Nurses In Telehealth and Why It is Important

Our technology through the years has been advancing to provide patients with nurses that can manage their care through the telephone and through field visits in their homes.  With the recent pandemic that has spread throughout the globe, more than ever the field of nursing doing telehealth has become important.

Through my job as an independent nurse consultant, I am able to provide much needed and sought after medical information to my patients and their family caregivers via telephone and telehealth.  In order for me to do this, I must be able to have good communication skills and if I am providing telemedicine a good eye for what may be concerning my patient.  In the past few years, telehealth has grown.  According to the American Academy of Ambulatory Care Nusring (AACN).  “Telehealth practice originally began when registered nurses (RNs) were available to patients by telephone to ensure they had access to health care. The RNs triaged patients to appropriate levels of care. ”

Many people lately since the pandemic occurred ask me what do you do for work?  My answer is, as a nurse consultant, I educate and assess my patients about their medications, symptoms, and chronic disease processes.  I ensure that they are making follow up appointments with their primary care doctors or their specialist.  Together we develop a plan of care that will best suit their current situation.  Now I also have injured workers that are seeing their doctors and anxious to get back to work.  They sometimes have chronic conditions that through my assessment they may or may not know about.  These are the moments when as a nurse consultant, I can educate them, provide best practices, and refer them to their primary care doctor to get the help that they need.  As for their injuries, I help them to get the right treatment ordered and coordinate their visits to another specialist that can help them when a referral is needed.  My job does not end there though, coordinating light duty work for the,m with their employing agency is another aspect of what I do.

Having a telehealth nurse allows doctors the ability to follow up with patients that are not able to come to the office as frequently by carefully monitoring the medications that they are on after they are reconciled with their pharmacist.  It also allows for a team approach in managing their healthcare with their caregiver and the patient to provide autonomy, a willingness to participate, and be involved in their own healthcare.

One important time that my patients benefit from is pre and post-surgery.  These are scary times for patients and knowing that they have a nurse to contact them and review their instructions before surgery, plan for their needs after surgery, and contact them afterward, assures them that they can manage their needs while waiting for the follow up with their doctor.

This year with Hurricane Dorian almost hitting Florida, there was preparation to plan ahead for patients especially those that were in need of a special needs shelter due to compromised health.  It takes preparation at the beginning of the hurricane season to assess all your patient’s needs and plans for disaster.  I usually start this around June 1st right when hurricane season starts so that if one should happen, we are prepared with the patient’s plan of care.  Once the warning is issued that we need to prepare, then I contact each one of my patients and put their emergency plan into place.  I visit each patient and make certain that they are prepared.  Once the danger is over, I follow up with each patient by phone and when it is safe to go out, I will visit them in their homes to ensure that they are safe.

Most all my patients receive an in-person visit from me at their home or doctor’s office but they also receive phone calls to maintain the communication lines open about their care.  Usually, I have flexibility in my schedule to take time off to spend it with my husband and my son or catch up on housework to free up my weekends.  However, during this pandemic of COVID-19, my short days have turned into 16 plus hour days almost 6 days a week and somedays 7 ( although I try to not let that 7th day happen).  Many ask what happened to your comfortable hours?  Well COVID-19 changed that !!  My patients are scared, they have more questions, I have more telehealth visits at doctor’s offices with patients because I am not able to go per my contracted client accounts; it is for their protection and mine.  So although tiring, I am grateful that I can still provide the care that they need through telehealth.

So today someone dropped off a sign at my door that says they are praying for healthcare heroes and first responders.  I am honored to be among the professions that help support our patients at home to keep them safe during this pandemic.  Every telehealth visit that I make with each patient has a COVID-19 question and answer session and they know that if they have a question, they can contact me.

So today, find a healthcare worker and honor them with a kind word of encouragement.  We are here working for the health of our country.

