PENS Reporter, Summer 2014 by AMP, Inc

VOL 26/NO 1

PENS

eporter

A bi-annual publication of the Pediatric Endocrinology

President’s

Nursing Society

Report

ood Day my Nursing colleagues!

In This Issue: 1 President’s Report 3 Meet Your Board of Directors 4 PENS Recognizes Select Members at 2014 Conference 5 Commitee Reports 7 The Highlights of PENS 2014 6 PENS E-Community – Join Us! 10 Bylaw Vote 2014 11 Bylaws Revision 2014 16 Annotated Bibliographies 17 Clinical Exemplar Submissions

I’m happy to write this note to you today as I reflect on our PENS Conference in Louisville this year. It was a great conference from the content, location, food and the time to network with each other! I think this was my 15th conference maybe? It seems my spring is always planned around the PENS conference. I can tell you that I look forward to it every year and find a way to make it happen in my life! PENS, to me, is more than just an organization, it is a life force on its own, so unique that it draws people in and keeps them in! From Kathy Clark as our founding PENS president who still comes to this day and participates as well as so many others… to (as we reviewed during our Leadership Lunch this year) those who stay on and keep sharing, learning and giving to PENS. Friendships are made across the miles, states and countries through PENS. This year at the end of our conference we had a wonderful speaker named Donna White who talked about “Compassion Fatigue.” She did an amazing job talking about what we all know so well and live every day. I know that we are all really busy with work and family and further responsibilities that we may find it hard to put any more into something. When Donna asked who in the crowd had at least 8 hours of sleep per night I put my hand up. She looked at me kind of puzzled as I was the only one with my hand up! She said “Where are you from?” I realized during her talk that I was an “anomaly” as a PENS nurse who did not feel all this “Compassion Fatigue” any longer. It has not always been this way! I’ve been living with Crohn’s disease since I was 14 years old, having had surgeries and plenty of procedures/drugs. I was inspired to be a nurse through the amazing care I received. I went on to get married, have a child and a full time job in Peds Endo Nursing. A few years later I was not doing so well. This was when a good friend once told me when I said I was having “a stressful day” with personal and work issues that “there is no such thing as a stressful day, it’s simply and opportunity to better manage your emotions, once you realize the impact of your attitude on your life you will not feel stressed.” I thought about that and read that statement dozens of times as I had it posted on my wall continued on page 2

P.O. Box 14516 Lenexa, KS 66285-4516  913.895.4628  877.936.7367  FAX: 913.895.4652  pens@goAMP.com www.pens.org

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2014-2015 President Nicole Kirouac, BN, RN nkirouac@hsc.mb.ca President-Elect Maryann Johnson, BSN, RN magj25@gmail.com Treasurer Linda Burkett, MSN, RN, CDE linda.j.burkett@medtronic.com Secretary Lisa M. Davis, MSN, CPNP davispnp@gmail.com

“President’s Report” continued from page 1 for over 10 years. I spent many hours reading and driving to work listening to audio books from world leaders like Wayne Dyer, Deepak Chopra, Louise Hay, Lisa Nichols, Bob Proctor and so many more. Somehow over time I have managed to accept that statement from my very good friend as truth, he was right, there is no such thing as a “stressful day.” To this day I am forever thankful as I stepped into this role as PENS President with excitement not nerves, with confidence and the knowledge that together we can continue to make PENS the amazing organization that was created over 25 years ago! “If you don’t like something, change it. If you can’t change it, change your attitude.” Maya Angelou Thank you for being part of this amazing organization we call PENS and I look forward to having all of you benefit as much as I have from all of us!

Nicole Kirouac RN BN PENS President

Director Carol Van Ryzin, RN, CPNP carol.vanryzin@yahoo.com Director Terri Lipman, PhD, CRNP lipman@nursing.upenn.edu Immediate Past President Catherine P. Metzinger, AAS, RN, CDE Patricenewman60@gmail.com Executive Director Jerrie Lynn Kind jlkind@goAMP.com

The PENS Reporter is published quarterly by the Pediatric Endocrinology Nursing Society (PENS). Views expressed herein do not necessarily reflect the opinion of PENS. Copyright © 2014 Pediatric Endocrinology Nursing Society Editor Lisa M. Davis, MSN, CPNP Akron Children’s Hospital PENS Executive Office P.O. Box 14516 Lenexa, KS 66285-4516 Direct: 913.895.4628 Toll-Free: 877.936.7367 Fax: 913.895.4652 Website: www.pens.org COPY SUBMISSIONS Please submit all future articles or items by e-mail to Lisa Davis at davispnp@gmail.com. Subject: PENS Reporter Item

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Meet Your Board of Directors

Nicole Kirouac, BN, RN President

Maryann Johnson, BSN, RN President–Elect

Linda Burkett, MSN, RN, CDE Treasurer

Lisa M. Davis, MSN, CPNP Secretary

Carol Van Ryzin, RN, CPNP Director

Terri Lipman, PhD, CRNP Director

Catherine P. Metzinger, AAS, RN, CDE Immediate Past President

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JerrieLynn Kind Executive Director

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PENS RECOGNIZES SELECT MEMBERS AT 2014 CONFERENCE PENS was pleased to honor the following members at the Awards Luncheon in Louisville during the conference: Excellence in Education Award – Amy Albrecht, MSN, CPNP Excellence in Advanced Practice Award – Jan Foote, DNP, ARNP, CPNP Winners of these two awards receive a one year-membership in PENS and an award certificate for display.

