Showing papers in "Creative Nursing in 2011"

Horizontal violence and the socialization of new nurses

Abstract: This article discusses research on horizontal violence in nursing, focusing on the cycle of horizontal violence within nursing education and how it impacts the socialization of newly graduated nurses. Michel Foucault's (1969,1980) work is used to provide a framework for understanding the socialization of nurses and for addressing horizontal violence experienced by nursing students, to help them prepare for the work environment.

Social justice advocacy in nursing: what is it? How do we get there?

Abstract: Social justice advocacy is an expectation of all nurses as expressed in the professional codes that guide nursing practice. Nursing literature reflects this shift in the focus of nursing advocacy, providing insight into the potentials and challenges associated with nursing's evolution toward a broader social justice advocacy model. This article describes the concept of social justice advocacy as currently reflected in professional codes and nursing literature and contrasts this with the individual patient-nurse advocacy model, which continues to dominate in nursing practice today. Challenges associated with movement toward a social justice advocacy model and options for addressing these hurdles are also discussed.

Works of art as a pedagogical tool: an alternative approach to education.

Abstract: Contemporary authors on nursing issues discuss the importance of expanding knowledge at all levels of nursing education to empower future nurses to respond in caring situations for the benefit of their patients. This article reviews several studies in which paintings, complemented by a pedagogical structure, allowed students to observe situations relevant to nursing. Results suggest that the use of visual art in nursing education can add a new dimension to students' experiences.

Sensitive care for the deaf: a cultural challenge.

Abstract: Of the more than 36 million American adults who have some degree of hearing loss (Centers for Disease Control and Prevention [CDC], 2008), 500,000 are acculturated into the culturally Deaf community who share behavioral norms, values, customs, educational institutions, and organizations. This article discusses the Deaf community, their culturally based health care needs, and health care providers' (HCPs) lack of understanding and recognition of Deafness as a distinct culture, which individually or cumulatively result in barriers to culturally sensitive care that can lead to disparities in care. It suggests transcultural methods HCPs can use to narrow the cultural divide.

What floats a float nurse's boat?

Abstract: Few studies have examined the personality traits of nurses, and none identified the personality traits of float pool nurses. Float pool nurses have specific personality traits that differ from unit-based nurses. Independence, Tough-Mindedness, Rule Consciousness, Social Boldness, Openness to Change, and Tension were six personality factors that were found to be statistically significantly different. As hospitals implement float pools or resource teams to meet staffing needs, gleaning insight into the specific personality traits of these individuals could assist in nurse recruitment and retention.

Evaluating shared governance: measuring functionality of Unit Practice Councils at the point of care.

