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DiversityNursing Blog

Life With a TBI: March Is National Brain Injury Awareness Month

Posted by Erica Bettencourt

Mon, Mar 02, 2015 @ 01:42 PM

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I find it strangely interesting that this time last year, as I was enduring the beginning of my life with a TBI, I had no idea that March was National Brain Injury Awareness Month. This year I feel compelled to shout it from the rooftops (or the computer screen)! Over the next few weeks, I intend to share with you stories and journeys of those living with a traumatic brain injury (TBI) or caring for a loved one who is recovering from one. My hope is to educate those who aren't familiar with TBI, and to help other TBI-ers understand that they are not alone, and that their symptoms are not just "in their head" (pun intended). 

Let me start by offering you some statistics on TBI from

    • Traumatic brain injury (TBI) is the leading cause of death and disability in children and adults from ages 1 to 44.


    • Brain injuries are most often caused by motor vehicle crashes, sports injuries, or simple falls on the playground, at work or in the home.



    • Every year, approximately 52,000 deaths occur from traumatic brain injury.



    • An estimated 1.5 million head injuries occur every year in the United States emergency rooms. 



    • An estimated 1.6 million to 3.8 million sports-related TBIs occur each year.



    • At least 5.3 million Americans, 2 percent of the U.S. population, currently live with disabilities resulting from TBI.



    • Moderate & severe head injury (respectively) is associated with a 2.3 and 4.5 times increased risk of Alzheimer's disease.



    • Males are about twice as likely as females to experience a TBI.



    • Exposures to blasts are a leading cause of TBI among active duty military personnel in war zones.



    • Veterans' advocates believe that between 10 and 20 percent of Iraq veterans, or 150,000 and 300,000 service members have some level of TBI.



    • 30 percent of soldiers admitted to Walter Reed Army Medical Center have been diagnosed as having had a TBI.


  • The number of people with TBI who are not seen in an emergency department or who receive no care is unknown.

There are three levels of traumatic brain injuries: mild, moderate and severe. Don't let these names fool you. A mild TBI is just as serious as a moderate or severe one. The names refer to loss of consciousness and mental alteration as a result of the trauma. In my case, we think I was unconscious for only about a minute or so, therefore classifying me as "mild". But like I said, don't let the name fool you. The resulting damage can be the same for all three -- a TBI does not discriminate. 

A TBI changes you. Literally and figuratively. My personality is different. My energy levels and sleep patterns are foreign to me. The confused woman in the kitchen staring at the oven is someone I am just now starting to understand. The woman who has to write a Post-it note for every single task on her to-do list is no longer the multi-tasker she once was. The woman who used to type at 100 words per minute with zero mistakes now has to take her time and correct many keystroke errors as she goes because her brain gets confused with letters.

I am finally coming to terms with this "new me." It has been just over a year since I fell on the ice, landing full force on my skull. In the beginning I was angry. I was confused. I was in a lot of pain, both physically and emotionally. People didn't understand. Didn't believe me. Couldn't understand my hidden injuries. I didn't have a strong support system, but what I did have was determination! 

Life with an "invisible" injury or illness can be a real challenge. Since I posted my last blog, "Life With a Traumatic Brain Injury," on The Huffington Post last month, I have made an entirely new circle of friends. I created a group on Facebook, affectionately named "The TBI Tribe." This is a safe place where we can hang out, talk, vent frustrations, share in each other's successes, and more importantly, have a place where we all feel like we fit in. I was craving an environment where others understood my struggles and didn't pass judgement. I have found exactly that in this tribe! 

I want to share with you a little bit about one of my new friends, Jennifer L. White from St. Louis, Missouri:

In July of 2000 Jennifer collapsed in her Atlanta, Georgia apartment. She called 911 and told them she was dying. She did, in fact, die in the ambulance on her way to the hospital. Fortunately medics were able to resuscitate her. Doctors determined that she had had a stroke and performed brain surgery to eradicate the brain bleed. She spent 10 days in the ICU followed by several months in a rehab facility. Overnight she went from the vice president of a large marketing firm, to unemployable and on disability. The massive stroke has left Jennifer with cognitive deficiencies, balance issues, and double vision. She jokes that she can, however, make a killer peanut butter sandwich! It's important to have a good sense of humor when dealing with a TBI. Aside from her impairments, Jennifer looks completely healthy and "normal." A few words from Jennifer:

The brain injury has affected me in a variety of ways. Emotionally, I am fragile but working hard to toughen my spirit.  I am much more introspective (I don't know if this is from the actual brain injury or the fact I now have more time to be introspective). Things are just harder for me than most people.   I have to actually think seriously about where I am stepping. 

