- Email: [email protected]
Congress General Sessions
Congress General Sessions
A
ttendees of the 60th Congress General sessions heard inspirational, practical, and thought-provoking presentations. Featured speakers at these sessions promoted collaboration, a culture of transparency in the OR, the power of positive thinking, improved approaches for decision making, emotional intelligence, and humor as a shortcut to happiness. Following are brief accounts of this year’s sessions. USING SIMULATION TO DEMONSTRATE PERIOPERATIVE COLLABORATION To exemplify the effect of collaboration between perioperative personnel and the infection preventionist, Paula R. Graling, DNP, RN, CNOR, CNS, past president of AORN and current president of the AORN Foundation, led a panel of eight health care professionals in a simulation about a fictional patient who developed a postoperative surgical site infection (SSI). During the Jerry G. Peers Lectureship, “Simulation: Collaboration Between the Perioperative RN and Infection Preventionist,” the panel performed a root cause analysis and debriefing to identify missed opportunities to prevent an SSI in the fictional patient. The simulation began in a clinic examination room when the patient presented with a superficial wound infection after hernia surgery. A series of videotaped vignettes portrayed the multidisciplinary team members reviewing the care provided to the patient during her hospitalization. After viewing each vignette, attendees were asked a series of questions and answered them by a show of hands. Attendees helped the panel identify multiple problems that might have caused the patient’s SSI, including
n
failure of the surgeon and anesthesia professional to adequately communicate whether antibiotic redosing should occur and, if so, when; and n failure of scrubbed personnel to adhere to the basics of aseptic technique. Dr Graling asked attendees to come to the microphone to report on successes and failures at their facilities. From this interactive discussion, attendees determined that everyone should at least consider the following steps: n
Implement updated presurgical skin preparation for all patients whether surgery is performed in the hospital or an ambulatory setting. n Remember to check the sterility of the instruments every time.
n
the patient’s failure to take the two prescribed preoperative antiseptic showers; n hair removal using a razor in the OR; n failure to cleanse the hub of the IV line before injecting the antibiotic;
A panelist participates in a root cause analysis and debriefing to identify missed opportunities to prevent a postoperative surgical site infection in a fictional patient. http://dx.doi.org/10.1016/j.aorn.2013.04.015
640 j AORN Journal
June 2013
Vol 97
No 6
Ó AORN Inc, 2013
CONGRESS GENERAL SESSIONS n n n
n
n n n n
Use forced-air warming for 30 minutes in the preoperative area. Avoid dual standards of care between inpatient and ambulatory settings. Repeat antibiotic dosing based on the percentage of blood loss so that the level of antibiotics in the blood remains consistent. Have an evidence-based, multidisciplinary conversation about bringing bags and personal items into the OR. Implement back-to-best practices to ensure staff member competency. Institute multidisciplinary follow-up of all reported adverse incidents. Ensure that the patient’s glucose levels are monitored and controlled. Make the infection preventionist an integral member of the surgical team.
The concluding sentiment and discussion focused on perioperative nurses as the patient’s last line of defense against acquiring an SSI and the importance of collaboration between perioperative team members and the facility infection preventionist to achieve best practices and thus prevent SSIs in vulnerable perioperative populations. REBECCA HOLM MSN, RN, CNOR CLINICAL EDITOR
A CALL FOR CULTURE CHANGE At the session “The New Accountability Movement: How Transparency Is Changing the OR,” Marty Makary, MD, MPH, discussed the state of patient safety in the United States. Little progress has been made in patient safety in the past 10 years despite efforts to promote it, according to Dr Makary, a surgeon at Johns Hopkins, Baltimore, Maryland, and New York Times bestselling author of Unaccountable, a book on how teamwork and transparency can save American health care. He shared the story of St Vincent’s Hospital in New York City, a once-prospering hospital that went bankrupt and closed after 160 years. The hospital’s
www.aornjournal.org
Dr Marty Makary stresses the need for culture change to improve patient safety.
