Happy New Year

 

 

7 qualities define what makes a good nurse

7 qualities define what makes a good nurse | Nurse.com

20 Tips for Nurses in Their First Year of Nursing

Tips for New Nurses 

 

 

15 things every nursing student needs to know

As new students prepare to start their nursing career, I believe the writer makes some really good points you should keep in mind. Nurse Kim

15 Things Every Nursing Student Needs to Know

September 3, 2013 by Brittney Wilson 

When I entered nursing school I knew very few people who were nurses. I questioned everyone that I thought might know anything about nursing on what I needed to know to do well in nursing school. Honestly I was given very little practical advice. But I don’t think it was the fault of the people I asked. I honestly think that many in nursing school struggle to make it through and wipe many of those memories from their brain. But I’m a firm believer that the nursing school experience doesn’t have to be a terrible one. And even though it’s going to be hard, you will be tired, and you’re probably not going to have a great social life, you can make it through nursing school while enjoying the experience (or at least not completely hating it!).
One of my personal goals in nursing has been to help mentor new and emerging nurses to give them the knowledge they need to be successful. I want to share what I’ve learned with you to make nursing school a little more tolerable.
The following represents 15 things that I feel every nursing student needs to know.

1. Nursing is nothing like you think it will be.

Even if your life is filled with nurses and you think you know exactly what you will encounter when you hit the floor you will soon find that you know nothing. I could give you a hundred examples but you won’t get it until you’ve been there. There are so many facets or nursing that you just can’t understand until you have lived it. Don’t feel bad about it just see it as an opportunity grow and learn.

2. You don’t need nearly as many books as is on your syllabus.

Although many may not agree with me on this, in my humble opinion that $1000 in text books per semester is outrageous and unneeded. Most of the information you need will be delivered in class and you might only look at them for a sentence or two. I suggest finding out who your instructors are and asking them if you really need 4 books for the 2 credit class you are taking. If you can’t reduce the amount of books you need to buy then you should partner with a friend and each buy half the books then share. If you’re working together as study buddies then you won’t miss the books that you didn’t purchase. Also, you should buy your nursing textbooks online from somewhere like Amazon. Most of the time you get free 2-day shipping and it’s usually much cheaper than the college bookstore.

3. You probably won’t keep your 4.0

If you’re a perfectionist then you are among your people. Many nurses have type A personalities and strive for their best. This often includes making good grades. But alas, dear nursling, you might not be able to maintain that immaculate 4.0 you’ve had throughout the rest of your college experience. Nursing school is a different brand of difficult and incredibly smart young men and women find it very difficult to maintain the same grade point average they had going in. You might make a B or two. Heck you might even make a few Cs. That’s ok. As you will find out soon enough, what doesn’t kill you will make you stronger. And I haven’t met a nurse yet who was asked for his or her transcripts when applying for a job.

4. Study groups will help you keep your sanity

On the very first day of nursing school our teachers highly recommended that we find people to carpool with and study with. While I didn’t take them up on this suggestion initially I really wish I had. It wasn’t until my second year in nursing school that I found a group of friends to study with and it really was a huge life saver. I would have done so much better the first year if I had just done this in this first place.

5. Every answer is correct. Your job is to know what is “most” correct.

One of the most difficult things for nursing students to grasp is how to answer NCLEX style test questions. What nursing school is really all about is teaching you how to critically think. This means that the answers aren’t always on the surface and you really have to know how to think about the bigger picture to know what answer is correct. In nursing there are many ways you can take care of patients and perform the same task but there are methods that work best. Nursing school is meant to try and teach you this skill. One of the best things you can do for yourself is find yourself an NCLEX strategy guide (I used Saunders Strategies for Test Success: Passing Nursing School and the NCLEX Exam) and study it before you even start nursing school. This will help you retrain your brain to answers the types of questions that will appear on tests in nursing school and the NCLEX and will really give you an edge in school.

6. If it feels like the teachers are trying to weed you out it’s because they are.

Not everyone is cut out to be a nurse. The hoops you jump through to get into and complete nursing school are not put in place simply to amuse your instructors. Nursing schools are ranked based upon their NCLEX pass rates and they only want students to make it through their program if they are sure they will be able to pass the NCLEX and work as a nurse. Think about all the responsibility a nurse has. Do you want just anyone taking care of you or your loved ones?

7. Your definition of busy will change.

Your priorities will shift and you will determine what is really important to you. Because of this you will have a new definition for what it really means to be busy. In the past you might have said you were busy because you didn’t “feel” like going out. Now you’ll actually be busy because you need to study the entire weekend to pass the test that is scheduled on Monday. You’ll regret many events and outings you blew off before because they won’t even be an option any more.

8. If bodily fluids make you queasy nursing isn’t for you.

There’s always at least a few students who make it into nursing school with a deadly fear or blood or an utter revolt for urine and feces. While I can tell you it isn’t all about poop, pee, blood and vomit, I’d be lying if I didn’t say that at least some portion of your nursing school experience will involve these lovely liquids. If you can’t cope with the sight of blood you need to some some serious emersion therapy to get over it now. Your clinical rotation is not the time to come to term with these fears.

9. You will have to give bed baths, wipe butts, and take vital signs.

Someone keeps spreading the rumor to nursing students, especially RN and BSN nursing students, that they won’t have to give bed baths, handle a code brown, take vital signs, and other ‘menial’ task. They’ve been told that nurses aides will take care of this and they will mostly be responsible for ‘paperwork.’ Let me be the first to give you a reality check: you’re gonna do all those things AND do paperwork. You don’t graduate from these responsibilities once you become a nurse. You own them. If you are lucky you might have a nurses aide to help you, but you better appreciate him/her for anything they assist you with. And you should never ask them to do something you have plenty of time to do yourself.

10. Your sense of humor will expand.

While my sense of humor has always been on the dry side, nursing school gave me a new appreciating for quick a wit and the ability to find humor in any situation. Nursing is stressful, emotional, and can be extremely tragic at times. Sometime in your life you will find yourself in the middle of a code situation with several nurses laughing and carrying on a conversation. You will learn that they aren’t doing this to be cruel or disrespectful. Nurses just have to find ways to cope with the tragedy and pain you will experience. Having a good and expanded sense of humor is a great way to do this.

11. Start networking now!

Do you know 10 people who could help you get a job if you were in a pinch? No? Well you need to start working on it. Yes? Well add 10 more.
Finding a job as a new nurse can be very difficult. And while many would have you believe there is a nursing shortage there are many new nurses who go months without securing employment. You need to make sure you have a good network so you can get your foot in the door and get your first nursing job.

12. Your first job probably won’t be your dream job.

I know you’re still in nursing school, but the time will come when you are seeking employment. The ‘exciting’ areas and specialties in nursing are usually very desirable and don’t often take new graduates. You might get lucky and land your dream job, but if you don’t then don’t let it get you down. With just a few few of years of experience under your belt you should be able to transfer into just about any nursing specialty you desire. And if you hate your first nursing job, after a year most will hire you readily.

13. Being a team-player is critical.

If you’re a introvert the time is now to get comfortable working with others. No nurse can operate on an island. You will often need help from your peers. In nursing school you will need help with studying, group projects, and graduating preparation. On the job you will need the help giving baths, answer call lights, and any number of things you may be too busy to tackle that way. Be prepared to give what you expect to get back or else you’re going to have a miserable experience in nursing school and as a nurse.

14. Maintain contact with your non-nursing friends.

The time will come when you are no longer in nursing school and you may or may not maintain contact with your nursing school classmates. If you do, that’s awesome. Even so, you need to be friends with people who aren’t nurses. Not every conversation has to focus on bodily functions or nursing horror stories. It’s nice to have a friend who doesn’t want to talk about nursing because moments with him or her are moments when you can truly escape from being a caregiver.

15. It’s okay to enjoy nursing school.

There are a million and one things that will irritate you and stress you out in nursing school. There are probably also a million and one articles and books about doing well in nursing school. Many of these tend to focus on the ‘work’ related with nursing school. But don’t let the ‘work’ of nursing school ruined the entire experience for you. While nursing school is hard it can also be fun! You gain an education and experience that will mold you into a nurse. You will make memories that you can get nowhere else. As a nursing student you need to make sure you work hard but you also need to play hard. Don’t forget to take time to enjoy this exciting milestone on your nursing journey!

From Medscape.com Definitely worth the read!

Has 'Patient Centeredness' Gone Too Far?

by H. Jack West, MD

"Well, the person I want managing my cancer is me," my patient told me in no uncertain terms.

