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AN recently interviewed Dr Terri Maxwell who is the chief clinical officer of Turn-Key Health where she is responsible for clinical care delivery, competence and quality. In addition, she serves as vice president, Clinical Education, Enclara Pharmacia, an affiliate of Turn-Key Health. A recipient of a Project on Death in America award from the Soros Foundation, Dr. Maxwell previously served as vice president of Strategic Initiatives, Weatherbee Resources Inc. and the Hospice Education Network. She also held a number of executive positions at Hospice Pharmacia, and established the Center for Palliative Care in the Department of Family Medicine at Thomas Jefferson University. A widely published author and frequent presenter at state and national meetings, Dr. Maxwell has served on a number of committees and editorial review boards, including the National Hospice and Palliative Care Organization (NHPCO) Relatedness subcommittee, NHPCO QAPI NCHPP steering committee, NHPCO Research committee and the Journal of Pain and Palliative Care Pharmacotherapy's editorial board. Dr. Maxwell earned a master's in Nursing and a Ph.D. in Nursing Science from the University of Pennsylvania, and a bachelor's in Nursing from the University of Rhode Island. In 2010, the College of Nursing at the University of Rhode Island made her a dean's list honoree at its Distinguished Achievement Awards.
We discussed palliative care and the initiatives seen in this area recently. She offered varied insights into this nursing specialty and how it encompasses so much of what we, as nurses do every shift.
Palliative care continues to advance end of life care in the US. What do you think is the biggest advance in this field in the last 5-10 years?
There have been so many advances in palliative care in the past 5 to 10 years. Some of the ones that come to mind include:
The role of palliative care in the health care system has grown in importance as people are living longer with chronic diseases and face a multitude of decisions about the use of technology, medications and therapies at the end of life.
In the last decade, palliative care has matured as a recognized, specialized, medical and nursing field.
In addition, there has been an explosion of articles and books about death and dying for lay people that has helped to create discussion about facing one's mortality at the end of life and the importance of quality over quantity of life.
Lastly, there has been an enormous expansion of programs throughout hospitals and more recently, into the community, to care for people with serious illness in their homes or in nursing homes.
Hospital-based palliative care services are expanding as advances in chronic disease management lead to longer lives. How does palliative care function in a hospital system?
Hospital-based palliative care programs vary in team composition and delivery models from hospital to hospital. Most are comprised of specially trained physicians, nurses, social workers, pharmacists and chaplains who provide consultative services.
These services generally focus on the provision of expert symptom management, help navigating the healthcare system, goals of care discussions and family meetings. These provide opportunities to offer support for decision-making, emotional and spiritual support as well as providing assistance to staff in caring for their seriously ill patients.
What traits are important for a palliative care nurse to develop?
Important traits of palliative care nurses include empathy, which is the ability to understand and share the feelings of others, compassion, the concern for others, and respect for human dignity. Communication and listening skills are critical, as is resilience in order to meet daily challenges, recover from difficulties and help to prevent burnout.
According to the National Hospice and Palliative Care Organization, the focus of palliative care is utilized across the continuum of care from pediatrics to geriatrics. How does palliative care differ among the patient populations?
The essential concepts and primary domains of care as outlined in the National Consensus Project for Quality Palliative Care (2009) are similar across patient populations, as are the needs of patients and their loved ones. However, there are differences in care goals and ways in which decisions are made, especially among those who are younger.
Palliative care teams need to also recognize differences in disease states and disease trajectories across the age spectrum, have specialized knowledge related to medication management for the very young and very old and alter their communication strategies as appropriate.
How do you see palliative care advancing in the years to come?
I expect to see greater diffusion of palliative care into the community, hopefully supported by new payment methodologies that do not limit access with restrictive eligibility requirements. As we move beyond a fee for service (FFS) model to a value-based payment methodology, health care payers and providers will increasingly recognize the value of palliative care.
What is needed is a more comprehensive and coordinated palliative benefit for those with advanced illness who otherwise fall through cracks in care based upon CMS regulations for Home Health Care and Hospice. As palliative care grows, we will need to address workforce deficits and training needs. I also hope to see greater integration of palliative care concepts into medical and nursing school curriculums.
