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Shhhhh...Listen

clock January 7, 2014 07:23 by author Lisa Bonsall, MSN, RN, CRNP

On New Year’s Day, an interview on the Today Show with Jon Gordon, a motivational expert and author, caught my attention. Mr. Gordon’s advice for those of us making resolutions for 2014, was to keep it simple by selecting one word to focus on for the upcoming year. Joni, over at Nursetopia, has been doing this for a few years and has shared her reflection on her words from 2012 and 2013, as well as her word for 2014.

After much thought, I’ve decided that my one word for 2014 will be “listen.” I often find myself thinking of my to-do list or what I will say next while someone else is talking, and before I know it, I’ve missed out on what he or she has said. As nurses, being good listeners is incredibly important – patients often confide in us and share things that they don’t tell anyone else. If we miss it, how can we be the best advocates for them?

While it would be great to just say “I’m going to always listen well,” I know that even with my best intentions, this won't happen. Being a better listener is going to take some work. So I’ve dug through our library and searched the web for some strategies to help sharpen my listening skills. Here’s what I found…

Tips for improving your listening skills

1. “SOLER” up: 

*Squarely face the patient

*Open up your posture (keep your arms uncrossed)

*Lean toward the patient

*Eye contact

*Relax

2. Eliminate distractions.

3. Be present in the current moment. Give your full attention and listen as if you will have to repeat what you are told.

4. Don’t interrupt.

5. Acknowledge the patient by nodding or using conversation cues, such as “yes” and “go on.”

6. Pay attention to nonverbal cues.

7. Use active listening or reflective listening to repeat back what a patient is telling you. This can encourage them to go on or to clarify what they are saying. For example, “It sounds like you’re saying the pain gets worse at night.”

8. When you notice that you are not listening, fix it by refocusing your attention. If necessary, apologize and ask the patient to repeat what you missed.

I realize some of these tips can be tricky depending on the environment in which you work. My advice? Do the best you can and try to ensure you’ll have ample time to hear responses when asking open-ended questions. Good luck!

Oh, and --- What is your word for 2014?

 

References

Calcagno, K. (2008). Listen Up...Someone Important is Talking. Home Healthcare Nurse, 333-336.

Jarrow, C. (2013, August 26). 10 Ways to Be Present and Be a Better Listener. Retrieved from Time Management Ninja: http://timemanagementninja.com/2013/08/10-ways-to-be-present-and-be-a-better-listener/

McMullen, L. (2013, August 24). How to Actually be a Good Listener. Retrieved from Huffington Post: http://www.huffingtonpost.com/2013/08/24/how-to-be-a-good-listener_n_3795849.html

Richardson, L. (2012). Motivational Interviewing: Helping Patients Move Toward Change. Journal of Christian Nursing, 18-24.



Peace and Health in ANS

clock September 19, 2013 03:47 by author Lisa Bonsall, MSN, RN, CRNP

The current issue of Advances In Nursing Science is a special one. The articles in this issue all are related to ‘peace’ and at a time when our country and our lives are faced with turmoil and violence, it is a welcome journal.

Here’s a look at some of the feature articles…

"No One Gets Through It OK": The Health Challenge of Coming Home from War
I was in a firefight one week and home in the next. And it was like, as an 18-, 19-year-old kid...you can't turn the switch off, you know what I'm saying? It was difficult for me to go home and make an instant switch to be a civilian. I didn't know how to act right. My energy was up here, but it needed to be down here.”

Critical Cultural Competence for Culturally Diverse Workforces: Toward Equitable and Peaceful Health Care
“…attaining equity-and ultimately peace-in health care delivery necessitates that nursing and other health care professions more carefully attend to the sociocultural context in which health care is delivered.”

Peace Through a Healing Transformation of Human Dignity: Possibilities and Dilemmas in Global Health and Peace
“Through personal experience in the region, I have witnessed the transformative power of Israeli-Palestinian relationship building through joint health initiatives. Yet, these experiences also reflect a reluctance of health care professionals working on such initiatives to explicitly address the conflict.”

The Language of Violence in Mental: Health Shifting the Paradigm to the Language of Peace
“…as language is a fluid medium that can be consciously reshaped just as a potter can reshape clay or an artist can rework a canvas, nurses can mold the language of nursing and health care to reflect the paradigm and the power of peace.”

