Looks that Heal

Texas Health Harris Methodist Fort Worth Hospital have some of the best nurses and support staff in the country. It’s not just because we’re a Magnet designated hospital although that’s a green flag (opposite of a red flag?) We’re a special hospital because we hire and keep the most qualified staff – staff who have a caring spirit to make the patient’s stay excellent. Since a hospital patient cannot see this “caring spirit” inside of us we have to express what we feel inside. This blog’s focus is on non-verbal communication and how the power of a smile is sometimes overlooked. Our facial expressions hold more power then what we say.

Misunderstandings are widespread as we attempt to read each other’s non-verbal communication, mannerisms, and gestures. For instance, it’s possible for an excellent nurse to “bend over backwards” and provide great care for a patient but a frown or angry appearance can cause these heroic actions to be misconstrued regardless of the nurse’s intent. I’ve handled numerous concerns as a Patient Advocate where the patient felt the nurse was not polite but could not give me any quotes since it was all non-verbal.

Smiling doesn’t come naturally to me and it used to be common for someone to walk up to me and say “What’s wrong?” My response was usually “HUH? I’m walking to my office!?” I still remind myself every day (or more) that I need to smile just enough that it won’t appear to people that I’m frowning while we’re having a discussion. There have been times when I’ve talked to sick patients, some with terminal cancer, who still have the courage to smile at me ---I walk out of their room and realize that I’m smiling too …without having to remind myself. It’s contagious! In a hospital setting where patients need emotional as well as physical healing, it’s the right thing to do.

I think that even if you’re having a bad day and don’t feel like smiling, you should still offer a small smile. Think about this, dedicated hospital staff are at times literally running around to serve others, but it’s possible to run and smile at the same time. If I walked into a patient’s room, a small smile would say what I feel inside, which is “I’m here for you.” If I walked in the same room with a small frown it could easily be construed as “You’re here for ME,” which won’t lead to excellent care. The old saying that a picture is worth a thousand words is true but so is this contrary saying: Without a sincere smile, it’ll take a thousand words to explain Texas Health Harris’s caring spirit.

- Craig Pomykal

Patient Advocate

Enjoy the chicken soup...and take care of yourself!

Well, it's flu season again, or put another way, it's STILL flu season. First the H1N1, then the "routine" seasonal flu. Both. Neither. Another choice? Allergies?
Just don't panic. Remember to be vigilant, but don't over react. Take care of yourself and your loved ones. Perform good hand hygiene, early and often. Don't join groups if you feel sick. Monitor your temperature. If you think you have the flu, with symptoms of aches, sore throat, fever, and even nausea and diarrhea, think about staying home. Treat yourself like you're sick. Treat the symptoms, but most of the time you don't need any antiviral antibiotics. By the way, obtaining an H1N1 nasal swab isn't much help. The swab is only positive a fraction of the time among patients who are positive for H1N1. As a result, a negative test doesn't rule out the H1N1 virus. By all means, if you're seriously ill, contact your physician. But the majority of us will suffer through a mild version of the flu, and need only to treat the symptoms -and stay away from crowds for a little while. ( I wonder how many people who felt sick still managed to show up at the first Cowboy's home game Sunday night? ) A dose of common sense will go a long way to helping us get through this novel flu season. Enjoy the chicken soup.

- Dr. Joe Prosser
vice president and chief quality officer

Are you ready for flu season?

The flu season has arrived early this year and with the new H1N1 virus continuing to cause illness, hospitalizations and deaths in the US. Flu shots and hand washing are two of your best defenses against this virus.

Many of our Faith Community Nurses have taken a proactive stance by providing information to their congregations on this flu season. There is so much information being circulated and it’s difficult some time to separate fact from myth. Here is some helpful information below:

To minimize exposure to communicable diseases, it is vital that individuals seek the appropriate level of medical care. Individuals who think they might have the H1N1 flu, particularly those who fall into a higher-risk category, should call their physician to make an appointment.