Thank you Dr Maxwell for your comments.
So...how does your hospital system, facility or practice utilize palliative care?
Here is a roll call of AN Palliative Care nurses
Are you looking to connect with other med-surg nurses, to learn the latest evidence-based research, and obtain the latest in clinical practice? If you said YES, then the 28th Annual Medical Surgical Nursing Conference in San Francisco will meet your needs. There will be accomplished speakers, posters and abstracts that present the latest in med-surg nursing.
April 5th and 6th, 2018, San Francisco, California
Call For Posters
Poster presentations will be done on both the 5th and 6th in sessions. Lynn Dow is the contact person.
If you are interested in presenting a poster, the educational tracks are as follows:
The AORN Global Surgical Conference and Expo 2018: Embrace Action - Mind, Body, and Spirit event will be March 24 - 28, 2018 in New Orleans, Louisiana.
Ernest N. Morial Convention Center
900 Convention Center Blvd.
New Orleans, LA 70130
Join Us in New Orleans - Nathalie Walker, AORN President - Embrace the Action!
If you are reading this article, then likely you have come to the same decision or are thinking about it. We each have a story or background as to how we came to make this life-altering leap into the sexy and emotionally fulfilling field of nursing right? (Teehee, that's a whole nother article!) Books, television shows, and movies like to portray nurses as being born knowing that this was our lifelong goal. While this may be true for some of us, how did the rest of us come to choose a career in nursing?
In late August 2017, allnurses.com released a survey that ran through September to determine what factors students consider when selecting a school. One of the questions asked nurses and student nurses, "Why did you choose nursing?". The survey, which is set to release soon, had over 1500 participants. The responses varied greatly; some were light-hearted answers (like the "sexy" comment, wearing scrubs, or liking all things gruesome); some practical, "it's what my parents would pay for"; some well thought out, "hours, schedule and pay", and some people were just plain "born to do this".
There were a number of similar and common threads woven through the survey responses. Nursing has ranked #1 as the most trusted profession for at least 15 years in a row in Gallup Polls. Job security, flexibility, and pay were a deciding factor for many choosing nursing as a career. No matter sick or well, people will always be in need of healthcare. Nursing was a popular second career choice as reported in the survey results, either from a non-healthcare profession or from many who were non-nursing healthcare professionals. They reported wanting to have more direct contact and connection with patients, many stating that they feel drawn to care for those in need, not to "sit behind a desk". The career opened up possibilities to work schedules so they could care for aging loved ones or children. For many it was a better, more stable paycheck offering sick and vacation time and better healthcare for themselves and their loved ones. Nursing also offered the ability to advance within the career itself and further their education toward ultimate life goals.
The "calling", or desire to care for people in a time of crisis or at their weakest, seems to be a strong pull toward nursing as a career. Several answers reflected "always having known that nursing was a calling", or that their "personality and heart guided them" toward this career. There were many replies that the "science" that nursing encompasses was the appeal. Anatomy, physiology, how the body responds to pharmacologic interventions, the technology of caring for the body systems was another popular response. The ability to think critically and quickly and to work with a team of like-minded professionals was a draw. Some answered that they loved the rush of emergent care, or on the flip side, the pace and attention to dying hospice patients and their loved ones.
A large number of participants were inspired by a family member (s). Some had family members that were in the healthcare profession and through watching, listening, or living with someone who is a nurse, they felt compelled to go on to nursing school themselves. Experiencing healthcare from the opposite side of the bed was another influence that a family had on many. For some being the patient and "living through" the healthcare continuum was the guide toward wanting to make a difference in the life of others.
As we all have come into the "wonderful world of nursing" for our various reasons, decisions, or life events it is clear that the survey has captured the uniqueness that each of us brings to the care of our patients and the advancement of our profession. Our passions, skills, and differences will ultimately keep nursing innovative and cutting edge while maintaining the very core of our career of care and compassion for others.
Keep your eyes open and watch for the complete results from the 2017 Student Survey to be posted soon. You will find out what students think are the most important factors to consider when searching for a nursing school. The interactive images will allow you to customize your view and discover how variables such as age, location, current level of educational standing, and degree program enrolled in can affect one's priorities.
