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A new response to questions about health care restructuring
FEBRUARY 1995, VOL 61, NO 2 PRRSIDENT’S
M E S S A G E
A new response to questions about health care restructuring eing a spokesperson for the nursing profession is not an easy task. A well-known author shares an interview experience. ~
The television cameras are rolling. They’ve trained on you. The reporter, so cordial moments ago, asks you a hideous question. It’s more than h i d e o u s i t ’ s “The Question from Hell.” Your heart pounds. Your mouth goes dry. You know you have to say something. But, what?[ The big questions being posed are, “What do you think about the major restructuring that is taking place in your health care facility?” and “What is nursing’s viewpoint on all of this?” We all must be prepared to answer these questions and be spokespeople for nursing, for our Association, and for the institutions in which we practice. Let’s examine the concepts that guide our practice and the vocabulary that describes our view of health care restructuring. NEW INSIGHTS AND IDEAS The author of The Fifth Discipline describes organizations that he predicts will thrive in the future as being learning organizations. The five components of such organizations are I systems thinking, I personal mastery, I mental models,
building a shared vision, and team learning.* The first two of these components are ingrained deeply in nursing; they are part of our wellrooted philosophy of care delivery. In quantifying our mental models, we must question the broad generalizations we use to understand the world and assess how these generalizations influence our actions. Do we indeed have a shared vision that is built on a set of principles and that guides us to our future? Is our vision full of commitment and sufficiently clear to lead us to goal-directed action? The final component is one with which we are familiar. Do we, however, engage in team learning enough that we can think with others as a team? Team learning requires that we relinquish our assumptions so we can develop new insights and learn new concepts and skillslearning that we could not accomplish through individual thought. In the current health care environment, team learning means that nurses cannot assume a posture of being protected from restructuring but must be part of the team that comes forward with ideas about new ways of organizing and structuring the ways we deliver care.
I
I
NEW VOCABULARY If we are seeking mental models that influence how we understand the world and a shared vision that is constructed of a set 308 AORN JOURNAL
of principles to guide our practice and delineate our future, we need a new vocabulary that characterizes our commitDR JANE c. ment and enerROTHROCK gy levels. This vocabulary cannot contain naive, innocent words or ones that protect us from being fully engaged in seeking new ways of delivering care. Here are some words and their definitions that we can begin using. I Reemerge: to come forth, become visible, develop, or evolve as something new or improved.3 a Reaffirm: to say positively, declare firmly, assert to be true? I Resurge: to rise again.5 Resurrect: to bring back into notice, practice, or use.h I Revitalize: to give vigor or life to.’ I Recreate: to refresh in body or mind, to nurture and create anew.R I Reimburse: to compensate for.’ I Reincarnate: to give new birth to the soul.’O
NEW ANSWERS FOR AN OLD QUESTION Let’s revisit the interview scenario but frame our responses in the new vocabulary that character-. izes our commitment. The television cameras are rolling, and they
FEBRUARY 1995, VOL 61, NO 2
are trained on you. The reporter asks “The Question from Heaven,” the question that every “reincarnated” nurse wants the chance to answer. Your heart pounds, and your mouth is dry, but you are ready to respond to the big questions, “What do you think about the major restructuring that is taking place in your health care facility?” and “What is nursing’s viewpoint on all of this?” You are prepared. The fear is under control as you tell yourself that it is only a camera. You know the rules for working effectively with the media: your voice, body, and face control the way you say something, but your mind controls what you say (and you know you have a wonderful mind-even though when the camera lights came on, you worried that you had lost it). You know the elements of a good answer: one that provides information that is honest, positive, understandable, and memorable. You take a deep breath and remember a prayer you read somewhere. Lord, Thou knowest better than I know myself that I am growing older and will someday be old. Keep me from getting talkative and particularly from the habit of thinking I must say something on every subject and on every occasion. [But, the reporter did ask me this question.] Release me from craving to straighten out everybody’s affairs [even though You know I am good at this]. Keep my mindfr-ee~from the recital of endless details; give me wings to get to the point. I ask for grace enough to listen to the tales of others’ pains.
