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January 01 2017

Best Practices for Informatics

The informatics that is available to nurses is amazing. Although there is always going to be something that someone thinks of that will improve the quality and speed of how we do our jobs, we as nurses have to be willing to have intellectual integrity that moves us beyond our own needs (Rubenfeld & Schaeffer, 2014). I used to work remotely from home as a manager for field case managers. Our case managers would go out in the field and see the members on our health plan. They carried a laptop so that they could document anywhere and pull up their member’s information. Of course the security to get into the laptop was only via an ever-changing token so that they could access it. With protected health information, the nurses had to be extremely aware of technology.

Years ago, many nurses had to document on paper when they would visit a patient in their home and they carried a paper chart in their car. Informatics has improved in leaps and bounds.

When the case manager is at the member’s home, they are able to do their assessments right in the member’s home and share the outcome from the assessments with the member. Meetings were held via WebEx when we had them because everyone worked from home. This made training on a new process easier giving everyone the ability to receive new information at the same time.

We also had a patient interface after the member was enrolled in our program. The member would get in the patient status screen and would be able to add goals to their plan of care that they wanted to work on. When the member filled this out, the nurse on the file would receive an alert that someone updated their file.

Close-up of happy female doctor talking with senior patient at clinic.

I see many opportunities for transforming knowledge from the use of informatics. For instance if we were able to send doctors an email right from the member’s file, and get the reply from them instantly, it would cut back on the time and phone calls to doctors to get certain forms filled out for the teams throughout. Some nurses that did not grow up with computers may have a challenge adapting, but with some education that can be done right from WebEx, they can learn. Computers and their programs are not going anywhere; they are the wave of the future.

References

Rubenfeld, M. G., & Scheffer, B. (2014). Critical Thinking Tactics for Nursing Achieving the IOM Competencies (3rd ed.). [P2BS-11]. Retrieved from http://online.vitalsource.com/books/9781284059571

January 01 2017

Culturally Competent

In today’s world, there needs to be more education of staff on diversity of cultures. In healthcare it is very important to have all staff, not just nurses, be aware of the different cultures that come in to the hospital, nursing home, rehab centers and doctor’s offices. Health and illness are looked at in many different ways by different cultures. Take for instance the Hispanic population; it is one of the fastest growing ethnic groups in the United States.

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There are many health risk factors in the Hispanic population. Some examples of health risk factors are smoking, uninsured under the age of 65, diabetes, diet, hypertension, obesity and low birth infants. There are also many causes of death seen in the Hispanic population for instance, heart disease, cancer, unintentional injuries, stroke, diabetes complications, chronic liver disease, homicide, influenza, pneumonia and disorders originating during pregnancy.

Hispanics are challenged on a daily basis because they have environmental and community risk factors as well. This group has limited access to healthcare, problems with immigration status, language barriers, cultural barriers, lack of preventative care, and lack of insurance and dangerous work conditions at times.

As nurses we need to be able to provide culturally competent care to our patients. At times rather than just going through the motions of medicating patients, we need to process the information that we are receiving. There are several strategies that we as healthcare workers can use. The first strategy in assuring culturally competent care should be evaluating the healthcare professional’s individual approach to the culture that is being worked with by asking yourself questions. Am I aware of my own biases and prejudices towards the group I am treating? Do I have the knowledge and skill to conduct the assessments that are needed in a sensitive manner? Do I seek out to interact with other cultures other than the ones I am comfortable with? Do I really want to be culturally competent? (Jeffreys, 2008) Another way that nurses can become more culturally diverse is by gaining the patient and family’s trust.

