caring june 14, 2001 - mghpcs.orgspired presentation on the importance of ap-preciating and...

InsideVincent Club Award ................ 1Jeanette Ives Erickson ........... 2

Advancing our strategic plan

Quality ..................................... 3Hazardous materials

Diversity .................................. 5The Hmong culture

A Death of One’s Own ............ 6Durante Awards ...................... 7Pediatric Conference .............. 8Exemplar ..............................10

Ellen Walsh, RN

Clinical Nurse Specialist ..... 11Ginger Capasso, RN

Children’s Health Fair .. 12Family-Centered Care

Awards .......................... 14Reading Disabilities ............16Nursing Grand Rounds ........17

Gender roles in theMuslim culture

Educational Offerings ...........18Materials Management .........20

Linen initiatives

CaringCaringJune 14, 2001

H E A D L I N E S

Working together to shape the futureMGH Patient Care Services

Newell: class ‘act’at this year’s Vincent

Showt was just like a Hollywood premiere! Brightlights, evening gowns, glitterati! As MGH galaevents go, the annual Vincent Club dinner andlive-theater performance is about as gala as it

gets! And this year’s May 5th extravaganza at Boston’sCopley Theater was no exception. Following cocktailsand a sumptuous dinner, the Vincent Club presented a

memorable rendition of the campycomedy, Raise the Roof, a tongue-in-cheek knock-off of the JudyGarland-Mickey Rooneymusicals of the 40s.

And couched in be-tween dinner and the showwas the presentation of the

I

continued on page 4

June 14, 2001June 14, 2001Jeanette Ives EricksonJeanette Ives Erickson

Jeanette Ives Erickson, RN, MSsenior vice president for Patient

Care and chief nurse

Advancing our strategicplan: ensuring our goals are

in line with staff’s needsn February, ourthird Staff Per-ceptions of theProfessional

Practice EnvironmentSurvey was distributedto clinicians throughoutPatient Care Services.Also earlier in the year,the PCS executive man-agement team held tworetreats to review, eval-uate, and update ourstrategic plan. The sur-vey and our strategicplanning retreats areimportant tools in oureffort to ensure that ourorganizational goals arein line with staff’sneeds.

In the coming weeks,I will be meeting withPCS directors, nursemanagers, and cliniciansto share the results ofour work so far. Ourefforts have yielded alarge amount of data,which is currently beinganalyzed and convertedinto a manageable for-mat for presentation. Ilook forward to sharingthis information withyou in open-forum dis-cussions and answeringany questions you mayhave.

After only threeyears of conductingstaff satisfactions sur-veys, already trends are

I starting to emerge thatprovide meaningfulfeedback about our stra-tegic direction. For in-stance, I can tell youthat of the clinicianswho responded to thesurvey this year (31%),80.5% across PatientCare Services indicatedthat they are satisfiedor very satisfied withtheir professional prac-tice environment. Com-pared to 74.1% in 1999,and 78.4% last year,this is a significant dif-ference, and a good bar-ometer of our ability torecognize and respondto issues of importanceto staff.

I will be re-conven-ing the PCS leadershipteam this summer for afollow-up retreat toshowcase best practicesamong and betweendepartments; developstrategies to forge col-laborative relationships;explore avenues forteam-building; and lookat opportunities totranslate successful sys-tems from one depart-ment to another.

Legendary CEO ofGeneral Electric, JackWelsh, says that assoon as you think youhave a best practice. . .you should share it! It’s

the quickest, most ef-fective way to spreadsuccess throughout anorganization. We willput that strategy togood use at our summerretreat!

In the meantime,some of the organiza-tional priorities we’veidentified and the initia-tives we’re undertakingto achieve them, arelisted below. As always,your input and feedbackare encouraged; I hopeyou’ll attend one of thepresentation sessions tohear a complete sum-mary of our survey re-sults and share youropinions. Look fortimes and dates of up-coming presentations infuture issues of CaringHeadlines and in unit-based postings.

Priority: Maximize re-tention and recruitmentstrategies to maintainappropriate patient ac-cess to care and en-hance care delivery

Initiatives (not a com-plete list):

Create mechanisms toshare best practices inrecruitment and reten-tionConduct focus groupswith staff who returnto MGH

Let staff who leaveMGH know that theyare welcome to comebackCreate programs totrack the success ofour retention/recruit-ment efforts

Priority: Adapt practicemodels and supportstructures to facilitatepatient access to careand enhance care deliv-ery


Focus on interdiscip-linary processesDevelop easy accessto patient informationacross practice set-tings and for multiple-admission patientsIdentify strategies toensure that all existingcapacity is utilized tosupport patients,minimize delays, andensure acceptance ofall transfersImplement electronicpatient assessmenttool

Priority: Provide a prac-tice environment thatsupports and promotesthe priority of qualityand safety for patientsand staff


Provide performance-improvement educa-tion using simple,easy-to-understandlanguageCreate central data-base for coordinatingall ongoing perform-ance-improvementinitiativesEnsure staff are ade-quately prepared tosafely care for violentpatientsEngage staff in identi-fying strategies toreduce injury andincrease patient safety

Priority: Set manage-ment performance ob-jectives and provideprofessional develop-ment opportunities toachieve them

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June 14, 2001June 14, 2001QualityQualityEnvironment of Care Survey Question

Function: Hazardous materials management

Question: What are the disposal methods for infectious and non-infec-tious medical waste (please give examples).

Answer(s):Infectious medical waste must be disposed of in a red plastic lined medicalwaste box.Some examples of infectious waste are blood bags and tubing, chest tubedrainage, and IV lines and bags (with blood).Non-infectious waste must be disposed of in a clear-plastic-lined wastereceptacle.

Tips about general safety

1) All staff who handle infectious waste materials should be trained inprocedures for proper handling and disposal.

2) Excessive volumes of infectious waste can result from lack of separationof infectious waste from non-infectious waste.

3) To decrease the volume of waste labeled, “infectious” for disposal,clarification was needed of what is to be considered infectious vs. non-infectious waste.

4) Information for staff was disseminated via poster campaign, volumetracking, and progress reports.

