Caring Headlines - DMAT Presentation - November …...Page 3 November 15, 2001 Collaborative Governance The Fielding the Issues section of Caring Headlines is an adjunct toJeanette

H E A D L I N E S

Inside:DMAT Presentation ................. 1

Jeanette Ives Erickson ............ 2Collaborative Governance

Fielding the Issues .................. 3Collaborative Governance

Latino Heritage Month ............. 5

Annual CollaborativeGovernance Celebration ..... 6

Exemplar ................................. 8Karlene LeMieux, RN,and Lisa Wright, RN

Case Management Week ....... 9

An Historic Perspective .........1019th Century Exemplar

A Cultural Perspective .......... 11A Visit to India

Respiratory Care Week ........12

Pastoral Care Week..............13

Physical Therapy Month .......14

Educational Offerings ...........15

Halloween at MGH ................16

Working togetherto shape the future

MGHPatient Care Services A grateful hospital says, ‘Thank-you!’

Standing room only, standing ovation,for Sue Briggs, MD (left), Marie LeBlanc, RN,

and the entire DMAT Team, for their presentation,“To New York City and Back”

(See page 4)

CaringCaringNovember 15, 2001

H E A D L I N E S

Page 2

November 15, 2001November 15, 2001Jeanette Ives EricksonJeanette Ives Erickson

Jeanette Ives Erickson, RN, MS,senior vice president for Patient Care

and chief nurse

O

Celebratingfive years of collaborative

decision-makingn Wednesday,October 10,2001, PatientCare Services

celebrated a milestone inthe evolution of our pro-fessional practice model.Five years earlier, wehad come together toalign our work. In ourhearts and minds wewere already a unitedmulti-disciplinary team.All we needed was aplan that would allow usto think together, strate-gize together, and craftour future together.

Six goals helped usarticulate our work:

Enhance communica-tion to promote un-derstanding of organ-izational imperativesand their involvementin clinical decisionsaffecting practice.Promote and advancea professional practicemodel that is respon-sive to the essentialrequirements of pa-tients, staff, and theorganization.Assure appropriateallocation of resourcesand equitable, com-petitive salaries.Position nurses, ther-apists, social workersand chaplains to havea strong voice in issuesaffecting patient careoutcomes.

Provide quality patientcare within a cost-effective delivery sys-tem.Lead initiatives thatfoster diversity of staffand create culturally-competent care strate-gies supporting thelocal and internationalpatients we serve.

From our goal to de-velop a professionalpractice model, emergedfour key questions:

Delineation: How dowe acknowledge andcapture clinical exper-tise?Description: How dowe create an environ-ment for learning andcapture opportunitiesto teach?Identification: Whatsystems need furtherrefinement, and whatresources are neededfor the development ofexpertise in practice?Definition: How do weacknowledge, cele-brate, and reward clin-ical expertise?

No one can really ‘de-fine’ professional prac-tice model. It is a frame-work that guides, sup-ports, and helps organizeour work. You, the deci-sion-makers, are thebackbone of our profes-sional practice model.

The model has ninecomponents:

Values that affirm ourworkA philosophy state-ment that synthesizesour beliefsStandards of practiceDecision-making thatempowers cliniciansProfessional devel-opment, includingcareer-advancementprogramsPatient-care deliverysystemPrivileging, credent-ialing, and peer-re-view systemsResearch-based prac-ticeTheories from pro-fession-specific ex-perts

The milestone wehave just achieved isabout your work, aboutour work, around col-laborative decision-mak-ing. Collaborative deci-sion-making places au-thority, responsibility,and accountability forpatient care with prac-ticing clinicians. And wehave been successfullyutilizing collaborativedecision-making in ourpractice for five yearsnow.

Our collaborative gov-ernance committees havebrought this aspect ofour professional practicemodel to life.

The Quality Commit-tee safeguards andensures the very rea-son for our existenceThe Professional De-velopment Committeechallenges us to talkabout our practice andrecognize the excel-lence of our workThe Ethics in ClinicalPractice Committeeprovides a forum forus to discover our col-lective wisdom andthen use it to advancequality patient careThe Patient EducationCommittee informsand empowers patientsThe Nursing PracticeCommittee gives us avoice and strengthensour influence overimportant practicedecisionsThe Nursing ResearchCommittee broughtlife to our spirit ofinquiry and supportsour movement towarda more research-basedpracticeThe Patient Care Ser-vices Diversity Steer-

ing Committee taughtus to see the good inourselves and in oursocietyThe Staff Nurse Ad-visory Committeebrings recognition toNursing and strength-ens me as your leader

We have come a longway from where westarted five years ago.The Staff PerceptionsSurvey tells me we aremaking great strides inchanging our culture forthe better. But we stillhave important initia-tives to discuss, consider,develop and implement.

Collaborative gover-nance is still young. Butwith every passing year,we are weaving our com-mittee work into the fab-ric of Patient Care Ser-vices. All members ofPatient Care Services areaccountable for an in-clusive decision-makingmechanism that works tobetter serve our patients,their families, and staff.

I thank all who havecontinued on next page

Page 3

November 15, 2001November 15, 2001

Collaborative GovernanceThe Fielding the Issues section of Caring Headlines is an adjunct to

Jeanette Ives Erickson’s regular column. This section gives the seniorvice president for Patient Care a forum in which to address currentissues, questions, or concerns presented by staff at various meetings

and venues throughout the hospital.

Fielding the IssuesFielding the Issues

Question: What is col-laborative governance?Jeanette: Collaborativegovernance is the com-munication and deci-sion-making model thatis employed within thestructure of our profes-sional practice model. Itplaces authority, respon-sibility and accountabi-lity for patient carewith practicing clini-cians. Collaborativegovernance is based onthe belief that

participation is em-powering and contri-butes to a broaderknowledge base

individuals makeappropriate decisionswhen they have suf-ficient informationa shared vision andcommon goals lead toproductivity andcommitmentindividuals are ac-countable for theirown practice

Question: What com-mittees are included incollaborative gover-nance?Jeanette: Eight commit-tees comprise our col-laborative governancestructure. They are: Di-versity, Nursing in Clin-

ical Practice, Ethics inClinical Practice, Pa-tient Education, Nurs-ing Research, Profes-sional Development,Quality, and the StaffNurse Advisory Com-mittee. All committeesare chaired by clini-cians, and each com-mittee is supported inits work by a coach whois a member of PCSleadership.

