5 Ways Nurses Can Improve Patient Mobility By Jennifer Thew RN

The benefits of mobility among hospitalized patients are well-known—decreased pressure ulcers, deep vein thrombosis, and functional decline—to name a few.

“Hospital-acquired pressure ulcers, falls in the hospital, falls that cause injury, DVTs, and pulmonary emboli are also caused by immobility,” says Maggie Hansen, RN, BSN, MHSc, senior vice president, chief nurse executive at Memorial Healthcare System in Hollywood, Florida. “They have other factors that contribute to them, but [nursing] is taking ownership for preventing some of those things that should never happen to patients.”

Still, finding the time to ambulate patients during a busy shift is something nurses often struggle to do.

“We heard feedback [from nurses] like, ‘I really wish I had more time to ambulate my patients,'” says Leslie Pollart, RN, MSN, MBA, director of nursing at Memorial Regional Hospital in Hollywood, Florida.  “While they knew it was important, competing priorities often impeded their ability to ensure timely patient mobility, and sometimes patients need more than one person to assist them in getting out of bed.”

To address this issue and ensure patients were getting the ambulation they needed to achieve optimal outcomes, the hospital revamped its mobility program, including creation of a designated mobility team.

Outcomes

According to both Hansen and Pollart, the program has had numerous results.

Pollart says lower extremity DVTs in patients have decreased by over 30% since implementation of the program. They have also seen improved disposition to the right level of care.

“What we have found by having the more aggressive mobility program is we’re not having physical therapists bogged down with doing consults that aren’t medically necessary,” Pollart says. “Now they can focus their time on the cases they really need to see. What we’re seeing is a better disposition for the patients when they leave.”

Families are also more confident taking patients home from the hospital, and conflict at discharge has decreased, she says.

“When you talk about discharge planning with a family member and the only paradigm they see is [a] loved one is always in bed, they start to get anxious because they think, ‘How am I going to be able to care for him or her at home?’ ” So, we wanted to make sure that we changed that perspective so that when that family came in, they saw patients who were out of bed for meals [or walking],” she says.

Hospital employee injuries have also decreased.

“At the start of the program, our employee-related patient handling injuries were quite high,” Pollart says. “They averaged anywhere from on the low end to maybe 9 or 10 a month, and on the high end to maybe 25 to 30 a month.”

After going live with a mobility team and investing in patient handling equipment, the hospital reduced employee injuries by over 60%.

“When you look at that just from an employee standpoint, one employee injury is too much,” Hansen says, “but when you look at [the] financial standpoint—if you were only looking at the dollars—every workers’ compensation claim … averages $20,000 dollars. The investment in that equipment is easily justified by the fewer number of injuries.”

Finally, staff engagement and satisfaction has also increased.

Nonclinician mobility team members who help with the program are inspired to follow a career path in healthcare, Pollart says.

“I have a couple that are going to continue to go to school to be therapists. Another one really likes exercise physiology,” she says. “So, it’s really helped them shape their future career path.”

And hospital staff understands that the organization is committed to creating a safe work environment.

“The fact is that our hospital did recognize [the staff’s] priorities and gave them a team and invested in the equipment,” Pollart says. “Their perspective about senior leadership understanding the complexities of the work they do has significantly increased because of it. They feel like the organization is committed to their safety.”

“Our mission [for the mobility program] is this: prevention of hospital-acquired functional decline and other adverse outcomes to facilitate the earliest and the most independent setting,” Pollart says. “Our philosophy was if you walk into the hospital, we want you to walk out.”

Here’s are the five ways they’re achieving that.

1. Make Mobility an Interdisciplinary Project

It was not just the nurses who wanted to improve patient ambulation, other disciplines were on board as well to create a new mobility program.

“With the physical therapists, similarly, we heard they frequently get pulled from doing their clinical consultation because nursing needs an extra pair of hands to get somebody out of bed,” Pollart says. “Likewise, one of my surgeons said, ‘You know, Leslie, I write activity orders, but they’re often not carried out consistently, so it’s a mere suggestion, not an order.’ That was [a] frustration.”

The director of rehabilitation and the IT department became engaged in the project. The IT department helped to integrate newly created assessment tools into the electronic medical record.

Thus, began the creation of a six-person dedicated mobility team.

