Strategies on Cultural Competence

In my own nursing career as a supervisor for field case managers, I have encountered patients and staff that come from diverse cultures. Every two weeks, our entire region would participate in something called Grand Rounds.  During those rounds, our medical director would review four cases that had been submitted for evaluation and best treatment options.  My team consisted of different cultures.  We had some wonderful nurses from different Caribbean Islands, some of them had a very strong accent, but that did not stop them from providing good care.

During one of our grand rounds, the medical director selected two of my case managers to present their case.  This case was presented in our own team meeting and we thought it would be a great one to present.  The one case manager we will call her Ms. R. presented a case about a member that had too many cats in the home and she was having difficulty staffing the case with home health aides because no one wanted to go in the home with so many cats. The medical director gave his evaluation of the case and the case was closed with the new information for the nurse case manager to implement.

During a manager meeting with about six other managers, the topic of case presentations came up and how each team needed to submit two cases per week, even if they were not selected for grand rounds.  A manager from England, who spoke with an English accent, stated that my team presented a lot of cases all the time.  I  stated that our strategy in our team meeting was to bring two cases every week so that everyone had a chance to comment. It also served as a good practice for the nurse presenting the case if the member was selected for grand rounds.  The English nurse manager asked me how I even understood Ms. R. and a few other staff from the islands that I had.  I politely let her know that I did have a diverse team and every one of them was a great nurse and social worker and did their jobs quite well.  As for understanding them, I listened to what they were saying intently and I did not multitask when they were speaking so that I could capture every word they said. Her response was I am glad that they are on your team (Clark et al., 2011).

I did resign from this position and unfortunately, four of the team went to this one manager and the other nine went to someone else.  But of the four there was one that was from Haiti, one from Grenada, one from Puerto Rico, and the other one was African-American.  I heard from all four about the poor treatment they were receiving from this manager. Of I course could only listen since I no longer worked there, but this was a perfect example of how not all nurses follow the code of respect for other people’s cultures.

With patients, it is the same thing, as nurses,  we are not always going to understand what someone is saying whether it is a language barrier, dysphagia from a stroke, or dementia, but we need to read the body language.  We need to fine tune our ears to try to understand what the person is saying. Living in Florida I am exposed to many cultures.  I myself am of Hispanic descent and although born in the states, I understand the diverse cultures that are here.

In integrating health teachings, many materials are available in Spanish and Creole, for the ones that are not, the use of translation companies are available through hospitals or managed care companies to help with the teaching that will be offered to the patients.

References

Clark, L., Calvillo, E., De La Cruz, F., Fongwa, M., Kools, S., Lowe, J., & Mastel-Smith, B. (2011, May-June). Cultural Competencies for Graduate Nursing Education. Journal of Professional Nursing, 27(3), 133-139.

A Review of a Nurse’s Role

A nurse can play three different roles as part of an interprofessional team.  The three roles consist of a nurse, nurse leader, and nurse educator.   The inter-professionalism team consists of other healthcare workers as well, not just nurses (Sommerfeldt, 2013). However, as nurses, the roles can be at different levels depending on the patient’s condition.  At my previous job, I worked as a complex case manager.  The team consisted of registered nurses, social workers (masters prepared) behavioral health specialists, community health workers, and nutritionists.  The nurse case manager managed the patient but if there was an issue with the patient in the home setting that required community resources, the community health worker would be consulted to assist in those needs.  If the member had psychological issues or other financial issues that required the need of a social worker or behavioral health specialist this referral would be added as well.  There was collaboration on the plan of care and all participated because we all were looking at the patient as a whole, not just as the part that each discipline took care of.  If a member was not able to pay his light bill or water bill due to financial difficulties until those needs were met through resources, any teaching that the nurse would do would be in vain.  A person cannot focus on teaching for their health or anything else if their mind is on their current financial strain, not their medical condition. In this instance, the nurse is playing the role of the nurse leader.

