METHODIST Leaders NURSE in Nursing AUGUST 2013 | A Magazine for Nurses
Summer
MAPP
& PCA Students
Enjoy Their Methodist Experience Page 8
TH E D EPART M EN T of N U RS I N G
A
A Message from
Ann Scanlon McGinity Senior Vice President and Chief Nurse Executive
Creating Paths to Success
2013 Editorial Board Members
At the end of every summer, we are always forced to say goodbye to our summer MAPP students. Once again, this year’s group proved to be a dedicated and talented collection of future nurses who demonstrated a strong willingness to learn throughout their experience at Houston Methodist Hospital. Many of the students shared their feedback with me and mentioned how they felt so fortunate to receive such a quality mentoring experience at our institution. Several expressed that besides the increased knowledge and friendships they gained, their time with us resulted in being their “best summer ever.”
Elizabeth Himes
Carlette Patterson
Beverley Lamoth
Joy Shiller
Kathy Materre
Maria Steele
Denise McNulty
Robyn Washington
The same holds true for our recent participants of our PCA Externship Program. Partnering with Communities in Schools, our summer externs gained hands-on experience in the health care setting. These students were from at-risk high schools and were hand-picked to participate in the program. Their drive and passion to succeed was truly inspiring, and by the end of the eight-week program, each participant had earned their Certified Nurse Assistant certification. We held a special reception for our participants earlier this month to reward their accomplishments. I am honored that our organization could play such a huge role in opening doors to their future. Our nurse mentoring initiatives also extended globally through a leadership training program offered through Houston Methodist Global Health Care Services, formerly Methodist International. Over 12 weeks ago, we welcomed three bright nursing leadership trainees from King Faisal Specialist Hospital and Research Centre in Riyadh, Saudi Arabia. During their time with us, they observed and collaborated with our nursing community—gaining great perspective and insight along the way. They each presented exciting projects that they plan to implement at their home facility. You can read more about this collaborative project on page 14. Our next cohort of trainees will be joining us on September 16, 2013. It is always a joy for me to see students continue along their individual journeys in the nursing profession, and the feedback and remarks we have received from these programs should serve as a testament to our outstanding team members who each year, without hesitation, take the time to make a difference in the lives of so many students. Identifying and mentoring top talent for future health care roles fulfills a very important responsibility we have as nurses. We are currently accepting applications for our 2013 Outstanding Nurse Award, which is sponsored by The Brown Foundation, Inc. This award recognizes an outstanding nurse at Houston Methodist Hospital who consistently demonstrates excellence in nursing practice, professional development and dedication to patients. The winning nurse receives $15,000. Many of you may think that is a difficult process, but it is actually very easy to lend your support behind a deserving nurse. The only arduous part of this award process falls on our judges, who are tasked with reviewing our finalists and selecting only one winner. Please remember that anyone can nominate, so I strongly encourage you to take a moment to recognize a colleague today. The deadline for all nominations is September 13, 2013, and nomination packets can be found by visiting our nursing intranet page.
Magazine Editor Trevor Mitchell
Graphic Designer Phyllis Gillentine
Photographers Phyllis Gillentine Trevor Mitchell
Do you have a
that you would like to post in the Methodist Nurse Magazine? Please submit your articles or ideas to Trevor Mitchell at tmitchell2@tmhs.org
Houston Methodist Nurses Unite to Help End Hunger Volunteers Needed for Upcoming ICARE In Action Event at Houston Food Bank
In recognition of World Food Day 2013, Houston Methodist nurses are joining the global movement to help end hunger—beginning right here in our local community.
FRIDay October 18
2013
Two Different Shifts are Available
8:00 a.m. - 12:00 p.m. or
1:00 p.m. - 4:00 p.m.
Nursing staff members are encouraged to register today as a volunteer for this approved event through the ICARE In Action program Employees will receive up to 4 hours (part-time) or 8 hours (full time) to participate. Space is limited!
For questions, please contact: Trevor Mitchell at 713-441-4507 or tmitchell2@houstonmethodist.org
Houston Food Bank Warehouse 535 Portwall St. Houston, TX 77029
All participants will receive a Houston Methodist ICARE in Action T-shirt! You must first register as an I CARE volunteer: Step 1: Visit www.methodisthealth.com/icare Step 2: Scroll down and select the “Volunteer Opportunities” tab. Step 3: Under the “Volunteer Opportunities” tab, select the link “Create Volunteer Profile.” Step 4: Fill out the form where required. They must enter their TMHS email address (not the new Houston Methodist email). Step 5: Once the form is filled out they will select the button “Add Volunteer Information to Profile.” Step 6: In the confirmation email, employees will receive a temporary password. Use the temporary password to login and change to something permanent.
Then, to register for the Houston Food Bank Nurse Volunteer Event:
Step 1: Go to www.methodisthealth.com/icare Step 2: Click on the Volunteer Opportunities tab below. Step 3: Select the option “Register for an Event.” Step 4: You will be prompted to enter your login information (verify account, then login) Step 5: Select the option “Register/Unregister for an event.” Step 6: Scroll down a little and In the “Registration Code” box enter the phrase: houstonmethodistnurses, then select “Register for Event.” Step 7: Select the Main Warehouse Support-Nurses Day activity then select “Register for Event.” Step 8: Finally, select the preferred time slot you wish to volunteer with then select “Complete Registration.”
