AACN President Christine S. Schulman, MS, RN, CNS, CCRN-K, a critical care and trauma clinical nurse specialist at Legacy Health in Portland, Oregon, says the theme also serves as a reminder to stay connected with one’s own principles and beliefs.
"When nurses are 'Guided by Why,' we reaffirm our core purpose and have a guiding beacon for what we can—what we must—do to ensure that every patient gets the excellent care they deserve. And that every nurse has the tools and the skills they need to provide that care," she says in a news release.
In addition to being guided by the question "why," nurses can benefit from pondering other questions, such as: What problem am I seeing? When am I seeing it? Who has a solution? Where can I find more information? And how is the problem being solved?
Following are three snapshots of NTI sessions that may hold answers to those questions as nurses seek solutions to nursing challenges. Additional HealthLeaders Media resources are included after the session descriptions for further study.
Telehealth could have significant influence on how and where healthcare is delivered, connecting providers and patients separated by geography.
Clinical areas such as critical care, pediatrics, emergency medicine, neurosurgery, behavioral health, and genetic counseling can all be supported by remote telehealth teams. The session described one organization's development of telehealth services and its integration into the EMR.
More on the topic of telehealth nursing can be found in the HealthLeaders Media article Critical-Care Group Updates TeleICU Standards,which provides an overview of the AACN's newly issued update to its teleICU nursing standards.
Preceptors are key players in successfully onboarding new staff to a nursing unit. A well-prepared preceptor can foster engagement, clinical knowledge, and professionalism. But strong interpersonal skills are needed to facilitate a fruitful preceptor-mentee relationship.
Fortunately, these skills can be learned.
The session highlighted insights into the development of an evidence-based preceptor program curriculum for preparing preceptors for their roles. It also offered a variety of continuous, quarterly development training topics to support ongoing skill development as well as retain skilled preceptors.
The Preceptor Program Builder by Diana Swihart, PhD, DMin, MSN, APN-CS, RN-BCandSolimar Figueroa, MHA, MSN, BSN, RNis one resource for creating a successful preceptor program. Published by HealthLeaders Media's sister divisionHCPro, the package includes core tools, best practices, processes, adaptable forms, and training materials for developing and evaluating preceptors, information for preparing preceptors for certification through portfolio-building, and a tested framework for preceptor programs.
Moral distress is a reality for nurses of all specialties. It can undermine integrity, lead to burnout, and jeopardize patient care. According to the presenters, nurses must develop skills in mindfulness, ethical competence, and moral resilience to address these issues.
A framework for restoring integrity by cultivating moral resilience includes: self-regulation; mindfulness; moral sensitivity, discernment and action; targeted communication skills; and personal accountability.
Rushton has shared her insights on moral distress and resilience with HealthLeaders Media in the past. She has discussed the need for healthcare leaders to create cultures that support ethical practice environments and establish mechanisms for others to speak up about practices that are challenging their sense of integrity without fear of retaliation.
In the cover story Beating Clinician Burnout, she suggests, "…leaders have to really take stock of the organizational processes, policies, and structures that are contributing to burnout and to allocate resources to support diverse strategies for clinician well-being, recognizing that one size doesn't fit all."
Bartels' concept of "The Pause," where care teams take about a minute after a patient's death to stop and honor the life that has left them, has garnered national and international interest.
"As an [emergency department] nurse, Jonathan created The Pause to help deal with his own feelings and help his colleagues after the death of a patient. That moment of reflection and compassion has grown into a movement that has profoundly impacted caregivers around the world," says AACN board president Christine S. Schulman, MS, RN, CNS, CCRN-K, in a news release.
Pause and Connect
The practice, Bartels says, gives healthcare providers permission to stop and honor loss, and it's a movement away from what he describes as "the industrialized/scientific/professional detachment" that healthcare practitioners have been trained in.
In short, it reconnects patients, family members, and providers with the essence of healthcare: humanity.
The ground for The Pause was laid around 2010, after Bartels attended a retreat that focused on developing resilience. Participants were challenged to go back to their healthcare facilities and create changes. At the time, Bartels was working in the emergency department, and he noticed how staff handled an unsuccessful resuscitation.
