The Claw-Face-Push

I'm feeling pretty on top of the world, what with 3 brand new grand babies over the past 10 months 😲.

My newest grandchild was welcomed into the family just last Sunday, August 11th. 

Please meet Christopher Morris and his proud parents, Alex (my sweet youngest son) and Paula (my amazing daughter-in-law).

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I've observed lots of similarities in my children's perinatal and postnatal experiences (besides the effusive buckets of joy 😃).

All three of my children chose to breastfeed their precious new babies.

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And all three experienced what I am now calling 'The Claw-Face-Push'.  However, unlike the claw in Toy Story which rescued Buzz Lightyear from a mass of toy aliens, ...

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this claw grasps the head of the precious newborn and then proceeds to do a face push of said newborn's head onto (or into more accurately) the unsuspecting breast of his or her mother.

Now, when I was a young NICU nurse I was introduced to the 'claw-face-push" technique, it was a pretty standard practice for the lactation naive.  The prevailing belief was that if we could get their little head on or at least near the nipple the baby would immediately latch on and all would be well with the world.  After all isn't breastfeeding natural and everyone knows what that means; it must be easy. 

Well, I think it's safe to say, successful breastfeeding is anything but easy.  It takes an enormous amount of patience, commitment, persistence, and conviction on the part of the mother and her partner.  Choosing to breastfeed can be empowering while at the same time exposing our deepest darkest vulnerabilities.

Women are in such a fragile state after giving birth physically, psycho-emotionally, and spiritually.  The mere thought that they may not be breastfeeding the 'right way' or 'may not have enough milk' can be devastating. Especially in the numbers obsessed medical world where we measure everything.

The fact that we can't measure how much milk the baby is taking from the breast at any given time MAKES US NUTS!

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And because it makes us crazy, we in turn pass our crazy on to mothers and make them feel incredibly insecure and anxious about their ability to nourish their baby.

You know the expression man does not live on bread alone? Well same rule applies to babies! Babies need more than calories to grow, develop and thrive.  It's not just the nutritional value of breastmilk that makes it so wicked awesome. It's the proximity, the intimacy, the tenderness, the uniqueness of nourishing and nurturing your child that feeds a physical, emotional and spiritual connection.   

So, when my children shared their experiences with the 'claw-face-push' they were all horrified that someone would be so rough with a brand new human being but their horror had no voice - why? Because they assumed the person knew what they were doing, even though it didn't look or feel right to them, they didn't say anything.

And this is where I am stepping in, on behalf of all the babies and families who have experienced the claw-face-push and say to my colleagues STOP IT!!! The service we provide to these beautiful families, be it in the NICU, Special Care or the Postpartum ward should never include force.  Nursing is NEVER about aggression, power, or judging for that matter.

If I put my hand on the back of your head and pushed it forward, your natural instinct would be to recoil, to push your head back against my hand.  This is exactly what the baby does - this is natural.

For so long we have used force to provide care. We rationalize that we must because it is with the best intention for the baby.  But, did you know that causing harm, regardless of your intention is considered maltreatment? 

I am going to challenge you to discover a new way.  A way led by compassion and kindness. A way that requires patience and presence. A way that will require courage to go against the status quo and promote hope and hopefulness.

It's not just breastfeeding where we are invited to do better and be kinder, it's every aspect of service we provide.  How we engage with our patients and their families defines how they will respond to us.  If we are kind, patient and compassionate they are open, trusting and feel cared for. If we are rushed, aggressive, and perfunctory they are guarded, defensive and not trusting, not just you but the system at large.  When these experiences are repeated over time ... neurons that fire together wire together.

All of us have experienced the claw-face-push in our life (maybe more than once),  when some external force was pushing us to do something we weren't ready for or we didn't choose.  Remember how that felt and let that memory fuel your desire to change how you proceed in your practice and in your life.

I'll leave you with a reading recommendation.  I've just started the book but am loving it so far. The book is entitled: "A Fearless Heart: How the Courage to be Compassionate can Transform our Lives"

I look forward to your comments on this post, in the meantime...

Take care and care well,

Mary

P.S.  Please consider joining us (LIVE or VIRTUALLY) in Las Vegas NV this Saturday, August 24th for Quantum Caring for NICU Clinicians.  In this one-day workshop we will present the science of hope, compassion and courage and the implications of these critical virtues to creating a trauma-informed approach to care in your clinical setting.

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DOWNLOAD THE BROCHURE

P.P.S.: We are accepting applicants to our FALL QUANTUM LEAP program. Quantum Leap is a 12-month leadership coaching and development program that provides the learner with a strong foundation in research and evidence-based best practices in trauma-informed newborn care while cultivating essential skills to become courageous and authentic leaders for change.

LEARN MORE

I look forward to speaking with you soon! 😊

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

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Want to just chat and explore how Caring Essentials can serve you? Schedule a Get Acquainted Call and start the conversation that will change the way you think about developmental care!

The babies and families are waiting!

Schedule your Get Acquainted Call TODAY!

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

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Do you like sailing?

WARNING THIS POST MAY INCLUDE EXTREME VULNERABILITY

Do you like sailing?  When my husband first talked about getting a sailing boat I thought, that sounds nice.  We would go to the boat show down at the expo center and look at different boats (and let me tell you there are some pretty fancy boats out there ).

