(0)
Best Practices Newsletter
The Saga of my Fractured Meta-Carpal
August 9, 2008 | by supportfornurses | Permalink
In May, I fractured my hand (meta-carpal, right hand); hence I had my first trip (as a patient) to the emergency dept. Since I have never experienced being a patient in emergency, I braced myself for what I anticipated would be a long wait with a lot of confusion. And, my assumptions were not that far off. Indeed, I was told to wait no matter where I went. Communication between doctor, nurse and various techs left a lot to be desired. At one point, a well-meaning nurse was about to place an IV in my arm, even though an operation had not yet been authorized. The staffing, of course, was a problem; a nurse placed a blood pressure cuff on me and then had to attend to another patient; I had to find her in order to remove it. That was pretty much the scene; people were friendly and polite (which was very nice); it is unfortunate that due to staffing problems, that communication between roles seemed to be minimal.
I quickly became my own patient advocate, asking questions and wanting to get a complete understanding of what was about to happen. Sometimes I received clear answers, sometimes not. What I did learn was that I had to have an operation to place pins in my hand (not fun); but the big issue was when to schedule the surgery. This is where my learning curve truly began. First, I was told that the operation would occur that evening; I was then told—forget that—it would happen the next morning; in fact, I was given an appointment slip with instructions as to how to prepare for a 10:30 surgery: don’t eat breakfast; have someone drive you back and forth to the hospital, etc.
Want more good tips and strategies, check out SupportForNurses.com excellent, top quality Tips Booklets! http://www.supportfornurses.com/booklets.php
An Unresolved Conflict affects the Team
April 26, 2008 | by supportfornurses | Permalink
Jan and Maria have worked in the same department for the past five years; their collegial relationship appears close—sometimes you imagine they could finish each other’s sentences. Lately, there has been noticeable tension in their relationship; it’s become clear that Jan is avoiding Maria, and Maria has no idea why. She hasn’t asked Jan why she is avoiding her; instead, she indulges in speculation—speculation that leads to rumination: “What happened?” “Why is Jan avoiding me?” “What did I do?” “Why does she hate me?” These tapes play over and over without end. Sometimes the questions change, but the tape keeps playing.
Poverty, Powerlessness and Healthcare
February 5, 2008 | by supportfornurses | Permalink
As a nurse, you may work in a clinic or hospital setting which largely serves people who live in or close to the poverty line; similar to treating people who are more affluent, it has its unique rewards and challenges. In order to work most effectively and empathically with this population, it is important to be aware of the issues that influence this population’s beliefs and their actions, including their health. People who are at the bottom of the economic ladder often suffer from very low self-esteem and have experienced little control over their life; that feeling of powerlessness has influenced their choices. When a person experiences little sense of control over their life, they are less likely to feel that taking responsibility makes a difference; it is as though they are saying, ‘life happens to me’. Obviously, this stance can be quite frustrating for a healthcare provider because someone who has experiences so little control over their life doesn’t understand how their actions can actually influence their health in both positive and negative ways.
An approach for a nurse to consider when treating people with low self-esteem (including feelings of overwhelming powerlessness) is to engage the patient with taking small, manageable steps to enlist a behavior change; for example, if a patient has to modify their diet, it is important to start the discussion with the question, “based on our conversation, what is one thing that you would be willing to do—one change that you can make in your diet?” If the patient is unable to identify a specific step (change), you may need to take a more active role with a patient. An initial dialogue can include, “let’s talk about what you usually like to eat for dinner?” If the patient reels off a menu with a litany of foods that are on the ‘avoid list’, you may want to make a suggestion that could motivate a response from the patient; an example of this approach might be, “instead of putting butter and salt on your fries, would you be willing to have a baked potato without salt?” The patient then has a frame of reference in which to make subsequent choices. This example represents a starting point: helping the patient to negotiate what they could imagine giving up along with discussing what they could add to their diet opens the door to the notion of options—options that a patient may have never considered. And when a patient is exposed to options, doors to other possibilities open in their life; this process could begin to shift the notion of powerlessness to empowerment, a terrific outcome for a patient who needs to change their behavior in some significant ways. While it is not unusual, at times, to feel impatient, frustrated and perhaps prejudiced towards a patient who experiences themselves as powerless it is not a reason to give up on a patient. Similar to other situations a nurse is faced with, the need to employ an effective strategy may be the key to success. It is definitely worth a try!
