DiversityNursing Blog

That’s right—there are men in nursing, too! It’s time to rid ourselves of outdated stereotypes. We don’t live in a society where boys only like blue and girls only like pink. Where boys can only play with legos and girls can only play with dolls. There’s too much variety in this world to limit ourselves to what we think is expected of us. There are women in engineering and mathematics, and there are men in nursing and healthcare.

Population Growing for Men in Nursing

Nursing is a fantastic career. In fact, the number of men in nursing is growing, with the percentage of male nurses increasing almost every year. In addition, there are more men in nursing schools, making up 13% of nursing school students. Find out more facts about male nurses by reading the men in nursing infographic below.

Source: www.collegeamerica.edu

By  Carly Dell

In the Future of Nursing report published by the Institute of Medicine, it is recommended that health care facilities throughout the United States increase the proportion of nurses with a BSN to 80 percent and double the number of nurses with a DNP by the year 2020. Research shows that nurses who are prepared at baccalaureate and graduate degree levels are linked to lower readmission rates, shorter lengths of patient stay, and lower mortality rates in health care facilities.

What does the job market look like for RNs who are looking to advance their careers?

We tackle this question in our latest infographic, “Career Paths for RNs,” where we look in-depth at the three higher education paths RNs can choose from to advance their careers — Bachelor of Science in Nursing, Master of Science in Nursing, and Doctor of Nursing Practice.

For each career path, we outline the various in-demand specialties, salaries, and job outlook.

Source: onlinenursing.simmons.edu

In the wake of media focus on the trials and bravery of nurses in the context of the Ebola crisis, leaders in the fields of nursing and clinical ethics have released an unprecedented report on the ethical issues facing the profession, as the American Nursing Association prepares to release a revised Code of Ethics in 2015.

The report captures the discussion at the first National Nursing Ethics Summit, held at Johns Hopkins University in August. Fifty leaders in nursing and ethics gathered to discuss a broad range of timely issues and develop guidance. The report, A Blueprint for 21st Century Nursing Ethics: Report of the National Nursing Summit, is available in full online at www.bioethicsinstitute.org/nursing-ethics-summit-report. It covers issues including weighing personal risk with professional responsibilities and moral courage to expose deficiencies in care, among other topics.

An executive summary of the report is available at: http://www.bioethicsinstitute.org/wp-content/uploads/2014/09/Executive_summary.pdf

"This blueprint was in development before the Ebola epidemic really hit the media and certainly before the first U.S. infections, which have since reinforced the critical need for our nation's healthcare culture to more strongly support ethical principles that enable effective ethical nursing practice," says Cynda Hylton Rushton, PhD, RN, FAAN, the Bunting Professor of Clinical Ethics at the Johns Hopkins School of Nursing and Berman Institute of Bioethics, and lead organizer of the summit.

The report makes both overarching and specific recommendations in four key areas: Clinical Practice, Nursing Education, Nursing Research, and Nursing Policy. Among the specific recommendations are:

• Clinical Practice: Create tools and guidelines for achieving ethical work environments, evaluate their use in practice, and make the results easily accessible.
• Education: Develop recommendations for preparing faculty to teach ethics effectively
• Nursing Research: Develop metrics that enable ethics research projects to identify common outcomes, including improvements in the quality of care, clinical outcomes, costs, and impacts on staff and the work environment
• Policy: Develop measurement criteria and an evaluation component that could be used to assess workplace culture and moral distress

What does this blueprint mean for nurses on the front line?

"It's our hope this will serve as a blueprint for cultural change that will more fully support nurses in their daily practice and ultimately improve how healthcare is administered -- for patients, their families and nurses," says Rushton. "We want to start a movement within nursing and our healthcare system to address the ethical challenges embedded in all settings where nurses work."

On the report's website, nurses and the public can learn more about ethical challenges and proposed solutions, share personal stories, and endorse the vision of the report by signing a pledge.

"This is only a beginning," says Marion Broom, PhD, RN, FAAN, Dean and Vice Chancellor for Nursing Affairs at Duke University and Associate Vice President for Academic Affairs for Nursing at Duke University Health System. "The next phase is to have these national nursing organizations and partners move the conversation and recommendations forward to their respective constituencies and garner feedback and buy-in. Transformative change will come through innovative clinical practice, education, advocacy and policy."