Poster Awards This year we are pleased to have received a grant from the Human Growth Foundation sponsoring this portion of our program. We thank them for the support! Nursing Research Poster Winner – Stephanie Woerner, RN, MSN, FNP-C, CDE, Poster #3 – Autonomy of Children with Type 1 Diabetes on Insulin Pump Therapy Case Study Poster Winner – Amy Drilling, BSN, RN and Jane Torkelson, RN, MS, Poster #4 – Complication of Untreated Congenital Hypothyroidism Informational Poster Winner – Rebecca Thompson, BSN, RN, CDE, Poster #14 – Strategies for Improving Patient and Family Education in Diabetes Care Novice Poster Winner – Kristine Welsh, CPNP, Poster #11, A Low Fat Recipe for Insulin Resistance PENS Also Recognized: Cindi Gordner for her previous role as Grant Director and Terri Lipman for her years served as PENS Column Editor – thank you for your service to PENS!

Congratulations to all of the PENS Conference Reimbursement Award Winners!

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COMMITTEE REPORTS Research

Education

Committee

Committee Members: Erin Booth, MSN, RN, CDE; Linda Burkett, MSN, RN, CDE; Sharron Close, PhD, MS; Maureen Dever, MSN, RN, CPNP-BC, CDE; Joan Fusick, BSN, RN; Carol Howe, PhD, RN, CDE; Kevin Lewis, DNP, RN, PNP-BC, CDE; Stephanie Woerner, MSN, RN, FNP-C Grant Director: Cindi Gordner, MSN, RN Board Liaison: Terri Lipman, PhD, CRNP, FAAN Purpose of the Committee: To promote, present, mentor and support pediatric endocrine research activity in the PENS organization Summary of Projects: PENS Research Abstracts and Posters: 16 abstracts were approved for poster presentation at the 2014 PENS Conference in Louisville, and submitted for publication in the Journal of Pediatric Nursing in the following categories: 3 nursing research, 8 case presentation, 3 informational, and 2 product-based research. Poster award winners will be announced at this conference. PENS Travel Grants: Six poster presenters were awarded conference reimbursement awards to attend the 2014 PENS Conference. PENS Grant Activity: No new grant applications were submitted this year. Nursing research and evidence-based practice grant applications are due annually on February 1st.

Committee Members: Kathy Clark, RN, MSN, PNP-BC; Rebecca Crespi; Patty Graves, RN, CPNP; Helen Grosskreuz, BSN, RN; Mako Sather, MSN, RN, CPNP; Traci Schaeffer, BSN, RN; Nancy Varni, MS, MBA, RN, CPNP; Colleen Weber, RN, BSN; Robin Witherow, RN Board Liaison: Carol Van Ryzin, RN, CPNP Purpose of the Committee: Under the direction of the Board of PENS, the Education Committee is responsible for developing educational projects/materials to meet the educational needs of the members and the families they serve. Summary of Projects: The committee has created an educational resource page for members only. There are 14 topics on the educational page (more to come) with educational resources for peds endo nurses, families, medications and patient support. The PENS Manual Chapters are also on the website and available for use. We are working on a CE reference page for members to use for their own continuing education. Cathy Flynn, MSN, RN, CPNP – Chair continued on page 6

PENS Research Session: Two grant recipients are presenting their research at the 2014 conference. Sharron Close is presenting Diagnosis Disclosure in Klinefelter Syndrome: A Process Model. Carol Howe is presenting Parent Health Literacy and Communication with Diabetes Educators in a Pediatric Diabetes Clinic: A Mixed Methods Approach. Jan M. Foote, DNP, ARNP, CPNP – Chair

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“Committee Reports” continued from page 5

Conference Planning

Committee

Nominating

Committee

Committee Members: Sherry Trunnel RN, CDE; Mary Burr MS, RN, CPNP Board Liaison: Nicole Kirouac, BN, RN Purpose of the Committee: The primary focus of the Nominating Committee has been to develop and present a slate of candidates from which the PENS membership will select its Board members and Nominating Committee members. Summary of Projects: Communication was maintained with teleconference meetings with the committee members. A slate of candidates was chosen for election for PresidentElect, Secretary, Director and Nominating Committee. The following members were elected to office beginning at the conclusion of the 2014 conference:  President-Elect – Maryann Johnson, BSN, M.Ed  Secretary – Lisa Davis, MSN, CPNP  Director – Terri Lipman, PhD, CRNP, FAAN  Nominating Committee – Patty Graves, RN, CPNP, CDE and Colleen Weber, RN We would like the membership to consider running for an office in the future. A total of 37.6% of the voting members voted, only a slight decrease over last year which was 40.0%. Please be sure you take the few minutes to vote in the next election! Fran Waite, RN – Chair

