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Chautauqua 1991: The Tradition Continues
OCTOBER 1991, VOL 54, NO 4
AORN JOURNAL
Colorado Nurses’ Association’s Annual Educational Seminar
C
hautauqua 1991: The Tradition Continues
July 26 through Aug 1,1991
C
hautauqua, the week-long educational seminar sponsored by the Colorado Nurses’ Association, is presented each year by highly qualified, recognized nursing leaders. This year, nurses convened in Vail, Colo, from July 26 through Aug 1 to attend the continuing education seminars. The theme of this year’s meeting was “Valuing Ourselves-Valuing Our Practice.” Nurses in various specialties and with different levels of expertise had the opportunity to interact with each other; learn the newest trends in nursing practice; and develop clinical, administrative, and educational skills. Following is a brief summary of some of the seminars presented at the 16th annual Chautauqua.
Working with the Media
S
usan B. Christoph, RN, DNSc, COL, US Army Nurse Corps, spoke to a full room about interviewing with different media. Dr Christoph, chief of the Department of Nursing, Ireland Army Community Hospital, Ft Knox, Ky, cited the “three Ps,” professional, proud, and powerful, as the
image nurses should attempt to portray to the media. Additionally, she discussed the importance of developing excellent presentation skills. “To work well with the media, you must know yourself and nursing, you must learn to write for and speak to multiple audiences, and you must cultivate good communication skills,” Dr Christoph said. She emphasized Colonel Susan B. Christoph animatedly that interviews are describes the pitfalls of interviewing opportunities for nurs- with the various media. es to deliver specific messages to specific Front-Line Managers ’ audiences. For interviewers who Dilemmas attempt to get you to stray from arol Montgomery, RN, your message, she listed severPhD, assistant professor, al transitory phrases the interviewee can use to acknowledge University of Colorado Health the interviewer’s point and then Sciences Center, Denver, disreturn to his or her original cussed the dilemmas of how managers can maintain effective message. Preparation is the most communication and a caring attiimportant step, according to Dr tude while performing their roles Christoph. When giving an as front-line managers. She offered three styles of interview, you must, “know your story, use quotable lan- communication to help nurses guage, consider the audience, resolve conflicts in a timely, and anticipate difficult ques- assertive manner. The cooperative communication style focustions,” she said.
C
843
OCTOBER 1991, VOL 54, NO 4
AORN JOURNAL
es on interrupting a person’s defensiveness (ie. inner speech) to get your message through. A second c om m u n i cation s t y 1e , referred to as “tit-for-tat.” is the simplest. shortest. and best method for reaching calculating people. It is based on the theory that predictable responses are required to increase trust. and that people must allow themselves to be provoked enough to set limits and to forgive. The most aggressive communication style is based on marine research. The following tips for survival apply to conflict situations. Assume unidentified fish are sharks. Do not bleed. even when cut. Blood sends sharks into a frenzy. Demonstrate to the shark that you a r e e x p e r i enced-use a sharp. controlled blow to the nose. Know that i t is unethical to offer another swimmer as a diversion. Aggressive communication also is used when communicating with tyrants. s h e s a i d . Nurses must be aware of nonverbal c o m m u n i c a t i o n a n d must be sure they do not use submissive gestures when communicating; tyrants respond to submissive gestures in the same way sharks respond to blood. She emphasized how important it is for nurses to maintain eye contact. She also stated the importance of follow-up after a conflict and approaching the person as an equal. Dr Montgomery discussed
the concept of caring and the risk for burnout among managers. She said managers have a more difficult time detaching themselves from their products (ie, people) and that the more feelings a person attaches to work, the greater the potential for pain and burnout. She offered the following advice to nurse leaders and managers. Embrace what is, rather than trying to make things perfect. D o not c o n f u s e a c t i o n with accomplishment. Allow people to make m i s takes and fail.
