursing homes, schools and other community organizations, have already signed up.
The original Medline Pink Glove Dance video premiered in the U.S.in November 2009 featuring 200 hospital workers wearing Medline's pink gloves and dancing in support of breast cancer awareness and prevention.The original video has since logged almost 14 million views on YouTube and has been the inspiration for hundreds of pink glove dance videos and breast cancer awareness events worldwide.
For the past two years, Medline, the largest U.S. manufacturer and distributor of healthcare products, has held a national competition to find the best video in North America. Last year, the competition attracted 275 entries and more than 80,000 people in 42 U.S. states, Puerto Rico and Canada. Separate competitions were also held in New Zealand and Australia.
Medline is donating a portion of each sale of the pink gloves to the National Breast Cancer Foundation to help fund mammograms for individuals who cannot afford them. What's more, Medline will now make a $25,000 donation to the breast cancer charity of the overall winner's choice; second place will receive $10,000 and third place $5,000.
Also new to the competition this year is an Artist's Choice category. Music groups 98° and Green River Ordinance, each of whom has a song as part of the competition, will choose a video for special recognition.
Contestants also have additional music selections to feature in the videos, including:
"Treasure" by Bruno Mars(new)
"Alive" by Krewella (new)
"Rise Up" by Green River Ordinance (new)
"What Makes You Beautiful" by One Direction(new)
"Some Nights" by Fun.
"Change the World" by Outasight
"Tonight is the Night" by Outasight
"Brave" by Sara Bareilles
"Impossible Things" by 98°
In addition, the top three video entries from academic institutions will again be eligible for a gift card and charity donation through School Health Corporation, a provider of medical supplies and equipment to school nurses and other specialty healthcare professionals.Gift card prizes and charitable donations range from $250 to $500.
The deadline for submitting your video for this year's competition is Oct. 4.All videos will then be posted online starting Oct. 25, with winners announced Nov. 15.
So what are you waiting for?Grab a few colleagues and put your heads together to see what you might come up with. It's for a great cause after all. And if you get in jam, or if you have participated in the past and have and tips and advice you can lend others please come back here to discuss and share your insights.
Race-based college admissions and affirmative action policies have been in the spotlight since the case Fisher v. University of Texas at Austin was brought before the Supreme Court.
Abigail Fisher, 23, sued the University of Texas at Austin and its officials "alleging that the University's consideration of race in admissions violated the Equal Protection Clause," according to Supreme Court documents.
The Supreme Court ruled in a 7-1 vote that the case would be sent back to the 5th Circuit Court of Appeals for reconsideration, USA Today reported.
"Despite the lack of a resolution on whether race-based admissions is constitutional, both sides of the case are claiming the ruling as a victory," noted USA Today.
Affirmative action supporters found the ruling encouraging because the Supreme Court did not overturn current policies while the opposition saw the decision as a chance for the lower court to reconsider its original ruling.
The American Association of Colleges of Nursing (AACN) joined the discussion lending its support to the University of Texas at Austin and race-based admission decisions as a whole.
"AACN joins with the larger higher education community to applaud the Supreme Court for continuing to support race-conscious admissions practices as a means to diversifying student populations," said AACN President Jane Kirschling in a recent statement. "Nursing's academic leaders have long recognized a strong connection between a culturally diverse nursing workforce and the ability to provide quality, culturally competent patient care. Achieving this goal must be a priority for the profession and requires action at the individual school level."
Where do you stand? Should race factor into the admission process?
Malinda Loflin, RN, BSN, is a certified case manager at a hospital in Oklahoma City. During her 22 years as a registered nurse, her clinical experience has been in many specialty areas including the operating room, post-anesthesia care unit, and the emergency department. In 2006, her father tragically died of opioid-induced respiratory depression after a routine surgery. She shared her experience and the impact that it has had on her and her family at the 2011 Anesthesia Patient Safety Conference.