When a patient is in the hospital a nurse can also play the role of a nurse that is doing dressing changes, medication administration, and other treatments.  The nurse’s role in the interprofessional team may consist of the doctor, physical therapist, and dietitian, this would be more medically involved because maybe the patient is recuperating from heart surgery and requires a lot of care initially.  The patient may be on a special cardiac diet, which can also be explained by the treating nurse, however in this instance, the member is starting something new, so a consult from the dietitian can help the patient understand the diet and the nurse can reinforce the teaching.

The nurse educator as part of the interdisciplinary team can be seen for example in a disease management setting.  This type of setting also has multiple specialties that can follow the patient.  In this instance, the nurse educator is educating the member on how to empower themselves and learn about managing their chronic disease by learning about taking their medications, following a diet and exercise program, learning to check their blood sugar, or blood pressure.  The nurse educator can document what the patient learned based on return demonstration in the plan of care.

All three roles bring value to the scenario that they are in because the nurse will be around the patient most of the time.  In each role, the nurse is responsible for all aspects of the patient’s care.  Regardless of which role the nurse is playing, working on an inter-professional team is a style of partnership that allows decision making to be collaborative (Sommerfeldt, 2013).  It takes many people to working together to get a patient discharged to his home.

 

References

Sommerfeldt, S. C. (2013, February 25 2013). Articulating Nursing in an Interpersonal World. Nurse Education in Practice, (13), 519. http://dx.doi.org/http://dx.doi.org/10.1016/j.nepr.2013.02.014

Importance of Professional Communication

Professional communication is very important when we are dealing with a patient’s health.  In this virtual world that we live in where more and more people are working in the field and from home, it is important that we maintain a standard of etiquette when speaking with people via electronic mail and in person. Rapid responses without thinking about them first can come across incorrectly in person and in writing.

In every organization, there are communication barriers, but overcoming them is part of being professional and respectful of others’ opinion.  One barrier that is seen in managers, is the inability to show respect to other team members and allow a learning environment.  This is a prime example of a barrier in a learning environment that will hinder an employee’s growth and affect the quality of patient care (Rubenfeld & Scheffer, 2014).

As a former manager of a team of nurses and social workers, collaboration existed in my direct report team, and as a team, we functioned using critical thinking, interdisciplinary team approach and collaborated on cases together.  But in the big picture of corporate America under the manager that I reported to, this was not acceptable, it was a multidisciplinary team.  In this type of team, there is only individual thinking in the group, meaning their way and no other opinions.  The focus will be on tasks and check off systems regardless if it is feasible to do (Rubenfeld & Scheffer, 2014).

Nurses do have the ability to be leaders and educators of a system that will stimulate change if they are assertive. In order to make an impact, a good team of interprofessional people is needed (DeNisco & Barker, 2013).  At the end of the day, the patient is the one who counts and the reason why changes are necessary. If more companies were focused on having a management style that was transformational vs transactional, this would alleviate the unnecessary resignation of employees, corrective action plans, and disgruntled employees.

In our team, for instance, a good way that we used to incorporate learning weekly was having one person do a case study and they would team up with another person on the team to present the case study on a difficult patient.  During this time the team had the ability to comment on the case, make suggestions and also refer to our medical director for review.

There are many teaching and learning styles that we can use to teach patients. The important thing is that no matter what we feel is our way or learning, not everyone will learn the same way.  Therefore as the nurse, we need to explore what is that patient’s learning style and teach in that way.  Another assessment the nurse can make in the home care setting is the readiness to learn.  If a patient is having difficulty paying his electric bill, he may not listen to the teaching on a diabetic diet and the foods that he is to be eating or buying, because he may not have the resources to purchase them.

In conclusion, managers and leaders need to be able to figure out a way to engage their teams, show them respect, praise them for a job well done and be able to involve them in the overall goal as a team vs. a transactional leader that dictates and causes poor morale amongst the team.

 

References

DeNisco, S. M., & Barker, A. M. (Eds.). (2013). The slow march to professional practice. Advanced Practice Nursing (2nd  ed., pp. 6-17). [Vital Source Bookshelf].