“Some mobility programs cross-trained patient care assistants,” Pollart says. “When I was evaluating that, I worried that someone who already had an established skill set would always feel like they had competing priorities.”

Many of the mobility team members were transporters at the hospital.

“We actually hired them for their attitude, their desire to learn a new skill, and their communication,” Pollart says.

The therapy department developed competencies to train the new team in safe patient handling.

“They had to go through a rigorous training with the therapy department,” she says. “It wasn’t just didactic, it was simulation. Then they went on to seeing patients paired with a therapist. The therapist then signed them off when they felt that [the team was] completely able to be independent.”

2. Designate Responsibility

One benefit of the mobility team is that it allows nurses and therapists to work at the top of their licenses.

“It allows the nurses to, for example, medicate a patient for pain in a timely manner rather than to get a patient out of bed. The person that doesn’t need a license to practice can [help ambulate patients] safely,” Hansen says.

To achieve this, it was important to clearly delineate each group’s responsibility with patient assists.

The mobility team is responsible for maximum assists, and nursing is responsible for independent or minimal assists. Therapists can be involved in a range of assists depending on the acuteness of the mobility issues and whether the patient needed a consultation for appropriate disposition, Pollart says.

“I think that’s what really went to the success of this program,” she says. “This wasn’t just adding a team and expecting them to solve all the problems with mobility, but defining those responsibilities according to each job role.”

3. Create an Assessment Tool

To clearly define the patient’s mobility needs, an assessment tool was created and integrated into the EMR. This allows nurses to delegate mobility responsibilities to the correct practitioner, such as nursing, physical therapy, or the mobility team.

“Based on how [a] patient scores on the tool, that patient’s mobility is assessed to be independent, minimal, moderate, or maximum assist,” Pollart says. “We wanted to target the mobility team and [the patients] that often required more man power to ambulate.”

The tool is used to assess patients on admission and then at least once per day during the duration of their hospital stay.

Four questions are asked in the assessment:

  1. Can the patient lift his or her legs often? If so, is it done independently or with assistance?
  2. Can the patient move from a lying to a sitting position independently or with assistance?
  3. Can he or she move from sitting to standing independently or with assistance?
  4. Can the patient take a step forward?

The tool prompts the practitioner to go to the next question depending on the response.

“Then the mobility team has a work list of all of those patients that score into the mobility team,” Pollart says. “We also populate the patient’s activity order.”

Additionally, the mobility team has daily huddles with physical therapists and nurse managers to discuss the patient assignments and their mobility needs.

4. Ensure You Have the Right Equipment

In addition to the mobility team and the assessment tool, the organization also invested about $2 million in safe patient-handling equipment such as lifts, as well as education on how to use the equipment.

The assessment tool used to determine a patient’s mobility status also tells nurses what the correct handling equipment is for that patient.

“Some of the patients just wouldn’t ambulate for fear of hurting the staff,” Pollart says. “Now the nurses can say, ‘You don’t have to worry because we have handling equipment that will help us help you get to a standing position.’ ”

5. Make Ambulation ‘Fun’

“Part of the program is to encourage patients, [and] to make ambulation kind of fun and something to look forward to,” Pollart says.

Upon admission, all family members are encouraged—unless it’s contrary to treatment—to bring in comfortable shoes for the patient. There are distance markers at certain points in the hospital so that the interdisciplinary team and the patients can track how far they’ve walked. Mobility journals are provided so patients can fill them out as they accomplish their mobility plans of care.

Patients are also encouraged to walk outside their rooms at least twice a day and to get out of bed for meals, which is known as “Heels for Meals,” because the patients have their heels on the floor while eating.

Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.

Source: https://www.healthleadersmedia.com/nursing/5-ways-nurses-can-improve-patient-mobility

Healthcare personnel shortage: Task Shifting, Task Sharing policy to the rescue

For a long time now in Nigeria, maternal mortality, morbidity, childbirth complications and other negative healthcare indices have continued to soar higher as the country is being subjected to a natural haemorrhage of health professionals who tend to seek greener pastures abroad or ensconce themselves in the urban areas of the country. According to statistics, 20 doctors, nurses and midwives are to attend to 10,000 Nigerians.

