1. Primary Prevention

The demand for secondary and tertiary prevention has drained available funding for the primary prevention of disease and illness. Through blogging, Registered Nurses can share knowledge from their area of expertise with blog readers to promote health and decrease risk of illness. Many individuals are looking to the internet for knowledge and answers to their questions. The Registered Nurse’s knowledge of evidenced based health care can provide a credible source to a global audience.

2. Establish Yourself as an Expert

Blogging can include information about your area of expertise with reviews of current literature and analysis of recent research. One of my areas of expertise is with celiac disease. I have been diagnosed with celiac disease for 5 years and have learned a tremendous amount about how to cook gluten-free, how to cope with a new lifestyle, how to raise children gluten-free and how to decrease associated risks.  In May/09, I will start sharing some of my experiences and knowledge at www.celiacnurse.com

3. Sense of Contribution

Sharing your knowledge with blog readers and other nurses provides a sense of contribution. I have found that contribution of knowledge and experiences is abundantly prevalent in the blogs I have read. Blogging can empower both the nurse and readers through interactive dialogue to collaboratively contribute unique ideas, new information, and explore future possibilities. Contributing to others feels good and helps everyone involved to grow.

4. Source of Feedback

Blogs can provide a continual source of feedback from other nurses and from the public. Blogs are interactive so readers can provide feedback about your content and you can respond to to the comments. Questionnaires and polls can also provide feedback to the nurse and the compiled results can benefit the readers. I enjoy the idea of self growth personally and professionally through blogging.

5. Develop Writing Skills

Blogging provides a way of developing your writing skills. I have been very busy for 10 years raising 3 children with allergies and auto-immune diseases and welcome this opportunity to not only share what I have learned, but to re-enter into the world of writing.

6. Therapeutic Value

I have learned a tremendous amount about myself through living  with an auto-immune disease and raising children with immune system problems. Sharing my experiences with others is therapeutic in many ways. It is empowering to share.

7. Marketing

Blogging can be valuable to promote yourself professionally or to promote a business. It could lead to a job opportunity in your area of expertise. It is an interesting addition to your resume.

Through the experience of blogging, nurses can learn more about marketing which may be beneficial if you have a business. I read an informative book recently called “The New Rules of Marketing and PR.” This book is written by David Meerman Scott and he has a website at www.davidmeermanscott.com.

There are blogs that discuss how to market your blog, such as Problogger (see below). I’m sure there are many other good blogs on marketing available. I am discovering new sites and information everyday. Please leave a comment if you are aware of other good blog sites that discuss marketing or if you have read a good book on this topic.

8. Current with Technology

Blogging can help nurses keep current with new technology. Your blog can be enhanced with podcasts, videos, e-books, pictures, and other types of add-in or plug-ins that may enrich the readers experience. Your knowledge of marketing and computer technology will increase as you blog. I am just starting my blogs and have learned a great  amount of useful information already. There are many blogs with content about blogging (I am still discovering more) that can provide great resources. ProBlogger at www.problogger.net is my current favorite site for blogging information. Darren Rowse is the author and he is also on twitter. Please leave a comment if you are aware of other blogs or books that are informative.

9. Share Passions, Dreams, Interests

You can share your passions, dreams, interests, and hobbies. On my “About Me” page I have listed areas I have worked, my education, sports I have tried, places I have traveled, and my favorite nursing theorist. Express yourself and your unique personality.

10. Social Networking

Through the process of blogging, nurses can network with readers who have similar interests from all over the world. Readers may provide insight into a different approach to health care or some new information related to your area of expertise. As well, nurses who blog on the same topics can link to each other (or to other readers who blog on the same topic) so readers can get a variety of opinions and views.

Conclusion

Blogging can benefit nurses in a variety of ways. I believe that blogging can provide Registered Nurses with a powerful tool to enhance their professional growth, promote health, and decrease risk from current illnesses on a global scale. I believe that blogging is a co-active venture between nurse and readers and I’m looking forward to a future of sharing and learning from others.

Introduce Yourself and Reveal Your Intention

I like to first introduce myself by saying my name, job title (RN), and outlining the task, questionnaire, goal or planning session I am hoping to complete with the patient. This helps to mentally prepare the patient and helps to initiate the flow of feedback from the patient.

Keep an Open Mind

Avoid forming an opinion before meeting the patient. Verbal information from other healthcare professionals is valuable, but don’t formulate any conclusions until you have done your own assessment. Previous behavior or conversations may have been influenced by environment, medications, or their previous medical condition. As well, there is no room for bias, stereotypes, or prejudices in accurate active listening. Every patient has had individualized experiences that influence them to express who they are in their own unique way.

