DiversityNursing Blog

By NAOMI CHOY SMITH

When Doctors Without Borders nurse Monia Sayah first arrived in Guinea in March, she couldn't have known she would witness the worst Ebola outbreak in history. Back then, there were 59 confirmed deaths from Ebola, a virus which can be fatal in up to 90 percent of cases. The death toll in West Africa has since soared to 932, the World Health Organization said Wednesday. In Guinea, where the first cases were reported in March, Ebola has killed 363 people.

"The fear is palpable," Sayah said, speaking to CBS News in New York after returning from her latest assignment. "People are very afraid because they never know if Ebola's going to hit their family or their village."

Because of the fear and stigma associated with the virus, Sayah said many infected people are choosing to hide their illness and often don't check in to treatment centers until it is too late. By that point, there is very little Sayah and her colleagues can do. They try to rehydrate the patients and administer antibiotics. But there is no proven treatment for Ebola, though an experimental drug is currently being tested.

Concerns have also been growing for the safety of medical workers in the field. A leading doctor died in Sierra Leone last week. A Nigerian nurse who treated that country's first Ebola victim died from the virus, Nigerian health officials said Wednesday, and two American medical missionaries infected with Ebola in Liberia are still battling the virus at Emory University Hospital in Atlanta.

But Sayah, who has spent a total of 11 weeks in Guinea, said she is not afraid. She and her colleagues take strict precautions to limit their risk of exposure. Before entering a high-risk zone, they suit up in head-to-toe protective clothing including gloves and goggles. "You do have to follow the rules," she said, "but accidents do happen."

She has to limit the amount of time she spends in the infected area. It's hot under the protective clothing, and exhaustion and dehydration are serious concerns. "The risk is you could faint, you could fall. You do not want to fall in a high-risk area," she said. "Maybe your goggles will move up and your eye will be infected."

Working so closely with patients at death's door has taken a personal toll. Sayah described the anguish of stepping outside a treatment facility to take a quick break from the intense heat, only to find that her patient had died in those ten minutes she was away. "It was really hard for me to know that they had died alone," she said, "not with someone holding their hands and reassuring them."

Sayah recalled the "hectic" challenges of setting up some of the first international treatment facilities for Ebola patients. By the end of May, she said, the medical community thought they had almost contained the virus. But soon after she left Guinea, another cluster of infected patients was found in another village. The virus was spreading like wildfire.

Several factors are contributing to the spread. The virus has an incubation period of up to 21 days, according to the WHO, and in West Africa the population is highly mobile, moving easily across porous cross-country borders. Traditional burial ceremonies in which relatives have direct contact with the body can also play a role in the transmission of Ebola.

Sayah found that many local communities distrust the healthcare system and foreigners. "Some have said we brought the Ebola to them," she said. "It's very difficult to contain the outbreak when communities are not cooperating." There were instances of infectious patients leaving the facility, she said, and many weren't receptive to the idea of isolation -- a crucial step in containing the virus.

During her breaks from the field, Sayah stays in touch with her colleagues on the front lines, hoping for the slightest bit of good news. Just this past week, she heard some. One of the patients who'd been under her care was discharged from hospital, apparently free of the virus.

But the situation on the ground remains dire, and Sayah hopes to see a greater response from the international community.

Despite the challenges, Sayah said she will return to West Africa to fight the outbreak. "When you're there and you see how much needs to be done," she said, "there is not a question of 'should I go back or not?'"

Source: www.cbsnews.com

By Lisa Esposito

When forensic nurse examiners work with survivors of violence – sexual assault, child abuse, elder abuse or domestic assault – they’re painstakingly collecting and documenting evidence that can hold up in a potential court case. And they’re taking care of a person who’s just been traumatized, often by someone they know well. Forensic nursing takes a balance of objectivity, skill and compassion, and it’s more than just a job for the professionals who do it.

Experts on the Stand

Whatever type of assault they’ve endured, survivors’ first encounter with law enforcement or medicine “paves the way for their entire future,” says Trisha Sheridan, a forensic nurse and clinical assistant professor at Texas A&M Health Science Center College of Nursing.

