DiversityNursing Blog

When Intensive Care Unit (ICU) nurses Kerrie Klepfer, BSN, RN, CNIII, and Jennifer LeBlanc, BSN, RN, CCRN, CNIV, were discussing ways to improve patient care, they had no idea that their efforts would save their hospital 2.9 million dollars and inspire similar initiatives across the globe. They just wanted to see their patients experience a safer, quicker recovery.

Klepfer and LeBlanc are two of four ICU nurses from Duke Raleigh Hospital in Raleigh, N.C., who participated in the American Association of Critical-Care Nurses (AACN) Clinical Scene Investigator (CSI) Academy. Their team developed “Walk This Way: Early Progressive Mobility in the ICU,” a 2013 patient care intervention that encourages mobility in ICU patients.

Nationwide, more than 229 nurses at 68 hospitals have completed or are now participating in the CSI Academy. AACN created the 16-month nursing leadership and innovation training program to empower hospital-based staff nurses as clinical leaders and change agents whose initiatives measurably improve patient outcomes and hospital bottom lines. Participating nurses identify a patient care problem and solution, then work to implement the project to fit the culture of their unit.

“Nurses know what the problems are and they often have ideas for solutions,” said Devin Bowers, RN, MSN, CSI program manager. “Giving them the time to think through their ideas and encouraging their creativity are key aspects of the CSI curriculum.”

At Duke Raleigh Hospital, Klepfer and LeBlanc’s team decided to focus on early progressive mobility.

“In our team’s experience as ICU nurses, the primary practice and standard of care was to keep patients sedated and on bed rest while in the ICU, especially when the patient was intubated,” said Klepfer. “Unfortunately, this extended period of immobility was leading to more extensive rehabilitation and longer hospitalization lengths of stay for patients – and, ultimately, higher costs for hospitals.”

The group produced evidence that increasing mobilization earlier – starting in the ICU – could reduce a wealth of complications, such as muscle atrophy, longer inpatient and outpatient rehab, ventilator associated pneumonia, pressure ulcers, falls, lengthy hospital stays, and cost for patients and hospitals.

The “Walk This Way” project had a tremendous impact within the ICU unit and hospital system. Early progressive mobility is now the standard of care in the Duke Raleigh ICU and is ordered routinely by the team for patients. To date, LeBlanc noted that the program has saved the hospital $2,935,488. Klepfer also noted that at Duke Raleigh Hospital, the protocol was met with excitement from patients and families and even contributed to a significant increase in the ICU’s Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Scores, a national survey that publicly reports patients' perspectives of care. Additionally, “Walk This Way” received national attention. The team and ICU unit were profiled in the media, including by Forbes magazine, and highlighted at the 2014 AACN National Teaching Institute & Critical Care Exposition (NTI) conference.

According to Bowers, the impact of the AACN CSI Academy extends far beyond the nurses who have participated in the program. Projects have spread within hospitals, cities and across states. Klepfer and LeBlanc’s program even had an impact internationally, when Jai Prakash Narayan Apex Trauma Center, a New Delhi, India hospital, patterned its early mobility project on the “Walk This Way” program.

“Creating sustainable change isn’t just about coming up with the idea. In order for the idea to ‘stick,’ it must become part of the cultural norm in a given unit or hospital,” said Bowers. “Frontline nurses are experts when it comes to knowing what will work and what won’t work within the culture of their unit or their organization. This is one of the key reasons that we believe the CSI Academy has been so successful.”

Nurses and other clinical leaders are encouraged to browse the CSI “Innovation Database,” a catalog of past projects completed through the CSI program. With more than 25,000 unique downloads of project materials, including toolkits, presentations and research, the database is a resource for nurses seeking practice-based solutions to improve patient outcomes and reduce costs.

Bowers believes that the long-term impacts of the AACN CSI Academy are positive outcomes for patients, a network of empowered nurses who are active change agents, and organizations that understand the value of frontline nurse-led initiatives by giving them the dedicated time and resources needed to focus on the work.

