DiversityNursing Blog

By Max Fisher

Ethnicity, like race, is a social construct, but it’s still a construct with significant implications for the world. How people perceive ethnicity, both their own and that of others, can be tough to measure, particularly given that it’s so subjective. So how do you study it?

When five economists and social scientists set out to measure ethnic diversity for alandmark 2002 paper for the Harvard Institute of Economic Research, they started by comparing data from an array of different sources: national censuses, Encyclopedia Brittanica, the CIA, Minority Rights Group International and a 1998 study called “Ethnic Groups Worldwide.” They looked for consistence and inconsistence in the reports to determine what data set would be most reliable and complete. Because data sources such as censuses or surveys are self-reported – in other words, people are classified how they ask to be classified – the ethnic group data reflects how people see themselves, not how they’re categorized by outsiders. Those results measured 650 ethnic groups in 190 countries.

One thing the Harvard Institute authors did with all that data was measure it for what they call ethnic fractionalization. Another word for it might be diversity. They gauged this by asking an elegantly simple question: If you called up two people at random in a particular country and ask them their ethnicity, what are the odds that they would give different answers? The higher the odds, the more ethnically “fractionalized” or diverse the country.

I’ve mapped out the results above. The greener countries are more ethnically diverse and the orange countries more homogenous. There are a few trends you can see right away: countries in Europe and Northeast Asia tend to be the most homogenous, sub-Saharan African nations the most diverse. The Americas are generally somewhere in the middle. And richer countries appear more likely to be homogenous.

This map is particularly interesting viewed alongside data we examined yesterday on racial tolerance, as measured by the frequency with which people in certain countries said they would not want a neighbor from a different racial group.

Before we go any further, though, a few important caveats, all of which appear in the original research paper as well. Well, all except for the report’s age. It’s now 11 years old. And given the scarcity of information from some countries, some of the data are very old, dating from as far back as the early 1990s or even late 1980s. Conceptions of ethnicity can change over time; the authors note that this happened in Somalia, where the same people started self-identifying differently after war broke out. And so can the actual national make-ups themselves, due to immigration, conflict, demographic trends and other factors. It’s entirely possible, then, that some of these diversity “scores” would look different with present-day data.

Another caveat is that people in different countries might have different bars for what constitutes a distinct ethnicity. These data, then, could be said to measure the perception of ethnic diversity more than the diversity itself; given that ethnicity is a social construct, though those two metrics are not necessarily as distinct as one might think. Finally, as the paper notes, “It would be wrong to interpret our ethnicity variable as reflecting racial characteristics alone.” Ethnicity might partially coincide with race, but they’re not the same thing.

Now for the data itself. Here are a few observations and conclusions, a number of which draw from the Harvard Institute paper:

• African countries are the most diverse. Uganda has by far the highest ethnic diversity rating, according to the data, followed by Liberia. In fact, the world’s 20 most diverse countries are all African. There are likely many factors for this, although one might be the continent’s colonial legacy. Some European overlords engineered ethnic distinctions to help them secure power, most famously the Hutu-Tutsi division in Rwanda, and they’ve stuck. European powers also carved Africa up into territories and possessions, along lines with little respect for the actual people who lived there. When Europeans left, the borders stayed (that’s part of the African Union’s mandate), forcing different groups into the same national boxes.

• Japan and the Koreas are the most homogenous. Racial politics can be complicated and nasty in these countries, where nationalism and ethnicity have at times gone hand-in-hand, from Hirohito’s Japan to Kim Il Sung’s North Korea. The lack of diversity perhaps informs these politics, although it’s tough to say which caused which.

• European countries are ethnically homogenous. This is, to me, one of the most interesting trends in the data. A number of now-global ideas about the nation-state, about national identity as tied to ethnicity and about nationalism itself originally came from Europe. For centuries, Europe’s borders shifted widely and frequently, only relatively recently settling into what we see today, in which most large ethnic groups have a country of their own. That developed, painfully, over a very long time. And while there are still some exceptions – Belgium has ethnic Walloons and Dutch, for example – in most of Europe, ethnicity and nationality are pretty close to the same thing.

• The Americas are often diverse. From the United States through Central America down to Brazil, the “new world” countries, maybe in part because of their histories of relatively open immigration (and, in some cases, intermingling between natives and new arrivals) tend to be pretty diverse. The exception is South America’s “southern cone,” where Argentines and Chileans, many of whom originally come from the same handful of Western European countries, tend to be more homogenous. I was surprised to see Canada rate as more diverse than the United States or even Mexico; it’s possible that the survey counted Quebecois as ethnically distinct, although I can’t say for sure.

