caring headlines - november 18, 2004 - chaplaincy ......of her special hobbies, origami, with a...

Inside:Chaplaincy .............................. 11111

Jeanette Ives Erickson ............ 22222Great Time to be a Red Sox

Fan; Great Time to be a Nurse

Fielding the Issues .................. 33333Clinical Narratives

Respiratory Care Week ........... 44444

Exemplar ................................. 88888Jennifer Podesky, PT

Physical Therapy Month ...... 1010101010

NICHE Program ................... 1212121212

Hand Hygiene ...................... 1212121212

Quality & Safety ................... 1313131313Standardization and Forced

Function

New Partnership for the

Burn Unit .......................... 1414141414

Educational Offerings ........... 1515151515

POE Inpatient Implementation

Complete ......................... 1616161616

CaringCaringNovember 18, 2004

H E A D L I N E S

Working tMGH P

P

Chaplaincy celebratesPastoral Care Week, welcomes

new director—by Marianne Ditomassi, RN,

interim administrator, Chaplaincy

continued on page 6

atient care is by its verynature, spiritual. Al-though spiritual care may

differ from hospital to hos-pital, being sensitive to the

traditions, culture, religion, andspiritual practices of everyoneunder our care and in our employ

is a high priority at MGH. Spirit-ual care can be religion-based or,as in the case of individuals withno religious affiliation, draw onany deep belief that has profoundmeaning in a person’s life. Spirit-

ual care is offered when individ-uals are in crisis or simply feel aneed for an expression of hope,trust, love, forgiveness, or wouldlike to participate in a particularreligious ritual. Using this frame-work of ‘meaning,’ chaplains

Buddhist chaplain, Suzanne Hudson, shares oneof her special hobbies, Origami, with a young visitor

to Chaplaincy’s Pastoral Care Week boothin the Main Corridor

ogether to shape the futureatient Care Services

November 18, 2004November 18, 2004Jeanette Ives EricksonJeanette Ives Erickson

Jeanette Ives Erickson, RN, MSsenior vice president for Patient

Care and chief nurse

n Saturday, Oc-tober 30, 2004,

while thousandsof other New Eng-

landers lined the streetsof Boston to see the RedSox world series victoryparade, 160 dedicatedstudent nurses from ac-ross the state gathered atMGH for the Massachu-setts Student NursesAssociation (MaSNA)annual convention. Spon-sored by MGH, the day-long event was an oppor-tunity for future nursesto network with peers,hear presentations bysome of the country’spremier nursing leaders,and gain insight into thechallenges and rewardsof a nursing career. Paneldiscussions, break-outsessions, tours of thehospital, and a recruit-ment/exhibit hall gaveattendees a broad over-view of the nursing pro-fession and a glimpseinto specific positionsavailable within variousspecialties.

Barbara Blakeney,RN, president of theAmerican Nurses Asso-ciation, spoke about awide range of subjectsfrom the importance ofpartnerships, to the pow-er of community, to theessence of the nursingprofession and the needto preserve the importantwork that we do. A pas-sionate advocate, Blake-ney stressed the need toadvance nursing through

O individual clinical prac-tice, research, and parti-cipation in professionalnursing associations.

Among the more than30 presenters were MGHclinicians, Susan Wood,RN, clinical nurse spe-cialist, and Lynne Che-voya, NP, nurse practi-tioner, who participatedin a panel discussion onNursing Pathways.

Throughout the day,student nurses had anopportunity to tour theMedical, Surgical, Burn,and Psychiatric units andask questions of staff ineach area. It was evidentthat attendees were eagerto get an up-close look atnursing practice at MGH.

Given that the RedSox victory parade wasgoing right by MGH, Ichose to focus my re-marks on current events:“What do nurses and theBoston Red Sox have incommon?”

When you think ofJohnny Damon, youthink of a player who’ssteady and reliable. He’sthere when you needhim; he comes throughin the clutch. In today’sdynamic healthcare en-vironment, nurses play akey role in coordinatingthe work of the inter-disciplinary team. Every-thing must work in con-cert to set the right bal-ance. Nurses are the back-bone of the healthcaresystem.

When you think ofOrlando Cabrera, theword ‘agile’ comes tomind. Throughout the2004 season, in the play-offs and world series,Cabrera navigated theinfield making unfath-omable plays. I’m oftenquoted as saying thatnursing is not for thefaint of heart. Nursingrequires constant prac-tice and close attentionto quickly changing sit-uations. Nurses need tolisten, be present, andmodify plans to meet theindividual needs of eachpatient.

Manny Ramirez isfocused and driven. WhenManny Ramirez comesto the plate, he is 100%focused on the task athand—hitting the ball.In the field, he’s equallyfocused. And on thoserare occasions when hemakes an error, his team-mates know it’s not forlack of trying; it’s notfor lack of commitment.There is no blame amongteammates at this level.In a hospital setting,patient safety is para-mount. To ensure thatevery clinician can func-tion at his/her highestlevel, we must create ablame-free culture. Clini-cians must feel support-ed in their practice—when things go well andwhen they don’t.

David Ortiz repre-sents power. Experienc-ed nurses are well aware

of the power of the nurse-patient relationship.

Jason Varitek is theunmistakable leader ofthe Red Sox. From hiskey position behind homeplate, he is the heart andsoul of the team. Nursesplay a pivotal role at thebedside. Strong leader-ship, collaboration, andcomposure are key tosuccess.

Kevin Millar is theRed Sox cheerleader. Heknows the importance ofpositive thinking; heappreciates the rewardsof his profession. Nurs-

ing is a noble profession.It’s up to us to promotethe image and practice ofnursing to the next gen-eration.

Trot Nixon is theembodiment of persever-ance. He overcame aserious back injury andworked tirelessly to re-gain his strength andmobility so he couldcontribute to the team’sultimate success. Nursesare constantly identify-ing ways to raise the baron care delivery, lookingfor opportunities to in-

It’s a great time to be aRed Sox fan; it’s great time

to be a nurse

continued on next page

Call for presentersThe Nursing Research Journal Club

invites you to present your original publishedresearch at un upcoming Journal Club meeting

Dates available in 2005January 12th July 13March 23rd September 14May 11th November 16

4:00–5:00pmWellman Conference Room

For more information e-mailMary Larkin, RN, ([email protected]) orCatherine Griffith, RN, ([email protected])

or visit:www.mghnursingresearchcommittee.org

fuse new and innovativethinking into our prac-tice.

When you think ofBill Mueller, you thinkof quiet strength anddetermination. Muellerconsistently and effect-ively keeps all his op-tions open to ensure hecan make the best pos-sible play in the heat ofthe moment. In nursing,there can be many op-tions when working to-ward a positive patientoutcome. Gathering in-formation, working with

other members of theteam, weighing options,and making informeddecisions in a timelymanner is key to deter-mining the most appro-priate plan of care forevery patient.

