Nurses share what their personal and institutional patient care plans are for 2011, and how those goals will affect patient care. From obtaining new certifications to taking the time to listen to and interact with those under their care, nurses focus on the bedside to take their practice to a whole new level. For more nurses resolutions, visit www.Nurse.com and click on the Regions tab to read 2011 care plans from nurses nationwide.
Kathleen Kriessler, RN, staff nurse, Tower 5 (pediatrics, med/surg, bone and joint), Orange Regional Medical Center, Horton Campus, Middletown, N.Y.Kathleen Kriessler, RN
In 2011, I plan to assume a leadership role in the prevention of pressure ulcers and care of those with pressure ulcers upon admission to our unit. As a member of the nursing Shared Governance Wound Council and the wound champion for my floor, I attend monthly three-hour meetings with the council during which we obtain up-to-date information on wound-care treatments, products and protocols under the direction of the wound, ostomy and continence nurse.
My goal is to identify practice deficiencies, assist and support with the educational needs of staff and provide learning opportunities using evidence-based practice protocols.
Starting immediately and with the support of my coordinator, any new nurse or aide who is hired on our unit will make weekly rounds with me on Wound Wednesdays. I will teach them that early recognition is the key to success. Left unchecked and unrelieved, pressure, malnutrition, incontinence, immobility, inactivity and friction/shear ultimately will lead to tissue damage. I will reaffirm that they understand the current protocols we are using, and I will ensure they know how to stage correctly and familiarize them with the products we use in pressure ulcer treatment.
I will chair a monthly meeting with our nursing assistants, and at this time I will hear about their concerns while also teaching them the importance of good skin care, nutrition and mobility. In addition, I will create a pressure ulcer prevention board on my unit.
The wound council participates in a yearly incidence and prevalence study. Starting in 2011, we will do it every three months to more closely monitor our practice.
This summer, ORMC will consolidate its Horton and Arden Hill campuses into the first new freestanding hospital to be built within New York state in more than 20 years. As we join together as one with a mission to improve the healthcare of our community, there will be endless possibilities for positive improvement of patient care. Im prepared to do my part, especially in pressure ulcer prevention.
Amelia Jordan, RN, staff nurse, ED, Trinitas Regional Medical Center, Elizabeth, N.J.Amelia Jordan, RN
In 2011, I hope to encourage and facilitate all eligible ED nurses to obtain their specialty certification. I am taking a proactive approach to this resolution. I will start by finding a small group of ED nurses to partner with and study for the certification exam. This small group will encourage other colleagues to join us in our quest for certification.
From there, the group will continue to grow, and there will be more peer support for the group members. They can share resources, books and knowledge, which also will defray the cost of studying for the certification examination. Peer support will encourage each and every nurse toward the final goal: passing the exam and getting certified in his or her specialty.
We then can encourage other units in the hospital to follow our lead. Yes, one nurses goal and resolution can have an effect on an entire unit and perhaps even on other units in the hospital. We plan on starting small and getting the ball rolling for the new year.
Maria Sangalang, RN-C, staff nurse, medical unit, CentraState Medical Center, Freehold, N.J.Maria Sangalang, RN-C
As a 2011 New Years resolution, the nursing staff on 3N at CentraState Medical Center want to have no unit-acquired pressure ulcers. We plan on achieving this goal by going back to the basics.
First, we completed educational in-services about the common reasons, causes and prevention of skin breakdown. We have created laminated, multicolored wheels, which are placed at the appropriate bedsides. The purpose of the wheel is to provide a visual reminder for staff to turn patients in a timely manner. The wheel is divided into two-hour segments, with recommendations as to which position and what time the patient should be turned.
We used this system when turning a patient who is normally cared for at home by an aide and her husband. The staff showed the family how to turn the patient and where to place pillows, and they plan on using these techniques at home.
We want our patients and families to know that our ultimate goal is quality patient care. Our patients and families appreciate our proactive care and our passion for caring, and we plan on keeping our New Years resolution of no unit-acquired pressure ulcers.
Dina Visram, RN, BSN, clinical coordinator, medical telemetry, Mountainside Hospital, Montclair, N.J.Dina Visram, RN
At Mountainside Hospital, our medical telemetry unit on 5E also is a TCAB unit. Transitioning Care at the Bedside is a national program of the Robert Wood Johnson Foundation that works to improve care on med/surg units in New Jersey. The objectives of TCAB correlate with my units goals to improve patient safety and patient and nurse satisfaction.
