The seriousness surrounding the problem of elder abuse in our society is often ignored or underrated. People have a tendency to put discussions of elder abuse on the backburner, in favor of more shocking stories that tend to grab the media spotlight.

Despite the lack of attention paid to the phenomenon of elder abuse, the American Psychological Association estimates that “4 million older Americans are victims of physical, psychological or other forms of abuse and neglect” every year. For every reported instance of abuse, experts estimate that 23 more go unreported.

There are many different types of elder abuse, but they can be broken into three categories:

1. Physical Abuse

Some of the most common signs of physical abuse include unexplained marks or injuries, such as bruises, pressure marks, welts, cuts, burns or broken bones. If the caregiver refuses to let you be alone with your loved one, this could also be an indicator of physical abuse. Other possible signs include broken glasses, ripped clothing and signs of restraint (such as rope marks around the wrist).

Remember, neglect is also a form of physical abuse. Some of the most common signs that an older adult is being neglected by a caretaker include sudden weight loss, malnutrition and dehydration. Unsanitary living conditions (like dirty sheets or bed bugs) are also indicators of neglect, as are untreated physical problems, like bed sores.

2. Emotional Abuse

The signs of emotional abuse include characteristics of depression, like uncharacteristic silence, loss of appetite and unexplained withdrawal from normal activities. Likewise, if you witness a caregiver acting in a way that is threatening, belittling or condescending, there’s a possibility that the person they’re charged with taking care of is experiencing emotional abuse. 

There are many people who don’t recognize emotional abuse or don’t think of it as a serious mistake. These individuals operate under the false assumption that emotional scars are somehow less violent or harmful than the physical ones. This is one of the characteristics of emotional abuse that makes it so dangerous—if you don’t recognize a problem as a problem, you can’t take steps to solve it.

3.       Sexual Abuse

                The most common signs of sexual abuse include an unexplained venereal disease or genital infection, unexplained vaginal or anal bleeding and bruises around the breast or genitals. Torn, stained or bloody underwear can also be an indicator of sexual abuse. 

                There are many reasons that sexual abuse can be difficult for many older adults to talk about. For some, it’s an issue of pride—they would rather suffer in silence than face the humiliation of admitting helplessness. Others are afraid of retaliation, and worry that they’ll be punished for speaking up. Whatever the specifics of the situation, it’s important to remember that the subject of sexual abuse is complicated and needs to be handled with sensitivity.

Conclusion:

                The most important thing to remember when you suspect that someone you know is being abused is that speaking out is half the battle. The invisibility of elder abuse is what makes it difficult to prevent and punish. By calling attention to the situation, you’ve already laid a foundation for preventing future instances of elder abuse.

Linda Bright is a staff writer and a public relations coordinator for MyNursingDegree.com. Given her experience as a former hospital administrator, she writes primarily about healthcare reform, patient rights and other issues related to the healthcare industry. In her free time, she enjoys Sudoku, spending time with her family, and playing with her poodle, Max.

The National Institute of Nursing Research (NINR) awarded $267,732 to the University of South Florida College of Nursing to study ways to reduce HIV/AIDS risk in college-aged black women, who are disproportionately affected by the disease. Rasheeta D. Chandler, PhD, ARNP, FNP-BC, assistant professor of nursing at USF, will lead the study.

"Tailoring an HIV Prevention for College-Aged Black Women" will adapt a previously-tested and effective sexual risk reduction approach, Health Improvement Project for Teens (HIP TEENS), to be culturally relevant and appropriate for college-aged African-American women. The research will test if this program, renamed Health Improvement Project for LADIES (HIP LADIES), helps reduce HIV/AIDS risk.

"This study is timely, and will be the template for future intervention studies conducted with black college women," Dr. Chandler said. "The award gives us the opportunity to improve the health of young black women."

AIDS.gov reports that of the more than 1 million people living with HIV in the United States, 46 percent are African-Americans. In addition, young black women are far more affected by HIV than young women of other races. The rate of new infections among young black females ages 13 to 29 is 11 times as high as that of young white females and four times that of young Hispanic females, according to the Centers for Disease Control and Prevention (CDC). The CDC reports that AIDS is the third leading cause of death among black women ages 25 to 34.

HIP TEENS is a small-group program for young women that uses interactive activities to provide information, motivate and teaches the skills girls need to reduce sexual risk behaviors. It was developed in 2004 by Dianne Morrison-Beedy, PhD, RN, WHNP-BC, FNAP, FAANP, FAAN, senior associate vice president of USF Health and dean of the College of Nursing. A randomized controlled trial led by Dr. Morrison-Beedy and recently published in the Journal of Adolescent Health reported that HIP TEENS significantly reduced sexual risk behavior and pregnancy rates in more than 700 adolescent girls.

