Promoting a Culture of Civility

Piri, Louisa, and I are conducting a study to learn more about experiences with incivility in nursing learning environments, as well as to identify strategies for promoting a culture of civility.

Please click here to learn more about who we are, how this study developed, and why we decided to pursue this topic.

We hope you will take 10-15 minutes to complete a 9-question survey, share your insights, and help nurses and future nurses learn in a culture of civility. This study is open to all nurses. You get to decide if you want to answer as a student or a faculty member. You don’t have to be either right now, just think back to when you were last in the classroom or clinical learning environment.

Click here to begin the survey.

Thank you, in advance, for helping nurses learn and grow, with a goal of making learning environments welcoming and respectful for all.

Healthy Holidays for Nurses

As nurses we often focus on taking care of others. At the holidays it’s important to take a few moments to also think about how we can take care of ourselves.

I’m a diabetes educator, so “surviving the holidays,” as you might imagine, is a common conversation. What about nurses? Holiday time is stressful for nurses as well. Like diabetes, nurses’ work doesn’t let up no matter what day it is.

Some ideas for self-care at the holidays include getting some physical activity. Going for a walk can do wonders for clearing the mind, helping with stress, and balancing out any extra holiday calories!

Speaking of calories, many patients/families give nurses food platters during the holiday season. While this is a very kind and thoughtful  gesture, another idea is to ask patients and their families to consider a donation to a chosen charity. Perhaps nurses could decide on a charity and post a sign on the unit about making a contribution rather than giving gifts or food to the nurses.

Another strategy is taking time for gratitude. Starting our day with gratitude can help us focus and stay positive.  Many people find giving back at this time of year very rewarding. Ways to do that may include serving food to those in need; donating to groups that collect holiday gifts for children, families and the elderly; coat drives; and many other opportunities.

Taking care of ourselves also means accepting ourselves – our strengths and weaknesses, successes and areas for improvement. If we do indulge in high calorie treats, or if we don’t make time for exercise, it doesn’t help to beat ourselves up or say “if only” or worse yet, to “should” on ourselves. Instead, we can say “next time,” and move on.

Let’s enjoy the special moments – with patients, with family and friends, and with ourselves. I hope nurses everywhere have a joyous holiday season. At this time of year (and always) I am grateful to be a nurse and to count all of you as colleagues in this important work we do.

Nurses and Social Media

I recently participated in a live Twitter Chat called Where are the Nurses? I think I saw it promoted on Twitter, but I can’t even remember for sure. Regardless, it piqued my interest and I joined in. The discussion was about nurses in leadership and in social media.

I’m a nurse and certified diabetes educator, and I’ve been engaged in social media since about 2008. That is when I joined Facebook to connect with friends – not at all related to my professional work. Then in 2011 I started a website with a blog because I was about to publish a book and was told I needed to have a blog. I soon became involved in what is called the Diabetes Online Community (DOC), which is made up of blogs, social networks, websites, and more – for, by, and about people with diabetes.

Shortly after that I created a “business page” on Facebook, where I started sharing diabetes-related items & information that I thought people would enjoy. Then I joined LinkedIn and Twitter. Yikes! But for a long time I did not interact much with the “Twitter Universe/Twitterverse” or LinkedIn. I wasn’t even sure what the point was. What I’ve learned about LinkedIn is that it’s about professional networking. It’s a great place to look for positions and to find people to fill positions. I’ve had someone find me on LinkedIn and ask me to write a chapter in a book and another person ask me to be on an advisory board.

My kids are into Instagram and Snapchat. I think of those two social media platforms as being strictly for social interactions. I think of Facebook as being either/both personal or professional. And I think of LinkedIn as being more professional. Twitter can also be used for either/both. I use Twitter for professional interactions: I “tweet” my weekly blog post – to get it out there – and I participate in occasional twitter chats.

Until two weeks ago I had only participated in diabetes-related Twitter Chats (also, it turns out, referred to as “tweetchats”). The one I saw promoted in a tweet was called “Healthcare Leadership” with the hashtag #hcldr (a hashtag is a label for a specific topic – you can search for topics by entering hashtags into Twitter or you can follow/participate in certain discussions by including the hashtag in your tweets). Healthcare Leadership is a “weekly, educational tweetchat Tuesdays at 8:30 pm Eastern (North America).” What was so ironic about my experience participating in this nursing tweetchat, was that several of the people involved were directly related to the DOC and regularly participate in diabetes tweetchats! It truly is a small Twitterverse (despite millions of users).

One of the questions asked in the #hcldr chat was why aren’t more nurses involved in social media? Some obvious answers might be lack of time or interest, but other suggestions included concerns about privacy, liability and “enmeshment.” Here is an abridged transcript of that Twitter-based conversation.