• Wide variation in the Middle East. The range of diversity from Morocco to Iran is a reminder that this part of the world is much less monolithic than we sometimes think. North African countries include large Berber minorities, for example, as well as some sub-Saharan ethnic groups, particularly in Libya. The diversity of Jordan and Syria are reminders of their internal complexity. Iran, with large Azeri, Kurdish and Arab populations, is one of the region’s most diverse.

• Diversity and conflict. Internal conflicts appear on first blush to be more common in greener countries, which might make some intuitive sense given that groups with comparable “stakes” in their country’s economics and politics might be more willing or able to compete, perhaps violently, over those resources. But there’s enough data here to draw a lot of different conclusions. One thing to keep in mind is that ethnicity might not be static or predetermined. In other words, as in the case of Somalia, maybe worsening economic conditions or war make people more likely to further divide along ethnic fractions.

• Diversity correlates with latitude and low GDP per capita. The report notes, “our measures of linguistic and ethnic fractionalization are highly correlated with latitude and GDP per capita. Therefore it is quite difficult to disentangle the effect of these three variables on the quality of government.” As above, keep in mind that correlation and causation aren’t the same thing.

• Strong democracy correlates with ethnic homogeneity. This does not mean that one necessarily causes the other; the correlation might be caused by some other factor or factors. But here’s the paper’s suggestion for why diversity might make democracy tougher in some cases:

The democracy index is inversely related to ethnic fractionalization (when latitude is not controlled for). This result is consistent with theory and evidence presented in Aghion, Alesina and Trebbi (2002). The idea is that in more fragmented societies a group imposes restrictions on political liberty to impose control on the other groups. In more homogeneous societies, it is easier to rule more democratically since conflicts are less intense.

Here’s the money quote on the potential political implications of ethnicity:

In general, it does not matter for our purposes whether ethnic differences reflect physical attributes of groups (skin color, facial features) or long-lasting social conventions (language, marriage within the group, cultural norms) or simple social definition (self-identification, identification by outsiders). When people persistently identify with a particular group, they form potential interest groups that can be manipulated by political leaders, who often choose to mobilize some coalition of ethnic groups (“us”) to the exclusion of others (“them”). Politicians also sometimes can mobilize support by singling out some groups for persecution, where hatred of the minority group is complementary to some policy the politician wishes to pursue.

Source: Washington Post 

By Jessica DuBois-Maahs

Diana Kamyk discusses the opportunities and challenges of her position as head of the U.S. diversity and inclusion program for Bayer Corp.

Diana Kamyk has dedicated her career to creating a diverse and inclusive work environment. As the head of the U.S. diversity and inclusion program for Bayer Corp., she makes it her mission to foster and facilitate a spirit of understanding within the workplace. The company has been recognized multiple times by Working Mother as a top company for working mothers while under Kamyk’s leadership. She oversees the diversity program at Bayer, of which the Women’s Leadership Initiative is a part. The Initiative aims to increase the number of female employees in managerial positions within the company. In addition, Kamyk helped found Bayer's Diversity Advisory Council, which facilitates and promotes diversity through various conferences and workshops.

How does Bayer's diverse workforce drive and promote innovation?
Through our U.S. Bayer Diversity Advisory Council, we incorporate diversity and inclusion initiatives — such as the Diversity Conference, Women’s Leadership networks and mentoring/coaching programs — into our business strategies and daily operations as a means to foster professional growth and to help build upon our culture. These efforts collectively help support the company’s belief that the more diverse the workforce, the more creative and innovative the results.

What are the goals of Bayer's various diverse employee networks?
Each network has between 50 and 450 members. Some develop new initiatives for their work locations, others get involved in job-related issues in science or the pharmaceutical industry. Their priorities range from doing voluntary work in schools, to promoting women in leadership positions, to offering a safe and inclusive workplace for homosexual, bisexual and transgender employees.

How does Bayer facilitate a work-life balance for moms?
The ProMoms professional network is a forum that allows working moms to learn from and provide support to each other. It creates awareness and understanding among all Bayer employees of the diverse roles of working moms and the contributions they offer to the workplace.

Bayer HealthCare in Berkeley, Calif., opened a new child care center in 2012 with space for 150 children, ages newborn through kindergarten. The child care center serves both children at Bayer and within the West Berkeley community. Bayer recognizes the importance of early childhood development. Therefore, providing an environment where a child can learn and develop to his or her full potential is critical in the maturation process and something that Bayer highly values.

