DiversityNursing Blog

Planning on celebrating the July 4^th holidays with fireworks? Follow these tips and you’ll be fine. Please share with your friends and co-workers.

BY MAGGIE FOX

www.nbcnews.com 

Hospital workers wash their hands hundreds of times a day. Nurses are constantly using alcohol gels, chemical wipes and iodine washes on themselves and on patients.

Now that there's a hand sanitizer dispenser at every hospital room door, it's time to check that they actually do work as well as everyone assumes and that they are safe, the Food and Drug Administration says.

So FDA issued a proposed plan Thursday for reclassifying some of the products, and for requiring makers to show they are safe and effective.

"We're not asking for any of these products to come off the market at this time."

In the meantime. FDA says, there's nothing for consumers to worry about and hospitals should continue using the products as they have been.

"What it seems they are doing is good due diligence," says Dr. Susan Dolan of Children's Hospital Colorado and the Association of Professionals in Infection Control.

"They are trying to look at the products, look at how they are being used today, how things have changed," she added.

The FDA proposes new rules making companies submit new studies looking at safety issues such as whether heavy, chronic use of the some of the products may cause them to soak in through the skin, or cause resistant bacteria to evolve.

Products that are not shown to be safe and effective by 2018 would have to be reformulated or taken off the market.

"We're not asking for any of these products to come off the market at this time. We're just asking for additional data," Theresa Michele, a director in FDA's drug center, said in an interview with The Associated Press. "And we're likewise not suggesting that people stop using these products."

Alcohol, iodine benzalkonium chloride and other germ-killers have been used for decades. But not to the degree that they are now.

"Twenty years ago you didn't find people using antiseptic gels 100 times a day. It just didn't happen," Michele said.

FDA points to studies that show some of the products might be absorbed into the body at higher levels than previously thought, showing up in blood and urine. Dolan says not all the studies show this, but it's worthwhile doing more checks.

"It's timely and it makes sense," Dolan said. "I do think consumers should not be worried. These are very effective products."

The FDA last updated its review of health care hand cleaners in 1994.

"They are trying to look at the products, look at how they are being used today, how things have changed."

"We emphasize that our proposal for more safety and effectiveness data for health care antiseptic active ingredients does not mean that we believe that health care antiseptic products containing these ingredients are ineffective or unsafe, or that their use should be discontinued," FDA said in its announcement.

The agency agreed to complete its review after a three-year legal battle with the Natural Resources Defense Council, an environmental group that accused the FDA of delaying action on potentially dangerous chemicals. In 2013 the FDA agreed to a legal settlement that included timetables for completing the review of various chemicals, including health care cleaners.

Environmentalists are mainly concerned about an ingredient called triclosan, which is used in most antibacterial soaps marketed to consumers. The agency issued a separate review of triclosan-containing consumer products in late 2013, saying more data are needed to establish their safety and effectiveness.

Bailey Johnson 

Some people like skydiving. Good for them. Some of us would prefer to stay on the ground where it's safe. But, you know, this video is sort of comforting in a way, because it shows that skydiving instructors are well-trained and know how to respond in a crisis. In another way, of course, this video is ABSOLUTELY TERRIFYING.

The video description has it all: "Possibly the scariest moment of my life. On the 14th of November 2014 while doing stage five of my Accelerated Free Fall program I have a near death experience. At around 9000ft I have a seizure while attempting a left hand turn. I then spend the next 30 seconds in free fall unconscious. Thankfully my jumpmaster manages to pull my ripcord at around 4000ft. I become conscious at 3000 ft and land safely back to the ground."

Yeah, we'll be staying on the ground, thanks.

Source: http://whatstrending.com

By LINDSAY CROUSE

When Paula Radcliffe won the New York City Marathon in 2007, nine months after giving birth to a daughter, Isla, Radcliffe was considered an anomaly. Her intense training through her pregnancy, which included twice-a-day sessions and grueling hill workouts, was scrutinized and criticized.

Seven years later, maintaining a top running career and a family has become relatively common. About a third of the women in the professional field of 31 for the New York City Marathon next Sunday have children.

“I watched Paula win New York, basically leading from the starting gun to the finish tape, and afterward she picked up her baby,” said Kara Goucher, a top American marathoner. “I realized I can do both. And I want to do both.”

Goucher, 36, finished third in the 2008 New York City Marathon, and this year she will run the New York race for the first time with her 4-year-old son, Colt, cheering her on.

When she contemplated having a child, Goucher engaged in the careful strategizing common to elite female athletes, who consider precisely when to become pregnant so as not to risk missing out on an Olympic medal or sacrificing a corporate sponsorship.

Elite female distance runners now run competitive times well into their late 30s. The average age of a top female marathoner is 30, and 19 women in next Sunday’s professional field are that age or older.

As athletic peaks for these top runners have overtaken fertility peaks, the decision to combine motherhood and training has become increasingly unavoidable. Competitive careers are stretching: The American Deena Kastor, expected to be another top finisher next Sunday, is 41.

