CaringHeadlines - November 16, 2006

Inside:

Medical Nursing ...................... 11111

Jeanette Ives Erickson ............ 22222Patricia Benner Visit

Fielding the Issues .................. 33333Flu Vaccine

Medical Nursing Practice

Committee ........................... 44444

Ushering in New Medical

Nurses ................................. 66666

Clinical Narrative .................... 88888Brittany Kupferberg, RN

Magnet Conference ............. 1111111111

Quality & Safety ................... 1212121212Safety Reports

Nutrition & Food ................... 1313131313Holiday Survival Tips

Recognition .......................... 1414141414Hess Receives Jimmy A.

Young Medal

Educational Offerings ........... 1515151515

McLeod Farewell ................. 1616161616

CaringCaringH E A D L I N E S

November 16, 2006

Working

MGH
together to shape the futurePatient Care Services
Medical nursing: a complexand rewarding specialty

(See stories on pages 4, 6, 8)

In the Respiratory Acute Care Unit on Bigelow 9, staff nurse,Greg Conklin, RN, prepares patient, Wayne Donnelly, for an EKG

November 16, 2006November 16, 2006Jeanette Ives EricksonJeanette Ives Erickson

Jeanette Ives Erickson, RN, MSsenior vice president for Patient

Care and chief nurse

he landmarkbook, Novice to

Expert, by Patri-cia Benner, RN,

professor, ThelmaShobe chair in Ethics andSpirituality at the Univer-sity of California, pro-motes the use of clinicalnarratives as a way touncover knowledge em-bedded in clinical prac-tice. Benner believesthat, “Narrative accountsof practice reveal theclinical reasoning andknowledge that comefrom experiential learn-ing. Clinical narrativescan become a resource tohelp practitioners under-stand their own practice,see and share the clinicalknowledge of peers, andreveal strengths and im-pediments of practice.”Narratives give cliniciansan opportunity to examinewhat they do and why.They allow clinicians todescribe their experiencesin a way that includestheir concerns, intuition,verbal exchanges, chal-lenges, conflicts, theirevolving understandingof events, their desire totake risks, and their feel-ings of doubt.

As important as it isfor clinicians to writestories describing theirclinical practice, it’s justas important to sharethose narratives and dis-cuss them with others.When clinicians discusstheir narratives with col-

leagues, peers, and clini-cal experts, they gainnew insights, discovercues that weren’t knownbefore, and make con-nections between pheno-mena that may have beeninvisible before. Whethersharing their own storiesor hearing someone else’s,discussion gives clini-cians an opportunity toview clinical practicefrom another perspective,and this process revealsinsight, wisdom, and bestpractices.

Narratives are helpfulto clinical leadership notonly in helping to deve-

lop individual cliniciansbut in understanding pat-terns of concern. Clinicalleaders can identify is-sues and concerns in cli-nical practice and insti-tutional systems by quan-tifying the themes thatemerge in narratives. Anincrease in narratives thattalk about ethical distressmay prompt a manager or

director to seek addition-al resources to assist staffin identifying and man-aging ethical situations.

Narratives can helpreveal what good, excel-lent, and not-so-excellentpractice looks like. Theycan reveal systems thatsupport excellence incare, and they can callattention to where sys-tems may need to be im-proved. It takes courageto tell a story where, de-spite our best efforts, wefail to achieve a positiveoutcome for a patient.But these are the storieswe must tell. These are

the stories that informpractice and enlightenstaff. It’s only throughhonest examination thatwe can truly achieveexcellence.

Narratives are a keytool in the developmentof reflective practice.Reflection, the ability tocarefully consider one’sown practice in order to

gain a greater depth ofunderstanding, influen-ces not only our presentway of thinking but ourfuture interactions. Clini-cians who reflect on theirpractice and gain insightinto their motivation,

judgment, and actions gointo the next situationmore present and aware.This is how a novicebecomes an expert; thisis how we continuouslyimprove practice and thecare we deliver to ourpatients.

In honor of MedicalNurse Day, Patricia Ben-ner visited MGH on No-

vember 15, 2006, to par-ticipate in two educa-tional sessions. The morn-ing session gave Dr. Ben-ner an opportunity tohear narratives written bymedical nurses and offerexpert commentary. Theafternoon session was amulti-disciplinary casepresentation exploringthe importance of team-work and collaborativepractice. I hope you wereable to attend one or bothof these sessions andhear the compelling stor-ies of your medical nurs-ing colleagues. Listeningto these narratives andthe lively discussion thatfollowed, I know youwould have been movedto share your own clini-cal practice. Perhaps wecan look forward to read-ing them in a future issueof Caring Headlines.

UpdateI’m happy to announcethat Maria Rice, RN, hasaccepted the position ofclinical nurse specialistfor the Emergency De-partment, effective No-vember 13, 2006.

Medical nursing,Patricia Benner, and clinical

narratives

“Narrative accounts of practice reveal theclinical reasoning and knowledge that comefrom experiential learning. Clinical narrativescan become a resource to help practitionersunderstand their own practice, see and sharethe clinical knowledge of peers, and revealstrengths and impediments of practice.”

—Benner and Benner, 2002

T

November 16, 2006November 16, 2006Fielding the IssuesFielding the IssuesFlu vaccine roll-out:are you prepared?

On November 7, 2006, the Provider Order Entry (POE) promptwas activated to cue providers to order flu vaccine for inpatients age

50 and older. Providers can choose the pre-selected order for flu vaccine,decline the order, or defer the decision for up to five days. The flu-vaccine

prompt will be active through March 31, 2007.

Question: What is theprocedure for administer-ing flu vaccine after anorder is received in POE?

Jeanette: Nurses screenpatients for eligibilityusing the Adult InfluenzaVaccination Screeningand Eligibility Form(#84511) and give pa-tients or family membersa copy of the 2006–07Inactivated InfluenzaVaccine Statement (Eng-lish form #84512; Spa-nish form #84513) toreview. If patients meetthe eligibility criteria,nurses administer thevaccine and complete theinformation at the bottomof the form. The form isfiled in the MedicationSection of the medicalrecord and a copy is giv-en to the patient or fa-mily member.

Question: Do nursesneed to obtain consentfrom a patient prior toadministering flu vac-cine?

Jeanette: No. But patientsand family members havethe right to refuse thevaccine after reviewingthe Inactivated InfluenzaVaccine Statement.