He talked about how romantic sailing would be as he pointed out the differences between motor boating and sailing.  At one point I actually said I liked how the sailboat moved with Mother Nature in the water while the motor boat just ripped right through her. (Mind you I had never been on a sailboat and had absolutely no idea about sailing -  just like my two grandbabies pictured here on the boat for the first time).

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So, my husband bought a sailboat a couple years ago and I have been officially introduced into sailing.  Since that fateful day I have struggled to find any redeeming qualities about his cherished pastime! 

Every boating outing has consistently been fraught with some kind of 'disaster' (according to me).  Of course my husband looks at all these 'events' as learning opportunities. He repeatedly tells me we are never in danger of 'going down with the ship' but I have struggled to believe him. 

We have a running joke at my house that my Danny is the patron saint of perpetual projects and the boat has truly confirmed his appointment to this post.  He loves puttering with the boat, tweaking this, fixing that and recently decided the boat needed a new furler for the jib (a furler is the long pole at the front of the boat that unfurls the jib sail).

Fast forward to yesterday (Saturday) when my husband asks me if I will go on a 'shake down' cruise to test out the new furler.  He knows I don't want to go but he also needs someone else to go with him and he knows I love him madly so I will go despite how I feel about sailing (that's true love guys ).

So, we are driving over to where the boat is moored and I am very quiet in the car.  My husband checks in on me "are you ok?" Me: "yeah, I'm fine" I say, meanwhile I am talking myself off the ledge inside my head. "We'll be fine; There is nothing to be afraid of; We won't be out too long; It's pretty windy out there; I wish I was a better swimmer; I'm starting to feel sick ".

We get out to the boat and it's a beautiful day. It's windy and I'm glad I brought my sweater.  Danny is buzzing about turning things on, checking stuff down below and I am being very quiet trying to will myself to be brave.  He loves this boating thing and I don't want him to sacrifice his joy because I am such a chicken.

He offers me the little bands you put on your wrists when you feel queasy but I decline.  I just want to get this whole thing over.  Dan turns the engine on and releases the boat from the mooring.  We motor out a bit before he tells me he's going to put the jib out. I offer to help and he directs me to what he needs and we are off. 

The boat responds to the wind, the sail fills taut with air - we are moving with Mother Nature and as we are, with my back to Danny, tears are falling from my eyes. I'm scared, I don't want to be scared, but I AM SCARED. 

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I turn my face to the sun and close my eyes. The fear keeps getting worse and worse but the feeling of the warm sunshine on my face feels good, feels safe.  I am praying on the inside and begging for this feeling of fear to leave me, tears running down my face. 

All of a sudden I imagine that the tears falling from my eyes are actually the fear leaving my body.  I envision it and let the tears flow freely knowing it's the fear leaving me.

The warm sun feels like a friend in this moment, the warm wind, her arm around me. The water beneath the boat reminds me of a much loved water mattress I had a kajillion years ago.

I opened my eyes and saw the jib sail full as the boat leaned to one side (my husband loves that) and all of a sudden I felt OK, I felt like I could do this, I could sail with my husband, I could even enjoy it - maybe).

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I was quiet for the rest of our little adventure, paying attention to my surroundings, taking in how I was feeling about being on the boat in that moment.  What had happened?

We returned to the mooring as the sun set.  I wanted to tell Danny what happened to me out there but wasn't sure how.  Would he think I was a nut? (I am a worry master black belt)

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I waited until this morning (Sunday) to tell him and as I was sharing my experience he looked at me and said: "You let go of the oars".  My eyes filled up with relief and joy.

I let go of the oars, I stopped resisting.  I let go of the fear of not being in control, the fear of not being able to manage Mother Nature, and in letting go I found a peaceful sense of acute presence and awareness to the beauty and blessings that were all around me. 

So, you might ask what does this have to do with the NICU, what does this have to do with me? I'm hoping it has a lot to do with you and the service we are called to in the NICU.

What you resist persists.  I resisted enjoying sailing because I was afraid of not being able to control the experience, control the outcome.  The more I held this belief the more overwhelming my fear became.  Resistance isn't a straight line. What we resist is often pretty convoluted and messy with subtitles and subterfuge.

What do you resist?

Some folks resist change but that begs the question, why resist change?  Everything changes, we change minute by minute, day by day. However, change can make you feel insecure and take away your super powers of expertise and confidence (like kryptonite and SuperMan).  When we resist change over time the fear of change, the fear of loss can paralyze us and keep us from growing and expanding in our practice and as a human being.

Some folks resist collaboration.  The idea of shared decision-making, sharing 'power' with other disciplines is super threatening to folks, especially in the hierarchical world of healthcare. But then again, you have to ask the question why? Why is sharing threatening to some folks? Is the 'power' they imagine they have in the workplace compensating for feelings of powerlessness in other areas of their life?

You know these people and I'll bet sometimes they can make your life crazy (just like I am sure I made my Danny crazy). But getting annoyed doesn't help anything get better.  The only thing that does help is love, patience, compassion, and understanding. 

Holding space for people to change themselves is the best we can do.   

My Danny has been holding space for me for a long time and I am grateful for his patience, love and kindness.  Can you hold space for your colleagues, your patient's family, even your own family and friends?

