KentuckyOne Nurse Advancing Nursing Across KentuckyOne Health
Winter 2016
Inside News At a Glance
2 Critical Need to Balance Work, Home and Self 3 RN Health Coach Transforms Patient Experience 4 Caring for Patients in Rural Kentucky 5 A Nurse Perspective: Ornish Reversal Program 6 Reaching Beyond the Hospital: KentuckyOne Health Transitions of Care 7 Healthy Babies, Healthier Kentucky
Nurses Reach Beyond the Hospital
8 Community Service and NPDP
We Are One. Nursing Vision: KentuckyOne nurses are leaders distinguished by evidence-based practice, exquisite service to others, and safe, effective care. Nationally renowned for our innovative practice environment, our nurses will achieve the highest level of outcomes by partnering with patients, their families, other care providers and our communities. Edward Allen Sizemore, DNP, APRN, NP-C Rural Family Nurse Practitioner
The Critical Need to Balance Work, Home and Self By Velinda Block, DNP, RN, NEA-BC, SVP, System Chief Nursing Officer
As I sit down to write this letter on a cold and snowy morning, my arms are a bit shaky and my legs are exhausted. I was up before 5 a.m. and started my day by working out hard at the gym for an hour. My body is telling me that I pushed it too far, and my mind is telling me, “Way to go!” By starting my day with a focus on me and my health, I am invigorated, energized and ready to be my best at work. As nurses, we are nurturers by nature – giving ourselves completely to the care of others is what we do. And this is what makes us so great at what we do. But, if we’re not careful, this can mean we put ourselves last, behind family members, friends and work. We may find that we rush home from a hard day at work to begin another long list of things we must get done, leaving little, if any, time for ourselves. Over time, this routine of self-neglect can impact our health, both mentally and physically.
Be an Author! Write About Your Passion for Nursing The Spring edition of KentuckyOne Nurse will celebrate our passion for nursing in honor of Nurses Week. If you would like to submit your story to be considered for this special edition, please include what inspires you to be a nurse and why you have chosen to work at KentuckyOne Health. Email your article (150 words or less) to KentuckyOneNurse@ kentuckyonehealth.org by March 31.
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Developing a regular exercise routine helps us in many ways. We can manage weight and blood pressure while we increase bone health and reduce stress. Some people find that setting aside time for meditation or reading can provide them with the needed balance to be fully present in their lives and at their best. We are more centered and more successful at everything we do if we are good to ourselves. It seems pretty simple, but it can be a real challenge to make these changes in our busy lives. As we start this new year, it is always a great time to step back, reflect on the past year, and course-correct if needed. I am not talking about setting “New Year’s resolutions,” but rather about setting priorities for you. You are outstanding men and women, and I am honored to work with such a talented group of nurses. I challenge you to focus this year on finding the balance between work, family, friends and most importantly…YOU!
RN Health Coach Transforms the Patient Experience By Dana Simpson, RN, KentuckyOne Health Partners
As an RN health coach with KentuckyOne Health Partners, I feel honored to serve my patients and strive to make a difference in each of their lives. Our personalized, care management approach and direct connection, allows us to support all aspects of our patients’ care. My work with a patient recently stands out as an example of how we can transform patient care across Kentucky. I started working with Frank Maraman in late summer 2015. Frank is a very active 83-year-old who was happy to begin working with a health coach to help him stay on a path of wellness and receive assistance with orthopedic issues. He worked part-time as a brick layer and has always been an active member of his community. As Frank’s designated RN health coach, I began working closely with Dr. Renu Mehta, his primary care physician, to provide the very best care for Frank.
What is a RN health coach? A RN health coach helps patients better understand how to stay healthy or get healthy. They do this by working with patients on how to manage their health conditions with medications and diet. Health coaches provide personalized care coordination to patients challenged by our complex health care environment.
One day Frank called me to tell me about his difficulty with ambulation and balance. I suggested that Frank see Dr. Mehta immediately and arranged a visit that same morning.
Dr. Mehta saw Frank and ordered several diagnostic tests. I met Frank and his family for the appointment. During this meeting, Frank’s family expressed their concerns, which led me to request that Dr. Mehta receive the test results STAT. While the results indicated nothing acute, I remained in close contact with Frank until the next steps were determined.