"During one of our intense resuscitations, I had noted that when we were done, we kind of just walked away from the situation," he says. "I realized that we had lost a ritual of honoring, so I knew that's where I could possibly [have] influence."
After losing a patient, Bartels took inspiration from the actions of a hospital chaplain who once requested the care team stop and pray after an unsuccessful resuscitation. "I emulated what a chaplain had done, but instead of offering a Judeo-Christian prayer, I asked that the room stop and honor the patient in humanistic language."
His example of such language: "Could we stop and honor this patient who was alive prior to coming in here, who was loved by others, who loved others, who had a life—and also take the moment to honor all the efforts we put into caring for the patient? I ask that we hold the space, to honor this patient in your own way and in silence." This allows staff to own the practice and honor a patient's last rite of passage when a chaplain is not available, he says.
The response to Bartels' action was positive. "People who were not necessarily religious per se came up to me and said, 'You gave me space to do this, and I thank you for that,' " he recalls. "It opened the door for others to imitate it, and others started to practice it. That's really how it took off—it was just people seeing it done once and then being empowered to do it themselves."
A Movement of Stillness
Thus, The Pause was born. It began to spread beyond the ED into UVA's other care areas. Trauma surgeons and anesthesiologists requested care teams to take part. It has spread to other healthcare facilities and settings, both nationally and internationally, as well.
"Other institutions have formalized it. Cleveland Clinic is now using it across the board," Bartels says. "It's being done for organ transplants in South Africa. When patients are donating, they do it for the donor and they do it for the recipients. In hospices, they're doing it, and they're also doing it out in the field for EMS care providers."
He adds that the University of Virginia's school of nursing is working on a preliminary national/international study to look at both the spread of The Pause and how different areas/cultures define it.
Anecdotally, those who take part in the ritual have had favorable experiences. "The results of that have been mostly qualitative reporting. 'This made me feel better; it felt right; it helped the family to see us do the practice,' " he says. "EMS [staff] and healthcare providers tell me [The Pause] shows that you really care. It's not just enough to try and save a life; it's that extra demonstrative of compassion."
As direct care providers, nurses are in a prime position to identify areas that need improving and, like Bartels, come up with solutions.
"Nurses are not only implementing the instructions and the guidance of the physicians; they are the eyes and ears of healthcare. They provide a huge portion of the direct hands-on care 24/7, and that affects outcomes," he says. "The way I see nursing really influencing is in helping to look at what outcomes are being worked [toward] for our patients. It's not just healing the disease, it's healing the whole patient. It's not just stating, 'I'm offering compassionate care'; it's actually giving compassionate care."
Bartels encourages executives to look to those nurses who are "informal leaders" to facilitate change.
"Leaders are not just the leaders who are identified by the institutions," he says. "These are leaders who are identified by their peers. Use them as change agents."
The American Association of Critical-Care Nurses' consensus statement reflects current evidence and best practices in TeleICU nursing.
Telehealth is a growing segment in the healthcare industry, thus providing nurses with new settings and opportunities in which to practice. The American Association of Critical-Care Nurses recognized the need for guidance in this area and issued the first authoritative document to define practice guidelines specifically for the emerging telenursing practice in critical care in 2013
Telehealth continues to evolve and so must nursing practice standards.
The AACN recognizes the fluidity of telehealth practices and, this month, issued an updateto its teleICU nursing standards.
Offers specific recommendations for the development, growth, and enhancement of teleICU programs.
Defines and identifies the essential elements of teleICU nursing practice for organizations, leaders, and nurses
Delineates the essential collaboration and partnerships necessary to successfully integrate teleICU nurses as valued members of the healthcare team
Updates a framework for implementing, evaluating, and improving teleICU nursing practice
Reestablishes a model of success for realizing optimal patient care and outcomes
Provides real-life scenarios for providing a continuity of care, identifying high risk patients, and decreasing mortality rates
Telehealth Model for Excellence
The consensus statement reflects current evidence, best practice, and the expert opinions of AACN’s 13-person TeleICU Task Force. The document also includes clinical scenarios with examples of how clinicians implemented each key recommendation in various environments.