Nursing spot checks on postoperative patients receiving opioids are not enough to ensure the safety of patients. I say this as both a registered nurse who works at a large medical center and as a daughter who has had the misfortune of seeing her own father die between nurses' spot checks.
Robert Goode was a devoted son, a loving and faithful husband, a nurturing father to me and my brother, and a wonderful grandpa to two boys who thought the world of him. He enjoyed fishing, traveling, and spending time with his family. At 63, he was 9 months away from retiring from Tinker AFB where he had worked as a civilian for over 40 years.
My dad had a hiatal hernia, a condition where part of the stomach sticks upward into the chest, through an opening in the diaphragm. Because he was having difficulty eating, he decided to have surgery to fix it. Although my dad had a history of heart problems, for which he had a pacemaker, he sought and received clearance to have the surgery from his cardiologist.
So on April 5, 2006, my dad underwent surgery through a standard procedure called laparoscopic Nissen fundoplication. Surgery was successful and after surgery the surgeon reported that everything went well and there had been no complications.
After recovery, he was transferred to a general med-surg unit. Within a day after surgery, April 6, he was up walking the halls and feeling great. He was looking forward to going home the next day.
Postoperative orders included a morphine PCA pump and supplemental oxygen. Although, my dad had a history of sleep apnea and used a CPAP at home, he was not electronically monitored. In other words, my dad's health and life rested on a nurse coming around to his room every 2-4 hours. No matter how dedicated the nursing staff, what would the odds be of one of them checking on him if his condition deteriorated? I am not a statistician, but the odds cannot be very good.
Moreover, my dad's room was at the end of hall and furthest away from the nurses' station. So, in between these 2-4 hour checks, he was relying on a nurse at the other end of the hall to notice that he needed attention. The odds, I believe, have surely gone down further.
Yet, this is often the standard of care that patients receive. The Lippincott Manual of Nursing Practice recommends that respiratory rate, sedation score and oxygenation be checked periodically on an hourly, two-hourly, or four-hourly basis. The chart below, developed by the San Diego Patient Safety Council, provides more frequent assessment of the patient, together with a respiratory assessment that also includes end tidal CO2:
In my father's case, this periodic assessment (although important for patient care) failed to detect his deterioration. As Dr. Robert Stoelting (president, Anesthesia Patient Safety Foundation) has stated:
"the conclusions and recommendations of the APSF are that ‘intermittent' spot checks of oxygenation (pulse oximetry) are not adequate for reliably recognizing clinically significant evolving drug-induced respiratory depression in the post-operative period."
Moreover, as Matthew Grissinger (director, error reporting programs, ISMP) explains:
"One reason why it (periodic spot checks by caregivers and pulse oximetry) is not effective is that a ‘periodic check' and pulse oximetry would only catch an error, not prevent the error."
For all patients, we want to prevent the error.
On April 7, at approximately 5:30 in the morning, we received the dreaded early morning phone call that he had taken a turn for the worst and that the doctor was with him. When I got to the hospital, I found my mother sitting outside his room crying. I could hear the sounds of a code being performed coming from inside his room.
We waited outside the room for almost 2 hours before his doctor came out to tell us they were able to get his heart beating again but he was in critical condition. He was then emergently transferred to another hospital that could accommodate his critical level of care.
After what seemed like hours, we were allowed to see him. He was on a ventilator and on multiple IV medications to sustain his cardiac function and blood pressure. He was unresponsive, cold, and bleeding from his mouth and nose.
Unfortunately, his body had begun to shut down. Not only did he have respiratory failure, he had developed renal and liver failures that lead to DIC. An EEG was performed that showed minimal brain stem activity; but, my family and I were still hoping and praying for a miracle.
All through the day the doctors and nurses in the ICU worked diligently to save his life. As the day progressed, his heart became more and more irritable and the medications were unable to keep his cardiac rhythm and blood pressure viable. At 5:00 that evening, as they were preparing to code him again, we made the heartbreaking decision to stop all resuscitative measures. He was pronounced dead at 5:15. Cause of death was an anoxic brain injury.