Question: What are theresponsibilities of com-mittee members?Jeanette: Members areresponsible for attend-ing committee meetings;

communicating infor-mation back to mana-gers/directors and col-leagues; and bringing tothe committee thethoughts and commentsof their co-workers.Members are also re-sponsible for activelyparticipating in meet-ings, initiating discus-sions, asking questions,and problem-solving.

Question: How longcan a person serve on acommittee?Jeanette: Co-chairs andmembers rotate everytwo years so that allstaff have an opportu-nity to participate.These appointments arestaggered to maintainthe necessary experi-ence level within eachcommittee and to allowexperienced members tomentor newer members.

Typically, opportunitiesto participate on com-mittees arise once ayear.

Question: When docommittees meet?Jeanette: Times andfrequency of committeemeetings vary, so checkwith committee leader-ship for specific sched-uling information. Ifyou’re interested in par-ticipating on a com-mittee, there’s an annualreport available throughThe Center for Clinical& Professional Devel-opment that may assistyou in selecting thecommittee of interest toyou. Speak with yourmanager or director toensure your partici-pation is supported. Formore information, con-tact The Center at726-3111.

participated on collabor-ative governance com-mittees, including out-going committee leaders,Regina Doherty, OTR/L,Karen Hopcia, RN, Bar-bara Cashavelly, RN,Kristin Parlman, PT,Clare Beck, RN, EdBurns, RRT, and com-mittee coach, DonnaJenkins, RN. And wel-come to those who arejust beginning theirmembership terms. Welook forward to helpingyou and working withyou as we move forward.

Jeanette Ives Ericksoncontinued from previous page

Updates

I’m pleased to an-nounce that MaryCoughlan Lavieri, RN,has accepted the part-time position of criti-cal-care clinical nursespecialist for The Cen-ter for Clinical & Pro-fessional Develop-ment. Mary will sup-port the North ShoreCardiac Surgical Pro-gram, working closelywith Donna Perry, RN,and the cardiac surgi-cal and peri-operative

nursing teams, andwill support the con-tinuing developmentof critical care initia-tives.On Monday, Novem-ber 19, 2001, Jill Nel-son, RN, will assumethe position of oncol-ogy inpatient nursepractitioner within thedivision of Hematol-ogy/Oncology. This isa one-year pilot pro-gram funded by On-cology Clinical Per-formance Manage-ment. Goals have beenestablished to helpevaluate the effec-tiveness of the pilot,including: decreasing

length of stay; effect-ing a smooth transi-tion to the next venueof care; improvingpatient- and family-

satisfaction; andimproving communi-cation/collaborationamong the entirehealthcare team.

Rewards for PCS employeeswho recruit or refer clinical staff for

hire within PatientCare Services

PCS Referral Program rewards PCSemployees who refer individuals for hire intospecific roles between now and December31, 2001

All current PCS employees are eligible(excluding directors, leadership and HR staff)

$1,000 will be given to employees whosereferrals are hired into PCS clinical positionsof 20 hours per week or more

For more information,contact Steve Taranto at 724-1567

Page 4


DMAT Team presentation:“To New York City

and Back”

Ives Erickson introduces teamin a packed Ether Dome

Special TeamsSpecial Teams

DMAT nurse says, ‘Thank-you’

I would like to take this opportunity to saythank-you to all the brave ‘unsung heroes’ whocharacterized the MGH community in the after-math of the September 11th tragedies. The un-sung heroes are those of you who performedwith dignity, caring and courage, the most dif-ficult task of all, the job of staying behind!

In recent times, much has been writtenabout the power of positive energy. Many reli-gions testify that grace and prayer can createchange, promote healing and move mountains.Nurse theorist, Martha Rogers, described humanand environmental energy fields as open, infinite and integral with one an-other. James Redfield, in his book, The Celestine Vision, talks about a ‘re-sponsive’ universe made up of an interconnecting web of energy relationships.

If we believe that we are all connected by energy, the terrible de-struction generated by the terrorist attacks in September was offset, repell-ed, and in many ways, neutralized by the outpouring of positive energyfrom the MGH community! That healing energy was created by prayer, bycovering a shift for a colleague, draping flags on office doors, talking withchildren, appreciating your family a little bit more, juggling your sched-ules to fill a sudden gap, making a donation to a meaningful charity, faci-litating a debriefing, making a welcome-home sign. . . by asking, “Are youokay?” and listening to the stories, and by keeping the everyday routine athome and at work on track.

By doing these things, you have defended our way of life and opera-tionalized the words of Buddha: “Hatred does not cease by hatred at any time;hatred ceases by love—this is the eternal law.” Please know that you allhave made a difference during these difficult times. Please know that youall are my heroes!

Mary O’Brien

Mary D. O’Brien, RN, MS, CSpediatric trauma nurse coordinator

his is a proud and historic moment,” said Jean-ette Ives Erickson, RN, senior vice presidentfor Patient Care, as she introduced MarieLeBlanc, RN, nurse manager and DMAT super-vising nurse, and her presentation, “To New

York City and Back: Our Mission to Ground Zero.”LeBlanc narrated a riveting photographic essay of theDMAT team’s deployment and work at Ground Zero.Before a backdrop of stunning images, LeBlanc spokeabout the speed and efficiency of the team’s response;the changing focus of their mission driven by thechanging reality at Ground Zero; the enormity of thedestruction; and the incredible and unwavering sup-port they received from fellow team members andfrom other DMAT teams who had been deployedfrom all over the country.

Bob Droste, RN, and Sally Morton, RN, describedwhat it was like to be part of the second wave whohelped staff the Cornell Burn Center at the New YorkPresbyterian Hospital. They spoke about having toquickly learn new equipment and technology, thehigh level of security surrounding the hospital, work-ing long hours, and the incredible outpouring of sup-port from the community, including cards and posterssent to the hospital by school children and others.

LeBlanc recognized the New York City police andfire fighters as the ‘real heroes,’ but applauded the“high level of organization, and the strength, spiritand courage exhibited by the entire DMAT team.”

“TMembers of the DMAT team (seated)

listen as Marie LeBlanc describestheir journey to Ground Zero.

Page 5


number of spe-cial events madeit possible forstaff, patients

and families to take partin October’s celebrationof Latin Heritage Monthat MGH. Presenta-tions, Nursing GrandRounds, and a LatinoHealth ResourceTable provided edu-cational materialsand information,while a Friday after-noon ‘fiesta’ suppliedfood, fun and frivol-ity!

