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Boston Marathon Bombing Victim Marries His Nurse


By DENISE LAVOIE Associated Press

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If something good could come out of the Boston Marathon bombing, James Costello and Krista D'Agostino seem to have found it.

Sixteen months after the attack killed three people and injured more than 260, including Costello, he married D'Agostino, the nurse who helped him recover. The couple exchanged vows Saturday at the Hyatt Regency Boston in front of about 160 guests.

A photograph of Costello with his clothes ripped to shreds and parts of his body burned became one of the most recognized images of the 2013 attack. He met D'Agostino, a nurse at Spaulding Rehabilitation Hospital, while he was recovering from multiple surgeries for shrapnel injuries and serious burns that required pig skin grafts on his right arm and right leg.

After the couple became engaged, Costello said he believed he was involved in the tragedy in order to meet D'Agostino, whom he described as his best friend and the love of his life.

"One thing that she hates that I always say is I'm actually glad I got blown up," Costello said on the "Today" show in December. "I wish everyone else didn't have to, but I don't think I would have ever met her if I didn't."

Wedding planner Rachael Gross said she and the other vendors involved in the wedding donated their services.

"They are the most gracious, generous, kind, ... loving couple," Gross said. "They believe that they were meant to meet."

The wedding ceremony was held outdoors on the hotel's third-floor terrace, with blue and white hydrangeas all around. The reception was held in the hotel's grand ballroom.

"It was more like a classic Nantucket style, but without a literal nautical theme," Gross said.

Costello, of Malden, was gathered with friends near the marathon finish line, watching for another friend who was running when two bombs exploded within seconds of each another. Three of Costello's friends lost a leg, while other friends suffered burns and shrapnel injuries.

During his two-week stay at Massachusetts General Hospital, Costello was among patients who met President Barack Obama. He was later transferred to Spaulding.

Costello and D'Agostino, both 31, are honeymooning in Hawaii.


10 Things That Drive Nurses Nuts (But We Deal With Anyway)


By Meaghan O'Keeffe

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Sometimes, being part of the nursing profession can feel exactly the same as being part of a family. You love it dearly, you can’t imagine your life without it, but there are lots of things about nursing (and family) that can drive the most balanced person completely nuts.

Deep down, you love nursing, even with all of its vein-popping, blood pressure elevating quirks.

Here is Scrubbed In’s list of things about nursing that drive nurses absolutely nuts, but we deal with anyway.

1. Call lights: Of course the purpose of call lights is to enable patients to get help when needed, but it’s hard not to get annoyed at the call light itself. It’s blinking, beeping, and taunting you because you just sat down to document. (See #2)

2. Documentation: For the love of all things nursing. Documentation is our greatest tool and the bane of our existence, all wrapped up into a flowchart, and an I&O’s chart, a nursing note, an incident report, a pre-anesthesia evaluation form, a…

3. (For our guys) Being called “male nurse:” For the men in our nursing community, hearing someone refer to them as a nurse, without “male” automatically attached, would be a breath of fresh air.

4. Body fluids: Nurses deal with body fluids all the time. It’s par for the course. But it’s not exactly something one wishes for. We don’t need to name them all. You’re well acquainted with most. They can really dampen your day. Pun intended.

5. Waving your ID to get into your bathroom at home: Many healthcare facilities have areas where you need to scan your ID to unlock the door. When you’ve tried that to get into your bathroom at home, it might be time to take a vacation.

6. Trying to use your fingerprint at the ATM: If you regularly use your fingerprint to get into medication and supply stations, you might find yourself trying to do the same at the ATM screen. Just hope that no one saw you.

7. Hearing a patient-alarm-like sound (outside of work): You’re out and about and someone’s cell phone ring sounds uncannily like an O2 sat alarm. Before you’ve had a chance to process, your pulse has quickened and you’re on high alert. Calm down, nervous system; you’re off duty today.

8. Patients who don’t take the full course of antibiotics: When a patient gaily reports that they stopped taking their antibiotics because they feel sooo much better, there’s a specific protocol you must follow. It involves closing your eyes, taking deep breaths and counting to 10 before calmly explaining the rationale behind completing the course in full.

9. Waking up at 5 a.m. on your day off: Finally, finally you can sleep in. You’ve been looking forward to it for days. But your brain seems determined to wake up as if you need to work today. At least you can stay in bed with your feet up.

