RNSpeak!

Stay Tuned!!!

2012-12-18T18:35:00.003-08:00

RNSpeak! is coming back online. Sorry for the long silence over the last year. I am finishing my doctorate and have little time for posts. However, stay tuned, more posts are coming ... and thanks for your patience.

RNSpeak! A Connected Community

2011-08-07T07:45:00.000-07:00

As the world of online technology evolves - so too must the people that use this technology. Technology scares many nurses because they believe it is taking the place of the human touch and that special connection they have with their patients. While I will submit to that feeling overall, I have found the use of technology beneficial in helping me manage the mired of information I must process on a daily basis. Further, I think technology helps with time management and evidenced-based practice. Prior to all these search engines, evidenced from research was hidden in journals and publications. If you did not subscribe, you simply did not know about the new developments that could offer improvements for patient outcomes.

The world is changing - we must adapt. If you recall the Borg from Star Trek - The Next Generation - they use to say "Resistance is Futile." I think this statement really says it all. So - embracing the world of technology, I am linking all of my online accounts together. It is my hope this will help move RNSpeak! into a connected world where more than myself and a few patrons will read this blog. Of course - I will need to do a much better job keeping this blog moving with interesting posts!

The posts here will be sent through Twitter to those following me. If you want to follow me on Twitter - my username is rnpatl.

Time to start blogging. Thanks to all of my fans that read this blog. You really are the best! All 2 of you. :)

A Reason to Write

2011-01-12T19:30:00.000-08:00

I have just finished one of my tutorials on writing and finding my scholarly voice. The tutorial that I found most compelling tonight is developing an addiction to writing. This tutorial was really quite wonderful and helped me to see where I have built some barriers to writing. In order to comply with the tutorial, I am suppose to identify some of my barriers to writing and then develop a plan to overcome these barriers in my quest to write more.

First, I must say that I love to write. Writing to me is very therapeutic. It helps me to process my thoughts for the hour, the day, or for whatever time frame I may need to process. It also allows me to listen to my own voice. I will admit readily that I don't often listen to my own voice and perhaps this is the reason I don't write as often. Well, before I say that, let me explore the barriers to why I have not written for a while. First, I have been totally demoralized by my doctoral program. While I do criticism very well, I guess I am try to find my way in this new world of writing. As a doctoral student, writing at this level is very different than how I wrote for my masters program. I think the main issue is with the scholarship. Each paragraph I write, it feels like I need to qualify everything I say with a reference. I do have an opinion and sometimes I state this opinion in my writing. I need to develop a better balance. So this is another barrier that stops me from writing. I get so caught up in the research and reading, I have little time left to write. Instead, I am rushing to write and I resent that because it takes the joy right out of it for me! Not having enough time to write is really an excuse for me sometimes. Yes, I am very busy with work and with school, but at the end of the day, I enjoy writing. Yet, I find excuses why something else should be a priority over my writing. Perhaps my rebuke is the result of my dwindling confidence because of being a doctoral student. Maybe I do not handle criticism as well I I thought I did. Time to explore that for sure.

Ok - time for my plan. First, I promise I will write at least 3-4 times per week. I can either write here in my blog (which I really enjoy doing for my entire 3 or 5 readers - I am thankful for you though), or I can write for assignments, or I can simply write for the sake of writing. I generally do that form of writing in my blog here. Whatever the case, I promise myself I will write at least 4 times a week. My reward for writing will be the writing itself and the accomplishment of knowing that perhaps I am regaining my writing confidence again. Yup - that sounds good. Oh and I can watch my favorite show on TV ... wait, I am going to do that anyway. Well ... the next time I write I will better describe my reward for writing.

Thanks for coming back to my blog. I hope you enjoy my new commitment to writing.

A Little Help for New Graduates

2010-11-25T19:59:00.000-08:00

BLOG STATEMENT: This post was originally listed on this blog in 2007 as a reminder to experienced nurses that new graduate nurses would be entering practice soon and as a way to give new nurses with some tips for success. I thought it was appropriate to re-post this message.

I certainly do not profess to be the expert here, but as a nurse for 23 years in med-surg, surgical progressive care, open heart, and ICU as well as a clinical nursing instructor and a graduate student (MSN), I think I have some general words of advice. So, for those of you who need it - here it is for what it is worth to you.

1. First - every time you sign your name as a RN - please remember how hard you worked for this accomplishment and the sacrifices of yourself and all those people in your life that helped you "make it!"
2. Remember, nursing is a hard job! It has always been a hard job and it will always be a hard job! (Florence Nightingale).
3. Learn as much as you can! Do NOT be afraid to ask questions. You might drive an experienced nurse crazy, but in the long run, any experienced nurse understands why you are asking the questions and will respect you for trying to build upon and grow your knowledge base. For those that don't - forget about 'em - they ain't worth the time of day and probably are burned out nasty nurses that need to get the hell out of the business.
4. Always remember - the only reason you are an RN is to care for that patient. They are the true reason our profession is here. Don't ever forget your compassion, honesty, love and integrity. Fight for that patient and the care they need - they are counting on you!
5. Never give a medication that you don't know how it works. Ask the "WHY" questions as many times as you need too until you feel you understand and are comfortable with WHY you are doing something. Too many nurses don't ask the "WHY" questions and that gets them into trouble.
6. Never let a physician intimidate you. Yes, they are more educated (in some cases) and have more experience than you do, but you are the person at the bedside that is best situated to see changes in condition. While in the beginning you might feel like you don't know enough - rely on other experienced nurses to review your assessment with. They will help you to determine what to say to the physician.
7. An employer will work you until you are dead! Live a balanced life and don't make excuses for having balance in your life. If they ask you to work extra and you know that your child has a play and you can't work - please know that NO can really mean NO! And, you don't need to feel guilty about it.
8. Don't get STUCK working in an area of nursing that you are not passionate about. It is the fastest way to burn out in this profession. Seek out learning opportunities that will grow your knowledge and skill in an area of nursing that you desire to work in. Nursing offers so much variety that there is really no reason to stay in a place that you are not happy working. And - don't let them tell you that you need a year of med-surg before you can go to a speciality area. While having a med-surg background offers you the opportunity to develop your skills and competencies - I have known many of nurses that went into a speciality areas right out of school and have been highly successful. It really all depends on your motivation and your commitment. You call the shots.
9. After you have finished your first year in nursing - pay it forward. Remember that poor new graduate that your manager just hired - help them, be friend them and mentor them. You owe it to them.
10. Remember that nursing is a life-long learning profession. No matter what happens in your life - keep learning and never forget the benefits of more education. And - finally, remember your days as a new graduate and be the experienced nurse that other new graduates can look too as a resource and a person to learn from.

