Nursing, as defined by the World Health Organization, encompasses care for people of all ages, families, groups, and communities, sick or well and in all types of settings. Nursing includes health promotion, illness prevention, and care of the ill. Regardless of your nursing role, or type of patient population you care for, health literacy is an essential competence necessary to effectively communicate and truly provide person-centered care. Health literacy is a precursor to health and considered a social determinant of health due to its influence upon health outcomes. It also includes engaging and empowering patients to access services and act upon health information to make informed decisions.
Early definitions of health literacy primarily focused on the skills or deficits of individuals when obtaining, processing, or understanding basic health information and services. The term has continued to evolve to reflect the complex, dynamic, multidimensional context-related components of health literacy. And while nurses have such a vital role in the promotion of health literacy, there is often a lack of understanding that health literacy is much more than the reading level of patient education material.
Nurses have a vital role in partnering with the 88% of the U.S. population that are not having their health care needs met. Nurses can make a difference beginning today!
Begin by checking out the 5 basic health literacy strategies every nurse should know.
1. Promote a shame-free environment.
Health literacy is the foundation to a successful nurse-patient interaction and necessary to promote patient safety. Writing all patient forms in plain language, providing assistance with paperwork, offering free interpretation services, and involving members of your community when designing materials or programs will assist with promoting a shame-free environment.
2. Use a health literacy universal precautions approach.
Always assume that everyone might experience difficulty understanding health information or navigating the complex health care environment. Even a well educated patient can have difficulty understanding the medical information provided.
3. Speak in plain language.
Plain language or “living room language” is beneficial for everyone! Using “everyday” words rather than medical jargon will allow you to meet your patients where they are and help clearly explain more involved concepts.
4. Confirm understanding with Teach-Back.
Respectfully ask patients to explain a concept or direction back to you. This helps ensure you were clear in all patient communications. It also gives you the opportunity to clarify any misunderstanding if needed. Teach-Back is not mimicking what you said—patients should use their own words to explain understanding.
5. Ask open-ended questions.
For example, “What are your questions?”, “What questions do you still have?, or possibly, “We just reviewed a lot of information. What parts would you like me to go over with you again?” Each of these examples can help encourage questions rather than “do you have any questions?, which often results in a quick response of “no”.
Learn more about health literacy and health literacy strategies in this award winning book, Health Literacy in Nursing: Providing Person-Centered Care. For additional resources or to request health literacy services, contact Health Literacy Partners.
Nurses are always concerned about keeping their patients safe. Besides doing so by being professional with caring directly for them, nurses also need to be aware of how communication—with other health care providers and patients—can either keep patients safe or put them at risk.
Arnold Mackles, MD, MBA, Patient Safety Consultant for Innovative Healthcare Compliance Group and member of The Sullivan Group’s RSQ® (Risk, Safety, Quality) Collaborative took time to answer questions about exactly how nurses can do this.
In Part 1 of this series, we address what high-risk situations could be as well as how nurses can safely communicate with other health care providers. Part 2 will cover specific ways in which nurses can communicate with their patients while keeping them safe.
What is a high-risk situation and what kinds of patients could be involved in these?
High-risk clinical presentations occur throughout multiple areas of medical care. Medical errors in these critical situations can induce significant patient harm or even death. You might find a high-risk scenario:
- In the emergency department as you care for all comers presenting with a wide variety of complaints from back pain and chest pain to headaches and injuries to extremities
- In the ICU when caring for fragile patients with a life-threatening infection
- Before, during, or after a surgery
You might also encounter groups of patients that are inherently more high-risk. These include:
- Patients with multiple comorbidities
Effective communication between nurses and other clinical providers plays a vital role in the effective management of high-risk clinical situations. Unfortunately, traditional nursing and medical school programs do not include training in techniques to ensure successful communication in health care. As a result, a significant number of patients are harmed by breakdowns in communication.
What are the best ways for nurses to communicate with other providers to best keep their patients safe?
