caring october 19, 2006 suponga que lleva largo tiempo haciendo planes para sus vacaciones. eso no...

Inside:

Latino Heritage Month ............ 11111(Véase traducción en

la página 6)

Jeanette Ives Erickson ............ 22222Celebrating our Latino

Community

Fielding the Issues .................. 33333Latino Heritage Month

Interpreter Services ................ 44444

Quality Core Measures for Heart

Failure .................................. 77777

Clinical Narrative .................... 88888Marjorie Voltero, RN

A Physical Therapist’s

Journey ............................ 1010101010

Ernesto Gonzalez Award ..... 1111111111

Clinical Nurse Specialist ...... 1212121212Mary Lavieri, RN

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

Universal Protocol ................ 1616161616

CaringCaringOctober 19, 2006

H E A D L I N E S

Working to

MGH P

O

Guest speaker, Esmeralda SaCarmen Vega-Barachowitz,

La presentadora invitada,(a la derecha) y Ara Rom

y Digna

gether to shape the futureatient Care Services

n September 22, 2006, forthe sixth consecutiveyear, MGH celebrated

Latino Heritage Month.Latino Heritage Month is

celebrated nationwide fromSeptember 15th toOctober 15th.Since 2000,MGH hasrecog-

nized the contributions of ourLatino workforce with a series ofevents. This year the main eventfeatured Puerto Rican author, Es-meralda Santiago, who spoke can-didly about her experiences as a

Latina woman. More than 115people filled O’Keeffe

Auditorium to hearSantiago’s inspira-tional talk. Said BethSchneider, directorof Treadwell Libra-ry, “EsmeraldaSantiago is a forceof nature and adelightful one at

that. She is arole model forall human-

kind.”

Santiago is a renowned writerwhose books include: When I wasPuerto Rican, Almost a Woman,and The Turkish Lover. She camefrom a very poor family in PuertoRico, moving to New York City atage 13, where, through hard workand perseverance she learned Eng-lish, attended the acclaimed HighSchool of Performing Arts, andafter eight years of communitycollege, transferred to, and grad-uated magna cum laude from,Harvard University. Santiagospoke about why she began writ-ing and how important it was forher to share her experiences. “Inthe books I was reading, I never

saw anyone like me,”said Santiago.

continued onpage 5

Latino Heritage MonthMes de la herencia latina

—by Carmen Vega-Barachowitz, CCC-SLP

(Photo by Abram Bekker)

ntiago (center) with (l-r): Ara Romero Perez, Elena Olson, and Digna Gerena. At right is jazz pianist, Leo Blanco.

Esmeralda Santiago, (centro), el pianista Leo Blancoero Pérez, Elena Olson, Carmen Vega-Barachowitz, Gerena (de izquierda a derecha).

October 19, 2006October 19, 2006Jeanette Ives EricksonJeanette Ives Erickson

Jeanette Ives Erickson, RN, MSsenior vice president for Patient Care

magine you’vebeen looking forward to your vaca-

tion for a long time.Finally, after much

planning and anticipa-tion, you escape the harshNew England weatherfor the warmth of PuertoVallarta. By your secondnight, over dinner at alovely little restaurant,you realize you’re actual-ly starting to relax. Andthat’s when it happens.

Your traveling com-panion falls and becomesdisoriented. An ambu-lance arrives and rushesyou to a local emergencyroom. All you care aboutis your loved one andgetting the best possiblecare for him. You want tobe able to tell the medicalteam about his recentheadaches, his slurredspeech, and the medica-tions he’s been taking.You know time is of theessence. But there’s aproblem: you don’t speakSpanish, and these clini-cians don’t speak Eng-lish. You feel desperatelyhelpless and alone.

Virtually every day atMGH, we see patientsfrom various cultures andbackgrounds who turn tous for help at similar,vulnerable times. As aworld-class healthcareorganization, we’re pri-vileged to serve a globalpatient population and anincreasing number ofimmigrants within ourown community. And ourworkforce increasinglyreflects this diversity.

When we talk aboutour Diversity Program,we’re talking about cre-ating a welcoming envi-ronment for all who visitor work at MGH. We’retalking about providingthe best and safest pa-tient-focused care forevery patient and familymember. This meanslooking at our practiceand our environmentthrough the patient’seyes and overcomingany barriers that threatento interfere with thatcare. It means exchang-ing information in thepatient’s language. Itmeans respecting whatwe might consider un-usual customs and be-liefs and incorporatingthose beliefs into ourplan of care.

Respecting diversityis more than a clinicalnicety. As healthcareproviders, it’s an essen-tial part of our practice.Without knowing theperson, we can’t meettheir needs.

As we observe Lati-no Heritage Month, wehave a wonderful oppor-tunity to celebrate thepeople, customs, andcontributions of the vitaland growing Latino com-munity. We have an op-portunity to ask how wecan provide even bettercare and support forpatients, families, andemployees of Latinodecent and all the diversepopulations we’re pri-vileged to serve.

I Suponga que lleva largotiempo haciendo planespara sus vacaciones. Esono es nada difícil imagi-nar. Finalmente, despuésde muchos planes y demucha anticipación ustedy su ser querido se esca-pan del clima aspero deNueva Inglaterra hacia elclima cálido de PuertoVallarta. Agradable idea.Dos noches después desu llegada, mientras ce-nan en un pequeño yencantador restaurante,cae en cuenta de que haempezado a sentirse másrelajada. Pero en eseinstante sucede algo.

Su ser querido se hacaído repentinamente yse ve desorientado. Llegauna ambulancia y loslleva a la sala de emerg-encia del hospital local.Su preocupación es porsu ser querido y por darleal grupo médico toda lainformación que puedaacerca del historial medi-co, los dolores de cabezarecientes, su habla distor-sionada antes de caer alpiso, los medicamentosque está tomando y losmotivos por los que lostoma. Usted sabe la urgen-cia con la que se necesitaesa información. Perohay un problema: Ustedno habla español y elpersonal médico no hablainglés. Ahora se sientedesesperada y totalmenteaislada y sola.

En el MGH, todos losdías atendemos pacientesde varias culturas o heren-cias culturales que acu-den buscando ayuda y

apoyo en momentos devulnerabilidad. Comoentidad de atención mé-dica conocida en todo elmundo, tenemos el privi-legio de atender tanto apacientes internacionalescomo a pacientes que haninmigrado a nuestra com-unidad y cuyo númeroaumenta continuamente.Nuestros empleados tam-bién reflejan esa mismadiversidad de orígenes.

Así que cuando habla-mos de nuestro Programade diversidad, sí habla-mos de crear un ambientede bienvenida para todoslos que visitan o trabajanen el hospital. Pero tam-bién estamos hablandode proveer la mejor aten-ción posible a cada unode nuestros pacientes y asus familias, de un modoseguro y enfocado haciael paciente. O sea, justa-mente el mismo tipo deatención que esperaría-mos recibir si estuviése-mos en su lugar. Estoimplica mirar nuestroentorno y nuestras prác-ticas por los ojos delpaciente y sobreponernosa toda barrera que pudie-ra impedirnos proveer

atención de óptima cali-dad. Esto incluye interca-mbiar información en elidioma del paciente y sufamilia. Esto implicarespetar su cultura y cre-encias e incorporarlas alcuidado y el tratamiento.Y, a veces, significa traerun poco de esa cultura anuestro mundo.

Respetar la diversidades más que una gentileza.Es un elemento esencialde nuestra práctica comoproveedores de cuidadosde salud. Sin conocer bienal paciente, podemos aten-der sólo parte de sus ne-cesidades.

Al celebrar el Mes dela herencia latina en MGH,tenemos una oportunidadmaravillosa de reconocera las personas, costum-bres, contribuciones yrecursos de este segmentovital de la comunidadlatina. También tenemosla oportunidad de pregun-tarnos cómo podemosapoyar y atender aunmejor a los pacientes, susfamilias y empleados deascendencia latina, y alos de las demás culturasque tenemos el privilegiode servir.

Celebrating our Latino communityCelebrando a nuestra comunidad

latina

October 19, 2006October 19, 2006Fielding the IssuesFielding the IssuesLatino Heritage Monthat MGH and across the

countryQuestion: What is the originof Latino Heritage Month?