5) Decreases in volume of infectious waste should be reflected in reduceddisposal costs.

100%

80%

60%

40%

20%

% Correct % Partiallycorrect

% Notcorrect

Environment of CareMonthly Staff Survey Results

Number of respondents = 111

85%

14%0%

1%


Cultivate and providecoaches and mentorsfor leadershipCreate formal andinformal opportuni-ties for staff to moveinto leadership posi-tionsEstablish task force todefine key perform-ance metrics

Priority: Implementstrategies that promotestaff diversity and inte-grate the delivery ofculturally competentcare into daily practice


Expand access to di-versity-trends dataCommunicate andpublicize diversityoutcomesContinue diversitytraining for leadershipIdentify and imple-ment technology toassist with interpret-ing/translating

UpdatesI’m pleased to announcethat Angelleen Peters-

Jeanette Ives Ericksoncontinued from previous page

Lewis, RN, assumed therole of nurse manager ofthe Endoscopy Unit onJune 4, 2001. Angelleenreturns to MGH fromHarvard Vanguard Med-ical Associates whereshe had been working asa nurse practitioner.

And Judy Silva, RN,started as nurse man-ager of the Ellison 11Cardiac Access Unit,also on June 4th. Judycomes to us from theBeth Israel Hospital.

Please join me inwelcoming Angelleenand Judy to our nursingleadership team.

I’m also very happyto inform you that SallyMillar, RN, director ofPCS Clinical SupportServices and the OfficePatient Advocacy, hasbeen elected presidentof the MassachusettsOrganization of NurseExecutives (MONE).Her one-year term inoffice begins July 1,2001. Please join me inwishing her success andhappiness in this newrole.

Jobs for Boston YouthFor more than a decade, MGH has provided part-time

employment to bright, motivated young peoplethrough the Jobs for Boston Youth Program.

Program starts July 9th

If you are interested in sponsoring a student(no financial obligation), call 6-8197, or send a brief

description of the job opportunity [email protected]

June 14, 2001June 14, 2001

Vincent Club’s annualAward of Distinctionfor Outstanding Con-tributions in Women’sHealth Care. This year’srecipient, the first wo-man and the first nurseto be recognized by thisprestigious award, wasJudy Newell, RN, MSN,nurse manager, Gyne-cology and GynecologicOncology. Newell joinsthe likes of Gerald Aus-ten, MD, and IsaacSchiff, MD, two dis-tinguished past recipi-ents of the award.

Linda Stikeleather,

Vincent Club Awardcontinued from front cover

president of the VincentClub and member of theVincent Award selectioncommittee, says, “Judy’snomination was sup-ported by everyone.Her years of dedica-tion, her strong lead-ership, her legen-dary warmth andcaring made her theperfect candidate.Coincidentally,Judy spoke at ourwinter seminar thisyear, and it was likethe icing on the cake!It was so obvioushow much her work

means to her and howmuch she impacts thelives of her patients. Weall just think she’s in-credible!”

Senior vice presidentfor Patient Care Ser-vices and chief nurse,Jeanette Ives Erickson,RN, says, “Judy is anarticulate and well re-

spected advocate forpatients and nurses. Shebrings an infectious en-thusiasm and love to herwork. She believes, as Ido, that nurses repre-sent the best essence ofwho we are—humanbeings caring for otherhuman beings. We aretruly privileged to have

Judy as one of our nurs-ing leaders; and all whohave been touched byher warmth and com-passion know that sheis truly deserving ofthis honor.”

Accepting the aw-ard onstage at the Cop-ley Theater, Newellthanked the VincentClub and added, “Inkeeping with thetheme of the evening,I’ll share with you thatI was actually namedafter Judy Garland!And I can honestly tellyou that when you’refortunate enough to dowhat you love everyday, and work withthe wonderful people Iwork with, you trulyare over the rainbow.And that’s where I amright now. . . over therainbow!”

Newell, backstage with IsaacSchiff, moments before

accepting the award.

Enjoying the show and sharing the prideare (l-r): Mrs. and Dr. James Mongan, Jeanette

Ives Erickson, and her husband, Paul.Newell reacts as she looksout and sees all the nurses in theaudience standing to honor her.

Linda Stikeleather looks on.

June 14, 2001June 14, 2001

An inside look at the Hmong culture:a real-world lesson in cultural diversity

n Tuesday,May 29, 2001,in a sessionsponsored

jointly by the PatientCare Services’ Divers-ity Program and TheCenter for Clinical &Professional Develop-ment, Hmong comedian/storyteller/multi-cult-ural consultant, TouGer Xiong, gave an in-spired presentation onthe importance of ap-preciating and celebrat-ing cultural differences.

Dressed in tradi-tional Hmong clothing,in what could be des-cribed as ‘performanceart,’ Xiong recountedstories from his child-hood, coming to Amer-ica from Laos with hisfamily as refugees ofwar.

He characterized theHmong people as war-riors, hunters, soldiers

O

DiversityDiversity

The many faces of Tou Ger Xiong

and farmers; a proudpeople with a heritageof perseverence, ethnicsurvival and storytel-ling. He conjured mem-ories of a simple child-hood, in a pre-industri-alized country, withclose family ties andmany strongly held cul-tural traditions.

In his physicallyanimated, often humor-ous, recollections,Xiong recalled what itwas like coming to Am-erica as a young boy,being the only Asianperson in his class, rote-ly reciting the Pledge ofAllegance, and his shockat realizing that Ameri-cans have “such longnoses!”

He entertained lis-teners as he told of hisglee at seeing snow forthe first time; of usingindoor plumbing (with atoilet instead of a tree!);

of doing laundry. . . in amachine!; and slowlybecoming acclimated toa new culture, a newway of life. Interweav-ing serious thoughtswith comical anecdotes,Xiong clearly made hispoint: appreciate whatyou have. Do not fearwhat is different. Em-brace the stories of allcultures—they holdimportant lessons forall of us. Don’t let fearand ignorance turn tohatred and racism. Letus celebrate our differ-ences as well as thethings we have in com-mon.