Many fans wonderedwhy coach, Terry Fran-cona, kept Mark Belhornin the line-up. CoachFrancona saw in Belhorna potential that manyothers didn’t see—hebelieved in Belhorn andhelped position him forsuccess. I cannot under-

score strongly enoughthe importance of havinga mentor to guide you inyour career, a personwho can help you to seeand realize your poten-tial.

We could spendhours talking about theRed Sox pitching staff.Pedro Martinez, DerekLowe, Keith Foulke, TimWakefield, Mike Timlin,Curt Shilling, and Bron-son Arroyo, to name afew. They were the ‘for-tress’ of the Red Soxteam, one cohesive groupwhose diverse arsenal ofskills complemented oneanother. And because ofthat, Coach Francona

was able to match theirstrengths to the needs ofthe team at any giventime.

I reminded the audi-ence of student nurses tokeep that concept of ‘afortress’ in mind whenthey begin to look foremployment. Whereverthey choose to work,they want to see a stronginfrastructure in place tosupport their profession-al practice. They want tosee:

strong leadershipevidence that nursingis valued and under-stoodopportunities for pro-fessional development

evidence that nursinghas a strong voice inclinical decision-mak-ingthe right tools, equip-ment, and resourcesavailable to supportpracticeIt’s a wonderful time

to be a Red Sox fan, andit’s a wonderful time tobe a nurse. As you cansee, in both cases, allmembers of the teammake key contributionsto the success of the or-ganization.

I’d like to thank allMGH employees whohelped make the MaSNAannual conference thegreat success that it was.

Jeanette Ives Ericksoncontinued from previous page

November 18, 2004November 18, 2004Fielding the IssuesFielding the IssuesOn the importance of clinical

narrativesQuestion: What are clini-cal narratives?Jeanette:Clinicial narra-tives are detailed descrip-tions of a patient-caresituation that include theclinician’s thoughts,intentions, and actions.Narratives can be writtenabout:

a situation where anintervention made adifference in a pa-tient’s outcome, eitherdirectly or indirectlyan intervention thatwent unusually wella situation where eventsmay not have gone asplanneda typical or ordinarysituationa situation in whichyou learned somethingthat changed your prac-tice

Question: Why are weshifting from the term,‘exemplar’ to ‘clinicalnarrative?’Jeanette:When PatriciaBenner, RN, publishedher seminal work, FromNovice to Expert, in 1984,she was able to discoverhow knowledge is em-bedded in practice byasking nurses to sharestories of their practice.She called these storiesexemplars. Over time,the term exemplar haschanged to clinical narr-ative because it betterreflects the story-tellingaspect of this writtenaccount of events. It alsotakes the pressure offclinicians who may thinkan exemplar has to beabout a commendable or‘exemplary’ situation.

Question: Why are nar-ratives important?Jeanette:Clinical know-ledge is embedded inpractice. It is developedover time, embodied byclinicians, and evoked inclinical situations. Asclinicians share narra-tives about particularpatient-care situations,their knowledge andpractice become visible.Clinical narratives pro-vide an opportunity toreflect on practice. Withthis reflection comes anopportunity to identifyareas of strength andareas that need furtherdevelopment, enhancingoverall practice.

Question: Narrativespublished in CaringHeadlines seem so dra-matic. Those situations

don’t reflect my practice.What if what I choose towrite about isn’t interest-ing to the reader?Jeanette: Insight intopractice is always inter-esting. Write about whatyou do; your care of pa-tients and families; theknowledge you bring tothe bedside; how youwork with the rest of thehealthcare team to pro-vide the best possiblecare to your patients.Every day clinicians atMGH make a differencein the lives of patientsand families. They allayfears, they help patientsregain mobility and inde-pendence, they teachpatients how to care forthemselves at home. Itmay not sound exciting,but every clinician bringssomething unique andspecial to patient care.Very often, the ordinaryreally is extraordinary.And we all learn from

listening to the stories ofour colleagues.

Question: The narrativesin Caring Headlines areso tight and well-written.I’m afraid my writingwouldn’t measure up.Jeanette:Caring Head-lines is read by MGHemployees, patients, fam-ilies, visitors, members ofthe community, and oth-ers all over the country.Because of this diversereadership, narrativesthat appear in CaringHeadlines are edited forgrammar, content, andstyle to ensure they canbe understood by clini-cians and non-cliniciansalike. While narrativesare first-person accountsof a clinician’s thoughts,intentions, and actions,they are edited to be suit-able for a broad audience.

For more informationon writing clinical narra-tives, contact Mary EllinSmith, RN, at 4-5801.

November 18, 2004November 18, 2004

espiratory CareWeek is an op-

portunity to honorand celebrate the

contributions ofrespiratory care profes-sionals and to take pridein the profession and theindividual accomplish-ments of respiratory ther-apists at MGH and aroundthe world. It’s also anexcellent time to educatethe public, recruit newstaff, and promote goodlung health in the com-munity. Respiratory careprofessionals work toensure the lung health ofall Americans throughadvocacy, public educa-tion, and research.

Respiratory CareWeek always falls in thelast full week of October.In 2003, the Wednesdayof Respiratory CareWeek officially becameknown as Lung HealthDay in an effort to bringlung-health awareness tothe public, to medicalprofessionals, and toconsumers around theworld. This year, Res-piratory Care Week wasobserved from October24–30th. Many hospi-tals, schools, and otherinstitutions held openhouses, sponsored spe-cial activities, performedcommunity events, andacknowledged the year-round efforts of respira-tory therapists.

Although it had beenan annual event locallyand regionally for manyyears, Respiratory CareWeek became an officialnational event in 1982when executives andofficers of the AmericanAssociation for Respira-tory Care (AARC) visit-ed the White House seek-ing an official proclama-tion to recognize Respir-atory Care Week as anational observance.Then-President RonaldReagan granted the re-quest, marking an histo-ric event for the AARC.Today, Respiratory CareWeek is observed in all50 states in the US andbeyond.

The MGH departmentof Respiratory Care cele-

brated Respiratory CareWeek, on October 27thwith display tables in theMain Corridor. Staff,visitors, and patientswere given informationon lung health and res-piratory care and had anopportunity to take a freepulmonary-functionscreening test.

About respiratory careand respiratory thera-pists

Most people take breath-ing for granted. It’s se-cond nature, an involun-tary reflex. Yet millionsof Americans suffer frombreathing problems. Forthem, every breath is amajor accomplishment.These people rely onrespiratory therapists and

the profession of Respir-atory Care to improvetheir breathing and makea significant differencein their lives.

What is respiratory care?Respiratory care is a life-supporting, life-enhanc-ing, healthcare profes-sion practiced underqualified medical direc-tion. It promotes optimalcardiopulmonary func-tion and health, and usesscientific principles toidentify and treat acuteor chronic dysfunctionof the cardiopulmonarysystem.