Abstract: Measuring the functionality of Unit Practice Councils (UPCs) in institutions on the Magnet journey is a rare occurrence. The Jackson Health System Unit Practice Council Functionality Measurement Tool is one of the first such attempts to provide an objective way to assess whether UPCs function in the way they were envisioned to perform. Jackson Health System (JHS), located in downtown Miami, Florida, is a 90-year-old integrated health care system of more than 1,500 beds. The system includes eight primary care and two long-term care centers, the Holtz Children's Hospital, two community hospitals, a tertiary care hospital/trauma center, schoolbased health centers, corrections health services, a mental health hospital, and a free-standing community mental health center. Jackson Memorial Hospital, the main hospital in the system, is the primary teaching hospital for the University of Miami Leonard M. Miller School of Medicine. JHS has approximately 12,000 employees including nearly 3,000 nurses who deliver care in more than 100 areas. Specialties range from heart transplantation to diabetes management. JHS embarked on the Magnet journey in 2006. The Center for Nursing Excellence (CFNE) was established to lead the journey. The Health Foundation of South Florida (HFSF) awarded the CFNE a $200,000 grant entitled A Fresh Start for Nursing to underwrite the Magnet effort for a 2-year period. JHS envisioned a Unit Practice Council (UPC) in every area where nursing is practiced. Monies from the grant funded the establishment of shared governance throughout the system (see Figure 1) and the hiring of a full-time UPC coordinator. SHARED GOVERNANCE Shared governance is a style of management in which frontline staff and managers work together to improve clinical practice. It extends the power, control, and authority over clinical practice to practicing nurses and other frontline staff. At JHS, it signified a radical break from traditional governance in which nurses had little power within its formal hierarchical structures. With the advent of shared governance embodied in the UPCs, frontline staff became involved in decisions to improve or change practice. More than 100 UPCs were established; some were subsequently consolidated because of system changes. Currently, there are 78 UPCs. UPCs were established to give frontline staff a voice in clinical decision- making processes at the unit, division, and organizational levels as best practices emanate from a unit or a division and are disseminated throughout the system. We believe that frontline staff members know best what patients need, and that staff members are being permitted to meet patients' needs as long as they are within the parameters of clinical practice. UPCs are not involved in collective bargaining, human resources, or budget issues. UPCs are empowered to fix certain problems they know to exist and to evaluate their practice for improvement as it relates to staff relationships; patient care; and staff, physician, and patient satisfaction. HISTORY UPCs at JHS were established rather quickly. In July 2007, there were approximately 33 UPCs; by July 2009, there were 94. The UPC coordinator for CFNE, working with Dr. Leah Kinnaird, the consultant at the time, sought an objective measure of the functionality of the UPCs. Many UPCs had demonstrated significant improvement in clinical outcomes after changes were made, whereas others were barely managing to stay afloat. The HFSF required quarterly reports about how the UPCs were making a positive difference at JHS while meeting process and outcome objectives outlined in the grant. In the latter part of 2008, the question arose: What tool is JHS using to evaluate the functionality of UPCs? At that time, the UPC coordinator was rating the UPCs as low, middle, or high functioning based on established expectations, which included the following: * Meeting regularly (biweekly or monthly) * Sending proper minutes to the UPC coordinator * Choosing officers (at least a chair, cochair, and recorder) * Maintaining a written and operationalized communication network * Attending monthly divisional steering council meetings * Checking e-mail at least daily * Working actively on a project related to areas within their control Despite notable clinical improvements in our system since the establishment of shared governance, many nurse managers and leaders did not embrace this system of evaluation, and neither did the HFSF. …

Testing a "Caring Assessment for Care Givers" Instrument

Abstract: Based on Kristen Swanson's theory of caring, Caring Assessment for the Care Giver has been traditionally used in preparation for Relationship-Based Care (RBC) implementation; however, its reliability and validity were not known. This article discusses the psychometric testing of the instrument. Caring is the essence of nursing practice, provides the practical dimension of professional nursing, and is an important predictor of satisfaction (Dingman, Williams, Fosbinder, & Warnick, 1999). Nurse theorists have recognized that caring is essential to an individual's overall sense of well-being, emotional safety, and satisfaction (Dingman et al., 1999; Koloroutis, 2004; Swanson, 1993; Watson, 2002). Human beings have a certain set of expectations and know when they feel cared for, which further promotes a sense of security (Duffy, 2003, 2005). When the individual's expectations match the behavior received, then satisfaction will occur (Dingman et al., 1999). Therefore, when the patient's, nurse's, and physician's needs are met, relationships are forged and satisfaction flourishes. Listening is a key component of caring behaviors and relationship building (McCrea et al., 2003). Listening requires that we know how to be present, to be silent, to observe, to listen, and to be heard within the context of trust and respect (McCrea et al., 2003). Alternatively, when clinical tasks become the priority of the nurse's work, relationships with medication carts, computers, and intravenous pumps are paramount, placing the development of human relationships secondary to the tasks at hand (Duffy, 2005). It is in this moment, when tasks supersede human connection, that nurses must reevaluate, become truly present and attentive to the needs and desires of another human being, and forge caring and responsive relationships with their patients (Arman & Rehnsfeldt, 2007). Developing this human caring process requires that nurses understand and value the mind-body-spirit connection, are aware of their own strengths and limitations, and know how to comfort with compassion and empathy within the context of a caring relationship (Watson & Foster, 2003). The technical and economic demands of the health care system do not diminish the need for crucial relational care; in fact, the need for higher level caring skills and knowledge has escalated (Benner, Sutphen, Leonard, & Day, 2010). It is through these human-to-human relationships that people live and die, heal and grow, and work and rest (Duffy, 2003; Koerner, 2007). RBC is a model with practical action steps espoused by education and leadership to promote effective change (Koloroutis, 2004). The RBC model includes concepts of Leadership, Teamwork, Professional Practice, Care Delivery, Resources, and Outcomes. Re-Igniting the Spirit of Caring (RSC) is one of the mechanisms by which an organization operationalizes the RBC model (Koloroutis, 2009). THEORETICAL FRAMEWORK The Caring Assessment for the Direct Care Giver (CACG) was developed as part of Re-Igniting the Spirit of Caring, a seminar designed for people who work in health care (Koloroutis, 2003). Initially used as an educational assessment during the course, the instrument was not intended for use in nursing research, nor had it been tested for reliability or validity. The CACG is based on Swanson's mid-range theory of caring, which asserts that caring involves interrelated processes between the nurse-as informed caregiver-and the patient (Swanson, 1991). Inherent in the theory are five caring processes: (a) Maintaining Belief, (b) Knowing, (c) Being With, (d) Doing For, and (e) Enabling/Informing. The first two processes- Maintaining Belief and Knowing-provide the philosophical foundation for establishing a respectful relationship with the patient and family built on their inherent human dignity and an authentic seeking to understand the experience of the patient and family (Koloroutis, 2009). …