“The AACN CSI Academy inspires and empowers nurses by demonstrating the connection between their nurse-driven patient care improvements and corresponding financial impact of the professional practice of nursing,” said Bowers. “In the end, this initiative supports nurses in developing a business case for pursuing better quality outcomes for patients.”

For Klepfer and LeBlanc, participation in the program had additional benefits.

“After completing the project, we noticed a significantly stronger bond within our ICU team and were better able to recognize each other’s unique qualities, capabilities and limitations,” said Klepfer. “This bond has become even stronger over time. Even though the specific project has ended and we are now implementing it, our sense of teamwork and motivation remains.” 

“For me,” explained LeBlanc, “involvement in the CSI program meant being a part of leading positive change – and feeling empowered to solve problems in our unit to change standards of care for the better.”

To learn more about the CSI program, visit www.aacn.org.

February 29th is Rare Disease Day- a day celebrated internationally to bring awareness to the 7,000 different types of rare diseases in the world. Globally, 300 million people are affected by a rare disease. Those fighting rare disease face unique struggles.  While there are millions affected by rare diseases- about 50% of rare diseases don't have a disease-specific foundation supporting funds or advocating for the disease. Also, many times common symptoms hide underlying rare diseases, leading to misdiagnosis and uninformed treatment at a later stage. In honor of rare disease day, take a moment to learn more about different rare cancers and diseases such as mesothelioma, a rare cancer caused by exposure to asbestos. 

Nursing is one of the most stressful occupations in America. Nurses have higher rates of illness and psychiatric problems than other professionals. There are things Nurses and other health professionals can do to minimize the stresses of Nursing. The best way to do this is to look at individual stressors and find ways to minimize or cope with them. 

Long Hours and Shift Work 

Long hours are stressful both physically and mentally. According to USA Today, the long hours Nurses work have become such a problem that the American Nurses Association has made recommendations about how many hours Nurses should work. The recommendations include not allowing Nurses to work more than 12 hours a day. Shift work also causes a lot of stress for Nurses, and the AMA has also made the recommendation to minimize night shifts for Nurses working both day and night shifts. 

Insufficient Resources 

Having insufficient resources makes a nurses' job more stressful, and it makes it harder for them to do their job properly. Insufficient resources take on different forms in different settings. Many times it is a shortage of Nursing personnel, which of course means the Nurses that are working have a higher workload. Other times, it is a lack of the material resources that Nurses need to do their job, whether it is due to budget cuts or oversight. Even small items like tape cause a big inconvenience when a Nurse has to search for it before she can draw blood or place an IV.  

Resources can be improved by improving pay for Nurses and making sure there is enough room in the hospital budget for other necessities. Proper inventory keeping is also important. If a Nurse notices a shortage in a particular area, it is important to mention it. Hopefully items are ordered immediately and put in the appropriate paces.

Poor Reward System 

Nurses are essential to the proper functioning of hospitals, and they work very hard. Yet many facilities don't have any kind of reward system in place, nor do they take the time to tell Nurses they are valued and appreciated. Many times Nurses are taken for granted.  

Studies have proven that rewarding employees for good behavior is essential to them being satisfied with their jobs and to retaining employees. Hospitals should have a rewards system in place. Nurses should also recognize each other for their hard work. 

Bullying and Abuse 

No one should have to endure bullying and abuse in the workplace. The ANA found that 17% of Nurses report being the victim of physical abuse at work, and 57% of Nurses reported being verbally abused or threatened. Physical abuse was usually perpetrated by patients or family members. Verbal abuse and bullying was usually at the hands of coworkers. 

Hospitals should hold educational seminars about what constitutes verbal abuse and bullying. Human Resources employees should be available to mediate and help employees solve conflicts. To protect against violence from patients and their family members, it is a good idea to have some type of security presence in the hospital. 

Lack of Communication  

Lack of communication also causes stress for Nurses. Communication between Nurses and doctors is essential to a hospital running smoothly. Daily or weekly meetings are one way to ensure proper communication. A suggestion box can give employees an anonymous way to communicate suggestions. 

