It was my sophomore year of college and we were heading into the hospital for the first time. We had been learning about communication and practicing with one another and now it was time to meet a REAL LIVE patient and use our skills. I was so nervous!

I realize now what this first encounter meant to me. I wanted my first official interaction with a patient to be a positive experience. I had already had some doubts about nursing as a career choice (you can read a little about that in Is Nursing Really For Me?) and thought that this experience would give me some insight if this path was indeed the right one for me.

Another thing that I realize now, was that I wouldn’t be just talking as a friend, daughter, sister, or student – roles that I was familiar with. This was new territory and this patient would look to me for answers and support. My role as a nurse was beginning and this patient would trust me to say and do the right thing. 

Despite my nerves, I remember wondering (and being a little impatient about) why we weren’t doing real nursing things when we went to the hospital. I know now that communicating with patients is real nursing. Making that human connection is a big part of what makes us different from other disciplines in health care. Think about how you communicate with patients, their family members and caregivers, and other healthcare providers. Think about how others communicate with you? Any differences?

I like to think that since becoming a nurse, I’ve become a better communicator. I try to consistently think before speaking. I work hard to really listen to others rather than thinking about what I’ll say next when someone else is talking to me. When a difficult conversation is taking place, I think back to the communication strategies that I learned during those first years of nursing school. I also try to pay attention to my own nonverbal cues and those of others.

Have your communication skills and strategies changes since becoming a nurse? How so?

Each week we select 3 articles to feature on our Recommended Reading list. We rotate the items on this list so there are always 10 articles available – and they are all free to read! It’s fun for me to choose these articles for several reasons – first, I get to do a lot of reading, but most of all, because I do think about what I’m “hearing” here on our blog, out there on our social media pages, and in real-life discussions with my nursing friends, when I select the articles to include each week. We also select 3 continuing education articles to include on our Recommended CE list, and remember, all of our CE articles can be read online free!

A hot topic lately, and one that is dear to me, is communication. Interactions with both patients and our colleagues are so important for outcomes and patient and staff satisfaction. We know that patients trust us, we know that we know our patients well, and we know that we are important members of the healthcare team. One of our current featured articles, Facilitating Goals-of-Care Discussions for Patients With Life-Limiting Disease—Communication Strategies for Nurses, has a great section with the heading Nurses' Special Relationship With Patients: 

“For those with a life-limiting illness, nurses are the "constant" in their journey through a frequently fragmented healthcare system. The nurse becomes familiar with the patient's medical history, health status changes, "behind the scenes" discussions of the team, family dynamics, and expressions of thoughts, concerns, and values. Thoughtful communication is essential throughout the trajectory. As the nurse builds a relationship based on trust and consistency, he/she may be viewed as "more approachable" than others in the healthcare team and, as a consequence, be part of informal discussions with patients and families. Therefore, the nurse is well positioned to facilitate discussions focused on goals of care and treatment choices in the setting of a progressive debilitating illness.”

We do have special relationships with our patients. They are relationships that allow us into patients' lives during critical times, they are relationships that allow us to advocate for our patients, and they are relationships that allow us to provide the best possible nursing care to our patients. I hope you enjoy this article and the others on our Recommended Reading lists! 

Happy Reading 

Reference

Peereboom, K., & Coyle, N. (2012). Facilitating Goals-of-Care Discussions for Patients With Life-Limiting Disease—Communication Strategies for Nurses. Journal of Hospice and Palliative Nursing, 14(4). 

A while back, I wrote a blog post about using SBAR (Situation-Background-Assessment-Recommendation) as a method to help organize change-of-shift report. First implemented by the U.S. Navy to reduce miscommunications, use of this tool is becoming more widespread in healthcare settings. It has been theorized that the use of a standardized approach such as SBAR creates a “common language” among healthcare professionals and thereby decreases communication errors and may even impact our behavior. A recent study published in Health Care Management Review explored this potential impact of SBAR on the daily activities of nurses.