Implementing a caring model.

Abstract: Caring is the essence of nursing; however, caring behaviors may not be identifiable in the health care environment today. Relationship-Based Care (RBC) provides an avenue to promote a caring environment. This article describes the process one hospital used to implement RBC in their organization.

Caring for the caretaker: a nursing process approach.

Abstract: Problem: Nurses begin their careers infused with a passion for making a difference in the lives of their patients. However, patients' needs and the demands made on their time can cause nurses to become desensitized to their own needs. The resulting dissonance between values and actions increases stress levels, which, if left unchecked, lead to burnout and compassion fatigue. Method: The nursing process is a dynamic and efficient problem-solving technique used by nurses in their approach to caring for their patients. This approach can help nurses who are experiencing stress and burnout to define their core values, develop goals, implement a plan of action, and realign their focus. Reflection and journaling bring insight and understanding to the process and promote growth. Outcomes: This process develops a stronger sense of self that leads to a solid foundation from which to act. The individual makes mindful choices from an integrated state based on positive goals. This leads to a sense of well-being and balance, which can decrease stress and promote satisfaction and a return of passion for our profession. As new nurses, we enter our profession with enthusiasm and the desire to make a difference for our patients. However, the cumulative effects of stress cause many nurses to lose their passion. It is the nature of nurses to respond to the needs of others before their own, but habitually putting off our own needs can cause us to become desensitized to them. Over time, we feel less vital and less energetic. Eventually, nothing satisfies us; and finally, we burn out. When our needs are pushed aside, so are desires, dreams, aspirations, and our selves. "Expert at caring for others, nurses are novices at caring for themselves, as reflected in the high rate of burnout that are endemic to nursing" (Hernandez, 2009, p. 129). One factor that differentiates nursing care from other disciplines is our use of the nursing process. Practiced throughout nursing school, it becomes so ingrained in our thinking that we use it automatically. However, this dynamic and efficient problem-solving technique need not be reserved only for patients; it can be a way for nurses to approach problems in our lives as well. By following the steps of the nursing process with flexibility, curiosity, and critical thinking, we can map out a plan of care for ourselves to return balance, enthusiasm, and satisfaction to our careers. ASSESSMENT The first step begins with self-assessment. Self-care is personal; no one else can tell you what you need to do for yourself. Some will advocate therapies such as yoga, aromatherapy, and/or meditation. These are certainly helpful adjunct therapies. However, we cannot improve the stress in our lives until we face the sources and cultivate new responses. Sources of stress can be internal or external. Reconnect with yourself through reflection. Give a name to your desires. Look at your dreams; it is possible to make them happen. Journaling works well to organize your thoughts and feelings. Use it to increase awareness of individual preferences, emotions, spiritual needs, and growth. If you find you are stuck, Kathleen Heinrich (2008) describes a free-write exercise in her book, A Nurse's Guide to Presenting and Publishing, that can help you get started. Specify a certain length of time between 1-2 minutes, put pen to paper, and let your thoughts flow without editing. Have a specific question in mind, and keep your pen moving, even if it starts with doodling (pp. 9-10). Define your core values. It is important to operate from these values-otherwise we experience dissonance or dis-integration. This dis-integration can be a strong source of moral distress. When you function from your values and beliefs, you feel on track and you respect yourself. The value of self-respect may be something we take for granted (Dillon, 2009). However, whether we respect ourselves determines how we live our lives. …

