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Study: Patients embracing telehealth, video conferencing

A new study suggests that patients are becoming more comfortable with telehealth solutions like video conferencing.

Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia published a series of qualitative interviews with telehealth patients, and the results were overwhelmingly positive. All participants indicated that they were satisfied with their telehealth visit, citing the convenience of receiving consultations from home, skipping office wait times and transportation costs.

One of the study’s authors, Rhea Powell, M.D., M.P.H., said that the video consultations could open up new opportunities for those who face barriers to medical care, and could be particularly useful for patients with chronic conditions such as diabetes and depression. Chronic conditions often don’t require a full exam, but they do require frequent short check-ins, which would be ideal for video conferencing.

The most surprising finding? Patients indicated a preference to receive bad news via video conference from their own homes. This goes against most clinical training, which teaches providers to deliver serious news in-person.

For more information about telehealth and nursing, check out the articles below from the Strategies for Nurse Managers’ Reading Room:

California Program Uses Telemedicine to Reach Medically Underserved

Telehealth provides opportunities to learn, educate and lead

Virtual reality a potential solution for pain management

This year has seen the release of multiple virtual reality (VR) headsets aimed at the home consumer. As they are becoming more affordable, hospitals and companies are researching the benefits in a healthcare environment, and the early results are positive.

Cedars-Sinai Medical Center and Children’s Hospital Los Angeles are conducting studies using the software, and the early results are positive. Cedars-Sinai researchers found that 20 minutes of using the VR software reduced patients’ pain by almost 25 percent; patients had an average pain score of 5.5 out of 10 before the VR experience and an average score of 4 after using the software. The researchers say this is a dramatic reduction, and not far from the effect of narcotics. At Stanford Children’s Health, they speculate that VR can be valuable for helping children get through tedious or uncomfortable procedures, such as physical therapy or imaging studies.

Though providers are cautiously optimistic about the possibilities, there are still some hurdles to overcome. It is difficult to find developers who want to target medical issues, because of the unclear path to profitability. One startup company, ApplieVR, is building a library of content designed to help patients “before, during, and after medical procedures” It’s also important to determine when the technology can helpful and when it can’t; some patients won’t respond to the applications as well as others, and researchers are careful not to oversell the value of VR at this early stage.

For more information, check out the MIT Technology Review article.

Do you think VR might replace Opoid use eventually? Let me know in the comments!

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.

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.

 

Creating a transgender-friendly healthcare environment starts with nurses

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:

  • You can download the full AAMC guide here.
  • WBUR has a list of tips to get you started.
  • Janis Booth’s full article has a lot of great information as well.
  • TransRecord and RAD Remedy are sites dedicated to gathering and sharing data on trans-friendly providers.

Do you have a compelling idea for a nursing book?

As a leading publisher of nursing and other healthcare products—including books, newsletters, webinars, and online training—HCPro is a great place to publish. If you have an idea for a book or other product that will benefit the profession of nursing, we would like to hear from you.

At HCPro, we value our expert authors as the foundation of our business and strive to build long-term relationships with them. We collaborate with our authors—a diverse and knowledgeable group of people focused on creating a personally satisfying and improved healthcare workplace for themselves and their colleagues. The nurses, nurse educators, and nurse managers who read our books appreciate our focus on quality, from project inception through collaborative development, publication, and distribution.

Whether you want to write a book, blog post, or article, or create a webinar, we’ll provide you with the feedback and tools you need to be successful. Contact us for more information.

Some topics we’re interested in: Managing intergenerational teams, delegation and supervision across the care continuum, charge nurse insights, creating a culture of safety, effective communications.

Hospitals still struggle to involved nurses in quality improvement activities

A study published recently in the Journal of Nursing Care Quality found that few nurses are involved in nurse-led quality improvement programs, and programs across the country do not appear to be growing at all, despite research that show the value of such programs in improving patient care.

The research team in the Journal of Nursing Care Quality study found few differences in the participation levels between nurses who were first licensed between 2004 and 2005 and nurses who were licensed between 2007 and 2008, particularly when it came to activities such as performance measurement, monitoring sustainability of improved practices, and efforts at performance improvement. The group anticipated greater variation, with the expectation that nurses from the second group would be more engaged than nurses from previous years.

While some programs did show promise, and while there has been an increase in the number of hospitals that participate in programs aimed to increase nurses’ engagement in safety and quality initiatives, the researchers concluded that nurses are an underutilized resource when it comes to improving patient outcomes. The authors of the study made several recommendations for hospital leadership, including having experienced colleagues guide new nurses in translating quality improvement knowledge into action, ensuring that nurses have sufficient time to participate in quality improvement activities, and providing timely feedback on nurses’ performances.

