What is “best nursing care?” Deconstructing the business model driving healthcare


The current feature on the AJN blog “Off the Charts” is a post titled “The Limitations of Rating Nursing Care by Customer Surveys.”  Since I have, for many long years, decried the practice of basing the evaluation of nursing care on patient satisfaction surveys, I jumped at the opportunity to read this post!  Of course we need and want to know how patients perceive the care we provide, but how we obtain this information, and what we do with this, is a key factor.  Since this approach derives fundamentally from the corporate business model, and is now practiced in the context of this model, the substance, use and outcomes of this practice are deeply flawed when examined from a NurseManifest perspective.  The example the author, Juliana Paradisi gives as an example of her best safe and compassionate nursing care involves a woman in extreme distress who “fired” her as her nurse –  a situation in which she could not break through the barriers inherent in the patient’s distress, but provided a level of care that was exemplary.

Even though the overarching business model that governs healthcare now is probably not going to go away soon (Ha!) – we can raise awareness of the limitations that this imposes on our practice, select specific actions to take to place these practices into context, and work to achieve whatever changes we can make.  We can start with addressing the question: “What is best nursing care” from the perspective of the values in the Nursing Manifesto.  There is no single answer to this question – but there are insights to be gained by thinking, talking and writing the ideas that arise from it. Once we have expressed our ideas, we can examine new and better ways to document our care, and continue to address the limitations of the existing practices that fail to document and support our best practices.

We welcome your ideas here – and stories about the times you provided what you think is the best nursing care!

off the charts

Expressing Gratitude For Our Global and Local Nursing Leaders


I have been fortunate to have been supported and influenced by many of nurses’ contemporary leaders: I studied with Dr. Jean Watson prior to completing my dissertation by taking 6 units of doctoral level electives with her at UCHS. I had contacted Dr. Watson during my Masters studies, and I was amazed at how approachable she was via email. Watson’s Theory of Human Caring has influenced and directed my work in a way that is immeasurable on many levels; being with her and spending a week in sacred center, studying emerging sacred-caring science concepts brought me to a new vision of how nursing education can and should be practiced.

 

I also stumbled upon the work of Dr. Peggy Chinn and the nurse manifest project during my early doctoral studies, and soon found myself embraced by the NurseManifest community. I was blessed to have been part of the first Nurse Manifest research project team, and the experience of presenting our findings together was monumental in my life as an emerging nursing scholar.

 

While Dr. Watson and Dr. Chinn epitomize the amazing academic and scholarly accomplishments of Nurses’ Living Legends, they both also remain approachable, kind, caring, and generous. They reflect back to us a deep love for nursing, coupled with calls toward caring and a level of social justice activism that is highly needed in our process of supporting both local and global healing. There are many other nurses whom I might call “global nursing leaders” who share in this attitude, commitment, and consciousness toward change.

 

I am also frequently touched by the leadership capacity of my nursing students; the willingness to change their lives, spread their wings, and find ways to bring caring, holism, and healing to the “local” bedside in environments where these concepts often remain fringe in the face of allopathic approaches. The many global nursing leaders inspire nursing students, and the continuum to me is clear; students and nurses need these leaders to raise our consciousness, build our confidence, and lead us into our own leadership capacity at the local level. We need global leaders to shine a light on our professional paths and support our deepening understanding of both self as nurse and our profession’s capacity to create nursing qua nursing as the norm.

 

I am honored to be working with my RN-BSN students this fall in their leadership coursework. We will look at Chinn’s Peace and power work and also explore leadership through holistic concepts. We will examine burnout and how we can recover or support others in their recovery through self-care. In analyzing our workplaces, we will explore Sharon Salzberg’s (a registered nurse and globally known meditation teacher) Real happiness at work: Meditations for accomplishment, achievement, and peace as a supportive tool for self-exploration around workplace issues.

 

Many nursing students struggle to perceive themselves as “local nurse leaders”, and I strive to support them to tap into their own leadership capacities, to create the types of healthcare workplaces where they can thrive and support the healing of their patients through integrative modalities and caring consciousness. I do believe one way to provide this platform for students’ emerging leadership is to create a caring environment for students, to support their own healing processes, and to role model shared leadership processes and self-care-healing for, and with, students. In this way, I humbly express my deepest gratitude for those global nursing leaders who have shone their light on my own professional and healing path when it was often far from clear where I was headed.

