DiversityNursing Blog

We found this interesting article about the growth of smartphone use and apps available to Nurses while at work. These apps are being used to research drugs, gather information about home care as well as diseases and disorders. This is an area that will continue to grow and hopefully provide much needed assistance to our hard-working Nurses.

A new survey indicates nurses are relying more than ever on their smartphone for clinical care – to the detriment of the so-called "doctor on call."

Conducted by InCrowd, a Boston-based market intelligence firm, the survey found that 95 percent of the 241 responding nurses own a smartphone and 88 percent use smartphone apps at work. More intriguing, 52 percent said they use an app instead of asking a colleague, and 32 percent said they consult their smartphone instead of a physician.

"The hospital gets very busy and there isn't always someone available to bounce ideas off of," one respondent said. Said another: "It's often easier to get the information needed using my smartphone – I don't have to wait for a response from a coworker."

Nurses have long been seen as an under-appreciated market for mHealth technology, and one that differs significantly from doctors, but that seems to be changing. Companies like Voalte are marketing communications platforms targeted at nurses, and even IBM has come out with a line of nurse-specific apps.

"There's a lot of untapped potential in the use of mobile apps for nursing," Judy Murphy, IBM's chief nursing officer, told mHealth News.

Unlike physicians, who are looking for apps that can retrieve information, enter orders and push notifications, nurses need apps that assist their workflow, offer quick information and coordinate multiple activities.

"It's all about care coordination," Murphy said. "Nurses want apps that can help them organize their day."

The ideal app will be simple in nature, so that it can be used quickly, and will help nurses organize several functions, from taking care of multiple patients to addressing orders from doctors, according to Murphy. Some tasks, like entering complex data into the EMR, actually clutter the form factor of the smartphone and are best handled at a workstation.

According to the InCrowd survey, nurses are quick to point out that their smartphones "enhance but don't substitute" for the physician, but when they're running around and need a quick question answered about medications, illnesses or symptoms, sometimes the app does the job more effectively – such as "in patient homecare situations when I need quick answers without making a bunch of phone calls," or "so I can make an educated suggestion to the doctor."

According to the survey, 73 percent of the nurses surveyed use their smartphones to look up drug information at the bedside, while 72 percent use it to look up various diseases or disorders. And befitting the various roles of the smartphone in the healthcare setting, 69 percent of nurses said they use their smartphones to stay in touch with colleagues. Other uses include viewing images and setting timers for medication administration.

Finally, the survey found that nurses are using smartphones in the workplace no matter who's paying for them. Some 87 percent of those surveyed said their employer isn't covering any costs related to the smartphone, while 9 percent are reimbursed for the cost of the monthly bill, 1 percent receive some reimbursement for the cost of the smartphone, and 3 percent are reimbursed for both the phone and the phone bill. Less than 1 percent, meanwhile, said their institution bans the use of personal smartphones while on duty.

"We're hitting the tip of the iceberg here with apps that a nurse will want and will use," Murphy said.

www.mhealthnews.com

Contributor: Eric Wicklund

We wholeheartedly agree with this article that Nurse Practitioners across the country should be allowed to practice without a doctor’s consent in a variety of medical areas.

What are your thoughts about this important issue? Do you strongly agree or disagree?

In March, Nebraska became the 20th state to allow nurses with the most advanced degrees to practice without a doctor’s oversight in a variety of medical fields. Maryland recently followed suit and eight more states are considering similar legislation.

What does all this mean? Nurses in Nebraska with a master’s degree or better, known as nurse practitioners, no longer have to get a signed agreement from a doctor to be able to order and interpret diagnostic tests, prescribe medications and administer treatments.

These changes are long overdue.

The preponderance of empirical evidence indicates that, compared to physicians, nurse practitioners provide as good — if not better — quality of care. As I’ve written previously, patients are often more satisfied with nurse practitioner care — and sometimes even prefer it.

The Institute of Medicine is unambiguously clear about this: 

No studies suggest that APRNs [Advanced Practice Registered Nurse] are less able than physicians to deliver care that is safe, effective, and efficient or that care is better in states with more restrictive scope of practice regulations for APRNs.

In addition, see this review of the literature in Health Affairs.

In general, nurse practitioners have the skills to prescribe, treat and do most things a primary care physician can do. They generally must have completed a Registered Nurse and a Nurse Practitioner Program and have a Masters or PhD degree. In addition, there are physician assistants, registered nurses, licensed vocational nurses, emergency medical technicians, paramedics and army medics. In most states, each of these categories has its own set of restrictions and regulations, delineating what the practitioners can and can’t do.