We were discussing the growing sense, felt mutually, that our therapeutic relationship was not working as we both would have liked. I told her that I felt I had the expertise to manage her case without taking direction from other doctors from whom she had solicited opinions or medical information she found online. That said, I never felt that I was dismissive of her questions or suggestions. She wanted to be in control and for me to write the orders for the lab tests, imaging, and treatment that she decided she needed.

Cases like this embody how the patient-physician relationship has evolved remarkably over the past few decades and even noticeably over the course of ongoing careers for many of us currently in practice. In fact, even the name for this relationship has flipped from the "doctor-patient" relationship we contemplated during my medical school years.

I have long supported the transition away from a paternalistic model of medicine wherein a doctor tells a patient what to do without additional explanation or context, and toward one that welcomes and encourages questions from patients and a thorough discussion of different treatment options. Ideally this leads to shared decision-making, where we mutually arrive at the best course of care based on my presentation of the anticipated benefits and risks of each option and the patient's personal preferences. I am deeply committed to the concept that patients can become sophisticated participants in their own care, so much so that I started an online cancer education nonprofit more than a decade ago that is dedicated to equipping patients with the tools to shape their conversations with their cancer care team.

I think it's a mistake to belittle the efforts of patients who learn what they can online with mugs that say "Don't confuse your Google search with my medical degree." But at the end of the day, only the physician has the license and responsibility to order tests and treatments for a patient, and they should feel that they are the ones with their hands on the steering wheel. I fear that the rallying cry of "patient centeredness" is creating a sentiment in some patients that they are the customer and the customer is always right.

I still believe that patients can become extremely sophisticated, thoughtful participants in their care. But the reality is that when you survey the many information sources that patients may use, some are far more credible than others. The website for the nonprofit I founded, Global Resource for Advancing Cancer Education, discusses current views on the best treatments in the context of appropriate molecular testing, randomized trial results, and the ambiguity of potential alternatives. What patients find in the mass media or online chat groups may occasionally be informed, but more often it features recommendations for supposed "game-changers" or "breakthroughs" based on early-phase or even preclinical study results, alternating with patient testimonials and admonishments to "not let them tell you no."

It is vital for patients to feel comfortable asking questions, but they also need to accept a physician's recommendation for or against something without it being perceived as a failure to accede to their demands. Similarly, we need to set limits acknowledging that we have other patients to see on a given day.

In these discussions, far too few patients understand that the bottom two thirds of the fine print enumerating a drug's many, many potential side effects are listed by the pharmaceutical company's legal team simply as a "cover-your-ass" maneuver to absolve them of responsibility for possible negative outcomes with their treatment. They are not hidden clues that explain multifactorial, nonspecific symptoms like fatigue.

We also need to remember that the tenacious foothold of fake cancer remedies in the minds of the lay public—as well as the entire existence of the antivaccine movement—is predicated on disinformation, along with a view that "science" and "evidence-based medicine" should be considered pejorative terms. There is great harm in elevating these patient perspectives as appropriate for medical decision-making.

Of course, like so many complex issues, the answer remains a shade of gray. It was long overdue for the medical community to recognize the importance of educating patients and welcoming their participation in shared decision-making. But only one side of the patient-physician relationship has the experience and medical training, as well as the legal responsibility, to direct care. The patient should be at the center, but that shouldn't sideline the physician.
 
H. Jack West, MD, is an associate clinical professor and executive director of employer services at City of Hope Comprehensive Cancer Center in Duarte, California. He founded the Global Resource for Advancing Cancer Education, co-hosts the "West Wind" podcast, and regularly comments on lung cancer for Medscape.

Quote From Ralph Marston

Set a small goal, and achieve it. Then immediately set another small goal, and achieve that.

Occasionally you'll have the opportunity to make big, sudden improvements. Yet always, in every moment, you are able to make small improvements.

There's great power in doing so. Because those small improvements add to each other, and build on one another.

The long and inexorable march of progress is not, by and large, a history of quick advances. It is a story of small improvements, and improvements on the improvements, made again and again.

Today you can continue that beneficial story. Right now, several small improvements await your attention, your action.

You don't have to wait one more moment for the chance to make a meaningful positive difference. Where you are, with what you have, make a small improvement, and set the process in motion.

#ralphmarstonquotes

11 Tips to Stop Stress Eating During Shelter-in-Place

By Zoe Davis, MA, LMHC, MS, CNC While this is a stressful time for many, it is also an opportunity to practice mindfulness and deep compassion for ourselves and our community. Food choices may be more emotional at this time as people look to food for comfort to lower anxiety and mitigate feelings of a loss of control. I hope some of these ideas for managing stress eating will be helpful to you and will provide their own source of comfort.

1. Try the H.A.L.T. method for emotional eating.

When going to get something to eat, simply check in to gauge what your real need is by asking yourself: “Am I Hungry, Angry, Lonely, Tired?” If you’re hungry, eat some nourishing food. If you’re angry (or stressed or anxious), do something to attend to that emotion, such as journaling, meditation, diaphragmatic breathing, drawing, or coloring (even adults can do this!). If you’re lonely, reach out to a friend or family member, and make regular social engagements a priority (virtually for now). If you’re tired, rest, drink some water, do some mild stretching, or get some fresh air with a walk to replenish your energy. When we create more space between the thought of eating something to soothe our emotions and the actual consumption, we create awareness of our true need and increase the likelihood of doing something to attend to that actual need.

2. Feed yourself well, and regularly.

Low blood sugar exacerbates feelings of stress and anxiety. Make sure you’re consuming regular meals that include adequate protein, healthy fat, plenty of vegetables, and some low-sugar fruit. Don’t go too long between meals, especially if you’re prone to feeling anxious or stressed. Your brain and body need nutrients regularly throughout the day, and when we are missing key B vitamins, fiber, minerals (like magnesium), and probiotics, we can feel more amped up and have a harder time relaxing.

3. Slow down your meals/snacks.

Take a few deep breaths before eating and chew your food thoroughly. Eating this way engages the parasympathetic nervous system and allows for better digestion and greater benefit from the foods you eat. This practice also naturally moderates the amount and types of food your body actually needs, drastically reducing the need for willpower.

4. Keep non-nutritive “comfort” foods out of your home.

Now is a great time to focus on the essentials and avoid foods that fill you up but don’t actually nourish you. Try making warm broth-based soups, roasted root vegetables, baked pear or apple with cinnamon, and gluten-free whole grains or pseudo-grains like wild rice, quinoa, and buckwheat as part of your comfort foods instead of white flour-based foods or sugary desserts.

5. Avoid stimulants.

Stimulants—such as refined sugars, too much caffeine, dyes, additives, and artificial sweeteners—can irritate or over-activate the nervous system and exacerbate anxiety, making it more difficult to experience a sense of calm.

6. Make time with family or friends to enjoy meals together.

If you live with others, take turns cooking and prepare the table where you will eat as a part of the meal to be enjoyed. Light candles, play relaxing music, and have positive conversations as part of the meal. Avoid stressful conversations with meals, and if you live alone, invite friends to a virtual dinner party via computer or phone. You can enjoy each other’s company even when not in the same space.

7. Practice gratitude.

Consider the work that went into growing or raising your food, the incredible abundance of our planet, and the many people along the way from planting to delivery that work hard every day to keep you nourished. Gratitude keeps us focused on appreciation, which is a boost to our immune system and can significantly lower stress levels.

8. Include intentional movement in some form on a daily basis.

When we move, we’re more in touch with our physical body and tend to choose healthier food options and drink more water. Additionally, exercise is immensely beneficial for lowering anxiety, improving our immune resistance, reducing stress, and encouraging sound sleep. While much of our lives may be more confined than we would like, we can still move every day. Some ideas include going for brisk walks/hikes in our neighborhood, taking dance classes online, doing weight resistant exercises with an app, or completing a regimen of yoga poses from books or instructional videos. 

9. Tap into your creative self or learn something new.

Try a virtual class online, get out your paintbrushes and paper, do collage, sing, dance, write poetry or stories, learn a language (or re-learn one), play a musical instrument if you have one, sew, knit, or anything else you’d like to try. Creativity is a great way to express yourself and de-stress. When we are creative and feel ourselves expressed, we are using energy in a positive way and tend to feel less restless. Decreasing feelings of restlessness can keep us from eating out of boredom.

10. If you have the capacity and aren’t doing too much already, offer to help someone else.

Volunteer in any way that is safe for you. Volunteer Match has thousands of opportunities, and you can do many of them virtually, or you can come up with your own way to help in your neighborhood. When we feel a sense of contribution and connection with our community, we tend to feel more in control and more grounded. This feeling is empowering and often leads us to take better care of ourselves (with food, movement, sleep, and more), as we feel more important to those around us.