The researchers interviewed nurses, nurse managers, and doctors in two hospitals where implementation of the SBAR protocol was in its early stages. Analysis of the data revealed two findings: first, that most thought of SBAR as strictly a means of standardizing communication, and second, that SBAR actually had a “more far-reaching effect than just being a communication tool.” 

So what are these “far-reaching effects?”

1. Schema development – SBAR facilitated the development of schemas which help nurses make intuitive decisions.

2. Contribution to the accumulation of social capital – The common language of SBAR serves as a means to integrate nurses into the organization.

3. Providing legitimacy – The common practice also helps individuals gain credibility.

4. Shift in logic – SBAR supports a shift from individual autonomy to standardization and formalization of the nursing profession.

Interesting findings! This fairly simple tool does have far-reaching implications – for our individual practice and our profession. If we communicate more effectively, make decisions more easily, and are integrated into the organization as a credible member of the healthcare team as a nursing professional, won't that ultimately lead to better patient care and outcomes?

Reference: Vardaman, J.M., Cornell, P., Gondo, M.B., Amis, J.M., Towensend-Gervis, M., Thetford, C. (2012). Beyond communication: The role of standardized protocols in a changing health care environment. Health Care Management Review 37(1), 88-97.

Sometimes no words are needed 
Just a nod may be all that is necessary 
A look of understanding 
One hand over another 
A friendly smile 
A shrug of the shoulders 
Someone sitting close by 
Not saying anything 
Just being there 
Sometimes that’s all we can do 
Sometimes that’s all that someone needs 
Sometimes that’s all that we need 
Running in circles to find an answer when no answer exists 
Can be frustrating 
We must learn to accept this 
Be there for one another 
Listen 
Feel 
Support 
Care 
Sometimes no words are needed 

Providing end-of-life care can be one of the most challenging responsibilities as a nurse, yet can also be one of the most fulfilling. When a patient’s wishes are respected and dying with dignity is a priority, death can be a peaceful and positive experience for the patient, his family, and the staff caring for him.

Oftentimes, our focus during end-of-life care is primarily on pain management and relieving or preventing labored breathing. Research published last month in the Archives of Internal Medicine calls attention to other factors that need to be addressed to improve care at the end of life. These include communication deficits, the importance of dyspnea assessments, implantable cardioverter/defibrillator deactivation, and bowel regimens.

In my opinion, the importance of communication at the end of life cannot be stressed enough. This includes communication among staff, among the patient and his family members, and between staff and the patient and his family. How many times have you encountered family members who didn’t agree with the wishes of a loved one as stated in his living will or who didn’t understand that an illness was terminal? How about physicians, nurses, and other professionals who were reluctant to address end-of-life issues?

It is important for all decision-makers and caregivers to understand and agree on a plan in order to ensure a positive experience at the end of life. For this to happen, communication is key. Take some time to read the following articles. You’ll find some great information to help educate patients, families, yourself, and your colleagues about end-of-life issues and care.

• Life-Support Interventions at the End of Life: Unintended Consequences
• Beyond Bad News: Communication Skills of Nurses in Palliative Care
• LEADERSHIP DIMENSION: Empowering Family Members in End-of-Life Care Decision Making in the Intensive Care Unit
• Partnering with Palliative Care 

Any article that has the word “tips” or “list” in the title always seems to grab my attention.  To me those words mean that the article is a quick read with valuable information that I shouldn’t miss. In this month’s OR Nurse 2010, I quickly turned to 7 tips to improve your professional etiquette. In this article, the author advises us on introductions, the importance of a confident handshake, specifics about body language, and more. I especially appreciated the following list of gestures to avoid:

“Some gestures may be misunderstood and considered offensive to people from other cultures. To play it safe, try to avoid these in conversation:
• the "okay" sign
• thumbs up
• the "V" for victory sign, especially with the palm facing inward
• pointing or snapping your fingers
• waving your hand with your arm raised.¹”

I must admit that I’ve been guilty of using several of these gestures, especially with mechanically ventilated patients or patients who were unable to communicate verbally for other reasons. Do you know of anything else that should be on this list? 