What should each of these professionals be allowed to do? Whatever they’ve been trained to do.

The doctors counter that someone who hasn’t trained to be a doctor might miss important symptoms or clues that a physician might catch. This observation is true but trivial. Every professional might miss something that someone who is better trained might catch. A specialist might catch something a primary care physician might miss. A specialist in one field (say, oncology) might catch something a specialist in some other field (say ENT) might miss.

Perhaps more relevant to common experience, Emergency Medical Technicians riding in ambulances are treating victims of accidents and emergencies every day. Would the care be slightly less risky if we put doctors in all those ambulances? Maybe. Is anyone seriously suggesting that we do that? Of course not.

Think of health care as a large market in which everyone has to make decisions about whether the patient-provider nexus is the right fit. It’s not just the providers who have to decide whether the problem lies within their area of competence. Patients must make those decisions too. In Britain (under socialized medicine), patients make such decisions all the time. For routine problems, most Britons see a National Health Service physician. But “if it’s serious, go private” is a common bit of advice in that country.

How do professionals handle these decisions? From the most part quite well. Walk-in clinics (where nurses deliver care following computerized protocols) have been around for at least a decade. Studies show that the nurses follow best practices as well or better than traditional primary care physicians. And I am not aware of any serious, reported cases of nurses failing to distinguish between cases they are competent to handle and those they are not.

But even if a nurse did make a serious mistake, doctors make mistakes too. There is no such thing as a risk free world. We encounter tradeoffs between cost and risk every day. There is no reason for politicians (beholden to special interests) to make these decision for us.

In Texas, which has some of the most stringent regulations in the country, however, a nurse practitioner can’t do much of anything without being supervised by a doctor who must:

•Not oversee more than four nurses at one time.

•Not oversee nurses located outside of a 75 mile radius.

•Conduct a random review of 10 percent of the nurses’ patient charts every 10 days.

•Be on the premises 20 percent of the time.

These restrictions make it virtually impossible for Texas’ 8,600 nurse practitioners to practice outside the office of a primary care physician. The Texas requirement that a doctor supervising nurse practitioners be physically present and spend at least 20 percent of her time overseeing them creates an incentive for the physician to require nurses to be employees, rather than self-employed professionals. When practitioners are employed by a doctor, the physician meets state supervision requirements simply by showing up. This allows the doctor to see her own patients while generating additional revenue from patients seen by the practitioners.

These regulations have the greatest impact on the poor, especially the rural poor. The farther a nurse is located from a doctor’s office, the less likely the physician will be willing to make the drive to supervise the nurse. This means that people living in poverty-stricken Texas counties must drive long distances, miss work and take their kids out of school in order to get simple prescriptions and uncomplicated diagnoses. This problem might be alleviated if nurse practitioners were allowed to practice independently in rural areas. But, under Texas law, these practices must be located within 75 miles of a supervising physician. A physician with four nurses located in rural areas could drive hundreds of miles a week to review the nurses’ patient charts. The result is that doctors in Texas don’t receive a return on investment sufficient to induce them to supervise nurse practitioners.

If all this sounds like the reinvention of the Medieval Guild system, that’s exactly what it is. In Capitalism and Freedom, Milton Friedman argued that these labor market restrictions are no more justified today than they were several centuries ago. The proper role of government, said Friedman, is to certify the skills of various practitioners; then let consumers decide what services to buy from them.

Contributer: John C. Goodman

www.forbes.com

By ALEXANDRA ROBBINS

www.nytimes.com 

SEVERAL emergency-room nurses were crying in frustration after their shift ended at a large metropolitan hospital when Molly, who was new to the hospital, walked in. The nurses were scared because their department was so understaffed that they believed their patients — and their nursing licenses — were in danger, and because they knew that when tensions ran high and nurses were spread thin, patients could snap and turn violent.

The nurses were regularly assigned seven to nine patients at a time, when the safe maximum is generally considered four (and just two for patients bound for the intensive-care unit). Molly — whom I followed for a year for a book about nursing, on the condition that I use a pseudonym for her — was assigned 20 patients with non-life-threatening conditions.

“The nurse-patient ratio is insane, the hallways are full of patients, most patients aren’t seen by the attending until they’re ready to leave, and the policies are really unsafe,” Molly told the group.

That’s just how the hospital does things, one nurse said, resigned.

Unfortunately, that’s how many hospitals operate. Inadequate staffing is a nationwide problem, and with the exception of California, not a single state sets a minimum standard for hospital-wide nurse-to-patient ratios.