A study of over 23,000 malpractice claims by the Harvard Medical Industries, Inc. (CRICO) revealed that “communication failures were linked to 1,744 deaths in five years.” The study also found 7,149 cases where communication breakdowns caused patient harm, and 26% of those breakdowns involved a miscommunication of the patient’s condition among providers.
One critical strategy to improve communication among providers is the use of the “read-back” method. In high-risk clinical situations, physicians often give verbal medication orders to nursing personnel. Such orders must be “read back” or “talked back” to the ordering physician or practitioner to confirm accuracy. This same technique should be utilized when receiving verbal lab and test results as well.
In one case, a nurse answered a telephone call from the lab with a patient’s biopsy test. The pathologist called in the result as being an “adenocarcinoma,” a type of malignant cancer. However, perhaps due to a poor phone line, the nurse thought the pathologist said the specimen “had no carcinoma.” A simple “read-back” would have avoided the error. “Doctor, did you say that the biopsy did not have a carcinoma?” The pathologist could then have then replied, “No, it is an adenocarcinoma which is malignant,” and the error would have been avoided.
Fortunately, there are a variety of simple techniques that nurses can employ to improve communication in clinical settings. It has long been known that nurses and physicians often describe the same patient situation in different ways. Nurses have been trained to give detailed, specific descriptions of a patient’s condition. Physicians, on the other hand, speak in bullets or quick lists of clinical findings. This mismatch in communication style can easily lead to misinterpretation and misunderstanding.
One simple method to overcome this communication barrier is the use of CUS – concerned, uncomfortable, and safety – to demonstrate an increasing severity of a patient’s condition. For example, if a postoperative patient is running an elevated temperature, the nurse could say, “Doctor, I am concerned about Mrs. Jones, as she has a temp of 102 degrees.” The next level of severity would be, “Doctor, I am uncomfortable with Mrs. Jones as she is spiking a temp to 103 degrees and is tachycardic.” As the condition worsens, the conversation might be, “Doctor, I am worried about the safety of Mrs. Jones. She is febrile, tachycardic, and complaining of severe abdominal pain.”
Many medical errors are caused by the reporting of incorrect or incomplete patient medical information during a handoff. Health care handoffs are an extremely common time in which communication mistakes occur. Fortunately, the health care industry now has access to easy-to-use handoff techniques. The SBAR method was originally created to ensure correct communication on nuclear submarines and has been adapted for health care use. The technique utilizes a handoff worksheet that is created by the sender of the clinical information, and then discussed with and handed off to the receiver of the information.
The simple mnemonic SBAR to be completed on the worksheet represents:
S – Situation: “What is going on with the patient?”
B – Background: “What is the clinical background or context?”
A – Assessment: “What do I think the problem is?”
R – Recommendations: “What would I do to correct it?”
Although the SBAR system is widely used today, some health care organizations are moving to a handoff technique that integrates the electronic medical record. One such method is I-PASS, in which the computer creates and prints out the handoff work sheet. The I-PASS worksheet mnemonic contains:
I – Illness severity
P – Patient summary
A – Action list for the next team
S – Situation awareness and contingency plans
S – Synthesis and “read-back”
Check out Part 2 for information regarding communication skills for nurses to safely speak with their patients.
A new healthcare nonprofit organization in Maryland recently launched to better address rural patients’ needs. IMBUEfoundation will provide care and transportation services to Maryland’s Eastern Shore communities, to improve residents’ options for care and lifestyle choices.
“IMBUEfoundation was established to eliminate the barriers that prevent people from accessing healthcare and living healthy lives,” founder Dr. Seun Ross said. “We are working to address obstacles like health literacy, transportation, and care coordination.”
Recent research by Harvard’s T.H. Chan School of Public Health, the Robert Wood Johnson Foundation and NPR shows that receiving good healthcare is the second-biggest problem for rural American families. Major health concerns for rural Maryland residents include chronic disease, health literacy, care coordination, outreach and education, according to a 2017 assessment by the Maryland Rural Health Association. IMBUEfoundation notes on its site that the lack of services and coordinated care has led many Maryland residents to struggle in finding proper care.
