Got milk?

I am so happy to share with you the birth of my 7th grand baby, Delilah Rose.

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Delilah is a rainbow baby and my daughter and son-in-law are over the moon (along with every single auntie, uncle, cousin, and grand parent ).  They are truly grateful to all the clinicians who cared for them and kept them safe.  But I'm afraid I expect more than safety.  Don't get me wrong, I am not trying to suggest that safety isn't important, of course it is.  But, gee whiz, if it was just about safety, if safety was the sole measure of excellence in healthcare we certainly wouldn't need Press Ganey, the Beryl Institute, the Patient Experience Institute and a myriad of other organizations defining quality in healthcare beyond safety.

The devil is in the details and as I observed the unfolding of my daughter's labor induction, cesarean delivery and postpartum care I was reminded that there is so much more to human centered, compassionate caring than keeping patients safe.

I mean at a minimum (and I mean bare bones minimum) we should keep our patients safe, but is that where the bar is?  Just keep them safe, keep them alive and we can pat ourselves on the back for a job well done? I'm afraid for many organizations mediocrity is alive and well; but is just OK really OK?

I spent the better part of the 48 hr labor induction period watching nurses spanning the spectrum of practice excellence.  And while I am not a proponent of a Stepford approach, I do expect consistency in compassion and kindness.  Adopting a trauma-informed approach to healthcare means that we recognize that traumatic experiences influence how we walk through life, how we show up in various situations.  A history of multiple pregnancy losses is traumatic and not acknowledging this and incorporating this awareness into the approach to care can add insult to injury.

I was particularly struck by the kindness, patience and compassion of the lactation consultants (LC).  Prior to meeting the LC my daughter received conflicting information, aggressive 'support' techniques, and disparaging commentary about her nipples (I don't think the intention was to be hurtful, but ignorance cannot be an excuse for thoughtless, unkind comments).  

I think what I am trying to get at is that we need to set the bar higher, we need to be compassionately present with the people we are invited to serve.  We must establish clear and measurable performance expectations that ensure excellence in kindness and compassion consistently and reliably.  

 “Sometimes you will never know the value of a moment until it becomes a memory.”   - Dr. Seuss

Now, as I share my perspective on this topic I do realize that it can feel uncomfortable acknowledging a trauma history. Many of us have not received training to help us talk about this subject with comfort, confidence and compassion. And so, we need to speak up and reach out for the resources and training necessary to ensure bolster our confidence and ensure consistent compassionate care.

Each and every human encounter is an invitation and an opportunity to share ourselves, our gifts and our hearts fully with another.  In this sharing we create a felt sense of safety, comfort and ease that transcends the lived moment. Join me in changing the face of healthcare, we can, should and must do better, certainly for our patients and their families, but for ourselves too!

One sure fire way to light your soul on fire and find your joy in work is to show up to your next care encounter fully present, no ego, no jargon and just simply be with the other person... and watch the magic happen. 

Take care and care well,

Mary

P.S.  If you are interested in learning how to raise the bar for compassionate excellence in your setting Caring Essentials can help.

Using breakthrough, evidence-based strategies Caring Essentials helps you achieve clarity, build congruence, and challenge you, your colleagues, and your organization to become a center of excellence in trauma-informed neuroprotective care.

The babies and families are waiting , 

Schedule your Transformation Call TODAY!

SCHEDULE YOUR CALL

 

P.P.S.  Here is your quote for the week!

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A Lot to Do Blues

Do you ever feel completely overwhelmed with your life?  Literally like you are running on a hamster wheel that you can't get off of?  I certainly have, in fact I wrote a song about it "A Lot to do Blues". (I wrote this and a series of other songs almost 20 years ago - be gentle when you listen ).

The song captures a time in my life when I was truly overwhelmed.  A single mom of six children, working full time nights, trying to make ends meet while making sure all my children were safe, fed and loved.  No small feat, let me tell you.

But this isn't about me, this is about all of us.  We all have 'stuff' in our lives; heavy, daunting and sometimes just plain scary stuff.  And what I found is that oftentimes this stuff can makes us feel very isolated, very frightened, and very inferior.

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If you are alive, you are susceptible to 'stuff'.  It's part of the human experience.  We live among humans all experiencing their own 'stuff' and for NICU folks, we work among humans enduring pretty significant, in-your-face heart aching stuff.  And yet, we often fail to see the stuff of others and consequently miss amazing opportunities to be of service, to heal, and to love. 