Houston Methodist San Jacinto News
Jane DeStefano
Vice President and Chief Nursing Officer
Births at HMSJ keep families together
W
hen Colt McWhorter bounced into the world at 8 pounds, 15 ounces, there was something unique about his birth. Everything went according to plan as far as cesarean sections go. But the book is being rewritten at Houston Methodist San Jacinto Hospital, as the maternal-child unit shifts its focus to family-centered care, starting with Colt’s delivery. Colt is the first child for Crosby residents Tina and Jason McWhorter. The couple tried to conceive for nearly two years, even enlisting the help of fertility doctors. After finally achieving their goal of having a child, it was very important to Tina – as with most expectant mothers – that everything went perfectly with this pregnancy. “Because of her age and the amount of time since her last pregnancy, we opted for a c-section for this birth,” said Dr. Alfred Lucius, Tina’s obstetrician. Lucius not only delivered Tina’s daughter Kayla 17 years ago, he also delivered Tina, age 37. Her personal connection to Lucius was the deciding factor in choosing to deliver at HMSJ. However, she’d heard of a new method taking place at other hospitals, which led to her request that her c-section be slightly different. She wanted skin-to-skin contact, or having the naked infant placed directly on her bare chest, in the operating room. This is a growing trend in c-section deliveries. Through a childbirth education class, Tina discovered Housotn Methodist San Jacinto was planning to start skin-to-skin contact deliveries. After learning more from Carrie Halsey, RN, SJMH childbirth educator, Tina discussed the possibility with her doctor and was excited that he was willing to make this birth special. “I didn’t even have to convince him,” she said. “He said he heard it was going to be starting sometime soon, so he was excited about it.” For Tina, the decision simply came down to not wanting to be without her newborn and husband during the operation and recovery. “That’s just so sad for moms because we work so hard to get this little bundle of joy and then we go through it for the nine months and we just have to lay there for an hour by ourselves. We kind of feel left out,” she said. A skin-to-skin delivery also meant that Jason, 33, didn’t have to choose between staying with his wife or his son. “You don’t want to have to choose, after your wife just finished with surgery, leaving her alone to go see your kid for the first time. You’d rather be together,”Jason said. “I think it takes a lot of pressure off of everybody.” In a typical cesarean section, the baby is swaddled and briefly shown to the mother before being sent to the nursery for further
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Tina and Jason McWhorter begin bonding with baby Colt in the operating room, while Tina’s procedure is completed. Skin-to-skin contact for c-section deliveries is a birthing option now available at Houston Methodist San Jacinto Hospital.
examination. In the case of Colt, after immediately checking his vital signs in the operating room, he was returned to his mother’s chest and swaddled in her arms for the duration of her surgery. Research in the American Journal of Maternal/Child Nursing has shown benefits of skin-to-skin contact include reduced anxiety, regulation of the baby’s body temperature and a decrease in symptoms of postpartum depression. Another advantage of skin-to-skin contact is successful breastfeeding. While in the recovery room, Colt began feeding within the first hour of life. His father credits this to being introduced to the concept so quickly. Because Colt didn’t have to go to the nursery, it allowed for extra bonding time between the three, giving them an additional hour to themselves. The remaining family members waited anxiously outside the operating room to catch a glimpse of the newest family member. To mark this significant occasion for the maternal child unit, the team held balloons and lined the hallway to cheer on the family as Tina was wheeled to recovery with Colt comfortably in her arms. The only time Colt was not held by his mom was when she moved from the operating table to a stretcher to be transported to recovery. After the experience, the McWhorters were excited and grateful for the opportunity to have the skinto-skin option for their son’s birth. Houston Methodist San Jacinto offers a free Saturday childbirth class on topics such as labor and delivery, relaxation and breathing techniques, epidurals, postpartum adjustment and more, plus a hospital tour. Classes are also available in Spanish. For specific class dates or to register, please call 281-420-7353.
Houston Methodist Sugar Land News
Janet Leatherwood
RN, MSN, VP / Chief Nursing Officer
A REFLECTIVE PRACTICE Reflective practice in nursing has been defined by Donald A. Schon as the examination of one’s own personal behavior and that of others during a situation that involves careful re-running in your mind, the events that occurred in the past. Others have described it as the process where the individual mindfully and prayerfully pauses to ponder professional or personal actions in such a way as to transform present and future experiences. The process is an opportunity to describe significant personal experiences that have meaning, and to make sense of events, situations, and actions in the workplace. For nursing, promoting reflective practice allows the individual to focus on one’s knowledge, skills, and behavior and to build on existing strengths and develop or identify a new range of techniques that can be used to develop one’s personal and professional ongoing development or competencies. With the rollout of the clinical career path over the last three years, reflective practice has been utilized as part of the requirement to advance on the clinical career ladder. This requirement assists the nurse to reflect on professional or personal actions in such a way to transform present and future experiences. The reflective narrative provides the reviewing board insight into the candidates’ experiences as a nurse and it provides for the nurse a time to reflect. As one recent nurse noted, “Why on Why, Do
I Do What I Do?”, or for another nurse to answer why and how nursing has impacted her. Themes of compassion, joy, empathy, and hope emerge as the stories unfold by each of the candidates. Proponents of this practice site that this practice is significant for nurses for many reasons. Three potential benefits include: First, as a nurse, we are involved in lifelong learning and reflective practice allows one to update professional skills by gaining feedback, creating new skills and knowledge. Secondly, it allows for us to consider the way we interact and communicate with each other since the profession of nursing depends on a culture of mutual support. Finally, it can be a constructive way of dealing with any events that may have been upsetting and allows for empathizing with others regarding an experience. Effective reflection can be a key skill for nurses and can be accomplished individually, in facilitated groups (such as Schwartz Rounds) or a combination of both. My hope for each of you as you manage the impact of caring for others on a daily basis, is that you will take time in your busy schedules to reflect on the positive strength and skill that you bring into your everyday practice of treating patients and allow it to refresh and restore your spirit. As always, thank you for being the very heart of what we do each day.
