Cone Health Nurse Executives

T H E P U L S E O F N U R S I N G A T C O N E H E A L T H Fall 2012

NURSINGBEATVol. 9 No. 4

INSIDE THIS ISSUE

EDITORIAL BOARD

The Moses H. Cone Memorial Hospital

Nicole Baltazar-Holbert, RN, MSNAssistant Director, Departments 2500, 2600, 6500

Ashley Jarrell, RN, BSN, BADepartment 2300, Surgical Intensive Care

Wesley Long Hospital

Maura Barber, RN, BSN, Copy Editor3West, Oncology

Women’s Hospital

Beth Smith, RN, MSN, NE-BCDirector, Mother Baby Unit, Central Nursery,

Lactation and Perinatal Education

Annie Penn Hospital

Debbie Green, RN, DNP, CENPVice President, Nursing and Patient Services

Behavioral Health Hospital

Akeysha McMurren, RN, MSNAdministrative Coordinator

Systemwide

Lisa Boland, RN, MSN, CHCRManager, Nursing Outreach and Retention,

Setting the Pace Editor

Belinda Hammond, RN, MSN, CEN, CCRNClinical Nurse Educator-Critical Care

Danyel Johnson, RN, MSNClinical Nurse Educator-Medical Surgical;

Research Council Representative

Ruthie Waters, RN, MSNRelationship Based Care Coordinator

Melody Bullock, RN, BSN, BS, MS, CRNI

Specialty Areas

JC Cooper, RN, BSN, CTRN, EMTCareLink

Lelia Moore, RN, BSN, FCNCoordinator, Congregational Nurse Program

Support Services

Peggy Wynn, MLISLibrarian, Wesley Long Hospital

Co-Editor, Nursing EducationPeggy Hewitt, RN, MSN

Department 2000

Co-Editor, Nursing ResearchNancy Summerell, RN, MSN

Clinical Orientation Nurse, ED Academy

Editor-in-ChiefSarah Lackey, RN, MSN, CCNS

Rapid Response TeamTo communicate and celebrate the dynamic power of Nursing innovations and enduring values

Read Nursing Beat online. Go to the Home Page and click on the Nursing Beat logo.

Nursing BeatMission Statement

1200 North Elm Street, Greensboro, NC 27401www.conehealth.com/nursing

Nursing Research Symposium

page 3

2 Message from Theresa Brodrick3 Nursing Research Symposium4 Women’s Hospital is One in Ninety 5 Can I Have Some Privacy, Please?6 Understanding the Role of the Doctor of Nursing Practice7 Caring: A Universal Language8 Knot So Fast9 Magnet: Certificates Awarded for Outcomes Reports10 Healing Spaces: Using Color in Care

10 Professional Nurse Advancement Program11 The Spread of 5-S at Cone Health12 Discovering Aromatherapy13 Setting the PACE14 Life-Changing Health Ministry to Refugees15 From the Editor15 Humpty Dumpty Awards16 Cone Health Nurse Executives

Theresa Brodrick, RN, PhD, CNS, CNA Executive Vice President & Chief Nursing Officer

Debbie Grant, RN, MSN, CENP VP Nursing/Patient Services, Moses Cone

Debbie Green, RN, DNP, CENP VP Nursing/Patient Services, Annie Penn

Annette Smith, RN, MSN VP Nursing/Patient Services, Wesley Long

Sue Pedaline, RNC, DNP, MS VP Nursing/Patient Services, Women’s Hospital

Shawn Godfrey, RNC, MHA VP Nursing/Patient Services, Behavioral Health

Cheryl Somers, RN, MSN, NEA-BC Executive Director, Emergency Services

LaVern Delaney, RN, MSN, MHA/MBA Director, Nursing/Patient Services, ICU Service, Moses Cone

Joan LoPresti, RN, MS, BSN Interim Director, Nursing/Patient Services, MedSurg Service, Moses Cone

Cheryl Hausner, RN, MSN, MSED Director, Nursing Practice and Education

Anne Brown, RN, MSN, PCCN Director, Nursing/Patient Services, Wesley Long

Youland Williams, RN, MSN, NEA-BC Executive Director, Nursing, Oncology Services

Karin Henderson, RN, MSN, CENP Executive Director, Organizational Integration

Dennis Campbell, RN, MS, BSN Executive Director, Quality Excellence

Cone Health Nurse Executives

Message from the CNO: A.D.N. vs. B.S.N.

Theresa Brodrick, RN, MSN, Ph.D., joined Cone Health as Chief Nursing Officer and Executive Vice President in April 2011. As Chief Nursing Officer, she is responsible for setting the tone of nursing care for the more than 2,600 nurses who work across the Cone Health network. One of her major focuses is to constantly improve the quality of patient care.

Cone Health

MAGNETTRANSFORMATIONAL LEADERSHIP

We serve our

communities by

preventing illness,

restoring health &

providing comfort,

through

exceptional people

delivering

exceptional care.

2

Theresa Brodrick, CNO, RN, PhD, CNS, CNA

15

I want to set the record straight about something. But first let me tell you about the greatest role model of a nurse that I ever met. She was a diploma nurse, the epitome of professionalism, and though I only knew her a short time (she died when I was a teenager), she effectively role mod-eled everything I ever aspired to be as a nurse. She was my mother.

She died in 1980. Since then, times have changed. Our colleagues at the bedside have well surpassed us in the educational requirements needed to practice in their profession. To enter into their profession and practice at the bedside, pharmacists, physical therapists, occupational therapists, speech therapists and registered dietitians all have greater educational requirements than nursing.

In 2010, The Institute of Medicine pub-lished a book called The Future of Nursing: Leading Change, Advancing Health. This book, based on evidence, challenges the nursing profession to step up to the plate and respond to the need to assess and transform the nursing profession and con-sider the challenges that face the nursing education system in this country by giving solutions to advance the system. The call to increase the number of BSNs to 80 percent by 2020 was one of them. As patient care and our healthcare industry become more complex, nurses need to obtain additional competencies such as leadership, health policy, research, evidenced-based practice, systems improvement, new technologies, community and public health knowledge to keep up with the increasing demands on our profession.

Since this book was published and since my arrival at Cone Health, the senior nursing leadership team has attempted to make it easier for Cone Health nurses to go back to school, if they want to, so we can meet these new nursing challenges. This is why all newly hired ADN’s are required to return to school and earn their BSN degrees in four years.

When nurses leave Cone Health, I have al-ways said that it is hardest to see the expe-rienced nurses go. That includes all nurses: diploma, ADN and BSN nurses. Those years of experience are not replaceable. I want to believe that my own years of experience have helped me to care for patients and staff with a level of care and expertise that newer nurses have not yet learned.

So let me set the record straight: For the past year I have heard (through the grapevine), that based on our practices and policies to hire more BSNs at Cone Health, I do not respect or value ADN or diploma nurses. This is the farthest thing from the truth. I certainly value and respect experi-ence. Remember the nurse who inspired me the most was a diploma nurse. At the same time, I have also accepted a role and a re-sponsibility to move Cone Health forward for the future of nursing in North Carolina. The greatest resistance I have encountered to improving nursing education at Cone Health has been from the nursing commu-nity. I know many other hospitals in North Carolina have not yet put this structure in place. We are very fortunate at Cone Health that we work in an environment that sup-ports, encourages and enables continued advancement, growth and development. So if there are any Cone Health diploma or ADN nurses who are questioning their value, please accept my deepest apologies. It was never my intention to communicate this, and I am truly sorry! Your knowledge and expertise are irreplaceable. I respect and value all that you do for our patients at Cone Health by providing such exceptional care.

