Patient education is something we often talk about in nursing, and regularly do during the normal care of our day. The challenge is that time is often short, and patients do not always retain the information the first time. I know it took me to learn the signs, symptoms and complications of Chronic Heart Failure, and I’ve never had to live with it. So both time and being able to retain information is an issue. How can we help patients retain information and better integrate it into our care? 

Another challenge is providing supporting materials. Globally very few hospitals have graphic designers and media specialists working for them, yet around the world we treat many of the same diseases. Nurses have full plates during their normal working day, there is rarely time to generate any new patient education materials especially material that integrates video, animations, or other forms of new media. So how can we address the challenge of creating time?

A final challenge, and these three are by no means an exhaustive list, is keeping the evidence up to date. Research and best practice practice is always being produced and creates changing goal lines. When the education material is finally created how is it kept up to date and how regularly can new information be added?

These are just some of the challenges that face patient education. So I want #RNchat to talk about ideas and ways we can solve these challenges. For example, Information Shareapy is a new website created by the Connecting Nurses initiative to help nurses share patient education resources. It is a community only for nurses, that allows us to share resources globally. Could this be a way we address some of these challenges?

Patient education can improve outcomes, reduce stress and enable patients as well as their care givers to be empowered. We need to do more than have libraries where patients could go. As nurses we need to emphasize patient education and find ways to integrate it into our care and continually improve our efforts.

The post #RNchat on Patient Education appeared first on Nursing Ideas.

The Article:

Hospital nursing and 30-day readmission among medicare patients with heart failure, acute myocardial infarction, and pneumonia

Big Idea:

Generally a health work enivonrment, lower nure patient ratios and more educated nurses are expected to improve care. This paper looks at the evidence of how the hospital environment (workplace culture, patient-to-nurse-ratio, and proportion of nurses with a BSN) effect patient care.

Evidence: The authors used data from California, New Jursey and Pennsylvania, which collect outcomes measure on patient with heart failure, acute myocardial infarction and pneumonia. This data was paired with mailed out surveys to nurses (>78,000 were completed), and the information was matched to their organizations (California=210, Pennsylvania=134, New Jersey=68).

Quotable:

Preventable hospital readimmission costs Medicare $15 Billion annually.

Only 52% of hospital staff were confident their patients could manage their own care when discharged.

This table or reasons for readmission was interesting to look at:

So What?

This research is an important piece to add to the pile supporting the savings that nurses make. Investing in the  nursing work environment could provide measurable impact for the healthcare system. As nurses we need to be aware of this evidence and use it at the table when discussion of changing nursing staff ratios or making the case for investing in workplace improvements for staff.

The post Nursing impact on 30-day re-admission appeared first on Nursing Ideas.

The Article:

Effect of Daily Chlorhexidine Bathing on Hospital-Aquired Infection [http://www.ncbi.nlm.nih.gov/pubmed/23388005]

Big Idea:

Can using chlorhexidine impregnated cloths to bed bath patients reduce rates of Multi-Drug Resistant Organism (MDRO) acquisition and bloodstream infection rates in hospitals?

Evidence:

Observational studies (looking at populations uncontrolled by researchers) suggest that chlorhexidine bathing reduces multidrug-resistant organisms (MDROs) aquisition and blood stream infections. This study conducted a cluster-randomized trial (they split up organizations and specific units to intervention [chlorhexidine] and control [nonantimicrobial cloth] groups. They worked with 6 organizations using their intensive care and bone marrow transplant units to see if they could identify any difference in MDRO aquisition and bloodstream infection rates.

Quotable:

• (Althought it was from another study) “Bleasdale et al. found that daily bathing with 2% chlorhexidine–impregated washcloths reduced the incidence of primary bloodstream infections by 60%.”
• 
• “The overall rate of MRSA or VRE acquisition was 23% lower during the intervention period”
• “hospital-acquired bloodstream infections was 28% lower during the intervention”
• “central-catheter–associated bloodstream infections was 53% lower during the intervention period than”
• “31% lower rate of primary bloodstream infections during the intervention period”

So What?

This paper adds to the evidence that chlorhexidine bathing can reduce rate of MDROs aquisition and bloodstream infections. The study reported 2.0% had skin reactions, which was less than the 3.4% of patients who had skin reactions to the control product, 85% of these reactions were classified as mild to moderate reactions and were considered unrelated to the bathing intervention. Bed bathing is a regular part of nursing care, and a frequent activity for patients. Making this a potentially important transition for hospitals to make to reduce the rate of MDRO aquition and blood stream infections. This intervention could prevent increase length of stay and adverse events to patients.

The post Can daily bathing with chlorhexidine reduce hospital aquired infection? appeared first on Nursing Ideas.