Committee Members: Kelly DeGrote, RN; Maryann Johnson, BSN, M. Ed.; Meg Keil, PhD, CRNP; Cheryl Switzer, MSN, RN, BPNP; Valerie Verdia, RN Board Liaison: Cathy Metzinger, AAS, RN, CDE Purpose of the Committee: Plan a 3 1/2 day conference with a minimum of 19 CEs including at least two general sessions per day, and multiple concurrent sessions addressing the educational needs of novice endocrine nurses, advanced practice endocrine nurses, and endocrine nurses who are diabetes educators. Summary of Projects: Reviewed evaluations of past programs, trends and needs assessment. Developed format and content of current program; reinstated Endocrine and Diabetes Case Studies. Developed a call for abstracts for concurrent sessions. Selected speakers for all conference sessions; increased Diabetes offerings in each concurrent session and several general sessions. Conducted monthly conference planning committee calls. Communicated with membership via e-blasts regarding various aspects of the conference planning process. Assisted at the conference with logistical activities, moderating sessions and introduction of speakers. Instituted formation of Buddy Program for New Members/First Timers. Assisted in forming 2015 conference planning committee. Initiated the selection of the program artwork and slogans for the 2015 PENS conference in Savannah, Ga. Tamara Nenadovich, RN – Chair

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THE HIGHLIGHTS OF PENS 2014

he PENS 2014 Conference was an awesome success! From top-notch education sessions to a packed exhibit hall talking to vendors to enjoying time with our sponsors at various events! If you did not have a chance to attend this year, we are sorry you missed it! Thank you to all of our attendees, vendors and sponsors who made this conference such a wonderful experience for us all!

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“Highlights” continued from page 7

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Have you joined the new PENS E-Community? Why wait? Start now! Communication between PENS members just got easier!  We are excited to offer our members information about our E-Community forums which are located in the Members Only section of our website. We have two forums open for members like you to interact with one another! Current Forum Topics include: General Peds Endo and Diabetes.

How do I sign up (subscribe)? Simply sign in to the Members Only section with your ID number and password. If you need your ID number, check your Insider email or contact us at PENS@goAMP.com. If you have not personalized your password, your password is: “PENS12.” If you have forgotten your password, use the links on that page to reset it. Once you are logged in, click on the “Communities” link on the upper right of the page. Once there, you can view our Rules and Regulations document in the Announcements section as well as peruse the different forum titles. To join a forum, simply click “subscribe” on the desired forum.

How does it work? Once subscribed, you will be able to interact with other PENS members by posting questions/comments pertaining to the specific topics. An email alert will be delivered to you when there is activity in the forum to which you have subscribed. To remove yourself from a specific forum, simply click “unsubscribe.”

Posting Tips

while composing a post (20-30 minutes), it is possible that the system will “time out” which will cause you to receive an error when attempting to post your message. The post may then be lost and need to be re-composed.  Editing Messages Please be sure to proof messages prior to posting (clicking the save button at the bottom of the screen). While the Forums provide the ability to go back and “edit” your post, please be aware that every edit that is made will be re-posted to all committee members resulting in multiple alerts going out. Practicing Tip #1 will assist with preventing the need to go back and edit posts.  Responding to Messages When you receive the notification email that a posting has been created, you must be logged in to the community to reply. If you are continuously logged in, you can click the link in the email and your response will be posted. However, if you are not logged in, your response will not post. It is best to come to the community and sign in to respond effectively. As nurses, we know we get a lot of great information from one another. This tool will allow you to ask questions and get answers directly from your peers! We hope that you enjoy the community and get the most out of this member benefit. If you have questions or problems, please do not hesitate to contact us.

 Lengthy Messages If you plan to post a lengthy message, it would be wise to write it out in a Word document first then copy and paste the text to the Forum when you are ready to post it. If you are interrupted or otherwise delayed

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BYLAW VOTE 2014 – JULY 2014 Dear Members: Your PENS Board of Directors have spent the last year in discussions and preparations for a new Strategic Plan for the Society laying the groundwork for activities over the next few years. In doing so, we’ve proposed a new mission and vision statement for the organization. Because PENS’ Bylaws must be amended prior to implementing the new plan, the Board looked very carefully at the current bylaws and are proposing the following bylaws be accepted for change by the membership. In March, we also presented a survey to the membership to get its thoughts on some of the proposed bylaw changes. While the survey responses were limited, we felt that this member feedback was important and it led to lively discussion at our Board meetings.  In response to the question “PENS Board members cannot be employed by industry,” an overwhelming 47% of respondents answered that they disagreed with this statement. However, in a subsequent question, “The PENS President cannot be employed by industry,” over 65% of respondents agreed with this statement. This solidified the Board’s thoughts that we need to clearly identify the role of the PENS President as being an individual who does not have any undue influence on the Board or organization as a whole by industry. Therefore, you will see that we have addressed this item in the proposed bylaws changes.  Another question we sought responses to was “The PENS President-Elect position may only be filled by a current or past Board member who has served at least two years in a prior capacity.” Forty-nine percent of respondents disagreed with this statement providing concerns that such a stipulation might make it harder for our nominating committee to get members to run for positions with this limitation. The Board’s reasoning for this change is that the workings of the organization is complex and having a President-Elect who has had no prior experience in the leadership with PENS may not be as knowledgeable as someone who has previously served in a leadership role. The Board also asked a subsequent question, “The PresidentElect position may only be filled by a current or past Board member or Committee Chair who has served at least two years in a prior capacity.” By opening this option to committee chairs, the respondents were in favor of this option by 53% with 33% disagreeing and the remainder choosing the neither agree nor disagree option. These responses were very helpful in our Board discussions and we are proposing the www.pens.org