10. Bringing a coffee to work, then drinking it cold four hours later: A hot cup of coffee at the start of your day is one of the simple pleasures of life. But did you really think you were going to drink it? You might at some point, it just may be more like iced coffee by then.

Your Turn

What drives you nuts about nursing?


Men in Nursing (Infographic)




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Nurses’ Survey Results Show ‘Dangerous’ Stress Levels


 By Vickie Milazzo

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A huge thank-you to everyone who took our survey “Are You Way Too Stressed Out?”

A remarkable 3,312 of you took the time out of your busy day to complete the survey, and this high response rate highlights the seriousness of this issue to the nursing world.

The results of the survey reveal the dangerous levels of stress that RNs pervasively live with, both at work and in their personal lives. Lack of sleep, 12-hour shifts, night shifts, poor diets, unrealistic workloads, lack of authority at the workplace and unsupportive management are just some of the key contributors to the stress being experienced by RNs today.

RNs are neglected by a system that overworks, under-appreciates and marginalizes the experience of individuals who are the most connected to patients.

Respondents had the opportunity to answer the question, “What are some of the things that stress you out the most?” Many of you were brutally candid, and I cringe at what you continue to put up with on a daily basis. These five responses are representative of the thousands received.

  • “People who have never done your job telling you how to do it. People who have lost sight of the patient — the focus is the $$.”

  • “Not having the authority to take care of the things that need to be done, but being responsible for it.”

  • “Long hours (12-hr shifts), working nights, poor pay, poor benefits that are dependent on maintaining hours to prevent losing the benefits, lack of PTO to cover sick/vacation days.”

  • “Overwork with no relief in sight, working for $3 to $5 dollars less than average city wages …”

  • “Corporate chaos, lack of support, unrealistic expectations, being put in possible license jeopardy due to corporate greed and mismanagement.” 

The system is broken! The very people treating patients are sick and in need of healing themselves. This is crazy.

The stress placed on RNs is eventually going to cause many of them to quit. Our nursing system is already grappling with an aging workforce and an aging general population. While the nation will need an increased number of RNs, we’re likely hurtling toward a nursing shortage. Stress leads to mistakes and errors, and hospital errors are already the third leading cause of death in the U.S. Put it all together, and we may be headed for a national healthcare crisis.

This is a report you will not want to miss. Download the full PDF report below and click through the SlideShare presentation, and share your own experiences with stress as an RN in the Reply section below. I want to hear from you!

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ESFP Nurse | Nursing Careers for ESFP Personality Types


By S.L. Page

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ESFP personality types are very compatible with many areas of nursing. As an ESFP, you’re full of energy and a zest for life. You genuinely enjoy being around people, and you are a true people-person. In fact, some people call your type the “parties,” as you always seem to be looking for a new social event to attend. When there, you can talk for hours and you enjoy being the center of attention. Other personality profiles refer to your type as the “Entertainer” or “Artisan.”

ESFP Overview: What is an ESFP Personality?

An ESFP is one of the main 16 personality types.  An ESFP will have scored the following dominant characteristics on a personality assessment: Extroverted (E), Sensing (S), Feeling (F), and Perceiving (P).  The breakdown and description of each of these dominant characteristics is listed below:

Extroverted (E): As an extrovert, you enjoy a lot of external stimulation. You love hanging with friends, meeting new people, or engaging in external things that stimulate your mind. When you’re isolated for too long at home, you’ll soon begin saying to yourself, “I’ve got to get out of this house!” In fact, you may say that after only one day alone at home!

You probably have a wide circle of friends, and you love getting together for a meal, hanging out, or just striking up a conversation with a random person. Because extroverts tend to enjoy talking and engaging in social situations, they often get labeled as “social butterflies.” You may have even been called a “people person” or “outgoing.” In fact, introverts sometimes get a bad rap due to extroverted people, as people often quip, “Why does that introvert keep to themselves so much? I wish they were more talkative and outgoing.”

You probably dislike writing or reading too much, and you’d much prefer to pick up the phone and make a call as opposed to writing an email. Some extroverts loath writing, although not all feel this way. Some extroverts make great writers, but most prefer face-to-face communication if given the choice. Some extroverts tend to have difficulty expressing their ideas in written form, as their minds are wired to work while engaging. ESFPs can spend a lot of time text messaging contacts, however, because they love to keep up with their friends and acquaintances.