Leaders in Nursing 5
Houston Methodist Willowbrook News
Sheila Fata
Vice President & Chief Nursing Officer
Forging Stronger Collaboration in Nurse-Physician Relationships This quote from Darwin
an evening “check-in” with nursing regarding laboring resonates with me as I consider “In the long history of humankind… patients to improve overnight the changes in health care and those who learned to collaborate and improvise communication. At the Medical the collaborative efforts that are most effectively have prevailed.” Alliance meeting, nurses and required for us to prevail amidst ~ Charles Darwin physicians discussed potential these changes. Collaboration solutions to processes around relies on relationships – and ED admissions and discussed whether personal or professional, possible solutions to the difficulties some physicians were relationships must be fostered in order to thrive. At Houston Methodist Willowbrook, our recognition of the need to foster having with CPOE. At the Surgical Alliance meeting, nurses raised concerns regarding physician delays which relationships between physicians and nursing staff led to the are causing the OR schedule to get behind. A collaborative launch of our “Physician-Nurse Alliance” initiative earlier recommendation was proposed and will be forwarded to the this year. The goal of this initiative is to enhance caregiver OR Committee for implementation. relations and improve satisfaction for both nurses and physicians. Research abounds regarding the importance of positive physician/nurse relations and communications. Improving The Alliance meetings officially kicked-off in February 2013. physician-nurse relationships will not only make Houston Physicians and nurses were invited to an event off campus Methodist Willowbrook an even better place to practice, it to mingle, socialize and provide input and ideas related to may have real impact on our patient care and satisfaction. our RN-MD relations. Three breakout groups, comprised of These are great reasons to embrace this work, and I thank nurse and physician volunteers, were formed and have met each of you for supporting the initiatives that have come each quarter. These groups engage in dialogue and focus on opportunities for improvement ranging from communication from the alliance meetings! to development of protocols. Now for the DRUM ROLL! Last month, we celebrated our first Daisy Award winner, Brenda Robles, BSN, RN, Nursery. Our initial meetings focused on physician concerns such as repetitive calls during the night shift and calls for non-urgent In addition, Wendi Froedge, MSN, RN, CCRN, Critical Care Services, and Robin Howe, MSN, RNC-OB, Women’s matters. We addressed this by revising our process around Services, were recently awarded the Gold Medal for the physician calls at night, adding charge nurse input and prestigious Good Samaritan Excellence in Nursing Awards. holding non-urgent calls until morning rounds. In our recent And, we have three Bronze Winners for that award: Cristina meetings, physicians acknowledged our improvement and Dimafiles, BSN, RN, CVRN, ICU, Jamie Puspos, BSN, thanked nurses, one saying “I haven’t received a 5 AM call RN, CVRN, PICC Team and Leung Shiu, BSN, RN, 5West. for a 3.5 K+ in months!” Congratulations to these nurses who have been recognized Here are a few updates from our most recent August by their peers. I am proud to be associated with them and the meetings. At the Obstetrics Alliance meeting, nurses entire team of nursing professionals who walk our halls proposed revisions to clarify and enhance the effectiveness of each day! labor and postpartum order sets, while physicians suggested
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Houston Methodist West News
Vicki Brownewell
Vice President & Chief Nursing Officer
Evidence-Based Practice Scholar Program to EBP were a lack of time and an unsupportive organizational culture, in other words, workplace resistance and a mentality that “we’ve always done it that way.”
In 2012, Melnyk et al. conducted a descriptive survey of a random sample of 1,015 members of the American Nurses Association. Surprisingly, the results showed that only 34.5% of respondents (350) agreed or strongly agreed that their colleagues consistently used evidence-based practice in treating patients. Moreover, a majority (76.2%) felt that they needed more educational opportunities, as they did not have access to knowledgeable mentors, resources, and tools needed to use EBP. Similar to other studies, Melnyk et al. concluded that the most common barriers Scholar(s) Unit Mary Schramm, OR Meka Smith Lisa Mauricio ICU Marcia Ozdenvar ICU Steve Hightower ICU Amy Gustin ICU Lacey Helmke, L&D Brandy Perez Nancy Jo Goldie, ICU / Eva Inikori Pharm Jozeliza Tan ICU Anila Varghese Med-Surg
Methodist West Houston Hospital is only slightly over two and half years old, but has been able to capitalize on the experience and knowledge of our sister facilities. Many of our sister facilities have instituted evidenced-based practice programs in the past. We have been fortunate to be able to participate in the System Evidenced-Based Practice and Research Council, led by Shannan Hamlin. By participating in this system council, we have been able to collaborate and learn from our fellow colleagues and share expertise. This council is also leading The Emerging Evidence-Based Practice (EBP) Scholar Program. This program is a year-long program designed to develop unit- or department-based EBP Scholars in advanced EBP knowledge and skills, and to teach EBP Scholars how to lead EBP initiatives in their respective units, departments, or hospitals. In this program, each hospital takes a turn in teaching a session. The EBP Scholar is led through the process. The EBP Scholar conducts a literature review for selected topics, appraises existing evidence using the Iowa Model of Evidence-Based Practice, and completes an EBP project. The following are some examples of the projects that the EBP scholars at our hospital are pursuing:
Project A Systematic Review Comparing Length of Stay Outcomes Between Transurethral Resection of the Prostate (TURP) and Green Light Laser (GLL) Surgical Procedures for the Treatment of Benign Prostate Benign Prostatic Hyperplasia (BPH). A Retrospective review on Acute Respiratory Distress Syndrome patients at a Community Hospital in order to Institute an EBP Protocol in the Intensive Care Unit A Retrospective Analysis of the Correlation in Cardiac Surgery Patients Between Length of Time from Extubation And First Activity to their Discharge Activity Level and Post Operative Length of Stay A Retrospective Review of Outcomes of Therapeutic Hypothermia in a Community Hospital A Retrospective Look at Outcomes of Sepsis Patients Identified by Primary Diagnosis/Sepsis Screening Tool The Attitudes, Perceptions, and Education of Nurses on Early Initiation of Skin-to-Skin Contact Immediately After Birth A Retrospective Comparison Study of Tight Control IV Insulin Verses Subcutaneous Insulin in CV Surgical Patients in the First 48 Hours Post-Operatively A Retrospective Study of the Outcomes of Cardiac Surgery Patients with a Smoking History Utilizing a Fast Tract Extubation (FTE) Program. The Effectiveness of an Inpatient Education Support Group for Heart Failure Patients on 30-Day Readmission Rate in a Community Based Hospital
