Remember The Mission

Lois Shillito and Kathy Cook with Helen Erickson

Intermediate Progressive Care Unit (IPCU) hosted Dr. Helen Erickson in the first “Modeling and Role Modeling (MRM) Grand Rounds April 29.  Application of our Professional Practice Model based on MRM theory to the diverse patient population in IPCU is challenging.  PPM once understood by nurses is a guide to delivery of targeted care based on patient needs.  These nursing interventions then lead to more satisfied patients with better outcomes.  Katherine Cox, BSN, RN, Kathy Cook, BSN, RN, Esther Hazlewood, RN, Jenny Ramos, RN, and Lois Shillito BSN, RN, shared their personal experiences of the challenges and the benefits of integrating MRM in their nurse/client relationships.

Nurses face the challenge of adapting to ongoing changes and meeting the demands in healthcare added to the acuity of our patient population.   Elements of care are being measured to provide better patient outcomes.   Nursing can become so focused on achieving certain measurements that we can forget that we are working with an individual human being with basic human needs.  We can only realize these needs when we are able to give ourselves a few moments to see our patients through their own eyes and see their disequilibrium between body, mind and spirit. We need to acknowledge that, in caring for our clients, we must address these three areas of the patient’s world to provide holistic care for better patient outcomes.

The following case is an example of how nurses were able to understand a unique individual patient and address this patients needs. 

Beatrice (assumed name), accompanied by her father was brought from the Emergency Center to our unit during the night shift. While staff settled her into the new environment, her father approached me to share some of her history.  She was 28 years old, but has the mind of a 12 year old.  Born with hydrocephalus, she had several surgeries at another facility resulting in cardiac arrest, tracheostomy, and the inability to walk. She presented with fever, shortness of breath and diagnosis of pulmonary embolism.

The first night must have been frightening, as she was in an unfamiliar environment. While her father was welcome to stay he needed to attend to wheelchair-bound wife.  She had also been a patient in our unit and they expressed confidence that Beatrice would be given the same level of care.  This conversation opened a window of trust and facilitated an understanding of how to care for Beatrice that would be essential for getting her through procedures and daily care.

First challenge was a chest CT.  I reassured her that I will be with her in CT which made her smile. Positioning her for the procedure was quite a challenge, because of limited ROM. With constant coaching and encouraging words regarding how much she is able to do, Beatrice successfully completed the CT.  She had a big grin on her face, knowing that she did a great job during the procedure. We all praised her after the CT.

Daily visiting hours were always something Beatrice looked forward to. Her mom and dad came in the evening and staff allowed them to stay beyond the visiting hours, playing games or watching her favorite TV show together. I would hear laughter from the room and look to see her laughing with her parents. Occasionally, the father would perform trache suctioning. Beatrice would give thumbs up during these happy moments, perhaps reassuring me that she is happy and feeling fine. After mom and dad left, Beatrice experienced problems sleeping or would constantly be pressing her call light even after nurses had been in the room trying everything to make her comfortable. She would ask to be suctioned frequently just to get staff in her room.

Beatrice was in a room by herself.  In reconsidering her emotional and mental equivalent to a 12 year old I asked if she would like to move to another room across from the nurses’ station.  There she could see all the staff, and to this she smiled and nodded right away.  So that morning, as soon as a room was available, she was moved to a room across from the nurses’ station, and from that point on she would hardly use her call light, as she began feeling that she was always with people. She still gave a thumbs up signal when I passed by, either a sign of reassurance for me or of appreciation for where was placed.

With all the collaboration of the different interdisciplinary team, Beatrice recovered and was discharged to a very supportive family.  Emotions such as anxiety, fear, hopelessness, and powerlessness are not measurable, yet it takes very little effort to address these basic individual needs that are major factor to reach the goal of our patient’s holistic health. These basic needs should never be treated as a source of disruption, because all it takes is a moment or two of perception to understand the client’s world and to establish a trusting relationship, which is a basic essence of providing holistic care to achieve equilibrium of health for our clients.

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Helene with UHS Staff

After surviving cancer and three brain surgeries, Helene Neville, a registered nurse from Phoenix, AZ , marked the halfway point of her 2,520-mile run across the country, delivering a VERY important message on healthy living to fellow nurses, who work in the front line of patient care. Helene received a warm welcome from University Hospital nurses who presented her with a special “Survival Kit,” as she made her way to the hospital.

Helene, also a fitness coach and trainer, says her health battles have empowered her to promote health and fitness. She was diagnosed with Hodgkin’s disease in 1993 and had conquered the disease in 2001 which meant surviving three brain surgeries that were performed between 1991 and 1997.