Being an extrovert doesn’t mean that you dislike alone time, it’s just that it tends to suck the life out of you after a while. You get energized and feel most comfortable around other people, especially many friends or family members.

You think better while talking, as opposed to writing or thinking alone. In fact, some of your best solutions or ideas have probably come to you while talking to others. You also tend to blurt out the answer if asked a question. In contrast, introverts hate being put on the spot, and prefer to mull over a question before replying.

Sensing (S):  As a sensing person, your mind tends to think of more rigid “here and now” concepts. You generally tend to think about the “what ifs” only rarely. You tend to notice minor details that other people may overlook. In fact, some people are quite shocked at the fact that you can sometimes make really keen observations. This can be a big benefit in nursing, as you may notice that a patient suddenly doesn’t look so well.

To illustrate how a sensing person things, consider an example of a large container sitting on the edge of a counter.  You would probably look at the large container of fluid and think, “That’s an interesting color. I wonder what this fluid is?” You may also examine the lettering used for the logo, and so forth. You’d probably read the details on the packaging and think about those things.

This type of thinking is in direct contrast with people who have the “intuitive” characteristic. Using this same illustration, an intuitive person may look at the same container you looked at and think thoughts like, “That may fall down. Then it could make a mess. Someone could slip and fall and hurt themselves. We could even be sued.”

That’s not to say that sensing people can’t have moments of intuition, or that people with intuition won’t see more concrete details. But generally speaking, sensing people are very in-tune with details and facts, and tend to not think of the possible scenarios that could happen.

Feeling (F):  As a person with the “feeling” characteristic, you have a strong inclination towards considering how things may affect people or society. When considering a decision, you tend to think of how other people may react, or how other people may be impacted by the consequences. As a result, people (or society in general) can be a big part of your decision making process. This can be a good characteristic to have as a nurse dealing with patients whose lives may be greatly affected by your actions.

Feelers have a very deep and empathetic heart to help people, and they genuinely care for others. If someone asks you how their new haircut looks, you’ll likely be very polite and try to focus on the positives to avoid hurting their feelings–even if the haircut looks terrible.

As a feeler, you also tend to have a strong need for happy relationships, both with yourself and people around you. If people aren’t getting along, it will tend bother you quite a bit. You’re a happy-go-lucky person who enjoys keeping in good standing with people. You also tend to have a natural affection for animals or pets.

This characteristic is in contrast to the “thinking” characteristic, in which people tend to make decisions based on logic, facts, or truth.

Perceiving (P):  As a person with the “perceiving” characteristic, you generally like to live life in a care-free manner. You usually don’t like to make extensive plans, and you prefer to just “wing-it.” You tend to be very adaptable to any given situation. This adaptability and spontaneity gives you a reputation of being a fun and exciting person to hang around.

You are likely to live a somewhat disorganized life, at least internally. You probably have a relatively messy or unorganized home or office space, although this is not true for all ESFPs. This personality characteristic is in contrast to the “judging” type, in which people tend to live in a more organized and controlled manner.

You also tend to procrastinate with deadlines and tasks, but will get a burst of energy when something has to be done. Some ESFPs have a wild side, and are sometimes referred to as “daredevils.” You may enjoy activities such as skydiving, rollercoasters, surfing, or other similar activities that give you that “thrill.”

Nursing Career Possibilities for ESFPs

You are a fun and entertaining “people-person.” You like to live life in a fun-loving way. This can help you quickly and easily connect with patients. You also have the ability to focus on details, and you can easily empathize with other people’s problems. As you make decisions, you ponder how they may affect other people. This means you are likely to keep your patients best interests at heart.

For this reason, there are many areas of nursing that may appeal to you. Floor nursing, pediatric nursing, ER nursing, and other exciting areas may be of interest. For ESFPs who have a daredevil side, you may also enjoy flight nursing. Being a camp nurse is also a good possibility. If you have a strong faith, Parish Nursing may also be a good fit, as you’d love interacting with people on a spiritual level.

There are a few pitfalls you’ll want to avoid on the job. First, ESFPs tend to dislike having to do routine tasks. You like to be stimulated in your environment, and if you have to do dull tasks, you’ll get bored quickly. You also dislike having to read long documents or write reports.

Another area of frustration for ESFPs is working alone. You enjoy the company of people, and if confined to an empty office all day, you’d probably get very exhausted. You get energized talking and engaging with people. You enjoy team settings.