At the time of publication, the vision statement of the report has been endorsed by the nation's largest nursing organizations, representing more than 700,000 nurses:

• American Academy of Nursing
• American Association of Critical-Care Nurses
• American Nurses Association
• American Association of Colleges of Nursing
• American Organization of Nurse Executives
• Association of Women's Health, Obstetric and Neonatal Nurses
• The Center for Practical Bioethics
• National League for Nursing
• National Student Nurses' Association
• Oncology Nursing Society
• Sigma Theta Tau International

Source: www.sciencedaily.com

Use of "antibiograms" in skilled nursing facilities could improve antibiotic effectiveness and help address problems with antibiotic resistance that are becoming a national crisis, researchers conclude in a new study.

Antibiograms are tools that aid health care practitioners in prescribing antibiotics in local populations, such as a hospital, nursing home or the community. They are based on information from microbiology laboratory tests and provide information on how likely a certain antibiotic is to effectively treat a particular infection.

The recent research, published by researchers from Oregon State University in Infection Control and Hospital Epidemiology, pointed out that 85 percent of antibiotic prescriptions in the skilled nursing facility residents who were studied were made "empirically," or without culture data to help determine what drug, if any, would be effective.

Of those prescriptions, 65 percent were found to be inappropriate, in that they were unlikely to effectively treat the target infection.

By contrast, use of antibiograms in one facility improved appropriate prescribing by 40 percent, although due to small sample sizes the improvement was not statistically significant.

"When we're only prescribing an appropriate antibiotic 35 percent of the time, that's clearly a problem," said Jon Furuno, lead author on the study and an associate professor in the Oregon State University/Oregon Health & Science University College of Pharmacy.

"Wider use of antibiograms won't solve this problem, but in combination with other approaches, such as better dose and therapy monitoring, and limiting use of certain drugs, we should be able to be more effective," Furuno said.

"And it's essential we do more to address the issues of antibiotic resistance," he said. "We're not keeping up with this problem. Pretty soon, there won't be anything left in the medical cabinet that works for certain infections."

In September, President Obama called antibiotic resistant infections "a serious threat to public health and the economy," and outlined a new national initiative to address the issue. The Centers for Disease Control and Prevention has concluded that the problem is associated with an additional 23,000 deaths and 2 million illnesses each year in the U.S., as well as up to $55 billion in direct health care costs and lost productivity.

Antibiograms may literally be pocket-sized documents that outline which antibiotics in a local setting are most likely to be effective. They are often used in hospitals but less so in other health care settings, researchers say. There are opportunities to increase their use in nursing homes but also in large medical clinics and other local health care facilities for outpatient treatment. The recent study was based on analysis of 839 resident and patient records from skilled nursing and acute care facilities.

"Antibiograms help support appropriate and prudent antibiotic use," said Jessina McGregor, also an associate professor in the OSU/OHSU College of Pharmacy, and lead author on another recent publication on evaluating antimicrobial programs.

"Improved antimicrobial prescriptions can help save lives, but they also benefit more than just an individual patient," McGregor said. "The judicious use of antibiotics helps everyone in a community by slowing the spread of drug-resistant genes. It's an issue that each person should be aware of and consider."

Multi-drug resistant organisms, such as methicillin-resistant Staphylococcus aureus, or MRSA, and other bacterial attacks that are being called "superinfections" have become a major issue.

Improved antibiotic treatment using a range of tactics, researchers say, could ultimately reduce morbidity, save money and lives, and improve patients' quality of life.

Source: www.medicalnewstoday.com

By George Putic

Each year, about one million babies throughout the world die of complications due to premature birth. Many of them could have been saved if given access to an incubator. But this expensive device is sorely lacking in developing countries. A young British researcher says he has found a solution -- a low-cost inflatable incubator.

Doctors say many expectant mothers in developing countries give birth prematurely, especially in refugee camps, largely because of poor diet and unhealthy living conditions.