Question: Why does theScreening and Admini-stration Form require somuch information?

Jeanette: A patient’seligibility to receive fluvaccine must be deter-mined prior to vaccina-tion (Section 1 of theform). If a patient is eli-gible for the vaccine andthe vaccine is administer-ed, the Department ofPublic Health requiresdocumentation, includingdate, lot number, manu-facturer, expiration date,injection site, and thesignature of the nurseadministering the vac-cine (Section 2 of theform).

Question: Are there anycontra-indications to theflu vaccine?

Jeanette: Yes. Patientsshould not receive the fluvaccine if they have al-ready received a flu vac-cine this season, or ifthey have any of the fol-lowing contra-indica-tions: previous severereaction to flu vaccine;an allergy to eggs, thi-merosal, or latex; a his-tory of Guillain-Barrésyndrome; or fever great-er than 100ºF or 38ºC atthe time of vaccination.

Question: Do I have towait until the day of dis-charge to administer thevaccine?

Jeanette: No. But if thevaccine is given on the

day of discharge, it mustbe given at least 20 min-utes prior to discharge sothe patient can be observ-ed for a reaction. Therisk of flu vaccine caus-ing serious side-effects issmall. Severe reactions,such as hives, shock, ordifficulty breathing occurrarely and should be re-ported immediately to thepatient’s physician.

Question: Do I need todocument vaccine infor-mation in the NursingDischarge Module?

Jeanette: Yes. The nursedischarging the patientneeds to document thedate the patient receivedthe flu vaccine or thereason the patient didn’treceive it. The prompt inPOE will not appear dur-ing subsequent admis-sions during the same fluseason if it has been doc-umented that the patientreceived the vaccine or acontra-indication wasindicated.

Question: Some of mypatients have an order forflu vaccine and the pneu-movax at the same time.Why is that? Can I ad-minister both vaccines atthe same time?

Jeanette: Providers nowsee a combined flu andpneumovax screen in

POE for patients 65 yearsold and older who areeligible to receive bothvaccines. Eligible patientshave no documentationof receiving the pneumo-vax since turning 65 andno documentation ofreceiving the flu vaccinethis season. Providershave the option of order-ing, declining, or defer-ring one or both vaccines.If both vaccines are order-ed, it’s safe to administerthem at the same time.Screening and documen-tation for the flu vaccineis outlined above. Patients

must be screened forpneumovax eligibilityusing the PneumococcalVaccination Screeningand Eligibility Form(#84502) and the patientor a family member isgiven a copy of the Pneu-mococcal PolysaccharideVaccine Statement (Eng-lish form #84492; Spa-nish form #84493). Allother documentationremains the same.

For more informationabout the flu and pneu-movax programs callJanet Madigan, RN, pro-ject manager at 6-3109.

The MGHTobacco Treatment

ServiceUnder the current standard, all

patients should be asked if they’ve usedtobacco products in the past 12 months. Ifthey have, the Tobacco Treatment Serviceshould be notified (6-7443) for a consult

In the smoke-free environmentof the hospital, The Tobacco Treatment

Service can help patients avoidnicotine withdrawal

Every patient who has smokedin the past 12 months should be

given a copy of the Guide forHospital Patients Who Smoke

(Standard Register form #84772).A copy of the guide is placed at

every patient’s bedside whenthe room is cleaned

Helping patients to quit smokingis part of the excellent care all

clinicians provide at MGH.

Make your practice visibleDocument your work

For more information,or to request a quit-smoking consult,

call 6-7443

November 16, 2006November 16, 2006

edical Nursingis an area of spe-cialty practicethat more often

than not dealswith the unexpected.Medical patients presentwith complex, diverse,physical and psycho-social needs that chal-lenge both novice andexperienced nurses in adynamic, ever-changingenvironment. Team-build-ing, collaboration, andconsultation among staffand unit leadership arecritical to daily opera-tions and effecting qua-lity patient-care outcomes.

The Medical NursingPractice Committee wasformed in March of 2005by the nurse managersand clinical nurse spe-cialists of the generalmedical units, the Medi-cal Intensive Care Unit(MICU), and the Respir-atory Acute Care Unit(RACU) to provide aforum for collectivelyidentifying, discussing,and resolving practiceissues of mutual concern.After weeks of brain-storming, it became clearthat the interests andissues raised by the groupwere related not only toprofessional practice butto performance-improve-ment, and professionaldevelopment, as well.Unit leadership was com-mitted to including staffnurses from each medicalunit as active participants.

Using the collaborativegovernance model, anurse manager and clini-cal nurse specialist as-sumed co-chair responsi-bilities with the intentionof staff nurses assumingthose roles later on witha nurse manager or clini-cal nurse specialist ascoach. Within the firstfew months, the MedicalNursing Practice Com-mittee agreed on the fol-

lowing vision statementto guide its work: “Tocreate a professionalpractice environment thatpromotes medical nurs-ing as a specialty throughclinical excellence, re-search-based practice, aspirit of inquiry, and acommitment to lifelongprofessional develop-ment.”

The committee identi-fied a mission statement

and guiding principles tosupport their vision. Itsmission is to provide aforum to identify, dis-cuss, and resolve issuesrelated to nursing prac-tice, quality improve-ment, and professionaldevelopment.

Guiding principlesare:

We believe... that trust,mutual respect, integ-rity, and a shared com-mitment to a unifiedteam approach are thefoundation for all wedoWe believe... that ‘know-ing the patient’ is cen-

tral to establishingtherapeutic relation-ships with patientsand the provision ofquality patient careWe believe... that aninterdisciplinary ap-proach individualizedto the patient’s physi-cal, emotional, cultur-al, and spiritual needspromotes better pa-tient-care outcomesWe believe... in thehealing power ofnursing and caringthrough service topatients, families, andone another

PracticePracticeThe Medical NursingPractice Committee

—by Cynthia LaSala, RNclinical nurse specialist

M

continued on next page

New graduate nurse, Leah Gamello, RN (left), suctions patient in theMedical Intensive Care Unit as preceptor, Christine McCarthy, RN, looks on


