Houston Methodist Nurse April 2014

APRIL 2014 | A Magazine for Nurses

METHODIST NURSELeading Nursing

Page 8

ORGANDONATION Close to Home

Get ready for

NURSESWEEK Page 14

Nurses Week 2014 is almost here! It is always an honor for our organization to

recognize our nurses for all that they bring to our team and to the nursing profession.

This year, we are once again looking forward to hosting a number of fun-filled events

and activities, including our systemwide Nurses Gala on Friday, May 2. Also, be sure to

look inside this issue for further details on all of our Nurses Week events.

Last month DNV conducted its annual site visit at Houston Methodist Hospital.

Overall, this survey was very successful and we identified areas where we have an

opportunity for improvement. Once we hear from DNV, I will send out areas for

improvement and we can begin addressing those with plans of action. I would like

to offer my gratitude to all staff members throughout our organization for their hard

work, active participation and eagerness to interact with our surveyors during their

time visiting our facilities. The reviewers from DNV were very impressed with our

delivery of care as well as our commitment to excellence, quality and safety.

The Good Samaritan Foundation is seeking nominations of outstanding nurses who

exemplify the finest qualities of the nursing profession for its Tenth Annual Excellence

in Nursing Awards. Nominees must be registered nurses and prior nominees are

eligible. I encourage each of you throughout to nominate a deserving colleague.

Nominations are being accepted through Friday, May 16, at 5 p.m. and are available

online at nominations.gsftx.org.

I hope everyone is enjoying this beautiful spring! It is a time for new beginnings and

adventures…so start your imagining today!

Time for New Beginnings

Ann Scanlon McGinityA Message from

Senior Vice President and Chief Nurse Executive

2014 EDITORIAL BOARD MEMBERSRosario AlvaradoShuntá Fletcher Donna EspositoSarah FlemingElizabeth Gigliotti Elizabeth HimesBeverly Hughes

Beverley LaMoth Robert MoreheadCarlette PattersonVerna Simmons-RobinsonJoy ShillerRobyn Washington

MAGAZINE EDITORKelli Gifford

GRAPHIC DESIGNER Phyllis Gillentine

PHOTOGRAPHERPhyllis Gillentine

Do you have a

STORYthat you would like to post in the

HOUSTON METHODIST NURSE MAGAZINE?Please submit your articles or ideas to Kelli Gifford [email protected]

THE DAISY AWARDfor Extraordinary Nurses at Houston Methodist HospitalHonor the compassion and care Houston Methodist nurses provide patients and their families every day.

LEADERS IN NURSING 3

Callie Rand, RN, the winner of the March DAISY Award, took one patient’s dying

wish and made it a reality. She often was the nurse caring for a young girl named Torrey and formed a

special connection with Torrey and her parents, Bill and Debbye.

During the last week of Torrey’s life, Callie learned that Torrey had a goal to make 1,000 origami cranes

when Debbye hung some of Torrey’s cranes over her bed. Torrey would not be able to reach her goal on her

own so Callie went into action, teaching other nurses how to fold the cranes.

One night, Callie gathered all the folded cranes and created a beautiful mobile that covered Torrey’s walls

and windows in her room. The effect was magical! The cranes danced and moved with any breeze. The

atmosphere in Torrey’s room changed.

In the morning, Debbye and Bill arrived to a beautiful room, full of Torrey’s creative spirit. Many of the cranes

were signed by the MICU staff, with messages of love, hope and encouragement.

Callie gave a wonderful gift to Torrey and her family and helped Torrey reach a goal. Callie’s care and

compassion left a “forever” mark on this family. Thank you Callie for all that you do!

WINNER CREATED MAGIC FOR HER PATIENT

Jane DeStefanoVice President and Chief Nursing Officer

Houston Methodist San Jacinto News

4 HOUSTON METHODIST NURSE

Collaborating to Improve Breastfeeding OutcomesBreastfeeding is one of the most effective preventive health measures for infants and mothers. Despite the many benefits of breastfeeding, only 14.5 percent of Texas mothers exclusively breastfeed for six months. To help reverse this trend, 22 hospitals/facilities in eastern Texas were selected to expand the work started in northern Texas last January by being part of a five-year quality improvement project aimed at improving facility environments to support a mother’s choice to breastfeed. “Houston Methodist San Jacinto Hospital is excited to be one of the 22 hospitals participating in this collaborative,” said Madelen Franco, nursing director, Maternal/Child Unit.

The Texas Ten Step Star Achiever Breastfeeding Learning Collaborative aims to help facilities create settings where a woman’s choice concerning breastfeeding can be best supported, with the goal of increasing exclusive breastfeeding. Started in 2012, the collaborative has worked to make improvements regarding breastfeeding for a 12-month period of time and these changes have been noted:

Educated on Pacifier Use: 17% increase (8,160 more mothers educated) Rooming In: 13% increase (6,240 more infants rooming in) Skin-to-Skin contact after vaginal birth: 13% increase (6,240 more infants going skin to skin) Prenatal Education: 12% increase (5,760 more mothers receiving documented prenatal education) Exclusive Breastfeeding Rates: 3% increase (1,140 more infants being exclusively breastfed at discharge)

“The number of mothers who breastfeed in the United States is much lower than we would like, and Texas has even lower rates than the national average,” says Charlie Homer, MD, MPH, president and CEO of NICHQ (the National Initiative for Children’s Healthcare Quality). “The success of this project to date has been tremendous. We welcome the new participants and look forward to engaging these teams to try new ways of delivering care that helps them determine how best to improve breastfeeding outcomes, which they then can share with other participants and beyond.”