Transportiiig Critically Ill Patients
P
atient transport blossomed in the military in the twentieth century, when more than 20,000 men were evacuated by helicopter from the battlefields in Korea, according to Renee Semonin-Holleran. RN, PhD, CEN. CCRN, chief flight nurse at University Air C a r e , Cincinnati. Since then, civilian flight p r o g r a m s have been established in several major cities across the country: however, many currently are experiencing financial hardships because of t h e e x p e n s e involved in critically ill patient transportation. Dr Semonin-Holleran said the cost of maintaining a flight program with two aircraft is a p p r o x i m a t e l y $60.000 p e r month. Insurance will pay for s o m e services, but b e c a u s e Medicare and Medicaid do not
reimburse for emergency transportation, the programs rely on donations to survive. Because trauma is the number o n e killer t h r o u g h t h e fourth decade of life, finding better ways to transport trauma victims to medical facilities is a major concern, according to Dr Semonin-Holleran. She listed the following reasons for using flight transport: f a s t e r than e m e r g e n c y ground transport, better able to carry multiple victims, and better able to access remote areas, including wilderness sites. Ground transportation takes three times longer than air transportation. The faster critically ill patients receive treatment, she said, the higher their chances for survival. Though there are risks involved in transporting trauma patients (eg, potential for further injury o r death, delays), D r Semonin-Holleran said medical personnel often have only about one hour to get the victim to help before he or she dies. At least one person on every flight has advanced life support training, so patients receive a higher level of care than they might if they were transported a n o t h e r way, s h e said. T h e main disadvantages of using helicopters to transport critically ill patients, according to Dr Semonin-Holleran, include weather limitations, helicopter a v a i l a b i l i t y , c o s t , a n d the impact on the patient. In c l o s i n g , D r S e m o n i n H o l l e r a n m e n t i o n e d three things every nurse interested in
OCTOBER 1991, VOL 54, NO 4
AORN JOURNAL
Throughout the pre- AORN took the lead a few sentation, Hartman years ago when it developed its encouraged nurses to standards of perioperative care, publish the results of and that AORN is in the foretheir quality improve- front on competency-based perment programs and formance standards. different methods of A quality improvement proimplementing those gram will be more meaningful, programs. Hartman said, if it is simple. “If Hartman presented staff members do not see it as the new terms and meaningful, they will not parconcepts in the ticipate, and it will not be AMH/92 Accreditation meaningful if staff members Manual for Hospitals. are not involved. Once you She explained that bring quality improvement into quality improvement performance, it becomes meanstill includes struc- ingful to staff because it carries Dr Renee Semonin-Holleran explains tures and Processes, some weight.” Hartman said the 1992 accredand that now it also the risks of emergency air transport. includes outcomes. itation manual is complete, but She described out- by 1994, the Joint Commission air transport should have: good comes as the result of process will be focusing on a more integrated approach (ie, functions communication skills, at least and structure. According to Hartman, when rather than specific disciplines) three years of critical care experience, and the ability to a quality threshold is not met, and the process of performance the Joint Commission surveyor review by peers, based on stanwork in a field environment. identifies it as an opportunity dards of performance. Documenting Quality that needs to be approached aggressively s a nurse surveyor for the and then reevaluated. Joint Commission on The surveyors look for a Accreditation of Healthcare concurrent approach in a Organizations, Oakbrook Ter- quality improvement race, Ill, Cynthia Hartman, RN, program, emphasizing MS, CNAA, spoke on the cur- the timeliness of the rent issues in documenting action and evaluation, quality. She described the she said. Current surveynineties as the decade that ors focus on interviewbelongs to the nurse. ing, teaching, and evalu“Nursing is a discipline that ating the patient’s ability is still trusted by the public. to manage his or her We need to continue to justify own care at home. our means,” she said, emphaHartman also focused sizing the need for nurses to on standards of care, statdocument improvement in ing that standards of care patient care, focusing on posi- and standards of practice tive outcomes rather than only are more interwoven than Cynthia Hartman fields questions in the past. She said that about documenting quality. negative ones.