More 2017 Student Survey Articles...
allnurses.com staff recently had the opportunity to interview Lisa Wolf, PhD, RN, CEN, FAEN,
Director of ENA's Institute for Emergency Nursing Research. She has published research about bullying and how it affects nurses patient care.
How does bullying in the ED manifest itself?
Bullying can manifest as the dynamics of aggression, which includes overt hostility, denigrating comments, giving inappropriate assignments for the nurses' experience and expertise, and selective reporting. More difficult to identify and call out, however, are the dynamics of exclusion, which is marked by a withdrawal of help, support, and information. These types of behaviors often result in a nurse being "set up to fail", which has consequences for patient care.
How does this differ from bullying in other departments?
I don't know that it is very different in other departments, but the constant flow of patients, the short turnaround times, and the initial lack of knowledge about patient conditions makes the emergency department a particularly high risk area for this dynamic to manifest.
What kind of collateral damage results from bullying in the ED?
Workplace bullying is a significant factor in the dynamics of patient care, nursing work culture, and nursing retention. The impact on patient care cannot be overestimated, both in terms of errors, substandard care, and the negative effects of high turnover of experienced RNs who leave, compounded by the inexperience of newly hired RNs
What methods did you find to be the most effective in addressing / decreasing
Our respondents report that a "calling it out" strategy by both staff and management is the most effective way to reduce bullying and its consequences. An assessment of hospital work environments should include nurse perceptions of workplace bullying, and interventions should focus on effective managerial processes for handling workplace bullying
As a result of your research, what type of training do you recommend?
Given that management is the key role in mitigating bullying behaviors, education in the identification of bullying behaviors (especially those marked by the dynamic of exclusion) and in addressing them with staff is probably the most effective way to reduce workplace bullying.
Bullying is becoming more pervasive in our culture as a whole. However, as nurses on the forefront of life and death decisions, it is imperative that nurses have a toolkit to deal with bullying at work. The American Nurses Association published a position paper on this in 2015 with a goal; "to create and sustain a culture of respect, free of incivility, bullying and workplace violence."
ENA has also published guidelines to deal with and curb lateral violence which is defined as; "violence, or bullying, between colleagues (e.g. nurse/nurse, doctor/nurse, etc.)."
"According to a 2011 study by the Emergency Nurses Association (ENA), 54.5 percent out of 6,504 emergency nurses experienced physical violence and/or verbal abuse from a patient and/or visitor during the past week. The actual rate of incidences of violence is much higher as many incidents go unreported, due in part to the perception that assaults are "part of the job"."
ENA offers a toolkit with six distinct steps to address workplace violence. The first step is acknowledging that it exists and that nurses have the capability to decrease the incidence. There are many shareholders in this initiative including the front line staff but managers and administrators also have a key role in this. JCAHO, OSHA and other governmental agencies require documentation of a safe workplace and offer recommendations as well.
Violence should never be tolerated. Do you feel safe from lateral violence in your emergency department? What has your ED done to combat lateral violence?
Urology nurses function in multiple environments including hospitals, same-day surgi-centers, private practices and home health. They may care for patients with multiple co-morbidities in addition to urologic needs. The urologic nursing specialty requires its professionals to have a comprehensive knowledge of developmental and aging changes that are essential to understanding acute and chronic urological diseases. Here is an article about urologic nurses.
There are several sub-specialties for urologic nurses too:
The Academy of Medical-Surgical Nurses wants to recognize and identify the contributions of med-surg nurses all year round but especially this week. Med-surge nurses form the basis of almost all nursing care. It is the fundamental practice of nursing encompassing many different diagnoses and levels of care.
Even though med-surg nurses have existed for many years it wasn't until 1990 that the AMSN was formed with an objectives to:
The American Nurse Project is a documentary about US, nurses in the US. Carolyn Jones, an award-winning cinematographer helps to show what we do in our daily work. She traveled the country for a year collecting stories, pictures, and videos of nurses doing what they do and helping people understand what we do.