Victims face a higher risk of post-traumatic stress disorder, depression, suicide and medical problems in the aftermath, she says, and those who “have a positive experience with someone who’s trained to deal with victims of violence” tend to not only have better legal outcomes, but better quality of life than others who receive standard emergency care. But in Texas, especially the more rural areas, forensic nurse examiners are few and far between.

While certified forensic nurse examiners undergo extensive skills training, Sheridan believes graduate programs can move forensic nurses to the next level, with a deeper understanding of the science behind the evidence they’re collecting, helping them explain the pathology and ramification of victims’ injuries in a courtroom. For instance, she says that information helped the jury “make a better-informed” decision when she testified in two recent cases of strangulation.

Taking On Domestic Violence

Strangulation is one of the most frequent injuries in domestic violence, yet symptoms are subtle and often downplayed, says Heidi Marcozzi, coordinator of the Intimate Partner Violence Program, started last year as a branch of District of Columbia Forensic Nurse Examiners, which also works with victims of sexual assault.

Forensic nurses look not only for bruises and scratches, but less obvious symptoms such as petechiae (small red or purple spots on the skin), voice changes, cough and headaches, Marcozzi says. They ask patients about loss of bowel and bladder function, which is a good indicator that they lost consciousness during the attack.

“Domestic violence is a huge issue” in the nation’s capital, Marcozzi says. The program’s 30 forensic nurses respond to these calls from MedStar Washington Hospital Center, anytime day or night. Within an hour of getting the call for a domestic violence case, the forensic nurse arrives at the hospital, where ER staff have already made sure the patient is in a quiet, private space rather than the waiting room.

Before the exam, the forensic nurse walks the patient through the whole process. “We see a fair amount of drug-facilitated sexual assaults, so we want to make sure it’s very clear that the patient is able to consent,” Marcozzi says. “Then we do a medical exam head to toe to make sure they’re physically stable.” Nurses pays close attention while patients describe the incident and use that account to guide where they collect evidence, including swabs that will later go to the crime lab for analysis.

The FNE photographs any injuries and examines the patient using a high-powered light source that can reveal hard-to-see signs like bruising. The light also helps the nurse locate "foreign secretions ... things will fluoresce under certain wavelengths – semen, urine, saliva,” Marcozzi says.

More Than Just a ‘Rape Kit’

Victims of sexual assault go through essentially the same process, with the addition of a pelvic exam, which takes an additional 15 minutes or so. Examiners photograph the genitals for signs of injury, and then collect swabs as indicated. Treatment comes next. If appropriate, patients can receive Plan B emergency contraception to prevent unwanted pregnancy, or medications to protect against HIV and other prevalent sexually transmitted infections.

In sexual assault cases covered by DCFNE, an advocate with Network for Victim Recovery of DC accompanies the nurse to the hospital and helps patients with crisis management, discharge plans, crime victim’s compensation and referrals for counseling.

Preventing the Worst

For domestic violence victims, the DCFNE program teams up with Survivors and Advocates for Empowerment, a nonprofit that provides advocacy and crisis intervention, and works to hold offenders accountable. SAFE runs the lethality assessment project for the District of Columbia – trying to determine which victims are at highest risk for being killed by their abusers.

Advocates evaluate the victim’s environment for cues – such as whether the abuser has easy access to weapons, or even “if there’s a child in the home who doesn’t belong to him, which, believe it or not, increases the severity of the risk,” says Natalia Marlow-Otero, SAFE director.

Of the 5,000 or so domestic violence cases SAFE sees each year, up to 1,900 are deemed high-lethality cases. Isolation is a “huge” factor among the women – and some men – who are victims of domestic violence. Isolation and abuse are even more prevalent among immigrant clients, Marlow-Otero says, so SAFE provides an English/Spanish helpline (1-866-962-5048). People can also call the National Domestic Violence Hotline at 1-800-799-7233 (1-800-​799-SAFE). ​

Source: http://health.usnews.com

Source: www.rntobsnonlineprogram.com

Source: http://onlinenursingdegrees.maryville.edu

By Vivien Mudgett

Chances are, if you have been a nurse for more than six months, you have been exposed to bullying or disruptive behavior. Research shows that more than 82% of nurses have been a target of bullying or have witnessed it. Over 60% of new nurses who experienced bullying are planning to leave their jobs. The frightening part of these statistics is that bullying is underreported!