The effort is being led by NICHQ and is funded by the Texas Department of State Health Services (DSHS) Nutrition Services Section (Texas WIC). Up to 81 facilities, segmented into three cohorts based on the state’s designated public health regions, ultimately will participate in the collaborative. The recently selected 22 facilities represent cohort B and are primarily in eastern and central Texas. Recruitment for cohort C facilities will take place in 2015 and engage hospitals in the southern and western regions of the state.

“What’s driving this project is the need to improve maternity and infant care, but we want to make sure we can sustain change by building quality improvement capacity at these facilities,” says NICHQ Project Lead Elaine Fitzgerald, D.Ph. “Building on the success of the first cohort, NICHQ and its Texas partners will continue to implement innovative strategies to help this second cohort of 22 facilities improve the quality of care they provide.”

Facilities participating in the project will learn how to conduct small tests of change, collect data on progress, and ultimately make beneficial, sustainable improvements that support breastfeeding. NICHQ will also bring the teams together virtually and in-person to share lessons, promote collaboration and learn from improvement and breastfeeding experts. The project aligns with the Texas Ten Step Program, a statewide effort to improving infant health and increase rates of exclusive breastfeeding.

“The 22 facilities participating in this collaborative are responsible for more than 52,000 births each year,” says NICHQ Project Director Jennifer Ustianov. “Texas has the second largest population of children in the entire country so it has the opportunity to be a leader in improving breastfeeding rates nationwide.”

For more information, please contact the Houston Methodist San Jacinto Hospital Maternal/Child Unit at 281-420-8625.



APPROXIMATELY TWO YEARS AGO, Houston Methodist Sugar Land Hospital opened “Advanced Wound Care Center” (AWCC) to provide comprehensive care for patients with a wide range of wounds. Patients who seek care at the center have wounds that can relate to underlying conditions such as diabetes while others seek treatment for wounds that develop from various sources ranging from traumatic accidents, radiation therapy, and pressure ulcers or to persistent infected wounds. It is not uncommon to see patients who have been referred to the AWCC with a multitude of complex wounds.

Over the last two years the wound care physicians, nurses and staff have seen significant results that have been life-changing for patients from across Fort Bend County and surrounding areas. Patients presenting to the AWCC find hope through the help of a multidisciplinary team that incorporates specially trained nurses and specialty physicians, including orthopedic surgeons, vascular surgeons and plastic surgeons. This specialty clinic addresses complex wounds through the use of special prescribed wound dressings, hyperbaric oxygen treatments, or, when appropriate, the use of biological agents. Each of these treatments, whether it is the use of the specially designed pressurized hyperbaric oxygen chambers that increase healing by assisting in pushing oxygen-rich blood into the wounds, or the use of skin substitutes, purpose and aim is to stimulate healing and help regenerate tissue and skin.

So what success have we seen? Listed below are two such stories that reflect the outstanding care

provided by the physicians and nurses in the wound center.

Following a traumatic crushing injury while on a motorcycle and after being hit broadside by a car, John was left with his leg broken in multiple places. To save John’s leg, the first steps required that one of our orthopedic surgeons perform a fasciotomy procedure that prevented acute compartment syndrome but left John at that stage with a large opening down the length of the his leg exposing bones and muscles to relieve pressure. Following hyperbaric oxygen treatments for three months and additional surgery for stabilization of his leg and ankle bones, John’s leg was saved.

Henry, following hiking through thick snow at high altitudes for an extended period around the Annapurna Mountains in Nepal, found his feet severely swollen and exhibiting early signs of frostbite. He was transported out via Medevac to a nearby hospital where he was informed it was possible he would need to have all of his toes amputated. After being flown home to Texas and aggressive treatment at the AWCC most of the patient’s toes were saved. His injuries required the amputation of his big toe and a portion of the little toe on one foot versus losing all of his toes. The good news is a majority of the wounds can be healed and the patient can return to normal activity in a short time if the patient presents in a timely manner.

We are thankful for the physicians, nurses and staff who provide excellent care in our wound care clinic and have made such a difference in so many of our patients’ lives in Fort Bend County.

Houston Methodist Sugar Land NewsJanet Leatherwood

RN, MSN, VP / Chief Nursing Officer

WOUND CARE: Center for Hope, Healing and Regeneration

Thank you for expressing loving care to our families and friends and for making an incredible difference in their lives.

Houston Methodist Willowbrook News

Sheila FataVice President & Chief Nursing Officer


Christine Bradley, MSN, RN, NE-BC, joined our leadership team as director of Cardiac Cath Lab in January 2014. Chris comes with more than 25 years of health care experience and clinical expertise in cardiovascular care. She has extensive leadership experience with organizations in Illinois in roles of manager, director and Associate CNO. Chris earned her MSN at the University of Illinois and is

a member of the Illinois Organization of Nurse Leaders and Sigma Theta Tau International Honor Society of Nursing.

Jennifer Cook, BSN, RN, joined the Houston Methodist team as manager of AOD and PACU Services in January 2014. Jennifer comes to us with 14 years of nursing experience in clinical settings such as surgical ICU and outpatient periop services, including three years as a nurse manager with the Saddler Clinic. Jennifer says she was excited to join the Houston Methodist family because of her family’s

experience with our ICARE values and her desire to work at a Magnet facility.