Principles for Establishing Trust When Developing a Substance Abuse Intervention With a Native American Community

Abstract: This article traces the development of a research project with a Native American community. Four principles were used to guide the development of the "Community Partnership to Affect Cherokee Adolescent Substance Abuse" project using a community-based participatory research approach. The principles suggest that establishing trust is key when developing and conducting research with a Native American community.

The sounds of silence: exploring lessons about silence, listening, and presence.

Abstract: Unless we-in our professional and nonprofessional roles-learn the importance and practice of deliberate silence, engaged listening, and restrained response, we will miss the opportunity to provide our presence and comfort to those about whom we care. And unless we-as health care professionals-learn these lessons, we will miss the opportunity to do all of that and provide a more accurate, complete diagnosis and informed plan of treatment. Done well, these practices have application to all our relationships with patients, colleagues, family, and friends. For the 1967 movie, The Graduate, Paul Simon and Art Garfunkel's score included their song, The Sound of Silence. Among the lyrics are these haunting words: People talking without speaking, People hearing without listening . . . . . . And no one dared Disturb the sound of silence. "Fools," said I, "you do not know Silence like a cancer grows. Hear my words that I might teach you, Take my arms that I might reach you . . ." (Simon, 1966)1 The song is full of wisdom about the role of silence, listening, presence, learning, connection, and absence of connection; in other words, how we relate to each other. It's more than coincidence that one definition of music includes reference not only to sounds, but also to a combination of sounds and silence, and that's what this essay is about. Actress Vanessa Redgrave, interviewed recently for The New York Times during her role in the Broadway revival of Driving Miss Daisy, reflected on the importance of listening-not only how the audience listens to the actors, but also how the actors listen to each other: If you don't listen, as Miss Daisy struggles to, you miss the nuances of what others are saying. . . . I've certainly taken it as something I've worked on myself-listen, listen, listen, really listen. You think you're listening, but you really have to work at it. [italics mine] (Healy, 2011, p. C1) And to listen, one has to be silent. Silence is an intentional act. In The Human Side of Medicine: Learning What It's Like to Be a Patient and What It's Like to Be a Physician, I wrote about another dimension of silence and listening: When her elderly mother complains to her about her problems, my friend asks, "Are you telling me this because you want advice, or because you want me to listen?" Sometimes, the patient needs neither answer nor remedy, but simply someone to listen with respect and without interruption. A patient told me, "To have someone who listens and gives thoughtful, trustworthy advice is a blessing. When I have a physician who listens, it's magic." (Savett, 2002, p. 34) Listening requires silence. Sometimes, nothing else is required other than an expression of understanding and validation of feelings. To listen, one must be present, not distracted, thinking about something or someone else; focused and reflective, not only on what is said, but also on the feelings behind what is being said. And one must be silent, in order to listen without interruption. That's a tall order. Silence takes practice. Some, but not all, laypeople are good at it. To be a really good nurse, physician, social worker, member of the clergy, or other clinical health care professional, being silent and listening are essential skills. Here's why. THE SOUNDS OF SILENCE Silence as a Way to Gather Information To learn about patients and their illnesses, we need to hear their story. The patient's story . . . holds most of the clues to diagnosis and treatment. More than any single laboratory or x-ray test or even the physical examination of the patient, the patient's story gives broad and valuable information about what's wrong. (Savett, 2002, p. 11) The initial open-ended question, "What brings you to the hospital (or office)?" allows patients to tell their story: what really happened and the associated feelings, emotions, reflections, and impact on the patient and family. …

Presence and attunement in health care: a view from infancy research.