Defining Bullying

Bullying is not an isolated incident. It is deliberate, rude, inappropriate, and possibly aggressive behavior of a coworker(s) to another coworker. The behavior is repetitive in nature, and may be overt or covert. It can also reflect an actual or perceived imbalance or power or conflict.

Bullying and disruptive behavior has been recognized as a threat to a nurse’s well-being and a threat to the safety of our patients. When a care team cannot get along, errors are made, patients feel the tension, and patient outcomes suffer.

As nurses, we are all working today in a very stressful environment with heavy workloads. More demands are being added on almost a daily basis. We are struggling to take good care of our patients and the stakes are high. Adding bullying to this equation makes the situation worse.

The paradox of bullying in nursing is that we all joined this marvelous profession because we are caring individuals. We want to show our compassion and be a healing presence to others. So how is it that this behavior is so prevalent in nursing? Research shows that the behavior continues because nurses are afraid of retaliation, normalize the behavior, don’t like conflict, and don’t really know what to do.

Here are 3 steps you can take to address this uncaring behavior in a caring way:

1. Stop and breathe!

   Separate yourself from the behavior for a moment and realize that YOU are not the cause.

2. Diffuse the situation.

   Do not react. Sometime reacting too fast can cause you to behave unprofessionally as well. As calmly as possible, ask to talk in private. If the behavior continues, be prepared to be the one to walk away.

3. Address the behavior.

   Find a private place to openly discuss the behavior and address the conflict.

   Two open ended discussion starters can be:  

   “When you yelled at me in front of the patient (or our co-workers), I felt humiliated. It was unprofessional and now the patient’s trust in the healthcare team has eroded. Was that your intent? Can we agree that in the future, if you have a problem with me, you will address it with me privately?”

   “Are you OK? Help me to understand the situation. I’ve noticed a conflict between us and I think it’s affecting the way we work, can we talk about it?”

In a perfect world, these 3 steps can alleviate and resolve the conflict between nurse co-workers. However, be prepared that it may take further discussion and possibly, include your unit supervisor or nurse manager. By addressing uncaring behavior, you are standing up and choosing not to be a victim.  

If you see someone else being bullied, don’t be a passive bystander. Stand next to the person and use supportive phrases while helping the person being bullied. This is especially if they are not able to speak for themselves at that moment. Most importantly, and most difficult to do: Stay calm, be confident, and always behave with integrity. Take the higher road.

Have you dealt with nurse bullies in the past? How did it go? Let us know in the comments.

Source: nursetogether.com

By Alison Stanton

When Joanne Clavelle was 12 years old, she began working as a candy striper at a Vermont hospital.

It didn't take her long to realize that she had found what she was meant to do.

"I used to feed patients, change their water pitchers and make eggnog with real eggs," Clavelle says. "After a couple of years of being a candy striper, the nurses at the hospital sort of adopted me, and I moved into a volunteer aide position in the emergency department. I got to wear a white uniform with white stockings and shoes; I thought I was in heaven."

Clavelle was hired as an EKG technician at the same hospital when she was 16. She worked every weekend doing what she loved.

Her dedication to outstanding patient care caught the eye of three physicians at the hospital.

"The doctors had a scholarship program," Clavelle says. "They gave me a scholarship, which helped pay for me to go to nursing school at the University of Vermont.

Thirty-plus years later, Clavelle is still as passionate as ever about her career as a nurse and providing top-notch patient care. Five months ago, she was named senior vice president and chief clinical officer at Scottsdale Healthcare.

"I absolutely love my job here," she says. "I have the opportunity to create a nursing infrastructure that focuses on outstanding patient care and ensures that we maintain our Magnet designation."