Communication Skills: Leap and Bounce©
November 12, 2007 | by supportfornurses | Permalink
By: Marlene V. Obermeyer, MA, RN
Culture Advantage Cultural Training and Continuing Education
Have you ever been in a situation where you felt tongue-tied, did not have any ready response to a remark, and only later you think, “I should have said________.”
Get some of your colleagues together to improve your communication skills while doing something fun. This is great for a team-building exercise.
Number of Participants: At least six persons gathered in a circle.
-
Equipment: Inflatable Ball
-
Poster board. Colored markers.
-
Room Requirement: Away from patient areas. (This could easily become a noisy activity!)
-
Rewards for winner or winners: (Your choice)
Review the following communication skills: L E A P
“L”: is for Active Listening. Description: Nodding, eye contact, attentive posture, facial expressions. It can also include encouraging comments such as “Go on…”, “Interesting!” “Hmmm…”
“E” is for Empathy. Description: Reflection of content and feeling.
Formula 1: Restating the feeling. “That must be very frustrating for you.”
Formula 2: Restating the feeling and content: You’re feeling ________ (state the feeling) because _____________(state the content).
Example: “You’re feeling frustrated because your best friend does not want to listen to your advice.”
“A” is for Asking questions, and checking Assumptions. Description: Asking: Ask open-ended questions, not answerable by yes or no.
Example: “What do you think about…?” “What do you mean by weird?” You can also ask a question by simply repeating the statement: “You’re feeling confused?”
Clarify your assumptions by asking the other person whether your interpretation is right or wrong.
Example: “I might be wrong, but did I understand you to mean that you and your best friend are not getting along very well?”
“P” is for Paraphrasing. Description: Restating the message in a different way, or summarizing several messages into one main message.
Example: “That does look like a lot of work for one person to do in one day!”
Instructions:
- Write the list of communication skills on the poster board. (L E A P, with a brief description of each.) Post the board so participants can see the list.
- Start with Person A with the ball and making a statement. For example, Person A says, “I can’t handle the stress anymore!”
- Person A throws the ball to Person B while calling out letter “L!”
- Person B catches the ball, and then chooses a response to the statement. (”L” is for active listening).
Example response: “Hmmmm…..interesting!”
- Person B then throws the ball to Person C while calling out the letter “E”.
- Person C chooses a response from the Empathy list (“That must be so discouraging!”) then throws the ball to the next person while calling out the next letter “A”. And so on.
- If a person cannot make up a response within 5 seconds, he/she can say “Pass” and then throws the ball to another person. After 3 “Passes” a person is “bounced” out of the game.
- After the letter ‘P” is called out and the process is completed for this letter, the last person throws the ball to another, and starts a new round. Make a new statement, call out the letter “L” and throw the ball to start a new round. For round 2, start with 2 statements; for Round 3, start with 3 statements, etc.
- Make your own rules for the winner or winners. This is a great activity for once a month meetings or team building activities. Print simple medals or certificates; for example, “LEAP and Bounce Champion of the Month” from your computer.
©Marlene V. Obermeyer, MA, RN, http://www.culture-advantage.com
Advocating cross-cultural excellence in health care.
© Mvobermeyer2007
Communication with Patients: What a New Nurse Needs to Know!