The theme of thisyear’s celebration,“Paving the Way forFuture Generations,”was evident in manyof the presentations,including, “WhyHealthcare Needs theForeign LanguageInterpreter Law,”

Marie C. Petrilli OncologyNursing Award

Congratulations to Laura Ghiglione, RN, staff nurse,Ellison 14, and Nancy Schaeffer, RN, Medical On-cology nurse practitioner, the recipients of this year’sMarie C. Petrilli Oncology Nursing Award. ThePetrilli award is given annually to recognize thecaring, compassion and commitment of MGH on-cology nurses. The award ceremony has been re-scheduled for the spring; Ghiglione and Schaefferwill be formally recognized at that time.

DiversityDiversity

A

“Wound & skin care:common problems, common

products”Program is designed to enhance participants’knowledge of latest developments in skin care

and wound management. At completion ofprogram, participants will be able to assess,

implement, evaluate and document care for arange of common wound and

skin-care problems.

Friday, December 7, 20017:30am–4:15pm

Training & DevelopmentCharles River Plaza

Please bring challenging casesfor discussion by panel

Contact hours will be awarded

For more information, call Joan Gallagher, RN,at pager #2-5410

Carmen Vega-Barachowitz,CCC-SLP

MGH celebrates LatinoHeritage Month

“Care of Latino Patients,”and “An Inside Look atthe Latino Culture, Her-itage and History atMGH and Beyond.”

Among those whoshared observations were

Allison Rimm, vice pres-ident of External Affairs,who spoke about ourmany advancements indiversity as an institu-tion; WinWilliams,

MD, of The Multi-Cul-tural Affairs Office,who spoke about theimportance of increasingopportunities for Latinoclinicians and increasingthe number of Latinoand Latina professionalsin our workforce; Ern-esto Gonzalez, MD,stressed that it’s every-

one’s responsibility toimprove services to ourLatino patients and em-brace opportunities foradvancement; and Car-men Vega-Barachowitz,CCC-SLP, director ofSpeech-Language Path-ology, shared some per-sonal experiences aboutwhat it was like for aLatina woman coming toAmerica for the firsttime. She spoke of thedifferent influences thatcontribute to diversitywithin the Latino popu-lation, and of the simil-arities. Said Vega-Bara-chowitz, “There arecommon threads that runthrough all of us—theimportance of family,religion, community, ourway of communicating,our shared sense of‘struggle.’ This is a timeto celebrate our similari-ties!”

Deborah Washington,RN, director of the PCSDiversity Program, shar-ed that with all the Lat-ino festivities going on,she really felt part of theLatino community.“Wouldn’t it be nice,”she said, “if we couldmake that feeling last allyear... not just for themonth of October!”

The Latino HeritageMonth Planning Commit-tee, chaired by ElenaOlson, was a multi-disc-iplinary, multi-culturalteam that included em-ployees from InterpreterServices, AMMP, TheMulti-Cultural AffairsOffice, and Food & Nu-trition Services (whoprepared an authenticLatino fiesta from reci-pes submitted by com-mittee members!)

Enjoying some Latinoculinary delights!

Providing therhythm...

(Photos by Abram Bekker, Bulfinch Photo Lab)

Page 6

November 15, 2001November 15, 2001Collaborative GovernanceCollaborative GovernancePast-year accomplishments

and goals for the future

Collaborativegovernancecommittee

leaders reporton their work andaccomplishments

at recent annualcollaborativegovernance

event inO’Keeffe

Auditorium.Pictured (l-r) are:

Regina Doherty, OTR/L,Jennifer Kelliher, RN,

Pam Wrigley, RN,Anne Cassels-Turner, RN,

Barbara Cashavelly, RN,Clare Beck, RN,

Susan Jaster, RN, andFirdosh Pathan, RPh.

n Wednesday,October 10,2001, PatientCare Services

celebrated another yearof collaborative decision-making as the annualcollaborative governancepresentations and dinnerwere held in O’KeeffeAuditorium and thegrand ballroom of theHoliday Inn. Committeeleaders were asked tosummarize the work andaccomplishments of theirrespective committeesover the past year, andshare their goals for thefuture. An overview oftheir reports is includedhere.

Ethics in ClinicalPractice Committee

Played leadership rolein development andimplementation of LifeSustaining TreatmentpoliciesIncreased staff aware-ness around ethicalaspects of careProvided education onethical issues to MGHcommunity

Future goals:Continue to developinterdisciplinary ethicsresourcesExpand collaborationwith other committeesregarding the intersec-tion of ethics withother committeecharges.

O Nursing PracticeCommittee

Revised NursingAssessment SheetDeveloped a One-Time MedicationSheetRevised NursingProcedure ManualEvaluated new andcurrent products forefficiency, cost, effec-tiveness, and safety

Future goals:Support developmentof computerized, on-line nursing recordContinue to work withMaterials Managementand front-line evaluat-ors to review newproducts.

Professional Develop-ment Committee

Developed guidingprinciplesUsed clinical narra-tives to identify unique-ness of MGH clinicalpracticeDescribed four levelsof practice:

EntryClinicianAdvanced clinicianClinician scholar

Identifed themes ofpractice:

Clinican-patientrelationshipClinical knowledgeTeamwork/collab-oration

Future goals:The ProfessionalDevelopment Commit-tee has completed thework of its originalcharge; it is currentlyawaiting its nextcharge.

Patient Education CommitteeEstablished ‘on-demand’ patienteducationMade educational videos availableon televisions at patients’ bedsidesRetained programmer to assist withexpansion of Patient Family Learn-ing Center website for MGH-speci-fic patient education documents

Committee members check inat the grand ballroom

Page 7

November 15, 2001November 15, 2001(Photos by Paul Batista, Bulfinch Photo Lab)

Diversity SteeringCommittee

Had strong participa-tion in the creation ofannual Diversity issueof Caring HeadlinesCoordinated BlackHistory Month Pin-ning CeremonyWas instrumental increating and display-ing multi-culturalholiday bannersHeld successful holi-day gift-giving eventto support the familiesof the HAVEN Pro-gram

Future goals:Continue to hold ‘bigevents’ celebratingdiversityPresent at NursingGrand RoundsDevelop more cultur-ally competent careinformational re-sources

Nursing ResearchCommittee

Initiated “Did youknow?” research-utilization posters onpatient care unitsDesigned and present-ed Research PosterPreparation Workshop(now an on-goingoffering of The Centerfor Clinical & Profes-sional Development)Expanded NursingResearch Day postersession to two weeksAdded more research-utilization resources toNursing ResearchGuide