decline was caused by executives who had become dangerously out of touch with the frontline providers, a trend Dr Makary indicated is one of the greatest threats to American medicine. He extended his argument by saying that this is a dangerous trend in society in general, not just in health care, and gave several examples in the financial industry. To solve the nation’s current problems in health care, the culture of medicine needs to change. Changing the culture of medicine involves lifting the veil of anonymity and restoring dignity and value in the OR. That begins with executives reaching out to frontline providers to understand what providers need so that they can do their jobs better. Dr Makary cited Steve Jobs, cofounder and former CEO of Apple, Inc, as a “genius manager” who leveled the hierarchy by eating in the company cafeteria and holding conversations with new employees. Dr Makary declared that good management is not something that needs to be invented but rather “a value in society we need to restore.” He described how Apple store employees are always eager to help customers, despite not having commission-based roles, because of the successful workplace culture that encourages workers to take pride in their organization. Dr Makary noted that a corporate culture goes “sour” when employees are concerned only about AORN Journal j 641
June 2013
CONGRESS GENERAL SESSIONS
Vol 97 No 6
“doing their job.” Culture defines how employees do things, including whether a surgeon pursues a minimally invasive surgery or a maximum invasive surgery. He then highlighted results from a questionnaire on safety attitudes that showed that only 18% to 20% of hospital personnel surveyed would go to their own facility for medical care. In a slide comparison, he showed a direct correlation between postoperative morbidity rates and the percentage of medical personnel who would feel safe as a patient in their own facility. As a lead author for the original Johns Hopkins surgical checklist and as a contributor to the World Health Organization Surgical Safety Checklist, Dr Makary stressed the importance of the preoperative checklist and, particularly, knowing the names of the team members who work on one’s shift. Among a survey of perioperative professionals, physicians ranked the lowest among nurses, anesthetists, and others for knowing the names of colleagues on their shift. The culture of “speaking up,” which encourages personnel to voice their concerns without fear of retribution, needs to be embraced. Research indicates that perioperative professionals are more likely to speak up when OR teams use surgical checklists. A recent study of hospital leaders revealed that 26% believe that nurses’ fear of retribution decreases safety at their hospital. Dr Makary gave the call to action to restore value and dignity in the OR by promoting the culture of speaking up, noting that changing the culture is necessary to save American health care.
in 2003. In his talk “Plugging in to Your Potential” at the AORN Foundation session, Martinez described three years of recovery and more than 32 surgeries. He talked to the audience about how nurses and his mother helped him change from a young, angry survivor who wondered what he had done to deserve his severe burn injuries and who saw his life goals disappearing to someone who believes that “you can choose where to go; you need to find a way to be positive, to adapt, and to overcome whatever comes your way.” Martinez humorously described his first thoughts after waking from a medically induced coma and listening to the physician describe what “the nurse” would help him do to recover. At his young age, he said, he tuned out the physician and imagined that this nurse would be a young gorgeous woman who would fall madly in love with him while providing his care. He was clearly disappointed to meet instead a bearded male nurse named Mike. Martinez told the audience that he and Mike became close friends, and he credits Mike with helping in his recovery. In a less humorous vein, he spoke of what it felt like to
LESLIE KNUDSON CONTENT EDITOR
THE POTENTIAL TO MAKE A DIFFERENCE At 19 years of age, JR Martinez believed that joining the army would provide him with educational opportunities that he could not access as the only son of a single mother. What it provided instead was a 34% burn injury and other severe injuries from driving over a roadside bomb in Iraq
642 j AORN Journal
JR Martinez entertains attendees with humorous and inspiring insights that he gained through his recovery from the severe burns that he sustained in Iraq in 2003.