October 10, 2007 | by supportfornurses | Permalink
As a nurse, one of the most challenging aspects of patient care is the ability to communicate effectively with each of your patients so they truly understand—understand what they need to do to adequately support their self-care. This is particularly important if you are treating a client with limited literacy. And since 1/5th of the American population can be described as ‘functionally illiterate’, it is important that instructions given to this patient population is delivered effectively. Note: this doesn’t mean that patients with limited literacy are stupid; it simply means that they either have a limited education or are struggling to communicate in a language that is not native to them.
As a first step, always assess what a patient is capable of understanding; there may be obvious signs, such as a patient who struggles with expression (can’t find the right words, etc) or a patient whose vocabulary is severely limited; in this case, directions should be delivered in a very simple and succinct manner; sometimes, the use of symbols can help increase a patient’s ability to understand; a typical example is the use of symbols (a series of facial expressions) to help patients communicate the level of pain they are experiencing. A variety of symbols and pictures can be very helpful in increasing a patient’s ability to understand.
Language: make sure your language is concrete and uncomplicated; avoid using words that are familiar to you, but may not be at all familiar to the patient; for example, your patients with limited literacy may not know or use the words like ‘urinate’ or ‘stool’; therefore, you may want to substitute the word ‘pee’ for urine and ‘B.M.’ or ‘bowel movement’ for stool. Also, look for clues in the patient’s language; if you hear a patient describe how they are feeling using their own metaphors or slang, ask them the meaning (to ensure your comprehension), and then use their language when communicating with them.
Consistency of language: when giving a patient an instruction use the same word repeatedly so as to minimize confusion; for example, if you use the word ‘drug’ to refer to a medication prescribed to the patient, then keep using the word, ‘drug’; otherwise, it may confuse a patient if they hear the word ‘drug’ in one sentence and ‘medication’ in the next; they may think you are referring to two different medications.
Finally, it can be challenge to slow down and strategize the best way to communicate to clients who struggle with language and literacy; spending more time with these patients may give you the desired outcome: fewer mistakes related to a patient’s understanding of their self-care and a higher level of patient satisfaction—what more can you ask for?
________________________________________________________________________
OCTOBER, 2007 DISCOUNT!
Purchase two booklets, you get the third one free! Here’s how it works:
When you purchase copies of two of the three booklets listed below, SFN will send you the third copy FREE! That’s right. Buy 2 booklets and get the third booklet free! A savings of over $10.00! www.supportfornurses.com
- 80 (PLUS) Terrific Tips for a Successful Transition: New Grad to Competent Nurse
- Tips and Strategies for Effective Time Management;
- 72 (PLUS) Tips for Accurate, Legal and Ethical Documentation
Health educators: don’t forget to read the sample of the tool-kit when visiting the website: Orienting Foreign-born Nurses to Work Effectively in American Hospitals: A Tool-kit for Health Educators; and consider purchasing our highly acclaimed, 65 Tips for Foreign-born Nurses Working in American Hospitals, an accessible reference guide for a nurse who needs to adapt to an American healthcare environment.
_________________________________________________________________________
Always, always check out your assumptions about a patient’s well-being!
August 30, 2007 | by supportfornurses | Permalink
While it is not uncommon to make assumptions about people, the way to ensure that your assumptions are correct is to always check them out. This is particularly important for a nurse, and here’s an example why: Carol is a new nurse in a big city hospital where she recently started working. She is learning how to treat a diverse group of patients, which is sometimes a real challenge. Carol recently cared for a patient, Gerta, who was friendly but quite reserved; when Carol asked Gerta how she was doing, Gerta characteriscally said, “fine, no problem”. Gerta also noticed how busy Carol was and had a tendency to ask Carol how she was doing during rounds.
Although Gerta lived in the United States for many years, she grew up in a country where the norms regarding expression of feelings and needs are frowned upon. Carol, on the other hand, enjoyed treating Gerta because she expressed herself clearly and never made demands. In fact, Carol felt particularly appreciative of Gerta’s non-demanding character, because she was new and the staff shortage in the department added to her stress.
