Archive for July, 2010

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On Difficult Truths, Anger, and Compassion: Recent Poems in ‘Art of Nursing’

July 30, 2010

By Sylvia Foley, AJN senior editor

Loafer Mod by pdstahl / Patrick Stahl, via Flickr

“Why couldn’t you leave cleanly?” asks the narrator of Ann Sihler’s poem, “Leavings,” featured in the June Art of Nursing. The poem, written in response to a suicide, speaks to the emotions of those left behind. Its central image, a pair of “oxblood loafers lying there / for all to see,” is somehow both mundane and horrifying. It’s a stark poem, suffused with the narrator’s anger; yet its lack of pretension also affords us  relief.

The married man with “schoolboy cheeks” in Nancey Kinlin’s poem, “Practicing at Post Office Square,” has just heard what no one wants to hear: “the result / is positive.” The poem, featured in July’s Art of Nursing, gives us the disclosure—from the nurse’s point of view. It’s a poem about mistakes and compassion, about what it feels like to be the one delivering bad news. Kinlin’s spare, clear writing doesn’t flinch from its difficult subject.

Both poems are free online (you’ll need to click through to the PDF files). We invite you to have a look, sit with them, and tell us what they evoke for you in the comments.

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Supporting Nurse Practitioners as ‘Priority Primary Care Practitioners’

July 29, 2010

By Susan McBride, PhD, RN, professor at Texas Tech University Health Science Center School of Nursing 

It’s important for nurses to understand the Medicare and Medicaid incentives to implement electronic health records (EMRs) and to move to their “meaningful use,” as well as the purpose of the Regional Extension Centers created to support nurse practitioners and other “priority primary care providers” in the implementation process.

Dr. Mari Tietze, John Delaney, and I are fortunate to be involved in two of the Regional Extension Centers in Texas. We believe that nursing professionals have many contributions to make in the evolving electronic highway in the U.S. We will blog later about our roles as nursing informaticists in the Regional Extension Center program.

What are ‘Regional Extension Centers’? Under the Office of the National Coordinator (ONC) Health Information Technology Initiative to support getting providers to meaningful use on electronic health records, the ONC has established Regional Extension Centers. There are 60 Regional Extension Centers that will furnish assistance to providers in specific geographic services areas covering virtually all of the U.S. A total of $643 million is devoted to these centers.

The purpose of the Regional Extension Centers is to support priority primary care practitioners in priority settings to implement and use EMRs according to the meaningful use requirements outlined in our previous post (below is a screenshot illustrating one example of how an EMR might align with meaningful use requirements; click image to enlarge). The goal of the program is to provide federally subsidized outreach and support services to over 100,000 priority primary care practitioners within the next two years. 

© 2010 e-MDs, Inc. All rights reserved. Product and company names are trademarks or trade names of their respective corporations.

Regional Extension Centers will provide the following support services to providers:

  • EHR implementation
  • education and training
  • project management
  • incentives
  • meaningful use

NPs as “priority primary care practitioners.” A priority primary care practitioner is defined by the ONC as a primary care provider  that is any doctor of medicine or osteopathy, any nurse practitioner, nurse midwife, or physician assistant with prescriptive privileges in the locality where she or he practices, who is actively practicing in one of the following specialties: family, internal, pediatric, or obstetrics and gynecology.

Priority settings. Many NPs work within priority settings identified by the ONC, including small group practices of 10 or fewer, public and critical access hospitals, federally qualified health care clinics, rural healthcare clinics, and other settings serving uninsured, underinsured, and medically underserved populations.

NPs are eligible for support services of the Regional Extension Centers. For more information on what services might be available to you, contact the Regional Extension Center within your geographic region. A table and map covering the 60 centers is available here.

Incentives program for EMR implementation. February 17, 2009, President Obama signed the American Recovery and Reinvestment Act (ARRA) and along with that Act $33 billion dedicated to Medicare and Medicaid incentives for providers and hospitals who adopt, implement, or upgrade an EMR system and meaningfully use that system. As we blogged previously, meaningful use of EMRs has many parameters that providers must meet—but with that comes financial incentives that eligible providers can receive.

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For Those Interested In Learning More, See Below….

