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.
Last year, millennials passed Gen Xers in workforce numbers, and now make up the majority of the workers in the U.S. according to the Pew Research Center. Another study shows that two out of three millennial workers hope to have a different job in five years, and that one in four said they might leave their job to pursue a different career. Nursing is not immune to this trend, so it’s more important than ever to keep your young staff motivated and engaged to prevent short-staffing. Below are some tips for engaging your millennial staff!
Show trust: Millennial workers tend to have an independent streak and want to find their own way; by showing your staff that you trust them to make decisions will bolster their confidence and engage their creativity. If you micromanage young workers, their more likely to pull away from your group and look elsewhere for career advancements.
Provide support and access: Showing trust does not mean leaving them alone. Millennial workers want to hear feedback from their superiors, and providing frequent in-person contact is very important for their job satisfaction. Make sure you’re willing to listen to them and provide support whenever possible.
Emphasize relationships: Similarly, millennial workers have a strong sense of commitment to others and seek to establish meaningful connections with their coworkers. Try to cultivate a close-knit staff by encouraging social outings and holding staff events; the unit will work better as a team and young staff will feel more connected to their job.
Talk about the future: Millennial workers are not likely to wait around for career advancements. If you can outline a career trajectory in your facility and help them get there, your young staff will be much happier in their position. Try to keep bureaucratic road blocks to a minimum, and you could have a future nurse leader for your hospital.
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Nurses are often the face of their hospital; they are typically the first staff member to interact with the patient, and nurses are integral to providing a positive patient experience. In the ever-shifting landscape of culture, healthcare providers need to avoid discrimination and work to make sure patients feel at ease. While we have many resources that address cross-cultural competency (like this article from our Strategies for Nurse Manager’s reading room or the Health and Human Services’ guide), the medical community is just beginning to address how to effectively treat transgender patients. The Association of American Medical Colleges (AAMC) recently released treatment guidelines for transgender patients, and it is vital that nursing staffs help battle unconscious bias and create a safe climate for all of their patients.
In 2010, Lambda Legal found that a staggering 70 percent of transgender people had experienced discrimination in a hospital setting, and a 2011 study by the National Center for Transgender Equality and the National LGBTQ Task Force reported that 19 percent of patients were denied healthcare because of their status (via the New York Times). Because of this, 28 percent of the respondents have postponed medical care when sick and 33 percent don’t pursue preventive care because of their past experiences with medical professionals.
Better nurse education would be a great start to counteract this trend of discrimination and improve the climate for transgender patients; and when it comes to educating your staff, a little can go a long way. Part of the problem is treatment knowledge, but many of the issues could be solved with improved sensitivity training. Basic language education, such as what pronouns to use and asking the patient how they’d like to be addressed, can make a transgender patient feel at ease. Adding a gender and preferred name component to medical records and ensuring that they are up to date can greatly improve the consistency and quality of care as well.
Janis Booth, RN, shares a great example of how hospital staff can help a transgender person feel at ease from one of her readers:
“My new doctor saw my list of meds and knew immediately and opened with, ‘You look great…how long ago did you begin your transition?’ Put me right at ease, immediately, even though my name change had not caught up with their record keeping. I presented new IDs and they updated my info.”
Small things like asking the right questions in a gentle way can open up the patient and make them more comfortable, which will make your job much easier as well. Nurses get to set the tone of the patient’s experience, so properly training your staff on gender issues can make all the difference for a transgender patient in need.
Here are some great training resources on the topic:
Are you caught in a web of putting others ahead of yourself? Nurses have a tendency to be codependent—admit it—and we thrive on giving it all to our patients, our colleagues, our families, our parents, and even to our worthy causes. Consequently, we’re spent and have nothing left for ourselves.
I challenge you to try a new way of being for this next phase of your fabulous life. It is an opportunity to reprogram that self-sacrifice tendency into a new, improved you who is focused on self-care. It might be awkward at first, but this is your time to shine and the quality of your life may depend on it. [more]
As a nurse manager or nurse leader, you probably have many unfilled dreams. What is standing in the way of you realizing those dreams? Think about whether this roadblock is a true obstacle or a false belief about yourself. Break it down into small components so you can chip away at it a little bit at a time. You can’t move a large boulder, but you can chisel off small rocks, until you have the strength to push it aside.
Write down one roadblock standing in the way of what you want in life. [more]
This may seem like an unusual question to ask nurse managers and nurse leaders, but it’s one that is worth thinking about. Is your job too comfortable? Is it not stimulating enough? Are you stuck in a rut?
Being in your comfort zone is comfortable, but it may not be the best place for you. If your goal is to have a more joyful existence, then take some risks. [more]
Hierarchy of Voice
Excerpted from Ending Nurse-to-Nurse Hostility, Second Edition, by Kathleen Bartholomew
Try the following exercise that I often use to encourage nurses’ self-esteem. I call it a “hierarchy of voice” because each step results in greater empowerment. Addressing specific behaviors that are a challenge to a nurse stimulates meaningful conversations about that individual’s stumbling blocks to empowerment and self-esteem.
In performance evaluations, share the following list and ask team members to pick 10 meaningful actions that they would like to [more]
If you’re lucky enough, there will be a moment in your nursing career where things don’t go as planned. No matter how carefully you plan or meticulously you control, your career choice starts to unravel. Instead of thinking this is a bad thing, it might be the point where the magic starts to happen and you embark on a new adventure.
I chose a nursing career based on what my college roommate was majoring in because I didn’t have a clue what I wanted to do. Even though my heritage said it was my destiny: my mother was a nurse, my grandmother was a nurse, and my great-grandmother (as the story goes) was a healer.
After all the hard work of studying to be a nurse, upon graduation I should have felt great about what I had accomplished, but what I was really feeling was “I don’t want to just sling bed pans as a nurse, there must be something more exciting for me to do.” As it turns out, my restless nature plus that wonderful nursing degree (for which I remain extremely grateful) allowed me to shift many times into many different nursing roles that provided me with great satisfaction in my long and varied career. [more]
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The stories in The Boston Globe annual “Patients Salute Their Nurses” piece offer an inspiring and humbling testament to all the nursing profession can be.
In 400 thank-you letters from grateful patients, family members, and colleagues, Boston’s nurses received personal acknowledgment and messages of love inspired by their deep commitment to the profession and their patients.
Here are snippets from some of my favorite letters:
Diane goes above and beyond, treating me with dignity and respect, even calling me weekly to check on my weight and well-being. Like a friendly drill sergeant, she reminds me to keep my weight down and to pay attention to what I eat.
Joe provided intense, meticulous, and sensitive care not only to Mike, but also to his extended family. Joe’s quiet and steady presence gave us hope and strength when we needed it most. Mike did not make it through the night, but the blow of his passing was softened by the gift of time that Joe made possible.