Dozens of studies have found that the more patients assigned to a nurse, the higher the patients’ risk of death, infections, complications, falls, failure-to-rescue rates and readmission to the hospital — and the longer their hospital stay. According to one study, for every 100 surgical patients who die in hospitals where nurses are assigned four patients, 131 would die if they were assigned eight.

In pediatrics, adding even one extra surgical patient to a nurse’s ratio increases a child’s likelihood of readmission to the hospital by nearly 50 percent. The Center for Health Outcomes and Policy Research found that if every hospital improved its nurses’ working conditions to the levels of the top quarter of hospitals, more than 40,000 lives would be saved nationwide every year.

Nurses are well aware of the problem. In a survey of nurses in Massachusetts released this month, 25 percent said that understaffing was directly responsible for patient deaths, 50 percent blamed understaffing for harm or injury to patients and 85 percent said that patient care is suffering because of the high numbers of patients assigned to each nurse. (The Massachusetts Nurses Association, a labor union, sponsored the study; it was conducted by an independent research firm and the majority of respondents were not members of the association.)

And yet too often, nurses are punished for speaking out. According to the New York State Nurses Association, this month Jack D. Weiler Hospital of the Albert Einstein College of Medicine in New York threatened nurses with arrest, and even escorted seven nurses out of the building, because, during a breakfast to celebrate National Nurses Week, the nurses discussed staffing shortages. (A spokesman for the hospital disputed this characterization of the events.)

It’s not unusual for hospitals to intimidate nurses who speak up about understaffing, said Deborah Burger, co-president of National Nurses United, a union. “It happens all the time, and nurses are harassed into taking what they know are not safe assignments,” she said. “The pressure has gotten even greater to keep your mouth shut. Nurses have gotten blackballed for speaking up.”

The landscape hasn’t always been so alarming. But as the push for hospital profits has increased, important matters like personnel count, most notably nurses, have suffered. “The biggest change in the last five to 10 years is the unrelenting emphasis on boosting their profit margins at the expense of patient safety,” said David Schildmeier, a spokesman for the Massachusetts Nurses Association. “Absolutely every decision is made on the basis of cost savings.”

Experts said that many hospital administrators assume the studies don’t apply to them and fault individuals, not the system, for negative outcomes. “They mistakenly believe their staffing is adequate,” said Judy Smetzer, the vice president of the Institute for Safe Medication Practices, a consumer group. “It’s a vicious cycle. When they’re understaffed, nurses are required to cut corners to get the work done the best they can. Then when there’s a bad outcome, hospitals fire the nurse for cutting corners.”

Nursing advocates continue to push for change. In April, National Nurses United filed a grievance against the James A. Haley Veterans’ Hospital in Tampa, which it said is 100 registered nurses short of the minimum staffing levels mandated by the Department of Veterans Affairs (the hospital said it intends to hire more nurses, but disputes the union’s reading of the mandate).

Nurses are the key to improving American health care; research has proved repeatedly that nurse staffing is directly tied to patient outcomes. Nurses are unsung and underestimated heroes who are needlessly overstretched and overdue for the kind of recognition befitting champions. For their sake and ours, we must insist that hospitals treat them right.

Phil Galewitz

www.usatoday.com 

With her children grown and husband nearing retirement, Amy Reynolds was ready to leave behind snowy Flagstaff, Ariz., to travel but she wasn't ready to give up her nursing career.

She didn't have to.

For the past three years, Reynolds, 55, has been a travel nurse – working for about three months at a time at hospitals in California, Washington, Texas and Idaho, among other states. Her husband accompanies her on the assignments. "It's been wonderful," she said in May after starting a stint in Sacramento. "It's given us a chance to try out other parts of the country."

Reynolds is one of thousands of registered nurses who travel the country helping hospitals and other health care facilities in need of experienced, temporary staff.

With an invigorated national economy and millions of people gaining health coverage under the Affordable Care Act, demand for nurses such as Reynolds is at a 20-year high, industry analysts say. That's meant Reynolds has her pick of hospitals and cities when it's time for her next assignment. And it's driven up stock prices of the largest publicly traded travel-nurse companies, including San Diego-based AMN Healthcare Services and Cross Country Healthcare of Boca Raton, Fla.

"We've seen a broad uptick in health care employment, which the staffing agencies are riding," said Randle Reece, an analyst with investment firm Avondale Partners. He estimates the demand for nurses and other health care personnel is at its highest level since the mid-1990s.

Demand for travel nursing is expected to increase by 10% this year "due to declining unemployment, which raises demand by increasing commercial admissions to hospitals," according to Staffing Industry Analysts, a research firm. That trend is expected to accelerate, the report said, because of higher hospital admissions propelled by the health law. 

