Greetings from the Chief Nursing Officer

AT THE FOREFRONT NURSING EDITIONW IN T ER /SPR ING 2013 U N I V ER SI T Y OF CHICAGO MEDICIN E 3Nursing Education: Ready for the Greatest ChallengesBY AMY ALDERMAN | STAFF WRITERMonths of planning and training bythe Center for Nursing ProfessionalPractice and Research (CNPPR) helpedmake for a smooth transition at theCenter for Care and Discovery.From the early days of last summerthrough the weeks following theFebruary 23 Patient Move Day, a teamof 20 in CNPPR labored to help prepare aworkforce of more than 2,300 people.“We’re a small group, but we’ve beensmall and mighty to get the job done,”said Clinical Nurse Educator Mary AnnStokas, RN, MSN, OCN.Headed by Nursing Education ManagerEmily Lowder, RN, PhD, NE-BC, andDirector of the Center for NursingProfessional Practice and ResearchKatherine Pakieser-Reed, RN, PhD,the group of educators and specialistsdivided and conquered the technologyand infrastructure of the new hospitalpavilion based on their expertise.“As a group, we’re really strong together,”Lowder said. “When you have newindividuals working on new equipment to30-year veterans using telemetry for thefirst time, nurse educators are the peoplewho are on the front line, and the pointpeople for implanting that technology.”For example, Stokas serves as a clinicalnurse educator for the Oncology CareCenter. Her experience as a consultant andmentor helped bridge the research behindthe curricula and the teaching of clinicaland non-clinical staff on the new systemsat the Center for Care and Discovery.Perioperative Services Clinical NurseSpecialist Rena Thompson, APN, MSN,CNS-BC, gave employees an overview ofthe operating rooms, which include thenew Image Stream interfacing system.Seeing clinical and non-clinical stafftake to the new systems made the workworthwhile, Thompson said.“In some of the classes, I saw people’sfaces light up,” she added. “To me, thathas been great to see.”During some sessions, nurse educators andspecialists trained 200 people per day.“We relied heavily on CNPPR to helppave the way into the Center for Care andDiscovery, and they showed us that theywere more than ready for the task,” saidchief nursing officer, Debra Albert, RN,MSN, MBA, NEA-BC, vice president ofPatient Care Services, and Patient MoveDay chief commanding officer.The many opportunities to walk thefloors and learn about the new surroundingspaid off, said Nastassia Gurganus,RN, a procedures nurse who works inprep and recovery.“I was happy because we got moreexposure to the facility where the suppliesare, and the equipment I’ll need. That’smy priority,” she added.Outfitting clinical staff with leading-edgetechnology and skills at the new hospital isjust one of the many behind-the-scenesinitiatives that clinical nurse educatorsand clinical nurse specialists have led sincetheir department centralized in 2005.Nursing education has trained nonclinicalstaff, including those from security,valet and food services, on wayfinding andon how to use equipment, such as theautomated external defibrillator.“Seeing non-clinical staff understandhow to use an AED and how it doesn’t justapply to treating people at a hospital, Ithink it empowers people,” Stokas said.Outside of preparing for the newhospital, the CNPPR team spreads itsindividual strengths across the MedicalCenter, from on-boarding new staff tocompleting annual competencies of over1,500 nurses, nursing assistants and ORand ER technicians. Clinical nurseeducators constantly work in tandemwith advanced practice nurses, includingclinical nurse specialists on evidencebasedpractice in all units in inpatient,pediatrics and adult care.Emily Lowder, RN, PhD, NE-BC, center, with Michele Ackerman, RN, MA, left, Senior Hospital OperationsAdministrator, and Elise Lauderdale, RN, MSN, OCN on Patient Move Day. Photo by Harvey Tillis“You have that ability to learn fromeach other, and build resources together,”Lowder said. “I think that’s where wedraw a lot of benefits.”