We are privileged to work in a hospital system that allows us to create this type of program which fosters and facilitates EBP with an interdisciplinary team. We are very fortunate to have such professional colleagues who truly collaborate and share their expertise and knowledge. Moreover, we are fortunate to be in new hospital with EBP Scholars who consistently seek to improve care. Our EBP Scholars
simply don’t accept that “we’ve always done it that way.” We are most privileged to have a leadership team who supports our EBP Scholars by providing them the time, educational opportunities, and access to the knowledgeable mentors, resources, and the tools needed to effective develop and implement EBP. By Kahla LaPlante and Laura Espinosa
Melnyk, B. & Fineout-Overholt, E. (2005). Evidence-based practice in nursing and healthcare. Philadelphia: Lippincott, Williams and Wilkins. Wallis, Laura (2012). Barriers to Implementing Evidence-Based Practice Remains High for U.S. Nurses. AJN, December 2012, Volume 12-Issue 12-p. 15. Melnyk BM, et al. (2012); J. Nurs Adm. 42(9):410–7.
Leaders in Nursing 7
MAPP Methodist Advancement into Professional Practice (MAPP) Summer Program
Setting the Pace for Success
Houston Methodist Hospital was once again proud to offer its summer Methodist Advancement into Professional Practice (MAPP) program to baccalaureate nursing students from across the nation. The program continues to provide these students with vast opportunities to enhance their learning and understanding of specific nursing specialties. Participants receive hands-on training through the program while working side by side with lead registered nurses in direct patient care. The assimilation into the health care setting has proven to be invaluable to these students as they begin their nursing career. Individuals who successfully complete the MAPP program are also better prepared to meet the demands and challenges facing tomorrow’s nurses. Our 2013 Summer MAPP students had an enlightening experience. Away from the hospital, they had several opportunities to explore the city to see what Houston had to offer. They also participated in many teambuilding exercises and events outside of the hospital, many of which are hosted by our Academic Outreach staff members. This summer’s MAPP students are: Cody Aarons, UT - Austin, TX; Genardine Arizala, Hawaii Pacific University, HI; Mike Caltzontzint, UT - Austin, TX; Kaitlyn Carter, University of New England; Julie Daniel, Stephen F. Austin (SFA), TX; Joshua Davis, UT - Austin, TX; Jennifer Doeden, Gustavus Adolphus College, MN; Erin Fibbe, Troy University, AL; Annie Flynn, U OF Pennsylvania, PA; Kelly Fristensky, Seton Hall University, NJ; Harley Keh, U OF Pennsylvania, PA; Caroline Mack, Georgetown University, D.C.; Taryn McCoy, U OF Illinois, IL; Tori Mechlem, Northern Kentucky University, KY; Kristin Mueller, Purdue University, IN; Elizabeth Oldenburg, Purdue University, IN; Nathanial Vazquez, Penn State, PA “I was told I would be working at the Ophthalmology OR and it caught me off guard. I was very nervous that I wouldn’t be prepared enough for the experience. My preceptor, Bettie, was so welcoming and helpful. She taught me the ins and outs of the OR with such patience and helped me feel right at home. I learned how to interview the patient, help prepare the OR, position and prep the patient for surgery, how to document, and I even got to scrub in and help the surgeons with cases. Everyone in Ophthalmology OR was so great to me and I am so thankful that I got to work -Erin Fibbe with them.” 8 Methodist Nurse
“On my first day on the Labor & Delivery floor, I was a bundle of nerves. My awesome preceptors have taught me so much and the hands-on experiences have been so beneficial. Working with both the mothers and the babies on this floor has taught a lot of patient care that goes into this unit. I cannot wait to pursue this area of nursing in the future.” -Jennifer Doeden
“My favorite part of the MAPP program is that we have the independence to venture out of the program as much as we wish and make lasting memories. I feel that I have made the most of this experience and I am so grateful to have been a part of this program. The MAPP program has helped confirm that nursing is exactly what I want to do and it has also given me a newfound confidence to continue pursuing my dreams.” -Cody Aarons
PCA Patient Care Assistant (PCA) Summer Externship Program
Making Dreams a Reality
“On my first day of E.L.I.T.E. training, I was overwhelmed with excitement! The instructors were constantly full of energy to educate us about The ICARE Values. These were always the values I have followed and applied on a daily basis. Learning about the hospital and how it tailors its services to provide an exceptional patient experience has really pushed me to do everything in my power so that the patient can become healthier and feel as comfortable as possible. The training was intense however, it helped in a tremendous way.“ -Jocelyn Coronel “I could have never imagined the magnitude of this experience. Just looking back at my first day on the floor, I was so nervous and excited to finally get to do what I have been waiting for. My preceptor wanted me to take the vitals and do a glucose reading on all 10 patients and I was like, “Wow I’m going to mess everything up!” Gladly I did not because I had her to guide me and show me the proper way to do it. This opportunity at Houston Methodist is truly a blessing and it’s just a great place to be!” -Darius Gardner “At Houston Methodist, I was introduced to the history of the hospital and the ICARE values. These values are a standard for treating patients, family and staff. Things began to move quickly and the rest of the week was filled with training. By the next week, I was on my Transplant unit, which is an awesome place to work. The staff embraced me as if I was one of their own. I could not have imagined a better way to spend my summer. This is truly an opportunity of a lifetime. I am now a recent high school graduate working for THE BEST HOSPITAL IN TEXAS—all thanks to this program! ” -Gabriela Bernal
