Are service dogs allowed in medical facilities, including doctor’s offices and hospitals, in the United States? If so, what is the responsibility of nurses to care for individuals accompanied by a service dog?
We ask these questions because there are currently more than 500,000 service dogs in the U.S., and the service dog community is growing in popularity. Types of service dogs include: guide dogs for the blind, emotional support, mobility assistance, medical alert, autism support, and more.
The American Disabilities Act (ADA) defines a service dog as one that is “individually trained to do work or perform tasks for the benefit of an individual with a disability, including a physical, sensory, psychiatric, intellectual, or other mental disability.”
This includes psychiatric service dogs who support those suffering from Post-traumatic stress disorder (PTSD), such as individuals active in the military or veterans. For those suffering from PTSD, it can be difficult for them because you can’t see the condition, but fortunately the service dog is trained to do so.
When A Patient Has a Service Dog
As a nurse, what are your responsibilities when a patient enters your medical facility attended by a service dog?
A little known fact is service dogs are not required to wear any specific labeling or attire to indicate visually that the animal is a service dog. Also, the ADA only classifies dogs as an approved service animal.
According to the ADA, you can ask the following two questions to a patient with a service dog:
- Is your animal required because of a disability?
- If so, what tasks is your service dog trained to do for you (the owner)?
You cannot ask the individual about her disability, to see any paperwork about the dog’s specific training, to have the dog demonstrate its tasks, or order the owner to make the animal wear a “service dog” vest.
Working with Patients and Pups
So as a nurse, what can you do to care for your patient? It’s twofold. First, your primary responsibility is to “protect the rights of the disabled patient,” and second, you want to make sure the owner keeps control of the animal.
Next, you want to follow the safety guidelines for your facility, which may include the restriction of animals in locations where the animal might compromise the environment, including sterile areas such as operating rooms or labs.
If you require want further instructions, you can always check with your facility manager or go to the ADA website to find out more.
With more and more service dogs assisting those with disabilities across the U.S., the likelihood of seeing an increase in service animals in medical facilities should be anticipated as is the proper treatment of these types of patients.
This story is brought to you by Michael O’Keefe at Consumers Advocate.
The first step in improving Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) performance is recruiting nurses with a focus on long-term retention. The national turnover rate for bedside RNs was 16.8% in 2017 with an average associated cost of $38,000 to $61,000 per nurse. Nursing turnover impacts each hospital’s bottom line, with costs averaging from $4.4 million to $7 million annually (source).
Multiple Costs of Turnover
More importantly, high nursing turnover negatively affects morale, quality of care, and HCAHPS scores. When there is a critical acute need to satisfy scheduling demands, hospitals cannot afford the luxury of being proactive in their recruitment efforts. Unfortunately, patching a schedule full of holes causes rapid hiring decisions instead of considering a quality applicant.
There are connections between patient perceptions of their health care experience and nurse staffing ratios. The hospitals with the highest number of nursing hours per patient day consistently rate higher on HCAHPS scores than other facilities. Nurses and patients alike thrive in a positive nurse work environment. But recruiting nurses with long-term retention factors is only half the battle.
Revisiting the Recruitment Process
Health systems have to streamline their recruitment process to re-focus on hiring and retaining nurses with targeted HCAHPs behaviors like responsiveness, ability to listen, and audience awareness. When interviewing candidates, it is essential to identify how the nurse will communicate with and answer patients. Optimal applicants will treat the patient with respect, communicate effectively, and respond quickly.
Hospitals must strive to recruit candidates who are committed to their work, patients, and the organization. When hospitals remain competitive to hire and retain talent, patients stand to benefit. Top-quality employees make for top-quality organizations and nurses are at the forefront.
Caitlin Goodwin MSN, RN, CNM is a Board Certified Nurse-Midwife and freelance writer. She has ten years of nursing experience and graduated with a MSN from Frontier Nursing University.
The Ohio University College of Health Sciences and Professions’ School of Nursing is putting virtual reality to use in the classroom. Assistant professor Sherleena Buchman helped create a Narcan simulation during the 2018 spring semester. Since then, the initial video simulation has been transformed into a virtual reality simulation.
A 360-degree video was made from cameras surrounding the Narcan simulation, which features two college students discovering a friend experiencing an opioid overdose. Throughout the scene, the students call 911 and work together to help their friend by administering Narcan.
“Using virtual reality goggles, the person can turn around and see everything. It’s really amazing,” Buchman shared with the CHSP Newsroom. “When you look down, you can see them going through the bag looking for Narcan. If you hear a noise, you can turn your head to look in that direction to see what’s going on. It’s just like you were physically in the room.”