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‘Meaningful Use’: What’s It All About, And Why Should Nurses Care?

July 26, 2010

By Susan McBride, PhD, RN, professor at Texas Tech University Health Science Center School of Nursing. McBride and fellow nurse informaticists Mari Tietze and John Delaney will be blogging here on the intersection of nursing and informatics in the coming days. 

By DeclanTM, via Flickr.

Everyone knows by now that the Obama administration has made electronic health records (EHRs) a high priority and is providing financial incentives to health care providers (and yes, nurses are included in that group) to adopt them. But not everyone knows it’s not just about converting records from paper to digital—its much more than that.

On July 13, the Office of the National Coordinator (ONC) for Health Information Technology (HIT) released the final rules establishing definitions for the “meaningful use” of EHRs. The final rule is 864 pages and contains critical information for nurses to understand about how electronic records will change our lives. 

(No one expects every nurse to read the entire document. That’s why we’re going to be blogging about some important aspects of the topic. In the meantime, click here for a good overview of meaningful use and electronic medical records, as well as links to more exhaustive information. And for a short, useful table breaking down the rule by health outcomes policy priorities such as ”improving care coordination,” have a look at this PDF: Stage 1. Meaningful Use Objectives and Associated Measures Sorted by Core and Menu Set.)

Ongoing concerns. The idea behind these rules is to establish EHRs within a National Health Information Network that will allow us to exchange health care information regardless of where we are in the nation. There are many concerns about privacy and security related to this network, and these concerns are likely to be the most difficult component to address in establishing it. But there are definite clinical advantages. Read the rest of this entry ?

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Should We Be Wary of Magic Pills for Shift Work Sleep Disorder?

July 23, 2010

By Shawn Kennedy, AJN editorial director/interim editor-in-chief

by LaertesCTB/via Flickr

Nurses of course work shifts—in my first year in the ER, I rotated monthly: one month on days, one on evenings, and one on nights. Nights were the hardest—coming to work at 11:30 pm when everyone else was still partying or heading to bed. Then trying to sleep in a 3rd floor apartment on Second Avenue in Manhattan—you could still hear all the street noises with the windows closed. You never quite felt yourself on a night shift.

But eventually you found ways to deal with sleeping—you got used to the noise and the light (earplugs and sleep masks helped). And then there was coffee or Coke or Pepsi and chocolate; for some it was NoDoz because they didn’t like coffee. Many of us found it worked well to sleep once kids went off to school and until they got home; that allowed for some errands to get done and for some family time at dinner. Then, a quick “laydown” for a nap around  9 pm for an hour or so was enough to get us through the night shift. Colleagues without children would head right out to do chores early in the morning and then head home to sleep from 1 pm to 9 pm. Summers were great—we’d all head to the beach right off shift at 8 am, have the beach to ourselves until noon, and then head home to sleep. We all eventually found our method or “drug of choice.” Read the rest of this entry ?

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Parting Thoughts: 10 Lessons Learned from Florence Nightingale’s Life

July 22, 2010

The final post in a series by Susan Hassmiller, Robert Wood Johnson Foundation (RWJF) Senior Adviser for Nursing, sent to us as dispatches from her summer vacation spent retracing Florence Nightingale’s influential career. The full series can be found by clicking here.  

My husband has called this trip a “game changer” for me, and indeed it has been.  I see things differently now, including our health care system . . . and the critical contributions that nurses are making, and need to continue making, to improve care for patients. Of course, I always knew this, but somehow this ups the ante for me—and I will use my new education to up the ante for nurses. I have learned so much, but let me share these 10 lessons I gleaned from Ms. Nightingale.

1. Never, ever stop learning. 
A broad education in the arts and sciences helps with critical thinking and making important connections that lead to action. I saw how Florence used her knowledge of math, statistics, sanitation, religion, and architecture to put a holistic plan together to improve the systems that care for patients. 

2. Ground yourself and your work in facts and evidence. Make your case indisputable.  Everyone should do this . . . not just those who call themselves “researchers.”

3. Muster the courage to follow your convictions. Step beyond what you think you can do. 

4. Treat every person holistically. Every person has a spiritual, mental, and physical side that must be nurtured for complete healing to occur. 

