Saturday, February 28, 2015

7 Characteristics of Highly Effective Nurses - A Manager's Perspective...

Characteristics of Highly Effective Nurses

Nursing is such an amazing occupation, and for most of us who hold the title it's a calling.  There has been tons of great press for nurses lately concerning how this occupation has been elevated to one of the most admired and trusted professions.  Also, nurses are one of the few professions that has the true ability to affect great change at the individual level with chosen actions.  So what type of nurses are those that patients and families remember with fondness?  It would be great to say that about every nurse, but having worked in the capacity of a nursing leader for a number of years that isn't always the case.  As a leader I like to work with staff to avoid those type of perceptions, and have tried to support the personal and professional growth of my teams to reduce those type of outcomes. The truth is that as a leader I'm the one in the background, and the true stars are the nurses delivering the care.  As a manager and nurse I've realized that the nurses who are the most effective often possess the 7 qualities that create an amazing impact on those we serve.

They're Positive - Each of these nurses in whatever specialty they've chosen can see the reality of the challenges they face, but they choose to maintain a positive perspective.  With this "half-full" attitude they have a much better chance at influencing the depressed patient, bringing hope to that family who just got bad news, or providing encouragement for the patient discharging who needs to remain compliant to minimize the progression of their illness.  These nurses understand that a positive outlook impacts their interactions with others, and ultimately can be the difference in creating a good experience for that patient and family during a difficult circumstance.

They're Flexible - How many times as nurses have we come to work to find out that assignments have been changed, or we're going to be doing something we didn't have in our plans?  That is called change, and it is an ever-present reality in life.  Nurses who can rise above this, and remain flexible are able to have a greater impact because they do what is needed in the moment.  These highly effective nurses step up and provide the influence necessary to drive the positive changes that are needed to make health care reform a reality.

They're a Learner - Do you know everything?  None of us do, and never will.  Nurses who understand that just because they've doing the same role for years doesn't mean they know it all. Nurses who can look for opportunities to grow in their current role, and understand that each day creates the opportunity to learn something new are those who have the greatest impact.  The new knowledge can seem to be unrelated to the delivery of care to a patient, but may be something like (mindfulness) that impacts stress levels by improving the ability to handle challenging situations which ultimately allows better care for patients because the staff member can think more clearly in tough times.

They're a Team Player - Each of us are unique individuals with varying talents and personalities, but as nurses we work as a team that cares for those who are looking to us to meet their needs.  Nurses who are highly effective realize that they need to use their skills and talents to benefit the team in meeting the needs of the patients.  They don't come to work with their own agendas, but understand they may have to sacrifice what they believe is most important at times for the team to reach their common goals.

They're the One with Integrity - Leaders like to hire competent professional nurses who have the ability to function successfully in their autonomous nursing roles.  This only happens when those functioning in these roles act with complete integrity.  Nurses who are highly effective choose to do the right thing every time they're confronted with an ethical dilemma where there is the ability to go the other direction.

They're Passionate - Nursing is not just a job, but it's about having the privilege of meeting people at some of the most difficult moments in their lives by creating a better outcome with the care provided. Nurses who are highly effective come to work each day with their game face on because they understand the importance of the role they play, and strive to make a difference in the lives of others who come into their path.  They believe that they have a greater calling, and want to change things for the better for each and every patient by delivering both empathetic and compassionate care.

They're Striving for Excellence - Finally, highly effective nurses are those individuals who choose to perform their duties to the best of their abilities each day of their nursing career.  Whether it is something menial, or something that carries great responsibility it is completed with the highest level of dedication to quality.  Nurses who carry this belief have the ability to reduce poor outcomes for patients because they choose to follow best practice, they impact their peers by instilling an example of always striving for excellence, and they stand out as people who need to be promoted to positions where they can expand their impact by leading others with the mantra of "excellence everyday".

It doesn't matter if you're a new grad, a seasoned nurse, or a nursing leader because these 7 characteristics of highly effective nurses can apply at all the levels.  As Gandhi stated, 

"Be the change you wish to see in the world". 

 Click here to visit Living Sublime Wellness.

Art of Nursing 2.0


Remembering Spock - Thoughts for the day

"It's all about trying to make the world and the universe a better place. I'm proud to be connected with it. I think we need that in our lives. We need ethical, heroic people trying to do the right thing to help others and to improve life on this planet and in the universe."

"Logic is the beginning of wisdom, not the end."

"I'm touched by the idea that when we do things that are helpful and useful, collecting these shards of spirituality, that we may be bringing about healing."

"Whatever I have given, I have gained."

"The more we share, the more we have."

Thursday, February 26, 2015

Hypnosis - The Power of Changing Perception...


There are so many self-help books on the market that talk about positive thinking, how you think determines your outcome, if you think it can happen it will.  The real message in those titles is that our mind is a powerful tool in driving our motivations and change in our lives.  In our MINDWAYS Smoking Cessation program we use a proven assessment tool to help uncover our client's strengths and underlying motivations.  This is extremely helpful in meeting people where they are in their personal challenges.  With this information we can work with them in a partnership that is focused on achieving their personal goal (smoke-free living).

This article supports the premise of our program by supporting the power of hypnosis in altering perception.  By allowing the brain to accept new messaging related to a personal challenge, new healthy changes can occur because the previous thoughts driving behavior have replaced.  We are so excited to see how many smokers who are desiring a change we can help.  Through our approach of understanding your story, identifying your strengths, providing new healthy messaging, and supporting people with ongoing resources in their journey we know we can maximize their quality of life by providing a lasting freedom from dependence through mind empowerment.