I see busyness as a shield that keeps us at a safe distance from the 'stuff' other people may be going through. You know what I mean, that messy, personal, here come the tears and I have no idea what to say to make it stop, be better or go away.  We say things like "I don't have time, I can't wait, I'm just too busy" or basically anything to avoid the discomfiture of raw human emotion. I mean after all, nobody wants to know your 'stuff', right?! 

But, what if we could just stop ... for one minute ... to see their 'stuff'... unfettered by the 'work' it creates for us.  If we could unbundle ourselves from our tasks, our schedules and our checklists to clearly see the human experience unfolding right in front of us, we would see ourselves - TRUTH!

What I know for sure is that we are not alone and we are not supposed to feel alone! If you've heard me speak, I always reference our shared humanity.  I believe  it's our shared humanity that allows each of us to be able to relate to other, to be there for another person, share their burden, lighten their load, empathize with them and be compassionate and kind. I mean after all when you get right down to it, we are not that different from each other.  And at the end of the day we all just want someone to try a little kindness

Take care and care well,

Mary

P.S.  If you find yourself overwhelmed, juggling lots of priorities and not knowing how you will get through it all Caring Essential's Quantum Leap Program can help!  

Here is what a recent Quantum Leap graduate had to say about the program:

Nancy Gillilan NNP is a graduate from the 2018 Spring Quantum Leap Program. Nancy shares an impromptu assessment of her program experience during a group Virtual Master Class Call. For more information about the Quantum leap program visit: https://www.caringessentials.net/quantum-leap

Using breakthrough, evidence-based strategies Caring Essentials helps you achieve clarity, build congruence, and challenge you, your colleagues, and your organization to become a center of excellence in trauma-informed neuroprotective care.

Let go of your busyness and excuses, TAKE THE LEAP!  

Schedule your Transformation Call TODAY!

 Schedule Your Transformation Call

 

P.P.S.  Here is your quote for the week!

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Imperfect Courage

I recently read this wicked awesome book entitled: "Imperfect Courage".  It was one of those reads that as I approached the end of the book the thought of it ending really bummed me out. So, I started to read it more slowly, putting it down for a couple days, then picking it up again until I got so engrossed in the final chapters I finished the book in one fell swoop. (Have you ever done that with a really good book?)

It's the only hard cover book (that wasn't a text book) that I actually used my highlighter in and then marked the highlighted areas with paper clips so I could find the wisdom Jessica shared more easily .

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One of the quotes that connected with me I found on page 18: "...choosing courage will always be the route to impact." These words resonated with me so strongly. 

It's such an amazing book I literally have been recommending this book to just about everyone I come across, (including you).  As I read Jessica's pages, through my change-maker, activist lens, I found alignment and inspiration in her words. 

That being said, choosing courage is scary, right?  Asking why we do something a certain way in clinical practice can raise eyebrows at the least and can create real turmoil for the questioner. 

I'm going to guess that these statements: 'Who do you think you are?', "We've been doing it this way for 30 years", and "This is how's it's done here" are all too familiar responses when one gets too curious (or maybe even just curious at all). 

It's just so hard to bump up against an immovable, crusty old culture that is set in its ways.  So we often 'just keep trying' doing the same things we've always done despite the fact that our 'trying' never seems to get results. 

As scary as embracing imperfect courage may seem, the mounting frustration we experience always trying but inevitably staying the same can be terrifying!

You know in your heart of hearts that there is a better way, that we can do better by our patients, their families and even ourselves.  

In the wise words of Yoda:  "Try not! Do or do not, there is no try!"

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'Try' is an escape hatch to get us off the hook; 'I'll try but you know how hard it is to change things here'.   But as we all know, anything worthwhile is worth the effort, but not effort alone. 

Change requires process and consistency, especially when we are looking for sustainability (consistency is the secret sauce). And so, imperfect courage invites us to stand up, embrace vulnerability, commit to collaboration, leverage our power to build a flourishing world for the babies we serve, the parents we support and the colleagues we bear witness with. 

We must do, but to do so requires courage and going scared!  The good news is you don't have to do it alone, nobody does.  The work I do with frontline clinicians and leaders revolves around the concept of tribe, community, and collaboration, in a nut shell, you are never alone. 

