Preventing Falls: A Crucial Skill

Preventing Falls: A Crucial Skill

Helping to prevent patient falls is absolutely crucial, as one simple fall can cause so many problems—everything from broken hips to traumatic brain injury.

Michele L. Kimball, RN, BSN, Senior Director of Nursing at Bethesda Dilworth, knows why it’s so important to keep patients from falling and assessing their risks. She took time to give us information about what nurses can do.

What are the most important things that nurses need to know when working with patients in health care facilities?

The most important thing for a nurse to remember when assessing for fall risk and developing a fall prevention plan is that the first step is “getting to know your patient.” But without knowing what places them at risk and knowing their routine, your plan will fail. Patients come to health care facilities for so many different reasons. Staff should consider in the beginning that getting acclimated to the routine of a facility is stressful and, depending on the patient, can be confusing.  Restoring as much of their daily routine as possible can lead to success.

What can nurses do when they have stubborn patients who may insist on getting out of bed without assistance?

Allowing them to make as many decisions that they can and restoring as much of their daily routine as possible can minimize risk. 

Involve family and educate, educate, educate.

For patients who are in their own homes—in the case of home health care nursing—what tips can nurses give to these folks to prevent them from falling?

The key is beginning the discharge process prior to them going home on home health through home evaluations and assessment of daily routines. Knowing where and how the patient would need to navigate inside their home is key. Educating them on needed adjustments to their home and warm hand offs to the home health nurse on outcomes of the assessments and recommendations is vital.

The patient’s willingness and ability to take in this education as well as support systems should be considered when developing a plan. 

What kind of health issues can lead to more falls? What information can nurses give to patients so that they can prevent these health problems?

A lot of fall prevention is learning what places them at risk in the first place.

Patients with high blood pressure need to routinely take their medications as prescribed and continue to monitor their blood pressures. These medications can cause dizziness and at times orthostatic hypotension.

Patients with heart failure should continue to take their medications as prescribed and monitor their heart rate, blood pressure, and fluid status. They should contact their doctor if they become short of breath, seem tired more than usual, or notice swelling in extremities. These symptoms can develop quickly and lead to a major health set back, but most importantly lead to weakness, dizziness, and unsteady gait all key contributors to falls.

Patients with diabetes should ensure that they are controlling their blood sugars and taking their medications as prescribed. Low blood sugars could lead to dizziness and fainting, placing them at a risk for falls. Glucose is food for the brain, and if your blood sugar is low and your brain isn’t getting fed, it leads to being tired and increases risk for poor decisions, lack of concentration, and black outs — again contributing to the risk of falls.

Tell patients not to take their health conditions lightly, to notify their doctors when symptoms occur, and if they feel “funny” or something “doesn’t feel right” err on the caution side and ask their physicians. Falls are dangerous, and for the elderly population they can lead to major injuries such as fractures and even death. There is almost always some functional decline after a major fall, and this decline can be the difference of a patient being able to stay in their home or have to seek out a long-term care facility.

Making the Holidays Fun for Nurses

Making the Holidays Fun for Nurses

Managers and any other health care staff who are supervising nurses—whether it’s in a hospital/medical center, an urgent care, or even at a private physician’s office—should know that holidays can be tough for your employees.

Anytime your staff is working on or around a holiday, that’s time they’re not spending with friends/family. That can be hard on them, no doubt.

But there are a lot of things you can do to make the holidays fun. When your nurses are happy, your patients can be happier. Their families can be happy. And being in the hospital or just being sick becomes easier to deal with.

Kelly Jo Wilson, MSN (Ed), RN, a Quality Nurse Coordinator—Transplant at UPMC Presbyterian Shadyside Hospital in Pittsburg, Pennsylvania, contributed a lot of ideas for how you can make this happen.

Remember, though—the most important aspect to remember is that you have to become involved to make the holidays fun as well.

Par-tay

Wilson suggests that you hold a holiday party for your staff. Most staff won’t mind pitching in with money or food, she says. But you have to head this up. It will mean more if you organize it all yourself, as opposed to dumping it on a staff member.