"Not only did HIP TEENS reduce sexual risk behavior, we significantly increased sexual abstinence in these girls as well," said Dr. Morrison-Beedy. "HIP LADIES is a critical next step for reducing risk in college-aged young women."

Dr. Chandler's study will specifically target African-American women attending traditional universities and historically-black colleges and universities in the southeastern United States.

"This project is my chance to contribute to reducing the incidence of new HIV cases in young African-American women," Dr. Chandler said. "When you ask why I'm passionate about my research, this is my community, and these are people who've touched my life with their stories."

Provided by University of South Florida

Source: Phys Org

Improving communication and strengthening teamwork among cardiac surgery teams are among recommendations for reducing preventable mistakes in the cardiac OR, according to a statement from the American Heart Association.

The statement provides recommendations for improving patient safety after the association reviewed evidence-based research focused on communication within and between teams, the physical workspace and the organizational culture of the cardiac OR.

"In multiple studies, self-assessment of communication and teamwork skills by surgeons and anesthesiologists is disturbingly discordant with the opinions of their associated nursing and perfusion staff," the statement authors wrote. "Surgeons rated the teamwork of other surgeons as high/very high 85% of the time, but nurses rated their collaboration with surgeons as high/very high only 48% of the time."

The authors also noted that in the OR, "conflicts are often poorly managed through avoidance, yielding or competition, when collaboration and compromise would yield a better outcome. Collaboration and compromise are particularly difficult when there is status asymmetry, whereby one member has greater power or seniority, such as physicians with nurses or an attending physician with residents."

Highlights of the statement, published Aug. 5 on the website of the journal Circulation, include: 

• Using checklists and/or briefings before every cardiac surgery, followed by postoperative briefings;

• Developing institutional policies to define disruptive behaviors by medical professionals in all hospital settings, with transparent, formal procedures for addressing unacceptable behaviors; 

• Establishing an institutional culture of safety by implementing a robust quality improvement system that encourages input from all team members to continuously identify and correct safety hazards. 

"From the data available," the authors wrote, "it appears that teams should be trained as teams, not as individuals; that use of simulated scenarios is effective; that both executive leadership and nurse managers are critical to effective implementation; and that repetition, continued coaching or both are required to strengthen and maintain benefits."

The authors noted the critical elements of teamwork can be summarized by the Six Cs: communication, cooperation, coordination, cognition, conflict resolution and coaching.

The statement is available as a PDF:http://circ.ahajournals.org/content/early/2013/08/05/CIR.0b013e3182a38efa.full.pdf

Source: Nurse.com 

By Melissa Assink, RN, BSN

I was in med/surg for 13 years before moving to hospice, where I have been privileged to work for almost 24 years. At age 5, I was telling people I wanted to be a nurse. I believe it was a vocational passion that God placed in my heart those many years ago. 

A recent loss in my personal life, followed by a visit from a former patient, brought my passion into even clearer focus. 

I had received a phone call from my brother, telling me that moments before our father had suffered a massive heart attack and died. Even though he had been in declining health in recent years, the news felt like it hit me completely out of left field. 

The day of Dad’s memorial service arrived. While the presence of those in attendance was a comfort, it was also overwhelming to greet the many people who joined us to celebrate his life. Some we had not seen for many years, and it seemed they all had stories to share about him. 

One of the first people to approach me after the service was a man who appeared to be maybe 85. He had white hair, was hunched over and used a walker. He came up to me and stood there, staring at me, as if willing me to remember who he was. I drew a blank and asked, "How do I know you?"

His response was amazing: "You were my nurse 30 years ago, when I was in the hospital for five days to have my gall bladder taken out." He said it very matter-of-factly, as though I should remember him out of probably thousands of patients I have cared for over the years. 

Rather flabbergasted, I asked, "Did you know my dad?" He indicated he did not, that he had simply seen the obituary in the paper and wanted to come to the service as a tribute to me, his former nurse.

My mind raced. This dear man had connected me with Dad by recognizing me as a listed survivor in his obituary. It meant that he had to remember my first name and my maiden name from a brief hospital stay more than 30 years ago. 

I wanted to sit down and talk with him about his memories, but he promptly turned, walked out the door and was gone as suddenly as he had appeared. It seemed as if he knew he had accomplished his mission. I was engulfed with people wanting my attention, and it became impossible to follow him.