AT THE FOREFRONT NURSING EDITIONW IN T ER /SPR ING 2013 U N I V ER SI T Y OF CHICAGO MEDICIN E 5Great moments in our historyPhotographed are: A. J. Carlson,E. O. Jordan, Frank Billings, R. Lillie,B. C. H. Harvey, R. R. Bensley, andWilliam Rainey Harper.1892 University of Chicago opens.Founding President William RaineyHarper envisions a medical schooland a hospital.1898 Harper forms an affiliationwith Rush Medical College forclinical training of medical students.1927 Billings Hospital opens with215 beds, housing Departments ofMedicine, Surgery and Pathology.University of Chicago MedicalSchool opens October 31, forgeslinks with the University’s basicsciences departments.1930 Bobs Roberts MemorialHospital opens, with 80 pediatricbeds.1931 Chicago Lying-in Hospital, with140 beds, opens on the Universityof Chicago campus. Also, theMcElwee-Hicks Hospital opens.1953ArgonneCancerResearchHospitalopens.1961 Goldblatt Pavilion opens,for outpatient services.1967 Wyler Children’s Hospitalopens with 100 beds.1977 Surgery-Brain ResearchInstitute opens; includes 17operating rooms and extensiveresearch space.1983 The Bernard A. MitchellHospital is dedicated, with 468beds. The new Chicago Lying-inHospital opens.1996 Duchossois Center forAdvanced Medicine opens.2005 Comer Children’s Hospitalopens.2009 The Gwen and Jules KnappCenter for Biomedical Discoveryopens.2013 The Center for Care andDiscovery opens to patients. Thenew hospital pavilion is the singlelargest health care investment onthe South Side.Nurses on Patient Move Day: From Mitchell and DCAM to the Center for Care and Discovery

AT THE FOREFRONT NURSING EDITIONW IN T ER /SPR ING 2013 U N I V ER SI T Y OF CHICAGO MEDICIN E 7Theorists, CON T I N U ED F ROM PAGE 6Kristen Swanson, RN, PhD, FAANSwanson Theory of CaringKristen Swanson emphasizes that nursesbring with them a body of professionalknowledge. The dean of University ofNorth Carolina at Chapel Hill School ofNursing, Swanson has investigatedpregnancy loss extensively since the1980s and has developed the SwansonTheory of Caring.Like Watson, Swanson believes thegoal of a nurse is not necessarily to curepatients. Rather, a nurse seeks to bringabout well-being in patients by engagingin “informed caring,” in contrast to thecare family and friends typically provide.That’s possible because nurses arearmed with scientific understanding andexperience in their field.Nurses must believe in their patients’ability to look forward to a meaningfulexistence, seeking to understand eventsin their patients’ lives through their eyes.They must also express to patients thatthey are available, assisting in their careand enabling them to help themselves.For more information about Swanson, goto https://www.mc.vanderbilt.edu/root/vumc.php?site=evidencebasedpractice&doc=40293Virginia Henderson, RN, MANeeds TheoryVirginia Henderson frames the nurseas an extension of a patient’s will.Henderson, who passed away in 1996,maintains a considerable influence in thefield of nursing: The American NursesAssociation refers to Henderson as a“modern legend” and Indianapolis is hometo the Virginia Henderson InternationalNursing Library.Like Orem, Henderson emphasizes theneed for nurses to help patients care forthemselves once again. She lists 14 basicfunctions and activities with whichnurses assist patients, such as breathing,eating, sleeping, worship and recreation.Her definition of nursing is notable as oneof the first to gain widespread acceptance.It is the “unique function of the nurse,” shesaid, “to assist the individual, sick or well,in the performance of those activitiescontributing to health or its recovery (orto a peaceful death) that he would performunaided if he had the necessary strength,will or knowledge.” She adds that the nurseshould “do this in such a way as to help(the patient) gain independence as rapidlyas possible.”For more information about Henderson,go to http://currentnursing.com/nursing_theory/Henderson.html.Dorothea Orem, RN, MSN EdSelf-Care Deficit Nursing TheoryThe late Dorothea Orem describes nursingas an “art,” a “helping service” and a“technology” enabling patients to take careof themselves. Orem spent more than twodecades in the field of nursing and nursingeducation before she developed herSelf-Care Deficit Nursing Theory.According to Orem, a nurse’s rolecan be “wholly compensatory,” “partlycompensatory,” or “supportive-educative,”depending on the severity of the patient’scondition. Patients who can care forthemselves completely do not requirenurses or may only need them to provideadvice and instructions for that care.When they are unable to take care ofthemselves, patients acquire what Oremdescribes as a “self-care deficit,” at whichpoint the nurse’s role is “compensatory,”meaning this nurse gives care to patientsthat they would provide themselves ifthey were healthy enough to do so.Read more about Orem athttp://currentnursing.com/nursing_theory/self_care_deficit_theory.html