Respectfully,

Theresa Brodrick, RN, PhD, CNS, CNA

The Humpty Dumpty Award goes to the department that has the greatest reduction in the number of falls from quarter to quarter. These results are a comparison of 2nd to 3rd quarter.

Department 3rd floor Oncology, Wesley Long (total reduction of 7 falls from 2nd-3rd quarter.) They used the following strategies to help reduce their falls:

• Hourly rounding• Patient education

• Communication among staff, patients, and families• Bed alarm usage• Improved staffing

Honorable Mentions:Department 3100—MC (total reduction of 4 falls from 2nd to 3rd quarter) Department 5100—MC (total reduction of 5 falls from 2nd to 3rd quarter)

Humpty Dumpty Award

From the Editor

Many nurses use the phrase “drowning” when they talk about that horrible, overwhelming feeling that comes when you have more to do than you have time. You want to do even more than just what is needed, but you cannot. I used it all the time. It seemed such a good word to describe that feeling.

Well, I was doing rounds the other day and got a bit of an epiphany—“drowning” has such a desperate, deathly connotation. Death by drowning, to me, would seem to be one of the worst ways to go — total submersion and lack of control, no results no matter what you do, covered over with no hope of recovery. I started thinking about the feeling that comes when using that word and challenged myself to find a different word that would still express the feeling without being quite so dire.

After a time, one came to me — it was ”underwater.” Now when I am overwhelmed and feeling panicked by how much there is to do and how little I think I can accomplish, I remind myself that I am not drowning, I am underwater. It brings a whole different perspective to my situation. Rather than being out of control, as with drowning, I am still covered over, but I can navigate. I have to hold my breath and plan carefully where and when to come up for air. I have to be deliberate in my actions so my energy doesn’t give out, and it is completely essential that I pace myself until I can get the next good, long breath of fresh air. I know I will not be underwater forever — I will not die from it. It is still intense, I still have to prioritize to the max, there is still more to do and more I would like to do than I can, but the whole situation is finite.

One thing that has been constant in my more than three decades as a nurse is that this feeling of being overwhelmed never retreats permanently. It may go for a time, but it al-ways comes back. For us, there will always be situations where the needs of humanity are more than we can meet, as individuals and as a group. I have resigned myself to accepting the fact that there will always be days when I want to revert to using the word ”drown-ing.” At least now I can catch that and redirect my thinking with another word and maybe liberate some of that much-needed energy to meet the situation at hand.

Nursing is not for the faint of heart. Yet it is one of the most rewarding, gratifying, intel-lectually stimulating work one can do, challenging us to use all we have to pull it off. For all the challenges it offers and all the rewards we gain, we have to continue to be creative in how we talk to ourselves so we have energy to do what we do. Is that not the first ele-ment of our care Relationship Based Care delivery model? Caring for Self, so we can care for others.

Sarah Lackey, RN, MSN, CCNS, [email protected]

“We have to be

creative in how

we talk to our-

selves so we have

the energy to do

what we do.”

Organizations represented in the audience of the Nursing Research Symposium:

Alamance Regional Medical CenterA&T State UniversityAlamance Community CollegeCarolinas HealthCare SystemCone HealthDuke UniversityHigh Point Regional Health SystemRandolph HospitalUNC Health Care UNC Chapel HillUNC CharlotteUNC GreensboroWake Med, CaryWake Med, RaleighWake Forest Baptist HealthWinston-Salem State University

Concurrent sessions:

Presented by Cone Health nurses:Heart Failure readmissions. Glycemic control in the ICU. Intraoperative Skin Prep. Faculty (Faculty? What does this mean?)

Presented by UNC Greensboro School of Nurs-ing faculty: Interventions for Family Survivors of Suicide. 30 years of Research on Patient Intimacy Concerns and What It Teaches Us about EBP.

Presented by Winston-Salem State faculty: Story Telling as a Means of Promoting Translational Research.

Posters covered a broad range of EBP, research and QI projects.

Poster awards:

1st place: Artificial Nutrition and Hydration at End of Life Bedside RN Knowledge and Confidence.

2nd place: Weighing in on the Facts: Best Practices in Daily Weight Monitoring for Heart Failure Patients.

3rd place: The Pressure is On: Skin Savers to the Rescue.

MAGNETEMPIRICAL OUTCOMES

Nursing Research SymposiumSeptember 14, 2012

3

Setting the PACE, Continued from page 13

14

Submit “Setting the Pace” items for the February Nurs-ing Beat edition to [email protected] no later than November 15th. Thank you!

Requirements for items submitted to Nursing Beat:

• Basic information (for each employee referenced in item) - Employee Name; Campus, Department; Highest Nursing Degree Earned, and National Certification (if applicable).

• Category assignment: Publication, Presentation, Poster, Promotion, Certification, or Graduation.

• Graduations must also include: Name of School and Degree Earned.

• Publications (In Print) must also include: Title of Article; Title of Publication/Book, Volume number (Issue Number); Date (month and year); Page range.

• Presentations (At the Podium) and Posters (On Display) must also include: Title of Presentation/ Poster; Location (Name of Event/Conference/ Forum); Date of Event (month and year).

• Brenda Chandler, RN, BSN, MHA, Care Management.• Stephen Coward, RN, BSN, MHA, Emergency Department, MedCenter High Point.• Lanisha Hunter, RN, BSN, MHA, Department 4700-CHF/Telemetry, Moses Cone Hospital.• Angela Moore, RN, BSN, MHA, Quality Department. Pfeiffer University.• Cheryl Poteat, RN, BSN, MHA, Palliative Care Unit, Wesley Long Hospital.• Annedrea Stackhouse, RN, MHA, Cardiac Rehabilitation, Moses Cone Hospital. Pfeiffer University.• Nekia Whitaker, BS, MHA, Nursing Administration, Behavioral Health Hospital. Pfeiffer University.• Pat Williams, RN, BSN, MHA, Department 5500-Medical/Telemetry, Moses Cone Hospital. Pfeiffer University.

BSN• Tori Wright, RN, BSN, Nursing Administration, Behavioral Health Hospital. Chamberlain College of Nursing.• Peace Okehie, RN, BSN, Maternity Admissions Unit, Women’s Hospital. Chamberlain College of Nursing.• Thomas Bailey, RN, BSN, Department 3100-Neuro ICU, Moses Cone Hospital. University of North Carolina at Greensboro.• Celine Harris RN, BSN, ICU, Annie Penn Hospital. Old Dominion University.• Lechia Davis, RN, BSN, Maternity Admissions Unit, Women’s Hospital. Old Dominion University.• Hannah Marie Mills, RN, BSN, Department 3300-Intermediate Care Unit, Moses Cone Hospital. Indiana State University.• Deana Ortiz, RN, BSN, Department 2100 Medical/Surgical ICU, Moses Cone Hospital. University of North Carolina at Greensboro.

“I’m seeing my dream come true – bring-ing nurses together from across the state of North Carolina for the purpose of advanc-ing evidence-based nursing practice.”