This is the sign that was left on our front yard today( Pardon the garden we were going to start planting flowers in it until COVID-19…times are too busy for gardening)

Rosie Moore, DNP, RN

Follow Rosie’s Nurse Corner

Website:  Windermere Baby and Family

 

 

 

 


Source: Rosie’s Nurse Corner

Leadership Styles and Organizational Changes

Leadership Styles and Organizational Changes

In my previous employment, I went through some challenging issues that started at the leadership level.  I was a manager of case managers at the time.  The role of the professional nurse when implementing a change is to identify that there is a need for a change (Rubenfeld & Scheffer, 2014).  Once the need for a change is identified by the nurse, the next step is to implement a change in behaviors efficiently and with quality. When identifying the area specifically that needs the change, nurses need to be deliberate in stating the purpose of the change.  When speaking to the target group about making the change, it is important to keep their attention span with non-lecturing phrases.  As nurses, we are not always in our comfort zone to explain why changes need to be implemented.  We should be prepared to explain why this change is needed and what improvements these changes will make.

Generally, people will always be resistant to change.  But as professional nurses, our focus is to build trust and credibility.  The goal is to acknowledge that the change is coming and that you empathize with the feelings of the upcoming change (Rubenfeld & Scheffer, 2014).

Where I used to work, they were very involved with ACHA (Agency for Healthcare Administration), because we held a state contract.  Evidenced-based nursing was in a sense required as far as the patient care when our case managers were managing a case.  However on the same note, although our case managers were not performing hands-on care, they were required to know about all their diagnoses and treatments.  We had social workers and nurses alike seeing the same types of members.  The issue with nurses and social workers seeing the same types of patients is that the social worker is not able to use his/her critical thinking skills in their area of expertise.   They were required to assist members who had complex medical issues for instance, on a ventilator or more complex medical problems.   A suggestion was made when I arrived at my workplace to utilize the social workers in conjunction with the nurses to manage the social aspects of the patients, however, the decision was denied.  It was noted that ACHA is not paying the company to rethink how cases were managed and by whom because it was not hands-on care, it was case management.

There was very little nursing involved in my job role, it was primarily reports and meetings to talk about reports and how to fix these reports.  It was an ideal job for someone that had an interest in the perfection of numbers and statistics.  Every other day, there was a new change that was being implemented. We often questioned why there was a change, but what we were told was that the change was immediate and mandatory.  For the staff case managers, these changes were difficult because the staff was in the field.  They may receive an email about something that needed to be changed as soon as possible, however, they may have just returned home at 4:30 or 5pm in the afternoon looking forward to the end of their day.  When the case managers check their emails,  they find deadlines on multiple items due.  These changes affect the staff because they have to work after hours to get the work completed timely. This kind of change caused many good nurses and social workers to resign.

As nurses or leaders, we tend to fall into the routine of lecturing due to the pressures that we are under.  However, two of the six dimensions of dealing with complex dynamic changes are creativity and intuition.  As a leader we should not just teach our group something, we should implement a way to bring creativity into the change and use intuition to know how to speak to our group.  The best way to implement a change is to get the group to commit to doing the new change and develop a smart goal with them that will allow them to measure their own goals.

The leadership theory that most resembles mine is the coaching leadership style.  The coaching leadership style allows me to work closely with staff at different levels and empower them to meet their goals and gain confidence in their strengths.  By being confident, they can focus on themselves as they work on their weaknesses.  In my previous job, the leadership style seemed like a dictatorship; however, for the purpose of the discussion here, it will be stated as coercive.  My manager’s favorite phrase was, “I gave a directive and everyone needs to follow it, any questions, 1 second wait time, no, good.  It’s due by close of business.”  If questioned on how to juggle that with all the meetings and other directives, the reply was always as a manager make it happen.  My manager always reminded me that she did not take lunch or breaks and she had “no life!” For fun,  she read the ACHA contract that was 350 plus pages because reading any other book was pointless (Barr & Dowding, 2012).

References

Barr, J., & Dowding, L. (2012). What makes a leader? In Leadership in healthcare (2nd ed., pp. 13-31). [Vital Source Bookshelf]. Retrieved from https://campus.capella.edu/web/library/home

Rubenfeld, M. G., & Scheffer, B. (2014). Critical thinking and patient-centered care. In Critical thinking tactics for nurses: achieving the IOM competencies (3rd ed., pp. 155-180). [Vital Source Bookshelf]. Retrieved from https://campus.capella.edu/web/library/home

 

Portrait, Dog, Animal, Suit, Business, Woman, Bitch

 


Source: Rosie’s Nurse Corner

What is Nursing in Today’s World

In the words of Florence Nightingale:

“Nursing is an art: and if it is to be made an art, it requires as exclusive a devotion, as hard a preparation as any painter’s or sculptor’s work; for what is the having to do with dead canvas or dead marble, compared with having to do with the living body, the temple of God’s spirit? It is one of the Fine Arts; I had almost said, the finest of Fine Arts.”