“Health care staff work hard all year, and a little incentive goes a long way,” she says. “Raise some funds, cook some food, and give the staff a good time!”

Food—and lots of it!

During the holiday season, treat your staff to some surprises. Have a catered lunch or dinner or even organize a potluck.

Cookie Exchange

Most people love cookies—and those who bake like to share their wares. Wilson says, “Cookie Exchanges are wonderful ways to let those staff members who love to cook and share their love of food with everyone else. Then you can exchange the different types of cookies. This is also a team-building exercise.”

Gift Cards

Even giving your nurses a $5 gift card for coffee will make a huge difference. It will give them a boost. Wilson stresses to be sure not to forget anyone or it could backfire.

Contests

Wilson suggests that you hone in on everyone’s competitive side and have some fun contests. Some ideas are: ugliest sweater, best cookie, best-decorated med car, or best holiday scrubs. “It’s a fun way to engage staff during the holidays,” she says.

One thing to keep in mind: “The manager has to be supportive and really the key person to organize. Even if they delegate to a party council or groups within the unit, they must engage in some way to truly show their appreciation and support,” says Wilson.

Various Faiths

Wilson says that if staff are of various faiths, encourage them to bring in a traditional dish that they make when celebrating with their family or friends. But there’s more: “Using a menorah or other decorative items according to their tradition is a great way to include everyone as well,” she says. Acknowledging everyone and their personal traditions is a great way to be inclusive.

“Give back to your nurses/health care staff who work so hard,” says Wilson.

Participating in Interprofessional Education: Why It’s Important for Nursing Students, Part 2

Participating in Interprofessional Education: Why It’s Important for Nursing Students, Part 2

Nursing students’ education should never occur in a vacuum. Because most nurses will work not only with patients throughout their careers, but also with varied health care professionals, it’s important for them to learn how to work with others even before they begin their employment. This is where interprofessional education comes into play.

In Part 2 of our interview, Judith Haber and Erin Hartnett of NYU Rory Meyers College of Nursing continue our conversation about why it’s so important for nursing students. (Revisit Part 1 of our interview here.)

This year, the study was on oral-systemic health. But have the students studied other health care issues in previous years? Why or why not? How are the issues chosen?

Judi Haber: NYU Rory Meyers College of Nursing and the OHNEP and TOSH programs have been at the vanguard of changing the national landscape about the importance of integrating oral health as an essential component of overall health. This priority addressed a national “Call to Action” by the Surgeon General in 2000 to address the gap in meeting the oral health care needs of the American public and to consider the relationship of oral health to overall health. Our programs have made a significant impact by “putting the mouth back in the head” in nursing education and clinical practice. 

Oral health and its links to overall health is our OHNEP and TOSH priority.  Because of the connections between oral health and numerous systemic health conditions like diabetes, cardiovascular disease, stroke, kidney disease, cancer, dementia, autoimmune conditions, and others, students are exposed to a wide variety of acute and chronic health problems. This provides a perfect platform to for interprofessional learning because it requires the clinical knowledge and expertise of multiple professions to create a care plan that is patient-centered and addresses the needs of the whole person. We have designed and implemented interprofessional clinical experiences across the lifespan that address the oral-systemic needs of each population: prenatal, pediatric, adult, and older adult.

What were the results from this interprofessional educational experience?

Judi Haber: We evaluate our interprofessional experiences using the Interprofessional Competencies Attainment Scale (ICCAS) before and after each experience. Our evidence shows a significant change in student self-reported interprofessional competencies from pre- to post-test across the professions.

What did the nurses learn from working with students in other disciplines?

Haber and Hartnett: Students from all four disciplines — Nursing, Medicine, Dentistry, and Pharmacy — felt that TOSH was a positive experience as evidenced from some of their comments.