Jeanette: On September 17,1968, Congress resolved thatthe President was authorizedto issue an annual proclama-tion designating the week ofSeptember 15th and 16thNational Hispanic HeritageWeek. The people of theUnited States, especially theeducational community, arecalled upon to observe theweek with appropriate acti-vities and festivities.

In 1988, the celebrationwas expanded to a monthbeginning on September15th, the anniversary of theindependence of five LatinAmerican countries: CostaRica, El Salvador, Guate-mala, Honduras, and Nicara-gua. Mexico declared itsindependence on September16th and Chile on September18th.

Question: I often hear thewords Hispanic and Latino.Do they mean the samething?

Jeanette: Hispanic refers toindividuals of Spanish orLatin American origin of anyrace who live in the UnitedStates. This includes indivi-duals from Spain, Mexico,Central America, South Am-erica, and the Caribbean(Puerto Rico, the DominicanRepublic, and Cuba). Latinoand Hispanic are frequentlyused interchangeably, but inits purest sense, Latino refersto people of Latin Americandescent, including those notof Spanish origin.

Question: Does the Spanishlanguage differ from countryto country?

Jeanette: The language itself isvirtually the same from oneSpanish-speaking country toanother, and people from dif-ferent countries are able tounderstand each other. How-ever, as is the case with vari-ous English-speaking coun-tries such as the United Statesand Great Britain, there aresome differences. These in-clude intonation, articulationof sounds, differences in vo-cabulary, and sometimes, spe-cific words may need clarifi-cation between the speakers.

Question: Can nurses educat-ed in Central America, SouthAmerica, or the Caribbeanpractice in the United Statesonce they have a work visa?

Jeanette: There is a two-stepprocess for obtaining a nursinglicense in the United States.The process is separate anddistinct from that of obtaininga work visa. The first step is tocontact the Commission onGraduates of Foreign NursingSchools (CGFNS). The CGFNSpre-screens foreign-educatednurses, including a review ofthe nurse’s education, licen-sure in his/her home country,an English-language profi-ciency test, and a ‘predictor’exam that provides an indica-tion of the nurse’s ability topass the US national licensureexam (NCLEX). The nursemust then meet state require-ments and successfully passthe NCLEX as established bythat state’s Board of Nursing.

Pregunta: ¿Qué origen tiene elMes de la Herencia Latina?

Jeanette: El 17 de septiembre de1968, el 90avo congreso de los Es-tado Unidos resolvió que el Presi-dente tenía autoridad para procla-mar que la Semana nacional de laherencia latina se reconoceríaanualmente durante una semanaque incluyera las fechas del 15 y16 de septiembre. Se insta anual-mente al pueblo de los EstadosUnidos, en especial al sector edu-cativo, a llevar a cabo ceremoniasy actos propios para celebrar lasemana.

En 1988 una enmienda a la leyextendió la celebración a un mes apartir de todos los 15 de septiem-bre, aniversario de la indepen-dencia de 5 países latinoamerican-os (Costa Rica, El Salvador, Gua-temala, Honduras y Nicaragua).Además México declaró su inde-pendencia el 16 de septiembre yChile la suya el 18 de septiembre.

Pregunta: A menudo oigo que seusa tanto la palabra hispano comola palabra latino, ¿tienen el mismosignificado?

Jeanette: Aquí en los EstadosUnidos usamos hispano para refe-rirnos a los individuos de origenespañol o hispanoamericano, decualquier raza, que residen en losEstados Unidos. Esto abarca aindividuos de España, de México,de Centro o Sur América y delCaribe (Puerto Rico, RepublicaDominicana y Cuba). Frecuente-mente se intercambia latino conhispano pero mas precisamentelatino abarca a todos los de ascen-dencia latinoamericana, incluyen-do a aquellos que no son de ascen-dencia española.

Pregunta: ¿Varía mucho el idiomaespañol entre país y país?

Jeanette: En general el español escasi idéntico en todos los paíseshispanohablantes y la gente seentiende de un país a otro. Sinembargo, existen diferencias talcomo las hay entre los paísesangloparlantes como los EstadosUnidos y Gran Bretaña. Éstas senotan en la entonación, la pro-nunciación de algunos sonidos yen el vocabulario. Cuando con-versan individuos de distintospaíses a veces tienen que aclararel significado que cada uno le daa ciertas palabras.

Pregunta: En el caso de enfer-meras que culminaron sus estu-dios en países de Centro América,Sur América o del Caribe, ¿pue-den ejercer su profesión en losEstados Unidos apenas obtienensu visa de trabajo?

Jeanette: El proceso de obtener lalicencia para ejercer la enfermeríaen los Estados Unidos tiene dospartes. Este proceso es distinto ycompletamente aparte del procesode obtener visa de trabajo. Elprimer paso es contactar a la Co-misión para enfermeras tituladasen escuelas de enfermería en elextranjero (CGFNS). Esta entidadhace una evaluación preliminarde la formación de las enfermeraseducadas en el extranjero quedesean ejercer en los EstadosUnidos. La evaluación preliminarimplica la revisión de la forma-ción de la enfermera, la licencia ocredencial del país de origen, unexamen de inglés y un examenque predice la capacidad de laenfermera para pasar el examennacional de licenciatura (NCLEX).Luego de pasar el primer paso, laenfermera tiene que cumplir conrequisitos adicionales y pasar elexamen NCLEX, según lo esti-pulado por cada concejo estatalde enfermería.

El Mes de la herencia latina, enel MGH y en todo el país

October 19, 2006October 19, 2006

magine for amoment thatyou’re Deaf and

you grew up in acountry where the

primary language wasSpanish. Imagine thatyou received little or noeducation and your lang-uage skills are extremelylimited. You can’t read;and communication withyour family is based onmade-up gestures andsuperficial lip-reading.At age 35, you and yourfamily move to the Unit-ed States and settle in theBoston area.

In Boston, you spendyour days at home withyour mother until eventu-ally you’re taken to anindependent living centerfor Deaf individuals.There, you meet otherDeaf, but your ability tocommunicate is limitedbecause you don’t knowAmerican Sign Lang-uage. You start on thedifficult journey of devel-oping your communica-tion skills and learningAmerican Sign Lang-uage.

One day, you begin tohave seizures. You’rebrought to MGH. You’reexamined, scanned, prob-ed, and admitted, but noone can communicatewith you. You feel likeyou’re in a vacuum. Butsoon, the ASL interpreteris notified and asked toassist with communica-tion.

This scenario pre-sents unique challengesfor the patient, the care-givers, and me as theASL interpreter. Uponarriving in the patient’sroom, I must do a quickassessment to identifywhat resources are re-quired to achieve the bestpossible communicationbetween the patient andthe providers. For a Deafpatient fluent in ASL,communication wouldhappen through me oranother hearing ASLinterpreter. But in thiscase, the patient is notconversant in ASL. Wehave to add other mem-bers to the team. We bringin a certified Deaf in-terpreter (CDI) to workin tandem with me.

When the providerspeaks, I interpret theconversation into ASLfor the CDI, who in turnuses a combination ofgestures, mime, drawing,and colloquial signs tomodify the language andget the message across tothe patient. When theDeaf patient responds toa question, the CDI inter-prets his response intoASL and the ASL inter-preter repeats it aloud inEnglish. This works wellfor the patient, but itleaves the patient’s mo-ther out, since she speaksonly Spanish.

Initially, the patient’shearing brother para-phrases for the mother,

but this compromises herability to obtain completeinformation and her son’sability to participate fullyin the conversation. Thischallenge is overcome byincluding a Spanish med-ical interpreter on theteam. The Spanish med-ical interpreter’s presencegives the mother fullaccess to exchanges withthe providers and relievesthe patient’s brother ofthe burden of trying tocommunicate with themother as the provider isspeaking. All resourceshave been engaged toachieve the best possiblecommunication. A sce-nario such as this mightwell be one of the fewtimes in this patient’s lifewhere he is empoweredto participate in his owncare.

This patient receivedfull access to communi-cation because the ASLinterpreter was promptlynotified of the patient’sarrival at MGH. Interpre-tation and assistive com-munication services forDeaf and hard-of-hearingindividuals are availableat MGH, and it is everypatient’s right to receivethem. In this scenario,one phone call madegood communicationpossible for all partici-pants—the patient, fam-ily members, and pro-viders. For more infor-mation about MGH In-terpreter Services, call6-6966.