Rubenfeld, M. G., & Scheffer, B. K. (2014). Critical Thinking TACTICS for Nurses:Achieving the IOM Competencies (3rd ed.). [Vital Source BookShelf]. Retrieved from http://online.vitalsource.com/books/9781284059571

When a Patient is in Pain

Have you ever thought about your patients in the hospital that are under severe pain?  When someone is in pain, the painful stimulation must be removed in order for them to function. In looking at the activities that we do on a daily basis like brushing our hair, getting dressed and many others, I can see how many would not be motivated because of the pain that they are in.  When physical therapy comes around, they at times lose their motivation because it is too painful.  But if we write the plan of care and recommend to the physician that they have medications given to the patient about 20-30 minutes before therapy, then the patient may be able to work through the therapy that may be painful otherwise.

Some patients who are being cared for in the home setting may have experienced an injury or disease process that prevents them from taking care of themselves and they get frustrated.  This is when we can show the patient ways to remain independent and give them choices when possible.  For instance what foods they like to eat within their diet or what days they want their bath. Everything depends on when they have the help available, but at least whenever they make a decision, we should give them that option.  We can help the patient have some decision making power (Alligood, 2013).

 

References

Alligood, M. (2013). Nursing Theorists and their Work (8th ed.). Retrieved from http://online.vitalsource.com/books/9780323091947

Cultural Differences and Beliefs

Our beliefs in about different cultures and patient care should be respect. When I worked as a nurse in labor and delivery, I met parents from different socioeconomic stages and cultures.  During the time that a mother would be in labor, it was interesting to see how the woman from one culture perceived pain vs another culture, as well as the role that the father played in the whole birthing process.  As nurses, we may not understand everyone’s language or their culture, but we are required to use cultural competence to be able to take care of our patients.  If we are too quick to judge another culture because our beliefs are different, we may not be able to objectively take care of our patient.  For example, there are some religions that do not believe in blood transfusions, however, as an adult, they can sign for themselves stating that they are refusing medical treatment and they understand the medical consequences of refusing it.  As nurses, our treatment of the patient and their family after refusing a transfusion should not be different.  We should be respectful of their religious beliefs.

Our own beliefs as a nurse can impact a patient in many ways.  For instance, if you find yourself in a Christian hospital where praying is okay with a patient and encouraged, and you feel comfortable asking the patient if they would like to pray, then you would do that.  Now in the same situation, if you are a nurse that is not very religious but works in a Christian hospital and a patient asks you to pray with them, it can be very awkward for the nurse.  The nurse can let the patient know that she will stay there as they pray and a warm touch of the nurse’s hand on the patient’s hand can be all the comfort that the patient needed.

When assessing a plan of care for a patient, the work situation, their lifestyle, culture, and religious preference will all affect how the plan of care is initiated.  The plan of care involves the patient with his or her own patient-centered goals.  These goals should be measurable and attainable.  There should be an intervention as to how the patient will achieve his or her goals. In the care plan,  there should be an end date as to when the goal is perceived to be completed.  Lastly, at the end of the evaluation date, there will be a review to see if the client was able to fulfill his goal and how much progress they have made.  If they have not fulfilled their goal, what barriers prevented them from achieving their goal?  Then a new plan of care should be started so that the nurse can keep track of the goals and formulate time frames to complete the old ones that haven’t been done.

The medical model defines illness and disease as the absence of it. The World Health Organization (WHO) concentrates on social and medical wellness. In today’s world of medicine, people still run to the emergency room because they do not have a primary care doctor. Therefore, we as a culture have not adopted in full the ability to practice holistic medicine and prevention vs. treating the illness after it has happened. Holistic medicine is noted to have four components; physical, mental, social and spiritual (DeNisco & Barker, 2013).

 

References

DeNisco, S. M., & Barker, A. M. (Eds.). (2013). The slow march to professional practice. Advanced Practice Nursing (2nd  ed., pp. 6-17). [Vital Source Bookshelf].

Leadership Styles and Organizational Changes

The role of the professional nurse when implementing a change is to identify that there is a need for a change (Rubenfeld & Scheffer, 2014).  Once the need for a change is identified by the nurse, the next step is to implement a change in behaviors efficiently and with quality. When identifying the area specifically that needs the change, nurses need to be deliberate in stating the purpose for the change.  When speaking to the target group about making the change, it is important to keep their attention span with non-lecturing phrases.  As nurses we are not always in our comfort zone to explain why changes need to be implemented.  We should be prepared to explain why this change is needed and what improvements these changes will make.

managers

Generally, people will always be resistant to change.  But as professional nurses, our focus is to build trust and credibility.  The goal is to acknowledge that the change is coming and that you empathize with the feelings of the upcoming change (Rubenfeld & Scheffer, 2014).

