DiversityNursing Blog

By Maria Sonnenberg

The Boy Scout motto of "be prepared" equally applies to today's school nurses, who not only deal with the typical bruises and tummy aches that have always been part of school life, but must now contend with a student population that is increasingly more medically fragile.

As school systems face budget cuts, nurses must also adapt to a "migrant" lifestyle as they are assigned to several schools during a workweek.

"There have been a lot of changes in the last 20 years," said Pamelia Hamilton, community health nurse consultant and school health coordinator for the Brevard Department of Health, which supervises the 160 nurses and health technicians who serve public schools in Brevard County.

According to the National Association of School Nurses, a third of all school districts reduced nursing staff in the past year because of the recession, and a quarter of all school districts in the nation don't have nurses. In these districts, medical emergencies are typically handled by a school's front office staff, the way they were in Brevard until the late 1980s, when nurses were first introduced to local schools.

Brevard's ratio of nurse to students — about 1 per 450 — is exemplary, when considering that Florida, with a nurse-to-student ratio of 1 to 2,537, is at the bottom of the list in the number of nurses in schools. Only Utah, North Dakota and Michigan are worse off in numbers. Vermont, on the other hand, has a ratio of 1 nurse per 396 students.

The National Association of School Nurses recommends a 1-to-750 ratio for well students and 1 to 125 in student populations with complex health care needs.

"People who live here think our nursing program is the norm everywhere, but when they move out, they are in for a shock," Hamilton said.

"What we do is so extraordinary that we've been recognized with several awards."

The health department hires, trains and pays the school district's nurses. In turn, the district reimburses the health department for most costs incurred in running the program.

New responsibilities

The foremost duty of a school nurse is to keep kids learning as long as possible. These days, that can take the form of fixing an accidentally stapled finger or a nasty cold, as it did years ago, but it can also entail helping a pregnant teen stay in school and teaching them to become a good mother. Brevard's Teen Parent Program, for example, assists about 250 pregnant girls at Palm Bay, Eau Gallie, Titusville and Cocoa high schools.

"We explain to them what is happening to their bodies and train them to care for their babies," Hamilton said.

School nurses today also go beyond the traditional boundaries of kindergarten to high school students. Nurse Travia Williams and her team of technicians travel through the county's Head Start program sites to provide the screening, physicals and related services necessary for the little ones to be better prepared when their school days start.

Other nurses are devoted to one-on-one care with medically needy students who otherwise would not be able to attend school.

School nurses are also tasked with managing children's increasingly complex medical conditions and chronic illnesses. A child may have a tracheotomy or require nasal gastric tube feeds by an experienced nurse. Nurses may be required to monitor students' insulin pumps and keep track of inhalers and EpiPens. In some instances, Medicaid pays for a private duty nurse to be with the student one-on-one throughout the school day.

"Professional responsibilities have not changed overall," said Carolyn Duff, president of the National Association of School Nurses. "What has changed is the increasing number of students with chronic health conditions, including asthma, diabetes and severe allergies. All of these conditions have the potential for life-threatening emergencies. What this means for school nurses is an increasing need to train and maintain a competent team of unlicensed school personnel to prevent, recognize and respond to emergencies.

"Another change is a welcome change," Duff said. "There is now a greater emphasis on prevention and wellness in health care."

"School nurses are identifying students at risk for both health and learning problems at an early age and are able to initiate early referrals for intervention and treatment."

The National Association of School Nurses lists data that underscores why school nurses' duties are so varied these days. Among students ages 12 to 19, pre-diabetes and diabetes has increased from 9 percent in 1999 to 23 percent in 2008, and 32 percent of children ages 2 to 19 are obese. More than 10 million children suffer from asthma. The prevalence of food allergies among children younger than 18 increased 19 percent from 1997 to 2007.

Mental health issues among students are on the rise. School nurses estimate they spent about a third of their time providing mental health services.

Overall, 15 percent to 18 percent of children and adolescents have a chronic health condition, nearly half of whom could be considered disabling.

ACA's impact

The enactment of the Affordable Care Act could provide an opportunity to strengthen a nurse program that serves the nation's 52 million school-age children. For many of these students, the school nurse is the sole provider of access to health care.

Health care reform's emphasis on wellness dovetails with the goals of school nurses, who provide continuity of care and promote healthy lifestyles for students during their most critical developmental years. They perform early intervention services such as periodic assessments for vision, hearing and dental problems with the goal of removing barriers to learning.