Premature birth is the biggest killer of children worldwide. Because these tiny babies are born before their lungs are fully developed, they are more susceptible to often deadly infections. But they could survive if placed in an incubator, where they would continue to develop in the closed chamber and warm, controlled environment.

However with a price tag of around $50,000, incubators are out of reach even for some hospitals.

Design engineering student James Roberts, 23,  of Britain says his $400 inflatable incubator may help solve this problem.

“It's basically an insulated piece of air, so it's like the difference between double and single glazing, so it's easier to keep the inside at a stable heat environment, heat temperature," he said.

The inflated incubator is collapsible and when folded resembles an ordinary travel bag.

It is powered through a regular electrical line, but Roberts said he has found a solution in case there is a power outage, which often happens in refugee camps.

“I thought 'why not car batteries?' There's loads of cars out there, they're pretty readily available. So you can plug this into a car battery. It will run for 24 hours and then when the mains [regular electrical line] comes back on, the mains can then charge this battery, and then that can run the incubator," he said.

Roberts' won the $47,000 James Dyson Award earlier this year for his incubator design. He said the project is still in the development phase, but the prize money will help him start a company for the mass manufacturing of inflatable incubators.

Source: www.voanews.com

By Melissa Wirkus

“HIT has been shown to help some patients, but it has also been shown to perhaps provide some complications in care, or less than adequate care, when messages are not received, when messages are interrupted or when messages are routed to the inappropriate person,” explained Milisa Manojlovich, PhD, RN, CCRN, associate professor at the University of Michigan School of Nursing (UMSN) and member of U-M’s Institute for Healthcare Policy and Innovation.

Manojlovich will serve as the primary investigator on a new $1.6 million grant from the federal Agency for Healthcare Research and Quality (AHRQ) that will focus on health IT’s effects on nurse–physician communication. Manojlovich and her co-investigators will look at how communication technologies make it easier or harder for doctors and nurses to communicate with each other. They hope their research will identify the optimal way to support effective communication while fostering improved and positive interdisciplinary team-based care.

Until the research is completed, Manojlovich offers some simple procedures clinicians can begin to adopt right now to help alleviate common problems with digital communication:

1.   Use multiple forms of technology  

Just like there is more than one way to treat a cold, there is more than one way to communicate electronically. Utilizing multiple forms of technology to communicate important information, or sometimes even reverting back to the “old-fashioned” ways of making a phone call or talking in person, can help ensure the receipt of a message in an environment that is often inundated.

“One of the things we are going to investigate is this idea of matching the message to the medium,” Manojlovich said. “So depending on the message that you want to send, you will identify what is the best medium to send that message.”

Using the current Ebola situation in Texas as an example, Manojlovich explained that using multiple forms of technology as a back-up to solely documenting the information in the EHR system could have mitigated the breakdown in communication that occurred. “Although the clinician did her job by entering the information into the EHR, she maybe should have texted or emailed the physician with the information or found someone to talk to in person about the situation. What we are trying to do with this study is see if there is another way that messages like this could have been transmitted better.”

2.   Include the whole message 

Reducing fragmented messages and increasing the aggregation of key data and information in communications may be one of the most critical pieces to improving communication between nurses and physicians. Manojlovich has been passionate about nurse–physician communication throughout her career and has conducted several previous studies on communication technologies.

“What we’ve noticed, for example, is that nurses will sometimes use the same form of communication over and over again. In one of the studies we actually watched a nurse page the same physician three times with the same question within an hour period.”

The physician did not answer any of the messages, and Manojlovich concluded it was because the pages were missing critical components of information related to the patient’s care plan. Increasing the frequency of communications can be beneficial, but only if the entire message and all important facets of information are relayed.

“If you do what you’ve always done, you’re going to get what you’ve always gotten. If you don’t alter or change the communication technology you are using, you are going to get the same results,” she added.

3.   Incorporate a team-based approach 

“At a really high level the problem is that a lot of these computer and electronic health record technologies are built with individuals in mind,” Manojlovich said. “When you talk about care process and team processes, that requires more interaction than the technologies are currently able to give us. The computer technologies are designed for individual use, but health care is based on the interaction of many different disciplines.”