Future goals:Increase collaborationwith other committeesSupport and consoli-date “Did you know?”poster topic-develop-mentGet research webpageup and running

Future goals:Continue to work on the PFLC web-page to provide easy access to patient-education documents for bedsidenursesImprove documentation of patienteducationContinue search for diversity-relatedand culturally sensitive materials

Quality CommitteeAssisted in implement-ing improvements inmedication administra-tionCollaborated withdirector of Quality toassist with JCAHOpreparationsWorked with NursingResearch Committeeand OccupationalHealth Services onissues related to em-ployee back injuriesCollaborated on im-plementation of hand-disinfection program

Future goals:Collaborate withDiversity Committeeto foster strategies forculturally competentcare deliveryFocus on systemsimprovement to en-hance patients’ accessto quality care

Staff Nurse AdvisoryCommittee

Made good use of timespent with senior vicepresident for PatientCare discussing issuesrelated to environmentof carePromoted recruitmentand retention initia-tives through openhouses and the Em-ployee Referral Pro-gramProvided input intodocumentation of careinitiative and educa-tional calendarAddressed issuesimportant to staff(such as parking)

Future goals:Continue open dia-logue on all issues ofimportance to clinicalstaffSupport legislative andpublic-relations initia-tives

Page 8


Lisa Wright, RN, staff nurse, White 8and Karlene LeMieux, RN,

case manager

M

continued on next page

Inter-disciplinary collaboration,effective communication result

in timely discharge

ExemplarExemplar

r. G is a 57-year-old manwho was trans-ferred to MGH

from a rehabilitationhospital in February. Hehad multiple medicalproblems, including bi-lateral below-the-kneeamputations precipitatedby severe vascular dis-ease, diabetes, and renalfailure requiring hemo-dialysis and frequenthospitalizations. Mr. Galso suffered from severedepression, which caus-ed him to attempt suicideby overdosing on insulin.

For this hospitaliza-tion he had been trans-ferred from a rehabilita-tion hospital with a diag-nosis of abdominal painand sepsis. Mr. G under-went surgery and be-cause of his fragilehealth, his recovery waslong and challenging.Mr. G was a brilliantman, but had a verystrong self-destructivestreak. Growing up hewas poor but received afull scholarship to an IvyLeague college. He soondropped out and began aslow decline into alco-holism. He found workin construction but con-tinued to drink despitemarrying and fatheringtwo daughters.

We met Mr. G whenhe was transferred toWhite 8, two monthsinto what would becomea nine-month hospitali-

zation. Lisa was Mr. G’sprimary nurse; Karlenewas his case manager.Little did we know thejourney we would betaking together.

Mr. G’s long illnessand frequent hospitaliza-tions robbed him of hissense of control over life.This was manifest by hisrefusal to eat after re-ceiving insulin. Whilewe all understood hisneed for control, wewere concerned abouthis falling blood-sugarlevels. His labile blood-sugar readings causednot only serious medicalproblems, but also manymissed therapy sessions.After working with himfor a little while, we real-ized there were certainthings he could control;but we couldn’t let himput his life at risk.

Lisa would stand infront of him and say,“You have to drink thisorange juice,” and hewould drink it. Wechanged the time hisinsulin was given so thathe wouldn’t receive ituntil breakfast. Slowly, arelationship and a trustdeveloped. We realizedhe needed to retain someindependence, so withthe assistance of PT andOT he was able to show-er independently, get inhis wheelchair, and tra-vel the hallways ofMGH. Mr. G was a fre-quent presence at Coffee

Central. Lisa would puta note on his chart alert-ing others to contact hisnurses if they were look-ing for him—we knewall his favorite haunts.

It is challenging tocare for patients whohave struggled with sub-stance abuse and ad-herence issues in thepast. Being able to re-main non-judgmentalallows the patient to feelvalued and cared for. Butas challenging as it is forclinicians, it’s harder forfamilies who often mustreconcile painful memo-ries with the demands ofa frail husband or parent.Mr. G’s family struggledwith a complicated his-tory, and we frequentlyconsulted social worker,Marilyn Wise, MSW,who had known the fam-ily in the past.

Mr. G’s recovery wasslowed by infections,primarily related to hisdialysis catheter. It be-came necessary for us toplace a permanent accessdevice in his arm, butdue to his vascular prob-lems, we had to place itin his (dominant) rightarm. Mr. G refused. Hefeared something wouldgo wrong and he wouldlose his right arm, andwith it, his independ-ence. He asked Lisawhat to do. It is a greatresponsibility when apatient asks for this kindof guidance, so Lisa spent

time talking with himabout his options and histrust in the surgeons. Ul-timately, he decided tohave the graft placed inhis right arm.

When Mr. G returnedfrom surgery, his armwas cool and the pulsefrom the graft was weak.He developed difficultymoving his hand. Wecarefully monitored hiscondition and workedwith the whole teaminvolved with his care.Everyone had an opinionbut no one was doing avery good job of com-municating with eachother or with Mr. G andhis family.

We decided we need-ed a family meeting sothat everyone’s concernscould be addressed. Theteam was going to meet15 minutes before themeeting to prepare; wemet for 45 minutes. Lisaforcefully advocated forMr. G and the need toestablish a concrete planto deal with his graft anddischarge plans. Karlenehelped us look at all ofthe conflicting views

involved in the case.Then we met with Mr. Gand his family.

Things could havegone very badly at thismeeting—complex fam-ily dynamics, unresolvedissues about the best wayto treat his graft, and amyriad of unknownsabout the future. But itwent well. The team wasunited, and Mr. G andhis family could see thatwe were working togeth-er to do what was rightfor him. The next day,tests showed that thegraft could not be saved,and it was removed.Occupational therapist,Tricia Cincotta, OTR/L,and physical therapist,Bob Dormund, PT, ag-gressively worked withMr. G to maintain func-tion of his hand.

Mr. G’s long journeywas drawing to an end.He told us he wanted toreturn home. We all un-derstood, but we didn’twant him to fail once hegot home. To preventthat, we felt he neededthe expertise of a rehabi-

Page 9


care at MGH.The Case Manage-

ment Department, underthe leadership of NancySullivan, originated sixyears ago with the con-solidation of UtilizationManagement and Con-tinuing Care. Case man-agers work to ensure thatpatients receive quality,patient-focused care thatmeets each patient’s spe-cific needs in a timely,cost-effective manner. AtMGH case managers are

Case Management Weekat MGH

—by Hilary Levinson, RNcase manager

registered nurses who arewell versed in all aspectsof insurance coverage.One of the primary goalsof case managers is towork with the healthcareteam to devise a compre-hensive discharge planfor patients. Case mana-gers assess, implement,coordinate, monitor andevaluate all of the op-tions and services nece-ssary to meet patients’healthcare needs.