In today’s world, many people do not respect nurses and the work that they do.  There are many types of nurses in different fields.  I personally have had the privilege of working as a nurse in medical-surgical units, labor and delivery, legal nursing,  home care, case management, workman’s comp, and field nursing.  The experiences that I gained in working in all of these different areas of  nursing make me who I am today.

Through out the past month, these same nurses that did not receive any gratitude have now started to receive recognition, some negative and some positive.  Nursing as we know it has changed many lives.  We have had to adapt to the way that we reach out to our patients for their protection and ours through telehealth nursing.  For many patients, this has been a great thing because they can still talk with their nurse and their doctor.  I see clients in their home and doctor’s offices, but during the COVID-19 shelter in, I have had to reach out by telehealth to my clients in order to continue to provide the services that they need.

Many people have been so scared that they are losing sleep and feeling stress due to not working and how are they going to pay their bills.  Then there are the nurses that work frontline in the hospitals and doctor’s offices and the nurses that now have to see patients through telehealth measures.  One would think that those of us that have jobs still amidst this pandemic would be grateful and kind, but instead, for some people, it is causing stress and anxiety as a result of undisclosed fear.

Fear’s acronym that has been shared is false evidence appearing real.  In this case, though it is fear of the unknown.  Will there be work, will I get infected? Will my family be okay?  These are all questions that go through people’s minds.  What can we do as nurses?  Pray and ask God for that peace to be the light in the midst of darkness.  Second, understand that we can’t change the world and those that are in it; but we can change the way we look at it and how we handle circumstances.

A friend paid me the greatest compliment the other day, he said “Rosie Moore you followed The Great Physician! Bringing healing and hope to those in despair.  keep up the good work.  There is a crown waiting for you!”  So today know that every type of nurse is important whether in the frontline or via telehealth.  When COVID-19 is over, never forget what our country went through and the work that nurses and other healthcare workers did.

 


Source: Rosie’s Nurse Corner

The Silence is Deafening

The Silence is Deafening

I have to admit that the last three weeks have been a whirlwind of information overload. We have heard updates from our President, our Governor, and our County Mayor. Through all of the news stations, online journalists, and newspapers, our social media has been bombarded with news of people getting sick with the COVID-19, people dying, businesses laying employees off, food and other supplies unavailable on the shelves, and families forced into working from home and homeschooling their children. But through it all when I sit out on my back porch the silence is deafening. I have been praying daily several times a day for our nation and our leaders. I have also prayed for my family’s protection from this invisible but deadly virus.

I feel God’s peace in my life. I go to bed at peace, I work during the day and I am at peace, I wake up and I am at peace. But I have to ask myself why is there silence? Has God forgotten about His children? Are we being punished as a global nation? As I read through scriptures and devotions and pray, it occurred to me that the reason there is silence is that for many years there was noise. The hustle and bustle of driving to work on overcrowded interstates, rushing to go here and there, parties at bars and venues, hate crimes, protests for different causes, bullying in schools and the workplace, as well as an increase in divorce rates, and abortions.

With the closing of non-essential businesses and a shelter-in order of everyone in their homes, the earth has been silenced. I see people walking and running outside for exercise, families playing on their front and back porches as well as riding their bicycles. There has been a silence of the news talking about crimes, protests, and all the news that causes stress to many because the focus has shifted to the virus. But again, I ask myself, why now? What is God trying to do with our global nation?

Yesterday I sent out messages on Facebook on our support pages for Empowering Women and Girls, our neonatal intensive care unit support page, and several texts to friends to just do a well check. I felt the need to connect with them to see how they were doing and what I can do to help them during this difficult time. Many responses were general to say that they were doing as well as can be expected given the circumstances; but some were sad because their jobs laid them off, while others were scared or angry because their employers were making them work without any protection of wearing a mask not knowing who they can be exposed to. I thought about it and responded with words of encouragement. But as I thought further, I sent information to some on work at home jobs and to others, I encouraged them to take this time to do something for themselves that they wanted to do; whether to go back to school or something as simple as rearranging closets, answering emails, and organizing their business marketing and websites.