“The level of technology acceptance has created opportunities to apply the teleICU model from rural to urban areas and from land to sea,” says task force co-chair Theresa Davis, PhD, RN, NE-BC, CHTP, clinical operations director for Inova Telemedicine enVision eICU in a news release. “The ability to leverage clinical expertise across miles in an efficient way is valuable in both critical situations and routine care delivery.”
In addition to creating a framework for implementing and evaluating teleICU nursing practice, the statement introduces a model for achieving excellence and optimal patient care and outcomes through:
To recruit optimal candidates and make the job application process more efficient, Children's Mercy launched a reverse recruitment initiative that has yielded positive results.
As strange as it sounds, healthcare recruiters have a lot in common with fishermen. They're always after that perfect catch, and "the one that got away" weighs heavy on their minds.
"I often get asked, 'What keeps you up at night?' and what I always used to say was that the person I need tomorrow came to my website today," says Molly Weaver, director of talent acquisition for Kansas City, Missouri–based Children's Mercy.
For example, a neurology nurse practitioner might have visited the Children's Mercy website only to leave after not seeing any job openings. It's possible that an opening might appear at a later date, Weaver points out.
However, Weaver would have no way of knowing that a potential candidate had visited the site, and so she would have no way of following up with the person once the position became available.
"I think too often, [as a job seeker] you don't see what you want and you move on, and I never knew you were there," she says.
So Weaver and her team reviewed their recruitment tools and decided to use a reverse recruiting method to better match candidates with hospital positions.
To address the fact that talented applicants were potentially slipping away, they created Introduce Yourself, an innovative, video employment application process that Weaver says, "reverses the job search."
The group's creative thinking has paid off: The program has helped match candidates with open positions, and it's made the hiring process more efficient. Here's how Children's Mercy found success.
Step 1: Address recruitment problems
In addition to not knowing what candidates had been on the site, Weaver says there were a few other issues that spurred the creation of Introduce Yourself.
"I had around a 40% drop-out rate of people starting our application and not finishing it," she says. "I can't afford to let 40% of my candidate flow just keep leaving."
Weaver attributes this to the lengthy job application. "It's long and painful and it asks for way too much information. We need your Social Security number, we need all sorts of other things, because eventually we need to run a background check. But I don't need that up front," she says. "Yet I didn't have a way, like a phased application, where I just get the basics up front and ask for more later."
Weaver also suspected that because of "jargony" job titles such as "patient access representative"—a person who checks in patients—candidates did not realize which positions they were qualified for.
"[Recruiters] know what's the right fit, and yet we expect our candidates to blindly figure that out on their own. [Candidates] don't know the organization, and they don't know what these jobs really are based on our job descriptions," she says.
Step 2: Simplify your application process
In October 2015, Children's Mercy went live with Introduce Yourself. At the top of the organization's Careers webpage is a section where candidates can select one of three options:
> Clinical
> Non-clinical
> Rehire
After clicking on the appropriate link, candidates are taken to a landing page where they create an account and upload their resume. They are then asked two simple questions:
1. Tell us about your background.
2. Tell us what you'd like to do for Children's Mercy.
Candidates record a brief video answering these questions. And that's it.
Each day, two recruiters (Children's has 10 on staff) cull through the video submissions and forward each submission to the recruiter with a position suitable for that particular candidate. For example, if a nurse submits a video, it will be sent to the nurse recruiter. Someone interested in working in the cafeteria will be passed on to the recruiter hiring for food services.
Weaver says candidates usually hear back from a recruiter within one to two days and are told one of the following responses: "'Here's a job we think you're a great fit for; apply for this job today;' or 'Can we keep you in mind and call you when we do have something?'" she says.
On rare occasions, the response is "no" in cases where candidates do not have the correct experience or background for a position at Children's Mercy. "That doesn't happen very much in a hospital system the size of ours, but every once in a while we'll get something that we just don't ever hire for," Weaver says.