The CDC has identified the following warning signs that adults may need immediate medical attention:
· Difficulty breathing or shortness of breath;
· Pain or pressure in the chest or abdomen;
· Sudden dizziness;
· Confusion;
· Severe or persistent vomiting; and
· Symptoms that improve but then worsen along with a fever.

In the meantime, the easiest ways to protect yourself from the flu is to get your flu shot, cover your mouth and nose when you sneeze, often sneezing into your elbow is the most efficient way, clean your hands often, and remind children to practice healthy habits, according to the CDC.

What is the proper hand-washing technique? To ensure hands are effectively cleaned, follow these six steps:
1. Wet hands with warm water.
2. Apply soap.
3. Rub hands together for at least 15 seconds (sing "Happy Birthday" twice or the "ABCs.") Be sure to wash front and back of hands, between fingers, around and under fingernails.
4. Rinse well, letting water drip off fingers, not run down arms.
5. Dry hands with paper towel.
6. Turn off water with paper towel. (Remember that dirty hands turned the water faucet on.)
Alcohol-based hand rubs and disinfecting wipes also may be used.

Flu shots are one of your best lines of defense with the flu. Our executives even received their flu shot yesterday. My question for you... have you had your flu shot this year?

I encourage each of you to practice good hand washing, cough manners and get a flu shot.

- Paulette Golden, RN, MSN

Manager of Community Health and Faith Community Nursing

Tough decisions and advanced directives

I recently had the opportunity to get to know one of our patients here at Texas Health Fort Worth. I came across this patient while spending some time with Carol Scheidel, our program manager for clinical ethics. This patient did not have many visitors, so I would make regular visits to learn about their patient journey and give them some company during the stay with us. This patient had an interesting case, but to comply with our good HIPAA policy, I’ll dance around any sensitive information. The patient suffered from a complication that pretty much left them and their family with tough decisions to make. The patient and the family had a difficult time making these tough medical decisions. Decisions on treatment and prolonging life are tough. The physicians and nursing staff did their best to explain the outcomes of the patient's options while respecting their right to decide how they wanted to proceed. It took quite a few days and a second opinion from an additional physician for them to finally make their decision.

This patient’s journey helped me better realize the great teamwork that goes into taking care of our patients. I was able to observe how our physicians, nurses, case managers, ethics representative, chaplains, dietary, and environmental services all worked together to take care of this individual. This coordination helped teach me how important each of these groups are in delivering quality care.

This case also taught me about the importance of filling out and distributing advance directives to our families. By filling out advance directives, we give our families and care providers the necessary information they need to make medical decisions based on our wishes. To receive a copy of an advance directive booklet that you can complete, please email carolscheidel@texashealth.org.

- Scott Spencer
Administrative Resident

Proper Nutrition is Vital to Healing

Meet Melanie Williams, registered dietitian. She came to Texas Health Harris Methodist Hospital Fort Worth confident that she would make positive contributions to the culture of care. And in fact, she has.

When I asked her about her job and caring for her patients, she said: “With my rehab coverage I usually see patients over an extended period of time. Some of the most challenging patients are our patient's that come to us unable to swallow or eat orally.” One of Melanie’s strongest virtues is patience, which is demonstrated in her daily patient contact.

She went on to describe the process saying “as their swallow becomes stronger and they begin their diets I am faced with trying to adjust tube feeding and work with them on their meal plan to promote oral intake”. “In many cases these patients are weaned from tube feeding. At discharge they are eating most of their meals and meeting their nutritional needs. It is very rewarding to see these patients through their progress and work to help meet their needs.”

- Hugh Gittens

Executive chef at Texas Health Fort Worth

Healthy Bites for Football Parties

It’s football season! Time for Monday Night Football Parties and tail gates gatherings. Many people consume excess calories while snacking on their favorite “munchy foods” at parties.
Pizza is a favorite for most…especially during a football game. However, now that football is on almost every night of the week…you might want to watch your pizza intake or learn how to make it healthy! The “Flatout Pizza” is a great alternative and is actually full of nutrients!