I have been reflecting on this former patient and his sudden reappearance in my life for several months. It was almost like he was an angel of sorts, sent to remind me how we, as nurses, touch the lives of people in our care at every turn. We sometimes are in good moods, sometimes not so good. We can become distracted by computerized charting, time management and policy and procedure manuals. 

It is easy to sometimes forget that we care for people when they are most vulnerable, sharing in their joys and sorrows in a way we might not always appreciate. We might forget their names by the next day, often as a coping mechanism, allowing us to go forth and care for the next person. We neglect to recognize they often do not forget us so easily. 

This former patient reminded me that we should never take any interaction for granted. We need to be caring and supportive, treating each of our patients with the respect and honor we’d like to experience if we were in their shoes. Our personal issues and circumstances are not important to them. They are watching us at every turn, looking for the light of our knowledge and support to see them through. A hug, a smile, a kind word, a moment of laughter or a shared tear — these are easy to give, but never forgotten. 

I pray I will always remember the responsibility I have to provide love, care and perhaps a moment of joy to the patients and families I interact with every time I put on my name badge. After all, we never know when a white-haired angel with a walker who received our care will cross our path and help us remember why we became nurses in the first place. 

Melissa Assink, RN, BSN, works for Providence Hospice and Home Care of Snohomish County in Everett, Wash. 

Source: Nurse.com

New guidelines from the United States Public Health Service update the recommendations for the management of healthcare personnel with occupational exposure to HIV and the use of postexposure prophylaxis. 

The guidelines, published in the September issue of Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America, emphasize the immediate use of a postexposure prophylaxis regimen containing three or more antiretroviral drugs after any occupational exposure to HIV. 

The PEP regimens recommended in the guidelines encourage the consistent use of a combination of three or more antiretroviral agents, which are said to be better tolerated than those recommended in the previously published guidelines from 2005, for all occupational exposures to HIV. Eligible antiretrovirals are from the following six classes of drugs: nucleoside and nucleotide reverse-transcriptase inhibitors, nonnucleoside reverse-transcriptase inhibitors, protease inhibitors, a fusion inhibitor, an integrase strand transfer inhibitor and a chemokine (C-C motif) receptor 5 antagonist. 

The guidance eliminates the previous recommendation to assess the level of risk associated with individual exposures to help determine the appropriate number of drugs recommended for PEP. 

“Preventing exposures should be the leading strategy to prevent occupational HIV infections,” David Kuhar, MD, an author of the guidelines and a medical epidemiologist with the CDC’s Division of Healthcare Quality Promotion, said in a news release. “However, when exposure occurs, it should be considered an urgent medical concern and a PEP regimen should be started right away, ideally within hours of the potential exposure.”

Expert consultation should be sought, but not at the expense of delaying treatment, according to the guidelines. Exposed healthcare personnel taking HIV PEP should complete a full four-week regimen and undergo follow-up HIV testing, monitoring for drug toxicity and counseling, beginning with follow-up appointments within 72 hours of the exposure. 

If a newer fourth-generation HIV antigen/antibody combination test is used for follow-up testing, an option to conclude HIV testing at four months, rather than the recommended six months after exposure, is provided. Many of the revised recommendations are intended to make the PEP regimen better tolerated, increasing the possibility that healthcare personnel complete the full regimen. 

The guidelines were developed by an interagency Public Health Service working group comprised of representatives from the CDC, National Institutes of Health, FDA and the Health Resources and Services Administration, in consultation with an external expert panel. The updated revisions were based upon expert opinion. 

Many HCP exposures to HIV occur outside of health clinic hours of operation, and initial exposure management often is overseen by emergency physicians or other providers who are not experts in the treatment of HIV infection or the use of antiretroviral medications, according to the news release. As such, the updated guidelines should be distributed and made readily available to emergency physicians and other providers as needed.

Read the guidelines: www.jstor.org/stable/10.1086/672271

Source: Nurse.com

By Jacqueline Lee

Doctors may have led the medical BYOD revolution, but nurses have followed their examples. According to a report from Spyglass Consulting group, 69 percent of nurses bring their own devices to work.

According to another survey from Absolute Software, half of hospital staff members bring mobile devices to work access e-mail and calendar applications. However, 36 percent use their mobile phones and tablets to access patient information.

The winner, in many cases, is the patient. Nurses often use their devices to access clinical reference materials right at the point of care. They also use devices to coordinate care with other clinicians.

Overall, nurses that exercise their BYOD power report a greater sense of autonomy in the workplace. They are more comfortable using their own devices, they feel a sense of control over computing and they report an improvement in work-life balance.