Carol’s relief treating Gerta turned to concern when she overheard Gerta telling her daughter how much pain she was in and how uncomfortable she was. This was an important ‘wake-up’ call for Carol, since she realized that she needed to be more attentive to Gerta, including asking her specific questions about her level of pain. Carol had assumed Gerta was doing fine; after all, her vitals and coloring were good,
and she didn’t appear to be uncomfortable. When Carol realized that this patient needed to more attention (not less), she spent her time with Gerta in a more productive way. During subsequent rounds, she asked Gerta specific questions about her pain-something she hadn’t done previously; she ask about the level of pain, the precise area of the pain, and she educated Gerta about options available to treat her pain. Also, Carol was careful not to insult Gerta by telling her that she should ’speak up’; she simply educated her, including letting her know that she didn’t need to be in pain and that treatment was available.
A nurse may be thankful and feel blessed when treating patients who are pleasant and not demanding, particularly in busy, understaffed hospitals. Having said that,it is always important to make sure that such a patient’s needs don’t get overlooked; that is not good patient care! Whether a patient expresses her
needs (or doesn’t), a nurse always needs to ask the appropriate questions, sometimes probing more in order to truly understand a patient’s condition. Vital signs are obviously important indicator regarding how a patient is doing.But spending time with a patient, asking the appropriate questions, a nurse can really find out what a patient truly needs.
________________________________________________________________________
Here is what’s NEW at SupportForNurses.com NEW Product for Health/Nurse Educators: SAVE MONEY: PURCHASE BEFORE SEPTEMBER 1ST!! Orienting Foreign-born Nurses to Work Effectively in American Hospitals: A Training Manual for Health Educators, by Geri-Ann Galanti, PhD. This extremely practical tool-kit contains a Leader’s Guide with exercises, activities, case studies and 119 power-point slides to help foreign-born nurses successfully learn the norms of an American health care environment. To find out more, http://supportfornurses.com/toolkit.php . Here’s what a happy customer had to say about the tool-kit! Orienting Foreign-born Nurses to Work Effectively in American Hospitals: A Training Manual for Health Educators should be incorporated into every US Hospital’s RN orientation that hires internationally educated nurses. This toolkit helps our Hospital Educators learn as well as teach their
UPDATED Tips Booklet:80 (PLUS) Terrific Tips for a Successful Transition: New Grad to Competent Nurse: you may remember 60 Terrific Tips for a Successful Transition: New Grad to Competent Nurse. This already terrific booklet has been updated and expanded; it includes more than 20 extra tips, case studies and a worksheet. This well-rounded, comprehensive tool is a great companion for a new nurse and the educators who support them! To find out more, http://supportfornurses.com/80_tips_new_grad.php.
UPDATED Product:Tips and Strategies for Effective Time Management has been expanded; it now includes more tips, more strategies, relevant case studies and an updated work-sheet! A great tool for keeping a nurse on time and on task! To find out more, http://supportfornurses.com/effective_time_management.php.
72(PLUS) Tips for Accurate Legal and Ethical Documentation contains all the answers a nurse needs to document patient care accurately, ethically and legally. Expect this booklet, with its wonderful examples and tips to improve your charting and elevate your documentation to a whole new level. To learn more, http://supportfornurses.com/72_tips_legal_docs.php.
65 Tips for Foreign-born Nurses Working in American Hospitals: Our highly acclaimed booklet is a wonderful resource for foreign-born nurses who need to adapt to the norms of working in an American Hospital. A nurse recruiter recently described it as “the perfect tool for nurses to read themselves as well as a tool for discussions groups”. This booklet is available in bulk, both electronically and as a hard copy. http://supportfornurses.com/65_tips_foreign_born.php.