Overcoming Rejection - 5 Ways to Open the Door to Your Success

“Sorry, you're not a fit", "you're just not my type", or "we have a better qualified candidate" are all common statements that many people hear when they're being rejected. It can be a heart-wrenching experience to be on the receiving end of these conversations by either a prospective employer, potential client, or a love interest, but how we react in these situations can either create the opportunities or the obstacles to our success. Therefore, it's essential that we create a strategy to effectively manage our response to rejection by following these 5 ways to successfully transition through the challenges and begin “Opening the Door to Our Success".

1.  Expect – If we want to effectively deal with rejection in life we need to understand that it will be a reoccurring theme in every aspect of our lives. Therefore, we can't live our lives fearful of taking the possible risks that may create opportunities, but instead move confidently forward with making life decisions. Understanding that life is not made up of just absolutes, but is full of shades of grey that are the drivers for how events unfold. When we don't allow ourselves to assume that something is supposed to happen we make it easier to prepare for a less than positive outcome. By expecting to experience rejection as part of life, and proactively preparing our minds for the experience we can more easily embrace the ramifications that occur from the situation.

2. Embrace - After we accept rejection we can fully embrace the feelings that it might create. By changing our perspective of the situation we allow ourselves to take a retrospective view of what occurred, and look to improve any attitudes and behaviors that may have contributed to the rejection. Reminding ourselves that even the most talented successful people in life get rejected should make it easier to handle the rejection experience. After moving through the emotions, and re-framing our thinking then we need to “dust off” and keep moving forward in life. We can only to take advantage of the opportunities that may arise when we have the emotional intelligence to prepare for chances at success.

3. Evolve - Just like many other situations in life, rejection provides the prospect for producing personal change and growth. If we use the occasion to be introspective and analyze our performance, personality, or any other aspect that may have contributed to the rejection we produce the likelihood that we’ll deal with rejection in life as a winner. Therefore, the situations are learning tools and not a means to choose to be victims, but reconfirm to ourselves that we possess the abilities and talents to be successful. When we completely evolve we become energized and excited to accept the new opportunities that exist in life.

4. Energized - It takes energy to make things happen, and to create the persona of a confident successful individual. When we exhibit a self-assured image people feel more comfortable providing new opportunities for success. During this phase of the rejection cycle we should be developing new plans and willingness to go back to "knocking on doors” that will lead to our success. Only when we have transitioned to a point where we’re energized by our new confidence can we realize or dreams.

5. Earn - The whole process of rejection is a process of human development that culminates in the ability to go out and earn new chances to succeed. As you transform your thinking by expecting the reality of rejection, embracing the feeling created, evolve with a new positive perspective, and develop an energized confidence that will propel you to gain the advantage that leads to earning the right once again to "Open the door to the Success" that is waiting for you in life.

Standing Around the Water Cooler with a Smile - Finding Satisfaction at Work...

Work, the one activity that consumes more time in our lives than anything else. Now with the ever-changing retirement requirements it's not uncommon for people to spend half their lives "Standing Around the Water cooler". So how can you keep a smile on your face while holding your water cup? The need to have a positive outlook at work and in life is vital to maintaining both mental and physical health.

Attitudes - Therefore, the first priority in achieving that smile is to be connected with how you look at life. What value do you place on work in your life? Is it a means to purely support your family or does it provide meaning and the vehicle to help you impact the world? Your personal value system is what will determine if you choose to take the next promotion that could result in working during your child's play or make the choice to stay in a position with less responsibility that requires less demands and time in your life. Defining your attitude is the first crucial step to finding satisfaction at work.

Accolades - The next component of maintaining a sense of satisfaction in the workplace is to be rewarded for your efforts. This can occur as a token of appreciation with a thoughtful note from your boss or possible the financial reward of a quarterly bonus. Both examples are delivered with intent show appreciation for your efforts on the company's behalf. If these type of accolades are missing in your workplace it can be challenging to feel appreciated and satisfied. The solution to ensuring this occurs is to have a strong work ethic every day you walk through the door to work, and stay positive about what is occurring in the company. If you behave in this manner you should be noticed for your good work, and receive the benefit of having a job that keeps you smiling at the water cooler.

Associations - Part of being successful and satisfied in the "Office" means you're able to have good interpersonal communication with your co-workers. A large part of how this occurs depends on your willingness to engage others, and show a genuine interest in their well-being. When you behave as a collaborative colleague is reduces the risk of disputes, but doesn't eradicate them from the office. If you want to enjoy your days at work "smiling at the water cooler", look for opportunities to be a thoughtful team player who can say a simple and courteous hi and thank you when appropriate.

Approach - Finally, that last ingredient to being satisfied at work is the mindset you consistently choose to maintain. Just as in life, there will be numerous changes that need to occur in the workplace. How you choose to handle these issues can impact your feeling of satisfaction. If you decide to get on board with leadership choices then you'll create a positive environment for all to enjoy. Then not only will you "be smiling at the water cooler, but so will your co-workers.

Every Day in Every Way - Thinking Your Way to Positive Life Outcomes...


Seeing the Tip of the Iceberg

The iceberg is part of the beautiful landscapes that can be seen in the coldest oceans on the planet.  They are a magnificent sight to behold, but are very deceiving to the observer because so little is actually seen.  Most scientific research done on icebergs has revealed the actual size is much larger than what is perceived.  Actually, most research supports that only 10% of iceberg is represented by the tip.