Dana Simpson, RN with patient, Frank Maraman
Later that evening, Frank’s daughter-in-law called me to say that Frank’s condition had worsened. I told her to take Frank to Sts. Mary & Elizabeth Hospital’s emergency room immediately. Frank was admitted to the hospital, where after further testing it was discovered he had a tumor compressing and encasing his thoracic spine. Frank was immediately transferred to Jewish Hospital, where surgery was performed that evening to remove the tumor. Frank is now in the outpatient locomotion program five days a week at Frazier Rehab. He continues to grow stronger each day. Without my careful monitoring and intervention, Frank’s health and well-being may have been jeopardized, and his outcome and experience may not have been as positive. Our RN health coaches are able to connect with patients most in need to ensure they get the very best care and have the best experience at the lowest possible cost. The health care system can be overwhelming for patients, particularly for those with many chronic conditions, elevated health risks, or for the elderly. It can be confusing to remember what instructions a doctor gave, why you are still taking a particular medication, or when you should get your first colonoscopy, for example. This is why the number of RN health coaches is growing in Kentucky. RN health coaches help patients achieve better quality of care and outcomes, and assist them with navigating the health care system. In this new era of health care which focuses on value versus volume, KentuckyOne Health Partners and our RN health coaches are dedicated to serving this need. We have the unique ability to touch patients’ lives throughout their health care experiences. Our goal is to provide better health, better care and better experience at a lower cost. As an RN health coach, I am proud to be a part of this new paradigm of medicine.
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Caring for Patients in Rural Kentucky By Edward Allen Sizemore, DNP, APRN, NP-C, Rural Family Nurse Practitioner
Imagine growing up in rural Southeastern Kentucky, with limited access to health care. Now, imagine that same small area with a handful of committed practitioners dedicated to caring for their local community. For me, it was practitioners like this who were the clinical backbone of health care in my rural community. Their vision and morality moved me, and as I care for my patients, I work to share this inspiration in all I do, every day.
The clinic opened in Wolfe County in September of 2012. The vast majority of patients had no health insurance. Many had received no formal health care in over 10 years. There were other obstacles affecting their ability to obtain care, such as a lack of transportation, no access to medicines, and a scarcity of specialty providers. I was challenged by these circumstances, but even more dedicated to finding solutions and delivering high quality care for the people of this community. I was able to get pharmaceutical companies to provide low-income patients with chronic conditions free medications. I was also able to communicate with specialty providers via telehealth. Patients were able to see these providers without having to arrange transportation and leave their familiar surroundings. They received the care they needed quickly without added costs or missed work due to travel.
Nancy Brandenburg, LPN and Edward Allen Sizemore, DNP, APRN, NP-C, with patient, Janice Dulin
My professional career began as a floor nurse on a medical/ surgical floor. I worked in other acute care settings too, recognizing that we never stop learning and are continually growing as professionals. Eventually I wanted more autonomy, so I pursued an MSN and became a family nurse practitioner. After graduation, I worked in a busy family practice at a local university. During my time there, I wished for even more autonomy and to be able to assess patient outcomes. I learned from my mentor about a clinic opening in rural Eastern Kentucky. I was never one to want to be a solo health care provider, but off I went!
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I now work in a rural clinic in Powell County and face many of the same challenges. But am back to solving the problems! There are a handful of patients without health insurance; there are no specialty providers in the immediate area; and transportation is an issue (many of my patients walk to the clinic). I manage the care of patients of all ages with numerous chronic comorbidities, such as hypertension and diabetes, and am dedicated to the community that I serve. How rewarding it is to work in a rural community! My patients tell me often how grateful they are to have this care available in such a small, rural setting. My staff and I are active members of the community and participate in local health fairs, Walk with a Doc and Career Day at the local elementary school. I will always remember that the seeds of my passion for caring sprouted not in undergraduate or graduate school, not while working on a busy medical/surgical floor, but instead in a rural Kentucky community served by devoted providers—caring for their neighbors, friends and community.
A Nurse Perspective: Ornish Reversal Program By Pam Oshana, MSN, RN, BC, Ornish Reversal Program and KentuckyOne Healthy Lifestyle Centers, Medical Center Jewish Northeast
was my calling ever since I was really young, so nursing is all I wanted to do. After graduating from school, I quickly realized that I loved working with people who had coronary disease, but I also realized that I was often dealing with patients at the end of their lives.
Pam Oshana, RN with Paul Greiling
Can you describe what impact the Ornish Reversal Program has had on our participants? Honestly, it’s unbelievable how much our participants have improved in just the past nine weeks. Some of them have lost weight, some have lowered their blood pressure, some have stopped taking medications—but all of them have seen improvements, and big ones at that.
Because of that, I started asking myself, “How can I help prevent people from getting to this point?” I’ve been wondering about that ever since. Well, the Ornish Reversal Program is my answer. I believe that, as clinicians, we need to look at people as holistically as possible, and this program does a better job of that than anything I’ve seen. This is exactly where I want to be: reversing heart disease, documenting results, working with participants— those have been my passions my whole life. It’s perfect for me.
Has the program changed your lifestyle choices in any way?
Additionally, over the course of the program, the participants have grown to be really close to each other and to us—the provider team.
I have a family history of heart disease—my dad died at 58 of a heart attack—so I’ve always been conscious about living a healthy lifestyle.