Who needs respiratorycare?People who have chroniclung problems such asasthma, bronchitis, andemphysema may needrespiratory care. Peoplewho’ve had heart attacks,been involved in acci-dents, or were born pre-maturely may need res-

piratory care. Peoplewith cystic fibrosis, lungcancer, other types ofcancer, or AIDS mayneed the special servicesprovided by respiratorytherapists in order tobreathe easier. People ofall ages need respiratorycare to keep their lungshealthy.

Who are respiratorytherapists?

Respiratory therapistsare important membersof the healthcare team,working in hospitals,skilled nursing facilities,emergency and urgenttransport centers, physi-cian’s offices, specializ-ed care hospitals, homehealth agencies, medicalequipment supply com-panies, and in patients’homes. There are morethan 110,000 respiratorytherapists practicing inthe US.

Most respiratory ther-apists work in hospitalsproviding intensive care,critical care, and perform-ing crucial neonatal pro-cedures. Respiratorytherapists are typicallypart of the life-savingresponse team for patientemergencies. Of the morethan 7,000 hospitals inthis country, approximate-ly 5,700 have Respir-atory Care departments.

Respiratory therapistsare uniquely trained totreat conditions of thecardiopulmonary system.The minimum require-ment to become a respir-atory therapist is an asso-ciate’s degree from an

Respiratory CareRespiratory CareMGH celebrates Respiratory

Care Week—by Ed Burns, RRT, quality improvement coordinator

Respiratory Care Services

R


Respiratory therapist, Neila Altobelli, RRT, offers pulmonary-function screening test to visitor during Respiratory Care Week


accredited respiratorycare program. Manyrespiratory therapistshave a four-year (or high-er) degree from an ac-credited program. Oncethey graduate, respira-tory therapists are requir-ed in many states to earncontinuing educationcredits to meet state li-censure requirements.

Respiratory therapistssit for the RegisteredRespiratory Therapist(RRT) credentialing exam.The National Board forRespiratory Care be-stows RRT credentialson those who successful-ly complete the rigorousexamination.

The professional as-sociation for respiratorytherapists is the Amer-ican Association for Res-piratory Care (AARC).

Respiratory therapistsperform both diagnosticand therapeutic proced-ures, including:Diagnostic

obtaining and analyz-ing sputum and breathspecimenstaking blood speci-mens and analyzingthem to determinelevels of oxygen, car-bon dioxide, and othergasesinterpreting data ob-tained from these spe-cimensmeasuring the capacityof patients’ lungs todetermine if there isimpaired functionperforming stress testsand other studies ofthe cardiopulmonarysystemstudying disruptivesleep-pattern disorders

Therapeuticoperating and main-taining highly sophis-ticated equipment toadminister oxygen orassist with breathingusing mechanical ven-tilation for treatingpatients who can’tbreathe adequately ontheir ownmonitoring and man-aging therapy to helppatients recover lungfunctionadministering medica-tions in aerosol form tohelp alleviate breathingproblems and preventrespiratory infectionsmonitoring equipmentand patient responsesto therapyconducting rehabilita-tion activities such aslow-impact aerobicexercise classes to helppatients who sufferfrom chronic lungproblems

maintaining artificialairways that may be inplace to help patientswho can’t breathe bynormal meansconducting smoking-cessation programs forpatients and others inthe community whowant to kick the tobac-co habit.

At this time of year wehonor and celebrate thecontributions of all MGHrespiratory care profes-sionals. The MGH Res-piratory Care Depart-ment, under the directionof Robert Kacmarek,RRT, is world-renownedin the field of respiratory

Respiratory Care Weekcontinued from previous page

care. Since its inceptionmore than 50 years ago,the department has con-tinually set the standardfor excellence in the pro-fession. The departmentprovides the highest qua-lity care while support-ing and participating inclinical research andeducation. Says Kacmar-ek, “I’m extremely proudof our staff. Their dedi-cation and hard work isevident to me and allother members of thehealthcare team. MGH isfortunate to have suchhighly skilled and edu-cated specialists. Theyare the best.”

Who’s Driving Your Bus?Are you in the fast lane but not enjoying

the ride? This seminar will help you feel morepositive and less stressed by taking charge

of your career and your life. Humorousinsights and practical ideas will inspire you tofind balance in caring for yourself and others.

November 18, 200412:00–1:00pm

Wellman Conference Room

Speaker: Suzanne O’Connor, RN, psychiatric clinical nurse specialist

Sponsored by the Employee AssistanceProgram (726-6976)

Feel free to bring your lunchNursing CEUs available

Holiday Gift-GivingEvent

On December 9, 2004, the Patient CareServices Diversity Steering Committee willonce again sponsor its Holiday Gift-GivingEvent. This is an opportunity to bring some

holiday cheer to families in our HAVENProgram who are truly in need.

For more information or to participate,please e-mail Beverley Cunningham at:

[email protected].

Respiratory therapist, Pamela Brown Early, RRT,staffs educational booth in the Main Corridor

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November 18, 2004November 18, 2004ChaplaincyChaplaincy

Imam Talal EidMuslim chaplain

“It has been a pleasure being amember of this team for more than sevenyears. Though we are of different faithswe work together in harmony. I wish the

troubled world could learn from ourexperience here at MGH.”

Anneca Philippakisinterfaith chaplain

“As MGH chaplains, we have much tooffer. When I walk into a patient’s room,

I bring my Greek Orthodox theologicaltraining, life’s experience, God’s blessings,

and the wisdom and experience of myco-workers and peers at MGH.”

Nancy Rainesinterfaith chaplain

“The MGH Chaplaincy is a very caringand thoughtful group of individuals. I

hope to establish a special ministry forSpanish-speaking patients and families,and I’d like to get involved with research

on the efficacy of prayer and otherspiritual healing modalities.”

Katrina Scottinterfaith chaplain

“I hope the Chaplaincy continuesto offer compassionate care, listening

skills, and the resources needed tobridge the gap between evidence-based

science and the personal experienceof each patient.”

Father Paul OgokeRoman Catholic chaplain

“It’s an honor to be part of this teamproviding spiritual care to our patients,

families, and staff.”

work with patients, families,and staff to help them identifyand draw on their own spiritualstrengths. Chaplains offer sup-port through non-judgmentallistening, sharing, and providingsacraments, scripture, and re-ligious rites, as appropriate.

Spiritual care is provided incollaboration with the multi-disciplinary team. Chaplains areoften called upon to offer spi-ritual care to staff membersdealing with highly emotionalpatient-care situations or per-sonal life events. MGH chap-lains are available to provideemergency and referral-basedspiritual care to patients, fam-ilies, and staff 24 hours a day, 7days a week. Requests for chapl-aincy services frequently comeat times of spiritual distress,when difficult diagnoses aredelivered, when making deci-sions about curative versus pal-liative care, and as part of end-of-life care.