Xiong left audiencemembers with thisthought: “Diversity isnot a special event; it isyour life experience. Letit be your experience365 days a year, 7 daysa week, 24 hours aday.”

Xiong, displays hand-embroidered“story cloth,” depicting the

history of his people.

June 14, 2001June 14, 2001

A Death of One’s Own: examiningthe issues around how we choose to die

Facilitators, Michael Wilson, RN, staffnurse, Bigelow 13, and Theresa Cantanno,

RN, staff nurse, Bigelow 14.

On Death and DyingOn Death and Dying

he third in a four-part series co-sponsored by theEthics in Clinical

Practice Committee, thePalliative Care Service,and The Center for Cli-nical & ProfessionalDevelopment, “A Deathof One’s Own,” focusedon issues surroundingend-of-life care in Am-erica and the implica-tions for patients, fami-lies, healthcare institu-tions and communities.

T This educational serieswas inspired by thetelevision special, OnOur Own Terms: Moy-ers on Dying, whichaired recently on PBS.

Moderators, MichaelWilson, RN, staff nurse,Bigelow 13, and Ther-esa Cantanno, RN, staffnurse, Bigelow 14, pro-vided a framework fordiscussion about whatit means to “die well,”what impacts our deci-sions around end-of-life

care, what we fear, andhow we can help initi-ate conversations aboutdeath and dying.

Discussion touchedon an array of topicsincluding religious con-cerns, physician-assist-ed suicide, alternativetherapies and comple-mentary medicine, DNRorders, advance direct-ives and MGH’s newand revised Life-Sus-taining Treatment pol-icies.

Copies of a docu-ment called, Five Wishes,were made available. An‘expanded’ version of ahealthcare proxy, it is aguide to help peoplemake and record theirdecisions about who isauthorized to makehealthcare decisions ontheir behalf and otherchoices around end-of-life care and treatment.

Decisions arounddeath and dying are nev-er easy, straight-for-

ward or predictable,which is why Wilsonand Cantanno encourageclinicians and familymembers to talk aboutend-of-life choicesahead of time, to ensurethat a patient’s wishesare honored.

“A Time to Change,”the final installment inthis series, is scheduledfor Friday, June 22, 2001,in O’Keeffe Auditoriumfrom 8:00–11:00am (and12:00–3:00pm).

June 14, 2001June 14, 2001

The Susan and Arthur Durante Award:a tribute to excellence, a legacy of kindness

RecognitionRecognition

e were all sad-dened thispast year tolearn of the

passing of long-timeMGH patient and friend,Arthur Durante. Hismemory will live on inmany ways, and hap-pily, one of those waysis the Susan and ArthurDurante Award for Ex-emplary Care and Ser-vice with Cancer Pa-tients, which he and hiswife, Susan, establishedin 1999.

W

Susan Durante (center) with award recipients,Marie Elena Gioiella, LICSW (left), and Anne Brogan

Back in March of1999, at the first pre-sentation of the awards,Arthur Durante said,“The MGH CancerCenter is a place with awarm, gentle heart.MGH has always beena place where peoplecome to be treated. . .now it’s a place wherepeople come to be heal-ed. Healing acts, such asa touch or a hug go justas far as any medicine.This award is to recog-nize individuals whoengage in that kind of

healing.” Those wordsand that sentiment arethe legacy of one ofMGH’s most passion-ate ‘teachers.’

When they createdthis award, the Duran-tes stipulated that tworecipients would beselected annually, onefrom a clinical setting,and one from a supportsetting. This year’s de-serving recipients of theDurante Award wereMarie Elena Gioiella,LICSW, clinical socialworker, and Anne Bro-

gan, administrative as-sistant for PediatricRadiation Oncology.Both receive a $1,000cash award to be used

for activities of theirown choosing that theyfeel will enhance theirrelaxation, rejuvenationand respite.

Summer Enrichment ProgramOffered through the Boston Area Health Education

Center, this 7-week, curriculum-based program offers8th- and 9th-grade students internships where they can

learn more about careers in health care.

Interns are on-site Monday throughWednesday afternoons totalling 9 hours per week.

Program starts July 16th

If you are interested in sponsoring a student(no financial obligation), call 6-8197, or send a brief

description of the job opportunity [email protected]

June 14, 2001June 14, 2001ConferencesConferencesHumanizing Healthcare for Children and

Mentoring for Our FutureThe 2nd MGH-sponsored national

pediatric conference at theWestin Hotel in Boston

May 27–30, 2001

Conference organizers, (clockwise from top left):Judy Sacco, Mary Lou Kelleher, and Judy Newell

Mary O’Brien, RN,pediatric trauma

coordinator, presents,“The Forgotten

Victims of Trauma.”

Carleyne Prince, admdirector of the MGH

Partnership, and panelisLove, of the Boston pu

system; Robert Cho, TimConnection program

Solangel Vargas, Timgraduate; and David MMGH Police & Securit

“The Science of Me

Celebration Shop singers, Paul Hill (left) and Jim Newton,entertain conference attendees, young and old!

Celebration Shop singers, Paul Hill (left) and Jim Newton,entertain conference attendees, young and old!

June 14, 2001June 14, 2001

Families:

Pedi the Bear (second from right!)entertains out-of-town conference guests

Pedi the Bear (second from right!)entertains out-of-town conference guests

Representing children and families,Britney Lingley shares her

experiences being cared for as apatient of MassGeneral

Hospital for Children

Rosalie Tyrrell, RN,clinical educator,

presents, “Balancingthe Costs of Caring

(This isn’t aboutFinance!”

ministrativeH-Timiltysts (l-r): Keithublic schoolmilty Sciencemanager;ilty School

Marquez, ofty, present,

entoring.”

Sharing her experiences as a parent and a healthcareprofessional, director of MGH Speech-LanguagePathology, Carmen Vega-Barachowitz, CCC-SLP,

presents, “Families and Professionals as Partners: aPrivilege and Solemn Commitment.”

Jointly sponsored by the MassGeneralHospital for Children and The Center

for Clinical & ProfessionalDevelopment, this national conference

for pediatric caregivers combinedlectures, presentations, panel discussions,

entertainment and fun to emphasize theimportance of preserving the human spirit in

the delivery of health care today. It was anopportunity for families and healthcare

professionals to communicate outside of thehospital setting and share ideas on

issues related to the careof children.