AT THE FOREFRONT NURSING EDITIONW IN T ER /SPR ING 2013 U N I V ER SI T Y OF CHICAGO MEDICIN E 8Critical Care Outreach Team Makes Early Lifesaving CallsBY AMY ALDERMAN | STAFF WRITERA group of six critical care nurses armedwith eagle-eye vision for what are oftenunrecognizable predictors of cardiac arrestamong high-risk patients are on the job atthe University of Chicago Medicine.UCM has a strong history with providingrapid response to changing patientconditions. The initial team, in 2005, wasreferred to as the Medical EmergencyTeam (MET). This transitioned to theRapid Response Team (RRT) in 2008.Now, in 2013 the team has evolved to theCritical Care Outreach (CCO) team that issolely dedicated to providing rapidresponse calls. The CCO is tasked withspotting the subtle traits of appendingcrisis and assisting nurses and physicianswith treatment before the need to call a“Dr. Cart” (A.K.A. Code Blue) arises.“We are giving nurses and physiciansanother pair of eyes and ears,” saidPatient Care Manager Jenny Taylor, RN,BSN, MS, CCRN, RN-BC. “Respondingearly on to the changing patient condition —this affords us time for appropriateassessments and interventions that canmake a huge difference for the patient.”The Critical Care Outreach (CCO) Team’sultimate goal is to prevent cardiac arrestsfrom happening outside the ICU.“In 2011 and 2012, 28 percent of the cardiacarrests at UCM happened outside of theICU. We hope with the CCO nursing teamin place, we can decrease that numbersignificantly,” said Meredith Borak, RN,MSN, quality resuscitation consultant.There are triggers that nurses identifyto activate an RRT, such as increasedrespiratory rate, chest pain, or mentalstatus changes, but the CCO nurses usecriteria to round on specific patients.Those patients include ICU transfers,prior Rapid Response Team patients,and patients about whom the charge nurseis most concerned.Aside from these triggers, nurses andphysicians should also trust their instinctsand call the Critical Care Outreach Team“if they just feel something is off with theirpatients but they can’t place what it is,”Taylor said.“I think we needed to bridge the gapbetween the ICU and general floors,” saidMiquela Duran-McConnell, RN, CCRN,who transitioned from the MICU to theCritical Care Outreach Team.Previously, rapid response calls wereanswered by patient care managers andpatient care support nurses. With theexpansion of the medical center and basedon the utilization of rapid response, it wasdecided that a dedicated team shouldsupport these 24/7 calls.Director of Critical Care Iliana Staneva,RN, MSN, MBA, CCRN, NEA-BC, whowas instrumental in getting this team inplace, said, “The need was clear.” “Weneeded a separate team,” she said. “Thesymptoms of mortality aren’t always easilyrecognizable early on. To prevent them,you need to have a trained team to roundon patients early on.”Miquela Duran-McConnell,RN, CCRN, checks CamillaWhitaker’s lungs two daysafter the Rapid ResponseTeam was called to herroom in Mitchell when shehad difficulty breathing.Photo by Amy AldermanCritical Care Educator Pat Gwizdalski, RN,BSN, CCRN, was instrumental in theorientation process to help prepare themfor their new role. Preliminary data showthe team already is making a positiveimpact on patients, and critical careoutreach/rapid response calls haveincreased since the team has been in place,said Borak.“It is early, but we can already tell thedifference,” Borak said. “The team is veryprofessional and adamant about explainingwhat they feel needs to be done for thepatient. When you go back and look at thesteps they’ve taken — they’ve been spot on.”Svetlana Modylevskaya, RN, BSN, startedwith the Critical Care Outreach Team inmid-January after working for an agencyin various ICUs for several years.In addition to working with nurses andphysicians, Modylevskaya feels she is apatient advocate, intervening to help avoidcardiac arrests from happening on thefloors outside of any ICUs. “I feel I amguiding my patients through a critical timeusing my critical thinking skills,” she said.To activate an RRT, dial 147 and requestan RRT/CCO to a particular room. Formore information about the team, contactTaylor at jennifer.taylor@uchospitals.edu.