States are testing different health care models for high value rather than high cost and high volume. School nurses are included in the plan.

"Health care reform will lead to greater opportunity for school nurses to successfully connect students from low-income families to medical homes, because more students will be insured," Duff said.

"More widespread access to medical homes will provide greater opportunity for school health services to focus on prevention and wellness and tighter management of students with chronic disease."

Source: USA Today

By: Marilyn Hagerty, Grand Forks Herald

She sets her alarm on weekdays for 5:30 a.m., and she jumps in the shower when it rings. She slips into her green nursing scrubs.

“I always listen to the 6 o’clock news,” says Amanda Lako, a third semester nursing student at UND.

From 8 a.m. until 4 p.m., on a typical day she’s in classes, sometimes at the Public Health Department at the Grand Forks County Office building, sometimes at the College of Nursing and Professional Disciplines at UND and sometimes at Altru Hospital.

In her rush for class, she might bring a baggie with dry cereal in it to eat. “I’m terrible,” she said. She depends on coffee to keep her running. And there are times when she is so tired that she sets her alarm to ring in eight minutes. She gives herself a short, short nap.

The road to a degree as an RN, or registered nurse, is long and challenging.

Amanda Lako is one of 324 students in the undergraduate baccalaureate program at UND. Lako is a junior in her third of five semesters. Beyond that, there will be a semester of practical work in a hospital setting before she graduates in December 2014.

She is passionate about nursing.

“It is a calling,” she told me. “Once you start it you know if it is right for you. There has to be a big desire.”

For Lako, that desire began when she was growing up on a farm near Arthur, N.D. She was 4 when she started shadowing an aunt who was a nurse. She had other aunts who were nurses.

She was smitten with nursing. As a freshman at UND, she became a CAN, or certified nurse assistant. And, she said, “I loved each and every one of the residents I helped.”

Her work as a CNA taught her how to relate to patients. “It was amazing to work on the CNA float pool at Altru. I worked on every floor wearing my light baby blue scrubs,” she said.

Her class of 52 has five male students. And Lako thinks it is awesome for a man to go into the career. “It takes the kind of men who have the biggest hearts and are so kind and gentle.”

In Lako’s mind, nurses are selfless. She admires people who have been her mentors including her school nurse, her church leaders. And she said, “Certain people just push you. I was adopted and I think I learned to be selfless from my parents.”

She isn’t always that serious. She works away at the pages of papers she must keep on patients. And she gets supper around 7 to 8 p.m.

Then there are the times in the evenings when she sits around the kitchen table with four other nursing students. They live together.

“We laugh, we sing, we complain. I depend on them to lighten things up.” 

UND’s nursing program

UND offered non-degree courses of study for nurses beginning in 1909.

In 1949, the first baccalaureate program in nursing was established and a Division of Nursing was created at UND. The same year, the State Board of Higher Education authorized the creation of the College of Nursing as a unit on campus.

The baccalaureate program was fully accredited by the National League for Nursing in 1963 and has remained accredited since that time, according to information provided by Lucy Heintz, clinical assistant professor and director of the Office of Student Services.

In 2013, in addition to the Department of Nutrition and Dietetics, the College of Nursing was joined by the Department of Social Work and the name was officially changed to the College of Nursing and Professional Disciplines.

Currently, the Department of Nursing has 324 students in its undergraduate baccalaureate program. The graduate program with 269 enrolled offers two doctoral programs. Master of Science degrees are available.

The graduate program has an enrollment of 269.

Source: Grand Forks Herald

Despite “measurable progress” in the three years since the release of the Institute of Medicine’s landmark report on the future of nursing, more work remains “to fully realize the potential of qualified nurses to improve health and provide care to people who need it.”

That assessment is part of a commentary by Harvey V. Fineberg, MD, PhD, president of the IOM, and Risa Lavizzo-Mourey, MD, MBA, president and CEO of the Robert Wood Johnson Foundation, on the aftermath of the report.

“The Future of Nursing: Leading Change, Advancing Health” was released Oct. 5, 2010, by the IOM with the support of RWJF. It provided a blueprint for transforming the nursing profession to “respond effectively to rapidly changing healthcare settings and an evolving healthcare system,” according to a report brief.