Infusing this collaborative mindset into the “siloed” technology realm will undoubtedly help to improve the communication problems between providers and clinicians at all levels and all practice settings--which is especially important in today’s environment of co-morbidities and coordinating care.

Nurses play a critical role in improving communication as frontline care providers. “Nurses are the 24-hour surveillance system for hospitalized patients. It is our job to do that monitoring and surveillance and to let physicians know when something comes up.”

“I believe that for quality patient care, a patient needs input from all disciplines; from doctors, nurses, pharmacists, nutritionists--everyone,” Manojlovich said. “We are being trained separately and each discipline has a different knowledge base, and these differences make it difficult for us to understand each other. Developing mutual understanding is really important because when we have that mutual understanding I think outcomes are better and it can be argued that the quality of care is better when you have everyone providing input.”

Source: www.nursezone.com

By Debra Wood

More and more people are seeking care in emergency departments, leading to crowding and extended wait times that can adversely affect patient satisfaction and outcomes. Many nurses, including ER nurses, have come up with ideas to improve throughput and enhance care.

“Wait times are a very prevalent problem,” said Paula Roe, BSN, MBA/HCM, FACHE, senior consultant with Simpler Consulting, based in Pittsburgh, Penn. “There are many things that can be done.”

Roe helps clients discover waste through Lean principles and thereby reduce ER wait times.

At the end of 2013, ProPublica launched an interactive news application called ER Wait Watcher, using government information to educate people about average wait times at emergency departments (EDs). ER Wait Watcher reports a national average waiting time of 28 minutes before the patient sees a physician.

The American College of Emergency Physicians reported in April 2014 that 46 percent of surveyed members reported an increase in emergency department patients since January 1, 2014. Most respondents, 94 percent, did not believe wait times were the biggest issue facing emergency patients and their ability to access care, however. Interestingly, their top concern was the limited supply of primary care physicians, followed by too many non-urgent patients that might instead be treated in a primary care setting.

Deena Brecher, MSN, RN, APN, ACNS-BC, CEN, CPEN, president of the Emergency Nurses Association, agreed that a lack of primary care contributes to ED crowding and waiting.

In a recent interview, she pointed out that patients boarded in the ED also stop the flow and lead to crowding. Other people have to wait longer because the ED stretcher is occupied. To solve the problem, Brecher said hospitals must involve the entire hospital in getting patients ready for discharge out, the beds cleaned and the transfers made.

“You have to think of crowding as a hospital problem and not an emergency department problem,” Brecher explained. “It involves an organizational effort.”

Jodi Pahl, chief nursing executive at St. Rita’s Medical Center in Ohio, and the team at St. Rita’s launched a comprehensive communications program to keep all hospital clinicians informed of when patient wait times in the ED increase beyond acceptable levels. Those communications may prompt physicians to discharge patients ready to go home more quickly. As a result of this program, St. Rita’s was able to decrease patient wait times, as well as walk-out rates. Patients wait to see the doctor an average of 34 minutes at St. Rita’s, according to ER Wait Watcher.

Several hospitals have opened fast-track systems to reduce wait time, by getting the “walking well” in and out, Brecher said. She also reported an increase in the use of provider-nurse teams at the initial point of entry. Tests can be ordered so results are available more quickly once the patient enters the ED. Patients with minor ailments can be treated and released.

Charge nurse Steven Kunz, RN, CEN, of Aria Health’s Torresdale campus emergency department in Northeast Philadelphia, reported that reducing ER wait times and improving care are the key focus areas of the hospital’s new emergency department.

“Our strategic group of stakeholders including nurses, physicians and administration, worked together to implement an updated registration system that includes a pivot nurse to help transform triage,” Kunz said.

The pivot nurse greets patients upon their arrival, obtains patient identifiers and vital signs, and performs a rapid assessment to determine the level of need for immediate care. The pivot nurse concept, combined with an expanded treatment area and more rapid evaluation and disposition by the physician, have worked to reduce wait times and improve patient satisfaction, he added.

