Nurse Clare Kneis: ‘Resilience Writing’ and other patient safety culture techniques

Clare Kneis and the OP Oncology Infusion Center team at the N.C. Cancer Hospital promote a positive patient safety culture by implementing techniques to build resilience and respect on the unit. Please read about Clare and take the 2013 Patient Safety Culture Survey before Nov. 20!

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Clare Kneis, RN, BSN, OCN, Nurse Manager of the Outpatient Oncology Infusion Center unit at the Cancer Hospital, understands that the work her staff does can be both rewarding and emotionally draining. Providing chemotherapy to outpatient cancer patients daily, weekly, or monthly, depending on patient treatment plans, allows the nursing unit to build relationships with their patients.

“Building relationships is one of the great things about this work, but it can also be stressful,” acknowledges Clare. “We see many situations where patients finish their chemo and go on and have a great life. And then we see other situations where patients deteriorate in front of us – we support them until the point they decide to go to hospice.”

To combat the toll such stresses can take on her staff, Clare has implemented several tools that provide for a better work environment and that help nurses balance the demanding nature of their work with the daily demands all of us face away from the work environment.

Designated a Tier I unit in the latest employee opinion survey, Clare’s staff was encouraged to write down two actions that would make them feel more respected at work by their colleagues and share them at a staff meeting. Each staff member read them aloud, discussed them at the meeting, and posted them in a common area where they can see them and be reminded of them daily. Awareness of each other’s needs has improved the staff’s ability to take care of each other – and to build respect.

“Until we take care of ourselves as individuals, we can’t take care of each other as a unit, and until we take care of each other as a unit, we can’t take care of our patients,” Clare says. “Sharing these actions has had a big impact, because otherwise we wouldn’t know what we needed to do for each individual. Everybody has different things that are respectful to them.”

Clare has implemented tools and ideas to help staff care for themselves as individuals. The unit has focused on the importance of stress-reducing activities such as getting enough sleep, eating healthy meals, exercising, recognizing when you’re tired, and encouraging each other to take breaks when needed. She has also implemented something called resiliency writing.

“Until we take care of ourselves as individuals, we can’t take care of each other as a unit, and until we take care of each other as a unit, we can’t take care of our patients,” says Clare Kneis.

“The idea is that you have an event, something stressful in your life occurs, and you write about it for about 20 minutes at least 3 days in a row,” Clare says. “You essentially write all your thoughts down. It doesn’t have to be organized, you don’t have to share it with anyone unless you want to, and you can just throw the writing away if you want to. It’s the physical act of taking your thoughts out of your head and putting them on paper rather than sitting and thinking about it. It helps to organize your thoughts better and helps to build your resilience because you’re able to become more at peace with the issue at hand.”

Clare has seen her unit continue to flourish through difficult times thanks to the writing, a technique similar to one offered by Chaplain Heidi Gessner each week in her Writing and Healing for Caregivers group.

Clare plans to continue her effort to build a positive patient safety culture among her unit for the foreseeable future. She looks forward to implementing Three Good Things and Random Acts of Kindness, tools that Paige Roberts uses on 3 Anderson, and to continue sharing the unit’s Community Agreement, which all staff abides by:

  • We respect each other as talented, different people with a host of skills and abilities and we believe our differences make us stronger.
  • We value the support we get from one another and commit to having each other's best interests at heart as we work together.
  • We value honest, open communication between ourselves and will continue to practice communication habits that make our workplace healthy.
  • We value laughter and honor the emotional toll our work takes on each of us and commit to giving each other room to laugh, cry, grieve, and celebrate.
  • We know that growing professionally is hard and sometimes painful work and we commit to creating an environment where we can each learn at our own pace, teach from our own areas of expertise, and role model the very highest clinical standards.
  • We take pride in maintaining a work space that is well maintained, clean, and orderly. We make every attempt as individuals and as a group to make sure that the contents of our clinic are properly placed and available in order to provide safe patient care and a pleasant working environment
  • We celebrate our victories, support each other through growth and learning, and offer encouragement for the clinical journey. We will hold one another accountable for creating a nurturing environment at work and demonstrate to our patients, families, and UNC community the value of our thoughtful communication and shared leadership goals.

Please take the 2013 Patient Safety Culture Survey between Nov. 1 and Nov. 20. In addition to measuring traditional metrics for patient safety, this year’s survey will measure how well UNC Hospitals’ units and outpatient clinics recognize the effects of stress as well as their levels of resilience.

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