You dislike organizing things due to your spontaneous nature. You like to experience things in real time, and you don’t like to ponder the “what-ifs” in life. You also may struggle clocking in on time.

Possible Nursing Career Matches for ESFPs

  • Home Nursing/Private Duty Nursing
  • ER Nurse
  • Parish Nurse
  • Hospice Nurse
  • Travel Nurse
  • General Floor Nurse
  • Ambulatory Nurse
  • Pediatric Nurse
  • Flight Nurse
  • Camp Nurse
  • Oncology Nurse

Are You an ESFP? Share Your Input

What areas do you hope to work as an ESFP? What jobs have you loved? What jobs have you hated? Please consider sharing your experience in the comment section below, as this may help other ESFP nurses in their careers.


5 ways to keep a normal social life while working the night shift



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Ah, the dreaded night shift. Every nurse will have to encounter it at some point in his or her career. Some enjoy the more patient-based shift with its lack of administrators and clerical work, while others never can get into the rhythm of being a night owl.

If you’re a nurse on the night shift, chances are you have plenty of non-medical professional friends who won’t keep the same schedule as you. So how do you keep a normal social life while you work the night shift? Check out these five helpful tips:

1. Plan ahead with your non-work friends. If your shift is starting at 7:00 PM, for example, you could realistically have time to meet them for dinner an hour or so ahead of time. The night shift might remove some of the spontaneity of your social life, but it doesn’t have to remove time for fun and socializing.

2. Limit your caffeine intake. It can be tempting to consume cup after cup of coffee to get through those long shifts, but it’ll throw your sleep rhythm off even more and cause you to have to miss out on social functions with friends and family during days off.

3. Treat the switch to normal sleeping hours like jet lag. Take short naps at first to store up some energy and then power through the day until it’s time for bed. This will quicken your transition back to a normal sleep schedule. Try making time for non-work friends the day after you’ve adjusted back to normal sleeping hours.

4. Group your night shift days together. This will assure that you can have longer stretches of days off or daytime shifts. That leaves plenty of time for recreation, fun with friends, errands and time with family, but it’s also better for your overall health!

5. Get to know your coworkers! You’re spending so much time with them at odd hours, so you might as well establish trust, rapport and friendship. Try and bond with them socially and professionally. For example, if you like exercising, invite them to go on an early morning hike or to a workout class with you after the shift ends; if you are a coffee nut, see if they want to grab a cup at a nearby café. You can also bond professionally by trying to coordinate procedural training, or going to conferences and professional development events together.

The night shift doesn’t need to kill your mood, routine or health. Treat it seriously, plan accordingly with your shifts and keep a positive outlook so you can make new friends and keep up with those outside of your professional circle!


Keep that bun in the oven: Induced births falling in the U.S.


By Joan Raymond

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Today's expectant moms and their doctors have decided it's not nice to fool Mother Nature. Rather than inducing labor, they're letting nature take its course, with the length of pregnancies in the U.S. on the upswing, according to a new study by the CDC.

The study released Wednesday tracks labor started through surgical or medical means during the years 2006 through 2012. The researchers found that induction rates at 38 weeks — once considered full-term gestation but now called an early-term gestation — declined for 36 states and the District of Columbia during this six-year period. Declines ranged from 5 percent to 48 percent.

Geography didn’t seem to matter. Thirty-one states and the District of Columbia posted declines of at least 10 percent. The researchers did find that trends in induction rates at each week from 35 weeks, considered late pre-term, to 38 weeks, varied by maternal age. At 38 weeks, though, induction rates declined for all maternal age groups under 40, dropping 13 percent to 19 percent for women in their 20s and 30s.

This is a sharp reversal of trends tracked from 1981 through 2006 in which the proportion of babies born at less than 39 weeks gestation increased nearly 60 percent, while births at 39 weeks or more declined more than 20 percent.

“We were surprised that the overall induction rate went down,” says lead researcher Michelle Osterman, a health statistician with the National Center for Health Statistics, which is part of the CDC.

And it is welcome news, too. “For years we were taught that the 37th or 38th week of pregnancy was full term, but we did not appreciate the neonatal outcomes,” says ob/gyn Dr. Nancy Cossler, vice chair for quality and patient safety at University MacDonald Women’s Hospital in Cleveland, Ohio. 

“It was an ingrained part of our culture that 37 weeks is OK, but it’s not necessarily OK for the baby,” she says, citing issues such as hypothermia, feeding difficulties and respiratory distress among infants born early.