The Chaplaincy providestraining and supervision in spi-ritual caregiving to volunteers,students, clinicians, and staffchaplains. Recently, the Chap-laincy began offering a first-of-

its-kind Spiritual Care Fellow-ship for Health Care Providers.

On October 13, 2004, incelebration of Pastoral CareWeek, MGH chaplains staffedan educational booth in theMain Corridor showcasing avariety of spiritual and religiousinformation. Musical story-tellers and political satirists,Charlie King and Karen Bran-dow, sang a number of hope-inspired songs. On October14th, patients, families, staff,visitors, and volunteers wereinvited to “the Blessing of theHands,” an annual affirmationand show of appreciation forthe many things our hands do toprovide comfort and care.

The MGH Chaplaincy iscurrently undergoing a transi-tion. In late 2003, ReverendMary Martha Thiel steppeddown as director to devote herenergies to pastoral education.Reverend Priscilla Denhamprovided interim leadership forthe Chaplaincy team, and onDecember 13, 2004, ReverendMarcia Marino will assume therole of director for the Chap-laincy. Marino comes to Bostonfrom Milwaukee, Wisconsin,where she was the metro regiondirector of Pastoral Care for theAurora Health Care System.

Welcome, Reverend Marino.

Reverend Marcia Marinonew director of the MGH Chaplaincy

Chaplaincycontinued from front cover

Father Gabriel MichelRoman Catholic priest

“As members of the Chaplaincyteam, I feel like we are instrumentsof faith, healing, and hope for the

community. I look forward to workingwith my colleagues, continuing to

provide pastoral care to our patientsand their families.”


Father Felix OjimbaRoman Catholic chaplain

“I feel privileged to work with this teamof professionals representing the major

religious, racial, and ethnic back-grounds. I’m proud of the way we

embrace every opportunity to serve ourculturally diverse patient population.”

Father Celestino PascualRoman Catholic chaplain

“Being an MGH chaplain is likebeing part of a big healing, human,

fun, supportive, diverse family!We are an integral part of theinter-disciplinary care team.”

Reverend Linda Knightinterfaith chaplain

“Whether I’m visiting patients, dialoguingwith colleagues, or doing administrativework, I always remember that I’m part ofa ‘higher team.’ Then I have to take offmy clogs, realizing the place where I’m

standing is Holy Ground.”

Karen Schmidtoncology chaplain

“We are a diverse group of committedchaplains from various faith traditions

holding different world views, yet we allshare a common goal—to support andcare for one another, our patients, their

families, and the staff of MGH.”

Rabbi Ben LancktonJewish chaplain

“No two days are alike. Every patient’sstory is unique. I’m inspired by my

colleagues whose support I feel everytime I enter a patient’s room. I’m buoyed

by their ability to meet the challengeswe face with both deep emotion

and good humor.”

Reverend Ann Haywoodpediatric chaplain

“As a chaplain, I have opportunitiesto be with people at all points in their

life journey. I’m thankful for the profoundinsight I’ve gained from the people I

serve in ministry. I’m fortunate to havecolleagues whose varied perspectives

enhance my ability to servethe MGH community.”

Mike McElhinnyoncology chaplain

“Being an MGH chaplain is like beingpart of a compassionate fellowship. I

always know that wherever I am,whatever I’m doing, I’m not alone. I lookforward to sharing our interfaith vision

with the whole MGH community.”

Edward ToddBuddhist chaplain

Gina Murrayadministrative coordinator

“It’s an honor and a privilege to workwith this incredibly dedicated staff who

provide pastoral care to patients,families, and staff. In spite of the

intense work we do, we manage tofind time to laugh and have fun.”

Sister Joanne LappetitoRoman Catholic coordinator

“It is so rewarding to be a memberof a team that strives to lighten the

burden and bring spiritual comfort topatients and their families. It’s also a lotof fun to spend time with my colleagues

who enjoy life and are so fullof good humor.”

Suzanne HudsonBuddhist chaplain

“It’s a great privilege to be part of the Chaplaincy team. We feel like we’ve beenwelcomed into a big family where every day we have an opportunity to learnsomething new. We live in an increasingly multi-cultural community. As MGH

chaplains, we’re in a position to help the hospital respond to the needsof an increasingly diverse patient population.”

Staff not pictured are:

Father Alfred DorvilRoman Catholic chaplain

Father Ron GoliniRoman Catholic chaplain

Duane MacLennandepartment secretary

Deacon Daphne Noyesinterfaith chaplain

Father Martin OkwirRoman Catholic priest

Joyce Spatarodepartment secretary


Jennifer Podesky, PTphysical therapist

M


Physical therapist employscreative strategies to ensure best

possible outcomesy name is Jenni-fer Podesky, andI have been a

physical ther-apist for ten years, thepast three at MGH as aninpatient therapist work-ing primarily with pa-tients admitted to theneuroscience units. Afterworking for many yearsat a rehabilitation hos-pital whose patient pop-ulation was largely homo-geneous, the first thing Inoticed about MGH wasthe great diversity amongpatients I was treating.Learning new thingsabout other cultures is anaspect of my job I reallyenjoy. On the other hand,patients who speak littleor no English pose aspecial challenge to thehealthcare team. Imaginehow frightening it mustbe for a person to be thesickest she’s ever been;potentially confused dueto her neurological diag-nosis; and unable to un-derstand what I’m sayingor communicate her needsto me. It’s difficult toobtain information orprovide the patient withmy best efforts whenthere is a language bar-rier. Working with a med-ical interpreter is essen-tial, not only in obtain-ing necessary informa-tion, but in connectingwith patients and fami-lies, establishing trustand rapport.

Never has collabora-tion been so rewardingas it was with Mr. B and

his family. Mr. B is a 38-year-old man who wasadmitted to the Neu-roscience ICU after sus-taining a traumatic braininjury due to an assault.He required an emergentcraniectomy to evacuatean epidural hematoma inthe posterior aspect ofhis brain as well as inter-vention to reduce a facialfracture. In addition tothe posterior hematoma,Mr. B also sustainedcontusions to both fron-tal lobes and focal hem-orrhages within the deep-er structures of his brain.Information in his medi-cal record indicated thatMr. B was from Braziloriginally and had onlybeen in the US for a fewmonths. He spoke noEnglish and was stayingwith family in the Bos-ton area.

Before even meetingMr. B, my review of hismedical record revealedthat he had sustained avery serious brain injury.I knew from the litera-ture that his prognosisfor a full recovery wasguarded given the factthat he had sustainedbilateral frontal lobeinjuries as well as a dif-fuse axonal injury. Giventhe lesion locations andtype of injuries he sus-tained, I was expecting aslower recovery in termsof arousal response andlikely significant impair-ments related to initia-tion and control of move-ment—all essential for

recovering function. Mr.B had demonstrated littlechange on his GlasgowComa Scale score sincebeing admitted, anotherpoor prognostic indicat-or.