What's the biggest challenge you face in your diversity role, and how do you overcome it?
With operations touching all corners of the globe, working with employees from varying cultures presents a wide range of challenges. Beliefs and priorities as they relate to diversity vary from country to country, so there is certainly a learning curve that we have to take into account as we work to implement unique programs — ones that are impactful and meaningful to employees — that support the foundation of diversity and inclusion across the globe.

Educating myself about each unique culture and understanding our specific employees, basically learning what works and what doesn’t work, has been invaluable for the creation of such plans. For anyone working at a global company, being able to think outside of your own borders and to understand other cultures is imperative to success.

Source: Diversity Executive

If you live a neighbourhood which is ethnically diverse, you're more likely to be healthier and less likely to experience racial discrimination, a new study has found.

Researchers at the University of Manchester say diversity is associated with higher social cohesion and a greater tolerance of each other's differences.

They also found that someone from an ethnic minority is less likely to report racial discrimination in an ethnically diverse neighbourhood.

And that a neighbourhood's high level of deprivation - rather than diversity - is linked with poor physical and mental health, low social cohesion and race discrimination.

The findings, based on analysis of census and survey data, will be presented tomorrow at a conference attended by the study researchers, policy makers and community organisations

Professor James Nazroo, director of the university's Centre on Dynamics of Ethnicity,said: "Our research and this conference is all about setting the record straight on those diverse neighbourhoods which are so widely stigmatised.

"So often we read in our newspapers and hear from our politicians that immigration and ethnic diversity adversely affect a neighbourhood, but careful research shows this to be wrong.

"In fact, the level of deprivation, not diversity, is the key factor that determines these quality of life factors for people in neighbourhoods.

"So our research demonstrates the disadvantages of living in deprived areas but the positives of living in ethnically diverse areas.

"It's deprivation which affects those Caribbean, Black African, Pakistani, and Bangladeshi people who are disproportionately represented in these neighbourhoods, as well as those white people who live alongside them."

Also according to the researchers, one in five (20%) people identified with an ethnic group other than White British in 2011 compared with 13% in 2001.

The ethnic minority populations of England and Wales lived in more mixed areas in 2011 and this mixing has accelerated over the past 10 years, says the study.

Traditional clusters of ethnic minority groups have grown but the rate of minority population growth is greatest outside these clusters with ethnic diversity spreading throughout the country.

Fellow researcher Dr Nissa Finney said: "Despite the clustering of ethnic minority people in some areas, the vast majority of ethnic minority people have a strong sense of belonging to Britain, feel part of Britain and feel that Britishness is compatible with other cultural or religious identities."

While colleague Dr Laia Becares said: "Increased diversity is beneficial for all ethnic groups so we say the policy agenda should develop strategies for inclusiveness rather than marginalising minority identities, religions and cultures.

"Policies aimed at reducing the stigmatisation of diverse neighbourhoods and promoting positive representations can only be a good thing."

The conference, entitled 'Diverse Neighbourhoods: Policy messages from The University of Manchester', will take place at Manchester Town Hall.

Source: UK Huffington Post

By Abigail Curtis

More than 70 years ago, Georgia Randall of Belfast was on a troop train that slowly made its way west across the country before depositing the new Army Nurse Corps recruit in the lively streets of San Francisco.

There, she boarded a converted cruise ship and set sail, with her ultimate destination unknown, the feisty and sharp centenarian recalled Saturday morning at her home while sitting at a table covered with old photographs of her World War II experiences.

She and the 14 other nurses who shared her stateroom also shared a bathtub full of water that they had to use for nearly two weeks of bathing.

“It was a bath in a Dixie cup,” Randall said, adding that the officers who expected the women to be “glamour girls” when they came to dinner were mistaken.

The cruise ship American ended up heading to Australia, where Randall, who spent her first years on a family farm in Sidney, Maine, worked for more than a year caring for the American men who had been badly injured in the bloody battles of the South Pacific. After her time in Mareeba, a “two pub town” on the northeastern coast of Australia where she worked in a station hospital, she spent more than a year working in a tent hospital that had been built in the jungle of New Guinea.

Randall is happy to describe the places she lived, the wildlife and exotic people she saw and the adventures she had during her stints in the Pacific. But when asked about the injured men she cared for during the war and the hard things she had seen, she demurred.

“The horrible things, who needs them?” she asked, just days before Memorial Day. “I don’t talk about those things. There’s no point in dwelling on it. We know a war is a war.”