Where I used to work, they were very involved with ACHA (Agency for Healthcare Administration), because we held a state contract.  Evidenced based nursing was in a sense required as far as the patient care when our case managers were managing a case.  However on the same note, although our case managers were not performing hands on care, they were required to know about all their diagnoses and treatments.  We had social workers and nurses alike seeing the same types of members.  The issue with nurses and social workers seeing the same types of patients is that the social worker is not able to use his/her critical thinking skills in their area of expertise.   They were required to assist members who had complex medical issues for instance, on a ventilator or more complex medical problems.   A suggestion was made when I arrived at my work place to utilize the social workers in conjunction to the nurses to manage the social aspects of the patients, however the decision was denied.  It was noted that ACHA is not paying the company to rethink how cases were managed and by whom because it was not hands on care, it was case management.

There was very little nursing involved in my job role, it was primarily reports and meetings to talk about reports and how to fix these reports.  It was an ideal job for someone that had an interest in perfection of numbers and statistics.  Every other day, there was a new change that was being implemented. We often times questioned why there was a change, but what we were told was that the change was immediate and mandatory.  For the staff case managers, these changes were difficult because the staff was in the field.  They may receive an email about something that needed to be changed as soon as possible, however they may have just returned home at  5pm in the afternoon looking forward to the end of their day and they find  emails with deadlines on multiple items due.  These changes affect the staff because they have to work late hours to get the work completed timely. This kind of change caused many good nurses and social workers to resign.

As nurses or leaders we tend to fall in to the routine of lecturing due to the pressures that we are under.  However two of the six dimensions of dealing with complex dynamic changes are creativity and intuition.  As a leader we should not just teach our group something, we should implement a way to bring creativity in to the change and use intuition to know how to speak to your group.  The best way to implement a change is to get the group to commit to doing the new change and develop a smart goal with them that will allow them to measure their own goals.

The leadership theory that most resembles mine is the coaching leadership style.  The coaching leadership style allows me to work closely with the staff at different levels and  empower them to meet their goals and gain confidence of their strengths so that they can focus on them as they work on their weaknesses.  In my previous job, the leadership style could have been called a dictatorship, however for the purpose of the discussion here it will be stated as coercive.

My manager’s favorite phrase was, “I gave a directive and everyone needs to follow it, any questions (1 second wait) no, good.  It’s due by close of business.”  If questioned on how to juggle that with all the meetings and other directives, the reply was always as a manager makes it happen.  My manager always reminded me that she did not take lunch, breaks and basically had “no life” outside of work and she expected those under her to be like her. She was not a woman who read books as a matter of fact, she indicated that books were a waste of time, for fun she read the ACHA contract that was 350 plus pages because reading any other book was pointless (Barr & Dowding, 2012).

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References

Barr, J., & Dowding, L. (2012). What makes a leader? In Leadership in healthcare (2nd ed., pp. 13-31). [Vital Source Bookshelf]. Retrieved from https://campus.capella.edu/web/library/home

 

Rubenfeld, M. G., & Scheffer, B. (2014). Critical thinking and patient-centered care. In Critical thinking tactics for nurses: achieving the IOM competencies (3rd ed., pp. 155-180). [Vital Source Bookshelf]. Retrieved from https://campus.capella.edu/web/library/home

Looking up to a Nurse

Have you ever thought about a nurse that you have worked with and looked up to?  What qualities do you admire?  The nurse that I would look up to would be someone who would be respected and trusted by her peers and her staff.

registered-nurse-large

In every organization there are communication barriers, but overcoming them is part of being professional and respectful of others’ opinion.  Another barrier that is seen in management is the inability to show respect to other team members and allow a learning environment. I agree that it is important for leaders to obtain feedback not only from their staff but from their peers.  The leader must be able to deal with the different personalities of the team that he/she is managing without letting personal feelings get in the way.