Over time, Mr. Brequired a tracheostomyand placement of a gas-trostomy tube to sustainhis ventilation and nutri-tion, and he was exper-iencing frequent seizureactivity and high temp-eratures. I noted that hewas requiring substantialanti-epileptics to controlthe seizure activity andadded this to my list ofpotential factors thatcould impact his arousalresponse.

When I first met Mr.B, he was in the Neuro-science ICU. My initialexamination revealedthat he was in a minimal-ly conscious state. Hewas opening his eyesspontaneously, but withno signs of awareness tohis self or his environ-ment. He demonstratedno spontaneous move-ment of his extremities,however he had reflexivemovement of both armsand legs to noxious sti-muli. His extremitieswere hypotonic, the op-posite of the classic spa-sticity that we think ofwith a stereotypical trau-matic brain-injured pa-tient.

Mr. B had weanedfrom the ventilator quiteeasily and was maintain-

ing good ventilation andgas exchange with sup-plemental oxygen via ahumidified trach mask.Given these findings, myinitial focus of physicaltherapy was to maintainrange of motion in hisarms, legs, and neck, andprotect his joints fromdamage due to a lack ofmuscular support as aresult of decreased mus-cle tone. I collaboratedwith nurses and othercaregivers about posi-tioning options to pre-vent skin breakdown.The location of his pos-terior craniectomy madepositioning his head chal-lenging. I was able toobtain a gel positioningpad from the clinicalnurse specialist to assurepressure was avoided onthe back of his head, andI incorporated cervicalrange of motion into mytreatment. I routinelyassessed Mr. B’s arousalresponse during my phy-sical therapy sessions todetermine any changes.Mr. B’s seizures werebecoming less frequentand over the course ofthe next week, he demon-

strated signs of improvedarousal response. Hewould open his eyesmore frequently and be-gan to vocalize and gri-mace with passive rangeof motion.

Knowing that Mr. Bspoke no English, I re-quested an interpreter bepresent at our next ses-sion. Despite instruc-tions in Portuguese, hecontinued to demonstrateno improvement in hisability to track objectsvisually or respond toauditory information. Iasked the interpreter towrite down phrases like,“Open your eyes,” “Lookat me,” “Move your leg,”in Portuguese so I couldensure I was getting thebest response I couldfrom Mr. B when I re-evaluated his arousalresponse and his abilityto follow commands. Atthe same time, Mr. B’soccupational therapisthad made a list of thesetranslated phrases andposted it over his bed sothe entire team couldcommunicate with him.

Despite improvement

Clinical NarrativeClinical Narrative


in his overall medicalcondition, Mr. B contin-ued to demonstrate veryslow improvement in hislevel of arousal responseand ability to followcommands and attend tovisual stimuli. He wasmedically stable andwould soon be ready fortransfer to a rehabilita-tion facility to continuehis recovery. Given theinjuries he sustained andhis current presentation,I knew Mr. B would havea long road to recovery.Experience told me thatafter an injury like this, itwould take many monthsfor Mr. B to progress to afunctional level where hewould need only oneperson to assist him withbasic needs such as bath-ing and toileting. Hewould most likely re-quire a wheelchair tonavigate out in the com-munity in the long term.Obtaining even thesegoals would require alengthy inpatient rehab-ilitation stay and a long-term commitment fromhis family. Unfortunately,rehabilitation in the Unit-ed States was unlikely.Plans were made to trans-fer Mr. B back to Brazilfor rehabilitation near hishome.

It was at this pointthat I met Mr. B’s family.My first contact withthem was at a meetingwith team members, Mr.B’s brother, sister-in-law,and cousin. The physi-cian reviewed Mr. B’smedical issues to date

and explained the sever-ity of his injury. Thefamily was overwhelmedby this information. Likemany families, their im-pression was that oncehe ‘woke up’ he wouldbe fine. Not only was hisinjury much more severethan they had initiallyunderstood, but giventhis information theywere concerned abouthis transfer back to Bra-zil and the medical carehe would receive there. Iknew I needed to use thismeeting as an opportu-nity to start some much-needed family-education.

I listened and tried todetermine how much thisfamily was ready to hearin regard to Mr. B’s phy-sical therapy program.Based on the questionsthey asked and their emo-tional responses, I knewI needed to keep the in-formation simple andfocused in the present. Iexplained the role ofphysical therapy anddescribed the interven-tions Mr. B was receiv-ing. I asked them to bringin pictures of other fam-ily members and provideinformation in Englishand Portuguese aboutwho they were so wecould incorporate fami-liar people and objectsinto our treatments. Iknew that emotionallysignificant informationstimulated the injuredbrain more effectivelythan words or objectsthat held no meaning. Iexplained this concept tothe family and they wereeager to help in any waythey could.

Mr. B’s sister-in-lawwas the primary spokes-

person for the family. Ischeduled a session whereshe and I could workwith Mr. B together. Thefollowing Monday sheparticipated in our treat-ment session. AlthoughMr. B was still demon-strating poor arousalresponse, he clearly re-sponded to her voice. Ischeduled regular timesfor her to participate intherapy with us. Over thecourse of the next tendays, Mr. B began todemonstrate increasedvisual tracking, initiallyto pictures of his wifeand 13-year-old daugh-ter. He eventually beganto smile and reach for thepictures—the first pur-poseful movement tocommand I had noted. Icontinued my family-education by explaininghow family memberscould help Mr. B’s re-covery when they visitedeach evening. I encour-aged them to tell Mr. B,in Portuguese, where hewas, what day it was, toshare family news, andsupport and comforthim. They learned range-of-motion techniques andways to encourage hisemerging motor recoveryby using some of thetechniques we used dur-ing our treatment ses-sions. Every time wemet, Mr. B’s sister-in-law reported improve-ments. He was beginningto nod ‘yes’ and ‘no’ toquestions, pull the sheetoff, kiss her good-byewhen she left, all signifi-cant improvements forMr. B. I knew he wasresponding to the emo-tional connection he had

with his family, and I’mconvinced that that play-ed a significant role inhis neurological recov-ery.

Mr. B remains in ourcare as discharge plan-ning continues. As in thebeginning, he respondsbest when spoken to inhis primary language.His face brightens, heshows more emotion,and it allows Mr. B toparticipate to the best ofhis ability. His physicaltherapy program contin-ues to evolve as his needschange. I continue tofocus on range of motionand positioning, andnow, managing the in-crease in muscle tone heis developing as his neu-rological recovery pro-gresses. Facilitation ofmovement is best accom-plished by having Mr. Bparticipate in ‘automatic’tasks and incorporatingthose into his daily rou-tine with other caregiv-ers. As his arousal re-sponse and ability tofollow commands haveimproved, the extent ofhis impaired motor func-tion has become evenmore apparent—con-firming the long road hehas ahead to regain evenbasic mobility skills.