In the weeks and months to follow our lives were in turmoil. My mother was stricken with grief and could no longer work and had to retire early. I had to leave my co-workers and friends that I had worked with for over 10 years. His mother became ill and no longer had the will to keep living, for she had lost her only child. He didn't get to see his oldest grandson graduate from high school. Even now after 5 years, there is a huge void in our lives.
In reviewing my dad's medical records, I learned the nurse who had been taking care of him on the night of the 5th had not checked on him since 11 pm. There were also pertinent morphine administration records "missing" from his chart. Her documentation showed that she precharted on him; in fact you can tell clearly where she changed her time; she wrote "0500 resting quietly, NAD [no acute distress], respiration even; 600 resting quietly, NAD". Then, "report given to the next shift"; but, in reality at that time, they were transferring him to another facility because he had coded.
Although I could criticize that nurse and all of the attending nurses for not being attentive enough, patients deserve better. It is not as though we don't have the technology to monitor for blood oxygenation, because we do with a pulse oximeter. Moreover, we do indeed have the ability to monitor for the adequacy of ventilation with capnography.
Now, I understand that technology will advance -- monitoring devices will improve, as they should. However, let's use what we have. Let's create an electronic safety net around our patients. Let's give those nurses down at the end of the hall a fighting chance to know when the patient furthest away from them is going into opioid-induced respiratory depression. Let's give nurses the comfort of knowing their patients are being continuously electronically monitored, so they can attend to other patients also needing their help. As a nurse, I have witnessed how continuous electronic monitoring can save patients' lives.
As Juliana Morath, RN, MS (chief quality and safety officer, Vanderbilt University Medical Center) says:
"Human vigilance is required but insufficient, continuous electronic monitoring needs to be there to support and back up nurses, and allow them to visit a patient while monitors are continuously assessing other patients for various physiological parameters (such as, oxygenation with pulse oximeter and adequacy of ventilation with capnography)."
My family lives each day with the horrors of the exclusion of electronic monitoring in postoperative patients receiving opiates. I truly believe that if my dad had been continuously electronically monitored he would still be here today. I am proud to say that I now work at a hospital that continuously electronically monitors our postoperative patients.
Nurses are not strangers to bullying - unfortunately. And new research points out bullying by nurses outnumbers what occurs in other professions. In fact, twice as many nurses as other working Americans have experienced bullying in the workplace.
According to a recent study in the Journal of Nursing Management, among 612 staff nurses, 67.5% had experienced bullying from their supervisors, while 77.6% had been bullied by their co-workers. Outside the healthcare industry, just 35% of Americans had reported workplace incivility, revealed a recent survey by the Workplace Bullying Institute.
So what is it about nursing that causes these trends? Is it the mixture of young nurses versus older nurses, or the stressful situations nurses face? But even more important than identifying the reasons should be finding the solutions.
ADVANCE covers bullying on a fairly regular basis, offering materials that can help solve this problem in the nursing profession. Recently, we ran a story on how social media provides new outlets for nurses to address horizontal violence and support each other. You can read more about this new wave of support at www.advanceweb.com/Nurses, keyword search "Facing Bullies in Nursing."
You also can view a webinar on combating workplace bullying that covers how addressing this common workplace problem is good for employees and patient outcomes too. You can find it archived at www.advanceweb.com/NurseWebinars.
And a recent CE article, "Motivating Co-Workers," may provide solutions for how nurses can all get along. Earn 1 CE credit - for free! - at www.advanceweb.com/NurseCE.
As bullying persists in the profession, it's important that everyone try to find ways to end the trend. Take the time to review these resources and address the issue at your workplace.
I live close to Philadelphia. It's a great city full of parks, theater, music and museums. If you are ever in the area for a conference, it's worth extending your stay. As a local, it's fun to do the "touristy" things, but since I can do this regularly I don't have to see the Barnes or the Art Museum because I don't know when I'll be back again, so I can do the lesser-known exhibits, like the Mütter Museum, or, one I discovered this past weekend, the National Liberty Museum.