“Healthcare is more than just going to the doctor,” Ross said. “For example, someone who lives in a place like Caroline County, which is both a food swamp and a food desert, is going to have a harder time making healthy food choices, which can lead to obesity— a major factor of chronic disease. It’s a domino effect.”
The new non-profit is helping those in need with nurse practitioners, acting as “clinical concierges” who provide counseling, monitoring, and stewardship activities. The nurse practitioners assist with coordinate care delivery for patients, explain healthcare plans and treatment options, and provide education on alternative care, in addition to other necessary tasks.
Modes of services provided by IMBUEfoundation include the Rural Health Collaborative, Care Coordination, and Transportation Service, in partnership with Lyft.
“From providing transportation to helping patients coordinate between doctors, IMBUEfoundation is working to make sure Maryland’s mid-shore residents have the resources they need to be healthy and happy,” Ross said. “But there’s still so much work to be done.”
For more information about IMBUEfoundation, visit imbuefoundation.org.
Stress manifests among nurses in various forms and can affect patient outcomes
Being a nurse can be fulfilling and rewarding. We get the privilege of helping new lives enter the world, comforting those who are exiting this world, and everything in between. Yet nursing is also taxing and draining at times. Off-shifts (nights and weekends), hectic workloads, violence from patients and families, and incivility among staff members can all cause physical and emotional wear and tear among nurses.
Unfortunately, issues like depression, burnout, and fatigue are extremely prevalent among nurses. As Alexandra Wilson Pecci writes in a recent article, one 2016 study found that nurses experience depression at twice the rate of those in other professions.
This is bad not just for nurses but also for patients. Another study Pecci highlights found a link between nurses reporting poor health, particularly depression, and higher rates of reported medical errors.
That’s a serious issue and one that certainly needs to be addressed.
Some recent HealthLeaders articles offer solutions to address stress among RNs.
Beating Clinician Burnout
There’s a common belief that burnout is a personal failing and that resolving dimensions of burnout — emotional exhaustion, cynicism, inefficacy — are that individual’s responsibility. Eat a salad, go for a walk, take a yoga class, and you’ll be fine. In reality, however, burnout is a sign that something is amiss within an organization, and healthcare leaders need to uncover both the prevalence of burnout at their organizations as well as its root causes.
“There needs be a framework to understand where the pain points are, and then how an organization can do something about that,” said Karen Weiner, MD, MMM, CPE, chief medical officer and CEO at Oregon Medical Group (OMG), a physician-owned, primary care–based multispecialty group of about 140 healthcare providers, with offices in the Eugene and Springfield area.
Weiner advises that leaders implement system-wide changes to address the factors contributing to burnout. After administering the Maslach Burnout Inventory at OMG, the organization made multiple changes including creating a physician-organization compact, developing new compensation practices, and redistributing workloads.
Creating Culture of Caregiver Support
A 2015 Gallup survey found that more than half of all healthcare workers report thriving in none or only one element (purpose, social, financial, community, physical) on the Gallup-Healthways Well-Being Index.
To better help employees cope with the emotional demands of caring for others, some organizations are implementing programs to prevent problems like burnout, suicide, and substance abuse.
“Strategies that could support employees include reducing the stigma about mental health concerns, providing resilience training and care for the caregiver support programs, and providing health and wellness benefits, including policies that allow for time off for mental health concerns as well as for physical health concerns,” said Celeste Johnson, DNP, APRN, PMH CNS, a member of the board of directors of the American Psychiatric Nurses Association and director of nursing, psychiatric services at Parkland at Green Oaks Hospital in Dallas.
For example, the University of Missouri Health System’s forYOU program provides support to healthcare workers experiencing symptoms of “second victim syndrome.”
