Innovative ideas to enhance patient care
Fueled by a new model of quality care, overall patient satisfaction with BWH’s Emergency Services has skyrocketed in the past two years — from 68 percent to 94 percent. “We view our patients as customers,” said William Briggs, RN, BSN, CEN, assistant nurse manager in the Emergency Department, who with staff educator Nicki Gilboy, RN, MS, CEN, has scrutinized and transformed the department’s operations. “We look for customer service issues that need enhancement.”
More attention is now given to patients’ comfort. Food and drinks are allowed in the waiting area. Staff are encouraged to see their behavior through the eyes of the customers — the 56,000 emergency patients treated each year at BWH, plus those who accompany them. “How patients and families are treated sets the tone for their perception of the hospital and whether or not they will seek care here in the future,” said Briggs.
The nurses’ improvement effort is among three initiatives that received a Mary S. Fay Enrichment Award in Nursing in May 2000. Funding from this annual award allows members of the nursing staff to learn, through direct observation and experience, how compassionate care is defined and provided in another setting, and use this information to enhance practices at BWH.
Applications are now being accepted for the 2001 awards, and any member of BWH’s nursing staff may apply. Funding may be used for a program, course or consultation with experts in the field related to the awardee’s care improvement initiatives. The award was named in honor of Mary S. Fay, RN, MSN, executive director of the Center for Excellence in Nursing Practice which oversees the awards. It was established by longtime BWH supporters Yousuf and Estrellita Karsh in recognition of all nurses at BWH and in appreciation of the compassionate and expert care they have received at the hospital. Applications for the 2001 awards, which were recently mailed to nurses’ homes, are due March 1.
Briggs and Gilboy are using their award to attend a three-day course at the Disney Institute Quality Management Program in Orlando, Fla. They will study principles of quality management that are universal to all service-oriented industries.
“When people come to BWH, they expect high-quality medicine. But they also judge us by personal interactions with our staff, the amenities we offer, and if we takethe times to explain things,” said Gilboy. She leads orientation classes for new Emergency staff and workshops attended by everyone in the department. New ideas constantly emerge. “The staff have taught themselves so much, such as how to handle difficult patient and family situations,” she said. “Our future goals include focusing on ways to deliver culturally sensitive care.”
Bioethical issues in caring for premature infants
Another 2000 award recipient is Gabriele Harrison, RN, a nurse in the Newborn Intensive Care Unit (NICU). Over the past 25 years, she has seen neonatal medicine evolve into a highly specialized field that helps premature and high-risk neonates survive. But technical and medical progress has created new ethical dilemmas.
“Sometimes we are faced with questions that have no black and white answers, only shades of gray,” she said.
Harrison’s award allowed her to attend a one-week intensive course at the Kennedy Institute of Ethics at Georgetown University. Nearly 100 people from around the world met with renowned experts to discuss the history, principles and terminology of bioethics, and effective models to make decisions. Upon returning to BWH, she developed a class on ethical principles and their application to NICU clinical practice, introducing staff to the language of ethics and the decision-making process.
“In health care, our mission is to do good and not do harm,” said Harrison. “But sometimes it is unclear how to achieve those goals. To determine the best course of care, we constantly must ask questions, such as: How do we weigh the needs of the child against the needs of the parents? How do we comfort parents in difficult situations? How can we take care not to impose our values on families? How can we as a staff learn to share our successes and our burdens? These and other questions are the basis for future discussions that we hope to have in our unit.”
Lactation counseling for premature newborns
Two other NICU nurses found that another area of opportunity within the unit was related to counseling mothers about the unique dynamics of breastfeeding premature babies. Maureen Allen, RN, BSN, IBCLC, and Kathleen Howard, RN, BSN, IBCLC, are now devoted solely to lactation consulting in the NICU. They are using their award to travel to academic hospitals in Houston and Chicago to study innovative breastfeeding programs.
Allen and Howard began the NICU lactation consulting service in mid-1999. Since then, the rate of mothers providing breast milk has risen from 50 percent to nearly 90 percent. In addition to nutritional benefits, breast milk imparts the mother’s immunity, promoting the health of the fragile newborn.
Before babies reach 32 weeks, they are unable to suck, swallow or breathe, functions necessary for feeding from a bottle or breast. But the mother’s milk needs to be established immediately to prevent her breasts from drying up. “We provide one-to-one education, helping mothers maintain their milk with a breast pump, sometimes weeks before the baby is able to suck,” said Howard. “It takes a lot of dedication to pump 8 to 12 times a day. It’s relatively easy to respond to a baby’s cry. It’s much harder to go by the clock.” The mother freezes the milk and brings it to the NICU, where it is provided via nasogastric feeding tube or by bottle, and eventually the baby begins to breastfeed. In the interim, Allen and Howard coach mothers to nuzzle their babies against the breast.
The nurses often are available by beeper to answer mothers’ questions. “It’s worth it to make sure things are going smoothly,” said Allen. They also are planning to do research, for example, to see if follow-up phone calls will make a difference in the number of women who transition from breast pumping to breastfeeding.
For more information on the Mary S. Fay Enrichment Awards in Nursing or for assistance with an application, please contact Janice Bingham via e-mail at jbingham@ partners.org, or call (617) 732-5558.