For the seventh consecutive year, The Methodist Hospital partnered with our local Communities in Schools program to foster the growth of young students interested in the nursing profession. Through our Summer PCA Externship Program, several students have the opportunity to work at Methodist in a nurse’s aide role and gain invaluable exposure to a professional work environment and various health care professions. The PCA externship also empowers participants to complete a nursing assistant certification course. A special thanks goes out to each of our nursing and observation units that have enabled these students to get started on rewarding professional careers in health care. This summer’s PCA students are: Gabriela Bernal, Dunn 4; Gloria Fernandez, Alkek 8; Jocelyn Cornel, Alkek 7; Darius Gardner, Main 5; Diana Roman, Main 3 OBS
Leaders in Nursing 9
The Iowa Model of Evidence(Part II) Based Practice By: Shannan Hamlin, PhD, RN, ACNP-BC, CCRN Director, Nursing Research and Evidence-Based Practice
‘‘Change is inevitable…adapting to change is unavoidable, it’s how you do it that sets you together or apart.’’ —William Ngwako Maphoto
W
hen conducting an evidence-based practice (EBP) project the use of a conceptual framework such as the Iowa Model helps to organize the clinician’s strategies in order to promote efficient use of time and prevent incomplete implementation of the practice change [1]. The Iowa Model (Appendix A) begins by encouraging clinicians to identify a question that is a priority for the organization. Problem-focused (e.g., financial data, clinical problem, process improvement data) or knowledge-focused (e.g., new research data, new guidelines, philosophies of care) are used as catalysts to encourage clinicians to critically think about the efficiency and effectiveness of their clinical and operational work environment and seek a scientific basis for decision-making [2]. Considering then how a topic fits within the organizational priorities will facilitate garnering support both from leadership and other disciplines in order to complete the project. Higher priority topics to consider may address 1) highvolume, high-risk, or high-cost procedures, 2) topics that align with the organization’s strategic plan, and 3) topics driven by other institutional or market forces (e.g., changing reimbursement) [3]. There are three decision points within the Iowa Model delineated by a diamond. The first decision point asks the question “Is this topic a priority for the organization?”. If the answer is ‘no’ then the model prompts the clinician to consider other triggers and returns them back to the problem- and knowledgefocused triggers for consideration of a different topic (feedback loop). As an example, a Midwestern children’s hospital used the Iowa Model as a framework for an EBP project in which the purpose was to improve and standardize nasogastric (NG) tube placement verification practices
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in order to minimize the risk of incorrectly placed NG tubes [4]. Current nursing practice was to check NG tube placement by auscultation of air insufflations over the abdomen. The project began as a knowledgefocused trigger as new information was published that suggested using a patient’s height as a method for determining NG tube depth in children. Once nursing leadership determined the project was a priority for the institution (i.e., high-volume and high-risk procedure) a team was developed to assist the staff nurse as the project leader. Once a project interprofessional team is formed, the model directs them to gather, critique and synthesize the literature for use in their specific practice. Using our pediatric NG tube example, the team found insufficient evidence to support the use of patient height as a parameter for NG tube insertion depth and particularly for ongoing placement verification before use. They did however, discover a high number of reported misplaced NG tubes in the pediatric population which was new knowledge for them, and the value of obtaining X-ray (the only 100% reliable method) verification upon insertion. Based on this evidence, the hospital’s pediatric NG tube standard of practice was updated. The second decision point on the Model asks “Is there a sufficient research base?”. Determining if there is enough research to guide clinical practice is a critical step in the EBP process; implementing a practice change on limited or poorly conducted studies will not produce the intended outcome and can be potentially dangerous. When evaluating the evidence the following criteria are useful to consider: (a) consistency of findings across research studies, (b) the level and quality of the research, (c) clinical relevance of the findings to practice, (d) similarity of sample
The Methodist Hospital System Interprofessional
When evidence is deemed sufficient, the practice change is piloted to determine feasibility and effectiveness of the change in the actual clinical setting. Pre- and post-pilot data will determine the appropriateness of adopting the change into practice. If the desired outcomes are not achieved in the pilot study, adopting the change is not appropriate (third decision point) and the EBP team should refocus on ongoing quality monitoring and consider a new problem- or knowledge-focused trigger (feedback loop). If the pilot data show positive outcomes the practice change is implemented into practice. Integrating a practice change is facilitated by leadership support, staff education, and continuous monitoring of outcomes [3]. Implementing a practice change can be a challenge. Effective, sustained implementation requires multiple reinforcing and interactive strategies. Using our pediatric NG tube example, the EBP team devised a baseline questionnaire to assess nurses current practice, knowledge and complication rates related to NG tube insertion and maintenance. The questionnaire revealed that nursing practice in their organization was neither standardized or evidence-based [4]. The project team provided staff education on the practice change using PowerPoint presentations, flyers and posters that highlighted the policy change. Each unit then identified a ‘change champion’ whose role was to educate their colleagues about the new change. After the new NG tube policy was approved, the online documentation system was updated to include the new policy changes as well as prompts to remind the nurses about NG tube maintenance tasks. To ensure the practice change is sustained, education regarding the practice change continues periodically on the units as well as being incorporated into new-hire orientation. The practice change is also included in nurses yearly competency (written and demonstration). Sustaining a practice change requires ongoing evaluation with information incorporated into performance improvement initiatives for example, to promote integration of the change into daily practice [3].