11. Practice good sleep hygiene.

Try to go to bed at the same time each night and limit foods at least 2 hours prior to sleep. Use blue-light filters on computers, phones, or tablets if you need to use them in the hour prior to bedtime. Getting at least 7 hours of sleep regularly helps to regulate hunger hormones, improve energy, and increase our stress tolerance.

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About the Author: Zoe Davis, MA, LMHC, MS, CNC, Amen Clinics Northern California

Zoe Davis, MA, LMHC, MS, CNC is a nutrition therapist, integrative health coach, and certified Irlen screener at Amen Clinics, where she has been honored to work with patients over the last four years. Zoe has Master’s degrees in human nutrition and functional medicine, is a licensed mental health counselor, and has a post-graduate certificate in nutritional psychology. This unique combination of education in both nutrition and psychology allows her to use a mind-body approach in a deeply integrated way.
Find out more about Amen Clinics, which offers comprehensive clinical evaluations and remote therapy sessions as well as in-clinic brain scanning, by speaking to a specialist today at 866-319-2743. If all our specialists are busy helping others, you can also schedule a time to talk.

8 Ways To Stay Busy While Sheltering In Place

8 Ways To Stay Busy While Sheltering In Place 

Online courses.

If you’re looking to brush up on a skill, now’s your chance.  Tons of companies offer free or paid online courses that can help you advance your career, learn a new skill, or just satisfy your curiosity itch.  Harvard University offers free courses in in a variety of areas from computer programing to 18th-Century Opera.  Courseara offers free courses that can be completed in as little as a day, and Yale is currently offering it’s super popular Happiness course online for free.  It’s never been a better time to pick up a new skill.

Reading.

Love a good book? It’s a great time to dig into that thriller you’ve been waiting to indulge in.  Or why not take on the list of classics you’ve always been wanting to try but “never have the time to tackle”.  Of course you know you can order books online from Amazon (hardcopy or for your kindle), but you can also rent ebooks for free if you have a library card, without ever needing to leave home.  Just plug your library card into the Libby app and access thousands of free library rentals that can be delivered straight to your kindle, or read within your smart phone!

Stay in touch online.

Now, more than ever, we need to stay in touch with those we love, even if we can’t see them face to face.  Thankfully, technology helps make that possible. Facetime, Skype, What’sApp and Zoom are all video chat apps that can help you keep in touch.  So host a family happy hour, or an afternoon tea, and keep your (virtual) social life going strong, even if you’re the only one sitting in your living room.

Get your arts and crafts on.

Are you an avid knitter? Always wanted to try your hand at painting or drawing? Maybe you’ve wanted to learn calligraphy. Use this time to get creative and relieve some of the stress that you might be feeling from all that’s going on.  Even if you think you’re not creative, give it a go. Getting lost in a project can help pass the time and give you something else to focus on.  Not sure where to start? Try an adult coloring book (or download and print some coloring sheets from online).  You might be surprised at how relaxing it is. 

(And, if you’re a sewer, check this way to put your skills to use and help with the coronavirus!) 

Practice a new language.

Let me guess – you took Spanish in high school and have always regretted not sticking with it?  Take this time to learn a new language! Lots of apps and programs exist that can help you master a new language in no time.  Try Rosetta Stone, Babbel, or Duolingo to get started. Then start thinking about the awesome trip abroad you can take to show off your skills once all this is over.

Get better at your musical instruments.

Have you always tinkered at the guitar? Plucked at the piano?  Use the time now to practice or learn how to play a musical instrument.  Music can be incredibly soothing and meditative, especially during times of stress. And like art, it can really help relax you to get caught up in learning a new piece or to learn how to play a new instrument. 

Master 3 new meals!

How many of you are always scrambling when it comes to cooking dinner? Or you never know what to make for a dinner party? If you like cooking, pick three meals you’d like to master over the next month. Then practice them until they’re perfect.  You’ll be able to draw on them for years to come (and your family will likely thank you!)

Don’t forget to workout!

Don’t make the mistake of using the shelter in place as an excuse to skip your workouts.  There are tons of options to work out from home. And even with stay at home orders, most cities are allowing people to get out for some exercise and sunshine. So download an app, or take a stroll around the block, go for a hike, or take a bike ride.  Just get moving. Every day. Your body, and your mind, will thank you.

From https://www.nafc.org

2020 Year Of The Nurse

If you haven't heard already 2020 is the year of the Nurse!! This is your time to celebrate YOU and all you do! ANA has some great ideas on how you can Excel, Lead, and Innovate! Take a look at these suggestions for Celebrating and Elevating Nursing.
Click Here For More!

Ideas for Cheap Dates

I just recently did this course and I love these ideas!

Here is the website for even more ideas: More Ideas

When you’re trying to stick to a budget but also want to treat your special someone to a date, you might feel stuck. After all, date nights can be expensive. Even if you don’t have anything more than dinner and a movie planned, you could end up paying close to $100! But don’t worry—there are plenty of ways to spend one-on-one time together in a budget-friendly way. Here are 40 cheap date ideas to get you started.

10 Cheap Date Ideas to Get Started

Let’s get one thing straight: Cheap doesn’t equal boring. If anything, it means you get to be a little more creative with how you plan the date. Plus, you get to think up exciting, out-of-the-box ideas and put in that extra effort. Here are 10 cheap date ideas to try out any day of the week.

1. Browse at a bookstore. If you find books you both like, put them on hold for pickup at your local library.
2. Listen to your throwback records, vintage tapes or mix CDs. Pick the ones that were important to you while you two were dating. Or if you’re still dating, share music that was important to each of you earlier in life.
3. Go out to breakfast. It’s the most important meal of the day, and it’s a much cheaper date than going out to dinner. There’s no rule out there saying you can’t have a date in the morning. So go ahead! Plus, who can pass up the chance to eat pancakes, eggs and bacon? Simple answer: No one—no one worth dating anyway . . .  
4. Watch the sunset or sunrise. C’mon—it doesn’t get more romantic than that!
5. Celebrate the year you met, got married or started dating. Watch a popular movie or listen to music from that year and try to recreate the style of the time. If the year was 1983, we’re sorry for the fashion options. But take heart—you’ll have some of the most iconic movies and music to choose from!
6. Take a dance lesson. There are tons of dance studios that offer a casual dance instruction with a time afterward to practice your moves. This is a great way to perfect your salsa, ballroom or disco dance moves together.
7. Hit up a sports game. All right, going to watch the pros play isn’t going to be cheap (unless you can score a great discount). But don’t worry. You can still be a fan in the stands! Take in a local college or high school sports game, and chat with your date about your glory days as a volleyball champ . . . at your super small school. (You can leave that part out if you want to.)
8. Volunteer together. Use your time to serve at a homeless shelter or elderly ministry. It’s amazing how helping others can bring the two of you together.
9. Test drive an expensive car. But don’t buy it! (Duh.)
10. Go to an open mic night. You never know what kind of talent you’ll get to hear!

From Dave Ramsey Financial Peace University

The Five Most Important Words You Can Say to a Patient

A technique for good communication

by Suneel Dhand, MD July 30, 2019

Our job as healthcare professionals is not just to diagnose our patients by applying our scientific knowledge and clinical skills, but also to be the "communicator-in-chief," "listener-in-chief," and "reassurer-in-chief."

Any doctor who doesn't fully grasp this is not doing the best job they can or being the best doctor they can be. I truly believe that over 90% of our everyday job as a physician involves being a good communicator. We've already reached a certain standard of clinical competence to be able to practice medicine and be unleashed on the general public. The rest is on us, to communicate well with patients and leave a positive impression at a low point in their lives. It's oh so easy to get into a groove where everyone becomes "just another name on our list" (and very human too, we all fall into that trap).

But the patient who is about to walk in and see us, or lying in the room we are about to enter, may have been waiting to see us for hours, days, or weeks. Imagine a family member or friend, the one you love the most, in that helpless situation where their life is turned upside down. It's important we never forget that, and remember that a large number of our patients are very anxious about the situation they are in.

The number one thing our patients want in those precious few minutes we have with them is to feel that their doctor truly cares and is there to help them. That's our job in a nutshell. There are a number of verbal and non-verbal techniques that can reinforce that sense of caring and connection.
On that note, here are five words that physicians can utilize at the end of their discussion, that can really help reassure them too. Most of the time, when discussing any potential serious issue that is going to be very treatable, any physician can simply lean in and say with a calm reassuring empathetic voice:

"It's going to be OK."

