Our Mission. To recognize, nurture, and give voice to the importance of Caring Practices in the. North Florida/South Georgia Veterans Health System

Our Mission To recognize, nurture, and give voice to the importance of Caring Practices in the North Florida/South Georgia Veterans Health System Our Mission: To recognize, nurture, and give voice to the importance of Caring Practices in the NF/SG VHS

Winter Haven Hospital: Setting the Standard THE VA CONTIGENCY AT WHH MENTORS, COLLEAGUES, & FRIENDS

Veterans Health Administration Includes 23 VISNs or Veterans Integrated Service Networks The Veterans health Administration includes 23 VISNs or Veterans Integrated Service Networks.

Covers VISN 8 Florida, South Georgia, Puerto Rico, Virgin Islands 79 Counties 61,000 Square miles 1.7 million Veteran population 8 Medical Centers 50 Clinics In 2009, served >523,000 veterans, more than any other VISN in the country The NFSG Veterans health System covers 52 counties, >26,000 sq mi, with a vet pop of 460, 000. We currently provide care to over 125,000 veterans making it the largest VA health system in the country

North Florida/South Georgia Veterans Health System Covers 52 counties 26,000 square miles Veteran population estimated to be over 460,000. 2 Medical Centers 10 Outpatient Clinics The NFSG Veterans health System covers 52 counties, >26,000 sq mi, with a vet pop of 460, 000. We currently provide care to over 125,000 veterans making it the largest VA health system in the country

MALCOLM RANDALL VA HOSPITAL GAINESVILLE, FLORIDA LAKE CITY HOSPITAL LAKE CITY, FLORIDA The 2 hospitals are Malcolm Randall in Gainesville and Lake City in Lake City, Florida

JACKSONVILLE NORTH FLORIDA/SOUTH GEORGIA SATELLITE CLINICS TALLAHASSEE MARIANNA THE VILLAGES COMMUNITY BASED CLINICS ST. MARY S LECANTO VALDOSTA PALATKA OCALA ST. AUGUSTINE There are 2 Satellite clinics and 7 CBOCS or Community Based Outpatient Clinics.

The Growing VA: Gainesville, Florida The new $86 million, 245,000 square feet tower will provide 240 private patient rooms, large enough to accommodate family members. In addition expansion plans include an $86 million addition with 245,000 sq ft and 240 private patient rooms. A patient centered environment will be emphasized. All rooms will be private with a fold out bed for family members. An interior designer has been hired to ensure a warm and comforting environment.

The Universal Services Task Force s April 2009 report laid out 12 principles that began to define this new culture. They are: 1. Honor the Veteran s expectations of safe, high quality, accessible care. 2. Enhance the quality of human interactions and therapeutic alliances. 3. Solicit and respect the Veteran s values, preferences, and needs. 4. Systematize the coordination, continuity, and integration of care. 5. Empower Veterans through information and education. 6. Incorporate the nutritional, cultural and nurturing aspects of food. 7. Provide for physical comfort and pain management. 8. Ensure emotional and spiritual support. 9. Encourage involvement of family and friends. 10. Ensure that architectural layout and design are conducive to health and healing. 11. Introduce creative arts into the healing environment. 12. Support and sustain an engaged work force as key to providing Veteran centered care The Universal Services Task Force s April 2009 report laid out twelve principles that began to define this new culture. They are: 1. Honor the Veteran s expectations of safe, high quality, accessible care. 2. Enhance the quality of human interactions and therapeutic alliances. 3. Solicit and respect the Veteran s values, preferences, and needs. 4. Systematize the coordination, continuity, and integration of care. 5. Empower Veterans through information and education. 6. Incorporate the nutritional, cultural and nurturing aspects of food. 7. Provide for physical comfort and pain management. 8. Ensure emotional and spiritual support. 9. Encourage involvement of family and friends. 10. Ensure that architectural layout and design are conducive to health and healing. 11. Introduce creative arts into the healing environment. 12. Support and sustain an engaged work force as key to providing Veteran centered care

Caritas Implementation A Grass Roots Approach for a Systemic Effect 1. Caritas Committee 2. System Wide In-services 3. Unit Projects 4. Yearly Local-Regional Conference 5. New Employee Orientation 6. The Future 1. Caritas Committee 2. System Wide In-services 3. Yearly Local-Regional Coference 4. New Employee Orientation 5. The Future

1. Caritas Committee Subcommittee of the Professional Development Council A Caritas Resource Nurse or Jeanie /approx. 40-50 caregivers. Jeanies - symbolizes the magic (all possibilities) that can arise from the lamp of the nursing profession a salute to 2 great nurses: Florence Nightingale & Dr. Jean Watson -1 st goal is to educate our Jeanies on Caring Theory-2010 -The Caritas Committee is a subcommittee of the Professional Development Council -Designate a Caritas Resource Nurse /approx. 40-50 caregivers-some designations are by type, character of areas, some are more geographical. To date have identified 33 distinct areas in our system identified and have recruited 29 Jeanies -Jeanies a salute to 2 great nurses: Florence Nightingale & Dr. Jean Watson -1 st goal is to educate our Jeanies on Caring Theory

Logo Progress Jeanie Pin Jeanie Packets -We use Jeanie packets- CC charter, Description of Caritas Jeanie, Resource information-websites, books, promote latest ICCs, info on HeartMath and Global Coherence Initiative. Logo- Shining The Light Jeanie Pin- awarded after a certain minimal education-still developing plan, criteria, evaluation Goal of Committee Meetings-develop a cohesive group with basic understanding of Caring Theory First 6-8 mos emphasis on this education. The rest of the year will be focused on helping them plan projects and inservices for their own areas. We are using the Caritas Coach Abstracts as examples.