Consider Other Triggers
No
E
E
THE IOWA MODEL OF EVIDENCE-BASED PRACTICE TO PROMOTE QUALITY CARE
Research Evidence Based Practice Council
SCI
characteristics, (e) feasibility of implementing the findings, and (f) the risk-to-benefit ratio [2]. If after a thorough literature review and synthesis, high-quality research evidence is not available, the project team may either recommend use of lower level evidence (e.g., case reports, expert opinion) or conducting a research study in order to generate the knowledge needed to base practice decisions [3].
The Methodist Hospital System presents
CE N
PRACTICE
BRIDGING THE GAP
Is this Topic a Priority for the Organization?
Yes Form a Team
Assemble Relevant Research & Related Literature
Critique & Synthesize Research for Use in Practice
Yes
No
Is There a Sufficient Research Base?
Is Change Appropriate for Adoption in Practice?
No
Yes Institute the Change in Practice
The Iowa Model of Evidence-Based Practice to Promote Quality Care
The final stage of the Iowa Model which is likely the most significant, entails disseminating the EBP change results internal and external to the organization through presentations and publications. Results dissemination is important for professional learning and ensures the growth of an EBP culture, expands our knowledge, precludes duplication of work and encourages positive EBP changes in other organizations [3]. The Iowa Model outlines a pragmatic approach to changing practice by melding quality improvement with timely translational science. The ultimate goal is always improvement in patient outcomes. Through the use of the Iowa Model, clinicians can effectively manage EBP projects and gain confidence in the fact that the best available evidence has been translated into practice at the bedside. Perhaps Florence Nightingale said it best: “You ask me why I do not write something…I think one’s feelings waste themselves in words, they ought all to be distilled into actions and into actions which brings results” [5]. References on Page 15
Leaders in Nursing 11
THINK PINK The term “Pink Slip” is usually associated with losing a job, but a new safety device being utilized at Houston Methodist Hospital has given the phrase an entirely new meaning. Over the past few months, Brenda Young, RN, who works as an occupational health nurse in the Employee Health Clinic (EHC), has been introducing a pink slip slide sheet that is designed to reduce back injuries. Young has provided training to several Houston Methodist nurses, PCAs and transporters. According to the Bureau of Labor Statistics, health care workers suffer seven times the average number of musculoskeletal injuries of all industries—which is more than construction and warehouse employees. The CDC reports that 12% of nurses leave the profession due to back pain. Oftentimes, this is attributed to when workers must reposition or transfer patients. Young’s own experience as a nurse as well as prior research she had conducted provided a great understanding of what would work in these types of situations. However, she had always noticed that there was limited use of any devices to reduce strain on workers’ backs— and felt that it was time to find a solution. One particular product, a pink slide sheet, was drawing great attention. It was extremely compact, disposable, and slippery. When our Employee Health Clinic team experimented with the “Pink Slip, they quickly realized that there was not any lifting involved at all. “We used a luggage scale to measure the difference in pulling weight on a draw sheet and using the ‘Pink Slip,’ said Young. “The initial force was reduced from over 50 pounds to less than 25 pounds. Then, once the patient gets moving, the force is even lower,” she added. Young now needed a small army of champions to help train and motivate others to use the “Pink Slip” properly. EHC began asking workers with prior back injuries if they would give the device a try. Young also created a training program to demonstrate utilizing the “Pink Slip” for all types of transfers and even conducted pilots on a few units. Nursing leaders at Houston Methodist have welcomed the “Pink Slip”—recognizing that this product will benefit staff members and also help to ensure safe patient mobilization. Requests and our “Pink Slip” supply have grown and an advisory committee has been established to explore additional methods to increase awareness of this product. “Most nurses would think twice before lifting 50 pounds at home. “That is equivalent to lifting five packs of 12 ounce water bottles or six gallons of milk simultaneously,” she said. However, they would not hesitate to lift up a 200 pound patient out of bed with just a draw sheet.” Since being implemented, the “Pink Slip” has been a big hit with staff members utilizing the device and, most importantly, no injuries have occurred. As awareness grows, more and more Houston Methodist nurses, PCAs and transporters are beginning to Think Pink!