Compassion Fatigue and Burnout 

Compassion fatigue happens when a Nurse stops caring about their job and patients. Sustained stress over a long period of time can lead to compassion fatigue. Burnout occurs when a Nurse becomes depressed, withdraws from others, and feels fatigued. 

To prevent compassion fatigue and burnout, try to take time off to relax. Don’t over extend yourself. Hospitals that have a reward system in place and make Nurses feel appreciated helps combat burnout. Everyone wants to feel appreciated in both our personal and professional lives.

Related articles: Dealing With Depressed Patients

6 Tips on Stress and Anxiety Management in Nursing

Nurses’ Survey Results Show ‘Dangerous’ Stress Levels

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In an environment where moments can mean life or death, it is undeniable that communication greatly matters. If the same message can be conveyed without losing meaning in a shorter or more efficient way, then it's a duty of the messenger, especially in a professional medical setting to optimize their communication skills. Speaking is literally only half of the equation, with great listening skills and information retention skills being able to effectively make repeated statements unnecessary. There are some ways to think critically about a healthcare organization to determine where it stands as a team regarding their communication abilities. Taking this closer look at the state of communication at a given facility is the crucial first step towards improving the communication therein. Increased efficiency in communication will result in saved time and increased focus that can be dedicated to the needs of patients, where it ultimately should.

Determining the state of the team's communication skills:

• Turn culture clash into culture strength: If there was no top-down strategy around cultural diversity as a marker of strength, then little petty fights about minor topics could escalate into all-out cultural clashes among a workforce. By the promotion an ideal of strength through unity, the team as a whole has the chance to get in front of any potential culture clash issue rather than chasing the problem, always trying to put out fires.
• Hold group meetings to discuss the overall state of communication at the facility: Management can play a massive role in putting the correct, positive spin on the topic of diversity in the workplace. The larger part of any staff will often be found to be on the same page about the acceptance, curiosity and positive interest in new cultures being integrated into the workplace at all times. By it being an official part of a corporate brand message and identity, the company embraces the diversity perspective even further.

Starting to help create a positive communication culture:

• Create regular workshops to go over basic principles in communications: Different individuals from diverse backgrounds will have unique perspective to share on the same topics, even if they technically speak the same language. Then, of course, there are the actual boundaries that exist between nations and languages that are completely distinct. If the staff of a healthcare facility can say "Hello" in ten distinct languages, that group brings themselves one step closer to the perfect awareness and diversity in their facility. 
• Hold regular cultural show and tell days within the staff: Each staff member, once they share their true selves, are going to have their own special cultural tale to share. If there is an encouraging environment in this way, it becomes natural and easy to leverage this diversity to enrich the staff with increased knowledge and awareness. Patients come from all over the world and there's never any way to predict who will become a patient next. With these principles in mind, a staff trained in cultural sensitivity and awareness will be better prepared to interact with new international cultures.
• Leverage modern and inexpensive tools: Any healthcare facility staff member is going to be all too familiar with the app store on their smartphone, but sadly quite few have downloaded any translation or language-learning app onto their phone. When these powerful and groundbreaking tools are now available and often for no outright cost, it's usually just a matter of pointing this out and creating a culture of support towards adopting these excellent tools to enable a team to begin using them.

Once the realization hits that communication is mostly a function of awareness, effort, empathy and genuine bonding experiences with groups, it becomes much easier to cultivate this environment of abundant and fruitful communication. If the entire healthcare facility can start to treat the state of communication at their facility as a togetherness exercise and a mission dedicated to a better experience for the patients, then the real results can start to be noticed.

Individual differences can make a group stronger and more powerful or they can also tear groups apart. The key to ensuring a positive outcome is to apply conscious effort around fostering excellent communication in any arena or avenue possible.