Abstract: In the nuanced exchange between mother and baby-with its exquisite attunement, which we now know creates neurobiological changes in both parties-we see a metaphor for the therapeutic relationship in health care. To the extent that the mother is fully present, the infant is not only regulated in the moment, but also learns to self-regulate. What is the power of the nurse's presence to heal and to increase the patient's participation in healing? And where does a nurse reach for this critical health care tool?

Implementing a professional nursing practice philosophy and model: using affective methods to address resistance.

Abstract: The desire of community hospitals to build more professionalism into nursing practice through the implementation of a practice philosophy and model can be driven by several factors, including practice needs, consistency, and/or a Magnet Recognition journey. The development team for this institution provided 30 2-hour sessions on professional practice to nurses on all shifts. This training was mandatory, with typical resistance for such programs. The rollout strategy wove cognitive and affective teaching methods that integrated head and heart, with very positive outcomes identified in postprogram evaluations.

Nursing: the skill and art of being in a society of multitasking.

Abstract: Multitasking, a media-driven bias toward dramatic scenarios, and an emphasis on meeting institutional goals in the form of documentation have led to a culture of action-based practice, which interferes with nurses' ability to simply be with patients. In order for nurses to be fully present with their patients, the cultural norm of multitasking and the emphasis on doing must be reexamined within the context of patient care.

Music's unspoken messages.

Abstract: Today, integrative medicine encompasses many healing arts therapies, including music. The universal language of music is simple, yet often forgotten, and communicates unspoken messages. The healing power of music in the health care setting creates a healing environment, distracts from pain, relaxes and de-stresses, and helps with sleep.

Designing the invisible architecture of your hospital.

Abstract: Before building or remodeling a hospital, architects develop a complete set of blueprints. That same sort of detailed attention should be given to the "invisible architecture" of core values, corporate culture, and emotional attitude because this has a much greater impact on the patient and employee experience than do the bricks and mortar. When you walk into a hospital, your first impression is determined by the physical environment. You have a very different feeling if there is a polished granite floor and a fountain than if the carpet is stained and ceiling tiles are falling out, don't you? But if you're a patient in the hospital for a week, or a new employee who's been there for 3 months, the granite floor and fountain are not what you'll talk about when people ask about your experience. You won't say, "What a wonderful hospital! You should see the carpet-and that beautiful wallpaper!" You will talk about things that cannot be seen with the eye. First impressions are created by design and decor; lasting impressions are established by what we call the invisible architecture of core values, corporate culture, and emotional attitude. Ironically, although we pay excruciating attention to every detail of the physical design (we would not so much as remodel a bathroom without a detailed blueprint), more often than not, the invisible architecture of hospitals is allowed to evolve haphazardly, without a plan. I have yet to visit a hospital that has an even marginally detailed cultural blueprint, even though most executives probably agree with the statement that "culture eats strategy for lunch." When we work with hospitals to help them clarify their invisible architecture, we actually use a construction metaphor. Invisible architecture is to the soul of your organization what physical architecture is to its body. Invisible architecture, not the buildings, determines whether yours is a good hospital, a great hospital, or just another hospital. It is built on a foundation of core values, supported by an infrastructure of corporate culture, and finished by the emotional attitudes reflected in the workplace. Let's look at each. A FOUNDATION OF CORE VALUES Core values define what you stand for and what you won't stand for. (As the song says, "If you don't stand for something, you'll fall for anything"). Zappos, a company that sells shoes online, has 10 core values that were created through an intensive process involving every employee ("create fun and a little weirdness" was obviously not written by an outside consultant). Zappos' Web site has a detailed description (narrated by "Core Values Frog") of the behavioral expectations created by those values. Those values, and the culture they underpin, are celebrated in the annual Culture Book the company publishes. Very few hospitals take their core values as seriously as Zappos does. When I'm speaking with groups of hospital professionals, including senior executives, and I ask for a show of hands by people who can tell me their hospital's values from memory, typically, no more than two hands in 10 are raised. I then proceed to "fire" everyone who did not raise a hand, explaining that if I were on their hospital's board of directors and discovered that they didn't care enough to learn our core values, I'd wonder how on earth they could know that those values are reflected in the way they care for patients and for each other. SUPERSTRUCTURE OF CORPORATE CULTURE Culture is to the organization what personality and character are to the individual. It is the fabric of traditions, customs, practices, and habits that characterize the organization. Culture is the only sustainable source of competitive advantage, and developing cultural blueprints is more important than designing buildings. Culture establishes behavioral expectations for employees. At Les Schwab tire stores, customers are greeted by a technician who runs out to their car the minute they pull into the parking lot. …