Remember the Healing Environment core measure set?  It includes not just the physical environment but the human and organizational components of the environment. These attributes of the healing environment are quintessential for success that is sustainable and measurable.  

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Bearing witness with healing intention is our way of engaging with patients and families with authenticity and love. This act of being human requires personal wholeness, professional growth, and imperfect courage! 

Take care and care well,

Mary

P.S.  If you find yourself struggling to cultivate courage to create the change you know is necessary in your practice setting Caring Essentials can help!  

Using breakthrough, evidence-based strategies Caring Essentials helps you achieve clarity, build congruence, and challenge you, your colleagues, and your organization to become a center of excellence in trauma-informed neuroprotective care.

Embrace IMPERFECT COURAGE and TAKE THE LEAP! 

Schedule your Transformation Call TODAY!

P.P.S.  Here is your quote for the week!

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What's blame got to do with it?

Have you seen Brené Brown's video on Blame?  It's wicked funny and of course incredibly true (click HERE to view)!  

Who doesn’t go to that place when something goes wrong? Blaming someone, anyone, gives us a sense of control, a kind of escape hatch that frees us from taking any responsibility.

I’m pretty sure there isn’t one person on the planet who hasn’t played the blame game at least once in their lifetime.  And what I find when I play the blame game is that I end up ruminating about whatever the heck it was that I was trying to distance myself from for hours and sometimes even days! (I’ve since learned that’s a terrible waste of time and integrity).

Brené points out that blaming is simply the discharge of discomfort and pain.  She explains that blame has an inverse relationship to accountability (which is a vulnerable place) and consequently impedes our capacity for empathy (what a wise woman ).  The challenge is that blaming is an accepted part of our culture and allows us to hide our shame and guilt for being ‘less than perfect’ (you know, for being human).

On the blaming spectrum there are two extremes.  On the one end of the spectrum is ‘gaslighting’.  That’s when a person calls into question the mental and emotional sanity of another person, insisting that their own version of reality is the absolute truth and the other person is, well, nuts.

Then there is the other end of the spectrum, the person who accepts blame for everything even when they are not responsible.  Truth be told, I’m not sure which is worse, but I guess it’s not so much a competition as it is an opportunity to be compassionate and practice empathy.

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What intrigues me about blaming is its inverse relationship to accountability.  The Merriam-Webster dictionary defines accountability as: “the quality or state of being accountable, especially an obligation or willingness to accept responsibility or to account for one’s actions.”  The thing I love about this definition is that it is about holding self accountable.  Accountability isn’t something that happens to you by outside forces. We may invite others to help us with our accountability (I have had my share of accountability buddies over the years, and still do today), but at the end of the day, I hold myself accountable.  

Much of the work I do with clinicians and teams revolves around accountability.  Folks that choose accountability are awesome folks to work with; they embrace their imperfections, celebrate vulnerability on their journey to grow, do better and achieve consistency and reliability (aka high performance).  These are not the folks that blame leadership for not investing in them, the folks that throw their hands up and say, ‘there’s nothing we can do’, ‘nobody cares about the babies’, ‘we never have any money for education’, blah, blah, blah.

The non-blamers (aka the accountable folks) take matters into their own hands, look for creative and innovative ways to change the status quo. They go for the gold, even though they may be scared, with their vulnerability and passion leading the charge. 

What’s blame got to do with it?  Blame is our excuse to stay stuck and continue to do things the same way for the next 30 years. Blame keeps us ‘safe’ from venturing into unchartered territory like change by turning a blind eye to our responsibility to First Do No Harm.  Blame gives us a sense of control when there is nothing to control. Blame has its roots in fear and insecurity. 

In healthcare it’s teamwork and collaboration that ensure quality outcomes. When we choose to blame, we undermine teamwork and sucker punch collaboration all for the sake of a 15-second rage fest that makes us feel temporarily powerful.  But, the long-term damage may very well be irreparable to the team, the quality of care delivered, and ultimately to oneself.

Here are 7 red-flag statements that may indicate you’re a blamer. 

(If any of these sound familiar, you are not lost .  Just stop and ask yourself: “What’s my responsibility? Or ‘What’s my part in this situation?”)

  1. “You shouldn’t have asked me to do it in the first place.”

Then why did you accept the responsibility for the task? Perhaps you should have refused it.

  1. “You didn’t give me enough time.”