What I know for sure is you can create any reality you choose.  You can choose to be afraid, insecure, and resistant or you can choose to trust, share, and be vulnerable. 

The choice is up to you. 

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Take care and care well,

Mary

P.S.  To learn more about how you can become a leader for change and a champion for trauma-informed care for infants, families and professionals schedule a Get Acquainted Call with me this week! 

I look forward to speaking with you soon! 

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

The babies and families are waiting!

Schedule your Get Acquainted Call TODAY!

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

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Does it Matter?

I'm working with this wicked amazing team in Scotland, NHS Grampian's Aberdeen Maternity Hospital.  We are working on a 6-month quality improvement initiative (Quantum Caring) focused on the Pain & Stress Core Measure, one of the 5 core measure standards for trauma-informed newborn care.

(Click HERE for more info on the core measures).  

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In addition to staff education and the testing and implementation phases of the project, it's imperative that there is support, engagement and buy-in from all the key stakeholders.  This includes the physician group.

I look forward to meeting with the docs.  They always pose interesting questions. Doctors think differently and this group expressed their different way of thinking with me. 

I like how these conversations give me the opportunity to understand where the medical team is coming from, gain insight into their concerns and to demonstrate the importance of this work for their patients, the families and society at large. 

 One question, posed by one of the residents stuck in my head:  

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"As we know, socio-economic status is one of the biggest influencers for long term outcomes in children.  With that being said, does it really matter if we provide developmental care during the hospital stay when these babies are discharged into these challenging circumstances that play a bigger role in their life?"

Fair enough question for sure, 'Does it Matter?'

Does developmental care matter in the big scheme of these infant's lives?  Well, I guess it depends on how you define developmental care.  If you define developmental care as something you do to the patient every three or four hours with your cares maybe it doesn't matter as much as we might like to think. 

When we look at the studies evaluating the impact of various care practices that fall under the umbrella of developmental care we often find a fair bit of inconsistency.  Many papers present barriers and challenges to providing consistent developmental care (here's an example).  

We do know however in NICUs that consistently provide high quality developmental care, this practice does make a difference in the short term and long-term outcomes of the infants. Montirosso et al published a series of papers highlighting the impact of developmental care on over 5 years, the NEO-ACQUA project.  The researchers defined developmental care by the 5 core measure standards and the principles of NIDCAP (Newborn Individualized Developmental Care and Assessment Program).  

The common denominator for impactful developmental care is THE FAMILY!

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Knowing that family-centered, family collaborative, developmental care makes a difference in the short term and long term outcomes of infants and families MUST COMPEL us to partner with parents and families right from the get-go, on admission!

Are the parents scared? YES! Are they vulnerable? YES!  But none of that changes the fact that they are the everything for this tiny person who presents to the NICU fighting for their life. 

The answer to the question 'Does it Matter' I think rests in how we engage parents and families right from the beginning of their NICU journey. How do we empower them?  How do we capitalize on this defining moment in their lives? How do we validate their role identity? How do we cultivate their confidence and competence in parenting their new child?

We can do lots of things to and for the baby but without love, without a sense of belonging, a feeling of security and connectedness with their family nothing really matters.  The adversity of the NICU experience will overshadow any attempts we make 'to do developmental care' without the family.  

We've a long way to go to humanize healthcare.  Let's step out of our silos and together, as fellow human beings appreciate what is really needed for our patients and their families. 

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All we need is love!

Take care and care well,

Mary

P.S.  To learn more about how you can become a leader for change and a champion for trauma-informed newborn care schedule a Get Acquainted Call with me this week! 

Let's Get Acquainted

I look forward to speaking with you soon! 

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

The babies and families are waiting!

Schedule your Get Acquainted Call TODAY!

Let's Get Acquainted

 

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

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Let's Raise the Bar!

When I first graduated from my master's program as an NNP my 'dream job' wasn't available so I took a position at a Level 1 nursery.  The hospital was interested in becoming a Level II Special Care Nursery and hired me to cover the delivery room and care for the newborns whose pediatricians didn't have privileges at the hospital.  My hours were Monday through Friday 8am to 5pm. 

I held the position for one-year, and it was one of the coolest jobs I ever had.  Some of the clinical highlights included managing the care of an infant with a sub-galeal hemorrhage, a newborn with an undiagnosed diaphragmatic hernia, a baby with a neck mass I discovered during my discharge physical examination, not to mention the numerous deliveries I attended which enabled me to hone my intubations skills 😷.

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Besides the adrenaline rush of these clinical emergencies, I also got to educate and mentor an amazing team of nurses.  These guys were so thirsty for new knowledge and the autonomy that new knowledge brings to clinical practice.  Even though I was hired for Monday through Friday I made myself available for off-duty hours as a back-up when there were clinical emergencies and built an amazing rapport with the off-duty pedi team.  I was experiencing true joy in my work :-)

Unfortunately, the hospital was denied a Level II nursery designation and my position was dissolved. I was not discouraged! This was a great job and I could clearly see the benefit of having an NNP on service in a Level 1 setting.  My role benefited the patients, the families, the nurses and the organization.  I needed to replicate this experience.