As I continued about my day yesterday, I still felt a pull in my heart that there was something I was not grasping during this time. I prayed before bed and asked God to show me what is the lesson that we are all supposed to learn here? It wasn’t until midnight that it came to me and immediately I got up to write this blog that you are reading today. This is all about a Silent Night, a Holy Night, and John 3:16; ” For God so loved the world that he gave his one and only Son, that whoever believes in him shall not perish but have eternal life. ” I know you may be asking what does that have to do with this pandemic. We are “one nation under God; indivisible with liberty and justice for all.” When you look up the meaning of indivisible, it means unable to be divided. Our nation and our families have been divided for quite some time. Our worship to Him has been diminished because something always distracts us from our time spent with Him. Our family life has suffered for many because we are focused on working all the time (myself included). This is not a post about pointing fingers and shaming anyone as the phrase says when you point at someone remember there are three fingers pointing right back at you.

When God sent His Son to die on the cross for us, He sent Him to save us, forgive our sins, and to worship Him. As a nation we did okay for a few years, but then the inevitable started and we lost our focus along the way. This last year we have seen hate among races and preferences, bullying, suicide, mental health problems including depression, murders, employers overworking employees not leaving enough time for them to spend with their families, and fearful if they do not keep up that they will lose their jobs. I am not saying that God came down from the Heavens last night and said all this to me, I am saying that when I prayed last night and asked God why this is happening, this is what I felt in my heart. Since we as a nation will not or cannot stop and change our circumstances either by choice or not, He gave us a way to stop and have a Silent Night/A Holy Night. What does that mean? Well, there is not one person in the entire world that is not affected in some way by this pandemic. Either we know someone that has it, we have it, our job is affected, or we are home on shelter in. Everyone has been touched by this. Now that God has our undivided attention, it is time for that Silent Night/Holy Night. Spend time with God, ask Him to forgive your sins (no one is perfect so we are all sinners so no saying that you do good and help the world, therefore, you are free of sin!), spend time talking with your family, playing outside with the kids on the porch or backyard, talk to your neighbors through the social distancing, by phone or the fence. This is the time for a Silent Night/Holy Night.

During these difficult days to come as we shelter in, “Keep the Faith” do not worry or stress for The Lord will provide. Allow His perfect peace to dwell in your hearts.

Remember Psalm 127:1-2

Unless the Lord builds the house,
    the builders labor in vain.
Unless the Lord watches over the city,
    the guards stand watch in vain.
In vain you rise early
    and stay up late,
toiling for food to eat—
    for he grants sleep to[a] those he loves.

In this verse what the author was trying to say is that God blesses us while we sleep probably just like He gave Solomon the desires of his heart while he slept. King Solomon could have asked God for riches and power but instead, He asked God for wisdom on how to lead his people and he, therefore, became one of the wisest men because he asked for wisdom instead of riches. So like Solomon let our daily prayer be, Lord please give me wisdom on how to be a good servant to You, how to lead my family during this pandemic, and do what is in Your will. The second prayer is, Lord please give me faith like Noah, because when things look grim and without hope, I want to have a faith that surpasses all doubt despite what I hear, read, and see. And lastly, as women our prayer should be, Lord during these difficult times when we think our beauty is affected because we cannot get our hair and nails done at the salon, or workout at the gym, etc, give us a heart like the Proverbs 31 woman. Help us to rest on the verse in Proverbs 31:30 ” Charm is deception and beauty is fleeting, but a woman who fears the Lord is to be praised.” Follow Galatians 6:9, ” Let us not become weary in doing good.”

I know that I may not have the popular vote today for blogs and some may choose to unfollow my posts, but that is okay, I am not here for the popular vote, I am here to just say what I felt in my heart. If this blog has blessed you let me and others know by sharing and commenting on it. I greatly appreciate the time you have taken to read this post.