AT THE FOREFRONT NURSING EDITIONW IN T ER /SPR ING 2013 U N I V ER SI T Y OF CHICAGO MEDICIN E 9Witt Honored for Excellencein Radiation TherapyNursing AchievementsBY JEFFREY BISHKU-AYKUL AND MARY STROKASTAFF WRITERSClinical Research Nurse Mary Ellyn Witt,RN, MS, AOCN, has been named thewinner of the 2013 Oncology NursingSociety’s Excellence in Radiation TherapyNursing Award, and smiles are in order.Specializing in caring for head and neckcancer patients, Witt has focused ondental preservation for patients andsurvivors who have undergone radiation,which can cause rampant tooth decay.“I have always felt my strongest asset wasbeing a patient advocate,” said Witt, whofirst worked at the University of ChicagoMedicine from 1976 to 1981, then cameback to stay in 1994. “I haven’t done it atMary Ellyn Witt, RN, MS, AOCN. Photo byMegan E. Dohertythe bedside for many years, but it isamazing what you can do by just askingquestions and making positive changeswith your nursing practice.”In the last decade, Witt has noted,the increase in the number of head andneck cancer survivors has presented newchallenges. Among them: ensuringthat patients who have undergonesuccessful radiation therapy maintaina healthy mouth.“Our number of survivors has grownand so have their survivorship needs,”Witt said.A survey Witt conducted in 2008revealed that only about one in 10 patientsis a regular user of a nighttime fluoridetray — a mouthpiece that helps deliverextra doses of fluoride to preserve teeth.The research led her to conclude thatmerely providing patients with thewritten steps necessary to maintain oralhealth did not guarantee their compliance.Instead, “the relationship between thepatient, oncology team, and the dentalhygienist should begin immediatelyfollowing a cancer diagnosis.”Her findings were published lastOctober in a continuing education articlein Registered Dental Hygienist magazine,garnering praise from dentists, as wellas hygienists.Anil Lal, executive administrator ofUniversity of Chicago Medicine’sDepartment of Radiation and CellularOncology, lauded Witt’s accomplishments.“Mary Ellyn’s work speaks for the qualityand uniqueness of our head and neckprogram,” Lal said. “The departmentis honored to have nursing that not onlyprovides good quality care but alsodevelop innovative practices andcontributes to research.”“It is amazing what youcan do by just asking questionsand making positive changeswith your nursing practice.”Mary Ellyn Witt, RN, MS, AOCNHer work has also gained internationalrecognition, leading her to present lastyear at the European Oncology NursingConference in Geneva, Switzerland.Despite all of the attention, Wittremains humbled.“I never thought this little survey backin 2008 would send me to Switzerland orlead to a publication in a dental hygienistjournal,” she said.Witt will receive the Excellence inRadiation Therapy Nursing Award at the38th annual ONS Congress conferenceon Thursday April 25 in Washington, D.C.