Our minds form a similar framework in the origin of our thoughts.  The “Conscious” is that tip you see from miles away as you are steering through the channels of life.  The “Sub-conscious” is the other 90% that is unseen, and has the ability to alter your course by creating undercurrents in our thought patterns that immediately change our direction without any volition on our part.

The conscious mind processes thoughts with sequence, rationale, and judgments.  It is the portion of our mind that seeks to understand why, and determines the morality of our current perception.  Sigmund Freud was known as the “Father Psychoanalytical Theory”, and divided the mind into three distinct areas:

“If you can conceive it, and believe it, you can achieve it!”

Conscious“The conscious mind consists of those things of which we are currently aware and to which we are currently attentive. The conscious mind also includes our current thinking processes, behaviors and environmental awareness. Hence, it can be obviously concluded that the conscious mind constitutes the major part of our current awareness.” 1

Pre-conscious – “The pre-conscious mind consisted of all those things of which we are aware, but currently are not attentive (Freud, 2002 revised ed.). He further conceived that we can choose to pay attention to these and deliberately bring them into the conscious mind. Finally, with respect to the pre-conscious mind, Freud believed that we can control our awareness to a certain extent, from focusing in very closely on one conscious act to a wider awareness that seeks to expand consciousness to include as much of preconscious information as possible.” 1

Sub-conscious - “The process and content are out of direct reach of the conscious mind. The subconscious thus thinks and acts independently (Freud, 2002 revised ed.). One of Freud's key findings was that much behavior is driven directly from the subconscious mind. This has the alarming consequence that we are largely unable to control our behavior, and in particular that which we would sometimes prefer to avoid. More recent research has shown that the subconscious mind is probably even more in charge of our actions than even Freud had realized Murphy, 2001).1  Freud also developed another theory that formed the vehicle for creating a link between the “conscious and sub-conscious”.  Freud's massive, overall theory on personality includes the Id, the Ego and the Super ego.
ü  The Id contains our primitive drives and operates largely according to the pleasure principle, whereby its two main goals are the seeking of pleasure and the avoidance of pain (Freud, 1962).1

ü   Freud goes on to say that it has no real perception of reality and seeks to satisfy its needs through what he called the primary processes that dominate the existence of infants, including hunger and self-protection. Unlike the Id, the Ego is aware of reality and operates using the reality principle. The reality principle implies that the Ego recognizes what is real and understands that behaviors have consequences. This includes the effects of social rules that are necessary in order to live and socialize with other people. It uses secondary processes such as perception, recognition, judgment and memory that are developed during childhood. The dilemma of the Ego is that it has to somehow balance the demands of the Id and Super ego with the constraints of reality (Freud, 1962). The Ego controls higher mental processes such as reasoning and problem-solving, which it uses to solve the Id-Super ego dilemma, creatively finding ways to safely satisfy the Id's basic urges within the constraints of the Super ego.1

“Continuous effort, not strength or intelligence is the key to unlocking our potential.”  W. Churchill

ü  The Super ego contains our values and social morals, which often come from the rules of right and wrong that we learned in childhood from our parents and are contained in the conscience. The Super ego has a model of an ego ideal which it uses as a prototype against which to compare the ego and towards which it encourages the ego to move. The Super ego is a counterbalance to the Id, and seeks to inhibit the Id's pleasure-seeking demands, particularly those for sex and aggression.1

The Link occurs when the sub-conscious absorbs information filtered through the parts of the personality.  The Ego is the “common sense” portion of the personality that can determine actions based on the judgments of the “super ego”.  There is a constant shuffle of information that occurs as perceptions formed by the personality are archived into the mind’s hard disk, the “sub-conscious”.  A good example of this process is learning to ride a bike.  To successfully ride a bike there needs to be a sequence of actions performed all at once.  Balance, speed, momentum, and judgment have to work interdependently to keep the bike moving safely down the road.  As conditions change, adjustments have to be made quickly to avoid disaster.  The sub-conscious alike quickly retrieves archived information, and passes it to the conscious so there is no need for a checklist to ride the bike.  Therefore, performance and behavior change are directed by the subconscious, and can be modified with the correct interventions which will create new perceptions. 

Creating the Pathway to Success

When people pursue their goals they need to believe in their ability to achieve success.  If they take action thinking their plan will fail, it most likely will.  The way to create a pathway to your success is by moving forward without the fear of failing.  Everyone knows there is always a chance of failure in anything we do, but where you choose to place your focus will determine your success.

There are volumes of research that has been conducted that proves the way we think can create varied outcomes.  Here are specific examples that show the power of the mind’s ability:
  1).  Drying Sheets - A group of Tibetan Monks meditation techniques were studied because they put their bodies in very difficult states for long periods, and appear to change their own physiology to achieve their spiritual goals. "In one of the most notable exhibits of their skills, a group of Tibetan monks allowed physicians to monitor the monk’s bodily changes as they engaged in a meditative yoga technique known as g Tum-mo. During the process the monks were cloaked in wet, cold sheets (49 f / 9.4 c) and placed in a 40 f (4.5 c) room. In such conditions, the average person would likely experience uncontrollable shivering and would shortly suffer hypothermia. However, through deep concentration, the monks were able to generate body heat, and within minutes the researchers noticed steam rising from the sheets that were covering the monks. Within an hour, the sheets were completely dry."2