Assess Emotions

Is the patient demonstrating non-verbal behaviour indicating they may be sad, angry, anxious, frustrated, happy, worried, or depressed? Body language can convey many different and contradictory meanings so it is important to clarify with the patient that your observation is accurate. The patient may need to discuss their current emotion before addressing your initial intention. Helping the patient to  address these emotions first ensures your listening is patient focussed.

Non-Verbal Behaviour is Contextual

Ensure all non-verbal behaviour is assessed in the context of which it occurred. For example, viewing a patient with arms crossed combined with unhappy facial gestures may lead someone to believe the patient is unhappy, angry, or frustrated. Assessing environmental stimuli (such as a open window and cool room) that may be influencing the patient’s body language and also clarification with questions or verbally summarizing what you see and hear from the patient can ensure understanding occurs. In this example, the patient may be cold and the unhappy facial gestures may be from the discomfort of shivering. Avoid making assumptions, always clarify.

Don’t Interrupt

Don’t interrupt the verbal flow of thoughts and emotions the patient is expressing. Hindering the continuity and rhythm of conversation may cause the patient to forget to share valuable information that may affect their care.

Assess Congruency

Is the patient’s verbal language congruent with their body language? Look for non-verbal clues from the patient. There have been situations where I have asked the patient a question and their answer is not congruent with their body language. For example, in my practice I commonly ask patients if they are experiencing any pain. There have been times when the patient’s answer is no, however, they are grimacing, holding a body part (such as their leg or abdomen), or tensing their muscles. Explaining to the patient what I see and asking the question in a different way can help to clarify the answer.

Some patients have difficulty expressing themselves because of communication issues such as aphasia, dysphasia, dysarthria, apraxia, or confusion. Use of visual aides such as pain scales, pictures, and assessment of non-verbal signals can help to assure you understand their issues.

Assess Choice and Rhythm of Words

Is the patient speaking slowly in a monotone tone that is often seen in depressed patients, or rapidly as seen in patient’s that are excited, angry, frustrated, anxious, or in a manic state? Is the patient using aggressive words, passive words, swearing, or using positive inspiring words? Is the patient forgetful, confused, using repetitive language,or experiencing poor concentration? Listening closely to word choice and rhythm can provide valuable insight into their emotional and cognitive state.

Respiratory status can affect word choice and the rhythm of words. Assess rate and rhythm of breath while listening. Difficulty breathing may cause a patient to use very few words as they may need to reserve their energy for breathing. Any abnormal breathing patterns or rates should be promptly investigated and treated.

Assess Tone of Voice

Is the patient’s voice loud, soft, whispering, slurred, normal for the situation, or are they shouting? Assessing tone of voice can give you clues indicating whether the patient is receptive to questions or conversation about their care. For example, if the patient is using a angry loud tone of voice when you go into his room to introduce yourself, you obviously should first  assess his emotional state before proceeding with other care. Always investigate unusual voice tones such as slurred speech (which could indicate alcohol use or a medical emergency) or a soft whispering voice (could have laryngitis, be feeling depressed or fearful).

Sadly, some patients experience delusions, hallucinations, or periods of confusion due to their medical state or frustration with a roommate or their prognosis and this can cause hostility towards anyone interacting with them. Recognition of non-verbal and verbal behaviour possibly indicating hostility can help the nurse to address the client’s feelings and defuse the situation by helping to re-orientate the patient (if confused) or problem solve to prevent further aggression. Always alert other colleagues if a patient is demonstrating hostility or aggression to ensure a safe outcome. Addressing the patient’s priorities/emotions first and getting help can help prevent a bad situation from escalating.

Objective Listening

In my practice, objective listening involves listening without imposing judgement. For example, reacting to verbal hostility from a patient in an angry defensive way may cause a nurse to miss clues that can lead to the source of the hostility. Investigation may reveal the patient has had a misunderstanding because of their language barrier or a medical problem that may cause disorientation such as a stroke, abnormal blood sugar, infection, abnormal oxygen saturation levels, or another condition leading to a altered cognitive state. Objective problem solving may lead to resolution of hostility in other situations. Cultural influences, age, gender, current medical state, medications, feeling a loss of control, coping skills, psychiatric problems, and available resources can all affect our current values and how people react in various situations.

