As Nurses Week is winding down, I am honored to share this excerpt from “The American Nurse.” Created by Carolyn Jones, this book explores the unique lives of nurses using photographs and personal stories. 

This infographic was shared with us by Erica Moss, who is the community manager for the online nursing programs at Georgetown University School of Nursing & Health Studies.

Unfortunately, as healthcare providers, we must be prepared to intervene during emergencies that we would never imagine.  The bombings at the Boston Marathon have left me with a heavy heart, yet I am inspired by the stories of heroism that have resulted. My thoughts and prayers go out to all those impacted by this tragedy.

When a traumatic event occurs, I tend to immerse myself in information – not so much the media details surrounding the event, but in the human stories, especially about the “helpers” that I’ve been reading so much about over the last few days. We have several articles related to emergency preparedness that may give you some insight and confidence that you are the nurse that would be using your skills to care for the injured with expertise and compassion.

 Dealing with Disaster
Nursing Management, July 2007

 Disaster preparedness: Are you ready?
Men in Nursing, June 2007

 Emergency Department Response to Terrorism
Topics in Emergency Medicine, March 2005

Sending heartfelt wishes to those affected by the events of this week. Many thanks to the first responders for their swift action and to those who continue to care for the injured. 

Attending any conferences this spring? Here’s a list of tips and timesavers to help you make the most of your time! 

1. Make a schedule. Plan which sessions you’ll attend and create your itinerary! Use the most convenient form that works for you – paper and pencil list or electronic device. Some conferences even have a smartphone app to help you do this. Check the attendee program or ask at the registration desk for details.

2. Pack comfortable shoes. Conference centers can be large, especially if it’s a big event with a large number of attendees. Also, remember that the walk through airports, train stations, and other public transportation centers can be long as well.

3. Do your homework. If you would like to speak with a presenter or are interested in connecting with a particular exhibitor, prepare your questions ahead of time. Sometimes the lines can be long and there may be limited time between sessions. Make sure you make the most of your time and convey your message clearly and succinctly.

4. Bring a notebook. Make notes on your computer, mobile device, or use pen and paper. Things you are learning and hearing will be fresh and exciting at the time, but when you return to your “real world,” you might not remember everything like you thought you would.

5. Keep some snacks handy. Not all airlines provide snacks, or if they do, there may be a charge for them. Also, if you are attending back-to-back sessions without much of a break, having a snack or two on-hand can help ease your hunger and keep you alert.

6. Consider packing an extra bag. You may accumulate quite a bit of ‘extras’ during the conference. From handouts and journals to goodies from the exhibit hall and souvenirs, it might make packing for your return a little easier. Be aware of airline restrictions and fees however! You could even consider using a larger bag than you need so you’ll have extra room for your return trip.

Enjoy your conference! Let me know which you’ve attended or are planning to attend, and what exciting and innovative things you learn. Also, please share your own tips too!

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 report. Nursing2006, 36(10).  

As I write this, I’m on my return flight from Nursing2013 Symposium in Las Vegas, Nevada. With each conference I attend, a highlight for me is developing new relationships and strengthening older ones with nursing colleagues from around the country and world. As nurses, we have an incredible amount of knowledge and experiences to share and getting away from our workplaces and joining together to talk and learn is exhilarating! By the nature of my work, so many of my relationships are “virtual” ones – communication via email, text, and social media is more the norm for me than face-to-face conversations, so it thrills me to connect in person with nurses that I’ve only “met” online.

I have quite a bit to share from this conference, but let me start with quotes that inspired & educated me during this event!

“Many times, a patient’s history leads to a diagnosis; the physical examination supports that diagnosis.”
Anne Dabrow Woods, MSN, RN, CRNP
Physical Assessment Skills for Adult Patients

“The most accurate way to take a blood pressure is by using the bell of the stethoscope.”
Anne Dabrow Woods, MSN, RN, CRNP
Physical Assessment Skills for Adult Patients

“It doesn’t take a title to be a leader.”
Jeff Doucette, MS, RN, CEN, FACHE, NEA-BC
Leading From Where You Are: Creating a Culture That Inspires

“Staff nurses are front-line leaders and often hold the key to resolving turnover drivers.”
Jeff Doucette, MS, RN, CEN, FACHE, NEA-BC
Leading From Where You Are: Creating a Culture That Inspires