change for the President-Elect position to have served in some capacity with PENS in a leadership role. This role can either be Board or committee service as a chair or committee member. We feel these volunteers have knowledge of PENS and are reasonably aware of the efforts for the very important role of PresidentElect and subsequent presidency of our organization. This would exclude a president-elect candidate who may not have been previously involved with the organization in a leadership role.  In addition to these important issues, our new mission and vision statement are being proposed to the membership. Under the presidency of Isabel Couto and continuing through Cathy Metzinger, we worked with a strategic planner to help us determine these two statements. Our current bylaws state goals which, while relevant, really belong in an organization’s strategic plan and not a bylaws document. While PENS has never had a vision statement, we thought it was very important to create a vision statement along with our new strategic plan. Vision and strategy are both important. But there is a priority to them; vision should come first. If you have a clear vision, you can more easily begin to form your strategies. We hope that you will agree! In the following document, you will see our current bylaws along with our proposed bylaws and the rationale for the proposed changes (in maroon highlights). We’d like each member to read over the bylaws and ask us any questions about clarity that you may have. In August, each voting member of PENS will have the opportunity to individually vote on each new change. The vote will be taken via our electronic mechanism and will take place from August 1-August 31. Please take time in the coming weeks to read and understand the document you will be asked to approve. Any questions may be directed to JerrieLynn Kind, Executive Director at PENS@goAMP.com. Frequently asked questions will be compiled and posted on our website with the answers for all to view. We hope that you will take advantage of this time to make your voice heard by voting for the proposed bylaws. Sincerely,

Nicole Kirouac, President

JerrieLynn Kind, Executive Director 10

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Pediatric Endocrinology Nursing Society Bylaws Revision 2014 Existing Bylaws

Proposed New Bylaws

Article I Name and Affiliation The name of the Society shall be the Pediatric Endocrinology Nursing Society. The Society may also be known as PENS.

Rationale for Proposed Changes No change recommended.

Article II Purpose, Mission and Goals A. Mission The mission of PENS is to provide members with resources to advance pediatric endocrinology nursing.

Article II Mission, Purpose and Vision A. Mission The Pediatric Endocrinology Nursing Society (PENS) is committed to the development and advancement of nurses in the art and science of pediatric endocrinology nursing.

B. Purpose The Pediatric Endocrinology Nursing Society is committed to the advancement of the art and science of pediatric endocrinology nursing. This includes the establishment and continued development of standards of practice, the enhancement of nursing research, the advancement of clinical expertise, and the promotion and recognition of excellence in nursing practice.

B. Purpose No change recommended. The Pediatric Endocrinology Nursing Society is committed to the advancement of the art and science of pediatric endocrinology nursing. This includes the establishment and continued development of standards of practice, the enhancement of nursing research, the advancement of clinical expertise, and the promotion and recognition of excellence in nursing practice.

C. Goals The goals of PENS are as follows: A. Develop standards of practice for pediatric endocrinology nursing. B. Establish standards of patient/ family education related to pediatric endocrinology. C. Advance knowledge through research and evidence-based practice in the area of pediatric endocrinology. D. Promote collaboration between health professionals practicing in pediatric endocrinology.

C. Vision The Pediatric Endocrinology Nursing Society will be renowned for its commitment to education and research, thus empowering nurses worldwide to provide optimal care for children with endocrine disorders.

Article III Membership, Dues, and Meetings A. Membership Section 1. Founding Members Individuals who were steering committee members as of November 6, 1986. Founding members have all the rights, responsibilities and privileges of active members.

Article III Membership, Dues, and Meetings

Change in verbiage to match new categories. To provide an updated mission statement in line with our organizations values.

Goals are a part of the organization’s strategic planning process and must have the ability to change fluidly with the growth of the Society. PENS goals are stated in its Strategic Plan. Identifying and communicating a clear VISION is one of the most important functions for any business. Having a clear, effective and shared vision defines the values of our organization and a strong vision also leads to improve productivity and efficiency.

No change recommended.

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“Bylaws Revisions 2014” continued from page 11 Existing Bylaws

Proposed New Bylaws

Rationale for Proposed Changes

Section 2. Active Members Individuals who have licensure as registered nurses and are interested in pediatric endocrinology nursing. Active members may hold an office, chair or serve on a committee, and vote.

Section 2. Active Members Individuals who are licensed as nurses and individuals who are licensed as advanced practice nurses and are dedicated to pediatric endocrinology nursing. Active members may hold an office, chair or serve on a committee, and vote.

Section 3. Associate Members Individuals who are allied health care professionals or are employed in marketing and service areas with an interest in the area of pediatric endocrinology. Associate members are eligible for all rights, responsibilities and privileges of active members except those of holding office, chairing committees and voting.

Section 3. Associate Members Individuals who are allied health care Include sales with marketing for professionals or are employed in market- employment area. ing/sales and service areas with an interest in the area of pediatric endocrinology. Associate members are eligible for all rights, responsibilities and privileges of active members except those of holding office, chairing committees and voting.

