Nursing Against The Odds: How Health Care Cost Cutting, Media Stereotypes, and Medical Hubris Undermine Nurses and Patient Care

In the United States and throughout the industrialized world, just as the population of older and sicker patients is about to explode, there is a major shortage of nurses. In Nursing against the Odds, one of North America’s leading health care journalists draws on in-depth interviews, research studies, and extensive firsthand reporting to help readers better understand the myriad causes of and possible solutions to the current crisis. To promote better care, Gordon calls for a broad agenda that includes safer staffing, improved scheduling, and other policy changes that would give nurses a greater voice at work. She explores how doctors and nurses can collaborate more effectively and what medical and nursing education must do to foster such cooperation. Finally, Gordon outlines ways in which RNs can successfully take their case to the public while campaigning for health care system reform that actually funds necessary nursing care

First, Do Less Harm: Confronting the Inconvenient Problems of Patient Safety

[Excerpt] This book is an exploration of why patient safety is advancing at what seems to be an almost glacial pace, despite the often vast and determined efforts of health care workers and managers. A collection of essays from prominent researchers, scholars, and even patients, this book aims to identify some of the gaps in the patient safety movement, the disconnected dots that do not coalesce despite decades of hard work and billions of dollars. It also identifies concerns that have not been integrated into the patient safety discourse or agenda of more established groups

Bedside Manners: Play and Workbook

[Excerpt] Our goal in the play was to create a balanced work. In Bedside Manners, the reader will find people who communicate poorly and those who communicate well. Although the play focuses primarily on physicians and nurses and the acute-care hospital setting, we have tried to expand the cast of characters to include others on the health care team and to include other settings. As the safety literature documents, poor communication between members of the health care team is not simply an individual problem—a question of a few bad apples spoiling the barrel—but is rather a system problem that stems from how health care has historically developed. Although it is beyond the scope of this commentary to describe that historical development, suffice it to say that the problems of contemporary health care team relationships have a long history and are shaped not only by economics but also by gender, culture, religion, ethnicity, and many other factors. Although our play is meant to stimulate discussion about health care teamwork and suggest ways that doctors, nurses, and others in health care can develop the skills necessary to create and sustain genuine interprofessional teams, it is primarily a work of theater. Its goal is to help those who work in health care approach a very hot topic in a way that is both interesting and even, dare I say it, fun. To accompany the play and make it more user-friendly, Scott Reeves, Lisa Hayes, and I have also written a workbook, which explains the various ways it can be performed, how to mount a performance, and how to lead a discussion or workshop after the play is over. We also explain how to use the play as part of an interprofessional curriculum. Although some in our audiences have scoffed at such a touchy feely or unconventional way to present a serious issue, our experience has convinced us that theater is a useful tool to enhance teamwork, patient safety, and also to create more satisfying workplace relationships. Theater has been with humankind since almost the beginning of our history precisely because it is such a powerful tool. It can be used by those in health care who spend their days working with sick, frightened, anxious people, people who are, by definition, not at their best. Under the best of circumstances, their work is beyond difficult. Good communication and teamwork not only produces good patient outcomes; it helps health care professionals care for one another

Laser induced breakdown spectroscopy of martian breccia Northwest Africa 7034: comparison with Mars Science Laboratory results

The Mars Science Laboratory (MSL) rover is utilizing laser-induced breakdown spectroscopy (LIBS) instrumentation to determine compositions of rocks shot in Gale crater, Mars, from a distance of 1.56-7 meters. At the same time, martian breccia meteorite Northwest Africa (NWA) 7034 was analyzed with the ChemCam engineering model laboratory LIBS instrument at Los Alamos National Laboratory (LANL) at a 1.6 m standoff distance under 7 Torr CO2. Each LIBS location was pulsed with 150 shots at 3 Hz and 13.5 mJ/pulse. Comparison of NWA 7034 LIBS results with the bulk composition acquired with electron probe microanalysis (EPMA) show agreement within LIBS instrument error. Comparison of NWA 7034 data with targets from Gale shows chemical and textural similarities. This study helps bridge the gap between Mars in situ and martian meteorite data by using LIBS data to determine compositions of heterogeneous rock samples outside the compositional range previously observed on Mars

From Silence to Voice: What Nurses Know and Must Communicate to the Public

[Excerpt] These experiences made us realize that we had underestimated the significance of cultural issues in the relationship between nursing and the external public world. Whereas we once thought that nursing could become significantly more visible by using more or less generic public relations techniques, we now believe that communication considerations specific to nursing must be addressed. Our metaphors also changed over time. Initially we thought in terms of the “invisibility” and “visibility” of nursing. Now we strongly feel the operative terms are “silence” and voice.” That is why we call this book From Silence to Voice and why we focus, in this edition, on moving beyond a “virtue script” that idealizes nursing toward messages that accurately depict nursing and its importance in health care

