DiversityNursing Blog

Photo: Forensic Technology Center of Excellence

Bruises are one of the most common injuries observed on victims of violent crime, such as victims of sexual assault and domestic violence, according to the National Institute of Justice (NIJ). 

"Bruise detection and diagnosis are currently conducted by sight, under regular light, and bruises are often difficult to see on victims of violence depending on their skin color and the age of their injury. As a result, individuals with dark skin tones are at a significant disadvantage in having their injuries properly identified and documented. This can have a significant impact on both medical and legal outcomes for victims of violence," said AZO Life Sciences. 

Katherine (“Kat”) Scafide is a tenured Associate Professor, Forensic Nurse and Scientist at George Mason University and she has innovated technology to improve bruise detection on dark skin tones. 

According to NIJ, one particular case inspired Scafide to look to technology to address this challenge. 

"As Scafide was examining the victim, documenting injuries and collecting evidence, the victim exclaimed that the individual bit her on her back. Scafide thought, if I can locate this bite – this bruise – I can swab for DNA evidence. She looked for the bruise using all the tools she had available at the time but could not locate the bite or corresponding bruise on the woman’s dark skin. Without documentation, there was nothing to substantiate the victim’s claim, and when their injuries cannot be documented, women are less likely to report incidents of sexual assault, are less likely to engage in the process, and have worse judicial and medical outcomes."

Dr. Scafide began her journey as a bruise Scientist during her doctoral work at Johns Hopkins where she garnered the name “paintball” lady for her unique method of creating injuries. At George Mason, she collaborated with colleagues at Texas A & M and Georgia State Universities, conducting one of the largest and most diverse bruise studies in modern forensic history. 

They discovered Alternative Light Source (ALS) was 5x better than white light at finding bruises on victims with varying skin tones.

According to NBC Washington, the technology is working in Baltimore, where Mercy Medical Center has started using it, and it has been introduced into court evidence in some domestic violence and assault cases. Scafide is hoping to expand the use of the technology both regionally and nationally.

"Forensic Nursing units haven't necessarily adopted this equipment for a variety of reasons: due to the lack of clinical practice guidelines, the cost of the equipment, the concern that there isn't sufficient research to support its practice, and we're looking to change that," Scafide said.

If you or someone you know is experiencing domestic violence, contact the National Domestic Violence Hotline by calling 1-800-799-SAFE (7233), visiting www.thehotline.org or texting LOVEIS to 22522.

Being a parent and a Nurse are demanding roles and it may seem almost impossible to thrive and manage both at the same time, but it is possible! If you're a parent in the Nursing field consider these tips below. 

Parent Guilt

This feeling of missing out on important moments in your children's lives while away at work can really build up negative emotions such as anxiety and depression. 

Author and Journalist Amy Westervelt has some advice to overcoming this guilt. First, stop beating yourself up over your choices and circumstances. Instead, remember the reasons behind your choices. Every time you think to yourself, “I feel bad about __” replace that with, “I made that decision because ___” and then move forward.

 Amy mentions it's important to remember that guilt is inherently tied to empathy. Feeling guilty means you have compassion, care, and concern for those around you. 

Set Standards Early

You must show up and give it your all at work as well as at home so it's best if you set clear parameters and priorities from the start. Openly talk with Supervisors, Coworkers, and Family about what shifts and commitments you are able to attend.

It's great to help coworkers with an extra shift from time to time but work shouldn't come at the expense of your family. If it's your day off, don't check emails and voicemails, focus solely on enjoying your time with loved ones. 

Connect With Fellow Nurse Parents 

There are plenty of Nurses who have children, it's a good idea to get to know them. They can give you tons of great advice and suggestions to improve your work life balance.

These parents know exactly what you're going through and can offer empathy and support. Just being able to talk to someone who can relate is a stress reliever. 

Declutter Your Days

In a perfect world you'd attend every parent teacher meeting, do car pool, eat pizza after soccer matches, etc. but in reality you can't say yes to everything. Life can become hectic with everyone's different schedules.