2).  Multiple Personality Disorder - In one case, published by the American Psychiatric Press, a doctor noted how medications prescribed to a dissociative identity disorder patient had different effects depending on what “personality” took the drug. For example, when a tranquilizer was given to the person’s childish persona, it made the individual sleepy and relaxed. However, when the adult personality was administered the same drug it made him anxious and confused. Similar results were found with other patients and with a variety of different medications. Doctors even noticed visibly apparent traits, like lazy eye, would come and go depending on which personality was present.  This phenomenon is especially fascinating since no one, including the patients, is claiming mysticism is at work. On the contrary, it is a genuine example of the mind altering the body.2

3). Placebo Effect - A placebo is an inert substance or belief which produces real biological effects in humans. It’s so widely accepted as fact that a placebo variable is included in most medical tests as way of proving if, say, a drug works on its own merits or because people “think” it works. There are tons of experiments showing the proof of the placebo, but one of the most amusing to watch is a test done by a group of Princeton students who decided to throw a non-alcoholic keg party for their unsuspecting classmates. The experimenters secretly filled a keg with O’Doul’s (contains about 0.4% alcohol while regular beer has around 5% alcohol) and then watched as their peers acted silly, slurred words, slept on the ground, and generally acted drunk. Although it’s nearly impossible to get intoxicated on O’Doul’s, these college students had such a strong belief they were drinking standard beer that it affected their behavior.2

In addition to re-framing our thoughts, we must take specific steps while we travel down our pathway to success.  Here is the “step by step” process:

Mission - Have a purpose
Have you ever been on a sailboat or motorboat?  Now think of the cruise you were on, and what would have happened if these boats didn't have rudders?  It wouldn't have been too fun floating aimlessly out in the middle of nowhere with the challenge of getting back on course.  Each of us are unique individuals with special talents and likes.  Do you have a plan to merge those two things, so you can enjoy the life making a difference?  If not, I encourage you to sit down and write a list - (create your mission) - It's time to attach that rudder to your life.

Take responsibility for your life
Things will happen in life that none of us expect, but how we respond to these events can
determine what we achieve.  No excuses - the Marine Corps taught me a great saying -
"Improvise, Adapt, and Overcome".  Be a problem solver.

Believe in yourself -   
A large part of achieving things in life is having the persistence and perseverance
to continue on when no one is at your side.  The only way you can do this is to
wholeheartedly believe in yourself and what you have to offer.  If you don't, then no one else
will.    Start your day in the morning by exclaiming “I can, I can, and I can".

“The road to success is not a path you find,
but a trail you blaze.”  Robert Brault 

Have the Mind of a winner
Creating the mindset of a winner is crucial to making it through life's hurdles.  How do
you look at the world?  When I was a manager I always encouraged staff to think of the
possibilities, and bring me new ideas that would improve our situation.  I knew any dud
could point out the negative in a situation, but I wanted to inspire them to be innovative
and imagine achieving the prize.  It sure made for a better work environment where people
felt comfortable to share ideas and possibilities.  Make sure to take time for yourself each
day to stay focused - at least 30 minutes at a minimum.

Create a Personal Plan for Your Success -   
How many games are won without a plan? 
Zilch.  Setting goals is the key to being a champion in your life.  There needs to be a
defined concerted effort to making your mission a reality.  Is it a new degree, a promotion,
a personal relationship, or your health?  Whatever it is you need to do the following to
be certain you hit the mark:

Use the SMART method - specific, measurable, achievable, realistic, and time specific.
  • Set incremental goals - the first goal might be something that can be easily achieved, but then begin to stretch yourself making more challenging goals that keep your eyes on the prize of achieving your mission/purpose.
  • Keep track of your successes
Reaching the Peak

When a climber is standing at the base of the mountain the peak can appear impossible to reach, but if they begin to visualize themselves at the top it quickly becomes less daunting. The process of using positive affirmations to change your perception is a similar process:

  •     "Positive Affirmations", are short directed positive action statements concerning something you want to achieve or change like a certain mindset or behavior.  These statements are used for sub-conscious messaging.  The way the affirmation is constructed is extremely important for changing thought patterns.  The more motivated you are to alter your life the greater possibility you’ll have to make your changes. 

  •   How do affirmations work?  When you say your positive affirmation, the subconscious archives the information for evaluation.  There are only two choices the subconscious can consider, acceptance or denial.  The subconscious won’t evaluate the response, but merely go with whatever the most prominent inner voice might be concerning the issue at hand.  Therefore, when you continue to say positive affirmations you provide the playback the subconscious will use when responding.  As you use the affirmation regularly you should feel a sense of well being related to what you’ve been saying.  When this occurs the affirmation is working.

  •    How to use them?  Here is a list of tips to follow that will encourage your success:                           
-  Make it personal
-  Make it positive
-  Make it current
-  Make it believable
-  Make it simple

*Stand in front of the mirror using a confident voice and stance.  Say your
affirmations 5x for each one you’ve created both in the morning, and before you
go to bed at night.

  •      How quickly can you see results?   When you choose to say affirmations that have meaning and a purpose you can see results quickly.  If you’re thinking becomes negative when saying the affirmation your subconscious may be resisting the message.  When this occurs do the following:
  •      Releasing statements – There may be emotions of feelings holding you back.  Say something like, “I forgive, I don’t need to feel, or any statement that releases any sense of guilt or shame that might be stalling the process. 
  •      Becoming statements – “I am becoming”.  Sometimes people struggle with I am, so I am becoming can be more believable and unlock the subconscious ability to accept the affirmation. 
  •       Acknowledgment statements – This is giving yourself a pat on the back.  “I met my goals successfully, and I feel great”.
As you follow these steps for using affirmations you’ll feel and see changes
occur within the first 30 days.  Here is a list for your first month.  You can do it!!!
30 Days to a New Beginning

Go through the list and choose 30 affirmations that apply to the changes you desire to make in your life.  You can create your own or alter these if that helps.  Remember this is a process that you’re starting, and will need to stay motivated to create the Positive outcomes you wish to see in your life.