References

Jeffreys, M. (2008, November/December). Dynamics of Diversity Becoming Better Nurses through Diversity Awareness. NSNA Imprint, 36-41. Retrieved from http://www.nsna.org/Portals/0/Skins/NSNA/pdf/Imprint_NovDec08_Feat_Jeffreys.pdf

January 01 2017

Critical Consciousness

My awareness of critical perspective has expanded beyond the arena of where I work, it has involved my charity The Gift of Life and my wedding business 27 Miracles. I started out my nursing career working in a high risk labor and delivery unit. In labor and delivery you meet all kinds of people from different walks of life, different religions, different ethnicities and socioeconomic status. During a critical time such as labor when there is pain, this is when you learn about other people’s cultures and how pain is perceived by them. As a nurse we learn about those different cultures through experience so that when we do encounter them, we can understand what level of privacy and respect they need.

My husband and I own a wedding and event planning business called 27 Miracles. Through the years we have become well known in our town for working with ethnic weddings from different countries as well as interracial. It has allowed me as an individual to learn many cultures and be able to show respect for other cultures and their ways of communicating. It is a beautiful thing to see love spoken and expressed in so many different languages and cultures through music, food and traditions.

I have learned through my nursing experiences and my wedding experiences how to appreciate people more and take interest in who they are as a person. As nurses we get busy when we work on the floor or in an office and talk about our patients as just another number because we are in a hurry. Even on our busy days, we need to stop along the road and take a moment to say hello to our patients, provide a gentle touch to their hand or shoulder, and a listening ear. These are all part of critical perspectives or as I like to call it cultural awareness.

Many say that the parents of premature babies experience preterm birth because the parent did something wrong, they smoked, drank, did drugs or a teen age pregnancy caused the premature birth. Although some of those reasons may be true, there is another side to prematurity that people do not think about. The mother that develops maternal illnesses like Diabetes and Hypertension, or the baby that for some reason starts developing intrauterine growth retardation and it is unsafe for him or her to be inside the womb. It is very easy to judge when you don’t know the situation or have never experienced it, but as nurses we need to develop ways of thinking that allows us to be aware about ourselves and those around us (Gotzlaf & Osborne, 2010).

Working with a population of parents that have premature babies, has shown me that premature birth happens all over the world. Premature birth limits no race, religion or economical status. Our job as a nurse is to be aware of the different cultures and take the time to learn about their culture and how you can work with that person.

References

Gotzlaf, B. A., & Osborne, M. (2010). A Journey of Critical Consciousness: An Educational Strategy for Health Care. International Journal of NursingEducation Scholarship, 7(1), 1-15. http://dx.doi.org/ 10.2202/1548-923X.2094

January 01 2017

Working Your Staff Unsafely

This week has been the week of speaking with different professionals on training and how companies place employees in jobs that are not properly trained in their skill set to pay them less and get more out of them. I used to work for a large insurance company that employed over 80,000 people. I worked in the long-term care department which had about 400 staff from administrative assistants to presidents. I was the manager of case managers which consisted of RN’s, LPN’s and Social Workers. They all did the same job and got paid different salaries to do it, however the job description and responsibility was the same.

I felt that this policy of having nurses and social workers working on the same cases needed to be changed. Having all the staff doing the same exact work and paying them differently based on their degree and expecting the same level of skill, was inappropriate. Nurses have a different skill set than social workers. If a patient has a medical issue, the social worker that is visiting that member in the home completing an assessment may not be able to capture that the member has been retaining water in their ankles and think to ask if they are on a diuretic. Much like the nurse that goes in the home setting and sees a patient that has issues paying their light bill won’t know where to call to find a resource for them. The patient may be concerned because they are on oxygen at home; they wonder how they will pay their light bill and what they will do if the power is turned off. This can be a liability to any staff member but also a disservice to the patient.

In contrast, I worked for another company that did case management. I loved that job, until federal cutbacks came along for the program during the new Obama administration. The company employed RN’s, MSW’s, CHW’s, Nutritionists and Behavioral Health Specialists. The cases were assigned only to nurses and there were two tiers of nurses, regular case managers and those that were more experienced received complex care patients. The other staff MSW’s, CHW’s , Nutritionists and Behavioral Health Specialists were consulting on the files that the nurses referred to them. They would work as a team with the nurses. This team work gave the patient a more well-rounded form of care.