We believe... in life-long learning and fos-tering an environmentthat encourages clini-cal inquiry, creativity,mentorship, and careerdevelopmentWe believe... that pro-fessionalism meansbeing personally ac-countable and respon-sible for one’s practice,on-going professionalgrowth, and the ad-vancement of profes-sional nursingWe believe... in thenurse as patient advo-cate and the criticalrole the nurse plays inempowering patients totake as active a role aspossible in their care to

achieve optimal well-ness and quality of lifeWe believe... in main-taining a safe environ-ment for patients, fam-ilies, and staff by mini-mizing the potential forinjury through collabo-rative problem-solving,performance-improve-ment, and promoting ablame-free environ-mentWe believe... in theimportance of celebrat-ing our successes andpromoting medicalnursing as a specialtypractice areaSince its inception,

some of the committee’sactivities and projectshave included the devel-

opment and implemen-tation of a template forgiving nurse-to-nursereport between the ICUand general medical units;establishing a workgroupto evaluate the use ofpatient observers; pro-posed guidelines relatedto smoking privilegesand behavioral manage-ment of patients withpsychiatric and/or sub-stance-abuse problems;development and imple-mentation of transcrip-tion guidelines for thetreatment record; unit-based best practices re-lated to minimizing therisk of patient falls; careof mechanically ventilat-ed patients and staff train-

ing needs; initial assess-ment and triaging offront-door admissions;the development andimplementation of plansto celebrate Medical Nurs-ing 2006; and a one-dayMedical-Surgical Certi-fication Exam ReviewCourse for staff nurses.

Interdisciplinary col-laboration related tothese projects and acti-vities has included theOffice of Quality & Safe-ty; the Admitting Office;Respiratory Care; physi-cians on the MedicalService; the Cardiac Nurs-ing Practice Group; Po-lice, Security & OutsideServices; staff special-ists; the Nursing PracticeCommittee; Human Re-sources; nursing super-visors; and the Psychiat-ric Clinical Nurse Spe-

Medical Nursing Practice Committeecontinued from previous page

cialist Consultation Liai-son Service.

The Medical NursingPractice Committee ispreparing for a transitionin leadership this month.Two staff nurses are takingover co-chair responsibi-lities, giving them andothers to follow a wonder-ful opportunity for person-al and professional devel-opment as nurse leaders.Nurse managers, clinicalnurse specialists, and staffnurses look forward toanother exciting and chal-lenging year of collabora-tion, problem-solving, andteamwork in advancing thespecialty of medical nurs-ing and promoting an en-vironment of clinical in-quiry and life-long learn-ing that ensures the high-est quality care to patientsand their families.

Medical Nursing Practice Committee


any new gradu-ate nurses optto work on ageneral medical

unit after gra-duation to gain experi-ence caring for patientswith a variety of medical,psychological, and socialissues. This multi-facetedpatient population pro-vides new graduates witha multitude of learningopportunities. Due to thecomplex needs of thesepatients, nurses musthave highly developedcritical-thinking and phy-sical-assessment skillsand the ability to effec-tively collaborate andcommunicate across dis-ciplines.

Bigelow 11 is a 25-bed general medical unitthat hires an average offive to seven new grad-uate nurses a year. Theclinical nurse specialist(CNS) role is shared byKate Barba, RN, andPatti Fitzgerald, RN. Inresponse to the increas-ing complexity of thegeneral medical popula-tion, CNSs, with staffinput, have implementedseveral strategies to as-sist new graduate nursesthroughout their first yearof practice.

New nurses on Bige-low 11 participate in aneight-week orientationperiod with an experienc-ed preceptor. During thistime, new graduate nursesslowly increase their

responsibility and patientassignments, until they’reable to function inde-pendently. The CNS actsas a resource to the newgraduate and the precep-tor during the orientationperiod. The CNS meetsfrequently with the pre-ceptor and new graduatenurse to evaluate theorientation process andto identify areas whereadditional support isneeded. Support can beas simple as providingresearch about certain

clinical conditions, or ascomplex as developingan in-depth learning planto ensure the new grad-uate’s successful comple-tion of orientation. Dur-ing orientation, the newgraduate nurse spends aday working with theCNS to review clinicalissues and competenciesnecessary for completionof orientation. This is acasual, low-stress daythat focuses not only onclinical issues but on thenew graduate’s psycho-

social and emotionaladjustment to his/hernew situation.

After the eight-weekorientation period ends,the CNS and all nurseson Bigelow 11 continueto provide support to thenew graduate. Bigelow11 has a strong culture oflearning, where questionsare encouraged, and noissue is too small. Every-one is expected to parti-cipate in helping the newgraduate nurse develop.

The CNS checks inwith the new nurse daily,discussing patient assign-ments and helping thenew graduate analyzeclinical data and create aplan of care. The resourcenurse checks in with thenew nurse several times

throughout the shift toensure he/she doesn’tbecome overwhelmed byhis/her patient assign-ment.

Working the nightshift can be challengingfor new nurses. A helpfulstrategy we’ve used toassist nurses to transitionto the night shift is tohave an experienced nightnurse act as a mentor tonew nurses over thecourse of a few nights.The experienced nursedoesn’t take a direct pa-tient-care assignment,but focuses on helpingnew nurses organize theirwork and adjust to thedifferent pace and re-sponsibilities of the nightshift.

Clinical Nurse SpecialistsClinical Nurse SpecialistsUshering new graduate

nurses into the complex specialtyof medical nursing

—by Kate Barba, RN, and Patricia Fitzgerald, RN

M


New nurse, Melissa Donovan,RN (right), with the aid of preceptor,Christina Dhimitri, RN, administers

antibiotic via Sigma pumpto patient, George Flynn


New graduate nursesare encouraged to selecta mentor. It can be thenurse’s preceptor or aanother experienced nursewith whom the new gra-duate has developed arelationship and whosepractice he/she admires.The new graduate andmentor attend the NewGraduate Nurse Develop-ment Program together,and mentors become asupportive resource tonew graduates thereafter.

Research shows thatthe six-month milestoneis an important one in the

development of a newnurse. This is when newgraduates’ competenceand proficiency increaseas they simultaneouslyexperience a decline inmorale and confidence.On Bigelow 11 we em-ploy a couple of strate-gies to help new gradu-ates over this develop-mental hurdle. On thenew graduate’s first dayon Bigelow 11, he/she isencouraged to plan avacation to coincide withtheir six-month anniver-sary. We’ve observed thatnurses need to re-energize

at this pivotal point, andtime away from the unit isa good way to achievethat. Last year’s new gra-duates took this advice toheart and planned a grouptrip to the DominicanRepublic. With supportfrom veteran staff mem-bers and some creativescheduling, we were ableto make this happen.They returned to the unitwell rested, tan, and eag-er to take on new chal-lenges.