Let’s breakdown “The Flatout Pizza” ingredients…When making common recipes healthy, the key is to choose low-fat, whole grain ingredients. In the case of the Flatout pizza, we start with a whole wheat flour-oat fiber base, the Flatout® wrap. It contains 9 grams of fiber AND 9 grams of protein. Next we add ½ cup tomato sauce and ½ cup 2% Mozzarella cheese which adds vitamin C and calcium. Top off with 1 cup of your favorite veggies to get in a variety of vitamins, minerals and fiber.

“The Flatout Pizza” Recipe
1 Flatout wrap
½ cup Barilla Tomato & Herb Pasta Sauce
½ cup grated 2% Mozzarella cheese
2 oz lean sliced Canadian Bacon
1 cup non-starchy veggies of choice
Toast in oven on “broil” for 1-3 minutes
Slice into pizza squares & enjoy!!!

Nutrition Facts per Pizza:
Calories: 390, Carbohydrate: 36 gm, Fiber: 14.5 gm, Protein: 39.5 gm, Fat: 14 gm, Cholesterol: 60 mg

If you have to order pizza out…
When ordering pizza at a restaurant there are some tips you can use to help make the pizza healthier. First, start by getting thin crust as many thick crust pizzas have lots more calories. Next, try to get a ham/veggie, chicken/veggie or veggie pizza. Toppings such as sausage, bacon, and pepperoni are very high in fat and thus not the best option. Then, blot your pizza with a napkin before eating to remove excess grease from the cooking process. Finally, remember that pizza is about portion size. Try to eat 1-2 slices and add a fresh salad or vegetable with it…this will increase the fiber content of the meal and help you feel more satisfied.

- Amy Goodson, MS, RD, CSSD, LD
Registered Dietitian
Ben Hogan Sports Therapy Institute
Executive Health Program

Stressed? Need to Debrief?

Everyone on our hospital medical staff has faced a crisis on more than one occasion. The continued exposure to crisis situations can take its toll on the most caring of individuals. So who will take care of the ones that take care of others? At Texas Health Resources we live by a promise- "We are individuals caring for individuals together". Part of living out that promise means we take care of each other. We encourage each other, carry each other, and (since we are a faith based hospital system) even pray for each other.
When crisis happens there are many tools that provide a means to take care of those whom are exposed to crisis. One of those tools is a "Critical Incident Stress Debriefing". More staff members are being trained in the art of CISM Debriefing at Texas Health Fort Worth in the hopes that we can build teams to provide CISM debriefings at any time day or night. When people think of crisis in a hospital setting the emergency room or an intensive care unit is what comes to mind. The truth of the matter is that crisis can occur anywhere in the hospital. Death can occur anywhere in the hospital, so can a cardiac resuscitation, anywhere there's pain and suffering a crisis moment can take place.
As a chaplain in the hospital I am heavily involved in caring for those that care for others. Despite my role as a caregiver for others and an advocate for crisis debriefing, I need care as well. This became acutely aware to me when I faced a death which touched many areas in my own life. The day before in the emergency room I had been actively recruiting people to participate in a critical incident stress debriefing. On the day I was facing a crisis it was a nurse that looked at me and asked the question "do you need a debriefing today?" (Individuals caring for individuals together). My answer was yes, I will in a little while. Unfortunately a little while or tomorrow never comes. Fortunately, I did not allow that to happen in my own life, however many health care workers never address the issues that are hurting them on the inside.
As a result of this knowledge, Texas Health Fort Worth undertook the task of studying compassion fatigue. The compassion fatigue study focused on the levels of compassion fatigue and compassion satisfaction for registered nurses and their family members. The results confirmed to us that the problems facing other health care workers throughout the country were being felt in our hospital. Some health care workers love what they do but suffer as a result of what they do. A new twist, to looking at compassion fatigue, was "what would our family members say about us?". Our families confirmed to us that we did indeed possess compassion fatigue and compassion satisfaction at our hospital.
With details of the study in hand, we are working in our hospital to reduce the levels of stress experienced by our staff. Our hospital has empowered unit based councils to discuss and address the problem. It is our hope that the unit based councils will come up with best practices that will not only affect our hospital, but give guidance to hospitals throughout the nation. By relying on our promise to help others, as well as take care of ourselves, we hope for a new day in health care!