Historically, MacDonald Women’s Hospital had a rate of about 11 percent for labor induction for non-medical reasons among patients who were 37 to 38 weeks pregnant. Today, it’s nearly zero. In 2013, only one birth among the 37 to 38 week gestational age was done through induction. The patient had metastatic breast cancer, which is not among the usual listed criteria for medical induction, and needed to start chemotherapy and needed an early delivery, says Cossler.

Indeed, there is a big push nationally for longer-term births, such as the large-scale educational program called the 39-Week Initiative, supported by the March of Dimes and other groups. It seeks to end non-medically indicated deliveries prior to 39 weeks. Last year, the American Congress of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine even recommended the label “term” in pregnancy, be replaced with categories based on gestational age. Today, babies born at 39 weeks through 40 weeks and six days of pregnancy are considered “full term.” Babies born at 37 to 38 weeks are now considered “early term.”

“I think this study is very positive since several of us have now provided evidence that babies have better outcomes (with longer term births),” says Dr. Kimberly Noble, assistant professor of pediatrics at Columbia University.

In a study published in the journal Pediatrics of 128,000 New York City public school children, Noble and her colleagues found that compared to children born at 41 weeks, those born at 37 weeks had a 33 percent increased chance of having third-grade reading problems, and a 19 percent increased chance of having moderate math issues.

But doctors do worry that the pendulum could swing too far and patients may be afraid of induced deliveries. 

Our study “can’t differentiate between induction done for medical reasons and induction done for convenience, and if your doctor says this baby needs to come out at 37 weeks because of a problem, you need to trust your doctor,” says Noble, citing issues such as maternal or fetal distress as a cause for earlier delivery. What patients and doctors shouldn’t do is schedule an earlier delivery because of a vacation or other issue. “We know that 39 weeks and beyond is good for the baby,” she says.


Men rapidly joining nursing ranks





Kevin Cischke left a music career after 25 years to pursue a new one in nursing, and it won’t bother him that he’ll be a man in a profession largely dominated by women.

As the face of the nursing profession slowly changes, Mr. Cischke, 45, is among the growing number of men signing up for the job. According to the U.S. Census Bureau, slightly less than 10 percent of the 3.5 million nurses in 2011 were men. That’s up from 1970, when only 2.7 percent of nurses were males.

For Mr. Cischke – who will receive a bachelor’s in nursing next year from Mercy College — nursing is in line with his interests. When introduced to nursing, the former organist and choir master for the Archdiocese of Detroit fell in love with it.

“A couple of my close friends who are nurses said I should look into this profession to see if it would interest me,” he said, during a break from his externship in the emergency room at Mercy St. Vincent Medical Center. “It was a whirlwind love affair that has not ended, and I don’t suspect that it will.”

Craig Albers, chief nursing officer and vice president of patient care services at Mercy St. Charles Hospital, said men in nursing offer an important component in the delivery of public health care.

“In the past, nursing was more of a pink collar profession and more of a career for women. A lot of times it’s seen as a profession for Caucasian women. Now, with large numbers of baby boomers retiring and seeking health care, we need a diverse workforce able to work with a diverse population,” said Mr. Albers.

A nurse himself since 1998, he began his college studies pharmacy. When he decided he needed more patient interaction, a professor suggested he look into nursing.

“I job shadowed an ICU nurse and the role really appealed to me. That’s what led me to the profession,” he said.

While also acknowledging the importance of racial diversity, Mr. Albers added, “Each of those different minorities bring a special perspective and skill set in how they work with and relate to patients.”

It was the patients who also attracted Mr. Cischke.

"I enjoy the patient-care side of things. I wanted hands-on patient care. That's what drives me, and the fact that I can continue to learn and grow fits my personality perfectly," he said.

He also liked contributing to the profession and addressing concerns of his male peers. In fact, when they discovered something missing in their nursing school experience, he led the way to establishing a local chapter of the American Assembly of Men in Nursing. The organization addresses issues that affect men in nursing. About 20 men and five women are members of the group.

"I continued to explore what the assembly had to offer, promote, and to accomplish and I realized that their goals aligned with what we needed to have at Mercy to support our male students," said Mr. Cishke, one of 116 male students in the nursing program.

The organization will also help groom male nurses for retiring baby boomers who increasingly use health care. Health professionals who deliver care to boomers must be on their toes.

