Nursing

Image courtesy of serch via Flickr

The Daily Iowan has an article about a nurse practitioner named Mary Shlapkohl, who has worked at the University of Iowa Children’s Hospital for many years. She managed to find a way to bring some much-needed cheer to the kids who are her patients.

Every day, Mary Schlapkohl wears a red I AM LOVED button pinned to the straps of her ID-card, dangling around her neck.

“A teenage girl gave this to me,” the 50-year-old said, clutching it in her hand.

The nurse-practitioner said when she asked the young patient handing them out for one, the child replied, “Ugh, you’re never going to wear it.”

“And so I’ve never not worn it, just to spite her,” Schlapkohl said and smiled.

Working at the University of Iowa Children’s Hospital for the last two decades has allowed her to meet numerous children and families facing cancer.

“I’ve worked here a long time, so everybody knows me, and I’m up here on the floor a lot,” she said.

A UI nursing alumna, Schlapkohl worked for two years as a bone-marrow transplant specialist before becoming an assistant head nurse for the inpatient unit at UIHC. In 1992, she became a nurse-practitioner — beginning her work in the UI’s second-level pediatric hematology oncology unit.

A few years after, Schlapkohl was invited to the first planning meeting for Dance Marathon. From there, she has witnessed its continued growth.

“I think of how [Dance Marathon] has evolved to where it is now, and I can’t believe it,” she said. “It’s not just the amount of money it has raised, but what this has grown to mean to our families has been just incredible and how much the students just embrace our families and become so involved with them.”

For Schlapkohl, Dance Marathon is like a partnership. The volunteers bring joy to distract patients, she said, and the hospital staff members help children get better and provide information to the families.

“So I think it’s a great parallel way of treating our patients and working with them together,” she said.

Children’s Hospital nurse Kristie Febus, who has worked with Schlapkohl for the last seven years, said she has a knack for working with children.

“I can honestly say that I have not seen a kid who doesn’t love Mary,” the 31-year-old said.

Febus said Schlapkohl always maintains a lot of energy around staff and patients.

“She figures out a way to put fun into the hospital,” Febus said. “This isn’t a very fun place, and somehow she is able to make the kids feel comfortable and make them feel like they’re at home. It’s always jokes and laughing with them, and she makes them feel like there’s a little bit of fun to be had here.”

For the last 15 years, the Joint Commission (formerly JCAHO) has been evaluating medical errors and their causes and using this data to improve patient safety standards. What it has found is that hand-off communication has played a role in approximately 80 percent of “serious preventable adverse events,” also known as sentinel events, in healthcare.

In 2006 the Joint Commission initiated National Patient Safety Goals, which changes emphasized goals on a yearly basis. These standards grew out of the recommendations of the Sentinel Event Advisory Group and target issues that most commonly lead to sentinel events. For 2011, Goal 2 focused on improving communication among caregivers since communication errors and breakdowns remain a leading cause of sentinel events.

Hand-off communication can be especially problematic, for several reasons such as one person is often at the end of their shift and wanting to go home, or a patient is being bumped up to a higher level of care and the care provider has already been under stress and strain from the patient’s more serious needs. Important details that are vital to the patient’s current state and treatments may be missed or misunderstood due to the stress of the situation and fatigue of the caregiver.

Image courtesy of Kathryn Weigel via Flickr

One method of improving the odds of giving and receiving a more thorough report has been for the oncoming nurse to perform an immediate baseline assessment to confirm the hand-off report. This method can take time and hold up an outgoing nurse from leaving the facility, which means that she must remain on the clock until the assessment is finished. Most facilities have strict time limits on end-of-shift overage minutes.

Another method that has been gaining ground is the hand-off sheet used in many facilities when transferring patients between units. Although a seasoned nurse knows if she’s is likely to have all the information she needs, a newer nurse may want the security of a completed hand-off sheet. Although nurses offer mixed reviews of the extra paperwork, a benefit is that the communication is documented.

Some nurses prefer the “walking report” where the off- and on-going nurses walk from room to room and give a hallway report outside the patient’s room. This allows a quick review of the nurses’ notes and the chart, and a quick visit with the patient. Other nurses feel this invites interruptions from family members, and patient requests that cannot be handled until after hand-off has been completed.

In school, nurses learn the quick 30-second head to toe assessment. While this method is a goal, in school most students only have one or two patients for their ‘shift.’ In the real world of nursing what works best is often found only through evidence-based practice and a lot of talking to other nurses to find out what works best for them.

Nursing is an incredibly important profession, but also an incredibly exhausting one. Few other jobs have such a large emotional component; nurses must deal with literally life-and-death situations on a daily basis.

The term “compassion fatigue” was coined about twenty years ago to describe the emotional state that some nurses reach when the emotional toll has become just too much.

An article in St. Louis Today outlines a program called which provides a curriculum for nurses wishing to become more emotionally resilient. You can’t control the stresses of nursing, but you can control how you respond to them.

The program’s curriculum taught the nurses five steps to resiliency:

• Self-regulation, which involves learning exercises to reduce stress when they perceive a threat. (more…)