5. Know your strengths and know your weaknesses. If you don’t know what they are, ask someone. Choose a job where you can make the most of your strengths. Contribute, contribute, and then contribute some more.

6. Use your network to accomplish what you think you might be unable to accomplish on your own. Don’t be afraid to ask important people to help you finish important jobs and make needed improvements. Likewise, say yes to helping others when you are asked.

7. Speak and write often about the lessons/learnings that you would like to share with others.

8. If you see something that needs to be changed, change it! Nightingale said, “Deed, not creed.” 

9. Don’t blame others for how things are, if you are not willing to change them yourself. Or at least solicit help from others to make needed changes.

10. Keep your standards high. Lack of time, fatigue, and ambivalence all undermine high standards. Our patients deserve more.

Sue Hassmiller at statue of Florence Nightingale, London*

* Note on photo: Of the many statues in London, there are only two that depict women who are not members of the royal family, and both are of nurses! The other nurse statue is of Edith Louisa Cavell, described by Wikipedia as “a British nurse and humanitarian. She is celebrated for helping some 200 Allied soldiers escape from German-occupied Belgium during World War I, for which she was executed.”

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Scutari: A Blog Post Will Never Do Justice To This Visit

July 22, 2010

This is the second to last in a series of posts by Susan Hassmiller, Robert Wood Johnson Foundation Senior Adviser for Nursing, that chronicle her summer vacation spent retracing Florence Nightingale’s influential career.

Scutari was a “tragedy of epic proportions of which bureaucratic muddle and sheer human incompetence played the larger part, thrown in with a measure of bad luck.”

–Mark Bostridge, from his book, Florence Nightingale: The Making of an Icon

The Hospital: What Florence Experienced
It is almost incongruent that a woman who wrote more than 14,000 letters and 200 books said upon arriving at Scutari Hospital, a converted army barracks, that she was without words to describe what she saw. Of course, as time caught up with her, the words flowed quite freely. Death and mutilation surrounded her in this well-known deathtrap.  Her nurses slept (“in catnaps”) in cramped quarters. Men were cramped into rooms and spilled out into the long corridors as they lay on straw beds on cold stone floors. Attendants had to walk over the men who were, by Nightingale’s command, a requisite 18 inches apart. More men died than lived.

Nightingale in Scutari ward/Library of Congress, via Wikimedia Commons

Nightingale hardly slept, took her meals by the spoonful, and spent most of her time caring for the men, overseeing the band of nurses she brought with her (some were hardworking and disciplined, while others were not), administering the overall operation of the system, fundraising, constantly devising ways to make improvements to save more men and, of course, recording everything. She recorded for herself as evidence for her improvements and to teach lessons, but also to publicize the horrors of the situation to decision makers and the public back in London. The London Times and her good friend Sidney Herbert, the Secretary at War, made good use of her reports, which led to myths that she was a spy.

No man was ever allowed to die alone. Either Nightingale or one of her nurses stood over each man with an accordion lantern (not a genie lamp) day and night, to provide comfort until his passing. Nightingale was said to insist that she be present at every operation, as brutal as it was. Chloroform was not used until the second quarter of the war, well after Nightingale arrived.

What I Experienced…
Scutari is the current home of the Turkish First Army and its administrative offices. Security is extremely tight and no pictures were allowed. The Nightingale Museum, which is visited infrequently because special permission and logistics are required to get in, is in one of the four towers of the massive fortress structure. In the long corridors to get to the tower, marble floors now glisten and windows sparkle from daily cleanings—immaculate conditions are the order of the day.

So you have to use your imagination and historical reference to place yourself in her bloody boots. I did. I saw the rooms where they would have been, and imagined how I would have to listen to the screams of grief and step over those who have died. I imagined the nurses making their constant rounds, up and down these very long corridors, doing all they humanly could. I know now that there was no such thing as a “genie’s lamp,” as is the myth in all the pictures. What the nurses carried were cotton accordion lamps, one of which I purchased at the same Grand Bazaar in town where Miss Nightingale bought hers. I did shed a few tears when I walked away with my purchase, knowing what the lamp symbolized. Read the rest of this entry ?