I define my life in two ways: before and after the stroke.  It has certainly delivered me a tough blow. I have been advised not to have children. I am scared that I am predisposed to have something else happen to me, and I am sorry that I don't find sweetness in the sweet things in life because I am more bitter than I want to be.  But call me crazy... I am glad to be alive. 

I hope that you will join me this month as I share with you more stories and continue to bring awareness to the world about TBI.


Topics: mental, March, Brain Injury, Awareness, head, head injuries, TBI, trauma, health, healthcare, patients

TV Anchor Shares Personal News In Heartbreaking Broadcast: 'I have ALS'

Posted by Erica Bettencourt

Mon, Feb 02, 2015 @ 11:55 AM

By Chris Serico

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Larry Stogner, a retiring news anchor for an ABC affiliate in North Carolina, stunned viewers on Friday when he revealed he has ALS.

"For nearly four decades, I have met you right here, usually at 6," the WTVD anchor said during a Jan. 23 broadcast, as a slideshow of his life and career appeared on a screen behind him. "Boy, we've seen a lot of change over those years, but we have to stop meeting this way. I am sure that in recent months, you've noticed a change in my voice; my speech, slower. Many of you were kind enough to email me ideas about what it might be, or just to show concern, and I truly appreciate that. As it turns out, I have ALS, Lou Gehrig's disease."

Stogner added that, last summer, he'd participated in an Ice Bucket Challenge video to help raise awareness and money for the cause. "Little did I know, it was about to change my life," he said. "There is no cure. My career in broadcast journalism is coming to an end."

Married with six children, Stogner joined WTVD in 1976. In addition to conducting one-on-one interviews with Barack Obama, John McCain and other prominent political figures, the Air Force veteran reported live from Raleigh-Durham and beyond — including a 2002 assignment in Afghanistan, according to his ABC11 bio.

In the final minute of the broadcast, Stogner called his WTVD position "the best job in the world," and shared plans to take two weeks of vacation with his wife before returning in early February to share "a few final thoughts and a more personal goodbye."

Flanked by four of his WTVD colleagues, he concluded, "And now more than ever, I say to you, for all those 39 years: Thanks for the company. Have a good night."


Topics: news, Awareness, health, healthcare, disease, medicine, treatment, cure, ALS, ice bucket challenge, TV, cause

Teal Pumpkins Make Halloween Safer For Kids With Food Allergies

Posted by Erica Bettencourt

Fri, Oct 24, 2014 @ 11:17 AM

By Meghan Holohan

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For children with food allergies, Halloween usually means they receive far fewer treats than their friends. But this year, their luck may improve if they can spot a teal pumpkin by the doors where they trick-or-treat.

That’s because a new campaign from the Food Allergy Research & Education (FARE), Teal Pumpkin Project, aims to make Halloween safe for everyone.

“Food allergies are potentially life-threatening. When we are looking at a Halloween celebration, it is really nice to provide something that is safe,” says Veronica LaFemina, spokeswoman for FARE.

LaFemina says that one in 13 children in the United States has a food allergy.

“The Teal Pumpkin Project encourages people to raise awareness of food allergies by providing non-food treats and painting a pumpkin teal … [which] indicates that house has non-food treats,” she says. Teal is the color for food-allergen awareness.

FARE recommends that families hand out stickers, glow-sticks, vampire teeth, bouncy balls, or spider rings instead of candy, which frequently contain allergens.

“What people don’t understand or realize is that the small candy bars that people pass out for Halloween are manufactured differently,” says Beth Demis, whose 4- year-old son Luke is allergic to tree nuts and coconut. “A regular Hershey bar is okay but a smaller one [is not].”

Demis says she learns this kind of information by being a vigilant label reader and participating in groups where people share information about allergens. But people unfamiliar with food allergies often don’t realize that smaller versions of safe candy are dangerous.  

While most parents of children with allergies provide a plan to their children, trick-or-treating remains a chore. FARE recommends that parents fill out an emergency plan with the help of their allergists and make sure they carry all the needed gear, including epinephrine autoinjectors (also known as EpiPens).   

“For Halloween time, they are just like other kids and want to dress up and participate,” says LaFemina. “It can be tough when you have to say ‘no thank you’ and trade away most of your candy because it’s not safe.”

Demis, who lives in Cincinnati, says that her three children abide by a long-standing rule: No one can eat any candy until mom or dad examines it. Luke can swap with his brothers for candy that is safe and it is placed in his own plastic baggie. He knows he can’t touch his brothers’ candy.  

Katherine Eagerton’s 3-year-old son, Caden, is allergic to soy, milk, strawberries, and tomatoes. He knows he should stay away from food that’s red, but he doesn’t quite understand what having a food allergy means. She’s excited that the Teal Pumpkin Project encourages non-food treats so that her son can enjoy Halloween like other children.