Apparently disturbed by this phenomenon, the Federal Ministry of Health, in 2014, came up with a national policy called Task Shifting, Task Sharing (TSTS) to promote rational distribution or delegation of tasks from the highly qualified health workers to the junior ones who have been trained in order to widen up access to healthcare services across the nooks and crannies of the country.

The policy is also intended to provide a legal framework or backing to enable Community Healthcare Extension Workers (CHEWs) to provide quality maternal and new-born healthcare as well as family planning services, especially at the Primary Healthcare Centres in the country.

Other areas which this framework is expected to cover include, but not limited to, epidemic or communicable diseases like the HIV/AIDS and other sexually transmitted infections, tuberculosis and leprosy diseases.

According to a report obtained by DAILY NIGERIAN, within the four years in which the policy has existed, the country’s health ministry, in collaboration with its supporting partners under the Partnership for Advocacy in Child and Family Health (PACFAH at Scale), have significantly dissipated energies towards the success of the policy. However, precious as the policy sounds, it, regrettably, met with resistance and other challenges across some states in the country.

The statistics show that, four years after, only 22 out of the 36 states of the country have adopted the policy and are currently at different levels of implementation. The rest neither are nonchalant nor unimpressed about the policy. With this, it is clear that some states are not committed to the policy.

Other challenges the document observed include funding challenges and a professional rivalry between doctors, nurses and CHEWS, with the former feeling threatened by an encroachment into his territorial grounds by the activities of the latter. For instance, a doctor would feel threatened if a trained CHEW attends to, or deliver pregnancies and so on.

To address these clogs in the policy’s wheel of progression, the policy, as it had roundly been observed, needed a review. To this end, PACFAH at Scale, in conjunction with the country’s health ministry, recently convened a stakeholders workshop in Abuja with all other implementing Civil Society Organisations (CSOs) view to brainstorming on the way forward.

In an interview with DAILY NIGERIAN during the event, Senior Technical Advisor to PACFaH@Scale  Project, Dr Emmanuel Abanida said that the workshop was a follow up to a successful stakeholders’ consultative meeting for the review of the TSTS policy held on June 4-8, 2018.

He disclosed that the main reasons for the workshop was to expand knowledge of the status of initiatives to monitor the state of implementation and revise the 2014 TS policy, increase awareness of the role of CSOs and Professional Associations as monitors within an accountability framework for effective TSTS implementation and strengthened linkages between service delivery and advocacy in TS implementation.

Mr Abanida added that participants are also expected to increase their awareness of the programs and activities of development partners working to implement TSTS policy at the national level as well as expand their knowledge of challenges and gaps in TS implementation at the state level.

“As we might all be aware, Nigeria is set to review the 2014 Task Shifting and Task Sharing Policy (TSTS) in 2018. The Task shifting and task sharing policy in the health sector is a global recommendation by the World Health Organization (WHO) designed to ensure equitable distribution of quality essential health care services in Human Resources for Health (HRH) constrained regions of the World,” he added.

While elaborating on the concept of TSTS policy, Mr Abanida explained that the policy is a process of delegation, whereby tasks are moved from highly specialized to less specialized health workers.

According to him, when properly done, the policy can make more efficient and effective use of the human resources for Health sector currently available by reallocating tasks among front-line health care workers.

During their deliberation, the participating CSOs unanimously reaffirmed that in order to address the shortage and gap in human resource in the sector, Task Shifting/Sharing is the only option available. They further noted that women and children are dying daily due to lack of competent health practitioners around their localities. According to them, large percentages of qualified doctors in the country are concentrated in the urban cities while the rural populace is left at the mercy of a few nurses and unqualified CHEWs.

65% of Nigerians lack proper access to healthcare services.
70% rural populace have no access to healthcare services.
Nigeria needs about 237,000 Medical Doctors.
Nigeria currently has 35,000 doctors only.
Nigeria has as low as152,000  Nurses and midwives.
To this end, they recommended that there is a need for the CHEWs who have ‘volunteered’ to stay back to be adequately trained, supervised and mentored in order to do the job well. They also called on the government at all levels to take ownership of the policy and support it through adequate funding and sustainability.

However, some participants expressed their fears over the policy, thinking that the policy could create room for more quackery, indiscipline and malpractices in the health sector.

Earlier in his remark, the Director/Head of Reproductive Health Division at the Federal Ministry of Health, Dr Kayode Afolabi, tasked the stakeholders on coming up with a viable policy document in order to provide efficient health care services, especially in the hard-to-reach areas of the country.