Suponga por un momen-to que es sordo, que na-ció y se crió en un paíshispanohablante. Supon-ga que no asistió muchoa la escuela y que no sabeleer. Sus destrezas decomunicación son míni-mas y se comunica consu familia por señas quehan establecido entreustedes y por lectura delabios muy superficial. Alos 35 años de edad setraslada a los EstadosUnidos para radicarse enBoston con su familia.

En Boston pasa eltiempo con su mamá ensu hogar hasta que even-tualmente se muda a unaresidencia donde viveindependientemente conotros sordos. Allí se en-cuentra limitado por susdestrezas de comuni-cación pues no sabe ellenguaje de señas ameri-cano (ASL). Se inicia enla difícil tarea de apren-der el lenguaje de señasamericano y mejorar su

capacidad para comuni-carse.

Un día le dan convul-siones y lo traen al Mass-achusetts General Hos-pital. En el hospital loexaminan a fondo, lehacen todo tipo de prue-bas y lo hospitalizan;pero nadie puede comu-nicarle lo que sucede y sesiente como en un vacío.Pronto se le avisa a laintérprete para el leng-uaje de señas americano,empleada en el hospital,de su ingreso y se le pideque ayude a facilitar lacomunicación.

Este tipo de situaciónpresenta retos únicospara el paciente, para elpersonal clínico, y paramí, intérprete del leng-uaje de señas americano.Al llegar a la habitacióndel paciente debo rápida-mente determinar quérecursos hacen falta paralograr buena comunica-ción entre el paciente y el

ISusan Muller-Hershon

ASL interpreter

sigue en la página 5

Interpreter ServicesInterpreter Services

Los intérpretes médicossobreponiéndose a

grandes retos

Medical interpretersovercome complex challenges

every day—by Susan Muller-Hershon, ASL interpreter


She knew other Latinosliving in the United Statescould relate to that feel-ing. She talked about thechallenges and joys ofliving (and loving) twocultures. Often witty, herstories resonated with allmembers of the audience.

One attendee askedhow Santiago felt aboutthe way Puerto Ricans

were portrayed in themovie, West Side Story(the fact that Puerto Ri-cans were played by Cau-casians actors). Santiagoshared that, through theyears, she’s learned thatdifferent experiencesaffect people in differentways and it’s importantto respect all views. “Thatmovie is meaningful to a

lot of people, includingLatinos. It has influencedpeople in positive ways,”said Santiago. “For thatreason, I think it was animportant film.”

Following Santiago’spresentation, many audi-ence members stayed tomeet her and expresstheir gratitude to her forbeing such an inspirationto the Latino community.

The celebra-tion continuedwith a reception

Latino Heritage Monthcontinued from front cover

under the Bul-finch tent with

Latin jazz musician, LeoBlanco from Venezuela,who played piano as at-tendees enjoyed cuisinefrom several Latin andCentral American coun-tries, Cuba, Puerto Rico,and Spain. “The food isto die for,” said one em-ployee. More than 800people tasted ropa viejo,paella, chicken empana-das, yuca chips, sweetplantains, guacamole andjicama sauce. But per-haps the most popular

dish was the scrumptiousdessert, pastel de tresleches (three milk cake).

The goal in celebratingLatino Heritage Month isto let employees of Latinoheritage know that thecontributions they bringto MGH and the UnitedStates are recognized andappreciated. This mes-sage, articulated by MGHpresident, Peter Slavin,MD, as he welcomed at-tendees to O’KeeffeAuditorium, resonatedwith Latino and non-Latino employees alike.

Enjoying LatinoHeritage Monthfestivities underthe Bulfinch Tent

(Pho

to b

y Ab

ram

Bek

ker)

personal clínico. Con lospacientes sordos quesaben ASL la comunica-ción se logra a través demí o de otro intérprete deASL oyente. Sin embar-go, en este caso el pa-ciente no sabe conversaren ASL. Hay que integrarmás personal al equipo yse trae a un intérpretesordo certificado (CDI-Certified Deaf Interpret-er) para que trabaje a lapar conmigo.

Cuando el personalclínico habla yo interpre-

to sus palabras a ASL y elintérprete sordo (CDI)las interpreta para el pa-ciente, usando una com-binación de gestos, mi-mos, dibujos, y señascoloquiales, modifi-cando el idioma y trans-mitiendo el mensaje alpaciente. Cuando el pa-ciente sordo responde alas preguntas del perso-nal clínico, el intérpreteCDI interpreta las res-puestas a ASL y yo, laintérprete de ASL, lasrepito en voz alta en in-

glés. Este arreglo solu-ciona la comunicacióndel paciente con el per-sonal clínico pero exclu-ye a la madre del pacien-te pues ella sólo hablaespañol.

Inicialmente un her-mano oyente del paciente,que habla inglés y espa-ñol, va resumiendo laconversación para lamadre. Sin embargo, estole impide a ella participarplenamente en el diálogo.Para sobreponernos aesto integramos un intér-prete médico de españolal equipo. Con este últi-mo intérprete se logra la

plena participación de lamadre y el hermano en eldiálogo con el personalclínico. De este modo seaprovechan todos losrecursos disponibles paralograr la mejor comuni-cación posible. Puedeque esta sea una de laspocas ocasiones en lavida del paciente en lasque se le otorgó el poderde participar de lleno ensu atención médica.

Este paciente se bene-fició de poder comuni-carse plenamente con elpersonal clínico debidoque se le dio avisó opor-tuno al intérprete de ASL

de su ingreso al hospital.En el MGH hay serviciosde interpretación y dedispositivos auxiliares decomunicación y todopaciente sordo o concapacidad de audicióndisminuida tiene derechoa recibirlos. En el casoaquí descrito con sólouna llamada telefónica sele posibilitó la buenacomunicación a todas laspartes –el paciente, sufamilia, y el personalclínico Para más infor-mación acerca de losservicios de interpreta-ción y comunicación enel hospital llame al 617-726-6966.

Los intérpretes médicoscontinuación de la página 4


l 22 de septiem-bre por sexto año

consecutivo secelebró el Mes deherencia latina

en el MGH. Estemes se celebra todos losaños del 15 de septiem-bre al 15 de octubre enlos Estados Unidos. Des-de el año 2000 el MGHha reconocido las contri-buciones de los emplea-dos de ascendencia latinacon varios eventos. Esteaño el evento principalfue la charla de la escri-tora puertorriqueña Es-meralda Santiago, quienhablo abiertamente desus experiencias comomujer latina. Más de 115personas acudieron alauditorio O’Keeffe paraescuchar la inspiradora

charla de Santiago. BethSchneider, directora de labiblioteca Treadwell,comentó “Esmeralda esuna fuerza de la naturale-za y encantadora. Ella esun modelo ejemplar paratoda la humanidad”. San-tiago es una escritoramuy conocida cuyos li-bros incluyen: Cuandoera puertorriqueña, Casiuna mujer, y El amanteturco. Hija de una fami-lia muy pobre de PuertoRico, Esmeralda se tras-lado a la ciudad de Nue-va York con su familia alos 13 anos de edad. Allí,con arduo trabajo y per-severancia, aprendió in-gles y estudió en la escu-ela secundaria de artesescénicas de la ciudad.Luego hizo ocho años de

estudios en varios cen-tros de estudios superi-ores antes de ingresar aHarvard University don-de culminó sus estudiosuniversitarios con recon-ocimiento magna cumlaude. Santiago conversóacerca de cómo se iniciócomo escritora y lo im-portante que fue para ellacompartir sus vivencias.“En los libros que leía,nunca encontraba person-ajes que se parecieran amí”, dijo Santiago. Ellasabía que otros latinos enlos Estados Unidos pod-rían identificarse con esesentimiento. Santiagohabló acerca de los retosy el placer de vivir y am-ar a dos culturas. Losrelatos de Santiago reso-naron mucho con el púb-

lico presente pues ella loscuenta con gracia y hu-mor.

Un concurrente lepreguntó qué siente acer-ca de cómo fueron repre-sentados los puertorrique-ños en la película WestSide Story, teniendo encuenta que el papel de lospersonajes puertorrique-ños se le dio a actores nopuertorriqueños de razablanca. Santiago compar-tió que con el paso de losaños ha aprendido que

cada experie-ncia nos afectaa cada uno deun modo dis-tinto y que esimportanterespetar todoslos puntos devista. “Esapelícula tienegran importan-cia y significa-do para muchos,inclusive paramuchos latinos.Ésta ha tenidoinfluenciaspositivas sobremuchos,” dijoSantiago. “Poreso pienso quees una películaimportante.” Alterminar lapresentación deSantiago, mu-

cho público se quedópara conocerla y agrad-ecerle por ser una inspir-ación a la comunidadlatina.