“I’m excited to see that it’s actually catching on,” says Eagerton, who lives outside of Baton Rouge, Louisiana. She’s using Facebook to encourage others in the state to offer non-food items this Halloween.

LaFemina says that 4.5 million people viewed the campaign’s first two posts and they have been shared 44,000 times.

Eagerton says that helping kids with food allergies feel included at Halloween will have a tremendous impact.

“These little treats will make such a big difference,” she says. 


Topics: Awareness, food allergies, pumpkins, teal, FARE, health, children

Have You Heard about the "Ice Bucket Challenge?"

Posted by Erica Bettencourt

Wed, Aug 13, 2014 @ 11:53 AM


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It may be warm in parts of the country, but some people aren’t drenching themselves in ice or cold water to cool down from elevated temperatures. A new phenomenon has hit the social media circuit – the “Ice Bucket Challenge.”

The challenge involves people getting doused with buckets of ice water on video, posting that video to social media, then nominating others to do the same, all in an effort to raise ALS awareness. Those who refuse to take the challenge are asked to make a donation to the ALS charity of their choice.

Beverly, Mass., resident Pete Frates, started the “Ice Bucket Challenge” with his family on the social sites Facebook and Twitter.  Frates, 29, has lived with ALS since 2012, and he has worked with The ALS Association’s Massachusetts Chapter.  A former Division 1 college athlete with Boston College Baseball, Frates tirelessly spreads awareness of Lou Gehrig’s Disease.

This viral sensation, which has used the hash tag #IceBucketChallenge, has attracted thousands of followers, including Boston Bruins stars Brad Marchand and Torey Krug, who willingly dropped frozen ice on themselves and issued the challenge to others.

“This is a creative way to spread ALS awareness via social media and in communities nationwide,” said Barbara Newhouse, President and CEO of The ALS Association.  “We thank Pete Frates and his family for getting so many people involved in spreading the word about ALS.”

Other examples of the challenge can be viewed on the Team FrateTrain Facebook page.


Topics: Awareness, ALS, ice bucket challenge, viral videos, donations

Trading on innocence

Posted by Alycia Sullivan

Fri, Sep 13, 2013 @ 11:51 AM

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By Cynthia Saver, RN, MS

Human sex trafficking can be illustrated in one sentence: "I can sell a kilo of cocaine once and I'm out of product, but I can sell a woman over and over 25 times a night 365 days a year and make a quarter of a million dollars off one girl." That observation a pimp made to Mary de Chesnay, RN, DSN, PMHCNS-BC, FAAN, editor of the book "Sex Trafficking: A Clinical Guide for Nurses," sums up why human sex trafficking has become a growth industry.

"Trafficking is a $32 billion a year business, more than Starbucks, Nike and Google combined," said de Chesnay, a professor in the WellStar School of Nursing at Kennesaw (Ga.) State University. "It's the most lucrative criminal enterprise behind drugs."

Many people think sex trafficking happens only in third-world countries, but it's also pervasive in the U.S. "It's not just an international problem, it's a national problem," said Patricia Crane, RN, MSN, PhD, WHNP-BC, DF-IAFN, associate professor at University of Texas Medical Branch Galveston and a specialist in forensic nursing. Victims include U.S. citizens and people from countries such as Mexico, Eastern Europe, Asia and South America.

The early 1970s is when de Chesnay first met a child who was being trafficked. When she asked the 11-year-old girl with an ectopic pregnancy about the baby's father, the girl replied, "It could be my father, my four brothers, or the men who come to party on the weekend."

That child was the first in a long line of girls and women (and some boys and men) de Chesnay has seen during her career. Accurate numbers are hard to come by, but the Polaris Project, an advocacy group that combats human trafficking, estimates that 100,000 children are involved in the sex trade in the U.S. each year. The average age of a U.S. victim is 12 to 14 years old.

Nurses are in a prime position to identify possible victims of sex trafficking when they seek medical treatment in the ED, free clinics, physician offices and other locations. But too often those opportunities are missed. According to the Family Violence Prevention Fund, a study found that 28% of trafficking survivors had contact with a healthcare provider during the situation, but the abuse wasn't recognized. 

Preying pimps

How do victims become entangled in sex trafficking? de Chesnay said many victims are "runaways or throwaways, they have bad home lives." Pimps hang out around bus stops and other locations to meet the runaways. The "Romeo" pimp first befriends girls (most victims are female). Soon the girl moves in with him. Selling the girl might start with the pimp simply asking her to date his friend. Soon she is on the street, at hotels or even in the pimp's home being sexually abused. de Chesnay said Romeo pimps are the most common, but a second type is the violent pimp, who isn't interested in establishing a relationship. In rare cases a victim might be kidnapped.