Medication Mix-Up: A Case Study
August 6, 2007 | by admin | Permalink
Kathy Quan, RN, BSN
It’s your third day this week with the same patient assignment. That’s somewhat unusual because patients don’t usually stay more than a couple of days on your floor. It’s nice because you’ve had a tough couple of weeks and could use an easier day. Not that these are especially easy patients, but you are familiar with their cases. They aren’t whiney and demanding. They are eager to get better and to be educated in their care. In one room you have two patients who are about the same age. They look similar too. One is May and the other is Mary. May has the bed by the window. You are trying to find a good way of telling them apart for yourself. Of course you have to check their ID band for anything official such as medications, etc., but just for idle conversation you’re aware that if they weren’t in bed you could have difficulty. They both were admitted with similar abdominal complaints and have had a series of tests. One has been diagnosed with Crohn’s disease and the other is still waiting for more definitive information. They are both ambulatory and have become fast friends in this setting. You stop and think about how easy it can be to confuse your patients. Good thing you have to double check identities!! You realize why this is so important. Even though you have gotten to "know" these two patients,you can still mix them up. A little while later you’re passing meds and another nurse needs something from your cart. No problem you have May’s meds in your left hand because she’s next to the window and Mary’s in your right hand because she’s next to the door.
When you enter the room, both women are sitting in chairs next to the window. They will both need water for their medications; you go to get them water instead of handing them the medication cups first. "Uh oh", you set down the medication cups and suddenly you are no longer certain who gets which medication! One has a new medication and the other has something for tomorrow’s test. Once again, you think to yourself, "Oh dear, who gets what?" And you realize the patients won’t be able to recognize them. You think, "What do I do now?" Not only that, you’re in a hurry because a doctor wants you to assist him in the next room. You’re almost positive which medication goes to whom, but you aren’t totally certain. And to make matters worse, the other nurse took your cart back down the hall. You’re afraid you might look stupid in front of the patients or make them lose confidence in your ability if you question yourself. On the other hand, you could possibly mix up the medications and have a lot of consequences. The doctoris impatient, and he’s known to get very angry if he has to wait.
The best choice is to tell the patients that you forgot something. State that you will be back with your medications in a few minutes. Help the doctor and then double check the medications and get them to the right patient. Now, if there is a time restriction such as 30 minutes prior to a meal, you’ll have to instruct the patient to wait an extra few minutes before eating.
Here is what’s NEW at SupportForNurses.com
NEW Product for Health/Nurse Educators:
Orienting Foreign-born Nurses to Work Effectively in American Hospitals: A Training Manual for Health Educators by Geri-Ann Galanti, PhD.
This extremely practical tool-kit contains a Leader’s Guide with exercises, activities, case studies and 119 power-point slides to help foreign-born nurses successfully learn the norms of an American healthcare environment. To find out more,
http://supportfornurses.com/toolkit.php
UPDATED Tips Booklet:
80 (PLUS) Terrific Tips for a Successful Transition: New Grad to Competent Nurse:
(You may remember: 60 Terrific Tips for a Successful Transition: New Grad to Competent Nurse)
This already terrific booklet has been updated and expanded; it includes more than 20 extra tips, case studies and a worksheet. This well-rounded, comprehensive tool is a great companion for a new nurse and the educators who support them!
To find out more,
http://supportfornurses.com/80_tips_new_grad.php
UPDATED Product:
Tips and Strategies for Effective Time Management
has been expanded; it now includes more tips, more strategies, relevant case studies and an updated worksheet! A great tool for keeping a nurse ontime and on task!
To find out more,
http://supportfornurses.com/effective_time_management.php
72(PLUS) Tips for Accurate Legal and Ethical Documentation
contains all the answers a nurse needs to document patient care accurately, ethically and legally. Expect this booklet, with its wonderful examples and tips to improve your charting and elevate your documentation to a whole new level.