Then why didn’t you negotiate a different deadline BEFORE you missed the one you agreed to?

  1. “You didn’t give me enough information.”

Then why didn’t you ask for more when you were given the task?

  1. “Well, I suppose you never made a mistake.”

Whether someone else has made a mistake isn’t the issue. The issue is yours- address it.

  1. “Oh yeah, well you’re__________.”

Whatever someone else may be, as in #4 above, it’s not relevant now. If you had a problem with that person prior to this conversation, you probably had ample opportunity to bring it up before this moment. Now is not the time.

  1. “What about (fill in person’s name)? Why don’t you ever say something to him/her?”

Turning the conversation to another person, especially someone who is not part of the conversation, is just another deflecting technique like #4 and #5 above. If you have a beef with someone else, take it to him or her.

  1. “You never liked me.” 
    When all else fails, turning the conversation away from behavior to the other person’s feelings about you is a classic technique for redirecting the conversation. How the other person feels about you CAN be addressed if they’re relevant, but only after addressing the concern that person originally brought to your attention.

Take care and care well,

Mary

P.S.  If you find yourself struggling in a culture of blame Caring Essentials can help!  

Using breakthrough, evidence-based strategies Caring Essentials helps you achieve clarity, build congruence, and challenge you, your colleagues, and your organization to become a center of excellence in trauma-informed neuroprotective care.


What I know for sure!

Are you an Oprah fan? I am!! I LOVE her book entitled: "What I know for sure".  I love her vulnerability and transparency sharing her journey of life lessons learned and her wisdom in recognizing that what you 'find along the way will be fantastic, because what you'll find will be yourself.' 

Since embarking on this journey of trauma-informed care in the NICU my understanding of the implications of this paradigm, across the board, has really expanded and what I know for sure is we all started out as babies.  I realize this might sound like a silly revelation but hang with me for a moment while I explain.

There is not one grown up on the planet that didn't start out as a baby and as such all those amazing things we talk about for our patients and their families, like neurodevelopment, neuroprotection, attachment, the importance of family and feeling safe, secure and connected were really important for our development too! 

And what I know for sure is that when a baby does not feel safe and secure, when their emotional needs are not met, when their physical needs of comfort and protection from pain are not addressed consistently - there are lifelong consequences. 

The ACE Study graphically demonstrated that adversity in childhood not only undermines lifelong health and wellness, but adversity in childhood is extremely prevalent, across the board (87% of the participants reported more than one adverse childhood experience)!

And now, here we are as adults with a shared experience of babyhood/childhood and I ask the question, what have we learned?  What have we learned from our childhood that can inform our adulthood and maybe even inform our work and our life?

Have we learned the power of kindness especially when one is feeling out of control, vulnerable, or afraid (have you ever felt like that?)

Have we learned that patience matters (remembering all those times we were hurried along or dismissed when we had questions and how small and invisible that made us feel?)

Have we learned the power of presence and how we can use this power to soothe and reassure another person who may be frightened, in pain, and/or feeling alone (remembering how scary it was when we were little and frightened and how a loving grown-up was able to reassure us by speaking softly and gently while maybe holding our hand or stroking our head)?

What I know for sure is that we are all the same, we share fears and pains and stories that transcend our backgrounds and our demographics.

When we embrace our shared humanness, our oneness, we open the door to impact, purpose and passion.

What I know for sure is you touch lives and impact lifetimes at home, at work and in your life!  I also know for sure that making your impact can be challenging, can be frustrating and can be overwhelming!

One small step to help you on your journey of impact is G.R.A.C.E.gather your attention, recall your intention, attune to the situation, consider your options, engage and end.  This very simple mindfulness activity can be employed anywhere, any time - try it and let me know how it works for you!

Take care and care well,

Mary

P.S.  If you find yourself struggling to align your work with your values, build your knowledge and cultivate your change leadership skills we can help!  

Using breakthrough, evidence-based strategies Caring Essentials helps you achieve clarity, build congruence, and challenge you, your colleagues, and your organization to become a center of excellence in trauma-informed neuroprotective care.

September 2018

This month's Science & Soul interview is with Sharon Bonifazi, Nurse Manager at Sierra Vista Regional Medical Center in San Luis Obispo California. Sharon will be opening our Spot Light Series - a new segment for our 2019 conference! Sharon is a passionate clinician and a compassionate, courageous leader. I love her, (I think you will too)!