Candidates then either go through a second video interview or are connected directly with a hiring manager for an on-site interview.
"That's way different than throwing your [resume] into the black hole of applicant tracking systems," says Weaver. "Applicants know that [recruiters] are going to be looking for it."
Step 3: Match candidates with the right job
Introduce Yourself is not just a video interview process; it's a way for recruiters—who know what jobs are opening—to match a candidate's skills and personality to a specific position.
"In my mind, what Introduce Yourself does is it gets the talent to the right opportunity instead of making them figure it out on their own," says Weaver.
"Sometimes they don't apply to the right job," she explains.
In fact, the first hire made through the Introduce Yourself program had previously applied to work at Children's Mercy multiple times, but not for the position she eventually secured.
"She never once applied for an access rep, but when she did Introduce Yourself, she said, 'I really want to be the person that checks people in,' "Weaver says. "She has a beautiful smile and really warm personality, and the minute we saw her video we said, 'She's an access rep.' She was hired in two weeks."
Two promotions later, that employee is now back in school to become a nurse.
"It's about seeing the person instead of the paper," Weaver says of the program. "I really believe that that's been a big shift in the way our recruiters talk. Now it's always about, 'Hey, did you see so-and-so's video today? We've got to find a place for her or him in the organization. Does anybody have anything for him?' It has kind of reversed our thinking, if you will."
Results
Annually, Children's Mercy hires about 1,600 employees. The traditional application process is still available and in use, but Weaver says about 10% of hires go through the Introduce Yourself program. That translates to about 10–15 employees a month.
In February 2017, 16 employees were hired through the program.
"Some of those people completed their video interviewing six months ago. One was a year ago. So sometimes it's not an immediate fix for the candidate," she says. "But they're getting communication [that applies] specifically to them. It's not just, 'We got your application,' it's, 'Here's where we think you fit.' "
Weaver notes that, though she's not sure why, employees hired through Introduce Yourself are more diverse than those hired through the traditional method.
"It's been running about 20% higher in the diversity rank than my general hires," she says. "I would be loath to say I knew the explanation other than to say it's about the person and you get to see them and their personality. It's not about what they show up as on paper."
Weaver says the program has also been successful in helping recruiters match candidates with tough-to-fill positions.
"We have filled some hard-to-fill stuff with people that we would have probably never known were on our website because they would have left and gone somewhere else," she says.
Additionally, time to fill positions is usually shortened with Introduce Yourself.
"They tend to go through the process faster because we've already seen them and heard them," Weaver says, "and we send those Introduce Yourself videos out to our hiring
managers."
After one hour of overtime, nurse to nurse collaboration drops from the 50th percentile to the 30th percentile.
Though common, working overtime may negatively influence nurses’ collaboration with their colleagues, finds anew study by researchers at NYU Rory Meyers College of Nursing.
“Our research suggests that the more overtime hours nurses work, resulting in extended periods of wakefulness, the greater difficulty they have in collaborating effectively,”Amy Witkoski Stimpfel, PhD, RN, assistant professor at NYU Meyers and the study’s coauthor, says in a news release.
Nurses often work long, irregular hours and unexpected overtime which puts them at risk for fatigue and sleep deprivation and can lead to impaired emotional, social, and cognitive processing. This, in turn, may hurt nurses’ ability to collaborate.
The study, published in the Journal of Nursing Administration, assessed how shift length and overtime impact nurses’ perceptions of collaboration with other care providers, specifically with other nurses and physicians.
Across the five types of nursing units measured, the average shift length was 11.88 hours
12-hour shifts appear to be are the predominant shift schedule for hospital nurses
Nurses worked, on average, 24 minutes longer than their scheduled shift.
33% of the nurses on a unit reported working longer than initially scheduled
35% percent of nurses said that the amount of overtime needed from nurses on their unit increased over the past year
“One in three nurses reported working longer than scheduled. This appears to be a chronic problem for nurses – one that extends an already long work day and appears to interfere with collaboration,” says the study’s lead author Chenjuan Ma, PhD, assistant professor at NYU Meyers.