My units 2011 New Years resolution is to create specific ways to keep the patient and family informed of tests, procedures and treatment plans. In part, we are responding to our family and patient requests in the Press Ganey results, which revealed that we needed to make sure patients know who their caregivers are and keep them informed of tests and medications.
First, we will provide each patient with an information packet at the time of admission, which will include a single sheet of paper with the patients room number, room phone number, physician name, front desk phone number and visiting hours. This information will assist in reducing patient and family anxiety and fears and help staff when reorienting them to the hospital setting.
We also will provide patients with a small writing pad where they can write questions for the physicians and nurses and any other healthcare provider, so they have their questions ready and feel empowered in the process. We want to implement bedside shift report, all in the effort of keeping our patients informed and involved.
We have a dry-erase board in each room for patient communication that lists the caregivers for the day, and we also have implemented designated family calling hours to keep patients and family informed.
By being a part of the TCAB program, we have implemented a number of initiatives on our unit. I have seen that by spending more time with our patients we have not only improved patient satisfaction but also increased our own nurse caring attitudes, compassion and satisfaction.
Melissa Anderson, RN, BSN, staff nurse, med/surg 3N, Orange Regional Medical Center, Arden Hill Campus, Goshen, N.Y.Melissa Anderson, RN
Nurses can make an enormous impact when they implement evidence-based care. One of the areas I have identified as needing improvement is in managing the pain of those who have no means of communication, those who are completely dependent on others and those who are vulnerable to unnecessary suffering.
Those in my care who I have learned the most from and who are especially close to my heart are those who are disabled mentally and physically. I recently took care of a patient who was severely disabled, had contractures and was unable to speak. This patient had major abdominal surgery, had as needed pain medications ordered, but was being undermedicated for pain. I was able to advocate on her behalf and get around-the-clock pain medications ordered and stronger pain medications for dressing changes. I have a severely disabled toddler, and I have had to advocate on his behalf for pain management because he had no means of expressing pain after he had a feeding tube placed. At the time, he was unable to cry or coordinate the movements of his body in discomfort; therefore, pain scales were an inappropriate tool.
These situations have encouraged me to advocate for this population through a collaborative team approach. I have begun this process by speaking with my nursing peers, nurse manager, nursing educator, the palliative care physician and our intensivist. They have all agreed there is a great need to better manage the pain of this vulnerable population and to educate others.
My short-term goals for 2011 are to meet as a team, develop a fourth pain scale (for those who do not fit into the current three scales) and to create and standardize pain management orders for those who are in an impaired state. These would be standing orders based on the severity of their diagnosis and any procedures the patient may have during their hospitalizations. Long-term goals would be to introduce this fourth pain scale and the concept of standardized pain management across the country.
Ava Ramirez-dela Cruz, RN-BC, senior staff nurse, orthopedics, White Plains (N.Y.) Hospital CenterAva Ramirez-dela Cruz, RN-BC,
My goals for the new year are to continue to provide excellent care by adhering to hourly rounding protocols and to deliver competent and compassionate care without losing my passion for the profession.
What I have learned from my patients throughout the years as I have matured professionally is that we have to be able to place ourselves in their situation and understand that human touch is more healing than machines and medications. It is essential to focus attention on what patients are sharing with us and to treat them with compassion and respect.
We alleviate patients anxieties and gain their trust when we take the extra time to explain goals, treatments and medications for the day and really hear their concerns. Ive found that when my patients can trust my competence and feel my concern through my words and actions, they are more likely to cooperate with their plan of care.
Implementing hourly rounding provides my patients with a sense of security that they are being cared for in the best possible way, increasing overall patient outcomes and patient and staff satisfaction.
Lieyin Pai, RN, staff nurse, yellow unit (children ages 1 to 12), Blythedale Children’s Hospital, Valhalla, N.Y.Lieyin Pai, RN
In 2011, I plan on enrolling in a certified pediatric nurse review course and taking the pediatric certification examination. I also hope to maintain effective and open communication with my patients and through that process, I will resolve all patient concerns and problems in a timely manner.
Over the past five years, I have realized that continuing education is critical for all nurses. Constant review as well as learning new concepts improves patient care, and through the process of becoming a certified pediatric nurse, I will be able to improve my patient care.
Patients are the best teachers. I have learned so much from my patients and their caretakers in the past five years, and I know I will continue to learn from them in 2011. It is critical to listen to what patients have to say and understand their routines and special cultural needs. It might be something as easy as asking a patient when he or she would like to take a bath. Mutual communication is the bridge between two sides of a river. In the beginning months of my nursing career, I struggled to complete my nursing tasks. Gradually, my patients taught me that in spending time and listening to them, I gave them the care they really needed.