Congratulations on passing your boards and becoming a nurse! We need you and we need you to stay around for a long time. Thank you for entering our noble profession and for making a REAL difference in the lives of patients that need your care and love. Thank you for caring.

The Path to Here! Where was the Advice?

2010-11-25T19:51:00.000-08:00

As I continue my educational journey to the DNP level, I reflect on how much time it has taken me to arrive at this point in my life. I am certainly proud of my accomplishments, but can’t help but think … “was there an easy or perhaps more time efficient way to earn all these credentials?” My answer (to myself anyway) is a resounding yes!

When I was younger and knew I wanted to teach, I went from college advisor to college advisor trying to get an established pathway for what courses I would need, what degree path I should take, etc., etc. Very few people were helpful and I felt as though I was self advising. Funny thing … I had no clue what to do – so self advising was like answering myself when I had a question but did not have the answer.

We talk so often about the shortage of faculty in nursing and we discuss funding options from the government, employers and scholarships. Yet, maybe it is time that look at something pretty simple – advisors that have half a clue about what nursing education is and how a young person might define a career path to one day become a nurse educator. Maybe, just maybe something as simple as giving information might provide us with a few more bright young people that want to become nurse educators.

This goal will start with me! I know that I can mentor a young person and provide them with an academic pathway that will ultimately lead to qualifications as a nurse educator. So – what about you all out there in nurse educator land … can you see where you can make a difference in the educational journey of a would-be nurse educator? It is time.

The Blog Wins!

2010-11-25T18:58:00.000-08:00

Despite no responses to my plea for your vote as to whether the blog stays or goes - I have made up my mind that the blog stays! I enjoy writing and after several hours of reviewing the posts I have made over the last 3 years - the blog really does have some great meaning.

I may change the focus of my blog a little more and center on the new degree I am pursuing. I am currently attending Capella University for my Doctor of Nursing Practice (DNP) degree. This new practice doctorate now available for nurses in clinical practice is a pretty important step. I want my focus to be on my journey while earning my DNP and on what I do with it after I graduate.

I have a great deal to say about nursing doctorate education and I think this blog provides the forum for that conversation.

Let me know what you think. Stay tuned - lots of changes are coming to RNSpeak! I think you might like the new blog - I know I will.

Should I Continue?

2010-11-17T03:09:00.000-08:00

My last post to my blog was in January of this year. Much has changed and I have so much more to say. But, do you want to hear what I have to say? Does this blog have meaning or is it a place where I come to vent or just write because I have something to say? Whatever the case for me - I want your opinion. Should this blog continue? If you come here often and you have read some of my writings and you think this blog provides meaning - send me a comment and let me know.

It seems that a lot of spammers have certainly located my blog. But I want real nurses or nursing students to tell me - "SAVE RNSPEAK! THE BLOG HAS MEANING!!!!!

Thank you.

A Special Shout Out to Cindy with Nursing2010!

2010-01-05T03:12:00.000-08:00

Resting on the bulletin board over my desk is a calendar "Men in Nursing." The calendar is publish through Nursing2010. As December of 2009 approached, I kept saying to myself that I needed to reorder the calendar. I remember I received the calendar from a friend of mine that has been very active with increasing the ranks of men in nursing. The calendar was well done and certainly promoted the excitement of being a nurse.

Nursing today for men is a wonderful professional career choice. I have been in the nursing profession for over 25 years and can say without hesitation that becoming a nurse was the single best career choice I could have made. Given the fact that I entered nursing at 18 years old ... that choice (at such a tender age) was very insightful.

Anyway, I sent an email to Cindy with Nursing2010 asking to reorder the calendar. She promptly wrote me back and said that the calendar is only sent to previously registered subscribers. I share with her that I was not aware of this and after several different emails back and forth - Cindy agreed to send a few calendars.

What makes this really important to me is that we are beginning our freshmen class this coming week; which has several male students. I think being able to offer a calendar that reflects men in professional nursing roles really serves as an excellent example that being a male in the profession of nursing is not only an educational advantage, it is a great career selection.

So - thanks Cindy for your thoughtfulness and for your kindness!

And ... so it begins yet again!

2009-12-29T14:28:00.000-08:00

As most of you who have been following my blog know ... I am a lifer! What does this mean? Well, it means that I am a professional student. I use to hear this term and never really understood that it was reserved for those that have this unchanging desire to continue their education through to completion, and then some.

As the title says, "And ... so it begins again" means that I am returning to school to complete my PhD in Education. My specialization will be in nursing education. This return to school represents the true completion of my formal education. I am scared, excited, dreading it and all the emotions you can experience. I know that the difference between those that have a PhD and those that don't is simply fortitude. I will continue until it is done.

I have also learned a new term that I did not know prior to starting this journey and that term is ABD. Now, most of you reading this blog are nurses, so we know an ABD is generally short for an abdominal pad. Nope, that is not what it is at all. ABD stands for All But Dissertation. This is when a PhD candidate has all the course work and comps completed, but has not completed the dissertation portion part of their graduation requirements. Interesting to note that many people are in the ABD category. Perhaps it stems from lacking motivation, overwhelming feelings that the dissertation is so involved that it will never be finished, or simply the student has just given up hope of completion. Not sure, but I know for me, this is a real issue. I will hold a PhD, not an ABD. SO - I will indeed have to stay motivated.

Will keep you all informed as the journey begins in April, 2010.

New Year Resolution???? Really?