  • I have unlimited creativity, drive and motivation.
  • I am motivated to continue perusing my goals.
  • New opportunities are showing up daily and I am inspired to take action.
  • I feel alive, energized and motivated to take on any task in front of me.
  • Motivation comes easily to me.
  • Staying motivated comes easily to me.
  • Because of my profound energy, I achieve and exceed at all that I do.
  • I am so motivated that others get inspired just by being around me.
  • I attract those that help me reach my goals.
  • I am motivated and live my life to the fullest.
  • My life is full of purpose and motivation.
  • I have unlimited energy and motivation.
  • I am happy and motivated when I achieve my goals.

“You’ve got to win in your mind before you win in life.”
John Addison

  • am easily motivated.
  • l easily stay motivated toward my dreams.
  • I stay motivated and energized when working toward my goals.
  • I wake up energized and ready to face the day.
  • I am confident in what I do and that keep me motivated to continue moving forward
  • I love myself and I am perfectly healthy.
  • Every cell in my body is health conscious. I am a health freak.
  • I am full of energy and vitality and my mind is calm and peaceful.
  • I avoid junk food. I eat healthy, nutritious food that benefits my body and large quantity of water that cleanses my body.
  • I think only positive thoughts and am always happy and joyous, no matter what the external conditions are.
  • I always feel good. As a result, my body feels good and I radiate good feelings.
  • Every day is a new day full of hope, happiness and health.
  • Good health is my birth right. I bless my body daily and take good care of it.
  • I am always happy, hale and hearty. Happy in spirit, hale in body and hearty in disposition.
  • I am of a strong heart and steel body. I am vigorous, energetic and full of vitality.
ÿ    Every day in every way I am getting healthier and healthier and feeling better and better.

Tuesday, February 24, 2015

“Holding Their Hands through Life – 3 Ways Nurses Deliver Patient-Centered Care”

What a special moment it is waiting in anticipation to hear that new cry of life, and a privilege to kneel at the bedside when a life leaves without regrets.  As nurses, our relationships with patients has always been unique because we are often the only healthcare professionals holding their hands through life.  We share the honor of participating in the joys of our patients improved health, and shed common tears at times when bad news is delivered that adds to their sorrows.  It is these experiences that have shaped our views and understanding that caring for a human being is truly a multidimensional experience.  It must involve meeting their physical needs with a healing experience, understanding how to meet their psycho-social to support their mental health, and finally seeing that each person has a spiritual component to their being that guides their actions and interactions.  These shared experiences with those we serve are the foundations that form the patient-centered care we deliver to our patients as we hold their hands through life.

Patient-centered care doesn't seem like it should be a foreign concept that people struggle to embrace, rather it should be the norm to have a patient's choice be considered when delivering care.  It actually sounds like a prudent and wise thing for organizations and clinicians alike to do for those in their care.  The reality is that this approach to patient care has recently been gaining resurgence in health care circles, and being defined clearly by agencies who desire to improve their quality engagement with the patients and families they serve.

  • One of the agencies is the IOM (Institute of Medicine) who defines patient-centered care as: "Providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions."  

  • Next, the American Association of Colleges of Nursing defines it as, “To recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values and needs”.  

  • Finally, the Beryl Institute defines the patient experience as the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care.

1.   Healing the Body – The Evolution in Caring

There are numerous other organizations both nursing and non-nursing that may have a variation on the definition, but the theme throughout all the definitions is that the patient is the core decision maker in their own care.  Another aspect of patient-centered care must also be to look at the patient as a whole person with varying physical, social, and spiritual needs that must be addressed to support delivering a patient-centered care approach.

So why does this seem like such a strange concept that is now just coming to the forefront of the medical community?  Since the inception of our great nation patients have been on a roller coaster of change that has been primarily driven by the influence coming from the schools of medicine.  These institutions have often set the standard for the patient provider relationship by enlisting the use of professional boundaries that often drain the humanity out of the delivery of medicine.  The focus has also been directive instead of participatory, but with the emergence of a pay for performance system of medicine the consumer will soon be in more control concerning how the relationship is built.  Even though physicians have had varying relationships with patients throughout the decades, the nurses’ role has always been a consistent source of support and bedside presence as we've held the hands of our patients through life’s challenges.

Today’s nurses are the offspring of one of the first nursing pioneers (Florence Nightingale) who started this concept of patient-centered care when she focused on caring for the physical needs of wounded soldiers during the Crimean War.  She worked tirelessly with other volunteers to improve the conditions of the wounded soldiers by reducing their risks of infection by promoting adherence to infection control standards.  According to Stephen Paget in the Dictionary of National Biography, “Nightingale reduced the death rate from 42% to 2%, either by making improvements in hygiene herself, or by calling for the Sanitary Commissioner”.  The influence and legacy that she created is now recited at most nursing graduations throughout the United States, and is known as the “Nightingale Pledge”.

"I solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician in his work, and devote myself to the welfare of those committed to my care."

Florence Nightingale’s experiences helped her to understand that physical needs are an important component of a person's being, and therefore tried to develop  approaches to care that supported this premise. She later used her influence to establish the first non-religious nursing school in London that remains in existence today.  Her dedication to caring for the human spirit by tending to both their physical and educational needs was the first step in helping today’s nurses deliver the patient-centered care.  By being that person at the bedside holding their hand, nurses can attentively listen to their needs of those they serve.