Improved profits — particularly in states that expanded Medicaid — have also made hospitals more amenable to hire travel nurses to help them keep up with rising admissions, analysts say.

At AMN Healthcare, the nation's largest travel-nurse company, demand for nurses is up significantly in the past year: CEO Susan Salka said orders from many hospitals have doubled or tripled in recent years. Much of the demand is for nurses with experience in intensive care, emergency departments and other specialty areas. "We can't fill all the jobs that are out there," she said.

Northside Hospital in Atlanta is among hospitals that have recently increased demand for travel nurses, said David Votta, manager of human resources. "It's a love-hate relationship," he said. From a financial viewpoint, the travel nurses can cost significantly more per hour than regular nurses. But the travel nurses provide a vital role to help the hospital fills gaps in staffing so they can serve more patients. 

Northside is using 40 travel nurses at its three hospitals, an increase of about 52% since last year. The system employs about 4,000 nurses overall. 

Historically, the most common reason why hospitals turn to traveling nurses is seasonal demand, according to a 2011 study by accounting firm KPMG. Nearly half of hospitals surveyed said seasonal influxes in places such as Arizona or Florida, where large numbers of retirees flock every winter, led them to hire traveling nurses. 

Though there have been rare reports of travel nurses involved in patient safety problems, a 2012 study by researchers at the University of Pennsylvania published in the Journal of Health Services Research found no link between travel nurses and patient mortality rates. The study examined more than 1.3 million patients and 40,000 nurses in more than 600 hospitals. "Our study showed these nurses could be lifesavers. Hiring temporary nurses can alleviate shortages that could produce higher patient mortality," said Linda Aiken, director of the university's Center for Health Outcomes and Policy Research. The study was funded by the National Institutes of Health and the American Staffing Association Foundation.

The staffing companies screen and interview nurses to make sure they are qualified, and some hospitals, such as Northside, also make their own checks. Nurses usually spend a couple days getting orientated to a hospital and its operations before beginning work. They have to be licensed in each state they practice in, although about 20 states have reciprocity laws that expedite the process.

Cherisse Dillard, a labor and delivery room nurse, has been a traveler for nearly a decade. In the past few years, she's worked at hospitals in Chicago, Dallas, Houston, Pensacola and the San Francisco area.

While delivering a baby is relatively standard practice, she said she makes it a practice at each new hospital to talk to doctors and other staff to learn what their preferences are with drugs and other procedures. Dillard, 46, often can negotiate to be off on weekends and be paid a high hourly rate. "When the economy crashed in 2008, hospitals became tight with their budget and it was tough to find jobs, but now it's back to full swing and there are abundant jobs for travel nurses," she said.

By Jethro Mullen

www.cnn.com 

But not for Annegret Raunigk.

The 65-year-old German grandmother recently gave birth to quadruplets, making her the oldest woman ever to do so.

The new arrivals increase her progeny to a total of 17 children. And let's not forget her seven grandchildren.

Raunigk, a single mother, gave birth last week to three boys and one girl after a pregnancy of just under 26 weeks, the German broadcaster RTL reported. 

The newborns -- whose names are Neeta, Dries, Bence and Fjonn -- were delivered by C-section and are being kept in incubators for premature babies, according to RTL.

Daughter wanted a younger sibling

Raunigk, a teacher from Berlin, made headlines 10 years ago when, at the age of 55, she gave birth to a daughter, Leila. And it was apparently Leila's plea for a younger sibling that encouraged her mother to try again.

"I myself find life with children great," Raunigk said earlier this year. "You constantly have to live up to new challenges. And that probably also keeps you young."

To become pregnant, she used in vitro fertilization (IVF) treatment with donated eggs that were fertilized.

One doctor tried to persuade her to abort one or two of the fetuses, but she refused to consider it.

Indian woman holds record

Raunigk, who had her first child at 21, is still not the oldest woman to give birth.

That record is held by Rajo Devi Lohan, an Indian woman who at 70 became the world's oldest known first time mother after three rounds of IVF.

Her daughter Naveen will turn 7 later this year.

What are your thoughts about this story?

www.npr.org 

A couple of extra minutes attached to the umbilical cord at birth may translate into a small boost in neurodevelopment several years later, a study suggests.

Children whose cords were cut more than three minutes after birth had slightly higher social skills and fine motor skills than those whose cords were cut within 10 seconds. The results showed no differences in IQ.

"There is growing evidence from a number of studies that all infants, those born at term and those born early, benefit from receiving extra blood from the placenta at birth," said Dr. Heike Rabe, a neonatologist at Brighton & Sussex Medical School in the United Kingdom. Rabe's editorial accompanied the study published Tuesday in the journal JAMA Pediatrics.