Becky Winders, MSN, RNC-OB, was welcomed as manager of the Mother/Baby unit in January 2014. Becky has work experience across the country, from Iowa to Tennessee. She arrived in Texas in 2000, serving as director of Maternal Child nursing at both CHRISTUS St. Catherine Hospital and Houston Northwest Hospital. In her short tenure with us, she has already organized the opening of our expanded

Mother-Baby bonding unit on the 3rd floor of the Women and Children’s Pavilion.

Pam Sprague, MSN, RN, joined us as manager of NICU in December 2013 bringing with her a diverse and interesting background in neonatal care. Originally trained in South Carolina, Pam has more than 20 years of management experience from her time in the Dallas area, having served as supervisor, manager and director of NICU (80 bed) at Baylor University Medical Center and Manager of NICU

and Transport Team (50 bed) at Methodist Dallas Medical Center. Additionally, she gained national exposure to best practices in her work as a hospital architecture/facilities consultant.

Didie White, BSN, RN, joined us as manager of Surgery in March 2014, a Houston Methodist veteran who comes to us from Houston Methodist San Jacinto. She joined the staff there in 1991 and served as manager of surgery from 1996 until her transfer to Willowbrook. Didie loves the operating room environment and is excited about the opportunity to bring her passion to HMWB. She is committed

to transforming the surgical experience for patients, physicians, and other hospital departments and brings an eye for process improvement to our team.

Makiltru (“Kiki”) Fontenette, MSN, RN, joined us in February 2014 as manager of MedSurg 5W. Kiki came to us from Memorial Hermann Memorial City where she served as director of a general medicine unit. Her leadership experience includes roles such as clinical coordinator and manager of Medical-Surgical and Telemetry/Intermediate Care Services. Kiki has a passion for creating an excellent patient

experience, which she has been sharing with our hospital‘s Methodist Experience team – it’s been great to watch the 5W HCAHPS scores significantly improve under her leadership.

Shawna Wallace, BSN, RN, was promoted to manager of MedSurg 6W in November 2013 as a result of her reputation as a clinical expert and leader, and commitment to our values. She has been part of the Willowbrook nursing team for 10 years, beginning as a staff nurse in the Intermediate Care Unit. She served as manager of IMU from 2009-11 where she gained experience in leading the care

for stroke patients. This makes her a perfect fit for her new role on MedSurg 6W, our stroke unit.

Talented Leaders at Willowbrook


Spring is upon us! This is the creative time of year when nature blooms, bringing with it a fresh sense of optimism and rebirth. This seems to be a good time to highlight several of the talented leaders who recently joined the nurse leadership team at Houston Methodist Willowbrook Hospital. Each brings energy and skill that that is certain to grow into great things for our and nursing teams and patient.

Houston Methodist West News

Vicki Brownewell Vice President & Chief Nursing Officer


NURSES ACHIEVE RN III POSITIONS By: Sarah Fleming

“Excellence requires commitment and involvement.” This is a phrase from an intelligent enlightened nursing theorist, Patricia Benner, that became a resounding mantra for a lot of us. A phrase that has shown itself true as evidenced by the journey of seven dedicated Houston Methodist West nurses as they navigated their way to achieving their RN III positions. We are all very proud of them. We wanted you to get to share and get to know them as we know them. And as we pondered on how we can celebrate our new RN III nurses, we came up with an inspired thought: Let them speak for themselves. What better way than to hear from them yourselves to get a glimpse of their thoughts and views — their own words of wisdom. And so the journey begins …

LATRICIA RUSSELLThe clinical ladder recognizes highly qualified nurses who are mentors and those who serve as a resource for staff members. The clinical ladder also provides an opportunity for advancement in the clinical settings for those nurses who are willing to go beyond their duties as a staff nurse. Being certified, being an active participant on a committee and volunteering are just a few requirements of a clinical ladder candidate. The clinical career ladder journey is a process that requires hard work and dedication to the nursing profession. Along this path, it has taught me that the more involved I am, the more I learn and the more I can teach others. Inspiring others to achieve excellence is success for me!

ANILA SIMON

Promoting nursing excellence and assuring quality patient care is always a main focus at Houston Methodist West and our clinical ladder program is a perfect example. Starting and keeping up the clinical ladder means increasing our knowledge,

professionalism and teamwork, and getting financially rewarded for it. I would like to thank each and everyone in the CCP committee for their enthusiasm, support, encouragement and transparency throughout this process.

STACEY CASTERI believe that Houston Methodist West fosters an atmosphere of higher education and continued learning. The clinical ladder is a great opportunity to showcase achievements and those nurses that are willing and have the desire to advance their career. Achieving an RN

III status is no easy step to take, it requires perseverance and dedication to your clinical area, but it is worth the work and effort. I believe that it is also a way to expand one’s knowledge and expertise in your specific clinical area. It is not only an opportunity for the nurse to shine, but a way to show their dedication to your clinical area.

ANNE HAMREWhen I started the clinical ladder journey, I had to reflect on my years of practice. It was sometimes challenging to put words on all the experiences that nursing has given me. I have worked as a nurse for over 20 years now; I still think nursing is the perfect career for me. I am grateful

for the people I have met — patients, families and colleagues alike— and the experiences I have had. I will encourage everybody to start on the clinical ladder journey; it is a valuable learning process. I am so grateful to work in an environment where I can grow in my field and develop in my leadership role as well.