This was when I created APNA (Advanced Practice Nurse Associates) and I actually got a contract with a local Level 1 nursery, I was on my way.  My dreams of being a primary care provider in an inpatient setting were all coming true. I was an entrepreneur - this was AMAZING!  Until I was summoned to the Department of Public Health to meet with the Perinatal Advisory Committee.  The committee was comprised of neonatologists and pediatricians from across the state who were concerned about my business plan.

Now, just to let you know, before I embarked on the creation of APNA I combed through the Commonwealth of Massachusetts Regulations governing advanced practice nursing in the state.  I was in the clear, there was no language that restricted this practice model, however the Perinatal Advisory Board thought differently.

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Their argument was that since there was no language sanctioning the model, they would not allow it to move forward.  They were concerned that embarking on this practice model created a 'slippery slope'.  Although they felt confident that I would provide safe, quality care, what guarantees were there that another NNP would provide the same level of service excellence. 

I did mention that any other NNP would be required to meet all the necessary requirements of an advanced practice nurse in this setting, to include board certification, just like any physician.  Nope, the idea was too innovative, to 'outside the box' - bye bye APNA.

The point of this story is the 'slippery slope' comment.  Currently our educational preparation for nurses and doctors ensures that minimum performance expectations are met.  But it appears that minimum performance expectations may not cut the mustard.  What do they call the person who graduates at the top of their medical school class and the person who passes by the skin of their teeth?  They call that person: 'Doctor' (and the same thing goes for nursing).

Sure, you have to pass your board exams, but is that really all it takes to be in service to people who are at their most vulnerable and most fragile?  Is it enough to know anatomy and physiology inside out and backwards? Is that truly all a patient needs, a good body mechanic?

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Have you heard of the term 'top of license' performer?  On first pass I thought this sounds pretty cool, I want to be a 'top of license' performer. But when I started really thinking about it, if there is a 'top of license' performer then there is a 'bottom of license' performer, right?

What does a 'bottom of license' performer look like?  They have a license, so they legally can practice their art, but I guess the question is, should they?  Should that 'bottom of license' performer really be interacting with vulnerable and fragile human beings - where is the bar set?

I believe very strongly it's time to RAISE THE BAR!  Raise the bar on education, clinical practice, and human caring.  Those 'top of license' qualifiers should be the minimum requirements for graduation, board certification and employment in the healthcare industry. 

Why am I so emphatic about this?  Because I know what 'bottom of license' looks like (and I believe you do too).  This level of service must not be tolerated.  And you know what, I think the 'bottom of license' professionals don't even know there is a bar, I mean after all they graduated along with their peers, they passed their boards, wasn't that the bar?

Establishing minimum performance expectations at the low end of the bar leaves a huge margin of concern for quality and patient safety. Folks don't know what they don't know.  But systems know.

For example, how much more research do we need to demonstrate that entry level nursing begins with a baccalaureate degree.  When I was in nursing school back in the day, the plan was that a BSN would be required as entry level into nursing by 1982! 

That's a long time ago and even today there is no consensus on what is required for entry level into nursing.  The system needs a shake up and that can only happen when we put our foot down and say enough is enough!  Our patients and their families deserve so much more!

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I expect ALL nurses to not only know their way around the human body but to know their way around the human heart, the human psyche, and the human soul.  I want ALL nurses to feel confident and competent to advocate for their patients and the patient's family.  Challenge the status quo and champion the change that is long overdue in healthcare!

It starts with raising the bar on undergraduate education and is sustained through lifelong learning and professional development. But we need skills in order to effect change.  We need confidence and competence to become successful change-makers. 

Transformation is a journey and a movement!

I invite you to take the leap and join the movement!  Learn how you can become an effective and successful change-maker. 

Take a moment and listen to what Nancy has to share about her journey to becoming a successful change-maker!

I can't do this alone, will you help?

Take care and care well,

Mary

P.S.  To learn more about the Quantum Leap program download the program flyer HERE and schedule your Transformation Call TODAY

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

The babies and families are waiting!

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

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P.P.P.S. When my daughter read this blog post she commented:

“I really don’t understand how doctors require so much schooling, yet nurses who interact so much more with patients only need a BS”.

I don’t understand either.

You're Fine! (Right?!)

Have you ever used that phrase when someone hurts themself and they are getting all dramatic (in the absence of blood or imminent death) and you quickly say "You're fine' (sometimes repeated in triplet "You're fine, you're fine, you're fine")?

Well, it's become somewhat of a joke at my house.  When my children were small and they would take a tumble and immediately burst into tears I would make a rapid assessment of the situation while all the while telling my child 'You're fine, You're fine, You're fine'.  (Am I the only one?)

Now, for the most part this phrase has served me well.  For the majority of the time my children have been fine and by telling them they are fine I feel in control, I believe I am calming them down through my reassurance while at the same time keeping myself calm (they're fine  they're fine  they're fine ), and for the most part, it all turns out well.

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There was that one time I had my son mow the backyard.  It hadn't been mown in awhile so it was a bit of a big job.  My son came into the house complaining of shortness of breath and I immediately told him he was fine and sent him back out in the yard.  Several hours later we were in the emergency room.  As it turns out he was having a reaction to all the pollens and allergens in the yard, he wasn't fine after all .