June 14, 2001June 14, 2001

Ellen Walsh, RN, BSNstaff nurse, Same Day Surgical Unit

(formerly, the Emergency Department)

From urgent care topalliative care, ED nurse is

a comforting presence

ExemplarExemplar

continued on page 15

t was a typicalmorning in theEmergency De-partment, when

we received notificationof a patient en route byambulance. Mr. K, a 73-year-old male, arrived insevere respiratory dis-tress with labored breath-ing, unable to clear hisown secretions. He hada complicated medicalhistory which includedcoronary artery diseaseand a recent diagnosisof recurrent lung cancer.We were also made awareof prior admissionswith similar symptomsalmost requiring intuba-tion but he had improv-ed quickly with admini-stration of diuretics.

Shortly after Mr.K’s arrival, his condi-tion deteriorated rapid-ly. He became hypoten-sive and tachycardiacassociated with profusediaphoresis and it be-came more difficult forhim to breathe. Althoughhe had difficulty speak-ing, he was able to ex-press his wish not to beplaced on a respirator.Being aware of his re-quest not to be intubat-ed, and feeling confidentthat his clinical situa-tion could be reversed, Iworked with other mem-

bers of the health careteam and quickly ob-tained intravenous ac-cess, gave meds to re-store his blood pressureand provided appropri-ate treatment to im-prove his breathing stat-us.

Thinking his condi-tion was caused by anew pneumonia seen onx-rays, it was felt wecould bring him throughthis crisis. It was diffi-cult for me to care forMr. K as he struggled tobreathe and becamemore and more tired.Although he couldn’texpress himself verbal-ly, there was no doubthe was aware of whatwas transpiring.

By now Mr. K’sfamily had arrived andwas very anxious to seehim. Mr. K’s primarycare physician andpsychiatric clinicalnurse specialist, whoknew the family fromprior emergency admis-sions, spoke with Mr.K’s family and apprisedthem of his critical con-dition.

Despite our efforts,there was minimal im-provement in his con-dition. His blood pres-sure remained low withan elevated heart rate.

He continued to havesevere breathing prob-lems. It became appar-ent that he would notpull through if we didnot intervene more ag-gressively.

The clinical nursespecialist returned fromthe waiting area, whereshe had spoken withimmediate family mem-bers and shared infor-mation about the familywith me. She told meMr. K had a son andtwo daughters, one whowas pregnant with Mr.K’s first grandchild.Also present was hiswife of many yearsfrom whom he was re-cently separated. Theywere all emotionallystressed and in need ofcomforting. Surroundedby numerous tubes,breathing masks, multi-ple IVs with medica-tions infusing, Mr. Kwas allowed to visitwith family members.

It was evident to methat his relatives wereupset at seeing him inthis environment. Theywere only allowed tostay a few moments.While I was still pre-sent in the room withMr. K, his primary carephysician returned todiscuss Mr. K’s options.

The doctor left to re-view Mr. K’s wisheswith the family. It wasdecided that Mr. Kwould not proceed withaggressive treatment;comfort measures onlywere to be provided.Even though I had beenintensely providing careto Mr. K for severalhours now, I knew themost difficult periodwas still ahead.

As I was discontinu-ing medications andother treatments, it wasapparent to me that Iwould now have toswitch gears. Being ac-customed to workingrapidly in an acute-caresituation taking all mea-sures possible to save alife, I now had to moveinto the less familiararea of helping a patientand his family copewith death and dying.

Mr. K’s family re-turned to the room andI explained to them whatI was doing to keep Mr.K comfortable. A mor-

phine drip was neces-sary, since he was rest-less and still having alot of difficulty breath-ing with increased con-gestion despite frequentsuctioning. I tried toprovide privacy and aquiet environment,which is not an easytask in a busy emergen-cy department. I askedif they had any ques-tions, and then I leftthem to be alone withtheir loved one. Period-ically I returned to theroom. I saw how un-comfortable they seem-ed to be, standingaround not able to talkto Mr. K. In hopes ofencouraging conversa-tion, I began askingquestions about theirfamily—things likewhere they lived andwhat their father did fora living before he be-came ill. I made a con-scious effort to includeMr. K in the dialogue. Ifelt it was important for

I

June 14, 2001June 14, 2001

hospital stays andavoidable readmissionsin high-frequency pa-tient populations. Thecenterpiece of the pro-gram was the creation ofjoint acute-care/home-care roles for staffnurses. This joint rolepermitted a decrease inthe RN percentage ofthe staffing mix on in-patient units. Benefitsof the model includedhigher retention of nursesand added revenue forthe hospital.

At a time when MGHand our service wereinvestigating all oppor-tunities to reduce costswhile maintaining thequality of care, the jointacute-care/home-caremodel of nursing prac-tice seemed to offer aviable approach to thesafe and early dischargeof certain vascular-sur-gical patients, especial-ly patients undergoinglower extremity by-pass surgery. Physicianand nursing leaders atMGH and the MGHSpaulding Home HealthAgency were immedi-ately receptive to theidea of creating a spec-ialty partnership pro-gram. (Preliminary neg-otiations had alreadyoccurred in preparation

for the home visitationprogram for the thennew Obstetric Service.)

Within a year, thespecialty staff nurses,the home visitation co-ordinator, and I werecross-trained for homecare, and in April, 1996,the MGH VascularHome Care Programwas launched. Fiveyears later, it continuesto operate. Approxi-mately 250 home visitsare made each month topatients who live in theGreater Boston area.

The unit-based tran-sitional home care pro-gram has been a catalystfor many practicechanges and several newprograms. For example,within three months ofinitiating the program, itwas clear that about80% of our home visitswere for wound manage-ment. For many pa-tients with arterial dis-ease and diabetes,wound healing was slowand expensive due tothe multiple home visitsthat had to be madeeach day. Staff nurse,Kathy Hurley, RN, in-quired as to whetherthere was any approachother than normal salinewet-to-dry dressingsthat would hasten the

healing of a patient’sstump wound. We con-sulted our enterostomaltherapy nurse, CarolynTamer, RN, for recom-mendations about alter-native wound care strat-egies. She introduced usto the world of hydro-gel and occlusive dress-ings.