The MGH/MGPOCase Management Pro-gram covers inpatientunits, primary care prac-tices, the EmergencyDepartment and Admit-ting. Case managerswork collaborativelywith patients, families,

and the entire patientcare team.

As specially trainednurses with expertise inall aspects of insurancecoverage and non-acuteservices, case managers:

facilitate and commu-nicate treatment anddischarge planningwith patients, familiesand all members ofthe healthcare teamfacilitate consults andtesting for appropriateservices and special-tiesclarify health-insur-ance issues, andexplain the intricaciesto patients and famil-iesmake recommenda-tions to expediteappropriate care anddischarge planscoordinate insurancebenefits with treat-ments and proceduresnecessary for a timelydischargeA luncheon reception

was held to recognizethe invaluable servicesprovided by case mana-gers throughout thehospital. Speakers in-cluded: Jeanette IvesErikson, RN, seniorvice president for Pa-tient Care; ElizabethMort, MD, assistantchief medical officerand director of DecisionSupport and QualityManagement; Brit Nich-olson, MD, chief medi-cal officer; James Rich-ter, MD, medical direct-or of the MGPO, andPeter Slavin, MD, chair-man and chief executiveofficer of the MGPO.

For more informationabout Case Manage-ment, call 6-3665.

Case ManagementCase Management

M Case Management Pro-gram to all who stoppedby. Patients, families,staff, and visitors had anopportunity to learnabout the role of casemanagers and the impactthey have on patient

GH observedNational CaseManagementWeek, October

9th–12, 2001, with aninformation/educationalbooth in the Main Cor-ridor, raising awarenessof the MGH/MGPO

Exemplarcontinued from page 8

litation hospital, and hefinally agreed.

Throughout his stay,Mr. G and his familyworked with three casemanagers. All encounter-ed difficulties as theyplanned for Mr. G’s dis-charge. Karlene wasfinally able to get the Gsto agree on a few facilit-ies and then advocatedfor his admission. Sheenlisted the assistance ofMGH therapists to talkto therapists in thesefacilities. The attendingphysician made phonecalls.

Mr. G was screenedand rejected by all of thefacilities to which weapplied. It was not goingto be easy to place Mr. Gwith his complex medi-cal needs. Finally, ourpersistence paid offwhen he was acceptedby two rehab hospitals.

The family refused oneof the options, and Mrs.G expressed anxiety atthe prospect of the other,saying she didn’t think itwas a good idea. Know-ing her, Karlene remind-ed Mrs. G that this hadbeen their first choiceand was probably the

best place for him.Perhaps because ofwhat we had beenthrough together, sheagreed.

The rehabilitationhospital wanted totransfer Mr. G that dayright after his dialysiscontinued on page 13

Staffing the Case Management educational booth are (l-r):Claudia DeLucia, RN, practice-based case manager; Karlene

Lemieux, RN, acute-care case manager; and ChristineGreenwood, RN, Emergency Department case manager

Greenwood fieldsquestions from

MGH visitor

Page 10


always on the alert forsome new development.Sometimes tokens ofgratitude, in the form ofkind words, come backto her from appreciativepatients or their friends,and again, where shehas done the most andendured the most, shereceives only censure.”(Sturtevant continueswith the narrative of anurse whose name isnot given; possibly, itwas Sturtevant herself.)

“Willie C, a poor,

haggard, emaciated boy,worn out and fractiousby long years of sick-ness and intense suf-fering, was brought tothe hospital. We lookedupon him as a boy,though against his namewe read ‘Age 22.’ Thecase was that of a ‘badknee’ and it proved tobe very bad indeed, andafter some weeks oftreatment, it finallycame to amputation. Itwas a long, tediouscase, and the nurseswere quite worn out

with Willie’s almostceaseless, fretful de-mands upon them dur-ing the many weeks thatlengthened into monthsthat he was under ourcare. Even the patienceof his mother, who hadremained with him for atime, was finally ex-hausted and she left himin our hands.

“But there came aday [about six monthslater] when Willie wasdischarged. We broughtout his clothes and webrushed his hair, andput on his one shoe. Wewrapped him in warmblankets, and the strongward tender took him inhis arms to the carriage,and as the carriagedrove out of the hospi-tal grounds we drew abreath of relief. Yes, wewere glad that Williewas gone, and yet wewere sorry that we wereglad.

“[After he had gone]we missed his peevishcalls, and his pale face

haunted us. We wouldask ourselves, ‘I won-der if we were patientenough with Willie?’and then the consolingthought would come,‘But even his mothergot out of patience withhim.’ And we wouldfall asleep, to be waken-ed by the night watch-er’s call, ‘Quarter offive!’

“No tidings cameback to us of Willie.But a reckoning daycame when we leastexpected it. ‘A gentle-man in the reception-room to see you,’ wasannounced one morningby the porter [five yearslater], and an uncomfor-table presentiment ofcoming disaster tookpossession of me. I ar-ranged my hair withtrembling fingers—nocaps in those days, un-fortunately, to give dig-nity to one’s bearingand confidence as abadge of office will—

Martha E. Stone, MS, AHIPcoordinator for Reference Services

Treadwell Library

An HistoricalPerspectiveAn HistoricalPerspectiveThe writings of Miss

Georgia Sturtevant, MGH’s‘last untrained nurse’

—submitted by Martha E. Stone, MS, AHIP

In my capacity as coordinator for Reference Services at Treadwell Library, I amsometimes called upon to research various aspects of the history of nursing atMGH. Occasionally, after I’ve answered a specific question, I’m so drawn to thesubject that I pursue it further for my own interest. This was the case with a ques-tion I received about Miss Georgia Sturtevant, the last ‘untrained nurse’ at MGH.