North Florida/South Georgia VHS Caritas Resource Nurse Education By Diane E Johnson BSN, RN & Cindy Schihl MSN, RN 13 1

Caritas Resource Nurse Light and ritual are used by individuals and groups to celebrate, heal, and reconnect with their members and their meanings. Dr. Jean Watson, Postmodern Nursing and Beyond Ritual is a way for nursing to imagine another way, of how things might be. (Watson) It is ritual and light which can create a path to reconnect nuring with its past-present-future

Caritas Resource Nurse Ritual is a way for nursing to imagine another way, of how things might be. (Watson) It is ritual and light which can create a path to reconnect nuring with its past-present-future

Caritas Resource Nurse Pinning Ceremony

Caritas Resource Nurse

Past Projects-2010 Contribution to the new Bed Tower Relaxation & Renewal Room for Nurses Week - May 6 th First local/regional conference - June 3 rd Creation of SharePoint site (intra-house webpage) FLAG (VA quarterly newsletter) Caritas Corner Creating a visual for Professional Practice Model Some projects we are currenlty engaged in include: Contribution to the new bed tower

Your Jeanies North Florida/South Georgia Veterans Health System Caritas Resource Nurses

Your Clinic Jeanies Mary Ellen Pelkey The Villages CBOC

Gainesville Jeanies Stephanie Perrin IV team Carol Bradley OR/SDSU/PACU

Caritas Implementation A Grass Roots Approach for a Systemic Effect 1. Caritas Committee 2. System Wide In-services

CARITAS PETALS OF CARING

IV Team & Supplemental Service Monthly Newsletter

The Birthday Board

Caritas/Magnet Fair- May 4 th 10 Processes- unit projects Interac;ve experience Centering Area Relaxa;on Area Presenta;ons for Magnet Watson HeartMath Awards for Nursing Excellence by CNO LeAnne Whitlow

Caritas Implementation A Grass Roots Approach for a Systemic Effect 1. Caritas Committee 2. System Wide In-services 3. Unit Projects 1. Caritas Committee 2. System Wide In-services 3. Yearly Local-Regional Coference 4. New Employee Orientation 5. The Future

Intentional Handwashing Project

Crea;ng and Sustaining a Healing Environment Can You Hear the Healing? 4A Noise Reduction Project

Effects of Noise (a review of the literature) Poor Patient Outcomes Disturbed rest and sleep Increase in readmissio n rates Decrease in patient satisfactio n Increase in length of stay

World Health Organization (WHO) US Environmenta l Protection Agency (EPA)

Noisiest 24 Monitoring time 0830-1330 90 81 Quietest time 2000-0530 68 45 39 50 23 0 dba max dba min average

Sources of Noise with Times 0730 1130 1530 1930 2330 0330 Range Staff / Range Staff Range Staff/ Range Staff / Range Staff Range TV

The Plan Turn televisions down off at night Take care of IV pump alarms quickly Answer call lights as quickly as possible Other?

The Plan Sound Ear Green outer ear Noise level OK Yellow inner ear Noise level is close to limit- time to lower the noise level Red inner light WARNING Noise level has exceeded limit bring down immediately!

The Plan Quiet Time Interven;on Occurs daily from 1330-1430 Flyer in admission packets/signs on unit Med and trash pick- up times changed Limit visitors Nurse/Tech team assist with tray pick- up offer comfort measures dim lights turn phone and pump alarms down TVs off close doors Minimize conversation No interruptions

Phase 3 Evalua6on Interventions in place at least 2 weeks Use assessment tools as in phase 1 Topf s patient survey Decibel levels/sources SHEPs score

Caritas Implementation A Grass Roots Approach for a Systemic Effect 1. Caritas Committee 2. System Wide In-services 3. Unit Projects 4. Yearly Local-Regional Conference 1. Caritas Committee 2. System Wide In-services 3. Yearly Local-Regional Coference 4. New Employee Orientation 5. The Future

1 st Regional Conference June 2010 Goal: Provide Educa9on on Caring Science & Prac9ces to local healthcare prac99oners Collabora9ve Effort Florida Sunshine Consor9um NF/SG VHS UF College of Nursing WCSI Approx 100 amendees & par9cipants Profits to Caritas Coach Scholarships

Caritas Implementation A Grass Roots Approach for a Systemic Effect 1. Caritas Committee 2. System Wide In-services 3. Unit Projects 4. Yearly Local-Regional Conference 5. New Employee Orientation 1. Caritas Committee 2. System Wide In-services 3. Yearly Local-Regional Coference 4. New Employee Orientation 5. The Future