These were the opening words from Theresa Brodrick, RN, PhD, Chief Nursing Officer, Cone Health, as she welcomed par-ticipants to the Nursing Research Sympo-sium, held Sept. 14. Nurses representing 16 organizations from across the state filled the audience at the Koury Convention Center (see side bar).

The keynote speaker was Bernadette Melnyk, RN, PhD, CPNP/PMHNP, FNAP, FAAN. Dr. Melnyk serves as the Associ-ate Vice President for Health Promotion, University Chief Wellness Officer and Dean of the College of Nursing at Ohio State University. She is a renowned author, consultant, national and international keynote speaker and widely acknowledged as an expert on evidence-based practice and research. Her enthusiasm was contagious as she stood before nearly 200 attendees and told us she was “plumb passionate about evidenced-based practice (EBP)” Change is not always easy. She calls the obstacles she has faced “character builders.”

“It currently takes 17 years for new knowl-edge to be translated into practice. That is too long for the patients and families who need good quality nursing care now. We have to create increasingly improve practice.

While nurses realize that EBP results in bet-ter outcomes for patients and families, what usually gets the attention of those who pres-ent barriers to change is the bottom line: It saves money. This as the “so what” factor.

In fact, Dr. Melnyk challenged us to con-sider two “so what” factors:

• So what will be the end outcome of the study or EBP project once it is complete?

• So what difference will the study or EBP project make in improving healthcare quality, costs or patient outcomes?

Throughout the day, Dr. Melnyk challenged us to find the gaps in our own practice environment and then fill those gaps. Search the literature for best practice, and if it’s not there, do our own studies to determine what the best practice is, she said. The pro-cess must start with vision and be followed by process and diligence. She presented us with two questions.

• What would you do if you knew you could not fail in the next two or three years? (She encouraged us to write it down and date it. The date would encourage us to keep on working toward an outcome.)

• What is the smallest EBP change that you can make when you go back to work that would have the largest impact on our patients?

“Begin with the end in mind,” she said. The results are what we are looking for, and how we get there are the first steps. She remind-ed us that the No. 1 regret that many have when looking back on their lives is not what they did, but what they did not do. “Don’t be afraid of failure,” she stressed. “Success is going from one failure to the next with enthusiasm.”

Pictures from left to right: 1. Rick Diehl, Kathleen Kearney, (fresh from the “Oz” presentation) and Cheryl Poteat accept the first place plaque for poster presentation.2. Symposium Planning committee: Peggy Hewitt, Eva Hyde, Anita Sherer, (Dr. Melnyk) Brenda Murphy, Kathleen Kearney, Barbara Deskins, (not pictured: Cheryl Hausner)3. Dr Melnyk, keynote speaker, with Cone Health’s Dr. Theresa Brodrick4. Marge Lessard, RN, explains her poster presentation5. Student nurses attended the Symposium6. Participants enjoyed poster sessions.

Cone Health Congregational Nurse ProgramLife-Changing Health Ministry

to Refugees in Our Community By Lelia Moore, RN

After a long hospital-based nursing ca-reer with Cone Health, Patricia Settle, RN, MSN, became a Congregational Nurse. She works within the Guilford County refugee community trying to address health disparities. Patricia will tell you that it has been some of the most rewarding and challenging work of her professional career.

Several months ago, an African woman in obvious distress was brought to Patricia’s refugee center office by a friend who spoke little English. After a quick assessment, Patricia knew that she had to get the woman to the Emergency Department for evaluation. For the patient who did not understand the language or the medical system, this was terrifying. Patricia reassured the patient through her calm, nurturing presence, and the patient was transported by ambulance to The Moses H. Cone Memorial Hospital.

After evaluation, Patricia’s patient was found to have a cardiac condition and a danger-ously elevated blood sugar. She was admitted to the hospital for a week. The patient teaching needed for a new insulin-dependent diabetic proved challenging. At discharge, the patient was given prescriptions for insulin and a variety of other oral medications.

When the patient returned to her small apartment, she had no way to purchase her medications and no knowledge of how to take them. She also did not understand the need to check her blood sugars. Patricia used community agencies and resources to help obtain the patient’s medications. She also arranged for interpreters to assist with teaching so the patient could understand the new diagnosis and required lifestyle changes. The relationship between Patricia and

the patient grew out of mutual trust, and Patricia is in regular contact with her diabetic patient. What would have happened if Patricia had not been in the refugee office, we can only guess.

Since 2009, grant funding from the Cone Health Foundation has allowed the four Con-gregational Nurses to work at different sites with refugees from all over the world. There are more than 150 languages and dialectics spoken in Guilford County, creating a chal-lenge in pure logistics for the delivery and oversight of healthcare for these community-based clinicians.

The Congregational Nurses working with the refugees are Lois Bazhaw (New Arrival School), Maureen Flak (Church World Services and Glen Haven), Brenda Gregory (Be-havioral Health Center for refugees) and Patricia Settle (Avalon Community). Building a trusting relationship in the midst of so many different cultural norms and languages is one of the largest hurdles the nurses face as they offer care. Through collaboration with UNCG Center for New North Carolinians, Church World Services, the New Arrival School and the African Coalition, the Congregational Nurses provide personal counsel-ing, health screenings, educational programs and health case management. For many refugees, the interventions of the Congregational Nurse have been life changing.

MAGNETSTRUCTURAL EMPOWERMENT

On front cover: Dr. Bernadette Melnyk, keynote speaker for the Nursing Research Symposium.

By Beth Smith, RN, MSN, NE-BC

Do you know that breastfeeding reduces the incidence and severity of many infectious diseases in infants, reduces infant mortality, optimally supports neurodevelopment, and lessens infants’ risk of becoming obese later in childhood? For mothers, breastfeeding decreases the risks of breast and ovarian cancers, diabetes, rheumatoid arthritis and cardiovascular disease. Yet despite the strong evidence of the benefits of breastfeeding, 50 percent of babies born in the United States are given formula within the first week of life, and only 31 percent of babies are breastfeeding at 9 months.

Recently Women’s Hospital was selected as one of 90 hospitals from 235 applicants to participate in a first-of-its-kind national initiative to significantly improve breastfeeding rates. This initiative, Best Fed Beginnings, offers a proven model that better supports a new mother’s choice to breast-feed.

“Women’s Hospital has always been a strong advocate of breastfeeding. There are many benefits to the health of both mother and child through breastfeeding,” says Cindy Farrand, President, Women’s Hospital. “Support, however, is vitally important. Joining this effort will ensure that mothers who intend to breastfeed are fully supported when they deliver in our facility.”

The National Initiative for Children’s Healthcare Quality (NICHQ) is leading the effort through a cooperative funding agreement with the Centers for Disease Control and Prevention and will work closely with Baby-Friendly USA Inc. Founded in 1999, NICHQ in an action-oriented organization dedicated to achieving a world in which all children receive the high-quality healthcare they need. Their mission is to improve children’s health by improving the systems responsible for the delivery of children’s healthcare. The Baby-Friendly Hospital Initiative is a global program sponsored by the World Health Organization and the United Nations Children’s Fund to encourage and recognize hospitals and birthing centers that offer an optimal level of care for infant feeding and mother-baby bonding. Women’s Hospital will work with these groups in pursuit of a “Baby-Friendly” designation. This designation verifies that a hospital has comprehensively implemented the Ameri-can Academy of Pediatrics-endorsed 10 Steps to Successful Breastfeeding. Breastfeeding rates are higher, and disparities in these rates are virtually eliminated in hospitals achieving this status.