Helene is making several stops along the way to promote both the run and her health and fitness book, Nurses in Shape, as she runs from Ocean Beach, CA, to Jacksonville Beach, FL, in 100 days. Her journey, called One on the Run, began May 1 and she’ll finish on August 17 as she celebrates her 50th birthday.

Helene Neville

“My run is not to realize my dreams, but to help others realize theirs,” says Neville, “The focus of my book is to educate nurses on how to reach higher levels of mental, emotional and physical wellness so that they may better serve their patients.”

University Health System nurses are honored that Helene chose University Hospital as her rest stop. University Health System earned Magnet status in February 2010, and is the first and only healthcare organization in South Texas to achieve Magnet recognition by the American Nurses Credentialing Center (ANCC), in Washington, D.C.

To learn more about Helene’s run across the U.S.A., visit www.oneontherun.com. You can also join her Facebook fan page, and cheer her on during her journey to healthy living!

Nurse Imagemakers

Lisa Sanchez, RN, administrative director, Patient Care Services, University Health Center-Downtown, and Irene Garcia-Sandate, MSN, RN, NNP-BC, who is on leave from the Neonatal ICU and Newborn Services, University Hospital, have been nominated for the 2010 South Texas Nurse Imagemaker award, by the Texas Nurses Association (TNA), District 8, and the Delta Alpha chapter of Sigma Theta Tau International (STTI) Nursing Honor Society.Sanchez and Sandate were among 34 other nurses recognized as “Nurse Imagemakers” for South Texas. In addition, Sanchez earned the Ruth Stewart Excellence in Nursing award. The awards were presented during a special luncheon held at Oak Hills Country Club, San Antonio, on May 22.All Imagemaker nominees are invited to write an essay on their definition of “Professional Image,” including two examples of how their practice contributes to the professional image of nursing.  Each year, one South Texas nurse is honored with the Ruth Stewart Excellence in Nursing award. The award, named for Ruth Stewart, a recognized nurse leader, educator and activist who set the “gold standard” for a positive image through community service and nursing accomplishments, selects the recipient of this honor.

Lisa Sanchez

Irene Sandate

Sanchez was overwhelmed and honored to earn the Ruth Stewart award this year. She told the crowd that she had a few gray hairs to prove her nursing career had been full of challenges and hard work. She was also quick to praise those who had made her the person she is today, especially her parents. Sanchez thanked Steve Enders, Sr. VP, Ambulatory Services; and Chris Vasquez, COO, for their support and vision.As the first healthcare organization to achieve Magnet status in San Antonio and South Texas, University Health System was also recognized and honored during the event.

Delta Chapter Sigma Theta Tau and the District 8 Texas Nurses Association recognized all of the University Health System staff in attendance and provided Evelyn Swenson-Britt, MS, RN, Magnet Project Director, a certificate in honor of the health system’s Magnet achievement.“University Health System honorees were also celebrated as nursing leaders whose contributions to our organization were pivotal in achieving Magnet Recognition,” said Swenson-Britt, MS, RN, Magnet Project Director.The 34 nurses selected as 2010 South Texas Nurses Imagemakers from healthcare educational and professional organizations in the South Texas community are honored as nurses who consistently model:

• A professional image and positive, caring attitude


• Leadership qualities


• A commitment to continuous learning


• Significant contributions to organization and community

For over 25 years, Sigma Theta Tau has recognized excellence in nursing through the Nurse Imagemaker award. Since 2006, the Texas Nurses Association, District 8, has partnered with Sigma Theta Tau to honor area nurses of distinction. Nurses are selected by their organizations to receive this award because of their professional image, positive and caring attitude, leadership qualities, commitment to continuous learning, and significant contributions to their organization and community.

Receiving Imagemaker Award

Nancy Ray

Welcome to Nurses Week.
Team members from across University Health System celebrated their Magnet status during Nurses Week – May 10-16. During the week, it seemed like no one could stop jumping with joy and excitement over becoming a “magnetically” excellent healthcare organization.  (See ad for Nurses week)

On the first day of Nurses Week, nurses were greeted by UHS executives, Mariachis and lots of Magnet balloons! They were provided with copies of the new nursing newsletter, emPOWERED, a quarterly publication featuring stories about our nursing excellence. The names of our nurses were spotlighted in our local newspaper, Express-News, for everyone in the city to know and appreciate the great nurses that work in our organization. (See ad)