Caritas Implementation A Grass Roots Approach for a Systemic Effect 1. Caritas Committee 2. System Wide In-services 3. Unit Projects 4. Yearly Local-Regional Conference 5. New Employee Orientation 6. The Future 1. Caritas Committee 2. System Wide In-services 3. Yearly Local-Regional Coference 4. New Employee Orientation 5. The Future

Current/Future Projects-2011 Caring Stories-all staff & council meetings Caritas Fair for Nurses Week- May 4 Caritas Workshop for Leadership-June 2 Noise Reduction Initiative Jeanie Pinning Ceremony- Nov Intentional Hand Washing Research Project

Intentional Handwashing Project

Intentional Handwashing Project Key Components of the Theory of Human Caring: The Caring Relationship The Caring Moment Caritas Processes

Intentional Handwashing Project However, job, family, & life stressors can interfere with our best intentions & practice

Intentional Handwashing Project Objective: To provide a simple, time-efficient tool which allows nurses to center themselves and return to the balanced and calm core of inner self Make contribution to Caring Science

Intentional Hand-washing Project Hand Washing -Opportunity to stop and reflect (15 seconds is enough) -Already part of nurses day, no additional tasks to accomplish or fit into busy agenda -Use time to release the past experience, come into the present moment, be open for next patient s needs - Use simple reminder on mirror by sink

Intentional Hand-washing Project Anticipated Outcomes Short Term Long Term Nurse feels less fatigued at end of day Nurse feels more open and mentally clear Nurse feels greater professional satisfaction Reduce burn out, improve nurse retention Increase emotional availability for relationships Enhance clinical judgment/critical thinking Engagement of professional practice through use of creative ideas, enhanced problem solving, collaboration

Intentional Hand-Washing Project PLAN Initial staff survey In-service staff Place small, but clearly visible plaque on mirrors of all sinks on unit Post staff survey

Intentional Handwashing Project Measure Outcomes: -Qualitative -Find tool -Post Survey -IRB approval

Intentional Hand-Washing Project OUR HIGHEST INTENTION

Jean Watson s Caritas Processes in Motion at The Villages VA Outpatient Clinic

PROCESS ONE: CULTIVATING THE PRACTICE OF LOVING KINDNESS AND EQUANIMITY TOWARD SELF AND OTHER AS FOUNDATIONAL TO CARITAS CONSCIOUSNESS Nurses Daily Prayer Circle. We pray daily for ourselves, for each other, and for our Veterans

PROCESS THREE: Primary Care Nurse, Brenda Gamble s Caritas Project. Brenda made these beautiful Mala beads that are used for meditation. She also describes how this practice can help nurture our spiritual self and enhance our nursing practice.

PROCESS EIGHT: Music Therapy in the Primary Care Waiting Area

PROCESS FOUR: DEVELOPING AND SUSTAINING A HELPING TRUSTING Your Superhero You are my patient, and I am your nurse... And so I pledge to do all in my power to promote and protect your health and well-being. To empower you with knowledge. Trust that I truly care about and respect every aspect of you Body, Mind, and Spirit. I will utilize all of my knowledge, kindness, caring and love to support and defend the unique and vital individual I see in you. To the best of my ability, I will be there for you. Primary Care Nurse, Donna Carroll s Caritas Project. Drawing and Poem.

PROCESS SEVEN: ENGAGE IN TEACHING LEARNING EXPERIENCE THAT ATTENDS TO UNITY OF BEING & SUBJECTIVE MEANING-ATTEMPTING TO STAY VA Nurses Play Military Bingo at the VFW Retirement Home in Fort McCoy, FL

THANKS TO THE VILLAGES OPC NURSES! MaryEllen Pelkey Original Idea and Presenter Carmen Ortiz Took all Pictures Brenda Gamble and Donna Carroll Presented Caritas Projects Anne Solow and Julie Alban Developed and Edited PowerPoint Presentation

5. The Future Goals: 2 Caritas Coaches on Committee by 2012 Establish a cohesive group with proficiency in Caring Theory and > 75% meeting attendance record 75% of Jeanies to an ICC by 2012 90% of all point of care staff to recognize and have basic understanding of the impact of the Caring Relationship and the Caring Moment on patient outcome. Yearly day-long retreat on Transformative Caring Principles for all point-of-care staff Interactive website linked with other VAs Goals: 2 Caritas Coaches on Committee by 2012 Establish a cohesive group with proficiency in Caring Theory and > 75% meeting attendance record 75% of Jeanies to an ICC by 2012 90% of all point of care staff to recognize and have basic understanding of the impact of the Caring Relationship and the Caring Moment on patient outcome. Yearly day long retreat on Transformative Caring Principles for all point of care staff Interactive website linked with other VAs

Thank you to Our Shining Light The Original Jeanie

And Thank You to our most gracious hosts: THANKS FOR LISTENING!!! The Nurses of Winter Haven Hospital If any one image pervades nursing s history, it is the light of the Nightingale's lamp, radiating the meaning of nursing s light and energy to the world. Dr. Jean Watson, Postmodern Nursing and Beyond