“I always wanted to have a child,” Goucher said, “and I didn’t want to wait until I was done, because I don’t really see an end date on my career. I wanted more in my life than just running. But the details of how you do that can get incredibly complicated.”

Elite runners often try to squeeze in a pregnancy and recovery in the 16-month window between world track championships in years with no Summer Olympics. This is one such year, and pregnancies abound.

Maternity leave in professional running is rare. A pregnancy is still frequently treated as if it were an injury, and women can experience a pay cut or not be paid at all if they do not compete for six months. During that period, they often remain bound to sponsors in exclusive contracts that can last upward of six years. Because the athletes are independent contractors, they are not covered by laws that protect employed women in pregnancy.

Lauren Fleshman, an N.C.A.A. 5,000-meter champion and a professional runner, switched to a women’s-oriented sponsor, the running apparel company Oiselle, before having a son in June 2013.

Referring to Goucher and Radcliffe, Fleshman said: “Kara and Paula showed that pregnancy doesn’t necessarily need to be an impediment to the athletic part of our careers, and blew up the vestiges of the myth of the ‘fragile woman’ who can’t be both a top athlete and a mother. But in terms of your career, there’s still the feeling that if you say you want to have a kid, you’re saying you don’t want to be an athlete.”

It does not help that so many people seem to have an opinion on the matter. After Alysia Montaño, a 2012 Olympian, ran an 800-meter race in June during her eighth month of pregnancy, her decision became the subject of intense public scrutiny.

“I wanted to help clear up the stigma around women exercising during pregnancy, which baffled me,” Montaño said. “People sometimes act like being pregnant is a nine-month death sentence, like you should lie in bed all day. I wanted to be an example for women starting a family while continuing a career, whatever that might be. I was still surprised by how many people paid attention.”

Montaño’s daughter was born in August.

“Giving birth is a very athletic activity, like going through intervals on the track,” Montaño said. “Like contractions, intervals can start out easy and progress as they get harder. There’s sometimes a point where you wonder, ‘Can I do one more set?’ But you know you’re going to make it. And then you kick to the finish.”

Other women have chosen different paths.

Clara Horowitz Peterson, a former top runner at Duke, focused on starting a family in her mid-20s, aiming for a racing peak afterward. Now 30, she is pregnant with her fourth child.

“I think if I’d chosen to train at altitude and log 120-mile weeks, I could have made it to the Olympics,” said Peterson, who typically runs 80 to 90 miles a week when not pregnant. “But that comes with sacrifices; you put your career first, and before you know it, you’re 28, maybe confronting fertility issues. I always felt like having children was more important to me than a running career.”

Still, Peterson ran right up until the births of her first three children. She qualified for the 2012 United States Olympic marathon trials just four months after delivering her second child, and she logged a 2-hour-35-minute time at the race four months later.

“I trained hard through that pregnancy,” Peterson said. “You can tell when you’re pushing it. You get twingy, or feel tendons pulling, so I backed off when that happened.”

To bounce back for the trials, Peterson said, she breast-fed her second child for only five weeks — finding that the hormones related to breast-feeding made her feel sluggish — and dropped the 20 pounds she typically gained during pregnancy in eight weeks without dieting. (She breast-fed her third child for six months.)

The understanding of women’s physical resilience during and after pregnancy has also developed in recent years.

“We still don’t have good science to guide us,” said Dr. Aaron Baggish, associate director of the cardiovascular performance program at Massachusetts General Hospital in Boston, which counsels elite athletes through pregnancy. “But unequivocally I think women should exercise through pregnancy, both for their baby and their own health. The body has evolved that way. Your baseline fitness level is the best guideline: Elite athletes start out with a higher threshold, so they can do more.”

After athletes give birth, efforts to get back into shape are consuming, coupled with the usual adjustments to caring for an infant. Breast-feeding interrupts the sleep that heals spent muscles and restores energy to a tired body. Babies are often kept out of group day care to prevent them from bringing home illnesses that could compromise rigid training plans.

Pregnancy can be hard to combine with any job. As in other fields, partners are generally a key component of elite athletes’ ability to continue their careers after having children.

Edna Kiplagat, a 35-year-old Kenyan who is among the favorites in next Sunday’s race, had two children before becoming a two-time marathon world champion and the 2010 winner in New York.

Her husband and coach, Gilbert Koech, gave up his running career to focus on hers and manage their family, making breakfast for their five children, three of whom are adopted, and taking them to school while Kiplagat trains.

Goucher’s husband, Adam, retired from professional racing a year after their son’s birth and started a running-related business. He tries to balance supporting her racing career with managing his new one, saying that he and Kara work to share equally in caring for Colt.

“Kara’s putting her body through a lot right now,” her husband said, “and we need to do everything possible to alleviate the stress of training. When she needs to go out and run, or needs to rest and recover, that’s my first priority.”

Goucher said she was taking the trade-offs in stride.

“It’s scary because the fact is for all women when you have a child, you do need to drop out for a long time, and you don’t know how you’ll come back,” she said. “It’s a huge risk. Of course, I’m serious about my job, but in life I needed to be more than that. So I think it was worth it.”

Source: www.nytimes.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