This designation, Clavelle says, is given to the top 8 percent of hospitals in the country.

"It recognizes organizations like ours that create a supportive environment for nurses to practice and provide high-quality care," she says. "I am committed to creating a culture where nurses and other providers give the best care possible. That's what it's really all about."

When she is not working, Clavelle enjoys painting.

Watercolors are especially appealing to her, and she takes art classes whenever she can.

Clavelle also likes to spend time with her husband, their adult children and their 14-year-old dog.

Even though Clavelle has spent the past 36 years working in health care, she says things amaze her — in a good way — about her work.

"I was pleasantly surprised and proud to learn that our hospital has a forensic-nursing program, and we also have a wonderful military partnership with the United States Air Force," she says. "It's a unique model for graduate nurses in the Air Force to participate in a number of programs, including a nurse-transition program and critical-care and emergency-trauma-nursing fellowship."

Who's Who in Business 2014

Joanne Clavelle is one of 50 women in various fields profiled in "Who's Who in Business 2014," a publication of Republic Media. Find the full publication online at azcentral.com in July.

Source: azcentral.com

By Nurse.com

This fall, Duquesne University in Pittsburgh will become the first academic institution in the U.S. and globally to offer a dual degree in nursing and biomedical engineering for undergraduate students, according to a news release.

“Duquesne has pioneered the integration of clinical knowledge and patient care with engineering techniques in a single program, creating the first bachelor’s degree of its kind,” Provost Timothy Austin, PhD, said in the release.

The five-year program will provide students with a foundational body of knowledge that keeps patient care and practical application at the core of studies supporting innovations and technological advances.

The joint degree could prove a tremendous value to employers and patients, said John Viator, PhD, director of Duquesne’s biomedical engineering program. 

By gaining actual clinical experience, students also will develop new perspectives with respect to a patient’s health and functional needs. “Engineers do not always fully appreciate the hospital culture and the clinical needs of patients,” Mary Ellen Glasgow, RN, PhD, FAAN, dean and professor of the School of Nursing, said in the release. “This dual degree gives our students both the engineering and nursing perspectives to solve real world clinical problems.” 

In addition to learning engineering and nursing, students will benefit from class and clinical experiences that incorporate the Toyota Production System principles (used to address safety, cost and efficiency) and the American Association of Critical Care Nurses’ Synergy Model. 

Job opportunities for biomedical engineers are expected to grow 27% between 2012 and 2022, and nursing careers are expected to expand by 19% in the same timeframe, according to statistics from the Bureau of Labor Statistics. With the combined knowledge and skills of the two disciplines, opportunities may be limitless for the “nurse engineer,” Viator and Glasgow predict.

“Our students will begin their careers with the preparation, knowledge and worldview usually seen in those with years of experience in the field,” Austin said in the release. “This exciting BME/BSN partnership illustrates Duquesne’s innovative academic programs and the university’s focus on preparing students with the knowledge and skills to serve others.” 

Source: nurse.com

BY JAMIE DAVIS

First up in this week’s news is a look at an article on humor and the mental health of senior citizens I found over at healthday.com. A new study from researchers at Loma Linda University in California looked at the effects of the stress hormone cortisol on aging patients’ memory and mental acuity. They studied the possibility that laughter might lower the effects of cortisol on the seniors.

Healing Power of Funny Videos

Two groups of senior citizens were shown a funny 20 minute video and then were tested on their memory and mental acuity as well as cortisol levels. This was then compared to tests on a group who did not see the video. The subjects who saw the funny video were found to score better on the memory tests and had lower cortisol levels suggesting that regular exposure to funny and humorous things can improve memory and mental state of seniors.

The study was presented recently at the Experimental Biology conference in San Diego. One of the authors summed up the research saying, “it’s simple, the less stress you have, the better your memory.” This doesn’t mean that we need to be comedians in the midst of our care for patients but it does point to the core nursing tenet that when we treat the whole patient we manage their overall health better.