CONGRESS GENERAL SESSIONS survive the explosion and be trapped in a burning Humvee. Martinez credits his nurse with helping him confront his devastating facial burnsdMike told him that what he would see when he looked in the mirror was not good, but it would get better, and he helped Martinez make it through a painful but necessary recovery. Nurses, he said, “help make scary and uncomfortable places not so scary.” After seeing the extent of his injuries, Martinez fell into a deep depression. He saw his life and his goals as having been destroyed and lashed out in anger at his mother when she tried to comfort him. His mother, whom he affectionately refers to as the “hand grenade,” told him he had a lot to learn. She encouraged him to be positive and told him that a purpose for his life would emerge. She also told him that whoever was in his life from this point on would be there because they valued him and would not be troubled by how he looked. He has come to believe that everyone has strengths and weaknesses and that in times of difficulty it is important to focus on strengths to cope and adapt to changes. During his recovery, Martinez did find new purpose. Hospital staff members asked him to speak to other patients with similar difficulties. He learned he could help people, which made him feel good. After being asked to speak publicly about his experience after his discharge, Martinez auditioned for and was offered a three-month role on All My Children, a soap opera, and went on to become a contestant on Dancing With the Stars. He has become a motivational speaker and still enjoys visiting patients to help them get through difficult experiences. In his parting words, Martinez cautioned that it is “easy to feel as if what you’re doing has no purpose or reward.” He voiced his hope that attendees would “walk away knowing that what you do is important and that I am grateful to know that nurses are there.” IMPROVING THE DECISION-MAKING PROCESS Dan Heath, a senior fellow at Duke University’s Center for the Advancement of Social Entrepreneurship and coauthor with his brother, Chip Heath,
www.aornjournal.org
of several motivational books, spoke to Congress attendees about decision making and how to make a difficult process easier. At “Decisive: How to Make Better Choices in Life and Work,” he noted that decisions are bad more often than they need to be and that human beings’ most flagrant bad decisions concern money, the people they choose as life partners, and medical issues. His book Switch: How to Change Things When Change Is Hard addresses how decision making can be improved. Heath told the audience that although common advice urges people to “trust their gut” or to rely on analysis, this is rarely successful. Of decisions made in the work arena, for example, 80% of mergers or acquisitions create no value and at least half of all newly hired employees leave within the first year. He suggested that to do better in work or in life, attendees should remember that people are rarely stumped for answers. The answers arrived at through intuition may be faulty, however, because intuition is a machine for jumping to conclusions that may or may not be accurate or helpful. “It is impossible to know if an intuition about something is trustworthy,” he said, but intuitions that can be trusted are “those
Dan Heath discusses important ways to make better decisions.
AORN Journal j 643
June 2013
Vol 97 No 6
that come from long experience or lots of repetition and those where the individual gets quick feedback about his or her decision.” As an example, he spoke of eating at a restaurant and showed the audience a photo of the red velvet cheesecake he wanted for dessert. His intuition was that this would be the perfect end to a perfect meal, but then he noticed that the calorie count was nearly 2,000; that quick feedback enabled him to pass on the dessert. Heath described a four-part process to improve decision making with the acronym WRAP: widen options, reality test, attain distance, prepare to be wrong. He encouraged attendees to widen their options rather than to act like teenagers, who often see only two options and do not have a secure or mature structure for making decisions. “Only 30% of teenagers consider more than one option when making a decision, and sadly, only 29% of organizations consider more than one alternative either,” he said. “The phrase ‘whether or not’ should set off alarms if you hear it when making a decision, because it is a narrow way of framing a decision.” He also recommended that attendees “fall in love twice”din other words, look for more than one option, avoid excessive focus, and resist intuitive or quick decision making. “Ask yourself, ‘Is there anything else I need to know and what else could be available?’” he posed. This process helps test reality, which may be camouflaged by emotion or pressure to make a decision. Attaining distance from the decision (eg, asking for time to consider choices) helps as well. Finally, he suggested that preparing to be wrong is helpful in that it readies a person for surprises and keeps options open by providing the opportunity to create a backup plan.
CONGRESS GENERAL SESSIONS Going on at Your Hospital?” Using jokes and funny video clips, Dr Pawliw-Fry stressed two tools for emotional intelligence that people can learn: making oneself vulnerable and building bridges. He said that although intelligence and technical skill are important to a certain level to be competent in a job, emotional intelligence is a bigger predictor of career success. When listing the traits of the best nurses they have ever known, most people would list emotional intelligence, such as staying calm under pressure, rather than extraordinary intelligence or technical skills. “If you want a star, it’s not about how smart you are,” Dr Pawliw-Fry said. People who are not afraid to admit they are wrong have more success in life. On successful teams, the leaders are first to admit when they have made mistakes. “You are a leader of folks,” Dr Pawliw-Fry said. “People are watching you. What do you do when you’re under pressure and you make a mistake?” If leaders admit their own mistakes, others team members will do likewise, improving the team overall. “Our challenge is to be that walking model of a leader,” he added.
HELEN STARBUCK PASHLEY MA, RN, CNOR CLINICAL EDITOR
LEARN EMOTIONAL INTELLIGENCE AND FIND SUCCESS Dr JP Pawliw-Fry spotlighted emotional intelligence at the opening keynote session, “What’s
644 j AORN Journal
Dr JP Pawliw-Fry describes emotional intelligence skills that can improve career and home life.