2009-12-27T04:22:00.000-08:00

Every year friends and family members ask me, "what are you going to resolve to do in the new year?" Every year (for me anyway) it is always the same two or three things that are my personal challenges. And every year they appear on my new year resolution list because I have either not stopped the activity or sometime during the new year failed to achieve the goal. Now, this is not true of every goal I have established, but for my New Year Resolutions - it is!

For 2010, I resolve to have no resolutions. I resolve to continue being the person I am and doing more for my growth and development. I resolve to work through the year as I always do and give over 100%. I resolve this year to help those in need more and to be more community oriented. I resolve to do a better job with staying connected with friends and family. Wow - for not having any resolutions - I sure listed a few. Oh yes, I almost forgot - for 2010 I resolve to become a millionaire. Why not - could happen! And, if it doesn't happen, guess what - I can put it on my next New Year resolution list.

I will admit that there is something exciting about a new year. Perhaps it feels like the slate from last year is clean, a new starting point for something that has meaning to you. So, I can see why millions of people do their best to set out some great goals for themselves. But I might suggest eliminating the pressure of New Year Resolutions, and just decide that perhaps a life change may be a larger challenge than expected. Instead of heaping the goals - start out small and slow and set a measurable goal that you can achieve. Smaller steps help to make larger steps in the new year.

I resolve to take smaller steps in my quest to achieve my goals! There ya go - together we just worked through a reasonable New Year Resolution. Have a great day!

Google Wave?

2009-12-10T03:20:00.000-08:00

What in the hell is Google Wave? Every time I think I have learned the newest technology, someone goes and makes something new. Here is the interesting part ... all this new technology is really amazing. As a teacher and a nurse - this new technology has some wonderful application considerations for patient teaching as well as class room teaching.

I am going to investigate this phenomena and report back here and tell you all about it. Of course - any of the 5 people that read my blog may feel free to tell us more too.

Here we go again ....

2009-10-18T13:18:00.001-07:00

For those of you that follow this blog - my many thanks and my many apologoies for being so tardy in keeping this blog updated. Today, I announce a new resolution, this blog will be kept up and going - I promise. I have a lot to say, but up until now, I have not had a lot of time to say it.

I have finally finished my MSN and cannot even begin to tell you how wonderful it is to have this accomplishment under my belt. I have also started working as a full time nursing instructor for a local private college and LOVE IT! I love working with the students. For those of you that don't know this - students are the most awesome people in the world and I love teaching them and helping them achieve their goals.

Anyway - back to my promise. I will be on this blog and will begin to catch up with all my blogging sites and friends once again. Please forgive, but more importantly - please keep reading!

Love you all in blogger world.

The End of a Long Journey

2009-03-07T18:38:00.000-08:00

Today I enter the 2nd week of my last graduate level class. The journey is about to end and I will finally graduate with my MSN after three very long years. I am proud of myself, but also humbled by the education I have received. I have been in school for the last 13 years of my life. First to complete my associates degree in nursing, then my bachelor's degree and now the master's degree. My kids have really never known a time that their dad was not in school.

It was about 15 or 16 years ago that I decided I wanted to teach nursing. There were no road signs that led the way for me, rather, it was my pure determination to succeed that made my path. Every advisor I ever spoke to could never tell me what courses I needed or the best path to be able to teach. I relied on peer nurses and other nurses that taught to help me find the way through the classes I needed to take. During this journey, I moved from Florida to North Carolina. Just as I graduated with my BSN, I was told by the local colleges that I would need a master's to teach full time. I was totally disappointed that after finally finishing a bachelor's degree that I still could not teach.

Today, as I round the corner to a major life achievement for myself, I am once again being faced with an educational challenge. When I finally hold that MSNeD, will I be able to teach or will someone in an Ivory tower some where make a new rule that will send me back to school? In order to teach - everyone must have a doctorate. I am fearful that if that becomes the requirement - there will be one less teacher ... me! That does not mean that I will not go on for my doctorate eventually - what it means is that I am tired of the road blocks and lack of probable direction.

People want to know why there is a "shortage" of faculty in nursing - perhaps it is because there is no reasonable and time saving method to become degreed and credentialed. Every time you think you have reached where you need to be, the rules change.

Anyway - I digress from my original intent - to graduate! Can't beat that feeling of wonderful personal accomplishment - I guess I am a pretty smart guy after all.

A Change of Plans

2008-12-23T13:18:00.000-08:00

For those that have been reading my blog - you know that I was working in a ICU for a rural hospital and also worked as an adjunct clinical instructor for a community college. Most also know that I am rounding out the completion of my graduate degree in nursing education. Whew! Ok - that helps me set the stage because I recently (almost 6 months now) accepted a position as a Nurse Educator for another rural hospital. The hospital never really had a nursing education department, so I was charged with the responsibility of developing this department from scratch.

In my humble opinion - how can a hospital exist without a nursing education department? For obvious reasons - I really can't go into any major detail about what happens when a hospital does not have a nursing education department. Suffice to say - bad things really do happen. Anyway, now I am charged with the responsibility of developing a fully integrated nursing education program of learning that includes the establishment of a nursing orientation, new graduate program and a program of on-going continuing education. It is very exciting, but also very overwhelming. It seems like they had no nursing education and now that they have a nurse educators, every educational need is urgent and a priority. That is the overwhelming part. The best part - being able to construct a nursing education department from the ground floor up and knowing that what you are doing is really laying an infrastructure to help nurses given patients better care. That is pretty awesome!

I will keep you informed of my journey. It should be very interesting to say the least.

Teenagers

2008-12-22T18:37:00.000-08:00

Okay - so I am a parent of three teenagers. My youngest is 16, my middle is 17 and my oldest is 19. Soon, the months will all collide and they will be 17, 18 and 19. All through their life, it was a challenge. They were all born so close together that managing all their individual needs was pretty tough. But, through it all, I felt like a competent parent that did a great job. As a single father, there were times when I felt like I needed to give them more of me than I had, but always seemed to find the energy.