Ethical Challenges in Health Care: Developing Your Moral Compass

Abstract: Ethical Challenges in Health Care: Developing Your Moral Compass Vicki Lachman, PhD, APRN, MBE. New York: Springer Publishing, 2009, 274 pages, $50.00. Dr. Vicki Lachman, clinical associate professor in the College of Nursing and Health Professions at Drexel University in Philadelphia, has authored a superb book, her second on ethics. Her exposition of ethical challenges is clear and will captivate any health professional. Nurses will benefit most, but all health professions are involved in ethical issues. Lachman's goal for the reader is to develop moral courage and to act in accordance with his or her values, without allowing fear to prevent the right action. Lachman begins each chapter with a meaningful quote and ends with key points to remember. It would have helped to include questions to stimulate reflective and critical thinking. Interspersed throughout the chapters are ethical case histories that provide examples of people experiencing or demonstrating what Lachman is explaining (for instance, cognitive reframing). The first section presents historical figures who defined and personified moral courage. Lachman discusses coping with emotions such as anxiety, fear, anger, and disappointment that can obstruct moral courage, and she offers practical processes to overcome these emotions with rational actions. Additionally, to gain moral courage, one needs assertiveness and negotiation skills. One scenario in which moral courage is particularly important is expressing bad news. A physician may be less than clear and straightforward in telling a patient about a serious health condition, leaving the nurse to clarify the bad news and respond to the patient's questions. These situations call for the nurse's presence, compassion, and honesty. The second section addresses demonstrating moral courage, which is necessary for patient advocacy. One case study describes a 90-year-old patient who chose not to have a recommended surgery even though without it, she would die. If the patient has the capacity for decision making and understands the consequences, then the patient's decision should be supported. Lachman points out the health professional's role in advance directives, which convey patients' wishes when patients are not able to speak for themselves. Sometimes, family members want life support equipment or procedures that the patient's advance directive states were not wanted, but the patient has the right of self-determination. …

The association of civility and ethics.

Abstract: Recently, I attended a lecture on workplace ethics. I was expecting an engaging discussion of patient rights, social justice, and worker rights. Instead, the lecturer stated that each time he discussed ethical practice over the past few years, someone in the audience inevitably wrote a scathing letter of complaint against him to his supervisor. In each letter, the author complained in such a way that the lecturer (and his supervisor) was led to believe that the issues he discussed, which were not inherently controversial, touched a nerve. As such, in an effort to be politically correct, the lecturer focused on civility and how that has been lost throughout our society, including in the workplace. He was concerned more than ever with the diminishing level of civility and civil discourse that has woven its way throughout society and our lives. One of the challenges in discussing ethical practice is that it can have different meanings and different definitions among clinicians and patients. In the book Choosing Civility by P. M. Forni (2002), civility and ethics are directly linked. Dr. Forni asserts that "a crucial measure of our success in life is the way we treat one another every day of our lives" (p. 4). He acknowledges that the essence of civility is awareness that what we say and do affects others. Civility requires respect, restraint, and responsibility and is manifested through our manners, acts of etiquette, and behaviors with others. Civility is about the cultivation of honesty, fairness, self-control, and prudence that can help each of us and society reach our potential. Without civility, we cannot act ethically. Fundamentally, ethics relates to the philosophy behind a moral outcome and addresses how we treat each other. Our acts of civility or incivility constitute the center of morality. The hallmarks of ethical behavior are trust, integrity, respect, transparency, honesty, and responsibility. When there are acts of unprofessional behavior, disrespect, and retaliation, we can often readily recognize unethical behavior and realize that our society and workplace lack the decency and the moral standing that holds society together, and that we at our core want to have. Through self-evaluation, we can decide that we will behave and act ethically. We can be resolute about our decisions, but the continual influx of "grey areas" of decisions and situations throughout our lives challenge our resolve. All too often, there are opportunities to yield to pressure from others and breach our ethics and our integrity. …

The healing power of art: is it just for patients?