This may sound like a very basic statement, but it's a very powerful thing for a patient to hear from their medical professional! It's underutilized in healthcare, especially by doctors. I would go much further and say that this statement can be used in any situation when you are talking to an anxious person, who is offloading a problem that concerns them, onto you. Do you have a friend who is in trouble? A family member who is worried about something? Be a good listener, give them some trusted advice and just tell them that "it's going to be OK." Obviously, sometimes a problem might be so bad that it may not be OK or solvable. But I guarantee most of the time, and for most people, there are better days ahead, and things will get better.

So tell them things are going to be OK. It's one of the best things you can say to anyone who is in a tough spot in life. 

Suneel Dhand, MD, is an internal medicine physician, author, and independent healthcare experience and communication consultant. He is co-founder of DocsDox.
This post originally appeared on KevinMD

Happy Holidays!

Happy Nurses Week!

We All Had to Start Somewhere

by Michelle Tanner, MSN, RN | Magazine, Nursing Mentorship, Nursing Students

Did you ever look back upon your career and reflect on those humble beginnings? As educators, we sometimes forget that it was not easy to aspire to the higher academic goals we have been so fortunate to have attained. When we counsel our students, we must not disregard that they too have many barriers to overcome in their journey to be successful. In retrospect, we can embrace the challenges we must face in the effort to ensure our students’ academic success.

One morning during break, I overheard one of my student’s discussion with her colleague regarding how lucky she was that her children would be cared for over the weekend. This would allow her time needed to study for the final exam. Knowing this student, I was aware that she was a single parent and working mom, and more importantly, my student was pursuing a future career in nursing no less. It was a revelation that this fortunate incident for her was not expected, but was a gift. I began to ponder how this student would have prepared for the final if the childcare issues had not been resolved. Upon review, I realized that this student’s grades were not always consistent. During counsel, her excuses for poor grades or incomplete homework assignments were due to illness (whether be it her own or one of her children’s) or because of a busy work schedule, which entailed all shifts conceivable. So, when did she have time to study?

Lack of study time was also noticeable in the part-time evening students. I ­recall the blank stares on their faces during a Q&A session in preparation for the day’s lesson. Upon inquiry, the group confessed that they had not prepared for the evening’s lecture in their attempt to balance work, family, homework, and study hours. The weekends had been relegated to study time in preparation for the upcoming week’s assignments, albeit incomplete. Add this to childcare, spousal duties, and familial responsibilities and you have one overworked, fatigued, and ill-prepared ­nursing ­student.

Many times, as educators we focus on the negative aspects of our students: the fatigue, lack of engagement during lecture or clinical, and the behavioral issues (tardiness, ­absenteeism, and disputes with colleagues). This can hinder our ability to focus on putting interventions into place to enhance our students’ learning abilities. We might complain about time consumed due to providing an inordinate amount of time with a student that was not responding to intense tutelage. Perhaps we should invest in discussions about the ever-changing policies affecting our curriculum or work hours. Somehow, the drudgery of this negative outlook overshadows a focus on the academic pursuits of those ­struggling to attain a portion of our accomplishments. We must be sensitive to the vulnerability of this population during their journey. Whether it be in the case of the traditional, the returning, or the recycled adult learner, financial constraints are taxing. Adhering to professional and attendance policies takes effort. Striving to maintain a precarious balancing act to function commendably in multiple roles are all central themes of the adult learner. In acknowledging this, it is incumbent upon us to assist our students in getting past these barriers.

I have contemplated methods to assist nursing students, which have resulted in ­better outcomes. Some interventions I have put into place have made the difference in my students’ success as evidenced in their test scores. The following interventions are worth noting:

Games: the Millennials love them. Who said learning should be boring? The younger generation thrives off the technological ­support, which ­surreptitiously enhances learning. The games can be competitive, informal, and applied individually or after breaking the class into groups. Games are used best when they can be accessed as a resource after classroom sessions as a study tool before testing.
Provide a quick recap at the end of class. Some students may be so attentive during lecture that they do not take notes that were imperative to have as a review for the next test. This is easy to rectify by providing a short review of pertinent facts at the end of the day, paying special attention to the material that will be included on the test. This quick review gives the learner another chance to process and make note of what the instructor was attempting to stress in the previous lecture(s). This may seem redundant, but we cannot forget that this is all new information for the learner.
Remind the student of your availability. I state my office hours on a weekly basis most emphatically after testing. This publicly reinforces my commitment to their learning needs and hopefully abates their reluctance to seek my instruction.
Review one-on-one over the previous tests taken with students who have scored poorly. Allow the student to reflect, write, and question the material covered in the test(s). Educators have gained insight about their students during these sessions (e.g., what type of learner they are, if there are linguistic barriers, and/or if there is a lack of effective study habits). This session also establishes a rapport between you and the learner, which can be motivational.
Allocate extra time to be available for hours before testing. You would be surprised to see how many students will attend for review after a long, clinical day in anticipation of a test pending the next day. Is it more time consuming? Not nearly as much as counseling them one-on-one would be.

These are a few tips I have used to incorporate in teaching my students before I notice a decline in test scores. As I look back on my humble beginnings, I realize that the barriers I encountered are not so different. I am fortunate enough to have had support and encouragement throughout my career as a student and as a practitioner. It is as challenging for both the educator and the learner; diligence is required from all parties. But we are in the trenches together. We all had to start somewhere.

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Latest posts by Michelle Tanner, MSN, RN

Enhancing Happiness Through Your Work

Enhancing Happiness Through Your Work

by Nuananong Seal & Mary Wiske | Apr 20, 2018 | Blog, Nurse Health, Nursing Careers | 0 Comments

Stress in nursing is most likely attributed to the physical and emotional demands of patients and families, work hours, shift work, interpersonal relationships, and other pressures that are central to the work nurses do. Stress adversely affects the health, safety, and well-being of nurses, patients, and health care organizations alike; therefore, it is essential for nurses to reduce job stress and increase their happiness through their work.

Studies show that loving your job has less to do with your job and more to do with you. That’s right, there are simple ways you can ensure your own happiness at work every single day. Because happiness is the sum of love, optimism, purpose, courage, productivity, health, perspective, humor, and fulfillment, you must manage to achieve. Happiness won’t come to you if you do nothing.

Here are six simple actions you can employ to reduce stress and enhance your happiness.

1. Find out what makes you happy.

When you know the answer, you can add it to your life. If you are not sure, you should start taking detailed notes whenever you feel happy.

2. Create and write down a daily goal of joy each day.

Creating a goal allows you to focus on who you are in the moment, recognize and live your values, and achieve your emotional energy and happiness. Try to create one thing that you can look forward to each day at work, whether it’s seeing a specific coworker or your special lunch break. Whatever it is, the simple act of looking forward to it will increase the happiness you associate with work.

3. Make yourself familiar and comfortable with each of your coworkers and patients.

Studies show that working with unfamiliar coworkers and in different settings negatively impacts you at work. Make sure that you take time to introduce yourself to your coworkers and get to know your patients. Being familiar with your coworkers and patients increases your confidence and happiness at work.

4. Be optimistic.

Research shows that positive people are less likely to become ill. Optimism has been linked to an improved sense of well-being so try to look on the bright side whenever you can.

5. Love yourself and take care of your health.

Caring for yourself must be a priority. Eating well, staying hydrated, and getting enough sleep can make you feel good. And when you feel good, you have the physical and mental energy to work through daily challenges and focus on what’s good about the day. Make time to do the things that make you happy in the moment as well, such as listening to your favorite song during a lunch break.

6. Last but not least, put a smile on your face, act happy, and laugh every day.

Acting happy and keeping a pleasant expression on your face puts your mind in a positive state. Try to let go of negative feelings and learn to forgive because forgiveness will help give you inner peace.

We All Had to Start Somewhere

We All Had to Start Somewhere

by Michelle Tanner, MSN, RN

Did you ever look back upon your career and reflect on those humble beginnings? As educators, we sometimes forget that it was not easy to aspire to the higher academic goals we have been so fortunate to have attained. When we counsel our students, we must not disregard that they too have many barriers to overcome in their journey to be successful. In retrospect, we can embrace the challenges we must face in the effort to ensure our students’ academic success.

One morning during break, I overheard one of my student’s discussion with her colleague regarding how lucky she was that her children would be cared for over the weekend. This would allow her time needed to study for the final exam. Knowing this student, I was aware that she was a single parent and working mom, and more importantly, my student was pursuing a future career in nursing no less. It was a revelation that this fortunate incident for her was not expected, but was a gift. I began to ponder how this student would have prepared for the final if the childcare issues had not been resolved. Upon review, I realized that this student’s grades were not always consistent. During counsel, her excuses for poor grades or incomplete homework assignments were due to illness (whether be it her own or one of her children’s) or because of a busy work schedule, which entailed all shifts conceivable. So, when did she have time to study?

