#Hellomynameis & Beyond

Hello, my name is Laurie.  On this humble introduction, lies the cornerstone of our therapeutic relationships.

The #Hellomynameis campaign was started by Dr Kate Granger in the UK. In 2013, unfortunately Kate was diagnosed with cancer and suddenly found herself as the one in the hospital bed, not next it. What she observed as a patient shocked her, especially the number of healthcare professionals who failed to introduce themselves before performing any cares.

Dismayed that we had forgotten such a basic, yet crucial step, in developing relationships with our patients, she wrote a blog article simply called #Hellomynameis and launched one of the most prolific social media campaigns we have seen in healthcare to date. Her call to action was easy – for everyone interacting with patients to start with an introduction.Picture3Kate also emphasized the importance of identifying your role in the patient’s care. Don’t underestimate the power of the sentence -“I’ll be the nurse looking after you today”. Nursing is consistently rated as one of the most trusted professions. Identifying yourself as a nurse, especially in a healthcare environment that now contains assistants in nursing or personal care assistants, can reassure anxious patients and instill them with a sense of confidence in your skills and abilities.

As Kate’s article and the #Hellomynameis campaign spread, the UK NHS was quick to jump on board. NHS chief executive Sir David Nicholson, as well as NHS England’s national medical director Sir Bruce Keogh and chief nursing officer Jane Cummings all added their support to the campaign. In 2014, the UK NHS also launched the Kate Granger Compassionate Care Awards, in her honour.

Kate has and continues to present to hospitals throughout the UK, spreading her message and advocating for the need to focus on compassionate, person-centered care.

WHO KNOWS YOUR NAME?

Have you ever heard the quote by Maya Angelou “They may forget your name, but they will never forget how you made them feel”. This is often recited as an ‘inspirational quote’ to nurses. Well, it seems this is more accurate than we realized.

Studies have shown that only 15-25% of hospital patients know their doctor’s name.  You might think nursing would do better – given the amount of time we spend with the patient in comparison. Think again. Up to 85% of patients do not know the name of the nurse who is looking after them (Arora et al., 2009; Makaryus & Friedman, 2005).

Now there are a number of factors at play. Firstly, are we actually introducing ourselves to the patient? And secondly, does the patient remember our names after the introduction?  A hospital admission is a stressful time.  Add to that hearing difficulties, language differences, dementia or delirium issues, and being cared for by at least three different nurses a day, with possibly a completely different three nurses, the next day. Even if we are introducing ourselves, is it any wonder our patients might struggle to remember?

I had a personal experience with this. I was caring for a patient, who I will call Jane. I had introduced myself at the start of the shift. We had a quite nice little conversation at the time and I helped Jane find some basic personal care items that made her feel much better. The rest of the shift, Jane could not stop gushing to me about this wonderful kind nurse and how lovely she was. It took me much longer than I’d like to admit, to realize Jane was actually talking about me. However, Jane had dementia, and didn’t remember me. The lesson I learnt – sometimes only an initial introduction isn’t enough.

WHAT’S IN A NAME YOU SAY?

You might ask, well does it really make that much difference if a patient doesn’t know my name? Research has shown that it does.  Patients who do not know the name of their doctor or nurse have a poorer understanding of their treatment plan or goals, take a less active role in their care, and feel uncomfortable asking questions, leaving them unasked, resulting in less informed decisions about their health (Arora et al., 2009; Makaryus & Friedman, 2005).

Additionally, it exaggerates the power-imbalance patients already feel when admitted to hospital. We know very personal details about them, we see them in very vulnerable states, and yet they don’t even know our names.  In Kate’s words, knowing someone’s name is “about making a human connection, beginning a therapeutic relationship and building trust…….it is the first rung on the ladder to providing compassionate care.”

THERAPEUTIC RELATIONSHIPS

The benefits of a strong therapeutic relationship between patients and nurses are well known and supported by research. Better patient outcomes, decreased adverse events, and improved patient experiences of care all come from this vital relationship (ANMC, 2006; Berman, Snyder, Kozier & Erb, 2008; Stein-Parbury, 2009).

Yet, the foundations of our therapeutic relationships are looking shakey. Can you honestly say you have developed a partnership with your patient if they don’t even know your name?

So what tools do we have available to help? Of course, there is the old name badge. Except of course for those ones that went through the wash, or went missing the day after orientation or, very commonly, are worn where they can’t be seen. Even when name badges are worn, they are really only helpful for the patient, when you’re next to bed and the patient has adequate eyesight to read them.