Georgia Sturtevant began her career at MGH in 1862 as an assistant nurse,and after two months was put in charge of a men’s surgical ward. During thattime—the Civil War era—male wards were filled to capacity because no soldierwas turned away if there was an empty bed. Sturtevant was appointed hospitalmatron on July 31, 1868, upon the death of her predecessor. I found it particularlyinteresting that she was also placed in charge of Treadwell Library, which at thattime was located in the Bulfinch Building. In her position as hospital matron,Sturtevant was the only female of all the officers at MGH. The stereotype of hos-pital matrons at that time, in the words of a 21st century British writer, was a‘tyrannical, starched battle-axe.’ By late 1873, preparations had begun to openMGH’s training school for nurses.

After 32 years of service, Sturtevant retired, in 1894. She was given a gift of$1,000 (the equivalent of $18,482 by today’s standards). She began writing aseries of articles on “Hospital Life Before the Days of Training Schools,” for anursing journal called The Trained Nurse. The fourth installment of her article,published in the April, 1896, issue, struck me as so contemporary, I thoughtCaring Headlines readers would enjoy seeing it. I have edited it for length, butthe essence and emphasis (italicized words) remain Miss Sturtevant’s.

The writings of Miss Georgia Sturtevant:a 19th century ‘exemplar’

continued on page 12

“Human nature is a com-plex problem at best,and sick human natureis sometimes incompre-hensible. A nurse hastwo distinct conditionsto consider—the indi-vidual and the case. Shehas not only to watchthe physical symptoms,but the moods, and fre-quently the personaleccentricities of thepatient as well, andsometimes the latter ismuch the hardest task ofall. She is always in astate of expectancy;

Page 11


Donna Perry, RNprofessional development coordinator

recently return-ed from a tripto India, whereI was part of a

cardiac surgery teamdeployed to help devel-op a cardiac hospital inPunjab, India. The teamincluded five staff fromBrigham and Women’sHospital, and was atremendous opportunityfor multiple disciplinesfrom two different hos-pitals to help bridge thecultural gap and bringhealthcare services to aplace where those ser-vices are desperatelyneeded.

Landing in Delhiwas like enteringanother world. Yoursenses are over-whelmed with abarrage of newsights, sounds, andsmells. Men inbusiness suits andbrightly coloredturbans stride downthe sidewalk. Wom-en in beautiful sarissit sidesaddle be-hind their husbands onmotor scooters as theyzip down the street.Often they hold one ortwo children as thesmall scooters providetransportation for theentire family. Bicyclerickshaws rush by, ladenwith people and parcels.Cows wander freely

down the middle of thestreet, stopping to grazeon the side of the road.Cows are revered assacred by the Hindus sothey are allowed to grazeundisturbed. The aromaof home cooking per-meates the air as manypeople live on the sideof the road in tents ormakeshift huts.

And everywhere isthe blare of horns. Thesound of honking isconstant as all the dif-ferent vehicles vie forspace on the crowdedroads. One driver toldus on the first day, “Youneed three things to

drive in India: a goodhorn. Good brakes. Andgood luck!”

The hospital itselfwas located in Mohali,Punjab which is justoutside the state capitalof Chandigarh. It is aspacious facility withstate-of-the-art equip-ment. Each patient’s

room contains a smallbed next to the patient’sbed for a family mem-ber to sleep. In India,it’s customary for afamily member to staywith the patient as apersonal-care attendant.The hospital is keptscrupulously clean byhouseboys who seem tobe constantly sweepingand mopping.

From the momentwe arrived, our visitwas a whirlwind ofwork-filled days follow-ed by evenings of warmIndian hospitality. Wewere invited to severalhomes for dinner where

we were treated to sump-tuous feasts of Indiandelicacies such as Tan-doori chicken, and ourIndian hosts were sogracious.

At the hospital, wefound nurses to be verysweet and enthusiasticto learn. They had agood knowledge baseabout their patients but

were timid about ex-pressing opinions tophysicians. Over thenext several days weworked with the nursesand observed their care.We found them veryreceptive to our sug-gestions, but reluctantto initiate a primary rolein planning care.

The publicperception of nurs-ing in India is verydifferent from theUS. Nursing isseen as a low-statusjob there, and theirrole is very task-oriented. A publicrelations consultantdescribed the pub-lic’s view of nurses

as, ‘two arms and twolegs.’ So we looked atthis as an opportunity toinfluence the develop-ment of professionalismamong nurses in India.

Each afternoon oneof our team memberslectured on a particulartopic. I gave a presenta-tion on the importance

of patient education.About 70 staff, physi-cians and nurses, camein on their afternoon offto attend the session.Patient-education is nota major aspect of care inIndia, but it is an areathey want to improve onas they develop a morepatient-centered philos-ophy.

I felt fortunate thatMGH has such a wellarticulated philosophyof nursing. I was able toshare our strong empha-sis on patient-focusedcare and our belief thatevery action is guidedby knowledge, enabledby skill, and motivatedby compassion.

My presentationincluded photographsthat have appeared inpast Nurse Week issuesof Caring Headlines.These photographsshowed MGH nurses inaction, and caring andcompassion were evi-dent in each picture.

Building bridges: a nurse’spassage to India

—by Donna Perry, RN,professional development coordinatorI

continued on page 14

The public perception of nursing in Indiais very different from the US.

Nursing is seen as a low-status job there,and their role is very task-oriented... So we

looked at this as an opportunity to influencethe development of professionalism

among nurses in India.

A CulturalPerspectiveA CulturalPerspective

Page 12

November 15, 2001November 15, 2001Respiratory CareRespiratory CareMGH celebrates Respiratory Care Week

October 21–27, 2001

Staffing the Respiratoy Care Week educational booth are (l-r): Laura White, RRT,Bill Perry, RRT, Pam Brown-Early, RRT, and Mike Underwood, RRT.

for even a nurse, anuntrained nurse, cannotcontrol her emotionsunder all circumstances.I went down the longflight of stone stairs,and as I opened thedoor of the receptionroom a gentleman ad-vanced to meet me. Hisstern face added greatlyto my discomforture,and my self-controlnearly deserted me. Thegentleman asked, ‘Areyou Miss ------, and didyou have the care of apatient by the name ofWillie C? Was he verytroublesome?’