AT THE FOREFRONT NURSING EDITIONW IN T ER /SPR ING 2013 U N I V ER SI T Y OF CHICAGO MEDICIN E 10A view of a typical operating room suite inside Kiev’s heart center. Photo by Andrey Ibragimov, RN, BSN, CNORA Heart-to-Heart with Ukranian NursesBY MEGAN E. DOHERTY | STAFF WRITERA University of Chicago Medicinenurse spent some of his recent vacationtime opening bridges to his Ukrainiancounterparts. General Operating Roomnurse Andrey Ibragimov spent two daysof an October trip home to Russia touringthe Ukrainian National Cardio-ThoracicCenter in Kiev, the capital of Ukraine.General operating room nurse AndreyIbragimov, RN, BSN, CNOR, stands outsidethe Ukranian National Cardio-Thoracic Centerduring his October visit. Photo courtesy ofAndrey IbragimovThe modern center, open in 2007,is small, specialized and instructional forboth its similarities and differences toits large American cousins. “They areactually living the lean philosophy,” saidIbragimov, RN, BSN, CNOR.Our year-old kaizen initiative isstandard practice at the Ukrainian center,he explained. “They are trying to be wisewith all their supplies and resources. It’senlightening that people can do so muchwith so little.”While 60 types of surgeries areroutinely performed at the University ofChicago Medical Center every day, Kiev’sis a low-volume facility, topping off at amaximum of 10 heart cases a day.Since Ukrainian nurses lack supportstaff like surgical technicians to help inthe operating room or environmentalservices staff to clean rooms, the nursesdo it all. These multitaskers also toilwithout the convenience of electronicmedical health records or internal email.“In a way, it’s bare bones. The amount ofresources we have here is really amazing,”Ibragimov said.Ibragimov, 29, immigrated to the UnitedStates from Russia in 2005 to become anurse and advance his education. Hejoined the Medical Center last year andwill earn his Bachelor of Science inNursing in 2013.While in Kiev, he fielded numerousquestions from his Ukrainian counterparts,who were curious to know howthings work in Chicago. He presented themwith a book of U.S. thoracic surgeryguidelines as a gift.“The director of the heart center wouldlove to bring some staff here to establishsome sort of education for them, likespending a day in one of our ORs, shadowingus and seeing how they couldstreamline their own processes,”Ibragimov said. “I would love for them tocome here, and even show them how weconduct nursing research.”

AT THE FOREFRONT NURSING EDITIONW IN T ER /SPR ING 2013 U N I V ER SI T Y OF CHICAGO MEDICIN E 11DAISY Award WinnersHumbled by NominationsBY AMY ALDERMAN AND MEGAN E. DOHERTYSTAFF WRITERSUniversity of Chicago Medicinedirect-care nurses have been honored bytheir colleagues and patients as winnersof the Diseases Attacking the ImmuneSystem (DAISY) Foundation. One nurseis honored each month with a surprisepresentation at his or her department.Every DAISY is given a sculpture called“The Healers Touch,” a DAISY lapel pinand a certificate. Cinnamon rolls are anextra DAISY perk. The founders of theorganization require all award presentationsto have cinnamon rolls, a favoritefood of J. Patrick Barnes, the founders’ lateson, who suffered from a clotting disorder,Idiopathic Thrombocytophenic Purpura.Anna “Apple” Umali, RNWhen Anna “Apple” Umali, RN, learnedthat the family of a dying man might notbe able to see him before he passed, sheraised funds and arranged for travel andfood for his family — all in one day. In amatter of hours, the patient’s family wason a train from Southern Illinois toChicago, and they were able to see him“just in the nick of time,” she said.Holding “The Healers Touch” sculpture, SayedSaad Iqbal, RN, BSN, is the December winner ofthe DAISY Award. Photo by Megan E. Doherty“We really helped that last moment ofhis to be full of love and family,” Umalisaid. This is one of many reasons HaroldInocencio, RN, nominated Umali forthe February DAISY Award.Umali forms long-lasting relationshipswith her patients and their families, andshe continues to dedicate her time as avolunteer nurse across internationalborders. She volunteered in the Philippinesafter the tsunami and in orphanages inKenya and Cambodia. This June,she’ll accompany a team led by J.P. Kress,MD, associate professor of medicine anddirector of the MICU, in a clinical volunteertrip to Haiti.