Lack of study time was also noticeable in the part-time evening students. I ­recall the blank stares on their faces during a Q&A session in preparation for the day’s lesson. Upon inquiry, the group confessed that they had not prepared for the evening’s lecture in their attempt to balance work, family, homework, and study hours. The weekends had been relegated to study time in preparation for the upcoming week’s assignments, albeit incomplete. Add this to childcare, spousal duties, and familial responsibilities and you have one overworked, fatigued, and ill-prepared ­nursing ­student.

Many times, as educators we focus on the negative aspects of our students: the fatigue, lack of engagement during lecture or clinical, and the behavioral issues (tardiness, ­absenteeism, and disputes with colleagues). This can hinder our ability to focus on putting interventions into place to enhance our students’ learning abilities. We might complain about time consumed due to providing an inordinate amount of time with a student that was not responding to intense tutelage. Perhaps we should invest in discussions about the ever-changing policies affecting our curriculum or work hours. Somehow, the drudgery of this negative outlook overshadows a focus on the academic pursuits of those ­struggling to attain a portion of our accomplishments. We must be sensitive to the vulnerability of this population during their journey. Whether it be in the case of the traditional, the returning, or the recycled adult learner, financial constraints are taxing. Adhering to professional and attendance policies takes effort. Striving to maintain a precarious balancing act to function commendably in multiple roles are all central themes of the adult learner. In acknowledging this, it is incumbent upon us to assist our students in getting past these barriers.

I have contemplated methods to assist nursing students, which have resulted in ­better outcomes. Some interventions I have put into place have made the difference in my students’ success as evidenced in their test scores. The following interventions are worth noting:

Games: the Millennials love them. Who said learning should be boring? The younger generation thrives off the technological ­support, which ­surreptitiously enhances learning. The games can be competitive, informal, and applied individually or after breaking the class into groups. Games are used best when they can be accessed as a resource after classroom sessions as a study tool before testing.
Provide a quick recap at the end of class. Some students may be so attentive during lecture that they do not take notes that were imperative to have as a review for the next test. This is easy to rectify by providing a short review of pertinent facts at the end of the day, paying special attention to the material that will be included on the test. This quick review gives the learner another chance to process and make note of what the instructor was attempting to stress in the previous lecture(s). This may seem redundant, but we cannot forget that this is all new information for the learner.
Remind the student of your availability. I state my office hours on a weekly basis most emphatically after testing. This publicly reinforces my commitment to their learning needs and hopefully abates their reluctance to seek my instruction.
Review one-on-one over the previous tests taken with students who have scored poorly. Allow the student to reflect, write, and question the material covered in the test(s). Educators have gained insight about their students during these sessions (e.g., what type of learner they are, if there are linguistic barriers, and/or if there is a lack of effective study habits). This session also establishes a rapport between you and the learner, which can be motivational.
Allocate extra time to be available for hours before testing. You would be surprised to see how many students will attend for review after a long, clinical day in anticipation of a test pending the next day. Is it more time consuming? Not nearly as much as counseling them one-on-one would be.

These are a few tips I have used to incorporate in teaching my students before I notice a decline in test scores. As I look back on my humble beginnings, I realize that the barriers I encountered are not so different. I am fortunate enough to have had support and encouragement throughout my career as a student and as a practitioner. It is as challenging for both the educator and the learner; diligence is required from all parties. But we are in the trenches together. We all had to start somewhere.


Michelle Tanner, MSN, RN, has 40 years of nursing experience, which has been derived from a diverse background. Over the course of her career, she has practiced in the acute care setting, long-term care, and management and presently teaches in New England.

The Link Between Cultural Communication, Hospital Safety, and Desired Outcomes

The Link Between Cultural Communication, Hospital Safety, and Desired Outcomes

by James Z. Daniels & Janice Bonham West | Apr 23, 2018 | Magazine, Nursing Diversity |

A clinician sees a Somali patient with a primary complaint of back pain and, following an exam, prescribes a traditional course of western medical action. The patient, however, is reluctant to act on the medical advice because he thinks his back pain is caused by a bad relationship with his parents or guilt over something he did. “It is always good (for clinicians) to have some knowledge about their patient’s culture, to know who they are dealing with,” says Fozia Abrar, MD, of Minneapolis. “It might cost time and money, but you save more money by not getting a misdiagnosis, by improving quality of care.”

Suffering from bacterial gastritis, a Somali woman in Minnesota visits several providers but does not take the medication they prescribe. When met with a smile and a greeting in her native language by Dr. Abrar, the patient complies with the same treatment recommended by the previous ­providers—Dr. Abrar successfully ­persuaded the patient to fill a prescription and take the medication because of her ­knowledge of the patient’s culture. This situation is not new or unique—medical ­anthropologist and psychiatrist Arthur ­Kleinman, MD, has spent 30 years championing cultural issues in ­medicine. He says a great body of evidence shows culture does matter in clinical care.

Every cultural group has traditional health beliefs that shape members’ perspectives about wellness. The increasingly diverse, twenty-first-century patient population requires clear communication and practitioner awareness of patient health perspectives in order to significantly impact patient satisfaction, safety, compliance, and outcomes.
Organizational Culture, Patient Satisfaction, and Safety

Organizational culture informs every worker whether patient satisfaction is a key value. By influencing employee behavior and how ­employees are treated, ­culture drives employee effectiveness, safety, and whether employees take advantage of opportunities as they arise. Organizations that dedicate additional employee resources to patient safety signal to employees that both employee effectiveness and patient safety are high ­priority. In other words, organizational values and beliefs guide employee commitment to patient and worker satisfaction. According to the Agency for Healthcare Research and Quality’s Hospital Survey on Patient Safety Culture: 2016 User Comparative Database ­Report, patient safety improved more at hospitals where they increased employment of staff who reported ­incidents, ­compared to hospitals that did not expand the number of employees who ­reported incidents.

At Atrius Health, a Massachusetts ambulatory care provider with 36 locations, staff can report safety events while updating existing electronic health records (EHRs). This reporting mechanism has increased the number of reported events, and as many as 30% of events reported monthly come in through the EHR tool, according to Ailish Wilkie, patient safety and risk ­management ­director for Atrius Health.

In other words, employee ­accountability shapes ­workplace and organizational culture.
Patient Culture, Provider Culture

In addition to the effect workplace culture has on patient satisfaction and employee competency, two additional areas of culture impact health care effectiveness. Both a patient’s cultural background and the provider’s scientific/medical culture inform patient and provider wellness perspectives. If patient compliance with the treatment plan is the goal, providers need to understand the patient’s cultural identity.

By the same token, patients need to know that their perspectives are respected. Few health care ­observational ­studies have reported ­sufficient information to support the claim of provider bias, but a 2006 study published in the Journal of General Internal ­Medicine reported that most internal medicine residents gain cross-cultural skills through informal training, and most stated that delivery of high-quality, cross-cultural care was important but were skeptical about the expectation of learning every little detail about all cultures. Barriers to ­cross-­cultural care included lack of time, not knowing enough about the religion or ethnic group of the patient they were caring for, and/or dealing with belief systems which are ­different than their own.

A 2000 study in Social ­Science and Medicine found that physicians rated ­minority patients more negatively than White patients; the study also reported that physicians viewed minorities as non-compliant and more likely to engage in risky health behaviors. Clearly, providers need reliable resources to add to their understanding of the patient’s perspective.

A 2017 survey of 111 health care providers revealed where providers currently turn to access cultural training and information, and what types of information providers need when they are unsure/unaware of the patient’s cultural profile and its implications for treatment decisions, patient compliance, and safety outcomes. The survey found that providers want more data on their patients’ use of nontraditional medicine; their faith beliefs; and who the health care decision-makers are.
Diversity and Disparities

An increase in racial and ethnic minority health ­professionals provides greater opportunity for minority ­patients to see a practitioner who speaks their primary language or is from their own racial or ethnic background. This can improve the quality of communication, patient safety, satisfaction, compliance, and outcomes. In addition to ­increasing the diversity of practitioners, hospitals are working to improve hiring diversity, employee cultural awareness, and organizational culture.

In 2015, The Health Research & Educational Trust (HRET) commissioned a ­national survey of hospitals and health systems to quantify the actions they are ­taking to ­promote diversity in leadership and ­governance, and reduce health care ­disparities. Data for this project were ­collected through a national survey mailed to the CEOs of 6,338 U.S. registered hospitals. The response rate was 17.1%, with the sample generally ­representative of all hospitals.