The rest of the day was dedicated to our Magnet Celebration!  Mr. George B. Hernández, Jr., UHS President/CEO; Peggy Deming, CFO; Chris Vasquez, COO; and Nancy Ray, CNO, were the party leaders!   The festivities kicked off at University Center for Community Health with cheers, dancing and proclamations from Texas State Representative Trey Martinez-Fischer, District # 116. Nancy Ray read the proclamation during the celebration. The unveiling of the trophy and the congratulatory message from Gail Wolf, DNS, RN, FAAN Chair, and Commission on Magnet Recognition, made it official. Plus, Nancy’s favorite moment couldn’t arrive a minute sooner. She was excited to distribute the Magnet pins to staff members. Everyone was ecstatic to finally wear their “magnetically” wonderful pins! The entire organization joined in the pinning as it takes an entire organization to obtain Magnet Recognition.

UHS Celebrates being Magnetic.

The party continued at University Health Center-Downtown with many more cheers, posters, food and the unveiling of the trophy, not to mention, more Magnet pins! Staff celebrated with music as the Magnet Champions ripped through the paper to the sounds of “We are the Champions!”  Pride was everywhere as CareLink cheerleaders led the crowd in a special “I am UHS” cheer!

University Hospital was the last stop for two more celebrations!  Not to be outdone, the Magnet Champions at University Hospital provided the crowd with a celebratory “Texas” dance and songs!  City of San Antonio Councilman W. Reed Williams, District # 8, was on hand to read the proclamation from the City of San Antonio signed by Mayor Julian Castro. The posters were displayed throughout the cafeteria from multiple units and departments from across the organization, demonstrating how each provides a critical piece to our Magnet designation.

Last but certainly not least, our night shift celebration began at 11 p.m. with more cheers, dancing and food! Mr. Hernández and Nancy provided the crowd with yet another proclamation from Texas State Senator Leticia Van De Putte, District #26. Team members were filled joy and pride over their hard work and dedication to providing excellent care. Their work has never gone unnoticed, as they labor throughout the night to help make our patients better.

The week continued with the annual Walk in My Shoes program, as UHS executives shadowed nurses for a morning. Also, several units conveyed their wonderful massages in a special essay contest describing their “magnetic” status. Various units enjoyed cake and punch in honor of Florence Nightingale’s birthday and the launching of the Nursing Ethics Council. This final celebration completed the Nurses Week 2010. We celebrated our commitment to excellence, and to making a difference in the lives of our patients in San Antonio and South Texas!

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Dr. Setzer and Diana Espinoza.

On Tuesday, May 11, it was an opportunity for the University Health System Foundation Board members and Vice Presidents to walk in the shoes of a nurse, and to see first-hand how our nurses deliver quality care at the bedside.

Jean Setzer, VP, Strategic Planning, shadowed Diana Espinoza, RN, in Labor and Delivery. She shared in a family’s fear of fetal distress and joy of a healthy delivery, even if it came through an unexpected caesarian section. The experience left her speechless and so grateful for this very intimate, yet intense experience.  

Chris Vasquez, COO, spent her morning with psychiatry nurses and was completely impressed on how Larry Toms, RN, advocated for and in her words “saved the patient’s life.” Some might view this as a contradiction, as psychiatry is usually not viewed in this way. However, that morning Tom worked diligently with the team to advocate and recognize a patient’s extreme needs and depression. She was able to see his knowledge and skill in action and the positive “life-saving” outcome it had in this patient’s life. 

Our CFO, Peggy Deming, and our VP for Facilities Management, Richard Rodriquez, stepped into the world of Transplant ICU and Transplant Telemetry.  Nurses Julianne Wisloff and Stephanie Knight were both eager to share their expertise with Deming and Rodriguez. Our visitors were able to witness the details and difficulties in transporting patients that are ventilated to procedures like safely moving them and ensuring their airway and respirations are managed. Also, demonstrating how to actually move patients to a procedure table brought new insights into why the safety initiatives are critical in our institution. 

Peggy Deming and Stephanie Knight.

Another experience was the end of life procedure. This experience was shared by Yvonne Gonzales, a University Health System Foundation Board member and Eva Balboa, RN, Surgical Trauma ICU. She requested permission from a patient’s family to share in their grief, as they prepared for the death of a loved one. As Ms. Gonzales reflected on the experience, she remembered the respect and dignity shown to this patient by Eva and the entire staff, as they continued to explain everything that was being done for this patient and the family. The difficulty and anguish was eased by the nurse’s commitment and compassion to remain dedicated to her patient, even until the end of life. 