“We look forward to working with Women’s Hospital and congratulate them on their success-ful application,” said Dr. Charlie Homer, President and CEO of NICHQ. “The large number of applications we received affirms the commitment of hospitals across our country to be part of a healthcare system that truly focuses on promoting health for women and infants. We are especially pleased that we received so many applications from hospitals in states where there are so few facilities with Baby-Friendly designation and from hospitals that serve populations of women who now are much less likely to breastfeed.”

Women’s Hospital is One in Ninety

As the state’s first free-standing hospital dedicated to women, Women’s Hospital is a special place for special people - women and infants. Estab-lished by Cone Health, this 134-bed hospital is dedicated to providing state-of-the-art, compassionate and personalized care to women at every stage of their lives.

Women’sHospital

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IN PRINTCatherine Rossi, RN, SANE-A, SANE-PLauren E. Ballina, BAJayne Batts, MD Renee Collette, RN, SANETerry Casto, RN, SANEKelly A. Foley, MD Elizabeth Goodman, RN, SANEDebra Holbrook, RN, RNC, SANE-AIsrael Liberzon, MD Samuel A. McLean, MD, MPHSheila A.M. Rauch, PhDSuzanne Rotolo, PhD, MSNApril C. Soward, MPHRebecca Wheeler, RN, SANE Publication: “Acute Severe Pain Is a Common Consequence of Sexual Assault.” The Journal of Pain; August 2012, 13(8), 736-741.

Sarah A. Lackey, RN, MSN, CCNSPublication: “Stabilization Snapshot.” Nursing Made Incredibly Easy!; September/October 2012, 10(5), 39–44

AT THE PODIUMCassandra Galloway, RN, MBA/MHALobel Lurie, RN, BSN, MA “Destination RN: Transition from Classroom to Career, A Themed Approach to Nurse Extern Program.” The Association for Nursing Profession-al Development (ANPD), Convention, Boston, July 12-15, 2012.

Marlienne Goldin, RN, BSN, MPA“ Nurses’ Ways of Knowing.” International As-sociation of Human Caring. Philadelphia, June 1, 2012.

Marlienne Goldin, RN, BSN, MPA“Caring in Leadership.” The Caring Science Sum-mer Institute, Boulder, CO, July 2012.

Shawn Godfrey, RN, BSN, MHA, RNC“State of Mental Health.” Kiwanis Club Meeting, Greensboro, August 2012. Kristin McLamb, RN, MSNSarah Clark, RN, MSN, CCRN“One Small Step for a Student Nurse, One Giant Leap to a Registered Nurse: Using Simulation to Assist the Transitioning Nurse.” The International Nursing Simulation/Learning Resource Centers Conference in San Antonio, June 2012.

Laurie McNichol, RN, MSN, GNP, CWOCN“The Conversion to Therapeutic Linen: An Inter-vention Addressing the Patient’s Microclimate.” The 44th Annual WOCN Conference, Charlotte, June 2012.

ON DISPLAYCameron Carlton, RN, MSNSandra Wheaton, RN, BSN“Developing Nurse Mangers Begins with Orienta-tion.” The Annual North Carolina Organization of Nurse Leaders Conference, Wilmington, June 2012.

Rhonda Rumple, RN, BSN, CCM Carroll Spinks, RN, GNP Sandra Spivey“Care Management: The Key to Success with High Risk Older Adults”. The National Geron-tological Advanced Practice Nurses Association”

31st Annual Conference, Las Vegas, September 2012.

ACCOLADESLobel Lurie, RN, MACassandra Galloway, RN, MBA/MHAThe poster titled “Destination RN: Transition from Classroom to Career, A Themed Approach to Nurse Extern Program” was chosen as Best Practice in Professional Development at the As-sociation for Nursing Professional Development (ANPD), Convention, Boston, July 12-15, 2012.

Laurie McNichol, MSN, RN, GNP, CWOCNHas been selected as one of four US representa-tives to the 12-member Guideline Development Group (GDG) for the 2014 National Pressure Ulcer Advisory Panel/European Pressure Ulcer Advisory Panel/Pan Pacific Alliance’s International Guideline for the Prevention and Treatment of Pressure Ulcers. Laurie attended the inaugural meeting for this group in London in June 2012.

Pat Mickley, RN, CCRN, ICU/Step-Down, Wes-ley Long HospitalRecognized by the ANCC Certification Cor-poration Board of Directors for achieving and maintaining CCRN credential for 35 years. “Achieving and maintaining the CCRN credential over time is further validation of a nurse’s dedica-tion to advance clinical knowledge and tangibly demonstrates a lifelong commitment to patients and families, employers and colleagues. You can take pride in knowing that your patients are cared for by a nursing professional of this caliber.”

GROWING IN LEADERSHIPDepartment Director• Mark Young, RN, BSN, MHA, CareLink.

Assistant Director• Teresa Yates, RN, BSN, CRNA, Anesthesia, Annie Penn Hospital. • Steve Marshall, RN, BSN, CCRN, Department 4000/4100-Inpatient Rehabilitation, Moses Cone Hospital.

Interim Assistant Director• Shinita Lee, RN, BSN, Department 5500- Medical/Telemetry, Moses Cone Hospital.• Dawn Melton, RN, BSN, Department 5000-Orthopedics, Moses Cone Hospital.

Nursing Shift Coordinator• Cheryl Britt, RN, Annie Penn Nursing Center.

GROWING IN PRACTICECertified Brain Injury Specialist• Shannon Amburn, RN, BSN, CBIS, Department 4000/4100-Inpatient Rehabilitation, Moses Cone Hospital.

Certified Critical Care Nurse • Rose Cullom, RN, Department 2900-Coronary Intensive Care/Step-Down, Moses Cone Hospital.• Lauren Kennedy, RN, BSN, CCRN, Department 2300-Surgical Intensive Care, Moses Cone Hospital.• Tina Miller, RN, 4th Floor Urology/ Intermediate Care, Wesley Long Hospital.• Jennifer Woody, RN, BSN, CCRN, Intensive Care Unit/Step-Down, Wesley Long Hospital.

Certified Electronic Fetal Monitoring• Joyce Berrong, RNC-EFM, OB Rapid Response, Women’s Hospital.

Certified Emergency Nurse • Christopher John Yelton, RN, BSN, Emergency Department, MedCenter High Point.

Certified Gastroenterology Registered Nurse• Melanie Bradsher, RN, BSN, CGRN, Endoscopy, Annie Penn Hospital.• Pam Shreve, RN, BSN, CNOR, CGRN, Endoscopy, Annie Penn Hospital.

Certified Neuroscience Registered Nurse• Andrew Chamkasem, RN, BSN, CNRN, Department 3100-Neuroscience ICU, Moses Cone Hospital.• Casey Cobb, RN, CNRN, Department 3100 Neuroscience ICU, Moses Cone Hospital.

Certified Rehabilitation Registered Nurse• Angie Joyce, RN, CRRN, Department 4000/4100-Inpatient Rehabilitation, Moses Cone Hospital.• Michele VonCannon, RN, CRRN, Department 4000/4100, Inpatient Rehabilitation, Moses Cone Hospital.