Patient care boards have been introduced in many health districts. The UK has also just started rolling out their own versions. These board act as communication tools and prompts to the nurse. I know there are differing opinions within nursing on the use of these boards.  I believe they can be a useful tool.  However, there is a very big proviso for these boards to be effective. That is – they should be filled out in consultation with the patient, not with the nurse ignoring or even having their back to the patient while completing it.

I also believe in a hectic shift, when you feel you are chasing your tail all day, nurses should simply focus on completing three key areas on the board – the patient’s name, the nurse’s name and the medical team.  Other areas of the board should be completed if the nurse has a chance during quieter periods and it is important to remember to ask the patient for their permission as this information is on public display within the room.

 

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For me personally, when I’m filling out the care board, I’m talking to the patient about what it means, answering questions, seeing if they have any concerns.   If I’m working with a student, their name is also on the board. When my patient has a team with a specific registrar and resident, I include them, as often the patient will have much more contact with them than the consultant.

Picture2(Yes, these are all real life examples of what patients have written on their boards.)

Now you might have noticed, those boards had a spot for the patient’s name. This is another area which should not be mindlessly copied from the patient’s notes.

It is another prompt to ask the patient – “What would you like me to call you?” There are many people who prefer to be called something other than their official first name. My full name is Laurelea, but I only get called that by my mother when I’m in trouble. Many patients go by their middle name or a nickname or they may even prefer a more formal Mr or Mrs Jones. You will never know if you don’t ask them.

It’s a bit like the old Don Spencer song “Please don’t call me a koala bear”.  Those who grew up in the 1980s might remember it and the line – “If your name was tom, and everyone called you dick? Isn’t it enough to make you sick, sick, sick”. Yet most patients will not correct you and go along with whatever YOU chose to call them.

KNOWING THE TEAM

I believe we also need to extend the campaign beyond the patients. Interactions between healthcare professionals should also start with #Hellomynameis. A successful multidisciplinary team, starts with everyone knowing each other’s names and roles. This can be crucial for patient care.

Nurses are often responsible for coordinating the care of their patient. If we know physiotherapy, OT, speech pathology all need to see the patient that day, we can work with the patient in planning essential cares such as showering or dressing changes, around these reviews.

It’s important to remember our team also includes the wardsmen who might be need to take the patient off the ward, blood collectors who will be stabbing them for tests we might be urgently awaiting the results of, and tea ladies who leave lunches for patients who may need assistance to eat.

Patients can also be under the care of a number of different specialties, such as a patient I recently cared for who was jointly admitted under the orthopaedic and geriatric medical teams, with consultations by the cardiology, respiratory and psych teams. In these situations, knowing who to contact and what for, is essential and this starts with an introduction. It’s not about ego or hierarchy; it’s about patient care and safety.

FINAL THOUGHT

At the end of the day, Kate’s message and the #Hellomynameis campaign is about remembering the patient in the hospital bed is also a person, and our care should be focused on them.

As a nurse, in my opinion, I think you can tell when you have developed an unshakable therapeutic relationship with your patient. They greet you like an old friend, sharing a joke or even a tear, and are never afraid to push the buzzer or ask questions. The ability to form this relationship with our patients is an essential, yet often underrated nursing skill, and it all starts with #Hellomynameis.

REFERENCES

Arora, V., Gangireddy, S., Mehrotra, A., Ginde, R., Tormey, M. & Meltzer, D. (2009). Ability of hospitalised patients to identify their in-hospital physicians. Internal Medicine, 169(2).

Australian Nursing & Midwifery Council. (2006). National Competency Standards for the registered nurse. Retrieved August 12th 2009 from http://www.anmc.org.au/professional_standards/index.php

Berman, A., Snyder, S., Kozier, B. & Erb, G. (2008). Kozier & Erb’s fundamentals of nursing: concepts, process, and practice. (8th Ed.). New Jersey: Pearson Prentice Hall.

Makaryus, A.N. & Friedman, E.A. (2005). Does you patient know your name? An   approach to enhancing patients’ awareness of their caretaker’s name. Journal for Healthcare Quality, 27(4). 53-56.

Stein-Parbury, J. (2009). Patient & Person: Interpersonal skills in nursing (4th Ed.). Sydney, Australia: Elsevier.

 

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One thought on “#Hellomynameis & Beyond

  1. You are so correct in what you say and so is Kate Granger. My 90 year old father in law was in and out of hospital several times in 2013. Despite us telling staff that he was forgetful they insisted on asking him lots of questions and going by what he said….incorrectly. They also put on the name board his first name…Louis. Never been known as that , we had told them it was Eric, several times, then they wondered why he didn’t respond!

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