Sit back, relax and enjoy this month's interview!

August 2018

We are in the throws of preparing for our 2nd Annual Congress for Trauma-informed Neuroprotective Care which will take place February 21-23, 2019 in Brugge Belgium at the gorgeous Hotel Dukes' Palace (you MUST join us!)

As a sampler (and an enticement to register), this month's interview is with Amy D'Agata, PhD, MS, RN Assistant Professor for the College of Nursing at University of Rhode Island. We are so honored to have Dr. D'Agata present at our congress! Pour yourself a cup of tea and enjoy this insightful interview with Dr. Amy D'Agata!

June 2018

Early Bird Registration is now open for the 2nd Annual Congress on Trauma-informed, Neuroprotective Care for Hospitalized Infants, Families and Clinicians - aka 2019 Science and Soul Congress

I will be interviewing various members of our esteemed congress faculty and posting the interviews in the ACUMEN to give you a flavor of what is in store for you when you join us in Brugge Belgium for our 2019 congress.  

Here is the interview with Mel MacIntyre, our opening speaker.  Mel is a Certified High performance Coach and the Director of the Soul Track for Caring Essentials Quantum Leap program.

May 2018

Hey everyone, I hope you all had a wonderfully relaxing Memorial Day weekend!  Things are in a bit of disarray in my neck of the woods as we do some pretty aggressive spring cleaning (I guess technically we are a little late in the season, but all is well as we get the job done).

The thing I like about spring cleaning (unlike regular cleaning) is that it feels a bit more mindful.  Going through closets and asking myself 'will I really ever wear that again' or 'how many CDs do we really need (if any)' or 'wow, I found a VHS tape, maybe I should keep it for historical purposes' - makes me think about  some NICU cultures.  You know the ones I'm talking about, where when asked 'why do we [insert practice] ', the answer is often 'we've been doing it this way for 30 years, it's the [fill in the hospital name] way.'  Holding onto practices (routines, rituals, or CDsjust because doesn't truly serve anyone. Certainly our patients  are not served when we fail to operate from an evidence-based, holistic and humanitarian  perspective. 

That kind of mindless, stagnant approach to care needs to be scrubbed out of existence (in my opinion).  It breeds apathy and disconnection that undermines patient safety, quality caring,  teamwork, and collaboration - everyone loses.

So, how about a challenge - identify one stagnant, out of date, dusty old practice in your clinical setting and get rid of it -  I double dog dare you :-).  And, if you're really courageous, share your dusty old practices in the comment section below.

Go ahead, do it - the babies and families are waiting.

March 2018

Article of the Month

Provenzi, L., Broso, S., & Montirosso, R. (2018). Do mothers sound good? A systematic review of the effects of maternal voice exposure on preterm infants' development. Neuroscience and Biobehavioral Reviews, 88, 42-50.

The authors present a thorough systematic review of the literature on the effects of maternal voice on preterm infant development. They preface there discoveries with an acknowledgement that the NICU, although brilliant in providing highly medicalized and technological care, in no way, shape or form, is a substitute for the maternal womb.

Studies that were included in the review were comprised of both recorded and live maternal voice. Outcome measures looked at the effect of maternal voice on heart rate and oxygen saturation; brain activation in response to maternal voice (using NIRS); incidence of feeding intolerance and time to full enteral feedings; infant behavioral and stress cues; cognitive and language development; and pain reactivity.

Despite AAP recommendations for sound levels (< 50 decibels) few studies reported information about the sound levels associated with maternal voice. One study (Panagiotidis & Lahav 2010) did report sound levels of maternal recorded voice (58.1 dB) and maternal recorded voice with biologic sounds (58.6) - both of which did not exceed the recommended safe leve of 60 dBs in the incubator (Graven & Browne 2008).

As a summary of their findings the authors suggest specific guidelines for future research but summarize by stating that "...maternal voice appears to be a promising intervention to facilitate intimacy and togetherness between mothers and infants in the NICU, both as complement and substitute of other touch-based interventions."

MUST READ and MUST IMPLEMENT!!!

Better Late than Never!