- Angelo Betancourt

Staff Chaplain

It's Fall, but Don't Fall!

As summer winds down, we look forward to a (hopefully) cooler time of year known as fall. Being a person who focus’s on injury prevention, when I hear the word “fall”, the first thought that comes to my mind isn’t seasonal. Here at Texas Health Fort Worth, the number one mechanism of injury for trauma admissions is falls in the elderly. And we aren’t alone on that statistic. Falls are the highest reason for emergency department visits across the United States. In fact, one in three adults age 65 and older falls each year. And if they do fall, they are twice as likely to fall again. Falls should not be a right of passage as we age. This problem has become so large that the State of Texas has declared September 21-25 as Fall Prevention Week. Coincidentally, this is also the first week of the new season!
With the national focus on health care and all its complex issues, prevention is certainly an obvious choice that each of us can make. For those of us that are not in the above mentioned age group, there are still opportunities to have a positive outcome and prevent falls. Talking with your family members and friends about adequate lighting in the house, securing throw rugs, installing grab bars in the bathroom are just a few things that can make a difference. In fact, just talking about fall prevention raises awareness. I know I talk with my parents frequently about ways not to accidentally “encounter the ground”. They are independent within their community. I want them to stay that way. I am sure each of us knows special folks like my parents that bring joy onto our lives. We want them to experience the best quality of life and to share in ours. Remind them to watch their steps, be physically active and review medications with their doctor annually. I know this sounds simple, but so did the warnings they gave us about “looking both ways”. Until next time, have a glorious “incident free” fall.

- Mary Ann Contreras

Your Child's Safety - First!

Learn about child passenger safety seats from a certified child passenger safety technician. You can meet one on one with these professionally trained employees and learn the best practices for keeping your precious cargo safe. Best of all this appointment is free.

The child passenger technicians will complete about 600 seat inspections this year with a misuse rate of nearly 100%. Most errors can be quickly corrected and the parents or care taker instructed on the change. Occasionally they will find a brand of seat and a model of vehicle that are not compatible and use their knowledge and skills to make things work. They keep up with the latest recall list and expired seats. These technicians are skilled not only in the installation of seats but are also knowledgeable of the laws.

The new traffic laws as of September 1, 2009 affect the children of Texas. Senate Bill 61 amends the existing child passenger safety seat statute. The bill requires children under the age of 8 years or at least 4’9” in height to be restrained in an approved child passenger safety seat. House Bill 537 requires all occupants of a vehicle to be secured in a safety belt, regardless of their age or where they are seated in the vehicle. To schedule your free car seat or booster seat inspection please call 1-888-THR-WELL.

More than anything - remember to buckle up!

- Becky Law
Manager of Childbirth Education

From Bermuda and Turkey - how far have you traveled?

If you are a frequent follower of the Texas Health Fort Worth blog, you know that most of the entries submitted to the blog speak on the service excellence provided at our hospital. Service excellence, commitment to quality, safety, respect, integrity, are all words that often appear in the blogs. In the Executive Health Program, our goals sing to the same tune with the Texas Health Fort Worth spirit, our team works closely together to ensure that our Executives receive the highest quality of care.

One of the ways we measure our success is through our repeat clients, clients who visit us for their annual physical, year after year. Since the inception of the program approximately 10 years ago, hundreds of physicals have been conducted. Jennifer Campbell, our Exercise Physiologists, who meets with each client, says she has been able to build a relationship with the Executives and speaks on how rewarding it is to be involved each year and interact with each Executive patient. For Jennifer, she has seen some of them for the past 8-10 years; allowing her to watch them grow, grow in their health and wellness, careers and families.