Most recently I found myself digging that phrase up again, this time with regards to my new grand baby.  My daughter, a brand new mom, asked me to listen to the baby's breathing, it was stridorous, it was intermittent, no color change and I couldn't really appreciate any retractions.  The baby seemed comfortable.  I suggested she let her pedi know about her concerns and see what she had to say. In my head I thought maybe a little laryngomalacia, she'd outgrow it, she was fine.

Apparently the pedi agreed, no intervention necessary.  I was happy but my daughter was not convinced.  She said it was worse at night, she was very bothered about it, she was worried. 

She took a video of the baby sleeping and sent it along to me. I shared it with a friend of mine who was a respiratory therapist who agreed - stridor, check in with the doctor.  I shared this '2nd opinion' with my daughter.

She was thankful for the 2nd opinion but wanted more reassurance so she shared the video with a pedi airway guy she had worked with many years ago and he in turn shared it with his ENT colleague.  "She needs to be seen immediately by a pedi ENT specialist" he told her and booked the appointment. 

Within the span of one week she was seen, had a sleep study that showed severe hypopnea and obstructive apnea, was admitted to the PICU, placed on CPAP, underwent a laryngoscopy during which they removed excessive tissue that was obstructing her airway and was discharged home off CPAP.  Turns out she was not fine... but I am happy to report she is fine now, thank goodness!

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I am so grateful for my daughter's mama bear instincts. She wouldn't let it go, she knew in her heart of hearts that something needed to be done.  And I felt bad. I minimized her observations, I minimized her insights and her status as mama bear with those 2.5 simple words: "She's Fine".

This has been weighing heavily on me over this past week.  How could I minimize my daughter's assessment, her insight and intuition about her sweet baby girl? How could I dismiss her concerns? 

I think what was going on inside my head and my heart was disbelief.  I could not accept that anything could be wrong; my daughter and son-in-law have waited a long time for this special little baby, enough is enough - she's fine!

But, what I have learned or better stated, what I've been reminded is that life isn't fine, it's messy and beautiful, scary and frustrating, awe-inspiring and exasperating all rolled into every breath we take. 

With each breath, like each experience, there is an invitation to choose how we will show up.  Will we show up rushed and dismissive or patient and present?  I think the scary stuff in life calls us to courage and calls us to a higher understanding of ourselves and our place in the world.  

For my daughter and son-in-law they embraced the call to parent under pressure.  They learned how to advocate for their precious baby.  They learned that not everyone knows everything and if it doesn't feel right it probably isn't right.  These are wicked important things to learn for sure!

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For me, I've learned to walk my talk with my family.  I preach on the importance of honoring the observations and insights from the families we serve in the NICU. I emphasize that what we think about another person's experience is simply irrelevant, it's our opinion (and you know what they say about opinions).  

The patient and family experience is the centerpiece to our work.  We are there to support them through their experience respectfully, compassionately, and with dignity.   And as easy as it is to write these words, it is much more difficult to live them, to make them live and breath in every moment of our work. 

This is my daughter’s family.

This is my daughter’s family.

At the end of the day we all want the best outcome, best experience and best life for our family, our friends, our patients, for everyone.  I think we can all agree it's sad when something threatens someone's joy and sense of safety.

As nurses we want to make things better, we want to do the right thing. But sometimes the right thing, the only thing has nothing to do with 'doing' but everything to do with 'being'.  Being present, listening to not only their words but their feelings, and hear what their heart is trying to tell us. 

It just takes 40 seconds to convey compassion and that's the real game changer   . 

Take care and care well,

Mary

P.S.  To learn more about the power and biology of compassion and hope join Sharon Bonifazi and me August 24th at Summerlin Hospital Medical Center, Las Vegas NV for our very first Quantum Caring for NICU Clinicians Workshop (brochure attached )

Quantum Caring Workshop Brochure

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

The babies and families are waiting!

Schedule your Transformation Call TODAY!

Let's Get Acquainted

 

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

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Do you trust me?

I'll be the first to admit I set the bar very high on healthcare and even higher on nurses and I think there is nothing wrong with that.  The people we are honored to serve are at their most vulnerable when admitted into the hospital. They are frightened, in pain, maybe confused or even angry and we have a responsibility to honor and acknowledge their experience with compassion, understanding, and kindness. 

IT'S NOT ABOUT US! IT REALLY IS ALL ABOUT THE PATIENT!!

There is a degree of gratitude healthcare professionals must connect with when engaging with patients and their families; "There but for the Grace of God go I" - John Bradford.  And this realization should spark deep compassion, empathy, grace and gratitude.

The experience of service we create for our patients, at the individual and organizational level, must be rooted in trust.  On first pass, patients trust we know what we are doing, they trust we will keep them safe and free of harm, they trustwe care about them as fellow human beings, they trust we will communicate with them openly, honestly and compassionately. 

But ... when that trust is broken, well that's a whole other kettle of fish. Maybe you can even relate to this on a personal level.  Have you had an experience with healthcare that left you feeling less trusting about a clinician or a facility?

Organizations and individuals must earn the respect and the trust of those they serve.  To earn trust there are 4 core elements:

  1. communication

  2. compassion

  3. consistency

  4. competence

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We make a lot of assumptions about communication, compassion, consistency, and competence that actually interferes with our capacity to build trusting relationships with our patients and their families.