Delaying the clamping of the cord allows more blood to transfer from the placenta to the infant, sometimes increasing the infant's blood volume by up to a third. The iron in the blood increases infants' iron storage, and iron is essential for healthy brain development.

"The extra blood at birth helps the baby to cope better with the transition from life in the womb, where everything is provided for them by the placenta and the mother, to the outside world," Rabe said. "Their lungs get more blood so that the exchange of oxygen into the blood can take place smoothly."

Past studies have shown higher levels of iron and other positive effects later in infancy among babies whose cords were clamped after several minutes, but few studies have looked at results past infancy.

In this study, researchers randomly assigned half of 263 healthy Swedish full-term newborns to have their cords clamped more than three minutes after birth. The other half were clamped less than 10 seconds after birth.

Four years later, the children underwent a series of assessments for IQ, motor skills, social skills, problem-solving, communication skills and behavior. Those with delayed cord clamping showed modestly higher scores in social skills and fine motor skills. When separated by sex, only the boys showed statistically significant improvement.

"We don't know exactly why, but speculate that girls receive extra protection through higher estrogen levels whilst being in the womb," Rabe said. "The results in term infants are consistent with those of follow-up in preterm infants."

Delayed cord clamping has garnered more attention in the past few years for its potential benefits to the newborn. Until recently, clinicians believed early clamping reduced the risk of hemorrhaging in the mother, but research hasn't borne that out.

Much of the research has focused on preterm infants, who appear to benefit most from delayed cord clamping, Rabe said. Preemies who have delayed cord clamping tend to have better blood pressure in the days immediately after birth, need fewer drugs to support blood pressure, need fewer blood transfusions, have less bleeding into the brain and have a lower risk of necrotizing enterocolitis, a life-threatening bowel injury, she said.

This study is among the few looking at healthy, full-term infants in a country high in resources, as opposed to developing countries where iron deficiency may be more likely.

The American Congress of Obstetricians and Gynecologists has not yet endorsed the practice, citing insufficient evidence for full-term infants. The World Health Organization recommends delayed cord clamping of not less than one minute.

It is unclear whether the practice could harm infants' health. Some studies have found a higher risk of jaundice, a buildup of bilirubin in the blood from the breakdown of red blood cells. Jaundice is treated with blue light therapy and rarely has serious complications.

Another potential risk is a condition called polycythemia, a very high red blood cell count, said Dr. Scott Lorch, an associate professor of pediatrics at the University of Pennsylvania Perelman School of Medicine and director of the Center for Perinatal and Pediatric Health Disparities Research at Children's Hospital of Philadelphia.

"Polycythemia can have medical consequences for the infant, including blood clots, respiratory distress and even strokes in the worst-case scenario," Lorch said. Some studies have found higher levels of red blood cells in babies with delayed cord clamping, but there were no complications.

Lorch also pointed out that this study involved a mostly homogenous population in a country outside the U.S.

"We should see whether similar effects are seen in higher-risk populations, such as the low socioeconomic population, racial and ethnic minorities and those at higher risk for neurodevelopmental delay," Lorch said.

So far, studies on delayed cord clamping have excluded infants born in distress, such as those with breathing difficulties or other problems. But Rabe said these infants may actually benefit most from the practice.

These babies often need more blood volume to help with blood pressure, breathing and circulation problems, Rabe said. "Also, the placental blood is rich with stem cells, which could help to repair any brain damage the baby might have suffered during a difficult birth," she added. "Milking of the cord would be the easiest way to get the extra blood into the baby quickly in an emergency situation."

ANGUS CHEN

www.npr.org 

If you're in the hospital or a nursing home, the last thing you want to be dealing with is bedbugs. But exterminators saying they're getting more and more calls for bedbug infestations in nursing homes, hospitals and doctor's offices.

Nearly 60 percent of pest control professionals have found bedbugs in nursing homes in the past year, according to an industry survey, up from 46 percent in 2013. Bedbug reports in other medical facilities have gone up slightly. Thirty-six percent of exterminators reported seeing them in hospitals, up from 33 percent. Infestations seen in doctors' offices rose from 26 percent to 33 percent in the past two years.

"Nursing homes would be difficult to treat for the simple reason you don't use any pesticides there," says Billy Swan, an exterminator who runs a pest-control company in New York City. That and the fact that there's a lot more stuff. "Somebody's gotta wash and dry all the linens, you know, and all their personal artifacts and picture frames."