He stressed that adequate training of frontline health workers is a major way of curbing health risks which some described as a weakness of the policy.

One of the participants, Halima Muqaddas, the Executive Director of Women, Children and Youths’ Health and Education Initiative, said the policy is grassroots-friendly and would go a long way in catering to the healthcare needs of the rural populace.

She said: “If you critically look at it, especially in the Northern part of Nigeria, like Bauchi State where I come from, eighty percent of the people live in rural areas and we know that the primary health care facilities in those rural areas are being manned by frontline healthcare workers like Community Healthcare Officers (CHOs) and Community Health Extension Workers (CHEWs).

“So, we this policy, communities at the grassroots will get the necessary healthcare services. For example, if a woman wants to go in for a normal delivery, she will have a health care provider that is trained and licensed to provide that service.

“However, once complications begin to set in, she will be referred appropriately to the next line of care. That is what is all about Task Shifting and Task Sharing.”

She added: “I know that a lot of professionals have reservations because they are protecting their territorial ground, but we cannot continue to deceive ourselves. In so many villages and rural areas, you don’t see a nurse, a doctor or even a midwife but if a CHEW is there, fine and good.

“When the individual is properly trained, he or she will be able to at least access whether the woman has risks of complications or a woman is going to have a normal delivery and advise her appropriately.”

Source : https://dailynigerian.com/healthcare-personnel-shortage-task-shifting-task-sharing-policy-to-the-rescue/

UK Nurse Who Had Her License Revoked for Talking to Patient About Jesus Win Case

A nurse in Great Britain who was dismissed from her nursing job for talking to patients about Jesus now has her full rights to practice nursing restored.

It all started two years ago after Sarah Kuteh was fired for alleged “gross misconduct” after her supervisor received complaints that she was talking to patients about her faith.

Kuteh says there was a pre-op assessment questionnaire she had to go over with patients and asking about their faith was part of it. She says from time-to-time this would lead her to conversations about faith with her patients. In one case, she even gave a patient her Bible.

She was surprised to learn about the initial complaints but once she did, she said she decided she would only share her faith in Jesus if a patient asked her about it.

However, the 15-year veteran nurse received additional complaints against her, was suspended and later fired.

“I was walked out of that hospital after all I had done during all my years as a nurse and I was told I couldn’t even speak to any of my colleagues,” she said in a Christian Concern interview.

“All I had done was to nurse and care for patients. How could it ever be harmful to tell someone about Jesus?” she asked.

The Christian Legal Centre represented Sarah in her appeal to be reinstated to full nursing rights and privileges.

Their chief executive, Andrea Williams, said if it weren’t for the pre-op question about faith, these conversations with patients would not have happened.

“Without proper investigation, she was fired and her long career as a nurse put under threat,” Williams said.

Kuteh was able to find work at a nursing home but was under certain restrictions imposed by the Nursing and Midwifery Council (NMC) and could work only under the supervision of a senior nurse.

When the NMC reviewed Sarah’s case and request to return to full rights as a nurse she had many character witnesses.

Christian Concern reports Sarah’s supervisor had lots of good things to say about her. She was described as “a kind, caring, honest, friendly nurse” and was also considered a “valuable member of the team. A co-worker told the NMC panel that she was “respectful” and “always acts professionally while on duty.”

At her hearing, Sarah said she should have given a Bible from the hospital chaplaincy to a patient instead of one of her own.

The panel eventually ruled: “It is in the public interest to return an otherwise experienced and competent nurse into practice.”
Source :http://www1.cbn.com/cbnnews/cwn/2018/august/how-could-it-ever-be-harmful-to-tell-someone-about-jesus-nurse-wins-two-year-fight-for-her-job

Kathryn “Kay” Hodges: New Jersey Nurse Turns 99 in November, Has no Plan to Retire Soon

On the second Thursday of every month, the Emerson Senior Club gathers together for meetings, dance classes and other activities. They also usually get their blood pressure checked, and the nurse on call is 98 years old.

Kathryn “Kay” Hodges is reportedly the oldest active nurse practitioner in the state. She’s been certified for 77 years, and has worked in Emerson for more than five decades. She’s been practicing so long that she started seeing some of her senior citizen patients when they were babies.