Help me endure them with patience. But, seal my lips on my own aches and pairt-they are increasing and my love of rehearsing them is becoming sweeter as the years go by. Teach me the glorious lesson that occasionally it is possible that I may be mistaken [but, I don’t think I’m mistaken this time]. Keep me reasonably sweet. [Is it okay to tell You I can think of other things I’d rather be called than “sweet”?] I do not want to be a saint [well, maybe just this one time]. Make me thoughtful but not moody, helpful but not bossy. With my vast store of wisdom, it seems a pity not to use it all. [Please, dear Lord, help me remember the things I want to say to this reporter.] Amen.” Then you take another deep breath, smile, and answer the questions with your new, powerful, articulate vocabulary. You say,
I believe that nurses and the care they provide will reemerge as the vital link in health care organizations, which seek to reaffirm their values of safe, eflcient, and effective patient care. There is a resurgence in the need to quantify the relationship between the care the patient receives and the outcome of that care. This need has resurrected the importance of the nurse to that care. As we have come to realize that the primary reason that a patient enters our health care facility is to receive 309 AORN JOURNAL
nursing care, there has developed a revitalized interest in the contribution of nurses to the quality of that care. Nursing, therefore, is participating in restructuring efforts that aim to recreate a model and system of delivering patientand family-centered care. Part of our vision of this restructuring is the achievement of reimbursementfor services we can provide that are underpinned by both quality and cost-effectiveness. We believe that quality care equals nursing care and that every patient deserves the care of a nurse. In general, I would say that what we have learned as a health care team in looking at new ways of organizing and structuring the way we deliver care in this institution has resulted in nothing less than the reincarnation of the long-held belief that nurses provide available, affordable, accessible care to this community. Remember, a news report is a public service, and you are not really talking to a reporter but to the public. Deliver the message without doing battle, without misleading the listener, without being defensive, and without wasting the listener’s time. Remember also not to confuse the listener. Take the message and deliver it effectively. JANE C. ROTHROCK RN, DNSc, CNOR PRESIDENT Editor‘s note: Dr Rothrock‘s telephone answering machine and fax number is (6 I 0) 565-76 18. This line is dedicated for AORN members.
FEBRUARY 1995. VOL 61. NO 2
NOTES I . A Lustberg. “Succeeding as spokesperson,” in Leudership (Washington, DC: American Society of Association Executives, 1992) L63-L66. 2 . P M Senge, The Fifth Discipline (New York: Doubleday and Co, Inc, 1990). 3, Meri-ium-Wehstc,r’sCollegiate Dictionary. tenth ed, sv “reemerge.” 97 1. 4. Mer.rYuni-Welxter’s Collegiate Dictionury. tenth ed, sv “reaffirm,” 971. 5 . Merriani- Wehster’sCollegiute Dictionary, tenth ed, sv “resurge,” 999.
6. Merriuni- Wehster’s Collegiate Dictioiiuy. tenth ed, sv “resurrect,” 999. 7. Mer.riani-Webster’s Collegiate Dictioriuiy. tenth ed, sv “revitalize.” 1003. 8. Merriani- Webster’sCollegiute Dictionar:v. tenth ed, sv “recreate,” 977. 9. Meri-iam-Wehster’s Collegiate Dictionary. tenth ed. sv “reimburse,” 986. 10. Mer.r.iunr-Wehstfr’.sCollegiate Dictioiwry . tenth ed, sv “reincarnate,” 986. I I.Prayers for the Growing Old, author unknown.
