HEADLINES
Nursing2017 covers the latest news in nursing and healthcare. See what's making headlines this month!

Tuesday, July 11, 2017

Guest editor: Tina Keeler, MSN, RN, Western Michigan University, Bronson School of Nursing in Kalamazoo, Mich.

Not so long ago, healthcare was primarily rendered in the home. Mothers and midwives attended the sick, and physicians were only called for emergencies. People came to hospitals with life-threatening illnesses, but the rest was taken care of at the kitchen sink.

As modern medicine advanced, hospitals began to emerge as a place of health and care instead of death and dying. Today, people seek out hospitals for a multitude of reasons: to celebrate a birth, to grieve a death, to replace a joint, to fix a gut, to repair damage done, or to prevent future injury.

Patients will have some sort of an experience when they come to the hospital. The question we need to ask ourselves is: What can we do to ensure their experience is a positive one?

Patient experiences are based on interactions with nurses and other staff that patients encounter while in the hospital. For example, Betty came to the ED with abdominal pain and is now having blood drawn. The nurse gives the scripted greeting, but is mechanical and minimally interactive. Even though the nurse has a professional manner and flawless technique, Betty perceives the experience as negative. Why? Her perception was that the nurse's demeanor was cold and uncaring. In reality, the nurse was focused on trying to follow protocol and not break sterile technique or contaminate the specimen. Although the service rendered was adequate, it didn't exceed the patient's expectations. What could the nurse have done better to create a positive patient experience?

First impressions are key, so smile and make a connection. Try starting a friendly conversation: "Oh, I see your name is Betty. My mother's name is Betty. She was named after her favorite aunt. Does yours have a special meaning?" While preparing to draw the blood specimen, the patient is probably secretly sizing up the nurse, who appears young. "Have you done this before?" the patient nervously asks. The nurse smiles once again and explains that she's done this many times before. She then compliments the patient on her lovely veins. "I wish more of my patients had vessels like yours. That would surely make my job easier," she says. The patient nervously adds, "But I've been told my veins roll and I'm a difficult stick." Once again, the nurse smiles and says, "Oh, then I have a special way to hold your arm to help prevent that from happening." Then she demonstrates the technique. The patient is put at ease and her experience is markedly better.

We, as nurses, need to expand the dialogue on patient experiences beyond rendering excellent clinical care. How can we engage patients and families to build positive healthcare experiences? By focusing on creating connections, starting with a smile!   


Wednesday, June 7, 2017

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Guest editor Susan Newman, MSN, RN, PCCN, is a clinical nurse at St. Elizabeth Healthcare in Edgewood, Ky.

"Heather, I'm so glad you're back today! Bill was trying to get out of bed when I got here, and he nearly fell going to the bathroom. He doesn't remember why he's here."

Scenes like this are common with older adult patients, who may become confused at night when hospitalized. Having an established relationship with the patient and his or her family allows the nurse to quickly provide reassurance, review possible causes, and act as indicated. The human connection is central to the nurse-patient relationship and a core value of the nursing profession. Each person involved contributes unique qualities to this relationship and, to some extent, is changed by the human interaction. The nurse's concern for the patient's well-being as an individual, rather than as a job-related means to an end, reflects this professional commitment. Nursing practice models, which promote nursing continuity of care, value this connection.

In the acute care setting, patients often see multiple caregivers from many different disciplines over the course of even 1 day. Both patients and nurses benefit from staffing patterns that promote continuity of care. A nurse who's familiar with the patient's unique health situation, preferences, and progress lessens anxiety and promotes trust. Because stress can produce unhealthy hormonal responses, this human connection can foster healing. For the nurse, continuity provides the opportunity to assess improvement and adjust interventions in response to the patient's changing status.

As economics have become the driving force of healthcare today, pressure mounts to manage costs associated with nursing in all possible ways. One strategy that's been put forth involves much greater reliance on dedicated contingency staffing, or float pools. At a national nursing conference, a presenter endorsed the value of an RN staffing pattern consisting of only 60% core nurses assigned to each unit as regular staff members.1 A large float pool consisting primarily of new graduate nurses, would provide 40% of the nursing care to patients under this staffing model.

Employing float pool RNs as an increasing proportion of the overall workforce increases the possibility that nurse-patient relationships will be based only on a brief encounter (12, 8, or even 4 hours). In such a setting, nurses expend more time familiarizing themselves with the patient's medical problems and the tasks to be completed during the assigned time interval. Nurses have little opportunity to recognize and build on progress or to detect subtle changes needing early intervention. Patient education also falters in float pool settings.

Because of the unpredictable and variable nature of the workload in hospitals, adjusting nursing resources per patient load is a necessity for many reasons, including safety, nurse satisfaction, and economic factors. But historically, measuring nursing cost and the impact of nursing care on patient outcomes has been a struggle, and this remains true today.  