            2.  Understanding the Mind – Hearing Your Patient’s Voice

It was a day much like any other where I was busily trying to create my schedule for the day of who I was going to see.  Not long into my routine I received word of a new patient I was going to follow at a local skilled nursing facility.  As a hospice nurse I had worked with patients and families in both the home and facility, but had recently chosen to focus my efforts on helping the end of life population we served in the nursing homes.

After ending the call with my boss I headed over to the facility where I met a gentleman named Gerry.  He was my new hospice patient on my caseload that appeared as a fatigued skinny man with scraggly whiskers on his face.  As I dove into our first meeting, Gerry explained about how his battle with cancer had been difficult, and that the doctor had finally let him know that his curative options had run out.  As he relayed this story to me I could see the sadness in his eyes, and heard the disappointment in his voice.  Trying to stay in the moment with him I asked what was it that I could do for him that would make him feel better?  He quickly stated, “I want a whopper”.  Did you say you wanted a whopper?  Yep, that's what I want. He had been diagnosed with a metastatic form of cancer that had quickly spread throughout his body, made him require more needs than his family could provide at home, and left him with some significant pain and symptom management issues.  If he was going to be stuck in this place he assured me that he wanted some of the comforts that made him happy.

There was a bit of a challenge at first with granting his request because his disease progression had diminished his ability to swallow, and put him at a severe risk for choking and aspiration.  After some negotiating with the facility staff, they agreed to let him have as many whoppers as he wanted.  With that solved I thought we were all set, but there was one more hope both he and his family shared.  When Gerry was at the last part of his life he wanted to go home to die. 

It was late Friday afternoon when I got a call from Gerry’s sister concerning how we could transfer Gerry home that day.  As I heard the news I thought things always seem to be more challenging on Fridays.  Thankfully, this time everything went off without a hitch.  We were able to get him home to his sister’s house that had a beautiful 180 degree view of the Puget Sound, and provided a bed that allowed us to raise his head to take in the view.  Later that evening Gerry passed away on his own terms by having his last whopper days before, surrounded himself with his loving family that night, and looked at the view from the place he called home.  It began by listening to his hopes, and ended by making his wishes come true by assuring he was always in control of his care.

3.  Comforting the Soul – A Token of Appreciation

During these transitions in life that our patients experience, nurses have always been that constant presence as they experience the resilience of the human spirit.  So much of the way a person heals is directly related to their beliefs.  Even for those individuals who claim not to subscribe to any organized form of religion or oppose it all together, they have an inner drive that makes them tick.  Whether you want to call it the soul, spirit, or just your inner self it is an important aspect of understanding and recognizing that care needs to be holistic.  Holistic nursing is defined as “all nursing practice that has healing the whole person as its goal” (American Holistic Nurses’ Association, 1998, Description of Holistic Nursing)

As nurses we must respect these beliefs, and be the advocate our patient needs to help them through the challenges.  It may be allowing them to wear garments that represent their beliefs, choosing to have a bloodless surgery, or coordinating for a spiritual guide to conduct whatever services they need to support their beliefs.  By supporting these actions we aid in their healing.

She was sitting in a rocking chair when I entered the room, and I could see she was knitting something in her lap.  It was a smiling lady in her late 80’s who began our first discussion by speaking about her beliefs.  She was a woman of faith, and our visits often turned to discussions concerning her beliefs, and what was going to happen when she passed away.  Even though she presented with confidence, she was quite fearful in our times alone.  Making her the center of our conversation, and encouraging her to focus on the visits by her family was the way I tried to calm her fears.  Over the next few weeks I spent more time with her focusing on reducing her anxiety through conversation, music therapy, and providing medication that aided in reducing her fears and discomfort.  Not long after our last visit I was able to meet with her family who presented me with the gift she was making on the day we met.  It is the creation that is displayed in the picture.  It holds a special place in my heart and my home.  Geraldine was a special and beautiful woman that forever touched my life because I was able to understand the importance of her beliefs, and how they impacted her thoughts, her actions, and the choices concerning the care she received.

As nurses we supply the largest manpower component in health care, and can be the voice of advocacy for our patients.  Patient-centered care is not only about ensuring that our patients are involved in their care, but that we are involved with them in the journey.  We must fully comprehend that delivering patient-centered care takes the ability to include all aspects of the person in their care.  It may be ensuring that they understand their conditions by showing dedication to providing consistent quality care for their physical needs.  When we build that trust and take the time to listen to their needs then we can create a continuum of care that delivers a holistic approach that is able to respect the uniqueness of that person’s physical, mental, and spiritual needs.  Finally allowing us to meet them where they need us the most.

It’s time for nurses to lead the charge in changing the face of health care by using a patient-centered approach in creating a new normal where it will be expected that patients receive care based on their individualized needs.  By understanding that patients need a multidimensional approach for their care involves seeing the wound, understanding the fear, and supporting their ability to connect with the beliefs that contribute to improving their care.  When we successfully ensure that every patient receives this same care we’ll be on our way to creating a better system of care for all.  It will be a place where people will be known, understood, and are provided empathy to ensure that they remain at the center of their care as we hold their hands throughout their journey.

This post was written as part of the Nurse Blog Carnival. More posts on this topic can be found at Big Red Carpet Nursing. Find out how to participate.

Art of Nursing 2.0

Thursday, February 19, 2015

5 Steps to Creating a Mindset for Success...


All people want to achieve some form of success in their life.  Even though the definition of that success may vary for each individual, the road to achieve that personal milestone is the same.  Obtaining the success you desire involves a series of actions or 4 "steps" that are controlled by our thought patterns and the mindset you choose. 