Another strategy weuse to help new graduatesget over that six-monthhurdle is what we call,“New Graduate Day.”This is a time when newgraduate nurses spend

time away from the unitwith the CNS and otherexperienced nurses toaddress any clinical, emo-tional, or psychosocialissues they may have.The content of the day isdriven by the needs of thenew graduates with ex-perienced nurses devel-oping and presentingclasses. A highlight ofthis day is the discussionsession with new gradu-ates and senior staff.These open discussionsgive both groups a betterunderstanding of percep-tions and needs andstrengthens relationshipsbetween staff.

New graduates attendother, structured programs

during their first year,such as Basic NursingRespiratory Care andSimulated Bedside Emer-gencies for New Nurses.These classes provideimportant clinical con-tent and an importantchange of pace from theclinical setting. We en-courage new graduates toidentify other educationalexperiences they’d like totry such as observing ondifferent units.

At the one-year mark,most new graduates aremuch more comfortablewith the routine of theunit and can easily han-dle their patient assign-ments. It’s at this pointthat our focus on theirdevelopment changes.We begin to encouragethem to participate inunit projects, orient tothe resource role, andbegin to think about par-ticipating in collabora-tive governance. We be-gin to have discussionsabout their interests andcareer goals and chal-lenge them to becomemore involved in unitand hospital-wide acti-vities.

The increasing acuityof our inpatient popula-tion impacts everyone,but none more than newgraduates. It truly does‘take a village’ to helpthem develop strong clin-ical skills and the valuesand philosophies thatthey’ll carry with themthroughout their entirecareers. By using a com-bination of strategies, weimprove their compe-tence and confidence,and set the stage for ahappy and successfulnursing career.

New Graduate Medical Nursescontinued from previous page

New nurse, Jessica Sullivan, RN(left) checks Patsy Luongo’s bloodpressure under the watchful eye ofpreceptor, Christina Connors, RN


Brittany Kupferberg, RNstaff nurse, White 9

M


Medical nurse bringsempathy, compassion, and advocacy

to end-of-life careBrittany Kupferberg is a clinician in the PCS Clinical Recognition Program

Clinical NarrativeClinical Narrative

Some portions of this text may have been altered to make the story more understandable to non-clinicians.

y name is BrittanyKupferberg, and Iam a staff nurse onthe White 9 Medi-

cal Unit. I startedthis particular day theway I start most days.When I got into work, Iprepared to accept reportfrom the night nurse. Wewere ‘trading assign-ments,’ which means Iwas taking all her pa-tients for the day shift.She told me that the pa-tient in room 42 wasgoing to break my heart.I listened to his story. A45-year-old man, whohad come to MGH for anevaluation of a question-able mass on his liver,had presented with com-plaints that his belly ‘justkept getting bigger’ de-spite the fact that he’dbeen losing weight. Hehad a new, sharp flankpain, and he had beenadmitted for a work-up ofthese complaints.

Mr. D had a knownhistory of hepatitis C,and was found to be inliver failure upon admis-sion. A biopsy of his liverwas performed, and wewere awaiting the results.After report, I knew I hadto see Mr. D first.

I went into his roomand saw a man whosebelly looked like it be-longed on someone else’sbody. He was thin andjaundiced and had thatall-too-familiar look offear in his eyes. I tried to

engage him in conver-sation but could tell hewas in no mood for talk-ing. I told him how tocall me if he needed any-thing, and assured himI’d be there with himthroughout the day.

An hour later, I notic-ed that Mr. D had a visit-or. I was caring for theother patient in the roomwhen I heard him tell thevisitor that I was hisnurse. I walked over andintroduced myself to thewoman whom I learnedwas Mr. D’s wife. Mrs. Dwas immediately engag-ing, asking questions,wanting to learn every-thing she could aboutwhat was going on withher husband’s care andhospital course. I sat withthem and told them botheverything I knew aboutMr. D’s care. In his wife’spresence, Mr. D openedup more and more. I en-joyed having Mr. D as apatient, and I was movedby how caring his wifewas. The rest of our firstday together was unevent-ful—Mr. D was beingmonitored and awaitingthe final results of hisliver pathology.

The next morningwhen I returned to work,I was rounding with theteam when I heard thenews for the first time.Mr. D’s pathology resultswere back, and they werevery poor. He had beendiagnosed with hepato-

cellular carcinoma, andthe lesion was so large ithad spread almost acrosshis entire liver. The teamconsulted Oncology, andthe junior resident andthe attending physicianplanned to talk with Mr.and Mrs. D at noon. Whenrounds were over, theoperations associate pag-ed me to Mr. D’s room. Iwent to see what he need-ed. Mrs. D said she wassorry to bother me; theyjust wanted to know whatthe doctors were going totalk with them about atthe noon meeting. I toldthem the doctors wantedto go over Mr. D’s testresults. Later, Mrs. Dtold me she knew some-thing was wrong in thatmoment. She saw in myeyes that everythingwasn’t as they’d beenhoping.

A little while later, Isaw the junior residentand attending physiciango into Mr. D’s room andclose the door. As I tend-ed to my other patients, Ikept a close eye on Mr.D’s door so I’d knowwhen their meeting wasover. A short while later,the doctors left the room.I wanted to go in, but Ithought they might needtime to digest what they’djust heard. I waited a fewminutes and then went into see them. Their eyeswere red and watery.They were both lying inthe small twin bed hold-

ing each other. I quietlytold them I was there forthem, but recognizedtheir need to just be witheach other.

That evening, Mr. Dcalled me and said hewas starting to feel shortof breath. I checked hislung sounds and oxygensaturations and heard hewas wheezing with bi-basilar crackles. His sat-uration was only 87%. Icalled the doctor, and webegan to give Mr. D anebulizer treatment andsome intravenous lasix.He immediately regainedcontrol of his breathing.Medically, this episodehad been easy to diagnoseand resolve, but it carrieda lot of meaning. Thiswas the first time Mr. Dhad had an acute episode.Up until now, his painand fatigue had beenchronic. This shortnessof breath was anotherindication that Mr. D wasmore than just a little ill.

The next morning,Mr. D was already awakeand waiting for me whenI came in to see him.Mrs. D was there, too.