‘Home and alive in ’45’

Randall had graduated from Crosby High School in Belfast in 1931, the only girl in a family of four brothers. She was a member of the first graduating class from the Waldo County General Hospital School of Nursing in Belfast, and when she got her cap in 1934 she launched into a long and varied career. At first, she worked at the Belfast hospital and then was a private-duty nurse. But when the war began, her youngest brother was in the service and she felt that she could do more for her country.

“It was luxury nursing. It wasn’t for me,” Randall said.

She joined up in April 1942, and was discharged on Christmas Day of 1945.

“Wasn’t that a good present?” she said, smiling. “Home and alive in ’45.”

When she enlisted at Fort Dix, N.J., she and the other nurses who arrived at the same time decided that they might as well “go the distance,” and volunteer for overseas duty.

Randall said that the military issued her woolen clothes as part of her uniform that were not useful in the hot places she worked. A Chinese green grocer in Mareeba used to roast peanuts by putting them in a tin tray on his shop roof, she said, and once she went on a crocodile hunt — though she did not get any crocodiles.

In Australia, the hospital was in a school that the Army had taken over, and during air raids, the nurses would move the patients out of the hospital on litters and place them between the sandbags that were stacked outside. During her first air raid, Randall grabbed a chocolate cake that she had just made and took it into the fox hole with her.

“Oh, I got ribbed because of that,” she recalled.

Later, when she was stationed in the 247th General Hospital New Guinea, in the jungle near the community of Lae, it was so hot she once saw the thermometer reach 130 degrees. Another nurse swore she saw it reach 136 degrees. Army engineers working at the nearby ammunitions dump dug the nurses a swimming hole that was fed by a cool mountain stream.

“It was clear water. Cool and delightful,” Randall said. “One of the other girls and I got brave. It got so hot at night, we couldn’t sleep. We’d go down and skinny dip.”

The 30 or so American nurses there also entertained themselves by taking funny pictures of each other — one of Randall shows her cavorting in a grass skirt — and getting them developed by the guys in the X-ray department.

“We were pin-up girls,” she laughed.

Another moment she remembered vividly was the time she was on night duty and saw that the mice around her feet were making a commotion. When Randall looked around, she saw that a venomous tiger snake had entered through a hole in the screen.

“It was beautiful,” she said, adding that the snake shone like flakes of gold. “We killed it. It was a crime to have done that. I saved the mice, I guess — one of the tragedies of war.”

When she was discharged and came home to Maine, she continued working for decades as a nurse around the midcoast. She also raised one son, David Emery, who later was elected to the U.S. House of Representatives.

Source: Bangor Daily News

 By CHRISTIN LULOW

Between 2 million and 3 million Americans take warfarin (Coumadin) to prevent blood clot formation, which is important in various medical conditions such as atrial fibrillation or after certain procedures, such as getting a new heart valve. Blood levels of a person’s international normalized ratio are measured regularly, and doses of the medication are adjusted accordingly.

Warfarin management may seem overwhelming, but anticoagulation clinics are here to help. While it may not seem like a lot goes into dosing warfarin, more goes into it than may be obvious. Nurses work with people on warfarin, and we want folks who take it to understand they play an important role in the management of their dosing.

A health care provider will start a patient on warfarin for a number of reasons. Although warfarin increases the time the body takes to form blood clots, it is a safe medicine to take when monitored appropriately. Routine follow-up for INR checks is an extremely important part of warfarin management.

During follow-up appointments, nurses will assess numerous issues with regard to your warfarin management. They will check your INR and compare it against your weekly dosing schedule. An INR reading may be outside of the optimal range for something as simple as a missed dose. However, when a patient starts or discontinues a medication, is ill, has been hospitalized or is scheduled for surgery, warfarin dosing is likely to be effected and will need to be adjusted.

It is the job of the nurse in the anti-coagulation clinic to figure out what to do with the patient’s warfarin dosing and when to safely see the patient back in the clinic to help maintain that patient within their goal range. The job of the patient taking warfarin is to notify the nurse in the anti-coagulation clinic of any changes in their medical condition or lifestyle that will affect INR readings.

This may sound simple, but many common activities can impact an INR level. What a person eats and drinks, how much a person exercises or doesn’t, any over-the-counter medications, prescription medications or herbal supplements, illnesses, whether a person smokes or doesn’t, dieting and weight changes, surgery and recovering from surgery are some of the other causes that can change a person’s INR reading. Anything out of the norm for a patient needs to be reported to the nurse at the anti-coagulation clinic immediately.