As the years past, I always felt connected to each of them; watching their budding personalities and seeing them grow into some really wonderful people. This bliss all ended when they turned 16.5 years old. Suddenly, I became this uncool guy that had "unreasonable" rules. I was mean, yelled alot and expected that they act like people that had manners. I mean, asking them to put a dish in the dishwasher was like congress declaring war.

Today, I find myself wondering why I became a parent. I was actually very happy to have children until the aliens came down from afar and stole them from me. My Friends tell me that they will return soon, around age 20. I am starting to see the return on my oldest who is on the verge of 20. Our relationship is almost back to normal. I asked her where she went and her response was "it is a secret - no parent is allowed to know where we go because they always return us." She said, you went their too when you were 16.5 and returned home when you were 20 but they made you forget." Perhaps she is right - I do remember times when I thought my parents were pretty uncool and wanted to spend every waking minute with my awesome and cool friends. I guess I never realized how traumatic it was on my parents or those that cared about me.

Anyway - I have made a decision as I journey through this right of passage as a parent - I will be glad when it is done and I have my normal kids back. I know they will be adults then, but at least I can see what they have become. I wonder though - will I still like them? Wow - that's a thought. I do know that I am ready for the teenage years to end. I only hope when my kids are parents and they have teenagers - they get to experience everything they have helped me experience as a parent of teenagers. I guess mom was right - pay back is really a bitch.

A Simple Hard Working American Man

2008-11-13T17:26:00.000-08:00

Dear President Bush and President - Elect Obama,

In light of the recent events with our economy and the millions of dollars our government is giving to failed Wall Street companies and the proposed additional millions of dollars to be given to other failing banks and companies, I would like to let you know my thoughts as an American and as a citizen of this great country.

First, as a free market society, it is the responsibility of the big companies to effectively and properly manage their budgets in an effort to remain in business. This means that a company must use it's financial resources wisely so that it can meet its financial obligations, and ultimately make a profit and stay in business. But, somehow, the companies that are needing financial assistance from our government have failed to meet this basic standard of operation. I believe a first year MBA graduate student would recognize when revenue was less than expenses and perhaps even take steps to either shore up revenue or simply reduce expenses to stay a float and in business. Yet, despite their rich salaries, the leadership of some of these financial institutions are unable to manage their books and stay a float. While I can understand that they made bad business decisions that are now impacting Americans, I don't understand why we (the taxpayer) should burden the poor business decisions of these organizations.

I believe we live in a free market society - this means that when one organization fails, another will rise in it's place and perhaps do a better job managing their financial affairs, stay in business and they may even offer a product that would be superior to the failed company. Yet - the government is preventing this failure with millions of dollars from taxpayers. I certainly understand the argument that if we allow these organizations to fail, it could ripple across the world and cause the entire world to fall into a deep recession. Wow - a global economy has some real bad drawbacks I guess!

Here I sit as a single, simple American man raising my family, paying my bills (at least most of them), sending my daughter to college, making my mortgage payment every month and working off my butt to have enough money to buy groceries. Yes gentleman, I am probably like a lot of Americans that go to work each day and try to make ends meet. Sometimes they do and if they don't, my family and I cut back until we have enough money to buy what we need and sometimes - what we want.

I was originally going to ask for a personal bailout for me, but, I am a bigger person that this. I work and do what I think is right. I will not be a victim or dependent on my government to support me. Nope - no bailout for me. I would suggest that before anymore money is sent to failing companies that you consider the plight of simple Americans like me and how hard we work to support the government's infrastructure. Don't just give our money away!

Thank you for taking the time to read the words of a simple American man. I really do appreciate the job you have and I know and pray that you (both of you) will do the right thing.

Sincerely,

A Simple American Man

About Time

2008-11-11T20:04:00.000-08:00

I bet most of you that follow my blog (maybe 5 people in total - ha!) have been wondering what happened to me. Well, the truth of the matter is that I lost my sign on and password and could not figure out how to sign back in. But - after several months of trying to locate my sign on - I finally found it. I now have it in a better place. So hopefully - I can keep blogging. Hope you all did not miss me too much. I will be back with some new stuff soon.

My Latest Literature Review! Family Centered Care in the Intensive Care Unit Through Open Visiting Hours