My education withthe family is ongoing asis my assessment of theirreadiness to hear newinformation and partici-pate in more hands-onaspects of his care. I seethe fatigue and frustra-tion that so many fami-lies experience whentrying to manage theirown life roles while con-tributing to the patient’srecovery. Throughout his

stay, the entire team hascontinued to support thefamily, helping themnavigate through thischallenging time. And,just like my plan for Mr.B, my family-educationwill continue to evolveand hopefully help bothMr. B and his familymove forward toward thebest possible outcome.

Comments by JeanetteIves Erickson, RN, MS,senior vice presidentfor Patient Care andchief nurse

Jennifer’s narrative is awonderful example ofholistic practice. Jennifersaw the physical, psycho-logical, and emotionalneeds of her patient andattended to all of them.Early on, she involvedMr. B’s family and usedfamiliar objects and pic-tures to engage and en-courage him; she quicklyrealized the positive im-pact this had on Mr. B’sattitude and spirit.

She was well awareof the limitations sug-gested by his prognosisbut never let that com-promise her efforts tohelp him achieve hishighest level of func-tioning. Jennifer soughtassistance from othermembers of the team tohelp maintain his skinintegrity and the func-tional status of his extre-mities. She made use ofour medical interpreters.She was sensitive to theneeds of Mr. B’s familyand their need to be in-volved in his care evenas they came to termswith Mr. B’s condition.

Thank-you, Jennifer.

Exemplarcontinued from page 8


ctober is NationalPhysical TherapyMonth, and it was

a month of profes-sional and commu-

nity-service activities forthe MGH department ofPhysical Therapy. Thisyear’s theme, “Get Fit forLife,” was the focus of aninformation booth in theWhite Corridor on Thurs-day, October 28, 2004.Members of the MGH com-

munity had an opportunityto learn about how to ach-ieve and maintain fitnessand talk about exercise-related issues with MGHphysical therapists.

Two professional pre-sentations highlighted ourcelebration of PT Month.On October 5th, Gail Jen-sen, PT, currently a pro-fessor in the department ofPhysical Therapy at Creigh-ton University in Omaha,

MGH celebrates PhysicalTherapy Month

—by Ann Jampel, PT, clinical education coordinator

Physical TherapyPhysical Therapy

Nebraska, presented a lec-ture entitled, “Theory, Prac-tice and the Developmentof Expertise: Insights intothe MGH Experience.”Jensen discussed the con-tinuum of practice fromnovice to expert and thecritical role of reflection inthis ongoing journey.

The 22nd annual, Mar-jorie K. Ionta Lecture washeld on October 19, 2004,at the MGH Institute of

Health Professions. Cyn-thia Coffin Zadai, DPT,presented, “Disabling ourDiagnostic Dilemma,”which outlined historicaland current-day challengesfaced by the physical ther-apy profession in devel-oping a diagnostic classi-fication system that repre-sents the unique know-ledge and skills of physicaltherapists.

Tapping in to the com-petitive spirit evidenced inlast year’s Spare ChangeChallenge to raise moneyfor the MGH Social Ser-vices discretionary fund,Physical Therapy joined

forces with OccupationalTherapy and launched aninter-departmental, pledge-funded dart tournament.Fourteen teams of thera-pists and one team of PCS‘executive ringers’ paidmoney for the privilege ofthrowing three magneticdarts from a regulationdistance (or, for a higherfee, from a closer distance).When all the darts hadsettled, Garth Savidge, PT,staff physical therapist,was declared the winner,and the Social Servicesdiscretionary fund was$1,400 richer.

O

Gail Jensen, PT, professor at Creighton University, lecturesto packed amphitheater at Physical Therapy Month event



If MGH’s participationin National Physical Ther-apy Month taught us any-thing, it is that education,community service, team-work, and philanthropycan be a whole lot of fun!

For more informationabout Physical Therapyservices at MGH, call AnnJampel at 4-0128.

Clockwise from top left:

Marjorie K. Ionta Lecturer, Cynthia Coffin Zadai,DPT, presents, “Disabling our Diagnostic Dilemma”Denise Montalto, PT, staffs booth in the Main CorridorDirector of Physical Therapy, Michael Sullivan, PT,takes aimSenior physical therapist, Emily Smith, PT, presentsSavidge with first-place prizeZadai with inpatient clinical service coordinator,Nancy Goode, PTStaff physical therapist, Matt Travers, PT, takes a shot

(Some photos provided by Physical Therapy; some photos taken by Paul Batista)


Perhaps you’ve heardabout the NICHE pro-gram coming to MGH.NICHE, Networking toImprove Care for Health-system Elders, is a pro-gram designed to helphospitals enhance thecare they provide to elderpatients and their fami-lies. It involves cultivat-ing a new way of think-ing and caring for thispatient population.

NICHE was develop-ed by the New York Uni-versity Division of Nurs-ing and originally focus-ed on promoting bestnursing practices in car-

ing for the elderly. AtMGH, we’ll be taking abroader, more multi-disciplinary approach tothis effort. NYU providesmany tools to assist or-ganizations in this work.By now, many MGHnurses are familiar withone of those tools, theGeriatric InstitutionalAssessment Profile, orGIAP.

During the first twoweeks of November,nurses caring for patientsin our adult medical-surgical areas were askedto complete a GIAP sur-vey. Results from the

survey will help us as-sess the knowledge, skilllevel, and attitudes ofstaff toward caring forelderly patients. Staffnurses, nurse managers,clinical nurse specialists,nurse practitioners, andpatient care associatesthroughout Patient CareServices were asked toparticipate in the survey.Thank-you to all whotook the time to completethe survey. Your inputwill provide valuableinsight and direction forfuture program planning.

Surveys are now ontheir way to NYU foranalysis. Results shouldbe available in early

2005. In addition to learn-ing more about ourselvesand our practice, we willbe able to compare ourresults to other hospitalsacross the country whohave implemented theNICHE Program. TheNICHE Core Team islooking forward to shar-ing the results of oursurvey with staff.

The next step is toconduct focus groupswith those who didn’thave an opportunity toparticipate in the GIAPsurvey. Since the surveywas designed specific-ally for nurses, we werenot able to use it withother members of themulti-disciplinary team.So the NICHE CoreTeam will conduct focusgroups over the next fewmonths with staff in oth-

er disciplines and de-partments throughoutthe hospital.

All clinicians play avital role in improvingcare for hospitalizedelders. The informationgained from the GIAPsurveys and focus groupswill be critical in priori-tizing and developingeducational programsand systems changesneeded to improve careof the elderly. It is im-portant to be able tomonitor the impact ofquality-improvementefforts as we move for-ward. The GIAP is justthe beginning of whatpromises to be an ex-citing effort to contin-uously look at ways toimprove the care of pa-tients and families atMGH.