“It was mostly actually us teaching each other. The facilitator was there if we had any questions, but she kind of popped in and out and just sort of listened, and let us sort of take the reins which was good.”
Shoshana Gindi, NYU Adult-Geriatric Acute Care Nurse Practitioner Student

“Usually at Long Island University, we’re with pharmacy students only, so this allowed us to basically see other professions and their points of views when it comes to assessing patients.”
Nada Annr, LIU Pharmacy Student

“It was kind of cool to see the role reversal when we got to the part where we were talking about the patient management because we got to learn more about the medications, the medical conditions, how those are managed, and kind of what their focus was versus ours and how those come together.”
Charlotte Guerrera, NYU Dental Student

“It’s good to really get another perspective from other specialties. The dentists will specifically ask about oral questions; a medical student will ask complete body questions. We can learn how to approach patients in a broader way.”
Brandon Oks, NYU Medical Student

“More and more in today’s world, we’re working with the other disciplines in the health care setting. We’re also learning the background of other people’s specialties: what their schooling looks like and what their clinical work looks like. I think that really helps, especially in the nursing field and nurse practitioners making a name for themselves. I think it helps to kind of normalize the battlefield in a sense and give everybody an understanding of what our education looks like.”
RoseMarie Cafone, NYU Psych-Mental Health Nurse Practitioner Student

“I have sort of a general idea of what the different professions do, but I really didn’t have any sort of deeper understanding of everything that they bring to the table. I think when we were interviewing the patient, just hearing the kinds of questions that they were asking–what they were focused on–was really helpful in understanding how they’re approaching a patient. And then we were all sitting around a table hearing what they were most concerned about really illustrated for me what each profession is really bringing to that conversation.”
Elana Kreiger-Benson, NYU Medical Student

“We talked about, ‘Would this be valuable in the real world?’ And we all agreed, yes, because especially today in our world with health care changing, it’s even harder to communicate, and communication’s a big problem. Hopefully there’s more trainings like this to help give better communication among all the different health care professions.”
Stephanie Fanelli, NYU Dental Student

“I don’t usually get to interact with dentistry students, so that part was amazing. Being able to see how a dentistry student or a pharmacist would be able to approach an issue with the patient’s mouth was helpful, and being able to make a plan for this patient and create an interdisciplinary team approach to caring for this patient was great.”
Megan Fendt, NYU Midwifery Student

 “A couple more of these a year would be beneficial.”
Brandon Oks, NYU Medical Student

What else is important for our readers to know about interprofessional education?

Erin Hartnett: The Oral Health Nursing Education and Practice Program (OHNEP), an innovative national initiative led by Executive Director Judith Haber, and Program Director Erin Hartnett has just been designated as a 2019 Edge Runner from the American Academy of Nursing. This initiative recognizes those individuals and organizations who are leaders in designing models of care and interventions to improve health care cost and access. OHNEP [received] this award on October 24, 2019, for its leadership in “putting the mouth back in the head” in nursing education and clinical practice, improving clinical outcomes, and making positive contributions to the financial health of organizations.

Nursing Side Gigs: Raising Puppies for Canine Companions for Independence

Nursing Side Gigs: Raising Puppies for Canine Companions for Independence

This is part of a monthly series about side gigs—nurses with interesting side jobs or hobbies. This month, we spotlight a volunteer puppy raiser.


In 2017, Catherine Burger, BSN, MSOL, RN, NEA-BC, now a Media & Brand Specialist for RegisteredNursing.org, was in the midst of building her own home-based business after having retired from corporate nursing. Along with her husband and their youngest son, Burger had moved from Sacramento to San Diego, California, and she was looking for a volunteer opportunity.

“I kept seeing puppies with yellow vests in my area,” recalls Burger. “We had lost our dog several years prior, and it took many years before I was ready for another dog. I told my family that I believed we were meant to raise a service puppy, so we looked into it more.”

Burger had friends already involved with Canine Companions for Independence (CCI), so she and her family were able to talk with them and ask lots of questions. After completing an online application, as well as a home visit by a CCI staff member, they were approved and placed on a list to receive a nine-week-old puppy to raise.