How do you engage your nurses in quality improvement? Share your tips and ideas in the comments section!

 

More time working with patients, less time documenting them

What would you be able to accomplish if you had one extra hour in your day? What about if you had several extra hours? Documentation, though a necessary part of healthcare, is potentially eating into hours that otherwise could be spent on patient care. Last month, MIT Technology Review wrote about a system designed by Xerox to automate and streamline some of the time-consuming tasks associated with technology, such as logging into computers, documenting details of patient care, reviewing patient files, and coordinating duties with colleagues.

According to the article, Xerox’s research into nursing documentation was spurred by a 2008 study published in The Permanente Journal that found that more than a third of nurses’ practice time was spent on documentation, with an additional 20% of nurses’ time spent on care coordination. Of the nursing practice time, only 20% was spent on patient care and 7% was spent on patient assessment and reading of vital signs.

We polled readers at StrategiesForNurseManagers.com to find out what percentage of their time was spent on documentation. Nearly half of all respondents (49%) indicated that documentation takes up more than 50% of their time, while another 22% estimated that it took 40%-50% of their time. A quarter of readers responded that 20%-40% of their day was comprised of documentation, and only 6% replied that documentation took up less than 20% of a given shift.

Given that nurses may also be working longer than their scheduled shifts to complete all documentation, and that longer shifts have been linked to nurse burnout and adverse effects on patient outcomes, is not unreasonable to connect the dots and state that less time spent on documentation could potentially improve patient outcomes and patient satisfaction. It seems that nurses would welcome any technology or system that would streamline documentation processes and allow them to get back to providing quality patient care.

Has your organization devised any methods for making documentation more efficient? Please share in the comments section!

Poll results: Using technology to connect with patients

Last month, I posted about the ways that technology could improve patients’ communication with nurses but could also place a greater burden on nurses for round-the-clock care and feedback. To get a feel for how often nurses used technology and social media to interact with patients, we posted a poll on StrategiesForNurseManagers.com asking nurses and other healthcare professionals to weigh in.

Approximately three-quarters (74%) of those who participated in the poll responded that they did not use social networking sites such as Twitter, Facebook, or LinkedIn to interact with patients, while the remaining 26% replied that they do use those technologies for patient interaction.

While these results indicate that social networking sites have not become a place for healthcare communications, I still wonder whether nurses and other practitioners use other forms of technology, such as emails, listervs, or websites, to share information with patients and respond to questions about treatment plans. As mentioned previously, these resources have the potential to improve patient care, but they must be leveraged appropriately.

How do you communicate and follow up with patients outside of their scheduled appointment times? Leave a comment below!

Nurse burnout and patient dissatisfaction linked to longer shifts

The longer a nurse’s shift, the more dissatisfied the patient, according to a recent study from researchers at the University of Pennsylvania School of Nursing. Researchers found that nurses who worked shifts of 10 hours or longer were more likely to experience burnout and job dissatisfaction than nurses who worked shorter shifts. Of the nearly 23,000 nurses involved in the three-year study, 65% worked shifts of 12-13 hours; the percentage of nurses who reported burnout and/or intention to leave their job increased incrementally with the shift length.

Longer shifts not only had a negative impact on nurses, but also affected patients and patient outcomes. According to researchers, seven out of 10 patient outcomes were significantly and adversely affected by the longest nursing shifts. Additionally, higher percentages of patients reported that the sometimes or never received help as soon as they wanted, and nurses sometimes or never communicated well, in hospitals with higher proportions of nurses working longer shifts.

Researchers recommended that nurse management monitor the hours nurses worked, including second jobs, and consider restricting the number of consecutive hours worked. Nurse leadership should also “encourage a workplace culture that respects nurses’ days off and vacation time, promotes nurses’ prompt departure at the end of a scheduled shift, and allows nurses to refuse to work overtime without retribution,” according to researchers.

While this may all seem like common-sense advice, it is far easier said than done. There are so many factors that could prevent a nurse from leaving the moment a scheduled shift ends, and it would be difficult to enforce a policy for “prompt departure.” Likewise, if an organization is already facing nursing shortages, it’s unlikely that nurses will feel comfortable refusing overtime or taking adequate time off. However, these are issues that must be addressed to prevent nurse fatigue and job dissatisfaction that could put patients at risk. Researchers are correct in that change must come from the top, and nursing leadership must initiate the cultural shifts necessary to prevent burnout and ensure safe, high quality patient care.

What is the average length of nursing shifts at your organization? Have you ever noticed a correlation between the length of a shift and nursing fatigue? Does your organization have any policies in place to address these issues? Share your thoughts in the comments section!