Progressive Care Certified Nurse• Jessica Childress, RN, BSN, PCCN, ICU, Annie Penn Hospital.• Kyle Duncan, RN, BSN, PCCN, Department 2300-Surgical ICU, Moses Cone Hospital.• Pam Garman, RN, BSN, PCCN, 4th Floor Intermediate Care/Urology, Wesley Long Hospital.• Melissa Howdeshell, RN, PCCN, Department 3700-Progressive Care Unit, Moses Cone Hospital.• Marissa Long, RN, BSN, PCCN, 4th Floor Intermediate Care/Urology , Wesley Long Hospital. • Hannah Marie Mills, RN, BSN, PCCN, Department 3300-Intermediate Care Unit, Moses Cone Hospital.• Lauren Mueller, RN, PCCN, Department 4700-Congestive Heart Failure/Telemetry, Moses Cone Hospital.

Orthopedic Nurse Certification• Dawn Melton, RN, BSN, Department 5000-Orthopedics, Moses Cone Hospital.

ADVANCING IN EDUCATIONDoctor of Nursing Practice • Thresa Brown, RN, DNP, ACNS-BC, Clinical Support, Annie Penn Hospital. The University of Alabama.• Debbie Green, RN, DNP, ANP/GNP, CNS, CENP, Nursing Administration, Annie Penn Hospital. The University of Alabama.

MSN/MBA• Crystal Adkins, RN, BSN, MSN/MBA, Care Link. Grand Canyon University.

Master’s of Healthcare Administration• Toni Bartlett, RN, BSN, MHA, Assessment, Behavioral Health Hospital. Pfeiffer University.• Sharain Carter, RN, BSN, MHA, General Surgery/Orthopedics, Wesley Long Hospital. Pfeiffer University.

Setting the PACEGroup picture: (left to right) Kaye Gable, MD, Beth Smith, RN, MSN, NE-BC, Beverly Daly, RN, BSN, IBCLC, Susan Pedaline, DNP, MS, RNC, Donna Wear, RNC, RN IV, Lisa Stigler Parnell, MD, MPHare members of the core team who will participate in the learning ses-sions with the Best Fed Beginnings Initiative and will help lead the journey to Baby Friendly designation at Women’s Hospital.

MAGNETNEW KNOWLEDGE, INNOVATIONS

AND IMPROVEMENTS

For mothers, breastfeeding decreases the risks of breast and ovarian

cancers, diabetes, rheumatoid arthritis and

cardiovascular disease.

Annie Penn Hospital is a not-for-profit organization located in Reidsville, NC, with 110 licensed acute-care beds. Annie Penn Hospital provides a number of specialties, including orthopedic surgery, gastroenterology, gynecology, urology, ophthalmology, general surgery, podiatry, nephrology, otolaryngology, and thoracic and general medicine.

Annie Penn Hospital

Until recently, the inpatient oncology units of 3 East, 3 West, and Palliative Care at Wesley Long Hospital all share one all-purpose family room, which can sometimes be a bustling place. Nursing staff of the Palliative Care Unit knew this space was not always conducive for the needs of fami-lies gathering to say goodbye to a loved one (sometimes in cases where relatives haven’t seen each other in a long time). So they recently converted an underutilized storage room into a “Serenity Room,” to offer families a place for quiet privacy, and closer proximity to the Unit beds.

Nursing staff initially proposed the idea of converting the storage room to then-Department Di-rector, Youland Williams, RN, MSN, NEA-BC, and Assistant Director Jean Wolf, RN, BSN, OCN, who met the idea with enthusiasm. Funding was still a stumbling block until an anonymous donor made a timely $2500 gift to the Unit. With funding in place, the department leadership empow-ered staff to make their own decisions about outfitting the room. Staff decided to go with a beach theme, to tie in with the existing seascape mural in the third floor hallway. Sue Ellen Grounds, RN, CHPN, went shopping at Rooms ‘R Us, and chose a couch, rugs and accessories in neutral, calming colors. Staff and families alike have expressed appreciation for the space. “The ‘Serenity Room’ has really had an impact,” said Amy Ray, Nurse Tech. Cheryl Poteat, RN, BSN, CHPN, agrees: “The room has been a godsend, and we only hear positive things.” In addition, the Palliative Care services physicians now have a place to hold small and important conferences with family members about end of life issues. The room makeover serves as an inspiring reminder to all of us that when we put patient/family needs first, and work as a team, good things result at Cone Health.

Wesley Long HospitalCan I Have Some Privacy, Please?

By Maura Barber, RN, BSN, and Jacqueline Clarke, RN, MSN, OCN

By Belinda Hammond, RN, MSN, CEN, CCRN

Cone Health Discovering Aromatherapy

512

Wesley Long Hospital has served the medical needs of the region since 1917. Founded by John Wesley Long, MD, a nationally known physician and surgeon, Wesley Long Hospital began as a small 20-bed clinic. Today, Wesley Long is a 175-bed modern medical center and home to Cone Health Cancer Center.

Wesley Long Hospital

Pam Tate, RN, BSN, CA, ICU, Annie Penn Hospital, credits aroma-therapy for turning her life around following her husband’s death in a traffic accident.

Pam did not think she could continue to live without him. In an attempt to heal her own spirit, Pam discovered aromatherapy. “I wanted an alternative to taking medication. I used aromatherapy to decrease depression, help me sleep and get rid of the nightmares as I began to pick up the pieces from my broken life.”

Pam also saw the possibilities for improving patient outcomes with aromatherapy. She and the nurses in the Annie Penn Intensive Care Unit have been practicing aromatherapy with patients for more than five years. They have seen patients report relief from pain, nausea and vomiting, edema and anxiety following aromatherapy. “There is not a day I work that I don’t use aromatherapy with my patients,” Pam says.

Aromatherapy is a complementary therapy; it does not replace medical treatment. Pure essential oils are extracted in concentrated form from plants. These essential oils can be inhaled (a drop or two on a cotton ball or in a room spray) or applied topically in a “car-rier” oil, or dissolved in bath water. The North Carolina Board of Nursing declares aromatherapy to be within the scope of nursing practice, upon completion of an eight-hour course such as the one Pam and Winnie Jarrell, RN, BSN, Annie Penn Hospital, frequently teach.

Interest in aromatherapy is growing within the Cone Health network. Not long after attending the aromatherapy class, Gin-ger Gleason, RN, BSN, and Diane Celano, RN, Department 5500-Medical/Telemetry, The Moses H. Cone Memorial Hospital, identified a patient who might benefit from their new knowledge. The patient had experienced multiple hospital admissions over the last year for ongoing cellulitis of both lower legs. Her right leg in particular was red and painful with weeping areas. With the patient’s permission, Diane applied wet compresses that contained several drops of lavender essential oil to the leg. By the end of her 12-hour shift, Diane noted a decrease in redness, and the outer edges of the wound had returned to a normal color. Within two days, the leg was much improved, and the patient could lift her leg without pain. Even the physician was impressed and encouraged further use of aromatherapy.

In addition to its anti-inflammatory properties, lavender essential oil decreases anxiety and promotes relaxation and rest. Marga-ret Gilchrist, RN, MSN, CCRN, and the staff of Department 2100-Medical/Surgical Intensive Care Unit, Moses Cone Hospital, are conducting nursing research on the use of lavender to reduce restraint use. Nurses on Department 4500, Palliative Care and Medical/Surgical, Moses Cone Hospital, are developing a study to determine if the inhalation of lavender essential oil will decrease the nurses’ stress levels. And Operating Room and Post-Anesthesia Care Unit nurses at Annie Penn Hospital will soon publish the results of their research using peppermint oil to relieve post-oper-ative nausea.