Buchman believes that as the simulation becomes more realistic, the students will learn even more than they could in a traditional nursing education setting. Currently, this simulation is only available in the university’s GRID Lab, but Buchman is working to have the simulation eventually available on all smartphones. The simulation will help students learn not only about Narcan and how to administer it, but how to view and think about addiction without a stigma.
“It leaves you with a feeling of ‘Wow, I just watched someone overdose and watched them come back,’” said Buchman. “The reactions viewers gave were interesting and emotional. They showed compassion as we sometimes don’t consider the side of the actual person who overdosed and the feelings of those that found them.”
Currently this simulation is only available for laymen, but Buchman is working on another version specifically for Ohio University’s nursing students that can be used as a teaching tool. She feels excited and grateful about her success with the simulations so far.
“It’s been a pretty amazing journey. I love technology, simulation and education and the students today have grown up with technology in their hands. This is a way we can impact them that’s familiar,” Buchman said. “It’s amazing to think that we can help create something that will help patients and help our community by impacting this generation of students and community members who see this and will be able to carry out these actions on their own.”
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.
After 1 hour of overtime, nurse-to-nurse collaboration drops significantly
Though it is common, working overtime may negatively influence nurses’ collaboration with their colleagues, according to a study by researchers at New York University’s Rory Meyers College of Nursing.
“Our research suggests that the more overtime hours nurses work, resulting in extended periods of wakefulness, the greater difficulty they have in collaborating effectively,” one of the two co-authors, Amy Witkoski Stimpfel, PhD, RN, said in a news release.
Nurses often work long, irregular hours and have unexpected overtime, which puts them at risk for fatigue and sleep deprivation and can lead to impaired emotional, social, and cognitive processing. This, in turn, may hurt nurses’ ability to collaborate, the researchers said.
The study, published in the Journal of Nursing Administration, assessed how shift length and overtime impact nurses’ perceptions of collaboration with other care providers — specifically with other nurses and physicians.
The researchers used 2013 survey data from the National Database of Nursing Quality Indicators, and analyzed responses from 24,013 nurses in 957 units from 168 U.S. hospitals.
Among the study’s findings:
- Across the five types of nursing units measured, the average shift length was 11.88 hours
- 12-hour shifts appear to be the predominant shift schedule for hospital nurses
- Nurses worked, on average, 24 minutes longer than their scheduled shift
- 33% of the nurses on a unit reported working longer than initially scheduled
- 35% of nurses said that the amount of overtime needed from nurses on their unit increased over the past year
“One in three nurses reported working longer than scheduled. This appears to be a chronic problem for nurses – one that extends an already long work day and appears to interfere with collaboration,” the study’s lead author, Chenjuan Ma, PhD, said in the news release.
Interestingly, the researchers did not find a significant relationship between average shift length and collaboration — meaning that longer-scheduled shifts did not necessarily lead to less collaboration. However, collaboration appeared to suffer in nursing units with longer overtime shifts and more nurses working overtime.
Collaboration on a unit was measured using the nurse-nurse interaction scale (RN-RN Scale) and nurse-physician interaction scale (RN-MD Scale). In addition, 1 hour of overtime was associated with a 0.17 decrease on the RN-RN scale and was marginally associated with a 0.13 decrease on the RN-MD Scale — in other words, a 0.17 decrease from the mean score on the RN-RN scale suggests that a unit’s rank on the RN-RN score would drop from the 50th percentile to roughly the 30th percentile, the team explained.
Advice for Nurse Leaders
The researchers advised that nurses, nurse managers, and hospital administrators should use overtime as infrequently as possible. Stimpfel and May said that while they recognize that longer shifts are the norm and that eliminating overtime may not be possible, offering fatigue management training and education would be helpful, as well as training to help nurses and physicians communicate effectively and respectfully.
“Our findings support policies that limit the amount of overtime worked by nurses,” said Ma. “In practice, nurse managers should monitor the amount of overtime being worked on their unit and minimize the use of overtime.”
Collaboration among healthcare professionals is critical for quality care and patient safety, the team emphasized. Previous studies have shown that patients receive superior care and have better outcomes in hospitals where nurses collaborate well with other healthcare providers. In fact, a study by Ma and two other co-authors published May 2 in the International Journal of Nursing Studies found that both collaboration between nurses and physicians and collaboration among nurses are significantly associated with patient safety outcomes.
This story was originally posted on MedPage Today.