Marianne de Bretan-Berg – Perioperative Blood Conservation Coodinator

This spring I had the opportunity to interview Marianne de Bretan-Berg, a Perioperative Blood Conservation Coordinator at Southlake Regional Health Centre. Nurses are most often the provider that administers blood product, and discusses the physiological need for with the prescriber. This makes having up to date knowledge about blood transfusions critical. In this interview Marianne talk about the paradigm change in healthcare about blood products and how her roll allows her to improve the quality of care to patients at her organization and reduce unnecessary use of blood products, which prevents risk and adverse events and outcomes.

Resources

• Ontario Transfusion Coordinators ONTraC
• Bloody Easy for Physicians and Health Care Professionals

The post How can nurses help hospitals save blood? appeared first on Nursing Ideas.

Steven Lewis – President of Access Consulting Ltd

Adjunct Professor of Health Policy, Faculty of Health Sciences at Simon Fraser University
At the Canadian Nursing Students’ Association National Conference in Saskatoon, I had the opportunity to sit down with Steven Lewis after he gave a presentation on how nurses can strengthen their professional voice. A fascinating individual who has worked in health care policy for much of his career, he has had many unique roles that give him a distinctive perspective on healthcare. He is a well known healthcare policy writer and analyst. In this short interview, I ask him about he began getting involved in large scale health system projects and how he would advise nurses and nursing students to begin getting involved.

Resources

• Drummond Report
• Improving access to emergency care: addressing system issues
• Steven’s parody of Dos Equis commercials about american healthcare

Steven Lewis from Robert Fraser on Vimeo.

The post Building the Professional Voice of Nurses appeared first on Nursing Ideas.

Dr Jean Watson

Distinguished Professor of Nursing; Murchinson-Scoville Endowed Chair in Caring Science
Founder of the Watson Caring Science Institute

Dr Watson is a distinguished professor and nursing theorist, who has both earned her doctorate (Educational Psychology and Counseling), and been awarded eight additional doctoral degrees from various countries. I had the pleasure of sitting down with Dr Watson at the Canadian Nursing Students’ Association in January, after she gave a keynote speech. It was an incredible opportunity to hear more about her background and how she became a nursing theorist, and to hear her elaborate on her current work on the Caritas Process.

Ten Caritas Processes

1. Embrace altruistic values and practice loving kindness with self and others
2. Instill faith, hope and honour with others
3. Be sensitive to self and others by nurturing individuals beliefs and practices
4. Develop helping-trusting-caring relationship
5. Promote and accept positive and negative feelings as you authentically listen to an other’s story
6. Use creative scientific problem-solving methods for caring decisions-making
7. Share teaching and learning that addresses the individuals needs and comprehension styles
8. Create a healing environment for the physical and spiritual self which respects dignity
9. Assist with basic physical, emotional, and spiritual human needs
10. Open to mystery and allow miracles to enter

Resources

• Implications of caring theory

Research

• Kate Bent, et.al. (2005). Being and Creating Caring Change in a healthcare system.International Journal Human Caring 9(3), 20-25
• Chantal Cara; (2003). Continuing Education.: A Pragmatic View of Jean Watson’s Caring Theory. International Journal for Human Caring. 7(3):51-61.
• Quinn, J., Smith, M., Swanson, K., Ritenbaugh, D. & Watson, J. (2003). Research guidelines for assessing the impact of the healing relationships in clinical nursing.Alternative Therapies. May/June 2003. 9(3): A65-A79.

Questions

Dr Jean Watson: Why are you here? What is your purpose?

Rob Fraser: Have you ever heard of centering exercises? If you are skeptical, have you ever pushed yourself to try it?

Image from: Vanguard Macneal Hospital

The post The science of caring appeared first on Nursing Ideas.

Peggy White RN MN

Program Manager – Health Outcomes for Better Information and Care (HOBIC) program

Documentation is a fact of life in nursing. However, electronic documentation and standardized nursing data is an exciting an relatively new field. As the Program Manager for HOBIC, Peggy White, works for the Ontario Ministry of Health and Longterm Care on integration of nursing based indicators into clinical documentation. As someone that has worked with a variety of nursing organizations and nurses on integrating nursing sensitive measures in clinical documentation Peggy has a lot to share with nurses and nursing students.

Resources

• Canada Health InfoWay
• SNOMED CT (Systematized Nomenclature of Medicine–Clinical Terms)

Research

• The Nursing Health Outcomes Project. (2005) White, Pringle, Doran, and Hall.
• Nursing-sensitive outcomes data collection in acute care and long-term-care settings. (2006) Doran, Harrison, Laschinger, Hirddes, Rukholm, Sidani, Hall, Tourangeau

Questions

Peggy White: What are you doing as a nurse to learn about standardization of data and what it means to your practice?

Rob Fraser: Have you worked with C-HOBIC or learned about it in school?

Image: Binary Null

The post Collecting and Standardizing Nursing Data appeared first on Nursing Ideas.