Warfarin management does not have to be confusing for the patient; supportive and knowledgeable anti-coagulation nurses can help greatly. What the nurses want you to focus on is being consistent.

Be as consistent as you can with your diet and your activity. Don’t worry about avoiding certain foods with vitamin K – except green and white tea; those are the only no-nos. If you like salads and green vegetables, eat them; they offer great health benefits. However, they can affect your INR readings, so it is important to be consistent in the quantity and regularity with which you eat these foods. Let the nurses adjust your warfarin doses around you; don’t adjust your lifestyle around warfarin.

Keep your scheduled appointment times for INR follow-up and take your warfarin as directed. Contact the anticoagulation clinic before you change, start or stop taking other medications. Always watch for signs of bleeding and or unusual bruising.

By following these basic guidelines, patients taking warfarin can live healthy, stable lives with minimal disruption caused by this life-saving medication. While it seems complex, with the help of your anti-coagulation nurse you can keep it simple!

Christin Lulow is a registered nurse in the Coumadin clinic at the International Heart Institute at St. Patrick Hospital.

Source: Missoulian

By Janice Lloyd

Whether you lose a loved one to disease, war, or a natural disaster like the tornado that tore apart Moore, Okla., last week, grief is the unwanted visitor that comes knocking at your door.

How we wrestle with grief — and ultimately push ahead to a new life — varies among individuals. But many of us who need help to bounce back are not getting it, health experts warn, jeopardizing our mental and physical health.

Toni Miles, director of the Institute of Gerontology at the University of Georgia, is embarking on a research project to find out how loss impacts health and what to do about it.

"Loss creates injury,'' Miles says. "It is a new risk factor for poor health in the public sphere."

Miles suspects grief is behind much of the nation's obesity, depression, diabetes, smoking and hospitalization.

"When you study caregiving, you know (grief) kills people,'' Miles says. "Obesity is also a big problem among caregivers. "

Finding support can be the key to a person's recovery and acceptance of the loss, says the American Cancer Society. Support can come from friends, physicians, spiritual leaders or mental health professionals. Everyone reacts differently to grief and for different periods of time. There's not one easy solution or answer, Miles says.

Getting the right amount of support is rare, according to a 2004 study on family perspectives on dying in the Journal of the American Medical Association. Lead researcher Joan Teno asked participants "during the last month (of their loved one's life), how much support in dealing with your feelings about a patient's death did the doctors, nurses or other professional staff taking care of him or her provide you: less support than was needed, about the right amount or more attention than you needed?''

Overall, 20% of the family members stated they did not have the right amount of support, and most said they got less support than they needed.

Teno, a professor of health services policy and practice in the Public Health Program at Brown University and a palliative care physician at Home & Hospice Care of Rhode Island, says her research shows families who use hospice at the end of life cope better than those who don't.

Donald Rosenstein, a professor of psychiatry at the University of North Carolina, is charting new territory into the bereavement process of fathers who lose their wives to cancer. He started a first-of-its-kind support group called Single Fathers Due to Cancer Program, part of the UNC Comprehensive Cancer Support Program.

"Everyone has a different reaction to grief,'' Rosenstein says. "We (health care professionals) don't have a lot of good information about how to get people to move on. But these fathers have been been teaching us."

Rosenstein says in addition to learning what the fathers need – how to discipline children by themselves, how long to wear their wedding bands, when is it OK to date, how long to call their in-laws in-laws — they're also learning how to help their children.

"For instance, moms always want to keep fighting and stay alive as long as possible for their families, but we're learning it's important for them to say goodbye," to provide a sense of closure for their families, he says. "We are also learning how much that helps the children and how to have that conversation with children."

Miles agrees that children are especially vulnerable: "Time doesn't heal all wounds,'' she says. "People in public health need to be discussing this topic more. There can be healthy outcomes from loss. It's up to us to help to find ways to make that happen more often and to push for policy that guarantees it."

ADVICE FOR DEALING WITH GRIEF

Grief is a typical reaction to death, divorce, job loss, a move away from family and friends, or loss of anything that is important to you, according to the U.S. Department of Health and Human Services:

It can last from several months to several years, and can be accompanied by feelings of guilt, sadness or numbness. It might cause trembling, breathing difficulties and sleeplessness. It is also normal to feel joy and to express humor.

People who don't process their grief can become angry, guilt-ridden and fail to care of their health. Here are the four steps along the way to healing from grief:

• Accept the loss.

• Work through and feel the emotional and physical pain.

• Adjust to living in the world without the person or lost item.

• Move on with life.

For more advice, an online guide to grief and bereavement is available from the U.S. Department of Health and Human Services.