She interviewed hundreds of nurses in many specialties: home health nursing, disaster nursing, prison nursing, hospital nursing - all the places where we do our job. Via her movie, she brings the human element to the public as to what we do and take in stride. She honors nursing thru her journalistic efforts. The interviews are riveting:
AllNurses recently interviewed Nurse Nacole, a well-known blogger and YouTuber. She is a critical care nurse who makes an impact via social media. She uses Instagram, Twitter, YouTube, Google and other platforms to get her message across. Her informational blog focuses on clinical tips for the new and experienced RN. Her YouTube channel discusses time management, how to work with a preceptor, and how to collaborate with other staff members.
Nurse Nacole is an enthusiastic young blogger who is an educated critical care nurse using evidence based practice to spread the word. Nursing is her passion. She relates that NTI is a great conference to network and learn about how other critical care nurses care for patients.
She is currently furthering her education to provide better care for her critically care ill patients. Nurse Nacole is set to receive her MSN in another year and then plans to pursue her DNP.
Enthusiasm and up to date info is the hallmark of Nurse Nacole's videos/blogs. Check her out.... AllNurses' Community Manager Mary Watts, RN recently interviewed her.
Allnurses.com staff recently attended the AACN NTI Conference in Houston. We were fortunate to interview several well-respected leaders in critical care nursing. One of our interviews was with Judy Crewell, PhD, RN, CNE who is a leader in spiritual care in critical care nursing. Dr. Crewell facilitated a session titled "Spiritual Care Matters in the Care of Critically Ill Patients and Families" in which she discussed the role of the nurse in providing spiritual care and shared strategies on how to provide interventions at the bedside for patients and families.
In an allnurses interview with her, Judy stated, "Spiritual care has been with us since the beginning of time. It used to be that physicians were also spiritual leaders." Research shows that patients who have religious or spiritual beliefs have better patient outcomes, especially if their spiritual needs are met. As healthcare professionals, it is mandated that we provide for the physical needs of the patient as well as the spiritual needs. In order to do this, we must include a spiritual assessment along with the physical assessment.
Dr. Crewell recognizes that not all nurses feel comfortable providing spiritual care, however, lack of comfort is not an acceptable reason to not meet the spiritual needs of the patient. The nurse needs to develop a self-awareness of how they feel about providing spiritual care and look for ways in which spiritual needs can be met, either through that nurse or by utilizing another care provider.
Prayer is often used in hospitals for both patient and staff support and can be quite comforting if used appropriately. Spiritual care must encompass all aspects of religious and spiritual beliefs. Patients and their families are very vulnerable while hospitalized. This is especially true for those in the critical care areas. It's important that nurses take their cues from the patients and their families in assessing spiritual needs and providing spiritual care. In nursing, it is important to remember that spiritual care is about the patient, not the nurse.
Nursing education has lacked spiritual care information which we often find as we get out into the nursing workforce. Judy stressed the need for incorporating more spiritual care concepts in nursing curriculums.
Dr. Crewell shared some tips as to what could be done to improve nurse comfort levels with providing effective spiritual care:
Mary Fran Tracy, PhD, RN, CCNS is the editor of AACN's journal, Advanced Critical Care. She spoke with allnurses Community Manager Mary Watts, RN at the recent NTI conference. The Advanced Critical Care Journal is a quarterly, peer-reviewed publication of in-depth articles intended for experienced critical care and acute care clinicians at the bedside, advanced practice nurses, and clinical and academic educators. Each issue includes a topic-based symposium, feature articles, and columns of interest to critical care and progressive care clinicians. AACN Advanced Critical Care contains concisely written, practical information for immediate use and future reference. Continuing education units are available for selected articles in each issue.
Have you ever thought of what goes into publishing an article in a nursing journal?
Mary Fran Tracy provides some tips:
Kathy Douglas, RN, MHA, was one of two recipients of AACN's Pioneering Spirit Award for 2017. According to the American Association of Critical-Care Nurses, "The recipients are directors of two insightful documentaries about nurses, one offering an insider's viewpoint, while the other presents an outsider-looking-in perspective. Both films showcase the valuable and varied contributions of nurses to patient care and the healthcare system."