The Power of Nursing


On January 24th in the early morning hours my husband Brian woke me up because he said his left arm was hurting and he was nauseated.  After I gave him two aspirin we rushed to the ED of our regional hospital….He had a myocardial infarction in process.  The cardiac cath team was called, and an amazing interventional cardiologist performed a balloon angioplasty to open up the blocked artery.  After Brian was stabilized in the CVICU he was transferred to the CV Step Down unit to wait for surgery.  On January 29th the cardiothoracic surgeon performed a CABG x 4 and Brian was discharged on February 3rd.  It was quite an ordeal.  There are always lessons we learn when we are the recipients of health care.

As you can imagine this has been a life-altering event for both of us. During this critical time every person that we encountered and every circumstance that occurred, big and small, mattered to us.  I can honestly say that Brian and I experienced the most excellent care that I could ever imagine, and this made a significant difference in his healing and my experience as a family member.

The nursing staff at this hospital were wonderful. We know that nurses are the heart and soul of any hospital. Every single nurse that we encountered was knowledgeable, skilled, attentive and compassionate.  They were truly person and family-centered.  Every one of them asked how she/he could be helpful to us.  Watching the nurse caring for Brian immediately after surgery in the CVICU was amazing to me.  It was like watching the conductor of a symphony.  Her technological competence was incredible…she monitored everything moment by moment, while continuing to focus on Brian as a person experiencing this critical event, and on me as a wife fearful of what was happening.  When I was waiting for news of Brian’s condition during surgery, several of the staff stopped in to encourage me and to give me updates if they could.  This was so meaningful to me.  When Brian was recovering, the CVICU staff pushed and encouraged him and did anything they could to make me comfortable.  All the staff on the step-down unit exquisitely cared for Brian, supported us and made us feel “at home”.  I’m so grateful to the nursing staff for creating the healing environment where this level of care happens.

We often hear about the horrors of poor nursing care, so I wanted to share this story of hope and encouragement with everyone.  I am so proud to be a nurse because of the profound difference we make in the lives of people in the most vulnerable moments of their lives.  Yes, our cardiologist and surgeon saved Brian’s life, but the nurses were equally biogenic (life-giving) to both of us.  They preserved our dignity, prevented complications, prepared us for discharge, facilitated a smooth transition, allayed our anxieties, relieved our pain, provided comfort, lifted our spirits with laughter, gave us critical information, challenged him to do more than he thought possible, instilled hope for the future, involved us in choices, and took the time to listen to our fears and rants.

P.S. Brian is in cardiac rehab now and is recovering.

Never ever ever underestimate the power of nursing. We transform lives by healing through caring.

Celebrating recovery with Brian!

Celebrating recovery with Brian!

Book of the Year Award – twice!


On September 14, 2014, I posted news of the newly published book “Philosophies and Practices of Emancipatory Nursing: Social Justice as Praxis,”  noting its relevance for all NurseManifesters!  The book is edited by Paula Kagan, Marlaine Smith, and Peggy Chinn, and contains 22 original chapters by some of the leading nurse scholars in the area of Emancipatory textcritical inquiry.  The book has gained some attention, but in January, it was awarded two AJN “Book of the Year” awards – in the categories of History and Public Policy, and in Professional Issues.  You can see the press release about all of the awards here.  The link to. the article online is here.  The detailed comments of the reviewers are posted on the web as supplementary digital content; you can access this information online as a subscriber, or through your library.  The book is available in both paper and electronic formats – here is the Amazon link!

We are thrilled with these awards, not just because we know how important this book it, but because it is amazing for a book of this type to gain this kind of recognition in a “field” that typically focuses on very pragmatic and even “technical” topics.  Both of the reviewers who selected the book in their category commented on how accessible the content of the book is, even though much of the focus is on complex philosophic ideas.  If you have not yet had a chance to see the book, consider asking your library for a copy, and take some time to browse, and read!  Share your comments here about the details you see as particularly important for manifesting nursing!

Spiritual consciousness and healing

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This is my first time posting a blog and the experience has been both exciting and a little uncomfortable. I am moving out of my comfort zone, writing from my heart and soul. I’m thankful for the experience and hope … Continue reading