Interestingly, the researchers did not find a significant relationship between average shift length and collaboration meaning longer scheduled shifts did not necessarily lead to less collaboration. However, collaboration appeared to suffer in nursing units with longer overtime shifts and more nurses working overtime.
Collaboration on a unit was measured using the nurse-nurse interaction scale (RN-RN Scale) and nurse-physician interaction scale (RN-MD Scale).
One hour of overtime was associated with a 0.17 decrease on the RN-RN scale and was marginally associated with a 0.13 decrease on the RN-MD Scale. In other words, a 0.17 decrease from the mean score on the RN-RN scale suggests that a unit’s rank on the RN-RN score would drop from the 50th percentile to roughly the 30th percentile.
Advice for nurse leaders
The researchers advise that nurses, nurse managers, and hospital administrators use overtime as infrequently as possible. While they recognize longer shifts are the norm and eliminating overtime may not be possible, they do suggest offering fatigue management training and education, as well as training to help nurses and physicians communicate effectively and respectfully.
“Our findings support policies that limit the amount of overtime worked by nurses. In practice, nurse managers should monitor the amount of overtime being worked on their unit and minimize the use of overtime,” Ma said.
Collaboration among healthcare professionals is critical for quality care and patient safety. Previous studies have shown that patients receive superior care and have better outcomes in hospitals where nurses collaborate well with other healthcare providers. In fact, a study published May 2 in the International Journal of Nursing Studies by Ma and her colleagues finds that both collaboration between nurses and physicians and collaboration among nurses are significantly associated with patient safety outcomes.
Florence Nightingale may be nursing's most famous caregiver, but don't overlook the way today's nurse leaders are influencing change in healthcare.
If you had to name a famous nurse, who would it be? Florence Nightingale, of course. Nightingale's invaluable work saving lives and laying the foundation of the nursing profession has captured the hearts and minds of both nurses and the general public. Even though she was born almost two centuries ago, the founder of nursing remains the face of nursing.
However, I often wonder if focusing on the past causes us to overlook the current ways nurses are shaping the nursing profession and leading changes in healthcare.
So this National Nurses Week, which culminates on May 12—Nightingale's birthday—I encourage you to keep the following saying in mind, "You don't know where you're going until you know where you've been," and take some time to reflect on the contributions of nurses both past and present.
The following are highlights from Nightingale's biography by the Florence Nightingale Museum paired with HealthLeaders Media stories featuring the work of modern-day nurses. Nurse leaders have built upon the foundations laid by the 'Lady with the Lamp' to drive the profession, patient care, and healthcare delivery forward.
Happy Nurses Week!
Problem solvers
When Nightingale arrived in Scutari, Turkey to provide care to soldiers injured in the Crimean War, she found unsanitary conditions and a lack of medical supplies at the military hospitals. She took steps to improve the conditions and cleanliness of the hospital environment.
Nurses can still be counted on to improve quality and outcomes, enhance an organization's culture, and build relationships with patients, colleagues, and the community. In the March/April HealthLeaders magazine cover story, Your Nurses Can Fix the Hospital, three nurse leaders share their thoughts on how nurses can influence change in healthcare and be drivers of innovation.
Advocates for change
After the war, Nightingale became an advocate for improving Britain's civil hospitals, communicating the need for reform by using statistics to show that more men had died from infections than from their injuries. According to her biography, Nightingale wrote some 13,000 letters as part of her campaigns, and corresponded with Queen Victoria for over thirty years.
"One of the conclusions that I've made in the last several years is—I don't say this in a negative way—but we often put forward the excuse that 'I'm too busy to get involved in policy work or advocacy because I'm always busy taking care of patients,' " Cipriano says. "To me, if we really believe it's important for nurses to influence the changes in healthcare, we need to find a way to support each other and to get the people on the front lines in front of the policymakers and in front of decision-makers in our organizations."
Educating nurses
Another of Nightingale's achievements was establishing the first professional training school for nurses, the Nightingale Training School. Education of nurses is still a hot topic.
Research, particularly that by Linda H. Aiken, PhD, FAAN, FRCN, of the University of Pennsylvania School of Nursing, has shown that having more nurses with bachelor's degrees improves patient outcomes.