The key recommendations: allow nurses to practice to the full scope of their education and training, provide opportunities for nurses to serve as healthcare leaders and increase the proportion of nurses with a BSN to 80% by 2020. Following the report, RWJF and AARP formed the Campaign for Action to implement the report’s recommendations at the state level. 

Regarding scope of practice for advanced practice registered nurses, Fineberg and Lavizzo-Mourey wrote that 43 state action coalitions have prioritized initiatives to remove scope-of-practice regulations that prevent APRNs from delivering care to the full extent of their education and training. Iowa, Kentucky, Maryland , Nevada, North Dakota, Oregon and Rhode Island have removed barriers to APRN practice and care, and 15 states introduced bills this year to remove physician supervision requirements that can hinder APRN care.

Regarding education and training, the proportion of employed nurses with a BSN or higher degree was 49% in 2010 and 50% in 2011. “Progress is likely to accelerate in the years to come,” Fineberg and Lavizzo-Mourey wrote, “because between 2011 and 2012 along there was a 22.2% increase in enrollment in RN-to-BSN programs and a 3.5% increase in enrollment in entry-level BSN programs.” The authors also noted a recent increase in the number of students enrolled in nursing doctorate programs. Of the 51 action coalitions, 48 have worked to enable seamless academic progression in nursing.

The authors noted that the influence of the campaign has paid off with a $200 million Medicare initiative to support the training of APRNs at hospital systems in Arizona, Illinois, North Carolina, Pennsylvania and Texas.

Regarding nurse leadership, Fineberg and Lavizzo-Mourey wrote, the “Campaign for Action has tapped established and emerging nurse leaders across the nation and is working to provide them with opportunities for networking, skills development and mentoring. A key strategy is to advocate for more nurses to serve on hospital boards.” 

Full commentary: http://bit.ly/176XyZs

Campaign for Action: http://www.rwjf.org/en/topics/rwjf-topic-areas/nursing/action-coalitions.html

“Future of Nursing” report: www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx

Graduate Nurse Education Demonstration: http://innovation.cms.gov/initiatives/gne/. 

Source: Nurse.com

By Debra Wood, RN

To achieve the national goal of improved health outcomes, many researchers and health advocates agree that patients must assume a greater role in managing their health

care. But how can facilities and health systems accomplish this kind of patient engagement? The answer may rest with nurses and nurse leaders, who have long overseen patient education about how to care for chronic conditions and make lifestyle changes to improve health.

“Promoting patient education has always been a part of our nursing role and obligation to the
patient,” said Debi Sampsel, DNP, MSN, BA, RN, chief officer of innovation and entrepreneurship at the University of Cincinnati’s College of Nursing in Ohio. “It has been a long-standing practice that nurses involve the patient across the life span in their own care.”

Sampsel finds nurses strive to and take great pride in promoting healthy lifestyles. And research has demonstrated that active, engaged individuals have far better health outcomes. The University of Cincinnati includes health promotion in the nursing curriculum and gives students an opportunity gain patient-engagement experience while working with the homeless and elementary and secondary school age youth.

“What’s new is old,” added Patrick R. Coonan, EdD, RN, NEA-BC, FACHE, dean and professor at the College of Nursing and Public Health at Adelphi University in Garden City, N.Y. “I went to nursing school 35, 40 years ago and what did they teach but to be the patient advocate, to teach the patient. But we got away from that in the last few decades.”

Coonan pointed out that today’s consumers and patients, particularly baby boomers, are better informed. They often turn to the Internet for facts, but he called it a nursing professional’s obligation to verify whether the online information is accurate. Boomers are not going to settle for a paternalistic “Just take this pill” without knowing why and how it will benefit them. And that often falls to the nurse.”

“We have to get away from the patient-doctor or patient–nurse relationship that is almost like a parent–child relationship, in existence for many years, to a more informed and empowered [consumer] who will take responsibility for their health,” said Rosemary Glavan, RN, MPA, CCM, senior vice president of clinical operations at AMC Health, a telehealth provider based in New York. “Baby boomers have been go-getters and always wanted to be in charge. They want to be empowered.”

Advocating with a personal connection

“As patient advocates, nurses and nurse leaders play a key role in promoting patient engagement,” said Cynthia M. Friis, MEd, BSN, RN-BC, associate association executive for SmithBucklin’s healthcare and scientific industry practice in Chicago. “Nurses are privileged with having the opportunity to spend more time with the patients to assess, plan, implement and then help clarify the plan of care with the patient and his/her family or caregivers. Nurse leaders are key in helping to ensure this role is realized. Nurses can do their jobs better with the full support of our nurse leaders.”