“I answered in theaffirmative as calmly asI was able. The pictureof indignant parents,sympathizing friends,and the ‘family physi-

cian,’ whom I had everyreason to believe wasstanding before me,passed rapidly beforemy mind. But thoughmy hands had grownabsolutely clammy bythis time, I determinedto defend myself andregain my self-controlby talking very rapidly,and I answered, ‘Yes,he certainly was verytroublesome indeed. Weknew that he had suf-fered a long time, andwe really pitied the boyvery much, and we triedto be very patient withhim, but his fretfulnessdid at times seem al-most unbearable. Evenhis mother—’

“But what a remark-able change had comeover the stranger. His

stern features had soft-ened and a smile trans-formed his face, as heanswered, ‘Yes, evenmy mother couldn’tstand my nonsense. ForI am Willie C, and Ihave come back to apol-ogize for my bad beha-vior.’ And he held outhis hand, and I noticedfor the first time theartificial leg that he hadlearned to manage withperfect ease. Here in-deed was a case of grat-itude we were whollyunprepared for.”

Miss Georgia Sturtevantcontinued from page 10

EAP Resource Table“Stress and the Holidays”

Many of us look forward to the holidays, but formany others it is a time of conflicting demands and

stressors. Visit the EAP Resource Tablefor suggestions on how to manage stress, setrealistic goals, and take better care of yourself

during the holiday season.

December 6, 200111:00am–1:00pmEat Street Cafe

December 13, 200111:00am–1:00pm

Building 149, Atrium Lobby, CNY

For more information, call theEmployee Assistance Program

at 726-6976

Laura White, RRT, and BillPerry, RRT, answer questions

for passers-by

On Tuesday, October 16, 2001, staff of RespiratoryCare Services offered a day-long educational booth inthe Main Corridor. Respiratory therapists were on handto educate people and answer questions about the manyservices provided by their department, including: me-chanical ventilation and airway management; bronch-oscopy assistance; asthma care and education; extra-corporeal life support; as well as a number of consult-ative, research-oriented, and community-service activi-ties. For more information, please call 724-4480.

Page 13


Published by:Caring Headlines is published twice eachmonth by the department of Patient Care

Services at Massachusetts General Hospital.

PublisherJeanette Ives Erickson RN, MS,

senior vice president for Patient Careand chief nurse

Managing Editor/WriterSusan Sabia

Editorial Advisory BoardChaplaincy

Mary Martha Thiel

Development & Public Affairs LiaisonGeorgia Peirce

Editorial SupportMarianne Ditomassi, RN, MSN, MBAMary Ellin Smith, RN, MS

Materials ManagementEdward Raeke

Nutrition & Food ServicesPatrick BaldassaroMartha Lynch, MS, RD, CNSD

Orthotics & ProstheticsEileen Mullen

Patient Care Services, DiversityDeborah Washington, RN, MSN

Physical TherapyOccupational Therapy

Michael G. Sullivan, PT, MBA

Reading Language DisordersCarolyn Horn, MEd

Respiratory CareEd Burns, RRT

Social ServicesEllen Forman, LICSW

Speech-Language PathologyCarmen Vega-Barachowitz, MS, SLP

Volunteer, Medical Interpreter, Ambassadorand LVC Retail Services

Pat Rowell

DistributionPlease contact Ursula Hoehl at 726-9057 for

all issues related to distribution

Submission of ArticlesWritten contributions should be

submitted directly to Susan Sabiaas far in advance as possible.

Caring Headlines cannot guarantee theinclusion of any article.

Articles/ideas may be submittedby telephone: 617.724.1746

by fax: 617.726.4133or by e-mail: ssabia @partners.org

Please recycle

Next Publication Date:December 6, 2001

ChaplaincyChaplaincyMGH celebrates Pastoral

Care Week

I n celebration of National Pas-toral Care Week, October 22-26,2001, The MGH Chaplaincysponsored a much-needed ses-sion of spiritual renwal and com-

ic relief in the form of stand-up comedian,Jackson Gillman. Gillman, who prefersthe description, ‘stand-up chameleon,’because he changes his voice and appear-ance to create a host of ‘supporting’ char-acters, used song, poetry, skits, and mimeto deliver a message of love and hope.

Gillman reminded listeners of the spi-rit and tenacity of a childhood friend withthe familiar lyrics: “The itsy bitsy spiderwent up the water spout. Down came the rainand washed the spider out. Out came the sun anddried up all the water. The itsy bitsy spider wentup the spout again!”

“Just like that little spider,” said Gillman, “wemust all. . . rise again!”

Evelyn Bonander, ACSW, director of SocialServices and the Chaplaincy, took the opportunityto thank MGH chaplains for what they do everyday, and especially for what they have done sinceSeptember 11th. Said Bonander, “Thank-you forplanning this session—I think we all needed to

remember how to laugh!”Reverend Mary Martha Thiel, coordinator of

the Chaplaincy, introduced members of theChaplaincy who were present, noting the greatdiversity of cultures and origins represented. SaidThiel, “Our hospital boasts a rich diversity of tra-ditions, cultures and languages from all over theworld. But as different as we all are, there is apalpable sense of unity for which we are all grate-ful.”

The Chaplaincy can be reached by calling6-2220.

Comedian, JacksonGillman

Exemplarcontinued from page 9

treatment. Lisa was off that day,and Karlene wasn’t there whenhe left. While we both wish wecould have seen him before heleft, we realized that after ourlong journey together, nothinghad been left unsaid.

The entire team had a greatfeeling of accomplishment atfinally getting Mr. G into anacute-level rehab facility, whenso many complications couldhave prevented it. We felt likethis might be Mr. G’s lastchance to regain his indepen-dence, return home, and perhaps

start picking up the pieces of hislife. Mr. G’s case is a powerfulexample of what can be ach-ieved when all members of thehealthcare team come togetherto advocate for the patient andhis family. While the trip wasfar from easy, we reached ourfinal destination, and it was,indeed, a beautiful conclusion.

Comments by Jeanet teIves Erickson, RN, MS,senior vice presidentfor Patient Care andchief nurse

What impressed me about thisnarrative was that the accounta-bility of each discipline over-lapped the accountability ofother disciplines. This was truly

a collaborative approach. Casemanagers assist patients andfamilies in developing and im-plementing discharge plans, butas this narrative so beautifullydemonstrates, nurses, therapistsand social workers all play akey role in ensuring the successof the plan.

In caring for this medicallycomplex patient, nurses, casemanagers and the entire health-care team worked together andcommunicated effectively toadvocate for Mr. G and his fam-ily. In the end, a timely and sat-isfactory discharge took placebecause of their efforts.

Thank-you Karlene andLisa.

