Peace and Health in ANS

ANS.jpgThe 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. Enjoy…and I wish you peace. 

Posted: 9/19/2013 2:22:30 PM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Inspiration


Exploring the lives of nurses

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. 

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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. Click the image to see its full size.

Posted: 5/11/2013 9:14:20 AM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Inspiration


Thank you to a special nurse

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?
 

More Reading & Resources
My preemie story
From MICU nurse to NICU parent
Journal of Perinatal and Neonatal Nursing

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Posted: 3/4/2013 2:53:48 PM by Lisa Bonsall, MSN, RN, CRNP | with 1 comments

Categories: Inspiration


How do you greet a patient?

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?

Posted: 3/1/2013 2:57:07 PM by Lisa Bonsall, MSN, RN, CRNP | with 1 comments

Categories: Inspiration


Last Words

I’ve seen a lot of patients die. And by a lot, I mean too many to count. Some deaths I remember clearly, perhaps because the patient was alone or had a large number of family and friends at the bedside, perhaps because he or she was close to my age, or perhaps because of religious traditions that took place during or after the death. It’s odd then, that when I think back to last words of patients before they died, I am at a loss. 

It could be because many of our patients followed a similar pattern prior to their death. Many were on mechanical ventilation which was withdrawn after many days, weeks, or months of progresses and setbacks. Most were unresponsive, either due to sedation or their disease process. They may have spoken their last words in my presence, but at the time I may not have realized that they were the last words they would ever speak. 

I do remember the last words of one patient in our unit. She was my grandmother. After a fall with a resultant hip fracture, she was transferred to us several weeks after surgical repair of her hip. Her oxygen requirements were increasing and she was becoming more and more agitated. In our unit she was treated for aspiration pneumonia, given anxiolytics, and supported with more and more supplemental oxygen each day.

We, her family, knew her wishes – she didn’t want to be intubated – and we respected that. I was working night shift, not as her nurse, but would stay much of the morning to help with her am care and to be there for rounds. On one particular morning, she was coughing and vomited. She had a hard time catching her breath. I called out for her nurse to suction her, when my grandmother grabbed my hand and said “No more.” We spoke of what that meant; it was a pretty intense conversation for a young nurse to have with her own grandmother. Then I called the rest of the family to explain our conversation and ask that they come to be with us. 

Everyone arrived throughout the day and we did what we could to keep her comfortable. We all spent time holding her hand and chatting with her when she was able. At one point, my grandmother asked for a grape soda. I found one for her and as she sipped it through a straw, she said to me “Lisa, I won’t be at your wedding.” “I know,” I said, “Grandmom, but you will always be with me.” Her response was “Yes… and grandpop knows what to give you.”

And those were her last words to me. I knew that she was referring to a wedding gift, and I laugh now when I think about it, because that was typical of my grandmother. She was an incredibly generous woman…always fighting over the check at dinner and pushing to pay at any cash register. These final words make me smile and think of who she was, not laying on that hospital bed, but as my grandmother.

What made me think of this was a recent book I just completed. In Looking for Alaska by John Green, the main character has a fascination with last words. He reads countless biographies and has memorized last words, even making it his mission to discover the “Great Perhaps” mentioned in the last words of François Rabelais. It was a good read, definitely thought-provoking, and I thank my niece for recommending it to me.

As nurses, some of us work with dying patients on a daily basis, while others, only rarely or sometimes. Regardless of your experience, do any last words stand out in your memory?

Posted: 11/25/2012 2:45:06 PM by Lisa Bonsall, MSN, RN, CRNP | with 5 comments

Categories: Inspiration


Top 10 Quotes from Nursing Management Congress 2012

Some wise words were spoken at Nursing Management Congress this year. Here’s my top list of quotes from the conference. Thank you to all of the experts who shared their experience and stories with us!

Without further ado…

1. “Our knowledge of what we do everyday is very limited; based on tradition, not science.”
Richard Hader, RN, PhD, FAAN, CHE, CNA, CPHQ, Conference Chairperson, Editor-In-Chief, Nursing Management Journal, Senior Vice President and Chief Nurse Executive, Meridian Health

2. “Intrapreneurs are ‘dreamers who do.’”
Kathy Russell-Babin, MSN, RN, NEA-BC, ACNS-B, Senior Manager, Institute for Evidence-Based Care, Meridian Health

3. “Prioritization is a fact of life in clinical practice.”
Sean Clarke, RN, PhD, FAAN, Director, McGill Nursing Collaborative for Education and Innovation in Patient and Family Centered Care, McGill University and the McGill Teaching Hospital Network