There are several leadership styles in companies, autocratic, democratic and laissez-faire. In the large insurance company that had all the workers regardless of skill set do the same job, the leadership was autocratic. The department maintained total control in all decisions and no opinions or suggestions were accepted from others. There was no opportunity to make a change due to the leadership style. In my prior job, where everyone worked on a tiered team, there was a democracy; decisions were made after consideration of input from the staff (Mitchell, 2013).

There are some days that as a professional you want to see changes implemented or at least considered, however the leadership does not support that. If you are the type of person that works for the better of seeing changes in a situation, get involved in the departments or committees that have a say in policy writing, this will be the only way to see changes that can be discussed for the betterment of the company.

References

Mitchell, G. (2013, April). Selecting the Best Theory to Implement Planned Change. Nursing Management, 20(1), 32-37. Retrieved from http://web.a.ebscohost.com.library.capella.edu/ehost/pdfviewer/pdfviewer?sid=4ba42c53-9a6d-4ec5-b6bb-2f078e04b7c7%40sessionmgr4001&vid=1&hid=4204

January 01 2017

Updating Training in the NICU

Most recently a nurse working in the neonatal intensive care unit (NICU) approached me to ask about changing policies at her hospital regarding the updated training that they offer the new nurses on the unit. In discussing the policy that she wanted changed in her unit, I would have to agree with her after reading about the training that they are giving the new staff. If the new staff is watching old videos and training with different staff that have a different approach on how to do things, this will create stress in the learner. There should be two trainers dedicated to teaching the new staff the preliminary things with several nurses trained as preceptors. During the preceptor time, additional staff should be brought in so that the preceptor can properly train the new nurse without ignoring the learner and their needs or neglecting the patients.

The new parents coming in to the nicu to spend time with their babies are already highly stressed, this is why it is imperative that they have a nurse who is confident in the care of their infant. The only way that this can be carried out is through the staff being properly trained. Using a program with a check off system is good as far as having the information taught, but there needs to be a return demonstration on it. Once the new nurse has been taught the things that are required about the unit and has completed the checklist, then the roles should be reversed. Meaning the preceptor becomes the nurse and the nurse becomes the preceptor going through the day with what the job entails and the preceptor documenting how well the nurse mastered the information. This will allow the preceptor to know if the new staff needs further instruction.

In thinking about what the nurse stated that the hospital has to spend money to send staff to conferences, purchase new training videos and new computers, this is a necessity. There is not any amount of money or value that can be placed on the life of a premature baby that a large hospital can’t do to properly train staff. There are online courses and expert teachers that may come and do continuing education monthly at the hospital so that they can save some money on sending staff to conferences. Also sending someone to the conference is a good idea, because they can come back with a wealth of knowledge to update the staff that did not go. Hospitals can also check if there is an option to purchase the conference material after the conference for those that could not attend. Implementation is considered the fourth step in the evidence based practice process. The problem is identified and the solution is noted, however implementing it is what is left to do (Fineout-Overhult & Johnston, 2006).

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The preceptor NICU nurse, should make every effort to make the environment for the new nurse, conducive to learning, the focus should be on the new nurse. The environment should be very comfortable and peaceful, allowing the new nurse to ask the necessary questions that they may have (Pilcher, 2012). In the end, if the investment to properly train new nurses is taken and continued throughout their employment, imagine the efficiency that the unit would have decreasing the stress level of this unit and increasing the patient satisfaction.

References

Fineout-Overhult, E., & Johnston, L. (2006). Teaching EBP Implementation of Evidence: Moving from Evidence to Action. Worldviews on Evidence Based Nursing, 194-200.

Pilcher, J. (2012, January/February). Toolkit for NICU Nurse Preceptors. Neonatal Network, 31(1), 39-44.

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Years of experience in Work Comp, Case Management, Disease Management, Utilization Review and Prior Authorization.

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Best Practices for Informatics

Culturally Competent

Critical Consciousness

Updating Training in the NICU