I am happy to share this issue with you and I hope that it will inspire you to infuse more peace into your nursing practice and your life. All of the articles can be read at no charge on NursingCenter while it is our Featured Journal…now through 10/1/13. Enjoy…and I wish you peace. 



3 Communication Principles

clock July 30, 2013 02:07 by author Lisa Bonsall, MSN, RN, CRNP

I just came across a great piece on communication in the June 2013 issue of Journal of Perinatal and Neonatal Nursing. The author, Lisa A. Miller CNM, JD, is an educator who is “obsessed with communication.” As nurses, I think we all need to have a bit of an obsession with communication – it’s a big part of what we do! How we communicate with patients, caregivers, and our colleagues is important for both patient and staff satisfaction. 

Think about a recent day at work. Now pick an interaction that occurred between you and another person or persons. Was it a positive or negative interaction? Could it have been improved and if so, how? 

In her editorial, Ms. Miller identifies the following 3 principles for communication:

Communication Principle #1: It's not you against them, it's you against you.

Communication Principle #2: Don't take it personally.

Communication Principle #3: Know what you are talking about before you start talking.

Take a few minutes to go back and read the article in its entirety. It’s a quick-read and well worth it!

Reference
Miller, L. (2013). Parting Thoughts: Can We Talk? Musings on Communication. Journal of Perinatal and Neonatal Nursing, 27(2). 



Standardizing nursing handoffs

clock March 29, 2013 02:54 by author Lisa Bonsall, MSN, RN, CRNP

Handoffs are a known “trouble spot” when it comes to patient safety. As nurses, we participate in handoffs any time we transfer care to another provider, whether at change of shift, transfer to another floor or unit, or transfer to another facility. Errors that occur during these times can result from a variety of barriers, many of which are human factors, ranging from understaffing and interruptions to fatigue and information or sensory overload. 

The Joint Commission requires a standardized approach to patient handoffs; it is one of the National Patient Safety Goals (2006 National Patient Safety Goal 2E). During her presentation “Effective Handoff Communication: A Key to Patient Safety” at Nursing2013 Symposium, JoAnne Phillips, MSN, RN, CCRN, CCNS, CPPS, shared several acronyms that can be used to help guide a well-organized transfer of information and minimize errors and omissions during patient handoffs. 

SBAR + 2 (See also The Art of Giving Report and The impact of SBAR.)
  Introduction
  Situation
  Background
  Assessment
  Recommendation
  Question & Answer

5 P’s Model
  Patient
  Plan
  Purpose
  Problems
  Precautions

PACE
  Patient/Problem
  Assessment/Actions
  Continuing/Changes
  Evaluation

I PASS the BATON
  Introduction
  Patient
  Assessment
  Situation
  Safety Concerns
  the
  Background
  Actions
  Timing
  Ownership
  Next

What is the standard for nursing handoffs where you work?

References:

Cairns, L., Dudjak, L., Hoffman, R., & Lorenz, H. (2013). Utilizing Bedside Shift Report to Improve the Effectiveness of Shift Handoff. Journal of Nursing Administration, 43(3). 

Riesenberg, L., Leisch, J., Cunningham, J. (2010). Nursing Handoffs: A Systematic Review of the Literature. American Journal of Nursing, 110(4). 

Schroeder, S. (2006). PATIENT SAFETY: Picking up the PACE: A new template for shift reportNursing2006, 36(10).  



Thank you to a special nurse

clock March 4, 2013 04:19 by author Lisa Bonsall, MSN, RN, CRNP

Two days ago we received 2 cards in the mail. They come every year at this time. They are never late and there is always a personal note included.

My sons are 12 years old today. These cards, which have come every year for the past 11 years, are not from their grandparents or aunts or uncles. They are not from their friends or my friends. These cards are from one of the nurses who cared for them in the Neonatal Intensive Care Unit (NICU) after they were born prematurely.

So I write this to recognize the continued feelings of gratitude and awe that I have for one special nurse. How can I thank her for caring for my children when I wasn’t able? How can I thank her for showing my boys love and compassion when I couldn’t be there? How can I thank her for helping us through our most difficult days, weeks, and months?