Over the last decade in nursing, the discipline of informatics has seen and witnessed some exponential changes. The word ‘informatics’ had been used in practice and literature since the mid-1970s, and was picked up by nursing in the early 1980s. As nursing entered the late 1990s, the term ‘eHealth’ began to collect support as the catch-all term used to describe practically anything that crossed between health and technology. With the rise and plateau of the eHealth vernacular both in professional and lay audiences in the latter part of this decade, other neologisms have gained momentum within healthcare – namely, Web 2.0 and social media.

To both insiders and outsiders, this confusing mixture of verbage to describe the use of technology and innovation in healthcare has long confounded individuals attempting to describe ‘what they do’. In my discussions with colleagues of the Ontario Nursing Informatics Group , I have realized that I am not the only person out there who sometimes does not know how to describe this informatics/eHealth/social media mixing pot.

A few months ago I began to critically question why I chose to use certain words, in specific writings or situations. For instance, why would I choose to use the word informatics, as opposed to eHealth to describe a hospital information system? Or, why would I select eHealth as opposed to informatics to outline the use of PDAs in clinical care? I didn’t really have an answer until I started looking at the network of actors (both human and non-human) that formulated and inscribed my past and present thought processes.

So, as you can see through my concept listing, the blurring of the terms exists at many entangled socio-political-technological levels. The ability tease apart the differences are rather difficult at the best of times and sometimes a moot endeavor. Context is probably the best predictor of what term to use, but even that rule of thumb can be flawed. In my short time (respectively) within the profession, I’ve had the opportunity to see terminology come, go, evolve, die, and be replaced with an entirely new cross-section of lexicon. Sadly, I doubt the future will bring any clarity to this issue.

I guess my take away point is to examine how you use certain terminology when describing innovation in healthcare. Neologisms are time limited and sometimes do not gain traction in the literature or practice language. It is probably wise to not fully align one’s self with a term that might only have a useful half-life of 3-4 years. I encourage you to attempt the reflective exercise I’ve tried above and let me know if any of your conceptualizations differ from mine – I’m interested to see how others conceptualize this mashup of terminologies used in describing the informatics discipline.

Image from TedEytan

The post The Mashup of Informatics, eHealth, and Social Media in Healthcare appeared first on Nursing Ideas.

The word “unconference” gets a mixed reaction from many, in healthcare it is usually more confusion then skepticism. For those of you that don’t know, the unconference was born out of the technology industry. They are about 4-5 years old depending who you ask, and they focus on participation by attendees. The wikipedia article on unconferences says they are

a facilitated, participant-driven conference centered on a theme or purpose.

Anyway, on Friday, May 28th 2010 I took part in organizing my second unconference called Mental Health Camp Toronto. This conference was a result of Anne attending Health Camp Toronto, and wanting to have one for her Mental Health. A few collaborators later (Madalyn, John, Carlos, and I) and we were on our way.

Although the unconference was born out of the technology industry, it provides an interesting model for participation, collaboration and knowledge transfer (if you want to be technical) for healthcare. I remember going to ChangeCamp, an event and community movement started by Mark Kuznicki to cultivate citizen participation and openness in government. Below is a short video of Mark explaining what an unconference is and how it might be useful in healthcare.

The crazy part is that, it takes the normal model of a committee of 10-30 people that make decisions (speakers, panels, etc) for hundreds of attendees and flips it on its head. With 5 people, we raised thousands of dollars and simply provide a space and food for participants to come together to talk about mental health, social media and anything that attendees wanted to discuss.

Needless to say, after many meetings at the Duke of York, Massey College, and the Centre for Addiction and Mental Health, the skype calls and a few hundred… maybe a thousand emails somehow it all came together. The event went incredible well and we were so happy to see our ‘baby’ born in 8 months.

The post A Conference for Participants appeared first on Nursing Ideas.

Dr Nancy Walton – @researchEthics

Ryerson University

Associate Professor – Daphne Cockwell School of Nursing
Chair – Research Ethics Board

As many nurses begin to learn about patient care and research the topic of ethics comes up, or at least it should. In this interview I sit down with Nancy Walton, a nurse that found her love for ethics while pursuing her graduate education. She was the Associate Director at Ryerson University in 2009 and is the chair of their Research Ethics board. As an ethicist and a nurse Nancy understand difficulties that both sides encounter when they met. That said she is passionate about helping nurses to understand and use ethical reason to solve situations that arise in patient care and to plan their research. Although her career track to tenure has the traditional list of publications and academic work she is also using more accessible methods of writing through her website Research Ethics. In this interview we talk about her work, the importance of ethics for nursing, how nurses can get more involved and learn more about ethics.

Resources

• Joint Centre for Bioethics
• Research Ethics Blog
• Nursing Ethics – Codes of Ethics
• College of Nurses – Practice Standard Ethics
• Nursing Ethics (wikipedia)
• Institutional Review Board (IRB) Blog

Questions

Dr Nancy Walton RN: What do you feel would help you to further engage with ethics? How can educators and ethicists make it more accessible?

Rob Fraser RN: Have you ever taken ethics training? How was ethics taught to you?

The post An Ethical Nurse appeared first on Nursing Ideas.