Nursing researchers are developing sophisticated techniques to collect and analyze data contained in electronic medical records to develop tangible measures of the impact of nursing continuity.2 Evidence-based staffing will be key to linking individual patients and nurses.3 Patient satisfaction scores also affect the financial success of healthcare institutions, and nursing care that recognizes the individual patient is key to positive values. As professionals, we nurses must clearly articulate the value of our profession and support efforts to validate the impact of nursing care.

References

1. Schwedhelm K, Schweikert R. (October 9, 2015). Healthy Work Life Balance: Staffing a Medical Surgical Unit. Lecture presented in American Nurses' Credentialing Center Magnet Conference 2015, Atlanta.

2. Stifter J, Yao Y, Lodhi MK, et al. Nurse continuity and hopsital-acquired pressure ulcers: a comparative analysis using an electronic health record "Big Data" set. Nurs Res. 2015;64(5):361-371.

3. Birmingham SE. Evidence-based staffing: the next step. Nurse Leader 2010;8(3):24-26, 35.​


Wednesday, April 26, 2017

Sickle cell disease

This month's feature Sickle cell disease: Where are we now? offers an update on this group of inherited red blood cell disorders. Several advances have been made over the past two decades enabling new levels of success in managing this disease through evidence-based screening and treatment guidelines. The article covers signs and symptoms, complications, and current treatment options, all crucial knowledge for nurses to help patients maintain an optimal quality of life.

An article published in The Philadelphia Tribune on April 18, 2017, Inequities in funding and research on sickle cell disease, claims the disease doesn't get the research funding it deserves. According to Health columnist Glenn Ellis, while over 100,000 Americans live with sickle cell disease, it's so far failed to garner the attention generated by some other genetic illnesses; for example, the Ice Bucket Challenge phenomenon benefitting ALS research. Ellis notes that many patients with sickle cell disease are undertreated and labeled as drug seekers due to their chronic pain. 

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According to an April 3, 2017, article on KSNT.com, some patients with sickle cell disease can hope for a cure through bone marrow transplants. In Kansas, a patient with sickle cell disease underwent a bone marrow transplant to treat her disease and relieve her chronic pain. This was the first such procedure performed in that state to treat sickle cell disease. One year after surgery, she's experienced no complications and still hasn't been readmitted to the hospital.

Remember to check in next month to see what's making headlines in May!



Friday, March 24, 2017

Human trafficking prevention efforts

Nurses have a special opportunity to care for those in our community who need help most. Through their professional roles, nurses can help put an end to the horrors of human trafficking.  

In this month's feature Victims of human trafficking: Hiding in plain sight, authors Melissa Byrne, Bridget Parsh, and Courtney Ghilain discuss how nurses can learn to recognize the signs of human trafficking, ask the right questions, and take action to help victims of this modern-day form of slavery. The authors point out that nurses have a legal obligation to report child victims of abuse. Any suspected human trafficking should be reported to the National Human Trafficking Resource Center. 



According to a March 21 
article from NBC News, a human trafficking survivor and activist has teamed up with New York State Assemblywoman Amy Paulin on a bill that would require every New York hotel to post a sign in its lobby containing the National Human Trafficking Resource Center hotline number as well as train hotel staff on how to identify victims. Learn more about this legislation here

 

Caring for our veterans

Nurses also have the privilege of providing care to those who once served our country.

The March feature Healing our heroes: Why I became a VA hospital nurse relates the passion that VA hospital nurse Robert N. McManus, a U.S. Air Force veteran, feels about his career. McManus writes that he has a unique "opportunity to give back to the brave men and women with whom I share life-changing experiences."

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March 20 article from Military.com explores how the Veterans Affairs Department is striving to deliver higher-quality care for veterans in rural regions through telemedicine. This could be a more effective way to treat patients with chronic conditions, such as HIV, who otherwise have limited access to specialized healthcare.

Remember to check in next month to see what's making headlines in April!

 

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Thursday, February 16, 2017

Love is in the air

February, the month of Valentine's Day and now newly declared American Heart Month, inevitably inspires talk of relationships, love, and heart health awareness. While one of our February CE features focuses on a cardiovascular clinical topic (check out When cardiac tamponade puts the pressure on), this month's Legal Matters warns against the potential danger of an office relationship.

In Beware the perils of an office romance, Kristopher T. Starr explains that an office romance in the clinical setting can have serious negative implications that sometimes trigger legal action, including perceived favoritism, nepotism, preferential treatment, power inequities, and corporate liability.​

The USA Today article Finding love on the job can mean keeping a secret echoes this sentiment. The article reports that while 41% of workers have dated a colleague, only 30% of those relationships ended in marriage. Most office romances end less than happily ever after and sometimes even yield legal entanglements. To prevent these situations from arising, the percentage of workplaces with rules around office relationships has grown from 25% in 2005 to 42% in 2013.  

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