Kathy, a film-maker and former critical care nurse, was "recognized for her conceptual and directorial work on the documentary 'NURSES, If Florence Could See Us Now,' released in 2013." Through the film, Kathy paid her respect to nurses and her lifelong nursing profession by telling nurses' stories through their own voices, simply interviewing nurses with a camera to capture authentic, candid conversations.
Allnurses had the opportunity to interview Kathy at the AACN's 2017 National Teaching Institute conference shortly after receiving the award. Nurses sometimes "lose the connection between why we do what we do," according to Douglas in the recent interview with allnurses' Community Manager, Mary Watts, RN.
Kathy continued in the interview; "We are the most trusted profession" and we must be vocal about what needs to be changed in healthcare today and be strong patient advocates. Now is the time to bring our voices to the table." These comments serve as the basis of the award which according to AACN is; "Successful applicants exemplify a pioneering spirit, influencing the direction of acute and critical care nursing."
In Kathy's words, "It's hard to find a life that has not been touched by a nurse."
Managing our patient's pain is a paramount concern for all nurses. AllNurses staff recently attended NTI in Houston and interviewed June Oliver, MSN, CNS from Swedish Covenant Hospital in Chicago. She is an eminent pain management specialist who has authored several articles on pain management for patients with substance abuse disorders. According to the American Society for Pain Management Nursing (ASPMN); "Failure to identify and treat the concurrent conditions of pain and substance use disorders will compromise the ability to treat either condition effectively. Barriers to caring for these patients include stigmatization, misconceptions, and limited access to providers skilled in these two categories of disorders."
In an article from the ASPMN, Ms Oliver states: "In 2010, an estimated 22.6 million Americans (8.9% of the population) aged 12 or older reported using an illicit substance in the previous month. Approximately 7 million of these individuals met diagnostic criteria for a drug use disorder, and an estimated 5.1 million persons reported they had used prescription pain relievers in a nonmedical or non-prescribed manner. Sixty-six percent of those individuals obtained these medications from a friend or relative, and nearly 80% of those friends or family members had each obtained their medications from a single prescriber."
Drug abuse is prevalent in our society and we, as concerned nurses must use multiple resources to help our patients. In the interview, Ms Oliver provides some concrete means to achieve this goal.
Nurse injuries are costly: for the nurse, for the facility, for the career field in general. Linet recently previewed a bed at NTI in Houston and allnurses was there! No one wants to experience an injury associated with patient care. Using an integrative approach, Linet developed a bed that assists the nurse to adequately care for a patient without increased risk of injury. We all know its not always possible to have extra help when turning patients, repositioning them in bed or ambulating them. This can lead to a nurse injuries and some of these injuries can be career-ending. Having intuitive equipment can reduce this risk.
Pressure injury reduction is also at the forefront of nurses and hospitals, especially critical care units where many patients are not ambulatory. In order to reduce these occurrences, Linet developed the Multicare bed powered by the Hercules Patient Repositioner. This bed has multiple modifications:
NTI in Houston provided AN with so many opportunities to interview leaders in the field of nursing as well as to view demonstrations of new products. Halyard representatives discussed oral care to reduce ventilator-acquired pneumonia (VAP).
Why is this so important? From the Society of Critical Care Medicine, "The role of oral hygiene in maintaining the health and well-being of patients in the intensive care unit (ICU) is indisputable. Oral care is a simple and effective strategy to reduce ventilator-associated pneumonia (VAP) in patients requiring mechanical ventilation. Colonization of the aerodigestive tract and aspiration of contaminated secretions into the lower airway are the two primary pathogenic processes of endemic VAP. Dental plaque can be a major reservoir of infection by respiratory pathogens in ICU patients.Pharmacological plaque control with chlorhexidine oral rinse is effective and also decreases oropharyngeal colonization by aerobic pathogens in ventilated patients."
Oral care for vented patients is always a concern and can be difficult and time-consuming. However, Halyard recently introduced a product that is specifically for patients with smaller mouths who need oral care. These self-contained kits include a self-cleaning Yankauer, a #8fr suction catheter and a small toothbrush. Here are some of the features:
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