Nurses ask questions, she added, and draw patients into thoughtful discussions about their care, helping them move forward when they feel overwhelmed and understand how to best care for themselves.

Establishing principles of engagement

Patewood Memorial Hospital in Greenville, S.C., participated in a national study by the Agency for Healthcare Research and Quality (AHRQ) and in the development of theGuide to Patient and Family Engagement in Hospital Quality and Safety.

Recommendations in the AHRQ guide include:

• Working with patients as advisors;
• Communicating effectively; 
• Giving bedside shift reports, where nurses do not talk with each other but involve the patient and family members he or she wants to participate; and 
• Engaging patients in transitions to home.

The hospital has experienced improvements to its HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey since implementing the program.

“The patients and families are much happier,” said Kerrie Roberson, MBA, MSN, RN-BC, CMS, nurse educator at Patewood. “Patient engagement is a partnership with the patient and families, and they trust you more when they see you are open about their care.”

Nurses at Patewood are leading discussions about patient engagement across the Greenville Health System and have begun sharing their experiences with others.

Other nurses gathered to develop Guiding Principles for Patient Engagement, released last year by the Nursing Alliance for Quality Care (NAQC), which was supported by the Robert Wood Johnson Foundation.

Principles in the NAQC guide include:

• Having a dynamic partnership with patients and their families; 
• Respecting boundaries; 
• Maintaining confidentiality; 
• Adhering to responsibilities and accountabilities; 
• Recognizing patients able to engage; 
• Appreciating patient rights; 
• Sharing information and decision making; and 
• Advocating for the patient.

“Patient-centered care and engaging patients is very important to improving quality outcomes, which includes reducing cost and better health of populations in the community, but also reductions in disparities of care,” said Maureen Dailey, PhD, RN, CWOCN, senior policy fellow for nursing practice and policy at the American Nurses Association (ANA), a member organization of the NAQC. “The patient is at the center of the team and must assume accountability for self-care and part of the outcome. But that evolution has yet to take place.”

Nurses must instill confidence and competence in patients’ self-care, Dailey explained. And patients need nurses to provide knowledge, support and symptom management.

“Nurses hold a central role in patient engagement,” Dailey concluded.

Combing nursing skills with technology

Along with the personal touch, many nurses are finding technology can assist with their patient-engagement efforts.

“As the responsibility of nursing advances to one of building and sustaining patient activation and the role of nursing moves to be more consultative across care settings, technology will play a vital role for both the nurse and the patient,” said Karen Drenkard, PhD, RN, NEA-BC, FAAN.

Drenkard, who has served as executive director of the American Nurses Credentialing Center (ANCC) and past director of the ANCC Magnet Recognition Program, will join GetWellNetwork in January as chief clinical/nursing officer, where she will lead the development of a nursing model of patient engagement. Her responsibilities will include studying and designing new ways to assess and improve patient activation through clinical practice and technology solutions across all care settings.

“Nursing can use interactive patient care technology to proactively engage the patient and shift the responsibility for completing certain care interventions,” said Drenkard, explaining patients can document daily signs and symptoms. Care providers use the network to send reminders about taking medications or the need for follow-up visits to their physician when data and input from the patient indicates the need to do so.

By Debra Anscombe Wood, RN

Always looking for new ways to improve patient care, nurses in the 45-bed, Level 3 NICU at Maxine Dunitz Children’s Health Center at Cedars-Sinai Medical Center in Los Angeles developed a program called BabyTime that uses iPads to promote maternal/child bonding across hospital units.

“You can see moms’ faces light up and glow because they are so happy to see their babies,” said Yvonne Kidder, RNC, MSN, a clinical nurse IV, who pioneered the BabyTime concept with Julius Caceres, RN, MSN, a NICU staff nurse and member of the unit’s informatics project team.

A new mom who required intensive care triggered the idea. A nurse practitioner went to update the mother about her baby’s status, but sensed there had to be a better way for nurses to communicate the child’s status to the new mothers who were not able to visit their babies in the NICU. About 10% to 20% of new moms cannot visit the NICU. Some are recovering from cesarean deliveries and others are dealing with complications.

“This was a nurse-led project,” Caceres said. “It was a great process to be involved in.” The nurses investigated different technologies, including hardwired bedside webcams, but settled on the Apple iPad with its FaceTime app because of its camera and audio capabilities.