"Our baby boomer population will be very informed and knowledgeable and Internet and computer savvy, and people going into the nursing profession will have to be extremely knowledgeable and confident and able to communicate with their patients because the patients are very knowledgeable," said Mr. Albers.

While male nurses' physical strength is also a plus for patient care, Mr. Albers said more men joining the field may pursue advanced fields in nursing, such as management, administration, business, and anesthetics. Those advanced career possibilities attracted Daniel Koehler to the profession.

"One of the great things about nursing is that once you are in it and have a job and have some experience after a few years, you can go into management, get a master's, or PhD," said Mr. Koehler, 32, who is in the nursing residency program at ProMedica Flower Hospital. "There are so many different avenues you can go into, so it was kind of a no-brainer that I picked this."

He received a bachelor's in nursing from Lourdes University in December. Eight years ago, he obtained a bachelor's in human biology from Michigan State University. He then worked in the restaurant and fitness businesses before going to nursing school.

He wasn't intimidated by the predominantly female profession, and in fact received positive responses from others.

"Most guys don't grow up thinking they want to be nurses," as many girls do, said Mr. Koehler, whose mother was a nurse in Germany. "With the guys I've met in the profession, I think less of that stigma now days."

Though slightly less than 10 percent of ProMedica's nurses are men and slightly more than 8 percent of the nurses in the Mercy health system are men, the idea that nursing is a woman's job stopped Roberta Pratte's father and grandfather, both medics in the military, from continuing in the profession. As a teenager, Ms. Pratte — a Mercy nursing professor — recalls hearing her grandfather speak fondly about nursing.

"Back then it wasn't something that men talked about or thought about. I sensed that they regretted that they were not allowed to follow their dream," said Ms. Pratte, an instructor at Mercy College. She has been a nurse for 33 years, and her mother was also a nurse.

Large numbers of nurses are expected to retire soon, adding to the already critical nursing shortage. That's why the profession is pushing to attract men and women into nursing. As a matter of fact, the American Assembly for Men in Nursing is campaigning to increase the number of male nurses by 20 percent by the year 2020, said Ms. Pratte. She also said the Institute of Medicine and the Centers for Disease Control and Prevention are reviewing how to fill nursing positions to ensure that the public gets proper care.


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Teaching geriatric care to a new generation.


By Stacey Burling


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George Palo is 90. He's repeating himself quite a bit these days and he's just had to downsize to a retirement community. He really misses his late wife.

Soon, he will also miss his beloved dog, Max.

This last bit of news caused a roomful of nurse educators to moan a sad, sympathetic, "Ohhhh" at a meeting last week at the Independence Blue Cross building in Center City.

George is a fictional character, created along with two others to help nurses in training understand dementia and its traveling companions among the elderly: depression and delirium.

The nurses' emotional response to George's impending loss was a sign of the emotional power of narrative, which the National League for Nursing is harnessing to improve education about late-life medical problems. The group also is embracing a multimedia approach that includes the written word, audio recordings of the "patients" voiced by actors, simulations that include mannequins and live actors, and the latest addition: virtual animations of the patients and nurse avatars who make treatment decisions.

"Traditional-based teaching is really over for most of us," Elaine Tagliareni, the league's chief program officer, told the crowd of about 175 who had gathered for her group's Advancing Care Excellence for Seniors conference. The Independence Blue Cross Foundation is a sponsor. Using technology to improve care was a theme this year.

The nursing group wants to reach a new generation of students who are already accustomed to multimedia learning, may be taking classes online, and will work in a world where technology increasingly connects patients, doctors, and nurses who are not in the same room.

Medical and nursing schools have long used standardized patients: actors who portray certain medical conditions. Increasingly sophisticated mannequins have been playing a bigger role in medical education in recent years.

Drexel University's College of Nursing and Health Professions began using a virtual-patient program produced by Shadow Health last year. It is meant to reinforce classroom training. The University of Pennsylvania School of Nursing also is using a Shadow Health program to teach nurses how to take a health history and perform a physical exam.

Gregg Lipschik, director of life-support training and undergraduate curriculum at the Penn Medicine Clinical Simulation Center, said Penn sometimes uses a virtual program to review resuscitation techniques. It pairs computer simulation and mannequins to teach procedures such as bronchoscopies.

Lipschik said use of simulation had been growing since 1999, when an Institute of Medicine report recommended it to reduce medical errors and improve teamwork. "It's really boomed in the last few years," he said.

