{"title":"Why Not Poems in the Waiting Room?","authors":"J. Young-Mason","doi":"10.1097/NUR.0000000000000200","DOIUrl":"https://doi.org/10.1097/NUR.0000000000000200","url":null,"abstract":"Anumber of years ago, as a consultant to a rural community hospital Healing Environment Committee, I recommended that TVs, piped-in music, and inappropriate magazines be removed from all waiting rooms. Most of the waiting rooms in the hospital opened out intomain corridors. The cacophony of the TVs andmusic combined was disconcerting, interrupting conversation and thought. Although committee members agreed that this was so, some thought that the community wanted and even needed the TV for distraction. They feared a backlash of anger. Discussions ensued, and it was pointed out by some that the choice of a TV program was usually made by one person and others present were expected to go along with that choice, even the level of sound. Another shared the fact that staff picked themusic in the laboratory waiting room, patients were never asked. It is important here to note ethnomusicologist Elizabeth Miles’ words on the implications of listening to other’s music choices. ‘‘Any time you listen to music that someone else has chosen you are allowing other people to color yourmood and control your body and mind.’’ The selection of magazines available was insensitive to the plight of thosewaiting, somewere an insult to their intelligence. None were in languages other than English. After lengthydiscussions, itwasdecided that itwould be a worthwhile endeavor to conduct a time-limited trial of media-free waiting rooms and the elimination of offensive magazines. Response boxes with blank page composition bookswere installed in eachwaiting room and commentary began to appear. The initial responseswere not overwhelmingly in favor of the proposal, but as timewent on, the peace and quiet began to be favored. It is always interesting to read invited ongoing commentary and to learn how thoughtful responses influence others in a way nothing else can. Some were surprised to be given a choice; others were grateful for the quiet. Some choice words and advice was shared about the problematic magazines. Then, the committee, in concert with patient and family representatives, began to introduce literature that spoke to this community’s citizens: books and magazines about nature, floral design, art, architecture, and photography; short story collections; and literary journals with poetry. In consultation with community teachers, intriguing, appropriate literature was selected for children and teenagers. Then one remarkable day, I encountered two teenage girls sitting in the Radiology Waiting Area, and wonder of wonders, they were reading poetry to one another from one of the journals in the waiting room. One said to the other, ‘‘Wait, listen to this!’’ And then she read an entire poem to her friend with full inflection and strong voice. Her friend listened intently to her. They never noticed me standing in the doorway. Today, entering a clinic or hospital waiting room, you will see people looking intently at their cell phones screensIscrolling up and down, reading and sendi","PeriodicalId":145249,"journal":{"name":"Clinical nurse specialist CNS","volume":"390 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123196662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Personhood… the Place for Wellness.","authors":"J. Fulton","doi":"10.1097/NUR.0000000000000210","DOIUrl":"https://doi.org/10.1097/NUR.0000000000000210","url":null,"abstract":"","PeriodicalId":145249,"journal":{"name":"Clinical nurse specialist CNS","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122100502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Disruptive Innovation in Graduate Nursing Education: Leading Change.","authors":"C. J. Thompson","doi":"10.1097/NUR.0000000000000199","DOIUrl":"https://doi.org/10.1097/NUR.0000000000000199","url":null,"abstract":"D isruptive innovation. It sounds messy, and rebellious. You may have run across this term in the leadership or business literature. Although disruptive innovation seems to be the new buzzword, the concept itself has been around a long time. For example, ‘‘creative destruction’’ defined businesses that took advantage of new technology and was coined by Schumpeter in the 1930s; in 1989, ‘‘permanent white water’’ denoted the turmoil and chaos in a changingworld, and the use of terms such as reengineering, reinvention, and healthcare reform in recent decades brings visions of change and chaos. However, the goal of disruptive innovation is not to bring chaos but to provide value to underservedmarkets. The innovation’s purpose is to transform an existingmarket or sector by introducing simplicity, convenience, accessibility, and affordability where complication and high cost are the status quo. Initially, a disruptive innovation is formed in a niche market that may appear unattractive or inconsequential to industry incumbents, but eventually the new product or idea completely redefines the industry.6({2) Personal computers, cellular phones, and the Internet are examples of disruptive innovation. In