I asked Jennifer to share some of her most rewarding encounters in working with the Executive's. Jennifer referred to the Executives who travel to us annually to have their physical. The display of loyalty to travel from another state and even country in some instances shows to her that we must be doing something right. Jennifer spoke on those who have traveled from around Texas, Florida, Maryland, Bermuda and even Turkey!

How far have you ever traveled for a physical? Leave your comments below.

- Clint Sanders

Finding a Physician that is Right for You!

A lot of factors go in to finding the right physician. One of the factors is at which hospitals the physician works. Here at Texas Health Fort Worth there is a rigorous credentialing process that the physician goes through. The physician completes an application and privilege card listing the types of procedures/treatments they would like to do at the hospital.

Once the application is received in the Medical Affairs Office then all of the information from their medical school forward is verified from the primary source. This verification includes every hospital where they have practiced, any extra training programs, peer references, time spent away from the practice, and a case log from the last two (2) years showing what procedures/illnesses they have performed/treated. In order to be sure that the physician is qualified to perform the procedures or treat the disease processes they are requesting, a copy of the physician’s privilege card is sent along with the request to verify that they are competent.

Questions are asked about the physician’s:
• Basic medical knowledge
• Professional judgment
• Clinical competence
• Technical skill
• Ethical conduct
• Cooperation/ability to get along with others
• Timely response to patient care needs
• Patient management
• Relationship with patient/patient’s family
• Relationship with nursing/hospital staff

Once all of these questions are answered and it is determined that the physician is competent then the physician is allowed to practice at THFW.

If you want to find a physician that is right for you, I encourage you to go here.

And if you want more information – such as what insurance they take, hours, locations, etc. you may contact Well Call – 1-888-442-7747.

Another good source of information on physicians is the Texas Medical Board. Individuals can chose to look up information on their physician. The profile will list where the physician practices, where they went to school and whether there have been any sanctions against the physician’s license. That website can be accessed at: http://www.tmb.state.tx.us/

It is important that you find the right physician for you. Take advantage of the opportunities you have to find the physician that you can have a long-standing relationship with.

- Dr. Karen Reed
Director of Medical Affairs

Trauma - an Orchestra of Life-Saving Care

Over the past three months, my time here at Texas Health Harris Methodist Hospital has been eye opening to say the least. Through clinical rotations and executive management meetings I have seen first hand the necessary composure for handling difficult situations.

One of the more astounding events I have witnessed is a “trauma situation”. THFW is designated as a Level 2 Trauma Center. This designation, like many others, requires the facility to meet numerous requirements. There are four levels of trauma with Level 1 being the highest and Level 4 being the lowest.

A Level 2 Trauma Center requires a facility to be on alert at all hours of the day. Trauma centers were established because hospitals realized that such life threatening events needed multiple specialties that may not be on call. This requires THFW to provide on call specialists, including surgeons, orthopedics, neurosurgeons, plastics surgeons, radiologists, anesthesiologists, etc.. In additional to 24 hour coverage, THFW provides outreach programs, educational programs in an effort to reduce the number of traumatic events. These programs focus not only on trauma education but on injury prevention as a whole.

The intent of this blog was not to educate individuals on Trauma Centers, but to express my appreciation and admiration for the Trauma Team at THFW. It seems as though it’s an orchestra of individuals providing life-sustaining care in the up-most distressing events. When I arrive on site to witness the care of a trauma patient, typically the whole team is waiting unvaryingly for the patient to arrive. Patients can come by family members, ambulances, and air (the majority of trauma centers have helicopters pads). Before the patient arrives, work has begun. Registration has gathered information in addition to nurses and patient care technicians reading the room. The ER physician and the Trauma Surgeon head the table as the patient arrives and delegates orders to ensure that the patient gets necessary care as fast and as safe as possible. Other disciplines are called in as needed. For example, a patient involved in a motor vehicle accident will needed multiple tests and most often the x-ray technicians are on standby outside the room waiting for the nod to come in and perform the test. As care is provided the chaplain weaves in and out gathering personal information and alerting family members of the situation and status. Once family members arrive they are given a current status and get answers to any questions the medical staff can provide. As care continues the physician and charge nurse will find time to speak with the family. Once the patient is stable family members are permitted to come back into the trauma area to see their loved ones.

