Elizabeth A. Carlson

Podcasts, blogs, and webinars.

The next term heard a lot is “blog” especially if you are at all associated with persons younger than 30 years. Blog entries are mentioned earlier when discussing RSS. A blog is the contraction of the words “Web” and “log,” and it is a series of comments, updates, or discussions usually originating from an individual on some topic or series of events. The entries are in reverse chronological order and are updated as the individual determines. They can be personal or professional in nature. Blogs are predominately used to enable the blogger to share their lives and thoughts with others or to serve as a form of self-expression. Blogs can be made private or public. The advantage to a blog is that communication through a blog is much faster than writing or even e-mailing. There are many nurses who maintain a blog and the material found on these blogs runs the gamut of personal musings to information. As with a Web site, the quality and accuracy of the content must be evaluated for accuracy and currency prior to use of the information in your practice. To locate a nursing-related blog, search for “blogs and nursing.” I found numerous sites but list only three to whet your appetite. These Web sites are www. northeastcenter.com/links_nursing_ blogs.htm, www.travelnursingblogs.com, andhttp://mediblogopathy.blogspot. com/.

Medical Errors, Passing Along Nursing Knowledge, and Stress and Burnout: Three Books

The three books reviewed are quite different from each other. The first book is a first-person report of medical errors and their sequelae. The second book focuses on knowledge transfer as part of succession planning, and the third book discusses stress and burnout.The first book is Anatomy of Medic

Improving patient safety through improved communication and teamwork.

DOI: 10.1097/NOR.0b013e3182558db6 N urses have patient safety as a primary goal. The three books and one website reviewed focus on improving patient safety through improved communication and teamwork. Flawless Execution: Use the Techniques and Systems of America’s Fighter Pilots to Perform at Your Peak and Win the Battles of the Business World by James D. Murphy, 2005, Regan Books, New York (208 pages,

Agency for Healthcare Research and Quality (AHRQ) Web site.

25.95). This may seem to be an odd book to review for a nursing journal but it links with the second book reviewed, The Debrief Imperative: the Secret Tool That Is Transforming Businesses the World Over. Flawless Execution describes an approach used in business that is built upon principles the author learned while training to be a fi ghter pilot. Murphy’s company, Afterburner, Inc., teaches other businesses how tools used in fi ghter pilot training can raise an individual’s level of execution and the corporation’s execution of their business. This is Murphy’s second book; the fi rst book applied the principles to the corporation whereas this book focuses upon the individual and, because individuals rarely act alone, the role of the group in the success. The idea of fl awless execution describes the world of the fi ghter pilot and the fact that sloppy execution of a mission can be lethal. The concept of fl awless execution underlies the need to strive for the best execution of whatever the individual is doing and to continue to evaluate what was and was not successful and make the necessary improvements. The book describes the Flawless Execution Model, which is based upon a pyramid that describes how the “mission” is executed. The heart of the pyramid is the execution engine that is called the “Plan -Brief-Execute-Debrief-Win” cycle. The details of this approach are subsequently discussed and examples are given. This is an interesting book and offers many good ideas that could be used to improve communication. Although this is a useful book, the knowledge gleaned from the next book reviewed, The Debrief Imperative, is not dependent on having read this book although it does place the material in context. The Debrief Imperative: The Secret Tool That Is Transforming Businesses the World Over by James D. Murphy and William M. Duke (2011) published by FastPencil, Inc. (pages 110,

Book Reviews: Communication

14.95). This book explains the fourth component in the Afterburner’s Flawless Execution model developed by Murphy that is the Stealth Debrief. The concept of debriefi ng after a situation is not new and on a regular basis is used for situations that are unusual or catastrophic in nature. However, the approach taken to debriefi ng as discussed by Murphy is somewhat different from other approaches. As part of the entire process of the Flawless Execution Model, the execution engine is the “Plan-Brief-ExecuteDebrief-Win’ cycle. The fourth component of this cycle is the STEATLH debrief, which, according to the author, is “one of the most powerful tools in the Flawless Execution Cycle is the continuous improvement and learning achieved through proper debriefi ng” (p. 19). The mnemonic, STEALTH, helps one remember the steps to a successful debriefi ng and “develops a culture of learning” (p. 19). Murphy states that the completion of the task or project includes the debriefi ng; it is not an addition to the process but the completion of the process. Each letter begins a component of the debriefi ng: Set the time; Tone; Execution versus objectives; Analyze execution; Lessons learned; Transfer lessons learned; and High note. This mnemonic assists in remembering the various components. The aspects of the STEALTH debrief that merits comment are twofold. The fi rst is what is meant by Tone. As described by Murphy, the debriefi ng is nameless and rankless, which means that anyone can bring up any issue without fear of reprisal. Although I know little about the military, it seems that rank is key in many decisions so as to have the debriefi ng nameless and rankless is quite unusual. The idea behind being “rankless” is that the critique is not of the individual on a personal level but of the actions taken. In addition, the debrief tone is set by the leader beginning with the mistakes they made. Imagine if this approach were the standard operating approach used in an interdisciplinary team. Imagine the type of communication that would result which is necessary for “fl awless” patient care. The other aspect of the STEATLH debrief is the last step, the High note. Murphy indicates that it is important to end on a high note by positively summarizing the accomplishments of the plan or project. After the discussion of what can be done better, leaving the debriefi ng on a positive note offers the team a sense of accomplishment. This approach creates the environment where members would willingly