DENISE AUSTINI am a NICU nurse of more than 25 years’ experience. I have found the greatest value of the clinical ladder is to show the world how much you have accomplished in your nursing career, to demonstrate the pride in your achievements and to validate your clinical expertise. It is hard

work, but when you are through and can proudly wear that RN III title, you have shown that it was important enough to you to go that extra step to get there. Nothing else can beat that feeling of success!“Some folks are wise and some are otherwise” — Tobias Smollett

So from the CCP committee we encourage you all, hold steadfast to Patricia Benner dictum reminding us that “caring is central to nursing and the lack of smugness is a mark of the wisdom and humility that comes with experience.” Let the journey of these inspiring peers of yours serve as an example that perseverance and hard work will accomplish what you want and what you deserve for your own professional growth.


Growing up, Carole Anderson was no stranger to Polycystic Kidney Disease (PKD) — her grandfather and an uncle died from it. So when her husband discovered he also had the disease, Carole knew what to expect for the most part, but didn’t realize at the time the integral role she would play in saving his life.

Carole, 71, distinctly remembers seeing a story on television about a woman donating her kidney to her husband. Over the years it was determined that matches did not have to be identical, so when it became necessary for her husband, John, 75, to have a transplant, she was tested along with their four children. Two of the boys were a perfect match to each other and the closest match to her husband. Carole wasn’t as close but was still a candidate.

“I simply decided that with my kids in their 20s and 30s at the time, they had a lot of life ahead of them,” Carole said. “I thought, we’re both retired, and it made sense for me to be the one to do it.”

In July 2000, John received a kidney from his wife, but not without mixed emotions.

“I struggled with that a long time,” John said. “I struggled the night before

she went in. I laid there and said, ‘I don’t want to do this to her, I don’t want her to have

to do this. I can go on the list and wait.’ I seriously considered that until the time I went up to the (Houston Methodist) hospital.

“We got together in the hospital in the waiting area and laid there for about an hour. Then she went in, and that was probably the worst hour or so of my life. She went in an hour before I did, and I was wondering what’s happening to her. Then when they brought me out after the transplant, the first time I woke up was probably one of the best moments of my life. You go from absolutely struggling…you’re tired, worn out, beat up all the time, not really doing much, and all of a sudden you wake up and want to jump out the bed and run around the room. It was a great feeling. You understood what it meant to have a kidney transplant.”

For the past 10 years, John and Carole have participated in the World Transplant Games and the Transplant Games of America, which will take place in Houston this July. “We’ve had a lot of fun,” John said. “It’s a really big deal to have the games here.”

By: Kelli Gifford, Nurse Marketing Analyst

“You go from absolutely struggling…you’re tired, worn out, beat up all the time, not really doing much, and all of a sudden you wake up and want to jump out the bed and run around the room. “ John Anderson

“When it comes to transplants, my role in this is just being the sick guy. I mean, that’s all I do,” said John. “Sometimes we get treated like we’re special — we’re not. We’re just sick people who got to be made well by somebody else’s effort. The real stars in this are the doctors and nurses who support the transplant program, are part of the transplant program and are willing to take care of us after the transplant. Also, the donors and their families — without them and the good Lord, none of us would be here.”


The Transplant Games of America is a multisport festival event for individuals who have undergone life-saving transplant surgeries. Competition events are open to living donors, organ transplant recipients, bone marrow recipients and a limited number of corneal and tissue transplant

recipients. More than an athletic event, the Transplant Games of America highlights the critical importance of organ, eye and tissue donation while celebrating the lives of organ donors and recipients.

The goal of Team Texas is to promote organ and tissue donation awareness. In 2012, Team Texas took 33 recipients, living donors and members of donor families, to the games. Sixty-seven friends, family members and supporters traveled with the team to Grand Rapids, Mich. They won 62 medals, but more importantly, raised the local awareness to the need for organ donation. Today Team Texas stands at more than 350 recipients, living donors and donor family members. Before Team Texas left for the games, C0-Manager Donna Esposito, RN, BSN, CCTC, set up a meeting with Janis Burke, Executive Director of the Harris County Houston Sports Authority, to talk about the city’s ability to hold the games here.

They joined Brian Gilliam, Houston Methodist Heart Transplant recipient and Manager of Team Texas, for more than two-and-a-half hours to understand what the games were all about. That day Burke knew she wanted to hold them here. The team submitted a 91-page bid to the Transplant Games of America, and on December 19, 2012, was awarded the games at a press conference at City Hall with the Mayor Annise Parker. At that event, Bill Ryan, CEO of the Transplant Games, passed the torch to Mayor Parker symbolizing Houston as the host city.

“The Transplant Games are so much about celebrating life and not really about athletics,” said Donna. “In 1994 when I took my first team, I was profoundly affected by seeing all the transplant recipients participating in all the different events. I took a man who at 32 years old had a heart transplant. Once very athletic, he was not even strong enough to get out of bed by himself before his transplant. Then 10 months after he went to the games and to see him running up and down the courts was incredibly emotional and overwhelming.

“Because a family in the midst of their own tragedy agreed to organ donation he has lived to get married and raise three children. He always talks about how grateful he is to that donor family. It just touches your heart beyond words. Everyone at the games shares a common bond, and the transplant community is a tremendous family. You make lifelong friends as a part of this event.”

TRANSPLANT GAMES OF AMERICAComing to Houston

Continued on page 10


Continued from page 9

DEBY MAGRUDER AND HER SON, AUSTIN

Shortly after Austin Magruder graduated high school in 1998 he caught bacterial meningitis, leading to long hospital stays. “He was in ICU for a month and they wouldn’t tell me if he would live or not,” said his mother, Deby Magruder.