So in order to stay on top of everyone's availability, creating a calendar at home and on your phone is a great way to stay organized. You can plan out meals for the week, keep track of extra curricular activities, kid's chores etc. Organization is key to a good work life balance.  

Hired Help

If you can afford to outsource help it can alleviate a lot of stress and free up time to spend with your family. For example, if trips to the grocery store are taking up too much time try getting them delivered. Overwhelmed with house cleaning? Hire someone to come and help clean for a couple hours. You find you don't have the energy to walk your dogs, local dog walkers are always available. 

Don't Forget About You

Balancing family and your career can tire you out physically and mentally. There's the old saying, "You can't pour from an empty glass." So it's important to take care of yourself. 

It's okay to ask friends and family for a helping hand in taking care of the kids so you can have some time to do things for you.

Use that calendar we mentioned above to schedule some self-care or time for the hobbies you enjoy. And if you find yourself with an open time slot, that doesn't necessarily mean you should fill it, leave some space to breathe. 

Give yourself some of the love you are constantly giving to others. You are a wonderful Parent and a terrific Nurse, so keep going - you got this! 

As many of you know, a career in Nursing is extremely challenging, but very rewarding as well. For the last 20 years, the Nursing profession has consistently been ranked as the most trusted, honest, and ethical by Gallup. 

Because Nursing is ranked so highly, it takes a special kind of person with a certain set of qualities and skills to be a Great Nurse.   

Some of those characteristics are: 

GOOD COMMUNICATION TO… EXCELLENT COMMUNICATION SKILLS

Communication skills are necessary in almost every career, but in Nursing it's one of the most important aspects of the job. It can literally be the difference between life and death. 

A great Nurse must be able to effectively communicate with fellow Nurses, Doctors, patients, and their families. If not, patients can feel neglected, medical errors can occur and the entire unit will be impacted. 

Emotional Stability

Nursing can be mentally taxing and experiencing traumatic events often takes a toll on you. Emotional stability is a trait that can be practiced and strengthened. It is a necessary characteristic for a Nurse to be successful in this career. 

Ideally, you should have the tools to cope with your feelings and seek assistance if you need it. 

Culturally Competent 

Everyday Nurses care for patients from cultural backgrounds of all kinds. A culturally competent healthcare provider improves patient satisfaction and overall care by understanding and acknowledging a patient's language, customs, and beliefs. 

Team Player

A great Nurse not only focuses on their own workload, but understands that they're a part of team that does whatever is necessary to ensure that all patients are taken care of. A strong team has each other's backs. 

Wants To Learn

The healthcare field is always evolving and requires continuing education throughout. There are plenty of opportunities to learn from experienced Nurses, preceptorships, mentoring programs and continuing education units (CEUs).  

Flexibility 

Many Nurses like the fact that each day is different. You never know what challenges will arise. With that in mind, Nurses often wear many hats and must adapt easily.

Sense of Humor

In a career filled with challenges, you have to find the humor in the craziest situations and laugh whenever you can, with discretion of course. A good sense of humor can alleviate stress and help spread positivity to others. You are human and you need some feel good vibes to get through difficult times. 

Organized

Time management is also a key organizational trait. You must stay on top of when medications are administered, the correct dosage of each med, and when patients need to be fed, bathed, etc. 

The list of traits that great Nurses share is truly never ending as You are almost super human! 

Here's some advice for keeping your cool with difficult visitors.

First Impressions

To start off on the right foot, get to know the visitors in the room by introducing yourself and building rapport. Be proactive and explain what everyone should expect, who else may be assisting in the process, and how often someone will be by to check in. Naturally, family members will worry and feel helpless. It's important to address any questions or concerns they have.

Listen and Acknowledge

When you start to recognize a visitor's behavior shifting in a negative direction, try to get to the root of the problem so you can diffuse the situation. Let them express their feelings and acknowledge their concerns. Try to understand the situation from their perspective.