While new research by Chenjuan Ma, PhD, associate professor at NYU Rory Meyers College of Nursing, has found that this goal will not likely be reached within the next two years, there has been an increase in BSN-prepared frontline nurses in U.S. hospitals—57% in 2013 compared to 44% in 2004.
"From my perspective, I think it's more important to look at how much effort we have put in to increase the number of nurses with baccalaureate degrees or how much progress we have made to increase the number of nurses with baccalaureate degrees," she says.
Additionally, New York State became the first state to pass a law requiring new nurses to earn a bachelor's degree within 10 years of initial licensure.
Hospital planning and organization
Nightingale also had a hand in hospital design, though her Nightingale wards—one large room with multiple beds—is in direct contrast to the current move toward private patient rooms.
Researchers shadowed ICU nurses and intermediate-level medical-surgical nurses and assessed the existing floor plan, used a parametric modeling tool, and created heat maps to provide a graphic representation of what a nurse's 12-hour shift looked like in terms of workflow and walking distances.
"One of the big [revelations] was around our whole process of medication passing," says Deana Sievert, RN, MSN, metro regional chief nursing officer and vice president for patient care services at ProMedica.
The architects used this information to design a unit that would cut down on walking time.
"We were able to take them from a three-mile journey on their shift to 1.5 miles. We cut in half the steps that they were taking," says Alison Avendt, OT, MBA, vice president of operations.
After the tower opens, more research will be done to see how the design is affecting workflow.
"Everybody wants to give the nurse as much time as possible to be with the patient [and] try to take away the things that are not value-added in the nurse's day," Avendt says.
Early-warning score system plus communication protocol prevents patient deterioration
After implementing a new communication bundle, Southern New Hampshire Medical Center saw both a significant decline in unplanned transfers of medical-surgical patients to the intensive care unit and ICU admissions of patients after a rapid response team call, a pilot study reports.
The 189-bed, Magnet-designated community hospital in Nashua, New Hampshire embedded a seven-item modified early-warning score system into the electronic medical record for patients in its four medical-surgical units and its ICU.
The EWS scale ranged from zero to 21.
Scores above four automatically generated a red exclamation point by the patient’s name on the EMR
The exclamation point was visible to the nurse and unit secretary
As part of the communication bundle, the score also triggered an electronic page to an experienced critical care nurse preassigned to respond to rapid response team calls.
After receiving the page, the ICU nurse:
Reviewed the patient’s EMR
Consulted with the patient’s nurse to discuss the score and develop a plan
The EWS also triggered a reassessment of at least one item on the EWS scale by the patient’s nurse. The combination of the consultation and the reassessment may initiate other actions, such as:
Notifying a provider
Administering as-needed medications
Following established protocols for interventions.
“The early-warning score helps identify patients with clinical signs of deterioration, but that information must be quickly communicated to a nurse with an appreciation for the urgency of the situation and the knowledge to take action,” says primary investigator Cheryl Gagne, RN, DNP, CNEA, chief nursing officer at the hospital. “Our communication bundle may have led to earlier and more effective interventions by medical-surgical nurses, facilitated by collaboration with experienced critical care nurses.”
During the study period:
ICU admissions of patients after RRT calls declined significantly
ICU admissions of patients with an EWS greater than four declined significantly
Response time to the EWS alert on the EMR decreased
RRT calls for patients with EWS greater than four declined
This suggests patients with patients with deteriorating conditions were identified early because the bundle prompted intervention before a patient’s score increased.
“Our communication bundle may have led to earlier and more effective interventions by medical-surgical nurses, facilitated by collaboration with experienced critical care nurses,” Gagne says.
Inside was a thank-you card from the health system where she had been hospitalized in March.
"Dear blank," the form letter began. I say "blank" because no one bothered to write my daughter's name in the space where it was supposed to be personalized. The card was symbolic of all that has been wrong with our monthlong healthcare saga.
Our experience had been a string of one frustrating, sometimes infuriating, moment after another. There had been inattention to detail, lack of listening, and poor care coordination (both clinically and administratively).