Many analysts predict that mobile devices will spell the end for overhead paging systems in hospitals. They may also replace nurse call systems that don't quite get the job done. To make the change as smooth as possible, however, hospitals and medical clinics will have to take an attitude of, "If you can't beat 'em, join ’em." Intel has made an interesting video on the subject:

For example, if staff members are demanding BYOD in a hospital, then the hospital's CIO and IT department need to develop a BYOD strategy that protects patient information. The BYOD strategy should be integrated hospital-wide so that staff members have a unified method of communicating with one another.

A BYOD-friendly hospital, for example, would not only be able to use smartphones to page nurses and to coordinate care. They could transmit alerts from different areas of the hospital as well as communicate lab results and radiology reports. Nurses and doctors could also use their own devices to place orders for important medical tests and to access patient records.

In a world where HIPAA violations garner heavy government fines, medical facilities have to be savvy about how staff members are using patient information. No personal mobile device, for example, should store patient records.

Hospitals that embrace BYOD can make the work of doctors and nurses much easier. In the end, happy medical staff translates to better patient care.

Source: HealthTech

by Carrie Tian 

“Just Ask!” That’s the slogan for a new campaign by the Massachusetts Nurses Association (MNA). The union is encouraging people to ask how many other patients their nurses will be treating that day. The slogan is meant to draw awareness to what the nurses union sees as a growing disconnect between the profit-driven healthcare industry and the quality care of its patients.

The campaign’s goal is to enact minimum mandatory staffing levels, capping the number of patients per nurse. After a similar measure failed to pass the state legislature in 2008, the MNA wants to take the issue directly to voters through a ballot initiative. The union has submitted the text of the Patient Safety Act to the Attorney General’s Office; the act’s terms include limiting nurses to having up to four patients in surgical units and in emergency rooms. Once approved, the union will need to collect 70,000 signatures by November for the Patient Safety Act to appear on the 2014 ballot.

Currently, California is the only state that has mandated nurse-patient ratios. However, this topic may well seem familiar to Mass. voters: state nurses have sought staffing legislation since 1995, and 2011 saw fraught contract negotiations between Tufts Medical Center and its nurses. CommonHealth analyzed how Tufts’ lower nurse ratio affected patient care.

Lynn Nicholas, president of the Massachusetts Hospital Association, alluded to the idea’s long history by calling the current initiative petition a “repeat of an arcane idea that has no merit” in a statement. She said that patients would be better served by having decisions about their care made on a case-by-case basis. Her reactions echoed those of  Michael Sack, President and CEO of Hallmark Health, who wrote an earlier guest post on CommonHealth. “This cookie-cutter approach would completely take away a hospital’s ability to tailor care to specific patient needs,” Sack wrote.

Source: WBUR CommonHealth

by Crystal Loucel

Because minorities are more likely to receive less and lower-quality health care and suffer higher mortality rates from cancer, heart disease, diabetes, HIV/AIDS and mental health illnesses than their Caucasian counterparts, there have long been calls to increase the number of minority providers to reduce these health disparities. Numerous studies have shown that patients are more likely to receive quality preventive care and treatment when they share race, ethnicity, language and/or religious experience with their providers.

The 2010 Institute of Medicine report The Future of Nursing: Leading Change, Advancing Health found that a diverse workforce – and the diverse perspective it provides – contributes to enhanced communication, health care access, patient satisfaction, decreased health disparities, improved problem solving for complex problems and innovation. Moreover, the Health Resources and Services Administration (HRSA) has found that minorities could improve access to care in underserved areas more than nonminority providers (see The Rationale for Diversity in the Health Professions: A Review of the Evidence [HRSA, 2006]).

Yet minorities are still under-represented in the health care workforce generally and in nursing in particular. In 1908, when Israel Zangwill popularized the term melting pot to describe the American population, it was 89 percent white, 10 percent black and less than 1 percent Indian, Chinese, Japanese and “others.” Today’s melting pot is considerably more diverse, composed of more than one-third racial and ethnic minorities; moreover, the United States Census Bureau expects that portion to be more than half by 2050.

“Today the nursing workforce does not adequately reflect the diversity in the population including gender,” says Beverly Malone, CEO of the National League for Nursing. Latinos, African Americans, American Indians and Native Alaskans compose only 7.6 percent of the nursing workforce, a dismal figure compared to the 25 percent in the general population. UCSF’s nursing student population is doing a bit better – in 2009, the latest year for which data are available, these same groups composed 16 percent of the UCSF nursing student body – but there is certainly room for improvement. When Asian Americans are included, a 2008 HRSA report showed that minorities make up 35 percent of the total population but only 17 percent of the nursing population.