A
OCTOBER 199 I , VOL 54, NO 4
AORNJOURNAL
According to Dr Joel, we can better meet the psychosocial needs of elderly people in the future by educating people on how to spend leisure time, identifying sensitivities in corporate employees who are over 50 years of age, g i v i n g t h e elderly t h e power to make decisions a b o u t therapeutic restraints, developing hospices for very frail elderly people rather than just for cancer Vicki D. Lachman, RN, PhD, CS. Health Care for the patients, and CNA, president. V L Associates. starting companion care Philadelphia, spoke at one of sever- Elderly programs. al luncheon seminars. Lachman he “ o v e r 85” a g e Aging should not be seen as emphasized the i m p o r t a n c e of unleashing your creativity and gave T g r o u p is g r o w i n g illness, and therefore as negaseveral suggestions on how to be faster than any other, and tive, Dr Joel said. “We must by the year 2020 there will educate nurses to see chronic more creative. be three dependents for disease as a new trajectory of every worker, according to wellness to avoid creating a Assertiveness: Just Say Lucille Joel, RN, EdD, FAAN, highly dependent and negative “Yes president of the A m e r i c a n aging population.” Nurses Association ( A N A ) , LYNNHOLLADAY im W o l i n s k i , M S W , a Kansas City, Mo, and professor ASSOCIATE EDITOR self-management consul- at Rutgers University College BONNIEG. DENHOLM, RN, MS, tant and national speaker. of Nursing, New Brunswick, CNOR began her presentation by say- NJ. CLINICAL EDITOR ing. “Look at people in your Though Medicare patients life, and identify who recycles account for only 40% of hospital your energy. Ask who recycles admissions, Dr Joel said, they back to you, and what you are consume 60% of hospital giving them.” resources. Elderly people often She said that saying “yes” to are admitted to hospitals because ourselves often is interpreted their movement and activity is by others as saying “no” to restricted. When one system in them, and they usually do not an elderly patient is failing, mullike it. tisystem problems often develop “Balance is about making that demand more complex treatchoices.” Wolinski said. She ments. explained that people need to She said society must work to clarify where they want to be. eliminate biases toward the T h i s could mean creating a elderly and must recognize what new identity by being assertive they are able to contribute. and setting boundaries. She explained that people have more control when giving than when receiving. Wolinski described assertiveness as “letting go of what others think.” The key is knowing your own needs and goals. Being a s s e r t i v e is not about telling anyone anything; it is about being creatively selfish and assertive with yourself, a c c o r d i n g to Wolinski.
”
K
AORN JOURNAL
Colorado Nurses’ Association’s Annual Educational Seminar
C
hautauqua 1991: The Tradition Continues
July 26 through Aug 1,1991
C
hautauqua, the week-long educational seminar sponsored by the Colorado Nurses’ Association, is presented each year by highly qualified, recognized nursing leaders. This year, nurses convened in Vail, Colo, from July 26 through Aug 1 to attend the continuing education seminars. The theme of this year’s meeting was “Valuing Ourselves-Valuing Our Practice.” Nurses in various specialties and with different levels of expertise had the opportunity to interact with each other; learn the newest trends in nursing practice; and develop clinical, administrative, and educational skills. Following is a brief summary of some of the seminars presented at the 16th annual Chautauqua.
Working with the Media
S
usan B. Christoph, RN, DNSc, COL, US Army Nurse Corps, spoke to a full room about interviewing with different media. Dr Christoph, chief of the Department of Nursing, Ireland Army Community Hospital, Ft Knox, Ky, cited the “three Ps,” professional, proud, and powerful, as the
image nurses should attempt to portray to the media. Additionally, she discussed the importance of developing excellent presentation skills. “To work well with the media, you must know yourself and nursing, you must learn to write for and speak to multiple audiences, and you must cultivate good communication skills,” Dr Christoph said. She emphasized Colonel Susan B. Christoph animatedly that interviews are describes the pitfalls of interviewing opportunities for nurs- with the various media. es to deliver specific messages to specific Front-Line Managers ’ audiences. For interviewers who Dilemmas attempt to get you to stray from arol Montgomery, RN, your message, she listed severPhD, assistant professor, al transitory phrases the interviewee can use to acknowledge University of Colorado Health the interviewer’s point and then Sciences Center, Denver, disreturn to his or her original cussed the dilemmas of how managers can maintain effective message. Preparation is the most communication and a caring attiimportant step, according to Dr tude while performing their roles Christoph. When giving an as front-line managers. She offered three styles of interview, you must, “know your story, use quotable lan- communication to help nurses guage, consider the audience, resolve conflicts in a timely, and anticipate difficult ques- assertive manner. The cooperative communication style focustions,” she said.