How has the Ornish Reversal Program helped you accomplish your goals as an RN?
What has delivering the program been like for your team?
I became a nurse because I’ve always wanted to help others. I’ve felt like that
We became very close as a team during the
implementation of the program, and that feeling has continued throughout this first cohort. The team’s members have become closer to each other than we ever were before. It has made us far more effective as a team, which will continue throughout future cohorts.
What does offering this program mean for KentuckyOne as a health system? Kentucky has consistently ranked poorly in regards to health with high rates of obesity, smoking, diabetes, heart-related disease, and other health challenges. But now things are changing, and KentuckyOne is at the forefront of that change. By offering the Ornish Reversal Program—which helps participants transform their lives through nutrition, exercise, group support, and stress management— we’ll be able to sustainably generate well-being in our community, and hopefully help Kentucky move its way up the statistical rankings of health in America.
The Ornish Reversal Program helps undo years of heart disease The Ornish Reversal Program — the first program to slow, through sessions focusedofon lifestyle stop and reverse the progression heart disease by focusing on four of your life: changes inelements four areas.
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Reaching Beyond the Hospital: KentuckyOne Health Transitions of Care By Bev Beckman, RN, CPHQ, ACM - Health Connections Transitions of Care Project Manager, Ginger Florence, RN - VNA Health at Home Health Connections Transitions of Care Program Manager and Lois Justice, MSW, BSN, RN, Transitional Care Coach
Introduction
Central and Eastern Program
Discharge and transition from the hospital setting to home is a critical time for patients where nurses are making a huge impact. Some patients, especially those with chronic disease who are at high risk for readmission to the hospital, need extended support in the community. In response to this need, KentuckyOne Health has developed programs that create a foundation for high quality, cost-saving and safe care transitions from the hospital to home. Programs have been developed that provide holistic support to both the urban and rural patient population. These programs include follow-up phone calls, home visits and tele-monitoring.
The central-eastern program, modeled after Eric Coleman’s Care Transitions, began as a CHI research study in 2010. The program has expanded, and currently serves Medicare patients hospitalized with a primary diagnosis of Chronic Obstructive Pulmonary Disease, Congestive Heart Failure (CHF), Acute Myocardial Infarction, or Community Acquired Pneumonia at Saint Joseph Hospital, Saint Joseph East, Saint Joseph Mount Sterling, and Saint Joseph London.
Louisville Program Thanks to a grant from the CHI Mission & Ministry Fund, the Health Connections Transitions of Care Program was developed by hospital and home care nurse leaders from the three Louisville hospitals, along with VNA Health at Home, to assist low-income, vulnerable patients in the community. The program is patterned after two evidence-based care transitions programs: the Eric Coleman Transitions Intervention and the Camden Coalition Interdisciplinary Care Transition Intervention. Both are focused on patient-centered goal setting to assist with both medical and social needs. Potential participants are identified while they are still hospitalized using LACE, a high-risk readmission assessment tool. Those identified are invited to enroll in the free 90-day outreach program. The community team becomes a “trusted friend” in patients’ homes.
0.7 Days Mean Inpatient Visits /100 0.6
0.80 0.8 Visits/100 Days
0.7
0.60 0.6
0.660
0.5 0.8
0.5
0.4
0.40 0.4
0.3 0.6
0.7
0.396
0.3
0.5 0.2
0.20 0.2 0.00 0.0 Baseline
0.44
0.0 0.2
0.43
Intervention 0.1 0.0
6
0.45
0.4
0.1 0.3
0.1
In 2011, through the CHI Mission and Ministry Fund, the team was able to purchase Philips monitoring equipment that transmits high-risk CHF patients’ weight and vital signs to the RN. This allows the team to intervene earlier, make informed clinical decisions, and allows patients to have involvement in their care. These practices have had a tremendously positive effect on reducing bed days and readmissions.
Transitions of Care programs are a holistic, collaborative effort between the hospital, community and medical home. These programs continue to demonstrate excellent patient outcomes and value to the patient and Mean ED Visits /100 Days health system. KentuckyOne Health will continue 0.49 to grow evidence-based programs that assist the vulnerable, medically fragile and chronically ill 0.48 patients in our hospitals as they transition back 0.478 0.47 into the community. 0.46
Visits/100 Days
0.8
The program has evolved to serve patients in 18 counties throughout central and eastern Kentucky. It makes use of RNs who are strategically located to serve patients in rural and underserved areas. Home visits and phone calls focus on accurate medication reconciliation, timely physician follow-up, patient recognition of the red flags that signal worsening conditions and patient goal setting.
