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.

May 2017

Spring is finally here in New England - Woo-Hoo! I hope the weather is nice where you are. Spring is such a great time of the year, and for me, the signs of new life, the return of the birds chirping in the morning, buds bursting from the tree limbs, and evidence that my peony planting has survived another winter fills me up with a quiet sense of joy and gratitude.

Technically summer doesn't begin for another month, but, Memorial Day weekend generally is the unofficial start of summer. With a three-day weekend on the horizon I am wishing you all a fun-filled, relaxing and safe holiday!

Since transitioning from the clinician role, to educator and then entrepreneur and subject matter expert I have been overwhelmed by the amount of support I receive from you! Its validating and encouraging that this work resonates with my colleagues and that spurs me on to create new and engaging ways to serve you.

I have created a closed Facebook group entitled The ACUMEN especially for you. The idea is you can post questions, share experiences, and network with the like-minded, passionate professionals that are our readership.

Click the button below to join the community!

Take care and care well,

Mary

April 2017

This past week marked the 120th Boston Marathon! It's a pretty amazing event! The picture to the right shows Kathrine Switzer crossing the finish line. How wicked awesome is that? She is 70 years old!

In 1967 Switzer registered for the marathon using her initials to cover up her gender (women were not allowed to compete with men and were considered too fragile for a marathon). When she was just a few miles from the finish line, the co-director of the marathon tried to shove her out of the competition but her boyfriend threw him to the ground and Switzer was able to finish the race proving to her running coach that women could run 26.2 miles.

Changing the culture of the NICU to reflect a trauma-informed, age-appropriate care paradigm can feel like a marathon. You try role-modeling evidence-based practices and behaviors, maybe you organize interesting lunch and learn sessions for your colleagues, you attend various conferences to expand your knowledge base in the hope of bringing back that special piece of information that will have everybody say "Aha, NOW I get it!'.

It can get pretty frustrating and we can can easily fall into the trap of blaming. We may blame management, our peers, and even ourselves for not supporting, not caring, and not knowing enough. Check out the video by Brene Brown on Blaming.

The challenge is to stay true to your path and embrace your GRIT (aka your passion and perseverance).

Click the highlighted text in this sentence for a self-care exercise in the form of a meditation to build your confidence and courage.

In the wise words of John Bytheway (yup, that's his name): "An inch is a cinch, a yard is too hard."

Please reach out to me for any guidance or insights, I am always happy to share and support the good work you do everyday - touching lives, impacting lifetimes!

Take care and care well,

Mary

March 2017

Back in January I asked folks to share their Word for 2017. The idea behind a word of the year is to shift from a long list of new year resolutions to a word that can be a guiding light throughout your year. Focus, alignment and clarity can be achieved through a single word. Thanks everyone for sharing your word for 2017! May your word be a beacon to you and bring you focus, alignment and clarity as you touch lives in all that you do!

Despite the vast number of passionate, caring professionals out in the world, there remains a handful who miss the mark - folks who have automated the work they do so that the human aspects have all but disappeared. Let me share a story of a friend of mine's recent experience with healthcare (it's not just babies that suffer). My friend (lets call her Sally) hurt herself while she was away from home and needed surgery. Sally was naturally distressed but discovered that her nephew was the orthopedic surgeon at the hospital where she was being treated - she breathed a sigh of relief that she would be in the care of a capable, qualified professional who was also a loving member of the family.

Things took a turn for the worse when Sally met the anesthesia team who were acutely pre-occupied with finding the best vein to cannulate, paying little attention to Sally and her mounting distress. As Sally began asking questions to the anesthesiologist, she was met with curt responses that did little to belie his dismissive irritation. As she lay on the gurney, all alone in the pre-op area, Sally was unable to hold back the silent tears that rolled down her cheeks. Once the IV was secure, the nurse told Sally she would start to feel sleepy and before Sally could ask what they gave her, Sally felt her grip on consciousness slip away as she drifted off into twilight, shrouded in fear, isolation, and the unknown.

The surgery went well, thank goodness however the aftermath of the experience lingers! Sally called me a few days after she got home and recounted the details of her experience but suddenly couldn't hold back her sobs, as if retelling the event brought her right back to her fear and distress. She was overwhelmed with how vulnerable she felt at the hands of professionals who appeared indifferent to her. Sally shared feelings of isolation and a lack of not only empathy but compassion from the pre-op team. Sally described herself as an 'object of care' and not a fellow human being who was frightened, alone, in pain needing someone to show a molecule of kindness and respect to her. She chided herself for being emotional, but in truth, she had every right to be emotional.

Her experience is unfortunately all to common.

Taking care and caring well - simple words and profound implications for ALL!

Mary

February 2017

Just got back from an amazing trip to Los Angeles California where I had the privilege to be a speaker at the 1st Annual NeuroNICU Nurse Conference put on by the awesome team at SynapseCare. The kitty family in the photo was crafted from play-doh used for one of my activities - it was tons of fun!

With over 180 attendees, the networking, learning and problem-solving was dynamic and clinically relevant.

Attending these types of events reminds me how blessed I am to be part of such a passionate, knowledgable, human-centered profession. All too often it's easy to get lost and overwhelmed by the competing priorities that confront us over the course of a shift. But, when we come together to problem-solve, learn and enhance the service we provide to other I think we are reminded that we are not in this alone; when we come together with a common goal we can move mountains and change lives!

Thanks again Kathi, Shannon, Jenn and the rest of the Synapsecare team, with a special shout out to my new BFF Marsha - let's do this again!!

And to all the attendees, please stay in touch!! Let's keep the momentum going! You make a difference everyday, touching lives and impacting lifetimes!

Take care and care well!

Mary