Those personal belongings might help account for the big disparity in infestations between nursing homes and hospitals, according to Dr. Silvia Munoz-Price, an epidemiologist at the Medical College of Wisconsin who studies infection control in health care facilities. "The more things you bring with you, the more likely you're bringing bedbugs, if you have a bedbug problem... and you live in a nursing home, so all your things are there."

By contrast, "When bedbugs are located in a hospital, they're usually confined to a couple of hospital rooms," Munoz-Price says.

And it may be easier for hospital staff to spot bedbugs.

"Hospital cleaning staff, nurses, doctors are extremely vigilant," says Jim Fredericks, chief entomologist for the National Pest Management Association, which conducted the survey along with the University of Kentucky. "[Bedbugs] don't go unnoticed for long."

And hospitals are typically brightly lit, routinely cleaned places. It's just much easier to find pests in this setting than in a dark movie theater, where only 16 percent of pest professionals report seeing bedbugs, according to the survey.

Fredericks says the recent multiplication of bedbug reports in medical facilities is just a part of a larger trend. Exterminators have been finding more of the bugs everywhere the parasites are most commonly found like hotels, offices, and homes, where virtually 100 percent of pest control professionals have treated bedbugs in the past year. And they've been popping up in a few unexpected places, too, like a prosthetic leg and in an occupied casket.

"There are a lot of theories as to why they've made a comeback," Fredericks says. It could be differences in pest management practices, insecticide resistance, or just increased travel. "Bottom line is nobody knows what caused it, but bedbugs are back." He falters for a moment. "And they're most likely here to stay."

The good news is bedbugs aren't known to transmit any diseases, and a quick inspection under mattresses or in the odd nook or cranny while traveling can lower the risk of picking the hitchhiking bugs up. Swan says a simple wash or freezing will kill any bedbug. "If you came home, took off all your clothes, put 'em in a bag – you'd never bring a bedbug home," he says. "But who does that?"

At least one reporter might start.

By Stephanie O'Neill

www.cnn.com 

It's the same age as Brittany Maynard, who last year was diagnosed with terminal brain cancer. Maynard, of northern California, opted to end her life via physician-assisted suicide in Oregon last fall. Maynard's quest for control over the end of her life continues to galvanize the "aid-in-dying" movement nationwide, with legislation pending in California and a dozen other states.

But unlike Maynard, Packer says physician-assisted suicide will never be an option for her.

"Wanting the pain to stop, wanting the humiliating side effects to go away -- that's absolutely natural," Packer says. "I absolutely have been there, and I still get there some days. But I don't get to that point of wanting to end it all, because I have been given the tools to understand that today is a horrible day, but tomorrow doesn't have to be."

A recent spring afternoon in Packer's kitchen is a good day, as she prepares lunch with her four children.

"Do you want to help?" she asks the eager crowd of siblings gathered tightly around her at the stovetop.

"Yeah!" yells 5-year-old Savannah.

"I do!" says Jacob, 8.

Managing four kids as each vies for the chance to help make chicken salad sandwiches can be trying. But for Packer, these are the moments she cherishes.

Diagnosis and pain

In 2012, after suffering a series of debilitating lung infections, she went to a doctor who diagnosed her with scleroderma. The autoimmune disease causes hardening of the skin and, in about a third of cases, other organs. The doctor told Packer that it had settled in her lungs.

"And I said, 'OK, what does this mean for me?'" she recalls. "And he said, 'Well, with this condition...you have about three years left to live.'"

Initially, Packer recalls, the news was just too overwhelming to talk about with anyone --including her husband.

"So we just...carried on," she says. "And it took us about a month before my husband and I started discussing (the diagnosis). I think we both needed to process it separately and figure out what that really meant."

Packer, 32, is on oxygen full time and takes a slew of medications.

She says she has been diagnosed with a series of conditions linked to or associated with scleroderma, including the auto-immune disease, lupus, and gastroparesis, a disorder that interferes with proper digestion.

Packer's various maladies have her in constant, sometimes excruciating pain, she says, noting that she also can't digest food properly and is always "extremely fatigued."

Some days are good. Others are consumed by low energy and pain that only sleep can relieve.

"For my kids, I need to be able to control the pain because that's what concerns them the most," she adds.

Faith and fear

Packer and her husband Brian, 36, are devout Catholics. They agree with their church that doctors should never hasten death.

"We're a faith-based family," he says. "God put us here on earth and only God can take us away. And he has a master plan for us, and if suffering is part of that plan, which it seems to be, then so be it."

They also believe if the California bill on physician-assisted suicide, SB 128, passes, it would create the potential for abuse. Pressure to end one's life, they fear, could become a dangerous norm, especially in a world defined by high-cost medical care.