To find out more,
http://supportfornurses.com/72_tips_legal_docs.php
65 Tips for Foreign-born Nurses Working in American Hospitals:
Our highly acclaimed booklet is a wonderfulresource for foreign-born nurses who need toadapt to the norms of working in an American Hospital. A nurse recruiter recently described it as "the perfect tool for nurses to read themselves as well as a tool for discussion groups". This booklet is available in bulk, both electronically and as a hard copy.
To find out more,
http://supportfornurses.com/65_tips_foreign_born.php.
Critical Thinking: An Acquired Taste for Many Nurses
January 5, 2007 | by supportfornurses | Permalink
I recently spoke to a recruiter of international nurses
regarding the obstacles that that foreign-born nurses
encounter when adapting to an American hospital environment;
his response, adapting to the use of critical thinking skills.
Now, we know that the consistent application of critical
thinking skills is a must for all nurses; it is a vital
component to a nurse‚s decision-making process when
treating patients. And we know that critical thinking
requires asking questions and challenging assumptions˜it
is not about blindly following an MD’s order or following
a specific protocol, if there is concern on the part of the
nurse that either can result in harm to the patient.
Yet many international nurses come to America from authoritarian
cultures, where questioning a doctor is frowned upon and
considered a sign of disrespect; it is simply not the norm.
Therefore, one of the biggest challenges for international
nurses is adapting to the use of critical thinking skills
on a regular basis, since it feels rude and uncomfortable
questioning a doctor or a protocol. While it is important
to acknowledge that the application of critical thinking may
initially be a great challenge—an acquired taste, it is a
skill that nurses need to gradually adapt in order to be
successful. If you are a nurse who is struggling to adapt
critical thinking skills, it is important to implement
these skills gradually. First, observe your colleagues
and watch how they apply critical thinking skills: the type
of questions they ask doctors and other colleagues as well
as the questions they ask patients. Observations of your
colleagues along with mentoring will help you become more
familiar with the process of questioning; it is an important
step in the implementation of this new skill. And,
if you are an American born nurse who is comfortable with
using critical thinking skills, lend a hand to your international
colleague: encourage observation; in your conversations, model
the process of asking questions, and exercise patience.
New skills are usually not acquired overnight, particularly,
when the skills are linked with crude behavior in one’s
culture of origin; with practice and patience, all nurses
can become effective critical thinkers.
Cultivate Resilience: Essential for a New Nurse
March 27, 2006 | by supportfornurses | Permalink
Resilience: The dictionary describes resilience as “springing
back to its original form after being bent or stretched, springy”.
The operative phrase is Œspringing back‚ following the inevitable
challenges that are part of daily life of being a floor nurse.
A nurse needs to cultivate resilience to ensure job satisfaction
and longevity in a contemporary clinical environment. The
cultivation of resilience on the floor means being able to
bounce back‚ when things happen that are outside of your control;
perhapsit is being the recipient of a doctor’s irrational anger;
having a patient yell at you about a procedure she doesn’t want;
adjustingto a new policy coming from administration that creates
more work for you and confusion for the team; the list goes on
and on.
The ability to bounce back‚ makes all the difference in your
abilityto tolerate an environment where circumstances can change
in aninstant and where you are expected to adapt to the changes
when they occur.
Developing resilience all starts with an attitude that embraces
flexibility: as a new nurse, be prepared to roll with whatever
comes your way; expect that changing circumstances will be
the norm on your shift. For example, what was happening
on the floor at 9am may look very different at 11am; 1pm
may look very different from 11am and so on.
Now, I am not suggesting that resilience means that you should
repress feelings of annoyance or frustration; your feelings are
important and acknowledging them is a way to prevent resentment
from building up. The trick is to allow those feelings to have
fluidity: allow them to move through you, rather than becoming
a calcified part of you. When that happens, your ability to be
resilient is severely compromised.
Cultivating resilience may not be easy, but it is worth the effort.
Bouncingback is the best way to keep stress at bay and make some
room forenjoying your job.