Parkland provides universal screening for suicide risk, including for those employees seen in the employee clinic.
How to Handle Cyberbullying in the Nursing Unit
Another source of stress among nurses is workplace violence, and cyberbullying meets that definition. Thanks to technology, bullying behaviors can now occur in digital form via means such as instant messaging, email, text messaging, social networking sites, or blogs.
According to the National Council for the State Board of Nursing’s policy on social media, any online comments posted about a co-worker may constitute lateral violence — even if the post is from home during non-work hours.
To confront cyberbullying, the policy states, individual nurses should save evidence of bullying comments. Then, during a private conversation, present the evidence to the person who made the comments. Document the conversation and its outcome and if there is a second instance of cyberbullying, report it to the nurse manager. If the behavior continues, alert the chief nursing officer.
Nurse managers should verbalize to their staff that there is a zero-tolerance policy for bullying of any kind, including comments made online. Managers should also educate staff on standards and polices regarding cyberbullying and should take derogatory remarks seriously.
Creating a work environment that addresses issues that contribute to nurse stress and burnout is more than something that’s just nice to do; it’s also a way to improve patient care. There are plenty of reasons to improve. Research by Linda H. Aiken, RN, PhD, at the University of Pennsylvania in Philadelphia, has found that patients who had surgery at hospitals with better nursing environments and above-average staffing levels have better outcomes at the same or lower costs than other hospitals.
Need any more proof?
This story was originally posted on MedPage Today.
You want to create the professional future that your heart desires, but perhaps you haven’t had much luck with standard career planning methods. You’ve tried coming up with a list of New Year’s Resolutions or setting SMART work goals, but by Valentine’s Day, you can’t remember them.
As a nurse, you’re someone who’s put in long hours in college to earn a degree so that you could pursue your chosen profession. You then clocked in many more hours working long shifts, on an often unpredictable schedule, in order to build a track record in your field.
Don’t stop now—you’re too valuable not to go after all your dreams in 2019. But maybe it’s time to explore a more creative New Year goal setting approach, like mindfulness.
You may have noticed the word “mindfulness” popping up all over the place, not only in health care organizations and the wellness industry, but also in technology corporations, like Google. Glance over any grocery store newsstand and you’ll see articles and even entire special publications by Oprah and Yoga Journal (of course!) but more surprisingly, Life-Time and Harvard Business Review.
So, what is mindfulness? Simply, mindfulness means that you’re paying attention to the present moment—not mired down with living in the past or anticipating the future. Science-based mindfulness practices have been proven, in many studies, to be helpful in creating your best life.
There are multiple physical and emotional health benefits to be had when you aim to live mindfully, including increased feelings of calm and focus, plus improved brain function.
As a point of comparison, “mindlessness” is what happens when you drive home at the end of a 10-hour shift, preoccupied with thoughts of your day. Then when you suddenly arrive at your destination, you can’t even remember how you got there!
You might be wondering how you can possibly plan your future when the whole point of mindfulness is to live in the present. As long as you don’t live in the future, it’s fine to fast-forward and project yourself into possible scenarios that you can imagine for yourself. (The trick—and it really is a trick—is to quickly come back to present-day reality.)
Mindfulness helps center you as you examine what’s really happening in the present and what you’d like for your life going forward. Then you’re less likely to get caught up in regrets about yesterday (woulda…shoulda…coulda…) or fears about what might happen tomorrow.
One important component of mindfulness, especially for nurses and other caretakers, is self-compassion. Like self-care, that gentle attitude towards self will help you to clear emotional roadblocks that may be holding you back from going after your dreams.
Mindfulness and self-compassion can help you be kinder to yourself, and cut through negative self-talk and self-doubt. You’ll begin to believe that not only do you have the ability to go after your nursing career goals, and that you deserve to achieve them, but that you absolutely will!
Or, you might find that you’re chasing a dream that isn’t your own anymore, in which case, maybe you should stop.