AORN Delegates May Nominate Candidates from the Floor AORN members have seen the ballot and read the AORN Board of Directors candidates’ position statements, but the nominations process is not complete until the delegates have had the opportunity to nominate additional candidates from the floor at Congress. This open nomination occurs during the report of the Nominating Committee at the first House of Delegates session. A delegate who wishes to nominate a candidate from the floor must verify the candidate’s eligibility
and willingness to serve. Copies of this documentation must be at the podium before the session begins. When the President asks for nominees for each office, all delegates who wish to nominate candidates will stand, address the President, and, after being recognized by the President, submit the names of the candidates. Each nomination must be seconded. After all nominations are made, each new nominee may present his or her candidate’s speech at the House of Delegates session.
Stimulation Therapy Improves Coma Recovery Recovery from coma depends on the severity and location of the injury, the amount of time in coma, and the patient’s personality characteristics before the injury. According to an article in the August 1994 issue of Critical Cure Nurse, chances for recovery from coma can be increased if the coma patient undergoes stimulation therapy. The article summarizes a previous study in which 16 coma patients underwent a stimulation program and 14 coma patients underwent routine care. Although both groups had similar causes of coma and comparable Glasgow Coma Scale scores, all the coma patients who underwent stimulation therapy recovered from coma, but only three in the control group recovered. Providing meaningful stimuli to coma patients as soon as possible helps produce patient responses and decrease sensory deprivation. Health care providers should determine patients’ social history, including interests, hobbies, favorite music, and daily routine and use this infomiation when developing a plan for
stimulation therapy. Because research indicates that touch may promote wellness and reduce intracranial pressure, the article advises using various textures, lotions, and tdctile pressures when bathing a patient. To activate neuronal systems, a nurse can expose a patient to various odors (depending on the degree of injury to the nose and face), such as the patient’s favorite coffee, perfume or cologne, or spices. Developing an individualized coma stimulation program should be a group effort that includes physicians, nurses, neuropsychologists, dietitians, speech and language therapists, physical and occupational therapists, and anyone else who interacts with the patient, including family members. If a group effort is not possible, critical care nurses can incorporate these techniques into their care routines. L D Helwick, “Stimulationprograms for coma patients, “ Critical Care Nurse 14 (August 1994) 47-51.
310 A O R N JOURNAL
M E S S A G E
A new response to questions about health care restructuring eing a spokesperson for the nursing profession is not an easy task. A well-known author shares an interview experience. ~
The television cameras are rolling. They’ve trained on you. The reporter, so cordial moments ago, asks you a hideous question. It’s more than h i d e o u s i t ’ s “The Question from Hell.” Your heart pounds. Your mouth goes dry. You know you have to say something. But, what?[ The big questions being posed are, “What do you think about the major restructuring that is taking place in your health care facility?” and “What is nursing’s viewpoint on all of this?” We all must be prepared to answer these questions and be spokespeople for nursing, for our Association, and for the institutions in which we practice. Let’s examine the concepts that guide our practice and the vocabulary that describes our view of health care restructuring. NEW INSIGHTS AND IDEAS The author of The Fifth Discipline describes organizations that he predicts will thrive in the future as being learning organizations. The five components of such organizations are I systems thinking, I personal mastery, I mental models,
building a shared vision, and team learning.* The first two of these components are ingrained deeply in nursing; they are part of our wellrooted philosophy of care delivery. In quantifying our mental models, we must question the broad generalizations we use to understand the world and assess how these generalizations influence our actions. Do we indeed have a shared vision that is built on a set of principles and that guides us to our future? Is our vision full of commitment and sufficiently clear to lead us to goal-directed action? The final component is one with which we are familiar. Do we, however, engage in team learning enough that we can think with others as a team? Team learning requires that we relinquish our assumptions so we can develop new insights and learn new concepts and skillslearning that we could not accomplish through individual thought. In the current health care environment, team learning means that nurses cannot assume a posture of being protected from restructuring but must be part of the team that comes forward with ideas about new ways of organizing and structuring the ways we deliver care.