Abstract: To be a caring professional one must learn to care for oneself. This article is an exemplar of one nurse's discovery of the use of music to cope with stress and grief. Living with unresolved grief and cumulative stresses may lead to the inability to experience the joy of nursing and ultimately to burnout. Art in all its forms provides a mechanism to cope with life's challenges and to create an atmosphere of healing. If you walk through nearly any hospital or clinic in the United States today, any remodeling endeavor seems to focus on creating an atmosphere of healing. Works of art donated by philanthropists line the hallways. Some organizations provide harpists or pianists to promote a healing environment filled with music. Bronze sculptures fill the public common spaces. Art-used as a healing device in health care settings. When I was a child, art class would send me into panicked anxiety, but my mother made sure I took piano lessons. Somehow, she knew it was important that I learn to play. Through all my musical experiences and in my nursing career, I have grown to appreciate how art and music can bring meaning to my patients during challenging life experiences, when words fall short. I have also learned how important art and music are in my own self-care. Most of my nursing career has been spent in pediatric intensive care. The fast pace of critical care does not always provide adequate time to emotionally process the acute tragedies or the ongoing accumulations of sadness and stress that occur in this setting. My colleagues were always supportive of each other whenever anyone had a bad shift, but sometimes this wasn't enough. One morning after a long, hectic, and ultimately sad night shift, I had an intense need to purge my feelings of overwhelming despair. Verbal venting of my feelings not being an option, I walked into my house and announced to my still sleeping family that I was going to play Rachmaninoff-badly. It had been many years since I played this piece, but my skill level did not matter. Those first dramatic chords provided an avenue for my soul to grieve over the events of the previous night. For the next hour, as I worked through the agitato, the first painful emotions began to ease. I played piece after piece; first, solemn and reflective in a minor key, then moving on to gospel and contemporary Christian, simply allowing the music to soften the intensity of my grief at all that this child, my patient, had lost. Then the tears came, surprisingly allowing me to play more expressively than I had in years. Eventually, I began to calm and to feel right again, ready to find closure. Searching through my books, I found "It Is Well With My Soul" by Philip Bliss, a perfect testimony about facing grief through a lens of hope and peace. And lastly, now in full circle, truly at peace again, ready to meet life with all its joys and sorrows, I chose to end with the one piece I still could play by memory: "Rustle of Spring" by Sinding-a classic romantic composition with flourishes of arpeggios and runs intermixed in a beautiful combination of chords that remind me of summer storms, trickling springs, and the budding of new life. …

Taking Learning to the Learner: Using Audio Teleconferencing for Postclinical Conferences and More

Abstract: Clinical educators are often burdened by conflicts that occur as they try to balance multiple postclinical scheduling demands with students' varying timetables. The purpose of this article is to inform educators how to use teleconferences to deliver valuable postclinical debriefing, model professional growth experiences, and more. The innovative use of teleconferencing as a pedagogical method enables educators to take learning to the learners.

The Making and Meaning of Presence: A Conversation With Jayne Felgen, MPA, RN.

Abstract: Jayne Felgen discusses the characteristics of presence, its relationship to caring, creating presence in challenging situations, creating structures that support therapeutic relationships, and the necessity for clarity-of self, of role, and of systems-in supporting people's ability to provide care that is based on relationships instead of tasks.

Pictures of a client's silent distress.

Abstract: A trust-based nurse-patient relationship and open communication can help nurses alleviate clients' intrapersonal and interpersonal distress. However, the client's silence about unspoken needs can present an obstacle to successful holistic care. This article describes how pictures, both mental and printed, can be used by nurses to open pathways of healing communication and holistic nursing care.

Change, chaos, adaptation: the effects of leadership on a work group.

