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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“The highest reward for a person's toil is not what they get for it, but what they become by it.”  -  John Ruskin                        

CEO/President, George B. Hernandez, Jr. waits while presenter makes introductions.

Kicking off the New Year, UHS nurses, support staff and senior level administrators came together for the Nursing Strategic Planning retreat. Nancy Ray, CNO, introduced CEO/President George Hernandez who provided the political horizon on health care reform.  His message was one of hope and encouragement!  Using Bob Dillon’s song, Times are changing , he emphasized that our organization is in a great position to meet the new challenges in health care.  Peggy Deming, CFO provided the audience with the financial data and how we can achieve our mission with a margin through excellence in patient care. Mark Webb delighted everyone with animation of our new facilities and UHS future!  Christian Vasquez, COO spoke for the first time to many nurses since joining UHS in August.  Her message was clear that our patients come first; we are here to provide them with care that not only satisfies them but exceeds their expectations.  Michelle Ingram provided a roadmap to the Quality solution in which we must become savvy in our use of data and metrics.  Last but not least, Nancy Ray, CNO set the stage for the afternoon!  Outlining the goals of quality, customer service, fiscal strength, and continuity of care for the nursing journey to professional excellence always strive for the best! Today is an opportunity for nurses to demonstrate their skill, dedication, and passion for the UHS mission in creating 2010 strategic plan.

Brainstorming Session

Over 90 UHS nurses formed several groups to brain storm on improving operations and fostering continuous improvement efforts in their units while serving patients. Dr. Jean Setzer, UHS Strategic Planner provided this large group with her skilled guidance and enthusiasm in creating the plan. She led each group with empowering suggestions to help nurses achieve their goals while using tools that would strategically implement their unit’s ‘action’ priorities. Goals and opportunities were identified and discussed as each participant enthusiastically expressed their ideas. As bright colored note pads and flip charts encompassed the room, it was clear each participant was dedicated to the goal at hand.   The plan and our Strengths, Opportunities, Aspirations, Results (SOAR) can be clicked on here.  The day provided new excitement, prospects for the future, and a plan!    The journey to excellence continues!

Nursing Research Week

Every day nurses at University Health System encounter situations that pose questions of what the nurse do in a given situation should.  Patients arrive for care and treatment with complex social situations, impacted by limited resources, which may be simple or very complex in nature.  When these patient’s situations create ambiguity or conflict, stress occurs.  

Sources of stress or conflict may be related to the different roles of the nurse as patient advocate, as hospital employee, as well as providing care under the direction on a physician.   This ambiguity or conflict may create moral distress when the nurse perceives that what is in the patients’ best interest may not be accomplished because of lack of autonomy or other institutional impediments.   Moral distress in nursing is disequilibrium that occurs when nurses are conscious of the morally appropriate action a situation requires but cannot carry out the action because of institution obstacles. 

The intensity of moral distress is influenced by the organizational culture which may impact the nurse in a variety of ways.  The organizational climate guides how ethical issues are addressed and creates an ethical climate. Organizational ethical climate is defined as the conditions and practices that affect the way difficult patient care problems, with ethical implications, are discussed and decided. Power, trust, inclusion, role flexibility and inquiry are present during these conditions

Jeanie Sauerland BSN, RN and Mary Anne Peinemann, MSN, RN wanted to understand more about these complex situations at University Health System.  They formed a discovery group in April 2009.  They became Co-Principle investigators along with discovery members Debra Fraley, MSN, RN, Bonnie Schranner, MSN, RN and Kathleen Marotta, BSN, RN.  Their mentor Catherine Robichaux, PhD, RN with expertise in nursing ethics led the way through their discovery process providing the latest in research as well as a guiding hand through grant fund application and the Institutional Review Board.   

These bold investigators were awarded grant funding from the Delta Alpha Chapter of Sigma Theta Tau International to study this phenomenon in November 2009.   Their questions “What are the levels of moral distress, perceptions of ethical climate and experiences of moral residue of registered nurses employed in acute nursing care units?” and  “Is Moral Distress related to the Ethical Climate within a Clinical Unit/organization?” will be answered after approval is received from the Institutional Review Board in the spring of 2010!  

Be looking for their exciting updates and conclusion to this Discovery Group!!

 

 

We are a magnet family!  The first Ambulatory Breakfast of Champions was held on May 30th!  With elegance the new ambulatory champions verified what makes the outpatient settings magnetically great! 

Nancy Ray, CNO welcomed the new champions and provided an overview of the New Magnet Model that we are following on the journey and where our trail has taken us so far.  Click here to view the presentation.  The transformation leadership within the organization is the beginning for all organizations on the magnet journey. 

Mary Anne Peinemann, MSN, RN and Susan Pawkett, BSN, RN provided the

foundation of our Structural Empowerment through our Shared Governance model.  The champions discussed the venues they are currently involved in with this model as well as their opportunities for empowered decision-making in their clinics.   Click here for presentation.  What is Exemplary Professional Practice in our ambulatory setting?  David Correa, RN and Deborah Forman-Lindsay, MSN, RN described the Health Literacy Project aimed at giving providers new understanding and approaches in working with patients and their literacy skills.   So how about those Empirical Quality Outcomes in the ambulatory setting?  Paul Alfieri, RN, C, ACRN, Lily Barrera, RN and John Halsell, RN provided new insights into the excellence in care for our patients living with HIV.  Their passionate presentation provided the audience with clear understanding of why their clinic is known by its patients as providing the best care!   And you said New Knowledge, Innovations and Improvements……Women’s Health Services Pauline Graham, RNC and Janelle Pehl, BSN, RN about the number of new innovative processes to include navigators and patient education materials to assist our new mom’s. 