Hard facts: Dangerous half-truths & total nonsense

evaluation presented is comprehensive and data based. Not only are you able to view what has been evaluated but you are also able to see what technology is currently in progress. The reviews are available to be downloaded in a variety of formats. This is an excellent site to recommend to colleagues and coworkers, especially someone who likes to adopt new technology or is the person who regularly brings innovative ideas and articles or advertisements on the “latest” medical device. These early adopters are great resources and interested in seeing what is new and how it has been assessed. Progressing on to the National Guideline Clearinghouse, you access evidence-based clinical practice guidelines. This site is an excellent resource and includes U.S. Food and Drug Administration advisories. A feature I particularly find useful is the ability to browse on the basis of the following classifications: Disease/ Condition, Treatment/Intervention, Measures/Tools, Organization, Guideline Index, Guidelines In Progress, or Guideline Archive. This enables me to go directly to a certain treatment or intervention or to see what a selected organization recommends. In the previous issue (March/April 2008) a toolkit for diabetes was reviewed. The Web site (http://www.ahrq. gov/qual/pips/) is an excellent resource for the toolkits that have been produced under the AHRQ Partnerships in Implementing Patient Safety (PIPS) grant program. This site can be You may be familiar with the Agency for Healthcare Research and Quality (AHRQ), a section of the U.S. Department of Health and Human Services, but you may not have gone to the Web site lately (http://www. ahrq.gov). A vast array of information related to healthcare excellence (as the banner states) is available via this Web site. The information is based on research findings and literature reviews. Experts in the various fields conduct focused studies, review the current available research and literature, and present an evaluation of the subject on the basis of the evidence available. The subjects are numerous and wide ranging. Located on the home page are the entry points divided into the following categories: clinical information; funding opportunities; research findings; specific populations; consumers and patients; data and survey; and quality and patient data. As you scan the list of entry points, let me highlight a few that are less well known. Under Clinical Information you can access evidenced-based care; outcomes and effectiveness; effective healthcare technology assessment; preventive services; clinical practice guidelines; and the national guideline clearinghouse. Within this grouping, one area to highlight is the Effective Healthcare Technology Assessment. The fact that the government-sponsored technology assessment programs may not be widely known, but the information available is very useful when the introduction of new technologies or new medical interventions is under consideration or being pilot tested. This site is an excellent resource to see whether the proposed technology has been evaluated and what objective information is available. As seen below, the impetus for this evaluation is to inform coverage decisions for Medicare and Medicaid, but all can benefit.

ACP Diabetes Care Guide: A Team-Based Practice Manual and Self-Assessment Program

T his column reviews two books that are related to each other because they both have communication as the underlying issue. However, were you to read them, you would fi nd that they are very different books about very different topics. One is a management book that offers a new manner of thinking and viewing work and working with employees. The second book looks at nurse communication with the patient and family at the end of life. Both are books worth looking into. A few years ago I had the opportunity to attend an all-day workshop led by Cy Wakeman. She is a dynamic speaker and looks at life in the workplace differently than other speakers or authors I have encountered or read. She has written a book that mirrors her workshops. She also offers access to podcasts and blogs via the website: http:// www.reali tybasedleadership.com. Reality-Based Leadership: Ditch the Drama, Restore Sanity to the Workplace, and Turn Excuses Into Results by Cy Wakeman (Foreword by Larry Winget). San Francisco, CA: Jossey-Bass. (Hardcover, September 2010). US

What to look for when evaluating web sites.

27.95 or e-Book, August 201 0, US

Leadership and Management

18.99) 161 pages. So why do you want to read the book and explore the website? The subtitle of the book gives you a clue: Ditch the Drama, Restore Sanity to the Workplace, and Turn Excuses Into Results. Wakeman is very forthright in her discussion and ideas about how a leader needs to work with employees to get results for the organization. Wakeman states that “current leadership methods are not working, and it’s time we admitted it” (p. 2). Wakeman draws from a 2008 “Gallup poll that showed that 71 percent of employees are disengaged to the point that they consider quitting Elizabeth Ann Carlson, PhD, Associate Professor, Rush University College of Nursing, Chicago, Illinois.