Volume 25
Number 17
August 8, 2014
Hospital of the University of Pennsylvania
`` Melissa Trolene of Founders 14 takes time to bond with Suzanne Leonard.
chair of HUP’s Patient and Family Advisory Council. “Think about it. You’re in bed, wearing very little and all kinds of people come in, poking and prodding you. When else would you invite total strangers into your bedroom? Never.”
Listen
Now, a new initiative at HUP is turning back the clock, in a sense, to enhance both the patient and nursing experience.
What is a Therapeutic Relationship?
to What I Say
Establishing a Strong Nurse-Patient Connection
“ When you build a relationship, the patient is more likely to comply with and have a better understanding of what needs to be done. And this, in turn, leads to better outcomes.”
Inside Taking OutAll tothe Talk...........2 HelpingTime People Time.....2 Roundtable. ................................3 A Community in Unity..............3 Free the SkinRide to Join Cancer Screening......................3 Conquer Cancer.........................3 Partners in Rehab. .....................4 DetermiNation Keeps Her Going...................................4 Shortakes...................................4 Heartfelt Thanks........................4
Advances in health treatment and technology have improved patient outcomes but this fast-paced and sometimes stressful environment can take a toll on the nurse-patient relationship. More of nursing now centers on technology, often in the areas of collecting and monitoring clinical data. Sometimes this means nurses have little time to sit down and just talk and connect with patients. And yet, hospitalizations are a time when that’s exactly what a patient may crave most. “When you come to a hospital, there’s a lot of fear and uncertainty … and a loss of control,” said Anita McGinn-Natali, co-
Nursing’s Shared Governance partnered with members of the Patient and Advisory Council to launch this initiative. The first step was for the Nursing Research Council to review the evidence and create a list of five evidence-based attributes necessary to establish and maintain a therapeutic relationship (see sidebar on page 2). The Nursing Professional Practice Council then drafted 10 nursing standards that translated these attributes into practice and brought them to the Advisory Council for feedback. The advisors’ responses surprised them. For example, something as simple as a nurse providing 10 minutes of uninterrupted time with a patient “makes me feel important, secure and cared for….. I feel like I’ve been heard.” Maintaining a professional stance means “Don’t sit on my bed. Don’t call me hon. Don’t talk about me outside of my room.” “We saw that so much of our work — what we need to accomplish as nurses — isn’t what’s most important to the patient, what they’re struggling with,” said Karen Anderson, MSN, clinical nurse specialist in Patient and Family Centered Care. Based on this feedback, the Council created (Continued on page 2)
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Listen
to What I Say
Establishing a Strong Nurse-Patient Connection
(Continued from page 1)
a six-hour educational program. The first two classes focused on learning to identify and incorporate the 10 standards into practice through observation on units and roll playing with the patient advisors. In one scenario, a patient comes on the unit from the ER. “We gave the nurse no clinical details. We just told them to find out what was important to the patient,” said Mauri Sullivan, MSN, clinical director of Oncology Nursing, who took the lead in this initiative. “We saw that nurses are very medically focused. In this situation, we think the hospital admission is what’s important but the patient is telling you that nobody is available to feed her dog and that’s what’s worrying her.” Another class examined the practices that help facilitate and improve nurse communication, with a focus on nurse-tonurse shift handoffs. “Patients told us the handoffs causes them the most anxiety — they’re nervous about the stranger who is
taking over their care,” said Michelle Otto, BSN, chair of the Nursing Quality Council and clinical nurse on Rhoads 1. “Sharing some personal information about the patient with the incoming nurse will help ease the transition.” Nurses also learned the importance of picking up on visual cues, not just verbal. “It’s about noticing. Patients and families feel very vulnerable. Nurses need to notice more about what’s in front of them,” Sullivan said.
Therapeutic Relationship
For a nurse-patient therapeutic relationship to be successful, all parties (including family members) must be fully engaged in the process. Based on research, the five most important attributes are: • Giving each patient undivided attention. • Actively listening. • Showing empathy. • Remaining non-judgmental. • Upholding a professional stance.
Jennifer Perno, BSN, chair of the Nursing Professional Development Council and clinical nurse on Founders 14, said the experience “made me change my practice. It helped bring the patient’s perspective to light.” For instance, “nurses are always busy but you can’t look busy when you come into a room,” she said. “Our goal is for patients to feel that they are our number one priority.”
“When a nurse rushes in, a feeling of panic comes into the room, which brings another level of stress,” agreed McGinn. “Be mindful that each patient is different with a different set of worries.”