Competence, for example, is often confused with training but it's so far from 'just training'.  Competence is when you demonstrate that you know what you're doing and why you are doing it.  For example, my brother was recently hospitalized and needed to have the bag changed on his new colostomy. 

When the nurse arrived, she had an ileostomy bag and when my brother pointed it out, the nurse notified the supervisor that my brother was refusing to let her change the bag.  When the supervisor confronted my brother, he explained that the nurse had the wrong equipment. The supervisor explained that she was new and didn't have much experience with colostomies (OK, so first, this should not be my brother's problem and I'm grateful that my brother knew the difference and could speak up for himself. How many patients aren't able to do that?).  

This novice nurse had a little bit of knowledge, but it was inaccurate.  Her communication to the supervisor did not reflect compassion and unfortunately she did not leave the impression that she was competent.

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Now, I am absolutely not throwing inexperienced nurses under the bus.  And this particular facility is not unlike any other facility where there is a mix of novice, advanced beginners, competent, proficient, and expert staff.  Diverse levels of experience among staff has many positive benefits, stimulating different ways of knowing and doing that can enhance critical thinking and even elevate the standard of care.  

However, many organizations (and individuals) miss out on creating an environment that supports professional growth and development in meaningful ways.  We stay stuck in teaching paradigms that allow us to check things off a list (a wicked long list) but don't really assure that knowledge has been translated into skill.  The 'Teach Back' method we use when educating parents / patients is something we must adopt with staff as well in order to establish performance expectations that are measurable and sustainable.

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Competency gaps impede consistency. Which basically means everyone just does their version of what they think is best which can be incredibly confusing for the patient / family (not to mention potentially unsafe). As Brené Brown says, "Clarity is Kindness". The inconsistency that many patients and families experience at the hands of healthcare professionals and organizations undermines their trust of the facility and the staff.

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And for babies, inconsistency keeps them on high alert, chronically stressed, never knowing what will happen next.

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We've such an amazing opportunity to take a step back and carefully examine our own cultures of care, what are the written policies and procedures and contrast them to the unwritten 'ways we do things here'.  Where are the inconsistencies?  Where are the opportunities to build trust? It's root cause analysis time and many of us know exactly what we need to do to change and it starts with cultivating TRUST.

I'm afraid, after 35+ years I still approach healthcare systems with caution, despite the multitudes of compassionate, competent trustworthy professionals I have encountered over the years, the paucity of consistency continues to make me wary.  Sad to say I am often pleasantly caught off guard when a healthcare professional is kind and compassionate to one of my family members or myself.  I wish I could rely on that experience to be a consistently reliable one.

Despite my 'en guard' approach however, I don't believe the system, with all its moving parts, is a lost cause. I am not giving up on the potential for healthcare at large to change and become aligned with Florence Nightingale's admonishment: 'The very first requirement in a hospital is that it should do the sick no harm' (check out Nightingale's Notes on Nursing for a comprehensive review of what constitutes nursing, it's as relevant today as it was back in the day).

Let's do this thing together .  All it takes is a little courage, like they say at TSA, if you see something, say something.  If you see something good, something to emulate - say something, recognize the individual and explore how you can make that good thing happen more often. An inch is a cinch, a yard is too hard.  We can transform the system one baby step at a time!

Do you trust me?

Take care and care well,

Mary

P.S.  If you are interested in learning more about transforming your culture of care, building competence and confidence in your staff, enhancing compassionate communication and delivering excellence in trauma-informed, age-appropriate care consistently reliable, Caring Essentials can help.

Using breakthrough, evidence-based strategies Caring Essentials helps you achieve clarity, build congruence, and challenges 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!

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

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Becoming Grandma

I LOVE being a grandma - it's truly like nothing I ever imagined.  It feels like the universe is giving back to me after all those years of mothering (aka fretting, feeding, following, finding, flushing, finishing, fixing, frenzying and freaking out) in a never ending effort to keep my children happy, healthy and safe.

As grandma (or Mimi as I am called by my grand babies) I get to swoop in and be all about the fun which includes (but is not limited to) pancakes for dinner, bubble parties on the front porch, and unlimited snuggles and cuddles. In addition to the rainbows and unicorns (literally), I also get be a role model and mentor for my babies and their parents too.  This aspect of grand-mothering has been a welcome delight.   

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The thing I have discovered on my parenting journey is that like pretty much every aspect of life, change happens, we grow, the people around us grow (and grow-up). We are all in a perpetual and dynamic state of 'becoming'.  Becoming what you might ask? Well, becoming the highest and truest expression of ourselves of course 😊.

I certainly could make it 'easy' for myself and just parent (and grand parent) as I always had in the past. I've done it this way for 30+ years why change now? (Sound familiar?) But the thing that is so wicked cool about all this is that I get a chance to write my own grandma script, informed by my past experiences and what worked and what didn't work. I get to integrate and share my wisdom with my daughters and sons. I get to help my children navigate the ups and downs of adulthood and parenthood.  And I get to learn and grow with this next generation about things that didn't even exist when I was a new parent.