ARTICLE IV Board of Directors A. The organization shall be governed by the Board of Directors. The Board of Directors includes the President, Immediate Past President, President-Elect, Secretary, Treasurer, and two Directors.

Section 1. President The President shall be the Chief Elected Officer of the Society and shall 1) preside at the meetings of the Board of Directors and at the annual membership meeting; 2) serve as an ex-officio member of all committees except the Nominating Committee; and 3) perform such other duties as directed by the Board of Directors. Section 2. Immediate Past President The Immediate Past President shall 1) assist and advise the President in the performance of the President’s duties; and 2) substitute for the President when requested.

Scope widened to include Advanced Practice Nurses (APN) and include Licensed Practical Nurses (LPN) and Licensed Vocational Nurses (LVN).

Section 4. Emeritus Members Individuals who are retired nurses over 55 years of age who are not currently New membership category. Allows employed in nursing, and have been an current, active members to retire and PENS member for ten (10) continuous maintain membership in the Society. years prior to the status change from active membership to retired status. Dues are one-half of the active membership annually. This addition is to not put undue influence of industry onto the organization by the president.

No change recommended.

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“Bylaws Revisions 2014” continued from page 12 Existing Bylaws Section 3. President-Elect The President Elect shall 1) assist the President in the performance of the president’s duties as requested; 2) learn the duties of the President; 3) substitute for the President or Immediate Past President as requested; and 4) assume the office of President at the end of the President’s term. Section 4. Secretary The Secretary shall 1) record all minutes of the meetings of the Board of Directors and of the annual membership meeting; and 2) perform such other duties as may be delegated by the Board of Directors.

Proposed New Bylaws Section 3. President-Elect The President Elect shall 1) assist the President in the performance of the president’s duties as requested; 2) learn the duties of the President; 3) substitute for the President or Immediate Past President as requested; and 4) assume the office of President at the end of the President’s term. The PresidentElect position may only be filled by a member who has served in a current or past PENS leadership role.

Rationale for Proposed Changes Addition of stipulation to require President-Elect position to have served on the PENS Board or leadership role in a previous capacity prior to taking on this important leadership role. A PENS leadership role is defined as a previous board or committee chair/member who has demonstrated leadership within PENS.

No change recommended.

Section 5. Treasurer The Treasurer shall manage the finances of the Society, in collaboration with Board.

No change recommended.

Section 6. Director Directors shall serve on the Board of Directors and shall carry out responsibilities as delegated by the Board of Directors.

No change recommended.

B. Term of Office Section 1. The President shall serve a one-year term as President-Elect, a one-year term as President, and a one-year term as Immediate Past President.

No change recommended.

Section 2. All other board members shall serve a two-year term. Board members shall serve no more than two consecutive terms in any one office or more than a total of six consecutive years on the board. Past presidents who wish to serve a second term as president must remain off the board for at least three years prior to running for president-elect. Past presidents who wish to serve in another office must remain off the board for at least one year prior to running for that other office.

Section 2. All other board members shall serve a two-year term. Board members shall serve no more than two consecutive terms in any one office or more than a total of seven consecutive years on the board. Past presidents who wish to serve a second term as president must remain off the board for at least three years prior to running for president-elect. Past presidents who wish to serve in another office must remain off the board for at least one year prior to running for that other office.

Section 3. The term of office shall begin at the close of the convention in the year of election.

Section 3. The term of office shall begin at the close of the conference in the year of election.

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With new requirement for President-Elect to have previously served in a leadership position, this term must be increased.

Change of wording from “convention” to “conference.” continued on page 14 13

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“Bylaws Revisions 2014” continued from page 13 Existing Bylaws Section 4. Terms of office shall be staggered. The Secretary and one Director shall be elected in even years, and the Treasurer and one Director shall be elected in odd years.

Proposed New Bylaws Section 4. Terms of office shall be staggered. The Secretary and one Director shall be elected in even years, and the Treasurer and one Director shall be elected in odd years.

C. Vacancy Section 1. The President-Elect shall fill a vacancy in the office of President. Other vacancies shall be filled by appointment by the Board of Directors.

Rationale for Proposed Changes No change recommended.

No change recommended.

Section 2. Any member filling a vacancy for an unexpired term of more than one year is deemed to serve one term.

No change recommended.

D. Removal from Board The Board of Directors may, by affirmative majority vote of the board, remove a member of the board for cause.

No change recommended.

ARTICLE VI Nominating Committee and Nominations for Office A. There shall be an elected five member Nominating Committee, two of whom may be employed by industry. B. The term of office shall be two years. Terms shall be staggered. A member shall serve no more than two consecutive terms.

No change recommended.

C. The Nominee for the Nominating Committee who receives the highest number of votes in even years shall chair the Committee.

C. The Immediate Past President will be the chair of the Nominating Committee.

Proposed change recommends the Immediate Past President chair this committee; bringing better insights to the needs/talents of prospective leadership.

D. The Nominating Committee shall nominate eligible candidates for the Board of Directors and the Nominating Committee.

No change recommended.

E. All Active members shall be eligible to be nominated to the Board of Directors.

E. All Active members shall be eligible to This change is to not put undue influence be nominated to the Board of Directors. of industry onto the organization by the If employed by industry, presidential president. positions may not be considered.