community

 

 

A True Leader

A true leader  places their staff before themselves and will work the job that their staff does so that they are familiar with it.  When I first moved to Florida, my first boss here was named Patty and she said to me when I started that she is the supervisor but she said to me that she will do the same job that I do.  She taught me that being a good manager means knowing what your staff’s job is and how to do it.  The reason being is because if you have someone who is out sick and there is not coverage, you will be able to jump in and help.  When thinking about Patty, she was a great leader because she encouraged me in the decision making process (Baer, 2012).

true-leader

As a nurse  I admire her because she followed Kouzes and Posner’s leadership model.  This model focuses on setting a vision, being a role model and enabling people to grow.

kouzners-practice-model

This is similar to John Kotter’s process for leading change in this day and age.

8steps

 

References

Baer, J. (2012). Theories of leadership. Leadership in health care (2nd ed., pp. 45-69). [Vital Source Bookshelf]. Retrieved from https://campus.capella.edu/web/library/home

Leadership Attributes

When a nurse leads by example and is not afraid to do the work that the  staff does, it makes for a strong leader. The people who follow that leader will know that although the nurse is in a position of higher authority, the nurse will still be humble enough to do the job the staff does and be able to explain it from their side and understand the position that they are in.  Knowing the staff’s job by example, allows the manager to know the timeliness of things that need to be accomplished and the ability of each worker’s caseload and what they can manage. A good leader will follow the  seven attributes to being a good leader vision, courage, integrity, humility, strategic planning, focus and cooperation (Baer, 2012).

nurse-managers

References

Baer, J. (2012). Theories of leadership. In Leadership in health care (2nd ed., pp. 45-69). [Vital Source Bookshelf]. Retrieved from https://campus.capella.edu/web/library/home

Why is Leadership Important to Nursing

Nurses are not often recognized for their professional expertise.  I know that when Florence Nightingale started the very first school of nursing her goal was to change how people viewed nurses by educating the nurses (DeNisco & Barker, 2013).

florence-nightingale

Leadership is important to nursing because without it, there is not going to be anyone to educate new nurses.  The baby boomers are retiring and we will need new teachers that are prepared to teach new nursing students as well as students at the graduate level.  Recent studies show that nurses that are prepared with their bachelor’s in nursing experienced less pressure ulcers, deep vein thrombosis and hospital acquired infections in their patients. It was noted that although an associate’s degree is less costly and provides the care needed to a patient; by the year 2020 the goals are 80% of nurses will have their BSN and doubling for nurses with their doctorate.

nursing-students

dnp-graduate

There are organizations that provide nurses of higher education grants to conduct research and be able to make difference.  In order for these research projects to be done, it is required that the nurse be able to write a solid proposal request for the grant.  This may require the skill of a grant writer, but the nurse must be knowledgeable in the project and what it entails in order to help the grant writer correctly write the grant to fund the project that the nurse wants to do (Laden, 2013).

In Orlando, we have the Florida Nurses Association.  It is an organization that will support nurses from the student level through the advanced level.  The organization is involved in many things especially any that are legislative where a nurse wants to make a difference.  The Florida Nurse’s Association has subgroups called Special Interest Groups ( Sigs), these groups will benefit the members because they are formed to specialize in something that a particular group wants to see changed.  For example there is a group called Nurse Entrepreneur Special Interest Group, this groups supports nurses that have an entrepreneur business that they want to start or have started.  If there is a group that you want to start for a particular interest  that you have and it is not a group already listed here, then after speaking with leadership in the group, if they approve it, then you could start it.  The group is responsible for having ten members in it in order for the group to work. A master’s and beyond prepared nurse would be able to conduct research needed for any new programs that need to be implemented.

nurse-entreprenuer

 

References

DeNisco, S. M., & Barker, A. M. (Eds.). (2013). The slow march to professional practice. Advanced Practice Nursing (2nd  ed., pp. 6-17). [Vital Source Bookshelf].

Ladden, M. D. (2013). The Case for Academic Progression: Why Nurses Should Advance Their Education and the Strategies that Make this Feasible. Retrieved from http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2013/rwjf407597