Establishing a therapeutic relationship between nurses and patients is a win-win on many levels. Studies show that patients experience less anxiety and fear and feel more empowered and secure. “When you build a relationship, the patient is more likely to comply with and have a better understanding of what needs to be done,” McGinn said. And this, in turn, leads to better outcomes. “We all take good care of patients but are we meeting their needs?” Otto said. “I learned many things we could do in our daily practice that coincide with the 10 standards. They don’t take longer to do and it’s not harder but they build trust with patients.” Said McGinn, “A patient wants to be heard, be considered and be reassured that you care, that you’re not forgetting me.”
Helping People All the Time Congratulations to April’s winners of the Helping People All the Time raffle. Silia Mills. . . . . . . . . . . . . . . . . . . . . . . . MICU Vicki Brown. . . . . . . . . . . . . . . . . . . Rhoads 4 Flora Bayawa. . . . . . . . . . . . . . . . . . . . . . CICU Vicki Pontillo. . . . . . . . . . . . . . . . . . . . . . CICU Joseph Casertano. . . . . . . . Patient Relations Duffy McCaughan . . . . . . . . . . . Silverstein 12 Karmen Hatton. . . . . . . . . . . . . . . . . . . . SFAS Colleen Hayes . . . . . . . . . . . . . . . . . Pharmacy
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Changes in Personal Practice
Also, “it’s important to take the time to compose yourself before entering a patient room. You don’t want other patients to know you were just in an emergency with another patient.”
`` Anita McGinn-Natali (l) with Mary Walton, director of Patient/Family Centered Care.
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Attributes o f
Donald Wharton. . . . . . . . . . . . . . . Pharmacy Lucas Nobile. . . . . . . . . . . . . . . . . . Pharmacy May Lin Chen . . . . . . . . . . . . . . . . . Pharmacy Joe Kluck . . . . . . . . . . . . . . . . . . . . . Pharmacy Alyson Destefano. . . . . . . . . . . . . . Pharmacy Meredith Rolleri. . . . . . . . . . . . Silverstein 12 Darline Rosier. . . . . . . . . . . . . . Silverstein 12 Jennie Jackson. . . . . . . . . . . . . . . Rhoads 2
Heather Gregg . . . . . . . . . . . . . . . . . Rhoads 2 Ashlee Newberry. . . . . . . . . . . . . . . . . .MICU William Lawrence. . . . . . . . . . . . . . Radiology Caren Levine. . . . . . . . . . . . . . . . . . Radiology Kathleen Wiley. . . . . . . . . . . . . . . . . Rhoads 7 Belinda Wilson . . . . . . . . . . . . . Silverstein 11 Shannon Maier. . . . Interventional Radiology Joe Cox. . . . . . . . . . . . Materials Management Josie Kannadan. . . . . . . . . . . . . . . . Rhoads 6
A Community in
Unity
Founded in 2003 by the Augustinian Defenders of the Rights of the Poor, Unity Clinic has relocated a few times over the years but has not lost steam along the way. Most of the clinic’s patient population are used to moving as well. Although all are welcomed, about 95 percent of its patients are immigrants from Indonesia and China. Numerous volunteers, including physicians, nurse practitioners, interpreters, a nutritionist, and others deliver care to about 45 patients every Tuesday night in the clinic’s two intake rooms, seven exam rooms, and phlebotomy lab. Thanks to support from Penn Medicine, Villanova University, and other community partners, they are able offer a wide range of services, with a focus on primary care and preventive medicine. But rising patient populations and other challenges put a strain on services, prompting Yoonhee Ha, research assistant at the Penn Medicine Center for Health Care Innovation and medical student clinic volunteer, to secure a Penn Medicine CAREs grant to support
“ Nearly all of our patients have limited English proficiency, and having a place like this which can provide culturally and linguistically appropriate service is invaluable.”
the practice. The grant will pay for diabetes glucose meters, privacy blinds for exam areas, and other important supplies. Giang Nguyen, MD, of Family Medicine, and founder of the Penn Asian Health Initiatives, serves as faculty advisor for the medical student volunteers. “Nearly all of our patients have limited English proficiency so having a place like this which can provide culturally and linguistically appropriate service is invaluable,” he said. “The Penn medical students and residents who come here are able to provide a much-needed service, but also learn a great deal about how to work effectively with interpreters, and how to deliver health care despite very limited resources.” One of those students is Cole Thompson, who serves as medical student coordinator. “I’m surrounded by a lot of people who are very passionate about what they’re doing and a lot of people are doing very different things, including working with free clinics, research opportunities, and more,” said Thompson, who volunteered as an English teacher in Indonesia for a year before starting medical school at Penn. “Penn Medicine is a very inspiring place, and this clinic is also a continuation of that inspiration for me.”