Elder CareElder CareNICHE Program moves forward

with GIAP survey and focus groups—by Jan Duffy, RN, staff specialist

The third quarter resultsof the Clean SweepstakesHand Hygiene Contest,sponsored by the STOP(Stop the Transmissionof Pathogens) Task Force,are in. Bigelow 9, Phil-lips 21, Bigelow 10,Ellison 17, Blake 12,White 12, Blake 6, andPhillips 22 are the bigwinners.

Bigelow 9 and Elli-son 17 have won all threecontests in their respec-tive clusters over the pastnine months. Blake 12and White 12 won twoof three contests in theircluster. And Phillips 21,Phillips 22, Blake 6 and

Bigelow 10 are first-timewinners.

Bigelow 9 clinicalnurse specialist, SueGavaghan, RN, says,“Using a hand disinfec-tant has become part ofour culture, part of ourpractice.”

Hazel Audet, RN,attributes their first-timewin on Phillips 21 to“raising consciousnessamong staff around theuse of CalStat before andafter patient contact.”

Pedro Torres, PCA,and hand-hygiene champ-ion on White 12, says,“We know it’s the rightthing to do for our pa-

tients and ourselves.”Brenda Eklund, RN,

champion from Blake12, posted laminatedcards with the ‘STOP-sign’ logo on the doorsoutside patient rooms asa reminder to staff. SaysEklund, “The CleanSweepstakes competitionhas been a great motivat-or for staff.”

Jackie Somerville,RN, co-chair of the taskforce, notes “Hand hy-giene is an importantinitiative for all teammembers at MGH.”

Judy Tarselli, RN,encourages staff to be-come safety advocates.

Hand HygieneHand HygieneAnd the winners are...

—by Rosemary O’Malley, RN, staff specialist

“Remember to use Cal-Stat before and after con-tact with your patientsand remind others to dothe same. Every time wetouch something we canunknowingly pick uppathogens left by others.Fortunately, we can alsostop the spread of thosepathogens by using goodhand hygiene beforeentering the next pa-tient’s room.”

This quarter, inpa-tient units are competingin the 50/70 Club Con-test. Units that achieve acompliance rate of 50%before patient contactand 70% after patientcontact are eligible towin an additional prize.

Remember, the realwinners are our patients.

Infection Control reportsa steady decline in noso-comial MRSA and VRErates over the first threequarters of 2004. Thedecline coincides with theroll-out of the hand hy-giene program and the in-troduction of the CleanSweepstakes RewardsProgram. This is only thebeginning. Ongoing at-tention to good hand-hygiene has a significanteffect on reducing noso-comial infections. Let’ssee if we can push thosenosocomial infectionrates down even further!

For more informationon the Clean SweepstakesHand Hygiene RewardsProgram, contact Rose-mary O’Malley, RN, at6-9663.

November 18, 2004

November 18, 2004

Next Publication Date:December 2, 2004

Published by:Caring Headlines is published twice eachmonth by the department of Patient Care

Services at Massachusetts General Hospital.

PublisherJeanette Ives Erickson RN, MS,

senior vice president for Patient Careand chief nurse

Managing EditorSusan Sabia

Editorial Advisory BoardChaplaincy

Reverend Priscilla Denham

Development & Public Affairs LiaisonVictoria Brady

Editorial SupportMarianne Ditomassi, RN, MSN, MBAMary Ellin Smith, RN, MS

Materials ManagementEdward Raeke

Nutrition & Food ServicesMartha Lynch, MS, RD, CNSD

Office of Patient AdvocacySally Millar, RN, MBA

Orthotics & ProstheticsMark Tlumacki

Patient Care Services, DiversityDeborah Washington, RN, MSN

Physical TherapyOccupational Therapy

Michael G. Sullivan, PT, MBA

Police & SecurityJoe Crowley

Reading Language DisordersCarolyn Horn, MEd

Respiratory CareEd Burns, RRT

Social ServicesEllen Forman, LICSW

Speech-Language PathologyCarmen Vega-Barachowitz, MS, SLP

Volunteer, Medical Interpreter, Ambassadorand LVC Retail Services

Pat Rowell

DistributionPlease contact Ursula Hoehl at 726-9057 for

all issues related to distribution

Submission of ArticlesWritten contributions should be

submitted directly to Susan Sabiaas far in advance as possible.

Caring Headlines cannot guarantee theinclusion of any article.

Articles/ideas should be submittedin writing by fax: 617-726-8594or e-mail: [email protected]

For more information, call: 617-724-1746.

Please recycle

QualityQualityStandardization and forced function

offer big results in the RACU

This section constitutes a new column in Caring Headlines. Because quality and safetyare such a vital focus of our daily work, Caring Headlines will carry a regular column offeringinsight into patient-safety issues, trends, research, and stories in the news. I encourage you toread and share this information with your colleagues, and feel free to suggest ideas for future

topics. For more information about this column, contact Georgia Peirce at 4-9865.

umans are not per-fect. No matter

what level of train-ing or experience,

when humans are involved,the potential for error al-ways exists—even in healthcare. Our focus is on ensur-ing that the probability oferror is as close to zero aspossible, even in the mostchallenging circumstances.

‘Standardization’ and‘forced function’ are twoproven methods of reducingthe potential for error in cer-tain circumstances. Throughstandardization, we increasethe likelihood that individ-uals engaged in particularactivities will easily locatewhat they need when theyneed it. In a car, for example,(no matter what year, makeor model) we know the ac-celerator will be found onthe floor below the steeringwheel to the right. The brakepedal is immediately to itsleft. This standardized place-ment makes finding the brakein an emergency an almostreflexive response.

Forced function intro-duces restriction(s) to a sys-tem that virtually preventspecific types of errors fromoccurring. For example, you

can’t start your car unless it’s inpark.

‘Constrained function’ isanother option. Constrainedfunction doesn’t eliminate thepotential for error, but it limitsthe probability of error. For ex-ample, you can drive a car with-out wearing a seat belt, but analarm sounds until your seat beltis fastened.

Examples of standardizationand forced function can befound throughout MGH. In theRespiratory Acute Care Unit(RACU), staff have made sev-eral relatively simple, but poten-tially life-saving, workplace re-designs to support practice, par-ticularly during respiratory em-ergencies. Working with Bio-medical Engineering, staff de-signed special boxes to hold atracheostomy tube, an ambumask, and a 10cc syringe. Theboxes are hung in the same lo-cation in each patient’s room.While staff can’t predict wherea respiratory emergency mightoccur, they can ensure that theappropriate supplies and equip-ment are immediately availablein a standard location in eachroom. Every staff member knowsexactly where to look for emer-gency supplies.

The RACU team uses forcedfunction to make it virtuallyimpossible, even in the heat of

an emergency, to reach forthe wrong size tracheostomytube. Every patient’s box isstocked with the appropriatesize tracheostomy tube forthe patient in that room.Staff have immediate accessto properly sized equipmentonly. Quality checks areperformed on the contents ofthe box twice a day to ensurecorrect sizing.