These situations evolve around high-stress environments when a necessity for level headedness and compassion. I express my utmost appreciation and admiration for the Trauma Team @ THFW – Thank you.

- Melissa Reichardt
Administrative Resident

More Magnet Moments....

- Photo credit: Glen E. Ellman

The call came in....and we celebrated!

The call came in at 11:05 this morning….. There were 200+ nursing staff, ancillary staff, and executives waiting to receive the much anticipated call from the American Nurses Credentialing Center. We have spent the last three years focusing on quality patient care, nursing excellence and innovation in nursing practice. We have built stronger teams, have constructed a strong culture of performance improvement, and have redefined our nursing model to ensure that the patient is at the center of everything we do. This is a defining moment for us. We were the first hospital in Tarrant County to achieve this prestigious award back in 2005 and are again the first seeking re-designation. Re-designation is not a given it must be earned and the expectation is that you are continually advancing and growing and that you are a leader in nursing and health care. There are 360+ hospitals in the state of Texas, and currently only 21 of them have achieved Magnet designation. So we all gathered in the auditorium, with positive energy flowing, and noise makers ready, we waited for the call…..
And then the phone rang and we received the excellent news that we had been expecting- we have been re-designated as a Magnet Designated Hospital. Let the celebration begin!! Congratulations to everyone for all of their hard work and dedication to patient care. This is definitely a team sport and we couldn’t do it without everyone doing their best everyday!

And now we will begin the journey for our next re-designation which will occur in 2013! More pictures to come tomorrow...

- Karen Robeano
Vice President of Patient Care Services and Chief Nursing Officer

Make your voice heard - politely!!!

Well, deep into the dog days of August, it’s hard to hear anything on the radio or television other than the bitter debate surrounding the health reform proposals. It wears me out. Too much anger…too much shouting…too much misinformation…make it go away! We all need to work together to make our healthcare system better!

Actually I don’t think that any reasonable individual has a clue about the content of the final legislation that may eventually be offered in Washington. Certainly, in my opinion, change will come. It has to come. Our current system, for all its strengths, has many flaws, and is slowly falling apart. Let’s get past the blame game: It’s not anybody’s fault. We’re getting older and needing more care. If we live longer, we consume more health care resources. (And we are living longer. This week a report showed our average life expectancy has risen to 78. Amazing as that is, we’re not the oldest living population in the world – Japan holds that honor at 81 years average).

Back to health care reform: while most of us are “satisfied” with our health insurance, most of us are also “concerned” that we could have benefits reduced. And yes, while many people choose to go “bare” and not carry health insurance, many more have lost their benefits, their jobs, their security. I am confident that everybody feels correct in their personal view of healthcare, and what they think needs to be done to improve the model. But I also think that everyone is behaving like the blind men and the elephant – they only see a small, personal part of the much bigger picture. This fact, coupled with the fact that the ongoing debate has morphed into bitter partisan politic, does more to raise blood pressure than to reassure.

Perhaps all the stakeholders - whether legislators, executives, health care workers, insurance companies, hospitals, pharmacies, insured individuals, or the uninsured, need to take a deep breath. There is much to loose if we can’t get health reform correct, and I think we need fresh discussions that will bring balance to the debate. Only through calmer discussion can the truths be manifest. Only through mature dialogue can we reach the compromises that will begin to move us in the right direction – ensuring that we have the resources to meet the health care needs in the communities we serve. Make your voice heard – politely.

Joe Prosser, M.D.
Chief Quality Officer