Related links:

4 nurse communication startups to improve patient outcomes

Three Tips for Better Nurse–Physician Communication In The Digital Age

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By Dr. Melissa DeCapua, DNP, PMHNP via www.bartonassociates.com

This article about “what’s in a name” caught our attention. We’re sharing it with you to find out if you’ve run in to this situation where you work. If you’re an NP or a PA, we know you’ve worked very hard to accomplish your degree requirements. Where you work, is your position sometimes referred to as “mid-level”? If so, read on and then tell us of your experience. Have you pointed out to Human Resources that this is a confusing term?

I had just graduated from nurse practitioner (NP) school and was on the job hunt. Skimming through a few job descriptions the word “mid-level provider” caught my attention. Having never heard that word, I assumed the job wasn’t meant for an NP. The next time it happened, a recruiter called my cell phone telling me there was an open position for a “physician extender” in rural Colorado. A what? It’s interesting how you can be an extension of someone who isn’t even present.

Then, a naive new-graduate, I didn’t quite grasp the scope of the problem. Although I did know one thing, neither of those titles captured who I was or what I did. As I’ve progressed through my career, I’ve heard myself called a “mid-level provider,” “physician extender”, and “non-physician” over and over again. Now-a-days my jaw tightens, and I gauge whether this is an appropriate situation to explain why these terms are offensive.

The time is now. This post will explore the words “mid-level provider,” “physician extender,” and “non-physician”, describing their historical uses and detailing three key reasons why this vocabulary should be eliminated.

Historical Use

These terms were originally created by physicians, and they are perpetuated by physician-led organizations and physician-centric corporations (Hoyt, 2012). The U.S. Department of Justice’s Drug Enforcement Administration uses “ mid-level practitioner” to describe professionals other than physicians, dentists, veterinarians, or podiatrists who dispense controlled substances. The Centers for Medicare and Medicaid have also referred to NPs and PAs as “physician extenders” but has more recently used the term “ non-physician practitioners.”

Why these terms should be eliminated

• Devalues Expertise

Describing NPs or PAs as “mid-level” doesn’t just imply, it asserts that they are providing something less than “high-level” care. However, ample evidence demonstrates that the services offered by these professionals is just as safe and effective as those provided by their physician colleagues.

Both NPs and PAs earn advanced degrees and undergo exhaustive course work, high-tech patient case simulations, and extensive clinical practice hours. Moreover, both clinicians pass national board certification exams and may specialize in any variety of medical specialities. The terms “mid-level provider,” “physician extender,” and “non-physician” undermine the expertise and contributions of NPs and PAs.

• Confuses Patients

Imagine you are a patient and being told, “The mid-level will see you now.” Naturally, you might wonder, “Who?” Using vague, collective vocabulary to describe NPs and PAs can confuse patients. When receiving healthcare services all patients expect and deserve the highest level care no matter who they are seeing. NPs and PAs are held to the same standard of care as physicians, offering the similar services of assessing, diagnosing, and treating medical conditions. By using more accurate terminology (i. e. NP and PA), patients can be assured they are receiving the best care at all times.

• Impedes Teamwork

In their seminal publication, Crossing the Quality Chasm, the Institute of Medicine called for interdisciplinary collaboration to solve the significant problems facing modern healthcare. Using a term like “mid-level” perpetuates a hierarchical healthcare system which impedes this need for teamwork. Most NPs and PAs dislike the terms “mid-level,” “physician-extender,” and non-physician. When they hear themselves described this way, it decreases morale and divides the team.

Take a Stand

To stop the use of these terms, everyone must take a stand. First, recruiters should remove this language from job descriptions, contracts, and business discussions. Employers and administrators specifically need to demonstrate their respect for NPs and PAs expertise by removing this language from the company website. Other healthcare professionals should stand up for their colleagues if someone uses this degrading language. Finally, both NPs and PAs should never allow someone to call them something that undermines their unique contribution to healthcare.