La celebración siguiócon una recepción en eltoldo Bulfinch dondeLeo Blanco, el músicovenezolano de jazz lati-no, tocó piano mientrasel público disfrutó de lacocina de varios paíseslatino y centroamerica-nos. “La comida está deataque”, comento unempleado. Más de 800personas probaron paella,ropa vieja, empanadas depollo, frituritas de yuca,plátanos fritos maduros,guacamole y salsa jíca-ma. Pero el plato maspopular fue un suculentopostre, el pastel de tresleches.

Nuestro objetivo alcelebrar el Mes de la her-encia latina es dejarlesaber a los empleadoslatinos que sus aportes alMGH y a los EstadosUnidos son reconocidosy apreciados. Este men-saje expresado por elpresidente del MGH,Peter Slavin, MD, aldarle la bienvenida alpúblico en el auditorioO’Keeffe, resonó contodos los empleados,latinos y no-latinos.

Thank-youSpecial thanks to translation

specialist, Karin Hobrecker, fortranslating articles in this issue of

Caring Headlines

AgradecimientoLe agradecemos a Karin Hobrecker

por las traducciones de estaedición de Caring Headlines

Mes de la herencia latina—by Carmen Vega-Barachowitz, CCC-SLP

E

CelebrationsCelebrations

Disfrutando de la fiesta del Mes de laherencia latina en el toldo Bulfinch


ver the past fewyears, the quali-ty of care pro-

vided at MGHhas become signifi-

cantly more visible withthe introduction of a num-ber of national dash-boards. These dashboardsreflect a consensus ofwhat the Joint Commis-sion on Accreditation ofHealthcare Organizations(JCAHO), the Center forMedicare & MedicaidServices (CMS), andother national regulatoryorganizations agree qua-lity core measures shouldbe. Today, MGH qualityscores are available onthe Internet alongside thescores of other hospitals,allowing consumers tosee and compare the qua-lity of care provided atMGH and elsewhere.We’re rightfully proud ofthe care we provide atMGH, but we cannottake it for granted. Ourquality efforts must beconstantly assessed, eval-uated, and improved.

As science and publichealth advance, peopleare living longer andexperiencing more chro-nic disease(s) includingheart failure (HF). Be-cause patients can andshould contribute to theirown care, their under-standing and participa-tion are key. Nurses playa central role in educat-ing patients and familiesand in helping them un-derstand how they can

contribute to their owncare.

The hospital qualitycore measures for HFhighlight patient-teach-ing, which encompassesdischarge instructionincluding all of the fol-lowing:

medicationsdietnext appointmentsigns and symptoms towatch foractivityweight-monitoringWeight-monitoring is

especially important forHF patients, since weight-gain is often the first signof impending decompen-sation. Patients who havesmoked in the last yearshould receive counsel-ing about smoking. Allteaching materials can befound in HF packets avail-

able on all medical andcardiac surgery units.

The first step is iden-tifying patients with HF.Sometimes this is a chal-lenge because patientshave multiple medicalconditions or are beingadmitted electively forprocedures that reflectunderlying chronic HF. Alist of all HF patients ise-mailed daily to nurseleaders and championson all units involved. HFpackets contain bookletsand summary sheets oftopics that should bereviewed with patientsand families. Nurses canstress patient-specificinformation, such as howmuch salt may be in pre-pared foods.

Because publiclyreported scores are basedon chart audits, it’s im-

portant that patient teach-ing be documented inmedical records. A recentsurvey found that somenurses, while providingexcellent patient educa-tion, fail to documentthat patient education inthe medical record. Ifnurses don’t documenttheir teaching, MGHscores don’t reflect theexcellent care we pro-vide. The Interdisciplin-ary Patient/Family Teach-ing Form is the best placeto document teaching,because everyone on theteam can see what’s beentaught.

Units that care for HFpatients employ a num-ber of strategies to ensurepatient education is doc-umented. Best practicesinclude: participation ofresource nurses; keepinga central notebook ofpatient-teaching status;and placing materials inareas commonly used bynurses and in the slots forthe green books near the

Quality core measures for heartfailure: the role of the nurse

—by Diane Carroll, RN, nurse researcher, and Paul Nordberg

O

entrance to the patients’rooms.

MGH has improvedgreatly in our publiclyreported scores, movingfrom 18% compliance atbaseline to about 60% inrecent data (see figure).Other hospitals across thecountry are achievingsimilar improvements.This is good news forpatients.

We need to be vigilantin ensuring that the excel-lent care we provide isaccurately documentedand reflected in publiclyreported scores.

Says Judy Silva, RN,co-chair of the CardiacClinical PerformanceManagement Team, “Heart-failure patients are every-where, not just on cardiacunits. Nurses are in thebest position to educatepatients and families onhow best to care for them-selves at home.”

For more information,contact Diane Carroll,RN, at 4-4934.

QualityQuality

Documentation of instructions for all: (1) medications, (2) diet, (3) next appointment,(4) signs and symptoms to watch for, (5) activity, and (6) weight-monitoring

100

80

60

40

20

Compliance with Heart Failure Teaching

0

% Y

es

Year2002

32%

2003

44%

2004

56%

2005

62%


Marjorie Voltero, RNstaff nurse, Endoscopy Unit

M

continued on next page

Empathy and advocacyguide resource nurse caring

for unsheduled endoscopy patientMarjorie Voltero, is an advanced clinician in the PCS Clinical Recognition Program

Clinical NarrativeClinical Narrative

y name is MarjorieVoltero, and I am astaff nurse on theBlake 4 Endoscopy

Unit. On theEndoscopy Unit, we pro-vide diagnostic and inter-ventional gastrointestinalprocedures to a diversepopulation of inpatientsand outpatients. Many ofthe outpatients we see areotherwise healthy and arehere for preventative,screening colonoscopies.(A procedure where avideo-assisted fiber-opticinstrument is insertedthrough the rectum, thenmaneuvered through thelarge intestine to allowphysicians to visualizeand remove polyps. Somepolyps can become can-cerous and early detec-tion is key to preventingand treating colon can-cer.) Other patients mayhave chronic gastrointes-tinal disorders or cancer,and still others sufferfrom acute symptoms ofgastrointestinal bleeding,biliary, or pancreaticdisease.

A major part of nurs-ing care for endoscopypatients is managinganxiety and pain before,during, and after the pro-cedure. For all patients,this includes pre-proce-dure assessment, pre-procedure teaching, andformulating an individu-alized plan of care. Dur-ing most procedures,intravenous procedural

sedation is used to mini-mize the discomfort ofthe procedure. The com-bination of sedation me-dication, proceduralbreathing techniques, andemotional support provid-ed by the nurse is usuallyvery effective in elimi-nating or controlling thepain and discomfort pa-tients can experience.

Some proceduresdon’t routinely requiresedation. One procedurethat doesn’t generallyinvolve anxiolytics ornarcotic pain control is asigmoidoscopy. Similarto a colonoscopy, thisprocedure can serve as acolon cancer screeningexam, but only examinesthe lower third of thecolon. Because less ofthe colon is examined,and the procedure takesonly about five minutes,there is less need to useprocedural sedation. Mostpatients are able to toler-ate sigmoidoscopies withonly pre-procedure teach-ing and emotional sup-port during the proce-dure.

One afternoon when Iwas working as the re-source nurse, one of ourendoscopists informedme he had a patient, Mr.M, who needed a proce-dure right away. He ask-ed if we’d be able to fithim in for a sigmoidos-copy that afternoon. Asthe resource nurse, it’smy responsibility to keep

the unit running smooth-ly, be aware of availableresources, and allocatethem efficiently to pro-vide optimal patient care.It was a busy day, andour resources were beingfully utilized at the time.Wanting to keep the unitrunning smoothly, butalso wanting to accom-modate Mr. M in a timelyfashion, I reassessed theafternoon schedule. I wasable to create an opportu-nity for Mr. M’s proce-dure within the hour.