Our introduction tohydrogel opened a win-dow on the $7 billionwound care industry.We learned about mois-ture-donating dressings,absorbent dressings,antibacterial prepara-tions, and topical growthfactors. During the firstyear of operation, wesaw at least a 50% re-duction in the numberof home visits per epi-sode of care for patientswho had undergone low-er extremity by-passgraft. In large part, thiswas due to a change tomoist wound healingstrategies.

As a result of ourprogress in wound man-

agement in the MGHVascular Home CareProgram, my role expan-ded to include woundcare consultant for pa-tients of the GreaterBoston Branch of Par-tners Home Care. As aconsultant, I generallyfollow a panel of 8 to15 home care patients,making 8 to 11 homevisits per week.

Our successful ap-proach to wound care inthe home trickled backinto the acute care set-ting—a ‘diffusion ofinnovation’ effect ofnurses practicing injoint acute-care/home-care roles. Similar diffu-sion has occurredthroughout the hospitalas a result of multiplefactors, including rota-tion of surgical resi-dents to other servicesand patient consultationon other units at nurses’and physicians’ requests.A collaborative effortamong CNSs and Ma-

The CNS role: a tapestryof change

—by Virginia Capasso, RN, NP, PhDclinical nurse specialist

Virginia Capasso, RN, NP, PhDclinical nurse specialist for Vascular Nursing and

the Vascular Home Care Program; andco-director of the MGH Wound Care Center

Clinical Nurse SpecialistsClinical Nurse Specialists

continued on page 15

hange is like agreat and mightyriver. It propelsforward, fueled

by other sources, fuel-ing new branches, andultimately, contributingto a new reality.

During my 15-yeartenure as a clinical nursespecialist, numerousfactors have fueled therestructuring of healthcare, including increasing-ly restrictive reimburse-ment parameters, theaging of the population,and technological ad-vancements. MGH hasresponded with broadinitiatives, such as oper-ations improvement andutilization management,to remain competitivein the changing market-place. The impact ofsuch a dynamic health-care environment on mepersonally has been tore-energize and reinventmy role approximatelyevery two years.

In 1995, as membersof the Case Manage-ment Planning Commit-tee, my colleague, Jo-anne Empoliti, and Iattended a case manage-ment conference in Phil-adelphia. We heard anurse administrator de-scribe a hospital-basedhome care program. Theprogram was designedto reduce lengths of

C

June 14, 2001June 14, 2001

MassGeneral Hospitalfor Children:

ThChildren’s H

200

June 14, 2001June 14, 2001

heHealth Fair01

Children and grown-ups playand learn about health and wellnessat the more than 50 educational boothsset up by nurses, therapists, chaplains,Police & Security, pet therapy specialists,and many other healthcare-relatedprofessionals at this year’s Children’sHealth Fair, April 26, 2001, on theBulfinch lawn and terrace.

June 14, 2001June 14, 2001

Family-Centered Care Awards celebratethe best in pediatric care

RecognitionRecognition

(L-r): Nursing assistant, Ed Wright; Dawn Moore, RN; Kim Mello, RN; Judy Deranian, RN (kneeling); Judy Newell, RN;Kim Waugh, RN; Dr. Alan Ezekowitz; Immacula (Kiki) Benjamin, RN; volunteer, Jack DiBona; child life specialist,

Marilyn Gifford; and Dr. Ronald Kleinman

nce again,staff gatheredin the Ellison18 visitor’s

lounge on the last dayof Children and Health-care Week, April 27,2001, for the presenta-tion of the Family-Cen-tered Care Awards,which honor caregiversof the MassGeneralHospital for Childrenwho exemplify our mis-sion and high standardsaround the care of child-ren and their families. Itis testament to the grow-ing scope and supportof these awards that thelounge can no longer

O accommodate all of thepresenters, recipients,and spectators presentfor the ceremony!

Nurse manager, JudyNewell, RN, introducedeach recipient and readbrief excerpts from theirnomination letters. Therecipients of this year’sFamily-Centered CareAwards were:

Deborah Bobola, RN,(NICU)Immacula “Kiki”Benjamin, RN,(Ellison 18)Dr. Robert Wharton,pediatricianKim Waugh, RN,(Ellison 17)

The entire staff of theBigelow 13 Burn Unit

As always, the namesof all who were nomi-nated were announcedand acknowledged.They included:

Janice Maenpaa, pa-tient care associate(Ellison 17)Kathie Pazola, RN,(Ellison 18)Karen DaRocha, RN,(Ellison 18)Lisa Donelan, RN,(Ellison 18)Cabrina Anderson,RN, (EmergencyDepartment)

Brenda Simpson,practice manager,(WACC 7)Jack DiBona, volun-teer (Ellison 17)Robin Fisher, LICSW,social workerDr. Julie Ingelfinger,pediatricianThe entire team ofMain OR nursingassistants

As these lists ofnominees and recipientsillustrate, and as Newellreminded attendeesmany times: our care ofchildren is not limitedto the pediatric units—we care for childreneverywhere!

As she read the let-ters, it became clearwhy these clinicians,employees and volun-teers were nominated.

About Kim Waugh,it was written:

Kim always advocatesfor our son. If she seesa potential problem, sheaddresses it with thedoctors right away andmakes sure somethingis done. Often, when wehave a concern, we ar-rive at the hospital onlyto find that Kim hasalready addressed theconcern with doctors—she’s one step ahead of

continued on next page

June 14, 2001June 14, 2001

terials Management hasfacilitated the availa-bility of new wound-care products in ourhospital inventory.

Recently, two moreopportunities have em-erged to effect change inpatient treatment andcare delivery. They areour weekly “WalkingWound Care Rounds”

and the pilot of a newMGH Wound CareCenter.

In February, 2001,our weekly “WalkingWound Care Rounds”were initiated as a pilotproject. The programwas designed to provideeducation and consulta-tion to staff nurses, ad-vanced practice nurses,

Clinical nurse specialistcontinued from page 11

them to use this oppor-tunity to express theirthoughts to him at thistime, as I knew hewould die shortly.