CONGRESS GENERAL SESSIONS Dr Pawliw-Fry also spoke about the emotional trap of confusing impact with event. Because of how our brains work, we tend to react emotionally to an event before we act rationallydwe feel before we think. For example, a nurse may feel as if a coworker’s actions were taken to target him or her. “People don’t do things to us; they do things for their own reasons,” Dr Pawliw-Fry said. “Before you throw someone under the bus, make sure you have enough info.” It is important to allow time for the emotional part of the brain to calm down, which can take 15 to 17 minutes, before reacting to a disruptive event. Another mistake is that we judge ourselves by our intentions but judge others by the effects of their actionsdwhat Dr Pawliw-Fry calls the “understanding gap.” He described his strategy for connecting to others as “building a bridge,” shortening the name of this process to “VVF”: ask questions to give a voice to the other person’s intentions; make the other person feel valued; and then, finally, provide feedback. He recommended that we show others we value them by saying what we mean, doing what we say, finishing what we start, and starting things on time. “If you build trust in your organization, that’s the foundation for collaboration,” Dr Pawliw-Fry said. By cultivating emotional intelligence, nurses can help build an effective team. He used the example of the very successful Chicago Bulls basketball team from the 1990s; even though most would agree that the team was lacking in some areas technically, their emotional intelligence, especially that of their coach, allowed them to achieve great success. CONGRESS CLOSES ON A HUMOROUS NOTE Mental health strategies, jokes, and a dance lesson combined to give attendees a memorable experience at the closing session, “Amazed and Amused: How to Survive and Thrive as a Health Care Professional.” Karyn Buxman, MSN, RN, CSP, talked about how stressful the OR environment can be and
www.aornjournal.org
recommended humor as a powerful tool to combat this stress. Referring to airplane safety demonstrations, she said that nurses need to take care of themselves first before they can help others. “Humor can be your oxygen mask,” she said. Humor is an important trait for leaders to have, according to Buxman, who noted that this trait does not necessarily have to take the form of telling jokes or being funny. People who are not good at making jokes can simply appreciate humor from other peopledtheir laughter will demonstrate to others that they have a sense of humor. Moving away from humor, Buxman taught attendees another method to maintain mental health. “We are going to teach you how to dance, to have a shortcut to happiness,” Buxman told attendees. She proceeded to teach attendees a series of dance moves, including the “cowboy” and “pony! (Gangnam style)” to the song “Just Dance” by Lady Gaga. Buxman also spoke about feeling “icky.” She said everyone has icky times and warned that anyone not currently going through an icky period or just getting out of one will experience it again. She
Karyn Buxman explains how being amazed and amused is the key to attaining true happiness.
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June 2013
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Vol 97 No 6
shared her own icky time: a seven-year period during which one of her sons had an undiagnosed ailment that caused severe symptoms, including temporary paralysis. Also in that period, her other son was diagnosed with a large chest tumor and her mother was diagnosed with Alzheimer disease. Fortunately, both of her sons recovered from their conditions. This period led Buxman to reexamine her life, and by doing so, she discovered the importance of self-reflection. She said that sometimes nurses tell her they feel as if they are not getting anywhere in work or in other stressful situations. She then asks them what their goals are, and they frequently say they do not know. Her response is to ask them, “Then how do you know you’re not already there?” Self-reflection is important in one’s
personal life, she said. For example, after Buxman and her husband divorced, she made a list of exactly what she wanted in a partner before she began to date again. One element of humor is what Buxman calls an “amazed and amused” attitude, which she said helps her appreciate what happens around her. She noted that many of the best things in her life would not have happened had the bad things not happened. Being amazed and amused by life allows people to experience true happiness.
ZAC WIGGY ASSOCIATE EDITOR
Correction May 2013, VOL 97, NO 5, page 556. Due to an editing error, the “No” and “Yes” headings in Table 2 were listed incorrectly. The table should have appeared as follows. The Journal regrets the error.
TABLE 2. Comparison of Groups for Incidence of Surgical Site Infection
Surgical site infection within 30 days of surgery
Parachoroxylenol prep (n ¼ 71) Other prep agents (n ¼ 91) Note: c2
646 j AORN Journal
(1, 162)
No
Yes
71
0
86
5
¼ 4.025, P ¼ .045.