“Canine Companions for Independence, a nonprofit organization, was founded in 1975 to provide expertly trained service dogs to enhance the lives of people with disabilities,” explains Burger. “These dogs are not just providing help with daily living by being the arms, legs, and ears of their partners, but also open to opportunities to live with greater independence and confidence.”

CCI provides these dogs to adults, children, veterans, and professionals, depending on their needs. The breeds used are yellow and black Labradors, Golden Retrievers, and mixes of these two breeds. “Most service-dog programs charge up to $40,000 for a trained assistance dog. Through volunteer puppy raisers like us, plus donations and sponsors, CCI is able to provide the trained dogs at no cost to the recipients,” says Burger.

When they started working with CCI, Burger and her family received a lot of training. “CCI provides mentoring, guidebooks, and many areas offer weekly training classes. As a puppy raiser for CCI, you commit to attending at least two puppy-training classes each week. There are professional dog trainers available for consult as needed if the puppy has any specific issues,” says Burger. “It is an extremely supportive program and community of puppy raisers. For example, we watch each other’s puppies when anyone is traveling.”

Burger and her family are raising their second puppy for CCI. Their first puppy, Nancy VI, is now a Change of Career (COC) dog, and they adopted her. Unfortunately, Nancy wasn’t able to get over having car anxiety. “We worked closely with the professional trainers to try to break her of the panting, drooling, and stiff body language,” says Burger. “While we were thrilled to adopt Nancy as our own COC dog, we were disappointed that she was not able to move into professional training to offer help and hope to someone in need.”

As puppy raisers, Burger and her family volunteer to provide everything for the puppy for the first 10 months of its life. Then they turn the puppy in for professional training. “We pay for the food, vet bills, vaccines, anything the puppy needs,” says Burger. “We are responsible to teach around 30 commands to the puppies at home — which are modeled through puppy class sessions — such as sit, down, back, side, heel, up, car, off, etc. Along with this training, our most important role is to socialize the puppies in public to get them ready to handle numerous situations in order for them to provide the most support to their future handler. Puppy class also provides field trips for the puppies to experience trains, buses, and even practice with getting through TSA and onto an airplane. The more confidence through varied experiences we can provide to the puppy, the more prepared they are for professional training and better prepared to be a strong assistance dog.”

Although they give so much to CCI and the community through raising puppies, Burger says that she and her family get a lot back as well. One of the best experiences has been seeing how the lives of those who receive dogs from CCI are radically changed. “Parents of an autistic child who, after receiving a dog for their son, were able to sleep through the night for the first time in 8 years because having the dog in bed gave him so much comfort,” says Burger. “I have also participated several times at Paloma Valley High School’s ‘Paws for Finals,’ where puppy raisers in the area bring their puppies to the school during finals. The kids are able to come pet and love on the dogs to minimize their stress. It brings tears to my eyes every time when I see a group of the popular kids, the geeky kids, the Emo kids, the shy kids, and the athletes all sitting around with their hands on my puppy, sharing dog stories together. It is also interesting that the puppies are absolutely exhausted after this stress-absorbing time with the kids!

“We are very proud to be associated with such an organization,” says Burger.

Participating in Interprofessional Education: Why It’s Important for Nursing Students, Part 1

Participating in Interprofessional Education: Why It’s Important for Nursing Students, Part 1

NYU Rory Meyers College of Nursing has been offering interprofessional education experiences for its nursing students since 2006. To explain how it works and why it’s essential for nursing education, we interviewed Judith Haber, PhD, APRN, FAAN, the Ursula Springer Leadership Professor in Nursing and Executive Director of the Oral Health Nursing Education and Practice (OHNEP) Program at NYU Rory Meyers College of Nursing, and Erin Hartnett, DNP, PPCNP-BC, CPNP, the Program Director of OHNEP and Teaching Oral-Systemic Health (TOSH) Programs at NYU Rory Meyers College of Nursing.

Haber and Hartnett took time to answer our questions. What follows is Part 1 of our interview. Keep on the lookout for Part 2 next week.

Why do you offer interprofessional education for nursing students? Why is it important?

