Patient Input on Obstacles to Sleep Helps Focus One Unit’s Improvement Efforts

Do you know anyone who’s ever had a good night’s sleep in the hospital? As nurses, we hear the complaints; as patients ourselves, or as family members of patients, we’ve been there.

Differing views on the source of a unit’s sleep problem.

After their hospital’s 20-bed telemetry unit received a low HCAHPS survey score on a quiet-at-night question, nurse practitioner Christian Karl Antonio and his colleagues at a northern California community hospital took on the challenge of improving patients’ sleep experience on the unit.

Before designing an intervention, they spoke with patients as well as staff, and were surprised to learn that the two groups see the problem differently.

“Patients perceived being awakened for vital signs, blood draws, and medication administration as the most frequently occurring factors that contributed to noise at night. On the other hand, staff members perceived that noise at night came from staff conversations, equipment with alarms, announcements on the paging system, and delivery carts, among other sources.”

[…]

2020-10-08T10:01:55-04:00October 8th, 2020|family experience, Nursing, nursing research, Patients|0 Comments
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All Unhappy Patients Are Not Alike

illustration by the author illustration by the author

The first sentence from Leo Tolstoy’s novel Anna Karenina is one of the most famous in literature:

“All happy families are alike; each unhappy family is unhappy in its own way.”

It can easily be applied to patients. Happy patients tend to love their doctors, feel they received the best possible care, and consider their nurses invaluable.

Unhappy patients are unhappy in their own way. The challenge for busy nurses is resisting the temptation to turn a deaf ear or feign listening, in effect reducing patients’ concerns to “waa, waa, waa.”

A common thread among unhappy patients is unmet expectations.

Sometimes the patient’s expectations are unrealistic because they’re based on incorrect assumptions—but they do not know this. Responding requires a willingness to listen and the patience to tease out why a patient is unhappy with their care. Let patients tell their stories. Most bedside nurses have limited time; it’s okay to enlist help from a case manager, social worker, or nurse navigator if necessary. However, investing time up front to improve communication with a patient may pay off in dividends by smoothing the rest of your shift.

Begin by listening. Sometimes, I’ll take a seat, and write what the patient says while they talk. This simple act conveys […]

2016-11-21T13:00:58-05:00September 6th, 2016|Nursing, nursing perspective, patient engagement|0 Comments
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Patient Satisfaction and Nursing: Listening Matters, Whatever the Situation

By Amanda Anderson, a critical care nurse and graduate student in New York City currently doing a graduate placement at AJN. Her last post on nursing and patient satisfaction surveys is here.

by runran/Flickr Creative Commons by runran/Flickr Creative Commons

During this hospital stay, how often did nurses listen carefully to you?
1. Never
2. Sometimes
3. Usually
4. Always

Listening Carefully About Patients
“Her crit is dropping with each bowel movement, and she just won’t stop bleeding,” said my night shift colleague during the early moments of my shift.

As soon as she finished telling me the rest of my new patient’s care, I got on the phone for the ordered blood. Waiting for the first of many products to be delivered, I went to see her. As I poked around the hanging drips and fluids, checking dosages and orders, setting alarm limits, I heard my patient’s voice:

“Hello, hello? I’m so anxious. I just fell asleep for a moment and now I’ve woken up and I’m terrified. I think I need to be changed again, and I just don’t know what to do, and who are you?”

My colleague, busy with the details of resuscitation, hadn’t said much about my new patient’s anxiety. Anxiety, too often coded as neediness, is clinically important, especially in a patient with questionable stability, and doubly in a patient whose […]

2016-11-21T13:02:10-05:00August 7th, 2015|narratives, Nursing, nursing perspective, Patients|3 Comments
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Surveys Aside, One Crucial Precondition for Real Patient Satisfaction

callbellBy Amanda Anderson, a critical care nurse and graduate student in New York City currently doing a graduate placement at AJN. 

During this hospital stay, after you pressed the call button, how often did you get help as soon as you wanted it?
1. Never
2. Sometimes
3. Usually
4. Always
5. I never pressed the call button

Everyone is talking about patient satisfaction these days. Purposeful rounding, responsiveness, and customer service are discussed in meetings, on blogs, and in conversations at work. An entire science has been created out of satisfaction, with whole journals devoted to patient experience and paid officers tracking scores and strategies. Since hospital reimbursement is linked to how happy patients are, we’ve suddenly gotten serious about satisfaction.

But behind the sterile questions on the HCAHPS survey, real stories about real people reside. I find myself often forgetting the flesh and blood that’s represented by each checked box, and am learning to realize that, while satisfaction is something to be striven for, dissatisfaction is something to be learned from.

In a series of posts, starting with this one, I’ll share stories of my own missteps—ones that may have caused my patients to answer never instead of always to questions about my care. The events described here helped me realize that, score or no score, responding to call bells actually matters at the human level:

Sarah […]

2016-11-21T13:02:20-05:00June 29th, 2015|Nursing, nursing perspective, patient engagement, Patients|9 Comments
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The 10 Most Popular Articles on AJN Right Now

From boliston, via Flickr From boliston, via Flickr

The 10 current “most viewed” AJN articles are below. Sometimes we’re surprised by the ones that go to the top of this list. At other times, the high interest in the article makes perfect sense. Most of these articles are currently free, either because they are CE articles or because they are shorter opinion pieces or the like. We hope you’ll have a look.—Jacob Molyneux, senior editor

“The Care of Pregnant Women in the Criminal Justice System” 

CE article. Overview: Current practices in the treatment and transfer of pregnant inmates in this country may negatively affect maternal and fetal health or well-being. Some violate federal or state laws; others conflict with standards of obstetric care and are widely considered unethical or inhumane. This article discusses these practices; their legal status; and implications for nursing practice, policy, and research.

“Developing a Vital Sign Alert System”

CE. Overview: This article describes the implementation of a nurse-designed, automated system for enhancing patient monitoring on medical–surgical and step-down nursing units. The system . . . was found to substantially reduce out-of-unit codes without increasing nurses’ workload.

“Mouth Care to Reduce Ventilator-Associated Pneumonia”

CE. Overview: Despite the well-established association between good oral hygiene and the prevention of VAP, the […]

2016-11-21T13:06:21-05:00October 11th, 2013|nursing perspective, nursing research|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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