George B. Hernández, Jr., our CEO/President, joined the Newborn Nursery team, during his Walk in My Shoes experience. He shadowed NICU nurses Katia Pelletier-Snell and Michelle Randsdell. He soon learned that wearing scrubs before entering our newborn nursery was a critical procedure. Their advocacy doesn’t stop, no matter who the individual, it’s a critical standard in protecting our patients from infection. His experience was enlightening; you could see it in his eyes, as he walked through the unit.

The stories shared by Walk in My Shoes participants were filled with the joys, sorrows, pains and amazements which are integral in a nurses daily walk. They truly experienced what it is like to walk in the shoes of nurses at University Health System! We salute our nurses for their commitment to excellence every day, and we thank those who took time from their busy schedules to see first-hand the superb job our nurses are doing to make the lives of all patients better.

Elizabeth "Ann" Maxey, RN, CCRN; Chasity McDonald, RN, CCRN; Michael Payne, RN, CCRN

Written By: Elizabeth "Ann" Maxey and Chasity McDonald

The Beacon award is a well deserved award for our unit.  The minute I heard about the award and what it meant to receive it, I knew our unit had to get it.  The idea was initially pitched to us by Craig Marshall, who was responsible for setting us on our Beacon Journey so many years ago.  We already met a great many of the criteria and the criteria that we did not meet we set out on the road to accomplishing. The word journey, is used a lot to describes the process in receiving the award and, to be honest, I cannot think of a better word.  We did not sit down one week and fill out the application. The process started and continued to evolve over several years. We had highs and lows just like any journey you take.  One of the great attributes about the Beacon Award is that it encompasses a 360 degree picture of the unit.  This means no one person can accomplish this task alone.  It is not only about nurses; it takes a whole team.  It encompasses everyone who has an interaction in our unit: patients, techs, physicians, clerks and visitors. For example that extra minute a nurse takes to answer a family's concerns, or the nurse that studies day and night to become certified.  The many years and dedication of service we have in the TICU alone screams Excellence.  I never had a doubt in my mind we would not receive the award. Then, finally,

I received a text message, "We won Beacon," from my co-worker Sonia Figueroa!  I remember standing in my kitchen and I could not contain my excitement! Word traveled pretty fast. Nancy Ray was very supportive and she gave our unit the opportunity to send 2 staff representatives to Washington, D.C. and represent the Transplant ICU and UHS at the American Association of Critical-Care Nurses' National Teaching Institute (NTI), where new Beacon Award unit recipients were recognized. I jumped at the chance. Our Director chose the two TICU Beacon Award representatives after asking those interested in making the trip to write a letter stating "WHY I SHOULD BE CHOSEN TO REPRESENT TICU AT NTI IN WASHINGTON, D.C.".  When Michael called and told me that I was selected to go, along with Chasity McDonald, it was the icing on the cake!!

On arriving to D.C., we attended the NTI Opening Ceremony. Sitting among seven thousand of our colleagues, I suddenly realized the impact that winning the Beacon Award had on me. When they asked all of the newly recognized Beacon winners to stand, I looked around saw such a small number of people stand up from the sea of 7,000 people sitting, and I knew we were among the elite. NTI was such a great learning experience and a fun time in general, to have gotten to share it with my co-worker was like no other

Poster presentation in DC

The STICU’s abstract was accepted for poster presentation at the May 2010 American Association of Critical Care Nurses National Teaching Institute Conference to be held in Washington DC.

This is the largest critical care nurses conference in the country with attendance ranging from 6,500-9,000 critical care nurses.

"Meeting Educational Needs with Portable Technology: Adapting to the Next Generation of Nurses”

Authors: Charles Reed, Heather Williams, Susanne Thees, Kate Robertson, Susan Gerhardt, Randy Beadle, & Nanette Larson.
Susanne Thees presented the poster.
The poster describes meeting the learning needs of the staff, through a novel method of disseminating medical information in a portable and on-demand format.
 

TICU is #1

(San Antonio, TX)    University Hospital’s Transplant Intensive Care Unit (TICU) has received the Beacon Award for Critical Care Excellence from the American Association of Critical Care Nurses (AACN). The TICU team is the first intensive care unit in San Antonio and just the second transplant ICU in the nation to receive this prestigious award. Developed in 2003 by the AACN, the Beacon Award recognizes individual critical care units that exhibit high-quality standards and exceptional care for patients and families while fostering and sustaining healthy work environments.

There are about 6,000 intensive care units in the United States, and less than four percent of them have been recognized for achieving, maintaining and documenting these extremely high standards. “This award is living proof of the great quality and service delivered on our transplant unit," said George B. Hernández, Jr., University Health System president/CEO.