Source: USA Today

by Meghan Kelly

Nurses are the unsung heroes of the hospital who navigate crappy software on outdated hardware to keep you healthy — and it needs to stop.

Executives from Cedar’s-Sinai and Kaiser Permanente explained at VentureBeat’s HealthBeat conference that technology innovators need to start focusing on new, consumer-like user experiences and better end-to-end communications software and hardware. Otherwise, nurses are going to start using their own devices, which creates obvious issues in privacy and data management.

“We’ve done a lot of ethnographic research of our nursing areas. … It’s still amazing when you walk into that environment that there’s still a tremendous amount of inefficiency, redundancy.” said Julie Vilardi, a registered nurse, as well as the executive director of Kaiser Permanente’s clinical informatics and strategic projects. “User experience it’s really critically important. Because of the consumer experience now is pretty slick, when you get into the walls of the hospital [consumer-grade experiences are] beginning to be the expectation, and we so don’t deliver it right now.”

She explained how nurses manage everything having to do with your hospital stay from the medication you’re prescribed, to food you eat, and the baths you take. They typically have four or so patients who may not even be in the same area of the hospital. These nurses often have to tote around workstations on wheels, and clunky communications devices that simply aren’t effective, but because of their ability work in a chaotic environment, they’re making due.

Darren Dworking, the chief information officer for Cedar’s Sinai Medical Center, said the center recently deployed 800 iPhones to its staff. He thought clinicians were going to shy away from using texting for communications, but he was wrong.

“A lot of our clinicians are beginning to use technology in other aspects of their life … they want to know how come they can’t have a healthcare version of that,” said Dworking. “Giving them something akin to a cordless phone isn’t going to do it for communications.”

Vilardi says she hopes to see developers create a consumer-grade iPhone experience for patient management and electronic medical records (EMR). She wants to be able to push an icon to get a patient assessment, and believes we’re very close to that reality. Dworking, however, encourages innovators to look beyond the EMR, which he says the window has closed on. Instead, he hopes that people will find a new way of displaying data and improving communications.

According to Vilardi, iOS phones and tablets really are the devices of choice in hospitals today. This is because vendors in general are taking more advantage of iOS than Android. She explained that Kaiser is looking for ways to integrate Android, however.

Nurses, speak up! We want to hear from you about your experiences with workstations on wheels, apps, and more. Comment below!

This article originally appeared on VentureBeat

Source: MedCity

By Christina Orlovsky Page 

If necessity is the mother of invention and Florence Nightingale is the mother of modern nursing, it’s only fitting that during National Nurses Week--culminating in Nightingale’s birthday, May 12--we take the time to recognize nurses’ inventions and the talented professionals who used their creative energy to improve patient care. Ever hear of the crash cart, for instance? It is just one of the many innovations that nurses have helped devise. 

So here is a salute to just a few nurse inventors, from past and present, who realized a need and turned their ideas into reality.

A Nurse-Turned-Physical Therapist’s Feeding Apparatus for Amputees 

For Bessie Blount, nursing was just one step on her long career path, but it was a step that led to several technological advances in assistive devices for amputees. Working with veterans disabled in World War II, Blount, who trained in nursing and then physical therapy, created an electronic device in the early 1950s that allowed amputees to eat on their own. When Blount didn’t receive support for her invention from the American Veteran’s Association, she donated the rights to the French government, and the rights to another invention--a disposable hospital basin--to Belgium. Blount, who became a pioneer among African American women in the mid-century, ended her career path in forensic science, which she practiced until her death in 2009. 

An ER Nurse Leader’s Profession-Changing Invention and Association  

In the 1960s, emergency department nurse Anita Dorr, RN, recognized the length of time it took to gather the supplies the unit needed in a critical situation. Together with her staff, who created a list of necessities, and her husband, who built a wood prototype, Dorr envisioned a wheeled “crisis cart” in 1968 that has since evolved into the crash cart of today. Dorr’s dedication to emergency nursing eventually led to the establishment of the Emergency Room Nurses Organization in 1970--a group that would later become the Emergency Nurses Association, today a 40,000-member-strong organization devoted to strengthening and supporting the professional specialty. 

A Mother-Daughter Duo’s IV Catheter Shield 

In the early 1990s, mother-daughter duo Betty M. Rozier, an entrepreneur, and Lisa M. Vallino, RN, BSN, a pediatric emergency nurse, teamed up to establish I.V. House, Inc., an intravenous therapy organization based in Chesterfield, Mo. With products designed out of a need Vallino had seen in her clinical years for site protectors that eased patient anxiety and reduced reinsertions, the original I.V. House device was patented in 1993; today, millions of I.V. House site protectors have been provided to hospitals worldwide. 