C
843
OCTOBER 1991, VOL 54, NO 4
AORN JOURNAL
es on interrupting a person’s defensiveness (ie. inner speech) to get your message through. A second c om m u n i cation s t y 1e , referred to as “tit-for-tat.” is the simplest. shortest. and best method for reaching calculating people. It is based on the theory that predictable responses are required to increase trust. and that people must allow themselves to be provoked enough to set limits and to forgive. The most aggressive communication style is based on marine research. The following tips for survival apply to conflict situations. Assume unidentified fish are sharks. Do not bleed. even when cut. Blood sends sharks into a frenzy. Demonstrate to the shark that you a r e e x p e r i enced-use a sharp. controlled blow to the nose. Know that i t is unethical to offer another swimmer as a diversion. Aggressive communication also is used when communicating with tyrants. s h e s a i d . Nurses must be aware of nonverbal c o m m u n i c a t i o n a n d must be sure they do not use submissive gestures when communicating; tyrants respond to submissive gestures in the same way sharks respond to blood. She emphasized how important it is for nurses to maintain eye contact. She also stated the importance of follow-up after a conflict and approaching the person as an equal. Dr Montgomery discussed
the concept of caring and the risk for burnout among managers. She said managers have a more difficult time detaching themselves from their products (ie, people) and that the more feelings a person attaches to work, the greater the potential for pain and burnout. She offered the following advice to nurse leaders and managers. Embrace what is, rather than trying to make things perfect. D o not c o n f u s e a c t i o n with accomplishment. Allow people to make m i s takes and fail.
Transportiiig Critically Ill Patients
P
atient transport blossomed in the military in the twentieth century, when more than 20,000 men were evacuated by helicopter from the battlefields in Korea, according to Renee Semonin-Holleran. RN, PhD, CEN. CCRN, chief flight nurse at University Air C a r e , Cincinnati. Since then, civilian flight p r o g r a m s have been established in several major cities across the country: however, many currently are experiencing financial hardships because of t h e e x p e n s e involved in critically ill patient transportation. Dr Semonin-Holleran said the cost of maintaining a flight program with two aircraft is a p p r o x i m a t e l y $60.000 p e r month. Insurance will pay for s o m e services, but b e c a u s e Medicare and Medicaid do not
reimburse for emergency transportation, the programs rely on donations to survive. Because trauma is the number o n e killer t h r o u g h t h e fourth decade of life, finding better ways to transport trauma victims to medical facilities is a major concern, according to Dr Semonin-Holleran. She listed the following reasons for using flight transport: f a s t e r than e m e r g e n c y ground transport, better able to carry multiple victims, and better able to access remote areas, including wilderness sites. Ground transportation takes three times longer than air transportation. The faster critically ill patients receive treatment, she said, the higher their chances for survival. Though there are risks involved in transporting trauma patients (eg, potential for further injury o r death, delays), D r Semonin-Holleran said medical personnel often have only about one hour to get the victim to help before he or she dies. At least one person on every flight has advanced life support training, so patients receive a higher level of care than they might if they were transported a n o t h e r way, s h e said. T h e main disadvantages of using helicopters to transport critically ill patients, according to Dr Semonin-Holleran, include weather limitations, helicopter a v a i l a b i l i t y , c o s t , a n d the impact on the patient. In c l o s i n g , D r S e m o n i n H o l l e r a n m e n t i o n e d three things every nurse interested in
OCTOBER 1991, VOL 54, NO 4
AORN JOURNAL