He ended up with kidney failure, was in a coma for more than a month and had to learn to walk again. Once he was well enough to leave, he did dialysis at home. His kidneys slowly got better over the next two years, but then he suffered renal failure. His mother knew she was a match because they both were blood type O-neg-ative. But Austin had received so much blood over the years from other donors that Houston Methodist doctors worried he would develop characteristics to fight it. Luckily, Deby still was deemed a candidate to donate to her son.

“It really was a no-brainer,” Deby said. “I knew it would hurt, but I knew I would get over it. He is so appreciative. He knows it’s unconditional love.”

Austin agrees. “For me, having my mom as my donor made things easier of course, but she’s always been there for me. She’s given a lot and sacrificed a lot for me, and I’m very grateful for it.”

Employees of the Cell & Gene Therapy/BMT Outpatient Infusion Center who were able brought baby pictures that were displayed on Easter cards and placed outside of the front desk lobby. There also is a collage of all the photos posted in front of the patient waiting area. Patients have been voting on who they think is the cutest baby. Four winners were selected with the grand prize going to director Jennifer Berry, and the team distributed Easter eggs to patients to celebrate the holiday.

Cutest Baby CONTEST in BMT Outpatient Infusion Center

L to R: Ivory Lacour, RN, 2nd place; Jennifer Berry, RN, MS, NE-BC, 1st place; Denise Pickens-Ware, RN, OCN, 3rd place; (not pictured) Audrey Scholoff, NP, AOCN, 4th place.

Evidence-based practice (EBP) is designed to empower health care professionals with the ability and knowledge to deliver high- quality care to patients in the most timely, cost-effective and efficient way possible (Middleton, 2007). In lieu of developing a strong systemwide EBP culture, it is important for health care professionals to adopt a spirit of inquiry. One of the first steps of EBP is to develop an EBP question. When health professionals consistently question clinical practice, believe in the value and effectiveness of EBP and obtain skills required to conduct EBP, there is a change in culture, practice and outcomes. The advantage of developing a spirit of inquiry is the confidence of the staff in

knowing that EBP is a valuable method of delivering the highest quality care to patients and their families (Melnyk, Fineout-Overholt, Stillwell, & Williamson, 2009).

Do not worry if you do not know where to begin. A common framework adopted by health professionals to develop an EBP question is known as the PICOT format. This tool is effective when reviewing the literature for a study or streamlining an EBP question. The acronym stands for Patient population or disease, Intervention or issue of interest, Comparison interventions or issues of interest, Outcome, and Time (Stillwell, Fineout-Overholt, Melnyk, & Williamson, 2010).

Using the PICOT format will help you formulate a succinct EBP question that may lead to a process or quality improvement project, policy change, or a study. The process of developing a spirit of inquiry allows the clinician to think outside of the box, challenge the status quo methods of care, question assumptions, and evaluate the effectiveness of current methods and processes, in an effort to improve the delivery of patient care (Riva, Malik, Burnie, Endicott, & Busse, 2012).

Nurses must address a great number of scenarios from day to day. It is critical for nurses to engage in developing clinical questions. The opportunity to uncloak new methodologies, traditions, evaluate the occurrence of treatments and outcomes, or assess what may work best for the patient, will only take place through inquiry.

By Kahla D. LaPlante, MHA, and Laura Espinosa, PhD

ReferencesMelnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2009). Evidence-based practice: Step by step: Igniting a spirit of inquiry. American Journal of Nursing, 109(11), 49–52. doi:10.1097/01.NAJ.0000363354.53883.58Middleton, J. (n.d.). Finding the research for evidence-based practice part one: The development of EBP. Nursing Times. Retrieved from www.nursingtimes.net/home/clinical-zones/leadership/finding-the-research-for-evidence-based-practice-part-one-the-development-of-ebp/292457.articleRiva, J. J., Malik, K. M. P., Burnie, S. J., Endicott, A. R., & Busse, J. W. (2012). What is your research question? An introduction to the PICOT format for clinicians. The Journal of the Canadian Chiropractic Association, 56(3), 167–171.Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Evidence-based practice, step by step: Asking the clinical question: A key step in evidence-based practice. The American Journal of Nursing, 110(3), 58–61. doi:10.1097/01.NAJ.0000368959.11129.79

When you have an idea or a question, but cannot figure out how to succinctly convey your thoughts think PICOT! Inquiring minds want to know!

STAY TUNED FOR INFORMATION ON THE 2015 EBP SYMPOSIUM!

DEVELOPING A SPIRIT OF INQUIRY: A Fundamental Element of Evidence-Based Practice

(Stillwell, Fineout-Overholt, Melnyk, & Williamson, 2010).

PICOT Elements

P = Patient Population?

I = Intervention or an issue of interest?

C = Comparative intervention?

O = Outomes critical or important?

T = Time is it a critical factor from start to completion of the project?

Types of Clinical Inquiry

Therapy What is the best treatment or intervention?

Prevention How can I prevent this problem?Diagnosis or What is the best way to assess the patient? Assessment What is the best diagnostic test?

Causation What is the cause of the problem?Prognosis What are the long-term effects of this problem?



By: Elizabeth Gigliotti

April is National Foot Health Awareness Month, so now is the perfect time to evaluate the health of your feet! The human foot is complex, containing 26 bones (the two feet contain a quarter of all the bones in the body), 33 joints and a network of more than 100 tendons, muscles and ligaments, not to mention all the blood vessels and nerves. You use your feet every day, probably without giving them much thought — they are just there ready to take you wherever you need to go. The average American walks approximately 8,000 to 10,000 steps a day,

which is the equivalent of walking five times around the earth during a lifetime! Although I have not encountered any studies to prove this, my hypothesis is that nurses probably walk twice as much as that! Think about it— your feet are probably begging for some TLC right about now.