In his talk, Heath points out that some experiences, or moments, have the power to jolt, elevate, or change a person.
The most memorable, positive portion of an experience is called a peak moment. Take for example, a trip to Disney World. When a person mentally revisits their time there, while there may have been crowds and lines, they are more likely to remember the way their child's face lit up with joy when they met Pluto. That is a peak moment that will be remembered for a lifetime.
"Peak moments matter," he says, "but the problem is we're not trained to build peaks, we're trained to fix problems."
In business, Heath says, research has shown that companies spend about 80% of the time fixing problems, and 20% of the time building peaks. That means for every hour spent on problems, only 15 minutes is spent on building peak experiences. Additionally, for every $1 made fixing a problem, $9 could be made by building a peak.
Four elements of peak moments
So how can nurse leadership build peak moments that will stick with patients for a lifetime and improve a patient's healthcare experience?
Peak moments contain some, or all, of the following four elements, Heath says.
Elevation—This element inspires a highly sensory experience, such as the birth of a new baby. It creates strong emotions such as joy, awe, or deep engagement. For example, at Salinas Valley Memorial Hospital, each time a baby is born the hospital operator plays Brahms' Lullaby over the intercom.
Insight—This element leads to a breakthrough. The breakthrough may not necessarily create moments of delight but can occur when someone has stretched themselves. Nurses are using motivational interviewing to give patients insight into personal motivations for changing behavior to promote health.
Pride—Many hospitals and healthcare organizations engage in meaningful recognition of staff through programs such as The Daisy Award. When nurses take pride in their work and it shows in their care practices, it can enhance patient experience. One study of 269 acute care hospitals found that compassion practices are significantly and positively associated with hospital ratings and a patient's likelihood to recommend.
Connection—This deepens the ties between people or groups and a sense of closeness and validation, and personalization occurs. In healthcare, we often call this patient-centered care. This is exactly why that thank-you card our family received missed the mark; it was generic and impersonal, and came across as insincere.
"If we embrace these elements," says Heath, "we can conjure more moments that matter."
Researchers develop a new tool to better understand the role uncertainty plays in readmissions.
Until now, the reasons why patients return to the emergency department after an initial visit have been anyone’s guess.
“We don’t do a good job of predicting which patients will come back to the emergency department, which means we don’t have a good understanding of why patients are coming back and how we could be assisting them in having a safer transition home from the first emergency department visit,” Kristin Rising, MD, director of acute care transitions and associate professor of emergency medicine at Jeffersonin Philadelphia, says in a news release.
However, through interview-based studies, Rising identified a common theme among these patients—uncertainty.
To better understand, document, and create effective solutions to address uncertainty—whether it be about managing symptoms or a disease process—Rising and a team of Jefferson researchers developed the Uncertainty Scale.
“As a field, we’ve had difficulty finding an approach that consistently works to identify and address individual patient needs. The Uncertainty Scale we developed gives us a tool to help do that,” Rising says.
Reasons for Uncertainty
The researchers took a patient-centered approach and developed the U-Scale based on direct patient input and listening sessions. The team spent two 6-hour days with two groups, each of about 20 patients, who had recently been patients in the ED. The patients brainstormed the types of uncertainty people have when they experience symptoms that may trigger an ED visit. They then worked with the research team to map the ideas into categories.
Some of the categories were:
Concern over treatment quality, which may lead a patient to return in hopes of a second opinion
Concern about lack of a diagnosis, thus leaving a patient with no satisfying explanation for their symptoms
Lack of clarity regarding self-management, such that patients are unsure how to deal with symptoms at home
Lack of self-efficacy, manifesting as patients not knowing where to go for help for certain symptoms
Lack of clarity about the decision to seek care, meaning that patients do not know which symptoms are serious enough to warrant seeing a health professional
Psychosocial factors, including worries that getting medical care might interfere with home and work commitments
General worries and concerns
Improve Provider-Patient Conversations
Rising advocates for training healthcare professionals about patient struggles related to uncertainty. She is working to develop a curriculum to teach physician residents to have more effective discharge conversations with patients when testing has not identified a definitive cause of their symptoms.