12 Methodist Nurse
FREQUENTLY ASKED QUESTIONS What makes the Pink Slip™ so slick? The patent pending Pink Slip™ is made with HD Poly, which is an engineered plastic resin with a high crystalline structure developed by Wy’East Medical. It is specially formulated and processed to minimize the coefficient of friction which makes it extremely slick as compared to other transfer assist devices. Is the Pink Slip™ radio translucent? Yes, it has been verified to be radio translucent. What is it made of? HD Poly (an engineered high density polymer that is specially formulated and processed). Is the HD Poly strong? Yes. The Pink Slip™ has no weight limit, and it has four times the strength of a common plastic garbage bag. Are there any electrostatic issues? No. The Pink Slip has been specifically engineered to be compliant with and exceed the NFPA-99 Standard for Health Care Facilities, 2005 edition. The Pink Slip™ can be used in all departments throughout a hospital, even where anesthetic gases and oxygen are used. The Pink Slip™ will not interfere with static sensitive electronic devices in a hospital. Can the Pink Slip™ be used on a patient with a pacemaker? Yes. The formulation and processes used in the manufacturing of the Pink Slip™ makes it compliant with the NFPA-99 Standard for Health Care Facilities, 2005 edition. What is the Recyclability rating of the Pink Slip™? The Pink Slip™ has the highest recyclability rating of any patient transfer product on the market. It is made from HD Poly material that is classified under the recycling code of #2. The recycling code for plastic resins is labeled 1 to 7, the lower the number the more likely the plastic will be recycled and not end up in a landfill. Please refer to your organization’s recycling department to set up a recycling program for the Pink Slip™. Can it be re-used? Yes, for the same patient. It can be sent home with a patient and continue to be used for many weeks in the home. Can it be disinfected or cleaned? No. This product is considered disposable. Simply discard if any fluids or solids are on it and replace it with a new Pink Slip™. Can more than one Pink Slip™ be used at the same time on a patient? Yes. It is recommended to use more than one Pink Slip™ on tall patients, bariatric patients or patients with heavy extremities. Does the Pink Slip™ have a weight limit? No. Use multiple Pink Slip™s on bariatric patients and refer to your facilities safe patient handling guidelines to determine the number of caregivers needed to transfer a bariatric patient. Does the Pink Slip™ contain latex? No. The Pink Slip™ is made from a patent pending HD poly which contains no latex. Is the Pink Slip™ FDA Approved? Wy’East Medical Corporation and the products we manufacture are registered with the FDA. The Pink Slip™ is listed as a Class I device and therefore exempt from pre-market notification and approval. What is HD Poly Warm-Touch Technology? The Pink Slip™ is made from a plastic resin that has good insulating properties. Insulating materials have high heat capacity so they are slow to change temperature and so this is why the Pink Slip™ feels warm to the touch (the heat stays in your hand).
WWW.PINKSLIPMED.COM
“Everyone is dedicated to the vision and mission of the hospital and to maintaining a high quality of care for the patients.” Sultan Saleh Jemah Alkhaibari, BSN, RN
LEADERSHIP TRAINING PROGRAM Impacts International Nursing Professionals By: Trevor Mitchell, Nurse Marketing Analyst
I
nternational nurse leadership trainees Sultan Saleh Jemah Alkhaibari, BSN, RN; Ahmed Al-Khaibary, BSN, RN; and Aliyah Ali Al-Qarni, BSN, RN, had no idea what to expect when they first arrived at Houston Methodist Hospital for three months of training this past summer. After completing a one-year long leadership development program in their homeland, they made the journey all the way from King Faisal Specialist Hospital and Research Centre, a 985-bed facility located in Riyadh, Saudi Arabia, because their facility’s Chief Executive Officer: H.E. Qasim Q. Al Qasabi, MD, FRCSI, FACS, wanted to reward them with an opportunity to further their training in the United States. “We were a bit nervous at first because we had heard so many things, both good and bad, about Texas. But, just by walking on the street, you could feel a genuine kindness from the people here,” said Ahmed. “They are so hospitable and caring, and approach you to help without even asking. And, within the hospital, the ICARE values that are found here made us all feel like we were just surrounded by support. If I ever had to choose a city to live in the U.S. — it would be Houston!”
14 Methodist Nurse
The group’s leadership training experience was facilitated by Houston Methodist Global, who worked collaboratively with nursing leadership to customize a learning experience that the trainees would never forget. All three participants took full advantage of an array of courses, assessments and clinical observations available at Houston Methodist. They also found enthusiastic mentors within our team who took great pride in sharing their knowledge and expertise. “In addition to the friendliness of staff, the transformational leadership at Houston Methodist and the commitment of the staff is something that truly stands out,” said Sultan. “Everyone is dedicated to the vision and mission of the hospital and to maintaining a high quality of care for the patients.” As part of the program, the trainees also enjoyed a “Lunch with Leaders” event, evidence-based practice seminars and accountability workshops. Another highlight of their training experience was a trip to Dallas, Texas, to attend the 2013 Association of Nursing Professional Development Conference. “I learned so much about accountability and how to communicate and work as a team to achieve your goals,”
Ahmed Al-Khaibary, BSN, RN, receives his certificate for completing the Nurse Leadership Training Program.
said Aliyah. “That is something I will definitely take back with me that I can apply immediately.” While the leadership training program provided a myriad of fun learning opportunities, the participants also had a challenging objective in mind, which was to develop an intervention that they could implement on their respective nursing units at King Faisal Specialist Hospital and Research Centre. Each trainee created presentations detailing their ideas, which were presented to Houston Methodist leaders at the conclusion of the program. Project topics included: developing a home health care model for cardiac patients, creating a recruiting and staffing model for the bone marrow transplant unit at a new cancer center, and developing a robust mentorship program for new nurses. Now that the group of nurse trainees have completed the leadership training program and returned to the Kingdom of Saudi Arabia to begin implementing practices they learned during their visit, our team at Methodist plans to keep in touch with them as they continue to grow into future nursing leaders in their country. “We are so honored to host these talented individuals who will lead the future of Nursing in Saudi Arabia,” said program manager for global education and training, Katherine A. Meese, MPH. “We are grateful for the involvement of our nursing teams and leaders at Houston Methodist, and know their mentorship
will make a lasting impact both for Saudi nurses and patients. It gives us great hope to see high caliber, engaged, and inspired nurses preparing to lead the next generation.” Continued from Page 11
EBP References 1.