Abstract: As nurses, we are very familiar with the environmental factors associated with change, the impact of chaos on working relationships, and the general milieu of a nursing unit. This story relates how a student in a leadership practicum was encouraged to look at change through an organizational lens when the leadership dynamics changed in a work group. The Roy Adaptation Model and chaos theory were applied as frameworks for this assessment as a way to organize and foster learning. Through this serendipitous opportunity, the student gained an insight into the dynamics of group process and an appreciation of the work it takes for leaders and managers to keep the work group in a healthy functional state.

The Life of a Bill: A Nursing Experience

Abstract: In an effort to better understand the process of health policy to advocate for increased legislative support for the nurse practitioner (NP) role, the authors attended the Nurse in Washington Internship (NIWI) sponsored by the Nursing Organizations Alliance from March 14-16, 2010. The restrictions on NP practice must be removed if we are to meet the health care needs of the populace. This article is a condensed discussion of the process of health policy.

The making and meaning of presence: a conversation with Jayne felgen, MPA, RN. Interviewed by Marty Lewis-Hunstiger.

Abstract: Jayne Felgen discusses the characteristics of presence, its relationship to caring, creating presence in challenging situations, creating structures that support therapeutic relationships, and the necessity for clarity-of self, of role, and of systems-in supporting people's ability to provide care that is based on relationships instead of tasks.

Integrating nursing science in the education process.

Abstract: With the present shortage of nursing faculty and the imminent retirement of current faculty, clinical nurses are encouraged to step into academia, bringing their enthusiasm, knowledge, and clinical experience. As nurses enter the world of nursing education, they will face two challenges: the paradigm shift from clinical nursing to learning process, and the vast diversity of students. Turning to the foundations of nursing, a young nurse educator generated teaching-learning strategies through integration of nursing sciences as a guide to becoming an effective educator. Contentwise, I was ready for my nursing theories, practice, and process class. Armed with my master list and course outline, I strode toward my classroom. It was my first day teaching in the graduate school, and I was a bit anxious, yet I was ready. I had insights to share and interest to incite, and a room full of minds to fill with the principles of Florence Nightingale, Dorothea Orem, and Betty Neuman, as well as all the newer nursing theories. Surely, the students would understand the importance of these fundamentals in their fields of expertise. Expertise-it dawned on me that this was not an undergraduate class in which I used teacher-centered strategies, feeding them information so they could automatically apply the concepts in their clinical learning experiences. I had jumped at the chance to teach in the graduate school when offered the job because of my own pleasant recollections of being a student there. At present, I would have to look before I leaped. As the students filed into the room, I noticed how diverse they were. Some were bright-eyed, optimistic young nurses; others came in fresh from nursing experiences in other countries; and then there were seasoned veterans in local nursing positions. Although I had been taught higher education pedagogies, it seemed that suddenly everything I had learned had become a blur. Out of this fog came the realization that my clinical experience is identical to my teaching experience in so many respects. I pictured my classroom as a nursing unit, full of clients with different diseases and health needs, and I had to manage the unit and attend to each of their individualized needs. Therefore, to provide the most effective, high-quality instruction, I needed to integrate my nursing foundations into the field of education. I greeted my students with a smile and welcomed them. I introduced myself as their learning facilitator and hoped that we would have a pleasant time learning together. I asked them to introduce themselves and to tell the class about their experiences in the field of nursing. Immediately, the younger nurses were at ease with me because of our similar ages, but the seasoned veterans seemed a little skeptical. I carefully assuaged their doubts by professing my genuine love for the nursing sciences, appreciating their commitment to lifelong learning and assuring them that their clinical experiences would be relevant to the coursework. Inside and outside the classroom, a smile and respectful attitude work wonders with all kinds of personalities. This is rule number one in building therapeutic nurse-client relationships: establishing trust and rapport (Antai-Otong, 2007). A friendly attitude toward students fortifies cooperation in the classroom by enhancing their perception of my support and warmth toward them (Ryan & Patrick, 2001). As a nurse would assess clients individually due the diversity of their health needs, I assessed my students' learning needs individually. I created a tool that assessed their career preferences and suitability, achievements, aptitude and potential, prior learning, basic and key skills, learning style interests and difficulties, job roles, self-esteem, and personal circumstances (Department for Education and Employment, 2001). These factors reflect the students' interacting domains: physical, interpersonal, sociological, and political, as postulated in the health career model (Hodges, 2008). …