“Their children or grandchildren [now] come,” said Hodges. “It’s a nice family connection.”

She works every Thursday, checking blood pressure and reading medications. Hodges also attends monthly county meetings, but her job responsibilities don’t tell the full story.

“Kay has never taken a sick day while working for the Borough of Emerson,” said Robert Hoffmann, Borough Administrator. “She’s like the post office motto: Neither rain nor snow nor gloom of night can keep Kay from her appointed rounds.”

Hodges says her best days are when she finds something troubling while checking a patient’s blood pressure. She will then encourage them go to a doctor for a checkup.

Though she just stopped driving this past spring, she has no plans of slowing down.

“I’ll let the good Lord take care of that,” Hodges responds when asked about retirement. “I like what I am doing, and as long as I can do it and do what I’m supposed to, and they have no objections, I will stay.”

The beloved nurse turns 99 on Nov. 1.
Source : https://pix11.com/2018/08/10/meet-njs-98-year-old-nurse-the-states-oldest-who-has-no-plans-to-retire/

How Media Influences Image of Nursing, Midwifery Careers

Public health research shows that the media affects how the public think about nurses and nursing as a profession.

Many health reports in print and electronic media relegate the views of nurses to general experiences while expert opinions are reserved for physicians.

This has, over time, influenced misconceptions and stereotypes of nurses.

One stereotype that is especially damaging to the profession is that the role of a nurse is to fetch things for physicians, especially during surgical procedures.

But nurses do much more than physicians, who, unfortunately, get credit for all the meaningful work done.

SETBACKS

Another is that nurses are uneducated and cannot make rational decisions on the welfare of patients without consulting physicians.

If nurses did not double-check and question physicians’ diagnoses and treatment, that would be malpractice.

Nurses usually have a better idea of a patient’s doing; their job is to protect the patient.

The third is of a self-sacrificing angel of mercy who does not mind being overworked and underpaid.

That explains why cases of industrial action by nurses have increased, especially in developing countries.

Another setback of this stereotype is the massive brain drain of developed countries in search of better life.

SOLUTION

Then, of course, is the negative female sexuality stereotype that depicts nurses as sex objects.

Research shows that nurses suffer an inordinate amount of sexual and other abuse at work.

These stereotypes persist as they are largely accepted in many media platforms and have been identified as among factors that inhibit the ability of nurses to provide quality patient care.

What can nurses do about it?

There is the widely accepted thinking that it’s better for nurses to keep their mouths closed — which may have evolved from the fact that the first nurses were nuns.

Even while working, nurses rarely speak about what they are doing and what they observe.
.
ADVOCATES

It is hard for people to learn about nursing through ‘collective closed-mouth policy’. Nurses need to be advocates of the profession.

They need to initiate partnership with the media since there are many of them who can be resources for journalists, bloggers and editors.

Nurses need to embrace communication technology, including social media, to sensitise the public on what they do including highlighting their success stories.

Many nurses are going out of their way to improve the morbidity and mortality statistics in their regions by initiating innovative community health projects but these efforts are neither recognised nor appreciated.

Finally, nurses need to pursue other avenues of conflict resolution, especially on their welfare, other than constantly resorting to industrial action as that fuels their negative image.

SOSPETER NDABA KIMANI is a programme manager at Aga Khan Development Network.

Filipino Nurse John Paul “Jap” Nofuente Denies Being Raped in Saudi Arabia

A Filipino nurse has become the subject of actual, no doubt about it, 100% fake news after a website falsely reported that he was raped in Saudi Arabia. The nurse, named John Paul “Jap” Nofuente, posted on Facebook on Saturday to debunk the online report.

Nofuente wrote on his Facebook post: “Please don’t believe everything you read on social media. Kindly report the article if it appears on your timeline. Thank you.”

He added a screenshot of the false report, which had this sensationalized headline in Filipino: “Handsome Pinoy nurse in Saudi, raped by five Arabs, a bottle of Coke was inserted into his butt, [now in] critical [condition]!”

The screenshot included an image of a bandaged person on a hospital bed, an image of a smiling Nofuente, and what looks like a small bottle of Coca-Cola.

The photoshop job also included a logo of local media company ABS-CBN, to make it appear that the news appeared in one of its television programs.