1.  Develop Emotional Intelligence 

In order to effectively develop a mindset for success you have to control the factors that may influence or impact that desired outcome.  One ingredient necessary to achieving success is your aptitude for being emotionally intelligent.  That is the way a person observes, assesses, prioritizes, and responds to the emotions encountered daily.  When someone can successfully control his or her reactions to the stimuli that affect emotions then he or she:

  •  Becomes a better team player through improved communication.
  • Increases empathy and understanding for others through active listening.
  • Asserts and proactively says no negative to being impacted by negativity. 
  • Delivers confident decisions in tune with his or her intuition.

Sounds like a smooth transformation, but managing emotions can be very challenging.  Some individuals allow emotion to affect responses like a rudderless ship adrift in a stormy sea.  It is not until a person learns to harness the power of emotions that the ship is able to reach the chosen destination.  This list is actions that a person who possesses a high level of emotional intelligence exhibits:

  • They remain calm and assess the quality of their emotions.
  • They take time to understand the causal effect behind the way they’re feeling.
  • They evaluate the validity of their feelings with a rational barometer.
  • They use a retrospective viewpoint to ensure consistency in their response.
  • They identify the triggers that were the precursors for their stress.
  • They capture the moment by using a journal to track frequency of feelings.
  • Finally, they assert control rather than becoming a victim to their emotions.

When you begin to implement these practices you’ll improve your emotional ability, and be more effective in using the appropriate emotional responses with others.  Then you’ll take the next step on your journey to achieving your mindset of success.  You’ll realize you are growing personally and professionally, and you can be more reliant in pursuing your hopes and dreams. 

 2.  Be Self - Reliant

According to Merriam and Webster, "Self Reliance is being reliant on one's own efforts and abilities".  The pursuit of your own ideas and dreams can be a difficult road fraught with negativity, but by ignoring damaging opinions you demonstrate your ability to have the internal strength necessary to achieve your dreams.  The second step in creating your mindset for success occurs when you:
  •    Believe that you have something to offer the world - A self-reliant person is able to see the value they hold because they have self-esteem.  Therefore, they are able to deflect negative things said or done to them because those aren't the images they see in the mirror.
  •  Are Confident in your ability to generate things that hold meaning and value - A self reliant person will be that inventor or leader that might go against the grain because in addition to their self esteem they are self confident about their talents and abilities.  They believe they have what it takes to get the job done.
  • Aren't swayed by negativity - Self reliant people can see the positive in situations because they look at life as a bunch of untapped possibilities.  They take full responsibility for their lives and don't play the victim role.  
  • Are Willing to forge the trail alone - With the world view that possibilities exist, it's not much of a leap for the self reliant person to pursue their dreams even if they have to deal with naysayers.  Their goal is to determine their happiness, and create the life they desire.
  • Enjoy collaboration and promote team success - The self reliant person is a good team player because their goal in collaboration is the same for others as for themselves.  They want people to make the most of their lives, and achieve their hopes and dreams.  Therefore, they willingly offer their support to ensure the success of the team.
  • Seek counsel if needed because you understand you don't know everything - Self reliant people are able to search out counsel when needed to support their success.  There is a huge difference between healthy self confidence and arrogance, and the self reliant person understands the wisdom at being able to see an issue from a variety of angles creates the best outcome possible.
  • Continue to look for opportunities to learn and improve - Learning and improving is a process that never ends.  Self reliant people pursue opportunities to increase their knowledge and skills because they understand it's the only way to stay ahead of the curve, remain relevant, and support their independence.
 How can you develop your self reliance, so that you can create a mindset for success?
  • Make a list of your abilities, knowledge, and skills.  Seeing it on paper will help you realize what you have to offer.
  • Create a list of ideas you have that you would like to pursue at your job or in your life. Take the idea a step further by plotting out a start to finish algorithm.
  • How do you look at life?  Start each day by choosing one positive quote that you can focus on throughout the day.  Use positive talk to reinforce your self esteem and confidence.  Be grateful.
  • Don't allow others to crush your dreams.  Write down five goals that you want to accomplish. Use the smart method - specific, measurable, achievable, realistic, and time specific.  Put this list where you can see it daily.  Stay focused, and reduce your interactions with any naysayers if you're unable to sway their negativity.
  • Look for opportunities to be a giver.  Add to the collaborative process.  Share your special knowledge or talent to improve the process, and create a win-win for all involved.
  • Do you have a mentor or someone that you can turn to for advice?  Make your own decisions, but cultivate a relationship with someone who will give you honest feedback concerning your thought process on ideas/projects you're pursuing.
  • When was the last time you took a class, read a book, or watched a webinar focused on improving your personal and professional skills?  Choose 1 thing you will do each month to increase your knowledge or skills.

You're on your way to creating your "Mindset for Success".  The biggest determiner of your success is your willingness to do whatever it takes to achieve that definition of success you've created for yourself.  Along the road, help others to catch your vision and encourage them to pursue their hopes and dreams.  If you start taking these steps you'll soon be on your way to ensuring you have the mindset to win.  Take care, and have a great day.

3.  Develop a Purpose

The reason for which anything is done, created, or exists.  In order to create a mindset for success you must have a purpose.  A purpose gives you direction, a reason to get out of bed, and can ignite a passion in you and others around you.  So, do you have a purpose?  How do you know?