I met Mr. M and hisfamily in the main wait-ing room. He seemedfrail and tired; his familywas very supportive andoffered to help in anyway they could. As I ex-plained how to fill outthe assessment form, Inoticed Mr. M was shift-ing his weight in hischair and grimacing. Ithought he might be inpain and asked if he wasuncomfortable. He saidhe was. He’d had rectalbleeding and pain forabout a week, especiallywhen sitting. I told him Ithought he might be morecomfortable lying on astretcher, and he agreed.After obtaining his per-mission, I asked his wifeto help complete the ad-mission paperwork as Ihelped Mr. M get readyfor the exam and get com-fortable on the stretcher.

Mr. M was scheduledfor a routine sigmoid-

oscopy and wasn’t sche-duled to receive sedationduring the exam. GivenMr. M’s current level ofdiscomfort, I thought itmight be better if theprocedure was performedwith sedation. I spoke tothe doctor about my as-sessment and exploredthe possibility of offeringMr. M sedation for hisexam. The doctor waswilling to do the proce-dure with sedation. I madethe necessary changesand went back to whereMr. M was lying com-fortably on the stretcherwith his wife and son byhis side. I spoke with Mr.M and his family aboutthe availability of seda-tion, and Mr. M admittedto being afraid of howmuch it would hurt. Heand his family expressedrelief at being able toreceive pain control forthe procedure. I explain-ed it would require plac-ing an intravenous and hewould need someone tobe responsible for himafter the procedure. Any-one receiving sedationmust have a responsible

escort at the time of dis-charge for safety reasons.I completed Mr. M’s as-sessment, explained theprocedure, and answeredthe questions he and hisfamily had. After I plac-ed the IV, he was ready tohave the procedure.

As I reviewed Mr.M’s assessment form, Inoticed he had prostatecancer and had receivedradiation treatment sixmonths before. I thoughtit might be possible thatMr. M’s bleeding was theresult of damage to hisrectum as a side-effect ofradiation. I’ve cared forpatients with a conditioncalled radiation proctitisbefore, and I knew itcould be controlled bytreating the weakenedblood vessels with a spe-cial type of cauterizationinvolving argon gas. AndI knew it could be doneduring the procedure Mr.M was about to have.This reinforced how im-portant it was for Mr. Mto have sedation duringwhat would now be amore painful and lengthy


Clinical Narrativecontinued from previous page

exam than originallyscheduled. I spoke withthe nurse who would becaring for Mr. M duringthe procedure, explainedall that had transpired,and arranged to have thenecessary equipmentavailable.

Mr. M was able totolerate the procedurewith moderate doses ofsedation, and the bleed-ing was stopped withargon gas coagulation.Because of the type ofmucosal injury he hadsustained, he would needat least one more treat-ment to keep the bleedingcontrolled. The doctorthanked me for my assist-ance in facilitating thesuccessful exam andmade arrangements withhis office to ensure Mr.M’s next sigmoidoscopywas scheduled with se-dation, too.

One of the challengesin a busy, outpatient set-ting can be establishing atherapeutic relationshipwith patients and theirfamilies. Because of thenature of an outpatientpractice, the amount oftime spent with indivi-dual patients may besmall, but every patientpresents with specificneeds to be identified andaddressed. I was able tocommunicate effectivelyand compassionatelywith Mr. M and his fa-mily to identify a needfor effective pain man-agement during his pro-cedure. Using my know-ledge and experience, Iwas able to relay this

assessment and potentialsolutions in a cooperativeand collegial manner toother members of theteam. This helped createan environment condu-cive to providing the bestpossible patient care. Iknow that because of myinterventions, Mr. M andhis family experienced

less anxiety and discom-fort during their stay inthe Endoscopy Unit.

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

The Endoscopy Unit is abusy, fast-paced, predo-minately outpatient prac-tice. As resource nurse,Marjorie had a widerange of responsibilities.She quickly prioritized

The MGH Chaplaincyinvites you to celebrate

Pastoral Care WeekTuesday, October 24, 2006

11:00am–1:00pmMain Corridor

The blessing of the handsThursday, October 26, 2006

6:30–8:00am; 11:30am–1:00pm;3:00–5:00pm

The MGH Chapel

All are welcome to join us in the Chapel forthis special blessing. We offer the blessing ofthe hands as affirmation and appreciation forall the tasks our hands do to provide comfort

and care for one another

If you would like to speak to a chaplain, callthe Chaplaincy at 617-726-2220.

Call forNominations

Norman Knight Preceptor ofDistinction Award

Nominations are now beingaccepted for the Norman Knight Preceptor

of Distinction Award, which recognizesclinical staff nurses who consistently

demonstrate excellence in educating,precepting, mentoring, and coaching

fellow nurses. Nominees are nurses whodemonstrate commitment to the preceptor

role, seek opportunities to enhance their ownknowledge and skills, and work tocreate a responsive and respectful

practice environment

Nurses may nominate nursecolleagues whom they know to be

strong educators, preceptors, mentors,and coaches. Nomination forms will beavailable on all inpatient units, in TheKnight Nursing Center for Clinical &

Professional Development (located onFounders 3 effective October 1st),

or upon request by e-mail

Nominations must be received byNovember 10, 2006

The Norman Knight Preceptor ofDistinction Award ceremony will be heldMarch 8, 2007. Recipient will receive a

certificate and professional-developmentaward in the form of tuition for a nursing

course or a program of study with aclinical nurse specialist

For more information,call Rosalie Tyrrell, RN, at 724-3019

her work and was able tofit Mr. M into the sched-ule without compromis-ing the care of other pa-tients, and ensuring thatMr. M was seen in a time-ly fashion. She advocatedfor Mr. M to receive se-dation to ensure optimalcomfort during his pro-cedure and proactivelyaddressed the issue of hisrectal bleeding. Her quickthinking, knowledge, andability to work effective-

ly with the team led to apositive experience andminimal discomfort forMr. M and his family.

As Marjorie pointedout, every patient pre-sents with a unique setof needs whether it’s aninpatient or outpatientunit. It’s our job to meetthose needs no matterwhat the setting. Mar-jorie did that, and more.

Thank-you, Marjo-rie.

The Employee Assistance Programpresents

Workingand Breastfeeding

by Germaine Lamberge, RN

Presentaion will provide expectantand nursing parents with all the basics ofbreastfeeding, pumping, problem-solving,

and a tour of the MGH Mother’s Corner

ThursdayThursdayThursdayThursdayThursday, November 9, 2006, November 9, 2006, November 9, 2006, November 9, 2006, November 9, 200612:00–1:00pm12:00–1:00pm12:00–1:00pm12:00–1:00pm12:00–1:00pm

VBK 401VBK 401VBK 401VBK 401VBK 401

For more information, please contact theEmployee Assistance Program at 726-6976


am honored tospeak today aboutprofessional devel-

opment and sharemy experiences with

you.When I graduated

from Physical Therapyschool back in 1994,when programs were stilloffering bachelor’s de-grees, my goals werenon-specific and probab-ly similar to those ofmost new PTs: learn andgrow and be the best PT Icould be. As I reflect onthe choices I’ve madeand the direction they’veled me, I realize I haveaccomplished more thanI ever thought possibleby keeping those goals inmind.

My first job was in anacute care hospital whereI rotated between inpa-tient teams every threemonths. The orientationprocess wasn’t very longor involved, there was nostructure in place formentoring or develop-ment, and I found myself‘on my own’ early in mycareer. The majority oflearning that took placewas due to my own ini-tiative, seeking out col-leagues for guidance andconfirmation, attendingcontinuing-educationprograms, reading arti-cles in journals, and ofcourse, learning by trialand error. I rememberwondering when I receiv-ed positive feedback at

my annual reviews howmy supervisors couldaccurately evaluate myperformance as I rarelyinteracted with them orhad and oversight in mypractice.

In less than two years,I recognized the need formore challenge and stim-ulation in my work en-vironment. I accepted aposition in a rural hospi-tal where the director ofPT was a former clinicalinstructor whom I hadadmired. I thought thiswould be a place where Icould branch out intooutpatient and home-health settings as well asacute and sub-acute care.