0.446
Baseline
Intervention
Healthy Babies, Healthier Kentucky By Mary Jo Westerfield, BSN, RN, Director of Obstetrics, Saint Joseph London. Contributions by Shelly Sanders, BSN, RN, Manager of The Birthing Center, Chemotherapy and Infusion Services and Timeshare Clinic, Saint Joseph Mount Sterling
Many clinicians are familiar with the Healthy People 2020 initiative of the U.S. Department of Health and Human Services. Nevertheless, many may not be aware that Healthy People 2020 has breastfeeding objectives, as breastfeeding is one way to improve maternal, infant and child health.
in 2014, the Saint Joseph London Hospital Birthing Center staff, with the support of the Volunteer Services Coordinator, renovated a consultation room into a dedicated lactation room. Today this room is in constant use by employee moms and many have expressed their gratitude for this support.
Healthy People 2020 has several goals associated with breastfeeding as seen in the table below. These goals reflect CDC benchmarks.
Another important way to support this initiative is by reaching out to the community. Saint Joseph London partnered with the Southern Kentucky Health Education Center to host an educational maternity fair in 2015. At the fair, the birthing center nurses promoted the benefits of breastfeeding to the attendees.
Age
Healthy People’s Breastfed Goal
Kentucky’s CDC Report Card
Children Having Been Breastfed
81.9%
61.3%
Breastfed at 6 months
60.6%
31.5%
Breastfed at 1 year
34.1%
22.8%
In the spirit of KentuckyOne Health’s mission, those Saint Joseph facilities with women’s services are supporting and promoting the Healthy People breastfeeding objectives and have either a certified lactation counselor or International Board Certified Lactation Consultant (IBCLC) on staff. Sarah Willoughby, RN, and Paula Marcum, RN lead the efforts at Saint Joseph Mount Sterling and Saint Joseph London. Both consultants offer breastfeeding support to mothers who have delivered. They offer breastfeeding classes and are on call to answer any questions new mothers may have.
KentuckyOne Health and our nurses are dedicated to supporting the Healthy People’s 2020 breastfeeding objectives. There is much work left to be done, but with the support of our dedicated employees, physicians and nurses, we can improve Kentucky’s report card on breastfeeding and the health of our mothers and infants. This initiative is one more way we bring wellness, healing and hope to all, including the underserved.
Kacey Bolton and her daughter, Sophia, practicing Kangaroo Care.
Additionally, on the birthing units, they practice Kangaroo Care. This practice involves placing a newborn in skin-to-skin contact with his or her mother immediately after birth. Kangaroo Care has been proven to improve breastfeeding rates. Although breastfeeding rates have risen in Kentucky over the last decade, there is an opportunity for improvement. One approach aimed at improving these rates is to increase the proportion of employers that have worksite lactation programs. With that in mind,
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Community Service and Nursing Professional Development Program By Jerri Passo, MSN, RN, RN-BC, NPDP Chairman
“Life’s most persistent and urgent question is ‘what are you doing for others?’”
Lena Campbell, RN, enrolled in NPDP, with Marilyn Greer representing Flaget Memorial Hospital at the Bourbon Festival. Both are educating the public on cancer prevention and heart health.
– Dr. Martin Luther King, Jr.
Community Service is a vital part of the nurse’s professional development journey. Nursing, as a profession, can influence change, improve health, and make a profound difference in the lives of our patients and our families—not only in the work environment, but also through community involvement. Nurses have unique skills and education, as well as vast experience within the health care arena, which allow them to be powerful forces of change in the health and wellbeing of the community.
In fact, community service is such a powerful element in the professional development of a registered nurse, the Nursing Professional Development Program (NPDP) recognizes the community service contributions of our nurses by allowing them to use community activities to support their NPDP application. Individuals receive points toward NPDP levels by participation in and/or development of a community service activity. Potential activities allow nurses to apply current
KentuckyOne Nurse Editorial Board Velinda Block, DPN, RN, NEA-BC; Katrina Bates, BSN, RN; Pam Elzy, MHA, MSN, RN, RN-BC; Cinda Fluke, M.Ed., BSN, RN, NEA-BC; Patrick McCool, BSN, RN; Lisa McQuillen, MA; Marguerite L. Newton, BSN, RN, CCRN-K; Tammy Sizemore, BSN, RN, CNML; and Elizabeth Walden, MA.
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skills to benefit others or develop new ways to serve the community. A few examples include: health assessment activities at community events or schools, speaking at a local venue on cardiovascular risk reduction, volunteering at a community clinic, or partnering with a violence prevention task force to educate young adults about bullying. The possibilities are endless. To learn more about the Nursing Professional Development Program, and further explore the community service opportunities, visit the professional development page on insidekentuckyonehealth.org/nursing.
KentuckyOne Nurse is a quarterly publication produced by the KentuckyOne Health clinical communications team. To contribute news articles or announcements, please contact KentuckyOneNurse@kentuckyonehealth.org or 502.560.8374.