2008-02-10T18:18:00.001-08:00

Family Centered Care in the Intensive Care Unit Through Open Visiting Hours
Nurses today have a unique challenge and opportunity to effectively balance the provisions of critical care on the acutely ill patient while also striving to meet the needs of family members impacted by the patient’s critical illness. The concept of family has changed over the years and expanded to include blood relatives as well as people that are significant to the patient. It is a fact that many people will either personally experience a critical illness or be impacted by a critical illness by a friend or family member (Gavaghan & Carroll, 2002).
The concept of family centered care and open visiting hours in the intensive care unit (ICU) has recently come into light as health care professionals, family members and researchers seek to examine the benefits of a more liberal policy for visitation. According to Farrell, Joseph, & Schwartz-Barcott (2005), visitation regulation have largely gone unchanged since the U.S. Public Health Service published visitation recommendations for the intensive care unit in 1962. The research on the subject matter remains limited and far more research is necessary in an effort to acquire empirical data relating to patient responses to a more liberalized visitation policy that is focused on family centered care.
This paper seeks to examine the literature available to answer the compelling question as to whether open visitation policy within the critical care environment provides recovery benefits to the patient. Adjunctive to this question is the need to recognize the family as an extension of the patient and determine their needs and motivation. This paper will explore five comprehensive studies in an effort to develop information on the compelling question. Further, each study will be critically reviewed to determine commonalities among the research as well as differences. Finally, the results of the review will provide conclusions that support change in practice and provide strategies for hospitals to develop a visitation policy that is consistent with the research and focused on family centered care.
Literature Review
The first research article is a study conducted by Gavaghan & Carroll (2002) with a purpose to integrate current knowledge about family centered care as a means to develop nursing interventions that promote family centered approach to care in the ICU. The primary thrust of the research was focused on family centered care theory, where the family is viewed as a “social unit that has significant effect on the patient’s outcomes” (Gavaghan & Carroll, 2002, pg. 65). Gavaghan & Carroll (2002) hypothesized that family members have needs that must be recognized by nurses in the critical care environment. Further, the authors set out to clarify these needs through the development of the Critical Care Family Needs Inventory (CCFNI). The CCFNI focused on five conceptual areas that researchers felt were important to the family and included: proximity, assurance, information, support, and comfort. According to Gavaghn & Carroll (2002) psychometric testing of the CCFNI supported appropriate measurement of the data collected by the tool. The study sample consisted of forty family members that completed the CCNFI (N=40). The results of this inventory revealed that family members often felt that their needs for information as well as proximity were met. However, the study revealed that visiting hours, support and comfort were often inconsistently provided by nurses and medical staff. Of special interest is the notion that while the hospital had a posted policy for visitation, nurses were inconsistent in their application of the policy. This inconsistency often made the family feel a sense of distrust to the nurses.
The final conclusion of this survey provided for suggested recommendations to improve family relationships in the ICU and improved satisfaction. Nurses are the primary means of information and support because they are the health care professionals that have direct and constant access to the patient. The study suggests that as a means to improve satisfaction, hospitals develop a visitation policy that embraces family in the care of the patient. Further, the facility should develop a brochure about family centered care and visitation that provides the family with an orientation to the activities of the ICU. Lastly, the author suggested that the use of volunteers to engage families in the orientation process provided needed relief to the nurses and actively involves a group of people that have the time to spend nurturing the family needs.
Another research article written by Farrell, Joseph, & Schwartz-Barcott (2005), focuses on the need to balance patient, visitor and staff needs in terms of open visitation in the ICU. This phenomenological qualitative study was driven by the need to answer the question about nurse perceptions while working with visitors in the ICU. The study focused on a sample of nurses (N=8) that work in the ICU and have voiced concerns over balancing the care of the critically ill patient while attempting to meet the increasing needs of family members. The tools used for this research included observation, questionnaire and interviews with the sample participants. The measurement and analysis of the data included host verification, where the researcher validates the quotes from the sample participants and allows the participants to verify their answers (Polit & Beck, 2004).
The findings of the survey demonstrated that nurses are central to access of the patient. Nurses hold the key to the gateway and depending upon their needs for the day can deny or grant access to the patient by family members. The major concern with this responsibility is the general lack of consistency by the nurses. One nurse may grant family access while another nurse denies access creating a disparity in the nurse-family relationship (Farrell, Joseph, & Schwartz-Barcott, 2005). Central to the nurse-family relationship is for the nurse to understand that family members have a need for information, and access to the patient. Likewise, families need to understand that nurses must balance the critical care of the patient, safety and have the ability to complete the nurse’s work while the family is present. The study also focused on how nurses manage family visitation during the patient’s routine care and when it is appropriate to ask a family member to leave. Study participants overwhelming cited that they asked family members to leave during the provisions of personal care (Farrell, Joseph, & Schwartz-Barcott, 2005). Further, nurses were conflicted as to whether family members should be present during codes. The study suggested that family presence during a code is very individualized and should be left to the discretion of the health care team and the family members (Farrell, Joseph, & Schwartz-Barcott, 2005).
In comparison to the first study reviewed by Gallaghan & Carroll (2002), Farrell, Joseph, & Schwartz-Barcott (2005) suggest that the ICU appoint one individual that can effectively manage the complex needs of the family, thereby allowing the nurse time to care for the patient. While Farrell, Joseph, & Schwartz-Barcott (2005) do not suggest a volunteer can manage this function, it is interesting to note that both studies made this recommendation.
Another study conducted by Livesay, Gilliam, Mokracek, Sebastian & Hickey (2005) detail the experiences of nurses that work in a Neuroscience Intensive Care Unit (NICU). The purpose of this study was to examine nurse’s perceptions about open visitation, determine if the nurses believe the policy needs to be changed, and how the actual policy in place impacts their patient’s recovery. This quasi-experimental research design had a participant sample of registered nurses and patient care technicians (N=30). The measurement tools employed were questionnaires that were distributed to study participants. Of the thirty participants, twenty-six responded (Livesay, et al, 2005). According to the study, 85% of the sample were aware of the visitation policy and provided this information to family members when they inquired about visiting hours. Nurses were more likely to be liberal with the visitation policy (10 of 25) if the patient’s condition was serious. Most of the nurses in the sample indicated they would ask family members to leave the ICU during normal care routines. The majority of nurses would recognize caregiver fatigue on the part of the family member and would suggest that the family member take a break to get a cup of coffee or go for a walk (Livesay, et al, 2005). An interesting point to note here is that the nurses studied most often recognized the family members need for information concerning the condition of the patient. Many family members were reluctant to leave the bedside if there were not some assurances from the nurse that they would contact the family member if the patient’s condition were to change. Another point of interest is that fact that when nurses provided the family with assurance that they would monitor the patient closely; the family member would leave the unit for a rest period (Livesay, et al, 2005).
The conclusion of this study resembled the conclusions of the two other studies reviewed. This study recommended that clear policy be established on visitation and that nurses apply the policy consistently across the board. In addition, the development of educational material and perhaps a contract for care is made between the family member and the nursing staff. This study identified the educational material be used as a means to provide the family with education about the patient’s needs, the nurses responsibilities and ways in which the family can be engaged in the care of the patient. Finally, like the other studies, this study also recommended that support personnel be included in the units of staffing in an effort to relief the nurse from the responsibility of meeting the complex needs of the family. Support personnel can provide the family member with needed information and contact during the critical care stay and increase the family’s satisfaction with the hospital (Livesay, et al, 2005).
The next study reviewed was one conducted by White (1994) that randomly selected 125 hospitals that had an intensive care unit (N=125) and to compare and contrast visiting policies for each hospital. 40% of the sample responded to the survey conducted by White (1994) during the study period. Of this 40% all participants had a visiting policy in place for pediatric and adult ICU. Visiting hours ranged from 8 hours to 14 hours with few having any form of visiting hours after 9:00PM. The general premise of the study was to determine if there were physiological reasons for more liberalized visitation as well as to describe the legal and ethical considerations for a more liberalized visitation policy.
As has been true throughout this literature review, most of the studies, including this study by White (1994) speak to the fact that the nurse is considered the gatekeeper. Use of this term employs the understanding that nurses are often the professional responsible for applying the policy of visitation within the critical care environment. In addition, the nurse directly impacts the family’s ability to have access to the patient or be denied access to the patient (White, 1994). The major difference in this research is the focus on ethical and legal considerations for visitation. According to White (1994), patients and their families have the right to be together through an acute illness. White (1994) suggests that as patients are isolated and in some cases forced isolation, this can and often does cause a general sense of distrust with the staff and increases the recovery period of the patient. Patients need the support and nurturing of their family during times of acute crisis or illness.
The conclusion of this survey suggested that nurses need to have a wide depth of understanding about the policy of the hospital in terms of visitation. Nurses often denied access to visitors if the business of the unit required such actions. Most often cited was the increased acuity of the patient or the staff limitations (i.e. shortages of staff members) (White, 1994).
The final research study that was reviewed was conducted by Eriksson & Bergbom (2007) and was designed to answer the question of whether family visitation actually helps the patient during recovery. While there is much discussion about family visitation, there is very limited research to support or deny the claim that increased visitation by family actually is beneficial to the patient. Eriksson and Bergbom (2007) used a prospective, explorative observational study design to answer the referenced question. They surveyed a sample group of 198 patients and their families during the study period (N=198). The nature of the study was longitudinal because it provided a study review period of eight months. The primary thrust of the study was to examine the results of family visitation on the clinical manifestations of the patient and whether these clinical results were related to increase family support. Data was collected over an eight month span of time and reflected a total of 198 patients. The data was analyzed via the Statistical Package for Social Sciences, Version 12 and deemed reliable (Eriksson and Bergbom, 2007).
At the completion of the study, the data revealed that there is really no conclusive evidence that increased family visitation had a direct positive or negative impact on the patient’s overall clinical performance. In fact, the researchers suggested that more research and study is needed in an effort to provide further evidence on the subject. The authors made reference to the fact that patients in the study that had no visitation during their stay in the ICU had a better mortality rate than those that had visitations (Eriksson & Bergbom, 2007). This result might lead one to believe that family visitations do not have any correlational relationship to clinical performance and recovery.
Discussion
Each study reflected a reasonable design and analysis methodology. Some studies reflected the perception of nurses with open visitation policies, while other studies focused on the patient’s clinical performance with increased family visitation. In each study, the data was compelling and revealed that family members have a need for close proximity (access) to the patient, a need for information, and a way to be engaged and involved in the patient’s care. Further, most of the studies reviewed suggested that educational material be developed in an effort to provide family members with an orientation to the critical care environment and the stated visitation schedule. Nurses were recognized as the gatekeeper for access to the patient and when there is disparity among nurses in terms of enforcement of vitiation policies it can negatively impact the nurse-family relationship. Some studies went so far to suggest that when visitation policies are not consistently enforced that it can cause a distrustful relationship between staff and family members and reduce overall family satisfaction with care.
Some inconsistency with the studies center around the overall influence open visitation has on the clinical performance of the patient. The study by Eriksson & Bergbom (2007) provided empirical data to refute the hypothesis that increased family visitation actually improve patient’s overall mortality and decreases the recovery process. Evidence from their study is contrary to the new age assumption that open visitation makes a real difference to the patient. While the results of their data may be true, the authors of the study suggest that more research be conducted to in an effort to analyze more data on the subject.
Conclusion
Open visitation in the critical care environment is being widely discussed as a means to improve patient outcomes and provide families with proper access. Research on the topic continues to be very limited. However, there is enough evidence to suggest that family-center care theory can be used as the corner stone of this foundational understanding into human dynamic. Families are evolving and changing and health care professionals must recognize that people who are important to the patient must be considered family members (Gavaghan & Carroll, 2002). While the industry adapts to the changing family unit, there are several strategies that nurses and hospitals can employ in an effort to better meet the needs of patients and their families. Some of these strategies include: the development of consistent and fair visitation policies designed to address the needs of the family, educating nursing staff about the need to fairly and consistently apply the visitation polices across the board without the need for disparity, and the development of educational material designed to orient the family member to the critical care environment as well as provide them with written information about stated visitation schedules. Further recommendations suggest that a member of the volunteer staff be appointed as a family liaison and conduct the family orientation. Also the development of a family engagement contract was suggested by one study in an effort to involve the family with the provisions of care. Finally, in an effort to provide ample access to the patient and allow fatigued caregivers the opportunity to take reasonable rest breaks, one study suggested that the hospital invest in beepers that can be assigned to family members that leave the ICU for breaks. Beepers provide the family member with a peace of mind that if they are needed or if the patient has a change in condition, the nursing staff will have ready access to alert them of these changes.
As hospitals and critical care environments develop their policies, they must keep in mind that nurses play a critical role as gatekeepers for the patient. The primary concern must always be for the well-being of the patient, but the family and their complex needs must be met as well. The challenge faced by today’s professional nurses is truly in the balance of these two different priorities.