My grand daughter Kina and her team won their state robotics competition 😃

My grand daughter Kina and her team won their state robotics competition😃

It's a great big and beautiful responsibility and opportunity but I do acknowledge that not everyone approaches it the same way - which is neither good nor bad but simply 'is'. That being said, I do invite grand parents to be open to new and different ways of parenting.  Just as your child learned how to ride a bike, they will learn to parent well with a mix of your love and support, a solid foundation in parenting education, and their own heart centered instincts. Resist the urge to lecture or judge. Support your daughters desire to breast feed, and your sons desire to provide skin-to-skin care.  Our understanding of the critical importance of meeting an infant's needs for safety, security and connectedness has certainly changed since I was a young parent (thank goodness).

Urge your parent children to listen to their hearts, champion their new baby, ask questions, and never abdicate their power in the most sacred of roles - becoming a parent.  Becoming a parent / grand parent isn't a destination, it's a journey, and it's a very scenic, convoluted and adventurous journey.  However, for some the journey may be fraught with challenges and for some, even trauma.  This is where health care professionals can step in and be that source of safety, compassion, and guidance for the family in crisis.

After all, NICU families are first of all, families right?  We must never lose sight of that very critical fact. As they navigate medical jargon, healthcare cultures and a smorgasbord of disciplines and personalities they are still a family - a family in crisis, but a family nonetheless.  Their encounter with the healthcare system is often fraught with confusion and fear and we hold the keys to mitigating and managing this. 

We must not overlook the resources that lie within the extended family, the grand parents. Now I do realize not all families have grand parents, but they may have other people in their social network who, like grand parents, can provide support and comfort.These amazing people can become a lifeline for the family in crisis.  We must engage them in the journey (of course with the parents approval).  When we are trying to educate parents, it may behoove us to also educate extended family members (remember more heads are better than one). 

I know this isn't an easy fix, but, it's a beginning and instead of thinking of a million different reasons why we must limit the presence of the family's support network, maybe we can put ourselves in their place.  Maybe put on our parent or grand parent hat (heck even our auntie or uncle hat, or beloved friend hat) and think what would best help this family through their crisis, how can I ease their suffering in a small but meaningful way.

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What I know for sure is that family matters, for better or for worse, family matters. And for the families we serve in the NICU, we play a crucial role in that family's becoming. As we bear witness in the course of our caregiving we have a responsibility to preserve and protect the integrity of family for the sake of the infant, the parents and society at large.  At the end of the day we are not different at all.  We ALL want our children to be healthy and happy, to be and feel loved, and to become the highest and truest expression of themselves!

Join the movement, show me and the world how you CARE OUT LOUD and let's shift this paradigm - together!

Take care and care well,

Mary

P.S.  If you are interested in learning more about changing the existing paradigm in neonatal intensive care and how to transform YOUR culture of care Caring Essentials can help.

Using breakthrough, evidence-based strategies Caring Essentials helps you achieve clarity, build congruence, and challenges 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!

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

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The Magic and Mystery of Memory

I'm writing this post to you from Scotland, Dunblane to be specific sipping a lovely cup of tea made by my dear friend's husband. (Why does tea always taste better when someone else makes it?)   Looking out the floor to ceiling window, the bucolic view is dappled with baby cows and their mamas grazing on the hillside.  As I gaze out I reflect on this past week and the amazingly heartfelt encounters I had with so many lovely souls up in Aberdeen.

I'm working with the neonatal staff at Aberdeen Maternity Hospital and their outlying community hospital in Elgin, Dr. Gray, to adopt and implement evidence-based best practices related to the Pain & Stress Core Measure. We began the program in March and kicked it off with a series of education sessions introducing  the biology of toxic stress and the relevance of trauma-informed care in the NICU. 

The June visit is about checking-in, in-person, to assess their progress with the pilot phase of this quality improvement initiative and set-up for implementation. In chatting with the project leads, we decided to re-run the education sessions as not everyone was able to attend in March - great plan and I was pumped (as you know, I can talk on this subject for ever ️).

I had just read a couple of papers talking about traumatic memory in babies and was eager to integrate and share this wicked interesting information.  As I was presenting the material in one of the sessions my attention was drawn to a woman sitting in the back of the room.  She seemed very intrigued and almost energized by my talk.  Needless to say this made me want to share more as her head nodded up and down in agreement in what I deduced as an understanding of the material.  She hung back after the session broke up to speak with me.  

Her enthusiasm was palpable and she very quickly began to share her story with me. She told me she was adopted as a baby and described how that experience left a deep hole inside her.  Her birth mother never wanted her, she shared, and as she said those very weighted words I could feel her deep sadness. Her adoptive mother came to pick her up from the hospital and found her all alone in a big room with lots of other babies unsupervised.  After picking her new baby up, the adoptive mother had to search for a caregiver and let them know she was here to take her baby home. Described as an independent baby, her adoptive mother noted that she was not a very cuddly baby, and the woman described how she remembers physically withdrawing from cuddles and snuggles from adults, including her new mom.

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She was so animated in the telling of her story and turned to look directly at me and said what I had presented in the learning session had been the explanation she had been in search of her entire life.  This lovely woman (possibly close to 50), had been searching for so long, searching for an understanding of her feelings, her sadness, her detachment from others. She shared her experience of years of counseling and therapy - and that here, in this tiny tutorial room, this presentation resonated with her, opened a door in her heart and mind and she felt free. 