The nursing league began its Advancing Care program in 2009, Tagliareni said, because "care of older adults is not well integrated into nursing programs" even though 75 percent of the care nurses give is to people over 65. It's adding the new dementia cases to expand education on another neglected topic.

The patient profiles are purposely complicated - like real people - and they unfold over time in unpredictable ways. The death of George Palo's golden retriever is a calamity not only because George's grief adds to his thinking problems but because walking Max was a key way the man exercised and interacted with the outside world. The profiles are accompanied by teacher information.

Tagliareni said that the dementia patients may not end up in the virtual world but that other fictitious elderly characters like Millie Larsen and Red Yoder may be available this fall in the gamelike "vSim for Nursing" program developed by Wolters Kluwer Health of Philadelphia and Laerdal Medical.

An audience member said her students easily identified with the league's patients. "That's my Pop-Pop," one of them told her.

The group at the meeting saw a younger virtual patient named Stan and his virtual nurse, Dan. Stan had gone to the emergency room with stomach pain from a bowel obstruction. The student, who had access to test information and doctor's orders, had to use a menu of options to decide what Dan should say and do. The animation was primitive, but the decisions were complex. At the end of their 30-minute encounter, the student received a number score and a report on what had been done and should have been done.

Barbara McLaughlin, head of nursing at Community College of Philadelphia, did a pilot test of vSim, which costs $100 per student for two years of access, with her students last year. "They liked them [the scenarios] a lot because it gave them the opportunity to do the same experience over and over and correct their mistakes," she said.



Nurses Play Critical Role in Responding to Global Resurgence of Pertussis


Wolters Kluwer Health

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Concerted effort is needed to reverse the ongoing rise in pertussis cases and deaths, especially among children and young people, according to the article in the Journal of Christian Nursing by Emily Peake, APRN, MSN, FNP-C, CLC, and Lisa K. McGuire, MSN, MBA-HCM, RN. "This effort begins with nurses and nurse practitioners and other primary care providers who educate patients and the public," they write. "The battle of pertussis is winnable through education, awareness, and vaccination."

Caused by infection with Bordetella pertussis  bacteria, pertussis has been increasing in recent years. In the United States, average annual pertussis cases increased from less than 3,000 cases per year during the 1980s to 48,000 in 2012, including 20 deaths. Worldwide, there are an estimated 50 million cases of pertussis and 300,000 deaths. Pertussis is a major cause of death in infants worldwide.

Why is pertussis on the rise? "Ambivalence toward precautionary childhood vaccinations" is a key reason, along with the lack of well-child visits and appropriate boosters. The arrival of non-vaccinated immigrants may also be linked to new clusters of pertussis outbreaks, according to Peake and McGuire. They write, "Nurses should educate patients and the public that follow-up booster vaccinations at all ages are critical to maintain immunity to pertussis and other vaccine-preventable diseases."

Issues including vaccine availability and cost, literacy and language barriers, and lack of information all contribute to the lack of recommended vaccinations. Fear of vaccination and religious objections also play a role. Most states allow exemptions from vaccination based on religious reasons, and there's evidence that even non-religious parents are using these exemptions to avoid vaccinating their children.

Nurses should reassure parents that that recommended vaccines are safe. Current diphtheria-tetanus-pertussis vaccines do not contain the mercury-containing preservative thimerosal. Adverse events occur in only a small fraction of vaccinated children, and most of these are mild local reactions.

"Practitioners must build a trusting relationship with patients and reinforce the need for vaccinations through face-to-face contact, engaging parents to discuss concerns, and provide evidence-based research to guide recommendations and reassure patients of the safety of vaccines," Peake and McGuire write. Waiting rooms provide a good opportunity to present videos and other educational materials.

The World Health Organization is working to increase the percentage of infants who receive at least three doses of pertussis vaccine to 90 percent or higher, especially in developing countries. Closer to home, partnerships should be formed with service organizations, food banks, churches, hospitals and schools. "These groups can help identify those most likely not to be vaccinated and help them find free or low cost immunizations," the authors write. "Faith community nurses are in an ideal role to create and lead these partnerships."

Nurses can also advocate for policies aimed at making universal vaccinations available for adolescents and adults. Peake and McGuire conclude, "By using our resources and uniting, a global battle will be waged and won against pertussis and the children of tomorrow can breathe easier for a lifetime."



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