DiversityNursing Blog

By Alice Park

Up to a third of teens in the U.S. don’t get enough sleep each night, and the loss of shut-eye negatively impacts their grades, mental well-being and physical health. Biologically, adolescents need fewer hours of slumber than kids — but there’s a bigger reason for teens’ sleep loss, according to a new study in the journal Pediatrics.

Katherine Keyes, an assistant professor of epidemiology at Columbia University, looked at survey data from more than 270,000 eighth-, 10th- and 12th-grade students at 130 public and private schools across the country, gathered between 1991 and 2010. Each student was asked two questions about his or her sleep habits: how often they slept for at least seven hours a night, and how often they slept less than they should.

She found that over the 20-year study period, adolescents got less and less sleep. Part of that had to do with the fact that biologically, teens sleep less the older they get, but Keyes and her team also teased apart a period effect — meaning there were forces affecting all the students, at every age, that contributed to their sleeping fewer hours. This led to a marked drop in the average number of adolescents reporting at least seven hours of sleep nightly between 1991–1995 and 1996–2000.

That surprised Keyes, who expected to find sharper declines in sleep in more recent years with the proliferation of cell phones, tablets and social media. “I thought we would see decreases in sleep in more recent years, because so much has been written about teens being at risk with technologies that adversely affect the sleep health of this population,” she says. “But that’s not what we found.”

Instead, the rises in the mid-1990s corresponded with another widespread trend affecting most teens — the growth of childhood obesity. Obesity has been tied to health disturbances including sleep changes like sleep apnea, and “the decreases in sleep particularly in the 1990s across all ages corresponds to a time period when we also saw increases in pediatric obesity across all ages,” says Keyes. Since then, the sleep patterns haven’t worsened, but they haven’t improved either, which is concerning given the impact that long-term sleep disturbances can have on overall health.

Keyes also uncovered another worrying trend. Students in lower-income families and those belonging to racial and ethnic minorities were more likely to report getting fewer than seven hours of sleep regularly than white teens in higher-income households. But they also said they were getting enough sleep, revealing a failure of public-health messages to adequately inform all adolescent groups about how much sleep they need: about nine hours a night.

“When we first started looking at that data, I kept saying it had to be wrong,” says Keyes. “We were seeing completely opposite patterns. So our results show that health literacy around sleep are not only critical but that those messages are not adapted universally, especially not among higher-risk groups.”

Source: http://time.com

By Felicity Dryer

Infographic Courtesy of PresidioHomeCare.com

By Felicity Dryer

We live in a high-stress world. Between having to attend to work, kids, homes and run back and forth between meetings and all of the other demands of everyday life, to say that things can get stressful is an understatement. 

If your constant on-the-go lifestyle has left you feeling run down, beat down and just plain old exhausted, then you need to stop and smell the proverbial roses for a little bit.

Taking time to enjoy something that is peaceful and that is just for you can do wonders for your health, your mental clarity and for your happiness. You don’t have to invest much time in such activities, either; reserving just 30 minutes a day to something that you enjoy and that promotes a bit of peacefulness and tranquility can do wonders.

Here’s a look at some activities that you can do for just 30 minutes a day and that will provide you with some simply amazing benefits.

Yoga: It seems like yoga is all the rage in the fitness world as of late (well, not really as of late; it’s been a trend for quite a while) – and there’s a reason why; yoga provides some pretty amazing benefits.

Just 30 minutes of yoga a day will help to increase your strength and flexibility, as well as tone your body. In addition to physical benefits, yoga can also increase your brain function. A recent study conducted by the University of Illinois found that people who participated in just 20 minutes of yoga a day experienced an increase in the speed and accuracy of their brain functions. Yoga also helps to reduce stress levels and boosts mental clarity; talk about some pretty amazing benefits for just 30 minutes of your time each day.

Meditation: Another activity that can provide fantastic benefits in just 30 minutes a day is meditation. When you think of people meditating, what comes to mind? People who are more peaceful, more astute and have more clarity? If so, there’s a good reason why – Because meditation helps to promote all of these things.

In fact, just 30 minutes of meditating a day can boost your creative thinking abilities, heighten your energy levels, decrease your stress levels and even ease the feelings of depression.

A Long Walk: If someone tells you to ‘go take a walk’, take them up on it! There are so many wonderful benefits associated with walking, and the best part is, it is so easy to do. Walking for just 30 minutes a day improves your cardiovascular health, decreases stress and anxiety, helps to keep off excess weight, tones muscles, boosts energy levels and it can even help to decrease your risk of dementia. Walking also just makes you happy. So kick off those painfulwork shoes and dust off your sneakers, and get moving. There is nothing more therapeutic than soaking up the warm sunshine and observing the beauty of nature while walking on a nice day.