The American Podiatric Medical Association (APMA) reports that 75 percent of all Americans will experience foot health problems at some point during their lives. Foot or ankle diseases, disorders and disabilities can adversely affect quality of life and mobility, so proper detection, intervention and care are critical. Additionally, there are a number of systemic diseases that are sometimes first detected in the feet, such as diabetes, circulatory disorders, anemia and kidney problems. Also arthritis, including gout, often attacks foot joints first.

Because foot health and overall well-being are interrelated, the APMA offers the following top health tips for healthy and happy feet:

DID YOU KNOW? April is National Autism Awareness Month?In order to highlight the growing need for concern and awareness about autism, the Autism Society has been celebrating National Autism Awareness Month since the 1970s. The United States recognizes April as a special opportunity to educate the public about autism and issues within the autism community.

What is Autism?Autism is a complex developmental disability that typically appears during the first three years of life and affects a person’s ability to communicate and interact with others. Autism is defined by a certain set of behaviors and is a “spectrum disorder” that affects individuals differently and to varying degrees. There is no known single cause of autism, but increased awareness and funding can help families today.

Know the Signs:• Lack of or delay in spoken language • Lack of interest in peer relationships• Repetitive use of language and/or motor mannerisms (e.g., hand-flapping, twirling objects) • Lack of spontaneous or make-believe play• Little or no eye contact • Persistent fixation on parts of objects

Source: Autism Society

PUT YOUR BEST FOOT FORWARD

1. Don’t ignore foot pain—it’s not normal. If the pain persists, see a podiatric physician.

2. Inspect your feet regularly. Pay attention to changes in color and temperature of your feet. Look for thick or discolored nails (a sign of developing fungus), and check for cracks or cuts in the skin. Peeling or scaling on the soles of feet could indicate athlete’s foot. Any growth on the foot is abnormal.

3. Wash your feet regularly, especially between the toes, and be sure to dry them completely.

4. Trim toenails straight across, but not too short. Be careful not to cut nails in corners or on the sides; it can lead to ingrown toenails. Persons with diabetes, poor circulation or heart problems should not treat their own feet because they are more prone to infection.

5. Make sure that your shoes fit properly. Purchase new shoes later in the day when feet tend to be at their largest and replace worn out shoes as soon as possible.

6. Select and wear the right shoe for the activity that you are engaged in (i.e., running shoes for running).

7. Alternate shoes — don’t wear the same pair of shoes every day.

8. Avoid walking barefoot—your feet will be more prone to injury and infection. At the beach or when wearing sandals always use sunblock on your feet as the rest of your body.

9. Be cautious when using home remedies for foot ailments; self-treatment can often turn a minor problem into a major one.

10. If you have diabetes it is vital that you see a podiatric physician at least once a year for a checkup.

So nurses, take time out of your busy schedule and give those feet the much needed TLC they want and deserve!

Happy feet are a happy you!

INFECTION CONTROL SPOTLIGHT


SOMETIMES ISOLATION CAN BE CONFUSING. Here’s a quiz to find out your “ISOLATION IQ.” GOOD LUCK!

Match these isolation precautions to the statements below. Choices are:a) Contact Precautionsb) Droplet Precautionsc) Airborne Precautionsd) Enteric, Special, or C. difficile precautions

_____ This isolation precaution is commonly used with drug resistant organisms (such as MRSA).

_____ With this isolation, the patient’s door must be kept closed.

_____ After contact with the patient, this isolation requires hand washing with soap and water only, not hand sanitizer.

_____ This isolation is used for patients who have meningitis, influenza or colds.

_____ This is the minimum isolation, and requires gown and gloves when entering the room.

_____ Environmental Services (housekeeping) must use special cleaning with this isolation.

_____ Health care workers who are fit-tested for an N-95 respirator and negative airflow room are requirements with this type of isolation.

_____ This isolation is used for patients who have TB, measles, or chickenpox.

_____ Patients with diarrhea are often placed in this type of isolation.

_____ A patient in this type of isolation is required to wear a surgical mask outside the room.

ISOLATION QUIZBy Robert Morehead, RN, ICPInfection Prevention and ControlHouston Methodist Hospital

How did you do? Answers will appear in next issue’s Infection Prevention Spotlight.

INTERVIEW: Q: What health care roles have you filled?

I have been a physician for nearly 14 years and worked in India and Saudi Arabia as a general practitioner (family practice physician).

Q: How long have you worked as an Infection Control Practitioner?

I’ve been an ICP since 2006.

Q: What led you to this role? To Houston Methodist? What keeps you here?

When I came to the United States, I had planned on continuing in my clinical field. But, due to selection restrictions in place for foreign medical graduates, that did not materialize. Instead, I completed a Master of Public Health degree and chose to become an Infection Control Practitioner. This had been my passion right from medical school. In May of 2012, I moved from Chicago to Houston. I applied and was fortunate to be hired by the Houston Methodist system.

Q: What do you like about being an ICP?

I really love being here because of the people. Secondly I am glad that I am away from the bitter cold of Chicago. The best thing I like is in getting involved with the intense analysis of deadly infections, such as Multidrug Resistant Organisms (MDROs), device associated infections (CLABSIs and CAUTIs) and surgical site infections (SSIs). I also like that I have an opportunity to teach others what I know from my medical life, particularly microbiology and epidemiology, which are relevant to preventing infections.