Our New Champions can be seen in our Ambulatory Gallery of Champions!  They can’t wait to share more of their magnetically great contributions that provide excellence in patient care! 

 

by Erin C. Rogers, BSN, RN

Reeves Rehabilitation Unit

Erin C. Rogers, BSN, RN of the Reeves Rehabilitation Center wears her brand new t-shirt.

I won a new t-shirt last week (Dec. 8, 2006) just for speaking up. It is bright yellow and has tiny people printed on it. Sounds like aliens have invaded!
Rehabilitation nursing sometimes sounds like that to other nurses. The goal of rehabilitation nursing as defined by the Association of Rehabilitation Nursing “is to assist individuals with disabilities and/or chronic illnesses to attain and maintain maximum function.”

Our current nursing staff brings a wide variety of experiences to our patient population including medical-surgical, intensive care and cardiac care. Reeves Rehabilitation unit consistently uses the interdisciplinary model of care to assist the patients to achieve outcomes. Our interdisciplinary team meets every Wednesday morning. The team consists of nursing, physicians, physical, occupational, speech and recreational therapists, pharmacy, dietary and case management.

Patients that make up this grouping are comprehensive and brain injury patients. Comprehensive patient diagnoses are multi trauma, transplant, amputees and debility. Brain injury patient diagnoses are stroke, traumatic brain injury and aneurysm clippings.

Spinal cord injury patients are seen on Thursdays by the team. Reeves Rehabilitation treats a wide variety of patients. The spinal cord patients can be either a complete or incomplete spinal cord injury. Depending on the patient’s injury, they will be either a paraplegic or a quadriplegic.

The team assists patients to gain new independence given their diagnosis. Most of our patients go home. Many can be independent and many need a care giver to assist in their new level of functioning.

This brief explanation is by no means the beginning or the end of defining our profession of rehabilitation nursing or the care that we provide for our patients. Please visit the Association of Rehabilitation Nursing website to gain more knowledge about the world of rehabilitation nursing at http://www.rehabnurse.org/.

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From the wake-up call sounded by the 1999 Institute of Medicine report, To Err Is Human: Building a Safer Health System to more recent research by Beth McGlynn and colleagues at RAND—which documented that the healthcare system delivers the right care to patients only half of the time—hospitals are increasingly criticized for providing care that is not as safe as it should be.

As the only San Antonio hospital to ranked by US News and World Report as one of America’s Best Hospitals, University Hospital is rolling out “Better Safe than Sorry,” a new patient safety initiative that aims to create no less than a systemwide culture of safety.

The first step – a survey of employees and physicians – is an online survey developed by the Agency for Healthcare Research and Quality (AHRQ).

Organizations working to develop or improve a culture of safety need a reliable measure to monitor the success of their initiatives. That’s why University Hospital selected the AHRQ’s Hospital Survey on Patient Safety Culture.

Using this survey tool, UHS researchers can gain information about the perceptions of front-line clinical staff about safety in their patient care areas and management’s commitment to safety. The survey also provides information about how perceptions vary across different departments and disciplines.

Employees may access the confidential survey by clicking on survey.UniversityHealthSystem.com.

“Paper” surveys may be obtained by calling Mary Anne Peinneman at 358.1579.

By Evelyn Swenson-Britt, MS, RN

The 2006 Strategic Plan for Patient Care Services was approved by the Operations Council Monday (February 13).

Many of you have not seen this document since our work session in November 2005. Please note that there has been some massaging of the ideas that were initially presented, but the overall goals have remained the same.


The plan utilizes the 2005 format. The overview is on the first tab; the entire plan is on the last tab. Navigate to sections of interest by clicking to the appropriate tabs. View the plan here!

Please share this information. Communication is key!

By Evelyn Swenson-Britt, MS, RN

Strategic planning is a management tool, period. As with any management tool, it is used for one purpose only: to help an organization do a better job - to focus its energy, to ensure that members of the organization are working toward the same goals, to assess and adjust the organization's direction in response to a changing environment. In short, strategic planning is a disciplined effort to produce fundamental decisions and actions that shape and guide what an organization is, what it does, and why it does it, with a focus on the future. (Adapted from Bryson's Strategic Planning in Public and Nonprofit Organizations)

Patient Care Services has developed their 2006 focused strategic plan to work toward the following goals and initiatives. Nancy Ray, MA, RN and 50 magnet champions, directors and educators met on November 18th 2005 to evaluate the progress made on 2005 plan and determine the strategic direction for 2006. Click here to download the PCS Strategic Plan.

Work on these goals and initiatives has already begun and changes will be taking place to improve our planning of care. A task force of staff nurses lead by Mickey Ryerson, MSN, RN has been working diligently on improving the ease of documentation of the Plan of Care. Mary Anne Peinnemann MSN, RN has been preparing the educators and directors in the newly developed plan and the entire nursing staff will be soon receiving education on this newly developed plan.



Work is continuing on the 360 process with a task force of staff nurses being led by Pamela Higby, MSN, MBA, RN. Piloting of tools and feedback from staff has resulted in new improved tools that have been deemed more useful in the process.

The strategic plan is a driving force that will keep Patient Care Services energies directed for 2006.