“The best leaders are personal leaders.”
Charles Denham, MD
A Lifesaver for Lifesavers: How to Survive the Rough Seas of Patient Safety and Value-Based Purchasing Demands

“Human factors that contribute to the complexities of patient handoffs include too few nurses, fatigue, rushed report, memory, nursing turnover, emotion, and information/sensory overload.”
JoAnne Phillips, MSN, RN, CCRN, CCNS, CPPS
Effective Handoff Communication: A Key to Patient Safety

“Every time lactate increases by 2, the risk of death [from sepsis] increases by 20%.”
Julie Miller, RN, BSN, CCRN
Sepsis: Nurses Implementing the Latest Guidelines

“The mortality for sepsis equals that of an acute MI in 1960.”
Julie Miller, RN, BSN, CCRN
Sepsis: Nurses Implementing the Latest Guidelines

“For every organ system that fails, mortality [from sepsis] increases by 22%.”
Julie Miller, RN, BSN, CCRN
Sepsis: Nurses Implementing the Latest Guidelines

“Falls are an adverse drug reaction.”
Anne Dabrow Woods, MSN, RN, CRNP
Recognizing and Treating Adverse Drug Reactions

“Angioedema from ACE inhibitors is not dose dependent.”
Anne Dabrow Woods, MSN, RN, CRNP
Recognizing and Treating Adverse Drug Reactions

“Start with what you know best, maybe a case study, and start writing.”
Denise Drummond Hayes, MSN, RN, CRNP
Bylines and Deadlines: Writing for Professional Publication

“Our work is based on science and evidence, but we are best known for our caring side.”
Margaret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP, FAAN, DCC
Finding Your Nursing Voice

“The person with a strong nursing voice is an expert problem solver who is more proactive than reactive.”
Margaret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP, FAAN, DCC
Finding Your Nursing Voice

As many of the sessions were happening concurrently, I know there is so much that I missed and I look forward to listening to several of the presentations when they are available online. For those of you who attended this conference, please share what you learned and what inspired you too! 

Also, you can view some photos from the conference on our Facebook page!

In 2010, more than one-third of adults in the United States were obese, according to the Centers for Disease Control.

It’s safe to call the issue of obesity an epidemic at this point, and it can lead to other complications like heart disease, Type 2 diabetes, stroke and certain types of cancer. The health problems caused by obesity are some of the leading causes of preventable death.

A new infographic from Nursing@Georgetown outlines some important statistics about this issue, aimed at increasing awareness and educating the public about the positive effects of a proper diet and exercise.

Things like eating whole grains, switching to low-fat milk, and increasing your intake of fruits and vegetables can help turn things around and lead to a healthier body. In addition, the USDA has developed a nutrition guide called MyPlate that outlines recommended food portions.

Exercise also helps, and all adults should set a long-term goal to accumulate at least 30 minutes of moderate-intensity physical activity on most days. Check out the infographic below for information, and ways we can all work to improve our health behaviors.

Via Nursing License Map and Nursing@Georgetown

This post is written by Erica Moss, who is the community manager for the online nursing programs at Georgetown University School of Nursing & Health Studies.

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?
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?

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?

I’m drawn to articles that offer tips, top ten lists, mnemonics, and quick-reads to make our days and lives as nurses run smoother. That’s why I’m happy to share that we’ve just added a new article to our Recommended Reading list with not one, but two handy mnemonic devices! Plus, the topic is ECG interpretation and you may recall that one of my most memorable days as a nurse began with analysis of a Six-Second Strip. 

Please allow me to share one of these clever mnemonics with you here (you can click through to the article to learn the other – enjoy free online access while it’s on our recommended reading list). 

So, what are the H’s and T’s referred to in the title of this post? They are the reversible causes of cardiac arrest, which include:

* Hypovolemia

* Hypoxia

* Hydrogen ion (acidosis)

* Hypo- or hyperkalemia

* Hypothermia

* Tension pneumothorax

* Tamponade, cardiac

* Toxins

* Thrombosis, pulmonary

* Thrombosis, coronary

Do you have any similar mnemonic devices to share? Let’s help one another to remember all that is nursing and healthcare!

Reference:

Craig, K., (2013). Heart Beats: Rhythm self-quiz: Fast and deadly. Nursing2013 Critical Care, 8(1).