While the RACU teamfunctions exceptionally wellduring respiratory emer-gencies, they continue toexplore ways to improvepatient safety. They haveimplemented a number ofsignificant and extensivepatient-safety initiatives thispast year. As you can see bythe above examples, relative-ly simple measures can ren-der big results.

We are all most familiarwith our own environment ofcare. We know where theremay be potential for acci-dents to happen. We need toask ourselves: Where aresafety risks highest? Wherecan we benefit from stand-ardizing, customizing, im-plementing forced or con-strained functions? How canwe make our unit and ourpractice safer for everyone?

H


n September 9,2004, severalmembers of the

Sumner RedstoneBurn Service at

MGH and the ShrinersBurn Institute met withmembers of the newlyformed Boston Firefight-ers Foundation (BFF) todiscuss the creation of anew partnership. Similarpartnerships betweenfirefighters and hospitalsin other states providedan impetus for this meet-ing. A long-standingpartnership between theNew York FirefightersBurns Foundation andNew York Weil CornellMedical Center has spur-red a number of commu-nity-based educationalinitiatives and donationsfor the betterment of theMedical Center’s burnservice each year.

The relationship be-tween MGH and Shrin-ers burn associates andthe Boston FirefightersFoundation began with avisit to a Boston firestation. The visit gavestaff an opportunity toshare an authentic firehouse meal with localfirefighters and live outsome childhood fantasieshaving to do with firetrucks and assorted fireequipment and apparel!

Returning the favor,members of the BostonFire Department wereinvited to visit MGHwhere they enjoyed aluncheon with burn asso-ciates and a guided tour

of the Burn Unit on Big-elow 13. Some of thetopics discussed duringthe visit were the possi-

MGH Burn Service partnerswith Boston firefighters

—by Max Gomez, administrative fellow

Community OutreachCommunity Outreach

O bility of providing edu-cational in-services forfirefighters and firefight-er trainees conducted by

burn associates; con-ducting co-sponsoredcommunity-outreachprograms; and develop-ing relationships amongand between the twogroups to strengthenfuture interactions (es-pecially in the event thata firefighter is injured in

the line of duty). TheBoston Fire Departmentalready enjoys a richhistory of hosting pedi-atric patients from Shrin-ers Hospital for toursand visits at various sta-tion houses in the Bostonarea.

For more informationabout the MGH-Shrinerspartnership with the Bos-ton Firefighters Founda-tion, call MaryLiz Bilo-deau, RN, at 6-8766.

At left: At left: At left: At left: At left: Bigelow 13

nurse manager, Tony

DiGiovine, RN (center), gives

a tour of the Burn Unit to

members of the Boston

Firefighters Foundation

delegation.

Below: Below: Below: Below: Below: Members of the

Boston Firefighters

Foundation present MGH

burn associates with a

commemorative T-shirt.

Educational OfferingsEducational Offerings November 18, 2004November 18, 2004

2004

2004

For detailed information about educational offerings, visit our web calendar at http://pcs.mgh.harvard.edu. To register, call (617)726-3111.For information about Risk Management Foundation programs, check the Internet at http://www.hrm.harvard.edu.

Contact HoursDescriptionWhen/Where

CPR—Age-Specific Mannequin Demonstration of BLS SkillsVBK 401 (No BLS card given)

- - -November 238:00am and 12:00pm (Adult)10:00am and 2:00pm (Pediatric)

Basic Respiratory CareEllison 19 Conference Room (1919)

- - -November 1912:00–3:30pm

Natural Medicines: Helpful or Harmful? Researching theLiterature on Herbs and Dietary SupplementsFounders 626

1.8December 14:00–5:30pm

CPR—American Heart Association BLS Re-CertificationVBK 401

- - -December 27:30–11:00am/12:00–3:30pm

Pre-ACLS CourseO’Keeffe Auditorium $100. (to register e-mail: [email protected])

- - -December 68:00–2:30pm

Chemotherapy Consortium Core ProgramWolff Auditorium, NEMC

TBADecember 78:00am–4:30pm

New Graduate Nurse Development Seminar ITraining Department, Charles River Plaza

6.0(for mentors only)

December 88:00am–2:30pm

OA/PCA/USA Connections“Superior Service Skills.” Bigelow 4 Amphitheater

- - -December 81:30–2:30pm

Intermediate ArrhythmiasHaber Conference Room

3.9December 88:00–11:30am

Pacing: Advanced ConceptsHaber Conference Room

4.5December 812:30–4:30pm

Nursing Grand Rounds“Palliative Sedation.” Sweet Conference Room GRB 432

1.2December 811:00am–12:00pm

Building Relationships in the Diverse Hospital Community:Understanding Our Patients, Ourselves, and Each OtherTraining Department, Charles River Plaza


Coronary SyndromeO’Keeffe Auditorium

TBADecember 108:00am–4:30pm

BLS Certification for Healthcare ProvidersVBK601

- - -December 148:00am–2:00pm

USA Educational SeriesBigelow 4 Amphitheater

- - -December 151:30–2:30pm

CPR—American Heart Association BLS Re-CertificationVBK 401

- - -December 167:30–11:00am/12:00–3:30pm

Psychological Type & Personal Style: Maximizing YourEffectivenessTraining Department, Charles River Plaza


Basic Respiratory CareEllison 19 Conference Room (1919)

- - -December 1712:00–3:30pm

CPR—Age-Specific Mannequin Demonstration of BLS SkillsVBK 401 (No BLS card given)

- - -December 218:00am and 12:00pm (Adult)10:00am and 2:00pm (Pediatric)

New Graduate Nurse Development Seminar IITraining Department, Charles River Plaza

5.4 (for mentors only)December 228:00am–2:30pm


CaringCaringH E A D L I N E S

Send returns only to Bigelow 10Nursing Office, MGH

55 Fruit StreetBoston, MA 02114-2696

First ClassUS Postage PaidPermit #57416

Boston MA

Implementation of

the electronic provider

order entry system

(POE) on the Obstetrics

Unit and in the Newborn

and Special Care

Nurseries (Ellison 13

and Blake 13 and 14)

marks completion of

the roll-out of the POE

system in all inpatient

services.

POE was originally

introduced in the

Medical Services in

1998, Surgical in 2000,

OB/GYN in 2001, and

Pediatrics in 2002.

For more information,

call Michele Cullen

at 6-6874.

POE implementation complete on inpatient unitsOrder EntryOrder Entry

Reviewing the finer points of the electronic order entry system are (l-r): Eun-Ju Kim, applicationsanalyst; Margaret Mary Finley, RN; Margaret (Mimi) Hassett, support staff (seated); Amy Stoney, RN;

and Zakia Chennane El Idrissi, patient care information associate.

caring headlines - november 18, 2004 - chaplaincy ......of her special hobbies, origami, with a...

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