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“Bylaws Revisions 2014” continued from page 14 Existing Bylaws

Proposed New Bylaws

Rationale for Proposed Changes

F. The Nominating Committee will strive to propose a ballot that is balanced in terms of employment setting. No more than two members of the board shall be employed by industry.

F. Members of the Nominating Committee who wish to appear on the ballot for a position on the Board of Directors must resign from the Committee.

No change recommended

G. Members of the Nominating Committee who wish to appear on the ballot for a position on the Board of Directors must resign from the Committee.

G. A vacancy on the Nominating Committee shall be filled by the Board of Directors.

No change recommended.

H. A vacancy on the Nominating Committee shall be filled by the Board of Directors.

No change recommended.

ARTICLE VII Elections A. The Nominating Committee shall prepare a ballot that shall be reviewed by the Board of Directors prior to the election. B. Elections shall be by electronic (e-mail) ballot. C. A plurality vote for any office shall constitute election. In case of a tie, the election shall be determined by the Chair of the Nominating Committee by lot. D. All ballots shall be destroyed following the election. Other records pertaining to the election shall be preserved.

ARTICLE VII Elections

ARTICLE X Amendments Proposals for amendments to these bylaws may be initiated by action of the Board of Directors. Individual members may submit suggestions for bylaws revisions for consideration.

Bylaws shall be amended by mail vote of the membership wherein a majority vote of ballots received constitutes adoption of the amendment.

Bylaws shall be amended by email vote of the membership wherein a majority vote of ballots received constitutes adoption of the amendment.

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No change recommended.

No change recommended. No change recommended.

D. All records pertaining to the election shall be preserved.

Physical ballots are not kept as election is electronic, however, all electronic results will be preserved.

Facilitates conducting Society business electronically, which is more cost effective and secure as well as gives all members a chance to participate.

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ANNOTATED BIBLIOGRAPHIES Long-Term Metabolic and Immunological Follow-Up of Nonimmunosuppressed Patients With Type 1 Diabetes Treated With Microencapsulated Islet Allografts – Four cases

Cognitive Development in Congenital Hyopthyroidism: Is Overtreatment a Greater Threat Than Under treatment?

his is an interesting study that challenges some of our current thinking regarding treating children who have congenital hypothyroidism (CH). Past studies have shown that Thyroid Stimulating Hormone (TSH) should rapidly be normalized at the initiation of treatment in order to optimize preservation of IQ points later on.

our nonimmunosuppressed patients with longstanding T1DM received intraperitoneal transplant of microencapsulated human islets. The study followed the patient for 3 years. The results showed that the grafts did not elicit any immune response. All patients turned positive for C-peptide response. Daily mean blood glucose, as well as HbA1c levels significantly improved after treatment. The daily exogenous insulin consumption declined in all cases. This is an interesting study and shows a promising future towards a cure for diabetes. However, there are limitations noted as with many studies. A very small sample size and a limited time that the cases were followed (three years) are two that are obvious. The article does however comment on the cases and notes that at seven years post-transplant all patients have returned to full exogenous insulin needs. Mako Sather MSN, CPNP Basta, G, Montanucci, P, Luca, G, et al. (2011). Long-term Metabolic and Immunological Follow-up of Nonimmunosuppressed Patientis With Type 1 Diabetes Treated with Microencapsulated Islet Allografts. Diabetes Care, Volume 34, November 2011 (p 2406-2409).

This study from The Netherlands compares and contrasts overtreatment (OT) and under treatment (UT) as it relates to IQ testing at 11 years of age. The research question was whether early UT or OT had any effect upon later cognitive scores. Sixty-one subjects with congenital hypothyroidism were tested at 1.8 years of age using the Mental Development Index, 6 years of age using the IQ6 and 11 years of age using the IQ11. There were 207 control subjects who were also tested at these time intervals. Results showed that subjects with fast or moderate TSH normalization had higher scores on the Mental Development Index than those with slow normalization. However there was no significant effect on IQ by age eleven. Subjects who had long or short periods of time of OT lost IQ points by age 11 years compared to those who were never over treated. Under treatment without evidence of OT was associated with normal developmental scores while UT with episodes of OT resulted in lower IQ scores by age eleven. This study suggests that overtreatment during the first two years has a negative effect on cognitive development by eleven years of age although rapid normalization of the TSH at initiation of treatment did not seem to effect the IQ level at 11 years of age. Nancy Varni, MS, MBA, CPNP Bongers-Schokking, Jacoba J., et. al. “Cognitive Development in Congenital Hyopthyroidism: Is Overtreatment a Greater Threat Than Under treatment?”, Journal of Clinical Endocrinology and Metabolism, November 2013, 98(11): 4499-4506.