I
I
NEW VOCABULARY If we are seeking mental models that influence how we understand the world and a shared vision that is constructed of a set 308 AORN JOURNAL
of principles to guide our practice and delineate our future, we need a new vocabulary that characterizes our commitDR JANE c. ment and enerROTHROCK gy levels. This vocabulary cannot contain naive, innocent words or ones that protect us from being fully engaged in seeking new ways of delivering care. Here are some words and their definitions that we can begin using. I Reemerge: to come forth, become visible, develop, or evolve as something new or improved.3 a Reaffirm: to say positively, declare firmly, assert to be true? I Resurge: to rise again.5 Resurrect: to bring back into notice, practice, or use.h I Revitalize: to give vigor or life to.’ I Recreate: to refresh in body or mind, to nurture and create anew.R I Reimburse: to compensate for.’ I Reincarnate: to give new birth to the soul.’O
NEW ANSWERS FOR AN OLD QUESTION Let’s revisit the interview scenario but frame our responses in the new vocabulary that character-. izes our commitment. The television cameras are rolling, and they
FEBRUARY 1995, VOL 61, NO 2
are trained on you. The reporter asks “The Question from Heaven,” the question that every “reincarnated” nurse wants the chance to answer. Your heart pounds, and your mouth is dry, but you are ready to respond to the big questions, “What do you think about the major restructuring that is taking place in your health care facility?” and “What is nursing’s viewpoint on all of this?” You are prepared. The fear is under control as you tell yourself that it is only a camera. You know the rules for working effectively with the media: your voice, body, and face control the way you say something, but your mind controls what you say (and you know you have a wonderful mind-even though when the camera lights came on, you worried that you had lost it). You know the elements of a good answer: one that provides information that is honest, positive, understandable, and memorable. You take a deep breath and remember a prayer you read somewhere. Lord, Thou knowest better than I know myself that I am growing older and will someday be old. Keep me from getting talkative and particularly from the habit of thinking I must say something on every subject and on every occasion. [But, the reporter did ask me this question.] Release me from craving to straighten out everybody’s affairs [even though You know I am good at this]. Keep my mindfr-ee~from the recital of endless details; give me wings to get to the point. I ask for grace enough to listen to the tales of others’ pains.
Help me endure them with patience. But, seal my lips on my own aches and pairt-they are increasing and my love of rehearsing them is becoming sweeter as the years go by. Teach me the glorious lesson that occasionally it is possible that I may be mistaken [but, I don’t think I’m mistaken this time]. Keep me reasonably sweet. [Is it okay to tell You I can think of other things I’d rather be called than “sweet”?] I do not want to be a saint [well, maybe just this one time]. Make me thoughtful but not moody, helpful but not bossy. With my vast store of wisdom, it seems a pity not to use it all. [Please, dear Lord, help me remember the things I want to say to this reporter.] Amen.” Then you take another deep breath, smile, and answer the questions with your new, powerful, articulate vocabulary. You say,
I believe that nurses and the care they provide will reemerge as the vital link in health care organizations, which seek to reaffirm their values of safe, eflcient, and effective patient care. There is a resurgence in the need to quantify the relationship between the care the patient receives and the outcome of that care. This need has resurrected the importance of the nurse to that care. As we have come to realize that the primary reason that a patient enters our health care facility is to receive 309 AORN JOURNAL
nursing care, there has developed a revitalized interest in the contribution of nurses to the quality of that care. Nursing, therefore, is participating in restructuring efforts that aim to recreate a model and system of delivering patientand family-centered care. Part of our vision of this restructuring is the achievement of reimbursementfor services we can provide that are underpinned by both quality and cost-effectiveness. We believe that quality care equals nursing care and that every patient deserves the care of a nurse. In general, I would say that what we have learned as a health care team in looking at new ways of organizing and structuring the way we deliver care in this institution has resulted in nothing less than the reincarnation of the long-held belief that nurses provide available, affordable, accessible care to this community. Remember, a news report is a public service, and you are not really talking to a reporter but to the public. Deliver the message without doing battle, without misleading the listener, without being defensive, and without wasting the listener’s time. Remember also not to confuse the listener. Take the message and deliver it effectively. JANE C. ROTHROCK RN, DNSc, CNOR PRESIDENT Editor‘s note: Dr Rothrock‘s telephone answering machine and fax number is (6 I 0) 565-76 18. This line is dedicated for AORN members.