Many nurses (including those who are reading this post) are involved in social media, while several others have not gotten there (yet). Some nurses may be using social media for personal reasons, but haven’t joined the professional side of it. It’s completely your choice about how you use social media. I acknowledge that it can take a lot of time. Time management skills are critical in nursing in general, let alone when using social media. But if you are looking for connections, or a new position, or simply want to reach out to discuss ideas, social media is a fabulous option.

Hope in Nursing and Health

I once heard that everyone wants to be healthy. I’ve also heard that everyone wants to have hope. Hope is something to hold onto like the strap on a subway train (I’m heading to NYC in a few days…). Is it possible to have both health and hope? I believe it is. And I believe that hope can help motivate us toward health.

Nurses play a role in helping people attain health and hope. When I think of all the many (many!) roles nurses play, there is always an underlying thread of health and hope.

In the academic setting, nurses teach future nurses about various aspects of health (and disease). They also teach these fresh minds how to be open, how to communicate, how to teach and support patients, and how to collaborate with colleagues. In other words, nurses teach our future generation of nurses how to maintain hope in health care.

Nurses teach other nurses and various health care professionals how to give better care – how to be alert for and solve problems, so that patients have the best possible outcomes. Nurses provide support for each other and their colleagues so that hope is present in the patient room, the emergency department, the nurses’ station, the break room, the cafeteria, the medication room, and so on.

Nurses work with government agencies, in homes, in schools, in clinics and in hospitals. In each of these settings (and all the ones I’m forgetting) nurses represent hope simply through the very work we do. Even nurses in the jail or prison setting bring hope through health.

Whether it’s easing pain or changing a dressing, explaining a medication or helping someone to the bathroom, nurses represent hope through healing. Even when healing is not an option, there is still hope. There is hope in a peaceful death. There is hope in a consoling hug.

I wonder if it’s possible to have health without hope. Probably not. Is it possible to be a nurse without hope?

Replacing words that shame and blame in nursing care

The last time I wrote about language and health, specifically diabetes, I mentioned several words that impart judgment, shame and blame. People with diabetes live with and manage a demanding and challenging disease. When we use words like non-compliant or poorly controlled we are not taking into consideration all the factors that could be at play. Can the person afford insulin? Are they experiencing food insecurity? Did they ever receive diabetes education? What is their level of health literacy?

Two weeks ago I gave a talk about the messages we send to children and adolescents at diabetes camp. I discussed how we can send messages of judgment, or messages of strength and hope, simply based on the words we choose. Empowering campers is the work of diabetes camp professionals and volunteers. For nurses outside of the camp setting, the focus is also on empowering people – in hospitals, clinics, home care, public health, academics, etc.

At the end of my presentation, there was some discussion. The people in the room who live with diabetes strongly agreed with my suggestions about language and messaging. However, two people (who happen to be health care professionals) raised the point that “there are times when it’s necessary to use words like uncontrolled, good and bad.” They argued that doing otherwise is not giving good care. One of them also shared that she thought my talk was judgmental. At the break another participant came up to me and said she agrees that these words are not “PC.”

My first response to these comments was concern. I am clearly not using effective messaging about messaging if this is how people respond! Then after thinking about this feedback for several days I realized that it was very important for me to hear these points. This is how I can do a better job explaining what I’m trying to say. If I come across as judging people for using certain words, that absolutely defeats my purpose. If I come across as not giving good care by avoiding certain words, that’s not my intent either. And if we are simply thinking of the words we use in health care as “PC” or “not PC,” then we are not looking at the underlying problem. And isn’t that what we learned back in nursing school? (Look at the underlying problem, don’t just treat the symptoms.)

So my approach to all this is to go back to the problem, which is using language that is not appropriate for chronic care. Patients in 2016 are demanding holistic, person-centered care – and language is part of that care. Words create a context for people, and through that context people create meaning. So if they hear words that make them feel judged, they are likely to translate that into “I’m a bad person.” If they hear poorly controlled they may feel they are a failure.

Some ways we can change the messages we send to people include using words that put the person first: woman who has diabetes, people living with diabetes, or child with diabetes, instead of diabetic. We can use words that build on people’s strengths, rather than their weaknesses: takes her medication about half the time, rather than she’s non-compliant. And we can use words that focus on physiology, rather than judgment: blood glucose levels in the target range, elevated A1C, glycemic variability, glycemic stability, or blood glucose management, instead of any version of control.

When a patient has blood glucose levels that are clearly not in a safe or healthy range, we can start by asking questions. How do they feel about it? Find out what they know or don’t know. What are their resources? Ask if it’s ok to make some suggestions or share some guidance. Acknowledge that it’s hard and scary. This is how we can give good care and empower people. It doesn’t require judgment or judgmental words to help people make changes.

By focusing on sending messages that are person-centered and strengths-based, words that are consistent with those approaches will naturally follow. We can’t change the history of health care, or the words that went with it. But we can change the messages we send going forward.