Judi Haber: These experiences are an important component of the education of all students in the health professions. Historically, health education in the United States has been delivered in well-established silos. Yet patients come to primary and acute care health care settings with health problems that cross the boundaries of those disciplines. Student exposure to interprofessional education (IPE) experiences are designed to break down the traditional professional silos and prepare students to practice in teams that understand each other’s roles and responsibilities, value and respect the contributions of all team members, and communicate and function effectively on interprofessional health care teams. That is the health system model of the present and future!

Professional practice silos also have been documented in a series of reports by the Institute of Medicine (2001; 2003) to have a negative impact on the quality and safety of patient care. Fostering interdisciplinary team building and collaborative practice was proposed to improve patient outcomes; a call to action challenged faculty educating students in the health professions to educate them interprofessionally as members of collaborative teams who “learned from, with, and about each other.” Publication of the Interprofessional Education Competencies (IPEC) in 2011 propelled this interprofessional education agenda and soon accreditation standards for nursing, medicine, dentistry, pharmacy, and other professions required evidence that students were being exposed to interprofessional education experiences. 

Essentially, these interprofessional education experiences are preparing students to “hit the ground running,” prepared to practice in high-performing teams following graduation.

What other students work with them? At what schools are they studying?

Judi Haber: The NYU interprofessional education experiences have always had a clinical focus and have always included dental and medical students and, more recently, pharmacy students.

What happens during this three-day study? How does it work?

Erin Hartnett: The TOSH–Teaching Oral Systemic Health event has been held every September for the past seven years. In 2013, we started with about 300 students from three schools–NYU Rory Meyers College of Nursing, NYU College of Dentistry, and NYU School of Medicine–and in 2019, our seventh year, we have almost 800 students from four schools–NYU Rory Meyers College of Nursing, NYU College of Dentistry, NYU School of Medicine, and Long Island University (LIU) Pharmacy.

TOSH brings together students from different health professions to participate in an interprofessional oral health simulation with a Standardized Patient and a case study discussion experience to learn from, with, and about each other. The goals of this experience are for the student to learn about oral health, specifically the oral health connection, and the oral exam; as well as to learn to work together as a team using the interprofessional educational competencies (IPEC competencies) to learn each other’s roles and responsibilities, values, and ethics and to learn to communicate and collaborate as a team for the good of the patient–to provide better, safer, more cost effective health care

Prior to the TOSH experience, all of the students are required to complete an assignment, which includes: two Smiles for Life Modules, read about the IPEC competencies, watch a video on the TeamSTEPPS®  SBAR communication techniques, and read an article about prescribing for acute dental pain (Clark et al, 2010; Agency for Healthcare Research and Quality).

Part 1

When students arrive at the Simulation Center, they take the Interprofessional Collaborative Competency Attainment Survey (ICCAS) on their phone (MacDonald, Archibald, Trumpower, Casimiro, Cragg, & Jelly, 2018). The ICCAS measures their interprofessional competencies prior to the experience. Students are then assigned to a team consisting of a nurse practitioner, midwifery, medical, dental, and pharmacy student.  They work together as a team obtaining a focused history from the Standardized Patient– which should lead them to suspect Type 2 Diabetes, periodontal disease, and acute dental pain.

The dental student then demonstrates the oral exam on the Standardized Patient to the other students, and each student is then required to practice the oral exam on the Standardized Patient with the dental student as mentor.

Part 2

The teams then all move to a case study discussion room where they meet with another team. The students introduce themselves to the other team and then each profession pairs with the member of their profession to develop a problem list. After completing the problem list, both groups meet back together to develop a care plan, which incorporates each profession.

Students then role-play calling each other on the phone using the TeamSTEPPS® SBAR technique to explain the Situation, Background, Assessment, and Recommendations for this patient.

At the end of the experience the students debrief with their facilitator on how the IPEC competencies were met.

Is participation required for nursing students or voluntary? Do the nursing students need to be in a particular semester in order to participate?

Erin Hartnett: All second-year NP and Midwifery students, fourth-year dental students, second-year medical students, and fourth-year pharmacy students are required to attend.

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