“One of Apple’s strengths is its user interface across devices,” Caceres said. As it uses the same operating system as the Volt iPhones the nurses already use, it was easier for them to learn to use the iPads.

Kidder reported that administration supported the idea and thought it would boost the patient experience. The nurses developed guidelines and presented in-services to fellow nurses about how to use BabyTime. “We made it very simple, because we thought we would get better buy-in,”
Kidder said.

Before turning the camera onto the baby, the NICU nurses prepare the new moms for what they will see — be it a ventilator, IV lines or other equipment. Siblings with mom also can see the baby. 

A nurse from the mom’s unit assists in connecting the system once per shift through the hospital’s internal Wi-Fi on a hospital-owned iPad. The program discourages use of personal devices, so the connection is secure and a nurse can be with the mom, answer questions and provide support. The two nurses check names and medical record numbers to ensure the right mom is looking at and talking to the right baby. Visits are allowed for about five minutes twice per day. New mothers can talk with the NICU healthcare team, ask questions and receive updates about the baby’s status.

“One of the great benefits is moms can meet the [baby’s] nurse,” Kidder said. Seeing the baby has a calming influence on the new mothers. “It helps reduce mom’s anxiety,” Caceres said. “Once the baby is stabilized, mom can have BabyTime.”

Babies respond as well when moms talk. Oxygen saturation rates go up, vital signs improve. “You can see decreases in the baby’s heart rate, and the babies seem calmer when they hear mom’s voice,” Caceres said.

Nurses clean the iPads between uses. The NICU devices are secured into a stand, and on the adult units, nurses lock up the iPads between sessions.

Since the program started, the BabyTime program has added iPads to make sure they are available to all moms who want to use them. 

“I can see it being used throughout the medical center,” Kidder said, suggesting physicians could offer families updates from the operating room. “This doesn’t replace face-to-face contact with the medical team, but it’s a bridge in communication to help us connect with families.” 

LEARN MORE, visit Cedars-Sinai.edu. 

Source: Nurse.com

One-on-one talks with nurses help mothers of premature infants cope with feelings of anxiety, confusion and doubt, a new study reveals.

"Having a prematurely born baby is like a nightmare for the mother," Lisa Segre, an assistant professor in the University of Iowa College of Nursing, said in a university news release. "You're expecting to have a healthy baby, and suddenly you're left wondering whether he or she is going to live."

Segre and a colleague investigated whether women with premature babies would benefit from having a neonatal intensive care unit (NICU) nurse sit with them and listen to their concerns and fears.

The study included 23 mothers with premature infants who received an average of five 45-minute one-on-one sessions with a NICU nurse and study co-author Rebecca Siewert.

"The mothers wanted to tell their birth stories," Siewert said in the news release. "They wanted someone to understand what it felt like for their babies to be whisked away from them. They were very emotional."

The sessions reduced depression and anxiety symptoms in the women, and boosted their self-esteem, according to the study published online recently in the Journal of Perinatology.

The findings show that "listening matters" when it comes to helping mothers of premature infants, Segre said.

"These mothers are stressed out, and they need someone to listen to them," she explained.

She and Siewert believe nurses are well-suited for the role.

"Listening is what nurses have done their whole career," Siewert said. "We've always been the ones to listen and try to problem solve. So, I just think it was a wonderful offshoot of what nursing can do. We just need the time to do it."

Source: US News Health

By Sarah Cutrufello, RN, MSN, OCN

As an oncology nurse, I witness how ordinary people living with cancer cope with their extraordinary disease; how common people summon the uncommon strength to receive the toxic cocktail of chemicals that medical professionals call “treatment.” Each case is different, each patient unique.

About two years ago, I was fortunate to develop a relationship with a woman who had a special way — quiet, gentle, dignified — of handling her disease. At 66, she had been diagnosed with acute myelogenous leukemia. 

When we first met, she looked up at me from her hospital bed and solemnly said, “I should be in Switzerland today … .” Her husband finished the thought — they had booked a week-long trip to Germany and Switzerland. Recently retired, the couple had reserved a place in their minds for that special spot to drink tall glasses of wine in a cabin overlooking the Alps. 

Yet here they were, in a hospital room in Philadelphia. Their updated itinerary consisted of eating tasteless scrambled eggs and lying on an uncomfortable mattress overlooking the brick buildings of the hospital’s sprawling city complex. It was not fair. 