References
Eriksson, T. & Bergbom, I. (2007). Visits to intensive care unit – frequency, duration and impact on outcome. British Association of Critical Care Nurses 12(1). 20-26.
Farrell, M., Joseph, D., & Schwartz-Barcott, D. (2005, January). Visiting hours in the ICU: finding the balance among patient, visitor and staff needs. Nursing Forum, 40(1), 18-28. Retrieved January 29, 2008, from CINAHL Plus with Full Text database.
Gavaghan, S., & Carroll, D. (2002, March). Families of critically ill patients and the effect of nursing interventions. Dimensions Of Critical Care Nursing: DCCN, 21(2), 64-71. Retrieved January 29, 2008, from MEDLINE database.
Livesay, S., Gilliam, A., Mokracek, M., Sebastian, S., & Hickey, J. (2005, April). Nurses' perceptions of open visiting hours in neuroscience intensive care unit. Journal of Nursing Care Quality, 20(2), 182-189. Retrieved January 29, 2008, from CINAHL Plus with Full Text database.
Polit, D. F., & Beck, C. T. (2004). Nursing research: Principles and methods (7th ed.). Philadelphia: Lippincott Williams & Wilkins.
Verhaeghe, S., Defloor, T., Van Zuuren, F., Duijnstee, M., & Grypdonck, M. (2005, April). The needs and experiences of family members of adult patients in an intensive care unit: a review of the literature. Journal Of Clinical Nursing, 14(4), 501-509. Retrieved January 29, 2008, from MEDLINE database.
Whitis, G. (1994, January). Visiting hospitalized patients. Journal Of Advanced Nursing, 19(1), 85-88. Retrieved January 29, 2008, from MEDLINE database.