UCSF has been trying to respond to the 2004 Sullivan Commission Report, titled Missing Persons: Minorities in the Health Professions, which recommended that health profession schools hire diversity program managers and develop plans to ensure institutional diversity, including providing educational support, commitment, role modeling and dedicated recruitment. Currently, Judy Martin-Holland serves as associate dean for Academic Programs and Diversity Initiatives at UCSF School of Nursing, a role in which she recruits minority students, seeks to integrate more diversity in the curriculum, and offers support programs for minority students. In addition, after years of medical student advocacy, Renee Navarro, vice chancellor Diversity and Outreach, created the School’s first Multicultural Resource Center. Though the center currently has no budget, its director, Mijiza Sanchez, hopes to advocate for the types of programs that the commission has recommended, such as the mentoring that Sanchez herself offers students.

It’s also important to remember that minorities often face barriers to financing their education and would benefit from scholarships, loan forgiveness and tuition reimbursement programs.

In addition, universities should link to minority professional organizations to promote enhanced admissions policies, cultural competency training and enhanced minority student recruitment. For example, as volunteer past president of the San Francisco Bay Area chapter of the National Association of Hispanic Nurses (NAHN), I am proactively connecting to the UCSF student group Voces Latinas Nursing Student Association (VLNSA) to do just that. VLNSA is open to students of all ethnicities who are interested in working with the Latino community; the ability to speak Spanish is not required. And organizations like NAHN typically offer reduced student membership and benefits such as mentoring, résumé revision, job postings, volunteer opportunities, networking and more for students, without requiring them to be from any particular racial or ethnic background.

That last point is important, because no matter how diverse your workforce, the goal is to create an environment that is inclusive and allows everyone to express themselves. As minorities, we cannot address our specific health issues alone; rather, this is a challenge for all health care providers. Given what we know about diversity and its importance to health care, we must partner to creatively address and embrace an ever more diverse future.

Crystal Loucel is a second-year master’s student at UCSF School of Nursing and past president of the San Francisco Bay Area chapter of the National Association of Hispanic Nurses. She has a master’s in public health, specializing in global health, from Loma Linda University; has served as an AmeriCorps and Peace Corps volunteer in Honduras; was one of eight RNs chosen in 2012 for a General Electric-National Medical Fellowship in primary care; and is a 2012 scholarship recipient from the Deloras Jones Kaiser Foundation. An earlier version of this piece appeared in the UCSF student newspaper, Synapse.

by Kathleen Hoffman

The Navajo Sugar Monster

Long ago the Holy People predicted that a monster would take over the Navajos.

Our mothers and fathers would change…No longer were man and woman together.

One after another this monster ate away their faces.

It gnawed away Navajo identity….Everything turned from light to dark….Words ceased to exist.

The Holy People begin to cry.

The Navajo language meets its end…Mouths would soon close entirely.

X marked the spot….Over the eyes and mouths of the people.

The Navajo were not human anymore.

They were beings who craved only one thing

It was not water or food…Nor prayer or traditions…Nor love or family.

The Holy People were right.

Sugar is our monster.

A killer claiming Navajo lives…With a craving that could never be satisfied

Who are these monsters?

Mom? Dad?  Where are the elders? Where is my family?  Who will save us?

It’s going to claim the next generation if things don’t change…

We must stand and make a change…Stand up and fight against this monster

For you…For your family,

Your mother, Your father, Your children

For your Nation.”

by Chantelle Yazzie (A neo-traditional story published on Wellbound Storytellers.)

Native Peoples have higher rates of death by alcoholism (552%), diabetes (182%) and unintentional injuries (138%) than other Americans.  The story above is a neo-traditional story addressing the impact diabetes is having on the Navajo nation.  Neo-traditional stories are creations of today’s Native Americans; attempts at merging the old ways and addressing today’s problems.

Native American’s believe in the power of the story to heal.  Traditional healing stories are unique to particular nations and certain individuals, specifically elders and healers are the only ones who can tell these stories.

According to Teresa Lamsam, of Wellbound Storytellers, specific individuals have a responsibility for traditional healing stories. “Most of the stories that would be relevant [to healing] are considered to have healing within the telling of them — which is what creates the responsibility for the person who carries the story [the healer].  The person who receives the story [patient] also has responsibility.  Usually, a ceremony must accompany the story.”

Do you have a story to share about your experience with diabetes?  Can you create a healing story?

Source: Medivizor