4. “We teach people how to treat us.”
Sharon Cox, BSN, MSN, Founder and Principal Consultant, Cox and Associates

5. “Shift from ‘busy’ to ‘productive.’”
Sharon Cox, BSN, MSN, Founder and Principal Consultant, Cox and Associates

6. “Don’t forget the patient in the shared decision making model.”
Richard Hader, RN, PhD, FAAN, CHE, CNA, CPHQ, Conference Chairperson, Editor-In-Chief, Nursing Management Journal, Senior Vice President and Chief Nurse Executive, Meridian Health

7. “As a patient, if a provider comes in with an unkempt appearance, do you want that person to touch you?”
Richard Hader, RN, PhD, FAAN, CHE, CNA, CPHQ, Conference Chairperson, Editor-In-Chief, Nursing Management Journal, Senior Vice President and Chief Nurse Executive, Meridian Health

8. “People can change when they are fighting for a cause bigger than themselves.”
John O’Leary, President, Rising Above

9. “When you know your ‘why’ you can endure any ‘how.’”
Victor Franco, Holocaust Survivor (shared by John O’Leary, President, Rising Above)

10. “One person always makes a difference.”
John O’Leary, President, Rising Above

Please keep in mind that I was not able to attend every session as the breakout sessions occurred concurrently. I'm sure I am missing many great quotes on this list! All of the sessions that I did attend were informative, but even more impressive to me, was how invigorating they were. From the enthusiasm in the audience and some of my conversations in the exhibit hall, I know I was not the only one feeling this way. 

Posted: 9/28/2012 8:51:25 AM by Lisa Bonsall, MSN, RN, CRNP | with 1 comments

Categories: Inspiration


What a great idea!

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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!

Posted: 9/18/2012 2:59:45 PM by Lisa Bonsall, MSN, RN, CRNP | with 1 comments

Categories: Inspiration


First Clinical

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 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?

Posted: 8/5/2012 2:40:30 PM by Cara Deming | with 0 comments

Categories: Inspiration


The Future Has Begun

It’s been almost 2 years since the Institute of Medicine (IOM) and the Robert Wood Johnson Foundation (RWJF) released Future of Nursing: Leading Change, Advancing Health and this landmark report is still being discussed and written about. This thrills me! People are hearing and learning about nursing. Other disciplines in healthcare have responded to the report. Nurses are making changes based on the report and sharing their plans and outcomes. Good things are happening!

We have a collection of articles and editorials all about the Future of Nursing Report and in the past few months several good reads have been published. Take a look:

Learn how the nursing staff at one New Jersey health system embraced the report and made changes to improve patient outcomes and satisfaction by reading Responding to Health Care Reform by Addressing the Institute of Medicine Report on the Future of Nursing (Nursing Administration Quarterly, September 2012).

 

In Nursing's future: What's the message? (Nursing Management, July 2012), the authors share the response of the Robert Wood Johnson University Hospital Division of Nursing, including “…creating opportunities within our hospital and our professional networks for honest conversation about the report and its implications, and then using strategic planning to design our action strategies.”

 

Read Wellness Promotion and the Institute of Medicine's Future of Nursing Report: Are Nurses Ready? (Holistic Nursing Practice, June 2012) and discover how the role of disease prevention and health promotion, or wellness, is a critical component for nurses in implementing the changes recommended in the IOM report. 

 

In the NACNS Position Paper: The National Association of Clinical Nurse Specialists Response to the Institute of Medicine’s The Future of Nursing Report (Clinical Nurse Specialist: The Journal for Advanced Nursing Practice, August 2012), the NACNS addresses several of the IOM recommendations with strategies and recommendations specific to clinical nurse specialists. 

 

The American Association of Neuroscience Nurses has also developed specific recommendations based on the report which were published in the Journal of Neuroscience Nursing (June 2012) – Integrating the Institute of Medicine Future of Nursing Report Into the American Association of Neuroscience Nurses Strategic Plan. 

 

There are over 35 editorials and articles that have been published in our journals since the release of the IOM report. All can be read online FREE --- be sure to check out Focus On: The Future of Nursing.  

What changes have you implemented in your practice or career plans? Have there been initiatives at your workplace since the release of the IOM report?

Posted: 7/29/2012 1:16:48 PM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Inspiration


Communication and relationships

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). 

Posted: 5/23/2012 8:36:42 AM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Inspiration


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