Penne Marino, RN, and colleagues at Lancaster General Hospital in Pennsylvania described in the Journal of Emergency Nursing in 2014 how a multidisciplinary team established a Bypass Rapid Assessment Triage process. Patients are met by a greeter nurse, who conducts a quick assessment to determine acuity and then places the patient in an appropriate bed. This new system reduced the time it took patients to see the physician and enhanced patient satisfaction. According to ER Wait Watcher, patients are seen by a doctor within 17 minutes.

The University of Kansas Medical Center (KUMC) in Kansas City, Kan., hired a bachelor’s-prepared emergency registered nurse as a flow coordinator in hopes of reducing its wait times. Seamus Murphy, BSN, RN, CEN, CPEN, CTRN, CPHQ, NREMT-P, at KUMC, and colleagues reported in the Journal of Emergency Nursing in 2014 how the flow coordinator decreased length of stay by 87.6 minutes, reduced the number of patients who left without being seen and decreased the number of time the hospital was on diversion. ER Wait Watcher reports an average wait time to see a physician is 34 minutes and more than eight hours for admitted patients to be roomed.

Nurses remain on the forefront of trying to improve throughput and reduce ER waiting times. Roe explained that nurses can assess improvements in three areas: triage, evaluation by medical staff and associated diagnosis and treatment, and then disposition.

“Each phase has its unique opportunities to eliminate barriers, reduce waste and improve wait times,” Roe said. “Nursing and how nurses deliver care is key in process improvement efforts. It’s important they are involved as frontline staff and part of studying the current state, helping to identify barriers to patient flow and understanding the solutions to deploy to make the situation better.”

Source: www.nursezone.com

By Maureen Salamon

Talking bystanders through CPR methods for a cardiac emergency during a 911 call can significantly boost survival rates, a new study suggests.

State researchers in Arizona examined the aggressive use of so-called pre-arrival telephone CPR guidelines -- step-by-step dispatcher instructions on administering cardiopulmonary resuscitation before trained rescuers arrive -- and found that it bumped survival of cardiac arrest patients from about 8 percent to more than 11 percent.

Cardiac arrest occurs when the heart's normal rhythm abruptly stops, and the organ can no longer pump blood and oxygen to the body. It can be triggered by a heart attack, but the two conditions are different.

Lead researcher Dr. Ben Bobrow said the type of focused intervention studied in his home state -- not only training telephone dispatchers but measuring bystander CPR outcomes and circling back to 911 centers with feedback -- is not done uniformly on a national basis, despite American Heart Association (AHA) guidelines.

But he hopes the results of his study, scheduled to be presented Saturday at the AHA meeting in Chicago, will promote that ideal.

"We believe strongly that this may be the best, and most efficient, way to improve survival rates across the country," said Bobrow, the medical director of the Bureau of EMS and Trauma System for the Arizona Department of Health Services. "Cardiac arrest is one of the leading causes of death, and as a country, despite tons of efforts ... this has not improved."

About 359,000 people in the United States suffered sudden cardiac arrest outside of a hospital setting in 2013, and more than 90 percent of them died, according to the AHA.

The heart association also has reported that 70 percent of Americans feel helpless to act during a cardiac arrest emergency because they don't know CPR or their training had lapsed.

Bobrow and his colleagues analyzed more than 4,000 audio recordings from 911 calls over three years from eight Arizona dispatch centers. That information, paired with emergency medical services (EMS) and hospital outcome data, showed that providing telephone CPR instructions prompted a jump in the number of bystanders implementing CPR, from 44 percent to 62 percent.

With the guidelines in place, the average amount of time elapsing between a bystander's call to 911 and the first chest compression in CPR dropped by 23 seconds, to 155 seconds.

"This research shows . . . that even the simplest of interventions, like having someone on the other end of a phone guide you [in CPR], can result in a remarkable difference of outcome," said Dr. Vinay Nadkarni, a spokesperson for the AHA, who wasn't involved in the study.

"That change is possible with a cellphone and our own two hands," added Nadkarni, an associate professor of anesthesiology and critical care at the University of Pennsylvania School of Medicine. "It's within our grasp."

