Most new year's resolutions are constant dichotomies, between more and less. Eat less, exercise more, read more, work less, learn more, complain less[horizontal ellipsis] the list goes on. Each year, we try to be reflective and prepare for the personal and professional challenges ahead.
The best advice has always been to reflect on the things that you love and places where you find value and happiness. Inevitably, my work always comes in a close second to family and home. The hospital has been a wonderful place to practice, learn, and grow. Today, it is as exciting for me as it was on my first day as a new graduate in the intensive care unit (ICU), different and changed, but still full of wonder and challenge. Each year, I make resolutions to help guide me through new challenges.
This year is a time to embrace what is new and embrace a new health care system. This issue, and the work to come in DCCN this year, will address what is new as we confront the challenges and changes ahead!
To guide this year's resolutions, it is timely to consider some of the following issues.
NEW TECHNOLOGY
If you have one resolution this year, it may be to embrace and learn about new technology. We are making tremendous strides toward the fully integrated electronic medical record. We must embrace this challenge; it is a certainty. Telemedicine and remote patient management will become routine. Mobile devices will continue to provide us with mechanisms to stay connected to our patients in the critical care environment and through many care transitions. Issue such as alarm fatigue, discussed in this issue by Purbaugh, will continue to be addressed in innovative ways.
NEW MODELS FOR INTEGRATIVE CARE
In 2014, we need to expand the use of alternative and complementary care. In this issue of DCCN, Hahn, Reilly, and Buchanan show us innovative and cost-effective ways to deliver integrated care in the acute care setting. Their model for a Volunteer Reiki Training program is brilliant! This model supports the goal of a healthier work environment for our staff, families, and patients. And, it is cost-effective!
NURSING EDUCATION MODELS
Ruth-Sahd challenges us to look at education-practice gaps, a timely topic for our first issue of 2014. As educational offering include distance learning, online and hybrid course work, we must consider that there are different ways to enter nursing and provide clinical support. The advent of many nurse internships and residency programs will continue to provide innovative models for preparing the new workforce.
NEW PATIENT CONNECTIONS
Technology and patients working as part of the care team will transform us. Soon patients will be connected to their live medical record as their vital signs and biometrics are collected and transmitted automatically. Much of how we communicate with patients will change. We may stay connected to our patients as they heal at home and continue to manage their own care. Perhaps they will feel less alone, more supported.
One randomized controlled trial in Kenya showed the effectiveness of text messaging to improve outcomes of HIV treatment as providers used weekly interactive follow-up check-ins to ask patients how they were doing, with phone calls but added a weekly text message to patients with a single word-"Mambo?" ("How are you?"). The intention was to promote self-care rather than issue timed medication reminders. Motivational messaging is a new term, an innovation. Some patients report feeling cared for and supported.1 For others, it may lead to reminder fatigue. Together, we will figure out a balance.
In the ICU, patients feel connected cell phones are close at hand. They ask to "face time" with family members as soon as they are extubated! Others hold up their phones to transmit the scene they view from their ICU beds or conference in family and friends as the team makes rounds.
NEW CARE MODELS
Also in this issue, Dillman, Mancas, and Jacoby describe some of the burdens we have felt when caring for the uninsured. Often unspoken, these concerns are very real for us. These issues should be invisible to us; it should not matter, but often it does. A new model to provide improved care to all citizens has been long overdue. However, the influx of newly insured patients will require us to think differently and design new models and new points of care.
To make the Accountable Care Organizations (ACO) work, hospitals and health systems are hiring dozens of new nurse practitioners. Most of these new models use nurse practitioners and physician assistants.
Also part of the medical home and ACO push are drugstore giants such as Walgreens and CVS/Caremark, which are linking with traditional providers of medical care, helping coordinate patient treatment with pharmacists and nurse practitioners in their retail clinics.2 Achieving this goal may require changes in policy, such as laws to expand the scope of practice for nurse practitioners. In the acute and critical care settings, we are expanding the scope and roles of nursing with some innovative roles such as the "attending nurse," as part of a new care delivery model.3 Incentives such as these were developed in response to the Institute of Medicine's call for health care redesign and new models of care in 2001.4
And finally, Nogler tells us that new models are needed to prepare patients and families for end-of-life care. Although we are hoping for the best, we as providers owe it to our patients and families to prepare them, and support each other, throughout the process.
It is a time to think differently, resolve to learn new things, and to become innovators within our practice. Enjoy this New Year; make resolutions to learn, grow, embrace what is new, and resolve to become an innovator!
Kathleen Ahern Gould, PhD, RN
Adjunct Faculty
William F. Connell School of Nursing
Boston College
Chestnut Hill, Massachusetts
References