A
ttendees of the 60th Congress General sessions heard inspirational, practical, and thought-provoking presentations. Featured speakers at these sessions promoted collaboration, a culture of transparency in the OR, the power of positive thinking, improved approaches for decision making, emotional intelligence, and humor as a shortcut to happiness. Following are brief accounts of this year’s sessions. USING SIMULATION TO DEMONSTRATE PERIOPERATIVE COLLABORATION To exemplify the effect of collaboration between perioperative personnel and the infection preventionist, Paula R. Graling, DNP, RN, CNOR, CNS, past president of AORN and current president of the AORN Foundation, led a panel of eight health care professionals in a simulation about a fictional patient who developed a postoperative surgical site infection (SSI). During the Jerry G. Peers Lectureship, “Simulation: Collaboration Between the Perioperative RN and Infection Preventionist,” the panel performed a root cause analysis and debriefing to identify missed opportunities to prevent an SSI in the fictional patient. The simulation began in a clinic examination room when the patient presented with a superficial wound infection after hernia surgery. A series of videotaped vignettes portrayed the multidisciplinary team members reviewing the care provided to the patient during her hospitalization. After viewing each vignette, attendees were asked a series of questions and answered them by a show of hands. Attendees helped the panel identify multiple problems that might have caused the patient’s SSI, including
n
failure of the surgeon and anesthesia professional to adequately communicate whether antibiotic redosing should occur and, if so, when; and n failure of scrubbed personnel to adhere to the basics of aseptic technique. Dr Graling asked attendees to come to the microphone to report on successes and failures at their facilities. From this interactive discussion, attendees determined that everyone should at least consider the following steps: n
Implement updated presurgical skin preparation for all patients whether surgery is performed in the hospital or an ambulatory setting. n Remember to check the sterility of the instruments every time.
n
the patient’s failure to take the two prescribed preoperative antiseptic showers; n hair removal using a razor in the OR; n failure to cleanse the hub of the IV line before injecting the antibiotic;
A panelist participates in a root cause analysis and debriefing to identify missed opportunities to prevent a postoperative surgical site infection in a fictional patient. http://dx.doi.org/10.1016/j.aorn.2013.04.015
640 j AORN Journal
June 2013
Vol 97
No 6
Ó AORN Inc, 2013
CONGRESS GENERAL SESSIONS n n n
n
n n n n
Use forced-air warming for 30 minutes in the preoperative area. Avoid dual standards of care between inpatient and ambulatory settings. Repeat antibiotic dosing based on the percentage of blood loss so that the level of antibiotics in the blood remains consistent. Have an evidence-based, multidisciplinary conversation about bringing bags and personal items into the OR. Implement back-to-best practices to ensure staff member competency. Institute multidisciplinary follow-up of all reported adverse incidents. Ensure that the patient’s glucose levels are monitored and controlled. Make the infection preventionist an integral member of the surgical team.
The concluding sentiment and discussion focused on perioperative nurses as the patient’s last line of defense against acquiring an SSI and the importance of collaboration between perioperative team members and the facility infection preventionist to achieve best practices and thus prevent SSIs in vulnerable perioperative populations. REBECCA HOLM MSN, RN, CNOR CLINICAL EDITOR
A CALL FOR CULTURE CHANGE At the session “The New Accountability Movement: How Transparency Is Changing the OR,” Marty Makary, MD, MPH, discussed the state of patient safety in the United States. Little progress has been made in patient safety in the past 10 years despite efforts to promote it, according to Dr Makary, a surgeon at Johns Hopkins, Baltimore, Maryland, and New York Times bestselling author of Unaccountable, a book on how teamwork and transparency can save American health care. He shared the story of St Vincent’s Hospital in New York City, a once-prospering hospital that went bankrupt and closed after 160 years. The hospital’s
www.aornjournal.org
Dr Marty Makary stresses the need for culture change to improve patient safety.