Remain Calm

If tensions start to rise and the visitor becomes angry or aggressive, it is best to remain calm and keep a physical distance. Try to maintain a composed voice, speak slowly, and use a low volume tone.

It is easy to get defensive, but it is best not to escalate the problem with more negative energy.

Don’t interrupt them. Wait for them to take a break from venting, acknowledge that you’ve heard them and jump in. This gives you the opportunity to take back control of the conversation and guide them to a solution. Master De-escalation Instructor, Myra Golden, calls this ‘the jump rope technique’.

Draw The Line

If inappropriate behavior occurs, it is important to stand up for yourself and set boundaries. If you feel the environment is becoming unsafe, remove yourself and call security.

Not sure what to say? Resilient Nursing has some good examples:

• “I am here to help. I will answer your questions and address your concerns, but I can’t do that if you are yelling at me.”
• “We are in a hospital. I need you to stop. You are disrupting patients and visitors right now.”
• “What you just did/said was not acceptable. If you continue, I will have to ask you to leave.”

Document

If any issues occur on the floor, you should let the Charge Nurse know about it. Also document the event, summarizing what took place and how you handled it. Not only is this good to have for legal reasons, it also makes other healthcare providers aware for the future.

Self-Care

Being involved in a conflict or altercation can take a toll on your stress levels. Be mindful of how you feel and take time to process your feelings. Do what you need to do to feel better. Try talking to a friend or coworker or try journaling.

But most importantly, don't take it personally. You are doing the best you can and are not responsible for someone else's bad reaction to stress. 

To answer this question, we did some research and discovered the answer is Yes, a deaf person can have a career in Nursing. In this article, we focus on 3 Nurses who are making it happen.

For Dionne Jaques, becoming a Nurse was a goal of hers for many years. She knew it would be difficult to achieve this goal because she is deaf. Dionne never gave up. She fulfilled her goal and is a Registered Nurse in a health care facility in Southern Utah. During her valedictorian speech at Nightingale College graduation, she said "Don't let your limitations slow you down".

There are many people like Dionne whose passion is Nursing, like Annie Resetar. Annie has moderate to severe hearing loss. She graduated from Walsh University with a Bachelor of Science in Nursing. She then interned at Akron Children’s Hospital and is currently working as an aide in a Nursing home.

Annie said, "I think my hearing disability sets me apart and makes me a better Nurse. It helps build trust with my patients. It is a testament that there are things wrong with all of us, but that should not get in the way of our lives and dreams. Rather, we simply must adapt and embrace these differences because they make us stronger."

Lauren Searls was born deaf and both of her parents are deaf. Her goal is to be a Family Nurse Practitioner. She received her RN degree from Johns Hopkins University School of Nursing and has applied for an MS in Nursing there.

According to the Rochester Institute of Technology, Lauren has relied on interpreters in the classroom and while visiting patients.

She said, "I go into the patients’ rooms with confidence, introduce myself, tell the patients that I am deaf and will rely on interpreters as needed. I have been able to make it work effectively. Although I do well in one-on-one situations and small group settings, I am not hearing and only 30 percent of the English language is lip readable and there is no guarantee that everyone speaks clearly or is easy to understand. Working with an interpreter is the only way I’ll be able to ensure I have access to what is going on around me.”

Nurses who are hard of hearing are legally entitled to use accommodations like ASL (American Sign Language) interpreters and tools such as amplified stethoscopes to assist them. To learn more about resources and accommodations, the Association of Medical Professionals with Hearing Loss (AMPHL) and the Society of Health Care Professionals With Disabilities advocates for deaf and hard-of-hearing professionals in the medical field.

Women of color in the United States suffer unacceptably poor maternal health outcomes, including high rates of death related to pregnancy or childbirth.

The Pregnancy Mortality Surveillance System started in 1987 and since then, the number of reported pregnancy-related deaths in the United States increased from 7.2 deaths per 100,000 live births to 17.2 deaths per 100,000 live births in 2015.

