Wednesday, June 10, 2009

Change of Shift: A Virtual Care Plan for Effective Communication

Welcome to Change of Shift, nursing's vibrant blog carnival! I'm thrilled to be your guest host this week and hope you'll find the posts embedded here as interesting as I have. If you're visiting my blog for the first time, I should warn you that I channel Florence Nightingale. I don't take extreme liberties with Miss Nightingale, just try and figure out what her work might say about ours. Sometimes I hit, sometimes I miss. Today, I'm weaving the voices of front line clinicians, consumers, and other interested (and interesting) bloggers around the theme of communication, showing, perhaps, where we are ("Can you hear me? Can you hear me now?") and what enhanced communication might do for us in the future.

Here's a story about engaging patients in their plan of care. It happened to me several years ago when I sought care in my local ED for unrelenting chest pain of 3 days duration, was diagnosed with bilateral pulmonary emboli and admitted for 5 days of inpatient anticoagulation. (This account, by the way, does not constitute medical advice from either Flo or Bo.)

In the early days, mostly spent waiting for a therapeutic INR to bubble up in my errant body-turned-chemistry set, I noticed a large whiteboard opposite my bed. The labels affixed to the board led me to believe that the date, weather, names of the people caring for me, plus key elements of my plan of care, could be written there. My boredom, spirits, and activity level increased in a linear fashion, and by day 3, I couldn't resist messing with the whiteboard which had remained uncluttered by any data save the preprinted labels. So I documented, as best I understood it, my plan of care: vegetate; oxygenate; medicate; anticoagulate; educate; ruminate; irritate; agitate; & dissipate.

Since that appeared to be an effective way to engage others (it certainly seemed to hasten my discharge), I thought I'd categorize words of wisdom from the blogosphere in a similar fashion.

If you haven't met e-Patient Dave, I'm happy to introduce you to this remarkable gentleman. Dave blogs about his personal journey surviving kidney cancer at The New Life of e-Patient Dave and An IT professional, Dave recently attempted to interface his complicated medical history, housed in a patient-accessible hospital e-record, with Google Health. The outcome? A personal health record riddled with serious and significant errors. Dave's experience is being used to illustrate the primitive state of electronic medical records, even when high-end institutional and consumer products are used by an IT professional. You can read about his testimony at the National e-Health board meeting here. (Be sure to click on the slide show for a quick re-cap of Dave's compelling story.) Since I believe consumers and front line clinicians share many of the problems that arise when IT solutions perform poorly, I thought I'd put "automate" at the top of the communication care plan. I'd also like to acknowledge the efforts of Dave and others who share their personal journey in hopes of improving the system. So we could add "advocate" here, too.

I was happy to see a piece about proper use of pulse oximeters from AJN's Off the Charts blog. So, in a nod to the A-B-C's I decided to put "oxygenate" near the top of the plan of care. RehabRN's War Stories post talks about things that, while not oxygen, deserve top billing on a priorities list. (You'll have to take a deep breath while reading this one, another defense for indexing it here.)

See Jane Nurse adds "medicate" to the plan (or maybe she doesn't) in a post entitled No More Nitro for You. Ross, a Nurse in Australia, writes Medication Errors: Behind Closed Doors, putting the issue of medication errors on the chart (or, if you read what he correctly notes about under-reporting of errors and disclosure, maybe he doesn't).

If "medicate" hasn't yet made the care plan for improving communication, I'll add it myself. Really. I blog about medication safety on Medscape (at On Your Meds), where High-Alert Drugs: Eating the Elephant One Bite at a Time advises how to avoid mix-ups involving the most commonly confused drug name pair. (Spoiler alert: it's morphine and hydromorphone.)

Staying true to his "can do" approach, Sean Dent at My Strong Medicine puts his addition to the care plan to work, evaluating two new television shows about nurses: Nurse Jackie vs. HawthoRNe: The Battle of the TV Show Nurses Continues.
Sandy Summers at The Truth about Nursing also takes on Nurse Jackie in a detailed piece that includes a link to the first episode.