Olfactory Clues

Noticing smells and odours can alert the nurse to possible factors that may influence behaviour. The scent of alcohol, tobacco, fruity breath from hyperglycemia, odour from various infections, or body odour from someone who is sweating (from pain, fever, myocardial infarction, etc) are all olfactory clues that should be investigated and considered in active listening.

Avoid Distractions

An ideal environment for listening is often difficult to achieve, especially in a hospital setting. Hospital environments can be challenging with many visual and auditory distractions. Other distractions may that may affect the nurse or patient include exhaustion, pain, hunger, nausea, feeling hot or cold, recently receiving bad news, or feeling worried about something.

The nurse can help to decrease distractions for the patient by giving medications, food, adjust the temperature, help the patient to problem solve or lesson any stressors, choose a quiet comfortable area, or promote rest times. Nurses can lesson possible distractions by letting colleagues know that you need some time with a patient, getting adequate rest before shifts, eating healthy high energy foods, finding a quiet space to talk, and focussing on the patient while with the patient. I believe that taking steps to lesson distractions helps patients to remain focused on the conversation they are having with you which may lead to greater insight into their medical and psychological needs. Important information can be missed with frequent distractions.

Conclusions

Avoid making assumptions while engaged in active listening. Assessing all verbal and non-verbal clues collectively can provide valuable information that can help to unveil the current psychological and physical medical needs of a patient. Clarifying with questions, verbally summarizing, and identifying feelings can demonstrate that the nurse understands what the patient is verbally sharing.

Be patient and empathetic. When you genuinely care about people it is evident in your body language. Use your non-verbal body language to let the patient know that you are listening. Eye contact (if culturally appropriate), respecting personal space, nodding your head when appropriate from time to time, leaning slightly forward to express interest, having your arms uncrossed and facing the patient while listening can demonstrate to the patient that you are listening to what they are saying. Many unwell patients feel a loss of control when they are ill and knowing that their nurse understands their medical problems and is advocating on their behalf can help them regain a sense of control and hope.  I believe that active listening empowers both patient and nurse to co-actively problem solve, advocate needs to the healthcare team, and  achieve the  highest state of health possible.

Assess Coherence

Is the client alert and orientated to person, place and time? Is the client cognitively able to make decisions or identify health goals? If the client is found to be confused/mentally incompetent following a cognitive assessment, then is there a family member/caregiver that is legally responsible for the client? I have found psychiatric consults, social work, and occupational therapy assessments to be valuable resources to sort out these issues.

Other factors that may affect a client’s cognitive abilities include infections, abnormal blood sugars, abnormal bloodwork levels such as electrolytes, low oxygen levels, exhaustion, or other diagnosis that can cause an altered mental state such as a stroke or brain cancer. Some medications, such as narcotics commonly used to relieve pain, can also affect decision making.

I have found that nurses can help increase a client’s orientation and decision making ability by checking oxygen saturation levels, blood sugar levels if relevant, and bloodwork results to ensure the results are within the normal range. Investigating acute confusion or worsening chronic confusion, ensuring a patient has adequate rest, assessing for side effects to medications, and assessing what time of day is best for decision making (some individuals have more difficulty making decisions later in the day) are also helpful to increase decision making abilities.

History

A thorough history completed at the time of the client’s admission identifies the client’s physical and psychological health concerns, current medications, types of alternative medicine used, allergies, spiritual or religious beliefs, cultural practices, and includes a current head to toe health assessment completed by the MD and nurse.

During this assessment I like to inquire about their lifestyle (active or sedentary), dietary habits, sleep issues, communication problems, disabilities, and methods the patient uses to relieve stress. Knowledge of this history helps me to customize my approach to co-actively identify goals and create a plan with the patient.

Assess Desire

Does the client have a desire to learn more about their health issues, identify goals, and understand  possible plans or paths to recovery? What are the patient’s priorities? Sometimes patients are overwhelmed by their situation,and are not able to focus on goals. Recent loss of a loved one, a traumatic event, extreme pain, depression, or being in a medically or psychologically unstable state can all influence desire. These issues may need to be dealt with first.

I have found that patients that have a desire to set goals generally have a greater commitment to identifying their goals, creating a customized plan, and have the required motivation to implement their plan.

Assess Physical Abilities

What activities of daily living is the client able to accomplish independently and what is the patient’s current prognosis? This knowledge guides the nurses, healthcare team, and client to set up realistic health care goals.