“She goes above and beyond her nursingduties and responsibilities,” Inocenciosaid. “She continues to touch lives andmake a difference in her family andpatients’ lives.”Syed Saad Iqbal, RN, BSNA nurse resident for a little more thanhalf a year, Syed Saad Iqbal, RN, BSN,calls work in the multispecialty unit atthe University of Chicago Medicine his“home-away-from-home.”Patient Care Manager Sandra Armstrong,RN, MS, who worked with Iqbal in 3SWat the time he received his nomination,says he’s a great influence in creating ahomey atmosphere.“He’s just one of those upbeat people,”Armstrong said. “He has a great smile.He does his job very well, but I don’t thinkthat’s it. It’s that personality that winsyou over. He’s kind and a little bit funny.”Iqbal was nominated for the DAISYaward by a patient who said he made herfeel comfortable, not only through hispain management, but also through hispositive attitude.Being nominated by a patient washumbling. “I have this very emotionalattachment to this institution. Wherever Iam or whatever I am, it’s because of thisUniversity. This is my opportunity togive back,” he said.Patient Care Manager Aurika Savickaite, RN, BSN, left, celebrates with the February DAISY award winner,MICU Staff Nurse Anna “Apple” Umali, RN. Photo submitted by Katherine Pakieser-Reed, RN, PhD

AT THE FOREFRONT NURSING EDITIONW IN T ER /SPR ING 2013 U N I V ER SI T Y OF CHICAGO MEDICIN E 12SAVE THE DATE: APRIL 12The University Of Chicago Medicine Department Of Nursing2013 NURSING RESEARCH AND EVIDENCE-BASEDPRACTICE SYMPOSIUMGwen and Jules Knapp Center for Biomedical Discovery900 E. 57th St., Chicago, IL 60637The University of Chicago Medicine Annual Nursing Research and Evidence-BasedPractice Symposium is a forum for UCM nurses and other health care professionals, andnurses from external organizations. The purpose is to share research and evidence-basedpractice experiences, disseminate study findings, and network with colleagues with theultimate goal of improving the quality and safety of patient care, and enhancing healthcare delivery.The keynote speaker,Melanie CreaganDreher, RN, PhD,FAAN, is the JohnL. and Helen KelloggDean and Professorof the College ofNursing at Rush University in Chicago. Inaddition to her role as dean, Dreher hashad a distinguished research career as theprincipal investigator of several community-basedstudies examining the healthand development of women and childrenin Jamaica. She will present “Creating aCulture for Evidence-based Practice.”Speaker KathleenCalzone, RN, PhD,APNG, FAAN, isa senior nursespecialist in thegenetics branch ofthe Center for CancerResearch at the National Cancer Institutein Bethesda, Maryland. She is a pastpresident of the International Society ofNurses in Genetics. Calzone will speakon the topic “The Genomic NursingScience Blueprint.”Click here to learn more: http://home.uchospitals.edu/pdf uch_034114.pdfThe cost to attend the symposium is $95 for University of Chicago Medicine and BiologicalSciences Division employees.Nurses WeekEvents May 6–10E ACH DAY OF T HE A N N UA LCELEBR ATORY W EEK H A S A T HEME.DETA ILS W ILL BE A N NOU NCED ONT HE IN T R A N ET HOME PAGE,http://home.uchospitals.eduMonday, May 6Unit Celebrations and RecognitionDAISY AwardTuesday, May 7Acknowledging accomplishments of the past yearNurses completing education, certifications,Publications, Conference PresentationsAPN Presenation: APN Roles: Past, Presentand FutureHuening AwardWednesday, May 8Nursing Grand RoundsHow to get started in publishingBlessing of HandsThursday, May 9Celebrating Nursing ExcellenceNursing AwardsFriday, May 10Movie Day“Nurses: If Florence Could See Us Now”Discuss the NDNQI Survey With Your TeamPatient care managers are encouragedto discuss the results of the NationalDatabase of Nursing Quality Indicatorssurvey with nurses in their unit.Having an open discussion will addbackground to the data compiled in theNDNQI survey, said Katherine Pakieser-Reed, RN, PhD, director of the Centerfor Nursing Professional Practiceand Research.“That discussion is your best way ofinterpreting the survey,” Pakieser-Reedsaid. Discussing the survey results alsoprovides an opportunity for an opendialogue about the changes that havetaken place since it was conductedlast fall. Following these discussions,patient care managers should create anaction plan based on the results andcomments from staff, Pakieser-Reed said.CongratulationsCheers to Lindsay Gregory, RN, MSN, CPN,Emily Lowder, RN, PhD, NE-BC, andFatenah Issa, MS, for having their abstract“There’s an App for That: Bringing NursingEducation to the Bedside” accepted for aposter presentation in April at theAmerican Society of PeriAnesthesiaNurses conference in Chicago.