NPs and PAs Weigh In

I recently started a discussion thread about this topic on the American Association of Nurse Practitioners LinkedIn page. The overwhelming majority agreed that these terms should not be used to describe NPs or PAs. Some of the comments that stood out the most to me:

• I will not apply for jobs using mid level provider, or extenders. It’s insulting to my profession and education. – Nurse Practitioner in Florida
 
• It would be nice if nurse practitioners received the respect and recognition they’ve earned through good patient care. -Nurse Practitioner in New Hampshire
 
• I have been truly blessed to work with MDs that actually appreciate, value, and acknowledge what we do and who we are. -Nurse Practitioner in India
 
• How do you extend a physician? It is suggesting that somehow we are not capable of working independent and we must be attached to a physician. I am a Nurse Practitioner of the highest level, and I am an extension of no one. -Nurse Practitioner in Florida 
 
• I am fairly certain they are not referring to us as mid-level providers to degrade us, but rather they’re unaware of how offensive it can be. -Nurse Practitioner in California 
 
• The term “mid-level ” is often used in a denigratory manner, lessening our worth and contribution to health care. This term should be retired and the contribution to healthcare overall made by all professionals should be recognized and validated. Nurse Practitioner in Texas

Barton Associates also conducted a poll on its Facebook page, asking NPs and PAs which term were most offensive. Approximately 1,380 NPs and PAs weighed in on the discussion. Here are the results:

• Mid-level (487 votes)
 
• Noctor (356 votes)
 
• Physician Extender (335 votes)

The poll also asked which term was the preferred term (other than NP or PA). Here are those results:

• Provider (919 votes)
 
• Healthcare Professional (122 votes)
 
• Clinician (115 votes)

Let’s be straight; if there is ever a group of people who are called a name that makes them feel disrespected or devalued, the solution is always to stop. If you’re in doubt as to what you should call an NPor a PA just use “NP” and “PA.” Now let’s get back to patient care.

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Written by Edgar Sandoval and Denis Slattery

After an hour that felt like an eternity, Diabate rubbed the ice our of her eyes and face spotted the gates to the nursing home with a sigh of relief.

“When I went out there, the wind it just, hit me in the face,” Diabate recalled on Sunday as she made her way through a second shift. “The winds were strong. The snow was high.”

Diabate said she wore snow boots and a bubble coat with a hoodie as she plowed through threatening strong winds and waist-deep snow.

“She was the only nurse than came in,” Hebrew Home supervisor Mojdeh Rutigliano said.

A few of the medical staffers had spent the night at the facility she added.

But more than 50 nurses that went home Friday were unable to make it back to work.

“The majority of our nurses called in sick. They just couldn't come,” Rutigliano said. “Talk about crisis mode. But it was such a relief to see her come in.”

Diabate said calling in sick did cross her mind, but then her desire to do good got the better of her.

“I really have to love what I do make such a commitment,” she said. “This is what it means to be a nurse.”

The monster storm that shuttered the city was no match for one Washington Heights nurse.

Chantelle Diabate bundled up and braved the worst of the winter weather Saturday to make it to her overnight patients at a nursing home in the Bronx.

The 32-year-old single mother was hailed as a hero for walking more than a mile during the debilitating snow storm that dumped 26.8 inches of snow to reach the Hebrew Home in Riverdale.

“I walked for about an hour and all I kept thinking was, I really love my patients,” Diabate said.

The snow angel has been working at the facility, which houses more than 840 elderly patients, for a little more than six months.

“We see them a lot. We’re like family,” Diabate said. “I’m tired but I decided to work a double shifts. They need me.”

Diabete said she found someone to care for her 3-year-old girl and then found a place to stay in the Bronx to be close to work. But she couldn't believe her eyes when she saw on the news that public transportation had been canceled and the storm was picking up speed.

“A friend walked with me and fell. At first I started out kind of like speed walking on ice. But then I realized this is like a workout and it's dangerous,” she said. “Then I thought, you know what? A slow and steady pace is going to get me there, eventually.”

After an hour that felt like an eternity, Diabate rubbed the ice our of her eyes and face spotted the gates to the nursing home with a sigh of relief.

“When I went out there, the wind it just, hit me in the face,” Diabate recalled on Sunday as she made her way through a second shift. “The winds were strong. The snow was high.”