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CLINICAL EXEMPLAR SUBMISSIONS

eing new not only to the nursing profession but also to the endocrinology department, I have been overwhelmed but also excited at the opportunity to learn more about the endocrine system and the complex disorders that affect our patients. I am continually challenging myself to learn more every day so I can be an asset not only to the department but also to our patients. Being in the clinic setting, most of the contact that I have with families is over the phone, but I do see patients and families for education, training or injections. I enjoy when the doctor introduces me to a family in clinic and I get to learn a little more about the patient and the family member on the other end of the phone line. Building that trusting relationship between me and the family is a crucial starting point. One morning I was preparing my equipment so I could give a Lupron injection to an eight-year-old girl. I walked out to the waiting area and walked over to the patient sitting in a chair by her mother and said “hi.” She had her head turned away from me and was looking at me through the corner of her eye. I smiled and tried to start a conversation. I could see the fear in her eyes as she kept telling her mom that she didn’t want another shot. I noticed that she had been reading a book with her mother while waiting and asked her if she would like to bring the book with her. She nodded her head yes but made no move to come with me. It took about 10 to 15 minutes to convince her to come to the scale to be weighed and measured. As we walked to the scale she was clutching her mother’s arm so tightly, I could only imagine what she was feeling. As I was measuring and weighing her I tried to keep the conversation light and ask her questions about herself and things that she liked. She was very timid and would look to mom often for her to reply to me. After getting her weight and height, I grabbed our little cold pack and we headed down the hall to the patient room. As we were walking down the hall to the room I tried to think of what I could do to make her more comfortable, since I was a new nurse in the office and she had never been introduced to me before. I started to ask her about her specific interests at school and what subject she liked the most and the least. She started to open up a little and talk to me but would tell her mom after each response that she did not want a shot. When we arrived in the room, she sat in a chair and I explained to her that I would tell her what I was doing in a step-by-step process so she was never surprised and she knew what I was doing before www.pens.org

I did it. She just continued to look at mom and tell her she did not want a shot. Because of her agitation, I asked an MA to come in and help hold the patient for the injection. Mom was insistent that she could hold her upper body still in the chair while the MA kept her legs still and encased between her own legs. As we were setting the supplies to give the injection, as much out of her sight as possible, she just kept saying “no” over and over again. I tried to take her mind off of things by asking her questions but she was solely focused on what was to come. I explained to the mom that she could not move and that she needed to hold her daughter very still and keep her arms enclosed in hers and she expressed the understanding and said she could do it. As the MA placed her legs on the outside of the patients legs and used her hands to steady her leg so we could administer the injection in the thigh the child began to scream and cry. We gave her the cold pack to place on her leg close to where we would give the injection to help numb the area and maybe to focus on the cold and not the injection. I let her know I was going to clean the area with the alcohol swab and that it would just be a little cold. As she continued to scream and cry I counted to three and told her when I was poking her. As I put the needle into her thigh, she threw her arms up and mom let go of her and she tried to come out of the chair. With the needle in her leg, the MA quickly placed her one arm in her lap and forced her back down in the chair and had her hands trapped under her arm in her lap. I quickly finished the injection, but when the needle was removed from her leg the needle was slightly bent because of her movement. The MA quickly took the needle and disposed of it in the Sharps container so as not to upset mom. At this time my heart was racing and my hands started to shake. My adrenaline had kicked into overdrive once the injection was over. I had a mixture of feelings at this time. I was frustrated that the mother let go of her daughter and did not hold her still, I felt sympathy for the little girl and what she must be feeling, and I also felt relief that we were able to finish the injection without more serious consequences arising. Once the initial rush was over (which was only seconds) I started to praise her and tell her how well she did and how strong she was. I let her know that we had special prizes and that she could choose one because she was so brave and strong. She continued to cry but she smiled when she heard she could have a prize. Our MA went to the closet and brought back four different prizes continued on page 18 17

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“Clinical Exemplar Submissions continued from page 17 that she could choose from and she picked a pink blanket that she could wrap around her. I noticed that the more I praised her for doing a great job the more she started to respond to me and the more she would talk to me. As I watched them leave I had a good feeling and felt like I had started to break the ice with her so that the next time she came in she may be a little more comfortable with me. I realized after this situation that the parents

Clinical Exemplar Submission: Four-Year-Old Boy with Short Stature E.M. came to our clinic with a referral of short stature, so my original intention was to do a history and physical examination to help determine if his short stature was caused by problems with his endocrine system. He has been living with his grandmother for the past year due to permanent removal of his care from his mother. She had been identified as a heavy drug user of multiple drugs before, during and after each pregnancy. Since Grandma gained custody of E. and his siblings, she has been dealing with many social issues and their numerous health problems. Upon entering the exam room, it was obvious that this child had a very serious skin condition. I determined that Grandma’s main reason for seeking care in our clinic was to see if there was a connection between his being short and his skin condition. She had been told the two conditions might be related. My compassion for this grandma struggling with raising 3 young children was immediate. She has been struggling with navigating the medical system, which has often been unsupportive. At one point a physician actually scolded her and told her she was wasting his time. She had tears in her eyes when she related the incident to me. The degree of E.’s skin breakdown was severe and she had tried more than a dozen over-the-counter remedies as well as prescription medications without being able to find anything that offered E. some relief. He was a polite and engaging 4-year old with severe itching. His skin had numerous lichenifications and excoriations with thickening of his skin on all body surfaces – yet he followed directions and answered questions pleasantly. His big brown eyes filled with tears before my exam because he has experienced so much discomfort with this condition in the past. My heart went out to him as I played and teased with him a bit to gain his trust. Such a sweet little boy!