She said she wasn’t go-ing to waste a second notbeing with her husbandever again. Mr. D saidsome friends were com-ing in to see him, and hedidn’t want to be seenlooking as badly as hefelt. I helped him shower,and as we walked back tohis bed, he said he ‘feltlike a million bucks.’ Ihelped him into the bath-room, as his gait wasgrowing more and moreunsteady. I helped himset up so he could shave.

While he was in thebathroom, I started totidy up his room. Mrs. Dthanked me for beingthere during this horribletime. I sat with her andasked how she was do-ing. Everyone had beenso concerned about Mr.D, no one noticed thatMrs. D was falling apartdespite the fact that shewas trying to be strong.Mrs. D immediately brokedown and started tellingme how she couldn’timagine life without herhusband. We sat andtalked and before long, I


Clinical Narrativecontinued from previous page

had tears in my eyes. Weheard Mr. D finishing upin the bathroom andquickly wiped our faces—we didn’t want him tosee how sad we were.

Later that day, Mr.D’s friends came to visithim, and he truly camealive. This man who’dbeen so flat, so scared,suddenly became a viva-cious character, tellingstories, making a roomfull of people laugh. Mrs.D came out and asked ifthey were being too loud.I smiled and told her Mr.D looked so happy withhis friends, I wouldn’tdare try to quiet themdown.

Later that night, Mr.and Mrs. D began to talk

about being discharged.They had decided theyneeded to go home. Gi-ven Mr. D’s grave diag-nosis, they wanted tospend as much time aspossible at home. I shar-ed this information withthe junior resident, andwe talked about prepar-ing Mr. D to leave thefollowing day.

That night, as I wasleaving, I saw Mrs. D asI was walking past theparking garage. She wastalking on her cell phone,and I waved to her as Iwalked by. She hung upabruptly and came overto me. She hugged meand thanked me for beingthere with them at thisdifficult time. She told

me how much it meant toher that I had taken thetime to ask her how shewas. She appreciated thatI had asked her when Mr.D wasn’t in the room.She was so worried forhim, but of course, shedidn’t want him to knowhow scared she was. Ihugged her and told herwhat a pleasure it hadbeen to take care of Mr.D.

I don’t think either ofthem realized what animpact they had on me.Mr. D was not a medical-ly complex patient. Hisvital signs were stable,he was able to do a lotfor himself, and he had agreat support system. Mr.D needed the kind of carethat can’t be learned froma book or by sitting in aclassroom. He neededsomeone to listen to him,

to sit and talk with hiswife, to make him feelcomfortable with hisdiagnosis—to the extentthat that was possible.

The next morning, Ibegan to prepare Mr. andMrs. D for discharge.During his hospitaliza-tion, Mr. D had someserious declines in hishealth. He was becomingweaker and weaker everyday. His pain had increas-ed, and as we increasedhis pain medication, hismental status becamefoggy. He needed morediuretics and had a newoxygen requirement. Ihad spoken with the ju-nior resident about hisdischarge. We were bothapprehensive about hisleaving, but we under-stood Mr. D’s desire tobe home. We both wantedto give him that chance.

I prepared Mr. andMrs. D for the possibilitythat they might have toreturn to the EmergencyRoom. I knew they’dboth think of it as a set-back, but I wanted themto know the signs to lookfor. And I didn’t wantthem to be surprised ifMr. D continued to de-cline. I searched for theright words to tell themwithout being discour-aging.

Even though it’s beenmonths since Mr. D’sadmission, I still think ofhim all the time. He wasone of those patients whomakes you rememberwhy you wanted to be anurse. I know I made adifference in his end-of-life care, and that is some-thing I will always trea-sure.

Comments by JeanetteIves Erickson, RN, MS,senior vice presidentfor Patient Care andchief nurse

This narrative beautifullyshowcases Brittany’sclinical skills and caringpractice. She knew intui-tively when Mr. and Mrs.D needed to be alone andwhen they needed herpresence. She reachedout to Mrs. D knowingthe entire family wasaffected by Mr. D’s ill-ness. Transitioning homeso close to the end of lifeis a tremendous stress foranyone. Brittany preparedMr. and Mrs. D for whatto expect and how tomanage once they werehome. She empoweredthem to ‘normalize’ avery out-of-the-ordinarysituation.

Thank-you, Brittany.

White 10 medical nurses, Barbara Badio, RN (left), andEllen Cellini, RN, check vital signs for patient, Bruce Pelissier


n November 5,2006, the Com-fort and Support

After Loss Com-mittee held its 15th

annual Pediatric, Neo-natal, and Obstetric Be-reavement Service. Thismemorial program isdedicated to familieswho have experiencedthe death of an infant,child, or adolescent, orwho have lost a childthrough miscarriage orstill-birth.

Fredda Zuckerman,LICSW, obstetric socialworker, moderated theservice. Ron Kleinman,MD, acting chief of Pe-

diatrics; Howard Wein-stein, MD, chief of Pedi-atric Oncology; and JudyNewell, RN, nurse mana-ger of the pediatric inpa-tient units participated inthe program; ReverendAnn Haywood-Baxter,pediatric chaplain, shar-red a non-denominationalreading; and several fam-ily members read storiesand poems reflective oftheir journeys throughgrief and bereavement.

Music was providedby Lora, Lisa, and Patri-cia Tamagini whose voic-es echoed poignantlythroughout the service.Parents, families, and

Comfort and Support AfterLoss Memorial Service—by Leslie S. Kerzner, MD, associate medical director, Special Care Nursery

O friends were invited totake part in the tradition-al naming ceremony;they received tulip bulbsand a pewter heart inmemory of their children.

Family members andcaregivers hung memor-ials on a remembranceboard; the memorialswill be added to a quilt inthe future. A slide showcapturing 15 years ofmemories was presented.

Following the ser-vice, a reception washeld in the East GardenRoom. The memorialquilts from 1998–2002were on display outsidethe General Store, and

RemembranceRemembranceseveral scrapbooks fromyears past were availablefor viewing.