decline was caused by executives who had become dangerously out of touch with the frontline providers, a trend Dr Makary indicated is one of the greatest threats to American medicine. He extended his argument by saying that this is a dangerous trend in society in general, not just in health care, and gave several examples in the financial industry. To solve the nation’s current problems in health care, the culture of medicine needs to change. Changing the culture of medicine involves lifting the veil of anonymity and restoring dignity and value in the OR. That begins with executives reaching out to frontline providers to understand what providers need so that they can do their jobs better. Dr Makary cited Steve Jobs, cofounder and former CEO of Apple, Inc, as a “genius manager” who leveled the hierarchy by eating in the company cafeteria and holding conversations with new employees. Dr Makary declared that good management is not something that needs to be invented but rather “a value in society we need to restore.” He described how Apple store employees are always eager to help customers, despite not having commission-based roles, because of the successful workplace culture that encourages workers to take pride in their organization. Dr Makary noted that a corporate culture goes “sour” when employees are concerned only about AORN Journal j 641
June 2013
CONGRESS GENERAL SESSIONS
Vol 97 No 6
“doing their job.” Culture defines how employees do things, including whether a surgeon pursues a minimally invasive surgery or a maximum invasive surgery. He then highlighted results from a questionnaire on safety attitudes that showed that only 18% to 20% of hospital personnel surveyed would go to their own facility for medical care. In a slide comparison, he showed a direct correlation between postoperative morbidity rates and the percentage of medical personnel who would feel safe as a patient in their own facility. As a lead author for the original Johns Hopkins surgical checklist and as a contributor to the World Health Organization Surgical Safety Checklist, Dr Makary stressed the importance of the preoperative checklist and, particularly, knowing the names of the team members who work on one’s shift. Among a survey of perioperative professionals, physicians ranked the lowest among nurses, anesthetists, and others for knowing the names of colleagues on their shift. The culture of “speaking up,” which encourages personnel to voice their concerns without fear of retribution, needs to be embraced. Research indicates that perioperative professionals are more likely to speak up when OR teams use surgical checklists. A recent study of hospital leaders revealed that 26% believe that nurses’ fear of retribution decreases safety at their hospital. Dr Makary gave the call to action to restore value and dignity in the OR by promoting the culture of speaking up, noting that changing the culture is necessary to save American health care.
in 2003. In his talk “Plugging in to Your Potential” at the AORN Foundation session, Martinez described three years of recovery and more than 32 surgeries. He talked to the audience about how nurses and his mother helped him change from a young, angry survivor who wondered what he had done to deserve his severe burn injuries and who saw his life goals disappearing to someone who believes that “you can choose where to go; you need to find a way to be positive, to adapt, and to overcome whatever comes your way.” Martinez humorously described his first thoughts after waking from a medically induced coma and listening to the physician describe what “the nurse” would help him do to recover. At his young age, he said, he tuned out the physician and imagined that this nurse would be a young gorgeous woman who would fall madly in love with him while providing his care. He was clearly disappointed to meet instead a bearded male nurse named Mike. Martinez told the audience that he and Mike became close friends, and he credits Mike with helping in his recovery. In a less humorous vein, he spoke of what it felt like to
LESLIE KNUDSON CONTENT EDITOR
THE POTENTIAL TO MAKE A DIFFERENCE At 19 years of age, JR Martinez believed that joining the army would provide him with educational opportunities that he could not access as the only son of a single mother. What it provided instead was a 34% burn injury and other severe injuries from driving over a roadside bomb in Iraq
642 j AORN Journal
JR Martinez entertains attendees with humorous and inspiring insights that he gained through his recovery from the severe burns that he sustained in Iraq in 2003.