Article of the Month

Perlo J, Balik B, Swensen S, Kabcenell A, Landsman J, Feeley D. IHI Framework for Improving Joy in Work. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2017. (Available at ihi.org)

"With increasing demands on time, resources, and energy, in addition to poorly designed systems of daily work, it’s not surprising health care professionals are experiencing burnout at increasingly higher rates, with staff turnover rates also on the rise. Yet, joy in work is more than just the absence of burnout or an issue of individual wellness; it is a system property.

Burnout leads to lower levels of staff engagement, patient experience, and productivity, and an increased risk of workplace accidents. Lower levels of staff engagement are linked with lower-quality patient care, including safety, and burnout limits providers’ empathy — a crucial component of effective and person-centered care.

So, what can health care leaders do to counteract this epidemic? IHI believes an important part of the solution is to focus on restoring joy to the health care workforce.

This white paper is intended to serve as a guide for health care organizations to engage in a participative process where leaders ask colleagues at all levels of the organization, “What matters to you?” — enabling them to better understand the barriers to joy in work, and co-create meaningful, high-leverage strategies to address these issues.

The white paper describes the following:

  • The importance of joy in work (the “why”);
  • Four steps leaders can take to improve joy in work (the “how”);
  • The IHI Framework for Improving Joy in Work: nine critical components of a system for ensuring a joyful, engaged workforce (the “what”);
  • Key change ideas for improving joy in work, along with examples from organizations that helped test them; and
  • Measurement and assessment tools for gauging efforts to improve joy in work."

12 Days of Articles in Review

Day 1! December 26, 2017

Day 2 - December 27, 2017

Day 3 - December 28, 2017

Day 4 - December 29, 2017

Day 5 - December 30, 2017

Why Families Matter! This article was selected in response to a post I read on a list serv asking if mother's receiving a blood transfusion were allowed to visit their baby in the NICU. Our language matters and says something about the culture of care we create.

Our language matters and says something about the culture of care we create. 'Allowing' a mother to 'visit' her brand new, critically ill baby should be a never event - We don't allow - we facilitate, we create, we support, we CARE. Sure, you need to address the clinical needs surrounding blood administration, but the default strategy should never be to keep the mother from her child.

Here is the citation to the wonderful article by Hilde Lindemann:

Lindemann, H. (2014). Why families matter. Pediatrics,134(Suppl 2), S97-103.

Day 6 - December 31, 2017

Day 7 - January 1, 2018

Day 8 - 12 Days of Articles in Review: January 2, 2018

Family Involvement in Quality Improvement: From Bedside Advocate to System Advisor! CITATION: Celenza, J.F., et al. (2017). Family involvement in quality improvement: from bedside advocate to system advisor. Clinics in Perinatology, 44(3), 553-566.

KEY POINTS

1. Involving families in neonatal intensive care unit (NICU) quality improvement is not a new concept, but recent developments in this partnership model have helped to shape the depth and breadth of family involvement in quality improvement.

2. Families are more than stakeholders in NICU quality improvement and can serve as active partners in system design and improvement.

3. Opportunities exist to enhance partnerships with families, and seeking to improve this key relationship is imperative to nurture a culture that ensures the best possible neonatal outcomes.

Day 9 - 12 Days of Articles in Review: January 3, 2018

Day 10 - 12 Days of Articles in Review: January 4, 2018

Day 11 - 12 Days of Articles in Review: January 5, 2018

Day 12 of the 12 Days of Articles in Review: January 6, 2018

Creating improved outcomes for you & your NICU in 2018

Calling you to become a pioneer of your NICU - Join us and TAKE THE LEAP!

What if 2018 was the year you finally created the transformation you know is possible for your patients, your unit, and yourself?

You have the power! I have seen your power in the gentle way you speak to your tiny patients, the comfort you offer parents, the extra hand you extend to your colleagues, and the way you champion change in your unit.

When I present at conferences and workshops about trauma-informed care and even when I work directly with NICU staff, my primary audience is usually the choir; those dedicated, like-minded clinicians that are passionate about trauma-informed, developmental care - they are the champions, they get it.  But what I have witnessed over the years is that the real work goes well beyond engaging the champions, right?   

In order to realize sustainable transformation the real work begins by bridging the gap between the engaged and empowered champions (you) and the rest of the staff!   Identifying this gap created a huge opportunity for me to figure out how I could better help clinicians overcome the personal challenges and obstacles they face in successfully implementing changes and becoming the powerful and influential practitioners they could be.

