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Shared decision making has benefits for minority patients

New evidence suggests that shared decision making (SDM) can improve the patient experience for minority groups, particularly LGBTQ patients of color.

Shared decision making aims to include the patient’s perspective when making care decisions and better educate patients about treatment options. SDM acknowledges that each patient is unique, so creating a dialogue between the provider and patient should increase patient engagement and result in better outcomes. As one researcher describes the shift: “It’s going from ‘I’m the expert, take my recommendation’ to ‘I am going to inform you and respect your wishes.’”

This idea of respecting and listening to a patient is at the heart of caring for all patients, but minority patients particularly benefit from an SDM approach. As we discussed in our post about transgender healthcare, an open dialogue and respect for how the patient would like to be addressed goes a long way to build trust for the patient; the same principle applies across minority groups.

The University of Chicago and the Agency for Healthcare Research and Quality have developed a new project called Your Voice! Your Health! aimed at researching SDM’s influence on minority healthcare and facilitate healthcare improvements for the LGBTQ racial and ethnic minority community. The researchers note that the confluence of minority statuses make it particularly difficult for LGBTQ patients of color; as Monica Peek MD, MPH, Associate Professor of Medicine at the University of Chicago Medicine told ScienceLife: “Racial/ethnic, sexual orientation, and gender identity minority status are all marginalized social identities, so they act in concert to further marginalize people who are trying to navigate the health care system.”

Because there is little existing research on LGBTQ patients of color, providers may not have the proper framework or tools for addressing their needs. Peek and her team developed a new conceptual model to illustrate how the patient and physician’s social identities effect SDM. As ScienceLife describes the strategy: “In the end, establishing trust boils down to how well a physician acknowledges her own identities in relation to those of her patients.” According to the group’s research, differences in social identity didn’t matter so long as the provider was compassionate and encouraged an educated dialogue, the hallmarks of a SDM approach.

program, Massachusetts General Hospital (MGH) reviewed what made the initiative a success. At first they relied on physicians to order decision aids and educational materials for patients to encourage informed discussion, but they didn’t see immediate results. Once they trained all staff and involved patients directly, the use of decision aids increased substantially. Leigh Simmons, MD, medical director of the MGH Health Decision Sciences Center, said of the initiative: “There now is a big push toward more team-based care in medicine; and once we started to engage the entire team – including front desk staff, medical assistants and most crucially, the patients – we saw the use of decision aids take off.” Once the full staff and patients embraced the program, physicians reported that they had more advanced discussions with patients and they are able to focus on what’s important to their patients.

Do you use shared decision making practices in your facility? Do you find it easier to connect with patients using these techniques? We would love to hear about it in the comments below!

For more information on the Your Voice! Your Health! project and a useful tool for establishing a patient dialogue, check out the full ScienceLife article.

Rock Your Health: Cleaning Up Your Act

As we enter the Spring Season, I feel the need to clean up my act.  Everything now feels better – more light at the end of the day, waking up to a light sky, chirping birds, walking outside again without slipping on the ice or worrying about walking in the dark, seeing sprouts of greenery and color once again.

That good feeling and renewed energy even compelled me to clean up one shelf in my office and now I not only feel better and more organized, but the empty places on the shelf makes me feel like I can even breathe easier.  Interesting how these simple things have powerful rewards.

So what can you clean up that will provide you with more relief and less stress?

Need support with cleaning up your act?  Email me at carol@carolebert.com and I’ll give you a complimentary laser coaching session.

Registered nurses not immune to industry influence

There’s been a concerted effort over the last few years to provide transparency for medical industries interaction with doctors, thanks to the Physicians Payments Sunshine Act instituted by the US Senate in 2010. The Sunshine Act requires medical manufacturers, such as drug and medical supply companies, to report payments and gifts given to physicians and teaching hospitals; the goal is to ensure that doctors are not swayed to make care decisions based on financial gains and prevent conflicts of interest. Last fall, two senators proposed a bill to amend the Sunshine Act that would include nurse practitioners (NPs) and physician assistants (PAs) as well, acknowledging that NPs and PAs wrote 14% of all drug prescriptions in 2014 and require the same transparency as doctors.

A new study released this week suggests that even registered nurses (RNs) without prescribing authority could be subject to these sort of interactions with the medical industry. All of the RNs that participated in the study said they had interacted with industry over the past year, averaging 13 one-on-one meetings over the year. Many also participated in sponsored meals or events, received gift offers and product samples, and some received payments for speaking, consulting, and market research work. Most interactions were with medical device and pharmaceutical companies, but some reported interactions with health technology and infant formula industries as well.

Though RNs don’t have prescribing authority, many nurses are part of purchasing committees for their facility. RNs play an integral role in decision-making throughout their facility, and there are no regulations for transparency between RNs and medical industries. Though the sample size is small (56 RNs participated in the study), the authors of the study think the results warrant additional research and regulation. As the largest and most-trusted healthcare profession in the US, it’s important to make sure RNs maintain their trustworthy reputation with their patients.