1. Pagana KD. The Nurse's Etiquette Advantage: How Professional Etiquette Can Advance Your Nursing Career. Indianapolis, IN: Sigma Theta Tau International; 2008.

Social networking and social media are not new concepts. Social communication has gradually advanced from face-to-face conversations and early forms of written and print communication to using the telephone for party lines and conference calls. Now we are using computers for group email (list serv), online forums, chat rooms, instant messaging, and blogs. Interactive social networking websites like MySpace.com and Facebook.com are becoming popular for staying connected with friends, classmates, and others with similar social, political, or entertainment interests.  Some examples of professional networks are LinkedIn, Tagged, and Plaxo. These sites and professional organization websites are helpful for making business contacts, finding jobs, and discussing challenging professional and business issues. 

The newer features of social networking allow the users to more easily exchange documents including articles, policies, and documentation forms. Some websites allow the nursing community to mentor newer nurses; recommend great job openings; and give advice about going back to school for advanced degrees. What's also helpful is that these discussions are archived and can be searched for later use.  

Professional and social networking have many benefits for nurses, but some nurses have not been very cautious about their use of these websites. Here are some examples of how to avoid making mistakes online.

1. Think before you post messages, photos, and videos. You would never want to tarnish your professional image, to embarrass a colleague, or to hurt your chances of career advancement.  
2. To protect yourself from identity theft, you must be aware that social networking sites are not private and limit the amount and type of personal information you share.
3. To avoid risk of a HIPAA violation, never publish patient information without written permission.

For those who want to share new techniques you discovered, search for cost-effective ways to deliver patient care, or to announce your recent accomplisments, there are many great websites waiting for you to post your news or to ask your questions. Happy blogging!

When I hear the words “patient safety”, the first thing that comes to my mind is medication errors. Of course, there are plenty more factors to consider with regard to patient safety – infections, surgical errors, and pressure ulcers, just to name a few. In fact, a search for the keywords “patient safety” on nursingcenter.com yields a result of 3,309 articles!

This week is Patient Safety Awareness Week. The theme, "Let's Talk: Healthy Conversations for Safer Healthcare" got me thinking about how conversation can minimize or prevent medication errors. Here are some of my ideas – please add to this list! Let’s learn from each other and help one another to improve patient safety!

Questions to ask patients:
1. What medications do you take regularly? How do you take them? When do you take them? With meals or on an empty stomach? Why do you take these medications? Do you ever not take them?
2. Do you take any medications “as needed”? What medications? Why do you take them?
3. Do you take any over-the-counter medications? What are they? Why do you take them? When do you take them?
4. Do you take and herbs or vitamins? When? How? Why?
5. Do you have any questions about your medication regimen?
6. Is there anything I can do to help you manage your medication routine?

Before administering a medication, ask him if he’s had this drug before, if he knows why it’s been prescribed for him, if the dose is his usual dose, and if he has any questions.

For discussion with our colleagues:
1. Let’s review his medication list.
2. How often did you give his pain medication (or any p.r.n. medication)? What were the results?

Also, if any questions arise at any time – talk about it! Confer with your nurse colleagues, pharmacist, and the prescriber. The patient and his family members or other caregivers can also be valuable sources of information.

Lastly, be sure to take a look at the website of the Institute for Safe Medication Practices (ISMP). Here you’ll find several must-have tools for nurses, including a ISMP’s list of high-alert medications, ISMP’s List of Error-Prone Abbreviations, Symbols, and Dose Designations, Oral Dosage Forms that should not be crushed, and more. 

Thanks for “listening” to me. What do you want to talk about?