Meeting Mel MacIntyre was a wonderful moment of synchronicity as she has devoted her 20 year career to supporting individuals, teams, and organizations to become more confident and empowered through change and achieve transformation that creates real results. Mel was the missing piece to my puzzle and had the skills and expertise to address the gap (and she's a wicked cool person too)!

We soon realized that by joining forces and combining our passions we could make a real, tangible difference in the world of neonatal care - changing lives and changing outcomes by supporting clinicians and practitioners just like you to reach new levels of performance and potential by implementing evidence-based practice changes.

But, it's not just about me and Mel - we need you to co-create a solution that speaks directly to your needs and your challenges. Your participation in this pilot program will expose even more opportunities to support you in the critical work you do everyday touching lives and impacting lifetimes!  

By Taking the Leap with us and becoming a pioneer in our pilot program you are making an investment in yourself that will take your life and career to a whole new level of success and in just 6 months you could be seeing and experiencing a new vision for your NICU and improved outcomes for the babies and families you serve. 

Your first step begins by registering your interest to TAKE THE LEAP!

Take care and care well,

Mary

November 2017

We have come a long way in our understanding of how the brain works, including consciousness which is related to the neurobiological and psychological development of the brain. A simple definition of consciousness is awareness of the body, oneself, and the outside world.

For a long time people have argued about the level of awareness newborns and infants have to the world around them and within them. If you can't remember it does it really matter, right? In Hugo Lagercrantz's most recent book: 'Infant Brain Development' he presents sound, biological evidence that consciousness begins when the thalamocortical connections have been established, which occurs around 23-25 weeks gestation. Consequently these extremely premature infants should be treated as a person, with the same human rights as an adult patient!

We remember through conscious and unconscious processes (explicit and implicit memory). And, as we are learning about the effects of early life adversity (mediated by toxic stress), the body does remember even if the conscious self does not!

The principles and practices of neuroprotective care make a difference and MUST become the true, measurable, consistent model of care for hospitalized newborns, infants and families!

"NICU staff need to keep their voices down, dim the lights when possible, allow infants uninterrupted periods of sleep, and minimize painful procedures when feasible. Parents need to be allowed to act like parents, helping to protect their child and fostering their growth and developmental well-being. In a large, busy NICU, these goals can be challenging and require a health care team with a dedicated and determined state of mind."

- Goldstein 2012

What's the state of mind in your NICU? Please consider participating in our State of Mind Survey. Survey Completion Time ~ 15 minutes

Take care and care well!

October 2017

I'm kind of obsessed with Brené Brown, but I am pretty sure I am not alone :-).

When Brené introduces the attributes of the wholehearted she talks about their courage to be imperfect, their compassion to be kind to themselves first and then to others, and finally their sense of connection as a result of their authenticity which she describes as their letting go of who they thought they should be in order to be who they were for connection. And underpinning these attributes, these wholehearted folks embraced their vulnerability believing it is their vulnerability that makes them beautiful!

As I watched the video and listened to her words I thought of my years as a bedside nurse struggling to fit in and be the nurse I thought I needed to be instead of the nurse I was. If you've ever been there you know how much courage it takes to stand in your practice - your power and honor the good work that so often gets translated into a myriad of tick boxes and tasks that must be completed before the end of the shift. We must choose the wholehearted path, which begins with vulnerability for in the beautiful words of Jean Watson: 

Maybe this one moment, with this one person is the very reason we are here on earth at this time…

Take care and care well

September 2017

Just getting back from Scotland, it was so fun to come across Caroline McHugh's Ted Talk and listen to her speak. I was not only captivated by her sweet lilting accent but also the content of her talk. 'The art of being yourself' was an intriguing topic and one I thought was apropos for this month's newsletter.

In reflecting on what is the secret sauce, or the magic behind the good work we, as clinicians, do every day in service to our patients, I think it boils down to this: being ourselves.

Cultivating authenticity must become a daily practice so that we can bring our true self to each and every encounter with patients, colleagues , friends and family. It takes courage to expose our vulnerabilities, but, it is our vulnerability that allows us to connect with other creating meaning and coherence with our shared humanity!

"Choosing authenticity means: cultivating the courage to be emotionally honest, to set boundaries, and to allow ourselves to be vulnerable; exercising the compassion that comes from knowing that we are all made of strength and struggle and connected to each other through a loving and resilient human spirit; nurturing the connection and sense of belonging that can only happen when we let go of what we are supposed to be and embrace who we are.- Brene Brown 2009

August 2017

I am humbled and grateful by the work of the authors of this month's article. I could not have imagined the explosion of research and reflection related to the concept of trauma-informed care in the NICU when I first blogged about it in 2011.