Considerable racial/ethnic disparities in pregnancy-related mortality exist. During 2011–2015, the pregnancy-related mortality ratios were—

• 42.8 deaths per 100,000 live births for black non-Hispanic women.
• 32.5 deaths per 100,000 live births for American Indian/Alaskan Native non-Hispanic women.
• 14.2 deaths per 100,000 live births for Asian/Pacific Islander non-Hispanic women.
• 13.0 deaths per 100,000 live births for white non-Hispanic women.
• 11.4 deaths per 100,000 live births for Hispanic women.

Variability in the risk of death by race/ethnicity indicates that more can be done to understand and reduce pregnancy-related deaths.

According to a report from the Centers for Disease Control and Prevention, African American mothers die at a rate that's 3.3 times greater than whites, and Native American or Alaskan Native women die at a rate 2.5 times greater than whites.

Pregnancy-related mortality rates are also high among certain subgroups of Hispanic women. A Science Direct article says, pregnancy-induced hypertension was the leading cause of pregnancy-related death for Hispanic women.

The CDC report also shows roughly 3 in 5 pregnancy-related deaths are preventable. But, the health care system fails to listen to diverse population's health concerns and so the maternal mortality rate keeps rising.

According to the Healthy People Final Review, Approximately 25% of all U.S. women do not receive the recommended number of prenatal visits.  This number rises to 32% among African Americans and to 41% among American Indian or Alaska Native women.

An article from the Center for American Progress believes there is little research on what social factors contribute to poor delivery and birth outcomes for American Indian and Alaska Native women because of the small population size and racial misclassifications. But they do know these women face many barriers when it comes to getting healthcare.

The National Partnership for Women & Families explains African American women experience more maternal health complications. 

• African American women are three times more likely to have fibroids than white women. Fibroids are benign tumors that grow in the uterus and can cause postpartum hemorrhaging. Also the fibroids occur at younger ages and grow more quickly for African American women.
• African American women display signs of preeclampsia earlier in pregnancy than white women. Preeclampsia involves high blood pressure during pregnancy and can lead to severe complications including death if not properly treated.
• African American women experience physical “weathering,” meaning their bodies age faster than white women’s due to exposure to chronic stress linked to socioeconomic disadvantage and discrimination over the life course, this makes pregnancy riskier at an earlier age.

The CDC report also shows that more than a third of pregnancy-related deaths were due to cardiovascular conditions. Cardiovascular disease is more common among black women and can occur at earlier ages than in white women.

It is very clear that health disparities have a lot to do with racism. Until it is addressed and programs are put in place to combat racism in healthcare, mortality rates will continue to rise.

We found this inspiring Pilot Program we think will be of interest to you. Healthcare provider, AdventHealth, rolled out an unusual program last year that hopes to “revolutionize” the way patient care is delivered around the country.

The goal of the pilot program, started in 2018, was to free up Nurses to provide more patient-centered care without the constant interruption of writing down the care as it was given. Nurses were paired with a Care Team Assistant (CTA) to document patients’ medical care at the time it was provided. This was done under the Nurse’s supervision and they worked as a team.

“This pilot is helping me be the type of Nurse that I dreamed of,” said Christine Reyes, a Registered Nurse at AdventHealth Altamonte Springs. “I became a Nurse because I wanted to show compassion to people who need it most, and this pilot is allowing me to do that even more.”

Results of the pilot program

·         Staff responsiveness (a measurement of the patient experience) improved by 12%.

·         Lab turnaround time improved by 13%.

·         73% of nurses said they feel they are able to spend more time with patients when assisted by a CTA.

Eric Stevens, CEO of acute care services for AdventHealth in metro Orlando said "AdventHealth is committed to finding innovative solutions to health care problems. We created this model to improve the way we work to make it easy for both our patients and staff. Our Nursing staff is key to providing compassionate, whole-person care. A hospital stay can be an unnerving experience. This program helps our Nurses spend quality time with our patients and their families to focus on supporting them while they heal."

AdventHealth is building on the success of the pilot and expanding it to other units.

What do you think of this program? Is it a good idea to implement at other hospitals? Share your ideas here.