Q: What message do you have for Houston Methodist Nurses?

After working abroad as a physician I am in a position to compare overseas hospitals with U.S. hospitals regarding infection prevention. I am proud to say that we are doing so much better in infection prevention here, and that our ICPs are diligently involved in infection prevention and control. My message is this: please, nurses, always be proactive in complying with all our IC guidelines. Strictly abide with the World Health Organization’s five moments of hand hygiene, and always be ready to work with ICPs, as infection prevention is everybody’s business.

Infection Control Practitioner Ather Khadija, MBBS, MPH, Houston Methodist Willowbrook Hospital


BUILDING A SECURE FUTUREBy ShuntÁ Fletcher, MSN, RN, NE-BC, CVRN-BC

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Working for the Houston Methodist Hospital Security Department, Taesha Kelly realized she had a passion to help others and felt one way she could help was to protect and serve. But then she thought of another way — to become a nurse.

After Kelly’s father became ill and had to be placed on dialysis, it fueled her passion to become a nurse. Because she’s a working mother, she realized she needed help to get started. One day while helping a nurse open a door she decided to ask her about nursing. As chance would have it, that nurse was career coach Shuntá Fletcher.

Fletcher asked Kelly to talk when she had some free time. Kelly made an appointment and began on her journey to getting the help she needed to put her on the path to nursing school. Fletcher spoke with her about any barriers she might need to overcome and how they could work together on those to create a good work/life balance to make this happen for her.

Kelly is now taking two courses a semester of her prerequisites and doing well. Fletcher continues to keep in close contact to ensure Kelly stays on track.

“My career coach LISTENS and answers every question that I have,” Kelly said. “The HMH coaching program is amazing; it gives you guidance to succeed and for me to look forward to becoming the nurse I’ve always dreamed to be.”

“The HMH coaching program is amazing; it gives you guidance to succeed and for me to look forward to becoming the nurse I’ve always dreamed to be.” Taesha Kelly

Nurses Week EventsMonday, May 5: Opening Reception: Dunn Rio Grande, 3 p.m.Ann Scanlon McGinity will provide opening remarks and chaplaincy will perform the blessing of the hands. There also will be a drawing for sports tickets, so make sure to be there!Poster Competition: Register your poster demonstrating an evidence-based research project. Posters will be competing for the top three prizes. First place will receive a paid conference trip, and second and third places will receive $50 gift cards. The deadline to register your posters is April 30. For more information or to register your poster, please contact Kayla Smith at [email protected] or 713-363-7108.

Tuesday, May 6:Scavenger Hunt: Test your HMH Nursing IQ by solving brain-teaser clues. To complete this scavenger hunt, you will need to print, take a picture, get a signature or locate an item to verify proof of discovery.

Wednesday, May 7:Nurse Fashion Show: Crain Garden, 11 a.m.Pick up paper gowns and nurse-hat templates at Dunn 693 between now and May 2, or during the opening reception May 5, take them to your units and design the best outfit you can! On May 7, you will represent your unit on the runway in Crain Garden, and the winner gets a pizza party for his or her unit! This is a chance to show your creativity, so have fun! Participation in the Fashion Show is open to the first 15 nurses to respond. To register, please contact Kelli Gifford at [email protected].

Thursday, May 8:Nursing Development Fund Silent Auction: Crain Garden, starting at 8 a.m.Each unit is invited to create a unique gift basket to be displayed and auctioned. This event raises money to support nursing professional development.

Friday, May 9:Executive Jail Fundraiser: Crain Garden, 10 a.m.Issue a warrant anonymously for the arrest of an executive or director for $25! Once arrested, the inmates will be placed in jail in Crain Garden and will have to make bail. Bail rates begin at $100 with a maximum fee of $250 based on the number of warrants issued. All proceeds are tax deductible and go to the Nursing Development Fund. Please stay tuned for more details!Breakfast Tacos: Dunn Rio Grande, 6:30-8:30 a.m.

If you would like greater career success or need help in solidifying your vision for the future coaching appointments are flexible and are conducted by face-face interview or telephone. For more information please contact The Center for Professional Excellence at 713.441.4546 or via email at [email protected].

LIGHTS! CAMERA! ACTION!

2015 MAGNET On Your Mind Re-Designation Campaign


MAGNET® BOOTCAMP was held for the Magnet Champions in March to review “What Magnet Means to Nurses” along with the following:

• Magnet Champion role• Update Magnet Unit Readiness• Magnet Storyboard• The History of Magnet• Domains, Pillars and Priorities

Preparations were for upcoming Interprofessional Magnet Fair on June 12 in Rio Grande.

Stress affects many individuals no matter their age or status and feels different to each person. For children, stressors may develop from family, peers, school and other resources. They may shut down or act out. As adults we feel stress from life, family and jobs. We deal with managing family and careers each day.

In order to alleviate stress, it is important to try and determine the cause. Many times we are able to determine what is going to activate the feeling of stress and try to control it. When you are stressed, your body responds as though you are in danger, making hormones that speed up your heart, make you breathe faster and give you a burst of energy. This is called the fight-or-flight stress response.

Some stress is normal and even useful. Stress can help if you need to work hard or react quickly. For example, it can release endorphins that help you win a race or finish an important job on time.

But if stress happens too often or lasts too long, it can have bad effects. It can be linked to headaches, upset stomach, back pain and sleep issues. It can weaken your immune system, making it harder to fight off disease. If you already have a health problem, stress may make it worse. It can make you moody, tense or depressed. Your relationships may suffer, and you may not do well at work or school.