Reading: Everyone knows that reading is important, but do you know why? Reading for just 30 minutes each day can increase your vocabulary, boost your creative thinking and critical thinking skills, stimulate your mind, improve your memory and focus and decrease stress levels. So, when you’re feeling like you just need to escape for a little while, curl up with a book or a magazine and submerse yourself in reading.

No matter how crazy your lifestyle is, you can spare just 30 minutes a day to enjoy the benefits that one of these activities can provide. You’ll be amazed by how much happier you will feel – you owe it to yourself!

Source: http://www.interplayhealth.com

By Debra Anscombe Wood, RN

Psychiatric emergencies can be as serious as a medical condition, but in traditional EDs, mental health patients may wait for treatment. Specialized psychiatric EDs serve that population quickly and efficiently. “They come in with everything from the need for prescription refills to being actively suicidal,” said Brian Miluszusky, RN, BSN, director of nursing in the emergency medicine department at NewYork-Presbyterian Hospital/Weill Cornell Medical Center in New York. “A suicidal person is as much at risk of dying as someone having an MI (myocardial infarction).” 

As demand for emergency care has increased, so has the number of mental health patients seeking services. A study from the Carolina Center for Health Informatics at the University of North Carolina at Chapel Hill reported in 2013 that nearly 10% of ED visits in North Carolina from 2008-2010 were for mental health diagnoses, and the rate of mental health related visits increased seven times more than overall ED visits. Mental health related ED visits increased by 17.7%, from 347,806 to 409,276 from 2008-2010. Stress, anxiety and depressive disorders were most common. 

A January 2012 American Hospital Association Trendwatch report said, “In 2009, more than 2 million discharges from community hospitals were for a primary diagnosis of mental illness or substance abuse disorder. ... Among children, mental health conditions were the fourth most common reason for admission to the hospital in 2009.”

The report said there were more than 5 million visits to EDs in 2009 by patients who had a primary diagnosis of mental illness or a substance abuse disorder. “Access to [psychiatric] care is not easily found [in the community], but if you are having a mental health crisis, you can walk into our emergency department 24/7 and be seen by a psychiatrist within a couple of hours,” said Jennifer Ziccardi-Colson, RN, MSN, BSW, MHA, vice president for nursing services at Carolinas Medical Center-Randolph, a behavioral health center with a psych ED and 66 inpatient beds in Charlotte, N.C. 

Psych EDs serve patients with acute episodes of behavioral health diagnoses, including feeling suicidal, anxious or depressed or abusing substances. “When patients come to us, they are assessed and seen promptly,” Ziccardi-Colson said. “People can feel comfortable coming to our environment to receive care.” 

Not all patients with mental illnesses receive care in a psych ED. Even at those hospitals with a dedicated psych emergency unit or a stand-alone psychiatric emergency services facility, patients with acute medical conditions, such as an MI or a broken hip, are treated in the regular ED. The ED provider must determine if a medical problem is contributing to mental status changes or if the problem is solely psychiatric in origin. 

Some psych EDs, such as San Francisco General Hospital and Carolinas Medical Center care for children as well as adults. Children and teens receive emergency psych services at Carolinas Medical Center-Randolph. Younger children, ages 3 to 6, come in with situational stress related to family dynamics, such as divorce or custody battles; depression or anxiety, often related to bullying at school or at home; suicidal ideation; conduct disorders; and behavioral issues related to autism or developmental delays. “In the emergency room, it’s crisis stabilization,” said Tez Bertiaux, RN, MSN, nurse manager for the ED at Carolinas Medical. “A lot of these children are followed in the community by a mental healthcare provider.”

The hospital’s social worker will arrange outpatient care for children who do not have a current therapist. Many are admitted to inpatient care. The psych emergency services program treats about 700 children and adolescents monthly, and the hospital admits about an equal number to its inpatient units, said Bertiaux.

Pediatric ED visits tend to increase during the school year, with school staff workers referring students for care. Some of the children are in foster care or are homeless or living in shelters. Some parents and guardians will stay during the stabilization and others do not. “It’s a very complex dynamic, because you are not just treating the patient — the family is involved,” Bertiaux said. 

Bertiaux said many of the mental health issues that bring children into the ED are related to their environment. “And that can be challenging,” she said.

Patients seeking care at a psych ED may be treated and discharged, but others require admission to a psychiatric bed for stabilization. Physicians at NewYork-Presbyterian and San Francisco General admit about 30% of their psych ED patients to the hospital. But treatment begins in the psych ED. “It’s amazing how much we can help people,” said Andrea Crowley, RN-BC, interim nurse manager in psychiatric emergency services at San Francisco General. “Some just need someone to talk to and bring them down from the crisis they are in. It makes you feel you are making a difference, and it’s a visible, tangible thing.” 