Titler MG, Kleiber C, Steelman VJ, Rakel BA, Budreau G, Everett LQ, Buckwalter KC, Tripp-Reimer T, Goode CJ: The Iowa Model of evidencebased practice to promote quality care. Critical care nursing clinics of North America 2001, 13(4):497-509.
2.
Westfall JM, Mold J, Fagnan L: Practice-based research-”blue highways” on the NIH roadmap. JAMA : The journal of the American Medical Association 2007, 297(4):403-406.
3.
Titler M, Adams S: Developing an evidence-based practice. In: Nursing Research Methods and Critical Appriaisal for Evidence-Based Practice. Edited by LoBiondo-Wood G, Haber J, 7th edn. St. Louis: Mosby Elsevier; 2010 385437.
4.
Grady PA: Translational research and nursing science. Nursing outlook 2010, 58(3):164-166.
5.
MacDermid JC, Graham ID: Knowledge translation: Putting the “practice” in evidence-based practice. Hand clinics 2009, 25(1):125-143, viii.
6.
Melnyk BM, Fineout-Overholt E, Gallagher-Ford L, Kaplan L: The state of evidence-based practice in US nurses: Critical implications for nurse leaders and educators. The Journal of nursing administration 2012, 42(9):410-417.
7.
Melnyk BM, Fineout-Overholt E, Fischbeck Feinstein N, Li H, Small L, Wilcox L, Kraus R: Nurses’ perceived knowledge, beliefs, skills, and needs regarding evidence-based practice: Implications for accelerating the paradigm shift. Worldviews on evidence-based nursing / Sigma Theta Tau International, Honor Society of Nursing 2004, 1(3):185-193.
8.
Graham ID, Tetroe J: Some theoretical underpinnings of knowledge translation. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2007, 14(11):936-941.
9.
Gawlinski A, Rutledge D: Selecting a model for evidence-based practice changes: A practical approach. AACN advanced critical care 2008, 19(3):291300.
10. Dearholt SL: The johns hopkins nursing evidence-based practice model and process overview. In: Johns Hopkins Nursing Evidence-Based Practice: Model and Guidelines. Edited by Dearholt SL, Dang D, 2nd edn. Indianapolis: Sigma Theta Tau International; 2012: 33-53.
Leaders in Nursing 15
Nursing News
The Methodist Hospital is proud to have nurses who are dedicated to the nursing profession, driven to achieve growth in their professional development, and creative and always compassionate in their care for patients.
Accolades
The accolades page is an opportunity for the nursing staff to showcase a few of the many exciting tributes our nurses receive. Please submit kudos to: tmitchell2@tmhs.org
Congratulations to Haley Hoskinson, R.N., C.C.R.N. from our MICU, who was recently selected as the Gold Award winner in the Large Hospital category of Good Samaritan Foundation’s 9th Annual Excellence in Nursing Awards. Congratulations also go out to Methodist Willowbrook Hospital nurses Robin Howe, M.S.N., R.N.-C., who won the Gold Award in the Small Hospital category and Wendi Froedge M.S.N., R.N., C.C.R.N., won earned the Gold Award in the Education: Clinician category. Bronze Award winners from TMH included Mei Jue, R.N., O.C.N., Johnie Leonard, M.S.N., R.N., C.E.N., N.E.-B.C. and Bobbi Musgrove, M.S.N., R.N.-B.C., C.I.C. Please join us in congratulating all of these outstanding nurses on such a remarkable achievement. Congratulations to Joe Garcia, who recently obtained his Family Nurse Practitioner (FNP) license. Way to go Joe! Kudos to Anita Willy, C.R.C.S.T., who recently passed the instrument specialist certification exam. Way to go Anita! Congratulations to Eva Boone, R.N., from Main 4, who recently graduated from Prairie View A&M with her MSN. Kudos to Thoi Nguyen, surgical tech II, who was honored at The Methodist Hospital OB/GYN Resident graduation as “Associate of the Year.” Monica McCloskey, R.N., was also honored as “Gyn OR Nurse of the Year.”
Congratulations to May Hmun, R.N., from Dunn OR, who recently passed the CNOR exam. Great job! Congratulations to our Department of Nursing for receiving recognition from the League of American Communications Professionals (LACP) for the fourth consecutive year. The Methodist Nursing 2012 Annual Report “A Commitment to Nursing Excellence” recently earned Silver in the health care category of LACP’s 2012 Vision Awards. Competing against over 6,000 other entries from over two dozen countries, our annual nursing publication again ranked among the world’s best. Congratulations to the staff nurse Nina Hawthorne, from Alkek 7, who was recently promoted to R.N. IV. Way to go Nina! Kudos also go out to the following nurses that were recently promoted to R.N. III on the Clinical Career Path: Rachel John, Dunn 8 East; Clayde Hagad, Dunn 10 West; Alisha Estay, CVICU; Oyebunmi Kutemi, Main 7 Southwest; Elizabeth Halbert, Endovascular; Sheryl Spurlin, Outpatient Center OR; Amy Bowers, NICU; Megan Chavarria, MICU; Ladha Memoona, Main 7 Southwest; Mary Venda, Main 7 Southwest; and Judie Lewis, Fondren 12. Congratulations to our health care colleagues at King Faisal Specialist Hospital & Research Center in the Kingdom of Saudi Arabia for achieving Magnet designation. The hospital has been collaborating with Houston Methodist Global over the past year to improve patient safety, management, and the quality of health care delivery in order to provide the best experience for patients.