`` (L–R) Helping out at Unity Clinic are Adam “Rafi” Rom, MD; Charles Wolf, MD; and Giang Nguyen. `` Photo credit: Andrew Slike, executive director, Augustinian Defenders of the Rights of the Poor.
Are you involved in volunteer outreach activities? If so, spread the word about all of the great work you do in the community. Go to Penn Medicine CAREs at http://uphsxnet.uphs.upenn. edu/community/ and click on “Report Your Activities.”
Join the Ride to Conquer Cancer
Benefitting Abramson Cancer Center!
Prove that there is strength in numbers as you join thousands of riders to cycle 150 miles in two days through Pennsylvania’s most beautiful scenery. The Ride to Conquer Cancer is for anyone — all you need is motivation, a bike and a helmet.
Your participation on October 11 and 12 will support our team approach to providing the most advanced cancer research, education, and care — and providing hope — to patients and families in our community and beyond. Don’t miss your chance to be a part of this life-changing event by registering at www. RidetoVictory.org or calling 844.777.RIDE. Can’t ride? Give us a call at 855.227.5575 to learn how to join our Crew. Crew Members will work to help create an incomparable experience for the Riders to show the world that heroes really do exist.
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Heartfelt Thanks
DetermiNation
A note to Joseph Savino, MD, of Anesthesiology and Critical Care [My sister] is doing much better every day. I would like to thank you for the hope you gave me the first time I met you and for taking such good care of my sister, you and your staff. It is a great hospital.
Keeps Her Going As a mentor chair for DetermiNation in Philadelphia,
she offers other athletes support and inspiration. Anna McKeon, a surgical technician in PeriOperative Services, is using DetermiNation to help change the course of cancer. The program, a part of the American Cancer Society, provides professional training and support to athletes who want to dedicate their participation in half-marathons, marathons, and triathlons to the fight against cancer. McKeon is herself a cancer survivor. Five years ago, she developed cancer of the parotid gland. “It’s very rare, especially in someone my age,” she said. After her health returned, she decided to get in shape and began participating as a DetermiNation athlete. McKeon not only runs. As a mentor chair for DetermiNation in Philadelphia, she offers other athletes support and inspiration. She said some want to do a good deed. Others have lost someone to cancer and it’s their way to cope. Others, like herself, are cancer survivors. Earlier this year, the ACS recognized McKeon’s many contributions by awarding her the Nancy Labelle “Fighting Spirit Award.” At the presentation, it was noted that the award is given to athletes who are “bigger than cancer and have inspired others without ever needing to say a word — they embody action, movement and progress against cancer. Above all they do it with love in their heart and a sincere passion to serve the community around them.”
A note to Sarah Orzechowicz of Silverstein 9 I underwent surgery with Dr. Paul Marcotte to correct spinal stenosis. After the surgery I was moved to Silverstein 9. There I was taken care of by you and your associates for two days and two nights…. The care you provided was very professional, and you were vey attentive, pleasant, personable and upbeat. You are a credit to your profession, to the Hospital of the University of Pennsylvania, and to the institution where you were trained. Thank you again for taking such good care of me. A note to CEO Ralph Muller ou have a very caring, dedicated and Y knowledgeable staff. If I had known they were that good, I’d have gotten sick earlier. Keep up the good work.
HUPdate Editorial Staff Sally Sapega Editor and Photographer
Do You Have A Great Project to Share with Others? The Quality and Patient Safety Award acknowledges Penn Medicine departments or teams who have exhibited leadership and innovation in activities that ensure high-quality clinical outcomes, patient satisfaction, patient safety, and/or operational improvement. It is an opportunity for teams to formally document their achievements in quality and patient safety over the last 12 months.
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To apply, go to http://uphsxnet.uphs.upenn.edu/ceqi/ and click on “2014 Quality and Patient Safety Submission Page.” The deadline for applications is September 16. For more information, contact Michael Anderson at 215.614.0632 or andersom@uphs. upenn.edu
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Lisa Paxson Designer
Administration
Susan E. Phillips Senior Vice President, Public Affairs Holly Auer Director of Communications Contact HUPdate at: 3535 Market Street, Mezzanine Philadelphia, PA 19104 phone: 215.662.4488 fax: 215.349.8312 email: sally.sapega@uphs.upenn.edu
HUPdate is published biweekly for HUP employees. Access HUPdate online at http://news.pennmedicine.org/inside/hupdate.
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