"Death can be beautiful"

Instead of fatal medication, Stephanie says she hopes other terminally ill people consider existing palliative medicine and hospice care.

"Death can be beautiful and peaceful," she says. "It's a natural process that should be allowed to happen on its own."

Stephanie's illness has also forced the Packers to make significant changes. Brian has traded his full-time job at a lumber company for that of weekend handyman work at the family church. The schedule shift allows him to act as primary caregiver to Stephanie and the children. But the reduction in income forced the family of six to downsize to a two-bedroom apartment it shares with a dog and two pet geckos.

Even so, Brian says, life is good.

"I have four beautiful children. I get to spend so much more time with them than most head of households," he says. "I get to spend more time with my wife than most husbands do."

And it's that kind of support from family, friends and those in her community that Stephanie says keeps her living in gratitude, even as she struggles with the realization that she will not be there to see her children grow up.

"I know eventually that my lungs are going to give out, which will make my heart give out, and I know that's going to happen sooner than I would like — sooner than my family would like," she says. "But I'm not making that my focus. My focus is today."

Stephanie says she is hoping for a double-lung transplant, which could give her a few more years. In the meantime, next month marks three years since her doctor gave her three years to live.

So every day, she says, is a blessing.

http://news.nurse.com 

A small study by researchers at The Ohio State University Wexner Medical Center found that a workplace mindfulness-based intervention reduced stress levels of employees exposed to a highly stressful occupational environment, according to a news release.

Members of a surgical ICU at the academic medical center were randomized to a stress-reduction intervention or a control group. The eight-week group intervention included mindfulness, gentle stretching, yoga, meditation and music therapy in the workplace. Psychological and biological markers of stress were measured one week before and one week after the intervention to see if these coping strategies would help reduce stress and burnout among participants.

Results of this study, published in the April 2015 issue of Journal of Occupational and Environmental Medicine, showed levels of the chemical salivary alpha amylase, were significantly decreased from the first to second assessments in the intervention group. The control group showed no changes. Chronic stress and stress reactivity have been found associated with increased levels of salivary alpha amylase, according to the release. Psychological components of stress and burnout were measured using well-established self-report questionnaires. “Our study shows that this type of mindfulness-based intervention in the workplace could decrease stress levels and the risk of burnout,” one of the study’s authors, Maryanna Klatt, PhD, associate clinical professor in the department of family medicine at Ohio State’s Wexner Medical Center, said in the release. “What’s stressful about the work environment is never going to change. But what we were interested in changing was the nursing personnel’s reaction to those stresses.”

Klatt said salivary alpha amylase, which is a biomarker of the sympathetic nervous system activation, was reduced by 40% in the intervention group.

Klatt, who is a trained mindfulness and certified yoga instructor, developed and led the mindfulness-based intervention for 32 participants in the workplace setting. At baseline, participants scored the level of stress of their work at 7.15 on a scale of 1 to 10, with 10 being the most stressful. The levels of work stress did not change between the first and second set of assessments, but their reaction to the work stress did change, according to the release. 

When stress is part of the work environment, it is often difficult to control and can negatively affect employees’ health and ability to function, lead author Anne-Marie Duchemin, PhD, research scientist and associate professor adjunct in the department of psychiatry and behavioral health at Ohio State’s Wexner Medical Center, said in the release. “People who are subjected to chronic stress often will exhibit symptoms of irritability, nervousness, feeling overwhelmed; have difficulty concentrating or remembering; or having changes in appetite, sleep, heart rate and blood pressure,” Duchemin said ih the release. “Although work-related stress often cannot be eliminated, effective coping strategies may help decrease its harmful effects.” 

The study was funded in part by the OSU Harding Behavioral Health Stress, Trauma and Resilience Program, part of Ohio State’s Neurological Institute.

 Gary Morley and Lisa Cohen

www.cnn.com 

Every time she competes in a race, she knows she'll collapse in a sobbing heap at the finish line.

Unable to feel her legs, she'll crumple into the arms of her athletics coaches. Ice-cold water will be applied to calm the misfiring nerve fibers blazing beneath her numb skin.

The teenager has gone through this post-race trauma for the past five years since being diagnosed with multiple sclerosis.

"Every day that I run, it might be my last day -- I could easily wake up tomorrow and not be able to move," the 19-year-old American tells CNN's Human to Hero series. 

"My initial MS attack caused lesions and scarring on my brain and my spine that affects the areas that are in control of how I feel my legs. So when I am overheated the symptoms reappear because my neurones start misfiring more.