In this new position, Iwas challenged in manyways and developed myclinical, professional,and leadership skills. ThePT director was activelyinvolved in the AmericanPhysical Therapy Aasso-ciation (APTA) as thechair of our district, andhis commitment to theprofession made a lastingimpression on me. Heencouraged me to getinvolved with the asso-ciation, introduced me toothers from whom I couldlearn, and eventuallysupported me in takingon the position of districtchair. When he returnedto graduate school toearn his master’s degree,he would share what hewas learning, and I wasinspired to do the same.

We would integrate thisnew information into ourpractice. As I expressedinterest, he gave me op-portunities to assist in theleadership and manage-ment of the department.My role grew to includethese new responsibilitiesin addition to patient careand clinical education.

After visiting Bostonand deciding to movehere, my connections inthe APTA led me to MGH.As is typical in the asso-ciation, people were morethan happy to help. Mass-achusetts was consideredan active chapter andmany of the names I wasgiven as resources arepeople I now know inperson. Before I knew it,I had interviewed for andaccepted a position atMGH. (It’s a testament tohow much I wanted thejob that I moved here inDecember and was im-mediately introduced tothe northeast winters.)

The transition to MGHwas more challengingthan I could have imagin-ed. My practice and clin-ical decision-making hadnever been scrutinized tosuch a degree, and I be-came acutely aware ofhow much I didn’t know.I was awed and inspiredby the knowledge andskill around me. I contin-uously researched andintegrated new infor-mation into my practice.Everything was ques-

tioned. Everything re-quired evidence. Every-thing could be improvedupon or done better.

With the generoussupport of the depart-ment, I decided to em-bark on my DPT. It seem-ed a natural extension ofthe work I was doing,another opportunity tolearn and develop, and itwas in line with APTA’svision. Though time-consuming, it was wellworth the effort and notas difficult as I had ima-gined. This was an indi-cation of how far I’dcome during my time atMGH. Somewhere alongthe way, it had becomeeasier—not less chal-lenging—just more na-tural. Questions asked bythe clinical specialist as Ioriented now came tomy own mind as I wentthrough my day. The‘Guide’ language was onthe tip of my tongue, anddocumentation flowedmore efficiently.

Over time, I was in-creasingly able to seehow much I knew, howmuch my practice hadchanged, and how much

more I had to offer mypatients. I don’t remem-ber exactly when I start-ed to consider applyingfor advanced clinicianthrough the Clinical Re-cognition Program. I washesitant that I might beover-estimating my levelof practice, but I broach-ed the subject with myclinical specialist, andshe gave me the supportand encouragement Ineeded to move forward.I can honestly say thatthe process was its ownreward. I strongly en-courage clinicians toengage in the process, asI found it to be an inval-uable and affirming ex-perience. By the time Icompiled my portfolio, Ihad a fully realized ap-preciation of where I wasclinically and all I hadachieved. It gave me theopportunity to reflect onmy career and profes-sional development.

I’ve always been opento new learning experi-ences. If something isscary, intimidating, andexciting all at the sametime, that’s generally a

Physical TherapyPhysical Therapy

Melanie Struzzi, PTstaff physical therapist


One therapist’s journey ofprofessional development

—by Melanie Struzzi, PT, staff physical therapist, speaking on the occasionof National Physical Therapy Month

I

good indication it’s theright path to take. Youdon’t necessarily have toknow your final destina-tion in order to accom-plish a lot along the way.

I’ve surrounded my-self with good people,which is not hard to do inthe PT profession. Bythis I mean people who

see the best in you andpush you to achieve it,who are good role mo-dels and mentors, andwho possess characteris-tics you’d like to developin yourself.

I’ve been activelyinvolved in the APTAand state chapters. Acommunity of peoplecommitted to the profes-

Physical Therapycontinued from previous page

sion and to helping youalong the way is inspir-ing. It’s great for network-ing, developing profes-sional skills, and access-ing resources.

I’ve given back alongthe way. I volunteered ata free-care PT clinic inthis country and at a ruralclinic in Mexico. I gain-ed far more from thatexperience than I gave. Iencourage you to look forways to give back to the

community beyond yourdaily work. We’re fortu-nate to be in a professionthat gives us so much.With the knowledge wehave, we’re in a uniqueposition to contributethrough volunteerism tothe health and wellnessof those who might nototherwise have access.

I’m grateful to be in aprofession where I cancontinue to grow andlearn, where I’m sur-rounded by so many won-

derful people, and whereI have the opportunity totouch so many lives. I’mgrateful to work in anenvironment where qua-lity of care is the toppriority, where profes-sional development isencouraged and valued,and where the commit-ment to both is evident inthe leadership and ac-complishments of thedepartment and the hos-pital.


The Ernesto Gonzalez Awardfor Outstanding Service to the

Latino Community

RecognitionRecognition

n Thursday, October 5, 2006, in the East Garden DiningRoom, Lourdes (Lulu) Sanchez, manager of MedicalInterpreter Services, became the second recipient of The

Ernesto Gonzalez Award for Outstanding Service to theLatino Community.

The award was created and named in 2005 to honor ErnestoGonzalez, MD, for his contributions to Latino patients, families,and communities. It now recognizes MGH employees who contri-bute to Latino-based initiatives within or outside the institution,and whose contributions help buildbridges with the MGH Latino commu-nity beyond their daily duties and re-sponsibilities.

Sanchez was nominated by KatiaCanenguez and Jossety Parada, whowrote in their letter of nomination: “Wewould like to nominate Lulu becauseshe embodies all the criteria for thisaward. Lulu has worked arduously toprovide this hospital with an excellentInterpreters Department. She has raisedthe bar for medical interpreters andhelped her staff gain the respect andrecognition they deserve. She has foundways to establish and maintain positiverelationships with people within andoutside of MGH.

“It is with great enthusiasm that wenominate Lulu for the outstanding jobshe does to ensure Latino patients inour community receive the high-qualitycare they deserve.”

O

(Photo by Michelle Rose)

El jueves 5 de octubre último se otorgó por segunda vez el PremioErnesto González. Este año se premió a Lourdes (Lulu) Sánchez,administradora del Servicio de interpretación médica, en reconocimi-ento de su ejemplar labor sirviendo a la comunidad latina.

El Premio se estableció en el año 2005 y se nombró en honor delDr. Ernesto González, MD, por sus contribuciones al bienestar de lospacientes latinos y sus familias y de la comunidad latina en general. ElPremio se otorga a empleados del MGH que contribuyen a iniciativas

para el bien de los latinos, dentro y fueradel hospital, y cuyas contribuciones fo-mentan la unidad en la comunidad latinadel hospital, yendo más allá de sus deberesy responsabilidades cotidianas.

Katia Canénguez y Jossety Paradapostularon a Sánchez para el Premio. Ellasescribieron en la postulación: “Queremospostular a Lulu pues ella representa todoslos criterios del premio. Lulu ha trabajadoarduamente para darle un excelente De-partamento de intérpretes al hospital. Ellale ha exigido mejor desempeño a los intér-pretes médicos logrando para ellos el re-speto y reconocimiento que merecen. Y hahallado formas de forjar y conservar re-laciones positivas con personas dentro yfuera del MGH”.

“Postulamos a Lulu con gran entusia-smo por motivo de la labor sobresalienteque hace día a día para asegurarse de quelos pacientes latinos reciban la atención dealta calidad que se merecen”.

Con el Premio Ernesto Gonzálezse reconoce una labor

sobresaliente en servicio de lacomunidad latina

This year’s Gonzalez award recipient, Lulu Sanchez,with first recipient, Ernesto Gonzalez, MD.

Lulu Sánchez ganadora del Premio para el 2006,acompañada por el primer galardonado, el Dr.

Ernesto González

October 19, 2006October 19, 2006Clinical Nurse SpecialistsClinical Nurse Specialists

t has been welldemonstrated inthe literaturethat when nurses,

physicians, andother healthcare pro-

fessionals work togetheras a team, patient out-comes are improved. In1992, one research studypredicted a decrease inthe risk of negative out-comes in the MedicalIntensive Care Unit at alarge teaching hospital inNew York. They foundthat when collaborationwas perceived as strongbetween nurses and phy-sicians, the predicted riskof negative outcomesdropped from 16% to5%. A subsequent studyin 2003 found that inten-sive care units with thehighest functioning teamshad statistically lowermorbidity rates.