Minorities represent a ­reported 32% of patients in hospitals that responded to the survey, and 37% of the U.S. population, according to other national surveys. In contrast, the HRET survey data show that minorities represent only 14% of hospital board membership, 14% of executive leadership positions, and 15% of first- and mid-level positions.

As a sign of progress, though, nearly half of hospitals surveyed had a plan to ­recruit and retain a diverse workforce matching their ­patient population. Further, 42% said they implemented a program to find diverse ­employees in the organization worthy of promotion.
Cultural Data Collection

The HRET data show that 98% of hospitals are collecting patient data on race. Additionally, other areas of data collection included ethnicity (95%) and first language (94%). But, the percentage of hospitals that correlated the impact these factors have to the delivery of care was a mere 18%. Remarkably, in 2011 only 20% of hospitals analyzed clinical quality indicators by race and ethnicity to identify patterns, whereas 14% looked at hospital readmissions, and 8% analyzed medical errors.

A serious flaw in the HRET survey was zero data collected on hospital patient national origin. The report listed myriad reasons why hospitals might be failing to meaningfully use the data, such as fearing potential liability issues after publicly acknowledging disparities in care, concerns about the public relations backlash, and a lack of knowledge in developing clinical programs that would reduce or eliminate inequalities. Plus, some hospitals noted the lack of a “diversity champion” on their staff to help lead the effort.

Hospitals seem to be making progress in educating staff on diversity, with 80% providing cultural competence training during orientation and 79% offering continuing education opportunities on cultural competency, according to the survey.
What’s Next?

Hospitals have begun to include leadership goals ­designed to reduce care disparities by implementing ­diversity initiatives such as: allocating adequate resources to ensure cultural competency/diversity initiatives are sustainable; ­incorporating diversity ­management into budget ­planning and ­implementation process; increasing hospital board diversity to reflect that of its patient population; board members demonstrating completion of diversity training; developing plans specifically to increase ethnic, racial, and cultural diversity of executive and mid-level management teams; and executive compensation tied to diversity goals.

Beyond the C-suite, hospitals are developing diversity plans with initiatives that include diversity goals in hiring manager performance expectations; implementation of programs to identify diverse, talented employees within the organization for promotion; documented plans to recruit and retain a diverse workforce that reflects the organization’s patient population; required employee attendance at ­diversity training; hospital collaboration with other health care organizations to improve health care workforce training and educational programs in the communities served; and education of all clinical staff during orientation about how to address unique cultural and linguistic factors affecting the care of diverse patients and communities.

This increased implementation of appropriate health care and adherence to effective diversity and cultural education programs at every level of health care will ultimately result in improved patient ­satisfaction, compliance, hospital safety, and patient health outcomes.


James Z. Daniels & Janice Bonham West
James Z. Daniels, MPA, MSc, is a consultant and writer who lives in Durham, North Carolina, and frequently contributes to ­Minority Nurse.

Janice Bonham West, MEd, is a writer and consultant who lives in Raleigh, North Carolina.

Transitioning wound care patients to post-acute care

Transitioning wound care patients to post-acute care
January 2018 Vol. 13 No. 1
Setting goals and meeting needs.

Takeaways:

When discharging patients from acute care facilities, consider cognitive and functional status; the home environment; family or caregiver support; access to services, medications, and transportation; and follow-up care.
Depending on the patient’s situation, the three goals of wound care are healing, maintenance, and comfort.
After discharge from an acute-care facility, patient medication management, diet, and lifestyle can help support wound healing.
Patient and family engagement and education, including their goals, preferences, and concerns, are fundamental to a successful transition.

By Armi S. Earlam, DNP, MPA, BSN, RN, CWOCN; Lisa Woods, MSN, RN-BC, CWOCN; and Kari Lind, BSN, RN

Discharge to post-acute care settings such as rehabilitation and skilled nursing facilities, long-term care hospitals, and home health depends on the patient’s overall health. Other factors that must be considered include the patient’s cognitive and functional status; the home environment; family or caregiver support; access to services, medications, and transportation; and follow-up care. In this article, we’ll focus on the needs of wound care patients who are transitioning to post-acute care.
Elements of a wound care discharge plan transition wound care patients post acute. When discharging a patient who needs wound care, acute-care clinicians (wound care nurse, discharging nurse, and case manager) should evaluate the comprehensive wound care plan, asking questions related to the goals of care, discharge setting, care provider, products and resources, patient factors that influence wound healing, and follow-up care.

What are the care goals?

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Depending on the patient’s situation, the three goals of wound care are healing, maintenance, and comfort. If the goal is wound healing, treatment should focus on wound granulation and eventual closure. However, if the wound is unlikely to heal (for example, an elderly patient with arterial wounds who is too frail for a vascular intervention), the goal is to keep the wound clean, stable, and free of infection.

For patients receiving end-of-life care, comfort is the goal. Treatment includes dressings that are changed less frequently, cause less pain, adequately absorb drainage, and control foul odor.

Keep in mind that goals may overlap and evolve, so the wound care plan should be modified as necessary.

Where will the patient go?

Wound severity and complexity may affect the choice of post-acute care setting. For example, a patient with multiple wounds requiring either negative pressure wound therapy (NPWT) or twice-daily dressing changes may be best placed in a long-term care hospital. On the other hand, someone who needs once-daily wound packing can be managed at home if the patient or family can perform dressing changes between home health nurse visits.

Additional considerations include clinician time needed to perform wound care and equipment availability. Some post-acute care settings may not have the resources for frequent dressing changes or clinician visits. The discharging facility must establish that the necessary equipment and clinical personnel are available.

Who will perform wound care?

Clinicians need to assess whether the patient is functionally and cognitively able to perform wound care. If not, other options include a home health nurse or a family member or friend. If the patient lives in a remote area and wound care will be done by a family member with only periodic visits by a home health nurse, the in-patient nurse needs to assess the caregiver’s ability to complete care tasks and provide education. The teachback method allows caregivers to demonstrate what they’ve been taught so the home health nurse can assess comprehension and ability.

If the patient is being discharged to a setting other than the home, the facility must demonstrate the availability of clinicians who have the knowledge and skills to manage the prescribed wound therapy.

What products and resources will the patient need?

Each facility and agency has its own formulary of wound care products; the brands used in the hospital may not be the same used in post-acute care. The patient’s insurer also may dictate what products will be used. For example, different manufacturers of NPWT products have contracts with different insurers, which will dictate what brand can be used at home.

Insurance companies reimburse home health agencies a set amount depending on the patient’s diagnoses. Daily dressings or costly products may not be feasible after acute-care discharge. However, an expensive product that requires twice-weekly dressing changes rather than twice-daily saves clinician time, making it a more cost-effective choice. Alternatively, substituting a less-expensive comparable product or therapy for an expensive one without loss of efficacy may facilitate a timely transition.

What patient factors should be addressed?

After a patient is discharged from an acute-care facility, medication management, diet, and lifestyle can help support wound healing. For example, patients with diabetes who have foot wounds must control their glycemic levels by following medication regimens and dietary recommendations, and patients who smoke should begin a cessation program. Patients with heart failure who have leg swelling and blistering that results in wounds must adhere to their diuretic therapy. To avoid infection that can impede wound healing, all patients must adhere to prescribed antibiotic regimens.

When treating pressure injuries, addressing the etiology is crucial. Clinicians or family members may be using the appropriate wound care products, but if the affected body part is not properly offloaded and pressure not redistributed adequately, then the wound treatment will be futile. For example, a pressure injury on the heel won’t improve if the cause of the pressure isn’t addressed by using offloading boots or pillows under the calves when the patient is resting in bed.

What are the follow-up care plans?

Discharge instructions should include detailed wound care guidelines and contact information for the provider with whom the patient should follow up. Plans for future supply procurement, conditions for revising the care plan, and access to transportation for follow-up care also should be considered.
Successful transitions

Safe and effective care transitions not only are best practices, but they’re also essential in today’s healthcare environment. Changes in reimbursement, including both incentives and penalties for certain discharge outcomes, along with a much-needed emphasis on quality, accountable care have encouraged this attention. Patient and family engagement and education, including their goals, preferences, and concerns, are fundamental to a successful transition. Nurses can help ensure that treatment goals and patient needs are met by providing support, education, and care.

The authors work at Lutheran Medical Center in Wheat Ridge, Colorado. Armi S. Earlam is the lead certified wound ostomy and continence nurse, Lisa Woods is a certified wound ostomy and continence nurse, and Kari Lind is an RN working in wound and ostomy care.
Selected references

Adkins CL. Wound care dressings and choices for care of wounds in the home. Home Healthc Nurse. 2013;31(5):259-67.