Password?

2008-02-10T18:11:00.001-08:00

Ok - I have admitted that I am new to the whole blogging experience, but to not be able to sign into your own blog - well, that is really pathetic! Yes, I guess that descibes me! Anyway - I have been unable to sign in becuase blog spot changed the way you enter your blog. I guess I did not remember my google sign in and apparently it was different than my blog. But, alas, I am here and I did find my way. Now, if I could only remember my yahoo sign in for myblogspot account, I would be all set.

Does it strike you as funny that in our lives today - we actually have to have a file for passwords and user IDs. I can remember way back when ... when there was no such thing as a user ID, or if we had a user ID, it was for our lunch account at the hospital.

Oh well - with advances come challenges. I guess someone needs to invent a password reminder - probably already done and a great thing to hack. That's a funny thought - the hackers can remember your user ID and passwords better than you!

I think that is why I am a nurse.

"Green" Nurses

2008-01-04T14:29:00.000-08:00

From the title, you might expect I was once again pontificating on the new graduate nurse. But, you would be wrong! The post title is really something significant to nurses as we look at the amount of disposable waste we generate in the hospital or health care environment each day. I have to admit - I am certainly no expert on this, but it would seem to me that every time I use a pair of gloves or use supplies that are perfectly packaged, I am making a not so wonderful contribution to the waste issue on our planet.

Have you considered the amount of waste you generate in one single shift? What happens to all this waste? I am sure it is incinerated, but the power necessary to incinerate this waste has to also take its tool on the natural resources of the planet as well. Are there better ways to package supplies? Are there better ways that health care professionals can promote a green attitude in the health care environment that does not place them or the patient at risk? I would certainly believe that we can and really should strive to look into this issue.

While I may not have the answers professionally about health care waste, I can start at home. I can make a difference at home and begin to explore how I can make a difference professionally. Hopefully you can too.

A LIttle Help for New Graduates

2007-12-19T17:47:00.001-08:00

I certainly do not profess to be the expert here, but as a nurse for 23 years in med-surg, surgical progressive care, open heart, and ICU as well as a clinical nursing instructor and a graduate student (MSN), I think I have some general words of advice. So, for those of you who need it - here it is for what it is worth to you.

1. First - every time you sign your name as a RN - please remember how hard you worked for this accomplishment and the sacrifices of yourself and all those people in your life that helped you "make it!"
2. Remember, nursing is a hard job! It has always been a hard job and it will always be a hard job! (Florence Nightingale).
3. Learn as much as you can! Do NOT be afraid to ask questions. You might drive an experienced nurse crazy, but in the long run, any experienced nurse understands why you are asking the questions and will respect you for trying to build upon and grow your knowledge base. For those that don't - forget about 'em - they ain't worth the time of day and probably are burned out nasty nurses that need to get the hell out of the business.
4. Always remember - the only reason you are an RN is to care for that patient. They are the true reason our profession is here. Don't ever forget your compassion, honesty, love and integrity. Fight for that patient and the care they need - they are counting on you!
5. Never give a medication that you don't know how it works. Ask the "WHY" questions as many times as you need too until you feel you understand and are comfortable with WHY you are doing something. Too many nurses don't ask the "WHY" questions and that gets them into trouble.
6. Never let a physician intimidate you. Yes, they are more educated (in some cases) and have more experience than you do, but you are the person at the bedside that is best situated to see changes in condition. While in the beginning you might feel like you don't know enough - rely on other experienced nurses to review your assessment with. They will help you to determine what to say to the physician.
7. An employer will work you until you are dead! Live a balanced life and don't make excuses for having balance in your life. If they ask you to work extra and you know that your child has a play and you can't work - please know that NO can really mean NO! And, you don't need to feel guilty about it.
8. Don't get STUCK working in an area of nursing that you are not passionate about. It is the fastest way to burn out in this profession. Seek out learning opportunities that will grow your knowledge and skill in an area of nursing that you desire to work in. Nursing offers so much variety that there is really no reason to stay in a place that you are not happy working. And - don't let them tell you that you need a year of med-surg before you can go to a speciality area. While having a med-surg background offers you the opportunity to develop your skills and competencies - I have known many of nurses that went into a speciality areas right out of school and have been highly successful. It really all depends on your motivation and your commitment. You call the shots.
9. After you have finished your first year in nursing - pay it forward. Remember that poor new graduate that your manager just hired - help them, be friend them and mentor them. You owe it to them.
10. Remember that nursing is a life-long learning profession. No matter what happens in your life - keep learning and never forget the benefits of more education. And - finally, remember your days as a new graduate and be the experienced nurse that other new graduates can look too as a resource and a person to learn from.

Congratulations on passing your boards and becoming a nurse! We need you and we need you to stay around for a long time. Thank you for entering our noble profession and for making a REAL difference in the lives of patients that need your care and love. Thank you for caring.

Start the Conversation Today!

2007-12-18T17:41:00.001-08:00

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Tell me what your thoughts are on this video!

Special Thank you!

2007-12-17T09:52:00.000-08:00

Over the course of the last several months, I have diligently tried to get my blog up and running. I have visited some wonderful, wonderful blogs and I want to take the opportunity to extend some thanks out there to a few of my new blogger friends and those that I hope to become blogger friends with as well. To DisappearingJohn a word of thanks! Your blog has been great to read and your help to get me started has been invaluable. Keep writing and doing what you do - it is exciting to read the next saga for sure! Thanks also to Kim at emergiblog - while you don't know me from adam - I have totally enjoyed reading your blog and your links have helped me to learn more about how to manage this blog business. To Crystal at Nurse Pickle you are one of my first real visitors and that is exciting (Yes John - you were really the first, but Crystal came to the site without any provocation - at least I think).