(Pho

to b

y Abr

am B

ekke

r, Bu

lfinch

Pho

to L

ab)

Page 14

November 15, 2001November 15, 2001Physical TherapyPhysical TherapyPhysical therapists celebrate National PT Monthby sharing blood, sweat and years of experience

Indiacontinued from page 11

One photo was of anurse holding the handof an intubated patientand talking with her. Itold them that educationwas an important part ofongoing care. The mes-sage was very well re-ceived. The senior car-diac surgeon asked meto reemphasize the im-portance of talking to

patients. He felt thiswas something that real-ly needed to be devel-oped.

Later in the week,some of us were invitedto a press conferenceabout nursing. We werevery excited but ner-vous because none of ushad ever been involvedin a press conferencebefore. We met withrepresentatives of apublic relations firm tohelp prepare us to talk

to the press. We metwith reporters from thelargest newspapers inIndia. One was from aHindi-speaking news-paper so there was a bitof a language gap. Butoverall, it went verywell. I gave an openingstatement describingour philosophy of nurs-ing and how nursing isa respected and trustedprofession in America.It was a wonderful op-portunity to represent

nursing and hopefullyelevate the public per-ceptions of nursing inIndia!

One reporter askedwhat we had learnedfrom nurses in India.After some reflectionwe talked about therespectful way that staffhad treated each otherand the great kindnessthat had been shown tous by virtual strangers.We witnessed how im-portant the family unit

is in India. With all ofour technological andeconomic advances,sometimes we lose sightof the importance ofhuman connections.Perhaps our visit toIndia taught us to stopworrying so much aboutthe future and start en-joying each moment asit comes.

Life is short, and inthe end, it’s the humanrelationships that makeit all worthwhile.

Photos (clockwise from top left):1) Physical therapists (l-r): Maria Fitzpatrick,PT, Laura Kastrenos, PT, Diane Heislein, PT,and Michael Tiffany, PT, staff educationalbooth in the Main Corridor.2) Tiffany, gives blood; Gail Fennessy, LPN,is the technician.3) Fitzpatrick, spends timeeducating a visitor.

hat betterway to cele-brate Nation-al Physical

Therapy Month thansharing knowledge,information, andinjury-preventionstrategies with staff,patients and visitorsto the MGH commu-nity? Well, givingblood was one way.That’s what a num-ber of physical ther-apists did on Tuesday, October 16, 2001.The department had originally wanted todonate blood right after the attacks on Sep-tember 11th, but were asked to defer theirdonation to a later date because of the hugenumber of people flooding the BloodDonor Center in response to the tragedies.So therapists decided to combine their‘group blood donation’ with their celebra-tion of Physical Therapy Month. On Wed-nesday, October 17th, it was back to busi-ness as usual as therapists took turns staff-ing an educational booth in the Main Cor-ridor.

W

Page 15

October 4, 2001October 4, 2001Educational OfferingsEducational Offerings

2001

2001

DescriptionWhen/Where Contact Hours

For more information about any of the above-listed educational offerings, please call 726-3111.For information about Risk Management Foundation educational programs, please check the

Internet at http://www.hrm.harvard.edu

Transfusion Therapy Course (Lecture & Exam)Bigelow 4 Amphitheatre

- - -Nov. 28, 8:00am–12:30pmNovember 30 (Exam)8:00–9:30am

New Graduate Nurse Development Seminar IITraining Department, Charles River Plaza

5.4 (contact hoursfor mentors only)

November 288:00am–2:30pm

Clinical Evaluation of the ElectrocardiogramStearns Auditorium, New England Medical Center

TBANovember 298:00am–4:00pm

Advances in the Management of Polytramatized PatientsTraining Department, Charles River Plaza

TBANovember 29 and 308:30am–5:30pm

Critical Care in the New Millennium: Core ProgramBrigham & Womens Hospital

45.1for completing all six days

December 3, 4, 5, 10, 11, 127:30am–4:00pm

Diversity Within Cultures: Implications for Health CareO’Keeffe Auditorium.

TBADecember 38:00am–4:30pm

On-Line Patient Education: Tips to Ensure SuccessPatient Family Learning Center

1.2December 47:30–8:30am

Chemotherapy ConsortiumNEMC


Nursing Grand RoundsO’Keeffe Auditorium

1.2December 61:30–2:30pm

CPR—American Heart Association BLS Re-Certificationfor Healthcare ProvidersVBK 401

- - -December 67:30–11:30am12:00–4:00pm

Intermediate ArrhythmiasVBK 601

3.9December 68:00–11:15am

Pacing and BeyondVBK 601

5.1December 612:00–4:00pm

Wound & Skin Care: Common Problems, Common ProductsTraining Department, Charles River Plaza


Care of the Respiratory-Compromised PatientO’Keeffe Auditorium

7.8 (RNs) .6 (SLPs)certificate of attendance

for OTs and PTs

December 108:00am–4:30pm

New Graduate Nurse Development Seminar ITraining Department, Charles River Plaza

6.0 (contact hoursfor mentors only)

December 128:00am–2:30pm

OA/PCA/USA ConnectionsBigelow 4 Amphitheater

- - -December 121:30–2:30pm

Advanced Practice Nurse Millennium SeriesO’Keeffe Auditorium

1.2December125:30–7:00pm

Preceptor Development Program: Level ITraining Department, Charles River Plaza

7December 138:00am–4:30pm

CPR—American Heart Association BLS Re-Certificationfor Healthcare ProvidersVBK 401

- - -December 177:30–11:30am12:00–4:00pm

2001: A Diabetic OdysseyO’Keeffe Auditorium

8December 178:00am–4:00pm

Page 16


CaringFND125

MGH55 Fruit Street

Boston, MA 02114-2696

CaringH E A D L I N E S

HalloweenHalloweenHalloween—BecauseMGH child life specialistsand pediatric caregiverstake Halloween v-e-r-yseriously, once again childrenon inpatient units had theopportunity to trick-or-treatin full Halloween regalia to thedelight of staff and visitors!All 101 (or 102!) Dalmatianscouldn’t make it, but the ones

that did make anappearance werea-d-o-r-a-b-l-e !

Pediatric chaplain,Patricia Byrne, and pal

The whole scary crew takes abreak in the Warren Lobby


Volunteers, Jack DiBona and Christina Friel (back),with Dalmatians (l-r): Gayle Gastineau, Maureen

Forbes, Ellen Millea, and Heather Peach.

Tracie Grant helps 7-year-old,Felistus Kangethe, celebrate her

first Halloween in America!

Documents

Caring Headlines - DMAT Presentation - November …...Page 3 November 15, 2001 Collaborative Governance The Fielding the Issues section of Caring Headlines is an adjunct toJeanette