"You can never really get used to the lack of feeling and the change of sensation, no matter how long you go through it. Every time it is still a bit of a shock and it's scary -- it freaks me out a little bit."

After five to 10 minutes she's able to get back on her feet again and start walking around, albeit a little stiffly as feeling slowly returns to her lower body.

It sounds like a nightmare ordeal that would put anyone off an athletics career, but Montgomery is determined to pursue her running dream.

She's actually faster now than before her diagnosis -- which, she says, was a painfully long and uncertain process following an accident playing soccer, falling hard on her neck and tailbone.

"It was really scary. I was so young. Most people with MS aren't diagnosed until their mid to late 20s, 30s. There wasn't anybody my age to relate to and understand what I was going through," she recalls. 

"It took so long to get back results and we were ruling things out and leaving MS as the last option. For a while they thought maybe it was cancer."

When the diagnosis finally came, it sent Montgomery into a spiral of anger, depression and denial.

She avoided confronting the issue with her parents -- Keith, a salesman, and mom Alysia, recently qualified as a nurse -- and younger sister Courtney.

"I tried to pretend I wasn't sick or anything -- I wanted to go on with life as normal as possible," Kayla says.

"Nobody at school knew, and we were not allowed to talk about it at home. I just avoided it at all costs, and that actually made it a lot harder. 

"The first couple of years after my diagnosis were impossibly hard -- I was so alone and still really scared. It was definitely a darker time in my life."

Running has proved to be her salvation. After a short break, in which she received treatment that made the numbness temporary, Montgomery decided she was going to make use of her legs while she still could -- despite knowing that exertion would bring back the symptoms.

"I wasn't amazing by any means but I was eighth on the team, so if somebody got hurt then I was there! And I wanted to be there if they needed me, so I trained so hard all the time and that definitely helped to deal with the things I wouldn't talk about," she says.

Montgomery's determination to succeed won her the North Carolina high school state title in the 3,200 meters last year, as she ran the 21st fastest time in the U.S.

She was team captain at Mount Tabor High School, setting several age-group records, and also excelled off the track in cross-country.

Now a freshman on an athletics scholarship at Nashville's Lipscomb University, she is studying molecular biology and has dreams of becoming a forensic scientist.

But before a career in CSI beckons, Montgomery is making the most of her chance to run for the college team.

"Racing is one of the greatest feelings in the world. I love it," she says. 

"Long-distance running is my favorite ... you have to have so much stamina, strength and determination. I like to push myself to my limits for as long as I can."

One of the big challenges is staying on her feet during a race. If she gets knocked over or falls, which sometimes happens, then it's difficult to get up again -- especially in the later stages.

"If it is a track meet you can't grab on to something, whereas cross country there might be a tree close by that you can pull yourself up on," Montgomery explains.

"It all depends on when I fall as to how it will affect the outcome of my race."

Montgomery trains three hours a day, six days a week, covering 60-75 miles.

Without being able to judge pace through her legs, she has learned a new way to run, by focusing on the movement of her arms.

The hard work is paying off. Lipscomb is a Division One university in NCAA competitions, giving her an elite platform on which to impress.

It's a long way from those early high-school days when she asked her coach, mentor and "second father" Patrick Cromwell about her chances of running at college level.

"He said, 'I don't know, you might be lucky if you can be a walk-on.' I was like, 'Well I'll show you, I'm going to run in college and not only that I'm going to run for a D1 school.' And I am! 

"Lipscomb is one of the best, it's really awesome to achieve that once really far-fetched dream."

Montgomery was actively recruited by Lipscomb, the first school to contact her -- others also rang "but a lot of them never called back" after she explained her condition.

"They made me feel so welcome," she says of her first visit to Lipscomb's campus. "They all knew my situation and it didn't bother them, and they didn't acknowledge it or ignore it either. It was exactly what I was looking for."

Her debut collegiate cross-country season was a steep learning curve, but Montgomery helped Lipscomb win a fourth successive conference championship in November, placing 13th overall and seventh in her team in the 5 km race.

On the track, she was sixth in the 10,000 meters last weekend as Lipscomb's women's team finished third at the Atlantic Sun championships in Florida, its best result at the event -- and a continuation of its rapid improvement since Bill Taylor, who recruited Montgomery, took over the athletics program in 2007.

She says the coach has given her the confidence to keep pushing herself, having taken a chance on her even though he realizes she may not be able to fulfill the four years of her scholarship if her condition gets worse.

"I keep running because it makes me happy," Montgomery says. "It makes me feel whole and safe, just because I know as long as I am running and still moving, I am still OK."