You can read the full study here, and an editorial accompanying the study here.

For more information about open payments data, check out CMS’s open payments site.

Rock Your Health: 90% of Managers Have Digestive Health Issues

When your stomach speaks to you – LISTEN UP! Your gut is trying to tell you something.  After recently returning from a “life-changing” and “stomach-changing” visit to the first accredited Functional Medicine Hospital and Holistic Healing Center in the world, I am compelled to share some takeaways that have made a significant difference in how I view and treat my digestive system. First – you need to know that about 80% of your immune system and ½ of your nerve cells and neurotransmitters involve your digestive system.

I had no idea that my gut is THE top priority when it comes to healing myself.  And I can tell you that even I, as a role-model for wellness, have some things to do to repair some of my digestive shortcomings. Can we now give our gut some love and respect? Let’s begin the process with some simple action steps you can implement right away. There is more to do of course, but this will get you on the right path.

  1. Drink lemon water first thing
    Start your day with the juice of a half of a lemon in a cup of warm water with a dash of cayenne pepper. Lemon can stimulate elimination of yesterday’s food, help destroy bad bacteria in the mouth and intestines and does many other great things. My grandfather used to start his day this way so it is an old-time remedy as well as used in Chinese medicine.
  2.  Eat in happiness and calm
    The process of digestion starts with your brain so when you sit down to eat, take three belly breaths in thru your nose and exhale slowly. This will engage your parasympathetic system that slows you down and disengages your sympathetic nervous system that speeds you up. Remember when the tradition was to say a prayer before you ate a meal? That is a practice that works in the same way.
  3.  Chew-Chew-Chew
    Food starts digesting in your mouth as soon as you start chewing. There is a digestive enzyme in your saliva that starts to break down the food but you need to chew longer for that to happen. So chew 25-50 times per bite of food to prepare the food for its trip down to the stomach.
  4.  Protect the acid in your stomach
    Your stomach contains HCL (hydrochloric acid) which is ready and willing to break down the food even more so it can be absorbed by the body. HCL also kills bacteria, viruses and potential antigens from making you sick. Because of these two important roles, you don’t want to dilute the acid and prevent it from doing its job. Therefore – don’t drink water when you are eating.
  5.  Drink water in between meals
    Consume half your body weight in ounces “daily” in order to aid your digestion, replenish your system, prevent dehydration and detoxify your body. Add a pinch of natural sea salt to each 32 ounces of water.

So far so good? Can you start doing these things? Need more guidance? Let’s talk! Just email me at carol@carolebert.com  and we can create a digestive health strategy to help get your gut in tip-top shape!

Perspectives on nurse leadership

The responsibilities of nurse leaders are changing rapidly and the role is more fluid than ever. We collected perspectives from several nurse leaders on how nurse leaders can stay effective in the ever-changing world of healthcare.

Jeanine Frumenti, RN, an expert in leadership consulting, posits that the most important aspect of nurse leadership is the ability to create a healthy work environment. “[Nurse Leaders are] always looking at what’s good for the organization, what’s good for their patients, their staff, their team — it’s not about them. And their focus stays on the goal… They’re transformational, giving those around them a voice, encouraging them to share in the decision-making, and owning their work and their practice.” This focus creates a healthy culture, that can allow their staff to flourish and take pride in their work.

Toby Cosgrove, CEO and President at Cleveland Clinic, writes that healthcare leaders need to embrace the quickly changing healthcare environment to remain effective. “Today’s leaders must have a clear vision of the future based on the most fundamental values of the organization. We need to communicate our strategies, achieve consensus, and move quickly to implement change. Innovation is essential, and so is the courage to fail. Most importantly, we must never give up.” Cosgrove agrees that leaders should rely on their staff and create an environment for them to grow: “A leader creates a learning environment that opens all caregivers to new skills and capabilities. Each of us needs to inspire and uplift our teams with a commitment to their professional growth and development.”

Claire Zangerlie, MSN, MBA, RN
, president and CNO for the Visiting Nurse Association in Cleveland, Ohio, argues that this impetus to teach should be applied to patients as well through population health management. As nurse leaders take on more and more responsibility, they will be able to educate “entire populations of patients through workshops and printed materials.” According to Zangerlie and her team, competencies that nurse leaders will need for population health management include: “Effective communication, including excellent negotiation skills; relationship management, including asserting views in nonjudgmental, nonthreatening ways; [and] diversity, including creating an environment that recognizes and values differences in staff, patients, families and providers.”

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Rock Your Health: Celebrate Spring!

S – Start a new project that is simple to accomplish but yields great rewards

P – Play often  – schedule “play” time or free time routinely on your calendar

R – Rejoice in the feeling of longer days with more time to enjoy life

I – Improve your attitude and let go of any leftover winter grumpies

N – Notice the good in others and say something about it to them

G – Gather co-workers regularly for fun events

“Spring is nature’s way of saying, ‘Let’s party!'”  — Robin Williams

Email me at carol@carolebert.com for more ideas on how to bring joy into your life and your work.