CONGRESS GENERAL SESSIONS survive the explosion and be trapped in a burning Humvee. Martinez credits his nurse with helping him confront his devastating facial burnsdMike told him that what he would see when he looked in the mirror was not good, but it would get better, and he helped Martinez make it through a painful but necessary recovery. Nurses, he said, “help make scary and uncomfortable places not so scary.” After seeing the extent of his injuries, Martinez fell into a deep depression. He saw his life and his goals as having been destroyed and lashed out in anger at his mother when she tried to comfort him. His mother, whom he affectionately refers to as the “hand grenade,” told him he had a lot to learn. She encouraged him to be positive and told him that a purpose for his life would emerge. She also told him that whoever was in his life from this point on would be there because they valued him and would not be troubled by how he looked. He has come to believe that everyone has strengths and weaknesses and that in times of difficulty it is important to focus on strengths to cope and adapt to changes. During his recovery, Martinez did find new purpose. Hospital staff members asked him to speak to other patients with similar difficulties. He learned he could help people, which made him feel good. After being asked to speak publicly about his experience after his discharge, Martinez auditioned for and was offered a three-month role on All My Children, a soap opera, and went on to become a contestant on Dancing With the Stars. He has become a motivational speaker and still enjoys visiting patients to help them get through difficult experiences. In his parting words, Martinez cautioned that it is “easy to feel as if what you’re doing has no purpose or reward.” He voiced his hope that attendees would “walk away knowing that what you do is important and that I am grateful to know that nurses are there.” IMPROVING THE DECISION-MAKING PROCESS Dan Heath, a senior fellow at Duke University’s Center for the Advancement of Social Entrepreneurship and coauthor with his brother, Chip Heath,
www.aornjournal.org
of several motivational books, spoke to Congress attendees about decision making and how to make a difficult process easier. At “Decisive: How to Make Better Choices in Life and Work,” he noted that decisions are bad more often than they need to be and that human beings’ most flagrant bad decisions concern money, the people they choose as life partners, and medical issues. His book Switch: How to Change Things When Change Is Hard addresses how decision making can be improved. Heath told the audience that although common advice urges people to “trust their gut” or to rely on analysis, this is rarely successful. Of decisions made in the work arena, for example, 80% of mergers or acquisitions create no value and at least half of all newly hired employees leave within the first year. He suggested that to do better in work or in life, attendees should remember that people are rarely stumped for answers. The answers arrived at through intuition may be faulty, however, because intuition is a machine for jumping to conclusions that may or may not be accurate or helpful. “It is impossible to know if an intuition about something is trustworthy,” he said, but intuitions that can be trusted are “those
Dan Heath discusses important ways to make better decisions.
AORN Journal j 643
June 2013
Vol 97 No 6
that come from long experience or lots of repetition and those where the individual gets quick feedback about his or her decision.” As an example, he spoke of eating at a restaurant and showed the audience a photo of the red velvet cheesecake he wanted for dessert. His intuition was that this would be the perfect end to a perfect meal, but then he noticed that the calorie count was nearly 2,000; that quick feedback enabled him to pass on the dessert. Heath described a four-part process to improve decision making with the acronym WRAP: widen options, reality test, attain distance, prepare to be wrong. He encouraged attendees to widen their options rather than to act like teenagers, who often see only two options and do not have a secure or mature structure for making decisions. “Only 30% of teenagers consider more than one option when making a decision, and sadly, only 29% of organizations consider more than one alternative either,” he said. “The phrase ‘whether or not’ should set off alarms if you hear it when making a decision, because it is a narrow way of framing a decision.” He also recommended that attendees “fall in love twice”din other words, look for more than one option, avoid excessive focus, and resist intuitive or quick decision making. “Ask yourself, ‘Is there anything else I need to know and what else could be available?’” he posed. This process helps test reality, which may be camouflaged by emotion or pressure to make a decision. Attaining distance from the decision (eg, asking for time to consider choices) helps as well. Finally, he suggested that preparing to be wrong is helpful in that it readies a person for surprises and keeps options open by providing the opportunity to create a backup plan.
CONGRESS GENERAL SESSIONS Going on at Your Hospital?” Using jokes and funny video clips, Dr Pawliw-Fry stressed two tools for emotional intelligence that people can learn: making oneself vulnerable and building bridges. He said that although intelligence and technical skill are important to a certain level to be competent in a job, emotional intelligence is a bigger predictor of career success. When listing the traits of the best nurses they have ever known, most people would list emotional intelligence, such as staying calm under pressure, rather than extraordinary intelligence or technical skills. “If you want a star, it’s not about how smart you are,” Dr Pawliw-Fry said. People who are not afraid to admit they are wrong have more success in life. On successful teams, the leaders are first to admit when they have made mistakes. “You are a leader of folks,” Dr Pawliw-Fry said. “People are watching you. What do you do when you’re under pressure and you make a mistake?” If leaders admit their own mistakes, others team members will do likewise, improving the team overall. “Our challenge is to be that walking model of a leader,” he added.
HELEN STARBUCK PASHLEY MA, RN, CNOR CLINICAL EDITOR
LEARN EMOTIONAL INTELLIGENCE AND FIND SUCCESS Dr JP Pawliw-Fry spotlighted emotional intelligence at the opening keynote session, “What’s
644 j AORN Journal
Dr JP Pawliw-Fry describes emotional intelligence skills that can improve career and home life.