Most people in this world have a purpose, but may not think of it as some big philosophical issue to discuss.  A good example may be a parent.  They may have other things in life that drive them and take their time, but providing for their child's needs is the driving purpose for all they do.  How do you choose your purpose?  Often people experience the opposite where they feel like they've been born with a purpose, something they have to do in their lives that will make an impact.

How do you either find your purpose or develop one if it seems to be a lacking piece of the puzzle for you?  It's a very similar process to goal setting.  Here are some tips you can use to get start:

-  What are the things that are important to you in life?
-  How do you look at the world?
-  Are there things you enjoy doing that bring joy to your life?
-  Can you think of some current challenges that you'd like to help solve?

Take a piece of paper and start answering these questions.  Start to filter your answers for similarities.  Then prioritize what's left with what's most important to you.  Hopefully you should have something written down that makes you feel passionate and excited.  Now you have your purpose, but a purpose without action doesn't accomplish anything.

So let's look at an example of how we could make this process work:

-  First of all I want to be successful in my life, which means having a career I enjoy, family and friends that I care about, and a cause that improves the lives of others.  Also, I'd like to make some money to be able to take care of my family.

-  Once I'm done writing my list I see that the things that hold value for me are to care about other people, do something that makes me feel like I make a difference, use my knowledge of medicine and health to create solutions to problems, be able to have the flexibility to spend time with my family, and make an income that provides for our needs and enjoyment.

-  What sticks out to me on the list is the central theme about working with people to make a difference with the knowledge and skills I posses.

-  My action is to find a job, a volunteer organization, or start a business where I can impact the lives of others using my medical background that will provide a living to support my family.

-  I'm going to start a business to help people take control of their health.  With this being my purpose it will guide the decisions I make, influence how I spend my time and efforts, and impact how I'm able to support my family.

This example was very generic, but your purpose can be very specific.  The importance of the exercise is to understand that we have to be driven by something in life.  We have to have a reason for taking a breath every day, for choosing how our kids will see us, and to live life using your gifts and talents so you won't have regrets about what you could have done.

4.  Be Tenacious

Tenacity means not easily pulled apart, tending to cling especially to another substance, persistent in maintaining, adhering to, or seeking something valued or desired.

Creating your "Mindset for Success" is similar to building a strong foundation on which a house is built.  It will be the mechanism to support additions to the structure, weather storms adequately, and keep you secure for years to come.  If you want to be successful you have to build the same strong and sturdy resolve to follow your dreams that will result in your success.

During the initial construction you laid out the boards of emotional intelligence.  That was so you could create a framework that wouldn't buckle under the pressures of emotional challenges.  Then you took out the blueprints and tried to see the lines, but the page had been smeared.  You had a deadline for this project, and knew you had to rely on your own skills.  You took out your pen and sketched out the missing components, so the job could be completed on time.

The next day you unveiled a sign that was going to stand in front of this new home.  It wasn't going to be like all the other homes on the block.  It had been built with many rooms, a large kitchen with plenty of room for a family, and an extra large laundry room that could fit three sets of washing machines.  As you removed the packaging from the sign it said “A New Day Home - A place for transitioning mothers of domestic violence".  This house had a purpose, to care for these women in transition by providing a safe and warm home where they could start to get back on their feet.

On this journey, you experienced challenges with not enough supplies and missing information, but you knew there were some women struggling to get to a safe place with their children.  Therefore, you worked long hours; you used your ingenuity, and remained dedicated to getting this home built on time.  You were tenacious in building this amazing structure.  On the day the front door opened, you were there to see the smiles on those ladies faces who would be the residents and heard the pitter-patter of their kids little feet running through the halls.  Your hard work and dedication resulted in this successful outcome.

Being a success takes work, but more importantly it calls for an inner strength that requires you to weather the storms of life, be resourceful with limited support, keep your eyes on the prize, and have the "intestinal fortitude" to keep going, so you achieve the impact and success that makes a difference.  

5.  Act with Integrity

Being successful is a result of our thoughts and motivations.  How we achieve that success also involves our actions.  I put the definition above for the final ingredient along with a picture that holds symbolic meaning for me in regards to ethics and honor.  The final ingredient or step for "Creating a Mindset for Success" is Integrity.

How we interact with others is crucial to our success.  Granted, I'm sure we can all name plenty of people that have worked their way to the top who might not hold this value close to their heart.  Those people still have to look in the mirror in the morning, and no one knows how they feel looking back at a person who doesn't have integrity.  Here's a quick story.

It was part of this company's leadership program for all managers to go through specific training to learn skills, and be in step with the culture of the company.  On the first day of the class there was an agreement that was made that allowed the managers to speak freely without reprisal.  As the week progressed there were a number of discussions concerning payroll, computer systems, and staff. During one of these discussions a manager in attendance started making disparaging remarks about one of their employees.  Some people looked uncomfortable because the employee being discussed was known to be a hard worker.

After the meeting that night, one of the managers who'd been disturbed by the whole event found the employee, and had a pep talk without providing any details of the earlier conversation.  This manager felt it was their duty to look out for the best interest of this employee.  Eventually word got back to the other manager who reported this to their superior, and the manager who had d the discussion with the employee was forced out of the company.

Where does integrity fit in this story?  Who's doing right and who's doing wrong?  Sometimes there are difficult situations we're exposed to where we have to act with our belief of integrity.  Those actions should represent a consistent track record of responding in the same manner to create positive outcomes.  Achieving success is a process that involves our entire being from our thoughts, to our emotions, to our motivations, and results in the actions people see.  You can create a foundation for your success by adopting this 5 step method that will result in achieving your dreams while remaining true to yourself.