"We are all so proud of the work done by this talented and dedicated team," added Christann Vasquez, University Health System chief operating officer.

To receive the award, a unit must meet 42 different criteria in six categories, including: Patient outcome, Evidence-based practice and research, Leadership and organizational ethics, Excellence/innovation in recruitment and retention, Education, training, and mentoring and Promoting healing environments.

The Beacon also provides nursing care units a way to better measure systems, outcomes and environments. “Your unit sounds like a great place to work and exhibits many Beacon qualities," wrote one of the Beacon Award reviewers.

"By reading your application, I get the sense that your unit holds each staff member and itself as a whole to a very high standard. Through all of the examples that you provided, I was able to develop an understanding of your unit culture," added another. “The teamwork of your unit staff and management is apparent in every exemplar. You have provided many excellent examples of unit based activities that show a consistent and pervasive sense of collaboration and excellence in practice."

Nancy Ray, RN, University Health System’s chief nursing officer, knows she has the best nurses in San Antonio. “It is so incredible what you all accomplish every day. I am so thankful you are UHS."

Michael Payne, RN, administrative director of the TICU agrees. “This is such a huge achievement! You all consistently provide the highest quality care and I hope you all take some time to pat yourselves on the back and appreciate your achievement.”

“I want you all to know how proud I am of you, and what a pleasure it is working with you," added Dr. Glenn Halff, medical director, University Transplant Center, and interim dean of the UT Health Science Center School of Medicine.

The AACN is the largest specialty nursing organization in the world, representing the interests of more than 500,000 nurses providing care to critically ill patients. University Health System was recently designated as a Magnet facility by AACN and this new award is further demonstration of the organization's commitment to excellence in patient care, and recruiting and retaining the very best nursing staff. To learn more about the Beacon Award, please visit www.aacn.org.

Charles Reed and Susanne Thees presenting Podcast Poster.

University Health System makes an impression at the Nursing 2010 Symposium held in Las Vegas during the 1st week in April. Approximately 1200 nurses from around the United States and Canada attended the conference which offered educational sessions focused on elevating nursing practice, inspiring transformation, and promoting innovation while enhancing cognitive and practical skills.  Ileana Fonseca, Susanne Thees, and Charles Reed presented FOUR posters highlighting initiatives worthy of our Magnet designation. These posters represented areas of process improvement, staff engagement, education, and quality.

The first poster:  Engaging Staff with Data: Implementing Nursing Quality Dashboards. Describes how UHS implemented dashboards to bring quality nurse sensitive indicator data to the bedside nurse.

Susanne Thees and Ileana Fonseca presenting Success is in Their hands.

The second poster: A Nurse's Subscription to Knowledge: Cultivating a Community of Learners Through Podcasting. Illustrates how to create, produce, and implement effective podcasts. Provides examples of podcasts produced at UHS.

The third poster: ENGAGING STAFF: Success is in Their hands.Demonstrates how staff participation in shared governance is more than just attending meetings, it is about engaging staff and tapping into an individuals’ talent to create a Healthy Work Environment.

The fourth poster: Patient Safety: Improving the Accuracy of Patient Identification While Performing Point-Of-Care Blood Glucose Tests. Exemplifies how a collaborative effort of multiple departments was successful in improving the accuracy of patient identification while reducing the number of invalid tests.

Simulation training has been used in various fields for many years, with the most well known example being that of airline pilots. Other examples of simulation include astronauts and business models.  Simulation in the healthcare field is relatively new, with several high fidelity adult and pediatric mannequins used for simulation training.  Only recently has a simulated newborn become available. 

In June of 2008, a request was presented to the University Health System Foundation for their assistance in pursuing grantsto fund the SimNewB for Newborn Services. The product was researched, published studies were reviewed, and many emails and documents were exchanged in preparing for grant application for the SimNewB.  This is what we learned:  SimNewB is ideal for training for the specific needs of neonates. The SimNewB accurately represents a full term, 50th percentile newborn female. Measuring 21 inches and weighing 7 pounds, SimNewB provides real-life training opportunities for clinical staff. The SimNewB mimics a newborn's complex physiological responses to a wide range of variables and is fully integrated with the American Academy of Pediatrics’ guidelines for neonatal resuscitation.

SimNewB arrived in November 2009, and has already made an impact.  She has been used many times in a teaching environment with a number of student interactions with her.  Since January, Residents and Interns who begin their rotation in the NICU spend a couple of refresher hours, practicing NRP skills.  And, the nurses recertifying their NRP have used “Bobbi” for their megacode. “Bobbi” has also been taken out and used at other facilities as a part of our outreach teaching.