Diabate said she wore snow boots and a bubble coat with a hoodie as she plowed through threatening strong winds and waist-deep snow.

“She was the only nurse than came in,” Hebrew Home supervisor Mojdeh Rutigliano said.

A few of the medical staffers had spent the night at the facility she added.

But more than 50 nurses that went home Friday were unable to make it back to work.

“The majority of our nurses called in sick. They just couldn't come,” Rutigliano said. “Talk about crisis mode. But it was such a relief to see her come in.”

Diabate said calling in sick did cross her mind, but then her desire to do good got the better of her.

“I really have to love what I do make such a commitment,” she said. “This is what it means to be a nurse.”

Related Link: 

Boston Hospital Medical Staff Brave Blizzard On Skis

Depression is a common situation dealt with on a daily basis. Most patients that Nurses find themselves coming in contact with have some form of illness or injury. This makes depression among patients common. Knowing how to spot it and how to react to depressed patients can help you handle the situation properly and deal with it with minimal stress.

What is Depression

Depression is a common disorder that affects many people every day. It affects all age groups, males and females, although females are more likely to suffer from it than males. Stress contributes to depression, making this illness more common in the last few years. The amount of stress an individual handles on a daily basis is on the rise and can contribute to depression.

What Contributes to Depression

There are a number of factors that contribute to depression. Stress is a huge factor. Debt, work and family can weigh heavily on the amount of stress someone experiences today. Age also plays a major role in depression and sickness in the elderly can increase the chances of them suffering from depression. This is a main factor as to why Nurses experience depressed elderly patients the most. Some elderly patients are forced to relocate to a new residence, while others become ill and are unable to live the life they are accustomed to. Some can feel abandoned by their loved ones and find themselves feeling alone. Leaving people without a strong social support network increases the chances of developing depression.

Signs of Depression

There are many warning signs of depression, although some may not be so easy to spot. A feeling of hopelessness or helplessness can lead to depression. Nurses often see this in elderly patients who don't have a lot of family support. A loss of interest in daily activities is another sign of depression. These signs can become apparent when patients are no longer able to get around on their own. Loss of mobility can make a patient no longer want to engage in activities for fear of embarrassment.

Changes in sleep patterns or appetite are another sign of depression. Nurses have to watch this sign as well, because certain medications can interfere with sleep and appetites of patients. Frequent physical complaints or ailments, anger or rage toward others and feelings of anxiety are other signs of depression. Many of these symptoms Nurses experience in their patients frequently. The key is determining when they start happening and ruling out any other possible causes. When there are no other possible causes, depression could be the reason.

How Can Nurses Help or Prevent Depression

Nurses play a vital role in their patient's lives, no matter the age of the patient. There are certain things that Nurses can do to help prevent depression altogether. Encouraging outdoor activities, even when your patient doesn't feel like doing them, is an excellent way to combat depression. A healthy diet and a regular eating schedule helps to recognize any changes in eating patterns. New hobbies help patients realize fun activities they can engage in to be entertained, even though they may not be able to do everything they could once do.

How Nurses Play an Important Role in Depressed Patients

Nurses are the people that patients see the most throughout the day, so it only makes sense that they play an important role dealing with depressed patients. Many things Nurses do can help a depressed patient not feel so worthless, and sometimes even lift their spirits. Talking to patients about their feelings is a good first step in dealing with their depression. Being sympathetic helps them know that you understand their feelings rather than judge them for how they feel.

Be careful about any advice you offer and always refer them to their doctor for specific medical advice. Accept their feelings toward the rest of the world. Trying to reason with them may make it seem like you are just another person who is against them or doesn't care about them. Reassure them of depression treatments and how effective they are. Let them know that treatment has high success rates, and they can work with their doctor to find the best treatment options.

It is common for Nurses to deal with depressed patients on a regular basis. Despite this, it is still important to remember to treat them as if they are all individual cases, and never group them together. A little reassurance could make all the difference in a depressed patient's outlook. The caring compassionate attitude that Nurses are known for could be exactly what a depressed patient needs.