A Sister Act for IV Safety  

Inventive IV lines took a colorful turn for nurse sisters Terri Barton-Salinas, RN, and Gail Barton-Hay, RN, whose half-century-plus of combined nursing experience provided helped them see the need for increased patient safety surrounding IV lines. Acknowledging the hazards of using clear, indistinguishable lines, the pair assisted with the product development of ColorSafe IV Lines, lines available in red, green, orange, blue and purple, with corresponding colored labels for the IV bags.  

A College’s Nursing-Engineering EHR Collaboration 

Perhaps no place is better for innovation than a university campus, which affords bright minds the opportunity to brainstorm, collaborate and experiment with creativity. One such innovative collaboration came out of the University of Tennessee at Knoxville, where the colleges of nursing and engineering partnered to create the DocuCare EHR, which integrates electronic health records into a simulated learning tool for students, changing the way nursing students learn and preparing them for the increasingly EHR-heavy hospital workforce. Developed by Tami Wyatt, PhD, RN, associate professor of nursing, and Xueping Li, PhD, associate professor of industrial and information engineering--co-directors of the university’s Health Information Technology and Simulation Laboratory--the product was purchased by health care publishing giant Lippincott Williams & Wilkins (LWW) in 2010 and is being utilized in nursing school curricula across the country.

© 2013. AMN Healthcare, Inc. All Rights Reserved. 

Source: Nursezone.com

By Karen Long

While all nurses evaluate the four vital signs of temperature, pulse, blood pressure and respiratory rate, Ellen Cunningham, RN, MSN, is among many RNs who assess a fifth: pain.

"Every patient has the right not to suffer in pain," said Cunningham, nurse manager at the Interventional Pain Center at North Shore-LIJ Health System’s Syosset (N.Y.) Hospital.

But assessing the pain of patients in the critical care setting can be difficult, especially if they have cognitive impairments or can’t speak. 

"Inability to provide a reliable report about pain leaves the patient vulnerable to under-recognition and under- or over-treatment," the American Society for Pain Management Nursing stated in a July 2011 position paper about pain assessments in patients unable to self-report. "Nurses are integral to ensuring assessment and treatment of these vulnerable populations."

How to assess a critically ill patient

Determining a nonverbal patient’s pain is "definitely like unpeeling an onion," Cunningham said. Many nurses follow a hierarchy for pain assessment to evaluate the pain of a patient who cannot self-report, said Barbara St. Marie, ANP, PhD, GNP, ACHPN, pain specialist and former member of the American Society for Pain Management Nursing’s board of directors. The ASPMN outlines the steps in its position paper as follows: 

Try to have the patient self-report pain. It often is difficult with critically ill patients, Cunningham said. Obtaining that information "may be hampered by delirium, cognitive and communication limitations, altered level of consciousness, presence of endotrachael tube, sedatives and neuromuscular-blocking agents," according to the position paper. Those patients might not be able to rate pain on a scale of one to 10, but could use a gesture such as grasping the nurse’s hand or blinking their eyes to indicate pain, St. Marie said.

Identify potential causes of pain. That could include surgery, trauma, catheter removals, wound care or constipation, Cunningham said.

Observe patient behavior. Several tools also exist to help nurses assess pain in patients who are unable to speak, said Donna Gorglione, RN, BSN, clinical nurse manager of the ICU and progressive care unit at Hudson Valley Hospital Center in Cortlandt Manor, N.Y. For patients who are aware but not able to voice their pain, nurses can use the Wong-Baker FACES Pain Rating Scale, said Maggie Adler, RN, MSN, WCC, associate director of standards and quality at HVHC. 

The Pain Assessment in Advanced Dementia Scale measures behaviors such as restlessness, agitation, moaning and grimacing that can indicate pain. Nurses observe the patient and score a zero, one or two in five areas — breathing independent of vocalization, negative vocalization, facial expression, body language and consolability — then add up the score. Zero equates to no pain while 10 means severe pain. Nurses then treat the patients based on the pain score, Adler said. For example, a two might indicate the patient’s pain could be eased with Tylenol, while a seven would dictate a more serious intervention, such as narcotics.

The critical care pain observation tool and Face, Legs, Activity, Cry, Consolability tool also are useful, St. Marie said. Changes in blood pressure, heart rate or respiration could be indicators of pain. "I always say that if someone has a physiologic indicator, that’s the point where you start investigating more," she said.