My boys are grateful to receive these cards each year and to be remembered on their birthday; however I’m not sure they grasp how much the cards are appreciated by me and my husband. This day of celebration for our kids still brings mixed emotions to us, feelings which are understood by this special NICU nurse who reaches out to us each year.

As a nurse, I have not had a continued relationship with any patient after discharge, although I can think of several that I wish I had. How about you?

 



How do you greet a patient?

clock March 1, 2013 00:14 by author Lisa Bonsall, MSN, RN, CRNP

How do you greet a patient?
With a hello? A smile? An introduction?
Do you share your role? The plan for the day?
Do you make eye contact?
How do you address him or her? Mr., Mrs., or Ms.? By first name?

Then what do you do?
Do you wash your hands?
Do you write or type while talking?
Do you use therapeutic touch?
Those communication skills you learned in nursing school?

How do you include the family?
Do you share information?
Did you ask the patient if it's okay to do so?
Do you consider everyone's feelings?
Do you welcome visitors?

How about your assessment?
Do you go head-to-toe?
What questions do you ask?
Do you teach as you go?

How and when do you document?
Electronic health record? Paper chart?
Do you use a checklist?
As you go? Or toward the end of your shift?

How about medications?
Do you know the indications and recommended dosing?
How about interactions and adverse reactions?
Do you ask a colleague to check calculations?

How do you handle other interventions and procedures?
Do you provide privacy?
Do you explain what you are doing?
Do you ask if the patient has questions?
Are you able to answer?

Time to go home?
Did you get a break?
Did you eat? Use the restroom?
Are you ready to leave?

How do you say good-bye?



Pause and listen

clock February 4, 2013 02:53 by author Lisa Bonsall, MSN, RN, CRNP

How many times has a patient said “I feel funny” or “I don’t feel right” and then proceeded to code shortly thereafter? That happened to me twice.

How many times have you felt pulled in different directions – between call lights, alarms ringing, medications to be administered, dressings to be changed, patient education to be provided, etc.? For me the answer is TMTC (too many to count!)

How many times has a patient deteriorated quickly or coded without any warning signs? I’d say several.

I wonder if during any of those times a patient was trying to reach out to me to say “I feel funny” or “I don’t feel right” and the opportunity to intervene passed without my knowledge because I was busy with other tasks.

Just thinking…

I wish that we had enough time during our day to just pause and listen. Wouldn’t that be nice?

 



Honored by a Liebster Award Nomination

clock October 30, 2012 10:15 by author Lisa Bonsall, MSN, RN, CRNP

Thank you to Julianna Paradisi of JParadisi RN's Blog for the Liebster Award nomination! These awards are a way for bloggers to get to know one another better, recognize one another, and share favorite blogs with their audiences. To continue the trend, I must share 11 things about myself, answer 11 questions asked by Julianna, and nominate 11 other bloggers and ask them 11 questions. So, here we go:

Eleven Things About Me
1. I speak Italian. My parents met when my dad was in the Air Force and stationed near my mom’s hometown in northern Italy. They married, had my brother, and then moved to the U.S. I learned the language from visiting our family and studying it in school. 

2. I like wearing glasses. I tried contact lenses but couldn’t get used to them. I own several pairs of glasses at any given time and like to order different styles online.

3. When time and acuity allowed, I thoroughly enjoyed washing patients’ hair, which was not usually an easy task in the Medical Intensive Care Unit. It was time consuming and messy, but I hope that someone will do that for me if I’m ever critically ill. 

4. I always, always wear a watch and am usually early for everything! It drives my family a little bit crazy!

5. I don’t like to style my hair, but if I have to, I usually straighten it, and then curl it. It makes no sense, I know.

6. NICU nurses are my heroes. For 2 months, they were lifesavers and caregivers to my twin sons who were born at 29 weeks.

7. I enjoy gardening. I find weeding relaxing and I don’t mind cutting the lawn or trimming shrubs. The best part, of course, is having fresh vegetables and herbs on hand all summer!

8. I still have many of my books from nursing school. They have been updated with new editions and even with all the information that is now available online, I still can’t part with them.

