Rosie Moore – Page 7 – JRM Nurse Consultants

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.

January 01 2017

Using Evidence to Change Policies

Rules are sometimes implemented by people who may not actually be a staff nurse to observe and see what a family’s needs are. In most hospitals these days there are more times that can be spent with families in intensive care units, however they are probably limited to 1-2 people. As a staff nurse, changing a policy that is not implemented is not a good thing, because if something were to happen while the family is there, the nurse may be reprimanded for not following protocol. What the staff nurse can do is collect information by asking a foreground question that is more specific (Rubenfeld & Schaeffer, 2014).

An example of a foreground question can be which visiting hours work best for families that have patients in the hospital? The nurse should look for the answers by recording the hours that the families are able to come in to see their loved one. Once this is determined, then the nurse can speak with the manager and bring the evidence that was collected, specifically how many families were questioned, what hours they were visiting, what is the majority of the time that families selected. Once the manager has had a chance to review the statistics provided, then this information can be taken to the decision makers of policies to review and come up with a better outcome. Making changes in the workplace can only take place when the staff genuinely cares about work place practices that will benefit their patient and the staff (Mitchell, 2013).

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

Judging the Quality of Research Articles

In this study fifteen mothers who had babies born in to the Neonatal Intensive Care Unit (NICU) were evaluated using Spradley’s domain analysis approach. The purpose of the study was qualitative to show how parents develop an ownership as a mother to the baby in the NICU. The study was also quantitative because mothers in the NICU dealt with all emotions that they felt throughout different stages in their stay from stress to grief and feeling like they could not take care of their baby (Heerman, Wilson, & Wilhelm, 2005). The researchers clearly stated their purpose in confirming their suspicion and that is that parents in the NICU do not feel like the baby is theirs until they go home with the baby. This method of study is done interview style and using different stages, meaning parents staying there from at least one week with a 24-34 week gestation baby. The study used middle class mothers that were Caucasian.

The method of study is a valid one to obtain research, however I may have opted to use mothers of different ages, different races and more than one hospital. The factors that I feel interfered with the integrity of the research study is that the people were all of one socioeconomic class and race. This does not give a valid study to the rest of the population, because premature birth does not make exceptions to race, economic status, geographic location, famous or not famous, it can affect anyone. A resource that would help would be other studies that used qualitative research as well with a broader subpopulation.

Although the study only used one socioeconomic class and one race, the study does express the issues that have been mentioned in other studies that talk about what parents feel when they are in the NICU like the study conducted by Dudek-Shriber that showed the stress of parents while in the NICU. The study that Dudek-Shriber utilized was a larger group of mothers and also a diverse population. In comparison to the current study, Dudek-Shriber’s study was more accurate because there was variety in stages of birth, race, mother’s age and the length of stay in the NICU (Raines, 2013).

There are clear links in the subpopulation collected by the researcher to obtain the conclusion obtained, which is that mothers feel like a visitor instead of a mother when they have their baby in the NICU. They do not feel that the baby is theirs until they go home. Now some mothers do feel that they are a part of the baby’s life while they are in the NICU from day one and get involved to the point that they start to act like the staff according to the results. These moms will use the same language to describe their baby but it is not really identifying them as a mother, they are still referring to the baby the same as the nurses. The bonding has not occurred when the mothers are going through the motions that the nurse are going through.

This study cannot be generalized as the researcher only used one race and only fifteen mothers. It was very specific to the one NICU. This study population is of course similar to the population I will be working with, because as noted earlier, prematurity does not make exceptions to race, economic status or age. The researchers concluded that nurses in the NICU need to ask the mothers if they want to be involved at the different stages of the baby’s care so that they can feel connected as a family. Nurses are sometimes very quick about their agenda and will forget to ask the mothers about being involved because they have an agenda to take care of.

References

Heerman, J. A., Wilson, M. E., & Wilhelm, P. A. (2005, May/June). Mothers in the NICU: Outsider to Partner. Pediatric Nursing, 31(3), 176-200.

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

Tag Archives: Rosie Moore

Critical Consciousness

Updating Training in the NICU

Using Evidence to Change Policies

Judging the Quality of Research Articles