I left the room andreturned later to over-hear his daughter, whowas now alone in theroom, telling her fatherhow she would tell herchild about him. An-other time I heard theson tell his father thathe loved him.

As a nurse workingin the Emergency De-partment, it is oftendifficult to care for adying patient and hisfamily while simultan-eously taking care ofother emergent patients.Reflecting back on thisparticular case, I feel Isuccessfully broughttogether the knowledgeand skills I have acquir-ed during my profes-

sional nursing career. Iwas able to manage thecare of a critically illpatient, provide crisisintervention to an emo-tionally distraught fam-ily and ultimately pro-vide palliative and com-fort care to a dying man.

Comments byJeanette IvesErickson, RN, MS,senior vice presidentfor Patient Care andchief nurse

This is a wonderful ex-ample of a nurse pro-viding care in a rapidlychanging situation. Mr.K’s needs shifted fromlife-saving measures tocomfort care in a veryshort time and Ellen hadto quickly switch gearsto continue to meet theneeds of Mr. K and hisfamily. Ellen workedclosely with membersof the team to providefor Mr. K’s physicaland clinical needs, but itwas Ellen’s human in-

tervention that allowedthis family to gentlybegin the grieving pro-cess.

No matter howprepared a family is,the death of a lovedone is always shock-ing. Ellen realized thatthis family neededhelp. She asked ques-tions about Mr. K andhis life before illness.She included him in theconversation, role-modeling for the fam-ily, letting them knowit was okay to sharetheir feelings eventhough Mr. K mightnot be able to respond.

What a wonderfulmemory for this fam-ily to have participat-ed in the loving, com-forting death of Mr. K.He left the world know-ing that he would liveon in the hearts andmemories of his child-ren and grandchildren.

Thank-you, Ellen.

Exemplarcontinued from page 10

and other members ofthe team who care forpatients with challen-ging wounds.

In March, 2001, Ihad the opportunity topresent, “Wound Man-agement in a Prospec-tive Payment System” atSurgical Grand Rounds.At the completion ofrounds, Dr. AndrewWarshaw, chief of sur-gery, announced thatthe department of Sur-gery was going to sup-

port a pilot programfor an MGH WoundCare Center. The pilotbegan on Tuesday, May29, 2001. Dr. WilliamAbbott and I are co-directors. The center istemporarily located inDr. Abbott’s office inWACC 458, and canbe reached by calling6-8025.

The river of changehas spawned this trans-itional home care spe-cialty. Its success has

been fueled by the in-fusion of expert know-ledge which, subsequent-ly, has influenced newapproaches to woundcare, nursing practice,and ongoing nursingeducation. It has alsocontributed to changingthe system for the deli-very of wound care atMGH. It has been anexciting journey for me,rafting through the tur-bulent waters of change,as a CNS at MGH.

Family-Centered Care Awardscontinued from previous page

us. Kim is such a live-ly, fun, spirited nursewho never seems totire of her patient loadand nursing duties. Weoften see her volun-teering to work extrahours when there is aneed.

About DeborahBobola, it was written:

Debbie has the abilityto put a family at easewhen they enter theNICU, especially thatfirst frightening time.She involves the wholefamily in the care oftheir child, teachingthem how to do some-thing and then step-ping back and lettingthem take over. Shehas a lovely sense ofhumor, which she usesto help put families atease. She will call amother at home to tell

her about the sweetthing her baby just did,or take a picture andmake a card for thefamily.

About Kiki Benja-min, it was written:

Kiki is always enhanc-ing her patient careskills through continu-ing education and work-shops. She recently satfor her pediatric hema-tology certification exam.Kiki is frequently askedto share her knowledgeas a mentor for newstaff. This is a role shetakes seriously and per-forms well. She has awillingness to share herknowledge without be-ing overbearing orthreatening... If I had achild on Ellison 18, Iwould want Kiki to bemy child’s caregiver.

June 14, 2001June 14, 2001

Reading Disabilitiesgraduation

cause for celebration!n Thursday, May 24, 2001, in the Wellman Con-ference Room, a record 32 students graduatedfrom the Reading Disabilities’ Orton-Gillinghamtraining class. Director of Reading Disabilities,

Phyllis Meisel, and medical director, David N. Caplan,presided over the ceremony, which was attended by staff,graduates, their families, friends and colleagues.

Reading DisabilitiesReading Disabilities

O

ReadingDisabilities staff

(l-r back row):Andrea Dolezal;Eileen Faggiano;

director, Phyllis Meisel;medical director, David Caplan;Elena Lakey; and Linda Alhart.

(Front row): Julie Bertram;Chuck Herron; and

Carolyn Horn.

Above: training class graduate accepts certificatefrom Reading Disabilities medical director, DavidCaplan, as director, Phyllis Meisel looks on.

At left: Staff of the ReadingDisabilities Department leadthe audience in a roundof applause for the 2001graduating class.

June 14, 2001June 14, 2001

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 Editor/WriterSusan Sabia

Editorial Advisory BoardChaplaincy

Mary Martha Thiel

Development & Public Affairs LiaisonGeorgia Peirce

Editorial SupportMarianne Ditomassi, RN, MSN, MBA,

executive director to the office of seniorvice president for Patient Care

Mary Ellin Smith, RN, MS

Materials ManagementEdward Raeke

Nutrition & Food ServicesPatrick BaldassaroMartha Lynch, MS, RD, CNSD

Orthotics & ProstheticsEileen Mullen

Patient Care Services, DiversityDeborah Washington, RN, MSN

Physical TherapyOccupational Therapy

Michael G. Sullivan, PT, MBA

Reading Language DisordersCarolyn Horn, MEd

Respiratory CareEd Burns, RRT

Speech-Language PathologyCarmen Vega-Barachowitz, MS, SLP

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 may be submittedby telephone: 617.724.1746

by fax: 617.726.4133or by e-mail: ssabia @partners.org

Please recycle

Next Publication Date:June 141, 2001

causal effect for how womenare viewed in Muslim culture.He noted that the terms Mus-lim and Islamic are often usedinterchangeably; but they are,in fact, different. “It is impor-tant to remember that societyhas an effect on the way of lifeof many people,” said ImamEid. Due to a lack of know-ledge of Muslim or Islamiccultures, people tend to judgeIslamics according to how allMuslims act.