Members of the Com-fort and Support AfterLoss Team include:

Fredda Zuckerman,LICSWKathryn Beauchamp,RNAnn Haywood-Baxter,MDiv

Genevieve Gonzales,LICSWHeidi Jupp, RNLeslie Kerzner, MDElyse Levin-Russman,LICSWJanet Madden, RNJoyce McIntyre, RNBrenda Miller, RNKristen Nuttall, RNHeather Peach, CCLSEileen White

MGH Institute of HealthProfessions

Information Sessions

Thursday, December 14, 2006, 6:00–8:00pmSaturday, February 24, 2007, 10:00am–12:00pm

Thursday, May 17, 2007, 6:00–8:00pm

For more information, visit: www.mghihp.edu/admissions/infosessions.html

Call for ProposalsThe Yvonne L. Munn, RN,Nursing Research Awards

Submit research proposals for the annualYvonne L. Munn, RN, Nursing ResearchAwards to be presented during Nurse

Recognition Week, May 6-11, 2007

Proposals are due January 16, 2007

Guidelines are available at:www.mghnursingresearchcommittee.orgFor more information, call 617-726-3836

Call for AbstractsNursing Research Day 2007

Categories: Encore presentations (posters presented

at conferences since May, 2006) Original research Research utilization Performance improvement

Some restrictions apply

For more information, go to the NursingResearch Committee website at:

www.mghnursingresearchcommittee.org

Abstracts must be receivedby January 31, 2007

(Photo by Michelle Rose)

Caregiver adds memento to remembrance board


ighteen MGHnurses led by

Keith Perleberg,RN, nurse manag-

er and co-chairof the Magnet Re-

designation Team, andSheila Golden-Baker,RN, clinical educator inThe Knight Nursing Cen-ter for Clinical & Profes-sional Development,attended the 10th nation-al Magnet Conference,October 4–6, 2006, inDenver, Colorado. Theconference was sponsoredby the American NursesCredentialing Center, adivision of the AmericanNurses Association thatawards Magnet status toqualified institutions.

In 2003, MGH wasthe first hospital in Mass-achusetts to receive Mag-net status, a designationthat must be re-earned

every four years. Theconference coincidedwith the kick-off of thehospital’s Magnet re-designation initiative.

Sixteen Magnet ambassa-dors attended the confer-ence; that’s a new rolecreated for the re-desig-nation process based onfeedback from Magnetchampions who partici-pated in the 2003 prepa-rations. Four staff nursesattended, selected byassociate chief nursesand nurse managers, as

well as a clinical nursesupervisor, and a Magnetambassador assistingwith Magnet championeducation.

Ambassadors willserve as a communica-tion link between Magnetteams and unit-basedMagnet champions.They’ll help sustain mo-mentum with on-going,reliable communicationand informed coaching.

The ‘mile-high’ con-ference offered manystrategies for reaching

ConferencesConferencesMagnet ambassadors attend

Denver conference—by Sheila Golden-Baker, RN; Gayle Peterson, RN;

and Madeleine McGarry, RN

and maintaining Magnetstatus. There were oppor-tunities to network withcolleagues from otherinstitutions, which washelpful to ambassadorswho were exploring cre-ative strategies for ourown re-designation ef-forts. Two nationallyknown speakers, CurtCoffman, author of First,

Break All the Rules, andMarlene Kramer, RN,nursing leader and auth-or, provided insightful,relevant commentary forfurther consideration.

As informative andinspiring as the confer-ence was, the highlightfor MGH attendees wasthe opportunity for am-bassadors to spend time

E

together away from the hos-pital and get to know eachother. Said one ambassador,“We started out as eighteenstrangers exploring a newrole, and over three days, wequickly became a cohesiveteam.” On the last evening,laughter and lively discus-sion were shared over asumptuous dinner madepossible by Jeanette IvesErickson, RN, senior vicepresident for Patient Care.

A group of weary butenergized MGH nurses ar-rived at the Denver airport,reflecting on their memo-rable experience and credit-ing Perleberg with facilitat-ing this exhilarating excur-sion.

Magnet ambassadorsand others participating inthe re-designation effortinclude:

Amie Stone, RNHeather Parker, RNMadeleine McGarry, RNJoanne Parhiala, RNGayle Peterson, RNDawn McLaughlin, RNCourtney Wells, RNDiane Lyon, RNSuzanne Algeri, RNErin Salisbury, RNJim Barone, RNKelley Sweeney, RNKeith Perleberg, RN (co-chair)Kate Boyle, RNSheila Golden-Baker, RN(support staff)Ann Morrill, RN;Mary McAuley, RNDenise Young, RNMaureen Mullaney, RNDiane Grobman, RNJoan Braccio, RNDavid Reisman (supportstaff)For more information

about our Magnet re-des-ignation initiative, contactSheila Golden-Baker, RN,at 6-1343.

“From a distance we look a little fuzzy, but up close,

it’s clear to see we share: SSSSStrength, UUUUUnity, PPPPPride,

EEEEExpertise, and RRRRRespect.”

— Jim Barone, RN, Magnet ambassador,

Main Operating Room

MGH nurses at Magnet conference in Denver

(Photo provided by staff)


afety reportsare the founda-

tion on whichmany performanceimprovements are

based. Performance-improvement initiativesare created because ofevents reported by staffand employees. Medicalerrors and patient safetyhave received a lot ofattention of late, andpatient safety is nowrecognized as a separate

discipline within qualityassurance. Because nursesare ‘front-line’ caregivers,their participation insafety reporting is evenmore crucial to safe andeffective patient care.

Near misses, or ad-verse events that don’tresult in harm, representopportunities to improvepractice and put mecha-nisms in place to ensurethat future adverse eventsdon’t occur. If the under-

Quality & SafetyQuality & SafetySafety reporting: a key

component of performance-improvement

—by Katie Farraher, senior project specialist, Office of Quality & Safety

lying conditions thatcontribute to near missesare quickly identified,remedied, and widelycommunicated, the likeli-hood of adverse eventsrecurring is greatly reduc-ed or eliminated. Thegoal of safety reporting isto gain a better under-standing of potentialproblems as they relate tosafety. Accurate informa-tion in safety reportsleads to effective root-

S

cause analyses and po-tential solutions to avoida recurrence of the event.

MGH fosters a blame-free culture for the re-porting of errors. Clini-cians should not feel thatcompleting a safety re-port would put them atrisk for disciplinary ac-tion. A blame-free culturerecognizes that it’s rarefor a single individual tobe the cause of an inci-dent; rather, multiplesystematic factors usual-ly contribute to circum-stances wherein adverseevents occur. A blame-free culture eliminatespunishment for adverseevents unless the em-ployee is found to have

engaged in malicious,reckless, or illegal beha-vior. Accidents do notconstitute malicious,reckless, or illegal beha-vior.