More than 150 nurses, chaplains, physical therapists and social workers within Cone Health are currently qualified to use aroma-therapy at the bedside. Patients are now often requesting aroma-therapy as a supplement to traditional medications. “Nurses have an awesome ability to change patient outcomes with aromatherapy. Providing the best possible care for our patients, families and selves is a goal worth pursuing,” Pam says. “The possibilities are endless, and aromatherapy makes perfect health ‘scents’!”

Department 2100 nurses Margaret Gilchrist, RN IV, MSN, CCRNDelia Turner, RN III conducting aromatherapy research.


AND IMPROVEMENTS


Sue Ellen Grounds converses with a family member in the Wesley Long Palliative Care Unit’s (3W) Serenity room.

“The ‘Serenity Room’ has really had an impact.”

– Amy Ray, Nurse Tech

“The room has been a godsend,

and we only hear positive

things.”– Cheryl Poteat, RN, BSN,

CHPN

6 11

By Melody Bullock, RN, BSN, BS, MS, CRNI

Cone Health is getting organized. Using a Japanese model referred to as “kaizen,” which means “improvement or change for the bet-ter,” several nursing units can now locate things more easily and efficiently, with less frustration. Nurses and staff whose units have implemented 5-S have expressed greater job satisfaction.

“It even makes everything look cleaner and more attractive,” says Brandi Brackin, RN, Pediatrics and the Pediatric Intensive Care Unit. Nancy Caddy, RN, appreciated the chance to inventory ev-ery bin to check for expired products. It turns out that all expired product got tossed -- just in time for the mock Joint Commission survey.

So what exactly is “5-S”? 5-S is a system of organization with a focus on visual order, using five Japanese words (see below). The technique, developed by Hiroyuki Hirano for Toyota Motors, aimed to minimize the time workers spent looking for tools, gauges or even paperwork. This time is considered “muda,” or waste, in the realm of kaizen. Ironically, the 5-S process also creates more “zen” (i.e., a peaceful environment), and improves the looks of storage areas.➢‘Seiri’ – Sorting, or putting like things together in the supply closet, is the first step and, for many (including the author), the most overwhelming one. ➢‘Seiton’ - stabilizing or straightening, refers to organizing, identify-ing and arranging. All supplies, equipment and paperwork included in the project are more easily located. A color guide or list is placed in a prominent area to aid in retrieval.➢‘Seiso’ - sweeping or shining, refers to maintenance and cleaning. This step provides the opportunity for deep cleaning that can only be accomplished when the shelves are bare.➢‘Seiketsu’ –standardizing makes the system easy to maintain by simplifying and bringing order to chaos.➢‘Shitsuke’- sustaining, is the last step, meant to keep the process going. This requires “buy-in” from everyone who uses the closet and from the person who restocks the supplies.

Department 5700-Medical/Surgical at The Moses H. Cone Memo-rial Hospital initiated 5-S under the leadership of Candace Hughes, RN, in 2006, then repeated the process when the department moved to their new space on Department 5100. Their experi-ence was presented at Wesley Long Hospital’s Nursing Leadership Council and at the Institute for Hospital Improvement national conference as part of 5700’s“Transforming Care at the Bedside” project.

Department 3700, Cardiac Telemetry at Moses Cone Hospital also initiated a 5-S project early in 2012 and recently presented their

results during Research Day as well as to Cone Health’s Nursing Leadership Council. This project stemmed from employee surveys showing the nurses felt their unit was “unkempt and cluttered.” They organized all large equipment, the cardiac monitor room, paper forms, and supply closets. The best thing about 5-S is “the ability to better care for patients by reducing the response time to call bells,” says Tammy Mebane, RN, citing her department’s unanimous agreement on this point. Carol Harris, RN, Director, notices increased employee pride as well as improved productiv-ity and cost savings. Next on the bandwagon: Ashley Jarrell, RN, BSN, Department 2300-Surgical ICU, Moses Cone Hospital, says her department’s assistant director, Kathleen Boss, RN, is in the early stages of trying to roll out 5-S on 2300. Who will be next?

Oh, and about that mock Joint Commission Survey… When the surveyor walked into the Pediatrics supply room, he praised the room’s appearance. “This room is so clean and uncluttered. I think I could walk on this unit and find whatever I need without ever working here before!” he said. “I doubt from the look of things I would even find an expired syringe…”and he didn’t!

For more Information:

1. “Lean and Environment Training Modules”. United States Government, Green Sup-

ply Network. http://www.gsn.gov/pubs/module5_6S.pdf. Retrieved 12 July 2012..

2. Ohno, Taiichi; Toyota Production System (TPS), ISBN 978-0915299140

3. Hirano, Hiroyuki (1995). 5 Pillars of the Visual Workplace. Cambridge, MA: Produc-

tivity Press. ISBN 978-1-56327-047-5.

The Moses H. Cone Memorial HospitalThe Spread of 5-S at Cone Health

The Moses H. Cone Memorial Hospital, the flagship of Cone Health, was established in 1953 to serve the community by delivering high-quality healthcare. That mission continues today. Located on a 63-acre campus, this 518-bed hospital is the largest medical center in its four-county region.

The Moses H. Cone Memorial Hospital

“Our new organi-zation model on Pediatrics allows us to find sup-plies in a timely manner so we can answer call bells quicker and spend more time with patients,” says Lindsey Strader, RN.

In 2010, the Institute of Medicine released a report which recommended the number of baccalaureate-prepared nurses increase from 50 to 80 percent. The report - The Future of Nursing: Leading Change, Advancing Health, - further suggested that the number of nurses prepared at the doctoral level should double by 2020.

Currently, less than 1 percent of nurses have doctoral degrees. A better educated nursing workforce is needed to respond to the changing demands of today’s com-plex healthcare environment. Nurses with doctorates are needed to conduct research, to implement research into practice and to teach future generations of nurses. Cone Health has embraced the IOM report and actively supports nurses seeking higher levels of education through tuition reimbursement and the REACH scholarship programs.

Nurses can choose to pursue one of two types of doctoral education in nursing: the Doctor of Philosophy (PhD) or the Doctor of Nursing Practice (DNP). PhD programs, designed to prepare nurse scientists and scholars, focus heavily on scientific content and research methodology. The DNP is designed to prepare experts in specialized

advanced nursing practice. Practice-related courses, such as epidemiology, pharmacology, health policy, health behaviors, informatics and leadership, are the core of the cur-riculum. The DNP curriculum emphasizes translating research into practice, evaluating evidence, applying research in decision-making, and implementing viable clinical and organizational innovations to change practice. In order to improve nursing science and practice, both the PhD and the DNP roles are essential.

Two nurses from Annie Penn Hospital are among the growing list of Cone Health nurs-es with higher levels of education. Thresa Brown , DNP, RN, ACNS-BC, Clinical Nurse Specialist, and Debbie Green, DNP, RN, CENP, Vice President, recently gradu-ated from the University of Alabama with their Doctor of Nursing Practice (DNP). The following interview with Debbie and Thresa explores the role of the DNP and why is this level of education important for nursing.

Why did you decide to pursue a DNP?