Imam Eid defined Islam as areligion and Muslim as thepeople who follow Islam.There are approximately 1.2billion Muslims living all overthe world. Islamics representtwo major groups; they are theShiites and the Surnites, andthere are also various cults.

For women in Islamic so-ciety, their role is based onIslamic teachings that placeemphasis on how both menand women can contribute tosociety and to their families.But there are also aspects ofwomen’s roles that are notrooted in Islam (religion). Awoman’s dignity and modesty,for instance, seeking education,or working outside the home,are part of the culture.

In closing, Imam Eid advis-ed clinicians caring for womenfrom Muslim or Islamic back-grounds to try to understandhow the woman and her hus-band handle matters of life.Having this broader under-standing and awareness of thewoman’s role in that particularculture will enhance the out-come of the patient-caregiverinteraction.

Gender roles in theMuslim culture

—submitted by Suzelle Saint-Eloi, RNclinical educator

Nursing Grand RoundsNursing Grand Rounds

or many clinicians therole of women in Mus-lim and Islamic culturesraises many questions.

Practices such as the coveringof women’s heads and faces,or the signing of consent formsby women’s husbands poseimplications for the provisionof health care.

A dialogue about this topicwas the focus of discussion atNursing Grand Rounds onThursday, May 3, 2001. Thesession, entitled, “GenderRoles in the Muslim Culture,”was presented by Muslimchaplain, Imam Talal Y. Eid.

Imam Eid highlighted theimportance of the Qu’ran (theIslamic holy Bible) and theSunnah (the second source ofIslamic law) in establishinggender roles.

To shed light on the roles ofmen and women in Muslimculture, Imam Eid presented anoverview of the Five Pillars ofIslam. The Five Pillars of Islamare prayer, faith, alms, fast,and pilgrimage. According toIslamic law, and in most Mus-lim cultures, both men andwomen perform these duties.According to the Qu’ran, mar-ried men and women are con-sidered protectors of one an-other. This dictates equality,and the philosophy that bothare responsible for contributingto the success of the marriageand family life.

Imam Eid suggested thatmisinterpretations about Mus-lim and Islamic culture are a

F

Time to ChangePart of a four-part series sponsored by the Ethicsin Clinical Practice Committee, the Palliative Care

Department, and The Center for Clinical & ProfessionalDevelopment, this session will present a successfulcommunity model (Balm of Gilead) to inspire change

in the healthcare system as it relates tocaring for dying patients.

The program will include both lecture and discussion, aswell as a video of the highly acclaimed Bill Moyers PBS

special, On Our Own Terms: Moyers on Dying.

Friday, June 22, 20018:00–11:00am

(repeated 12:00–3:00pm)O’Keeffe Auditorium

For more information, call The Center for Clinical &Professional Development at 726-3111.

20June 14, 2001June 14, 2001

20

—Educational —Educational DescriptionWhen/Where Contact

Hours

For information about Risk Management FounInternet at http://ww

Preceptor Development Program: Level IIProgram is geared toward experienced nurses who have functioned as clinical preceptors. This workshopprovides participants with an opportunity to further advance their knowledge and skills in developingeffective strategies to meet the challenges of precepting, managing conflict, thinking creatively, andcoaching for success. For more information, or to register, call The Center for Clinical & ProfessionalDevelopment at 726-3111.

7.8June 288:00am–4:30pmTraining DepartmentCharles River Plaza

CPR—American Heart Association BLS Re-TrainingRegistration is required by 12:00 noon of the day prior to class. For information, or to register, call TheCenter for Clinical & Professional Development at 726-3111.

- - -July 57:45am, 1:00pm, 4:00pmVBK 401

Nursing Grand RoundsNursing Grand Rounds are held on the first and third Thursdays of each month. For more informationabout this session call The Center for Clinical & Professional Development at 726-3111.

1.2July 51:30–2:30pmO’Keeffe Auditorium

Transfusion Therapy Course (Lecture & Exam)For ICU nurses only. Pre-registration is required. For information, call Sue Pauley at 6-3632; to register,call The Center for Clinical & Professional Development at 726-3111.

- - -July 11, 8:00am–12:30pmJuly 13 (Exam)8:00–9:30amBigelow 4 Amphitheatre

OA/PCA/USA ConnectionsContinuing education session offered for patient care associates, operations associates, and unit serviceassociates. This session is entitled, “Specialty Beds: the Intricasies, the Differences.” Pre-registration isnot required. For more information, call The Center for Clinical & Professional Development at 726-3111.

- - -July 111:30–2:30pmBigelow 4 Amphitheater

Culturally Competent Care: Understanding Our Patients, Ourselves and Each OtherProgram will provide a forum for staff to learn about the impact of culture in our lives and interactionswith patients, families and co-workers. Topics include understanding and defining the importance ofculture; the principles of cultural competency; understanding the dynamics of difference; the culture ofWestern bio-medicine; and the appropriate use of language services. A variety of interactive exercises willhelp to illustrate the concepts presented. For more information, call The Center for Clinical & Profes-sional Development at 726-3111.

7.2July 128:00am–4:30pmTraining DepartmentCharles River Plaza


- - -July 187:45am, 1:00pm, 4:00pmVBK 401


1.2July 191:30–2:30pmO’Keeffe Auditorium

Intra-Aortic Balloon Pump WorkshopThis two-day workshop sponsored by the ICU Educational Consortium is for ICU nurses only. The pro-gram will provide a foundation for practice in the care of critically ill patients requiring balloon-pumptherapy. Day one hosted by and ICU Consortium hospital; day two held at MGH for MGH staff. Toregister, or for more information, call The Center for Clinical & Professional Development at 726-3111.