fact, the Internet has been identified as the number 1 disruptive force in recent history. The theory of disruptive innovation was created by Dr Clayton Christensen from Harvard University and posits that transformation in any industry occurs when small entities disrupt larger ones by focusing on efficient and economical processes and procedures as simpler solutions for complex problems; the disruptors also focus on a new or underserved market of consumers. It is important to note that the impetus behind the disruption is not to improve a product, but to meet consumers’ unmet needs. Because these innovations upset the status quo, they are resisted and frequently ignored by those stakeholders, as inconsequential. However, disruptions can also cause the larger entities to innovate to defend theirmarket sector. The goals of both types of innovations (disruptive and defensive), if successful, lead to positive outcomes for the consumer. Disruptive innovation is not confined to the business world, though; so let us talk about disruptive innovations in healthcare and education. The passage of the Patient Protection and Affordable Care Act in 2010 was, and remains, the impetus for much disruption in healthcare deliveryVand ultimately for nursingeducation. Theestablishmentof clinical nurse specialists (CNSs), nurse practitioners, and other advanced practice nurses to address unmet consumer needs has also been labeled as a disruptive innovation in healthcare delivery. Indeed, CNSs have been at the forefront of disruptive change by challenging the status quo and designing innovative processes and procedures to improve the delivery of healthcare and promote positive patient outcomes. The growth of independent primary care andurgent care clinics in retail establishments ","PeriodicalId":145249,"journal":{"name":"Clinical nurse specialist CNS","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124278198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Perspectives on Global Healthcare.","authors":"Marlena Seibert Primeau","doi":"10.1097/NUR.0000000000000188","DOIUrl":"https://doi.org/10.1097/NUR.0000000000000188","url":null,"abstract":"Healthcare is organic. This fundamental aspect of healthcare was slowly recognized and acknowledged over my years of teaching a Global Health course and traveling abroadwith students. After interacting with nurses, medical personnel, and the general public in various countries, it became evident that a nation’s healthcare system is not just a static entity. Healthcare is created, then grows, develops, and changes according to the needs of anation and the culture, history, andpersonality of its citizens. Beginning in the late 1970s, a Public Broadcasting System documentary series entitled Connections (An Alternate View of Change) looked at science and inventions from both an interdisciplinary perspective and as a largely unintentional interaction of discrete events. As creator and science historian James Burke noted, the development of anything in our world cannot be viewed as a singular event, but rather as a network of interrelated events, with each of those events occurring for various individual reasons with no awareness of the possible future results. Burke suggested several corollaries to his theory: first, that the modern world has no ideawhere today’s ‘‘isolated’’ eventswill lead, second that the probable increase in both speed and complexity of these connections will impact individual freedom and privacy, and third, the probable consequences to the entire system in case of a breakup or collapse of one of the interconnected networks. In many ways, healthcare systems mimic Burke’s theory on how the world interconnects. Healthcare does not occur in isolation; it is developed and changed by people, events, and the connections between them. History, culture, education, politics, and geography all play an integral part in contemporary healthcare; comparisons of these topics add dimension and depth to the learning experienced and insight developed by the students in my Global Health course. What does historical perspective bring to understanding healthcare systems, and what role does a nation’s history play in current-day healthcare? The history of a nation illuminates that nation’s view of individual health and the development of its healthcare system. The aftermath of war, the immediacy of a national trauma, and the realities of public health concerns, such as infectious disease or a widespread disaster, all help determine the role that healthcare plays in the lives of a country’s citizens. Inmany parts of Europe, World War II is not just a distant memory; it is a remembrance that is integral to the national consciousness. With the influx of refugees, the damaged cities, and the necessary rebuilding of a society, systemic programs such as universal health coveragewere both an imperative and a reasonable solution for the postwar problems experienced by many European countries. William Beveridge, one of the creators of Britain’swelfare state, said in 1948 that ‘‘social security and world security were indissolubly linked.’’ Professional nursing ","PeriodicalId":145249,"journal":{"name":"Clinical nurse specialist CNS","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127495473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Nurses in Business: The Time Is Now.","authors":"S. Alexander","doi":"10.1097/NUR.0000000000000185","DOIUrl":"https://doi.org/10.1097/NUR.0000000000000185","url":null,"abstract":"More and more nurses are beginning businesses for many reasons: wound care, family therapy, in-home respite services, and acute/chronic patient management. Owning a business can be a fulfilling and flexible way to build a career, or it can be a professional nightmare. According to the US Department of Labor Statistics, half of all small businesses will fail within 5 years, and only a third survive 10 years or more. For nurses who want to start their own businesses, taking the time to plan a strategy of business design, implementation, and ownership can contribute to long-term success. Use your head. The first key investment is the timeneeded to create a solid business plan,which should begin asmuch as a year before the doors of a new company are ready to open. Think carefully about realistic short-, mid-, and longterm goals. The bottom line for any business is revenue generation, and this entails more complexity in the world of healthcare. For example, howmanypatientswill need to be seendaily to create the cash flowneeded to sustain daily operations, while building capital for other projects? Lending agencies will likely want to review this business plan as they work with potential borrowers to design the best financial strategies for new companies. In the beginning, an attorney, preferablywith a specialty in business law, will be needed to assist with creating the articles of incorporation for the company and obtaining tax identification numbers and to offer expertise on the intricacies of state and local business permits and licensing. To prepare the physical site of the business, the negotiation of building leases or purchases, repair and/or renovations contracts that may be necessary, and follow-up inspections to ensure that local building codes are met is needed. For many health-related businesses, having a location near the local hospital maximizes visibility for those patients whomay be unattached to providers and in need of care. An attractive building,with easy-to-access entrances, bright lighting, and lots of parking,may be especially appealing to patient populations such as older adults or familieswith small children. Manage the bottom line. The cycle of revenue generation is vitally important to a business; in healthcare, this begins with providers’ ability to produce cash flow. To bill third-party reimbursers, healthcare providersmust be credentialed with each insurer. The process of credentialing can be lengthy, taking 3 to 6 months or more with some reimbursers. Once the physical and mailing addresses of the business are established, the process of credentialing can begin. Retaining a billing agency that can comprehensively manage the credentialing process simultaneously for multiple insurers is a strategy that has been suggested by practice owners as a method to both initiate and maintain cash flow from day 1 of operations (C. Landrum, personal communication, October 8, 2015). Creating financial policies for the business, with rev","PeriodicalId":145249,"journal":{"name":"Clinical nurse specialist CNS","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129292919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Greg Lum's \"Prisoner of Pain\".","authors":"J. Young-Mason","doi":"10.1097/NUR.0000000000000180","DOIUrl":"https://doi.org/10.1097/NUR.0000000000000180","url":null,"abstract":"Ihave been haunted for a very long time by Greg Lum’s piercing narrative about the spiritual and psychological exile he descended into after an accident irrevocably altered his life. There was life before the accident and life after. His life before was full of promise and the enjoyment of the culture of theater and music with his friends. He was writing his PhD dissertation on dramatic adaptations of classical works of literature. His life after the accident was centeredon attempts to find relief from severe and constant pain. On his journey to find relief, he encountered healthcare providers who insisted that he was getting something out of being in pain, others who withheld medication until he ‘‘begged’’ essentially blaming him for his afflictions just as ‘‘Job’s friends blamed him for his.’’ He found somemeasure of control over his life when he began going to a pain clinic and exercising more regularly. ‘‘I see that I can have some say and can take a more active role in dealing with the symptoms even if no one else can determine what’s wrong with me. But what I don’t need is psychobabble on top of trying to cope with pain.’’ Lum describes the problematic effects of pain and antidepressantmedications on his cognition. He is angered by the burden of guilt imposed upon him by those who could not diagnose the sources of pain throughout his body. And then there is the sadness that he is unable to finish his dissertation. ‘‘I suspect thatwhat orwho I am is decided bywhat kind of pain, and howmuch pain I’m in. I can no longer remember a timewhen Iwasn’t in pain. The last 7 years have pretty muchbecome fused and fuzzy and haveoverwhelmed any memories of my life before this intense, chronic pain that has changed my life to an existence. I can recall only colorless memories of what I’ve done in the past, such as traveling, living, and studying abroad, but I can’t remember what they felt like because pain filters and interferes with even my memories. I can’t call up memories of physical activities. For instance, I can recall going to the Comédie Francaise, but I can’t remember actually sitting through Le Bourgeois Gentilhomme for however long it lasts and recalling how it felt to be so caught up in the play that I’d forget myself, because if I try, all I can call up is how painful it would be now to even go to such an event. (I angered my neighboring spectators at the last play I saw because I couldn’t sit still.).’’ Livingwith severe and chronic pain can be a life lived in exile. Greg Lum’s life after his accident echoes Sophocles’ Philoctetes, who was abandoned on an uninhabited island after being crippled by a wound that would not heal. His incessant cries of agony and complaint and the malodorous wound were unbearable to his comrades in the Greek Army. Certain encounters that Greg Lum experienced with healthcare ‘‘providers’’ left him overwhelmed with anger and sense of abandonment. At times it seemed as though no one knew what to do or how to help ","PeriodicalId":145249,"journal":{"name":"Clinical nurse specialist CNS","volume":"105 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115621311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Antidote Is Finally Here! Idarucizumab, A Specific Reversal Agent for the Anticoagulant Effects of Dabigatran.","authors":"P. O'Malley","doi":"10.1097/NUR.0000000000000192","DOIUrl":"https://doi.org/10.1097/NUR.0000000000000192","url":null,"abstract":"Despite the availability, safety, and efficacy of novel oral anticoagulants (NOACs) compared with warfarin, acceptance and use have been hampered by lack of a specific reversal agent. Thismay be part of the reasonwhy anticoagulants remainwidely underprescribed for stroke prevention in atrial fibrillation. The lack of an antidote to reverse NOACs in emergent situations such as lifethreatening bleeding or emergentmajor surgery has been a significant clinical issue until now. The recent approval of idarucizumab (Praxbind; Boehringer Ingelheim, Ridgefield, Connecticut) to reverse the anticoagulant effects of dabigatran (Pradaxa; Boehringer Ingelheim) has resulted in the first and only NOAC with a specific reversal agent. Pradaxa was approved in 2010 to prevent stroke and systemic blood clots in patients with atrial fibrillation and for the treatment and prevention of deep venous thrombosis and pulmonary embolism without a specific reversal agent. Now, Praxbind has been approved specifically for Pradaxa under the FDA’s accelerated approval program (http://www.fda.gov/ForPatients/Approvals/Fast/ucm405447 .htm), which permits drug approval for serious conditions that is likely to provide a clinical benefit.","PeriodicalId":145249,"journal":{"name":"Clinical nurse specialist CNS","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129270923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"What constitutes a dignified death? The voice of oncology advanced practice nurses.","authors":"Deborah L Volker, Michael Limerick","doi":"10.1097/01.NUR.0000289749.77866.7c","DOIUrl":"https://doi.org/10.1097/01.NUR.0000289749.77866.7c","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to explore the concept of dignified dying from the perspective of oncology advanced practice nurses.</p><p><strong>Methodology: </strong>A naturalistic, hermeneutic approach was used to interview the study participants. A sample of 19 oncology advanced practice nurses was obtained by combining data sets from 2 larger studies of patient control and end-of-life care. Audiotaped interviews of the nurses were transcribed verbatim and were analyzed using a phenomenological approach.</p><p><strong>Results: </strong>The analysis revealed that dignified dying is an experience that includes the following themes: going in peace, maintaining bodily integrity, and dying on their own terms.</p><p><strong>Conclusions: </strong>Advanced practice nurses lend an important perspective that expands understanding of the concept of dignified dying. Future studies of patient and family perceptions will enhance knowledge of their needs and lead to intervention studies to promote an end-of-life experience that is consistent with patient priorities and values.</p>","PeriodicalId":145249,"journal":{"name":"Clinical nurse specialist CNS","volume":" ","pages":"241-7; quiz 248-9"},"PeriodicalIF":1.2,"publicationDate":"2007-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.NUR.0000289749.77866.7c","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41011651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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