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Written by Laurie Mason Schroeder 

SALISBURY TOWNSHIP — With his wide blue eyes, unruly hair and bashful grin, 26-year-old Justin Smith looks perpetually, happily surprised.

Doctors at Lehigh Valley Health Network describe the Penn State student from McAdoo, Schuylkill County, as a "medical miracle," perhaps the only person in history to survive hypothermia so extreme that he was literally frozen solid after falling unconscious in a snow bank while walking home in subzero temperatures.

"It's still sinking in, I guess, so it's hard to think of it as a miracle," Smith said. "I'm lucky. That's all I can say."

Smith and his family traveled to Salisbury Township Monday to thank the doctors and nurses at LVHN who saved his life. His father, Don Smith, wept as he described finding his son in the snow on the morning of Feb. 21.

"I remember holding him. He was so cold, frozen. He was like a block of concrete," he said.

Justin Smith's ordeal began around 9:30 p.m. Feb. 20, as he was walking home from the Tresckow Fire Company, a social hall where he and his friends often spent Friday nights having a few drinks.

It was a 2-mile trek that Smith had made countless times, he said, to avoid drinking and driving. Smith does not recall slipping and hitting his head, but doctors believe that's what happened as he walked along Tresckow Road.

He landed face up in a snow bank, eyes open, staring at the sky.

That's how Don Smith, a Hazleton Area High School teacher, found his son the next morning around 7:30 a.m., alerted by one of Justin's friends who had called to say that she had not heard from him and was worried. The temperature overnight had fallen to 4 below zero.

Don Smith gathered his son in his arms and sobbed as he rocked back and forth in the snow. Justin wasn't breathing and had no pulse. His eyes were still open and his arms and his feet had turned black from the cold.

"I just kept praying to the Lord, 'Bring him back, just bring him back'," Don Smith said.

Paramedics believed Justin Smith was dead and called the coroner. A sheet was pulled over his head.

Dr. Gerald Coleman, an emergency room doctor at LVHN's Hazleton campus, urged paramedics to transport Smith by helicopter to LVH-Cedar Crest, where he was revived with a procedure called extracorporeal membrane oxygenation in which blood is removed, oxygenated and warmed, then returned to the body.

Dr. James Wu, a cardiothoracic surgeon, performed the delicate procedure, which is typically used to save patients whose lungs and heart are damaged by the flu or a heart attack.

Smith spent the next 15 days in a coma. When he woke up, doctors were amazed to find that he had suffered no apparent brain damage.

"This case has taught me that sometimes you have to go with your gut, even when all logic demands otherwise," Coleman said.

Both of Smith's pinkie fingers and all of his toes had to be amputated because of frostbite. But the damage could have been far worse, said Dr. John Castaldo, a neurologist at LVH.

While extreme cold can preserve organs by putting the human body in a state of suspended animation, Castaldo said, once ice crystals form in the blood stream, death soon follows.

"Justin was right on the brink," Castaldo said.

Smith spent nearly three months at LVH-Cedar Crest and at Good Shepherd Rehabilitation Hospital in Allentown before returning home May 1.

Smith, who had studied at Penn State's main campus, is now finishing his psychology degree via online classes. On weekends, he works to improve his golf game, a challenge because of his lost fingers and toes.

Smith's mother, Sissy, and sisters Ashley and Sarah have been by his side throughout his recovery. His friends are glad to have him back, he said, and he's earned the nickname "Iceman" from his buddies.

As he took turns Monday hugging the LVHN doctors and nurses who had saved his life, Smith said the enormity of what happened to him hasn't sunk in yet.

"I'm just grateful. I'm proof of what can happen when great people work together," he said.

Social media can and is a wonderful and easy way to connect with people on a personal or professional basis. Most platforms are free and easy to use. It's not difficult to find people and topics of interest. People can find and connect with their peers, family, and friends. They have unlimited access to the entire world.

Before anyone begins (or continues) their adventures into the world of social media, there are a few points to be aware of as a healthcare professional. With freedom comes advantages and disadvantages.