It was such a gift to work at the Carney Hospital (2010-2013) where I was introduced to the concept during my brief stint as the Interim Nurse Manager of the Inpatient Adolescent Psychiatric Unit. The amazing mentors and teachers I had opened my eyes to a different way of viewing hospitalization and the NICU.

This trauma-informed paradigm validates the therapeutic value we, as individuals, bring to the patient care encounter. It is at the shared interface of care, where services are rendered and received, that we connect, on a human level, and make a difference - but only if we pay attention, only if we are truly present.

For, it is in the present moment where miracles happen and where everything can change, for ourselves, our patients and our society.

Article of the Month

Sanders, M.R. & Hall, S.L. (2017). Trauma-informed care in the newborn intensive care unit: promoting safety, security and connectedness. Journal of Perinatology, 00, 1-8.

The authors connect the dots between the lived experience of the NICU infant-family dyad and the biological imperative of social connectedness through an understanding of Stephen Porges Polyvagal Theory.

Toxic stress derails healthy development across the lifespan and is the biological substrate for the Adverse Childhood Experience (ACE) Study. The adversities described in the study included physical, emotional and sexual abuse, neglect (both physical and emotional), as well as a host of household dysfunctions. The study revealed that a child's experience of multiple ACEs is a major determinant of physical and emotional health and wellbeing as an adult.

Sanders & Hall expose the infant's vulnerabilities to toxic stress both in utero and in the NICU, but also invite the reader to view the parent's experience through a Polyvagal lens and adopt a trauma-informed approach to engagement and partnership. NICU parents, whose story may include ACEs, may experience overwhelm or re-traumatization and have difficulty processing what is happening to their family. In creating a safe, relationship-oriented rapport NICU clinicians are able to promote safety and security for parents empowering them to embrace the primacy of their role identity and foster connectedness with their baby.

Operationalizing the six key principles of trauma-informed care for the NICU setting combined with an understanding of the body's response to stress helps NICU clinicians shift from a 'what's wrong with you' perspective to a trauma-informed reflection of 'what happened to you.'

This is truly a BRILLIANT PAPER and a MUST READ!!

July 2017

Introducing the term 'trauma' into the NICU lexicon has been met with mixed responses. For many clinicians, the term is 'too loaded', for others, the term is rejected out of hand with statements like: 'I am not a source of trauma for my patients, I am trying to save lives'. And then, there are many who feel the term does indeed describe the infant-family experience in the NICU and, even has implications for the clinician.

The journey I have been on with this idea of adopting trauma-informed care as a model for care in the NICU, PICU, and beyond originates from what is known about early life adversity, childhood trauma, and toxic stress. The word trauma is a loaded word, it is a strong word that upends how we view the critically ill infant's experience of care - it is unsettling but that doesn't make it any less appropriate or accurate. In the great words of William Shakespeare "a rose by any other name would still smell just as sweet".

In Chapter 4 of the book 'Scared Sick' the authors talk about 'Little Traumas - Prenatal and Perinatal'. The chapter opens with the history of 'baby pain' and the pioneering work of Dr. Sunny Anand. Dr. Anand's work transformed the surgical care of critically ill infants and slowly began to tear down decades of skepticism regarding infant and fetal pain that characterized much of 20th century research and clinical practice.

An exhaustive list of prolific researchers have compiled more than enough evidence to validate that infants and even fetuses experience pain, yet we continue to deny or minimize these experiences - could this not be considered traumatic?

Despite what is known about the traumatic effects of maternal separation on the neonate, NICUs across the globe are challenged with ensuring parental presence and parent-infant closeness in the NICU.

I could go through each of the original, NANN endorsed core measure sets highlighting how we still struggle, for various reasons, to consistently and reliably provide developmentally supportive, age-appropriate care for hospitalized newborns, infants and families but it's probably time to get off my soap box.

The word trauma is harsh and harshly accurate. It's powerfully descriptive and gives us thought to pause and reflect on the actual lived experience of our patients and their families. 

Maybe, just maybe, the word trauma is strong enough to catalyze a change in NICU culture that is long overdue.