Agency for Healthcare Research and Quality. Care Transitions from Hospital to Home: IDEAL Discharge Planning: Implementation Handbook.

Alper E, O’Malley TA, Greenwald J. Hospital discharge and readmission. UpToDate®. April 3, 2017.

Dreyer T. Care transitions: Best practices and evidence-based programs. Home Healthc Nurse. 2014;32(5):309-16.

Hudson R, Comer L, Whichello, R. Transitions in a wicked environment. J Nurs Manag. 2014;22(2):201-10.

Krapfl LA, Peirce BF. General principles of wound management: Goal setting and systemic support. In: Doughty DB, McNichol LL, eds. Wound, Ostomy and Continence Nurses Society® Core Curriculum: Wound Management. Philadelphia, PA: Wolters Kluwer; 2016; 69-79.

Milne C. Challenges of transitioning wound patients through the continuum of care—Q & A. November 2016.

Adapting to Overnight Shifts: 5 Common Mistakes and How to Avoid Them

Adapting to Overnight Shifts: 5 Common Mistakes and How to Avoid Them

Mar 30, 2018 | Blog, Minority and Community Health

Working overnight shifts is a big change for many nurses, but it’s also extremely common. With the 24-hour demands of the bustling, modern health care system, there’s a good chance you’ll have to work the night shift at some point in your career, especially when you’re starting out. But don’t fret! There are many ways to ensure that the transition from day to night goes as smoothly as possible.

All nurses need to be on their A-game with technical medical skills and emotional resilience no matter what time of day they’re working. Night shift nurses have to shoulder even more burdens because they often work mostly or entirely alone for their shift. While there’s no one “right” way to adapt to the night shift, there are several common mistakes that you’ll want to avoid to build good habits.

Common Mistakes to Avoid When Switching to the Night Shift

Going against your circadian rhythm is no small task. However, resorting to quick fixes will only make your shifts more difficult in the long run. Avoid these five common mistakes and you’ll adapt to the swing of a night shift quickly.

1. Not getting enough rest before starting a shift.

As a nurse, it’s important to always be sharp on the job. The staff at Gurwin Jewish Nursing and Rehabilitation Center emphasize that not getting enough rest is the number one mistake that new night shift workers make, and it’s one of the most dangerous. Since shifts are often upwards of eight hours long, there’s no safe way to “power through” on too little sleep. This goes for both on-shift work and driving when sleep-deprived.

How to Avoid It:

Install blackout curtains where you sleep and get a fan or white noise generator.
Turn off your phone, get a “Do Not Disturb” sign, and inform loved ones of your schedule.
Staying up for a few hours to relax and take care of yourself may be easier for some nurses than going straight to bed at the end of a shift. You’ll figure out what works for you with time, so don’t be afraid to experiment.
Take proper care of your legs and feet while on your shift, so you won’t be troubled by pain or soreness when you’re trying to sleep.
Light soothing candles and practice stretches to relax yourself before bed.

2. Leaning on sugary foods, alcohol, or caffeine instead of proper nutrition.

It can be tempting to snack on chocolate or chug coffee to keep yourself going through your night shift. Keep in mind that, if consumed in excess, coffee can lead to jitters at first, followed by a crash. You’ll be far better off if you instead focus on getting more sleep.

How to Avoid It:

Plan and pack your meals ahead of time to avoid relying on vending machines.
Schedule your heavy meals so they won’t interfere with sleep.

3. Letting your personal life fall into disorder.

Sometimes it’s hard to keep your personal life in order while working the night shift. Errands, social gatherings, and childcare all battle for your attention when you’re not at work. This reduces your ability to get good sleep and, in turn, to focus at work.

How to Avoid It:

Yoga and meditation help you relax and leave work behind so you can be present when you’re engaging with family or friends.
Establish a schedule for sleep, chores, and activities. This will reduce the stress of missing out on things.
Plan gatherings ahead of time with friends and family to ensure you can make it to fun gatherings.

4. Not asking for help or feeling like you have to “do it all.”

Yes, there are fewer resources available overnight at the hospital. This can lead to superhero-esque thinking, where you refuse or even genuinely forget to ask for help. Being honest about needing a hand is better than dropping the ball because you’re juggling while tired.

How to Avoid It:

Get to know the others who work nights so you can trade favors.
Get to know the resources available to you during your shift.
Ensure that your roommates or family are sharing the load with you at home.
Choose sleep over chores when possible at home. Others can help you with chores, but they can’t sleep for you!

5. Missing out on workplace bonding, training, or resources due to night shifts.

It’s easy to feel forgotten when working the night shift. Try not to miss out on opportunities for bonding, continuing education, or extra support because of your schedule. It can be hard to make time or schedule changes for these opportunities, but they’re integral to your career development down the line.

How to Avoid It:

Check announcement boards and learn about opportunities available at your workplace.
Make it known to your boss and coworkers that you’re interested in additional training, support, resources or team bonding even if you work the night shift.
Ask if there are online resources available for any opportunities that you simply cannot attend.

Your job as a nurse is important. Don’t let working the night shift get in the way of providing the best care possible to your patients and yourself. Getting enough sleep is integral to your job performance and personal health, but that’s not always enough. You also need to make sure you’re practicing good self-care and focusing on your health along the way. With these great tips, you’ll adapt to the night shift in no time!

Deborah Swanson is a medical office professional with two decades of experience helping small practices and large hospitals alike improve efficiencies. She recently started consulting with allheart.com providing insight into the daily activities of medical professionals and how best to serve them.

News You Can Use: Detecting Dysphagia

Detecting dysphagia
May 2017 Vol. 12 No. 5

Author: Carel Mountain, DNP, RN, CNE; Kimberlee Golles, MS, CCC-SLP

It’s 8:00 am and time for your 83-year-old patient, Virginia Johnson*, to take her oral medication. She was admitted with a left femoral fracture following a fall. After the initial surgery, she developed a urinary tract infection, and this morning she is disoriented and confused. As Mrs. Johnson takes the first pill, you notice she takes a long time to swallow and then coughs immediately after. You recognize that Mrs. Johnson may have dysphagia and that she’s at risk for developing aspiration pneumonia.

As the population ages, hospital clinicians see more patients with dysphagia resulting from stroke, dementia, and Parkinson’s disease. (See Causes of dysphagia.) Patients with dysphagia are at high risk for developing aspiration pneumonia as a result of food, liquid, or oral bacteria going into the lungs. Other complications include dehydration, malnutrition, and airway obstruction. Through consistent patient interaction and using a simple assessment technique, nurses can recognize dysphagia early and make referrals to help prevent complications, decrease hospital stay, and contribute to the health and safety of patients.


Bedside assessment

Use the PASS acronym to determine your patient’s risk for dysphagia (See Don’t PASS up the opportunity.) Start by asking if it’s probable that the patient will have difficulty swallowing. For example, intubated patients and those with feeding tubes are at risk for dysphagia. Next, ask for an account or history of previous swallowing problems, which may indicate future problems and the need for additional or immediate intervention.

The third step is to screen your patient for observable symptoms such as drooling, coughing, or change of voice or speech. Your observation doesn’t need to be formal; simply watch the patient while he or she is eating or taking medications. However, to ensure accuracy, make the following preparations:

Ensure that the patient is seated as upright as he or she can tolerate without significant discomfort or pain.
Make sure the patient is fully awake and alert.
Note patient behaviors when eating or taking medication. For example, does the patient appear impulsive or anxious?

Any of the following signs or symptoms may indicate the need for an immediate referral to a speech-language pathologist (SLP) for dysphagia assessment:

coughing or throat clearing before, during, or after swallowing
wet, gurgling voice before, during, or after swallowing
shortness of breath after swallowing
drooling or loss of liquid from the mouth
holding food or liquid in mouth for extended time without swallowing
complaining of food or liquid feeling stuck.

Patients with risk indicators should also be referred for assessment by an SLP. Making a referral may not require input from a provider, but check your organization’s policy.
Interdisciplinary referral

Collaboration between speech pathology and nursing can help reduce complications related to poor swallowing. The SLP, after careful assessment, can adjust the patient’s diet related to the degree of swallowing difficulty. In addition, the SLP may prescribe the following exercises:

neck muscle exercises
tongue and oral exercises
coughing exercises
pursed lip breathing
effortful swallowing.

Nursing considerations

Poor oral function can lead to an increase in gram-negative anaerobic bacteria and masticated food residue in the mouth, both of which increase the patient’s risk of developing upper respiratory infections and aspiration pneumonia. And in patients with decreased mobility, compromised respiratory status, or reduced cognition, poor oral hygiene may increase the risk of bacterial infections secondary to aspiration of secretions, food, or liquid into the lungs.