I personally believe that everyone is unique and that realistic healthcare goals are set with the understanding that anything is possible. I have seen many miracles and believe the human body is very resilient and with the right resources can recover from a variety of illnesses. I believe that keeping an positive open mind is important and that patient’s beliefs can influence their recovery.

Assess Baseline Knowledge

How knowledgeable is the patient about their diagnosis and current healthcare concerns? Are there knowledge gaps that need to be addressed by the nurse or other healthcare professionals. While teaching the patient health professionals should consider the patient’s educational and professional background and ask the client how they prefer to learn? There are many methods of teaching/learning that the patient can choose from to maximize their learning experience. I have found that increasing a client’s knowledge base before goal setting can enhance a client’s capacity to identify their goals and make sound healthcare choices.

Communication Abilities

A sore throat, persistent cough, laryngitis, shortness of breath, aphasia, dysphasia, dysarthria, apraxia, visual or auditory impairments, and inability to speak the local language are examples of health conditions that can make communication a challenge. Consultation with a speech language pathologist or speech and language therapist, can help identify the type of disorder that is affecting a patient’s communication abilities and will provide guidance to the rest of the health care team and caregivers that are communicating with the patient. Use of a interpreter that is fluent in in the patient’s language or that is competent in American Sign Language (ASL) can also help to ensure the patient can express their concerns, knowledge gaps, and desired goals. Lip reading, writing on paper or computer, are additional ways patients can communicate.

I have also found that ensuring the patient has their hearing aides, glasses, and any medicines to lesson persistent cough or shortness of breath also helpful. In my practice, I have found that sitting face to face, maintaining eye contact (if culturally appropriate), listening to a client without interrupting, repeating what I have heard to ensure understanding, speaking clearly and if necessarily loudly (for client’s with some hearing loss), discussing one topic at a time, using language that is easily understood (lesson use of medical jargon or technical terms), finding answers to questions in a timely manner, and use of required consults has helped me to foster a effective communication style with my patients. It is also valuable to listen to the patient’s tone, word choice, and non-verbal behaviour. Ask about their feelings around this experience. Ensuring time for questions and providing the patient with a written copy of their goals and plan of care are other ways to ensure the communication is clear. I believe that accurate communication between nurse, healthcare team, and the client is critically important to ensure the patient is fully supported to achieve their goals.

Tool for Goal Setting

Assess Goal-Setting Environment

I have found that home environments tend to have less distractions than hospitals and are better for goal setting. Hospital environments can be challenging with many visual and auditory distractions. Other distractions may include exhaustion, pain, hunger, nausea, feeling hot or cold, recently receiving bad news, or feeling worried about something.

The nurse can assess for these possible distractions before goal setting and give medications, food, adjust the temperature, help the patient to problem solve or lesson any stressors, choose a quiet comfortable area, or promote rest time prior to goal setting. Additional measures can be implemented for patients with visual or auditory challenges. Ensure the room is well lit to optimize sight. Place a ASL interpreter beside the nurse or the facilitator of the meeting so that they are both in the client’s view. Look directly at the patient for the entire conversation, not the interpreter. Maintain eye contact and keep your mouth visible for lip reading. Graphics, pictures, and hand gestures may also be helpful, when appropriate.

I believe that taking steps to lesson distractions helps clients to remain focused on goal identification and creating a plan. Important information can be missed with frequent distractions.

Identification of Resources

Assessment of the patient’s resources before goal identification can help identify family members or caregivers involved in the patient’s care, spiritual supports, cultural practices that are health promoting and stress relieving, alternative medicine practices, financial resources/concerns, home environment, current equipment utilized, and current specialists, MD’s,and healthcare workers involved in the patient care.

Resources that are required for successful goal achievement can be identified when goal setting with the patient. Additional hospital and community resources such as social work, speech language pathologist or therapist, occupational therapy, physiotherapy, dietitian, religious or spiritual supports, or specialists can be consulted as necessary. I believe that understanding the client’s resources can help to identify gaps and understand resources that are required for optimal health.

Conclusion

Encouraging the patient to identify their health concerns and what is the most important goal to them helps to empower them during a time when many patients feel a loss of control. I feel I can help patients to achieve their goals by linking them with resources, advocating their needs to other healthcare professionals, finding the answers to their questions as soon as possible and helping them to set goals and implement a plan. Maintaining a positive attitude (share stories of inspiration) and imagining myself in their situation helps me to co-actively create individualized goals and a care plan that is customized to their needs. It is important to remember that every patient is unique.