“As emergency physicians, we focus primarily on acute care, fixing the most immediate life-threatening problems. Facilitating a safe and effective transition home for patients who do not appear to have a life-threatening problem is also a really critical part of our job that is often overlooked,” Rising says.
The research has changed how Rising delivers news to her patients. She realized what she considers good news – that tests are normal and a patient’s symptoms do not appear to be life threatening – could actually be experienced as bad news from the patient perspective. She now takes time to acknowledge and validate potential patient struggles related to ongoing uncertainty.
“If a patient comes in with a problem and I tell him that testing is normal and I haven’t found a cause of his symptoms, it might give momentary relief, but that patient still is no closer to understanding what is causing his distress. It’s not all good news, and we have to acknowledge that we have not improved patients’ sense of uncertainty about their disease with this news,” she says.
The team of researchers plans to continue to refine and validate the U-Scale, and use it to test interventions to alleviate different categories of uncertainty.
Dwelling on negative feelings caused by daily stressors leads to poorer health decades later.
Stress is a part of life. It can be a useful feeling that spurs productive actions like filing taxes, passing medications on time, or studying for an exam. However, the way individuals cope with stress, varies. While some get bogged down by life’s daily stressors, others are quicker to shake-off stressful events.
Now, new research published in the journal Psychological Science, suggests a person’s ability to recover from stress is important to long-term physical health outcomes.
Scientists from University of California, Irvine,found that people whose negative emotional responses to stress carry over to the next day are more likely to report health problems and physical limitations later in life compared with peers who can, “let it go.”
“Our research shows that negative emotions that linger after even minor, daily stressors have important implications for our long-term physical health,” says UCI psychological scientist Kate Leger a news release.
Get over it
Leger and her colleagues analyzed data from a nationwide survey of more than 1,100 adults. Over eight days, participants answered questions about the number and type of daily stressors they experienced over the past 24 hours.
Stressful events included:
Arguing or almost arguing with someone
Experiencing a stressful event at work, home, or school
Experiencing discrimination based on race, gender, or age
Having something bad happen to someone you’re close to
Experiencing any other bad or stressful events
Each day, they also reported how much of the time over the previous 24 hours they had felt a variety of negative emotions.
Almost a decade later, they answered questions about their physical health including whether they experienced any of 26 different chronic illness in the last year, or if they’d ever experienced heart disease or cancer. They were also asked about their ability perform activities of daily living, such as getting dressed, bathing, walking around, climbing stairs, or carrying groceries. They then rated how much they felt their health interfered with these ADLs.
Participants whose negative feelings continued to the day after a stressful event—on days without a stressful event occurring—had more chronic physical health conditions and limitations in their day-to-day activities 10 years later than those whose emotions were contained to the day of the stressful event.
“This means that health outcomes don’t just reflect how people react to daily stressors, or the number of stressors they are exposed to—there is something unique about how negative they feel the next day that has important consequences for physical health,” Leger explains.
The importance of resilience
These findings highlight the importance of a concept that is gaining traction in among healthcare professionals—resilience—often described as the antidote to burnout.
A 2011 study by nurse researchers at the University of Pennsylvania School of Nursing found that 34% of nurses scored higher than the average for healthcare workers on the Maslach Burnout Inventory emotional exhaustion subscale.
“Stress is common in our everyday lives,” Leger adds. “It happens at work, it happens at school, it happens at home and in our relationships. Our research shows that the strategy to ‘just let it go’ could be beneficial to our long-term physical health.”
Page West, RN, MHA, MPA, senior vice president and chief nursing executive at Dignity Healthis working to help the organization's nurses cultivate resilience.
"If we focus on resilience and figuring out what is that magic piece of work that allows nurses or providers to keep in touch with their heart and soul, then we don't reach the burnout phase," West says. "We need to continue to build processes and time into the work day for the nurses to be able to connect their heart and their mind. To allow them to have some moments for reflective pause that get them through the day rather than just having to do task after task after task."