9. I love to fold clean laundry but hate to put it away.

10. Math was always my favorite subject. I took Calculus I and II as my electives in nursing school and now I enjoy tackling math homework with my kids, although they are learning things very differently than I remember!

11. Nurse bullying, horizontal violence – whatever you want to call it – upsets me tremendously, especially when it involves students or new nurses. We really need to support one another! We all started as beginners!

Eleven Questions From Julianna
1. Who was your childhood hero? My older brother! I would do anything to get his attention! I remember even begging my mom to make him say “I love you” to me. 

2. What book (s) have you read more than once? Firefly Lane by Kristin Hannah.  It’s a wonderful tale of friendship, but a real tear-jerker! Also, The $64 Tomato by William Alexander.  I read it every year while prepping our garden for the upcoming season. Even my kids like to hear excerpts of the author’s trials and tribulations in the garden!

3. If you could do one thing in your life over, what would it be? I probably would have done my MSN in acute care. I enjoyed women’s health and am glad to have that knowledge and experience, but I think my real passion is critical care.

4. In one sentence or less, how would you describe yourself? This is tough! Ok, here goes… I am a mom, wife, daughter, sister, and aunt who thrives on being with and caring for others.

5. What is your favorite way to exercise? Walking with friends. It’s a great way for us to catch up on each other’s lives and put in some miles!

6. Name one person from any era, dead or alive, you would like to meet. Mother Teresa. 

7. What is your secret talent? I can tap dance; took lessons for 13 years!

8. Do you ever dance to music when no one is watching? Yes, but it’s definitely more fun when my whole family gets into it!

9. What is your all-time favorite TV show? Friends.

10. What TV show theme song do you know by heart? So many! Friends, Cheers, Brady Bunch…. Also, thanks to my kids – Phineas & Ferb and Good Luck Charlie. 

11. What is one ability you wish you had, possible or not? I wish I could control time – the possibilities are endless…

Eleven Nominations
These are my favorites – enjoy! (Full disclosure- two are LWW journal blogs)
Nursetopia
Nurse Story
Correctional Nurse.net
Infusion Nurse Blog
Nursing Staff Development: Behind the Firewall
ANS: Advances in Nursing Science Blog
AJN’s Off The Charts
RNspiration
3cs: coffee, children, and cancer
At Your Cervix
Crass Pollination: An ER Blog

Eleven Questions for My Nominees
1. What makes you laugh?
2. Have you ever written for publication?
3. What was your first nursing job?
4. What is your favorite blog post that you’ve written?
5. What’s your favorite TV or movie quote?
6. What is your biggest fear?
7. Do you sing in the shower? If yes, do you have a favorite genre or song?
8. What’s your favorite vacation spot?
9. Can you describe your best memory of nursing school?
10. When did you know you wanted to become a nurse?
11. What do you find most fulfilling about being a nurse blogger?



What a great idea!

clock September 18, 2012 05:43 by author Lisa Bonsall, MSN, RN, CRNP

I just spent a wonderful long weekend in Nashville, Tennessee at Nursing Management Congress 2012. What a great city, great venue (Gaylord Opryland Resort and Convention Center), and great event! I learned a lot, connected with lots of nurse managers and executives, and enjoyed my surroundings. I have lots to share with you over my next few blog posts, but I’m especially excited to share the following idea which was presented by one of the attendees and then shared by Sharon Cox, BSN, MSN during the opening session, titled “Nurse Managers: Adding Value in a Time of Volatility.”

During one of the preconference workshops, a discussion about staff recognition had begun, when one attendee (I wish I knew her name to give credit where credit is due) shared a means of recognizing staff members that has had positive results. Rather than recognizing a staff member with a pat on the back or a letter of recognition to be filed, this manager asks the staff member (and I’m paraphrasing here), “I’d like to let someone important to you know what a valuable asset you are to us. To whom could I send your letter of recognition?”  She then wrote a personal note to to the person selected. 

This manager said she’s written to parents, spouses, mentors, and children of her staff members and has gotten positive feedback from all involved. She even met one staff member’s parents at a wedding and was thanked in person for the note she had written about their daughter.  

What a great idea!



First Clinical

clock August 5, 2012 01:44 by author Lisa Bonsall, MSN, RN, CRNP

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?



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