Throughout the pre- AORN took the lead a few sentation, Hartman years ago when it developed its encouraged nurses to standards of perioperative care, publish the results of and that AORN is in the foretheir quality improve- front on competency-based perment programs and formance standards. different methods of A quality improvement proimplementing those gram will be more meaningful, programs. Hartman said, if it is simple. “If Hartman presented staff members do not see it as the new terms and meaningful, they will not parconcepts in the ticipate, and it will not be AMH/92 Accreditation meaningful if staff members Manual for Hospitals. are not involved. Once you She explained that bring quality improvement into quality improvement performance, it becomes meanstill includes struc- ingful to staff because it carries Dr Renee Semonin-Holleran explains tures and Processes, some weight.” Hartman said the 1992 accredand that now it also the risks of emergency air transport. includes outcomes. itation manual is complete, but She described out- by 1994, the Joint Commission air transport should have: good comes as the result of process will be focusing on a more integrated approach (ie, functions communication skills, at least and structure. According to Hartman, when rather than specific disciplines) three years of critical care experience, and the ability to a quality threshold is not met, and the process of performance the Joint Commission surveyor review by peers, based on stanwork in a field environment. identifies it as an opportunity dards of performance. Documenting Quality that needs to be approached aggressively s a nurse surveyor for the and then reevaluated. Joint Commission on The surveyors look for a Accreditation of Healthcare concurrent approach in a Organizations, Oakbrook Ter- quality improvement race, Ill, Cynthia Hartman, RN, program, emphasizing MS, CNAA, spoke on the cur- the timeliness of the rent issues in documenting action and evaluation, quality. She described the she said. Current surveynineties as the decade that ors focus on interviewbelongs to the nurse. ing, teaching, and evalu“Nursing is a discipline that ating the patient’s ability is still trusted by the public. to manage his or her We need to continue to justify own care at home. our means,” she said, emphaHartman also focused sizing the need for nurses to on standards of care, statdocument improvement in ing that standards of care patient care, focusing on posi- and standards of practice tive outcomes rather than only are more interwoven than Cynthia Hartman fields questions in the past. She said that about documenting quality. negative ones.
A
OCTOBER 199 I , VOL 54, NO 4
AORNJOURNAL
According to Dr Joel, we can better meet the psychosocial needs of elderly people in the future by educating people on how to spend leisure time, identifying sensitivities in corporate employees who are over 50 years of age, g i v i n g t h e elderly t h e power to make decisions a b o u t therapeutic restraints, developing hospices for very frail elderly people rather than just for cancer Vicki D. Lachman, RN, PhD, CS. Health Care for the patients, and CNA, president. V L Associates. starting companion care Philadelphia, spoke at one of sever- Elderly programs. al luncheon seminars. Lachman he “ o v e r 85” a g e Aging should not be seen as emphasized the i m p o r t a n c e of unleashing your creativity and gave T g r o u p is g r o w i n g illness, and therefore as negaseveral suggestions on how to be faster than any other, and tive, Dr Joel said. “We must by the year 2020 there will educate nurses to see chronic more creative. be three dependents for disease as a new trajectory of every worker, according to wellness to avoid creating a Assertiveness: Just Say Lucille Joel, RN, EdD, FAAN, highly dependent and negative “Yes president of the A m e r i c a n aging population.” Nurses Association ( A N A ) , LYNNHOLLADAY im W o l i n s k i , M S W , a Kansas City, Mo, and professor ASSOCIATE EDITOR self-management consul- at Rutgers University College BONNIEG. DENHOLM, RN, MS, tant and national speaker. of Nursing, New Brunswick, CNOR began her presentation by say- NJ. CLINICAL EDITOR ing. “Look at people in your Though Medicare patients life, and identify who recycles account for only 40% of hospital your energy. Ask who recycles admissions, Dr Joel said, they back to you, and what you are consume 60% of hospital giving them.” resources. Elderly people often She said that saying “yes” to are admitted to hospitals because ourselves often is interpreted their movement and activity is by others as saying “no” to restricted. When one system in them, and they usually do not an elderly patient is failing, mullike it. tisystem problems often develop “Balance is about making that demand more complex treatchoices.” Wolinski said. She ments. explained that people need to She said society must work to clarify where they want to be. eliminate biases toward the T h i s could mean creating a elderly and must recognize what new identity by being assertive they are able to contribute. and setting boundaries. She explained that people have more control when giving than when receiving. Wolinski described assertiveness as “letting go of what others think.” The key is knowing your own needs and goals. Being a s s e r t i v e is not about telling anyone anything; it is about being creatively selfish and assertive with yourself, a c c o r d i n g to Wolinski.
”
K