COVID-19 Should I Be Concerned

There is a lot of stress and fear globally regarding the COVID-19 and what we are supposed to be doing to protect ourselves.  The media, friends and family, popular theme parks, businesses including airlines, cruises, and places of attractions, all have something to share about the COVID-19.  This is a household word that gets used in households on a daily basis probably more times than we want it to be.  Should we be concerned? That is an outstanding yes!! Why?  Well, first of all, let’s dissect what is happenbing, fear ( false evidence appearing real).

There is a lot of things that we are uncertain of and many times people will provide us information that may not be accurate.  They are not telling us to be mean, but they themselves are scared because they do not have all the facts.  Our healthcare professionals are leaning on the Center for Disease Control (CDC) and the World Health Organization ( WHO) to provide them the latest facts.  I am sure there are doctors who specialize in microbiology ( that famous petri dish that I hated in college) to do a battery of tests on this organism.  They learn something new each day.  There is not a specific cure as the virus has not been here long enough to develop a vaccine against it.  This is what causes the fear of not having a cure, not knowing if you contract it what will happen to you, your family, and your job, not to mention your friends.  So now that we dissected what the real issue here is fear, let’s see if we can put your mind at ease while we let the professionals figure out how to eradicate this virus.

“First of all Coronavirus disease 2019 (COVID-19) is a respiratory illness
that can spread from person to person. The virus that causes
COVID-19 is a novel coronavirus that was first identified during
an investigation into an outbreak in Wuhan, China.”

“The virus is thought to spread mainly between people who
are in close contact with one another (within about 6 feet)
through respiratory droplets produced when an infected
person coughs or sneezes. It also may be possible that a person
can get COVID-19 by touching a surface or object that has
the virus on it and then touching their own mouth, nose, or
possibly their eyes, but this is not thought to be the main
way the virus spreads.”

The symptoms are Fever, Cough, and Shortness of breath.  Pretty common symptoms that can be overlooked for many upper respiratory infections.  These symptoms can manifest themselves at any time in the 2-week window after becoming infected.

The way to protect yourself and others from catching the COVID-19 is to practice washing your hands for 20 seconds with antibacterial soap before eating, after eating, after using the bathroom, after touching your nose, eyes, or mouth.  You should also wash your hands after coming from the grocery store or any other public place that is not your home.  If you do not have access to soap and water right away uses the antibacterial right away.  If you shake hands with someone, do not be afraid to use your antibacterial.  I know people may frown at that and think you are germophobic, but really it is okay if questioned a simple explanation stating that you want to practice good infection control and want to be certain that you do not compromise them or your family is enough stated.

Always wash your hands after preparing food and serving or taking care of others ( no matter age).  Avoid contact with people that are sick and if you feel sick, stay home.  do not try to go to church, restaurants, activities, school, or any public spaces with multiple crowds and pawn it off on allergies. Everyone knows allergies are not contagious so many people who cannot afford to stay home because they do not get paid for being out, tell everyone that they have allergies.  Yes someone may have allergies but until this is verified by a doctor or nurse practitioner, stay home!

Be sure to clean surfaces with antibacterial wipes or household disinfectants as the virus can live on surfaces and if touched it can cause someone to get the virus.  When you come home from the outside, take your shoes off outside clean the bottom of the shoe and do take a shower at night before bed or if possible as soon as you come home from work.

I know this all may sound excessive, but if you follow good infection control, it will help decrease the stress that the media is causing you by playing the news 24/7.  Limit the times that you watch the news so that you are able to function on a day to day basis.  Have a cup of chamomile tea for bed to allow your mind to relax and get rest.  Start your day with something positive such as a daily devotion, prayer, or if you do not do any of the latter, watch a tv show that brings laughter to you.  Listen to the news midday or afternoon, this will give you at least what happened in the evening and the morning and not bombard you.

Sick Woman Cold

 

I hope that this has brought you some comfort.  For specific updated information go directly to one of these sites:

CDC/Center for disease control

WHO/World Health Organization

OSHA/Occupational and Safety Health Administration

As a nurse, I have to practice above and beyond the CDC, WHO, and OSHA rules so that I can protect myself and my patients.  So I understand and get everyone’s concerns right away.

Be blessed and be safe.

 


Source: Rosie’s Nurse Corner