In that moment of our first meeting, I felt a profound sadness. This woman had an exciting life that she shared with her husband, who one could instantly tell was head over heels for his wife. Cancer was robbing her of this life.

She never said she was scared or upset or angry. She was appreciative of everything I did. When the physician’s team came in, she fooled them with her sweet smile and upbeat attitude. It almost was worthy of some kind of perverse Oscar award for “Best Performance in a Terminally Ill Role.” 

But I could see through the act to the deep pain and hurt of the “actress” lying in bed; someone who was struggling to come to terms with the fact that as recently as a month prior she was enjoying a vibrant life with her husband and friends back home.

A few weeks later, on St. Patrick’s Day, she could barely wait to tell me as I walked in, “I should be at a great party today.”

“A great party? Tell me about this party,” I said.

Her face lit up as she told me how her neighborhood opened its homes on St. Patrick’s Day to hold a sort of bar crawl. Again, though, there was the hint of disappointment. 

I listened with a smile on my face and said — as I always said when we talked about events she could no longer attend — “When you get out of here, you will do these things. I promise.” These words felt like equal parts truth, lies and hope mixed together in some kind of phrase that needs to be said on such occasions.

Later, as I was unhooking her blood transfusion, I noticed she had found a few moments to sleep. I stood there for a moment, silently, my eyes filling with tears. It occurred to me just how disappointed she must have been every time she woke up and was confronted with the reality that is cancer. 

She was not in Switzerland or Germany or enjoying a great St. Patrick’s Day party with friends. The life she had known before cancer stopped her in her tracks was happening someplace far removed from where she was. She would die about a year and a half after I met her. 

Above all else, this experience taught me the importance of approaching patients with open ears and an open heart. Dealing with anxiety, anticipation, fear, loneliness, uncertainty or any number of other emotions, our patients often need a kind of nursing care that goes beyond administering their prescribed treatment.

At the close of that day’s shift, I said to another clinician, “I feel her sadness. She breaks my heart.” To which the other person gave a quick chuckle and said, “She’s not sad.” 

I thought to myself: another Oscar-worthy performance. 

Source: Nurse.com

Psychological interventions reduce by half deaths and cardiovascular events in patients with heart disease, according to a data analysis.

“The nurses on our coronary care unit observed that patients were less likely to have another heart attack, die or return to hospital when we talked to them about their treatment, played music for them or helped religious patients to say prayers,” Zoi Aggelopoulou, RN, PhD, a study author from NIMTS Veterans Hospital Athens in Greece, said in a news release. “It made us think that coronary heart disease is not just physical but also has a psychological component.

“We wanted to find out if others had observed the same thing, and whether psychological support had a real impact on the outcomes of patients with coronary heart disease.”

As presented in Madrid at the annual meeting of the Acute Cardiovascular Care Association of the European Society of Cardiology, researchers conducted a meta-analysis of nine randomized controlled trials that had been published previously. They evaluated whether psychological interventions could improve outcomes of patients with coronary heart disease when combined with a conventional rehabilitation program.

The researchers found the addition of psychological interventions reduced mortality and cardiovascular events by 55% after two years or more. The benefits were not significant during the first two years.

“We found a huge benefit of psychological interventions after two years, with less patients dying or having a cardiovascular event and therefore fewer repeat hospital visits,” Aggelopoulou said in the news release. “The interventions included talking to patients and their families about issues that were worrying them, relaxation exercise, music therapy and helping them to say prayers."

The researchers concluded psychological interventions should be incorporated into the rehabilitation of patients with coronary heart disease. “More clinical trials are needed to clarify which interventions are most effective and how they can best be implemented,” Aggelopoulou said in the news release.

“We can help our patients by simply talking to them or introducing new things like music therapy into our clinical practice,” she added. “Coronary units are busy places — in Greece we sometimes have one to two nurses for 10 to 20 patients in the coronary care unit, and we are under time pressure.

“But our finding that the addition of psychological support on top of physiological therapies reduces death and cardiovascular events by 55% should be a wakeup call that these interventions really do work. Preventing repeat hospital visits would free up the time we need to implement them.” 