Debbie: “I am an advanced practice nurse, with a master’s degree from the University of Virginia as a Clinical Nurse Specialist and a post-master’s degree from the University of North Carolina at Greensboro as a nurse practitioner. The DNP is a clinical doctorate, and it really spoke to my passion for improv-ing care at the bedside.”

Thresa: “I had a desire to advance my educa-tion for many years. I have a master’s degree in nursing education and a post-master’s certificate as an adult health Clinical Nurse Specialist, both from East Carolina Univer-sity. The PhD program did not really speak to my desire to remain in the clinical arena. When I heard of the DNP degree as a clini-cal doctorate, I was intrigued. After research-ing the two degrees, I knew the DNP would offer the opportunity to further my educa-tion and put that education into practice in the clinical setting.”

What are you doing with your DNP in your work today? How does having the DNP preparation have an impact on your practice?

Debbie: “The curriculum for the DNP program has enhanced my knowledge in my administrative practice. I am more aware than ever about evidence-based practice, research, informatics, policy and how to

change practice from a very global level.”

Thresa: “The DNP is a natural extension of my role as a CNS. The curriculum is an expansion of the knowledge I have gained while practicing as a CNS. I echo Debbie’s sentiments about the curriculum expanding my knowledge and comprehension of how the APRN can effect change.”

Who should consider a DNP program?

Debbie: “Nurses who have a desire to achieve a clinical doctorate, who want to improve care through the vigorous use and analysis of evidence, who want to take nursing research and implement it into practice, who desire to be ‘change agents’ on an organizational, local, national or interna-tional level. Other Cone Health nurses with their DNP are Sue Pedaline, DNP, RN, Vice President, Women’s Hospital, and Brandon Bennett, DNP, RN, CNOR, CEN, NE-BC, Executive Director Operative Services, The Moses H. Cone Memorial Hospital.”

Thresa: “Again, I agree with Debbie’s state-ment. The nurse who wants to excel in his/her clinical practice on a doctoral level should consider the DNP. The education provided allows a polishing and deeper exploration of how the advanced practice nurse can truly make a difference in practice. It is more than just a title or a degree to be achieved; it is also the advancement of our profession as a whole. Every nurse who furthers their education elevates our profes-sion.”

Understanding the Role of the Doctor of Nursing PracticeBy Nancy Summerell, RN, MSN, CEN, Debbie Green, DNP, RN, CENP, and

Thresa Brown, DNP, RN, ACNS-BC


AND IMPROVEMENTS

Thresa Brown, DNP, RN, ACNS-BC and Debbie Green, DNP, RN, CENP

1979 First DNP program established at Case Western Reserve Uni-versity

2004 Eight DNP programs in the United States

2006 American Association of Col-leges of Nursing publishes The Essentials of Doctoral Education for Advanced Nursing Practice

2012 Fifty-two accredited DNP pro-grams, 69 DNP programs pursu-ing accreditation

2013 Targeted date for opening of DNP programs at University of North Carolina (UNC)-Chapel Hill, UNC-Charlotte, Winston Salem State, East Carolina and Western Carolina. MAGNET

STRUCTURAL EMPOWERMENT

10 7

The Behavioral Health Hospital is an 80-bed facility with a team of highly skilled physicians, case managers, counselors, social workers, nurses and therapists.

Behavioral HealthHospital

By Ruthie Waters, RN, MSN

Having never traveled overseas, my level of excitement was hardly containable. I dreamed for months about how my friends and I would fly into the City of Hope in Tanzania, provide much needed medical care and education, save lives and build life-changing relationships. I would leave with tons of stories about how I had played a valuable role in changing the lives of others for the better by sharing Relationship-Based Caring in a foreign land.

We arrived at the City of Hope to a very warm welcome with more than 100 children singing and dancing. This is the way that they show appreciation in their culture - singing songs and praising God for bringing people in to help. Af-ter receiving our assignments for clinic, I could hardly sleep that night. I awoke the next morn-ing just after dawn to the sound of children singing and working. They were completing chores, feeding the animals and working in the fields, all before the school day began.

Upon our arrival at the clinic on our first day, we saw a sea of people who had come from miles around. They had walked for hours just to see the doctors and nurses from the United States that were here to “fix” their ailments. There were more than 500 people waiting to be seen as we walked up to begin our first clinic day! Unfortunately we had to turn over half of them away, but many of them stayed overnight with friends in surrounding villages so that they could come back the next day.

There were many people who touched my heart as I helped care for patients and fami-lies. One family who especially stood out had a little boy who was only 7 months old. His eyes were sunken, his fontanel (soft spot) was sunken and he had very little life (literally and figuratively) in him. I remember looking at the doctor, her eyes met mine and we were think-ing the same thing: ”Is he going to make it?” He was so severely dehydrated that he could have died right there on the table. As I worked beside the doctor to treat this little one with limited supplies, no clean water and no electric-

ity, my thoughts went back to Department 6100-Pediatrics. There, we could start an IV or put down a nasogastric tube and feed him. However, we were in Ntagacha, Tanzania, a very poor village. While we did have some do-nated IV tubing and a few needles and bottles of fluid, this little one had no veins. We decided to rehydrate him slowly by mouth with a salt water and electrolyte mixture – Gatorade for babies.

I would spend the next five hours giving him syringes full of the fluid every 10 minutes. Our translator explained the plan of care, and we moved to another room in the clinic to begin treatment. I looked into the eyes of the little boy’s mother, and I could see the anguish she felt. Although we did not speak the same language, I touched her hand and said softly “Sawa,” which is OK in Swahili. She smiled and nodded as if she needed that brief moment of encouragement, that connection – one mother to another – to help her in that moment.

After about two hours of liquid intake, the little guy perked up and was even beginning to wiggle around in his mother’s lap. We all shared a sigh of relief and a silent hope that he was go-ing to continue to get better. By the end of the day he was able to nurse on mom’s milk, and they were given another cup of the mixture for their long journey home. We hugged and said our good-byes and received many thanks for what we had done to help this family.

While I may never see them again, that family touched my spirit. They helped me to recon-nect with my caring and nurturing self. In those critical moments of caring for this tiny patient and his family, I remembered why I became a nurse and why I choose to stay in this noble profession. It’s all about building relationships of a lifetime – even on the other side of the world – with the simple and universal language of caring.

Relationship Based CareCaring: A Universal Language


After completing the PNAP CBL staff members wishing to become new RN 3 or RN 4 clinical ladder participants can meet with their Department Director to discuss interest in the PNAP program be-ginning October 1. Completing the PNAP application (leadership signature required) and enrolling in the PNAP class through CBL begins the process; within 6 months a completed portfolio must be

submitted, after which a meeting with leadership to complete the Ap-plicant Checklist is required. The PNAP review committee will then schedule a date for an interview with the committee. See specific RN 3 and RN 4 requirements at Homepage.Resources.Reference Docu-ments.PNAP.

The Professional Nurse Advancement Program

Whether we realize it or not, we use color in our lives to affect or reflect the way that we feel. In a healthcare environment, color sends interesting nonverbal messages. For example, nursing uniforms are of-ten pastel shades in pink, green, blue and lilac. These colors are said to convey nurturing, devotion, caring and a love for humanity, characteris-tics that are encouraged and supported in the Cone Health network.