Houston Methodist offers many outlets for managing stress to help employees. The Wellness Center offers exercise classes, stress classes, weight-loss programs and many other options. The hospital also offers opportunities to obtain educational information to make employees’ jobs easier through knowledge, which can eliminate stress through better skills. There also is a group to help with speaking, Nurse Speak, which assists us all in communicating with each other on all levels, which can be very stressful. The Case Management De-partment has developed a Shared Governance Committee, and one of the things they do is provide information on transition and help educate the staff and patients on alleviating the stress of being in the hospital, provide a better hospital stay and a safer transition home.

Stress manifests itself in many ways and there can be many triggers for each of us. The best thing is to find a way of managing the stress. Try something you enjoy doing each day, and laugh, I mean really laugh, form deep down. Now that is instant stress relief.

Managing StressBy: Verna Simmons-Robinson

Sharon Tatum MSN, RN, ACNS-BC, CEN, RN IV,

Clinical Specialist Emergency Services, has been accepted for the “Project PROTECT: Infection Prevention Fellowship” from ENA (Emergency Nurses Association). This 12-month fellowship combines in-person and virtual educational sessions, one-on-one mentoring and a capstone improvement project to be implemented at the fellow’s own organization. Congratulations, Sharon!

Wendi Froedge, RN-IV, MSN, CCRN, RN IV, Critical Care Services, Houston Methodist Willowbrook Hospital, is presenting at two different national conferences in May: The Pathway to Excellence Conference, which will be held in San Antonio, and the QSEN Quality and Safety conference in Baltimore. The first is a podium talk and the second is a poster presentation. Way to go, Wendi!

Cristina M. Dimafiles, RN,BSN CVRN-BC, Charge RN CVCU/SICU, Houston Methodist Willowbrook Hospital, attended the Patient Safety Conference in St. Louis in March, where her poster abstract on the Use of the Ventilator Bundle: ICU Captures Zero VAP (Ventilator associated Pneumonia) for Four Years was accepted and presented. Also, that same topic was accepted and also will be presented in the upcoming QSEN (Quality of Safe Education for Nurses ) conference in Baltimore.

Elaine Ngitit RN,BSN,CCRN, Houston Methodist Willowbrook Hospital, had a Poster Abstract titled “Step Forward: Implementing Mobilization in the ICU” accepted to NTI and she will be an Evidenced-Based Solution Poster Presenter at the AACN’s National Teaching Institute (NTI) and Critical Care Exposition on May 17-22 in Denver. I sent a copy of my notice to Denise McNulty some time ago. It’s also in the list on AACN website.

Please congratulate the following staff on achievement of their RN III at Houston Methodist West Hospital: Anne Marie Hamre; Latricia Russell; Aisha Olaleye; Anila Varghese; Denise Austin; Lacey Helmke; Stacey Caster.

Christiane Perme, PT, CCS, was selected by the Acute Care Section of the American Physical Therapy Association to deliver the 2015 Acute Care Section Lecture at its Combined Sections Meeting next year. This recognition is given to physical therapists who have advanced practice of physical therapy in the acute care setting. Congratulations, Chris!

AccoladesNursing

NewsHouston Methodist Hospital is proud to have nurses who are dedicated to the nursing profession, driven to achieve growth in their professional development, and creative and always compassionate in their care for patients.

The accolades page is an opportunity for the nursing staff to showcase a few of the many exciting tributes our nurses receive. Please submit kudos to: [email protected].

Physical therapists from Houston Methodist Hospital were active participants at the recent Combined Sections Meeting of the American Physical Therapy Association. More than 11,000 PTs and PTAs from around the nation attended. Chris Perme, PT, CCS, presented a lecture titled “Mechanical Ventilation: The Inspirations, Expirations, and Frustrations of Physical Therapists.” Bobby Belarmino, PT, CCS, and Judy Ragsdale, PT, participated in the panel presentation “Post Professional Clinical Residencies & Fellowships in Acute Care.” Kenji Nawa, research rellow for HMRI, had a poster “Inter-Observer Reliability and Validity of the Perme ICU Mobility Score.”

Congratulations to Dunn 9 employees Karlo Roasa, Molly Krug and Simone Dobbs-Wilson who have each received their CVRN. Way to go!

Elizabeth Halbert, BSN, R.N., CRN, RNIII, in Endovascular Radiology/PACU, has been elected as the treasurer for 2014-15 of the organization Texas Gulf Coast Center-Association for Radiologic and Imaging Nursing. She has been appointed as a member of the program planning committee of ARIN’s national organization. Beth will also be one of the speakers/moderator addressing the hot topics at the upcoming ARIN 2014 Spring Convention next week in San Diego. Congratulations, Beth!

Francis Hidalgo passed his CCRN exam! Great job, Francis!

Congratulations to the following nurses from Dunn 9 CVIMU for passing their CVRN exam: Eugene Frogozo, RN, CVRN-BC; Karlo Roasa, R.N., CVRN-BC; Molly Krug, R.N., CVRN-BC; and Simone Dobbs-Wilson, R.N., MBA, CVRN-BC.

Congratulations to Beverley A. Anderson, R.N., CNOR, on her appointment to the Association of Perioperative Nurses (AORN) International Relations Committee 2014-15. Way to go!

Amanda Cormier, RN II, from MICU, has not had an “unscheduled PTO” since she was hired in 2009. Great job, Amanda!

Documents

Houston Methodist Nurse April 2014