Nadkarni said that Bobrow and his team had done an "excellent job" in helping 911 dispatchers in Arizona use certain phrases to prompt quick action among bystanders who witness a cardiac arrest.

For example, before the intervention, dispatchers typically asked 911 callers if anyone was available to perform CPR, or if they would be willing to. After the Web-based and live training, the revised script emphasized the importance of dispatchers directing callers to start CPR, saying something like, "You need to do chest compressions and I'm going to help you. Let's start."

With the apparent success of this approach, Bobrow said he and his team have asked the U.S. Centers for Disease Control and Prevention to consider implementing it on a national scale. Funding for such a program is needed, he said.

"It would be an incredibly inexpensive intervention for how many lives it would save," he said. "We estimate conservatively that it would save several thousand lives per year. It's not complicated stuff . . . and the beauty of the 911 system is that it already exists."

Research presented at scientific conferences typically has not been peer-reviewed or published and results are considered preliminary.

Source: www.medicinenet.com

By  John DeGaspari

Using the Internet to access health information may be out of reach for many older Americans, according to a study by researchers at the University of Michigan. According to the study, less than one-third of Americans age 65 and older use the Web. Within that age group less than 10 percent of those with low health literacy, or who lack the ability to navigate the healthcare system, go online for health-related matters.

The results of the study have been published in the Journal of Internal Medicine. Data was analyzed from the 2009 and 2010 Health and Retirement Study, a nationally representative survey of older adults; about 1,400 of the participants were asked about how often they use the Internet for any purpose, and, in particular, how often they search for health and medical information.

Health literacy was found to be a significant predictor or what people do once they are online. Elderly Americans with low health literacy are less likely to use the Internet at all, according to the researcher; and if members of this group do surf the Web, it is not generally to search for medical or health information.

“In recent years, we have invested many resources in Web-based interventions to help improve people’s health, including electronic health records designed to help patients become more active participants in their care,” according to lead author of the study Helen Levy, Ph.D., research associate professor at the University of Michigan Institute for Social Research, in a prepared statement. “But many older Americans, especially those with low health literacy, may not be prepared for these tools.”

Senior author Kenneth Langa, M.D., a professor of Internal Medicine at the University of Michigan Medical School, cautions that as the Internet becomes more central to health literacy, older Americans face barriers that may sideline them. He recommends that “Programs need to consider interventions that target health literacy among older adults to help narrow the gap and reduce the risk of deepening disparities in health access and outcomes.”

Source: www.healthcare-informatics.com

A number of eye conditions can be treated by administering drugs directly into the eye. Yet, conventional needles have a bunch of drawbacks, including the patients’ fear of needles entering such fragile parts of the body and the difficulty of accurately administering medication into a targeted region of the eye. For glaucoma, for example, eye drops are prescribed which have a shorter active lifetime and are often skipped by the patients. An easy injection that works for months at a time would help control the disease considerably better.

Researchers at Georgia Tech and Emory University have been working on microneedles and formulations to safely and effectively deliver drugs into the eye. The microneedles are designed to only penetrate to the correct depth and the formulations need to be viscous enough to stay in place and release their therapeutic compounds in a controlled fashion. The researchers have already tested the microneedles on laboratory animals and showed that they can place drugs within the targeted sections of the eye.

More from Georgia Tech:

The microneedle therapy would inject drugs into space between two layers of the eye near the ciliary body, which produces the aqueous humor. The drug is retained near the injection side because it is formulated for increased viscosity. In studies with an animal model, the researchers were able to reduce intraocular pressure through the injections, showing that their drug got to the proper location in the eye.

Because the injection narrowly targets delivery of the drug, researchers were able to bring about a pressure reduction by using just one percent of the amount of drug required to produce a similar decline with eye drops.

To treat corneal neovascularization, the researchers took a different approach, coating solid microneedles with an antibody-based drug that prevents the growth of blood vessels. They inserted the coated needles near the point of an injury, keeping them in place for approximately one minute until the drug dissolved into the cornea.

In an animal model, placement of the drug halted the growth of unwanted blood vessels for about two weeks after a single application.

Source: www.medgadget.com