Over the past fouryears, the culture in theMGH Medical IntensiveCare Unit (MICU) hasmoved toward a morecollaborative model.Medical and nursingleadership have met fre-quently to discuss stra-tegies for increasing col-laboration on the unit.Several retreats wereheld where MICU nursesand attending physiciansdiscussed practice andoutcomes compared toother ICUs; plans for thecoming year, and strate-gies to improve collabor-ation and practice.

The goal was to shiftfrom a ‘medical model,’focusing strictly on med-ical issues presented byphysicians, to a ‘collab-orative model’ wherenurses, physicians, andtherapists present, inter-act, and work together toimprove outcomes. Whendisciplines work collabo-ratively, everyone bene-fits—most importantly—the patient. As an integralpart of the team, nursesand therapists developstronger communicationskills, more autonomy,and an elevated sense ofself-worth.

To create a more col-laborative practice in theMICU, the nurse manag-er, the unit medical direc-tor, and I met frequentlyto discuss medical andnursing practice issueson the unit. Our prioritywas to create a culture inwhich nurses wouldwant to be included inrounds.

Cultural changes usu-ally take time. We talkedwith nurses about parti-cipating in rounds. Weasked questions like:Why is it important forus to be part of rounds?What’s preventing usfrom participating inrounds? We discussedimproved outcomes whennurses and physicianswork collaboratively as ateam.

Every month, thenurse manager, medicaldirector, operations co-ordinator, a staff nurse,and I met with the in-coming medical teams.

We welcomed them tothe unit and talked aboutcollaborative practice.We stressed teamwork,the importance of goodcommunication, and theneed for nurses to bepresent at rounds.

Within the first fewdays of each month, staffwould let me know howthings were working.

We’d discuss issues thatmight arise, such as or-dering scans without thenurse or therapist beinginformed.

Part of my role was tofacilitate nurses’ presenceat rounds. This sometimesmeant talking with indi-vidual nurses or physi-cians to ensure that every-one felt welcome andincluded in the process.When I’d see a teammaking rounds without anurse, I’d go and relievethe nurse at the patient’sbedside so he/she couldjoin rounds.

This past February,the MICU held a nursingretreat where we discuss-ed problem-solving andteam-building strategies.We talked about nursesbeing present at rounds.I brought up the idea ofnurses presenting atrounds. The responsewas overwhelminglypositive. We decided thatnurses would presentovernight events in con-juction with interns, andthey would review flow-heets.

Following the retreat,the nurse manager and Imet with our medicaldirector to discuss the

possibility of nurses pre-senting at rounds. We allagreed it was a good idea.We decided to implementthe change following thenext MICU medicine-nursing retreat in thespring.

We began havingnurses present at roundson one team and contin-ued with the traditionalmethod on the other team.A week later, house staff,nurses, and attendingphysicians met to discussthe impact of the change.Feedback was overwhel-mingly positive, especial-ly from house staff. Someof their comments were:Rounds are faster, moreefficient; interns are ableto learn more at roundswhen they don’t have todo the whole presentationthemselves; it’s nice tohear nurses present firstrather than hear a differ-ent perspective later on.

Nurses also had afavorable response, say-ing, ‘Who better to re-view flowsheets thannurses? After all, we’rethe ones filling themout.’

The decision wasmade to continue with

Evolution of collaborativepractice in the Medical Intensive

Care Unit—by Mary Lavieri, RN, clinical nurse specialist

Mary Lavieri, RNclinical nurse specialist

I


The goal was to shift from a

‘medical model,’ focusing strictly

on medical issues presented by

physicians, to a ‘collaborative

model’ where nurses, physicians,

and therapists present, interact, and

work together to improve outcomes

(Pho

to p

rovi

ded

by s

taff)


Published by:

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

Services at Massachusetts General Hospital.

Publisher

Jeanette Ives Erickson RN, MS,senior vice president for Patient Care

and chief nurse

Managing Editor

Susan Sabia

Editorial Advisory Board

ChaplaincyMichael McElhinny, MDiv

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

Materials ManagementEdward Raeke

Nutrition & Food ServicesMartha Lynch, MS, RD, CNSDSusan Doyle, MS, RD, LDN

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, Security & Outside ServicesJoe Crowley

Public AffairsSuzanne Kim

Reading Language DisordersCarolyn Horn, MEd

Respiratory CareEd Burns, RRT

Social ServicesEllen Forman, LICSW

Speech, Language & Swallowing DisordersCarmen Vega-Barachowitz, MS, SLP

Volunteer, Medical Interpreter, Ambassador

The MGH QuitSmoking Service haschanged its name to:the Tobacco Treatment

ServiceUnder the current standard, all patients

should be asked if they’ve used tobaccoproducts in the past 12 months. If theyhave, the Tobacco Treatment Service

should be notified (6-7443) for a consult

Patients may be more comfortablein the smoke-free environment of the

hospital if they have access to nicotine-replacement products. The TobaccoTreatment Service can help patients

avoid nicotine withdrawal

If patients want to quit smoking,the Tobacco Treatment Service is

available for assistance

Every patient who has smoked in the past12 months should be given a copy of theGuide for Hospital Patients Who Smoke

(Standard Register form #84772). A copyof the guide is placed at every patient’s

bedside when the room is cleaned

Helping patients to quit smoking ispart of the excellent care all clinicians

provide at MGH.

Be sure to document your work andmake your practice visible

For more information, or to request aconsult, call 6-7443

Call for ProposalsThe Yvonne L. Munn, RN,Nursing Research Awards

Staff are invited to submit researchproposals for the annual Yvonne L. Munn,

RN, Nursing Research Awards to bepresented during Nurse Recognition Week,

May 6-12, 2007Proposals are due January 16, 2007Guidelines for developing proposals

are available at:www.mghnursingresearchcommittee.org

under “Funding Sources”For more information, contact

Virginia Capasso, RN,at 617-726-3836, or by e-mail at

[email protected]

Helping childrensuccessfully navigate

the teenage yearsAttention-deficit/hyperactivity

disorder

A one-day conference for parents,educators, and healthcare professionals

Wednesday, November 1, 2006 7:30am–4:45pm

Sheraton Ferncroft, Route 1 Danvers

Registration is required(discount for registering by October 25th)

For more information about rates, topics,and presenters, call 978-354-2660

Next Publication Date:

November 2, 2006

and LVC Retail ServicesPat Rowell

Distribution

Please contact Ursula Hoehl at 726-9057 forquestions related to distribution

Submission of Articles

Written contributions should besubmitted directly to Susan Sabia

as far in advance as possible.Caring Headlines cannot guarantee the

inclusion of any article.

Articles/ideas should be submittedby e-mail: [email protected]

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

Please recycle

nurses presenting at rounds onboth teams. But there were somestumbling blocks. One problemwas communication. As newteams and attending physiciansrotated through the MICU, thenew plan wasn’t consistentlydisseminated to everyone. Andthere was some misunderstand-ing as to whether nurses pre-senting at rounds was mandatory

Collaborative Practice in the MICUcontinued from previous page

or optional. We’re currentlyworking to resolve those issues.

Have we attained our goal ofcreating a more collaborativepractice in the MICU? I believewe have. A few weeks ago, themedical director approached meand asked me to observe theteam rounding. “Look at that,”he said. “Margaret [the nurse] isat the head of the table review-ing the chart. She has house

staff’s undivided attention.They’re talking about the care ofthe patient together.”

Our practice is always evolv-ing. Though we’ve succeeded inimplementing an importantchange on our unit, it’s easy toslip back into old habits. Wemust continue to value changeand look for ways to improveour practice and the care wedeliver. Our experience in theMICU supports the research thatcollaborative practice improvespatient care.


ietetic interns(DIs) are stu-dents workingat MGH to learn

as much as pos-sible about all areas ofdietetic practice. DIswork with clinical regi-stered dietitians (RDs) ininpatient areas learningto assess patient nutritionneeds. Here, they consultand communicate withother healthcare profes-sionals, learning from allmembers of the team.Nurses help DIs under-stand the patients’ condi-tions, whether or notthey‘re eating, and othernutritional needs theymay have. Nurses play a

pivotal part in helpingDIs navigate the patient-care process. With theguidance of an RD pre-ceptor, DIs implementnutrition care plans andcontinually monitor andadjust those plans aspatients’ conditionschange.

In the Main Kitchen,patient food service, andretail areas, DIs learnculinary and managementskills in preparation fordelivering safe, efficientand tasty meals to pa-tients and customers in atimely fashion.