Obtain a proxy report. Parents of young children or caregivers and family members of the elderly can provide vital information about what is causing patients’ pain, Cunningham said. "Credible information can be obtained from family members who know the patient well and may be a very consistent caregiver throughout their illnesses," St. Marie said.

Try an analgesic trial. If the other methods to determine pain yield inconclusive results, a trial could help, St. Marie said. Nurses administer low doses of any number of opioids and look for the patient to settle down, change facial expression or otherwise indicate a decrease in pain. According to Cunningham, any of those would indicate the patient had pain and not distress.

Pain management treatments

After assessing the patients’ pain, level of consciousness and respiratory status, nurses look at other indicators such as comorbidities, kidney and liver function, estimated blood loss from surgery and amount of opioids received in the OR and PACU. Nurses can use a variety of treatments to block pain through multiple receptors and pathways, St. Marie said.

Medications — such as nonsteroidal anti-inflammatory drugs, opioids, acetaminophen, local anesthetic agents and antiepileptics — through various pathways are common ways to treat pain. "Pain mechanisms involve our entire body, so it’s not just one pathway" that pain is transmitted through, St. Marie said. Nurses can now help block pain at many of those pathways.

Not all pain can be eliminated, Gorglione said. In some cases, a patient’s goal is to reduce pain to a tolerable level. "That’s an important piece of pain management," she said. "Sometimes we can’t get your pain to zero. If you can tolerate a level of three or four, we can get your pain there, and you can perform your activities of daily living."

Besides medications, patients can benefit from holistic therapies including music, massage or even hand-holding or warm blankets, Gorglione said.

"The tendency with medicine is to run right to the medicine cabinet," Adler said, noting other therapies can be effective. For some patients at HVHC, music has made a difference. "We’ve had patients and patients’ families thank us for the special attention and how relieved they were and how much it helped," Gorglione said. An integral part of pain management is reassessment after treatment. Nurses should use the same tool they used for assessments to determine whether the patient has a lower level of pain, St. Marie said.

Challenges in treating pain

Along with determining the right treatment, nurses face a variety of challenges in pain management. For example, some patients think pain is a normal part of their illnesses and refuse pain medication, Adler said. Elderly patients often have anxiety about becoming dependent on medications, Gorglione said. In those cases, educating the patient about pain management can help.

In other situations, the challenges come from providers. Patients who arrive in the ICU and have addiction issues often are stigmatized or marginalized because providers blame the victim, St. Marie said. But a patient going through withdrawal needs "serious pain control," she said.

Nurses have to overcome the challenges to be able to assess, treat and reassess patients’ pain, Cunningham said.

"No matter how old someone is, no matter how cognitively impaired they might be, it never takes away that they might be in pain," she said.

Source: Nurse.com

 By Morgan Whitaker

As a massive tornado swept through the Oklahoma City area Monday afternoon, Moore Medical Center stood directly in the path of destruction.

The building was pulverized by the 200 mph winds, sending patients and staffers scrambling to safety zones located in the center of the hospital. Miraculously, all the staff, patients and families survived the storm.

That includes nurse Cheryl Stoepker, who used her own body to protect a newborn she’d delivered barely an hour earlier. When she heard news of the approaching twister, she wheeled the newborn and his mother down to the cafeteria, a windowless room on the first floor of the hospital.

“It was dark, that was the first thing that told us something was happening,” she toldPoliticsNation on Tuesday. “We could hear the hail hitting the building even though we were on the first floor and it’s a two-story [building],” she explained.

“So we at that point got down on the floor, patient and myself, took her baby, put him in laps, and we hugged, and we started praying,” she said. “The baby was a little over an hour old, didn’t even have a diaper yet at that point, but mom and I held the baby and prayed and made it through.”

When the storm passed, Stoepker and her patient were forced to climb out in the darkness, navigating around debris as she tried to push the new mother and her child out in a wheelchair. They made their way out alongside one of her colleagues, herself 33-weeks pregnant, and pushing yet another infant and mother who’d just given birth. Eventually the wreckage was impossible to wheel through, and her patient, with only a few minutes of recovery from labor, walked–barefoot–out of the building.

Only 24 hours later, she’s still coming to terms with her experience. “It’s hard to describe and I’m still trying to deal with it and figure out what happened,” she said. As Rev. Sharpton said, this hero who saves lives and cares for people everyday in ordinary circumstances was able to keep a precious patient alive in extraordinary circumstances too.

Source: MSNBC