And finally - a special thank you to all those bloggers listed in my favs! While I may not have linked you here - you are linked on my blog and I read you faithfully. At times, I may lurk not comment on what you have written, but I love the readings! Thanks to you all and I hope my blog will one day be as successful as yours!

PS - For Lisa at cargosarge your site has great meaning and I hope you continue to develop your blog. Many women have come home from Iraq with stories of their own and need a place to read, and post so they too can begin the slow and arduous process of healing. Your long range idea to provide a blog for these ladies is forward thinking and compassionate!

Impacting Lives!

2007-12-14T16:15:00.000-08:00

This past week, I finished the fall semester with my clinical group. I have worked with these students both in the classroom, lab and now in the clinical arena for the entire semester. As a clinical instructor, I am not sure that you really ever realize the impact you have on a student until you see the difference in what they have become.

Case in point are my initial freshmen students. These folks (most of them) were as green as green can come. Each having their own background and their own personal reason for wanting to join the ranks as a registered nurse. My quest, to teach them how to become registered nurses.

As we entered the clinical environment, I came to realize that these guys and girls had a great deal of anxiety. I thought anxiety was good, because it keeps you on your toes and helps you to question everything, making a mistake a lot harder to come by. After the first rotation, I could see that these students were going to need to some hard love! That is what they got. Hard love. My expectation of their knowledge growth was predictable. They knew I wanted them to learn and they worked hard to do what was needed to demonstrate their growth.

As the semester ended this week and I held my last clinical day with these young men and women, I was thrilled to be a part and to witness their knowledge growth. They had finished out their first semester and were successful. Each had developed strength, confidence, but more importantly, their passion to care for people became stronger.

I salute you guys - you know who you are and say thank you for making this last semester one of my best!

They asked me to publish this "ODE" that I wrote them for their last day - so here is the "ODE" as requested.

An Ode to the
Student Nurse

Fundamentals, sciences and labs galore
I am a student nurse and I know there is lots more
I work and I slave to know all this stuff and
Go to the bedside and lose it fast enough!

The teacher, he’s great and helps me a lot,
But when he asks why, I stand there in shock

Does he not know, does he not care,
I am a nursing student and I am aware!
Ask me those questions, I’ll tell you I know
But the truth is, I am buried in oh no!

Room 235 and 236 are assigned to me,
teacher comes down the hall to tell me they are all in pee
Luis is shoutin, help me in here
The patient is squirting, it looks like yellow beer.

Todd comes a running with Amanda aside,
Paige and Landon have on their stride.
They’re working sir, exclaims Mike with a grin,
As he barrels past with the hairs on his chin.

Tammy’s a smiling, she got quite the laugh
As she sees all the students quickly run past.
She shouts Hey Teacher, you need me there too,
Only to find that her patient is blue.

Autonomic Dysreflexia she shouts to the crowd,
But she knew it already and was real proud!
Bravo to you and all of your cronnies,
The nurses love you and they are not phonies.

Stephanie just stands there gathering it all in,
Oh these silly students, she says with a grin.
They will all learn, they will all know
That nursing is something you pace as you go.
No running is needed and no shouting galore,
Simply walk to the patient and clean the pee up off the floor.

This class is almost over and it all about to end,
I know I’ve learned a lot and Teacher has been my friend
Today I sit and ponder the fate of my career,
I wonder to myself, was that really beer?

Thoughts - Reflection

2007-12-07T06:49:00.000-08:00

So - I have returned to school to finish my Masters degree. Ultimately, I want to teach. That has been and continues to be a firm desire of mine. I think I have a great deal to offer new nursing students. I have been teaching in an adjunct capacity for sometime now. Interesting though, that every time I finish a degree in nursing, the requirements to teach on a full time basis seem to change right at the same time I finish school. It can be and often is very frustrating to me. While I recognize the need for faculty members to have advanced degrees, it is frustrating how the degree requirements change right at the same time as I finish my education.

Ok - here is my question - when I finish my MSN, will the requirements for teaching change again to the PhD level? Is it a bad thing to require more advanced education for nursing educators? No - not at all, but I really wish someone would clue me in the changes so I can be prepared rather than disappointed.

I will earn my PhD and then colleges and universities are going to be hard pressed to tell me that I am not qualified to teach.

Ok - enough about that!

I have not been on for a while and apologize to my devoted readers ( I think that totals about 2 people), but you are both very special to me and I am glad that you read my blog. I have really grown to love blogging and hope to spend a great deal more time doing this. Of course - right now I should either be at the gym, finishing (starting actually) my Christmas shopping, or doing my homework assignment, which is due tonight. But I'd rather be here.

I am going to begin a section in my blog for theory. As I finish my course work on nursing theorists, I have discovered that theory can be extremely interesting. Yes, the elements of theory are boring and some theories are simply boring as well. But, the more I read and discover nursing theory the more compelling I am to inquire further. I think there is such a need for effective theoretical framework as nurses navigate the health care maze these days. We need empirical information that will help us as nurses to advocate for our patients and get the care they need.

Patients enter and leave the health care system so fast that many of their chronic needs fall through the cracks. As nurses, we have an opportunity and an obligation to help these patients access care and serves that will promote a quality of life. As a nurse - I love the advanced technology of our time, but I hate the health care system. There needs to be major change if we are ever to help those that need our help the most. As the baby boomers age - the system will become more bogged down and access to health care more difficult for those that need it the most.

As nurses - are we powerless to voice our desire for effective change to the system? I DON'T THINK SO! We are the most powerful professional group in health care. Our numbers are staggering, if we would only come together with one STRONG, collective voice. Yelling - IT IS TIME FOR CHANGE! Are you going to join and become a member of the collective voice? Or, are you going to just sit back and watch the system devour patients? Interesting and thought provoking.