Rather than blaming,MGH looks ‘behind’ theincident to determinewhat factors were presentthat allowed the adverseevent to occur. MGH val-ues the support of all em-ployees in ensuring opti-mal patient safety andperformance-improve-ment. Nurses play an in-tegral role in patient safe-ty, performance-improve-ment, and quality care.

For more informationon safety reporting, callKatie Farraher, at 6-4709.

Why does hand hygiene need to be performed beforecontact with patients or their environment?

We all have germs living on our skin. We can’t seethem, but they’re there. We can pick up germs simp-ly by touching other people or contaminated sur-faces.

The germs we carry can cause infection or illnesswhen conditions are right or our resistance is low.They can be spread to other people and surfaces bydirect contact, a simple touch.

Fortunately, germs on our hands can usually be remov-ed with good hand hygiene. This is important to re-member, especially when caring for patients at great-er risk for infection.

Hand hygiene before contact prevents the spread ofgerms to patients and their environment.

Can gloves be used as a substitute for hand hygiene?

No. Gloves do not eliminate the need for hand hy-giene, and hand hygiene does not eliminate the needfor gloves when recommended or required.

Hands must be disinfected:before gloves are worn andafter gloves are removed

Why?

Gloves are not 100% effectivein preventing hand contaminationGlove materials may contain imperfections thatare invisible to the naked eyeWarm temperatures inside gloves can promotethe growth of germs already present on your skinHands can become contaminated as gloves areremovedCal Stat must be used to reduce the levels of bac-teria on your skin before and after glove use.

What are the benefits of Cal Stat?

More effective than soap and waterFaster than hand-washingBetter for your skin than alcohol-based handcleanersSafe and environmentally friendly

MGH is committed to improvinghand hygiene

Frequently asked questions about hand hygiene:

Stop the Transmissionof Pathogens

Infection Control UnitClinics 131726-2036

November 16, 2006

November 16, 2006

Next Publication Date:

December 7, 2006

Published by:

Caring Headlines is published twice eachmonth by the department of Patient Care

Services at Massachusetts General Hospital.

Publisher

Jeanette Ives Erickson RN, MS,senior vice president for Patient Care

and chief nurse

Managing Editor

Susan Sabia

Editorial Advisory Board

ChaplaincyMichael McElhinny, MDiv

Editorial SupportMarianne Ditomassi, RN, MSN, MBAMary Ellin Smith, RN, MS

Materials ManagementEdward Raeke

Nutrition & Food ServicesMartha Lynch, MS, RD, CNSDSusan Doyle, MS, RD, LDN

Office of Patient AdvocacySally Millar, RN, MBA

Orthotics & ProstheticsMark Tlumacki

Patient Care Services, DiversityDeborah Washington, RN, MSN

Physical TherapyOccupational Therapy

Michael G. Sullivan, PT, MBA

Police, Security & Outside ServicesJoe Crowley

Public AffairsSuzanne Kim

Reading Language DisordersCarolyn Horn, MEd

Respiratory CareEd Burns, RRT

Social ServicesEllen Forman, LICSW

Speech, Language & Swallowing DisordersCarmen Vega-Barachowitz, MS, SLP

Volunteer, Medical Interpreter, Ambassadorand LVC Retail Services

Pat Rowell

Distribution

Please contact Ursula Hoehl at 726-9057 forquestions related to distribution

Submission of Articles

Written contributions should besubmitted directly to Susan Sabia

as far in advance as possible.Caring Headlines cannot guarantee the

inclusion of any article.

Articles/ideas should be submittedby e-mail: [email protected]

For more information, call: 617-724-1746.

Please recycle

t starts subtly: an invita -tion to a Halloweenparty; hosting Thansgiv-ing for family and friends;

a Christmas catalog; theannual e-mail asking you to

hold the date for the office holi-day party. The holiday season isupon us. This time of year canbe a challenging time to main-tain a healthy diet and exerciseprogram. The month betweenThanksgiving and New Year’s isa concentrated period of timefilled with parties, travel, shop-ping, and visiting, all of whichdisrupt our normal routine.

Family, friends, and food areintegral parts of almost everyholiday tradition.

People often report gainingweight during the holidays. Thisweight gain is typically small,but it almost never goes com-pletely away. And that gradualweight-gain over a number ofyears can significantly increaseyour risk for heart disease anddiabetes. It’s appropriate at thistime of year to focus on mainte-nance strategies that can giveyou some flexibility in your eat-ing and activity regimens whilestill getting lots of enjoymentout of every gathering. Beloware Nutrition & Food Services’top ten holiday survival stra-tegies:1) Plan ahead. Decide what

your plan is for managingyour eating and drinking inevery situation. Be specificand realistic.

2) Don’t go hungry. Avoid ‘sav-ing up’ your calories. Have asmall snack to curb yourappetite. Make sure to eatbreakfast and lunch.

3) Keep your alcohol intake

low. Alcohol is high in calo-ries and increases appetite.Stick to sparkling water anddiet drinks.

4) Practice portion control. Usesmall plates, small cups, andtake small servings of every-thing.

5) Don’t be the ‘hostess with themostess.’ Freeze those left-overs for another day, or givethem to guests as they leave.

6) Modify recipes. Re-createsome family favorites withlower-calorie ingredients, ortry something new altogether.Monthly magazines likeCooking Light and RealSimple offer great holidayfood ideas.

Holiday survival strategies—by Melanie Pearsall, RD, registered dietitian

Nutrition & FoodNutrition & Food

I

7) Make grocery shopping‘extra’ healthy. Make yourweekly shopping run extrahealthy with lots of fruits,vegetables, and low-caloriesnacks to help offset thosecalories eaten at parties.

8) Don’t forget to exercise. Tryto maintain your usual exer-cise routine, or even better,kick it up a notch. Even smallincreases in exertion and timehelp burn off those extra cal-ories.

9) Eat mindfully. Focus on qua-lity, not quantity.

10) Get support. Enlist the aid offamily, friends, or a register-ed dietitian to help you stayon track.


Hess receives prestigiousJimmy A. Young Medal

Blood donorsneeded during the

holidaysEvery year around the holidays, blood supplies

dwindle as people become distracted with seeminglymore pressing matters. During the busy weeks of

Thanksgiving and Christmas, blood donorsare needed more than ever.