Like liberty itself, the museum's mission is "dedicated to preserving freedom and democracy by fostering good character and understanding for all people through education." The museum offers an intense view of people who have suffered loss of liberty and those who have fought to protect or regain other people's liberty as well as their own. It addresses everything from religious persecution to honoring those who lost their lives in 9/11 to those impacted by physical or mental challenges.
The stories and messages are complemented by glass artwork including several pieces by Chihuly. And, of course, there is a children's area to teach our youth about civility and protecting and respecting each other.
As I walked through this section of the exhibit I thought: nurses should have to visit this museum as part of their licensure renewal. Each time we post an article about nurse bullying, horizontal violence or professional intimidation, we get comments for days from nurses who experience this. Bullying is rampant in nursing.
Liberty is the state of being free within society [or workplace] from oppressive restrictions [or meanness] imposed by authority [or co-worker] on one's ways of life [or work life]. I wonder if we called it oppression, or pointed out that liberties are at risk, rather than labeling it bullying, nurses would think twice about their actions and words.
To help kids understand liberty and civility there were a few exercises I thought could be used on a nursing unit. Visitors are invited to write down harmful names they have been called or have called others then put the list into a shredder to symbolically erase the harmful names from having an impact on them. There was also a forgiveness bridge, where you think about someone you are holding a grudge against or just don't like; or someone who has been unkind to you. When you cross the bridge, you leave the ill-feelings behind and move forward.
Finally there are mirrors and you see your own reflection multiple times and are reminded that this one person you are seeing can make a difference. Guidelines to achieve this are presented. Maybe these guidelines should be posted in nursing units. They are reprinted here with permission of the museum:
10 Ways to Resolve Conflicts
- Listen more. Talk less. It helps you understand the other person's point of view.
- Ask when you want something. Making demands only makes things worse.
- Focus on the problem, not the person. It's the only way to solve a disagreement.
- Always deal with the problem at hand. Never bring up old issues or resentments.
- Take responsibility for your part in conflicts. Your view may not be completely right either.
- Express your feelings without blaming the other person. Blame never solves anything.
- Always talk things out. Never use physical force to express your anger.
- Choose your words carefully. Once a word is spoken it cannot be taken back.
- Look for a solution that is agreeable to both parties. If one person isn't satisfied, the problem isn't solved.
- Step back and put the problem into perspective. A problem you have today may not seem so bad tomorrow.
P.S. If you visit Philly, skip the cheese steak; there are so many better food options in this city.
The American Academy of Pediatrics (AAP) recently released a policy statement, published in the May issue of the journal Pediatrics, that offers guidelines for planned home births.
The AAP outlines a number of recommendations, including:
- There should be at least one person present at the delivery whose primary responsibility is the care of the newborn infant and who has the appropriate training, skills and equipment to perform a full resuscitation of the infant.
- All medical equipment, and the telephone, should be tested before the delivery, and the weather should be monitored.
- A previous arrangement needs to be made with a medical facility to ensure a safe and timely transport in the event of an emergency.
While the majority of the guidelines are straightforward, there is one aspect of the AAP's policy statement that has caused controversy among midwives.
According to the AAP, "pediatricians should advise parents who are planning a home birth that AAP and American College of Obstetricians and Gynecologists recommend only midwives who are certified by the American Midwifery Certification Board."
This recommendation, reported TIME, "has upset certified professional midwives, who deliver the majority of babies born at home in this country but are accredited by a different body - the North American Registry of Midwives (NARM)."
Kristi Watterberg, MD, lead author of the AAP's home birth guidelines told TIME that "the AAP is simply echoing a similar recommendation from the American College of Obstetricians and Gynecologists regarding which midwives should attend home births.
Do you support the AAP's guidelines? What would you recommend to your patients?