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Searching for the Evidence? AJN Series Demystifies EBP

July 21, 2010

By Shawn Kennedy, AJN interim editor-in-chief

Trying to get evidence-based practice (EBP) implemented in your hospital or nursing home? Running into problems or just not quite sure how to proceed? Well, AJN has the answer.


EBP should be the basis for any clinical practice. Since last November, AJN has published a series of articles by the faculty at Arizona State University College of Nursing and Health Innovation’s Center for the Advancement of Evidence-Based Practice. Articles are published every other month and are designed to take the reader, step-by-step, towards implementing EBP. The current article describes the beginning steps to appraising the evidence; or go here to read the first article and follow in sequence.

Listen to a podcast with series leaders Bernadette Melnyk, PhD, RN, CPNP/PMHNP, FNAP, FAAN, and Ellen Fineout-Overholt, PhD, RN, FNAP, FAAN, the authors of Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice. And we’ll have a second “Ask the Authors” call in November (check our home page for details after November 1).

If you’ve had problems or hit snags on your journey to EBP, e-mail me (shawn.kennedy@wolterskluwer.com) so we can address these issues on our next call.

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Florence Comes to Constantinople…And I Come to Istanbul

July 21, 2010

By Sue Hassmiller, PhD, RN, FAAN, the Robert Wood Johnson Foundation Senior Adviser for Nursing (from an ongoing series of posts by Hassmiller, who’s spending her summer vacation retracing crucial steps in Florence Nightingale’s innovative career)

As I enter the city of Istanbul today, I am tired. Almost immediately I catch myself and remember that it took me just 3.5 hours to fly from London to Istanbul and it took Ms. Nightingale almost a month to sail here (Istanbul was called Constantinople at the time). She was sick most of the time, but resolute in her mission. I look around at the airport and see that all I come into contact with are standing upright, while those Nightingale came into contact with were mostly horizontal. Read the rest of this entry ?

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Ms. Nightingale as an Applied Statistician

July 20, 2010
By Sue Hassmiller, PhD, RN, FAAN (latest in a series of posts by Hassmiller, who’s spending her summer vacation retracing crucial steps in Florence Nightingale’s innovative career)
 
Here at the home of Florence Nightingale, Embley Park (for more on Embley Park, see last week’s blog post), approximately 100 people have convened to study the impact of the “Lady with the Lamp.” The lady herself was multifaceted, and so is this crowd of scholars. There are nurse leaders, of course, but also museum curators, historians, educators, and biographers. They are all interested in their own piece, but also in how their piece fits into the bigger whole of her life. Today we heard Professor Thomas from the University of Southampton School of Business discuss her contributions as an applied statistician.
   

Nightingale in Scutari ward/Library of Congress, via Wikimedia Commons

Representing mortality. Early in her life, Ms. Nightingale identified the need for hospitals and healthcare systems to collect and use data to improve care. She asked what use are statistics “if we don’t know what to make of them?” She is credited with developing the famous “coxcomb” illustration, which was a multidimensional way of depicting mortality rates. She used statistics at Scutari Hospital (also called Selimiye Barracks) in Turkey to guide her actions and used statistics and data in the London Times to convey the travesty of the Crimean War. 

Institutional and cultural barriers. But Nightingale didn’t just rely on data for getting more of what she needed for the soldiers—she also used storytelling . . . a lesson that’s not lost on me in terms of affecting policy today. However, and this is a big however, just as they do today, politics, context, and culture reigned supreme. Read the rest of this entry ?

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Florence Nightingale and the Red Cross

July 19, 2010

By Sue Hassmiller, PhD, RN, FAAN, Robert Wood Johnson Foundation Senior Adviser for Nursing (this is the latest in a series of posts by Hassmiller, who’s spending her summer vacation retracing crucial steps in Florence Nightingale’s innovative career)

British Red Cross thrift store, Romsey, England

Anyone who knows me knows I am a devotee of the American Red Cross. After the Red Cross helped me find my parents after a Mexico City earthquake nearly 35 years ago, volunteering for them is how I spend my free time and my money . . . So when I travel, I always check in with the Red Cross, no matter the state, no matter the country, and tell them my story, and tell them: Thank you and keep up the good work.  Read the rest of this entry ?

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