One of Nofuente’s followers shared a screenshot of the same article shared in a Facebook group.
AFP Philippines has debunked the false news and shared several links on sites where the story was shared.

Visited today, the websites only have titles saying the nurse had passed away (he hasn’t). The video that accompanies the title can no longer be found.

Turns out the photo of the bandaged patient on a hospital bed was stolen from a crowdfunding website. He turned out to be Aljun Andrade, an overseas Filipino worker in Riyadh who was severely beaten up.

Nofuente told AFP that while he is indeed a nurse, he has never worked in Saudi Arabia.

AFP said that such clickbait reports are used to lure netizens to answer surveys that lead to online advertisements.

source : https://uk.news.yahoo.com/tale-fake-news-nurse-denies-062035247.html

Development of an Innovative Endocrinology Training Program for Nurse Practitioners

Abstract

Background:Nurse practitioners (NPs) have a critical role in meeting the growing demand for health care in the current complex health care system. The use of NPs in both primary care and specialty settings is expected to rise significantly by 2025 in response to increased demands and a shortage of physician providers.

Method:The Duke University School of Nursing, with funding from the Health Resource Services Administration, has implemented the first endocrinology specialty training program for primary care NP students.

Results:The first in the country, this innovative, hybrid training program prepares primary care NP students to manage complex diabetes mellitus and general endocrine conditions.

Conclusion:Well-trained NPs can help meet the increased demands in primary care. This subspecialty certificate program provides a framework for other graduate nursing schools that are considering adding specialty content as a supplement to primary care training. [J Nurs Educ. 2018;57(8):506–509.]

Kathryn Evans Kreider, DNP, APRN, FNP-BC, BC-ADM; B. Iris Padilla, PhD, FNP-BC

No preferential treatment for admission at FCT School of Nursing – Official

Amanda Pam, Secretary, Health and Human Services Secretariat in FCTA, on Wednesday said there would not be preferential treatment for any candidate during the forthcoming FCT School of Nursing entrance examination.

Pam said this when the Kogi State Governor’s Wife, Hajia Rashidat Bello, paid her an advocacy visit on girl child education in Abuja on Wednesday.
According to her, there is always transparency in admitting students as well as running the school activities since it is owned by the Federal Capital Territory Administration.

She pledged her commitment to providing a fair playing ground for all candidates who met the entry requirements.

She said: “We will give more attention to the catchment areas which are Kogi, Niger and Nasarawa states.

“We will be fair to the candidates who have applied so that we can meet up to our requirements.

“We are always transparent in setting and marking our exams in the FCT.”
Pam said that the secretariat had secured approval from National Council of Nursing to increase the admission from 50 to 100 students.

On her part, Bello said that her visit to the FCT health secretary was to solicit for her help in the area of giving more opportunities to indigent female candidates from the state.

The wife of the Kogi governor said that she was committed to empowering the less privileged girls in the state, particularly on education.

She appealed to the FCT administration to always evolve measures that would assist Kogi State to boost its scheme for girl child education.

Source: The Eagle

American Psychiatric Nurses Association (APNA) Awards Scholarship to 30 Nursing Students

The American Psychiatric Nurses Association (APNA) has announced that they will be awarding 30 nursing students with the 2018 Board of Directors Student Scholarship. The APNA student scholarship program is intended to encourage students to pursue the field of psychiatric-mental health nursing and develop the next generation of leaders in the profession.

Undergraduate and graduate level nursing students across the country are invited to apply for the scholarship each year or be nominated by a member of their nursing school faculty. Scholarship winners are also awarded travel and lodging to attend the APNA Annual Conference as well as a one-year APNA membership to enjoy the professional benefits.

APNA President Linda Beeber, PhD, PMHCNS-BC, FAAN, tells PRWeb.com, “We are very proud to offer these 30 outstanding nursing students the opportunity to become part of our professional community and gain a unique perspective on the benefits of working in the field of psychiatric-mental health care. The Board of Directors Student Scholarship provides nursing students with extensive professional connections and support that helps them move forward in their careers.”

The APNA is a national professional membership organization committed to the specialty practice of psychiatric-mental health nursing and wellness promotion, prevention of mental health problems, and the care and treatment of persons with psychiatric disorders. For a list of the 2018 scholarship recipients, visit here.