CONGRESS GENERAL SESSIONS Dr Pawliw-Fry also spoke about the emotional trap of confusing impact with event. Because of how our brains work, we tend to react emotionally to an event before we act rationallydwe feel before we think. For example, a nurse may feel as if a coworker’s actions were taken to target him or her. “People don’t do things to us; they do things for their own reasons,” Dr Pawliw-Fry said. “Before you throw someone under the bus, make sure you have enough info.” It is important to allow time for the emotional part of the brain to calm down, which can take 15 to 17 minutes, before reacting to a disruptive event. Another mistake is that we judge ourselves by our intentions but judge others by the effects of their actionsdwhat Dr Pawliw-Fry calls the “understanding gap.” He described his strategy for connecting to others as “building a bridge,” shortening the name of this process to “VVF”: ask questions to give a voice to the other person’s intentions; make the other person feel valued; and then, finally, provide feedback. He recommended that we show others we value them by saying what we mean, doing what we say, finishing what we start, and starting things on time. “If you build trust in your organization, that’s the foundation for collaboration,” Dr Pawliw-Fry said. By cultivating emotional intelligence, nurses can help build an effective team. He used the example of the very successful Chicago Bulls basketball team from the 1990s; even though most would agree that the team was lacking in some areas technically, their emotional intelligence, especially that of their coach, allowed them to achieve great success. CONGRESS CLOSES ON A HUMOROUS NOTE Mental health strategies, jokes, and a dance lesson combined to give attendees a memorable experience at the closing session, “Amazed and Amused: How to Survive and Thrive as a Health Care Professional.” Karyn Buxman, MSN, RN, CSP, talked about how stressful the OR environment can be and
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recommended humor as a powerful tool to combat this stress. Referring to airplane safety demonstrations, she said that nurses need to take care of themselves first before they can help others. “Humor can be your oxygen mask,” she said. Humor is an important trait for leaders to have, according to Buxman, who noted that this trait does not necessarily have to take the form of telling jokes or being funny. People who are not good at making jokes can simply appreciate humor from other peopledtheir laughter will demonstrate to others that they have a sense of humor. Moving away from humor, Buxman taught attendees another method to maintain mental health. “We are going to teach you how to dance, to have a shortcut to happiness,” Buxman told attendees. She proceeded to teach attendees a series of dance moves, including the “cowboy” and “pony! (Gangnam style)” to the song “Just Dance” by Lady Gaga. Buxman also spoke about feeling “icky.” She said everyone has icky times and warned that anyone not currently going through an icky period or just getting out of one will experience it again. She
Karyn Buxman explains how being amazed and amused is the key to attaining true happiness.
AORN Journal j 645
June 2013
CONGRESS GENERAL SESSIONS
Vol 97 No 6
shared her own icky time: a seven-year period during which one of her sons had an undiagnosed ailment that caused severe symptoms, including temporary paralysis. Also in that period, her other son was diagnosed with a large chest tumor and her mother was diagnosed with Alzheimer disease. Fortunately, both of her sons recovered from their conditions. This period led Buxman to reexamine her life, and by doing so, she discovered the importance of self-reflection. She said that sometimes nurses tell her they feel as if they are not getting anywhere in work or in other stressful situations. She then asks them what their goals are, and they frequently say they do not know. Her response is to ask them, “Then how do you know you’re not already there?” Self-reflection is important in one’s
personal life, she said. For example, after Buxman and her husband divorced, she made a list of exactly what she wanted in a partner before she began to date again. One element of humor is what Buxman calls an “amazed and amused” attitude, which she said helps her appreciate what happens around her. She noted that many of the best things in her life would not have happened had the bad things not happened. Being amazed and amused by life allows people to experience true happiness.
ZAC WIGGY ASSOCIATE EDITOR
Correction May 2013, VOL 97, NO 5, page 556. Due to an editing error, the “No” and “Yes” headings in Table 2 were listed incorrectly. The table should have appeared as follows. The Journal regrets the error.
TABLE 2. Comparison of Groups for Incidence of Surgical Site Infection
Surgical site infection within 30 days of surgery
Parachoroxylenol prep (n ¼ 71) Other prep agents (n ¼ 91) Note: c2
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(1, 162)
No
Yes
71
0
86
5
¼ 4.025, P ¼ .045.