Psych care a growing need

Carolinas Medical has seen a steady increase in psych ED volume during the past several years. It treats about 18,500 patients annually with a variety of psych disorders and continuously operates at 100% occupancy. Construction is under way to double the psychiatric hospital’s inpatient beds to 132. 
Johns Hopkins Hospital in Baltimore’s psych ED census has experienced a 30% jump this year. “People are sicker, and there are fewer resources in the community,” said Kate Pontone, RN, MSN, nurse clinician 3 and nursing service line leader for Psychiatric Emergency Services at Johns Hopkins. “Outpatient programs that had space available are no longer options. People are running out of medications or cannot afford transportation. Many of the same reasons emergency departments are crowded.” 

A March 2012 Congressional briefing by the National Association of State Mental Health Program Directors reported, “the economic downturn has forced state budgets to cut approximately $4.35 billion in public mental health spending over the 2009-2012 period,” a trend it expects will continue. While at the same time, there was a 10% increase in consumers receiving state-supported mental health services. 

In July 2012, the Treatment Advocacy Center released the paper “No Room at the Inn: Trends and Consequences of Closing Public Psychiatric Hospitals,” which found nationwide, closures of such hospitals “reduced the number of beds available in the combined 50 states to 28% of the number considered necessary for minimally adequate inpatient psychiatric services.” And “in the absence of needed treatment and care, individuals in acute or chronic disabling psychiatric crisis increasingly gravitate to hospital emergency departments, jails and prisons.”

Volume at San Francisco General’s psych ED has jumped from 500 per month to 600 per month. “It could be due to closures in programs,” Crowley said. “We are starting to see a fallout from lack of services in the community.” 

Volume also has increased at NewYork-Presbyterian where, typically, a dozen or more psych patients are waiting in the regular ED for a bed in the psych ED, Miluszusky said. Difficulty transferring patients to an inpatient bed clogs up the EDs. A lack of insurance complicates transfers, and patients may end up boarding in a regular or psych ED. 

Patients may walk in, arrive by ambulance or with a petition for involuntary commitment, because they are deemed dangerous to themselves or others. First responders may take a mental health patient to a psych ED rather than to a community hospital without such specialized services. “This is a growing population, and emergency rooms will have to evolve,” Miluszusky said. “The population is getting so big; we are going to have to think of new ways to handle it.” 

Benefits of a separate psych ED

Psychiatric emergency services programs typically are staffed with behavioral health professionals, allowing mental health interventions to begin quickly, and often the onsite team can stabilize the patient, avoiding a hospitalization, according to the article “Treatment of Psychiatric Patients in Emergency Settings” in the journal Primary Psychiatry. “You don’t have agitated psych patients in the emergency room with all of the sick people,” Crowley said. “It’s a specialized environment where you can begin treatment better.”

Nurses and other members of the psych ED team have a solid understanding about different mental health conditions and their treatment. They can begin therapeutically talking with patients immediately. “Our patients appreciate being cared for by someone who is familiar with their medications and their symptoms and can intervene when they begin to decompensate,” Pontone said. “You get specialized care and the rooms are safe,” said Miluszusky, who adds that improves outcomes. 

Psych EDs often are locked units and feature specially outfitted rooms, with no sharp corners, no cords, nonexposed plumbing and a calm atmosphere. The safety features prevent patients from harming themselves or creating tools to harm others. “Our main priority is patient safety,” Ziccardi-Colson said. “There’s no potential for suicide or other negative outcomes.”

Ziccardi-Colson reported Carolinas Medical’s psych ED operates cost effectively, in part because of its ability to begin treatment and stabilize. “We’re able to process people more quickly than a medical ED,” Ziccardi-Colson said. 

Miluszusky said having a psych ED can be cost effective, because it reduces overtime pay necessitated by providing one-on-one oversight of a psych patient in the medical ED. 

Nurse staffing varies by institution, often with psychiatric nurses providing care, such as at San Francisco General’s psych ED. “It’s an exciting job, where you see a wide variety of people,” Crowley said. “You have a profound effect on people’s lives.”

Emergency nurses, who have received specialized training in the care of mental health patients and de-escalating situations, staff the psych ED at NewYork-Presbyterian. Nurses from a Johns Hopkins inpatient psych unit covers the emergency room, and Pontone describes significant interest from the inpatient staff. The hospital also cross-trains the ED nurses, so they can step in during an emergency. Pontone says nurses who love psychiatric nursing are interested in the management of the acutely ill patient, who needs as much care and support as they can get in a safe environment. “We like to be there when patients are in crisis and need help,” she said. “And we are good in a crisis.”

Ziccardi-Colson said every day presents challenges, but the reward of helping patients to wellness is inspiring and keeps nurses motivated. “Those who like it, love it,” Crowley said. “And for those who are not into it, we are happy to do it for them.” 

Source: Nurse.com

By Janice Lloyd

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

ADVICE FOR DEALING WITH GRIEF

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

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

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

• Accept the loss.

• Work through and feel the emotional and physical pain.

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

• Move on with life.

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

Source: USA Today