FEBRUARY 1995. VOL 61. NO 2
NOTES I . A Lustberg. “Succeeding as spokesperson,” in Leudership (Washington, DC: American Society of Association Executives, 1992) L63-L66. 2 . P M Senge, The Fifth Discipline (New York: Doubleday and Co, Inc, 1990). 3, Meri-ium-Wehstc,r’sCollegiate Dictionary. tenth ed, sv “reemerge.” 97 1. 4. Mer.rYuni-Welxter’s Collegiate Dictionury. tenth ed, sv “reaffirm,” 971. 5 . Merriani- Wehster’sCollegiute Dictionary, tenth ed, sv “resurge,” 999.
6. Merriuni- Wehster’s Collegiate Dictioiiuy. tenth ed, sv “resurrect,” 999. 7. Mer.riani-Webster’s Collegiate Dictioriuiy. tenth ed, sv “revitalize.” 1003. 8. Merriani- Webster’sCollegiute Dictionar:v. tenth ed, sv “recreate,” 977. 9. Meri-iam-Wehster’s Collegiate Dictionary. tenth ed. sv “reimburse,” 986. 10. Mer.r.iunr-Wehstfr’.sCollegiate Dictioiwry . tenth ed, sv “reincarnate,” 986. I I.Prayers for the Growing Old, author unknown.
AORN Delegates May Nominate Candidates from the Floor AORN members have seen the ballot and read the AORN Board of Directors candidates’ position statements, but the nominations process is not complete until the delegates have had the opportunity to nominate additional candidates from the floor at Congress. This open nomination occurs during the report of the Nominating Committee at the first House of Delegates session. A delegate who wishes to nominate a candidate from the floor must verify the candidate’s eligibility
and willingness to serve. Copies of this documentation must be at the podium before the session begins. When the President asks for nominees for each office, all delegates who wish to nominate candidates will stand, address the President, and, after being recognized by the President, submit the names of the candidates. Each nomination must be seconded. After all nominations are made, each new nominee may present his or her candidate’s speech at the House of Delegates session.
Stimulation Therapy Improves Coma Recovery Recovery from coma depends on the severity and location of the injury, the amount of time in coma, and the patient’s personality characteristics before the injury. According to an article in the August 1994 issue of Critical Cure Nurse, chances for recovery from coma can be increased if the coma patient undergoes stimulation therapy. The article summarizes a previous study in which 16 coma patients underwent a stimulation program and 14 coma patients underwent routine care. Although both groups had similar causes of coma and comparable Glasgow Coma Scale scores, all the coma patients who underwent stimulation therapy recovered from coma, but only three in the control group recovered. Providing meaningful stimuli to coma patients as soon as possible helps produce patient responses and decrease sensory deprivation. Health care providers should determine patients’ social history, including interests, hobbies, favorite music, and daily routine and use this infomiation when developing a plan for
stimulation therapy. Because research indicates that touch may promote wellness and reduce intracranial pressure, the article advises using various textures, lotions, and tdctile pressures when bathing a patient. To activate neuronal systems, a nurse can expose a patient to various odors (depending on the degree of injury to the nose and face), such as the patient’s favorite coffee, perfume or cologne, or spices. Developing an individualized coma stimulation program should be a group effort that includes physicians, nurses, neuropsychologists, dietitians, speech and language therapists, physical and occupational therapists, and anyone else who interacts with the patient, including family members. If a group effort is not possible, critical care nurses can incorporate these techniques into their care routines. L D Helwick, “Stimulationprograms for coma patients, “ Critical Care Nurse 14 (August 1994) 47-51.
310 A O R N JOURNAL