Source: Nurse.com

The Health Insurance Marketplace open enrollment launch on October 1, 2013 spurred discussion about the influx of newly insured patients and the shortage of primary care professionals. Nursing@Simmons, an online Master of Science in Nursing program for aspiring Family Nurse Practitioners, created an infographic to illustrate the state of primary and preventive health care in the U.S. and the role nursing professionals hold. This infographic provides a snapshot of what has happened in the years since the Affordable Care Act was conceptualized and enacted, in addition to showing how nurse practitioners are contributing to primary care.

Share the infographic below to raise awareness about the role that Family Nurse Practitioners play in health care reform under the Affordable Care Act.

Source: Simmons Nursing

What is NO MORE?

NO MORE is a new unifying symbol designed to galvanize greater awareness and action to end domestic violence and sexual assault.  Supported by major organizations working to address these urgent issues, NO MORE is gaining support with Americans nationwide, sparking new conversations about these problems and moving this cause higher on the public agenda.

The history of NO MORE

The NO MORE symbol has been in the making since 2009. It was developed because despite the significant progress that has been made in the visibility of domestic violence and sexual assault, these problems affecting millions remain hidden and on the margins of public concern. Hundreds of representatives from the domestic violence and sexual assault prevention field came together and agreed that a new, overarching symbol, uniting all people working to end these problems, could have a dramatic impact on the public’s awareness.

The signature blue vanishing point originated from the concept of a zero – as in zero incidences of domestic violence and sexual assault. It was inspired by Christine Mau, a survivor of domestic violence and sexual abuse who is now the Director of European Designs at Kimberly-Clark. The symbol was designed by Sterling Brands, and focus group tested with diverse audiences across the country who agreed that the symbol was memorable, needed and important.

Who is behind NO MORE?

Every major domestic violence and sexual assault organization in the U.S. – from men’s organizations like A CALL TO MEN and Men Can Stop Rape, to the National Domestic Violence Hotline and the National Alliance to End Sexual Violence, to groups that help teens like Break the Cycle and Futures Without Violence, to organizations that advance the rights of women of Color and immigrants like Casa de Esperanza and SCESA to the U.S. Dept. of Justice’s Office on Violence Against Women – all of them and more are behind NO MORE.

View the complete list of organizations here.

What do we do?

NO MORE is spotlighting an invisible problem in a whole new way. The first unifying symbol to express support for ending domestic violence and sexual assault, NO MORE can be used by anyone who wants to normalize the conversation around these issues and help end domestic violence and sexual assault. Our vision is that NO MORE will be everywhere – on websites, t-shirts, billboards. Organizations and corporations, large and small, will embrace this symbol as their own. When an abuse case makes media headlines, you will instantly see NO MORE being tweeted, discussed on Facebook, worn as jewelry and on t-shirts; made into buttons and posted in classrooms, offices, billboards and grocery stores across the country. NO MORE will help end the stigma, shame and silence of domestic violence and sexual assault. NO MORE will help increase funding to prevent domestic violence and sexual assault.  Like the pink ribbon did for breast cancer and the red ribbon did for HIV/AIDS, NO MORE will help to change behaviors that lead to this violence.

Get the symbol today and start showing your support.

Why should I care?

The next time you’re in a room with 6 people, think about this:

• 1 in 4 women experience violence from their partners in their lifetimes.
• 1 in 3 teens experience sexual or physical abuse or threats from a boyfriend or girlfriend in one year.
• 1 in 6 women are survivors of sexual assault.
• 1 in 5 men have experienced some form of sexual victimization in their lives.
• 1 in 4 women and 1 in 6 men were sexually abused before the age of 18.

These are not numbers. They’re our mothers, girlfriends, brothers, sisters, children, co-workers and friends. They’re the person you confide in most at work, the guy you play basketball with, the people in your book club, your poker buddy, your teenager’s best friend – or your teen, herself. The silence and shame must end for good.

How can I help?

There are hundreds of ways you can spread the word about NO MORE.

Say it: Learn about these issues and talk openly about them. Break the silence. Speak out. Seek help when you see this problem or harassment of any kind in your family, your community, your workplace or school. Upload your photo to the NO MORE gallery and tell us why you say NO MORE.

Share it: Help raise awareness about domestic violence and sexual assault by sharing NO MORE. Share the PSAs. Download the Tools to Say NO MORE and share NO MORE with everyone you know. Facebook it. Tweet it. Instagram it. Pin it.

Show it: Show NO MORE by wearing your NO MORE gear everyday, supporting partner groups working to end domestic violence and sexual assault and volunteering in your community.

Learn more here.