Cone Health Behavioral Health Hospital has also been applying the “psychology” of color theory to its recent redecorating efforts. In June 2012, the Behavioral Health Hospital implemented a color change on one hallway of the Adult Inpatient Unit, which houses primarily patients with mood disorders such as depression. The goal of the new color palette, which uses variations of orange tones, is to positively impact the mood and behavior of patients.

The Journal of Nursing and Residential Care, September 2007, reports research findings that suggest environmental factors such as color, have the potential to affect mood on a subconscious level and can also impact us physically as well psychologically. Color can help to enhance people’s experiences and emotional states. Certain colors, like orange, are said to encourage activity and increase energy levels.

Feedback about the new colors on the Unit has been positive. “I think it’s cheery. I like it,” says Tori Wright RN, BSN, Administrative Coor-dinator, Behavioral Health Hospital. Nicole Pettine, RN, BSN, Adult Unit, agrees, “It seems to have increased the patients’ energy levels.” Essentially, this redecorating effort was neither arbitrary nor just about picking the trendiest new color – it actually had patients’ best interests in mind.

Healing Spaces: Using Color in Careat Cone Health Behavioral Health Hospital

By Akeysha McMurren RN, MSN

Adult Inpatient room at Cone Health Behavioral Health Hospital after color change.


AND IMPROVEMENTS

8 9

Imagine you are fast asleep. It is the middle of the night. You are lying in bed, and you get the feeling that your back is tightening up. You begin to shift your weight to turn on your side when you realize that your arms are tied down. This was the reality for at least 22 percent of our patients in critical care areas.

The continued infringement of freedom and autonomy through the use of restraints is a serious matter and prompted the cre-ation of a Restraint Reduction Task Force at Cone Health. The members are staff nurses, Clinical Nurse Specialists and lead-ers from across the system.

The group’s purpose is to explore ways to reduce and eliminate the use of physical restraint, seclusion and isolation. 88 percent of patients report the restraint experience to be unpleasant, and several studies reveal restraints do not prevent the removal of IV lines or reduce patient falls.

The Cone Health task force began by obtaining policies and making site visits to other facilities, reviewing evidenced-based practice and consulting The Joint Com-mission. This work resulted in the creation of the “Knot So Fast Algorithm.” The algorithm is a quick and effective way to evaluate the need for restraints by having insightful discussions with co-workers be-fore any patient is placed in restraints. Staff and physicians were educated about the importance of restraint use reduction and the benefits to patient care. This initiative has yielded remarkable outcomes. “We are doing our patients a wonderful ser-vice by not using restraints, and we observe our patients so frequently that the families really appreciate it,” says Crystal Rice, RN, Department 2900-Cardiac Intensive Care, Moses Cone Hospital.

Effective networking also led to the discov-ery of less-confining equipment options, such as safety mitts, which fit like a glove yet allow the patient free movement; posey sleeves that conceal medical lines; and activity blankets as effective diversion. “Our leadership and Theresa Brodrick, Chief Nursing Officer, challenged us to reduce restraints by 50 percent this fiscal

year,” said Marsena Pardee, RN BSN, MHA, Clinical Nurse Specialist. “Not only were we challenged, but she also provided us with the resources to reduce restraint use – i.e., sitters, site visits and new products.”

Several departments are now using aroma-therapy in lieu of restraints, in which the inhalation of essential oils works on the pa-tient’s limbic system resulting in a calmer, more relaxed feeling.

The Restraint Reduction Task Force and all those involved in this initiative have enjoyed positive outcomes. After eight months of education and implementation of the “Knot So Fast” Algorithm, restraint use has been reduced from 22 to 3 percent. Keeping patients restraint-free at 3 percent will requires everyone’s efforts. Using cre-ative tools and strategies will ensure success.

By Sarah Lackey, RN, MSN, CCNS

As the work proceeds for the writing of the 2,000-page Magnet redesignation document, information about projects, initiatives and evidence-based activities is needed from bed-side clinicians who are directly involved in patient care. One reporting form to repre-sent the Magnet culture is a Measure of Magnet submission, available from the Magnet website and set up for electronic submission. As we move into writing Magnet items that require concrete and measured outcomes, the “Constructing Magnet Outcomes” report will be the template to use for submitting information.

Recipients of the first “Constructing Magnet Outcomes” (CMO) was Operative Services. They submitted a CMO report outlining their signature research in wound classification. They submitted a report and all the evidence needed to represent their project in the New Knowledge, Innovations and Improvements section of the document. Their project was sizeable: they identified a discrepancy, audited more than 14,000 charts, conducted multidisciplinary education, tracked results, and disseminated findings locally, regionally, nationally and internationally.

The Operative Services team was presented with their certificate at the Sept. 12 Nursing Leadership Council meeting.

From left to right:Theresa Brodrick, RN, PhD, CNS, CNA; Jes-sica Scheer, RN, BSN; Jennifer L. Zinn, RN, MSN, CNS-BC, CNOR; Vangela Swofford, BSN, RNASQ-CSSBB; Ruth Sappenfield, MA ; David H. Newman, MD, FACS.

Pictured here with Theresa Brodrick, Kristie Payne, Director, Department 5100-Surgical, and Jan Teal, Director, Department 4000/4100-Inpatient rehabilitation, accept a CMO recogni-tion for the work on a Coude Catheter protocol. Their teams devised a com-petency and training format for nurses on off shifts to insert catheters for pa-tients who cannot wait for a urologist. The initiative involved staff at Wesley Long Hospital and The Moses H. Cone Memorial Hospital.

Submit your evidence-based projects for inclusion in the Magnet Redesignation docu-ment. The simplified template can be accessed from the Magnet icon on the homepage. Click the Resources tab and see the file for the Constructing Magnet Outcomes link. Contact [email protected] for help or guidance.

MagnetCertificates awarded for

Outcomes reports


Constructing Magnet Outcomes

I Purpose and Background What was the problem?

Evidence: What evidence shows the problem?(numbers, feedback, scores, complaints, patient care inefficiency, etc) Attach actual docu-ments below in attachments section I.

II SolutionHow did you come up with the solution you tried? (discussion, survey, literature, etc)

Evidence: Show evidence of your methods (dis-cussion-ie: Shared Governance minutes; survey-copy and results; literature-article references, etc)

What was the solution and how did you imple-ment it?

Evidence: Attach actual documents below in Solution section II.

III EvaluationDid your solution work? Discuss briefly.

Evidence: Evidence of the solution working: improved numbers, feedback, surveys, scores, etc. Attach actual documentation in section III below.

Discuss why the results were significant.

Evidence: What difference did it make to patients, families, staff, work flow, efficiency, safety, etc.?

IV EnculturationDid your solution become permanent?

Evidence: Attach department protocol, policy, photo of permanent change, etc, section IV below.

Did the solution spread? Other departments? Other campuses? In Nursing through publications or presentations?

Evidence: Provide evidence by indicating pre-sentation time, date and participants; publication reference information; actual articles, section IV below.

V Who was involved?Evidence: Name people, departments and titles. Attach in section V below.

VI Time frameOver what time frame did your work take place?

Evidence: Start date and finish date.

By Nicole Baltazar-Holbert RN, BSN, MSN

Knot so Fast: Let’s Avoid Restraints


Using restraints can be directly related to these significant health complications:

• constipation• incontinence• pressure ulcers• loss of bone mass • loss of muscle tone• decreased mobility• skin abrasions• edema• asphyxiation • falls

Cone Health Nurse Executives

Documents

Transcript of Cone Health Nurse Executives