Bold Voices - December 2017 - 20
AT THE BEDSIDE
The spiritual care board
is designed to help
patients of all faiths
express their feelings.
ommunicating with ICU
patients who cannot speak
can be challenging, including
understanding spiritual or religious
Two chaplains created a spiritual
care board to meet the needs of critical care patients who are intubated
or cannot speak for other reasons.
Joel Berning, NewYork-Presbyterian/
Columbia University Medical Center,
collaborated with fellow chaplain
Seigan Ed Glassing, reports "A
Chaplain Designed a Way for ICU
Patients to Request Prayers, Poetry
and a Hand to Hold," and an accompanying video, in CNN.
Similar to the communication
board that ICU staff use to identify
patients' physical needs, the spiritual
care board is designed to help patients
of all faiths express their feelings. It
lists icons such as lonely, scared, loved
or peaceful along with requests to
play music, pray, talk with me, etc.
Patients point to or note the colorful
icons with a dry-erase marker. In addition, they can rate their spiritual pain
Berning also worked with Matthew
Baldwin, a pulmonary and critical care
physician at NewYork-Presbyterian,
to measure the board's effectiveness.
The resulting study, "A Novel Picture
Guide to Improve Spiritual Care and
Reduce Anxiety in Mechanically
Ventilated Adults in the Intensive Care
Unit," was published in Annals of the
American Thoracic Society.
"Before using the board, the 50
patients who participated rated their
level of anxiety as an average of 64
on a scale of 0-100. After using the
board, their average self-reported
anxiety level dropped to 44, a
reduction of 31%," the article notes.
"Patients said that they ... were
better prepared to cope with their
continued recovery after hospitalization," Baldwin adds in the article.
"And they felt more at peace with
who they were and what they had
How do you help your patients
reduce anxiety and meet their spiritual
needs? Tell us at aacnboldvoices@
aacn.org, click on the blue auto-reply
button in the digital edition or post
a wall comment at facebook.com/
REFERENCE: Berning JN, Poor AD, Buckley SM, et al. A
novel picture guide to improve spiritual care and reduce
anxiety in mechanically ventilated adults in the intensive
care unit. Ann Am Thorac Soc. 2016;13(8):1333-1342.
Conscientious 'Nudges' Can Help Patients and Families
The task for conscientious
clinicians is not to avoid
inﬂuencing choices, but to
avoid restricting them.
udges" can assist patients and families in challenging situations, particularly
with end-of-life decisions.
In "End-of-Life Decisions Can Be Difﬁcult: This Doctor Thinks 'Nudges'
Can Help," in STAT, Scott Halpern, a critical care physician at the University of
Pennsylvania, Philadelphia, and founding director of the university's Palliative and
Advanced Illness Research Center, explains that nudges can inﬂuence choices in ways
that produce the best outcomes.
"The 'best interests' standard, where, absent compelling evidence about what a patient would truly want, we
should act in a way that we believe - or know, based on evidence - would promote their best interests," Halpern
says. "A 'nudge' is a way of framing a set of choices to essentially steer people toward a particular option without
shutting out other options," the article adds.
For example, Halpern cites a family's decision on whether to choose chest compressions for their family
member, and the clinician knows that such actions probably won't help. "So as I developed more experience,"
Halpern says, "I became comfortable saying, 'In this situation your loved one's heart may stop. If it did, we would
not routinely do chest compressions, because they would be unlikely to work. Does this seem reasonable?'"
Because end-of-life decisions usually happen just once, patients and families may not know their choices and
preferences. "And choices about which we don't have deep underlying preferences are exactly the ones on which
nudges are likely to exert their greatest effects."
Halpern says that as the experts, caregivers already bear responsibility when providing options because of defaults
or choices listed ﬁrst, so they can't avoid inﬂuencing patients. "And better to inﬂuence choice mindfully in a way
that likely promotes good outcomes for your patients than to continue doing so haphazardly."
Table of Contents for the Digital Edition of Bold Voices - December 2017
Pres Note Front Teaser
AACN Updates Scope and Standards for Acute Care Nurse Practitioners
NTI 2018: Make Your Case for Attending and Register by December
Certification Holiday Reflections
Certified Nurses Day 2018
The Spirit of Giving: One Certified Nurse’s Contributions
Improving Joy in Work
Invest in Yourself With an AACN Scholarship
Disinfectant Use Associated With COPD in Nurses
The Joint Commission Revises NPSG 7 Requirements
Guidelines: Noninvasive Ventilation for Acute Respiratory Failure
High-Risk Vascular Surgeries and Postoperative Myocardial Infarction
FDA Clears MRI System for Premature Babies
New Assay Can Distinguish Bacterial From Viral Infections
Missions of Mercy
How Hospitals Can Save Without Sacrificing Care
DNA Cancer Screening Shows Potential
Smartphone App May Help Screen for Pancreatic Cancer
Cardiologist-Intensivist Model Improves Outcomes
Social Media: Legal and Ethical Issues
Unused Opioids May Pose Health Hazard
AACN’s Facebook Community Weighs In
Conscientious ‘Nudges’ Can Help Patients and Families
Helping ICU Patients With Spiritual Needs
In Our Journals
Bold Voices - December 2017 - Cover1
Bold Voices - December 2017 - Cover2
Bold Voices - December 2017 - Pres Note Front Teaser
Bold Voices - December 2017 - Masthead
Bold Voices - December 2017 - NTI 2018: Make Your Case for Attending and Register by December
Bold Voices - December 2017 - Certified Nurses Day 2018
Bold Voices - December 2017 - The Spirit of Giving: One Certified Nurse’s Contributions
Bold Voices - December 2017 - Invest in Yourself With an AACN Scholarship
Bold Voices - December 2017 - The Joint Commission Revises NPSG 7 Requirements
Bold Voices - December 2017 - High-Risk Vascular Surgeries and Postoperative Myocardial Infarction
Bold Voices - December 2017 - New Assay Can Distinguish Bacterial From Viral Infections
Bold Voices - December 2017 - 12
Bold Voices - December 2017 - 13
Bold Voices - December 2017 - How Hospitals Can Save Without Sacrificing Care
Bold Voices - December 2017 - Smartphone App May Help Screen for Pancreatic Cancer
Bold Voices - December 2017 - Social Media: Legal and Ethical Issues
Bold Voices - December 2017 - Unused Opioids May Pose Health Hazard
Bold Voices - December 2017 - 18
Bold Voices - December 2017 - 19
Bold Voices - December 2017 - Transitions
Bold Voices - December 2017 - 21
Bold Voices - December 2017 - President’s Note
Bold Voices - December 2017 - Cover3
Bold Voices - December 2017 - Cover4