When you give blood, your donation is separatedinto three parts:

red cells can be used to treat trauma and surgicalpatientsplatelets are used to care for cancer patientsplasma helps burn and hemophilia patients

One donation can potentially help three people

Sickle-cell-anemia patients can use up to five pintsof blood per month

The need for blood increases with advances in medi-cal technology

MGH is the largest transfuser of blood in Massa-chusetts, and one of the largest in the nation

Every two seconds, someone needs blood

Only 5% of eligible donors donate blood

The number-one use of blood is treating cancer

There’s a 97% chance you’ll need blood in yourlifetime

One out of every ten hospital patients needs blood

Treatment for cancer, organ transplants, and surgerydepends on the availability of blood

The nations blood supply has decreased by 3% peryear since 1987

When you donate blood, your blood pressure, pulse,temperature and iron level are checked, and you’ll benotified if any abnormalities are found

Giving blood is safe, simple, and satisfying

Type O is the most common blood type. Type O cansafely be transfused to patients with any other bloodtype and is frequently used in emergencies. Becauseof its compatibility with other blood types, type O isthe most widely used and frequently needed bloodtype

Do you really havesomething more important

to do...?

RecognitionRecognition

ssistant directorof RespiratoryCare, Dean

Hess, RRT, hasbeen named the 2006

recipient of the Ameri-can Association of Res-piratory Care’s highesthonor, the Jimmy A.Young Medal. He willaccept the award at thenational meeting of theAARC in Las Vegas inDecember.

The Jimmy A. YoungMedal is given to a mem-ber of the respiratorycare profession whoexceeds all expectationsfor meritorious serviceand who has made asignificant contributionto the advancement ofthe profession. The

award was created in1976 to honor the mem-ory of Jimmy Young, arising star in the respir-atory care professionwho was widely recog-nized for his work inrespiratory care educa-tion and management.Young was the firstdirector of the Inhala-tion Therapy Depart-ment at MGH and co-wrote one of the firsttextbooks on respiratorycare, Principles andPractice of InhalationTherapy, published in1970.

In the October issueof AARC Times, DavidPeirson, MD, professorof Medicine, Pulmon-ary, and Critical Care

A Medicine at the Univer-sity of Washington, saidof Hess, “Dean is a peer-less teacher who hasbrought a scientificallysound, physiologicallybased approach to ad-dressing bedside prob-lems to a generation ofphysicians, nurses, andfellow respiratory ther-apists. He is perhaps thevery best writer in hisprofession, worldwide.”

Says Robert Kacma-rek, RRT, director ofRespiratory Care atMGH, “Dean’s originalresearch on aerosol ther-apy has to be consideredone of the most signi-ficant academic contri-butions to the profes-sion.”

Educational OfferingsEducational Offerings November 16, 2006November 16, 2006

2006

2006

For detailed information about educational offerings, visit our web calendar at http://pcs.mgh.harvard.edu. To register, call (617)726-3111.For information about Risk Management Foundation programs, check the Internet at http://www.hrm.harvard.edu.

WhenWhenWhenWhenWhen DescriptionDescriptionDescriptionDescriptionDescription Contact HoursContact HoursContact HoursContact HoursContact HoursBuilding Relationships in the Diverse Hospital Community:Understanding Our Patients, Ourselves, and Each OtherTraining Department, Charles River Plaza

7.2November 298:00am–4:30pm

Intermediate Respiratory CareO’Keeffe Auditorium

TBADecember 18:00am–4:30pm

CPR—American Heart Association BLS Re-CertificationVBK401

- - -December 77:30–11:00am/12:00–3:30pm

CVVH Core ProgramTraining Department, Charles River Plaza

6.3December 77:00am–12:00pm

16.8for completing both days

Oncology Nursing Society Chemotherapy-Biotherapy CourseYawkey 2220

December 7 and 148:00am–4:00pm

BLS Certification for Healthcare ProvidersVBK601

- - -December 188:00am–2:00pm

New Graduate Nurse Development Seminar ITraining Department, Charles River Plaza

6.0(for mentors only)

December 138:00am–2:30pm

Pacing ConceptsHaber Conference Room

4.5December 1312:15–4:30pm

CPR—American Heart Association BLS Re-CertificationVBK401

- - -December 137:30–11:00am/12:00–3:30pm

OA/PCA/USA ConnectionsBigelow 4 Amphitheater

- - -December 131:30–2:30pm

Preceptor Development ProgramTraining Department, Charles River Plaza

7December 138:00am–4:30pm

CPR—Age-Specific Mannequin Demonstration of BLS SkillsVBK401 (No BLS card given)

- - -December 188:00am and 12:00pm (Adult)10:00am and 2:00pm (Pediatric)

Nursing Grand Rounds“Anaphylaxis.” O’Keeffe Auditorium

1.2December 211:30–2:30pm

New Graduate Nurse Development Seminar IITraining Department, Charles River Plaza

5.4 (for mentors only)December 278:00am–2:30pm

CPR—American Heart Association BLS Re-CertificationFND325

- - -January 87:30–11:00am/12:00–3:30pm

BLS Certification for Healthcare ProvidersFND325

- - -January 98:00am–2:00pm

New Graduate Nurse Development Seminar ITraining Department, Charles River Plaza

6.0(for mentors only)

January 108:00am–2:00pm

Nursing Grand RoundsHaber Conference Room

1.2January 1011:00am–12:00pm

OA/PCA/USA ConnectionsBigelow 4 Amphitheater

- - -January 101:30–2:30pm

Psychological Type & Personal Style: Maximizing YourEffectivenessTraining Department, Charles River Plaza

8.1January 118:00am–4:30pm

Assessment and Management of Patients at Risk for InjuryYawkey 2230

TBANovember 308:00am–4:00pm


White 9 bids farewellto ‘grande dame’ McLeod

after 35 yearsThe White 9 Medical Unit recently bid farewell to unit service

associate, Udell McLeod, who retired after 35 years of service

to MGH. McLeod, the unit’s ‘grande dame,’ had been the longest

serving employee on White 9 until the day she retired. Friends,

co-workers, and administrators gathered for a special reception

in her honor and to wish her well as she embarks on a new

chapter of her life in Jamaica. (McLeod is wearing a corsage.)

FarewellFarewell

Send returns only to Bigelow 10Nursing Office, MGH

55 Fruit StreetBoston, MA 02114-2696

First ClassUS Postage Paid

Permit #57416Boston MA

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