should be allowed to remain close to their child to provide comfort, but it is best if the professionals who are trained hold the child for the safety of not only the child but the professionals as well. This was a great lesson for me so I will be better prepared the next time. I am looking forward to continuing to learn and progress in the Endocrinology Department. Heather Evans

As I was talking to Grandma, my thinking about this encounter changed. Of course we needed to determine the reason for his short stature, but even more important was the need to support this grandma in her efforts to advocate for her child. Her priority was clearly his comfort, with his stature being a secondary concern. When we mentioned a referral to a pediatric dermatologist at a university medical center some distance away, she did not hesitate to let us know she would do whatever it took to help him. What I have concluded from this experience is that we can follow an algorithm to help us apply evidence-based science in diagnosing and treating our patients, but nothing can replace human compassion for our patients. We may need to alter our original goals in meeting a patient’s needs based on our assessment of the whole child and family. In this situation, it became clear that dealing with E.’s skin condition was the priority. Once this is dealt with properly, we will have time to deal with the less life-altering issue of his growth. As I struggle to learn a new job and fit into a new clinic situation, it’s easy to have my thoughts consumed with all the medical tests, labs and pathophysiology of this area of specialty. I must remind myself that my patients are coming to me only after they have already experienced not only medical issues, but also frustrations with navigating a complicated medical system. This was a great reminder to me that sometimes the needs of the provider must be altered to best serve the needs of our patients. There is no better feeling than helping someone bring comfort to someone they love. Susan Lathrop

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“Clinical Exemplar Submissions continued from page 18

s a new Pediatric Endocrinology nurse I have learned so much over the last year. It has been an interesting transition from my last job in Labor and Delivery. I am loving every day working with kids with endocrine disorders. In our practice we try very hard to calm our kids before any procedure. We try to give them a sense of confidence and security so as not to feel as anxious. No one likes to get a shot or an IV and I am the one who has to do most of these procedures in our office. So I have tried to find ways to help distract the children and give them that sense of confidence and security. We recently had a patient come in for a growth hormone stimulation test who was filled with anxiety. You could see the tears forming in her eyes as I entered the room and started explaining the procedure to her and her parents. As we talked about the IV I noticed her eyes getting bigger and bigger. In our practice we use “magic spray” to numb the skin before we insert the needle. She was intrigued by this so I sprayed a little on her arm so she could feel it. She was so excited about the magic spray. As we moved on to the IV procedure, the girl looked up at me and asked again in her sweet little voice, “Is it going to hurt?” I explained that it would be like a little pinch, and that with the magic spray, she would not feel much. As her fear subsided, she took a deep breath and the procedure was finished within a minute. She looked at me and said, “Was that it?” Feelings of relief were all over her face. We also saw a young boy who was crying from the moment his name was called to come back and be weighed and measured. He was scared and wanted to be anywhere else but in our office. I knew this little guy was going to need some convincing. I remembered that a few days previous, I had happened upon some light up bracelets at the dollar store. I picked them up in hopes that I might be able to use them in the office one day. This seemed like the perfect moment. As I explained the magic of the bracelet to the little boy, he started to calm down. There were three settings on the bracelet, blink slow, blink fast and glow. I explained that when he was really scared, he needed to press the blink fast button and he would be amazed by the wonder of the bracelet. As we started the procedure, I noticed that he had pushed the blink button.

There are some children though who are so worked up and scared that it is very hard to even talk to them. We usually have a medical assistant or even our nurse practitioner come in to help with each of our IV procedures which has proven very helpful. They are sometimes able to distract these patients while the procedure is performed. Once it is over, most children respond well as they realize that it was not as bad as they thought it would be. A few months ago, a patient came in for her first Lupron shot. As I walked into the room, the little girl was sitting on the table, kicking her legs back in forth and gripping tightly to the edge of the table. I could tell that she was not going to let me near her willingly. We have a device that we can use for our children as they get their intramuscular (IM) shots. It is called Buzzy Bee. We strap it on above or below the injection site. It has an ice pack that is attached to it. Once it is strapped on the patient, you flip a switch and it begins to vibrate. This not only distracts the patient, but it also is designed to distract the pain away from the injection site by stimulating the nerve endings around it. I suggested that we try Buzzy Bee. She seemed uneasy but she allowed me to place it right below the point of injection. We also used the “magic spray” that we have in our office. I asked a medical assistant to come in with me and together we were able to distract the patient and make her comfortable enough to let us give her the Lupron shot. Afterward, she was surprised at how easy it was. She stated, “That wasn’t so bad, it still hurt a little, but it wasn’t that bad.” At Central Ohio Pediatric Endocrinology and Diabetes Services (COPEDS), we have really tried to help our children not be scared of the procedure that they are about to have. We do whatever we can to make them as comfortable as possible. Giving them a sense of security helps so much. Using magic spray, Buzzy Bee and/or distraction techniques has been so very helpful. I enjoy being able to take away some of the stress and anxiety these kids have to deal with at each visit. I love our office and the kids we see. I love being able to help these children overcome their fears. I can see myself here for quite a while. Kelly Spicer

As I got the needle out, he asked his mom to press the blink fast button. We used the magic spray and before he knew it, we were done. No more crying.

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Issue One ď&#x201A;Ž 2014