Poverty is another factor. "They get involved because it's an opportunity to make some money," said Donna Sabella, CRNP, PhD, MEd, MSN, PMHNP-BC, director of global studies and the office of human trafficking at the College of Nursing and Health Professions at Drexel University in Philadelphia. "They may also need money for an addiction."

So why don't victims just leave? "If they were functioning well like us, they would find a way," said de Chesnay. "But these girls are broken in spirit. They have no self-worth and are damaged mentally and physically."

Fear is another contributing factor, Sabella said. "The pimps say they'll hurt them, their family or their children," she said. 

Identifying victims

Victims of sex trafficking have "all kinds of medical and psychological issues," de Chesnay said. Physical signs and symptoms of potential trafficking include burns, dislocated limbs or fractures, missing teeth, vaginal or rectal trauma, persistent or untreated sexually transmitted diseases or urinary tract infections, malnutrition and problems with the jaw or neck. Other signs include not being able to produce identification, having inconsistent stories about their lives and how injuries occurred, hypervigilance, and the presence of tattoos that might be "brands."

A victim might seem submissive, allowing the accompanying person, who might be his or her pimp, to respond to questions. Sabella said it's important to get the patient alone. She suggested saying, "It's hospital policy that we speak to patients alone."

Crane said that another option is to have the person with the victim fill out paperwork or ask him or her to stay in the waiting area while the nurse obtains a specimen. Once alone with the patient, nurses should choose their words carefully. "Don't ask them it they are being trafficked," Sabella said. "They won't understand the term."

Instead, Crane suggested questions such as: Can you come and go as you please? Where do you sleep and eat? Has anyone threatened your family? Is anyone forcing you to do anything you do not want to do?

Crane advises conveying messages such as, "We are here to help you. We can find you a safe place to stay. If you are a victim of trafficking and you cooperate, you won't be deported."

When faced with a trafficking victim, "the immediate problem is the medical condition," said de Chesnay. "Be kind, nonjudgmental and provide access to services." (See resources below story.)

She said nurses shouldn't present themselves as rescuers because victims don't always want to be rescued. Nurses should let victims know what to do when they are ready by providing them with information about resources such as the national hotline.

Sabella added that nurses should be aware that the victim doesn't know them and is in a difficult situation. "Don't be surprised if someone doesn't jump up and say thank you," Sabella said. "Be prepared when people say no."

In some cases, the nurse might be laying the groundwork for helping a victim leave in the future. "One woman went home because her pimp said he would kill her dog," Sabella said. "She came back the next day with the dog." She suggests telling victims they can call the hospital if they change their mind. If possible, the same nurse who saw the patient could do a follow up call in a few days, allowing another opportunity for contact. Crane said if a woman won't admit to being a victim, Crane will set up another visit to provide another chance to talk with her.

Some experts recommend giving the victim a card with the hotline number written on it, but de Chesnay advises not giving victims materials. "If pimps see it, they will beat them up," she said, adding that Georgia recently passed a law requiring the posting of signs with the hotline in places such as hospitals and hotels.

Nurses also should watch for victims in their own backyards. "A lot of this [sex trafficking] takes place in neighborhoods," Sabella said. 

Reporting & recovery

If the victim is a child, mandatory reporting laws for abuse apply. In addition, some states require reporting in the cases of victims of domestic violence. Nurses should tell the patient if they are required to file a report. Reporting gives victims access to an advocate who can help with resources. For example, in March 2013, President Obama signed the latest reauthorizaton of the Trafficking Victims Protection Act, linking it to the Violence Against Women Act. "VAWA money can now be used for sex trafficking victims in a domestic violence situation," said Crane. The victim has to agree to cooperate in prosecuting the pimp to receive funds that can help her or him escape from the situation.

Unfortunately, few residential recovery programs exist in the U.S. — Sabella estimates 10 to 15. She was a founding member of Dawn's Place, a residential recovery program for trafficked and prostituted women in Philadelphia. Sabella modeled the one-year program after a program in Phoenix. Such programs often must depend on volunteers because little funding is available for these efforts.
Besides needing treatment for physical problems such as injuries from beatings and gynecological issues, survivors will need care for psychological conditions such as post-traumatic stress disorder, anxiety and depression.

"Slavery didn't end with the Emancipation Proclamation," de Chesnay said. "Nurses can step up and play a role in ending it for good. The crucial first step is awareness, people need to be educated about human trafficking, learn the warning signs and memorize the hotline number."

Nurses can request their facilities hold a seminar on the topic. Sabella and de Chesnay, who both teach a course on human trafficking, said that the subject should be part of nurses' basic education.

The next step is to work with law enforcement to develop policies for the facility where the nurse works. "Many nurses do not act because they do not know what to do once they become aware," de Chesnay said. "The protocol must spell out clearly the steps to take if a human trafficking victim walks through the door." 


Topics: United States, Awareness, sex trafficking, nurse research, prevention

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