Collaborative Caring: Stories and Reflections on Teamwork in Health Care

[Excerpt] There are many theoretical and conceptual books and countless articles that have explored issues of teamwork in general and teamwork in health care in particular. The editors, and many of the authors in this book, have read most, and have even written some of them. To tackle the issue of teamwork, we have, however, taken a different approach. Rather than write a theoretical book about what teamwork is, what it is not, where it exists in health care, what barriers prevent its implementation and how they can be removed, we have chosen instead to address these questions through narratives and reflections that vividly describe good teamwork as well as problems in creating, leading, and working on genuine teams. What we believe is too often lacking in the literature is a clear and compelling picture of what teamwork looks like on the ground, in the institutions where health care work is delivered and where teams play well, or don\u27t play well, on a daily basis. The question we ask here is thus: What is the state of play in most health care institutions? To describe the state of play, we have asked clinicians to write what we think of as where the rubber hits the road stories or reflections about the nature of teamwork in their own particular work setting. To gather these stories, we talked to many people in different health care disciplines. In the invitation for submissions we wrote the following: We are seeking short, concise narratives that describe a concrete example in which you personally have been involved. The idea here is not to focus so much on the individual doctor-patient, nurse-patient, therapist-patient communication but the teamwork that was involved in ensuring that the standard of care was met or exceeded. If the patient or family was involved, so much the better. Stories can deal with interprofessional or intraprofessional teamwork. On balance, we would prefer to have more stories about interprofessional or occupational teamwork. Nonetheless, we recognize that interprofessional work depends on the ability to create teamwork within an occupation or profession. Stories involving support staff, such as housekeepers who spoke up about a patient safety issue, are definitely within the purview of this book. We would also welcome personal reflections that would enhance our understanding of either how to produce genuine teamwork or the obstacles that stand in its way

Excluded Actors in Patient Safety

[Excerpt] In this chapter we argue that it is necessary to create a fundamentally different patient safety template. Creating that template can produce impressive results. Maimonides Medical Center in Brooklyn has been successful at creating a safer hospital environment because it has involved both unions and frontline workers

Year One of School Improvement: Examples from Nine Schools

School improvement research asks the question “How do schools improve over time?” and thus is focused on school culture and the change process

Field Notes from the Light: An Ethnographic Study of the Meaning and Significance of "Near-Death Experiences"

This dissertation is based on a comprehensive study which investigated the meaning and social significance of "near-death experiences" (NDEs) by situating 50 experiencers (NDErs) as the "inside" experts on these profound, subjective experiences and their real-world impact. I used a phenomenological, "person-centered" ethnographic approach, new to Near-Death Studies, to make experiencers' lives the orienting framework for my study. Informed by "reformist" qualitative-research ethics and health-education-and-counseling values, I analyzed study-participants' life-history narratives against medical-scientific Near-Death Studies explanatory models, an NDE-Integration-Trajectory (NDE IT) patterns model, and social construction and identity-alternation theory. My findings were, first, that study participants' descriptions of NDE impact and aftereffects, which matched previous findings, were adequately explained by neither social construction nor medical-scientific theory. Second, participants in this and previous studies described significant NDE interpretation and integration problems, in which I recognized a previously unidentified, health-education-and-counseling-related, pattern of unmet NDE integration needs. Third, my findings supported the previous NDE IT findings and model; and also recognized the importance of individuals' multiple cultural meaning systems in shaping their NDE integration patterns.. Fourth, 29 of 50 study participants had not sought out and did not identify Near-Death Studies as a useful NDE integration context or resource; and they described it negatively if they mentioned it at all. Moreover, the 21 participants who had sought a connection with Near-Death Studies expressed similar dissatisfactions. My findings speak to the need for development of a research agenda and model(s) designed to assess and address the education and counseling needs of tens of millions of NDErs, and their health care providers. My analysis addresses the potential social-wellness value, as well as the needs, of a community of 13 million adult NDErs, in the U.S. alone. It situates its analysis within a context of escalating social and ecological crises and an in-progress paradigm-shift away from the still-official Newtonian/Cartesian material world view of Western culture. It recognizes the potential social value of NDErs' collective visibility as agents, among many others of a (re)emergent sacred worldview; one that is linked to the world views of diverse indigenous knowledge systems as well as of quantum physics