Make sure your hospitals have access to humorous videos and movies in their in-house TV system. Maybe even share a suggested funny YouTube video of the day with your patients who wish to view it. When appropriate, you could even open up your patient interactions with a simple joke. Maybe “why did the chicken cross the road” will be a precursor to better patient interactions in the future.

Source: nursingshow.com

By Melissa McGlensey

Melvyn Amrine, of Little Rock, Ark., may not remember the details of his life since his Alzheimer's diagnosis, but he recently proved that his love for his wife transcends memory.

Melvyn was diagnosed with Alzheimer's disease three years ago and since then it hasn't been easy for his wife, Doris, CBS News reported. Melvyn at times doesn't remember details like whether he proposed to his wife, or vice versa. However a recent holiday prompted Melvyn to remember the most important thing.

On the day before Mother's Day, Melvyn went missing. Considering he normally requires assistance to do any walking, his family was alarmed and notified the police.

When police found Melvyn, he was 2 miles from his house and he was resolute in his goal, according to Fox 16. He was going to the store to buy flowers for his wife for Mother's Day, just like he had done every year since they had their first child.

Sgt. Brian Grigsby and Officer Troy Dillard were touched by Melvyn's determination, and decided to help the elderly man complete his mission by taking him to a store and even paying for the flowers.

"We had to get those flowers," Grigsby told CBS News. "We had to get them. I didn't have a choice."

Melvyn's flowers made a very sweet surprise for his wife of 60 years, Doris, as well as a reminder to the rest of us that love knows no obstacles.

"When I saw him waking up with those flowers in hand, it just about broke my heart because I thought 'Oh he went there to get me flowers because he loves me,'" Doris told Fox 16.

She added to CBS News: "It's special, because even though the mind doesn't remember everything, the heart remembers."

Source: Huffingtonpost.com

By Ilene MacDonald

Despite new technology and evidence-based guidelines, medical mistakes happen too frequently and may lead to as many as 400,000 preventable deaths each year.

But two new programs, launched at the University of Virginia Medical Center, offer a new approach to patient safety that may prevent medical errors, WVTF Public Radio reports.

This year the organization introduced a simulation lab in the pediatric intensive care unit. The "Room of Errors" features high-tech infant mannequins attached to monitors. When doctors and nurses enter the lab, they have seven minutes to determine what is wrong.

As part of a recent exercise, a doctor-nurse team worked together to spot 54 problems with the scenario, including the fact the ventilator wasn't plugged into the correct outlet, the heat wasn't turned on and the potassium chloride was programmed at the wrong concentration.

The interpersonal, team-based learning approach helps doctors and nurses improve their ability to make decisions together and communicate with one another, Valentina Brashers, M.D., co-director of the Center for Interprofessional Research and Education, an effort headquartered at UVa's Schools of Nursing and Medicine, told WVTF.

"Knowing that there are others that you can work to think with you and share with you their concerns as you work through difficult problems makes care provision a much more enjoyable and rewarding activity. It reduces staff turnover. It creates an environment where we feel like we're all in it together with the patient," she said.

The pilot proved so successful that the medical center intends to roll it out to the entire hospital.

In its quest to eliminate medical mistakes at the organization, UVa also launched a second patient safety initiative that calls for hospital administrators to meet each morning to talk about any problems that occurred in the previous 24 hours, according to a second WVFT article.

The "Situation Room" features white boards and monitors, where administrators review every new infection and unexpected death and then visit the places where the problems took place.

Sometimes the solutions are easy fixes, such as a receptionist who removed a mat that caused patients to trip at the entrance of an outpatient building. Others, caused by communication problems, are more complicated, Richard  Shannon, M.D., executive vice president for health affairs, told the publication. To address it, Shannon wants to shake up the medical hierarchy where the physician sits at the top.

"The physician may spend 20 minutes at the bedside a day. The nurse is there 24/7 and has about 13 times more direct contact with the patient than does the physician," he told WVFT. "You can't have someone at the head of the pyramid who is absent a lot of the time."

Finally, to encourage better communication among caregivers, patients and families, Shannon now encourages healthcare professionals to make rounds in the afternoon, when visitors are on premises.

Source: fiercehealthcare.com