Shauna shares what it's been like to be handed a painful diagnosis, examining the best way to proceed when the words on the plan of care are unwelcome in The Six Words I Never Wanted to Speak.

And if you're looking for comprehensive ways to evaluate, check out 50 Fascinating Online Psychology Tests provided by The Forensic Scientist Blog. (Flo & Bo thinking, "TMI." But, hey, please yourself.)

While healthcare is full of interesting challenges, we're not short on thinkers contemplating solutions. Over at Digital Doorway, Keith, a seasoned blogger and mentor to many (including Flo & Bo), examines health coaching as a natural place for nurses to apply their knowledge and skills in Health Coaching and Multiple Chemical Sensitivity. Thanks for modeling out-of-the-box ways to nurse while dealing with personal health challenges. You get the first, but not only entry, under "Cognate," Keith!

Mother Jones at Nurse Ratched's Place considers the merits of microblogging and online networking in The Twitter People, while fessing up, Nurse Jackie-style, to a small addiction problem. (Okay, Twitter-addiction may not be in the same league as Nurse Jackie's problem.)

Kim at Emergiblog, the mothership of Change of Shift, offers words of wisdom in the "just think" department, too. She points to the value of civil discourse when communicating in the virtual realm. If you didn't know what, Jane, you ignorant $^&*! meant before now, you're in for a treat! Pick your words carefully when documenting on the care plan, too!

Finally, if you want a textbook approach for maximizing your cognitive abilities, check out The SharpBrains Guide to Brain Fitness.

Over at Nurse Connect, Nurse Kathy provides a spot-on list of things she thinks could transform nursing and asks, What's on your nurse's dream list?. Read it (especially if you need a laugh). I'll simply say I could have squeezed her into the care plan under "automate," "medicate," or "cognate." But since she's exceptionally creative, I'm going to give her a special place in the communication plan of care: innovate.

The systems we rely on (Paging, e-Patient Dave! Paging e-Patient Dave!) often don't set up healthcare workers to win. In My Garage, Your Checklists & Patient Safety, Joe Bormel at Healthcare Infomatics illustrates how other industries apply principles from human factors engineering to determine when and whether humans benefit from prompts. Flo & Bo are always interested in spreading the word about "the science behind the compliance" (e.g., Joint Commission standards).

I somehow felt "procreate" should fall near the bottom of the care plan. (And may your fingers turn black and rot off if you enter it on mine!) But the topic is surely on the minds of bloggers. As a long-time perinatal nurse, I'm always interested in these conversations. My engineer's mind simply cannot wrap itself around processes that yield such highly variable results as Cesarean birth rates (spanning from 20% to 40% in the course of my 25 year career). What's up with that?

Chris, from The Man-Nurse Diaries, sums up what's being said about home birth in the blogosphere with Home Birth Bonanza. And a host of communication-sensitive strategies for promoting healthy birth experiences can be found In A Maternity Care Utopia at Rebirth.

Over at Reality Rounds, we get to see how incomplete unit-to-unit communication impacts staff in The Pregnancy Secret (or as the author aptly observes, "how nurses get outed at work when they are pregnant").

Dave at The Back Pain Blog sends words of evidenced-based wisdom about Back Pain and Your Mattress setting the tone for "rejuvenate," a key component needed to communicate. Finally, Nurse Laura from Nurse Connect adds her prescriptive advice. You'll know exactly what should be next on your "to do" list once you've read Nurses: It's Time to Reorient Ourselves.

Thanks for visiting! Use the comment space to add to the virtual plan of care!

Change of Shift happens again on 6/25, hosted by RehabRN. Send submissions to


Kim said...

Wow - this looks fantastic!!! Just got my internet back up (how DARE it go down!) so will post a link and spread the word!

Thanks so much for hosting!

Mother said...

Great set of posts. Thanks for including me in your lineup. I wonder if Nurse Jackie is addicted to Twitter.


Jeff said...

Wow, great job I can't wait to read all of it.

Reality Rounds said...

Thanks for hosting! Great job.

Shauna said...

Looking forward to some fantastic reading! Thanks for including me.

Love the layout--Great job!!!

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