14.4for completing

both days

July 23: 7:30am–4:00pm atMount Auburn HospitalJuly 24: 8:00am–4:30pm atMGH (VBK6)


- - -July 25, 8:00am–12:30pmJuly 27 (Exam)8:00–9:30amBigelow 4 Amphitheatre

Caregiver Skills for the New MillenniumThis program is designed to promote organizational and personal excellence, inspire creativity and per-sonal and professional success in today’s challenging healthcare environment. Topics will include: man-aging conflict, negotiating, and balancing the personal and psychological costs of caring.To register, orfor more information, call The Center for Clinical & Professional Development at 726-3111.

7.2July 268:00am–4:30pmTraining DepartmentCharles River Plaza

01June 14, 2001June 14, 2001

01 Offerings— Offerings—

DescriptionWhen/WhereContactHours

ndation educational programs, please check theww.hrm.harvard.edu


- - -August 27:45am, 1:00pm, 4:00pmVBK 401

1.2August 21:30–2:30pmO’Keeffe Auditorium

Nursing Grand RoundsNursing Grand Rounds are held on the first and third Thursdays of each month. This presentation willfocus on, “Haitian Women’s Health Issues,” presented by Karen Hopcia, RN, and Suzelle Saint-Eloi, RN.For more information, call The Center for Clinical & Professional Development at 726-3111.


- - -Aug. 8, 8:00am–12:30pmAugust 10 (Exam)8:00–9:30amBigelow 4 Amphitheatre

Culturally Competent Care: Understanding Our Patients, Ourselves and Each OtherProgram will provide a forum for staff to learn about the impact of culture in our lives and interactionswith patients, families and co-workers. Topics include understanding and defining the importance ofculture; the principles of cultural competency; understanding the dynamics of difference; the culture ofWestern bio-medicine; and the appropriate use of language services. A variety of interactive exercises willhelp to illustrate the concepts presented. For more information, call The Center for Clinical & Profes-sional Development at 726-3111.

7.2August 88:00am–4:30pmTraining DepartmentCharles River Plaza

OA/PCA/USA ConnectionsContinuing education session offered for patient care associates, operations associates, and unit serviceassociates. This session is entitled, “Caring for Patients in Restraints.” Pre-registration is not required.For more information, call The Center for Clinical & Professional Development at 726-3111.

- - -August 81:30–2:30pmBigelow 4 Amphitheater

Critical Care in the New Millennium: Core ProgramFor ICU nurses only. This program provides a foundation for practice in the care of critically ill patients.Pick up curriculum books and location directions from the Center for Clinical & Professional Develop-ment on Founders 6 before attending program. For more information, call The Center for Clinical &Professional Development at 726-3111.

45.1for completing

all six days

August 13, 14, 15, 20, 21,227:30am–4:00pmLocation TBA

16.8for completing

both days

Advanced Cardiac Life Support (ACLS)—Provider CourseProvider course sponsored by MGH Department of Emergency Services. $120 for MGH/HMS-affiliatedemployees; $170 for all others. Registration information and applications are available in Founders 135,or by calling 726-3905. For course information, call Inez McGillivray at 724-4100.

August 168:00am–5:00pmWellman Conference RoomAugust 208:00am–5:00pmWellman Conference Room


1.2August 161:30–2:30pmO’Keeffe Auditorium

Chemotherapy ConsortiumPick up pre-reading packet, and pre- and post-tests at The Center for Clinical & Professional Devel-opment on Founders 6. For more information, call Joan Gallagher at pager #2-5410. Pre-registration isrequired. To register, call The Center for Clinical & Professional Development at 726-3111.

10September 48:00am–4:30pmDana Farber InstituteJimmy Fund Auditorium


- - -September 67:45am, 1:00pm, 4:00pmVBK 401


1.2September 61:30–2:30pmO’Keeffe Auditorium

June 14, 2001June 14, 2001

CaringFND125

MGH55 Fruit Street

Boston, MA 02114-2696

CaringH E A D L I N E S

where it now makesgood economic sense toupgrade our bath towel.

The new towel,which was introduced inMarch, is wider, longerand heavier than the onepreviously carried. Ourhope is that where threetowels may have beenneeded for bathing be-fore, now two will besufficient. In addition tothe larger size, the newtowels are also softerand more absorbent. Wewelcome your feedbackon this improvement.Please send commentsdirectly to Gary Mul-rey, via e-mail.

In conjunction withthe towel upgrade, wehave initiated a programto supply a daily par-level of utility towels toinpatient units. We arehoping that staff willuse these (blue, striped)towels for cleaning,thereby leaving morebath towels and washcloths available for theirintended use. The utili-ty towels are re-usableand should be placed inthe soiled linen hampersafter use. They can befound in the yellownylon bags attached toall the linen exchangecarts marked, “utility

towels for cleaning.”There is also an

ample supply of green-dyed cloth rags avail-able on Ellison 23, theEnvironmental Servicesstorage area. These ragsare available for usethroughout the hospital.

Currently, there is aproject underway toreview our inpatientgowns. One of the morefrequent requests wereceive is for largergowns (particularlyextra large IV gowns).Patients feel more com-

Materials ManagementMaterials ManagementLinen Initiatives

—by Gary MulreyMGH linen supervisor

fortable and less ‘expos-ed’ in larger garments.We are evaluating a va-riety of different stylesand patterns with thehelp of the Nursing-Materials ManagementTask Force. More infor-mation on this initiativewill be shared as ourwork progresses.

For more informa-tion on any of thesenew linen initiatives,please call Gary Mul-rey, linen supervisor, at4-1732.

he MaterialsManagementLinen Depart-ment is pleas-

ed to announce recentchanges that will greatlyimprove the quality ofpatient care. First, thereis the introduction of anew bath towel. Forquite a while, we haveknown about issuesaround towel quality,but were unable to makea change because of thehigh incidence of losttowels. However, a co-operative effort bet-ween Nursing and Ma-terials Management hasreduced the amount oflost towels to the point

T

The July 5th issue of CaringHeadlines will be exclusively

dedicated to the Stephanie M.Macaluso Expertise in Clinical

Practice Awards

caring june 14, 2001 - mghpcs.orgspired presentation on the importance of ap-preciating and...

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