Outpatient registereddietitians teach counsel-ing techniques to DIs so

they can work with cli-ents, special programparticipants, and high-school groups to encour-age good nutrition.

As part of the pro-gram, interns form teamsto create a formal busi-ness plan—develop abusiness venture conceptand translate it into abusinessproposal.Some of thebusinessplans devel-oped by DIshave beenselected forimplementa-tion at MGH.

Upon

completion of the intern-ship, DIs are eligible tosit for the RegisteredDietitian Examination tobecome registered dieti-tians.

The MGH DieteticInternship is the only onein the country accreditedto prepare students topractice in the four areasof: Clinical Nutrition/Medical Nutrition Ther-apy; Community Nutri-tion; Food Service Sys-tems Management; andBusiness Entrepreneur.

TheDieteticintern-ship is a50-week,post-bacca-laureateprogramsponsor-ed by theMGHdepart-

MGH dietetic interns: who arethey and what do they do?

—by Kathleen E. Creedon, RDdirector, Dietetic Internship, and education manager

D

ment of Nutrition &Food Services and ac-credited by the Commis-sion on Accreditation forDietetic Education. Ap-plicants must have com-pleted a specified under-graduate dietetic curric-ulum that includes sci-ences, nutrition, manage-ment, accounting, econo-mics, psychology andother areas of study. It’sa plus if interns have hadexperience in health care,food service, or have hadbusiness or retail experi-ence.

Many graduates ofthe MGH Dietetic In-ternship have gone on tohold positions such aspresident of our profes-sional association, col-lege professors, physi-cians, and managers.Many have continued asMGH staff members andmoved into leadershippositions here.

For more infor-mation about theMGH DieteticInternship, contactKathy Creedon at617-726-2589.

(Photos provided by staff)

Students

participating in

the MGH Dietetic

Internship are

exposed to

a number of

learning

experiences,

nutrition experts,

and clinical

situations

during their

50-week

program at

MGH

Nutrition & FoodNutrition & Food

Educational OfferingsEducational Offerings October 19, 2006October 19, 2006

2006

2006

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.

WhenWhenWhenWhenWhen DescriptionDescriptionDescriptionDescriptionDescription Contact HoursContact HoursContact HoursContact HoursContact HoursBLS Certification–HeartsaverVBK601

- - -October 318:00am–12:00pm

Phase II: Wound Care EducationTraining Department, Charles River Plaza

TBANovember 1 and 88:00am–4:30pm

CPR—American Heart Association BLS Re-CertificationVBK401

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

Oncology Nursing Concepts: Advancing Clinical PracticeYawkey 2210

TBANovember 28:00–4:00pm

Greater Boston ICU Consortium CORE ProgramMount Auburn Hospital

44.8for completing all six days

November 3, 7, 10, 14, 17, 217:30am–4:30pm

- - -Creating a Therapeutic and Healing Environment Part IIO’Keeffe Auditorium

November 38:00am–4:00pm

New Graduate Nurse Development Seminar ITraining Department, Charles River Plaza

6.0(for mentors only)


More than Just a Journal ClubYawkey 2210

1.2November 84:00–5:00pm

Nursing Grand Rounds“Zambia Nursing Project.” Haber Conference Room

1.2November 811:00am–12:00pm

OA/PCA/USA ConnectionsBigelow 4 Amphitheater

- - -November 81:30–2:30pm

- - -Advanced Cardiac Life Support (ACLS)—Provider CourseDay 1: O’Keeffe Auditorium. Day 2: Thier Conference Room

November 10 and 208:00am–5:00pm

TBAThe Essence of Patient EducationThier Conference Room


CPR—American Heart Association BLS Re-CertificationVBK401

- - -November 157:30–11:00am/12:00–3:30pm

Pediatric Advanced Life Support (PALS) Re-Certification ProgramVBK601-607

- - -November 158:00am–12:30pm

Basic Respiratory Nursing CareSweet Conference Room

- - -November 1612:00–4:00pm

Workforce Dynamics: Skills for SuccessTraining Department, Charles River Plaza

TBANovember 168:00am–4:30pm

Nursing Grand Rounds“How to Write a Research Abstract.” O’Keeffe Auditorium

1.2November 161:30–2:30pm

BLS Certification for Healthcare ProvidersVBK601

- - -November 208:00am–2:00pm

A Diabetic OdysseyO’Keeffe Auditorium

TBANovember 208:00am–4:30pm

Chaplaincy Grand Rounds“Parenting at a Challenging Time.” Gray Building, 4th floor

- - -November 1411:00am–12:00pm

CPR—Age-Specific Mannequin Demonstration of BLS SkillsVBK401 (No BLS card given)

- - -November 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)November 228:00am–2:30pm


Send returns only to Bigelow 10Nursing Office, MGH

55 Fruit StreetBoston, MA 02114-2696

First ClassUS Postage Paid

Permit #57416Boston MA

CaringCaringH E A D L I N E S

hen caringfor patients,

what is ityou value

most? Thesafe, quality care youprovide? Your capacityfor empathy? Your abilityto share with patients andfamilies? Is it that feelingthat you’ve accomplishedall you can for your pa-tient?

Some elements ofpractice are so ingrainedin us that we no longerhave to consciously thinkabout every little step.But what about new po-licies and practices? Howdo we integrate new ele-ments of practice into ourdaily routine withoutsacrificing patient safetyand quality of care?

The Universal Proto-col or ‘Time-Out’ policyhas been an integral partof practice in the Oper-ating Rooms since June,2000. Now, in accord-ance with Joint Commis-sion on Accreditation of

Healthcare Organizationsstandards, the UniversalProtocol policy has beenadopted throughout thehospital, including am-bulatory settings. TheUniversal Protocol policyprescribes a processwhereby clinicians take atime-out before perform-ing any invasive proced-ure to verify that the cor-rect patient is having thecorrect procedure on thecorrect side at the correctsite. As part of the pro-cess, a check-list is com-pleted prior to any inva-sive procedure that posesa potential risk to a pa-tient. Invasive proceduresthat require a time-outinclude: chest-tube place-ment, central line place-ment, paracentesis, thora-centesis, lumbar punc-tures, tracheostomy tubechanges, or bronchosc-opies. Time-outs shouldbe observed no matterwhere in the hospitalprocedures are perform-ed.

The Universal Proto-col policy promotes safe,accurate patient care.Checking the patient’sname and medical recordnumber on the identifi-cation band prior to anyprocedure is already partof safe care at MGH. Wedo the same before send-ing a patient to anotherunit or test site. For ex-ample, if we send a pa-tient for a needle-guidedbiopsy, we verify heridentity and medical re-cord number to makesure an order has beenwritten prior to her leav-ing the unit. In manycircumstances we alsoverify that a signed in-formed consent is inplace prior to transport.

We all play a role inensuring that UniversalProtocol becomes in-grained in our practice.Invasive procedures mayonly be performed onyour unit rarely, but weneed to be vigilant inensuring a time-out is

observed every time, nomatter how infrequentlya procedure is performed.All staff should knowwhere time-out check-lists are kept on theirunits and be able to iden-tify Universal Protocolresources throughout thehospital. By taking theseproactive steps, we canintegrate Universal Pro-

tocol into our practice andcontinue to promote excel-lence and safety in patientcare.

For more informationon the Universal Protocol,to read the policy, see thecheck-list, or access aneducational tool, visit theMGH JCAHO website. Ifyou have questions, pleasecall Ruth Bryan at 6-8945.

Universal Protocol: how doesit affect my practice?

—by Ruth J. Bryan, RN, clinical nurse specialist

WCaring means notsharing (the flu!)

In preparation for the 2006-2007 flu season,

Occupational Health Services is offering its

annual flu clinic. All staff, employees, and

volunteers are encouraged to be vaccinated

Clinic dates:October 30–November 3, 2006

7:00am–5:00pmWACC Cafeteria

November 4–November 5, 20067:00am–5:00pmMain Corridor

Please bring your MGH/PHS ID badge

and wear sleeves that roll up easily. For those

unable to attend the clinics, walk-ins are

welcome on Thursdays at Occupational

Health, starting Thursday, November 9th.

For more information, or to schedule an

appointment, call Occupational Health

Services at 617-726-2217

Quality & SafetyQuality & Safety

caring october 19, 2006 suponga que lleva largo tiempo haciendo planes para sus vacaciones. eso no...

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