Later that week I presented the session to the staff at the community hospital and as I wrapped up I invited the group to share their insights on the material. Like so many of the learners I have met, the group acknowledged resonance with the material and the content.  And then, one of the pediatricians raised his hand. He spoke very deliberately to share one of his earliest memories.  It was of a 'huge' green needle (needle gauge is often color coded and green represents a 21 gauge needle).  He described his terror as the needle was thrust into his leg and believes that it was that incident that was the root of his lifelong phobia of needles.  

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My colleague at the community hospital, where the pediatrician worked, shared with me that this particular physician never provided sucrose or any non-pharmacologic intervention for painful procedures so she was surprised about his story and hoped that his revelation would positively impact his future practice. I hope so too.

My adopted friend seemed literally born again, she wanted to be part of the QI project team. She felt a renewed sense of empowerment and wanted to create a better story, a better memory for the babies and families she served. 

These two powerful stories, along with so many others people have shared with me over the years, demonstrate the power of trauma-informed care, the power of authentic healing presence and the power of kindness. 

It doesn't matter if we think the baby 'won't remember' the NICU experience with its painful procedures, parental separation, and socio-emotional isolation.  It's not our experience, it's theirs!

Babies remember how the world makes them feel at a very quintessential level, a cellular, somatic level.  It's time to change the system, to change how we engage with our patients, their families and each other.  It's time to return to humans being love instead humans doing tasks.

Are you ready to make the change?

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Let compassion lead us forward ❣️

Take care and care well,

Mary

P.S.  If you are interested in learning more about the biologic relevance of trauma-informed care and how to transform the culture of care in your organization Caring Essentials can help.

Using breakthrough, evidence-based strategies Caring Essentials helps you achieve clarity, build congruence, and challenges 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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Chocolate Chip Cookies

In case you didn't know, I have been told I make amazing chocolate chip cookies ️.  I hope this doesn't sound like a brag, I am being super honest, my kids used to sell my cookies to their classmates at school - they are that good.

Recently, my youngest daughter called me up to ask what was the special ingredient in my cookies.  She says she follows the recipe to the letter but her cookies never come out like mine.  I told her my secret ingredient was love (I know it sounds a bit hokey, but it's true).  I explained that as I make the cookies I think about how they will be enjoyed, how my grand babies will smile broadly with cookie debris smeared over their faces, how my husband will delight when there are cookies in the cookie jar for that late night snack, and how the smell of freshly baked cookies lingers in the house and welcomes visitors with a friendly olfactory 'hello'. 

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She was a bit skeptical but tried the secret ingredient in her next batch and to her surprise they came out AMAZING!!  She called me back to share her delight and we had a nice talk about how when you pay attention to cookie making , when you are present for the baking experience - well, it's a game changer (or maybe a tastebud changer ).  

Being present, in the moment, is a game changer not only for cookie making but for pretty much everything in life. When we choose to be present to our life, something magical and transformative happens. 

Have you ever had the experience when you are doing something so mundane it's almost hypnotic and out of the blue you are infused with inspiration, insights and creative thoughts?  This happens to me when I am ironing or when I go for a walk and sometimes at the gym.  I am teleported out of my 'life situation' (a term used by Eckart Tolle) and I enter 'now'.  

The power of 'now' as caring-healers is the secret ingredient for the work we do in the NICU. I often talk about the difference between 'doing to' and 'being with'.  'Doing to' is task driven, no presence needed but when we shift to 'being with' it's like everything opens up and we can see how we are touching the other person and how that person is touching us.  The late Dr. Steven Hoath used the mobius strip analogy when we were creating the universe of developmental care model to exemplify that moment of presence in caring.  He used the expression "the shared interface of care, where care is rendered and received".  To fully engage with this shared interface, one must be present with other.  

Pretty much every human being (and other mammals too) knows when they are 'seen' and when they are a passing task.  It's something you feel deeply in your soul.  I recently shared the story of when I had just given birth to my son Alex and  was in my postpartum room when I got a call from my family to tell me dad was not doing well (he had cancer and died a few months later).  As I wept in my room, cradling my brand new baby boy the nurse came into my room and very quietly sat beside me and simply placed her hand on my shoulder. 

This incredibly simple act meant the world to me and in that moment my grief was seen, was acknowledged and I felt I was given permission to feel all the feelings I felt in that overwhelming moment of sadness.  To this day, now 30 years later, when I retell this story the feelings I felt then come rushing back and I am reminded I want to be that nurse.  I want to be that caring-healer who silently bears witness and provides comfort through presence for another. 

Paying attention, being in the now can feel challenging, particularly in the fast-paced world of neonatal intensive care but for those of you who consciously choose to touch the lives of the people you serve every day, the path is presence.  I invite you to try it, just for one care encounter.  Be fully present to your patient, greet them verbally, place your hands on them lovingly, pausing until you know they have acknowledged your presence.  Proceed with care slowly, paced by your patients response to you. Make eye contact, speak soothingly, intentionally to them as a fellow human being, be authentic, be with them.

Let me know how it goes  

Take care and care well,

Mary

P.S.  If you are interested in learning how to integrate mindful presence into your practice and the culture of your organization Caring Essentials can help.

Using breakthrough, evidence-based strategies Caring Essentials helps you achieve clarity, build congruence, and challenges 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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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! 

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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.