To prevent these complications secondary to dysphagia, ensure good oral hygiene. Provide consistent oral care, at least three times a day, including cleaning the tongue, palate, and teeth with a brush or swab. You or the SLP also can train patients, nursing assistants, and family members to provide oral care. It’s best to choose a consistent time, such as lunch, for reminding and encouraging the patient to perform swallowing exercises prescribed by the SLP

To ensure consistency of care, document all nursing interventions, including aspiration precautions, education, and patient understanding.
Stop complications before they start

Your early and accurate detection of dysphagia helps reduce patient complications. Using the PASS bedside swallowing assessment is an easy way to identify at-risk patients, make appropriate referrals, and stop the complications of dysphagia before they start.

After recognizing Mrs. Johnson’s difficulty swallowing, you notify her physician and make a referral to the SLP, reporting your PASS observations. After completing the swallowing evaluation, the SLP informs you that Mrs. Johnson appears safe for nectar thickened liquids and requests that her pills be administered crushed in puree. By working as a team, you and the SLP adjusted Mrs. Johnson’s plan of care, thus avoiding potential complications and ensuring Mrs. Johnson an uneventful recovery.

Carel Mountain is director of nursing at Sacramento City College in Sacramento, California. Kimberlee Golles is a speech-language pathologist at Kaiser Permanente Medical Center in Walnut Creek, California.

*Name is fictitious.
Selected references

Campbell G, Carter T, Kring D. Nursing bedside dysphagia screen: is it valid? J Neurosci Nurs. 2016;48(2):75-9.

Canham M. Looking into oropharyngeal dysphagia in older adults. Nursing. 2016;46(6):36-42.

Hines S, Kynoch K, Munday J. Nursing interventions for identifying and managing acute dysphagia are effective for improving patient outcomes: a systematic review. J Neurosci Nurs. 2016;48(4):215-23.

Park Y, Oh S, Chang H, Bang, H. Effects of the evidence-based nursing care algorithm of dysphagia for nursing home residents. J Gerontol Nurs. 2015;41(11):30-9.

Seedat J, Penn C. Implementing oral care to reduce aspiration pneumonia amongst patients with dysphagia in a South African setting. S Afr J Comm Disorders. 2016;63(1).

Why your nursing networks matter

Why your nursing networks matter
March 2018 Vol. 13 No. 3
Networks help you advance your career, provide high-quality care, and support your colleagues.

Takeaways:

Professional networks are crucially connected to quality patient care.
Building a professional network can take two paths: a network in your immediate clinical environment or one created through an organization.
Professional networking has rules, such as adding value to others, building a professional image, and being prepared and positive.

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN, and Tanya M. Cohn, PhD, MEd, RN

nursing network matter
Maria is a direct-care nurse working on a medical/surgical unit in an acute-care hospital. She recently achieved certification and became a member of a national nursing organization for her specialty, both of which are needed to advance through the clinical ladder at work. However, Maria isn’t sure why her hospital values membership in the national organization or how it will help her career. She has a busy personal life and doesn’t have time to volunteer in her local chapter.

Maria’s lack of understanding about the value of professional networks isn’t unusual. Many nurses never make the investment of getting involved with professional associations or take the time to ensure that they have a strong network of colleagues within and outside their own organization. They wonder why they should spend what free time they have on an activity that seems so indirectly related to their work, and they fail to see how a network can enhance their professional growth or be a wise career investment.

The value of professional networks

Maria, like all direct-care nurses, is part of the profession of nursing. As a member of the profession, she has the opportunity to develop through continuing education, certification, and membership in nursing organizations. These activities will help Maria evolve from a novice to an expert nurse and open doors to professional networks. Professional networks also will provide her with mentorship, support, and teamwork opportunities. For example, if Maria’s interested in developing specific skills or advancing her education, she can use her network to identify a mentor for skill development or guidance on educational opportunities.

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Professional networks are crucially connected to quality patient care. Specifically, healthcare demands evidence-based practice, but nurses across the nation frequently are faced with variations in patient care and deep-rooted sacred cows of practice that are neither evidence-based nor current. Working in silos of individual clinical settings, nurses are left with less-than-optimal patient care and the need to develop evidence-based solutions from scratch. This is where professional networks can promote evidence-based practice through collaboration. For example, as a member of a national organization, Maria has access to networking with other medical/surgical nurses. Together they can compare and share best practices or research findings from their clinical practice, reducing the need to re-create the wheel individually. The result is consistent evidence-based, high-quality patient care.

For young nurses like Maria, a strong network can help when looking for new career opportunities. Many positions are never advertised, and workforce recruiters acknowledge that their best referrals come from professionals whose judgment they trust. Today’s healthcare environment is volatile, so building a strong network should be part of a professional insurance policy.
Steps to building a network

Building a professional network can take two paths: a network in your immediate clinical environment or one created through an organization. Both require common steps.

First, establish an understanding of your goals and who can help you achieve them. For Maria, this could include using her knowledge and experience as a certified medical/surgical nurse to establish a unit-based education program or to take part in a unit-based council to work collectively with other nurses through
evidence-based practice and nurse competencies. Maria also might be interested in tapping into the nursing organization she’s joined to seek out up-to-date practice alerts. Regardless of the professional network, after goals are set and the right people are identified, you can interact, share knowledge, and receive plans to help you achieve your goals.

If you don’t have a specific goal in mind, building a professional network might seem daunting or unclear. Start by putting yourself out there in the nursing profession. For Maria, who may not be able to commit to joining a committee within the nursing organization, she can plan to attend the organization’s annual conference. While there, she can take steps to maximize the networking experience. First, she should think about some conversational topics and introductory questions to use when interacting with other attendees. Depending on Maria’s professional goals, the topics and questions could revolve around clinical practice, leadership development, or advancing education. In addition, Maria should be professionally prepared for the conference, including wearing professional attire and taking business cards. She also should plan to attend all social events and interact with the conference vendors, who could be potential future employment opportunities or offer cutting-edge evidence-based products she can share with her clinical colleagues.
The golden rules of networking

Networking opportunities exist everywhere, including online with sites such as Facebook, LinkedIn, and Twitter. Many nursing organizations have Facebook and Twitter accounts that nurses can follow to support networking about clinical practice and professional development. LinkedIn, on the other hand, helps nurses identify mentors and colleagues with similar interests. Regardless of whether you’re networking at a conference, within an organization, or online, you’ll need to follow some rules. (See Expert advice.)nursing network matter expert advice
Networking for introverts

If you’re naturally introverted, networking may not come easily. You may even avoid networking events because they’re exhausting and force you outside your comfort zone. The hardest part can be walking through the door into a room. Fortunately, most people would rather talk than listen, so let others do the talking. You can never go wrong asking questions and establishing common ground. (See Get the conversation started.) Chances are that once you start asking questions, the conversation will flow easily. Most nurses like to be asked about their opinions and sought out for advice. You’ll be seen as a great networker because you take the time to listen.
Join the networked world

Over the course of her career, Maria will learn that building a network is one of the most powerful opportunities that membership in a professional association can provide. A good network outside her clinical setting will help her gain access to and act on new information quickly. She’ll also save time and energy by accessing other professionals who’ve overcome some of the same challenges she’s facing. Many young nurses have fast-tracked their careers by getting involved with association committees or running for office.

We live in a networked world, so developing your networking skill set is important to your career success. You never know what new opportunities you’ll encounter or who you’ll meet until you extend your hand, introduce yourself, and start asking questions.

Rose O. Sherman is a professor of nursing and director of the Nursing Leadership Institute at Christine E. Lynn College of Nursing, Florida Atlantic University in Boca Raton. You can read her blog at www.emergingrnleader.com. Tanya M. Cohn is a nurse scientist at West Kendall Baptist Hospital Nursing and Health Sciences Research in Miami, Florida.
Selected references

Cain S. Quiet: The Power of Introverts in a World That Can’t Stop Talking. New York: Broadway Paperbacks; 2012.

Henschel T. How to grow your professional network. 2018.

Jain AG, Renu G, D’Souza P, Shukri R. Personal and professional networking: A way forward in achieving quality nursing care. Int J Nurs Educ. 2011:3(1):1-3.

Mackay H. Dig Your Well Before You’re Thirsty: The Only Networking Book You’ll Ever Need. New York: Currency Press; 1997.

Maxwell JC. The 21 Irrefutable Laws of Leadership: Follow Them and People Will Follow You. Nashville, TN: Thomas Nelson; 2007.

Sherman RO. Building a professional network. Nurse Leader. 2017;15(2):80-1.