Advantages:

• Connecting with anyone in the world. Simply Googling a word, topic, business, or an individual will give anyone complete access to anything they want to know. Whether they are blogging, using Twitter, Facebook, LinkedIn, or any other social media platform, there are people there to talk to.
• Networking has never been easier. Sharing information and learning is at anyone's fingertips. Whether they are talking to someone local or across the world, social media brings you together. Distance is no longer a problem.
• Since 80% of all internet users are looking for health information, anyone can and will reach a large audience with their outreach and posts. People want information and Nurses have plenty to give them. They are able to correspond at their convenience and have the time to do so.
• Education for Nurses and others is available. There are numerous groups and programs that offer classes and give them opportunities to learn and interact with their peers and other students.

Communication flows easily and in abundance on the internet and that's also where the disadvantages come into play.

Disadvantages:

• Privacy doesn't truly exist on the internet. Regardless of any and all security features, once something has been posted, it's there forever. Even deleting it doesn't get rid of it. It is still stored somewhere in the clouds and is never truly gone. It's crucial that a person think twice before posting. Screen shots cause the comment or post to remain forever on someone's computer.
• The risk of inaccurate information becoming a "fact" is common. It takes a bit of work and due diligence to research the accuracy of what you’re reading, but it's worth the time. A person should only share or repeat what they themselves have thoroughly researched and confirmed as accurate.
• Not HIPAA compliant. Very few software programs meet the strict guidelines for HIPAA regulations, including but not limited to Skype and Google Hangouts, texting and email. Unless the individual is discussing a patient as a Nurse and on a secure platform, one should never post anything about their patients.

Violating HIPAA regulations has resulted in healthcare professionals facing disciplinary actions such as:

•  Fines levied
•  Suspension from work
•  Being expelled from Nursing school
•  License revoked/fired
•  Criminal charges being brought
•  Incarceration

Abuses on social media as a Nurse are far reaching. Whether a Nurse violates HIPAA or behaves in an improper and unprofessional manner (arguing online, breaching patient confidentiality, harassment, etc.) can and does impact not only them, but their employer and their professional affiliations as well. This can also involve the state board and violate state laws.

Posting the pictures of patients, even when their identity is concealed, has resulted in the above actions being taken against a Nurse and other healthcare professionals.

The best rule of thumb with social media is this: Remember that what you are about to post will be accessible to 7 billion people, so post as if everyone will read it. Social media can be fun as long as you understand the good and the bad.

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The new year is here and the opportunities for a fresh start it brings shouldn't be cast aside. Nurturing the opportunity as if it were a patient can yield surprising benefits both in and out of the job title. There is always room for improvement in a position that demands the hardest work for the sweetest reward, the gratitude of well-cared for patients.

Mind and Body

It is never too late to get personal health on the right track. Though the push for a healthier lifestyle should come from within, the simple fact is much like fitness instructors or your fellow doctors, patients ultimately expect those in health care roles to be healthy themselves. So whether it involves starting (and sticking to) that new gym membership or curbing poor eating habits, do your best to stand firm.

As a Nurse, the mind is just as important to nurture as the human body. With the continuous implementation of newer technology into the healthcare field, it can never hurt to be one step ahead by taking classes, particularly given the fact they look great on a resume. Focus on adding in new certifications such as those for operative nursing or ACLS, or expanding current skills. Regardless of qualms, continuing your education or taking the plunge on the journey to a BSN, MSN, NP or PhD is a worthy cause for the new year.

Tools of the Trade

Clearly technology is only as effective as the individual operating it, but that doesn't mean Nursing staff don't benefit from productive upgrades in the work space. Many programs and devices can increase efficiency enough to make good Nursing care, great Nursing care. Even if the requests for technology and program upgrades were rebuffed, all is not lost. Focus on using what is available even if it is only yourself. Vow to be more patient focused and less task and goal focused, which is the line that separates the average from the amazing in the eyes of the patient. Spend the new year becoming a better you, as this will ultimately equal a happier and better Nurse.

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