For a research-based ideas on how to start your mindfulness journey, visit the Center for Healthy Minds at the University of Wisconsin-Madison. Or for inspiration on where to go next in your career journey, visit Johnson & Johnson’s Discover Nursing website and and take their Find Your Specialty quiz.
Rates of substance use disorder have continued to grow in the United States and studies have shown that 10-15% of health care professionals abuse substances at some point in their lifetime. Many individuals working in the health care field are dealing with patients, so these numbers present serious safety issues for their patients if a professional is impaired. To get some first hand insight on this issue, I have asked two nurses in recovery, Kristin L., RN, and Cynthie K., RN, to share their experience and knowledge on the subject to shed awareness on this issue.
Kristin has been sober for 13 years and began abusing prescription opioids during her career in nursing. She has been able to retain her license despite facing legal consequences.
Cynthie has been sober for 6 months and is still facing consequences from her drug and alcohol abuse.
How did your addiction affect your career?
Kristin was working with intubated patients where they administered Fentanyl and she began stealing any extra Fentanyl because, as she explained, after she took it once, she had to have it every time she went to work. After 9 months she was caught and arrested the first time, resulting in the loss of her medical license. Kristin felt like she dodged a bullet by ending up with misdemeanors, but she began working as a medical secretary where she immediately started calling in prescriptions for herself. When she was caught doing this, she spent 4 months in jail and is now carrying the weight as a convicted felon. Fortunately, she was able to retain her nursing license after a 5 year monitoring program.
When Cynthie made the decision to get sober, she was working as Director of Nursing. She explains that working while impaired affected her judgement and decision making. She wasn’t able to perform to the best of her ability and no longer had the enthusiasm about work that she once had. She frequently called out of work because drinking became more important. Since her judgement was off, she thinks it could have had an effect on patient outcome which was potentially dangerous for families who were in difficult situations. She notes that she lost her job due to a DUI, but was able to maintain her license through the help of a nurse who worked with a statewide program for professionals with substance use disorder.
What kind of programs and support were you offered?
Through the Professional Assistance Procedure (PAP) program in Wisconsin that Kristin participated in, she was given a restricted license so she could still work as a nurse. She had to do weekly random drug screens, attend counseling, 12 step meetings, and submit quarterly reports to the nursing board. If at any time she did not comply to these standards, her license may have been suspended again.
In New York, Cynthie was able to get help through the Statewide Peer Assistance for Nurses (SPAN) program. A nurse who worked with SPAN helped Cynthie go to detox and treatment, allowing her to get help before her license was revoked as a result of her DUI. In this program, individuals are subject to random drug screenings while being closely monitored by a supervisor so they may continue to practice while obtaining the help and support of professionals.
What would you add to these programs to make them more effective?
Kristin and Cynthie both feel strongly that anyone working with narcotics or controlled substances should be subject to random drug screens. Both women believe that if we tested more people in hospitals and clinics, the numbers of addicts silently suffering would be astonishing. Kristin estimates that many providers would lose about 10% of the workforce due to substance abuse problems. She suggests that a great addition to the programs offered to her would be a yearly training on how to report to the nursing board. With these ideas implemented, the hope is for health care professionals to feel safe reporting anyone suffering in silence.
What measures can be taken for prevention of substance abuse in the health care field?
Despite different stories and consequences, both Kristin and Cynthie agree that more conversation about substance abuse, in both the health care field and within society as a whole, need to take place. Both women explain it would be beneficial to invite a recovering health care professional, who has personally suffered through addiction, to share their story with others at yearly conferences or trainings. Kristin explained that having a person share their experience, as a health care professional suffering from addiction, can potentially help reduce the stigmas surrounding addiction. Kirstin also believes this could help not only the individual struggling, but their families as well. Bringing awareness to the disease of addiction can help reduce the stigmas of addiction and open the lines of communication for other nurses in similar situations, in hopes of allowing them to reach out and ask for help.