Sleep vital to nurses’ performance

For many nurses, sleep is an afterthought. With long shifts and busy schedules, it can be hard to make the time for a full night’s rest, particularly for night nurses. But it might be worth the effort, both for nurses and their patients.

Most importantly, not getting enough sleep can put patients at risk. Without proper rest, your decision making and reaction time decreases significantly, which can make the difference in in an acute care setting. It can also affect your recall, which might lead to preventable mistakes like incorrectly assessing a patient’s condition or a medication error.

Beyond the patient safety concerns, lack of sleep can also make it harder to perform all of your duties. Amount of sleep has a corresponding impact on your mood. Without enough sleep, you can feel more anxious and stressed out, making it harder for you to communicate with your coworkers and patients. Additionally, sleep is key staying healthy and in shape; so after a long shift, your sore feet and back won’t recover properly unless you get enough sleep.

Nurses learn about the negative effects of sleep deprivation, but never take the time to take care of themselves. So the next time you think about staying out late or taking an extra shift, maybe consider getting some extra rest instead.

For more information about sleep deprivation, visit the National Institutes of Health’s site.

 

Featured webcast: Drug Diversion in Healthcare: Improve Security and Avoid Fines

Phcpro_live_webcast-iconreventing the theft of controlled substances at hospitals continues to be an tremendous issue even with increased security measures. Failed drug diversion programs in hospitals have led to record fines and in the midst of heightened scrutiny over drug security, hospitals must improve their processes to avoid litigation.

On Thursday, April 26 from 1–2:30 p.m. Eastern Time, join us for a live webinar with expert speaker Kimberly New, JD, a nurse, attorney, and consultant who specializes in helping hospitals prevent, detect, and respond to drug diversion.

During this program, New will discuss drug diversion by healthcare personnel and present specific steps facilities can take to minimize the risk of patient harm. She will discuss fundamental components of a diversion prevention, detection, and response program through an overview of the scope of the problem, including case studies. New will also review regulatory standards and best practices relating to controlled substance security and diversion responses. She will additionally provide tips on how to promote a culture in which all employees play a significant role in the deterrence effort.

At the conclusion of this program, participants will be able to:

  • Identify risk factors and signs of employee drug diversion
  • Fully comply with regulatory requirements of the DEA and other accrediting organizations
  • Train staff on how to report suspected abuse and who to report it to
  • Create a culture of accountability and develop an effective drug diversion prevention plan

Don’t miss this opportunity to hear practical advice and have complex regulations simplified in this program suitable for your whole organization. For more information or to order the webcast on demand, call HCPro customer service at 800-650-6787 or visit the HCPro Marketplace.

California nurses seven-day strike ends in stalemate

On March 15, the newly unionized nurses of Kaiser Permanente Los Angeles Medical Center arranged a seven-day strike in hopes of getting their first collectively-bargained contract.

Last summer, 1,200 nurses voted to join the California Nurses Association (CNA), and the walkout was their first major action since joining the union. Negotiations for a new contract have been taking place since September, and this timed strike is part of the negotiation process. The union hopes to improve the conditions both for the RNs and their patients; the nurses report being understaffed, often having to cover units outside of their specialties, and seek economic improvements to attract and retain qualified nurses. Another concern brought up by the union is the hospital’s plans to open a medical school in the next few years, which will put additional strain on the hospital and its staff. The combination of factors led to the strike.

Kaiser Permanente expressed disappointment at the nurse’s tactic, and claims that they made a fair offer last month that went without a response. Additionally, Kaiser notes that their nurses are among the highest paid in the region, and their new offer would keep them there.

All of this is happening among growing concerns about healthcare coverage, as demand has spiked over the past few years.

The striking RNs have gone back to work after seven days of picketing, and negotiations between the two sides are still ongoing.

Getting nurses from bedside to the boardroom

Last week, we discussed some of the benefits of having nurses in executive positions. It is crucial to bring a myriad of perspectives to these positions, and nurses are significantly underrepresented in hospital leadership. This week, Becker’s Hospital Review has offered up some tips about how nurses can prepare for hospital board seats.

The first thing an aspiring nurse should consider is the core competencies of the hospital board. This can be a little different for each hospital, so having a specific facility or type of facility in mind would be helpful; if you can find a facility that matches your nursing specialty, even better. Often, boards have lists of competencies, so not having the right core skills can sink an application right away.

Once you establish the required skills would need, you can begin working towards that goal. Many nurses don’t have opportunities to develop governance skills on the job, so it might be helpful to look outside the hospital for that. Volunteer board positions in their community or at a nonprofit organization can be a great way to get experience in governance and make nurses more appealing candidates for board positions.

Connections are key in this process as well. Nurses should meet with board members and the chair if possible, to better understand the board’s mission and how they might align with it. These relationships can be crucial to obtaining a board position, but also to keep it. Board members can become mentors that can teach nurses how to navigate their new responsibilities and help them through the gauntlet of new board membership.